RESUMO
Norwegian populated-based normative data on the Yale Children's Inventory (YCI) were provided for boys. All parents of boys aged 8 through 11 years in the county of Hammerfest received the YCI, and 77% responded. Mean scores on the YCI scales attention, activity, tractability, and fine motor were significantly lower in the Norwegian sample compared to the US normative data. Factor analysis of the 40 scale items yielded factors that corresponded generally well to the YCI scale constructs derived from US samples. We conclude that the scale constructs of the YCI seem to be transferable across these two cultures, but that restandardization is warranted. Further research is needed to establish cut-off values for clinical screening purposes. The Yale Children's Inventory has the potential to become a valuable screening tool for behavioral problems at school-age.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Comportamento Impulsivo/psicologia , Testes Psicológicos , Transtornos Psicomotores/diagnóstico , Criança , Análise Fatorial , Humanos , Masculino , Noruega , Vigilância da População , Transtornos Psicomotores/psicologia , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Extracorporeal membrane oxygenation (ECMO) may serve as extracorporeal lung assist (ECLA) in patients with acute respiratory failure (ARF) or as extracorporeal heart assist (ECHA) in patients with low output syndrome (LOS) after open heart surgery. From 1988 to 1992 seven patients underwent ECMO in our hospital; four suffered from ARF and three from LOS. Various bypass techniques were employed. Two ARF patients, aged 58 and 18 years, had veno-venous bypass; in the latter, ECMO was reinstituted as a veno-arterial bypass one week after weaning. In a three-year-old boy, the ECMO outflow tubing was primarily connected to the pulmonary artery, and shortly afterwards relocated to the common carotid artery. In a 31-year-old man with ARF, and three LOS patients, a 56-year-old woman, and two men aged 68 and 70 years, ECMO was veno-arterial with direct access to the ascending aorta. A heparin-coated system was used, and all but one patient, who was treated with warfarin, received a daily low dose of heparin, which was withdrawn after from one to nine days. Six patients were weaned off ECMO after 4.5 to 21 days. Three ARF patients recovered completely; the child died. In one LOS patient, ECMO was withdrawn due to a poor general condition. Two others were weaned off ECMO and the intra-aortic balloon pump, and the inotropic support was significantly reduced, but both died of multiple system organ failure. Although no firm conclusions can be drawn from these few case reports, the heparin-coated system used as ECLA appears promising, whereas ECHA seems to imply a poor prognosis in patients who are not candidates for cardiac transplantation.
Assuntos
Baixo Débito Cardíaco/terapia , Oxigenação por Membrana Extracorpórea , Coração/fisiopatologia , Pulmão/fisiopatologia , Insuficiência Respiratória/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Aorta , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Artéria Carótida Primitiva , Criança , Pré-Escolar , Oxigenação por Membrana Extracorpórea/instrumentação , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Heparina/administração & dosagem , Heparina/uso terapêutico , Humanos , Balão Intra-Aórtico , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , Artéria Pulmonar , Taxa de Sobrevida , Síndrome , Varfarina/administração & dosagem , Varfarina/uso terapêuticoRESUMO
Effects of acute mental stress on gastric antral motility were investigated in 23 healthy persons and 25 patients with functional dyspepsia (FD). Real-time ultrasonography of gastric antrum was recorded, after ingestion of 500 ml meat soup, during a 4-min resting period, 2.5 min of mental stress, and a 4-min recovery period. Amplitude of antral contractions was scored as a fraction of relaxed area. Motility-index was calculated as the amplitude multiplied by frequency. Measurement of skin conductance reflected sympathetic tone, and respiratory sinus arrhythmia (RSA) was calculated to index vagal tone. Antral motility was reduced by mental stress in the healthy persons, but not in FD patients. Group differences were significant for amplitude (p < 0.002) and motility-index scores (p < 0.02). Sympathetic tone increased during stress in both groups. Vagal tone was lower in the FD patients than in the healthy controls (p < 0.001). The lack of stress-related reduction of motility among patients with FD may, therefore, be a consequence of poor vagal tone.
Assuntos
Dispepsia/fisiopatologia , Esvaziamento Gástrico/fisiologia , Transtornos Psicofisiológicos/fisiopatologia , Antro Pilórico/inervação , Nervo Vago/fisiopatologia , Adolescente , Adulto , Nível de Alerta/fisiologia , Dispepsia/diagnóstico por imagem , Dispepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicofisiológicos/psicologia , Sistema Nervoso Simpático/fisiopatologia , UltrassonografiaRESUMO
Extracorporeal membrane oxygenation was introduced as a supplement ot mechanical ventilation in the treatment of two patients with severe acute respiratory failure and as heart assist in one patient with acute refractory cardiac failure after open heart surgery. The system includes a membrane oxygenator and a roller pump. The whole circuit is coated with partially degraded heparin covalently bound to the surface (Carmeda Bioactive Surface), reducing the need of systemic heparinization to a minimum. In the first case of acute respiratory failure a veno-venous bypass was employed, with cannulas in the right atrium and the femoral vein. Given a blood flow through the circuit of 2.5 l/min, ventilator settings could be favourably reduced. The patient was weaned off the bypass system after six days, off the ventilator after 120 days, and recovered completely. In two cases the system served as partial venoarterial bypass, and blood was returned to the ascending aorta. A 31 year-old male victim of a smoke inhalation lung injury was on bypass for four and a half days. He recovered completely after another 17 days of mechanical ventilation. A 68 year-old man with pump failure after cardiac surgery needed extracorporeal support as heart assist for seven days. On the eighth day he was weaned off intra-aortic balloon-pumping as well. Unfortunately, he died of septicemia, with multiple organ failure, 13 days later. The heparin-coated extracorporeal membrane oxygenation system may represent a major advancement in the treatment of critically ill patients in need of cardiopulmonary assist.
Assuntos
Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca/terapia , Insuficiência Respiratória/terapia , Doença Aguda , Adulto , Idoso , Dióxido de Carbono/sangue , Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pressão Parcial , Respiração com Pressão Positiva , Insuficiência Respiratória/fisiopatologiaRESUMO
The role of prior stress experience on the response of the organism to a later stressor has been studied in terms of the extent of gastric ulceration induced by the second stressor. These studies have focused largely on effects of prior stress (shock, restraint, activity) on the ulceration developing under later restraint and activity stress. The studies indicate that prior exposure to restraint stress provides some protection against later restraint ulcer development. Using shock as the prior stressor, the effects on later restraint stress are determined by the particular characteristics of the shock (controllability and predictability), and by contextual factors. Studies are lacking on the significance of these characteristics of shock for later activity stress ulcers. Further studies are required therefore on the significance of psychological characteristics of the prestress, and on the effects of these prestressors at different stages of the life cycle. The identification of these factors, and a clearer picture of the protective and exacerbating effect of prior stress will allow us to explore the physiological (central and peripheral) mechanisms underlying ulcer development and ulcer susceptibility.
Assuntos
Úlcera Gástrica/etiologia , Estresse Psicológico/complicações , Animais , Ratos , Restrição Física , Úlcera Gástrica/psicologia , Estresse Psicológico/psicologiaRESUMO
During the period March 1987-May 1988, postoperative infection or colonization with Enterobacter cloacae occurred in 9/379 (2.4%) patients who underwent cardiovascular surgery. Five of the patients were infected with multiply beta-lactam resistant E. cloacae, of whom 4 had been infected with an identical, resistant strain during intervals of months. This strain was also found in the environmental flora of the cardiovascular operating suite and in a sink reservoir in the surgery department. All 4 patients with the identical resistant strain had serious complications during the postoperative period with symptoms of septicaemia in 3, multiorgan failure and shock in 2, and mediastinitis in 3. The single resistant strain of a different serotype was also associated with severe postoperative complications. The 4 sensitive strains were all different serotypes. None caused septicaemia, one was associated with mediastinitis, another with an uncomplicated sternum infection, and 2 were from sputum. In the 3 latter patients with sensitive strains and few postoperative complications, cephalosporins had not been used during the pre- or postoperative period.
Assuntos
Infecção Hospitalar/microbiologia , Enterobacter/efeitos dos fármacos , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Departamentos Hospitalares , Salas Cirúrgicas , Centro Cirúrgico Hospitalar , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Idoso , Antibacterianos/farmacologia , Procedimentos Cirúrgicos Cardíacos , Resistência Microbiana a Medicamentos , Enterobacter/isolamento & purificação , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sepse/microbiologia , Sorotipagem , Procedimentos Cirúrgicos Vasculares , beta-LactamasRESUMO
We describe five patients with serious nosocomial infection caused by resistant Enterobacter cloacae. Four of the patients underwent cardiovascular operations and were infected with an identical, multiple beta-lactam resistant E cloacae strain. The fifth patient was admitted with several wounds and skin-ulcers containing both resistant and sensitive E cloacae of other types. The resistant strain caused septicemia in four patients; three developed multiorgan failure and one died. The most probable causes of these infections were an abundant and constant reservoir of E cloacae in a sink at the operating unit, periodical breakdown of barriere routines, and heavy use of cephalosporins.