The effect of treatment with angiotensin-converting enzyme inhibitors on survival of pediatric patients with dilated cardiomyopathy

Summary Outcome in 81 pediatric patients with dilated cardiomyopathy was reviewed to assess whether treatment with angiotensin-converting enzyme (ACE) inhibitors affected survival. Age at onset was 3.6±0.6 years. Twenty-seven children (group 1) were treated with ACE inhibitors. Conventional therapy was used in the remaining 54 patients (group 2). There were no significant differences between the two groups in age at onset, left ventricular shortening fraction, left ventricular end-diastolic pressure, or mean pulmonary artery pressure. Patients treated with ACE inhibitors had a significantly better survival during the first year (p<0.05) with continuation of this trend throughout the second year (p=0.06). Beyond 2 years there was a tendency toward better survival in ACE inhibitor-treated patients, but the differences were no longer significant (p=0.14). These data, along with observations in adult patients with chronic cardiac failure, indicate that converting enzyme inhibitors have a beneficial effect on prolonging survival of infants and children with severe left ventricular dysfunction from dilated cardiomyopathy.     

Successful treatment of acute lymphoblastic leukemia in a child with cystic fibrosis

A 3 1/2 year old girl with cystic fibrosis who underwent successful treatment for acute lymphoblastic leukemia remains in complete remission 36 months after diagnosis. We also report high clearance rates of three antineoplastic agents in this patient. Drug doses were adjusted to achieve optimal systemic exposure. © 1994 Wiley-Liss, Inc.     

Use of Breast Cancer Screening by Older Hispanic Women

The purpose of this exploratory study was to provide information on older Hispanic women's access to and use of breast cancer screening services. Interviews were conducted with 150 Hispanic women, 47 to 93 years of age, in a southwestern city. The results indicated that differences in use and compliance with recommended screening guidelines were due primarily to differences in access to the health care system and attitudes about preventive care. Targeted strategies for these women have to be developed and implemented to ensure that they receive the necessary information to avail themselves of breast cancer screening procedures.     

Comparative effects of luminance and scatter on the pattern visual evoked potential and eye-hand reaction time

We investigated the effect of reduced luminance and increased scatter on the pattern visual evoked potential and eye-hand reaction time evoked to a check size of 0.5° in 10 normal subjects. Data analysis indicated that a reduction in luminance as well as an increase in scatter caused a statistically significant increase in the peak time of the pattern visual evoked potential P₁₀₀ wave. The reaction time, however, was not significantly affected by the initial 0.9-log unit attenuation of the stimulus luminance or the 0.3 scatter filter. Further attenuation of luminance or increase of scatter also yielded statistically significant increases. Our results suggest that the reaction time is less affected by a reduction in luminance or an increase in scatter of a 0.5° stimulus than the pattern visual evoked potential is and therefore represents a more reliable test to assess visual function, especially in the presence of medial opacities, which are known to reduce luminance and produce scatter.     

Ensuring NCLEX-RN success for first-time test-takers.

A major indicator of baccalaureate nursing program effectiveness is the pass rate on the National Council Licensure Examinations, Registered Nurse (NCLEX-RN) among first-time candidates. This article highlights the scope, instructional methods, and outcomes of the remediation program at Georgetown University School of Nursing & Health Studies (GU-NHS). With implementation of the multifaceted program, the NCLEX-RN pass rate for first-time takers at GU-NHS has been consistently above the national mean among all first-time candidates. Although it is impossible to determine which strategy made the greatest contribution to the success of the program, the cumulative effect is impressive and indicates the students are prepared for the challenge of the examination and contemporary nursing practice.     

Evaluation of Plasmapheresis on the Removal of Tobramycin

A 26-year-old man with thrombotic thrombocytopenic purpura resulting in respiratory and renal failure was treated with plasmapheresis (PP). Coexisting pulmonary infiltrates were empirically treated as pneumonia with various antibiotics, including vancomycin and tobramycin. The half-life of tobramycin was 6.93 hours. During PP the half-life of tobramycin decreased to 4.47 hours as determined by three random levels. The fraction eliminated due to PP was 35.5% and the fraction cleared by PP was 10.9%. We conclude that PP contributed significantly to the total clearance of tobramycin. The need for supplemental doses must be evaluated in each patient based on post-PP serum concentrations.     

BDNF increases monoaminergic activity in rat brain following intracerebroventricular or intraparenchymal administration

We have previously demonstrated alterations in serotonin metabolism within descending pathways following infusion of brain-derived neurotrophic factor (BDNF) into the midbrain, near the periaqueductal gray and dorsal and median raphe nuclei. The aim of the present study was to extend these studies to include a comprehensive regional examination of monoamine (serotonin, dopamine and norepinephrine) and metabolite levels in discrete areas of the intact, adult rat forebrain following direct intraparenchymal midbrain BDNF infusion. We have compared neurochemical changes following midbrain infusion of BDNF to those obtained following intracerebroventricular (i.c.v.) infusion. Significant increases in levels of 5-HIAA and/or the 5-HIAA/5-HT ratio were found in all areas examined including the hippocampus, cortex, striatum, n. accumbens, substantia nigra and hypothalamus following both midbrain and i.c.v. infusion. Changes in dopaminergic activity were also observed, but displayed more regional specificity, i.e. changes were found primarily within the striatum and cortex. The two infusion sites produced similar patterns of neurochemical effects although the magnitude of the changes did vary in some areas. These results suggest that BDNF increased synthesis and/or turnover of serotonin, and to a lesser extent dopamine, in the mature rat forebrain. Furthermore, these data point to possible functional roles for BDNF in neuropsychiatric and neurodegenerative conditions which involve a dysregulation of these monoamine systems.