Growth deficiency: which children are at risk?
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Body Height↗
Biomedical subjects
P Moore
Publications and source records attributed to P Moore.
Preventing the nosocomial transmission of tuberculosis.
OBJECTIVE: To study the efficacy of expanded tuberculosis infection control measures consisting primarily of administrative controls. DESIGN: Descriptive case series. SETTING: University-affiliated, inner-city hospital. INTERVENTIONS: Introduction of expanded tuberculosis infection control measures (including an expanded respiratory isolation policy). MEASUREMENTS: The number of tuberculosis exposure episodes and skin test conversion rates of health care workers were measured before and after implementation of expanded infection control measures. Tuberculosis exposure episodes (the number of patients who were not placed in respiratory isolation at admission but who subsequently had a diagnosis of acid-fast bacilli smear-positive pulmonary tuberculosis during that admission or within 2 weeks of discharge) were compared for two time periods: the 8 months before and the 28 months after implementation of infection control measures. Tuberculin skin test conversion rates among health care workers were evaluated during a 2.5-year period. RESULTS: After expanded infection control measures were implemented, the number of tuberculosis exposure episodes decreased from 4.4 per month (35 episodes among 103 patient admissions for potentially infectious tuberculosis over 8 months) to 0.6 per month (18 episodes among 358 patient admissions for smear-positive pulmonary tuberculosis over 28 months) (odds ratio, 9.72; 95% CI, 4.99 to 19.25 [P < 0.001]). The cumulative number of days per month that potentially infectious patients with tuberculosis were not in isolation decreased from 35.4 to 3.3 (P < 0.001). A concomitant decrease in tuberculin skin test conversion rates in health care workers was seen; 6-month tuberculin skin test conversion rates decreased steadily from 3.3% (118 conversions in 3579 health care workers; 1/92 to 6/92), 1.7%, 1.4%, 0.6%, to 0.4% (23 conversions in 5153 workers [1/94 to 6/94]) (P < 0.001). CONCLUSIONS: Infection control measures effectively prevented nosocomial transmission of tuberculosis to health care workers. Administrative controls appear to be the most important component of a tuberculosis infection control program and should be the first focus of such a program, especially at public hospitals, where resources are most likely to be limited.
Adult↗
Regulation of protein kinase C activity in cerebral microvessels.
Regulation of protein kinase C (PKC)-mediated responses may occur by inhibition of PKC-dependent phosphorylation or by dephosphorylation of targets by specific phosphatases. Mechanisms for the regulation of PKC were examined in isolated cerebral microvessels and compared to those in brain. The data demonstrated that inhibitors of phosphorylation are responsible for the regulation in brain microvessels while dephosphorylation by protein phosphatases accounts for a substantial portion of the regulation of the PKC response in brain. In addition, the inhibitory activity apparently increases with age. These results suggest that the control of PKC may be cell-type specific and developmentally regulated.
Aging↗
The reliability of depression diagnosis in chronic low back pain. A pilot study.
The variability in estimated rates of major depressive disorder (MDD) in chronic pain samples may be accounted for by sample and methodological differences. Most studies rely on a single measure of depression and lack independent or repeated measures. This study investigated the prevalence of psychiatric disorders in a convenience sample of 18 patients disabled by low back pain (LBP) referred to, evaluated, and treated in a comprehensive pain rehabilitation program specifically designed to restore work readiness and return to work. Subjects had one or more spinal conditions, had work-related back pain for more than 6 months (x = 23.8), were Caucasian, predominantly young (x = 37.5) and male (55%), and were disabled on workers' compensation and approved for rehabilitation. The performance of three diagnostic procedures, the Pain Medicine Evaluation, an independent Structured Clinical Interview for DSM-III-R (SCID), and Longitudinal Clinical Diagnosis were compared with the "gold standard" of the Final Diagnosis which incorporated information from the other three. Also, the performance of a questionnaire, The Pain & Mood Structural Interview (PMSI), designed to assess the causal relationship of pain and mood and specifically the confounding effects of physical factors, was examined. Thirteen of 18 patients (72%) were diagnosed with MDD at Final Diagnosis. MDD diagnosis was made on 4 of 18 patients (22%) on the initial Pain Medicine Evaluation and on 9 of 18 patients (50%) on the SCID, with only 1 ruled out by the confounding questionnaire, for a SCID current prevalence of 44%. Both the SCID and Pain Medicine Evaluation accurately diagnosed the MDD cases they identified; 9 of 13 MDD cases (69%) were precipitated by a physical factor other than their pain. Three episodes of MDD were ruled out by confounding. These findings are discussed in relation to their implications for assessing pain patients for psychiatric comorbidity.
Adult↗
Child preferences for post-tonsillectomy diet.
Dietary advice for children who have undergone tonsillectomy and adenoidectomy (T&A) is divergent. We studied dietary preferences in 2 series of children who underwent T&A. The first group of 50 subjects was offered a variety of types of food the morning after surgery and they preferred liquids, followed by soft foods and were least likely to choose rough foods. When only liquids and soft foods were offered to a second group of 50 subjects, less food was wasted compared with the first group. A liquid/soft diet enhances food consumption and should continue to be advocated to facilitate recovery from T&A after surgery.
Adenoidectomy↗
Human plasma DSIP decreases at the initiation of sleep at different circadian times.
Nocturnal plasma delta sleep-inducing peptide-like immunoreactivity (DSIP-LI) was determined serially in seven healthy male subjects. Time courses during nocturnal sleep (2300-0800 h), nocturnal sleep deprivation (2300-0500 h), and morning recovery sleep (0500-0800 h) after sleep deprivation were compared. A significant decrease in plasma DSIP-LI was found at the transition from wakefulness to sleep in both evening sleep (2300 h) and morning recovery sleep (0500 h). Time courses were accompanied by physiological changes in sleep electroencephalographic slow-wave activity, and in plasma concentrations of cortisol and human growth hormone. No sleep stage specificity was found. It is concluded that DSIP is influenced by the initiation of sleep.
Adult↗
Intraaortic spring coil loops: early and late results.
OBJECTIVES: Our aim was to determine the late fate of intraaortic spring coil loops after embolization of aortopulmonary vessels. BACKGROUND: In some aortopulmonary collateral vessels and patent ductus arteriosi, the narrowest segment is close to the aorta; coils used to close such vessels will "straddle" the lesion, allowing one or more coil loops to protrude into the aortic lumen. The consequences of this procedure are unknown. METHODS: We reviewed the cineangiograms of all patients who had at least one aortopulmonary collateral vessel or patent ductus arteriosus closure between January 1, 1988 and August 31, 1993. From this group, 53 patients had multiple-plane angiographic evidence of intraaortic coil loops. All subsequent cineangiograms were reviewed to determine coil position or movement and evidence of recanalization or endothelial coverage of the coil loop. We also reviewed each hospital record or communicated directly with referring physicians to identify any subsequent complications such as emboli or endocarditis. RESULTS: Of the 53 patients with intraaortic coil loops, 49 patients had closure of one or more aortopulmonary collateral vessels (59 vessels), and 4 had closure of a patient ductus arteriosus (4 vessels). Patient follow-up ranged from 1 day to 66 months (median 20 months); follow-up was not available in 6 patients. Five of the 53 patients (9.3%; 95% confidence limits [CL] 3.1% to 20.7%) died at operation or of end-stage heart failure. Patients with late angiography had no residual flow in 31 of 35 aortopulmonary collateral vessels (88.6%; 95% CL 73.3% to 96.8%), and 0.5 mm separated the coil and aortic contrast column in all 12 coils with adequate angiography, suggesting endothelial coverage of the intraaortic coil loop. No episodes of stroke, embolic events, endocarditis or coil migration were reported. CONCLUSIONS: Although coil occlusion of aortopulmonary collateral vessels or patent ductus arteriosi may produce intraaortic coil loops, endothelialization appears routine. No late complications associated with intraaortic coil loops were observed.
Aorta, Thoracic↗
Inhaled nitric oxide and hemodynamic evaluation of patients with pulmonary hypertension before transplantation.
OBJECTIVES: We investigated the effect of inhaled nitric oxide and infused acetylcholine in patients with pulmonary hypertension undergoing cardiac catheterization before cardiopulmonary transplantation. BACKGROUND: The fate of patients under consideration for transplantation of the heart or lungs, or both, is influenced by the evaluation of their pulmonary vascular reactivity. METHODS: We evaluated 11 patients who were classified into two groups on the basis of mean left atrial pressure > 15 mm Hg (group I, n = 6) or < or = 15 mm Hg (group II, n = 5). All patients inhaled nitric oxide at 80 ppm. This was preceded by an infusion of 10(-6) mol/liter of acetylcholine in seven consecutive patients (n = 3 in group I, n = 4 in group II). RESULTS: In group I, inhaled nitric oxide decreased pulmonary artery pressure from (mean +/- SE) 71 +/- 13 to 59 +/- 10 mm Hg (p < 0.05), pulmonary vascular resistance from 14.9 +/- 3.8 to 7.6 +/- 1.7 Um2 (p < 0.05) and intrapulmonary shunt fraction from 17.8 +/- 3.6% to 12.7 +/- 2.1% (p < 0.05). Left atrial pressure tended to increase from 27 +/- 4 to 32 +/- 5 mm Hg (p = 0.07). In group II pulmonary vascular resistance decreased in response to nitric oxide from 36.4 +/- 9.0 to 31.1 +/- 7.9 Um2 (p < 0.05). Cardiac index, systemic pressure and resistance did not change in either group. Seven patients who received acetylcholine had no significant alteration in pulmonary hemodynamic variables. CONCLUSIONS: These preliminary observations suggest that nitric oxide is a potent pulmonary vasodilator with minimal systemic effects. It may be useful in discriminating patients needing combined heart and lung transplantation from those requiring exchange of the heart alone.
Acetylcholine↗
The levoatriocardinal vein: morphology and echocardiographic identification of the pulmonary-systemic connection.
OBJECTIVES: This study considers the array of pulmonary-systemic connections made by the levoatriocardinal vein. The primary and associated lesions that play a role in forming this vein are examined, and echocardiography is discussed as a method for its rapid identification. BACKGROUND: The levoatriocardinal vein is a pulmonary-systemic connection that provides an alternative egress for pulmonary venous blood in left-sided obstructive lesions. It is thought to result from the persistence of anastomotic channels that connect the capillary plexus of the embryonic foregut to the cardinal veins. Only 12 cases of levoatriocardinal vein have been reported since its first description in 1926. A comprehensive description of the morphology and echocardiographic identification of this lesion has been unavailable because of its rarity. METHODS: A retrospective study was performed in 13 patients with a levoatriocardinal vein from the University of California, San Francisco. Echocardiographic findings were compared with those obtained by angiography or at necropsy. In addition, the details of 12 previously published case reports were reviewed. Age at presentation, primary obstruction to pulmonary venous return, integrity of the atrial septum and origin and drainage of the levoatriocardinal vein were compared. RESULTS: Patient age at presentation was < 2 years, with most patients presenting before age 6 months. Variations of the hypoplastic left heart syndrome accounted for the majority of primary defects encountered, although multiple but less severe left-sided lesions were seen. The atrial septum was functionally intact in most patients. The levoatriocardinal vein, defined echocardiographically, originated predominantly from the smooth-walled left atrium and drained to the superior vena cava or innominate vein; however, variations of this pattern existed. CONCLUSIONS: As a physiologic entity, the levoatriocardinal vein provides a mechanism for decompression of pulmonary venous return primarily in patients with left ventricular inflow obstruction. A levoatriocardinal vein is thought to form when the atrial septum fails to provide an alternate egress for left atrial blood. However, when a septal defect or alternative shunt occurs in conjunction with a levoatriocardinal vein, the clinical presentation may be postponed. Echocardiography provides a rapid, noninvasive modality for identifying the pulmonary-systemic connection, which may masquerade as the vertical vein in anomalous pulmonary venous connection or act as an occult source of left to right shunting in patients undergoing surgery for hypoplastic left heart syndrome.
Coronary Circulation↗
Variability of the relative afferent pupillary defect.
PURPOSE: Afferent asymmetry of visual function is detectable in both normal and pathologic conditions. With a computerized test, we assessed the variability in measuring afferent asymmetry of the pupillary light reflex, that is, the relative afferent pupillary defect. METHODS: In ten normal subjects, pupillary responses to an alternating light stimulus were recorded with computerized infrared pupillography. The relative afferent pupillary defect for each test was determined by using a new computer analysis. The 95% confidence interval of each determination of relative afferent pupillary defect was used to represent the short-term fluctuation in its measurement. To optimize the test for clinical use, we studied the influence of stimulus intensity, duration, and number on the variability of the relative afferent pupillary defect. RESULTS: When the relative afferent pupillary defect was based on only a few light alternations (stimulus pairs), there was excessive variability in its measurement (95% confidence interval > 0.5 log units). With approximately 200 stimulus pairs, the 95% confidence interval was reduced to less than 0.1 log unit (relative afferent pupillary defect +/- 0.05 log unit). Also, there was less variability when the dark interval between alternating light stimulation was less than one second. CONCLUSIONS: Computerized infrared pupillography can standardize the alternating light test and minimize the error in quantifying a relative afferent pupillary defect. A reproducible relative afferent pupillary defect measurement is desirable for defining afferent injury and following the course of disease.
Adult↗
Non-epileptic attack disorders in children and adolescents: a single case study.
Previous research into non-epileptic attack disorder (NEAD) has focused on the individual. We report a teenager with non-epileptic seizures which highlights the importance of the family in the development and maintenance of such attacks. The authors propose that in children and adolescents the focus of therapeutic intervention should be the individual within the context of the family.
Adolescent↗
Leptomeningeal dissemination of malignant glioma simulating cerebral vasculitis. Case report with angiographic and pathological studies.
BACKGROUND: The complex clinical and radiological picture of leptomeningeal spread of tumor is well recognized as a problem of systemic cancer but is less frequent in primary cerebral glioma, particularly as a presenting picture. While brain ischemia and infarction may occur in patients with subarachnoid tumor, the mechanism for these complications remains unclear. Angiographic and pathological demonstrations of direct vascular involvement by disseminated glioma are particularly sparse. We report a patient presenting with multiple infarctlike lesions with postmortem evidence of direct vascular involvement by glioma. CASE DESCRIPTION: A 54-year-old woman presenting with seizures, headache, and changes in mental status was found to have vascular narrowing in cerebral blood vessels and ischemic lesions on neuroimaging studies of the brain, interpreted as cerebral vasculitis. A brain biopsy showed leptomeningeal glioma. Postmortem examination demonstrated a glioblastoma arising around the right sylvian fissure with extensive subarachnoid dissemination of tumor. The leptomeningeal tumor caused vascular narrowing by encasement, direct vascular wall invasion, and thrombosis and was associated with underlying infarctlike foci of parenchymal necrosis. CONCLUSIONS: This case demonstrates an unusual presentation of glioblastoma clinically and radiographically mimicking cerebral vasculitis, and it illustrates a variety of mechanisms for tumor-produced vascular compromise.
Cerebral Angiography↗
Constant observation: implications for nursing practice.
1. Constant observation is an increased level of observation and supervision in which continuous one-to-one monitoring techniques are utilized to assure the safety and well-being of an individual patient or others in the patient care environment. 2. Individuals who provide constant observation vary widely among health care facilities; but ultimately are the responsibility of the registered nurse. There are many areas that must be addressed by institutions when considering the use or implementation of constant observation. These include: measuring the associated costs, risk management, role development, orientation of employees, and performance evaluation. 3. The changing health care environment and public concern over the quality of health care and risk management require nursing administrators to consider risk-benefit and cost-benefit analyses related to constant observation. There is continued need for protocol and policy development, as well as for guidelines and orientation of staff regarding constant observation.
Cost-Benefit Analysis↗
Binding of fosphenytoin, phosphate ester pro drug of phenytoin, to human serum proteins and competitive binding with carbamazepine, diazepam, phenobarbital, phenylbutazone, phenytoin, valproic acid or warfarin.
The protein binding of [14C]fosphenytoin, (3-phosphoryloxy-methyl phenytoin disodium), a phosphate ester prodrug of phenytoin sodium, to human serum proteins, serum albumin and alpha 1-acid glycoprotein was determined by ultrafiltration. The mean +/- SD% of fosphenytoin bound to human serum proteins was 95.7 +/- 0.48%. Binding to albumin (36.5 mg/ml) decreased linearly from 89.2 to 67.3% when the fosphenytoin concentration was increased from 6 to 200 micrograms/ml. Fosphenytoin was weakly bound to alpha 1-acid glycoprotein (13.3%). Simultaneous incubation with high concentrations of carbamazepine (10 micrograms/ml) and diazepam (5 micrograms/ml) or therapeutic concentrations of phenytoin (10 micrograms/ml) had no effect on the binding of fosphenytoin to human serum proteins. High concentrations of phenobarbital (160 micrograms/ml), phenytoin (50 micrograms/ml), or valproic acid (500 micrograms/ml), however, caused slight, but significant, increases in the free fraction of fosphenytoin in serum protein. Phenylbutazone and sulfisoxazole resulted in a 48% increase in fosphenytoin free fraction while warfarin had a slight (8%), but significant, increase in free fraction of fosphenytoin. It was concluded that the concentration of albumin was the most important determinant for the plasma free fraction of fosphenytoin in man. Potential increase in fosphenytoin clearance may be observed in hypoalbuminemia.
Adult↗
Patients presenting with pruritus.
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Age Factors↗
[Development and validation of a survey for evaluation of the satisfaction of patients with medical consultation in primary care clinics].
The aim of this work was to devise, and assess the reliability, of an instrument to measure satisfaction with medical consultation of primary care urban patients at public outpatient clinics. A model was elaborated, based on data collected from the literature and from focal groups of patients and physicians, and an enquiry was developed and applied at four outpatient clinics. Fifty enquiries were obtained and analyzed to discard questions of difficult understanding. Next, a second self administered questionnaire and with fewer questions was devised. Its reliability was assessed in 53 enquiries, obtaining a Cronbach's a of 0.904. Questions that decreased consistency were discarded, finally obtaining a self administered instrument with 22 questions. This enquiry was used in 174 patients. Results were subjected to factorial analysis with varimax rotation, which separated three factors that explain 64% of the variance. It is concluded that a valid and reliable instrument was obtained.
Adolescent↗
Use of perinatal and infant health services by Mexican-American Medicaid enrollees.
OBJECTIVES: Lack of health insurance and a regular source of medical care are barriers affecting use of health services by Mexican Americans. We studied perinatal and infant health service use by Mexican-American women and non-Hispanic white women and their infants enrolled in Arizona's Medicaid program and explored characteristics associated with use of health services. DESIGN: A descriptive comparative study that used data collected from office records, birth certificates, and household interviews. SETTING: Participants resided in the state's most populous county and were enrolled in the Arizona Health Care Cost Containment System, a health maintenance organization-oriented Medicaid demonstration project. SUBJECTS: Random sample of 308 Mexican-American mother-infant dyads and 312 non-Hispanic white mother-infant dyads. The women were enrolled before the sixth month of pregnancy and for 60 days post partum; their infants were continuously enrolled throughout their first year. OUTCOME MEASURES: Timing and number of prenatal visits and a modified Kessner Index, postpartum visits, number and purpose of office visits during the infants' first year, and immunizations received. RESULTS: Mexican Americans averaged fewer prenatal visits than non-Hispanic whites (8.6 vs 10.2 visits) and were less likely to have "adequate" care (41.1% vs 52.8%). Both groups of mothers are well below the 68% of women nationally who receive adequate prenatal care. Controlling for important socioeconomic status and cultural characteristics, ethnicity had a strong independent effect on the number of prenatal visits and adequacy of prenatal care. Mexican-American infants made fewer visits (8.2 vs 9.8) and completed fewer age-appropriate immunizations than non-Hispanic whites. CONCLUSIONS: Health insurance and a regular source of care are insufficient conditions for ensuring adequate use of maternal and child health services by Mexican-American Medicaid enrollees. Factors associated with their less frequent use of these preventive health services include higher numbers of children, transportation problems, and less assistance from their support system.
Acculturation↗
Scalp-ear-nipple syndrome: additional manifestations.
Scalp-ear-nipple (SEN) syndrome is a rare, autosomal dominant condition that causes aplasia cutis congenita of the scalp, alteration of the shape of the external ear, and hypoplasia of the nipple. Women in a new family, the fifth to be described, had virtually complete aplasia of the breast and a small skin dimple without any pigmentation instead of a normal nipple, although other affected women had normal breast and nipple development. Dental changes included widely spaced or missing secondary teeth; the ears were cupped or folded and stood out from the head, axillary apocrine secretion and axillary hair growth were reduced; and finger nails were brittle. There was no generalized abnormality of sweating. Some patients had partial syndactyly of the 3rd and 4th fingers, and complete cutaneous syndactyly of the 2nd and 3rd toes. and 3rd toes.
Abnormalities, Multiple↗