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Biomedical subjects

T Groshong

Publications and source records attributed to T Groshong.

At least 19 recordsLinked to original sources
PubMed2000

Initial experience with isradipine for the treatment of hypertension in children.

BACKGROUND: Isradipine is a calcium channel blocker of the dihydropyridine class. It has limited effects on myocardial contractility; is available in a powder-filled capsule and has a half-life of 6 to 8 hours. METHODS: Pharmacy records were reviewed to identify pediatric patients who had received isradipine. The following demographic data were obtained: age, weight, sex, underlying medical problems, and initial blood pressure values. Information concerning isradipine included the initial dose and its interval, subsequent dose escalations, blood pressure response to the medication, and duration of therapy. RESULTS: The study population comprised 12 patients, ranging in age from 10 days to 11 years. The etiology of the hypertension was renal in 9 cases and nonrenal in 3. Initial dosing with isradipine was 0.1 mg/kg/dose. Six patients had emergent hypertension, and their blood pressure had been controlled with intravenous nicardipine before oral isradipine. Six patients received initial therapy with oral isradipine. Isradipine was monotherapy in 7 patients and in combination with other agents in 5 patients. The dose of isradipine required for blood pressure control was 0.6 +/- 0.3 mg/kg/day (range, 0.3 to 1.2 mg/kg/day). Isradipine failed to provide effective blood pressure control in 2 patients. In 1 of these patients, isradipine was effective after peritoneal dialysis. CONCLUSIONS: Isradipine is an effective, orally administered agent for control of hypertension in children.

Administration, Oral↗
PubMed1999

Relationship between conditional early acceptance into medical school and medical school leadership and academic performance: the Conley Scholar experience at the University of Missouri-Columbia.

UNLABELLED: The Conley Scholars Program at the University of Missouri-Columbia was created in 1987 to guarantee top flight students entrance to medical school without the frantic competition well known in undergraduate pre-med programs. The program provides greater freedom as undergraduates than most combined baccalaureate-MD programs. It is not known how this freedom and avoidance of the "pre-med syndrome" affects medical school performance and relative leadership qualities compared to traditional medical students. The goals of this study are to: a) compare relative composition and performance of Conley medical students to traditional medical students; b) assess the role of Conleys in leadership positions within medical school organizations. METHODS: Using the medical school computer data files and AMCAS application files, composition, academic, and leadership data were collected regarding all medical school classes containing Conleys. Statistical analysis was performed on all data. RESULTS: The results suggest that: a) Conley Scholars averaged significantly higher undergraduate GPAs than other medical students; b) Conley Scholars averaged higher GPAs throughout medical school; c) Conley Scholars are more likely to hold medical school leadership roles than traditional medical students. CONCLUSIONS: The results confirm the value of the Conley Scholar Program. Benefits extend beyond academic achievement to encompass the development of leadership skills recognized by faculty and peers.

Chi-Square Distribution↗
PubMed1999

Acute interstitial nephritis following amoxicillin overdose.

Antibiotics are commonly prescribed medications for pediatric infections. Acute interstitial nephritis has been reported with B-lactam antibiotics. We report the case of a 4-year-old boy who ingested 240 mg/kg of amoxicillin and developed acute oliguric renal failure with hematuria and crystalluria. The patient was hospitalized for serial renal function and electrolyte evaluation. Although he developed hyperkalemia, full recovery was obtained with conservative management. This case emphasizes that medications considered to be non-toxic even with overdose can have serious adverse effects which may require therapeutic intervention.

Acute Disease↗
PubMed1998

Nicardipine for hypertensive emergencies in children with renal disease.

Hypertensive emergencies secondary to renal diseases were treated with nicardipine in three children. Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its physiological actions include vasodilation, with limited effects on the chronotropic and inotropic function of the myocardium. Nicardipine, starting at 5 microg/kg per min and then continued at a maintenance infusion of 1-3 microg/kg per min, effectively controlled the mean arterial pressure in the three patients. Apart from occasional superficial thrombophlebitis in a fourth patient, no adverse effects were noted.

Adolescent↗
PubMed1996

Hypertensive crisis in children.

Children presenting with hypertension should be considered for emergency treatment when there is evidence of end-organ toxicity. Complications of extreme hypertension may be very serious, even life threatening, with the potential for life-long sequelae. Of greatest significance is damage to the central nervous system. Treatment of hypertensive emergencies should be directed toward the lowering of blood pressure enough to reduce toxicity, but not at a rate likely to cause hypoperfusion of vital organs. This blood pressure reduction should, in general, be carefully controlled in an intensive care unit, with attention to central nervous system, cardiac, and renal function. Intravenous agents are preferable under these circumstances, due to greater ease in modulating blood pressure. In the absence of specific contraindications, a continuous infusion of nicardipine or sodium nitroprusside is preferable. Intravenous labetalol by bolus injection, followed by continuous infusion, also may be used. Oral agents should be reserved for circumstances in which symptoms of end-organ toxicity are mild or absent. Since general pediatricians have limited experience with the treatment of hypertensive emergencies, consultation with physicians experienced in treating hypertensive emergencies is suggested when possible.

Antihypertensive Agents↗
PubMed1988

Kinetics of peritoneal dialysis in children: role of lymphatics.

Intraperitoneal fluid is absorbed continuously by convective flow into the peritoneal cavity lymphatics. We evaluated the role of lymphatic absorption in the kinetics of peritoneal dialysis during standardized four hour exchanges in six children using 40 ml/kg of 2.5% dextrose dialysis solution. Cumulative lymphatic absorption averaged 10.4 +/- 1.6 ml/kg and reduced the total net transcapillary ultrafiltration during the dwell time by 73 +/- 10%. Due to the considerable lymphatic absorption rate, maximum intraperitoneal volume was observed before osmolar equilibrium. Extrapolated to four study exchanges per day, lymphatic absorption decreased the potential daily drain volumes in the children by 27 +/- 5% and daily peritoneal urea and creatinine clearances by 24 +/- 4% and 22 +/- 5%, respectively. Compared with four hour exchanges using two liters of 2.5% dextrose dialysis solution in 10 adult CAPD patients with average peritoneal transport, the children had more rapid equilibration of urea, greater absorption of dialysate glucose, higher lymphatic absorption and lower net ultrafiltration (P less than 0.01 to P less than 0.05). Lymphatic absorption therefore causes a relatively greater reduction in net ultrafiltration and solute clearances in children than in adults.

Adolescent↗
PubMed1980

Neonatal renal failure: usefulness of diagnostic indices.

Forty-two oliguric neonates were prospectively studied to evaluate the usefulness and reliability of various diagnostic indices in differentiating renal failure from functional (prerenal) oliguria. Twenty-two infants had functional oliguria, 16 had renal failure, and four infants had probable early renal failure. Statistically significant differences between functional oliguria and renal failure were found with regard to the urine sodium, urine to serum ratios of sodium, urea, and creatinine, renal failure index, and fractional excretion of sodium. However, sharp demarcation of the two groups was possible only when the renal failure index or fractional excretion of sodium was used. Fractional excretion of sodium values of 2.5 or greater seem to differentiate renal failure from functional oliguria in this study.

Acute Kidney Injury↗
PubMed1979

Propranolol in human plasma and breast milk.

To assess the problem of continuing propranolol therapy in a breast-feeding mother, studies were performed to determine simultaneously plasma and breast milk concentrations of propranolol after single dose (40 mg) and continuous dose (40 mg 4 times daily) treatment with this drug. Breast milk and plasma concentrations of propranolol peaked between 2 and 3 hours after dosing. Propranolol concentrations in breast milk were less than 40 and 64 percent, respectively, of peak plasma propranolol concentrations after single dose and continuous dose administration. It was estimated that the maximal cumulative propranolol load to this breast-feeding infant, consuming 500 ml of whole milk, when the mother received 40 mg of propranolol 4 times daily would be 21 microgram/24 hours. This dose is considerably less than the usual therapeutic dose of propranolol for infants.

Adult↗
PubMed1976

Chronic cytomegalovirus infection, immunodeficiency, and monoclonal gammopathy-antigen-driven malignancy?

An infant with severe combined immunodeficiency had normal numbers of lymphocytes which bore E rosette and surface Ig markers in an appropriate distribution. However, only minimal responsivity to in vitro stimulation by mitogens and allogenic cells, and none to antigens could be elicited; functional antibody responses were also nil, except to cytomegalovirus. Intrauterine-acquired cytomegalovirus may have caused his immune dysfunction, although the possibility of a postnatal infection cannot be excluded. Therapy with transfer factor and thymus transplantation was unsucessful in restoring immunity and may have aggravated a pre-existing monoclonal gammopathy. It is possible that the monoclonal protein was derived from B-cells transplacentally received from the patients mother.

Antibody Formation↗
PubMed1975

Treatment of severe combined immunodeficiency with bone-marrow from an unrelated, mixed-leucocyte-culture-non-reactive donor.

A 7-month-old boy with severe combined immunodeficiency had no relative who was a suitable bone-marrow donor as determined by mixed-leucocyte-culture (M.L.C.) testing. In the general population an M.L.C.-nonreactive, unrelated donor was found among individuals who were identical with our patient at the Four locus. Following a bone-marrow transplant this child showed signs of rapid immunological reconstitution and only a mild graft-versus-host reaction. Unfortunately, the child died 31 days post-transplantation of cytomegalovirus infection. The findings support the hypothesis that matching for lymphocyte-defined antigens among unrelated individuals will permit successful immunological reconstitution.

Bone Marrow Cells↗