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Biomedical subjects

J J Hutter

Publications and source records attributed to J J Hutter.

At least 19 recordsLinked to original sources
PubMed2006

The management of life-threatening haemorrhage following blunt facial trauma.

Life-threatening bleeding is uncommon following blunt facial trauma. There have been few reports in the literature describing its optimal management and a clear approach to treatment is yet to be defined. Reported strategies for control of facial haemorrhage include oro-nasal packing, external carotid artery ligation, transantral ligation of the internal maxillary artery, maxillary reduction and angiographic embolisation. Advances in angiography and selective vessel embolisation have made this the treatment of choice in cases of bleeding following penetrating facial injury. Its use in the management of bleeding following blunt facial trauma is unclear. The combined experience of the facial trauma teams at Harborview Hospital, Seattle, USA and Liverpool Hospital, Sydney, Australia yielded four cases of severe life-threatening haemorrhage following blunt trauma that underwent angiography. The roles of various management strategies were evaluated to generate a preferred management pathway in treating severe bleeding following blunt facial trauma.

Accidents, Traffic↗
PubMed2000

Immune tolerance for haemophilia patients with inhibitors: analysis of the western United States experience. The Tri-Regional Nursing Group.

The experience with immune tolerance (IT) induction therapy for haemophilia patients with inhibitors, instituted during 1990-97 at 17 haemophilia treatment centres in the western United States, was reviewed. IT was instituted in 104 of 139 (75%) of all identified haemophilia A and haemophilia B patients with inhibitors. Doses and schedules for IT varied but most patients were treated with a daily administration of 25-200 units kg-1 day-1. Successful immune tolerance (defined as Bethesda Unit titres < 1.0) was achieved in 57 of 81 (78%) patients who completed therapy. IT success was significantly greater for those patients with historic titres < 100 BU (P < 0.0003) and those with titres of < 10 BU at initiation of IT (P < 0.0001). IT success was uniformly achieved in 16 patients with low to moderate responding inhibitors. IT in infants < 2 years of age was problematic due to the presence of high titre inhibitors and complications of venous access. Frequent complications of IT included increased bleeding during intravenous access device insertion (20%) and infections associated with venous access devices (64%). IT is widely accepted as a treatment modality for haemophilia patients with inhibitors. Patient participation in IT regimens and management during therapy is facilitated greatly by the efforts of treatment centre nurse coordinators who are knowledgeable about haemophilia and its complications. Additional clinical trials will be necessary to define better initial dose, schedule, dose adjustment and success/failure criteria for IT.

Adolescent↗
PubMed1996

Overexpression of heat shock protein 72 in transgenic mice decreases infarct size in vivo.

BACKGROUND: Previous studies have demonstrated that induction of heat shock protein (HSP) 72 by whole-body hyperthermia reduces infarct size in an in vivo model of ischemia and reperfusion. Furthermore, hearts obtained from transgenic mice that overexpress HSP72 demonstrate improved functional recovery and decreased infarct size in vitro after global ischemia and reperfusion. METHODS AND RESULTS: To test the hypothesis that overexpression of HSP72 in transgenic mice reduces infarct size in vivo, transgenic mice that were heterozygous for a rat HSP70i gene ([+]HSP72) and transgene-negative littermate controls ([-]HSP72) were subjected to 30 minutes of left coronary artery occlusion followed by 120 minutes of reperfusion. Core body temperature was monitored with a rectal thermometer and maintained between 36.5 degrees C and 37.0 degrees C with a heating pad. Infarct size, determined by dual staining with triphenyltetrazolium chloride and phthalocyanine blue dye, was smaller in [+]HSP72 mice compared with [-]HSP72 mice (12.7 +/- 2.8% [n = 7] versus 33.4 +/- 4.5% [n = 6], infarct size/risk area, respectively; P < .05; mean +/- SEM). CONCLUSIONS: Overexpression of HSP72 reduces infarct size in this in vivo transgenic mouse model of myocardial ischemia and reperfusion.

Animals↗
PubMed1996

Potent antifibrillatory effect of combined blockade of calcium channels and 5-HT2 receptors with nexopamil during myocardial ischemia and reperfusion in dogs: comparison to diltiazem.

The need for novel antifibrillatory therapy is underscored by clinical trials indicating that the incidence of sudden cardiac death is increased by sodium or potassium channel blockade and is only partially reduced by beta-blockade. We examined the efficacy of nexopamil, which possesses the unique combination of calcium channel and 5-HT2 receptor blockade, in preventing ventricular tachycardia (VT) and fibrillation (VF) and reducing T-wave alternans magnitude during coronary artery occlusion and abrupt reperfusion in dogs. The results were compared with L-type calcium channel blockade alone with diltiazem. The effect of nexopamil was tested during a 10-min period of left anterior descending (LAD) coronary artery occlusion and release in chloralose-anesthetized dogs. T-wave alternans magnitude was assessed by complex demodulation. The drug reduced the incidence of VT during occlusion (from 5 of 6 to 0 of 6, p < 0.03) and VT/VF during abrupt reperfusion (from 5 of 6 to 0 of 6, p < 0.03) and suppressed the T-wave alternans magnitude increase induced by occlusion (from 14.62 +/- 3.96 to 1.39 +/- 0.34 mV x ms, p < 0.01) and reperfusion (from 17.33 +/- 4.67 to 2.34 +/- 0.77 mV x ms, p < 0.01). When 30-s left stellate ganglion stimulation (10 V, 5-ms pulses, 10 Hz) was superimposed on occlusion, nexopamil reduced the VT/VF incidence (from 8 of 11 to 4 of 11, p < 0.05) and T-wave alternans magnitude (from 24.80 +/- 5.05 to 15.81 +/- 5.09 mV x ms, p < 0.05). Calcium channel blockade alone with diltiazem decreased the incidence of ventricular tachyarrhythmias (from 5 of 10 to 1 of 10, p < 0.05) and T-wave alternans magnitude (from 16.75 +/- 3.06 to 2.87 +/- 1.23 mV x ms, p < 0.05) during coronary artery occlusion. During reperfusion, diltiazem's reduction in arrhythmia incidence (from 5 of 8 to 2 of 8) was not statistically significant, although the decrease in T-wave alternans (from 28.60 +/- 3.43 to 8.27 +/- 3.73 mV x ms, p < 0.05) was significant. Therefore, nexopamil was superior to diltiazem in protecting against reperfusion-induced arrhythmias. Nexopamil's significant antifibrillatory effect during both coronary artery occlusion and abrupt reperfusion is reliably tracked by T-wave alternans magnitude. Because the major component of the protection could be reproduced by blockade of the L-type calcium channel with diltiazem, nexopamil's antiarrhythmic action appears to be due mainly to blockade of this channel. Nexopamil's antiplatelet action through blockade of 5-HT2 receptors may confer additional protection against reperfusion arrhythmias.

Animals↗
PubMed1996

Amphotericin B lipid complex treatment of a leukemic child with disseminated Fusarium solani infection.

We report a case of Fusarium solani infection in a 2 1/2-year-old girl with acute lymphoblastic leukemia and severe neutropenia. The infection, initially limited to her sinuses, became disseminated, as evidenced by the development of a characteristic cutaneous lesion on her left leg after a cumulative dose of amphotericin B of 18.3 mg/kg. Amphotericin B lipid complex (ABLC), 5 mg/kg/day, in conjunction with repeated surgical debridement of the sinuses and correction of neutropenia with granulocyte colony stimulating factor (GCSF), led to clinical and mycologic cure.

Amphotericin B↗
PubMed1993

Spinal epidural hematoma in a hemophilic infant.

PURPOSE: Although intracranial hemorrhage remains a leading cause of death in hemophilia, spinal epidural hematoma is seen rarely. Decompressive laminectomy has a high associated morbidity, and recent reports have suggested that patients can be treated conservatively without surgical intervention. PATIENTS AND METHODS: We present a case of spontaneous spinal epidural hematoma diagnosed by MRI scan in a 6-month-old hemophilic infant. Immediate treatment with factor VIII replacement was instituted. RESULTS: There was rapid and complete clinical and radiographic resolution. CONCLUSION: This case shows that selected hemophilic patients with spinal epidural hematoma can be spared surgical decompression by prompt medical attention.

Factor VII↗
PubMed1993

Dobutamine pharmacokinetics and pharmacodynamics in normal children and adolescents.

Pharmacokinetic and pharmacodynamic data on adrenergic agents in children have revealed wide ranges of plasma clearance rates and hemodynamic responses in patients with critical illnesses or myocardial dysfunction. In order to more clearly elucidate the underlying pharmacologic processes, graded i.v. dobutamine infusions of 0.5, 2.5 and 5.0 micrograms/kg/min were sequentially administered to healthy children and adolescents. Plasma dobutamine concentrations and hemodynamic responses, including echocardiographic measures of systolic and diastolic function, were determined at each infusion rate. Pharmacodynamic data were evaluated by both threshold modeling and mean hemodynamic responses to each infusion rate. Mean plasma dobutamine clearance was 115 +/- 63 ml/kg/min, with an intersubject variability greater than 5-fold. These data establish that the previously published wide variability in dobutamine clearance is not due simply to underlying disease states. Dobutamine clearance was linear over the dosage range evaluated. Dobutamine improved systolic function even at plasma concentrations attained with infusion rates as low as 1 to 2 micrograms/kg/min. The improved systolic function was at least partially due to inotropic effects. In addition, dobutamine improved diastolic function and reduced afterload. Chronotropic effects were observed in only two subjects and only at higher plasma concentrations than the other hemodynamic effects. Individualized threshold modeling effectively described the log-linear relationship between plasma dobutamine concentration and hemodynamic response beyond the threshold concentration.

Adolescent↗
PubMed1992

Therapeutic cytoreduction in a 7-month-old baby with acute leukemia.

A 7-month-old girl with acute biphenotypic leukemia [t(4;11)] had accompanying anemia, thrombocytopenia, and a white blood cell count of 535,000/microL with 98% blasts. Before instituting chemotherapy, therapeutic leukapheresis was done to reduce the threat of complications from leukostasis. Using a Cobe Spectra blood cell separator primed with modified blood, we processed 1,395 mL of her blood, removing 201 mL of the buffy coat containing 5.8 x 10(10) white blood cells. This reduced the WBC count to 301,000/microL. Only a single procedure was done, without significant complications. The rationale of this preparatory cytoreduction is discussed critically. Subsequent chemotherapy resulted in a long-lasting remission.

Acute Disease↗
PubMed1992

Dobutamine stress echocardiography: a sensitive indicator of diminished myocardial function in asymptomatic doxorubicin-treated long-term survivors of childhood cancer.

Doxorubicin is an effective anticancer chemotherapeutic agent known to cause acute and chronic cardiomyopathy. To develop a more sensitive echocardiographic screening test for cardiac damage due to doxorubicin, a cohort study was performed using dobutamine infusion to differentiate asymptomatic long-term survivors of childhood cancer treated with doxorubicin from healthy control subjects. Echocardiographic data from the experimental group of 21 patients (mean age 16 +/- 5 years) treated from 1.6 to 14.3 years (median 5.3) before this study with 27 to 532 mg/m2 of doxorubicin (mean 196) were compared with echocardiographic data from 12 normal age-matched control subjects. Graded dobutamine infusions of 0.5, 2.5, 5 and 10 micrograms/kg per min were administered. Echocardiographic Doppler studies were performed before infusion and after 15 min of infusion at each rate. Dobutamine infusion at 10 micrograms/kg per min was discontinued after six studies secondary to a 50% incidence rate of adverse symptoms. The most important findings were that compared with values in control subjects, end-systolic left ventricular posterior wall dimension and percent of left ventricular posterior wall thickening in doxorubicin-treated patients were decreased at baseline study and these findings were more clearly delineated with dobutamine stimulation. End-systolic left ventricular posterior wall dimension at baseline for the doxorubicin-treated group was 11 +/- 1.9 mm versus 13.1 +/- 1.5 mm for control subjects (p less than 0.01). End-systolic left ventricular posterior wall dimension at the 5-micrograms/kg per min dobutamine infusion for the doxorubicin-treated group was 14.1 +/- 2.4 mm versus 19.3 +/- 2.6 mm for control subjects (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

A survey of antiemetic use in children with cancer.

Pediatric oncologists within Pediatric Oncology Group institutions were surveyed to determine current antiemetic practices for children receiving chemotherapy and the basis for those practices. A mean severity rating for associated nausea and vomiting was calculated and used to rank 31 chemotherapeutic agents commonly used in the treatment of childhood cancer. Antiemetics were used 17%, 79%, and 98% of the time for chemotherapeutic agents with mild, moderate, or severe associated nausea and vomiting, respectively. A median of one, two, and three antiemetics were used for mild, moderate, and severe agents, respectively. Antihistamines and phenothiazines were the drugs most commonly used for agents causing mild or moderate nausea and vomiting, and metoclopramide hydrochloride/antihistamines with lorazepam and/or corticosteroids were used most often for chemotherapeutic agents causing severe nausea and vomiting. Most oncologists based their choice of antiemetics on personal experience. Current literature addressing the treatment of nausea and vomiting in children receiving chemotherapy, as reviewed here, does not always support the present clinical practices.

Antiemetics↗
PubMed1984

Varicella-zoster antibody titers in children with leukemia and lymphoma. Relationship of titer to varicella-zoster infection.

Serum varicella-zoster (VZ) antibody titers were determined by a simple, indirect immunofluorescent antibody technique in 50 children with leukemia or non-Hodgkin's lymphoma. Sixteen children had initial antibody titers that were not detectable at a serum dilution of 1:8 and were considered to be susceptible to varicella. Thirty-one patients had initial serum VZ antibody titers of 1:16 or greater, while three had levels of 1:8. The serum antibody titer was 1:8 or greater in 16 children with a history of varicella. Seven episodes of localized herpes zoster were observed in children whose VZ titer was 1:8 or greater prior to onset. Two nonfatal infections with primary varicella developed in children with leukemia in remission whose initial titers were less than 1:8 and were associated with a convalescent rise in VZ antibody to levels greater than 1:16. Three susceptible children received zoster immune plasma or zoster immune globulin for varicella exposure, causing a transient rise in serum VZ titer. The assessment of serum VZ titer by this immunofluorescent antibody technique combined with the prior varicella history is useful in defining the population of children with leukemia and non-Hodgkin's lymphoma who are susceptible to primary varicella.

Antibodies, Viral↗
PubMed1983

Two sensitive echocardiographic techniques for detecting doxorubicin toxicity.

This investigation was designed to evaluate echoes of patients who received a course of doxorubicin (225-550 mg/m2) by two sensitive indicators of myocardial fibrosis: (1) M-mode scans of thickening-thinning curves of the left ventricular posterior wall (LVPW), and (2) two-dimensional qualitative evaluation of LVPW contraction at three levels of the LV short axis (leaflet, chordal, and papillary). These were compared to standard M-mode shortening fraction (delta S). Eighteen children with cancer were evaluated; 11 had received doxorubicin and 7 were treated with other agents. Echocardiographers were unaware of the treatment category. All controls and 10 of 11 doxorubicin patients had normal delta S. An M-mode echocardiogram of the expanded LVPW was digitized and wall thickness was evaluated by determining if diastolic relaxation had the normal two phases or only one; six of ten doxorubicin patients and no controls had abnormal relaxation. Qualitative evaluation of LVPW and septal contraction toward the center of the ventricle showed that seven of eleven patients who received doxorubicin and one control (a postthoracotomy patient) had contraction deficits. Six of seven with contraction deficit were the same patients with slowed relaxation. The greatest contraction deficit occurred in the LVPW behind the posterior mitral leaflet. Patients with more extensive involvement had an additional contraction deficit extending to the apex. These tests are more sensitive for detection of doxorubicin toxicity than delta S.

Adolescent↗
PubMed1982

Treatment of patients with refractory myelogenous leukemia with BCOMM[1,3-bis-chloro(2-chloroethyl)-1-nitrosourea (BCNU), oncovin (vincristine), cyclophosphamide, high-dose methotrexate and methyl-glyoxal bis-guanylhydrazone (MGBG)].

Ten patients with AML refractory to anthracyclines and cytosine arabinoside were treated with vincristine 1.4 mg/m2 and methotrexate (MTX) 2.5 gm/m2 by intravenous (IV) bolus on day 1 [citrovorum factor (CF) rescue began 24 h later], BCNU 80 mg/m2, and cyclophosphamide 900 mg/m2 IV 36 h after MTX and MGBG 300 mg/m2 IV over 1-2 h on days 3, 4, and 5. Bone marrow aplasia was achieved in all patients by day 12. Five patients (50%) achieved complete remission (CR). Two patients died of sepsis during induction. The median duration of remission was 24 weeks (range 8-38). Maintenance therapy was employed in three patients (high-dose MTX-CF in 2 and MGBG plus BCNU in 1), but did not appear to significantly increase the duration of remission. Nausea and vomiting occurred in eight patients. Five patients developed moderate stomatitis and one developed a moderately severe cutaneous reaction. This pilot experience demonstrates that patients with refractory AML can achieve CR after aggressive treatment with so-called second-line drugs. and may indicate that collateral sensitivity to MTX exists in cells which have become resistant to anthracyclines, a situation we previously described in an experimental cell line.

Adolescent↗