Palliative care for children with cancer--home, hospital, or hospice?
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Child↗
Biomedical subjects
J Hunt
Publications and source records attributed to J Hunt.
Subtyping aggression in children and adolescents.
To document the existence of "predatory" (goal-oriented, planned, hidden, or controlled) and "affective" (impulsive, unplanned, overt, or uncontrolled) subtypes of aggression, this study assessed 73 aggressive child and adolescent psychiatric patients for the presence of theoretically predatory and affective behaviors. Cluster analysis, using the reliable items, confirmed the predicted partition, yielding a "predatory" and an "affective" cluster. The scale, with a total score from +5 (fully predatory) to -5 (fully affective), had good internal consistency (alpha = .73). The score distribution tended to be bimodal, with peaks at -3 (predominantly affective) and 1 (mixed). Patients with "affective" aggression were more likely to have lower IQ, to receive neuroleptics or lithium, and to have a chart diagnosis of schizophrenia. History of drug abuse was more frequent among the "predatory" patients.
Adolescent↗
Systemic lupus erythematosus and miliary tuberculosis in a prepubertal girl--a case report.
A 13 year old girl presented with miliary tuberculosis and active systemic lupus erythematosus (S.L.E.). She responded to a combination of antituberculous drugs and systemic steroids. This case illustrates the fact that S.L.E. presenting in childhood may be rare but not unknown and exemplifies the need for vigilance in detecting life threatening infections in this group of patients.
Adolescent↗
Clinical experience with a hypotonic oral rehydration solution for treatment of pediatric gastroenteritis in the United Kingdom.
Animal and human perfusion studies suggest that water absorption can be optimized by glucose-electrolyte solutions with low total osmolality. A new oral rehydration solution (ORS), reformulated Dioralyte (RD), containing 60 mmol/L of sodium and 90 mmol/L of glucose with an osmolality of 240 mosm/kg, was tested for safety and efficacy in children in the United Kingdom with acute gastroenteritis. In a double-blind, controlled trial, RD was compared with standard Dioralyte (SD), a widely used low-sodium, high-glucose solution containing 35 mmol/L of sodium and 200 mmol/L of glucose, with an osmolality of 310 mosm/kg. Infants and children aged 2 weeks to 3 years admitted with acute gastroenteritis of less than five days' duration and mild to moderate dehydration were randomized to receive either RD or SD. Clinical and laboratory assessments were made on admission and 12, 24, and 48 hours after treatment. Thirty-two children were enrolled in the study; 14 received RD and 18 SD. No adverse effects from either ORS were reported. Efficacy was evaluated in 24 patients, of whom eight received RD and 16 SD. Total ORS intake and intake in milliliters per kilogram were similar in both treatment groups. Mean fluid balance, mean percentage weight change, and median stool frequency did not differ between the groups at 12, 24, and 48 hours after onset of treatment. Three (12.5%) patients had greater than or equal to 0.05% reducing substances in the stool during treatment, and the incidence was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Child, Preschool↗
Placental CSF-like activity.
We have examined amniotic fluid and cultured supernatants of a variety of placental cells for the presence of colony-stimulating factor (CSF) activity. The supernatants of cultured human choriocarcinoma cell lines, Jeg and Jar, contained CSF activity that induced the formation of granulocyte-macrophage colony-forming unit (CFU-GM) and multipotential colony-forming unit (CFU-GEMM) colonies. Cultured supernatants of nontransformed rat placental cells, chorionic villous cells, and amniotic fluid also induced CFU-GM colonies.
Amniotic Fluid↗
Ultrastructural damage to equine intestinal epithelium induced by enteropathogenic Escherichia coli.
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Animals↗
Silicone in the liver: possible late effects.
We describe two renal transplant recipients who presented with clinical and biochemical abnormalities of liver function in whom liver scarring and silicone particles were identified in the liver by light microscopy. The presence of silicon in the particles was confirmed by x-ray energy dispersive spectroscopy. In one patient liver abnormalities were first noted more than two years after haemodialysis was discontinued and in a second patient abnormalities were still present more than four years after successful kidney transplantation. No other specific cause for the chronic liver abnormalities was determined and we consider that these may be related to the presence of silicone degradation products in the liver. Other patients haemodialysed using a siliconised peristaltic blood pump insert system may also be a risk of developing similar late complications.
Adult↗
An electrode montage for electrocardiographic monitoring.
An electrocardiographic electrode montage is described using electrodes mounted on the manubrium sterni (RA), xiphisternum (LA) and V5 position (LL). The lead II setting on the monitor, equivalent to CM5, offers optimal ischaemia detection, while lead I, now a vertical lead, manubrium to xiphisternum, results in maximal P wave amplitude. The montage has been evaluated in sixty-two intensive care patients with electrocardiographic abnormalities and has been used extensively in intensive care, the operating theatres and in shock wave lithotripsy. The 'Prince Henry' montage offers advantages over the standard bipolar leads in P wave amplitude, arrhythmia diagnosis and artefact rejection.
Arrhythmias, Cardiac↗
Temperature dependent survival of UV-irradiated Escherichia coli K12.
We have found that several excision deficient derivatives of Escherichia coli K12 survive better after UV irradiation if incubated at 42 degrees C than if incubated at 30 degrees C. The highest survival was observed when incubation at 42 degrees C followed UV irradiation and was maintained for at least 16 h. Our results indicate that this temperature dependent resistance (TDR) requires a functional recA gene, but not uvrA, uvrB, recF, or recB genes, or the recA441 (tif-1) mutation which allows thermoinduction of the recA-lexA regulon. Our data are consistent with the idea that the increase in survival observed at 42 degrees C reflects enhanced daughter-strand gap repair by DNA strand exchange. Although the conditions used to elicit TDR can induce heat shock proteins and thermotolerance in E. coli, the relationship between the two responses remains to be elucidated.
DNA Repair↗
Atherosclerosis and coronary bypass surgery in hereditary factor VII deficiency.
A 66-year-old man with homozygous deficiency of factor VII (less activity than 4 percent of normal) had a minimal hemorrhagic tendency and severe coronary atherosclerosis, and underwent aortocoronary saphenous vein bypass surgery. Although plasma factor VII coagulant activity and cross-reacting material were markedly reduced, comparable amounts of factor VII antigen were detected in peripheral blood mononuclear cells of both the patient and of a normal subject by Western blotting techniques. Accelerated coagulation was observed following brief exposure of the patient's phytohemagglutinin-stimulated peripheral blood mononuclear cells to low concentrations of ambient factor VII in vitro. Evidence indicates that factor VII plays a role in vivo in both hemostasis and atherogenesis and it might be assumed that factor VII deficiency would both predispose to excessive bleeding and forestall atherosclerosis. However, these observations suggest that factor VII-mediated thrombin generation may proceed by partitioning of small amounts of factor VII on tissue factor-expressing cells and that factor VII contained within monocytes may facilitate tissue factor-induced coagulation by these cells. These features may provide efficient coagulation activation despite a deficiency of the plasma coagulant protein. The current results may explain, at least in part, the minimal bleeding tendency, and also the occurrence of thrombosis and atherosclerosis in certain persons with factor VII deficiency.
Aged↗
Reduction of serum lipoproteins in man by the oral administration of a prostaglandin analogue (enprostil).
Retrospective analysis of ulcer healing trials utilizing enprostil, a synthetic dehydroprostaglandin E2 analogue, has demonstrated a 10% or greater reduction in total serum cholesterol in 64%, 64% and 67%, respectively, of hypercholesterolemic subjects receiving the drug in doses of 70 micrograms, 35 micrograms, and 7 micrograms bid, respectively. Only 16% of subjects receiving placebo exhibited a similar reduction (P less than 0.05). The median percent changes for hypercholesterolemic patients receiving enprostil 70 micrograms, 35 micrograms, or 7 micrograms bid, and placebo were -17%, -13%, -11%, respectively, while the median percent change for those on placebo was 0% (P less than 0.05). Eight normocholesterolemic subjects participated in a double-blind crossover study comparing enprostil 70 micrograms/d with its placebo. Nine days of enprostil administration was associated with reductions in total serum cholesterol (-16%) and apolipoprotein B (-16%) and with significant reductions from baseline for LDL-cholesterol (-22%), the LDL/HDL-cholesterol ratio (-13%), and the ratio of serum apolipoprotein B to apolipoprotein A-1 (-12%). Relative to placebo, mean HDL-cholesterol, total triglycerides, and apolipoprotein A-1 concentrations remained unchanged. Daily oral administration of microgram quantities of enprostil is associated with reductions in total cholesterol, LDL-cholesterol, and apolipoprotein B suggesting therapeutic potential of this synthetic prostaglandin for the treatment of hyperlipidemia.
Administration, Oral↗
Artificial dermis for major burns. A multi-center randomized clinical trial.
This communication presents an 11-center prospective randomized trial using the artificial dermis invented by Burke and Yannas. Patients with life-threatening burns who underwent primary excision and grafting within 7 days of injury had comparable sites randomized to receive either the artificial dermis (study site) or the investigator's usual skin grafting material (control site). Control materials were autograft, allograft, xenograft, or a synthetic dressing. Epidermal grafts were applied to the study site during a second operation, and surviving patients were followed for 1 year after grafting. One hundred thirty-nine sites on 106 patients were studied. Mean burn size was 46.5 +/- 15% mean total body surface (TBSA). Overall mortality was 13%, and mean hospital stay was 68 +/- 45 days. Median artificial dermis take was 80% compared with 95% for all comparative sites, but the take was equivalent to that of all nonautograft control materials. Results with the artificial dermis improved slightly as the investigators became more familiar with the material. Donor site thickness for the study site averaged .006'' +/- .002'' compared to .013'' +/- .018'' for control (p less than .0001) and the epidermal donor site healed an average of 4 days sooner (10 +/- 6 vs. 14 +/- 8 days) (p less than .0001). As the wounds matured during the first year, both patients and surgeons felt that both sites became more comparable in appearance and function. At the completion of the study, there was less hypertrophic scarring of the artificial dermis, and more patients preferred the artificial dermis to the control graft. Artificial dermis with an epidermal graft provides a permanent cover that is at least as satisfactory as currently available skin grafting techniques, and uses donor grafts that are thinner and donor sites that heal faster.
Adolescent↗
Cecostomy revisited. Still a useful operation.
The necessity of a cecostomy in the management of large-bowel obstruction continues to be debated. Recent reviews have tended to discredit or disregard this therapeutic method in favor of the colostomy. Past criticism has focused on three central issues. First, local stomal care is difficult. Second, satisfactory bowel preparation cannot be accomplished. Third, a high incidence of surgical closure of the cecostomy is reported. In light of this continuous controversy, a retrospective review of tube cecostomies was conducted to assess the indications, morbidity, and success or failure associated with this treatment modality.
Adult↗
secD, a new gene involved in protein export in Escherichia coli.
New mutants of Escherichia coli altered in protein export were identified in phoA-lacZ and lamB-lacZ gene fusion strains by searching for mutants that showed an altered lactose phenotype. Several mutations mapped in a new gene, secD. These mutants were, in general, cold sensitive for growth, and the mutations led to an accumulation of precursor of exported proteins. The secD gene is closely linked to tsx on the E. coli chromosome, but separable from another gene proposed to be involved in export, ssaD, which maps nearby. A plasmid carrying secD+ was identified and used to show that the mutations are recessive. The secD gene may code for a component of the cellular export machinery.
Bacterial Proteins↗
The sympatho-adrenal system and plasma levels of adrenocorticotropic hormone, cortisol and catecholamines in equine grass sickness.
Plasma levels of adrenocorticotropic hormone (ACTH), cortisol and catecholamines were used to study the role of the sympatho-adrenal system in equine grass sickness. Statistical evaluation determined differences of hormone levels between seven horses with grass sickness (one acute, five subacute and one chronic), six horses with colic (one with laminitis) and 16 control horses before and after mild stress. Plasma levels of the hormones were higher in horses with acute and subacute grass sickness than in the other groups. No differences were detected between horses with colic and stressed control horses but some hormone levels differed between control and colic horses and control horses before and after stress. It is possible that hyperactivation of the sympatho-adrenal system is caused by stress but it is uncertain whether the stress is only a result of the severity of the disease or also plays a role in its aetiology.
Acute Disease↗