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Biomedical subjects

C T Kisker

Publications and source records attributed to C T Kisker.

At least 37 records · Page 2Linked to original sources
PubMed1985

Effects of acidosis on fetal and maternal blood coagulation: a fetal lamb model.

The effects of fetal acidosis (mean pH 6.93) on fetal and maternal blood coagulation were measured. Test results from 10 fetal lambs and mother ewes (127 +/- 2 days mean gestation) before and after fetal lactic acid infusions were compared to test results from eight control fetal lambs and mother ewes (127 +/- 3 days mean gestation) before and after control glucose infusion. Significant changes found in acidotic fetal lambs not seen in control fetuses included an increase in the white blood cell count (mean 2800/mm3 before to 3600/mm3 after acidosis; p = 0.0009), a shortening of the thrombin time (mean 17.8 s before to 11.2 s after acidosis; p = 0.0001), and decreases in the activities of factor V (mean 57% before to 37% after acidosis; p = 0.0014) and factor IX (mean 35% before to 29% after acidosis; p = 0.0128). There was also a reduction in the concentration of fibrinogen (mean 147 mg/100 ml before to 125 mg/100 ml after acidosis; p = 0.0492) but no significant changes in the levels of fibrin monomer, fibrinogen/fibrin degradation products, or antithrombin III. In vitro exposure of five different fetal whole blood samples to a pH of 6.9 for 2 h at 37 degrees C did not result in significant changes in any of the coagulation factor activities. A significant decrease in the level of factor V was also found in the mother ewes of the acidotic fetuses (mean 141% before to 113% after acidosis; p = 0.006) and a decrease in the level of maternal factor IX approached significance (mean 119% before to 102% after acidosis; p = 0.0564).(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1984

Intelligence and achievement testing in childhood cancer: three years postdiagnosis.

Intellectual and educational testing, employing primarily the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the Wide Range Achievement Test (WRAT), was administered to two groups of children, one with acute lymphoblastic leukemia (ALL), the other with a solid tumor (ST) which did not invade or involve the central nervous system (CNS). Initial testing was completed within 30 days following diagnosis and repeated one year and three years later. Separate ANOVA procedures on the ALL and ST patients were completed, with followup ANOVA procedures for two age groups. The ALL patients declined significantly on WISC-R vocabulary (p less than 0.05) and Full Scale IQ (p less than 0.05), but no significant changes were obtained from the ST patients. Separation of the ALL group into two age groups, less than 8 years and greater than or equal to 8 years revealed significant declines in the younger group on Verbal IQ, Performance IQ, Full Scale IQ, and WRAT arithmetic. However, no significant declines were observed in the older ALL group. The results suggest that declines in ability and achievement are limited to those ALL patients treated with CNS prophylaxis at relatively young ages.

Achievement↗
PubMed1983

Glucocorticoid stimulation of blood coagulation factor activities in the fetal lamb.

Blood coagulation factor activities, including factors II, VII, IX, X, XI, and XII, are lower than normal in full-term infants and more severely depressed in premature infants. Previous studies in our laboratory using a fetal lamb model indicated that most coagulation factor activities increase during the latter part of the third trimester of pregnancy. Since glucocorticoid stimulation of the fetus accelerates fetal lung maturation in experimental models and in offsprings of mothers with impending premature labor, we hypothesized that glucocorticoid stimulation might induce increases in blood coagulation factor activities similar to those found near term. Two sets of experiments were carried out in chronically catheterized fetal lambs early in the third trimester (100 to 120 days gestation). In one set of experiments, one twin from each of 10 twin sets was infused with hydrocortisone (2 mg/hr for 48 hr). The twin sibling served as a control. In the other set of experiments, six pregnant ewes were given 15 mg of beta-methasone intramuscularly every 24 hr for two doses. Five pregnant ewes were injected with saline and used as controls. Fetal blood samples were obtained prior to and 48 hr after the start of the hydrocortisone infusions and prior to and 24 hr after the second dose of beta-methasone given to the pregnant ewes. The results of blood coagulation factor activities comparing glucocorticoid-stimulated fetuses with controls demonstrated significant increases in the activities of blood coagulation factors II, V, VII, IX, and X in the stimulated fetuses. There were no significant changes in the activities of factors VIII, XI, or XII. The results confirmed the hypothesis that glucocorticoid stimulation increases many blood coagulation factor activities in the fetus.

Animals↗
PubMed1982

Blood coagulation changes after hypoxemia: a fetal lamb model.

The effects of fetal hypoxemia on blood coagulation (platelet count, prothrombin time, partial thromboplastin time, fibrinogen, factors II, V, VI, VIII, IX, X, XI, XII, XIII and von Willebrands activities, fibrin degradation products, and fibrin monomer) were evaluated in nine chronically catheterized fetal lambs early in the third trimester of pregnancy (107-110 days gestation). Seven chronically catheterized fetal lambs of similar gestational ages served as controls. The hypoxemic episode (pO2 14 mm Hg) was maintained for 1 hr in the experimental group during which time there were only minimal changes in PCO2, arterial pressure, heart rate, and pH. Epinephrine and norepinephrine levels increased significantly in stressed animals--22 pg/ml pre- to 1025 pg/ml postepinephrine, and 475 pg/ml pre- to 2292 pg/ml postnorepinephrine. There were no significant changes in blood coagulation factor activities related to the hypoxic stress although, one fetus who experienced acidemia did develop a transient increase in fibrin monomer. Slight through significant increases in VIII coagulant activity activity (4.0%), von Willebrand activity (5.9%), and factor XII activity (4.3%) occurred in both the hypoxemic and control fetal lambs. These changes were associated with minimal increases in the white blood cell count (15%) and slight decreases in the mean arterial pressure (3.9 mm Hg) hemoglobin (1.2 g), and hematocrit (2.9%) and may have been related to the blood loss of 25% that occurred as a result of sampling in both groups. There were no differences between the hypoxic and control animals' levels of coagulation factor activities when measured during an 18-day follow-up period except for a slight increase in factor X activity (10%) in the control animals not apparent in the nine hypoxic animals. Thus an episode of severe fetal hypoxemia in the absence of hypotension, acidosis, and hypercarbia does not lead to acute or chronic alterations in blood coagulation factor activities in the fetal lamb.

Animals↗
PubMed1981

Diagnosis and treatment of coagulopathy in the newborn.

Appropriate management of the bleeding newborn is easily accomplished by first assessing the clinical circumstances under which the bleeding occurs. Having determined the clinical circumstances, knowledge of the pathophysiology of disseminated intravascular coagulation, liver failure, vitamin K deficiency, and hemophilia coupled with knowledge of the normal levels of coagulation factor activities at birth leads to selection of appropriate laboratory tests to confirm the etiology of the bleeding. Once the etiology is confirmed, treatment requires management of associated clinical conditions and replacement of vitamin K and/or deficient coagulation factors.

Blood Coagulation Disorders↗
PubMed1981

Development of blood coagulation--a fetal lamb model.

To study the normal development of blood coagulation factor activities in a growing fetus while avoiding the effects of labor and delivery, a chronic fetal lamb model was developed in which serial blood samples from 10 fetuses were studied during the third trimester of pregnancy and 24 hr after birth. Under operating room conditions with sterile technique, a polyethylene catheter to which heparin had been bound to both internal and external surfaces was inserted into the femoral artery of the fetus. The catheter was brought out through a skin pouch to the side of the ewe and enclosed in a zip lock bag. Blood samples were withdrawn from the catheter three times each week for measurement of coagulation factor activities. Levels of coagulation factor activities at birth in noncatheterized animals were not different from those found in catheterized animals except for factor IX activity which was 12% higher in the catheterized animals (0.02 less than P less than 0.05). The patterns of development for each of the coagulation factors were similar in all 10 animals studied. Fibrinogen, prothrombin, and factor VII show a decrease in activity early in the last trimester of pregnancy. Both factors VIII and IX show a significant increase in activity (23% factor VIII and 12% factor IX) associated with the process of delivery. The levels of coagulation factor activities at birth in the lamb relative to adult sheep normals are similar to those found in humans with the exception of factor XIII. Factor XIII is at normal levels in the newborn lamb and is reported to be at levels approximately 50% of the adult level in human infants.

Animals↗
PubMed1981

Physician incentives for shared management of childhood cancer patients.

Four years' experiences of 69 primary care physicians who delivered more than 70% of the chemotherapy to 174 children with cancer were assessed. Five academic pediatric oncologists were responsible for diagnosis, assignment to a clinical trial protocol, and overall management. The academicians saw the patients at diagnosis and at regularly scheduled intervals but provided care for less than 30% of the outpatient visits. Factors examined included: (1) why the primary care physicians agreed to participate in the care of these patients, (2) how they thought their participation affected the patient and the patient's family, (3) how participation affected their personal and professional development, (4) how participation affected their practice, (5) what their perceptions were concerning the merits of traditional specialist management, and (6) their overall evaluation of the Iowa shared-management program. The initial agreement by primary care physicians to participate in shared management was related to their perception that it would improve the overall care of their patients. The physicians agreed that the program saved the family time and money, was of educational value, personally satisfying, and not economically detrimental to their practice. They did not identify areas where specialist management had clear advantages over shared management and none reported dissatisfaction with this management program.

Child↗
PubMed1980

Rectosigmoidal colitis in common variable immunodeficiency disease.

A patient with common variable immunodeficiency disease is described with severe colitis confined to the rectosigmoid region. Inflammation was extensive in the regions involved and exhibited a character that we believe is most unusual. Inflammation was transmural in the regions involved. Macrophages were the major inflammatory cells, and no granulomas or giant cells were seen. Although the disorder seemed distinct from either ulcerative colitis or Crohn's disease, the colitis responded favorably to oral azulfidine, prednisone, and to steroid enemas.

Adolescent↗
PubMed1980

Clinical and occult testicular leukemia in long-term survivors of acute lymphoblastic leukemia.

Twenty-nine of 60 boys with acute lymphoblastic leukemia survived for more than 30 months and were potential candidates for discontinuation of therapy. Six patients developed overt clinical testicular leukemia: one at 34 months from diagnosis while receiving therapy and five at three to 17 months after therapy was stopped. Elective wedge biopsy of the testes has become part of the evaluation prior to discontinuation of therapy since 1977. Six of 18 boys had microscopic evidence of leukemic infiltration of the testes: four with diffuse involvement and two with focal clusters of leukemic cells. Testicular biopsy is recommended at the time of discontinuation of therapy and perhaps early in the course of the disease, although a negative biopsy does not exclude some focal lesions. The eventual outcome of those with occult testicular leukemia remains to be determined.

Child↗
PubMed1980

Cost-effectiveness of a shared-management delivery system for the care of children with cancer.

Costs of two alternative methods for obtaining comparable quality outpatient care for pediatric cancer patients were examined. Costs incurred in obtaining care from specialists, "specialist-management," were compared to costs incurred in obtaining "shared-management," care provided by specialists and primary physicians combined. Shared-management medical costs for outpatient care were 10% less than they would have been had the care been obtained from specialists. The nonmedical costs of transportation, parking, food away from home, and lost productivity or income were all less under the shared-management medical care delivery system than they would have been had specialist management been utilized. The total estimated cost differences between the alternative systems for the delivery of outpatient care ($2,191.34) represents for shared management a mean saving per patient of approximately 29% in direct out-of-pocket expenses and a 59% savings in the indirect costs of lost income or productivity. A total theoretical mean 41% saving per patient was shown to accrue through the use of shared management.

Child↗
PubMed1980

Health outcomes of a community-based therapy program for children with cancer--a shared-management approach.

Critical to providing cancer therapy to children in rural areas is finding dependable sources of therapy near the patients' homes. In this study, comparison was made of 668 visits by 24 patients to nearby private practitioners, who carried out 70% of the therapy, with 712 visits by 22 other patients for whom all care was managed by pediatric hematologist-oncologists. There was no significant difference by Wilcoxon rank sum test between the two groups in the accuracy with which protocol rules were followed, in the incidence of neutropenia, infection, fever, thrombocytopenia, drug toxicity, or the proportion of days hospitalized. The findings indicate that the private practitioners participating in a shared-management system were a dependable resource for providing 70% of the total cancer therapy to these patients.

Antineoplastic Agents↗
PubMed1979

Blood coagulation following vasectomy.

Concern that men may have an increased risk of the development of thrombophlebitis following vasectomy prompted the study of 58 vasectomized men and 37 age-matched controls. Eight patients undergoing total hip replacement also were studied, since they are known to have an increased risk of thrombotic complications. There were no changes in coagulation suggestive of a thrombotic tendency in the vasectomized population, though an increase in fibrinogen concentration was present preoperatively, and transient increases in factor V concentration, prothrombin time, and fibrinogen concentration were seen postoperatively in some cases. None of the vasectomized patients had clinical evidence suggestive of thrombosis.

Blood Coagulation↗