Algorithm to identify components of arterial blood pressure signals during use of an intra-aortic balloon pump

Existing bedside cardiovascular monitors often inaccurately measure arterial blood pressure during intra-aortic balloon pump (IABP) assist. We have developed an algorithm that correctly identifies features of arterial pressure waveforms in the presence of IABP. The algorithm is adaptive, functions in real-time, and uses information from the electrocardiographic (ECG) and arterial blood pressure signals to extract features and numeric values from the arterial blood pressure waveform. In its current form, it requires reliable ECG beat detection and was not intended to operate under conditions of extremely poor balloon timing. The algorithm was evaluated by an expert (P.F-C.) on a limited data set, which consisted of 12 1-minute epochs of data recorded from 6 intensive care unit patients. A criterion for selection of patients was that the ECG beat detector could detect ECG beats correctly from the waveforms. The overall sensitivity and positive predictivity for beat detection were 94.04% and 100%, respectively. For feature identification, the overall sensitivity was greater than 89%, positive predictivity was 100%, and the false-positive rate was 0%. The performance measures may be biased by the criteria for patient selection. This approach to identifying waveform features during IABP improves the accuracy of measurements. The utility of using 2 sources of information to improve measurement accuracy has been demonstrated and should be applicable to other physiologic signal-processing applications.     

Clostridium cadaveris bacteremia in the immunocompromised host

Clostridium cadaveris, usually considered a non-pathogen, was isolated from blood cultures of two febrile patients with cancer. The bacteremias appeared to have originated from the abdomen. This organism has not been previously reported as the etiological agent in this setting. © 1993 Wiley-Liss, Inc.     

Factors Associated with Social and Behavioral Problems Among Children Recently Diagnosed with Brain Tumor

Compared the psychological adjustment of 81 children with braintumors to that of 31 control children with various malignanciesnot involving the central nervous system. Both groups exhibitedsignificantly increased frequencies of elevations on one ormore age- and gender-corrected Social Competence and BehaviorProblems scales of the Child Behavior Checklist (CBCL) relativeto normative expectations. Comparison of the Brain Tumor andCancer Control groups revealed no significant differences onany CBCL scale. Among children diagnosed with brain tumors,stepwise multiple regression analyses revealed that low childIQ, residence in a single-parent family, moderate to severedisfigurement, low SES, tumor location, and severe functionalimpairment were associated with decreased Social Competencescores. Elevated Behavior Problems scores were associated withyounger maternal age at the child's birth, tumor location, andresidence in a single-parent family. Results reinforce the needto consider complex relationships between demographic characteristicsof the child's family, type of brain damage, and the cosmeticand functional status of the child in determining acute psychologicaladjustment of brain-damaged children.     

IMMUNE MECHANISMS IN ATOPIC DERMATITIS: STUDIES AND HYPOTHESIS

The pathogenesis of atopic dermatitis remains uncertain. The aim of this study was to correlate blood and skin findings with respect to analysis of immunoregulatory T cells in 18 patients with severe atopic dermatitis. Circulating T lymphocytes were characterised by flow cytometry, and in situ infiltrates of acute skin lesions identified by the immunoperoxidase technique. Analysis of peripheral blood T lymphocyte sub-sets failed to reveal any difference from normal controls. Skin infiltrates were strongly positive for T11 – the pan T lymphocyte marker. The majority of these cells both in the dermis and epidermis were of the T4 helper-inducer sub-set, while a smaller proportion of cells were of the T8 suppressor- cytotoxic T cell sub-set. T6 positive Langerhans cells were markedly increased in the dermis of affected skin, compared with normal skin. The finding of increased numbers of helper-inducer T lymphocytes' in association with increased numbers of Langerhans cells, which function as antigen presenting cells, suggests a strong immunological mechanism in disease pathogenesis, and may yield knowledge both with respect to origin of skin damage and elevation of IgE.     

Paediatric short stay unit in a community hospital: Effective,efficient and popular

Objectives: Short stay medicine is a cost‐effective and efficient way to manage patients with suitable conditions. Paediatric acute illness and injury are amenable to short stay medicine. Before January 2004, when Maroondah Hospital recommenced inpatient care for children, 700 children were transferred annually to other hospitals. We describe the implementation and performance of the first paediatric short stay unit (SSU) in Victoria, which was designed to remedy this situation. Methods: Set in a 291‐bed metropolitan hospital, we audited paediatric emergency attendances, admissions, transfers and discharges. We present quality and consumer satisfaction data. Results: The environment was designed for the physical, developmental and social needs of children. We implemented education, a system of exclusion criteria and pathways to enhance safety. Over 12 months, of 9097 paediatric attendances, 1101 required inpatient care. Among them, 862 patients were admitted to the SSU and 239 were transferred. Accordingly, 78% of admitted patients were cared for in‐house. Median length of stay was 20 h. Of the 708 reviewed cases, there were 19 (3%) unexpected transfers from the SSU, 59 (8%) long stays (>48 h) and no deaths. Via a telephone survey, there were 30/355 (8%) unplanned representations and satisfaction data were overwhelmingly positive. We suggest that this model is suitable for centres with limited paediatric cover. In‐house senior emergency physician cover might be preferable to an after‐hours junior staff‐only model. Conclusion: A co‐located paediatric SSU within an ED is an efficient, popular and viable alternative for paediatric services to be delivered in a suburban setting.     

Angiographic demonstration of incoordinate motion of the ventricular wall after the Fontan operation.

OBJECTIVE--To study regional wall motion of the systemic ventricle in patients after the Fontan operation. DESIGN AND PATIENTS--Systemic ventricular angiograms of 15 patients after the Fontan operation and of 11 unoperated patients with a univentricular atrioventricular connection were digitised frame by frame. Strict criteria for abnormal wall motion were used so that minor abnormalities were not considered. RESULTS--Incoordinate contraction of the ventricular wall was found in five of the 11 patients before and in four of the 15 patients after the Fontan operation (NS). Only three of the 11 patients before the Fontan operation, showed incoordination of ventricular relaxation, but incoordinate relaxation was seen in 12 of the 15 patients after operation (p less than 0.01). CONCLUSIONS--Whereas incoordination of ventricular contraction was common in patients with a univentricular atrioventricular connection, before or after the Fontan operation, incoordinate relaxation of the ventricular wall was a common consequence of the Fontan operation and was rare in patients before operation.     

Intraosseous lipoma of the body of the sphenoid bone.

A case of intraosseous lipoma arising from the body of the sphenoid bone with intrasellar and suprasellar components is reported. This is the first report of this uncommon tumour occurring in an atypical intracranial site, producing the locally invasive and pressure effects of visual failure and hypopituitarism. The diagnosis was based on computed tomographic (CT) and magnetic resonance (MR) imaging with histological confirmation following frontal craniotomy.     

Efficacy of topical cobalt chelate CTC-96 against adenovirus in a cell culture model and against adenovirus keratoconjunctivitis in a rabbit model

Background  

Adenovirus (Ad), associated with significant morbidity, has no topical treatment. A leading CTC compound (CTC-96), a Co^III chelate, was found to have potent in vitro and in vivo antiviral efficacy against herpes viruses. In this study CTC-96 is being tested for possible anti-Adenovirus activity.