Effect of theophylline on gastroesophageal reflux in normal adults.

In a randomized, double-blind manner, 15 normal adults were given a single oral loading dose of anhydrous theophylline (6.5 +/- 0.9 mg/kg) and nine normal adults were given placebo.

Home total parenteral nutrition during pregnancy: a case report.

A 26-year-old female was given total parenteral nutrition without complications during the last 2 months of her pregnancy. A partial small bowel obstruction caused by Crohn's disease prevented oral alimentation, necessitating parenteral nutrition. A term, female infant weighing 2680 grams was delivered vaginally without complications.

Reduced serum levels of 1 alpha,25-dihydroxyvitamin D during long-term total parenteral nutrition.

Painful bone disease, characterized by patchy osteomalacia and inactive bone, can develop in patients treated with total parenteral nutrition for more than 3 months. Serum levels of 1 alpha,25-dihydroxyvitamin D (1 alpha, 25(OH)2D), 24,25-dihydroxyvitamin D and 25-hydroxyvitamin D were measured in seven adults and five children treated with parenteral nutrition for 9 to 60 months. Serum levels of 1 alpha, 25(OH)2D were markedly reduced, while levels of 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D were normal.

"Antral dysmotility". An unrecognized cause of chronic vomiting during infancy.

Ten infants who were less than nine months of age and had chronic nonbilious vomiting were evaluated for gastroesophageal reflux. Upper gastrointestinal series in all showed delayed gastric emptying, a funnel-shaped antrum, absent antral peristalsis, and gastroesophageal reflux. None had evidence of anatomic obstruction in the stomach or duodenum.

Congenital stricture of the common hepatic duct: an unusual case without jaundice.

A 3-yr 8-mo-old female was diagnosed as having a congenital stricture of the common hepatic duct. She demonstrated hepatomegaly with marked elevations of serum transaminases, alkaline phosphatase, and bile acids without clinical jaundice or hyperbilirubinemia. Liver biopsy suggested extrahepatic obstruction.

Chronic idiopathic intestinal pseudo-obstruction syndrome. Radiologic signs in children with emphasis on differentiation from mechanical obstruction.

The radiographic pattern of chronic idiopathic intestinal pseudoobstruction syndrome (CIIPS) in children includes: (a) manifestation of motility disorder, and (b) signs of bowel occlusion. The findings on plain films are identical to those of mechanical obstruction. However, when there is a clinical history of chronic symptoms of a disparity between the patient's clinical condition and the radiographic findings, opaque studies are indicated.

100 patient years' experience with the Broviac silastic catheter for central venous nutrition.

Use of the Broviac silastic catheter totaling 37,039 patient days' experience has been studied at UCLA Hospital. When combined with standardized protocol for performance of parenteral nutrition and line care, and consistently supervised, the Broviac catheter provided inpatient as well as home parenteral nutrition with minimal complications. Catheter-related sepsis occurred once every 1,058 catheter-use days; minor or major complications developed once every 330 days.

Bone disease associated with total parenteral nutrition.

An unusual metabolic bone disease which developed in 11 adults receiving total parenteral nutrition (TPN) for more than 3 months was characterised by the insidious onset of bone pain which became very severe and caused considerable disability. Serum levels of calcium, phosphorus, 25-hydroxy-vitamin D, and serum immunoreactive parathyroid hormone were normal. Patchy osteomalacia with impaired mineralisation and decreased bone turnover were seen on histomorphometric analysis of bone biopsy specimens.

Candida laryngitis in chronic mucocutaneous candidiasis. Its association with Candida esophagitis.

Four patients with chronic mucocutaneous candidiasis (CMC) underwent esophagoscopy and microlaryngoscopy. Cultures were obtained by biopsy of the larynx and the esophagus. Three of the four patients with laryngeal disease proven by laryngoscopy and culture also had extensive esophageal disease.

Monozygotic twins with Crohn's disease: a case report.

Twin brothers whose monozygosity was demonstrated by analysis of dermatoglyphic patterns, chromosome banding, HLA typing, and gene markers developed Crohn's disease within 8 mo of each other. Both had involvement of the terminal ileum, colon, and rectum, as well as arthritis. However, one had severe esophagitis and recurrent pancreatitis, and the other had severe arthritis and oral mucosal involvement.

Successful treatment of chronic mucocutaneous candidiasis with ketoconazole.

Ketoconazole, a new oral antifungal agent, was evaluated in the treatment of four patients with severe chronic mucocutaneous candidiasis refractory to standard antifungal therapy. Three had Candida esophagitis, and too had previously received intravenous amphotericin B. Initial ketoconazole dosage was 100 mg daily for patients weighing less than 30 kg and 200 mg daily for patients over 30 kg.

Candida esophagitis and laryngitis in chronic mucocutaneous candidiasis.

Five children (aged 11 to 19 years) with lifelong chronic mucocutaneous candidiasis had 12 episodes of esophageal and/or laryngeal candidiasis documented by endoscopy. Symptoms included hoarseness (8/12), dysphagia (6/12), and hemoptysis (1/12). There was poor correlation between oral lesions and esophageal or laryngeal involvement.

Acquired bile duct stricture in childhood related to blunt trauma. Report of a case and review of the literature.

A 13-year-old boy had obstructive jaundice following several episodes of blunt abdominal trauma. At surgery, a stricture of the common bile duct, for which no other cause could be found, was identified and corrected. We describe our approach to the problem of obstructive jaundice in childhood.

Cell-mediated immune defects and infection. A study of malnourished hospitalized children.

Severe protein calorie malnutrition in children in developing countries has been characterized by noticeable depression of cell-mediated immunity and an increased manifestation of infectious illnesses. We studied 23 hospitalized US children whose admitting diagnoses included severe malnutrition to see if similar findings existed. Children were divided into two groups based on the percentage of E rosettes (T cells) prior to nutritional therapy.

Gastroesophageal fundoplication for the management of chronic pulmonary disease in children.

Gastroesophageal reflux is a common cause of chronic pulmonary disease in children. Forty-two children with recurrent pneumonia or severe asthma were evaluated and shown to have signicant reflux. Esophagography and esophageal pH testing proved the best diagnostic tests for determining reflux.

Home parenteral nutrition in infants.

The effects of prolonged home total parenteral nutrition on growth and psychomotor development were studied in eight infants during a two-year period. Each patient was begun on HTPN in the first 60 days of life, using a Broviac silastic catheter for venous access. Normalization of somatic growth has been observed in all patients during the study period.

The ultrasonic and biochemical diagnosis of pancreatitis in children.

Pancreatic ultrasonography and the determination of serum amylase and amylase creatinine clearance ration were performed on 17 normal children and on 35 children with abdominal pain. In all 17 normal subjects the echodensity of the pancreas was equal to or greater than that of the liver. Nineteen patients with abdominal pain had reduced echodensity of the pancreas when compared to that in normal children, and two of the 19 had pseudocysts.

Home parenteral nutrition.

One hundred and six patients were placed on a home parenteral nutrition program because of severe gastrointestinal tract lesions. In 41, sufficient improvement allowed the resumption of oral alimentation. Forty-eight remain on the program.

Home parenteral nutrition: an alternative approach to the management of complicated gastrointestinal fistulas not responding to conventional medical or surgical therapy.

Twelve patients, 9 with enterocutaneous fistulas and 3 with enterovaginal fistulas, were placed on a home parenteral nutrition (HPN) program after conventional inpatient total parenteral nutrition with bowel rest and/or surgical attempts at fistula closure failed. Fistula closure was achieved (in 66%) after from 28 to 400 days on the program. Six closed spontaneously while 2 were closed surgically.

Home parenteral nutrition in children with Crohn's disease: an effective management alternative.

Seventeen pediatric patients, ages 9.25--20.5 yr, were placed on a program of home parenteral nutrition (HPN) for severe, symptomatic Crohn's disease.

Clinical experience with total colectomy and endorectal mucosal resection for inflammatory bowel disease.

During the past 3 yr, 17 patients with chronic ulcerative colitis and 6 with Crohn's disease who had severe rectal and colonic involvement underwent excision of the rectal mucosa without removal of the rectal muscle in combination with total colectomy and cutaneous ileostomy as a 1- or 2-stage procedure. This operative technique has cured each of the patients of their primary colonic and rectal disease and has obviated many of the unpleasant complications that often occur after total proctectomy, such as impotence, prolonged perineal drainage, and bladder dysfunction. The operation has the further advantages of lower operative blood loss, shorter operative time, and earlier safe ambulation.