Biomedical subjects
Publications and source records attributed to M J Ott.
Intravenous gamma-globulin is being used with increasing frequency in the care of children. This article reviews the physiology of the immune system, the pharmacology of intravenous gamma-globulin, and presents four case studies. Administration guidelines, adverse reactions, and appropriate interventions are discussed. A table comparing four commonly used products is presented.
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Self-esteem is known to be altered in children with chronic illness. Do accelerated normal changes, such as those that occur in children with precocious puberty, also alter the child's self-esteem? Twenty-eight children with precocious puberty participated in a nonrandomized descriptive pilot study using a structured interview, the Piers-Harris Children's Self-Concept Scale, and self-portrait drawings. Results indicate that the overall self-esteem of the majority of children was within normal limits as measured by the Piers-Harris Children's Self-Concept Scale, but closer analysis found that many of the children had difficulty with peer relationships and increased levels of anxiety. These findings were supported by the results of the structured interview and the children's self-portraits. Nursing implications from this pilot study are discussed.
Some derivatives of hematoporphyrins are strongly retained by tumor tissue as compared to normal tissue, and exposure of these photosensitizers to radiation in the visible spectrum can cause serious biological damage. These properties have been exploited in the development of a new treatment for cancer termed photodynamic therapy (PDT). However, recent studies have also demonstrated that PDT can also induce a state of systemic immunosuppression. The purpose of this study was to determine whether PDT-induced suppression of contact hypersensitivity (CHS) responses was an active phenomenon that could be adoptively transferred by viable splenocytes from PDT-treated mice. Although induction of adoptively transferable suppressor cells in PDT-treated mice required exposure to antigen, the suppressor cells were found to be antigen nonspecific in their function. Furthermore, splenocytes from PDT-treated mice were capable of generating levels of allospecific cytotoxic T lymphocyte (CTL) activity which were comparable to those generated by normal control mice, but the ability of irradiated spleen cells from PDT-treated mice to stimulate a mixed lymphocyte response (MLR) was dramatically impaired. Finally, chromatographic separation of T cells, B cells and macrophages showed that the cell type which mediates adoptively transferable suppression of CHS responsiveness is in the macrophage lineage.
Munchausen Syndrome by proxy as a form of child abuse is appearing with greater frequency in the literature. It is essential for pediatric nurses to know this form of child abuse and to aid in early detection, diagnosis, and intervention. The purpose of this article is to present a model of care to assist nurses in detecting and managing affected children and their families.
Primary care providers should have the ability to identify normal and abnormal variations of sexual development in children. The incidence of precocious puberty is approximately one child in every 10,000 children in the United States. While etiologies vary, precise differential diagnosis is essential because it will determine the course of treatment required. New forms of therapy using long-acting luteinizing releasing factor agonists are currently being investigated. Developmentally appropriate explanations for affected children regarding the diagnosis and treatment plan are a crucial component of care. Ongoing educational and emotional support for the child and family are essential as they learn to cope with early sexual development.
Although photodynamic therapy is being used increasingly for the diagnosis and treatment of human cancer, its effect on immune responses has received little attention. This aspect was examined in a murine model. Mice given peritoneal photodynamic therapy had markedly decreased contact hypersensitivity responsiveness, not observed with cutaneous photodynamic therapy. The immunosuppression was systemic, because contact hypersensitivity was depressed at distal, unirradiated sites. Photodynamic therapy induced adoptively transferable cells that inhibited contact hypersensitivity responses in naive mice. The immunosuppression was reversible, but persisted for 3 weeks after photodynamic therapy. An acute-phase response characterized by leukocytosis and elevated serum amyloid P levels was observed in mice given photodynamic therapy but not in mice treated with either laser or dye alone. These data suggest a link between the acute-phase response and immunosuppression. Thus, although photodynamic therapy shows promise in cancer treatment, the induction of decreased systemic immunoresponsiveness is an important observation with potentially detrimental consequences.
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Hepatitis B virus (HBV) infection is a health problem that affects numerous infants and children in the United States. Approximately 4000 to 6000 new infections occur each year in children and adolescents; most often they become infected without obvious clinical manifestations. Some persons become chronically infected, and this asymptomatic chronically infected population serves as a reservoir for HBV. Immunization of all newborn infants and adolescents for HBV is a vital step toward eradicating HBV from the general population. Pediatric nurse practitioners are in a strategic position to provide education and the carry out immunization efforts that will dramatically decrease the morbidity associated with HBV.
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Guided imagery, a form of relaxed, focused concentration is a natural and powerful coping mechanism. Easily learned, guided imagery can be used as an adjunct to the care of toddlers and preschool children who are experiencing anxiety and pain. The nurse must first prepare him/herself, the parent, and the child for the experience. Techniques of joining, leading, pacing, and word choice facilitate the process, informed by an understanding of child development. This low tech, cost-effective intervention can promote children's personal coping abilities and increase their sense of self-esteem.
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