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Biomedical subjects

L Sullivan

Publications and source records attributed to L Sullivan.

122 records · Page 7Linked to original sources
PubMedDate not supplied

Efficacy of simulated epinephrine-containing epidural test dose after intravenous atropine during isoflurane anesthesia in children.

BACKGROUND AND OBJECTIVES: A double-blind, randomized study was performed to investigate heart rate (HR) and blood pressure responses to 2 doses of intravenous (IV) epinephrine (0.5 and 0.75 microg/kg) in 61 children, ages 3 months to 12 years. METHODS: Anesthesia was maintained with isoflurane (age-adjusted 1 minimal alveolar concentration [MAC]) in oxygen. All patients received IV atropine (10 microg/kg) and 5 minutes later were randomized to receive IV solutions (0.1 mL/kg) containing 1% lidocaine (n = 19, group I) with saline; lidocaine 1% with epinephrine 0.5 microg/kg (n = 21, group II); or lidocaine 1% with epinephrine 0.75 microg/kg (n = 21, group III). HR was recorded at 0, 15, 30, 45, 60, 90 seconds, and 2, 3, 4, and 5 minutes after test-dose injection. Systolic blood pressure (SBP), diastolic blood pressure, and end-tidal carbon dioxide were recorded at steady-state isoflurane anesthesia, after the injection of atropine, and at 45-second intervals after test-dose injections. RESULTS: Median maximum increases in HR were similar in groups II and III at 19 and 22 beats per minute (beats/min), respectively. An HR increase of > or =10 beats/min was observed in 19 of 21 patients who received 0.5 microg/kg epinephrine and 21 of 21 patients receiving 0.75 microg/kg. None of the patients in group I developed HR increases > or =10 beats/min. SBP increased > or =15 mm Hg in 17 of 21 patients in group II and 19 of 21 in group III. No dysrhythmias or T-wave amplitude change was noted. CONCLUSIONS: A simulated epidural test dose containing lidocaine 1 mg/kg with epinephrine 0.75 microg/kg, administered IV following atropine, may reliably increase HR to indicate unintentional injection into epidural vessels of children anesthetized with 1 MAC isoflurane.

Anesthesia, Inhalation↗
PubMedDate not supplied

Favorable attitudes toward testing for chromosomal abnormalities via analysis of fetal cells in maternal blood.

PURPOSE: The NICHD Fetal Cell Isolation Study (NIFTY) was a multicentered project to isolate fetal cells from maternal blood to detect fetal chromosomal abnormalities. The project included a psychosocial component, which is the basis of this article. We examined the attitudes of high-risk pregnant women toward the availability of a maternal blood test to identify fetal chromosomal abnormalities, how women would respond to hypothetical normal and abnormal maternal blood testing results, and the factors associated with a woman's preference to have an invasive procedure in response to a normal maternal blood test. METHODS: High-risk pregnant women (N = 854) planning to have prenatal diagnostic invasive testing (amniocentesis or chorionic villus sampling) completed a survey. RESULTS: The women highly favored maternal blood testing. Almost all women would seek invasive testing after an abnormal blood test. Only half of the women would seek invasive testing after a normal blood test; these women were older, more willing to terminate their pregnancy, and valued the increased accuracy of invasive testing more highly than women who would not have invasive testing after a normal maternal blood test. CONCLUSIONS: Women having invasive diagnostic testing welcome a noninvasive procedure that uses fetal cells in maternal blood, and its availability would decrease invasive testing by approximately 50%. Research needs to examine the attitudes and anticipated responses of other risk groups as well as the effects of information about maternal blood test sensitivity and specificity on attitudes and responses.

Abortion, Eugenic↗
PubMedDate not supplied

Structured skin care regimen to prevent perineal dermatitis in the elderly.

A preliminary investigation was conducted to determine the efficacy of a structured skin care regimen to prevent perineal dermatitis in incontinent geriatric psychiatry patients. A 10-week, prospective, clinical trial was conducted (n = 15). Four weeks (weeks 2 to 5) were devoted to monitoring the unstructured pretreatment nursing skin care practice and to determining the incidence of perineal dermatitis in incontinent patients. Four weeks (weeks 7 to 10) were also spent implementing and observing the structured nursing skin care regimen. The study revealed that 33% (three) of the subjects in the unstructured skin care group and 33% (two) of the subjects in the structured skin care group had perineal dermatitis. In subjects with a combination of urine and stool incontinence perineal dermatitis developed within 2 days. The findings suggest that perineal dermatitis occurs quickly in the presence of urine and stool incontinence. Further research is needed to validate the efficacy of a structured skin care regimen to prevent perineal dermatitis.

Aged↗
PubMedDate not supplied

Ultrasonography and fine needle aspirate cytology of the mesenteric lymph node in normal domestic ferrets (Mustela putorius furo).

The large mesenteric lymph node of 28 normal ferrets was imaged with ultrasound. The large node, located in the mid-abdomen at the root of the mesentery, was round to ovoid and uniformly hyperechoic. Mean ultrasonographic dimensions of the lymph node were 12.6 +/- 2.6 mm by 7.6 +/- 2.0 mm. Fine needle aspirates of 20 lymph nodes were obtained either using ultrasound guided free-hand techniques or at necropsy. The cytological descriptions were compared to histological descriptions of 13 lymph node core biopsies obtained during laparotomy or necropsy as well as 10 peripheral blood smear differentials. The large mesenteric lymph node of ferrets could be easily imaged and measured by ultrasound and evaluated by fine needle aspirate cytology. Normal lymph node cytology may include an eosinophilic infiltrate.

Animals↗
PubMedDate not supplied

Improving participation in HIV clinical trials: impact of a brief intervention.

PURPOSE: To determine if a brief intervention that provides information about AIDS clinical trials to HIV-infected patients at the initiation of primary care increases the participation of women, persons of color, and injection drug users (IDUs) in clinical trials. METHOD: 196 outpatients beginning HIV primary care at a municipal hospital were followed from September 1994 to April 1996. During the intake assessment, each patient met briefly with a research assistant who described the purpose, role, and availability of clinical trials. Contacts for further information about trials were given to patients who expressed interest. At the end of the 20-month period, enrollment rates of all patients, including women, persons of color, and IDUs, into clinical trials were compared with previously published enrollment rates of patients at the same hospital but prior to the development of this brief intervention. RESULTS: The characteristics of the 196 HIV-infected patients were: 27% women; 47% IDUs; 14% gay/bisexual men; and 76% persons of color. Overall enrollment in AIDS clinical trials was 14.8% during the 20-month follow-up period. There was no significant difference in participation rates between males and females (p =.20), whites and persons of color (p =.71), and IDUs compared with non-IDUs (p =.90), whereas previously published data had shown significantly higher enrollment rates among males, whites, and non-IDUs. CONCLUSION: Providing all HIV-infected patients with information about the meaning, role, and availability of AIDS clinical trials at the initiation of HIV primary care reduces differences in participation rates by gender, race, and history of drug use.

Anti-HIV Agents↗
PubMedDate not supplied

Auto-immunity to spermatozoa and quality of semen in men with spinal cord injury.

OBJECTIVE: To determine the presence of anti-sperm antibodies in serum, and on spermatozoa, in men with spinal cord injury. DESIGN: Thirty men whose injury occurred 1 to 18 years ago compared with 30 men with normal semen. PATIENTS AND INTERVENTIONS: Eighteen tetraplegic and 12 paraplegic patients were treated with vibrator or rectal electrostimulation, yielding a total of 25 ejaculates. RESULTS: Semen analyses (WHO): volume low, with concentration > 100 million/mL in 80%; 8/30 exhibited sperm agglutinating antibodies, but with low titres. CONCLUSIONS: Low titres of serum antibodies and absence of attached IgA antibodies indicate autoimmunity is not the cause of low sperm motility and penetration capacity in these patients.

Adolescent↗
PubMedDate not supplied

Evaluation of diaphragm electromyogram contamination during progressive inspiratory maneuvers in humans.

The diaphragm electromyogram (EMGdi) is susceptible to contamination by non-diaphragm related electrical signals such as the ECG, electrode motion artifacts, and other sources of noise. It is difficult to distinguish between these contaminating signals and those that are representative of the non-contaminated EMGdi, especially during periods when the EMGdi amplitude is relatively small, as during mild contractions of the diaphragm. The aim of the present study was to evaluate how contaminating signals influence the EMGdi power spectrum center frequency (CF) during progressive inspiratory maneuvers. EMGdi and transdiaphragmatic pressure (Pdi) were measured via an esophageal electrode in eight patients with cervical cord injury performing inspiratory capacity (IC) maneuvers. The influence of the contaminating sources on CF was evaluated by two spectral deformation indices, one which is sensitive to both high and low frequency spectral deformation (omega index), and the other which is sensitive to high frequency deformation only (CF1000/CF500 index). The results indicated that EMGdi CF values scattered over a wide frequency range, particularly when the signals were obtained at Pdi levels less than 15% of Pdimax, or at lung volumes less than 30% of IC. When the spectral deformation indices were applied, the scattering in CF values was drastically reduced. This was expressed by a factor of 4 reduction in the coefficient of variation of the CF values. The majority of the excluded EMGdi signals (i.e. not satisfying the spectral deformation index inclusion levels), had low CF values mainly due to the presence of electrode motion artifacts. It was concluded that: 1) The majority of EMGdi power spectrums are deformed early on during unloaded inspirations, and their CF values should be carefully interpreted as being representative of diaphragm function. 2) The relative contribution of contaminating signals in the EMGdi decreases proportionally throughout the first two thirds of an inspiration to IC. 3) The use of visual inspection of the signal in the time domain is questionable as a method to discriminate non-contaminated signals. 4) Analysis of the signal in the frequency domain makes it possible to detect the influence of signal contamination.

Adult↗