Bedside heparin monitoring by activated partial thromboplastin time measured with a dry reagent.
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Biomedical subjects
Publications and source records attributed to R Linder.
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Wound management includes treatment of injuries, chronically open wounds of various origin, and incisions. Despite successful primary wound healing has good functional and cosmetic results, primarily closure should not be forced by raising wound tension or in wounds with increased risk of infection, respectively. Standards of trauma wound debridement according to location and type of wound are still in force. Anatomically incorrect type of surgical incisions may disturb wound healing. Sutures of the subcutaneous tissue are associated with increased risk of infection and should therefore be avoided. Alternatively, vacuum drainages may be used. Antibiotics should only be given exceptionally and if so, not as a local application. In case of chronically open wounds, underlying diseases should be treated, respectively. Moist wound healing using occlusive dressings has been established successfully in local management of chronic wounds.
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Multi-formatted films of 90 ultrasound examinations of the gallbladder (stones 56 cases, sludge 20 cases, hydrops five cases, normal gallbladder nine cases) have been digitalized and stored in a personal computer. Image data of each examination was processed to extract a 19-dimensional vector that represents the essential diagnostic information of each examination. This vector was evaluated by three different classification algorithms: (1) classical nearest neighbor principle, (2) classical linear discriminant analysis, (3) multilayered backpropagation neural network. The correct classification rate was 64% (58/90) for the nearest neighbor principle, 97% (87/90) for the linear discriminant analysis, and 99% (89/90) for the backpropagation neural network. We conclude that, (1) automated classification of ultrasound images is possible for limited diagnostic problems, (2) a neural network approach can be used successfully for that goal, and (3) the efficiency of the more flexible neural network approach is comparable to large-scale classical methods.
A review of the literature on the surgical treatment of nesidioblastosis in childhood was made to answer the following questions: age at operation, surgical procedure, pathohistological findings, incidence of recurrence and its treatment, as well as mortality. Primary subtotal pancreatectomy appears to be the method of choice. It should be performed as early as possible following exact diagnosis. Total pancreatectomy is reserved for treatment of a recurrence.
In order to evaluate long-term renal graft function, 149 cyclosporin A and prednisolone (CyA/P)-treated renal transplant recipients were compared with 119 azathioprine and prednisolone (Aza/P)-treated patients. Only patients who had a functioning graft for at least 1 year and who were maintained on their initial immunosuppressive protocol were included. The minimum follow-up period was 4 years. Renal graft function was estimated by yearly determinations of serum creatinine and creatinine clearance. The CyA/P-treated patients had a significantly higher serum creatinine and a significantly lower creatinine clearance at every point in time post-transplantation than Aza/P-treated patients (P less than 0.001). The evolution of renal graft function, as reflected in the line of regression for serum creatinine and creatinine clearance versus time, was estimated for each individual patient. There was an almost stable renal function, as assessed by the median of the slopes of the regression line for serum creatinine versus time in both groups. The median increase in serum creatinine was only 1.4 mumol/l per year for Aza/P-treated patients and 2.4 mumol/l per year for CyA/P-treated patients (difference NS). The median decline in creatinine clearance was 2.18 ml/min per 1.73 m2/year in the Aza/P group and 1.07 ml/min per 1.73 m2/year in the CyA/P group (P = 0.05). In patients with a functioning graft for at least 5 years, creatinine clearance remained unchanged in both groups during the study period. In conclusion, renal graft function, as assessed by measurements of serum creatinine and creatinine clearance, remained essentially unchanged for at least 5 years after transplantation, regardless of the immunosuppressive protocol used.(ABSTRACT TRUNCATED AT 250 WORDS)
Human pancreatic elastase 1 (E1) is a novel pancreas-specific proteinase that has not yet been investigated after pancreatic transplantation (PTx). Using a recently developed E1 ELISA, we studied the E1 serum curves in 36 type I diabetic patients subjected to PTx with enteric exocrine diversion from the pretransplant value up to 8 years after transplantation (n = 731 samples). A characteristical pattern was observed: following PTx, E1 rose above the normal range to a peak within 6 days and then gradually fell to stabilize after 4-6 weeks at an elevated level (10 ng/ml) for approximately 1 year. Two to 8 years after PTx, E1 levels were still slightly elevated (1-6 ng/ml) in 14/20 patients. During 24 acute rejection episodes, E1 was found not be a sensitive rejection marker during the early postoperative period because of its slow decline from the peak level. However, increasing E1 levels in seven patients more than 2 months after PTx were associated with a variety of lesions to the pancreatic graft, thus suggesting a useful marker indicating exocrine graft damage late after PTx. The slightly elevated levels even years after PTx are most probably due to the non-portal venous drainage of the pancreatic graft.
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The 95-degree angled condylar screw (DCS) has been proven to be a valuable implant in the operative repair of comminuted and two-level fractures of the subtrochanteric region. Technically, it is easier to insert than the 95-degree angled condylar plate providing higher stability and the possibility of corrections even after insertion.
We are developing a data base that will allow us to select endpoints that would be useful in the detection of reproductive toxicity in a multigenerational test. In this effort, carbendazim (MBC), a known reproductive toxicant, was administered to male and female rats from weaning, through puberty, gestation, and lactation. A similar study was conducted with hamsters. In rats, MBC was administered at 0, 50, 100, 200, or 400 mg/kg/day. Hamsters were dosed at 0 or 400 mg/kg/day. In the parent (P0) generation, landmarks of puberty were measured. In females, estrous cyclicity, litter size, the number of implants, organ weights, and histology were assessed. Our assessment of the male rat included organ weights, testicular and epididymal sperm counts, a quantitative measure of sperm motility, sperm morphology, testicular histology, and endocrine measures. The growth, viability, and reproductive function of the offspring (F1) were observed during a 4-month period of continuous breeding. In the P0 of both species. MBC did not alter pubertal development, growth, or viability. The reproductive potential of the rats treated with MBC at 200 and 400 mg/kg/day was reduced due to effects on sperm production and fetal viability. In the male rat, MBC treatment markedly altered sperm morphology, testicular and epididymal weights, and sperm numbers and testicular histology. Fertility, sperm motility, and hormonal levels were altered, primarily in the males with very low sperm counts. The ability to conceive did not appear to involve a female factor. In P0 female rats, MBC administration caused postimplantation losses in the high-dosage groups and a few malformed rat pups were found in the litters from the 100 and 200 treatment groups. MBC was less toxic to the hamster than the rat. The only reproductive effects induced by MBC treatment were on sperm measures. Fertility of the P0 generation and fetal and neonatal (F1) viability were not decreased by MBC administration. In the male rat, testis weight, sperm numbers in the cauda epididymis and testis and sperm morphology were sensitive to the effects of MBC. In females, counting implantation scars at necropsy was useful, as this information allowed us to confirm pregnancy and identify postimplantation losses induced by MBC administration.
Among 40 type I diabetic patients who received a segmental pancreatic allograft with enteric exocrine diversion and had normal endocrine graft function for more than one year, 12 patients have had occasional episodes of "graft pain" associated with short-term hyperamylasemia. The symptoms usually resolved after 1-4 days. To determine possible precipitating factors, 80 such episodes were analyzed by interviewing all the patients and reviewing their files. To study the impact on endocrine graft function, the results of the serial intravenous glucose tolerance tests were plotted versus time. Episodes of late graft pancreatitis occurred at any given time between 6 and 51 months after transplantation. The frequency of bouts ranged between 1 and 31 per patient. The symptoms and clinical course were clearly different from late rejection episodes. Except for one severe case which resulted in graft loss, endocrine graft function did not deteriorate. Four conditions were found to correlate with the attacks: mental stress, alcohol and food intake, infections, and direct mechanical pressure to the pancreatic graft. We conclude that late graft pancreatitis can be distinguished from late rejection episodes and that the pancreatic graft may be more prone to acute pancreatitis than the native pancreas. The endocrine capacity of the pancreatic graft is usually not affected even by repeated attacks.
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