A comparison of two ventilator systems using an infant lung model.
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Equipment Design↗
Biomedical subjects
B Horn
Publications and source records attributed to B Horn.
Transient hypoparathyroidism following successful treatment of hypercalcaemia of malignancy in a dog.
A 4-year-old, entire female, English Cocker Spaniel was presented for treatment of lymphosarcoma and secondary hypercalcaemia. After induction chemotherapy the dog became severely hypocalcaemic and showed signs of weakness, muscle fasciculation and facial pruritus. Hormone analysis confirmed inadequate production of parathyroid hormone. Although hypocalcaemia has been previously reported as a component of tumour lysis syndrome, it has not been associated with transient parathyroid hormone deficiency.
Animals↗
Evaluation of an insulin zinc suspension for control of naturally occurring diabetes mellitus in dogs.
OBJECTIVE: To evaluate duration of action of an insulin zinc suspension (Caninsulin, Intervet) in spontaneously occurring cases of canine diabetes mellitus and suitability of its use as a once daily administered insulin for treatment of this disease. DESIGN: Eight client-owned canine diabetics were included in a prospective pilot study. All dogs had been treated with Caninsulin for a minimum of 2 months and were considered on clinical grounds to be adequately stabilised. PROCEDURE: Dogs were hospitalised for 24 h and blood collected every 2 h via indwelling venous catheters for blood glucose determination. RESULTS: Once daily Caninsulin administration failed to maintain glycaemic control for greater than 13 h in five of eight dogs, but acceptable blood glucose concentrations were maintained for 22 h and greater than 24 h in two others. One dog became distressed during hospitalisation and the blood glucose curve did not show an identifiable response to the insulin. CONCLUSION: Most diabetic dogs may require twice daily administration of Caninsulin for satisfactory glycaemic control, but once daily administration may be adequate in some animals. More comprehensive investigation into duration of activity of Caninsulin is warranted.
Animals↗
Disseminated Mycobacterium avium infection in a dog with chronic diarrhoea.
A 3-year-old Maltese-cross dog presented with a 4-month history of chronic diarrhoea and inappetence. Poorly regenerative anaemia, leukocytosis and hypoproteinaemia were evident on several occasions. Biopsies of stomach, duodenum and colon revealed marked infiltration of mucosae by macrophages containing many acid-fast bacilli. Similar organisms were numerous in a faecal smear. Melaena, hematochezia and severe abdominal pain developed and were unresponsive to therapy. Following euthanasia and necropsy, histiocytic cells containing acid-fast bacilli were found throughout the gastrointestinal tract, mesenteric and peripheral lymph nodes, spleen, liver, kidney and lungs. The organism was identified as Mycobacterium avium by bacterial culture and polymerase chain reaction testing.
Animals↗
Autoimmune hemolytic anemia in patients with SCID after T cell-depleted BM and PBSC transplantation.
We report a high incidence (19.5%) of autoimmune hemolytic anemia (AIHA) in 41 patients with SCID who underwent a T cell-depleted haploidentical transplant. Other than infections, AIHA was the most common post-transplant complication in this patient cohort. Clinical characteristics and treatment of eight patients who developed AIHA at a median of 8 months after the first T cell-depleted transplant are presented. All patients had warm-reacting autoantibodies, and two of eight had concurrent cold and warm autoantibodies. Clinical course was most severe in two patients who had cold and warm autoantibodies. Five patients received specific therapy for AIHA. Successful taper off immunosuppressive therapy for AIHA coincided with T cell reconstitution. Delayed reconstitution of T cell immunity, due to T cell depletion, immunosuppressive conditioning and CsA, as well as paucity of regulatory T cells, are the likely explanations for the occurrence of AIHA in our patient cohort. Screening of the population at risk may prevent morbidity and mortality from AIHA.
Anemia, Hemolytic, Autoimmune↗
An adult system versus a Bain system: comparative ability to deliver minute ventilation to an infant lung model with pressure-limited ventilation.
UNLABELLED: We compared the efficacy of an adult circle system versus a Bain system to deliver minute ventilation (V(E)) to an infant test lung model using pressure-limited ventilation. To simulate a wide variety of potential infant clinical states, V(E) was measured with two compliances: at peak inspiratory pressures (PIP) of 20, 30, 40, and 50 cm H2O and at respiratory rates (RR) of 20, 30, 40, and 50 breaths/min. Each measurement was made three times, and their average was used for analysis. Data were analyzed using the multiple regression technique. In both normal and low-compliance lung models, V(E) was nearly identical between adult circle and Bain systems (P = 0.67 for normal compliance model, P = 0.89 for low-compliance model). V(E) positively correlated with RR (P < 0.001), PIP (P < 0.001), and lung compliance (P < 0.001). Very high PIP or RR were required to deliver V(E) to the low-compliance lung model. The adult circle system is equivalent to the Bain system in its ability to ventilate an infant test lung over a wide range of RR, PIP, and two compliances during pressure-limited ventilation. V(E) is dependent of PIP, RR, and lung compliance. With low-compliance lungs, both systems require a high PIP. We conclude that both anesthetic systems deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants. IMPLICATIONS: We obtained results from this infant test lung study that indicate that either an adult circle breathing system or the Bain system can reliably deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants.
Adult↗
Pressure-limited ventilation of infants with low-compliance lungs: the efficacy of an adult circle system versus two free-standing intensive care unit ventilator systems using an in vitro model.
UNLABELLED: We compared the efficacy of a Drager Narkomed GS (North American Drager, Telford, PA) equipped with an adult circle system with two free-standing infant ventilator systems (Servo 300; Siemens Medical Systems, Danvers, MA and Babylog 8000; North American Drager) to deliver minute ventilation (VE) using pressure-limited ventilation to a test lung set to low compliance. To simulate a wide variety of potential patterns of ventilation, VE was measured at peak inspiratory pressures (PIP) of 20, 30, 40, and 50 cm H2O and at respiratory rates (RR) of 20, 30, 40, and 50 breaths/min. Each measurement was made three times; the average was used for data analysis using the multiple regression technique. Delivered V(E) was positively correlated with both PIP (P = 0.001) and RR (P = 0.001). Only minimal differences in VE were observed between the circle and the two free-standing systems. At lower RR and PIP, the Babylog 8000 system delivered slightly higher VE than the circle system, whereas at higher RR and PIP, the Babylog 8000 delivered slightly lower VE than the circle system; these differences in VE were not statistically significant (P = 0.45). The Servo 300 delivered slightly higher VE than the circle system in all test conditions, but these differences were not statistically significant (P = 0.09). None of the differences in delivered VE between the Servo 300 and the circle system are of clinical importance. IMPLICATIONS: Our laboratory investigation suggests that pressure-limited ventilation delivered by a standard adult circle system compares favorably with that of freestanding infant ventilators used in pressure-limited mode. Changing from an adult circle system to a free-standing pressure-limited ventilator may not substantially improve ventilation of a low-compliance infant lung; the efficacy of such a practice should be investigated.
Adult↗
[The new face of tuberculosis--update for the practitioner].
Migration, poverty, hunger, HIV epidemia and development of multiresistant TB require more awareness of the problem "tuberculosis'. Investigation and treatment of TB are a challenge to every doctor and require not only knowledge and skills, but also a lot of ability in communication and empathy to master numerous difficult conditions.
AIDS-Related Opportunistic Infections↗
Retrograde fibreoptic intubation in a child with Nager's syndrome.
PURPOSE: The authors describe a retrograde fibreoptic technique for tracheal intubation in a micrognathic child with a tracheo-cutaneous fistula. CLINICAL FEATURES: A four-year-old child with Nager's syndrome presented for surgical closure of a tracheocutaneous fistula. A tracheostomy tube had been placed in the neonatal period for management of upper airway obstruction due to severe micrognathia. At 2 1/2 yr of age, after a successful mandibular advancement procedure, the tracheostomy was removed and the child allowed to breathe through the natural airway. Preoperative physical examination revealed an uncooperative child, unable to open her mouth due to limited temporo-mandibular motion. The child was first anaesthetized with ketamine, 70 mg im, then halothane by mask. The authors were unable to open the child's mouth sufficiently to allow rigid laryngoscopy. Attempts at oral and nasal fibreoptic intubation were unsuccessful. Ultimately, the authors were able to intubate nasally by passing an ultrathin Olympus LF-P laryngoscope under direct vision through the tracheocutaneous fistula in a cephalad direction, through the larynx and nasopharynx, then out the nares. An endotracheal tube was then advanced over the fibreoptic scope and positioned distal to the tracheocutaneous fistula. The surgical procedure was successfully accomplished and the trachea was extubated postoperatively without difficulty. CONCLUSION: Retrograde fibreoptic intubation may be an option for airway management of a select group of children who cannot be intubated by traditional techniques.
Child, Preschool↗
Care-giver evaluation of anti-gastroesophageal reflux procedures in neurologically impaired children: what is the real-life outcome?
Although the pediatric surgical literature is replete with reports of the success of operations for gastroesophageal reflux, postoperative complications are being reported with increasing frequency for the neurologically impaired subpopulation. Because a large portion of a care-giver's life is involved in attending to a neurologically impaired child, parental satisfaction with the outcome of these operations should be an important consideration when the use of such procedures is contemplated. The purpose of the present study was to assess the impact of antireflux operations with respect to care-giver opinions regarding the procedure. The authors retrospectively reviewed 25 charts (of 13 girls and 12 boys; age range, 3 months to 18 years) and documented (through survey results) perceived child well-being, objective care requirements, and overall care-giver satisfaction with the procedure. Results indicate there was significant improvement in feeding indexes, care-giver perception of the child's comfort, and quality of life postoperatively. Moreover, there was significant improvement in the care-givers' attitudes regarding their child, including the level of frustration in caring for the child, and the parents' overall quality of life. Care-givers also believed that the operation's result was about or better than what they had expected. In conclusion, the study documents care-giver satisfaction with antireflux procedures. Postoperatively, child care is easier and the quality of time spent with the child is better. The impression of better quality of life postoperatively for a neurologically impaired child may be the greatest success in this sometimes frustrating endeavor.
Adolescent↗
[The many-colored picture of endocrine crisis in clinical practice--psychological symptoms in hormonal emergencies].
Four case reports from a general practitioner's daily work illustrate the problem of endocrine crises hidden by psychiatric symptoms. Psychologic and psychiatric problems in a GP's office are very frequent; endocrine crises are very rare, but with high consequences for the patient. Optimal coordination and cooperation between psychiatric and somatic clinicians and investigation are necessary for optimal education of future physicians.
Addison Disease↗
A simple method of blood pressure determination in pediatric patients when automated noninvasive blood pressure measurement fails.
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Anesthesia↗
[A lecture on the topic of stress].
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Humans↗
[The rescue chain does not stop in the hospital].
When a patient is saved from a severe illness or accident, his doctor (family practitioner) must care about many problems which are not really medical but also social, psychologic, financial, occupational or political. The interest must be revealed during education and supported by head doctors in hospitals during vocational training years. Therefore, postgraduate training must discuss not only medical problems; the themes mentioned above are just as important.
Acute Disease↗
A new method of endotracheal tube fixation for pediatric neurosurgical patients.
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Adhesives↗
[Greetings from Sherlock Holmes].
Just at a time, when practical education and post-graduate training is really a permanent problem, it is necessary to pay attention again and again to the rare problems, which also appear in the doctor's office. They are by far not only "rare and useless": The recognition by the physician may be vital for the patient. Four examples from daily practice illustrate the significance of rarities in the physician's office as a permanent challenge.
Adult↗
[Nicotine weaning in clinical practice].
A few facts about the smoking problem, strategies and possibilities of nicotine withdrawal in practice and thoughts on prevention of recurrence of smoking are reviewed. This presentation is intended as support to the antismoking campaign of the Swiss Health Office and the Federation of Swiss Physicians.
Family Practice↗
Cancer symptom management in the elderly.
Clear and concise written guidelines must designate accountability for coordination of the persons involved. As might be assumed by the preceding discussion, the process takes considerable time and effort. The development of clear guidelines is a long term venture and usually does not occur quickly. In some cases a nearby agency may have developed a useful protocol that when shared with area providers, is quickly accepted. However, one to two years is not uncommon to developing a complex plan of care or protocol which can be used effectively and is specific to the conditions in a particular setting. Written guides, when developed correctly, should save all providers' time, and ensure better client care. Clear directions regarding the care to be provided and well-established lines of communication can save health care providers time and increase the likelihood of better health outcomes for the client. The coordination of planning within the home care agency, and across professional, agency and geographic boundaries is a prerequisite for successful cancer symptom management. The central aim in planning is to enhance the family's ability to manage independently and to facilitate continuity of care in the use of health care services. For the client to have the greatest potential for symptom amelioration, the home care agency must assume a major role in the coordination of care providers in the delivery of care.
Aged↗