The clinical approach to certain post-nataly acquired causes of mental retardation.
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Brain Damage, Chronic↗
Biomedical subjects
W E Bell
Publications and source records attributed to W E Bell.
Current therapy of acute bacterial meningitis in children: Part I.
The therapy of acute bacterial meningitis is changing rapidly because of the introduction of new antimicrobial agents and new techniques of vital function support. Proper spinal fluid examination, anticonvulsant drug administration, management of increased intracranial pressure, and correct choice of antibiotics are essential to achieve optimal therapy.
Anti-Bacterial Agents↗
Neuroradiographic abnormalities in congenital cytomegalovirus infection.
To determine the spectrum of neuroradiographic abnormalities associated with congenital cytomegalovirus (CMV) infection, CT brain scans of 15 infants with symptomatic infection were reviewed. The initial CT scans were abnormal in 13 patients. Abnormalities included intracranial calcifications, cortical atrophy, ventricular enlargement, subdural effusions, porencephaly and polycystic encephalomalacia. Intracranial calcifications were present in 33% of the infants. In addition, three of the 15 infants developed progressive hydrocephalus which required ventriculoperitoneal shunt placement. These cases illustrate that congenital CMV infection causes a variety of structural CNS lesions and suggest that progressive hydrocephalus may be a relatively common consequence of symptomatic congenital CMV infection.
Atrophy↗
Magnetic resonance imaging in childhood disseminated encephalomyelitis.
We report the magnetic resonance imaging features in two children with post-infectious disseminated encephalomyelitis. Magnetic resonance imaging dramatically demonstrated multiple white matter lesions in both children and resolution of lesions in conjunction with clinical recovery. These cases indicate that magnetic resonance imaging has considerable diagnostic utility in disseminated encephalomyelitis of childhood.
Brain↗
Hypothermia-induced reversible polyneuropathy: electrophysiologic evidence of axonopathy.
A 2 1/2-year-old child developed peripheral polyneuropathy following exposure to hypothermia. Serial electrophysiologic studies over the next 10 months revealed progressive recovery from severe axonopathy. The literature on cold-induced neuropathy is reviewed. The two electrophysiologic studies reported previously in cold-induced polyneuropathy patients are discussed and compared with findings of our patient.
Action Potentials↗
Recurrent lateral rectus palsy in childhood.
Five patients with recurrent, lateral rectus palsy in childhood, examined at the University of Iowa Hospitals over a period of 22 years, are reported. During the same period, 131 abducens nerve palsy patients, younger than 18 years of age, were evaluated. Eighteen similar patients, most single case reports, are reviewed from the literature. All reported patients, including our own, shared the following features: spontaneous recovery within 6 months in the majority of patients, ipsilateral recurrence, and painless palsy. There is female and left-sided preponderance. Etiology is undetermined. Hypotheses include viral etiology, neurovascular compression by aberrant artery, and migraine.
Abducens Nerve↗
Current therapy of acute bacterial meningitis in children: Part II.
Despite many advances in the past decade in the development of new antimicrobials, acute bacterial meningitis continues to have significant morbidity and mortality in infants and children. Regardless of the effectiveness of the antibiotic preparations, future improvements in outcome is most likely to occur because of more rapid diagnosis and initiation of therapy. The standard penicillins, chloramphenicol, and the aminoglycosides continue to hold an important place in treatment. The recent introduction of new extended spectrum penicillins, including piperacillin and mezlocillin, in addition to the development of the third generation cephalosporins, have expanded alternatives for treating bacterial meningitis. The most appropriate and effective antibiotic or combination of antibiotics must first be selected; thereafter, its use must be monitore to identify its beneficial effects as well as possible adverse effects.
Anti-Bacterial Agents↗
Understanding temporomandibular biomechanics.
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Biomechanical Phenomena↗
Accelerated myelination in early Sturge-Weber syndrome demonstrated by MR imaging.
Magnetic resonance imaging of the brain in two infants with Sturge-Weber syndrome has demonstrated a pattern of accelerated myelination in the abnormal cerebral hemisphere. The extent of myelination was most apparent on the T1-weighted inversion recovery sequence while the T2-weighted images demonstrated concomitant changes in hydration of the brain. We propose an explanation for this finding based on cerebral ischemia underlying the leptomeningeal angioma.
Angiomatosis↗
Evaluation of pachymeningitis by contrast-enhanced MR imaging in a patient with rheumatoid disease.
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Arthritis, Rheumatoid↗
Evaluation of bromfenac and ibuprofen for pain after orthopedic surgery.
STUDY OBJECTIVES: To determine the relative analgesic potency and adverse effect liability of bromfenac 25, 50, and 100 mg, and ibuprofen 200 and 400 mg in the treatment of postoperative pain after orthopedic surgery. DESIGN: Randomized, double-blind, single-dose, parallel-group relative potency assay with evaluations at 30 minutes and then at hourly intervals for up to 6 hours. SETTING: Two wards of the orthopedic surgery department at the Centralsjukhuset (Central Hospital) in Karlstad, Sweden. PATIENTS: Two hundred inpatients with steady, moderate or severe pain within 72 hours after orthopedic surgery. INTERVENTIONS: Patients received a single oral dose of bromfenac 25, 50, or 100 mg, or ibuprofen 200 or 400 mg, when they experienced steady, moderate or severe pain that, in their opinion, required an analgesic. Using a self-rating record, subjects rated their pain and its relief for 6 hours after medicating. MEASUREMENTS AND MAIN RESULTS: The study was a valid relative potency assay with estimates of bromfenac's potency relative to ibuprofen ranging from 10.9 (nurse's global evaluation) to 16.7 (sum of hourly analog pain intensity difference scores). That is, 11-16 times the dose of ibuprofen must be administered to equal the analgesic effect of bromfenac. Patients who had eaten breakfast or lunch within 60 minutes before or 30 minutes after receiving the study medication ("fed" patients) had lower efficacy scores than those who had not ingested food within these time constraints before or after receiving the study medication ("fasted" patients). Furthermore, patients who had eaten before receiving the study medication had significantly lower efficacy scores than those who had eaten after receiving the study medication. CONCLUSIONS: The relative potency of the analgesic effect of bromfenac to ibuprofen is 11-16.7 in patients with pain after orthopedic surgery. Fed patients may have lower analgesic efficacy than fasted patients. Adverse effects for both bromfenac and ibuprofen were transient and consistent with the pharmacologic profiles of the drugs.
Analgesics↗
Evaluation of two opioid-acetaminophen combinations and placebo in postoperative oral surgery pain.
STUDY OBJECTIVE: To determine the relative analgesic potency and adverse effect liability of hydrocodone bitartrate 7.5 mg with acetaminophen 500 mg, codeine phosphate 30 mg with acetaminophen 300 mg, and placebo in the treatment of pain following oral surgery. DESIGN: Randomized, double-blind, single-dose, placebo-controlled, parallel-group study with self-ratings at 30 minutes and then at hourly intervals from hour 1 to hour 6. SETTING: Private, oral surgery practice sites. PATIENTS: Three hundred twenty-four outpatients with moderate or severe pain after the surgical removal of impacted third molars were selected. One was lost to follow-up and 32 did not need an analgesic; 232 patients had valid efficacy data. INTERVENTIONS: Patients were treated with a single oral dose of hydrocodone bitartrate 7.5 mg with acetaminophen 500 mg, codeine phosphate 30 mg with acetaminophen 300 mg, or placebo when they experienced steady, moderate or severe pain that, in their opinion, required an analgesic. Using a self-rating record, subjects rated their pain and its relief for 6 hours after medicating; estimates of peak and total analgesia were derived from these subjective reports. MEASUREMENTS AND MAIN RESULTS: This study was a valid analgesic assay. Both active treatments were significantly superior to placebo for all measures of analgesic efficacy. The hydrocodone-acetaminophen combination was significantly superior to the codeine-acetaminophen combination for total pain relief and the number of evaluations with 50% relief. Both active treatments manifested an analgesic effect within 30 minutes; the effect persisted for 5 hours for the codeine combination and 6 hours for the hydrocodone combination. Adverse effects were transient, consistent with the pharmacologic profiles of opioids, and none required treatment. CONCLUSIONS: A slight advantage in analgesic efficacy was demonstrated in this single-dose study for the hydrocodone-acetaminophen combination. Repeat-dose studies, however, should be conducted to determine the clinical significance of the difference in analgesic effect of these opioid combinations.
Acetaminophen↗