ABSTRACT
Between January 1982 and December 1983, 335 Broviac catheters placed in 270 infants and children were prospectively evaluated. The average duration of catheter life was 99.7 days, yielding a total accumulated experience of 33,394 catheter days. Blood culture-proven bacteremia occurred on 77 occasions (23%), an average of one spetic episode for every 434 days of catheter use. Temperature elevation was the only consistent clinical sign of infection occurring in 91% of the children. White blood cell counts remained within the normal range in the majority of patients. The differential counts were most helpful, however, documenting a significant increase in the number of immature neutrophils. The rise in band forms was frequently observed 24 to 48 hours before the onset of clinically evident sepsis. Platelet counts did not change significantly. Eighty-eight microorganisms were identified on blood culture. Eighty-three bacterial isolates were recovered (94%) and five fungi. The vast majority of patients (86%) had a single organism on blood culture but polymicrobial sepsis was observed on 11 occasions. Staphylococcus sp (38%) and Streptococcus sp (25%) species were most common. Of particular importance, 48% of coagulase negative staphylococci were nafcillin-resistant. Of the gram negative bacteria, Klebsiella (10%) and Pseudomonas (6%) species were most frequent. In 53 patients, antibiotic therapy was administered in an attempt to salvage the catheter. Bacteremia was controlled successfully in 39 (74%), and in the other 14 children, persistent sepsis dictated catheter removal. One patient (0.4%) died as a result of catheter-related sepsis.
Subject(s)
Catheterization/adverse effects , Sepsis/etiology , Catheterization/instrumentation , Child , Child, Preschool , Equipment Contamination , Female , Humans , Infant , Infant, Newborn , Infusions, Parenteral , Male , Mycoses/etiology , Prospective Studies , Silicone Elastomers , Time FactorsSubject(s)
Brain/drug effects , Carboxy-Lyases/metabolism , Glutamate Decarboxylase/metabolism , Glycine/analogs & derivatives , Seizures/chemically induced , Animals , Blood-Brain Barrier , Brain/enzymology , Dose-Response Relationship, Drug , Glycine/metabolism , Glycine/pharmacology , Male , Mice , Stereoisomerism , Structure-Activity RelationshipSubject(s)
Catalepsy/chemically induced , Haloperidol/pharmacology , Animals , Female , Haloperidol/administration & dosage , Humans , Rats , Time FactorsABSTRACT
The mechanisms underlying the dissociation of the extrapyramidal and antipsychotic properties of haloperidol as compared to clozapine were explored by studying the effects of these drugs on dopamine metabolism in the straitum and tuberculum olfactorium (TO) of the rat. Homovanillic acid and 3,4-dihydroxyphenylacetic acid were simutaneously measured in these regions by a gas chromatographic techinque after treating the rats with different doses of the drugs. Dose-response curves and time-action curves were generated. For both drugs, a higher dose was required to achieve half-maximal metabolite elevation in the TO as compared to the striatum. The apparent differential sensitivity to haloperidol was attributed to differences in time to peak response. The time to peak response to clozapine was similar in both structures. Thus, the striatum appears to be more sensitive to clozapine than the TO with respect to elevation of dopamine metabolites. The effect of haloperidol on dopamine metabolism in the striatum was more persistent than that in the TO. After 4 hours, metabolite levels were still elevated in the striatum, whereas after 2 hours they returned to base line in the TO. The extrapyramidal effects of haloperidol may be due to the persistent action of this drug on dopamine metabolism in the striatum, and the lack of extrapyramidal effects of clozapine may be due to its brief action on dopamine metabolism in the striatum.