Service excellence in health care.
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Consumer Behavior↗
Biomedical subjects
T Mayer
Publications and source records attributed to T Mayer.
A mutant form of the rho protein can restore stress fibers and adhesion plaques in v-src transformed fibroblasts.
The organization of polymerized actin in the mammalian cell is regulated by several members of the rho family. Three rho proteins, cdc42, rac and rho act in a cascade to organize the intracellular actin cytoskeleton. Rho proteins are involved in the formation of actin stress fibers and adhesion plaques in fibroblasts. During transformation of mammalian cells by oncogenes the cytoskeleton is rearranged and stress fibers and adhesion plaques are disintegrated. In this paper we investigate the function of the rho protein in RR1022 rat fibroblasts transformed by the Rous sarcoma virus. Two activated mutants of the rho protein, rho G14V and rho Q63L, and a dominant negative mutant, rho N1171, were stably transfected into RR1022 cells. The resulting cell lines were analysed for the organization of polymerized actin and adhesion plaques. Cells expressing rho Q63L, but not rho wt, rho G14V or rho N1171, showed an altered morphology. These cells displayed a flat, fibroblast like shape when compared with the RR1022 ancestor cells. Immunofluorescence analyses revealed that actin stress fibers and adhesion plaques were rearranged in these cells. We conclude from these data that an active rho protein can restore elements of the actin cytoskeleton in transformed cells by overriding the tyrosine kinase phosphorylation induced by the pp60(v-src).
Actins↗
Bacterial meningitis in adults: demonstration of inner ear involvement using high-resolution MRI.
OBJECTIVE: To visualize the sites involved in audiovestibular dysfunction during bacterial meningitis in adults and to relate these findings to the extent of hearing impairment and vestibular dysfunction. BACKGROUND: Hearing impairment is among the most frequent complications of bacterial meningitis. METHODS: High-resolution MRI (HR-MRI) of the inner ear was performed in seven adult patients with hearing loss as a complication of bacterial meningitis. RESULTS: Five patients had unilateral (n = 1) or bilateral (n = 4) contrast enhancement of vestibulocochlear structures. The structures most frequently involved were the cochlear nerve (n = 9), the first cochlear turn (n = 9), the vestibulum (n = 9), and the semicircular canals (n = 7). There was a significant correlation between clinical and MRI findings: all nine ears with cochlear enhancement were deaf (hearing loss >90 dB), whereas none of the five ears with normal MRI findings had hearing losses of more than 90 dB (range, 30 to 70 dB; p = 0.0005). Vestibular dysfunction as revealed clinically and by quantitative vestibular function testing was found in six of seven patients (11 of 14 ears). Five of these patients (nine ears) also demonstrated enhancement of the vestibular organ on high-resolution MRI of the inner ear. CONCLUSIONS: High-resolution MRI can visualize the involvement of vestibulocochlear structures in bacterial meningitis in both cooperative and consciously impaired patients. These findings suggest a correlation between abnormalities on MRI and the extent of cochlear dysfunction.
Adolescent↗
Detection of regional melanoma metastases by ultrasound B-scan, cytology or tyrosinase RT-PCR of fine-needle aspirates.
Physical examination and ultrasound B-scan screening are important follow-up procedures in melanoma patients with regional disease. However, they do not allow definite diagnosis of suspicious lesions. Fine-needle aspiration cytology (FNAC) enhances the diagnostic accuracy in such patients but, unfortunately, reaches its technical limits, particularly when very small or necrotic lesions are examined. We therefore tested whether tyrosinase reverse transcription polymerase chain reaction (RT-PCR) of fine-needle aspirates (FNA-PCR) could help to increase diagnostic sensitivity. With clinical follow-up in 69 melanoma patients 81 regional lymph nodes were detected by ultrasound B-scan examination, nine of whom appeared to be palpable. Technically, FNAC was successful in all 81 lymph nodes, while FNA-PCR failed to obtain RNA at detectable levels in two lymph nodes of two patients. Of 79 lesions which have been completely evaluated by B-scan, FNAC and FNA-PCR, 44 proved to be melanoma metastases by histopathology, while the remaining 35 lesions were finally classified as non-specific lymph nodes. Of the 44 melanoma metastases 80% (n = 35) have been detected by B-scan, 90% (n = 39) by FNAC and 100% (n = 44) by FNA-PCR (P < 0.05 vs FNAC, P < 0.005 vs B-scan). In the subclass of lesions with diameters below 10 mm the sensitivities were 72% (n = 13), 78% (n = 14) and 100% (n = 18) respectively. In 35 regional lymph nodes classified as benign lesions, FNAC was always negative while FNA-PCR produced one positive result. Neither of these methods did produce false positive results in 15 control lymph nodes of non-melanoma patients. We conclude, that FNA-PCR might have superior sensitivity as compared to FNAC or ultrasound B-scan, particularly in melanoma lesions with diameters below 10 mm.
Adult↗
Gabapentin add-on treatment: how many patients become seizure-free? An open-label multicenter study.
The aim of the study was to find out the percentage of patients with localization-related epilepsy achieving complete seizure control with gabapentin (GBP) add-on therapy. Patients under anti-epileptic drug monotherapy during 8 weeks baseline (BSL) with 6 or more seizures were treated with GBP for 26 weeks up to 2400 mg/day. Patients obtaining complete seizure control of all seizures or any partial seizure type during the last 8 weeks were calculated. Seizure frequency was compared between BSL and last 8 weeks. In all, 110 patients were enrolled (92 completed, 18 discontinued): mean age of the completers: 37.6 years (range 16-72), median seizure frequency per 28 days at BSL: 6.8 (2.5-24.5), mean duration of epilepsy: 17.6 years (0.2-51.4), mean duration with GBP for completers: 182.8 days (144-187). Complete seizure control of all seizures was achieved in 8.7% of patients (simple partial seizures: 13.3%, complex partial seizures 24.3%, secondarily generalized seizures: 61.5%): 38% of the patients became seizure-free in at least 1 seizure-type; 40% experienced adverse events. Assessment for quality of life (QoL) and trough plasma levels of GBP did not correlate with the good effect of GBP.
Acetates↗
Regaining control of your practice. Physician empowerment through active 'followership'.
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Family Practice↗
[Neuroradiologic diagnosis in acute stroke].
Noninvasive diagnostic procedures as spiral-CT (CT-angiography and perfusion-CT) as well as MRI-techniques (diffusion-imaging, perfusion-imaging and MR-angiography) have enriched the diagnostic modalities in acute stroke. Angiography by MRI or CT has replaced digital subtraction angiography in most acute stroke cases. Despite of the advantages of MRI, CT still remains the procedure of choice in acute stroke. 1. Acute hematoma is easily detected by CT. 2. Occlusion of the main arterial stems are identified by CT-angiography. CT fulfills all the requirements for therapeutic decisions in acute stroke.
Acute Disease↗
Weighing capitation's cost.
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Capitation Fee↗
Sex differences in the use of health care services.
BACKGROUND: Sex differences in the use of health care services can be substantial at several stages of life. However, the extent to which differences in reproductive biology and mortality affect the use of health care services is unclear. METHODS: We studied age- and sex-specific per capita use of health care resources for a one-year period during 1994 and 1995 in the Canadian province of Manitoba, where there is universal insurance for a comprehensive range of health care services. Using information obtained from administrative records of physicians' services and acute hospital care, we tabulated the use of health care resources by male and female subjects in three categories: care for conditions specific to sex, care provided to persons who died during the study year, and care provided for all other conditions. RESULTS: The crude annual per capita use of health care resources (in Canadian dollars) was greater for female subjects ($1,164) than for male subjects ($918). Approximately 22 percent of health care expenditures for female subjects was associated with conditions specific to sex, including pregnancy and childbirth, as compared with 3 percent of expenditures for male subjects. An estimated 14 percent of health care expenditures for male subjects was consumed by persons who died during the study period, as compared with 10 percent of expenditures for female subjects. After adjustment for the use of health care associated with sex-specific conditions and differences in mortality, the female:male ratio in health care expenditures was reduced from 1.3 to 1.0. CONCLUSIONS: Expenditures for health care are similar for male and female subjects after differences in reproductive biology and higher age-specific mortality rates among men have been accounted for.
Female↗
Measurement of the electron energy and energy spread at the electron storage ring BESSY I.
Knowledge of the electron energy with a small uncertainty is necessary for the Physikalisch-Technische Bundesanstalt (PTB) to operate the electron storage ring BESSY I, and the future BESSY II, as a primary radiation source standard of calculable synchrotron radiation. At BESSY I the electron energy can now be measured either by the long-established method of resonant spin depolarization or by the newly set up method of Compton backscattering (CBS) of laser photons (CO(2) laser, lambda = 10.6 micro m). Results obtained at different electron energies by these two independent methods are presented. They agree within a relative uncertainty of better than 10(-4). The advantages and disadvantages of these two complementary techniques are described and applications of CBS for the measurement of other storage-ring parameters, e.g. the electron energy spread, are given.
Journal Article↗
Socioeconomic outcomes of combined spine surgery and functional restoration in workers' compensation spinal disorders with matched controls.
STUDY DESIGN: A longitudinal cohort study (n = 448) comparing functionally restored discectomy (n = 123) and fusion (n = 101) workers' compensation patients to matched, unoperated control patients (n = 123 and n = 101, respectively). OBJECTIVES: To determine successful treatment outcomes uniquely important in a workers' compensation environment when spine surgery is combined with comprehensive tertiary rehabilitation, to optimize anatomic and social sequelae. SUMMARY OF BACKGROUND DATA: Multiple recent studies confirm suboptimal socioeconomic outcomes for spinal surgery for degenerative conditions in a workers' compensation venue. In other musculoskeletal regions, there is a clear relationship between the quality of postsurgical rehabilitation and the impact on disability, recurrent injury, and future health care use. It is hypothesized that poor surgical outcomes in compensation injuries may result from outmoded postoperative methods, rather than failures of patient selection or surgical technique. No previous combination of surgery plus rehabilitation has been carefully evaluated with disabled workers undergoing spine surgery. Functional restoration is an individualized medically directed, interdisciplinary program using quantitatively directed exercise progression, psychotherapeutic interventions, and monitoring of specific socioeconomic outcomes for chronically disabled workers. METHODS: This study prospectively evaluated a cohort of consecutive functional restoration program graduates (n = 1202). Two surgical groups, discectomy (n = 123) and fusion (n = 101) were matched to two groups of unoperated control patients, control/discectomy and control/fusion, selected from the same cohort of patients with chronic spinal disorders based on age, gender, race, length of disability, and workers' compensation jurisdiction. A structured clinical interview was administered 12 months after program completion, with a contact rate of 95% to 98%. RESULTS: Socioeconomic outcomes for work return, health care use, and recurrent lost-time injury were assessed. All groups demonstrated a return-to-work incidence of more than 85%, but work retention at 1 year was higher for the fusion group than for the discectomy or control/fusion groups. Health care use was significantly higher for the discectomy group than the control/discectomy or fusion groups for reoperation (8% vs. 4%/ 2%), as well as other factors. All groups showed comparable recurrent lost-time injury rates (2-3.3%), and made comparable improvements in prospectively collected physical and psychological measures. CONCLUSIONS: Discectomy patients had work, health care utilization, and recurrent injury outcomes comparable with those for unoperated control patients. Fusion patients had better outcomes of work retention, reoperation, and health care use compared with the unoperated control patients and even with discectomy patients, in spite of more cases of previous surgery and greater duration of disability. The discectomy and fusion cohorts of operated chronic spinal disorder compensation patients with subsequent functional restoration had the best documented outcomes found in the literature for this population. In spite of the common presumption that spine surgery patients fare poorly in a workers' compensation environment, these results demonstrate that such patients can show remarkably successful objective outcomes if accompanied by effective rehabilitation, documenting efficacy and clinical utility. A new clinical approach is required to evaluate prospectively the combination of surgery and rehabilitation in chronic pain/disability workers' compensation patients, in which the surgical role is to correct an anatomic lesion, but the socioeconomic outcomes either occur spontaneously or are effected through some form of rehabilitation.
Adult↗
Maturation of phagosomes is accompanied by specific patterns of small GTPases.
In this study we purified phagosomes of the ciliated protozoan Tetrahymena thermophila to analyze aspects of the maturation pathway of phagocytotic vesicles. Phagosomes were labeled with magnetic microparticles and then purified in high amounts with the help of a permanent magnet. By combining a pulse-chase labeling protocol with the magnetic separation procedure we were able to isolate phagosomes of defined ages, which represent distinct stages of their maturation pathway. GTP-overlay assays showed that a set of small GTPases of the ras superfamily is associated with these phagosomes. Phagosomes isolated at different stages of maturation revealed a change in the pattern of the small GTPases. Some small GTPases identified by the GTPase overlay assays could be aligned to India ink stained protein spots in two-dimensional gels of isolated phagosomes. The results presented here are a first step to identify the members of small GTPases associated with phagosomes during their maturation pathway. Microsequencing of pooled polypeptides by mass-spectrometric techniques will identify the primary structure of these small GTPases.
Animals↗
[Recommendations for blood studies and clinical monitoring in early detection of valproate-associated liver failure. Results of a consensus conferences 9 May - 11 May 1997 in Berlin].
Valproate is a frequently used antiepileptic drug. It is associated with rare but serious adverse effects like liver failure. The first symptom is impairment of the patient's well being. Isolated changes of standard laboratory liver parameters are not reliable early indicators. Thus, according to the knowledge of today, prophylactic blood screening cannot predict complications. On the contrary, clinical symptoms are the most relevant indicators of impending complications, eventually supported by laboratory findings. An abrupt withdrawal of valproate and administering carnitin in parallel can interrupt the otherwise fatal course of the complication and induce a subsequent recovery. At a Consensus Conference the current knowledge about early detection and therapy of the valproate-induced serious hepatotoxicity was discussed. The results regarding recommended laboratory screening, as well as diagnostic and therapeutic strategies are reported.
Adolescent↗
[Diffusion-weighted MR imaging in a case of dissociative amnesia].
The differential diagnosis of psychogenic vs. organic amnestic syndromes may cause difficulty in certain cases. Here, we report a case of psychogenic amnesia which occurred after alcohol intoxication and mild head trauma. The initial memory deficit was very severe consisting of near-complete retrograde amnesia and anterograde amnesia covering 12 hours. The deficits resolved within a 4-week period of time. Brain CT and MRI scans revealed two circumscribed lesions of the right temporal lobe which were interpreted as old posttraumatic lesions. To ascertain the diagnosis, diffusion-weighted MR imaging (DWI) and brain perfusion SPECT were performed. The basal temporal lobes neither showed focal changes of perfusion, nor enhanced signal intensity on DWI as has been recently reported in patients with transient global amnesia. Later, the dissociative nature of the disorder could be confirmed by the exploration of recent psychological conflicts and the delayed type of recovery. We regard diffusion-weighted MRI as a powerful means to differentiate acute amnestic syndromes.
Adult↗
[Calculation of absolute cerebral blood volume and cerebral blood flow by means of electron-beam computed tomography (EBT) in acute ischemia].
The utility of electron beam computed tomography (EBT) to estimate cerebral blood volume (CBV) and cerebral blood flow (CBF) was evaluated. Eleven patients with suspected acute cerebral ischemia were investigated. The EBT was performed with an acquisition time of 50 ms per slice at eight parallel levels. To compare signal/noise and contrast/noise ratios the data from the EBT investigation were compared to a similar examination on a spiral CT. The signal/noise ratio with EBT was about 30%, the contrast/noise ratio 25% of that with spiral CT. The absolute values of CBV were 4.9 +/- 1.2 ml/100 g (EBT); CBF was 50.5 +/- 7.0 ml/100 g/min in normal contralateral brain tissue. In four patients with proven infarcts on follow-up, the ischemic areas had a CBV ranging from 1.7 to 3.8 ml/100 g, while CBF ranged from 9.4 to 24.5 ml/100 g/min. Using a bolus injection of contrast material, calculation of absolute CBV and CBF is feasible using EBT. Advantages of EBT are the absolute measurements possible and it's multislice capability. Disadvantages, however, are caused by the high image noise, limiting the demarcation of ischemic tissue.
Acute Disease↗
Reading epilepsy: report of five new cases and further considerations on the pathophysiology.
Five new cases of reading epilepsy (RE) are reported. This is an epilepsy syndrome belonging to the group of idiopathic localization-related epilepsies. They all have some interesting features which contribute to the understanding of the pathomechanism and nosology of this specific type of reflex epilepsy. In our first patient the precipitating effect of texts in unknown languages depended upon phonematic intricacy. With our second case, changes of script within the text (Latin to Greek) increased the precipitating effect. The visual aura experiences reported in vague terms by some patients with RE may represent ictal dyslexia. For case three RE had been misdiagnosed as phobic neurosis. Even if a patient has a history of development dyslexia, and ictal dyslexia is a feature of the seizures, the onset of RE is not during primary school age but at puberty. Our fourth patient's manifestation factor of (late-onset) RE was a change of scriptural environment (Kyrillic to Latin) . Unilateral myocloni were observed with bilateral spike wave discharge in RE, and carbamazepine possibly increased the epileptic response in RE. With the co-occurrence of RE and juvenile myoclonic epilepsy in case five, the clinical features of both syndromes remained separate. All five patients responded well to treatment with valproic acid, and all confirmed that the syndrome has no tendency to deteriorate in long-term follow-up.
Adolescent↗
Gabapentin potentiation of the antiepileptic efficacy of vigabatrin in an in vitro model of epilepsy.
1. An enhancement of promoted release of gamma-aminobutyric acid (GABA) and a change in GABA-metabolism have been suggested as mechanisms of action of gabapentin. Vigabatrin is supposed to act mainly via inhibition of GABA-transaminase but it also interferes with GABA-release and GABA-uptake. On the basis of these mechanisms of action, a pharmacodynamic interaction of the two antiepileptic drugs could be supposed which might be of relevance in the sense of a rational polypharmacy. 2. To address the aforementioned hypothesis, experiments were carried out on hippocampal slices (n=107) of guinea-pigs (n=70). Epileptiform field potentials (e.f.p.) were induced by omission of magnesium from the bath solution and recorded in the stratum pyramidale of the CA3 region. Gabapentin (30-600 microM; 5.1-102.72 microg ml(-1)), vigabatrin (50-200 microM, 6.45-25.8 microg ml(-1)) and the GABA(A)-receptor antagonist bicuculline (100 microM) were added to the bath solution for 3 h. 3. Gabapentin, in concentrations up to 600 microM, failed to decrease the repetition rate or duration of e.f.p. (n=19). However, vigabatrin, evoked a dose-dependent reduction of the repetition rate of e.f.p. For a concentration of 100 microM (12.9 microg ml(-1)) there was a reduction down to 48+/-5% (mean+/-s.e.mean) of the initial value within 3 h (n=11). With simultaneous administration of vigabatrin (100 microM) and gabapentin (60 microM) for 3 h (n=15), the repetition rate of e.f.p. decreased down to 8+/-3%, which is significantly different from the values obtained after administration of 100 microM vigabatrin alone (P<0.0001). Both, the antiepileptic effect of vigabatrin alone and the enhancement by gabapentin were blocked by the GABA(A)-receptor antagonist bicuculline (100 microM, n=16). 4. These results demonstrate that gabapentin is able to augment the antiepileptic effects of vigabatrin significantly. It is possible that a change in the GABA-release machinery is induced by vigabatrin which then can be augmented by gabapentin.
4-Aminobutyrate Transaminase↗
Selling your medical practice.
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Costs and Cost Analysis↗