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Biomedical subjects

A Jacob

Publications and source records attributed to A Jacob.

At least 19 recordsLinked to original sources

Medical clinic referral letters. Do they say what they mean? Do they mean what they say?

Consecutive general practitioner referrals to three general medical clinics were examined prospectively to assess whether the reason for referral was being correctly interpreted by consultants. The resultant data revealed that although this was not always the case, such misunderstandings did not appear to affect subsequent management. Explicit reasons for referral in the referral letter however could improve both the quality and value of out-patient consultations.

Communication

[Estimated biological markers of progression in human immunodeficiency virus infection].

The biological markers for determining as early as possible the progression in the infection by the human immunodeficiency virus (HIV) are very important for the health care of patients, and to adapt their anti-retroviral treatment. Among those, four independent biological markers for predicting a pejorative evolution in the following 36 months are used in medical practice: two specific for HIV, p24 antigenemia and serum titre of antibodies to the p24 core antigen, and two non-HIV specific surrogate markers, the beta 2-microglobulinemia and the absolute number of CD4 T cell in blood. P24 antigenemia corresponds to an active retroviral in vivo replication. The cut off for detection is about 10 pg/ml. It is difficult to detect in black people, and in the asymptomatic or pauci-symptomatic stages of the disease. The apparition or the increase of the serum p24 antigen levels suggest the occurrence of opportunistic infections. P24 antigenemia decreases or disappears during the treatment by zidovudine. The diminution or the disappearance of serum antibodies directed to the p24 core protein are secondary to the deficiency of the humoral immunity, and to an increase of the viral replication, which occur at the late stage of the disease. The diminution or the disappearance of serum antibodies to p24 precede the occurrence of AIDS by several months. The increase of the serum beta 2-microglobulin level is associated with the severity of the disease. In the San Francisco prospective cohort, the progression to AIDS in 36 months was 69% when beta 2-microglobulinemia was more than 5 mg/l, 33% when it was between 3.1 to 5 mg/l, and 12% when it was less than 3 mg/l. The beta 2-microglobulin intra-thecal synthesis level could serve as a marker for the specific HIV encephalitis. The CD4 lymphocyte count constitutes an independent provisional marker for progression to AIDS, probably the most important, but mainly of statistical value. A lymphocyte count of 200 CD4/mm3 is considered as the threshold of full blown AIDS. Beside these classic biological markers, numerous other parameters have been evaluated, without knowing their practical interest. Although the predictive markers for AIDS have a real statistical significance, their interpretation could be difficult or hazardous when applied to a sole individual. In a relatively short delay, the actual biological markers will probably be completed or changed, in the routine medical practice, by the use of direct virological markers evaluating the viral load (plasmatic or cellular viremia).

Antiviral Agents

A chemiluminescent immunoassay for urinary thromboxane B2.

Because of the vasoactive properties of thromboxane A2 and other related prostaglandins, much research has been conducted on drugs which alter their levels. Urinary levels of thromboxane B2 and 2,3-dinor thromboxane B2 (major urinary metabolite of thromboxane B2) are used as an indication of thromboxane production in-vivo. In order to accurately measure urinary TXB2 levels of subjects on investigative drugs which lower TXA2 and subsequently TXB2, a simple and sensitive analytical tool becomes necessary. We have thus developed a non-radioisotopic (chemiluminescent) assay for urinary TXB2. Sensitivity has been demonstrated to 5 pg/ml. The method correlates well with gas chromatography/mass spectrometry (the accepted reference method) even without column chromatographic purification prior to the conduct of the chemiluminescent assay (r = 0.96). In addition, we have demonstrated feasibility for a chemiluminescent assay to measure urinary 2,3-dinor TXB2.

Acridines

Facial muscle reanimation using the trigeminal motor nerve: an experimental study in the rabbit.

Surgical repair of facial nerve deficits may be marred by lack of muscle control and donor region paresis. Using New Zealand white rabbits, a study was undertaken to evaluate facial muscle reanimation with a donor source not previously used: the motor division of the trigeminal nerve. The results were compared with the severed facial nerve and hypoglossal-facial coaptation. An atrophy scale was calibrated for facial muscles of the rabbit. Clinical, electromyographic, and histomorphometric findings confirmed that the trigeminal nerve was a suitable donor source. The neurorrhaphy produced an exponential rate of repair.

Anastomosis, Surgical

In vivo 14C isotopic evaluation of amino acid oxidative catabolism in the growing chick. I. Fast respiratory 14CO2 and acetyl-CoA renewal.

A single dose of [1-14C] or [U-14C]glycine or L-[1-14C] or [U-14C]valine was injected intraperitoneally into 1- and 3-week-old chicks. Continuous automatic determination of respiratory 14CO2 and determination of 14C in excreta and uric acid were carried out for 8 h. Computer-aided analysis of the kinetics of respiratory 14CO2 demonstrated two exponentially decreasing components, 'fast 14CO2' and slow 14CO2'. Fast 14CO2 production represents the immediate oxidation and/or decarboxylation of the 14C-labeled amino acid. The half-lives differed according to the nature of the 14C-labeled amino acid but not to the age of the chick. The size of the acetyl-CoA pool labeled by [14C]glycine was between 10 and 15 mmol/100 g of chick. Metabolic partition of a circulating plasma free amino acid between oxidation and retention could be quantified by an isotopic index.

Acetyl Coenzyme A

In vivo 14C isotopic evaluation of amino acid oxidative catabolism in the growing chick. II. Slow respiratory 14CO2 and protein renewal.

Analysis of the respiratory 14CO2 of growing chicks injected intraperitoneally with [1-14C] or [U-14C]glycine or valine has shown the presence of a delayed 'slow 14CO2' exponential component. The half-lives, about 3 h, are independent of the nature of the amino acid and of the age (1-3 weeks) of the animal. As supported by investigations in cycloheximide-treated chicks of the oxidative catabolism of glycine, valine and acetate, slow 14CO2 is significantly associated with the degradation of short-lived proteins.

Acetates

Diagnosis of occupational dermatitis by general practitioners and employment medical advisors: a pilot study.

This pilot study examined how closely general practitioners and employment medical advisors agreed when jointly investigating occupational dermatitis. The criterion for admitting a patient to the study was dermatitis on one or both hands. This presented most commonly among men aged 41-60 years and women aged 21-40 years. There was some reluctance among general practitioners to take part in the study, probably owing to the medico-legal problems associated with this condition. General practitioners and employment medical advisors were equally likely to attribute a case of dermatitis to occupational factors if the patient was employed in industry; but if the patient was in nonindustrial employment, general practitioners were more likely to consider the possibility of an occupational origin than employment medical advisors. These differences suggest that before initiating a wider study more information is required concerning the trigger mechanisms for dermatitis on the hands in order to reduce the diagnostic variability.

Adult

Effect of the Indian gooseberry (amla) on serum cholesterol levels in men aged 35-55 years.

The effect on total serum cholesterol and its lipoprotein fractions of supplementation of the diet with amla (Emblica officinalis, Gaertn., the Indian gooseberry) was studied in normal and hypercholesterolaemic men aged 35-55 years. The supplement was given for a period of 28 d in the raw form. Both normal and hypercholesterolaemic subjects showed a decrease in cholesterol levels. Two weeks after withdrawing the supplement, the total serum cholesterol levels of the hypercholesterolaemic subjects rose significantly almost to initial levels.

Adult

[The PACS model plan at the Freiburg University Clinic. A first step toward a radiologic picture archiving and communication system].

In a study performed at several clinical departments of the University of Freiburg, West Germany, it was found that approximately 180,000 patient examinations based on computed tomography, magnetic resonance, nuclear medicine, ultrasound as well as digital and conventional radiography, produce over 1,000,000 pictures. It was assumed that modern technologies can greatly facilitate the handling of such a quantity of images. This applies to diagnosis and therapy planning as well as to communication and archiving of this large amount of data. The study also assumes that the technologies to be considered, e.g. fiber optical networks, optical archives and medical work stations, which represent the main components of PACS, should be introduced in a stepwise manner following a clear overall conception. As the first step the implementation of a local area network (LAN) in the departments of radiology and general surgery is planned. Important criteria for the selection of these particular departments are improvements in health care for a maximum number of patients and in the working profiles for the greatest possible number of physicians and assistant personnel. A cost reduction as compared to the present system through more efficient communication and archiving of the digital images is expected. New perspectives for medical research as well as for medico-technical developments are also expected. Examples are the 3-D representations of human anatomy and the manufacturing of custom-designed prothetic devices. Scheduling and budgetary plans for equipment and manpower are further study results for the Freiburg PACS-Project.

Germany, West

Chronic granulomatous disease in an adult.

We have described a 49-year-old man with chronic granulomatous disease. The diagnosis was established by a deficiency of NBT dye reduction by neutrophils, in addition to impairment in 14C-1-glucose utilization, 125I-iodination of zymosan, chemiluminescence, superoxide radical generation, and bactericidal activity toward S aureus. This adult patient exhibits many characteristics of chronic granulomatous disease of childhood but of less severity, which may explain his unusually long survival. It is thus important to consider the diagnosis of chronic granulomatous disease not only in children but also in adult patients having the characteristic pattern of recurrent infections.

Blood Bactericidal Activity