[Guideline 'Treating asthma in children' for pediatric pulmonologists (2nd revised edition). I. Diagnosis and prevention].
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Biomedical subjects
Publications and source records attributed to J Tolboom.
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A newly developed behaviour registration system, Laboratory Animal Behaviour Observation, Registration and Analysis System (LABORAS) for the automatic registration of different behavioural elements of mice and rats was validated. The LABORAS sensor platform records vibrations evoked by animal movements and the LABORAS software translates these into the corresponding behaviours. Data obtained by using LABORAS were compared with data from conventional observation methods (observations of videotapes by human observers). The results indicate that LABORAS is a reliable system for the automated registration of eating, drinking, grooming, climbing, resting and locomotion of mice during a prolonged period of time. In rats, grooming, locomotion and resting also met the pre-defined validation criteria. The system can reduce observation labour and time considerably.
BACKGROUND: In patients with a short small bowel, D-lactic acidemia and D-lactic aciduria are caused by intestinal lactobacilli. The purpose of this study was to obtain a detailed picture of the metabolic acidosis in young children with short small bowel. METHODS: Feces, blood, and urine of children with short small bowel and acidosis were studied microbiologically and/or biochemically. RESULTS: Previous findings were confirmed that more than 60% of the fecal flora of patients with small short bowel, who are not receiving antibiotics, consists of lactic acid-producing lactobacilli. In blood, D-lactic acid was the most prominent metabolite: the highest serum D-lactate (15.5 mmol/l) was observed in a sample taken immediately after the onset of hyperventilation. The highest D-lactate excretion was in urine collected some hours after the onset of hyperventilation, and amounted to 59 mol/mol creatinine. Acidosis in the patients with short small bowel was related to strongly increased serum D-lactate and anion gap and to strongly decreased serum bicarbonate and pH. CONCLUSION: In children with small short bowel and acidosis, the common intestinal flora of mainly lactobacilli abundantly produces D-lactic acid from easily fermentable carbohydrates. Thus, these bacteria directly cause shifts of bicarbonate, pH, and base excess and indirectly cause shifts of the anion gap, as well as hyperventilation. These kinetic parameters are strongly associated.
Gastrointestinal symptoms in myotonic dystrophy are increasingly observed, but major intestinal movement disorders such as intestinal pseudo-obstruction appear to be an infrequent complication. We describe a 13-year-old boy who, after appendectomy, developed intestinal pseudo-obstruction syndrome as the first clinical manifestation of myotonic dystrophy. He developed several similar episodes thereafter, which responded to conservative measures. When a child with myotonic dystrophy presents with an ileus, the diagnosis of intestinal pseudo-obstruction should be considered and therapy should then be conservative.
D-Lactate produced by abundant intestinal lactobacilli during acidotic episodes in short bowel (SB) patients is commonly regarded as a main factor in the pathogenesis of SB syndrome-associated (D-lactic) acidosis. Since we had observed that gram-positive bacteria, mainly lactobacilli, were abundant even in the absence of acidosis, we studied serum concentrations and urinary excretions of D- and L-lactate in young and adult SB patients, especially during nonacidotic periods. Serum L-lactate and urinary L-lactate excretion were similar in adults and children. Serum D-lactate and urinary D-lactate excretion were higher in SB children than in SB adults. Food consumption affects D-lactate production and alters D-lactic acidemia and aciduria. We conclude that D-lactate is frequently present in serum of SB patients even in the absence of acidosis. High serum concentrations and urinary excretions may reflect dietary factors in these patients.
The usefulness of quantitative nuclear image features (QNI) for the histological classification of lung carcinomas was investigated. As no clear distinction could be established between the distributions of these features for the nuclei of squamous cell, adenocarcinoma, and large cell carcinoma, the attention was restricted to the discrimination between small cell lung carcinoma (SCLC) and non-small cell carcinoma (NSCLC). This discrimination is the crucial one in discussions about the choice of treatment. The differences between SCLC and NSCLC are statistically highly significant for various QNI features. The use of more than one QNI feature hardly raised the discriminatory performance with respect to the distinction between SCLC and NSCLC. Inferences were made about the probability and confidence interval of SCLC for a given QNI feature. It is concluded that in cases of uncertainty or disagreement, nuclear characteristics are useful for the discrimination between SCLC and NSCLC.
In order to determine the effect of thymectomy on the prognosis of patients with myasthenia gravis, an analytical-descriptive study was carried out in the Neurological Clinic of the Groningen University Hospital and the Mathematical Institute of Groningen University. In 183 patients with generalized myasthenia gravis without thymoma, with onset between 9 and 46 years of age, the severity of the disease was scored by one neurologist at fixed times (0.5, 1, 2, 3, etcetera up to 15 years) after onset. Thymectomy was performed in 144 patients at different times (0.5, 1, 2, 3, etcetera up to 7 years) after onset. Logistic regression analysis was carried out with, as the criterion for marked improvement, a decrease of the disease score by 50%. Using this criterion, age, sex, duration of the disease and severity of the disease prior to operation played no distinct parts as prognostic factors. At different periods after the onset of the disease, groups of patients operated or not (yet) operated were compared. Patients subjected to thymectomy within 5 years after onset of myasthenia gravis had a better probability of halving of the severity score than patients not subjected to operation. These data render it possible in the individual patient to make an adequate estimate of the probability of marked improvement if thymectomy is performed or postponed.
An infant with superior vena cava syndrome due to thrombus formation in the superior vena cava, sourced from a central venous line, was treated with urokinase. It was used in a loading dose of 250,000 units/1.73 m2/15 min, followed by continuous infusion of 125,000 units/1.73 m2/h for three days. After two days of urokinase treatment, the clinical signs of superior vena cava syndrome completely disappeared. No bleeding complication was observed.
Cytomorphometry, using various cytopreparatory techniques on bladder washings and histomorphometry on the resected bladder tumours, was used in an attempt to answer the question: Can cytomorphometry replace histomorphometry for grading of bladder tumours? For the analysis of quantitative data, a probit model was used. Three out of the four cytomorphometric methods provided data supportive to the histomorphometry. Using one of the four cytomorphometric methods was sufficient to enhance grading accuracy and all were equally good. Two cases of high grade carcinoma in situ were properly identified by cytomorphometry (as judged on the follow-up data) but the concurrent resected papillary tumours were low grade. These findings indicate that cytomorphometry is a useful method in bladder tumour grading. In some cases it is preferable to histomorphometry.
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