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Biomedical subjects

I W Booth

Publications and source records attributed to I W Booth.

At least 109 records · Page 6Linked to original sources
PubMed1991

Malnutrition at diagnosis of malignancy in childhood: common but mostly missed.

A prospective, controlled study of nutritional status in 100 newly diagnosed paediatric oncology patients is reported. Results showed that although patients' height-for-age and weight-for-height were normal, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSFT) were significantly less than reference and control values. Moreover, 20% of patients had MUAC below the 5th percentile (P less than 0.001) and 23% had TSFT more than 2 SD below the mean (P less than 0.001). The discrepancy between these assessments is attributed to the effect of large tumour masses masking diminished true body weight. Children with intra-abdominal solid tumours had significantly lower MUAC and TSFT than those with either extra-abdominal solid tumours or leukaemia, and were more likely to be malnourished based on arm anthropometric criteria. Of all subjects, 44% were consuming less than 80% of their recommended daily allowance of energy at diagnosis, compared with 0% of controls (P = 0.001).

Adolescent↗
PubMed1991

Intestinal malrotation: the role of small intestinal dysmotility in the cause of persistent symptoms.

To investigate the possibility that small intestinal dysmotility is a cause of long-standing and persistent symptoms in patients with malrotation, we retrospectively reviewed 94 patients operated on for intestinal malrotation. In 50 patients operated on during the neonatal period, associated abnormalities were common (24%) and all presented with obstructive symptoms; only three (6%) had continuing mild symptoms the postneonatal period (aged 1 month to 1 year), five of whom (22%) had other abnormalities. Recurrent vomiting was the most common presentation (11/23); only 5 patients (21%) had acute obstruction. Response to operation was good in 18 (78%) and two had persistant symptoms; both died. Twenty-one patients presented beyond infancy (aged greater than 1 year), only 19 of whom had symptoms of less than 2 months' duration. Eight (47%) of those with long-standing symptoms had no relief from operation. Small bowel motility was recorded manometrically in 4 patients with long-standing symptoms. The findings suggest that small intestinal dysmotility may be common in patients with malrotation and persistant symptoms.

Adolescent↗
PubMed1991

Recurrent and persistent diarrhoea in a rural Zimbabwean community: a prospective study.

Prospective surveillance of patterns of diarrhoeal disease was conducted in a cohort of 204 young children living in a rural community in Zimbabwe. Trained field assistants recorded morbidity data obtained by weekly recall of mothers. Diarrhoea was defined by a commonly used local word, and a diarrhoea-free gap of three or more days was taken to signify a new attack. Diarrhoea was common in this study population with a peak incidence between 6 and 18 months of age. There was, however, wide individual variability in diarrhoea attack rates (range 0 to 20 attacks) during the 22 month study period. Whilst only 6 per cent of the recorded diarrhoea episodes were persistent (lasting longer than 14 days), a high proportion (26 per cent) of subjects had at least one attack of persistent diarrhoea (PD) during follow up. Children who had frequent attacks of acute diarrhoea also tended to have PD; PD was rare in those with few attacks. Thus, within this uniformly deprived African community, there were individuals who had a much higher susceptibility to diarrhoea compared to others. An understanding of this variability may point the way towards more effective interventions in the control of diarrhoeal disease.

Child, Preschool↗
PubMed1991

Hypereosinophilic syndrome in childhood appearing as inflammatory bowel disease.

A 7-year-old girl with hypereosinophilic syndrome is described, the first such patient to present with inflammatory bowel disease. Hepatosplenomegaly, anaemia, and hypergammaglobulinaemia were also prominent features. Colonoscopy revealed a frank colitis of nonspecific histologic appearance. An elemental diet was unhelpful, but there was a prompt clinical and partial haematological response to systemic steroids. She has remained well receiving a small maintenance dose of prednisolone for 3 years.

Child↗
PubMed1991

The adaptive response of rectal electrolyte absorption to impaired sodium balance in young children.

Rectal electrolyte transport was measured in nine children (median age 160 days) with ileostomies, using a nonequilibrium dialysis technique. Rectal sodium absorption and potassium secretion were significantly higher in children with a subnormal sodium balance compared with children with a positive sodium balance. Rectal sodium absorption and potassium secretion were unchanged after ileostomy closure. These data indicate that rectal electrolyte transport in children can adapt to even modestly impaired sodium balance.

Child, Preschool↗
PubMed1991

Atypical allergic colitis in preterm infants.

Two atypical cases of colitis due to cow's milk protein intolerance (CMPI) are reported, affecting preterm infants. One developed a toxic dilatation of the colon and responded well to a casein hydrolysate based feed. The second presented insidiously and failed to tolerate a casein hydrolysate, but responded well to a chicken-based modular feed.

Acute Disease↗
PubMed1991

The nutritional consequences of gastrointestinal disease in adolescence.

The growth spurt of adolescence, during which body weight nearly doubles and height increases by 16%, demands an increased delivery of nutrients by the gastrointestinal tract. Chronic disorders of digestion and absorption at this age, therefore have a potentially profound effect upon growth, skeletal maturation and sexual development. Moreover, the emotional climate of adolescence, which requires affiliation with peer groups, and a distancing from authority figures such as doctors and parents, is often associated with a deterioration in drug and dietary compliance and with erratic clinic attendance. Nutritional problems in adolescent patients with Crohn's disease, cystic fibrosis and coeliac disease are the most common. About one third of adolescents with Crohn's disease experience growth failure and delayed sexual development, probably as a consequence of long-term undernutrition. There is a strong argument for the care of these patients being in the hands of paediatric gastroenterologists. Enteral nutrition, often administered overnight, is successful in inducing catch-up growth, and reducing steroid dosage, although resection of diseased gut is often followed by good growth, and surgery should not be overlooked. Cystic fibrosis in adolescence is commonly complicated by protein-energy malnutrition. Pathogenesis includes anorexia, maldigestion and an increase in resting energy expenditure. Malnutrition has been treated by a number of enteral regimens. In general, there is no place for repeated, short-term interventions of less than 6 months. Long-term studies have all shown good nutritional repletion and growth, but results with respect to improved respiratory function are conflicting. More prospective control trials are needed before the precise indications for enteral nutrition in cystic fibrosis can be accurately defined. Once started it is difficult to stop, although preoperative treatment of patients awaiting heart-lung transplantation seems entirely appropriate. The major problem in the management of coeliac disease in adolescence is dietary compliance. Even those patients who claim to have good dietary compliance often have jejunal biopsy evidence of gluten ingestion and tend to be underweight. This is particularly worrying, as after 5 years adherence to a gluten free diet, the increased risk of gastrointestinal malignancy appears to return to normal.

Adolescent↗
PubMed1991

Nasogastric feeding at home: acceptability and safety.

A questionnaire was administered to 70 families with experience of home enteral nutrition. All but one patient received at least some of their feeding overnight. During 11,041 patient days of home enteral nutrition, no serious complications were seen. Sleep disturbance was common, however, and affected 59 parents and 35 children. A nocturnal cough or 'chestiness' were noted in 10 children suggesting occult gastro-oesophageal reflux. Enteral feeding disposables were not prescribable by general practitioners, and funding for the equipment was inadequate in the hospital and community. The mean time to arrange funding for equipment was eight months (range two weeks to two years). Parental views on home enteral nutrition were positive and none felt that its disadvantages outweighed the benefits. Altogether 35 children were described as being more happy and active. Given adequate preparation and continued support at home, parents can manage home enteral nutrition safely and effectively.

Adolescent↗
PubMed1991

Staff training: a key factor in reducing intravascular catheter sepsis.

A children's hospital nutritional care team prospectively monitored the frequency of sepsis in central venous catheters used for administering parenteral nutrition. During an initial study period of 12 months, 26/58 (45%) of catheters were removed because of proved sepsis. The possible causes of this alarmingly high rate were examined, with catheter care techniques on the wards coming under particular scrutiny. As a result protocols were modified and an intensive staff training programme implemented throughout the hospital, led by the nutritional care sister. Subsequently, the catheter sepsis rate was significantly reduced with only 9/107 (8%) of consecutive catheters becoming infected. These findings emphasise the key role that education of staff plays in controlling central venous catheter sepsis and the importance and cost effectiveness of special nursing staff in implementing such measures.

Asepsis↗
PubMed1991

Early growth faltering in rural Zimbabwean children.

Longitudinal data on weight and height were collected during the first 30 months of life from children living in a deprived rural community in Zimbabwe. All were breast-fed for up to a mean of 21 months; maize porridge being introduced from three months onwards. During the first 6 months, growth was similar to, or even exceeded, that of the NCHS reference population. Thereafter, growth faltering was common. By the age of 30 months, there was a mean deficit in weight of 2,0 kg in girls and 2,3 kg in boys, and a mean deficit in height of 8 cm in boys and 9 cm in girls. No seasonal variation in growth pattern was found. The substantially better growth of more privileged children in Zimbabwe and elsewhere in Africa, would suggest that these children were failing to realise their full genetic potential for growth because of adverse environmental factors.

Body Height↗
PubMed1991

Enteral nutrition in childhood.

The frequency with which malnutrition may complicate chronic illness in children has been belatedly recognized, as has the role that nutritional support may play, either as primary treatment or in the management of disease- or treatment-related malnutrition. Consequently, enteral nutrition is increasingly used in the management of sick children.

Child↗
PubMed1990

The long-term sequelae of ileocolic anastomosis in childhood: a retrospective survey.

The long-term effects of ileocolic anastomosis in children are not known. We therefore carried out a survey of all such patients treated at our hospital between 1971 and 1985. Thirty-seven patients were identified and invited to attend for follow-up. Twenty-seven (73 per cent) were examined and included in the survey. Mean age at survey was 7.8 years (range 1.6-17.6 years) and mean duration since operation was 6.3 years. Necrotizing enterocolitis and intussusception were the commonest indications for operation. As judged by height, weight and skin fold thickness, all patients were well nourished. Seven (26 per cent) had loose stools, five had chronic folic acid deficiency and one was vitamin B12 deficient. We conclude that resection of the ileocaecal region is well tolerated in childhood and does not affect growth. Loose stools are directly related to the length of ileal resection.

Adolescent↗
PubMed1990

Eosinophilic proctitis with giant cells: a manifestation of cow's milk protein intolerance.

Two infants, subsequently shown to have cow's milk protein intolerance, presented with rectal bleeding in the first week of life. Rectal biopsies showed eosinophilic infiltration of the mucosa with several multinucleated giant cells. IgG, IgM, and IgA containing plasma cells were present but IgE could not be detected in rectal biopsies. While cow's milk protein intolerance is a well-recognized cause of proctocolitis in infancy, eosinophilic granulomatous-like lesions with giant cells may be a prominent feature and do not exclude the diagnosis.

Biopsy↗