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Biomedical subjects

J W Greene

Publications and source records attributed to J W Greene.

At least 55 records · Page 3Linked to original sources
PubMed1985

Interaction of anticonvulsants and oral contraceptives in epileptic adolescents.

Oral contraceptives are in widespread use, and are commonly prescribed for contraception in patients taking other medications. An example of this is the concomitant use of oral contraceptives and anticonvulsants in epileptic patients. This combination creates a potential for drug interactions which may alter the efficacy of both medications. An apparent interaction between oral contraceptives and anticonvulsants was observed in this study of epileptic adolescent females. This interaction was evidenced by menstrual irregularities which occurred in 65% (7 of 11) of adolescents on both medications concomitantly. The frequency of irregularity was significantly higher in these adolescents when compared to adolescents on either medication alone. Irregularities appeared to be alleviated by increasing the strength of the oral contraceptive, and although a concern, the increased dosage did not affect seizure control.

Adolescent↗
PubMed1985

Stressful life events and somatic complaints in adolescents.

Although life stress has often been associated with recurrent pain in children and adolescents, level of stress has not previously been found useful in differentiating patients with functional pain from those in whom other conditions are diagnosed. In this study, a standard measure of stressful life events was systematically administered to 172 adolescents seen for the first time at an outpatient adolescent clinic. Patients with recurrent pain for which no organic etiology could be identified reported significantly higher life stress than patients being seen for routine checkup, acute minor illness, stable chronic illness, or pain with clinically diagnosed organic cause. Furthermore, patients referred for behavior problems indicated significantly higher life stress than all other patient groups. It is suggested that a measure of stressful life events may be a useful adjunct to the clinical interview and is of particular value in identifying specific stressors and planning treatment to address them.

Adolescent↗
PubMed1983

Acetaminophen poisoning in infancy.

Acetaminophen is widely used in children of all ages, and overdosage from this medication is common. Although severe hepatotoxicity from over-dosage occurs in adults, acetaminophen seems to have a wide margin of safety in younger children. This has been ascribed to altered pharmacokinetics in this age group. We report two cases in which severe acetaminophen-induced hepatoxocity occurred in two infants. Neither infant reportedly received potentially toxic dosages, by history, but toxic drug levels were present in both.

Acetaminophen↗
PubMed1982

Improved prediction of fetal lung maturity in diabetic pregnancies: a comparison of chromatographic methods.

Following planned termination of pregnancy, infants of diabetic mothers have shown a continued vulnerability to the respiratory distress syndrome (RDS), suggesting false positive results on fetal lung maturity testing. We studied the adequacy of the standard one-dimensional chromatographic lecithin/sphingomyelin (L/S) ratio for predicting RDS in 56 diabetic and 50 nondiabetic pregnancies. An exceptionally low incidence of RDS was noted for the study (0.95%) as well as for diabetic pregnancies alone (1.85%). The clinical results were further compared to a new method for determining L/S ratios and identifying other pulmonary phospholipids by two-dimensional chromatography. Values for two-dimensional L/S ratios were significantly lower from 36 through 38 weeks' gestation (P less than 0.01), suggesting improved accuracy and a lessened risk for false positive results in preterm deliveries. Positive identification of amniotic fluid phosphatidylglycerol (PG) was related to increasing L/S ratios (P = 0.001), but only 50% of nondiabetic and 16.7% of diabetic amniotic fluid samples contained PG when the L/S was 2:1 or greater (P = 0.02). The identification of PG serves to confirm fetal lung maturity, but the L/S ratio remains the best available indicator of fetal lung maturity for all high-risk pregnancies.

Chromatography↗
PubMed1981

Management of febrile outpatient neonates.

To determine whether all febrile outpatients below the age of two months should be routinely hospitalized and given parenteral antibiotics because of the possibility of occult sepsis or meningitis, 147 such admissions were reviewed over four years. None of the neonates had occult bacterial meningitis, while one may have had occult sepsis. Because serious infections may have been missed in outpatients not hospitalized, the outcome of all such illnesses seen in the clinic during a subsequent six months was monitored; none of 17 hospitalized or 20 followed as outpatients experienced sepsis or meningitis. If our findings are confirmed in other studies, febrile outpatient neonates with a well appearance, normal cerebrospinal fluid and physical examination, and dependable follow-up may not require universal hospitalization and antibiotics.

Ambulatory Care↗
PubMed1981

Effect of resident peer review on charting behavior.

Traditionally the medical profession and, more recently, federal agencies have promoted peer review to improve quality of health care, although its effectiveness is uncertain. To assess ability of peer review to increase recording of comprehensive care, the resident charting of growth, immunizations, and family, past medical, developmental, and birth history was monitored in randomly selected charts six months before (747 charts) and six months after institution of peer review (691 charts). Faculty emphasis for charting remained uniform throughout the study. During ten 1-hour sessions, pediatric residents reviewed the charts of their colleagues for comprehensive care and other measurements using a standard form. Although faculty were not present, residents reported by post-study interview that vigorous discussion and peer pressure occurred during the sessions, and subjectively they felt their charting had improved. An objective assessment indicated charting of past medical history worsened after peer review was initiated, and charting of family history improved slightly. All changes were marginal. Charting was not related to the volume of patients seen by individual residents or their level of training but was relatively consistent for individual residents over successive rotations.

Documentation↗