[Electronic fetal monitoring during labor--disillusionment or premature rejection].
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Biomedical subjects
Publications and source records attributed to D Weinstein.
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To determine the most accurate roentgenographic technique for the measurement of limb-length discrepancy, the twenty lower extremities of ten cadavera were measured with use of both orthoroentgenograms and lateral scout computed-tomographic scanograms. The actual anatomical limb length also was measured, to serve as a control. The effects of flexion of the knee joint, use of an external fixator, cost and time of the examination, and exposure to radiation also were determined. No statistically significant difference in the measurements of the length of the femur was found between the two methods at neutral or at 15, 30, or 45 degrees of flexion of the knee. However, computed tomography was significantly more accurate than orthoroentgenography in the measurements of length of the tibia and of total length of the limb when the knee was flexed to 30 degrees or more (p less than 0.01). The placement of an Ilizarov fixator did not alter the results. The cost and time necessary to complete an examination were comparable for the two methods. However, computed tomography delivered only 20 per cent of the radiation needed for orthoroentgenography. Computed tomography is more accurate than orthoroentgenography for the measurement of limb-length discrepancy in patients who have a flexion deformity of the knee.
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We evaluated the clinical utility of patient-reported erectile functioning information in discriminating Rigiscan-determined functional (greater than or equal to 70% penile tip and base rigidity and greater than or equal to 10 minutes' duration) from insufficient (less than 40% penile tip and base rigidity and less than or equal to 6 minutes' duration) erectile capacity, in a population of chronically ill men presenting with erectile dysfunction. Forty-three male veterans completed an extensive medical and psychologic evaluation, including a detailed assessment of sexual functioning, and then underwent two consecutive nights of supervised in-hospital Rigiscan sleep evaluations. Results of discriminant function analysis indicated that patient reports of morning erections and ejaculatory ability accurately predicted group membership for functional (96.7%) and insufficient (100%) categories. Careful attention to patient self-report is suggested for the urologist's initial appraisal of erectile dysfunction in populations of older, chronically ill men.
We evaluated the relevance of patient reported sex history information in predicting erectile functioning as measured by the RigiScan monitor. A total of 46 male veterans who presented with erectile dysfunction completed an extensive medical and psychological evaluation including a sexual history, and then underwent 2 consecutive nights of inhospital RigiScan sleep evaluation performed under supervision. Multivariate analyses indicated a significant relationship among patient reported sex history information, and RigiScan measurements of tip and base duration, and rigidity. The sex history item with the greatest predictive power was the question regarding early morning erections. The results of this study highlight the importance of patient reported information, and the significance of obtaining a detailed sex history in the evaluation of older, primarily chronically ill patients who present with erectile dysfunction.
The role of magnetic resonance imaging and plain radiographs in evaluating osteomyelitis in the diabetic foot was studied. Fifty patients were prospectively examined by magnetic resonance imaging and plain radiographs to determine the extent of infection. Thirty-seven patients had positive MRI for osteomyelitis and 19 were positive with conventional radiography. Thirteen patients had negative MRI healed with short course of antibiotics. Five patients with positive MRI received four weeks' course of intravenous antibiotics with two still having persistent infection in the six weeks follow-up. Thirty-two patients underwent surgery with favorable results. Sixty-two bone specimens were obtained for histologic evaluation of osteomyelitis. In cases with histologic proof of diagnosis, magnetic resonance sensitivity was 99%, specificity was 81%, and accuracy was 94%. Thus magnetic resonance imaging was shown to have a high sensitivity, specificity, and accuracy in detecting osteomyelitis.
The authors describe a recent case of agenesis of the right lobe of the liver. Such cases are rare and can be diagnosed with state of the art imaging modalities, ultrasound and computed tomography, which permit early diagnosis and help avoid liver complications of cirrhosis, cholangiocarcinoma and hepatoma. This type of congenital anomaly can be associated with biliary tract disease, portal hypertension or other congenital anomalies.
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Guinea pigs were administered chronic fluphenazine decanoate for 11 months and oral movements (OMs) were periodically observed using several different paradigms. Shortly after the initiation of neuroleptic treatment, increased OMs were seen in the drugged animals, but these did not persist and may have reflected a decreased fear (freezing) reaction in the tranquilized animals, being correlated with increased locomotion in open field. After 7 months of neuroleptics, twitch-like movements of the orofacial region were observed in the drugged animals; these dyskinetic movements were enhanced by administration of d-amphetamine. These twitch-like movements appear to be a better model of tardive dyskinesia in the guinea pig than the initially observed and normal-appearing OMs.
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Highly purified recombinant human tumor necrosis factor (TNF) was found to induce interleukin 1 (IL 1) production in diploid human FS-4 fibroblasts. Demonstration of IL 1 activity was based on the ability of TNF-treated FS-4 cells, subsequently fixed with formaldehyde, to stimulate thymocyte proliferation in the presence of phytohemagglutinin. Incubation of FS-4 cells with the optimal dose of TNF (10 ng/ml) resulted in a marked increase in [3H] thymidine uptake by thymocytes co-cultured with formaldehyde-fixed FS-4 cells. Induction of this apparently membrane-associated IL 1 (MA-IL 1) activity was demonstrable at 6 hr and reached a plateau after 48 hr of incubation with TNF. FS-4 cells did not secrete soluble IL 1 in response to TNF. Dexamethasone suppressed the synthesis of TNF-induced MA-IL 1. A monoclonal antibody specific for TNF neutralized MA-IL 1 induction, indicating that the induction is due to TNF, and not to a contaminant in the TNF preparation. The ability of TNF to induce IL 1 synthesis in FS-4 fibroblasts at the transcriptional level was confirmed by S1 nuclease protection assay. Cytoplasmic RNA from uninduced FS-4 cells contained no demonstrable RNA hybridizing with a human IL 1-alpha cDNA probe and low levels of RNA hybridizing with an IL 1-beta cDNA. Induction with TNF resulted in the appearance of IL 1-alpha mRNA and a very significant increase in IL 1-beta mRNA, indicating that TNF induces the synthesis of both IL 1-alpha and IL 1-beta in FS-4 cells.
A new family of small cytoplasmic RNA species (scRNAs) was found to be associated with human term-placental free messenger ribonucleoprotein particles (mRNPs). Placental scRNAs strongly inhibit translation of both homologous and heterologous mRNAs in a cell-free rabbit reticulocyte system. scRNAs could be resolved into at least four different RNA species. One of the RNA molecules, scRNA species 1, was the most potent protein synthesis inhibitor found among the placental scRNAs. The nucleotide sequence of the scRNA species 1 was determined. In spite of its short length, scRNA species 1 still exhibited a very strong inhibitory effect on the in vitro protein synthesis. scRNAs were found to be complexed with proteins in the form of scRNPs. Proteins of these complexes enhanced the inhibitory effect of scRNAs on in vitro translation. Experiments provided evidence that inhibition of in vitro protein synthesis by the scRNAs is not dependent upon mRNA concentration. However, inhibition can be overcome by increasing the ratio lysate/scRNAs, thus suggesting that scRNAs act on some essential component of the cell-free system. The degree of inhibition is decreased when scRNAs are added after the start of translation, suggesting that scRNAs (or scRNPs) interfere with the initiation stage of translation, probably acting on an initiation factor(s). Placental scRNAs are unique in their size, being smaller than other known scRNAs. Their association with free cytoplasmic repressed mRNPs in human placenta suggests that scRNAs play a role in the regulation of mRNP metabolism and, consequently, in the control of mRNA translation.
Free mRNPs isolated from human term placental tissue were examined for protein kinase and phosphoprotein-phosphatase activities. Free mRNPs incubated with [gamma-32P]ATP in a protein kinase standard buffer show self-phosphorylation in the absence of exogenous substrates. Treatment of phosphorylated products with alkali showed a significant phosphorylation of tyrosine residues within the mRNP-proteins. An alkaline-phosphatase activity was found to be tightly associated with the mRNPs. Both heat stable and heat labile alkaline phosphatase activities were found in the mRNPs. Heat labile alkaline phosphatase is the major isoenzyme form of the mRNPs. The existence of both protein kinase(s) and alkaline phosphatase activities in placental free cytoplasmic mRNPs might suggest that a balance between phosphorylation, specifically on tyrosine residues, and dephosphorylation states of some of the mRNP-proteins is relevant for their physiological functions, and may therefore play a role in the regulation of mRNPs' metabolism and, consequently, in mRNA translation.
Among 60 spinal cord injury patients who underwent external urethral sphincterotomy 45 experienced success and 15 failed. Failure was established when symptomatic urinary tract infections and high vesical residuals persisted. Urodynamic findings demonstrated detrusor areflexia in 10 patients (66 per cent), detrusor-sphincter dyssynergia in 2 (13.2 per cent), detrusor hyperreflexia with unsustained bladder contractions in 1 (6.6 per cent), and detrusor hyperreflexia and bladder neck obstruction in 2 (13.2 per cent). Among these failures poor detrusor contractility predominated. Detrusor-sphincter dyssynergia may indicate an inadequate surgical relief of obstruction. Bladder neck obstruction may indicate that a bladder neck incision should be considered when an external sphincterotomy is performed.
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Cyclic changes were observed in the content of blood monocytes during the menstrual cycle of normal women. Elevated blood monocytes were found during the ovulation period as well as in other conditions which are associated with increased blood estradiol (E2). To understand the possible association between E2 and monocytosis, we analysed the in vitro effect of E2 on the development of myelomonocytic colonies in culture. E2 in physiological concentrations was found to increase the number of colonies developed from peripheral blood mononuclear cells (PBM) of both females and males. The optimal concentration for the augmenting effect on males' PBM was lower than that for females. Mononuclear cells derived from cord blood, which yielded much higher numbers of colonies than adult PBM, also responded to the stimulatory effect of E2. Estrone and estriol were less effective than E2 in adult PBM. In contrast, progesterone, diethylstilbestrol and testosterone did not affect the number of colonies at the range of physiological concentrations tested. The anti-estrogen Tamoxifen did not inhibit the stimulatory effect of E2. The augmenting effect of E2 on monomyelocytic colony formation may explain at least in part the increase in blood monocyte content of women with high E2 as well as other phenomena of macrophage and granulocyte changes associated with the menstrual cycle.