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Biomedical subjects

C J Sells

Publications and source records attributed to C J Sells.

At least 19 recordsLinked to original sources
PubMed1992

Antiepileptics and the development of congenital anomalies.

We are conducting a prospective cohort study of epilepsy and pregnancy to determine the nature and extent of adverse pregnancy outcomes in infants of mothers with epilepsy (IME). Women with epilepsy were enrolled no later than the first trimester and were matched with controls; their infants were examined at 8 weeks by pediatricians blinded to maternal status. A number of variables were compared between case and control infants: birth weight, length, gestational age, head circumference, Apgar scores, feeding difficulties, neonatal irritability, and presence of major malformations and minor anomalies. The number of minor anomalies per infant was greater for IME than for controls (mean, 5.05 and 3.65, p less than 0.0001 per infant, respectively). Prominent occiput was the only anomaly seen significantly more often in IME than in controls (p less than 0.05).

Abnormalities, Drug-Induced↗
PubMed1992

Epilepsy in pregnancy: developmental outcome of offspring at 12 months.

Women were enrolled in our prospective cohort study of epilepsy and pregnancy to determine the developmental outcome of offspring and the immediate outcome of pregnancy. Women with epilepsy (case group) were enrolled before conception or during the first trimester, and women without epilepsy or chronic illness (control group) were recruited during pregnancy. We have now completed 12-month evaluation for 43 children in the case group and 41 in the control group. We found no difference in growth parameters between the groups. The children in the case group had a higher mean number of minor anomalies than did those in the control group, and their features were consistent with those previously reported for children exposed to AEDs in utero. Developmental differences between the two groups varied, with some differences reaching statistical significance. The findings reported here are preliminary, since the children will be evaluated through 3 years of age.

Abnormalities, Drug-Induced↗
PubMed1990

Pharmacokinetics of anticonvulsants in pregnancy: alterations in plasma protein binding.

Anticonvulsant levels decline as pregnancy progresses, even in the face of constant and, in some cases, increased dosages of medications. It has been suggested that this decline is responsible for the increase in seizure frequency seen in approximately one-third of the women with epilepsy who become pregnant. Changes in plasma protein binding may explain the declines in anticonvulsant concentrations during pregnancy. A prospective cohort study was designed to test this hypothesis. Carbamazepine, phenytoin and phenobarbital were studied. The mean total concentrations of all 3 drugs declined as pregnancy progressed, rising in the postpartum period. Free concentrations also declined, but did so significantly only for phenobarbital. The free fraction for all anticonvulsants studied rose significantly throughout pregnancy. Protein binding is significantly altered during pregnancy for all 3 drugs studied and appears to account for much of the decline in anticonvulsant concentrations seen in this condition. It is suggested that free rather than total drug concentrations be monitored in pregnant women with epilepsy.

Adult↗
PubMed1986

Effectiveness of the Denver Developmental Screening Test with biologically vulnerable infants.

The Denver Developmental Screening Test (DDST) was initially developed specifically to identify children with mental retardation. However, its use in screening low birth weight and other biologically at-risk infants for motor problems is widespread. In view of the absence of biologically vulnerable children in the DDST standardization sample, and the limited validational support available for its use with children under 30 months of age, the purpose of this study was to investigate the effectiveness of the DDST in screening 62 Neonatal Intensive Care Unit graduates during infancy. Categorical results (Normal, Questionable, Abnormal), obtained in the home setting by DDST, were compared with results of Neonatal Intensive Care Unit Follow-up Clinic evaluations. There was a marked underselection of the DDST's categorical results in identifying those infants with suspect or abnormal findings on the more detailed clinic evaluations. However, the effectiveness of the screeners' clinical impression ratings (based on observations made during administration of the DDST) in identifying infants with positive criterion results was encouraging. These findings suggest that, although the DDST's categorical results may be of limited value in screening biologically vulnerable infants, administration of the DDST may provide a useful framework for more systematically observing and documenting significant qualitative aspects of an infant's developmental status, particularly for the screener who is less experienced in neuromotor assessment. These observations need to be defined further, and validated.

Developmental Disabilities↗
PubMed1979

Influences on measured intelligence in Down's syndrome.

The measured IQ and parental educational level of 57 children with Down's syndrome were compared. The phenomenon of decreasing IW with increasing chronological age in Down's syndrome was considered in the data analysis. There was no trend toward better cognitive performance by children of higher-educated parents. Thirty-one of the children had attended an early, continuous stimulation program. This experience accounted for most of the observed IQ variance.

Adolescent↗
PubMed1979

The Summitt syndrome: observations on a third case.

A 6 1/2 year old male presented with acrocephaly, brachydactyly, clinodactyly, mild syndactyly of the hands and feet, genu valgum, and marked obesity. Roentgenograms of the hands revealed hypoplasia or aplasia of the middle phalanges. Roentgenograms of the feet revealed hypoplasia of the middle phalanges and deformity of the proximal phalangeal epiphyses of the great toes. Chromosomes studies revealed a normal 46,XY karyotype, and psychological testing revealed low normal intelligence. Current data support autosomal recessive inheritance, although X-linkage cannot be excluded.

Child↗
PubMed1979

An interdisciplinary health care setting's experience with groups for parents of children having specific disabilities.

This paper describes the planning, implementation, use, and evaluation of a group for parents of children with Williams elfin facies syndrome in an interdisciplinary health care setting. The group utilized a modified educational approach that resulted in significant gains reported by participants in learning about educational opportunities and rights of the handicapped, terminology and labeling of Williams syndrome, and meeting and sharing with other parents. The experience has implications applicable in interdisciplinary health care settings for use of groups as an aid in reducing the conflict that may result from the frequent combination of research and service to individuals with specific disabilities.

Abnormalities, Multiple↗
PubMed1978

The management of patients with cerebrospinal fluid shunts.

This article outlines the principles of management of the patient with a cerebrospinal fluid shunt, emphasizing the clinical and laboratory methods of determining shunt malfunction or infection. Appropriate therapies for each complication are described.

Anti-Bacterial Agents↗
PubMed1977

Nutrient intake and stimulant drugs in hyperactive children.

Recent studies have demonstrated suppressed growth of height and weight in children receiving stimulant drugs for hyperactivity. For approximately twelve months, growth data and food records were collected on two subjects receiving different types and dosages of stimulant drugs. The two cases demonstrated that dextroamphetamine levels of 10 mg. or more and methylphenidate levels of 30 mg. or more decreased caloric intake significantly. This decrease may be limiting for long-term growth. Both subjects had a variety of feeding problems due to poor appetite. Careful nutritional evaluation and planning are important to insure optimal energy and nutrient intake in these children receiving stimulant drugs.

Ascorbic Acid↗
PubMed1977

Prevention of mental retardation: the role of medicine.

In the past 100 years striking progress has been made in the prevention of mental retardation. Since mental retardation is a symptom rather than a distinct disease entity, its prevention requires attention to many different areas. Heterozygote detection, specific factors of pregnancy, the current status of newborn screening, and major postnatal factors associated with mental retardation are some of the issues discussed in this centennial paper. Although considerable progress has been made, the causes and, hence, the modes of prevention of mental retardation for the majority of retarded individuals are unknown. Continued progress will require the combined efforts of both medical and social scientists if the goal, the prevention of mental retardation, is to be realized.

Abnormalities, Drug-Induced↗
PubMed1977

Microcephaly in a normal school population.

Heights, weights, and head circumferences were obtained on 1,006 students, ages 5 to 18 years, attending regular classes in four schools in a suburban Seattle school district. From the 1,006 students initially examined, 19 (1.9%) had a head circumference two or more standard deviations below the mean for age and sex. Intelligence quotients and academic achievement scores were obtained on these children and compared with normal controls. No significant difference was found between mean IQs of the study subjects and the controls (99.5 vs. 105), but mean academic achievement scores were significantly lower in the study subjects (49 vs. 70; P less than .001). In addition, although mean IQs were not significantly different between those subjects whose head circumference was proportional and those whose head circumference was relatively small, mean academic achievement scores were significantly higher (60 vs 39; P less than .02) in those subjects whose head size was proportional.

Achievement↗
PubMed1977

Gram-negative cerebrospinal fluid shunt-associated infections.

Twenty hydrocephalic children with cerebrospinal fluid (CSF) shunts over an 11-year period were seen with Gram-negative central nervous system (CNS) infections. Seventeen infections were with single organisms and three were mixed. Sixteen of 20 (80%) of the infections occurred within five months of shunt surgery. Complete shunt removal or replacement in a new site plus systemic and intraventricular antibiotics resulted in a 100% (9/9) cure rate. Systemic and intraventricular antibiotics alone or in combination with incomplete shunt removal generally were unsuccessful. Significant morbidity and mortality were associated with these infections. Of the 18 patients with follow-up data, seven (39%) died with the infection, four (22%) sustained definite CNS damage, three (17%) were retarded after infection but their preinfection status was unknown, and only four (22%) patients escaped without definite sequela. Early recognition and appropriate therapy, hopefully, will improve the current bleak prognosis

Adolescent↗
PubMed1977

Cerebrospinal fluid shunts.

Cerebrospinal fluid (CSF) shunt technology has undergone rapid advances in the past two decades. As a result, pediatricians and other primary care physicians are being asked with increasing frequency to provide care for persons with CSF shunts. Familiarity with the more common shunts is a prerequisite to intelligent management of shunt related problems. Physicians providing daily care must have carefully documented hospital records and operative notes available to them as well as information detailing the safe evaluation of shunt patency and function if they are to manage patients with CSF shunts properly. In addition, parents and guardians must be alerted to signs and symptoms related to shunt malfunction.

Cerebrospinal Fluid Shunts↗