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Biomedical subjects

L Heitlinger

Publications and source records attributed to L Heitlinger.

10 recordsLinked to original sources
PubMed2001

Reuse of negative CLOtest kits in children.

BACKGROUND: The rapid urease test, CLOtest, is used frequently in endoscopy suites. In the developed world, a negative CLOtest result is extremely common. The question of whether reuse of previously negative CLOtest kits is appropriate in children and the cost saving of such a practice were investigated. METHODS: Children who underwent diagnostic endoscopic procedures were prospectively recruited to the study. In each procedure gastric biopsy specimens were obtained for 2 rapid urease tests, one a new kit and the other a used negative kit obtained from previous procedures. In addition gastric specimens were also obtained for routine histologic examination. RESULTS: In 121 (99.2%) patients a complete concordance between new and used CLOtests was observed. Chi-square analyses showed a significant association between CLOtest results and each of the following factors: gastritis, the presence of Helicobacter pylori organisms, and H pylori-associated gastritis. Assuming an average rate of 15% positive CLOtest results in our pediatric population, the annual savings at the rural hospital was $265 and at the urban children's hospital, $1958. CONCLUSION: Reuse of a negative CLOtest is reliable and may reduce costs, especially in facilities with a high volume of endoscopic procedures.

Child↗
PubMed1995

Constipation and dietary fiber intake in children.

OBJECTIVE: Severe constipation in children is associated with rectal overdistension and insensitivity. Treatment typically involves three phases: disimpaction (days to weeks), laxative use (months), and a high-fiber diet (lifelong). The purpose of this survey is a discussion of therapies that recognize the unique problems that children with severe constipation have. METHODS: Four-day diet logs were obtained from children who had no history of chronic bowel disease. Their intake of dietary fiber was determined from the logs and was compared with the dietary fiber ingested by children who had chronic constipation. These data sets were compared in light of our current understanding of the need for dietary fiber. RESULTS: Approximately half of the children from families who were health conscious enough to request dietary evaluation still fell below the age + 5 guidelines for grams of dietary fiber intake per day. The children referred to use with chronic constipation had all been instructed "to eat a high-fiber diet." Those constipated patients were consuming less than one fourth of the recommended fiber intake. CONCLUSIONS: This survey underscored the difficulties in beginning and in maintaining high-fiber diets in children. When families receive advice to administer a high-fiber diet, they are unable to accomplish this unless they receive intensive and ongoing dietary counseling. Even among health-conscious families, only half of the children received the recommended amounts of dietary fiber. Further public education in this regard is warranted.

Cathartics↗
PubMed1990

Cisapride for intractable constipation in children: observations from an open trial.

Twelve patients with chronic constipation refractory to the vigorous use of emollients, enemas, and/or laxatives were chosen for study of the investigational prokinetic agent, Cisapride. The patients included 8 boys and 4 girls with diagnoses of functional constipation. Ages ranged from 2 to 13 years; duration of symptoms before Cisapride use ranged from 1.5 to 9.75 years; duration of previous treatment ranged from 0.75 to 6 years. The mean number of doses of anticonstipation agents employed per week was 14. Of the 12 patients, 10 had persistent encopresis, while 11 required hospitalization for disimpaction an average of 1.6 times in the year prior to Cisapride use. Three had chronic urinary tract complaints. Anal manometry suggested a sensory deficit in 8 of 10 patients tested. Ganglion cells were identified by rectal biopsy in all 12 patients. Cisapride treatment (0.14-0.3 mg/kg/dose) spanned 26-72 weeks (61 +/- 12). Stool frequency per week was not significantly changed, but five of seven patients who had reported hard stools had softer stools on the drug (p less than 0.05). Encopresis ceased in 8 of 10 cases, while the number of episodes decreased substantially in the other 2 cases (p less than 0.05). All alternate forms of anticonstipation therapy were withdrawn in 8 of 12 cases (p less than 0.001). Urinary problems improved in two of the three patients reporting symptoms. One patient showed no improvement in any parameter while on the agent, despite 26 weeks of administration. Side effects were infrequent, generally occurred early, and were limited to cramping, nausea, mild vomiting, anorexia, and headaches. One patient ceased use of the drug for persistent headaches.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Proximal small intestinal mucosal injury. Maintenance of glucose and glucose polymer absorption, attenuation of disaccharide absorption.

The effect of chronic intragastric infusion of hypertonic mannitol on small intestinal mucosal structure and function was studied in adult rats. Animals were gavage-fed 20% mannitol (1300 mosm) at a dose of 5 ml/100 g body weight daily for seven days. Control animals were gavage-fed tap water on the same schedule. On day 8, the animals were anesthetized, the duodenum cannulated, and a test sugar (glucose, glucose polymer, lactose, sucrose, or maltose) was infused at a dose of 0.5 g/kg body weight in 2.5 ml distilled water over less than 1 min. Portal vein glucose was measured at 30-min intervals from 0 to 120 min. Mannitol treatment resulted in histologic and biochemical alterations (reduced lactase, sucrase, maltase) limited to the proximal small intestine compared to the control group. The absorption of glucose and glucose polymers was similar in mannitol-treated and control animals. In contrast, digestion and absorption of lactose, sucrose, and maltose was significantly diminished in mannitol-treated animals when compared to controls. No changes in permeability to polyethylene glycol 4000 or Na+-coupled glucose transport were observed in mannitol-treated animals compared to controls. These data suggest that when the intestinal mucosa is exposed to hyperosmolar loads that the digestive capacity for disaccharides is suppressed more than its glucose absorptive capacities. Furthermore, glucose oligomers may be more readily digested and absorbed than disaccharides, in this setting, due, in part, to the proximal injury and less pronounced proximal-distal gradient for glucoamylase than other brush-border carbohydrases.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Corn syrup sugars: in vitro and in vivo digestibility and clinical tolerance in acute diarrhea of infancy.

We evaluated the in vitro and in vivo digestibility and clinical tolerance of three corn syrup sugars (DE10, 15, 24) and one infant formula containing corn syrup sugar as the sole carbohydrate source (DE24). In vitro studies were conducted using human duodenal fluid and jejunal mucosa with normal enzyme activities. In vivo studies included intragastric perfusion studies and tolerance tests using the corn syrup sugars and a clinical formula trial in 32 infants with acute diarrhea. Results of the in vitro studies showed that each of the corn syrup sugars was well hydrolyzed by duodenal fluid and by mixtures of duodenal fluids and mucosal homogenates. Similarly, in vivo studies revealed significant hydrolysis in the proximal intestine, as measured during the perfusion studies, and adequate absorption, as indicated by a rise in serum glucose concentration during tolerance tests. Only patients who had a marginal serum glucose rise after a glucose meal had a blunted rise after a corn syrup feeding. More than 85% of the infants beginning the clinical trial tolerated the formula well and gained weight at or above the expected rate for age during the study interval. These data indicate that, except with severe mucosal injury and secondary monosaccharide intolerance, glucose polymers of the dextrose equivalents tested are suitable carbohydrate sources for infants recovering from acute diarrhea.

Clinical Trials as Topic↗
PubMed1983

Citrobacter ventriculitis in a neonate responsive to trimethoprim-sulfamethoxazole.

There are increasing reports of citrobacter central nervous system infections in neonates. These organisms cause brain abcesses in a high percentage of patients. They may be resistant to commonly used antibiotics. We report a term male infant with underlying meningo-myelocoele and hydrocephalus in whom Citrobacter diversus meningitis and ventriculitis developed. Initial antibiotic therapy including intraventricular amikacin failed to sterilize the ventricles or alter a deteriorating clinical course. Adding intravenous trimethoprim-sulfamethoxazole to the therapeutic regimen resulted in reversal of a progressively worsening condition and eventual recovery. Trimethoprim-sulfamethoxazole should be considered as a potentially useful alternative antibiotic for susceptible central nervous system infections.

Amikacin↗
PubMed1980

Communicating hydrocephalus following total parenteral nutrition.

Communicating hydrocephalus secondary to cerebral venous outflow obstruction has been reported in a few patients several months following removal of a TPN catheter. We report the case of an infant who developed this sequal 4 mo after the catheter was removed. We illustrate the techniques used to delineate the type of hydrocephalus. A lumbo-peritoneal shunt was performed to alleviate the condition.

Cerebrospinal Fluid Shunts↗
PubMed1978

Radiography of hydrocephalus after total parenteral nutrition.

An infant with chronic diarrhea developed hydrocephalus following treatment with total parenteral nutrition (TPN) via jugular vein catheterization. Total parenteral nutrition is used when nutritional needs cannot be met adequately by oral alimentation. Serial computerized tomograms showed progression of communicating hydrocephalus. Superior sagittal sinograms demonstrated bilateral internal jugular vein occlusion with extensive venous collateralization. Lumboperitoneal shunt effectively decreased raised CSF pressure. A judicious approach to alternative venous routes for hyperalimentation is suggested. Radiographic delineation of communicating hydrocephalus by computerized tomography and superior sagittal sinography is presented.

Brain↗