Cardiac injury from an air gun pellet: a case report.
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Child↗
Biomedical subjects
B S Alpert
Publications and source records attributed to B S Alpert.
Renin-angiotensin-aldosterone system in healthy subjects aged ten to eighteen years.
We obtained normative data for plasma renin activity (PRA) and plasma aldosterone concentration from a biracial sample of 195 healthy, normotensive children and adolescents aged 10 to 18 years. The sample included 119 boys and 76 girls, of whom 103 were black and 92 were white. The mean PRA value (+/- SD) was 2.52 +/- 1.95 ng/ml per hour, with minimal and maximal values of 0.1 and 13.50 ng/ml per hour. The mean plasma aldosterone concentration was 12.56 +/- 8.59 ng/ml, with minimal and maximal values of 1.6 and 50.1 ng/ml. We also examined the effects of subject characteristics and electrolyte intake. The slope relating sodium excretion to PRA was negative and highly significant (slope = -0.01; p < 0.003). The slope relating PRA to plasma aldosterone concentration was positive and highly significant (slope = 1.59; p < 0.0001). We did not observe differences in either variable as a function of age, sex, race, or family history of hypertension. These results suggest that differences based on race and family history of hypertension observed in adults are not present in youth.
Adolescent↗
Racial aspects of blood pressure in children and adolescents.
The incidence, prevalence, and severity of essential hypertension are higher in minority adult populations, especially black Americans. Studies have not uniformly shown that black children and adolescents have higher blood pressure values than whites of the same age. The goal of this article is to review data available comparing minority and white populations. A section discussing studies addressing racial differences in related topics is included to demonstrate the existing fields of research that may not be familiar to the general pediatrician.
Adolescent↗
Salvage of wounds following failed tissue transplantation.
During the past 20 years, 972 microvascular transplantations have been performed for 783 patients, with an overall failure rate of 6.2 percent. Fifty-four of the 60 failed transplantations were available for long-term follow-up and were retrospectively reviewed with respect to the original indications for transplantation, the number, and the type of salvage procedures performed following transplant failure. This study illustrates that the choice of salvage procedures performed following transplant failure depends on the original indications, the location, and the severity of the resultant wound. Failure following transplantation for coverage of contour defects or unstable wounds can often be managed by non-microsurgical methods. In contrast, when the indications for transplantation included the transfer of specialized tissues for thumb or digit reconstruction, the restoration of motor or sensory function, or the coverage of a limb-threatening wound, requirements for reconstruction could be satisfied only by a second successful tissue transplant. Eighteen of the 54 cases underwent an additional transplantation, with an 89 percent success rate.
Adolescent↗
Ambulatory blood pressure patterns in youth.
We examined the influence of sex, race, and age on ambulatory blood pressure (BP) patterns in youths. The subjects were 300 normotensive, healthy adolescents between the ages of 10 and 18 years, including 160 boys and 140 girls, of whom 149 were white and 151 were black. The data were divided into periods of activity (Period I: 8 AM to 10 PM) and inactivity (Period II: 10 PM to 8 AM). Boys had higher systolic BP during both Period I (117 +/- 11 nu 112 +/- 8 mm Hg; P < .05) and Period II (109 +/- 11 nu 106 +/- 10 mm Hg; P < .03). Blacks had higher systolic (108 +/- 10 nu 106 +/- 10 mm Hg; P < .01) and diastolic BP (63 +/- 8 nu 60 +/- 7 mm Hg; P < .003) during Period II. Interactions between race and age were found for both systolic (P < .005) and diastolic (P < .005) BP during Period II. Further analyses indicated associations between age and both systolic (beta = 1.16; P < .001) and diastolic (beta = 1.04; P < .0001) BP in black but not white subjects. An interaction was observed between sex and age for systolic BP during Period II (P < .005), with a relationship for boys (beta = 1.47; P < .001) but not for girls. These results suggest that the black adolescents showed a progressive increase in nocturnal BP with age, a pattern not observed in the white youths. This increased BP load may contribute to the early development of hypertension and BP-induced target organ damage in blacks.
Adolescent↗
Unrecognized injuries in patients referred for emergency microsurgery.
Replantation of amputated parts and emergency microvascular repair of injured extremities are the two most common applications of clinical microsurgery. A major complication of emergency referral of such cases is the existence of the other injuries unrecognized at the time of initial evaluation. We have reviewed this complication within a series of emergency microsurgical cases referred to this unit. Several reports examining this problem of missed injuries exist in the general trauma literature. To our knowledge this study is the first to look at this important problem in the context of acutely injured patients referred for emergency microsurgery. A retrospective analysis of patients referred to Davies Medical Center over a 7-year period was performed. Nine of 1100 patients (0.8%) transferred to our unit for microsurgical evaluation and treatment had unrecognized coexisting injuries that put those patients at high risk for injury-specific morbidity and demanded immediate changes in the original care planned at the time of referral. Brief case histories of these patients are outlined. We review the trauma literature of such injuries. A concise protocol elucidating the guidelines and pitfalls of emergency microsurgical referral is offered.
Adolescent↗
Assessment of ventricular performance after chronic beta-adrenergic blockade in the Marfan syndrome.
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Adolescent↗
A prospective study of familial aggregation of blood pressure in young children.
In a prospective study, we evaluated familial aggregation of blood pressure in a sample of 175 normotensive families with children 3 to 6 yr old. Systolic and diastolic blood pressure measurements of parents and children were correlated at 1, 2, and 3 yr intervals. Spearman rank-order correlation coefficients between parents and children were significant for mother-son pairs. In particular, mother-son blood pressure correlation coefficients were significant for systolic blood pressure across all 3 yr and for diastolic blood pressure during yr 2. Further analyses were performed adjusting for body mass index (BMI), age, physical activity, sodium intake, potassium intake, and parental smoking status, and alcohol use. The Spearman correlation coefficients for mother-son pairs remained significant for yr 1 and 3 after adjusting for these blood pressure correlates. These results are consistent with cross-sectional studies and suggest that both genetic and environmental contributions to blood pressure status are important in young children.
Adult↗
Recipient vessels for microvascular transplants in patients with hemifacial microsomia.
Hemifacial microsomia is a developmental abnormality involving structures derived from the first and second branchial arches. Microvascular transplants are increasingly being used to improve facial contour in patients with this condition. We have reviewed 9 patients with this abnormality to determine which recipient vessels have been used. In 6 patients, the facial vessels were located and used for flap revascularization. In 3 patients, the facial vessels could not be identified intraoperatively, and the occipital artery and a branch of the external jugular vein were used as recipient vessels. In this series of hemifacial microsomia patients, therefore, the facial vessels could not be located in 3 patients. We recommend that surgeons performing microsurgical transplants in cases of hemifacial microsomia be prepared to explore the external carotid and external jugular systems for recipient vessels.
Face↗
Improved salvage of complicated microvascular transplants monitored with quantitative fluorometry.
Quantitative fluorometry has been used to monitor circulation in transplanted toes and cutaneous flaps in our unit since 1982. Analysis of 177 uncomplicated transplants monitored by quantitative fluorometry shows that this technique has low false indication rates for arterial occlusion (0.6 percent of patients) and venous occlusion (6.2 percent of patients). None of these patients was reexplored because of a false monitor reading, and except for single abnormal sequences, monitoring appropriately indicated intact circulation throughout the postoperative period. Quantitative fluorometry has correctly indicated vascular complications in 21 (91.3 percent) of 23 transplants over an 8-year period. The salvage rate (85.7 percent) of the fluorescein-monitored reexplored transplants was significantly higher than the salvage rates of similar reexplored transplants not monitored with fluorescein and of reexplored muscle flaps (which cannot be monitored with the fluorometer used at this unit). These clinical data indicate that quantitative fluorometry is a valid and useful postoperative monitor for transplanted toes and cutaneous flaps.
Fluorometry↗
Ethnicity, pressor reactivity, and children's blood pressure. Five years of observations.
During the 5 years of this investigation, resting blood pressure and pressor reactivity were measured in 292 white children and 46 black children in 1987, 1988, 1989, and 1991. In 1987, all children were in the third grade; in 1991, the children were in the seventh grade. Reactivity was assessed with a standardized psychological stressor, a television video game. Children displayed significant stability of absolute blood pressure and heart rate reactivity between grades 3 and 7. At all examinations, black children demonstrated blood pressure reactivity that was significantly greater in magnitude (both absolute level and change from resting measurements) than that of white children. Black children exhibited significantly greater heart rate reactivity only when defined as change from the resting measurements; absolute levels of heart rate reactivity were comparable for blacks and whites. For black children, blood pressure reactivity in 1987 was the strongest predictor of resting blood pressure (both systolic and diastolic) in 1991. Among white children, resting blood pressure was the strongest predictor of future resting blood pressure. Further research is needed to determine if ethnic differences in children's pressor reactivity are associated with ethnic differences in the prevalence of hypertension.
Aging↗
Treatment of chronic osteomyelitis of the lower extremities with debridement and microvascular muscle transfer.
Of our 55 patients treated for lower extremity osteomyelitis, 91% underwent debridement and microvascular muscle flap coverage with eradication of their infections and restoration of ambulation. This series of patients helps to solidly establish the efficacy of this approach to the treatment of osteomyelitis.
Adolescent↗
Whether to measure change from baseline or absolute level in studies of children's cardiovascular reactivity: a two-year follow-up.
Blood pressure and heart rate were measured at rest and during a television video game in 399 healthy children. At the first assessment, children were in third grade and at the 2-year follow-up, they were in fifth grade. Children were classified according to race (black/white), gender (boy/girl), body mass index (light/heavy), and video game performance (low score/high score). Correlational analysis indicated that irrespective of the classification variable, absolute reactivity values, e.g., a heart rate of 110 bpm, tended to be more stable than change reactivity values, e.g., a heart rate change of 10 bpm. The greater stability of absolute values was most pronounced with systolic blood pressure. Absolute values were at least as stable as resting values and frequently demonstrated greater stability. Mean and maximal reactivities were correlated comparably. We conclude that children's reactivity is a stable characteristic and that, unless indicated by a priori hypotheses, the use of absolute values is preferable to the use of change values.
Arousal↗
Bad results after large toe to thumb transplantation.
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Amputation, Traumatic↗
Stability of ethnic differences in children's pressor responses during three annual examinations.
In this study, 395 healthy children had blood pressure and heart rate measured both at rest and during a stressful video game. Identical measurement procedures were used for three annual examinations. Consistently, black children demonstrated significantly greater pressor responses than white children. In view of the greater prevalence of hypertension among black adults than white adults, these data suggest that blacks exhibit hemodynamic irregularities well before the onset or diagnosis of hypertension.
Black People↗
Microsurgical tissue transfer in patients more than 70 years of age.
Between 1982 and 1989, three women and seven men older than 70 years of age underwent elective free-tissue transfer. Nonhealing wounds of 1 scalp, 2 upper extremities, and 7 lower extremities were covered with 3 serratus anterior, 3 latissimus dorsi, 2 gracilis, and 2 lateral arm flaps. Major coincidental medical problems included hypertension, congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, metastatic lung cancer, tachyarrhythmias, syncope, elevated liver function tests, and previous arterial bypass in the affected lower extremity. One flap failed and 2 others were compromised by venous thromboses but salvaged by reoperation. There were no major anesthetic complications. This series demonstrates that elective free-tissue transfers can be safely performed in patients older than 70 years of age.
Age Factors↗
Sequential multiple free flap transfers for reconstruction of devastating hand injuries.
Restoring function to a severely damaged hand can require complex reconstructions using multiple tissue transfers to replace skeletal, soft tissue, and nerve components. We present 2 patients with severe hand trauma treated with serial multiple flap transfers, an operative sequence not previously reported in detail. One patient underwent five flap transfers in three operations, whereas the second patient underwent four flap transfers in two operations. All the flaps survived. Total anesthesia time for these patients was 43.5 and 34.5 hours, respectively. Both patients obtained measurable functional restoration, and suffered no significant perioperative morbidity. These patients illustrate the clinical feasibility of serial multiple microvascular transplantations for complicated reconstructions.
Adult↗