The successful use of continuous negative extrathoracic pressure in a child with Glenn shunt and respiratory failure.

Following a Glenn shunt, an infant required mechanical ventilation (IPPV) for pneumonia, a phrenic nerve palsy and chylothoraces. In order to improve her deteriorating clinical condition, we used continuous negative extrathoracic pressure (CNEP) to minimise the deleterious effects of IPPV on pulmonary blood flow. She was successfully weaned from IPPV and supported with CNEP.

A case of congenital chylothorax treated by pleuroperitoneal drainage.

A congenital chylothorax that necessitated recurrent pleural taps was successfully treated by a pleuroperitoneal shunt that was inserted when the infant was 28 days old. Further thoracentesis was avoided and failure to thrive was overcome.

Negative extrathoracic pressure ventilation in central hypoventilation syndrome.

Nine patients with central hypoventilation syndrome (CHS) were treated with negative extrathoracic pressure ventilation (VNEP). Treatment with VNEP was started between 20 days and 57 months of age, which was two days to 47 months after diagnosis. The equipment to provide VNEP utilised a new system with a latex neck seal and Perspex chamber allowing easy access to the child.

Home event recordings of oxygenation, breathing movements, and heart rate and rhythm in infants with recurrent life-threatening events.

For an evaluation of the usefulness of event recording in identifying mechanisms for apparent life-threatening events, 94 infants (median age, 3.1 months; range, 0.5 to 12 months) with a history of two or more apparent life-threatening events of hitherto unknown cause underwent event recording of transcutaneous oxygen pressure, arterial oxygen saturation, (not recorded in all patients), breathing movements, pulse waveforms, electrocardiogram, and instantaneous heart rate.

Diagnosis and management after life threatening events in infants and young children who received cardiopulmonary resuscitation.

Objective: To determine the mechanisms and thereby appropriate management for apparent life threatening events treated with cardiopulmonary resuscitation in infants and young children.

Design: Prospective clinical and physiological study.

Setting: Royal Brompton Hospital or in patients' homes, or both.

Home monitoring of transcutaneous oxygen tension in the early detection of hypoxaemia in infants and young children.

Twenty three patients (age range 0.5-40 months) with recurrent cyanotic episodes underwent physiological recordings, including transcutaneous oxygen tension (TcPO2) from a monitor modified for use at home (Kontron 821S). Of 69 episodes in which the arterial oxygen saturation (SaO2, Nellcor N200) was less than or equal to 80% for greater than or equal to 20 seconds and/or central cyanosis was present, the TcPO2 monitor alarmed (less than or equal to 20 mmHg or 2.

Automatic speech recognition for disabled people.

It has been suggested that one of the most promising areas for the application of speech recognition is in helping handicapped people (Leggett and Williams, 1984). Within the last decade, many improvements have been made in the performance of automatic speech recognisers and current technology is discussed in relation to the needs of the disabled population. Recent research developments in the field of automatic speech recognition are reviewed, with particular reference to voice control of robotic arms and environmental control units.

Selective defect in the antibody response to Haemophilus influenzae type b in children with recurrent infections and normal serum IgG subclass levels.

We studied 15 children with recurrent infections and normal serum IgG, IgM, IgA, and IgG-subclass levels. After immunization, the geometric mean serum IgG antibody concentration to Haemophilus influenzae type b (Hib) was eightfold lower than that of age-matched control subjects (p = 0.002).

IgG subtype abnormalities with normal total IgG in a clinical allergy practice.

Thirty-one of 75 patients with recurrent upper respiratory infections were found to have immunoglobulin G subclass deficiencies with normal levels of total immunoglobulin G in a clinical allergy and asthma practice. Sixteen were IgG3 deficient, thirteen IgG2 deficient, and two were IgG1 deficient. Only one patient had an IgA deficiency.

Duration of action of oral albuterol in an asthmatic population.

In a randomized, double-blind, two-way crossover study in four centers, 124 patients received single doses of 4 or 6 mg of albuterol and placebo on two separate visits. Pulmonary function tests were performed at intervals up to ten hours. Both dosages produced peak bronchodilation responses which occurred at two hours and significant activity was maintained for at least eight hours.

Efficacy and tolerance of fluocortin butyl administered twice daily in adult patients with perennial rhinitis.

Fluocortin butyl (FCB) is a newly developed corticosteroid drug with no detectable systemic corticosteroid activity when it is used topically. Previous studies have demonstrated the therapeutic efficacy of FCB applied topically to the nasal mucosa three to four times a day for perennial rhinitis. The therapeutic efficacy of FCB used only twice daily, with total daily dosages similar to those previously found to be effective when these were applied more frequently, was studied in a multicenter, double-blind, placebo-controlled trial.

Concomitant bitolterol mesylate aerosol and theophylline for asthma therapy, with 24 hr electrocardiographic monitoring.

A higher incidence of fatal asthma after increased use of combined inhaled beta 2-agonists and theophylline has been attributed to additive cardiac toxicity of these agents. This study had three major objectives: first, to evaluate the efficacy and safety of a new long-acting beta 2-agonist, bitolterol mesylate, given as metered-dose aerosol in a regular "round-the-clock" asthma medication regimen; second, to compare the efficacy and safety of bitolterol with those of sustained-release theophylline alone and of the combination of bitolterol and theophylline; third, to use 24 hr Holter monitoring to evaluate cardiac toxicity of the three medication regimens. This was a 6 wk double-blind study of regular, daily medication in 36 young non-steroid-dependent and 37 older steroid-dependent stable asthmatic patients.

Multi-center, double-blind, placebo-controlled trial of fluocortin butyl in perennial rhinitis.

Fluocortin butyl (FCB) is a newly synthesized corticosteroid with a high ratio of topical to systemic activity. FCB was studied in a multi-center, double-blind, placebo-controlled trial of therapy of perennial rhinitis. The study was conducted between January and May 1981.

Chord keyboards.

Unlike the standard typewriter keyboard, keying on a chord keyboard is carried out by simultaneous patterned pressing of one or more keys. This results in fewer keys being needed on a chord keyboard when compared with a sequential keyboard, where keys are pressed one at a time. For example, five keys allow a total of 31 (2(5) - 1) different chord combinations to be generated.

Affinity chromatography of amniotic fluid alphafetoprotein using concanavalin A-sepharose.

We measured Concanavalin A (Con A) non-binding alphafetoprotein in amniotic fluid from 21 normal pregnancies and 20 abnormal pregnancies (complicated by anencephaly, spina bifida, or exomphalos) using small Con A-sepharose chromatography columns. There was a highly significant difference between percentage non-binding alphafetoprotein levels for pregnancies with a normal outcome (mean result 32%; range 18-47%) and pregnancies complicated by a neural tube defect or exomphalos (mean 14%; range 7-20%). The test is therefore of potential value in cases where there is uncertainty over the interpretation of total amniotic fluid alphafetoprotein levels.

Determination of the Catterall classification in Legg-Calvé-Perthes disease.

Fifty hips in forty-four children with Legg-Calvé-Perthes disease, treated at the Shriners Hospital for Crippled Children, San Francisco, were evaluated with a simplified method of Catterall's classification. Our data indicate that the Catterall rating changed in 40 per cent of the hips when they were classified before they had reached the fragmentation stage of Waldenström compared with only 6 per cent when they were classified after fragmentation had occurred.

Anaphylaxis to sunflower seed.

The clinical and immunological investigation of three patients with an acute anaphylaxis after ingesting commercial varieties of sunflower seeds is presented. Specific IgE-mediated hypersensitivity has been demonstrated in all three patients to sunflower seed extract by history, direct skin tests, and positive radioallergosorbent test (RAST) titers. RAST inhibition was positive in two patients tested.