British medical bulletin
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British medical bulletin · Jan 1997
ReviewExtra-corporeal membrane oxygenation for paediatric respiratory failure.
Extracorporeal membrane oxygenation (ECMO) uses modified cardiopulmonary bypass technology to provide prolonged respiratory or cardiorespiratory support for patients of all ages who have failed conventional intensive care management. The use of ECMO for neonatal respiratory failure is now evidence-based following the publication of the randomised UK Collaborative Trial. ECMO use in children remains more controversial, but overall survival of 71% is possible in a group of moribund patients whose mean PaO2/FIO2 ratio of 61 mmHg accurately predicts death in studies of conventional ventilation. Common diagnoses for children requiring ECMO support are pneumonia and the acute respiratory distress syndrome (ARDS).
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British medical bulletin · Jan 1997
ReviewLung development and early origins of childhood respiratory illness.
In the last two decades, 5 cohort studies have been initiated to examine the association of infant respiratory function with genetic and environmental risk factors, as well as with subsequent lower respiratory illness in early childhood. While the current complexity of respiratory function tests in this age group precludes study samples with sufficient power to examine more complex issues, information from these studies has provided an exciting adjunct to that available from the longer cohort studies. ⋯ In addition, gender differences in airway function and the response to maternal smoking have been observed. Larger collaborative population-based studies are needed to explore the environmental, genetic and immunological mechanisms responsible, but will depend on the development of less invasive tests of airway function appropriate for use in healthy infants.
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British medical bulletin · Jan 1997
ReviewObesity, non-insulin-dependent diabetes mellitus and the metabolic syndrome.
Obesity is characterised by alterations in metabolic function which result from a combination of increasing total body fatness and the regional distribution of adipose tissue. Abdominal visceral obesity is particularly associated with hyperinsulinaemia, increased portal vein free fatty acid concentration, hepatic gluconeogenesis, altered adrenocortical activity and androgen secretion and reduced plasma sex hormone binding globulin levels. ⋯ In contrast to the considerable knowledge about the biochemical background to these alterations, relatively little is understood about the mechanisms through which an individual's ethnic background influences the changes. This chapter reviews these important issues.