Tuberculosis simulating asthma in an infant.
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Asthma↗
Biomedical subjects
M F Guill
Publications and source records attributed to M F Guill.
Respiratory manifestations of gastroesophageal reflux in children.
Gastroesophageal reflux is often overlooked as both a cause and a complication of respiratory disease in children. The manifestations may be protean and may bear little clinical relationship to the gastrointestinal tract. However, a high index of suspicion for its potential role in unexplained respiratory symptoms may yield large benefits for the physician and patient alike.
Asthma↗
Unrecognized exercise-induced bronchospasm in adolescent athletes.
OBJECTIVE--As part of their preparticipation physical examinations, 1241 middle and high school student athletes completed a questionnaire and were interviewed to elicit risk factors for unrecognized exercise-induced bronchospasm (EIB). Spirometry was then performed when the students were at rest. RESEARCH DESIGN--All participants completed a questionnaire, were interviewed, and underwent baseline testing to determine forced expiratory volume in 1 second (FEV1). SETTING--All testing was performed in a school setting. SELECTION PROCEDURES--Athletes known to have EIB who were receiving appropriate treatment (46 athletes [4%]) and athletes with no risk factors based on medical history and normal results of spirometry (847 athletes [68%]) were eliminated from further evaluation. Students with medical histories indicating risk of unrecognized EIB and students with abnormal results of spirometry were eligible for exercise challenge by standard treadmill protocol. MEASUREMENTS AND RESULTS--Of the 348 eligible students, 230 (66%) completed the exercise challenge. Sixty-six of the 230 students had greater than 15% reduction in FEV1, and 50 of the 66 students had greater than 20% reduction, representing a 29% occurrence of previously undiagnosed EIB in a population of students identified with screening to be at risk of unrecognized EIB. Of the 179 students identified to be at risk based on medical history only, 28% had EIB. Of 33 students with positive results of spirometry but no medical history that put them at risk, 15% had EIB. Of the 18 students with medical histories that put them at risk and positive results of spirometry, 61% had EIB. Including the subpopulation with reduction in FEV1 of greater than 15%, students shown to be at risk after screening, and students previously identified as having EIB, 145 students were identified as having EIB (12%). CONCLUSIONS--These data are in accord with results of previously reported studies of college and Olympic athletes. The data may have implications for more extensive screening in the adolescent population.
Adolescent↗
Type I diabetes in an adolescent with common variable immunodeficiency.
A male adolescent with common variable immunodeficiency developed type I diabetes approximately 1 year after the initiation of immunoglobulin therapy. Immunologic evaluation revealed decreased numbers of T cells and an intrinsic B cell defect in immunoglobulin production. Lymphocytes from the patient failed to generate normal suppressor activity. There were no insulin or islet cell antibodies present in the patient's serum or in the commercial immunoglobulin preparations he received. The patient's HLA phenotype included HLA-DR3 and 4, placing him genetically at high risk for type I diabetes.
Adolescent↗
Chronic abdominal pain, lymphopenia, and hypogammaglobulinemia in a 9-year-old female.
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Abdomen↗
Use of transfer factor in a pediatric AIDS patient with disseminated Mycobacterium avium intracellulare.
An 8-year-old male with AIDS and disseminated Mycobacterium avium intracellulare infection was treated with transfer factor (TF) prepared from maternal lymphocytes. Subsequent lymphocyte stimulation studies and repeat cultures failed to demonstrate improvement during treatment. His overall clinical status remained unchanged. No adverse effects of TF were noted.
Acquired Immunodeficiency Syndrome↗
IgM deficiency: clinical spectrum and immunologic assessment.
Selective IgM deficiency has been associated with recurrent infections and enteric protein loss. We have evaluated eight patients with IgM deficiency presenting with recurrent infections and manifestation of atopy. A variety of subtle immunologic aberrations were noted, including depressed IgM and elevated IgG responses to immunization with bacteriophage OX174. Despite normal quantitative IgG in most patients, IgG antibody responses to diphtheria-tetanus and/or pneumococcal polysaccharide antigens were generally depressed. No correlation could be made between antibody responses (or lack thereof) and the nature of infections in any given patient.
Adolescent↗
Clinical and pharmacokinetic evaluation of a sustained-release liquid theophylline preparation.
Theolan Suspension is the first long-acting liquid theophylline dosage form. A crossover study comparing the pharmacokinetic and clinical response to Theolan Suspension (administered every 12 hours) with aminophylline solution (administered every 8 hours) in children younger than 12 years of age is reported. Twenty-seven patients completed the study: 17 children were aged 6 years or younger and five patients were 3 years or younger. All patients were withdrawn from bronchodilator therapy and then were titrated to clinically effective doses of study medication. There was an equivalent and significant reduction from baseline levels in the mean symptom score during administration of theophylline suspension (42%; p less than or equal to 0.001) and aminophylline solution (57%; p less than or equal to 0.001). Mean values for FEV1 (1.2 versus 1.3 L), FEV1/FVC (77% versus 79%), and reduction in acute metaproterenol use (24% versus 43%) in children receiving theophylline suspension and aminophylline solution revealed no differences between products. Adverse effects were reported more frequently for the aminophylline solution, possibly caused in part to its taste. Of children stating a taste preference, eight of 10 children chose the Theolan Suspension. The suspension demonstrated a lower peak theophylline blood level at a later time (11.6 micrograms/ml at 3 1/2 hours), compared to the solution (14.6 micrograms/ml at 1 1/2 hours; p less than or equal to 0.01). Indexes of theophylline fluctuation during the dosing interval indicated equivalent or reduced variability for the suspension. Relative bioavailability of theophylline suspension was 89% of that for the solution.(ABSTRACT TRUNCATED AT 250 WORDS)
Asthma↗
A multicenter, open study of the non-sedating antihistamine, terfenadine (Seldane), in the maintenance therapy of seasonal allergic rhinitis.
A multicenter open study was conducted throughout the 1984 fall pollen season to assess the possible development of tolerance or loss of efficacy to terfenadine in the maintenance therapy of patients with seasonal pollinosis. Patients with proven allergic pollinosis were entered into a 1-week initial treatment period taking terfenadine 60 mg bid and only those who responded to the initial treatment with "moderate" to "complete" relief continued on terfenadine throughout a 4 to 11-week pollen season for evaluation of continued efficacy. A total of 179 patients from five study centers were enrolled in the initial treatment period and 154 (86%) responded to terfenadine with "moderate" to "complete" relief of symptoms. Of these 154 patients who continued terfenadine treatment, approximately 90% of the patients maintained the same degree of relief throughout the pollen season. All symptoms of seasonal pollinosis including nasal congestion improved significantly the first day of treatment. This improvement in symptoms continued during the first week and remained unabated throughout the pollen season. The incidence of adverse events was low with sedation being reported by only 2.8% of patients at some time point during the study. It is concluded that terfenadine is a safe and effective non-sedating antihistamine in the maintenance therapy of seasonal allergic pollinosis and that tolerance is not noted during continued administration.
Adult↗
Effect of interleukin-2 and mitogen on in vitro immunoglobulin production by peripheral blood lymphocytes from patients with selective IgM deficiency.
Immunoglobulin production by mitogen and recombinant interleukin-2-(rIL-2)-stimulated lymphocytes from IgM-deficient patients was studied. The findings were that subnormal serum IgM levels did not necessarily predict defective in vitro IgG or IgM production, lymphocytes from some IgM-deficient patients exhibited defective T cell function, and rIL-2 did not enhance defective in vitro immunoglobulin production.
Adult↗
Pediatric acquired immune deficiency syndrome with panhypogammaglobulinemia.
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Acquired Immunodeficiency Syndrome↗
Comparison of inhaled metaproterenol, inhaled atropine sulfate, and their combination in treatment of children with acute asthma.
The separate and combined effects of inhaled metaproterenol and atropine sulfate were evaluated in the treatment of 44 episodes of acute asthma occurring in 35 children ranging in age from 13 months to 13 years. Peak expiratory flow rate and pulmonary index were measured before and after each of up to three inhalation treatments. Significant improvement in peak flow rate (P less than .04) was noted after the second inhalation of metaproterenol both with and without the combination of atropine sulfate compared with the effects of atropine alone. Patients treated with metaproterenol and metaproterenol combined with atropine also experienced fewer therapeutic failures (2/15 and 2/16, respectively) compared with those treated with atropine (6/13, P less than .02). Pulmonary index scores did not differ among the treatment groups. Inhaled metaproterenol appears to be more effective than inhaled atropine sulfate in the treatment of children with acute asthma. The addition of inhaled atropine sulfate appears to offer no advantage over treatment with inhaled metaproterenol alone.
Acute Disease↗
Multicenter, double-blind, placebo-controlled trial of terfenadine suspension in the treatment of fall-allergic rhinitis in children.
Children, aged 6 to 12 years, with fall-pollenosis symptoms, were evaluated for their response to a new antihistamine, terfenadine, in a multicenter (six centers) 1-week, double-blind, placebo-controlled trial. All had positive skin tests to grass/weed pollens and/or mold spores prevalent in the fall at each center. Patients were administered placebo or terfenadine as suspension on a randomized basis, with children weighing less than 30 kg receiving terfenadine suspension, 30 mg twice daily, and those weighing greater than 30 kg receiving 60 mg, twice daily. Of the 119 children enrolled, 79 received terfenadine and 40 received placebo. All but two (lost to follow-up) were included for the evaluation of drug safety, whereas 16 were excluded from the efficacy evaluation (11 receiving terfenadine and five receiving placebo) because of protocol noncompliance. Overall, varying degrees of control of symptoms were observed in 85% of the patients in the group taking terfenadine as compared to 60% in the group taking placebo. The symptoms of rhinorrhea, nasal congestion, and sneezing demonstrated the best response. There was no difference between the two groups in adverse events or side effects. Before and after treatment complete blood count, biochemical profile, and urinalysis revealed that there was no change from beginning to end and no difference between the groups. We conclude that terfenadine suspension is a safe, nonsedating antihistamine with an incidence of side effects no different from that of placebo. It is more effective than placebo in controlling symptoms of fall pollenosis in children.
Benzhydryl Compounds↗
AIDS in a child 5 1/2 years after a transfusion.
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Acquired Immunodeficiency Syndrome↗
Metabisulfite sensitivity: case report and literature review.
Sulfiting agents have recently been identified as food and drug additives responsible for adverse reactions. These reactions are not rare and may result in life-threatening asthma and anaphylaxis. We report a 34-year-old female with intractable asthma and urticaria. Sensitivity to sulfites was suspected based on exacerbation after restaurant meals and metaproterenol 5% inhalant solution. Bronchial provocation challenge resulted in a 28% decrease in FEV1 and a 34% decrease in FEF25-75 at the 0.01 mg/ml dose. Thirty-two cases of sulfite sensitivity reported in the literature are reviewed. Foods and drugs containing sulfites are listed. The pathogenic mechanism is unknown. The FDA allows the addition of sulfites to foods and drugs without disclosure. Only recently has this potential hazard been recognized. The FDA is considering a labeling requirement on drugs that do contain sulfites.
Adult↗
Chronic urticaria related to sialoadenitis.
A 31-year-old black male experienced severe recurrent urticaria and angioedema during meals. An abnormal sialographic pattern indicated submandibular sialoadenitis, and surgical excision of the gland resulted in complete resolution of the urticaria. This report describes the association of sialoadenitis and urticaria and possible mechanisms involved.
Adult↗
Junctional epidermolysis bullosa. Treatment with phenytoin.
Junctional epidermolysis bullosa (EB) is a rare, heritable, blistering disease of the skin characterized by presence of bullae at birth, lack of scarring of the lesions, and early death. To date there has been no effective treatment for the disease. Phenytoin, which decreases collagenase activity in human skin explants and fibroblast cultures, has been used successfully to treat patients with recessive dystrophic EB. We found a marked decrease in new blister formation in one child with junctional EB during phenytoin therapy.
Diagnosis, Differential↗
Phenytoin therapy for junctional epidermolysis bullosa.
Junctional epidermolysis bullosa (JEB) is a recessively inherited mechanobullous disease characterized by neonatal onset of blisters, healing without scarring or milium formation, dystrophic nails, and internal involvement in some patients. Several treatment modalities have been tried, including systemic corticosteroids and oral vitamin E, but no form of therapy has been uniformly successful. We describe a patient with JEB treated with phenytoin, followed by improvement in his skin lesions.
Adolescent↗