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Biomedical subjects

H Milgrom

Publications and source records attributed to H Milgrom.

At least 37 records · Page 2Linked to original sources
PubMed1997

Ipratropium nasal spray in children with perennial rhinitis.

OBJECTIVE: To compare the efficacy and safety of ipratropium nasal spray and placebo administered twice each day for 4 weeks in pediatric patients with perennial rhinitis who had rhinorrhea as a major complaint. METHODS: This was a multicenter, double-blind, parallel group study. Patients aged 6 to 18 years with symptoms of perennial nonallergic (PNAR) or perennial allergic rhinitis (PAR) were randomized to receive ipratropium (42 micrograms per nostril) or placebo nasal spray, double-blind, twice each day for 4 weeks. Efficacy was evaluated by nasal symptoms, especially anterior rhinorrhea, and quality of life. Previous caregivers for rhinitis and medications used in the past were also evaluated. RESULTS: A total of 202 patients were empanelled, 162 with PAR, 40 with PNAR; of these 151 with mild-severe rhinorrhea were evaluated for efficacy. Treatment with ipratropium reduced symptoms of rhinorrhea primarily in patients with PNAR. In patients with PAR this response was less pronounced, and was seen as a modest decrease in the severity of rhinorrhea noted in the first 2 weeks of treatment. Quality of life assessments confirmed that rhinorrhea was bothersome to these pediatric patients, and suggested that treatment with ipratropium nasal spray was associated with an improvement, especially in the patients with PNAR. There were few adverse events; these were similar in the two treatment groups. CONCLUSIONS: Ipratropium nasal spray 0.03% administered at a dose of 42 micrograms/nostril bid is a safe and effective new therapy for control of anterior rhinorrhea in pediatric patients with PNAR. Twice daily administration is adequate for patients with PNAR, but patients with PAR might benefit from more frequent administration (e.g., tid).

Administration, Inhalation↗
PubMed1997

Nonadherence to asthma treatment and failure of therapy.

Adherence to clinical regimens is paramount in determining their effectiveness. Asthma is a chronic illness that requires consistent, anti-inflammatory therapy. A "high risk" profile for fatal or near-fatal asthma has emerged that includes suboptimal pharmacotherapy in conjunction with severe disease, psychologic dysfunction, black race or Hispanic-American ethnicity, and residence in an urban area with a high concentration of poverty. Collaboration between physicians and patients is necessary to allow individuals to make choices informed by medical facts and the physician's experience. Objective monitoring of adherence and pulmonary function and acceptance by the clinicians of the National Asthma Education and Prevention Program guidelines to control airway inflammation are essential in order to reduce the unacceptable rates of morbidity and mortality associated with asthma.

Asthma↗
PubMed1996

Steroid-resistant chronic urticaria associated with anti-thyroid microsomal antibodies in a nine-year-old boy.

The case of a 9-year-old boy with severe chronic urticaria of 6 months' duration is described. The urticaria was associated with intractable bronchospasm and abdominal cramping and was unresponsive to antihistamines and high doses of corticosteroids. Even though the child was euthyroid, he was treated with thyroid hormone after the presence of anti-thyroid microsomal antibodies was documented. Within 1 month the patient demonstrated full remission. He remained free of symptoms for 9 months after discontinuation of treatment. After a relapse he again responded to thyroid hormone therapy. Children with chronic, intractable urticaria and documented evidence of anti-thyroid microsomal antibodies may benefit from treatment with thyroid hormone.

Adrenal Cortex Hormones↗
PubMed1996

Noncompliance and treatment failure in children with asthma.

BACKGROUND: Accurate and reliable information about children's use of inhaled medications is needed because of the growing reliance on these drugs in the treatment of asthma and the excessive morbidity and mortality attributable to this disease. OBJECTIVE: This study was designed to evaluate the adherence of children with asthma to regimens of inhaled corticosteroids and beta-agonists. METHODS: Data collected electronically by metered-dose inhaler monitors were compared with data recorded by patients on traditional diary cards. A volunteer sample of 24 children, between 8 and 12 years old, who had asthma for which they were receiving both inhaled corticosteroids and beta-agonists, participated over a 13-week period. Each child was accompanied by a parent to all study visits. The main outcome measures were the use of medication as reported by diary card entries and recorded by electronic monitoring and disease exacerbation, as indicated by requirement for oral corticosteroids. RESULTS: The median use of inhaled corticosteroids reported by patients on their diaries was 95.4%, whereas the median actual use was 58.4%. More than 90% of patients exaggerated their use of inhaled steroids, and diary entries of even the least compliant subjects reflected a high level of adherence. The children who experienced exacerbation of disease sufficient to require a burst of oral corticosteroids differed markedly from the others in their adherence to prescribed therapy as recorded by the electronic monitors. The median compliance with inhaled corticosteroids was 13.7% for those who experienced exacerbations and 68.2% for those who did not. CONCLUSIONS: Electronic monitoring demonstrated much lower adherence to prescribed therapy than was reported by patients on diary cards. Low rates of compliance with prescribed inhaled corticosteroids were associated with exacerbation of disease. Poor control of asthma should alert the physician to the possibility of noncompliance.

Administration, Inhalation↗
PubMed1995

Exercise-induced anaphylaxis related to specific foods.

We describe the case, documented by challenge results, of a 16-year-old girl with exercise-induced anaphylaxis associated with eating pizza and a cheese sandwich. Patients in whom a specific coprecipitating food has been identified should avoid it for at least 12 hours before exercise. All patients should be instructed to avoid eating 6 to 8 hours before exercise, discontinue exercise at the first sign of symptoms, and exercise only with a companion prepared to administer epinephrine.

Adolescent↗
PubMed1993

Treatment of steroid-dependent asthma with recombinant interferon-gamma.

We have recently reported that treatment of patients with severe atopic dermatitis with recombinant interferon-gamma (rIFN-gamma) resulted in clinical improvement as well as a reduction of circulating eosinophils. Since IgE-dependent late phase allergic reactions and eosinophilic infiltration are thought to play an important role in the pathogenesis of asthma, we conducted a two centre randomized double-blind placebo-controlled trial of rIFN-gamma in the treatment of steroid-dependent asthma. Patients were treated with daily subcutaneous injections of either 0.05 mg/m2 rIFN-gamma (n = 9) or placebo (n = 11) for 90 days. All patients completed the study without significant drug toxicity noted. Oral prednisone dose, forced expiratory volume in 1 second (FEV1), peak expiratory flow rates (PEFR) and circulating eosinophil counts were monitored throughout the trial. There was no significant difference between the two treatment groups in per cent reduction from baseline of daily prednisone (P = 0.51). There was also no significant difference between the two treatment groups in per cent change from baseline in FEV1 (P = 0.54) or in PEFR (P = 0.75). Total circulating eosinophil counts decreased by 31% in the rIFN-gamma group and increased by 8.5% in the placebo group (P = 0.09). We conclude that this treatment regimen was not effective in patients with steroid-dependent asthma.

Adolescent↗
PubMed1993

Current issues in the use of theophylline.

Theophylline is a safe and effective medication for the management of chronic asthma. It reduces nocturnal bronchospasm and airways hyperresponsiveness, and its addition to effective doses of beta-agonists and corticosteroids leads to further improvement in symptom control. These properties are the result of actions other than simple bronchodilation, and there is a strong possibility that anti-inflammatory activity accounts for its clinical advantages. Serious side effects are uncommon and their rate can be further reduced through appropriate precautions. Recent studies have alleviated the concern over cognitive and behavioral side effects in children.

Asthma↗
PubMed1992

Theophylline-induced behavior change in children. An objective evaluation of parents' perceptions.

OBJECTIVE: To evaluate children who take theophylline for the presence of behavioral side effects and to determine whether the beliefs about these side effects held by their parents are supported by their own observations. DESIGN: A double-blind, placebo-controlled, randomized, crossover protocol. Under both study conditions the children completed tests that measured their attention, impulsivity, memory, activity level, and mood, while the parents rated their behavior. PATIENTS: The subjects were 8- to 12-year-old children with asthma whose parents had observed adverse behavioral side effects while the children were taking theophylline. Among cited side effects were impulsivity, hyperactivity, altered mood, and impaired attention. RESULTS: No differences related to treatment could be detected from the parent questionnaires or from six of nine scores of the psychological evaluation of the children. The children, however, made fewer attention errors and showed a mild increase in anxiety and hand tremor of the dominant hand while they were receiving theophylline. All mean changes were small. No significant relationship was found between theophylline concentrations in the serum and degree of change in mood or attention. Eleven of 42 participants were disqualified for noncompliance during the study. CONCLUSION: Parental beliefs about the side effects experienced by their children are not supported by their own observations performed through a blinded protocol. These results are in conflict with reports of a high incidence of adverse behavioral side effects attributed to theophylline therapy.

Affect↗
PubMed1991

Asthma--something old, something new ....

Asthma is an inflammatory disease characterized by infiltration of the airways by eosinophils and ensuing bronchial hyperresponsiveness. The activation of eosinophils and their recruitment to the airways are strongly influenced by T-lymphocytes and their products. There is now evidence that successful therapy of asthma results in changes in the ratios of helper and suppressor T-lymphocytes both in the circulation and in bronchoalveolar lavage fluid. Theophylline, a drug which has been used in asthma therapy for many years, provides additional benefit for patients already treated with effective doses of beta-agonists and/or corticosteroids. The effects of theophylline on lymphocyte traffic and function have not been studied extensively. However, there is evidence from studies conducted in renal transplant recipients and patients with asthma that theophylline increases the numbers and activity of suppressor T-lymphocytes in the peripheral circulation. This property of theophylline may provide a therapeutic benefit in the treatment of asthma, one that is distinct from its activity as a bronchodilator.

Adrenal Cortex Hormones↗
PubMed1986

Dysplastic nevus syndrome: association with multiple primary neoplasms.

A 65-year-old white man with dysplastic nevus syndrome is presented. The patient also developed an extramammary Paget's disease of the scrotum, two malignant melanomas of the skin of the arm and abdomen, two squamous cell carcinomas in the mouth, and several benign tumors such as lentigo maligna, dermatofibroma, and a cavernous hemangioma. Besides the well-established tendency of patients with the dysplastic nevus syndrome to develop malignant melanomas of the skin, their possible propensity to develop other primary malignant neoplasms is discussed.

Aged↗