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Biomedical subjects

R S Fowler

Publications and source records attributed to R S Fowler.

At least 19 recordsLinked to original sources
PubMed1991

Congenital heart disease, parental stress, and infant-mother relationships.

The effect of congenital heart disease on early social relationships was assessed by observing 42 infants with the disease and 46 healthy infants in a standardized laboratory setting with their mothers. Significantly fewer infants with congenital heart disease, in comparison with healthy peers, were considered to have secure relationships with their mothers. The quality of the infant-mother relationship in the group with congenital heart disease was not related to parents' reports of their own stress or psychologic well-being. Severity of illness did not have a direct effect on the quality of the infant-mother relationship, but securely attached infants showed more subsequent improvement in health than insecurely attached peers showed. Attention to the infant-mother relationship in clinical care may improve the social development of babies with congenital heart disease and may have positive effects on physical health as well.

Adult↗
PubMed1990

Chronic illness in infancy and parenting stress: a comparison of three groups of parents.

Compared responses of parents of infants with cystic fibrosis, those with congenital heart disease, and those with healthy babies on the Parenting Stress Index. Diagnostic group differences were found mainly in the Child Domain with parents of ill infants reporting greater stress. Differences between mothers and fathers were found mainly in the Parent Domain. The groups did not differ in reports of stress arising from life events other than the target child's illness.

Adaptation, Psychological↗
PubMed1986

Synthetic patch angioplasty for repair of coarctation of the aorta: experience with aneurysm formation.

Patch graft angioplasty is an accepted technique for the repair of some forms of coarctation and for recoarctation. Since 1970, 63 patients at our institution underwent 65 operations for repair of coarctation (ages 3 days to 32 years); in 27 it was the initial operation and 38 needed surgery for recoarctation. Average follow-up was 3.5 years (range 3 months to 14 years). There was one death, 20 patients with persistent hypertension, and eight patients with a persistent arm/leg pressure gradient (14 to 30 mm Hg at rest). Five patients required reoperation, two for recoarctation and three for aneurysm formation. The aneurysms were found on routine chest x-rays 3, 3.7, and 13.5 years after surgery. All aneurysms were repaired with left heart bypass in which a Dacron tube graft was used without complications. Synthetic patch angioplasty to repair coarctation was effective; however, aneurysm formation was a late complication in 5% of our patients. All patients undergoing patch repair should be followed on a yearly basis to allow early detection of aneurysms.

Adolescent↗
PubMed1985

Electrocardiographic estimate of peak systolic pressure gradient in children with aortic stenosis.

In children with congenital aortic stenosis a modified mapping system was created to explore the electrocardiographic potentials on the chest surface from the left sternal edge (direct anterior), left axillary line (direct lateral) and midchest (45 degrees anterior to the lateral lead) in the third through the seventh intercostal spaces. Potentials were normalized according to chest size based on elliptical and cylindrical models of the chest with the heart at the center. The unadjusted and adjusted potentials were correlated with the peak systolic gradients across the left ventricular outflow tract and equations to predict the gradients were derived by stepwise multiple regression analysis. The best equation was: Gradient = -15.0 +(3.845 X MCT 4) +(0.474 X CD X LSS 3) + (0.138 X CD X MCS 3) where MCT 4 = T wave amplitude in the lead in the fourth interspace in the midclavicular line CD = AP chest diameter in cm LSS 3 = S wave amplitude in the lead in the third interspace at the left sternal border MCS 3 = S wave amplitude in the lead in the third interspace in the midclavicular line (R = 0.84, SEE = 24.3) There are areas on the chest surface that are unexplored by standard electrocardiography. The electrocardiographic potentials from these areas, when normalized for chest size, yield better estimates of transaortic gradients than previous estimates from the routine electrocardiogram.

Adolescent↗
PubMed1984

Sequelae of mild closed head injuries.

Thirty-nine minimal to mild closed head injuries without neurological signs were evaluated by a series of clinically available psychometric tests to determine the presence of identifiable intellectual deficits, rate of recovery, and personality or occupational changes. Even minimally head-injured patients suffer measurable cognitive deficits and occupational and behavioral changes.

Adolescent↗
PubMed1982

The ECG in aortic stenosis. Value of TAVF and QV6.

Fifty patients with a mean age of 9.2 years (range, 1.2 to 17.5 years) had cardiac catheterization performed under standardized conditions plus a scalar ECG the previous day. Twenty different direct measurements and 25 derived measurements from the ECG were correlated with the resting peak systolic gradient across the aortic valve. Some of the best correlations were with the measured TAVF, TV6, QV6, and the sum of SV1 + RV6 with r values between .33 and .59. Another group of different patients with isolated aortic stenosis were studied with measurements of the important ECG segments. The r value of this "test" series was similar to that of the original group, so the groups were pooled. The best three-term regression equation involved TAVF, QV6, and the sum (SV1 + RV6), with r = .636. A scoring system was also devised to predict severity. If the TAVF is 0.1 mV or less or the TV6 is 0.3 mV or less or if there is no Q in V6, the gradient may be high. In our series, the ECG estimation of resting peak systolic gradient across the aortic valve in aortic stenosis was enhanced by the inclusion of TAVF and QV6 in the regression equation, as well as SV1 + RV6.

Adolescent↗
PubMed1981

A comprehensive scoring system for evaluating Noonan syndrome.

A multidisciplinary team assessed 23 patients with various manifestations of the Noonan syndrome, including pulmonary valve stenosis (with leaflet dysplasia), "typical" facial appearance (including hypertelorism, epicanthic folds, flat nasal bridge, and apparently low-set ears), short stature, and mental retardation. Seven patients had a family history of the syndrome. A comprehensive scoring system was devised on the basis of frequency and severity of manifestations and results of invasive and noninvasive tests in these patients and those reported in the literature. The scoring system was condensed into a score card for clinical use and validated by "blind" application to patients with isolated pulmonary valve stenosis or suspected Noonan syndrome. Use of a scoring system to diagnose a syndrome for which there is no specific diagnostic test facilitates accuracy and decreases observer bias. In the case of unusual congenital disorders it is particularly valuable for a pediatrician in general practice.

Adolescent↗
PubMed1981

Pinpointing: one method of improving staff compliance with rehabilitation regimens.

This project investigated the effects of a systematic pinpointing and feedback system upon staff follow-through with assignments on a rehabilitation inpatient service. The number and percentage of tasks were recorded over 8 weeks. An ABAB time series reversal design was used where the baseline phases occurred during weeks 1--2 and 5--6, and the intervention occurred during weeks 3--4 and 7--8. Intervention consisted of directing chart round interactions so that assignments were given to specific team members and a list of these tasks was distributed to the team. Results indicated that team performance was significantly affected during intervention weeks. Specifically, the percentage of pinpointing increased from 40% during baseline to an intervention average of 96%. Also, team compliance increased from baseline levels averaging 44% to a mean of 87% during the intervention. The effects of such inexpensive techniques on team effectiveness and the resultant cost benefits to patients in a rehabilitation setting are reviewed.

Cooperative Behavior↗
PubMed1981

Cor pulmonale in cystic fibrosis.

A VCG and an orthogonal ECG were done on 66 ambulatory patients with cystic fibrosis. Arteriolized pO2, FEV1/VC and MBC were related to electrocardiographic measurements. In this group of adolescent and young adult patients the most helpful electrocardiographic sign of cor pulmonale is a low voltage representing the left ventricle. The four best indicators from the cardiogram are (1) Rx less than .8 mv; (2) Rx/Sx less than 4.0; (3) Tx less than .4 mv; and (4) MLVF + MLVH less than 2.5 mv. If more than one indicator is found cor pulmonale is likely present. Increased voltage over the right ventricle does not identify patients with cor pulmonale.

Adolescent↗
PubMed1981

Spironolactone therapy in infants with congestive heart failure secondary to congenital heart disease.

The efficacy of treatment with spironolactone for congestive heart failure secondary to congenital heart disease was studied in 21 infants under 1 year of age. All received digoxin and chlorothiazide. In addition, group A (n = 10) was given supplements of potassium and group B (n = 11) received spironolactone. Daily clinical observations of vital signs, weight, hepatomegaly, and vomiting were recorded. Paired t test analysis showed significant reduction in liver size and weight (P less than 0.01) and respiratory rate (P less than 0.05) in group B, and less significant decreases in group A. The incidence of vomiting was slightly lower in group B. We conclude that the addition of spironolactone hastens and enhances the response to standard treatment with digoxin and chlorothiazide in infants with congestive heart failure.

Chlorothiazide↗
PubMed1981

Rapid evolution from "normal" left ventricular outflow tract to fatal subaortic stenosis in infancy.

Serial clinical, echocardiographic, haemodynamic, and angiocardiographic data support the conclusion that over four months severe discrete subaortic stenosis evolved from a previously angiocardiographically normal left ventricular outflow tract in an infant who had a successful repair of thoracic aortic coarctation. This case supports those who suggest that a myocardial factor may play an important role in the change in form and function of some congenitally malformed hearts.

Angiocardiography↗
PubMed1981

Thallium myocardial perfusion scans for the assessment of right ventricular hypertrophy in patients with cystic fibrosis. A comparison with other noninvasive techniques.

The incidence of right ventricular hypertrophy in 32 patients with cystic fibrosis was studied using thallium 201 (TI-201) myocardial perfusion scans, and compared with other noninvasive techniques including electrocardiography, vectorcardiography, and M-mode echocardiography. The patients (mean age, 17.3 yr; range, 7 to 33) had a wide range of clinical and pulmonary abnormalities (mean Shwachman-Kulczycki score, 66.6). In the total study group, TI-201 scans, like the vectorcardiograms and the M-mode echocardiograms, gave a surprisingly high proportion of positive predictions for right ventricular hypertrophy (RVH) (44%). The correlations with all other noninvasive methods were uniformly poor, so caution must be exercised in using this technique to predict early RVH in order to follow the natural history of cor pulmonale in cystic fibrosis. At the time of the study, 6 patients had clinical evidence of right ventricular failure, and in this disease setting must have had RVH. In 3 patients, RVH was confirmed at autopsy, and it was successfully predicted by TI-201 scans in 5 of the 6 patients. The false negative scan may have been due to regional myocardial ischemia secondary to severe right ventricular failure. In contrast, the vectorcardiogram, using Fowler's new criteria, made a successful prediction of RVH in all 6 patients, and the electro cardiogram in only 3. Although the M-mode echocardiogram was abnormal in all patients, it would have predicted RVH (with increased right ventricular anterior wall thickness) in only 1 patient. We concluded that TI-201 myocardial perfusion cans are good at confirming RVH in cases with established right ventricular failure, but have no advantage over vectorcardiographic assessments, which are logistically easier to perform and carry no radiation risks.

Adolescent↗
PubMed1981

Pulmonary artery stenosis following aortopulmonary anastomoses.

From 1965 to 1979, 44 patients with Potts and 50 with Waterston aortopulmonary anastomoses were studied angiographically. Fifty-two of the 95 shunts had been banded to limit growth of the anastomosis. Later the internal diameter of the anastomosis was measured in 34 children when the cardiac defect was repaired. On those with late measurements, growth was limited effectively in 17 of the 18 (94%) shunts that had been banded, whereas five of the 16 (31%) unbanded anastomoses grew to more than 6.5 mm internal diameter (p = 0.05). The difference in incidence of moderate or severe stenosis of the pulmonary artery near or at the anastomosis nearly reached a significant level (p = 0.07), occurring in 50% of children with banded shunts in comparison with 31% of children with unbanded shunts. Mean pulmonary artery pressures were obtained in 77 children, 36 with potts and 41 with Waterston shunts. Six of 43 with a banded anastomosis had a mean pulmonary artery pressure above 30 mm Hg, the highest being 43 mm Hg. Seven of 34 children with an unbanded anastomosis had a mean pulmonary artery pressure of 30 mm Hg or more, and in three the pressures were over 50mm Hg. In unbanded Potts or Waterston shunts the incidence of pulmonary artery stenosis was 60%. This high incidence discourages the use of these aortopulmonary anastomoses if other shunts can be constructed safely and effectively.

Aorta↗
PubMed1981

Pressure relief training device: the microcalculator.

The use of a commercially available timer/microcalculator as a pressure relief training device for spinal cord injury patients is discussed. The device can be programmed to emit a high frequency tone at the end of a specified time interval, and then reset itself to repeat the cycle as long as is desired. The device's low cost, high reliability, convenient size and attractiveness to patients contribute to high potential as a training device. A rationale for using such a device soon after the onset of disability, rather than after pressure sores develop, is discussed.

Equipment and Supplies↗
PubMed1981

Experience with aortic and mitral valve replacement in children.

Ninety-two children underwent aortic (AVR) or mitral valve replacement (MVR), or both, at the Hospital for Sick Children in Toronto from 1963 to February, 1980. No early or late deaths occurred in 39 children having AVR. However, in 50 children having MVR, the operative mortality was 32% and the actuarial survival rate 5 years after operation was only 50%. Major complications occurred with almost equal frequency in the two groups; 50% of children surviving AVR or MVR experienced major complications within 6 years of operation. Retrospective comparison of results with tissue and mechanical valves showed no clear advantage with either type of prosthesis. Outgrowth of a prosthetic valve was satisfactorily managed in children with AVR but presented a difficult problem in those with MVR, who required frequent reoperation to increase the prosthetic valve to adult size. Prosthetic valve replacement in children is a palliative procedure at best, and every effort should be made to preserve the natural valve by a more conservative repair technique.

Adolescent↗
PubMed1980

Kinesthetic biofeedback: a treatment modality for elbow range of motion in hemiplegia.

Two treatment modalities for increasing active elbow extension with hemiplegic subjects were tested. Twenty subjects were randomly assigned to one of two treatment groups--an experimental treatment technique using kinesthetic biofeedback, or a control group consisting of an occupational therapy approach aimed at increasing functional use of the envolved upper extremity. The results indicate that kinesthetic biofeedback was as beneficial as conventional occupational therapy. It was also demonstrated that an individual's age, sex, or length of time beyond one-year post-CVA did not significantly affect treatment outcome. A majority of subjects in both treatment groups improved in ways not directly related to treatment, which suggests the need for long-term follow up of hemiplegic patients.

Adult↗
PubMed1980

Tricuspid atresia, transposition of the great arteries, and banded pulmonary artery. Repair by arterial switch, coronary artery reimplantation, and right atrioventricular valved conduit.

A 14-year-old boy with tricuspid atresia, transposition of the great arteries, and previous pulmonary artery banding underwent repair by arterial switch procedure with coronary arterial reimplantation, plus connection of the right atrium and ventricle with a valved conduit. Pre- and postoperative hemodynamic and angiographic investigations are presented with comments on operative technique and the rationale for this unique operation.

Adolescent↗