Late angiographic stent thrombosis of polymer based paclitaxel eluting stent.
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Adult↗
Biomedical subjects
A Low
Publications and source records attributed to A Low.
Acoustic analysis of the voice in pediatric cochlear implant recipients: a longitudinal study.
OBJECTIVE: To characterize inherent acoustic abnormalities of the deaf pediatric voice and the effect of artificially restoring auditory feedback with cochlear implantation. DESIGN: Inception cohort. SETTING: Academic referral center. PATIENTS: Twenty-one children with severe to profound hearing loss (15 prelingually deaf, 6 postlingually deaf) accepted into the cochlear implant program were followed for up to 6 months. Patients unable to perform the vocal exercises were excluded. INTERVENTIONS: Objective voice analysis was performed using the Computerized Speech Laboratory (Kay Elemetrics) prior to cochlear implantation, at the time of implant activation and at 2 and 6 months postactivation. Assessments were based on sustained phonations and dynamic ranges. MAIN OUTCOME MEASURE: Fundamental frequency, long-term control of fundamental frequency (vF0) and long-term control of amplitude (vAM) were derived from sustained phonations. The dynamic frequency range was derived from scale exercises. Formant frequencies (F1, F2, F3) were determined using linear predictive coding. RESULTS: Fundamental frequency was not altered by implant activation or experience (P = 0.342). With profoundly deaf subject, the most prevalent acoustic abnormality was a poor long-term control of frequency (vF0, 2.81%) and long-term control of amplitude (vAm, 23.58%). Implant activation and experience had no effect on the long-term control of frequency (P = 0.106) but normalized the long-term control of amplitude (P = 0.007). The mean frequency range increased from 311.9 Hz preimplantation to 483.5 Hz postimplantation (P = 0.08). The F1/F2 ratio remained stable (P = 0.476). CONCLUSION: In children, severe to profound deafness results in poor long-term control of frequency and amplitude. Cochlear implantation restores control of amplitude only and implies the need for additional rehabilitative strategies for restoration of control of frequency.
Acoustics↗
Atomic force microscopy investigation of isolated virions of murine leukemia virus.
Virions of mouse leukemia virus spread on glass substrates were visualized by atomic force microscopy. The size distribution mode was 145 nm, significantly larger than that for human immunodeficiency virus particles. The distribution of particle sizes is broad, indicating that no two particles are likely identical in content or surface features. Virions possess knoblike protrusions, which may represent vestiges of budding from cell membranes. Particles which split open allowed imaging of intact cores with diameters of 65 nm. They also permitted estimation of viral shell thickness (35 to 40 nm) and showed the presence of a distinct trough between the shell and the core surface.
Animals↗
Atomic force microscopy investigation of wild-type Moloney murine leukemia virus particles and virus particles lacking the envelope protein.
Moloney murine leukemia virus (M-MuLV) lacking the gene for the envelope glycoprotein (env(-)) was produced in NIH 3T3 cells and investigated using atomic force microscopy (AFM). The particles were compared with similarly produced wild-type virions, some of which had been exposed to a monoclonal antibody against the surface component of the envelope protein (SU protein). The env(-) particles generally exhibit a distinctly different external appearance suggesting only a low density of associated proteins that have an almost fluid, mechanically unstable character. The weakly associated proteins may be host cell membrane proteins that are incorporated into the viral membrane in place of or in addition to virus envelope protein. The amount of this non-viral protein on virion surfaces appears to vary from negligible in most cases to a substantial complement in others. It seems clear that the presence of the envelope protein, in a mechanical sense, significantly strengthens and stabilizes the virion envelope. Binding of monoclonal antibody to wild-type virions indicates that some particles expose a significant amount of antigen while adjacent virions may not. This suggests that the conformation of the envelope glycoprotein or the disposition of oligosaccharides may be different among particles, on some virions exposing the specific epitope, and others little or none.
Animals↗
Impact of reversibility of no-reflow phenomenon on 30-day mortality following percutaneous revascularisation for acute myocardial infarction--insights from a 1328-patient registry.
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Adult↗
What is true community-acquired urinary tract infection? Comparison of pathogens identified in urine from routine outpatient specimens and from community clinics in a prospective study.
In order to identify the true nature of community-acquired urinary tract infections, the uropathogens isolated from 100 patients with urinary tract infection included in a prospective study conducted in community clinics were compared to 244 isolates from outpatient urine specimens routinely submitted to the laboratory. Significant differences in both the spectrum of bacteria and their antibiograms were found between the two groups. Laboratory data analysis of uropathogens from outpatient urine specimens may not reflect the true bacteriology of urinary tract infections acquired in the community. Hence, surveys based on laboratory data alone may overestimate resistance rates, leading to misinformed choices being made when treatment is empirical.
Anti-Bacterial Agents↗
Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications.
OBJECTIVE: To evaluate the safety and efficacy of intra-ureteric capsaicin for loin pain haematuria syndrome (LPHS). PATIENTS AND METHODS: In an open prospective pilot study, four middle-aged patients (three women and one man) with LPHS resistant to therapies such as splanchnic nerve block, psychological treatment or renal autotransplantation (one) were assessed. An intra-ureteric infusion of capsaicin (30 mg/100 mL of 30% alcohol in saline) for 30 min with bladder irrigation was administered under general anaesthesia, with a subsequent intravenous patient-controlled narcotic analgesic pump for pain control. Double-concentration capsaicin was used for second infusions, if necessary when the response to the earlier infusion was inadequate or incomplete. RESULTS: The first patient had experienced reduced pain levels for the first 3 months only, with no benefit from the subsequent treatments with higher doses of capsaicin (60 mg). The second patient with recurrent pain in an autotransplanted kidney had no benefit from either a 30 or 60 mg capsaicin infusion a month apart, but developed a fibrotic stricture at the transplant pelvi-ureteric junction, requiring pyelocystoplasty. The third patient with concurrent depression had no benefit from a 30-mg infusion of capsaicin. The fourth patient experienced no pain relief from a 30 mg infusion of capsaicin but developed proteinuria secondary to mesangial proliferative glomerulonephritis, ureteric inflammation needing stenting within 7 days of treatment and subsequently nephrectomy for a nonfunctioning kidney at 3 months. CONCLUSION: Intra-ureteric capsaicin was neither effective nor safe in LPHS; the contribution of the alcohol diluent cannot be excluded.
Adult↗
Fatal pulmonary haemorrhage with the combined use of abciximab and fibrinolytic agent.
The increased bleeding risk associated with the use of abciximab has been well reported. The risk appears to be amplified when abciximab is administered concurrently with a fibrinolytic agent. We report and review the literature on the occurrence of a case of fatal pulmonary haemorrhage, a rare bleeding complication, in a patient who received both these drugs.
Abciximab↗
Influence of different biodegradable carriers on the in vivo behavior of human adipose precursor cells.
The correction of soft-tissue defects presents a challenge in plastic and reconstructive surgery. The implantation of isolated and culture-expanded adipose precursor cells is a solution to this problem because these cells differentiate into adipocytes when implanted in vivo. Appropriate scaffolds are needed in soft-tissue engineering to allow the differentiation of precursor cells. The optimal carrier needs to be defined. In this study, human preadipocytes were isolated and cultured. Three different carrier materials were seeded with 106 preadipocytes each and implanted in 42 nude mice. Sponges and nonwoven carriers based on hyaluronic acid modified by esterification (HYAFF 11) were compared with collagen sponges. Scaffolds without cells served as negative controls in the same animal. After 3 and 8 weeks, the grafts were explanted. Macroscopic appearance, weight, thickness, microscopy, immunohistochemistry, and TEM (scaffold structure, cellularity, penetration depth of the seeded cells, vascularization) were assessed and evaluated for differences in scaffold-cell interactions.Preadipocytes differentiated earlier in vitro when attached to HYAFF 11 scaffolds than to other carrier materials. Macroscopically, all preadipocyte constructs were yellowish and well vascularized, and the controls were white and avascular. Vessel formation was more pronounced around mature adipocytes. Microscopically, HYAFF 11 constructs showed a higher cell density than collagen constructs. The pores of the sponges contained more differentiated adipocytes than the nonwoven carriers, whereas the undifferentiated preadipocytes were more numerous in the nonwoven material. Penetration of adipose precursor cells was deeper and more homogeneous in HYAFF 11 scaffolds. Electron microscopy demonstrated well-differentiated adipocytes and large amounts of extracellular matrix in HYAFF 11 sponges.HYAFF 11 sponges supported the expansion and differentiation of the adipose precursor cells. This carrier is superior to the nonwoven carrier with regard to adipocyte differentiation and superior to the collagen sponge with regard to cellularity. This is a promising method for the reconstruction of soft-tissue defects. Modifications of the scaffold (larger pore size and coating with adipogenic factors) will be examined in further experiments.
Adipocytes↗
Endoscopic vs conventional hernia repair from an immunologic point of view.
BACKGROUND: In this study we tried to estimate the local surgical trauma in patients undergoing endoscopic or conventional hernia repair via the changes in peripheral blood T cell subpopulations (i. e., T-helper 1 (TH1) and TH2 cells), recently shown to be recruited differentially to inflammatory sites. METHODS: Cells were identified flow-cytometrically by intracellular cytokine staining on a single cell level in 30 patients undergoing conventional (Shouldice) or total extraperitoneal patch (TEPP) hernia repair. RESULTS: The TH1 cells decreased postoperatively in Shouldice patients on an average of 20.8-31.4%, whereas in TEPP patients only a minor decline (mean, 7.8-9.2%) was observed. The TH2 cells did not change significantly in TEPP patients, and a small increase (mean, 7.7%) was detected in Shouldice patients. CONCLUSIONS: Our results suggest that the postoperative reduction in TH1 cells reflects local surgical trauma and can be helpful in evaluating different surgical procedures. When conventional and endoscopic hernia repair were compared, the latter proved less traumatizing.
Adult↗
Teaching medical students alcohol intervention skills: results of a controlled trial.
OBJECTIVE: To assess the relative effectiveness of videotape feedback and lecture methods for teaching alcohol brief intervention skills. DESIGN: In a controlled trial, two student blocks received a manual, lecture and demonstration about the principles and practice of brief alcohol intervention. In addition, experimental students made a 20-min videotape and participated in a 1.5-h small group feedback session. Prior to and after training, all students completed questionnaires and videotaped interviews with simulated patients. SETTING: Faculty of Medicine and Health Sciences of the University of Newcastle, Australia. SUBJECTS: Final-year medical students. RESULTS: Levels of alcohol-related knowledge, attitudes and interactional skills as well as general interactional skills were significantly improved after teaching. Alcohol-related interactional skills that were unsatisfactory at pretest reached satisfactory standards at post-test. An intergroup comparison of the improvement between pre- and post-teaching scores indicated that there was no significant difference in the effectiveness of the two methods. CONCLUSIONS: Training can improve medical student performance in alcohol intervention. Further research is required to examine the relative effectiveness of different teaching methods.
Adult↗
Researchers' views about priorities for research on alcohol, tobacco and other drugs.
There have been few attempts to study systematically researchers' views about priorities for addiction research. This mail/telephone survey of 101 Australian researchers achieved a 90% response rate. Respondents believed there should be a 50/50 split between the agency-directed and researcher-initiated methods of funding allocation. The top four drugs in terms of desired proportions of research spending were alcohol 32%, tobacco 18%, opiates 9% and prescribed drugs 9%. Researchers' preferences for high funding allocations on prevention research were at odds with the low level of Australian studies in this area. Complexities of design and methodology were nominated as the most important barriers to prevention research. The divide between qualitative and quantitative approaches was not identified as a major barrier to personal or prevention research. In addition to increases in both overall and specific funding, greater collaboration and political support were viewed as important facilitating factors for research efforts. Improved researcher training and the need to integrate research into quality assurance programmes were also nominated as useful means of encouraging prevention studies.
Journal Article↗
Regional chemotherapy and transcatheter arterial chemoembolization.
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Antineoplastic Agents↗
[Forensic aspects of complicated laparoscopic cholecystectomy].
As laparoscopic cholecystectomy becomes more established, interest in legal aspects increases. The legal cases dealt with in Germany since the introduction of this laparoscopic method in 1989 were studied to determine the legal consequences of complications. Of 40 cases, 16 were judged to be cases of malpractice, whereas 24 were not. The most common cause was injury of the common bile duct (26 cases). Seven of these 26 cases were judged to be cases of malpractice, 2 of these as grave errors. The main reasons for the acceptance of a case as malpractice were delay in changing to conventional cholecystectomy, delayed revision, laparoscopic revisions and not reverting to conventional cholecystectomy in unclear situations.
Cholecystectomy↗
Non-life-threatening blunt chest trauma: appropriate investigation and treatment.
Non-life-threatening blunt chest trauma is a commonly occurring phenomenon. No clear guidelines exist in the literature regarding the appropriate investigation and treatment, and most clinicians' practice patterns are based on anecdote, individual experience, and the theoretical risk of complications. A prospective study was undertaken of all patients with non-life-threatening blunt chest trauma presenting to a high-volume, community-based teaching hospital emergency department. No clinical features were found to have a high enough positive predictive value for rib fracture or any other injury to warrant their use as a screening tool for further investigations. No significant lung injury was detected in the study cohort of patients, on either an immediate or delayed basis. In the absence of compelling evidence of an underlying lung injury, the performance of chest or rib radiography is of no benefit, and considerable cost savings can potentially be realized.
Adolescent↗
[Changes in the cytokine concentration (Il-6, Il-8, Il-1ra) and their cellular expression of membrane molecules (CD25, CD30, HLA-DR) after surgical trauma].
UNLABELLED: Elective surgical approaches and trauma cause changes in the production of different cytokines, an increased production of acute phase protein and changes in the expression of different cell surface markers. METHODS: In a prospective study we examined the C-reactive protein level, the production of the cytokines IL-6, IL-8 and IL-1 RA in 25 laparoscopic and 21 conventional cholecystectomies. In addition the cell surface markers CD25 and CD30 on different cell populations and HLA-DR on monocytes were measured. Statistical analysis was made by Student's-t-test and Mann-Whitney's rank sum test. RESULTS: The humoral markers showed a more distinct increase in patients operated on conventionally two and 24 hours after surgery, the differences between the two surgical approaches were significant (p < 0.01). The cell surface markers CD25 and CD30 showed the same reaction. The HLA-DR expression on monocytes was significantly lower in patients operated on conventionally. CONCLUSIONS: Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines and cell surface markers. Laparoscopic cholecystectomies cause less activation of the immune system than conventional operations.
Acute-Phase Reaction↗
Recurrent graft pain following renal autotransplantation for loin pain haematuria syndrome.
OBJECTIVE: To review retrospectively the Perth experience of autotransplantation for loin pain haematuria syndrome and identify possible factors associated with its failure. PATIENTS AND METHODS: The medical records of 11 women patients (median age 42 years, range 29-48) who had 12 autotransplantations were reviewed. All patients were then interviewed and asked whether they considered the operation a success. RESULTS: All patients initially had complete relief of symptoms. Three patients who had four transplants are still symptom-free with a follow-up of 24-46 months. Five patients have had partial relief with marked variability in their patterns of recurrent pain. Three patient have symptoms as severe as those before operation. One kidney was lost because of acute thrombosis and another developed a urinoma. No patient had deterioration in renal function. CONCLUSION: Renal autotransplantation is a treatment option of last resort, with acceptable morbidity in patients with intractable, functionally disabling renal pain, but three-quarters of these patients may develop recurrent pain in the transplant site. A current or past history of depression or absence of haematuria may represent risk factors for a poor post-operative prognosis. Treatment failure is predictable by a poor response to sympathetic neurolytic block.
Adult↗
[Bile duct injuries after laparoscopic cholecystectomy].
Injuries to the extrahepatic bile duct present a severe complication in laparoscopic cholecystectomy occurring in 0-2.6%. From June 1991 to September 1994 four patients were treated to the Department of Surgery at Bonn University with bile duct injuries after laparoscopic cholecystectomy. All had complete sections of the common bile duct. They were treated twice with a biliodigestive anastomosis and once by direct suturing of the d choledochus. One of our own patients suffered an injury of the right hepatic duct, most probably due to a thermic lesion. In all cases anatomy was irregular or unclear. To avoid these complications an intraoperative cholangiography should be performed in these situations. The reconstruction after inadvertent injuries of the bile duct depends on the localisation and the age of the lesion.
Adolescent↗