PubMed Health⌕ Search

Biomedical subjects

T Tracy

Publications and source records attributed to T Tracy.

70 records · Page 4Linked to original sources
PubMed1990

Congenital bronchopulmonary malformations. Diagnostic and therapeutic considerations.

Congenital bronchopulmonary malformations are uncommon but potentially life-threatening anomalies of infants and children. Between 1970 and 1988, 45 patients from birth to 13 years of age (23 boys and 22 girls) underwent evaluation and treatment for bronchopulmonary malformations. Thirty-seven had solitary lesions: bronchogenic cyst (n = 13), cystic adenomatoid malformation (n = 9), congenital lobar emphysema (n = 6), pulmonary sequestration (n = 6), arteriovenous malformation (n = 2), and bronchial atresia (n = 1). Eight additional patients had two simultaneous abnormalities and three patients had congenital diaphragmatic hernias. Twenty-one patients had respiratory symptoms, which were severe in seven. Twelve had pulmonary infection and 10 patients were completely free of symptoms. Plain chest roentgenogram was the only diagnostic imaging performed in 11 patients. Thirteen patients underwent computed tomographic scan, but in only four was it essential for diagnosis. Prenatal ultrasonography in three patients demonstrated cystic adenomatoid malformation in two, with one false negative study. Postnatally, ultrasonography was also useful in establishing the diagnoses of cystic adenomatoid malformation and pulmonary sequestration. Thoracotomy with excision of the lesion by lobectomy or pneumonectomy resulted in survival of 42 patients (93%). Three deaths in neonates were due to pulmonary hypoplasia and hypertension. Two of them had concomitant diaphragmatic hernia; the other had a cystic adenomatoid malformation and died despite the use of postoperative extracorporeal membrane oxygenation. These data demonstrate that congenital bronchopulmonary malformations usually can be diagnosed by plain chest x-ray films. Ancillary studies such as ultrasonography or computed tomography may occasionally be necessary. Combinations of the different types of bronchopulmonary malformations occurred frequently. All lesions, including symptomatic lesions in neonates, can be managed surgically soon after diagnosis.

Adolescent↗
PubMed1990

Safety and efficacy of combined gemfibrozil-lovastatin therapy for primary dyslipoproteinemias.

In 25 patients with primary dyslipoproteinemias and severe premature atherosclerosis, during an average combined Lopid-Mevacor treatment span of 12.5 months per patient, our specific aim was to assess safety and efficacy of open-label therapy with diet, gemfibrozil (Lopid), and lovastatin (Mevacor). Because targeted lipid values were not reached on diet alone (low-density lipoprotein cholesterol [LDLC] less than 120 mg/dl, high-density lipoprotein cholesterol [HDLC] greater than 35 mg/dl or total cholesterol [TC]/HDLC less than 4.5), the patients received Lopid, 1.2 gm/day as their initial lipid-lowering drug. Because targeted lipid levels were not reached with Lopid treatment alone after 3 or more months, Mevacor was added, with 17 subjects receiving 20 mg/day, five receiving 40 mg, two receiving 60 mg, and one receiving 80 mg. Outpatient visits were repeated during combined therapy every 6 to 8 weeks, with an average of 6.4 visits per subject, 162 measurements of fasting lipids and liver function tests, and 127 measurements of creatine phosphokinase (CPK). By selection, all patients had normal liver function (gamma-glutamyltransferase, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT) levels) and normal CPK levels at baseline. No gamma-glutamyltransferase levels were high during combined therapy. Of the 162 liver function test measurements, five (3.1%) SGOT levels and three (1.9%) SGPT levels were high. Of 127 CPK measurements, three (2.4%) were high; one subject had a high CPK measurement, and one subject had two high measurements for CPK. No symptomatic myositis or myalgias developed in the subjects; none had palpable skeletal muscle tenderness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Lack of concordance in classification of coronary heart disease risk: high-risk HDL cholesterol less than 35 mg/dl in subjects with desirable total serum cholesterol, less than 200 mg/dl.

In using National Cholesterol Education Program guidelines (for desirable low risk, a total cholesterol level less than 200 mg/dl, and for high risk, a level of high-density lipoprotein cholesterol (HDLC) less than 35 mg/dl), our specific aim was to examine lack of concordance in classification of coronary heart disease (CHD) risk by HDLC less than 35 mg/dl in subjects with total cholesterol less than 200 and to determine whether lack of concordance increased as group CHD risk increased. We studied four cohorts ranging from putatively low to high CHD risk. These included self-referred subjects in a public urban total cholesterol screening (n = 897), hospitalized patients with depression (n = 144), Cholesterol Center referrals at presumed high CHD risk (n = 1120), and patients having coronary arteriography (n = 145) because of presumed coronary artery disease. Total cholesterol was less than 200 mg/dl in 25% of subjects from the urban sampling, in 54% of hospitalized patients with depression, in 27% of Cholesterol Center referrals, and in 41% of those undergoing cardiac catheterization. In these four cohorts, of subjects with total cholesterol less than 200, 7%, 26%, 25%, and 48%, respectively, had HDLC less than 35 mg/dl. The likelihood of having total cholesterol less than 200 and HDLC less than 35 mg/dl was 1.7% in urban public subjects, 6.8% in Cholesterol Center referrals, 13.9% in depressed patients, and 20% in cardiac catheterization patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗
PubMed1988

Cricoid split for subglottic stenosis in infancy.

Historically, tracheostomy has been used for infants with airway obstruction caused by congenital or acquired subglottic stenosis. Postoperative morbidity and mortality with this provisional operation led Cotton, in 1980, to substitute anterior cricoid split as the primary definitive procedure. Within the past three years, anterior cricoid split has been performed in 4 infants, aged 3 to 9 months, with acquired (3 patients) or congenital (1 patient) subglottic stenosis requiring ventilation through an endotracheal tube. Following cricoid split, the trachea is stented for 12 to 14 days by a nasotracheal tube, with extubation and rigid bronchoscopy in the operating room with the patient under anesthesia to confirm healing and patency. During an 18- to 24-month follow-up in these 4 patients, morbidity has been minimal, patency has persisted, and stridor has not recurred. Accordingly, a conclusive operation, cricoid split, rather than a temporizing tracheostomy may be employed for certain obstructive tracheal lesions early in life.

Cricoid Cartilage↗
PubMed1988

Right pneumonectomy syndrome: a lethal complication of lung resection in a newborn with cystic adenomatoid malformation.

A newborn girl underwent a right pneumonectomy for cystic adenomatoid malformation. She subsequently developed compression of the trachea and left mainstem bronchus by a combination of aortic arch, pulmonary artery, and ductus arteriosus. She died while planning aortic suspension, and the anatomic relationships were confirmed by autopsy. This problem is potentially treatable by a variety of means.

Coronary Angiography↗
PubMed1988

Use of the Greenfield filter in adolescents for deep vein thrombosis and pulmonary embolism.

Serious venous thromboembolic disease is now recognized more frequently in the pediatric age group. Caval interruption is indicated most commonly for prophylaxis against life-threatening or recurrent pulmonary embolism (PE) when anticoagulation is ineffective or contraindicated. Greenfield vena caval filters have been utilized locally in 415 adult patients with 97% long-term patency and 5% recurrent embolization. Its application in adolescents is reported herein. Standard adult (30-mm) vena caval filters were placed in ten patients, ages 13 to 18. Four filters were required following PE, six were used for deep venous thrombosis (DVT) when anticoagulation was contraindicated, and one was inserted prophylactically. In eight patients, filter insertion was accomplished with local anesthesia, while two underwent filter placement under general anesthesia administered for other procedures. One filter was misplaced into the right renal vein, requiring a second filter insertion. All patients have been followed from 1 to 11 years with yearly vascular duplex imaging and radionuclide venograms documenting caval patency without clinical embolic sequelae. This duplicates the adult experience in safety and efficacy. As recognition of venous thromboembolism becomes more frequent in the pediatric age group, safe caval interruption may be necessary for those excluded from or not responsive to anticoagulation. This technique may be extended to smaller patients with miniaturization of both filter and carrier.

Adolescent↗
PubMed1986

Ileoproctostomy with J-pouch: use of the Swenson pull-through for reconstruction after proctocolectomy for ulcerative colitis.

Continence can be preserved by several operations following proctocolectomy for ulcerative colitis. The Swenson procedure, used for congenital megacolon, may be applied for reconstruction following proctocolectomy for other colonic disease. Rectal eversion and resection to the dentate line obviates the need for mucosectomy and permits ileoanal anastomosis with excellent exposure. Two girls, 9 and 11 years of age, underwent proctocolectomy, formation of an ileal J-pouch, and a Swenson pull-through with ileoanal anastomosis. One year following closure of diverting ileostomies, both children have 2 to 3 continent bowel movements daily with very rare nocturnal soiling. Anal manometry is normal. The application of this method for ileoanal anastomosis may broaden the choice of operations for selected children requiring proctocolectomy.

Child↗
PubMed1985

Tracking of high- and low-density-lipoprotein cholesterol from childhood to young adulthood in a single large kindred with familial hypercholesterolemia.

Tracking of high- and low-density-lipoprotein cholesterol (HDLC, LDLC) from childhood to young adulthood was assessed in 77 children and in 53 adults from a single large pedigree with familial hypercholesterolemia who were respectively less than or equal to 19 and greater than or equal to 20 years old when first studied in 1973, with reassessment in 1984. No children and only five of the adults had received LDLC lowering therapy from 1973 to 1984. The rank correlations between the 1973 and 1984 measurements for LDLC were 0.73, 0.74, and 0.87; and for HDLC were 0.55, 0.73, and 0.65 (P less than 0.0001 for all correlations), respectively for relatives who were less than or equal to 12, 13 to 19, and greater than or equal to 20 years old in 1973. The 1973:1984 LDLC and HDLC correlations, categorized by relationships to the proband, were as follows: (1) unrelated, LDLC = 0.16, HDLC = 0.56;* (2) first-degree relatives, LDLC = 0.90, HDLC = 0.30; (3) second-degree relatives, LDLC = 0.79, HDLC = 0.39; and (4) other relatives, LDLC = 0.62, HDLC = 0.64. All nine of the probands' first-degree relatives who were above the age-sex specific LDLC 95th percentile in 1973 were also greater than the 95th percentile for LDLC in 1984. Similarly, seven of eight second-degree relatives with LDLC greater than the 95th percentile in 1973 were greater than the 95th percentile in 1984, as were ten of 15 other relatives. LDLC levels in childhood in this extended kindred were highly predictive of adult values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Malignant fibrous histiocytomas in children.

The natural history of malignant fibrous histiocytomas in children has not been well delineated. During a 6-year period, we have treated six patients less than 18 years of age. The sites of origin included the retroperitoneum in 2 patients, neck in 2 patients, and extremities in 2 patients. Surgical treatment consisted of wide local excision in 5 patients and amputation in 12; radiation and/or chemotherapy were administered to 2 patients following resection of all tumor. All children remain free of local recurrence or distant metastases with a median follow-up in excess of 4 years. These data suggest that malignant fibrous histiocytomas in children may have a better prognosis than in adults.

Adolescent↗
PubMed1982

Changes in plasma lipid and lipoprotein fractions after alteration in dietary cholesterol, polyunsaturated, saturated, and total fat in free-living normal and hypercholesterolemic children.

To assess the effects of dietary cholesterol and the amount and type of fat on plasma lipid and lipoproteins, nutrient intakes were altered sequentially over 15 months in 11 normal children and 12 children with heterozygous familial hypercholesterolemia. After a 3-month base-line assessment period, on an ad libitum diet, the following diets were given sequentially for three months each: dietary cholesterol greater than 450 mg/day, total fat less than 35% of total calories, and polyunsaturated fat to saturated fat ratio (P/S) greater than 1.5 (diet 1); dietary cholesterol less than 160 mg/day, total fat less than 35% total calories and P/S greater than 1.5 (diet 2); dietary cholesterol less than 160 mg/day, total fat 40% total calories P/S = 1 (diet 3), and dietary cholesterol greater than 450 mg/day total fat greater than 40% total calories, P/S less than 0.04 (diet 4). In normal and familial hypercholesterolemic children the high dietary P/S ratio lowered total and low-density lipoprotein cholesterol in the presence of high dietary cholesterol; sharp reductions in dietary cholesterol lowered the total and low-density lipoprotein cholesterol slightly in familial hypercholesterolemia subjects when P/S was high. High-density lipoprotein cholesterol was not affected by large changes in dietary cholesterol or amount or type of fat. Sustained dietary alteration which significantly lowers total and low-density lipoprotein cholesterol with commercially available products is achievable and practical in free-living children.

Adolescent↗
PubMed1982

Studies of familial type III hyperlipoproteinemia using as a genetic marker the apoE phenotype E2/2.

Clinical symptoms, lipoprotein patterns, and apoE phenotypes were determined in 17 individuals with type III hyperlipoproteinemia (type III HLP) and in their relatives and spouses. The apoE phenotype E2/2 occurred in 15 type III HLP probands (88%) and the apoE phenotype E4/2 was found in 2 probands. In each of the families studied, the apoE phenotype inheritance was compatible with a model we previously proposed in which apoE is determined at a single genetic locus with three common alleles. The apoE phenotypes E4/4, E3/3, and E2/2 represent homozygosity for the apoE alleles epsilon4, epsilon3, and epsilon2, respectively, whereas the apoE phenotypes E4/3, E3/2, and E4/2 represent heterozygosity for the apoE alleles epsilon4/epsilon3, epsilon3/epsilon2, and epsilon4/epsilon2, respectively. Plasma lipids in 69 relatives of type III HLP probands were analyzed by apoE phenotype and revealed no significant differences between phenotypes in the levels of cholesterol, triglyceride, or HDL cholesterol. However, there were differences between the apoE phenotypes in LDL cholesterol levels (P = 0.01) and in the ratio of VLDL cholesterol/total triglyceride (ratio) (P < 0.01). Relatives with the apoE phenotype E2/2 had the lowest LDL cholesterol levels and the highest ratios. Of these eleven individuals with the apoE phenotype E2/2 who were not type III HLP probands, two males were taking lipid-lowering drugs, one male had mild angina at age 59, five individuals had ratios >0.25 and two had ratios >0.30 with the ratios for males (0.28 +/- 0.06) significantly greater than the ratios for females (0.17 +/- 0.06) (P < 0.01), and seven had evidence of floating betaVLDL on lipoprotein electrophoresis. In addition, when compared to a control group in the general population, the whole group of relatives had normal cholesterol and HDL cholesterol levels, slightly low LDL cholesterol levels, and almost twice elevated triglyceride levels. In summary, a) a very strong but not invariate association exists between type III HLP and the apoE phenotype E2/2 with some type III HLP individuals having the apoE phenotype E4/2; b) apoE phenotype inheritance is determined by three alleles at a single genetic locus; c) relatives of type III HLP probands, no matter what their apoE phenotype, have on the average nearly twofold elevated plasma triglyceride levels compared to a control population; and d) non-proband type III HLP individuals with the apoE phenotype E2/2 have been identified. As a group these individuals, particularly the males, show a tendency to express type III HLP, but clearly genetic or environmental factors other than the apoE phenotype E2/2 are required for the full phenotypic expression of this disease.-Breslow, J. L., V. I. Zannis, T. R. SanGiacomo, J. L. H. C. Third, T. Tracy, and C. J. Glueck. Studies of familial type III hyperlipoproteinemia using as a genetic marker the apoE phenotype E2/2.

Adult↗
PubMedDate not supplied

A matched pairs analysis of venoarterial and venovenous extracorporeal life support in neonatal respiratory failure.

It has been suggested that venovenous (VV) extracorporeal life support (ECLS) confers a survival advantage over venoarterial (VA) ECLS. These results have been confounded by differences in patient populations. In this study, a matched pairs comparison of survival and complication rates in neonatal respiratory failure patients managed with VA or VV ECLS was performed. Retrospective matching of 643 VA and VV patient pairs from the Extracorporeal Life Support Organization Registry was performed. Pairs were matched by same year, same diagnosis, gestational age +/- 1 week, birth weight +/- 0.3 kg, and oxygenation index +/- 5. Further matching for hemodynamic status was possible for 272 pairs and included pre ECLS CPR, use of epinephrine, and arterial pH +/- 0.1. Statistical significance was defined for outcome and selected complication rates using McNemar's chi-square analysis with correction for multiple comparisons. A survival advantage for VV was significant when matching for respiratory failure (83.8% VA versus 91.5% VV), but was not significant when matching for hemodynamic failure (90.4% VA versus 94.5% VV). In the latter match, hemolysis (10.7% VA versus 23.5% VV) and cannula kinking (0.4% VA versus 10.6% VV) were more common with VV ECLS. The incidence of intracranial hemorrhage did not significantly differ between groups (6.3% VA versus 7.4% VV). Survival is not significantly greater with VV ECLS when patients are matched for degree of respiratory and hemodynamic failure. Hemolysis and cannula kinking are more common with VV ECLS. There is no identified difference in the incidence of intracranial hemorrhage.

Carotid Arteries↗
PubMedDate not supplied

Organizational change from the "mom and pop" perspective.

Can hospitals successfully embark on large-scale organizational change without using outside consultants? Nursing administrators have an intense interest in the answer to this question. If change can be designed from inside the organization, the chances are greater that the change will fit better with the organization as a whole, and that buy-in by staff will be significant. The authors review the elements that need to be in place to conduct a successful change process internally, and support their concepts with a case study.

Arizona↗