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Biomedical subjects

B Barlow

Publications and source records attributed to B Barlow.

At least 37 records · Page 2Linked to original sources
PubMed1993

Efficacy of pediatric trauma care: results of a population-based study.

To determine concordance between regional outcome and national norms with respect to pediatric injury diagnosis, severity, and mortality in a state lacking a well-organized trauma system, we compared summary data from all pediatric trauma-related hospital discharge abstracts compiled by the [New York State Department of Health] Statewide Planning and Research Cooperative [Mandatory Hospital Reporting] System (SPARCS), with comparable data from pediatric trauma centers participating in the National Pediatric Trauma Registry (NPTR), for similar epochs in the late 1980s. Analysis was based on 14,234 cases from SPARCS and 17,098 cases from NPTR. Data were grouped by principal anatomic diagnosis (ICD-9-CM N-code) and injury severity score (ISS), for each of which incidence and mortality were calculated, both individually and collectively, then compared item by item for sources of variance. Overall, the two data sets showed the expected discordance, with NPTR being skewed toward more complex and severe injury. However, when analyzed cell by cell, a striking degree of concordance emerged in both incidence and mortality for injuries of comparable severity in all but a few selected subsets. Isolated skeletal injuries were treated less frequently in pediatric trauma centers, and combined system injuries to the skeleton, brain, and internal organs were treated more frequently in pediatric trauma centers. However, while the fatality rates were similar between SPARCS and NPTR for most diagnoses, given comparable ISS, survival was some ten times greater in pediatric trauma centers for patients with either brain or internal injuries--the leading causes of pediatric injury mortality--and for skeletal injuries, when the injuries sustained were of moderately great severity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Epidemiology of pediatric trauma: importance of population-based statistics.

To determine the validity of using hospital-based pediatric trauma registry data to draw specific inferences with regard to regional pediatric trauma system design, we compared statistical data on the incidence and mortality of pediatric and adult injuries and burns calculated by the New York State Department of Health, based on legally mandated reports of injury deaths and hospital discharges for 1989. During this year, some 488 children, aged 0 to 14 years, died as a result of injuries, a rate of 13.8 per 100,000 annually, of whom 408 (11.6/100,000) died as a result of traumatic injuries or burns, a population-based rate 20% of that observed in adults. During the same period, 16,402 children were hospitalized for treatment of traumatic injuries and burns, a rate of 465 per 100,000 annually, a population-based rate 56% of that observed in adults; and of this number, some 90 children died, yielding an in-hospital mortality "rate" (ie, case fatality ratio) of 0.55%, and a population-based rate of 2.6 per 100,000 annually. Thus, 9.0 of the 11.6 per 100,000 children who died in New York State in 1989 as a result of traumatic injuries and burns were not admitted to the hospital and, therefore, were unknown to the statewide hospital reporting system.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1992

The epidemiology of severe injuries to children in northern Manhattan: methods and incidence rates.

The epidemiology of injury incidence in inner-city children has not previously been described. This study presents the methods used and the incidence rates found for severe injury (causing hospitalisation or death) in a population of 89,000 children under age 17 years in northern Manhattan, a largely poor area of New York City. The average annual incidence rate (measured from 1983 to 1987) for severe injuries to children under 17 was 846/100,000 a year. The vast majority (79%) were classified as unintentional. Nine per cent were due to assault, 3% were self-inflicted and in an additional 9% the intention was unclear. Classified by cause, the highest incidence (per 100,000/year) was found for falls (218), vehicle-related (141, primarily pedestrian), ingestion (119) and burns (110). Guns caused 3% of the injuries (27). The death rate from injury was 18.7/100,000, 36% of which was due to homicide. In an additional 28%, intentional injury was suspected. The suicide rate was 0.4/100,000. The leading causes of injury death included guns and burns (both 2.7/100,000). Compared with childhood injury rates in predominantly rural and suburban populations, the rates reported here for northern Manhattan are higher for overall injury incidence (fatal and non-fatal) and for homicide, but lower for injury mortality not due to homicide.

Acute Disease↗
PubMed1990

Mortality and head injury: the pediatric perspective.

The records of 10,098 children entered into the National Pediatric Trauma Registry (NPTR) were analyzed to define the characteristics of pediatric head injury and the impact of extracranial trauma on Central Nervous System (CNS) injury. The 4,400 NPTR head injuries were then compared with 16,524 head injuries recently reported from a predominantly adult trauma registry to illustrate potential population differences. Results indicate that children have a lower mortality, that the addition of extracranial injury significantly reduces recovery potential, that CNS injury is the predominant and most common cause of pediatric traumatic death, and that the automobile is the most lethal component of a child's environment.

Adult↗
PubMed1989

National Pediatric Trauma Registry.

The National Pediatric Trauma Registry (NPTR) is a multi-institutional database designed to compile information concerning all aspects of pediatric trauma care. The registry is designed and operated in a manner that maximizes data accuracy and provides this information to all participating investigators. The growth of the database has allowed the NPTR to provide the first accurate epidemiologic description of pediatric trauma as a national disease, as well as to develop national norms for pediatric trauma care. The registry presently contains 10,177 patients, and is undergoing revisions (phase II) to allow a more focused evaluation of various aspects of the clinical care and rehabilitation of the pediatric trauma patient.

Child↗
PubMed1989

A highly conserved Brassica gene with homology to the S-locus-specific glycoprotein structural gene.

The S-locus-specific glycoprotein of Brassica and the gene encoding it (the SLG gene) are thought to be involved in determining self-incompatibility phenotype in this genus. It has been shown that the Brassica genome contains multiple SLG-related sequences. We report here the cloning and characterization of a Brassica oleracea gene, SLR1, which corresponds to one of these SLG-related sequences. Like the SLG gene, SLR1 is developmentally regulated. It is maximally expressed in the papillar cells of the stigma at the same stage of flower development as the onset of the incompatibility response. Unlike SLG, the SLR1 genes isolated from different S-allele homozygotes are highly conserved, and this gene, which appears to be ubiquitous in crucifers, is expressed in self-compatible strains as well as self-incompatible strains. Most importantly, we show that the SLR1 gene is not linked to the S-locus and therefore cannot be a determinant of S-allele specificity in Brassica.

Amino Acid Sequence↗
PubMed1988

Major blunt abdominal trauma due to child abuse.

We reviewed 15 years' experience with childhood trauma at two hospitals in different cities, one a city hospital, the other a children's hospital, to learn the extent, circumstances, presentations, and consequences of major blunt abdominal trauma due to child abuse. Some 10,000 children admitted to these hospitals for treatment of injuries from 1972 through 1986 provided the basis for the study; the incidence and severity of pediatric trauma at the two hospitals was similar, in that 13% of the visits to both hospitals' emergency rooms were for trauma, of which 5% resulted in admission. Major blunt abdominal trauma due to child abuse accounted for 22 of these cases, six at the former, 16 at the latter, and represented less than 0.50% of all abused children seen at both institutions. The average age was 24 mo; 14 were boys and eight were girls. In only two instances was the family unit intact; in both, the child was abused by the babysitter. Otherwise, the father, or the mother's "boyfriend," was responsible. Overall mortality was 45%, and was related both to type of injury and presenting signs. Of one who presented with an epigastric mass due to a pancreatic hematoma, none died; the pseudocyst which subsequently developed resolved on bowel rest and TPN. Of three who presented with bilious vomiting due to duodenal hematoma, none died; one required operative evacuation. Of five who presented with peritonitis due to duodenojejunal rupture, one died; this child presented greater than 24 hr following injury in profound septic shock. Of three who presented with hypovolemia due to moderate hemorrhage, none died; the former two were managed conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1987

Fifteen years' experience with penetrating trauma to the head and neck in children.

To determine the extent and consequences of penetrating trauma to the head and neck in children, as well as the safety and efficacy of selective management of penetrating wounds of the face and neck, we reviewed our experience with these injuries since 1970. During this interval, 45 children aged 2 to 17 years were admitted for treatment of 37 missile wounds (MW) and eight stab wounds (SW). Most patients reached the hospital within 30 minutes of injury. The greatest single number of these injuries were due to accidents; violent crimes accounted for the remainder of injuries in which a motive for attack was known. Craniotomy was performed in neurologically viable patients only; neck exploration was reserved for those patients who presented with profuse hemorrhage, an expanding or pulsatile hematoma, respiratory distress, or violation of the esophagus, trachea, or great vessels seen on fluoroscopy, endoscopy, or angiography. Overall survival was 87% (MW 84%, SW 100%). Three of the nonsurvivors presented in extremis with gunshot (GSW) wounds to the head, and died shortly thereafter, while two who presented with similar injuries survived craniotomy but died subsequently from irreversible brain damage; one presented in shock due to massive hemorrhage (internal jugular vein transection flush with the base of the skull) and exsanguinated during attempted repair. Among the 39 survivors, 15 sustained multiple wounds, but only two presented in shock, due in both instances to tension pneumothorax. Soft tissue injuries of the scalp, face, and neck accounted for 36 of the 39 nonfatal wounds; five of these involved major cervical structures, but only four required immediate exploration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

External silo reduction of the unruptured giant omphalocele.

Construction of an external silo dressing over the intact omphalocele membrane allows complete reduction of the giant omphalocele with enlargement of the abdominal cavity before surgical intervention, so that primary closure of the abdominal wall can be achieved. Three infants with giant omphalocele containing a central liver were successfully managed by this technique avoiding the complications associated with operative silo placement or simple membrane painting.

Bandages↗
PubMed1987

Response to injury in children with closed femur fractures.

Fifty children admitted with closed femur fracture as a single major injury were monitored for change in vital signs and hematocrit. Hypotension was not observed. No child required blood replacement. Only 33% of the children had a measurable change in hematocrit, averaging a four-point drop. There was a marked febrile response to injury in 80% of the children which lasted an average of 4 days. Children admitted with femur fractures who develop hypotension or rapid drop in hematocrit should be promptly evaluated for another source of blood loss.

Adolescent↗
PubMed1986

Investigation of alternative mechanisms of collagen-induced platelet activation by using monoclonal antibodies to glycoprotein IIb-IIIa and fibrinogen.

Anti-HuPl-ml (reactive with IIIa) and anti-C2G7 (reactive with the carboxyl terminal of the alpha chain of fibrinogen) were used to investigate platelet aggregation, fibrinogen binding and thromboxane synthesis induced by low dose collagen (LDC) or high dose collagen (HDC) in normal or aspirin treated platelets. Anti-HuPl-ml and anti-C2G7 inhibited LDC induced platelet aggregation almost completely whilst abolishing fibrinogen binding; thromboxane production although reduced, still occurred. Thus LDC activation was dependent on fibrinogen binding to Gp IIIa. Aggregation of platelets induced by HDC was inhibited with anti-C2G7 or anti-HuPl-ml by 15-35% in association with a modest reduction in thromboxane (TxB2) production (with anti-HuPl-ml) and total inhibition of fibrinogen binding. When anti-HuPl-ml was added to aspirin treated platelets, aggregation with HDC although substantially reduced was not totally abolished. Collagen appears to activate platelets in a dose related manner in which there are at least three possible mechanisms via: (i) GpIIb-IIIa and associated fibrinogen binding; (ii) prostaglandin pathway; (iii) an alternate pathway responsible for approximately 20%-30% of platelet aggregation.

Antibodies, Monoclonal↗
PubMed1985

Nasopharyngeal carcinoma: clinical and radiographic findings in children.

Nasopharyngeal carcinoma (NPC) in childhood occurs so infrequently that it is not suspected in affected children until the disease has been present for a long time and local spreading has occurred. The survival rates are therefore quite poor. Six children with NPC are described. A massive local lymph node spread simulating lymphoma was present in half of the patients; in the other half the disease was more subtle, presenting with epistaxis and CNS involvement. If an evaluation of the nasopharynx were part of the initial physical examination in children, the diagnosis of NPC would be made earlier and survival rates would improve.

Adolescent↗
PubMed1984

Indications and techniques of upper gastrointestinal endoscopy in infants and children.

Review of 98 endoscopies done over a 4-year period demonstrated that these procedures aided in the diagnosis and management of infants and children with upper gastrointestinal disorders. Endoscopic indications included evaluation of the esophagus in gastroesophageal reflux, achlasia, and lye ingestion; and evaluation of biliary and pancreatic diseases. Other indications included diagnosis of the site of upper gastrointestinal bleeding and treatment of esophageal varices with sclerotherapy, esophageal strictures with steroid injection and removal of foreign bodies. The majority of the procedures were done under sedation. There were no complications.

Adolescent↗
PubMed1983

Stab wounds in children.

The Pediatric Surgical Service of Harlem Hospital Center admitted 75 children, 16-years-old and younger, with stab wounds since 1969. Rapid resuscitation and triage of children with major injuries directly to the operating room achieved 100% survival. Review of the circumstance of injury revealed that 75% of the stab wounds were inflicted by children and 66% were known to have been intentional. Social service and psychiatric intervention for troubled children and their families is essential and may decrease the risk of subsequent traumatic injury.

Adolescent↗
PubMed1983

Ten years of experience with falls from a height in children.

Falls from a height are a major cause of accidental death in urban children. The medical and social data on 61 children admitted over the last decade for falls of one or more stories were reviewed. Seventy-seven percent of the children survived. Of the children who fell three stories or less, all survived (100%). Fifty percent mortality occurred between the fifth and sixth floors. Seventy-seven percent of the falls were accidental and 23% of the children jumped or were pushed. The 96% decrease in accidental falls from windows since 1979 demonstrates that the "Children Can't Fly" program in New York City has almost eliminated accidental falls from windows in our hospital population.

Accidents, Home↗
PubMed1983

Detection of glycoprotein IIb and IIIa by monoclonal antibodies.

Murine monoclonal antibodies were produced against human platelet membranes and screened on platelets by a 125I protein A radioimmunoassay. Several clones produced platelet specific antibodies as they showed no reaction with peripheral blood lymphocytes, neutrophils, bone marrow (excluding megkaryocytes) or several cell lines. Two antibodies (designated anti-HuPl-m1a and anti-HuPl-m1b) were of particular interest in that although platelet specific they were non-reactive with platelets from a thrombasthenic patient. In functional assays these two antibodies could specifically inhibit ADP and collagen induced aggregation of platelets and release of ATP, retard platelet aggregation and ATP release induced by epinephrine, and inhibit ADP induced platelet fibrinogen binding. These two antibodies appear to recognize glycoproteins IIb and IIIa as analysis by SDS-PAGE using radiolabelled membranes revealed a two chain structure of molecular weight 112000 and 122000 daltons when run after reduction and 87000 and 140000 daltons non-reduced.

Adenosine Triphosphate↗