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Biomedical subjects

P Steiner

Publications and source records attributed to P Steiner.

At least 19 recordsLinked to original sources
PubMed1992

The role of assisted ventilation in survival after respiratory failure in children with AIDS.

OBJECTIVES: To determine the role of assisted ventilation in children with the acquired immunodeficiency syndrome and acute respiratory failure, and to identify any measurement or variable that predicted survival. DESIGN: Retrospective study. SETTING: Kings County (New York) Hospital Center, a tertiary-level inner-city municipal hospital. PARTICIPANTS: Twenty-three children with acquired immunodeficiency syndrome who were endotracheally intubated and mechanically ventilated because of acute respiratory failure. MEASUREMENTS/MAIN RESULTS: There were 24 episodes of acute respiratory failure, as one patient survived a first episode and died during the second episode 2 years later. We failed to identify any measurement or variable that predicted survival. During 12 episodes (50%), the patients survived and were weaned from the ventilator. CONCLUSIONS: Our findings indicate that a decision to avoid intubation and assisted ventilation in a child with acquired immunodeficiency syndrome and acute respiratory failure should not be made based merely on the presumption of a lethal outcome.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage as a diagnostic tool in children with AIDS.

OBJECTIVE: To report our experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage in children with the acquired immunodeficiency syndrome and acute lower respiratory tract disease. DESIGN: Retrospective study. SETTING: Children's Medical Center of Brooklyn, NY, a tertiary-level inner-city hospital. PARTICIPANTS: Eighty-five children with acquired immunodeficiency syndrome and acute lower respiratory tract disease. INTERVENTION: One hundred five flexible fiberoptic bronchoscopies with bronchoalveolar lavages. MEASUREMENTS/MAIN RESULTS: Infective agents were recovered in 88 procedures (84%). Potentially pathogenic bacteria were identified in 56 (56.6%) of 99 procedures. Viruses were found in 28 (29%) of 96 lavages, and fungi in 37 (41.6%) of 89 specimens. Pneumocystis carinii was identified in 22 (22.2%) of 99 specimens. Mycobacteria were isolated from 14 (14%) of 100 specimens. A serious complication occurred in only one procedure (0.95%). CONCLUSION: Flexible fiberoptic bronchoscopy with bronchoalveolar lavage is a safe and effective diagnostic procedure that identified infective agents in 80% of children with acquired immunodeficiency syndrome and concomitant acute lower respiratory tract disease.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Gastric lavage is better than bronchoalveolar lavage for isolation of Mycobacterium tuberculosis in childhood pulmonary tuberculosis.

We compared the sensitivity of gastric lavage (GL) with bronchoalveolar lavage (BAL) for isolating Mycobacterium tuberculosis (Mtb) from 20 children with a presumptive diagnosis of primary pulmonary tuberculosis. GL was performed on three consecutive mornings after an overnight fast. BAL was performed on the same day as the last GL. Specimens were submitted for smears and culture for Mtb. None of the acid-fast stained smears was positive. Cultures of BAL fluid on 2 patients (2 of 20 or 10%) were positive for Mtb. Cultures of the gastric aspirates from the same 2 patients were also positive for Mtb. Eight additional patients had positive GL cultures with negative BAL cultures, resulting in a total of 10 of 20 (50%) patients with positive GL cultures for Mtb. The results of our study indicate that GL done on three consecutive days is better than BAL for the bacteriologic diagnosis of childhood pulmonary tuberculosis.

Bronchoalveolar Lavage Fluid↗
PubMed1992

Patients with dementia involving families to maximize nursing care.

Incorporating family members in the care of patients with dementia provided pertinent psychosocial data, led to mutual decision-making regarding care, and produced changes in the responses of the residents with dementia, as well as in the family and nursing staff. The experimental group experienced increases in psychosocial nursing diagnoses with planning and interventions to meet the problems, more extensive problem description, and an active focus on interaction and change in the nurse's notes. As a result of collaborative nursing and family involvement, personal articles were brought from home; family collateral visits and interaction increased; families were more involved in the unit, medical center, and support groups; and p.r.n. medication use was decreased. As health-care technology prolongs the life of patients with chronic illness and sequelae such as dementia, nurses will need to continue to include families as collaborators in providing quality care.

Aged↗
PubMed1991

Detection of Bordetella pertussis associated with the alveolar macrophages of children with human immunodeficiency virus infection.

In humans, infection with Bordetella pertussis is considered to be localized to an epithelial surface. However, an intracellular state in cultured cells and in the macrophages of infected animals has been shown. By using indirect immunofluorescence with a monoclonal antibody, it was found that 3 of 20 bronchoalveolar lavage specimens from children with human immunodeficiency virus infection had B. pertussis associated with pulmonary alveolar macrophages. None of the cultures from the patients grew B. pertussis. The B. pertussis appeared to be intracellular.

Bordetella pertussis↗
PubMed1991

Interleukin-1 beta and tumor necrosis factor-alpha synergistically stimulate nerve growth factor synthesis in rat mesangial cells.

Recent evidence indicates that cytokines are potent inducers of nerve growth factor (NGF) expression both in peripheral tissues and the central nervous system and that NGF, in addition to its neurotrophic action, also acts as an immunoregulatory agent. It was of interest to investigate whether inflammatory cytokines affect NGF production in renal mesangial cells, which play a crucial role in the modulation of the local immune function in the glomerulus. Our results show that the simultaneous addition of interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) elicited a marked (13-fold) increase of NGF protein released by cultured rat glomerular mesangial cells within 24 h, whereas IL-1 alpha in combination with TNF-alpha, as well as the cytokines alone, did not promote the synthesis of NGF. The synergistic effect was dose dependent (maximal at 1 nM) and due to enhanced gene expression, since the cytokine treatment caused a fivefold increase in NGF mRNA after 8 h. Stimulation of NGF synthesis was abolished by mepacrine and dexamethasone, indicating that phospholipase A2 may be involved in NGF regulation. Moreover, pretreatment of the cells with the lipoxygenase inhibitor nordihydroguaiaretic acid (NDGA) abolished induction of NGF by cytokines; in contrast, the specific cyclooxygenase inhibitors indomethacin and diclofenac failed to modify NGF production. These data suggest that a lipoxygenase metabolite produced in response to IL-1 beta and TNF-alpha acts as a mediator in NGF gene expression. In conclusion, these findings support a model in which a cytokine cascade including NGF may play an important role in the pathophysiology of inflammatory renal diseases.

Alkaloids↗
PubMed1991

Childhood asthma mortality: the Brooklyn experience and a brief review.

Pediatric asthma mortality is a perplexing and increasingly serious problem. Although many possible etiologic factors have been suggested, clear relationships are yet to be delineated. In addition to reviewing the literature, we studied the clinical and pathologic features of 14 local pediatric asthma deaths that occurred over a 7-year period. Thirteen of 14 children were African-American. Nine of 14 children (64.3) were older than 10 years of age, and 11 of 14 (78.6) were males. Based on a history of clinical features, 10 of the 14 children were characterized as severe asthmatics. Despite the fact that the majority of the children were regarded as severe asthmatics, only 1 of 14 had been evaluated with pulmonary function testing, and only 2 of 14 were receiving corticosteroids. Furthermore, only 2 of 14 were regarded as having good medical follow-up for their asthma. Ten of 14 children died suddenly secondary to asthma. One child was possibly abusing sympathomimetic inhalers, and none had evidence of toxic serum levels of theophylline. Six of 14 children (all adolescents) who died suddenly were negative on urine toxicology screening for cocaine, heroin, etc. Pathologic findings available for 10 children revealed mainly mucus plugging of the airways and collapse of various segments of the lungs, as well as pneumonia and pneumothorax in one child. In this group of children with sudden deaths (except for one child with pneumothorax), no other cause of death could be found.

Adolescent↗
PubMed1979

Primary drug resistance in children. Drug susceptibility of strains of Mycobacterium tuberculosis isolated from children during the years 1973 through 1977 at the Kings County Hospital Center of Brooklyn.

A continuing study of the frequency of primary drug resistance among children treated at the Kings County Hospital Center of Brooklyn during the years 1973 through 1977 showed a high incidence of primary drug resistance to isoniazid (8.8 per cent) and to streptomycin (12.3 per cent). In contrast, there were no strains resistant to cycloserine, viomycin, ethambutol, or rifampin, and only one of 57 strains (1.8 per cent) was resistant to ethionamide, and one (1.8 per cent) was resistant to para-aminosalicylic acid. Comparison with previous studies begun in 1961 showed no significant increase in resistance to isoniazid during 3 prior periods of study and no increase in resistance to streptomycin during the last 2 periods of study. It must be emphasized that these findings relate only to the children of a local community, and do not reflect the prevalence of primary drug resistance elsewhere in this country or among different age groups.

Adolescent↗
PubMed1979

Electrophoretic separation of high-density lipoprotein choelsterol evaluated and compared with the modified lipid research clinic procedure.

We evaluated a new agarose-gel-electrophoretic procedure (Corning) (I) for separating and quantitating of high-density lipoprotein cholesterol (HDLC), comparing it with the modified Lipid Research Clinics (LRC) procedure (heparin 183 kilounits/L, MnCl2 92 mmol/L) (II). Method I was insensitive to an HDLC concentration of 50 mg/L, but gave a linear dose-response curve between 130 and 1200 mg/L. Method II is sensitive to 50 mg/L and linear from 50--1200 mg/L. The within-plate CV for the Corning method varied from 26.2% for an HDLC of 168 mg/L to 6.8% for 580 mg/L. Within-day between-plate CV for the Corning method ranged from 22.1% at 155 mg/L to 8.0% at 651 mg/L, compared to 3.0 and 0.8% for the modified LRC procedure. Between-day CV for method I was 20, 12.6, 4.3, and 3.5% for HDLC concentrations of 175, 435, 542, and 678 mg/L, respectively; for method II it was 14, 5, 3.5, and 2.6%, respectively. Analysis of HDLC in 100 patients by both procedures showed mean HDLC values to be significantly lower (mean + SD, 27.8 +/- 1.7 mg/L; p less than 0.001) by method I. In 46 patients with HDLC less than 450 mg/L, this difference was accentuated (mean + SD = 40.5 +/- 2.6 mg/L) and clinically significant. Electrophoretic methods offer a promising further alternative method for HDLC separation and quantitation, but the negative bias, present limited sensitivity, and lack of precision at less than 450 mg/L indicate that they are not yet optimal for routine clinical use for patients with values less than 450 mg/L.

Child↗
PubMed1978

Multi-laboratory comparison of three heparin-Mn2+ precipitation procedures for estimating cholesterol in high-density lipoprotein.

Plasma high-density lipoprotein is commonly estimated by measuring the cholesterol remaining in plasma supernatant solutions after other lipoproteins, which contain apolipoprotein B, are precipitated with heparin and Mn2+. The method (method I) now in use by the Lipid Research Clinics, in which Mn2+ is at 46 mmol/liter final concentration, is reasonably accurate, but precipitation and sedimentation of lipoproteins other than high-density lipoproteins is often incomplete. We evaluated two modifications of method I. In method II, the Mn2+ concentration was doubled; the second modification (method III) included the increased Mn2+ concentration in a combined heparin Mn2+ reagent, decreased sample volume (2 ml), and a shorter incubation time (10 min at room temperature). The percentages of samples with turbid supernates (i.e., incomplete sedimentation) by methods I, II, and III were 9, 3, and 2%, respectively. Among non-turbid supernates, the percentages of samples containing measurable apolipoprotein B (incomplete precipitation) were 79, 19, and 16%, respectively. We conclude that method III is the most convenient and accurate of the three procedures.

Chemical Precipitation↗