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Biomedical subjects

J M Pepple

Publications and source records attributed to J M Pepple.

7 recordsLinked to original sources
PubMed1986

A comparison of nitroglycerin and nitroprusside for inducing hypotension in children: a double-blind study.

Intravenous nitroglycerin (NTG) and sodium nitroprusside (SNP) were compared as hypotensive agents in anesthetized children and adolescents. The drugs were studied in a prospective, randomized, double-blind fashion in 14 patients anesthetized with nitrous oxide: oxygen, morphine, and thiopental. NTG in doses as high as 40 micrograms X kg-1 X min-1 was ineffective at decreasing mean arterial pressure (MAP) below 55 mmHg or causing a decrease in MAP greater than one-third of baseline values. SNP was uniformly successful at inducing hypotension in all patients, including those patients in whom NTG failed. The dose of SNP required to induce hypotension was 6-8 micrograms X kg-1 X min-1. Both NTG and SNP decreased systemic vascular resistance, although SNP did so to a much greater degree than NTG (64% vs. 29%; P less than 0.01). Only SNP increased cardiac index significantly (2.27 +/- 0.35 to 4.44 +/- 1.36; P less than 0.003). Both drugs reflexly increased heart rate, necessitating the use of intravenous propranolol (range from 1 to 3 mg) in all patients. Both drugs produced small decreases in arterial oxygen tension and increases in the average alveolar-arterial oxygen tension gradient (SNP, 44 +/- 13 vs. NTG, 41 +/- 6). SNP use was associated with a slight metabolic acidosis (pH = 7.38 +/- 0.01; base excess [BE] = -6 +/- 1). Neither drug produced any other untoward reaction. SNP appears to be the agent of choice for the reliable and sustained induction of deliberate hypotension in children and adolescents.

Adolescent↗
PubMed1985

Effect of abdominal distension on central and regional hemodynamics in neonatal lambs.

Elevations of intraabdominal pressure (IAP) can occur during surgical repair of gastroschisis and omphalocele and lead to ischemia of abdominal organs. We examined the effect of elevated IAP on central hemodynamics and regional abdominal organ blood flow, measured by radiolabeled microspheres, in 11 pentobarbital-anesthetized neonatal lambs. Stepwise increases in IAP were obtained by inflating a large bag placed intraperitoneally with air to pressures of 15, 20, and 25 mm Hg. Measurements were made at 30 min of elevated IAP and 30 min after deflating the bag. Mean aortic pressure was not significantly altered at an IAP of 15 mm Hg (78 +/- 4 mm HG) (+/- SE) or 20 mm HG (76 +/- 4 mm Hg) compared to baseline (81 +/- 4 mm Hg), but was decreased at the highest IAP (68 +/- 5 mm Hg). Stepwise decreases in blood flow to all abdominal organs, except adrenal gland, occurred with elevated IAP, and blood flows to these organs (except spleen) returned to or above baseline on bag deflation. At IAP of 15, 20, and 25 mm Hg, cardiac output was reduced by 14, 21, and 35%, respectively. Similar percent reductions of renal blood flow occurred. However, regional gastrointestinal blood flow decreased by a greater extent (35, 50, and 54% at each respective IAP). Hepatic arterial blood flow more than doubled at each IAP, but this was not sufficient to maintain total liver blood flow, or presumably total oxygen delivery to liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1981

C-reactive protein in spinal fluid of children with meningitis.

We have evaluated a commercially available latex agglutination system for the detection of C-reactive protein in CSF by a prospective study of 56 patients with CSF pleocytosis. On initial lumbar puncture, C-RP was detected in 100% (24/24) of patients with culture-proven bacterial meningitis, compared to 6% (2/32) of patients in the nonbacterial group (chi 2 c = 44.8, P less than 0.0001). C-RP in CSF had a sensitivity of 1.0 and a specificity of 0.94 for detecting culture-positive, bacterial meningitis. It was a more sensitive test for differentiating bacterial from nonbacterial meningitis on initial CSF examination than was the number of CSF leukocytes, the absolute number of CSF polymorphonuclear leukocytes, CSF glucose concentration, CSF protein concentration, or Gram staining of CSF. Detection of C-RP by latex agglutination may prove to be a practical and reliable method for differentiating bacterial from nonbacterial meningitis.

Adolescent↗
PubMed1980

Activation of the alternative complement pathway by Histoplasma capsulatum.

The present study was performed to determine whether Histoplasma capsulatum (yeast phase) is able to activate the alternative complement pathway. H. capsulatum yeasts were shown to consume C3 in C4-deficient guinea pig serum. Immunoelectrophoretic conversion of alternative pathway component factor B confirmed that C3 consumption was mediated by activation of the alternative pathway. These results demonstrate that H. capsulatum is able to activate the alternative complement pathway.

Animals↗
PubMed1978

Gilles de la Tourette syndrome: further studies and thoughts.

A possible association between the Gilles de la Tourette and Lesch-Nyhan syndromes has recently been postulated. Fourteen patients with Tourette syndrome demonstrated no similarity to Lesch-Nyhan based upon patterns of inheritance, behavioral changes, or alterations of purine metabolism. Despite a strong male predominance, a sex-linked pattern of inheritance could not be confirmed. Self-mutilating behavior was found in 4 male patients but was readily differentiated from that characteristic of the Lesch-Nyhan syndrome. Quantitation of hypoxanthine-guanine phosphoribosyltransferase and isoelectric focusing of its isoenzymes produced results that were indistinguishable from those in controls. We speculate that, pathophysiologically, Tourette syndrome represents an imbalance between the central neurotransmitters dopamine and serotonin rather than an alteration in purine metabolism.

Child↗