PubMed Health⌕ Search

Biomedical subjects

A T Edmunds

Publications and source records attributed to A T Edmunds.

At least 19 recordsLinked to original sources
PubMed1999

Crying significantly reduces absorption of aerosolised drug in infants.

AIM: Therapeutic aerosols are routinely used in the management of infant obstructive airways disease. Infants often become distressed during administration. The aim of this study was to determine the influence of distress and disease severity on the absorption of aerosolised drug in this age group. METHODS: Fifteen infants, eight with resolving chronic lung disease of prematurity (mean age, 13 months), and seven infants with normal birth histories (mean age, 11 months) were studied. Flow through small airways was assessed by measurement of partial forced expiratory flow volume curves. Each infant was then given a dose of 20 mg nebulised sodium cromoglicate via a Sidestream nebuliser and distress was graded as: 1, not distressed; 2, distressed. Infants were excluded if contact with the mask was lost for more than 10 seconds. Urine was collected for eight hours and analysed for excreted drug by radioimmunoassay. RESULTS: Sodium cromoglicate is absorbed by the respiratory epithelium, and undergoes renal (43%) and hepatic (57%) excretion. A mean of 0.43% of the total nebulised drug dose was excreted in the urine of the non-distressed infants compared with 0.11% of total dose in the distressed infants. Flow through the small airways was significantly reduced in infants with chronic lung disease of prematurity. Maximum flow at functional residual capacity did not correlate with the amount of drug in the urine, but the degree of distress did. CONCLUSION: To maximise absorption, nebulised drugs should be given to settled infants. The degree of airways disease does not influence drug absorption in this age group.

Administration, Inhalation↗
PubMed1997

Assessment of pulmonary function in resolving chronic lung disease of prematurity.

AIM: To investigate the longitudinal changes of interstitial and airways disease in resolving chronic lung disease of prematurity (CLD). METHODS: Thirty three infants were studied between 35 and 40 weeks of postconceptional age, and then at three monthly intervals throughout their first year. Measurements of mean arterial oxygen saturation (MSaO2) and its variability (delta MSaO2) were recorded. PaCO2 and PaO2 were determined while the infants breathed steady state 50% oxygen via a hood. From these, the alveolar arterial difference (A-a) DO2(50) was calculated. Airway disease was assessed by the measurement of partial forced expiratory flow volume curves (PEFC) to give Vmax Frc. RESULTS: The cohort mean +/- 95% confidence intervals measured between 35 and 40 weeks were for MSaO2 (89.25 +/- 1.87%, range 75-96.5%) and delta MSaO2 (4.79 +/- 0.8%, range 0.16-9.64%), PaCO2 (5.89 +/- 0.56 kpa, range 4.2-10.11 kpa), (A-a) DO2(50) (22.7 +/- 2.56 kpa, range 6.67-31.4 kpa) and VmaxFrc (41.5 +/- 8.65 mls/second, range 8.5-103.7 ml/second). The most significant improvement in all measurements occurred within the first three months (P = 0.05). An MSaO2 of less than 90% in room air at 1 year of age was predicted between 35 and 40 weeks postconceptional age by an (A-a) DO2(50) of greater than 29 kpa, with a sensitivity of 0.85 and a specificity of 0.88, and a PaCO2 greater than 7 kpa predicted a specificity of 0.78 and a sensitivity of 0.88. Predictions were strengthened by combining the above criteria and these then gave a sensitivity and specificity of 1. CONCLUSION: Measurements of (A-a) DO2(50) and PaCO2 taken between 35 and 40 weeks can be used to assess the degree of pulmonary dysfunction at 1 year. Quantification of the severity of CLD could be used as a measurable end point for early neonatal intervention studies.

Humans↗
PubMed1996

Prediction of early outcome in resolving chronic lung disease of prematurity after discharge from hospital.

In an attempt to identify those infants with resolving chronic lung disease of prematurity (CLD) at greatest risk of sudden infant death syndrome or acute life threatening event (SIDS/ALTE), or readmission to hospital following discharge, recordings of arterial oxygen saturation were made on 35 infants. Recordings were collected while the infants were breathing room air. Movement artefact was excluded and the data analysed to provide the mean individual arterial oxygen saturation (MSaO2), and the variability of the mean individual oxygen saturation (delta MSaO2). These data were related to clinical outcome recorded over the three months following investigation. A MSaO2 less than 90% on discharge predicted hospital admission within three months with a sensitivity of 1 and a specificity of 0.76, and SIDS/ALTE with a sensitivity of 1 and a specificity of 0.75. A delta MSaO2 greater than 6% predicted SIDS/ALTE with a sensitivity 0.88 and specificity of 1. Infants with resolving chronic lung disease of prematurity who are at risk of increased morbidity and mortality can be assessed by accurate measurement of mean arterial saturation.

Bronchopulmonary Dysplasia↗
PubMed1995

ICF syndrome (immunodeficiency, centromeric instability and facial anomalies): investigation of heterochromatin abnormalities and review of clinical outcome.

A further patient with the ICF syndrome (immunodeficiency, centromeric heterochromatin instability of chromosomes 1, 9 and 16 and facial anomalies) is described. This case is the second to be reported with consanguinity of the parents. This lends support to the theory of autosomal recessive inheritance. The features of the 15 published cases are reviewed. The clinical and cytogenetic characteristics of the syndrome are discussed, and new evidence provided as to the role of centromeres and centric heterochromatin in the production of chromosome aberrations. Correspondence with other authors has made possible a review of the clinical outcome in this condition.

Abnormalities, Multiple↗
PubMed1995

An audit of medical paediatric out-patient appointments and letters.

All medical out-patient appointments of a firm of three consultants at the Royal Hospital for Sick Children were reviewed over a four week period. Of 758 appointments initially offered, 490 (64%) patients attended; 19% of patients cancelled and 17% did not attend without cancelling. Delay from referral to attendance ranged from 0 to 9 weeks. The characteristics of those patients experiencing prolonged registrar-only follow-up are described. The content of subsequent letters to family practitioners was usually adequate compared to accepted standards. Delays in dictation of letters were usually short in comparison to delays in typing. Such delays and the intervals between consultant review of out-patients may prove costly to providers. Potential improvement strategies are discussed.

Appointments and Schedules↗
PubMed1992

Detection of respiratory syncytial virus in acute bronchiolitis in infants.

Direct detection of respiratory syncytial (RS) virus antigen in nasopharyngeal secretions (NPS) provides the most rapid diagnostic test for RS infection, but more sensitive methods might be more beneficial in the study of virus shedding. RS virus RNA was extracted from cells stored at -70 degrees C either in suspension with added RNAse inhibitor or as a pellet without inhibitor. The RNA was reverse transcribed, the resultant cDNA amplified by the polymerase chain reaction and detected by ethidium bromide staining after electrophoresis through agarose gel (RT-PCR). Of 217 specimens tested, 106 were positive by antigen detection, 99 by RT-PCR, and 92 by virus isolation. In a series of 97 sequential NPS specimens from 15 infants in whom RS virus induced bronchiolitis was confirmed, antigen detection proved most sensitive in the first week after onset and RT-PCR detected most positive specimens in the second week. Storage of the cells as a pellet proved more satisfactory than storage as a suspension. A further round of amplification using nested primers increased the number of positive results obtained by RT-PCR. The sensitivity of antigen detection using directly labelled monoclonal antibody to RS virus was slightly higher than that of RT-PCR, but the specificity was slightly lower.

Antigens, Viral↗
PubMed1986

Inhaled beclomethasone and oral candidiasis.

Two hundred and twenty nine children aged 6 to 15 years attending the asthma clinic at the Royal Hospital for Sick Children, Edinburgh, had throat swabs taken to determine the incidence of candida colonisation of the oropharynx. One hundred children (group A), who were not receiving steroids, were compared with 91 children (group B) receiving less than 500 micrograms of inhaled beclomethasone a day and 38 children (group C) receiving 500 micrograms or more of inhaled beclomethasone a day. Sore throat and hoarse voice were not related to the presence of candida or to treatment with inhaled steroids. The incidence of candida was greater in the groups given treatment with steroids but did not increase at a higher dosage, nor was it related to the type of inhaler used. There was only one case of clinical thrush in all the children studied.

Adolescent↗
PubMed1984

Deletion of the long arm of chromosome 11 [46,XX,del(11)(q24.1--qter)].

A child who presented at three months of age with pyloric stenosis and pancytopenia was found to have a partial deletion of the long arm of chromosome 11, del(11)(q24.1----qter). Only two previous cases have been described with an apparently identical chromosomal deletion, and both exhibit similar phenotypic features. Other patients with larger deletions of the distal region of the long arm of chromosome 11 show many features in common with these three cases. It is suggested that the region of the long arm of chromosome 11 from band q24.1 to qter may contain the genetic material responsible for the expression of the 11q - phenotype.

Chromosome Deletion↗
PubMed1983

Pulmonary eosinophilia associated with carbamazepine.

An 8 year old girl treated with carbamazepine developed eczema, wheeze, and evidence of pulmonary eosinophilia. Single dose challenge confirmed allergy to this drug. This reaction should be considered in patients being treated with carbamazepine who develop respiratory symptoms.

Carbamazepine↗
PubMed1982

Cardiac output measured by transthoracic impedance cardiography at rest, during exercise and at various lung volumes.

1. Cardiac output measured by transthoracic impedance cardiography has been compared with simultaneous measurements made by the indirect Fick CO2 rebreathing method in nine adults and 14 children. All were healthy normal volunteers. Sixty-six comparisons were made at rest and during steady exercise at work loads up to 100 W. 2. Impedance measurements of cardiac output were consistently higher than indirect Fick measurements of cardiac output, but after application of a correction factor related to packed cell volume there was close correlation between the results obtained by the two methods (r = 0.94). 3. The mean coefficient of variation of impedance measurements of cardiac output was 13% at rest and 5% during steady-state exercise. 4. Changes of lung volume due to breath holding or resulting from addition of an expiratory resistance did not affect the measurement of cardiac output by impedance. 5. Transthoracic impedance cardiography is a rapid, non-invasive technique for measurement of cardiac output. It requires very little active co-operation from the subject. The method would probably give reliable results for patients with respiratory illnesses such as acute asthma or bronchiolitis, during which changes of lung volume may be expected to occur.

Adult↗
PubMed1981

Cardiovascular response during severe acute asthma and its treatment in children.

Heart rate, blood pressure, pulsus paradoxus, and cardiac output measured by means of transthoracic electrical impedance cardiography have been recorded in 29 children mean age 10 years +/- 2 SD during status asthmaticus. Changes were recorded over the first two hours of treatment during which all patients received oxygen, intravenous fluid, and hydrocortisone, and were randomly assigned to receive aminophylline, salbutamol, or both. Admission values showed significant correlation of pulsus paradoxus with PaCO2 (r = 0.66). Pulsus paradoxus was greater than 20 mmHg for all patients with PaCO2 above 5.5 kPa. Mean stroke volume and cardiac output were 89% and 131% of the resting convalescent values in the same children. Stroke volume cardiac output and heart rate did not correlate with peak expiratory flow rate or blood gas measurements. Aminophylline and salbutamol together were associated with significantly greater increase in PEF than aminophylline alone (P less than 0.05). Nebulised salbutamol was just as effective as intravenous salbutamol. Heart rate and systolic blood pressure declined significantly after nebulised salbutamol and aminophylline, but not after intravenous salbutamol and aminophylline. Stroke volume and cardiac output did not change significantly in any treatment group.

Acute Disease↗
PubMed1979

A clinical comparison of beclomethasone dipropionate delivered by pressurised aerosol and as a powder from a rotahaler.

14 children with severe asthma were studied for 2 months in a double-blind cross-over trial to compare the efficacy of beclomethasone dipropionate delivered as an aerosol and as a powder from a rotahaler. Inhalation via the aerosol was satisfactory in 13 patients, each of whom used the rotahaler correctly. Younger children preferred to use the rotahaler. Comparison of daily symptoms, twice daily peak expiratory flow rate (PEFR), and use of salbutamol during the 2 months of the trial showed that control of asthma was equally good, irrespective of the device used to deliver active beclomethasone.

Adolescent↗
PubMed1979

Status asthmaticus in children: a one-year study.

50 children were admitted on 72 occasions during one year in status asthmaticus, defined as wheezing not relieved by two doses of bronchodilator 4 hours apart. At least one-third of children were hypercapnoeic on admission. They were managed with either oral prednisolone and nebulised salbutamol. Those with peak expiratory flow rates of greater than 25% expected for height were satisfactorily managed on the oral regimen. One child needed assisted ventilation. 73% were fit for discharge within 4 days and more than half of them needed a change in maintanance treatment.

Adolescent↗
PubMed1979

A comparison of oral choline theophyllinate and beclomethasone in severe perennial asthma in children.

Fourteen children with perennial asthma previously treated with beclomethasone dipropionate were studied for four months in a crossover trial to compare the efficacy of choline theophyllinate and beclomethasone dipropionate aerosol in the control of their symptoms. Assessments were made using twice daily peak flow measurements, together with daily records of symptom scores and use of extra salbutamol. Beclomethasone and oral choline theophyllinate together improved control of asthma in comparison with beclomethasone alone. Reduction of the dose of beclomethasone from 400 microgram/day caused worsening of asthma. Oral choline theophyllinate did not prevent this deterioration and therefore cannot replace beclomethasone for the long-term treatment of such asthmatic patients.

Administration, Oral↗
PubMed1978

Clinical applications of serum theophylline measurement by high pressure liquid chromatography.

Serum theophylline concentration was measured in children both during treatment of status asthmaticus with intravenous aminophylline, and as outpatients while they were taking oral theophylline compounds for long-term management of asthma. The clinical value of the measurements was assessed. Measurement using high-pressure liquid chromatography is simple and requires only a small volume of blood. Knowledge of serum theophylline concentration facilitates careful control of dosage of both intravenous aminophylline during treatment of status asthmaticus, and of oral theophylline in outpatients. It is useful in the evaluation of symptoms which may be due to toxic side effects of treatment. It also makes possible an assessment of patient compliance with prescribed treatment among those whose symptoms have not improved.

Adolescent↗