Autotransfusion in bilateral internal mammary artery bypass: cost effectiveness in the 1980s.
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Blood Transfusion, Autologous↗
Biomedical subjects
F H Taylor
Publications and source records attributed to F H Taylor.
Consequences of unremitting middle-ear disease in early life. Otologic, audiologic, and developmental findings in children with cleft palate.
To learn whether chronic otitis media with effusion during early life has lasting otologic, audiologic, or developmental consequences, we evaluated 24 closely matched pairs of children with repaired palatal clefts whose treatment had been equivalent except with regard to persistent otitis media during early life. One group had undergone early (mean age, 3.0 months) myringotomy with placement of tympanostomy tubes, followed by assiduous monitoring and an aggressive treatment program to maintain ventilation in the middle ear. The other group had undergone initial myringotomy later (mean age, 30.8 months) or not at all (two subjects) and presumably had had continuous middle-ear effusion throughout most or all of the first few years of life. Eardrum scarring was equal in both groups. Hearing acuity and consonant articulation were impaired in both groups, but hearing acuity was less impaired (P = 0.05 to 0.10) and consonant articulation significantly less impaired (P = 0.03) in the group undergoing early myringotomy. Mean verbal, performance, and full-scale IQs and scores on psychosocial indexes were normal in both groups and did not differ significantly between the groups. These findings support the hypothesis that early, longstanding otitis media may result in impairment of hearing and of speech, but they do not support the hypothesis that cognitive, language, and psychosocial development are adversely affected.
Audiometry, Pure-Tone↗
Neonatal characteristics of maltreated infants and children.
We compared selected neonatal characteristics of 40 children who were abused and neglected (34) or who failed to thrive (six) and 40 nonabused, thriving children individually matched by hospital of birth, gender, mother's welfare status, race, and age at which abuse or failure to thrive was manifested. The populations were preponderantly lower-class, black, and male. The following characteristics were overrepresented in the study population: birth order second or later, low birth weight, admitted to neonatal intensive care unit, and discharged from hospital after mother. The higher incidence of full-term infants who were small for gestational age for the study population (20%) than for the control population (3%) was of borderline significance. The lower distribution of birth weights in relation to expected birth weights for the full-term study subjects, however, was highly significant.
Black or African American↗
Extra early physical contact and aspects of the early mother-infant relationship.
We tested the hypothesis that extra early physical contact between mother and infant enhances aspects of their early relationship. Healthy, middle-class mothers and their healthy, firstborn, singleton infants delivered vaginally at full-term were randomly assigned to receive either regular contact (RC; N = 39) or extra early physical contact (EC; N = 39) following delivery. RC infants remained in cribs beside their mothers' beds, while EC infants and mothers had a mean of 46 min of physical contact in the recovery room. There was no difference between EC and RC subjects for the following outcome measures: amount of time mothers chose to have infants with them during the postpartum hospital stay; quality of mother-infant interaction at two days and one month; concern mothers expressed for the infant at one month; mothers' perception of their postpartum adjustment; mothers' perception of the infant at two days and one month, and of the infant's temperament at eight months; and extent of mothers' assisting with and soothing the child during a physical examination at 13 months. EC children cried significantly less during the examination at 13 months. These findings do not support the hypothesis that extra early physical contact between mother and infant enhances their relationship.
Adaptation, Psychological↗
Extra early mother-infant contact and duration of breast-feeding.
We tested the hypothesis that extra early physical contact between mother and infant is associated with prolonged breast-feeding. Healthy, advantaged mothers and their healthy, mature, vaginally-delivered, firstborn infants were randomly assigned to receive either regular contact (N = 39) or extra early contact beginning approximately one-half hour after delivery (N = 39). Fifty-three (68%) of the 78 infants were breast-fed. Age at which complete weaning occurred was known for 50 (94%) of the 53 infants. Prolonged breast-feeding was not significantly associated with extra contact. Suckling during extra early contact was associated with greater incidence of breast-feeding at two months (p less than 0.001) and three, four and five months (0.10 greater than p greater than 0.05) for male and female infants combined.
Breast Feeding↗
Idiopathic (Bell's) facial palsy: natural history defies steroid or surgical treatment.
Idiopathic (Bell's) facial palsy is a self-limiting, non-life threatening, and spontaneously remitting disorder. The natural history of Bell's palsy is favorable: 84% of 1011 patients with Bell's palsy studied by one investigator recovered satisfactorily without treatment, and no valid clinical trials conducted to date have provided definitive evidence that treatment with steroids or surgery improves upon this figure. The authors studied 273 patients with Bell's palsy to evaluate the prognostic significance of evoked electromyography in predicting the possible benefit of transmastoid facial nerve surgical decompression. The results indicated that even when evoked electromyography was used to select those patients who might benefit most from transmastoid surgery, outcome in patients treated surgically was no better than can be expected to occur without treatment. Based upon these observations, transmastoid facial nerve surgery is not recommended to treat Bell's palsy because no benefits have been identified which outweigh the risks of surgery.
Electric Stimulation↗
Effects of sequencing of the total course of combined hyperthermia and radiation on the RIF-1 murine tumor.
The optimal sequence for clinical utilization of combined radiotherapy and hyperthermia is not known. The clinical trials have resulted in similar responses whether hyperthermia is given before or after radiation. Moreover, studies addressing the best sequence for an entire course of multifractionated hyperthermia and radiation are lacking. In these experiments, the importance of sequencing of heat and irradiation in a multifractionated treatment regimen in RIF-1 murine tumors was studied. It was observed that a close sequence of heat and irradiation is more beneficial than separate cytotoxic action. When heat and irradiation were given simultaneously, (within 1 hour) 67% to 75% of the tumors were cured. Heat and irradiation given sequentially (the entire course of one following the entire course of the other, each separated by 72 hours) cured 20% of the tumors. No tumors were cured when treated with heat or irradiation alone. The tumor regrowth time (mean tumor doubling time) is much longer in simultaneous treatment than in sequential treatment. It appears that heating first decreases the effectiveness of subsequent irradiation, causing a shorter growth delay than the opposite sequence. Heat alone does not alter the tumor bed permanently, but irradiation seems to do so, resulting in a slower rate of growth upon recurrence.
Animals↗
Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials.
We studied the efficacy of tonsillectomy, or tonsillectomy with adenoidectomy, in 187 children severely affected with recurrent throat infection. Ninety-one of the children were assigned randomly to either surgical or nonsurgical treatment groups, and 96 were assigned according to parental preference. In both the randomized and nonrandomized trials, the effects of tonsillectomy and of tonsillectomy with adenoidectomy were similar. By various measures, the incidence of throat infection during the first two years of follow-up was significantly lower (P less than or equal to 0.05) in the surgical groups than in the corresponding nonsurgical groups. Third-year differences, although in most cases not significant, also consistently favored the surgical groups. On the other hand, in each follow-up year many subjects in the nonsurgical groups had fewer than three episodes of infection, and most episodes among subjects in the nonsurgical groups were mild. Of the 95 subjects treated with surgery, 13 (14 per cent) had surgery-related complications, all of which were readily managed or self-limited. These results warrant the election of tonsillectomy for children meeting the trials' stringent eligibility criteria, but also provide support for nonsurgical management. Treatment for such children must therefore be individualized.
Adenoidectomy↗
Indications for surgery for Bell's palsy.
Transmastoid surgical decompression of the facial nerve was found to have no positive effect in recovery from facial nerve function in patients with Bell's palsy. Since the risks of such surgery are greater than the benefits, this procedure should not be performed on patients with Bell's palsy unless a tumor is suspected. A mass lesion is suspected if there is complete paralysis and loss of response to evoked electromyography within the first 2 weeks after onset of the palsy or if there is recurrent facial paralysis on the same side. Rehabilitation surgical procedures should be reserved for patients with acute Bell's palsy with keratitis unresponsive to medical therapy or for those seen late in the course of the disease to correct undesirable sequelae.
Electromyography↗
A simple technique for stabilizing the heart during right coronary grafting.
A monofilament traction suture passed through the holes in a button provides safe and gentle but firm stabilization of the heart during right coronary grafting.
Blood Vessel Prosthesis↗
Transplacental immunization of the human fetus to tetanus by immunization of the mother.
Experimental studies in rats showed that immunization of the pregnant female led to the transplacental immunization of her fetuses. The possibility that this also occurred in humans was explored by immunizing 42 pregnant women with tetanus toxoid (2.5 or 5 Lf) in the fifth and eighth months of pregnancy and comparing the immune responses of their offspring with the responses of the offspring of 25 unimmunized mothers. Only the offspring of the immunized mothers were sensitized to tetanus. IgM antitetanus antibodies were in their blood before immunization with diphtheria, pertussis, tetanus vaccine (DPT), they had a more rapid (P less than 0.01) response to DPT immunization, and they were still highly sensitized (P less than 0.01) to tetanus 13 mo after birth. In addition, pregnancy had no immunosuppressive effect (P less than 0.05) on the responses of the mothers to tetanus toxoid. Thus, transplacental immunization occurs in humans; it enhances the response of the offspring to subsequent immunization, and it could be used to circumvent the necessity for immunization in early neonatal life.
Adolescent↗
Treatment of early-onset neonatal hypocalcemia. Effects on serum calcium and ionized calcium.
For the treatment of early-onset neonatal hypocalcemia, 50 neonates received either a high dose (group H), a low dose (group L), or no parenteral calcium (Ca) (group CON). Groups H and L received parenteral Ca either as a continuous infusion (group C) or by intermittent injection (group I). After the first 24 hours of treatment, groups H, C, and I had higher serum Ca concentrations than did group CON. After the entire 72-hour study period, group H had a lower incidence of hypocalcemia (serum Ca level < 7.0 mg/dL) when compared with all other patients. Although a relatively high Ca intake statistically increased serum Ca levels, eight of 13 patients in group CON (62%) completed the 72-hour study without requiring parenteral Ca. Based on these results, we recommend parenteral Ca treatment for only those patients with persistent hypocalcemia, tetany, or a seizure disorder.
Calcium↗
Bell's palsy: surgery based upon prognostic indicators and results.
We studied 164 patients with Bell's palsy prospectively over the six-year period between August 1974 and June 1980. We found that the results of measuring tear production, submandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis--either unfavorable or favorable--for spontaneous return of facial function. When the test results were 26% or more of normal, 90% of the patients had complete recovery of function; these patients were given a favorable prognosis on the basis of the results of tests described above. The natural history of Bell's palsy in patients with an unfavorable prognosis could be improved if a transmastoid facial nerve decompression to the labyrinthine segment were performed. The results were better with this approach than with supportive or steroid therapy or transmastoid vertical-horizontal surgical decompression of the facial nerve.
Electric Stimulation↗
Strain and age effects on immobilization stress in JAX rabbits.
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Adrenocorticotropic Hormone↗
Abnormalities of T lymphocyte subsets in patients with progressive systemic sclerosis (PSS, scleroderma).
Thirty-one patients with PSS (scleroderma) were examined for evidence of abnormalities in T lymphocyte subsets. TG and TM subpopulations of peripheral blood T lymphocytes were enumerated by rosetting techniques. The helper-suppressor functions of these lymphocytes were studied in the PWM-activated in vitro assay. The absolute numbers of TG cells in patients with DS as well as those with the CREST syndrome variant of PSS were decreased in comparison with those in age-matched healthy controls (p < 0.05). The numbers of TM and T "null" cells were not significantly altered (p > 0.05). The reduction in the number of TG cells was not caused by lymphocytotoxic antibodies. The mean helper-suppressor scores for patients with PSS and DS (1.25) and those with CREST syndrome (1.36) were higher (p < 0.05) than the mean score for healthy individuals (0.80). No relationship between the immunoregulatory abnormality and the presence or titer of CICs, ANAs, hypergammaglobulinemia, or various clinical manifestations of PSS could be demonstrated in individual patients. The finding of abnormalities in T lymphocyte subpopulations and the demonstration of their altered functional expression in patients with PSS indicate that immunoregulatory mechanisms may play an important role in this connective tissue disease.
Adolescent↗
Antiemetic effectiveness of intramuscular hydroxyzine compared with intramuscular droperidol.
In a double-blind randomized study 150 outpatients receivng the same anesthetic for first trimester therapeutic abortions were equally divided into three groups: control; droperidol, 2.5 mg IM; or hydroxyzine, 100 mg IM. The injection was given immediately after thiamylal (Surital) induction of anesthesia, and the incidence of nausea, retching, or vomiting (NRV) was recorded at 15-minute intervals for 3 hours after surgery. NRV occurred in 56% of control patients, in 44% of patients given droperidol, and in 10% of patients given hydroxyzine. The patients receiving hydroxyzine and droperidol were more sedated and experienced a delay in return of hand-eye coordination as measured by the time for the Trieger motor test to reach preoperative levels. All patients equaled their preoperative performance during the 3rd hour after surgery and were discharged 4 hours following general anesthesia. We conclude that intramuscular hydroxyzine hydrochloride, 100 mg, is a significantly better antiemetic than intramuscular droperidol, 2.5 mg.
Abortion, Induced↗
Growth and reproduction complex in the rat. Genes linked to the major histocompatibility complex that affect development.
The linkage of the major histocompatibility complex (MHC) and the growth and reproduction complex (Grc) in the rat was studied in an F2 hybrid population generated from female BIL/1 (RT1l-Grc) and male YO (RT1u-Grc+) animals: 1.722 offspring were born, and 1,568 were weaned and studied. The body weights of the offspring segregated with the RT1 haplotype of the MHC, and the RT1l homozygotes were significantly smaller than their RT1l/u and RT1u/u littermates. The growth rate of the RT1l/l animals was approximately the same as that of the BIL/1 animals, and both were significantly less than the growth rates of the RT1l/u, RT1u/u, and YO (RT1u) animals. The testes of the RT1l animals showed an arrest of spermatogenesis at the early pachytene stage of the primary spermatocytes, and they were approximately 1/10 as heavy as the testes of the RT1l/u and RT1u/u animals. The ovaries in females of all three haplotypes had the same weight, but there was a decrease in the number of ova released per cycle in the RT1 l/l animals. The major loss of the RT1l homozygotes, which caused distortion of the phenotypic ratios among the offspring, did not occur in utero but in the early postnatal period before weaning. There were 7/1568 recombinants between the MHC, using the RT1.A antigen as the marker, and the Grc, using small body size (dw-3) as the marker, and 1/1568 recombinant between the loci influencing body size (dw-3) and fertility (ft) of the Grc. These data gave the following map distances (95% confidence levels): RT1.A to dw-3, 0.45 (0.25-0.96) centimorgans and dw-3 to ft, 0.07 (0.04-0.40) centimorgans. A female recombinant was used develop an inbred line carrying the RT1.Al-Grc+ chromosome.
Animals↗
The flexible fiberoptic bronchoscope: diagnostic tool or medical toy?
We began using the fiberoptic bronchoscope March 1, 1971, and after more than 2,800 examinations are convinced it is a highly useful diagnostic tool. We pass the open-end straight bonchoscope into the upper trachea under local anesthesia. Then, the fiberoptic bronchoscope is passed through this conduit. The advantages of the technique are discussed. The greatest advantage of fiberoptic bronchoscopy is the extended visibility it provides of peripheral lesions in the tracheobronchial tree. In this series, which includes more than 700 patients with primary bonchogenic carcinoma, the tumor was visible in one-third of the patients when only the straight bronchoscope was used while in two-thirds it was visible with the flexible bronchoscope. There were no deaths, and complications were rare and of little consequence. Thoracic surgeons are urged to use this instrument.
Biopsy↗