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PubMed1999

Effect of carbenoxolone on the plasma renin activity and hypothalamic-pituitary-adrenal axis in congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

OBJECTIVE: To test the hypothesis that carbenoxolone, an inhibitor of 11beta-hydroxysteroid dehydrogenase, might augment the ACTH-suppressing and mineralocorticoid activities of hydrocortisone without a corresponding increase in peripheral hydrocortisone effects, we assessed the effects of carbenoxolone in patients with congenital adrenal hyperplasia. DESIGN AND PATIENTS: Six patients with classic 21-hydroxylase deficiency (5 salt-losing, 1 nonsalt-losing) were enrolled in this study. The study protocol involved 3 treatment periods (except for patient 3): phase 1, hydrocortisone and fludrocortisone; phase 2, hydrocortisone, fludrocortisone and carbenoxolone; phase 3, hydrocortisone and carbenoxolone. Patient 3 was not treated with fludrocortisone at baseline, so she participated only in phase 1 (hydrocortisone only) and phase 2 (hydrocortisone and carbenoxolone). Hydrocortisone and fludrocortisone dosages were kept the same during the study except for the discontinuation of fludrocortisone during phase 3. MEASUREMENTS: Plasma adrenal androgens or their precursors (androstenedione, 17-hydroxyprogesterone, and testosterone, and urine pregnanetriol); plasma cortisol, cortisol-binding globulin, ACTH, apparent cortisol metabolic clearance, 24-h urine 17-hydroxysteroids, and urine free cortisol; mineralocorticoid activity, as measured by plasma renin activity, body weight, plasma potassium, and mean blood pressure; fasting insulin/glucose ratio, protein balance, % eosinophils in peripheral blood, and total urine pyridinoline and deoxypyridinoline; TRH stimulation of TSH and pyridostigmine/GHRH stimulation of growth hormone. RESULTS: Compared to phase 1, the addition of carbenoxolone (with or without concurrent fludrocortisone administration) produced statistically significant decreases of 20-50% in mean plasma 17-hydroxyprogesterone, androstenedione, and renin activity. Since carbenoxolone also decreased the apparent metabolic clearance rate of cortisol by 20%, other measures of systemic glucocorticoid activity were examined. Carbenoxolone did not produce a cushingoid appearance or increase body weight, blood pressure, blood glucose or plasma insulin levels. Carbenoxolone also did not suppress stimulated GH levels, but did decrease TRH-stimulated TSH levels by approximately 20% (P < 0.05). CONCLUSION: Carbenoxolone can augment the adrenal androgen-suppressing activity of hydrocortisone in patients with 21-hydroxylase deficiency. These observations support the hypothesis that selective inhibition of enzymes that metabolize cortisol may lead to new approaches to improve the treatment of congenital adrenal hyperplasia.

11-beta-Hydroxysteroid Dehydrogenases↗

PubMed2004

Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry.

OBJECTIVE: Obstructive sleep apnea (OSA) in children is usually effectively treated by adenotonsillectomy (T&A). However, there may be a waiting list for T&A, and the procedure is associated with an increased risk of postoperative complications in children with OSA. Needed is a simple test that will facilitate logical prioritization of the T&A surgical list and help to predict children who are at highest risk of postoperative complications. The objective of this study was to develop and validate a severity scoring system for overnight oximetry and to evaluate the score as a tool to prioritize the T&A surgical list. METHODS: This study comprised 3 phases. In phase 1, a severity score was developed by review of preoperative overnight oximetry in children who had urgent T&A in 1999-2000. In phase 2, the score was validated retrospectively in 155 children who had polysomnography (PSG) before T&A in 1992-1998. In a phase 3, a 12-month prospective evaluation of a protocol based on the score was conducted. RESULTS: In phase 1, a 4-level severity score was developed on the basis of the number and the depth of desaturation events (normal to severely abnormal, categories 1-4). In phase 2, the McGill oximetry score correlated with severity of OSA by PSG criteria. In phase 3, a clinical management protocol was developed based on the score. Of 230 children tested, 179 (78%) had a normal/inconclusive oximetry (category 1) and went on to have PSG. Those with a positive oximetry (categories 2-4; 22%) had no additional sleep studies before T&A. Timing of T&A was based on oximetry score, leading to a significant reduction in waiting time for surgery for those with higher oximetry scores. Postoperative respiratory complications were more common with increasing oximetry score. CONCLUSIONS: Overnight pulse oximetry can be used to estimate the severity of OSA, to shorten the diagnostic and treatment process for those with more severe disease, and to aid clinicians in prioritization of T&A and planning perioperative care.

Adenoidectomy↗

PubMed1995

The clinical introduction of a third generation lithotriptor: Modulith SL 20.

The Modulith SL 20* was designed as a third generation lithotriptor with outstanding disintegrative efficacy in vitro, and equipped with a combined fluoroscopic and ultrasound localization system integrated in a multifunctional table. Its introduction to clinical extracorporeal shock wave lithotripsy took place in 3 phases. In phase 1 (49 patients) only in line ultrasound localization was possible. The many caliceal stones were adequately disintegrated with restricted generator voltage. In phase 2 (81 patients) fluoroscopic localization with the virtual focus of an adapted x-ray C-arm unit enabled in situ lithotripsy of ureteral stones in 33% of all patients. Phase 3 (549 patients) was characterized by additionally increasing the generator voltage to 20 kv. This development of the lithotriptor by improving the localization system and shock wave energy resulted in the possibility for successful disintegration of stones in the entire upper urinary tract (including the complete ureter), decreased treatment time (52 to 39 minutes) and an improved efficiency quotient (0.45 to 0.67). During phase 3 auxiliary measures were performed before lithotripsy in 24% of the cases. After 1.8% of the treatments minor or moderate perirenal fluid collection or bleeding was detected by routine followup sonography. A 91% stone-free rate was achieved with only 9.3% curative auxiliary measures after extracorporeal shock wave lithotripsy, including a 23% retreatment rate. Thus, the Modulith device had a high efficacy quotient compared with other lithotriptors.

Adult↗

PubMed2002

A method using sustainability indicators to compare conventional and animal-friendly egg production systems.

The objective of this paper was to describe a method that enables a comparison of egg production systems for their contribution to sustainable development of egg production, using data from the Netherlands for demonstration purposes. One conventional system, the battery cage system, and two animal-friendly systems, the deep-litter and the aviary systems, illustrate this method. The method is based on a three-phase framework that identifies relevant issues regarding sustainable development (Phase 1), translates issues into sustainability indicators (Phase 2), and assesses the contribution of sustainability indicators to sustainable development (Phase 3). Phases 1 and 2 are based on analysis of literature and consultation with experts. Phase 3 is based on graphical and numerical comparisons. A graphical comparison presents the relative deviation between actual and target values for each sustainability indicator. A numerical comparison combines the relative deviation for each sustainability indicator into an overall contribution of an egg production system to sustainable development. Sustainability indicators selected include economic performance, ammonia emission, energy use, hen welfare, farmer welfare, and egg quality. Based on equal importance of these indicators, the battery cage system shows the least negative contribution to sustainable development. The aviary system is considered a better animal-friendly alternative for a battery cage system when compared with a deep-litter system. The aviary system especially needs to improve economic performance and farmer welfare. The conclusion can only be tentative, however, because methodological aspects such as selection and weighting of sustainability indicators will need careful attention and further research.

Animal Welfare↗

PubMed2000

Evaluation of renal function in normal and hydronephrotic kidneys in rats using gadolinium diethylenetetramine-pentaacetic acid enhanced dynamic magnetic resonance imaging.

PURPOSE: Magnetic resonance imaging (MRI) is becoming established as a modality complementary to computerized tomography and ultrasound for evaluating kidney function. The evaluation of renal function during ureteral obstruction may be improved by contrast enhanced MRI. We evaluated dynamic changes in relative signal intensity in normal and hydronephrotic rat kidneys after intravenous injection of gadolinium (Gd) diethylenetetramine-pentaacetic acid (DTPA). MATERIALS AND METHODS: Using Gd-DTPA enhanced dynamic MRI we evaluated 35, 1-year-old rats, including 10 with partial and complete unilateral ureteral obstruction, respectively, and 15 with sham operated nonobstructed kidneys. Partial obstruction was created in 2-day-old rats by embedding the left ureter into the psoas muscle. Complete obstruction was created 10 days before MRI by placing a ligature around the upper third of the left ureter. MRI was performed before and 0.1 to 60 minutes after and intravenous injection of Gd-DTPA. We calculated relative signal intensity per time interval in the renal cortex, medulla and pelvis. RESULTS: Dynamic relative signal intensity patterns differed significantly among normal, and partially and completely obstructed kidneys. In normal kidneys signal intensity changes were divided into 3 phases after Gd-DTPA administration. During phase 1 rapid parenchymal uptake of Gd-DTPA within the initial minute after injection produced a rapid signal intensity decrease in the cortex, which achieved a minimum of 28% of pre-injection intensity. During phase 2 signal intensity decreased in the medulla and pelvis to a minimum of 18% and 22%, respectively, of pre-injection intensity within 5 minutes. During phase 3 significant relative signal intensity recovery began in the cortex at 7 minutes, and in the medulla and pelvis at 10 to 15 minutes, and lasted 30 to 60 minutes. In partially obstructed kidneys the 3 phases were significantly slower than in controls. In completely obstructed kidneys only phase 1 occurred within 60 minutes. CONCLUSIONS: Gd-DTPA enhanced dynamic MRI provides useful information for distinguishing obstructed from nonobstructed and partially from completely obstructed kidneys.

Animals↗

PubMed2000

Evaluation of the urological complications of living related renal transplantation at a single center during the last 10 years: impact of the Double-J* stent.

PURPOSE: We evaluated the impact of the routine use of Double-J stents for decreasing urological complications in living related renal transplantation at a single center during the last 10 years. MATERIALS AND METHODS: Our 3-phase longitudinal study included 670 consecutive living related renal transplants from 1989 to 1998. In phase 1 from 1989 to 1993 a stent was introduced as and when required in only 15 of 170 patients. In phase 2 from January 1994 to April 1995 we randomized 57 and 43 cases to stenting and no stenting, respectively. The stent was removed after 4 weeks. In phase 3 from May 1995 to December 1998 all patients received a stent, which was removed 10 to 14 days just before discharge home. We reviewed urological complications at various time frames to determine the impact of routine Double-J stenting on decreasing urological complications. RESULTS: In phase 1 the major ureteral complication rate was 8.8%, which decreased to 3% in phase 2 when half of our cases were stented. In phase 3 there was only 1 ureteral complication (0.04%) in 400 patients, of whom all received a stent. The overall ureteral complication rate in nonstented and stented cases was 8.5% (18 of 213) and 0.22% (1 of 457). There was no difference in urological complications or stent related problems whether the stent was removed at 4 or 2 weeks. However, stent removal at 2 weeks eliminated the possibility of a forgotten stent, avoided repeat hospitalization for stent removal and decreased the cost. Routine stenting was cost-effective and almost eliminated urological complications. CONCLUSIONS: Routine Double-J stenting prevents ureteral complications. Early removal at 2 weeks is advisable. The short duration of stenting is effective and saves the cost of repeat hospitalization at a later date.

Adolescent↗

PubMed1991

Pavlovian conditioning in the rabbit during inactivation of the interpositus nucleus.

1. We have examined the role of the anterior interpositus nucleus (AIP) of the cerebellum in Pavlovian conditioning of the nictitating membrane response (NMR) of the rabbit with the use of reversible brain lesions produced by the local anaesthetic lidocaine. Previous experiments have demonstrated that destructive lesions of the AIP prevent the performance of conditioned NMRs (CRs). Microinjections of lidocaine into the AIP were used in the present experiment to determine whether the deficit in the performance of CRs resulted from a deficit in learning or memory. 2. A 3-phase procedure was employed to determine whether associative learning required the function of the AIP. In phase 1, rabbits were trained to make CRs to a flashing-light conditioned stimulus (CS) that was paired with an air-puff unconditioned stimulus (UCS) directed at the cornea. In phase 2, the AIP was anaesthetized during a session of conditioning in which a tone CS was paired with the UCS. Presentations of the light CS were interpolated throughout the tone conditioning in order to monitor the degree to which CRs were impaired by lidocaine. Phase 3 occurred after the effects of the lidocaine had dissipated and consisted of a test of retention to determine whether learning occurred during phase 2 but could not be expressed because of a performance deficit resulting from the inactivation of the AIP. 3. Infusion of lidocaine into the AIP abolished CRs to the light CS and prevented the performance of CRs to the tone CS in phase 2. The effect of the infusion was specifically due to a conduction block of neurons and/or fibres in the lateral aspect of the AIP. The infusion of lidocaine into regions surrounding the AIP did not affect CRs elicited by the light CS or prevent acquisition of CRs to the tone. Infusions of saline directly into the AIP did not impair the performance of CRs to either the tone or light CS. Quantitative analysis of diffusion revealed that the abolition of CRs was accompanied by anaesthetization of the AIP. 4. The retention test in phase 3 indicated that learning occurred normally during phase 2 when the AIP was inactivated and performance was abolished. When the function of the AIP was restored and performance had recovered, the subjects demonstrated a frequency of CRs to the tone CS that was indistinguishable from control subjects whose performance had never been impaired. 5. The CRs observed during the retention test provided an unequivocal measure of associative learning.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2003

Histopathologic recognition of involved margins of lentigo maligna excised by staged excision: an interobserver comparison study.

OBJECTIVES: To assess interobserver and intraobserver concordance for identifying positive and negative margins in staged excisions of lentigo maligna and lentigo maligna melanoma and to determine if control biopsy specimens are useful to improve concordance. DESIGN: Retrospective, randomized interobserver and intraobserver comparison study of archived pathologic specimens. The study was conducted in 3 phases, and slides were evaluated blindly and independently by 5 pathologists: in phase 1, all slides were randomized and diagnosed as positive or negative. In phase 2, every third slide was evaluated again and diagnosed as positive or negative. In phase 3, slides were organized into cases, allowing evaluation of each margin in the context of the positive control (tumor from the center of the lesion) and negative control (control biopsy specimen), if available. SETTING: University referral center. STUDY MATERIAL: A total of 301 glass microscopic slides from 27 patients who underwent staged excision for lentigo maligna or lentigo maligna melanoma from March 1997 to April 2001. MAIN OUTCOME MEASURES: Interobserver and intraobserver concordance between original diagnoses and study diagnoses rendered on all slides by 5 pathologists. RESULTS: Phase 1 and 3 agreement was moderate (kappa range, 0.4-0.5). Phase 2 (intraobserver) agreement was moderate to good for all pathologists (kappa range, 0.6-0.9). Subset analysis revealed a statistically significant increase in agreement with the use of a control strip biopsy specimen for difficult slides. CONCLUSIONS: Interobserver concordance for margin analysis in lentigo maligna and lentigo maligna melanoma is moderate, and intraobserver concordance is moderate to good. A control strip biopsy specimen may improve concordance in some cases.

Adult↗

PubMed1984

Mid-diastolic intraventricular functional block. A new mechanism for intermittent intraventricular blocks?

Experimental and clinical studies have demonstrated the existence of phase 3 and phase 4 functional blocks. In this report six cases are presented in which the electrophysiological study demonstrated the existence of a functional intraventricular block different from phase 3 and phase 4 blocks. In these cases the occurrence of the block was related to the presence in mid-diastole of a zone of block preceded and followed by intervals of unimpaired conduction. In two of 6 cases the functional block (infrahisian block) was not present in the basal tracing; it occurred during programmed atrial stimulation in a range of critical H1H2 coupling intervals delivered late in diastole, and did not appear after earlier stimuli. In the remaining four cases the conduction disturbance (2 RBBB, 2 infrahisian blocks) was present in the basal tracing, but disappeared both during early and late supraventricular extrastimuli, the first having short H1H2 intervals, the latter having H1H2 intervals longer than H1H1 basal cycle length. The width of the mid-diastolic zone of block varied from a few msec to hundreds of sec, and increased as heart rate increased. Two hypotheses are put forward in order to explain the electrophysiological mechanism responsible for the phenomenon: 1) a longitudinal dissociation in the conducting system, generating two different ways, one having a long refractory period, the other having a phase 4 spontaneous depolarization; they would be responsible of phase 3 and phase 4 blocks respectively. The early and late zones of conduction could be explained by an alternate conduction in one of the two ways, while the mid-diastolic zone of block could be due to a simultaneous block in both ways; 2) the existence of a diastolic oscillatory potential (late after-depolarization). In the latter case we can suppose that the mid-diastolic block was due to the stimulation of the cells of the conducting system before the restoration of the normal diastolic potential. Our electrophysiological data offer a new contribution to the understanding of intermittent intraventricular blocks. However further experimental and clinical studies are needed to confirm our electrophysiological hypotheses.

Adult↗

PubMed1982

[Kinetics of lymphocyte sub-populations and plasma cells in the mammary gland of primiparous sows in relation to gestation and lactation].

Qualitative and quantitative changes in pig lymphocyte sub-populations (T, B, L and nulls) were studied in the mammary gland of primiparous sows, as well as the appearance and development of plasma cells in relation to the 3 phases of mammary development: gestational, colostral and lacteal phases. Results showed: 1) An early colonisation of mammary epithelium from the beginning of the gestation phase by the three T, B and L lymphocyte subpopulations; 2) The presence of activated T lymphocytes, especially during the colostral phase; 3) The appearance of plasma cells during the colostral phase and their increase during the lacteal phase; 4) Not only the T, B and L lymphocyte subpopulations increased during the lactation but there was also a special increase in null lymphocyte subpopulation. These results give new data which are particularly important in allowing us to envisage immunization schemes for the pregnant sows, with the aim of enhancing local mammary or lactogenic immunity by transfer of antibodies and lymphocytes to the newborns.

Animals↗

PubMed1999

Increasing muscle mass in spinal cord injured persons with a functional electrical stimulation exercise program.

OBJECTIVE: To determine the magnitude of changes in muscle mass and lower extremity body composition that could be induced with a regular regimen of functional electrical stimulation (FES)-induced lower-extremity cycling, as well as the distribution of changes in muscle mass among the thigh muscles in persons with spinal cord injury (SCI). STUDY DESIGN: Thirteen men with neurologically complete motor sensory SCI underwent a 3-phase, FES-induced, ergometry exercise program: phase 1, quadriceps strengthening: phase 2, progressive sequential stimulation to achieve a rhythmic pedaling motion (surface electrodes placed over the quadriceps, hamstrings, and gluteal muscles); phase 3, FES-induced cycling for 30 minutes. Participants moved from one phase to the next when they met the objectives for the current phase. MEASURES: Computed tomography of legs to assess muscle cross-sectional area and proportion of muscle and adipose tissue. Scans were done at baseline (before subjects started the program), at first follow-up, typically after 65.4+/-5.6 (SD) weekly sessions, and at second follow-up, typically after 98.1+/-9.1 sessions. RESULTS: Increases in cross-sectional areas were found in the following muscles: rectus femoris (31%, p<.001). sartorius (22%, p<.025), adductor magnus-hamstrings (26%, p<.001), vastus lateralis (39%, p = .001), vastus medialis-intermedius (31%, p = .025). Cross-sectional area of adductor longus and gracilis muscles did not change. The ratio of muscle to adipose tissue increased significantly in thighs and calves. There was no correlation among the total number of exercise sessions and the magnitude of muscle hypertrophy. CONCLUSIONS: Muscle cross-sectional area and the muscle to adipose tissue ratio of the lower extremities increased during a regular regimen of 2.3 FES-induced lower extremity cycling sessions weekly. The distribution of changes was related to the proximity of muscles to the stimulating electrodes.

Adipose Tissue↗

PubMed1986

The angioarchitecture of the Lewis lung carcinoma in laboratory mice (a light microscopic and scanning electron microscopic study).

53 Lewis lung carcinomas implanted subcutaneously into C57BL/6-mice were examined. The animals were killed at various stages of tumor growth (TG) and prepared for histology and for scanning electron microscopy (critical-point-dried tissue; vascular corrosion casts). Prior to casting animals were rinsed using different perfusion pressures. Casting was done by manual injection of the resin, whereby different influx-rates were applied resulting in low, medium and high pressure preparations. We discern 3 phases of tumor angiogenesis (TA) occurring during 4 stages of TG among which vasodilation establishes the first reaction of the host vascular system to a growing tumor implant. During this stage 1 of TG, tumor nidation, nearby sinusoidal dilated host capillaries form globular outgrowings (phase 1 of TA). Subsequently radially arranged sprouts, which preferentially arise from venous host vessels, grow into the centre of the implant (phase 2 of TA). Stage 2 of TG, early tumor growth, is characterized by necrosis of the central tumor tissue and the development of a central avascular cavity. Thus the tumor vascular system is organized like a hollow sphere with a central cavity and a peripheral vascular "envelope" with large vessels embracing the tumor and centrifugally growing vascular sprouts, which arise from the venous part of the vascular "envelope" and invade the surrounding host tissue (phase 3 of TA). During stage 3 of TG, late tumor growth, many vessels of the basket-like vascular "envelope" obliterate. In stage 4 of TG, prefinal phase, the peripheral vascular density decreases continuously. Thus vascular sprouting and proliferation of viable tumor cells is confined to basal regions of the tumor.

Arterioles↗

PubMedDate not supplied

Long-term use of intranasal insulin in insulin-dependent diabetic patients.

This study, in 3 phases, compared the long-term acceptability and efficacy of insulin administered by nasal spray with an intensified subcutaneous regimen in nine type I (insulin-dependent) diabetic subjects on baseline therapy with ultralente insulin. In phase 1, patients were begun and stabilized on a regimen of ultralente daily and Actrapid insulin three times daily. Phase 2 consisted of 4 mo of this intensified subcutaneous regimen. In phase 3, intranasal administration of insulin, with 1% (wt/vol) sodium glycocholate, replaced Actrapid insulin for 4 mo. Glycemic control was compared in each of the three phases. It was possible to maintain the dose of ultralente insulin relatively constant in only six of the nine subjects during the intranasal phase of the study. The six subjects showed a significant rise in glycosylated hemoglobin during the intranasal phase (10.4 +/- 0.6% intranasal vs. 9.1 +/- 0.3% subcutaneous, P less than .05) but not in plasma or urinary glucose levels. There was no significant change in the incidence of hypoglycemic episodes during intranasal insulin therapy in this group. The other three subjects were considered treatment failures. Six of the nine original subjects expressed a preference for intranasal insulin, and one subject complained of mild nasal irritation insufficient to cease treatment. The intranasal route of administration of insulin has the potential to replace short-acting insulin as an adjunct to longer-acting insulin in some insulin-treated diabetic patients.

Administration, Intranasal↗

PubMed1996

Decreasing catheter-related infection and hospital costs by continuous quality improvement.

OBJECTIVES: a) To reduce the rate of catheter-related infection, using improved skin preparation and catheters impregnated with silver sulfadiazine and chlorhexidine; b) to decrease the number of unnecessary guidewire exchanges of existing catheters by substituting suspected catheter-related sepsis for fever alone as an indication to change an indwelling catheter; and c) to decrease the hospital costs associated with guidewire exchanges and new catheter insertions. DESIGN: Sequential, prospective, descriptive studies using a continuous quality management approach. SETTING: A 20-bed trauma intensive care unit at a university teaching hospital. PATIENTS: Patients (n = 147) admitted from July 1 to December 31, 1992 (phase 1); 34 patients admitted in June and September 1993 (phase 2); and 156 patients admitted between January 1 and June 30, 1994 (phase 3). INTERVENTIONS: Phase 1: Proportions of catheter-related infections and catheter-related bacteremia were compared with our prior reported results. Indications for guidewire exchange were analyzed, and the rate of catheter-related infection for each indication was derived. Phase 2: The rate of catheter-related infection was determined for a trial group of triple-lumen catheters impregnated with silver sulfadiazine and chlorhexidine. Phase 3: Four components were altered. Impregnated triple-lumen catheters were used instead of unprotected catheters. Chlorhexidine skin cleanser was substituted for povidone-iodine solution during initial aseptic preparation during catheter insertion and subsequent guidewire exchange. Suspected catheter-related sepsis was substituted for fever as an indication for guidewire exchange. The "safe" period (the time before considering changing a catheter because catheter-related sepsis was suspected) was extended from 2 to 4 days. MEASUREMENTS AND MAIN RESULTS: The overall rate of catheter-related infection in phase 1 was 15% (15% for triple-lumen catheters and 16% for introducers). Catheters changed for site inflammation had a 46% rate of catheter-related infection, significantly higher than for all other indications, including fever (p < .03). The rate of catheter-related infection was significantly (p = .0002) higher for catheters in place for > 10 days compared with lesser durations. Fever was the indication for 42% of all guidewire exchanges. In phase 2, the catheter-related infection rate was 2% (one positive of 48 catheters), significantly (p = .0231) lower than the phase 1 rate. In phase 3, the overall rate of catheter-related infection was 8.6%, significantly (p = .0067) lower than the 15% rate in phase 1. The proportion of protected triple-lumen catheter catheter-related infections decreased significantly (p = .0024) from 15% to 6%. The rate of catheter-related infection for introducers was the same in both phases (p = .33). The days of catheterization for all catheters increased from 4.5 +/- 2.6 to 5.4 +/- 3.6 (p < .0001). The days for triple-lumen catheters increased from 4.7 +/- 2.7 to 7.0 +/- 3.9 (p < .0001). For introducers, there was no difference in the days of catheterization. The proportion of catheters changed for suspected catheter-related sepsis decreased significantly (p < .0001) to 23% from the 42% changed for fever in phase 1. The proportion of catheter-related infections for catheters changed for fever was 18% in phase 1. The proportion of catheter-related infections for catheters changed for suspected catheter-related sepsis was 13% in phase 3 (p = .43). The total number of catheters used per patient in phase 3 was 1.9 +/- 1.4, significantly lower than the 2.6 +/- 2.7 catheters used in phase 1 (p = .0018). The number of triple-lumen catheters decreased from 1.8 +/- 1.2 to 1.0 +/- 1.2 in phase 3 (p = .0001). CONCLUSIONS: Catheters impregnated with silver sulfadiazine and chlorhexidine had a smaller proportion of catheter-related infection compared with unprotected catheters. Fever alone as an indication for guidewire exchange resu

Anti-Infective Agents↗

PubMed1995

The effect of ambient temperature and saline loading on changes in plasma and urine electrolytes (Na+ and K+) following exercise.

In this study 4 Standardbred geldings (age 3-8 years, weight 431-531 kg) were used. The horses were fed a hay and oat diet and the total sodium intake was about 32 mg/kg bwt (690 mmol/day). An exercise test (ET) which contained 3 phases was performed. Phase I consisted of 23.5 min of mainly submaximal exercise, Phase 2 of 2 h of box rest and Phase 3 of 26 min of exercise including an intensive trot over 2600 m at 90% of VO2max. The ET was repeated 3 times: the first at 20 degrees C (30-40% RH), the second at 35 degrees C (30-40% RH) and the third at 35 degrees C (30-40% RH) after a nasogastric administration of 10 litres of 0.9% NaCl solution (35 degrees C and saline load [+ F]). Blood samples were taken before, during and after exercise. To measure fluid loss, horses were weighted before and after the ETs. Total urine output was determined 2 days before the ET (control), throughout the exercise day and for 2 days after (recovery days). There were an increase in blood and rectal temperatures after both exercise phases and a significant higher blood temperature was observed after exercise at 35 degrees C compared to 20 degrees C. The horses lost about 2% of their bodyweight (bwt) during the ETs. The plasma protein concentration increased during the exercise phases and remained elevated 2 h after exercise at both 20 degrees C and 35 degrees C, even though the horses had free access to water. The plasma protein concentration had returned to pre-exercise levels 26 h post exercise. After the saline load, total plasma protein concentration fell and increased only at the end of each exercise phase. The major mechanism regulating fluid balance after exercise seemed to be a lowered urinary excretion since water intake did not increase significantly. Urinary potassium excretion was positive throughout the experiment. During control days there was a positive sodium balance, shown by a urinary sodium excretion of 260 mmol/day. Post exercise urinary sodium excretion fell and remained very low until the second day of recovery, except after saline loading. In addition, plasma sodium was lowered 26 h after exercise at 35 degrees C. This study shows that with a daily salt intake of 38 g it will take several days to compensate for a sodium loss caused by sweating. Therefore, it is recommended that extra salt be given during the exercise day. In the experimental situation, pre-exercise saline supplementation was beneficial since the recovery time was shortened.

Animals↗

PubMed2001

A 48-month multicentric clinical investigation: implant design and survival.

This report is based on a total of 2,955 implants of 6 different designs, randomized and placed in 829 patients and followed for 48 months. Implant failure was defined as nonintegration at uncovering or removal due to mobility, persistent pain, infection, and evidence of radiographic bone loss. Failures were reported for 3 phases of treatment: implant placement to uncovering (phase 1), uncovering to loading (phase 2), and postloading (phase 3). Differences in survival were compared with Kaplan-Meier survival curves. The maxillary single tooth application resulted in 95.2% survival for the hydroxyapatite-coated grooved implants. In the maxillary completely edentulous application, survival of hydroxyapatite grooved and screw implants were considerably better compared with the titanium screw implants. The hydroxyapatite-coated cylinder had better survival than the titanium basket and screw designs in the mandibular completely edentulous application. The hydroxyapatite-coated cylinder and grooved implants in the maxillary posterior partially edentulous application had similar survival rates. The survival of the hydroxyapatite-coated cylinder exceeded that of the titanium basket in mandibular posterior partially edentulous applications. Analyses by phase of treatment indicated a pattern of early failure for nonhydroxyapatite-coated implants compared with hydroxyapatite-coated implants. The implant with the highest survival at all phases of treatment was the hydroxyapatite-coated press-fit cylinder. Two hydroxyapatite-coated implant designs performed well in the challenging posterior maxillary region.

Adult↗

PubMed2002

Pain and disability, perceptions and beliefs of a rural Indian population: A WHO-ILAR COPCORD study. WHO-International League of Associations for Rheumatology. Community Oriented Program for Control of Rheumatic Diseases.

OBJECTIVE: The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases (COPCORD) primarily aims to estimate the burden of rheumatic-musculoskeletal symptoms/disorders (RMS). We investigated data on pain and disability, perceptions and beliefs in the first rural community based COPCORD study in India. METHODS: A total of 4092 adults were interviewed (response rate 89%) in a population survey (Stage 1) in Bhigwan village in 1996 using modified COPCORD core questionnaires. Twenty-one trained volunteers completed the survey in 5 weeks. Those reporting RMS were identified (Phase 1) to complete a self-evaluation questionnaire (Phase 2) prior to rheumatological evaluation (Phase 3). Phase 2 included questions on perceptions and beliefs regarding pain, effect on life, work and socioeconomic factors, disability, and therapy; only the moderate and severe grades were considered significant. Patients marked their pain sites on a manikin during the presurvey week. A validated modified Health Assessment Questionnaire disability index (HAQDI) in the local language evaluated functional disability. RESULTS: RMS were the predominant ailments reported by 746 adult villagers (18.2%; 95% CI 17.1, 19.2). Moderate pain of > 2 years' duration was reported by almost 60% of RMS patients. Neck (6%), lumbar (11.4%), shoulder (7.4%), elbow (6.5%), wrist (6.4%), hand (6.1%), knee (13.2%), calf (6.6%), and ankle (6.5%) were the common painful sites, predominantly in women; 91%, 89%, and 31% with RMS reported a significant grade of pain, RMS illness, and disturbed sleep, respectively. In the age group 25-54 years, 21% of those with RMS perceived a significant effect on work ability, while less than 20% of those with RMS admitted a similar effect on their personal life (including finances). About 10% with RMS had ceased to work because of RMS. Among RMS subjects 21% scored a significant HAQDI, but many more reported significant difficulty (HAQ) in the individual items of walking, hygiene (squatting), arising (from sitting cross-legged), reaching, and occupational/household chores; this corresponded to the dominant pain sites in low back and lower limbs. Oral tobacco use was reported to be significantly greater (p < 0.001) in the RMS patients. Past trauma was recalled by 23% of patients, and many connected this to their RMS. Modern medicines were consumed by 55% of patients with RMS. Among patients, 86% and 65% expected "pain relief" and "cure," respectively, from their doctor; 23% of patients wanted greater sympathy and attention. However, 21% of patients had never visited a doctor and were only identified by the COPCORD study. CONCLUSION: The findings of this study (1) demonstrate that RMS, although a predominant ailment, has a modest effect on daily living in most subjects with RMS; (2) indicate there is inconsistency between the measures of pain and disability (using HAQ) and their effects; (3) describe the beliefs and expectations of the community. Based on the data and community support, the COPCORD has been continued for Stages II and III, especially with a view to health education.

Adult↗

PubMed2000

Radiofrequency treatment for obstructive tonsillar hypertrophy.

OBJECTIVE: To evaluate the safety and efficacy of in-office, temperature-controlled radiofrequency submucosal tissue volume reduction using the Somnoplasty procedure for the treatment of symptomatic chronic obstructive tonsillar hypertrophy. DESIGN: A prospective, nonrandomized, 3-phase protocol using in vitro and in vivo studies associated with operative tonsillectomy and clinical procedures performed in-office. SETTING: Hospital operating room and private practice otolaryngology office. STUDY POPULATION: In vitro studies of 14 tonsil specimens following tonsillectomy; in vivo studies of 11 tonsils before tonsillectomy; and clinical procedures performed on 9 adults, ages 24 to 47 years, with symptomatic chronic tonsillar hypertrophy. OUTCOME MEASURES: For phase 1, histologic tissue sections; for phase 2, histologic tissue sections and clinician and patient questionnaires regarding procedure morbidity; and for phase 3, measurements of oropharyngeal airway size and clinician and patient questionnaires regarding procedure morbidity and symptom improvement. RESULTS: A 2-needle radiofrequency probe ablated tonsil stromal tissue while leaving overlying mucosa and underlying structures intact. On average, oropharyngeal airway was enlarged 12 mm, with a 70.8% calculated reduction in tonsil size. Procedures were well tolerated and had only minimal pain and dysphagia. There were no episodes of hemorrhage, and patients resumed normal activity within 1 to 2 days. Substantial improvement was reported in daytime sleepiness, snoring, voice clarity, swallowing, and throat irritation. CONCLUSIONS: Temperature-controlled radiofrequency submucosal tissue volume reduction is a safe and effective method of treating symptomatic obstructive tonsillar hypertrophy. It is well tolerated by the patient under local anesthesia in the physician's office and has minimal postprocedure pain and dysphagia, with rapid return to normal activity. The procedure reduces tonsil size and increases airway size, leading to a reduction in symptoms.

Adult↗