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Biomedical subjects

C F Robertson

Publications and source records attributed to C F Robertson.

At least 91 records · Page 5Linked to original sources
PubMed1990

Deaths from asthma in Victoria: a 12-month survey.

The circumstances surrounding the death of all patients who died from asthma in the State of Victoria over a 12-month period from May 1, 1986 were investigated. Data were collected using an interviewer-administered questionnaire as soon as practicable after registration of the death. In 168 cases asthma was considered to be the cause of death and adequate data were obtained in 163; 75 of these were male (74 over 60 years of age). Thirteen per cent had a history of trivial or mild asthma, 22% of moderate and 65% of severe asthma. Thirty-four per cent had not been limited at all or only by active sport, while 39% had had no previous hospital admission for asthma. In only 18% had there been a previous admission to an intensive care unit. Forty-seven per cent were taking inhaled beclomethasone or sodium cromoglycate regularly and 27% were taking corticosteroids by mouth regularly. Death occurred outside hospital in 150 of 163 subjects. In the final attack 58% had a sudden onset and collapsed within minutes, 20% were found dead and 27% had an acute progression of an established attack. Twenty-nine per cent of the deaths were assessed as preventable: preventable factors included inadequate assessment or therapy of prior asthma (35%), poor compliance with therapy (33%) and delay in seeking help (43%). As a significant number of subjects in this survey could not be classified as "high risk", it is important that clinicians ensure that all patients are aware of optimal maintenance management and have a clear individualized plan of what to do in the event of deteriorating asthma.

Adolescent↗
PubMed1990

Variability of pulmonary function tests in cystic fibrosis.

The aim of this study was to define the within-subject variability for tests of respiratory function in patients with cystic fibrosis (CF) within the day, from day to day and from week to week. Twenty-eight patients with CF (aged 9-19 years) and 23 healthy height matched controls (aged 9-18 years) had measurements made of spirometry, lung volumes, maximal flows at three lung volumes and maximal inspiratory and expiratory pressures at the mouth. Testings were done on nine occasions, three times within a day, on consecutive days at one week intervals. Each individual's variability was summarized both as the within-subject coefficient of variation (WCV) and within-subject standard deviation (WSD). Means of WSD and median WCV are reported for both the patients with CF and normal subjects. The within-subject variability of VC, FEV1, TLC, RV, and RV/TLC was more appropriately assessed by the use of WSD rather than WCV. The WSDs in the CF group were significantly more variable (P less than 0.005) than in the normals for VC and FEV1. WCV best summarized within-subject variation for FEF25-75, FRC, V25, V50max and V75max for which the CF subjects were significantly more variable (P less than 0.005). Individuals' variability was very consistent, therefore assessment of significant change could be made more accurately by predetermining the variability of that individual, rather than using group data. We stress the importance to consider increased variability from day to day and week to week in the interpretation of change in lung function in patients with CF, and provide reference values for accurate interpretation of serial pulmonary function test results.

Adolescent↗
PubMed1990

Tracheostomy in children with Guillain Barré syndrome.

During the 10-yr period beginning January 1979, 59 infants and children with Guillain Barré syndrome (GBS) were admitted to our hospital. Tracheostomies were performed in 15 patients and their records were reviewed. Fourteen patients were recalled for assessment of pulmonary function and respiratory muscle strength (RMS). The median duration of assisted ventilation (including endotracheal [ET] intubation) was 21 days and the median duration of tracheostomy was 39 days. Only two patients were discharged with the tracheostomy in situ. All patients were successfully decannulated at the first attempt. No tracheostomy-related complications or symptoms were reported apart from croup in two patients. On review, lung volumes and maximal inspiratory and expiratory flows were normal. There was no evidence of tracheal stenosis or significant tracheomalacia. RMS tests were normal. In this hospital, tracheostomy is a safe, well-tolerated procedure in the management of infants and children with GBS who need long-term ventilation. There were no deaths and all patients returned to their normal school or were gainfully employed after their illness, although 12 patients had mild persistent weakness of at least foot dorsiflexion.

Adolescent↗
PubMed1990

Tracheostomy.

The records of all children who had a tracheostomy performed over a 10 year period from January 1979 were reviewed. Altogether 142 patients aged 1 day to 24.8 years received a tracheostomy, 70 in the first year of life. The conditions necessitating tracheostomy were trauma (n = 21), acquired subglottic stenosis (n = 21), subglottic haemangioma (n = 16), Guillain-Barré syndrome (n = 14), Pierre Robin syndrome (n = 9), craniofacial disorders (n = 9), micrognathia (n = 5), and others in 47. In patients successfully decannulated the median period of tracheostomy was 104 days (range 3 days to 9.0 years) and in 25 patients the tracheostomy is still in situ. Eighty four patients (60%) were discharged from hospital with their tracheostomy in situ and no patient was kept in hospital because of a tracheostomy beyond four weeks. There were two tracheostomy related deaths in hospital. Both patients had severe acquired subglottic stenosis secondary to ventilation for lung disease of prematurity. There were no tracheostomy related deaths at home; complications included tracheal granulomas and polyps (n = 19). After removal of the tracheostomy 13 children had a fistula requiring surgical closure and four required revision of the tracheostomy scar. Tracheostomy is well tolerated in small children, with few complications and can be managed safely in the home by the family.

Adolescent↗
PubMed1989

Analysis of DNA probes for the prenatal diagnosis of cystic fibrosis.

Cystic fibrosis is a common autosomal recessive disease in white persons. Prenatal diagnosis by DNA analysis became possible in families with a child who is affected by cystic fibrosis when the probes pJ3.11, metH and metD, which are linked closely to the cystic fibrosis gene (CF) were described. The recent description of the XV-2c and KM.19 probes has improved the prenatal diagnosis of cystic fibrosis greatly. The KM.19 probe alone was informative in eight of 12 families that were studied while XV-2c was informative in eight of 12 families that were studied while XV-2c was informative in only two of the 12 families. In contrast, the use of the pJ3.11, metH and metD probes in combination allowed full diagnosis in six of the 12 families. The combined use of the CF-linked probes produced informative data for all 12 families. Therefore, in most families with at least one affected living child, the first-trimester diagnosis of cystic fibrosis is possible with fetal DNA that has been prepared from chorionic villous samples. Strong linkage disequilibrium was found with both the KM.19-PstI polymorphism and the XV-2c-TaqI polymorphism and the CF gene.

Alleles↗
PubMed1989

Effect of bracing on respiratory mechanics in mild idiopathic scoliosis.

The use of a corrective orthopaedic brace is an established form of management for patients with progressive idiopathic scoliosis. Thirteen patients with mild idiopathic scoliosis were studied with and without the corrective brace applied. Lung volumes and the pattern of chest wall and abdominal movement were measured during quiet breathing. Transdiaphragmatic pressures were measured in six of the patients and upper ribcage movement in seven patients. Application of the brace resulted in a significant reduction in vital capacity (14%), functional residual capacity (22%), and total lung capacity (12%). There was no effect on respiratory rate or minute volume. In the erect position the pattern of chest wall movement was altered with a reduction in lower ribcage movement of 46% and abdominal wall of 39% and an increase in upper ribcage movement of 43%. These changes were greater in the supine position. There was at least a twofold increase in end inspiratory and end expiratory gastric pressures during tidal breathing, but oesophageal pressures were not affected by the brace. Transdiaphragmatic pressures showed a similar twofold increase, which implies a substantial increase in the work of breathing. In view of the doubts concerning the influence of bracing on the natural history of idiopathic scoliosis and the substantial functional effect of bracing on the respiratory system, it is suggested that the current practice of bracing in this condition needs to be reviewed.

Adolescent↗
PubMed1989

Testing children for pulmonary function.

Tests of pulmonary function provide evidence of the nature and severity of lung disease; they occasionally aid a specific diagnosis and they are an excellent guide to the patient's progress. They assist the physician to establish the severity of the disease.

Child↗
PubMed1988

Necrotizing enterocolitis in full-term infants. A case-control study.

We performed a case-control investigation of 43 full-term infants with necrotizing enterocolitis (NEC) to identify possible risk factors and unique features of the disorder in the more mature infant. Two control groups were used. The first consisted of "healthy" term infants. The second was a group of "sick" term infants who did not develop NEC. The 43 term infants with NEC represented 12.7% of all 338 neonates with NEC. The median age at onset of symptoms was 2 days, and 18 infants developed NEC on the first day of life. Two (4.7%) of the 43 affected term infants died, while 35 (11.9%) of 295 preterm infants with the disorder died. Only three of the full-term infants who subsequently developed NEC had entirely unremarkable courses prior to the onset of symptoms. Sick infants, in particular those who are small for gestational age or require exchange transfusions, are at risk for NEC. Several other features that may be associated with the subsequent development of NEC include the following: perinatal asphyxia, presence of umbilical catheters, antecedent respiratory distress, polycythemia, and maternal preeclampsia. Full-term infants with these features should be treated with cautious observation and aggressive management early in the neonatal period should they develop signs and symptoms suggestive of NEC.

Enterocolitis, Pseudomembranous↗
PubMed1988

Inherent variability of pulmonary function tests in infants with bronchiolitis.

During the last decade, many new methods of assessing pulmonary function in infants have been introduced. However, considerable controversy has arisen when these different techniques are used to assess the efficacy of various inhaled medications. The currently employed measures of pulmonary function have been reported to have coefficients of variation of less than 10%. However, these figures refer to repeated measurements made in individual babies over a short period of time, with the infant in a constant position. They may not be applicable to studies on the effects of drugs when a significant time interval elapses between measurements, particularly if the infant is repositioned during this time. In the present study, we found that the variability of measurements of thoracic gas volume (TGV), passive respiratory mechanics, and forced expiration approximately doubled if the infant was taken out of the plethysmograph, or repositioned within the plethysmograph, between sets of measurements. The between-test coefficients of variation ranged from 4.8% to 18.9% for TGV, 7.8% to 23.5% for respiratory system resistance, from 5.0% to 24.1% for respiratory system compliance, and from 10.8% to 36.1% for maximal flow at functional residual capacity. These results demonstrate that the commonly employed infant pulmonary function tests have wide variability in infants with acute wheezing illnesses. Before studying the efficacy of therapeutic interventions in such infants, it is necessary to establish the individual variability of the tests in the infants under the conditions of the study. Failure to do so may result in erroneous conclusions and recommendations.

Bronchiolitis, Viral↗
PubMed1987

Pulmonary restrictive effect of bracing in mild idiopathic scoliosis.

The use of bracing in the treatment of mild idiopathic scoliosis is controversial. A study of 33 adolescents showed that bracing significantly decreased lung volumes. Functional residual capacity was reduced by a mean of 26%, 18% of children showing a reduction of greater than 40%. The mean reduction in total lung capacity was 16% and in forced vital capacity 18%. This restriction of lung function by bracing might have a deleterious effect on lung growth or might impose an additional risk factor in the presence of other disorders, such as asthma and diaphragmatic weakness. The use of bracing in individuals with mild scoliosis should be judiciously reassessed.

Adolescent↗
PubMed1984

Delivery of sodium cromoglycate by pressurized aerosol.

Sodium cromoglycate (SCG) has recently been formulated as a pressurized aerosol. Twenty-five asthmatic outpatients taking SCG via the Spinhaler were studied in a double-dummy, double-blind cross-over trial in which subjects took Spincaps containing 20 mg of SCG for 2 months, and for the alternate 2 months were treated with SCG aerosol delivering 1 mg/actuation. There was no evidence of clinical deterioration occurring during the period on aerosol SCG. During this period however cough frequency was significantly lower and when data for the 8-13 and 14-46 year age groups were analysed separately, this decrease was seen to be confined to the younger group. Furthermore, this group but not the adults, showed a significant improvement in morning peak expiratory flow rate. We conclude that the aerosol preparation of SCG is a useful alternative to delivery by Spinhaler for patients who are able to coordinate, and that it may have special advantages for children.

Adolescent↗
PubMed1984

Deterioration in lung function after general anaesthesia in patients with cystic fibrosis.

48 hours after oesophagoscopy and injection sclerotherapy of oesophageal varices under general anaesthesia, 11 studies of 6 children with cystic fibrosis and portal hypertension showed a significant deterioration in 4 tests of lung function. The largest falls were seen in Forced Expiration Volume in one second (p less than 0.01) and Forced Expiratory Flow between 25% and 75% of Vital Capacity (p less than 0.02). In 14 studies of 10 children with portal hypertension from other causes a significant fall occurred only in Peak Expiratory Flow Rate (p less than 0.01). The slight falls in Forced Expiratory Volume in one second and Forced Expiratory Flow between 25% and 75% of vital capacity were significantly smaller than those observed in the patients with cystic fibrosis (p less than 0.05; p less than 0.01).

Adolescent↗