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Biomedical subjects

R B Klein

Publications and source records attributed to R B Klein.

18 recordsLinked to original sources
PubMed2000

Stress and airway resistance in children with asthma.

OBJECTIVE: The present study implements an experimental paradigm to examine airway reactivity to stress in children with asthma and controls. METHOD: 114 children with asthma and 30 controls (ages 9-15) participated. The protocol involved 5 min of baseline physiological measurements followed by a 5-min stressful task. Skin conductance (EDG), skin temperature, and heart rate were measured continuously. Airway resistance was measured at baseline and after the task. RESULTS: 110 children (76% of the sample) were significantly "stressed" as shown by physiological changes. Asthmatics and controls differed on overall airway resistance, F(1, 108)=12.3, P<.001. The entire sample demonstrated a trend toward increased airway resistance in response to stress, F(1,108)=3.1, P<. 08. A portion of asthmatics (22%) had increases of greater than 20% of baseline airway resistance. Changes in airway resistance in response to stress were unrelated to asthma severity, F(2,78)=2.0, ns. CONCLUSION: Children with asthma and controls demonstrate variation in airway function in response to stress, although increases are likely more meaningful for children with asthma. Further research is needed to examine the mechanisms underlying this response.

Adaptation, Physiological↗
PubMed1999

Thresholds of resistive load detection in children with asthma.

Threshold detection of added resistive loads was studied in asthmatic children and compared to data previously obtained in a group of healthy children. The relationships between possible psychological predictors of perceptual ability, the perceptual threshold, and functional morbidity variables were also investigated. Our subjects were 103 children (mean age, 10.9 years) with asthma who completed two laboratory protocols in which they were asked to distinguish breaths with varying degrees of added resistance from unloaded breaths. Using two different computer-driven protocols, resistances were presented as percentages of each child's intrinsic respiratory system resistance (R(rs)). Cognitive ability was assessed through subtests of the Wechsler Intelligence Scale for Children, 3rd edition (WISC-III), and functional morbidity was quantified through a combination of school absences, emergency medical visits, and days hospitalized. Detection thresholds for both protocols were highly correlated with intrinsic resistance (r = 0.49 and 0.66; P < 0.001). Weber fraction thresholds were significantly lower for asthmatic children than healthy controls. Thresholds were not significantly related to either intelligence or pulmonary functional abnormalities due to asthma. Methodologic limitations require cautious interpretation of the results, but we conclude that psychophysical approaches may be useful in the study of symptom perception in pediatric asthma.

Adolescent↗
PubMed1998

Recovery of arm function in patients with paresis after traumatic brain injury.

OBJECTIVE: To characterize the frequency of recovery of arm paresis in patients with traumatic brain injury (TBI) admitted to rehabilitation. DESIGN: Retrospective review identifying a cohort of patients with moderate or severe arm paresis after TBI followed at least 6 months postinjury. SETTING: Freestanding acute rehabilitation hospital TBI unit. PATIENTS AND METHODS: Forty-four patients with moderate to severe arm paresis were selected from 264 consecutive admissions and characterized by injury pathology subtype, injury severity (duration of unconsciousness [loss of consciousness, LOC] and posttraumatic amnesia [PTA]), age, and level of paresis according to Brunnstrom Stages of Recovery (BS 1 to 6). Patient groups with and without arm paresis were compared according to these variables (t tests and chi(2)). MAIN OUTCOME MEASURES: Recovery of arm paresis to isolated motor function (BS 5 or 6) and time to achieve recovery. Recovered and nonrecovered patients were compared (Mann-Whitney, t tests, and chi(2)) on injury severity, initial level of paresis, age, time to rehabilitation admission, and pathology subtype. Time to recovery was compared for patients at different levels of initial paresis, ranges of LOC, and pathology subtypes (Mann-Whitney and Kruskal-Wallis tests). RESULTS: Forty-four patients (17%) had moderate (BS 3 to 4) or severe (BS 1 to 2) paresis at rehabilitation admission. They were more severely injured than nonparetic patients based on longer LOC (p < .002) and PTA (p < .009). Thirty-six patients (82%) recovered by 6 months; 72% of these recovered by 2 months. If still paretic at 2 months, only 56% recovered. Mean recovery time was 6.9 weeks (SD, 6.1) from injury. Time to recovery was best predicted by initial level of paresis and injury severity (r2 = .48), but not age. Patients with diffuse injury tended towards a more protracted recovery (7.9 weeks, SD 6.5) than patients with focal injury (4.2 weeks, SD 3.9) (p = .08) and only those with diffuse injury showed further recovery after 3 months. CONCLUSIONS: Arm paresis after TBI is relatively infrequent. Most patients recover by 2 months but later recovery is possible, especially in patients with primarily diffuse brain damage. Recovery is highly related to initial impairment, injury severity, and distribution of brain injury.

Adolescent↗
PubMed1998

Relationship of asthma severity and psychological problems in children.

OBJECTIVE: To determine whether physiological severity of asthma is associated with increased psychological symptoms in children. METHOD: Participants were 337 children, aged 7 to 19 years (mean 11.9, SE 0.13), and a parent of each child. Children's asthma severity was rated by experienced pediatric asthma specialists using current guidelines from the National Heart, Lung, and Blood Institute. Children filled out the Children's Manifest Anxiety Scale and the Weinberger Adjustment Inventory. Parents reported on their child's medical history, completed the Child Behavior Checklist (CBCL) about their child, and completed the Pennebaker Inventory of Linguid Languidness as a measure of their own physical symptoms. RESULTS: Child-rated anxiety symptoms were unrelated to asthma severity or to markers of asthma functional morbidity. Parental ratings of internalizing symptoms in their children were related to severity. Parent physical symptoms explained 10.2% of the variance in CBCL Internalizing symptoms, and asthma severity added an additional 6.7% to the variance. CONCLUSIONS: Asthma severity may be a more salient stressor to parents, who in turn report higher levels of child internalizing symptoms for children with severe asthma, than to children themselves. Contrary to prior hypotheses, children with severe asthma did not rate themselves as having higher levels of anxiety than those with mild or moderate asthma or than standardized norms.

Adolescent↗
PubMed1996

Symptom perception in pediatric asthma: relationship to functional morbidity and psychological factors.

OBJECTIVE: Perception of changes in respiratory symptoms is a critical element in the self-management of pediatric asthma. The purpose of this study was to quantify perceptual accuracy in childhood asthma, to investigate links between symptom perception and functional morbidity, and to examine relationships between psychological variables and perceptual accuracy. METHOD: Eighty-six children, aged 8 to 15 years, attending an asthma camp made subjective estimates of asthma severity immediately prior to spirometry an average of 31 times at camp. The correlation coefficient between these measures (the child's accuracy index) was analyzed in relation to morbidity data and to scores on instruments that assessed trait anxiety, repressive coping style, intelligence, behavior problems, and parental symptom-reporting patterns. RESULTS: A wide range of perceptual ability was found, as children's subjective-objective r ranged from-.39 to .88. Greater perceptual accuracy was significantly related to fewer days missed from school and fewer emergency medical visits. Of the psychological variables assessed, only intelligence was significantly related to accuracy. CONCLUSIONS: Symptom perceptual ability is an important psychosomatic factor affecting the course of asthma for some children. Further study is indicated to understand psychological variables in addition to intelligence that may determine a child's perceptual accuracy.

Adaptation, Psychological↗
PubMed1995

Spirometric patterns in childhood asthma: peak flow compared with other indices.

The objective of this study was to determine patterns of pulmonary function abnormalities and to evaluate how adequately peak flow monitoring was correlated to other spirometric indices in childhood asthma. Ninety-one children, aged 8-15 years, with moderate-to-severe asthma were repeatedly tested in a summer camp. On-site medical staff permitted 24-hour-a-day supervision. Subjective and objective clinical evaluations of asthma status were made over 14 consecutive days. Detailed clinical history and clinical observations were made by an experienced staff, and a total of 2,663 pulmonary function tests were performed regularly three times daily and whenever a child sensed asthma symptoms. Patterns of obstruction were divided into large airway abnormalities and small airway abnormalities. There was a low concordance between standard large airway measures, such as the peak expiratory flow rate (PEFR) or the forced expiratory volume in 1 second (the FEV1), and measures of small airway obstruction, such as the forced expiratory flow rate 25-75% (FEF25-75). Normal PEFR measurements do not always indicate that all other pulmonary function measures are normal. In fact, 18% of children with a normal PEFR had abnormal FEF25-75 values. Results demonstrated that the FEF25-75 was the most specific and sensitive measure of airway obstruction. PEFR is widely used to monitor asthma symptoms objectively because it is technically simple to perform, relatively inexpensive, and helpful in most cases. It is, therefore, appropriate for asthma education programs to recommend PEFR as an objective measure to guide in making therapeutic decisions. Our data and clinical observations support the "Guidelines for the Diagnosis and Management of Asthma" of the NIH Health Asthma Education Program that suggest that children have more complete pulmonary function testing along with frequent PEFR measures. Many children may appear asymptomatic, while recording normal PEFR measures, and still having significant asthma. Repeated pulmonary function testing and evaluation of the pattern of respiratory obstruction aids in managing this challenging group. We recommend that efforts be made to develop a simple and inexpensive method of measuring FEF25-75 that will allow this measurement to be made even at home.

Adolescent↗
PubMed1994

Chronic bronchitis in children.

Chronic bronchitis in childhood is a diverse group of illnesses with pathophysiology differing markedly from the adult condition. Airway disease in children is very common and results in significant and increasing morbidity and mortality. Chronic abnormalities in the bronchioles secondary to infection and morbidity of the bronchi secondary to neonatal problems are unique to children. Because more of these children are reaching adult life each day, these conditions are highlighted. Differential diagnosis, clinical evaluation, and recent treatment advances are discussed.

Asthma↗
PubMed1993

Evaluation and risk factors of latex allergy in spina bifida patients: is it preventable?

Allergic reactions to latex, varying from urticaria to life-threatening IgE-mediated anaphylaxis, have been described in patients with spina bifida. In a study of 50 patients 60% had a latex allergy identified by history, a radioallergosorbent test and/or a skin prick test. Latex allergic patients had undergone statistically more surgical procedures than nonallergic patients (9.5 versus 6.7) with a p value of 0.03. The presence of latex allergy did not correlate with the number of intra-abdominal procedures (1.9 versus 1.4) or with the number of years on clean intermittent catheterization (7.7 versus 5.9). These results suggest that latex allergy is acquired through multiple exposures due to breakdown of blood tissue barriers. Therefore, we recommend that all patients with spina bifida undergoing surgery be evaluated for latex allergy and that all surgical procedures in spina bifida patients, from the time of birth, be performed in a latex-free environment.

Adolescent↗
PubMed1993

Cognitive coping strategies of children with chronic illness.

Children with chronic illness need to adapt to more stresses than do healthy children. Research highlights the problems of children with chronic illnesses but not how they cope in response to the stress created by these problems. Cognitive appraisal of a stressor and of response options is an important aspect of coping. Our cross-sectional study investigated whether children with chronic illness used cognitive strategies for coping as often as did healthy children. One hundred seventy five children from summer camps with juvenile arthritis, asthma, or diabetes were compared with 145 healthy school children. Spontaneous responses to common painful and stressful events were categorized into coping or catastrophizing ideation. Data on anxiety, disease severity, and other sociodemographic variables were obtained. Coping strategies were reported by 64% of children with chronic illness and 63% of healthy children and varied significantly with age (p < .05) in both groups. Children with different chronic illnesses performed similarly except for a trend among children with severe juvenile rheumatoid arthritis who had higher rates of coping. For the individual stressful events, the rate of coping varied from 46% to 86%. The highest rates of coping responses were found with the child's recent personal stressful event where adolescents with chronic illness were twice as likely to offer more complex coping responses. More children with chronic illness than healthy children offered coping strategies in response to venipuncture (p < .001) but not to dental injection. Children with chronic illness report coping as their predominant strategy for adapting to common painful and stressful events.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1991

Intraoperative anaphylactic reaction due to latex hypersensitivity.

Severe anaphylactic reaction secondary to latex allergy has lately been recognized and reported especially in individuals with spina bifida. We report a case of severe intraoperative anaphylactic reaction due to latex allergy. Preoperative testing for latex allergy may be helpful in determining latex allergy. We suggest a preoperative management protocol for patients who are thought to have latex allergy. An increased awareness to latex allergy will help avoid this potentially catastrophic event.

Adolescent↗
PubMed1990

Accuracy of symptom perception in childhood asthma.

Children's reports of their asthma symptoms are used as important data in the assessment and management of pediatric asthma, but little is known about the accuracy of such reports. Children's subjective perception of the level of asthma symptoms was correlated with peak expiratory flow rate measures on average of 34 observations for 37 children with asthma. Subjective/objective correlations for a given child varied from 0.86 to -0.16. The children's perceptual accuracy was not related to age or sex, or to duration or severity of asthma. Implications for clinical practice are discussed.

Adolescent↗
PubMed1980

Monocyte chemotaxis under agarose: defects in atopic disease, aspirin therapy, and mucocutaneous candidiasis.

Using Ficoll-Hypaque-separated cells, monocyte chemotaxis was measured by an agarose technique in patients with increased susceptibility to infection, with atopic dermatitis, and in individuals taking aspirin. In vitro effects of aspirin, hydrocortisone, aminophylline, ephedrine, and diphenhydramine were also studied. Significantly decreased chemotaxis was found in one 9-year-boy with severe mucocutaneous candidiasis and three of 22 patients with atopic dermatitis. In the atopic group of patients greater than 10 years of age, mean monocyte chemotaxis was significantly decreased from the age-matched control group. This decrease did not correlate with serum IgE levels, absolute blood eosinophil counts, or clinical symptom scores. Following aspirin ingestion, mean monocyte chemotaxis significantly decreased whereas neutrophil chemotaxis was unaffected. Using therapeutic concentrations, drug levels of aspirin and aminophylline in vitro caused greater than 35% inhibition of monocyte movement.

Adolescent↗
PubMed1980

Recurrent erysipelas caused by group B streptococcus organisms.

Group B beta-hemolytic streptococcus (GBS) has emerged as a major cause of neonatal infections. Serious GBS infections in adults occur most frequently when predisposing illness is present. Recurrent erysipelas caused by GBS is reported in a woman who had chronic lymphedema after a radical hysterectomy and radiation therapy. Type III GBS was identified from cultures of vulvar vesicles, vaginal mucosa, and blood. Prophylactic penicillin V potassium therapy prevented further episodes of erysipelas. Group B beta-hemolytic streptococcus should be considered a possible cause of erysipelas or cellulitis.

Abdomen↗
PubMed1979

Childhood dermatomyositis and polymyositis. Treatment with methotrexate and prednisone.

The conditions of three children with dermatomyositis and one child with polymyositis were treated for nine to 31 months with combined prednisone and intravenous methotrexate (1 mg/kg/wk) when prednisone alone was ineffective in controlling the disease or when there were substantial steroid-related toxic effects. All children showed a major clinical improvement within three months despite concomitant reduction of the prednisone dose. Three children completely recovered; one patient relapsed and died. The toxic effects of methotrexate included elevated liver transaminases (3/4), nausea (2/4), abdominal pain (2/4), bone pain (2/4), mild neutropenia (1/4), and mild pruritus (1/4). Intravenous methotrexate is an effective adjunct to steroid therapy in the treatment of steroid-resistant or life-threatening dermatomyositis-polyositis or dermatomyositis-polymyositis complicated by severe steroid-related effects.

Child↗
PubMed1977

Miconazole in the treatment of chronic mucocutaneous candidiasis: a preliminary report.

Miconazole, a new imidazole antimycotic agent, was given intravenously to five children with chronic mucocutaneous candidiasis over an 18-month period. There was marked improvement of mucosa and skin in two patients, moderate-to-milk improvement in two, and no improvement in one. Nail lesions were not improved in any patient. Adverse reactions included phlebitis, pruritus, nausea and dizziness, rash, wheezing, mild transient anemia, and mild transient transaminase (SGOT and SGPT) elevations; it was necessary to discontinue treatment in only one patient. No renal toxocity was noted. Miconazole appears to be a relatively safe and promising alternative to amphotericin B in chronic mucocutaneous candidiasis.

Adolescent↗
PubMed1976

Severe combined immunodeficiency with B lymphocytes: in vitro correction of defective immunoglobulin production by addition of normal T lymphocytes.

A 6 1/2-month-old male with severe combined immunodeficiency (SCID) had a low percentage and number of T cells (11%; 241/mm3) and a high percentage and number of B cells (52%; 1187/mm3) and null cells (37%; 868/mm3). In vitro studies were performed to determine if this child's primary defect involved differentiation of both T and B lymphocytes or if failure of B lymphocytes to differentiate into immunoglobulin producing cells was secondary to T lymphocyte abnormalities. Immunoglobulin production by lymphocytes in response to polyclonal mitogens (pokeweed mitogen and foetal calf serum) was measured by pulse-labelling cells with 3H-leucine and then precipitating cytoplasmic and secreted immunoglobulins with polyvalent anti-human immunoglobulin and S. aureus (Cowan strain I) protein A. The patient's lymphocytes did not synthesize immunoglobulins in vitro in response to mitogens. They did not suppress synthesis of immunoglobulins by normal lymphocytes. However, addition of normal purified T cells, which themselves did not synthesize immunoglobulins, enabled the patient's B lymphocytes to become immunoglobulin synthesizing and secreting cells. Gamma, mu, and light chains were secreted. This suggests that the primary abnormality was in the T-cell axis at the level of lymphoid stem cells or prothymocytes and that failure of B lymphocytes to become immunoglobulin-producing cells was secondary to this defect.

Antibody-Producing Cells↗
PubMed1975

Probable neonatal propoxyphene withdrawal: a case report.

A baby with neonatal withdrawal from propoxyphene as evidenced by severe diarrhea, flapping tremors, shrill cry, diaphoresis, hypertonicity, and seizures is presented. Propoxyphene and its metabolites were identified in the patient's serum and urine. We express concern about the wide use of propoxyphene and its proposed use in substitution programs for detoxifying and maintaining heroin addicts in view of the possibility of neonatal complications.

Dextropropoxyphene↗