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Biomedical subjects

A F Lee

Publications and source records attributed to A F Lee.

11 recordsLinked to original sources

Adrenal corticosteroid secretion in fetal sheep: pulsatile pattern at rest.

This study was undertaken to define the resting pattern of fetal pituitary-adrenocortical function. Experiments were performed at 127-145 days gestation in fetal sheep with chronic peripheral and adrenal cannulas inserted under halothane anesthesia. With the fetus in a baseline state, over 6 h, at 30-min intervals, maternal and fetal peripheral samples were collected for blood gases and cortisol (F), corticosterone (B), and adrenocorticotropic hormone (ACTH) concentrations, and three successive, 2-min adrenal samples were collected for determination of F and B secretion rates. We observed high-frequency, episodic bursts of F secretion. A lower frequency oscillation of F secretion, with a period of approximately 90 min, was defined by cosinor analysis. The mean amplitude of the oscillation increased from 45 to 507 ng/min with advancing gestation. The pattern of B secretion was similar to that for F but was quantitatively lower. An oscillatory period of approximately 90 min for plasma F was present in a majority of experiments. Pulsatile rhythms for ACTH were defined in 10 of 14 experiments, with periods ranging from 1.64 h in the least mature group to 2.37 h in the oldest fetus. Mean data revealed exponential increases in both F secretion and plasma ACTH from 129 to 145 days gestation.

Activity Cycles

Intramuscular versus intravenous ritodrine hydrochloride for preterm labor management.

A prospective, interinstitutional comparative trial was undertaken to examine the efficacy, safety, and pharmacodynamics of different administration routes of ritodrine hydrochloride for the management of preterm labor. Forty-five subjects between 20 and 36 weeks' gestation received either intravenous (n = 24) or intramuscular (n = 21) therapy. Successful tocolysis occurred in 14 of 21 (67%) patients in the group treated intramuscularly and in 16 of 24 (67%) patients in the group treated intravenously. A greater mean dose (8.6 versus 3.3 mg/hour) and a higher mean serum concentration (38.9 versus 24.7 micrograms/ml) were needed to achieve successful tocolysis in the intravenous group as compared with the intramuscular group. Patients who did not respond to tocolytic therapy in both groups had levels of ritodrine in the blood either equivalent to or greater than those of subjects who were successfully treated. Analysis of ritodrine levels in the successfully treated intramuscular group demonstrated significant differences in blood levels depending on muscle group used. These differences can be at least partially attributed to higher mean doses administered to patients receiving vastus lateralis injections as compared with those receiving gluteal muscle injections. The results suggest that intramuscular administration of ritodrine is an efficacious and safe route of drug delivery. Additional studies are needed to better define dose-response curves for the intramuscular administration of ritodrine hydrochloride.

Buttocks

The relationship between sleep and sudden infant death.

Infants epidemiologically at high risk for SIDS demonstrate a variety of abnormalities in sleep-state organization, maturation, and sleep-state modulation of cardio-respiratory control mechanisms. These involve both the REM and quiet-sleep states and are seen in twins who have had no evidence of clinical cardio-respiratory compromise during infancy as well as in near-miss infants who have suffered serious cardio-respiratory failure. Although these infants have higher levels of REM sleep around 40 weeks, of special concern is the decrease in the maturation of the quiet system, which becomes evident after 44 weeks, and the reported quiet-sleep abnormalities in reflex control of respiration and arousal. The source of these abnormalities is environmental rather than genetic and most likely occurs prenatally. During the critical period for SIDS, infant sleep begins to coalesce from a series of naps to more prolonged night time sleep periods that last up to 8 hours. We believe that the ability to maintain physiologic homeostasis during prolonged sleep is a challenge facing infants who are epidemiologically at risk for sudden infant death. The challenge facing sleep research is the more complete understanding of the relationship between prolonged inhibition, homeostasis, arousal, and development.

Diseases in Twins

Open dorsal dislocations of the proximal interphalangeal joint.

Eighteen open dorsal dislocations of the proximal interphalangeal joint were treated in 17 patients over a 12-year period. The severity of this injury may be underestimated. Complications included synovitis, stiffness, septic arthritis, and loss of the digit. Factors associated with a poor prognosis included a concomitant injury to the hand, a fracture from the base of the middle phalanx, and treatment in the emergency room. For optimum results, we recommend antibiotic therapy, thorough debridement in the operating room, reattachment of the palmar plate and repair of the collateral ligaments if necessary, and temporary joint immobilization (3 weeks) followed by an aggressive range of motion program.

Adolescent

Electrical shock.

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Electric Injuries

The sleep state characteristics of apnea during infancy.

The sleep state characteristics of infant sleep apnea were studied in 36 twins examined by polygraphy at 40, 44, and 52 weeks after conception. The definition of sleep apnea is dependent upon the length of apnea, sleep state, and post-conceptional age. None of the infants had apnea longer than 20 seconds and apnea of 10 seconds or longer was uncommon. The attack rates for apneas 2 to 4.9 seconds long were highest in REM and lowest in qliet sleep. The attack rates for apneas 5 to 9.9 seconds long were equal in REM and indeterminate and lowest in quiet sleep. The percentage of infants with apnea of 10 seconds or longer at 40 weeks was highest in REM (27%) and indeterminate sleep (42%) and lowest in quiet sleep (12%). At 52 weeks, apnea 10 seconds or longer during REM decreased to 0%. The effect of maturation on apnea varies with sleep state. Over the period from 40 to 52 weeks, quiet sleep apnea was unchanged and indeterminate sleep apnea decreased only between 40 and 44 weeks. Although REM apnea 2 to 4.9 seconds long was unchanged, REM apnea 5 to 9.9 seconds long decreased between 40 and 44 weeks, and REM apnea of 10 seconds or longer decreased from 27% at 40 weeks to 0% at 52 weeks. This suggests that semi-independent apnea turn-on and turn-off mechanism operate during REM sleep. A correlation between brief apneas and the longer apneas was seen only during REM sleep. For all sleep states, there was no correlation between the levels of apnea of 5 seconds or longer at 40, 44, and 52 weeks.

Aging

Effect of tissue temperature on ulnar nerve conduction velocity in the dog.

The motor conduction velocity of the ulnar nerve of 19 mature dogs anesthetized with pentobarbital was electromyographically determined before and at tissue temperature decrements of 2 degrees (C) during cooling of the forelimb. Precooling (37 C) conduction velocity was 56 +/- 7.6 m/second (mean +/- standard deviation). At a tissue temperature of 20 C, conduction velocity was reduced to 31 +/- 6.3 m/second. Regression analysis indicated that conduction velocity decreased linearly by 1.7 m/second for each degree of decrease in tissue temperature between 37 and 20 C.

Aged