Pediatric ventilation outside the operating room.

Various ventilatory techniques have been developed in recent years to treat severe respiratory disease states in the pediatric population. Techniques and strategies involving the use of conventional ventilation, high frequency ventilation, nitric oxide, partial liquid ventilation, and extracorporeal circulation are discussed.

Pediatric resuscitation outside the operating room.

Protocols regarding the treatment of cardiac arrest of the pediatric patient outside the operating room are continually being reviewed as knowledge regarding the pathophysiology of cardiac arrest and the pharmacologic properties of resuscitative drugs has progressed. The indications for treatment of cardiac arrest by the various resuscitative drugs, and techniques for obtaining access for the administration of these drugs are discussed.

Pediatric eye emergencies.

Anesthesia for pediatric eye emergencies is predicted on prevention of a rise in intraocular pressure and avoidance of extrusion of the intraocular contents in the setting of a full stomach. Sedation or general anesthesia is frequently necessary for adequate examination of the eye.

Pediatric neuroanesthesia. Arteriovenous malformations.

Intracranial arteriovenous malformations can occur singly, multiply, and in conjunction with aneurysms and denovo, family, or in conjunction with connective-tissue disorders. Intracranial hemorrhage is the most common presentation, occurring in 20% to 50% of cases. In children, seizures are the second most common presentation occurring in 15% to 20% of cases.

Pediatric neuroanesthesia. Neural tube defects.

Neural tube defects of the brain and spinal cord, among the most common birth defects in the United States, cause neurologic morbidity from the lesions themselves and from associated hydrocephalus and Arnold-Chiari malformation. Because the myelomeningoceles, and encephaloceles are repaired surgically within hours of birth, neonatal anesthetic management with attention to fluids, body temperature, intravenous access, and monitoring is important. Anesthesia for treatment of hydrocephalus and Arnold-Chiari malformation takes into consideration the presence of intracranial hypertension and the need for manipulation of vital structures in the posterior fossa.

Pediatric neuroanesthesia. Hydrocephalus.

Hydrocephalus, one of the most common adult and pediatric neurosurgical disorders, is an abnormal accumulation of cerebrospinal fluid in the ventricular system as a result of obstruction to the flow of cerebrospinal fluid. Causes of hydrocephalus include congenital obstruction, hemorrhage, infection, cysts and tumors, and associated neural tube deformities (i.e.

Maternal deaths in a developing country: a study from the Aga Khan University Hospital, Karachi, Pakistan 1988-1999.

Objective: The maternal deaths occurring over a twelve-year period (1988-1999) in a tertiary referral center were reviewed. The purpose of the study was to assess the causes of these maternal deaths.

Setting: The Aga Khan University Hospital (AKUH) Karachi, Pakistan.

Female genital tuberculosis revisted.

Objective: To assess the clinical presentation of genital tuberculosis and to study various modes of diagnosis and treatment.

Setting: The Aga Khan University Hospital (AKUH), Karachi.

Method: A retrospective case review of all index female cases of genital tuberculosis, admitted to AKUH over twelve years of period.

Three-week delayed delivery in a triplet pregnancy at full dilatation with aggressive tocolysis.

We describe our aggressive management of a woman with a triplet pregnancy resulting from in vitro fertilization who presented at 22 weeks' gestation in labor with full cervical dilation. Successful multiagent tocolysis and delayed delivery of the two remaining fetuses after delivery of the presenting fetus led to an improved outcome for all three babies.

Situs inversus with hypertrophic cardiomyopathy in identical twins.

We describe identical twin sisters born to nonconsanguineous, healthy parents. Both twins had situs viscerum inversus and developed hypertrophic cardiomyopathy in adulthood.

Agreement between urinalysis and self-reported drug use.

One hundred fifty-eight drug users received an interview that included self-reported drug use. Opiate/cocaine use in the prior 48 hours was assessed by urinalysis. Fifty-five subjects received a urine test after the interview and 103 were tested before.

Chemoprevention of colonic aberrant crypt foci by an inducible nitric oxide synthase-selective inhibitor.

Inducible nitric oxide synthase (iNOS) is overexpressed in colonic tumors of humans and also in rats treated with a colon carcinogen. iNOS appear to regulate cyclooxygenase-2 (COX-2) expression and production of proinflammatory prostaglandins, which are known to play a key role in colon tumor development. Experiments were designed to study the inhibitory effects of S,S'-1,4-phenylene-bis(1,2-ethanediyl)bis-isothiourea (PBIT) a selective iNOS-specific inhibitor, measured against formation of azoxymethane (AOM)-induced colonic aberrant crypt foci (ACF).

Trends in injection risk behaviors in a sample of New York City injection drug users: 1992-1995.

Objectives: This study assessed the relation between year of recruitment into an AIDS prevention project and likelihood of engaging (yes/no) in injection risk behaviors.

Methods: In total, 834 injection drug users were recruited over a 44-month period (January 1992-August 1995) in New York City. Logistic regression was used to examine trends in three behaviors, across four successive annual cohorts: using needles/syringes that were previously used by another person, using injection supplies (e.

Inhibition by dietary menhaden oil of cyclooxygenase-1 and -2 in N-nitrosomethylurea-induced rat mammary tumors.

Studies in laboratory animals and epidemiological surveys suggest a relationship between the type and amount of dietary fat and mammary cancer. One mechanism proposed to explain this relationship is modulation by dietary fat, of mammary tumor eicosanoid levels through action at the rate limiting enzyme in eicosanoid synthesis, cyclooxygenase (COX). Until recently there have been no studies which have examined COX gene expression in human breast or rodent mammary tissues.

A strategy for reducing the mortality rate from vasa previa using transvaginal sonography with color Doppler.

Vasa previa is a cause of sudden unanticipated fetal death, with a fetal mortality of 33-100%. Transvaginal sonography (TVS) and color Doppler may aid in making the diagnosis antenatally, allowing elective Cesarean delivery, thereby avoiding fetal death from exsanguination which would occur if the membranes were allowed to rupture in labor. Whilst it is not feasible to screen all pregnant women for vasa previa, antenatal examination with TVS and color Doppler of women at risk, specifically those with low-lying placentas, bi-lobed, multi-lobed and succenturiate-lobed placentas, multiple pregnancies and pregnancies resulting from in vitro fertilization may lead to antenatal diagnosis of the condition.

The effects of oxytocin on the pattern of electrical propagation in the isolated pregnant uterus of the rat.

In the isolated pregnant myometrium of the rat, the pattern of propagation was investigated by recording simultaneously from 240 different extracellular sites while the contraction of the tissue was recorded isometrically. Analysis of all recorded electrograms allowed the two-dimensional spread of activity in the myometrium to be reconstructed. From these activation maps, the conduction velocities were measured in the longitudinal, oblique and transversal directions.

The initiation, continuation, and termination of spontaneous episodes of circus movements in the pregnant myometrium of the rat.

Objectives: The objectives of this study were to determine the mechanisms responsible for the initiation and the termination of episodes of circus movements and to describe the characteristics of these circuits in rat myometrium.

Study Design: By means of simultaneous recordings from 240 sites in Wistar rats at 17, 19, or 21 days' gestation, a spatial and temporal analysis was performed on the electrical activation from the beginning until the end of 22 episodes of circus movements.

Results: The initiation of reentry was caused by (1) transient unexcitable areas at the beginning of the burst or (2) lines of conduction blocks.

Dietary fish oil inhibits the expression of farnesyl protein transferase and colon tumor development in rodents.

Although epidemiological and experimental studies indicate a strong relationship between different dietary fats and risk of colon cancer, the modulating effects of these nutritional factors at the molecular level are not fully elucidated. Activated ras genes have been implicated in the etiology of many human malignancies, including colon cancer. It is well established that the transforming ability of ras-p21 depends on its correct localization in plasma membrane.

Urban crack users: gender differences in drug use, HIV risk and health status.

This study assessed gender differences in drug use, HIV risk, and health status in a sample of urban crack users. Using targeted sampling, 1434 crack users (66% male and primarily African-American and Puerto Rican), were recruited from the streets of East Harlem, New York City. A standardized, structured interview was administered, drug use was validated by urinalysis, and HIV testing was offered.

Prevalence of chlamydial infection in females attending antenatal and family planning clinics in Karachi Pakistan.

A prospective study was undertaken to investigate the relative prevalence of Chlamydia trachomatis in asymptomatic pregnant women of 2 socioeconomic groups and those attending the family planning clinics. Group 1 consisted of women attending the antenatal clinics of the Aga Khan University Hospital which caters to the affluent strata of our society (n = 100). Group 2 comprised women attending the antenatal clinics of Lady Dufferin Hospital which provides free obstetric care to women belonging to the lower socioeconomic groups of Karachi (n = 100).

Crack users in east Harlem, New York and Philadelphia, Pennsylvania: HIV-related risk behaviors and predictors of serostatus.

Crack use has been associated with increased risk for HIV seropositivity. This study was undertaken to examine HIV-related risk behaviors among crack users in East Harlem, New York and Philadelphia, Pennsylvania, two northeastern communities which have reported extensive crack use. Crack users recruited in East Harlem (n = 1434) and Philadelphia (n = 694) were compared on demographics, drug and sex-related risk behaviors, health-related behaviors, and HIV serostatus.

The role of apoptosis in the modulation of colon carcinogenesis by dietary fat and by the organoselenium compound 1,4-phenylenebis(methylene)selenocyanate.

Studies in laboratory animals have demonstrated that dietary supplements of organoselenium, 1,4-phenylenebis(methylene)selenocyanate (p-XSC) inhibit colon carcinogenesis. Diverse chemopreventive agents and clinically used anticancer drugs have been shown to induce apoptosis in colonic tumors. Inducing apoptosis is a key mechanism for the effectiveness of some chemopreventive agents; however, failure of apoptosis is now believed to contribute to the development of human cancer.