From the Georgia Medical Care Foundation: "premature discharge" as a peer review concept.
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Biomedical subjects
Publications and source records attributed to M Burns.
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Sons of alcoholic fathers (high risk, HR) and matched control men from families without alcoholism (low risk, LR) were administered, in a randomized double-blind fashion, either a placebo beverage or an isovolemic beverage containing ethanol (0.8 g/kg). Serial blood sampling for determination of plasma gamma-aminobutyric acid (GABA)-like activity, mood, and intoxication ratings were performed. The HR subjects were found to have significantly less plasma GABA-like activity than LR during the placebo condition. The alcoholic beverage condition washed out the differences in plasma GABA between groups. Significant interactions between risk group status and beverage conditions were found with respect to plasma GABA-like activity. Alcohol produced an increase in mean GABA-like activities among HR subjects, whereas a slight decline was noted among LR subjects. Plasma GABA-like activity also had a significant inverse correlation with self-reports of perceived tension in the placebo condition, and tension, confusion, and intoxication in response to the alcoholic drink. Since previous investigators have reported reduced plasma GABA levels in alcoholic individuals, reduced plasma GABA-like activity may be a biological marker for vulnerability to alcoholism or for heightened tension as a behavioral factor that predisposes to alcoholism.
From 1986 through 1989, 23 infants (18 of whom were less than 30 days old) required peritoneal dialysis within their first 6 months of life. Modifications to conventional peritoneal dialysis included modified Silastic Tenckhoff catheters, peel-away sheaths for percutaneous insertion, automated peritoneal dialysis "cyclers," and generous omentectomy. With these modifications, there were no bowel perforations, and the infants were successfully dialyzed for prolonged periods. Eight of the 23 infants developed end-stage renal failure and were prepared for transplantation. All had gastrostomy tubes placed to supplement oral nutrition. Living, related transplantation was performed when the child weighted 10 kg. Four of the eight completed this protocol. One child with congenital nephrotic syndrome died before transplantation. One transplant was complicated by a technical problem (venous thrombosis), which resulted in allograft loss and return to peritoneal dialysis. Kidney function, growth, and development in the survivors were excellent.
The effects of the phospholipase A2 (PLA2) toxins, beta-bungarotoxin and notexin, and the PLA2 enzymes from Naja naja atra and Naja nigricollis snake venoms on the plasma membrane integrity of synaptosomes were examined. Synaptosomes were isolated from rat brain cerebral cortex, corpus striatum and hippocampus. Osmotic activity, lactate dehydrogenase leakage, and leakage of 2-deoxy-D-(1-3H)-glucose-6-phosphate were monitored (37 degrees C, 10-120 min) following incubation with 0.5, 5 and 50 nM concentrations of toxins and enzymes. Damage to the synaptosomal plasma membrane was time and concentration but not tissue dependent. The potencies of the treatments were as follows: N. n. atra PLA2 greater than or equal to N. nigricollis PLA2 greater than notexin greater than beta-bungarotoxin. Chelation of Ca2+ with 5 mM EDTA completely inhibited plasma membrane disruption caused by beta-bungarotoxin and N. n. atra PLA2. One mg/ml of bovine serum albumin also blocked the disruptive action of N. n. atra PLA2, while 8 mg/ml was required to antagonize beta-bungarotoxin. A correlation between phospholipid hydrolysis and loss of membrane integrity was also observed. The generation of phospholipid hydrolytic products may be critical in the permeabilization of synaptic plasma membranes by these toxins and enzymes, however, they do not explain the presynaptic specificity and potency of beta-bungarotoxin and notexin.
Performance decrements associated with therapeutic drugs may increase the risk of many common activities that require intact skills. However, accident data that define such risks are difficult to obtain, and the assessment of skill decrements often must be based on data obtained from the laboratory study of drug effects. The validity and reliability of conclusions drawn from laboratory data are a function of experiment design and measurement methods. Critical issues include the assumptions, rationale, and hypotheses underlying laboratory measurement of skills performance. Drug doses and dosing regimens, subject characteristics, and response measures are key variables that limit data interpretation. The design of reported experiments, including the selection of a battery of laboratory tests, reveals the underlying issues, and data from the experiments demonstrate both valid conclusions and constraints on interpretation.
For patients with restrictive as well as obstructive disease, pulmonary rehabilitation offers a comprehensive program that affects all areas of their life. Marked improvement is seen in exercise tolerance and in performing all activities of daily living. Compliance with drug therapy and other prescribed treatment also improves. The isolation, depression, and irritability that so often accompany respiratory disease are alleviated by ongoing membership in patient support groups. Patients again become active participants in life.
Contemporary health services administrators face tasks of complex decision making. One approach is to identify the dominant problem, then respond. An inventory of such problems and responses can play a vital role in organizational survival.
Multiple benefits of oxygen therapy for hypoxemic patients with chronic lung disease are well established. Steady flow oxygen therapy is inefficient, wasteful and has a high cost. The Oxymizer pendant improves efficiency of oxygen delivery compared with SF. However, the device requires that the patient inhale and exhale nasally to maximize its oxygen-saving properties. When patients do PLB they may not receive full oxygen-saving benefit of the pendant. Yet PLB itself can increase SaO2. We evaluated an AP, which does not require nasal exhalation, in nine patients with COPD. We measured SaO2 while breathing oxygen via SF and the AP with nasal-only breathing and PLB. Results indicate that the AP maintains an increase in SaO2 over SF during nasal-only breathing and a further increase during PLB. We conclude that AP acts as an oxygen conserver during PLB; PLB with the AP achieves greater savings than with nasal-only breathing.
The behavioral effects of the antihistamines terfenadine and diphenhydramine were compared in a placebo-controlled, double-blind crossover study. Performance of skills deemed important in safe man-machine interactions was objectively assessed one, three, and five hours after administration of test substances. The results indicate that diphenhydramine use resulted in various degrees of impairment of the ability to perform a visual-search task, a tracking task, a divided-attention task, and a vigilance task. Terfenadine users performed as well as or better than placebo-treated subjects. No differences between terfenadine and placebo were found on a subjective evaluation scale. Diphenhydramine users consistently reported feelings of impairment.
1. Ninety healthy adult men participated in a study of the effects on performance of 60 mg fluoxetine, 50 mg amitriptyline or placebo, alone and in combination with 5 mg diazepam or placebo. 2. In a 2X3 factorial design study, groups of 15 Ss received one of six possible treatment combinations. 3. Ss were tested with a battery of laboratory tests at two post-dosing times. 4. Amitriptyline impaired the performance of all tasks. When diazepam was added to the amitriptyline treatment, the impairment of three tasks increased. Diazepam alone produced impairment on two measures. 5. Fluoxetine alone impaired no task; some impairment occurred with the fluoxetine-diazepam combination.
Acanthamoeba infection of the cornea is an entity now recognized with increasing frequency. We saw two cases of Acanthamoeba sclerokeratitis in contact lens wearers in whom scleritis (anterior and posterior) played a central role in the clinical course of the disease. Scleritis is probably a more common component of Acanthamoeba infection than has generally been acknowledged. Posterior scleritis has not, to our knowledge, been reported previously in this disorder. The clinical diagnosis of Acanthamoeba infection has often been missed due to lack of a definition of the historical and clinical criteria by which this disease is characterized. We reviewed the 26 previously reported cases and suggest a set of criteria that can be used to establish an early diagnosis. Historical criteria include minor corneal trauma, exposure to soil or standing water, or contact lens wear. Clinical characteristics include severe pain, infiltrative (often ring-shaped) stromal keratitis, variable anterior uveitis, epithelial erosion, scleritis, standard bacterial culture negativity, chronicity, and lack of response to antimicrobial agents.
Renovascular hypertension is a curable disease that has recently been recognized with increasing frequency. A renal scan in a 1-month-old hypertensive white male showed diminished function of the right kidney, and his peripheral vein renin was elevated. Multiple antihypertensive medications failed to control his hypertension, and right kidney function deteriorated. An arteriogram showed two stenotic renal arteries supplying the right kidney. The smaller inferior artery supplied 35% of the kidney. Selective vein renin levels were greater than 15,000 ng/dL on the right side. Technical considerations in the repair of this lesion included midline transabdominal incision to expose the abdominal aorta and the inferior vena cava; dissection of inferior vena cava (IVC) with division of selected lumbar veins; full mobilization of right kidney and transsection of both renal arteries and the renal vein; perfusion of kidney via each renal artery with cold Sach's solution after resection of arterial stenoses; end-to-side microvascular anastomosis of the smaller (2 mm) renal artery to the main renal artery at the hilum with 10-0 nylon over in situ perfusion cannula; renal artery passed under the IVC to the aorta; and right kidney autotransplanted to a new site on the abdominal aorta with an end-to-side (5.0 mm) renal artery to the aorta and an end-to-side renal vein to IVC anastomosis. Following revascularization, perfusion was excellent and the blood pressure returned to normal. At 6 months follow-up, selective renal vein renins were normal and an arteriogram showed no stenosis. Meticulous dissection, cold perfusion, microvascular anastomosis, and autotransplantation salvaged this kidney and resolved the hypertension.
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Pursed lips breathing (PLB) training is often used in the management of patients with chronic obstructive lung disease (COLD). Previous clinical studies have demonstrated that PLB improves arterial oxygen saturation (SaO2) and CO2 removal as well as relieving dyspnea. Twelve hypoxemic subjects with stable COLD were randomly assigned to either the pursed lips (P) or control group consisting of general relaxation (R). The SaO2 was monitored via ear oximetry, and respiratory rate and tidal volume were monitored using a strain gage transducer and the minute volume was calculated. The PLB was taught by an experienced instructor using the ear oximeter as a monitoring display with a goal toward increasing SaO2. The subject was taught general relaxation (Rlx) with the aid of pleasant music. We compared PLB and Rlx treatments using an A-B-A crossover study design. In both groups, PLB significantly improved SaO2 over baseline (p less than 0.001) whereas Rlx did not. We conclude that patients can learn to increase their SaO2 by PLB using ear oximetry adjunctively.
Fifteen healthy adults, aged 60 years and older, participated in a double-blind, crossover study of trazodone in comparison with amitriptyline and placebo. A battery of laboratory tests was used to measure drug effects on information processing, attention, and visual-motor skills. Amitriptyline 50 mg impaired vigilance and tracking performance and increased drowsiness. Trazodone 100 mg impaired only the most difficult tracking task. This study demonstrates that cognition and performance are less adversely affected in geriatric subjects by trazodone than by amitriptyline beginning 90 minutes after a single-dosage trial.
This study determined the prevalence and clinical significance of a positive direct antiglobulin test (DAT) observed in pretransfusion tests on red cells from patients with acquired immunodeficiency syndrome (AIDS). Transfusion service records showed that prevalence of a positive DAT on red cells was 18% (10/55) in AIDS patients compared to 0.6% in general hospital patients during a 2-year period (1981-1983). A similar rate of 18% (8/45) was observed in other hyperglobulinemic patients. Of the 10 AIDS patients whose red cells were DAT positive, four had IgG and complement, four had IgG, and two had complement alone on their red cells. The eluates were not reactive with normal red cells nor with penicillin or cephalothin-coated red cells. Clinically, no hemolysis was observed. In this series a positive DAT in AIDS patients appeared not to be associated with autoimmune hemolytic anemia. The positive DAT in AIDS patients may be due to the hyperglobulinemic state.
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