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Biomedical subjects

L L Barton

Publications and source records attributed to L L Barton.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1995

Stress in pediatric faculty. Results of a national survey.

OBJECTIVES: To determine current levels of pediatric faculty stress experienced by pediatric faculty and to examine contributors to and consequences of this stress. DESIGN: Random survey, using attitude questionnaire. SETTING: Twenty-six medical school-based pediatric programs nationwide. PARTICIPANTS: Two hundred fifty-two full-time pediatric faculty members. MAIN OUTCOME MEASURES: Stress level; importance of specific sources of stress and fulfillment; satisfaction with time allotted to various activities; social support; satisfaction with career choices. RESULTS: The return rate was 64%. Forty-six percent of respondents reported "high" or "very high" levels of usual stress; 64% were stressed beyond a "comfortable" level at least "frequently." Women (P < .05), assistant or associate professors (P < .001), and faculty on the tenure track (P < .006) reported feeling "overstressed" more often. Major sources of stress were pressure to do research, family needs (48%), and lack of personal time (40%). About half (51%) agreed that the recent emphasis on reducing resident stress has led to increased pressure on faculty members. Frequency of feeling overstressed was reduced if respondents felt valued by their chairperson (P < .001) and by other faculty (P < .01). Within the last year, 47% had considered moving to another medical school. Another 43% had considered leaving academia. The more frequently the respondent felt overstressed, the more likely he or she was to have considered such changes (P < .001). CONCLUSIONS: The stress currently experienced by pediatric faculty is substantial and seems to affect long-term commitment to academic medicine. Creative solutions to this issue should be explored.

Adult↗
PubMed1995

Formate dehydrogenase activity in cells and outer membrane blebs of Desulfovibrio gigas.

Formate dehydrogenase in Desulfovibrio gigas was measured by following the release of 14CO2 from radiolabeled formate. Experiments with whole cells using sulfate as the electron acceptor revealed optimal formate dehydrogenase activity at pH 7.0 and formate utilization followed saturation kinetics. While formate dehydrogenase was constitutively produced in pyruvate or lactate media, the formate dehydrogenase activity was markedly increased in cells grown with formate as the electron donor. In cell-free experiments with methyl viologen or 2,6 dichlorophenolindophenol, about 1% of the cellular formate dehydrogenase activity was present in blebs from the outer membrane. Electron microscopy revealed that these blebs were closed structures with diameters ranging from 80-800A and were not induced by changes in osmotic pressure or cellular autolysis. Analysis of blebs revealed the presence of lipopolysaccharides and two proteins with molecular masses of 70 and 53 kDa.

Journal Article↗
PubMed1994

Stress and the residency program director.

A survey of pediatric program directors was performed to identify stressors on pediatric residents as perceived by the directors and to ascertain the relationship of stress experienced by house staff and faculty. Major stressors for pediatric residents were acuity/complexity of patient diseases and financial concerns. Major stressors for program directors were administrative duties. Although nearly three fourths of the program directors had completed a fellowship, only one half were on the tenured track. The majority of program directors believed that as resident working hours and stress decreased, faculty workload and stress increased. Stress experienced by faculty appears to require further investigation and remediation.

Humans↗
PubMed1994

Amebic meningoencephalitis caused by Balamuthia mandrillaris.

Free-living amebae etiologically associated with central nervous system (CNS) infection in children have included Acanthamoeba, Naegleria, and recently, leptomyxid ameba. Two previously healthy children are reported with CNS infection caused by leptomyxid ameba, recently classified as Balamuthia mandrillaris. One child, a 27-month-old boy, had right hemiparesis and aphasia, and the other, a 13-year-old girl, had headache, right hemiparesis, diplopia, and left facial weakness. Cerebrospinal fluid studies of both children revealed a mononuclear pleocytosis and mildly elevated protein. The younger child developed seizures and progressive cerebrovascular occlusions; both developed hydrocephalus and coma progressing to death 16 days after onset of symptoms. The younger child at autopsy had necrotizing meningoencephalitis, left internal carotid arteritis, and amebic trophozoites and cysts in brain. Perivascular trophozoites were difficult to distinguish morphologically from macrophages in the older child, who had no cyst forms. Indirect immunofluorescence test revealed CNS infection with B. mandrillaris in both. This leptomyxid ameba, formerly considered an innocuous soil organism, should be considered in the differential diagnosis of progressive or atypical childhood stroke.

Adolescent↗
PubMed1994

Pediatric emergency training: an alternative teaching-patient care model.

We describe a cost-effective alternative to the pediatric and general emergency department (ED), the emergent/urgent care clinic (EUC). The vast majority of pediatric Medicaid-eligible patients are rerouted from the ED to the EUC, where they receive care from pediatric residents and faculty. A retrospective analysis of patient encounter forms from two EUCs was performed. The type and distribution of diagnoses at the EUCs were comparable with published data from pediatric and general EDs. The cost of care in the EUC is significantly less than that in the ED, although the educational opportunities for house staff and patients are superior to those obtained in the traditional ED setting. A patient population that historically seeks episodic care in EDs is provided with continuity of care and disease prevention through screening, guidance, and up-to-date immunizations.

Ambulatory Care↗