Biomedical subjects

R F Gochman

Publications and source records attributed to R F Gochman.

5 recordsLinked to original sources

PubMed1998

The absolute neutrophil count: is it the best indicator for occult bacteremia in infants?

Occult bacteremia affects approximately 5% of febrile children ages 2 to 36 months. Many physicians empirically treat children who have a temperature higher than 39 degrees C, a white blood cell (WBC) count of more than 15.0 x 10(9)/L, and no focus of infection with antibiotics. We undertook this investigation to better define predictive indicators for bacteremia. Specifically we were concerned with determining whether the absolute neutrophil count (ANC) is a better diagnostic indicator than the total WBC count and whether the manual differential (which includes a band cell count) is necessary or helpful. Three separate groups of patients aged 2 to 36 months were assessed retrospectively. Group A consisted of febrile children (temperature, > 39 degrees C) who had positive blood cultures (50 patients). Group B included febrile children (temperature, > 39 degrees C) who had negative blood cultures (59 patients). Group C, nonfebrile children admitted to the hospital was the control group (61 patients). The ANC and the total WBC count were significantly higher in group A than in group B. Although they were equally sensitive, the ANC was more specific than the total WBC count. Band cell counts of greater than 10% and the percentage of total neutrophils also were greater in group A than in group B. The values for group C were not significantly different from those for group B. Although a total WBC count of 15.0 x 10(9)/L is currently used to identify children at risk for occult bacteremia, the ANC seems to be as sensitive an indicator and may be more specific. Our study demonstrated that (1) the WBC count is a good indicator of occult bacteremia, (2) the ANC is as sensitive as the WBC count and may be more specific, (3) automated ANCs are comparable to manual ANCs, and (4) the band cell count is insensitive as an indicator and does not add any predictive value.

Bacteremia↗

PubMed1994

Albuterol delivered via metered-dose inhaler with spacer for outpatient treatment of young children with wheezing.

OBJECTIVE: To determine the efficacy of albuterol delivered via metered-dose inhaler with spacer for the treatment of wheezing infants. DESIGN AND SETTING: Double-blind, prospective, placebo-controlled, clinical crossover trial undertaken at the emergency department of a university-affiliated children's hospital. PARTICIPANTS: Forty-two patients aged 1 to 18 months presenting to the emergency department with wheezing. INTERVENTION: Subjects were randomly assigned to one of two blinded treatment groups. Group 1 received two albuterol treatments followed by two placebo treatments. Group 2 received two placebo treatments followed by two albuterol treatments. Each treatment consisted of two puffs from a metered-dose inhaler with spacer at 20-minute intervals. MEASUREMENTS/MAIN RESULTS: On enrollment and 20 minutes after each treatment, a clinical assessment was made by the principal investigator, which included heart rate, respiratory rate, pulse oximetry, wheezing score (0 to 3), and retraction score (0 to 3). Both treatment groups had statistically significant improvement in mean wheezing score associated with albuterol therapy (P < .05 using Dunnett's t test). Mean retraction score improved over time in both groups only during drug therapy. However, the improvement of only group 2 reached statistical significance (P < .05 using Dunnett's t test). Scores were then classified as "improved" and "not improved" for analysis with McNemar's test. Group 2 had a statistically significant proportion of patients with improved retraction score related to albuterol therapy. The remaining dichotomized results, while not achieving statistical significance, showed a trend in the direction expected from a beneficial drug effect. CONCLUSIONS: Albuterol delivered by metered-dose inhaler with spacer to wheezing infants aged 1 to 18 months reduces the severity of wheezing and retractions.

Administration, Inhalation↗

PubMed1993

Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient.

OBJECTIVE: To assess the prevalence of laboratory abnormalities (complete blood cell count, electrolytes, blood urea nitrogen, creatinine, glucose, aspartate aminotransferase, alanine aminotransferase, amylase, lipase, urinalysis [U/A]) and the sensitivity and specificity of the physical examination (PE) and screening laboratory tests for identifying intra-abdominal injury (IAI) in moderately injured pediatric patients. DESIGN, PARTICIPANTS, AND SETTING: Phase I: Retrospective chart review of 285 consecutive level II (moderately injured) trauma patients seen at a children's hospital emergency department/pediatric trauma center. All patients were received directly from the scene and had the following data recorded: mechanism of injury, Glasgow coma score, trauma score, pediatric trauma score, systematically recorded PE findings, laboratory results, and injuries detected during hospitalization. Phase II: To confirm the sensitivity of the PE and U/A found in phase I, the model was applied to 91 additional trauma patients identified by International Classification of Diseases, 9th revision (ICD-9) codes as having IAI. INTERVENTION: None. RESULTS: Phase I: A total of 3939 tests were ordered for the 285 patients entered in phase I. Aspartate aminotransferase and alanine aminotransferase values were obtained in 59% of patients; glucose level was obtained in 78% of patients; complete blood cell count, U/A, and levels of electrolytes, blood urea nitrogen, creatinine, amylase, and lipase were obtained in more than 85% of patients. The overall prevalence of laboratory abnormalities was 5.7%. Fourteen patients (4.8%) were identified who had a total of 23 significant IAIs (9 pancreatic, 6 splenic, 5 renal, 3 hepatic). The PE combined with U/A showing more than five red blood cells per high-power field had a sensitivity of 100%, specificity of 64%, positive predictive value of 13%, and negative predictive value of 100% for the detection of IAI. The presence of laboratory abnormalities suggesting injury did not increase the sensitivity of the model and significantly decreased both specificity and positive predictive value. Phase II: The PE combined with U/A identified an abnormality in 89 (97.8%) of 91 cases (95% confidence interval = 94.8% to 100%). CONCLUSIONS: In the moderately injured pediatric trauma patient, (1) there is a low prevalence of laboratory abnormalities; (2) the PE combined with U/A is a highly sensitive screen for IAI; and (3) in patients with a normal PE of the abdomen and a normal U/A, laboratory testing seldom identifies unsuspected IAI.

Abdominal Injuries↗

PubMed1991

Use of portable ultrasound to assist urine collection by suprapubic aspiration.

STUDY OBJECTIVE: To determine whether portable ultrasound can improve the success rate of suprapubic aspiration (SPA). DESIGN: Patients were randomly assigned to either ultrasound or no ultrasound groups. In the ultrasound group, patients underwent SPA if ultrasound revealed urine in the bladder: if no urine was present, patients underwent catheterization instead of SPA. In the no-ultrasound group, SPA was attempted without ultrasound. All unsuccessful SPAs were followed by catheterization and measurement of urine volume. SETTING: Children's hospital-based pediatric emergency department. PARTICIPANTS: Children less than 2 years old who required SPA. INTERVENTIONS: Ultrasound versus no ultrasound. RESULTS: Thirty-five patients were randomized to the ultrasound group, and 31 were randomized to the no-ultrasound group. SPA was successful in 79% of attempts in the ultrasound group compared with 52% in the no-ultrasound group (P = .04). The sensitivity and specificity of ultrasound were 90% and 86%, respectively. CONCLUSION: Portable ultrasound can significantly improve the success rate of SPA and limit nonproductive attempts at SPA.

Cost-Benefit Analysis↗

PubMed1981

Three-dimensional myocardial and ventricular shape: a surface representation.

To date, a detailed three-dimensional (3D) analysis of cardiac shape and size has not been available. Accordingly, we developed a method for such an analysis using sectioned hearts and a computer-based 3D description of the epi- and endocardial surfaces of the left and right ventricles (LV and RV) and the interventricular septum. The accuracy of this analysis as a function of section thickness (hs) was evaluated and reference axes for the LV, RV, and myocardium determined in eight canine hearts. After diastolic arrest, the RV, LV, and their atria were fixed in formaldehyde solution at pressures of 6 and 12 cmH2O, respectively. The hearts were then cast (plastic or gelatin) and sectioned, and the surfaces were digitized. We found that 1) accurate 3D computer reconstructions and computed volumes of the LV, RV, and myocardium were obtained then hs less than or equal to 5 mm, 2) the apex-to-base circumference and cross-sectional area relations could be approximated provided hs less than 10 mm, and 3) the section centers of gravity for the LV, RV, and myocardium defined three distinct vertical lines. Thus, an accurate description of 3D configuration is obtainable by a 5-mm section thickness. The centers of gravity provide a set of geometrical references for the study of shape in normal and diseased hearts.

Animals↗