A preliminary analysis of medical futility decisionmaking: law and professional attitudes.

Judicial decisions reviewed in this article indicate that courts have taken two disparate approaches to disputes over futility of treatment. To explore whether a consensus on medical futility is developing among hospitals, the authors conducted a nationwide survey of health care professionals at hospitals. Respondents assigned importance ratings to factors used in recent futility decisions made at their institutions. The resulting importance ratings showed significant variation by characteristics of the institution (comparing respondents from for-profit, not-for-profit, and government hospitals) and by profession of the respondent (comparing physicians and nurses). The respondents' judgments endorsed three distinct strategies for making futility decisions (i.e., emphasis on the patient's decision preferences, providing for the patient and family, and adhering to objective medical and social norms).

Sleep apnea in patients receiving growth hormone.

Among 145 patients treated with recombinant human growth hormone (GH), four developed sleep apnea (two obstructive, two mixed) associated with tonsillar and adenoidal hypertrophy in three. These four patients had no local risk factors predisposing to upper airway obstruction (i.e., frequent pharyngitis or sinusitis). Clinical and/or polysomnographic features of sleep apnea improved following cessation of GH therapy in one patient, and following tonsillectomy and adenoidectomy in all patients. The present observations indicate that, albeit rarely, obstructive and/or central sleep apnea may occur in children treated with GH. Polysomnography should be considered if symptoms of snoring, interrupted sleep, daytime somnolence-particularly if associated with tonsillar hypertrophy-appear in children during GH therapy.

Sleep abnormalities in patients with severe cerebral palsy.

The all-night polysomnographic findings of nine patients with spastic quadriparesis (mean age 36.7 months) were analysed retrospectively and compared with those of nine age-matched controls (mean age 37.4 months). The cerebral palsy group had significantly more respiratory disturbances per hour of sleep, with five of nine being diagnosed as having obstructive sleep apnea. They also had fewer changes in body position during the night. Interictal epileptiform discharges averaged 23.3 per cent of the total arousals in the cerebral palsy group. Obstructive apnea, decreased ability to change body position, and interictal epileptiform discharges are prevalent in the sleep of patients with severe cerebral palsy, and contribute towards its disruption.

Conservative management of spinal epidural hematoma in hemophilia.

Two patients with hemophilia and spinal epidural hematoma, who were treated successfully with serial Factor VIII infusions, are reported. This form of conservative therapy may circumvent the need for decompressive laminectomy and its attendant complications in instances in which the neurologic deficit is mild or stable. Somatosensory evoked potential studies were useful in documenting spinal cord dysfunction in 1 of the 2 patients.