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Biomedical subjects

J Lantos

Publications and source records attributed to J Lantos.

At least 19 recordsLinked to original sources
PubMed1992

What is the legal 'standard of medical care' when there is no standard medical care? A survey of the use of home apnea monitoring by neonatology fellowship training programs in the United States.

In treating a patient, a doctor is obliged to use the skill and care that is ordinarily used by reasonably well-qualified doctors in similar cases. In addition, the only way in which a juror may decide whether the defendant used the skill and care which the law required of him or her is from evidence presented by doctors called as expert witnesses (cf Illinois Pattern Jury Instructions). However, what should be done if expert opinions differ concerning the care that is "ordinarily used"? Home apnea monitoring (HAM) is prescribed at times for graduates of neonatal intensive care units despite the fact that indications for its use are not well established and efficacy is completely unknown. The authors attempted to determine standards for HAM as it is currently practiced in neonatology training programs. The primary teaching hospital for each of the 99 neonatology training programs in the United States was identified. Both the medical director (MD) and a neonatal intensive care unit nurse manager (RN) were asked about the use of HAM in their own nursery for four clinical vignettes. Each vignette depicted a 1000-g birth weight infant, currently 7 weeks old and ready for discharge. In three vignettes, the infant had demonstrated no apnea, mild apnea (resolved by 2 weeks of age), or moderate apnea (requiring theophylline therapy at discharge) during the hospital course. In the fourth vignette, the infant had no apnea but was to be discharged home with supplemental oxygen. For 67 of 99 training programs, paired responses of RN managers and MD directors were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMed1991

Bone marrow transplantation for sickle cell disease. A study of parents' decisions.

BACKGROUND: Bone marrow transplantation has been shown to cure sickle cell disease, but it carries a 15 percent mortality risk. To determine whether parents would accept this risk to cure their children of sickle cell disease, we interviewed parents of children with sickle cell disease who were being followed in a university hospital clinic. METHODS: We assessed parents' attitudes by using questions based on the standard reference-gamble paradigm. After we gave them descriptions of bone marrow transplantation and graft-versus-host disease (GVHD), the parents were presented with a series of hypothetical situations. In the first situation, bone marrow transplantation was described as offering certain (100 percent) survival with cure of sickle cell disease. In subsequent descriptions, the mortality rate associated with bone marrow transplantation was increased by 5 percent increments. The parents indicated the highest mortality risk at which they would consent to the procedure in order to cure their children. RESULTS: In order to obtain a cure for their children, 36 of 67 parents (54 percent) were willing to accept some risk of short-term mortality, 25 of 67 (37 percent) were willing to accept at least the 15 percent short-term mortality risk we estimate to be the current figure for bone marrow transplantation, and 8 of 67 (12 percent) were willing to accept a short-term mortality risk of 50 percent or more. Nine parents (13 percent) said they would accept both a mortality risk of 15 percent or more and an additional 15 percent risk of GVHD. The parents' decisions were not related to the clinical severity of their children's illness. CONCLUSIONS: At current rates of mortality and morbidity with bone marrow transplantation, a substantial minority of the parents of children with sickle cell disease may consent to bone marrow transplantation for their children. Parental attitudes should be factored into decisions about whether to offer bone marrow transplantation to children with sickle cell disease.

Adolescent↗
PubMed1991

Clonal distribution of K1 and K5 antigen possessing Escherichia coli isolates.

A significant difference was observed in the occurrence of the examined markers (Col+, ColV+, Hly+, Aer+, AbR) and in the plasmid carrier state between strains with and without K1 and K5 antigens. Plasmids of the same size were harboured by serotypes possessing K1 and K5 antigens, e.g. among O1: K1: H- strains plasmids of 60-79 Md, among O1: K1: H7, O18ac: K1: H7, O45: K1: H7 and O83: K1: H- strains plasmids of 80-95 Md were frequent. The average plasmid number was higher in K1 strains than in K5 strains. In serogroup O1 the frequency of the plasmid carrier state was associated with the O serogroup and not with the K antigen. The plasmid number in K5 of serogroups O6 and O18 was lower than in K5- strains. Plasmids of 80-95 Md were predominant among the strains derived from blood and cerebrospinal fluid, whereas these plasmids were rare among the K1 and K5 strains isolated from other sources. Plasmids of 60-79 Md were frequent among strains derived from different sources. The 30-40 Md plasmids were relatively frequent among strains isolated from urine. In contrast with literary data, O1: K1: H-, O1: K1: H7 and other frequent serotypes consisted of different clones. Different clones were found within a single serotype, too.

Anti-Bacterial Agents↗
PubMed1990

Influence of protective drugs on the elevation of extracellular potassium ion concentration in the brain during ischaemia.

Influence of drugs on the changes of extracellular potassium ion concentration in the brain during total cerebral ischaemia was investigated. The aorta of the dogs was clamped twice with an intermittent reperfusion period of 60 min. In control experiments no significant difference was found in the elevation of extracellular potassium ion concentration of the brain during the first and second clampings. In the present study drugs were administered 10 min prior the second aorta occlusion. Verapamil in a dose of 0.125 mg/kg proved to be ineffective. Piridoxilate in a dose of 10 mg/kg and piracetam in a dose of 100 mg/kg delayed to a small extent the potassium outflow. The following drugs enhanced significantly the duration before the steep increase of potassium ion outflow: phenytoin in a dose of 10 mg/kg by 31.8 sec (p less than 0.01), ethyl-butyl-thiobarbital in a dose of 15 mg/kg by 30.2 sec (p less than 0.05), and lidocaine in a dose of 100 mg/kg by 115.8 sec (p less than 0.01). Comparing present results to our earlier data (obtained after 50 sec ischaemia) it can be concluded, that these protective influences become more effective during longer ischaemic period (2-5 min), when lidocaine, phenytoin and ethyl-butyl-thiobarbital were used. Moreover, in spite of the observation seen during shorter ischaemia, even piridoxilate and piracetam exerted some degree of protective effect. No such effect of verapamil could be detected in the present experimental model.

Animals↗
PubMed1990

Influence of protective drugs on the EEG during short-term transient ischaemia.

Influence of drugs on the cessation time of the brain electrical activity (resistance time) during total cerebral ischaemia evoked by clamping of the aorta for 50 sec; on the duration of its reappearance during reperfusion (restitution time) and on the background activity of EEG were studied. The experiments were carried out in 7 groups. Each group contained 5 animals. Nine clampings with intermittent reperfusion periods of 10 min were performed in each animal. One group served as control. In the remaining ones after the first three clampings the animals were given Glyo-6, Nootropil, Verpamil, Epanutin, Inactin or Lidocain. The resistance and restitution times measured in the control group as well as the reproductibility of the power spectrum values of the EEG provided evidence for the stability of the model. Glyo-6 in a dose of 10 mg/kg, Nootropil in a dose of 100 mg/kg or Verpamil in a dose of 0.125 mg/kg did not alter the above-mentioned parameters. As an effect of the administration of Epanutin in a dose of 10 mg/kg, the resistance time increased slightly, whereas restitution time decreased significantly. Administration of Inactin in a dose of 15 mg/kg, or Lidocain in a dose of 100 mg/kg increased considerably resistance time for a period of about one hour. The results indicate that in the initial phase of ischaemic brain damage both the cessation of EEG activity and the restitution during reperfusion after short-term occlusion of the circulation can be influenced favourable with drugs which decrease cerebral metabolism, inhibit synaptic transmission and have membrane stabilizing effect.

Animals↗
PubMed1989

Ethical issues in growth hormone therapy.

Pediatricians face clinical and ethical dilemmas about therapy to augment growth in short children who do not meet classic criteria for growth hormone (GH) deficiency. Biologic norms of health are unhelpful because of the uncertain relationship between stature, GH secretion, health, and disease. Instead, we suggest that GH therapy be evaluated from the perspective of cultural norms. We compare GH therapy for short normal children with currently accepted therapies for non--life-threatening pediatric conditions such as well-child care, cosmetic therapy, treatment of psychological problems, and invasive outpatient therapy for chronic conditions. Based on this analysis, we argue that the burdens of therapy, the uncertainty about long-term risks and benefits, the unclear therapeutic end point, and the implications for child health policy place routine GH therapy for children without documented deficiency of GH secretion outside current pediatric ethical norms. Such therapy is properly administered within a comprehensive clinical research protocol.

Beauty Culture↗
PubMed1978

The donor kidney: I. Morphology of adequate preservation.

The structure of the dog kidney can be preserved in hypothermic intracellular-type solutions, but after 6 hours the appearance of pathologic focal changes such as mild oedema, lesions of the cellular elements, podocyte heteromorphism, vacuolization, disintegration of the basal membrane and of the cytomembrane structrues and even cell degeneration, is unavoidable.

Alkaline Phosphatase↗
PubMed1978

Study of pancreatic tissue pH in the early stage of experimental acute pancreatitis.

Pancreatic pH was measured electrometrically over a period of 3 h in 34 dogs with acute necrotic pancreatis. The disease had been induced with sunflower oil in 10, with Na-taurocholate in 10 and with hen's egg yolk in 10 animals. Four dogs served as controls. The pH of the pancreatic tissue changed differently in the different groups, in accordance with the different pathomechanisms. Injection of sunflower oil was followed by a protracted acidosis of pancreatic tissue, that of taurocholate by a transitory moderate decline of pH. Egg-yolk produced an evanescent, slight fall in pancreatic pH, followed by complete normalization within a few minutes. The differences between the initial and the 3-h values attain the level of significance only in case of sunflower-oil pancreatitis.

Acute Disease↗
PubMed1978

pH-map of the stomach of normal and vagotomized dogs.

By means of electrometric surface measurements a peculiar pH-map of the mucosa of normal and vagotomized dog stomachs was obtained illustrating the different acid producing capacities of the various regions of the stomach, on the one hand, and showing that all types of vagotomy will reduce local acid secretion.

Acetylcholine↗
PubMed1977

Transfer of erythromycin resistance in Staphylococcus aureus.

In the course of an outbreak of enteritis and conjunctivitis, Staphylococcus aureus was isolated from newborn infants. Strains cultured at a later phase of the outbreak differed from those found at the beginning in being resistant to several antibiotics, showing resistance to typing phages and releasing phages of the same lysis spectrum (10(9) p.f.u./ml after heating at 56 degrees C for 2 min). Transduction experiments with a strain and its cell-free lysate showed that inducible erythromycin resistance was transferable to strains isolated at the beginning of the outbreak and to laboratory strains. Plasmid origin of resistance was confirmed by (i) high transduction frequency; (ii) transduction to RN981 rec- mutants; (iii) kinetics of transduction; (iv) elimination of resistance. Mixed culture experiments yielded transductants at high frequency with resistance to erythromycin, streptomycin and tetracycline.

Erythromycin↗
PubMed1977

Electric activity and oxygen tension of the brain during ischaemic anoxia and reperfusion.

Electric activity of the cerebral cortex and the mesencephalon and pO2 of the brain surface were analysed in 47 dogs after serial periods of cerebral anoxia induced by clamping of the aorta for less than 3 minutes and subsequent reperfusion. After restoring the circulation, characteristic stages were observed in the normalization of cortical electric activity and pO2. Improvement in cortical oxygen utilization progressed parallel to the return of rapid activity, though normalization of the EEG preceded that of oxygen utilization. The relative duration of the stages determined from the pO2 curve and from the parameters of electric activity allowed conclusions concerning the injury of the brain tissue. It is assumed that [1] after ischaemic anoxia an excess perfusion develops in the brain; [2] during anoxia, autoregulation of the cerebral vascular system ceases simultaneously with the disintegration of the oxidative metabolic processes of the brain; [3] restitution of the cortex is indicated more reliably by its oxygen consumption rate than by the normalization of EEG activity.

Animals↗
PubMed1976

Antigenic changes in Pseudomonas aeruginosa in vivo and after lysogenization in vitro.

Pseudomonas aeruginosa cultures not conforming in antigenic structure to established serogroups were isolated from infants and from infants and from 23 O antigen type strains lysogenized with 22 different phages in vitro. The derivatives, characterized by smooth colonial form and heat stability, retained at least part of the antigens of the parent strains and became agglutinable in certain heterologous sera. All derivatives showed immunoelectrophoretic patterns identical with those of the parent strains. Antigenic analysis showed the presence of factors in the derivatives identical with (italicized figures), bilaterally related to (non-bracketed figures) or unilaterally related to (bracketed figures) O antigens of LANYI's schema: (i) changes in vivo, 01 leads to 01, (O8); O11a, 11b leads to O11a, 11c; (ii) changes in vitro, O1 leads to O1, (O8); O4a, 4b leads to O4a,4b,O1,O8,(O10a), O11; O4a,4b leads to O4a,4b,O1,O8,O10a,O11; O4a,4c leads to O4a,4c,O1,(O8),(O10a),(O11). The antigenic changes were accompanied usually by a loss of sensitivity to several typing phages and the lytic spectrum of phages released from the derivatives had become narrower. The findings suggest that multiple agglutinability of P. aeruginosa frequently encountered in nature is associated with phage action.

Antigens, Bacterial↗
PubMed1976

Viability of extracorporeally perfused dog livers.

The possibility of structural and functional preservation of the isolated liver has been studied in dog experiments. A sterile liver preparation left in situ was worked out, having practically no ischaemic period, except during perfusion. Nevertheless, well-defined lesions (perivascular and interstitial oedema, dissociated contraction of the smooth muscle elements of the veins, cellula accumulation in the sinusoids) appeared, accompanied by a gradual reduction (microcirculatory disorders, enzyme derailment) of the function of hepatocytes.

Animals↗
PubMed1975

Resorption of 125I-labeled fibrin bioplast from the dorsal muscle of rats.

Fibrin bioplast is an implant material made from plasticized fibrin. The resorption and route of elimenation of 125I-tagged bioplast plates implanted into the back muscle of rats have been studied in 18 experiments. Variation in radioactivity of the implant, appearance of the activity in the urine and fecal output, supplemented with information on the radioactivity of the implant site and that of isolated organs, reveal that the elimination of bioplast begins on the 12th day and proceeds at an even rate without pathological tissue reactions. By the 42nd day 10 to 12% of the original material is present. The elimination of the implant material is complete and occurs mainly with urine through the kidneys.

Animals↗