摘要:

SummaryWe developed a physiology-based scoring system, the Physiologic Stability Index (PSI) to assess severity of acute illness in the total population of pediatric Intensive Care Unit (ICU) patients. Thirty-four variables from seven physiologic systems were chosen, and the degree of abnormality of each variable was assigned a score reflecting the clinical importance of the derangements. Validity was demonstrated by comparing PSI to hospital mortality and to two other methods that reflect severity of illness, the Clinical Classification System (CCS) and the Therapeutic Intervention Scoring System (TISS). Four hundred and twenty three consecutive admissions to a multidisciplinary ICU were followed daily. Patients classified into higher CCS classes had significantly higher PSI scores (P<0.001), and there was a highly significant correlation (P<0.001) between PSI and TISS scores. The linear-logistic regression of observed mortality versus PSI was highly significant (P<0.0001) and provided an excellent fit. Highly significant differences between survivors and nonsurvivors were observed for PSI scores (P<0.001), as well as for composite slopes of the regression of PSI scores versus days of care (P<0.001). These data demonstrate validity of the PSI scoring system.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummaryWe examined adult sheep lymphocytes for the following surface markers: Surface membrane immunoglobulin, antigen identified by anti-sheep thymocyte globulin and complement receptors. We quantitated sheep peripheral blood mononuclear leukocyte proliferative responses to mitogens and alloantigens, and demonstrated a neutrophil-directed chemotactic factor (NLDCF) liberated by mitogen-stimulated sheep mononuclear cells. A comparison of adult and fetal sheep from 120-150 d of gestation demonstrated that/) fetal sheep had adult proportions of surface membrane Ig+ and T+ lymphocytes but a significant decrease in FcIgG receptor+ lymphocytes, 2) proliferative responses of fetal sheep blood mononuclear cells to mitogens and alloantigens were comparable to adult responses, and 3) fetal mononuclear leukocytes failed to produce the lymphokine, NLDCF, in response to mitogen stimulation.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummarySequential blood sampling every 30 min was performed in six adolescent males. Samples were analyzed for serum phosphate ((Pi), total calcium (CaT), and blood ionized calcium (Ca++) concentrations. A circadian (24-h) pattern was observed for each mineral: 1) Ca++concentrations followed a U-shaped curve with a peak at 11 AM and a trough at 3:30 PM; 2) CaTconcentrations followed a W-shaped curve with maxima at 11 and 1 AM and troughs at 5 AM and 6 PM; and 3) Piconcentrations followed an M-shaped curve with peaks at 4 PM and 3:30 AM. The overall mineral patterns were similar in shape to those previously decribed in adult males. In contrast, however, the amplitude of the Pifluctuations were considerably greater in the adolescents compared with that in adults (3.0 mg/dl versus 1.2 mg/dl). The Ca++pattern diverged from the CaTpattern during the nocturnal phase to an extent that neither pattern could be predicted from the other. Ultradian rhythms were found in some of the time series mineral data sets; however, no single frequency encompassed all subjects for each circulating mineral.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummaryWe determined the activities of tyrosine aminotransferase (TAT, EC 2.6.1.5), p-hydroxyphenylpyruvate oxidase (p-HPPA oxidase, EC 1.14.2.2) and fumarylacetoacetate fumarylhydrolase (FAH, EC 3.7.12) in cytosol of the liver and kidney tissues obtained at autopsy from a case of hereditary tyrosinemia type I. Values were compared with those from a control group of autopsied tissues from three adults and six children, who had died of other causes. In tyrosinemia, these three hepatic enzyme activities were all decreased: TAT showed approximately 35%, p-HPPA oxidase 11%, and FAH 60% of the corresponding control values. On the other hand, kidney enzymes in tyrosinemia revealed that FAH was most significantly decreased to approximately 14% of the control activity. Kmvalues for substrate— determined for p-HPPA oxidase and FAH—were not different between the patient and controls, suggesting no altered properties of these enzymes. We conclude that in the present case of hereditary tyrosinemia type I, the activities of p-HPPA oxidase in liver and FAH in kidney were most strikingly affected. This fact may in part explain the deteriorated metabolism of tyrosine observed in this patient.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummaryWe evaluated the accuracy of height predictions based on the tables of Bayley and Pinneau (2) in 43 boys with short stature. Sixteen boys were treated with androgens and 27 received no treatment. In 17 boys whose bone ages were within normal limits, and who received no treatment, the mean ± SE predicted height of 164.9 ± 1.5 cm was not significantly different from the mean adult height (166.5 ± 1. 5 cm). The predicted height exceeded the actual adult height by more than 5.1 cm in only one instance [5.1 cm is the degree of accuracy reported by Bayley and Pinneau (2)]. In 10 boys, whose bone ages were severely delayed (more than 2 SD below their chronologic age) and also were not treated, predicted height overestimated adult height by more than 5.1 cm in five of them. This difference was statistically significant (P<0.05). In five boys with normal bone ages, androgen therapy had no significant effect on either predicted height (168.1 ± 4.1 before, 166.8 ± 4.4 cm after) or actual adult height (166.5 ± 4.1 cm). The 11 boys with severely delayed bone ages had a significant increase in predicted height during androgen therapy (165.4 ± 1.5 to 169.8 ± 1.7 cm, P<0.01), but actual adult height (162.4 ± 2. 4 cm) was not significantly greater than pretreatment predicted height. Further, the number of boys whose predicted height exceeded their adult height by 5.1 cm was not significantly different in treated (4/11) or untreated (5/10) boys. The Bayley-Pinneau method of predicting adult height markedly overestimates adult height in about one-half of boys who have a bone age delay of more than 2 SD. Short-term therapy with androgens does not alter this outcome.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummaryIn 23 children with asthma and 18 healthy controls, cold air challenge (CACh) was done twice during the same half day, and in the asthmatics a third time together with a histamine challenge (HCh) 2 wk later. Pulmonary functions were tested before and after each challenge. No overlapping of individual responses to CACh in seven forced expiratory flow tests proved the power of discrimination of this technique in children. The limits of “normal” reactions ranged from minus 9% for larger airway-related to 26% for smaller airway-jelated flows. Short-term reproducibility of induced changes, in percentage of baseline, was excellent (r=0.815-0.954); in percentage of predicted postchallenge abnormality it was even bettern (r=0.926-0.975). The response in small airway-related flow rates (-43.1 ± 12.8 to -51.9 ± 16.8% of baseline) was much larger than in others (-27.6 ± 14.6 to -32.1 ± 17.3% of baseline). This, the different baseline-toresponse correlations in various measurements, and the divergent dose response to colder versus less cold air in large (60.7 ± 21.9 versus 65.4 ± 21.5% predicted, postchallenge values) and small airway-related tests (28.9 ± 18.7 versus 29.5 ± 15.1% predicted, postchallenge values) in asthmatic children suggest a predetermined, small airway-related limitation of individual reactivity, which is independent of the baseline situation. All asthmatics responded positively to HCh but quantitative results of the two methods did not correlate. Responses to CACh also better characterized the clinical severity of asthma than those to HCh. Determining the individual optimum by a bronchodilator and the physiologic abnormality by CACh, the whole functional dimension of a child's asthma can be established.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummaryThe protective effect of four commercial human gammaglobulin batches (I-IV) in mice was studied using six different strains of group B streptococci (GBS): types la; Ib; II, R-protein negative (R-); II, R+; HI, R-; and III, R+. Each mouse received 1.0 ml gammaglobulin and 0.5 ml bacteria, 106-108colony forming units (CFU). There was a close correlation between antibody levels measured by the use of radiolabeled protein A and the mouse-protective effect of the gamma-globulins. The mouse-protection tests demonstrated that batch I protected against GBS types la and III, R— at low concentration (65 mg/kg mouse weight), against type Ib at medium (260 mg/kg) and against type III, R+ at high concentration. Batch IV protected against types la and Ib, although the doses were four times higher than those in batch I, but did not protect against type III, R+. There was no mouse protection by any of the batches against type II. Antibody levels against Ibc and R, protein antigens, were substantially lower in batch IV. Because the results of these mouse-protection studies indicate the importance of such antibodies against protein antigens, batches I—III might be more useful for therapy of neonatal GBS-septicemia.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummarySerum factors related to oxygen exposure were studied in 56 full-term cord blood samples and in 69 newborn infants of varying gestational age (GA). Serum malondialdehyde (MDA), which reflects membrane lipid peroxidation, was elevated during the first 2 d of life and rose to a peak at 3-5 d of life. This peak value was unrelated to GA or to assisted ventilation.The serum antioxidant, vitamin E, showed a significant rise by 6-10 d, and came into the adult range after d 11. Vitamin E levels did not correlate with GA, assisted ventilation, or the development of bronchopulmonary dysplasia (BPD). Serum ceruloplasmin, another antioxidant, was measured both by activity assay and by protein concentration assay. Little activity was found in cord blood. Ceruloplasmin activity increased during the first 48 h of life, and both activity and protein concentration correlated with GA at that time. Infants who subsequently developed BPD had a less active protein than infants on ventilators who did not develop BPD. In addition, activity and protein levels on 3-5 d were lower in infants on ventilators than in those not requiring assisted ventilation.Serum levels of a-l-AP activity and protein concentration were also correlated with GA during the first 48 h of life. The less mature infants had levels of activity and protein which were significantly less than the more mature infants and significantly less than the full-term cord values. The proportion of active protein correlated with GA at 3-5 d, indicating that the less mature infants had a lower proportion of active protein. All infants had activity and protein levels within the normal range for healthy adults by 6-10 d.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummaryIn the current study, thein vitroviability and resistance to methylprednisolone (MP) was investigated in lymphocytes from patients with cystic fibrosis (CF) and normal controls. The addition of MP to phytohemagglutinin-stimulated lymphocyte cultures inhibits the proliferative response in a dose-dependent way. The dose response curves to MP were similar in CF cultures and controls (P > 0.05). Neither preincubation nor pulse exposure to MP revealed any difference between normal and CF lymphocytes.Skin fibroblasts from patients with CF have been reported to show increased resistance to the toxic effect of dexamethasone (1–3, 5–6). This study was undertaken to investigate the suppressive effect of glucocorticoids on another cell culture system using MP on phytohemagglutinin-stimulated lymphocytes.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

SummaryThe acute response to simulated hypoglycemia induced by 2- deoxyglucose (2DG) was compared with the prolonged fasting test as a possible screening test for detection of childhood hypoglycemia. Ten children, ages 2-9 yr, without a documented history of hypoglycemia were classified retrospectively as reference subjects. While fasting, their plasma glucose decreased to an average of 50 mg/dl (range, 30-74) between 28-36 h. After infusion of 2DG, 50 mg/kg IV over 30 min, their plasma glucose increased by an average of 35 mg/dl (range, 19-56) between 60- 120 min. The half-life of plasma 2DG was 48 min. Twenty-three other children in the same age range had an abnormal response to one or both of these tests. Thirteen of these children became definitely hypoglycemic while fasting (glucose<30 mg/dl) and also failed to increase their plasma glucose by more than 10 mg/dl after 2DG. Five children had plasma glucose values between 30-40 mg/dl during the first 24 h of fasting that were associated with a change in mental status but responded to 2DG with an increase in plasma glucose. The remaining five subjects had an apparently normal response to fasting but did not respond to 2DG; two of these had documented spontaneous hypoglycemia. No cases of documented hypoglycemia were undetected by either test. It is concluded that the 2DG test is a short safe supplement to fasting which is equally effective as the prolonged fasting test in detecting hypoglycemia. Neither test alone is completely reliable, but the combination is complementary.

ISSN:0031-3998    

出版商:OVID    

年代:1984

数据来源: OVID