Passion and cadence: a commentary on the report to the Congress of the United States by the Office of Technology Assessment entitled Adolescent Health.
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Adolescent↗
Biomedical subjects
M I Cohen
Publications and source records attributed to M I Cohen.
Weakness of short-term synchronization among respiratory nerve activities during fictive vomiting.
In decerebrate, paralyzed cats, phrenic (PHR) and lumbar abdominal (ABD) nerve discharges during both neural respiration and fictive vomiting (FV) were subjected to spectral and coherence analyses. During respiration, PHR discharge exhibited high-frequency oscillation (HFO), manifested as a narrow spectral peak (range 57-90 Hz) in autospectra and left-right coherence spectra. During FV, the following occurred: 1) the HFO peak disappeared and was replaced by a broad peak with higher modal frequency (range 84-120 Hz), indicating elimination of inputs from the medullary inspiratory pattern generator. 2) Left-right PHR coherence spectra had no distinct peaks, indicating that correlations between opposite PHR discharges were now not frequency specific. 3) Although ABD and PHR autospectra were similar, PHR-ABD coherences were near zero, indicating lack of common inputs on a short time scale. 4) Nonzero coherences between ABD nerves were confined to ipsilateral pairs. Thus coherence analysis indicates that the outputs of the vomiting pattern generator are temporally dispersed on a short time scale and are not necessarily common to different motoneuron populations.
Abdomen↗
The pediatrician's role in the diagnosis and treatment of substance abuse.
Abuse of drugs and alcohol is pervasive in our society. The role of the pediatrician as a health-care provider from birth through young adulthood includes recognizing the stigmata in newborns of prenatally ingested drugs as well as being able to treat neonatal drug withdrawal syndromes. Questioning about drug use and other closely related topics should be incorporated into all health-care maintenance visits, starting at the age of 10 y, with parental participation and anticipatory guidance being offered. Physical examination and laboratory testing are not as helpful in confirming an impression of substance abuse as a comprehensive interview and a full appreciation of the warning signs of substance abuse. Treatment of the problematic user with a multidisciplinary team that understands adolescent development and behavior as well as the problem of substance abuse is crucial. The decision to treat the teen in an ambulatory or inpatient setting is determined by the extent of abuse, underlying medical problems and psychopathology, and the degree of family dysfunction. The pediatrician must not avoid addressing these issues with patients. If, however, upon identifying an adolescent or a newborn with a drug problem, the pediatrician feels uncomfortable or ill-prepared to manage the patient, appropriate professional referrals are warranted. Despite exercising the referral option for treatment, as advocate for child and family, the pediatrician remains professionally bound to track all drug abuse-related referrals while continuing to participate in the general ongoing care of the patient and family. Finally, the pediatrician should retain a public advocacy role in the community by offering educational, preventive, and supportive efforts in the continuing struggle against drug abuse.
Adolescent↗
Adolescent health: is it now on the nation's agenda?
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Adolescent↗
Predicting success on conditional release for insanity acquittees: regionalized versus nonregionalized hospital patients.
This research compared the outcomes of two cohorts of insanity acquittees: one group was treated solely in the maximum security state forensic hospital before their release to the community (nonregionalized) and the other group was treated at the state forensic hospital and transferred for further treatment at less secure state regional hospitals (regionalized). This research describes the outcome of a group of insanity acquittees (regionalized patients) never previously studied. The applicability of a prediction model based on earlier research of insanity acquittees was tested on the patients. Findings on four outcome indicators are reported: rearrests within five years after release, overall functioning in the community five years after release, rehospitalizations for mental illness, and successful completion of the terms of the five-year conditional release (nonrevocation). Discriminant analysis was performed on the four outcome variables. The model was found to accurately predict the four types of outcome from 69 percent to 94 percent accurately for the nonregionalized insanity acquittees and from 87.5 percent to 95.8 percent for the regionalized patients. This model is currently being adapted to classify patients into potential high- and low-risk groups at the time of conditional release for the purpose of determining the intensity of outpatient supervision.
Cohort Studies↗
Fast rhythms in phrenic motoneuron and nerve discharges.
1. Fast rhythms in discharges of individual phrenic (PHR) motoneurons were studied by spectral and interval analyses; and they were compared, using coherence analysis, with similar rhythms in whole-PHR nerve discharge. The purpose of this study was to ascertain the origin of the two rhythms, manifested as distinct spectral peaks, in PHR motoneuron and nerve discharge: medium-frequency oscillations (MFO, usual range 20-50 Hz); and high-frequency oscillations (HFO, usual range 50-100 Hz). 2. In paralyzed artificially ventilated cats, unit recordings were taken from 1) 26 isolated single PHR fibers (in 8 sodium pentobarbital-anesthetized cats) and 2) 27 identified PHR motoneuron somata in the spinal cord (in 5 decerebrate cats). Simultaneous whole-PHR activity was monophasically recorded from the contralateral PHR nerve for 1 and from both PHR nerves for 2. 3. The signals were subjected to time- and frequency-domain analyses. The latter included a novel application of coherence analysis to the study of population synchrony. 4. The autospectra of all PHR units showed prominent MFO peaks in the frequency range of the nerve MFO spectral peaks, as well as harmonic peaks, indicating the presence of this type of fast rhythm in the units' discharges. Spectral analysis of the augmenting PHR activities in different segments of the inspiratory (I) phase showed that the frequency of unit MFO and of nerve MFO rose during the course of I. Further, cycle-triggered histogram and interval analysis indicated that the frequencies of unit MFO autospectral peaks were very close to the peak firing rates of the units during the portion of I analyzed. Thus unit MFO spectral peaks reflected the rhythmic and augmenting discharges of the motoneurons, and similar nerve MFO peaks reflected the superposition of individual motoneuron discharges. 5. The coherences of motoneurons' MFOs to nerve MFOs were low or zero, indicating that only partial and weak MFO correlations occurred within the PHR motoneuron population. 6. In those cats (n = 11) that had clear PHR nerve HFO spectral peaks, about one-half of the recorded PHR motoneurons had HFO, as indicated by HFO peaks in the unit autospectra and/or the unit-nerve coherences. 7. For motoneurons having HFO, the coherence between unit and nerve HFOs was substantial, particularly when the latter were strong, indicating HFO correlations among a number of PHR motoneurons. 8. In the light of theoretical considerations on the generation of aggregate rhythms from superposition of unitary rhythms, these observations indicate the following.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
Progression of experimental infantile hydrocephalus and effects of ventriculoperitoneal shunts: an analysis correlating magnetic resonance imaging with gross morphology.
Although previous ultrasonographic studies did monitor ventricular enlargement successfully in experimentally-induced models of feline hydrocephalus, the resolution of neuroanatomic detail was relatively poor after placement of a ventriculoperitoneal (VP) shunt because the skull had ossified over the coronal sutures. Therefore, the present study employed magnetic resonance imaging to follow the progression of ventriculomegaly more accurately, as well as to evaluate the compensatory effects of VP shunting. Hydrocephalus was induced in kittens between 7 and 10 days old by injection of kaolin into the cisterna magna. Age-matched controls received similar injections of saline. At 9 to 14 days after the kaolin injection, the hydrocephalic animals received VP shunts. Anesthetized kittens were scanned at various intervals before and after shunt placement and were killed for morphological correlation. The features observed on the magnetic resonance imaging scans were consistent with the gross morphological changes that accompanied ventricular enlargement. The lateral ventricle began to enlarge as early as 1 day after the kaolin injection, and within 3 days, both the occipital and temporal horns, along with the 4th ventricle, showed signs of moderate dilatation. By 5 days, a bilateral communication had been established through the septum pellucidum. Continued expansion of the ventricular system occurred from 6 to 20 days after injection, to the point where the cerebral cortex was reduced to less than 25% of its original thickness. The internal capsule was stretched and edematous, the caudate nucleus was compressed ventrolaterally, and the cerebellar hemispheres were eroded and/or compressed. Animals in which shunts were successfully placed demonstrated a dramatic improvement in behavior, and a reduction of about 50% in the size of the lateral ventricles within 2 days. In some cases, the lateral ventricles became slit-like within 1 week. When they were killed, about half of the animals that received shunts exhibited mild to moderate ventriculomegaly. These results indicate that magnetic resonance imaging is an excellent method for visualizing the morphological changes associated with this animal model, that these alterations occur soon after the onset of hydrocephalus, and that VP shunting can successfully reduce ventriculomegaly.
Animals↗
Afferent projections to the inspiratory neuronal region of the ventrolateral nucleus of the tractus solitarius in the cat.
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Animals↗
Illicit drug use among urban adolescents. A decade in retrospect.
Over the past decade (1967 to 1977), 76,000 adolescents were screened for a history and somatic signs of illicit drug use at a detention center for juveniles and at an adolescent inpatient unit of a university-affiliated hospital. Dramatic changes in the patterns of drug abuse are reported. Opiate use was prominent in the first half of the decade with a peak in 1970 to 1971 and marijuana use more prominent in the last five years. Inhalant abuse as represented by glue and halogenated cleaning fluids was documented only early in the decade, while the existence of stimulant and depressant abuse follows still other patterns over the decade. Hospital admissions for serious somatic complications of illicit drug use, namely, overdose, drug-related death, hepatic coma, detoxification, and viral hepatitis, were correlated only with trends in the use of opiates. Awareness of drug abuse patterns among adolescents is important for the health professional so that complications can be diagnosed and treated and educational efforts properly directed.
Adolescent↗
Asymptomatic transient uveitis in children with inflammatory bowel disease.
Although acute anterior uveitis has been noted in children with inflammatory bowel disease, it has not been appreciated in the absence of ocular symptoms. To determine the presence of asymptomatic uveitis, slit-lamp examinations were performed in 19 children with granulomatous bowel disease and seven with ulcerative colitis. In the former group, six had uveitis, while no abnormalities were noted in those with ulcerative colitis. Abnormalities consisted of cells and flare in the anterior chamber. In the group with asymptomatic uveitis, all were male, three were black, and all had colonic involvement. No positive correlations were noted between the presence of uveitis and bowel symptoms, duration of illness, extraintestinal manifestations, or specific treatment regimens. None of the six children with uveitis had evidence of spondylitis, and five were HLA-B27-negative. Repeated eye examinations six to 12 months later disclosed no evidence of uveitis in four of five children and improvement in the remaining child. These data suggest that asymptomatic transient uveitis is common in children with granulomatous bowel disease, but progression to severe adult uveal disease remains unclear.
Adolescent↗
Profile of 24-hour plasma glucose and insulin concentrations. Their variation with two methods of total parenteral nutrition administration.
The concentration of glucose and insulin in the plasma during total parenteral nutrition (TPN) was measured every 20 minutes during a 24-hour period in three subjects with granulomatous enterocolitis. During a gravity drip, parallel variations in rate of flow and plasma glucose and insulin concentrations were seen, and both hypoglycemia and hyperglycemia occurred. During a constant (pumped) infusion, plasma glucose and insulin concentrations were stable and normal. Glucose excretion in the urine was negligible and adequate gains in weight occurred, suggesting utilization of the administered nutrients. Hypertonic solutions for TPN should be infused at a constant rate either by careful attention to the flow rate during changes of intravenous bottles and tubing or by using a constant-infusion pump. Infusion of TPN solutions at a constant rate minimizes the risk of hypoglycemia or hyperglycemia.
Adolescent↗
Properties of inspiratory termination by superior laryngeal and vagal stimulation.
Electrical stimulation of two respiratory afferent nerves, the vagus and the internal branch of the superior laryngeal, was used to terminate inspiration. The short latency responses of phrenic motoneurones to these stimuli were studied to determine if inspiratory termination was preceded by a characteristic phrenic motoneurone discharge pattern, reflecting changes in brainstem inspiratory neurone discharge and inspiratory terminating mechanisms. Stimulus trains of sufficient intensity delivered to the superior laryngeal nerve terminated inspiration within 50 ms and were preceded by a stereotyped pattern of phrenic motoneurone discharge. This consisted of a short latency (disynaptic), predominantly contralateral excitation in response to the first shock of the train, followed by a marked and long lasting inhibition. In contrast, vagal stimulation typically terminated inspiration hundreds of milliseconds after the onset of the stimulus train and was not preceded by a stereotyped pattern of phrenic motoneurone responses to single shocks. Transient short latency responses were obtained but were extremely small, requiring considerable excitation followed by a moderate bilateral depression of activity. Inspiration could be terminated with or without the presence of these short latency responses. These results indicate that superior laryngeal and vagal (presumably pulmonary stretch receptor) afferents have different projections to brainstem inspiratory neurones and may exert their effects on inspiratory duration through different, but as yet undefined, neural mechanisms.
Action Potentials↗
Neurogenesis of respiratory rhythm in the mammal.
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Action Potentials↗
Effect of lead exposure on the activity of some hepatic enzymes in the rat.
Seven-day-old rats were fed 1% lead acetate tetrahydrate solution for 2, 4, or 7 days. Adult rats were fed the same lead solution for 6--8 wk. In the newborn rats, hepatic UDP-bilirubin glucuronyl transferase (GT) and gamma glutamyl transpeptidase (GGTP) activities were markedly increased. GT activity was increased after 4 days as compared to the controls (6.3 +/- 0.3 vs. 4.3 +/- 0.3, P less than 0.001), and was maximal after 7 days of treatment (7.5 +/- 0.4 vs. 4.6 +/- 0.4, P less than 0.001). GGTP activity was already maximally increased after 2 days of lead treatment (1.4 +/- 0.2 vs. 0.4 +/- 0.1, P less than 0.001). Hepatic GT and GGTP activities were similarly increased in adult rats (7.9 +/- 0.3 vs. 5.1 +/- 0.1, P less than 0.001, and 0.7 +/- 0.1 vs. 0.4 +/- 0.1, P less than 0.005, respectively). In vitro studies adding lead citrate to liver homogenates did not produce any direct effect on GT and GGTP activities.
Animals↗
Simultaneous gastric and plasma immunoreactive plasma carcinoembryonic antigen in 108 patients undergoing gastroscopy.
Simultaneous measurement of plasma and gastric immunoreactive carcinoembryonic antigen (CEA) was performed in 108 patients undergoing upper gastrointestinal endoscopy. Gastric immunoreactive CEA was more sensitive than plasma CEA (92% vs. 65% positive) in patients with gastric cancer. In cancer patients gastric CEA was significantly higher than in all other patient groups. The extent of disease, the histologic type of adenocarcinoma, and the macroscopic appearance of the tumor had no influence on gastric CEA results. Gastric CEA was elevated in 44% of patients with gastritis and 26% of patients with benign gastric ulcers, but was never elevated in patients with no gastric pathology. In patients with benign disorders, elevated gastric CEA was significantly correlated with atrophic gastritis especially of moderate or severe degrees. Elevated levels persisted in patients with pernicious anemia and severe atrophic gastritis but returned to normal with healing of benign gastric ulcers. Simultaneous measurement of gastric total protein or potassium content was necessary to correct for variations in sample collection. We conclude that gastric CEA was not useful for distinguishing between benign and malignant lesions but should be studied further for screening high risk patients, for identifying and following patients with "premalignant" conditions, and for following cancer patients before and after surgery and/or chemotherapy.
Adenocarcinoma↗
Health needs of the adolescent.
In recent years, considerable effort has been devoted to the study of those core elements necessary to define a reference standard of health for adolescents. In our program, indices of adolescent disability were developed based on an analysis of 12 years of data from approximately 75,000 teenage patients. In-hospital (14,000), ambulatory (15,000), and community based (50,000) adolescent contacts offered differing indices of disease. Targeted screening efforts produced significant epidemiologic data and generated recommendations for adolescent ambulatory screening standards which were then applied to such community experiences as school health programs and urban group home settings. Both demonstrated significant levels of disability in excess of 50% of the populations studied. Alternatively, review of more complex problems observed within a hospital setting specific for adolescents revealed significant chronic disability. Clearly the health requirements of the adolescent are extensive but effective interventions must be based on carefully considered indicators of unmet needs.
Adolescent↗
Perihepatitis associated with salpingitis in adolescents.
Perihepatitis, one manifestation of complicated gonorrhea, is infrequently diagnosed and reported. This study was undertaken to examine the incidence of gonococcal perihepatitis in adolescents as well as to study the effect, if any, of this condition on tests of liver function. Accordingly, the records of 137 adolescents with salpingitis were evaluated. Right upper quadrant tenderness or hepatic enlargement was noted in 27, while amino transferase level elevations were observed in 19 of the 59 in whom these tests were performed. All findings resolved promptly following initiation of intravenous penicillin therapy. The observation of hepatic dysfunction in 27% of these adolescents suggests that perihepatitis occurs more frequently than reported in adults and should be considered in the evaluation of the conditions of adolescents with salpingitis or upper abdominal tenderness.
Adolescent↗