Outpatient paediatric fibreoptic proctosigmoidoscopy: possible and useful.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to H Nazer.
Explore the source record for details and available documents.
Ethanol has important effects on the alimentary tract. Nearly every study in the literature documents some aberration of absorption or metabolism of multiple vital nutrients. Malnutrition related to both poor dietary intake and malabsorption plays an important role in the clinical problems of chronic alcoholics. From a clinical viewpoint, the assessment of nutritional status by standard techniques, including serum assays for vitamins and trace elements may add to the ability to treat the alcoholic for potentially detrimental disorders. Malabsorption of ingested nutrients is common, despite the lack of salient physical findings. Therefore, parenteral administration of nutrients may be advisable, pending the reversal of the exocrine and intestinal mucosal defect. Increasing awareness of such deficiencies may lead to their earlier recognition, appropriate therapy, and prevention of further complications.
Although Wilson's Disease is a treatable disorder, 9 of 15 cases referred with undiagnosed liver disease in the present series died in 3 to 53 days of admission. We have reviewed these cases to identify features that would allow earlier diagnosis and improvement in management. The presenting symptoms were lethargy and malaise (11 cases), jaundice (11), abdominal pain (9), and deteriorating school performance (4). At diagnosis, all fatal cases had jaundice and ascites, while only one of the 6 survivors had ascites and two had jaundice. Evidence of hemolysis was found in 3 fatal cases and 5 survivors. Serum bilirubin concentrations, aspartate transaminase, and prolongation of prothrombin time were significantly more abnormal in the fatal cases (p less than 0.01) as compared with the survivors. Cirrhosis was present in all fatal cases and in 2 of the 6 survivors. Wilson's Disease must be excluded in children presenting with frank liver disease as well as those with hemolytic anemia, persisting lethargy, abdominal pain, or deteriorating school performance.
Patients with systemic amyloidosis often have symptoms related to impaired gastrointestinal motility. Delayed gastric emptying may result from autonomic nerve and/or smooth-muscle infiltration with amyloid. In two patients with gastroparesis secondary to amyloidosis, metoclopramide hydrochloride therapy quantitatively enhanced gastric emptying. We suggest that metoclopramide treatment may be useful in the supportive therapy of patients with delayed gastric emptying due to amyloidosis.
Gastrointestinal problems and, in particular, diarrhoeal illnesses are the commonest cause of morbidity and mortality among young children in Jordan. Children with diarrhea constitute about 20% of admissions to Jordan University Hospital (JUH). The aetiology of diarrhoea is multifactorial and bacterial pathogens are seldom isolated. Stool viruses have not been investigated. There is a steady fall in the prevalence of breast-feeding with a consequent increase in gastroenteritis, especially among the poor. The use of electrolyte solutions for oral rehydration therapy is encouraged, and the use of antibiotics in diarrhoeal illness is discouraged. The addition of sucrose instead of glucose to electrolyte solutions has also been adopted. Cow's milk protein intolerance, coeliac disease and chronic inflammatory bowel disease are rarely encountered. Hepatitis is common and is a major cause of morbidity among school children. Cystic fibrosis has been recognized in Jordan but is rare. JUH has been selected as the referral centre for cystic fibrosis in the Middle East.
Explore the source record for details and available documents.
From among 1,248 stool specimens examined during the 2-year period, February 1979 to February 1981, astrovirus was detected by electron microscopy in 42 specimens from 28 children. Diarrhoea was an invariable clinical feature; vomiting occurred in 18 children, abdominal pain in 7, and mild dehydration in 5. Fourteen of the children with acute diarrhoea were admitted directly to the gastroenteritis unit. The other 14 children developed their acute diarrhoea sometime after hospital admission. Although the excretion of astrovirus was associated with mild gastroenteritis, the presence of other enteric pathogens in 16 of the 28 children limited the degree to which the clinical symptoms could be attributed to astrovirus alone. Transient monosaccharide intolerance lasting 1 to 2 days occurred in 18 children, and cow's milk protein intolerance requiring milk elimination for several months was a sequel in 3 children.
Explore the source record for details and available documents.
Solid-phase extraction and group separation by anion exchange chromatography were combined with capillary column liquid chromatography-mass spectrometry (LC/MS) to permit a thorough characterization of bile acids and intact conjugates of bile alcohols in human urine. Groups of compounds were separated according to acid strength and were analysed on a capillary column, 0.25 x 500 mm, packed with 5 microns particles of Chromasil C18, and connected via a fused silica capillary to the continuous-flow fast atom bombardment (CF-FAB) or electrospray (ES) sources of an AutoSpec-TOFFPD hybrid mass spectrometer. Acetonitrile:water mixtures containing 30 mM ammonium acetate pH 7.2 were used as mobile phases, with 5% glycerol added for FAB Ionisation. Bile acids were analysed directly or after derivatization of carboxyl groups with 4-aminobenzenesulphonic acid. Negative-ion spectra (m/z 1000 or 800 to 300 or 100) were recorded using the point detector or, in the case of ES ionization, the focal plane array detector (FPD). Deprotonated molecules of bile acids containing a sulphonic acid group were detected with a spectral signal to noise ratio of 5:1 when about 90 fmol were injected onto the column of the LC/CF-FAB system. The corresponding peak in the reconstructed ion chromatogram gave a signal-to-noise ratio of about 25:1. The sensitivity could be increased 20-50 times by using ES ionization and the FPD. Bile acids without a sulphonic acid group gave about 70% of the signal of sulphonic acids using ES ionization. The capillary column LC/MS systems were evaluated by analyses of urine from an infant with cholestatic liver disease. More than 150 different bile acids and bile alcohol conjugates were detected, some of which were partially characterized using collision induced dissociation (CID) of the deprotonated molecules and B/E linked scans. A number of compounds were detected for the first time, e.g. di-, tri-, and tetra-hydroxycholestanoic acids conjugated with N-acetylhexosamine and cholestenediol, cholestenetriol and cholestanetriol doubly conjugated with sulphuric acid and glucuronic acid. The relative merits of ES and FAB ionization are discussed.
A case of calcification of the umbilical vein in a premature infant with nephrocalcinosis and cholelithiasis is described. Such an association might have resulted from prematurity, bronchopulmonary dysplasia, umbilical vein catheterization, total parenteral nutrition, and furosemide therapy. Follow-up ultrasound examination at 9 months of age revealed spontaneous resolution of calcification of both the gallbladder and the umbilical vein but not of the kidneys.
Aeromonas sobria was identified from soil and canal water at the East End of London. There was a correlation between water and faecal isolates from children attending the nearby Children's Hospital. In view of the potential risk of enteric and non-enteric infections due to Aeromonas spp, efforts are needed to ensure that canals, rivers, natural water sources and domestic water supply are free of these organisms.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Immunosuppressive regimens are usually required for patients receiving organ transplants. The development of a post-transplant lymphoproliferative disorder is an infrequent complication of such therapy. FK 506 is a new immunosuppressant agent that has recently been used in patients receiving organ transplantation. This report describes a 20 month old Saudi child who developed post-transplant lymphoproliferative disorder while receiving FK 506 following liver transplantation. Such a complication has been recognized with cyclosporine but has not been well addressed as yet with FK 506. The child also developed progressive renal complications. There was also a difficulty in interpreting the results for IgM antibodies to different viruses. The overall features of progressive renal toxicity and those of lymphadenopathy, hepatosplenomegaly, fever, neutropenia and thrombocytopenia reversed following discontinuation of FK 506 therapy. It is concluded that all the above complications, though reversible, may well be linked to the new immunosuppressant agent FK 506.
Explore the source record for details and available documents.
This study was designed to test whether three sequential stool specimens are necessary for reliable detection of intestinal parasites in routine laboratory examinations. There were 175 patients in whom a single species of intestinal parasite or ova was identified on at least one occasion when three stool specimens were examined over a period of 14 days from the first recorded specimen. Examination of a first stool specimen detected parasites and/or ova in 102/175 patients (58.3%); examination of a second specimen identified an additional 36 positive patients (20.6%) and examination of a third specimen yielded a final 37 previously undetected patients (21.1%). These findings indicate that at least three stool specimens should be examined to confirm the presence of intestinal parasites. Even with such practice, it is not possible to guarantee that there is no infestation, but examination of fewer specimens would run a definite risk of false negative results.