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Biomedical subjects

J Devlin

Publications and source records attributed to J Devlin.

At least 19 recordsLinked to original sources
PubMed1992

Tartrazine in atopic eczema.

Multiple double blind placebo controlled challenges with tartrazine 50 mg (three challenges) and glucose placebo (three challenges) were performed in 12 children with atopic eczema aged 1 to 6 years. The children were selected on the basis of severity (regular clinic attenders) and a parental history that tartrazine provoked worsening of the eczema. In only one patient did the three tartrazine challenge periods correspond with the highest symptom scores or the highest physician observer scores, and the probability of this occurring by chance in one or more patients out of 12 was 0.46. In this sample we were unable to confirm intolerance to tartrazine in 11 out of 12 patients.

Child↗
PubMed1991

Elemental diet for refractory atopic eczema.

A total of 37 children with refractory wide-spread atopic eczema were treated with an antigen avoidance regimen comprising hospitalisation, exclusive feeding with an elemental formula for a median duration of 30 days, and measures to reduce exposure to pet and dust mite antigens at home. After the initial period of food exclusion, food challenges were performed at intervals of seven days, and the patients followed up for at least 12 months. Ten of the children (27%) either failed to respond to the regimen or relapsed within 12 months. Improvement in the eczema was seen in 27/37 (73%) patients, by discharge from hospital their disease severity score had fallen to a median of 27% of the pretreatment figure, and only 3/27 required topical corticosteroids. There were no clinical or laboratory findings which could be used to predict the outcome. Drawbacks to the regimen were prolonged hospitalisation (median 70 days), a fall in body weight and serum albumin concentration, and a risk of anaphylactic shock (4/37 cases). A strict antigen avoidance regimen may be associated with improvement of atopic eczema where conventional treatments have failed.

Animals↗
PubMed1991

Holidays and atopic eczema.

Information was collected by telephone about 300 holidays taken over a three year period by 126 children with severe atopic eczema. During the holidays, improvement in eczema occurred more frequently (112/300, 37%) than deterioration (63/300, 21%). There was a significant correlation between improvement and a more southerly holiday location: improvement was common in holidays taken in the Mediterranean or further south (63/92, 69%), but holidays in northern Britain were more likely to be associated with deterioration (27/100, 27%) than improvement (13/100, 13%). Changes in eczema were correlated with changes in asthma in 231 holidays taken by children with both conditions, but improvement was not significantly associated with pet ownership. All patients returned to their preholiday state, usually within two weeks of return home. The causes of changes in eczema while on holiday have not been identified.

Adolescent↗
PubMed1991

Six food diet for childhood atopic dermatitis.

Sixty-three children with severe atopic dermatitis aged 0.4 to 14.8 years, were treated with a diet eliminating all but six foods for a 6-week period. Nine (14%) abandoned the diet before 6 weeks had elapsed. Twenty-one (33%) completed the diet but did not benefit. Thirty-three (52%) patients obtained greater than or equal to 20% improvement in the disease severity score at 6 weeks, and for these patients, foods were reintroduced singly at weekly intervals. The outcome at 12 months was the same for the group who responded to the diet, the group who failed to respond, and the group who failed to comply, because of the tendency for dermatitis to improve markedly in all three groups. Although dietary elimination of this type may be associated with immediate improvement, the long term outcome appears to be unaffected by dietary success or failure.

Adolescent↗
PubMed1991

Atopic and seborrheic dermatitis: practical management.

Atopic dermatitis is common and causes sleep loss, a disfiguring appearance, an unpleasant odour, teasing, short stature and restriction of career choice in severe cases. There are no drugs which control the scratching; distraction, keeping the nails short and smooth, and the use of mittens at night are all helpful. The sedative action of the older H1 antihistamines makes them useful if scratching prevents a child from falling asleep. Emollients are useful for the associated skin dryness. The least potent topical steroids should be used sparingly to avoid the main hazards of skin atrophy, systemic absorption and growth stunting. Bacterial skin infection with Staphylococcus aureus and sometimes beta-haemolytic streptococci is common and is best treated with oral antibiotics. Herpes simplex virus skin infection is also common; the initial infection occasionally causes a lethal (if untreated) illness. Allergy to house dust mites, pet animals, pollen and food can worsen dermatitis in some cases. There is no test however, which can be used to predict those patients who will respond to avoidance measures, so that management tends to be based on empirical trials of antigen avoidance. Seborrheic dermatitis is a common disorder that usually occurs in the first months of infancy. Findings consist of greasy yellow scales on the scalp (most simply treated with an emollient) and well-demarcated erythematous patches in the diaper area that spread to other areas such as the axillae and neck (usually requiring topical steroids). Some cases go on to develop atopic dermatitis, but many others, although florid, resolve spontaneously.

Administration, Cutaneous↗
PubMed1990

Cartilaginous pseudocyst of the external auricle in children with atopic eczema.

Four children with severe atopic eczema developed painless endochondral pseudocysts of the external auricle. The lesions were bilateral in two cases. In one case the lesion spontaneously resolved; of the remaining five lesions, one contained haematoma and the other four contained serous fluid. The aetiology of these lesions and their association with atopic eczema are unclear, but repeated minor trauma from rubbing may play a part.

Child, Preschool↗
PubMed1990

Serum levels of trace metals in children with atopic eczema.

The hypothesis that atopic eczema is associated with a non-specific decrease in the serum concentration of trace metals was examined by measurement of the levels of zinc, copper and iron in 134 children with atopic eczema and 112 controls. The results failed to confirm the hypothesis. There was no significant difference between patients and controls for the concentrations of serum zinc, iron, iron-binding capacity and albumin. Patients with eczema had a significantly higher copper concentration (median 21.0 mumol/l) than controls (median 17.0 mumol/l), and a significantly lower concentration of ferritin (median 11.9 ng/ml for patients and 16.5 ng/ml for controls). There was a highly significant correlation between the surface area of skin affected by eczema and the concentrations of albumin and orosomucoid.

Child↗
PubMed1990

Intolerance to oral and intravenous calcium supplements in atopic eczema.

Children treated with dietary restriction for food intolerance may require calcium supplementation, particularly if cows' milk and milk substitutes are not tolerated. We report two children with atopic eczema who reacted adversely to a number of calcium supplement formulations.

Administration, Oral↗
PubMed1989

Calcium intake and cows' milk free diets.

In children with atopic eczema on elimination diets, the calcium intake was below the estimated requirement in 15 out of 20 who avoided cows' milk and received no milk substitute, and in three out of 26 who avoided cows' milk but were provided with a soya or casein hydrolysate formula.

Adolescent↗
PubMed1989

Diabetics treated with continuous subcutaneous insulin infusion pumps.

Sixteen insulin-dependent diabetics commenced continuous subcutaneous insulin infusion (CSII) pumps either because of poor control (15 patients), or because of preference (1 patient). The study examined the diabetic control achieved, patients attitudes and CSII pump complications. Statistically significant improvements in HbAlC which fell from a pre-treatment mean of 12.57% to 10.0% at three months (p less than 0.01) and 10.6% at six months (p less than 0.02) were achieved. At nine months the improvement was not statistically significant. Fourteen of the 16 patients wished at the end of one year to continue this treatment. This study reports a low rate of symptomatic hypoglycaemia and infusion site infection. However, there was a large number of cases of ketoacidosis which highlights the need for extreme vigilance in monitoring patients treated by this method.

Adult↗
PubMed1989

The single-session family interview.

Currently, attempts are being made to integrate family systems theory and technique into the practice of family physicians. Although the importance of the family has been demonstrated in a number of medical situations and although several authors have indicated situations in which it is useful for the physician to convene the family, to date no explicit guidelines have been developed for conducting a single-session family interview. This article presents a framework for conducting such an interview, structured in three stages (contracting, exploration, and closure) with clinical examples for each stage. The single-session family interview provides the family physician with realistic guidelines for helping families who face medical dilemmas and for improving the physician's practice. The guidelines have proven useful in teaching residents the skills involved in understanding family dynamics and conducting productive family meetings.

Family↗
PubMed1986

alpha-Ketoisocaproate is superior to leucine in sparing glucose utilization in humans.

The present study was designed to examine the glucose-sparing effect of leucine and its keto acid alpha-ketoisocaproate (KIC) in vivo. Two groups of overnight-fasted normal volunteers were studied. In the first group, eight subjects received an intravenous infusion of leucine and six subjects received KIC (2.3 mumol X kg-1 X min-1) for 3 h; on another occasion, all subjects received saline and acted as their own controls. In the second group, 11 subjects received an infusion of 1 mU X kg-1 X min-1 for 3 h with a variable glucose infusion to maintain euglycemia. On another occasion, five subjects received an additional infusion of leucine and six subjects received KIC each at 2.3 mumol X kg-1 X min-1 for 3 h. The amount of exogenous glucose required to maintain euglycemia (M, mg X kg-1 X min-1) was used as an index of total body glucose utilization. Forearm exchange of leucine, KIC, glucose, and lactate was determined in both groups. Both leucine and KIC infusions alone decreased glucose uptake (42 and 40%) and increased lactate release (37 and 116%, respectively). Hyperinsulinemia (6-fold basal) and euglycemia resulted in a fivefold increase in glucose uptake across the human forearm. The amount of exogenous glucose required to maintain euglycemia averaged 7.4 +/- 0.5 mg X kg-1 X min-1. The combination of leucine and insulin infusions did not alter the stimulated forearm glucose uptake nor did it change M (7.25 +/- 0.6 mg X kg-1 X min-1, P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

A cytogenetic study of familial medullary carcinoma of the thyroid.

Familial medullary carcinoma of the thyroid (MCT) is a malignant neoplasm of the calcitonin-producing C-cells of the thyroid gland, inherited in an autosomal dominant pattern with a high degree of penetrance. We have studied 26 individuals from 5 New England families with MCT with the goal of finding a cytogenetic test useful in the detection of the presence of the gene. G-banded metaphase spreads, segregational errors of chromosomes, breakage in untreated cells, breakage in bleomycin-challenged cells, and high-resolution banding of prophase/prometaphase spreads were examined; one or more of each of these procedures were studied in at least one affected individual in each of 5 families. All specimens were coded, and slides were scored blindly. All tests were negative with respect to significant differences from controls. We did not observe the minute deletion from the short arm of chromosome 20 that was reported by other investigators to occur in individuals with multiple endocrine neoplasia types 2A and 2B which include MCT. Contrasting results from our study and several other cytogenetic studies of MCT may reflect genetic heterogeneity among the families studied and/or differing environmental factors in various geographic locations that are possibly associated with initiation and onset of the disease.

Bleomycin↗