ABSTRACT
Twenty young children between the ages of 4 and 103 months involved in drownings had brain evoked potential (EP) studies done shortly after the incident (median 2 days) to determine if auditory click and visual flash EP patterns were predictive of outcome. Results were examined in relation to good survival or non/poor (vegatative) level of survival. Results were also compared to selected clinical and laboratory data previously reported as predicting outcome. These preliminary findings indicate that if patients have evoked potential abnormality (EPA) scores greater than 2.7 there is little chance of survival. With EPA scores below 2.7 it was found that there is a good chance of survival. Cortical responses to auditory and visual stimulation were observed to be good predictors of outcome despite their inherent variability in young children and the presence of barbiturate coma. Brainstem responses to auditory stimulation alone were poor predictors. Previously reported clinical and laboratory predictors of outcome did not hold up except for muscle flaccidity which, when present, was associated with non/poor survival.
Subject(s)
Brain Damage, Chronic/diagnosis , Drowning/diagnosis , Electroencephalography , Child, Preschool , Evoked Potentials, Auditory , Evoked Potentials, Visual , Female , Humans , Hypoxia, Brain/diagnosis , Infant , Male , PrognosisABSTRACT
Between 1972 and 1981 40 victims of near-drowning were admitted to the Santa Clara Valley Medical Center. Hospital records were reviewed with regard to: 1) the circumstances of submersion and rescue; 2) the patient's condition upon arrival at the emergency room; 3) treatment, hospital course, and ultimate outcome. There were ten hospital deaths, 23 patients recovered completely, and seven were discharged with incapacitating neurologic disability. Three of the neurologically impaired patients died between 1 and 13 months after discharge. All patients who arrived with a beating heart were eventually discharged neurologically intact. Of the 21 patients who required in-hospital cardiopulmonary resuscitation, ten died, seven remained comatose, and four recovered without serious neurologic deficits. The use of hypothermia, steroids, and barbiturate coma was not randomized, but did not appear to influence ultimate outcome. Intracranial pressure was monitored in five patients and was never elevated during the first 24 hours. The complete recovery of nearly 20% of apparently lifeless individuals justifies aggressive resuscitation and support of all victims of near-drowning.
Subject(s)
Near Drowning/therapy , Resuscitation/methods , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Barbiturates/therapeutic use , Child , Child, Preschool , Coma/etiology , Emergency Service, Hospital , Female , Humans , Hypothermia, Induced , Infant , Male , Middle Aged , Near Drowning/complications , Neurologic Examination , Pneumonia/drug therapy , Pneumonia/etiology , PrognosisABSTRACT
Several compounds having portions of the camptothecin ring system were prepared. These compounds were screened against L1210 lymphoid leukemia with negative results. Two of the analogs which contained the pyridine and hydroxylactone D and E rings were also screened for inhibition of DNA and RNA syntheses in HeLa cells. Each of these analogs had decreased activity as compared with comptothecin and there was no degradation of DNA in the HeLa cells. This suggest that the D and E rings are not a sufficient requirement for camptothecin-like activity.
