Biomedical subjects
Publications and source records attributed to R J Yetman.
Glass-mercury rectal temperatures were compared with aural temperatures ("rectal equivalent" mode) in 234 children from birth to age 36 months. Sixty-two percent of measurements were divergent by at least 0.3 degrees C, 35% by greater than 0.6 degrees C. The aural infrared thermometer cannot be recommended for these ages; measurements were unacceptably inaccurate.
Blood pressure (BP) and heart rate (HR) data were collected over 24 h with an ambulatory BP monitor to (a) determine the existence of 12-, 24-, and combined 12- and 24-h BP patterns in children as previously noted for adults; (b) provide MESOR (an acronym for midline estimating statistics of rhythm), amplitude, and acrophase data for subgroups of students by race and gender; and (c) determine the influence of HR (as an estimate of activity) on BP and BP patterns for 100 normal, healthy students 9-12 years of age. We found no statistically significant differences between various racial groups or between gender for MESOR, amplitude, acrophase, or degree of sinusoidality of circadian rhythmicity (R2 values) for BP; clinically interesting differences were observed, including lower MESOR BPs in Hispanic males when compared with their female counterparts and slightly higher MESOR BPs in blacks of both genders when compared with whites. In addition, we demonstrated subgroups of students who exhibited specific 24-h and combined 12- and 24-h patterns. Also, 67% of subjects showed stable or nonrhythmic BP patterns, perhaps related to BP sampling intervals. Differences in HR, as a surrogate measure of activity, accounted for 56% of the variation in systolic BP but only 26% in diastolic BP over the 24 h.
To provide an objective measure of the effects of on-call stress on the blood pressure (BP) of a group of pediatric residents, we used a SpaceLabs Ambulatory Blood Pressure Monitor (ABPM) to compare 37 pediatric residents' on- and off-call BPs. Residents wore the ABPM for 24 h (once on call and again off call) to assess systolic and diastolic BPs every 30 min during the day and hourly overnight. We found significantly higher MESOR (an acronym for midline estimating statistic of rhythm, which yields a mean value more representative of the true mean than an average of a series of measurements) BPs and BP loads (%BP readings > 135 mm Hg for systolic and/or 85 mm Hg diastolic) during the on-call period. Some residents became hypertensive on call, and the normal 24-h pattern of lower nighttime blood pressures was altered during this period. ABPM monitoring may prove useful in evaluating the effectiveness of interventions to reduce the stress of residency training.
OBJECTIVE: To compare temperatures obtained with glass-mercury axillary and aural infrared thermometers with temperatures obtained with glass-mercury rectal thermometers. DESIGN: Blind comparison with criterion standard. SETTING: Well-baby nursery at a private teaching hospital. PATIENTS: Convenience sampling of 200 term newborn infants. INTERVENTION: Temperatures were measured simultaneously with glass-mercury rectal and axillary thermometers for a 3-minute period by one investigator. In a blinded fashion, a second investigator obtained three aural temperatures by using two tympanic membrane thermometers. One tympanic membrane reported infants' rectal-equivalent temperatures, and a second reported oral equivalent temperatures. RESULTS: Temperatures obtained with glass-mercury rectal and axillary thermometers for the population were similar (37 degrees +/- 0.4 degree C vs 36.8 degrees +/- 0.3 degrees C, respectively), but 25% of measurements at these two sites differed by > 0.3 degree C. Oral-equivalent tympanic membrane temperatures were more accurate than rectal-equivalent temperatures in predicting an infant's glass-mercury axillary and rectal temperatures (75% of oral-equivalent temperatures vs fewer than 50% of rectal-equivalent temperatures were within 0.3 degree C of either glass-mercury rectal or axillary measurements). CONCLUSIONS: Temperatures obtained with glass-mercury axillary and rectal thermometers are similar in most cases. However, temperatures obtained with tympanic membrane thermometers either in the rectal-equivalent mode or in the oral-equivalent mode did not accurately reflect an infant's rectal or axillary temperature. We believe that tympanic membrane temperatures should not be substituted for rectal or axillary temperatures in assessments of newborn infants.
Intraoral free musculocutaneous flaps can be bulky and inflexible for reconstruction of mucosal and soft-tissue defects to the head and neck. Free muscle flaps alone can be much less bulky and restore better contour than musculocutaneous flaps. When using free muscle flaps, however, it was felt that a skin graft was needed for proper epithelialization without significant contracture. Nine patients, average age 59 years (range 42 to 71 years), six males and three females, underwent extirpation of head and neck tumors and reconstruction with free muscle flaps only. Mucosal defects from 4 x 4 to 12 x 10 cm (four floor of mouth, five hard palate) were filled. Reconstruction was done with seven free rectus abdominis muscle flaps and two internal oblique/iliac bone flaps. All flaps survived with no significant complications. There was one minor abdominal wound separation. All patients who were able to swallow started oral feedings by 2 weeks postoperatively. Total epithelialization of even the large defects was completed by 8 weeks. Histologic assessment revealed an early fibrin layer over the muscle at 1 week with eventual epithelialization that was indistinguishable microscopically from normal surrounding mucosa. There was some contracture in all the flaps, but this was not clinically significant, even in the large defects. Intraoral free muscle flaps offer a safe and reliable reconstructive method that has led to a good functional result.
Cost containment measures have reduced dramatically the length of stay for normal newborns, in some cases jeopardizing the ability to obtain appropriate newborn screens. In our hospital, we found that an unacceptable number of patients had mistakenly been screened before 24 hours of age. As pressures to shorten hospitalization increase, health-care providers must examine the impact of such changes on their ability to obtain adequate newborn screens. Potential solutions include continued vigilance in gathering specimens after 24 hours of age, interpretation of time-sensitive tests in an age-adjusted manner, and repeating newborn screens after 24 hours of age.
The use of weights is an increasingly popular conditioning technique, competitive sport and recreational activity among children, adolescents and young adults. Weight-training can cause significant musculoskeletal injuries such as fractures, dislocations, spondylolysis, spondylolisthesis, intervertebral disk herniation, and meniscal injuries of the knee. Although injuries can occur during the use of weight machines, most apparently happen during the aggressive use of free weights. Prepubescent and older athletes who are well trained and supervised appear to have low injury rates in strength training programmes. Good coaching and proper weightlifting techniques and other injury prevention methods are likely to minimise the number of musculoskeletal problems caused by weight-training.
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OBJECTIVES: To determine whether the use of an ambulatory blood pressure monitor (ABPM) is feasible and gives accurate readings in children, and to provide data on normal daily blood pressures (BPs) and BP patterns in children. DESIGN: Cohort. SUBJECTS: Ninety-nine healthy fifth-grade students. INTERVENTIONS: Students wore an ABPM for 24 hours while recording their activities in diaries. Before and after the study period, each subject had three BPs simultaneously measured with the ABPM and a mercury manometer to assess the accuracy of the ABPM. An activity scale was retrospectively applied to diary entries to help explain the variety of BP patterns noted during data analysis. RESULTS: Systolic BPs obtained with the ABPM at the beginning and end of the study were slightly higher than those obtained with a mercury manometer; diastolic BPs were virtually identical. A circadian pattern of BPs was noted: mean systolic and diastolic BPs were higher during the day than at night. The BP patterns ranged from "hypoactive" (little baseline variation) to "hyperactive" (wide fluctuations with spikes to elevated BP ranges) during various activities. In general, higher BPs were noted at times of increased activity or emotional levels. CONCLUSIONS: Ambulatory BP monitoring was well tolerated, and measurements were reproducible and accurate. The variety of BP measurements noted at different activity levels indicate that a child's activity should be considered during data analysis. As further experience is gained, the ABPM should prove helpful in diagnosis and management of hypertension in children.
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Ten patients with dermatofibrosarcoma protuberans, all of whom had been treated previously by conventional excisional surgery without success, were treated with Mohs micrographic surgery. A team approach utilizing margin control by Mohs-trained physicians and reconstruction by surgical specialists was employed. Average follow-up exceeds 3 1/2 years, with no recurrences. Microscopically controlled excision appears to be the treatment of choice for dermatofibrosarcoma protuberans.
The use of temporary arteriovenous shunt constructed in the lower extremity prior to a free microvascular transfer of an internal oblique/iliac crest flap, is described. The indications for the technique are presented. Conventional free flap transfer may require maturation of a suitable inflow source or outflow conduit, which is provided by a temporary shunt, subsequently used for recipient vessels. The two-stage procedure is applicable when local vessels are inadequate for immediate transfer.
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The rehabilitation of the patient with an upper extremity burn begins with the study and understanding of the magnitude of burn problems. The initial care as well as reconstruction of selected chronic deformities is presented to help the physician to develop an approach to some of the more common burn injuries.
The University of Texas Women, Infants, and Children (WIC) Well Child Clinic was established in January 1992 to provide high-quality "user-friendly" health care to children in Houston, Texas. As the name implies, the traditional services of the WIC nutritional program are coupled with primary care to offer more comprehensive and greater access to care. The services are provided by pediatric nurse practitioners and focus on health maintenance, with an emphasis on anticipatory guidance and immunizations. Acute care and management of chronic illness are also provided. The clinic serves as a teaching site for pediatric nurse practitioner and medical students. This article addresses the rationale for and planning of a WIC-based clinic and the implementation of the plan and addresses issues concerning reproducibility in other settings.
Early identification of children at risk for hypertension, proper evaluation, and appropriate management is important to prevent the serious long-term complications associated with the condition. This article defines primary and secondary hypertension in children, describes accurate blood pressure measurement techniques in children, presents the evaluation of a child with hypertension, and discusses therapy and prevention.
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