Student perceptions of the learning environment.
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Australia↗
Biomedical subjects
R L Henry
Publications and source records attributed to R L Henry.
Oral corticosteroids for wheezing attacks under 18 months.
In a double blind, partial crossover trial we compared treatment with prednisolone with treatment with placebo (56 treatments) in 38 children aged less than 18 months (mean age 9.8 months, range 3-17 months), 30 of whom had required previous admission to hospital. Placebo or oral prednisolone 2 mg/kg/day in two divided doses for five days was given during acute exacerbations of symptoms on an outpatient basis. Daily symptom scores of cough, wheeze, and breathlessness did not show any significant difference in rate of improvement or overall outcome, either between the two whole groups or within subgroups aged less than 6 months, 6-12 months, and 12-18 months. Parental preference failed to indicate superiority of treatment with prednisolone over treatment with placebo in the 18 crossover patients, and parents were equally as likely to feel that treatment with either placebo or prednisolone had had positive effect in non-crossover patients. Two children required admission to hospital during treatment, one aged 5 1/2 months being treated with prednisolone, and one aged 14 months being treated with placebo.
Age Factors↗
Nebulised beclomethasone dipropionate suspension.
We compared nebulised beclomethasone dipropionate suspension against placebo in 16 children with moderately severe asthma in double blind crossover fashion. Three children withdrew due to deterioration while on placebo. Of the remaining 13, eight were better on beclomethasone and five on placebo. These trends in favour of nebulised beclomethasone were not significant and do not suggest that the suspension is as effective as inhaled powder or aerosol topical steroid formulation.
Asthma↗
Continuing respiratory problems three and a half years after acute viral bronchiolitis.
We reviewed the clinical progress of 81 children as part of a prospective study three and a half years after admission to hospital with acute viral bronchiolitis in infancy. Fifty six (69%) reported episodes of lower respiratory symptoms continuing over the preceding year, 25 (31%) had symptoms lasting for longer than two weeks on two or more occasions, 14 (17%) had symptoms for more than 100 days, and six (7%) required readmission to hospital with acute respiratory illness. Two years previously, these percentages had been 82%, 36%, 33%, and 13% respectively. Forty six (57%) children were said to be improving or to have become asymptomatic, but eight (10%) were deteriorating. There was no difference in the personal or family history of atopy, nor in the rate of skin test positivity between those with and without continuing symptoms, suggesting that atopy does not play an important role in the persistence of symptoms. Less than half the symptomatic children had received bronchodilator treatment during the preceding 12 months.
Acute Disease↗
Hemostasis: the balance concept of procoagulant and inhibitor systems and use of the serial thrombin time (STT).
The balance concept between the procoagulant and inhibitor systems allows a perspective to better diagnose opposite hemostatic mechanisms, especially hemorrhagic tendencies as a result of intravascular consumption coagulopathy from pathologic fibrinolysis. Concepts presented are intended to provide a base for following the ever changing patient therapeutic response in the course of these sometimes fulminant conditions. A concise description of the Serial Thrombin Time test (STT) is presented as a rapid quantitative test for the differentiation of opposing mechanisms affecting hemostasis. Typical patient cases are presented to demonstrate the use of the STT in diagnosis, selection of therapeutic agents, and management of hemorrhagic episodes. Presented are cases of disseminated intravascular coagulation, primary fibrinolysis, coronary thrombosis, and hemophilia.
Blood Coagulation↗
Nebulised ipratropium bromide and sodium cromoglycate in the first two years of life.
In a double blind crossover trial, we compared sodium cromoglycate, ipratropium bromide, and water in 23 asthmatic children less than 2 years old (mean age 11.8 months). Each child received nebulised solutions containing 20 mg of sodium cromoglycate, 250 micrograms of ipratropium bromide, or 2 ml water three times a day for three two month periods. Daily symptom scores did not show significant differences between the treatments but parental preferences indicated that both sodium cromoglycate and ipratropium bromide were superior to placebo. Sodium cromoglycate was prophylactic and was more likely to help the older patients. Ipratropium bromide produced an immediate clinical benefit and the response was not age dependent. We were unable to pick responders from non-responders on the basis of lung function tests performed on a routine outpatient basis. Both ipratropium bromide and sodium cromoglycate help some but not all asthmatic children aged less than 2 years.
Aerosols↗
Mistabron effects on platelets and blood coagulation.
The mucolytic drug Mistabron is often used in bleeding situations. The purpose of this study is to assess the safety of this drug in such circumstances. The platelet function of human blood is not impaired by clinically used Mistabron dosage, after stimulation with epinephrine, ADP or arachidonic acid. Coagulation proteins are not modified by Mesna, neither in vitro (blood from human beings), nor in vivo (rats).
Animals↗
Specialist approach to childhood asthma: does it exist?
Twenty six paediatricians and 21 consultant physicians concerned in the care of children with asthma answered a postal questionnaire on various aspects of the management of asthma, attitudes to referral, and the nature of advice given to parents and children. The 47 specialists had considerable differences in opinion for more than half the questions, including the role of allergen skin tests and the use of "breathing exercises." In addition, the paediatricians disagreed with the responses of the non-paediatricians on common issues such as whether to use aminophylline suppositories and whether swimming helps children grow out of asthma. These results have disturbing implications for the advice that specialists give to general practitioners, children, and parents.
Asthma↗
Simple drug delivery system for use by young asthmatics.
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Aerosols↗
Diminished adherence of sickle erythrocytes to cultured vascular endothelium by piracetam.
Erythrocytes from both normal and sickle cell donors were incubated on a bed of cultured rat vascular endothelial cells. Although the adherence of the erythrocytes to the endothelial cells was equivalent for both classes of donor, addition of 1.5 mM piracetam significantly decreased this adherence regardless of donor.
Anemia, Sickle Cell↗
Restoration of phagocytosis and oxidative metabolism by Piracetam in failing human neutrophils: a qualitative assessment.
By the use of immunobeads, a convenient clinical laboratory test is available which detects, in metabolically stressed leukocytes, failing or absent phagocytosis and/or impaired to absent oxidative metabolic activity. Furthermore, it has been demonstrated that Piracetam, 2-oxo-pyrrolidine acetamide, will restore such compromised neutrophils to normal functional status. In 4 of 19 patients, all with a variety of serious diseases, a range from impaired to total failure of neutrophilic phagocytic and metabolic oxidative activities was detected by the test. Piracetam, as shown by qualitative methods, restored to optimal activity the two impaired neutrophil functions in these 4 patients. Quantitative techniques are available currently to establish the beneficial effect of Piracetam on such defective neutrophils. Piracetam merits additional study to determine its efficacy in enhancement of restorative effects on compromised neutrophils which have been observed. The clinical promise of this investigation offers benefit to some patients now jeopardized by certain stressful diseases in part due to agonal failure of neutrophils.
Adolescent↗
Lung function after acute bronchiolitis.
We performed 211 lung function measurements on 93 children in the first year after they had been admitted with acute bronchiolitis. During the convalescent phase of the illness, 77% of the infants were hyperinflated with a thoracic gas volume greater than 40 ml/kg and 3 months later 43% were hyperinflated. Twelve months after the initial illness, 17% still had lung function abnormalities and most of these children have had lower respiratory tract symptoms. For the group as a whole about 60% have had at least one episode of wheezing. Specific conductances were significantly lower in children from atopic families, indicating worse lung function, but the significance of this finding is unclear.
Acute Disease↗
Ineffectiveness of ipratropium bromide in acute bronchiolitis.
In a double blind randomised trial, we found no evidence that nebulised ipratropium bromide was of clinical benefit in acute bronchiolitis.
Acute Disease↗
Pseudomembranous croup.
During a 2-year period, 7 children were seen with a severe form of laryngotracheobronchitis associated with sloughing of the respiratory epithelium and profuse mucopurulent secretions. We have called this condition pseudomembranous croup. The children had severe upper airways obstruction, appeared toxic with high fever, and were older than the typical age group for viral laryngotracheobronchitis. Lateral x-ray films of the airways showed subglottic narrowing and often these suggested the presence of radio-opaque foreign material in the tracheal lumen. At endoscopy, in addition to pseudomembrane in the subglottic region and trachea, there was thick mucopus and debris, and in some cases these changes extended into the bronchi. An artificial airway was required in all except one, and even after intubation it proved difficult to maintain the airway. Staphylococcus aureus was the most common pathogen isolated from tracheal cultures but other organisms were grown.
Airway Obstruction↗
Nebulised therapy in acute severe bronchiolitis in infancy.
We have measured total work of breathing before and after the inhalation of water, salbutamol, and ipratropium bromide, given as nebulised solutions, in 39 studies on 25 infants with acute, severe bronchiolitis. Twenty minutes after nebulised water, mean work of breathing per minute was increased by 4% and work per litre by 10% with 2 infants having significant improvement and 2 others showing deterioration. After salbutamol, mean work of breathing per minute showed a 22% increase and work per litre a 0.5% rise. The condition of only one child improved by greater than 25% after this drug. Ipratropium bromide led to significant improvement in 6 out of 15 studies and no corresponding deterioration. The group results showed a fall in work of breathing, 18% in work per minute and 16% in work per litre.
Acute Disease↗
Bronchodilator effects of the H1 receptor antagonist--clemastine.
We investigated the specific H1 receptor antagonist, clemastine, in 15 children with asthma. In the respiratory unit, clemastine was an effective bronchodilator but in a clinical trial we could not show any significant benefit compared with placebo.
Adolescent↗
Respiratory problems 2 years after acute bronchiolitis in infancy.
We assessed the clinical progress of 55 children 2 years after admission to hospital with acute bronchiolitis and performed lung function tests on 40. During the 2 year follow up period 75% of the children had wheezed, 36% had 2 or more lower respiratory symptoms lasting more than 2 weeks, 33% had more than 100 days of lower respiratory symptoms, and 13% were readmitted to hospital with acute respiratory disease. In addition 60% of the children were hyperinflated on lung function tests. Many of the children with hyperinflation at the 2 year assessment had not been hyperinflated 1 year earlier, suggesting variable airways obstruction. Reversibility of airways obstruction was also assessed by response to nebulised salbutamol. Nine children had a fall greater than 15% in airways resistance after salbutamol and these children had the highest baseline airways resistances. Airways resistance was higher in the children with a family history of atopy.
Acute Disease↗