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Biomedical subjects

W Lenney

Publications and source records attributed to W Lenney.

At least 55 records · Page 3Linked to original sources
PubMed1993

Late pulmonary scintigraphic defects after uneventful recovery from simple focal pneumonia of childhood.

We present a pilot study designed to determine whether pneumonia in children accompanied by focal consolidation on the chest radiograph (CXR) is associated with late abnormality as detected by radionuclide lung scintigraphy. 14 children with focal pneumonia were assessed 1 year after initial presentation. In 12 both krypton-81m ventilation and technetium-99m MAA perfusion studies were performed, while in two only perfusion studies were obtained. All cases had a further CXR. Abnormal or equivocal cases were reviewed clinically. Scans and CXRs were independently assessed by two observers and subsequently consensus reached by discussion. There were five abnormal and nine normal lung scans. Two defects matched the site of the initial pneumonia while three did not. A CXR at the time of lung scanning was normal except for one case with a small focus of consolidation on the opposite side to the initial pneumonia but with a normal lung scan. Similarly, clinical assessment at the time of scanning was unremarkable, with no history of further respiratory episodes except in one child excluded from the study because of an interval diagnosis of asthma. This pilot study indicates that lung scan defects are common in the medium term after supposedly uncomplicated pneumonia in childhood. The cause of these defects remains uncertain. The correlation with the site of the initial radiological abnormality is variable, pointing to the need for further research in this area. The importance of independent blind interpretation is also highlighted.

Child↗
PubMed1992

Management of asthma in pre-school children.

The management of asthma in pre-school children often presents physicians with challenging problems. This article addresses the diagnostic criteria by which the diagnosis may be made, discusses the prognosis of untreated asthma and states the principles underlying the treatment of asthma in this age group. The management according to a stepwise protocol is discussed with reference both to maintenance therapy, and the treatment of acute severe asthma. The methods by which appropriate medication may be delivered are also described.

Age Factors↗
PubMed1990

Long term follow up after inhalation of foreign bodies.

The long term results of treatment of inhalation of foreign bodies in a district children's hospital and in a tertiary referral centre were reviewed by clinical assessment, chest radiography, and standard four view 81mKr ventilation/99mTc macroaggregated albumin perfusion imaging (V/Q lung scan). The overall incidence in the population served by the district hospital was roughly one in 14,000/year. Of the 12 children reviewed there, three had abnormal chest radiographs and four had abnormal V/Q scans as a result of inhalation of the foreign bodies. Of 21 children treated and reviewed at the referral centre, eight had abnormal chest radiographs, and 14 had abnormal V/Q lung scans. Three factors were assessed for prognostic importance: site of impaction, initial radiographic appearance, and time before removal. A child who had inhaled a foreign body into the left lung and who had collapse/consolidation on the initial chest radiograph was at greatest risk of long term complications. These children merit close follow up.

Child, Preschool↗
PubMed1989

Mineral balance studies in sick preterm intravenously fed infants during the first week after birth. A guide to fluid therapy.

Mineral balance studies were performed in 61 sick preterm infants given parenteral fluids only. Their gestational ages varied from 24 to 35 weeks, and 50 required mechanical ventilation. Two consecutive balance studies were performed; the first from admission to 48 hours in all babies given maintenance fluids of 10% Dextrose, and the second from 48 hours to 7 days in those babies given intravenous feeding (IVN). At the beginning and end of each balance period, the baby was weighed and an arterial blood sample taken for blood gases, electrolyte, urea, creatinine and protein determinations. During the balance period all urine was collected and analysed for electrolyte, urea, and creatinine composition, and all fluid intake was recorded. The balance of a mineral was calculated as the difference between parenteral intake and urine output. Infants requiring IVN were allocated alternatively to regimen X or regimen Y, which had the same calcium content of 9.5 mmol/L, but different phosphate contents, regimen X containing 7.3 mmol/L and regimen Y 11.6 mmol/L. In those infants requiring prolonged IVN, 12-24 hour balance studies were performed at weekly intervals after day 10. 1. Phosphate deficiency developed in infants given regimen X, who had higher urine calcium excretion, lower percentage calcium retention and lower plasma phosphate levels than those given regimen Y. These differences were apparent by day 7 and persisted after day 10. In infants given regimen Y, mean calcium retention from admission to day 7 was 3.9 mmol/kg, and after day 10 was 0.9 mmol/kg/day. 2. In the first 48 hours, urine output and creatinine clearance varied widely and were lower in infants with higher oxygen requirements at 48 hours. Ten babies had severe oliguria with outputs less than 10 mL/kg/day. Creatinine clearance was directly related to gestational age, mean arterial blood pressure, and plasma protein concentrations on admission. After 48 hours, urine output and creatinine clearance increased considerably. 3. In the first 48 hours, metabolic acidosis was produced by increased plasma non-protein metabolisable acid concentrations, which were associated with low creatinine clearances, and were thought to be due to lactic acid accumulation in response to decreased tissue perfusion. At 7 days, metabolic acidosis was of similar severity but was produced by decreased plasma non-metabolisable base concentrations, caused by increased urine loss of net base, and not directly by IVN.(ABSTRACT TRUNCATED AT 400 WORDS)

Acidosis↗
PubMed1989

School holidays and admissions with asthma.

The admission rate for asthma at a children's hospital was studied over an 11 year period. Admissions varied unpredictably over periods of a few days, but there was a repeated yearly pattern of peaks and troughs with an interval of several weeks. The short term variation could be attributed to chance effects alone, excluding any important role for short term influences--for example, weather changes--in precipitating asthma admissions. There was a definite association between the longer term variation and school holidays. The admission rate fell during holidays and there were two or more peaks during terms. The pattern is consistent with a largely viral aetiology for asthmatic attacks throughout the year. We postulate that school holidays disrupt the spread of viral infections in a community, with synchronisation of subsequent attacks. Travel during holidays may facilitate acquisition of new viral strains by the community.

Adolescent↗
PubMed1988

Frusemide-induced nephrocalcinosis in very low birth weight infants.

Three very low birth weight infants, treated with frusemide for broncho-pulmonary dysplasia are described. They all developed medullary nephrocalcinosis identifiable by real time ultrasound. The sonographic findings of diffuse medullary hyper-echogenicity appears to be specific for nephrocalcinosis.

Bronchopulmonary Dysplasia↗
PubMed1988

Stridor in childhood asthma.

Three asthmatic children are reported with shortness of breath due to stridor. The stridor was preceded by a deterioration in asthma control necessitating the introduction or increased dosage of a pressurized beclomethasone inhaler. The stridor mimicked asthmatic symptoms and was only differentiated by auscultation directly over the neck and by response to nebulized adrenaline. One child had a laryngeal foreign body which probably gained entry via a pressurized inhaler.

Administration, Inhalation↗
PubMed1988

Biometeorological triggers in childhood asthma.

The relationship between child asthma admissions and biometeorological factors was investigated over a 16-month period. No relationship was found with many commonly suspected precipitants such as temperature, humidity and wind. There was however a strong association with rainfall (P much less than 0.001). Associations occurred with low barometric pressure and counts of coloured basidiospores and green algae, but no significant relationship was found with grass pollen.

Adolescent↗
PubMed1988

Rising asthma admissions and self referral.

An eight fold rise in asthma admissions to the Royal Alexandra Hospital for Sick Children, Brighton occurred over the 15 year period 1971-85. The cause was an increase in the number of children seen, rather than increased readmission. The initial rise was associated with the introduction of nebulised salbutamol in 1976. The children concerned were mainly over 5 years old. Three years later came a larger influx of younger children. Circumstances leading to admissions were examined in a prospective study over a one year period. There were 605 admissions, 437 (72%) were self referrals. The commonest reason parents gave for preferring hospital treatment was the availability of nebuliser treatment.

Adolescent↗
PubMed1987

Asthma in primary schools.

Seven schools in the Lewes area were visited to identify which children were using inhalational treatment for asthma. The attitudes of the parents and schools were assessed, as was the children's skill in using inhalers. Five per cent of all children were receiving inhalational treatment with bronchodilator drugs. On average they had missed seven school days in the past year. The opinions of the parents about treatment appeared to be determined by the severity of the child's asthma. Most schools coped well with giving bronchodilators, though there was no real understanding of the nature of the disease or treatment. Most children who had received pressurised inhalers could not use them satisfactorily.

Asthma↗
PubMed1987

Effect of a single oral dose of prednisolone in acute childhood asthma.

140 children of 184 with acute asthma entered a randomised double-blind trial of oral prednisolone (n = 67) compared with placebo (n = 73) administered soon after admission. The dose of prednisolone was 30 mg in children under 5, otherwise 60 mg. All children also received salbutamol. All had moderate or severe dyspnoea. Initial evaluation was similar for both groups. On reassessment after a few hours 20 children in the prednisolone group were fit for discharge compared with only 2 in the placebo group. There were no early reattendances. Children remaining in hospital had a shorter median duration of stay and were less likely to require further steroid therapy if they had initially received prednisolone. In acute asthma the prompt use of a single dose of oral prednisolone can reduce morbidity and the need for hospital care.

Acute Disease↗
PubMed1986

Nebulized salbutamol and ipratropium bromide in asthmatic children.

Varying doses of nebulized salbutamol, ipratropium bromide and a combination of both were given to 20 asthmatic children. All therapies produced effective bronchodilation. Ten mg salbutamol caused elevation of pulse rate and finger tremor whilst the duration of action of 0.6 mg salbutamol was too short. Dose-response effects were clearly seen with salbutamol but not with ipratropium bromide. A summation effect was not demonstrated when the medications were combined.

Adolescent↗
PubMed1986

Nebulised beclomethasone dipropionate in preschool asthma.

Twenty nine young children with severe recurrent asthma were given nebulised beclomethasone dipropionate or normal saline in a double blind manner over a six month period. Progress was monitored using diary score cards. Those receiving beclomethasone had lower symptom scores, had more symptom free days, and required less additional treatment with bronchodilator agents. The code needed to be broken more frequently if normal saline was used. Over the study period height and weight increases in the two groups were similar, and no serious side effects were noted.

Aerosols↗
PubMed1986

Calcium and phosphate content of intravenous feeding regimens for very low birthweight infants.

Fifteen infants with birth weights below 1500 g, who required intravenous feeding from birth, were given one of two regimens differing only in their calcium and phosphate content. The duration of intravenous feeding varied from 26 to 75 days, and infants were studied after the age of 10 days when growth could be expected to have started. Five infants were given regimen A, which provided calcium and phosphate intakes of 0.55 and 0.44 mmol/kg/day, and 10 received regimen B, which provided intakes of 1.08 and 0.89 mmol/kg/day, respectively. Infants given regimen A had lower plasma and urine phosphate but similar urine calcium excretion to those given regimen B. Plasma calcium concentrations were higher in infants on regimen A than regimen B. In infants given regimen B plasma phosphate concentration was inversely related to weight gain, and urine phosphate and calcium concentrations were significantly correlated with urine sodium results.

Calcium↗
PubMed1986

Nebulised ipratropium and salbutamol in asthma.

Treatment with nebulised salbutamol or a mixture of salbutamol and ipratropium was given to 138 children. Length of hospital stay and number of nebulised doses required did not differ. In severe asthma response was greater with salbutamol alone. In mild asthma response was greater with combined treatment.

Acute Disease↗