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PubMed2002

Axons and glial interfaces: ultrastructural studies.

At most vertebrate nerve transitional zones (TZs) there is a glial barrier which is pierced by axons passing between the CNS and PNS. Myelinated axons traverse this in individual tunnels. The same is true of larger non-myelinated axons. This holds widely among the vertebrates, for example, the large motor axons of the sea-lamprey Petromyzon (which also possess TZ specializations not found in mammals). Smaller non-myelinated axons traverse the TZ glial tunnels as fascicles and so the barriers are correspondingly less comprehensive for them. Accordingly, in nerves composed of non-myelinated axons, such as the vomeronasal or the olfactory, a TZ barrier stretching across the nerve is effectivelyabsent. The chordateAmphioxus differsfrom the vertebrates in lacking a TZ barrier throughout. Invertebrates also lack glial barriers at the TZs between ganglia and interconnecting nerve trunks. The glial barrier at the dorsal spinal root TZ (DRTZ) has considerable value for analysing protocols aimed at achieving CNS regeneration, because it provides a useful model of the gliotic reaction at sites of CNS injury. Also, it is especially amenable to morphometric analysis, and so enables objective quantification of different protocols. Being adjacent to the subarachnoid space, it is accessible for experimental intervention. The DRTZ was used to investigate the value of neurotrophin 3 (NT3) in promoting axon regeneration across the TZ barrier and into the CNS following dorsal root crush. It promoted extensive regeneration and vigorous non-myelinated axonal ensheathment. On average, around 40% of regenerating axons grew across the interface, compared with virtually none in its absence. These may have traversed the interface through loci occupied by axons prior to degeneration. Many regenerating axons became myelinated, both centrally and peripherally.

Animals↗

PubMedDate not supplied

[Field epidemiology and social epidemiology].

Comparing field epidemiology and social epidemiology, we pretend to think about the no explicit images and meanings operating in both necessary convergent fields, about the obstacles present in epidemiological practice to fulfil its social function and about the necessity of changing epistemological, methodological and practice grounds, beginning with field epidemiologists teaching programmes. Field epidemiology would tend to act in an absent theoretical frame. On the other hand, social epidemiology would tend to prioritize theoretical developments (thinking and research about social determinants) without correspondent action, because of the limits to change public policies. Other differences are found at intervention level (micro-macrospace), its aim (outbreak control vs. inequalities control) and the way to communicate with society. They are similar in the methodological concern, the predominance of orientation based on positivism and framed through statistic methods, but in process of epistemological opening, the stress experienced between the alternative relationship to a virtual world of data bases or to the real society, their peripherical situation in relation of the political, social, institutional and professional system and the tendency to professional frustration. Finally, we ask ten questions to the field epidemiologists related with their present practice, in order to consider if they are developing social epidemiology, and propose some changes in epidemiologist teaching and practice.

Epidemiology↗

PubMed2000

Allergic bronchopulmonary aspergillosis in the asthma clinic. A prospective evaluation of CT in the diagnostic algorithm.

OBJECTIVE: Allergic bronchopulmonary aspergillosis (ABPA) occurs in cases of atopic asthma and may result in important lung disease. Early diagnosis is essential as this disease is responsive to steroids. However, while asthma is common, ABPA is infrequently diagnosed. CT allows precision in the diagnosis of central bronchiectasis (which is virtually pathognomonic of ABPA) and may enable earlier diagnosis. DESIGN: A prospective evaluation of 255 patients with asthma for ABPA, using skin prick testing (SPT) for Aspergillus fumigatus (AF) as a screening tool and incorporating CT into the diagnostic algorithm. SETTING: Asthma clinic, Green Lane Hospital, Auckland, New Zealand. PARTICIPANTS: Patients with asthma. INTERVENTIONS: ABPA was diagnosed using "essential" criteria (ie, asthma, SPT positivity to AF, elevated serum total IgE, elevated serum AF-specific IgE, and pulmonary infiltrates seen on chest radiography or central bronchiectasis seen on CT scan) and "minimal essential" criteria (ie, asthma, SPT positivity, and central bronchiectasis). MEASUREMENTS AND RESULTS: Two hundred fifty-five consecutive patients with asthma who consented to SPT were studied: 218 of 255 patients (86.8%) were atopic; and 47 of 255 patients (21.6%) were AF-positive, of whom 35 accepted further evaluation including CT scanning. A secure diagnosis of ABPA, satisfying all essential criteria, was evident in 9 of 35 patients (25.7%), a proportion that increased to 13 of 35 patients (37.1%) by using the minimal essential diagnostic criteria. CONCLUSIONS: SPT positivity to AF was present in approximately 20% of patients in the asthma clinic. A diagnosis of ABPA is disclosed by CT in 25 to 40% of SPT-positive patients, depending on the selection of diagnostic criteria. These findings support the use of SPT as a screening tool in the asthma clinic and indicate that a routine CT scan is warranted in SPT-positive patients.

Adult↗

PubMed2004

Use of incident reports by physicians and nurses to document medical errors in pediatric patients.

OBJECTIVES: To describe the proportion and types of medical errors that are stated to be reported via incident report systems by physicians and nurses who care for pediatric patients and to determine attitudes about potential interventions for increasing error reports. METHODS: A survey on use of incident reports to document medical errors was sent to a random sample of 200 physicians and nurses at a large children's hospital. Items on the survey included proportion of medical errors that were reported, reasons for underreporting medical errors, and attitudes about potential interventions for increasing error reports. In addition, the survey contained scenarios about hypothetical medical errors; the physicians and nurses were asked how likely they were to report each of the events described. Differences in use of incident reports for documenting medical errors between nurses and physicians were assessed with chi(2) tests. Logistic regression was used to determine the association between health care profession type and likelihood of reporting medical errors. RESULTS: A total of 140 surveys were returned, including 74 from physicians and 66 by nurses. Overall, 34.8% of respondents indicated that they had reported <20% of their perceived medical errors in the previous 12 months, and 32.6% had reported <40% of perceived errors committed by colleagues. After controlling for potentially confounding variables, nurses were significantly more likely to report >or=80% of their own medical errors than physicians (odds ratio: 2.8; 95% confidence interval: 1.3-6.0). Commonly listed reasons for underreporting included lack of certainty about what is considered an error (indicated by 40.7% of respondents) and concerns about implicating others (37%). Potential interventions that would lead to increased reporting included education about which errors should be reported (listed by 65.4% of respondents), feedback on a regular basis about the errors reported (63.8%) and about individual events (51.2%), evidence of system changes because of reports of errors (55.4%), and an electronic format for reports (44.9%). Although virtually all respondents would likely report a 10-fold overdose of morphine leading to respiratory depression in a child, only 31.7% would report an event in which a supply of breast milk is inadvertently connected to a venous catheter but is discovered before any breast milk goes into the catheter. CONCLUSIONS: Medical errors in pediatric patients are significantly underreported in incident report systems, particularly by physicians. Some types of errors are less likely to be reported than others. Information in incident reports is not a representative sample of errors committed in a children's hospital. Specific changes in the incident report system could lead to more reporting by physicians and nurses who care for pediatric patients.

Attitude of Health Personnel↗

PubMed2001

Mucormycoses.

Over recent years the clinical importance of mucormycosis has significantly increased. Most frequently mucormycosis occurs in neutropenic patients with haematological diseases. It is caused by fungi of the order Mucorales. The clinical patterns of the disease produced by different genera or species of Mucorales are virtually identical. Rhizopus, Absidia, Rhizomucor and Mucor are the organisms most commonly isolated from patients who suffer from mucormycosis. Diagnosis of mucormycosis is difficult as it is based on culture methods or microscopy of clinical specimens. The diagnosis is often only made after a delay or even post-mortem. Therapy includes surgical intervention if possible and is based on systemic amphotericin B (conventional or liposomal).

Amphotericin B↗

PubMed1985

Psychosocial factors for failure to adapt to dental prostheses.

Currently, the best approach to the care and treatment of the patient with phantom bite lies in the dentist's familiarity with the signs and symptoms of these syndromes. This is especially important for those dentists interested in the practice of prosthetic dentistry. The patient with phantom bite presents problems for which there are no conventional solutions. This situation is not an isolated phenomenon for dentistry. Rapid and major advances in dental technology and public health programs during the last few decades have radically changed the character of the patient population. Interventions have become more effective and thus more contributive to a larger chronic dental population. Fewer persons lose their teeth. Palliation has become an alternative to the edentate state. Prolongation of the dentition has created need for the more complex treatments. These resulting interventions have also increased the number of organic, psychogenic, sociogenic, and iatrogenic complaints. Many of these complaints are not curable but nor are they terminal with regard to the dentition. For these chronic patient groups, dentistry has become an illness maintenance system. Thus, treatment intervention must begin to be viewed within the context of the ever-increasing complexity of technologic advances. In many cases, prolonged dental intervention and palliation result in the emergence of symptoms secondary to treatment. These secondary symptoms or "side effects" are sometimes more destructive than the disease the treatment was intended to palliate. Treatment, although frequently helpful, can, under certain circumstances, harm the patient. Phantom bite may be a metaphor for such a circumstance, as virtually all treatments promote the illness. Nowhere in the practice of dentistry is the advice of Szasz more relevant: "Don't just do something, stand there!"

Adaptation, Psychological↗

PubMed1996

Trends in vascular surgery--an evaluation of operative activity in Finland 1976-1992.

To evaluate trends in vascular surgical activity in Finland, data were gathered from cross-sectional questionnaire surveys during three separate years. The material consisted of 1,658 (1976) and 4,887 (1992) procedures in Finland, and 1,039 (1988) and 1,212 (1992) in the Tampere region. In 1976 there was an annual mean of 350 vascular reconstructions per one million inhabitants, 660 in 1992, and 967 if also endovascular revascularisations were included. Sympathectomy was virtually vanished by 1992, thromboembolectomies clearly decreasing, carotid, aortic aneurysm and femorodistal surgery increasing and endovascular surgery emerging as a new major force, comprising of one third of all vascular activity. Vascular surgical activity appears to be strongly increasing, but the treatment pattern has markedly changed towards well-targeted endovascular and vascular interventions with a decreasing number of emergency operations and ill defined procedures like sympathectomies.

Cross-Sectional Studies↗

PubMed1997

On the Way to New Horizons: Telemedicine in Oncology.

Breathtaking insights into carcinogenesis and tumor biology have been gained mainly by recent technical advances in molecular-biological and genetic techniques. Thus, dimensions of earlier diagnosis and the development of new concepts in therapy arise, which were previously unavailable. There is no doubt that through these techniques the future role and tasks of surgical oncology will change. New indications will result, for example, in the context of prophylactic therapy of hereditary malignant disease or the removal of tissue predisposed to tumors. However, modes of therapy orientated toward molecular biology will still be dependent on specialist surgical interventions in the future. Examples are such innovative concepts of therapy as transport of a therapeutic device to or into tumor cells (e.g., gene gun), or even simply obtaining the necessary tumor tissue for therapy (vaccination with transfected autologous tumor cells). Therefore, the future of surgical oncology will be influenced quantitatively as well as conceptually by new qualitative requirements. Improving precision of the surgical intervention will have to go hand-in-hand with a further reduction in surgical trauma. The consistent use of laser, video, computer and communication technology can be seen as an important predeterminant here for optimizing diagnostic and therapeutic procedures. If correctly guided, the professional experience of the individual surgeon and his personal efficiency can also be positively influenced by the swift conversion of society to multimedia and information technology. Major advances in interdisciplinary communication, as one important factor in the choice and the course of suitable complex therapies in oncology, will have to target and help to overcome former weak spots. Communication in and outside one department or hospital, as well as external communication between different medical disciplines and specialists, is being developed further and increasingly refined. The possibilities of modern technology in addition to verbal exchange include visual and interactive "tele"-communication. This renders a new option to the physician, as without direct patient contact he is able to observe, counsel and actively interact - the latter even more so in the future. In oncology the increase of knowledge thus far has gone hand-in-hand with further specialization. This explains the difficulties one encounters in the correct evaluation of relevant data of one specific patient. Telemedicine will help to focus on the advantages of specialist knowledge by rendering access to all available data. These possibilities should furthermore be accessible during a consultation, an examination or in the course of a surgical intervention. Real-time modalities are referred to as telepresence and exceed by far a mere electronic version of the patient's medical folder. Especially in oncology, interdisciplinary collaboration is immensely important for successful therapy. Preoperative diagnostic data are still to be evaluated according to the intraoperative findings. At this decisive moment, it is necessary to involve specialists of other oncological disciplines. Real-time communication devices have to be present in order to transfer image data and clinical observations and ensure the best possible transmission quality to resident and geographically distant experts. With further technological perfection and widespread availability of interactive consultation, other applications include the "second opinion" in the daily routine. Another fascinating option in oncology is offered by visual computer simulation in virtual reality (VR). Medical data are visualized according to the human perception by the means of scenic simulation. From that point of view, VR technologies represent a practicable user interface between computer technology and the individual human being. Through VR, three-dimensional worlds containing virtual objects, which consist of computer-generated data, are created, which the user may explore and liberally interact with. The perfect simulation of realistic settings offers a method of training that may be extended to the field of oncology, as it has been known for a comparatively long period of time from flight simulators in space and air technology. In contrast, medical training is currently achieved mainly by "training-on-the-job." There is well-proven and widely acknowledged certainty of the tremendous influence that the number of surgical interventions-in other words, the training skills of the surgeon-has on the success of a diagnostic or therapeutic intervention. Previously, the subjective experience of the physician acquired from earlier cases determined his efficiency to a large extent. It was, in addition, influenced essentially by perception, "performance on the day" and personal attitude. The goal must be to strengthen the objective criteria as the basis for consistent decision-making processes and clear instructions for therapy. Strict quality management as practiced in air technology has clearly led to a reduction in accidents, and, accordingly, a similar effect is imaginable in oncology with continuous training using VR simulators, leading to improved therapeutic outcome. Other possibilities for use are principally implied and similarly useful for medical school and postgraduate training. The idea of computer-guided medical procedures or medical robots is therefore no longer a mere utopia. Telepresence, telerobotic and VR techniques should, in principle, effectively support the physician in diagnostic processes and therapy. The responsibility for coordination and sensible use of new technological developments will still remain with the physician, such as improving and simplifying medical procedures. Technology should be used according to the situation, not to adapt the patient to a technocratic environment, but to emphasize human treatment of the individual patient. From the opinion of the telephone being a futile technical invention to the other extreme of computed technology as a substitute for the physician (Dr. Cyber), the future role of telemedical techniques and their potential for medical advantage or support, especially in the field of oncology, should be critically viewed and evaluated.

Journal Article↗

PubMedDate not supplied

Reduction of neural damage in irreversible cerebral ischemia by calcium antagonists.

Because of the complexity and cost of clinical investigations and the virtual lack of pharmacological leads, drugs for the treatment of strokes have to be tested extensively in animal models closely mimicking the human disorder. With the recent introduction of in vivo NMR imaging (MRI) and spectroscopy (MRS), it is now possible to evaluate the consequences of strokes and to monitor the effects of therapeutic interventions in animals with the same methodology as in humans. The appearance and evolution of brain infarcts in spontaneously hypertensive rats (SHR), after occlusion of the middle cerebral artery (MCA), were detected with MRI. In coronal sections through the rat brain, regions with increased MRI signal started to become discernible after 6 h and turned out to be largely necrotic already after 24 h, as revealed by histology. The location (fronto-parietal cortex, caudate-putamen) and total infarct size, as determined from MR images or histology, were highly reproducible. Posttreatment with the dihydropyridine calcium antagonist isradipine (PN 200-110), at a daily dose of 3 X 0.3 mg/kg sc, reduced the total infarct size by 30-40%, determined by quantitative MRI and confirmed by histology. Biochemical markers of necrosis, such as the increased brain wet wt, the levels of sodium, potassium, dopamine, and noradrenaline, were changed toward normal values. The functional consequences of these morphological effects of isradipine were reflected by the parallel improvement of a neurological score. Follow-up observations made by MRI and histology indicated that the morphological differences between treated and control animals were still present to the same extent after 2 wk and, therefore, seem to be permanent. In order to elucidate the putative mechanisms involved, the influence of calcium antagonists on cerebral blood flow (CBF) and high energy phosphates (HEPs) was investigated. CBF was measured quantitatively with [14C] iodoantipyrine in MCA-occluded SHRs. Although isradipine had no effect on CBF in the contralateral hemisphere, at a dose reducing infarct size, it increased the reduced blood flow in the lesioned hemisphere toward normal values. HEPs (PCr and ATP) as well as inorganic phosphate (Pi) and intracellular pH were measured noninvasively in the rat brain by 31P MRS using a surface coil. Under normal conditions, calcium antagonists had no effect on these parameters.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2002

Interventional radiology.

PURPOSE OF REVIEW: The capabilities of interventional radiology are developing faster than perhaps any other branch of medicine. Coupled with and fuelled by parallel advances in computer technology, medical physics and developments in endovascular catheter technology, interventional radiologists are innovating not only replacements for open surgeries, but entirely new therapies as well. This has, however, provided a range of new potential complications for the patient and, in contrast to other areas, presents risks for the anesthesiologist as well. RECENT FINDINGS: The techniques involved in interventional radiology have found applications throughout not only medicine but surgery in particular. Here there has been a medicalization of surgical procedures. CT scanning has evolved to the extent that it is now possible to utilize multislice CT scanners, ones with multiple, flat panel digital detectors, to provide real time CT fluoroscopy. Similarly this technology has facilitated the construction of hybrid iMR/X-ray systems, thus enabling dual modality imaging without moving the patient. Another facet of the new breed of iMR systems is their integration in real time with computerized, frameless stereotactic navigation systems. This has enabled the radiological image to keep pace with the changes in anatomy consequent to anesthetic and surgical manipulations. SUMMARY: In the light of these new developments in interventional radiology there is much research to be done. Further developments in imaging and computer processing technology will doubtless make possible the real time integration of anatomical image with metabolic state and functional anatomy. The impact of the hazards of these new techniques on the safety of anesthesia has, however, been the subject of virtually no research. A particularly needy area will be the ergonomics of the delivery of anesthesia care in these new environments.

Journal Article↗

PubMed2006

Silymarin protects against acute ethanol-induced hepatotoxicity in mice.

BACKGROUND: Accumulated evidence has demonstrated that both oxidative stress and abnormal cytokine production, especially tumor necrosis factor-alpha (TNF), play important etiological roles in the pathogenesis of alcoholic liver disease (ALD). Agents that have both antioxidant and anti-inflammation properties, particularly anti-TNF production, represent promising therapeutic interventions for ALD. We investigated the effects and the possible mechanism(s) of silymarin on liver injury induced by acute ethanol (EtOH) administration. METHODS: Nine-week-old mice were divided into 4 groups, control, silymarin treatment, EtOH treatment, and silymarin/EtOH treatment, with 6 mice in each group. Because control and silymarin values were virtually identical, only control treatment is shown for ease of viewing. Ethanol-treated mice received EtOH [5 g/kg body weight (BW)] by gavage every 12 hours for a total of 3 doses. Control mice received an isocalorical maltose solution. In the silymarin/EtOH group, silymarin was dissolved in the EtOH and gavaged simultaneously with EtOH at a dose of 200 mg/kg BW. At 4 hours after the last dosing, the mice were anesthetized and subsequent serum alanine aminotransferase (ALT) level, hepatic lipid peroxidation, enzymatic activity of hepatic cytochrome P450 2E1, hepatic TNF-alpha, and glutathione (GSH) levels were measured. Histopathological change was assessed by hematoxylin and eosin staining. RESULTS: Acute EtOH administration caused prominent hepatic microvesicular steatosis with mild necrosis and an elevation of serum ALT activity, induced a significant decrease in hepatic GSH in conjunction with enhanced lipid peroxidation, and increased hepatic TNF production. Supplementation with a standardized silymarin attenuated these adverse changes induced by acute EtOH administration. CONCLUSIONS: Silymarin protects against the liver injury caused by acute EtOH administration. In view of its nontoxic nature, it may be developed as an effective therapeutic agent for alcohol-induced liver disease by its antioxidative stress and anti-inflammatory features.

Alanine Transaminase↗

PubMed2005

Transbronchial biopsy using endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation.

STUDY OBJECTIVES: We evaluated the feasibility, safety, and efficacy of transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS) and virtual bronchoscopy (VB) navigation for small peripheral pulmonary lesions < or = 30 mm in diameter. DESIGN: Pilot study. SETTING: A national university hospital. PATIENTS: We performed TBB using EBUS-GS with VB navigation for 29 patients with 30 small peripheral pulmonary lesions (average diameter, 18.6 mm) between January 1, 2004, and August 31, 2004. INTERVENTIONS: VB images were reconstructed from helical CT data. TBB was then performed using EBUS-GS with VB navigation. RESULTS: In all patients, TBB was performed safely with no complications. Bronchi seen on VB imaging were highly consistent with the actual structures confirmed using fiberoptic bronchoscopy. Following VB navigation, the endobronchial ultrasonography (EBUS) probe was inserted into third- to sixth-generation bronchi. Twenty-four lesions (80%) were visualized on EBUS images. Average durations of the initial EBUS examination of lesions, first biopsy, and the total procedure were 9.56 min, 11.99 min, and 25.72 min, respectively. Nineteen lesions (63.3%) were diagnosed from histopathologic or cytologic examination. Diagnostic sensitivities were 44.4% (8 of 18) for lesions < 20 mm in mean diameter and 91.7% (11 of 12) for lesions 20 to 30 mm in mean diameter. CONCLUSIONS: In summary, TBB using EBUS-GS with VB navigation was safely performed and was effective in diagnosing small peripheral pulmonary lesions.

Adult↗

PubMed2006

A virtual bronchoscopic navigation system for pulmonary peripheral lesions.

STUDY OBJECTIVES: We performed ultrathin bronchoscopy for pulmonary peripheral lesions using a system that displays virtual bronchoscopy (VB) images to the lesion simultaneously with actual images and navigates the bronchoscope to the target bronchus. We then evaluated the system with regard to its usefulness and problems. DESIGN: A pilot study. SETTING: A tertiary teaching hospital. PATIENTS: The subjects were consecutive patients with small pulmonary peripheral lesions (< or = 30 mm). INTERVENTIONS: Using this system, the rotation, advancement, and retreat of VB images were possible, and the bronchus into which the bronchoscope was to be advanced was displayed. VB images were displayed along with actual images, and the ultrathin bronchoscope was advanced to the target bronchus under direct vision. Under CT and radiographic fluoroscopy, a pair of forceps was inserted into the lesion via the bronchoscope. Thin-section CT images were obtained; after confirming the advancement of the bronchoscope into the target bronchus and the arrival of the forceps at the lesion, a biopsy was performed. RESULTS: Study subjects included 37 patients with 38 lesions. VB images to a median of the sixth- (third- to ninth-) order bronchi could be produced. Using this system, the ultrathin bronchoscope could be advanced into the planned route for 36 of the 38 lesions (94.7%). The system was used for a median of 2.6 min, and the median examination time was 24.9 min. The biopsy forceps could be advanced to the lesion in 33 of the 38 lesions (86.8%), and diagnosis was possible for 31 lesions (81.6%). CONCLUSIONS: This navigation system is useful for ultrathin bronchoscopy for pulmonary peripheral lesions.

Adult↗

PubMed2007

Drug-induced musculoskeletal disorders.

Drug-induced musculoskeletal disorders represent a broad clinical spectrum, from asymptomatic biological abnormalities to severe and even life-threatening diseases. Since an increasing number of drugs have been implicated in inducing rheumatic symptoms and/or syndromes, this review is not meant to be exhaustive, bearing in mind that the development of any musculoskeletal disorder should be considered as possibly related to a medication. The purpose of this article is to provide an overview of the more frequent drug-induced musculoskeletal disorders. These include: (i) arthralgias and arthropathies, including chondropathies and inflammatory arthritis; (ii) connective tissue diseases, especially lupus-like syndromes; (iii) periarticular disorders, including tendinopathies, enthesopathies and frozen shoulder; (iii) bone diseases, such as osteoporosis, osteomalacia and osteonecrosis; and (iv) myopathies. Although virtually all drug classes may induce musculoskeletal disorders, a significant part of them are related to corticosteroids, vaccines, antibacterials and lipid-lowering agents. Knowledge of drug-induced musculoskeletal disorders avoids carrying out unnecessary investigations, and allows optimal management of the patients, i.e. early discontinuation of the offending agent, adequate treatment monitoring and/or intervention with appropriate preventive actions.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Myocardial substrate utilization and hemodynamics following repeated coronary flow reduction in pigs.

The effect of repeated local ischemia and reperfusion on myocardial metabolism and ventricular performance was studied in 12 open-chested pigs fasted overnight. Myocardial ischemia was induced by reduction of the flow in the left anterior descending coronary artery to 40% of control during 30 min. After 35 min of reperfusion a second 30-min occlusion period was started, again followed by a 35-min reperfusion period. At the end of both reperfusion periods coronary flow and coronary resistance had returned to control values. During control there was lactate uptake, but no significant uptake of glucose, free fatty acids (FFA), triglycerdies, glycerol and inosine. During the first occlusion period the heart released lactate and inosine, and used glucose and FFA. At the end of the first reperfusion period lactate uptake approached control values, but inosine was still released by 10 of the 12 animals. In the second ischemic period, glucose and FFA were again taken up. Lactate and inosine were released, but the production was much smaller than during the first occlusion period. Depletion of myocardial glycogen and high-energy phosphates could be responsible for this quantitatively different response. Necrosis may have played a role, although enzyme release was minimal and only observed after the second occlusion period. Heart rate, peripheral resistance and ventricular filling pressure were virtually unchanged throughout the course of the experiments. Maximum rate of fall of left ventricular pressure (min LVdP/dt) decreased during ischemia and did not recover during reperfusion. Changes in min LVdP/dt and cardiac output were more closely related than changes in max LVdP/dt and cardiac output. This model cannot be used for the study of interventions during myocardial ischemia in which the animal serves as its own control.

Animals↗

PubMed2004

Inpatient rehabilitation of patients requiring hemodialysis.

OBJECTIVE: To evaluate the outcomes of patients who require hemodialysis and are admitted to an inpatient rehabilitation unit. DESIGN: Retrospective review of the data of all admissions to an inpatient rehabilitation unit in 2001. SETTING: University medical center. PARTICIPANTS: All inpatient rehabilitation admissions in 2001 (N=531), including 497 patients who did not require hemodialysis and 34 who required hemodialysis. INTERVENTION: A comprehensive rehabilitation program including physical therapy and occupational therapy. Speech and language therapy and rehabilitation psychology were provided when necessary. MAIN OUTCOME MEASURES: Length of stay (LOS), change in total score on the FIM instrument, FIM efficiency, and place of discharge. RESULTS: Admission and discharge FIM scores of the patients requiring hemodialysis were virtually identical to those of the other patients admitted to the unit. The average LOS of the hemodialysis patients was 5.4 days longer than that of the other patients, and, therefore, efficiency scores of the dialysis group were less than those of the other patients. The rate of discharge to the community did not differ significantly for the dialysis group. CONCLUSIONS: Patients who require hemodialysis can benefit from rehabilitation services. Their improvement on the FIM instrument is comparable to that of other patients, but their LOS may be longer than that of other patients.

Aged↗

PubMed1996

Expandable versus conventional esophageal prostheses: easier insertion may not preclude subsequent stent-related problems.

BACKGROUND: Although expandable esophageal endoprostheses may be easier to insert and are associated with fewer procedure-related perforations, data comparing clinical results with these stents to those obtained with conventional prostheses are sparse. METHODS: We reviewed the records of all patients undergoing esophageal stent placement at our institution between October 1983 and July 1995 to define relative risks, clinical results, and need for reintervention prior to death, contrasting conventional to a variety of expandable esophageal endoprostheses. RESULTS: Over the period of review, 47 patients had conventional prostheses (CP) and 38 had expandable prostheses (EP) placed. Fifteen of 44 patients with CP and 14 of 38 with EP for malignancy also had esophago-airway fistulas. Insertion complications, prestent and poststent dysphagia scores, and complete fistula occlusion rates were comparable. Subacute complications were higher in the patients receiving EP (80%) than in those receiving CP (60%), possibly related to the prospective accumulation of data in patients receiving EP. Survival data were virtually identical and approximated 3 months for either group. CONCLUSIONS: Although both CP and EP improve dysphagia and occlude tracheoesophageal fistulae, patients ill enough to require a prosthesis do poorly regardless of prosthesis design. Moreover, although EP may be easier to insert than CP, stent- and patient-related problems persist and may require additional intervention.

Aged↗

PubMed2001

Pilot test of an Internet virtual world chat room for rural teen smokers.

OVERVIEW: This pilot study evaluated the acceptability and efficacy of an Internet-based virtual reality "world" for teen smoking cessation. Rural teens at six school sites interacted in real-time in the virtual world with a trained cessation counselor and other teen smokers over a 2-month period in seven 1-hour chat sessions. The cessation counselor used motivational interviewing, a "client-centered" nonconfrontational approach to behavior change that has shown promise with behaviors resistant to change. Smoking behavior and attitudes were assessed at baseline, after intervention, and at 1-month follow-up. Significant changes were found in quitting, amount smoked, and intentions to quit. Positive trends were seen in past-week abstinence rates, quit attempts, and attitudes toward quitting.

Adolescent↗