Aspiration of the nasal septum: a new complication of cocaine abuse.
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Bronchi↗
Biomedical subjects
L Klein
Publications and source records attributed to L Klein.
Acute physical exercise alters apolipoprotein E and C-III concentrations of apo E-rich very low density lipoprotein fraction.
To evaluate the influence of exercise on the apolipoprotein (apo) composition of very low density lipoprotein (VLDL) subfractions, we exercised 6 sedentary men for 30 min, 1 h after a fatty meal. VLDL fractions from samples drawn 4, 6 and 8 h post-prandially were separated from pre-stained plasma by high performance liquid chromatography and fractionated to apo E-poor (heparin-unbound) and apo E-rich (heparin-bound) fractions. The postprandial peak area (volts) and apo E, C-II and C-III concentrations (mg/dl) of post-exercise VLDL fractions were compared with corresponding postprandial values obtained at rest. Plasma triglycerides (TG) levels (mg/dl) were significantly lower 4 (P < 0.05), 6 (P < 0.02) and 8 h (p < 0.05) postprandially; the apo E-poor VLDL fraction was not modified by exercise and its apo concentrations were in the low range of detection; the apo E-rich VLDL peak area significantly decreased 4 (P < 0.01), 6 (P < 0.01) and 8 h (P < 0.05) postprandially; the apo E concentration of apo E-rich VLDL was significantly lower 4 (P < 0.02) and 6 h (P < 0.05) postprandially; the apo C-III concentration of apo E-rich VLDL significantly increased, 4 and 6 h postprandially (P < 0.05). Apo E-rich VLDL is, presumably, the metabolically active fraction of the particle and may regulate plasma TG level following exercise. The metabolic role of apo E-poor VLDL remains to be defined.
Adult↗
The effects of vascularity and cyclosporin A on the mechanical properties of canine fibular autografts.
We studied the biomechanical behavior of orthotopic canine autografts as influenced by vascularized supply and the administration of cyclosporin A at three months and six months post-surgery. The model was the proximal 8 cm of the fibula in young adult dogs. In vascularized grafts, blood supply was re-established by microvascular re-anastomosis. Experimental controls were sham-operated and unoperated bones. Mid-graft test sections were subjected to loading-to-failure in torsion to determine the strength and stiffness. In both three- and six-month groups, vascularized grafts were significantly stronger and stiffer than contralateral nonvascularized grafts. Vascularized grafts were not significantly different from sham-operated bones. A 30-day regimen of cyclosporin A was found to have no measurable effect on mechanical properties for any individual treatment group. The results indicate that re-established blood supply can be a major factor in maintaining the mechanical integrity in large-segment cortical autografts.
Animals↗
Blood and amniotic fluid contact sustained by obstetric personnel during deliveries.
OBJECTIVE: The objective of this study was to characterize blood and amniotic fluid contact sustained by obstetric personnel during deliveries. STUDY DESIGN: Trained observers collected data on 1376 person procedures during 230 deliveries at Grady Memorial Hospital from May to October 1989. Rates of contact were compared by means of the chi 2 test. RESULTS: At least one blood or amniotic fluid contact occurred during 79 (39.1%) of 202 vaginal and 14 (50.0%) of 28 cesarean deliveries; a needle stick occurred in 4 (2.0%) of the vaginal deliveries. Obstetricians and midwives had the highest rates of blood and amniotic fluid contact (18.7% and 28.8% of person procedures, respectively). Half of the contacts sustained by midwives might have been prevented by the use of gowns. Most contacts sustained by obstetricians might have been prevented by face shields, impervious gowns, and impervious shoe covers. CONCLUSIONS: Obstetricians and midwives had substantial risk of blood and amniotic fluid contact during delivery; many of their contacts were potentially preventable.
Amniotic Fluid↗
Human immunodeficiency virus infection among inner-city adolescent parturients undergoing routine voluntary screening, July 1987 to March 1991.
OBJECTIVE: The objective of our study was to describe the human immunodeficiency virus epidemic among pregnant adolescents undergoing follow-up in a large inner-city hospital. STUDY DESIGN: We conducted a case-control study comparing demographic and risk behaviors of seropositive and seronegative adolescents (aged 13 to 20) identified from a population undergoing routine voluntary antibody screening at Grady Memorial Hospital in Atlanta, Georgia, between July 1987 and March 1991. RESULTS: Of 10,794 pregnant adolescents screened, 51 (4.7/1000) were infected with human immunodeficiency virus. More than one fourth of case patients were < or = 17 years old. Significantly more case patients than controls reported a history of crack cocaine use (10 [19.6%] vs 23 [8.2%] p < 0.05). A majority (58.8%) of case patients reported no risk factors for infection, and the remainder (41.2%) were presumably infected by heterosexual contact. Thirty-nine controls (13.8%) had self-identified risk factors for infection. CONCLUSIONS: Pregnant adolescents in our center are at risk for human immunodeficiency virus infection and should be targeted for human immunodeficiency virus education and risk reduction counseling.
Adolescent↗
Effect of lovastatin on lipoprotein fluidity in patients with hypercholesterolaemia.
Lovastatin was administered to six hypercholesterolaemic patients (mean plasma cholesterol 450 mg dl-1). Plasma lipoproteins (VLDL, LDL, and HDL) were separated before and following 7 and 12 weeks treatment with lovastatin. Fluidity was quantified by fluorescence polarization measurements using 1,6-diphenyl 1,3,5 hexatriene (DPH) as the fluorescent probe. Lovastatin treatment resulted in a significant reduction of total plasma cholesterol, LDL cholesterol and VLDL cholesterol (-41%, -44%, -68%, respectively). Fluidity measurements showed significant (p < 0.01) increase in LDL fluidity by 11% and 21% after 7 and 12 weeks of lovastatin treatment, whereas, VLDL fluidity was increased by 27% after 12 weeks of therapy. HDL fluidity was not altered. These alterations in the fluidity of the atherogenic lipoproteins (LDL and VLDL) in hypercholesterolaemic patients may prove to be of significance in reducing the risk of atherosclerosis.
Adult↗
Impact of hospital discharge planning on meeting patient needs after returning home.
This study examines the contribution of hospital discharge planning in meeting the needs of patients for care after their return home. A random sample of 919 admissions (age 60 and over) to five hospitals was studied to obtain information on characteristics of discharge planning during the patients' hospital stay. Specifically, information was obtained on the involvement of a designated professional for managing and coordinating the discharge plan, and the extent to which the planning was interdisciplinary. Patient interviews conducted two weeks after discharge provided information on needs for care related to: (1) treatment, (2) activity limitations, and (3) other self-sufficiency limitations. Patients were asked about their need for care in these three areas and about whether or not these needs were being met. Overall, 97 percent reported one or more needs for care and 33 percent reported that at least one of these needs was not being met. Findings show that the involvement of a discharge planning case manager is related to a significant reduction in unmet treatment needs, but not to reductions in activity limitation, other self-sufficiency needs, or overall needs. No significant effects of interdisciplinary planning were identified. These findings suggest that treatment-related benefits result when a case manager has specific responsibility for the discharge planning of elderly patients returning home after hospitalization. These results provide insights into what is being achieved through current discharge planning practices. The meeting of specific patient needs through enhanced discharge planning may save future costs by reducing the rates of complications and hospital readmissions in an era of prospective payment, thus potentially offsetting the increased costs involved in planning and coordinating postdischarge care for older adults.
Activities of Daily Living↗
Crack cocaine: a risk factor for human immunodeficiency virus infection type 1 among inner-city parturients.
OBJECTIVE: To define the relationship between crack cocaine use and human immunodeficiency virus (HIV) infection while controlling for other HIV risk factors. METHODS: We performed a case-control study among inner-city pregnant women who were followed at a large urban hospital in Atlanta, Georgia; 79 of the women were HIV-1-infected and 525 were seronegative. We identified the women from a prenatal population undergoing routine voluntary HIV-1 antibody screening. RESULTS: From July 1, 1989 to December 31, 1990, we screened 13,469 pregnant women; 80 (5.9 per 1000) were HIV-1-infected. One seropositive woman who did not complete a risk-behavior questionnaire was excluded from the study. Seropositivity was associated with a history of crack cocaine use (odds ratio 2.3, 95% confidence interval [CI] 1.1-4.8), intravenous drug use (odds ratio 14.5, 95% CI 4.5-46.3), and a history of sexually transmitted diseases (odds ratio 2.6, 95% CI 1.5-4.5). We found a significant interaction (P = .01) between a history of crack cocaine use and employment status: Unemployed women who used crack cocaine were 3.5 times more likely to be HIV-1-infected than were employed women who used crack cocaine. CONCLUSIONS: Crack cocaine use was found to be a risk factor associated with HIV-1 infection among pregnant women, particularly those who were unemployed. This finding suggests that the impact of crack cocaine use on HIV transmission may be related to economic factors and possibly to either trading sex for money to buy cocaine or trading sex for the drug.
Acquired Immunodeficiency Syndrome↗
Computed tomography and magnetic resonance imaging of the female lower urinary tract.
Computed tomography (CT) and magnetic resonance (MR) imaging have become invaluable imaging modalities in the diagnosis of diseases involving the lower urinary tract. Both CT and MR imaging are able to accurately stage bladder carcinoma, with MR imaging able to distinguish between superficial and deep muscle invasion of tumor. CT and MR are also the studies of choice for evaluating retroperitoneal fibrosis, which often affects the urinary tract; MR imaging is often able to detect the presence of active inflammation and occasionally rule out a malignant cause. MR imaging holds promise for the evaluation of stress urinary incontinence and urethral disease. Although diseases of the distal ureter continue to be most accurately diagnosed by intravenous urography and retrograde studies, CT and MR imaging may serve a helpful secondary role.
Female↗
Incidence and prevalence of human immunodeficiency virus infection in a prenatal population undergoing routine voluntary human immunodeficiency virus screening, July 1987 to June 1990.
To characterize the epidemiologic characteristics of human immunodeficiency virus type 1 infection in an urban prenatal population in the southeastern United States, we conducted serial routine voluntary antenatal human immunodeficiency virus antibody testing and obtained self-reported human immunodeficiency virus risk behavior profiles on women registering for prenatal care. From July 1987 to June 1990, 23,432 women registered for prenatal care. The majority of women (95%) consented to human immunodeficiency virus antibody testing and completed risk behavior profiles. The cumulative incidence of human immunodeficiency virus infection increased from 3.5 per 1000 in 1987 and 1988 to 5.3 per 1000 in 1989 and 1990. A history of "crack" cocaine use emerged as a significant risk factor for infection (p less than 0.01). The majority (70%) of human immunodeficiency virus-infected women did not self-acknowledge risk factors for infection and would not have been identified if screening had been targeted. The increasing incidence of human immunodeficiency virus type 1 infection in our prenatal population reinforces the need for our continued routine voluntary antenatal human immunodeficiency virus screening and risk behavior assessment.
Acquired Immunodeficiency Syndrome↗
Bone mass and comparative rates of bone resorption and formation of fibular autografts: comparison of vascular and nonvascular grafts in dogs.
The metabolic fate of whole grafts that were either vascularized or nonvascularized were compared. This study was designed to quantify and correlate changes in bone resorption, formation, and mass in orthotopic, stably fixed, weight-bearing autografts. The grafts were 8-cm segments of the fibula that were internally fixed. Fibula segments subjected to sham operations, nonvascularized autografts, and vascularized autografts were studied in 16 dogs at three months after surgery. Three months prior to surgery the dogs were labeled repeatedly over two months with 3H-tetracycline and 3H-proline. Metabolic turnover of whole grafts was evaluated by quantifying loss of 3H-tetracycline for measuring postoperative resorption of bone mineral and loss of 3H-collagen for resorption of bone collagen. Net changes in bone dry weight, calcium, and collagen per whole grafts were obtained to determine differential changes in the mineral and matrix mass. The difference in change between bone resorption and bone mass was used to determine the amount of new bone formation that had replaced the resorbed bone. Vascularized autografts lost more mass (12%), and had more bone resorption (40%) and more bone formation (28%) than sham operated and unoperated fibulas. Nonvascularized grafts lost much more bone mass (48%) because resorption was large (61%) and formation was relatively small (13%). More new bone was formed in vascularized autografts than in nonvascularized autografts. During the incorporation of bone grafts, resorption is an early and rapid process, whereas formation is a late and slow process.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Differential patterns of incorporation and remodeling among various types of bone grafts.
The early (3 months) and later (6 months) patterns of incorporation and bone formation have been evaluated histomorphometrically for different types of bone grafts; that is, vascularized and nonvascularized autografts with and without ciclosporin, and vascularized and nonvascularized dog leukocyte antigen (DLA)-mismatched allografts with and without ciclosporin. The vascularized bones were superior to the nonvascularized ones in healing and remodeling their grafted segments. In the autograft bones, ciclosporin did not alter the incorporation process 3 months after transplantation but delayed and increased the remodeling activities in the long run (6 months). Nonvascularized allografts underwent vigorous resorption, and were markedly porotic. Ciclosporin administration significantly reduced resorption and enhanced remodeling in nonvascularized allografts. The remodeling of allografts was similar to that of autografts in the presence of ciclosporin, but stopped soon after the administration of ciclosporin ceased.
Animals↗
The use of fasciocutaneous flaps on perforating vessels.
The distally based fasciocutaneous flaps on perforating vessels are mobile, well shapable and cosmetically satisfactory ones. In soft tissue defects of the lower third of the leg the above flaps should be a method of choice for their simple applicability and shapability of tissues. Pedicular fasciocutaneous flaps enable us to enlarge the possibilities of reconstructive surgery in this field. Microsurgical flaps may then be reserved for more important losses of soft tissues.
Humans↗
Determinants of acceptance of routine voluntary human immunodeficiency virus testing in an inner-city prenatal population.
Routine voluntary prenatal human immunodeficiency virus (HIV) counseling and testing offer the opportunity to encourage reduction of high-risk behaviors among uninfected women and to identify those women with asymptomatic HIV infection. To characterize the determinants of acceptance of routinely offered and encouraged HIV testing in inner-city parturients in Atlanta, we identified two groups of women, one that declined HIV testing and another that accepted testing. Each group was asked to complete a questionnaire designed to assess the effectiveness of pre-test counseling. During the 7-month study period, 4731 women registered for prenatal care and 4574 (97%) consented to HIV testing. Nearly all women stated that they were not pressured into having HIV testing performed. Women who accepted HIV testing were more likely to be young, black, and single (P less than .001) and less likely to have received education beyond high school (P less than .05). More accepters than decliners thought the HIV counseling session was valuable (97 versus 91%; P = .04); 55% of accepters agreed to antibody testing because of concern about the risk of transmitting HIV infection to their fetus or infant. More accepters than decliners indicated a willingness to have HIV testing in a future pregnancy (74 versus 33%; P less than .001). These data suggest that most inner-city parturients in our institution view routine voluntary HIV counseling as a valuable component of their prenatal care.
Adolescent↗
Automated immunoassay for prolactin with the Abbott IMx analyzer.
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Autoanalysis↗
Routine human immunodeficiency virus infection screening in unregistered and registered inner-city parturients.
Women who receive little or no prenatal care are at increased risk of adverse pregnancy outcome. Although many of these women are disadvantaged and presumably at increased risk for human immunodeficiency virus (HIV) infection, few data are available to describe risk behaviors and infection prevalence in this population. To better characterize HIV infection in unregistered inner-city parturients in Atlanta, we offered routine voluntary screening for HIV antibody and requested HIV risk-behavior profiles on all unregistered and registered parturients seen at Grady Memorial Hospital from July 1, 1987 to June 30, 1988. Of the 834 unregistered and 7356 registered parturients screened, significantly more unregistered parturients were seropositive on enzyme-linked immunosorbent assay and Western blot testing, 12 (1.4%) versus 26 (0.4%) (odds ratio 4.06; 95% confidence interval 1.93-8.43). Five unregistered and 15 registered parturients were seropositive by repeat enzyme-linked immunosorbent assay testing but were Western blot-negative. Significantly more unregistered parturients reported both a history of intravenous drug use, 4.4 versus 1.5% (odds ratio 3.09; 95% confidence interval 2.10-4.54), and crack cocaine use, 3 versus 0.8% (odds ratio 3.96; 95% confidence interval 2.42-6.44). Significantly more unregistered parturients acknowledged risk factors for HIV infection, 14.3 versus 9.9% (odds ratio 1.46; 95% confidence interval 1.19-1.80). Nearly all registered and 86% of unregistered parturients consented to HIV testing. Nearly all parturients completed HIV risk-behavior questionnaires. These data suggest that unregistered inner-city parturients in Atlanta are at greater risk of being HIV-infected and are more likely to report risk behaviors for infection.
Adolescent↗
Decreased very low density lipoprotein fluidity in familial hypercholesterolemia.
The fluidity of lipoproteins from normolipidemic subjects and from familial hypercholesterolemic patients was investigated by fluorescence polarization. The fluorescent probe DPH (1,6-diphenyl-1,3,5-hexatriene) was incorporated into the lipoprotein fractions, and assessment of the fluidity pattern of each particle was determined by fluorescence anisotropy measurements over a temperature range of 10 to 40 degrees C. The very low density lipoprotein (VLDL) of the hypercholesterolemic patients was found to be considerably more rigid than the respective VLDL of normolipidemic subjects. Analysis of the constituents of the various lipoproteins suggested that the large difference in the fluidity between hypercholesterolemic and normal VLDL patients might be due to increased VLDL cholesterol/triglyceride, cholesterol/protein and cholesterol/phospholipid ratios, which were 10, 2 and 1.4 fold higher, respectively, in the hypercholesterolemic VLDL patients. Decreased VLDL fluidity in familial hypercholesterolemic patients may be of importance in the pathogenesis of their accelerated atherosclerosis.
Adolescent↗
Simultaneous measurement of bone formation and resorption in vivo.
Bone resorption and formation in terms of milligram of calcium deposited into and released from whole humerus of 15-23 weeks old male rats were assessed, via linear least-squares regression analysis of change in calcium content and 3H-tetracycline kinetics of the bone. The rate of resorption was 0.376 mg calcium per day, while formation was 0.758 mg calcium per day. The data indicate that the computation results in a simultaneous and explicit measurement of bone resorption and formation at the organ level.
Animals↗