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Powell MR, Kim UO, Weisgerber MC, Simpson PM, Nugent M, Basir MA. Readiness of obstetric professionals to inform parents regarding potential outcome of premature infants. J OBSTET GYNAECOL 2012; 32:326-31. [DOI: 10.3109/01443615.2012.656743] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Simpson PM, Bendall JC. Prehospital non-invasive ventilation for acute cardiogenic pulmonary oedema: an evidence-based review. Emerg Med J 2010; 28:609-12. [DOI: 10.1136/emj.2010.092296] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jenkins PJ, Teoh K, Simpson PM, Dave J, Simpson AHWR, Breusch S. Clostridium difficile in patients undergoing primary hip and knee replacement. ACTA ACUST UNITED AC 2010; 92:994-8. [PMID: 20595121 DOI: 10.1302/0301-620x.92b7.23412] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antibiotic prophylaxis is routinely administered during joint replacement surgery and may predispose patients to Clostridium difficile-associated disease (CDAD). The primary aim of this study was to determine the incidence of this following joint replacement, using a cefuroxime-based regimen. Patients developing CDAD were compared with a control group of patients without CDAD. The incidence of the former was 1.7 per 1000 primary joint replacements. Those patients prescribed additional antibiotics had a higher incidence of CDAD (p = 0.047), but there was no difference between the two groups in relation to the use of gastroprotective agents (p = 0.703). A trial of a new prophylaxis regimen would require 43 198 patients in each arm to show a reduction of one case per 1000 procedures. Cefuroxime-based antibiotic prophylaxis is safe in patients undergoing primary elective joint replacement.
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Affiliation(s)
- P J Jenkins
- Department of Orthopaedic, Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SU, UK.
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McGee BB, Simpson PM, Gossett JM, Johnson GS, Thornton A, Richardson V, Johnson C, Bogle ML. Food choices, health behavior, and risk factors for hypertension and diabetes among Lower Mississippi Delta Residents. FASEB J 2007. [DOI: 10.1096/fasebj.21.6.a1051-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - P. M. Simpson
- Arkansas Children’s Hospital Research Institute1120 Marshall St., Slot 512‐43Little RockAR72202
| | - J. M. Gossett
- Arkansas Children’s Hospital Research Institute1120 Marshall St., Slot 512‐43Little RockAR72202
| | - G. S. Johnson
- Southern University and A & M CollegeE. C. Harrison DriveBaton RougeLA70813
| | - A. Thornton
- Southern University and A & M CollegeE. C. Harrison DriveBaton RougeLA70813
| | - V. Richardson
- Southern University and A & M CollegeE. C. Harrison DriveBaton RougeLA70813
| | - C. Johnson
- Southern University and A & M CollegeE. C. Harrison DriveBaton RougeLA70813
| | - M. L. Bogle
- USDA, ARS, SPA, Delta NIRI900 S. Shackleford Road, Suite 509Little RockAR72211
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Wheeler JG, Fair M, Simpson PM, Rowlands LA, Aitken ME, Jacobs RF. Impact of a waiting room videotape message on parent attitudes toward pediatric antibiotic use. Pediatrics 2001; 108:591-6. [PMID: 11533323 DOI: 10.1542/peds.108.3.591] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To reduce the injudicious use of antibiotics, we developed an educational strategy that focused on parents of pediatric patients and their physicians. METHODS This intervention was conducted in 5 pediatric practices in Arkansas during a 9-month period. Baseline data on parent attitudes about antibiotics and physician practice habits were measured by questionnaire. During the following 36 weeks, an educational videotape about the judicious use of antibiotics was played in waiting rooms. The videotape on antibiotics used a standard script based on the recommendations of the American Academy of Pediatrics. The physicians and staff at each site were actors in the videotape. During week 2 and week 36 of videotape use, parent attitudes were measured again. After the baseline week, the physicians and staff in each site were provided a standard in-service review of the American Academy of Pediatrics recommendations for judicious use of antibiotics. A study nurse recruited patients, administered questionnaires, and reviewed charts on-site. RESULTS Parents who were exposed to the videotape were significantly less inclined to seek antibiotics for viral infections. Passively provided pamphlets were not read. No significant change in antibiotic prescribing by physicians was seen. CONCLUSION Parent-focused passive education tools are effective at changing parent attitudes toward the use of antibiotics. Although physicians have blamed parent attitudes and demands for the overuse of antibiotics, changes in parent attitudes in this study were not associated with changes in prescribing rates. Changes in parent attitudes may be necessary but do not seem sufficient for changes in antimicrobial prescribing patterns.
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Affiliation(s)
- J G Wheeler
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA.
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James LP, Farrar HC, Darville TL, Sullivan JE, Givens TG, Kearns GL, Wasserman GS, Simpson PM, Hinson JA. Elevation of serum interleukin 8 levels in acetaminophen overdose in children and adolescents. Clin Pharmacol Ther 2001; 70:280-6. [PMID: 11557916 DOI: 10.1067/mcp.2001.118243] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Elevations of inflammatory cytokines have been reported in animal models of acetaminophen (INN, paracetamol) toxicity. In addition, interleukin 8, a chemokine, has been found to be elevated in toxin-associated hepatic disease (ie, acute alcoholic hepatitis). The purpose of this study was to measure serum cytokine levels in children and adolescents with acetaminophen overdose and to evaluate relationships between cytokine elevation and hepatotoxicity. METHODS Serum levels of tumor necrosis factor alpha, interleukin 1beta, interleukin 6, interleukin 8, and interleukin 10 were measured by ELISA in children and adolescents (n = 35) with acetaminophen overdose. Peak cytokine levels were examined relative to biochemical evidence of hepatocellular injury, nomogram risk assessment, and prothrombin time. RESULTS Five patients had aspartate aminotransferase or alanine aminotransferase levels >1000 IU/L, and 4 patients had aspartate aminotransferase or alanine aminotransferase levels > or =100 IU/L and < or =1000 IU/L. No elevations of tumor necrosis factor alpha or interleukin 1beta were detected. Peak interleukin 8, but not interleukin 6 or interleukin 10, correlated with hepatotoxicity (Mann-Whitney exact test, P <.001). The peak interleukin 8 level was greater in patients at high risk by the nomogram combined with those presenting at >15 hours, as compared with other patients (Mann-Whitney U test, P <.01). The interleukin 8 level peaked before aspartate aminotransferase or alanine aminotransferase in 5 of the 9 patients with hepatotoxicity. In addition, interleukin 8 concentrations of >20 pg/mL were associated with peak prothrombin time values (Mann-Whitney exact test, P <.015). CONCLUSIONS Interleukin 8 elevation in patients with acetaminophen hepatotoxicity corresponds with other common clinical measures that are predictive of hepatocellular injury. Further study is warranted to evaluate possible mechanistic relationships between inflammatory cytokines and acetaminophen hepatotoxicity in children and adults.
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Affiliation(s)
- L P James
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock 72202, USA.
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7
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O'Neill JM, Schutze GE, Heulitt MJ, Simpson PM, Taylor BJ. Nosocomial infections during extracorporeal membrane oxygenation. Intensive Care Med 2001; 27:1247-53. [PMID: 11511935 DOI: 10.1007/s001340101029] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2000] [Accepted: 05/07/2001] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine trends in nosocomial infection associated with Extracorporeal Membrane Oxygenation (ECMO). DESIGN Retrospective review of all patients who underwent ECMO over a 4-year period at our institution; specifically, examining reasons for placement and duration of time on ECMO, as well as nosocomial infections incurred while on or shortly after discontinuation of support. Infections were considered ECMO-related if the organism was recovered on support or within 7 days from decannulation. Analyses were performed utilizing Pearson's chi-square for dichotomous factors and t-tests for continuous factors. RESULTS Of 141 patients requiring ECMO support, 90 (64%) survived to hospital discharge. Indication for support included circulatory failure (53%) and non-cardiac (47%). Twenty-six percent of patients developed infections on ECMO. Organisms isolated included: bacterial 20 (54%), fungal 10 (27%), mixed five (14%) and viral two (5%). Infection sites included: blood 13 (35%), urine nine (24%), mixed eight (22%), wound five (14%) and lung two (5%). Seventy-eight percent of infections noted occurred in cardiac patients. Patients with nosocomial infections were supported for a median of 169 h (range, 84-936 h), versus those without nosocomial infection [146 h (range, 50-886 h); P<0.001]. Procedures on ECMO were associated with an increased risk of infection (P<0.001) as was the presence of an open chest (P<0.025). CONCLUSIONS The incidence of infection in ECMO patients at our institution has not increased significantly since our previous study. Cardiac patients have increased risk for nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest.
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Affiliation(s)
- J M O'Neill
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, Arkansas 72202-3591, USA. O'
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James LP, Wilson JT, Simar R, Farrar HC, Kearns GL, Simpson PM, Hinson JA, Pumford NR. Evaluation of occult acetaminophen hepatotoxicity in hospitalized children receiving acetaminophen. Pediatric Pharmacology Research Unit Network. Clin Pediatr (Phila) 2001; 40:243-8. [PMID: 11388672 DOI: 10.1177/000992280104000501] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The safety of repeated doses of acetaminophen in ill children with the potential of reduced glutathione stores has been questioned. This study measured hepatic transaminases in children and adolescents (n=100) who received > or = 6 therapeutic doses of acetaminophen over a 48-hour period of hospitalization. Acetaminophen-protein adducts were measured in a cohort of subjects with hepatic transaminase elevation (n=8) and in those (n=10) receiving concurrent drug therapy with agents that induce the cytochrome P450 enzymes involved in acetaminophen metabolism. Acetaminophen-protein adducts were not detected in this cohort of 18 subjects. Based on this pilot study, the routine use of acetaminophen at therapeutic doses in ill, hospitalized children and adolescents appears safe.
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Affiliation(s)
- L P James
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock 72202, USA
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Bhutta AT, Rovnaghi C, Simpson PM, Gossett JM, Scalzo FM, Anand KJ. Interactions of inflammatory pain and morphine in infant rats: long-term behavioral effects. Physiol Behav 2001; 73:51-8. [PMID: 11399294 DOI: 10.1016/s0031-9384(01)00432-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neonatal rat pups exposed to repetitive acute pain show decreases in pain threshold and altered behavior during adulthood. A model using prolonged inflammatory pain in neonatal rats may have greater clinical relevance for investigating the long-term behavioral effects of neonatal pain in ex-preterm neonates. Neonatal rat pups were exposed to repeated formalin injections on postnatal (P) days 1-7 (P1-P7), with or without morphine pretreatment, and were compared with untreated controls. Behavioral testing during adulthood assessed pain thresholds using hot-plate (HP) and tail-flick (TF) tests, alcohol preference, and locomotor activity (baseline and postamphetamine). Adult rats exposed to neonatal inflammatory pain exhibited longer HP latencies than controls and male rats had longer HP thresholds compared to females. Male rats exposed to neonatal morphine alone exhibited longer TF latencies than controls. Both neonatal morphine treatment and neonatal inflammatory pain decreased ethanol preference, but their effects were not additive. During adulthood, male rats exposed to neonatal inflammatory pain exhibited less locomotor activity than untreated controls. We conclude that neonatal formalin and morphine treatment have specific patterns of long-term behavioral effects in adulthood, some of which are attenuated when the two treatments are combined.
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Affiliation(s)
- A T Bhutta
- University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA
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10
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Abstract
OBJECTIVE This study was undertaken to examine variation in therapies and outcome for pediatric head trauma patients by patient characteristics and by pediatric intensive care unit. Specifically, the study was designed to examine severity of illness on admission to the pediatric intensive care unit, the therapies used during the pediatric intensive care unit stay, and patient outcomes. DATA SOURCES AND SETTING Consecutive admissions from three pediatric intensive care units were recorded prospectively (n = 5,749). For this study, all patients with an admitting diagnosis of head trauma were included (n = 477). Data collection occurred during an 18-month period beginning in June 1996. All of the pediatric intensive care units were located in children's hospitals, had residency and fellowship training programs, and were headed by a pediatric intensivist. METHODS Admission severity was measured as the worst recorded physiological derangement during the period <or=6 hrs before pediatric intensive care unit admission. Therapies and resource use were based on the Therapeutic Intervention Scoring System with adaptations for pediatrics. The use of intracranial pressure monitoring was recorded on admission to the unit (within 1 hr) and at any time during the pediatric intensive care unit stay. Outcomes were measured at the time of pediatric intensive care unit discharge by the Pediatric Overall Performance Category scale. Risk factors for mortality were examined by using bivariate analyses with significant predictors as candidate variables in a logistic regression to predict expected mortality. Intracranial pressure monitoring and other therapies were added to the mortality prediction model to test for protective effects. Finally, race and insurance status were added to the model to test for differences in the quality of care. RESULTS The overall mortality rate for the entire sample was 7.8%. Mortality rates for children <or=1 yr old were significantly higher than for children >1 yr old (16.1% vs. 6.1%; p = .002). Comparisons by insurance status indicated that observed mortality rates were highest for self-paying patients. However, patient characteristics were not associated with use of therapies or standardized mortality rates after adjustment for patient severity. There was significant variation in the use of paralytic agents, seizure medications, induced hypothermia, and intracranial pressure monitoring on admission across the three pediatric intensive care units. In multivariate models, only the use of seizure medications was associated significantly with reduced mortality risk (odds ratio = 0.17; 95% confidence interval = 0.04-0.70; p = .014). CONCLUSIONS Therapies and outcomes vary across pediatric intensive care units that care for children with head injuries. Increased use of seizure medications may be warranted based on data from this observational study. Large randomized controlled trials of seizure prophylaxis in children with head injury have not been conducted and are needed to confirm the findings presented here.
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Affiliation(s)
- J M Tilford
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202-3591, USA
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11
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Affiliation(s)
- P M Simpson
- Department of Pediatrics, University of Arkansas, Little Rock, Arkansas, USA
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James LP, Abel K, Wilkinson J, Simpson PM, Nichols MH. Phenothiazine, butyrophenone, and other psychotropic medication poisonings in children and adolescents. J Toxicol Clin Toxicol 2001; 38:615-23. [PMID: 11185968 DOI: 10.1081/clt-100102010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the presentation, epidemiology, management, and outcome of phenothiazine and butyrophenone ingestions in children requiring hospitalization. METHOD Retrospective case series in two pediatric hospitals. RESULTS Eighty-six cases were identified among 83 patients. The majority (69.7%) of ingestions occurred in children <6 years of age and there was no gender predominance. These ingestions were more common in African Americans (65.1%). They occurred more commonly in the patient's (64.0%) or a relative's (22.1%) home and haloperidol and thioridazine accounted for 58.1% of exposures. Depressed levels of consciousness and dystonia were the most common presenting signs, present in 90.7% and 51.2% of patients, respectively. Miosis occurred in only 13.9% of the patients. Fluid boluses were administered to 28.7% of the patients but about a quarter of these had coingested potentially cardiotoxic drugs. In addition, 2 of the 12 (13.9%) patients with abnormal electrocardiograms had also ingested potentially cardiotoxic drugs. Numerous diagnostic tests were performed in these patients including electrolyte panels (80.2%), complete blood counts (69.8%), liver function tests (31.4%), serum osmolality (20.9%), blood cultures (10.5%), lumbar punctures (17.4%), head computed tomographies (15.1%), and electroencephalograms (3.5%). The median length of hospitalization was 1.78 (range 1-9) days and there were no deaths. Patients presenting with dystonias were more likely to have extensive diagnostic testing for neurologic disease than those presenting without dystonias. CONCLUSION The presentation of phenothiazine and butyrophenone ingestions in children and adolescents may be nonspecific and confounded by coingestants. Patients with dystonias had more extensive neurologic testing than patients without dystonias, suggesting that physicians may not recognize dystonias as a clinical finding characteristic of phenothiazine or butyrophenone exposure.
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Affiliation(s)
- L P James
- Department of Pediatrics, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock 72202, USA.
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Lensing SY, Gillaspy SR, Simpson PM, Jones SM, James JM. Encouraging physicians to respond to surveys through the use of fax technology. Eval Health Prof 2000; 23:349-60. [PMID: 11067195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
High response rates in surveys of physicians are difficult to achieve. One possible strategy to improve physicians' survey participation is to offer the option of receiving and returning the survey by fax. This study describes the success of the option of fax communication in a survey of general practitioners, family physicians, and pediatricians in Arkansas with regard to pediatric asthma. Eligible physicians were given the choice of receiving the survey by telephone, mail, or fax. In this observational study, physicians' preferences, response rates, and biases for surveys administered by fax were compared with mail and telephone surveys. The overall survey response rate was 59%. For the 96 physicians completing an eligibility screener survey, the largest percentage requested to be surveyed by fax (47%) rather than by telephone (28%) or mail (25%). Faxing may be one strategy to add to the arsenal of tools to increase response rates in surveying physicians.
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Affiliation(s)
- S Y Lensing
- University of Arkansas for Medical Sciences, Little Rock, USA.
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Abstract
CONTEXT Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care. OBJECTIVES This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay. DESIGN AND SETTING A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group. Participants. Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993. MAIN OUTCOME MEASURES Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences. RESULTS The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio:.95; 95% confidence interval:.91-.99), and reduced length of stay (incident rate ratio:.98; 95% confidence interval:.975-.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay. CONCLUSIONS The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.
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Affiliation(s)
- J M Tilford
- Department of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock, Arkansas, USA.
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15
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Hamer RM, Simpson PM. Comparison of clozapine and risperidone. Am J Psychiatry 2000; 157:310. [PMID: 10671435 DOI: 10.1176/appi.ajp.157.2.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lieh-Lai MW, Kauffman RE, Uy HG, Danjin M, Simpson PM. A randomized comparison of ketorolac tromethamine and morphine for postoperative analgesia in critically ill children. Crit Care Med 1999; 27:2786-91. [PMID: 10628627 DOI: 10.1097/00003246-199912000-00030] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a single dose of ketorolac compared with morphine for the relief of pain in children, and to determine the safety of ketorolac. SETTING Tertiary pediatric intensive care unit in a university-affiliated hospital. DESIGN Prospective, randomized, double-blind, parallel, single-dose, positive control study. PATIENTS Children admitted to the intensive care unit with postoperative pain. INTERVENTIONS Patients received a single dose of either morphine or ketorolac as the first postoperative analgesic when the pain score indicated significant pain. Blood pressure, heart rate, and urine output were recorded, as well as blood urea nitrogen, creatinine, bleeding time, hematuria or proteinuria, and aspartate aminotransferase. Side effects such as nausea and vomiting were noted. Morphine was used for rescue treatment if the patient continued to have significant pain > or =30 mins after study drug administration. MEASUREMENTS AND MAIN RESULTS Of the 102 children studied, 48 received morphine and 54 received ketorolac. The percentage of patients reporting pain relief in the first and second hours after drug administration was not different between groups. Likewise, the proportion of patients who met the criteria for pain relief during the entire evaluation period was not different between groups. There was a trend toward fewer patients who received ketorolac requiring remedication in the first 4 hrs compared with those who received morphine, but this trend did not reach statistical significance. More patients in the morphine group failed to achieve pain relief at any time after the dose compared with those who received ketorolac. There were no differences between the two groups in physiologic or laboratory variables. Vomiting was more common in patients who received ketorolac. CONCLUSION Ketorolac is comparable to morphine in relief of postoperative pain in children. A single dose of ketorolac does not result in abnormal postoperative bleeding or alter renal function. However, ketorolac may cause nausea and vomiting in some patients.
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Affiliation(s)
- M W Lieh-Lai
- Department of Pediatrics and Pharmacology, Children's Hospital of Michigan, Detroit 48201-0105, USA
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Aly AM, Simpson PM, Humes RA. The role of transthoracic echocardiography in the diagnosis of infective endocarditis in children. Arch Pediatr Adolesc Med 1999; 153:950-4. [PMID: 10482211 DOI: 10.1001/archpedi.153.9.950] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is frequently suspected but infrequently diagnosed in children. Clinicians often order echocardiograms to "rule out" IE. In an era of cost constraint, clinically efficient strategies must be developed to eliminate unnecessary tests. We hypothesized that transthoracic echocardiography (TTE) is only useful in children in whom there is a high clinical suspicion of IE based on history, physical examination, and persistently positive blood cultures. OBJECTIVE To determine the role of TTE as a screening test for suspected IE in children. METHODS Echocardiographic reports and medical records were reviewed retrospectively for 173 consecutive patients who underwent TTE to rule out IE from January 1993 to August 1996. RESULTS Persistent fever was the predominant symptom leading to a suspicion of IE (120 patients [69.4%]). Fifty-seven (32.9%) of the 173 patients had congenital heart disease and 95 patients (54.9%) had indwelling venous catheters. Twenty-six patients (15.0%) were diagnosed and treated for IE. Twelve (46.2%) of these 26 patients had vegetations seen on TTE. The conditions of the remaining 14 patients were diagnosed clinically and these patients had persistently positive blood cultures. By univariate analysis, the risk factors associated with the diagnosis of IE were malaise, congestive heart failure, new or changing heart murmur, leukocytosis, hematuria, and the presence of 2 or more positive blood cultures for the same organism. The risk factors associated with positive TTE were malaise, congestive heart failure, new or changing heart murmur, leukocytosis, hematuria, and 2 or more positive blood cultures. The presence of an indwelling catheter or immunocompromised status were not predictive of vegetation or IE. CONCLUSIONS Transthoracic echocardiography has poor sensitivity as a screening test for IE in patients with low clinical probability of the disease. A diagnostic algorithm for IE is suggested based on these data.
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Affiliation(s)
- A M Aly
- Cardiology Division, Children's Hospital of Michigan, Wayne State University, Detroit 48201, USA
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Petronis JD, Regan F, Briefel G, Simpson PM, Hess JM, Contoreggi CS. Ventilation-perfusion scintigraphic evaluation of pulmonary clot burden after percutaneous thrombolysis of clotted hemodialysis access grafts. Am J Kidney Dis 1999; 34:207-11. [PMID: 10430963 DOI: 10.1016/s0272-6386(99)70344-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study is to determine, by using rigorous methods, if pulmonary perfusion defects were detectable by ventilation-perfusion scintigraphy after percutaneous thrombolysis of clotted hemodialysis access grafts. Thirteen patients were studied. Four patients underwent pharmacomechanical thrombolysis with urokinase and the remainder had mechanical thrombolysis alone. Pre- and postthrombolysis scintigraphic studies were performed on all patients. Perfusion defects were described as vascular (well-defined borders confined to segmental boundaries) or nonvascular. Vascular defects were graded by severity (0 to 3) and area (0 to 3) for each involved segment. Nonvascular defects were graded by severity (0 to 1) and area (0 to 1). Two experienced readers evaluated the scans blinded to each other's results and all other clinical data, including thrombolysis outcomes. Twelve patients did not have any significant worsening of their perfusion defect scores postthrombolysis. In only one patient did a study show a new nonvascular perfusion defect with a matching ventilation abnormality. The defect was believed to be caused by mucus plugging. The patient had no evidence of pulmonary embolism. Our study suggests emboli that resulted from the pharmacomechanical or mechanical thrombolysis procedure were either small, underwent lysis before impacting the lung, or were below the limit of detection of ventilation-perfusion scintigraphy.
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Affiliation(s)
- J D Petronis
- Department of Pediatrics, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
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Abstract
The risk of colorectal carcinoma is increased in pediatric-onset inflammatory bowel disease (IBD). There is little information available regarding the colonic mucosal proliferative state in children with IBD. The aim of this study was to assess colonic ornithine decarboxylase (ODC) activity, a marker of cell proliferation, in pediatric IBD patients. ODC activity was assessed in colonic mucosa from 23 children (7 with ulcerative colitis, 9 with Crohn's disease, and 7 controls) undergoing colonoscopic examination. ODC activities were then compared with degree of inflammation of biopsied samples. ODC activities in patients with and without corticosteroid treatment were also analyzed. The mucosal ODC activities of sigmoid colon and rectum were significantly higher (2.5- to 4-fold) in both ulcerative colitis and Crohn's disease. The higher ODC activity was associated with increased mucosal inflammation. Moreover, treatment with corticosteroids decreased the ODC activity. In conclusion, using ODC activities as a marker of cell proliferation, our results suggest that there is a higher colonic mucosal proliferative state in children with IBD. The increased ODC activities were associated with increased colonic mucosal inflammation. Colonic mucosal ODC activity may provide an additional parameter to access the therapeutic efficacy of corticosteroid treatment in pediatric IBD patients.
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Affiliation(s)
- R B Pillai
- Department of Pediatrics, Wayne State University School of Medicine; and Children's Hospital of Michigan, Detroit 48201, USA
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21
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Simpson PM, Lensing SY, Hamer RM. Predictors of early school age outcomes in very low birth weight children. J Dev Behav Pediatr 1999; 20:205-6. [PMID: 10393077 DOI: 10.1097/00004703-199906000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Fernández-Madrid F, VandeVord PJ, Yang X, Karvonen RL, Simpson PM, Kraut MJ, Granda JL, Tomkiel JE. Antinuclear antibodies as potential markers of lung cancer. Clin Cancer Res 1999; 5:1393-400. [PMID: 10389924 PMCID: PMC5635656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
There are multiple case reports of antinuclear antibodies (ANAs) in patients with malignancies, yet to date there has not been a systematic survey of ANAs in lung cancer. We have previously reported that autoantibodies to collagen antigens resembling those found in the connective tissue diseases are consistently detected in the sera from lung cancer patients. In this work, we looked for the presence of ANAs in the sera from these same patients. Sera from 64 patients with lung cancer and 64 subjects without a history of cancer were retrospectively tested for reactivity on immunoblots of nuclear extracts of HeLa, small cell carcinoma, squamous cell carcinoma, adenocarcinoma, large cell carcinoma of the lung, and of normal lung cells. Associations were sought between the reactivities on immunoblots and lung cancer cell type, diagnosis, and progression-free survival by the method of classification and regression trees (CARTs). Cross-validated CART analyses indicated that reactivities to certain bands in immunoblots are associated with different types of lung cancer. Some of these autoantibodies were associated with a prolonged survival without disease progression. Our data suggest that autoimmunity is often a prominent feature of lung cancer and that molecular characterization of these antigens may lead to the discovery of proteins with diagnostic and prognostic value.
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Affiliation(s)
- F Fernández-Madrid
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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23
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Lieh-Lai MW, Stanitski DF, Sarnaik AP, Uy HG, Rossi NF, Simpson PM, Stanitski CL. Syndrome of inappropriate antidiuretic hormone secretion in children following spinal fusion. Crit Care Med 1999; 27:622-7. [PMID: 10199545 DOI: 10.1097/00003246-199903000-00046] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES a) To determine if antidiuretic hormone (ADH) is elevated in patients undergoing spinal fusion, especially in those who have clinical evidence of syndrome of inappropriate antidiuretic hormone (SIADH); b) to evaluate the relationship between ADH secretion and the secretion of atrial natriuretic peptide (ANP). SETTING Tertiary care pediatric intensive care unit (ICU) in a university hospital. DESIGN A prospective cross-sectional, observational study with factorial design. PATIENTS Thirty patients > or = 10 yrs of age undergoing spinal fusion admitted to the ICU for postoperative care. INTERVENTIONS Patients underwent anterior, posterior, or both anterior/posterior spinal fusion. Blood was collected for serial measurements of ADH, ANP and serum electrolyte levels. Heart rate, blood pressure and central venous pressure were measured. MEASUREMENTS AND MAIN RESULTS Thirty children were studied. Nineteen had idiopathic scoliosis, nine had neuromuscular scoliosis, one had Marfan's disease, and one had congenital scoliosis. Ten (33%) children met clinical criteria of SIADH. There was no difference in duration of surgery, blood loss, volume of iv fluid administration pre- and intraoperatively, or type of scoliosis between those who developed SIADH and those who did not. Hemodynamic variables were similar in both groups. ADH levels increased in both groups immediately postoperatively and at 6 hrs after surgery, but were much more elevated in those patients with SIADH. Patients with SIADH also had significantly higher ADH levels preoperatively. In relation to serum osmolality, ADH was considerably higher in those with SIADH compared with those who did not. Although ANP values tended to be higher in the group with SIADH, this did not reach statistical significance. CONCLUSION SIADH occurs in a subset of children who undergo spinal fusion. The diagnosis of SIADH can be made easily using clinical parameters which are well-defined. In the face of SIADH, continued volume expansion may be harmful, and should therefore be avoided.
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Affiliation(s)
- M W Lieh-Lai
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201-2196, USA
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24
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Klein MS, Eames CH, Simpson PM, Szof CA, Humes RA, Kauffman RE. Information at the point of care: effect on patient care and resource consumption. J Healthc Inf Manag 1999; 13:67-81. [PMID: 17283851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- M S Klein
- Department of Library Services, The Detroit Medical Center, Children's Hospital of Michigan, USA
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25
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Hamer RM, Simpson PM. Bootstraps and jackknives: limitations. J Investig Med 1998; 46:273-4. [PMID: 9737087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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26
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Holtrop TG, Yee HY, Simpson PM, Kauffman RE. A community outreach lead screening program using capillary blood collected on filter paper. Arch Pediatr Adolesc Med 1998; 152:455-8. [PMID: 9605028 DOI: 10.1001/archpedi.152.5.455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To test whether a method of fingerstick blood sample collection onto filter paper could be used as an alternative screening method in the field in settings where environmental lead contamination is a high risk. METHOD Members of the Pediatric Mobile Team of Children's Hospital of Michigan, Detroit, collected paired venous and capillary blood samples from 120 children, aged 6 months to 6 years, who presented for services at any of 7 sites located in decaying neighborhoods of older sections of Detroit. All samples were analyzed for lead content by graphite furnace atomic absorption spectrometry. RESULTS When filter paper samples with blood lead levels of 0.48 micromol/L (10 microg/dL) or higher were compared with matched venous samples, the concordance coefficient was 0.96. The sensitivity and specificity of the filter paper samples relative to the venous samples for a cutoff of 0.48 micromol/L (10 microg/dL) or higher were 94% and 99%, respectively, with a positive predictive value of 97%. However, at a cutoff of 0.72 micromol/L (15 microg/dL), the sensitivity and specificity dropped to 75% and 98%, respectively, with filter paper samples underreporting blood lead values. At any cutoff point (0.48, 0.72, or 0.96 micromol/L [10, 15, or 20 microg/dL]), the filter paper method was highly specific for lead. CONCLUSIONS Capillary filter paper sampling is an accurate and practical alternative to venous sampling for blood lead screening using 0.48 micromol/L (10 microg/dL) as the cutoff. The filter paper method predicts levels of 0.72 micromol/L (15 microg/dL) or higher less well. The cause of divergent values above 0.72 micromol/L (15 microg/dL) is not clear. Environmental contamination of capillary filter paper, however, does not seem to be an explanation.
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Affiliation(s)
- T G Holtrop
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA
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27
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Abstract
The discovery of sexual images embedded in an advertisement significantly affected responses to the advertisement by 147 female and 159 male undergraduates.
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Affiliation(s)
- P M Simpson
- College of Business, Northwestern State University, Natchitoches, LA 71497, USA.
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28
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Matherly LH, Taub JW, Wong SC, Simpson PM, Ekizian R, Buck S, Williamson M, Amylon M, Pullen J, Camitta B, Ravindranath Y. Increased frequency of expression of elevated dihydrofolate reductase in T-cell versus B-precursor acute lymphoblastic leukemia in children. Blood 1997; 90:578-89. [PMID: 9226157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The relationships between dihydrofolate reductase (DHFR) levels or methotrexate membrane transport and acute lymphoblastic leukemia (ALL) immunophenotype were evaluated on 51 T-cell and 44 B-precursor ALL specimens from 90 pediatric ALL patients at diagnosis and relapse, using a fluorescent methotrexate analog (PT430) and flow cytometry assay (Matherly et al, Blood 85:500, 1995). For T-cell ALL, 35 of 45 (78%) of newly diagnosed patients' specimens exhibited elevated DHFR relative to DHFR levels in ALL blasts from methotrexate-responsive patients. For 30 of 45 diagnostic T-ALL specimens, DHFR expression was heterogeneous, with up to 3 separate subpopulations covering a 44-fold range; the DHFR-overproducing fractions comprised 10% to 88% of the total blasts. Elevated DHFR was less common in B-precursor ALL at diagnosis, being detected in only 17 of 36 specimens (47%); 11 of these samples exhibited DHFR heterogeneity. Median maximal DHFR levels were fourfold higher in T-cell than B-precursor ALL at diagnosis. Within a particular phenotypic group, there were no correlations between DHFR levels and patient prognostic features, including age, sex, chromosomal abnormalities, white blood cell counts (WBCs), and percentage of S-phase. However, for B-precursor ALL, there was a notably higher fraction of African-American than white patients with elevated DHFR. For patients (both phenotypes) with low WBCs (<50,000/ microL), event-free survival times were significantly shorter for those expressing DHFR above a threshold level than for patients expressing DHFR below this level (P < .016); this relationship was not seen for patients with high WBCs (>50,000/microL). Elevated DHFR was detected in 11 of 14 relapse specimens (5 of 6 T-cell and 6 of 8 B-precursor). Two of five paired relapse specimens (both T-cell) from patients treated with methotrexate exhibited increased DHFR levels over those at diagnosis (2.5- to 5-fold); the fraction of DHFR-overproducing blasts was also increased in 4 of 5 paired relapse specimens (2 B-precursor and 2 T-cell). In contrast to the variations in DHFR, highly impaired methotrexate transport was detected in only 6 of 95 ALL specimens, including both diagnosis and relapse. There was no correlation between phenotype and impaired transport. These data provide further rationale for the use of mechanistically based prognostic factors to complement known biologic or disease-based prognostic indicators in the design of ALL therapy including methotrexate, particularly with patients presenting with low WBCs. The finding of a markedly increased frequency of DHFR overexpression in T-cell over B-precursor ALL suggests that this difference is associated with the poorer prognosis of patients with T-cell ALL treated with standard-dose antimetabolite therapy and implies that higher-dose methotrexate (> or = 1 g/m2) during consolidation therapy may be useful in the treatment of this disease.
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Affiliation(s)
- L H Matherly
- Barbara Ann Karmanos Cancer Institute, the Department of Pharmacology, Wayne State University School of Medicine, the Children's Hospital of Michigan, Detroit 48201, USA
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Abstract
OBJECTIVE To determine the mortality rate, during the first 2 years of life, in infants who were exposed to cocaine, opiate, or cannabinoid during gestation. METHODS For a period of 11 months, a large group of infants were enrolled and screened at birth for exposure to cocaine, opiate, or cannabinoid by meconium analysis. Death outcome, within the first 2 years after birth, was determined in this group of infants using the death registry of the Michigan Department of Public Health. RESULTS A total of 2964 infants was studied. At birth, 44% of the infants tested positive for drugs: 30. 5% positive for cocaine, 20.2% for opiate, and 11.4% for cannabinoids. Compared to the drug negative group, a significantly higher percentage (P < .05) of the drug positive infants had lower weight and smaller head circumference and length at birth and a higher percent of their mothers were single, multigravid, multiparous, and had little to no prenatal care. Within the first 2 years of life, 44 infants died: 26 were drug negative (15.7 deaths per 1000 live births) and 18 were drug positive (13.7 deaths per 1000 live births). The mortality rate among cocaine, opiate, or cannabinoid positive infants were 17.7, 18.4, and 8.9 per 1000 live births, respectively. Among infants with birth weight </=2500 g, infants who were positive for both cocaine and morphine had a higher mortality rate (odds ratio = 5.9, confidence interval [CI] = 1.4 to 24) than drug negative infants. Eleven infants died from the sudden infant death syndrome (SIDS); 58% were positive for drugs, predominantly cocaine. The odds ratio for SIDS among drug positive infants was 1.5 (CI = 0.46 to 5.01) and 1.9 (CI = 0.58 to 6.2) among cocaine positive infants. CONCLUSION We conclude that prenatal drug exposure in infants, although associated with a high perinatal morbidity, is not associated with an overall increase in their mortality rate or incidence of SIDS during the first 2 years of life. However, a significantly higher mortality rate was observed among low birth weight infants (</=2500 g) who were positive for both cocaine and opiate.
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Affiliation(s)
- E M Ostrea
- Department of Pediatrics, Hutzel Hospital, Children's Hospital of Michigan and Wayne State University, Detroit, Michigan 48201, USA
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30
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Abstract
OBJECTIVE To assess parents' and adolescents' perceived need for parental consent for minor adolescents to participate in minimal risk research studies based on procedural invasiveness (anonymous surveys, interviews, and blood or urine testing) and sensitivity of the topics (sexuality, drug and alcohol use, and sexually transmitted diseases and human immunodeficiency virus [HIV]). METHODS An anonymous self-report questionnaire was administered to 100 adolescent-parent pairs at 2 clinical sites (urban and suburban) of Children's Hospital of Michigan in Detroit. RESULTS By invasiveness of the research procedure, the proportions of parents and adolescents who perceived a need for parental consent were as follows: face-to-face interviews, 62% vs 48%; telephone interviews, 72% vs 46%; blood or urine testing, 77% vs 62%; and blood testing for HIV status, 78% vs 59%. These differences were only significant for telephone interviews and HIV blood testing. For anonymous surveys, a minority of parents (33%) and adolescents (26%) reported that parental consent was needed. Based on sensitivity of the research topics, the proportions of parents and adolescents who perceived a need for parental consent were as follows: sexuality, 60% vs 34%; drug and alcohol use, 56% vs 44%; contraception, 62% vs 46%; and sexually transmitted diseases and HIV testing, 56% vs 52%. These differences were only significant for sexuality. Parents with higher education believed that teens could give their own consent (P < .05). Fifty-seven percent of parents and their teens agreed that parental consent for anonymous surveys was not necessary. For more invasive procedures and more sensitive topics, the percentage of disagreement ranged from 28% to 55.5%. CONCLUSIONS There is a greater perceived need for parental consent to adolescent participation in research studies among parents than among teens for more invasive procedures and more sensitive topics. These results suggest the need for sensitivity to differing adolescent and parental perceived need for parental consent for a minor adolescent to participate in such studies. Further studies with larger samples are needed to determine what factors influence diverse parent and adolescent opinions.
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Affiliation(s)
- A Sikand
- Division of Adolescent Medicine, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA
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31
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Wesnes K, Simpson PM, Jansson B, Grahnén A, Weimann HJ, Küppers H. Moxonidine and cognitive function: interactions with moclobemide and lorazepam. Eur J Clin Pharmacol 1997; 52:351-8. [PMID: 9272403 DOI: 10.1007/s002280050300] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Moxonidine represents a new generation of centrally acting antihypertensive drugs. It binds to I1-imidazoline receptors and exerts its antihypertensive activity through a reduction in systemic vascular resistance, while cardiac output remains unchanged or even increases slightly. Moxonidine is prescribed for the treatment of mild to moderate hypertension. Typical doses are 0.4 to 2.0 mg given as one dose in the morning or as divided doses in the morning and evening. METHODS The effects of moxonidine 0.4 mg once daily in combination with moclobemide or lorazepam were investigated in two, double-blind, randomised, placebo-controlled, two-way crossover studies in a total of 48 healthy volunteers. Safety assessments were made in each study and included pre- and post-study measurement of blood pressure, heart rate, ECG, haematology, blood biochemistry, and urinalysis, and recording of adverse events. RESULTS In the first study, moxonidine alone was found to produce small but statistically significant impairments of vigilance detection speed at 4 h and 6 h. Lowering of subjective alertness was also observed. Repeat dosing with moxonidine produced an impairment of memory scanning performance. These findings were not reproduced in the second study, in which moxonidine alone produced an improvement in immediate word recall at 4 h and 6 h. No interactions were observed when moxonidine was co-administered with moclobemide. Moxonidine, when co-administered with lorazepam, produced interactions with three tasks requiring high levels of attention: choice, simple reaction time and digit vigilance performance; memory tasks; immediate word recall, delayed word recall accuracy; and visual tracking. A total of 47 adverse events were reported in study 1. Moxonidine produced a slight decrease of systolic and diastolic blood pressure. In study 2, a total of 55 adverse events were reported. In both trials, the most frequently reported events were tiredness and dryness of mouth, the latter occurring only under the moxonidine treatment. There were no clinically relevant changes observed in blood pressure, pulse rate, and laboratory tests in either study, nor was there any evidence of any interaction between moxonidine and either moclobemide or lorazepam. CONCLUSION Moxonidine was found to be safe and well tolerated in healthy volunteers. However, the impairments on attentional tasks were greater when moxonidine was co-administered with lorazepam 1 mg. These effects should be considered when moxonidine is codosed with lorazepam, although they were smaller than would have been produced by a single dose of lorazepam 2 mg.
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Affiliation(s)
- K Wesnes
- Cognitive Drug Research Limited, Reading, UK
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32
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Nelson DA, Simpson PM, Johnson CC, Barondess DA, Kleerekoper M. The accumulation of whole body skeletal mass in third- and fourth-grade children: effects of age, gender, ethnicity, and body composition. Bone 1997; 20:73-8. [PMID: 8988351 DOI: 10.1016/s8756-3282(96)00312-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this longitudinal study is to describe bone mass and body composition, and the annual changes in these measurements, among third grade students recruited from a suburban school district. Whole body bone mineral content (WBBMC), bone mineral density (WBBMD), fat, and lean mass were measured by dual-energy X-ray absorptiometry. Bone mass in the lumbar spine (LBMC) region of the whole body scan was also utilized. 773 students (38% white, 57% black, 5% other) had baseline visits; 561 had a second measurement a year later. At baseline, black children have significantly higher WBBMC, WBBMD, height, and lean mass than whites. Black males, but not black females, have a greater LBMC. There are no significant gender differences in body size, WBBMC, or WBBMD, although girls have a greater LBMC and fat mass, and boys have a higher lean mass. Most of these differences persist in visit 2. The annual change in bone and lean mass is greater in blacks. Stepwise linear regression analyses of bone mass on body size, gender, and ethnicity and their interactions indicate that log-transformed weight explains most of the variance in both WBBMC and WBBMD (multiple r2 = 0.90 and 0.64, respectively). There are significant black/white differences in intercepts and slopes. Other variables explain only another 1%-2% of the variance. The strongest Pearson correlations are between changes in bone mass and changes in lean mass and log-transformed weight (r ranging from 0.62 to 0.84, p = 0.0001). We conclude that there is a significant black/white, but not male/female difference in whole body bone mass and bone density before puberty. Ethnic and gender differences in bone and body composition suggest that the lean component may contribute to a greater peak bone mass in blacks vs. whites, and perhaps in males vs. females.
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Affiliation(s)
- D A Nelson
- Wayne State University School of Medicine, Department of Medicine, Detroit, MI 48201, USA
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Seagull FN, Mowery JL, Simpson PM, Robinson TR, Martier SS, Sokol RJ, McCarver-May DG. Maternal assessment of infant development: associations with alcohol and drug use in pregnancy. Clin Pediatr (Phila) 1996; 35:621-8. [PMID: 8970754 DOI: 10.1177/000992289603501203] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surveillance by parental concern has been advocated to assess whether formal child developmental testing is needed. To determine whether alcohol intake or illicit drug use in pregnancy is associated with differences in maternal perception of infant development, mothers with acknowledge alcohol and drug habits during pregnancy (N = 120) were interviewed at 11 months' postpartum, within 1 month before infant testing by use of the Bayley Scales of Infant Development. Women with heavy alcohol intake during pregnancy (> 3.5 oz absolute alcohol per week) were 15-fold more likely to overestimate their infant's mental development (P < 0.05), whereas mothers using illicit drugs were 4-fold more likely to overestimate their infant's physical development (P = 0.02). Given the frequent denial of substance abuse, we suggest that health care providers be cautious in accepting a lack of parental concern about a child's development and rely more heavily on formal testing, particularly in high-risk populations.
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Affiliation(s)
- F N Seagull
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, USA
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Abstract
BACKGROUND Single-site or multisite atrial pacing may reduce the incidence of atrial fibrillation in humans. The therapeutic mechanisms may include synchronization of atrial repolarization (repolarization "memory") and/or decreased dispersion of atrial repolarization. These responses have not been well documented in intact atria. METHODS AND RESULTS Monophasic action potential recordings were made from six atrial epicardial sites in 39 isolated perfused rabbit heart preparations during 3 hours of continuous right atrial, left atrial, or biatrial pacing. Action potential recordings obtained at times 0, 45, 90, 135, and 180 minutes were computer analyzed for activation time (AT) and 90% action potential duration (APD) at each site. No consistent relationship could be demonstrated between APD and AT at any time during atrial pacing (all P > .05). On average, left atrial APDs were longer than right atrial APDs by up to 6.3 ms at all times, regardless of the site of pacing (P < or = .05). At all times, dispersion of atrial repolarization was minimized by left atrial pacing compared with right atrial pacing (21.6 +/- 9.1 versus 32.4 +/- 15.1 ms, respectively, at time 0; P < .05). Biatrial pacing provided no further reduction in dispersion of repolarization compared with left atrial pacing (all P > .05). CONCLUSIONS No relationship can be demonstrated between atrial AT and APD in the isolated rabbit heart preparation. This differs from ventricular repolarization "memory," which is demonstrable under the same conditions. Left atrial APD is, on average, longer than right atrial APD, suggesting spatial heterogeneity in repolarization. Dispersion of atrial repolarization is minimized by left atrial pacing in this preparation with no further advantage to biatrial pacing.
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Affiliation(s)
- M A Wood
- Department of Internal Medicine/Cardiology, Medical College of Virginia, Richmond 23298-0053, USA
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35
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Sarnaik AP, Meert KL, Pappas MD, Simpson PM, Lieh-Lai MW, Heidemann SM. Predicting outcome in children with severe acute respiratory failure treated with high-frequency ventilation. Crit Care Med 1996; 24:1396-402. [PMID: 8706497 DOI: 10.1097/00003246-199608000-00020] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES a) To demonstrate the effect of high-frequency ventilation on gas exchange in children with severe acute respiratory failure unresponsive to conventional ventilation; b) to identify patients at high risk of death early after institution of high-frequency ventilation. SETTING Tertiary care pediatric intensive care unit in a university hospital. DESIGN A cross-sectional, observational study with factorial design. PATIENTS Thirty-one patients with severe acute respiratory failure defined as a Pao2/F1o2 of < 150 torr (< 20 kPa) with a positive end-expiratory pressure of > or = 8 cm H2O and/or Paco2 of > 60 torr (> 8 kPa) with an arterial pH < 7.25. INTERVENTIONS Patients received either high-frequency oscillation or jet ventilation if respiratory failure was unresponsive to conventional ventilation and if the underlying disease process was deemed reversible. MEASUREMENTS AND MAIN RESULTS Thirty-one children were managed with high-frequency ventilation, 11 children with jet and 20 children with oscillator. Arterial blood gases and level of ventilatory support were recorded before and at 6, 24, 48, 72, and 96 hrs after institution of high-frequency ventilation. There was an improvement in an arterial pH, Paco2, Pao2, and Pao2/FID2 6 hrs after institution of high-frequency ventilation (p < .01). This improvement, along with decreased need for oxygen, was sustained through the subsequent course. Twenty-three (74%) of 31 children treated with high-frequency ventilation survived. Survivors showed an increase in an arterial pH, Pao2, Pao2/FIO2, and a decrease in Paco2 within 6 hrs, whereas nonsurvivors did not. Oxygenation index was the best predictor of outcome. A combination of an initial oxygenation index of > 20 and failure to decrease the oxygenation index by > 20% by 6 hrs after initiation of high-frequency ventilation predicted death with 88% (7/8) sensitivity and 83% (19/23) specificity, with an odds ratio of 33 (p = .0036, 95% confidence interval 3-365). CONCLUSIONS In patients with potentially reversible underlying diseases resulting in severe acute respiratory failure that is unresponsive to conventional ventilation, high-frequency ventilation improves gas exchange in a rapid and sustained fashion. The magnitude of impaired oxygenation and its improvement after high-frequency ventilation can predict outcome within 6 hrs.
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Affiliation(s)
- A P Sarnaik
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201-2196, USA
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Srivuthana K, Yee HY, Bhambhani K, Elton RM, Simpson PM, Kauffman RE. A new filter paper method to measure capillary blood lead level in children. Arch Pediatr Adolesc Med 1996; 150:498-502. [PMID: 8620231 DOI: 10.1001/archpedi.1996.02170300052010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To develop and evaluate a new filter paper method to determine capillary blood lead levels accurately in children. DESIGN Paired comparison of lead levels determined in capillary whole blood dried on filter paper with lead levels in venous whole blood samples determined by a reference method. SETTING Children's Hospital of Michigan clinics, Detroit. PATIENTS One hundred children aged 9 months to 6 years. INTERVENTIONS Lead concentrations determined in capillary whole blood samples dried on filter paper were compared with concentrations measured in paired venous whole blood samples by a reference method. MAIN OUTCOME MEASURES Comparability of the two lead assay methods was assessed with the concordance coefficient. The sensitivity, specificity, and positive predictivity of the capillary filter paper method relative to the reference method were determined at three intervention decision concentrations of blood lead defined by the Centers for Disease Control and Prevention. RESULTS There was high agreement between the two assay methods, with a concordance coefficient of O.96. The capillary filter paper assay had a sensitivity of 90% and specificity of 90% for differentiating blood lead levels of 0.48 mumol/L (10 micrograms/dL) or more. Blood lead levels of 0.72 mumol/L (15 micrograms/dL) or more and 0.96 mumol/L (20 micrograms/dL) or more were identified with 98% and 94% sensitivity and 98% and 99% specificity, respectively. Positive predictivity was 93%, 98%, and 97%, respectively, at the three blood lead concentration decision points. CONCLUSION The capillary filter paper method for blood lead analysis described herein provides a convenient, sensitive, accurate, and inexpensive method to examine children for elevated blood lead levels.
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Affiliation(s)
- K Srivuthana
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, USA
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Fusilier MR, Simpson PM. AIDS patients' perceptions of nursing care quality. J Health Care Mark 1996; 15:49-53. [PMID: 10142387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The authors propose a model, adapted from literature on quality in health care and services marketing, that identifies dimensions of quality in nursing care for persons with AIDS. In focus groups, respondents expressed concern about structural factors such as formal hospital practices, and process factors, which include nurses' knowledge of AIDS treatment and issues, their use of universal precautions, discrimination issues, expressions of empathy, and provision of health status information to the patient.
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Affiliation(s)
- M R Fusilier
- Division of Business, Northwestern State University of Louisiana, Natchitoches, USA
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Abstract
BACKGROUND Technological limitations have precluded investigation of long-term temporal patterns of ventricular tachyarrhythmia recurrences. Newer implantable cardioverter-defibrillators permit such analyses by accurately recording the time and date of tachycardia detections during long-term follow-up. This study tests the hypothesis that ventricular tachycardia occurrences are randomly distributed over time in individual patients. METHODS AND RESULTS The time and date of 727 episodes of ventricular tachyarrhythmias were recorded from the data logs of 31 patients with implantable cardioverter-defibrillators followed for a median of 177 days (range, 7 to 782 days). All patients had three or more ventricular tachycardia detections and no detections from causes other than ventricular arrhythmias. In 28 of 31 patients, the distribution of the interdetection time intervals during follow-up differed significantly (all P < .01) from an exponential model distribution of interdetection intervals that assumed that detections were equally likely to occur at any time during follow-up (random). The Kolmogorov-Smirnov goodness-of-fit test was used to compare sample and model distributions. In each patient, the nonrandom distributions resulted from a preponderance of interdetection time intervals that were shorter than predicted by the random model, resulting in a temporal clustering of arrhythmic events. The interdetection interval was < or = 1 hour and < or = 91 hours for 55% and 78% of all intervals, respectively. When only those episodes receiving shock or antitachycardia pacing therapy were analyzed, 25 of 29 patients still manifested nonrandom distributions (all P < .01). When only episodes with tachycardia rates > 240 beats per minute were analyzed, 11 of 13 patients manifested non-random distributions (all P < .01). CONCLUSIONS Ventricular tachycardia detections and delivered antitachycardia therapies by implantable cardioverter-defibrillators are nonrandomly distributed throughout long-term follow-up in the majority of patients. The temporal clustering of these arrhythmic events may allow preemptive antiarrhythmic therapy and should be considered in the design of therapy based on suppression of spontaneous ventricular arrhythmias to statistically derived end points.
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Affiliation(s)
- M A Wood
- Department of Medicine (Cardiology), Medical College of Virginia, McGuire Veterans Administration Medical Center, Richmond 23298, USA
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Abstract
PURPOSE To assess distribution, operation, and ownership of magnetic resonance (MR) imagers in Virginia in 1991. MATERIALS AND METHODS Questionnaires regarding ownership, location, hours of operation, annual throughput, sources and amounts of revenue, and expenses were mailed to identified providers. Data, specifically regarding ownership and location, were analyzed. RESULTS Staff from 95% of MR facilities responded. Most facilities were located in and around major metropolitan areas. Population density per imager ranged from one per 76,000 to one per 222,000 persons. Imagers in larger metropolitan areas were operated for longer hours with higher revenues and greater expenses than were those in lower-population-density areas. Imagers owned by physicians in a position to self-refer had the highest patient throughput, the most revenue, and a much lower percentage of revenues from Medicare and Medicaid than did other ownership types. CONCLUSION Patient access to MR services in Virginia is inhomogeneous. Important aspects of utilization are location and ownership. Ownership by physicians who can self-refer is associated with higher use, greater overall revenues, and less service to the poor and elderly.
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Affiliation(s)
- M H Lipper
- Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908
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Wood MA, Simpson PM, London WB, Stambler BS, Herre JM, Bernstein RC, Ellenbogen KA. Circadian pattern of ventricular tachyarrhythmias in patients with implantable cardioverter-defibrillators. J Am Coll Cardiol 1995; 25:901-7. [PMID: 7884095 DOI: 10.1016/0735-1097(94)00460-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study examined the temporal patterns of ventricular tachycardia detections by implantable cardioverter-defibrillators for circadian variability. BACKGROUND Previous studies of circadian arrhythmia patterns have been methodologically limited by very brief observational periods. Late-generation implantable cardioverter-defibrillators accurately record the times of arrhythmia detections during unlimited follow-up. METHODS Forty-three patients with late-generation implantable cardioverter-defibrillators were followed up for 226 +/- 179 days (mean +/- SD). The times of all recorded episodes of ventricular tachyarrhythmias were retrieved from the data log of each device during follow-up. RESULTS The weighted distribution of 830 ventricular tachyarrhythmia episodes from the 43 patients fit a single harmonic sine curve model with a peak between 2 and 3 P.M. (95% confidence interval 1:13 to 4:13 P.M., R = 0.75, p < 0.05). The distributions of spontaneously terminating episodes, episodes receiving device therapy, episodes receiving shocks and episodes in the absence of antiarrhythmic therapy also fit the sine curve model (all R = 0.53 and 0.73, all p < 0.05), all with peak frequencies between 2:08 and 3:09 P.M. and 95% confidence intervals for peak frequencies between 11:38 A.M. and 5:07 P.M. Episodes recorded during continuous antiarrhythmic drug therapy did not fit the model (p > 0.05). CONCLUSIONS The distribution of ventricular tachyarrhythmias detected by late-generation implantable cardioverter-defibrillators follows a circadian pattern, with a peak tachycardia frequency between noon and 5 P.M. This pattern was not observed in patients receiving antiarrhythmic drug therapy. Knowledge of circadian periodicity for these events has implications for patient management.
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Affiliation(s)
- M A Wood
- Department of Medicine, Medical College of Virginia, Richmond 23298
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Simpson PM, Huang KC. Nitrous oxide and bowel function. Br J Anaesth 1994; 73:124-5. [PMID: 8038049 DOI: 10.1093/bja/73.1.124-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Abstract
BACKGROUND The frequency and morbidity of bradycardia during anesthesia in infants are not well documented. This study sought to determine the frequency of bradycardia during anesthesia in infants (0 to 1 yr) compared to that in older children, describe causes and morbidity, and identify factors that influence its frequency. METHODS Computerized information abstracted from 7,979 anesthetic records of patients ages 0-4 yr undergoing noncardiac surgery were examined for the presence or absence of intraoperative bradycardia. To study bradycardia in infants, 4,645 anesthetics in patients aged 0-1 yr were considered. Those with bradycardia to heart rates less than 100 beats/min were examined for causes, morbidity, and treatment of the bradycardia. For analysis of influencing factors, the frequency of bradycardia in infants was related to age, sex, race, ASA physical status, surgical site (body cavity), complexity (major or minor) and duration, type of primary anesthetist, type of supervising anesthesiologist, and anesthetic agents. Logistic regression was used to estimate the significance (P < 0.05) and odds ratios for each. RESULTS The frequency of bradycardia was 1.27% in the 1st yr of life, but only 0.65% in the third and 0.16% in the 4th yr, a significant difference. Causes of bradycardia in infants included disease or surgery in 35%, the dose of inhalation agent in 35%, and hypoxemia in 22%. Morbidity included hypotension in 30%, asystole or ventricular fibrillation in 10%, and death in 8%. Treatment involved epinephrine in 30% and chest compression in 25%. Associated factors included an ASA physical status of 3-5 (vs. 1 or 2) and longer (vs. shorter) surgery. Bradycardia was less than half as likely when the supervising anesthesiologist was a member of the Pediatric Anesthesia Service as with other anesthesiologists (P < 0.001). CONCLUSIONS Bradycardia is more frequent in infants undergoing anesthesia compared to older children and is associated with substantial morbidity. It is more likely in sicker infants undergoing prolonged surgery and less likely when a pediatric anesthesiologist is present.
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Affiliation(s)
- R L Keenan
- Department of Anesthesiology, Medical College of Virginia--Virginia Commonwealth University, Richmond 23298
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Arrowood JA, Kline J, Simpson PM, Quigg RJ, Pippin JJ, Nixon JV, Mohanty PK. Modulation of the QT interval: effects of graded exercise and reflex cardiovascular stimulation. J Appl Physiol (1985) 1993; 75:2217-23. [PMID: 8307882 DOI: 10.1152/jappl.1993.75.5.2217] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
During exercise, as heart rate (HR) increases, the QT interval of the electrocardiogram shortens. The mechanism(s) involved in this QT shortening has not been clearly defined. To distinguish the influence of increased circulating catecholamines from myocardial efferent stimulation, the relationship between HR and QT interval was investigated during exercise and cardiovascular reflex stimulation in cardiac transplant patients and normal control subjects. Because of cardiac denervation, increases in HR in these patients are solely due to circulating catecholamines and thus allow isolation of their effect on the QT interval. Twenty-one cardiac transplant patients were studied and compared with 16 normal control subjects. The QT-HR relationship was determined according to an exponential model during treadmill exercise in both groups [QT = 0.12 + 0.492e(-0.008.HR) and QT = 0.12 + 0.459e(-0.007.HR) in normal subjects and transplant patients, respectively] and was statistically similar between groups, suggesting similar QT interval shortening in both groups. During cold pressor and Valsalva maneuvers, HR increased significantly in normal subjects only, whereas QT interval changed minimally in both groups. These results suggest that during exercise the QT interval is influenced predominantly by increases in circulating catecholamines rather than by neurally mediated reflex autonomic changes.
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Affiliation(s)
- J A Arrowood
- Department of Internal Medicine, Medical College of Virginia, Richmond 23298
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Pates RD, Lundberg MT, Hennen J, Boymel C, Webber A, Wright G, Hayes RP, Simpson PM, Lynch GW, Merwin E. Creation of state-level Medicare database for healthcare evaluation applications. Proc Annu Symp Comput Appl Med Care 1993:663-7. [PMID: 8130558 PMCID: PMC3203557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Health Care Quality Improvement Initiative (HCQII) of the Health Care Financing Administration (HCFA) calls for Professional Review Organizations (PROs) to undertake pattern analysis of large administrative datasets for the purposes of quality of care assessment. The limitations of such administrative databases (primarily the MEDPAR file and derivatives thereof) include impoverished information regarding clinical attributes of Medicare enrollees and the process and outcome of their healthcare. This paper describes preliminary efforts to address this problem by the creation of a database, the PRO Concatenated Database (PCD), from the pooled implicit judgment review data of four Peer Review Organizations (PROs). The data elements comprising the PCD were carefully selected to provide important information regarding quality and appropriateness of care. Preliminary inter-state comparative studies employing the PCD are discussed. A method is also described by which the analytical power of state-level databases may be enhanced by linkage to state-level Modeled MEDPAR data which are issued by HCFA and contain patient-level risk-adjusted mortality data. This approach to the acquisition of data whose clinical content is enriched may prove to be particularly useful to the PRO community during the pattern analysis phase of the HCQII. Such analyses will evolve into more detailed studies involving primary data collection followed by dissemination of the results to local healthcare providers. In this manner, the PCD may facilitate rapid feedback regarding the effectiveness of healthcare delivery to the local community.
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Affiliation(s)
- R D Pates
- Thomas Jefferson Health Policy Institute
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Hocker JR, Simpson PM, Rabalais GP, Stewart DL, Cook LN. Extracorporeal membrane oxygenation and early-onset group B streptococcal sepsis. Pediatrics 1992; 89:1-4. [PMID: 1727991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Recently, extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy for newborns with overwhelming early-onset group B streptococcal sepsis. To determine which clinical factors best predict mortality and to evaluate the outcome of this therapy, a retrospective examination of the clinical course and outcome of ECMO-eligible newborns with early-onset group B streptococcal sepsis was undertaken. The study period was divided into two phases based on when ECMO was initially used at Kosair Children's Hospital as therapy for septic neonates. Phase 1 (pre-ECMO) was the period from January 1, 1982, through June 15, 1986, and phase 2 (ECMO) from June 16, 1986, through December 31, 1989. Newborns with gestational age greater than or equal to 34 weeks, birth weight greater than or equal to 2000 g, and evidence of early-onset group B streptococcal sepsis were eligible for study. Only newborns who received mechanical ventilation were evaluated. Sixteen patients from phase 1 met the above criteria. Of those, 10 exhibited no sign of hypotension and all survived. Of the 6 patients with hypotension, 3 died. Forty patients were identified from phase 2. Seven patients remained normotensive and all survived. Thirty-three patients were hypotensive, of which 15 received ECMO and 13 survived. Of the 18 who did not receive ECMO, 7 died. Regarding all hypotensive newborns, those who did not receive ECMO had a trend toward lower survival (P less than .06) and were more likely to die if they were of lower birth weight, manifested a persistent acidosis (pH less than or equal to 7.25), and had an absolute neutrophil count less than 500 cells/mm3.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J R Hocker
- Department of Pediatrics, University of Louisville School of Medicine, KY
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Wesnes KA, Simpson PM, White L, Pinker S. AUTOMATED MICROCOMPUTERIZED COGNITIVE EVALUATION OF THE ELDERLY AND DEMENTED. Clin Neuropharmacol 1992. [DOI: 10.1097/00002826-199202001-01107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- P M Simpson
- School of Health Studies, University of Portsmouth, Queen Alexandria Hospital, Cosham, Portsmouth, Hants PO6 3LY, UK
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Abstract
Scopolamine produces a satisfactory model of the attentional and secondary memory deficits seen in Alzheimer's disease (AD) that can be used to screen compounds for potential therapeutic usefulness. Physostigmine, which is known to enhance memory in AD, produced marked and widespread antagonism of the scopolamine-induced impairments, indicating the sensitivity of the model and establishing its relevance for the clinical situation. HP 029, a novel anticholinesterase, also exhibited widespread potency in the model, and in an international trial with patients with AD, it subsequently showed improvement on similar measures, demonstrating the predictive use of the scopolamine model.
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Affiliation(s)
- K A Wesnes
- Cognitive Drug Research, Reading, United Kingdom
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Abstract
The impact of extracorporeal membrane oxygenation (ECMO) on neonatal leukocyte content and function was examined in six patients. Patients were treated with ECMO for a mean of 134 h (range 44-246 h). Absolute neutrophil counts decreased from 14679 +/- 2291/mm3 to 7791 +/- 1672/mm3 after 2 h of ECMO. However, neutrophil phagocytosis and oxidative burst remained unchanged during the first 48 h of bypass. Monocyte counts also decreased during bypass, and at times were undetectable in 50% of patients. Monocyte HLA-DR content was decreased compared to normal cord blood prior to initiation of ECMO, and remained low throughout ECMO. However, the content increased significantly after termination of bypass. Plasma C3a levels increased transiently, paralleled by an increase in neutrophil CR3 expression. While moribund infants had some impairment of host defenses prior to ECMO, there was no further impact of ECMO per se on the parameters measured, other than transient complement activation and decreased monocyte counts.
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Affiliation(s)
- J R Hocker
- Department of Pediatrics, University of Louisville, Kentucky
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Purcell KG, Spencer LV, Simpson PM, Helman SW, Oldfather JW, Fowler JF. HLA antigens in lichen sclerosus et atrophicus. Arch Dermatol 1990; 126:1043-5. [PMID: 2200345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several reports have found conflicting data regarding the association between lichen sclerosus et atrophicus (LSA) and HLA types. Association with HLA-A31 and -B40 has been noted, whereas another report found no correlation. We are the first to specifically examine HLA types in white patients in the United States. We have found a significant association between LSA and HLA-A29 and -B44 individually and an even stronger association with the combination of A29 and B44. A review of previous LSA-HLA studies, as well as several reports of HLA typing in familial LSA, is discussed, with consideration given to possible reasons for the discrepancies among the various studies.
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Affiliation(s)
- K G Purcell
- Division of Dermatology, University of Louisville, Ky
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