PubMed Health⌕ Search

Biomedical subjects

J Dooley

Publications and source records attributed to J Dooley.

At least 37 records · Page 2Linked to original sources
PubMed1997

Establishment of reference pressure of transcutaneous oxygen for the comparative evaluation of problem wounds.

Seventy-two healthy males and females serially breathed air and 100% O2 at 1.0 atm abs (1.01 bar; AIR and O2, respectively), then 100% O2 at 2.36 atm abs (2.39 bar, HBO) to establish reference values for chest (CH), leg (LG), and foot (FT) PtcO2. Subjects sequentially a) rested supine with legs extended (baseline); b) elevated their monitored leg; c) returned to supine/extended position; d) assumed a seated, both legs dependent posture; and e) returned to supine/extended position. LG and FT PtcO2 decreased during leg elevation and increased when both legs were dependent during AIR, O2, and HBO (P < 0.0001, respectively). LG PtcO2 of females exceeded that for males in all conditions (P < 0.05 to P < 0.0001). Baseline CH PtcO2 also was greater than LG PtcO2 for all subjects in all conditions (P < 0.01 to P < 0.0001) and greater than FT PtcO2 for all conditions (P < 0.01 to P < 0.0001) except AIR. We conclude that: a) position and hyperoxygenation of an extremity significantly affect PtcO2; b) PtcO2 does not follow a decreasing CH to FT gradient in all conditions; c) a gender difference exists for LG PtcO2; and d) PtcO2 reference data are established for the comparative evaluation and clinical management of problem wounds.

Adult↗
PubMed1996

Failure of pulse intravenous methylprednisolone treatment in juvenile dermatomyositis.

OBJECTIVE: To review the experience with high-dose intravenous pulse methylprednisolone (IVMP) therapy in patients with juvenile dermatomyositis (JDM) in our institution. STUDY DESIGN: We reviewed the charts of seven consecutive patients (four female subjects; three male subjects; age 3 to 18 years (mean age 8 years) treated for JDM between 1989 and 1992. RESULTS: All patients met the criteria of Bohan and Peter for JDM and were treated within 3 months of onset of weakness. All received initial treatment with IVMP, 30 mg/kg per day for 3 days, administered weekly for between 1 and 4 weeks. Treatment with orally administered prednisone was required because of deteriorating muscle strength and persistent elevation of creatine kinase activity despite IVMP in five patients, increased skin vasculitis in one patient, and elevated creatine kinase activity with no improvement in strength in one patient. CONCLUSION: We conclude that muscle strength in patients with JDM may deteriorate during pulse IVMP therapy when this is used alone as initial treatment, even early in the course of the illness. We recommend either conventional high doses of orally administered corticosteroids or IVMP with oral corticosteroid therapy as initial treatment of JDM.

Administration, Oral↗
PubMed1996

MRI and nonverbal cognitive deficits in children with neurofibromatosis 1.

Magnetic resonance imaging brain scans and neuropsychological assessments of 17 children who met the NIH consensus diagnostic criteria for neurofibromatosis Type 1 were carried out in order to determine if there is a relationship between presence of high intensity signal abnormalities on MRI scans and nonverbal cognitive deficits. Cranial MRI scans in 10 patients (58.8%) demonstrated high intensity signal abnormalities, most frequently in the cerebral peduncles. Fifteen patients had nonverbal cognitive deficits (88.2%), including difficulty judging the orientation of lines, matching complex visual stimulus configurations, recalling pictures of faces, as well as copying and drawing from memory a complex geometric figure. There was not a significant association between nonverbal neuropsychological deficits and presence of high intensity signal abnormalities on MRI scans, possibly because the location of these hyperintense abnormalities was typically below the level of the basal ganglia. These findings suggest that the high intensity signal lesions seen on the MRI scans of children with neurofibromatosis Type 1 do not predict or explain their nonverbal cognitive deficits.

Adolescent↗
PubMed1996

Families are content to discontinue antiepileptic drugs at different risks than their physicians.

PURPOSE: To define the risk of seizure recurrence (RSR) that families and physicians would accept before discontinuing antiepileptic drugs (AEDs) for children with controlled epilepsy. METHODS: A questionnaire was completed by families of 76 children with epilepsy > or = 3 months seizure-free and by their attending epilepsy specialist (n = 4). RESULTS: Forty-two percent of families were unwilling to discontinue AEDs with an RSR of 25%. In contrast, 20% were willing to accept a > 75% RSR. Several factors differentiated the risk acceptable to families: previous seizure frequency (risk adverse with intermediate frequency), multiple seizure types (risk taking), grade or grades repeated in school (risk adverse), and the family's strategy of playing lotteries. Although families and physicians were prepared to accept similar median RSR (35 and 40%, respectively), individual answers did not correlate (r2 = -0.07). Physicians were unable to predict the families response (r2 = 0.09). CONCLUSIONS: Our current practice is to discontinue AEDs after 2 years of seizure-free results in seizure recurrence of 30-40%. This risk may seem excessive to more than half of families, whereas other families will risk stopping AEDs at higher risks of recurrence. Physicians are poor judges of the degree of risk that is acceptable to a particular family, which may account in part for the anxiety manifested by families at AED discontinuation.

Adolescent↗
PubMed1996

Lamotrigine-induced rash in children.

Of 68 children treated with lamotrigine, a new antiepileptic medication, five developed a rash. One child developed Stevens-Johnson syndrome on lamotrigine monotherapy. Of the five patients with the rash, three were admitted to the hospital (two to the intensive care unit). All recovered completely, but one child had a recurrence of the rash within 30 minutes of reexposure to lamotrigine after 6 months.

Adult↗
PubMed1996

Does the number of seizures before treatment influence ease of control or remission of childhood epilepsy? Not if the number is 10 or less.

Using a population-based regional cohort of 479 children with epilepsy, we studied the effect of the number of pretreatment afebrile seizures on seizure control and remission. The number of pretreatment seizures varied from 1 to 20. For the first 10 pretreatment seizures, there was no significant difference or trend in (1) the proportion of children who were seizure free long enough to attempt stopping medication (mean, 70%), (2) the number of breakthrough seizures before control was achieved, or (3) the proportion of children who were seizure free after stopping medication for the first time (mean, 70%). More patients with more than 10 pretreatment seizures had complex partial seizures (59%) than those with 10 or fewer seizures (16%) (p < 0.00001). We conclude that there does not appear to be any penalty for seizure control or early remission of epilepsy if medication is delayed for up to 10 pretreatment seizures.

Adolescent↗
PubMed1996

Discontinuation of anticonvulsant therapy in children free of seizures for 1 year: a prospective study.

We studied 97 children who were weaned from antiepileptic drug therapy 1 year after their last seizure. Medication was withdrawn over 4 to 8 weeks, and patients were followed for 12 to 57 months (32.4 +/- 13.1; mean +/- SD) or until seizure recurrence. The overall probability of remaining seizure free was 78% at 3 months, 71% at 6 months, 66% at 12 months, and 61% at 24 months (95% CI, 51, 71), similar to studies that have required longer treatment periods. Factors retained in multivariate analysis were female sex, age at seizure onset over 120 months of age, seizure type, and clinical evidence of neurologic abnormalities. Using these risk factors, a simple method of predicting the 24-month recurrence risk was possible.

Anticonvulsants↗
PubMed1996

Use of transcutaneous pressure of oxygen in the evaluation of edematous wounds.

Transcutaneous pressure of oxygen (Ptco2) was measured in edematous wounds before and after a regimen of hyperbaric oxygen (HBO2) therapy, in patients breathing normobaric air (AIR), 100% normobaric oxygen (O2), and 100% O2 at 239 kPa (2.36 atm abs; HBO). Wounds also were scored for severity, including three ratings for periwound edema. Only during AIR was pre Ptc O2 of markedly edematous wounds significantly lower than that of moderately edematous and non-edematous wounds (P < 0.001). After HBO2 therapy, wound severity score and periwound edema rating decreased significantly (P < 0.001), and periwound edema ratings could no longer be distinguished by PtcO2. Although pre periwound PtcO2 measured during both O2 and HBO evaluations was significantly greater than that measured during AIR (P < 0.0001) and was positively correlated with subsequent change in wound severity (P < 0.05), regression analyses failed to yield a significant prediction equation. The authors conclude: a) dramatically marked increases in PtcO2 of normally hypoxic (< 30 Torr O2) edematous wounds during O2 and HBO challenges demonstrate that periwound edema is an O2 diffusion barrier during normal conditions; b) HBO2 therapy significantly reduces periwound edema in markedly edematous wounds; c) despite significant correlations between pre-therapy periwound PtcO2 measured during O2 and HBO challenges and changes in wound severity, single PtcO2 measurements are not predictive of changes in periwound edema or overall wound severity.

Adult↗
PubMed1995

EEG results are rarely the same if repeated within six months in childhood epilepsy.

OBJECTIVE: To assess the reliability of interictal spike discharge in routine electroencephalography (EEG) testing in children. METHOD: EEG results of all children diagnosed in Nova Scotia with epilepsy onset between 1977-85 (excluding myoclonic, akinetic-atonic and absence) were reviewed. The results of the EEG at time of diagnosis (EEG1) were compared with those of a second EEG (EEG2) within 6 months. RESULTS: Of 504 children with epilepsy, 159 had both EEG1 and EEG2. EEG2 was more likely ordered if EEG1 was normal or showed focal slowing but less likely if EEG1 contained sleep (p < 0.05). EEG1 and EEG2 were both normal in 23%. If EEG1 was abnormal, there was a 40-70% discordance for the type of abnormality on EEG2. Abnormalities were present on both EEG1 and EEG2 in 67 cases. Of the 42/67 with major focal abnormalities on EEG1, 7 had only generalized spike wave on EEG2. Of the 17/67 with only generalized spike wave on EEG1, 7 showed only major focal abnormalities on EEG2. Statistical testing showed low Kappa scores indicating low reliability. CONCLUSIONS: The interictal EEG in childhood epilepsy appears to be an unstable test. A repeat EEG within 6 months of a first EEG may yield different and sometimes conflicting information.

Child↗
PubMed1995

The prognosis and treatment of headaches in children--a ten year follow-up.

The prognosis and methods of treating headaches were studied in a group of children, 10 years after their initial diagnosis in 1983. Follow-up was achieved for 77 patients (81%). Headaches persisted in 72.7% but were much improved in 81.3%. Medication use was uncommon, with non-prescription medications used by 30.3% and prescription medications by only two. These data suggest that although childhood onset headaches are likely to persist, children who receive early education regarding the use of non-pharmaceutical methods of headache control appear to rely on these methods even after an interval of 10 years.

Adolescent↗
PubMed1994

What types of epilepsy are preceded by febrile seizures? A population-based study of children.

In a population of 850,000, the authors studied afebrile seizures that follow febrile seizures. Review of all paediatric EEGs identified 504 children with epilepsy beginning between 1977 and 1985. Follow-up averaged 85 months. 14.9 per cent had preceding febrile seizures: 13 per cent complex partial, 13 per cent partial/secondary generalized and 22 per cent generalized tonic-clonic. The rate of preceding febrile seizures did not vary with the cause of epilepsy. Prolonged febrile seizures were not associated with any particular afebrile seizure type. Of 17 with preceding prolonged febrile seizures, seven developed intractable epilepsy: 17.9 per cent of the total intractable cases. Only two developed idiopathic intractable complex partial seizures after prolonged febrile seizures. The authors conclude that febrile seizures most often precede generalized tonic-clonic afebrile seizures. Prolonged febrile seizures rarely precede idiopathic intractable complex partial seizures. The febrile seizure tendency may be a fundamental marker of an individual's seizure threshold.

Adolescent↗
PubMed1994

Maternal serum screening in the Sioux Lookout Zone. Complicated test for an unspecified need.

We investigated whether the incidence of fetal abnormalities among patients in Sioux Lookout Zone differs from incidence elsewhere in Canada, whether First Nations people would agree to screening, how information could be disseminated, and what practical considerations would affect implementation. Incidence appears to be similar to elsewhere, but First Nations people's cultural and spiritual beliefs and the difficulty of taking action once results are confirmed make current screening programs inappropriate.

Chorionic Gonadotropin↗
PubMed1994

Outcome of surgery for failed endoscopic extraction of common bile duct stones in elderly patients.

Endoscopic sphincterotomy (ES) is the treatment of choice for common bile duct stones in elderly patients. For those in whom endoscopic clearance of the common bile duct fails the treatment options include stenting, dissolution therapy and lithotripsy. Surgery is often avoided because of the reported high morbidity and mortality in elderly patients. We have reviewed the outcome of patients referred for surgery after failed endoscopic clearance of common bile duct stones. Over a 3-year period, 100 patients with common bile duct stones were referred specifically for endoscopic clearance of the common bile duct (median age 69 years, range 19-97 years). In seven patients duct clearance was possible without ES and in five patients ES was considered inappropriate. ES was attempted in 88 patients and was successful in 75 (85%). Of the 13 patients failing ES or stone removal, surgery was performed in nine and four were stented. Of patients having successful ES (n = 75), ten were referred for surgery because of incomplete duct clearance. Surgery was performed to obtain duct clearance in 19 patients (eight male, 11 female, median age 77 years, range 47-90 years). Of the 19, eight had previously undergone a cholecystectomy (42%) and 17 of the 19 had biliary tract drainage preoperatively (90%). The procedures performed consisted of choledocholithotomy in all plus cholecystectomy (11), choledochoduodenostomy (7) and choledochojejunostomy (7). There were no deaths and only one major complication. The median total inpatient stay was 26 days (range 14-75 days) and the median postoperative stay was 12 days (range 7-50 days). We would conclude that open surgery can be performed safely and effectively in elderly patients with retained bile duct stones.

Aged↗
PubMed1993

Which child will have a febrile seizure?

OBJECTIVE: To identify risk factors predictive of a first febrile seizure. DESIGN: Case-control study. SETTING: Regional referral pediatric hospital emergency department. PATIENTS: Seventy-five patients aged 6 months to 4 years presenting with a first febrile seizure were age-matched to two febrile and two afebrile noninfectious controls who had never had a seizure. METHODS: Telephone interview of parents. MAIN OUTCOME MEASURES: Risk factors assessed included family history of febrile or afebrile seizures, neurodevelopmental abnormality, and child-care arrangement. Analysis was done by matched case-control and logistic regression. RESULTS: Factors associated with a significant increase in risk of a first febrile seizure were febrile seizures in first-degree relative (odds ratio [OR], 4.5) or second-degree relative (OR, 3.5); neonatal discharge at 28 days or later (OR, 5.6); parental report of "slow" development (OR, 4.9); and day-care attendance (OR, 3.1). For children with two risk factors (an estimated 3% of the population), the risk of developing febrile seizures is approximately 28% (assuming a population incidence of febrile seizures of 4%).

Case-Control Studies↗