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Biomedical subjects

H S Winter

Publications and source records attributed to H S Winter.

64 records · Page 4Linked to original sources

Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis.

Intraepithelial eosinophils in esophageal biopsy specimens were noted to be an indicator of prolonged acid reflux. The presence of even a few intraepithelial eosinophils correlated with abnormal acid clearance determined by overnight intraesophageal pH probe study. This new marker also appeared to be an early lesion, as evidence by its presence in children under age 2 yr, and in biopsy specimens from the proximal esophagus where traditional histometric features (basal zone thickening and papillary lengthening) were lacking. Furthermore, when intraepithelial eosinophils were seen in the proximal 75% of the esophagus, they served to identify more severe disease by correlation with greater abnormalities in the pH probe study. Although this new marker is a histologic indication of prolonged acid reflux and may be appreciated in routine endoscopic biopsy specimens in children, it has been observed in patients over 18 yr of age and may be applicable to the adult population.

Adolescent↗

An improved radionuclide method for the diagnosis of gastroesophageal reflux and aspiration in children (milk scan).

A radionuclide study using technetium-99m-labelled milk feeding is described for the detection of gastroesophageal reflux and aspiration in children. A comparison of findings in 39 patients referred for both radiographic and radionuclide studies showed that barium studies were positive in 25.6% and radionuclide studies in 59% of cases, reflecting the sensitivity of the radionuclide technique. This technique is also physiological and allows prolonged patient monitoring. It is simple to perform and should prove useful in the evaluation of patients suspected of having gastroesophageal reflux and aspiration.

Adolescent↗

Cellular (T cell) immunity in the human newborn.

The cellular immune system of the human newborn, like the rest of the immunologic apparatus, is anatomically intact, antigenically inexperienced, and functionally deficient. The latter is suggested by the newborns' enhanced susceptibility to infection, diminished delayed cutaneous hypersensitivity reactions, and selective abnormalities (when compared to adults) of measures of cellular immunity in vitro. These include impaired proliferative response to ubiquitous antigens, depressed lymphotoxin, migration inhibition factor, and immune interferon production, and diminished cytotoxic reactions including cell-mediated lympholysis. By contrast, other aspects of neonatal T cell function, such as to mitogens or allogeneic lymphocytes, natural interferon and leukocyte inhibition factor production, and number and percentage of E-rosette-forming cell are generally normal. These decreased functional properties may provide an explanation for the newborns' susceptibility to infection and for the occasional occurrence of engraftment of foreign cells from either the mother or from prenatal or neonatal blood transfusion.

Cytotoxicity, Immunologic↗

The return of Boston exanthem. Echovirus 16 infections in 1974.

Although the "Boston exanthem" has been seen rarely over the past 20 years, in the summer of 1974 we identified ten children, aged 1 week to 7 years with echovirus 16 infections. Seven of the children had rashes, and in four, the illness suggested roseola infantum. Five of these children were neonates, all with illnesses severe enough to mimic sepsis. In addition information obtained on echovirus 16 isolations occurring in 1974 elsewhere in the country showed an additional 27 isolations from eight states. It is postulated that more outbreaks of the Boston exanthem or other echovirus 16 illnesses will appear during the next several years, before the virus again "disappears".

Boston↗

Successful bone marrow transplantation against mixed lymphocyte culture barrier.

If bone marrow transplantation is to become widely applicable in the treatment of patients with leukemia and aplastic anemia, the necessity to have a perfectly histocompatible donor must be overcome. In an effort to define the roles of HL-A type and mixed lymphocyte culture (MLC) reactivity in the determination of successful engraftment and the occurrence of graftversus-host disease (GVHD), we have attempted transplantation of a child with acute myeloblastic leukemia (AML) using an HL-A identical, MLC-reactive sibling donor. Successful engraftment has been accomplished, as documented by the appearance of multiple donor genetic markers in the recipient. There is no evidence of severe GVHD. The recipient is alive, without evidence of leukemia, and has returned to full activities 9 mo after transplantation. The recipient now produces lymphocytes, which have the MLC reactivity that characterize the donor's lymphocytes, rather than that of her own pretransplant lymphocytes. This experience demonstrates that successful bone marrow transplantation in patients with leukemia can be accomplished in the face of MLC reactivity.

Adolescent↗

The use of nifedipine for the treatment of achalasia in children.

Four adolescents with achalasia were treated with nifedipine. All the patients' symptoms improved dramatically. On manometric evaluation, following oral nifedipine, the lower esophageal sphincter pressure decreased approximately 50%. No change in esophageal peristaltic activity was noted. Side effects were minimal; two patients had mild headache initially. Nifedipine, which is commonly used in adult patients with achalasia, may be beneficial for short-term symptomatic relief in children until more definitive therapy can be performed.

Adolescent↗

Pyloric stenosis and eosinophilic gastroenteritis in infants.

Eosinophilic gastroenteritis is known to cause gastric outlet obstruction in adults, but has been reported only rarely in infants presenting with pyloric stenosis, a common form of gastric outlet obstruction in children. We describe two infants who presented with classic clinical and radiographic evidence of pyloric stenosis and who were found to have histologic evidence of eosinophilic gastroenteritis on gastric antral biopsies. Their presentation is compared with the clinical and laboratory findings of 47 other infants with pyloric stenosis.

Dietary Proteins↗