Biomedical subjects
Publications and source records attributed to J M Ewig.
Three children with acquired immunodeficiency syndrome who had pneumonia develop were infected simultaneously with Pneumocystis carinïi and Streptococcus pneumoniae. Such coexistence has not been previously reported in children. One patient received prophylactic treatment against Pneumocystis carinïi before his illness.
Adolescent pregnancy has increased in the past decade (1-5), often in association with poverty, poor education, and inadequate prenatal care. While it has been suggested that adverse pregnancy outcomes are more common among adolescents in the inner city, recent data show that in a white, middle-class population teenaged mothers are more likely to have adverse pregnancy outcomes (5). Asthma is also becoming more common, with an incidence of at least 6.6% in 15-16 year old girls (6,7). Poverty and living in the inner city are associated with increased morbidity and mortality from asthma (8-11). Adolescents with asthma who become pregnant provide an added challenge to the physician who must consider the impact of the pregnancy on the asthma and vice versa. The physician must understand the effects of both the asthma medication and/or poorly controlled disease on the fetus. The physician must also be able to convey this information to the adolescent in a developmentally appropriate manner to enable the patient to make informed health care decisions (12).
In order to determine the long-term sequelae of prune belly syndrome (PBS) and whether the absence of abdominal wall musculature impairs exercise performance we studied nine patients 6 to 31 yr of age with PBS. Conventional spirometry, lung volumes, DLCO, and respiratory muscle strength were measured. A progressive 1-min incremental exercise test was performed on a cycle ergometer, and relative abdominal and chest wall displacements were measured by respiratory inductive plethysmography (RIP). Mean values of TLC, FRC, and RV were 94 +/- 12, 88 +/- 13, and 94 +/- 41%, respectively. Mean values of PEFR, FEV1, and FEF25-75 were 83 +/- 24, 92 +/- 23, and 83 +/- 28%, respectively. Maximal expiratory pressures were significantly reduced in seven of nine patients, with marked reduction in four (>3 SD below the mean). Percent predicted maximal VO2 achieved, % maximal work, and % maximal heart rate were 79 +/- 13, 78 +/- 14, and 87 +/- 2%, respectively. All seven subjects with absent abdominal musculature had paradoxical motion of the abdomen during quiet respiration in the erect or sitting position and while exercising. These subjects had synchronous breathing at rest in the supine position. Although the etiology of the relatively low work rates and VO2 achieved was multifactorial, we speculate that the abdominal paradox in these subjects necessitates abnormally large rib cage displacements during exercise, which may be a significant contributing factor to exercise limitation in some of these subjects.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
BACKGROUND: Pneumocystis carinii pneumonia is a common opportunistic infection in pediatric acquired immunodeficiency syndrome (AIDS). Mortality rates of 34% have been reported for the acute infection, with much higher mortality rates occurring in the presence of respiratory failure. Corticosteroids reduce the morbidity and mortality in adults with AIDS and P carinii pneumonia. We report herein our experience with corticosteroids in P carinii pneumonia in pediatric AIDS. METHODS: When the data on adults were published, we began treating our patients with corticosteroids. We compared these children (group 1) with those children treated in a similar manner, but without corticosteroids (group 2). RESULTS: The two groups had similar ages, initial serum lactate dehydrogenase levels, and initial alveolar-arterial difference in partial pressure of oxygen. There was a significant (P < .001) reduction in the need for mechanical ventilation and in mortality in the corticosteroid-treated group. CONCLUSION: Corticosteroid therapy during acute infection with P carinii in young children with AIDS appears to significantly reduce morbidity (as measured by the need for mechanical ventilation) and mortality.
While the care of cystic fibrosis (CF) patients has been mainly the province of pediatricians, great improvements in the therapy and life span of CF patients often results in their transition to care by adult physicians. In this review of CF, we begin with an overview of the epidemiology and genetics of the disease, with a discussion of the recently found ion abnormalities that lead to the clinical manifestations. This is followed by a discussion of the pathophysiology. Methods of diagnosis, ranging from the gold standard, the sweat test, to recent advances based on a greater understanding of the genetics of the disease are reviewed. This is followed by a discussion of therapy primarily geared to the treatment of the respiratory complications, as they are the most common lethal factors of the disease. We point out controversies where they exist. Newer forms of therapy such as lung transplantation are discussed, and we finish with a discussion about future therapeutic modalities, some of which are being approved as the paper is in print.