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Biomedical subjects

T C Halpin

Publications and source records attributed to T C Halpin.

29 records · Page 2Linked to original sources
PubMed1977

Home total parenteral nutrition: an alternative approach to the management of children with severe chronic small bowel disease.

A home program of total parenteral nutrition (HTPN) has been developed for managing patients with severe chronic small bowel disease who would otherwise be unable to leave the hospital. Six such children were treated by this program using a Broviac catheter to shorten hospitalization, to decrease the cost of care, and to normalize their lives as much as possible. They ranged in age from 2 1/4-17 yr and received HTPN for periods of from 1-11 mo. Criteria for instituting this therapy were the inability to maintain fluid and nutritional balance on therapeutic diet or oral formula, or a need for 30 or more days of conventional TPN. The 6 patients had a total of 1139 days on HTPN with 1 episode of catheter sepsis and 1 localized infection at the catheter site. None of the catheters clotted but 1 was accidentally dislodged. Small bowel adaptation occurred in 4 of the 6 patients. This allowed gradual discontinuous of HTPN and reinstitution of total oral alimentation.

Adolescent↗
PubMed1977

Chronic idiopathic intestinal pseudo-obstruction syndrome in children--clinical characteristics and prognosis.

Eleven children with the diagnosis of chronic idiopathic intestinal pseudo-obstruction are presented. Four children, all siblings of a symptomatic patient, were asymptomatic and were diagnosed radiographically. The clinical course was characterized by intermittent episodes of abdominal distention, vomiting, abdominal pain, diarrhea, constipation, and malnutrition. Radiographic studies were most helpful in making the diagnosis. Findings on upper gastrointestinal series included abnormal esophageal motility, delayed gastric emptying, dilated loops of small bowel, and disorganized transit of barium. Half of the patients had abnormal evacuation patterns on barium enema. Manometric studies of esophageal motility were abnormal in seven of ten children. In those patients studied, small bowel and rectal biopsies contained ganglion cells. Treatment was directed at relieving symptoms, which in four patients became persistent and required total parenteral nutrition. CIIPS carries a poor long-term prognosis in children.

Biopsy↗
PubMed1977

Colitis, persistent diarrhea, and soy protein intolerance.

Four infants with suspected soy protein intolerance were studied prospectively. All had vomiting, diarrhea, hematochezia, and weight loss of more than 10%. Laboratory abnormalities included anemia (3), acidosis (3), hypoalbuminemia (3), hypernatremia (1), hyponatremia (3), and mild eosinophilia (2). Symptoms developed between three hours and five days after systematic testing with increasing volumes of soy formula. After challenge with soy protein formula, proctosigmoidoscopy and rectal biopsy were performed within 24 hours of developing stools with gross blood. Proctosigmoidoscopy showed both spontaneous and induced friability and loss of vascular pattern in mucosa. Rectal biopsy showed acute colitis with crypt abscesses, depletion of mucus from rectal glands, and polymorphonuclear leukocytes within the lamina propria. Soy protein-induced colitis should be suspected in those infants who present with persistent and bloody diarrhea after being fed soy formula.

Biopsy↗
PubMedDate not supplied

Inhibition of bile flow in the isolated perfused rat liver by a synthetic parenteral amino acid mixture: associated net amino acid fluxes.

To identify a role for amino acids in cholestasis associated with total parenteral nutrition, we measured bile formation by the isolated perfused rat liver in the presence and absence of added amino acids. All livers were infused constantly with sodium [14C]taurocholate (0.28 mumoles per min) for 90 min. At 40 min, a primed-constant infusion of a synthetic L-amino acid mixture (121 + 19.3 mumoles of N per min) was administered for an additional 50 min. Mean bile flow rates during the amino acid infusion were reduced from 15.4 microliter per min per 10 gm liver weight to 10.4 microliter per min per 10 gm (p less than 0.005). There was no significant change during saline infusion of control livers, and there was no significant difference in perfusate osmolalities in the two groups. Although biliary recovery of infused taurocholate was slightly lower in the experimental perfusions than in controls (95.3% vs. 101.7%, p less than 0.05), there was no significant reduction in taurocholate excretion rate during the infusion in either group. Bile flow changes were related to ambient concentrations and net fluxes of individual amino acids in the perfusate. Of the 14 infused amino acids, glycine and arginine achieved levels greater than 3 times greater than reported physiological postprandial portal venous concentrations in the rat, and together constituted about 25% of the 90-min perfusate amino acids (8.3 mM). The highest net hepatic uptake was for glycine (125 mumoles per hr per 10 gm), which was almost 50% of its infusion rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMedDate not supplied

High incidence of pulmonary symptoms in infants evaluated for esophageal disease.

Of 62 children (1-24 months of age) evaluated for esophageal disease, 22 were found to have pulmonary symptoms of apnea, pneumonia, wheezing, cyanosis, cough and stridor. Upper gastrointestinal series showed free gastroesophageal reflux in 10 of 22 infants; 3 were thought to have stricture. Acid-reflux test was positive in 13 of 15 and correlated with the presence of esophagitis in 12. In addition to esophagitis, endoscopic examination found two foreign bodies and an esophageal stricture unrecognized during fluorescopy. Endoscopic grasp biopsy was inadequate in most infants for the histologic evaluation of esophagitis. However, suction biopsy correlated well with endoscopically diagnosed esophagitis. In infants where medical therapy failed and symptoms were life-threatening, a Nissen fundoplication resulted in excellent resolution of symptoms. In children who present with prolonged and often life-threatening symptoms, esophageal dysfunction should be evaluated by rigorous testing.

Child, Preschool↗
PubMedDate not supplied

Cyclic parenteral nutrition during allogeneic bone marrow transplantation.

Two adolescents who underwent successful allogeneic bone marrow transplantation were nutritionally managed on a fat-free cyclic parenteral nutrition (PN) regimen. Serum concentrations of prealbumin, albumin, and transferrin were prospectively evaluated to assess the efficacy of nutritional therapy. Both patients tolerated the cyclic PN metabolically. Serial albumin and transferrin concentrations varied slightly and were less sensitive indices of changing nutritional status. In contrast, prealbumin concentrations decreased uniformly during periods of metabolic stress. At the cessation of Pn therapy, all serum proteins were within the normal range. Cyclic PN appears to be a safe, practical approach to the nutritional management of patients undergoing bone marrow transplantation.

Adolescent↗
PubMedDate not supplied

Prophylaxis and treatment of childhood rickets with parenteral cholecalciferol.

The safety and efficacy of parenteral cholecalciferol was evaluated in the treatment and prevention of childhood rickets. Children with active disease, and those at high risk for developing rickets were treated either with intravenous or intramuscular cholecalciferol in dosages of 1000 to 1500 IU daily, for periods of 28 to 450 days. All children with rickets responded with radiographic evidence of healing. No child in the prophylaxis group developed bone disease. Side effects were minimal. Parenteral cholecalciferol is a safe and effective therapy for the treatment and prevention of childhood rickets.

Alkaline Phosphatase↗