Biomedical subjects

Joan S Reisch

Publications and source records attributed to Joan S Reisch.

6 recordsLinked to original sources

PubMed2006

Preparing data for analysis using microsoft Excel.

A critical component essential to good research is the accurate and efficient collection and preparation of data for analysis. Most medical researchers have little or no training in data management, often causing not only excessive time spent cleaning data but also a risk that the data set contains collection or recording errors. The implementation of simple guidelines based on techniques used by professional data management teams will save researchers time and money and result in a data set better suited to answer research questions. Because Microsoft Excel is often used by researchers to collect data, specific techniques that can be implemented in Excel are presented.

Biomedical Research↗

PubMed2005

Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study.

Severe acetaminophen hepatotoxicity frequently leads to acute liver failure (ALF). We determined the incidence, risk factors, and outcomes of acetaminophen-induced ALF at 22 tertiary care centers in the United States. Detailed prospective data were gathered on 662 consecutive patients over a 6-year period fulfilling standard criteria for ALF (coagulopathy and encephalopathy), from which 275 (42%) were determined to result from acetaminophen liver injury. The annual percentage of acetaminophen-related ALF rose during the study from 28% in 1998 to 51% in 2003. Median dose ingested was 24 g (equivalent to 48 extra-strength tablets). Unintentional overdoses accounted for 131 (48%) cases, intentional (suicide attempts) 122 (44%), and 22 (8%) were of unknown intent. In the unintentional group, 38% took two or more acetaminophen preparations simultaneously, and 63% used narcotic-containing compounds. Eighty-one percent of unintentional patients reported taking acetaminophen and/or other analgesics for acute or chronic pain syndromes. Overall, 178 subjects (65%) survived, 74 (27%) died without transplantation, and 23 subjects (8%) underwent liver transplantation; 71% were alive at 3 weeks. Transplant-free survival rate and rate of liver transplantation were similar between intentional and unintentional groups. In conclusion, acetaminophen hepatotoxicity far exceeds other causes of acute liver failure in the United States. Susceptible patients have concomitant depression, chronic pain, alcohol or narcotic use, and/or take several preparations simultaneously. Education of patients, physicians, and pharmacies to limit high-risk use settings is recommended.

APACHE↗

PubMed2003

Study of the MIB-1 labeling index as a predictor of tumor progression in pilocytic astrocytomas in children and adolescents.

PURPOSE: The pilocytic astrocytoma (PA) is the most common childhood brain tumor. This report examines the MIB-1 labeling index (LI) as a predictor of progression-free survival (PFS) among childhood PAs. PATIENTS AND METHODS: Consecutive PAs were examined to determine whether the MIB-1 LI was associated with tumor progression. Other variables evaluated included tumor location, use of adjuvant therapy, extent of resection, and age at diagnosis. RESULTS: One hundred forty-one children were identified (mean +/- SD age, 7.6 +/- 4.7 years; range, 0.43 to 18.56 years); 118 children had adequate tissue for MIB-1 immunohistochemistry. The 5-year PFS was 61.25%. By log-rank analysis, an MIB-1 LI of more than 2.0 was associated with shortened PFS (P =.035). Patients with PAs who underwent complete surgical resection, had tumors located in the cerebellum, and were treated with surgery only also had more prolonged PFS (P =.001 for all). Tumors in the optic pathways were associated with a shorter PFS (P =.001). Restricting the evaluation of MIB-1 LI to only incompletely resected tumors revealed an insignificant trend of MIB-1 LI of more than 2.0 having a shortened PFS. Multivariate analysis demonstrated completely resected tumors and tumors located in the cerebellum as less likely to progress (P =.001 and.019, respectively). CONCLUSION: Children with PAs with an MIB-1 LI of more than 2.0 have a shortened PFS. PAs that are completely resected and are located in the cerebellum have a prolonged PFS. This initial study suggests that the MIB-1 LI identifies a more aggressive subset of PAs. Further work should focus on elucidating features of pilocytic astocytomas that will identify prospectively children at risk for progression.

Adolescent↗

PubMed2003

Capnometry for noninvasive continuous monitoring of metabolic status in pediatric diabetic ketoacidosis.

OBJECTIVE: To determine the utility of continuous noninvasive capnometry for monitoring pediatric patients with diabetic ketoacidosis as assessed by the agreement between end-tidal carbon dioxide (PetCO2) and PCO2 DESIGN: Clinical, prospective, observational study. SETTING: University affiliated children's hospital. INTERVENTIONS: Patients with diabetic ketoacidosis were monitored with an oral/nasal carbon dioxide (CO2) sampling cannula while in the emergency department. Laboratory studies were ordered per protocol. PetCO2 values were correlated with respiratory rate, PCO2, and pH. MEASUREMENTS AND MAIN RESULTS: One hundred twenty-one patients were monitored for 5.9 +/- 0.32 hrs. The average (mean +/- sd) initial values for pH were 7.08 +/- 0.18; respiratory rate, 35.1 +/- 9.1 breaths/min; PetCO2, 18.6 +/- 10.8 torr; and venous PCO2, 20.2 +/- 10.6 torr. At the conclusion of the observation period, averages were pH, 7.29 +/- 0.05; respiratory rate, 22.4 +/- 3.7 breaths/min; PetCO2, 35.3 +/- 5.8 torr; and venous PCO2, 36.8 +/- 5.3 torr. For all 592 observations, the correlations between PetCO2 and venous PCO2 (r =.92, p =.0001), PetCO2 and pH (r =.88, p =.0001), Petco2 and respiratory rate (r = -.79, p =.0001), and respiratory rate and pH (r = -.80, p =.0001) were statistically significant and the correlations with respiratory rate were inversely related to pH and PetCO2. The difference scores were not related to the average scores for initial readings (r = -.073, p =.43), final readings (r = -.124, p =.18), and overall readings (r =.057, p =.17). Limits of agreement between the two methods were established with PetCO2 lower than venous PCO2 with 95% limits of agreement 0.8 +/- 8.3 (2 sd) torr. CONCLUSIONS: PetCO2 monitoring of patients with diabetic ketoacidosis provides an accurate estimate of PCO2. Noninvasive PetCO2 sampling may be useful in patients with diabetic ketoacidosis to allow for continuous monitoring of patients.

Adolescent↗

PubMed2003

Synapse loss may be a minor contributor to decreased regional cerebral blood flow in Alzheimer disease.

In this study we tested the hypothesis that synapse loss contributes to decreased regional cerebral blood flow (rCBF) in Alzheimer disease (AD). We compared antemortem rCBF and postmortem analysis of synaptophysin, as a measure of synapse loss, in 13 cases of AD. rCBF studies were performed using inhaled xenon gas (Xe-133), which yields quantitative results. Synapse loss was evaluated in postmortem brain samples using an enzyme-linked immunosorbant assay (ELISA) that measures synaptophysin, with results expressed as picomoles synaptophysin/10 mg brain. Synaptophysin was expressed either as concentration (QS method) or as the ratio of the concentration to the combined results in frontal, temporal and parietal lobe (RS method). There was no correlation between synapse loss and rCBF using the QS method and only borderline significance between right SPECT and right temporal synaptophysin using the RS method. The results of this study suggest that synapse loss may be a minor contributor to the decreased rCBF observed in AD.

Aged↗

PubMed2002

Nonperioperative strokes in children with central nervous system tumors.

BACKGROUND: Nonperioperative strokes are rare yet potentially devastating events for children with central nervous system (CNS) tumors. The incidence of and risk factors for nonperioperative strokes in children with CNS tumors is unknown. METHODS: The authors performed a retrospective review of children from their institution with CNS tumors. The incidence of stroke in the nonperioperative period and the influence of patient demographic factors, coexisting genetic diseases, tumor type, and treatment modality on the subsequent occurrence of a stroke were determined. RESULTS: Eight hundred seven consecutive patients from the authors' institution with CNS tumors were observed for a combined 3224 nonperioperative years. Thirteen patients (1.6%) had a nonperioperative stroke, for an incidence of 4.03 strokes/1000 years of nonperioperative patient follow-up. Eight patients were males, and the median age at diagnosis of a CNS tumor was 4.8 years (range, 0.3-18.6 years). The median duration from diagnosis of a CNS tumor until the occurrence of stroke was 2.3 years (range, 0.3-15.8 years). Among numerous potential risk factors individually examined by chi-square analysis, only treatment with radiation therapy was associated with the subsequent development of a stroke (chi-square, P = 0.007). By logistic regression analysis, treatment with radiation therapy and a diagnosis of an optic pathway glioma were the only statistically significant variables associated with a stroke. CONCLUSIONS: Strokes are much more common among children with CNS tumors. Children treated with radiation therapy and those with optic pathway gliomas have a higher association with the occurrence of a subsequent nonperioperative stroke. Because children with optic pathway gliomas may be at particularly high risk of stroke after radiation therapy, the desired beneficial therapeutic effects of irradiation must always be weighed against its potentially adverse effects, including stroke.

Adolescent↗