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Biomedical subjects

J Perlman

Publications and source records attributed to J Perlman.

At least 19 recordsLinked to original sources
PubMed2001

Pathophysiology of neonatal resuscitation: application in a global context.

Despite the adoption of evidence-based guidelines for neonatal resuscitation, formulated with international consensus, the process of resuscitating a newly born infant remains a uniquely local activity. Variations in the physical environment, cultural and medical beliefs, and available resources mediate significant difference in practices worldwide. Yet, the universal nature of the physiology surrounding birth, and its disturbances, provides a common basis for reference. Recognition of the importance of assistance available at the moment of birth, management of the thermal environment, and establishment of adequate ventilation is nearly universal. Differences in specific practices arise from local differences in the risks and challenges to perinatal health, which, in turn, stem from the environment or the available resources. Valuable information can be learned through comparison and evaluation of different techniques. In such a way, the evidence base for neonatal resuscitation can be strengthened and infants around the world can share in the benefits realized.

Asphyxia Neonatorum↗
PubMed2001

Medications during resuscitation -- what is the evidence?

Medication use during neonatal resuscitation is uncommon. The infrequent use of resuscitation medications has impeded rigorous investigations to determine the most effective agents and/or dosing regimens. The medications most commonly used during delivery room resuscitation include epinephrine, sodium bicarbonate, naloxone hydrochloride and volume expanders. The available evidence for each of these medications is reviewed in this article.

Asphyxia Neonatorum↗
PubMed2000

International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines.

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: * Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. * Preventing heat loss: Hyperthermia should be avoided. * Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO(2) detection can be useful in the secondary confirmation of endotracheal intubation. * Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. * Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. * Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

Blood Volume↗
PubMed1999

Coexistent holoprosencephaly and Chiari II malformation.

Chiari II malformations and holoprosencephaly have been considered to be brain malformations that differ with respect to teratogenic insult, embryologic mechanism, and morphology. We herein describe coexistent Chiari II malformation and holoprosencephaly that occurred in a viable infant. A review of the literature regarding Chiari II malformations and holoprosencephaly suggests that a disturbance to the mesenchyme in early embryologic life may be the cause of both malformations.

Arnold-Chiari Malformation↗
PubMed1997

Recommendations for follow-up care of individuals with an inherited predisposition to cancer. II. BRCA1 and BRCA2. Cancer Genetics Studies Consortium.

OBJECTIVE: To provide recommendations for cancer surveillance and risk reduction for individuals carrying mutations in the BRCA1 or BRCA2 genes. PARTICIPANTS: A task force with expertise in medical genetics, oncology, primary care, gastroenterology, and epidemiology convened by the Cancer Genetics Studies Consortium (CGSC), organized by National Human Genome Research Institute (previously the National Center for Human Genome Research). EVIDENCE: Studies evaluating cancer risk, surveillance, and risk reduction in individuals genetically susceptible to breast and ovarian cancer were identified using MEDLINE (National Library of Medicine) and from bibliographies of articles thus identified. Indexing terms used were "genetics" in combination with "breast cancer," "ovarian cancer," and "screening," or "surveillance" in combination with "cancer family" and "BRCA1" and "BRCA2." For studies evaluating specific interventions, quality of evidence was assessed using criteria of the US Preventive Services Task Force. CONSENSUS PROCESS: The task force developed recommendations through discussions over a 14-month period. CONCLUSIONS: Efficacy of cancer surveillance or other measures to reduce risk in individuals who carry cancer-predisposing mutations is unknown. Based on expert opinion concerning presumptive benefit, early breast cancer and ovarian cancer screening are recommended for individuals with BRCA1 mutations and early breast cancer screening for those with BRCA2 mutations. No recommendation is made for or against prophylactic surgery (eg, mastectomy, oophorectomy); these surgeries are an option for mutation carriers, but evidence of benefit is lacking, and case reports have documented the occurrence of cancer following prophylactic surgery. It is recommended that individuals considering genetic testing be counseled regarding the unknown efficacy of measures to reduce risk and that care for individuals with cancer-predisposing mutations be provided whenever possible within the context of research protocols designed to evaluate clinical outcomes.

Antineoplastic Agents, Hormonal↗
PubMed1996

Homing in on the homeless: assessing the physical health of homeless adults in Los Angeles County using an original method to obtain physical examination data in a survey.

OBJECTIVE: Public policy that decreases the finding for social services may combine with the ascendancy of corporate managed care to increase the health care deficit. Assessing the health impact of these policy changes on various populations is a fundamental challenge for health services research. Disadvantaged populations, such as the homeless, are likely to be affected disproportionately. Research quality data on the physical health of such populations are difficult and expensive to obtain. In particular, physical examination data have not been available and self-reports are insufficient. Our objective: to develop and utilize a structured physical exam system enabling lay survey researchers to report reliably physical findings related to six tracer conditions in a disadvantaged population. STUDY SETTING: A field survey of homeless adults in Los Angeles County, California. Respondents were 363 homeless adults representing a subsample of a probability sample of the county's homeless adult population. STUDY DESIGN: We integrated existing measures with expert clinical opinion and original means of data collection into a structured physical exam enabling lay interviewers to identify the prevalence of vision problems, significant skin disorders, peripheral vascular disease of the lower extremities, selected podiatric disorders, hypertension, and tuberculosis in a sample of homeless adults. PRINCIPAL MEASURES: We describe lay interviewer performance in terms of mastery of the necessary material based on written and practical exams and in terms of the number of respondents successfully followed. We base our description of the instrument on the time necessary to complete it, and on the proportion of each component successfully completed during the field survey, as well as on interrater reliability. We report the prevalence of the various clinical conditions according to self-report and according to the structured limited physical exam, as well as the marginal proportion of respondents who were identified by the physical exam and not by self-report. PRINCIPAL FINDINGS: Interviewers performed the exam successfully under field conditions. Respondent acceptance of the instrument was high. Interrater agreement was 100 percent regarding the need for referral on the basis of blood pressure and vision. Kappa statistics for skin, foot, and edema findings were .67,.71, and .81, respectively. Adjusted for sampling weights, 60 percent of this population required referral for at least one of the specified conditions. For those portions of the survey for which both self-report and physical exam data were available, lay interviewers made significant percentages of referrals on the basis of physical findings alone. CONCLUSIONS: High blood pressure, poor vision, peripheral vascular diseases of the feet and legs, and significant skin conditions are prevalent among the homeless in Los Angeles County. Without physical exam data, estimates of the prevalence of these conditions will be incorrect. Researchers can use laypersons to collect reliable and valid physical exam data on disadvantaged populations. This represents a new tool for assessing and monitoring the health of these populations.

Adult↗
PubMed1993

Vasectomy and prostate cancer risk: methodological review of the evidence.

Two recent studies have reported a significantly elevated risk of prostate cancer among vasectomized men. To assess whether the new results conflict with earlier studies that found no significant overall association, and, if so, whether such a conflict could have a methodological basis, we reviewed the six major epidemiological studies of this topic. Statistical analysis revealed significant (p < 0.01) heterogeneity among the associations in the six studies, attributable to one of the recent studies. Scrutiny of the studies for fulfillment of eight methodological standards for scientific validity revealed that no study completely fulfilled more than four standards, and that all studies were deficient in avoiding detection bias and obtaining accurate vasectomy histories. Our review indicates that the evidence on this topic is indeed conflicting, that the quality of the evidence does not resolve the conflict, and that future studies of this topic, designed to ensure scientific credibility of results, are needed.

Adult↗
PubMed1993

Congenital cytomegalovirus infection presenting as cerebral ventriculomegaly on antenatal sonography.

Antenatal sonography in two cases demonstrated cerebral ventriculomegaly and decreased head circumference, subsequently found to be secondary to cytomegalovirus (CMV) infection. In both cases, the lateral ventricles were enlarged and lissencephaly was diagnosed in the neonatal period. The findings of ventriculomegaly and decreased head circumference on antenatal sonography warrant further investigation for CMV via amniotic fluid cultures or fetal blood, given the poor prognosis in infants with symptomatic infection.

Adolescent↗
PubMed1992

Neisseria sicca endocarditis with embolic phenomena.

Two patients with poor oral hygiene developed Neisseria sicca endocarditis, one after probable intravenous drug abuse and Staphylococcus aureus endocarditis and the other after a periodontal surgical procedure. Both experienced significant embolic phenomena and both required 6 or more weeks of intravenous antibiotic therapy. The diagnosis of N. sicca endocarditis must be considered when this organism is isolated from blood cultures in patients with emboli.

Adult↗
PubMed1992

Distortion-product otoacoustic emissions in human newborns and adults.

Cubic distortion-product otoacoustic emissions (DPEs) may have clinical and research applications. We reliably recorded DPEs at some frequencies in all of the normal-hearing human adults and newborns tested. Adult and newborn DPEs were of comparable amplitude, with the exception that a prominent dip between 1 and 3 kHz in the adult data was less evident in the newborn data. DPE amplitude was a linear function of the intensity of the eliciting primary stimuli. The slopes of the linear input-output functions increased with increasing frequency. Except at the highest frequencies assessed, adult input-output functions were steeper than newborn input-output functions.

Acoustic Stimulation↗
PubMed1992

Maximum length sequence auditory evoked brainstem responses in human newborns and adults.

Experiment 1 investigated developmental differences at high stimulus rates by using maximum length sequences (MLSs) and cross-correlation techniques to recover auditory evoked brainstem responses (ABRs). Reliable MLS ABRs were recorded in all of the newborns tested at the highest rate presented (minimum interpulse interval = 1.1 msec). Interpreting developmental rate effects from latency and amplitude shifts is problematic. Identification of higher order kernals offers new information concerning developmental rate effects. Kernel slices were measured at lower rates in more adults than newborns, suggesting that the newborn auditory system is less sensitive to temporal nonlinearities than the mature auditory system. This runs counter to developmental rate studies using conventional stimuli. Experiment 2 investigated developmental differences at high rates due to varying stimulus intensities. MLS wave V intensity functions were less steep than conventional wave V intensity functions. MLS thresholds were also higher than conventional thresholds (primarily due to the newborn data). Without equating for signal-to-noise ratio, it is difficult to make unambiguous conclusions concerning the observed developmental differences.

Acoustic Stimulation↗
PubMed1989

Oral contraceptive use and the risk of chlamydial and gonococcal infections.

Oral contraceptive users were compared with nonusers with respect to the rate of cervical infections by Chlamydia trachomatis and Neisseria gonorrhoeae. The comparison was adjusted for differences in demographic and behavioral characteristics between the two groups. The rates of infection among oral contraceptive users were increased by approximately 70% (statistically significant) for both pathogens. Cervical ectopy was implicated in the increased rate of chlamydia but not gonorrhea. Rates of gonorrheal infection differed significantly among oral contraceptive formulations; rates were higher for formulations containing more androgenic progestins.

Adult↗
PubMed1988

Respiratory origin of fluctuations in arterial blood pressure in premature infants with respiratory distress syndrome.

A variable fluctuating pattern of arterial BP often precedes intraventricular hemorrhage in mechanically ventilated preterm infants. To learn more about the origin of this pattern, arterial BP and respiratory muscle activity were studied in five intubated premature infants who were at high risk for intraventricular hemorrhage. We monitored esophageal pressure, gastric pressure, and arterial BP. Consistent findings were: (1) arterial BP fluctuations have the same frequency and direction of change as esophageal and gastric pressure changes associated with spontaneous breathing (R ranged from .93 to .98, P less than .001); (2) spontaneous apneic pauses were accompanied by sudden and complete cessation of arterial BP fluctuations; (3) large "cough-like" fluctuations in esophageal and gastric pressures, seen in all infants, were associated with the largest fluctuations in arterial BP; (4) cutaneous stimulation had negligible effect on fluctuation in arterial BP provided no change in esophageal and gastric pressures occurred; (5) the effects of change in esophageal and gastric pressures on arterial BP were nearly simultaneous (0.05 to 0.25 second latency); (6) respirator pressure fluctuations had negligible effects on the fluctuations in arterial BP. These data suggest that the fluctuations in arterial BP are directly related to respiratory muscle activity and are most consistent with the familiar pulsus paradoxus that occurs in various other cardiorespiratory diseases.

Blood Pressure↗