PubMed Health⌕ Search

Biomedical subjects

L Mendelson

Publications and source records attributed to L Mendelson.

At least 19 recordsLinked to original sources
PubMed1998

Dose-related efficacy of budesonide administered via a dry powder inhaler in the treatment of children with moderate to severe persistent asthma.

OBJECTIVE: To determine the efficacy and safety of budesonide delivered by an inhalation-driven dry powder inhaler (Turbuhaler) in children with moderate to severe persistent asthma. STUDY DESIGN: In our randomized, double-blind, placebo-controlled, parallel-group, multicenter study, a total of 404 children with asthma, who were aged 6 to 18 years and who had been receiving inhaled glucocorticosteroid therapy, were randomly assigned to receive either 100, 200, or 400 micrograms of budesonide or placebo twice daily for 12 weeks. At baseline, mean forced expiratory volume in 1 second (FEV1) was 74.6% (range, 30.7% to 123.3%) of the predicted normal value. RESULTS: Patients in each of the three budesonide treatment groups showed significant dose-related improvements in lung function (morning peak expiratory flow and FEV1), in asthma symptoms, and with a significant decrease in inhaled beta 2-agonist use in comparison with placebo. Improvements were evident within 2 weeks and were maintained throughout the 12 weeks. Budesonide treatment had no significant effect on hypothalamic-pituitary-adrenal axis function, and the incidence of reported adverse events was similar in all treatment groups. CONCLUSION: Budesonide administered via a dry powder inhaler provided dose-related improvements in lung function and clinical status and was well tolerated by children (6 to 18 years of age) with moderate to severe persistent asthma.

Administration, Inhalation↗
PubMed1998

Efficacy and safety of budesonide inhalation suspension (Pulmicort Respules) in young children with inhaled steroid-dependent, persistent asthma.

BACKGROUND: Inhaled glucocorticosteroids are indicated for the treatment of persistent asthma; however, many young children are unable to effectively use currently available inhalers. OBJECTIVE: We sought to evaluate the efficacy and safety of 3 different twice daily doses of budesonide inhalation suspension (Pulmicort Respules) in inhaled steroid-dependent asthmatic children. METHODS: This was a 12-week, randomized, double-blind, placebo-controlled, parallel-group study involving 178 children (age range, 4 to 8 years) at 17 centers in the United States. Budesonide inhalation suspension doses of 0.25 mg, 0.50 mg, or 1.0 mg twice daily were administered by means of a jet nebulizer and air compressor system. Efficacy was assessed by recording at home nighttime and daytime asthma symptom scores, use of rescue medication, pulmonary function tests, and treatment discontinuation because of worsening symptoms. Safety was assessed by reported adverse events and changes in baseline and adrenocorticotrophic hormone-stimulated plasma cortisol levels in a subset of patients. RESULTS: Baseline demographics, symptom scores, and pulmonary function data were similar across treatment groups. All doses of budesonide inhalation suspension were superior to placebo in improving nighttime and daytime asthma symptom scores (P </=.026), reducing use of breakthrough medication (P </=.032), and improving morning peak expiratory flow (P </=.030). The number of dropouts because of worsening asthma was also significantly fewer in the budesonide groups (P </=.015). There were no differences between doses of budesonide. Adverse events and basal and adrenocorticotrophic hormone-stimulated cortisol responses were not different between budesonide and placebo groups. CONCLUSION: Budesonide inhalation suspension, 0.25 mg, 0.50 mg, and 1.0 mg twice daily, is an effective and safe treatment for young children with inhaled steroid-dependent, persistent asthma.

Administration, Inhalation↗
PubMed1993

Late-onset papilledema following spinal injury. Case report.

Papilledema, is a known complication of various spinal pathologies. It has, however, been only infrequently reported following spinal injury, and may be overlooked in these cases. Presented herein is a 27 year old male who suffered thoracic and lumbar spinal injuries. Papilledema following mild increase in intracranial pressure (IICP) developed 3 weeks following trauma, and subsided within 8 weeks. The importance of routine repeat ophthalmoscopic examinations following spinal injury to detect changes characteristic of IICP is emphasized.

Acetazolamide↗
PubMed1993

Fluticasone propionate aqueous nasal spray is safe and effective for children with seasonal allergic rhinitis.

INTRODUCTION: Fluticasone propionate aqueous nasal spray, a new topical corticosteroid preparation, is effective when given as 200 micrograms once daily in patients (> 12 years of age) with seasonal allergic rhinitis. STUDY OBJECTIVE: To evaluate the efficacy and safety of fluticasone proprionate aqueous nasal spray in children aged 4 to 11 years with seasonal allergic rhinitis. STUDY DESIGN: Multicenter, randomized, double-blind, placebo-controlled, parallel-group. PATIENTS: Two hundred fifty children aged 4 to 11 years with moderate-to-severe nasal symptoms, a positive skin test reaction to a late-summer or autumn allergen, a history of seasonal allergic rhinitis, and documentation of an unsatisfactory response to conventional treatment. INTERVENTIONS: Children were randomly assigned to receive fluticasone propionate, either 100 micrograms or 200 micrograms, or placebo, given by intranasal spray once daily in the morning for 14 days. MEASUREMENTS AND RESULTS: Severity of nasal symptoms (obstruction, rhinorrhea, itching, and sneezing) was recorded on visual analog scales by investigators at weekly visits and by patients (or adult guardian) daily in the evening. According to investigator and patient ratings, both fluticasone propionate 100 micrograms/d and 200 micrograms/d lowered total nasal symptom scores when compared with placebo. Both dosages of fluticasone propionate were more effective than placebo on the basis of investigator-rated overall clinical evaluation of efficacy at the end of treatment, with significant improvement (as opposed to moderate or mild improvement, no change or worsening) noted in 21% to 29% of the active-treatment groups vs 9% in the placebo group. There were no significant differences between the two fluticasone propionate dosages in any efficacy measurement. Morning plasma cortisol concentrations and frequency of drug-related adverse events were similar in the fluticasone propionate and placebo groups. CONCLUSION: In children as young as 4 years, 100 micrograms of fluticasone propionate aqueous nasal spray given once daily is as effective as 200 micrograms given once daily, the usual adult dose for the treatment of seasonal allergic rhinitis. Both fluticasone propionate dosages were well tolerated and neither dosage appears to interfere with the hypothalamic-pituitary-adrenal axis in children.

Administration, Topical↗
PubMed1992

Fatal and near-fatal anaphylactic reactions to food in children and adolescents.

BACKGROUND AND METHODS: Reports of fatal or near-fatal anaphylactic reactions to foods in children and adolescents are rare. We identified six children and adolescents who died of anaphylactic reactions to foods and seven others who nearly died and required intubation. All the cases but one occurred in one of three metropolitan areas over a period of 14 months. Our investigations included a review of emergency medical care reports, medical records, and depositions by witnesses to the events, as well as interviews with parents (and some patients). RESULTS: Of the 13 children and adolescents (age range, 2 to 17 years), 12 had asthma that was well controlled. All had known food allergies, but had unknowingly ingested the foods responsible for the reactions. The reactions were to peanuts (four patients), nuts (six patients), eggs (one patient), and milk (two patients), all of which were contained in foods such as candy, cookies, and pastry. The six patients who died had symptoms within 3 to 30 minutes of the ingestion of the allergen, but only two received epinephrine in the first hour. All the patients who survived had symptoms within 5 minutes of allergen ingestion, and all but one received epinephrine within 30 minutes. The course of anaphylaxis was rapidly progressive and uniphasic in seven patients; biphasic, with a relatively symptom-free interval in three; and protracted in three, requiring intubation for 3 to 21 days. CONCLUSIONS: Dangerous anaphylactic reactions to food occur in children and adolescents. The failure to recognize the severity of these reactions and to administer epinephrine promptly increases the risk of a fatal outcome.

Adolescent↗
PubMed1992

Symptomatic postprandial hypotension in high paraplegia. Case report.

Symptomatic postprandial decrease in blood pressure has been described in patients with various autonomic disorders, but not in patients with spinal injuries. Presented herein is a 31 year old female patient with traumatic complete paraplegia under the T3 level, in whom postprandial hypotension (PPH) was observed. The PPH was preceded by an increase in insulin level and was followed by an acceleration of heart rate. Oral caffeine prevented the hypotension and alleviated the symptoms. It is suggested that the PPH might be manifested as a result of damage to an upper thoracic spinal baroreflex. Clinical investigation of PPH is recommended for patients with high paraplegia.

Adult↗
PubMed1992

Lumbar spine dimensions in paraparetic patients: a 10 year follow up study.

Lumbar spinal AP radiographs of 13 C3-T11 paraparetic patients taken at about a 10 year interval were compared. The height (H) and maximum width (W) of the interapophysolaminar spaces (IALS), the width of the vertebral bodies at their waist (V) and the relationship between them showed minimal change over the follow up period. The difference between the late and early mean IALS height values increased caudally but was statistically significant only below L5. Subjective evaluation of the consecutive x-ray films revealed few new degenerative abnormalities. It is concluded that the normal aging process, which includes horizontal spreading of the lumbar vertebral bodies and narrowing of the lumbar spinal canal, is not accelerated by paraparesis and may even be retarded by relative immobilization.

Adult↗
PubMed1992

Is the appearance of periarticular new bone formation related to local neurological disability?

The present work examined the relationship between the appearance of periarticular new bone formation (PNBF) and the presence of local sensorimotor disability, and the relationship between PNBF and the severity of the motor disability. The study population consisted of 18 patients with spinal cord lesions and 18 patients with traumatic brain injury. The confinement of PNBF below the level of neurological deficit in patients with spinal cord lesions, and mainly to paralysed or paretic limbs in brain injured patients, indicates a possible causal relationship between the presence of sensorimotor disability and PNBF. On the other hand, the high incidence of bilateral PNBF in patients with incomplete spinal lesions and the appearance of PNBF in some nonplegic and even paretic limbs in the brain injured patients, demonstrates the lack of connection between the severity of the motor deficit and the risk of PNBF. It is suggested that local factors which are related to sensorimotor disability are probably involved in PNBF induction, but additional elements may also play a role in the induction of PNBF and in its propagation.

Adolescent↗
PubMed1990

Effects of exercise on the signal-averaged electrocardiogram in coronary artery disease.

The effects of exercise on the signal-averaged electrocardiogram (SAECG) were investigated in 52 patients with stable coronary artery disease. The SAECG was recorded before and immediately after the exercise test and analyzed at 25 to 250 Hz and 40 to 250 Hz. All patients had SAECG with noise level less than or equal 0.8 microV at 25 Hz and less than or equal to 0.6 microV at 40 Hz and with the difference in noise level between control SAECGs and SAECGs after exercise less than or equal to 0.2 to 0.3 microV. Twenty-eight patients developed ST changes consistent with transient subendocardial ischemia that persisted during the SAECG recording after exercise. There was no significant difference between control SAECGs and SAECGs after exercise in patients with or without a positive exercise test. The absence of significant change on the SAECG was not related to the presence or absence of prior myocardial infarction, site of infarction, development of exercise-induced ventricular arrhythmias or presence of an abnormal recording at baseline. These data suggest that exercise-induced electrophysiologic changes and ventricular arrhythmias may not be related to the anatomic-electrophysiologic substrate that underlies late potentials on the SAECG.

Arrhythmias, Cardiac↗
PubMed1990

Juvenile Parkinson's disease and its response to L-dopa therapy.

Four youngsters, between the ages of 13-27 years, presented dystonic foot. Two to three years following the appearance of the dystonic foot, cogwheel rigidity and tremor appeared on the dystonic foot side. Treatment with low doses of levodopa/carbidopa consistently reversed the symptoms. "On-off" phenomena appeared in the first years of treatment and persisted for the entire period of 5 to 15 years of illness. No parkinsonian signs were present when the dystonic foot appeared. Based on our observations and on a review of the literature, we conclude that responsiveness to low doses of L-dopa is the major marker of juvenile Parkinson's disease.

Adolescent↗
PubMed1990

Transverse myelitis associated with mycoplasma pneumoniae: case report.

Acute transverse myelitis (ATM) is a disorder of the spinal region of the central nervous system. In the present case, the clinical course showed ATM associated with mycoplasma pneumoniae (MP) and little recovery; the girl was left with a flaccid paraplegia, and thus differed from other cases in the literature which all reported complete or near-complete recovery.

Adolescent↗
PubMed1989

Sleep tonus inversion: a feature of juvenile dystonic parkinsonism.

Polysomnographic monitoring of a 16-year-old girl suffering from dopa-responsive dystonic parkinsonism showed a change in the distribution of muscle activity in thigh muscles during different stages of sleep. The hamstring muscles were hypertonic at sleep onset compared with the vastus lateralis of the quadriceps muscles. At the third sleep cycle of each of the 2 nights, the time at which sleep benefit becomes clinically evident, the hypertonia in the hamstring muscles was reversed and the vastus lateralis became more hypertonic. It is suggested that the muscle tonus inversion marks the moment at which the sleep process alleviates the dystonic parkinsonian state manifested at wakefulness as a circardian fluctuation. According to our data, the flexor-extensor tonus inversion during sleep was not yet described in the literature, and may be an associated feature of dopa-responsive dystonic parkinsonism.

Adolescent↗
PubMed1988

Late onset isofenphos neurotoxicity.

Late progressive polyneuropathy followed by pyramidal findings in a 20 year old agricultural labourer who ingested Isofenphos solution during his work, is presented. The patient was confined to a wheelchair within 6 weeks, regained walking ability within 6 months, and a 23 months' follow up revealed slight additional clinical improvement with minimal progression of the pyramidal signs. The neuropathic clinical manifestations, the EMG and the nerve conduction studies were compatible with a pathology of a distal, mainly axonal, mainly motor neuropathy.

Adult↗
PubMed1987

Fluctuating dystonia responsive to levodopa.

Four cases of hereditary progressive dystonia with diurnal fluctuation were studied. All were sporadic; three of them mimicked spastic diplegia; and the fourth showed some similarity to torsion dystonia. Emotional or cognitive disturbance, or both, was seen in three. The correct diagnosis was suggested by fluctuating signs and symptoms, which worsened towards evening, but this was reached only after many years of handicap, hospital admissions, and invasive diagnostic procedures. Typically there was a prompt, pronounced, and sustained response to moderate doses of levodopa. Sleep recordings were obtained in three patients and showed increased body movements during rapid eye movement sleep. Several close relatives had periods of increased leg movements during sleep. It is suggested that hereditary dystonia responsive to levodopa should be considered as the diagnosis in children with fluctuating signs of motor disability syndromes, simulating torsion dystonia or spastic diplegia. Polysomnographic studies may be helpful in diagnosis and may also detect early or subclinical cases.

Child↗
PubMed1985

Complement proteins and C3 anaphylatoxin in the tears of patients with conjunctivitis.

Previous studies in our laboratory have demonstrated pollen-specific IgG antibodies in the tears of patients with vernal conjunctivitis (VC) and elevated tear IgG levels in patients with contact lens-induced giant papillary conjunctivitis (GPC). Tear secretions were examined for complement (C) proteins to determine the role of this effector system in the pathogenesis of these ocular disorders. The tears of VC (15) and GPC (10) patients with active disease had elevated tear levels of both C3 and factor B. By use of transferrin as a marker for the leakage of plasma proteins into the tears, most C3 was locally produced by the conjunctival tissues. Although immune complexes could not be detected in the tear secretions, increased levels of C3 des Arg were present in the tears that suggested complement activation with the generation of anaphylatoxins. These studies suggest that complement may be important in the inflammatory ocular process of VC and GPC and that the generation of anaphylatoxins (C3a), even by nonimmune mechanisms, may contribute to basophil and mast cell activation with the release of inflammatory mediators into the tear secretions.

Complement C3↗
PubMed1985

Sex and aphasic syndromes.

Sex differences in the incidence of aphasia and its types has been the subject of interest in recent literature. We studied the records of 275 patients with C.V.A. and 62 with C.C.I., serially admitted to the Loewenstein Rehabilitation Hospital between 1965 and 1980. Aphasia Test results were recorded within one month of onset and again 3-5 months later. No significant sex differences were found in the incidence of aphasia or in aphasia syndromes in C.V.A. patients, but males far outnumbered female patients with C.C.I. The average ages of males and females in our aphasia population and among the syndrome types were not significantly different. We found that severity of disabilities, as measured by auditory comprehension, failed to show significant sex differences, although males tended to have more severe types of aphasia with poorer prognosis for recovery. Patterns of improvement to less severe types of aphasia were not statistically significant in males and females.

Adult↗