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Biomedical subjects

K L Reed

Publications and source records attributed to K L Reed.

At least 73 records · Page 4Linked to original sources
PubMed1988

Fetal cardiac Doppler flow studies in prenatal diagnosis of heart disease.

The prenatal diagnosis of fetal cardiac disease has become increasingly accurate as the technology of ultrasound has improved. Although two-dimensional real-time ultrasound remains the primary method of diagnosis, Doppler blood flow velocity estimates can provide valuable pathophysiologic information to support the anatomic diagnosis. We present six cases in which Doppler studies contributed to the accuracy of the diagnosis of fetal heart disease, including tetralogy of Fallot, right and left ventricular hypoplasia, atrioventricular canal defect, double-outlet right ventricle, and pulmonic stenosis. Velocities in these cases are compared with those in normal fetuses. If Doppler flow velocities are not consistent with the observed morphologic changes, further observations are indicated. Inasmuch as most anatomical heart lesions result in altered flow patterns, Doppler investigations of intracardiac and extracardiac flow should be a routine component of the fetal echocardiogram when structural abnormalities are found.

Adolescent↗
PubMed1988

Occupational therapy articles in serial publications: an analysis of sources.

This study was designed to locate and document serial literature on occupational therapy published since 1900. Emphasis is placed on finding articles on occupational therapy or by occupational therapists from sources other than those normally associated with the professional journals. Multiple sources were used including print indexes, online databases, occupational therapy bibliographies, and tables of contents or yearly indexes. Almost 7,000 articles were identified, not including those published in foreign journals. Occupational therapy publications have increased steadily since 1900, with the most rapid increase during the 1970s and 1980s when five new occupational therapy journals were initiated. Suggestions for formulating search strategies are included.

Abstracting and Indexing↗
PubMed1988

Prenatal diagnosis of congestive heart failure in a fetus with a sacrococcygeal teratoma.

Two-dimensional Doppler echocardiography was used to diagnose congestive heart failure in a fetus with a large sacrococcygeal teratoma. Ultrasound performed for size-date inconsistency revealed a 27.5-week fetus with hydrops and a large solid and cystic mass in the sacral region. Fetal echocardiography showed dilated ventricles and a pericardial effusion; Doppler ultrasound demonstrated increased velocities and volume flows, along with tricuspid and mitral regurgitation. At delivery, the mass was bleeding actively, the amniotic fluid was markedly bloody, and the neonatal hematocrit was 10%. We postulate that intrauterine hemorrhage from the teratoma led to anemia and high-output cardiac failure confirmed by Doppler echocardiography, and suggest that all fetuses with sacrococcygeal teratomas be evaluated by two-dimensional Doppler echocardiography to detect the presence of congestive heart failure, in order to allow well-timed therapeutic interventions.

Adult↗
PubMed1987

Changes in intracardiac Doppler blood flow velocities in fetuses with absent umbilical artery diastolic flow.

Umbilical artery Doppler blood flow velocity studies were used to identify 14 fetuses with absent flow during diastole to determine the significance of absent umbilical artery diastolic flow. Outcomes of these fetuses were recorded, and the associated intracardiac Doppler changes were identified in 12 of them. Maximal and mean intracardiac flow velocities were measured, and volume flows through the right (tricuspid valve, pulmonary valve) and left (mitral valve, aortic valve) sides of the heart were compared. Ratios of intracardiac peak flow velocity in late diastole to peak flow velocity in early diastole were calculated. Eleven fetuses had intrauterine growth retardation, and four had multiple congenital anomalies. Fetuses with no diastolic flow in the umbilical artery had increased volume flow across the tricuspid and pulmonary valves compared with normal fetuses of similar weights. The ratio of right-sided to left-sided volume flow in the heart (2.15:1) was increased compared with values in normal fetuses (1.33:1, p less than 0.01). The ratio of late diastolic to early diastolic peak flow velocities across the mitral valve was decreased (p less than 0.01). Absent umbilical artery diastolic flow is associated with increased tricuspid and pulmonary valve volume flow and changes in mitral flow velocity patterns, which suggests that there are alterations in left ventricular function.

Abnormalities, Multiple↗
PubMed1987

Congenital heart block and cardiac anomalies in the absence of maternal connective tissue disease.

The association of congenital heart block with maternal connective tissue disease and autoimmunity has been recently reported. Two cases of heart block were diagnosed in utero at 23 and 24 weeks' gestation. Both mothers had extensive workups for connective tissue disease that were negative. Two-dimensional and Doppler echocardiography were performed in utero and both infants had left atrial isomerism, atrioventricular canal defects, and severe hydrops in addition to heart block. Review of the recent literature identifies a subset of congenital heart block in which the mothers have no evidence for connective tissue disease, and the fetus or neonate has complex cardiac malformations and hydrops. The common features in these babies are atrioventricular canal defects and isomerism. No reports of congenital heart disease among the children of mothers with connective tissue disease fit this description. Our recent experience and literature review emphasize the previously known association between congenital heart block and congenital heart disease. This association is especially important in light of the poor prognosis for this group of fetuses and neonates.

Adolescent↗
PubMed1987

Effect of maternal magnesium sulfate treatment on fetal heart rate variability.

The effect of maternal magnesium sulfate treatment on fetal heart rate variability (FHRV) was evaluated by comparing the maternal serum magnesium level drawn during labor to the degree of FHRV seen concurrently on fetal rate heart monitor strips. The records of 57 patients treated with intravenous magnesium sulfate for hypertensive disorders of pregnancy were studied. Fetal heart rate variability was measured by both subjective assessment and objective measurement. The difference in beats/min between the average high and low fetal heart rates, at the time the magnesium level obtained, was used as the objective measurement. Labor records were reviewed and neonatal outcome recorded. Data from individual patients not treated with analgesics were analyzed separately in addition. Statistical methods used included analysis of variance, Student's t-test, and Chi square analysis. The range of magnesium levels was 2.3-7.4 mEq/L. Thirty-four women had single determinations of magnesium levels and 23 had multiple determinations. Statistical analysis showed no significant change in FHRV with increasing maternal magnesium levels. In addition, no significant effect of maternal magnesium level on FHRV was noted in the group that did not receive meperidine, morphine, or epidural anesthesia. Neonatal outcome, assessed by Apgar scores, did not vary with maternal magnesium level. We conclude that maternal magnesium sulfate treatment, in the therapeutic ranges normally obtained, does not significantly affect fetal heart rate variability.

Female↗
PubMed1987

Cardiac Doppler flows during fetal arrhythmias: physiologic consequences.

Eighty-six fetuses of 21-41 weeks' gestation with arrhythmias were studied with ultrasound and heart rate monitoring. The type of arrhythmia was identified by M-mode studies and was confirmed by postnatal electrocardiogram in 70 infants. The most common arrhythmia was premature atrial contractions (76), followed by premature ventricular contractions (five), paroxysmal supraventricular tachycardia (four), and atrial fibrillation/flutter (one). Doppler echocardiography was performed in 54 fetuses to measure flow velocities across the atrioventricular and semilunar valves. After isolated premature atrial and ventricular contractions, post-extrasystolic potentiation was demonstrated by an increase in fractional shortening (N = 32) of 49 +/- 6% in the right ventricle and 64 +/- 7% in the left ventricle. When post-extrasystolic beats were compared with normal beats, Doppler-determined time-velocity integrals increased 43% across the tricuspid valve, 41% across the mitral valve, 34% across the pulmonary valve, and 38% across the aortic valve. Mean velocity increased significantly after conversion to normal sinus rhythm in the five fetuses with supraventricular tachycardia (P less than .05). By studying the physiologic consequences of fetal arrhythmias using two-dimensional Doppler and M-mode ultrasound, we have documented the presence of post-extrasystolic potentiation after premature contractions, the existence of the Frank-Starling mechanism, and an increase in mean velocity (and therefore in cardiac output) after conversion of fetal tachyarrhythmias to normal sinus rhythm.

Arrhythmias, Cardiac↗
PubMed1987

Fetal and neonatal cardiac assessment with Doppler.

During recent years, Doppler ultrasound has become an instrument with which the fetal and neonatal cardiovascular system can be examined noninvasively. In fetuses with suspected cardiac anomalies, Doppler examinations can be used to complement two-dimensional and M-mode studies. Information derived from human fetal intracardiac studies has established that the human fetal heart is right-heart dominant, less compliant than the adult heart, and changes with advancing gestation. Much work remains to be performed to use this information to better manage ongoing pregnancies, and to optimize transition to neonatal life.

Blood Flow Velocity↗
PubMed1987

Fetal pulmonary artery and aorta: two-dimensional Doppler echocardiography.

Two-dimensional and pulsed Doppler ultrasound techniques were used to examine 87 fetuses between 17 and 41 weeks' gestation in order to compare pulmonary artery and aortic outflow diameters, mean and maximal flow velocities, and transvalve flows. For purposes of analysis, fetuses were divided into two groups: those less than 31 weeks, and those of 31 weeks or more. Diameters of the pulmonary artery and aortic outflow region increased with advancing gestational age (P less than .001), while mean and maximal Doppler flow velocities did not change. Transvalve volume flow increased across both regions (pulmonary artery from 381 +/- 12 mL/minute to 530 +/- 13 mL/minute and aortic outflow from 286 +/- 10 mL/minute to 410 +/- 13 mL/minute, P less than .001) with advancing gestation. Pulmonary artery diameters were larger than aortic outflow diameters in both groups (P less than .01), while mean Doppler flow velocities were not significantly different. Maximal Doppler flow velocities were greater in the aorta than in the pulmonary artery (P less than .001), and transvalve flow was greater across the pulmonary artery than the aorta in both groups (P less than .05, ratio 1.3:1). This work demonstrates differences in fetal pulmonary artery and aortic outflow anatomy and physiology that must be considered in evaluating studies of fetal cardiac physiology.

Aorta↗
PubMed1986

Doppler echocardiographic studies of diastolic function in the human fetal heart: changes during gestation.

With the combined use of two-dimensional ultrasound and Doppler echocardiography, noninvasive examination of the human fetal heart and circulation has recently become possible. These techniques were employed to investigate diastolic atrioventricular valve flow in the fetal heart in 120 fetuses studied between 17 and 42 weeks of gestation. Two-dimensional ultrasound was used to examine fetal and intrauterine anatomy, and estimates of gestational age were made based on biparietal diameters and femur lengths. Doppler echocardiography was performed with a 3.5 or 5 MHz Doppler sector scanner. Flow velocity patterns were obtained through the tricuspid and mitral valves during diastole. Peak flow velocity during late diastole or atrial contraction (A) was compared with peak flow velocity during early diastole (E) in four groups of fetuses: Group 1, 17 to 24 weeks of gestation; Group 2, 25 to 30 weeks; Group 3, 31 to 36 weeks; and Group 4, 37 to 42 weeks. The ratio of A to E decreased significantly as gestational age advanced, from 1.56 +/- 0.06 (+/- SE) to 1.22 +/- 0.03 across the tricuspid valve (p less than 0.001) and from 1.55 +/- 0.04 to 1.22 +/- 0.06 across the mitral valve (p less than 0.001). In tricuspid valve measurements, peak flow velocity during early diastole increased from 26.3 +/- 2.0 cm/s in Group 1 to 36.5 +/- 1.7 cm/s in Group 4 (p less than 0.001), whereas peak flow velocity during atrial contraction did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1986

Cardiac Doppler flow velocities in human fetuses.

Cardiac Doppler flow velocity studies were performed in normal human fetuses between 18 and 40 weeks of gestation. Two-dimensional linear array and sector scanning techniques were used for the initial evaluation of the fetuses, which included a standard ultrasound examination to determine normal anatomy and estimated gestational age and weight. Fetal cardiac ultrasound examination was then performed, with four-chamber, short-axis/great vessel, long-axis/left ventricular outflow tract, and aortic arch views obtained. Pulsed echo Doppler instrumentation was used to obtain flow velocity measurements through the tricuspid, pulmonary outflow, mitral, and aortic outflow regions. Calculation of transvalve volume flow for mitral and tricuspid valves was performed by combining the valve anulus sizes and calculated mean temporal velocities for the valves. Maximal flow velocities were greater through the tricuspid (mean maximal velocity 51 +/- 1.2 [SE] cm/sec) than through the mitral (47 +/- 1.1 cm/sec; p less than .05) valve regions, with a wide range of scatter for results between fetuses but less than 6% average variation in the individual fetuses during gestation. For 18 fetuses, right heart dimensions and volume flows (mean 307 + 30 ml/kg/min) were greater than left heart dimensions and volume flows (232 +/- 25 ml/kg/min). Doppler echocardiography may prove to be useful as an adjunct to imaging echocardiography for evaluation of fetal cardiac anatomy and function.

Aorta↗
PubMed1986

Desipramine and 2-hydroxydesipramine in human breast milk and the nursing infant's serum.

Desipramine and its metabolite 2-hydroxydesipramine were measured in the milk of a nursing mother and in the plasma of the mother and infant during administration of 300 mg/day of desipramine to the mother. Similar concentrations of both compounds were found in maternal plasma and milk. A pharmacokinetic plot of the milk over 24 hours showed the expected rise and fall of the substances following a single nighttime dose. Neither parent compound nor metabolite could be detected in the infant's serum even though the measurements were made shortly after peak ingestion by the infant. Furthermore, no clinical signs of toxicity were observed in the infant after 3 weeks of treating the mother with desipramine.

Adult↗
PubMed1986

Tools of practice: heritage or baggage? 1986 Eleanor Clarke Slagle lecture.

Occupational therapists have used many media and methods over the years to achieve the therapeutic potential of occupational therapy. Yet the reasons for selecting a specific medium or method frequently have been lost or changed without consideration of the result to the therapeutic situation. When neither therapist nor patient understands fully the rationale for a medium or method, the therapeutic potential of that medium or method may be compromised. The author suggests there are eight factors that influence the selection and discarding of media and methods in the practice of occupational therapy. The effects of the eight factors can be summarized in 14 assumptions. Three examples--arts and crafts, sanding blocks, and work-related programs--are used to illustrate the factors and assumptions. It is suggested that improved analysis of occupations based on values and interests could reduce the separation of meaning and purpose in the selection and discarding of media and methods used in occupational therapy practice.

History, 19th Century↗
PubMed1984

The nonlinear kinetics of desipramine and 2-hydroxydesipramine in plasma.

Plasma levels of desipramine (DMI) and the unconjugated form of its principal metabolite 2-hydroxydesipramine (OH-D) were measured under steady-state conditions in nine depressed inpatients during treatment with 75 mg DMI every 12 hr and after at least 1 wk of an increased dose of DMI (after steady state). When DMI dosage was raised after an initial steady state had been reached, the rise in plasma DMI level was proportionately greater than the increase in dosage, suggesting saturation of DMI elimination pathways. Levels of OH-D rose in proportion to dose, suggesting saturation of DMI elimination by 2-hydroxylation could not explain DMI plasma level changes. In contrast, there were no dose-dependent effects on the disposition of amitriptyline or its metabolite nortriptyline in subjects receiving the same amitriptyline dose.

Administration, Oral↗
PubMed1984

Understanding theory: the first step in learning about research.

This article describes a teaching method used to explain to undergraduate students how a theory is organized and how a practice model is derived based on the theory. Kielhofner's temporal adaptation of Neville's application of temporal adaptation in practice are used as examples of a developing theory and practice model. The relevance of theory analysis to research design and methods is stressed.

Models, Theoretical↗