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H A Hein

Publications and source records attributed to H A Hein.

At least 37 records · Page 2Linked to original sources
PubMed1995

Duration of vecuronium-induced neuromuscular block as a predictor of liver allograft dysfunction.

The major causes of liver graft failure are acute rejection, technical failure, and primary nonfunction (PNF). This study was undertaken to determine whether delayed return of neuromuscular function correlates with allograft primary dysfunction in humans given vecuronium. Twenty-two adult patients undergoing orthotopic liver transplantation were given an initial dose of vecuronium, 0.1 mg/kg intravenously (i.v.). All patients recovered from vecuronium-induced neuromuscular block prior to explantation. No additional neuromuscular blocker was given until the liver graft was implanted and reperfused. Fifteen minutes after reperfusion another 0.1 mg/kg vecuronium was given IV and recovery time from attaining complete neuromuscular block to return of the fourth twitch of a train-of-four was recorded. Patients were divided into three groups according to postoperative liver function. Group I consisted of 17 patients with immediate normal liver graft function. Group II consisted of four patients with primary dysfunction (PDF) [peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) > 2000 U/L, prothrombin time > 16 s, and poor quality and quantity of bile within 3 days postoperatively] which eventually recovered normal function. Group III consisted of one patient with PNF (uncorrectable coagulopathy, severe metabolic acidosis, rising AST and ALT, and minimal or no bile output), whose graft never recovered. Recovery time in Groups II and III was prolonged compared to Group I (P < 0.05). Recovery time in Group III was prolonged compared to Group II (P < 0.05). A test based on these results using a recovery time of > 135 min as a predictor of PDF has a sensitivity and specificity of 80% and 76%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Temperature corrected thrombelastography in hypothermic patients.

Thrombelastograms and other coagulation studies are performed at 37 degrees C, regardless of the patient's body temperature. This prospective study of 45 patients undergoing orthotopic liver transplantation was conducted to evaluate the effect on the thrombelastogram performed at the patient's actual body temperature compared with a control thrombelastogram heated in the standard fashion to 37 degrees C. Thrombelastograms were obtained after the induction of anesthesia and at various times throughout the operation when clinically indicated. A freshly drawn sample of the patient's blood was divided into two aliquots and run simultaneously on two thrombelastographs; one thrombelastograph was modified with a thermostat to perform the test at the patient's body temperature and the other was unmodified to serve as a control. The temperature of the patients in this study ranged from 36.9 degrees C to 32 degrees C. The variables of the thrombelastogram measured were: r (reaction time in minutes), r + K (coagulation time in minutes), alpha (coagulation rate in degrees), and MA (maximum amplitude in millimeters). Whenever the patient's body temperature was less than 37 degrees C, statistically significant prolongation of the reaction time, coagulation time, and decrease in the clot formation rate occurred compared with control variables at 37 degrees C. Overall means were as follows: r for control, 8.24 +/- 0.28 min; r for temperature corrected, 9.32 +/- 0.27 min; r + K for control, 15.4 +/- 0.65 min; r + K for temperature corrected, 17.5 +/- 0.81 min; and alpha for control, 39.8 +/- 1.22 degrees; alpha for temperature corrected, 37.7 +/- 1.23 degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Predicting poor-communication status in preschool children using risk factors present at birth.

The speech and language status of 662 children between the ages of 30 months and 5 years was determined through the use of parent report information. Twelve of these children were reported by their parents to have been diagnosed as having a speech-language disorder, and 50 of these children were found to be at or below the 10th percentile in language development for children of their age. Information about family background and birth history obtained when these children were born was evaluated with respect to its power to predict speech-language status in these preschool children. A set of risk criteria was found to accurately predict 55% of those children with poor communication skills and 76% of those with normal communication development. This prediction was improved by the addition of data about the child's birth order. These results suggest that programs of preschool identification should consider the inclusion of a registry of children who are at risk for a communication disorder.

Birth Order↗
PubMed1990

The relationship of unwed status to infant mortality.

We studied the impact of unwed status on infant mortality in the state of Iowa, where obstetric and newborn care is readily accessible. Our purpose was to document the extent of the contribution of unwed status to infant mortality and to compare unwed gravidas with their married counterparts. We hoped the comparisons would provide information that could be used for future programs of prevention. Our data encompassed a 10-year period (1977-1986) during which the incidence of infant deaths occurring in offspring of unmarried women was significantly greater than expected. The unwed population commonly consisted of younger, poorly educated, primigravid women who frequently did not seek prenatal care. We suggest that personal factors inherent in this group of women may be more operative than lack of access to perinatal care in determining pregnancy outcome. We believe our data underscore the need to redouble efforts to prevent unintended pregnancy.

Female↗
PubMed1988

'Anestheticography': on-line monitoring and documentation of inhalational anesthesia.

The safe practice of inhalational anesthesia requires control over the amount of volatile anesthetic delivered to the patient. With minimal fresh gas flow this is facilitated by continuous monitoring and recording of the agent's concentration ('Anestheticography'). Alterations brought about by routine clinical maneuvers become visible. We recorded the course of the inspiratory and expiratory concentration of volatile anesthetic (Isoflurane) by infrared absorption and a trend recorder. Changing the carrier gas composition during high flow from 75% to 25% nitrous oxide in oxygen resulted in a 10% increase of the inspiratory isoflurane concentration. Activating the oxygen bypass or exchanging the soda lime canisters was followed by a prolonged disturbance of concentrations, most pronounced with minimal flow. Initiating emergence by closing the vaporizer during minimal flow led to a slow decrease in concentration whilst at a flow of 61/min the inspiratory isoflurane concentration rapidly decreased to subanesthetic levels. Insertion of a charcoal filter into the inspiratory limb of the breathing circuit immediately dropped the inspiratory concentration to undetectable levels. 'Anestheticography' is a useful means of monitoring and documentation of inhalational anesthetic. With the use of a charcoal filter all advantages of minimal flow anesthesia can be realized throughout the entire anesthetic, including emergence.

Anesthesia, Inhalation↗
PubMed1987

Long-term surveillance of high-risk children.

We followed a group of high-risk children, both those who passed early developmental screenings and those who did not. Three hundred sixty-two children who had previously passed screenings were evaluated at 5 years of age. Significant differences were found between this group and a comparison group in mean scores on verbal, perceptuomotor, and preacademic tests. Children who had previously failed screenings at or before 30 months of age were followed up through telephone interviews with referral agencies and records review. Ninety percent proved to have significant problems, and 67% were in special education programs at 5 years of age. This study demonstrates the need for long-term follow-up of high-risk children at least to the age of school entry.

Child↗
PubMed1987

[Fiber optic orotracheal intubation].

Fiberoptic intubation is widely accepted in the management of a "difficult airway". In the majority of these cases the underlying anatomical findings require a nasal approach. We report a case of fiberoptic intubation where nasal passage was not possible. Orotracheal fiberoptic intubation was easily performed using a Williams oral airway and a Patil-Syracuse face mask. We recommend this technique for those cases where fiberoptic intubation is indicated but contraindications to the transnasal route apply and an "asleep-intubation" is desired.

Airway Obstruction↗
PubMed1987

Partial exchange transfusion in term, polycythemic neonates: absence of association with severe gastrointestinal injury.

Partial exchange transfusion is often used to treat neonatal polycythemia. Concern about the risk of necrotizing enterocolitis following the procedure has recently been raised. We report a retrospective analysis of 185 term, polycythemic neonates who received partial exchange transfusion. No evidence of severe gastrointestinal injury was found. The technique for partial exchange transfusion we report consists of removal of blood from the umbilical vein with reinfusion of a commercial plasma substitute through a peripheral vein. Based on our data and a literature review, we offer suggestions for future conduct of partial exchange transfusion in polycythemic neonates.

Gastrointestinal Diseases↗
PubMed1987

Full bladder.

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Aged↗
PubMed1986

The status and future of small maternity services in Iowa.

Small Iowa community hospitals (fewer than 500 deliveries annually) are currently the site of approximately 37% of hospital births in the state. Many of these facilities face severe financial constraints aggravated by reduced Medicare payments and diagnosis-related group payment mechanisms. The quality and quantity of services provided by small hospitals are illustrated by birth and mortality data for the period that spans the development of Iowa's regionalized perinatal care system. Small hospitals appear to compare very favorably when matched with their larger level I counterparts with regard to neonatal mortality rates, incidence of births of very-low-birth-weight neonates, survival of very-low-birth-weight neonates, occurrence of neonatal deaths relative to the total birth population, and incidence of neonatal morbidities. Because these hospitals provide valuable services in Iowa's perinatal care system, their closure may seriously compromise perinatal health care for rural Iowans.

Birth Rate↗
PubMed1986

The changing pattern of neonatal mortality in a regionalized system of perinatal care.

Neonatal deaths in Iowa were reviewed for the years 1982 and 1983. As in a similar review of deaths in 1978 and 1979, respiratory distress syndrome, bacterial sepsis, asphyxia, lethal malformations, and extreme immaturity accounted for approximately 90% of deaths. Fewer deaths occurred in 1982 and 1983 and the causes of death shifted toward the nonpreventable. Lethal malformations became the leading cause of death and showed an increased incidence over the previous period. The greatest reduction of deaths was in level 1 hospitals. Ability to effect further reduction in neonatal deaths was estimated by calculation of an idealized neonatal mortality rate for the state and each level of care. These calculations suggest that future reduction in mortality must come primarily from improved care in level 2 and 3 centers rather than from further change in level 1 provider behavior.

Asphyxia Neonatorum↗