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Biomedical subjects

C Johnston

Publications and source records attributed to C Johnston.

At least 217 records · Page 12Linked to original sources

Pediatric critical care transport survey: team composition and training, mobilization time, and mode of transportation.

A survey was conducted to determine the current standard of care with regard to team composition and training, mobilization time, and vehicle use for pediatric critical care transport. An evaluation of 30 pediatric referral centers revealed that 60% provide a critical care transport team. Of those teams, the mean number of transports per year was 304. Response time ranged from 10 to 90 minutes. All teams included a physician all or most of the time; 100% of teams included a critical care nurse, and 50% always included a respiratory therapist. Ambulances alone are used in 28% of systems, with the remainder using combinations of ambulances, helicopters, and fixed wing aircraft. A proposal is presented for future standards in pediatric critical care transport with regard to the factors discussed.

Child↗

Islet-cell antibodies as predictors of the later development of type 1 (insulin-dependent) diabetes. A study in identical twins.

To determine the value of islet-cell antibodies, both complement-fixing and non-complement-fixing, in predicting the later development of Type 1 (insulin-dependent) diabetes, we studied different groups of identical twins. Twelve twins have developed diabetes and 11 of these had non-complement-fixing islet-cell antibodies before diagnosis, and eight out of nine tested had complement-fixing islet-cell antibodies. Of the twins who have remained non-diabetic for many years and are now unlikely to develop diabetes, twelve have had non-complement-fixing islet-cell antibodies at some stage but only four have ever had complement-fixing antibodies. In 29 non-diabetic co-twins tested within 5 years of the diagnosis of diabetes in the affected twin the presence of islet-cell antibodies, especially complement-fixing, predicted the progression to frank diabetes with a high specificity (100%), sensitivity (88%) and predictive value (100%). In pairs remaining discordant the antibodies were found more frequently in the diabetic than the non-diabetic twin. We conclude that the presence of islet-cell antibodies is not genetically determined and can occur without progression to diabetes. However, the presence of islet-cell antibodies, especially complement-fixing, in non-diabetic twins tested soon after the diagnosis of their co-twin, indicates a high risk for the development of diabetes.

Autoantibodies↗

Treatment of recurrent nightmares by the dream reorganization approach.

Dream reorganization is introduced as a new theoretical and treatment approach to the alleviation of recurrent nightmares, derived from the principles of the Seligman and Yellen (1987) theory of dream construction. The cognitive-behavioral dream reorganization treatment package consists of two treatment components. Systematic desensitization with coping self-statements is employed to alter the emotional episode by counterconditioning a relaxation response to anxiety-evoking nightmare content. Guided rehearsal of mastery endings to dream content hierarchy items is added to modify the secondary visual stimuli associated with recurrent nightmares. The dream reorganization approach is presented in the case of a 10-year-old male with a fear of sleeping alone due to recurrent nightmares. Following treatment, the client reported 100% reduction in nightmares and demonstrated 100% reduction in night time arrival in the parents' room. The present report provides a theoretical rationale for dream reorganization, and future directions for research in the treatment of recurrent nightmares.

Adaptation, Psychological↗

Conservative management of primary cervical lymphoma using combination chemotherapy: a case report.

A 22-year-old nulligravida presented with a stage IE/IIIB primary malignant lymphoma of the cervix which measured 8 cm in diameter. In order to preserve reproductive potential, a 12-week course of methotrexate with leucovorin rescue, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin was administered. One month later a 4-cm-diameter left parametrial mass was excised at laparotomy; no tumor was detected in the specimens obtained. Menses resumed after an additional 6 months. The patient was clinically disease-free at the 33-month follow-up.

Adult↗

Gastric heterotopia causing airway obstruction.

Two infants are reported each with a mass of heterotopic gastric tissue in the hypopharynx causing airway obstruction. Endoscopic laser removal of the tumours proved a satisfactory method of treatment. Gastric heterotopia in the head and neck region is rare but should be considered as a cause of stridor in infants.

Airway Obstruction↗

Levels of adult alcohol consumption induced by interactions with child confederates exhibiting normal versus externalizing behaviors.

Investigated levels of distress and alcohol consumption in Ss interacting with problematic vs non-problematic child confederates. Social drinkers were randomly assigned to interact with boys trained to enact behaviors characteristic of either normal or attention-deficit disorder/conduct disorder (ADD/CD) children. Mood data were collected before and after the interaction. Ss engaged in ad lib beer consumption for 20 min, while anticipating another interaction with the same boy. Children in the ADD/CD role produced comparably distressed moods for both male and female Ss. However, only men drank to higher blood-alcohol levels in the ADD/CD vs. normal child condition. Results suggest that higher rates of drinking observed in fathers of ADD/CD children may be partly a function of their particular response to the distress associated with interactions with such children.

Adult↗

Serological profiles in the connective tissue diseases in Zimbabwean patients.

The serological profiles of 104 Zimbabwean patients with clinically diagnosed connective tissue diseases were determined. The prevalence of rheumatoid factor was less than would have been expected in other geographical groups, but the prevalence of antinuclear antibodies was similar. Despite considerable racial, socioeconomic, and genetic differences in our patient group compared with other previously published studies the specificity and sensitivity of antinuclear antibodies, notably to DNA and Sm, correlated well with clinical diagnoses. This study validates the use of these serological tests in the investigation of this group of patients.

Adolescent↗

Hyponatraemia and Moduretic-grand mal seizures: a review.

Three cases are presented which emphasize the importance of hyponatraemia as a cause of grand mal seizures. The combination of hydrochlorothiazide and amiloride appears to increase the risk of hyponatraemia. We discuss the aetiology and treatment of hyponatraemia and review the necessity for such combination therapy. We recommend caution in prescribing diuretics and preparations such as Moduretic should be used only in those few patients shown to need potassium supplementation.

Aged↗

Mothers' attitudes and their children's behaviors in 3-year-olds born prematurely and at term.

A sample of 94 mothers and their 3-year-old children participated in a cross-sectional study to measure maternal overprotective attitudes and children's behavior problems. Mothers in the full-term group (n = 47) were matched to mothers in the preterm group (n = 47) on maternal age, maternal education, and marital status. The groups were balanced for the child's gender, birth order, and mother's nationality. The subjects answered the Mother-Child Relationship Evaluation (MCRE) to measure maternal attitudes and the Behavior Screening Questionnaire (BSQ) to measure behavior problems in preschoolers. Overall, children born prematurely have the same incidence of behavior problems as children born full-term. However, the subgroup of preterms who had respiratory distress syndrome (RDS) had a higher incidence of behavior problems. Conversely, the results suggest that mothers of children born prematurely without RDS have more overprotective attitudes towards their children. Maternal overprotection is minimally associated with behavior problems.

Attitude↗

A psychometric study of positive and negative nominations and the pupil evaluation inventory.

Two peer evaluation measures, the Pupil Evaluation Inventory (PEI) and positive and negative nominations were compared in a sample of 260 children in grades 1 to 5. Stabilities of the measures were assessed over a 4-month period. In the total sample, PEI factors and negative nominations were more stable than positive nominations, and PEI Aggression and Withdrawal scores were more stable than negative nominations. PEI Aggression and Withdrawal scores were more stable in grades 3 and 5 than in grade 1, and the Likability factor was more stable in grades 2 to 5 than in grade 1. Negative nominations were most strongly correlated with the PEI Aggression factor, and positive nominations were more strongly correlated with Likability than with Aggression. Implications for the use of these nomination measures are discussed.

Aggression↗

Chronic angiotensin converting enzyme inhibition in the two-kidney, one clip hypertensive rat.

Treatment with an angiotensin converting enzyme (ACE) inhibitor in renovascular hypertension produces acute effects on renal function; however, the long-term consequences of this are not known. We have studied the effect of chronic enalapril treatment on renal structure and function in the two-kidney, one clip model of renovascular hypertension in the rat. Four weeks after the left renal artery was clipped, the hypertensive rats were randomly allocated to treatment with enalapril, minoxidil or to no treatment. The drug dose was titrated for maximal hypotensive effect. After 4 months of treatment blood pressures were 129 +/- 3 mmHg (enalapril), 193 +/- 5 mmHg (minoxidil) and 220 +/- 4.8 mmHg (no treatment). Twelve months later survival was 84% (enalapril group), 48% (minoxidil group) and 15% (untreated group). Split kidney function (51Cr-EDTA clearance, ml/min) of the clipped kidneys was 0.0 (enalapril group), 0.26 +/- 0.23 (minoxidil group) and 0.74 +/- 0.13 (untreated group). The clipped kidney from enalapril-treated rats weighed 0.46 +/- 0.1 g, much less than in the minoxidil-treated group (1.2 +/- 0.07) or the untreated group (1.14 +/- 0.10). Enalapril treatment was withdrawn for 2 weeks in five rats, but the clipped kidney remained small and non-functional. Histological examination revealed marked interstitial fibrosis and tubular atrophy in clipped kidneys from both enalapril groups, in contrast to minor changes in the minoxidil-treated and the untreated groups. We conclude that chronic enalapril treatment of two-kidney, one clip hypertension in the rat improved survival and preserved total renal function, but was associated with irreversible fibrotic atrophy of the clipped kidney.

Angiotensin-Converting Enzyme Inhibitors↗

Pediatric prehospital care in a southern regional emergency medical service system.

A retrospective review of 2,302 ambulance run reports from the Birmingham Regional Emergency Medical Service System indicated that 6% of all runs are for patients in the pediatric age group (less than 18 years of age). Injuries related to emergencies were responsible for more than 65% of pediatric runs, and 30% were related to motor vehicle accidents. Surprisingly, 8% of calls were for seizure disorders, a figure much higher than in the adult population. Approximately 38% of the runs involved children between the ages of 6 and 12 years. Significantly more male than female patients were involved. This descriptive epidemiologic study is antecedent to effective planning and implementation of pediatric prehospital care programs. Training of emergency personnel should be targeted toward treating motor vehicle injuries, seizures, poisoning, and upper airway obstruction in children.

Accidental Falls↗

Defects in beta-cell function and insulin sensitivity in normoglycemic streptozocin-treated baboons: a model of preclinical insulin-dependent diabetes.

During the preclinical period of human insulin-dependent diabetes, both impaired pancreatic beta-cell function and increased insulin resistance are found, although normoglycemia is preserved. To better understand the changes in beta-cell function and insulin sensitivity that occur in preclinical insulin-dependent diabetes, we performed a panel of in vivo beta-cell function tests and measured insulin sensitivity in adolescent male baboons both in normal health and after a small dose of streptozocin which did not induce hyperglycemia. Nine animals were studied before (stage 1) and 1 week after receiving a low dose of streptozocin (stage 2). There was no change in fasting plasma glucose or insulin. The mean glucose disposal rate (Kg) remained within the normal range, but dropped from 2.0 +/- 0.2% +/- SE) to 1.2 +/- 0.1%/min (P less than 0.01), the acute insulin response to arginine (AIR(arg)) fell from 67.7 +/- 19.4 microU/mL (485.8 +/- 139.2 pmol/L) to 32.8 +/- 7.2 microU/mL (235.3 +/- 51.7 pmol/L; P less than 0.05), and the acute insulin response to glucose (AIR(gluc)) fell from 881 +/- 243 microU/mL.10 min (6321 +/- 1744 pmol/L.10 min) to 334 +/- 82 microU/mL.10 min (2396 +/- 588 pmol/L.10 min; P less than 0.01). The most dramatic change, however, was in the ability of hyperglycemia to potentiate AIR(arg) (expressed as the slope of potentiation). This was reduced by 94% from 1.8 +/- 0.5 to 0.1 +/- 0.1 (P less than 0.01), with almost no overlap in values between stages 1 and 2. Insulin sensitivity was also lower 1 week after streptozocin treatment. When the animals were restudied 8 weeks after streptozocin treatment (stage 3) most measures of beta-cell function were not significantly different from those in stage 1. The fasting plasma glucose level was 85.4 +/- 4.3 mg/dL (4.7 +/- 0.2 mmol/L), Kg was 1.8 +/- 0.3%/min, fasting plasma insulin was 35.9 +/- 8.5 microU/mL (257.6 +/- 61.0 pmol/L), AIR(arg) was 67.0 +/- 15.4 microU/mL (480.7 +/- 110.5 pmol/L), and AIR(gluc) was 615.3 +/- 265.3 microU/mL.10 min (4413 +/- 1901 pmol/L.10 min), and tissue insulin sensitivity was 2.7 +/- 0.4 x 10(4) min/microU.mL. These values show extensive overlap with those of stage 1, from which they are not significantly different. The slope of glucose potentiation, however, remained low in all animals at stage 3.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗