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V McCarthy

Publications and source records attributed to V McCarthy.

10 recordsLinked to original sources
PubMed2000

Identifying montages that best detect electrographic seizure activity during polysomnography.

STUDY OBJECTIVES: Recognizing epileptic seizures during video polysomnography (VPSG) can be challenging, particularly when using standard, limited EEG montages and paper speed. Few sleep laboratories have PSG equipment that allows for the recording of 18 channels of EEG without compromising the ability to detect sleep apnea, periodic limb movements, and parasomnias. We studied the ability of sleep medicine- and EEG-trained polysomnographers to correctly identify epileptic seizures during PSG using 4, 7, and 18 channels of simultaneous EEG, recording at conventional PSG and EEG paper speeds. The purpose of this study was to determine the value of limited EEG montages viewed with EEG reformatting capability in the identification of seizures during PSG. DESIGN: Blinded EEG analysis of seizures and arousals during VPSG. SETTING: Tertiary care hospital with sleep laboratory and epilepsy monitoring unit. PATIENTS: Subjects with focal (partial) epilepsy that underwent video-EEG monitoring. INTERVENTIONS: We designed two 7-channel EEG montages that might facilitate the identification of seizures arising from the frontal and temporal lobes. Sleep medicine- and EEG-trained polysomnographers were asked to review tracings containing frontal or temporal lobe epileptic seizures and arousals from sleep. Utilizing the capability of our digital recording equipment to reformat EEG channels and change paper speeds, we asked the readers to classify events recorded with 4, 7, and 18 channels of simultaneous EEG, at paper speeds of 10 and 30 mm/sec. MEASUREMENTS AND RESULTS: 6 readers viewed 32 sleep-related events (13 frontal lobe seizures, 11 temporal lobe seizures, and 8 arousals). The following factors were analyzed for their influence on accuracy of event detection: 1) the type of training of the reader (EEG vs. sleep medicine); 2) the number of EEG channels (4, 7, or 18); and 3) paper speed (10 vs. 30 mm/sec). Pair-wise comparisons and generalized estimating equations were used to identify factors leading to more accurate detection of seizures and arousals. 77% of events were correctly identified: 74% of seizures and 88% of arousals. Seizure detection was better using 7 and 18 channels (sensitivity of 82% and 86%, respectively) than 4 EEG channels (sensitivity of 67%) for temporal lobe seizures only. The number of EEG channels did not affect the accuracy of frontal lobe seizure detection. For EEG-trained readers, accuracy was greater using 30 mm/sec than 10 mm/sec paper speed (85% vs. 78% correct, respectively). CONCLUSIONS: Adding EEG channels and EEG reformatting capabilities to PSG interpretation improves the detection of some types of epileptic seizures. Accuracy of temporal lobe seizure detection using an abbreviated 7-channel montage approximates that of an 18-channel EEG recording. However, the same is not true of frontal lobe seizures in which accuracy was similar regardless of the number of EEG channel available. Further studies are needed to identify specific EEG montages that would best detect epileptiform activity during VPSG.

Electrodes↗
PubMed1998

Sleep apnoea in endocrine diseases.

The pertinent literature on the prevalence, clinical manifestations and pathogenic mechanisms of sleep apnoea (SA) in endocrine diseases, namely acromegaly, Cushing syndrome, hypothyroidism and diabetes mellitus was reviewed. An increased prevalence is well documented in patients with active and treated acromegaly. While most authors report peripheral obstruction, due to hypertrophy of tongue and pharyngeal tissues, to be the cause of SA in acromegaly, some findings argue for a role of hormone-induced changes of central respiratory control. SA is also more common in hypothyroidism, especially when myxedema is present. The associated edema and myopathy appear to be of pathogenic importance. Thyroxin substitution is frequently effective for the treatment of SA but nCPAP can be necessary initially and in some patients even after remission of clinical signs of hypothyroidism. In Cushing disease and syndrome, parapharyngeal fat accumulation can cause SA, but no epidemiological information is available. In non insulin dependent diabetes (NIDDM), obesity is the common risk factor for both, nocturnal hypoxia and insulin resistance. In IDDM, the development of autonomic neuropathy may predispose to SA. Where treatment of the underlying endocrine disease is unable cure the associated SA, nCPAP is usually the treatment of first choice. More prospective studies are clearly needed to establish prevalences and resolve the controversies regarding pathogenesis.

Cushing Syndrome↗
PubMed1998

Anabolic effects of growth hormone treatment in young children with cystic fibrosis.

BACKGROUND: Malnutrition is commonly found in children with Cystic Fibrosis (CF) and is characterized by poor weight gain and linear growth. Almost one-third of children with CF are below 5th percentile for weight and height. Intensive nutritional supplementation may not result in sustained improvement in weight gain and linear growth. OBJECTIVE: To evaluate the anabolic effects of GH, Humatrope (Eli Lilly, 0.05 mg/kg/day) was administered to five children with CF (3 males/2 females) for an average period of 2 years. METHODS: All patients were maintained on caloric intake of 1.3-2.0 times the recommended daily allowance. Patients underwent standard growth hormone (GH) stimulation studies and measurement of IGF-1 and IGFBP-3. RESULTS: The mean +/- SE for age and skeletal age were 3.2 +/- 0.85 years and 2.0 +/- 0.45 years, respectively. Growth was assessed by determining both weight and height, which were normalized for age and sex by calculating Z scores using HANES I reference data. Differences in Z scores between clinic visits (delta Z) were calculated for both weight and height to determine changes in growth velocity. The mean Z scores for weight and height were markedly attenuated in CF children as compared with healthy children (-1.95 +/- 0.23 and -2.8 +/- 0.27, respectively). The mean +/- SE for maximum stimulated GH value, IGF-1 and IGFBP-3 were 9.2 +/- 1.2 ng/dl, 67 +/- 6 ng/ml, and 1.7 +/- 0.22 mg/L, respectively. GH treatment improved weight and height Z scores (-0.11 +/- 0.05 and -0.94 +/- 0.18, p < 0.01) significantly. The delta Z scores for weight and height were significantly increased during first and second year of GH treatment (p < 0.02). Also, the average values of IGF-1 and IGFBP-3 were significantly increased as compared to pretreatment values (186 +/- 37 ng/ml and 3.0 +/- 0.22 mg/L, p < 0.01). CONCLUSIONS: GH treatment significantly improves weight and linear growth in young patients with CF. These data suggest that anabolic effects of GH may be beneficial for treatment of malnutrition in children with CF.

Body Height↗
PubMed1995

Ethics in nursing practice: confidentiality for women and their children with HIV/AIDS.

HIV-positive women and their children experience substantial problems brought about by the illness itself and service-delivery issues. Significant ethical concerns are raised when providing care to this patient population, and the ramifications of compromises in patient confidentiality are extremely serious. All practicing nurses should be familiar with the issues and potential solutions.

Adult↗
PubMed1987

Aerosolized ribavirin in the treatment of patients with respiratory syncytial virus disease.

Thirty children 1 to 33 months of age were enrolled in a study of aerosolized ribavirin therapy for respiratory syncytial virus lower respiratory tract illness. Twenty patients received ribavirin and 10 received placebo. There were no significant differences between the groups in chronologic or gestational age or in days of illness prior to admission. Among patients with pneumonia 17% of 6 placebo patients vs. 64% of 11 ribavirin patients had radiographic evidence that multiple lung lobes were affected (P = 0.06). Placebo patients received 42.5 to 94.7 hours (mean, 58.6) of aerosol therapy, whereas ribavirin patients received 36.3 to 95.6 hours (mean, 55.7). Seventy-seven percent of all study patients were discharged within 5 days of starting treatment. Severity of illness was evaluated daily using a scale of 0 (normal) to 4+ (most severe). Ribavirin patients initially had a mean severity score 0.5 higher than placebo patients. By Day 2, their rate of improvement was significantly greater than that of placebo patients (P = 0.001). By Day 5, 36% of ribavirin patients with rales showed improvement, whereas rales persisted in 100% of placebo patients. The rate of improvement of oxygen saturation from first to last day of treatment was statistically significant only for ribavirin patients (P = 0.02). On Day 3, 65% of ribavirin patients (13) vs. 50% (5) placebo patients shed 10(-0.5) 50% tissue culture infective dose virus per 0.2 ml of nasal wash. No side effects or toxicity were associated with aerosol therapy. A short course of ribavirin treatment (approximately 3 days) proved safe and beneficial.

Administration, Inhalation↗
PubMed1986

Successful preoperative apheresis of factor VIII antibody using factor VIII concentrate as a replacement fluid.

Plasma exchange was performed on a patient with hemophilia A and inhibitor to factor VIIIC prior to bilateral cataract removal. Koate was used as replacement fluid with effective reduction of the inhibitor level. From the technical standpoint we found out that factor VIII is best reconstituted in water and directly infused through the venous line and not the centrifuge bowl.

Adult↗
PubMed1977

Osteolytic lesions following traumatic pancreatitis.

We present a case of osteolytic lesions secondary to medullary fat necrosis associated with pancreatitis. The bone lesions are usually secondary to pancreatic trauma and evaluation of possible child abuse is indicated. The roentgenographic findings may not be seen until three to four weeks after the onset of pancreatic disease, and must be differentiated from osteomyelitis and traumatic periostitis. The presence of multiple lesions in many bones without substantial clinical signs of infection should suggest the pancreas as the primary problem.

Bone Resorption↗
PubMed1977

Neurophysiological correlates of acupuncture: limbic and thalamic responses to analgesic studies in non-human primates.

Single unit activity from chronically implanted squirrel monkeys was analyzed to evaluate the effect of acupuncture stimulation on limbic and thalamic structures associated with pain. Extracellular recordings and computer-generated interspike interval histograms (ISIH) were obtained from n. parafasicularis and n. ventralis posteromedialis of the thalamus and the laternal septum, basal amygdala and anterior cigulate cortex. Thalamic activity remained unchanged while limibc units demonstrated statistically significant alterations in both cell firing rate and the ISIH in response to acupuncture stimulation. Although pain thresholds in response to tooth pulp stimulation were increased by morphine (37-51% +/- 2.1), acupuncture proved totally ineffective. This may be interpreted as a selective response to acupuncture in CNS structures primarily concerned with the affective component of pain.

Action Potentials↗