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Biomedical subjects

L S Fox

Publications and source records attributed to L S Fox.

At least 19 recordsLinked to original sources
PubMed2001

A pilot randomized trial of carbamazepine for behavioral symptoms in treatment-resistant outpatients with Alzheimer disease.

The authors performed a 6-week, randomized, double-blind, placebo-controlled, parallel-group trial of carbamazepine (400 mg/day) with 21 agitated subjects (16 completers) who had been treated unsuccessfully with antipsychotics. There was greater improvement for the carbamazepine group on the Clinical Global Impression of Change (P=0.055) and the Brief Psychiatric Rating Scale (BPRS) Hostility item (P=0.009), with a trend toward worsening on the BPRS Hallucination item (P=0.067). Overall, carbamazepine showed modest clinical benefit in these subjects, who had not responded to antipsychotics, and particular benefit for hostility. The effect on global ratings was similar to those found in an earlier report in nursing home residents.

Aged↗
PubMed2000

A sociocultural stress and coping model for mental health outcomes among African American caregivers in Southern California.

A sociocultural stress and coping model to explain emotional distress among caregivers of family members who have dementia across ethnic and cultural groups is presented and explored in a sample of 41 African American and 128 non-African American caregivers. In this sample, African American caregivers reported lower levels of burden but equal levels of depression and anxiety. In the structural equation model, previous reports that African Americans' lower appraisal of caregiving as burdensome resulted in lower levels of emotional distress were confirmed. However, in this model, this pathway was counterbalanced by a tendency of African American caregivers to use emotion-focused coping and, therefore, increase emotional distress. African American caregivers were also younger and in poorer health, factors which tend to increase both burden and emotional distress outcomes. As suggested by the sociocultural stress and coping model, the influences of ethnic group variables on stress and coping processes are complex and multidirectional.

Activities of Daily Living↗
PubMed1999

Telephone reporting of the results of cardiac procedures: feasibility and primary care physician preferences.

PURPOSE: We evaluated the feasibility and time required for routine telephone communication with primary care physicians after cardiac procedures and surveyed primary care physicians as to their preferences for the method and content of reports of cardiac procedures. SUBJECTS AND METHODS: A phone call was made within 1 day of the procedure during normal working hours to the primary care physician for all 414 patients who underwent cardiac catheterizations or interventions during a 1-year period. Subsequently, all 211 primary care physicians were mailed a questionnaire on the effectiveness of phone calls as compared with other communication methods. RESULTS: The primary care physician was reached with one call for 51% of patients and could not be contacted with up to five calls to office, clinic, or hospital for 32% of patients. Mean (+/- SD) phone time per patient was 4.1 (+/- 2.0) minutes. Surveys were returned by 119 (56%) of 211 referring physicians. Telephone communication was rated as "very helpful" by 69%. Most primary care physicians (86%) were "very" or "a little pleased" to receive phone calls. Survey respondents identified the summary of the results and the recommendations for treatment as the most important parts of the report. Respondents preferred personal phone calls or faxed reports to phone messages left with office staff, reports sent by electronic mail, or mailed written reports. CONCLUSIONS: Most primary care physicians find personal phone calls helpful and desirable, but the effectiveness of routine phone calls is limited by the availability of primary care physicians during working hours and the time required for phonereporting.

Attitude of Health Personnel↗
PubMed1998

Severity of cognitive impairment in Alzheimer's disease affects list learning using the California Verbal Learning Test (CVLT).

Impairment in list learning is considered a primary symptom of Alzheimer's disease (AD), yet there are no published reports examining the relationship between list learning and severity of cognitive impairment. We gave nine-item and 16-item versions of the California Verbal Learning Test (CVLT; Delis et al., 1987), a standardized shopping list assessment of memory, to 24 AD patients (mean age = 76.2 +/- 8.1; mean years of education = 13.8 +/- 2.4), who were stratified into four groups based on MMSE scores (mean = 16.0 +/- 5.6). ANOVAs revealed severity effects for total list learning (p < 0.001), the first trial (p < 0.001), the last trial (p < 0.001) and short- and long-delay recall measures. Most of these differences seemed due to floor effects. For example, the modal number of words recalled after a delay was 0 by subjects with MMSE scores below 21. Severity of cognitive impairment was associated with the proportion of intrusions such that the most severely demented subjects gave almost entirely intrusion responses. Surprisingly, list length did not significantly affect any of the free recall measures. Our results suggest that list learning and recall seem to be lost relatively early in AD. Measures of list recall like the CVLT may not be useful in tracking severity of cognitive impairment over time.

Aged↗
PubMed1998

Mood induction with older adults: a tool for investigating effects of depressed mood.

To validate the use of mood induction with older adults, 22 older participants receiving a depressed mood induction were compared with 20 controls and 17 older persons with high Center for Epidemiologic Studies-Depression Scale (CES-D) scores. The mood induction procedure, using self-referent statements and music, changed Depressive Adjective Checklist and CES-D scores in each of 2 sessions 1 week apart. Findings indicated that the use of mood induction procedures with older adults can provide experimental control of mood.

Affect↗
PubMed1997

Early extubation after cardiac operations in neonates and young infants.

OBJECTIVE: This study was undertaken to determine the feasibility of early extubation of the neonate and young infant after surgical repair of congenital heart lesions. METHODS: The records of all patients less than 90 days of age who had cardiac operations over a 1-year period were reviewed. During this time, all patients were managed as potential candidates for early extubation. Fifty-six patients are included with a mean age of 32 +/- 31 days and a mean weight of 3.7 +/- 0.9 kg. RESULTS: Twenty-eight patients (50%) were extubated in the operating room or within 3 hours after arriving in the intensive care unit. This included 38% of patients less than 7 days of age, 50% of patients 8 to 30 days of age, 44% of patients 31 to 60 days of age, and 69% of patients 61 to 90 days of age. Three patients (11%) extubated early required reintubation. No deaths were related to early extubation. Only one patient was negatively affected by early extubation. Patients extubated early had shorter stays in the intensive care unit (3.3 +/- 3.9 vs 6.7 +/- 2.9 days) and shorter postoperative hospital stays (5.9 +/- 3.3 vs 13.5 +/- 9.7 days), as well as lower intensive care unit ($5,851 +/- $7,225 vs $12,064 +/- $4,419) and total hospital ($21,108 +/- $14,941 vs $31,608 +/- $9,861) costs than patients who were ventilated. CONCLUSIONS: Early extubation can be accomplished safely in many neonates and young infants undergoing cardiac operations for repair of congenital heart defects and can shorten hospital stay and reduce costs.

Cardiopulmonary Bypass↗
PubMed1992

Intralobar pulmonary sequestration presenting as congestive heart failure in a neonate.

We recently evaluated a premature infant with intralobar pulmonary sequestration which presented with signs of CHF. The infant initially underwent ligation of a PDA but subsequently developed tachycardia, tachypnea, and a continuous murmur which radiated to the back. The diagnosis of a pulmonary sequestration was suggested by Doppler echocardiography and confirmed by aortography. The sequestration was successfully treated by surgical removal of the involved lobe.

Aortography↗
PubMed1991

Amniotic fluid embolism.

Amniotic fluid embolism is an almost universally fatal complication of pregnancy. We have presented a case and reviewed the literature concerning this rare but catastrophic problem.

Adult↗
PubMed1991

Rapid attenuation ("fade") of the chronotropic response during vagal stimulation in the canine newborn. Evidence for a prominent neuropeptide Y effect.

We studied the time-dependent changes in the response of heart rate (sinus cycle length) to 30-second trains of vagal stimulation (8 Hz), repeated every 2 minutes, in canine neonates aged 7.1 +/- 2.5 (mean +/- SD) days. The first vagal train prolonged the sinus cycle length by 58 +/- 35%, but the response was attenuated during subsequent trains (98 +/- 5% inhibition of the vagal response after only 6.4 +/- 1.7 trains). After 40 minutes, complete restoration of the chronotropic response could be demonstrated. Receptor desensitization could be excluded as the reason for the attenuation by demonstrating preserved responses to exogenous acetylcholine. Neuropeptide Y, a sympathetic cotransmitter that has been shown to attenuate parasympathetic responses (thought to be the result of inhibition of the release of acetylcholine from parasympathetic nerve terminals), was administered (50 micrograms/kg) to eight newborns. Exogenous neuropeptide Y resulted in a complete inhibition of the chronotropic response to vagal stimulation, with restoration of the chronotropic response occurring after 60 minutes. Thus, exogenous neuropeptide Y mimicked the effect of repetitive vagosympathetic trunk stimulation; this finding suggested that neuropeptide Y release from sympathetic nerves during repetitive vagosympathetic trunk stimulation may have resulted in the observed attenuation of the vagal chronotropic response. To test this hypothesis, seven other newborns underwent chemical sympathectomy (50 mg/kg i.p. 6-hydroxydopamine for 3 days, tyramine verified), and in these newborns, stable chronotropic responses to repetitive vagosympathetic trunk stimulation were observed (inhibition of vagal response was 0 +/- 18% after 10 stimulus trains).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholine↗
PubMed1989

Optimal management of patients with complete atrioventricular septal defect.

Controversy still persists as to whether patients with complete atrioventricular septal defect should be treated by primary total correction or a two-stage approach utilizing initial pulmonary artery banding. We believe a selected management program dictated by each individual patient's anatomy, presentation (size and preoperative functional class), and associated anomalies should be practiced, but with a strong preference toward initial total repair incorporating modern techniques to construct left and right atrioventricular valves, correct valvular incompetence, and close ventricular and atrial defects. Utilizing this management program, 23 consecutive patients (age 5 days to 51 months) with complete forms of atrioventricular septal defect were surgically corrected from July 1, 1984 through June 30, 1988. Fourteen patients were 12 months of age or less at the time of complete repair. Five patients (22%) had initial pulmonary artery banding, but only 2 were performed by us. Both had very extenuating circumstances making complete repair inappropriate. Only 2 of these 23 patients having complete repair died (hospital mortality 9%) and one had pulmonary artery banding 3 years previously. Of the 5 patients with initial pulmonary artery banding, 3 (60%) required right ventricular outflow tract reconstruction and/or repair of pulmonary artery bifurcation stenosis. We believe these good results support our continued practice of selective management of patients with complete forms of atrioventricular septal defect, but we maintain a strong preference toward initial complete repair.

Cardiac Surgical Procedures↗
PubMed1987

An easy and safe technique for ventricular septal defect closure in hearts with atrioventricular discordant connection and dextrocardia.

When ventricular septal defect exists in hearts with atrioventricular discordant connection and dextrocardia, closure of the defect can most easily be accomplished by exposure through the left atrium and retracted tricuspid valve leaflets. This approach provides good visualization of all aspects of the defect and keeps the suture line away from the conduction tissue, thus reducing the possibility of iatrogenic heart block.

Atrioventricular Node↗
PubMed1984

Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profoundly hypothermic cardiopulmonary bypass. An experimental study.

A study was made of the relation of brain blood flow and oxygen consumption to changes in perfusion flow rate during cardiopulmonary bypass at 20 degrees C in nine cynomolgus monkeys. Four perfusion flow rates varying from 0.25 to 1.75 L X min-1 X m-2 were randomly instituted, each for a 10 minute period. At the end of each period, brain arteriovenous oxygen content difference was measured and 15 mu radioactive microspheres were injected into the arterial perfusion line. The brain was then removed and section into anatomic regions and radioactivity was counted. Regional and total brain blood flows were calculated, as was whole brain oxygen consumption. Brain perfusion continued in all areas at all perfusion flow rates. Whole brain blood flow decreased (p less than 0.0001) as perfusion flow rate was reduced (45 +/- 6.5, 41 +/- 7.9, and 23 +/- 2.8 ml X min-1 X 100 gm-1 at 1.5, 1.0, and 0.5 L X min-1 X m-2, respectively). The proportion of the total perfusion delivered to the brain increased (p = 0.003) with decreasing perfusion flow rates (5.4% +/- 0.78%, 7.1% +/- 1.24%, and 8.2% +/- 1.11% at 1.5, 1.0, and 0.5 L X min-1 X m-2, respectively). Brain blood flow resistance remained unchanged (p = 0.4) while that of the remaining body increased (p less than 0.0001). There was a greater reduction of blood flow in the cortical white matter (p = 0.01) than in other regions of the brain. Brain oxygen consumption was the same (p = 0.5) at all perfusion flow rates, related to an increasing percent oxygen extraction with decreasing perfusion flow rate (p less than 0.0001). The data indicate that all areas of the brain remain perfused, even at low perfusion flow rates, during profoundly hypothermic cardiopulmonary bypass, and that brain oxygen consumption is maintained in part by increased oxygen extraction and in part by redistribution of the perfusate from the remaining body to the brain.

Animals↗