[Examination for dislocation of the hip in the neonatal period].
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Clinical Competence↗
Biomedical subjects
S Pedersen
Publications and source records attributed to S Pedersen.
[Atypical Mycobacterium infections of the neck].
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Adolescent↗
Septoplasty and/or submucous resection? 5 years nasal septum operations.
Information obtained from the case-records and completed questionnaires from 478 patients operated in the 5-year-period 1980 through 1984 with either septoplasty or submucous resection (SMR), has been analysed on an average 31 months after surgery. Two hundred (42 per cent) underwent SMR and 278 (58 per cent) septoplasty. Twenty per cent presented for a clinical follow-up examination. Of the 478 patients, 63 per cent were satisfied. More patients were satisfied with the functional results after septoplasty, which also resulted in fewer and smaller perforations than SMR. Septoplasty ought to replace the latter as the routine procedure. 10 per cent had troublesome crusting independent of the technique used. Change in the external shape of the nose is a minor problem for the patients, and was not regarded as an indication for re-operation. Patients with allergic rhinitis may undergo septal surgery on general lines.
Adolescent↗
Cumulative dose response relationship of terbutaline delivered by three different inhalers.
In a controlled, open cross-over study 15 asthmatic children received increasing doses of terbutaline (0.125 mg + 0.125 mg + 0.25 mg + 0.5 mg + 0.1 mg) delivered by a pressurized aerosol alone or with a tube spacer or a nebuhaler attached. At no time was there any significant difference in measured FEV1 or percent increase in FEV1 between the three inhalers. However, when eight patients with bronchodilation greater than 50% on all tests days were studied separately, a significantly greater improvement in FEV1 was seen after the first three inhalations of terbutaline when a nebuhaler or a tube spacer was used compared with the response after the pressurized aerosol (P less than 0.05) Bronchodilation measurements did not differ after use of the two spacers. There was no statistically significant difference in side effects between the three inhalers, but there was a trend towards a higher occurrence of side effects when the pressurized aerosol was used alone.
Adolescent↗
Urine cortisol excretion in children treated with high doses of inhaled corticosteroids: a comparison of budesonide and beclomethasone.
Thirty one children with asthma were treated with inhaled beclomethasone and budesonide in a randomized cross-over study of 2 x 6 weeks' duration. The excretion of free cortisol in two 24 hour urine samples, collected at the end of each treatment period, was significantly higher (mean = 76.3 nmol per day) during budesonide treatment than during beclomethasone treatment (mean = 53.7 nmol per day) (p less than 0.01). The difference between the two drugs was more pronounced in the eight children who received 1,000 and 1,200 micrograms per day than in the 22 children who received 800 micrograms per day. Four children had cortisol excretion below the normal range when treated with beclomethasone. This was seen in one child during budesonide treatment. The age of the child did not influence the result. The long term clinical significance of these findings has yet to be elucidated.
Administration, Inhalation↗
[A rapid method for theophylline determination in whole blood].
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Chromatography↗
Effects of miaA on translation and growth rates.
We have measured the growth rates and elongation rates for different proteins in wild-type, miaA, rpsL, and miaA, rpsL double mutants of Escherichia coli in the presence as well as the absence of streptomycin. The data show that while miaA and rpsL mutants inhibit elongation rates to equivalent levels, miaA inhibits the growth rate twice as effectively as does rpsL. The double mutant is more effectively inhibited than either single mutant and Sm repairs in part the growth rate as well as protein elongation rates. The data suggest that the conditional streptomycin-dependent phenotype of the double mutant cannot be due simply to the depressed polypeptide elongation rates of the double mutant.
Escherichia coli↗
Pharmacokinetics of budesonide in children with asthma.
The pharmacokinetics of the glucocorticoid budesonide was studied in 6 children with asthma after i.v. injection of 0.5 mg and oral inhalation of 1 mg as an aerosol. Budesonide is a 1:1 mixture of the epimers 22 S and 22 R, which were assayed separately by HPLC combined with RIA. All pharmacokinetic parameters of the epimers differed except the half-life of about 1.5 h. It was significantly shorter than that reported in adults. Plasma clearance averaged 103 l X h-1 for epimer 22 R and 74 l X h-1 for epimer 22 S; calculated per kg body weight these values were about 50% higher than in adults. The difference was about 40% when calculated per m2 of body surface area. Since budesonide is a high-clearance drug, the data indicate higher liver blood flow X kg-1 body weight and m2 of body surface area in children. The systemic availability of the aerosol was approximately 30% of nominal dose, i.e. the same as in adults. The high clearance and short half-life of budesonide in children are advantageous in reducing the risk of possible systemic side-effects of prophylactic treatment of asthma in childhood.
Administration, Inhalation↗
Absorption characteristics of once-a-day slow-release theophylline preparation in children with asthma.
The single- and multiple-dose absorption characteristics of a new sustained-release theophylline preparation, which has been formulated for once per day dosing in adults, were investigated in children aged 8 to 14 years. Four single doses were studied, each dose separated by 1 week. During steady state the preparation was given once daily in the morning for 1 week, and serum theophylline concentration was determined through two dosing intervals (48 hours). The product showed excellent sustained-release characteristics and consistent absorption profiles, which were not affected to any clinically important extent by the intake of various meals. After single doses, only 77% to 91% of the product was absorbed during the first 28 hours after dosing. However, bioavailability was complete both after single doses and during steady state. Eight of 14 children had steady-state fluctuations in serum theophylline levels of less than 90% when given doses once daily. Steady-state day-to-day variations in serum theophylline profiles were small in all patients except one, in whom differences up to 33 mumol/L (6 micrograms/mL) were seen (8 hours after dosing). We conclude that this formulation is completely absorbed at a sufficiently slow and consistent rate to permit acceptable fluctuations in absorption with once daily dosing for many, but not all, patients. However, it should not be used in very young children until bioavailability has been studied in this age group.
Absorption↗
Inhaler use in children with asthma.
1. Coordination difficulties, stop of inhalation at actuation and fast inhalations are the most important problems children experience when using a PA while difficulties with correct loading and splitting of the capsule are the most prevalent problems with the RO. 2. Most children older than 5 years can be taught effective use of an inhaler and once the correct technique has been learned is it rarely forgotten if the inhaler is used regularly. 3. Insufficient instruction at the time of prescription is the major cause of inefficient inhaler use in children who use their inhalers regularly. 4. Use of a TS makes it easier for children to inhale slowly. Furthermore, compared with a PA and TS reduces the occurrence of coordination problems and stop of inhalation when the aerosol is fired; otherwise there seems to be little clinical difference between a PA and a TS. 5. Problems with correct inhaler use are accentuated during episodes of acute wheeze when supervision or help from an adult may be needed. 6. Pauses between doses of inhaled bronchodilators are likely to improve bronchodilation during episodes of acute wheeze, whereas there is no need to recommend pauses between the puffs of bronchodilators or between puffs of bronchodilators and corticosteroids in the routine day to day management of patients. 7. Children using a TS should be taught to inhale as slowly as possible. Tilting the head back during inhalation, breath-holding after the inhalation and exhalation through the nose do not enhance response. Furthermore, the lung volume at which the aerosol is actuated is relatively unimportant as long as the child inhales as deeply as possible after actuating the aerosol. 8. The effect of powder inhalers is dependent upon a certain inspiratory flow rate and therefore there is a risk of reduced effect during episodes of acute wheeze or in children with low pulmonary function. This risk may be greater with a RO than with a FPI. 9. Children using a Rotahaler or a Fenoterol powder inhaler should be taught to inhale as fast as possible. They need not tilt the head backwards during inhalation or hold their breath afterwards. 10. Conclusions from one inhaler should be applied with caution to other inhalers. 11. The long list of instructions currently considered to represent the essentials of correct inhalation technique can be markedly simplified without any significant loss of effect in children receiving inhaled therapy with bronchodilators and corticosteroids.(ABSTRACT TRUNCATED AT 400 WORDS)
Administration, Inhalation↗
[Hyperlipemia in a neonate following administration of Diazemuls].
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Diazepam↗
Effects of food on the absorption of theophylline in children.
The results of studies evaluating the effects of a standardized substantial breakfast on the absorption of four different sustained-release theophylline preparations in children and adults are summarized. Theolair SR showed a substantial reduction in rate but not extent of absorption. With Theo-Dur Sprinkle the bioavailability was reduced to 44%, and the absorption profiles became unpredictable with marked interindividual variations. Apart from a minor shift to the right of the serum concentration versus time curve no clinically important food effect was found when Somophyllin was tested. Pronounced "dose dumping" and increases in maximum serum concentration were observed in half the patients when Uniphyllin was taken with food, whereas bioavailability and time to maximum serum concentration remained unchanged. The food effect was more marked in children than in adults with all preparations, and some of the effects were found in children only, indicating that it is not sufficient to examine the influence of food solely in adults. It is concluded that the in vivo performance of sustained-release theophylline formulations in combination with food cannot be predicted on the results from absorption studies in fasting patients or from in vitro dissolution tests. Furthermore, individual data are often more important than mean data, which may sometimes even be misleading.
Child↗
Absorption of Theo-Dur Sprinkle with food: importance of types of meals and medication times.
The bioavailability and absorption pattern of theophylline from Theo-Dur Sprinkle were investigated in adults both in fasting conditions and after two different meals. Theophylline administered intravenously was used as a reference. Furthermore, the importance of the time of medication in relation to the meal consumption for the effect of food on absorption was studied. The preparation was well absorbed under fasting conditions. A high water-content meal (apple sauce) delayed the absorption of theophylline slightly but did not influence the extent of absorption (bioavailability, 83%). A dry meal (corn flakes and bread) markedly affected both absorption pattern and bioavailability. Long delays in absorption and periods of rapid absorption of theophylline were found, and the bioavailability was reduced from 92% (fasting) to 65% (p less than 0.05). Substantial interindividual variations in absorption were observed. Taking the preparation 5 minutes before the dry meal instead of immediately after markedly reduced the effect of food on absorption. Bioavailability increased to about 84%, and the absorption profiles became much more reliable.
Adult↗
The importance of a pause between the inhalation of two puffs of terbutaline from a pressurized aerosol with a tube spacer.
In a double-blind crossover study, 16 children with asthma were treated with two puffs of terbutaline (0.25 mg per puff)/placebo from a pressurized aerosol with a tube spacer. The puffs of terbutaline were taken either immediately after each other (TT) or with a pause of 3 minutes (3TT) or 10 minutes (10TT) between the two puffs. All active treatments compared with placebo resulted in a significant bronchodilation, both under normal day-to-day conditions and during acute attacks of bronchoconstriction (p less than 0.01). Under basic conditions there was no statistically significant difference in increase in FEV1 after TT, 3TT, and 10TT treatments (22%, 24%, and 25%, respectively). During attacks of acute wheeze, however, a pause between the two puffs of terbutaline improved bronchodilation significantly from 49% (TT), to 68% (3TT), and 78% (10TT) (p less than 0.01). There was no statistically significant difference between 3TT and 10TT treatments. It is concluded that pauses between the doses of inhaled terbutaline is likely to improve bronchodilation during episodes of wheeze or poor control of symptoms, whereas there appears to be no need to recommend pauses between the puffs in the routine day-to-day management of children with moderate asthma.
Adolescent↗
Food induced changes in theophylline absorption from a once-a-day theophylline product.
Bioavailability and the absorption pattern of theophylline from the sustained release theophylline (SRT) product, Uniphyllin, were studied in eight adults and eight children under fasting conditions in the morning, after a standardised breakfast in the morning, and under fasting conditions in the evening (adults only). Theophylline given intravenously was used as a reference. The extent of absorption of theophylline was complete for all administrations of SRT both in adults and children. In adults the absorption profiles after the three administrations of SRT were very similar and at no time point was there any difference in serum theophylline concentration or fraction absorbed between the three regimens. In addition, inter and intra individual variations in absorption were small. In children food caused a substantial change in the absorption pattern of theophylline so that the profiles became rather unpredictable with delays in absorption and periods of rapidly increasing serum drug concentrations. In three of the patients the dose dumping phenomenon resulted in toxic serum drug concentrations. Dumping of the dose could take place at any time interval between 3 and 15 h post dosing. Cmax was about 50% higher after fed than after fasting medication (P less than 0.01). It is concluded that children should not take SRT in large doses in combination with food.
Absorption↗
Food and fasting absorption of a single dose of a sustained release theophylline sprinkle formulation in children.
The bioavailability and absorption pattern of theophylline from a single dose of a slow release theophylline sprinkle product (Somophyllin) were investigated in 10 asthmatic children both in fasting conditions and after a standardized breakfast. Theophylline given intravenously was used as a reference. The fasting absorption of Somophyllin was rather fast with peak serum theophylline levels 3-5 h (mean 3.7 h) after dosing. Food produced a small but statistically significant reduction in the rate of absorption of theophylline, so that the mean time to peak serum theophylline level was 5.6 h (range 4-8 h) after food. In no case was there any important difference between the absorption profiles on the test days, and the bioavailability was complete after both fasted and fed intake of the product (92.5% and 105%, respectively). It is suggested that to obtain the optimum absorption profile children should take Somophyllin with food rather than between meals.
Asthma↗
Errors in inhalation technique and efficiency in inhaler use in asthmatic children.
256 asthmatic children receiving regular inhalation therapy demonstrated how they used their inhalers. Pulmonary function measurements (PFM) were made before and after the demonstrations, and errors in technique were recorded. 242 children had reversible airway obstruction on the day of study. In only 109 (45%) did the inhalation result in an increase in FEV1 greater than or equal to 15% (efficient technique). An efficient inhalation technique was found in 46% of children who demonstrated a pressurized aerosol, 59% who demonstrated a tube spacer aerosol and 46% who demonstrated a rotahaler, and the frequency of efficient technique varied from 17% to 84% between six different groups of instructors. 87% of children controlled and 25% not controlled with PFM at the time of prescription had an efficient technique. Children under 6 years had a more inefficient and a more faulty technique than older children, but otherwise age did not influence the result. Neither was time since instruction of any importance for efficiency or number of errors. The errors recorded that seem to influence efficiency most were: coordination problems, rapid inspirations, ceasing to inspire when the aerosol was fired, and inhalation through the nose. The results emphasize the paramount importance of clear instructions and control of inhalation technique at the time the treatment is prescribed.
Adolescent↗
Simplification of inhalation therapy in asthmatic children. A comparison of two regimes.
In a placebo-controlled double blind cross-over study of 3 X 3 weeks' duration the effectiveness of a new set of simple instructions for the use of spacer aerosols was compared with that of the rather complicated manufacturer's instructions in the daily treatment of 22 children with severe asthma. All children received inhaled budesonide and terbutaline at the lowest dose possible for satisfactory symptom control. Both the simple and complicated regimes were significantly better than placebo (P less than 0.01), but there was no indication that the complicated regime was superior to the simple regime. On the contrary, the children used significantly more rescue terbutaline and experienced more daytime symptoms when treated according to the complicated regime (P less than 0.01). 19 of 21 children who completed the study preferred to use the simple regime (P less than 0.01). It is concluded that instructions for the use of spacer aerosols should be substantially simplified and that conclusions from laboratory studies should be tested in the day-to-day management of asthmatics before these aerosols become widely used.
Adolescent↗