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Biomedical subjects

J W Thompson

Publications and source records attributed to J W Thompson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Malignant infantile osteopetrosis: otolaryngological complications and management.

OBJECTIVES: To inform otolaryngologists about upper airway obstruction requiring tracheotomy and other otolaryngological manifestations of malignant infantile osteopetrosis (MIOP) and to discuss pathophysiological features, management, and new treatment strategies in MIOP. DESIGN: Ongoing case series combined with a retrospective chart review. SETTING: International tertiary pediatric hospital. INTERVENTIONS: Patients with MIOP were initially referred for treatment and routine follow-up. Tracheotomy was performed to manage obstructive sleep apnea. Audiograms were also performed at regular intervals. RESULTS: The records of 9 patients were examined. The otolaryngological findings of hearing loss, obstructive sleep apnea (sometimes requiring tracheotomy), otitis media, and chronic osteomyelitis with facial fistulas were identified. CONCLUSIONS: Osteopetrosis is a rare condition caused by a failure of the osteoclast to resorb bone. This results in thickened dense, deformed, and easily fractured bone. As a result, growth failure, anemia, hypoplastic dentition, chronic infections, facial fistulas, blindness, hearing loss, nasal congestion, and upper airway obstruction may occur. The management of otolaryngological problems in a child with osteopetrosis is an important component in comprehensive care. To our knowledge, this study represents the largest case series of MIOP in the otolaryngology literature.

Face↗
PubMed1998

Antidepressant prescribing practices of outpatient psychiatrists.

BACKGROUND: The authors examined recent changes in the number and proportion of patients prescribed antidepressants by psychiatrists in outpatient private practice and characterized antidepressant prescription patterns by patient age, sex, race, payment source, and clinical diagnosis. METHODS: The authors analyzed physician-reported data from the 1985 and 1993-1994 National Ambulatory Medical Care Survey, focusing on visits to physicians specializing in psychiatry. Logistic regressions were used to examine associations between survey year and antidepressant prescription, adjusting for the presence of other variables. RESULTS: The proportion of outpatient psychiatric visits in which an antidepressant was prescribed increased from 23.1% (95% confidence interval [CI], 19.7%-26.5%) in 1985 to 48.6% (95% CI, 47.5%-49.7%) in 1993-1994. After controlling for several patient variables, psychiatric patients were approximately 2.3 (95% CI, 1.8-2.9) times more likely to receive an antidepressant in 1993-1994 than in 1985. In 1993-1994, selective serotonin reuptake inhibitors accounted for approximately half of the psychiatric visits with an antidepressant prescription. Increases in the rate of antidepressant prescription were particularly evident for children and young adults; whites; new patients; and patients with adjustment disorders, personality disorders, depression not otherwise specified or dysthymia, and some anxiety disorders. CONCLUSIONS: During the late 1980s and early 1990s, there was a significant increase in the prescription of antidepressants by office-based psychiatrists. This increase was greatest for patients with less severe psychiatric disorders.

Adjustment Disorders↗
PubMed1998

Definitive localization of isolated tracheoesophageal fistula using bronchoscopy and esophagoscopy for guide wire placement.

PURPOSE: To aid in identification of isolated tracheoesophageal fistulas (TEF), many surgeons have recommended the bronchoscopic placement of a ureteric or Fogarty catheter. This method can fail because of intraoperative dislodgment of the catheter. The authors present a new technique that enables us to definitively isolate and treat all H-type fistulas. METHODS: Six cases of isolated TEF are presented consisting of 4 H-type fistulas, a proximal pouch fistula, and a recurrent TEF. Three of the patients had undergone a total of four prior failed operations at outside institutions using attempted bronchoscopic catheter placement. On all six patients, bronchoscopy was first performed where the fistula tract was noted in the trachea and a guide wire was passed through the fistula. After orotracheal intubation, the authors performed rigid esophagoscopy; the guide wire was identified and brought out through the mouth. This created a wire loop through the fistula. With the use of x-ray we were then able to visualize the level of the fistula and determine whether a cervical or thoracic approach should be used. Identification of the fistula intraoperatively was then facilitated by traction on the loop by the anesthesiologist. RESULTS: Five of the six TEFs were repaired with neck exploration; one required right thoracotomy. In all patients, the fistula was identified and divided. There were no recurrences or other complications. CONCLUSION: This new technique is a simple and definitive method in identification and treatment of isolated TEF.

Bronchoscopes↗
PubMed1998

Cost-effectiveness of mandatory compared with voluntary screening for human immunodeficiency virus in pregnancy.

OBJECTIVE: To determine the cost-effectiveness of mandatory screening for human immunodeficiency virus (HIV) in pregnancy compared with that of voluntary screening under varying assumptions about patient behavior. METHODS: Using a health care system perspective, a decision-analysis model was constructed to estimate the outcomes and costs of the two strategies. Average and incremental cost-effectiveness ratios were calculated for each strategy. Sensitivity analyses were performed to test the effects of different values on the results of the simulation. In particular, we examined the potential effects of changes in patient behavior resulting from mandatory screening on our estimates of cost-effectiveness. RESULTS: At a prevalence of 170 per 100,000, average costs per case prevented were $255,158 and $367,998 for mandatory and voluntary screening, respectively. The incremental cost-effectiveness of mandatory compared with voluntary screening was $29,478. These values decreased as prevalence of HIV increased, or as the estimated lifetime cost of pediatric HIV infection increased: above an estimated cost for pediatric HIV of $129,250, mandatory screening was less expensive and more effective than voluntary screening. Assumptions about patient behavior affected these results: a 40% reduction in zidovudine acceptance in women identified only through mandatory screening increased the incremental cost-effectiveness to $112,434. The impact of behavior increased as the prevalence of HIV increased. CONCLUSION: Mandatory screening will prevent more cases of pediatric AIDS, but at a somewhat higher cost than voluntary screening under baseline assumptions. The cost-effectiveness of mandatory screening will be influenced by patient behavior, especially acceptance of zidovudine treatment among women who would have refused voluntary screening.

AIDS Serodiagnosis↗
PubMed1998

Preliminary results of the use of indole-3-carbinol for recurrent respiratory papillomatosis.

OBJECTIVE: We report the preliminary results of a phase I trial using indole-3-carbinol for the treatment of recurrent respiratory papillomatosis. Indole-3-carbinol is a chemical that is found in high concentrations in cruciferous vegetables and has been shown to alter the growth pattern of recurrent respiratory papillomatosis cell cultures and to be effective in an in vivo animal model of recurrent respiratory papillomatosis. METHODS: Eighteen patients were treated with oral indole-3-carbinol and had a minimum follow-up of 8 months and a mean follow-up of 14.6 months. All patients received indole-3-carbinol, and outcome measures included a change in papilloma growth rate and the need for surgery during treatment compared with before treatment. All patients had serial examinations with videoendoscopy to document papilloma location and growth rate. RESULTS: Thirty-three percent (6 of 18) of the study patients had a cessation of their papilloma growth and have not required surgery since the start of the study. Six patients have had reduced papilloma growth rate, and 6 (33%) patients have shown no clinical response to indole-3-carbinol. Indole-3-carbinol affects the ratio of hydroxylation of estradiol; changes in the ratios of urinary 2-hydroxylation and 16-hydroxylation of estradiol caused by indole-3-carbinol correlated well with clinical response. No major complications or changes in the children's growth curve were noted. CONCLUSIONS: The preliminary results of treating recurrent respiratory papillomatosis with indole-3-carbinol holds promise. Longer follow-up of this patient group and a blinded, controlled trial are required. We conclude that indole-3-carbinol appears to be safe and well tolerated and may be an efficacious treatment for recurrent respiratory papillomatosis.

Adult↗
PubMed1998

The effect of emotional support on maternal oxytocin levels in labouring women.

OBJECTIVE: The presence of a supportive companion to women in labour has been found to reduce the duration of labour and the incidence of oxytocin augmentation. The mechanism which produces this improvement is unknown but work in animals suggests that environmental disturbance produces changes in endogenous oxytocin secretion. This study was carried out to assess maternal oxytocin secretion in relation to the presence of a supportive companion in labour. STUDY DESIGN: A randomised controlled trial involving allocation of unsupported women in the first stage of labour to a period of 1 h with a supportive companion or 1 h without. Sixteen women with uncomplicated singleton pregnancies who were in the active phase of the first stage of labour were studied. Maternal oxytocin levels were assayed by radioimmunoassay for 16 min (eight specimens) before and after the support or control period. RESULTS: There are no differences between maternal oxytocin levels in the two groups of patients. There was no difference in either of the two groups between the oxytocin levels pre and post the support/control period. CONCLUSIONS: One hour of birth support in the first stage of labour did not improve maternal oxytocin levels when compared to a control group.

Adult↗
PubMed1998

Successful medical therapy for deeply invasive facial infection due to Pythium insidiosum in a child.

Pythiosis occurs in animals and humans who encounter aquatic habitats that harbor Pythium insidiosum. Drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have been cured only by radical surgical debridement. A 2-year-old boy developed periorbital cellulitis unresponsive to antibiotic and antifungal therapy. The cellulitis extended to the nasopharynx, compromising the airway and necessitating a gastrostomy for feeding. P. insidiosum was isolated from surgical biopsy specimens of the affected tissue. On the basis of in vitro susceptibility studies of the isolate, the patient was treated with a combination of terbinafine and itraconazole. The infection resolved over a period of a few months. The patient remained well 1.5 years after completing a 1-year course of therapy. Cure of deep P. insidiosum infection is feasible with drug therapy.

Anti-Infective Agents↗
PubMed1998

Fire in the operating room during tracheostomy.

BACKGROUND: Fire in the modern operating room is still a constant danger today despite the usual absence of the historically explosive anesthetic gases, cyclopropane, and ether. During a tracheostomy, three conditions are present that will support an explosive or combustive event: heat, fuel and oxygen. METHODS: We report three routine tracheostomy cases during which a fire was ignited. One patient had a minor burn during the cauterizing of a bleeding vessel. There was a visible flame in all cases and, in one case, the cloth drapes ignited. There were no serious airway injuries to any patients and all had a complete and uneventful recovery. We duplicated the same conditions in our laboratory. RESULTS: We discuss each case and give effective techniques to prevent ignition during surgery in the future. For our study, we reproduced flames in a cadaver trachea using halothane and the electrocautery in an oxygen-rich environment. We describe a protocol that has effectively prevented tracheostomy fires in our institution and may decrease the risk during other procedures as well. Also, we reviewed the literature to provide insight into the magnitude of the problem. CONCLUSIONS: High-oxygen concentration, the presence of fuels such as suture and tissue, and an igniting spark from the electrocautery device produce the proper conditions for a fire during tracheostomy. Taking the proper precautions can minimize if not eliminate this risk.

Adolescent↗
PubMed1998

Effects of morphine administration on the fetal production of oxytocin in labour.

1. Animal and human work has indicated that maternal oxytocin secretion is under the control of endogenous opiates. Previous workers have described the fetal production of oxytocin in addition to maternal production. The study of the interaction between exogenously administered opiates and oxytocin secretion may give insight into the activity of any opiate-mediated regulatory mechanism of oxytocin secretion in the fetus. This study was designed to investigate the effect of an opiate (5 mg of morphine) given to the mother on the fetal production of oxytocin in labour. 2. Morphine was given by the attending clinicians for analgesic purposes to women in the first stage of labour. After delivery umbilical artery vein and maternal vein specimens were taken. 3. Four groups of patients were studied: women after normal vaginal delivery without analgesia in labour (n=10); women after normal vaginal delivery who had morphine administration in the first stage of labour (n=12); women who had an emergency Caesarean section in the first stage of labour (n=11); women who had an elective Caesarean section at term who were not in labour (n=11). 4. Oxytocin levels were measured by radioimmunoassay in the maternal vein, umbilical artery and umbilical vein specimens. Morphine was measured by radioimmunoassay in the umbilical vein specimens. 5. The umbilical artery minus vein concentration of oxytocin was calculated for each patient (A-V). There was no change in the umbilical (A-V) concentration of oxytocin if morphine had been given to the mother in labour; this applied to fetuses delivered vaginally or by Caesarean section. When the fetuses who were exposed to morphine were analysed separately, there was no correlation between the umbilical vein morphine concentration and the umbilical (A-V) oxytocin concentration either in Caesarean or vaginal deliveries. 6. Fetal oxytocin production was not affected by the maternal administration of morphine in the first stage of labour. This applies to the oxytocin production in the first and second stage of labour.

Analgesia, Obstetrical↗
PubMed1997

Brief bilateral vocal cord paralysis after insecticide poisoning. A new variant of toxicity syndrome.

We describe a new variant of life-threatening organophosphate toxicity syndrome that produces a brief bilateral vocal cord paralysis. There are 3 recognized types of toxicity syndrome: acute (instantaneous), intermediate (slightly delayed, i.e., hours to days), and delayed (weeks to months). Ingestions of large doses of insecticides lead to a cholinergic crisis and possible death (acute-type syndrome). Exposures to lower doses may cause the intermediate- or delayed-type syndrome. The intermediate-type syndrome is characterized by slightly delayed polyneuropathy and generalized weakness. Transient vocal cord paralysis has also been reported in association with other neurologically profound findings. The delayed-type syndrome can produce muscle weakness for months. Our patient, a 2-year-old boy, was found eating a substance later found to be contaminated with insecticide. Within minutes, fever and somnolence developed, followed by progressive respiratory distress and stridor, without generalized weakness. The child's condition progressed to complete airway obstruction, and intubation was necessary. Emergency laryngoscopy and bronchoscopy were performed to rule out epiglottitis or a foreign body. Instead, a bilateral vocal cord paralysis was found. The paralysis lasted 2 days before completely resolving. Insecticide poisoning was suspected. We theorize that our patient manifested a combination of the acute-type syndrome, because of the immediacy of the onset of the symptoms (i.e., fever and somnolence), and the intermediate-type syndrome, because of the transient vocal cord paralysis. Because of the potential dangers involved, we wish to familiarize physicians concerning organophosphate poisoning; to alert the medical community to this variant of toxicity syndrome, which involves transient bilateral vocal cord paralysis; and to demonstrate the benefit of early otolaryngological consultation for the prevention and treatment of airway obstruction in patients with suspected organophosphate poisoning, be it from insecticides or poison gas.

Child, Preschool↗
PubMed1997

Airway management of neonates with antenatally detected head and neck anomalies.

Five cases of prenatally detected neck masses that had a potential for airway obstruction at birth are described. The various options for management of the airway are discussed, including using maternal-fetal circulation until intubation, rigid bronchoscopy, tracheotomy, cyst aspiration, or extracorporeal membrane oxygen support. Congenital abnormalities involving the fetal face or neck are extremely rare. With technical advances in ultrasonography, these masses were first noted on prenatal ultrasound in the late 1970s. Before that period, they were detected at delivery. These masses are solid or cystic and may cause asphyxia because of airway obstruction at the time of delivery. The survivability of these neonates without immediate intervention at birth is 0% to 20%. If a neck mass is detected in the fetus by prenatal ultrasonography, then a strategic plan for these types of cases should be developed early in the prenatal period. The airway management plan should be tailored for each individual case. Coordination and the expertise of an obstetrician, neonatologist, anesthesiologist, and pediatric otolaryngologist are needed to manage these complex situations.

Adult↗
PubMed1997

Bedside videoscopic placement of feeding tubes: development of fiberoptics through the tube.

OBJECTIVE: Transpyloric small intestine feeding tube placement can be difficult and tedious. Currently accepted techniques are associated with disadvantages and risk. The purpose of this study is to describe the development of a new technique: bedside videoscopic placement using fiberoptics through the tube. DESIGN: Prospective, descriptive case study. SETTING: Intensive care unit in a teaching hospital. PATIENTS: Subjects were divided into two groups: a) group 1: eight healthy volunteers (seven male, one female); b) group 2: nine critically ill patients (six male, three female; eight of these patients were intubated). INTERVENTIONS: Standard 12-Fr (4.0-mm) feeding tubes (n = 19) were placed. Two patients from group 2 had feeding tubes placed on two separate occasions. The feeding tubes were inserted by the oral (n = 8) or nasal (n = 11) route under direct vision, using a 6.7-Fr (2.2-mm) fiberoptic scope through the feeding tube. MEASUREMENTS AND MAIN RESULTS: We visualized enteric structures clearly through the feeding tube in all subjects and patients. Based on visual landmarks, we advanced the feeding tube through the pylorus and into the duodenum in all individuals. Transpyloric tube placement was confirmed videoscopically (n = 19) and radiographically (n = 18). In three subjects from group 1, the feeding tube entered the first part of the duodenum, while, in the remainder of the subjects, the tube passed into or beyond the second portion of the duodenum. In eight (73%) of 11 attempts on the nine critically ill patients from group 2, the feeding tubes were advanced to the distal duodenum or jejunum. The time required for placement in group 2 ranged from 2 to 43 mins (mean 18 +/- 12 [SD]). The feeding tubes remained in place 10 +/- 4 days and patients met their estimated caloric needs within 24 hrs. Residual volumes of nutrition in the small bowel were < 5 mL. There were no documented episodes of aspiration. CONCLUSION: This new technique has the potential for rapid, accurate, and safe feeding tube placement in patients requiring nutritional support.

Adult↗
PubMed1996

Antimicrobials prescribed for otitis media in a pediatric Medicaid population.

Antimicrobial prescribing patterns for Tennessee Medicaid children having their first case of otitis media (OM) in at least nine months were studied. Tennessee Medicaid claims data for patients under 11 years whose first documented OM diagnosis in 1993 occurred in the fourth quarter and who had had an antimicrobial claim filed within two days of diagnosis were studied to determine antimicrobial prescribing patterns. Of 7357 children meeting the study criteria, 70% were less than three years of age, 65% were Caucasian, and 60% had a rural address. Twenty antimicrobials were prescribed. Amoxicillin was prescribed most frequently (53% of the time), followed by cefaclor; all first-line therapies (amoxicillin, ampicillin, erythromycin-sulfisoxazole, and trimethoprim-sulfamethoxazole) accounted for 64% of the prescriptions, but only one fourth of the costs. The highest use of first-line therapy was associated with children under three years of age; children without prior antimicrobial therapy, recent upper respiratory infection (URI), or recent sinusitis; children seen by emergency department physicians; and children seen by urban physicians. Tennessee Medicaid would have saved +68,250 if first-line therapy had been used for all children having their first occurrence of OM in the fourth quarter alone. The savings to the state were estimated at +300,000 or more in 1993 had first-line therapy been used for most first occurrences of OM in all four quarters plus even a small percentage of the estimated 30,000 remaining repeat OM cases. Amoxicillin was prescribed 53% of the time, and all first-line therapies 64% of the time, for children with their first case of OM in at least nine months. In children without recent antimicrobial therapy, URI, or sinusitis, first-line therapy was still used only 72% of the time.

Age Distribution↗
PubMed1996

Effects of global competition on health care administration in Finland and the United States. What you can do to save your practice.

Global competition, a faltering Finnish economy, and deep recession are forcing difficult decisions on the health care administrators of this Nordic country known for its extensive social welfare safety net and socialized health care system. In the first part of this article the Finnish health care system and its problems, as well as possible solutions, are presented. Similarities to our own system are noted and discussed. In an interview, the director general for the Minister of Social Affairs and Health of Finland, Kimmo Leppo, expressed concern about future funding sources in his country for the same levels of social welfare and health care programs that presently exist. The Finns are considering managed competition among providers, increasing copayments, excess hospital beds, anticipated hospital closures in their country, block grants, and how to deal with rising physician unemployment. He was interested in the proposed US government health care plans, and especially the state of Tennessee's TennCare plan, a state plan that closely resembled the failed Clinton health care reform package. The second part of this article explores how global competition has brought the pressure of modern competitive economics into the US medical arena.

Cost Savings↗
PubMed1996

The 24-hour rhythm of oxytocin and beta-endorphin secretion in human pregnancy.

OBJECTIVE: Animal work suggests that maternal oxytocin secretion is influenced by the secretion of endogenous opioids in pregnancy. Spontaneous labour and pre-labour uterine activity follow a 24-hour rhythm the origin of which has not been explained but may be related to diurnal changes in oxytocin secretion. This study was performed to document the changes over a 24-hour period in maternal oxytocin and beta-endorphin secretion. DESIGN: A 4-hourly blood profile was undertaken for a 24-hour period. PATIENTS: Sixteen women with singleton pregnancies of more than 36 weeks gestation and 10 women with pregnancies in the mid trimester were studied. MEASUREMENTS: Blood was sampled 4-hourly for 24 hours beginning at 1200 h. Oxytocin was measured in all patients and beta-endorphin-like immunoreactivity was measured in 15 patients. RESULTS: A simple index was defined for comparing night-time levels to daytime levels for both oxytocin and beta-endorphin. In all cases more than 36 weeks gestation the index was positive for oxytocin (night-time levels were higher) and in all cases the index was negative for beta-endorphin (night-time levels were lower). In the mid trimester women all values of the index for oxytocin were positive but in the beta-endorphin group equal numbers demonstrated a positive or a negative index. CONCLUSIONS: Reciprocal 24-hour rhythms were demonstrated between oxytocin and beta-endorphin; however, it is not clear whether this relationship is causal.

Circadian Rhythm↗
PubMed1996

Evaluation and management of hemoptysis in infants and children. A report of nine cases.

Hemoptysis is an occasional complication of adult pulmonary disease and is rare in children. The most common causes in adults are infection, bronchiectasis, pulmonary neoplasm, cystic fibrosis, pulmonary infarct, and trauma; in children the most common causes are infection and congenital abnormalities of the cardiopulmonary vasculature. Nine cases of hemoptysis in seven infants and two children will be presented. Two cases were fatal, thus illustrating the importance of rapid and definitive therapy early in the course. One of the fatal cases is the first case report in the otolaryngological literature of fatal hemoptysis in the newborn as a result of vascular anomalies associated with an absent left pulmonary artery. Eight cases of various causes, including small vessel vascular abnormality, trauma, recurrent pulmonary infection, and laryngotracheal papilloma, are discussed. The literature is reviewed, embryology is discussed, and a mechanism of death is theorized for the patient with the congenital vessel anomaly. Management considerations for hemoptysis in infants and children are discussed.

Anti-Bacterial Agents↗