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Biomedical subjects

T C Halpin

Publications and source records attributed to T C Halpin.

At least 19 recordsLinked to original sources
PubMed1987

Radiographic findings in children and young adults with Barrett's esophagus.

The upper-gastrointestinal examinations of 32 patients (mean age, 11 years) with histologically proven Barrett's esophagus were reviewed to evaluate the radiologic findings in children. All patients had symptoms of chronic gastroesophageal reflux and/or esophagitis, including atypical findings such as aspiration pneumonia, seizures, and failure to thrive. Fourteen patients had other diseases that might predispose them to abnormal esophageal motility and gastroesophageal reflux. Twenty-five patients had single-contrast and seven patients had double-contrast examinations. Four patients had normal single-contrast studies; 24 had gastroesophageal reflux; 12 had strictures; 10 had esophageal ulcers; and only four had hiatal hernias. The most notable difference between the results of endoscopy and the upper-gastrointestinal studies was the rate of detection of esophageal ulcers. Ten of the patients with single-contrast studies had ulcers seen at endoscopy but not shown radiologically. No specific radiologic signs of Barrett's esophagus were found, although most of our patients had abnormal upper gastrointestinal studies.

Adolescent↗
PubMed1985

Multifocal osteonecrosis in adolescents with Crohn's disease: a complication of therapy?

Three adolescents with severe Crohn's ileocolitis developed osteonecrosis after receiving intravenous corticosteroids and parenteral nutrition, including 10% lipid infusion. Each had achieved clinical remission with therapy. However, several months following completion of therapy, each developed arthralgias and arthritis of weight-bearing and non-weight-bearing joints. Roentgenographic evaluation revealed osteonecrosis involving multiple joints. Osteonecrosis may result from the interference with blood flow to bone and has been produced in animals by infusion of lipid solutions and administration of corticosteroids. We report these cases of osteonecrosis as a probable complication of corticosteroid and lipid infusion in adolescents treated for severe Crohn's disease.

Adolescent↗
PubMed1985

Intestinal lymphangiectasia and thymic hypoplasia.

We have evaluated the immunological abnormalities present in a 6 year old patient with primary intestinal and generalized lymphangiectasia confirmed by intestinal, lung and lymph node biopsies. Lymphocyte loss through the gut was confirmed by the detection of lymphocytes in her stool. An increased enteric protein loss was suggested by hypoproteinaemia, peripheral oedema, and a very short half-life for i.v. immune serum globulin (3 days). Lymphocyte subpopulation analysis revealed a selective loss of T lymphocytes, with a proportionally increased loss of the OKT4 positive helper/inducer subpopulation. Functionally, there was a decrease in proliferative responses to some mitogens and to allogeneic cells, and a lack of T cell help for in vitro B lymphocyte differentiation into immunoglobulin secreting cells. Natural killer function was normal. In this patient, a concomitant thymic deficiency was documented by failure to identify thymic tissue on a thymus biopsy and by an absence or decrease of the serum thymic factor (thymulin) and thymosin alpha 1. No compensatory lymphopoiesis was detected in the bone marrow. In an attempt to increase T lymphocyte development, the patient was treated with thymosin fraction 5. Daily treatment with this preparation resulted in a transient clinical improvement which could not be sustained on a weekly thymosin treatment schedule. However, lymphocyte numbers did not increase during this treatment. The findings in this patient support the notion that T lymphocytes are needed to stimulate thymic epithelium. In situations of excessive loss of long lived T lymphocytes a secondary thymic atrophy may occur and further contribute to the development of a deficiency in cell-mediated immunity.

Child↗
PubMed1984

Parietal cell function of full-term and premature infants: unstimulated gastric acid and intrinsic factor secretion.

A 1-h basal collection of gastric secretions was taken from 14 healthy full-term infants (group I) and 10 premature infants (group II). Simultaneously, acid and intrinsic factor (IF) secretion was measured. In an additional group of 19 full-term infants (group III), 16 had IF detectable in their gastric secretions immediately at birth. Volumes of gastric juice (ml/kg/h) and IF secretion (ng/kg/h) were similar for group I and group II infants. Acid secretion (mEq/kg/h) was significantly less in group II (p less than 0.01). There was a linear correlation between acid secretion (mEq/kg/h) and IF secretion (ng/kg/h) for group I (r = 0.85, p less than 0.001). There was no correlation between the values for the premature infants in group II. The study documents that the parietal cell of the premature infant has the same capacity to secrete IF as the cell of the more mature infant. It also demonstrates the presence at birth of IF in gastric secretions, which suggests in utero secretion and independence from enteral feeding for stimulation.

Gastric Acid↗
PubMed1983

Cyclic parenteral nutrition during bone marrow transplantation in children.

Nine children underwent ten bone marrow transplants for malignancies and were supported by parenteral alimentation administered in cyclic fashion 18 hours daily. Children received cyclic parenteral nutrition for an average of 29 days, which provided a caloric intake (mean +/- SD) of 55.9 +/- 18.1 Kcal/kg/day, and a nitrogen intake of 0.28 +/- 0.08 g/kg/day. Nutritional status was assessed using nitrogen balance, creatinine-height index, and visceral protein concentrations including serum albumin, transferrin, and prealbumin. Minimal transient elevation in tests of liver function were observed without marked derangement in blood glucose, electrolytes, or osmolality. Unlike prealbumin, determinations of nitrogen balance, creatinine-height index, serum albumin and transferrin concentrations did not parallel changes in clinical status. Cyclic parenteral alimentation is a practical approach to the maintenance of nutrition during intensive antitumor therapy and provides an infusion-free period for the administration of drugs and blood transfusions without interfering with nutritional support. Prealbumin accurately reflects changes in the patient's clinical status at any point and is easily and reliably determined.

Adolescent↗
PubMed1983

Chronic diarrhea and neutropenia not associated with pancreatic insufficiency: a non-Shwachman-Diamond entity.

Six children with chronic diarrhea and neutropenia, initially referred for evaluation of Shwachman-Diamond syndrome, were found to have no evidence of pancreatic insufficiency. All presented in the spring with a prodromal respiratory illness. Hematologic evaluation was normal except for iron deficiency anemia and neutropenia. Small intestinal biopsies of all children showed inflammation, consistent with chronic enteritis. The children were followed until growth returned to previous percentiles. Diarrhea and neutropenia resolved by 6-month follow-up, and there was no recurrence of the neutropenia at 1 year.

Agranulocytosis↗
PubMed1983

Prostaglandin E2 concentration in gastric secretions of critically ill, full-term, and premature infants.

Critically ill, full-term, and premature infants are at increased risk to develop gastric mucosal ulceration. The cytoprotective effects of prostaglandin E2 (PGE2) may be important in the preservation of gastric mucosal integrity in these patients. PGE2 concentrations in the gastric secretions of seven full-term and 16 premature infants with severe pulmonary disease were measured by radioimmunoassay. The mean PGE2 concentration was significantly greater in the full-term infants (460 +/- 94 pg/ml), (mean +/- S.E.M.) than in the premature infants (190 +/- 35 pg/ml), P less than 0.01. There was a linear correlation between gestational age and PGE2 concentration, r = 0.70, P less than 0.001. In the 11 infants greater than or equal to 35 wk gestational age there was a linear correlation between gastric pH and PGE2 concentration, r = 0.69, P less than 0.01.

Dinoprostone↗
PubMed1982

Importance of early ileostomy closure to prevent chronic salt and water losses after necrotizing enterocolitis.

Six infants with necrotizing enterocolitis were discharged after periods of prolonged hospitalization (two to nine months) with intact ileostomies. Their initial hospitalization was complicated by feeding difficulties, chronic diarrhea, sepsis, rickets, and developmental delay. All were rehospitalized within three months, with severe acidosis and dehydration after a presumed viral-type illness. Each had large-volume ileostomy output, which was rich in electrolytes and bicarbonate. A prolonged recovery phase (two to eight months) again was punctuated with episodes of diarrhea, problems in starting oral feeding, and sepsis. After reanastomosis of the remaining bowel, no infant has had a similar life-threatening episode. It is speculated that the infants' recurrent "salt-and-water-losing states" are secondary to either an anatomic or functional loss of the colon. This problem appears to be a poorly recognized sequela of bowel surgery and necrotizing enterocolitis, and early reanastomosis of discontinuous bowel should be of benefit.

Dehydration↗
PubMed1981

Use of intravenous iron dextran injection in children receiving total parenteral nutrition.

We conducted studies using intravenous (IV) iron dextran injection in 14 hospitalized infants and children with iron deficiency who required total parenteral nutrition. A single, total dose of IV iron dextran was administered during a two-hour period (preceded by a test dose of 25 mg). Doses administered ranged from 50 to 782 mg, with an average dose of 15.2 mg/kg body weight. No adverse reactions were noted during the test dose or infusion. The IV administration of iron dextran appears to be a safe method of treatment for iron repletion in children who are unable to tolerate feedings as a result of malabsorption, inflammatory bowel disease, or chronic debilitating diseases.

Adolescent↗
PubMed1981

Pathologic childhood aerophagia: a recognizable clinical entity.

Pathologic childhood aerophagia is a rarely recognized, often poorly treated entity that has remained almost undescribed in either the surgical or pediatric literature. In only 1 of 9 children the condition was recognized at presentation. The initial diagnosis of the others was Hirschsprung's disease (2), malabsorption syndrome (3), gastric outlet syndrome (1), constipation (1), and esophagitis (1). Five were hospitalized and two underwent surgical procedures. History disclosed a remarkably constant triad: previous normal stooling pattern, visible and often audible air swallowing and excessive flatus. Physical examination often demonstrated a markedly or intermittently distended and tympanitic abdomen. Abdominal musculature was thinned in children with chronic aerophagia. Roentgenographic evaluation showed massively distended loops of intestine throughout without associated air-fluid levels. There was marked compression of the diaphragm with limited excursion in some. Laboratory and malabsorption testing was normal. Treatment is limited to recognition of the problem, nasogastric decompression in severe cases and psychologic counseling when symptoms persist in the older child. The recognition of this condition may lead to a better understanding of its pathophysiology and will reduce the number of unnecessary admissions or surgical procedures.

Adolescent↗
PubMed1981

Stability of an extemporaneous formulation of injectable cholecalciferol.

THe stability of an extemporaneous formulation of injectable cholecalciferol 40,000 IU/ml was assessed. A preparation of cholecalciferol 40,000 IU/ml in a solution of propylene glycol with ethanol 10% was prepared. The solution was stored at 4 degrees C in 2-ml sterile glass vials protected from light. Cholecalciferol content was measured initially and periodically for 199 days using a high-pressure liquid chromatography technique. A 7.3% loss of cholecalciferol potency from baseline was observed over the 199-day period. In contrast to currently available preparations, this extemporaneous formulation of injectable cholecalciferol potentially offers a versatile dosage form for therapeutic or prophylactic therapy of vitamin D deficiency. It was easily prepared and retained more than 90% potency of cholecalciferol for at least six months. The addition of this formulation to large-volume parenteral or parenteral nutrition solutions is not recommended, however, because compatibility data are not available. In addition, the biological activity of the preparation has not been assessed.

Cholecalciferol↗
PubMed1980

Endoscopic small bowel biopsy in children with a modified multipurpose biopsy tube.

Small bowel biopsy is a difficult procedure in infants and children, and the authors describe a new technique. The Quinton multipurpose suction biopsy instrument is incorporated into an Olympus GIF-P2 fiberoptic endoscope to allow positioning of the biopsy capsule under direct visual control. Fourteen children, 2 months to 4 years of age, have been biopsied, and tissue was successfully obtained in 20 of 21 procedures. Nine of 21 endoscopic examinations of duodenal mucosa were abnormal and gave additional diagnostic information.

Biopsy↗
PubMed1980

Pulmonary arterial lipid deposit in newborn infants receiving intravenous lipid infusion.

Three newborn infants are described with a distinctive pulmonary arterial lipid lesion, characterized by a wide foamy layer of intima partially occluding the lumen of small muscular pulmonary arteries. Lipid stains indicated lipid infiltration of the walls of these arteries, involving not only the intimal layer, but media and adventitia as well. All three infants had received intravenous lipid infusions. All three infants also had histologic evidence of pulmonary hypertension, one on the basis of chronic lung disease (BPD) and two on the basis of congenital heart disease. A retrospective autopsy study of long-term neonatal ICU dwellers receiving such infusions revealed two additional patients with lipid deposits in pulmonary arterial walls. It is speculated that the pulmonary arterial lipid deposits were derived from the lipid infusions and were dependent on antecedent or concurrent vascular damage from pulmonary hypertension.

Chronic Disease↗
PubMed1978

Abnormal rectal immunoglobulin pattern in Hirschsprung's disease.

The immunoglobulin content of rectal biopsy tissue and secretions from twelve neonates in whom Hirschsprung's disease was suspected was determined by an organ-culture technique and radioimmunoassay. The immunoreactive IgG content of explanted rectal tissue and its secretions in those six children who proved to have Hirschsprung's disease was much higher than in those with other types of obstructive lower-intestinal disease. Increased amounts of IgG may represent maternally derived antibody associated with neonatal gut neural elements. This seems to be the first report of an immunological abnormality in Hirschsprung's disease.

Humans↗