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Biomedical subjects

J Metzger

Publications and source records attributed to J Metzger.

At least 19 recordsLinked to original sources
PubMed2007

Randomized clinical trial of Lichtenstein's operation versus mesh plug for inguinal hernia repair.

BACKGROUND: Two of the most commonly used open prosthetic tension-free techniques for inguinal hernia repair are Lichtenstein's operation and the mesh plug repair. The technique of choice remains a subject of ongoing debate. The objective of the present investigation was to compare the two surgical procedures with respect to associated morbidity and recurrence rates. METHODS: Five hundred and ninety-five patients with 700 primary or recurrent inguinal hernias were randomized to undergo either Lichtenstein's operation or mesh plug repair. The primary endpoint of the investigation was the recurrence rate 1 year after surgery. Secondary endpoints were perioperative complications and reoperation rates. RESULTS: At 12-month follow-up, 597 hernia repairs (85.3 per cent) were evaluated. There were no significant differences regarding recurrence rates and perioperative complications. However, there was a significant difference in the overall reoperation rate between the two treatment groups, with 13 reoperations (4.2 per cent) in the Lichtenstein group and four (1.4 per cent) in the mesh plug group (P = 0.047). CONCLUSION: Lichtenstein's operation and the mesh plug repair are comparable with respect to perioperative complications and recurrence rates.

Adult↗
PubMed2004

Ileocecal reservoir reconstruction after total mesorectal excision: functional results of the long-term follow-up.

BACKGROUND: The aim of this study is to obtain functional results of the long-term follow-up after TME and ileocecal interposition as rectal replacement. METHODS: The study included patients operated on between March 1993 and August 1997 who received an ileocecal interposition as rectal replacement. Follow-up was carried out 3 and 5 years postoperatively. For statistical analysis, the paired t-test, rank test (Wilcoxon), and chi-square or Fisher's exact test were applied; level of significance, P<0.05. RESULTS: Forty-four patients were included in the studies. Of these, five were not available and four patients could not be evaluated (dementia 1, radiation proctitis 1, fistula 1, pouchitis 1). Seventeen patients died during the observation period; 12 died of the disease. Recurrence of the disorder occurred in 2 of 35 patients (5.7%); 26 and 18 patients, 3 and 5 years postoperatively, respectively remained in the study. At 5 years, 78% of the patients were continent; mean stool frequency was 2.5+/-1.6 per day. CONCLUSIONS: Functional results and subjective assessment of ileocecal interposition were constant at 3 and 5 years postoperatively. If construction of a colonic J-pouch is not possible due to lack of colonic length, especially after prior colonic resections, the ileocecal interpositional reservoir may offer an alternative to rectal replacement.

Anastomosis, Surgical↗
PubMed2004

Agro-economic impact of cattle cloning.

The purpose of this paper is to review the economic and social implications of cloned cattle, their products, and their offspring as related to production agriculture. Cloning technology in cattle has several applications outside of traditional production agriculture. These applications can include bio-medical applications, such as the production of pharmaceuticals in the blood or milk of transgenic cattle. Cloning may also be useful in the production of research models. These models may or may not include genetic modifications. Uses in agriculture include many applications of the technology. These include making genetic copies of elite seed stock and prize winning show cattle. Other purposes may range from "insurance" to making copies of cattle that have sentimental value, similar to cloning of pets. Increased selection opportunities available with cloning may provide for improvement in genetic gain. The ultimate goal of cloning has often been envisioned as a system for producing quantity and uniformity of the perfect dairy cow. However, only if heritability were 100%, would clone mates have complete uniformity. Changes in the environment may have significant impact on the productivity and longevity of the resulting clones. Changes in consumer preferences and economic input costs may all change the definition of the perfect cow. The cost of producing such animals via cloning must be economically feasible to meet the intended applications. Present inefficiencies limit cloning opportunities to highly valued animals. Improvements are necessary to move the applications toward commercial application. Cloning has additional obstacles to conquer. Social and regulatory acceptance of cloning is paramount to its utilization in production agriculture. Regulatory acceptance will need to address the animal, its products, and its offspring. In summary, cloning is another tool in the animal biotechnology toolbox, which includes artificial insemination, sexing of semen, embryo sexing and in vitro fertilization. While it will not replace any of the above mentioned, its degree of utilization will depend on both improvement in efficiency as well as social and regulatory acceptance.

Animals↗
PubMed2004

Risk of injury for occupants of motor vehicle collisions from unbelted occupants.

OBJECTIVE: Unbelted occupants may increase the risk of injury for other occupants in a motor vehicle collision (MVC). This study evaluated the association between occupant restraint use and the risk of injury (including death) to other vehicle occupants. DESIGN: A population based cohort study. SETTING: United States. SUBJECTS: MVC occupants (n = 152 191 unweighted, n = 18 426 684 weighted) seated between a belted or unbelted occupant and the line of the principal direction of force in frontal, lateral, and rear MVCs were sampled from the 1991-2002 National Automotive Sampling System General Estimates System. Offset MVCs were not included in the study. MAIN OUTCOME MEASURE: Risk ratios and 95% confidence intervals for injury (including death) for occupants seated contiguous to unbelted occupants compared to occupants seated contiguous to belted occupants. Risk ratios were adjusted for at risk occupant's sex, age, seating position, vehicle type, collision type, travel speed, crash severity, and at risk occupants' own seat belt use. RESULTS: Exposure to unbelted occupants was associated with a 40% increased risk of any injury. Belted at risk occupants were at a 90% increased risk of injury but unbelted occupants were not at increased risk. Risks were similar for non-incapacitating and capacitating injuries. There was a 4.8-fold increased risk of death for exposed belted occupants but no increased risk of death for unbelted occupants. CONCLUSIONS: Belted occupants are at an increased risk of injury and death in the event of a MVC from unbelted occupants.

Accidents, Traffic↗
PubMed2003

Distinction between atrioventricular reciprocating tachycardia and atrioventricular node re-entrant tachycardia in the adult population based on P wave location; should we reconsider the value of some ECG criteria according to gender and age?

AIMS: Distinction between atrioventricular node re-entrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT) is sometimes difficult using location of retrograde P waves on ECG. METHODS: P wave location was retrospectively determined in 137 anterior slow-fast AVNRT (85%) and 26 orthodromic AVRT (15%) with narrow QRS occurring in 161 successive patients without pre-excitation. Mechanism of arrhythmia was assessed by electrophysiological study and confirmed by the efficacy of radiofrequency ablation. P waves were classified as invisible, visible after the QRS, or as R' in V(1) and/or S in II. Correlations with arrhythmia mechanism were made according to gender and age (>or= or <65 years old). RESULTS: Mechanism was related to gender but not to age, with a higher proportion of AVNRT in women (89/97, 91%) than in men (48/66, 72%) (P=0.001). AVRT presented with visible P waves in 26/26 cases (100%) while AVNRT presented with invisible P waves in 36/137 (27%), R'V(1)/SII in 79/137 (57%) and visible P waves in 22/137 (16%). P wave location during AVNRT was related to age but not to gender, with a higher proportion of AVNRT with visible P waves in elderly than in younger patients: 8/27 (29%) vs 14/110 (12%) (P=0.03). Visible P wave during AVNRT was mainly caused by a delay in nodal retrograde conduction in 17/22 patients (77%). Mechanism of tachycardia with visible P waves was related to gender (AVNRT in 14/22 women (64%), AVRT in 18/26 men (70%), P =0.02) and to age, although non-significantly (AVNRT in 8/13 (62%) old vs 14/35 (40%) young patients, P=0.18). A visible P wave was predictive of AVNRT in 25% and in 60% of the men and women younger than 65 years old, and in 50% and in 71% of older men and women respectively (P=0.08 - borderline significance). CONCLUSIONS: Correct distinction between anterior slow-fast AVNRT and orthodromic AVRT can be reliably made regardless of gender or age in case of R'V(1)/SII or invisible P wave. AVRT as the expected mechanism should be reconsidered in the case of visible P waves in the elderly and in the female gender in the absence of pre-excitation.

Age Factors↗
PubMed2002

Subjective and functional results after replacement of the stomach with an ileocecal segment: a prospective study of 20 patients.

BACKGROUND AND AIMS: The optimal reconstruction procedure after gastrectomy is still a matter of debate. The ileocecal interpositional graft offers an excellent reservoir capacity, the preservation of duodenal passage, and a natural antireflux barrier (ileocecal sphincter). PATIENTS AND METHODS: We prospectively analyzed the quality-of-life outcome in 20 patients undergoing ileocecal interpositional graft (13 subdiaphragmatic reconstruction, 7 intrathoracic reconstruction) after gastrectomy in a University Hospital and a Canton Hospital (mean follow-up 6 months), operative and postoperative morbidity, body weight, reflux, and dumping symptoms. In a smaller series of nine patients we performed functional tests such as gastric emptying measurements, glucose tolerance tests, and manometry of the gastric substitute. RESULTS: The mean gastrointestinal quality-of-life index in the subdiaphragmatic reconstruction group 114, and that in the intrathoracic reconstruction group was 106. Mild reflux and dumping symptoms were noted by no patients in the former group and by two of seven patients in the latter. In the smaller series of nine patients gastric emptying time was faster in the intrathoracic group, but no difference in plasma glucose level was found between the two groups. CONCLUSIONS: Reconstruction after gastrectomy with an ileocecal interpositional graft achieves good quality of life with an acceptable morbidity. The technique seems to reduce the occurrence of postoperative reflux and dumping symptoms.

Anastomosis, Roux-en-Y↗
PubMed2001

The generation of both T killer and Th cell clones specific for the tumor-associated antigen HER2 using retrovirally transduced dendritic cells.

Induction of antitumor immunity involves the presence of both CD8(+) CTLs and CD4(+) Th cells specific for tumor-associated Ags. Attempts to eradicate cancer by adoptive T cell transfer have been limited due to the difficulty of generating T cells with defined Ag specificity. The current study focuses on the generation of CTL and Th cells against the tumor-associated Ag HER2 using autologous dendritic cells (DC) derived from CD34(+) hematopoietic progenitor cells which have been retrovirally transduced with the human epidermal growth factor receptor 2 (HER2) gene. HER2-transduced DC elicited HER2-specific CD8(+) CTL that lyse HER2-overexpressing tumor cells in context of distinct HLA class I alleles. The induction of both HLA-A2 and -A3-restricted HER2-specific CTL was verified on a clonal level. In addition, retrovirally transduced DC induced CD4(+) Th1 cells recognizing HER2 in context with HLA class II. HLA-DR-restricted CD4(+) T cells were cloned that released IFN-gamma upon stimulation with DC pulsed with the recombinant protein of the extracellular domain of HER2. These data indicate that retrovirally transduced DC expressing the HER2 molecule present multiple peptide epitopes and subsequently elicit HER2-specific CTL and Th1 cells. The method of stimulating HER2-specific CD8(+) and CD4(+) T cells with retrovirally transduced DC was successfully implemented for generating HER2-specific CTL and Th1 clones from a patient with HER2-overexpressing breast cancer. The ability to generate and expand HER2-specific, HLA-restricted CTL and Th1 clones in vitro facilitates the development of immunotherapy regimens, in particular the adoptive transfer of both autologous HER2-specific T cell clones in patients with HER2-overexpressing tumors without the requirement of defining immunogenic peptides.

Alleles↗
PubMed2001

Prevalence of Helicobacter pylori infection in peptic ulcer perforations.

BACKGROUND: Most patients with chronic peptic ulcer disease have Helicobacter pylori (H. pylori) infection. In the past, immediate acid-reduction surgery has been strongly advocated for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery. METHODS: In 47 consecutive patients (mean age = 64 years, range 27-91) suffering from acute peptic ulcer perforation the preoperative presence of H. pylori (CLO test), the surgical procedure (laparoscopy or open surgery), the outcome of surgery, and the success of H. pylori eradication with a triple regimen were prospectively studied. RESULTS: Of these patients 73.3% were positive for H. pylori, regardless of the previous use of nonsteroidal anti-inflammatory drugs (NSAIDs). Thirty-eight per cent underwent a simple laparoscopic repair. Conversion rate to laparotomy reached a high of 32%. The main reasons for conversion were the size of the ulcer, and/or diffuse peritonitis for a duration of over 12 hours with fibrous membranes difficult to remove laparoscopically. In the H. pylori positive patients, eradication was successful in 96% of the cases. Mortality and morbidity rates were greater in the laparoscopic group (p < 0.05). Follow-up (median 43.5 months) revealed no need for reoperation for peptic ulcer disease and no mortality. CONCLUSION: We have found a high prevalence of H. pylori infection in patients with perforated peptic ulcers. An immediate and appropriate H. pylori eradication therapy for perforated peptic ulcers reduces the relapse rate after simple closure. Response rate to a triple eradication protocol was excellent in the hospital setting.

Adult↗
PubMed2001

Human immunodeficiency virus, hepatitis B, C and D in Bangladesh's trucking industry: prevalence and risk factors.

BACKGROUND: Human immunodeficiency virus (HIV) and hepatitis B and C, viral infections with shared percutaneous, mucosal and perinatal routes of transmission, are responsible for serious morbidity and mortality globally. In Bangladesh there is a dearth of research on prevalence and risk factors for these diseases. This study examines the prevalence of HIV and hepatitis (B, C, D) and risk factors associated with infection in men in Bangladesh's trucking industry (drivers and helpers on trucks), a population at risk for sexually transmitted infections. METHODS: The study population comprised 388 men (245 drivers, 143 helpers) working out of Tejgaon truck stand in Dhaka, Bangladesh. Subjects were selected through a two-tiered sampling strategy. Of 185 trucking agencies 38 were randomly selected and a of 10 subjects was recruited from each agency. Subjects were interviewed, underwent a comprehensive physical examination and had blood samples taken. Gold standard laboratory tests were conducted to detect HIV, hepatitis B, C, and D infections. To assess risk factors associated with current hepatitis B infections or being a carrier (HBsAg) and lifetime exposure to hepatitis B infection (anti-HBc), simple and multiple logistic regression analyses were performed. RESULTS: The prevalence of diseases were: HIV 0%, hepatitis C <1%, hepatitis B surface antigen 5.9%, antibody to hepatitis B core antigen 48.1% (with 5 of the 23 HBsAg positive cases testing positive for HBeAg and 18 for anti-HBe), and hepatitis D 0%. Having ever received a therapeutic injection and having had relations with a commercial sex worker (CSW) in the past year were both significantly associated with lifetime exposure to hepatitis B (anti-HBc); having received a therapeutic injection in the past year was associated with being either currently infected with hepatitis B or a carrier (HBsAg). CONCLUSIONS: The results of the study illustrate the importance of educating health care practitioners about the dangers of unsterile injections, and of educating men in the trucking industry as well as their partners (CSW in particular) about the importance of condom use, especially in high-risk sexual contacts.

Adolescent↗
PubMed2001

Sensitive chemiluminescence immunoassay for the determination of rat serum alpha1-acid glycoprotein.

We present the establishment of a sensitive immunoassay for the determination of alpha1-acid glycoprotein (orosomucoid, AGP) in rat serum. The assay is based upon antigen capture by surface-immobilized specific polyclonal rabbit anti-AGP antibodies with biotinylated rat AGP (rAGP) as the tracer, and formatted as competitive enzyme immunoassay. Signaling is performed by streptavidin-conjugated horseradish peroxidase. Enzyme activity is quantified by an enhanced chemiluminometric method, allowing the sensitive detection of rAGP serum levels in small sample volumes.

Animals↗
PubMed2001

Beta(3)-adrenoceptor agonist-induced increases in lipolysis, metabolic rate, facial flushing, and reflex tachycardia in anesthetized rhesus monkeys.

The effects of two beta(3)-adrenergic receptor agonists, (R)-4-[4-(3-cyclopentylpropyl)-4,5-dihydro-5-oxo-1H-tetrazol-1-yl]-N-[4-[2-[[2-hydroxy-2-(3-pyridinyl)ethyl]amino]ethyl]phenyl]benzenesulfonamide and (R)-N-[4-[2-[[2-hydroxy-2-(3-pyridinyl)- ethyl]amino]ethyl]phenyl]-1-(4-octylthiazol-2-yl)-5-indolinesulfonamide, on indices of metabolic and cardiovascular function were studied in anesthetized rhesus monkeys. Both compounds are potent and specific agonists at human and rhesus beta(3)-adrenergic receptors. Intravenous administration of either compound produced dose-dependent lipolysis, increase in metabolic rate, peripheral vasodilatation, and tachycardia with no effects on mean arterial pressure. The increase in heart rate in response to either compound was biphasic with an initial rapid component coincident with the evoked peripheral vasodilatation and a second more slowly developing phase contemporaneous with the evoked increase in metabolic rate. Because both compounds exhibited weak binding to and activation of rhesus beta(1)-adrenergic receptors in vitro, it was hypothesized that the increase in heart rate may be reflexogenic in origin and proximally mediated via release of endogenous norepinephrine acting at cardiac beta(1)-adrenergic receptors. This hypothesis was confirmed by determining that beta(3)-adrenergic receptor agonist-evoked tachycardia was attenuated in the presence of propranolol and in ganglion-blocked animals, under which conditions there was no reduction in the evoked vasodilatation, lipolysis, or increase in metabolic rate. It is not certain whether the beta(3)-adrenergic receptor-evoked vasodilatation is a direct effect of compounds at beta(3)-adrenergic receptors in the peripheral vasculature or is secondary to the release or generation of an endogenous vasodilator. Peripheral vasodilatation in response to beta(3)-adrenergic receptor agonist administration was not attenuated in animals administered mepyramine, indomethacin, or calcitonin gene-related peptide(8-37). These findings are consistent with a direct vasodilator effect of beta(3)-adrenergic receptor agonists.

Adenylyl Cyclases↗
PubMed2001

[Implantable defibrillator. Update].

The implantable cardioverter-defibrillator is a device able to detect and efficiently treat life-threatening ventricular arrhythmias. Its decisive accomplishment in reducing sudden cardiac death and total cardiac mortality, opposed to the insufficient reliability of the traditional therapies explains its present ascendancy. In this review, the working principles and the implant techniques are developed, as well as the complications and the usual problems which could be encountered in implanted patients. Finally, the current indications are discussed in the light of recent clinical trials.

Arrhythmias, Cardiac↗
PubMed2001

Guidelines for inguinal hernia repair in everyday practice.

BACKGROUND: The Royal College of Surgeons of England published clinical guidelines for the management of groin hernia in adults in July 1993. We compared our indications, techniques, complications and outcome with these guidelines. PATIENTS AND METHODS: A consecutive series of 440 patients who underwent a groin hernia repair from the 1 July 1994 to 30 July 1995 were studied retrospectively. Special consideration was given to the advantages and acceptance of day-case surgery. Confidential questionnaires were sent to all patients 6-12 months following surgery. RESULTS: The majority of elective primary inguinal hernias (83%) were repaired by the open tension-free Lichtenstein mesh technique. Our selection criteria for day-case surgery included ASA I, age (< 65 years) and social situation; 56% underwent an operation on a day-case basis. Including in-patients discharged within 24 h following operation, this proportion of 'day-cases' increased to 72.5%. Less complications occurred in the day-case group (P = 0.018). However, this difference may be caused by incomplete reporting of complications in the day-case group. There were no significant differences in patients' satisfaction, postoperative attendance for medical advice or time back to work between the day-case and in-patient group. CONCLUSIONS: The guidelines need to be reviewed. The Lichtenstein repair offers an excellent and simple technique for hernia repair as a day-case procedure. Our results suggest that the number of hernia repairs performed as a day-case could substantially be increased to more than the recommended 30%. Time off work is mainly influenced by the advice given by GPs and surgeons. Reducing time off work by giving more appropriate recommendations and increasing the number of day-case surgery cases could significantly reduce the costs of health-care.

Aged↗
PubMed2001

Inpatient e-ordering.

Explore the source record for details and available documents.

Clinical Pharmacy Information Systems↗
PubMed2000

Evidence rather than costs must guide use of the implantable cardioverter defibrillator.

Randomized controlled trials have shown superior survival rates with implantable cardioverter defibrillators (ICDs) compared with antiarrhythmic drugs in survivors of cardiac arrest and life-threatening ventricular tachyarrhythmias, as well as in high-risk patients with ischemic heart disease and inducible ventricular tachycardia (VT). Current defibrillators are small and implanted with techniques similar to standard pacemakers. They provide high-energy shocks for ventricular fibrillation (VF) and rapid VT, antitachycardia pacing for monomorphic VT, and antibradycardia pacing. Limited evidence suggests that ICD therapy is cost-effective when compared with other widely accepted treatments. The use of ICDs is likely to continue to expand in the future. Ongoing clinical trials will define further prophylactic indications of the ICD and clarify its cost-effectiveness ratio in different clinical settings.

Cost-Benefit Analysis↗
PubMed2000

The gp130-stimulating designer cytokine hyper-IL-6 promotes the expansion of human hematopoietic progenitor cells capable to differentiate into functional dendritic cells.

OBJECTIVE: Hyper-IL-6, a fusion protein of interleukin-6 and its specific receptor, together with stem cell factor leads to the proliferation of primitive hematopoietic progenitor cells. Based on these findings, the current study examined whether hyper-IL-6 promotes the growth of precursor cells that can be further differentiated into dendritic cells in the presence of additional cytokines. METHODS: Dendritic cell cultures were generated from CD34(+) hematopoietic progenitor cells derived either from bone marrow or from peripheral blood. CD34(+) cells were cultured in the presence of cytokines for 2 weeks and then used for phenotyping and T-cell stimulation assays. RESULTS: Hyper-IL-6 in the presence of stem cell factor induced a 60- to 80-fold expansion of CD34(+) progenitor cells following 2 weeks of culture in serum-free medium. The addition of granulocyte-macrophage colony-stimulating factor to hyper-IL-6 and stem cell factor was essential for the differentiation of expanded progenitor cells into antigen presenting cells capable of inducing a primary T-cell response to soluble protein, which is a typical feature of dendritic cells. Phenotypic analyses confirmed the expansion of immature dendritic cells, which could be further differentiated into mature CD83(+) dendritic cells under the influence of interleukin-4, interleukin-1beta, tumor necrosis factor-alpha, and prostaglandin E(2). The capacity of expanded dendritic cells to stimulate protein-specific CD4(+) T cells was used to stimulate a primary T-helper cell response to the recombinant protein of the hepatitis-B core antigen in healthy donors. CONCLUSION: The expansion and differentiation of functional dendritic cells from CD34(+) progenitor cells under serum-free culture conditions allow for the possibility to develop more effective ways to immunize against viral infections and tumor diseases.

Antigen Presentation↗