Mood swings in patients with panic disorder.

Depression is frequently found in patients with panic disorder. It is known that patients suffering from panic disorder and depression have more severe symptoms of anxiety and avoidance and respond less well to treatment with antidepressants. The General Behaviour Inventory, an instrument that identifies subjects with subsyndromal and syndromal recurrent mood disorders was completed by 108 patients in a panic disorder program.

Reference ranges for respiratory rate measured by thermistry (12-84 months).

Previous studies of respiratory rate in children have had a number of methodological problems. The aim of this study was to construct age specific reference ranges for respiratory rate. Respiratory rate in children attending childcare centres, kindergartens, and schools was measured using a nasal thermocouple to obtain respiratory waveforms.

Computer-assisted instruction in Australian medical schools.

Objective: To survey the use of computer-assisted instruction (CAI) in undergraduate medical student education in Australia.

Setting And Design: A postal questionnaire survey of medical school deans, and department heads, in all Australian medical schools.

Results: 90% of deans, and 88% of department heads responded to the questionnaires.

Sickle cell disease with complicated influenza B virus infection.

The Committee on Infectious Diseases of the American Academy of Pediatrics, and the Advisory Committee on Immunization Practices of the Center for Disease Control for many years have recommended the routine use of influenza vaccine in various hemoglobinopathies including sickle cell disease. This recommendation, however, has not been included in the patient care protocols of the Comprehensive Sickle Cell Centers program of NIHLB. Most clinicians have not used yearly influenza vaccine for their patients with sickle cell disease.

Respiratory timing in intubated neonates with respiratory distress syndrome.

Respiratory timing was studied in 100 babies ventilated for respiratory distress syndrome (RDS) during a brief period of continuous positive airway pressure. For the 76 spontaneously breathing babies the mean (SD) inspiratory and expiratory times were 0.31 (0.

Microscopic observations on tracheal aspirates from ventilated neonates. II. The onset of bronchopulmonary dysplasia and other changes.

A total of 450 undiluted and unprocessed tracheal aspirates from 120 intubated infants were examined microscopically for evidence of bronchopulmonary dysplasia and other changes. In 19 infants desquamated sheets of dysplastic epithelium in the fresh aspirate provided an early indication of developing bronchopulmonary dysplasia. Examination of unstained tracheal aspirates can provide, within minutes, information not only about the onset and development of bronchopulmonary dysplasia, but also provide evidence for milk or formula aspiration and for gastro-oesophageal reflux.

Cluster randomization in large public health trials: the importance of antecedent data.

Large-scale public health trials are often randomized by geographic or administrative clusters, for reasons of financial or organizational exigency. In this paper, we deal with the situation where the dependent variable is a count of events, such as mortality from, or incidence of a given disease. Simulation results show that this design may decrease power by more than 50 per cent.

Treatment of neonatal hyperbilirubinaemia by plasmapheresis.

A term baby developed severe hyperbilirubinaemia in association with group-B streptococcal sepsis. Haemodynamic instability deterred us from performing exchange transfusion, and so plasmapheresis was used to lower the bilirubin level. The procedure was very effective and well tolerated.

Effects of physical stress on complete blood count and venous blood gas profile of individuals with sickle cell trait.

The association between sickle cell trait (SCT) and adverse effects of exercise has been controversial. While individuals with SCT are at higher risk of sudden death, the mechanism for this outcome remains to be elucidated. In order to shed light on this controversy, we have monitored venous blood count and blood gas parameter values in normal and SCT subjects during treadmill exercise.

Breast screening, prognostic factors and survival--results from the Swedish two county study.

The results of the Swedish two-county study are analysed with respect to tumour size, nodal status and malignancy grade, and the relationship of these prognostic factors to screening and to survival. It is shown that these factors can account for much of the differences in survival between incidence screen detected, interval and control group cancers but to a lesser extent for cancers detected at the prevalence screen where length bias is greatest. Furthermore, examination of the relationships among the prognostic factors and mode of detection indicates that malignancy grade, as a measure of inherent malignant capacity, evolves as a tumour grows.

Predictions of the AIDS epidemic in the U.K.: the use of the back projection method.

Back projection methods are used to predict the yearly number of new AIDS diagnoses and the number of new HIV infections, to the end of 1992. The AIDS, but not the HIV, predictions are insensitive to the choice of incubation period distribution. A wide range of predictions is consistent with the AIDS diagnoses in years up to 1987, but limited ancillary information on the relative rates of new HIV infection in 1984 to 1987 can be used to narrow this range.

Tracheal aspirates from neonates during endotracheal intubation: detection of surfactant by polarized light microscopy.

A technique for detecting the presence of pulmonary surfactant in the tracheal aspirates obtained from preterm babies is described. The specimens were examined by means of polarized light microscopy. Surfactant could be simply and rapidly identified by its appearance as birefringent particles in volumes of aspirate as little as 1 microliter.

Simple method for securing umbilical catheters.

A method for securing umbilical catheters is described. It has been used successfully in over 350 babies. It is a simple and rapid method that allows for easy repositioning and, unlike some established techniques, has no potential for damage to the preterm baby's skin.

Maternal rubella and the congenital rubella syndrome.

The major goal of rubella immunization is the prevention of the congenital rubella syndrome. As many as 20 per cent of women in the reproductive age group in the United States continue to be susceptible to rubella despite the immunization programs currently in place. Intensified efforts are therefore needed to identify persons at risk for infection and to vaccinate them.

Randomized trial of artificial surfactant (ALEC) given at birth to babies from 23 to 34 weeks gestation.

Artificial surfactant (ALEC) composed of dipalmitoylphosphatidylcholine and unsaturated phosphatidylglycerol in a ratio of 7:3 (w/w) and a dose of 50-100 mg was suspended in 1 ml of cold saline and used at birth as a prophylaxis against the respiratory distress syndrome and its complications in a two centre randomized prospective trial involving 341 babies from 23 to 34 weeks gestation regardless of their antenatal problems. The surfactant had little effect in babies above 29 weeks gestation and was most beneficial in babies under 30 weeks gestation (67 controls and 69 surfactant treated babies). In this subgroup the artificial surfactant significantly reduced the inspired oxygen and peak ventilator pressure requirements during the first 96 h, the incidence of intraventricular haemorrhages from 40% to 19% (P less than 0.

A simple technique for recording the electromyogram of the external abdominal oblique muscle in the newborn.

A technique for recording activity in the external abdominal oblique muscles of the human newborn is described. It uses simple, self-adhesive, surface electrodes arranged to reduce electrocardiographic interference. This method is applicable to studies of the respiratory patterns of very pre-term babies undergoing intensive medical care.

Cerebral blood flow velocity variability in infants receiving assisted ventilation.

Cerebral blood flow velocity was measured using Doppler ultrasonography in 20 babies who weighed less than 2500 g at birth and who were receiving assisted ventilation; their patterns of spontaneous respiration were recorded simultaneously. The babies were induced to breathe synchronously or asynchronously with the ventilator by manipulating the inspiratory and expiratory time settings. The variability of cerebral blood flow velocity (coefficient of variation) was calculated from the area of the maximum Doppler frequency shift envelope for 10 cardiac cycles from 211 recordings made on 42 occasions, and was greatest within 12 hours of birth after which it fell progressively over the next 48 hours.

Expiratory muscle activity in preterm babies.

The activity of the right external abdominal oblique muscle, in relation to respiration, in newborn babies from 25 to 34 weeks' gestation was studied, using surface electrodes. Babies without respiratory difficulties showed no activity associated with respiration in these muscles. Grunting babies with respiratory disease showed pronounced activity during expiration.

Parenteral nutrition-associated cholestasis: recovery following phenobarbitone.

A case is presented of a very preterm neonate who developed severe cholestatic jaundice in association with prolonged parenteral nutrition. The effects of a therapeutic trial of phenobarbitone on bilirubin and liver enzymes are shown. This case suggests that phenobarbitone may have a role to play in the treatment of this condition, which is contrary to indications in a few other case reports in the literature.

Synchronous mechanical ventilation of the neonate.

We describe a simple technique of neonatal ventilation that induces the neonate to breathe in synchrony with the ventilator. This preserves the beneficial effects of spontaneous respiration (unlike therapeutic paralysis) and reduces potentially harmful interactions between baby and ventilator. The technique uses measurements of the neonate's own respiratory timing.

Monitoring spontaneous respiration in the ventilated neonate.

A technique for monitoring the ventilated neonate's own respiratory efforts using a pneumatic capsule apnoea alarm is described.