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Biomedical subjects

M Radford

Publications and source records attributed to M Radford.

At least 37 records · Page 2Linked to original sources
PubMed1995

Assessment of the continued supervision and asthma management knowledge of patients possessing home nebulizers.

This paper describes the results of a questionnaire survey on some aspects of nebulizer use, nebulizer instruction, and features relating to the recognition and management of deteriorating asthma. The study population consisted of 90 children with home nebulizers attending a paediatric asthma clinic, and 200 asthmatic children and 200 asthmatic adults whose nebulizers had been purchased directly from a manufacturer in the U.K. The results suggest that follow-up supervision of the patients who bought their own nebulizers occurred in only approximately 25% of cases. Written information focusing on the management of symptoms was also lacking. Peak flow meters were being under-used. Although the majority (77-100%) of patients were aware of the '4 h rule' for repeat use of bronchodilator therapy at home, there was still some confusion about the acceptable time interval and action to be taken should the dose be required more frequently. Very few (32%) in the nationwide adult group had a crisis action plan should the nebulizer fail to produce relief. This paper recommends that a simple treatment and crisis plan should be included with the purchased nebulizer, highlighting the key areas to be discussed by the patients with the doctor or other medical professionals. Such a package may prevent the occasional disaster that can occur with unsupervised nebulized bronchodilator usage.

Acute Disease↗
PubMed1995

Current lifestyle of young adults treated for cancer in childhood.

The aim of this study was to look at the current lifestyle of young adult survivors of childhood cancer between the ages of 16 and 30 years to document their achievements and expose any psychosocial problems. Sixty six young adult survivors were contacted and asked if they and their siblings (16-30 years) would take part in a lifestyle study; 48 patients and 38 sibling controls were interviewed. This took the form of a structured lifestyle questionnaire, a self esteem questionnaire (Oxford Psychologists Press), and an unstructured interview. Fifty five per cent of patients achieved five or more A-C grades at 'O' level/GCSE compared with 62% of siblings and a national average of 30%. Despite that these patients were significantly less likely to go on to higher education than their siblings. The two groups were equally employable and earning similar salaries. There were three cases of known employer prejudice. A slightly higher percentage of patients than siblings had their driving licence. Seventeen patients felt their appearance had changed and eight felt that they had a residual physical mobility problem. Both groups were socially active and equally likely to partake in competitive sports. There was no overall difference in the self esteem of the two groups. In general the survivors of childhood cancer were coping well in their young adult life and achieving the same lifestyle goals as their siblings. However, significant problems have been identified.

Adolescent↗
PubMed1994

Do mutations at the glycophorin A locus in patients treated for childhood Hodgkin's disease predict secondary leukaemia?

Childhood Hodgkin's disease has a high cure rate but second cancers are common, related to treatment and perhaps genetic predisposition. The glycophorin A (GPA) mutation assay measures the frequency of NO and NN mutant erythrocytes of MN blood-group heterozygous individuals. Mutant frequencies in Hodgkin's disease patients were compared with controls. No significant difference from controls was found pretreatment or in patients treated with radiotherapy only. Patients who received chemotherapy had a significantly increased frequency (total mutation frequency per 10(6) cells: 31 vs 11, p < 0.001), which may be relevant to their known increased risk of secondary leukaemia.

Adolescent↗
PubMed1994

Synovial sarcoma of the larynx in a child: case report and histological appearances.

Synovial sarcoma of the larynx is extremely rare having been reported only six times previously in the literature. We add another case report, which to our knowledge is the first recorded case in a child. We discuss the alternative approach of combination chemotherapy and radiotherapy which in this case led to a remission lasting about 3 years. The immunohistological and ultrastructural characteristics of the tumour are also presented.

Adolescent↗
PubMed1993

Cutaneous squamous cell carcinoma following treatment for acute lymphoblastic leukaemia.

The importance of second malignant neoplasms following successful treatment of childhood malignancy is of concern to all professionals involved with the care of these patients. We present an 18 year old patient with a squamous cell carcinoma of his lower lip following prolonged treatment for acute lymphoblastic leukaemia in childhood. The rarity of this tumor in this age group and the aetiological factors involved in developing the second malignancy are discussed.

Adolescent↗
PubMed1993

Overnight urine growth hormone, cortisol and adenosine 3' 5' cyclic monophosphate excretion in children with chronic asthma treated with inhaled beclomethasone dipropionate.

Overnight urine samples were obtained from 34 asthmatic children, 24 of whom were receiving inhaled beclomethasone dipropionate (BDP), and 30 controls. The urine volume of the children receiving inhaled steroids was significantly greater than that of the other asthmatic children and of the controls (P < 0.05). Urine growth hormone was within the normal range for all of the subjects and there was no demonstrable relationship between urine growth hormone and height or height standard deviation score. Urine steroid output was significantly reduced in the BDP receiving group when the results were expressed in U l-1 but there was no difference between the groups when the results were expressed per specimen. Urine adenosine 3' 5' cyclic monophosphate (cAMP) results were similar for all groups. We conclude that use of BDP increases overnight urine volume but, in our study, does not appear to influence the output of urine cortisol. Urine free cortisol measurements may not be a very sensitive tool for the detection of small changes in endogenous steroid production. The use of BDP does not adversely affect the output of urine growth hormone.

Administration, Inhalation↗
PubMed1993

Comparison of the efficacy and safety of inhaled fluticasone propionate 200 micrograms/day with inhaled beclomethasone dipropionate 400 micrograms/day in mild and moderate asthma.

This study was designed to compare the efficacy and safety of a new inhaled corticosteroid, fluticasone propionate at a total daily dose of 200 micrograms, with beclomethasone dipropionate 400 micrograms/day in childhood asthma. A total of 398 asthmatic children (aged 4-19 years) were randomised to receive either fluticasone propionate 200 micrograms daily or beclomethasone dipropionate 400 micrograms daily for six weeks inhaled via a spacer device from a metered dose inhaler. During the study the patients recorded morning and evening peak expiratory flow rate (PEFR), symptom scores, and use of beta 2 agonist rescue medication. In addition, clinic visit PEFR and forced expiratory volume in one second were measured. Safety was assessed by recording all adverse events and by performing routine biochemistry and haematology screens including plasma cortisol concentration before and after treatment. For the purposes of analysis the diary card data were grouped into three periods: week 3 (days 15-21), week 6 (days 36-42), and weeks 1-6 (days 1-42). The results showed no significant difference between treatments on most efficacy parameters. However, there were significant differences in changes from baseline in favour of fluticasone propionate for % predicted morning PEFR both at week 3 (fluticasone propionate 6.1%, beclomethasone dipropionate 3.9%) and at week 6 (fluticasone propionate 8.3%, beclomethasone dipropionate 5. 9%) and % predicted evening PEFR at week 6 (fluticasone propionate 7.3%, beclomethasone dipropionate 4.9% and over weeks 1-6 (fluticasone propionate 5.5%, beclomethasone dipropionate 3.6%. Comparison between groups showed that the group receiving fluticasone propionate had a lower % of days with symptom-free exercise at week 6 (fluticasone propionate 87%, beclomethasone dipropionate 81%) and % days without rescue medication at week 6 (fluticasone propionate 87%, beclomethasone dipropionate 80%) and over weeks 1-6 (fluticasone propionate 80%, beclomethasone dipropionate 73%). Except for a higher incidence of sore throat in the fluticasone propionate group, the two treatments did not differ with regard to safety. There was no evidence of adrenal suppression with either treatment. In conclusion, fluticasone propionate 200 microgram daily ws at least as effective and as well tolerated as beclomethasone dipropionate 400 microgram daily in childhood asthma.

Administration, Inhalation↗
PubMed1992

Characterization and molecular analysis of nondisjunction in 18 cases of trisomy 21 and leukemia.

We recently began a cytogenetic and molecular study of nondisjunction in leukemic Down syndrome individuals to determine whether the mechanism by which the extra chromosome 21 originates predisposes the individual to leukemia. In the present report, we summarize our observations on 18 patients with trisomy 21 and acute or transient leukemia, including 11 patients with acute lymphocytic leukemia, three with acute myeloid leukemia, one with B-cell lymphoma, one with acute megakaryoblastic leukemia, and two with transient leukemia. Results of DNA marker studies of the parental origin of the extra chromosome 21 indicated that 16 of the 18 cases (89%) were maternally derived, a percentage similar to that seen among nonleukemic Down syndrome patients. We noted that most leukemic Down syndrome patients had one locus or more in which parental heterozygosity was maintained in the trisomic individual, indicating a meiotic rather than a mitotic origin for the trisomy.

Adolescent↗
PubMed1992

'VEEP' in children with Hodgkin's disease--a regimen to decrease late sequelae.

In an attempt to decrease the risk of second malignancies and future infertility in children with Hodgkin's disease (HD) while retaining acceptable remission rates, an anthracycline based regimen containing no alkylating agent has been devised. VEEP contains vincristine, epirubicin, etoposide and prednisolone given at 3 weekly intervals. Forty-four patients, aged 2-15 years, have been treated: ten relapsed patients and 34 previously untreated with chemotherapy (including three relapsed stage I treated initially with radiotherapy). The median follow up for all patients is 25 months (range 6-52 months). The response rate in previously treated patients was 80% (95% CI 44-97%) and five remain alive in remission. The response rate in untreated patients was 88% (95% CI 72-97%) with 62% CR + CR(u) (uncertain/unconfirmed) (95% CI 44-77%). Of four patients who had a final response of CR(u) three have relapsed at 9, 16 and 38 months. Two of the children in CR have relapsed at 6 and 16 months. The relapse free rate at 3 years is 67% (95% CI 17-82%). In this pilot study the event free survival appears somewhat poorer than conventional combinations and further follow up is required to confirm the salvagability of relapsed patients.

Adolescent↗
PubMed1992

Increased resting energy expenditure in childhood asthma: does this contribute towards growth failure?

In order to determine whether or not there was a relationship between disorders of growth in children suffering from asthma and either increased resting energy expenditure or inadequate energy intake, a group of 34 children suffering from perennial symptoms were studied. A control group matched with the asthmatic children for sex and fat free mass were similarly studied. The children kept seven day records of weighed food intake. Basal metabolic rate was measured on one occasion in the fasted state by means of indirect calorimetry using the ventilated hood technique. The asthmatic children kept a 28 day record of peak expiratory flow rates, asthma symptoms, and medication usage. The asthmatic children expended significantly more energy at rest than their matched controls in absolute terms (14%). There was no correlation between height or height SD score and any parameter of energy balance. The causes of these finding are as yet speculative.

Asthma↗
PubMed1991

Comparative study of affective disorders in three Asian countries. II. Differences in prevalence rates and symptom presentation.

This study used standardized diagnostic criteria and method to investigate both prevalence rates and nature of symptoms of depressive disorders in three Asian centres--Nagasaki, Shanghai and Seoul. Of the patients who visited a psychiatric clinic in each of the 3 centres for the first time, over 20% suffered from depression. Unlike previous reported prevalence rates for Asian countries, these results suggest that rates in Asia may not be much lower than those reported in Western countries. Although prevalence rates of depression were similar in all 3 centres, differences in symptoms were noted.

Adolescent↗
PubMed1990

Treatment of clinical stage I Hodgkin's disease by local radiation therapy alone. A United Kingdom Childrens Cancer Study Group study.

The UKCCSG study of the treatment of Hodgkin's disease between January 1982 and January 1988 accrued 209 patients. Of these, 59 had clinical Stage I disease. These 59 patients were treated with radiation therapy alone to sites of initial involvement. In case of relapse, combination chemotherapy was used. With a median follow-up of 3 years, 50 patients are alive with no evidence of disease after radiation therapy alone. Nine patients have relapsed between 5 and 55 months (median time to relapse, 18 months). Eight patients have been successfully treated with combination chemotherapy and are alive with no evidence of disease (one of these patients having had two relapses). One patient has died after widespread relapse. Of the 59 Stage I disease patients, 85% are relapse free after single-modality treatment. Overall survival is 98%. Long-term complications are minimal at this stage but long-term follow-up is essential.

Adolescent↗
PubMed1989

A study of depression in two cultures: a transcultural study with Japanese and Australian clinically depressed patients.

Recently there has emerged a growing interest in transcultural aspects of depressive disorders. Unlike earlier studies, recent research has concentrated on using standardized assessment and evaluation procedures in an effort to reduce "differences" associated with research techniques. The following paper reports a study which, using the WHO developed Standardized Assessment of Depressive Disorders (WHO/SADD) schedule, examines the nature of depressive symptomatology in Australian and Japanese clinically depressed patients. While results supported the presence of a "symptom core" common to both cultures, some unexpected findings in relation to "feelings of guilt" and "severity of depression" were noted.

Adolescent↗
PubMed1989

Prevalence of respiratory symptoms among 7 and 11 year old schoolchildren and association with asthma.

A new self administered questionnaire completed by parents was used to study the prevalences of wheeze, shortness of breath, and cough in 2503 Southampton schoolchildren aged 7 and 11 together with exacerbating factors and background information including treatment and diagnosis. The questionnaire had a response rate of 84% and was found to be highly repeatable with respect to current symptoms. The overall prevalences of wheeze and shortness of breath in the current year (1986) were 12.1% and 8.5% respectively. Social class, home ownership, parental smoking, and presence of a family pet were unrelated to symptom prevalence. According to the parents the overall diagnosis rate for asthma was 9.5%. In common with other studies, however, we found considerable evidence for undertreatment. The symptoms of wheeze and nocturnal and morning breathlessness occurred more commonly in boys, but this sex ratio decreased with increasing age. The prevalences of wheeze and shortness of breath were similar in the two age groups. In contrast, there were only small differences between the sexes with respect to cough whereas, among children without wheeze or shortness of breath, there was a fall in the prevalence of cough from 18.9% at 7 years to 8.7% at 11 years. When controlling for the other respiratory symptoms, wheeze was the only symptom significantly related to parental asthma. The fall in the prevalence of cough between the two age groups is unlikely to be related to changes in asthma prevalence and, when not associated with wheeze, may be an indicator of separate pathology.

Age Factors↗
PubMed1989

Prevalence of atopy and range of bronchial response to methacholine in 7 and 11 year old schoolchildren.

A sample of 397 from 2503 children aged 7 and 11 years, who took part in an earlier questionnaire study of respiratory symptoms in Southampton, was chosen for methacholine bronchial provocation and allergen skin testing. Results were obtained from 330 (84%). A good level of repeatability was achieved for bronchial provocation testing giving a 95% confidence interval equivalent to 1.74 doubling concentrations. The main problem encountered with methacholine was its bitter taste in high concentrations. The proportion of children, in whom the dose of methacholine which produced a fall of 20% in the forced expiratory volume in one second (PD20 methacholine) was less than or equal to 6.4 mumol, fell from 29.1% at 7 years to 16.5% at 11 years. The prevalence of atopy increased from 26% at 7 years to 31.6% at 11 years. A highly significant association was found between bronchial responsiveness to methacholine and atopy, which was independent of symptoms or age group.

Bronchi↗
PubMed1989

Associations between respiratory symptoms, bronchial response to methacholine, and atopy in two age groups of schoolchildren.

Data on respiratory symptoms were obtained on 2503 schoolchildren aged 7 and 11 in Southampton by means of a self administered parental questionnaire. Children were classified into seven symptom groups from which 330 were tested for bronchial responsiveness to less than or equal to 6.4 mumol methacholine and skin tested for the presence of atopy. The symptoms of wheeze, cough, and shortness of breath were all significantly associated both with each other and bronchial responsiveness to methacholine but only wheeze was associated with atopy. The association of wheeze with both bronchial responsiveness to methacholine and atopy remained highly significant when controlling for the symptoms of cough and shortness of breath. Neither cough nor shortness of breath, however, were significantly related to bronchial responsiveness to methacholine when controlling for the symptom of wheeze. This study therefore calls into question the epidemiological relevance of these two symptoms as diagnostic features of asthma, particularly in the absence of wheeze, although they may be useful indicators of morbidity. Wheeze was not related to bronchial responsiveness to methacholine in the absence of atopy or to atopy in the absence of bronchial responsiveness to methacholine but was strongly related to the combination of the two phenomena. The presence of these three characteristics could therefore indicate a discrete disease entity. The decrease in the prevalence of cough between 7 and 11 years appeared to be mirrored by a similar decrease in the prevalence of wheeze when the symptom was not associated with the combination of bronchial responsiveness to methacholine and atopy. On the basis of these findings and those of others we suggest that the latter group may represent children with a separate disease entity(ies) or with residual symptoms secondary to acute viral or other infections of the lower respiratory tract.

Asthma↗