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Biomedical subjects

J Kempf

Publications and source records attributed to J Kempf.

At least 19 recordsLinked to original sources
PubMed1999

Noninvasive pressure support ventilation (NIPSV) with face mask in patients with acute cardiogenic pulmonary edema (ACPE)

OBJECTIVES: To assess (1) the short-term hemodynamic, respiratory and arterial blood gas effects of NIPSV in patients with ACPE who were likely to require endotracheal intubation, (2) the initial causes of failure and (3) the side effects and the difficulties of this technique. DESIGN: Uncontrolled, prospective clinical study. SETTING: Teaching hospital intensive care unit. PATIENTS: 26 consecutive patients with severe ACPE. INTERVENTIONS: Noninvasive ventilation via a face mask, using a pressure support mode (20.5+/-4.7 cm H2O), with an initial fractional inspired oxygen of 93.0+/-16% and a positive end-expiratory pressure of 3.5+/-2.3 cm H2O. The need to intubate the patients within 48 h was considered as a criterion of failure of the procedure. MEASUREMENTS AND RESULTS: Clinical and biological parameters were measured at 15 and 30 minutes, 1 h and 2 h and at 1 h and 2 h, respectively. There were 5 (21%) failures and 21 (79%) successes. In both the success and the failure groups, clinical and blood gas parameters improved at the first measure. In the success group, within 15 min of the start of NIPSV, pulse oximetry saturation (SpO2) had increased from 84+/-12 to 96+/-4% (p<0.001), the respiratory rate (RR) had decreased from 36+/-5.3 to 22.4+/-4.9 breaths/ min (p<0.0001) and within 1 h the arterial oxygen tension and pH, respectively, had increased from 61+/-14 to 270+/-126 mm Hg (p<0.0001) and from 7.25+/-0.11 to 7.34+/-0.07 (p<0.01) and the arterial carbon dioxide tension (PaCO2) had decreased from 54.2+/-15 to 43.4+/-6.4 mm Hg (p<0.01). There were no statistical differences between the success and failure groups for the initial clinical parameters: SpO2, RR, heart rate, mean arterial pressure. The only differences between the success and failure groups were in the PaCO2 (54.2+/-15 vs. 32+/-2.1 mm Hg, p<0.001) and the creatine kinase (CPK) (176+/-149 vs. 1282+/-2080 IU/l, p<0.05); this difference in CPK activity was related to the number of patients who had an acute myocardial infarction (AMI) (4/5 in the failure group vs. 2/21 in the success group, p<0.05). All patients with AMI in the failure group died. CONCLUSION: Among patients in acute respiratory failure, those with severe ACPE could benefit from NIPSV if they are hypercapnic, but NIPSV should be avoided in those with AMI.

Acute Disease↗
PubMed1997

[Obstructive renal insufficiency caused by amoxicillin crystalluria].

A 76-year-old woman was admitted to the ICU for a meningitis with rhombencephalitis due to Listeria monocytogenes. The treatment included amoxicillin (250 mg.kg-1.day-1) and gentamicin (3 mg.kg-1.day-1 over 6 days). Neurological outcome was favourable. However at the 14th day, an acute renal failure occurred, following macroscopic haematuria and milkiness urine. CT scan and sonography confirmed the diagnosis of obstructive renal failure with bilateral ureteral obstruction. Crystalluria caused by amoxicillin was suspected. Endoscopic ureteral insertion of double-J catheters permitted the recovery of a normal renal function.

Acute Kidney Injury↗
PubMed1996

Haemodynamic study as guideline for the use of beta blockers in acute theophylline poisoning.

It has been proposed that beta-blocker therapy reverses metabolic and cardiovascular disorders in acute theophylline poisoning. We present a case of acute theophylline overdose treated with esmolol under haemodynamic control. Haemodynamic monitoring was useful in determining the appropriate duration of administration of esmolol and in deciding on treatment with fluids.

Adrenergic beta-Antagonists↗
PubMed1996

Discrimination learning and multiple reversals in young adult and older monkeys (Macaca arctoides).

Two groups of five young adult an older stumptailed macaques (Macaca arctoides) were tested on a visual discrimination task followed by a reversal upon attainment of criterion; task and reversal were repeated until 20 reversals with the same pair of objects had been completed. Both groups required more trials to learn the first reversal than the original discrimination, with no significant difference between the groups. Older monkeys tended to show more perseverative errors on early reversals, but a striking improvement in their scores across successive blocks of reversals culminated in performances virtually indistinguishable from those of the young group by the end of testing.

Age Factors↗
PubMed1996

Impact of tobacco-free policy on recruitment and retention of adolescents in residential substance abuse treatment.

As residential treatment programs consider adopting smoke-free policies, treatment providers question whether such policies interfere with patient recruitment and retention. This study assesses the effect of a smoke-free policy on retention using a sample of 155 low-income, mainly minority youth, randomly assigned to two long-term adolescent residential programs at the New Jersey Substance Abuse Treatment Campus. One of these programs has a smoke-free policy, the other does not. Smoking rates are high for the sample. Eighty-five percent of those adolescents smoke, on average half a pack daily, and 39% smoke a pack or more daily. Differential dropout rates between programs for key time periods related to tobacco withdrawal were analyzed to assess the potential effect of smoking policy on retention. Differential dropout rates at the point of program assignment, in the first two days of residency (p = .43), and for the first two weeks of residency (p = .37) show no differences between programs. While analyses showed heavy smokers are more likely than others to leave treatment early, they were likely to leave from either program regardless of smoking policy. As well, verbal expressions of dissatisfaction with smoking policy did not result in drop outs. These results indicate that smoke-free policies have no detrimental effect on program retention.

Adolescent↗
PubMed1995

Positive and negative effects of nuclear receptors on transcription activation by AP-1 of the human choline acetyltransferase proximal promoter.

We have examined the 5'-flanking region (944 bp) of the human choline acetyltransferase (hChAT) gene for sequences that modulate its transcriptional activity and identified a sequence 5'-TGACCCA-3' which confers c-Jun/c-Fos (AP-1) inducibility of homologous and heterologous promoters. Using transient transfections in neuroblastoma NE-1-115 and COS-1 cells, we show that ligand-activated estrogen receptor (HEGo) represses the transcriptional activation by c-Fos/c-Jun. Testing HEGo mutants in transfection assays reveals that the ligand-binding domain is crucial for this repression, whereas the N-terminal (A/B) region and the DNA-binding domain are not essential. Gel retardation assays show that the hChAT AP-1 recognition sequence binds in vitro baculovirus-produced c-Jun/c-Fos proteins. This binding is inhibited by addition of baculovirus-produced HEGo. In contrast to HEGo, ligand-activated glucocorticoid, androgen, and retinoic acid receptors (RARs) enhance the transcription activation induced by c-Jun/c-Fos. All three types of RARs--RAR alpha, beta, gamma--and RXR alpha are able to stimulate AP-1 activity on the proximal hChAT promoter. Several mechanism possibilities involving protein-protein interaction are discussed to explain the phenomena.

Cells, Cultured↗
PubMed1995

Factors associated with pregnancy and pregnancy resolution in HIV seropositive women.

This study examines factors associated with pregnancy and pregnancy resolution among 238 HIV-infected women, 55 of whom experienced a recent pregnancy since learning of their HIV positive serostatus. Results suggest the importance of psychosocial and cultural factors, particularly those involving the primary sex partner, to reproductive decision-making in HIV-infected women. They also indicate a consistency of reproductive behavior before and after HIV infection, suggesting that the infection itself does not significantly alter existing childbearing trends. Biomedical considerations relating to the mother's health status and the risk of transmission to the child have a greater impact on decisions surrounding pregnancy resolution than they do on the probability of becoming pregnant.

Abortion, Induced↗
PubMed1995

Diffuse Tl-201 uptake in the lungs. Etiologic classification and pattern recognition.

Diffuse Tl-201 uptake in the lungs could be because of cardiac, neoplastic, inflammatory, or interstitial lung disease. Examples from the different categories, differential diagnosis, and different patterns are presented. The authors discuss the different mechanisms of increased Tl-201 uptake in the lungs which vary according to the underlying pathology.

AIDS-Related Opportunistic Infections↗
PubMed1995

Diffuse bilateral lung uptake of TI-201 chloride in CMV pneumonitis. Case presentation with histopathologic correlation.

Diffuse intense lung uptake of TI-201 chloride without abnormal Ga-67 citrate in a case of cytomegalovirus pneumonitis in a patient with AIDS is presented. An autopsy performed within 4 days of imaging revealed no pulmonary pathology other than diffuse cytomegalovirus infection with abundant histiocytes and inclusion bodies and pulmonary congestive heart failure. Among the various mechanisms of TI-201 accumulation, active transport through Na-K ATPase appears to be predominant in this case, as suggested by innumerable histiocytes. It is the authors' experience that positive TI-201 uptake without abnormal Ga-67 accumulation is highly specific for pulmonary Kaposi sarcoma. The presence of such discrepancy between TI-201 and Ga-67 uptake in AIDS patients decreases the specificity of a TI-201 positive/Ga-67 negative lesion for pulmonary Kaposi sarcoma, especially with the rising incidence of both cytomegalovirus and Kaposi sarcoma in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Clinical predictors of computed tomographic abnormalities following pediatric traumatic brain injury.

Children commonly seek attention in emergency departments following head injury. Head computed tomography (CT) is often used to decide subsequent disposition. Clinical criteria predicting CT abnormalities would allow effective and timely treatment and minimize unnecessary procedures depleting overburdened medical resources. We prospectively compared presenting clinical features with subsequent emergent head CT in 300 children less than 19 years old over a nine-month period. The disposition of patients following imaging was also recorded. Only suspected abuse was more than 50% positively predictive in children below age two and those above age two. Two signs were more than 67% positively predictive in both age groups: focal motor deficit and pupillary asymmetry. Patients with abnormal CTs were the only children to undergo emergent neurosurgery (30%) and were nearly five times as likely to be intensively monitored. Children with normal CTs were nearly five times as likely to be observed in a routine department or at home. We conclude that no single clinical feature can predict with certainty an abnormality on immediate head CT. However, children suspected of being abused, and those with focal motor deficits or pupillary asymmetry, should be imaged. Finally, emergent CT when judiciously ordered likely reduces unforeseen morbidity and minimizes costly intensive care observation.

Adolescent↗
PubMed1994

Severe malaria in African adults living in a seasonal endemic area.

OBJECTIVE: This study investigates severe malaria in African adults living in a seasonal endemic area. DESIGN: A prospective study of all adults admitted with severe malaria over 2 consecutive seasons: October 1990 till January 1991 and October 1991 till January 1992. SETTING: ICU (15 beds) of Hôpital Principal, Dakar, Sénégal. PATIENTS: 23 patients: 14 men and 9 women with a mean age of 30 +/- 3 years were included in the study; all fulfilled the 1990 WHO criteria for severe malaria. RESULTS: At admission, 12 patients were comatose (Glasgow Coma Scale < 10), 7 had generalized convulsions. Parasitaemia was 135 +/- 52 x 10(9)/l. Biological indications of severity were as follows: hypophosphataemia < 0.8 mmol/l in 14 cases, serum creatine phosphokinase > 500 IU/l in 15 cases; and PaO2 < 70 mmHg in 5 cases. Serum TNF alpha levels, measured in 16 cases, were increased at 298.4 +/- 63.5 pg/ml, serum levels of IL-6 and IL-2SR were also elevated: 609.5 +/- 304.2 pg/ml and 297.6 +/- 35.6 pg/ml respectively. Circulating IgM and IgG antibodies were found in 14 out of 16 patients. Serum levels of TNF alpha, IL-6 and IL-2SR correlated positively with each other. TNF alpha and IL-2SR were also positively correlated to parasitaemia. Intravenous therapy with quinine at loading dose was favorable in 19 patients. Four patients died during the study, 3 from multiple organ failure. CONCLUSIONS: This work demonstrated that severe malaria in a seasonal endemic area displays original clinical features with a high rate of either cerebral malaria or multiple organ failure.

Adolescent↗
PubMed1994

Diffuse thallium lung uptake in Pneumocystis carinii pneumonia.

Five patients with AIDS with Pneumocystis carinii pneumonia (PCP) showed diffuse bilateral lung uptake on sequential thallium and gallium scans. This creates a problem in the sequential use of these tests for the differentiation of Kaposi's sarcoma from acute inflammatory or other malignant diseases. In Kaposi's sarcoma, thallium uptake is usually focal and not diffuse unless associated with other pathology. However, in PCP the diffuse thallium lung uptake may be due to congestion, increased vascular permeability, and extravasation of thallium into the lung parenchyma.

AIDS-Related Opportunistic Infections↗
PubMed1993

Identification and analysis of the human choline acetyltransferase gene promoter.

Choline acetyltransferase (ChAT) is the key enzyme responsible for the synthesis of the neurotransmitter acetylcholine and is reduced in various central neurodegenerative diseases. From a previously selected 12.6 kb human choline acetyltransferase (hChAT) genomic clone, we have identified and characterized a promoter region of 895 bp. Sequence analysis revealed the presence of a TATA-like box, a CAAT box and several putative regulatory responsive elements. Three transcription initiation sites were determined by primer extension analysis. The Northern blot of poly(A)+ RNA, showed a single band of 2300 Nt in the human nucleus accumbens and facial nucleus. By using transient transfections into NE-1-115 and COS-1 cells of the 5' flanking region of the hChAT gene we identified a sequence of 66 bp upstream of the transcription start site which confers responsiveness to proto-oncogenes c-Fos/c-Jun. These data suggest that the hChAT gene may be a physiological target of c-Fos/c-Jun and therefore may play a role in neuronal responses to various stimuli.

Base Sequence↗
PubMed1993

Gallbladder activity appearing 6 minutes after the intravenous injection of Tc99m MAG3 simulating a picture of obstructive uropathy of the right kidney.

Two cases of Tc-99m MAG3 renograms performed on the same day are presented. Both of them show considerable liver activity, which is a known drawback for MAG3 by distribution. In the first case, gallbladder activity appeared after 6 minutes, at the same time when tubular drainage and caliceal activity started to show in both kidneys. The gallbladder activity was superimposed over the upper calyces of the right kidney and simulated an obstructive pattern in the time-activity curves. This early gallbladder activity after intravenous injection of Tc-99m MAG3 has not been previously reported. The second case is presented for the purpose of confirming that nothing in the preparation of the kit contributed to this phenomenon.

Adult↗
PubMed1993

Differences in performance of young and old monkeys on a visuospatial memory task.

Two groups of stumptailed macaques (Macaca arctoides) were compared in terms of performance on a visuospatial working memory task involving repeated presentations of an array of 15 doors, each of which concealed one food reward at the start of a session. Rewards obtained by the subject were not replaced. Errors were defined as responses to doors previously pushed open during the session. Both groups generally obtained all rewards and showed improved performance across sessions, but old monkeys consistently made more errors than young ones, especially in the latter half of a given session. Further, old monkeys were less diverse in the errors they made, indicating different response strategies by the two groups.

Age Factors↗