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Biomedical subjects

E G Ford

Publications and source records attributed to E G Ford.

48 records · Page 3Linked to original sources
PubMed1987

Mediastinal mass following chemotherapeutic treatment of Hodgkin's disease: recurrent tumor or thymic hyperplasia?

Hyperplasia of the thymus is a normal physiologic response in infants and children during recovery from life-threatening illness. New, recurrent, or residual mediastinal masses in children treated for malignant disease present a diagnostic dilemma. Are these masses recurrent disease or simply normal reactive thymic hyperplasia? Our experience from 1979 to 1986 includes 14 children aged 1 to 17 years (mean 7.4 years) who were identified with new or recurrent mediastinal masses during or after chemotherapeutic treatment for malignant disease (lymphoma 9, Wilms tumor 2, leukemia 1, osteosarcoma 1, malignant teratoma 1). The mediastinal masses were treated by a variety of methods depending on the attending physician's preference (close observation 2, oral steroids 5, steroids and subsequent biopsy 1, open biopsy 6). Chest roentgenograms of "observation only" patients have showed stable mediastinal changes without clinical evidence of recurrent disease. Patients treated with steroids showed resolution of the mediastinal masses in 48 hours to seven days, without recurrence. Patients undergoing open biopsy showed only thymic hyperplasia and/or lymph nodes. We suggest a stepwise approach to evaluation of these patients. Mediastinal masses occurring during, or shortly following, chemotherapeutic treatments of malignant disease should first be treated with oral prednisone (60 mg/m2/d x 7 to 10 d). If the patient shows a complete or partial resolution, then follow-up includes frequent chest roentgenograms and/or a second course of steroids. If the mass fails to respond to steroids, or enlarges, then open biopsy through a minithoractomy will clarify the diagnosis. Follow-up of our patients is from 3 months to 7 1/2 years (mean 5 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Steroid administration potentiates urinary nitrogen losses in head-injured children.

Exogenous steroid administration has been shown to increase post-traumatic nitrogen excretion in adults. Children sustaining head injuries and treated with steroids have previously been shown to have markedly increased total urinary nitrogen levels; the amount of nitrogen excreted is also directly related to the degree of injury, as evidenced by the Modified Injury Severity Score (MISS). It is unclear whether the increased protein breakdown in these patients is a result of the head injury or a result of the catabolic effects of steroids. Nineteen children aged 4-14 years, suffering head injuries, were prospectively studied. In ten children, management included steroid administration (1-1.5 mg/kg/day dexamethasone X 3-5 days); the remaining nine were similarly managed; however, without steroids. The groups were matched for age, weight, MISS, and Glasgow Coma Scale Score. The steroid-treated group showed a significantly higher urinary nitrogen excretion (mean, 256 +/- 24 mg/kg/day) than the nonsteroid-treated group (mean, 172 +/- 29 mg/kg/day) (p less than 0.02). These data suggest that steroids potentiate an already accelerated post-traumatic catabolic response seen in children with head injuries. Our data suggest that steroid use, which is common, mandates aggressive nutritional support in the management of children with head injuries.

Adolescent↗
PubMed1987

"Spot" urine collections do not accurately represent 24-hour sodium excretion in surgically stressed children.

Deranged metabolism in posttraumatic or surgically stressed children makes fluid and electrolyte management difficult. Clear guidelines for salt and fluid administration have not been established. Recent management trends utilize four-hour and eight-hour "spot" urine collection measurement to imply 24-hour requirements. Six children, having suffered traumatic disease or surgical stress, were studied on an hourly basis for characterization of urinary sodium loss. Measured hourly values were combined to represent four-hour and eight-hour "spot" collections and then extrapolated to represent 24-hour losses. A great variation in sodium excretion was demonstrated on hourly samples; the variations were compounded by extrapolation. The extrapolated values varied from the measured hourly sodium losses by 0.66 to 123%. The four-hour extrapolations varied from measured values 14 to 198% (mean 55.2%). The eight-hour combinations varied 6.59 to 136% (mean 44.1%). On the basis of these data, we discourage the use of extrapolated values to imply 24-hour requirements. We support the use of a standard intravenous fluid (one-half strength normal saline or Ringer's lactate) with frequent urinary sodium determinations to individualize fluid and electrolyte management.

Adolescent↗
PubMed1987

Efficacy of anomalous pancreatic drainage in choledochal cysts correlates with age of presentation and suggests etiology.

The etiology and pathogenesis of choledochal cysts, although frequently debated, are as yet unknown. Findings in three recent patients suggest a possible etiology that may also explain the variability in age at presentation. Each of these patients (ages 12 months, four years, and ten years) was found to have an Alonso-Lej Type I cyst and at operation had an absence of the distal intraduodenal common bile duct, suggesting the lack of a common channel with the main pancreatic duct. Partial decompression of the anatomically obstructed bile duct was afforded by an anomalously high insertion of the accessory pancreatic duct and communication with the duodenum by way of the main pancreatic duct. All patients were managed by excision and retrocolic choledochojejunostomy. The efficacy of decompression correlated with the age of presentation and size of the cyst. These findings suggest agenesis-atresia of the distal common bile duct as one possible etiology of choledochal cysts and may explain the variable age at presentation.

Biliary Tract↗
PubMed1983

Tube feeding at home.

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Education, Nursing, Continuing↗
PubMed1983

The elderly at risk: a critical examination of commonly identified risk groups.

This study assessed the nature and extent of the risk or disadvantage for 11 subcategories of the elderly population usually referred to as risk groups. Interviews with 619 over-60-year-olds living in Aberdeen were used to score the ;personal resources' for coping with difficulties-health, psychological, activity, confidence, support, material resources. Risk profiles have been drawn up and these show substantial variation in both the nature and extent of risk or disadvantage between the groups.Of the 11 groups, we concluded that the isolated, the childless and the never married are probably the least disadvantaged. The recently widowed, those living alone, the poor and those from social class V form an intermediate group with both strengths and weaknesses in terms of risk. The groups at greatest risk are the recently moved, recently discharged, divorced/separated and the very old, who all score worse than the whole sample in terms of health and psychological functioning.

Aged↗
PubMedDate not supplied

Predictors of severe renal dysfunction after heart transplantation and intravenous cyclosporine therapy.

We conducted a retrospective analysis of 23 consecutive adult heart transplant patients treated with intravenous cyclosporine for induction of immunosuppression to determine predictors of early (within 2 weeks of transplantation) severe renal dysfunction. Selected risk factors included creatinine clearance less than 55 ml/min, hospitalization before transplantation, perioperative cardiovascular compromise, postoperative cardiovascular compromise, use of ranitidine, use of captopril, and preoperative intraaortic balloon pump support. Each risk factor was assigned a score of 1. Of 23 patients, 16 (69.7%, group 1) completed a course of intravenous cyclosporine for induction of immunosuppression, whereas seven (30.4%, group 2) developed severe renal dysfunction, precluding the use of intravenous cyclosporine for induction. Chi-square analysis showed hospitalization (p less than 0.001), creatinine clearance (P less than 0.001), perioperative cardiovascular compromise (p less than 0.05), and intraaortic balloon pump support (p less than 0.05) to be significantly associated with severe renal dysfunction. Of the patients with a risk factor score of 2 or greater, 87% developed severe renal dysfunction, and 100% with a score less than 2 did not. The best predictors of severe renal dysfunction were, in order, hospitalization, creatinine clearance, and perioperative cardiovascular compromise. Modification of the risk factor score with only these factors showed a score of 2 or greater predictive of severe renal dysfunction in 100% of patients; of those patients with a score less than 2, 94% did not develop severe renal dysfunction. This early experience suggests that risk factor analysis may be useful in the selection of patients in whom intravenous cyclosporine may be given with minimal risk for developing severe renal dysfunction.

Acute Kidney Injury↗