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Biomedical subjects

A J Scalzo

Publications and source records attributed to A J Scalzo.

14 recordsLinked to original sources
PubMed2000

Poison prevention counseling: a comparison between family practitioners and pediatricians.

OBJECTIVES: To compare the current opinions and practices of family practitioners with those of pediatricians regarding poison prevention anticipatory guidance (PPAG) and to further assess which factors, if any, are associated with providing counseling on this topic. DESIGN: Cross-sectional mail survey. PARTICIPANTS: Family practitioners and pediatricians throughout the United States and Puerto Rico, randomly selected from the membership list of the American Medical Association. MAIN OUTCOME MEASURE: Reported frequency of providing parents with PPAG. RESULTS: Of the 1000 physicians surveyed, 975 were eligible and 500 returned surveys that could be analyzed (227 family practitioners and 273 pediatricians), for a response rate of 51.3%. The majority of physicians in each field (family practice, 81.9%; pediatrics, 87.2%) reported that they believe it is their responsibility to provide PPAG to parents (P = .08). Family practitioners, however, were less likely than pediatricians to provide parents with PPAG (66.5% vs 91.9%; P<.001). When adjusted for other variables, such as age and sex, family practitioners were 5.4 times less likely than pediatricians to provide parents with PPAG (odds ratio, 0.19; 95% confidence interval, 0.09-0.37). Family practitioners, more often than pediatricians, cited lack of training on poisoning prevention as a reason for not providing parents with PPAG (46.1% vs 18.2%; P = .02). Among all physicians, those who received postresidency training on PPAG were more likely to provide PPAG than those who had not received postresidency training on this topic (odds ratio, 3.21; 95% confidence interval, 1.44-7.18). Having received residency training on poisoning prevention, however, did not increase the likelihood of providing PPAG (odds ratio, 1.69; 95% confidence interval, 0.86-3.30). CONCLUSIONS: Although it is currently recommended to include PPAG as part of the routine preventive pediatric care, this study shows that one third of family practitioners do not provide parents with PPAG. Family practitioners should increase their efforts aimed at poisoning prevention. Those involved with training residents in family practice and pediatrics should place greater emphasis on this topic to increase the impact of this training on actual PPAG practices.

Adult↗
PubMed1998

Carbon monoxide mass exposure in a pediatric population.

OBJECTIVES: To describe the outcomes of a mass carbon monoxide (CO) intoxication, and to calculate the CO half-life in a pediatric school-aged population. METHODS: A retrospective chart review was performed based on Regional Poison Center database information, hospital laboratory data, and medical records of the pediatric patients who sought care at one of 3 St. Louis area hospitals, after exposure to high levels of CO. Exposures occurred on January 5, 1996, after evidence of a CO leak was discovered at an area elementary school. Charts were reviewed for major demographics, symptoms reported, carboxyhemoglobin (COHb) levels and times, and level of effect. RESULTS: Information about 177 (35%) of the 504 children in attendance at school that day was available. Mean age was 8.7 +/- 1.8 years (range 4-12 years). Symptoms were present in 155 (88%) of the 177 children for whom data were available. Initial COHb levels were obtained for 147 (83.1%) of the 177 children. First mean COHb level was 7.0% (95% CI = 6.6-7.5%). Second COHb level was obtained for 26 children with a mean of 2.7% (95% CI = 2.2-3.2%). Calculated half-life of COHb, on 100% O2 at 1 atm, was 44.0 minutes (95% CI = 39.6-48.2 minutes). CONCLUSION: Some children had symptoms at COHb levels that traditionally have been considered nontoxic. The elimination of COHb was found to be more rapid in this population of children than reported in other studies.

Carbon Dioxide↗
PubMed1996

Fatal accidental dibucaine poisoning in children.

Dibucaine is a potent amide anesthetic available in over-the-counter preparations. Compared with lidocaine, substantially lower doses of dibucaine may result in seizures, dysrhythmias, and death. We present three fatal cases of accidental dibucaine ingestion in children and discuss the toxicity, treatment, and prevention of such ingestions.

Administration, Oral↗
PubMed1996

Marked hypocalcemia and ventricular fibrillation in two pediatric patients exposed to a fluoride-containing wheel cleaner.

In two separate cases, pediatric patients exposed to Armor-All Quicksilver Wheel Cleaner exhibited systemic toxicity including mental status changes, marked hypocalcemia, and ventricular fibrillation. One child also demonstrated profound hypomagnesemia. These are the first pediatric reports of near-fatal outcomes after ingestion or inhalation of a hydrofluoric acid-like product, namely, ammonium bifluoride.

Ammonium Compounds↗
PubMed1994

Phase II trial of piroxantrone in metastatic gastric adenocarcinoma.

Piroxantrone, a synthetic intercalating agent, was studied in patients with advanced, measurable gastric adenocarcinoma who had not received prior chemotherapy. The starting piroxantrone dose was 150 mg/m2 given intravenously over 1 hour on day 1 and repeated every 21 days. Response and toxicity could be evaluated in 15 patients. No complete, partial, or minor responses were observed. Toxic effects included granulocytopenia, anemia, vomiting, nausea, anorexia, fatigue, stomatitis, alopecia, hyperbilirubinemia, and increased alkaline phosphatase levels. At the stated dose and schedule, piroxantrone does not possess significant activity against advanced gastric cancer.

Adenocarcinoma↗
PubMed1990

Extracorporeal membrane oxygenation for hydrocarbon aspiration.

Extracorporeal membrane oxygenation is a pulmonary bypass procedure that has been employed in adults to provide temporary treatment for reversible acute pulmonary and cardiac insufficiency. The technology of membrane oxygenation has been used since 1977 in neonates with predictably fatal pulmonary failure due to respiratory distress syndrome, persistent fetal circulation or persistent pulmonary hypertension of the newborn, meconium aspiration syndrome, and congenital diaphragmatic hernia. The use of extracorporeal membrane oxygenation in older children with other pulmonary disorders has been limited. We report two cases of hydrocarbon aspiration involving petroleum-based products, both successfully treated with extracorporeal membrane oxygenation. A 15-month-old male infant who aspirated baby oil (light mineral oil) is particularly unusual owing to the generally expected low risk of aspiration with a hydrocarbon of such viscosity (greater than 60 Saybolt Universal Seconds). The second patient is a 16-month-old male infant who aspirated furniture polish (mineral seal oil). In both children severe intractable hypoxemia developed despite intensive ventilatory support, and they became candidates for alternative therapy. Extracorporeal membrane oxygenation provides a potentially life-saving option when a patient fails to respond to conventional therapy for hydrocarbon aspiration.

Extracorporeal Membrane Oxygenation↗
PubMed1989

The use of neuroendocrine immunoperoxidase markers to predict chemotherapy response in patients with non-small-cell lung cancer.

Small-cell lung cancer (SCLC), a chemotherapy-responsive disease, is characterized by neuroendocrine properties. In contrast, non-small-cell lung cancer (NSCLC) is at best moderately responsive to chemotherapy, and only 10% to 20% of cases demonstrate neuroendocrine properties. The present study is a retrospective analysis of the use of immunoperoxidase markers for neuron-specific enolase (NSE), Leu-7, and chromogranin A in NSCLC patients treated with chemotherapy. It was designed to determine if the presence of neuroendocrine markers predict for response to chemotherapy. The diagnostic slides and blocks were obtained on 52 NSCLC patients who were treated with chemotherapy (26 responders and 26 nonresponders). Immunoperoxidase studies were performed, and slides were scored without knowledge of the patient's response. Markers were positive in responders and nonresponders, respectively, as follows: NSE, 14 of 26 (54%) versus seven of 26 (27%), P = .04; Leu-7, 11 of 25 (44%) versus five of 26 (19%), P = .08; and chromogranin A, three of 26 (12%) versus 0 of 26 (0%), P = .71. Two markers were positive in 10 of 26 responders (38%) and 0 of 26 nonresponders (0%), P less than .01. Responders with two or more positive markers showed superior survival (median, 79 weeks) compared with responders with fewer than two positive markers (median, 51 weeks) and nonresponders (median, 27 weeks). These data suggest that the presence of neuroendocrine markers in NSCLC is associated with an increased likelihood of response to chemotherapy and may add to the standard parameters (performance status, weight loss) used to select patients for chemotherapy.

Adult↗
PubMed1987

Thrombotic thrombocytopenic purpura: treatment with plasmapheresis.

Twenty-one episodes of thrombotic thrombocytopenic purpura (TTP) were treated with plasmapheresis. Adjunctive agents included corticosteroids, aspirin, dipyridamole, and vincristine. There were 17 patients; 12 were female. The median age was 41 years. Most patients presented with neurologic symptoms. Thrombocytopenia was profound with a mean initial platelet count of 14,900/mm3. The mean hematocrit on presentation was 26.7% and the mean LDH 1300 IU/L. Eighteen episodes responded completely following plasmapheresis/plasma exchange (86%). Response was prompt, the initial rise in platelet count occurred after a mean of four exchanges, and complete response (a platelet count over 150,000/mm3) was obtained after a mean of nine exchanges. Four of the episodes treated were relapses that occurred in three patients. All responders are alive with a median duration of follow-up of 20 months. The three patients who failed to respond have died. This report extends recent observations that the addition of plasmapheresis/plasma exchange to the therapy of TTP has significantly improved the outlook for patients with this disorder.

Adrenal Cortex Hormones↗
PubMed1982

Unusual cause of increased intracranial pressure from metastatic germ cell cancer.

Metastatic lesions within the brain parenchyma are usually responsible for the development of increased intracranial pressure in patients with metastatic cancer. The lesions can usually be easily documented by computerized axial tomography (CT) of the head. Other causes must be sought in patients with metastatic cancer who present with signs of increased intracranial pressure and whose CT scan of the head fails to reveal any parenchymal lesions. Cranial metastases obstructing venous outflow from the brain may present in this manner.

Adult↗
PubMedDate not supplied

Malposition of pediatric gastric lavage tubes demonstrated radiographically.

Gastric lavage may be indicated in the initial treatment of toxic substance ingestion. We retrospectively surveyed the charts of 36 pediatric patients who underwent gastric lavage to evaluate the clinical and radiographic evidence indicating proper tube placement. Only 14 patients had a radiograph prior to lavage, and 50% of these documented malposition. The most common was excess tube insertion, stretching the stomach inferiorly towards the pelvis. The traditionally acceptable clinical test by auscultation of insufflated air was favorable in 100% of patients, thus failing to detect all of the malpositionings documented radiographically. We suggest that initial insertion of tube length be based on the patient's height or length using an adaptation of Strobel's previously published formula for esophageal pH probe placement: Tube Insertion Depth (TID), orogastric = 9.7 cm + (0.226 x length of patient in cm) and TID, nasogastric = 8 cm + (0.252 x length of patient in cm). These formulae have been displayed in graphic form for easy use. Diagnostic imaging remains the only certain means to document tube placement. Prospective studies to validate the formulae in clinical use are ongoing.

Adolescent↗
PubMedDate not supplied

Behavioral therapy for urinary incontinence.

Urinary incontinence is a serious and costly problem that affects many patients, especially the elderly. Because this population is growing, many methods of treatment for urinary incontinence have been developed. However, even though the behavioral techniques have been available for years, only recently has the use of formal behavioral methods become more popular as a less invasive alternative for the treatment of incontinence. These methods have proven effective in several series. This article reviews the treatment of types of urinary incontinence with behavioral therapeutic techniques.

Behavior Therapy↗