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Papers by Michael L Loren
BMJ, Nov 22, 2003
In vitro fertilisation for all? Fertility treatment may be an economic blessing Editor-Ashcroft i... more In vitro fertilisation for all? Fertility treatment may be an economic blessing Editor-Ashcroft in his editorial and the National Institute for Clinical Excellence in its consultation document avoid the question of how the value of in vitro fertilisation can be measured both in absolute terms and relative to other health spending priorities. 1 2 When we read and hear of children born as the result of in vitro fertilisation we should not think, "There's another £15 000 gone." But rather, "There's another couple whose distress has been relieved and who have the opportunity to experience the love and fulfilment of children; there's another human being who has been given the opportunity to live a life; and, there's another person to pay the taxes for our healthcare and pensions when we retire."
Archives of pediatrics & adolescent medicine, Dec 1, 1976
Sir .—The resident seminar "Differential Diagnosis of Cataracts in Infancy and Children"... more Sir .—The resident seminar "Differential Diagnosis of Cataracts in Infancy and Children" ( Am J Dis Child 130:184, 1976) will be a useful reference. There are a number of points that deserve mention. The review overlooked cataracts associated with atopic dermatitis. 1.2 With the high incidence of atopic dermatitis (3% to 5% of the general pediatric population), this may be an important exclusion. Perhaps a slit-lamp examination should be routinely ordered for the child with chronic, moderate to severe eczema. Finally, corticosteroids are commonly used to treat chronic disorders such as asthma, rheumatoid arthritis, and chronic renal disease. The incidence of cataracts in cortico steroid-treated patients varies from 10% to 38% in reported studies. 3.4 We currently recommend that a slit-lamp examination be performed at least every six months on all patients receiving corticosteroids regularly. This simple examination will complete the comprehensive care of children placed on long-term corticosteroid therapy.
Chest, Mar 1, 1978
Page 1. DOI 10.1378/chest.73.3.438-a 1978;73;438 Chest Melvin A. Welch, Jr. Asthma Intermittent P... more Page 1. DOI 10.1378/chest.73.3.438-a 1978;73;438 Chest Melvin A. Welch, Jr. Asthma Intermittent Positive-Pressure Breathing in ... Breathing in Asthma To the Editor: Loren et al1(9148) have concluded that IPPB did not offer any advantage over simple nebulization in patients ...
The Lancet, Mar 1, 1976
may well prevent the often fatal major secondary lesions. We fully endorse the recommendation of ... more may well prevent the often fatal major secondary lesions. We fully endorse the recommendation of Bateman et al. that rapid surgical drainage and prolonged antibiotic therapy for at least a month is indicated.
PubMed, Apr 1, 1980
A sustained release theophylline preparation, administered on a q8h or q12h schedule, was evaluat... more A sustained release theophylline preparation, administered on a q8h or q12h schedule, was evaluated in 12 severly asthmatic children. Total 24-hour theophylline dosage and peak theophylline levels were significantly higher during the q12h dosage schedule. Trough theophylline levels were similar with the two schedules. Four subjects on the q12h schedule had peak theophylline levels greater than 20 mcg/ml. Pulmonary functions, including FEV1 and MMEF, and the clinical stability of the patients were similar with the two regiments. Other than the higher peak theophylline levels that occurred with the q12h dosing schedule, there were no apparent differences noted between the dosage schedules.
JAMA: The Journal of the American Medical Association, 1980
Recent investigations have demonstrated that exercise-induced asthma (EIA) can be prevented by in... more Recent investigations have demonstrated that exercise-induced asthma (EIA) can be prevented by inspiration of warm, fully humidified air during exercise. We evaluated the success of a surgical face mask, used to retain warm, humidified, expired air, in preventing EIA in ten asthmatic children. subjects underwent six minutes of exercise on a treadmill during two sessions, in one session breathing room air and in another wearing a mask covering the nose and mouth. On the control day, average group forced expiratory volume in 1 s (FEV1) and maximal midexpiratory flow rate (MMEF) decreased from the preexercise baseline value to 66% and 47% of baseline, respectively, at six minutes; on the mask day, FEV1 and MMEF were 91% and 82% of the baseline values (increased in all subjects). A simple face mask may be an inexpensive, nonpharmacologic alternative for alleviation of EIA.
Chest, 1978
The findings in three children with severe asthma are presented. Following intensive round-the-cl... more The findings in three children with severe asthma are presented. Following intensive round-the-clock therapy with theophylline (the dosage of which maintained serum levels of theophylline between lO/ug/ml and 20/¿g/ml) and therapy with prednisone (20 mg twice daily for three weeks or more), there were improvements in spirometrie and body Plethysmographie measurements. Despite this therapy, abnormalities in the forced expiratory volume in one second, the maximal midexpiratory flow, the residual volume, and specific airway conductance remained. These cases represent a subgroup of asthmatic children with reactive airways who have an irreversible component to their disease.
Annals of Emergency Medicine, 1981
gonococcal disease. ESR elevation is variably present. A negative cervical Gram's stain does not ... more gonococcal disease. ESR elevation is variably present. A negative cervical Gram's stain does not exclude gonococcal disease, but can be quite specific if vaginal flora is eliminated and a pure endocervical specimen obtained. When GC is seen, a presumptive diagnosis of GC salpingitis may be made. Culdocentesis recovers turbid fluid and leukocytes in 80% of those with moderate or severe symptoms, but may also be positive in other types of intra-abdominal pathology. When pelvic abscess is suspected, ultrasonography is a highly accurate means of diagnosis. (Editor's note: The high incidence of false positive diagnoses and their nature, namely missed appendicitis and ectopic pregnancy, is of great concern. While laparoscopy will reduce this, it is not practical to laparoscope all patients with non-classic presentations, negative cervical Gram's stains, and negative culdocenteses as indicated.
The Journal of Pediatrics, 1977
Aminophylline bioavailability and the across-time stability of plasma theophylline levels Three g... more Aminophylline bioavailability and the across-time stability of plasma theophylline levels Three generic aminophylline products were examined and found to have equivalent bioavailability. Plasma theophylline levels were found to be reproducible in most patients (intraclass r = O. 7). There were some patients who showed wide swings in plasma theophylline levels without signs of toxicity or clinical deterioration.
The Journal of Pediatrics, 1977
The Journal of Pediatrics, 1979
The Journal of Pediatrics, 1976
BMJ, Nov 22, 2003
In vitro fertilisation for all? Fertility treatment may be an economic blessing Editor-Ashcroft i... more In vitro fertilisation for all? Fertility treatment may be an economic blessing Editor-Ashcroft in his editorial and the National Institute for Clinical Excellence in its consultation document avoid the question of how the value of in vitro fertilisation can be measured both in absolute terms and relative to other health spending priorities. 1 2 When we read and hear of children born as the result of in vitro fertilisation we should not think, "There's another £15 000 gone." But rather, "There's another couple whose distress has been relieved and who have the opportunity to experience the love and fulfilment of children; there's another human being who has been given the opportunity to live a life; and, there's another person to pay the taxes for our healthcare and pensions when we retire."
Archives of pediatrics & adolescent medicine, Dec 1, 1976
Sir .—The resident seminar "Differential Diagnosis of Cataracts in Infancy and Children"... more Sir .—The resident seminar "Differential Diagnosis of Cataracts in Infancy and Children" ( Am J Dis Child 130:184, 1976) will be a useful reference. There are a number of points that deserve mention. The review overlooked cataracts associated with atopic dermatitis. 1.2 With the high incidence of atopic dermatitis (3% to 5% of the general pediatric population), this may be an important exclusion. Perhaps a slit-lamp examination should be routinely ordered for the child with chronic, moderate to severe eczema. Finally, corticosteroids are commonly used to treat chronic disorders such as asthma, rheumatoid arthritis, and chronic renal disease. The incidence of cataracts in cortico steroid-treated patients varies from 10% to 38% in reported studies. 3.4 We currently recommend that a slit-lamp examination be performed at least every six months on all patients receiving corticosteroids regularly. This simple examination will complete the comprehensive care of children placed on long-term corticosteroid therapy.
Chest, Mar 1, 1978
Page 1. DOI 10.1378/chest.73.3.438-a 1978;73;438 Chest Melvin A. Welch, Jr. Asthma Intermittent P... more Page 1. DOI 10.1378/chest.73.3.438-a 1978;73;438 Chest Melvin A. Welch, Jr. Asthma Intermittent Positive-Pressure Breathing in ... Breathing in Asthma To the Editor: Loren et al1(9148) have concluded that IPPB did not offer any advantage over simple nebulization in patients ...
The Lancet, Mar 1, 1976
may well prevent the often fatal major secondary lesions. We fully endorse the recommendation of ... more may well prevent the often fatal major secondary lesions. We fully endorse the recommendation of Bateman et al. that rapid surgical drainage and prolonged antibiotic therapy for at least a month is indicated.
PubMed, Apr 1, 1980
A sustained release theophylline preparation, administered on a q8h or q12h schedule, was evaluat... more A sustained release theophylline preparation, administered on a q8h or q12h schedule, was evaluated in 12 severly asthmatic children. Total 24-hour theophylline dosage and peak theophylline levels were significantly higher during the q12h dosage schedule. Trough theophylline levels were similar with the two schedules. Four subjects on the q12h schedule had peak theophylline levels greater than 20 mcg/ml. Pulmonary functions, including FEV1 and MMEF, and the clinical stability of the patients were similar with the two regiments. Other than the higher peak theophylline levels that occurred with the q12h dosing schedule, there were no apparent differences noted between the dosage schedules.
JAMA: The Journal of the American Medical Association, 1980
Recent investigations have demonstrated that exercise-induced asthma (EIA) can be prevented by in... more Recent investigations have demonstrated that exercise-induced asthma (EIA) can be prevented by inspiration of warm, fully humidified air during exercise. We evaluated the success of a surgical face mask, used to retain warm, humidified, expired air, in preventing EIA in ten asthmatic children. subjects underwent six minutes of exercise on a treadmill during two sessions, in one session breathing room air and in another wearing a mask covering the nose and mouth. On the control day, average group forced expiratory volume in 1 s (FEV1) and maximal midexpiratory flow rate (MMEF) decreased from the preexercise baseline value to 66% and 47% of baseline, respectively, at six minutes; on the mask day, FEV1 and MMEF were 91% and 82% of the baseline values (increased in all subjects). A simple face mask may be an inexpensive, nonpharmacologic alternative for alleviation of EIA.
Chest, 1978
The findings in three children with severe asthma are presented. Following intensive round-the-cl... more The findings in three children with severe asthma are presented. Following intensive round-the-clock therapy with theophylline (the dosage of which maintained serum levels of theophylline between lO/ug/ml and 20/¿g/ml) and therapy with prednisone (20 mg twice daily for three weeks or more), there were improvements in spirometrie and body Plethysmographie measurements. Despite this therapy, abnormalities in the forced expiratory volume in one second, the maximal midexpiratory flow, the residual volume, and specific airway conductance remained. These cases represent a subgroup of asthmatic children with reactive airways who have an irreversible component to their disease.
Annals of Emergency Medicine, 1981
gonococcal disease. ESR elevation is variably present. A negative cervical Gram's stain does not ... more gonococcal disease. ESR elevation is variably present. A negative cervical Gram's stain does not exclude gonococcal disease, but can be quite specific if vaginal flora is eliminated and a pure endocervical specimen obtained. When GC is seen, a presumptive diagnosis of GC salpingitis may be made. Culdocentesis recovers turbid fluid and leukocytes in 80% of those with moderate or severe symptoms, but may also be positive in other types of intra-abdominal pathology. When pelvic abscess is suspected, ultrasonography is a highly accurate means of diagnosis. (Editor's note: The high incidence of false positive diagnoses and their nature, namely missed appendicitis and ectopic pregnancy, is of great concern. While laparoscopy will reduce this, it is not practical to laparoscope all patients with non-classic presentations, negative cervical Gram's stains, and negative culdocenteses as indicated.
The Journal of Pediatrics, 1977
Aminophylline bioavailability and the across-time stability of plasma theophylline levels Three g... more Aminophylline bioavailability and the across-time stability of plasma theophylline levels Three generic aminophylline products were examined and found to have equivalent bioavailability. Plasma theophylline levels were found to be reproducible in most patients (intraclass r = O. 7). There were some patients who showed wide swings in plasma theophylline levels without signs of toxicity or clinical deterioration.
The Journal of Pediatrics, 1977
The Journal of Pediatrics, 1979
The Journal of Pediatrics, 1976