PubMed Health⌕ Search

Biomedical subjects

W F Dodge

Publications and source records attributed to W F Dodge.

At least 19 recordsLinked to original sources
PubMed1994

Population pharmacokinetic models: effect of explicit versus assumed constant serum concentration assay error patterns upon parameter values of gentamicin in infants on and off extracorporeal membrane oxygenation.

Prior authors had hypothesized (but not clearly found) an increased apparent volume of distribution (Vd) for gentamicin in neonates undergoing extracorporeal membrane oxygenation (ECMO). We chose to study the question in our own clinical setting. To develop population pharmacokinetic models of the drug, we used the nonparametric expectation and maximization population modeling method and data from 11 neonates who received gentamicin on ECMO, including 6 infants who received gentamicin both on and off ECMO for severe respiratory failure. We found an increased Vd for gentamicin on ECMO and attributed much of the difference from prior investigations to our use of an explicitly determined laboratory assay error pattern for the measured serum concentrations rather than using constant weighting of the serum level data points. For six infants, while on ECMO their median Vd was 0.748 L/kg compared with a median Vd of 0.471 L/kg after ECMO was discontinued. The median clearance of gentamicin in the six infants while undergoing ECMO was 0.239 L/h compared with 0.350 L/h after ECMO was discontinued. The median half-time (T1/2) was 9.24 h while on ECMO compared with 3.87 h when off ECMO. We conclude that while undergoing ECMO, neonates have a higher volume of distribution for gentamicin, a lower clearance, and a much longer half-life.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1992

Confirmation. Practice behavior for treatment of new morbidity disorders reflects residency experience.

The purpose of the present study was to evaluate congruence between practice and residency training in the treatment of children with five "new morbidity" disorders. Data were obtained through mailed questionnaires. Counseling and behavior modification, without medications, were used for all five disorders by respondents most recently completing pediatric residency. Medications were used more frequently by pediatricians who had completed their residency training longer ago, particularly for nocturnal enuresis and chronic abdominal pain. The most recent graduates tended to treat a larger number of children with temper tantrums and separation anxiety. This is believed to result from more recent graduates being more comfortable and confident in recognizing and treating these conditions. In contrast, no association was noted between year in which residency was completed and number of children treated for nocturnal enuresis and chronic abdominal pain. This results from parents volunteering these symptomatic conditions since they perceive them to be medical problems.

Behavior Therapy↗
PubMed1991

Gentamicin population pharmacokinetic models for low birth weight infants using a new nonparametric method.

Availability of personal computer programs for control of drug regimens has stimulated interest in modeling population pharmacokinetics. In this study, we found parameter values for gentamicin in two infant populations with low birth weights. The models were developed by use of a parametric (i.e., standard two-stage algorithm) and with a new nonparametric expected maximum algorithm. Data for the two populations (i.e., infants less than or equal to 31 weeks' and greater than 31 but less than or equal to 34 weeks' gestational age) were obtained from infants admitted to the University of Texas Medical Branch intensive care nursery between August 1, 1988, and July 31, 1989. The new nonparametric method was demonstrated to be not only the equal of the standard two-stage method for population modeling but better, especially in use of sparse data sets (e.g., single serum levels). It also obviates the need for selecting proper starting conditions for the least-squares fitting procedure used in the standard two-stage method.

Computer Simulation↗
PubMed1989

Lytic/"DPT" cocktail: time for rational and safe alternatives.

These therapeutic approaches to the premedication of children, in our opinion, offer a more rational, probably safer, and at least equally efficacious treatment regimen as the DPT/lytic cocktail. It is understood that controlled, double-blind comparative clinical trials in children are needed of these or other potential premedicant regimens for specific pediatric procedures (e.g., cardiac catheterization, CT scans, bone marrow aspiration, gastrointestinal endoscopy, pleural taps, etc.) to establish the premedication treatment(s) with the greatest benefit-to-risk ratio. Until these data are available, we must maintain prudence in the selection (design) of premedicant regimens and carefully monitor all children receiving these "cocktails."

Child↗
PubMed1977

Cost effectiveness of renal disease screening.

Diseases of the kidney and their complications represent a major cause of disability and death. Search for evidence that the prognosis for a substantial portion of patients with chronic renal disease might be effectively influenced by early screening has been largely unrewarding. There is limited evidence that the progressive course of many chronic renal diseases can be arrested by presently available therapeutic methods. Thus, except for detection of bacteriuria in pregnant women, it would seem unreasonable to seek early identification. In addition, screening of asymptomatic individuals may create unnecessary, serious, economic and psychosocial problems for the many patients with benign or transient urinary abnormalities.

Bacteriuria↗
PubMed1977

Nephronophthisis. Renal function and histologic studies in a family.

Nephronophthisis (previously described as familial juvenile nephronophthisis and medullary cystic disease) is characterized by insidious renal failure, its main features being increased urinary sodium loss, pitressin-resistant hypotomic polyuria, polydipsia, normal urine sediment and absence of hypertension. Renal function and histologic studies were performed in a family in which two siblings had this disorder, while the parents and two other siblings appeared clinically normal. Both parents demonstrated a moderate impairment of maximum urinary concentration. The values for tubular free water reabsorption (TcH2O) were relativley normal in the parents and the healthy siblings. One of the index patients showed only minimal sodium wasting even though he had hyposthenuria, thus suggesting an involvement of the collecting ducts in the early stage of neophronophthisis. No evidence of proximal tubular dysfunction was found. Although the light-microscopic examination of renal biopsies from the parents and the healthy siblings was unremarkable, electron microscopy revealed probable abnormalities in all four. An autosomal recessive mode of inheritance is, therefore, suggested in this family. The etiology of nephronophthisis is obscure but a likely possibility is that the renal damage results from an inborn metabolic error.

Adolescent↗
PubMed1976

Proteinuria and hematuria in schoolchildren: epidemiology and early natural history.

Over the past several decades screening for disease in large asymptomatic populations has increased, culminating most recently with a federal mandate for early, periodic screening, diagnosis and treatment of all children from low-income families. The present study of five consecutive examinations in over 12,000 schoolchildren shows the cumulative occurrence of proteinuria and hematuria to be surprisingly high (greater than 6%). Comparison of this large number of children with the few individuals in whom death occurs from chronic renal disease annually (less than 0.03%) suggests that the vast majority of these children with urinary abnormalities have either no renal disease or at most a self-limited condition. Observation of 512 children with proteinuria and 78 with hematuria for one to five years after initial detection and referral to their physician or clinic provides a measure of both contemporary management and early natural history. These observations suggest that there is a need to question the overall effectiveness of urinary screening and that early inclusion of roentgenographic and urologic investigations in management seems unwarranted. Rather, these children should be followed for long periods of time. Additional investigations are indicated when worsening of the abnormal findings or other evidence of renal or systemic disease occurs. If routine urinary screening is performed, it should be as one aspect of a multiphasic program by the primary physician so that it can be coupled with a clearly defined plan for follow-up and management of subjects with abnormal findings.

Age Factors↗