BACKGROUND: An organ dysfunction (OD) scoring system for critically ill children is not yet available, and the method for developing such a system is not well defined. The aim of this study was to compare two developmental methods for assessing OD in critically ill children. METHODS: Consecutive admissions between January and May 1997 in three French and Canadian pediatric intensive care units (PICUs) were studied prospectively. Physiologic data were selected using a Delphi method; the most abnormal values during PICU stay were recorded. The outcome measure was the vital status at PICU discharge. Six organ systems were studied: hepatic, cardiovascular, renal, hematologic, respiratory, and neurologic. For each of the six organ systems, the PEdiatric Multiple OD (PEMOD) system included one variable and the PEdiatric Logistic OD (PELOD) system included several variables. Severity levels and relative weights of ODs were determined according to the mortality rate (PEMOD) or by logistic regression (PELOD). RESULTS: There were 594 admissions, including 51 deaths (9%). Severity levels and relative weights of ODs were: four levels graded from 1 to 4 for the PEMOD system and three levels with scores of 1, 10, and 20 for PELOD system. For both systems, calibrations were good (p = 0.23 and p = 0.44 respectively). The PELOD system was more discriminant than the PEMOD system (areas under the ROC curves 0.98 and 0.92, respectively, p < 10(-5)). Moreover, with the PEMOD system, four ODs did not contribute significantly to the prediction of PICU outcome. CONCLUSIONS: The PELOD system was more discriminant and had the advantage of taking into account both the relative severities among ODs and the degree of severity of each OD.

Adolescent↗

PubMedDate not supplied

Cancer prevention in the community: a survey of community residents.

Lifestyle exposures account for the greatest proportion of risk factors for cancer, yet these exposures have proven most difficult to alter. Despite intensive intervention efforts, many behaviour change programs are ill suited to the community. This research was undertaken to increase our understanding of prevention activities of interest to a sample of residents in two Ontario communities. 248 (62.3%) adult residents responded to a semi-structured self-administered questionnaire including open-ended questions on health issues, exposures and prevention activities of interest. While some of the beliefs expressed by respondents might have been anticipated (e.g., cigarette smoking and family history increase risk of cancer), others were not (e.g., only between 40 and 75% of respondents thought a high fat diet increased risk). Furthermore, many of those with personal health concerns expressed an interest in prevention. This process is proposed as a first step in launching more appropriate and sustainable community-based health promotion programs for cancer prevention.

Adult↗

PubMedDate not supplied

Late presentation of a gastrocolic fistula after percutaneous fluoroscopic gastrostomy.

Gastrocolic fistula (GCF) has previously been described with percutaneous endoscopic gastrostomy procedures. However the present case of GCF is to our knowledge the first reported in the literature. It developed as a complication of the fluoroscopic technique three months after percutaneous fluoroscopicically guided gastrostomy-tube insertion. GCF was symptomless and was discovered during button replacement in a 74-year-old head and neck cancer patient. In patients with complex upper abdominal anatomy, the use of US or CT should be recommended to avoid such problem.

Aged↗

PubMedDate not supplied

Post-cardiac catheterization femoral fistula corrected by ultrasound-guided compression.

We present a case of post-cardiac catheterization femoral fistula diagnosed by color and pulsed Doppler sonography and treated by ultrasound-guided compression. We avail ourselves of the case to review the echo Doppler semiology of the different types of arteriovenous fistulas with an emphasis on the functional analysis of the dialysis accesses. We also stress the therapeutic options in front of undesirable shunts.

Aged↗

PubMedDate not supplied

Incidental sonographic finding of an extracranial internal carotid artery aneurysm confirmed by CT angiography.

We report a rare case of an extracranial internal carotid artery aneurysm (EICAA) discovered incidentally by color Doppler sonography (CDUS) and confirmed by CT angiography with three-dimensional reconstructions. As both brain MRI and cerebral angiography were normal and the patient remained asymptomatic, he was neither operated on nor stented but was discharged with appropriate antiplatelet therapy. The volume of his EICAA is checked regularly by CDUS.

Aneurysm↗

PubMedDate not supplied

[The manipulation of information of developed formulas for the study of structure-activity relationships. Application to antiparasitic agents].

Beside traditional univariate methods of pharmacochemical (pharmacomodulation...), and of molecular pharmacology ("binding"...) most global approach (multivariate) of structure-activity and structure-toxicity relationships may been in action with processing implement. Developed formula may been treated by different algorithmic methods as molecular connectivity matrix which use atoms, bindings, chemical functions, fragments, of any molecule. This technique allows to research and to automatically count structural fragments of molecule, different in their chemical aspect but having the same port of activity. So, with this profile of fragments it is possible to build a spanning tree (PRIM'S arborescent skeleton) and to place a priori on it, new structures with other properties to value their activity level in the designed field. We applied these techniques to 50 most prescribed antiparasitic active principles.

Information Systems↗

PubMedDate not supplied

[Multivariate analysis as a means of access to optimal pharmacochemical specificity and to molecular archetypes].

For complex works as studies relationships structure-activity, in heterogeneous therapeutic families we have selected mathematical methods founded upon systemic approach rather analytic one, appealing to bibliographical data, taking into consideration a plurality of biological targets and envisaging structural extrapolations rather than interpolations. Compared with classical QSAR, multivariate analysis (factorial analysis and multidimentional data reduction) intend from structuration of whole complex items to definite spheres of correlations between structural parameters and biological ones to issue then on a symetric typology of this two groups of parameters. These approaches have not only a descriptive character but lead to operational conclusions through an interactive dialogue with data bank; for example: --to explore acting potentiality of others molecular families or/and particular sub-structures --to find chemical sequences of molecules synthesized for other aims but not again experimented for this property. The case of antiparasitic agents is here developed.

Analysis of Variance↗

PubMedDate not supplied

Erythrocyte membrane-bound daunorubicin as a delivery system in anticancer treatment.

Drug encapsulation in erythrocytes has been proposed to extend its biological lifetime. Molecules encapsulated this way are protected against rapid cellular metabolism and body elimination. Unfortunately, drugs such as daunorubicin cannot be efficiently entrapped in erythrocytes since drugs diffuse rapidly from the cells. In order to overcome this problem, we have covalently linked daunorubicin to erythrocyte membranes (ghosts) using two different types of linking arms: glutaraldehyde and cis-aconitic acid. Both ghost-daunorubicin conjugates were tested in vitro on mouse leukemia cells (P388D1) and on human osteosarcoma cells (CRL-1427). Results showed a better cytotoxic activity for ghost-glutaraldehyde-daunorubicin conjugate than for ghost-cis-aconityl-daunorubicin conjugate. Both conjugates were also tested in vivo on CDF1 mice bearing P388D1 cells. T/C% of 161 and 103 respectively were observed with ghost-glutaraldehyde-daunorubicin and ghost-cis-aconityl-daunorubicin conjugate at 6.0 mg/kg. Compared to free drug, the increase in survival time could be explained by a slow release of daunomycin in the circulation from the erythrocyte membranes, leading to a more complete absorption by cancer cells.

Animals↗

PubMedDate not supplied

In vitro and in vivo activity of 1-aryl-3-(2-chloroethyl) urea derivatives as new antineoplastic agents.

A few 1-aryl 3-(2-chloroethyl)ureas (CEU) were synthesized and screened in vitro for their cytotoxicity. Some of these derivatives were assayed for their mutagenicity, their in vivo toxicity and their antineoplastic activity. Methyl 4-(p-(3-(2-chloroethyl) ureido) phenyl) butyrate, 4-methyl and 4-tertbutyl (3-(2-chloroethyl) ureido) phenyl) butyrate, 4-methyl and 4-tert-butyl (3-(2-chloroethyl) ureido) benzene had an ID50 of 28, 20 and 4 microM respectively when tested on LoVo cells, while chlorambucil (CBL) and CCNU had an ID50 of 21 and 45 microM. These 3 chloroethyl urea derivatives were not toxic when injected i.p. at doses up to 220 mg/kg, whereas chlorambucil was already toxic at 18.5 mg/kg. The survival time of BDF1 mice bearing L1210 leukemia tumors was significantly enhanced by intraperitoneal injections of CBL and CEU. The most cytotoxic derivative (tert-butyl derivative) gave the best antineoplastic activity with a median survival time 1.77 times that of the control at 10 mg/kg/day and was not toxic, whereas CBL at this concentration enhanced survival time by a factor of 1.6 and presented important side effects. The 4-tert-butyl (3-(2-chloroethyl) ureido) benzene and the methyl 4-(p-(3-(2-chloroethyl) ureido) phenyl) butyrate showed no mutagenicity when assayed on TA-97, TA-98, TA-100 and TA-102, four strains of S. thyphimurium, while CBL had a weak effect on TA-102 and CCNU was highly mutagenic on TA-100 and TA-102.

Adenocarcinoma↗

PubMedDate not supplied

[Comparison study by electroretinography of ocular effects of pesticides in the mouse (author's transl)].

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Animals↗