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Biomedical subjects

R S Burd

Publications and source records attributed to R S Burd.

At least 19 recordsLinked to original sources
PubMed2001

Nutritional support of the pediatric trauma patient: a practical approach.

It is mandatory to evaluate and develop a plan for nutritional support for all injured children who are hospitalized. Although most childre" will rapidly resume normal oral intake, more severely injured children should be started on parenteral or enteral nutrition as soon as possible after admission. The mode of delivery and composition of nutritional support differ depending on the clinical setting and can change during the recovery period. Development of an initial plan and modification of the plan depending on the child's response will most effectively meet the metabolic demands after injury.

Child↗
PubMed2001

Anaesthetic management and high frequency oscillatory ventilation.

In an effort to decrease morbidity and mortality, newer modes of mechanical ventilation have been introduced into the critical care arena. One such technique, high frequency oscillatory ventilation (HFOV) relies on respiratory rates greater than 150 b.min-1, small tidal volumes, and the maintenance of a constant distending pressure thereby limiting peak inflating pressure and potentially the incidence of barotrauma. Despite the frequent application of this technique in the ICU setting, there is limited information concerning its intraoperative use. We present three infants who represent the perioperative applications of HFOV: (i) elective preoperative use to minimize lung movement and interference with surgical exposure during thoracotomy and PDA ligation; (ii) intraoperative application when progressive alterations in respiratory compliance led to ineffective intraoperative ventilation/oxygenation; and (iii) anaesthetic care for a neonate already receiving HFOV. The techniques of HFOV and previous reports of perioperative use are reviewed.

Anesthesia↗
PubMed2001

The optimal approach for management of metachronous hernias in children: a decision analysis.

PURPOSE: Up to 30% of children undergoing unilateral hernia repair will later get a hernia on the contralateral side that requires repair. Three approaches have been used to address the potential for development of a metachronous hernia: (1) observation and repair of a contralateral hernia only if it later becomes apparent, (2) routine contralateral groin exploration, and (3) laparoscopy to evaluate the contralateral groin for a potential hernia. The purpose of this study was to use decision analysis to determine which approach resulted in the lowest morbidity, mortality, and cost. METHODS: A decision tree was constructed for the management of metachronous hernias that accounted for the occurrence of both nonincarcerated and incarcerated metachronous hernias. Baseline values were estimated from recent reports in the literature. Total charges for each approach were obtained from available hospital records and were used to estimate cost. RESULTS: Observation was favored over laparoscopy and laparoscopy over routine exploration with respect to preventing spermatic cord injury and preserving future fertility. Although a second operation may be required when observation is used, this approach was associated with only a small increase in anesthesia-related complications (1 in 17,847), cardiac arrests (1 in 62,500), and death (1 in 312,500). Although observation was the favored approach with respect to cost, laparoscopy was less expensive when the expected incidence of metachronous hernias was high. CONCLUSIONS: Observation is the preferred approach to metachronous hernias because it results in the lowest incidence of injury and cost for most patients and is associated with a minimal increase in anesthesia-related morbidity and mortality. Laparoscopy may be advantageous for patients at high risk for development of a contralateral hernia. As a strategy for preventing metachronous hernias without consideration for injury or cost, routine exploration should be limited to situations in which laparoscopy cannot be performed because of small patient size or a preference for spinal anesthesia.

Child↗
PubMed2001

Noninvasive monitoring of carbon dioxide during mechanical ventilation in older children: end-tidal versus transcutaneous techniques.

UNLABELLED: We prospectively compared the accuracy of end-tidal CO(2) (ETCO(2)) and transcutaneous CO(2) (TCCO(2)) monitoring in older pediatric patients (4 yr or older) receiving mechanical ventilation for respiratory failure. ETCO(2) and TCCO(2) were simultaneously monitored and compared with arterial CO(2) (PaCO(2)) values when arterial blood gas analysis was performed. Eighty-two sample sets were compared. The ETCO(2) to PaCO(2) difference was 6.4 +/- 6.3 mm Hg, whereas the TCCO(2) to PaCO(2) difference was 2.6 +/- 2.0 mm Hg (P < 0.0001). The absolute difference of ETCO(2) and PaCO(2) was 5 or less in 47 of 82 measurements, whereas the absolute TCCO(2) to PaCO(2) difference was 5 or less in 76 of 82 measurements (P < 0.00001). Regression analysis of ETCO(2) and PaCO(2) values revealed a correlation coefficient of 0.5418 and an r value of 0.8745. Regression analysis of TCCO(2) and PaCO(2) values revealed a correlation coefficient of 1.0160 and an r value of 0.9693. Bland-Altman analysis revealed a bias of -5.68 with a precision of +/-6.93 when comparing ETCO(2) with PaCO(2) and a bias of 0.02 with a precision of +/-3.27 when comparing TCCO(2) and PaCO(2) (P < 0.00001). TCCO(2) monitoring provided an accurate estimation of PaCO(2) over a wide range of CO(2) values and was superior to ETCO(2) monitoring in older pediatric patients with respiratory failure. TCCO(2) monitoring may be considered as a useful adjunct to monitoring of ventilation in this patient population. IMPLICATIONS: The authors report on the accuracy of noninvasive, transcutaneous CO(2) monitoring during mechanical ventilation in children 4 yr or older. Application of this technique should be useful by decreasing the need for repeated, costly, and sometimes painful arterial blood gas analysis, and the continuity of assessment should facilitate proactive, rather than reactive, ventilator manipulations.

Adolescent↗
PubMed2001

An effective approach for preventing and treating gastrostomy tube complications in newborns.

Gastrostomy tube site complications can be difficult to manage and may temporarily prevent use of the tube for feeding. Such complications are especially common in premature newborns. Lcakage is the usual cause of tube-site complications. This makes maintenance of effective intragastric and transabdominal tube seals the most effective approach for preventing and treating tube-site complications in newborns. This article explains how to use balloon volume and transabdominal segment length to recognize problems that can lead to leakage and how to correct these problems before they cause complications. It also addresses skin care at the site.

Equipment Failure↗
PubMed2001

Factors associated with the resolution of postoperative ileus in newborn infants.

Reliable indicators of ileus resolution following laparotomy have not been identified in newborn infants. The purpose of this study was to correlate commonly available clinical parameters with the resolution of postoperative ileus in newborn infants after abdominal procedures. The presentation, treatment, and postoperative abdominal examination of 60 consecutive newborn infants who underwent a heterogeneous group of primary abdominal operations were evaluated. No significant association was observed between the time to first bowel movement (resolution of ileus) and age, postconceptual age, weight, degree of intraabdominal contamination, duration of surgery, type of operative procedure, presence or absence of abdominal distension, and time to first bowel sounds. Opioid use was associated with a delay in the time to first bowel movement that was not accounted for by the effects of any other variable. Easily obtainable clinical parameters are not universally useful for predicting the duration of ileus in newborn infants after abdominal surgery. The use of opioids is associated with delayed resolution of ileus. Measures to limit the use of opioids may be effective in shortening the duration of postoperative ileus in newborn infants.

Abdomen↗
PubMed2000

Presentation and management of epigastric hernias in children.

BACKGROUND/PURPOSE: Although epigastric hernias are common, there are no reports that describe the presentation and treatment of these defects in children. The authors reviewed their experience with these hernias to develop recommendations for their management in this age group. METHODS: Medical records were reviewed for all children younger than 18 years who presented for evaluation of an epigastric hernia at our institution over 14 years. Data on presentation, operative findings, and postoperative results were obtained. RESULTS: Forty children were evaluated for an epigastric hernia, representing 4% of all pediatric patients seen for treatment of a hernia. An epigastric hernia was first observed at birth in 12 patients (30%). All children presented with a mass in the epigastrium. The hernia was observed to be either symptomatic (abdominal wall pain or tenderness) or enlarging in 22 patients (55%). Thirty-eight children underwent repair, and 2 were lost to follow-up. There was no recurrence or morbidity associated with surgical repair of these defects. CONCLUSIONS: Epigastric hernias are common in children and frequently present in infancy. Because most are either symptomatic or enlarging, the authors recommend repair of these defects at the time of presentation.

Child↗
PubMed1998

Apnea following spinal anaesthesia in two former pre-term infants.

PURPOSE: To report the occurrence of apnea and bradycardia in two former pre-term infants who received spinal anaesthesia without inhalational or intravenous anaesthetic agents during inguinal herniorrhaphy. CLINICAL FEATURES: Two former pre-term infants who had no recent history of apnea or bradycardia and who had been discharged from the hospital presented for anaesthetic care during inguinal herniorrhaphy. Spinal anaesthesia using 1 mg.kg-1 tetracaine in dextrose 10% was performed. A sensory level of T4-6 was obtained in both infants. Neither infant received intravenous, oral, or inhalational agents for sedation. Five to ten minutes after placement of the spinal block, the two infants had frequent episodes of apnea and bradycardia. No change in the sensory level of spinal anaesthesia was noted. The apnea and bradycardia continued for a variable time into the postoperative period. Caffeine benzoate 10 mg.kg-1 was administered to one infant. Other than the apnea and bradycardia, both infants had uncomplicated postoperative courses. CONCLUSION: Apnea can occur when spinal anaesthesia is used as the sole anaesthetic technique in the former pre-term infant. Appropriate monitoring for such problems based on the infant's post-conceptual age is suggested.

Age Factors↗
PubMed1994

Inhibition of splenic macrophage tumor necrosis factor alpha secretion in vivo by antilipopolysaccharide monoclonal antibodies.

OBJECTIVE: This study tried to determine whether administration of antilipopolysaccharide (LPS) murine monoclonal antibody (mAb) 2A3 to mice was associated with (1) protective capacity during experimental gram-negative bacterial sepsis, and (2) inhibition of tumor necrosis factor alpha (TNF-alpha) secretion in the systemic circulation and at the tissue level during experimental infection. DESIGN: Mice received an initial intravenous injection of either saline or 100 micrograms of anti-LPS mAb 2A3, and 1 hour later underwent intraperitoneal inoculation of viable Escherichia coli 0111:B4. Mortality was assessed daily for 7 days. Separate groups of mice were treated similarly and plasma TNF-alpha concentrations were determined from blood samples obtained at 1, 3, 6, 10, and 16 hours after infection by enzyme-linked immunosorbent assay. Concurrently, splenocytes harvested from animals 3, 10, and 16 hours after infection were incubated in culture ex vivo and supernatant TNF-alpha levels were determined. RESULTS: Pretreatment with anti-LPS mAb 2A3 prior to an intraperitoneal challenge of live E coli 0111:B4 was associated with the following: (1) significant protective capacity (100% vs 0% mortality, P < .001); (2) inhibition of plasma TNF-alpha levels 16 hours after infection (1257 +/- 323 pg/mL vs 292 +/- 254 pg/mL, P < .001); and (3) abrogation of TNF-alpha secretion derived from splenic macrophages isolated 16 hours after bacterial challenge (229 +/- 12 pg/mL vs 107 +/- 48 pg/mL, P < .05). CONCLUSIONS: These results strongly support the contention that inhibition of LPS-induced TNF-alpha secretion at both the tissue and systemic levels is a key mechanism by which anti-LPS mAbs provide protection during gram-negative bacterial peritonitis. We believe that in vivo monitoring of macrophage cytokine secretion will be critical for elucidating the precise role of a variety of mediators in the pathogenesis of gram-negative bacterial sepsis.

Animals↗
PubMed1994

Diagnosis and treatment of cytomegalovirus disease in pediatric renal transplant recipients.

The purpose of this study was to identify factors associated with the development of cytomegalovirus (CMV) disease and to assess the morbidity of this illness in pediatric renal transplant patients. The authors retrospectively reviewed the records of 135 patients (< 18 years of age) who underwent a total of 151 transplants (146 kidney transplants, five kidney/liver transplants) over 5 years (average follow-up period, 33.0 +/- 21.7 months). They assessed the risk factors that previously have been associated with the development of CMV disease in adults (age, occurrence of acute rejection episodes, and preoperative donor and recipient CMV serological status) and evaluated the incidence of associated graft loss and mortality. Twenty-two episodes of CMV disease were diagnosed based on evidence of CMV infection and on clinical symptoms; the episodes were treated in 17 patients. A multivariate analysis showed that the development of CMV disease was associated with age of > or = 13 years (P = .02), concomitant liver transplantation (P = .01), and treatment of acute rejection (P = .04). In addition, patients who were CMV-seronegative preoperatively and received a graft from a CMV-seropositive donor (P = .04) or who were CMV-seropositive preoperatively and received a graft from a CMV-seronegative donor (P = .02) were more likely to have CMV disease. Although all patients with CMV disease required hospitalization and were treated with intravenous ganciclovir, CMV disease was not associated with increased allograft loss or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Anti-endotoxin monoclonal antibodies protect by enhancing bacterial and endotoxin clearance.

In this study, we sought to determine the mechanism(s) by which a type-specific anti-lipopolysaccharide monoclonal antibody (an IgG directed against the O-antigen polysaccharide region of Salmonella minnesota lipopolysaccharide) and its F(ab')2 fragments protect during gram-negative bacterial peritonitis and endotoxemia in mice. During peritoneal infection, (1) IgG significantly decreased mortality, bacteremia, and endotoxemia at all time points compared with saline solution pretreatment and (2) F(ab')2 fragments reduced mortality at 24 hours but not thereafter, and had no effect on bacteremia but reduced endotoxemia compared with saline solution pretreatment. In the endotoxin model, IgG pretreatment significantly reduced mortality compared with saline solution pretreatment, while F(ab')2 fragments had no significant effect on mortality. No difference in endotoxemia was observed in mice that received IgG, F(ab')2 fragments, or saline solution pretreatment during endotoxemia. These results suggest that type-specific anti-lipopolysaccharide monoclonal antibodies protect by Fc-mediated clearance of both bacteria and endotoxin.

Animals↗
PubMed1993

Anti-lipopolysaccharide monoclonal antibodies inhibit macrophage TNF messenger RNA synthesis in vitro.

Gram-negative bacterial lipopolysaccharide (LPS, endotoxin) directly stimulates macrophages to produce tumor necrosis factor (TNF). TNF, in turn, produces a constellation of adverse effects that includes hypotension, systemic acidosis, arterial hypoxemia, and death. Transcription of the TNF gene occurs within minutes of LPS stimulation and appears to be a critical control point in the synthesis and secretion of TNF protein by macrophages. We hypothesized that murine monoclonal antibody (mAb) 8G9 directed against Escherichia coli 0111:B4 LPS would provide protective capacity against an E. coli 0111:B4 bacterial challenge in vivo and would concurrently inhibit LPS-induced synthesis of TNF mRNA and secretion of TNF protein in vitro. E. coli 0111:B4 LPS was used to stimulate a macrophage-derived cell line (RAW 264.7) to produce TNF in the presence or absence of mAb 8G9. Media alone and LPS without 8G9 mAb served as controls against which the effect of 8G9 mAb was compared. Total cellular RNA was purified and analyzed by a Northern blotting technique utilizing a radiolabeled cDNA probe specific for TNF mRNA. TNF mRNA levels from each sample were quantitated by autoradiograph densitometry. Pretreatment with mAb 8G9 provided protective capacity against an intraperitoneal E. coli 0111:B4 bacterial challenge in vivo when compared with saline pretreatment alone (22% versus 90% mortality respectively, P < 0.05). Preincubation of LPS with mAb 8G9 resulted in a significant inhibition of LPS-induced TNF mRNA synthesis (63 +/- 20%, P < 0.01) and TNF protein secretion (88 +/- 10%, P < 0.001) in vitro.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

A rapid procedure for purifying IgM monoclonal antibodies from murine ascites using a DEAE-disk.

A method for purifying IgM monoclonal antibodies (mAbs) from murine ascites using a DEAE-disk is described. After ammonium sulfate precipitation, ascites proteins are redissolved and loaded onto a DEAE-disk. MAb then is eluted from the disk using a stepwise NaCl gradient. IgM mAb produced by this procedure was > 95% pure as assessed by reducing SDS-PAGE analysis and was free of significant IgG contamination as determined by double radial immunodiffusion analysis. Yield of IgM mAb was approximately 2% of total ascites protein and approximately 10% of the amount of IgM contained in crude ascites. MAb retained immunoreactivity as assessed by ELISA, and the affinity index was evaluated by thiocyanate elution and remained unchanged. This two step technique for purifying IgM mAb from murine ascites is rapid, simple, and yields mAb of sufficient purity and immunoreactivity for the majority of mAb applications.

Animals↗