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Biomedical subjects

K A Ballew

Publications and source records attributed to K A Ballew.

8 recordsLinked to original sources
PubMed1995

Tuberculosis screening in adults who have received bacille Calmette-Guérin vaccine.

The incidence of tuberculosis among immigrants to the United States is 12 times that in the native-born population. Screening immigrants for tuberculosis is complicated by the widespread use of bacille Calmette-Guérin (BCG) vaccination. To determine the utility of tuberculin testing in adults who have been vaccinated with BCG vaccine, we studied the tuberculin reactions of 80 adults who came to us for naturalization physical examinations. No adverse effects were reported from tuberculin testing. Subjects from regions with a low prevalence of tuberculosis who had received BCG vaccine were significantly more likely to have a positive reaction than subjects who had not received BCG vaccine. However, among subjects from regions with a high prevalence of tuberculosis, there was no difference in the prevalence of positive reactions between those who reported having BCG vaccinations and those who said they had not. Interpretation of tuberculin reactions in immigrants who receive BCG vaccinations depends on the prevalence of tuberculosis in the country of origin. Adults receiving BCG vaccination who have a positive reaction and no evidence of active tuberculosis should receive prophylactic therapy or be observed carefully.

Adjuvants, Immunologic↗
PubMed1995

Vena cava filter devices.

Vena cava filters are effective in preventing pulmonary embolism (PE) in patients with deep vein thrombosis or PE who either have contraindications to anticoagulation or have sustained a PE despite adequate anticoagulation. Although vena cava filters are not without complications, clinically significant morbidity and mortality are low. The use of vena cava filters as primary prophylaxis or therapy for deep vein thrombosis and PE should await the results of controlled trials.

Anticoagulants↗
PubMed1994

Predictors of survival following in-hospital cardiopulmonary resuscitation. A moving target.

BACKGROUND: Counseling patients about the risks and benefits of in-hospital cardiopulmonary resuscitation (CPR) can potentially reduce patient suffering and hospital costs. However, there is currently much disagreement regarding the overall rate of in-hospital CPR survival and characteristics that identify patients more or less likely to survive CPR. METHODS: The charts of all adults who were pulseless and received basic CPR at a 720-bed university hospital during 1990 and 1991 were reviewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room, or cardiac catheterization laboratory. Each patient's chart was reviewed to determine the presence of explicitly defined clinical characteristics. RESULTS: Overall, 50 (16.0%) of 313 patients survived to discharge. Before arrest, only impaired functional capacity and sepsis identified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0% of those with cancer and 18.1% of those 70 years or older. CONCLUSIONS: The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate reported here is higher than similar reports and why more clinical characteristics were not found to predict CPR survival. Investigators of in-hospital CPR should use explicit criteria to describe the conditions studied and report survival for patients who receive basic CPR. The impact of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival.

Adult↗
PubMed1994

Differences in case definitions as a cause of variation in reported in-hospital CPR survival.

To determine the effect of different case definitions on reported survival following in-hospital cardiopulmonary arrest, the authors reviewed the charts of 411 patients for whom a nurse completed a cardiac arrest form at a university hospital during a two-year period. Survival to discharge was 16.0% for patients who required basic cardiopulmonary resuscitation (chest compression and pulmonary ventilation), 18.6% for patients who were pulseless and apneic, 23.0% for patients who were pulseless or apneic, and 28.2% for all 411 patients for whom a cardiac arrest form was completed. These results demonstrate that reported survival to discharge following in-hospital cardiac arrest varies widely depending on the case definition that is used.

Cardiopulmonary Resuscitation↗
PubMed1992

Toxicity potential of oral lidocaine in a patient receiving mexiletine.

OBJECTIVE: To report a case of toxicity from orally administered lidocaine in a patient with cardiomyopathy receiving concurrent mexiletine therapy. DATA SOURCES: Case reports, review articles, and studies identified by search of the MEDLINE database and Current Contents. STUDY SELECTION: All reports of toxicity from orally administered lidocaine were reviewed. DATA SYNTHESIS: Lidocaine, a local anesthetic, is widely used to treat cardiac arrhythmias. Toxicity with the parenteral form occurs frequently. In contrast, there are few reports of toxicity with oral lidocaine, most of them occurring in children receiving large doses relative to body weight. We report a case of intoxication in an adult with severe cardiomyopathy and concurrent mexiletine therapy who received only two doses of oral lidocaine. CONCLUSIONS: Although it is rarely reported in adults, clinicians must be alert to the possibility of toxicity from orally administered lidocaine. This is most likely to occur in patients with conditions known to reduce lidocaine clearance, when higher-than-usual doses are administered, or when concurrent therapy with oral lidocaine analogs may be present.

Administration, Oral↗