Medication compliance in children with asthma

A questionnaire to assess compliance with prescribed therapy was completed by 200 children with asthma. The validity of the questionnaire was assessed objectively by measuring plasma theophylline concentrations in 37 subjects and by weighing metered dose aerosol canisters before and after use in 19 subjects. The average compliance was 67.9%. The close agreement between answers to the questionnaire and the objective measurements of compliance indicated that most participants recalled the drug regimens accurately. Good compliance was related to whether Australia was the parents' country of origin, to knowledge of the disorder and to comprehension of medication but was not related to perception of the severity of the illness. This study demonstrates that compliance is relatively poor even in a clinic population which attends regularly and appears well-motivated.     

Interpretation of in-vitro thyroid function tests during pregnancy

Summary. In-vitro thyroid function tests are difficult to interpret in pregnancy because of, among other things, the effect of oestrogens on thyroid binding globulin (TBG) concentrations. In an attempt to clarify the position, serum concentrations of total thyroxine (T₄), free T₄, TBG, T₄/TBG ratio, tri-iodothyronine (T₃) and thyroid stimulating hormone (TSH) were measured. Total T₄ and TBG concentrations rose to above the non-pregnant reference range by 20 weeks. The T₄/TBG ratio fell to hypo-thyroid values by 20 weeks but although the free T₄ level was lower in the third trimester compared with values in the first and second trimesters, only a few subjects had hypothyroid values. The TSH values remained unchanged throughout pregnancy. The significance of these changes is discussed and reference ranges for these hormones at each trimester are provided.     

The management of acute abdominal pain in children

Objective : Acute abdominal pain is a common problem in childhood, and appendicitis is frequently diagnosed by general practitioners and doctors working in emergency departments. The objective of the present report was to determine the frequency of appendicitis in a group of children with acute abdominal pain presenting to the emergency department of a general hospital, as well as attempting to analyse the manner in which these patients were managed.
Methodology : The initial assessment in hospital (by resident hospital staff) of the study group of patients was analysed and their subsequent clinical progress documented.
Results : The present report shows that the vast majority of children with acute abdominal pain do not have appendicitis and that appendicitis is significantly over-diagnosed by junior hospital doctors.
Conclusions : Appendicitis is a clinical diagnosis, best made by an experienced member of the paediatric surgical team. Frequent review, with a minimum of investigations, provides the best means of making a rational decision regarding surgery.     

Feeding problems in young PKU children

Behavioural feeding problems were found to be more prevalent in a group of 15 PKU children aged 1-5 years when compared to non-PKU controls. The parents of PKU children identified poorer appetites ( p < 0.01), a more limited range of foods consumed ( p < 0.03) and more gastrointestinal symptoms such as vomiting and constipation ( p < 0.03) than control children. The children were slower to feed ( p < 0.03), were more likely to dislike sweet foods and some ate separately from the rest of the family at mealtime ( p < 0.03). The effects on normal feeding behaviour should be considered when advocating strict diet therapy for young PKU children.     

Neurophysiological abnormalities in genuine female stress urinary incontinence

Summary. Perineal sensory and motor function was investigated in 28 women with genuine stress incontinence of urine and compared with a matched control group. Electrosensitivity of the dorsal nerve of the clitoris and of the urethral mucosa was significantly diminished in these patients (eight measurements 'insensitive'). Three different reflex latency measurements (dorsal nerve to external anal sphincter, dorsal nerve to urethral sphincter, urethral mucosa to external anal sphincter) were prolonged in incontinence (14 absent reflexes). Mean motor unit potential duration of the external anal sphincter was also prolonged, reflecting an early neuropathy. Anorectal manometry detected significantly weaker squeeze pressures in stress incontinence although other variables were unaffected.