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Biomedical subjects

A A Klein

Publications and source records attributed to A A Klein.

At least 19 recordsLinked to original sources
PubMed2003

Mobile phones in the hospital--past, present and future.

The phenomenon of electromagnetic interference by mobile phones is real and potentially clinically significant. This has been recognised by the Department of Health and the Medical Devices Agency, leading to bans on phone use in hospitals. Current evidence suggests that mobile phones can cause malfunction of medical equipment, but only when used in close proximity. Allowing phone use in non-patient care areas and improving staff education may improve compliance with hospital policies.

Cell Phone↗
PubMed2000

Bile duct size does not predict success of portoenterostomy for biliary atresia.

BACKGROUND/PURPOSE: Presence of large bile ducts (>200 microm) at the portal end-plate has been suggested to predict success after portoenterostomy. The authors reviewed their patients with biliary atresia to test the hypothesis that bile duct size in patients with successful portoenterostomy was no different than in the patients with unsuccessful portoenterostomy. METHODS: The authors reviewed the patients at their institution from 1989 to 1998 who had the diagnosis of biliary atresia (n = 38). A pathologist blinded to the results of the operation confirmed the measurements of the bile duct remnants. RESULTS: Five of the 38 patients did not have a portoenterostomy. They underwent cholangiogram and liver biopsy and were evaluated for liver transplantation. All patients who underwent surgery (n = 33) had a Roux-en-y hepaticojejunostomy. Twenty-one patients had successful surgery (64%) and 12 patients (36%) had unsuccessful surgery. The average age at operation in the successful group was 50.9 +/- 3 days and in failures, 57.9 +/- 4 days (P = .16). Duct size at the portal end-plate was not different between the successes and failures. Two of the patients in the success group had no evidence of bile ducts grossly or histologically. CONCLUSION: Children presenting early in infancy (<3 months) with biliary atresia should undergo a portoenterostomy regardless of the size of the bile ducts at the time of exploration.

Bile Ducts↗
PubMed1994

Glutaraldehyde treated autologous pericardium in complete repair of tetralogy of Fallot.

Pericardium has been used for decades to facilitate the repair of tetralogy of Fallot (TOF). The impact of glutaraldehyde preserved autologous pericardium when used as a right ventricular outflow tract (RVOFT) patch in TOF was analyzed in 36 consecutive children undergoing complete transventricular repair. In 18 (group I) the pericardium was treated in conventional fashion (harvested and preserved in saline solution). In the other patients, the pericardium was treated in 0.625% glutaraldehyde solution for 20 minutes and then washed in saline prior to being implanted as an RVOFT patch (group II). The perioperative (prior to hospital discharge) as well as the 6-month postoperative Doppler echocardiograms were assessed with 100% follow-up. The studies were evaluated and graded by blinded observers for the presence and severity of an RVOFT dilatation (+0 to +4) relative to the size of the aortic valve annulus. The age of patients in group I and group II (29 months, 34 months) were similar as was the incidence of transannular patching (44%, 41%). Postrepair hemodynamics revealed no significant difference in the right ventricular/left ventricular pressure ratios (42%, 41%) or in the systolic RVOFT pressure (24 mmHg, 29 mmHg). The predischarge echocardiograms showed no outflow tract (OFT) dilation in either group. There was no morbidity or mortality in either group. At approximately 6 months postoperatively (6.2 mo, 5.7 mo), 72% of group I patients had RVOFT diameters that were larger (+1, +2) than the predischarge diameters when reviewed by three observers. In group II there was a single patient with dilatation of the RVOFT and this graded as +1.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1993

A five-year clinical experience with 112 Blalock-Taussig shunts.

In spite of recent advances in neonatal open repair for complex cyanotic heart disease, some patients require palliation with a systemic-to-pulmonary artery shunt. We report a 5-year experience (1985-1990) with 112 Blalock-Taussig shunts. Forty-six of the 92 patients had some variant of tetralogy of Fallot, with a wide spectrum of diagnoses in the remainder. The median age at surgery was 3 months. A classic Blalock-Taussig shunt was done in 26% (group I), and a 4- or 5-mm PTFE graft was utilized in the remainder (group II). The technical aspects of each of the procedures are reviewed. There were three early deaths in the entire group, none of them related to Blalock-Taussig shunt function. There was no incidence of early shunt insufficiency, bleeding, infection, limb ischemia, or pulmonary artery distortion. There was a 21% incidence of clinical congestive heart failure, seen somewhat more commonly in group I. The overall need for reshunting/open repair was similar in both groups, but there was a statistically longer interval between the initial Blalock-Taussig shunt and the second procedure in group I (21.6 vs 12.4 months). The Blalock-Taussig shunt remains a safe, reliable, and effective means of increasing pulmonary flow.

Adolescent↗
PubMed1991

Unique variant of Taussig-Bing heart: double-outlet right ventricle with double ventricular septal defects and double overriding of great arteries.

A cyanotic, tachypneic newborn was diagnosed to have double-outlet right ventricle of the Taussig-Bing type. Cardiac failure did not respond to medical treatment or surgical palliation. Postmortem examination revealed two ventricular septal defects (VSDs), one a malalignment VSD in the membranous septum and adjacent tissue and the other in the anterosuperior part of the muscular septum. The D-malposed aortic root emerged mainly from the right ventricle, with aortic-mitral continuity. The larger posterolateral pulmonary root arose almost entirely from the right ventricle, confluent with the muscular VSD, and unrelated to the mitral valve. Its right ventricular aspect was obstructed by hypertrophied infundibulum. This unique malformation of the heart functioned as a double-outlet right ventricle of Taussig-Bing type. In addition, however, the malformation had elements of tetralogy of Fallot because of the malaligned VSD and hypertrophied conal musculature (although pulmonary flow was excessive), and also of complete transposition of the great arteries because of the arrangements of the two VSDs, which favored aortic flow from right ventricle and pulmonary blood flow from the left ventricle. Thus, a single heart presented similarities to three anatomic and functional entities.

Double Outlet Right Ventricle↗
PubMed1989

Epidemiologic aspects of Kawasaki disease in a Manhattan hospital.

Epidemiologic and clinical features of Kawasaki disease in 106 patients seen between 1980 and 1986 at The New York Hospital in midtown Manhattan were compared with those in large series from the United States, Canada, and Japan. Dissimilarities in our Kawasaki disease experience included ethnic heterogeneity of our patients (50% white, 18% black, 16% Hispanic, and 16% Oriental) and, in comparison with the Japanese experience, an older mean age (3 1/2 vs 1 1/2 years) with fewer children less than 2 years of age (32% vs 50% to 60%). In comparison with the general population of the geographic urban and suburban referral area for our hospital and in comparison with our general pediatric population, Oriental children with Kawasaki disease were overrepresented (16% vs 2%). More families of children with Kawasaki disease were members of the upper and middle class (73%) than were the population seen in general pediatrics (31.7%) at our hospital. Personal interviews with 63 families of children with Kawasaki disease and 63 control families with children paired for ethnic group, sex, and age revealed no epidemiologic differences except for use of rug shampoo within 1 month of onset in 16 episodes in 15 children with Kawasaki disease in 14 families (22% of families) compared with two families of control children (3%) (P less than .001).

Age Factors↗
PubMed1987

Coronary artery involvement in Kawasaki syndrome in Manhattan, New York: risk factors and role of aspirin.

Since January 1980, 110 children having 113 attacks of Kawasaki syndrome were studied. Age at onset was 7 weeks to 12 years (mean 3 6/12 years, median 2 9/12 years); 77% were younger than 5 years of age; the male to female ratio was 1.8; racial distribution was 52% white, 19% black, 14% Hispanic, and 16% Asian. Protocol of management consisted of high-dose aspirin (100 mg/kg/d) until afebrile, and then 81 mg every day until free of coronary aneurysm. Two-dimensional echocardiograms were done weekly during the acute stage, at 2 and 6 months after onset, and yearly if a coronary abnormality was detected. At 1 month, 51 coronary arterial abnormalities were present in 25 patients. Risk factors for a coronary abnormality were duration of fever greater than or equal to 2 weeks, level of platelet count, marked elevation of ESR, and age younger than 5 years. No statistically significant difference in incidence of aneurysms was detected between patients on high-dose aspirin and those on medium-or low-dose aspirin.

Aspirin↗
PubMed1986

BASIS: the development of a self-report measure for psychiatric inpatient evaluation.

Reliable and valid instruments are vital to assess the course and outcome of psychiatric disorders. This paper describes the development of BASIS (Behaviour and Symptom Identification Scale), a self-report assessment instrument for assessing functioning of psychiatric inpatients, and provides validating data for its use in a psychiatric hospital. The instrument was administered to 677 newly admitted patients. For approximately half of the sample, patients' nearest relatives provided parallel ratings of the patient. Interviews were repeated three to six weeks after admission and again six months after discharge. Test-retest reliability was found to be comparable to that for a standardized symptom checklist (SCL-90). Analyses of validity pointed to the instrument's capability in discriminating diagnostic groups, item correlations with similar symptom dimensions on other assessment measures, and correlations with relative's assessments of patients on the same measure. In conclusion, BASIS appears to be a promising tool for psychiatric inpatient evaluation studies.

Data Collection↗
PubMed1984

Sympathetic nervous system and exercise tolerance response in normotensive and hypertensive adolescents.

Comparative evaluation of isometric and dynamic exercise performance in normotensive, borderline hypertensive and hypertensive adolescents was made. Hemodynamic changes were correlated with level of adrenergic sympathetic nervous system activity as measured by plasma epinephrine and norepinephrine values. No significant intergroup differences were found with respect to isometric exercise with the exception of high peak isometric exercise heart rates and plasma epinephrine levels in the patients with significant hypertension. During dynamic treadmill testing, patients with the most marked hypertension demonstrated a statistically significantly greater tachycardia response to exercise that correlated with highest peak exercise epinephrine levels. The most hypertensive systolic dynamic exercise response was evidenced in the borderline hypertensive group in which peak exercise norepinephrine values were significantly higher than in other groups. Maximal exercise serum lactate levels were higher in hypertensive patient groups than in normotensive subjects. Altered hemodynamic response to peak dynamic exercise appears to exist in adolescents with borderline and significant hypertension and is in part mediated by altered activity of the sympathetic nervous system.

Adolescent↗
PubMed1984

Outcome evaluation findings: a decade of experience.

Using the experience and findings of the McLean Hospital Evaluative Service Unit as a framework, this report presents an overview of outcome evaluation during the last decade and outlines some directions for future work in the field. Evaluation techniques and criteria are discussed, with particular emphasis on the effectiveness of the problem-focused approach, using patient and family perceptions of treatment and outcome. Various factors relating to successful post-hospital adjustment are enumerated, with adherence to aftercare and the presence of a strong social support system emerging as significant. In our own work, patient characteristics found to be correlated with good outcome are being older, married, or diagnosed with an affective disorder. Of the problems and symptoms explored, improvement in depression emerges as the best indicator of good mental health at follow-up.

Evaluation Studies as Topic↗