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Biomedical subjects

J K Webb

Publications and source records attributed to J K Webb.

At least 109 records · Page 6Linked to original sources
PubMed1981

Placebo-controlled study of phenobarbitone and phenytoin in the prophylaxis of febrile convulsions.

Of 138 children who had a first febrile convulsion before their second birthday, 48 were treated with phenobarbitone, 47 with phenytoin, and 43 with a placebo for 12 months. Drug levels were monitored and adverse effects of the drugs were noted. Compared with placebo, phenobarbitone significantly reduced recurrences among children under 14 months old at the time of their first convulsion, but nor among older children. Phenytoin was an ineffective prophylactic agent. Ideal drug levels were difficult to maintain, and many recurrences occurred when concentrations were suboptimal. Behavioural disturbance in children taking phenobarbitone was not a serious problem. The decision to give continuous prophylaxis for febrile convulsions is complex, and each case must be judged on its merits. For children who have a first seizure before 14 months of age prophylaxis may be advisable and phenobarbitone is effective.

Age Factors↗
PubMed1981

Monitoring of phenobarbitone and phenytoin therapy in small children by salivary samples.

Concentrations of phenytoin or phenobarbitone have been measured serially using saliva samples in 75 very young children receiving one of these drugs for prevention of recurrent febrile convulsions. Saliva samples were easily obtained and the measured concentrations were a valuable guide to drug dosage during the treatment period. Mean (+/- SD) saliva concentrations were, for phenytoin, 1.0 +/- 0.8 mg/litre (3.8 +/- 3.0 mumol/litre) and, for phenobarbitone, 7.9 +/- 2.6 mg/litre (24.0 +/- 11.3 mumol/litre) and did not alter significantly during the period of observation. Despite frequent review with assessment of compliance, it proved difficult to achieve and maintain target drug concentrations. Paired samples of saliva and plasma were obtained from 36 children before treatment was terminated. Drug concentrations in saliva correlated well with those in plasma and mean plasma: saliva ratios (phenytoin, 8.4; phenobarbitone, 2.2) were comparable to results obtained previously in adults.

Dose-Response Relationship, Drug↗
PubMed1981

Behavioural effects of phenobarbitone and phenytoin in small children.

Mothers of 56 children under 2 years old taking phenobarbitone and mothers of 55 children taking phenytoin recorded on questionnaires changes they had noted in the children's behaviour 3 and 9 weeks after starting the drug. Severe behavioural disturbance was noted by many, but the pattern and incidence was similar to that recorded by the mothers of 50 children starting a placebo, and we attribute it to the effect of a recent hospital admission. There was a small improvement in the behaviour of 20% of children who had been taking phenobarbitone for a year when they stopped it, but in this age group the disturbance caused by phenobarbitone did not appear to have been great.

Child Behavior Disorders↗
PubMed1980

Breast-feeding and respiratory syncytial virus infection.

The pattern of breast-feeding in 127 infants admitted to hospital with respiratory syncytial virus infection was compared with that in 503 age-matched controls. Thirty per cent of children with infection had been breast-fed compared with 49% of controls. The approximate relative risk of being admitted to hospital with respiratory syncytial virus infection if not breast-fed was 2.2. Several other factors were also considered, including an assessment of maternal care and home environment; the mother's age, marital state, and smoking habits; the number of siblings; and gestation. Adverse factors were all associated with an increased risk of admission with infection, but breast-feeding still appeared to provide protection after controlling for these other factors in turn. These findings provide further support for encouraging mothers to breast-feed their infants and should prompt further studies into the immune status of mothers and into the nature of the protective factors in their breast milk.

Breast Feeding↗
PubMed1979

Fissuring of the posterior annulus fibrosus in the lumbar spine.

Severe back-ache in young adults may present a difficult clinical problem when the absence of neurological signs results in delayed diagnosis. Fourteen patients, with discographic evidence of posterior annular fissuring are reported. The discrepancy between painful disability and negative radiographic examination including radiculography is stressed. Discography has proved to be the investigation of choice in these patients. This will demonstrate the morphology of the lesion and reproduce the symptomatology in the majority of cases. The clinical implications are discussed.

Adolescent↗
PubMed1978

Study of 8-year-old children with a history of respiratory syncytial virus bronchiolitis in infancy.

Thirty-five children known to have had respiratory syncytial virus bronchiolitis in infancy were examined at the age of 8 and their respiratory function tested. The results were compared with those in 35 controls matched for age, sex, and social class. Although 18 of the children who had had bronchiolitis in infancy had experienced subsequent episodes of wheezing, these were neither severe nor frequent in most cases and had apparently ceased by the age of 8. Nevertheless, the mean exercise bronchial lability of the children who had had bronchiolitis was significantly higher than that of the control children and the mean peak expiratory flow rate at rest significantly lower. Atopy, assessed by family and personal history alone, did not seem to be related to either bronchiolitis or wheezing episodes after bronchiolitis. The parents of the children who had had bronchiolitis smoked significantly more cigarettes during the infant's first year of life than those of the control children. The results suggest that bronchiolitis and childhood asthma are not closely related. Bronchial hyperreactivity might be inherited independently of atopy, but environmental factors seem the most likely link between severe respiratory infection in infancy and chronic or recurrent respiratory illness in adult life.

Asthma↗
PubMed1977

Viruses and febrile convulsions.

In 276 children admitted to hospital with febrile convulsions a wide range of virus types was identified by means of nasopharyngeal secretions and cough/nasal swabs. The overall virus identification rate was 49%. Analysis of age, sex, family history, and past history showed no marked differences between the virus-positive and the virus-negative children. More than 80% had symptoms of respiratory infection in association with their convulsions, whether or not a virus was identified. Convulsions were not apparently more severe in the virus-positive group. Rapid virus diagnosis was found helpful in the management of children with febrile convulsions. The virus aetiology of many febrile convulsions has implications both for hospital cross-infection and for research into methods of prevention.

Child, Preschool↗
PubMed1976

Breast-feeding protects against respiratory syncytial virus infections.

Eight out of 115 infants admitted to hospital with respiratory syncytial (RS) virus infection had been breast-fed compared with 46 out of 167 controls; this difference was statistically significant. Twenty-one specimens of human colostrum were examined, and all contained RS virus neutralising activity. Specific IgA and IgG were detected in 18 specimens, whereas IgM was detected in none. The titre of IgA antibody was usually higher and correlated more closely to the titre of neutralising activity than that of IgG. Infants inhale milk feeds and regurgitate them through the nose, and the IgA collecting in the respiratory tract might protect against severe respiratory infection. Alternatively, if severe RS virus illness is a sign of hypersensitivity to the virus breast-feeding might protect the infant from an early sensitising infection.

Adult↗
PubMed1976

Experience with the dynamic compression plate (DCP) in 418 recent fractures of the tibial shaft.

A consecutive series of 435 fresh fractures of the tibial shaft was internally fixed by the new dynamic compression plate (ASIF-DCP). All but 2 cases could be reviewed personally within 1-2 years after operation, while 15 patients had died. The functional results and postoperative complications are reported separately for the 334 closed and 101 open fractures. In spite of a higher rate of complication in the open fractures, their functional results were about as good as in the closed cases. In our experience the new dynamic compression plate proved to be very satisfactory for internal fixation of fractures of the tibia.

Adolescent↗
PubMed1976

Hidden flexion injury of the cervical spine.

This paper describes seven patients who developed late vertebral deformity after flexion injuries of the cervical spine. In four the clinical and radiological features were subtle and because the patients walked into an emergency department the severity of the injury was not initially appreciated. Certain specific clinical and radiological features of flexion injury are described and emphasis is placed on the importance of correct management. A radiological tetrad is described which should alert the surgeon to the possibility of damage to the posterior interspinous complex of the cervical spine and so lead to further radiological investigations. Despite the frequency of flexion injuries the alarming complications described in this paper are rare.

Adolescent↗
PubMed1975

Hospital cross-infection on children's wards with respiratory syncytial virus and the role of adult carriage.

A further 18 children who acquired respiratory syncytial (R.S.) virus infection on general paediatric wards have been identified, bringing the total number of hospital cross-infections by this virus to 46 for the last 3 annual R.S. virus epidemics on Tyneside. 25 of these 46 illnesses involved the lower respiratory tract. Carriage of R.S. virus by staff and visitors was studied on one ward, and appeared to be responsible for at least 2 and probably 4 of the 6 cross-infections detected on this ward. Methods for controlling the transmission of virus by adults on children's wards are discussed.

Carrier State↗
PubMed1975

Plasma osmolality, sodium, and urea in healthy breast-fed and bottle-fed infants in Newcastle upon Tyne.

Dale, G., Goldfinch, M. E., Sibert, J. R., and Webb, J. K. G. (1975). Archives of Disease in childhood, 50, 731. Plasma osmolality, sodium, and urea in healthy breast-fed and bottle-fed infants in Newcastle upon Tyne. Plasma osmolality, sodium, and urea were measured on samples from 50 healthy infants, aged between 18 and 125 days, attending child health clinics in Newcastle upon Tyne. 3 infants had osmolalities greater than 300 mOsm/kg, a lower incidence of hyperosmolality than that previously reported. There was a difference (P less than 0-001) between the plasma urea levels of breast-fed and bottle-fed infants, but not between the osmolalities of these groups. The mean plasma urea of bottle-fed babies was 53 mg/100 ml (SD 12-47), 50-1 mg/100 ml (SD 10-9) if additional solids were being given, and 18-4 mg/100 ml (SD 7-81) for breast-fed babies. There was little difference between the plasma sodium levels of each group. The mean plasma sodium for all groups combined was 135-2 mmol/1 (SD 2-3); no plasma sodium exceeded 140 mmol/1.

Body Weight↗