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Biomedical subjects

K Sullivan

Publications and source records attributed to K Sullivan.

At least 109 records · Page 6Linked to original sources
PubMed1994

The impact of recent legislative change in Germany.

Cost-containment policies introduced in Germany under the 'Health Structure Act' at the beginning of 1993 marked a dramatic turnaround in German healthcare policy. The traditional arms-length approach of government policy makers, under which responsibility for implementation of the measures specified in national legislation was devolved upon the representatives of healthcare providers and statutory health insurance funds, was replaced by government mandates at the national level. These mandates-including price controls, a national pharmaceuticals budget and copayment changes-had a dramatic impact on the German healthcare system and on the German pharmaceutical market in particular. Eventually, these national controls are to be phased out as the associations of healthcare providers and health insurance funds negotiate the terms for implementation of further measures specified in the 'Health Structure Act': regional budgets, prescription guidelines, stricter controls of prescribing behaviour and a positive list. Despite this gradual return to the federalistic principles of the German healthcare system, the German pharmaceutical market will never be the same.

Budgets↗
PubMed1994

Issues in the assessment of nutritional status using anthropometry.

Four issues in the use and interpretation of anthropometry are discussed at the level of the population and of the individual. The first issue is the index or indices of choice: weight-for-height versus height-for-age versus weight-for-age. The selection of an index or indices depends upon many factors, and no one index is completely adequate in all situations. Proposed criteria are provided to assess the severity of low anthropometry within populations. The second issue is the scale of the index: z-scores (or standard deviations) versus percentiles versus percent-of-median. z-Scores have several properties that make them superior to the other two scales. A third issue deals with limitations in the current growth reference; one of these is the disjunction between the growth curves at 2 years of age, resulting from the use of two different populations in the reference. It is important that this disjunction be recognized by researchers so that the anthropometric findings are interpreted correctly for this age range. Lastly, some issues to do with the collection of single versus multiple anthropometric measurements on children are discussed.

Anthropometry↗
PubMed1993

Three-year-olds' understanding of mental states: the influence of trickery.

This study examined the claim that children under 4 cannot conceptualize false mental states. Fifty-one children between 3;0 and 4;2 were tested in a Standard and a Trick Condition. In the Standard Condition, children were given a modified version of the Smarties task developed by Hogrefe, Wimmer, and Perner (1986). In the Trick Condition, the Smarties task was modified so that children were required to trick another person by switching the contents of a familiar box. Results revealed that a majority of subjects responded correctly to Ignorance and False Belief Questions in the Trick Condition, but not in the Standard Condition. There were no differences in children's ability to attribute ignorance and false belief. These results suggest that even young 3-year-olds have the ability to attribute mental states that differ from their own, even though this ability has proved elusive and difficult to demonstrate.

Child, Preschool↗
PubMed1993

Renal transplantation in children and adolescents: the 1992 annual report of the North American Pediatric Renal Transplant Cooperative Study.

From January 1987 to January 1992 the North American Pediatric Renal Transplant Cooperative Study registered and followed 2,037 children and adolescents 17 years of age or less who received 2,197 renal transplants at 75 participating centers in the United States and Canada. The cumulative experience over 5 years of data collection demonstrated trends in renal transplantation practice for pediatric patients. The percentage of live donor organ recipients receiving donor-specific blood transfusions decreased from 40% in 1987 to less than 12% in 1991; random blood transfusions also were used less frequently during the most recent 2 years of the study. Immunosuppressive therapy on posttransplant day 0 or 1 with polyclonal and monoclonal antilymphocyte agents was used in over 40% of transplants. There was also a notable preference for the combined use of prednisone, azathioprine and cyclosporine as maintenance immunosuppression. The percentage of live donor source graft recipients receiving cyclosporine increased from 78% in 1987 to 90% in the most recent year, and considered together, nearly 90% of live donor and cadaver organ recipients received cyclosporine. The observed graft survival probabilities for live donor grafts were 88%, 83%, 81% and 76% at years 1-4 post transplantation, respectively. The 1st through 4th year graft survival probabilities for cadaver grafts were 74%, 68%, 63% and 58%, respectively. The five most common causes of pediatric end-stage renal disease have remained as: hypoplastic-dysplastic kidney, obstructive uropathy, focal segmental glomerulosclerosis, reflux nephropathy and systemic immunological diseases throughout the 5 years of this study. There has been a decrease in children 2 years of age or less undergoing transplant surgery. On average, 50% of graft failures were due to the various forms of rejection. Vascular thrombosis (14%) and recurrence of primary renal disease (7%) were the next most frequently encountered causes of graft failure. Poor linear growth was identified as a problem affecting the majority of children both before and after transplantation. Post transplant linear growth was best among recipients less than 6 years of age at transplantation and recipients of all ages who received alternate-day prednisone. A total of 16 malignancies were reported during the 5 years of study. A total of 105 deaths were reported, with infection (41%) the most common primary cause of death. The 2-year patient survival probabilities were 95.5% and 93% for recipients of live donor and cadaver grafts, respectively.

Adolescent↗
PubMed1993

Imaging lung cancer with radiolabeled antibodies.

Radiolabeled antibodies have been studied by several investigators as to their potential role in the diagnosis and staging of lung cancer. Studies with indium-111-labeled antibodies in limited numbers of patients have shown that 75% to 100% of primary lung tumors can be delineated and that the detection of metastases is dependent on size and location. Hepatic metastases and lesions smaller than 2 cm frequently are not visualized. Other studies with a technetium-99m-labeled Fab fragment of NR-LU-10 have been carried out for the staging of small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). In a large, well controlled multicenter study of patients with SCLC, staging by antibody imaging alone was as accurate as a combination of the conventional staging tests, and the positive predictive value for antibody staging of extensive disease was greater than 95%. In patients with NSCLC, antibody imaging was comparable to computed tomography for staging the mediastinum and was able to identify distant metastases at the same time.

Carcinoma, Non-Small-Cell Lung↗
PubMed1993

Chronic meningococcemia in a child with a deficiency of the sixth component of complement.

Chronic meningococcemia represents an uncommon manifestation of meningococcal disease. Microbial and host factors which may predispose to this form of meningococcal disease are not understood. Although acute meningococcal disease is frequently found in patients with terminal complement deficiencies, the relationship of chronic meningococcemia to complement deficiencies is unclear. We present a case report and a review of the literature describing chronic meningococcemia in association with deficiencies of the complement system. A total of eight cases were identified, all of whom were male. Six of the eight patients were children and two of the eight had a previous history of meningococcal disease. This case report, in conjunction with the previously reported cases, suggests an association between complement deficiencies and chronic meningococcemia.

Bacteremia↗
PubMed1993

Taking up the gauntlet: accepting the challenge of glove evaluation.

Cost-conscious purchasers may wonder what glove is best suited for the maximum number of applications. The Food and Drug Administration requires that products released for marketing meet the ASTM standards, which were developed by industry strictly to standardize production. Glove characteristics, such as length and cuff features, size, gauge, flexibility and elasticity, donning lubricants, sterility and color must be considered, and fact separated from mis-conceptions. A glove-related issue causing concern is allergic responses to latex and chemical substances used in the glove manufacturing process. Reactions to gloves can be categorized as irritation, delayed hypersensitivity and immediate hypersensitivity, all of which reflect different underlying causes. Industry, concerned consumers and the FDA are looking for ways to lower the allergen content in gloves. Glove deterioration and chemical permeability problems usually result from various environmental factors and improper use. Despite concerns about viral permeability of gloves, the literature indicates that intact gloves serve as adequate barriers to viruses. Controlling gloves costs requires their appropriate use.

Equipment Design↗
PubMed1993

Long-term follow-up of growth in children post-transplantation.

With improving graft survival, growth post-transplantation, demands increasing attention from pediatric transplant physicians. As our data base matures, the North American Pediatric Renal Transplant Cooperative Study is able to track growth patterns longitudinally. Of 2086 patients enrolled in the registry, 412 patients have had a functioning graft for at least three years. The mean growth deficit for this group was -2.46 and the change in Z score at three years was 0.16 (P < 0.01). Of various factors that could conceivably impact on growth post-transplantation such as donor source, race, number of transplants, and immunosuppressive therapy, only age at transplant and the original height deficit are significant. Most growth retarded children over the age of six years are unlikely to exhibit accelerated growth post-transplantation.

Adolescent↗
PubMed1992

Immunosuppressive therapy of aplastic anemia: results of a prospective, randomized trial of antithymocyte globulin (ATG), methylprednisolone, and oxymetholone to ATG, very high-dose methylprednisolone, and oxymetholone.

Sixty-eight patients with moderate (n = 15) or severe (n = 53) aplastic anemia were entered into a prospective, randomized, two-arm treatment study comparing antihuman thymocyte globulin (ATG), lower-dose methylprednisolone (LDM) and oxymetholone to ATG, higher-dose methylprednisolone (HDM), and oxymetholone. There were no differences between the two groups when comparing age, sex, etiology of aplasia, disease duration, severity of aplasia, or pretherapy granulocyte counts. Side effects of LDM and HDM were similar. Of the 64 patients evaluable for response to therapy, 12 of 33 (36%) who received LDM had complete, partial, or minimal responses compared with 15 of 31 patients (48%) who received HDM (P = .33). Actuarial survival at 4 years is 43% for patients in the LDM group and 47% for patients in the HDM group (P = .99). Causes of death included hemorrhage, infection, evolution to acute leukemia, and complications of subsequent bone marrow transplantation. Long-term complications included paroxysmal nocturnal hemoglobinuria (n = 3), evolution to myelodysplasia or acute leukemia (n = 6), and recurrent aplasia (n = 6). We were unable to show a significant difference in toxicity, response rate, or survival for patients treated with ATG, oxymetholone, and LDM compared with patients who received ATG, oxymetholone, and HDM.

Adult↗
PubMed1992

Phase II trial of recombinant human granulocyte-macrophage colony-stimulating factor in patients undergoing allogeneic bone marrow transplantation from unrelated donors.

The safety and possible efficacy of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) were evaluated in 40 consecutive patients who received transplants from unrelated donors. rhGM-CSF was administered by 2-hour daily intravenous infusion from day 0 to day 20 or day 27 after the marrow infusion. These patients were compared with 78 historical patients who received transplants from unrelated donors who did not receive rhGM-CSF. The rhGM-CSF-treated patients were older (P = .037) and were treated less frequently in laminar air flow rooms (P = .005) than were control patients. However, the rhGM-CSF-treated group had a higher proportion of "good risk" patients with chronic myelogenous leukemia in chronic phase (P = .006) than did the comparison group (P = .017), rendering comparisons of transplant-related complications not meaningful. rhGM-CSF was well tolerated and did not adversely increase the incidence of graft rejection or increase the incidence and severity of acute graft-versus-host disease. The median day the absolute neutrophil count reached 500/mm3 in patients who received rhGM-CSF was day 21, which was not different from that of historical patients. Nevertheless, the numbers of febrile days and septicemic episodes within the first 28 days in patients who received rhGM-CSF were less than in historical patients. The probability of nonrelapse mortality at 1 year in patients who received rhGM-CSF was 22%. In view of the retrospective nature of the control group, we cannot conclusively determine whether rhGM-CSF administration was beneficial. A prospective, randomized controlled study of rhGM-CSF is required to confirm these suggestive data.

Adult↗
PubMed1992

A rapid polymerase chain reaction method for identifying fixed specimens.

DNA profiling analysis of preserved tissue samples was achieved by using an extraction method which incorporated the use of a chelating resin "Chelex" to chelate inhibitory polyvalent metal ions. An automated sequencer was used to estimate sizes of low molecular weight trimeric and tetrameric microsatellites labelled with fluorescent dyes. The entire analysis can be completed within 48h. Probabilities of chance association using two microsatellites were calculated as ranging between 10(-2) and 10(-4). The methods described have considerable potential for use in routine genetic analysis of preserved samples.

Alleles↗
PubMed1992

Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction.

The outcome of adult respiratory distress syndrome complicating cardiopulmonary bypass has changed little in recent years. A retrospective, case-controlled study was designed to assess the incidence of the adult respiratory distress syndrome in these circumstances and the extent to which it could be linked with pre and peri-operative predictive factors. Eleven patients who developed the syndrome out of 840 who underwent cardiopulmonary bypass over a 9 month period were compared with 53 controls matched for sex, operation and surgeon. The incidence of adult respiratory distress syndrome and its mortality were 1.3% and 53% respectively. Significant predictors were a high intra and postoperative intervention score, the total volume of blood pumped during bypass (greater than 300 l) and age (greater than 60 years). These risk factors should alert the clinician to the possibility of severe postoperative pulmonary complications.

Adult↗
PubMed1992

A pilot study of low-dose cyclosporin for graft-versus-host prophylaxis in marrow transplantation.

Nineteen patients with leukaemia, preleukaemia, and aplastic anaemia were treated by marrow transplantation from HLA-identical siblings. All were given postgrafting immunosuppression with a combination of methotrexate (days 1, 3, 6 and 11) and cyclosporin (days--1 to 180). In an attempt at reducing cyclosporin-associated toxicity, we explored whether the cyclosporin dose during the first 2 weeks could be decreased by 50% (from 3.0 to 1.5 mg/kg/d intravenously) without adversely affecting the incidence, onset, and severity of acute graft-versus-host disease (GVHD) and overall survival. Results from this pilot study were compared to those of a matched cohort of 38 patients given a standard dose of 3.0 mg cyclosporin/kg/d starting on day--1. The cumulative incidence of grade II and III acute GVHD in the 'low dose' cyclosporin group was 42% compared to 51% in the 'standard dose' group (P = 0.60). Three-year survival was 63% and 54% respectively (P = 0.59). Patients receiving the reduced cyclosporin dose during the first 14 d appeared to have less hepatotoxicity, and the methotrexate and cyclosporin doses administered were closer to the doses intended per protocol. We suggest that 'low dose' cyclosporin from day--1 to day 15 postgrafting might be as effective as 'standard dose' cyclosporin during that time period for the prevention of acute GVHD.

Acute Disease↗
PubMed1992

Diffuse anterior scleritis during OKT3 monoclonal antibody therapy for renal transplant rejection.

OKT3, a murine monoclonal antibody, is a potent, specific immunosuppressive agent used in solid-organ transplantation both as an adjunct during induction therapy and for treatment of steroid-resistant graft rejection. Minor, self-limiting ocular complications are often seen with this drug, of which conjunctivitis is the most common, occurring in approximately three-quarters of patients. We describe the more serious and previously unreported complication of diffuse anterior scleritis, which developed on the fifth day of OKT3 therapy in a 47-year-old man who had undergone cadaveric renal transplantation. Despite continuation of OKT3 treatment the scleritis resolved rapidly with increased dosages of prednisone.

Glucocorticoids↗