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Biomedical subjects

F A Oski

Publications and source records attributed to F A Oski.

At least 73 records · Page 4Linked to original sources
PubMed1979

A prospective randomized study to determine the efficacy of steroids in treatment of croup.

We evaluated the use of dexamethasone in the management of acute laryngotracheobronchitis (croup). Thirty patients, ranging in age from eight to 60 months, were evaluated in a prospective, double-blind study. Patients received dexamethasone, 0.3 mg/kg at the time of admission and a similar dose 2 hours later, and were compared with a placebo group receiving saline. Sixteen patients received dexamethasone and 14 patients received the placebo. Severity of each group was scored by a standardized system. Patients receiving dexamethasone had a mean admission score of 8.46 points; patients receiving placebo, 8.14. Twenty-four hours after admission the patients in the treatment group had a mean score of 1.19 as contrasted with a score of 5.58 for the placebo group (P less than 0.01). We concluded that dexamethasone when administered in adequate dosage by an intramuscular route hastens the recovery of infants and children with acute uncomplicated croup.

Child, Preschool↗
PubMed1979

Clinical implications of the oxyhemoglobin dissociation curve in the neonatal period.

Factors responsible for determining the position of the oxyhemoglobin equilibrium curve during the neonatal period are briefly reviewed and the clinical implications of these changes are examined. Two clinical trials employing exchange transfusions as an adjunct to conventional therapy of the severe respiratory distress syndrome have both demonstrated that this procedure reduces mortality. In neither study was it possible to demonstrate that the improvement was a direct consequence of the reduction in hemoglobin's affinity for oxygen that was produced by the substitution of fetal hemoglobin by adult hemoglobin. Data on the role of the position of the oxyhemoglobin equilibrium curve in the regulation of erythropoiesis during the "anemia of prematurity" demonstrate that the ability to unload oxygen is more important than the absolute hemoglobin level in both the stimulus to erythropoietin production and the clinical manifestations of anemia. The gradual shift of the position of the oxyhemoglobin equilibrium curve which occurs during the early months of life may not be sufficient in all infants to meet the growing preterm infants' metabolic needs without evoking additional cardiac compensation.

Anemia↗
PubMed1979

The mean corpuscular volume (MCV) in children with acute lymphoblastic leukemia.

Although most children with acute lymphoblastic leukemia (ALL) are anemic at the time of diagnosis, the cause of this anemia remains obscure. In an effort to characterize the anemia, we analyzed the mean corpuscular volume (MCV) at the time of diagnosis. The MCV was selected because of the observation that older erythrocytes have a reduced MCV and an anemia presumably related to decreased red blood cell production should be reflected by a reduced MCV. A total of 54 patients fulfilled the criteria for analysis. Of this group, 33 per cent had an increased MCV, 61 per cent had a normal MCV, and 6 per cent had a decreased MCV for age. Patients with an increased MCV were found to have a significantly lower hemoglobin and platelet count. The number of females in the group with the increased MCV was 83 per cent as contrasted with 43 per cent in the group with a normal MCV. At relapse, 71 per cent of patients with an initially increased MCV had an elevated MCV as contrasted with only 23 per cent in the group with an initially normal MCV. These observations suggest that in patients with ALL and an increased MCV, a maturation defect may be present that affects all cell lines and may be the result of a diffusible substance released from the leukemic cells. The MCV cannot be used as a reflection of mean cell age in patients with ALL and does not support the belief that the anemia in ALL is merely the result of a "crowding-out" process.

Adolescent↗
PubMed1979

Nutritional anemias.

The role of the metals, iron and copper, and the vitamins E, folic acid, and B12 in the genesis of nutritional anemias in infancy have been reviewed. All are preventable. The precise requirements for each of these trace elements and vitamins in the small premature infant remain to be defined. The nonhematologic consequences of these nutritional deficiencies require further study. Anemia may prove to be the least important manifestation of the deficiency states.

Adolescent↗
PubMed1979

Vitamin E and platelet function.

In both animals and humans, vitamin E deficiency is associated with platelet hyperaggregability. In six E-deficient children, thrombocytosis was associated with marked hyperaggregability of their platelets to ADP, epinephrine, and collagen. Platelet malonyldialdehyde (MDA) formation was used as an indicator of prostaglandin formation, and was found to be increased during the E deficiency state. Following E repletion, both platelet aggregation and platelet MDA formation returned to normal. The addition of vitamin E to platelets in vitro has been associated with inhibition of platelet release, aggregation, and MDA formation. Extending these in vitro observations further, six normal controls were given 1600 units of vitamin E orally daily for 2 weeks to elevate their plasma E levels and the E content of their platelets in vivo. Concomitant with the elevation in their plasma E levels, there was an inhibitory effect of 12--20% on platelet MDA formation following E ingestion. These studies suggest that E deficiency increases the in vivo synthesis of platelet endoperoxides and prostaglandins, and that E excess has the opposite effect, i.e., inhibition of the endoperoxide intermediates of prostaglandin synthesis.

Animals↗
PubMed1979

The "In-Training Examination" of the American Board of Pediatrics: does it test for "new" or "old" information?

The American Board of Pediatrics In-Training Examination or "Pre-Test" is not in widespread use as a means of evaluating the cognitive knowledge and problem-solving skills of hourse officers. The examination is modeled after the certifying examination of the American Board of Pediatrics. The 1977 Pre-Test was analyzed in an attempt to determine whether awareness of recent medical knowledge was required to pass this examination. The 7th through 10th editions of the Nelson Textbook of Pediatrics were used as a reference source. These editions represent information that is from 5 to at least 20 years of age. Analysis of the 190 items revealed that the correct answer was known for 148 or 78% of the questions at least 20 years ago. These results suggest that the Pre-Test, and presumably the American Board of Pediatrics certifying exam, measures the candidates' knowledge of long-standing core information.

Educational Measurement↗
PubMed1978

Peripheral lymphadenopathy in childhood. Ten-year experience with excisional biopsy.

We reviewed our experience with excisional lymph node biopsy over a ten-year period in an attempt to determine which clinical features, if any, were predictive of histologic diagnosis. A total of 75 patients, aged 8 months to 17 years, were available for review. Of these patients, 41 (55%) had nodes with nondiagnostic hyperplasia, 16 (21%) had noncaseating granulomatous lymphadenitis, 5 (7%) showed the caseating lesion of tuberculosis, while 13 (17%) showed a lymphoreticular malignant neoplasm. While patients with lymphoma more frequently had a history of weight loss or arthralgia, no one clinical feature, by either its presence or absence, could predict the biopsy diagnosis. All five patients with supraclavicular lymhadenopathy were found to have mediastinal disease. Of the 41 patients initially found to have nondiagnostic reactive hyperplasia, seven (17%) ultimately proved to have a specific pathologic process.

Adolescent↗
PubMed1978

The effects of therapy on the developmental scores of iron-deficient infants.

To test the hypothesis that iron deficiency in infants and children is associated with behavioral alterations, 24 infants with iron deficienty anemia, ages 9 to 26 months, were randomly assigned to a treatment and control group. Bayley Scales of Infant Development were administered before treatment with intramuscular iron or placebo; the test was readministered in five to eight days. Children treated with iron showed a significant increase in their scores on the Mental Development Index averaging a mean gain of 13.6 points in a mean time of 6.8 days. The treated group was found to become more alert and responsive and demonstrated improvement in tests of gross and fine motor coordination. These findings support the hypothesis that iron deficiency in infants produced developmental alterations and that these changes are rapidly reversible with iron therapy.

Anemia, Hypochromic↗
PubMed1978

Free erythrocyte porphyrins in cord blood.

Red cell free erythrocyte porphyrin determinations were performed on cord blood specimens from 236 term infants and on capillary blood specimens from 63 preterm infants weighing less than 1,500 gm, during the first week of life. These results were contrasted with those obtained from 398 normal infants and children ages 1 to 6 years. The mean FEP value for the infants was significantly higher than that observed in the normal control subjects. In 10.5% of the term infants and 15.9% of the preterm infants, values in excess of 120 microgram/dl RBCs, the highest value recorded in the normal subjects, were observed. Elevations in FEP values were not related to either blood lead concentration or hematocrit levels in the infants. Infants with elevated FEP values were found to have lower serum iron and transferrin saturation values than did infants with low FEP values. These findings suggest that elevations in cord blood FEP values may indicate a state of relative iron deficiency present at birth.

Capillaries↗
PubMed1978

Laboratory studies of erythrocytic pyruvate kinase deficiency. Pathogenesis of the hemolysis.

Genetic polymorphism exists in erythrocytic pyruvate kinase (PK)-deficient hemolytic anemia, as briefly described. Destruction of erythrocytes varied in extent, but its mechanisms in different PK-deficient polymorphic persons investigated were similar. A paradoxical post-splenectomy reticulocytosis regularly occurred. Qualitative enzymatic differences, the biochemistry, and measurements of erythrocytic destruction were made in several PK variants. 51Cr autologous and cross-transfusions of PK-deficient erythrocytes into volunteers showed multimodel regression lines of several erythrocytic cohorts. 59Felabeled PK-deficient reticulocytes donated by PK-deficient splenectomized subjects were transfused 20 hours before splenectomy into two PK-deficient infants with hemolysis, and into two adult volunteers with autoimmune thrombocytopenia. The highest reticulocyte concentration in any organ initially was within the spleen. Radioiron-labeled erythrocytes and cytologic data showed large splenic reticulocyte pools. Splenic macrophages ingesting reticulocytes and erythrocytes were seen by both light and electron microscopy of the splenic pulp. After cyanide additives inhibiting reticulocyte oxidative phosphorylation, a bizarre erythrocytic cytologic configuration was found by scanning electron microscopy. These studies of PK-mutant subjects with PK-deficient erythrocytic hemolysis showed age dependent destruction of erythrocytes. Bimodal Cr survival data suggested reticuloendothelial removal of short-lived erythrocytes and reticulocytes. The transfusions of radioironlabeled PK reticulocytes and the data obtained by scanning electron microscopy suggested that the spleen was the initial hostile organ destroying a cohort of susceptible erythrocytes, prinicpally reticulocytes.

Anemia, Hemolytic↗
PubMed1978

Aspirin-induced hemolysis: the role of concomitant oxidant (H2O2) challenge.

Studies were conducted in an attempt to determine the hemolytic potential of acetylsalicylic acid (ASA) on normal intact red blood cells (RBCs). ASA (25 mg/100 ml) did not impair RBC G-6-PD, glutathione peroxidase or catalase activity, glutathione stability, or hexose monophosphate shunt activity. Hemolysis was not observed after incubation with ASA alone but was quickly noted after exposure to ASA (25 mg/100 ml) and H2O2 (1.2%). Hemolysis did not occur with H2O2 alone but was directly proportional to the ASA concentration. Hemolysis was preceded by peroxidation of membrane lipid and was inhibited by the presence of the antioxidant, thymol. With ASA and H2O2 a marked reduction in membrane phosphatidyl ethanolamine occurred with oxidation of 20:4 and 22:6 fatty acids. No effect on phospholipids or fatty acids occurred with either ASA or H2O2 alone. Salicylic acid, singly or with H2O2, does not exhibit these effects.

Adult↗
PubMed1978

Differentiation of orbital cellulitis from preseptal cellulitis by computed tomography.

Computed tomography (CT) was used in the management of four patients with periorbital inflammation. These patients were selected for CT scanning because of the difficulty, on clinical examination alone, in determining the degree of orbital disease. The CT scans confirmed the presence and defined the location of an orbital abscess in three patients and eliminated the presence of an abscess in the fourth. On the basis of this experience, CT scanning is recommended in the evaluation of children with periorbital inflammation in whom proptosis, ophthalmoplegia, or loss of visual acuity develops, or in whom severe eyelid edema prevents adequate eye examination.

Adolescent↗
PubMed1978

Erythrocytes of the human neonate.

This review has focused on the fetal erythrocyte. Fetal erythropoiesis, the production of a red cell with a shortened life-span, and the unique characteristics of this cell with respect to membrane structure and function, energy metabolism, and hemoglobin synthesis have been described. The hematologic manifestations of a variety of red cell abnormalities of structure, metabolism, and hemoglobin synthesis have been presented, as well as a discussion of the anemia of prematurity and selected nutritional disturbances that may distort this normal physiologic adaptation. We hope this review has served to further the reader's appreciation of this complicated and fascinating cell. Much more needs to be learned about the fetal erythrocyte. It is to be hoped that a fuller understanding of the fetal erythrocyte will provide insights into fetal development in general.

Cell Survival↗
PubMed1977

The anemia of prematurity. Factors governing the erythropoietin response.

We performed sequential studies in 45 premature infants (birth weights less than 1500 g) from 7 to 120 days of age to determine factors governing the erythropoietin response to a declining hemoglobin concentration. The hemoglobin level and the plasma erythropoietin showed a significant inverse correlation (r = 0.50, P less than 0.001), as did, even more strikingly, the plasma erythropoietin response and the infants' oxygen-unloading capacity (r = 0.55, P less than 0.001). In infants with "right-shifted" oxygen-hemoglobin dissociation curves (hemoglobin F less than 30 per cent) hemoglobin levels fell 2 to 3 g per deciliter lower than those in infants with "left-shifted" curves (hemoglobin F greater than 60 per cent) before comparable erythropoietin responses occurred. It appears that premature infants respond appropriately to alterations in oxygen unloading capacity and that the position of the oxygen-hemoglobin dissociation curve and not the hemoglobin concentration alone has a major role in modulated erythropoiesis.

Birth Weight↗
PubMed1977

Neutropenia, fever, and infection in children with acute lymphocytic leukemia.

In an attempt to determine the relationship between neutropenia (absolute granulocyte count less than 1,000/cu mm), infection, and disease status, 20 patients with acute lymphoblastic leukemia were observed for a total of 34 patient-years. Febrile episodes occurred with much greater frequency in patients during the course of treatment induction (0.9/mo), or while in relapse (2.46/mo) than while in remission (0.19/mo). A cause for fever was identified much more frequently in patients in remission, both when neutropenic and nonneutropenic. When absolute granulocyte counts fell below 200/cu mm, a cause for fever was generally identified regardless of disease status. We propose that the majority of febrile episodes in patients at the time of induction of treatment or in relapse with neutrophil counts of more than 200/cu mm are caused by the disease process rather than secondary to a diagnosable infection.

Agranulocytosis↗
PubMed1977

Sickle cell anemia in an American white boy of Greek ancestry.

A 7-year-old American white boy of Greek ancestry had sickle cell anemia. The disease in this patient was not accompanied by painful episodes or recognizable hematologic complications, although he did demonstrate considerable delay in skeletal maturation. The patient sought medical attention for a dermatologic problem that was ultimately diagnosed as pityriasis rubra pilaris. To our knowledge, this is the first demonstrated example of sickle cell anemia in a white male described in the United States.

Anemia, Sickle Cell↗