Dr. Julius Lempert.
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Fenestration, Labyrinth↗
Biomedical subjects
J A Sullivan
Publications and source records attributed to J A Sullivan.
Edmund P. Fowler Memorial Lecture. Otology in the modern hospital.
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Audiometry↗
Assessment of vestibular sensitivity.
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Animals↗
Pregnancy induces expression of cPLA2 in ovine uterine artery but not systemic artery endothelium.
OBJECTIVE: To determine whether pregnancy increases cytosolic phospholipase A2 (cPLA2) expression in uterine artery (UA) endothelial cells and vascular smooth-muscle (VSM) cells, and whether ovarian steroids mediate this effect. METHODS: Uterine arteries and omental arteries (systemic control) were isolated from pregnant (120-130 days' gestation) ewes and from nonpregnant ewes synchronized to the corresponding phases of the ovarian cycle (follicular or luteal) or ovariectomized. In addition, ovariectomized ewes were treated with vehicle, estradiol-17 beta (E2 beta), progesterone (P4), or combined E2 beta/P4 for 10 days, and UAs were collected. Arteries from all studies were separated into mechanically isolated endothelial and VSM fractions. Proteins were then solubilized and separated on 7.5% sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by Western immunoblotting using an affinity-purified mouse monoclonal antibody for cPLA2. RESULTS: Both UA endothelium and VSM fractions were seen to express cPLA2, detected as a single band with a molecular mass similar to that observed in myometrium (about 100 kD). Distribution of cPLA2, when expressed per microgram of protein, was observed as 40% in UA endothelium compared with 60% in VSM fractions. Uterine artery endothelial cPLA2 expression was specifically increased 1.9-fold in pregnancy (P < .05), whereas there was no significant change from VSM. Furthermore, in ovariectomized sheep versus intact luteal or follicular phase animals, there was no significant change in cPLA2 expression in endothelium or VSM. Administration of E2 beta, P4, or their combination in ovariectomized sheep also failed to reproduce the pregnancy-induced increase in cPLA2 expression in UA endothelium. Omental artery endothelial and VSM cPLA2 expression was observed at similar magnitudes as UA expression, but levels were consistently unchanged by pregnancy, the ovarian cycle, or ovariectomy. CONCLUSIONS: cPLA2 was expressed throughout the endothelium and VSM of both uterine and omental arteries, but only in UA endothelium was pregnancy associated with elevated cPLA2 expression. The lack of change in cPLA2 expression with the ovarian cycle or in ovariectomized animals, even after prolonged treatment with E2 beta, P4, or E2 beta/P4 combined suggests this pregnancy-induced increase in cPLA2 may not be estrogen and/or progesterone dependent.
Animals↗
The effect of prestorage irradiation on posttransfusion red cell survival.
Transfusion-associated graft-versus-host disease (TA-GVHD) may occur whenever immunologically competent allogeneic lymphocytes are transfused to an immunocompromised recipient. Irradiation of blood components eliminates the risk of TA-GVHD but may damage the cellular elements in the transfused component, particularly if the cells are stored for prolonged periods in the irradiated state. To study the effect of irradiation on long-term storage of red cells, AS-1 red cells from eight normal subjects were prepared on two occasions. On one occasion, the units were stored as standard AS-1 red cells for 42 days at 4 degrees C; on the other, they were exposed to 3000 cGy radiation within 4 hours of collection and then were stored as AS-1 red cells for 42 days at 4 degrees C. The donations were at least 12 weeks apart. Irradiated units demonstrated significant elevations in poststorage plasma hemoglobin (Hb) (623 +/- 206 vs. 429 +/- 194 g/dL [6230 +/- 2060 vs. 4290 +/- 1940 g/L], p less than 0.02) and plasma potassium (78 +/- 4 vs. 43 +/- 9 mEq/L [78 +/- 4 vs. 43 +/- 9 mmol/L], p less than 0.01) and significant decreases in red cell ATP (1.9 +/- 0.2 vs. 2.1 +/- 0.3 microM/g Hb, p less than 0.04) and 24-hour posttransfusion red cell recovery (68.5 vs. 78.4%, p less than 0.02), as compared to nonirradiated units. It can be concluded that irradiation with 3000 cGy damages red cells and that long-term storage in the irradiated state may enhance this damage. Red cells should not be stored for 42 days after irradiation with 3000 cGy.
Blood Preservation↗
Nitrous oxide compared with intravenous regional anesthesia in pediatric forearm fracture manipulation.
A prospective, randomized study of intravenous (i.v.) regional anesthesia compared with nitrous oxide gas was performed in a group of 28 pediatric patients with forearm fractures requiring manipulation in the emergency department. The groups were compared in terms of pain perceived by the patients, success of manipulation, safety, and duration of procedure. The methods showed no significant difference in amount of pain perceived by the patient for the total pain experience. No medical complication was seen in either group. Because of a technical problem with an i.v. regional block, fracture manipulation was not completed in one patient. Nitrous oxide treatment required significantly less time for completion of the procedure.
Adolescent↗
Osteomyelitis of the calcaneus in children.
Eleven cases of calcaneal osteomyelitis in children are reported. Seven were hematogenous cases, and the remaining four were related to puncture wounds. The clinical presentation was less dramatic than that seen in typical long bone osteomyelitis. Laboratory findings were also less striking. A mixture of organisms was isolated from patients in the hematogenous group. In contrast, all puncture-related cases had cultures positive for Pseudomonas aeruginosa. Plain radiographic findings were noted at the time of presentation in 63%. Those findings were characteristically different in hematogenous and puncture-related cases. Oblique lateral radiographs can be important for diagnosis in puncture-related cases. Radionuclide bone scanning was an important diagnostic test in the absence of plain radiographic changes and in the very young patient. Surgery was performed in 82% of the cases. There were no recurrences or chronic infections. Two complications occurred in one patient, including residual scar sensitivity and early fusion of the calcaneal apophysis.
Adolescent↗
The role of computerized tomographic scan in the management of Gradenigo's syndrome: a case report.
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Acute Disease↗
Comparison of Harrington instrumentation and segmental spinal instrumentation in the management of neuromuscular spinal deformity.
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Adolescent↗
Management of thoracic and lumbar spine fractures with Harrington distraction rods supplemented with segmental wiring.
Fifteen patients with acute, unstable fractures of the thoracolumbar spine were treated with Harrington distraction rods supplemented with segmental sublaminar wires. This proved to be an effective means of managing these fractures, enhancing stability and decreasing the complication rate. No patients developed hook cut-out, pseudarthrosis or gibbus. The amount and duration of external immobilization is decreased enhancing rehabilitation in spinal cord injuries.
Adolescent↗
Lateral humeral condylar fractures in children.
Fifty-three patients with 56 fractures of the lateral humeral condyle were reviewed and the results were assessed to determine the amount of displacement that could be relied on to produce satisfactory results. Closed treatment resulted in satisfactory results if the initial displacement did not exceed 2 mm. This required close follow-up for detection of displacement. Percutaneous pinning of nondisplaced and minimally displaced fractures is an acceptable alternative in any situation in which close scrutiny cannot be ensured. Those fractures with greater than 2 mm of displacement should be reduced, pinned, and immobilized for 6-8 weeks. Evidence of delayed union after 8 weeks is an indication for internal fixation and possibly bone grafting. Established nonunions in good position are best treated by open reduction and bone grafting. In this series, varus deformity was the most common deviation from a normal carrying angle. The functional results were invariably good regardless of the radiographic or clinical findings.
Adolescent↗
Management of septic arthritis in children.
Forty-five children underwent initial nonoperative treatment of hematogenous septic arthritis in joints other than the hip. Only joints with symptoms for less than 6 days and without associated osteomyelitis were included. Thirty-four of the 49 joints were successfully managed by aspiration and antibiotics, whereas the remaining joints were successfully managed by surgical drainage following a lack of response to nonoperative treatment. All children had a satisfactory result after an average follow-up of greater than 3 years. Early diagnosis and treatment are more important than the method of drainage. If a lack of response is seen to initial nonoperative treatment, surgical drainage will still lead to a satisfactory outcome.
Ankle Joint↗
Arthrographic diagnosis of elbow injuries in children.
A prospective study was established to evaluate the value of arthrography in children with a variety of elbow injuries. Thirty-six arthrograms were performed on children with an average age of 3.8 years at an average of 20 h from the time of injury. The diagnosis made on the basis of standard radiographs was confirmed for 17 patients, and the initial diagnosis was altered for seven (19%). More important was that the treatment of these seven patients was altered by the arthrographic findings. Six of these seven were candidates for surgical management until arthrographic evaluation indicated a different diagnosis or that they could be treated nonoperatively. Elbow arthrography is recommended in skeletally immature patients whose diagnosis is in doubt. This technique is particularly helpful in humeral condylar fractures.
Arthrography↗
Effects of neurodevelopmental treatment on movement patterns of children with cerebral palsy.
Twelve children with mild, moderate, or severe cerebral palsy were examined and videotaped before and after an intensive course of physical therapy in a neurodevelopmental treatment course. These tapes, demonstrating various predetermined movement patterns, were then randomized and viewed by six evaluators. None of the evaluators could tell the difference between before and after films. This demonstrated that significant changes were not seen in children with cerebral palsy after 6 weeks of therapy.
Adolescent↗
Management of femoral shaft fractures in the adolescent.
Forty-four patients (45 fractures) with open physes (age range 11-16 years) underwent treatment for femoral shaft fractures. Seven malunions occurred in the 24 fractures in the nonoperative group; none occurred in the 21 fractures treated by intramedullary nailing. Hospital stay was significantly shorter in the operatively treated patients. There was no premature growth arrest in the surgical group.
Adolescent↗
Lawn mower injuries of the pediatric foot and ankle: observations on prevention and management.
We reviewed 32 children with lower extremity injuries caused by power lawn mowers. Functional outcome of 21 patients was evaluated. Anatomical injury patterns provide some guidelines in management and prediction of functional outcome. Consistently, the most severe injuries result from ride-on mowers and wounds to the posterior/plantar foot and ankle. Our experience with pediatric foot and ankle lawn mower injuries permits recommendations for maximum functional outcome with minimal intervention. Public awareness and mower safety devices may be required to decrease the rate of accidents in the future.
Accident Prevention↗
Career trends of master's prepared family nurse practitioners.
The purpose of this study was to examine the career trends of family nurse practitioner (FNP) graduates of one master's program. A questionnaire was mailed to all FNPs (N = 113) who graduated 1-11 years earlier; there was a response rate of 83%. The survey revealed that for both first and present jobs the majority were providing direct patient care as a primary care provider or practicing in an indirect role. The study findings indicate that for these graduates there is a long term commitment (demonstrated through continued employment) as well as opportunity to practice in the nurse practitioner role in a direct or indirect capacity.
Adult↗
Evaluation of injuries in youth soccer.
Soccer has rapidly gained in interest in the United States. A paucity of available data on soccer injuries led us to formulate this study to quantitate and categorize injuries acquired during a program of youth soccer (under age 19). A prospective study of 1,272 players showed an injury rate of 2.6 injuries per 100 participants. The injury rate for girls was twice as great as for boys. The under 10-age group was seldom injured (less than 1 injury per 100 participants), but the overall injury rate in the players of secondary school age was 7.7 injuries per 100 participants. Most injuries were not serious. Soccer appears to be a safe activitiy for adolescents and children.
Adolescent↗