Biomedical subjects

B Yuksel

Publications and source records attributed to B Yuksel.

52 records · Page 3Linked to original sources

PubMed1992

Randomised trial of inhaled steroids in preterm infants with respiratory symptoms at follow up.

BACKGROUND: Preterm infants often suffer from recurrent respiratory symptoms at follow up. Although these infants are responsive to treatment with bronchodilators some continue to wheeze or cough despite treatment. In a randomised double blind placebo controlled trial, the ability of inhaled steroids to reduce recurrent respiratory symptoms and the requirement for bronchodilator treatment in preterm infants less than two years of age has been assessed. METHODS: Eighteen premature infants with mean gestational age 28 weeks and postnatal age 10.5 months were recruited. The study consisted of two six week treatment periods separated by a two week washout period. The infants received either 200 micrograms of beclomethasone dipropionate or placebo as one puff twice daily from an inhaler, through a spacer and a face mask. Parents kept a daily record of their infants' respiratory tract symptoms (wheeze and cough) and use of bronchodilators. Functional residual capacity (FRC) was measured at the beginning and end of each six week period. RESULTS: The symptom score was reduced by 37% in the active compared with the placebo period. During the active period the infants had a mean of 28 bronchodilator free days, compared with 22 days in the placebo period. The FRC improved significantly in the active but not the placebo period. CONCLUSION: Regular dosage with beclomethasone by inhalation is a useful treatment for preterm infants with respiratory symptoms.

Administration, Inhalation↗

PubMed1992

Comparison of a subjective and a quantitative assessment of the neonatal chest radiograph.

The aim of this study was to assess if quantitative classification of the chest radiograph appearance at 7 days predicted chronic oxygen dependency (oxygen dependency beyond 8 weeks of age) more accurately than did subjective classification at 28 days of age. Thirty preterm infants, median gestational age 27 weeks, who had chest radiographs taken for clinical purposes at 7 and 28 days of age, were recruited into the study. The 7-day chest radiograph was scored according to the lung volume, presence of opacification, interstitial changes, pulmonary interstitial emphysema and cystic elements. The range of chest radiograph scores was from 0-18, a score of 18 indicating the most abnormal appearance. The 28-day chest radiograph was classified as Type I or Type II chronic lung disease (CLD), according to the presence or absence, respectively, of coarse reticulation. The median chest radiograph score at 7 days of the 30 infants was 5 (range 2-14). In predicting chronic oxygen dependency, a chest radiograph score of 5 at 7 days had 83% sensitivity and 75% specificity, but a diagnosis of Type II CLD at 28 days of age had only 67% sensitivity and 67% specificity. We conclude that a quantitative assessment of the chest radiograph appearance at 7 days is more useful than a subjective assessment at 28 days of age.

Chronic Disease↗

PubMed1991

Selective expression of a VHIV subfamily of immunoglobulin genes in human CD5+ B lymphocytes from cord blood.

Human B lymphocytes expressing the CD5 surface antigen (CD5+ B cells) constitute a subset capable of producing polyspecific antibodies recognizing a variety of self antigens. The repertoire of antibodies produced by CD5+ and CD5- B cells is different. However, it is not yet established whether this distribution is reflected in different immunoglobulin variable region gene (IgV) use. Rearrangement of heavy chain IgV (IgVH) genes represents one of the first identifiable stages in the maturation of B cells, and occurs in a developmentally ordered fashion. The repertoire of IgVH gene expression is highly restricted during fetal life but diversifies progressively after birth. A high frequency of VH gene use from the relatively small VHIV gene family has previously been demonstrated in human fetal liver B cells. In the present study, 102 B cell lines established by Epstein-Barr Virus-transformation of separated CD5+ and CD5- cord blood B cells, were examined for the frequency of IgV expression using monoclonal antibodies to cross-reactive idiotypes (CRI). The results demonstrate a relatively high frequency of VHIV gene use (30%) in B cells from cord blood. Furthermore, two mutually exclusive CRI associated with distinct subgroups of the VHIV family are segregated in their association with either subset of B cells. One CRI is exclusively expressed in lines established from CD5+ B cells while the other is associated with lines established from CD5- B cells.

Antigens, CD↗

PubMed1991

Relationship of symptoms to lung function abnormalities in preterm infants at follow-up.

Recurrent respiratory symptoms are common in preterm infants in the first 2 years of life. The aim of this study was to determine the lung function abnormalities associated with such symptoms. Forty preterm infants, with a median gestational age of 29 weeks were studied at a median postnatal age of 12 months. Twenty-two suffered from recurrent symptoms, defined as wheezing and/or coughing on at least 4 days per week over the previous month. Lung function was assessed by measurement of functional residual capacity (FRC), using a helium gas dilution technique, and airway resistance (Raw) and thoracic gas volume (TGV) plethysmographically. No significant difference was found in TGV between symptomatic and asymptomatic infants, but the median FRC was lower (P less than 0.01), Raw higher (P less than 0.01), and FRC:TGV ratio lower (P less than 0.001) in the symptomatic infants. These lung function abnormalities in the symptomatic infants are suggestive of gas trapping.

Airway Resistance↗

PubMed1991

Ipratropium bromide for symptomatic preterm infants.

Twelve preterm infants, median gestational age 31.5 weeks, were entered into a randomised, placebo-controlled trial of bronchodilator therapy. Their postnatal age was a median of 17.5 months and all suffered from recurrent respiratory symptoms. The infants received either inhaled placebo or 40 micrograms of ipratropium bromide (active therapy) three times a day utilising a coffee cup as a spacer device. Each therapy was administered for 2 weeks. The symptom score during the active period was reduced by 59% compared to the placebo period (P less than 0.01) and this was associated with 38% improvement in lung function in the active period compared to a 20% change in functional residual capacity over the placebo period (P less than 0.01). We conclude inhaled ipratropium bromide appears to be an effective treatment for symptomatic infants at follow up.

Birth Weight↗

PubMed1991

A chest radiograph scoring system to predict chronic oxygen dependency in low birth weight infants.

The usefulness of a chest radiograph scoring system to predict chronic oxygen dependency (oxygen dependency at 36 weeks post conceptual age) was determined in 40 infants with a median gestational age 27 weeks (range 24-32 weeks). The scoring system assessed the appearance of the preterm infant's chest radiograph taken at one month of age, and graded the radiograph according to lung volume, the presence of opacification, cystic elements and interstitial change (maximum score 24). Infants who were chronically oxygen dependent had significantly higher scores (median 9, range 7-20) than those not oxygen dependent (median 3, range 0-13, P less than 0.01). All nine chronically oxygen dependent infants had a score greater than 6, in comparison with only two of 31 infants not chronically oxygen dependent (P less than 0.01). A chest radiograph score of 6 thus had a sensitivity of 100% and specificity of 93.5% in predicting chronic oxygen dependency.

Bronchopulmonary Dysplasia↗

PubMed1991

Paradoxical response to nebulized ipratropium bromide in pre-term infants asymptomatic at follow-up.

Lung function measurements were performed before and after bronchodilator, nebulized ipratropium bromide (10 micrograms kg-1), in 20 pre-term infants [median gestational age 28 weeks (range 23-32 weeks) at a median postnatal age of 10 months (range 6-16 months)]. Eight of the infants had recurrent respiratory symptoms. Thoracic gas volume (TGV) and airways resistance (Raw) were measured by a plethysmographic technique and functional residual capacity (FRC) by a helium gas dilution technique. There was no significant change in either TGV or FRC following bronchodilator in the symptomatic and asymptomatic infants. Nebulized bronchodilator resulted in a significant improvement in Raw amongst the symptomatic infants (P less than 0.05), but a paradoxical response, that is, a deterioration (P less than 0.05) in Raw amongst the asymptomatic infants. In three asymptomatic infants, lung function measurements were repeated before and after nebulized saline and a similar deterioration in Raw was noted. We conclude the demonstration of respiratory symptoms at follow-up is useful in predicting infants who would have a beneficial response to nebulized ipratropium bromide.

Administration, Intranasal↗

PubMed1991

Neonatal respiratory distress and lung function at follow-up.

Eight infants (gestational age 27-32 weeks) ventilated in the neonatal period had significantly higher airway resistances at 6 months, but not 1 year, than eight infants matched for gestational age but without any neonatal respiratory problems. We conclude that neonatal ventilation or respiratory distress causes a temporary impairment of lung function.

Follow-Up Studies↗

PubMed1991

Auto- and polyreactivity of IgM from CD5+ and CD5- cord blood B cells.

The presence of the CD5 (67 kDa) molecule on the surface of B cells has been considered a marker for cells producing auto- and polyreactive antibodies. Cord blood B lymphocytes (rich in CD5+ B cells) have been sorted into CD5 positive and negative populations by flow cytometry using monoclonal antibodies to CD20 and CD5. Clones of these populations were obtained by immortalization with Epstein-Barr virus. Clones derived from both CD5+ and CD5- B cells produced IgM which was auto- and polyreactive with a higher frequency of these specificities in the CD5+ population. These data indicate that expression of surface CD5 on cord blood B cells is not a definitive marker of an auto/polyreactive population.

Antibodies, Monoclonal↗

PubMed1991

Lung function abnormalities at 6 months of age after neonatal intensive care.

Respiratory function was studied in 46 preterm infants (median gestational age 28 weeks) at 6 months of age. Respiratory function was assessed by measurement of thoracic gas volume, airways resistance (from which specific conductance was calculated), and functional residual capacity. To determine the effect of the duration of neonatal intermittent positive pressure ventilation (IPPV) on respiratory function, the infants' results were divided into three groups: group A, no IPPV; group B, IPPV for less than seven days; and group C, IPPV for more than seven days. Measurements of thoracic gas volume and functional residual capacity were similar to published reference ranges and there were no significant differences between the three groups. Measurements of airways resistance and specific conductance were higher than published reference ranges (mean airways resistance of group A, 34 cm H2O/l/sec; B, 34.1 cm H2O/l/sec, and C, 30.4 cm H2O/l/sec) but there was no significant difference between the three groups. The 95% confidence intervals of the difference of the means between groups A and B were -6.94 to 6.73 cm H2O/l/sec and between groups A and C -3.8 to 11.0 cm H2O/l/sec. Our results suggest that factors other than neonatal ventilation may be more important in the pathogenesis of chronic lung function abnormalities in preterm infants.

Chronic Disease↗

PubMed1991

Chest radiograph scoring system for use in pre-term infants.

A scoring system to characterize the pre-term infant's chest radiograph appearance has been evaluated. Chest radiographs taken at 1 month of age in 20 infants (median gestational age 27 weeks) were scored according to abnormalities of lung volume, presence of opacification, interstitial changes and cystic elements (maximum score 17). The median score was 4 (range 1-14); the highest scores were for the only infants with cystic elements and/or interstitial changes on their chest radiographs. The scoring system documented accurately the severity of neonatal respiratory distress; the highest scores occurred in those infants requiring the most prolonged respiratory support, i.e. ventilated beyond 1 week of age (p less than 0.01) and oxygen-dependent beyond 1 month (p less than 0.01). It was also a useful predictor of chronic respiratory problems, with an 88% sensitivity in the detection of infants with the most severe lung function abnormalities at 6 months of age.

Female↗

PubMed1991

Effect of nebulized salbutamol in preterm infants during the first year of life.

The acute effect on lung function of nebulized salbutamol and saline (placebo) has been investigated in preterm infants at follow-up. Twenty two premature infants, median gestational age 29 weeks (range 26-32 weeks) and birthweight 1,264 g (720-1,800 g), were studied at a median postnatal age of 7 months (range 6-9 months). Nine of the infants had recurrent respiratory symptoms; they coughed and/or wheezed at least 3 days per week for the previous 4 weeks. The remaining 13 infants were free from recurrent or persistent respiratory symptoms. Thoracic gas volume (TGV) and airways resistance (Raw) were measured and specific airway conductance sGaw calculated before and 10 min after salbutamol and normal saline given via a nebulizer. Amongst the symptomatic infants administration of nebulized salbutamol was associated with a median reduction in Raw of 25% (p less than 0.01) and also a significant improvement in sGaw (p less than 0.01). In the asymptomatic infants neither Raw nor sGaw changed significantly. Nebulized saline caused no significant change in lung mechanics in either the symptomatic or asymptomatic infants. We conclude that nebulized salbutamol is an effective bronchodilator for symptomatic preterm infants less than one year of age.

Aerosols↗

PubMed1990

Effective bronchodilator treatment by a simple spacer device for wheezy premature infants.

Ten preterm infants with recurrent respiratory symptoms (median gestational age 30 weeks) were entered into a non-randomised placebo controlled trial of bronchodilator treatment at 12.5 months of age. The infants had coughed or wheezed, or both, on at least four days a week for the past month. The infants received either placebo or 500 micrograms terbutaline from an inhaler using a coffee cup as a spacer device. Each treatment was maintained for two weeks, first placebo then active drug. The symptom score was reduced by 65% during the active treatment period compared with the placebo period and this was associated with a 32% improvement in lung function, reflected in an increase in functional residual capacity. We conclude that inhaled bronchodilator treatment given with a simple spacer device is useful for preterm infants with recurrent respiratory symptoms in the first two years of life.

Bronchodilator Agents↗

PubMed1990

Recurrent respiratory symptoms in the first year of life following preterm delivery.

Recurrent respiratory symptoms in the first year of life following preterm delivery were documented in two studies. In the first study a questionnaire was sent to all parents of preterm very low birth weight (VLBW) infants who had been admitted during a six-month period to the Neonatal Intensive Care Unit (NICU) at King's College Hospital (KCH) and who lived within the local district. Questionnaires were also sent to parents of a control group of infants who were recruited by random selection. All the controls lived locally and were delivered at KCH in the same six-month period as the study group, but were born at 37-41 weeks of gestation and had had no neonatal problems. The questionnaire documented frequency of cough and wheeze, medication and hospital admissions. Recurrent respiratory symptoms (wheeze or wheeze and cough) occurred in 65% of the preterm VLBW infants but only 33% of the controls p less than 0.001. Less than 10% of infants in either group had received bronchodilator therapy. Admission to hospital in both groups was more common amongst children who had recurrent wheeze (p less than 0.01). In the second study all preterm VLBW infants admitted to the NICU in a six-month period were followed prospectively over the first year of life. The nature and frequency of respiratory symptoms and frequency and length of re-admission was documented and related to the duration of neonatal ventilation. Twenty-three of the 44 preterm VLBW infants (53%) followed prospectively had recurrent wheeze and/or cough.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Weight↗

PubMedDate not supplied

Persistent müllerian duct syndrome associated with irreducible inguinal hernia, bilateral cryptorchidism and testicular neoplasia: a case report.

Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism. A case is reported of normal male appearance with bilateral cryptorchidism and a right irreducible inguinal hernia. On exploration, an uterus with two fallopian tubes and a testicle were found in the hernia sac. The uterus, fallopian tubes and left testicle were en bloc removed. Right orchidopexy and hernia repair were performed. In conclusion, if there is an adult bilateral cryptorchidism, surgeons should take into consideration a persistent müllerian duct syndrome.

Adult↗

PubMedDate not supplied

Primary hyperparathyroidism in an infant with three parathyroid glands and pulmonary calcinosis.

A 2 month-old male infant presented with severe hypercalcemia due to parathyroid hyperplasia. A total parathyroidectomy and partial heterotopic autotransplantation were carried out. Hypercalcemia recurred two months later. Normocalcemia was re-established after removing one half of the implanted tissue. Despite two separate surgical explorations and several imaging studies, including 99mTc-sestamibi scintigraphy, ultrasonography, and MRI, only three parathyroid glands were found. Severe pulmonary calcinosis has not previously been reported in children with PHPT. In conclusion, developmental variations of the parathyroid glands may be difficult to identify with present imaging techniques. This may pose difficulties in management of PHPT. The present report describes pulmonary calcinosis as a sequela which can cause additional morbidity in these infants.

Adult↗