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Biomedical subjects

S Keller

Publications and source records attributed to S Keller.

At least 19 recordsLinked to original sources
PubMed1998

ECT in Texas: 19 months of mandatory reporting.

BACKGROUND: Texas law requires that all non-federal clinical facilities providing electroconvulsive therapy (ECT) report every treatment to the state's mental health agency. The resulting data provide total population information about treating physicians and hospitals; payment source; patient age, sex, ethnicity, diagnosis, and admission/consent status; symptom severity and response; numbers and types of treatments; and untoward events occurring within 14 days after treatment. METHOD: We reviewed all reports of ECT between September 1993 and April 1995 (2583 reports, approximately 15,240 treatments). RESULTS: About 6% (N = 117) of Texas psychiatrists performed ECT during the period, at 50 hospitals. One of 13 state-funded mental institutions performed ECT on-site; some occasionally contracted with private hospitals. Almost all patients (88.1%) were white. Some older age groups received proportionately more ECT than younger groups, but no sharp increase was associated with eligibility for Medicare. Five patients were less than 18 years of age; 70.3% were female. Virtually all patients (99.0%) consented to the treatment themselves (rather than by guardian), including committed-but-consenting patients (1.5%). Reports (5.8%) described multiple-monitored treatment (MMECT, not depatterning). Group data indicated generally good-to-excellent response, as measured by a five-point symptom-severity scale. Eight patients died within 14 days of a treatment, 2 possibly of anesthesia complications and 3 others in accidents or by suicide. Four were receiving maintenance treatments (generally about every other week). No death appeared related to ECT stimulus or seizure. CONCLUSION: ECT in Texas is performed by a small minority of psychiatrists and is unavailable to many patients who need it. It is most accessible to white patients who receive care outside the public sector. Our data support the common finding that ECT is generally safe and effective.

Adolescent↗
PubMed1997

Good postural habits: a pilot investigation using EMG scanning of the paraspinals.

The assumption is tested that changes from poor to good postural habits can be identified by specific patterns in paraspinal activity. Paraspinal activity is measured by using an electromyographic (EMG) scanning procedure introduced by Cram. Two samples were addressed. The first sample consists of 32 pain-free medical students. Measurements were taken twice at intervals 3 min apart in a sitting position with arms hanging at the side. The first assessment refers to a normal and relaxed, and the second assessment to an upright "physiological" position of the spine recommended by Brügger. Data indicate that changes to good postural habits are represented by a significant decrease in the activity of the cervical paraspinal area (CPS), whereas in the trapezius and the thoracic area (T1, T6), the activity of the muscles is significantly increased. The hypothesis is put forward that these changes also occur as a consequence of a preventive low back school training. The second sample consists of 26 asymptomatic female employees of a medical hospital who had previously suffered from back pain attacks, but who were without pain during the assessments. Recordings taken before and after participation in the back school at 3 months apart show a similar pattern of significant changes in paraspinal activity (CPS, T6), although their magnitude is less pronounced. No pre-post changes could be observed in the trapezius. The findings partly support the hypothesis. Further research is needed to evaluate the relationship between EMG recording and postural habits.

Adult↗
PubMed1996

Tissue-specific isoforms of chicken myomesin are generated by alternative splicing.

Myomesin is a high molecular weight protein that is present in the M-band of all fiber types of cross-striated skeletal muscle and heart. We have isolated two cDNAs encoding tissue-specific isoforms of chicken myomesin with calculated molecular masses of 174 kDa in skeletal muscle and 182 kDa in heart. Distinct sequences are found at the 3'-end of the two cDNAs, giving rise to different C-terminal domains. Partial analysis of the gene structure has shown that in chicken, both isoforms are generated by alternative splicing of a composite exon. Amino acid sequences show that the main body of myomesin consists of five fibronectin type III (class I motifs) and seven immunoglobulin-like domains (class II motifs). An identical structure was found in M-protein and human 190K protein (the human counterpart of chicken myomesin), and a comparable domain arrangement occurs in the M-band-associated protein skelemin. We postulate that myomesin, M-protein, and skelemin belong to the same subfamily of high molecular weight M-band-associated proteins of the immunoglobulin superfamily and that they probably have the same ancestor in evolution.

Alternative Splicing↗
PubMed1996

Spontaneous pneumothorax in the AIDS population.

Spontaneous pneumothorax (SP) in patients with acquired immunodeficiency syndrome (AIDS) has become the leading cause of nontraumatic pneumothorax in the urban population. However, the appropriate treatment, especially the role of surgical intervention, remains controversial. A retrospective study of 33 patients with AIDS who were treated for 38 episodes of SPs (5 bilateral SPs) at our institution was conducted. The study consisted of 25 males (76%) and 8 females (24%) with a mean age of 38 years. Concurrent Pneumocystis carinii pneumonia was detected in 29/33 patients (88%). Three forms of treatment were utilized for the 38 pneumothoraces (5 of which required two modalities): closed tube thoracostomy, 28/38 (group 1); observation alone, 10/38 (group 2); and operative procedures, 5/38 (group 3). There were eight hospital deaths, four following resolution of the SP. Follow-up was available for 14 patients, 11 of whom died a median of 3 months post-discharge. Three patients were alive 1, 3, and 18 months post-discharge. AIDS-related SP is strongly associated with Pneumocystis carinii pneumonia and is predictive of a short-term survival. The treatment should be individualized, and, although resolution of the pneumothorax can be expected, the coexisting AIDS-related illnesses determine the outcome.

AIDS-Related Opportunistic Infections↗
PubMed1995

Quantity and quality of venom released by a spider (Cupiennius salei, Ctenidae).

The amount of venom injected by the spider Cupiennius salei depended on the efficiency of the mechanical defence of the prey species. Spiders were milked for the first venom (i.e. the first microlitre of venom emitted) versus remaining venom, and for venom regenerated from emptied glands. HPLC gel filtration and IEF electrophoresis showed that the protein content of the first venom was only half as compared to that of the remaining venom, and that this was due to a dilution of all proteins. Venom regeneration came in two speeds. The amount of venom was regenerated more rapidly than the protein concentration. Newly regenerated venom as compared to older venom was characterized by a lower concentration of all proteins and by a higher total concentration of free amino acids, whereas histamine and taurine did not follow this trend. K+ concentration and pH remained similar during venom regeneration. Crickets injected with the venoms showed less acute symptoms when the protein concentration was lower, namely with the first venom and with newly regenerated venom. Consequently, a spider which modulates the quantity of venom injected into a prey also directly changes the venom quality. The ecological consequences of this are discussed. This paper also discusses which region of a gland (ampulla, extracellular and intracellular parts of the glandular sac) is involved in the changes of the venom quality.

Amino Acids↗
PubMed1995

Acute promyelocytic leukemia.

Significant advances have occurred in the diagnosis, treatment, and long-term outcome of patients with acute promyelocytic leukemia (APL). The purpose of this review is to describe the molecular genetics of this disease, the use of all-trans retinoic acid (ATRA) in clinical trials of APL, and the clinical and basic research questions for future investigation. Findings of clinical studies in mainland China using ATRA as induction therapy for patients with APL concurrent with laboratory characterization of the molecular changes in APL have led to worldwide clinical trials of ATRA in the treatment of patients with APL. Major advances in understanding the molecular biology and genetics of APL have occurred over the past 5 years. These findings have been translated into novel treatment strategies using all-trans retinoic acid as a differentiation agent in the induction phase of therapy resulting in improved long-term outcome, reduced morbidity, and lower costs for patients with APL. Advanced molecular techniques are being employed for diagnosis and for monitoring of patient response to treatment.

Child↗
PubMed1994

Survival following resection of clinically occult N2 non small cell lung cancer.

BACKGROUND: The role of resection in Stage IIIA (N2) non-small cell lung cancer (NSCLC) remains controversial despite reported survival rates of 25-40%. This study was undertaken to identify factors associated with a high risk of treatment failure after resection of clinically occult Stage IIIA (N2) NSCLC: Such prognostic factors may identify high risk patients as candidates for future clinical trials of multimodality lung cancer treatment and be important stratification factors in such trials. METHODS: The clinical and pathological records of 32 patients with clinical NO pathologic N2 NSCLC who underwent lobectomy (n = 17), pneumonectomy (n = 12), or bilobectomy (n = 3) and complete mediastinal lymph node dissection at Fox Chase Cancer Center from 1987 to 1991 were reviewed. A multivariate analysis of clinical and pathologic variables was performed. RESULTS: Median follow-up was 15 months (range 5-55). Fifty-nine percent have recurred and 44% have died. Median disease free and overall survival were 16 and 19 months, respectively. Two year disease free and overall survival were 24% and 43%, respectively. No patient with more than one level of mediastinal lymph node metastases survived two years free of disease. Univariate and multivariate analysis revealed a longer disease free survival for those receiving adjuvant radiation therapy (19 vs 5 months) but no increase in overall survival. CONCLUSIONS: This experience with clinically occult Stage IIIA (N2) NSCLC suggests that multiple levels of mediastinal lymph node metastases predict treatment failure in patients following resection and that adjuvant mediastinal radiation improves disease free but not overall survival.

Adult↗
PubMed1994

Analysis of elastin cross-linking and the connective tissue matrix of abdominal aortic aneurysms.

BACKGROUND: Studies of the connective tissue matrix of abdominal aortic aneurysms (AAAs) have yielded conflicting results, and the glycosaminoglycan content has not been previously reported. The present work was done to evaluate the matrix components of AAAs, including the cross-link content of the residual elastin. METHODS: Aortic specimens from AAAs and controls were sequentially extracted with salt, Brij, and urea; and the residual pellets were the subject of further studies. Elastin was purified by hot alkali treatment; other matrix components were determined by conventional methods. RESULTS: Elastin content of the purified material was reduced in AAA. The cross-link content, desmosine+isodesmosine, was also reduced in AAA as a ratio to insoluble matrix dry weight. However, the cross-link content as a ratio to valine in the purified elastin was normal. The amino acid profiles of representative AAA and controls elastin preparations were similar to that of reference elastin. The amino acid content of the insoluble matrix of AAA revealed a significant reduction of protein (controls = 820 +/- 40 micrograms/mg versus AAA = 700 +/- 20 micrograms/mg, p < 0.05); the collagen content was unaltered. The content of glycosaminoglycan in AAA was noted to be significantly reduced (controls = 33.5 +/- 3.4 micrograms/mg versus AAA = 17.1 +/- 2.0 micrograms/mg, p < 0.05). CONCLUSIONS: The data do not support the hypothesis of a primary cross-link deficiency in elastin of AAA; but the reduced contents of protein and glycosaminoglycans in AAA suggests basic biochemical alterations in the diseased aorta that warrant further investigation.

Amino Acids↗