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Biomedical subjects

H Eigen

Publications and source records attributed to H Eigen.

At least 55 records · Page 3Linked to original sources
PubMed1988

Bronchoscopy for aspirated foreign bodies in children. Experience in 131 cases.

One hundred thirty-one children underwent rigid bronchoscopy under general anesthesia for suspected aspirated foreign bodies. There were 79 boys and 52 girls, with a mean age of 2.1 years. Physical examination showed decreased breath sounds (n = 130) and wheezing (n = 119) over the affected site. Chest roentgenograms were diagnostic or suggestive of aspirated foreign bodies in 127 cases (97%). Radiopaque lesions were noted on roentgenograms in ten cases. Four infants had a preoperative hypoxic arrest. Two patients had negative results of bronchoscopy (1.5%). Extraction of the aspirated foreign body was carried out at laryngoscopy in two patients and by forceps under direct vision at bronchoscopy in 97 patients. A Fogarty catheter was used in 12 cases. Postendoscopic complications included fever (n = 27), pulmonary infiltrate (n = 11), ventilatory support (n = 4), and pneumothorax (n = 2). Rigid bronchoscopy for aspirated foreign body in children is a safe, effective, and sometimes life-saving procedure. Morbidity is low and mortality is zero.

Bronchi↗
PubMed1988

Infants with cystic fibrosis: pulmonary function at diagnosis.

Meconium ileus (MEC), failure to thrive (FTT), and a combination of FTT and pulmonary symptoms (COMB) are the most frequent symptoms of cystic fibrosis (CF) at the time of diagnosis. The purpose of this study was to compare to normal controls (NC) the pulmonary function of CF infants at the time of diagnosis, when grouped by these symptoms. The measurements of pulmonary function included oxygen saturation (SaO2), functional residual capacity (FRC), mixing index (MI), total respiratory system compliance (Crs), and maximal flow at FRC (VmaxFRC). Compared to NC (n = 33), the MEC group (n = 5) had a higher MI (54 vs. 42%) and no difference in SaO2, Crs or VmaxFRC. There were no significant differences between FTT (n = 8) and NC groups although there was a tendency for Crs to be lower in the FTT group (5.1 vs. 6.8 ml/cm H2O). When compared to all other groups, the COMB group (n = 11) had significantly lower SaO2, MI, Crs, and VmaxFRC. The normal lung function in the MEC group is consistent with the normal anatomy reported in CF infants dying secondary to meconium ileus. Longitudinal evaluation of the infants in this study, following initiation of care as patients with a diagnosis of CF, may allow us to determine whether symptoms at diagnosis remain an important determinant of lung function in infancy.

Cystic Fibrosis↗
PubMed1988

Absence of long term pulmonary sequelae after mild meconium aspiration syndrome.

To assess residual damage from meconium aspiration syndrome (MAS), we studied 12 children, ages 6 to 9 years, an average of 7.4 years after injury. Our sample consisted of mildly affected patients, only one having required intubation and mechanical ventilation in the acute phase of illness. In each child we measured FVC, FEV1, PEFR, MMEFR, VisoV, lung volumes by plethysmography, DLCO and calculated FEV1/FVC and RV/TLC. Methacholine bronchial challenge was performed and the PD20 was calculated. These results were compared with those obtained from a group of 12 normal children studied in our laboratory. No significant difference was found for pulmonary function parameters studied, except for VisoV which was greater in MAS patients than normals (P less than 0.02). Given the inherent high degree of variability with VisoV, we were not able to ascribe this isolated finding to be indicative of small airway disease in these asymptomatic patients. We conclude that patients with mild to moderate initial insult from MAS show an absence of pulmonary sequelae when tested at an average of 7.4 years of age.

Bronchial Provocation Tests↗
PubMed1988

Bronchodilator responsiveness in infants and young children with cystic fibrosis.

Response to the inhaled bronchodilator, metaproterenol, was evaluated in 28 outpatient infants and young children with cystic fibrosis (CF) (mean age, 16 months) and in 22 normal control children (mean age, 13 months). Lung function was assessed from partial expiratory flow volume curves generated by the rapid compression technique and was quantitated by the maximal expiratory flow at functional residual capacity (VmaxFRC). For the normal control group there was no significant change in VmaxFRC after the aerosol of either normal saline or metaproterenol. At baseline, the group of infants with CF had significantly lower values of VmaxFRC than did the normal control infants (202 versus 273 ml/s, p less than 0.05). The CF group demonstrated no significant change from baseline VmaxFRC after the aerosol of normal saline. However, after metaproterenol the CF group had a significant increase (p less than 0.001) in VmaxFRC, which eliminated the difference in VmaxFRC between the CF and normal control groups (267 versus 276 ml/s). We conclude that infants and young children with CF have increased bronchomotor tone and that bronchoconstriction represents a significant component of the airway obstruction present in patients with CF at this age.

Child, Preschool↗
PubMed1987

Evaluation of the addition of cromolyn sodium to bronchodilator maintenance therapy in the long-term management of asthma.

Three hundred ninety-seven patients, aged 5 to 63 years, took part in a year-long international multicenter, double-blind, placebo-controlled trial. The patients, whose asthma was considered not adequately controlled, were divided into two groups according to their principal medication at entry (group A, oral and/or inhaled beta 2-bronchodilators; group B, methylxanthines, with or without beta 2-agonists) and randomly allocated to additional treatment with cromolyn sodium (metered-dose inhaler, 2 mg, four times a day, or capsules, 20 mg, four times a day) or matching placebo. A 2-month baseline preceded 10 to 12 months of treatment. After 4 to 8 weeks of treatment, patients were encouraged to reduce bronchodilator usage. Patients used diary cards to record asthma severity, sleep difficulty, morning and evening peak expiratory flow rates, days of disruption of normal activity, use of test treatments, and concomitant medication. Significant differences favoring cromolyn sodium (p less than 0.05 and better) were observed for most of the treatment period in respect to (1) asthma severity, (2) morning and evening peak expiratory flow rates, and (3) days of disruption of normal activity. Patients receiving cromolyn sodium experienced fewer exacerbations and tended to use less concomitant medication than patients receiving placebo. Patients' opinions of treatment significantly favored cromolyn sodium. These results demonstrate the value of the addition of cromolyn sodium to existing therapy in the long-term management of asthma and endorse its use as a first-line treatment.

Adolescent↗
PubMed1987

Total respiratory system compliance in asymptomatic infants with cystic fibrosis.

Total respiratory system compliance (Crs) was assessed by the weighted spirometer method in 11 asymptomatic infants (mean age, 11.1 months) with cystic fibrosis (CF) who had normal chest radiographs. In addition to Crs, functional residual capacity (FRC), respiratory rate (RR), and mixing index (MI) were measured. There was no significant difference in FRC between normal controls (n = 36) and CF infants (190 +/- 69 versus 186 +/- 63 ml; p less than 0.8), although the CF group had a higher RR (32 +/- 7 versus 37 +/- 7 BPM; p less than 0.05) and a lower MI (45 +/- 7 versus 40 +/- 8%; p less than 0.05), reflecting an abnormal distribution of ventilation. The lower Crs (9.0 +/- 3.4 versus 5.7 +/- 2.8 ml/cm H2O; p less than 0.01) and the lower specific compliance, Crs/FRC (0.049 +/- 0.013 versus 0.029 +/- 0.007 1/cm H2O; p less than 0.0001), in the CF group were the parameters that best distinguished the normal control and CF infants. We conclude that the measurement of Crs represents a noninvasive method for detecting early pulmonary function abnormalities in CF infants.

Cystic Fibrosis↗
PubMed1987

Evaluation of pulmonary parenchymal disease by magnetic resonance imaging.

Thirty-eight patients with a wide variety of different disorders of the lung have been imaged using magnetic resonance. The disorders studied include congenital abnormalities, acute and chronic inflammation, vascular disorders, primary and secondary tumours of the lung, haematomas and infarcts. Magnetic resonance imaging identified all lesions seen on chest radiographs, but it is not quite as sensitive as computed tomography is for detection of very small abnormalities. Magnetic resonance may provide information to aid in differentiation of a wide variety of disorders causing diffuse pulmonary abnormality and might also prove helpful in differentiating acute inflammation from pulmonary collapse or fibrosis. In some disorders, such as lobar emphysema, cystic adenomatoid malformation and sequestration, the findings on the magnetic resonance scan alone will permit a correct diagnosis to be made in many cases. It is believed that magnetic resonance imaging has more potential for pulmonary imaging than has previously been recognised.

Adolescent↗
PubMed1986

Specificity and sensitivity of methacholine challenge test in children with normal and hyperreactive airways.

To assess the ability of the methacholine challenge test for separation between normals and patients with clinically apparent mild airway hyperreactivity, the provocative dose of inhaled methacholine required to cause a 20% drop in the forced expiratory volume in one second was evaluated in two selected pediatric populations. On the basis of a standardized respiratory questionnaire, 70 subjects, 4-16 years of age were identified. Included were 49 normal individuals, and 21 individuals with mild airway hyperreactivity who responded to bronchodilators. Methacholine inhalation challenges were performed by use of a standard inhalation procedure. Forty-seven percent of the normals (23/49) had a positive methacholine challenge test while 24% (5/21) of the patients with hyperreactive airways had a negative test by the standard criteria. A wide spectrum of specificity and sensitivity of methacholine challenge was obtained at different doses of methacholine. The greater the sensitivity, the lower the specificity. Therefore, we postulate that the methacholine challenge test can be helpful in making the clinical diagnosis but it does not allow a clear and perfect separation between normal and clinically apparent mildly airway reactive patients in a pediatric age population.

Adolescent↗
PubMed1985

Intra-abdominal complications of cystic fibrosis.

In recent years patients with cystic fibrosis (CF) have experienced longterm survival and have demonstrated a number of intra-abdominal complications. This report evaluates the intra-abdominal complications seen in 69 of 189 children with cystic fibrosis from 1972 to 1983. Forty-one patients were boys and twenty-eight girls. Complications occurred in 36 neonates, with meconium ileus (MI) noted in 33 and giant cystic meconium peritonitis (GCMP) in 3. Meconium ileus equivalent occurred in seven older children presenting with bowel obstruction. In addition, rectal prolapse occurred in 12, inguinal hernia in 10, intussusception in 3, cholelithiasis in 3, GE reflux in 4, stress ulcer in 1 and appendicitis in 1. Three infants with GCMP survived resection and enterostomy. Infants with MI were divided into simple (15) or complicated (18) cases. Nonoperative therapy using gastrografin enema was successful in three of eight with simple MI. Operative enterotomy and irrigation was successful in three cases while resection and enterostomy was done in nine. MI was complicated by atresia, volvulus and/or perforation in 18 cases requiring resection and anastomosis or enterostomy. Survival for MI was 86% compared to 36% in 25 MI patients treated in the previous two decades. Meconium ileus equivalent was successfully managed using gastrografin enema in five of seven children. Only 3 of 12 children with rectal prolapse required repair. Two cases of intussusception were reduced while one required resection. Three of 10 children had hernia recurrence due to chronic pulmonary problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1985

Predictability and consequences of spontaneous extubation in a pediatric ICU.

To determine the incidence of, and the factors contributing to spontaneous extubation (SE), we followed prospectively all intubated children admitted to a pediatric ICU. Eleven potential risk factors were monitored and scored twice daily for 8 consecutive months. Using data from the first 204 patient admissions, we evaluated the risk factors by orthogonal discriminant analysis and found that four factors (patient age, amount of secretions, endotracheal tube slippage, and state of consciousness), when considered together, had good discriminating power for SE vs. intentional extubation. We tested this method on the next 45 patient admissions and identified all seven spontaneously extubated patients as high risk. Analysis of covariance revealed successful discrimination between low-risk and high-risk patients for up to three days after patient admission. Overall, the incidence of SE was 13% (33 of 249). The effect of extubation on gas exchange was the same for spontaneously and intentionally extubated patients. No morbidity or deaths were attributed to SE. Standard ventilator low-pressure alarms did not reliably signal the presence of SE, nor did upper extremity restraints keep patients from extubating themselves.

Adolescent↗
PubMed1985

Bleomycin lung injury in children. Pathophysiology and guidelines for management.

The development of pulmonary side effects, especially pulmonary fibrosis, during treatment with bleomycin is well documented in adult oncology patients, but not in children. A report of fatal pulmonary fibrosis which developed after exposure to oxygen while under anesthesia in a 3-year-old boy treated with bleomycin exemplifies the problem. The prevention of long-term complications associated with bleomycin is especially important in children, since a child cured of a malignant neoplasm may enjoy many years of productive life. Given the present limitations, guidelines for management of pediatric patients given bleomycin include: discontinuation of bleomycin therapy with the onset of symptoms; serial pulmonary function testing during the course of treatment; and early treatment with high-dose corticosteroids (prednisone 2 mg/kg/day) if symptoms occur.

Bleomycin↗
PubMed1985

Evaluation of lung sounds by telephone.

We evaluated the utility of a newly designed electronic stethoscope that can be used with the telephone system. Nine patients with wheezing, crackles, or other adventitious sounds were evaluated by a physician examiner who used a conventional stethoscope and another physician who received the signal of the electronic stethoscope via telephone. When their findings were compared, it was found that physicians agreed in 95% of observations. The potential uses of the electronic stethoscope are discussed.

Adolescent↗
PubMed1985

Achalasia and tracheal obstruction in a child.

A 13-year-old patient was referred for evaluation of pulmonary symptoms and was subsequently diagnosed to have achalasia. An esophagram revealed a dilated esophagus which obstructed the trachea at the thoracic outlet during a forced expiratory maneuver. Pulmonary function tests, obtained before and after esophagomyotomy, are presented.

Adolescent↗