Biomedical subjects
C C Berry
Publications and source records attributed to C C Berry.
Postnatal white matter necrosis in preterm infants.
One hundred twenty-seven infants less than 36 weeks of gestation (mean +/- SE = 31 +/- 3.2 weeks) were studied with echoencephalography to determine the incidence and complications associated with white matter necrosis. Ten infants (8%) developed cysts ten or more days after birth, indicating postnatal onset of white matter necrosis. Univariate analysis showed that postnatal white matter necrosis was significantly associated with maternal infection (other than urinary infection), respiratory distress syndrome, and longer requirement of an oxygen concentration greater than 40%. Forward logistic regression analysis showed postnatal white matter necrosis to be associated with maternal infection, chronic placental infarction, congenital pneumonia, and longer requirement of an oxygen concentration greater than 40%. Neurodevelopmental outcome was abnormal during infancy in 4 of the 6 survivors with postnatal white matter necrosis. Severe respiratory disease and maternal and/or fetal infection appear to increase the risk of the immature brain to white matter necrosis, predisposing the infants to subsequent neurodevelopmental delay.
Adverse reactions to contrast media. Ionic and nonionic media and steroids.
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BEACHES: an observational system for assessing children's eating and physical activity behaviors and associated events.
An integrated system for coding direct observations of children's dietary and physical activity behaviors was developed. Associated environmental events were also coded, including physical location, antecedents, and consequences. To assess the instrument's reliability and validity, 42 children, aged 4 to 8 years, were observed for 8 consecutive weeks at home and at school. Results indicated that four 60-min observations at home produced relatively stable estimates for most of the 10 dimensions. Interobserver reliabilities during live and videotaped observations were high, with the exception of "consequences" categories that occurred in less than 1% of observed intervals. Evidence of validity was provided by findings that antecedents were associated with respective dietary and physical activity behaviors. The five physical activity categories were validated by heartrate monitoring in a second study. The Behaviors of Eating and Activity for Children's Health Evaluation System is appropriate for studying influences on diet and physical activity in children in a variety of settings.
The development of a testicular self-examination instructional booklet for adolescents.
Testicular cancer (TC) is the most common cancer in 15-34-year-old males, but many young men are unaware of their risks, symptoms, and possibility of detection by testicular self-examination (TSE). After a pretest to determine baseline knowledge and TSE activity, 66 young men, 15-20 years old (means = 18.5 +/- 1.5), were given a programmed-learning self-instructional booklet to read. A posttest after completion of reading the booklet assessed attitudes and new knowledge. A 2-year follow-up tested knowledge and current TSE activity. Pretest analysis revealed that only 15% of the subjects were aware of their risks of TC, and only 6% had been taught TSE by a health professional. Subjects were unable to correctly identify the symptoms of TC, and only 1.5% reported regularly performing TSE. At 2-year follow-up, 95% (p less than .001) knew that a small lump was the most common symptom of TC, and 67% reported performance of TSE (p less than .001). These results suggest that adolescent males are not being taught about TC and TSE, and that our booklet is effective in teaching young men about TC risks and symptoms and how to perform TSE. This self-instruction method may be useful in health education classes for high school and college age youth.
Effect of normal MSAFP screening on maternal age for genetic amniocentesis.
Routine maternal serum alpha-fetoprotein (MSAFP) screening for neural tube defects is considered by many to be standard obstetrical care, and recently many have encouraged this test to screen for Trisomy-21 (Down's syndrome). We questioned whether, after a normal MSAFP screen, the risk of Trisomy-21 decreases enough to warrant modifying the recommended age for genetic amniocentesis for Down's syndrome. A logistic regression was developed which, using reported values for sensitivity and specificity for MSAFP detection of Trisomy-21 and assuming a constant threshold risk in opting for amniocentesis, indicates that genetic amniocentesis for Trisomy-21 may be deferred in some women who have a normal MSAFP screening. Sensitivity analysis of varying thresholds for a normal MSAFP demonstrates that a 37 year old woman with a median MSAFP level has the same risk for Trisomy-21 as an unscreened women who is 4.5 years younger. An abnormal MSAFP is useful in screening for neural tube defects and possibly for Trisomy-21. A normal MSAFP may allow for delaying the potentially risky amniocentesis in otherwise low-risk pregnancies.
A tutorial on confidence intervals for proportions in diagnostic radiology.
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Ionic vs nonionic contrast media: a proposal.
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Obstetrics--way back when!
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The failure of prehospital trauma prediction rules to classify trauma patients accurately.
Clinical prediction rules are used extensively by most regionalized trauma systems to identify which patients have sustained major injuries. Because of reported high misclassification rates of some of these rules and the known global difficulty of transporting prediction rules, four such rules (the Trauma Score, the CRAMS Scale, the Revised Trauma Score, and the Prehospital Index) and two newly derived rules were statistically analyzed using a cohort of 2,434 injured patients. All rules accurately predicted mortality with a minimum sensitivity and specificity of 85%. However, not one of the rules was able accurately to identify surviving patients who had sustained major injuries. In this instance, no rule was able to achieve a sensitivity of at least 70% while achieving a specificity of 70%. These results suggest that the problem with trauma prediction rules lies in the inherent limitations of the clinical data on which they are based. In view of this, the usefulness of existing prehospital trauma predictive rules must be questioned.
Interday reliability of function assessment for a health status measure. The Quality of Well-Being scale.
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Nonionic vs ionic contrast media: what do the data tell us?
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Internal Consistency Analysis: a method for studying the accuracy of function assessment for health outcome and quality of life evaluation.
Social, mental and physical function are major components of health outcomes and health related life quality, but the accuracy of function measurement is difficult to study rigorously. Internal Consistency Analysis (ICA) uses multiple sources of evidence from a survey interview to study the accuracy of a classification. It was developed to study function classifications for a general health outcome measure, the Quality of Well-being (QWB) scale. ICA is described and evidence of its utility in improving the classifications needed for the QWB is presented.
Protective effects of corticosteroids in contrast material anaphylaxis.
A prospective, randomized study of the potential protective effects of corticosteroids administered as pretreatment against contrast material (CM) reactions is reported. Patients (n = 6,763) from multiple institutions received either a single dose of steroids (32 mg of oral methylprednisolone, approximately 2 hours before CM challenge), a double dose (32 mg approximately 12 hours and 2 hours before CM challenge), or placebo. All contrast injections were with ionic media and were given intravenously. The two-dose (but not the one-dose) corticosteroid regimen provided significant protection. The effect on reaction incidences of a number of historical variables is also tabulated.
Trisomy 21 in newborn infants: chest radiographic diagnosis.
Chest radiographs of 30 infants with trisomy 21 and 881 unaffected infants were evaluated for the following findings common in trisomy 21: multiple manubrial ossification centers, 11 rib pairs, and a bell-shaped chest. Radiographs were obtained in the first 48 hours of life. Of the 881 unaffected infants, 85 (9.6%) exhibited multiple manubrial ossification centers; 46 (5.2%), 11 rib pairs; and 208 (23.6%), bell-shaped chest. Of the 30 infants with trisomy 21, 24 (80%) exhibited multiple manubrial ossification centers; ten (33%), 11 rib pairs; and 24 (80%), bell-shaped chest. The probability of trisomy 21 in routinely radiographed newborn infants is 0.05% when none of the three findings is present, 1.6% with multiple manubrial ossification centers alone, 0.2% with 11 rib pairs alone, and 0.7% with bell-shaped chest alone. The probability of trisomy 21 increases in patients with two findings and reaches 58.4% in patients with all three findings.
Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material.
The x-ray contrast mediums used over the past three decades have been salts of iodinated acids administered in highly hypertonic concentrations. We conducted a multiinstitutional randomized study of the protective effects of pretreatment with corticosteroids against reactions to intravenous contrast material. We gave 6763 patients two doses of oral corticosteroids (methylprednisolone, 32 mg) approximately 12 hours and 2 hours before challenge with contrast material, one dose of oral prednisolone approximately 2 hours before challenge, or placebo in the same dosages. The two-dose corticosteroid regimen, but not the one-dose regimen, significantly reduced the incidence of reactions of all types (P less than 0.05) except a category of reactions dominated by hives, for which the reduction approached significance (P = 0.055). In recent years, several relatively expensive monomeric nonionic iodinated compounds having approximately half the osmolality of the corresponding ionic compounds and a lower reaction rate have become available. With our two-dose corticosteroid regimen, the incidence of reactions necessitating therapy in patients receiving the ionic medium approximated that reported in an unblinded nonrandomized study of patients receiving a newer intravenous nonionic medium without corticosteroid pretreatment. We conclude that the much less expensive ionic medium, if administered with corticosteroid pretreatment, may serve as a reasonable alternative to intravenous nonionic medium, without loss of safety.
Relationship between human prostatic epithelial cell protein synthesis and tissue dihydrotestosterone level.
To evaluate the role of small amounts of prostatic tissue dihydrotestosterone (DHT) as a stimulus to epithelial cell protein synthesis, we studied tissue from 27 patients given various androgen-blocking drugs for 1 week before transurethral resection of the prostate (TURP) and measured epithelial protein synthesis and DHT levels in the tissue specimens. Test drugs before TURP included megestrol acetate 160 mg per day, with and without Tamoxifen 40 mg per day, or ketoconazole 1200 mg per day. The tissue was processed immediately and epithelial cells separated by digestion of tissue with 0.5% collagenase. After separation, epithelial cells were labelled with either 3H-leucine or L-35S-methionine. The DHT level was measured in whole prostatic tissue. Megestrol acetate alone and with tamoxifen significantly decreased both the incorporation of 3H-leucine into protein and the tissue concentration of DHT; megestrol acetate plus ketoconazole significantly decreased L-35S-methionine incorporation into protein and the DHT level. When the data correlating DHT with protein synthesis using both labelling techniques were combined, the curves were parallel and a strong correlation was noted between DHT and protein synthesis over a wide range of values (P less than 0.001). These results suggest that in hormone-dependent prostatic cancer even small amounts of prostatic DHT such as may occur from adrenal androgens following castration may significantly stimulate protein synthesis of the tumour epithelial cells.
Age, race, diagnosis, and sodium effects on the pressor response to infused norepinephrine.
We studied the blood pressure responses to infused norepinephrine in 34 normotensive and 21 unmedicated subjects with essential hypertension. The two groups were similar in age, relative body weight, and urinary electrolyte excretion. Patients were studied on two extremes of dietary salt (200 mEq Na and 10 mEq Na per day). The dose-response curves were highly linear (p less than 0.00001) for both systolic and diastolic blood pressures. There was no evidence for an increased sensitivity to infused norepinephrine among the hypertensive subjects. On the other hand, older subjects had steeper slopes (p less than 0.005). Subjects on a high salt diet had steeper slopes than those on low salt diets (p less than 0.0025); this trend was especially apparent among blacks (p less than 0.005). Black and white hypertensive subjects responded to the high salt diet in opposite fashion: The blacks showed an increased pressor sensitivity (p less than 0.05), whereas the whites demonstrated a nonsignificant decreased pressor sensitivity. These results indicate that age, race, and salt effects must be meticulously controlled in studies of sympathetic nervous system physiology.