Biomedical subjects

M Reynolds

Publications and source records attributed to M Reynolds.

At least 73 records · Page 4Linked to original sources

PubMed1994

Eikenella corrodens endocarditis in an intravenous drug user: case report and literature review.

A rare case of Eikenella corrodens endocarditis in an intravenous drug user is reported. Repeated blood cultures from the patient established the diagnosis of this infection. However, evaluation of the cardiac function using two-dimensional echocardiography with Doppler flow demonstrated a large pedunculated tricuspid vegetation. Also evident on this study was a dilated right ventricle with diminished contractility and regurgitation. Complete sterilization of the blood was achieved after a 2-week course of intravenous penicillin and gentamicin followed by an additional 4-week course of intravenous penicillin alone. Clinicians treating suspected IV drug users should be aware of the potential pathogenicity of this rare, facultative, anaerobic gram-negative bacillus (E corrodens). A combination of intravenous penicillin and aminoglycoside should be considered as the initial treatment followed by an additional course of intravenous penicillin for such patients with valvular vegetation.

Adult↗

PubMed1993

Pulmonary changes following extracorporeal membrane oxygenation: autopsy study of 23 cases.

Extracorporeal membrane oxygenation (ECMO) has become an established mode of therapy in many centers for potentially fatal neonatal respiratory failure refractory to conventional therapy. We reviewed the findings of 23 autopsies of patients placed on ECMO therapy during the period from 1988 to 1992 at our institution in order to document the pulmonary histopathologic changes and to correlate such changes with the duration of treatment. Interstitial and intra-alveolar hemorrhages, as well as hyaline membrane formation, were the most common findings during the first few days of therapy. Reactive epithelial hyperplasia (bronchial and type II pneumocytes), squamous metaplasia, and smooth muscle hyperplasia were observed as early as 2 to 3 days after initiation of ECMO therapy. Interstitial fibrosis was noted only after 7 days of ECMO therapy. In three patients treated for 15, 19, and 21 days there was replacement of the terminal airways and alveoli by tall columnar and mucin-producing epithelium. Alveolar and bronchiolar calcifications were noted in seven of the 23 cases in this series. Pulmonary vascular changes were seen in association with persistent fetal circulation, meconium aspiration, and respiratory distress syndrome. These changes are most likely due to the compounded effect of ECMO and the underlying pulmonary insult.

Cadaver↗

PubMed1993

A 25-year experience with renal tumors of childhood.

A retrospective analysis of the medical records of 234 children with renal tumors managed over a 25-year period at the Children's Memorial Medical Center was undertaken to evaluate long-term morbidity and mortality. There was a significant increase in survival over the years of the study. The 5-year survival for patients treated during the period 1985 to 1989 was 94% versus 68% for the period 1965 to 1969. Thirty-three children have died, 15 with known disease progression. Long-term morbidity included scoliosis (39), cardiorespiratory insufficiency (13), hypertension (7), renal insufficiency (7), small bowel obstruction (10), chest wall deformity (3), amenorrhea (1), leg length discrepancy (1), and 1 patient with an esophageal stricture. One patient with cardiomyopathy secondary to adriamycin has recently undergone cardiac transplantation. Five patients with renal insufficiency have required dialysis. Of these five, one patient has had two renal transplants. The presence of distant metastases and positive hilar or regional lymph nodes were the only findings at operation that were associated with an increased mortality (P = .005). There was a significantly increased mortality in those children operated on by general surgeons or urologists at other hospitals (11/43) versus those operated upon at our hospital (22/191) (P = .033). There was no statistical difference in the staging or histology among these children. We feel that the careful and systematic approach of a radical nephrectomy assures accurate staging of the tumor removing gross and microscopic disease in the abdomen.

Cause of Death↗

PubMed1993

Cisplatin, vincristine, and fluorouracil therapy for hepatoblastoma: a Pediatric Oncology Group study.

PURPOSE: To estimate the disease-free survival rate in children with grossly resected hepatoblastoma treated with cisplatin, vincristine, and fluorouracil (CDDP/VCR/FU) and to assess the disease-response rate and disease-free survival (DFS) rate in children with unresectable or metastatic tumors treated with this combination. PATIENTS AND METHODS: Sixty assessable patients with hepatoblastoma received therapy with five (stage I and II) to seven (stage III and IV) courses of CDDP (90 mg/m2), day 1, and VCR (1.5 mg/m2), and FU (600 mg/m2), day 3. RESULTS: Nineteen of 21 patients with stage I or II disease survive free of disease (actuarial survival, 90% at 5 years). Twenty-four of 31 patients with stage III disease achieved a complete remission (CR) after chemotherapy and surgical excision; actuarial DFS at 4 years is 67%. Only one of eight patients with stage IV disease achieved a remission and survives. CONCLUSION: Relatively brief exposure to chemotherapy with CDDP/VCR/FU provided excellent disease control to patients with grossly resected tumors. In patients with initially unresectable disease, this therapy provides a response rate and DFS rate comparable to regimens that contain doxorubicin (DOX).

Actuarial Analysis↗

PubMed1993

Coagulase-negative staphylococci in conjunctivitis and blepharitis.

Coagulase-negative staphylococcus (C-NS) are regarded as normal flora of the lids and conjunctiva. The ability of these organisms to cause conjunctivitis and blepharitis can be overlooked or disregarded. To elucidate the role of individual C-NS species in these eye diseases we compared Staphylococcus sp. isolated from the conjunctiva and lids of 50 healthy volunteers with 248 strains of Staphylococcus isolated from patients with staphylococcal conjunctivitis or blepharitis. S. epidermidis was the most frequent species isolated from the conjunctiva and lids of both groups. S. aureus was isolated only from infected patients. No individual C-NS species was found to be significantly associated with eye disease, but the colony count of C-NS after isolation was a useful indicator of conjunctivitis and blepharitis. The ability of Staphylococcus to ferment mannitol or mannose was associated with isolates only from infected patients.

Blepharitis↗

PubMed1993

Effect of intravenous erythromycin on postoperative ileus.

We attempted to determine whether the administration of erythromycin shortens the period of postoperative ileus by a prospective, double-blind, placebo-controlled study. Seventy-seven patients were randomized and included in the statistical calculations. The patients were stratified according to the operation performed (cholecystectomy, celiotomy, or other major abdominal operations). Forty-one patients (group 1) received 250 mg erythromycin intravenously every 8 h for nine doses upon admission to the recovery room. Thirty-six patients (group 2) received placebo. The time (in hours) to first passage of flatus, first liquid meal, first bowel movement, and total length of hospital stay was recorded. There was no significant difference between group 1 and group 2 in time to first flatus (54.9 +/- 29 vs. 53.9 +/- 27 h, respectively), first meal (70.4 +/- 44 vs. 71.7 +/- 65), first bowel movement (81.8 +/- 32 vs. 80.1 +/- 28), or length of hospital stay (185.2 +/- 183 vs. 182.1 +/- 163). Erythromycin, in the dosage tested in this study, does not seem to alter clinical parameters of gastrointestinal motility after an abdominal operation. New prokinetic agents may deserve further studies.

Abdomen↗

PubMed1992

Comparison of positive and negative intrusive thoughts and experimental investigation of the differential effects of mood.

The similarity between positive and negative intrusive thoughts is considered for both recently occurring, personally relevant intrusions and for the same intrusions occurring during an experimental task involving self-monitoring. The results indicate that positive and negative intrusions differ in most respects. There was evidence that increasing the frequency of negative thinking is associated with a deterioration of mood. In a subsequent experiment, induced happy and sad moods were shown to differentially affect frequency of intrusions in a fashion consistent with mood congruency effects previously found in experiments on the effect of mood on memory. The implications of these findings for disorders involving the experience of intrusive thoughts such as OCD and depression are discussed.

Adaptation, Psychological↗

PubMed1992

Chemotherapy can convert unresectable hepatoblastoma.

The surgical evaluation and management of children with hepatoblastoma has changed with recent advances in imaging modalities and preoperative chemotherapy. Pediatric Oncology Group (POG) Study no. 8697 has followed 63 patients with hepatoblastoma from 1986 to 1991. Twenty-six patients underwent primary tumor resection followed by chemotherapy consisting of cisplatin, vincristine, and 5-fluorouracil (group I). Thirty-seven patients with "unresectable" tumors received preoperative chemotherapy. Twenty-nine of these patients responded to chemotherapy and 26 underwent delayed surgical resection (group II). Eight patients had an inadequate response to chemotherapy; two have had successful liver transplantation and six are dead of disease progression. "Unresectable tumor" involved both liver lobes (25 patients), encased the inferior vena cava (2), involved adjacent tissues (1), involved the hepatic veins (2), or was deemed too large for safe resection (7). Two patients had distant metastases. The reason for an unresectable designation was not reported in five patients. The determination for an unresectable designation included exploratory laparotomy in 14 patients, angiogram in 7, computed tomography scan in 20, and magnetic resonance imaging in 3 patients. Operative times and transfusion requirements were similar in both groups. Perioperative complications were higher in patients in group II. There was no mortality and only minor morbidity associated with chemotherapy in each group. In both groups 77% of the patients are in complete remission after 13 to 54 months. Preoperative chemotherapy can allow successful resection of initially "unresectable" hepatoblastoma. Primary resection that may result in exsanguination should be postponed and chemotherapy given.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

Morbidity associated with total colon Hirschsprung's disease.

Increased awareness of total colon Hirschsprung's disease (TCH) has led to improvement in patient care and a decrease in the associated mortality. Morbidity has remained high and necessitates close follow-up to prevent the development of life-threatening complications. We retrospectively reviewed the records of 20 children with TCH treated at this institution since 1961. Follow-up averaged 40.4 months (range, 1 to 150). All patients were diverted with an ileostomy or jejunostomy. Eight children had a Swenson pull-through, three had a Martin procedure, and eight had a Kimura procedure. One child with multiple anomalies died after his ileostomy. There were no postoperative deaths. Complications following ileostomy and pull-through procedures included excessive fluid losses, wound infections, stoma problems, and bouts of enterocolitis. Three children had no reported complications. Seventeen complications were reported in eight children with the Kimura procedure, 10 in the three children with the Martin procedure, and 22 in the eight children with the Swenson procedure. These complications resulted in an average of 4.4 admissions per patient (range, 1 to 11) with an average length of stay of 96 days per patient (range, 10 to 598). Twelve patients required an average of 63 days of total parenteral nutrition and eight needed 328 days (range, 23 to 867) of supplemental nasogastric feedings. Ten patients required at-home rectal irrigations and seven patients required rectal dilations. Nearly half of all patients were kept on antimotility agents long term. Since 1985 we have performed the Kimura procedure for all children with TCH and have seen a decrease in morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1992

Choledochal duct cyst: resection with physiologic reconstruction.

BACKGROUND: The accepted surgical treatment of choledochal duct cyst is complete excision and enteric drainage through an intestinal conduit. Peptic ulceration and fat malabsorption have been reported after Roux-en-Y reconstruction. Such long-term complications may be avoided by a technique that simulates normal physiology. METHODS: Twenty-one patients have undergone resection of a choledochal duct cyst in the past 12 1/2 years. The pathologic duct is resected to the level of normal mucosa. A short segment of jejunum with a intussusception valve (1.5 to 2 cm) is interposed between the common hepatic duct and the duodenum. The medical records and all radiographs of each patient were reviewed. Eighteen children were reexamined or the parents were contacted by phone. RESULTS: Twenty of 21 patients recovered without major perioperative complications. Twelve of them are well and have no symptoms at 3 to 12+ years (mean, 6 years) after operation. Four children are currently well 6 to 19 months after operation. Three children were well when lost to follow-up. Two patients have radiographic evidence of incompetence of the interposition valve. One of these, who initially underwent operation at 9 months of age, was reexplored at 10 months and at 10 years for a stricture at the hepaticojejunal anastomosis. The other, a 7-year-old girl who was admitted with jaundice and pancreatitis, has had episodic abdominal pain for 7 years after operation but is well. CONCLUSIONS: The valved jejunal interposition hepaticoduodenostomy offers superior biliary reconstruction after excision of a choledochal duct cyst. Normal physiology is simulated, with bile draining directly into the duodenum. A short conduit prevents stasis, and biliary reflux is minimized with the addition of an intussusception valve.

Child↗

PubMed1992

The nuts and bolts of organizing and initiating a pediatric transport team. The Sutter Memorial experience.

Specialized interfacility transport teams are capable of delivering critical care medicine to the patient at the referring hospital and while en route to the tertiary care center. To do so effectively, however, requires adequate financial and human resources; management of equipment, supplies and personnel; ongoing education for transport team members; and an aggressive quality assurance program. Team members and team management should always be prepared for worst-case scenarios, and develop a method for problem resolution as troublesome issues arise. The ultimate goal of serving the needs of the critically ill child can be consistently met only if there is a high level of commitment of all involved--from the hospital administrator and medical director to the transport coordinator and team members.

California↗

PubMed1991

The relationship among guilt, dysphoria, anxiety and obsessions in a normal population--an attempted replication.

The results of a previous study indicated that guilt as rated on the Perceived Guilt Index (PGI), predicted unpleasant intrusive thoughts, but self-reported anxiety and depression did not. In the present investigation, subjects indicated whether or not they experienced both pleasant and unpleasant intrusive thoughts, their frequency and a rating of how pleasant or unpleasant these thoughts were. They also completed self report ratings of depression, anxiety, obsessional ritualizing, and the PGI. Results of a regression analysis indicate that the best standardised questionnaire predictor of unpleasant intrusive thoughts is depression as rated on the BDI, and anxiety as rated on the BAI. The best standardised questionnaire predictor of pleasant intrusive thoughts is low anxiety. The PGI does not independently predict pleasant or unpleasant intrusive thoughts.

Adolescent↗

PubMed1991

The impact of level 1 pediatric trauma center designation on demographics and financial reimbursement.

A retrospective analysis of medical and financial records of trauma patients admitted over a 4-year period was undertaken to determine the impact of level 1 pediatric trauma center designation on demographics and financial reimbursement. Three hundred fifty-four patients were admitted from November 1, 1985, to October 31, 1986 (Prelevel 1 designation [PREL1]). Five hundred seven patients were admitted from November 1, 1986, to October 31, 1987 (Postlevel 1 designation [PostL1]) (P less than .005). Mechanisms of injury were similar in both groups, with falls being most prevelant (PreL1, 50.8%; PostL1, 43.4%). The magnitude of injuries in the PostL1 period, as expressed by Pediatric Trauma Scores and Injury Severity Scores, did not change significantly. The types of injuries, as indicated by organ systems involved, did not change. The exception was thoracic injuries, which increased from 1.7% to 4.5% (P = .037). Total hospital charges per patient increased ($5,820 PreL1; $7,691 PostL1) (P = .034). Collection rates did not change (77.6% PreL1; 76.4% PostL1). The institution incurred a financial loss per patient of $1,149 PreL1 and $1,795 PostL1 (P = .055). Years 2 and 3 PostL1 designation were analyzed to identify trends (year 2 PostL1: November 1, 1987 to October 31, 1988 [488 patients]; year 3 PostL1: November 1, 1988 to October 31, 1989 [459 patients]). The distribution of Pediatric Trauma Scores and Injury Severity Scores did not change. Total hospital charges per patient remained fairly constant ($8,082 year 2 PostL1; $7,276 year 3 PostL1). Unreimbursed costs increased significantly compared with losses during the PostL1 period ($4,262 year 2 PostL1, P less than .005; $2,799 year 3 PostL1, P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)

Chicago↗

PubMed1991

Graft-versus-host disease following ECMO.

Since 1973, over 3,000 newborns have been treated worldwide for respiratory failure with extracorporeal membrane oxygenation (ECMO). ECMO requires transfusion of numerous blood products including platelets and packed red blood cells. Transfusion-associated graft-versus-host disease (GVHD) developed in one of the authors' patients following treatment with ECMO. ECMO exposes newborn infants to a large number of blood components. Although a rare complication, GVHD can be prevented by irradiating blood products prior to transfusion. We now irradiate all blood products prior to use during ECMO and recommend that other institutions do the same.

Extracorporeal Membrane Oxygenation↗

PubMed1991

Necrotizing enterocolitis following intrauterine blood transfusion.

Intravascular intrauterine transfusion allows a more sophisticated and exact approach to the management of severe Rh hemolytic disease. This technique involves direct manipulation of the fetal umbilical vessels; its hazards include umbilical cord trauma and thrombosis or emboli. The consequences of such events in utero are largely unknown. In this case necrotizing enterocolitis occurred in a full-term infant after three intrauterine intravascular transfusions.

Blood Transfusion, Intrauterine↗

PubMed1991

Pediatric falls from heights.

Injuries resulting from falls from heights still constitute a significant portion of urban trauma. At this pediatric trauma center, 70 children were admitted from 1985 to 1988 after sustaining a fall of 10 feet or greater or at least one story. The mean patient age was 5 years and 68% of the patients were boys. Seventy-eight percent of falls occurred from 2 stories or less and usually took place at or near the home. Most patients sustained a single major injury and all survived. The majority of injuries involved the head or skeleton and residual functional deficits were uncommon. The incidence of falls from heights has remained high in urban areas despite public education and building codes that require window guards and safety rails.

Accidental Falls↗

PubMed1991

Goldmann tonometry and fluorescein solution: a way to avoid contact lens staining.

Topical instillation of fluorescein during standard Goldmann tonometry may cause subsequent contact lens staining. We evaluated a method of Goldmann tonometry that uses only a small amount of fluorescein. In this experimental technique, the fluorescein is applied only to the tip of the applanation cone with fluorescein-coated tissue paper. Thirty patients had their intraocular pressures (IOPs) determined by this method. The IOP measurements were then repeated on the same eyes after instillation of fluorescein directly onto their eyes. In addition, 20 soft contact lens wearers had their IOPs determined by the experimental method, with contact lenses fitted immediately after the measurements. There was no statistically significant difference between the IOPs measured by the standard technique and by the experimental method. In addition, no fluorescein staining was detected in the 20 soft contact lenses examined. Our results suggest that the proposed method is accurate and useful in determining IOP prior to soft contact lens fitting.

Contact Lenses, Hydrophilic↗

PubMed1990

Increased nerve growth factor receptor mRNA in contused rat spinal cord.

Peripheral nerve injury induces the expression of nerve growth factor receptor (NGFR). To determine whether a similar induction results from injury of the spinal cord, NGFR mRNA content was determined using Northern blot hybridization analysis of total RNA from spinal cords of rats contused in the mid-thoracic region. By four days after contusion NGFR mRNA was significantly increased in the thoracic segments that included the injury site. The induction was maximal at 7 days, about 5- to 7-fold the level of uninjured controls, and remained 4 times higher than controls at 14 and 28 days after injury. These results suggest that axotomy in the CNS may also trigger the molecular mechanism(s) leading to up-regulation of NGFR expression.

Animals↗