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Biomedical subjects

J Plunkett

Publications and source records attributed to J Plunkett.

15 recordsLinked to original sources
PubMed2001

Fatal pediatric head injuries caused by short-distance falls.

Physicians disagree on several issues regarding head injury in infants and children, including the potential lethality of a short-distance fall, a lucid interval in an ultimately fatal head injury, and the specificity of retinal hemorrhage for inflicted trauma. There is scant objective evidence to resolve these questions, and more information is needed. The objective of this study was to determine whether there are witnessed or investigated fatal short-distance falls that were concluded to be accidental. The author reviewed the January 1, 1988 through June 30, 1999 United States Consumer Product Safety Commission database for head injury associated with the use of playground equipment. The author obtained and reviewed the primary source data (hospital and emergency medical services' records, law enforcement reports, and coroner or medical examiner records) for all fatalities involving a fall. The results revealed 18 fall-related head injury fatalities in the database. The youngest child was 12 months old, the oldest 13 years. The falls were from 0.6 to 3 meters (2-10 feet). A noncaretaker witnessed 12 of the 18, and 12 had a lucid interval. Four of the six children in whom funduscopic examination was documented in the medical record had bilateral retinal hemorrhage. The author concludes that an infant or child may suffer a fatal head injury from a fall of less than 3 meters (10 feet). The injury may be associated with a lucid interval and bilateral retinal hemorrhage.

Accidental Falls↗
PubMed2000

Physiologic periosteal changes in infancy.

Surface modulation is part of normal bone growth. However, the radiologic appearance of physiologically growing bone in infancy may resemble changes secondary to trauma. This case report reviews bone remodeling in the postnatal infant and describes its unique radiologic and pathologic characteristics, allowing normal to be differentiated from healing and repair.

Autopsy↗
PubMed1999

Shaken baby syndrome and the death of Matthew Eappen: a forensic pathologist's response.

Subdural hemorrhage, retinal hemorrhage, and cerebral edema have been considered diagnostic for a "shaken infant" since the syndrome was described almost 30 years ago. However, the specificity of these findings has been disputed by defense witnesses in recent U.S. criminal prosecutions. This review examines the scientific basis for the shaken baby syndrome.

Battered Child Syndrome↗
PubMed1999

Sudden death in an infant caused by rupture of a basilar artery aneurysm.

Ruptured aneurysms of the cerebrovasculature in infancy and early childhood, except for "giant" aneurysms and arteriovenous malformations, are rare. Seizures, loss of consciousness, and apnea are the usual presenting signs in infancy; symptoms such as headache or visual disturbances and signs such as cranial nerve compression or meningeal irritation commonly found in older children or adults are absent in infants. However, the morphologic findings (i.e., subarachnoid and retinal hemorrhage, and occasionally subdural hemorrhage) may be mistaken for inflicted trauma, especially if the aneurysm is not identified. Sudden death caused by rupture of a cerebral aneurysm has not been previously described in an infant. This report outlines the investigation and autopsy findings in a 7-month-old infant who died unexpectedly as a result of rupture of a complex basilar artery aneurysm.

Aneurysm, Ruptured↗
PubMed1999

Sudden death in an infant caused by rupture of a basilar artery aneurysm.

Ruptured aneurysms of the cerebrovasculature in infancy and early childhood, except for "giant" aneurysms and arteriovenous malformations, are rare. Seizures, loss of consciousness, and apnea are the usual presenting signs in infancy; symptoms such as headache or visual disturbances and signs such as cranial nerve compression or meningeal irritation commonly found in older children or adults are absent in infants. However, the morphologic findings (i.e., subarachnoid and retinal hemorrhage, and occasionally subdural hemorrhage) may be mistaken for inflicted trauma, especially if the aneurysm is not identified. Sudden death caused by rupture of a cerebral aneurysm has not been previously described in an infant. This report outlines the investigation and autopsy findings in a 7-month-old infant who died unexpectedly as a result of rupture of a complex basilar artery aneurysm.

Aneurysm, Ruptured↗
PubMed1983

Use of the hazard rate to schedule follow-up exams efficiently. An optimization approach to patient management.

The problem of surveillance for metastasis in a cancer patient is modeled as an allocation problem. The hazard rate of metastasis appearing determines the efficient scheduling of follow-up exams. An optimal schedule of follow-up exams is shown to be dependent on the hazard rate, K, and D. K relates the cost of testing to the benefit of early detection. It diminishes as benefit increases or cost diminishes. D is the time by which a metastasis' detection by testing precedes its clinical presentation. Hence it is a direct measure of the effectiveness of testing. The optimal testing frequency = (hazard rate/2K)1/2. Testing may be stopped when the hazard rate drops below 2K/D2. Tests need never be routinely scheduled if the intervals between tests exceed D in length.

Follow-Up Studies↗
PubMed1982

The radiographic follow-up of patients with Ewing sarcoma: a demonstration of a general method.

An analysis of the patterns of detectable tumor recurrence using the concepts of hazard rate, predictive value, and cumulative probability was undertaken to assess the appearance of metastases in Ewing sarcoma. This study comprises 107 patients who were seen between 1964 and 1977. The distribution of the sites of metastases indicates that repeated examinations of both lungs and bones are necessary for the effective surveillance of both truncal and extremity primary lesions. The hazard rates for metastases suggest that these serial examinations should be concentrated early in the follow-up period for truncal primaries and more uniformly distributed for extremity primaries. The method used is general and is applicable to any disease for which the surveillance for recurrence or a complication is of major concern. The results of the analysis may be used in the selection and scheduling of follow-up examinations for patients with Ewing sarcoma, and in advising the patient of the prognosis for continued remission.

Bone Neoplasms↗
PubMedDate not supplied

Comparison of techniques for examining long-term ECG recordings.

The Holter superimposition method was compared with the Argus/H computer system and the Stein/Peterson frozen display technique in the analysis of 94 long-term ambulatory ECG recordings using technical staff experienced with each analysis procedure. The use of the Holter superimposition method resulted in a failure of detection of 33-66 percent of ventricular and supraventricular arrhythmias as compared to the two other computer-based playback systems. The Argus/H system and the frozen display method of Stein and Peterson were comparable with respect to ventricular arrhythmia detection, but the frozen display method was superior to the Argus/H system with respect to the detection of supraventricular arrhythmias.

Arrhythmias, Cardiac↗