Inhaled salbutamol for wheezy infants: a randomised controlled trial.

Background: Salbutamol is frequently used as a bronchodilator for infants who wheeze. Many single dose studies have questioned its effectiveness.

Aims: To investigate the response of wheezy infants to salbutamol over an extended time period in order to elucidate either symptomatic relief or a protective effect.

Imperforate anus, Hirschsprung's disease, and trisomy 21: a rare combination.

Three well known pediatric problems, Hirschsprung's disease, anorectal anomaly, and trisomy 21, are presented in the same patient. The authors describe the problems encountered in making the final diagnosis and suggest management options when faced with this unusual situation.

The difficult orchidopexy: the value of the abdominal pre-peritoneal approach.

Objective: To analyse the outcome of using the abdominal pre-peritoneal (APP) approach to orchidopexy.

Patients And Methods: During an 8-year period, the experience of one surgeon in the management of 553 boys (median age 4.5 years, range 1-13) with undescended testes (596 testes) was assessed.

Prednisolone in acute childhood asthma: clinical responses to three dosages.

Ninety-eight children aged 1-15 years entered a randomized double-blind study investigating an appropriate dose of oral prednisolone in children admitted to hospital with an acute exacerbation of asthma. None of the children had recently been treated with oral prednisolone. Following admission, the children were randomized to receive prednisolone 0.

Early phase wound healing by primary intention as shown by ultrasonography.

We present a series of high-resolution ultrasound images obtained during healing in children of appendicectomy wounds by primary intention. These show that the incision can easily be identified for several months after surgery although skin swelling subsides rapidly. Fluid collections and gas are not usually seen in uncomplicated appendicectomy wounds, whereas some degree of oedema and exudation can be expected in the first few days post-operatively and suture material can be identified for six to eight weeks.

The effect of wound dressings on diagnostic ultrasound imaging.

A study was carried out to determine the effect of wound and fixation dressings on diagnostic ultrasound imaging. Each dressing was scanned with four ultrasound probes at two focal depth settings and the results were independently rated by five observers on a scale of 0-5. Data were analysed using the Chi-squared test and Pearson's correlation coefficient for inter-observer rating.

Safety and efficacy of calcipotriol ointment (Dovonex) in treating children with psoriasis vulgaris.

Calcipotriol (Dovonex) ointment has been shown to be an effective, well tolerated, and acceptable treatment for psoriasis vulgaris in adults. This open study was conducted in 16 U.K.

Efficacy and safety of salmeterol in childhood asthma.

Unlabelled: In children with asthma, twice daily administration of salmeterol 25 micrograms, salmeterol 50 micrograms and salbutamol 200 micrograms were compared in two, 3-month, double-blind, parallel group studies, one using metered dose inhalers (MDIs), the other using dry powder inhalers (Diskhaler, DPIs). Both studies were continued for a further 9 months during which time exacerbation rates, lung function at the clinic and adverse events were monitored. Similarities in design and methodology of the two studies justified a combined analysis.

Pilgrim's progress: the effect of salmeterol in older children with chronic severe asthma.

Twenty-four children aged 12-17 years entered a randomized, double-blind placebo-controlled study investigating the use of salmeterol in chronic severe asthma. In addition to their usual medication, the children were given either placebo or 100 micrograms salmeterol b.d.

Renal tubular leakage complicating microcephalic osteodysplastic primordial dwarfism.

We describe a male infant with phenotypic and radiological features of microcephalic osteodysplastic primordial dwarfism type I/III. He showed severe osteoporosis and biochemical derangement owing to renal tubular leakage, which has not previously been reported in this condition. He died aged 5 months.

Prednisolone and salbutamol in the hospital treatment of acute asthma.

The use of oral prednisolone (2 mg/kg) to treat children admitted to hospital with acute asthma was assessed in a placebo controlled study. Children were further randomised to receive either 0.15 mg/kg salbutamol every 30 minutes for the first three hours of admission, or 5 mg salbutamol every one to four hours as needed.

Late pulmonary scintigraphic defects after uneventful recovery from simple focal pneumonia of childhood.

We present a pilot study designed to determine whether pneumonia in children accompanied by focal consolidation on the chest radiograph (CXR) is associated with late abnormality as detected by radionuclide lung scintigraphy. 14 children with focal pneumonia were assessed 1 year after initial presentation. In 12 both krypton-81m ventilation and technetium-99m MAA perfusion studies were performed, while in two only perfusion studies were obtained.

Use of budesonide in severe asthmatics aged 1-3 years.

The treatment of severe asthmatics aged 1-3 years with budesonide administered via Nebuhaler and Laerdal facemask was assessed in a six month, double blind, placebo controlled study. Patients were randomised to budesonide (n = 20) or placebo (n = 20) treatment. Daily symptom scores were recorded by parents and clinic visits occurred every six weeks.

Audit strategies to reduce hospital admissions for acute asthma.

An eightfold rise in hospital admissions for acute asthma from 1971-85 prompted two studies to audit the admissions policy at the Royal Alexandra Hospital. In the first study the on call senior house officer (SHO) was replaced by an experienced registrar and over a four month period 53 children out of 158 were sent home from the receiving room compared with six out of 39 seen by the SHOs. In the second study an SHO training programme was established together with a home treatment package.

Use of pulse oximetry in the hospital management of acute asthma in childhood.

Oxyhemoglobin saturation values were recorded before and 10 minutes after 5 mg of nebulized salbutamol in 75 children (age, 1.5-14.6 years) admitted to hospital with acute asthma.

Prolonged hypoxaemia after nebulised salbutamol.

Pulse oximetry is increasingly used to assess hypoxaemia in respiratory illnesses. Six children presenting with acute asthma and prolonged falls in oxygen saturation values after treatment with salbutamol are described who were subsequently shown to have pneumonic consolidation on chest radiography.

Prevention of viral induced asthma attacks using inhaled budesonide.

Thirty two preschool children were entered into a double blind, placebo controlled study using intermittent budesonide to treat viral induced wheeze. Active treatment was either 800 micrograms twice a day via a spacer or 1600 micrograms twice a day via a spacer and facemask in those children too young to use a mouthpiece. Treatment was started at the onset of an upper respiratory tract infection and continued for seven days or until symptoms had resolved for 24 hours.

Management of asthma in pre-school children.

The management of asthma in pre-school children often presents physicians with challenging problems. This article addresses the diagnostic criteria by which the diagnosis may be made, discusses the prognosis of untreated asthma and states the principles underlying the treatment of asthma in this age group. The management according to a stepwise protocol is discussed with reference both to maintenance therapy, and the treatment of acute severe asthma.

Early thrombocytopenia in HIV infection.

Three children aged between 7 months and 2 years developed thrombocytopenia as an early feature of HIV infection. The prevalence of this condition, possible pathogenesis, and options for treatment are discussed. HIV testing should be considered in the investigation of a child with thrombocytopenia.

Dipylidium caninum in an infant.

The tapeworm, Dipylidium caninum, occurs worldwide in dogs and cats. It may occur rarely in children, when the infection may be unrecognised or misdiagnosed. We report such a case.

Initial investigation of childhood urinary tract infection: does the plain abdominal X ray still have a role?

To reassess the plain abdominal X ray (AXR) in the initial investigation of childhood urinary tract infection, radiologists from four paediatric units prospectively collected data on the yield from the AXR in 683 children. Five children had renal calculi. All were detected on ultrasound, but one was not visible on the initial AXR.

Renal sonography in long standing Lesch-Nyhan syndrome.

The Lesch-Nyhan syndrome is an x-linked defect of purine metabolism resulting in its classical form in major neurodevelopmental abnormality, hyperuricaemia, and hyperuricosuria. Uric acid calculi and crystalluria are common. Allopurinol is the main method of reducing serum and urinary uric acid levels, but results in xanthinuria and oxypurinoluria, both of which may cause crystal nephropathy and calculi.

Perianal appearances associated with constipation.

The perianal appearances were studied prospectively of 136 constipated children (mean age 3.9 years, 67 boys, 69 girls). Anal dilatation, fissures, tags, warts, perianal oedema, redness, blueness, and veins were recorded.