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Biomedical subjects

Mary E Fallat

Publications and source records attributed to Mary E Fallat.

17 recordsLinked to original sources
PubMed2007

Ethics and the pediatric surgeon.

PURPOSE: Care of infants and children with life-impairing or life-threatening congenital and acquired disorders often raises ethical concerns for pediatric surgeons. The purpose of this survey was to determine the level of interest in clinical ethics and how respondents would manage ethical dilemmas within several clinical case scenarios. METHODS: A 12-item validated questionnaire developed by the Ethics and Advocacy Committee was provided for the American Pediatric Surgical Association (APSA; www.eapsa.org) members on the organizational website. General categories of questions included informed consent, patient privacy, and what constitutes research. RESULTS: The survey was completed by 235 of the 825 APSA members; a response rate of 28.4%. The majority (62%) were in academic practice, 22% had additional education or an advanced degree in ethics, and 11% were members of a hospital ethics committee. There was a clear majority response for seven questions. Topics generating the most controversy included the impact of consent by minors, decision making in the neurologically devastated child, what constitutes research in pediatric surgery, the use of interpreters for consent, and patient privacy. Respondents chose a well-referenced manuscript as the preferred modality for ethics education of the APSA members. CONCLUSION: Pediatric surgeons have a general interest in clinical ethics as it relates to the care of their patients. An important mission of the Ethics and Advocacy Committee can be to provide education that gives guidance and knowledge to the members of APSA on timely topics in surgical ethics.

Adolescent↗
PubMed2007

Pediatric injuries: prevention to resolution.

Despite improved education and prevention initiatives, trauma remains the leading cause of death in children. A variety of preventative measures have been developed to decrease the morbidity and mortality, and the financial burden on the health care system. This article discusses injury prevention strategies, issues in prehospital care, and key points of initial resuscitation. In addition, the major injury patterns are described with attention paid to the diagnosis and management of patients with multiple traumatic injuries.

Abdominal Injuries↗
PubMed2006

Thyroglossal duct and other congenital midline cervical anomalies.

Thyroglossal duct anomalies and dermoid cysts comprise the vast majority of congenital midline cervical masses seen in children. Unusual lesions of the midline neck include ranulae and midline cervical clefts. Workup and management is lesion-dependent, and an accurate preoperative diagnosis is essential for planning and performing an appropriate surgical procedure. This discussion presents an overview of the relevant embryology, pathophysiology, and diagnostic modalities for these congenital midline cervical anomalies. Additionally, the current principles of surgical management are described.

Branchial Region↗
PubMed2006

Intersex genetic anomalies with malignant potential.

PURPOSE OF REVIEW: Mutations in genes contributing to sexual determination and differentiation can cause clinical syndromes with potential for the development of malignant tumors. This article focuses on intersex disorders requiring surveillance for and/or operation to prevent or treat malignancies. RECENT FINDINGS: Classification of intersex disorders into risk groups gives guidance to physicians about children who are vulnerable to malignant degeneration of the gonads or kidneys. The gonads most at risk are both dysgenetic and intra-abdominal, and early gonadectomies are recommended as malignancies have been reported in infancy. Predominant risk groups include syndromes of gonadal dysgenesis and Ullrich-Turner syndrome. Partial gonadectomy is feasible in true hermaphrodites commensurate with sex of rearing. Histologically normal intra-abdominal gonads may be left through puberty (androgen insensitivity syndromes). A palpably normal descended gonad in a child with a Y chromosome can be observed if the child is reared as male. Certain intersex syndromes with splice variants of the WT1 gene are susceptible to Wilms' tumors (Frasier and Denys-Drash syndromes). SUMMARY: Prevention or early recognition of malignancy in intersex disorders requires knowledge of the risk factors including dysgenetic gonads, a Y chromosome with intra-abdominal gonads and dysgenetic syndromes with WT1 gene splice variants. This paper describes the evolution toward laparoscopic gonadectomy in intersex patients, as a means to remove abnormal gonads and associated ductal structures as dictated by the disease or syndrome.

Child↗
PubMed2005

University of Louisville experience and contributions to pediatric trauma care.

Care of the injured patient has been a focal point of surgical training at the University of Louisville. Under the direction of Dr. Hiram C. Polk, Jr, M.D., the Trauma Service has received national recognition for excellence in patient care and surgical research. This experience has provided a foundation for further endeavors in trauma care by program graduates. Summaries of contributions to the peer-reviewed literature or to hospital programs by former trainees who specialized in pediatric surgery are presented. Topics include the treatment of pediatric solid-organ injury, pelvic fracture, pellet-gun injury, and caustic cutaneous burns. The impact of the pediatric Trauma Service at Kosair Children's Hospital in Louisville, KY, with an emphasis on compassionate care and the development of a bereavement intervention program, also is presented.

Child↗
PubMed2005

Serum Müllerian-inhibiting substance levels in adolescent girls with normal menstrual cycles or with polycystic ovary syndrome.

OBJECTIVE: To compare serum müllerian-inhibiting substance (MIS) concentrations in adolescent girls with polycystic ovary syndrome (PCOS) or normal menstrual cycles. DESIGN: Prospective study. SETTING: University department of obstetrics and gynecology. PATIENT(S): Thirty-one girls (12-18 years old) with PCOS and 17 girls (12-19 years old) with normal menstrual cycles. INTERVENTION(S): Serum was collected from girls with PCOS or normal cycles during the early follicular phase of the menstrual cycle, stored frozen until assayed. MAIN OUTCOME MEASURE(S): Serum levels of MIS, E2, free-T, androstenedione, LH, and FSH. RESULT(S): Serum MIS levels in girls with PCOS were significantly higher compared with normal girls (4.1 +/- 2.2 [SD] and 2.4 +/- 1.0 ng/mL, respectively). The subjects were stratified for body mass index (BMI) (< and >25 kg/m2). Serum MIS levels in PCOS girls (4.2 +/- 3.0 ng/mL [BMI <25 kg/m2] and 4.0 +/- 1.6 [BMI >25 kg/m2]) were significantly higher compared with normal girls (2.2 +/- 0.8 and 2.6 +/- 0.7 ng/mL, respectively). CONCLUSION(S): Adolescent girls with PCOS have significantly higher serum MIS levels compared with normally cycling girls. Serum MIS levels in PCOS were not influenced by BMI. Increased MIS production may represent an early manifestation of the disease.

Adolescent↗
PubMed2005

Benign ovarian masses.

Primary tumors of the ovary are uncommon in children and the majority of these masses are not malignant. As newer diagnostic imaging techniques have increased the detection of all ovarian masses, the frequency of ovarian cancer has actually decreased. Clinical symptoms are generally not helpful in distinguishing benign from malignant masses, but radiographic criteria have been developed. Surgical treatment is aimed at ovarian preservation if the lesion proves benign.

Adolescent↗
PubMed2005

Paratubal and tubal abnormalities.

The fallopian tubes are the essential genital ducts that convey the female sex cells for fertilization. They are differentiated and detectable early in fetal life. There are numerous paratubal and tubal abnormalities that can occur at any point in the female life. Some of these are rare but may initiate significant morbidity and/or manifest as life-threatening clinical problems. A comprehensive understanding of symptoms, diagnosis, optimal imaging modalities, and medical and surgical management is vital to identify the best treatment option. The clinical entities described in this article include torsion, hydatids of Morgagni, paraovarian cysts, infections including tuboovarian abscess/pyosalpinx and salpingitis isthmic nodosa, ectopic pregnancy, tumors, and genetic disorders.

Fallopian Tube Diseases↗
PubMed2005

Lymphangiomatosis: a case report.

Lymphangiomatosis is a rare congenital malformation that can involve visceral organs, soft tissue, and bone. This report describes a 5-year-old female with this disorder who presented with respiratory distress and subsequently died. Clinical, diagnostic, and treatment aspects of this entity are discussed.

Child, Preschool↗
PubMed2005

Preparing Kentucky's emergency departments for a comprehensive trauma care system: the Kentucky Hospital Association emergency department survey.

Kentucky continues to lag in development of a statewide trauma care system, and objections to implementation have arisen from hospital emergency departments. In order to clarify these issues, the Kentucky Hospital Association conducted a statewide survey. Respondents represented 95% of the state's general acute care hospitals. A large majority (78%) reported that they could not meet the American College of Surgeons' (ACS) standards for verification as a trauma care facility at any level, and a similar number (81%) opposed requiring verification for facilities providing trauma care. Staffing deficiencies (particularly surgical specialists) were the primary reason cited for facilities' inability to meet ACS standards, while objections to requiring ACS verification were based on concerns about the ability of EMS to transport patients to definitive care in a timely enough manner. Recommendations included improvements in emergency department (ED) facilities and staffing as well as EMS capacity and training. Improvements in Kentucky trauma care will require additional funding to increase the number of verified facilities and enhance coordination among providers and facilities.

Certification↗
PubMed2005

Kentuckians support trauma system improvement: the Kentucky Trauma Survey report.

A household telephone survey was conducted in mid-2004 to assess the degree of information and support among Kentuckians regarding the state's trauma care system. The 800 completed responses reflected a very strong degree of support (79%) for trauma system improvement and funding. Responses also indicated low levels of understanding regarding trauma care facilities and their level of service. Respondents with personal or family experience of emergency medical services and trauma care were significantly more likely to identify trauma facilities correctly. The most popular option (69.6%) for generating additional trauma system funds was a 5% levy on guns and ammunition. Three quarters (74.2%) of respondents indicated that they would vote for a legislative candidate who supported trauma system funding. Overall, survey findings demonstrate a strong, broad mandate for legislative initiatives to improve Kentucky's trauma care.

Adolescent↗
PubMed2004

Do-not-resuscitate orders for pediatric patients who require anesthesia and surgery.

This clinical report addresses the topic of preexisting do-not-resuscitate (DNR) orders for children undergoing anesthesia and surgery. Pertinent issues addressed include the rights of children, surrogate decision-making, the process of informed consent, and the roles of surgeons and anesthesiologists. The reevaluation process of DNR orders called "required reconsideration" can be incorporated into the process of informed consent for surgery and anesthesia. Care should be taken to distinguish between goal-directed and procedure-directed approaches to DNR orders. By giving parents or other surrogates and clinicians the option of deciding from among full resuscitation, limitations based on procedures, or limitations based on goals, the child's needs are individualized and better served.

Anesthesia↗
PubMed2003

Limitations of electronic databases: a caution.

OBJECTIVE: The purpose of this study was to assess the completeness and accuracy of information from two electronic datasets, one of which is voluntarily submitted, the other submitted by mandate. METHODS: Emergency department (ED) data have been voluntarily submitted by several hospitals to the Kentucky Emergency Medical Services Information System (KEMSIS). Similar information on all patients admitted to the hospital has been submitted by mandate to the state under the Uniform Billing Act (UB92). UB92 data for patients with at least one diagnosis code > or = 800 were available. The KEMSIS and UB 92 data for one hospital were compared to those manually abstracted from the ED log and medical records for completeness and accuracy. RESULTS: There were 316 patients listed on the ED log that were subsequently admitted to the hospital. The KEMSIS database contained 266 (84%) of these records, but only 91 (34%) were classified as having been admitted. Of those correctly classified as admitted, only 25 (27%, or 9% of the total 266) were correctly classified as to the hospital of admission (directly to hospital or transferred to another facility). Discharge diagnoses in the KEMSIS database and hospital records were concordant in 240 (90%) of the patients, even for those misclassified as to disposition. There were 37 patients listed in the ED log admitted during the study period with at least one discharge diagnosis field > or = 800. Eight patients were transferred to another institution, making the total population available for study period 29. Only eight (28%) of these patients were included in the UB92 database. The diagnosis codes were concordant between the UB 92 data and ED log in all cases. CONCLUSIONS: There is significant misclassification and/or omission in electronic databases. This is true regardless of whether data is reported voluntarily or by mandate. Electronic data must be independently validated before they are used for policy or research purposes.

Databases, Factual↗
PubMed2002

Relationship between serum müllerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women.

OBJECTIVE: To examine the relationship of serum müllerian-inhibiting substance (MIS), E(2), free-T, LH, and FSH in untreated women with polycystic ovary syndrome (PCOS) and in women with normal menstrual cycles. DESIGN: A prospective study. SETTING: University Departments of Obstetrics and Gynecology and Surgery. PATIENT(S): Twenty-seven women with PCOS and 20 women with normal menstrual cycles. INTERVENTION(S): Serum was collected from women with PCOS and from normal women during the early follicular phase of the menstrual cycle, stored frozen until assayed. MAIN OUTCOME MEASURE(S): Serum levels of MIS, E(2), free-T, TSH, LH, and FSH were measured. RESULT(S): Serum müllerian-inhibiting substance levels in PCOS patients were significantly higher compared with normal women (+/- SE; 5.3 +/- 0.7 and 1.4 +/- 0.2 ng/mL, respectively). An inverse correlation (r = -0.5965) was found between serum levels of MIS and E(2) in PCOS women, but not in normal women. Women with PCOS had higher serum LH levels than those of normal women (15.2 +/- 1.2 and 5.0 +/- 0.7 mIU/mL). CONCLUSION: In this study, women with PCOS have significantly higher serum MIS levels than normal women. The inverse relationship between müllerian-inhibiting substance and E(2) levels suggests that MIS may modulate ovarian E(2) synthesis and have a role in the disordered folliculogenesis characteristic of PCOS.

Adult↗
PubMed2002

The effect of severe traumatic brain injury on the family.

BACKGROUND: The effects of traumatic brain injury on family dynamics and finances have not been extensively studied. We designed a 30-item survey to determine the effects of the injury on the child, parent(s), and siblings, and whether parents were retrospectively content with the decisions related to aggressiveness of care. METHODS: A questionnaire written on a sixth-grade reading level was mailed to 46 families of children who survived a traumatic brain injury resulting in an initial Glasgow Coma Scale score < or = 7. This is a descriptive study without statistical analysis. Human Studies Committee review and informed consent were obtained. RESULTS: Thirty-two of 46 (69.6%) surveys were completed by mail or telephone. Mean patient age at time of injury was 8.7 years, mean time since injury was 3 years, and mean Glasgow Coma Scale score was 3.7. Approximately one third of children have disabilities related to education, socialization, and/or self-care skills; require multiple health care visits each month; and require prescription medications. Over one third of families were impacted in a moderate to profoundly negative way; 30% of families reported a deterioration in finances or loss of job; and 16% reported a worsening of adult relationships. In 13 of 32 cases, modification of current housing or new housing was required to facilitate home care. Siblings were adversely affected in approximately 16 of 28 families, exhibiting behavioral problems, increased fear, and withdrawal from the injured child. Only 1 of 32 families stated that they would have considered less aggressive treatment, even if it led to the child's death. CONCLUSION: Traumatic brain injury of a child had a negative impact on family dynamics and/or sibling behavior in more than one third of families. Despite this, most families would not limit or withdraw care if they could reconsider decisions regarding treatment. This information can be used to counsel families.

Adaptation, Psychological↗
PubMed2002

The relationship between müllerian inhibiting substance and androgens in boys with hypospadias.

PURPOSE: The etiology of hypospadias is probably multifactorial and disruption of androgen production may have a role. Müllerian inhibiting substance (MIS), a hormone produced by Sertoli cells, has been shown to suppress androgen biosynthesis in Leydig cells by inhibiting cytochrome P450c17 hydroxylase/lyase (CYP17) gene expression. We investigated the relationship between serum MIS and androgens in boys with isolated hypospadias compared with normal boys. MATERIALS AND METHODS: Serum levels of MIS, testosterone and androstenedione were measured in 29 boys with distal hypospadias (midshaft or less) and 21 normal boys undergoing circumcision. The subjects were stratified according to age 12 months or younger (group 1) and 13 to 24 months old (group 2). Statistical evaluation was performed by Student's t test. RESULTS: Mean age plus or minus standard error of mean of normal boys and their respective age matched groups with hypospadias were not significantly different. Within each respective age group serum müllerian inhibiting substance levels in boys with hypospadias were significantly higher compared with those of normal boys (129.6 +/- 1.8 and 96.1 +/- 1.8, p <0.03 for group 1 and 143.2 +/- 2.0 and 77.2 +/- 2.3, p <0.005 for group 2). Serum MIS levels were not statistically different when normal boys or boys with hypospadias were compared across age groups. In group 1 serum testosterone levels in boys with hypospadias were not significantly different from those of normal boys (0.36 +/- 0.20 and 0.56 +/- 0.32 pg./ml., respectively). In group 2 normal boys serum testosterone levels were higher than these in boys with hypospadias (2.36 +/- 0.47 and 0.35 +/- 0.23 pg./ml., p <0.01). Serum androstenedione levels in group 1 boys with hypospadias were significantly lower compared with those of normal boys of similar age (0.29 +/- 0.1 and 0.64 +/- 0.16 ng./ml., respectively, p <0.003). Androstenedione levels among older boys were not different (0.49 +/- 0.25 and 0.32 +/- 0.11 ng./ml., respectively. CONCLUSIONS: The association between elevated serum MIS levels and lower testosterone concentrations in boys with hypospadias suggests that MIS may have some role in the development of hypospadias, possibly mediated by MIS inhibition of CYP17 gene expression.

Androstenedione↗