PubMed Health⌕ Search

Biomedical subjects

M Penner

Publications and source records attributed to M Penner.

At least 19 recordsLinked to original sources
PubMed2005

Multidisciplinary forensic approach--investigation of a neonaticide and alleged concomitant rape.

In the case presented, a young woman claimed to have spontaneously aborted a 30-weeks old fetus conceived after being raped by her cousin. The police investigation was centred on a probable neonaticide, mitigated by a possible rape. In Israel, the crime of rape carries a heavy punishment similar to that of first degree murder. Thus the implementation of the most recent scientific forensic techniques is of paramount importance in charging or clearing a suspected rapist. The skeletonized fetal remains were found four months after the reputed abortion. The alleged neonaticide was supported by the results of the forensic clinical and anthropological examinations, while the rape accusation was dismissed by the results of the molecular biology identification of the skeletonized fetal remains. The aim of this report is to encourage the forensic community to apply a multi-disciplinary approach, thus maximizing the decision making competence of the courts of law.

Adult↗
PubMed2001

Reimbursement for complimentary/alternative medicine by California HMOs.

Beginning in the 1990s, researchers indicate a growing acceptance of complementary/alternative medicine in America. In this 1999 study, we surveyed California HMOs to determine the extent they reimburse for the following complementary/alternative therapies: nutrition counseling, chiropractic, acupuncture, massage and herbal medicine, as well as whether they require these providers to be licensed or otherwise credentialed. As hypothesized, California HMOs are more likely to reimburse for each of these therapies vs. an aggregate of 13 western U.S. states of which California is one. California's huge and competitive HMO market may be a factor.

California↗
PubMed1997

How HMOs assess medical groups and IPAs.

California health maintenance organizations (HMOs) frequently capitate physician organizations--independent practice associations (IPAs) and multispecialty medical groups--to export their risk for professional and outpatient ancillary services. Physician organizations benefit when successful in managing the risk, and from having greater control over medical management decisions. HMOs carefully assess the physician organization's ability to manage capitated risk and provide high-quality care. HMOs gather information on the physician organization's finances, business relationships, physician compensation arrangements, credentialing, hospital relationships, ancillary contracts, procedures for 24-hour care, claims administration, member services, information systems for reporting and tracking utilization, and procedures for utilization/quality management. These data are analyzed to determine whether capitation contract negotiation should proceed.

California↗
PubMed1996

Unilateral spinal anesthesia using low-flow injection through a 29-gauge Quincke needle.

Restriction of sympathetic denervation during spinal anesthesia may minimize hemodynamic alterations. Theoretically, the use of nonisobaric anesthetics may allow unilateral anesthesia and thus restrict sympathetic denervation to one side of the body. The present prospective study investigates the incidence of unilateral spinal anesthesia using hyperbaric bupivacaine 0.5% (1.4 mL, 1.6 mL, 1.8 mL, or 2.0 mL) injected via a 29-gauge Quincke needle with a pump-controlled injection flow of 1 mL/min. In 96 consecutive patients undergoing unilateral surgery of the lower extremities, spinal anesthesia was performed in the lateral decubitus position, which was maintained for 20 min postinjection. Increases in foot temperature of at least 0.5 degrees C were defined as sympathetic blockade. The incidence of unilateral block was not significantly influenced by the amount of bupivacaine. For all 96 patients, the incidence of unilateral sympathetic and complete motor block was 69% and 77%, respectively. Frequency of unilateral sensory block (assessed by pinprick and temperature discrimination) was significantly lower (28%). Strict unilateral spinal anesthesia was achieved in 24 cases (25%). Twenty minutes after injection of the local anesthetic, mean arterial blood pressure decreased significantly in patients with bilateral sympathetic blockade from 87 +/- 8 to 83 +/- 8 mm Hg (P < 0.01) but not in patients with unilateral sympathetic blockade (from 87 +/- 11 to 85 +/- 10 mm Hg). In conclusion, low-flow injection (1 mL/min) of hyperbaric bupivacaine 0.5% via a 29-gauge Quincke needle prevented bilateral sympathetic blockade in more than 69% of the patients. The data further suggest that loss of temperature discrimination alone is not a reliable estimation of sympathetic block.

Anesthesia, Spinal↗
PubMed1995

Phage T4-coded Stp: double-edged effector of coupled DNA and tRNA-restriction systems.

The optional Escherichia coli prr locus encodes two physically associated restriction systems: the type IC DNA restriction-modification enzyme EcoprrI and the tRNA(Lys)-specific anticodon nuclease, specified by the PrrC polypeptide. Anticodon nuclease is kept latent as a result of this interaction. The activation of anticodon nuclease, upon infection by phage T4, may cause depletion of tRNA(Lys) and, consequently, abolition of T4 protein synthesis. However, this effect is counteracted by the repair of tRNA(Lys) in consecutive reactions catalysed by the phage enzymes polynucleotide kinase and RNA ligase. Stp, a short polypeptide encoded by phage T4, has been implicated with activation of the anticodon nuclease. Here we confirm this notion and also demonstrate a second function of Stp: inhibition of EcoprrI restriction. Both effects depend, in general, on the same residues within the N-proximal 18 residue region of Stp. We propose that Stp alters the conformation of EcoprrI and, consequently, of PrrC, allowing activation of the latent anticodon nuclease. Presumably, Stp evolved to offset a DNA restriction system of the host cell but was turned, eventually, against the phage as an activator of the appended tRNA restriction enzyme.

Amino Acid Sequence↗
PubMed1994

Somatic APC and K-ras codon 12 mutations in aberrant crypt foci from human colons.

Aberrant crypt foci (ACF) are microscopic lesions which have been postulated to precede the development of adenomatous polyps, the precursors to colorectal cancer. APC and ras gene mutations have been shown to be important early molecular events in the development of colorectal neoplasms. The objective of this study was to establish the nature and frequency of these two genetic alterations in ACF harvested from human colorectal resection specimens. One hundred and fifty-four ACF comprised of between 1 and 56 crypts were harvested from the grossly normal mucosa of colorectal resection specimens of 28 patients with varying pathological diagnoses. One hundred and twenty-five ACF from 20 colons were screened for the presence of K-ras codon 12 mutations with a polymerase chain reaction/restriction enzyme-based method. The APC gene mutation cluster region was screened in 65 ACF from 20 colons using a polymerase chain reaction/single strand conformation polymorphism technique. Putative mutations were confirmed by direct sequencing. K-ras codon 12 mutations were identified in 13% (16 of 125) of ACF. We also identified APC mutations in 4.6% (3 of 65) of ACF. The results of this study demonstrate that both APC and K-ras mutations occur in ACF. These observations support the role of the ACF as a colorectal cancer precursor and provide further insight into the early genetic changes which occur during colorectal tumorigenesis.

Adenomatous Polyps↗
PubMed1994

[Benefits and risks of autologous blood donation].

Aim of this review is to compare benefits and risks of autologous blood transfusion with special emphasize on donation and retransfusion risks. Autologous blood transfusion may reduce the transfusion-associated mortality by 70%. Another advantage of preoperative autologous blood donation is the increase in erythropoiesis. Immunologic and viral infectious complications have not been reported with transfusion of autologous blood. On the other hand, autologous blood predonation is associated with risks during donation and retransfusion. Reactions due to routine autologous predonation of blood have been examined in several studies. Mild and moderate reactions occurred in similar frequencies with autologous predeposit and homologous donations, respectively. High risk autologous predonation has also been successfully performed in patients with end-stage heart or lung disease and in pregnancy. No data could be retrieved concerning the frequency of retransfusion-associated risks, e.g., clerical error or contamination of blood products. Bacterial contamination of autologous blood is published only in case reports. Autologous blood transfusion has minor impact on hospital mortality since overall risk of transfusion is low compared to mortality of anesthesia and surgery. However, no reliable criteria exist by which rare severe complications such as unstable angina or transient ischaemic attacks could be predicted. In cases with minor blood loss isovolaemic haemodilution should be performed instead of autologous predeposit. Autologous predonation should be done whenever other forms of autologous transfusion are not sufficient to exclude homologous transfusion.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Autologous blood donation and isovolemic hemodilution--indications and practical implementation].

OBJECTIVE: The state of the art of autologous blood transfusion is described with special emphasis on safety aspects, indications and medicolegal implications. DATA SOURCES AND SELECTION CRITERIA: Literature was retrieved using the MEDLINE literature database. Medical and legal expert opinions on autologous blood transfusion programmes are presented as well as the actual German jurisdiction. Guidelines for autologous predeposit and haemodilution used in the University of Münster are described. RESULTS: In the past decade all forms of autologous transfusions gained increasing influence in haemotherapy due to the ongoing discussion on the safety of blood products. The German Federal Court has demanded that whenever homologous perioperative transfusion is considered likely, patients have to be offered autologous predeposit. Legal conditions for autologous programmes directed by anaesthetists not specialised in transfusion medicine are described. Whole-blood predeposit should be limited to two autologous units. In cases with minor blood loss, isovolaemic haemodilution may be performed instead of autologous predeposit. However, autologous transfusions have their specific risks that are either related to the patient or to the procedure of autologous predeposit, e.g., clerical error, contamination of blood products and technical faults. Standard procedures of the University of Münster to ensure low-risk autologous transfusion are presented. They consist in adequate handling and proper identification, testing of donor for virus infection markers, bacterial culture from blood products and a list of contraindications: anaemia, unstable angina, myocardial infarction within 3 months, decompensated heart insufficiency, aortic valve stenosis with angina, and cases with infection and fever. CONCLUSION: The risks related with autologous transfusion should be lower compared to homologous transfusions. Well-defined standards concerning indications and techniques are required to reach this goal.

Blood Donors↗
PubMed1993

[Transfusion-induced virus infections: how great is the risk?].

The risk of infection by blood transfusions contaminated with the human immunodeficiency virus (HIV) and/or the hepatitis C virus (HCV) was dramatically reduced after the introduction of blood donor screening using specific and sensitive 2nd- or 3rd-generation enzyme immunoassays for virus antibody detection. In addition, donors selection provides the greatest safety. The strategy for safe blood supply includes medical examination and self-exclusion of donors. For example, in German blood donors, the current detection rate of HIV is between 1.36 and 1.82 confirmed positive results per 100,000 blood donations. For hepatitis C the rate of anti-HCV-positive donors is between 0.27 and 0.49%. The overall risk of HIV infection ranges from 1 in 500,000 to 1 in 3 million and that of a transfusion-associated HCV infection from 1 in 20,000 to 1 in 40,000 per transfused blood unit. From the observed virus load among German blood donors, the transfusion-associated mortality was calculated to be 1 in 260,000 per transfused blood unit. Implications are discussed resulting from this low risk of HIV and/or HCV infection by blood transfusions.

Blood Component Transfusion↗
PubMed1992

[Tubal malpositioning as a cause of tubal cuff hernia].

Airway obstruction of endotracheal tubes may occur during general anaesthesia. A case is reported where endobronchial intubation and inflation of the cuff caused herniation into the left bronchus before the malpositioning had been corrected. This led to a cuff herniation that caused airway obstruction at the end of anaesthesia. The regional overinflation of the tubes cuff could be reproduced by a model by other tubes of the same type. Malpositioning of endotracheal tubes may cause cuff herniation that potentially leads to acute airway obstruction.

Aged↗
PubMed1991

Preventing low birth weight: marketing and volunteer outreach.

Low birth weight (LBW) contributes to infant mortality and continues to be a public health concern in the United States. A community-based prenatal program was established to prevent low birth weight through early and continuous prenatal care. Two key dimensions of the program were marketing and the use of volunteer neighborhood outreach workers. This paper explores the role of the program's public health nurses in relation to these dimensions and makes recommendations regarding marketing and use of outreach workers.

Arizona↗
PubMed1991

Using postcards to increase patient provided information on medication use.

Many elderly persons take medications that their physicians do not know about. The reasons include multiple prescribers, errors in prescriber records, and lack of patient-to-physician communication on medication use. This study assessed the use of mailed cues (postcards) to prompt elderly patients to bring all medications to physician office visits. Four family physician offices were studied; every other current elderly patient received a postcard reminder several days before an appointment. Of those receiving cards, 72% brought in medicines, compared to 8% of the controls.

Aged↗
PubMed1990

Isolation by polymerase chain reaction of a cDNA whose product partially complements the ultraviolet sensitivity of xeroderma pigmentosum group C cells.

A xeroderma pigmentosum (XP) cell line from complementation group C has been complemented to attain ultraviolet (UV) resistance and DNA repair proficiency, by transfection with a human expression cDNA library, followed by selection to UV resistance. We now show that the transfected cDNAs can be rescued from cellular DNA of a secondary transformant by its in vitro amplification using expression-vector-specific oligodeoxyribonucleotides as primers in a polymerase chain reaction. The amplified cDNAs were cloned into a mammalian expression vector. Their transfection into XP cells identified a single cDNA which specifically complemented the UV sensitivity of a group-C-derived cell line to the same partial UV-resistance levels exhibited by the transformant from which the cDNAs were rescued.

Base Sequence↗
PubMed1990

Expression of the cDNA for the beta subunit of human casein kinase II confers partial UV resistance on xeroderma pigmentosum cells.

An immortalized xeroderma pigmentosum cell line belonging to the complementation group D (XP-D) was transfected with a normal human cDNA clone library constructed in a mammalian expression vector. Following UV-irradiation-selection, a transformant having a stable, partially UV-resistant phenotype was isolated. A transfected cDNA of partial length was rescued from the transformant's cellular DNA by in vitro amplification, using expression-vector specific oligonucleotides as primers in a polymerase chain reaction (PCR). Expression of this cDNA complemented the UV sensitivity of the XP-D cell line to the UV-resistance levels characteristic of the primary transformant. The nucleotide sequence of the cDNA was determined. The deduced protein identified the cDNA as encoding for the beta subunit of casein kinase II (CKII-beta). Similar to the effect exerted by the truncated CKII-beta cDNA, expression of a cDNA clone encompassing the complete translated region of CKII-beta leads to XP-D cells partially resistant to UV-irradiation. However, transfection of CKII-beta cDNA could also partially complement the UV-sensitivity of a xeroderma pigmentosum cell line belonging to group C (XP-C). Analysis by Southern, Northern and RNAase mismatch cleavage techniques did not reveal any functional defect in the CKII-beta gene of cell lines derived from either 7 XP-D or 10 XP-C families. We therefore consider it unlikely that either the XP-D or the XP-C DNA repair deficiency is associated with a defect in the beta subunit of casein kinase II. Nevertheless, our findings suggest the possibility that the cell's response to DNA damage is modulated by CKII-dependent protein phosphorylation.

Base Sequence↗
PubMed1990

Excess insured health care costs from tobacco-using employees in a large group plan.

Health insurance costs from tobacco have been estimated from tobacco's contribution to annual or lifetime costs for heart disease, emphysema, and selected cancers. Because health plans seldom identify tobacco users, there are few published studies that compare users with nonusers. This study gathered data on paid claims from a large group's indemnity plan (4108 users, 16,723 nonusers) from Jan 1 to Nov 30, 1988. Tobacco users had more admissions per 1000 (124 v 76), days per 1000 (800 v 381), a longer average length of stay (6.47 v 5.03 days), higher average outpatient payments ($122 v $75), and higher average insured payments ($1,145 v $762). Tobacco use is correlated with other high-risk behaviors; thus, cost and utilization differences are not solely due to its effects. Nevertheless, tobacco users add to employer costs for health insurance as well as for absenteeism, workers' compensation, and life insurance. Employers may use these data to reduce costs by not hiring tobacco users, adding surcharges for their health insurance, and strongly encouraging cessation. Issues of equity are discussed in terms of coerciveness and intrusiveness.

Costs and Cost Analysis↗
PubMed1990

[Effect of a new 10% hydroxyethyl starch solution HES/270/0.5 on blood coagulation, blood loss and hemodynamics in comparison with 3.5% PPL].

20 patients scheduled for total hip replacement were given 1,000 ml of a new preparation of 10% hydroxyethylstarch (HES) (MW 270,000: 0.5) preoperatively. They were compared to a group of 20 patients who received 1,000 ml of 3.5% plasma protein solution (PPS). HES caused a more pronounced hemodilution than PPS. With HES, central venous pressure (CVP) rose significantly higher than with PPS. PTT was significantly prolonged in the HES but not in the PPS group. TT was significantly reduced by HES in comparison to PPS. PT (Quick-value %) and fibrinogen levels showed no difference in both groups. Blood loss and transfusion volume were comparable to HES and PPS until 24 h after the operation. One patient showed generalised flush after HES. This HES preparation is a colloid with volume-expanding properties and appears to be without clinically apparent effects on coagulation (up to a volume of 11).

Blood Coagulation Tests↗