Biomedical subjects
Publications and source records attributed to B M Schnapf.
This report describes a precocious eight-year-old child who presented with hallucinations from excessive use of albuterol inhalers. Shifting the child to a powdered form of albuterol (without the fluorocarbon propellant) controlled his asthma, and his behavior improved rapidly. The potential harmful effects of fluorocarbons used as propellants for inhalers are discussed.
Partial esophageal obstruction was an unusual complication of tracheostomy in an infant. Emesis and failure to thrive prompted a modified barium-swallow study, which revealed that the tracheostomy tube was causing an obstruction in the proximal esophagus. Use of a shorter, customized tube eliminated the esophageal obstruction, allowing normal feeding and weight gain.
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STUDY OBJECTIVE: Pulse oximetry was used to measure arterial oxygen saturation and the extent of hypoxemia in pediatric patients undergoing FB. DESIGN: Arterial oxygen saturation was measured (1) prior to the procedure to provide a baseline value, (2) when the bronchoscope was positioned in the nasopharynx, and (3) when the bronchoscope was positioned in the mid-trachea. SETTING: Fiberoptic bronchoscopy was performed in the Pediatric Special Care Unit or in the Pediatric Pulmonary Laboratory using an Olympus BF3C4 fiberoptic bronchoscope with a 3.5-mm outer diameter. PATIENTS OR PARTICIPANTS: Thirty-six children who underwent diagnostic or therapeutic bronchoscopy for a variety of reasons were evaluated. They ranged in age from 6 to 142 months; 20 were male and 16 were female. INTERVENTIONS: There were no interventions. MEASUREMENTS AND RESULTS: Of the 36 patients, 29 experienced a fall in SaO2 levels exceeding 5 percent of baseline values. The youngest age group, 6 to 12 months, showed the greatest drop in saturation as compared with the other groups. Desaturation was significantly increased by midtracheal FB. CONCLUSIONS: A decline in arterial oxygen saturation that may be substantial in infants and children undergoing FB examination was frequently noted, especially in smaller infants and when the bronchoscope was positioned in the mid-trachea. Supplemental oxygen and a brisk procedure time will minimize the risk of dangerous hypoxia.
To test the hypothesis that involuntary smoking can result in increased drug metabolism, five nonsmoking healthy male volunteers (21-36 y old) were enrolled in a study of single-dose theophylline pharmacokinetics before and after intense environmental tobacco smoke (ETS) exposure. Exposure was provided by spending 3 h/day for five consecutive days in a small room with a smoking apparatus that burned four cigarettes simultaneously, at a rate of 20 cigarettes/h. Measurement of urine continine concentration demonstrated that significant absorption from ETS occurred in all subjects. However, pre- and post-exposure pharmacokinetic parameters for theophylline did not differ significantly: Vz = 0.438 vs 0.440 l.kg-1; t1/2 = 9.19 vs 9.69 h; CL = 34.4 vs 32.6 (ml.kg-1.h-1), respectively. Similarly, 24-hr urinary excretion of theophylline and its metabolites was unchanged by ETS exposure. We conclude that intense short-term passive smoking does not affect theophylline disposition. The possibility of chronic ETS exposure causing alterations in drug metabolism cannot be excluded.
Severe respiratory distress developed in a 5-month-old infant approximately ten days after pneumonectomy for complete sequestration of the right lung. Right pneumonectomy syndrome was diagnosed by bronchography, which revealed thinning and obstruction of the left main bronchus during expiration. A right thoracotomy was then performed, and an inflatable tissue expander with a subcutaneous injection port was inserted into the right chest cavity to prevent recurrence of the mediastinal shift and to allow for future growth. The patient has done well, requiring reinjection of the prosthesis with additional volume on one occasion in a 20-month period of follow-up.
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Patients with insulin dependent diabetes mellitus (IDDM) and limited joint mobility (LJM) were studied to determine if altered respiratory mechanics were another manifestation of a generalized disturbance in collagen metabolism. Lung volumes and maximal expiratory flow volume curves were measured in 23 patients with IDDM. Patients were divided into 2 groups: (1) 11 without LJM, and (2) 12 with severe LJM. The groups were matched for age, sex, and glycemic control but not for duration of IDDM. In patients with severe LJM, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were significantly decreased (p less than 0.05). Total lung capacity (TLC), thoracic gas volume (TGV) at functional residual capacity (FRC) and residual volume (RV) were also significantly lower (p less than 0.05) in the severe LJM group. There was no evidence of air-flow obstruction in either group. Our results demonstrate an association between severe LJM and a significant decrease in lung volumes. This could be due to decreased lung compliance or restriction of chest wall expansion.