bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Experience With Sudden Unexplained Death in Epilepsy at a Tertiary Epilepsy Center
Authors: McGregor Amy , Wheless James
Published: June 2007

Sudden unexplained death in epilepsy is rare in children, and few studies report risk factors. We reviewed our experience with 17 cases of sudden unexplained death in epilepsy to determine risk factors in children. The charts of all patients with onset of epilepsy at less than age 18 years who suffered sudden unexplained death in epilepsy between August 1992 and April 2004 at our epilepsy center were retrospectively reviewed. Deaths were classified as possible, probable, or definite sudden unexplained death in epilepsy. There were seven cases of definite, nine cases of probable, and one case of possible sudden unexplained death in epilepsy. Generalized tonic-clonic seizures and prone position during sleep were found to be major risk factors. Sudden unexplained death in epilepsy in children and adolescents is associated with convulsive seizures, and aggressive treatment of nocturnal generalized tonic-clonic seizures might help lower the occurrence. (J Child Neurol 2006;21:782—787; DOI 10.2310/7010.2006.00175).
Magnetic Resonance Imaging (MRI) Findings in Children Surviving Extremely Premature Delivery and Extremely Low Birthweight With Cerebral Palsy
Authors: Bodensteiner John B. , Johnsen Stanley D.
Published: June 2007

To delineate the frequency, severity, and characteristics of the brain injury occurring in children surviving extremely premature birth, we reviewed brain magnetic resonance images (MRIs) of children with cerebral palsy whose birthweight was less than 1000 g and whose gestational age was less than 28 weeks. The patients were all enrolled in the state Children's Rehabilitative Services clinic, where cerebral palsy is an automatic qualifying condition. We tabulated the MRI findings with respect to the cerebellum, periventricular white matter, and corpus callosum. The inclusion criteria were met by 157 children; 94 had an MRI. The available scans were reviewed by the authors, and the findings were tabulated. Fifty scans were available for review. There were 4 totally normal scans, 18 scans had normal cerebellar imaging, and 8 scans were felt to have normal cerebral findings. The common cerebral abnormalities included decreased white-matter volume without gliosis (n = 36), periventricular leukomalacia (n = 16), and a thin corpus callosum (n = 18). Cerebellar abnormalities were found in 32. The cerebellar findings included destruction of major portions of the cerebellum (usually the inferior vermis and hemispheres) (n = 23) and focal or unilateral loss of cerebellar tissue (n = 4). The high incidence of injury to the cerebellum has not been previously appreciated. The most common cerebral injury is decreased volume of white matter in the periventricular regions without gliosis. The pattern of cerebellar injury suggests a vascular insult, and the deficient white matter without gliosis suggests immaturity of oligodendrogliocytes with limited response to injury. Both lesions are more or less unique to the age at which the insult occurred and represent an emerging, newly recognized type of cerebral palsy. (J Child Neurol 2006;21:743—747; DOI 10.2310/7010.2006.00179).
Specific Neurologic Complications of Human Immunodeficiency Virus Type 1 (HIV-1) Infection in Children
Authors: Wilmshurst Jo M. , Burgess John , Hartley Patricia , Eley Brian
Published: June 2007

Pediatric human immunodeficiency virus type 1 (HIV-1) infection is endemic throughout southern Africa. Neurologic complications are described in 20% to 60% of published series, mostly related to HIV-1 encephalopathy. With increasing HIV prevalence, more atypical cases are presenting. We present, as illustrative cases, seven children (three girls) with unusual neurologic sequelae as a consequence of HIV-1 infection. The median age at presentation was 33 months (range 7 months—6 years). Five of the seven children were developmentally normal before presentation. They presented with progressive multifocal leukoencephalopathy, myelopathy, intractable seizures, acute vasculitis and blindness, hemiplegia, peripheral neuropathy, and paraspinal lymphoma. Neuroimaging of the brain was performed in five patients, of whom one had basal ganglia calcification. All children had poor outcome with incomplete recovery or continued deterioration. In conclusion, children with HIV-1 infection who survive beyond the first year of life can present with a wide variety of neurologic complications. A similar spectrum of neurologic manifestations is likely to occur in other sub-Saharan African countries, characterized by high HIV prevalence. The case histories demonstrate that the neurologic features of pediatric HIV infection do not easily fit into a simplified classification system. (J Child Neurol 2006;21:788—794; DOI 10.2310/7010.2006.00188).
Refractory Status Epilepticus Owing to Human Parvovirus B19 Encephalitis in a Child
Authors: Erol Ilknur , Alehan Füsun
Published: June 2007

Human parvovirus B19 is the agent that causes erythema infectiosum (fifth disease), a disease that is generally benign and self-limiting. This virus also is associated with severe disease in hemolytic or immunocompromised patients. It rarely causes meningoencephalitis in healthy children. Herein we present the case of a 10-year-old healthy girl with refractory status epilepticus possibly owing to human parvovirus B19 encephalitis who was successfully treated with high-dose corticosteroids. To our knowledge, this is the first report of human parvovirus B19 encephalitis complicated by refractory status epilepticus in a child. (J Child Neurol 2006;21:820—822; DOI 10.2310/ 7010.2006.00194).
Intractable Epilepsy Secondary to Cyclosporine Toxicity in Children Undergoing Allogeneic Hematopoietic Bone Marrow Transplantation
Authors: Gaggero Roberto , Haupt Riccardo , Fondelli Maria Paola , De Vescovi Raffaella , Marino Alessia , Lanino Edoardo , Dallorso Sandro , Faraci Maura
Published: June 2007

The long-term evolution to intractable epilepsy in children treated with cyclosporine administered for graft-versus-host-disease after hematopoietic stem cell transplantation was evaluated. In a group of 185 children treated with cyclosporine after bone marrow transplantation, 15 (8%) presented with acute seizures that were generalized in 7 and focal in 7 and had absence status in 1. Electroencephalography (EEG) and neuroimaging showed predominant abnormalities in the occipital regions. One patient died shortly after the seizure; in seven cases, seizures remitted, whereas relapses were observed in seven others. After the first year, seizures persisted chronically in four cases and evolved to intractable epilepsy. Focal temporal epilepsy was diagnosed in three cases, whereas in the fourth case, a multifocal epilepsy was observed. Magnetic resonance imaging (MRI) detected mesial temporal sclerosis in all of these cases. The risk factors associated with evolution to epilepsy included lower age at transplantation (3—5 years), more than one relapsing seizure in the first year after transplantation, and longer treatment with cyclosporine. Not only can cyclosporine cause acute central nervous system toxicity, it can also determine intractable epilepsy associated with mesial temporal sclerosis. (J Child Neurol 2006;21:861—866; DOI 10.2310/7010.2006.00196).
Dopamine Agonist Therapy in Low-Response Children Following Traumatic Brain Injury
Authors: Patrick Peter D. , Blackman James A. , Mabry Jennifer L. , Buck Marcia L. , Gurka Matthew J. , Conaway Mark R.
Published: June 2007

The objective of this study was to determine whether a dopamine agonist could improve mental status among children in a low-response state following traumatic brain injury. In an 8-week, prospective, double-blind, randomized trial, 10 children and adolescents ages 8 to 21 years ( = 16.7 years) with traumatic brain injury sustained at least 1 month previously and remaining in a low-response state (Rancho Los Amigos Scale level ≤ 3) received pramipexole or amantadine. Medication dosage was increased over 4 weeks, weaned over 2 weeks, and then discontinued. At baseline and weekly during the study, subjects were evaluated with the Coma Near Coma Scale, Western NeuroSensory Stimulation Profile, and Disability Rating Scale. Scores improved significantly from baseline to the medication phase on the Coma Near Coma Scale, Western NeuroSensory Stimulation Profile, and Disability Rating Scale (P < .005). The weekly rate of change was significantly better for all three measures on medication than off medication (P < .05). Rancho Los Amigos Scale levels improved significantly on medication as well (P < .05). There was no difference in efficacy between amantadine and pramipexole. No unexpected or significant side effects were observed with either drug. This clinical trial supports the benefit of two dopamine agonists in the restoration of functional arousal, awareness, and communication. These drugs can be helpful in accelerating eligibility for acute rehabilitation among children and adolescents who have sustained significant brain injuries. (J Child Neurol 2006;21:879—885; DOI 10.2310/ 7010.2006.00203).
Intensive Pediatric Constraint-Induced Therapy for Children With Cerebral Palsy: Randomized, Controlled, Crossover Trial
Authors: Deluca Stephanie C. , Echols Karen , Law Charles R. , Ramey Sharon L.
Published: June 2007

A randomized crossover trial of a new form of pediatric rehabilitation was conducted with 18 children with hemiparesis. Half were randomly assigned to receive pediatric constraint-induced therapy involving constraint of the functional upper extremity and intensive therapy with the hemiparetic upper extremity. Controls received conventional physical and occupational therapy and then were crossed over to receive pediatric constraint-induced therapy. Pediatric constraint-induced therapy produced significantly greater gains than conventional rehabilitation services. (J Child Neurol 2006;21:931—938; DOI 10.2310/7010.2006.00201).
Mitochondrial DNA Deletion in a Child With Mitochondrial Encephalomyopathy, Growth Hormone Deficiency, and Hypoparathyroidism
Authors: Cassandrini Denise , Savasta Salvatore , Bozzola Mauro , Tessa Alessandra , Pedemonte Marina , Assereto Stefania , Stringara Silvia , Minetti Carlo , Santorelli Filippo M. , Bruno Claudio
Published: June 2007

We report an 11-year-old boy with short stature, bilateral ptosis, sensorineural hearing loss, muscle weakness, and endocrine abnormalities. Brain magnetic resonance imaging (MRI) showed a bilateral abnormal signal in the globus pallidus and in the midbrain tegment. Muscle biopsy specimens showed ragged red and cytochrome c oxidase negative fibers, and biochemical analysis of muscle homogenate showed a partial defect of complex I and IV activities of the respiratory chain enzymes. Analysis of mitochondrial DNA by a polymerase chain reaction screening procedure and Southern blot revealed a novel heteroplasmic single mitochondrial DNA deletion of 7.8 kb in different tissues. This deletion was absent in the blood DNA of his mother and brother. This case further expands and confirms the wide clinical spectrum of mitochondrial disorders associated with single large-scale mitochondrial DNA deletions. (J Child Neurol 2006;21:983—985; DOI 10.2310/7010.2006.00218).
Risk Factors for Seizures in Very Low Birthweight Infants With Periventricular Leukomalacia
Authors: Kohelet David , Shochat Rina , Lusky Ayala , Reichman Brian
Published: June 2007

This population-based observational study aimed to determine the perinatal factors that were associated with the occurrence of seizures in very low birthweight infants with periventricular leukomalacia. The study sample consisted of 545 infants from the Israel National Very Low Birthweight Infant Database, gestational age 24 to 36 weeks, who survived beyond 28 days of age, in whom a late cranial ultrasonographic examination was performed and in whom periventricular leukomalacia was diagnosed. To evaluate the association between periventricular leukomalacia and confounding variables on the occurrence of seizures, the chi-square test, univariate analysis, and a logistic regression model were used. Of the 545 infants who developed periventricular leukomalacia, 102 (18.7%) had seizures. Significant independent predictors of seizures among these infants were decreasing gestational age, intraventricular hemorrhage, posthemorrhagic hydrocephalus, sepsis, and necrotizing enterocolitis. Infants with both sepsis and necrotizing enterocolitis had a 4.6-fold increased risk of seizures, further suggesting a possible role of infection in the pathogenesis of brain injury in preterm infants. (J Child Neurol 2006;21:965—970; DOI 10.2310/7010.2006.00226).
Phenylketonuria in Pediatric Neurology Practice: A Series of 146 Cases
Authors: Yalaz Kalbiye , Vanli Lale , Yilmaz Engin , Tokatli Aysegul , Anlar Banu
Published: June 2007

The neurologic manifestations of patients with phenylketonuria treated at different ages are illustrated in this series of 146 cases, including 9 sib pairs. In addition to well-known findings such as mental retardation, autistic features, microcephaly, and tremor, motor retardation was common and responded promptly to dietary treatment. Hypotonia and diminished reflexes were more frequent findings than hypertonia. Four sib pairs showed divergent features, such as the later-treated sibling having higher function than the early-treated one. Because siblings have a similar genotype and similar environmental and dietary conditions, this observation can be explained by differences in phenylalanine transport to the brain or additional metabolic or perinatal factors influencing the neurologic outcome. (J Child Neurol 2006;21:987—990; DOI 10.2310/7010.2006.00228).
Systemic and Ocular Findings in 100 Patients With Optic Nerve Hypoplasia
Authors: Lourdes Garcia M. , Ty Edna B. , Taban Mehryar , Rothner A. David , Rogers Douglas , Traboulsi Elias I.
Published: June 2007

To describe associated ocular, neurologic, and systemic findings in a population of children with optic nerve hypoplasia, a retrospective chart review of 100 patients with optic nerve hypoplasia for the presence of neurologic, radiologic, and endocrine abnormalities was performed. Neuroimaging and endocrine studies were obtained in 65 cases. Visual acuity and associated ocular, neurologic, endocrine, systemic, and structural brain abnormalities were recorded. Seventy-five percent had bilateral optic nerve hypoplasia. Conditions previously associated with optic nerve hypoplasia and present in our patients include premature birth in 21%, fetal alcohol syndrome in 9%, maternal diabetes in 6%, and endocrine abnormalities in 6%. Developmental delay was present in 32%, cerebral palsy in 13%, and seizures in 12%. Of those imaged, 60% had an abnormal study. Neuroimaging showed abnormalities in ventricles or white- or gray-matter development in 29 patients, septo-optic dysplasia in 10, hydrocephalus in 10, and corpus callosum abnormalities in 8. There was an associated clinical neurologic abnormality in 57% of patients with bilateral optic nerve hypoplasia and in 32% of patients with unilateral optic nerve hypoplasia. Patients with unilateral and bilateral optic nerve hypoplasia frequently have a wide range and common occurrence of concomitant neurologic, endocrine, and systemic abnormalities. (J Child Neurol 2006;21:949—956; DOI 10.2310/7010.2006.00241).
Iatrogenic Cardiovascular Disease Secondary to Diagnostic and Therapeutic Procedures
Authors: Gold Robert L. , Rios Jorge C.
Published: June 2007

The number of diagnostic and therapeutic procedures performed in cardiology continues to grow. These pro cedures are generally considered safe or of minimal risk to the patient. However, it is important to remember that significant complications may occur, and in each patient the risk: benefit ratio must be carefully weighed. In this review, the complications documented in the medical literature resulting from the use of cardiologic interventions and procedures are discussed. A thorough knowledge of these complications and their precipitat ing factors can help minimize the risk to the patient.
Hypertensive Crises
Authors: Ram C. Venkata S. , Hyman David
Published: June 2007

Hypertensive crises are a group of medical conditions in which a rapid decrease in blood pressure is necessary to prevent serious complications. Although uncommon in clinical practice, a hypertensive crisis should be recog nized and treated promptly. Any form of hypertension may be associated with hypertensive crisis, the main determinant being the level of blood pressure rather than the cause of hypertension. In certain clinical situa tions the abruptness with which the blood pressure in creases seems to be more important than the absolute level of blood pressure in causing the hypertensive crisis (e.g., toxemia of pregnancy in women and acute onset of hypertension in children with acute glomerulo nephritis). In other clinical situations the absolute level of blood pressure does not affect the seriousness of hy pertension so much as coexisting complications that may make even moderate hypertension dangerous (e.g., acute aortic dissection and acute left ventricular fail ure ).
Central Venous Catheterization: A Comprehensive Review, Part I
Authors: Seneff Michael G.
Published: June 2007

Central venous catheterization is an indispensable tech nique in today's practice of medicine. It was initially used to monitor central venous pressure; however, this method has become obsolete. Central venous access is now more commonly established to administer hyper tonic intravenous alimentation or to insert pulmonary artery catheters. The sites available for central venous catheterization include the antecubital veins, external and internal jugular veins, subclavian vein, and femoral vein. Many of these sites offer more than one method of insertion. Although the indications for central venous access are well known, there is a general lack of respect for the considerable incidence of associated complica tions. It is useful to separate complications into two categories: those associated with venipuncture and catheter insertion, which will vary greatly depending on the route chosen, and those associated with catheter maintenance, which tend to be similar. The various methods of central venous catheterization are com prehensively reviewed with regard to specific indica tions, technique, and complications.
Analytic Reviews : The Diagnosis of Brain Death in the Adult Patient
Authors: Powner David J.
Published: June 2007

The biological tenet upon which brain death is founded is absolute. The brain's inability to undergo cellular divi sion ensures that once individual neurons die they can not be replaced. Extrapolating this to the total brain, once the entire brain is dead no recovery can occur, and the patient's family can be guaranteed of that fact. The clinician, therefore, is faced primarily with a diagnostic challenge in determining that brain death is indeed pres ent. The components, procedures, and limitations of that diagnostic process in the adult patient are the sub jects of this discussion.
Airway Management of the Nonintubated Patient
Authors: Coleman Diana Lewis , Cohen Neal H.
Published: June 2007

Maintenance of an unobstructed airway and administra tion of controlled ventilation by face mask can save the life of the patient unable to sustain adequate spontane ous ventilation. Techniques for obtaining an unob structed airway are reviewed, as are methods of posi tioning and holding the face mask. Breathing bag systems used to deliver supplemental oxygen and posi tive-pressure ventilation to the nonintubated patient are discussed.
Prospective Study of Pulmonary Artery Balloon Floatation Catheter Insertions
Authors: Gill John B. , Cairns John A.
Published: June 2007

All Swan-Ganz catheter insertions over a 6-month pe riod were examined prospectively to determine current patterns of utilization, details of insertion, and the na ture, severity, and frequency of complications. There was an attempt to insert a Swan-Ganz catheter on 169 occasions in 153 patients with an eventual success rate of 95%. Catheterizations were classified as medical (82) or surgical (87). Medical patients were more acutely ill, required longer insertion time for venous cannulation (9.6 ± 7.7 min versus 8.1 ± 9.2 min; p < 0.01), needed their catheters for a longer period of time (90 ± 89 hours versus 64 ± 59 hours; p < 0.05), and had a poorer hospital survival (46% versus 86%; p < 0.05). There were no complications either during or following insertion in 45% of procedures or 50% of patients. There were 14 major complications in 8% of proce dures and 9% of patients; the most serious were com plex ventricular dysrhythmias, which accounted for the death of one patient. Most of the complications were minor and of no consequence to the patient. We con clude that Swan-Ganz catheterization, performed by a variety of operators in high-risk patients, provides reli able measurements over a long period of time with an acceptable frequency of major complications.

The pulmonary artery balloon floatation catheter (Swan-Ganz catheter), which permits the measure ment of blood pressure and flow as well as mixed venous blood oxygen saturation, is widely used in the investigation and management of patients with a variety of medical and surgical illnesses accom panied by hemodynamic derangements. In seri ously ill patients, major complications might be an ticipated if medical personnel lacked the necessary skills and experience to undertake an invasive pro cedure and to employ sophisticated technology. Al though many case reports exist, there are few pro spective studies that delineate the frequency and severity of such complications.

The purpose of this study was to examine pro spectively all Swan-Ganz catheter insertions in a busy community-based, acute care university teach ing hospital with housestaff. The intent was to out line current patterns of utilization and details of the insertions and, within this context, to determine the nature, severity, and frequency of complications oc curring during insertion as well as the subsequent clinical course of patients receiving Swan-Ganz catheters.
Coma Following Cardiac Arrest: A Review of the Clinical Features, Management, and Prognosis
Authors: Maiese Kenneth , Caronna John J.
Published: June 2007

Sudden cardiac death is an important clinical problem that accounts for 750,000 deaths in the United States each year. There are 200,000 cardiac resuscitations each year, of which only 70,000 are successful. Survival depends upon early cardiopulmonary resuscitation and defibrillation. The brain's ability to tolerate no more than a few minutes of circulatory arrest is the major factor limiting the success of cardiopulmonary resusci tation. Cardiac arrest results in a spectrum of clinical disorders depending on the severity of cerebral anoxia. Neurological sequelae in survivors range from transient states of confusion and amnesia to prolonged uncon sciousness in a coma or in the vegetative state. Sequen tial neurological examinations alone or in conjunction with evoked potentials, electroencephalogram, com puted tomography, and positron emission tomography can indicate the degree of central nervous system dam age and the likely outcome. The clinical management of patients in coma following cardiac arrest involves resto ration of cardiopulmonary and metabolic homeostasis. No effective delayed therapy yet exists that can reverse anoxic damage, but several promising therapeutic agents are under laboratory and clinical investigation.
Analytic Reviews : Rapid Tranquilization of the Agitated Intensive Care Unit Patient
Authors: Tesar George E. , Stern Theodore A.
Published: June 2007

Agitation in intensive care unit patients is a problem that is often ignored or undertreated. The presence of agita tion warrants a thorough investigation for underlying causes (e.g., metabolic and systemic abnormalities, drug intoxication or withdrawal, hypoxia, and pain) so that the precipitating disturbances can be identified and cor rected. When these conservative measures fail to con trol a patient's agitation, it may be necessary to resort to mechanical restraint and sedating medication. The au thors present guidelines for the pharmacological man agement of agitation and the risks and benefits associ ated with the use of specific agents.
Neurophysiological Monitoring in the Intensive Care Unit
Authors: Cascino Gregory D.
Published: June 2007

Electroencephalography and evoked potentials are ob jective and reproducible studies used in the intensive care unit as an extension of a neurological examination. The techniques can be performed serially at the bedside and are used diagnostically in the evaluation of patients with altered states of consciousness, seizure disorders, and threatened cerebral perfusion. EEG is used in the determination of brain death. Auditory evoked poten tials have been demonstrated to be an effective method of delineating a peripheral auditory dysfunction in neo natal patients. Potential uses of electroencephalography and evoked potentials include predicting outcome and monitoring a patient's response to therapeutic interven tion. Importantly, these studies may provide the only assessment of central nervous system function when the neurological examination is precluded (e.g., barbitu rate-induced coma).
Analytic Reviews : Neuropsychiatric Toxicity of Meperidine
Authors: Shochet Robert B. , Murray George B.
Published: June 2007

The use of meperidine can lead to neuropsychiatric tox icity manifested by excitatory states and seizure. Nor meperidine, an active metabolite, is the agent responsi ble for this toxicity; its long half-life of elimination allows for significant accumulation with repeated dosing of the parent compound. Normeperidine is proconvul sant, and this property alone may account for the toxic symptoms. Psychiatric symptoms often herald the onset of toxicity and may be the result of complex partial seizure. A pathophysiological mechanism of toxicity is suggested, and management of the toxic patient is dis cussed.
Analytic Reviews : Routine Intensive Care Unit Admission Is Not Indicated for Suspected Myocardial Contusion
Authors: Brunel Wiley , Stoll Jorden , May Kristine , Markison Robert E. , Schecter William P.
Published: June 2007

The clinical records of 72 patients with blunt chest trauma who were admitted to our intensive care unit (ICU) exclusively to rule out myocardial contu sion were retrospectively reviewed. Electrocardiogram (ECG) abnormalities were present on admission in 56% of patients, and all patients had negative creatine phos phokinase isoenzyme levels. Eight percent of patients required treatment for arrhythmias, all of whom were symptomatic at the time of initial presentation. Delayed cardiac complications developed in none. Patients with normal ECGs on admission had a benign hospital course. This study suggests that patients with blunt chest trauma who are admitted to the ICU solely to rule out myocardial contusion in the absence of initial ECG ab normalities or hemodynamic instability are unlikely to experience delayed cardiac complications. A policy of routine ICU admission is neither medically indicated nor cost effective. Observation in a monitored medical/ surgical ward may provide an acceptable alternative for this group of patients.
Continuing Care of Multiorgan Donor Patients
Authors: Powner David J. , Jastremski Michael , Lagler Regis G.
Published: June 2007

Preserving the optimal function of donor organs must be the primary goal of physicians caring for patients who have been certified brain dead and from whom organs will be transplanted. During the hours before organ removal, several significant medical challenges may emerge. These challenges include restoration and maintenance of intravascular volume and cardiac output to assure adequate oxygen delivery to donor tissue; re suscitation of the patient from spontaneous cardiac ar rest ; evaluation and reversal of polyuria; management of poikilothermia and the effects of hypothermia; and treat ment of hypopituitarism and other possible changes in circulating hormones. Individual organ function and the interdependency among donor organs must be carefully monitored and balanced to assure that the recipient re ceives organs that have the best opportunity for optimal primary function. Care of the multiorgan brain dead pa tient and his or her family requires a multidisciplinary team skilled not only in the medical and surgical aspects of transplantation but also in the care of families who have suffered loss.

A new focus for patient care is appropriate after the decision has been made that a patient is brain dead and will become an organ donor. Because preser vation of brain function is no longer possible, treat ment priorities should shift to maximize perfusion and function of the donor organs. Through careful management of the donor patient, the recipient will receive organs that are less likely to undergo pri mary failure. This discussion will review the physio logical support necessary to sustain brain dead pa tients and to optimize donor organ function until organ removal is completed. It is assumed that indi vidual organs will be assessed and accepted or re jected for donation using criteria established by lo cal organ procurement teams. Such criteria will not be discussed here.

The brain dead organ donor presents a variety of management challenges (Table 1) that may extend over many hours while members of transplant teams and organ recipients are assembled and tis sue testing is completed. The responsibility for care may remain with the admitting physician or critical care medicine specialists, or it may be transferred to the transplant service. Coordination, however, remains the key to a successful outcome. The avail ability and interest of a knowledgeable physician to supervise the donor patient's care continues to be crucial because a variety of problems, each capable of rendering donor organs useless, may develop in the hours between brain death and organ removal.
Zollinger-Ellison Syndrome in the Intensive Care Setting
Authors: London Jerry F. , Frucht Harold , Doppman John L. , Maton Paul N. , Gardner Jerry D. , Jensen Robert T.
Published: June 2007

Management of patients with Zollinger-Ellison syn drome differs markedly from management of patients with idiopathic gastric acid hypersecretion or routine peptic ulcer disease. Because of the possible complica tions arising from gastric acid hypersecretion or from complications caused by the gastrinoma itself, patients with these disorders frequently present to critical care physicians. It is important that critical care physicians be familiar with the acute presentation of patients with Zollinger-Ellison syndrome as well as the appropriate treatment. We review the important points pertaining to the recognition and treatment of Zollinger-Ellison syn drome in the acute care setting.
Judgmental Error in Intensive Care Practice
Authors: Goldman Gilbert M.
Published: June 2007

Clinical judgment and its sources of error are inves tigated by studying the clinician's use of mental strate gies, heuristics, and biases. I review these findings, which have been obtained by analyzing medical judg ment in nonintensive care settings, with emphasis on appropriate applications for the intensivist. Particularly important in the intensive care unit (ICU) setting are sources of judgmental error introduced by using hy pothesis-driven reasoning and by attempting to intu itively mimic probabilistic reasoning. Such mental short- cuts are intended to aid the clinician, but are potential hindrances if misused. During ICU decision making, cer tain tendencies toward error are accentuated and must be recognized and guarded against. Conversely the in tensivist's valid judgments can best be defended if the context and constraints of ICU decision making are well understood. I analyze those tendencies and contexts shown to be important to intensive care and review opportunities to improve both the practice and under standing of clinical judgment in this setting.
Severity Stratification in Life-threatening Asthma
Authors: Zimmerman Jack E. , Galler Leslie H. , Judson James A. , Streat Stephen J. , Trubuhovich Ronald V.
Published: June 2007

Severity differences may in part explain the large varia tions in asthma mortality that occur in different coun tries. This study examines the use of APACHE II for measuring asthma severity in 118 adult asthma admis sions at one intensive care unit in New Zealand during 1987-1988. Most admissions were hypercapnic (72%), and 61 % had an altered level of consciousness. Mean APACHE II score was 20 in the emergency department and 12 upon ICU admission. We summarize the extent of physiological derangement using four acute physiol ogy score (APS) ranges. Each APS range stratified admis sions into groups with differing clinical course, therapy, and outcome. These results document a high level of asthma severity among patients treated in New Zealand, the country with the world's highest asthma mortality. APACHE II provides a valid and reproducible measure of asthma severity and should be useful for describing and comparing international differences in asthma severity and as a case-mix control in studies of asthma therapy.
Routine Monitoring of Critically I11 Patients
Authors: Curley Frederick J. , Smyrnios Nicholas A.
Published: June 2007

The explosion in computer use and technology during the past several decades has dramatically changed criti cal care. All vital signs can now be monitored accu rately, noninvasively, and continuously. We examined the predominantly noninvasive methods of monitor ing temperature, arterial blood pressure, heart rate and rhythm, respiratory mechanics, and gas exchange that can be used continuously on almost every patient in the intensive care unit. We conclude that temperature should be measured either intermittently with a rectal thermometer or continuously with a rectal, bladder, or great vessel thermocouple or thermistor probe. Arterial pressure should be measured either intermittently with a sphygmomanometer and cuff or continuously with an indwelling arterial catheter, except in specific situa tions when automated indirect monitoring may be use ful. Electrocardiographic rhythm monitoring has been clearly shown to improve prognosis in patients after acute myocardial infarction and should be universal in all intensive care units. Ischemia monitoring may prove beneficial, but its role has not been clearly defined. Re spiratory inductance plethysmography is effective in measuring respiratory rate, tidal volume, and breathing pattern. Pulse oximetry is useful in detecting occult hy poxemia. It should be continuous on most patients. Transcutaneous oxygen and carbon dioxide measure ment has a limited role in monitoring gas exchange and perfusion. Capnography also has a limited role in the intensive care unit but is more helpful in the operating room.
Thrombocytopenia in the Intensive Care Unit Setting
Authors: Wittels Edward G. , Siegel Robert D. , Mazur Eric M.
Published: June 2007

Thrombocytopenia is a commonly encountered labora tory abnormality in the intensive care unit setting. Al though moderate degrees of thrombocytopenia may be dismissed as clinically trivial, severe thrombocytopenia can have catastrophic consequences. This review di vides the potential pathogenesis of thrombocytopenia into three pathophysiological categories: (1) produc tive, (2) consumptive, and (3) distributional. The im portant etiologies and appropriate therapies for throm bocytopenia in each of these categories are discussed. We have attempted to emphasize the underlying patho genic mechanisms as well as highlight the diagnostic dilemmas likely to be faced by intensive care unit physi cians. Although this review stresses those thrombocyto penic disorders most likely to be encountered in the intensive care unit, chronic etiologies of thrombocy topenia are also discussed because preexistent throm bocytopenia will further complicate the care of any acutely ill intensive care unit patient.
Management of Pain in the Critically Ill
Authors: Stevens Donald S. , Edwards W. Thomas
Published: June 2007

Analgesia for critically ill patients can be provided most effectively by the use of modern techniques. Under standing of the anatomical pathways for nociceptive sig nal transmission allows the use of techniques that mod ulate or block nociceptive information at several levels (periphery, spinal cord, and systemic). A comprehen sive discussion of analgesic techniques at each level is presented. Formulation of a treatment plan is discussed. Several examples are presented to show the decision- making process for the use of modern analgesic tech niques in critically ill patients.
Contemporary Irish Textile Artists: Exploring Experiences of Gender, Culture, and Artistic Medium
Authors: Nelson Nancy J. , LaBat Karen L. , Williams Gloria M.
Published: June 2007

The purpose of this study was to understand what textile art means in Irish culture and society through the lens of women who create it. The methodology used in this study was founded in part on the phenomenological exploration of meaning within lived experience and was informed by concerns raised within and central to contemporary feminist writing about women’s experiences in society and culture. Four interpretive techniques were used to collect data in the field: long interviews, a demographic questionnaire, close observation, and an analysis of each artist’s work. Three conceptual areas were used to structure the thematic interpretation: identity, marginality, and agency. The results of this interpretation provide insight into the ways that textiles, as an artistic medium, help to shape and redefine notions of gender and creative expression in a socio-cultural context.
Objective Evaluation for the Comfort of Free Movement of a Narrow Skirt
Authors: Lai Sang-Song
Published: June 2007

The textile industry lacks an objective approach for determining the level of comfort and amount of free movement in narrow skirts. My research focused on developing a model for predicting the level of comfort and movement of narrow skirts sewn according to the fabric mechanical property of the Fabric Assurance by Simples Testing (FAST) system. Fabric mechanical properties of G (shear stiffness), B (bending rigidity), F (formability), and E100 (extensibility at a load of 100 gf/cm) were included in the model. The artificial neural network method, based on fabric mechanical properties, was used to establish the model. The model revealed a correlation coefficient between the predicted value and the practical value as high as 0.98. The mean value of residual absolute stood at 0.3. These numbers demonstrate the excellent predictability of this model.
Department Elimination and Its Relationship to Student Identity Issues: A Feminist Perspective
Authors: Michelman Susan O.
Published: June 2007

In this paper I examined undergraduate student identity issues in relation to the elimination of the Department of Consumer Studies at the University of Massachusetts at Amherst. The purpose of writing this paper was to provide some insight into our students’ identity, particularly in relation to the broader academic community. A feminist perspective (both theory and method) was used to examine gender issues that exist within textiles and clothing and gender bias in the larger academic community that impacts our female-dominated field.
Tourists’ Souvenir Purchase Behavior and Retailers’ Awareness of Tourists’ Purchase Behavior in the Southwest
Authors: Swanson Kristen K. , Horridge Patricia E.
Published: June 2007

The purpose of this study was twofold: (a) determine retailers’ awareness of tourists’ souvenir purchase behavior and (b) provide guidelines for retailers concerning the souvenir purchase behavior of tourists in the southwestern United States. Two random samples were used, tourists (n = 398) and retailers (n = 307). Printed questionnaires included demographic questions respective to each sample and Likert-like scales (Souvenir Merchandise Assortment, Merchandise Selection Factors, Store Attributes). Data were obtained through a modified Salant and Dillman (1994) procedure and analyzed with AnswerTree® software. Retailers were somewhat aware of the souvenir purchase behavior of tourists when consideration was given to souvenir assortment, merchandise selection factors, and store attributes. Tourists wanted retailers to (a) carry souvenir assortments that included local foods and fine jewelry, (b) consider souvenir selection factors such as craftsperson’s reputation and motif or design of place visited, and (c) not emphasize store location in a high pedestrian traffic area. Implications for retailers to satisfy tourists in souvenir purchases are indicated.
Pattern Categorization of Male U.S. Civil War Reenactor Images
Authors: Strauss Mitchell D.
Published: June 2007

In the United States, hobby organizations participate in the public reenactment of historical events. The most popular is Civil War reenacting, which can be viewed as a manifestation of the unresolved nature of that war. Interpretation of reenacting has high potential for exploring American sensibilities and analysis of dress authenticity serves as a central focus for interpreting reenactor culture. To understand dress authenticity, field images of reenactor impressions photographed by the author at a national reenactment were evaluated with methods of visual anthropology and DeLong’s system of visual analysis to establish pattern categorizations. The research also identified basic perceptual cues used to sort images along a continuum of dress authenticity. The final stages of the research involved appraising photographic imagery for meaning of dress in an effort to understand the cultural underpinnings of the movement.
Bench Marking for Strategic Planning Based on Faculty Productivity
Authors: Laughlin Joan , Kean Rita C.
Published: June 2007

The purpose of this study was to obtain and analyze data about teaching and research in textiles and clothing programs and to complete the first steps in a benchmarking process. TAPPI data from Doctoral/Research I and II institutions were analyzed using frontier analysis. The input variable in assessing productivity was textiles and clothing faculty full-time equivalents (FTE); the output variables were teaching (weighted enrolled students) and research (scientific, refereed journal articles published). Units can use productivity data in two ways: should the unit’s efforts address maximizing the outputs given a certain level of inputs; or should the unit’s efforts be directed to minimizing inputs given a certain level of outputs?
Global Products, Global Markets: Jeans in Korea and the United States
Authors: DeLong Marilyn , LaBat Karen , Nelson Nancy , Koh Aeran , Kim Yangjin
Published: June 2007

This cross-cultural study illustrates how products selected for their basic similarities are distinguished in use by cultural context. Jeans, a product manufactured in both South Korea and the United States, were selected as the research stimuli. Subjects were regular wearers of jeans, 32 of whom were from the United States and 34 from Korea. All were females between the ages of 18 and 24, and students at one of two large metropolitan universities in their respective countries. Participants responded to four brands of jeans similar in appearance: two were U.S. brands (Levi’s and Gap) and two were Korean brands (GV2 and Bang Bang). Subjects’ perceptions of the products were explored for similarities and differences in criteria for wear and purchase of jeans. Country of manufacture mattered less than country of origin, appearance and other factors related to use in a cultural context. For both groups, color, fit, tactile qualities and price also were important criteria in wearing and purchasing jeans. Though respondents used similar criteria in this cross-cultural comparison, differences in weighting of those criteria yielded significantly different results.
Asian-American Consumers in Hawai’i: The Effects of Ethnic Identification On Attitudes Toward and Ownership of Ethnic Apparel, Importance of Product and Store-Display Attributes, and Purchase Intention
Authors: Kim Soyoung , Arthur Linda B.
Published: June 2007

This research investigates how strength of ethnic identification influences attitudes toward and ownership of ethnic apparel, importance of product and store-display attributes, and purchase intention among Asian American consumers in Hawai’i. The sample included 167 Asian Americans who visited apparel stores in Honolulu that had Asian-inspired clothing predominantly displayed. The study results showed that those participants who identified themselves strongly with their ethnic group put more emphasis on ethnic features of clothing and window displays than those with a weak ethnic identification. Overall, attitudinal measure of ethnic identification appeared to be a more important variable than the use of ethnic language in understanding importance of product and store-display attributes.
The Use of Writing in the Apparel Curriculum: A Preliminary Investigation
Authors: Johnson Kim K. P. , Yurchisin Jennifer , Bean Denise L.
Published: June 2007

Writing activities can be used throughout the apparel curriculum to promote successful learning and to develop and improve students’ written and verbal communication skills. As a result of a mandate from our university to incorporate writing-intensive courses within our apparel curriculum, this descriptive study was designed to investigate the amount and types of writing currently required within undergraduate apparel curricula within the United States. We used a questionnaire to survey instructors representing 34 institutions that offered undergraduate apparel programs. The data for 136 courses are presented. Writing was a component of both required assignments and examinations. An in-class essay was the primary type of writing used on exams. The majority of courses had at least one written assignment. Written assignments were primarily research projects or papers, out-of-class essays, and reading reports. Overall, respondents indicated that the amount of writing required in apparel courses was about right but very few respondents indicated these courses had been approved as “writing intensive.” More respondents agreed that requiring additional writing would help students develop necessary workplace skills than agreed that requiring additional writing would help students master key course concepts.
Design Elements and Consumer Characteristics Relating to Design Preferences of Working Females
Authors: Yoo Seulhee
Published: June 2007

My study was designed to investigate the effect of design elements and consumers’ personal, psycho-social, job-related, and physical characteristics on business jacket design preferences of working females. A self-administered questionnaire including visual stimuli was mailed to 1,500 randomly drawn working females across the U.S. The sample consisted of 265 respondents who wore business jackets to work at least once a week. Repeated measures ANOVA, Least Squares Means, and the Solution option of SAS/STAT® were utilized. Clothing design elements and their interrelationships affected consumers’ evaluations of design attractiveness. In addition, personal characteristics (i.e., age and ethnicity), psycho-social motivation (i.e., ability to modify self-presentation and self-monitoring), and physical profile (i.e., figure type) affected consumer design preference. The findings can be strategically implemented into apparel design and purchase scheme by apparel manufacturers and retailers.