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Biomedical subjects

J A Church

Publications and source records attributed to J A Church.

At least 55 records · Page 3Linked to original sources
PubMed1991

Comparison of two techniques for sedation in dental surgery.

Forty-eight patients were randomised to receive sedation of outpatient dental surgery with midazolam. Sedation was given using the Verrill technique (24 patients) and the Glasgow Dental Hospital technique (24 patients). The differences in recovery and patient acceptability were assessed. There was no statistical difference in mean recovery times between the two groups. Memory function was examined using the Warrington memory test. Fewer patients in the Verrill group recalled the injection of local anaesthetic but they demonstrated memory defects 4 hours after sedation for words and 3 hours for faces. The Glasgow Dental Hospital group demonstrated memory defects for words up to 2 hours following sedation, but not for faces at any time. Thirty-eight patients would have dental surgery again with similar sedation. The dental surgeon found conditions for surgery inadequate in two patients. In view of the shorter duration of amnesia we recommend the Glasgow Dental Hospital technique.

Adolescent↗
PubMed1991

Underdiagnosis and undertreatment of chronic sinusitis in children.

A review of outpatients diagnosed with sinusitis during the previous year by the allergy services of Childrens Hospital of Los Angeles and Kaiser Permanente, Orange County, revealed 34 patients who had protracted discomforting and debilitating symptoms. The mean duration of symptoms was approximately six months (range 1-14 months). None had been previously diagnosed as having sinusitis or received appropriate treatment. Although all were referred for evaluation of allergic rhinitis and/or asthma, approximately 1/3 were found to have neither of these conditions. Among patients who had asthma, their asthmatic symptoms were aggravated by the sinusitis. All patients eventually responded favorably to appropriate antibiotic therapy. Earlier diagnosis and appropriate therapy would have foreshortened the course of this very discomforting condition. In recent years, we have observed a marked increase in the number of patients referred with the chief complaint of "worsening allergy" and who were subsequently found to have sinusitis. Most of the patients experienced significant incapacitation for protracted periods before a correct diagnosis was made and treatment instituted. In all but a few cases, prompt and sustained improvement followed appropriate therapy. The purpose of this report is to present a retrospective review of 34 illustrative cases.

Child↗
PubMed1989

Lymphomatoid granulomatosis in a 13-month-old infant.

Lymphomatoid granulomatosis is an infrequent, progressive, and frequently fatal vasculitis which typically occurs in middle aged males. We describe a 13-month-old infant with lymphomatoid granulomatosis who presented with chronic otitis media and "failure to thrive." Although it is well recognized that rheumatic conditions may result in failure to thrive, pediatricians often fail to consider this possibility and the proper diagnosis and treatment are correspondingly delayed. Lymphomatoid granulomatosis occurs with increased frequency in immunocompromised patients. In our case both hypogammaglobulinemia and persistent evidence of Epstein-Barr virus infection suggest that the infant was immunocompromised. Whether these factors predisposed this infant to lymphomatoid granulomatosis is uncertain. No patient with the onset of lymphomatoid granulomatosis prior to 7 years of age has been reported.

Agammaglobulinemia↗
PubMed1988

Sedation following cardiac surgery: evaluation of alfentanil and morphine in the presence of a computerized closed loop arterial pressure controller.

Forty patients who had undergone coronary artery graft surgery and who required vasodilator therapy for postoperative hypertension were given infusions of either alfentanil or morphine together with bolus doses of midazolam for sedation and analgesia while ventilation was controlled artificially. Sodium nitroprusside (SNP) was administered to both groups using a computer-controlled closed loop system which adjusted the infusion rate to maintain a preset target arterial pressure. Target pressure +/- 5, 10, 15 and 20 mm Hg was maintained longer in the group receiving alfentanil. This group also required less SNP per hour. No difference was noted between the groups in the time taken to regain spontaneous ventilation and to extubation of the trachea, although the alfentanil group tended to be sedated more deeply during the infusion. The main advantage of alfentanil over morphine at doses used in this study was its superior ability to attenuate hypertensive responses to noxious stimuli, providing improved haemodynamic stability.

Aged↗
PubMed1988

Evaluation of a new, shorter method of administration of adrenergic aerosols in the treatment of asthma.

Approximately 15 to 20 minutes are usually required to administer adrenergic agents by nebulization in the treatment of asthma. But young children often do not tolerate these prolonged treatment periods. A "5-breath" method was found to provide comparable improvements in pulmonary function and result in minimal and comparable side effects, but required only one minute to administer. The "5-breath" method may, therefore, be the method of choice in the young or otherwise uncooperative patients.

Administration, Inhalation↗
PubMed1988

Cardiac arrest associated with halothane anesthesia in a patient receiving theophylline.

A case of a 10-year-old asthmatic patient who had cardiac arrest during induction for elective ear surgery is presented. The patient's serum theophylline level was 21.6 micrograms/mL one hour after surgery. It is likely that, since other factors that can contribute to cardiac arrest during the perioperative period were not present, the combined use of aminophylline and halothane was responsible.

Anesthesia↗
PubMed1987

Human immunodeficiency virus-associated Kaposi's sarcoma in a pediatric renal transplant recipient.

An 11-year-old boy developed Kaposi's sarcoma and progressive T lymphocyte deficiency 5 years after cadaveric kidney transplantation for end-stage renal disease. He had received 17 individual red blood cell transfusions prior to and during transplantation in 1980. Human immunodeficiency virus (HIV) was cultured from blood in cerebrospinal fluid and HIV antibodies were detected with enzyme immunoassay and immunoblot techniques. The recipient of the donor's other kidney was well and HIV antibody-negative. The patient was treated with etoposide with excellent although transient regression of tumor. Allograft function has remained stable despite minimal immunosuppressive therapy and the need for high-dose anticonvulsant therapy. This case represents the first pediatric patient with acquired immune deficiency syndrome (AIDS) and Kaposi's sarcoma following kidney transplantation.

Blood Transfusion↗
PubMed1986

Primary Candida meningitis and chronic granulomatous disease.

The occurrence of two rare entities in a single patient can be fortuitous or may signify some deeper relationship. A young boy was recently treated for primary Candida meningitis. Autopsy findings suggested to an experienced pathologist the presence of chronic granulomatous disease (CGD), unrecognized during his life. The patient's identical twin brother was tested and found to have the typical laboratory features of CGD. The literature on Candida meningitis was reviewed and 15 cases were discovered that apparently arose in the absence of recognized predisposing causes. All but one of these cases occurred in males, and most occurred during the first three decades of life. The case reports and literature review presented herein suggest that CGD should be suspected when a case of "primary" Candida meningitis is encountered.

Candidiasis↗