Biomedical subjects
B Lee
Publications and source records attributed to B Lee.
Venous flow rate and its effect on the delivery of an intravenous stimulus in psychophysiological studies.
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Mrs. D, my first cancer patient.
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A shielded sound-attenuating chamber.
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Houston: they emphasize their nursing.
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Administrator on a spot: upgrading Houston district hospitals is a test of nerve and skill.
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Further Observations on certain Reducing and Oxidising Reactions in Milk.
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Pediatric colonoscopy.
With the improvement of instruments, colonoscopy has become applicable also for children. During the past 10 years, pediatric colonoscopies were performed 83 times on 45 infants and children. The value and indications in pediatric colonoscopy are described here. Pediatric colonoscopy is a very significant complement to the conventional clinical and radiologic examinations.
Endovascular repair of abdominal aortic aneurysm in a patient with renal transplant.
Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.
Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study.
BACKGROUND: In February, 1999, a local US health department identified a cluster of pertussis cases among neonates born at a community hospital and recommended oral erythromycin for post-exposure prophylaxis for about 200 neonates born at that hospital between Feb 1 and Feb 24, 1999. We investigated a cluster of seven cases of infantile hypertrophic pyloric stenosis (IHPS) that occurred the following month among the neonates who had received erythromycin. METHODS: We obtained a masked, independent review of the IHPS ultrasonography diagnoses, calculated the monthly IHPS incidence, and compared index and historical (1998-99) IHPS cases with respect to several characteristics including erythromycin exposure. We used a retrospective cohort of infants born in January and February, 1999, to investigate further erythromycin exposure and development of IHPS. FINDINGS: An independent review confirmed the ultrasonographic diagnoses of all seven index IHPS cases. All index cases versus none of the historical IHPS cases had been given erythromycin for pertussis prophylaxis. The IHPS rate for infants born in the hospital in February, 1999, was 32.3 per 1000 liveborn infants, representing nearly a seven-fold increase over 1997-98 (relative risk 6.8 [95% CI 3.0-15.7]). Among infants born in January and February, 1999, erythromycin was associated with IHPS (absolute risk 4.5%, relative risk infinity [1.7-infinity]). INTERPRETATION: Neonates receiving oral erythromycin may have an increased risk of IHPS. The risks and benefits of erythromycin for neonatal pertussis prophylaxis should be re-evaluated, and caution should be used in defining risk groups for prophylaxis.
Effect of hypoxia on respiratory activity in the foetus.
1. Breathing movements stop soon after the induction of hypoxia in foetal animals, a response attributed to the active inhibition of the respiratory centres. Separate studies using punctate lesions have identified lateral pontine and thalamic sites in foetal sheep from which respiratory inhibition may arise, but whether either of these loci are actually oxygen sensitive or whether they receive input from other regions responsive to hypoxia, has not been established. 2. FOS immunocytochemistry was used to identify neuronal pools activated by hypoxia in the brain of late-gestation foetal and newborn sheep. FOS-positive cells were found in the pons in regions corresponding to the medial parabrachial and Kolliker-Fuse nuclei and were shown to be catecholaminergic. Neurons in this pontine region were also activated by the piperizine drug almitrine, which, like hypoxia, inhibits respiratory output in the foetus but is a respiratory stimulant in the newborn and adult. Because these pontine neurons do not express FOS protein after challenge with hypoxia or almitrine in the newborn lamb, we argue that they are crucial to the hypoxic inhibition of respiratory activity in foetal life. 3. The role of the placenta in determining these foetal responses and how this may change at birth is discussed.
Approaches to implementing a philosophy of scholarship.
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The effect of a bereavement group experience on bereaved children's and adolescents' affective and somatic distress.
Losing loved ones through death is a common experience for children. Children living in urban centers may be at greater risk for death of family members as a result of increased daily stress and poverty. Children who experience permanent loss of family members without support to grieve are at greater risk for mental health problems. Manifestations of grief that frequently occur in children are psychosomatic complaints and affective distress. This study investigates the prevalence of loss by death among two groups of inner city youths, and the impact of a bereavement group experience on subjects' affective distress and somatic complaints. A significant difference was found between pretest and post-test scores on somatic complaints for the elementary school aged group.
Vertebral artery injury and cerebellar stroke while swimming: case report.
A twenty-five year old woman suffered the acute onset of dysequilibrium followed by headache, nausea, vomiting, vertigo, and slurred speech while swimming. Brain imaging revealed a right cerebellar infarct. Intravenous digital subtraction angiography showed a hypoplastic right vertebral artery and focal narrowing of the dominant left vertebral at the level of the C1-C2 junction. The patient was treated with aspirin and dipyridamole and immobilized for two weeks. She achieved almost complete recovery. Repeat angiography showed resolution of the left vertebral artery defect. Other cases of posterior circulation infarction associated with head turning during sports and ordinary activities are reviewed.
Identifying ICU patients who would not benefit from total parenteral nutrition.
This study attempted to improve patient selection for total parenteral nutrition (TPN) by identifying ICU patients whose prognoses were so hopeless that they would not or would no longer benefit from TPN. Computerized trend analysis of daily Apache II scores, corrected for the presence, number, and duration of major organ system failures was used to predict individual hospital outcome among 50 intensive care unit patients treated with TPN. Thirteen of the 18 deaths were correctly predicted without any false predictions. During the study, the results of predictions were not used to influence clinical decision making. If TPN was withheld in the five patients predicted to die before starting TPN, or withdrawn in the eight patients when they were predicted to die, $28,350 or 11.5% of the cost of TPN during the study period would have been saved. This hypothetical study shows that elimination of inappropriate treatment of patients with hopeless prognosis with the aim of avoiding the prolongation of the process of dying and unnecessary suffering is a compassionate patient-selection strategy that can result in major savings in healthcare resources.
Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients.
Continuous enteral feeding is widely practiced in intensive care units (ICU). We found that pneumonia developed in 54% of 24 ventilated patients on continuous enteral feeding for more than 3 days. This appeared to affect only patients with a persistently high morning (7:00 am) gastric pH, with 12 of 13 (92%) patients developing pneumonia. In 11 patients the causative organisms were cultured initially from the stomach, oropharynx and trachea before pneumonia supervened. This effect was distinct from that found with the prophylactic use of antacids or H2-receptor antagonists. The mortality (46%) of this group of patients was 1.6 times greater than the expected mortality predicted by the Apache II Severity of Disease Classification System.
Rheology of the vitreous body. Part I: Viscoelasticity of human vitreous.
The rheological properties of the vitreous body of the eye are believed to be a function of composition and to differ among species, as well as to vary regionally within the vitreous. These properties are essential to the mechanical functioning of the eye. Although there are gross, qualitative data on vitreous rheology available in the literature, quantitative rheological measurements on human vitreous and on eyes of other species are sparse and incomplete. The aim of the research reported in this series of papers is to study the rheological behavior of human, bovine, and porcine vitreous, to measure the macromolecular and electrolyte content of these samples, and to correlate and compare these values for the different species as a function of location in the vitreous. In this paper, the rheological model used to correlate viscoelasticity of the vitreous is presented, and a detailed description of the rheological instrumentation and methods of analysis used is given. Data on the rheological properties of human vitreous, as a function of location within the eye, are presented. The results show that in the human eye there are significant differences in a number of the viscoelastic parameters as a function of location within the vitreous body.
Rheology of the vitreous body: Part 2. Viscoelasticity of bovine and porcine vitreous.
The viscoelastic properties of the vitreous body from bovine and porcine eyes were determined by microrheometry. Each vitreous sample was sectioned into anterior, central and posterior segments. The rheological properties of each species and region were compared with each other and with the viscoelastic properties of human vitreous reported earlier. The results showed significant variations among species, as well as between regions in all species. All regions of human vitreous have significantly different rheological properties from those of the cow, and from the anterior and posterior regions of the pig; however, the viscoelastic behavior of the central porcine region closely resembles that of the human. In comparing the three species, the major differences found are in those parameters characterizing "viscous" or dissipative properties; values of "elastic" or energy storage properties were similar.