Partial expiratory flow-volume curves in infants and young children.
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Child, Preschool↗
Biomedical subjects
W J Morgan
Publications and source records attributed to W J Morgan.
Fatal prolonged foreign body aspiration following an asymptomatic interval.
Patients with nondiagnosed foreign body aspiration usually have persistent symptoms and occasionally die. We are reporting two patients with histories suggestive of foreign body aspiration who were not definitively studied because of resolving symptoms. Both children became asymptomatic but subsequently developed acute, total airway obstruction and died. These cases demonstrate the difficulty of diagnosing aspiration and the necessity of timely intervention.
Airway Obstruction↗
Passive exhalation technique correlates with esophageal balloon measurements of respiratory mechanics in beagle pups.
We correlated respiratory system mechanics measured by passive exhalation technique with pulmonary mechanics assessed by esophageal balloon technique to determine the ability of each to detect histamine-aerosol-induced changes in conductance and compliance. Eight beagle pups were anesthetized with chloralose and mechanically ventilated 6 times over a 2-wk period of an acute canine parainfluenza II infection. Measurements of respiratory mechanics were obtained by both methods after aerosol challenge with 5 breaths of saline and after each of 9 increasing doses of histamine. Pulmonary conductance and static compliance of the lung were measured by the esophageal balloon method. The rate constant of the respiratory system was calculated by computer-assisted analysis of passive exhalation. Static compliance of the respiratory system was measured after 2 s of apnea, and conductance of the respiratory system was calculated as compliance multiplied by rate constant. Paired data were obtained on 349 measurements. As expected, both conductance and compliance decreased significantly (p less than 0.05) after histamine aerosol challenge by both techniques. Rate constant did not change significantly by either method. The 2 techniques were highly correlated (p less than 0.001) for conductance (r = 0.76), compliance (r = 0.94), and rate constant (r = 0.66). We conclude that analysis of respiratory mechanics using the passive exhalation method correlates well with esophageal balloon data. Furthermore, passive exhalation techniques are technically simple and can detect changes in respiratory mechanics associated with histamine challenges.
Animals↗
The child with persistent cough.
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Child↗
Expiratory flow limitation in infants with bronchopulmonary dysplasia.
We evaluated lung function in 20 infants with bronchopulmonary dysplasia (BPD) during the first year of life. Compared with a group of age- and size-matched controls, the infants with BPD had a significantly (P less than 0.005) lower functional residual capacity (FRC; 25 +/- 4 vs 18 +/- 6 ml/kg) at less than 10 1/2 months after conception, but no significant difference during the remainder of the first year. The partial expiratory flow volume curves in the infants with BPD were markedly concave, with tidal breathing approaching expiratory flow limitation. The infants with BPD had significantly (P less than 0.01) lower absolute and size-corrected flows than did control infants, and 50% of the infants with BPD required rehospitalization because of acute respiratory distress associated with a lower respiratory tract illness. In addition, the slope of the linear regression of maximal expiratory flow at FRC (in milliliters per second) vs length (in centimeters) was significantly lower (P less than 0.001) for the infants with BPD than for normal control infants (2.25 vs 4.52), indicating poor growth of the airways. Oxygen saturation (SaO2 was negatively correlated with maximal expiratory flow at FRC, indicating that measurement of SaO2 alone may not be sufficient in the evaluation of lung function in infants with BPD. We conclude that, although infants with BPD improve clinically during the first year of life, they have abnormal functional airway growth; the decreased expiratory flow reserve helps to explain their high risk for acute respiratory distress during lower respiratory tract illness.
Airway Resistance↗
Physiologic growth and development of the lung during the first year of life.
Pulmonary function tests were performed on a total of 125 healthy infants younger than 25 postconception (pc) months of age. Maximal expiratory flow at functional residual capacity (VmaxFRC) was measured from partial expiratory flow-volume curves, and functional residual capacity (FRC) was measured by the helium dilution technique. There was a highly significant (p less than 0.01) linear regression for both VmaxFRC and FRC with increasing body length. The highest size-corrected flows (VmaxFRC/FRC) were obtained in the healthy premature (2.7 FRC/s, n = 6) and full-term (2.5 FRC/s, n = 5) infants, and there was a relatively constant value between 13 and 25 pc months of age (1.2 FRC/s), which was similar to those reported in older children and adults. In an age-matched group of infants 10 to 16 pc months of age, females had both higher absolute flows (126 versus 102 ml/s, p less than 0.03) and size-corrected flows (1.4 versus 1.0 FRC/s, p less than 0.001) than did males. These physiologic data support the concepts that neonates have proportionately larger airways relative to their lung volume at FRC, infants have size-corrected flows similar to those in older children and adults, and female infants have proportionately larger airways relative to their lung size than do male infants.
Chloral Hydrate↗
Emergency care of the elderly in the short-stay ward of the accident and emergency department.
Review of a consecutive series of the elderly patients who presented unheralded to the Accident and Emergency Department of the Royal Gwent Hospital showed that a relative minority (11%) were difficult to manage because they had no obvious acute medical condition or injury which qualified them for admission by the firms to whom they were first referred. The difficulty was compounded by the shortage of geriatric beds. Judicious use of short-stay ward beds in the accident and emergency department relieved pressure on beds elsewhere and allowed a short space of time in which preparation could be made for the patient's further care in the community. Elderly patients were removed quickly from the stretcher area of the accident and emergency department to the quieter surroundings of the short-stay ward, where their immediate nursing requirements could be readily met. It was not then necessary for them to be on a trolley for hours while junior doctors haggled on the telephone or nurses were too busy to administer food, drink and bedpans.
Aged↗
Hand injuries in south Wales coal miners.
Fifty eight coal miners attended the Royal Gwent Accident and Emergency Department with serious hand injuries over a three year period. The commonest cause of the injuries was falling rock or coal from the pit roof crushing the hand and the commonest type of injury was the crushed, compound fracture of the terminal phalangeal area of the digit, with or without pulp loss. Records of the time off work with the injury were obtained in 52 miners. Only seven (13%) returned to work within one month. Of 40 individual distal phalangeal injuries reviewed after one year, only four (10%) had normal sensation and full movement at the distal joint. Nevertheless, only seven miners (13%) had to alter their initial occupation at the mine and move to lighter duties.
Accidents, Occupational↗
Polysomnography scoring for sleep apnea. Use of a sampling method.
The all-night polysomnogram is used to assess the severity of sleep apnea by the quantitative analysis of a number of respiratory and sleep parameters. Because precise scoring of these parameters is a time-consuming process, we studied the effect of scoring varying percentages of polysomnograms on the accuracy of estimating sleep apnea severity. Twenty adult all-night polysomnograms with apnea-hypopnea (AH) indexes ranging from 1.0 to 67.8 were scored in the following manner: every 30-s epoch (100% scoring), every other epoch (50% scoring), every fourth epoch (25% scoring), every sixth epoch (16.7% scoring), every eighth epoch (12.5% scoring), and every tenth epoch (10% scoring). Each method was then compared with 100% scoring. For each parameter we established criteria for classifying studies as having a mild, moderate, or severe degree of abnormality. The number of studies correctly categorized for the following parameters was: (1) AH index, 20/20 for 50 and 25% scoring, 19/20 for 16.7 and 10% scoring, and 18/20 for 12.5% scoring; (2) AH time, 20/20 for 50, 25, and 16.7% scoring, 17/20 for 12.5% scoring, and 18/20 for 10% scoring; (3) mean AH duration, 20/20 for 50, 25, and 12.5% scoring, 18/20 for 16.7% scoring, and 15/20 for 10% scoring; (4) mean event percent O2 saturation, 20/20 for 50 and 25% scoring, 18/20 for 16.7 and 12.5% scoring, and 17/20 for 10% scoring; (5) longest AH, 19/20 for 50% scoring, 18/20 for 25% scoring, and 15/20 or less for 16.7, 12.5, and 10% scoring; (6) lowest percent O2 saturation, 19/20 for 50% scoring, 17/20 for 25% scoring, and 15/20 or less for 16.7, 12.5, and 10% scoring.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The chronic bronchitis complex in children.
In childhood, a clear definition, etiology, natural history, therapy, and prognosis have not been described for chronic bronchitis. In fact, its validity as a single disease entity is in question. This article offers a pragmatic approach by considering "chronic bronchitis" as a pathophysiologic description of a symptom complex that results from the interaction of both intrinsic and extrinsic factors. In this schema, the physician should rule out more specific diagnoses and prevent further airway disease by limiting exogenous causes of airway damage and treating identifiable endogenous ones.
Adrenergic beta-Agonists↗
Brucella classification and regional distribution.
The most significant advances in the field of Brucella classification since the last meeting have been in the field of Brucella phages reviewed by Corbel & Morgan (1980) Handbuch der Bakteriellen Infektionen bei Tieren, 4, Ed Blobel & Schliesser) and Corbel & Morgan (Bergey's Manual of Determinative Bacteriology. In press). The Berkeley phages, especially the BK2 variant has been found to be able to lyse smooth B. melitensis, as well as smooth strains of the other species. A further advance has been the isolation of phages which lyse rough strains of B. abortus as well as B. canis and B. ovis. The most recent comprehensive account of the world-wide distribution of brucellosis has been given by Hansen and Müller (1982. Tierarztl Umschau 37, 564-570), supplemented by recent reviews by Morgan, Hellman, Weber, Meyer, and Wundt (1980) in Handbuch der Bakteriellen Infektionen bei Tieren 4). Except in those countries where B. abortus infection has been eradicated in cattle, the disease still remains a world-wide problem in cattle, sheep, goats and pigs as well as in wild animal reservoirs in certain parts of the world.
Bacteriophage Typing↗
Foreign bodies in the hand.
A prospective study was carried out on 164 consecutive cases presenting at the Accident Department with foreign bodies in the hand. The distal segment of the digits was the commonest site. The late, symptomatic presentation of patients, together with the development of symptoms in patients managed conservatively indicate that foreign bodies should be removed. General anaesthesia is rarely required, but an effective "block" with a tourniquet is necessary, as infiltration anaesthesia has a high failure rate, and secondary exploration a high complication rate. Glass fragments are almost always visible on plain x-rays.
Accidents, Occupational↗
Legislation covering the licensing of veterinary medicines in the United Kingdom.
The procedures used in the United Kingdom governing the licensing of veterinary medicines based on an advisory committee procedure are summarised. The article does not purport to cover all aspects of medicines legislation and must not be treated as a complete or authoritative statement of the law on any particular case. Reference should be made to the Medicines Act 1968 and regulations made under the Act. It does not cover EEC legislation.
Legislation, Drug↗
Acute worsening of congenital lobar emphysema with subsequent spontaneous improvement.
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Female↗
Tetanus prophylaxis and accidental wounds.
Of 400 consecutive patients who had wounds treated in the Accident Department, 200 remembered receiving either booster injections or a full course of tetanus toxoid in the last 10 years. During this period, 182 patients received their initial toxoid injection in association with treatment of a wound in an accident department. Only 71 (38%) of these patients attended for a full course of injections. From our assessment of the wounds and the patient's anti-tetanus immunity, 79 patients (20%) were considered to be at risk of developing tetanus. By further considering the time interval elapsed between injury and treatment, a 'high risk' group of 13 patients (3%) was recognised. It is recommended that the use of human immunoglobulin should be reserved for the 'high risk' group, and that the remainder of the 'at-risk' patients should receive penicillin prophylaxis only.
Adolescent↗
The delayed treatment of wounds of the hand and forearm under antibiotic cover.
In wounds of the hand and forearm treated within 4 h of injury, prophylactic clindamycin, in a dose of 150 mg 6-hourly for 5 days, did not reduce the infection rate. In wounds treated after 4 h the infection rate was reduced, but not significantly so. There was a significant reduction in the infection rate comparing all wounds treated within 4 h with those treated after 4 h. Early treatment of wounds is more important than prophylactic antibiotics, although these may have a part to play where late treatment is unavoidable.
Clindamycin↗
Correlation between clinical and radiological diagnosis for fractures and dislocations in an accident department.
Clinicians and radiologists agreed on the presence or absence of fracture or dislocation in 897 of 1011 cases (89%). The agreement was closer in cases that were thought on clinical grounds to show no injury. We think the high incidence of agreement in this group should help to reduce the number of radiographs used in an accident department. Further analysis of the results indicates which areas of the body have most missed fractures.
Adolescent↗