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Biomedical subjects

W H Mason

Publications and source records attributed to W H Mason.

At least 19 recordsLinked to original sources
PubMed1996

The management of common infections in ambulatory children.

Antimicrobial therapy of infection in ambulatory children remains the cornerstone of the pediatrician's practice. Despite a cornucopia of newer antimicrobial agents, the older "tried and true" drugs continue to be favored based on their history of effectiveness, lack of toxicity, and low price. It also is clear that the widespread use of antimicrobial agents has contributed to the development of resistance. We must reevaluate our antimicrobial use so that we only treat infections likely to benefit from antimicrobials. Better diagnostic techniques should be developed for rapid and accurate identification of pathogens. Finally, alternative therapeutic strategies should be investigated, such as shorter courses of treatment or use of vaccines, to lessen the selective pressure on the microbial flora. To fail to meet this challenge will mean the more rapid transition into the "postantibiotic era".

Ambulatory Care↗
PubMed1994

Solution-focused therapy and inpatient psychiatric nursing.

1. Creative ways must be found to deliver high quality nursing care--with fewer nurse-patient interactions--to patients experiencing more severe problems. 2. Solution-focused therapy underscores the positive attributes of the patient; facilitates the development of a working partnership between the nurse and patient; helps the patient develop future-oriented goals; and identifies actions necessary for reaching those goals. 3. As a result of incorporating solution-focused therapy at the institution highlighted in this article, the quality of patient care, as well as effectiveness and cohesiveness of the nursing staff, improved.

Comorbidity↗
PubMed1993

Epidemic measles in the postvaccine era: evaluation of epidemiology, clinical presentation and complications during an urban outbreak.

A total of 440 cases of measles were seen at a single children's hospital during an epidemic in a large urban center. These cases were retrospectively analyzed for demographic characteristics, exposure histories, risk factors for and incidence of complications, outcome and financial consequences. More than 90% of children were < 5 years of age and 56% were < 15 months of age. Ninety-four percent were of Hispanic or African-American ethnic background. A visit to a medical facility was the only source of infection for 83 of the 115 patients for whom exposure histories were available. Four patients with underlying immunodeficiency were among those nosocomially exposed and one died of pulmonary complications. Of the 440 patients 195 (44.3%) required hospitalization for measles complications. The mean age of hospitalized patients, 1.9 +/- 2.4 years, was not different from those not admitted (2.1 +/- 2.5 years; P < 0.25). The most frequent indications for admission were respiratory tract complications (pneumonia and/or croup) seen in 161 patients and dehydration in 25 patients. Fourteen required intensive care and 11 required intubation and mechanical ventilation. Three children died, all of pulmonary involvement. Total hospital and medical charges for care of these patients was more than $1.7 million dollars.

Adolescent↗
PubMed1992

Laryngotracheobronchitis as a complication of measles during an urban epidemic.

OBJECTIVE: To evaluate demographic and clinical correlates of laryngotracheobronchitis (LTB) as a complication of measles during a community-wide epidemic. DESIGN: Retrospective review of medical records. SETTING: Childrens Hospital Los Angeles, a large urban pediatric facility, during a regional epidemic of measles studied January through June 1990. PATIENTS: All patients identified at our hospital who met Centers for Disease Control criteria for measles. MEASUREMENTS AND RESULTS: Of 440 patients with measles, 82 also had LTB (18.6%). Patients in whom LTB developed were significantly younger (mean +/- SD: 14.7 +/- 8.2 months) than the cohort (24.8 +/- 30.1 months) (p less than 0.001) and more likely to require hospitalization (91.5%) than the cohort (44.3%) (p less than 0.001). Thirteen patients (17.3%) required intensive care, including 9 (11%) who required endotracheal intubation for a mean of 8.3 +/- 7.1 days. Pulmonary function testing of five patients with an endotracheal tube in place, including three not clinically assessed as having pneumonia, indicated the presence of concomitant lower respiratory tract disease. CONCLUSION: Laryngotracheobronchitis was a frequent and often severe complication of measles. The likelihood that LTB would develop was inversely related to age, generally required inpatient care, and necessitated endotracheal intubation in severely affected patients.

Adolescent↗
PubMed1991

Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease. United States Multicenter Kawasaki Disease Study Group.

STUDY OBJECTIVES: (1) To determine those diseases that most often mimic Kawasaki disease (KD) in the United States. (2) To examine the physical findings and laboratory studies that influenced experienced clinicians to exclude the diagnosis of KD. (3) To compare epidemiologic features of patients with KD and patients referred for evaluation of possible KD in whom alternative diagnoses were established. DESIGN: Case comparison study. SETTING: Seven pediatric tertiary care centers. PATIENTS: Consecutive sample of 280 patients with KD and 42 comparison patients examined within the first 14 days after onset of fever. MEASUREMENTS AND MAIN RESULTS: (1) Infectious diseases, particularly measles and group A beta-hemolytic streptococcal infection, most closely mimicked KD and accounted for 35 (83%) of 42 patients in the comparison group. (2) The standard diagnostic clinical criteria for KD were fulfilled in 18 (46%) of 39 patients in whom other diagnoses were established. (3) Patients with KD were significantly less likely to have exudative conjunctivitis or pharyngitis, generalized adenopathy, and discrete intraoral lesions, and more likely to have a perineal distribution of their rash. The patients with KD were also more likely to have anemia and elevated erythrocyte sedimentation rate; leukocyte count less than 10 X 10(3)/mm3 and platelet count less than 200 X 10(3)/mm3 were significantly less prevalent in patients with KD. (4) Residence within 200 yards of a body of water was more common among KD patients. CONCLUSIONS: (1) Measles and streptococcal infection should be excluded in patients examined for possible KD. (2) Laboratory studies that may be useful in discriminating patients with KD from those with alternative diagnoses include hemoglobin concentration, erythrocyte sedimentation rate, and serum alanine aminotransferase activity. (3) Residence near a body of water may be a risk factor for the development of KD.

Age Factors↗
PubMed1991

Nosocomial measles infection in a pediatric hospital during a community-wide epidemic.

From Jan. 1, 1988, through Dec. 31, 1988, a total of 89 cases of measles were observed at Childrens Hospital of Los Angeles, and 37 patients were admitted to the hospital. Of the 37 patients, six were not initially thought to have measles, which resulted in exposure of 107 patients and 24 personnel. Of the exposed patients, measles developed in four. One nosocomially infected infant died of pneumonia. Another exposed patient was subsequently admitted to another hospital with unrecognized measles, which led to exposure of an additional eight patients. Of seven employees in whom measles developed, two required hospitalization because of pneumonia. Two hundred eleven employee days were lost because of measles exposure or infection. Infection control interventions included prophylaxis of exposed patients, employee education, and measles immunization for susceptible personnel. Of 1103 hospital personnel considered susceptible to measles, 800 received monovalent measles vaccine. No secondary cases of measles occurred in hospital personnel who received appropriate prophylaxis. We conclude that infection control programs aimed at mandating measles immunity in hospital employees at risk should be instituted.

Age Factors↗
PubMed1991

Imipenem/cilastatin treatment of bacterial meningitis in children.

The safety and efficacy of imipenem/cilastatin were evaluated in 21 children, ages 3 to 48 months, with bacterial meningitis. Eradication of bacteria from the cerebrospinal fluid was demonstrated within 24 hours of antibiotic therapy in all but 2 patients who had Haemophilus influenzae type b meningitis and ultimately achieved bacteriologic cure after 2 to 3 days of imipenem/cilastatin therapy. Cerebrospinal fluid penetrations of imipenem and cilastatin were determined at various times after drug administration with mean cerebrospinal fluid: serum ratios of 14 and 10% for imipenem and cilastatin, respectively. The study was terminated when 7 (33%) patients developed seizure activity after antibiotic therapy was administered. The usefulness of imipenem/cilastatin for the treatment of bacterial meningitis in children may be limited by a possible increased incidence of drug-related seizure activity.

Anti-Bacterial Agents↗
PubMed1991

Congenital cleft foot deformity (split foot or lobster claw).

A case of congenital cleft foot deformity, also known as lobster claw or split foot, is presented. The condition is rare. A review of the literature reveals that this deformity will often coexist as part of a constellation of congenital and familial abnormalities. Surgical correction of the cleft foot is difficult and often deferred.

Adult↗
PubMed1991

Prevalence and isolation of Toxoplasma gondii from white-tailed deer in Alabama.

Nineteen white-tailed deer (Odocoileus virginianus) from 5 counties in Alabama were examined for infection with Toxoplasma gondii. Twenty-gram samples of heart tissue were bioassayed in mice, serum was examined for T. gondii antibodies using the direct agglutination test, and sections of heart muscle were examined histologically for tissue cysts. Toxoplasma gondii was isolated from 4 of 19 (21%) white-tailed deer hearts. Antibody titers of greater than or equal to 1:50 were found in sera from 7 of 16 (44%) white-tailed deer. Histological examinations of tissue sections from white-tailed deer hearts were negative for T. gondii.

Agglutination Tests↗
PubMed1989

Meningococcal infections in children: a review of 100 cases.

One hundred children with meningococcal infection diagnosed from January 1, 1985, to February 29, 1988, were reviewed. Clinical manifestations ranged from fever alone to fulminant septic shock with purpura fulminans. Twenty-nine percent of the children presented without skin lesions. Of the 55 patients with meningitis, 6 lacked cerebrospinal fluid abnormalities on initial lumbar puncture but cerebrospinal fluid cultures were positive. An overall case fatality rate of 10% was noted with the following poor prognostic indicators identified: hypothermia; seizures or shock on presentation; a total peripheral white blood cell count less than 5000/mm3; a platelet count less than 100,000/mm3; and the development of purpura fulminans. Meningococcal infections remain an important cause of morbidity and mortality in children. Infections caused by Neisseria meningitidis (including meningitis) should be considered even in the absence of skin lesions or cerebrospinal fluid abnormalities.

Adolescent↗
PubMed1988

Prevalence of Sarcocystis odocoileocanis from white-tailed deer in Alabama and its attempted transmission to goats.

Sarcocysts of Sarcocystis odocoileocanis were found in tissue sections of hearts and tongues examined by light microscopy from 30 (88%) of 34 white-tailed deer (Odocoileus virginianus). Hearts were infected less often (13 of 34, 38%) than were tongues (30 of 34, 88%). Sarcocysts of Sarcocystis odoi were not observed in the white-tailed deer examined. A gray fox (Urocyon cinereoargenteus) excreted sporocysts after consuming tongues of white-tailed deer infected with S. odocoileocanis. Two goats inoculated with either 50,000 or 500,000 sporocysts of S. odocoileocanis isolated from the gray fox did not have sarcocysts in tissue sections of the heart, tongue, diaphragm, or esophagus when examined 122 days postinoculation. Dogs fed these tissues from control or inoculated goats did not pass sporocysts in their feces. The present study demonstrates: (1) a high prevalence of S. odocoileocanis infection in white-tailed deer in Alabama, and (2) that goats are not suitable intermediate hosts for S. odocoileocanis.

Alabama↗