Use of the USCOM® noninvasive cardiac output measurement system to predict the development of pre-eclampsia in hypertensive pregnancies.

Objectives: To assess the ability of the USCOM® (USCOM), using measurements of cardiac output (CO) and systemic vascular resistance (SVR), to predict the development of pre-eclampsia (PE) and severe PE in hypertensive pregnancies.

Study Design: Prospective cohort study of women in the second or third trimester recruited at a tertiary center in Sydney, Australia. Demographic data and hemodynamic measurements using the USCOM were taken for all study participants at recruitment.

The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis.

Background: Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth and is seen in patients who have severe congenital scoliosis with fused ribs. Traditional spinal surgery does not directly address this syndrome.

Methods: Twenty-seven patients with congenital scoliosis associated with fused ribs of the concave hemithorax had an opening wedge thoracostomy with primary longitudinal lengthening with use of a chest-wall distractor known as a vertical, expandable prosthetic titanium rib.

The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis.

1. Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth. 2.

Children with special health-care needs in Texas.

A comprehensive system for the delivery of care to children with special healthcare needs and to their families has been developed by the department of pediatrics of The University of Texas Health Science Center at San Antonio. A description of the structure and operations of this system is presented and offered as a model for the state of Texas.

The effects of cyclosporine and dexamethasone on an alveolar macrophage cell line (NR8383).

Lung infections are a major source of morbidity and mortality in recipients of lung transplants. Prominent among the pathogens that cause pneumonias in these subjects are gram-negative bacilli, particularly Pseudomonas strains. One important reason that bacteria infect the lungs of these patients is that pulmonary defenses are impaired by the drugs used to prevent transplant rejection.

Pneumocystis carinii induces an oxidative burst in alveolar macrophages.

There is evidence that alveolar macrophages (AM) play a role in the clearing of Pneumocystis carinii from the lungs. To investigate the mechanisms involved in this process, we studied in vitro the induction of an oxidative burst by P. carinii in a cell line of macrophages (NR8383) and AM from normal rats.

Role of the zymolyase-sensitive cyst wall of Pneumocystis carinii in the oxidative burst of macrophages.

Alveolar macrophages are thought to participate in clearing Pneumocystis carinii (Pc) from the lungs. We have recently demonstrated that Pc cysts and trophozoites induce an oxidative burst in a cell line of rat alveolar macrophages (NR8383). In order to investigate the mechanism of this response, we examined the effect that disruption of the Pc cyst wall with zymolyase had on the cyst's ability to elicit H2O2 from NR8383 macrophages and correlated these results with the electron microscopic appearance of the cyst wall.

Pediatric AIDS: adolescence, delinquency, drug abuse, and AIDS.

Sexual promiscuity often is part of the lifestyle of teenagers who are delinquent and abuse drugs, and that behavior puts them at increased risk of contracting HIV infection/AIDS. Many of these juveniles are runaways or live in disorganized homes, and as a result they are hard to reach and it is extremely difficult to provide health and other services to them. Indeed, these youths at risk most frequently may be identified and helped when they run afoul of the law and enter the judicial system.

Pediatric AIDS: psychosocial impact.

There is no question that the domain of the American family has been invaded by the HIV infection/AIDS epidemic. The disease, and particularly its form affecting children (pediatric AIDS), has had marked psychosocial impact on patients and families (intellectual/cognitive, emotional/behavioral, spiritual, and financial) and on our society in general (adverse or favorable). These impacts of pediatric AIDS are discussed in the present communication.

Pediatric AIDS: systematic approach to patient management.

In order to provide comprehensive care to infants, children, and adolescents with HIV infection/AIDS, a systematic approach to clinical management had to be developed. This approach involves "case management" by experienced health professionals, including initial evaluation and needs assessment, planning of services, brokerage of services, continuity of intervention until an outcome is reached. The care is delivered in hospitals, clinics, homes, residential facilities, respite care centers, and hospices.

Pediatric AIDS: impact on health systems.

For 9 years we have recognized HIV infection/AIDS as an unstoppable epidemic affecting infants, children, and adolescents as well as adults. Now we see the tremendous impact of this disease on the health systems of this country. During these past 9 years, we have witnessed the transformation of the epidemic from one primarily affecting male homosexuals to one invading the average US family through heterosexual and vertical transmissions and through needle-sharing practices of intravenous drug abuse.

Pediatric AIDS: prevention of HIV infection in infants and children.

The Centers for Disease Control reported that 109,167 cases of AIDS had been diagnosed since 1981 and that approximately 40,000 persons were living with AIDS at the time of this writing. These numbers, however, are the tip of an iceberg that consists of approximately 1.5 million Americans who are infected by the human immunodeficiency virus (HIV).

Pediatric AIDS: treatment and outcome of patients.

The treatment of pediatric patients with HIV infection/AIDS is structured according to the clinical classification of the disease by the Centers for Disease Control; it involves prophylaxis, therapy against the human immunodeficiency virus, and therapy for the opportunistic infections and non-infectious complications of this disease. In spite of all these forms of therapy, the universal outcome of HIV infection/AIDS is the death of the patients. Prevention remains the only effective means to curb this epidemic.

Pediatric AIDS: clinical presentation and diagnosis.

HIV infection/AIDS in infants and children under the age of 13 years expresses itself clinically so differently from the same infection in adults that a separate classification of the symptomatology has been adopted. Recurrent bacterial infections, as well as various opportunistic infections predominate, and while Kaposi's sarcoma is infrequent in pediatric patients, lymphomas occur with high frequency. The diagnosis of HIV infection/AIDS in children is presented.

Pediatric AIDS: a new health problem on the Texas horizon.

The current epidemic of HIV infection/AIDS initially limited to homosexual males appears to be spreading through heterosexual transmission and intravenous drug abuse. Infants, children, and adolescents are affected. We examine the modes of transmission of HIV infection in this population and the impact the spreading of this infection in the pediatric age group will have on Texas.

A continuous alveolar macrophage cell line: comparisons with freshly derived alveolar macrophages.

Responses of a recently developed rat alveolar macrophage cell (NR8383.1) line were compared to those of freshly derived alveolar macrophages in vitro. Marked inter- and intraspecies heterogeneity in levels of phagocytosis of unopsonized Pseudomonas aeruginosa or zymosan was noted among freshly derived alveolar macrophages from rats, rabbits, and baboons.

Resistance of mucoid Pseudomonas aeruginosa to nonopsonic phagocytosis by alveolar macrophages in vitro.

A unique, recently described rat alveolar macrophage cell line (NR8383) was used to study the interaction of the pulmonary immune system with a mucoid cystic fibrosis isolate of Pseudomonas aeruginosa (SRM-3), its nonmucoid revertant (SRM-3R), and a non-cystic fibrosis isolate (PAO-1). Strain SRM-3 was cultivated in a chemostat system to allow maintenance of an entirely mucoid population. The alveolar macrophage response to the mucoid and nonmucoid strains of P.

From growth factor dependence to growth factor responsiveness: the genesis of an alveolar macrophage cell line.

A rat pulmonary alveolar macrophage (PAM) cell line (NR8383) was initiated in culture in the presence of a gerbil lung cell conditioned medium (GLCM), and has been propagated continuously for over 36 mo. When examined at different times throughout this in vitro period, NR8383 exhibited characteristics typical of macrophages: (a) Zymosan ingestion was seen in 90 to 98% of the cells examined; (b) Pseudomonas aeruginosa phagocytosis in 50 to 80%; (c) Nonspecific esterase activity in greater than 95%. During the first 6 mo.

Individualizing gentamicin dosage in patients with cystic fibrosis: limitations to pharmacokinetic approach.

Gentamicin serum concentrations were measured in 15 children and seven adults with cystic fibrosis and in eight children with other diseases. Potentially toxic trough concentrations occurred in three of the first nine patients studied, in whom the dose and a 4-hour dosing interval were prescribed on the basis of one-compartment pharmacokinetic calculations (Sawchuck-Zaske method). In contrast, final concentrations were within the accepted target ranges for the remaining 13 patients with cystic fibrosis, in whom the dose and interval were adjusted empirically on the basis of a single pair of "peak" and trough values.

Stimulus-permeability coupling in rat pulmonary macrophages challenged by Pseudomonas aeruginosa. An X-ray microanalysis study.

Electron probe X-ray microanalysis (XRMA) of freeze-dried ultrathin sections provides the capability of measuring intracellular elemental content. This methodology was used to investigate the stimulus-permeability coupling responses associated with phagocytosis of Pseudomonas aeruginosa by cultured pulmonary alveolar macrophages (PAMs) of rats. PAMs were challenged with P.