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Biomedical subjects

G Fleisher

Publications and source records attributed to G Fleisher.

At least 37 records · Page 2Linked to original sources
PubMed1987

Slow versus rapid closed-chest cardiac compression during cardiopulmonary resuscitation in puppies.

The recommended rates for closed-chest cardiac compressions during CPR are based on physiologic variations with increasing age rather than experimental data. Using puppies, we compared mean arterial pressure, cardiac index (CI), and cerebral blood flow (CBF) at a slow (40/min, group 1) and a rapid (120/min, group 2) rate. CBF was measured in all experiments by N2O uptake before and during CPR from cardiac arrest induced with KCl. Both CI and CBF were measured in half of the subjects with radiolabeled microspheres. Groups 1 and 2 were similar in terms of baseline mean weight, mean arterial pressure, CI, CBF, and arterial and venous blood gases. During resuscitation for group 1, the mean CI was 221 ml/min . m2, and the mean CBF was 4 ml/100 g . min determined by N2O uptake (2 ml/100 g.min by microspheres); in group 2, the respective means were 248 ml/min . m2 and 4 ml/100 g . min with both techniques. The values for mean CI and CBF (N2O or microspheres) did not differ significantly at either rate of compression. The N2O uptake and microsphere techniques for measuring CBF correlated closely during spontaneous cardiac contractions and mechanical chest compressions. We conclude that a) closed-chest cardiac compressions at either rate studied provided inadequate CBF, and b) the N2O uptake and microsphere techniques give similar measures of CBF under conditions of normal and low flow.

Animals↗
PubMed1986

Central and peripheral catheter flow rates in "pediatric" dogs.

Several authors have reported flow rates for various catheters in vitro, but these studies may not reflect differences in vivo because of intravascular pressure, valves, and/or venous tortuosity, particularly in the small vessels of the child. We studied flow rates of four small-gauge catheters in a "pediatric" dog model. We found that flow rates were less in vivo than in vitro, less in peripheral than in central veins, and equal in hypovolemic and normovolemic dogs. Our data indicate that the results of in vitro studies cannot be extrapolated directly to predict achievable flow rates in clinical practice. In particular, a small-diameter catheter in the central circulation may allow delivery of fluid under pressure at a faster rate than does a catheter of larger diameter in a peripheral vein. Thus decisions about site, type, and size of catheter for fluid resuscitation should be based on data obtained in vivo.

Animals↗
PubMed1986

Effect of dichloroacetate in the treatment of anoxic lactic acidosis in dogs.

Lactic acidosis is seen frequently after severe anoxia and circulatory failure. Because dichloroacetate (DCA) has been shown to be effective in the treatment of lactic acidosis, we studied its effect on lactate levels and pH in arterial and sagittal sinus blood specimens in a pediatric canine model of anoxic cardiac arrest followed by CPR. Lactate levels rose steadily in all puppies receiving DCA alone (group 1), DCA plus bicarbonate (group 2), bicarbonate alone (group 3), or neither drug (group 4). Arterial and sagittal-sinus lactate levels were in the range of 2 mmol/L during the baseline period, 6 mmol/L after anoxic arrest, and 10 mmol/L after 20 min of CPR. Bicarbonate, but not DCA, significantly raised arterial pH. Neither drug reversed the progression of acidosis in the sagittal sinus; mean pH ranged from 6.85 to 6.92 among the four groups after 20 min of CPR. We speculate that DCA did not decrease lactate levels or raise the pH in either the peripheral circulation or the CNS (sagittal sinus) because of poor perfusion achieved during closed-chest cardiac compression.

Acetates↗
PubMed1985

Open- versus closed-chest cardiac compressions in a canine model of pediatric cardiopulmonary resuscitation.

Whether or not the principles of adult resuscitation apply to the pediatric population remains unknown. In order to study this issue, a pediatric animal model was developed using puppies 6-12 weeks of age and 2-8 kg in weight. Hemodynamic status was assessed using standard methods, and measured global cerebral blood flow was assessed using the nitrous oxide (Kety-Schmidt) technique after placement of a catheter in the sagittal sinus. In this initial study, five puppies resuscitated with closed-chest cardiac compression (CCCC) were compared with five receiving open-chest cardiac compression (OCCC). Although mean systolic arterial pressures were equal with both methods during resuscitation (40 versus 49 mm Hg, P = 0.19), OCCC produced a greater cardiac output and a higher cerebral blood flow (5 versus 18 ml/100 g/min, P = 0.008). Only one of five dogs treated with CCCC had a blood flow during resuscitation greater than 15 ml/100 g/min, as compared with four of five receiving OCCC. Finally, three of five dogs in the CCCC group experienced liver lacerations, while none who were resuscitated by OCCC sustained any gross visceral injuries.

Animals↗
PubMed1985

Temperature response to antipyretic therapy in children: relationship to occult bacteremia.

The response of rectal temperature to antipyretic therapy was studied in an attempt to identify a clinical characteristic that would distinguish children with occult bacteremia from those with sterile cultures of blood. Children 3-24 months of age with initial temperature recordings of 38.9 degrees C or greater had a blood culture drawn and received a standard dose (10mg/kg) of either aspirin or acetaminophen. Temperature was again recorded 60-120 minutes later. During the period of investigation, 255 patients were studied; 16 had bacteremia, and 239 had sterile blood cultures. There was no difference in the response to antipyretic therapy between the two groups. The mean decrease in temperature for each was similar (1.3 versus 1.05 degrees C, P = 0.14). The authors conclude that response to antipyretic therapy does not distinguish children who are bacteremic from those who are not.

Acetaminophen↗
PubMed1985

Pediatric catheter flow rates.

The flow rates of the 18- to 24-gauge catheters most commonly used in pediatrics were studied to determine which catheters and infusion techniques allowed for rapid volume replacement in infants and children. As expected, short, large-diameter catheters were found to have a higher flow rate, and flows under pressure in the largest catheters tested were up to 17 times greater than in a longer, smaller diameter catheter. Catheters designed for peripheral venous insertion in children showed an 18 to 164% increase in flow rate when compared with the same gauge catheters designed for central venous use. Thus, intravenous access via a central vein does not guarantee more rapid fluid infusion unless the use of the central vein permits the insertion of a catheter larger in diameter than any that could be placed peripherally. Knowledge of the flow rates determined for the various catheters in this study will assist the physician in optimizing fluid resuscitation of the critically ill or injured child.

Blood Transfusion↗
PubMed1985

Coin ingestion: does every child need a radiograph?

We studied 80 children who presented to the emergency department (ED) with a complaint of coin ingestion to determine whether radiographs are necessary in all situations and to determine which symptoms or signs are predictive of esophageal coins. Radiographs were considered positive if the coin was in the esophagus. Radiographs were positive in 25 (31%) of patients, of whom 11 (14%) had no symptoms or signs in the ED. Fifty-five (69%) of the 80 patients had subdiaphragmatic foreign bodies (44 [55%]), or no foreign bodies (11 [14%]) seen on films. Fourteen (18%) of the children required removal of the coin. Variables correlating with positive radiograph, in order of significance, included localization, choking at ingestion, drooling in the ED, vomiting, and chest pain (P less than .05). Symptom type was predictive of radiographic findings, and it may be predictive of need for removal. All 14 patients with symptoms or signs in the ED had positive films, as compared to 11 of 66 (16.6%) with no symptoms (chi square = 33.555; P less than .001). Although this relationship is significant, the finding of esophageal foreign body in 17% of patients with no symptoms leads us to recommend that all patients have a chest radiograph if coin ingestion is suspected.

Child↗
PubMed1985

Detection of cancer in the pediatric emergency department.

We reviewed the Tumor Registry for 1981 at the Children's Hospital of Philadelphia to identify all the children with newly diagnosed cancer who were seen initially in the emergency department (ED). Of the 220 new patients listed, 16 (7.3%) sought initial care in the ED (1 per 4,500 ED visits). Seven had leukemia, five had non-CNS solid tumors (2 lymphoreticular, 1 Wilms', 1 neuroblastoma, and 1 ovarian), and four had CNS tumors. Among the children with leukemia, pallor (6) and decreased activity (4) were the most common complaints. Duration of symptoms ranged from 4 days to 3 weeks. Physical examination showed pallor (5), splenomegaly (4), fever (3), hepatomegaly (3), lymphadenopathy (3), and ecchymoses or petechiae (2). The complete blood count and peripheral smears were all abnormal. The five patients with non-CNS solid tumors had symptoms related to the location of their neoplasms. The patients with Wilms' tumor, neuroblastoma, and ovarian dysgerminoma had abdominal masses; the patient with lymphoma had a large, painful inguinal node; and the patient with histiocytosis X had an infiltrative rash, gingivitis, and pneumonitis. Of the four children with CNS tumors, three had headache, and one had an incidentally detected scotoma following head trauma. All four eventually had abnormal neurologic exams and computer tomographic scans, but two were discharged initially with psychiatric diagnoses. We conclude that cancer, although rare in children, occurs with greater relative frequency in the referral hospital ED than that predicted by published cancer rates from the referring hospital's ED.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Nervous System Diseases↗
PubMed1985

Injuries involving household furniture: spectrum and strategies for prevention.

We undertook a study to determine the incidence and spectrum of childhood injuries from accidents involving household furniture, using coffee tables as an example. Our review of data from the Consumer Product Safety Commission indicated approximately 250,000 furniture-related injuries in 1982 in the United States, 25 percent of them from coffee tables. Most of the injuries were lacerations of the head and face. In a review of injured children from our emergency department, we found that square or rectangular coffee tables with sharp edges were usually involved. A survey of pediatricians found that only 40 percent offered any advice to parents about hazardous types of household furniture. We conclude that furniture injuries are an important hazard for children and suggest strategies for prevention.

Accident Prevention↗
PubMed1985

Rib fractures in children.

We reviewed the charts of 21 children admitted to the hospital with rib fractures to determine the cause of trauma, the relationship of the number and location of rib fractures to other injuries, the course of flail chest in children, and the frequency and characteristics of injuries caused by child abuse. Sixteen (76%) of 21 children were injured by accidental causes, most commonly by motor vehicles. However, five (24%) children were victims of child abuse. Nineteen children fractured an average of 3.5 ribs (range 1 to 8), while two other children fractured 22 and 23 ribs. Neither an increased number of fractures, nor first or second rib fractures were associated with more severe intrathoracic injuries. Two children with flail chest required intubation but recovered without further complications. The five children with nonaccidental rib fractures were young, had an unexplained history, and a paucity of multiple trauma. These characteristics should alert the physician to the possibility of child abuse in the patient with rib fractures.

Accidents, Traffic↗
PubMed1985

Human bites in children.

We studied 40 children aged four months to 18 years seen in the Emergency Department (ED) to determine the spectrum of human bites and the incidence of infection in treated and untreated wounds. Initial data concerning time elapsed until a physician examined the bite, site and size of the bite, whether the bite was infected when first seen, and whether antibiotics were prescribed, were obtained from the ED chart. Follow-up by phone or mail was available on 33 of the 40 children. The incidence of human bites was one in 600 visits. The commonest lesion was a superficial abrasion of the face, inflicted by another child. Twenty-nine of the 33 bites were uninfected when first seen; 13 of them received no antibiotics; and 16 received oral antibiotics. There was no significant difference in mean age, sex, site, or type of wound between these two groups. None of 13 untreated and one of 16 treated children developed an infection (P = NS). Four patients had infected wounds when first seen; three received oral antibiotics; and one was admitted for intravenous antibiotics. Of the three on oral antibiotics, two were subsequently admitted to the hospital. Conclusions. We came to the following conclusions at the end of the study. (1) The majority of human bites in children are superficial and do not become infected. (2) Antibiotics do not appear to be useful in prophylaxis for minor bite wounds seen shortly after injury. (3) Follow-up is necessary for all bite wounds, since serious infection may develop, or an established, seemingly minor infection may worsen.

Adolescent↗
PubMed1985

Anoxic cardiopulmonary arrest in a pediatric animal model: clinical and laboratory correlates of duration.

We studied the response to anoxia in young dogs in order to provide some clinical and laboratory guidelines with which to gauge duration of respiratory and cardiorespiratory arrest in children. Immediately following the onset of anoxia, the animals developed hypertension. After a mean period of 279.5 seconds (range, 224 to 325 sec), they became asystolic. Following an observation period of five minutes after the onset of asystole, pH declined to a mean of 7.01 and PO2 declined to 7.1 torr, while PCO2 rose to 92.1 torr. We concluded that asystole occurs after a relatively brief period of anoxia during a time interval when the brain retains the potential for full recovery. While no single factor clearly indicates a very prolonged arrest, a pH below 6.9 which does not rise with the institution of adequate ventilation suggests anoxia of greater than five minutes' duration.

Animals↗
PubMed1984

Epstein-Barr virus infections in pregnancy: a prospective study.

We studied 4063 pregnant women during 4108 gestations for evidence of infection with Epstein-Barr virus. Forty-six (1.1%) were susceptible early in gestation, and only three showed seroconversion. Two of the infants born to these three women were normal, one had tricuspid atresia. None of the infants had IgM antibodies to EBV at birth, and their cord blood lymphocytes did not give rise spontaneously to EBV-carrying lymphoblastoid cell lines. Thus we were unable to document intrauterine infection with EBV.

Adult↗
PubMed1984

Management of lymphadenitis in childhood: the role of percutaneous needle aspiration.

Bacterial lymphadenitis occurs commonly during childhood, but the preferred initial therapy has not been clearly established. We studied lymphadenitis in children to determine the course of patients with fluctuant and nonfluctuant infections, and to assess the role of percutaneous needle aspiration as a form of therapy. Of 32 patients diagnosed as having lymphadenitis, 30 were followed successfully (26 with initially nonfluctuant and four with initially fluctuant infections). Fluctuance subsequently developed in four of 26 lymph nodes that were initially firm to palpation. In all eight children with fluctuant lesions the infections were resolved following percutaneous needle aspiration and antibiotic therapy, and 25 of 26 with initially nonfluctuant infections were cured with antibiotic therapy alone or with antibiotics accompanied by percutaneous aspiration when fluctuance developed (four cases). Thus we recommend initial percutaneous aspiration for the treatment of lymphadenitis whenever abscess formation is detected clinically.

Adolescent↗