Treatment of a child with acute cyclosporine overdose.
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Charcoal↗
Biomedical subjects
A B Anderson
Publications and source records attributed to A B Anderson.
The clinical utility of pulse oximetry in the pediatric emergency department setting.
Pulse oximetry provides a noninvasive, painless, accurate, and rapid method for measuring arterial oxygen saturation (SaO2). It has been shown to be valuable in anesthesia and critical care and recently has been used extensively in the outpatient setting. As is often the case with new technologies, little has been published on the basic issues of reliability, reproducibility, and effect on patient care. This prospective clinical study evaluated the basic principles of pulse oximetry in the pediatric emergency department setting and tested the hypotheses that pulse oximetry SaO2 measurements are reliable and provide valuable information, in addition to clinical and laboratory data which affect patient assessment and management. One hundred twenty patients were enrolled in phase 1 and 437 in phase 2 of the study. Pulse oximetry readings were reproducible with an intraclass correlation of 0.87. SaO2 measurements changed the assessed degree of illness in 188 (53%) patients; 47 (13%) were felt to be more ill and 130 (37%) to be less ill than at initial assessment. Sixty-nine (17%) patients were identified in whom SaO2 readings changed management plans; 27 (8%) were managed more aggressively (intubation, surgery, or admission), while 40 (11%) were managed less aggressively (discharged). In three cases, pulse oximetry was instrumental in the diagnosis of a serious illness. The results from this study indicate that pulse oximetry SaO2 readings are stable and reproducible and provide information which impacts significantly on patient assessment and management.
Adolescent↗
Local anesthesia in pediatric patients: topical TAC versus lidocaine.
Lacerations requiring sutures are a common surgical emergency in children. Traditional anesthesia prior to suturing has been intradermal lidocaine. TAC (0.5% tetracaine, 1:2,000 adrenalin, 11.8% cocaine) is a topically applied anesthetic. A randomized, placebo-controlled, double-blind clinical study was conducted to test the hypothesis that topical TAC and intradermal lidocaine are equally efficacious with respect to patient compliance with the suturing process, ie, anesthetic application and placement of sutures, and development of wound complications. Patients less than 18 years old, with lacerations 5 cm or less in length, located in well vascularized, nonmucous membrane areas were included. Patients were entered into the intradermal or topical groups; the intradermal group received lidocaine and the topical group was randomized to receive either TAC or placebo. One hundred fifty-one patients were enrolled in the study. There was no significant difference in the rates of successful initial anesthesia with TAC (89%) and lidocaine (79%). TAC was significantly better (P less than .002) with regard to patient compliance with the suturing process than lidocaine or placebo. Seventeen percent of patients who received placebo had initial anesthesia. These results suggest that TAC, when applied correctly, may be the preferred anesthetic for laceration repair in children.
Administration, Topical↗
Duration of fever prior to onset of a simple febrile seizure: a predictor of significant illness and neurologic course.
This study tested the hypothesis that the duration of fever prior to the onset of a simple febrile seizure may be an important clinical variable with respect to patient outcome. The duration of fever prior to seizure according to patient history was defined as either long (greater than or equal to 24 hours) or short (less than 24 hours). We hypothesized that simple febrile seizures which occur with a history of a fever of long duration (LDF) are more likely to be associated with a significant illness at presentation or a subsequent neurologically abnormal course than are simple febrile seizures which occur with a history of a fever or short duration (SDF). Of 100 cases which met study criteria for simple febrile seizures, nine had a LDF and 91 had a SDF prior to the development of a seizure. No statistical differences in age, sex, maximum fever recorded in the emergency department, duration of seizure, WBC, or electrolytes were found between patients with SDF and LDF (P less than 0.01). Of the nine patients with a LDF, all had either a significant illness at the time of initial visit or a subsequent neurologically abnormal course. Of the 91 patients with a SDF, 88 had a good outcome, while two had a significant illness at the time of visit, and one had a subsequent neurologically abnormal course. These results suggest that children with a history of LDF prior to the occurrence of a simple febrile seizure are more likely to have a serious illness at presentation or a subsequent neurologically abnormal course than are children with seizures which occur with a history of SDF.
Bacterial Infections↗
Effector mechanism of tumor immunity in murine plasmacytoma.
The development of concomitant tumor immunity to plasmacytoma (PC) was previously demonstrated by the detection of splenic immune T-lymphocytes that inhibited the growth of PC in local adoptive transfer (Winn) assay. This immunity was down-regulated by cyclophosphamide-sensitive suppressor T-cells. The effector mechanism was further studied. It was found that immune spleen cells contained no cytotoxic T-lymphocytes as determined by 51Cr release assay. Immune spleen cells, however, exerted a cytostatic effect on PC cells in vitro; coculture of immune spleen cells with PC cells inhibited the [3H]thymidine uptake by tumor cells. No in vitro generation of cytolytic activity was observed. The cytostatic effector cells were found to be radiosensitive, nonadherent, Thy-1+, Lyt-1-2+ lymphocytes that required direct cell-cell contact for cytostasis. Plasmacytoma arising from transplants of mixtures of PC cells and immune spleen cells had a slower growth rate in vivo and incorporated less [3H]thymidine in vitro, findings consistent with the cytostatic effect of immune spleen cells. Studies comparing cytostatic cells assayed in vitro and immune splenic effector cells assayed in vivo (Winn assay) revealed that the former were short-lived (less than 26 days), high dose cyclophosphamide (200 mg/kg) resistant, and cross-reacting to other PC, whereas the latter were long-lived (greater than or equal to 102 days), high dose cyclophosphamide sensitive, and individual tumor specific. Immune spleen cells, however, could inhibit heterologous PC growth in vivo, if the homologous PC were also present. These findings are consistent with the hypothesis that the concomitant tumor immunity in PC involves terminal cytostatic effector T-cells with a broader target spectrum and tumor-specific helper T-cells that are required for clonal expansion and maturation of cytostatic cells in vivo.
Animals↗
The influence of steroid hormones on the uterine cervix during pregnancy.
This paper reviews the evidence concerning the actions of steroid hormones on the connective tissues of the pelvis. Most available data concern the effects of steroids on the cervix. The time course of cervical softening in rats, sheep and humans suggests the possibility that the changes in connective tissue biochemistry that underlie the physiological phenomenon of cervical softening are under hormonal control. Both oestrogens and progestogens have been implicated in the control of cervical softening. However, recent experiments using inhibitors of 3 beta-hydroxysteroid dehydrogenase suggest that cervical softening can be produced in both sheep and humans by progesterone withdrawal in the absence of high circulating concentrations of oestradiol-17 beta.
3-Hydroxysteroid Dehydrogenases↗
Latent oculogenital infection with Chlamydia trachomatis.
Thirty patients attending a sexually transmitted disease clinic were evaluated for genital and ocular infection with chlamydia. Eight patients had positive conjunctival immunofluorescent staining. This represents an asymptomatic, latent carrier state with important epidemiologic considerations.
Chlamydia Infections↗
Haemophilus influenzae type b unsuspected bacteremia.
To further define the clinical features and natural history of unsuspected Haemophilus influenzae type b (Hib) bacteremia, we retrospectively reviewed the records of 322 Hib infections observed during a 45-month period at Children's Hospital, Boston. We identified 31 patients with unsuspected Hib bacteremia and 19 with unsuspected Hib antigenemia and sterile blood cultures. Bacteremic patients were typically under two years of age (81%), had high fevers (mean = 39.5 degrees C), and frequently had otitis media (65%) diagnosed as their only focus of infection at presentation. Nineteen of 31 were empirically treated with oral antibiotics. Ten of 31 (32%) developed focal infectious complications consisting of meningitis (n = 7), cellulitis (n = 2), and pneumonia (n = 1). Children with focal infectious complications differed from those without infectious complications in having a significantly higher mean fever of 40.3 degrees C compared to 39.7 degrees C (P less than 0.05). Five of 19 (26%) empirically treated patients developed focal complications (all meningitis) compared to five of 12 (42%) untreated patients. Blood cultures at follow-up visit were positive in three of 19 (9%) treated patients and seven of 12 (42%) untreated patients (P less than 0.05). Of the 19 children with antigenemia and sterile blood cultures, 16 (84%) were empirically treated with antibiotics, and none had positive blood cultures or focal infections on follow-up evaluation. Children with occult Hib bacteremia are at high risk for developing serious focal infections, particularly meningitis, despite empiric antibiotic therapy. Once Hib bacteremia is suspected, strong consideration should be given to parenteral in hospital antibiotic therapy. The utility of rapid antigen detection for identifying high-risk patients requires further evaluation.
Antigens, Bacterial↗
Increase in cervical extensibility during labor induced after isolation of the cervix from the uterus in pregnant ewes.
Surgical transection of the cervix was done on eight ewes in late pregnancy. This procedure resulted in most of the length of the cervix being mechanically disconnected from the uterus. Labor was induced by injection of dexamethasone phosphate into a fetal hind limb during operation in four of the eight ewes. The success of the induction of labor was confirmed by observation of increased uterine activity and by measurement of the concentrations of progesterone and 17 beta-estradiol in peripheral plasma. Ewes were put to death approximately 48 hours after injection of dexamethasone and the extensibility of the isolated portion of the cervix was determined. Cervices taken from ewes in which labor had been induced were found to have softened considerably compared to control cervices taken from ewes in which the cervix had been transected without induction of labor. The results suggest that cervical softening can still occur during labor in the absence of any direct mechanical or local vascular connection between the cervix and uterus.
Animals↗
Population structure in the Connecticut Valley: II. A comparison of multidimensional scaling solutions of migration matrices and isonymy.
In a previous paper (Swedlund et al., 1984) we have described the population structure of the historical Connecticut River Valley of Massachusetts in terms of matrimonial migration matrices. Using procedures described by Morton (1973), Harpending and Jenkins (1974), Jorde (1980), and others the exchanges between subdivisions which make up the matrices are made column stochastic and analyzed to predict genetic kinship. Subsequently the kinship estimates within and between subdivisions can be interpreted as genetic covariance and compared to the actual geographic distances between the respective subdivisions using a principal components analysis. In the present paper we extend these results by applying nonmetric multidimensional scaling to the migration matrices, and to isonymy matrices based on the same communities. We demonstrate that the multidimensional scaling configurations of marital migration represent the actual geographic relationships between the communities quite effectively for this particular case study from historical Massachusetts. Moreover, we argue that while these migration data may provide good estimates of social and genetic exchange between the subdivisions, surname analysis may also be informative of processes not revealed in the migration matrices alone.
Demography↗
Effect of inhibition of prostaglandin synthesis on cervical softening and uterine activity during ovine parturition resulting from progesterone withdrawal induced by epostane.
The effects of an inhibitor of 3 beta-hydroxysteroid dehydrogenase (epostane) on uterine activity and cervical softening have been studied in eight sheep during late pregnancy. Treatment with epostane led to a rapid decline in the concentration of progesterone measured in utero-ovarian venous plasma, to less than 10% of the pretreatment value within 30 min of bolus injection. This was followed by a significant (P less than 0.02) increase in the concentrations of metabolites of prostaglandins E and F in utero-ovarian venous plasma and uterine activity similar to that seen in the final stages of normal labour. Measurements of cervical tissue extensibility made ex vivo showed the cervix to have softened considerably. These changes occurred without any significant change in the concentration of oestradiol-17 beta in utero-ovarian venous plasma. Infusion of mefenamic acid, an inhibitor of prostaglandin synthesis, prevented the changes in uterine activity and cervical softening that occurred after injection of epostane alone. Mefenamic acid also reduced the increase in concentrations of metabolites of prostaglandins E and F in plasma, although the concentration of progesterone in these animals showed the same abrupt fall which occurred in sheep after injection of epostane alone. These results suggest that progesterone withdrawal, in the absence of any subsequent rise in circulating oestrogen concentrations, is sufficient stimulus to induce cervical softening in the ewe. Cervical softening following progesterone withdrawal can be prevented by inhibition of prostaglandin synthesis.
3-Hydroxysteroid Dehydrogenases↗
Splenic immune effector and suppressor cells in mice bearing a growing plasmacytoma.
The occurrence of tumor immunity in mice bearing a growing plasmacytoma (PC) was studied by local adoptive transfer assay. Spleen cells from mice with a large PC but not with a nonpalpable or small PC retarded and often inhibited entirely the growth of homologous PC. They occasionally caused late regression of growing homologous and heterologous PC. The individual tumor-specific immune effector cells were found to be radiosensitive, non-adherent, Thy 1-positive T-cells. They were resistant to treatment of mice with high-dose cyclophosphamide (CTX). Their generation, however, was abrogated by low-dose CTX and irradiation at the early stage of their development. Spleen cells from PC-bearing mice treated with high-dose CTX were enhanced in their effector activity, suggesting the co-existence of CTX-sensitive suppressor cells. The suppressor cells could be demonstrated in spleens of mice bearing a heterologous PC and were found also to be radiosensitive, non-adherent, Thy 1-positive T-cells. Their generation was blocked by treatment of mice with CTX during the early stage of PC development. These findings provide evidence for the occurrence of immune effector T-cells in mice with a growing PC. This immunity appears to be down-regulated by CTX-sensitive suppressor cells.
Animals↗
Oestrogens, prostaglandins, and cervical ripening.
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Animals↗
Concentrations of the prostacyclin metabolite, 6-keto-prostaglandin F1 alpha, in amniotic fluid during late pregnancy and labour.
Concentrations of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha, the stable metabolite of prostacyclin, PGI2) have been measured in amniotic fluid obtained during late pregnancy and labour. Samples taken at amniotomy during spontaneous labour contained a significantly greater concentration of 6-keto-PGF1 alpha than samples taken at amniotomy before the onset of labour (p less than 0.01). There was no correlation between the level of 6 keto-PGF1 alpha in amniotic fluid before labour and gestational age (p greater than 0.1). It is suggested that prostacyclin may have a functional role in the mechanism of parturition in man.
Amniotic Fluid↗
The effect of cervical encerclage on plasma prostaglandin concentrations during early human pregnancy.
In women having either cervical encerclage under general anaesthesia or a vaginal examination in the early second trimester of pregnancy, peripheral plasma levels of 13,14-dihydro-15-keto prostaglandin F (PGFM) were measured before and after each procedure. A significant rise in circulating levels of PGFM was found within minutes of completing cervical encerclage but not after vaginal examination or induction of general anaesthesia.
Anesthesia, General↗
Melatonin in the maternal and umbilical circulations during human parturition.
The concentration of melatonin in maternal peripheral plasma was measured during late pregnancy, term and pre-term labour. There was a small increase in the mean concentration of melatonin during labour which was significant in term labour. Umbilical arterial and venous plasma, whether obtained at term, after spontaneous vaginal delivery or at Caesarean section, contained significantly greater concentrations of melatonin than maternal plasma. A significant arterio-venous difference was demonstrated for both groups of umbilical samples with raised venous levels after spontaneous vaginal delivery but higher arterial levels at Caesarean section.
Cesarean Section↗
The effect of danazol on menorrhagia, coagulation mechanisms, haematological indices and body weight.
Eighteen patients with objective evidence of menorrhagia (more than 80 ml menstrual blood loss) were treated with danazol for twelve weeks. Danazol significantly reduced the menstrual blood loss from 231 +/- 39 ml (mean +/- SEM) to 135 +/- 33 ml in the first treatment month and the mean loss thereafter was only 21 ml and 3 ml for the second and third months respectively. A rapid increase in haemoglobin level and a reduction in the number of days of bleeding were also observed on danazol treatment. No important effect on the coagulation profile was observed during the period of study. Three months after stopping danazol, menstrual blood loss (103 +/- 27 ml) was still significantly less than the pre-treatment loss.
Adult↗
Changes in coagulation factors in postmenopausal women on ethinyl oestradiol.
Coagulation factors II, VII, X, VII + X complex and anti-thrombin III were measured in 10 postmenopausal women before, during and after a four-month course of 20 microgram daily of ethinyl oestradiol, taken three weeks in four. Factors VII, X and VII + X complex rose significantly during treatment but only factor X levels were significantly elevated at the end of the four-month treatment period. There was no change in factor II or anti-thrombin III levels. These effects on coagulation factors during ethinyl oestradiol therapy are, in general, similar to those found during treatment with conjugated equine oestrogens and oestradiol valerate in a previous study from the same laboratory. It seems likely that equipotent doses of ethinyl oestradiol and 'natural' oestrogens have similar effects on these coagulation factors.
Antithrombin III↗