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At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Residential mobility during pregnancy for mothers of infants with or without congenital cardiac anomalies: a reprint.

Maternal residence at time of delivery is sometimes used as a proxy for residence during early pregnancy to estimate environmental exposures. Residential addresses during time of conception through the first trimester were obtained from mothers of 152 infants with congenital cardiac anomalies and 175 controls, and they were compared with the addresses at delivery abstracted from birth certificates. An estimated 24.8% (95% CI = 20.3, 29.9) of women moved between the time of conception and delivery, and the percentage of cases and controls who moved was similar. Use of address at time of delivery may reduce the likelihood of finding an association between a congenital malformation and a maternal environmental exposure.

Adult↗
PubMedDate not supplied

A survey of the monosodium glutamate content of foods and an estimation of the dietary intake of monosodium glutamate.

The MSG contents of a wide range of manufactured foods (over 200 samples) were measured using the AOAC Procedure (ion-exchange chromatography followed by formol potentiometric titration). The results obtained were used, in conjunction with published data on UK food consumption, to calculate tentative estimates of the dietary intake of MSG for specific groups of the UK population.

Adolescent↗
PubMed1998

Central nervous system action of melatonin on gastric acid and pepsin secretion in pylorus-ligated rats.

We recently demonstrated that centrally administered melatonin at low doses inhibits the induction of gastric lesions by water-immersion restraint stress. To investigate the mechanism of the potent anti-ulcer action of melatonin, the central nervous system (CNS) effects of melatonin on gastric acid and pepsin secretion were studied in conscious pylorus-ligated rats. Intracisternal (i.c.) melatonin (1-100 ng) dose-dependently decreased acid and pepsin output, while a higher i.p. dose (1 microg) had no inhibitory effect. The i.c. melatonin did not change serum gastrin concentrations. Serum melatonin concentrations at 1 and 4 h after i.c. administration of 10-100 ng melatonin did not differ from those in rats receiving i.c. vehicle. The present results suggest that melatonin administered centrally modulates the secretion of gastric acid and pepsin which may explain, at least in part, the protective, anti-stress role of melatonin in the gastric mucosa observed in our previous study.

Animals↗
PubMedDate not supplied

Dual-phase helical CT of nonfunctioning islet cell tumors.

PURPOSE: The aim of this study was to evaluate the utility of dual-phase imaging in the assessment of nonfunctioning islet cell tumors (NFITs). METHOD: Six patients with histologically and biochemically proven NFIT were evaluated by arterial and portal venous dual-phase helical CT. Scan delay was 20 s for the arterial phase and 70 s for the portal phase. Each phase was assessed by consensus reading and specifically evaluated for tumor conspicuity, hepatic metastases, vascular encasement by tumor, and presence of lymphadenopathy. RESULTS: Overall, tumor conspicuity was greater in the arterial phase (5/6) than in the portal venous phase (1/6) with a mean tumor/normal pancreas attenuation difference of 31.8 HU in the arterial phase compared with 19.2 HU in the portal venous phase. The arterial phase detected a total of 17 liver metastases compared with 9 seen in the portal phase. Lymph node enlargement was noted in three patients, which, although visible in both phases, was more easily discernible in the arterial phase. Venous encasement by tumor was better evaluated on the delayed portal venous phase than the arterial phase. CONCLUSION: Dual-phase helical CT scanning leads to improvement in the detection and staging of NFITs.

Adult↗
PubMedDate not supplied

CT features of an intraductal polypoid mass: Differentiation between hepatocellular carcinoma with bile duct tumor invasion and intraductal papillary cholangiocarcinoma.

OBJECTIVE: To determine the CT features capable of differentiating hepatocellular carcinoma (HCC) with bile duct tumor invasion (BDTI) from intraductal cholangiocarcinoma (IDCC). METHODS: Multiphasic CT images of 14 patients with HCC with BDTI and 18 patients with IDCC were retrospectively reviewed. Analysis of the CT findings included the size, location, and margin of the intraductal mass, the enhancement pattern of intraductal lesions, degree of ductal dilatation, presence of downstream ductal dilatation and ductal wall thickening, presence of parenchymal mass and its size, continuity of parenchymal mass with intraductal mass, and liver cirrhosis. Objective evaluation of the enhancement patterns of intraductal tumors was done by measuring the CT attenuation coefficients of the tumors and the uninvolved hepatic parenchyma in each phase. Among these findings, statistically significant variables were then determined using Fisher exact test or Mann-Whitney test. RESULTS: Significant variables that helped differentiating HCC with BDTI from IDCC included the presence of parenchymal mass, liver cirrhosis, and the hyperattenuating intraductal tumor on the hepatic arterial phase (HAP). On unenhanced images, the tumor-to-liver contrast of IDCC (16.7 +/- 8.1) was greater than that of HCC with BDTI (6.4 +/- 10.4), but on HAP, that of HCC with BDTI (26.5 +/- 28.2) was greater than that of IDCC (5.9 +/- 18.7) (P < 0.05). In addition, there was a significant difference in the enhancement ratio of the intraductal tumors on portal venous phase (PVP) between the 2 conditions (P = 0.003). CONCLUSIONS: Several objective and subjective multiphasic CT findings may help differentiating HCC with BDTI from IDCC.

Adult↗
PubMed1999

Avascular necrosis of the femoral head after intertrochanteric fractures.

OBJECTIVE: To determine factors that may influence the appearance of avascular necrosis after intertrochanteric fractures. DESIGN: Retrospective. SETTING: University hospital. PATIENTS: Twelve patients between the ages of fifty-nine and eighty-eight who had developed avascular necrosis of the femoral head after treatment of an intertrochanteric femur fracture at our institution between 1976 and 1995. Fractures were classified according to Kyle and Gustilo. There were three Type I, two Type II, six Type III, and one Type IV fractures. MAIN OUTCOME MEASURES: Risk factors for osteonecrosis, fracture pattern, surgical influence, location of the nail within the femoral head, and valgus malalignment. RESULTS: All fractures healed. Five patients had risk factors for osteonecrosis. Intertrochanteric fractures with a proximal fracture line appeared in five patients. The nail tip was situated in every quadrant of the femoral head. Valgus malalignment occurred in three cases. CONCLUSIONS: Avascular necrosis of the femoral head is an uncommon complication after intertrochanteric fractures. The pathogenesis is unknown, but in patients developing pain who have had intertrochanteric fractures, osteonecrosis should be included in the differential diagnosis, especially in cases with risk factors for osteonecrosis or a proximal intertrochanteric fracture line that perhaps disrupts the vascular anastomotic ring at the base of the femoral neck.

Aged↗
PubMed1994

Risk of subsequent cardiac events in stable convalescing patients after first non-Q-wave and Q-wave myocardial infarction: the limited role of non-invasive testing. The Multicenter Myocardial Ischemia Research Group.

BACKGROUND: Patients recovering from myocardial infarction are frequently evaluated by non-invasive tests for evidence of myocardial ischemia before returning to work or full activity. The purpose of this study was to evaluate the prognostic significance of clinical and non-invasive ischemic test variables assessed in 549 stable, convalescing patients (median 2 months) after their first Q-wave (n = 363) and non-Q-wave (n = 186) myocardial infarction. METHODS: The ischemic tests performed were resting ECG, exercise ECG, ambulatory ECG, and stress thallium scintigraphy. RESULTS: Cardiac events (unstable angina requiring hospitalization, non-fatal reinfarction, or death from cardiac causes) were observed during a mean 23-month follow-up in 57 patients (15.7%) with Q-wave and in 31 of patients (16.7%) with non-Q-wave infarction. In a step-wise Cox regression model, the only significant independent predictors of subsequent cardiac events (P < 0.001) were post-infarction angina and insulin-dependent diabetes mellitus. The type of infarction did not make a significant contribution to the risk of cardiac events (P = 0.29). However, an interaction between infarct type and post-infarction angina was of borderline significance (P = 0.065), with angina associated with more cardiac events in patients with non-Q-wave than in those with Q-wave infarction. None of the ischemic tests contributed significantly to the Cox model in predicting cardiac events in either infarct type. CONCLUSION: Stable convalescing patients who have recovered from first Q-wave and non-Q-wave myocardial infarction have similar long-term prognoses. The occurrence of post-infarction angina is associated with increased risk of cardiac events in patients with both infarct types, with more marked effect in non-Q-wave than Q-wave infarctions. Ischemia detected by non-invasive tests performed in the convalescing phase after myocardial infarction was not prognostically useful in either infarct type.

Convalescence↗
PubMed2000

Procalcitonin and proinflammatory cytokine interactions in sepsis.

Immunoneutralization of procalcitonin (ProCT), a putative mediator of sepsis, has been shown to increase survival in an animal model of sepsis. To better understand the role that ProCT plays in the sepsis cascade, we studied the relationship of this hormone to the proximal proinflammatory mediators, IL-1beta and TNFalpha. Hamsters were made septic by i.p. implantation of Escherichia coli-impregnated agar pellets. A time line study of serum IL-beta, TNFalpha, and ProCT levels showed that the increase in the cytokines was transient and less than 2-fold over baseline, whereas ProCT increased >100-fold by 12 h and remains elevated through 24 h. TNFalpha (400 microg/kg) was injected into healthy animals, inducing an elevation in ProCT that was 25-fold greater than controls. ProCT (30 microg/kg) was given to healthy and septic animals. In healthy animals, there was no significant elevation in serum IL-1beta or TNFalpha levels. In septic animals, IL-1beta was modestly blunted at 3 h but not at 12 h, and there was no change in TNFalpha levels. ProCT did not initiate or enhance IL-1beta or TNFalpha expression; however, the massive and sustained elevation of this hormone seen in sepsis can be induced by the proximal cytokine, TNFalpha. This study suggests that ProCT is a secondary mediator that might augment and amplify but does not initiate the septic response. Immunoneutralization of ProCT may prove to be an important clinical strategy, in view of its sustained elevation and the difficulty in initiating therapy for sepsis during the early phases of illness.

Animals↗
PubMed2002

A practical, comprehensive classification for pediatric myelodysplastic syndromes: the CCC system.

PURPOSE: Pediatric myelodysplastic syndromes (MDS) are biologically diverse. The French-American-British (FAB) classification of adult forms of MDS is not always applicable because many pediatric patients do not fit into any of the categories. To circumvent the FAB schema and other flawed formats, the authors developed a practical classification system for childhood MDS. PATIENTS AND METHODS: The authors analyzed 40 children with MDS diagnosed in Toronto between 1988 and 1998 to test the utility of the classification. Children were classified according to three main features: category, cytology, and cytogenetics. RESULTS: Using this system the authors were able to classify all 40 patients; about half could not be classified by FAB. Patients could also be longitudinally classified by serial analysis to show progression of disease. Juvenile myelomonocytic leukemia was excluded because of its known myeloproliferative pathogenesis. Chronic myelomonocytic leukemia, which almost never occurs in children, was also omitted. Also excluded were other chronic myeloproliferative disorders and any cytopenias without malignant potential. CONCLUSIONS: Based on these data, the CCC system appears to have prognostic potential; children with advanced class and cytogenetic abnormalities had a poorer outcome. The authors urge international adoption of this system for uniformity in clinical practice and reporting purposes.

Adolescent↗
PubMedDate not supplied

Essentials for effective communication in oncology nursing: assertiveness, conflict management, delegation, and motivation.

The ability to communicate effectively with a multidisciplinary team in an assertive manner to resolve conflict, motivate others, and delegate tasks is a prerequisite skill to promote a harmonious work environment. Acquisition of this skill is often a combination of inherent attributes and learned experiences. This article describes a program on assertiveness, conflict resolution, motivation of others, and delegation. Nurses are encouraged to seek expertise from other departments (e.g., Human Resources) to help them develop similar programs.

Ambulatory Care↗
PubMed1994

Extracellular domain of pemphigus vulgaris antigen (desmoglein 3) mediates weak homophilic adhesion.

Pemphigus vulgaris antigen is in the cadherin supergene family. We hypothesized that the extracellular domain of pemphigus vulgaris antigen might mediate homophilic cell adhesion because 1) the originally described cadherins (e.g., E-cadherin) mediate this type of adhesion, 2) pemphigus vulgaris antigen is localized in desmosomes that are cell adhesion junctions, and 3) autoantibodies in pemphigus vulgaris patients cause loss of cell adhesion. To test this hypothesis we used a system developed for E-cadherin that, when transfected into L cells (mouse fibroblasts), has been shown to cause aggregation. Because this aggregation requires the cytoplasmic domain of E-cadherin to bind to catenins, we made a chimeric cDNA construct that encodes the extracellular domain of pemphigus vulgaris antigen and the cytoplasmic domain of E-cadherin. Analysis by immunofluorescence and flow cytometry with pemphigus vulgaris sera indicated that the pemphigus vulgaris antigen extracellular domain of this chimeric molecule (PVEC) was expressed on the cell surface of transiently transfected cells and permanently transfected L-cell clones. Immunoprecipitation of the chimeric molecule from extracts of these clones showed that the E-cadherin cytoplasmic domain bound catenins. Surprisingly, these L-cell clones displayed only slight aggregation compared to an L-cell clone transfected with E-cadherin. This weak aggregation was, however, specific and homophilic, as determined by cell sorting of only PVEC transfectants into aggregates from mixtures of PVEC and neomycin resistance gene transfectants, one of which was labeled with a fluorescent dye. We conclude that the extracellular domain of pemphigus vulgaris antigen mediates weak homophilic adhesion and is not interchangeable in function with the extracellular domain of E-cadherin.

Animals↗
PubMed1993

Intermittent thiopentone for teaching fibreoptic nasotracheal intubation.

A technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubating fibrescope. During endoscopy patients spontaneously breathed oxygen-enriched air and passage of the tracheal tube was facilitated by suxamethonium. Arterial blood pressure, heart rate and arterial oxygen saturation were monitored continuously. Time from loss of eyelash reflex to successful intubation was 113 (90) (35-480) s (mean (SD) (range)). Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients; the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.

Adolescent↗
PubMed2005

Optimization of biometry for intraocular lens implantation using the Zeiss IOLMaster.

PURPOSE: To compare the accuracy of biometry using conventional A-scan ultrasonography and partial coherence interferometry, and to improve the accuracy of biometry by sequential audit of postoperative refractive error. METHODS: The study was performed in three phases. In phase 1, 20 consecutive patients undergoing routine phacoemulsification underwent biometry using both A-scan ultrasonography and the Zeiss IOLMaster (ZIOLM). A single experienced optometrist refracted all patients 2 weeks after surgery. The errors between expected and achieved refraction were calculated and compared between the two methods. In phases 2 and 3, a further 22 and 20 patients, respectively, were recruited and only the ZIOLM was used for biometry. The manufacturer's suggested A-constant was refined and the error between expected and achieved refraction was calculated. RESULTS: In phase 1, the median unexpected error for the ZIOLM was +0.63 (interquartile range +0.368 to +1.015) and for A-scan biometry was - 0.24 (interquartile range - 1.335 to +0.802). In phase 1 65% of patients' postoperative refractions were found to be within 1.0 D of emmetropia using the ZIOLM (55% using A-scan biometry). Refinements to the A-constant improved this to 95% by phase 3. CONCLUSION: An error was identified in IOL power estimation with the ZIOLM, when using the manufacturer's recommended A-constant (recommended and previously optimized ultrasound A-constant 118.0; ZIOLM optimized A-constant 118.6). Serial modifications to the A-constant were successful in reducing the unexpected error to well within the tolerance limits of published international standards.

Adolescent↗