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Biomedical subjects

S Geller

Publications and source records attributed to S Geller.

At least 19 recordsLinked to original sources
PubMed2001

A multicenter, matched case-control study of risk factors for equine laminitis.

Risk factors for equine laminitis were examined in a prospective case-control study of the 258 cases seen at six collaborating veterinary teaching hospitals over a 32-month period. Case-control pairs were matched on institution, clinician, and season of diagnosis. The 90% of case-control pairs (78 acute, 155 chronic) that had complete data for age, gender, and breed were used in separate conditional logistic-regression models for acute and chronic laminitis. There was an increase in risk for horses with acute laminitis from 5 to 7 years of age (OR 4.7, 95% CI 1.3-16) and from 13 to 31 years of age (OR 3.9, 95% CI 1.3-12) (both compared to <5 years); risk was increased for chronic laminitis from 10 to 14 years (OR 3, 95% CI 1.4-6.8) and from 15 to 38 years (OR 2.9, 95% CI 1.4-6.1) (both compared to <6 years). Mares - but not stallions - were more likely than geldings to develop acute laminitis (OR 2.6, 95% CI 1.1-6.2) and chronic laminitis (OR 2.0, 95% CI 1.1-3.6). In the small acute-laminitis data set, the breed variable was collapsed into three categories: Thoroughbred (THB, reference), the Quarter Horse (QH), and other (non-QH-THB). The non-QH-THB group was at increased risk of acute laminitis (OR 3.8, 95% CI 1.2-11.8). For the seven breed-group categories used in the chronic-laminitis model, however, all non-THB breed groups appeared significantly at risk as compared to the THB, with odds ratios ranging from 3.3 (95% CI 1.3-8.30) for the QH to 9.1 (95% CI 2.1-39.3) for ponies.

Acute Disease↗
PubMed2000

Evaluation of transdermal fentanyl patches for analgesia in cats undergoing onychectomy.

OBJECTIVE: To evaluate efficacy and safety of using transdermal fentanyl patches (TFP) for analgesia in cats undergoing onychectomy. DESIGN: Randomized controlled clinical trial. ANIMALS: 45 client-owned cats weighing > or = 2.7 kg (5.9 lb) undergoing onychectomy, onychectomy and ovariohysterectomy, or onychectomy and castration. PROCEDURE: Cats were randomly assigned to be treated with a TFP (25 micrograms/h) or butorphanol; TFP were applied a minimum of 4 hours before surgery (approx 8 hours prior to extubation). Rectal temperature, heart rate, respiratory rate, force applied by the forelimbs, and serum fentanyl concentration were measured, and temperament, recovery, degree of sedation, severity of pain, severity of lameness, and appetite were scored before and periodically for up to 40 hours after surgery. RESULTS: Cats treated with a TFP had better recovery scores at 2 of 4 evaluation times, lower sedation scores at 2 of 8 evaluation times, and lower pain scores at 6 of 8 evaluation times, compared with cats treated with butorphanol. Use of a pressure-sensitive mat to evaluate force applied by the forelimbs did not reveal any differences between groups but did reveal a significant difference between preoperative and postoperative values. Mean +/- SD serum fentanyl concentrations were 1.56 +/- 1.08, 4.85 +/- 2.38, 4.87 +/- 1.56, and 4.35 +/- 2.97 ng/ml approximately 8, 24, 32, and 48 hours, respectively, after TFP placement. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that use of a TFP (25 micrograms/h) for postoperative analgesia in cats undergoing onychectomy with or without surgical sterilization is safe and effective.

Administration, Cutaneous↗
PubMed2000

Physicians helping the underserved: the Reach Out program.

In the current health care environment of competition and market forces, concern has arisen that the classic principle of serving disadvantaged persons may not be fulfilled due to pressures from managed care. Reach Out, a $12 million national program of the Robert Wood Johnson Foundation, was developed to recruit leaders from among practicing physicians to organize projects to care for the uninsured and underserved. Physician volunteerism was a key component of all projects. Thirty-nine Reach Out projects were implemented and carried out across the United States, with average funding per project of $300000 distributed over a period of 4 years. Seven model types emerged, the most common of which, the free clinic and the referral network, accounted for two thirds of the total. At the program's conclusion, 199584 patients were enrolled and 11252 physicians recruited. Project execution was more complex than initially supposed, and major progress commonly was not evident until the third or fourth year, but at least two thirds of the projects are likely to continue with local support. With strong physician leadership and a funded administrative core, organized community efforts can develop and sustain an effective program. Programs such as Reach Out cannot solve the national problem of access to health care, but they can make a small but important impact on the number of uninsured and underserved persons without access to health care.

Altruism↗
PubMed1999

Effective MCH epidemiology in state health agencies: lessons from an evaluation of the Maternal and Child Health Epidemiology Program (MCHEP).

OBJECTIVES: The Maternal and Child Health Epidemiology Program (MCHEP), jointly sponsored by the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA), was evaluated in 1996-1997. As part of this evaluation, an effort was undertaken to identify components of effective MCH epidemiology, to examine their prevalence across participating states, and to assess differences with respect to these components between MCHEP and non-MCHEP states. METHODS: A case-study evaluation was undertaken in which nine states (five MCHEP and four non-MCHEP) rated themselves on a benchmark questionnaire and participated in interviews conducted during site visits. At the completion of the evaluation, 16 components of effective MCH epidemiology in state health agencies were identified. The nine states were rated by the evaluation team on each component. Ratings across all states and between MCHEP and non-MCHEP states were compared. RESULTS: There was a great deal of variability among the nine states with respect to the presence of the components of effective MCH epidemiology. Components on which the states appeared weakest overall were the presence of adequately trained personnel, the presence of adequate management information systems to support MCH programs, and whether the state health agency's epidemiologic unit understands the MCH planning cycle. States with an MCHEP assignee had a higher overall mean score than non-MCHEP states across all components. There were seven components on which the two groups of states differed. These include whether the MCH director is empowered in the state health agency, whether the state health agency has identified internal epidemiologic capacity building as a priority, and whether analytic leadership is available for MCH epidemiologic activities. CONCLUSIONS: Building and maintaining MCH epidemiologic capacity in state health agencies requires attention to a variety of factors. While the presence of an MCH epidemiologist is important, this is only one of many components that must be considered as both the federal and state governments seek to promote and institutionalize effective MCH epidemiology in state health agencies.

Benchmarking↗
PubMed1998

Biomedical equipment in the neonatal intensive care unit: is it a stressor?

The objective of this research was to learn more about nurses' perceptions of the sources of stress in a neonatal intensive care unit and based on the results, to initiate programs to combat stressors. Nurses were asked to complete a demographic sheet and stress audit. Thirty-three (52%) nurses responded and reported that their greatest source of stress was centered on bio-medical equipment--specifically on access, storage, design, and function issues. Nurses reported their least sources were advanced positions, stable infants, and routine procedures. Plans are underway to remedy equipment issues--primarily to inform and collaborate with others.

Adult↗
PubMed1998

Preliminary evaluation of a resiliency-based preschool substance abuse and violence prevention project.

The Resilient Children Making Healthy Choices (RCMHC) Project is an early childhood prevention initiative designed to promote health and social competence in young children by training their teachers in skills aimed at nurturing children's resilient development. Through a model program implemented in ten Head Start and other community-based preschool classrooms, teachers were trained in the use and integration of resiliency-based substance abuse/violence prevention strategies in their teaching practices. Analysis of outcome data from a pre-post comparison group design revealed increases in teacher interactional skills designed to enhance children's resiliency, and improvements in children's prosocial behaviors.

Adaptation, Psychological↗
PubMed1997

Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: a prospective study.

PURPOSE: We conducted a prospective study to clarify the clinical utility of magnetic resonance angiography (MRA) in the treatment of patients with lower extremity arterial occlusive disease. METHODS: During the interval of September 1993 through March 1995, 79 patients (43% claudicants, 57% limb-threatening ischemia) were studied with both MRA and contrast arteriography (ANGIO) and underwent intervention with either balloon angioplasty (9%), surgical inflow (28%), or outflow (63%) procedures. MRA and ANGIO were interpreted by separate blinded vascular radiologists, and arterial segments from the pelvis to the foot were graded as normal or with increasing degrees of mild (25% to 50%), moderate (51% to 75%), or severe (75% to 99%) stenosis or occlusion. Treatment plans were formulated by the attending surgeon and were based initially on hemodynamic, clinical, and MRA data and thereafter with ANGIO. Additional study surgeons formulated independent and specific treatment plans based on MRA or ANGIO alone. Indexes of agreement (beyond chance) for arterial segments depicted by MRA and ANGIO were assessed (kappa value), and treatment plans formulated were compared (chi-square). RESULTS: Precise agreement (%) and the percent of major discrepancies (segment classified as normal/mild stenosis on one study and severe stenosis/occlusion on the other) between MRA and ANGIO for respective arterial segments was as follows: common and external iliacs (n = 256) 77/3.5; superficial femoral and above-knee popliteal (n = 255) 73/6.7; below-knee popliteal (n = 131) 84/3.8; infrapopliteal runoff vessels (n = 864) 74/12.4; pedal vessels (n = 111) 69/19.8 Kappa values indicated moderate agreement (between MRA and ANGIO) beyond chance for all arterial segments. Treatment plans formulated by the attending surgeon, the MRA surgeon, and the ANGIO surgeon agreed in more than 85% of cases. Inability of MRA to assess the significance of inflow disease and inadequate detail of tibial/pedal vessels were the principal deficiencies of MRA in those cases where it was considered an inadequate examination. CONCLUSION: These findings suggest MRA and ANGIO are nearly equivalent examinations in the demonstration of infrainguinal vascular anatomy. MRA is an adequate preoperative imaging study (and may replace ANGIO), particularly in those circumstances when the risk of ANGIO is increased or when clinical and hemodynamic evaluation predict the likelihood of straightforward aortofemoral or femoral-popliteal reconstruction.

Aged↗
PubMed1996

Techniques for intrasplenic hepatocyte transplantation in the large animal model.

BACKGROUND: The preferred therapy for acute and chronic liver insufficiency and severe heritable disorders of liver metabolism is whole-organ transplantation. However, due to the shortage of organ donors and high cost, alternative therapeutic approaches have been proposed, including transplantation of normal allogeneic hepatocytes. Recently, it has been reported that many hepatocytes transplanted into the spleen migrated to the liver. We therefore carried out a series of large-animal experiments to reexamine the intrasplenic route and to develop a method for large-scale hepatocellular transplantation in pigs. METHODS: Allogeneic porcine hepatocytes were transplanted using the following routes: (1) retrograde injection of cells via the splenic vein, (2) intraarterial injection of cells, (3) direct intrasplenic injection of cells after laparotomy, (4) percutaneous intrasplenic injection of cells under laparoscopic control, (5) laparoscopic intrasplenic injection of cells. The number of cells injected varied from 2 x 10(9) to 10 x 10(9) cells. RESULTS: Of all the methods tested, only direct intrasplenic injection of 2 bln of cells was found to be compatible with survival. However, even with this "small" number of cells (2% original liver mass), there was a significant risk of spleen infarction, perisplenic adhesion formation, and portal vein thrombosis. The laparoscopic approach was found to be reliable, simple, and safe. CONCLUSION: Even though the spleen is considered by many authors the optimal site for hepatocellular transplantation, transplantation of cells in a number needed to support the failing liver may be associated with significant complications, morbidity, and mortality.

Animals↗
PubMed1990

Inhibition of leukotriene D4-induced bronchoconstriction in normal subjects by the oral LTD4 receptor antagonist ICI 204,219.

The sulfidopeptide leukotrienes may play a role in the pathogenesis of asthma. Previous clinical trials with leukotriene antagonists have shown only minimal protection from subsequent challenge with inhaled LTD4. Using a double-blind, placebo-controlled crossover design, we tested the hypothesis that the LTD4 receptor antagonist, ICI 204,219, could inhibit LTD4-induced bronchoconstriction in normal subjects. On separate days, 3 to 7 days apart, a single oral 40-mg dose of ICI 204,219 or placebo was ingested. At 2 h (Group I), 12 h (Group II), or 24 h (Group III) after the dose, six subjects in each group underwent bronchoprovocation testing with aerosolized LTD4. The airway response was assessed by measuring specific airway conductance (SGaw) and the FEV1. ICI 204,219 had no effect on baseline pulmonary function. When given 2 h before the LTD4 challenge, ICI 204,219 increased by 117-fold the concentration of LTD4 required to reduce SGaw 35%: 34 +/- 10 versus 3,965 +/- 894 micrograms/ml (placebo versus ICI 204,219; p less than 0.05). When given 12 h before the LTD4 challenge, ICI 204,219 increased by ninefold the concentration of LTD4 required to reduce SGaw 35%: 33 +/- 11 versus 304 +/- 125 micrograms/ml (p less than 0.05). When given 24 h before the LTD4 challenge, a smaller effect was found: 12 +/- 3 versus 60 +/- 24 micrograms/ml (p less than 0.05). Plasma levels of ICI 204,219 correlated with efficacy across groups (r = 0.83, p less than 0.001), but imperfectly within groups. No adverse effects (symptoms or abnormal laboratory test results) were noted after ingesting the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas.

The National Polyp Study (NPS), a randomized clinical trial to evaluate effective surveillance of patients discovered to have one or more colorectal adenomas, was the framework for this statistical analysis which used a multiple logistic model to assess the independent risk factors of patient and polyp characteristics associated with high-grade dysplasia in adenomas. The database included 3371 adenomas from 1867 patients. Adenoma size and the extent of the villous component were found to be the major independent polyp risk factors associated with high-grade dysplasia (p less than 0.0001). The adjusted odds ratios were 3.3 for medium-sized adenomas and 7.7 for large adenomas relative to small adenomas and 2.7 for villous A adenomas, 3.4 for villous B adenomas, and 8.1 for villous C and D adenomas relative to tubular adenomas. Increased frequency of high-grade dysplasia in adenomas located distal to the splenic flexure was attributable mainly to increased size and villous component rather than to location per se. The adjusted odds ratio was 1.4 (p less than 0.11) for left-sided location. Multiplicity of adenomas affected the risk for high-grade dysplasia in patients but was dependent on adenoma size and villous component and was not an independent factor. The adjusted odds ratio was 1.3 (p less than 0.17) for multiplicity. Increasing age was associated with risk for high-grade dysplasia in patients, and this effect was independent of the effect of adenoma size and histological type. The adjusted odds ratio was 1.8 (p less than 0.0016) for age greater than or equal to 60 yr. Gender was not associated with high-grade dysplasia. The adjusted odds ratio was 1.0 (p less than 0.95) for men. The size of the patient series, the prospective nature of the data collection, the completeness of information on all patients, the requirements of complete examination of the entire colon and pathological examination of all lesions encountered, and the exclusion of patients with previously diagnosed adenomas are, collectively, features unique to this study. The detailed model provided by the analysis integrates multiple patient and adenoma factors associated with high-grade dysplasia in colorectal adenomas.

Adenoma↗
PubMed1989

Simon nitinol inferior vena cava filter: initial clinical experience. Work in progress.

The Simon nitinol filter for percutaneous interruption of the vena cava to prevent pulmonary embolism is currently undergoing a multicenter clinical trial. Preliminary clinical results are reported as work in progress. The results in 44 patients at two centers are analyzed in detail, and major events are reported from 103 patients in 17 centers in the United States during a 10-month period. The filter was successfully inserted via the femoral or jugular route in all patients through a 9-F catheter. The placement procedure was easy and without significant complications. Follow-up studies included plain radiography, ultrasonography, magnetic resonance (MR) imaging, and clinical evaluation. No filter migration or perforation occurred among the 103 patients. Symptomatic occlusions occurred in 7%-9%, comparable to other series, and some asymptomatic occlusions were detected with MR imaging only. The implications of occlusion of the filter are discussed.

Adult↗
PubMed1986

The child and/or the embryo. To whom does it belong?

The relationships between embryos and children conceived by assisted procreation and their genetic and uterine parents are discussed. The situations arising in AID, embryo donation, surrogacy, etc. are debated in relation to the status of embryos and children as projects of the parents producing them. The same principle is applied to the use of embryos in research.

Abortion, Spontaneous↗
PubMed1984

CT patterns of splenic infarction: a clinical and experimental study.

The computed tomographic (CT) appearance of splenic infarction has classically been described as peripheral, wedge-shaped, and low in density. Two investigations were designed to determine the appearance of splenic infarcts: (a) a clinical study of 12 patients and (b) a canine experimental model. In the clinical study, two previously undescribed patterns of splenic infarction were found. The classic peripheral, wedge-shaped defects were seen in four patients; multiple, heterogeneous lesions were seen in five; and massive hypodense lesions were noted in three. In three of the nine patients who had both precontrast and postcontrast CT scans, the unenhanced images alone would not have permitted the diagnosis. Contrast enhancement markedly improved infarct visualization in the remaining six. The experimental study of splenic infarction in dogs indicated that CT images can accurately depict the various phases of an infarct as it evolves through stages of congestion, hemorrhage, inflammation, organization, and fibrosis. In addition, a new contrast material--liposome-encapsulated diatrizoate--was used in one of the dogs and was found to produce greater and more sustained differences between normal and abnormal tissue than did conventional contrast material.

Adolescent↗
PubMed1982

Acute therapy with megestrol acetate decreases nuclear and cytosol androgen receptors in human BPH tissue.

This study measures the effect of megestrol acetate (Megace), a progestational antiandrogen, on nuclear and cytosol receptor concentrations in human BPH prostates. Prostatic tissue was obtained at surgery from both untreated patients with BPH and patients pretreated for three to eleven days with 120 to 160 mg of Megace daily; tissues were homogenized and separated into cytosol and crude nuclear fractions. Cytosol and salt extractable nuclear fractions were subjected to saturation analysis with 3H R1881 over the range of 0.5 to 10 nmoles in exchange reactions for 20 hours at 15 degrees C. Cytosol receptor concentration decreased significantly from 32.7 to 8.7 femtomoles per mg protein (P less than 0.05); nuclear receptor also was significantly reduced from 317 to 43.8 femtomoles (fmole) per mg DNA (P less than .001). Plasma testosterone also decreased significantly from 3.65 to 1.01 ng/ml in Megace-treated patients. These effects of Megace on receptor concentration appear to be qualitatively quite different from those reported following castration in animals or following high-dose estrogen therapy in humans. The mechanism of action of Megace in decreasing both cytosol and nuclear androgen receptor concentrations is unknown. It is possible that decrease in receptor concentration is secondary to either the progestational or antiandrogenic effects of Megace. These possibilities are currently under study.

Cell Nucleus↗