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Biomedical subjects

M L Mitchell

Publications and source records attributed to M L Mitchell.

At least 19 recordsLinked to original sources
PubMed1997

Routine skin cleansing with povidone-iodine is not a common cause of transient neonatal hypothyroidism in North America: a prospective controlled study.

A high incidence of transient neonatal hypothyroidism has been observed in premature infants after routine skin cleansing with iodine. Because these reports have been predominantly from Europe, a borderline, iodine-deficient area, we wished to determine whether this was also true in North America, an iodine-sufficient area. A prospective, controlled study was performed in premature babies < or = 36 weeks gestation admitted to a neonatal intensive care nursery. Thyroxine (T4) and thyrotropin (TSH) were measured at day 1, days 4 to 6, and 10 to 12 after skin preparation with iodine or with a noniodine-containing antiseptic solution (chlorhexidine) that served as control. If repeat cleansing was required, this sequence was repeated. Urinary iodine was quantitated on days 1 to 3 to estimate iodine exposure. There was no difference in the mean T4 concentration at any of the time points evaluated nor in the incidence of transient hypothyroidism between the iodine-exposed (2/17) and control babies (0/14) despite urinary iodine excretion up to 88 times the control value. Unexpectedly 5 iodine-exposed but 0 control babies developed severe hypothyroxinemia (T4 < 40 nmol/L), compatible with the sick euthyroid syndrome; one of them died. We conclude that, unlike in Europe, transient hypothyroidism is not a common sequela of routine skin cleansing with iodine in premature newborn infants in North America. This difference in incidence may be due to prior iodine status. Whether excessive iodine absorption in premature infants is associated with thyroid-independent toxic effects remains to be clarified.

Anti-Infective Agents, Local↗
PubMed1997

The effects of nursing care guided by self-regulation theory on coping with radiation therapy.

PURPOSE/OBJECTIVES: To test the hypotheses that preparatory informational interventions based on self-regulation theory delivered to radiation therapy (RT) recipients by staff nurses would reduce disruption in patients' usual life activities and have a positive effect on the moods of patients who tended to have pessimistic expectations about outcomes. DESIGN: A quasi-experimental design with repeated measures. SETTING: University-affiliated RT department. SAMPLE: 226 patients receiving RT for breast or prostate cancer. METHODS: The control-group patients received the nursing care that was the standard of practice before the experimental interventions were introduced. The experimental-group patients received theory-based interventions four different times from staff nurses. Patient data were collected by interview four different times. MAIN RESEARCH VARIABLES: Type of nursing interventions generated, optimistic or pessimistic expectations about outcomes (Life Orientation Test), amount of disruption in usual life activities (Sickness Impact Profile), and moods (Bi-Polar Profile of Mood States). FINDINGS: The patients who received the self-regulation theory-based nursing interventions experienced less disruption in their usual life activities during and following RT. Among the patients who tended to be pessimistic, those who received the theory-based interventions had a more positive mood than those who did not receive the interventions. IMPLICATIONS FOR NURSING PRACTICE: Staff nurses should use self-regulation theory-based interventions to help patients cope with RT.

Activities of Daily Living↗
PubMed1996

Thyroid function in very low birth weight infants: effects on neonatal hypothyroidism screening.

OBJECTIVES: To supply normative data for screening thyroxine (T4) and thyrotropin concentrations correlated with birth weight and age at screening of infants with birth weights ranging from 400 to 5500 gm, and to document the effects of screening of very low birth weight (VLBW) infants, because VLBW infants comprise 0.86% of surviving newborn infants and have very low total T4 concentrations with normal or elevated free T4 concentrations as a result of deficient protein binding of thyroid hormones. STUDY DESIGN: Both retrospective and prospective studies were used. We conducted retrospective analyses of screening of T4 and thyrotropin concentrations in 9,324 term, 18,946 low birth weight, and 3,450 VLBW infants in Massachusetts, and a prospective study of T4 and thyrotropin concentrations in 48 VLBW infants at 2 weeks of age. Forty of the infants also had hormone measurements at 4 weeks, 29 at 8 weeks of age, and 24 had analysis of cord blood samples. RESULTS: Median T4 concentrations for each weight group (in 250 gm increments) increased progressively and significantly up to 2500 gm. Of the surviving VLBW infants, 1.5% had screening T4 concentrations that were unmeasurably low (<3.9 nmol/L (0.3 microgram/dl)). The mean T4 concentration varied with age at screening, increasing from cord blood concentrations to a peak at 1 to 3 days of age and thereafter decreasing to a nadir at about 2 weeks in both low birth weight and VLBW infants. In VLBW infants the mean concentrations return to the level of 1 to 3 days by 4 to 8 weeks of age. The incidence of screening thyrotropin concentrations > or = 40 mU/L correlates inversely with weight. The incidence of early, transient hypothyroidism in VLBW infants defined by this thyrotropin concentration was eight times that in term infants. Two infants had late-onset, transient hypothyroidism at 2 and 7 weeks, respectively. CONCLUSIONS: The normative data related to birth weight and age at screening allow proper interpretation of VLBW results for primary T4 and primary thyrotropin screening programs. Screening of the concentrations of T4 and thyrotropin in VLBW increases the number of secondary measurements of T4 in a primary thyrotropin screening program and the number of secondary thyrotropin measurements in a primary T4 screening program by 6% and 9%, respectively. We recommend screening analyses for VLBW infants in the latter part of the first week of life and again at 2 and 4 to 6 weeks of age. This protocol would increase the number of screening analyses by 1.6%.

Birth Weight↗
PubMed1995

Topical iodine and neonatal hypothyroidism.

OBJECTIVES: To determine whether skin care practices with iodine-containing disinfectants are putting patients in the neonatal intensive care unit at risk for primary hypothyroidism. Cutaneous exposure to povidone-iodine antiseptic solutions may be a cause of primary hypothyroidism in neonates. DESIGN: Prospective pilot study. SETTING: Level III neonatal intensive care unit of a university-affiliated hospital. PARTICIPANTS: Sequential sample of 47 medial and surgical patients admitted to the neonatal intensive care unit who received cutaneous povidone-iodine applications in preparation for invasive or surgical procedures. METHODS: Seven to 10 days after iodine exposure, capillary blood samples were obtained on filter paper blots for thyroid function testing and urine samples were collected to determine quantitative iodine concentrations. A plasma creatinine level was determined for each subject. RESULTS: A total of 47 patients were enrolled. The gestational ages of subjects ranged from 26 to 41 weeks (mean, 33.6 weeks); the male-to-female ratio was 28:19; and the birth weights ranged from 0.7 to 5.1 kg(mean, 2.42 kg). The thyroxine level ranged from 20 to 187 nmol/L (1.6 to 14.6 micrograms/dL) (mean, 102 nmol/L [7.9 micrograms/dL];reference, > or = 90 nmol/L [> or = 7 micrograms/dL]; and the thyrotropin level ranged from 0.1 to 16.5 mU/L (mean, 6.4 mU/L; reference, < 20 mU/L). The mean uridine iodine concentration was 2798.0 micrograms/dL (reference, < 40 micrograms/dL), and the mean plasma creatinine level was 60 mumol/L (0.69 mg/dL) (reference, < or = 50 mumol/L [ < or = 0.6 mg/dL] for males and < or = 40 mumol/L [ < or = 0.5 mg/dL] for females). CONCLUSIONS: There was no documentation of primary hypothyroidism in our subjects despite elevated urine iodine levels. While it is still possible that patients who receive long-term iodine exposure in other settings (eg, cardiac catheterization) are at risk for primary hypothyroidism, our study suggests that the amount of iodine absorbed through routine neonatal intensive care unit procedures does not substantially alter thyroid function during the first 10 days of life. An important confounding variable is that seven patients were receiving dopamine hydrochloride infusions and four were receiving dexamethasone phosphate at the time of sample collection. We therefore cannot rule out the possibility that these medications masked a thyrotropin level elevation that would have occurred in a primary hypothyroid state. We discuss implications for the interpretation of the results of neonatal thyroid function tests.

Administration, Cutaneous↗
PubMed1995

Measurement of thyroglobulin in newborn screening specimens from normal and hypothyroid infants.

BACKGROUND AND OBJECTIVE: Thyroglobulin (Tg) has been found in varying concentrations in infants and children with congenital hypothyroidism. Our primary goal was to ascertain whether Tg in filter paper blood specimens used for routine newborn screening would be a useful adjunct in the early diagnosis of newborn children with congenital hypothyroidism. Our secondary objective was to correlate the results of the Tg determinations with the results of thyroid scintigraphy in the same cohort of infants with congenital hypothyroidism. DESIGN: An RIA kit with high sensitivity for the measurement of Tg in serum was modified for use with filter paper blood specimens. Results of thyroid scintigraphy were obtained from the family physicians on 10 infants with ectopic thyroid glands and 18 who were considered to be athyreotic. MEASUREMENTS: Determinations of Tg were carried out retrospectively on newborn screening filter paper blood specimens from 61 full-term normal infants and 42 newborns with confirmed congenital hypothyroidism. RESULTS: Thyroglobulin concentrations during the first week of life in the normal controls ranged between 17 and 160 micrograms/l, with a median of 66 micrograms/l. Tg values for infants with ectopic thyroid glands ranged between 38 and 282 micrograms/l, with a median of 160 micrograms/l, with a median of 66 micrograms/liters. Tg values for infants who were considered athyreotic had Tg values ranging between undetectable and 104 micrograms/l with a median of 15 micrograms/l. Fifty per cent of the athyreotic patients and 50% of patients with ectopic thyroid glands had Tg values above or below the normal range and thus fell within the diagnostic category of hypothyroidism on the basis of Tg alone. Fifty per cent of patients who were considered athyreotic by scintigraphy had Tg concentrations ranging from 20 to 104 micrograms/l. CONCLUSION: These studies have shown that thyroglobulin can be measured in the same filter paper blood specimens used for routine newborn screening. Estimation of thyroglobulin in screening specimens from hypothyroid and normal infants indicated that some infants with congenital hypothyroidism could be identified solely on the basis of the thyroglobulin concentration. Comparison of the result of scintigraphy with thyroglobulin levels in the same hypothyroid patients suggested that thryoglobulin provided a more reliable marker for the presence or absence of the thyroid gland than did scintigraphy.

Biomarkers↗
PubMed1995

Early minimal feedings promote growth in critically ill premature infants.

Critically ill premature infants requiring mechanical ventilation and an umbilical artery catheter usually do not receive enteral feedings during the acute phase of their illness. We studied the safety and benefit of early minimal enteral feedings during this time in a prospective, controlled, and randomized study. Twenty-nine infants were randomly assigned to receive only standard intravenous fluid and nutrition (nothing per OS, NPO group; n = 13), or in addition to receive small-volume hypocaloric continuous feedings (1 ml/kg/h), beginning at 24 h of age (early-feeding group; n = 16). Standard enteral feedings were begun in both groups at the resolution of the acute phase of the illness and advanced by protocol. The two groups were of comparable birth weight, gestational age, and Apgar scores. There were no significant differences in the episodes of feeding intolerance. Two infants in the NPO group developed clinical signs of necrotizing enterocolitis. Serum diamine oxidase and somatomedin C were measured weekly until 30-60 days of age and were not different between the two groups. The early-feeding group required fewer days to reach 120 ml/kg/day enteral intake (early-feeding group 10 +/- 3 days, NPO group 13 +/- 4 days; p < 0.05). On day 30 of life the early-feeding group was 223 +/- 125 g above birth weight, while the NPO group was 95 +/- 161 g above birth weight (p < 0.05). The average intake (kcal/kg/day) from day 6 to day 30 was not different between the two groups. We conclude that early minimal feedings in critically ill very-low-birth-weight infants requiring mechanical ventilation are well tolerated and result in reduced time to reach 120 ml/kg/day of enteral feeding and in a greater weight gain by day 30 of life.

Amine Oxidase (Copper-Containing)↗
PubMed1993

Interdepartmental quality assurance using coded autopsy results.

A system of reporting discrepancies between antemortem and postmortem diagnoses was devised for use in interdepartmental quality assurance at a large community medical center. Between 1988 and 1991, 213 autopsies comprising 6% of deaths were coded using the system of Battle et al. (1) and distributed to the quality assurance committees of clinical departments. A major discrepancy was found in 11.7% (95% confidence interval; 6.8 to 18.4%) of adult cases. The discrepancy rate tended to increase with increasing patient age, but there was no significant effect due to patient sex, race, hospital of origin, clinical department of origin, whether the autopsy was restricted to examination of only part of the body, or whether the patient died in or out of the hospital. The possible uses of the quality assurance system and problems encountered with its implementation are discussed.

Abstracting and Indexing↗
PubMed1991

A comparison of skeletal muscle morphology with training between young and old Fischer 344 rats.

Muscle mass, fiber area, total fiber number, fiber population and capillarity were assessed in 6- and 25-month-old animals trained by treadmill running at 75% mean maximal capacity for 10 weeks. Serial cross-sections were stained for ATPase activity to differentiate fiber types and expose capillaries. Aging and training effects were demonstrated in maximal running speed and endurance running time. Soleus muscle mass increased in the aged, however, soleus and EDL total fiber number were declining. When adjusted for muscle weight, a significant reduction existed in fiber number for the aged soleus. Fiber area increased in the old soleus compared to young. All changes in the EDL were specific to the deep region. While there was a tendency for the capillaries/fiber and fiber area to be higher with training in the Type I fibers of the soleus, it was only significant for the young animals. Thus, while the majority of variables that showed a training effect did so across both age groups, this was not the case for vascularity. Age-associated changes in muscle morphology appear to be both muscle and fiber specific.

Aging↗
PubMed1991

Case report 697: Neuropathic arthropathy of the shoulder with no identified cause.

Two cases of neuropathic disease of the shoulder without evidence of a neurological disorder are described. The absence of any neurological disorder led to the cases being initially mistaken for primary neoplasms of bone, lending support to the vascular theory of pathogenesis of this lesion. Careful attention to the radiographic features and knowledge that a neurological disorder need not be present should lead to the correct diagnosis.

Adult↗
PubMed1991

Prevalence of thyroid deficiency in pregnant women.

OBJECTIVE: The present study was designed to determine the current prevalence of gestational hypothyroidism, since maternal thyroxine deficiency is associated with poor obstetric outcomes and mental retardation in the surviving offspring. DESIGN: TSH concentrations were measured in the sera of women at 15-18 weeks of gestation. Those sera with TSH concentrations above 6 mU/l and the two sera closest in order with TSH concentrations below 6 mU/l were further analysed for T4, FT4, TBG, and antithyroid antibodies. Study criteria for hypothyroidism were sera with elevated concentrations of TSH plus both a free T4 concentration and a total T4 concentration and/or T4/TBG ratio more than two standard deviations below the mean for the control pregnant women. PATIENTS: The sera were from 2000 consecutive women in Maine being tested for alpha-fetoprotein concentration at 15-18 weeks of gestation. RESULTS: TSH concentrations above 6 mU/l were found in the sera of 49 women, 2.5% of the pregnant women. Six women with elevated TSH concentrations (range 6.9-54 mU/l) had both a FT4 concentration and a T4/TBG ratio and/or a T4 concentration more than two standard deviations below the respective control means, meeting the study criteria for thyroid deficiency, and thus giving a prevalence of 0.3%. The remaining 43 women with elevated TSH concentrations were classified as having compensated thyroid disease although some may have been hypothyroid. Fifty-eight per cent of women with TSH concentrations above 6 mU/l and 90% of the women with elevated TSH concentrations and at least one thyroxine index more than two standard deviations below the control means had positive titres of antithyroid antibodies as opposed to 11% of the controls. CONCLUSIONS: Although it is not known what severity of maternal thyroid deficiency is necessary to cause fetal brain damage, the present data indicate a sufficiently high prevalence of thyroid dysfunction to demand investigation of the mental development of the offspring of women with thyroid dysfunction and of the effect of replacement therapy.

Adult↗
PubMed1991

Gender differences in the development of relationships during late adolescence.

Until recently, inadequate measures of affiliation need and relationship closeness hindered investigations into the social development of adolescents. For example, assumptions about gender differences (Douvan & Adelson, 1966; Gilligan, 1982) and age-related changes (Dunphy, 1972; Erikson, 1968; Newman & Newman, 1976) in affiliation need and relationship closeness have remained virtually untested. To better understand adolescent social behavior and test these assumptions, recently developed measures of affiliation need and interpersonal closeness were used to examine seventy-four 18- to 20-year-olds. In support of Erikson's theory, need for social comparison declined with age for both sexes. However, in support of Gilligan's theory, not only were females more attached to their partners, but these gender differences were most pronounced for the 18-year-olds. Finally, Dunphy's (1972) assumption that adolescents' need for stimulation peaks around age 18 or 19 and then declines, and Newman and Newman's (1976) position that need for emotional support declines in later adolescence, held true--but only for females.

Adaptation, Psychological↗
PubMed1989

Infrared spectroscopic investigations of pulmonary surfactant. Surface film transitions at the air-water interface and bulk phase thermotropism.

The molecular structure of the phospholipid component of intact pulmonary surfactant isolated from bovine lung lavage has been examined by Fourier transform infrared spectroscopy. Two different physical states of the surfactant were examined by means of different infrared spectroscopic sampling techniques. Transmission infrared experiments were used to study the surfactant in the bulk phase. In these experiments, the thermotropic behavior of the bulk surfactant was monitored by temperature-induced variations in the phospholipid acyl chain CH2 stretching frequencies. A broad phase transition (confirmed by differential scanning calorimetry) was noted with an onset temperature near 15 degrees C and a completion temperature near 42 degrees C. In addition to the bulk transmission experiments, external reflection infrared spectroscopy was used to examine surfactant films in situ at the air-water interface. As surface pressure was increased from 0 to 43 dyn/cm, a gradual and continuous decrease in the CH2 stretching frequency was noted for the surfactant. Thus, under surface pressures which correspond to large lung volumes in vivo, the surfactant acyl chains exist mostly in the ordered (trans) configuration. The frequency shift in the CH2 stretching mode is consistent with a continuous ordering of the acyl chains upon compression over the pressure range 0-43 dyn/cm, and implies that a weakly cooperative phase transition occurs in the hydrocarbon region of the surface film. The surface film transition is especially noted in the pressure-area curve of the surfactant and approximates in two dimensions the broad thermotropic phase transition of the bulk phase surfactant. Substantial differences were observed between the response to surface pressure changes of intact surfactant compared with the main surfactant phospholipid, 1,2-dipalmitoyl-sn--glycero-3-phosphocholine. The changes in response are attributed to the presence of additional surfactant components. The current work demonstrates the ability of infrared spectroscopy to obtain structural information on the surfactant in physical states that directly relate to those in vivo.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed1989

The relationship of insulin-like growth factor-I to total thyroxine in normal and low birth weight infants.

IGF-I concentrations were determined by RIA in eluates of dried blood collected on filter paper from infants who ranged in age from 3 to 21 d. The infants were separated into normal (greater than 2.5 kg) and low (less than 2.5 kg) birth wt groups and further subdivided on the basis of normal (greater than 83.7 nmol/liter) or low (less than 64.4 nmol/liter) levels of thyroxine. Both the normal and low birth wt groups whose blood thyroxine was in the normal range had similar mean IGF-I values during the 1st wk of life that were significantly higher (p less than 0.05) than those of either the normal or low birth wt groups whose thyroxine concentrations were below normal. Infants older than 1 wk of age with normal birth wt and normal thyroxine levels had significantly greater (p less than 0.05) mean IGF-I values than those of any of the other groups. Infants in the low birth wt-normal thyroxine group exhibited modest increases in IGF-I levels after the 1st wk of life that were significantly greater (p less than 0.05) than those found in the low birth wt-low thyroxine infants. These studies have demonstrated that IGF-I concentration is correlated positively with total thyroxine and with birth wt and that the latter is confounded by the former.

Humans↗
PubMed1988

A technique for monitoring mammalian cell growth and inhibition in situ via Fourier transform infrared spectroscopy.

A single culture of Chinese hamster ovary cells was grown on germanium attenuated total reflectance (ATR) crystals and continuously monitored in situ via ATR/Fourier transform infrared (FT-IR) spectroscopy for approximately 60 h. The cells were seeded into a specially designed flow cell which controlled physiological conditions, flow rate, and addition of growth medium or metabolic inhibitors. Infrared spectra were taken at 20-min intervals until a confluent monolayer was formed. Several strong bands are evident in the spectra which can be generally ascribed to molecular features of cellular components. Cell growth kinetics were measured as a function of infrared band intensity over time and exhibited the normal lag phase, logarithmic growth, and stationary phase on reaching confluence. Spectra of growing cells, normalized to the area under the spectral region 1800-1000 cm-1, were subtracted from reference spectra of confluent cells at 60 h. Difference spectra showed that the largest differences were observed between confluent cells and cells in early growth stages. Differences may reflect cell morphological changes, biochemical activity, and degree of ATR crystal exposure to the bulk medium. ATR/FT-IR spectroscopy of living Chinese hamster ovary cells was also used in a toxicological study to monitor the effects of hydroxyurea, an inhibitor of DNA synthesis. Delayed growth was observed in the cell growth curve of the hydroxyurea-treated cells during the course of treatment as compared to the control culture.

Animals↗