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Biomedical subjects

D Janner

Publications and source records attributed to D Janner.

30 records · Page 2Linked to original sources
PubMed1995

Emergency department presentation and management of pediatric heart transplant recipients.

The object of this study was to review and delineate the presenting complaints, signs, symptoms, and Emergency Department (ED) management of pediatric heart transplant recipients who presented to Loma Linda University Medical Center's (LLUMC) Emergency Department. A retrospective chart review was made of all of the pediatric heart transplant patients who presented to the ED at LLUMC from January 1986 through February 1993. The department is part of a 600-bed university hospital with an associated 250-bed children's hospital that includes a pediatric heart transplant center and an ED that sees over 38,000 patients per year. The retrospective review collected information relating to chief complaint, physical findings, laboratory analysis, and diagnoses. Forty-seven patients (23%) presented to the ED for a total of 76 visits. The patients presented a median of 278 days (range 19 days to 6.5 years) after transplantation. The most common chief complaints were related to the respiratory tract, and the most common diagnoses (55%) were related to infectious processes. Fever was present in 21% of the visits. Three of 13 blood cultures obtained were positive. Cardiac symptoms were present in 14% of the visits with two rejection episodes. Hospital admission was required for 22 (29%) of the ED visits. Results showed that pediatric heart transplant recipients are most likely to present to the ED with infections. Although infections from opportunistic organisms and bacteremia must be considered, most infections are similar to those in the nontransplanted child. Life-threatening conditions such as graft rejection are less likely. Nevertheless, the emergency physician should maintain caution in the evaluation of these patients. Close cooperation and consultation with the transplant team will assure the optimal outcome for these patients.

Adolescent↗
PubMed1994

Concentrations of procaine and aqueous penicillin in the cerebrospinal fluid of infants treated for congenital syphilis.

Penicillin concentrations in cerebrospinal fluid (CSF) were measured at various hours and days of treatment in 163 infants undergoing therapy for congenital syphilis. The CSF levels were compared for three treatment regimens. Aqueous penicillin G (A-PEN), 100,000 U/kg per day, was used in 23 infant, and a dosage of 200,000 U/kg per day was used in 40 patients; procaine penicillin G (P-PEN), 50,000 U/kg per day, was used in 100 children. Mean CSF penicillin levels were 0.416, 0.493, and 0.077 microgram/ml, respectively, in the three treatment groups. The mean CSF penicillin concentration among the 63 infants treated with either of the A-PEN regimens (0.465 microgram/ml) was significantly greater than the mean concentration (0.077 microgram/ml) among those treated with P-PEN (p < 0.001). Among those who received A-PEN, the difference in dosage was not associated with a significant difference in mean CSF penicillin concentration (p = 0.68). All the specimens obtained from patients who received A-PEN, but only 82% of those from patients who received P-PEN, had treponemicidal concentrations (> or = 0.018 microgram/ml). However, 33.3% (9/27) of specimens from infants who received P-PEN, tested between 18 and 24 hours after a dose, had CSF penicillin concentrations < 0.018 microgram/ml. These data suggest that administration of A-PEN may be the preferred therapy if CSF levels > 0.018 microgram/ml are desired, especially for infants with severe disease or congenital neurosyphilis.

Humans↗
PubMed1992

Reliability of polymerase chain reaction in the detection of human immunodeficiency virus infection in children.

During a 3-year period we followed 128 human immunodeficiency virus (HIV) antibody-positive children ages 6 days to 11 years clinically and with an HIV diagnostic panel consisting of antibody (by enzyme-linked immunosorbent assay and confirmed by indirect fluorescence assay or Western blot), p24 antigen detection, HIV isolation from peripheral blood culture and molecular detection of HIV nucleic acids by polymerase chain reaction (PCR). The PCR procedure included 30 cycles of amplification using two separate gag primer pairs (SK38/39 and SK101/145), followed by detection with probes to areas amplified (SK19 and SK102). Results of PCR were available within 48 hours and were sensitive (97%) and specific (100%). PCR should be obtained on all children exposed perinatally, and aggressive management should be undertaken for those found to be positive.

AIDS Serodiagnosis↗
PubMed1992

Pediatric streptococcal toxic shock syndrome.

Two children who presented with fever, rash, and hypotension were found to have group A beta hemolytic streptococcal toxic shock syndrome. These cases are reported to remind physicians who care for acutely ill children that exotoxin-producing streptococci can produce clinical features and multisystem failure similar to staphylococcal toxic shock syndrome.

Child↗
PubMedDate not supplied

Methotrexate therapy for complex graft rejection in pediatric heart transplant recipients. The Pediatric Heart Transplant Team--Loma Linda.

BACKGROUND: We retrospectively reviewed all pediatric heart transplant recipients at Loma Linda University Medical Center between January 1990 and September 1993 to evaluate the efficacy and safety of methotrexate when it is used for the treatment of graft rejection. METHODS: Twenty-eight of 156 patients (18%) received methotrexate therapy. The dose used for recurrent rejection was 10 mg/m2/week given every 12 hours for three doses. Rejection history, complete blood counts, liver function tests, and infectious complications were reviewed. RESULTS: Eighteen patients were treated for recurrent rejection. Methotrexate was begun at a median of 115 days (13 to 1093 days). Older patients were more likely to receive methotrexate (p < 0.01). Efficacy was assessed as rejection episodes (mean +/- standard deviation) occurring in the 2 months before methotrexate administration compared with the 2 months after methotrexate administration and fell from 2.0 +/- 0.2 to 0.6 +/- 0.2 episodes (p < 0.001). The rejection rate (rejections per patient-month) fell in treated patients to a rate similar to patients who did not receive methotrexate. Two patients (11%) died while receiving methotrexate. An additional nine patients were treated for acute rejection with hemodynamic compromise, and one was treated for graft-versus-host disease. The incidence of significant infections was 50% (but no deaths were due to infection) during methotrexate therapy in all patients treated (n = 28). The minimum white blood cell count in the first month of methotrexate therapy occurred at 2 weeks (median of 2700 to 3500 x 10(6) cells/L). Only one patient had elevated transaminase levels. CONCLUSION: Methotrexate is an effective and safe adjunct in the management of chronic pediatric cardiac graft rejection.

Adolescent↗
PubMedDate not supplied

Severe pneumonia after heart transplantation as a result of human parvovirus B19.

The diverse manifestations of human parvovirus B19 infection have been well established. Erythema infectiosum, fetal hydrops, adult arthropathy, and aplastic anemia in patients with hemoglobinopathies or underlying immunocompromise have been described. Recently we successfully treated a patient who, after heart transplantation, had fever, rash, and pneumonia with respiratory failure caused by human parovirus B19. Human parovirus B19 has not been reported previously as a pathogen causing pulmonary disease after pediatric heart transplantation, and we wish to report it at this time.

Antibodies, Viral↗