Current nutritional recommendations in peritoneal dialysis.
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Adult↗
Biomedical subjects
G Russell
Publications and source records attributed to G Russell.
The spatiotemporal development of innervation in spinal ligaments of chickens.
The development of the innervation of both central and lateral (intertransverse) spinal ligaments was investigated in chickens between the time of hatching and 13 wk of age. A total of 36 White Leghorn chickens in 4 groups of 9 at ages 0, 2, 7, and 13 wk were used. The spinal ligaments were dissected, serially sectioned and labelled with a monoclonal antibody against neurofilament protein and observed using either conventional fluorescence or confocal microscopy. Only a few nerve elements were found in the ligaments at hatching and these consisted simply of single nerve fibres and small nerve bundles. The number of nerve elements increased rapidly up to 7 wk of age when large nerve bundles and Ruffini corpuscles were also found. The number of nerve elements decreased between 7 and 13 wk birds when the ligaments had begun to ossify and the amount of collagenous ligamentous tissue was significantly reduced. The fluctuation in numbers of neural elements was due to changes in numbers of single nerve fibres and small nerve bundles rather than large nerve bundles and Ruffini corpuscles which remained constant. In contrast to this significant increase in numbers of nerve elements, the innervation density of the ligaments decreased because of the overwhelming increase of the ligament volume due to growth. There were no differences between ligaments on the left and right sides of the body, but there was an unequal distribution of the neural elements within the ligaments; most were found in the cranial third of the intertransverse ligaments. These results show that significant changes in innervation of spinal ligaments occur during development and reflect the possibility that damage to the ligaments during this time could produce significant and permanent damage, especially in relation to the maintenance of an erect spine.
Animals↗
The nature and distribution of the innervation of human supraspinal and interspinal ligaments.
STUDY DESIGN: To use fresh, human supraspinal and interspinal ligaments and document their innervation. OBJECTIVES: To characterize the innervation of the human supraspinal and interspinal ligaments. SUMMARY OF BACKGROUND DATA: The nature and distribution of the innervation of spinal ligaments remains unknown. METHODS: Sections of spinal ligaments were labeled with a fluorescent antibody against neurofilament proteins and observed with a confocal microscope. RESULTS: The ligaments were found to be well innervated. Innervation was equally distributed along the ligament, symmetrically distributed between left and right sides, and more densely distributed in the periphery. Pacinian corpuscles were scattered randomly, close to blood vessels, whereas Ruffini corpuscles were in the periphery, close to the collagen bundles. CONCLUSIONS: Human supraspinal and interspinal ligaments are well innervated. This innervation might form the basis of neurologic feedback mechanisms for the protection and stability of the spine. These mechanisms might also be important in the development of diseases such as scoliosis.
Adult↗
Paroxysmal vertigo as a migraine equivalent in children: a population-based study.
We studied the prevalence, causes and clinical features of paroxysmal vertigo (PV) in the well-defined childhood population of the City of Aberdeen. We applied a screening questionnaire to 2165 children (10% random sample of all children 5-15 years of age) attending schools in Aberdeen. Children with a history of at least three episodes of vertigo over the past year due to unknown causes were invited for clinical interview and examination. Children with PV were compared with a group of children with migraine, and with a group of asymptomatic children matched for age and sex. Forty-five children fulfilled the diagnostic criteria for PV (prevalence rate 2.6%, 95% CI 1.9-3.4). They were noted to have clinical features in common with children with migraine, including trigger and relieving factors, associated gastrointestinal and sensory symptoms, vasomotor changes, and a similar pattern of associated recurrent disorders (such as headache, abdominal pain and cyclical vomiting), atopic diseases and travel sickness. Also, they had a twofold increase in the prevalence of migraine (24%) compared with the general childhood population (10.6%). The overlap in the clinical features of PV and migraine suggests that the two conditions are related and that it is reasonable to continue to regard PV as a migraine equivalent.
Adolescent↗
The relationship between cyclic vomiting syndrome and abdominal migraine.
Abdominal migraine and cyclic vomiting are both self-limiting episodic conditions of children, with periods of complete normality between episodes. The clinical features of both syndromes show considerable similarity, and resemble those found in association with migraine headaches. It is proposed that cyclic vomiting is a condition related to migraine.
Abdominal Pain↗
Cyclical vomiting syndrome in children: a population-based study.
We studied the prevalence and the characteristic features of cyclical vomiting syndrome (CVS) in the defined childhood population of the City of Aberdeen, in Scotland. Initial screening was done by questionnaire in 10% of all children between 5 and 15 years of age (2,165 children) attending schools in Aberdeen, followed by clinical interviews of symptomatic children. We invited for clinical interview 69 children (3.9%) with a history of unexplained vomiting; 46 (67%) attended. Of them, 34 fulfilled the criteria for the diagnosis of CVS (prevalence rate, 1.9%). Children with CVS had a mean age of 9.6 years and a mean age at onset of symptoms of 5.3 years (range, 1-13). The overall sex ratio was 1:1, although in younger children boys were more commonly affected than girls. Seven children (21%) also suffered from migraine, 10 (29%) from travel sickness, and 10 (29%) from atopic diseases. The attacks of vomiting occurred on average eight times per year, with a mean duration of 20 h. Travel was a frequent precipitating factor. Attacks were commonly associated with pallor, anorexia, and malaise and were often relieved by rest and sleep. The clinical features of CVS overlapped to a large extent with those of migraine, suggesting a common pathogenesis. Features common to both conditions included trigger factors, associated GI, sensory, and vasomotor symptoms, and factors that relieved attacks. There was also an association between CVS and headache, abdominal pain, atopic diseases, and travel sickness.
Adolescent↗
Myocarditis and haemolytic uraemic syndrome.
A 13 year old girl is reported who presented with haemolytic uraemic syndrome (HUS) due to Escherichia coli O157:H7 infection. She died during the acute phase of the illness after an episode of unexplained sudden circulatory collapse. Postmortem examination confirmed the diagnosis of HUS and showed histological evidence of myocarditis manifested by the presence of inflammatory cell infiltration in the myocardium and around the conducting system.
Adolescent↗
Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine.
Fourteen children with abdominal migraine were treated with pizotifen and placebo in a double blind crossover trial. The results showed pizotifen to be clearly superior to placebo in the prophylaxis of abdominal migraine. The importance of clearly distinguishing abdominal migraine from other forms of recurrent abdominal pain is emphasised.
Abdominal Pain↗
Prevalence and clinical features of abdominal migraine compared with those of migraine headache.
The prevalence and clinical features of migraine headache and abdominal migraine were studied in the well defined population of Aberdeen schoolchildren. Ten per cent of all children (2165) aged 5-15 years were given a questionnaire inquiring, among other symptoms, about the history of headache and abdominal pain over the past year. A total of 1754 children (81%) responded. Children with at least two episodes of severe headache and/or sever abdominal pain, attributed by the parents either to unknown causes or to migraine, were invited to attend for clinical interview and examination. After interview, 159 children fulfilled the International Headache Society's criteria for the diagnosis of migraine and 58 children had abdominal migraine giving estimated prevalence rates of 10.6% and 4.1% respectively. Children with abdominal migraine had demographic and social characteristics similar to those of children with migraine. They also had similar patterns of associated recurrent painful conditions, trigger and relieving factors, and associated symptoms during attacks. The similarities between the two conditions are so close as to suggest that they have a common pathogenesis.
Abdominal Pain↗
Persistent nocturnal cough in childhood: a population based study.
A cross sectional epidemiological study was carried out to investigate the validity of persistent nocturnal cough (PNC) as an independent marker of childhood asthma. A screening questionnaire on respiratory symptoms was applied to 4003 children attending primary schools in Aberdeen, after which 799 symptomatic children and a random selection of 229 asymptomatic children were invited to attend for a diagnostic interview. Six hundred and seven (359 boys and 248 girls) symptomatic children and 135 asymptomatic children (57 boys and 78 girls) were selected from the screening questionnaires. Of 607 children with respiratory symptoms when interviewed, 27 (nine boys and 18 girls) had isolated PNC, and 97 (51 boys and 46 girls) had multiple symptoms (polysymptomatic asthma). The incidence of prematurity was highest in the group with PNC (19%). The prevalence of hay fever in children with PNC (11%) was similar to that of the asymptomatic group (15%) and less than that in the group with polysymptomatic asthma (41%). Eczema was twice as common in the PNC (19%) as in the asymptomatic children (10%) but only half as common in the polysymptomatic asthma group (35%). The prevalence of a parental history of hay fever was similar in all three groups. The prevalence of a parental history of eczema was similar in the PNC (7%) and asymptomatic (7%) groups but higher in the polysymptomatic asthma group (22%). The prevalence of a history of parental asthma was 30% in children with PNC, 13% in the asymptomatic group, and 42% in those with polysymptomatic asthma. The parents of three (11%) children with PNC were aware of a diagnosis of asthma; two of these children (7%) were on inhaled bronchodilator treatment and one (4%) was on a slow release theophylline preparation. Using a stepwise discriminant analysis procedure, in 18 (67%) children with PNC predicted membership was in the asymptomatic group and only nine (33%) children with PNC were grouped into the polysymptomatic asthma category. It is concluded that the clinical features of children with PNC resembled those of the asymptomatic population more closely than those of the polysymptomatic asthmatic population. In this age group PNC, in the absence of wheeze, shortness of breath or tightness in the chest, is likely to be a manifestation of atypical or hidden asthma in only a minority of cases.
Asthma↗
Simultaneous tracheal and oesophageal pH measurements in asthmatic patients with gastro-oesophageal reflux.
BACKGROUND: An association between asthma and gastro-oesophageal reflux is well recognised but the underlying mechanism is unclear. One suggestion is that gastric juice is aspirated into the tracheal and upper airways but detection of these events is difficult and involves radioisotopic studies. A new method of making direct measurements of tracheal and oesophageal pH over a 24 hour period is described, together with its application to patients with asthma. METHODS: The technique involves insertion of simultaneous tracheal and oesophageal pH probes under general anaesthesia. Continuous monitoring of pH over a 24 hour period is possible, permitting comparison with peak flow readings during wakefulness and at night should the patient be disturbed. Representative data from four patients with asthma (mean FEV1 62% predicted) and symptomatic gastro-oesophageal reflux, together with data from three non-asthmatics, is presented. RESULTS: Thirty seven episodes of gastro-oesophageal reflux lasting more than five minutes were recorded. Of these, five were closely followed by a fall in tracheal pH from a mean (SE) of 7.1 (0.2) to 4.1 (0.4) and a fall in peak expiratory flow (PEFR) of 84 (16) l/min. When gastro-oesophageal reflux occurred without tracheal aspiration the fall in PEFR was 8 (4) l/min. CONCLUSIONS: This new technique was well tolerated and allowed quantitation of the number, duration, and timing of episodes of tracheal micro-aspiration. Unlike acid reflux without aspiration, these events appear to be related to significant acute changes in lung function in asthmatic patients. Further studies with this new method may elucidate the role of gastro-oesophageal reflux in asthma.
Asthma↗
Posterior subcapsular cataract and inhaled corticosteroid therapy.
BACKGROUND: Although posterior subcapsular cataract complicates both systemic and topical corticosteroid therapy, the literature on the effects of inhaled corticosteroids is conflicting. METHODS: One hundred and forty children and young adults on inhaled corticosteroids were examined by slit lamp ophthalmoscopy after pupillary dilatation; 103 had received one or more short courses (< or = 7 days) of oral corticosteroids in the management of acute asthmatic attacks and four had also received one or more prolonged courses (> or = 4 weeks) of alternate day oral corticosteroid therapy. RESULTS: Bilateral posterior subcapsular cataract was identified in one girl who had received several prolonged courses of oral corticosteroids, but was not identified in any other patient. CONCLUSIONS: There is no evidence to support the contention that inhaled corticosteroid therapy on its own, or in association with short courses of oral corticosteroid therapy, might cause cataracts. Although children receiving long term systemic corticosteroid therapy should be screened for cataracts, this is unnecessary in children on inhaled corticosteroids alone.
Administration, Inhalation↗
Case reports and confidentiality. Opinion is sought, medical and legal.
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Attitude of Health Personnel↗
Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer.
PURPOSE: The purpose of this study was to elicit preferences for the treatment of metastatic breast cancer in women with early-stage breast cancer who were given hypothetical treatment scenarios. We predicted that quality of life, demographic, and treatment variables would have an impact on patient preferences. PATIENTS AND METHODS: One hundred fifteen patients with stage 1-IIIA breast cancer were interviewed. All patients had either mastectomy or lumpectomy plus radiotherapy as primary treatment. Sixty-seven (58%) had prior adjuvant chemotherapy. Patients were given four clinical scenarios that described a woman with metastatic breast cancer who was stated to have a life expectancy of 18 months. Side effects of the treatment options were systematically varied from low (hormonal therapy) to life-threatening (high-dose experimental therapy) and were consistent with common clinical situations. Patients were asked to select which treatment, with its associated toxicity, they would accept and prefer for a 50% chance of specified increments in life expectancy, ie, 5 years, 18 months, 1 year, 6 months, 1 month, and 1 week. RESULTS: Quality of life at the time of interview, previous chemotherapy treatment, and degree of difficulty of previous treatments did not predict patient preferences. The greater the toxicity potential of the treatment, the less likely patients were to accept the treatment, although approximately 15% of patients would prefer high-risk treatment for as little as 1 month of added life expectancy. Between 34% and 82% of patients would prefer different therapies for a 6-month addition to life expectancy, whereas almost all patients would accept treatment for a 5-year increase in length of survival. Younger patients were more willing to assume the risks of treatment for a small increase in life expectancy. Of note, between 54% and 78% of patients would elect to start the different treatments even without symptoms related to metastatic disease. Moreover, 76% of patients would prefer standard treatment or an experimental agent to reduce symptoms or pain, even if such treatment did not prolong life. Additionally, only 10% of patients would allow randomization to a clinical trial comparing high-dose with standard chemotherapy. Participation in the study was not distressing to most patients. CONCLUSION: Patients showed clear preferences for specific treatments for metastatic disease when given hypothetical scenarios. There was a wide range of patient preferences for treatment based on risk-benefit assessment, but a substantial percentage of patients would accept the risk of major toxicity for minimal increase in overall survival.
Adult↗
Salmeterol xinafoate in children on high dose inhaled steroids.
BACKGROUND: Current UK and international guidelines on asthma management recommend that, in pediatric patients still symptomatic on treatment with high-dose inhaled corticosteroids, consideration should be given to the introduction of regular twice daily long-acting beta 2-agonists. OBJECTIVE: The purpose of this study was to assess the efficacy and safety of inhaled salmeterol xinafoate 50 micrograms bid via the Diskhaler when added to the existing treatment of children with moderate to severe asthma. METHODS: A 12-week multicenter, double-blind, placebo-controlled, parallel group study was conducted at 78 hospital centers throughout the United Kingdom, involving 210 asthmatic children aged between 4 and 16 years of age. Morning peak expiratory flow (PEF), evening PEF, night-time and daytime symptoms and relief medication usage were recorded daily by the patient or parent over a 12-week treatment period. RESULTS: Compared with placebo, the addition of salmeterol xinafoate to existing high dose inhaled corticosteroid treatment significantly improved mean morning PEF expressed as percent predicted (PEF-PP) during the first 4 weeks of treatment (median increase 6.5 percentage points P < .001). This effect persisted throughout the 12-week treatment period (P < .05). Both groups demonstrated an overall improvement in mean morning PEF-PP, 7.5 percentage points for salmeterol xinafoate and 4 percentage points for placebo. The mean evening PEF-PP followed a similar although less pronounced trend which was significant only during the first 4 weeks of treatment (P = .014). Daytime relief medication and recorded symptoms were reduced significantly in both groups. There was a greater improvement in the number of symptom-free days during the first 4 weeks (P < .01) and the last 4 weeks (P < .05) of treatment for salmeterol xinafoate. The overall incidence and nature of minor adverse events was similar in both groups. CONCLUSIONS: This study demonstrates that the addition of salmeterol xinafoate to inhaled corticosteroid therapy in symptomatic asthmatic children significantly improves morning PEF-PP, and reduces their symptoms and use of relief medication.
Administration, Inhalation↗
A comparison of spinal ligaments--differences between bipeds and quadrupeds.
Following dissection, the spinal ligaments were observed in a selection of bipedal, pseudobipedal and quadrupedal animals during a search for an appropriate animal model for investigating the innervation of these ligaments. Midline spinal ligaments were found in all animals while lateral spinal ligaments could only be observed in bipedal (human) and pseudobipedal (avian) species. The presence of lateral spinal ligaments in these animals and their absence in quadrupeds suggests that the development of the lateral ligaments reflects a mechanical challenge unique to the erect spine and that these lateral spinal ligaments are fundamental to the stability of an erect posture.
Animals↗
Social support and health-related quality of life in black and white dialysis patients.
OBJECTIVES: To identify factors associated with health-related quality of life (HRQoL) in end stage renal disease (ESRD) patients treated with dialysis, and to identify potential racial differences in HRQoL. DESIGN: Cross-sectional study. SAMPLE/SETTINGS: 256 dialysis patients; 72 black women, 59 black men, 61 white women, and 64 white men at Piedmont Dialysis Center, a university-affiliated dialysis center in northwest North Carolina. METHODS: Information was obtained on perceived social support, social networks, blood chemistries, blood pressure, cause of renal failure, treatment-related factors, and socioeconomic factors. HRQoL indicators included two measures of life satisfaction, limitations in leisure-time activities, and Karnofsky's Physical Functioning Scale. RESULTS: On all HRQoL indicators, blacks consistently rated their HRQoL better than whites. In univariate analyses, lack of social support was consistently related to poorer HRQoL. In multivariate regression analyses, good social support and black race were the two strongest predictors of more positive responses to each of the HRQoL indicators, after controlling for the effects of the other investigated factors. With respect to the Karnofsky scale, younger age and fewer medications taken were additional significant predictors of better functioning. CONCLUSIONS: HRQoL was consistently rated better among blacks than among whites. In addition, perceived social support exerted a strong, independent influence on objectively and subjectively measured HRQoL of ESRD patients.
Black or African American↗
Quantitative morphology of the lateral ligaments of the spine. Assessment of their importance in maintaining lateral stability.
STUDY DESIGN: This study used human cadaveric material to examine the three-dimensional morphology and biomechanics of the superior and lateral costotransverse ligaments and the intertransverse ligament of the spine. OBJECTIVES: To provide descriptive and quantitative data on the morphology of the lateral ligaments of the spine and to assess their importance in maintaining lateral stability, especially regarding the pathogenesis of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Ligaments have been reported as being able to stabilize the spine by mechanical constraint and by neurologic feed-back. Midline spinal ligaments have been well studied but do not appear to be effective in maintaining lateral stability because of their sites of attachment. Lateral ligaments of the spine have not been adequately documented in the literature. METHODS: The morphology, sites of attachment, and dimensions of the superior costotransverse ligament, lateral costotransverse ligament, and intertransverse ligament from thoracic level 7 to thoracic level 10 were determined on 32 human cadavers. RESULTS: The intertransverse ligament was found not to be a true ligament. The lateral costotransverse ligament was a true ligament but did not have the characteristics appropriate for involvement in lateral stability. The superior costotransverse ligament also was a true ligament and had all of the characteristics appropriate for involvement in the active lateral balancing of the spine. CONCLUSIONS: In contrast to the midline ligaments of the spine, the superior costotransverse ligament perhaps is the most important ligament for active lateral balancing of the spine and warrants further study, particularly regarding the development of idiopathic scoliosis.
Aged↗