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Biomedical subjects

J P Hieber

Publications and source records attributed to J P Hieber.

10 recordsLinked to original sources
PubMed1981

Abnormalities of the auditory brainstem response in post-meningitic infants and children.

The auditory brainstem response (ABR) was recorded in 86 infants and children from 1 month to 14 years of age following episodes of bacterial or viral meningitis. Thirty-two demonstrated some degree of cochlear impairment. These was a high incidence of neurological sequellae in these children. Eight children exhibited abnormal changes suggestive of brainstem dysfunction. Six of these eight children also had abnormal neurologic examination. Recovery, or at least improvement in the ABR, occurred in six infants who were assessed upon discharge from the hospital, and then again several months post-hospitalization. In each case improvement was attributed to a resolving conductive component. The ABR was found to be effective for identifying hearing impairment and brainstem dysfunction in pediatric patients following central nervous system infection. Objective information, not available from other methods of assessment was obtained.

Adolescent↗
PubMed1978

Comparison of human rotavirus disease in tropical and temperate settings.

Human rotaviruses (HRV) are a common cause of acute nonbacterial gastroenteritis in pediatric patients. A prospective study of HRV disease in a temperate (Dallas) and a tropical (San Jose, Costa Rica) setting demonstrated differences in seasonal distribution. In both locales, HRV accounted for 50% to 60% of acute nonbacterial gastroenteritis episodes from December through February; this period corresponded to the cooler months of winter in Dallas and to the dry season in San Jose. During the rest of the observation year, the virus was not recovered from any Dallas patients, but was found in 30% to 40% of Costa Rican patients in every month but May. Signs, symptoms, and laboratory values suggest the small bowel as the major site of pathophysiology; mucosal disruption may occur in some cases.

Acute Disease↗
PubMed1977

A pharmacologic evaluation of penicillin in children with purulent meningitis.

We undertook a prospective study of the pharmacokinetics of penicillin G (administered intravenously every four hours for a total of b50,000 U per kilogram per day) in the cerebrospinal fluid of children with purulent meningitis. Both the absolute mean cerebrospinal-fluid penicillin concentration (0.8, 0.7 and 0.3 microgram per milliliter) and the percentage of the simultaneous serum penicillin concentration measurable in the cerebrospinal fluid (18.4, 9.9, 4.9 per cent) declined on the first, fifth and 10th days of therapy, respectively. A mean peak cerebrospinal-fluid penicillin concentration of 0.96 micrograms per milliliter was measured at least transiently on all three study days. This pharmacokinetic pattern correlated with the return of cerebrospinal-fluid protein concentration toward normal (P less than 0.01). Penicillin G in the dosage studied is adequate therapy for most streptococcal and meningococcal meningitis in children; an increased dosage may be necessary when the minimal inhibitory concentration of penicillin to the etiologic agent is unusually high.

Age Factors↗
PubMed1977

Acute disseminated staphylococcal disease in childhood.

From 1964 to 1974 we treated 15 children who had acute disseminated staphyloccal disease. The majority were previously-well males over 5 years of age. Thirteen of 15 patients had one or more cutaneous lesions characteristic of staphyloccal septicemia. Fifty percent of extracutaneous foci of staphylococcal infection were not detected on hospital admission and one third of these lesions were noted for the first time at autopsy. An absolute polymorphonuclear cell count of greater than 10,000/cu mm or an absolute band-form count of greater than 500/cu mm, or both, correlated with the presence of one or more inadequately treated sites of infection. These foci were responsible for bacteremia continuing after the initiation of antimicrobial therapy and for prolonged fever. The overall mortality was 27%; three of the four deaths occurred in patients with predisposing medical conditions. In addition to prolonged antimicrobial therapy, all patients should be evaluated carefully for the presence of occult metastatic sites of staphyloccal infection.

Acute Disease↗
PubMed1977

Hepatitis and pregnancy.

The maternal and fetal outcomes of 50 pregnancies complicated by acute viral hepatitis were examined. Twenty (40%) cases were due to type B hepatitis virus. The clinical course of the maternal hepatitis was unaffected by the pregnant state. Maternal hepatitis (type B or nontype B) had no effect on the incidence of congenital malformations, stillbirths, abortions, or intrauterine malnutrition; it did increase the incidence of prematurity (type B 31.6%; nontype B 25%; overall 27.6%) over that seen in the general delivery population (10 to 11%). Eight mothers acquired acute type B hepatitis during the third trimester; two of their infants (25%) were found to be chronic asymptomatic carriers of hepatitis B surface antigen and to have mild, persistent elevations of SGOT for up to 45 months.

Carrier State↗
PubMed1976

Reevaluation of kanamycin dosage in infants and children.

It was recently reported that the dosage of kanamycin formerly recommended for neonates of 7.5 mg/kg every 12 h did not produce therapeutic serum concentrations of 15 to 25 mug/ml, but a larger dosage of 10 mg/kg every 12 h was required. Reevaluation of the pharmacokinetics of kanamycin in infants and children was therefore undertaken. Sixteen time-concentration curves after a dose of 5 mg/kg were obtained from patients 2 months to 12 years of age; the mean peak serum kanamycin concentration was 10.9 (range, 3.6 to 17.9) mug/ml at 0.5 h. Ten time-concentration curves were obtained after a dose of 10 mg/kg; the mean peak serum concentration was 17.6 (range, 8.4 to 30) mug/ml. Eight patients were studied on successive days, and there was doubling of the 1-h peak serum concentration when the dose of kanamycin was increased from 5 to 10 mg/kg. Standard serum bactericidal tests were done against Escherichia coli and Enterobacter cloacae strains, each with a minimal bactericidal concentration of 5 mug of kanamycin per ml. All 3 sera containing 21 mug or more of kanamycin per ml demonstrated a bactericidal titer, whereas only 2 of 23 sera containing less than 21 mug of kanamycin per ml did so. The currently recommended dosage of kanamycin for infants and children fails to produce serum concentrations in the therapeutic range, and preliminary data suggest that the dosage should be increased to 10 mg/kg per dose every 8 h.

Child↗
PubMedDate not supplied

An outbreak of gentamicin-resistant Enterobacter cloacae infections in a pediatric intensive care unit.

The intensive care unit at Children's Medical Center in Dallas is a medical-surgical unit that cares for pediatric patients of all ages. In 1978 an outbreak of infections occurred that was caused by a gentamicin-resistant strain of Enterobacter cloacae. Thirty of the 34 patients involved in the outbreak were neonates. Six patients developed bacteremia, five of them neonates. The neonates who became infected were significantly smaller (less 1500 g) and more premature (less than 35 weeks) than control patients. Neonates with bacteremia had a significantly higher incidence of congenital anomalies. In a multi-specialty pediatric intensive care unit newborn infants were the group of patients at high risk for nosocomial infection.

Disease Outbreaks↗