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Biomedical subjects

A M Landstra

Publications and source records attributed to A M Landstra.

4 recordsLinked to original sources
PubMed2006

[Accurate assessment of heart murmurs in children: thorough medical history and physical examination required].

4 children, boys aged 12, 5, 1.5 and 11 years, had a heart murmur. The 12-year-old boy could also not finish a football match and appeared to have atrioseptal defects (ASD). The 1.5-year-old boy had pulmonary symptoms that were not responsive to asthma medication; he also had ASD. The 11-year-old boy had had chest pain and pressure following exertion for 2 years; he appeared to have an aortic stenosis. Symptoms disappeared in all 3 patients after surgical correction. In the 5-year-old asymptomatic boy the murmur was deemed to be innocent following medical history and physical examination. Children frequently have heart murmurs. Most heart murmurs are innocent but some are caused by heart defects. Careful evaluation of the medical history and physical examination are critical in the differentiation of innocent and pathological heart murmurs. Routine supplementary diagnostic tests in children with heart murmurs are of limited value and are often misleading. One should inquire about specific and nonspecific symptoms and also perform systematic inspection, palpation and auscultation to identify any characteristics that suggest a heart murmur caused by a heart defect.

Aortic Valve Stenosis↗
PubMed2003

Effect of intravenous hydrocortisone on nocturnal airflow limitation in childhood asthma.

Low endogenous cortisol levels appear to contribute to the pathophysiology of nocturnal asthma. Lower cortisol levels are associated with lower forced expiratory volume in one second (FEV1) levels in children with asthma. The aim of the present study was to identify whether substitution of low serum cortisol with intravenous hydrocortisone decreases 24-h FEV1 variation and/or indirect measures of airway inflammation. Hydrocortisone was given over 24 h in a double-blind randomised crossover design to 26 subjects. FEV1 was measured every 4 h during 24 h; blood eosinophils and airway responsiveness to methacholine and adenosine 5'-monophosphate (AMP) were measured at 04:00 h and 16:00 h. Cortisol levels increased during the night and morning hours. FEV1 values were higher at all time points in children with nocturnal asthma (n=10; 24-h FEV1 variation > or = 15%) which was significant at 08:00 h, unlike in the non-nocturnal asthma (NA-) group (n=16). Numbers of eosinophils (10(9) x L(-1)) at 04:00 h decreased in the asthma group (median 0.61 (range 0.05-1.42) versus 0.52 (0.05-1.79)). Provocative dose causing a 20% fall in FEV1 (PD20) methacholine did not change, whereas PD20 AMP improved only at 16:00 h in the NA- group (72.0 (0.13-144.0) versus 144.0 (2.25-144.0) mg x mL(-1)). These results show that substitution of lower endogenous 24-h values of cortisol contribute to higher forced expiratory volume in one second values and a decrease of blood eosinophils as an inflammatory marker in more severe airway obstruction.

Adolescent↗