This novel triple regimen produces a cleaner colon than Fleet Phospho-soda, is associated with a trend towards a quicker and more efficient colonic examination, and is also 30% cheaper per patient.
An umbilical catheter fragment embolus in a neonate was difficult to approach due to fixation of both ends, in the left atrial appendage and the ductus venosus, respectively. A tip-deflecting guide wire was used in unique fashion to free the catheter fragment and allow its percutaneous removal via the femoral vein approach.
(Spon. by L.J. Butterfield). The pressure in an infant's airway when CPAP is delivered by nasal prongs has not been previously repor ted. Using air-filled catheters and differential pres sure transducers we have measured simultaneous pressures in nasal prongs (Ppr) and pharynx(Ppx) in 1 8 newborns. After a steady state was achieved, end expi ratory pressure in five consecutive breaths was measured: these were usually identical but otherwise were averaged. The pressure difference (Ppr-PpXsAP) was lo in infants with visual evidence of tight palato-glossal apposition. Though there was much variation, babies whose mouths were a) spontaneously open without tonguelpalate seal had a %AP=48% + 4% (weighted average + SEM), b) spontaneously closed or who had a demonstrable seal had a %AP-8% 2 3%; these are significantly different means (p=<.001). In the latter group there was a close correlation between P p r and Ppx (r-0.965). The ability to maintain a good seal was not related to gestational age, post natal a g e , severity or type of disease. However, babies who maintained a good seal frequently had an active gag reflex (Fisher exact test p=.04). Spontaneous closure o f the mouth usually indicated a good seal but forcible closure di rut r o n q l q t p n t l v A~r r a * c -~m~a m m e r s m l t n H o s p~t a l m e e n hllzabeth osp ta for Children, London. England. . -Godfrey and Mearns have shown that exercise intolerance in children with C.F. is related to airway obstruction. Recently Campbell et a1 suggested that poor nutrition leads to abnormal serum lipids which may lead to tissue hypoxia. Our study investigated the roles of hypoxia, lung mechanics, nutritional status and serum lipids in limiting exercise tolerance. Twenty children with C.F. of varying severity performed two progressive exercise tests on a cycle ergometer, once breathing air, once 02. The body mass percentile,(EMP), as a measure of appropriateness of weight for height, was calculated from the body mass index.Serum lipids, maximal mid-expiratory flow rate (MMT) and maximum voluntary ventilation were measured. In five, end tidal C02 (PETC02) was monitored throughout the test. 0 had very little effect on the work accomplished by each child. '?he mean percent work expected from height (Wmax) was 75 and the heart rate at the final work load was 175/min.,20 less in normal children suggesting adequate car3iovascular reserve at the final work load. Wmax correlated with the MMF,the BMP and the Shwachman score. The children with the lower MMF's had little respiratory reserve at the final work load. Despite this,no child at any time had an elevated PETCO .jerum lipids,while abnormal in every case,did not correlate with ny parameter measured.We conclude that nutritional status and C irway obstruction are closely correlated with exercise tolerance n C.F. and that,unlike the adult with chronic disease,exercise imiting dyspnea occurs with a normal PETC02. Fetal lung maturation is typified by independent increases in both lecithin (TL) and disaturated lecithin (DS...
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