The accuracy of five tests for the diagnosis of gastroesophageal reflux in children was performed in 93 symptomatic children with gastroesophageal reflux and 16 nonreflux patients. These tests include the barium esophagram, the Tuttle test, extended esophageal pH monitoring, esophagoscopy, and esophageal biopsy. Esophagoscopy was less sensitive in detecting reflux in patients than any other test (P = less than 0.001), and biopsy was more likely to identify reflux patients than the barium swallow (P = less than 0.02), but there was no test superior to others. The severity of esophagitis noted at endoscopy or the presence of eosinophils or neutrophils in the mucosa was not associated with a decreased possibility that one other test would be normal or that surgical repair of the reflux would be performed. Patients with extended esophageal pH test scores markedly elevated were less likely to have another negative test (P = less than 0.01) and more likely to have surgical repair of gastroesophageal reflux (P = less than 0.001). Obtaining two tests of esophageal function that agree increases the certainty of diagnosis, and use of several tests are indicated if the results of a single test do not support the clinical impression.

Adolescent↗

PubMed1982

Bone mineral status of lactating mothers of different ages.

To determine the effect of age on the bone mineralization of lactating mothers, 48 healthy mothers were evaluated at 2 and 16 weeks post partum. All mothers were divided into three age groups: less than or equal to 18 years, 19 to 30 years, and greater than 31 years old. At 2 and 16 weeks post partum, blood was drawn for measurement of serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D. Bone mineral content was measured by photon absorptiometry. Dietary history was also recorded. At both 2 and 16 weeks, there were no differences in the serum values or bone mineral content among the three age groups. However, there was a decrease in the bone mineral content between the 2 and 16 weeks' values in the less than or equal to 18 years age group, 1.049 +/- 0.088 versus 0.895 +/- 0.051 gm/cm (p less than 0.05). Dietary intakes were similar among the three groups, but only one of seven mothers less than or equal to 18 years of age met the recommended dietary allowance for calcium or phosphorus, as compared to six of seven older mothers who met the recommended dietary allowance for calcium or phosphorus (p less than 0.01). We conclude that young lactating mothers less than or equal to 18 years old at risk for bone demineralization because of low dietary intakes of calcium or phosphorus.

Adolescent↗

PubMed1982

Growth and bone mineralization of normal breast-fed infants and the effects of lactation on maternal bone mineral status.

To determine if human milk provides for adequate growth and bone mineralization during the lst yr of life, 91 term infants were evaluated. Infants were divided into three groups human milk alone, human milk with supplemental vitamin D, and Similac. Lactating mothers who were receiving supplements of calcium and vitamin D were also studied to determine the effects of lactation on their bone mineral status. Blood was drawn from infants and mothers for measurements of serum calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D. Bone mineral content was measured by photon absorptiometry. Growth was similar between breast-fed and formula-fed infants. Regardless of type of feeding, male infants grew heavier and longer than corresponding female infants. Serum calcium and phosphate levels were similar among the three infant groups: only 25-hydroxyvitamin D levels at 4 months and serum alkaline phosphatase at 2 wk and 6 months of age were different among the three infant groups. Biochemical and vitamin D values were similar among the lactating mothers. There were no differences in infant bone mineral content among the three groups, but male infants had higher bone mineral content than female infants. There were no effects of the duration of lactation of maternal bone mineral content or vitamin D status.

Aging↗

PubMed1981

Adequate bone mineralization in breast-fed infants.

To determine if human milk provides sufficient nutrients for adequate bone mineralization in healthy term infants, 76 term Caucasian infants were evaluated at 2 and 16 weeks of age. The infants and their mothers were divided according to the infant's diet into three groups: human milk alone, human milk with supplemental vitamin D, and Similac. At 2 and 16 weeks of age, bone mineral content was measured by photon absorptiometry and blood was drawn for measurement of serum calcium, phosphate, alkaline phosphatase, and 25-OH vitamin D. At both 2 and 16 weeks of age, BMC was similar among all three feeding groups. At 16 weeks of age there was no difference in serum total Ca, ionized Ca, P, or alkaline phosphatase values. At 16 weeks of age the serum 25-OH D concentration was lower in the infants fed human milk alone (P less than 0.05), but was within the normal adult range. Maternal BMC and serum 25-OH D values are similar among the three groups. No seasonal effect on BMC was observed. Our data suggest that during the first 16 weeks of life, routine vitamin D supplementation for breast-fed term Caucasian infants may not be necessary.

25-Hydroxyvitamin D 2↗

PubMed1980

Patterns of gastroesophageal reflux in children following repair of esophageal atresia and distal tracheoesophageal fistula.

We studied gastroesophageal reflux (GER) in 25 children between 3 and 83 mo post-repair of esophageal atresia and distal tracheoesophageal fistula (EATEF). The incidence of GER was determined by 18-24 hr pH monitoring of the distal esophagus and gastroesophageal scintiscan following the ingestion of 99mTc sulfur colloid in apple juice. Gastric emptying was also assessed in 20 children. Only 17 of 25 (68%) children had significant GER by esophageal pH monitoring, and 13 of 20 (65%) had significant GER by gastroesophageal scintiscan. Significant GER was found in 10 of 12 (83%) patients wih recurrent vomiting, respiratory symptoms or severe esophagitis. Three of these 10 patients required an operation to control GER. Significant GER occurred in continuous, discontinuous and mixed patterns. The discontinuous pattern was seen in 11 of 17 (65%) children, and was associated with slow gastric emptying. The only factor during the repair of EATEF that subsequently was associated with a higher incidence of significant GER (88% vs. 59%) and slow gastric emptying (11.2 +/- 4.2% vs. 25.9 +/- 3.7% gastric emptying at 30 min, p less than 0.05) was excessive tension at the esophageal anastomosis. Many children with EATEF do not have significant GER, but in those with significant GER slow gastric emptying seems to be important.

Esophageal Atresia↗

PubMed1979

A simple method for the rapid separation of replete ixodid females from their eggs.

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Animals↗

PubMed1978

The role of anti-acetylcholine receptor antibody in neonatal myasthenia gravis.

An opportunity to investigate the role of anti-acetylcholine receptor antibody (anti-AcH R-antibody) in neonatal myasthenia gravis was presented when an infant was born to a symptomatic myasthenic mother who elected to breast feed the child. Pyridostigmine bromide determinations in plasma and breast milk were made by quantitative gas liquid chromatography. Anti-AcH R-antibody was assayed by an immunoprecipitation method. Simultaneous maternal blood and milk samples did not suggest concentration of pyridostigmine bromide in milk or significant transfer of medication through demand breast feeding. Weakness was not noted in the neonate in spite of high levels of anti-AcH R-antibody demonstrated in her blood. Presence of a markedly elevated anti-AcH R-antibody in a pregnant patient symptomatic with myasthenia gravis does not necessarily predict a clinically affected offspring, nor does the elevated antibody in the infant, presumably acquired transplacentally, necessarily result in clinical symptomatology in the newborn period.

Acetylcholine↗

PubMedDate not supplied

Eating and drinking in labor. A literature review.

This literature review questions the routine practice of denying food and fluids to women in labor. Fasting in labor, an established practice throughout the United States since the 1940s, is now under careful scrutiny. Many clinical practices, especially those that offer midwifery services, are currently instituting policies to allow and encourage eating and drinking in normal labor. To date, there have been no reported rises in maternal mortality with this policy change; neither have there been any reports of detrimental outcomes for mother or infant.

Anesthesia, Conduction↗

PubMedDate not supplied

Skin microvascular architecture and perfusion studied in human postmastectomy oedema by intravital video-capillaroscopy.

Breast cancer treatment often causes chronic arm oedema. Oedema depends on the balance between microvascular filtration and lymph drainage, but little is known about the microvessels in postmastectomy oedema (PMO). We investigated cutaneous capillary density in PMO, since capillary density is one of the factors influencing fluid load on the lymphatic system. Video-capillaroscopy allows the skin microcirculation to be examined in vivo and recorded for later analysis. Patient arm volumes, measured optoelectronically, increased by 30 +/- 13%. The forearm skin of each arm was examined in 7 normal subjects (mean age 22 years) and 15 PMO patients (mean age 61 years). Native capillaroscopy was found to underestimate capillary density. Venous congestion increased the number of capillaries detected by native capillaroscopy by 26-28%. Fluorescein detected 19-27% more capillaries than native capillaroscopy. Using fluorescein, no significant difference in mean capillary density was found between the right (50 mm-2) and left (48 mm-2) arms of normal subjects (p = 0.53). Surprisingly, cutaneous capillary density in the swollen arm (33 mm-2) was not significantly less than in nonswollen arms (35 mm-2) of patients, despite a mean 14% increase in skin area. Capillary density decreased significantly with age. Relative to the volume and area changes, the density results indicated that cutaneous neovascularization had occurred in the swollen arm.

Adult↗

PubMedDate not supplied

Glucose response to discontinuation of parenteral nutrition in patients less than 3 years of age.

BACKGROUND: The effects of abrupt discontinuation and tapering of total parenteral nutrition (TPN) on glucose concentration were compared in patients < 3 years of age. METHODS: Serial glucose concentrations were measured over 120 minutes after abrupt discontinuation as compared with tapering (decreasing infusion rate by 50% for 1 hour before discontinuation). Serial insulin concentrations were measured after abrupt discontinuation. RESULTS: There was a significantly greater decrease in glucose concentration from baseline at 30 minutes after abrupt discontinuation as compared with tapering. Fifty-five percent (6/11) of the patients developed hypoglycemia (glucose concentration < 40 mg/dL) after abrupt discontinuation. Age, glucose infusion rate, and serum insulin concentrations were not predictive of the development of hypoglycemia. The tapering regimen did not prevent hypoglycemia, which developed in 20% (2/10). CONCLUSION: The high incidence of hypoglycemia after TPN discontinuation in children < 3 years of age requires monitoring of serum glucose concentration when initiating intermittent TPN until tolerance is documented.

Blood Glucose↗

PubMedDate not supplied

Core responsibilities of board trustees.

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Community Health Planning↗