Irene L. Hudson

Double-Blind Controlled Trial of Azathioprine in Children With Newly Diagnosed Type I Diabetes

A double-blind controlled trial of azathioprine (2 mg · kg−1 · day−1) was conducted with 49 patients aged 2–20 yr (mean 10.8 yr) who had newly diagnosed type I (insulin-dependent) diabetes. Patients were randomly assigned to receive either azathioprine (n = 24) or placebo (n = 25) for 12 mo, beginning within the 20 day period after diagnosis. Baseline clinical and metabolic characteristics did not differ between the two groups. No patient experienced complete remission, defined as restoration of normal carbohydrate tolerance without other treatment. Partial remission, defined as good metabolic control (hemoglobin A1c ≤7.9%, preprandial blood glucose ≤8 mM with an insulin dose of <0.5 U. kg−1 · day1), occurred in 10 placebo (40%) and 7 azathioprine (29%) patients at 6 mo and in 4 placebo (16%) and 4 azathioprine (17%) patients at 12 mo (differences not significant). Fasting plasma C-peptide was significantly greater in the azathioprine-treated group at 3 and 6 mo, but this difference was not sustained. C-peptide responses to a standard meal and the frequency of islet cell and insulin antibodies did not differ between the two groups over the 12-mo period. Azathioprine caused no significant side effects. We conclude that in the dosage used, and despite early effects on endogenous insulin secretion, azathioprine alone does not influence the remission phase in children with newly diagnosed type I diabetes.

Clinical manifestations of cows’ milk allergy in childhood. II. The diagnostic value of skin tests and RAST

In a study of cows’ milk allergy (CMA) in infancy, 135 consecutive challenges were performed on children with a good clinical history of the disorder. Of these, only half of the patients were shown to have the disease. Highly atopic patients responded rapidly to small volumes of milk with acute urticaria, wheezing, stridor and eczema, whereas patients who were relatively non‐atopic developed symptoms of eczema, bronchitis and wheezing over several hours or days. In a statistical evaluation of the diagnostic value of skin tests and RAST it was shown for the extracts used in this investigation, and for the population studied, all patients with SPT 4 had CMA. The results highlight the potential diagnostic value of SPT in the identification of children with some forms of CMA if standardized cows’ milk allergen extracts can be prepared.

USE OF BENZHEXOL HYDROCHLORDE TO CONTROL DROOLING OF CHILDREN WITH CEREBRAL PALSY

The use of benzhexol hydrochloride to control drooling was evaluated in a group of 20 children with cerebral palsy. Drooling was measured before treatment and then repeatedly until an optimal dosage of benzhexol hydrochloride was attained. 17 of the 20 children showed an improvement in drooling, and side‐effects were minimal. This type of medication appears to be useful in the treatment of drooling.

Factors predicting residual β-cell function in the first year after diagnosis of childhood type 1 diabetes☆

Twenty-five children aged 2-14 years (mean age 8.39 +/- 0.78 years) were studied prospectively during the first year after the diagnosis of type 1 diabetes. Of their clinical and metabolic features at diagnosis, only age showed a significant independent relationship with endogenous C-peptide production during the first year. Age was correlated with higher values for basal and stimulated plasma C-peptide at 7-14 days after diagnosis, at 6 months and at 12 months. At diagnosis, age was also associated with a higher value for HbA1c and a lower prevalence of insulin antibodies. C-peptide production peaked at 3 months and thereafter declined. Mean HbA1c and insulin requirement were both minimal at 6 months. At diagnosis, there were significant inverse relationships between basal C-peptide production and both insulin dose and HbA1c and between stimulated C-peptide production and HbA1c. Basal and stimulated C-peptide production were inversely related to insulin dose at 6 and 12 months. Stimulated C-peptide was higher at 12 months in children retaining islet cell antibodies. These findings confirm the importance of age as a predictor of residual beta-cell function in type 1 diabetes and indicate that older children present clinically following a slower course of beta cell destruction.

Effect of Ipratropium Bromide On Respiratory Mechanics in Infants with Acute Bronchiolitis

The effect of nebulized ipratropium bromide in 14 infants (mean age:20 weeks, range:4–41) with acute respiratory syncytial virus bronchiolitis was examined. A modified rapid chest compression technique was used to obtain partial expiratory flow‐volume curves and maximum flow at functional residual capacity. Passive respiratory mechanics were assessed by brief occlusion at end inspiration. Thoracic gas volume was measured in a body plethysmograph. No significant difference was found in forced and passive respiratory mechanics pre‐ and post‐ipratropium bromide. No subgroups could be identified. These results do not support the use of ipratropium bromide in acute viral bronchiolitis.

Late adolescent outcome of early onset anorexia nervosa

Abstract Forty‐three young female patients admitted consecutively to hospital with anorexia nervosa (AN) were reevaluated in late adolescence an average of 4.3 years following initial presentation. Follow‐up interviews were conducted individually by a paediatrician and a psychiatrist on 32 of the original 43 patients (mean age 18.3 years) with outcome assessed by multidimensional physical, menstrual, eating behaviour, psychosocial and global outcome criteria. Physical outcome, as assessed by validated indices of body adiposity, was within the normal range (3‐97th percentiles) in 94% of the 32 patients seen at follow‐up, although only 56% reported regular cyclical menstrual function. Good physical outcome, however, was not necessarily predictive of successful adjustment in other areas. Eating behaviour was unequivocally normal in only 25% of patients, with a majority still dieting, bingeing or vomiting with meals, Psychosocial adjustment was satisfactory in the majority of cases but varied widely. Univariate and multivariate statistical analysis identified higher premorbid and admission body mass index (BMI) percentiles, a family history of obesity and shorter duration of illness on admission as significant prognostic indicators of favourable physical outcome. Although girls who develop AN in early adolescence are generally thought to have a favourable long‐term prognosis, health professionals need to be aware that these patients form a heterogeneous group and may have considerable ongoing physiologic and psychologic disturbance despite normalization of body mass.

Objective assessment of limb movement in children with cerebral palsy

A preliminary report of a method for assessing the quality of movement in children with cerebral palsy, using an accelerometer, is presented. Able‐bodied and disabled children performed a simple task, and there were marked differences between the two groups. Whilst the technique requires further development, it is hoped that accelerometry may eventually provide an objective tool to enable rigorous testing of various therapeutic procedures in cerebral palsy

Objective test of the quality of motor function of children with cerebral palsy: preliminary study.

An objective test of motor function would enable better evaluation of various treatment programmes for children with cerebral palsy. The use of tri‐axial accelerometry was investigated in 36 children with cerebral palsy and in 53 children without disabilities. Variables discriminated well between able‐bodied and disabled children, and there was a high level of retest reliability. The technique requires further development, but shows promise of providing the ability to gather objective data about the quality of motor function.