Publications

Abstract

Inasmuch as growth hormone is known to interact with the immune system, we studied immune functions including immunoglobulins, cell surface markers, mitogen responses, and polymorphonuclear cell function in eight children with growth hormone deficiency, ages 1 to 17 years, before and during treatment with human growth hormone for 12 to 16 months. Before treatment, immune functions were normal in all children. Treatment with human growth hormone did not significantly affect serum immunoglobulins, polymorphonuclear cell function, or percent T cells. However, percent B cells decreased to subnormal levels in seven of seven patients. T helper/suppressor ratios, decreased in all patients, to subnormal values in seven of eight patients; and mitogen responses decreased to below normal in all. The decline of percent B cells was transient in all patients, of T helper/suppressor ratios in seven of eight, and mitogen responses in five of eight patients. In vitro incubation of lymphocytes with growth hormone resulted in no changes in cell surface markers or mitogen responses. Although the depression of immune functions resulted in no increased rate of infections during the observation period, we do not know the possible effects of prolonged treatment and therefore caution, against the indiscriminate use of human growth hormone. The effects of biosynthetically obtained growth hormone on immune function remain to be determined.

Abstract

Although fairly large individual discrepancies were noted between the systolic and diastolic readings obtained through intra-arterial and auscultatory methods, the mean differences in these readings were not found to be significant. In agreement with AHA standards, the disappearance of sound was found to be a better indicator of intra-arterial diastolic pressure than was muffling. The only hemodynamic variable that had a significant relationship (p < 0.001) with the discrepancy in diastolic readings was heart rate. The level of systolic and diastolic pressure readings, pulse pressure, and PVR varied minimally in this sample. Extremely high and low values were present when these parameters were correlated with discrepancies in other studies. While CO/CI and SV were depressed in most of the sample, in this limited number of subjects, these parameters alone, were not found to be associated with a discrepancy. The findings of this study suggest the following implications for clinical practice and further research: 1. Cuff size needs to be individualized for each patient. 2. Palpatory readings should be obtained before auscultation. 3. A way to determine the frequency response and damping coefficient should be available and used when comparing intra-arterial and auscultatory readings. 4. Simultaneous auscultatory and intra-arterial pressures should be taken in the same arm when assessing any discrepancy. In addition, auscultatory and palpatory, brachial and forearm pressures should be compared with an intra-arterial reading. Measurements of brachial and radial blood flow in the forearm would be useful in seeking to explain a discrepancy between measurement methods.

Abstract

Many women who have had cardiac valve replacements have reached or will soon be reaching childbearing age. Pregnancy exposes these women to potential problems resulting from the previous valvuloplasty. The three most common problems in this population–thromboembolism, infective endocarditis, and myocardial decompensation are discussed through a review of current literature. Preventive measures and treatment modalities are presented in order to assist nurses caring for these clients during their pregnancy.