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Biomedical subjects

H Levison

Publications and source records attributed to H Levison.

At least 145 records · Page 8Linked to original sources
PubMed1983

Long-term evaluation of fenoterol by two different modes of administration (oral versus metered aerosol).

Thirteen asthmatic children were treated double-blind for 6 weeks each with either inhaled or oral fenoterol (a beta-2-selective adrenergic bronchodilator) three times a day. The oral dose regimen resulted in superior bronchodilation on the basis of peak expiratory flow rates, although clinical symptom scores did not differ with the route of administration. We conclude that oral fenoterol can be used on a chronic basis for the treatment of moderate asthmatics. Doses of inhaled fenoterol higher than 0.4 mg three times per day used in this study may be required to produce a similar effect to 0.8 mg/kg of oral fenoterol in three divided doses.

Administration, Oral↗
PubMed1983

Pathophysiology of the ciliary motility syndromes.

The ciliary motility syndromes are characterised by specific and genetically determined defects of cilia with resulting impairment of mucociliary defense mechanisms in the respiratory tract. The ciliary pathobiology, clinical observations, serial pulmonary function and chest radiographs are reviewed and correlated for a series of 33 patients with the ciliary motility syndromes, aged from 0.5 to 75 years. The clinical course and progressive nature of this disease emphasizes the importance of early and accurate diagnosis to prevent irreversible pulmonary damage.

Adolescent↗
PubMed1983

Assessment of a new device (aerochamber) for use with aerosol drugs in asthmatic children.

We compared the pulmonary response to fenoterol delivered by a conventional MDI with the response after MDI plus the aerochamber (AC). Twelve children with moderate to severe asthma (mean age 10.8 years) participated in this double-blind crossover study. On two consecutive days, in random order, subjects received one puff of fenoterol hydrobromide (200 mcg) either by MDI or MDI plus AC. Pulmonary function, cardiovascular response and tremor were assessed over a period of four hours. In a similar fashion, the children received one puff of fenoterol three times a day for six weeks by either method in a randomized open study. Daily symptoms and peak flows before and after drug were recorded in daily diaries. The patients returned to the pulmonary function laboratory at 6 and 12 weeks for four hour pulmonary function tests. In the short-term study, the magnitude and time course of pulmonary response was similar for both treatment regimens (p greater than 0.4). No significant effects on blood pressure or pulse or differences in tremor assessment were seen. Similarly, in the long term study the baseline pulmonary function and pulmonary response were markedly consistent between the two treatment regimens (p greater than 0.05). Peak flows were significantly higher in the evening than in the morning (p less than 0.001) and the magnitude of the response to drug was higher in the morning than the evening (p less than 0.001). There were no differences between MDI and MDI plus AC in daily symptom scores or use of concomitant medication. We conclude that acute or chronic administration of fenoterol aerosol to asthmatic children by MDI with or without the AC produces similar benefits in pulmonary function, symptomatology and concomitant medication. The AC device would be a useful adjunct for a child who has difficulty in coordinating the metered dose inhaler.

Aerosols↗
PubMed1983

Prognostic value of sweat-chloride levels in cystic fibrosis: a negative report.

Sweat-chloride levels at the time of diagnosis have been reviewed from 708 patients with cystic fibrosis. Sixty-one patients, shown to be non-steatorrheic, were found to have significantly lower levels than 647 patients with severe pancreatic insufficiency. Although patients who retain pancreatic function are known to have less severe pulmonary involvement and a better overall prognosis (5), we were unable to show any correlation of sweat-chloride levels at diagnosis with pulmonary function, current age or Shwachman clinical score which might be of prognostic value.

Chlorides↗
PubMed1982

Improved respiratory prognosis in patients with cystic fibrosis with normal fat absorption.

The clinical presentation, courses, and sweat chloride values of 72 CF patients with normal fat absorption are described. In general, these patients had milder clinical symptoms and a lower mean sweat chloride value than their counterparts with steatorrhoea. Pulmonary function tests, including FEV1, FVC, FEF25%-75%, PaO2, and RV/TLC%, were significantly better in patients with normal fat absorption compared with both male and female patients who had steatorrhoea. The maintenance of better pulmonary function, coupled with the low mortality, suggests that patients without steatorrhoea have a better prognosis. This difference remains unexplained, but may be contributed to by nutritional, genetic, or pancreatic factors.

Adolescent↗
PubMed1982

Antibiotic prophylaxis in cystic fibrosis: inhaled cephaloridine as an adjunct to oral cloxacillin.

The effect of prophylactic antibiotics on bacterial colonization of the respiratory tract and on general progression of cystic fibrosis was studied in a two-year prospective study of 47 mildly to moderately affected patients. One group of patients received inhaled cephaloridine and the other received no inhaled antibiotic; both groups received cloxacillin orally. Carriage of Haemophilus influenzae was greater in the group not receiving inhaled antibiotic (55% vs 20%). Rates of carriage of Staphylococcus aureus (23%). Pseudomonas aeruginosa (greater than 90%). Pseudomonas cepacia (45%), and other organisms were similar in both groups. There were no significant differences between the two groups in incidence of respiratory tract infections or hospital admissions, clinical scores, radiologic scores, or rate of change of pulmonary function. Although continuous antistaphylococcal antibiotic prophylaxis may be successful in suppressing colonization with S. aureus, it may also contribute to the high rates of carriage of Ps. aeruginosa and Ps. cepacia observed in patients with cystic fibrosis.

Administration, Oral↗
PubMed1982

An evaluation of incentive spirometry in the management of pulmonary complications after cardiac surgery in a pediatric population.

Changes in pulmonary function and the development of atelectasis in the postoperative period have been well documented in the adult population. The use of incentive spirometry has been shown to be effective in the prevention of these postoperative complications. At the Hospital of Sick Children, we studied 17 children (8 control and 9 study) to determine if the same trends occurred. Baseline and follow-up roentgenograms and pulmonary function tests (PFTs) were documented for both groups. In addition, the study group followed the protocol for incentive spirometry. There was significantly less atelectasis in the study group (33%) than in the control group (88%). There was a significant loss of pulmonary function postoperatively in both groups. However, there were no statistically significant differences between the groups either in the degree of pulmonary function loss postoperatively or in the recovery baseline pulmonary function to discharge. We conclude that incentive spirometry is as effective in reducing the incidence of atelectasis in children undergoing cardiac surgery as in adults.

Adolescent↗
PubMed1982

Evaluation of pulmonary function in muscular dystrophy patients requiring spinal surgery.

Scoliosis associated with muscular dystrophy frequently necessitates surgical stabilization of the spine. The timing of surgery usually is based on the degree of spinal angulation. Pulmonary function, which deteriorates with age in children with muscular dystrophy, should also be an important consideration in this timing. In a retrospective study of 48 patients who underwent spinal stabilization, preoperative respiratory function tests were correlated with postoperative respiratory complications. The percentage of predicted vital capacity provided the best indicator of outcome and values of less than 30% were associated with major respiratory complications. Spinal fixation failed to arrest the decline in respiratory function in these patients, but it seemed to slow the rate of deterioration compared with preoperative changes. Evaluation of pulmonary function should play a major role in the timing of surgical intervention in muscular dystrophy.

Adolescent↗
PubMed1982

Comparison of three different preparations of disodium cromoglycate in the prevention of exercise-induced bronchospasm: a double-blind study.

In its usual form, disodium cromoglycate (DSG) contains lactose as a carrier (DSGL +). It has been suggested that lactose may effect irritant receptor sites, thus causing a degree of bronchoconstriction or less blocking of exercise-induced bronchospasm (EIB). This study was designed to assess and compare the ability of three different forms of DSG to block EIB. Eighteen asthmatic children and adolescents were given either DSGL+ by Spinhaler, DSG without lactose (DSGL-) by Spinhaler, nebulized (and also lactose-free) DSG solution (DSGN), or placebo in a randomized double-blind fashion on four occasions within a 10-day period. Pulmonary function tests were performed before and after medication and again after a standardized treadmill exercise test. After the exercise that followed treatment with each form of DSG the decreases in peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV1) were significantly less than that seen after treatment with placebo. There was no significant difference between any of the three preparations of DSG. A complete block of EIB (decreases in PEFR and FEV1 of less than 12.5% and 10%, respectively) was seen in ony 11% of studies using all forms of DSG however, DSG was considered to be 'clinically effective' in 59% of studies.

Adolescent↗
PubMed1982

The immediate effect of sodium cromoglycate on the airway.

The authors compared the bronchodilator effect of nebulized solutions of sodium cromoglycate (SCG), salbutamol, and saline (placebo) in 10 asthmatic children, measuring peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced expiratory flow from 25% to 75% of the forced vital capacity (FEF25%-75%) before and every five minutes to a maximum of 20 minutes after each aerosol. SCG produced significant bronchodilation compared with saline as measured by PEF. This effect was not seen with FEV1 or FEF25%-75%. Salbutamol had a more immediate effect and produced a greater degree of bronchodilation than SCG. When an immediate bronchodilator effect is required SCG is not recommended.

Airway Obstruction↗
PubMed1981

Pregnancy in cystic fibrosis: a better prognosis in patients with pancreatic function?

Pregnancy in patients with cystic fibrosis is likely to become a more common occurrence as a result of improving survival rates in females with this condition. Eleven pregnancies in seven patients with cystic fibrosis are presented. Despite previous reports on the hazards of pregnancy in women with cystic fibrosis, only one pregnancy required a therapeutic abortion to preserve the health of the mother. Nine of the pregnancies occurred in five mothers who had no pancreatic insufficiency, and no significant deterioration in pulmonary function occurred during or after pregnancy. These patients who do not require pancreatic enzyme supplementation appear to represent a special subgroup within cystic fibrosis in whom not only pulmonary function but also the overall prognosis is better, and in whom pregnancy can be tolerated without undue hazard.

Adult↗
PubMed1981

Postgraduate course presentation. Infantile bronchial asthma.

There is no evidence that any type of therapy, including hyposensitization therapy, will directly influence prognosis. The long-term prognosis of childhood asthma is less optimistic than previously believed. Approximately 30% of the patients who become symptom-free in adolescence relapse and become symptomatic in early adulthood. Blair's recent 20-yr follow-up report on 267 childhood asthmatics revealed that only 50% had become almost or completely symptom-free. Moreover, there is evidence that 60% of those who become symptom-free still demonstrate bronchial hyperreactivity and are liable to wheeze again if challenged with an appropriate stimuli. Therefore, the dictum that most children "outgrow" their asthma is incorrect and a more likely explanation is that most childhood asthmatics "outgrow" their pediatricians.

Acute Disease↗
PubMed1981

Cor pulmonale in cystic fibrosis.

A VCG and an orthogonal ECG were done on 66 ambulatory patients with cystic fibrosis. Arteriolized pO2, FEV1/VC and MBC were related to electrocardiographic measurements. In this group of adolescent and young adult patients the most helpful electrocardiographic sign of cor pulmonale is a low voltage representing the left ventricle. The four best indicators from the cardiogram are (1) Rx less than .8 mv; (2) Rx/Sx less than 4.0; (3) Tx less than .4 mv; and (4) MLVF + MLVH less than 2.5 mv. If more than one indicator is found cor pulmonale is likely present. Increased voltage over the right ventricle does not identify patients with cor pulmonale.

Adolescent↗
PubMed1981

Measurement of ventilation in children using the respiratory inductive plethysmograph.

A new technique to measure ventilation, based on the separate contributions of rib cage and abdomen to tidal volume, the respiratory inductive plethysmograph was evaluated in 20 healthy children. The accuracy of the method was determined by simultaneously measuring tidal volume with a pneumotachograph in the standing, sitting, supine, left lateral decubitus, and prone postures. Comparison of these two techniques showed mean correlation coefficients greater than 0.96, mean slopes between 0.98 and 1.11, and mean SEE of less than 8% in all postures studied. Breathing through a mouthpiece connected to a pneumotachograph resulted in a substantial change in the pattern of breathing and a mean increase in tidal volume of 32% (P less than 0.05). In the standing and sitting postures, rib cage contribution to tidal volume was predominant (greater than 65%) whereas in the recumbent postures abdominal contribution was predominant (greater than 61%). We conclude that the RIP is an accurate means of measuring ventilation in children and that it avoids the artifacts caused by using a conventional respiratory measuring apparatus.

Abdomen↗