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At least 415 records · Page 23Linked to original sources
PubMed1999

Customized EMG needle insertion guide for the muscle afferent block of jaw-deviation and jaw-opening dystonias.

OBJECTIVE: Jaw-opening and jaw-deviation dystonias are characterized by mouth opening or lateral shift of the mandible due to involuntary contraction of the lateral pterygoid muscle, causing difficulties in speech or mastication. We introduce the method of muscle afferent block by using a removable device for inserting a hollow electromyographic needle. STUDY DESIGN: A technique for fabricating a customized needle insertion guide into the lateral pterygoid muscle is described. Using the device, intramuscular injection of lidocaine and ethanol was performed in 3 patients with jaw-opening dystonia and 2 with jaw-deviation dystonia. Subjective improvement was assessed on a linear self-rating scale ranging from 0 (no improvement) to 100 points (complete cure). RESULTS: The overall subjective improvement was 72% +/- 16.4% without major side effects. CONCLUSIONS: The device is very useful for safe and accurate injection into the lateral pterygoid muscle. The muscle afferent block is effective for jaw-opening and jaw-deviation dystonias.

Adult↗
PubMed1996

Subdermal contraceptive implant (Norplant) continuation rates among adolescents and adults in a family planning clinic.

STUDY OBJECTIVE: The purpose of this study was to prospectively evaluate the continuation rate of subdermal contraceptive implants (Norplant) among adolescent (< 20 years) and adult (> or = 20 years) women in the clinic population of a tertiary care medical center. DESIGN: Adolescents and adults desiring contraception for greater than a 6-month period were eligible for Norplant insertion. Prior to insertion, personal counseling and extensive education were provided. Following insertion, rapid access, personal counseling, and prompt treatment were provided for complications that occurred. Device removal was available to all individuals at any time upon patient request or if side effects could not be ameliorated. Patient demographic, historical, physical, and follow-up data were entered into a computer data base. RESULTS: Since February 1991, 1800 subdermal contraceptive implants were inserted. Of these 1688 patients were prospectively followed, providing 45,576 women-months of data for analysis. Adolescents comprised 40% of the study population. Over a 50-month period, the cumulative continuation rate for adolescents was 93.6%, and for adults it was 91.1%. The mean duration of use among adolescents was 26.5 months and for adults was 27.6 months. CONCLUSIONS: There was no significant difference between adolescent and adult subdermal contraceptive implant continuation rates for up to 50 months of use. In this patient population, high continuation rates may result from a combination of extensive patient education and intensive surveillance by a well-trained and dedicated multidisciplinary staff. When all patients are enrolled in a program that provides aggressive education and supportive follow-up, age is not a significant factor in continuation rates.

Adolescent↗
PubMedDate not supplied

Patient satisfaction with spinal cord stimulation for predominant complaints of chronic, intractable low back pain.

BACKGROUND CONTEXT: Results of subsequent surgical intervention in patients with intractable pain after lumbar spine surgery are typically worse than for initial surgery, particularly in those with predominant complaints of back pain rather than lower extremity pain. Spinal cord stimulation (SCS) has been found to yield good results in patients with primary complaints of intractable lower extremity pain. Technological advances have broadened the indications for this treatment. PURPOSE: The purpose of this study was to evaluate patient satisfaction after SCS in the treatment of patients with predominant complaints of chronic, intractable, low back pain. STUDY DESIGN/SETTING: Data were collected from retrospective chart review and patient follow-up questionnaire. Patients were treated at a spine specialty center. PATIENT SAMPLE: The study group consisted of the consecutive series of our first 41 patients who underwent SCS for predominant complaints of low back pain. The mean symptom duration was 82.9 months, and the mean age was 47.9 years (range, 28-83 years). All but three patients had previously undergone lumbar spine surgery (mean, 2.3 prior surgeries). OUTCOME MEASURES: At the time of follow-up (5.5-19 months after SCS implantation), patients completed questionnaires assessing their satisfaction with their outcome, if they would have the procedure again knowing what their outcome would be and if they would recommend SCS to someone with similar problems. In determining outcome, a negative response was assigned for patients who had the device removed. A worst-case analysis was also conducted in which a negative response was assigned for patients lost to follow-up or who failed to respond to a particular question. Data were also collected on complications and re-operations. METHODS: All trial stimulation procedures were performed under local anesthetic with the patient providing feedback concerning pain relief achieved with various lead placements and settings. If one lead did not provide acceptable relief in all the areas needed, placement of a second lead was pursued. If the patient failed to maintain acceptable pain relief (> or =50% pain relief) during a multiday trial period, the leads were removed. If adequate relief was maintained during the trial period, the receiver was implanted. RESULTS: Responses to the follow-up questionnaire indicated that 60% of patients considered themselves improved from their preoperative condition and the remaining 40% did not; 78.1% of patients would recommend SCS to someone with similar problems, 69.0% were satisfied, 75.0% would have the procedure performed again if they had known their outcome before implantation. Among the 36 patients in whom the system was implanted, it was later removed in 4 because of lack of sufficient pain relief. Other re-operations included repositioning of the leads to regain pain relief in the areas needed, replacement of a malfunctioning unit and revision of lead extension wires. CONCLUSIONS: In this retrospective study, the majority of patients were satisfied with the results of SCS and would have the procedure again knowing what their outcome would be. These results suggest that further investigation of SCS is warranted in this difficult to treat patient population presenting with predominant complaints of chronic, intractable, axial low back pain.

Adult↗
PubMed2005

Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis.

BACKGROUND & AIMS: The aim of this study was to report the long-term clinical response to high-frequency gastric electrical stimulation (GES) in 16 patients with postsurgical gastroparesis who failed standard medical therapy. METHODS: Clinical data collected at baseline and after 6 and 12 months of GES included (1) severity and frequency of 6 upper gastrointestinal (GI) symptoms by using a 5-point symptom interview questionnaire and total symptom score, (2) health-related quality of life including physical composite score and mental composite score, (3) 4-hour standardized gastric emptying of a solid meal by scintigraphy, and (4) nutritional status. RESULTS: The severity and frequency of all 6 upper GI symptoms, total symptom score, physical composite score, and mental composite score were significantly improved after 6 months and sustained at 12 months ( P < .05). All patients had delayed gastric emptying at baseline. Gastric emptying was not significantly faster at 12 months, although 3 normalized. At implantation, 7 of 16 patients required nutritional support with a feeding jejunostomy tube; after GES, 4 were able to discontinue jejunal feeding. The mean number of hospitalization days was significantly reduced by a mean 25 days compared with the prior year. One patient had the device removed after 12 months because of infection around the pulse generator. CONCLUSIONS: Long-term GES significantly improved upper GI symptoms, quality of life, the nutritional status, and hospitalization requirements of patients with postsurgical gastroparesis. Although vagal nerve damage or disruption was part of the underlying pathophysiology, GES therapy was still effective and is a potential treatment option for the long-term management of postsurgical gastroparesis. A controlled clinical trial of GES for PSG patients (who are refractory to medical therapy) is indicated given these encouraging results.

Adult↗
PubMed1999

Determinants of contraceptive discontinuation in six developing countries.

This analysis investigates the determinants of contraceptive discontinuation in six developing countries, using data from Phase I surveys of the DHS programme. Cumulative probabilities of discontinuation at 24 months for reasons other than the desire for another child were examined. By this time, typically about 40% of couples have stopped use and most are subsequently at risk of an unwanted conception. Discontinuation of IUD use was found to be less common than for other methods, partly perhaps because cessation of use requires a deliberate decision to have the device removed. The most important results are negative ones. Neither the schooling of couples nor their type of residence exerted appreciable influence on discontinuation. The policy and programme implications are discussed. Prior use of a method, fertility preferences and the related demographic factors of age and family size emerged as pervasive predictors of discontinuation.

Adolescent↗
PubMed2003

Electrostatic precipitator collection efficiency and trace element emissions from co-combustion of biomass and recovered fuel in fluidized-bed combustion.

Particle and trace element emissions from energy production have continuously been subject to tightening regulations. At the same time, not enough is known on the effect of different combustion processes and different fuels and fuel mixtures on the particle characteristics and particle removal device operation. In this investigation, electrostatic precipitator fractional collection efficiency and trace metal emissions were determined experimentally at a 66 MW biomass-fueled bubbling fluidized-bed combustion plant. The measurements were carried out at the inlet and outlet of the two-field electrostatic precipitator (ESP) at the flue gas temperature of 130-150 degrees C. Two fuel mixtures were investigated: biomass fuel containing 70% wood residue and 30% peat and biomass with recovered fuel containing 70% wood residue, 18% peat, and 12% recovered fuel. The particle mass concentration at the ESP inlet was 510-1400 mg/Nm3. Particle emission at the ESP outlet was 2.3-6.4 mg/Nm3. Total ESP collection efficiency was 99.2-99.8%. Collection efficiency had a minimum in particle size range of 0.1-2 microm. In this size range, collection efficiency was 96-97%. The emission of the trace metals As, Cd, Co, Cr, Cu, Mn, Ni, Pb, Sb, Tl, and V was well below the regulation values set by EU directive for waste incineration and co-incineration.

Air Pollutants↗
PubMed2000

Local and systemic immune response to surgery under balanced anaesthesia in children.

We studied perioperative changes in the immune response and compared changes in the peripheral blood with those in the wound in 20 boys (0.5-3 years) during elective inguinal surgery under balanced anaesthesia. Blood samples were drawn before premedication, immediately, and 4 or 24 h after anaesthesia. Cells from the wound were harvested with the Cellstick device, removed from the wound 4 (n=10) or 24 h (n=10) after anaesthesia. We found decreased lymphocyte counts in the peripheral blood, increased percentages of activated T lymphocytes and B lymphocytes, and decreased percentages of total T lymphocytes, T helper cells and T cytotoxic cells. The percentages of T helper cells and B lymphocytes were lower in the wound than in blood. Mitogen-induced lymphocyte proliferative responses decreased. This study demonstrates perioperative changes in the immune response in children and, as a new finding, that immune effector cells in the blood and in the wound are in a dynamic balance.

Analysis of Variance↗
PubMed1997

Further experience with the periurethral expander: a new type of artificial sphincter.

OBJECTIVE: To determine the long-term effects of the periurethral expander, a new device for the treatment of urinary incontinence in children. PATIENTS AND METHODS: Twenty-five patients (mean age 11.2 years, range 3-22) had a periurethral expander implanted around the bladder neck within the last 41 months. Twelve of these patients had neurogenic bladders as a result of myelomeningocele, 12 had undergone unsuccessful exstrophy reconstructions and one had megalourethra. Bladder augmentations were carried out in 23 of the patients. The mean follow-up was 23 months. RESULTS: Ten patients had the device removed due to erosion and/or infection; patients with exstrophy were more susceptible to complications. Patients with neurogenic bladders use clean intermittent catheterization and the remainder void spontaneously. The mean pressure in the cuff was 58.7 cmH2O. CONCLUSION: The periurethral expander seems to be a valid option in the treatment of selected cases of urinary incontinence in children and young adults. There were more complications in patients with exstrophy/epispadias and such patients must be considered unsuitable for this treatment.

Adolescent↗
PubMed2001

Chloramphenicol treatment for vancomycin-resistant Enterococcus faecium bacteremia.

OBJECTIVE: To evaluate the results of treating vancomycin-resistant Enterococcus faecium (VREF) bacteremia with chloramphenicol. METHODS: We retrospectively reviewed the charts of all adult patients with VREF bacteremia treated with chloramphenicol during the calendar year 1998 at a 522-bed tertiary referral center in New York City. Patients were identified by reviewing microbiology laboratory records. Patients with clinically significant VREF bacteremia who received chloramphenicol for at least 48 h were included in the study. Clinical and microbiological outcomes were determined. Microbiological and molecular tests were performed on a small representative sample of isolates to identify the presence of resistance mechanisms and to look for similarity among the isolates. RESULTS: Seven episodes of significant VREF bacteremia occurred in six patients. Mean age was 54 years. All patients had cancer and three had severe neutropenia. Five of seven episodes were associated with chronic indwelling devices, but in only one of these cases was the device removed. All isolates were susceptible to chloramphenicol in vitro. All six microbiologically evaluable episodes had a favorable response to chloramphenicol treatment, and four of seven (57%) clinically evaluable episodes had favorable outcomes. Only one death may have been due to VREF bacteremia, so the maximal attributable mortality was 14%. The three representative samples that were tested further were indistinguishable from one another and they displayed no evidence of resistance mechanisms. CONCLUSIONS: In a cohort of severely ill cancer patients, chloramphenicol was effective in treating VREF bacteremia. The use of chloramphenicol should be considered in treating infections with this highly resistant organism, where therapeutic options are limited.

Adult↗
PubMed1998

Heparin removal after cardiopulmonary bypass in a patient with adverse reaction to protamine.

A 74-year-old man underwent elective coronary surgery under cardiopulmonary bypass. A few minutes after the protamine administration was started, he suddenly developed a severe hypotension necessitating cardiac massage and recannulation for pump assistance. A further test dose of protamine provoked an identical reaction. We installed a Heparin Removal Device, which allows for ex-vivo deheparinization. In 35 minutes ACT decreased from 480 sec to 180 sec and clots appeared in the operating field. This system provides an excellent alternative to protamine in patients with an adverse reaction to protamine.

Aged↗
PubMed2001

The role and remediation of animal allergens in allergic diseases.

Animal allergens are common causes of both acute and chronic allergic disease. The most important animal allergens are derived from mammals, principally cats, dogs, rats, mice, horses, and cows, which secrete or excrete allergens into the environment. Allergic sensitization may occur at home or in the workplace. Cat and dog allergens commonly cause allergies in the home and affect the general population. Laboratory animal handlers often have allergic reactions to rats and mice. Cow dander allergy is usually caused by occupational exposure and occurs in farmers and farm workers. Horse allergy occurs among people who regularly handle horses, either professionally or for recreational purposes. Over the past 20 years, the major animal allergens have been defined and characterized with regard to their molecular structure, immunogenicity, and environmental distribution. One remarkable finding has been the fact that most of the mammalian allergens that have thus far been cloned belong to a single family of proteins called the lipocalins. In addition to these molecular similarities, it has also been shown that most of the animal allergens are quite similar with regard to their aerodynamic properties. Although much is yet to be learned, progress is being made in our knowledge regarding the steps that may be necessary to control exposure to these allergens through environmental modifications in both homes and occupational settings. These measures include source control, air filtration devices, barrier devices, removal of carpeting and other reservoirs, and, in some cases, washing of the animal.

Allergens↗
PubMed2000

Filtration of activated granulocytes during cardiopulmonary bypass surgery: a morphologic and immunologic study to characterize the trapped leukocytes.

Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction. This study examines whether a leukocyte filter removes activated granulocytes or a general leukocyte population. Eleven patients undergoing cardiopulmonary bypass surgery were included in this study. Leukocyte filtration was achieved before the reperfusion phase with a Pall non-woven polyester filter located at the venous side of the heart-lung machine. After filtration, the trapped granulocytes inside the filter were examined morphologically with light and scanning electron microscopy and immunologically by CD45RO antigen binding to the filter material. Furthermore, leukocyte release markers were measured to determine whether cells were activated during filtration. Microscopic evaluation revealed 84% granulocytes and 14% lymphocytes trapped in the filter, compared with 78% granulocytes and 22% lymphocytes in the blood before filtration. Granulocytes were trapped significantly more in the first blood contact layer of the filter material than in the middle layer and last layer, whereas lymphocytes trapped slightly more in the middle layer. The near maximum level of CD45RO expression was measured on granulocytes trapped inside the filter material, whereas CD2 and CD19 measured on lymphocytes were bound to a minor extent. Beta-glucuronidase concentration did not increase after filtration, suggesting the absence of activation of granulocytes by filtration. A leukocyte filter made of non-woven polyester material removes the activated granulocytes rather than leukocytes at random. This implies that this particular type of leukocyte removal filter is suitable for use in cardiopulmonary bypass patients whose granulocytes in the circulation are activated. Furthermore, measurement of activated granulocytes instead of total leukocyte count is likely preferable for functional assessment of leukocyte removal devices.

Aged↗
PubMed2001

Treatment of anovulatory anoestrous postpartum dairy cows with a gonadotropin-releasing hormone (GnRH), prostaglandin F2 alpha, GnRH regimen or with progesterone and oestradiol benzoate.

AIM: To compare 2 treatments for anovulatory anoestrus (AA) in postpartum dairy cows. The treatments were combinations of gonadotropin-releasing hormone (GnRH) and prostaglandin F2 (PG) or progesterone (P4) and oestradiol benzoate (ODB). METHODS: Forty AA cows from each of 5 herds were blocked by age (2 or 2 years old) and randomly assigned to 1 of 2 treatments. The first group (GPG) were treated with 250 mug of a GnRH analogue, gonadorelin, followed 7 days later by 15 mg of the PG analogue, luprostiol. Two days later the cows were injected with 250 mug of gonadorelin. Cows were artificially inseminated 16-24 h after the second GnRH injection. The second group (P4+ODB) were treated with an intravaginal P4 releasing device for 6 days, followed 24 h after device removal by injection of 1 mg of ODB. Cows were pregnancy tested 35-40 days after the initial insemination and twice again at 6-8 week intervals thereafter. RESULTS: There was no significant difference between P4+ODB and GPG groups in the percentage of cows submitted for insemination in the first 7 days (94.0% vs 100% for P4+ODB vs GPG, respectively; p>0.3), in conception rate to first insemination within the first 7 days (43.6% vs 35.0% for P4+ODB vs GPG, respectively; p>0.2), in the percentage of cows conceiving in the first 28 days of the breeding period (68.0% vs 58.3%, P4+ODB vs GPG, respectively; p>0.1), or in median interval from the end of treatment to conception (20 vs 21 days; p>0.1). CONCLUSIONS: No differences in the reproductive performance of AA cows treated with either P4+ODB or GPG were detected. However, given the small number of animals enrolled, further data are required before the GPG protocol can be recommended for treatment of AA cows.

Journal Article↗
PubMed2001

Post-stroke violent adventitial movement responsive to levo-dopa/carbi-dopa therapy.

Previous reports in the literature concerning cerebrovascular accident have illustrated cases of post-stroke tremor. Treatments of these studies have varied. Trials of levo-dopa have been reported in two such cases. This case study reports on a case of a patient with a left thalamic, left superior cerebellar artery infarction with a lacunar infarction in the basal ganglia. The patient developed a violent tremor/movement disorder which was unresponsive to haloperidol. With this failure, and with the evidence of a basal ganglion lesion, levo-dopa/carbi-dopa was introduced as an intervention. The amplitude of the tremor was dramatically reduced, with protective devices removed, and with complete cessation of the tremor at rest. The medication was withdrawn and reintroduced with a reduction and subsequent resolution of the symptoms. A discussion of the previous studies of movement disorder with cerebrovascular accident is included.

Aged↗
PubMed1996

Sonicated vascular catheter tip cultures. Quantitative association with catheter-related sepsis and the non-utility of an adjuvant cytocentrifuge Gram stain.

Microbial quantification of potentially infected intravenous catheters is used to determine whether the removed device may be the source of sepsis. In this study, the authors defined a clinically significant colony count using the sonication technique to implicate the catheter as the source of sepsis. The utility of a cytocentrifuge-prepared Gram's stain of sonication broth as a rapid test for the accurate diagnosis of catheter-related bacteremia and fungemia was also evaluated. Initially, 230 consecutive vascular catheter cultures were performed. In 14 patients, the blood culture was found to grow in the same organism as the catheter culture. The eight blood-culture positive patients with probable catheter-related sepsis had four catheters with 10(4)-10(5), and four with more than 10(5) CFU derived from the catheter sonication broth. Six bacteremias not catheter related showed three catheters with < 10(3), two with 10(3)-10(4), and one with > 10(5) CFU. One catheter-related bacteremia had a negative culture. A subsequent validation study on 175 catheter specimens using 1,000 CFU as a cut-off between a positive and negative test fully separated eight patients with catheter-related bacteremia from six patients with infection at a distant site. Cytospin Gram stain, studied in the initial evaluation, was positive in 17 catheters with < 10(3) CFU, 4 at 10(3)-10(4), 4 at 10(4)-10(5) and 9 with > 10(5) CFU in the sonication broth. No correlation was found between this test and catheter-related sepsis. From these results, the authors concluded that those catheters with counts below 10(3) CFU in the catheter sonication broth do not appear to have an association with catheter-related sepsis, and that a Cytospin Gram stain done with the sonication technique does not correlate with the presence of catheter sepsis.

Bacteremia↗
PubMed1986

Usefulness of a test for slime production as a marker for clinically significant infections with coagulase-negative staphylococci.

The usefulness of a test for slime production as a marker for clinically significant infections with coagulase-negative staphylococci and its implications for therapy were examined. Hospital records were reviewed for 59 patients from each of whom more than one isolate of coagulase-negative staphylococci was obtained. In patients with a prosthetic device, 81% of 59 infectious episodes were due to a slime-positive coagulase-negative staphylococci. In contrast, 22 noninfectious episodes (in which the organisms were contaminants) were equally distributed between episodes due to slime-positive or slime-negative isolates (P = .005). Only 32% of infections caused by slime-positive organisms, in contrast to 100% of infections caused by slime-negative organisms, were improved by treatment with antibiotics alone (P = .02). Prosthetic device removal in addition to antibiotic treatment significantly improved the outcome in patients with infections due to slime-positive organisms when compared with treatment with antibiotics alone (93% vs. 32% improvement; P = .00025).

Anti-Bacterial Agents↗
PubMed2004

No evidence for pituitary priming to gonadotropin-releasing hormone in relation to luteinizing hormone (LH) secretion prior to the preovulatory LH surge in ewes.

The purpose of this study was to determine the occurrence of and the regulatory mechanisms involved in priming of the pituitary to GnRH before the preovulatory LH surge in sheep. Experiment 1: Forty-two ewes had progestagen devices removed after 14 days and were assigned to luteal (Lut) or follicular (Foll) groups. Fifteen days later, blood sampling was initiated either immediately or 36 h after induced luteolysis in groups Lut and Foll, respectively. After 4 h, ewes were administered either saline (n = 5) or 250 ng (n = 8) or 10 microg (n = 8) of GnRH. Five ewes per treatment group were killed 1 h later, while remaining animals were blood sampled for a further 7 h. Experiment 2: Eighteen ewes were allocated to Lut and Foll groups (described above). Blood samples were collected from 2 h before GnRH (10 microg) treatment until 7 h after. Despite up-regulated GnRH-R mRNA levels in Foll ewes, pituitary content and plasma levels of LH and LHbeta mRNA levels were similar between groups. Mean FSHbeta mRNA and plasma FSH levels were elevated in Lut ewes but declined after GnRH treatment. Inversely, plasma estradiol and inhibin-A concentrations were higher in Foll ewes and declined after GnRH treatment. Fewer LH(+ve)/secretogranin II(-ve) (SgII(-ve)) granules were present in gonadotropes of Foll ewes, coincident with increased basal LH levels. Fewer smaller sized granules were present after GnRH treatment. In conclusion, there was no evidence of self-priming before onset of the preovulatory LH surge. Constitutive release of LH(+ve)/SgII(-ve) granules may maintain basal LH levels while smaller sized, presumably mature granules may be preferentially released after GnRH stimulation.

Animals↗