The effects of erythromycin on theophylline elimination in normal males.

The effects of three erythromycin preparations on theophylline elimination kinetics were examined in 23 male subjects. Subjects received 6 mg/kg of the theophylline elixir orally and elimination kinetics were determined. The population was then randomized to receive either a lactose placebo, erythromycin base, erythromycin stearate, or erythromycin ethylsuccinate. Each 250-mg preparation was given four times a day for six days. On day seven, a repeat kinetic study was performed. The mean theophylline half-life of controls was 7.8 +/- 2.6 hours. The half-life increased significantly in all erythromycin treatment groups. The increase for the base, stearate, and ethylsuccinate groups was 51.7, 21.3, and 60.3 per cent, respectively. The total body theophylline clearance decreased significantly in all treatment groups. This was not associated with biochemical evidence of hepatitis. Three of four smokers who received erythromycin manifested no increase in theophylline half-life, in contrast to one of 13 nonsmokers. There was no difference in the percentage theophylline bound to serum protein for any of the erythromycin treatment groups or controls as determined by ultracentrifugation.

Granting authority to a new policy. A community benefit services policy becomes part of the general business strategy.

Bon Secours Health System's new strategic plan and community benefit services policy integrates the planning, budgeting, evaluating, and reporting of community benefit services into management processes at the same level of authority as other operational activities. The strategic plan of Bon Secours Health System, headquartered in Marriottsville, MD, documents the system's mission, operating principles, vision, and five goals, one of which is to improve the communities' health status. The community benefit services operating policy requires that the Bon Secours Health System chief executive officer (CEO) and each local system CEO and nursing home administrator form a multidisciplinary local work group to be responsible for community benefit services. Each local work group assesses the needs of its community within the framework of the annual planning process. Determining what services are needed and how to deliver them is relatively easy. The difficult task is determining which of the many needs to address. What a community lacks may be the result of poor or inadequate public policy. For example, its priority may not be healthcare. In these situations healthcare providers may be best able to serve the community by providing indirect support to social service providers or by advocating for change. The community benefit services operating policy provides a standard approach to match the community's priority needs with the institution's resources and produce a measurable improvement in health status.

Impact of short-term oral steroid use upon children's school achievement and behavior.

Physicians need clarification of whether the temporary use of adrenal corticosteroids to abort acute asthma can adversely effect school achievement and behavior problems. Nineteen nonsteroid-dependent asthmatic children were given prednisone orally while all other medications were kept constant. Five days later, when they were seen in the physician's office, an academic achievement test was administered to the child; and the child, a parent, and a teacher completed behavior rating surveys. After 2 weeks off the steroids the child returned to the physician's office and the achievement test and rating scales were completed again. There was no significant difference between the achievement test scores and behavior ratings in school or at home under the two conditions. Short-term use of oral steroids does not impair children's basic academic skills nor their behavior at school or home.

C1 esterase inhibitor deficiency: three presentations.

We have presented three patients representing three of the four reported forms of C1 esterase inhibitor deficiency. The C1INH deficiencies are in general distinguishable from each other and from other forms of angioedema by their complement patterns. The acquired C1INH deficiency must be part of the differential in patients without a family history of angioedema since it may precede the diagnosis of more serious medical conditions such as lymphoproliferative disorders.

Theophylline half-life in infants and young children.

Pharmacokinetics of theophylline elimination were studied in a 54-child population. Subjects' ages ranged from three months to six years. The mean half life was 4.92 hours, with S.D. +/- 1.88 hours. This is at variance with previous reports. Ages and half lives were compared and there were no correlations in this young age group.

The relationship of allergies and allergy treatment to school performance and student behavior.

The purposes of this project were to study the relationship of allergies and allergy treatment to school behavior. Parents of allergic and nonallergic children (grades K-12 and from different socioeconomic status) completed a survey form. The 400 parent respondents reported no significant difference between allergic and nonallergic children in terms of academic and language performance, retention, diagnosis as handicapped, or behavior problems; allergic children were absent from school more. Eustachian tube dysfunctions were significantly related to academic and behavior problems. Certain medications were related to overactive types of behavior. Parents who considered their children's behavior as inappropriate tended to contribute a portion of it to side effects of medication. 65% of the parents reported positive results from treatment on behavior at home; they tended to be unsure of the impact on school behavior. Direct relationship of allergy and allergy treatment on academic performance is questionable, except for the impact of upper respiratory problems on listening and attention. Use of certain medications with already behavior disordered children requires caution. Better communication among physicians, teachers and parents is advised.

Non-compliance in asthmatic children: a study of theophylline levels in a pediatric emergency room population.

Sub-therapeutic theophylline levels due to patient (parent) non-compliance is a significant cause of outpatient treatment failure in childhood asthma. In a study of 50 known asthmatic children with acute asthmatic episodes, 98% had sub-therapeutic theophylline levels less than 10 mcg/ml with 75.5% due to inadequate patient (parent) compliance.

Radiographic imaging studies in pediatric chronic sinusitis.

BACKGROUND: The diagnosis of chronic sinusitis is dependent on the radiographic evidence of sinus disease. METHODS: We evaluated the performance of radiographs and computed tomographic (CT) scans for the examination of the paranasal sinuses of 91 patients of both sexes, ranging in age from 2 to 17 years, who had chronic upper respiratory tract symptoms for at least 3 months. The CT scan findings were categorized as no disease; minimal disease, and mild, moderate, and severe sinusitis. RESULTS: Fifty-eight patients (63%) had chronic sinusitis: CT scan abnormalities were minimal in 17%, mild in 19%, moderate in 21%, and severe in 43%. There was a statistically significant correlation between rhinorrhea (r = 0.25, p = 0.01), cough (r = 0.27, p = 0.009), and the severity of sinus abnormality as determined by CT scan. Clinical presentation in the mild, moderate, and severe sinusitis groups (p < 0.05) was significantly different from that of the no disease group, whereas the minimal disease group had subclinical presentation (p = 0.11). Clinically significant chronic sinusitis often occurred at multiple sites: 44% of patients had pansinusitis, 50% had disease involvement of at least two sinuses, and 6% had disease in a single sinus. When sinus radiographs were compared with CT scans (n = 70 cases), radiographs could not identify minimal disease. For clinically significant sinusitis, sinus radiographs detected disease in 1 of 5 (20%) frontal sinuses, 0 of 12 (0%) sphenoidal sinuses, and 17 of 31 (54%) ethmoidal sinuses. With the minimal criteria of 40% to 50% opacification or fluid level filling of the maxillary antrum, radiographs detected disease in 37 of 49 (75%) cases. The sensitivity and specificity for a Waters view to confirm clinically significant chronic sinusitis without specifying the sites and severity were acceptable at 76% and 81%, respectively. When limited sinus CT scans were compared with full CT evaluation (n = 49 cases), limited studies detected 5 of 5 (100%) frontal, 9 of 11 (82%) sphenoidal, 14 of 19 (73%) ethmoidal, and 39 of 40 (97%) cases of maxillary sinusitis. The overall agreement was 88%. CONCLUSIONS: A single Waters view is an acceptable part of the initial evaluation of pediatric chronic sinusitis; however, a limited CT scan is a better alternative.

Cockroach allergy in Kentucky: a comparison of inner city, suburban, and rural small town populations.

The cockroach has been reported as a major allergen in inner city asthmatic patients. The retrospective chart review of 799 patients tested over a 10-year period (1981-1991) derived from a private allergy practice and a university allergy clinic is reported. Patients from both groups were divided geographically by home zip codes into inner city, suburban, or rural small town populations. Criteria for positive skin tests were wheal greater than 5 mm for prick and greater than 10 mm for intradermal tests with flare. Overall, 36.9% (295/799) of all patients surveyed were positive by either prick or intradermal skin testing. Cockroach reactivity was observed in 38.6% (95/246) of the private patients tested with 36.2% (200/553) of the university patients showing positive results. The inner city populations in both groups of patients were similar with 43.7% and 40.3% of the private and university patients, respectively, testing positive, with an overall positivity of 41% for all inner city patients. Inner city and rural small town populations for both study groups demonstrated almost identical reactivity with 41% and 43% overall positivity, respectively. Of the suburban group, 37.5% of the private patients and 28.8% of the university patients had reactive skin tests results with an overall rate of positivity of 30.1%. This rate (30.1%) is significantly less than the rate for either inner city (41.0%, P < .05) or rural small town (43.6%, P < .01) populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics and taste acceptance of an alcohol-free oxtriphylline solution.

As follow-up to earlier studies done on the pharmacokinetics of theophylline preparations in young children, an alcohol-free oxtriphylline syrup preparation was studied. Oxtriphylline syrup demonstrated no appreciable change in the pharmacokinetic parameter of half-life in this young age group. Therapeutic dose relationship were studied in conjunction with trough level measurements. Patient acceptance of this preparation is judged to be excellent.

Chronic sinusitis among pediatric patients with chronic respiratory complaints.

We examined the prevalence of chronic sinusitis among children who presented to allergy clinics with chronic (> or = 3 months) respiratory symptoms. Ninety-one patients, ranging from 2 to 17 years of age with 62% male and 72% white, completed the study. Fifty-nine percent of patients had positive skin test results, and 25.3% had chronic asthma. Paranasal sinuses were examined by coronal sinus computed tomographic scan. Sixty-three percent (58 to 91) had chronic sinusitis, 5.5% (5 of 91) had concha bullosa, 1% (1 of 91) had foreign body, and 19% (19 of 91) had deviated nasal septums. Among symptoms of sneezing, nasal congestion, postnasal drip, coughing, wheezing, rhinorrhea, and headache, no single symptom was an acceptable predictor of abnormality on computed tomographic scan examinations. Combining the symptoms of moderate to severe rhinorrhea and cough with minimum sneezing had a specificity of 95% and a sensitivity of 38% in predicting the presence of chronic sinusitis. Allergic rhinitis (p = 0.27), mild deviated nasal septum (p = 0.11), unobstructive concha bullosa (p = 0.13), and passive exposure to cigarette smoke (p = 0.53) were not risk factors associated with sinus abnormalities. Age (r = 0.30, p = 0.004) in pediatric patients with chronic respiratory symptoms was the single risk factor significantly associated with abnormalities on sinus computed tomographic scan. Seventy-three percent of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 had chronic sinusitis.(ABSTRACT TRUNCATED AT 250 WORDS)