Effects of sodium pump inhibitors on spontaneous acetylcholine release at the neuromuscular junction.
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Acetylcholine↗
Biomedical subjects
D S Feldman
Publications and source records attributed to D S Feldman.
Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine: a physician survey.
BACKGROUND: Survey studies have shown that physicians believe managed care is having significant impact on many of their professional obligations. METHODS: Primary care physicians were asked about the impact of managed care on: (1) physician-patient relationships, (2) the ability of physicians to carry out their professional ethical obligations, and (3) quality of patient care. In 1996 we surveyed 1011 primary care physicians in Pennsylvania. The survey group's responses were graded on a Likert scale. Space was provided for respondents to include written comments. The SPSS statistical software (SPSS Inc, Chicago, Ill) was used to analyze the data. RESULTS: The response rate was 55%. Most respondents indicated that under managed care physicians are less able to avoid conflicts of interest and less able to place the best interests of patients first. The majority responded that quality of health care is compromised by limitations in location of diagnostic tests, length of hospital stay, and choice of specialists. A significant minority (27%-49%) noted a decrease in the physician's ability to carry out ethical obligations, to respect patient autonomy, and to respect confidentiality in physician-patient communication. Most physicians expressed that managed care made no impact on ability to obtain informed consent or to provide information. There were small but statistically significant sex differences, with female physicians more negative toward managed care. CONCLUSIONS: Many physicians surveyed believe managed care has significant negative effects on the physician-patient relationship, the ability to carry out ethical obligations, and on quality of patient care. These results have implications for health care system reform efforts.
Attitude of Health Personnel↗
Ontogenesis of lumbar spinal somatosensory evoked potentials after posterior tibial nerve stimulation in the rat.
Although data are available regarding lumbar spinal somatosensory evoked potentials (SSEPs) after posterior tibial nerve stimulation in the mature rat, age-related changes spanning the period of early development have not been defined. We obtained lumbar spinal SEPs after posterior tibial nerve stimulation in 6 cohorts of animals (N = 36) ranging in age from weanling (15 days) to early adulthood (110 days) by recording from needle electrodes placed in the L1-2 and L5-6 interspinous ligaments. Absolute latencies of the major wave form components at the two recording sites declined rapidly until the mid-juvenile period (36 days) and more slowly thereafter. Mean peripheral conduction velocities (+/- S.D.) increased from 11.06 (+/- 0.02) to 33.22 (+/- 3.55) m/sec and mean central conduction velocities (+/- S.D.) increased from 6.27 (+/- 1.07) to 23.64 (+/- 3.84) m/sec from 15 to 110 days respectively. The linear relationships of central and peripheral conduction velocities to both age and weight as defined by standard regression were highly significant. No sex differences were noted for peripheral velocities at all ages studied. Central velocities revealed significant sex differences at 110 days but not earlier. This study demonstrates that lumbar spinal SEPs after posterior tibial nerve stimulation undergo a predictable evolution which can be represented by a simple cable model of a lengthening myelinated pathway.
Age Factors↗
Transfer following rapid kindling in the prepubescent rat.
In order to investigate the transfer effect following rapid kindling in the immature animal, prepubescent rats were initially kindled in the amygdala using interstimulus intervals of 5 min followed by transfer kindling in the contralateral amygdala at age 100 days using twice daily kindling. A second group of rats were kindled in the prepubescent period with hourly stimulations followed by transfer kindling at age 100 days using twice daily stimulations. A control group underwent sham-kindling in the prepubescent period followed by twice daily kindling at age 100 days. While a transfer effect was seen in both the rapidly kindled and hourly kindled groups, the transfer effect was greater in the animals kindled with the longer interstimulus interval. While rapid kindling produces a long-standing change in brain excitability, the effect is less pronounced than with hourly kindling techniques.
Age Factors↗
The use of bone scan to investigate back pain in children and adolescents.
Children with back pain frequently undergo detailed investigation because of the perception that a high percentage will have a treatable spinal condition. The purposes of this study was (i) to determine the percentage of children with disabling back pain presenting to our institution who had a diagnosis (i.e., to explain their back pain), (ii) to evaluate the clinical markers that should alert clinicians to underlying pathology, (iii) and to determine the prognosis of children with back pain and no specific diagnosis. This study was a retrospective analysis of consecutive children undergoing single-photon emission computed tomography for a primary complaint of back pain. Data collection included chart review, radiographic analysis, and clinical follow-up with the Roland and Morris scale for pain and disability. Two hundred and seventeen patients with an average age of 13 years (range, 2.7-17.7) were reviewed on average 4.4 years after presentation (range, 1.1-7.2 years). One hundred and seventy children (78.3%) had no specific diagnosis to explain their back pain, 15 children (6.9%) had spondylosis, 10 children (4.6%) had tumor, and the remaining 22 children (10.1%) had various diagnoses including infection, Scheuermann's kyphosis, herniated disc, kidney disease, facet arthritis, degenerative disc disease, congenital anomalies, and tethered cord. Factors associated with positive diagnoses were constant pain and male gender. Night pain, constant pain, and duration of symptoms <3 months were associated with the diagnosis of a tumor. Although the majority of children presenting with persistent back pain had no demonstrable cause, of 132 contactable patients 94 (71%) had persisting pain at the time of clinical follow-up. In conclusion, the majority of children with disabling back pain has no demonstrable cause and the majority will continue to have pain years after initial presentation.
Adolescent↗
Extra-articular triplane fracture of the distal tibial epiphysis.
We describe an extra-articular triplane fracture of the distal tibia in the skeletally immature patient. This variant of the triplane fracture has been largely ignored in the literature. The clinical significance of recognizing this fracture is that, although it constitutes an epiphyseal fracture, it remains extra-articular. Unlike the standard triplane fracture that exists through the tibiotalar joint, this variant can be treated acceptably with less than an anatomical reduction, therefore often avoiding the need for surgical management.
Adolescent↗
Behavioral effects of kainic acid administration on the immature brain.
Prepubescent male rats with an amygdaloid electrode in place were administered kainic acid (KA) intraperitoneally (i.p.) while controls received phosphate-buffered saline (PBS). All KA-treated animals developed status epilepticus with bilateral forelimb clonus and ictal discharges on the EEG. The rats were then tested as adults for learning, memory, emotionality, social interaction, and activity level using the T maze, water maze, handling test, home cage intruder test, and open field test. KA-treated rats learned at a slower rate in the water maze and T maze than the controls. In addition, KA-treated rats had evidence of impaired memory during spatial bias testing in the water maze. In the home cage intruder test, KA-treated animals were more submissive and less aggressive than control animals. Finally, KA-treated animals were significantly more active than control animals in the open field test. This study demonstrates that KA administration to the immature brain, in a convulsant dose, results in permanent changes in behavior, learning, and memory.
Age Factors↗
Hip arthrodesis in adolescents using external fixation.
Between 1994 and 1998, seven adolescents underwent hip arthrodesis with the use of an external fixator. Mean time of follow-up was 24.0 months after surgery. The duration of fixation and time to fusion were 6.6 months (range, 5-9.5 months) and 8.0 months (range, 5.2-15 months), respectively. At most recent follow-up, there was a significant improvement in the mean modified Harris hip score, in which the maximum score is 91 points after omitting 9 points for hip range of motion and deformity, from 25.7 before surgery to 66.7 after surgery (p < 0.01). The advantages of this procedure include (i) the ease and accuracy of obtaining the proper position for fusion, (ii) the ability to lengthen the affected leg at the same time, (iii) the diminished likelihood of compromising future hip operations, and (iv) the ability to ambulate and bear weight throughout the treatment course. We recommend this method of hip arthrodesis with external fixation for patients with intractable hip pain necessitating this procedure.
Adolescent↗
Psittacine pox virus: virus isolation and identification, transmission, and cross-challenge studies in parrots and chickens.
An avian pox virus was isolated from Amazon parrots dying with severe diphtheritic oral, esophageal, and crop lesions. The virus was propagated on chorioallantoic membranes (CAM) of 10-day-old chicken embryos, and a homogenate of the infected CAM was rubbed vigorously onto the conjunctiva, oral mucosa, and defeathered follicles of two healthy Amazon parrots and three conures. All experimental birds developed cutaneous and ocular pox lesions, and one parrot developed oral pox lesions. Specific-pathogen-free chicks inoculated with the virus isolate developed skin lesions identical to those of the parrots. Chickens vaccinated with fowl and pigeon pox vaccines and inoculated with the psittacine isolate developed lesions typical of avian pox. Chickens vaccinated with the psittacine virus were susceptible to fowl and pigeon pox virus infection. This pox virus isolate may thus be regarded as a potential pathogen for chickens.
Animals↗
Lesions induced in the respiratory tract of chickens by serologically different adenoviruses.
Ten strains of adenovirus representing 10 serotypes were administered intratracheally to two groups of 3-week-old specific-pathogen-free chickens. Birds in group 1 were given only adenovirus. Birds in group 2 were inoculated with a virulent infectious bursal disease virus (IBDV) by eye-drop at one day of age as well as with the adenovirus at 3 weeks. The chicks were examined daily. Respiratory rales were observed in some birds with the dual infection. Gross pathologic alterations were minimal and limited to multiple scattered, pale foci in the lungs of an occasional bird in various groups. Histopathologic changes in the lungs were those of multifocal interstitial and, occasionally, diffuse pneumonia. The pneumonic lesions were more severe in the chickens given IBDV. Tracheitis was seen with two of the serotypes.
Adenoviridae↗