Floyd H. Taylor

Frequency and severity of infections in day care

This study was undertaken to compare prospectively the frequency, nature, and severity of infections experienced by children in three types of child care arrangements: home care, group care (two to six children), and day care (seven or more children). Children were enrolled at birth and observed for 12 to 18 months. At entry there were 159 children in home care, 40 in group care, and 45 in day care. The families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Severe illnesses were defined by high fever, duration exceeding 10 days, or physician visit. Children remaining in their original child care group for at least 1 year were compared with regard to the frequency and severity of illness. Children in group care and day care were more likely than children in home care to experience at least six respiratory infections, more than 60 days of illness, and more than four severe illnesses (P less than 0.01). Similarly, life table analyses showed that children in home care had fewer episodes of infection than did children in day care (P less than 0.01). Although no children were hospitalized because of acute infections during the first year of study, hospitalization for myringotomy and tube placement occurred in 21% of children in day care and 3% of children in home care (P less than 0.01).

Prognostic factors in mobile tongue and floor of mouth carcinoma

This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the antierior tongue and floor of mouth.

Consequences of unremitting middle-ear disease in early life. Otologic, audiologic, and developmental findings in children with cleft palate.

To learn whether chronic otitis media with effusion during early life has lasting otologic, audiologic, or developmental consequences, we evaluated 24 closely matched pairs of children with repaired palatal clefts whose treatment had been equivalent except with regard to persistent otitis media during early life. One group had undergone early (mean age, 3.0 months) myringotomy with placement of tympanostomy tubes, followed by assiduous monitoring and an aggressive treatment program to maintain ventilation in the middle ear. The other group had undergone initial myringotomy later (mean age, 30.8 months) or not at all (two subjects) and presumably had had continuous middle-ear effusion throughout most or all of the first few years of life. Eardrum scarring was equal in both groups. Hearing acuity and consonant articulation were impaired in both groups, but hearing acuity was less impaired (P = 0.05 to 0.10) and consonant articulation significantly less impaired (P = 0.03) in the group undergoing early myringotomy. Mean verbal, performance, and full-scale IQs and scores on psychosocial indexes were normal in both groups and did not differ significantly between the groups. These findings support the hypothesis that early, longstanding otitis media may result in impairment of hearing and of speech, but they do not support the hypothesis that cognitive, language, and psychosocial development are adversely affected.

Radiotherapy of nonfunctional adenomas of the pituitary gland. Results with long-term follow-up

A total of 112 patients with the diagnosis of nonfunctional pituitary adenoma received radiation therapy at the University of Pittsburgh between 1964 and 1987. Postoperative radiation therapy was administered in 87 patients. Actuarial progression‐free survival (tumor control) at 5, 10, 15, and 20 years was 97%, 89%, 87%, and 76%, respectively. Radiation prescribed to the 95% isodose ranged from 35.72 Gy to 62.32 Gy. Multivariate analysis showed decreased tumor control to be significantly associated with increasing field size (P =.036). No improvement in tumor control could be detected with increasing total radiation dose or nominal standard dose (NSD). One patient developed optic neuropathy and another developed a glioblastoma after doses in both patients of 4750 cGy in 25 fractions. External beam radiotherapy for nonfunctional pituitary adenomas was found to be effective and safe when doses less than 4750 cGy in 25 fractions were used.

Incidence of cerebral infarction after radiotherapy for pituitary adenoma

The incidence of cerebral infarction was studied in 156 patients irradiated for treatment of pituitary adenomas. Seven patients experienced strokes at intervals of 3.2 to 14.6 years after irradiation. The observed incidence was not significantly greater than the expected value of 3.5 strokes (P = 0.078). Six strokes occurred in patients receiving equivalent doses (ED) of 1070 ret or more (observed to expected ratio 3.87, significantly elevated; P < 0.001). Univariate log‐rank analysis showed that the risk of stroke was significantly higher (P = 0.010) in patients receiving an ED of 1070 ret or more (4180 cGy/22 fractions) than those receiving lower doses. Multivariate analysis, however, demonstrated that the increased risk of stroke was associated only with increasing age (P < 0.0001), not ED (P = 0.148). Due to these inconsistent statistical results, no definitive conclusions could be reached about the relationship between radiation dose to the pituitary and subsequent cerebral infarction.

Idiopathic (bell's) facial palsy: Natural history defies steroid or surgical treatment.

Idiopathic (Bells) facial palsy is a self‐limiting, non‐life threatening, and spontaneously remitting disorder. The natural history of Bells palsy is favorable: 84% of 1011 patients with Bells palsy studied by one investigator recovered satisfactorily without treatment, and no valid clinical trials conducted to date have provided definitive evidence that treatment with steroids or surgery improves upon this figure. The authors studied 273 patients with Bells palsy to evaluate the prognostic significance of evoked eleetromyography in predicting the possible benefit of transmastoid facial nerve surgical decompression. The results indicated that even when evoked electromyography was used to select those patients who might benefit most from transmastoid surgery, outcome in patients treated surgically was no better than can be expected to occur without treatment. Based upon these observations, transmastoid facial nerve surgery is not recommended to treat Bells palsy because no benefits have been identified which outweigh the risks of surgery.

Prophylactic Methicillin for Shunt Operations: Effects on Incidence of Shunt Malfunction and Infection

In a double-blind study, 74 children were randomly treated with prophylactic methicillin at the time of ventriculo-peritoneal shunting. There were 7 infections in the placebo group and 2 in the methicillin-treated group. There was no statistically significant difference in infection or overall malfunction rate between the two groups. The risk of shunt malfunction in the 2nd to 6th month after surgery was significantly greater in the placebo group (7 of 26 patients) than in the methicillin-treated group (1 of 26 patients). Delayed shunt malfunction may be prevented by a short course of perioperative antibiotics.

History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented.

As part of a prospective study of indications for tonsillectomy and adenoidectomy, we followed closely 65 children with histories of recurrent throat infection that seemed impressive (at least seven episodes in one year, five in each of two consecutive years or three in each of three consecutive years), but lacked documentation. During the first year of observation, only 11 children (17 per cent) had episodes of throat infection with clinical features and patterns of frequency conforming to those described in their presenting histories. Of the remaining 54 children, 43 (80 per cent) experienced no, one or two observed episodes each, and most of the episodes were mild. We conclude that undocumented histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy.

Vitamin C and Acute Illness in Navajo Schoolchildren

To evaluate earlier observations, including our own, showing usefulness of vitamin C for managing the common cold, we performed a double-blind trial of vitamin C versus placebo in 868 children. There was no difference in number becoming ill (133 versus 129), number of episodes (166 versus 159) or mean illness duration (5.5 versus 5.8 days) between the groups. Children receiving vitamin C had fewer throat cultures yielding beta-hemolytic streptococcus (six versus 13, P less than 0.10), but no difference in overall complicated illness rate (24 versus 25). Plasma ascorbic acid levels were higher in the vitamin group 24 to 26 hours after supplementation (1.28 versus 1.04 mg per 100 ml, P less than 0.01). Children with high plasma ascorbic acid concentrations had longer mean illness (6.8 versus 4.0 days, P less than 0.05) than those with low levels. Vitamin C does not seem to be an effective prophylactic or therapeutic agent for upper respiratory illness.

Pharmacokinetics of succinylcholine in infants, children, and adults

The elimination of succinylcholine appears to follow first‐order kinetics with a linear relationship between intensity of effect and logarithm of the dose. Determination of the time‐course of neuromuscular blockade following succinylcholine in infants and children allowed us to compare the rate of recovery and elimination rate constant with those determined by others in adults. The rate of recovery was independent of dose for each age group. The rate of recovery was faster in children than in il?fants; the rate of recovery of infants wasfaster than that of adults. The elimination rate constant for infants was similar to that of children; for both the infants and children the rate constants appeared dissimilar from those of adults.