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Biomedical subjects

H Mekhjian

Publications and source records attributed to H Mekhjian.

13 recordsLinked to original sources
PubMed1999

Patient satisfaction with telemedicine in a prison environment.

Prison inmates were surveyed about their perceptions of the use of videoconferencing in clinical consultations. A 14-item questionnaire was used to assess satisfaction with the patient-physician clinical interaction. Of the 299 inmates surveyed immediately after their teleconsultations, 221 completed questionnaires that were suitable for analysis (74%). Only 9% of patients indicated that they were not satisfied with the teleconsultation. They rated the telemedicine context well above the midpoint of the scale (16) on both an information-exchange and a patient-comfort dimension, with means of 29 and 24, respectively. There was a significant difference (P < 0.01) in the patient-comfort dimension in terms of the location of the prisoners. No significant differences were found in patient satisfaction related to the specialty of the physician. The results suggest that many contextual factors must be considered to understand the communicative implications of patient satisfaction with telemedicine.

Female↗
PubMed1997

Left ventricular diastolic function after coronary artery bypass grafting: a correlative study with three different myocardial protection techniques.

BACKGROUND: This study was designed to examine the effect of myocardial protection on diastolic function after cardiac operations. METHODS: Subjects were patients with normal preoperative diastolic function who were scheduled for coronary artery bypass grafting. Group I received anterograde cardioplegia; group II received anterograde and retrograde cardioplegia; and group III was protected with ventricular fibrillation and intermittent aortic crossclamping. Operations were performed with mild hypothermia and ventricular venting through the left superior pulmonary vein in all cases. Left ventricular diastolic function was evaluated with pulsed-wave Doppler transesophageal echocardiography (samples at the mitral valve leaflet: four-chamber view) and left superior pulmonary vein flow velocity. The flow patterns were stored on videotape and sent to an independent investigator for analysis. Left ventricular ejection fraction was calculated with transesophageal echocardiography (short-axis view, two-dimensional and M-mode). RESULTS: Left ventricular diastolic function, as measured by the ratio between the peak velocities during early filling and atrial contraction and by systolic diastolic superior pulmonary venous flow ratio, was significantly impaired in all three groups 5 minutes after discontinuation of cardiopulmonary bypass. At 1 hour after operation, these values had returned to control levels only in group III. There was an increased incidence of supraventricular arrhythmias in group III. There were no significant hemodynamic differences among the three groups. CONCLUSIONS: Left ventricular diastolic function was severely impaired after cardiopulmonary bypass. The degree of impairment depended on the myocardial protection used. The impairment in diastolic function was less when ventricular fibrillation and intermittent aortic crossclamping were used, and greater when anterograde and retrograde cardioplegia were used.

Adult↗
PubMed1996

An Ohio telemedicine system for prison inmates: a case report.

BACKGROUND: A project was established by The Ohio State University Medical Center (OSUMC) and the Ohio Department of Rehabilitation and Corrections (ODRC) to investigate the use of telemedicine in providing health care to Ohio's prison inmates. OBJECTIVES: To determine the effects of telemedicine on continuity of inmate care, the sense of isolation experienced by health care providers at remote institutions, the security risks incurred when transporting inmates to outside facilities, and the overall cost of care. In tracing the initial adoption and implementation of the project, the authors describe health care in Ohio's prisons and the unique nature of providing that care. METHODS: The project was conducted over a 1-year period, from November 1994 through December 1995, using a variety of methods: direct observation of inmate consultations; participation in task force meetings; unstructured interviews with physicians, prison administrators, ancillary health care personnel, and security guards; and initial collection of survey data. RESULTS: Telemedicine enables Ohio's inmates to receive health care in a more timely fashion than before. Physicians and inmates were generally satisfied, and the costs of providing inmate medical care were reduced by lessening or eliminating the need for additional security guards, vans, chase vehicles, and travel time for physicians. CONCLUSIONS: Some initial hurdles in using the system, such as scheduling and triage, are being overcome as new methods are devised, and additional incentives for specialty physicians to use the system are being investigated. The OSUMC/ODRC project suggests that the advantages of using telemedicine in prison settings are immense, and the ODRC plans to expand the network to include two more remote sites early in 1996.

Delivery of Health Care↗
PubMed1991

Double blind, placebo controlled trial of metronidazole in Crohn's disease.

A double blind study compared the efficacy of metronidazole in two doses (20 mg/kg, 10 mg/kg) with placebo in patients with Crohn's disease. One hundred and five patients participated but only 56 completed the 16 week study -21 were withdrawn for deterioration of symptoms, 17 for adverse experiences, and 11 for protocol violation. Significant improvement in disease activity as measured by the Crohn's disease activity index (metronidazole 20 mg/kg, 97 units; metronidazole 10 mg/kg, 67 units; placebo -1 unit, p = 0.002) and serum orosomucoid (metronidazole 20 mg/kg/day, 49; 10 mg/kg/day, 38; placebo, -9, p = 0.001)) were detected. Changes in C reactive protein concentrations did not achieve significance when all three groups were considered but were significant when all metronidazole treated patients were grouped and compared with the placebo treated patients (0.8 v -0.9, p less than 0.05). Although patients receiving metronidazole 20 mg/kg/day had a greater improvement in disease activity than those receiving 10 mg/kg/day (difference 30 units (95% confidence intervals -27-87), the small sample size may have precluded the detection of statistical significance. Preliminary analysis suggests that metronidazole was more effective in patients with disease confined to the large intestine or affecting both small and large bowel than in those with small bowel disease only. There were no differences in remission rates between metronidazole and placebo treated patients. We conclude that metronidazole warrants further assessment in the treatment of patients with active Crohn's disease.

Analysis of Variance↗
PubMed1989

Effects of enteric neural stimulation on chloride transport in human left colon in vitro.

Nonpathological segments of muscle-stripped left colon from patients undergoing surgery for carcinoma, diverticulitis, or other causes were set up in flux chambers in order to determine the influence of intrinsic neurons on ion transport. In the basal state, both sodium and chloride were actively absorbed, and there was no significant residual ion flux. Electrical field stimulation of the intrinsic mucosal innervation evoked an increase in short-circuit current that was dependent on stimulus frequency and strength. The response was mimicked by scorpion venom, which is known to depolarize neurons, and was nearly abolished by tetrodotoxin, which prevents neurotransmitter release. Atropine reduced, but did not abolish, the response to neural stimulation. Carbachol, aminophylline, and theophylline significantly increased short-circuit current above basal levels. Electrical field stimulation evoked an increase in short-circuit current that could be accounted for by a decrease in net chloride absorption without any significant effect on sodium absorption or residual ion flux. These results suggest that ion transport in the human left colon is regulated by intrinsic submucosal cholinergic neurons as well as other neuronal types, and activation of these nerves could provide the basis for certain diarrheal disorders.

Aged↗
PubMed1984

Additional chenodiol therapy after partial dissolution of gallstones with two years of treatment.

During the National Cooperative Gallstone Study, therapy with chenodiol, 750 or 375 mg/d, for 2 years resulted in confirmed, complete gallstone dissolution in 14% and 5% of patients, respectively, and partial dissolution (greater than 50%) in 27% and 18%. The present study was done to determine the frequency with which complete dissolution occurs in patients having partial dissolution of gallstones who receive additional therapy. Eighty-six of one hundred thirty-eight eligible patients continued to receive 750 mg/d (61 patients) or 375 mg/d (25 patients) of chenodiol for 1 year. Patients whose oral cholecystogram at the end of the year showed further (greater than 50%) dissolution continued to receive chenodiol, (28 patients at 750 mg/d and 11 patients at 375 mg/d) for a second year (total duration of therapy, 4 years). A final oral cholecystogram was taken at the end of the fourth year. Complete dissolution occurred in 23% and 16% of patients receiving chenodiol, 750 or 375 mg/d, respectively, for an additional 1 or 2 years.

Chenodeoxycholic Acid↗
PubMed1982

Effects of amino acids and gastric inhibitory polypeptide on insulin release in dogs.

Insulin release following intravenous administration of an amino acid solution with and without a simultaneous infusion of varying amounts of porcine gastric inhibitory polypeptide (GIP) was studied in dogs. Group I received a 10-amino acid mixture (300 mosmol/kg iv) at 16.6 ml/min for 1 h; group II, amino acid mixture plus 0.5 micrograms.kg-1.h-1 porcine GIP; group III, amino acid mixture plus 1.0 micrograms.kg-1.h-1 of GIP; group IV (a and b) received either 0.5 or 1.0 micrograms.kg-1.h-1 of GIP alone. Compared to group I, groups II and III had a greater insulin response during the first 30 min of the infusion. Group] IV (a and b) showed no insulin release. Glucose concentrations showed no significant change in all groups. From these results, it is concluded that insulin release after intravenous infusion of an amino acid mixture plus GIP is greater than after amino acids or GIP alone. It appears that this effect is more pronounced in the early phase of insulin release.

Amino Acids↗
PubMed1982

Pretreatment biliary lipid composition in white patients with radiolucent gallstones in the National Cooperative Gallstone Study.

Biliary lipid classes (bile acids, phospholipids, cholesterol) as well as individual biliary bile acids were measured in duodenal bile samples obtained before treatment from 284 white men and 264 white women participating in the National Cooperative Gallstone Study. The patients had radiolucent gallstones present in visualizing gallbladders. Calculated biliary cholesterol saturation was significantly higher in women (143 +/- 43, mean +/- SD, vs. 132 +/- 39 for men). Chenodeoxycholic acid was the major biliary bile acid in both sexes (40.0 +/- 9.9 in men; 38.8 +/- 9.3 in women, NS). Cholic acid was the second most common bile acid, constituting 32.9 +/- 8.8 in men and 31.8 +/- 8.9 in women (NS). When other demographic and clinical characteristics, including serum lipids, were related with biliary lipid composition, only percent ideal body weight correlated significantly. The partial correlation coefficient adjusted for percent ideal body weight indicated that the proportion of chenodeoxycholic acid correlated negatively with the mole fraction of cholesterol in bile in men, but not in women. Multiple regression analyses showed that bile saturation could not be predicted reliably from any clinical, chemical, or radiologic measurement in either sex. Published data for biliary lipid composition in individuals with biliary disease showed considerable overlap with the National Cooperative Gallstone Study data reported here, suggesting that cholesterol gallstone disease is not caused solely by increased biliary cholesterol saturation.

Adult↗
PubMed1977

Esophageal intramural pseudodiverticulosis.

Three cases of esophageal intramural pseudodiverticulosis (EIP) are described and the literature reviewed. We conclude that EIP is an inflammatory disease of unknown etiology characterized by dilatation of the esophageal submucosal glandular elements. The classic radiographic picture which is that of collar-button-shaped outpouchings projecting in a perpendicular fashion from the luminal surface is mainly related to dilatation in the glandular ductal system. It is usually diagnosed in the sixth and seventh decades, but all ages may be affected. Dysphagia is a very common but not universal symptom of the disease process. Approximately one third of these patients have diabetes mellitus. Strictures of the esophagus are frequently seen, and varying degrees of esophagitis may be manifest endoscopically. Esophageal motility disturbances are common and may be severe. Candida infestation with and without tissue invasion has been seen in a number of patients and should be searched for in all cases of EIP.

Candida albicans↗