Changing the law: how boards of dental examiners influence the legislative process.
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Governing Board↗
Biomedical subjects
D N Brotman
Publications and source records attributed to D N Brotman.
Hemodialysis graft salvage.
Hemodialysis access procedures account for a large percentage of patients undergoing surgical treatment. Salvage procedures are frequently used to extend the life of a thrombosed graft and thereby maximize the limited available access sites. Factors that may influence the success of salvage procedures, as well as the financial risk to benefit comparison, may be of increasing importance in the era of aggressive medical cost containment. The charts of 70 patients who underwent 116 thrombectomies or revisions of polytetrafluoroethylene (PTFE) hemodialysis arteriovenous grafts of the upper extremity for thrombosis were retrospectively analyzed. Patency of salvaged grafts by life-table analysis was 75.0 percent at two days, 45.0 percent at 30 days, 18.0 percent at 120 days and 2.5 percent at one year. Patency was 59 and 25 percent for revised grafts at 30 and 120 days, respectively, versus 30 and 10 percent at the same time intervals for thrombectomized grafts only. Minimum combined operative and hospital costs were $4,350 per salvage attempt. Salvage patency of PTFE dialysis grafts of the upper extremity was dismal, especially when thrombectomy alone was used. No specific patient factors were predictive of patency interval. Based upon these results, we cannot continue to recommend graft thrombectomy alone for thrombosed dialysis grafts. Because the poor results with graft revision as well, placement of a new graft without any attempt at salvage may be the best therapeutic and cost-effective option.
Adult↗
The presence and significance of carnosine in histamine-containing tissues of several mammalian species.
Histamine is known to exert profound effects on the cardiovascular system in many mammals. Carnosine (beta-alanyl-L-histidine) is a dipeptide previously known to be present only in a few tissues. It is our hypothesis that carnosine serves as a non-mast cell reservoir for histidine, available for histamine synthesis during periods of physiologic stress. To validate this hypothesis, we demonstrated the existence of carnosine in multiple histamine-rich tissues in several mammalian species; documented a metabolic link between carnosine and histidine, histamine and 3-methylhistamine (a degradation product of histamine) in unstressed animals, and showed that tissue carnosine is decreased simultaneously with an increase in tissue histamine during stress.
Animals↗
Existence of carcinine, a histamine-related compound, in mammalian tissues.
Carcinine (beta-alanylhistamine) was synthesized in vitro from histamine and beta-alanine. It was detected quantitatively using an HPLC method previously described for the quantification of the related compounds histamine, histidine, carnosine and 3-methylhistamine. Carcinine was identified in several tissue of the rat, guinea pig, mouse and human, and was then shown to be metabolically related in vivo to histamine, histidine, carnosine and 3-methylhistamine through radioisotopic labeling. The results demonstrate that carcinine may be concurrently quantitated using the same HPLC method as that used to measure histamine, histidine, carnosine and 3-methylhistamine. These findings suggest a role for carcinine in the carnosine-histidine-histamine metabolic pathway and in the mammalian physiologic response to stress.
Animals↗
DRGs and the "negative" trauma workup.
We conducted a study to assess the financial impact of the diagnostic workup and care of 136 trauma patients admitted to our institution during a six-month period who were subsequently found to have only minor injuries (Injury Severity Score less than or equal to 9, Abbreviated Injury Score less than 3). The New Jersey DRG reimbursement system, an all-payer system, failed to provide adequate financial compensation overall, as the average loss per patient (operating cost minus reimbursement) was $508. Lost potential revenue (hospital charges minus reimbursement) was even greater, averaging $1,834 per patient. We conclude that the New Jersey DRG reimbursement system, in its current form, provides inadequate reimbursement for the system, in its current form, provides inadequate reimbursement for the proper workup and treatment of trauma patients with minor injuries. Because these patients are those most likely to help "subsidize" the care of sicker patients, changes in the system are necessary to allow hospitals to continue to provide state-of-the-art trauma care and to continue to minimize the number of preventable deaths due to trauma.
Adolescent↗
Positive inotropic effect of carcinine in the isolated perfused guinea pig heart.
Carcinine (beta-alanylhistamine) is a recently discovered compound that is present in the hearts of several mammalian species, including man. Although the function of carcinine is unknown, its structural similarity to histamine, a compound known to have profound effects on the mammalian heart, and to carnosine (beta-alanylhistidine), a compound which we have previously shown to serve as a histamine source, led to the hypothesis that carcinine may play a role in mammalian cardiac physiology. We therefore administered several doses of carcinine (10, 25, 50, 75, and 100 micrograms) to isolated, perfused guinea pig hearts in a Langendorff apparatus. Carcinine exerted a dose-dependent positive inotropic effect, similar to that of histamine. Comparable doses of carnosine yielded no measurable change in contractility. We conclude that carcinine appears to be a positive inotrope in the mammalian heart, and may play a role in cardiac physiology via its metabolic link to histamine.
Animals↗