Long-term home care: does it really work?
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Age Factors↗
Biomedical subjects
W Ryan
Publications and source records attributed to W Ryan.
A district general hospital experience of surgical treatment of gastric and duodenal ulcer from 1970 to 1982.
Seven hundred and thirteen patients who had undergone 793 operations for peptic ulcer disease during the years 1970 to 1982 were subsequently referred to a gastric follow-up clinic. The indications for initial elective surgical treatment (514) were failed medical management (448), recent hemorrhage (32) and obstruction of gastric outflow (34); for initial emergency surgical treatment (199), the indications were hemorrhage (97) and perforation (102). Reoperation was required in 80 patients-previous perforation (40), recurrent ulcer (32), reperforation (three), hemorrhage (three) and obstruction of gastric outflow (two). The over-all postoperative mortality rate was 4.2 per cent (33 of 713); 15 deaths occurred after elective surgical treatment (2.5 per cent) and 18 after emergency surgical treatment (8.6 per cent). The postoperative morbidity expressed in terms of duration of postoperative stay was unaltered for each procedure throughout the study period. Follow-up attendance rates at one, three, five and ten years were 86, 85, 74 and 28 per cent, respectively. Iron deficiency anemia was detected in 13.6 per cent of gastric resection procedures and 1.6 per cent of vagotomy and drainage procedures. No instances of macrocytic anemia and only two instances of asymptomatic metabolic bone disease were recorded. By providing accurate data for surgical audit, which suggested that screening for metabolic sequelae in the first decade after surgical treatment is not indicated and which resulted in alteration of policy toward peptic ulcer perforation, a specific follow-up clinic has proved valuable in formulating the over-all management policy regarding surgical treatment for peptic ulcer.
Adult↗
Metabolic emergencies in cancer medicine.
This article describes the many metabolic complications encountered in the management of cancer patients. Pathogenetic mechanisms and therapy are discussed, with special emphasis on hypercalcemia, the most common of these disorders.
ACTH Syndrome, Ectopic↗
Duodenal ulcer perforation: the effect of H2 antagonists?
One hundred and two patients with perforated duodenal ulcers over a 13 year period (1970 to 1982) have been prospectively followed-up at a special gastric clinic. Of the 37 patients with perforation of their acute ulcer, 34 were treated by oversew and three had an initial definitive operation (vagotomy and drainage). The remaining 65 patients presented with perforation of a chronic ulcer and 54 were treated by oversew and 11 underwent definitive surgery--nine had vagotomy and drainage and two had partial gastrectomies. Seven of the 34 patients (20.5%) with acute ulcer perforation treated by simple oversew subsequently required definitive ulcer surgery at a mean 17.5 months after perforation and 31 of the 54 patients (57.4%) with chronic ulcer perforations required definitive surgery at a mean 27.4 months after perforation. The introduction of H2 antagonists in 1977 did not alter the re-operation rate in patients with chronic ulcer perforation managed by oversew. Results of this study provide further evidence in favour of treating patients with perforation of their chronic duodenal ulcer by definitive surgery whenever possible.
Acute Disease↗
The effect of alcohol intoxication on inflammation of the cornea.
New Zealand albino rabbits received daily intraperitoneal injections of alcohol (ethyl alcohol), 1.6 g/kg and the effect of short-term (three days) and long-term (six weeks) administration on corneal inflammation was studied. Both regimens produced an average peak serum concentration of more than 0.200 g/dL, a level consistent with gross intoxication in the majority of humans. Clinical signs of intoxication were present in all animals, manifested by a gross disturbance of equilibrium and gait. Neither regimen produced measurable liver damage. Nonetheless, following both regimens of alcohol administration, significantly fewer polymorphonuclear leukocytes invaded the corneas of animals receiving alcohol than invaded the corneas of simultaneously run controls receiving intraperitoneal saline. These data provide a mechanism to explain why an alcoholic individual might not cope with a corneal infection as well as a nonalcoholic person, an observation long thought to be true clinically.
Alcoholic Intoxication↗
Fistula-in-ano in childhood: a congenital etiology.
In a comparative study of fistula-in-ano and perianal abscess, over a 12-year period, evidence is presented to suggest that fistula-in-ano in childhood has a congenital etiology.
Abscess↗
A prospective randomised controlled trial of mezlocillin versus netilmicin in biliary surgery.
A prospective randomised controlled trial of mezlocillin versus netilmicin in 133 patients undergoing biliary surgery at a district hospital is reported. Sixty-four patients received mezlocillin and 69 received netilmicin. The two groups of patients were comparable with regard to age, sex, underlying pathology and operative procedures performed. The incidence of infected bile at operation was 14.2% and both antibiotics were equally effective in reducing postoperative bacteraemia (0.75%) and wound infection (4.5%) to acceptable levels. It is concluded that netilmicin is a more cost-effective antibiotic in biliary surgery than mezlocillin.
Aged↗
Risk management checkup. Hospitals still have a long way to go.
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Financial Management↗
Thalamic kindling: electrical stimulation of the lateral geniculate nucleus produces photosensitive grand mal seizures.
Kindling is traditionally viewed as a chronic, focal epilepsy model which consistently induces complex partial seizures from limbic structures in animals. This study revealed that primary or exceedingly rapid secondary generalized seizures could also be kindled when stimulation was applied to the lateral geniculate nucleus, a thalamic region involved in sleep regulation and possibly also photosensitive epilepsy. Two experiments were conducted in cats. Experiment 1 compared the development of generalized tonic-clonic convulsions and associated sleep disorders following electrical stimulation of the lateral geniculate nucleus (N = 4) and the amygdala (N = 4). Experiment 2 described the effects of intermittent light stimulation on seizure thresholds in both groups. Three primary findings distinguished the epileptogenic process in those two brain regions. First, generalized electroencephalographic and clinical seizures accompanied the first afterdischarge obtained with thalamic stimulation. In contrast, focal seizures with secondary generalization appeared during a 3- to 4-week period of afterdischarge elicitations from the amygdala. Second, amygdala-kindled cats showed fewer sleep spindles during slow-wave sleep whereas cats kindled in the lateral geniculate nucleus had abnormal sleep spindles approaching spike wave-like activity. Third, only the latter cats showed reduced seizure thresholds in response to photic stimulation. Based on the anatomic substrates involved, the clinical and electrographic profiles observed during kindling and the type of sleep disturbance shown, we concluded that lateral geniculate nucleus kindling may represent primary generalized epilepsy, possibly of a photosensitive nature; alternatively, the rapid propagation of abnormal discharge was also consistent with the important role of the thalamus in secondary seizure generalization.
Amygdala↗
Penetrating injuries of the Iliac vessels. Early recognition and management.
Exsanguination due to hemorrhage caused death in 18 percent of patients with penetrating iliac vessel trauma. Improved survival demands earlier recognition and expedient operative control. One hundred fourteen patients were treated at a single institution during an 11 year period. Gunshot wounds were the predominant cause of injury and combined arteriovenous injury was present in 40 percent of the patients. Twenty-one of the 28 deaths were directly related to vascular injury. All deaths occurred in patients who were initially hypotensive. Seventy-six percent of patients presented with entry wounds below the umbilicus, positive abdominal examination, and hypotension. Earlier recognition is based on this triad. Failure to respond to volume repletion portends a grave prognosis, but it is often reversed by rapid operative intervention. All hypotensive patients with entry wounds below the umbilicus and positive abdominal examination should be taken immediately to the operating room for resuscitation and operation.
Humans↗
A candidate reference method for uric acid in serum. II. Interlaboratory testing.
We describe the interlaboratory testing of a candidate Reference Method (Part I) for uric acid in serum. The method is based on the ultrasound spectrophotometric quantitation of uric acid before and after incubation with uricase. A comprehensive investigation involving 12 laboratories was organized to document the transferability, intra- and interlaboratory precision, and general reliability of the candidate Reference Method. The interlaboratory CV with this method was about 2 to 6% for uric acid concentrations ranging from 0.12 to 0.60 mmol/L. The results detailed here demonstrate that the method can be successfully duplicated among different laboratories.
Evaluation Studies as Topic↗
Titrimetric and gravimetric calibration of pipettors: a survey.
Methods for gravimetric and titrimetric calibration of pipets are described. Both methods of calibration gave good reproducibility from 5-500 microliters. The titrimetric method gave the lowest coefficient of variation for pipettors from 1-10 microliters and was the better method for these smaller volumes. In addition, the titrimetric method took one-third the time of the gravimetric method. Pipettors of various types were obtained from 38 different laboratories and used to survey performance. The titrimetric method was used to calibrate 572 pipettors of different types. A significant percentage of the pipettors were greater than 3% from their nominal value.
Calibration↗
The creatine kinase curve area and peak creatine kinase after acute myocardial infarction: usefulness and limitations.
We determined creatine kinase (CK) curve areas in 112 patients with acute myocardial infarction. Two-hour sampling was performed for the first 24 hours or until peak CK was reached, and a gamma density function was used to calculate curve areas from all available samples. Attempts to predict CK curve area by means of the portion of the curve prior to peak CK proved to be inaccurate; not until values 2 hours or more beyond peak CK were utilized did predicted and actual CK areas agree well. A good correlation (r = 0.93) was found between CK area and peak CK. To establish an approach for detecting peak CK in the clinical setting, a range of sampling intervals (4 to 24 hours) was assessed; 4- and 6-hour sampling intervals for 48 hours produced maximum CK values at or above 85% of true peak CK in 90% and 89% of patients, respectively, and average maximum CK at both sampling intervals exceeded 94% of that obtained with 2-hour samplings. We conclude that this simplified approach can provide a basis for estimating infarct severity in the individual patient.
Creatine Kinase↗
Polyadenylate-polyuridylate enhancement of 7,12-dimethylbenz-anthracene skin carcinogenesis.
Double-stranded polynucleotide polyadenylate-polyuridylate (Poly AU) enhanced skin tumor formation in Swiss mice by 75% when injected prior to a single application of 7,12-dimethylbenzanthracene (DMBA). When given after the carcinogen application Poly AU did not significantly enhance tumor formation.
9,10-Dimethyl-1,2-benzanthracene↗
Incubation of 3,4-benzo(s)pyrene with serum fractions: effect on tumor production.
The effect on tumor formation in Swiss mice of incubation of 3,4-Benzo(a)pyrene [B(a)P]either with saline or saline containing serum, gamma-globulin or albumin (form mouse or rabbit) was investigated. A high incidence of sarcomas (80--100%) was obtained in Swiss mice by B(A)P incubated in vitro with rabbit serum, rabbit gamma-globulin, mouse serum, mouse gamma-globulin, and saline. A lower incidence (60--65%) was obtained with B(a)P incubated with mouse serum, mouse albumin, and rabbit albumin. The data suggest that binding of B(a)P to protein, particularly to albumin, significantly decreases the biological activity of B(a)P.
Animals↗
Assessment of long-term antiarrhythmic therapy: studies on the long-term efficacy and toxicity of tocainide.
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Adult↗
Efficacy of a new oral agent (tocainide) in the acute treatment of refractory ventricular arrhythmias.
To assess the efficacy of tocainide, a new oral analog of lidocaine, 30 patients with ventricular arrhythmias refractory to quinidine, procainamide and propranolol were treated with this agent. The dose of tocainide ranged from 400 to 800 mg every 8 hours. Peak tocainide blood levels 1 to 4 hours after administration ranged from 5.0 to 15.0 microgram/ml (mean 10.3). The suppression of ventricular premature beats by 75 percent or more was arbitrarily used as a measure of drug efficacy. In 13 patients who met this criterion, ventricular premature complexes, assessed with 24 hour ambulatory tape monitoring, decreased by an average of 88 percent. In 8 of 11 patients, repeated symptomatic bouts of ventricular tachycardia were completely suppressed. Considering both the response of ventricular premature complexes and the abolition of ventricular tachycardia, 18 patients (60 percent) responded to tocainide. Twenty-one patients (70 percent) had initial gastrointestinal and central nervous system side effects; most of these were transient or responded to a reduction in dose. In two patients disorientation and a skin rash required withdrawal of tocainide. These adverse effects did not appear to be due to the interaction of tocainide with other antiarrhythmic agents. It is concluded that tocainide is an effective oral agent for the therapy of potentially lethal ventricular arrhythmias refractory to other medication.
Administration, Oral↗
Benzo[alpha]pyrene antibody inhibition of benzo[alpha]pyrene-induced mutageneis.
An antibody to benzo[alpha]pyrene (BP) was prepared. The isolated antibody showed a specificity for BP and a low reactivity with another carcinogenic hydrocarbon, 7,12-dimethylbenz[alpha]anthracene (DMBA). The BP-antibody inhibited the in vitro cytotoxic and mutagenic activity of BP in both a rat embryo fibroblast- and a rat lung cell-mediated mutagenesis system. A possible correlation of these in vitro findings to the in vivo carcinogenesis situation is discussed.
9,10-Dimethyl-1,2-benzanthracene↗