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Biomedical subjects

I W Booth

Publications and source records attributed to I W Booth.

At least 73 records · Page 4Linked to original sources
PubMed1994

The clinical value of solid marker transit studies in childhood constipation and soiling.

Assessment of constipation in childhood is difficult, particularly when the presenting symptom is spurious diarrhoea or faecal incontinence. We have therefore assessed the clinical usefulness, reliability and acceptability of a solid marker transit technique in 52 patients with constipation (median age 8.0 years; range 2-13.5 years) at two referral centres. Median duration of symptoms was 60 months. Soiling was a prominent feature in 43 children (83%). Ten, 3 mm pieces of 6FG radio-opaque Silastic tubing were given orally at 9am on days 1, 2 and 3 and a plain abdominal film taken on day 5. Laxative treatment was not interrupted. Each film was divided into right colon, left colon and rectosigmoid areas, using bony landmarks, and the marker content of each area counted. The coefficient of variation of intra and inter-observer errors was 3.1% and 2.1% respectively. By day 5, 7% (group median) of markers were still in the right colon, 17% in the left colon and 42% in the rectosigmoid. Twenty-one patients (40%) had normal transit, 4 (8%) mild delay, 9 (17%) moderate and 18 (35%) severe transit delay. Marker distribution indicated slow pan-colonic transit in 29% and slow segmental transit in 10%. In 21%, clustering of markers in the rectosigmoid suggested outlet obstruction. A significant correlation was found between both transit delay and marker distribution and the severity of clinical symptoms of constipation and soiling. Repeat studies in six children following colonic evacuation revealed significant improvement (P < 0.05) in marker transit.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Intestinal microvillous dystrophy: a variant of microvillous inclusion disease or a new entity?

We report three patients with intestinal microvillous dystrophy, two of whom were siblings. The relatively delayed clinical presentation and the lack of classical microvillous inclusions distinguish these cases from the previously described microvillous inclusion disease (MVID). There appears to be an underrecognized spectrum of microvillous disorders leading to fatal intractable secretory diarrhea in infants. In our three cases the diagnosis was suggested by periodic acid-Schiff (PAS) and alkaline phosphatase preparations of a jejunal biopsy specimen showing thinning or absence of brush border staining, which was confirmed by electron microscopy. The latter showed poorly developed and haphazardly arranged microvilli with intracytoplasmic vesicular bodies but no true inclusions. As in MVID, the prognosis of intestinal microvillous dystrophy is poor. The occurrence of the disease in two siblings of consanguinous parents suggests an autosomal recessive inheritance, and like MVID, genetic counselling of affected families is essential.

Female↗
PubMed1994

Munchausen syndrome by proxy unmasked by nasal signs.

The protean manifestations of child abuse continue to cause diagnostic difficulty. Recent observations of the high mortality in victims of Munchausen syndrome by proxy, and their siblings, reinforce the need for early diagnosis and appropriate intervention. We report the nasal manifestations which unmasked Munchausen syndrome by proxy in an infant who presented with intestinal and peri-orifical signs masquerading as Crohn's disease. The possibility of Munchausen syndrome by proxy should be considered in an infant with persistent nasal excoriation presenting as part of an undiagnosed illness.

Adult↗
PubMed1994

Feeding problems in young PKU children.

Behavioural feeding problems were found to be more prevalent in a group of 15 PKU children aged 1-5 years when compared to non-PKU controls. The parents of PKU children identified poorer apatites (p < 0.01), a more limited range of foods consumed (p < 0.03) and more gastrointestinal symptoms such as vomiting and constipation (p < 0.03) than control children. The children were slower to feed (p < 0.03), were more likely to dislike sweet foods and some ate separately from the rest of the family at mealtime (p < 0.03). The effects on normal feeding behaviour should be considered when advocating strict diet therapy for young PKU children.

Case-Control Studies↗
PubMed1994

Bacterial contamination of enteral feeds.

Enteral nutrition is increasingly used to provide nutritional support for children in hospital and at home. No suitable formula is available for preschool children, however, and until recently a modular feed has been prepared. The hypotheses were examined that the use of a modular feed is associated with increased bacterial contamination, and that contamination is more common in the home than in hospital. Thirty five children receiving enteral nutrition initially in hospital and subsequently at home were allocated randomly to receive either a modular feed or a newly available sterile ready to use paediatric feed. Samples of feed were taken from the nutrient container immediately after filling and at the end of feeding. The results show that feed contamination is common in hospital and at home, but significantly more so at home. The data indicate the importance of hygiene training for parents and the desirability of a ready to use formula.

Bacteria↗
PubMed1994

Siblings with microvillous inclusion disease.

Two male siblings from a consanguinous Pakistani family had fatal diarrhoea with an onset at 24 and 48 hours after birth. A diagnosis of microvillous inclusion disease (MVID) was established by showing characteristic light and electron microscopic features in the small intestinal biopsy specimen on day 6 of life in case 1. The typical abnormalities of MVID were also demonstrated retrospectively in case 2 by examining archival appendicular tissue from 10 years previously. These cases are consistent with an autosomal recessive inheritance for MVID. Retrospective diagnosis of MVID is possible by examining appropriate archival material, which may aid genetic counselling and future research.

Appendix↗
PubMed1994

Gastric emptying in preterm infants.

An ultrasonic technique was used to compare gastric emptying after a feed of expressed breast milk and formula milk in a blind, cross over study of preterm infants. Fourteen infants (median gestational age 33 weeks) were studied on 46 occasions. Each infant received a nasogastric feed of either expressed breast milk or formula milk, and the alternative at the next feed. Real time ultrasound images of the gastric antrum were obtained and measurements of antral cross sectional area (ACSA) were made before the feed and then sequentially after its completion until the ACSA returned to its prefeed value. The half emptying time (50% delta ACSA) was calculated as the time taken for the ACSA to decrease to half the maximum increment. On average, expressed breast milk emptied twice as fast as formula milk: mean 50% delta ACSA expressed breast milk 36 minutes; formula milk 72 minutes. The technique was reproducible and there was no significant difference between the emptying rates of feeds of the same type for an individual infant. These data show that breast milk has a major effect on gastric emptying, which may have important implications for preterm infants who have a feed intolerance due to delayed gastric emptying.

Animals↗
PubMed1994

Erythromycin in neonatal postoperative intestinal dysmotility.

The motilin agonist erythromycin was used successfully in four infants receiving prolonged parenteral nutrition for severe intestinal dysmotility after gastrointestinal surgery. In a further child with a neuropathic intestinal pseudo-obstruction erythromycin induced a striking small intestinal manometric response, but was without effect in a child with an intestinal myopathy.

Erythromycin↗
PubMed1994

Enteral nutrition as primary therapy in short bowel syndrome.

The spectacular success of parenteral nutrition in supporting patients during small intestinal adaptation after massive resection, tends to obscure the prolonged periods often needed for such adaptation to take place. After neonatal small intestinal resection for example, it may take more than five years before adaptation is complete. There is therefore a strong argument for examining ways in which adaptation can be facilitated, in particular, by the addition of novel substrates to enteral feeds. Pectin is completely fermented by colonic bacteria to short chain fatty acids. In the rat, addition of pectin to enteral feeds led to a more rapid adaptive response in both the small and large intestine after massive small intestinal resection, although faecal nitrogen losses were increased. In a similar rat model, the provision of 40% of non-protein energy as short chain triglycerides facilitated the adaptive response in the jejunum, colon, and pancreas. The importance of glutamine as a metabolic substrate for the small intestine makes it another potential candidate and some, but not all animal studies, have suggested a therapeutic effect: increasing the glutamine content of feeds to 25% of total amino acids produced enhanced jejunal and ileal hyperplasia, even on a hypocaloric feed, and an improved overall weight gain. Studies in humans are very limited, but such promising results in the experimental animal suggest that this is probably a fruitful area for further study.

Acidosis↗
PubMed1994

Psychiatric presentation of Crohn's disease. Diagnostic delay and increased morbidity.

Four children presented to child psychiatric clinics with a variety of symptoms. They were all later recognised as having Crohn's disease. There was a significant delay between the onset of symptoms and diagnosis, compared with a control group of patients with Crohn's disease whose presentation was with predominantly gastrointestinal symptoms, which was associated with evidence of increased morbidity. Children with abdominal and psychiatric symptoms occurring in combination need serial assessments of physical status, including height and weight, and measurements of inflammatory and nutritional status.

Adolescent↗
PubMed1994

Diarrhoea and growth faltering in rural Zimbabwe.

OBJECTIVE: To assess the evidence that diarrhoea is an important cause of growth faltering in young children in developing countries. DESIGN: Prospective, longitudinal cohort study. SETTING: Worker's compounds on commercial farms in Shamva, rural Zimbabwe. SUBJECTS: 204 children < 12 months old were enrolled, 73 from birth. The median age at enrolment was 4 months. Eleven children died and 39 were lost to follow-up. INTERVENTIONS: Prospective weekly diarrhoea surveillance by farm health workers and monthly anthropometry. RESULTS: Growth faltering was severe, but there was little difference in average rates of growth between children with frequent diarrhoea and infrequent diarrhoea. The results of an interval-based data analysis were consistent with there being only a transient effect of diarrhoea on weight gain. Estimation of weight faltering following episodes of diarrhoea and the rate of return to the trend in the 9-14 month age range, indicated that weight loss associated with each episode was small (approximately 2%) and return to the child's trend was 90% complete within a month. At older ages than this, weight loss appeared to be less, and estimates were not statistically significant. CONCLUSIONS: These observations lend weight to the hypothesis that recurrent episodes of diarrhoea are not a potent cause of growth faltering in early childhood except in a small minority of largely catastrophic cases. Inadequate food intake is a more plausible explanation.

Anthropometry↗
PubMed1993

Biochemical stability during parenteral nutrition in children.

The aim of this study was to assess the frequency and importance of biochemical abnormality related to parenteral nutrition (PN) in a group of infants, and to devise an appropriate policy for routine biochemical surveillance. A standard monitoring protocol based on widely published guidelines was applied to 30 consecutive patients (age 3 days-3 years) referred to a children's hospital nutritional care team for PN. No serious biochemical abnormalities were observed to arise simply as a consequence of PN. Electrolyte disturbance most commonly occurred before starting PN. Biochemical abnormality was most likely to be found in patients with abnormal fluid and electrolyte losses. Protocols for biochemical surveillance during PN err on the side of caution and often suggest frequent and comprehensive testing. In stable patients such as the surgical newborn, this is both expensive and unnecessary, and simpler monitoring regimes may be used with safety.

Journal Article↗
PubMed1993

Epigastric impedance recording for measuring gastric emptying in children: how useful is it?

Epigastric impedance recording was used to measure gastric half-emptying time (t1/2) of orange squash in 45 healthy infants and children. The relationship between age, body size, and composition and the impedance increase after gastric filling was investigated, together with the effects on half-emptying time of adding fat, increasing viscosity, and increasing osmolality in the test meal. The mean t1/2 for orange squash was 13.5 min. The increase in impedence per unit volume ingested showed a significant inverse relationship with age (r = -0.62, p < 0.001), and with various anthropometric variables (r ranged from -0.48 to -0.80, p < 0.01). No relationship was observed between t1/2 and age, sex, body size, or composition. Addition of 1.25% triglyceride or a 600-fold increase in viscosity of the test meal were both accompanied by a significant lengthening of t1/2 (p = 0.005 and p < 0.001, respectively), but t1/2 did not alter with a fourfold increase in test meal osmolality. The test was well tolerated by all subjects, but its usefulness is limited by susceptibility to movement artefact, and also the necessity to use simple, liquid test meals.

Adolescent↗
PubMed1993

New method for determining faecal fat excretion in infancy.

Collecting complete, timed stool samples for the estimation of faecal fat from infants wearing nappies is difficult. A gravimetric method has been adapted by applying a chloroform/methanol homophasic solvent system to extract lipids from whole soiled nappies. In a study of 22 collections in six infants, no stools were lost and the recovery of lipids was 96%, with results similar to a reference titrimetric method. In addition to total fat, individual lipids were measured using gas-liquid chromatography. The method simplifies stool collection and analysis, is aesthetically more acceptable, and leads to reduced microbial hazards. It also allows the detailed study of excreted lipid species enabling the coefficient of absorption of dietary lipids of various chain lengths to be determined individually.

Chemistry, Clinical↗