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Biomedical subjects

G J Canny

Publications and source records attributed to G J Canny.

At least 37 records · Page 2Linked to original sources
PubMed1991

Management of asthma in early life.

The infant and preschool child with asthma present a unique challenge to the physician responsible for their medical care. Asthma is common in childhood, and estimates of its prevalence in infants and children below the age of 2 years range from 5 to 10%. Despite significant medical advances in the treatment of acute asthma and in the maintenance therapy of the stable asthmatic, reports indicate that morbidity from asthma is on the increase. A clear understanding of the pathophysiologic mechanisms involved, and the array of management possibilities will allow the physician to develop a therapeutic strategy which is suitable for the child and family. With an organized rational approach, the management of the young asthmatic can be a rewarding and pleasant experience for the child, family and physician.

Adrenal Cortex Hormones↗
PubMed1991

Pregnancy and cystic fibrosis.

Despite reduced fertility, pregnancy is likely to occur with increasing frequency in cystic fibrosis in proportion to the number of patients reaching childbearing age. Thirty-eight pregnancies in 25 patients with cystic fibrosis are presented. Twelve of the 25 mothers were pancreatic-sufficient. Despite previous reports of the hazards of pregnancy in cystic fibrosis, we found that pregnancy was well tolerated by the vast majority of our patients and had little effect on their pulmonary and nutritional status. Therapeutic abortion for medical indications was required in two pregnancies. The incidence of prematurity and the neonatal mortality rate were low, and no congenital abnormalities occurred. We conclude that pregnancy can be tolerated by the majority of cystic fibrosis patients, particularly those who are pancreatic-sufficient.

Adolescent↗
PubMed1990

The progressive nature of childhood asthma.

Asthma is the most common chronic disease in childhood. It has been repeatedly stated that childhood asthma is a self-limiting disorder, but this is a misleading and often inaccurate generalization. Prospective studies have demonstrated that many patients who had seemingly outgrown their disease experienced symptoms again as they grew older. In addition, recent evidence suggests that, despite the lack of clinical manifestation of asthma, there is a persistence of bronchial hyperreactivity for several years. A number of epidemiologic studies have identified factors that seem to be associated with the persistence of asthma into later childhood or adult life. Information about the effects of treatment of asthma on the natural history of the disease is vital. While treatment greatly reduces the morbidity from asthma, it is not known whether early recognition and aggressive treatment of the disease have any influence on the outcome of the disease later in life.

Adolescent↗
PubMed1990

Childhood asthma: a rational approach to treatment.

Asthma is a common, but frequently underdiagnosed and undertreated, condition in childhood. In most children, the diagnosis of asthma can be made on the basis of history, physical examination, and simple investigations. Successful management of asthma is contingent upon both patient and parents having a clear understanding of the condition, the goals, and specific details of treatment. The majority of children with asthma can be managed by avoidance of provoking factors, and suppression of symptoms with drug therapy. Drug therapy should follow a logical scheme such that a child with mild, infrequent asthma attacks would receive intermittent bronchodilator therapy, whereas a child with severe chronic asthma would ultimately be treated with maintenance steroids. Response to therapy should be assessed by serial measurement of pulmonary function. Certain features peculiar to infantile asthma demand a modified approach to the management of asthma in this age group.

Asthma↗
PubMed1989

Hypercapnia in relation to pulmonary function in Duchenne muscular dystrophy.

Arterialized blood gases were analyzed in 143 patients with Duchenne muscular dystrophy (DMD) to assess the relationship between forced vital capacity (FVC) and hypercapnia. The majority of patients studied had PaCO2 values in the low or normal range. Only six older patients had hypercapnia (PaCO2 greater than or equal to 45 mm Hg), and all these patients had FVC values less than or equal to 40% predicted. We conclude that hypercapnic respiratory failure occurs as a late preterminal event in DMD.

Blood Gas Analysis↗
PubMed1989

Nocturnal home oxygen in the treatment of hypoxemic cystic fibrosis patients.

The effect of nocturnal oxygen therapy on mortality and morbidity rates and on progression of disease was tested in a double-blind, randomized trial of 28 subjects with advanced cystic fibrosis. Patients were selected on the basis that their awake arterial oxygen tension was less than 65 mm Hg when they were clinically stable. Oxygen was prescribed in 1 L/min increments to obtain an awake arterial oxygen tension of greater than or equal to 70 mm Hg. Subjects received humidified oxygen or room air from modified concentrators. They were enrolled over a 3-year period and followed for an average (+/- SD) of 26 +/- 9 months. The average number of hours per night of concentrator use was 5.3 +/- 3.2 hours in the air group and 7.0 +/- 1.9 hours in the oxygen group. Over the follow-up period there were four deaths in each group, and oxygen therapy had no significant effect on the frequency of hospitalizations. Progression of disease was ascertained from nutritional status, pulmonary function, blood gas values, exercise ability, and right ventricular ejection fraction response to exercise (as measured by equilibrium-gated radionuclide angiocardiography), and psychologic status was measured by standardized tests of mood, self-esteem, and cognitive function; group comparisons for the first year revealed no significant differences; however, school or work attendance was maintained in the oxygen group but deteriorated in the air group. Clinical signs of cor pulmonale were documented during follow-up in 10 patients in toto, and all lived at least 9 months from the onset of these signs. The lack of association between the onset of these signs and imminent death, or the usefulness of measurements of the maximal oxygen uptake during progressive exercise and the right ventricular ejection fraction response to exercise as prognostic indicators, suggest that death may not be the result of cor pulmonale. We conclude that nocturnal oxygen treatment in patients with cystic fibrosis did not appear to affect mortality rates, the frequency of hospitalizations, or the progression of disease; oxygen use should be instituted only after the development of symptoms related to hypoxemia.

Adult↗
PubMed1989

Severe acute asthma in a pediatric intensive care unit: six years' experience.

The management of children with severe acute asthma who required admission to the intensive care (ICU) of this hospital during 1982 to 1988 was reviewed retrospectively. A total of 89 children were admitted to the ICU on 125 occasions. During the study period, 24% of the patients were admitted to the ICU on more than one occasion. Prior to admission to this hospital, patients had been symptomatic for a mean of 48 hours. Although all patients had received bronchodilators before admission to hospital, only 23% of patients had received oral corticosteroids. According to initial arterial blood gas values determined in the ICU, 77% of the patients had hypercapnia (PaCO2 greater than 45 mm Hg). The pharmacologic agents used in the ICU included nebulized beta 2-agonists (100% of admissions), theophylline (99%), steroids (94%), nebulized ipratropium bromide (10%), IV albuterol (38%), and IV isoproterenol (10%). Mechanical ventilation was necessary in 33% of admissions; the mean duration of ventilation was 32 hours. Ten patients had pneumothorax; in six cases, these were related to mechanical ventilation. Three of the patients who received mechanical ventilation died, representing a mortality of 7.5%. In each of these patients, sudden, severe asthma episodes had developed at home, resulting in respiratory arrest. They had evidence of hypoxic encephalopathy at the time of admission to the ICU and eventually were declared brain dead. It was concluded that delay in seeking medical care and underuse of oral corticosteroids at home may have contributed to the need for ICU admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

Acute asthma: observations regarding the management of a pediatric emergency room.

Because inadequate assessment and inappropriate treatment of acute asthma have been implicated as contributing factors in morbidity and even deaths, the management of acute asthma, as practiced in an emergency room, were reviewed. The study population comprised 1,864 children (mean age 5.6 years; 65% boys) who attended the emergency room with acute asthma on 3,358 occasions during a 16-month period. Visits occurred more commonly in winter and usually in the evenings; 93% were self-referred and the mean duration of symptoms was 41 hours. Most acute episodes were associated with infection. Although chest auscultation, heart rate, and respiratory rate were recorded during the majority of visits, evidence that pulsus paradoxus had been measured could be found for only 1% of visits. Results of lung function and blood gas values were rarely recorded, but chest radiographs were obtained in 18% of visits. Drugs used in the emergency room included beta 2-agonists (93% of visits), theophylline (16%), and systemic steroids (4%), but no child received anticholinergic therapy. In 26% of patient visits, admission to hospital occurred; one patient died. The erratic fashion in which asthma severity appears to have been assessed and the failure to document whether lung function had been measured are causes for concern. The surprisingly high hospitalization rate may have been avoided if bronchodilators and corticosteroids had not been underused in the emergency room.

Acute Disease↗
PubMed1988

Hepatic abscess and cystic fibrosis.

Extrapulmonary infection is rare in cystic fibrosis. We describe two adult patients with cystic fibrosis whose course was complicated by the development of liver abscesses. The possible aetiology of these abscesses is discussed and the diagnosis, treatment and prognosis of pyogenic hepatic abscess is briefly reviewed.

Adult↗
PubMed1988

Cardiopulmonary adaptation at rest and during exercise 10 years after Mustard atrial repair for transposition of the great arteries.

Discordance exists between apparently reduced systemic right ventricular function and the reported asymptomatic state of many patients after atrial repair for transposition of the great arteries. To evaluate this clinical observation, cardiopulmonary response to exercise in 17 asymptomatic patients with no significant postoperative hemodynamic abnormalities was assessed by upright bicycle ergometry according to a modified Jomes protocol 11.5 +/- 1.5 years after Mustard atrial repair. Seventeen age- and sex-matched normal adolescents constituted the control group. Incremental exercise was performed to determine maximum work capacity, heart rate, blood pressure, oxygen saturation, and minute ventilation. Cardiac output was computed at rest and during steady-state exercise by a carbon dioxide rebreathing method at 50% of the maximum workload achieved during incremental exercise. Height and weight were similar in patients and controls (p greater than .05). Resting pulmonary function variables were normal in all subjects. At peak exercise, respiratory quotient was greater than 1 in both patients and controls (1.12 +/- 0.09 and 1.09 +/- 0.08 respectively, p greater than .05). Patients achieved a lower peak heart rate (172 +/- 14 vs 185 +/- 11 beats/min, p less than .01), lower maximum work capacity (2.3 +/- 0.6 vs 3.3 +/- 0.7 W/kg, p less than .01). The ratio of minute ventilation at peak exercise to maximum resting voluntary ventilation was normal (less than or equal to 80%) in both groups. The ventilatory equivalent for oxygen was similar at rest, but significantly higher in patients than in control subjects at peak exercise (42 +/- 7 vs 36 +/- 5, p less than .006).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1988

The approach to chronic cough in childhood.

Chronic cough is a fairly common pediatric complaint. Usually, it is secondary to irritation of the airways following a respiratory viral infection. In these cases, the cough tends to diminish over time. There may, however, be a subsequent development of bronchial hyperreactivity. Asthma is common in the pediatric population. From 50% to 90% of chronic coughers may have hyperreactive airways. In the absence of a pulmonary function laboratory to test for this, a trial of bronchodilator therapy is warranted. Other conditions discussed may also cause chronic cough and a thorough history and physical examination with some simple radiologic investigations can help pinpoint the cause. Specific therapy can then be used to manage the problem. In addition to specific therapy, care must be taken to explain to the parents and patient the physiology of the cough and why it is present. Anxieties and fears should be dealt with in a caring and direct manner. Occasionally, non-specific therapy is needed to allow the parents and child some rest and relief.

Child↗
PubMed1988

Aerosols--therapeutic use and delivery in childhood asthma.

Aerosol therapy has dramatically improved the lifestyle of the children with asthma, reflecting both the availability of more effective and safer drugs and alternative methods for their delivery. Inhaled treatment with bronchodilators, cromolyn, and inhaled corticosteroids, used singly or in various drug combinations, can control all but the most intractable asthmatic. It is essential that the inhalational device prescribed is appropriate for the child's age and that careful instructions are given as to optimal inhalation technique. Infants and young children with asthma should be given a trial of inhaled bronchodilators, recognizing the limitations this treatment may have in this age group.

Administration, Inhalation↗
PubMed1987

Energy expenditure of patients with cystic fibrosis.

Resting energy expenditure was measured by open-circuit indirect calorimetry in 71 patients, aged 8.9 to 35.5 years, with cystic fibrosis who had no recent history of acute lung infection. Pulmonary function and nutritional status were studied simultaneously. In most patients, resting energy expenditure was above normal (range 95% to 153% of predicted values for age, sex, and weight as derived from the Harris Benedict equations), and was negatively correlated with pulmonary function (P less than 0.01) and nutritional status (P less than 0.01) when expressed as a percentage of body fat. Pulmonary status was positively correlated with nutritional status (P less than 0.01). We conclude that resting energy expenditure in patients with cystic fibrosis exceeds normal values and that the increase correlates with a deterioration in lung function and nutritional status.

Adolescent↗