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Biomedical subjects

G G Shapiro

Publications and source records attributed to G G Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1983

Mouth breathing in allergic children: its relationship to dentofacial development.

While there are many claims that abnormal breathing patterns alter facial growth, there are limited controlled data to confirm this. We evaluated forty-five North American Caucasians of both sexes, ranging in age from 6 to 12 years. Thirty chronically allergic mouth-breathing subjects were selected from a pediatric allergy practice, and fifteen nonallergic nose breathers were selected from a general pediatric practice. Each subject underwent an intraoral clinical examination and a cephalometric radiograph analysis. Various skeletal and dental relationships were evaluated for statistical differences related to mode of breathing and age. The upper anterior facial height and the total anterior facial height were significantly larger in the mouth breathers. Angular relationships of the sella-nasion, palatal, and occlusal planes to the mandibular plane were greater in the mouth breathers, and their gonial angles were larger. The mouth breathers' maxillae and mandibles were more retrognathic. Palatal height was higher, and overjet was greater in the mouth breathers. Maxillary intermolar width was narrower in the mouth breathers and was associated with a higher prevalence of posterior cross-bite. Over all, mouth breathers had longer faces with narrower maxillae and retrognathic jaws. This supports previous claims that nasal airway obstruction is associated with aberrant facial growth. Longitudinal studies are needed to evaluate the effectiveness of early intervention in preventing these growth alterations.

Age Factors↗
PubMed1983

Double-blind evaluation of methylprednisolone versus placebo for acute asthma episodes.

Twenty-eight children with persistent bronchospasm after outpatient therapy were treated for eight days with methylprednisolone or placebo in a prerandomized double-blind manner, in addition to treatment with optimal oral bronchodilators. At follow-up visits 1, 7, and 14 days after onset of therapy, a history was taken and physical examination and pulmonary function tests were performed. Initially and on the 14th day, patients underwent cosyntropin tests of adrenal function. Patients kept daily peak flow charts. Both groups improved with time. However, by 24 hours after starting methylprednisolone therapy, the placebo group continued to show reversibility after isoproterenol inhalation whereas the methylprednisolone group did not. By day 7 there were significantly more patients with normal 1-second forced expiratory volume (FEV1) and forced expiratory flow in the middle half of the forced vital capacity (FEF25-75%) in the methylprednisolone group and mean FEF25-75% was significantly higher for this group (P less than .02). By day 14, six days after finishing treatment with the study drugs, more patients in the placebo group had residual wheezing, but pulmonary function tests were now similar for the two groups. Although both groups showed a decline in cosyntropin responsiveness on day 14 compared with day 1, there was no difference between the steroid- and placebo-treated patients. This study proves that short-term corticosteroid therapy will accelerate resolution of moderately severe and severe-acute attacks of asthma without significant suppression of adrenal function.

Adrenal Glands↗
PubMed1982

Methacholine bronchial challenge in children.

Methacholine sensitivity was evaluated in 166 young subjects who had normal resting spirometric values but who presented problems suggesting lower airways hyperreactivity. Fifty-eight patients (35%) did not have significant sensitivity. The diagnosis of asthma was excluded in this subgroup. Forty-one patients (25%) had mild methacholine sensitivity, 49 (30%) had moderate sensitivity, and 18 (11%) had extreme methacholine sensitivity. Many patients who reacted had chief complaints of cough, bronchitis, or other low respiratory-tract symptoms and did not complain of wheezing. Methacholine challenge helped to clarify appropriate therapy in these individuals. One-year follow-up of these patients showed most patients to be continuing the therapeutic regimen that had been prescribed initially. Methacholine bronchoprovocation was a useful adjunct to management of this large outpatient population of children and young adults and deserves attention as a procedure relevant to patients care, not solely as an investigational test.

Adolescent↗
PubMed1982

Individualization of theophylline dosage using a single serum sample following a test dose.

Because formulas for theophylline requirement based on weight alone carry the risk of overdosing and toxicity, this study was designed to test a clearance nomogram for determining daily theophylline requirement after a known initial dose of theophylline. Twenty asthmatic children who had not taken theophylline for at least 36 hours fasted and were given one dose of anhydrous theophylline (5 mg/kg). Six hours later the serum level was measured and the appropriate dosage of sustained-release theophylline to achieve a serum level of 10 micrograms/ml was selected from the clearance nomogram. Three to seven days later a six-hour theophylline level was obtained. Of 20 patients, therapeutic levels of 10 to 30 micrograms/ml were achieved in 15, and the remaining five patients had levels close to this (range 6.2 to 16.0 micrograms/ml). The dosage requirement per 24 hours ranged from 10 to 32 mg/kg/24 hr. This method of determining theophylline requirements for children required measurement of the serum theophylline level only once for the determination of a safe and effective daily dose. It is especially valuable when follow-up is difficult and is a safe way to avoid serious overdosing while being certain of effective dosing.

Asthma↗
PubMed1982

Altered theophylline clearance during an influenza B outbreak.

During the 1980 influenza B outbreak in King County, Washington, 11 children whose asthma had previously been controlled with a stable theophylline dose, developed theophylline toxicity on this same dose. Two had seizures, eight had nausea and vomiting, and three had headaches. All had clinical evidence of a febrile viral illness. The toxicity appeared to be related to decreased theophylline clearance, which gradually returned to preillness levels over a period of one to three months. Six of ten children had serologic evidence of influenza B, which is presumed to be the cause of the altered clearance. In children receiving chronic theophylline therapy, symptoms of vomiting, headaches, or seizures during a viral illness may be due to theophylline toxicity rather than the virus. Such patients should have an immediate serum theophylline determination, even if previous levels have been in the therapeutic range.

Asthma↗
PubMed1982

Treatment of persistent eustachian tube dysfunction in children with aerosolized nasal dexamethasone phosphate versus placebo.

Forty-five children aged two to 10 years with persistent eustachian tube dysfunction received a three-week course of aerosolized nasal dexamethasone phosphate or placebo. Patients were randomly assigned to the drug or placebo group and received one spray in each nostril three times a day for three weeks. Middle ear pressure and gradient were assessed with tympanometry. Tympanic membrane mobility, position and presence of middle ear fluid were assessed by the investigators initially and at weekly intervals during the study. Fasting morning plasma cortisol levels were obtained prior to starting the study and at its conclusion. The dexamethasone-treated group showed a significant increase in patients with normal middle ear pressure compared to placebo after one week and a significant increase in the number of patients with normal middle ear gradient at the second week. By the conclusion of the study there were no significant differences between the groups. Within the dexamethasone group, however, there were statistically significant increases in patients achieving normal middle ear pressure, tympanic membrane mobility and position in one or both ears. Plasma cortisol levels fluctuated widely from one determination to another and did not show an over-all declining trend for the dexamethasone group. However, two dexamethasone patients had a transient fall in cortisol level to below the normal range. These results support some therapeutic efficacy for nasal aerosolized dexamethasone but also point out the therapeutic value of time alone. The observation that most improvement occurred in the first two weeks and that some worrisome cortisol changes occurred suggests that dexamethasone therapy should be limited to two weeks and be undertaken with caution.

Administration, Intranasal↗
PubMed1981

Short-term double-blind evaluation of flunisolide aerosol for steroid-dependent asthmatic children and adolescents.

The purpose of this study was to compare the effectiveness of flunisolide aerosol prescribed as .5 mg (two inhalations) twice daily and placebo in terms of oral steroid sparing ability in a population of 32 known steroid-dependent children and adolescents. Patients were stabilized on the lowest tolerated dose of daily AM or alternate AM oral corticosteroid for at least one month before entering the study. They were randomly assigned to either flunisolide or placebo treatment for the 12-week, double-blind trial. Patients were seen every two weeks for symptom assessment, physical examination, and pulmonary function testing. Tests of adrenal function were done initially and at the study's conclusion. The flunisolide group had improved asthma control compared with the placebo group. The daily oral steroid requirement decreased in 100 percent of the flunisolide group compared with 53 percent of the placebo group (P less than .01). Pulmonary function and endocrine function remained stable for both groups. There were no adverse effects. Flunisolide aerosol in doses of .5 mg twice daily appears to be topically active and to have oral steroid potential without apparent adverse effects.

Adolescent↗
PubMed1981

Effectiveness of terbutaline and theophylline alone and in combination in exercise-induced bronchospasm.

Theophylline and terbutaline, alone and in combination, were evaluated for effectiveness in treating exercise-induced bronchospasm (EIB) when used at doses that should be tolerated by adolescents taking them intermittently: theophylline, 250 mg (fast release) and terbutaline, 2.5 mg. Twenty-one subjects, 12 to 19 years of age, with EIB performed standardized exercise tests on four separate days and received either theophylline, terbutaline, the combination, or placebo in a prerandomized double-blind manner prior to exercise. Exercise tests were performed two and five hours after each study drug administration. Blood samples were drawn before and again two and five hours after drug administration for theophylline level. Pulmonary function [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory flow rate (FEF 25% to 75%)] was recorded before and after exercise. All of the active treatments were better than placebo in diminishing EIB. The combination was statistically better than terbutaline or theophylline alone. The effect of theophylline was not significantly different from that of terbutaline. The combination induced significantly more tremor than either agent individually. Either drug alone or the two in combination is effective for diminishing EIB. Although the combination may have additive properties for some patients, the increased incidence of tremor may diminish its appeal. Either drug alone or in combination is effective in decreasing EIB for at least five hours, which makes them practical choices for treatment of school-aged children.

Adolescent↗
PubMed1979

Gastroesophageal reflux in steroid-dependent asthmatic youths.

The aims of this study were to evaluate the incidence of gastroesophageal reflux (GER) in chronic allergic steroid-dependent asthmatic children and to assess whether a medical antireflux regimen might improve pulmonary status of asthmatics found to have reflux. Nineteen patients had a determination of lower esophageal sphincter (LES) pressure, pH assessment after acid instillation into the stomach (acid reflux test), and esophagram. After the reflux evaluation, an antireflux regimen was instituted for three weeks; patients were followed with asthma symptom diaries and weekly pulmonary function tests for this period and for another three weeks after finishing the regimen. Gastroesophageal reflux, diagnosed by positive acid reflux test, occurred in nine patients. Five patients had low LES pressure (less than or equal to 12 mm Hg), and two patients had an abnormal esophagram. There were no significant changes in asthma symptoms or pulmonary function tests with the medical antireflux regimen. Although GER does exist in a high percentage of this patient sample (47%), a short-term antacid and positional antireflux regimen does not improve the pulmonary status of these patients.

Adolescent↗
PubMed1979

Cloprednol therapy in steroid-dependent asthma.

Cloprednol is a new oral corticosteroid with a short half-life that is presently under investigation for use in asthma. Seventeen steroid-dependent children and adolescents were switched from daily treatment with prednisone to cloprednol for a one-year study. Patients showed a statistically significant improvement in symptoms while receiving cloprednol therapy. Two patients had extraordinarily good responses. Growth trends, bone age, and chest roentgenograms were not remarkably changed by cloprednol. Pulmonary function was stable. There was a significant improvement in fasting morning cortisol levels and ability to respond to metyrapone and adrenocorticotropic hormone (ACTH) challenge. Cloprednol appears to be a promising drug for steroid-dependent patients who require oral corticosteroid therapy.

Adolescent↗
PubMed1978

Pulmonary and endocrine function before and after therapy with cromolyn sodium in asthma. Studies in steroid-dependent and nonsteroid-dependent asthmatic children and adolescents.

This study evaluated growth, chest radiographic manifestations, pulmonary function, and function of the pituitary-adrenal axis before and after therapy with cromolyn sodium in two groups of asthmatic youngsters, ie, 18 steroid-dependent patients and ten nonsteroid-dependent patients. The following three groups evolved: (1) steroid-dependent patients; (2) patients weaned from therapy with steroids; and (3) nonsteroid-dependent patients. Growth failure and cataracts were limited to the steroid-dependent group, while abnormalities of the lungs and pituitary-adrenal axis occurred in all three groups. Symptomatic benefits from therapy with cromolyn were striking for all groups. Chest x-ray films and the distribution of alveolar ventilation were more likely to reflect this clinical improvement than tests of pulmonary function and analyses of blood gas levels. Endocrine abnormalities in the steroid-dependent group were significant and were not quickly reversed by withdrawal of therapy with steroids. Even nonsteroid-dependent patients had abnormalities which may be related to having chronic asthma. Therapy with cromolyn seemed to promote some restoration of the function of the pituitary-adrenal axis, as indicated by better responsiveness to administration of metyrapone, which correlated with improved symptomatic control of asthma.

Adolescent↗