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Biomedical subjects

T Kramer

Publications and source records attributed to T Kramer.

At least 19 recordsLinked to original sources
PubMed2000

High-performance liquid chromatographic determination of morphine and its 3- and 6-glucuronide metabolites by two-step solid-phase extraction.

To provide more accurate measurement of morphine and its metabolites for a study of the genetic differences on morphine response, a method for the analysis of morphine and its metabolites is described which has the advantages of increased sensitivity and specificity by using a cleaner extraction. The new extraction method involves both the hydrophobic isolation on a carbon cartridge and ion-exchange isolation on ion-exchange resin which has not preliminary been described for morphine analysis. The combination of these two steps successfully purified drugs from human plasma with maximum removal of interfering substance comparing with a conventional C18 cartridge alone. The analytes are quantified by high-performance liquid chromatography on a reversed-phase C18 column employing a mobile phase consisting of 25% acetonitrile in 0.05 M phosphate buffer (pH 2.1), and 2.5 mM sodium dodecyl sulfate as the pairing ion with a combination of electrochemical and fluorometric detections. The recoveries for morphine (M), morphine-3-glucuronide (M3G), morphine-6-glucuronide (M6G) and hydromorphone after the SPE procedure were 86+/-7.1%, 82+/-6.9%, 79+/-6.0% and 85+/-6.0%, respectively. Limits of detection for this method are 0.1 ng/ml for M, and 0.18 ng/ml for M3G and M6G. Limits of quantitation were approximately 0.25 ng/ml for M, and 0.45 ng/ml for M3G and M6G. The present assay was applied to measure M, M3G and M6G content in human plasma to test the applicability and suitability of this method for clinical and research use.

Chromatography, High Pressure Liquid↗
PubMed2000

Granulocyte selected live Salmonella enteritidis vaccine is species specific.

Selection of Salmonellae from granulocytes may result in safe and effective vaccine strains. We demonstrated that the reduced virulence of such strains is limited to the species in which the selection was made. Repeated (sequential) selection of Salmonella enteritidis from chicken granulocytes yielded an avirulent strain for chickens. Repeated (sequential) selection of Salmonella enteritidis from pig granulocytes (neutrophils) yielded a strain that was comparable to the original wildtype strain.

Animals↗
PubMed2000

The coordination of bimanual prehension movements in a centrally deafferented patient.

Many everyday tasks require that we use our hands co-operatively, for example, when unscrewing a jar. For tasks where both hands are required to perform the same action, a common motor programme can be used. However, where each hand needs to perform a different action, some degree of independent control of each hand is required. We examined the coordination of bimanual movement kinematics in a female patient recovering from a cerebrovascular accident involving anterior regions of the parietal lobe of the right hemisphere, which resulted in a dense hemianaesthesia of her left arm. Our results indicate that unimanual movements executed by our patient using her non-sensate hand are relatively unimpaired. In contrast, during bimanual movements, reaches executed by our patient using her non-sensate hand show gross directional errors and spatiotemporal irregularities, including the inappropriate coupling of movement velocities. These data are discussed with reference to the role played by limb proprioception in the planning and control of prehension movements.

Aged↗
PubMed1998

Psychiatric disorders in adolescents in primary care.

BACKGROUND: Little is known about psychiatric disorders in adolescents who attend primary care. METHOD: Prospective study of 13- to 16-year-olds consecutively attending general practice. Information was obtained from adolescents, parents and general practitioners, using questionnaires and research interviews. RESULTS: 136/200 (68%) of adolescent attenders took part. Two per cent presented with psychiatric complaints. From research interviews with adolescents, psychiatric disorder in the previous year was found in 38%, with moderate impairment of functioning in over half (according to Children's Global Assessment Scale scores). Most disorders (42/50, 84%) were emotional ('internalising') disorders. Psychiatric disorders were significantly associated with high levels and intensity of physical symptoms and with increased health risks. General practitioner assessment of psychiatric disorders was low on sensitivity (20.8%) but high on specificity (90.7%). Doctors identified most severely affected adolescents. CONCLUSIONS: Depressive and anxiety disorders are common among adolescent general practice attenders and linked to increased physical symptoms; general practitioner recognition is limited.

Adolescent↗
PubMed1997

In the eye of the storm. Promoting quality initiatives for behavioral health care.

The restructuring of how behavioral health care services are financed, managed, and delivered has controlled costs but raised concerns about quality. The need and opportunity has never been stronger for professionals and organizations from previously disparate segments of the field to closely collaborate on broad-based quality initiatives. This article reviews the collaborative initiatives established by one organization that are affecting all segments of the field through research projects, publications to disseminate information, and conferences to promote discussion. Implications, new directions, and opportunities for evaluation researchers are proposed.

Health Promotion↗
PubMed1997

Quality assessment and improvement standards for behavioral group practices.

Behavioral group practices have agreed on performance indicators and have established national benchmarking standards. Collaborative study, led by the Institute for Behavioral Healthcare's Council of Behavioral Group Practices (CBGP), facilitates practice pattern evaluation, trend analysis, and clinical quality improvement. The study reports the benchmarking standards for quality assessment and improvement standards in behavioral group practices in the comprehensive 1995 and 1996 CBGP Performance Indicator Reports.

Efficiency, Organizational↗
PubMed1997

Cost and value of performance indicators. Results from IBH's (Institute for Behavioral Healthcare) National Leadership Council.

Consumer Reports style report cards are becoming commonplace in our industry and will emerge as a necessary component of 21st century behavioral healthcare. As a result, health plans and providers are increasingly required to invest in and maintain an infrastructure for comparative performance measurement and reporting. Policymakers and accrediting agencies must be careful to require reporting about the most cost-effective indicators in order to minimize the extra cost burden imposed upon health plans and providers by this effort. The Institute for Behavioral Healthcare's National Leadership Council evaluated "real life" performance indicators already in use in health plans, facility-based provider settings, community mental health centers, and behavioral group practices. This study shows which performance indicators are most worth measuring and those which are not, and why. Significant implications for policy and accrediting organizations, and for the behavioral healthcare field, are discussed.

Health Care Surveys↗
PubMed1997

Pediatric vertebral osteomyelitis: diagnosis using computed tomography.

The diagnosis of pediatric vertebral osteomyelitis has been enhanced through the use of computed tomography scan and magnetic resonance imaging. A retrospective analysis of seven patients with vertebral osteomyelitis was done to determine the studies used in medical management decisions and the outcome of these studies. Computed tomography scans were valuable in predicting if a patient would respond to medical management. The presence of a phlegmon on the computer-assisted tomography scan uniformly resulted in a failure of medical management or an indication for primary surgical management.

Adolescent↗
PubMed1996

Absorption of short-chain fatty acids across ruminal epithelium of sheep.

Investigations on the absorption of shortchain fatty acids across ruminal epithelium of sheep were performed both in vitro (Ussing chamber technique, using propionic acid representatively for short-chain fatty acids) and in vivo (washed, isolated reticulorumen). A pH-induced, nearly tenfold increase in the concentration of undissociated propionate led to an only twofold increase in mucosal-to-serosal flux of propionate (in vitro). Neither amiloride (1 mmol.l-1, in vitro) nor theophylline (10 mmol.l-1, in vivo), inhibitors of the ruminal Na+/H+ exchanger, exerted any significant influence on propionate fluxes or short-chain fatty acids absorption, respectively. Total replacement of luminal Na+ (by choline) did not alter short-chain fatty acids absorption (in vivo). Mucosal 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (0.1 mmol.l-1) or mucosal nitrate (40 mmol.l-1) markedly reduced propionate net flux (in vitro). Increasing mucosal Cl- concentration brought about a significant drop in mucosal-to-serosal flux of propionate (in vitro) and in short-chain fatty acids net absorption (in vivo), respectively. The results obtained suggest that short-chain fatty acids are absorbed both as anions and as undissociated acids across ruminal epithelium of sheep. It is concluded that short-chain fatty acids anions either compete with Cl- for binding sites at a common anion-exchange mechanism or that they are absorbed by an short-chain fatty acids anion/ HCO3- exchanger indirectly coupled to a Cl-/HCO3- exchanger via intracellular bicarbonate.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed1996

Fetal and maternal catecholamine levels at delivery.

The objective of this study was to investigate any relationships between maternal and fetal catecholamine levels and clinical labour outcomes. Patients were a subgroup of healthy primigravid women who were enrolled for a randomized controlled trial of labour companionship and who had blood samples for catecholamines at delivery. Norepinephrine, epinephrine and dopamine were determined by high performance liquid chromatography. There were no significant correlations between the maternal and fetal catecholamine levels and labour duration. Fetuses who had umbilical artery base excess < -10 had significantly higher epinephrine (p = 0.03) and dopamine (p = 0.02) levels and those who had a pH less than 7.2 had significantly higher dopamine (p = 0.02) levels. These results confirm a high fetal catecholamine response to hypoxia.

Adolescent↗
PubMed1993

Pregnancy during graduate medical training.

In 1990, 30% of resident physicians were women, and by the year 2010 it is estimated that nearly one-third of all physicians will be women. With the increasing percentage of women residents, pregnancy during residency is a fact of life for most residency programs, yet it continues to provide problems for many programs. The authors comment on much of the literature and discuss the problems and issues surrounding pregnancy during residency, including the effects of pregnancy on the mother and infant as well as the effects of pregnancy on the residency program, the other residents, and the patients. The authors advocate that well-written, specific parental leave policies (for paternal as well as maternal leave) would help alleviate many of these problems. Data obtained from the 1991-92 annual survey of the American Association of Directors of Psychiatry Training indicate that 84% of responding U.S. adult and child psychiatry programs had maternity leave policies, an increase from what previous surveys have indicated. Further national studies, in other specialties, are needed to provide better data on the impact of pregnancy during residency and to help develop more effective parental leave policies.

Female↗
PubMed1993

Do high fetal catecholamine levels affect heart rate variability and meconium passage during labour?

OBJECTIVES: To determine the relationship between umbilical arterial catecholamine levels and fetal heart rate variability and meconium passage. STUDY DESIGN: A prospective descriptive study was performed. Umbilical artery catecholamine levels were measured in 55 newborns and correlated with fetal heart rate before delivery, umbilical arterial pH, base excess and the presence of meconium-stained liquor. RESULTS AND CONCLUSION: The range of catecholamine levels was enormous, with very high epinephrine or norepinephrine levels in several fetuses. We were unable to demonstrate an association between high catecholamine levels and the presence of normal fetal heart rate variability despite acidaemia. We postulate that high catecholamine levels may inhibit fetal meconium passage.

Adolescent↗
PubMed1992

[Manometric follow-up after resection of Zenker's diverticulum].

Since 1977, 15 patients have undergone surgery for Zenker's diverticula at the University of Würzburg Department of Surgery. We were able to follow up 6 of them after an average of 4 years (5 months to 10.5 years). Preoperative manometric findings available on one patient revealed markedly impaired coordination between pharyngeal contraction and relaxation of the upper esophageal sphincter. After resection of the diverticulum and myotomy of the upper sphincter this was not observed in any of the patients. Myotomy also was followed by significant lowering of resting pressure in the upper esophageal sphincter to mean levels of 18 mm Hg (normally 90-100 mm Hg). By contrast, one patient who did not undergo intraoperative myotomy had only a moderate reduction of resting pressure (to 30-45 mm Hg) and a normal maximum contraction pressure of 100 mm Hg. This patient developed a relapse. Our manometric evidence underscores the importance of intraoperative myotomy as an adjunctive procedure in diverticulum resection. By helping reduce the resistance imposed by interference of impaired coordination with pharyngeal contraction, it also results in a lower rate of relapse.

Aged↗