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H Segal

Publications and source records attributed to H Segal.

At least 37 records · Page 2Linked to original sources
PubMed1995

The effects of cardiopulmonary bypass on systemic and coronary levels of von Willebrand factor.

Von Willebrand factor antigen (vWF Ag) is a marker of endothelial injury which has been shown to rise during surgical procedures, including cardiopulmonary bypass (CPB). The aim of this study was to determine whether intermittent aortic cross-clamping during CPB causes the release of vWF Ag from the coronary vascular bed, which would suggest coronary vascular endothelial cell perturbation. Fifteen consecutive patients undergoing CPB with aortic cross-clamping during coronary artery bypass surgery and/or valve replacement by the same surgeon were studied. Paired venous and coronary sinus samples were taken pre- and post-thoracotomy, prior to cross-clamping on CPB, and 1, 5 and 10 minutes after release of the aortic cross-clamp. Plasma vWF Ag (IU/ml) was measured by ELISA. Venous vWF Ag measured prior to skin incision was 0.75 +/- 0.11 IU/ml (mean +/- SEM) and fell to 0.53 +/- 0.07 IU/ml after institution of CPB but prior to aortic cross-clamping (P < 0.01 vs pre-incision sample). Coronary sinus vWF Ag measured prior to aortic cross-clamping was 0.54 +/- 0.06 IU/ml (P = NS vs paired venous sample). At 1, 5 and 10 min after release of the aortic cross-clamp there was a progressive rise in vWF Ag in both venous and coronary sinus samples (1 min: 0.67 +/- 0.05 IU/ml vs 0.75 +/- 0.10 IU/ml, 5 min: 0.73 +/- 0.07 IU/ml vs 0.76 +/- 0.09 IU/ml, 10 min: 0.74 +/- 0.08 IU/ml vs 0.79 +/- 0.09 IU/ml; P = NS venous vs coronary sinus, respectively). Levels of vWF Ag were highest immediately prior to the termination of CPB (venous: 0.95 +/- 0.12 IU/ml; coronary sinus: 0.91 +/- 0.14 IU/ml). We conclude that cardiac surgery using CPB with aortic cross-clamping is associated with a progressive rise in coronary sinus and venous levels of vWF Ag.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

False-positive cryptococcal antigen latex agglutination caused by disinfectants and soaps.

Five disinfectants or soaps were tested to determine if any could be responsible for false-positive results obtained with the Latex-Crypto Antigen Detection System kit (Immuno-Mycologics, Inc., Norman, Okla.). Three disinfectants or soaps (Derma soap, 7X, and Bacdown) produced false-positive agglutination after repeated washing of ring slides during testing of a known negative cerebrospinal fluid specimen.

Antigens, Fungal↗
PubMed1995

A prospective study of adolescent suicidal behavior following hospitalization.

Identification of factors associated with adolescent suicidal behavior following psychiatric hospitalization would facilitate development of effective aftercare interventions. This prospective study identified specific predictors of suicidal behavior in 100 adolescents during a 6-month follow-up period. Standardized baseline assessments and structured follow-up telephone interviews were conducted with adolescents and their guardians. Eighteen percent of adolescents reported suicidal behavior during the follow-up period, primarily of low medical lethality and minimal or ambivalent suicidal intent. This behavior was associated with suicidal thoughts, family dysfunction, and dysthymia. It was not associated with initial posthospitalization treatment compliance. Implications of these findings are discussed.

Adolescent↗
PubMed1994

Comparison of updated Vitek Yeast Biochemical Card and API 20C yeast identification systems.

The updated Vitek Yeast Biochemical Card (YBC) was compared with the API 20C by using 409 germ tube-negative yeasts and Geotrichum spp. that were either clinical or proficiency sample isolates. The API 20C was the reference standard. The 409 isolates represented nine genera and 21 species. Morphology agars were inoculated and interpreted for each isolate. The API 20C identified 406 isolates (99.3%), while the Vitek YBC identified 367 (89.7%). Both systems identified the majority of yeasts after 24 h of incubation--73.4% were identified by the API 20C and 77.4% were identified by the Vitek YBC. The Vitek 24-h reading had some incorrect identifications. These included 14 isolates of Candida tropicalis that were identified as Candida parapsilosis (91 to 97% reliability) and 3 isolates of Candida krusei that were called Blastoschizomyces capitatus (Geotrichum capitatum), Candida rugosa, and Candida zeylanoides. In total, the Vitek YBC misidentified 30 isolates, while the API 20C misidentified 3 isolates. In addition, results for 14 isolates with the Vitek YBC were listed under the category "no identification." Morphology agars were required for identification with 89 isolates (21.9%) when the API 20C was used and with 50 isolates (12.6%) when the Vitek YBC was used. Apart from the price of the Vitek instrument, the API 20C costs $1.28 more per test than the Vitek YBC. Overall, the updated Vitek YBC compares favorably with the API 20C in the identification of common yeasts such as Torulopsis glabrata, C. parapsilosis, and Cryptococcus neoformans. However, problems were encountered with the Vitek system in the identification of C. tropicalis, C. krusei, Trichosporon spp., and some Cryptococcus spp. The routine use of morphology agars with either method is recommended.

Agar↗
PubMed1994

Community relations.

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Community-Institutional Relations↗
PubMed1994

Salman Rushdie and the sea of stories: a not-so-simple fable about creativity.

This paper examines Salman Rushdie's tale 'Haroun and the Sea of Stories', written for his younger son while Rushdie was in hiding from the fatwa. It is a fairy tale about the boy Haroun, who travels to the moon to find a cure for his father's loss of capacity to tell stories. There he discovers that the Ocean of Stories-source of all stories--is polluted. The author sees this tale as a parable of creativity, which can be used on many levels. On one level, it describes the artist's struggle against forms of political oppression, which aims at destroying all art, speech and thought. On another level, it could be seen as an internal conflict between the creative forces derived from the life instinct and those which are destructive and self-destructive deriving from the death instinct. Rushdie describes ways of dealing with this conflict and different outcomes depending on the way the conflict is faced.

Creativity↗
PubMed1994

Phantasy and reality.

To mark the fiftieth anniversary of the Controversial Discussions the author has selected the interplay between phantasy and reality for further consideration. Basing her thinking on her reading of Klein and Freud she reviews her own contribution to symbolic forms of expression--the distinction between a symbol and a symbolic equation--which combine phantasy and reality and articulates this with the recent work of the philosopher Wollheim. She restates her argument that the early processes of symbol development and their pathological variations are analysable through an understanding of the patient's relationship to the analyst, offering as it does an opportunity to explore and analyse the influence of phantasy and reality in influencing how the patient perceives the analyst and acts towards her. This view is illustrated with material from several cases leading on to a discussion of the nature and function of phantasy, delusion formation and phantasy-testing leading to thought.

Defense Mechanisms↗
PubMed1993

Hemostatic changes in heart transplant recipients and their relationship to accelerated coronary sclerosis.

Hemostasis was assessed in 115 steady-state heart transplant recipients (HTRs) and compared with that of 23 age-matched healthy controls and 21 age-matched patients with ischemic heart disease (IHD). Compared with the controls, the HTRs had increased levels of fibrinogen (mean and 95% confidence limits of 4.50 [4.32-4.68] g/L versus 3.47 [3.07-3.87] g/L, P < 0.001), factor VIIC (1.16 [0.98-1.21] IU/ml versus 0.99 [0.89-1.10] IU/ml, P < 0.001), and von Willebrand factor antigen (1.72 [1.58-1.88] IU/ml versus 1.00 [0.80-1.26] IU/ml, P < 0.001). HTRs had increased antithrombin III activity (P = 0.002) and protein C activity (P = 0.002), with a decrease in total protein S levels (P < 0.001) but no change in free protein S levels. Stepwise discriminant analysis of hemostatic variables showed that fibrinogen was the best discriminator of the three groups, classifying 55.6% of HTR, 40% of IHD, and 66.7% of the controls. More marked prothrombotic changes were found in HTRs transplanted for IHD than for other causes; this reached significance for prothrombin (P = 0.048), factor IX (P = 0.003), and poor fibrinolytic activity as measured by euglobulin clot lysis time (P = 0.008). The HTRs with accelerated coronary sclerosis (ACS) tended to have the most prothrombotic changes; this reached significance with factor IX (P = 0.03). In conclusion, HTRs have perturbed hemostasis; the net effects of these changes are prothrombotic. The relationship between prothrombotic changes and ACS merits further studies.

Adult↗
PubMed1993

Analgesic onset time as a measure of topical anesthetic efficacy in spontaneous toothache pain: a pilot study.

The purpose of this pilot investigation was to determine the usefulness of analgesic onset time as a measure of topical anesthetic efficacy in patients with spontaneous toothache pain. Under blinded conditions, 20 patients with spontaneous toothache pain from an open tooth cavity were randomly assigned to receive either 20% benzocaine or placebo (80% polyethylene glycol). The medication was applied directly to the open cavity in a volume of 3 drops. Patients then depressed a stop watch when they initially experienced pain relief. Patients who did not obtain relief were assigned the maximum onset value of 600 seconds. The average analgesic onset time was 111.8 seconds in the benzocaine group and 289.0 seconds in the placebo group. In the benzocaine group, 90% of the patients reported some pain relief, while a surprisingly high 60% reported some pain relief in the placebo group. The results of this study suggest that in the spontaneous toothache pain model, analgesic onset time is a valuable measure of topical anesthetic efficacy. In addition, polyethylene glycol at a concentration of 80% may not be a totally inactive vehicle.

Adult↗
PubMed1993

On the clinical usefulness of the concept of death instinct.

Freud's concept of the death instinct is often considered as a purely biological speculation, and very few psychoanalysts consider it useful in clinical work. Yet Freud was led to it by purely clinical problems. Klein used Freud's concept of the duality of instinct in her clinical work, but mainly she addressed herself to the conflict between love and hate of the object, considering hate as an expression of the deflected death instinct. I contend that the death instinct from the beginning is directed at both the perceived object and the perceiving self, resulting in such phenomena as pathological projective identification, described by Bion. The defences against the death instinct create vicious circles leading to severe pathology. I try to show in some clinical examples how analysing those vicious circles, and confronting the death instinct in the stable setting of analytic work, can lead to a mobilisation of the life forces in the patient.

Adult↗
PubMed1992

Aprotinin and heparin monitoring during cardiopulmonary bypass.

BACKGROUND: When high-dose aprotinin is used during cardiopulmonary bypass, there is a prolongation of the activated coagulation time (ACT), which is used to monitor heparinization. The aim of this study was to provide guidelines for monitoring heparin levels by the ACT if aprotinin is used during cardiopulmonary bypass. METHODS AND RESULTS: Heparinized blood from six healthy controls and nine patients on cardiopulmonary bypass was aliquoted and mixed with various concentrations of aprotinin. ACTs were performed on these samples. Activated partial thromboplastin times (APTT) were performed on the citrated plasma mixed with varying concentrations of heparin and aprotinin from the same control patients. Prothrombin times (PT) were performed on plasmas mixed with aprotinin. Aprotinin produced a dose-related prolongation of ACT and APTT but had no effect on PT. This effect occurred whatever the activating agent and in the absence of heparin. CONCLUSIONS: Aprotinin prolongs the ACT and APTT independently of heparin. If high-dose aprotinin is used during cardiopulmonary bypass, ACTs should be maintained at times > 750 seconds to allow for appropriate levels of heparin.

Aprotinin↗