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Biomedical subjects

M Reynolds

Publications and source records attributed to M Reynolds.

At least 19 recordsLinked to original sources
PubMed1992

Comparison of positive and negative intrusive thoughts and experimental investigation of the differential effects of mood.

The similarity between positive and negative intrusive thoughts is considered for both recently occurring, personally relevant intrusions and for the same intrusions occurring during an experimental task involving self-monitoring. The results indicate that positive and negative intrusions differ in most respects. There was evidence that increasing the frequency of negative thinking is associated with a deterioration of mood. In a subsequent experiment, induced happy and sad moods were shown to differentially affect frequency of intrusions in a fashion consistent with mood congruency effects previously found in experiments on the effect of mood on memory. The implications of these findings for disorders involving the experience of intrusive thoughts such as OCD and depression are discussed.

Adaptation, Psychological↗
PubMed1992

Chemotherapy can convert unresectable hepatoblastoma.

The surgical evaluation and management of children with hepatoblastoma has changed with recent advances in imaging modalities and preoperative chemotherapy. Pediatric Oncology Group (POG) Study no. 8697 has followed 63 patients with hepatoblastoma from 1986 to 1991. Twenty-six patients underwent primary tumor resection followed by chemotherapy consisting of cisplatin, vincristine, and 5-fluorouracil (group I). Thirty-seven patients with "unresectable" tumors received preoperative chemotherapy. Twenty-nine of these patients responded to chemotherapy and 26 underwent delayed surgical resection (group II). Eight patients had an inadequate response to chemotherapy; two have had successful liver transplantation and six are dead of disease progression. "Unresectable tumor" involved both liver lobes (25 patients), encased the inferior vena cava (2), involved adjacent tissues (1), involved the hepatic veins (2), or was deemed too large for safe resection (7). Two patients had distant metastases. The reason for an unresectable designation was not reported in five patients. The determination for an unresectable designation included exploratory laparotomy in 14 patients, angiogram in 7, computed tomography scan in 20, and magnetic resonance imaging in 3 patients. Operative times and transfusion requirements were similar in both groups. Perioperative complications were higher in patients in group II. There was no mortality and only minor morbidity associated with chemotherapy in each group. In both groups 77% of the patients are in complete remission after 13 to 54 months. Preoperative chemotherapy can allow successful resection of initially "unresectable" hepatoblastoma. Primary resection that may result in exsanguination should be postponed and chemotherapy given.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Morbidity associated with total colon Hirschsprung's disease.

Increased awareness of total colon Hirschsprung's disease (TCH) has led to improvement in patient care and a decrease in the associated mortality. Morbidity has remained high and necessitates close follow-up to prevent the development of life-threatening complications. We retrospectively reviewed the records of 20 children with TCH treated at this institution since 1961. Follow-up averaged 40.4 months (range, 1 to 150). All patients were diverted with an ileostomy or jejunostomy. Eight children had a Swenson pull-through, three had a Martin procedure, and eight had a Kimura procedure. One child with multiple anomalies died after his ileostomy. There were no postoperative deaths. Complications following ileostomy and pull-through procedures included excessive fluid losses, wound infections, stoma problems, and bouts of enterocolitis. Three children had no reported complications. Seventeen complications were reported in eight children with the Kimura procedure, 10 in the three children with the Martin procedure, and 22 in the eight children with the Swenson procedure. These complications resulted in an average of 4.4 admissions per patient (range, 1 to 11) with an average length of stay of 96 days per patient (range, 10 to 598). Twelve patients required an average of 63 days of total parenteral nutrition and eight needed 328 days (range, 23 to 867) of supplemental nasogastric feedings. Ten patients required at-home rectal irrigations and seven patients required rectal dilations. Nearly half of all patients were kept on antimotility agents long term. Since 1985 we have performed the Kimura procedure for all children with TCH and have seen a decrease in morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1992

Choledochal duct cyst: resection with physiologic reconstruction.

BACKGROUND: The accepted surgical treatment of choledochal duct cyst is complete excision and enteric drainage through an intestinal conduit. Peptic ulceration and fat malabsorption have been reported after Roux-en-Y reconstruction. Such long-term complications may be avoided by a technique that simulates normal physiology. METHODS: Twenty-one patients have undergone resection of a choledochal duct cyst in the past 12 1/2 years. The pathologic duct is resected to the level of normal mucosa. A short segment of jejunum with a intussusception valve (1.5 to 2 cm) is interposed between the common hepatic duct and the duodenum. The medical records and all radiographs of each patient were reviewed. Eighteen children were reexamined or the parents were contacted by phone. RESULTS: Twenty of 21 patients recovered without major perioperative complications. Twelve of them are well and have no symptoms at 3 to 12+ years (mean, 6 years) after operation. Four children are currently well 6 to 19 months after operation. Three children were well when lost to follow-up. Two patients have radiographic evidence of incompetence of the interposition valve. One of these, who initially underwent operation at 9 months of age, was reexplored at 10 months and at 10 years for a stricture at the hepaticojejunal anastomosis. The other, a 7-year-old girl who was admitted with jaundice and pancreatitis, has had episodic abdominal pain for 7 years after operation but is well. CONCLUSIONS: The valved jejunal interposition hepaticoduodenostomy offers superior biliary reconstruction after excision of a choledochal duct cyst. Normal physiology is simulated, with bile draining directly into the duodenum. A short conduit prevents stasis, and biliary reflux is minimized with the addition of an intussusception valve.

Child↗
PubMed1992

The nuts and bolts of organizing and initiating a pediatric transport team. The Sutter Memorial experience.

Specialized interfacility transport teams are capable of delivering critical care medicine to the patient at the referring hospital and while en route to the tertiary care center. To do so effectively, however, requires adequate financial and human resources; management of equipment, supplies and personnel; ongoing education for transport team members; and an aggressive quality assurance program. Team members and team management should always be prepared for worst-case scenarios, and develop a method for problem resolution as troublesome issues arise. The ultimate goal of serving the needs of the critically ill child can be consistently met only if there is a high level of commitment of all involved--from the hospital administrator and medical director to the transport coordinator and team members.

California↗
PubMed1991

The relationship among guilt, dysphoria, anxiety and obsessions in a normal population--an attempted replication.

The results of a previous study indicated that guilt as rated on the Perceived Guilt Index (PGI), predicted unpleasant intrusive thoughts, but self-reported anxiety and depression did not. In the present investigation, subjects indicated whether or not they experienced both pleasant and unpleasant intrusive thoughts, their frequency and a rating of how pleasant or unpleasant these thoughts were. They also completed self report ratings of depression, anxiety, obsessional ritualizing, and the PGI. Results of a regression analysis indicate that the best standardised questionnaire predictor of unpleasant intrusive thoughts is depression as rated on the BDI, and anxiety as rated on the BAI. The best standardised questionnaire predictor of pleasant intrusive thoughts is low anxiety. The PGI does not independently predict pleasant or unpleasant intrusive thoughts.

Adolescent↗
PubMed1991

The impact of level 1 pediatric trauma center designation on demographics and financial reimbursement.

A retrospective analysis of medical and financial records of trauma patients admitted over a 4-year period was undertaken to determine the impact of level 1 pediatric trauma center designation on demographics and financial reimbursement. Three hundred fifty-four patients were admitted from November 1, 1985, to October 31, 1986 (Prelevel 1 designation [PREL1]). Five hundred seven patients were admitted from November 1, 1986, to October 31, 1987 (Postlevel 1 designation [PostL1]) (P less than .005). Mechanisms of injury were similar in both groups, with falls being most prevelant (PreL1, 50.8%; PostL1, 43.4%). The magnitude of injuries in the PostL1 period, as expressed by Pediatric Trauma Scores and Injury Severity Scores, did not change significantly. The types of injuries, as indicated by organ systems involved, did not change. The exception was thoracic injuries, which increased from 1.7% to 4.5% (P = .037). Total hospital charges per patient increased ($5,820 PreL1; $7,691 PostL1) (P = .034). Collection rates did not change (77.6% PreL1; 76.4% PostL1). The institution incurred a financial loss per patient of $1,149 PreL1 and $1,795 PostL1 (P = .055). Years 2 and 3 PostL1 designation were analyzed to identify trends (year 2 PostL1: November 1, 1987 to October 31, 1988 [488 patients]; year 3 PostL1: November 1, 1988 to October 31, 1989 [459 patients]). The distribution of Pediatric Trauma Scores and Injury Severity Scores did not change. Total hospital charges per patient remained fairly constant ($8,082 year 2 PostL1; $7,276 year 3 PostL1). Unreimbursed costs increased significantly compared with losses during the PostL1 period ($4,262 year 2 PostL1, P less than .005; $2,799 year 3 PostL1, P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)

Chicago↗
PubMed1991

Graft-versus-host disease following ECMO.

Since 1973, over 3,000 newborns have been treated worldwide for respiratory failure with extracorporeal membrane oxygenation (ECMO). ECMO requires transfusion of numerous blood products including platelets and packed red blood cells. Transfusion-associated graft-versus-host disease (GVHD) developed in one of the authors' patients following treatment with ECMO. ECMO exposes newborn infants to a large number of blood components. Although a rare complication, GVHD can be prevented by irradiating blood products prior to transfusion. We now irradiate all blood products prior to use during ECMO and recommend that other institutions do the same.

Extracorporeal Membrane Oxygenation↗
PubMed1991

Necrotizing enterocolitis following intrauterine blood transfusion.

Intravascular intrauterine transfusion allows a more sophisticated and exact approach to the management of severe Rh hemolytic disease. This technique involves direct manipulation of the fetal umbilical vessels; its hazards include umbilical cord trauma and thrombosis or emboli. The consequences of such events in utero are largely unknown. In this case necrotizing enterocolitis occurred in a full-term infant after three intrauterine intravascular transfusions.

Blood Transfusion, Intrauterine↗
PubMed1991

Pediatric falls from heights.

Injuries resulting from falls from heights still constitute a significant portion of urban trauma. At this pediatric trauma center, 70 children were admitted from 1985 to 1988 after sustaining a fall of 10 feet or greater or at least one story. The mean patient age was 5 years and 68% of the patients were boys. Seventy-eight percent of falls occurred from 2 stories or less and usually took place at or near the home. Most patients sustained a single major injury and all survived. The majority of injuries involved the head or skeleton and residual functional deficits were uncommon. The incidence of falls from heights has remained high in urban areas despite public education and building codes that require window guards and safety rails.

Accidental Falls↗
PubMed1991

Goldmann tonometry and fluorescein solution: a way to avoid contact lens staining.

Topical instillation of fluorescein during standard Goldmann tonometry may cause subsequent contact lens staining. We evaluated a method of Goldmann tonometry that uses only a small amount of fluorescein. In this experimental technique, the fluorescein is applied only to the tip of the applanation cone with fluorescein-coated tissue paper. Thirty patients had their intraocular pressures (IOPs) determined by this method. The IOP measurements were then repeated on the same eyes after instillation of fluorescein directly onto their eyes. In addition, 20 soft contact lens wearers had their IOPs determined by the experimental method, with contact lenses fitted immediately after the measurements. There was no statistically significant difference between the IOPs measured by the standard technique and by the experimental method. In addition, no fluorescein staining was detected in the 20 soft contact lenses examined. Our results suggest that the proposed method is accurate and useful in determining IOP prior to soft contact lens fitting.

Contact Lenses, Hydrophilic↗
PubMed1990

Increased nerve growth factor receptor mRNA in contused rat spinal cord.

Peripheral nerve injury induces the expression of nerve growth factor receptor (NGFR). To determine whether a similar induction results from injury of the spinal cord, NGFR mRNA content was determined using Northern blot hybridization analysis of total RNA from spinal cords of rats contused in the mid-thoracic region. By four days after contusion NGFR mRNA was significantly increased in the thoracic segments that included the injury site. The induction was maximal at 7 days, about 5- to 7-fold the level of uninjured controls, and remained 4 times higher than controls at 14 and 28 days after injury. These results suggest that axotomy in the CNS may also trigger the molecular mechanism(s) leading to up-regulation of NGFR expression.

Animals↗
PubMed1990

Factors that influence the prevalence of positive catch trials in glaucoma patients.

We evaluated factors that influence the catch-trial response in automated perimetry by consecutively examining 408 glaucoma patients (703 eyes) with either the program 30-2 or a 76-point screen with a quantified defect on the Humphrey Field Analyzer. The prevalence of positive catch trials using both programs was: 15.9% fixation losses, 5.5% false-positives, and 17.0% false-negatives. The only significant difference between the two programs was a lower prevalence of false-negatives on the program 30-2 (P less than 0.01). False-positive responses showed a significant positive correlation to fixation losses, and the catch trial response in general was correlated significantly to defect depth, test time, age, and visual acuity (P less than 0.05). This study suggests that the prevalence of positive catch trials is not an independent variable when testing glaucoma patients with automated perimetry and is not reduced by using a screening strategy over a full-threshold exam.

Adolescent↗
PubMed1990

Transfusion requirements in conservative nonoperative management of blunt splenic and hepatic injuries during childhood.

Nonoperative management of splenic and hepatic injuries in children is safe, and the majority of those with isolated injuries do not require blood transfusion. Thirty-seven children were treated for blunt splenic or hepatic trauma from November 1983 to September 1989. There was one death in a patient with a lethal head injury. No operations were performed on those with isolated splenic or hepatic injuries. Three of those with multiple injuries underwent delayed laparotomy. Two had perirenal and retroperitoneal hematomas without active bleeding, and one had a bowel obstruction secondary to an intramural jejunal hematoma. There were no late complications related to the splenic or hepatic injuries. Eight children (22%) required surgery for other injuries. Twelve children were not transfused, including the majority (8/11) of those with isolated splenic or hepatic injury. The hematocrit of four of these children fell to below 28% and this anemia was well-tolerated. Two children with bleeding disorders (factor VIII [antihemophilic factor] and factor XII [Hageman factor] deficiency) did not require packed red blood cells transfusion. Two clinically distinct groups of children received blood transfusions: (1) eight patients with multiple injuries were transfused during initial resuscitation when unstable or during early operation for other system trauma (mean, 62.0 mL blood/kg body weight); and (2) three hemodynamically stable patients with isolated injuries and 14 stable patients with multiple injuries were transfused empirically after initial resuscitation solely because of decreasing blood counts. They received an average of 16.5 and 21.1 mL blood/kg body weight, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1989

Ultrasound of the distal pouch in infants with imperforate anus.

Optimal surgical management of the newborn with imperforate anus depends on accurate determination of the level of the rectal pouch. Eighteen children with imperforate anus were evaluated with ultrasound. The distance from the end of the pouch to the perineum was measured. Ultrasound correctly predicted the level of the distal pouch in all 12 children who had confirmation of the pouch level by surgery or by distal contrast stomagrams. Six children have not yet had definitive surgery. Five children with a pouch to perineum (P-P) distance of less than or equal to 10 mm and three of six children with a P-P distance of 10 to 15 mm had successful correction by a simple perineal anoplasty. Three of six children with a P-P distance of 10 to 15 mm and all of those (seven) with a P-P distance greater than 15 mm were diverted with colostomies.

Anus, Imperforate↗
PubMed1989

Giant iatrogenic splenic pseudocyst.

Partial splenic arterial embolization was used to treat hypersplenism in a 10-year-old boy with portal hypertension secondary to congenital hepatic fibrosis. After embolization the spleen remained enlarged, but the boy's platelet count increased and his variceal bleeding ceased. One month later, he returned with vomiting and an abdominal mass. Computed tomography showed a large cyst of the spleen with a small rim of residual splenic tissue. Percutaneous drainage with ultrasound guidance yielded 2,800 mL of brown fluid. Wedge-shaped infarctions are described early after splenic embolization, and these areas eventually fibrose and contract. In this case, the embolization resulted in splenic necrosis and liquefaction with pseudocyst formation. This unusual complication was effectively treated without surgery.

Child↗
PubMed1989

A comparison between regimens containing chemotherapy alone (busulfan and cyclophosphamide) and chemotherapy (V. RAPID) plus total body irradiation on marrow engraftment following allogeneic bone marrow transplantation.

The effect of two conditioning regimens given prior to allogeneic bone marrow transplantation (BMT) on the kinetics of engraftment were compared. 5 patients received busulfan and cyclophosphamide: 7 patients received daunorubicin, vincristine, cytosine arabinoside, methylprednisone and VM-26 plus total body irradiation (TBI). Bone marrow progenitors (BFU-E, CFU-E, CFU-GM, CFU-F) were assayed up to 3 months post-BMT. All progenitors were severely depressed in spite of peripheral blood recovery. There was no stromal recovery in any adult patient post-BMT. There was no significant difference in time to engraftment, or colony forming units, or between patients conditioned with chemotherapy alone or chemotherapy plus TBI. We were unable to detect effects of graft-versus-host disease or cytomegalic viral infection on bone marrow progenitors or peripheral blood recovery in this study.

Bone Marrow↗