Biomedical subjects

R L Baker

Publications and source records attributed to R L Baker.

At least 19 recordsLinked to original sources

PubMed2001

Complete atrioventricular block after valvular heart surgery and the timing of pacemaker implantation.

The natural history of patients who developed complete atrioventricular block after valvular heart surgery was investigated to determine the optimal timing for pacemaker implantation. Patients who developed complete atrioventricular block within 24 hours after operation, which then persisted for > 48 hours, were unlikely to recover; such patients could potentially undergo earlier pacemaker implantation if otherwise ready for discharge.

Adult↗

PubMed2001

Role of transisthmus conduction intervals in predicting bidirectional block after ablation of typical atrial flutter.

INTRODUCTION: Complete bidirectional cavotricuspid isthmus block is the endpoint for ablation of typical atrial flutter. The purpose of this study was to determine whether the extent of prolongation of the transisthmus interval after ablation predicts complete bidirectional block. METHODS AND RESULTS: Fifty-seven consecutive patients underwent 60 ablation procedures for isthmus-dependent atrial flutter. The clockwise and counterclockwise transisthmus intervals were determined before and after ablation during pacing from the low lateral right atrium and the coronary sinus. Bidirectional block was achieved with ablation in 55 (96%) of 57 patients. The transisthmus intervals before ablation and after complete transisthmus block were 100.3 +/- 21.1 msec and 195.8 +/- 30.1 msec, respectively, in the clockwise direction (P < 0.0001), and 98.2 +/- 24.7 msec and 185.7 +/- 33.9 msec, respectively, in the counterclockwise direction (P < 0.0001). An increase in the transisthmus interval by > or = 50% in both directions after ablation predicted complete bidirectional block with 100% sensitivity and 80% specificity. The positive and negative predictive values were 89% and 100%, respectively. The diagnostic accuracy of a > or = 50% prolongation in the transisthmus interval was 92%. CONCLUSION: Prolongation of the transisthmus interval by > or = 50% in the clockwise and counterclockwise directions is associated with a high degree of diagnostic accuracy and an excellent negative predictive value in determining complete bidirectional transisthmus block. This may be a useful and simple adjunctive criterion for assessment of complete transisthmus conduction block.

Aged↗

PubMed2001

Electrogram polarity and cavotricuspid isthmus block during ablation of typical atrial flutter.

INTRODUCTION: The atrial activation sequence around the tricuspid annulus has been used to assess whether complete block has been achieved across the cavotricuspid isthmus during radiofrequency ablation of typical atrial flutter. However, sometimes the atrial activation sequence does not clearly establish the presence or absence of complete block. The purpose of this study was to determine whether a change in the polarity of atrial electrograms recorded near the ablation line is an accurate indicator of complete isthmus block. METHODS AND RESULTS: Radiofrequency ablation was performed in 34 men and 10 women (age 60 +/- 13 years [mean +/- SD]) with isthmus-dependent, counterclockwise atrial flutter. Electrograms were recorded around the tricuspid annulus using a duodecapolar halo catheter. Electrograms recorded from two distal electrode pairs (E1 and E2) positioned just anterior to the ablation line were analyzed during atrial flutter and during coronary sinus pacing, before and after ablation. Complete isthmus block was verified by the presence of widely split double electrograms along the entire ablation line. Complete bidirectional isthmus block was achieved in 39 (89%) of 44 patients. Before ablation, the initial polarity of E1 and E2 was predominantly negative during atrial flutter and predominantly positive during coronary sinus pacing. During incomplete isthmus block, the electrogram polarity became reversed either only at E2, or at neither E1 nor E2. In every patient, the polarity of E1 and E2 became negative during coronary sinus pacing only after complete isthmus block was achieved. In 4 patients (10%), the atrial activation sequence recorded with the halo catheter was consistent with complete isthmus block, but the presence of incomplete block was accurately detected by inspection of the polarity of E1 and E2. CONCLUSION: Reversal of polarity in bipolar electrograms recorded just anterior to the line of isthmus block during coronary sinus pacing after ablation of atrial flutter is a simple, quick, and accurate indicator of complete isthmus block.

Adult↗

PubMed2001

Prevalence of central venous occlusion in patients with chronic defibrillator leads.

BACKGROUND: Many patients with previously implanted ventricular defibrillators are candidates for an upgrade to a device capable of atrial-ventricular sequential or multisite pacing. The prevalence of venous occlusion after placement of transvenous defibrillator leads is unknown. The purpose of this study was to determine the prevalence of central venous occlusion in asymptomatic patients with chronic transvenous defibrillator leads. METHODS: Thirty consecutive patients with a transvenous defibrillator lead underwent bilateral contrast venography of the cephalic, axillary, subclavian, and brachiocephalic veins as well as the superior vena cava before an elective defibrillator battery replacement. The mean time between transvenous defibrillator lead implantation and venography was 45 +/- 21 months. Sixteen patients had more than 1 lead in the same subclavian vein. No patient had clinical signs of venous occlusion. RESULTS: One (3%) patient had a complete occlusion of the subclavian vein, 1 (3%) patient had a 90% subclavian vein stenosis, 2 (7%) patients had a 75% to 89% subclavian stenosis, 11 (37%) patients had a 50% to 74% subclavian stenosis, and 15 (50%) patients had no subclavian stenosis. CONCLUSIONS: The low prevalence of subclavian vein occlusion or severe stenosis among defibrillator recipients found in this study suggests that the placement of additional transvenous leads in a patient who already has a ventricular defibrillator is feasible in a high percentage of patients (93%).

Adult↗

PubMed2000

Effects of digoxin on acute, atrial fibrillation-induced changes in atrial refractoriness.

BACKGROUND: Atrial fibrillation (AF) shortens the atrial effective refractory period (ERP) and predisposes to further episodes of AF. The acute changes in atrial refractoriness may be related to tachycardia-induced intracellular calcium overload. The purpose of this study was to determine whether digoxin, which increases intracellular calcium, potentiates the acute effects of AF on atrial refractoriness in humans. METHODS AND RESULTS: In 38 healthy adults, atrial ERP was measured at basic drive cycle lengths (BDCLs) of 350 and 500 ms after autonomic blockade. Nineteen patients had been treated with digoxin for 2 weeks. After a several-minute episode of AF, atrial ERP was measured serially at alternating BDCLs. Compared with pre-AF ERPs, the first post-AF ERPs were significantly shorter in both the digoxin and the control groups (P:<0.001). The post-AF ERP at a BDCL of 350 ms shortened to a greater degree in the digoxin group (37+/-16 ms) than in the control group (20+/-13 ms, P:<0.001); similar changes occurred at a BDCL of 500 ms. During post-AF determinations of the atrial ERP, secondary AF episodes occurred significantly more often in the digoxin group (32% versus 16%; P:<0. 04). CONCLUSIONS: After a brief episode of AF, digoxin augments the shortening that occurs in atrial refractoriness and predisposes to the reinduction of AF. These effects occur in the setting of autonomic blockade and therefore are more likely to be due to the effects of digoxin on intracellular calcium than to its vagotonic effects.

Administration, Oral↗

PubMed2000

Cost analysis of transthoracic cardioversion of atrial fibrillation with and without ibutilide pretreatment.

BACKGROUND: Ibutilide may result in chemical cardioversion of atrial fibrillation and facilitates transthoracic cardioversion by lowering the defibrillation energy requirement. Whether routine pretreatment with ibutilide increases or decreases the cost of cardioversion is unknown. The purpose of this study was to compare the cost of outpatient transthoracic cardioversion of atrial fibrillation with and without ibutilide pretreatment. METHODS: Using a model based on published literature and hospital accounting information, a hypothetical group of 100 patients with atrial fibrillation and a left ventricular ejection fraction >0.30 underwent 2 strategies of outpatient cardioversion: transthoracic cardioversion with and without routine pretreatment with 1 mg ibutilide, and with and without involvement of an anesthesiologist for sedation. If transthoracic cardioversion was unsuccessful in patients who did not receive ibutilide, transthoracic cardioversion was repeated after administration of ibutilide. RESULTS: If an anesthesiologist was involved, transthoracic cardioversion with ibutilide was associated with incremental cost-savings as the efficacy of ibutilide alone in restoring sinus rhythm increased above the critical values of 20%, 27%, and 35% when the efficacy of transthoracic cardioversion alone was 60%, 80%, and 100%, respectively. In the absence of an anesthesiologist, routine pretreatment with ibutilide increased the cost of cardioversion at all success rates of transthoracic cardioversion. CONCLUSIONS: In the presence of an anesthesiologist, whether or not routine pretreatment with ibutilide lowers the mean cost of cardioversion is determined by the success rates of chemical cardioversion with ibutilide and transthoracic cardioversion. In the absence of an anesthesiologist, ibutilide pretreatment increases the cost of cardioversion.

Anesthesia, General↗

PubMed2000

CNS toxicity after topical application of EMLA cream on a toddler with molluscum contagiosum.

EMLA (eutectic mixture of local anesthetics) cream is used topically to provide local anesthesia for a variety of painful superficial procedures. Although the side effects of EMLA are usually mild and transient local skin reactions, potential life threatening complications can be encountered. We report a case of central nervous toxicity after EMLA application for curettage of molluscum contagiosum lesions in a pediatric patient. This complication was the result of a therapeutic misadventure that led to an excessive application of EMLA cream over an extensive area causing an overdose of lidocaine and prilocaine with their subsequent systemic toxicities.

Administration, Topical↗

PubMed1999

Grooming decisions by damselflies, age-specific colonisation by water mites, and the probability of successful parasitism.

We examined whether host damselflies (Ischnura verticalis) in different stages of development were differentially susceptible to parasitism by larval water mites (Arrenurus pseudosuperior). We found that mites were successful in reaching the parasitic phase more often if they colonised hosts closer to emergence. Thus, we predicted that more mites should colonise damselflies closer to emergence and damselflies closer to emergence should spend more time defending against mites. We found that mites colonised damselflies closer to emergence in one of two experiments, but that damselflies in different stages of development did not differ in time spent defending against mites.

Animals↗

PubMed1998

Breed and season effects on the peri-parturient rise in nematode egg output in indigenous ewes in a cool tropical environment.

A study was carried out at the International Livestock Research Institute (ILRI) Debre Berhan Research Station in Ethiopia from 1992 to 1995 to compare the peri-parturient rise (PPR) in faecal nematode egg counts (FEC) in ewes of two indigenous sheep breeds. A total of 1439 Menz and 1347 Horro ewes were single sire mated following oestrus synchronization to lamb in the wet and dry season. Three ewe treatment groups were constituted as mated/lactating/undrenched; mated/lactating/drenched; unmated/undrenched for three wet and three dry lambing seasons. All ewes grazed naturally contaminated pasture. Levels of faecal egg output were monitored at mating, 3 months after mating, 2 weeks before lambing, 4, 8 and 12 weeks post-lambing. A significant PPR in FEC occurred 2 weeks before lambing and peaked at 4 weeks post-parturition in ewes lambing just before the beginning of the dry season (October/November). There was no significant increase in FEC when lambing occurred before the onset of the long rainy season (May/June). The PPR in this study was associated with both lactation and seasonal availability of third-stage infective larvae on pasture. There was no consistent breed difference in FEC during the six sampling periods from mating to weaning. Faecal cultures and worm counts from both breeds confirmed the presence of Longistrongylus (Pseudomarshallagia) elongata, Trichostrongylus spp.and Haemonchus contortus. The role of the peri-parturient rise of FEC in ewes in gastrointestinal nematode transmission is discussed.

Animals↗

PubMed1998

Resistance of Galla and Small East African goats in the sub-humid tropics to gastrointestinal nematode infections and the peri-parturient rise in faecal egg counts.

A study was carried out from 1994 to 1996 to compare the resistance to naturally acquired gastrointestinal (GI) nematode infections (predominantly Haemonchus contortus) of 88 Galla and 114 Small East African (SEA) goats (does) in the sub-humid coastal region of Kenya. Live weights (LWT), blood packed cell volume (PCV) and faecal egg counts (FEC) were recorded each year at mating, 3-4 months after mating, 1-2 weeks before kidding and 1-4 months after kidding. There was a significant increase in FEC and a decline in PCV in lactating does compared to non-lactating does over the peri-parturient period. This peri-parturient rise in FEC occurred in both breeds but was more marked and persistent in the Galla than in the SEA. The SEA does were more resistant to GI nematode infections than Galla does as shown by their significantly lower FEC and higher PCV at all sampling times over the reproductive cycle, but this breed difference was particularly marked over the lactation period.

Animals↗

PubMed1997

Controlling the spread of vancomycin-resistant enterococci with a rehabilitation cohort unit.

Enterococci are common to the human gastrointestinal tract. Recently there has been an emergence of vancomycin-resistant enterococci (VRE); infection requires strict contact isolation. Patients with VRE infections are at higher risk for morbidity and mortality. As a result of the high prevalence of VRE, it was recommended that a cohort unit be established to control its spread within our metropolitan community hospital. We report the development of a rehabilitation VRE cohort unit. We present case studies of five patients who developed nosocomial colonization and one with an infection with VRE; all were treated on the rehabilitation cohort unit. Protocols for VRE isolation and procedures for decontamination in the cohort unit were developed. If a cohort unit is necessary, it is feasible to conduct a rehabilitation program in a cohort unit with strict adherence to contact isolation.

Adult↗

PubMed1997

The epidemiology of nematode infections in sheep in a cool tropical environment.

The epidemiology of nematode infections in Menz sheep was studied in the highlands of Ethiopia at the International Livestock Research Institute (ILRI), Debre Berhan Research Station, using a series of tracer lambs grazing contaminated pasture for either 4, 16, 32 or 48 weeks from July 1992 to June 1994. The basic nematode seasonal infectivity pattern was expressed in terms of relative numbers of third-stage larvae (L3) available on pasture for different months. Data from faecal nematode egg counts, pasture larval recoveries and worm counts from the tracer lambs were used to investigate the infectivity pattern. Four nematode species of economic importance: Longistrongylus (Pseudomarshallagia) elongata, Trichostronglylus colubriformis, Haemonchus contortus, and Dictyocaulus filaria, were recovered from sheep. The largest numbers were recovered during the wet season (i.e. July to November) with peaks in late August and early September. During this 2 year study period, the seasonal pattern of sheep gastrointestinal nematodes was clearly defined. An important finding was that conditions during the short rainy season (i.e. March-May) were not conducive to the development and survival of nematode eggs and the free-living stages, hence little or no transmission occurred. Rainfall and humidity seemed to be the most important factors for the development of eggs and free-living stages. The period of acquisition of third-stage larvae from pasture was found to be relatively short, suggesting that a strategic control programme is feasible with minimal anthelmintic use. Results from the studies are discussed in relation to control strategies.

Animals↗

PubMed1995

Evidence for multiple anthelmintic resistance in sheep and goats reared under the same management in coastal Kenya.

Four experiments, two with sheep and two with goats, were carried out to determine the efficacy of ivermectin, fenbendazole, levamisole, closantel and some of their combinations by faecal egg count reduction tests. In the first experiment, injectable ivermectin, oral ivermectin, fenbendazole and levamisole were tested in 6-month-old lambs, and their reduction percentages were 77%, 13%, 42% and 92%, respectively. In the second experiment, with yearling sheep, the reduction percentages were 35% for injectable ivermectin, 32% for fenbendazole, 99% for levamisole, 48% for closantel, 92% for injectable ivermectin combined with fenbendazole, 99% for injectable ivermectin combined with levamisole, and 100% for fenbendazole combined with levamisole. In the study with 18-month-old goats given the same dose rates as those recommended for sheep, the reduction percentages were 73% for injectable ivermectin, 25% for fenbendazole, and 78% for levamisole. Another group of 14-month-old goats was treated with dose rates 1.5 times those recommended for sheep and the reduction percentages were 93% for levamisole, 92% for injectable ivermectin, and 97% for a combination of levamisole and ivermectin. In all experiments with sheep and goats the gastrointestinal nematode parasites identified by larval cultures were Haemonchus contortus, Trichostrongylus spp. and Oesophagostomum spp. The gastrointestinal nematodes of both sheep and goats on this farm are resistant to ivermectin and fenbendazole, whereas levamisole is still effective in sheep, but not in goats. The results are discussed in relation to the farm as a source of breeding stock to smallholder farmers and its potential to spread anthelmintic resistance.

Animal Husbandry↗

PubMed1993

The heritability of gingival crevice depths in sheep.

The gingival crevices of the four central incisor teeth of 396 sheep with known sires were measured at the mid-labial, mid-mesial and distal (interproximal), and mid-lingual aspects to test the hypothesis that gingival crevice depths were heritable. In total, 6336 gingival crevices were examined. Mean crevicular depths were 1.50 mm (labial), 3.16 mm (interproximal) and 6.52 mm (lingual). Within breedstrain genetic variation was examined and paternal half-sib heritability estimates were found to be high for the interproximal crevice depth (0.66 +/- 0.20) and the lingual crevice depth (0.69 +/- 0.21), but lower, and non-significant, for the labial crevice depth (0.24 +/- 0.17).

Animals↗

PubMed1993

Second generation follow-up of the Danish perinatal study women: study design and factors affecting response.

To study the mother-infant correlation of fetal growth and duration of pregnancy, women who were born as subjects in the Danish Perinatal Study (1959-61) were traced and interviewed, and the pregnancy and birth records of their children were abstracted. The study population consisted of 159 women who were small-for-gestational age (SGA) at birth, 162 who were preterm, 38 who were both preterm and SGA, and 939 term, appropriately-grown control women. Methods for sample selection, measuring gestational age and fetal growth in both generations, locating and interviewing the women, abstracting the records of their children, and obtaining paternal birth and adult stature are described. A total of 84.5% of the selected women were successfully interviewed; the fraction interviewed did not differ by maternal birth status. The medical records of over 98% of pregnancies to the study women were abstracted, making it possible to study various factors associated with completion of an interview. By a variety of measures, women of higher socio-economic status were more likely to be interviewed. Birthweight and adult weights were available for 63 and 73% of the children's fathers.

Cohort Effect↗

PubMed1993

Delivery of preterm and small for gestational age infants across generations.

Two generations of women were studied to clarify the influence of a woman's own preterm delivery or intrauterine growth retardation on her later risk of delivering preterm or growth-retarded infants. The first generation consists of the cohort of women who gave birth at the National University Hospital (Rigshospitalet) in Copenhagen from 1959 to 1961 and the second, those of their daughters that have delivered themselves. The background of the study and the procedures involved are described. The percentage of data obtained and the preliminary findings concerning the relationship between social and demographic factors and the willingness of subjects to participate are included.

Adolescent↗

PubMed1990

Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature.

Histoplasmosis is a serious opportunistic infection in patients with AIDS, often representing the first manifestation of the syndrome. Most infections occurring within the endemic region are caused by exogenous exposure, while those occurring in nonendemic areas may represent endogenous reactivation of latent foci of infection or exogenous exposure to microfoci located within those nonendemic regions. However, prospective investigations are needed to prove the mode of acquisition. The infection usually begins in the lungs even though the chest roentgenogram may be normal. Clinical findings are nonspecific; most patients present with symptoms of fever and weight loss of at least 1 month's duration. When untreated, many cases eventually develop severe clinical manifestations resembling septicemia. Chest roentgenograms, when abnormal, show interstitial or reticulonodular infiltrates. Many cases have been initially misdiagnosed as disseminated mycobacterial infection or Pneumocystis carinii pneumonia. Patients are often concurrently infected with other opportunistic pathogens, supporting the need for a careful search for co-infections. Useful diagnostic tests include serologic tests for anti-H. capsulatum antibodies and HPA, silver stains of tissue sections or body fluids, and cultures using fungal media from blood, bone marrow, bronchoalveolar lavage fluid, and other tissues or body fluids suspected to be infected on clinical grounds. Treatment with amphotericin B is highly effective, reversing the clinical manifestations of infection in at least 80% of cases. However, nearly all patients relapse within 1 year after completing courses of amphotericin B of 35 mg/kg or more, supporting the use of maintenance treatment to prevent recurrence. Relapse rates are lower (9 to 19%) in patients receiving maintenance therapy with amphotericin B given at doses of about 50 mg weekly or biweekly than with ketoconazole (50-60%), but controlled trials comparing different maintenance regimens have not been conducted. Until results of such trials become available, our current approach is to administer an induction phase of 15 mg/kg of amphotericin B given over 4 to 6 weeks, followed by maintenance therapy with 50 to 100 mg of amphotericin B given once or twice weekly, or biweekly. If results of a prospective National Institutes of Allergy and Infectious Disease study of itraconazole maintenance therapy document its effectiveness, alternatives to amphotericin B may be reasonable.

Acquired Immunodeficiency Syndrome↗

PubMed1989

In vivo tyrosine hydroxylation rate in retina: effects of phenylalanine and tyrosine administration in rats pretreated with p-chlorophenylalanine.

p-Chlorophenylalanine was administered to rats to inhibit hepatic phenylalanine hydroxylase activity. Two days later, phenylalanine injection was noted to produce substantial increases in serum phenylalanine levels, and relatively modest increments in serum tyrosine levels. Rats injected with p-chlorophenylalanine 2 days earlier showed a normal light-induced activation of retinal tyrosine hydroxylase activity in vivo, measured as dihydroxyphenylalanine accumulation following pharmacologic inhibition in vivo of aromatic L-amino acid decarboxylase activity. In addition, tyrosine injection into p-chlorophenylalanine-treated rats in the light produced anticipated increments in retinal tyrosine hydroxylation rate, showing the enzyme to be functionally normal. The acute administration of phenylalanine (62.5-500 mg/kg i.p.) to p-chlorophenylalanine-treated rats produced dose-related increments in retinal phenylalanine. In vivo tyrosine hydroxylation rate in retina was normal at all doses below 300 mg/kg. However, at the highest dose (500 mg/kg), when retinal phenylalanine levels were almost 5-times normal tyrosine hydroxylation rate consistently fell (to about half-normal values). These results demonstrate that very large elevations in tissue phenylalanine levels do not stimulate tyrosine hydroxylation in vivo, and that at extremely high levels phenylalanine inhibits tyrosine hydroxylation rate.

Animals↗