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PubMed2005

Sustainability of change with quality general practitioner education in adolescent health: a 5-year follow-up.

OBJECTIVE: To determine whether improvements gained in general practitioners' (GPs') self-perceived competency, attitudes and knowledge after an intervention in adolescent health care designed with evidence-based strategies in continuing medical education, are maintained longterm, 5 years post intervention. The intervention was designed with evidence-based strategies in continuing medical education. DESIGN: We carried out a follow-up postal survey of the cohort of metropolitan Australian GPs trained in the intervention 5 years previously. Measures Subsets of the original measures, used in the randomised controlled trial of the intervention, were selected to re-assess the GPs by postal survey. Self-perceived competency, attitude and knowledge were measured. Doctors were also asked about further training in adolescent health over the 5 years since the intervention and about self-reported practice. RESULTS: A total of 46 of 54 (85%) of the original intervention group returned a questionnaire. Scores at 5 years were all higher than at baseline (P < 0.01) and improvements were sustained in all measures from 12 months to 5 years after the intervention. In all, 25/46 (54%) doctors had received further training in related areas over the 5 years, but this did not improve sustainability. A total of 45/46 (98%) reported maintaining their clinical approach to youth and 22/46 (46%) reported maintaining practices to address systemic barriers to adolescent health care access. CONCLUSIONS: Quality education designed according to evidence-based strategies of effectiveness has advantages for longterm sustainability.

Adolescent↗
PubMed1999

The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma.

BACKGROUND: Splenectomy at the time of resection of esophageal, gastric, or colon cancer has been correlated with inferior longterm survival. No such effect has yet been demonstrated for pancreatic cancer. STUDY DESIGN: Patients undergoing resection of pancreatic adenocarcinoma with curative intent at Memorial Sloan-Kettering Cancer Center between October 1983 and October 1995 were identified from a prospective clinical database. The impact of splenectomy on hospital stay and survival was calculated with univariate and multivariate nonparametric methods. RESULTS: Of 332 patients undergoing pancreatectomy, 326 with confirmed local or regional disease only formed the study cohort. Of these, 37 underwent concomitant splenectomy (11.4%). Splenectomy was significantly correlated with distal or total pancreatectomy, primary location in tail or body, portal vein invasion or resection, a larger maximal tumor diameter, and an operative blood loss of greater than 2,000 mL. Death or need for reoperation was not affected by splenectomy. Patients undergoing splenectomy had a higher median transfusion requirement (3 versus 1; p = 0.002). The median postoperative length of stay was 15 days regardless of splenectomy. At a median followup of 16.3 months (36.4 months for surviving patients), the median actuarial survival was 12.2 months with splenectomy versus 17.8 months without splenectomy (p<0.005). On multivariate analysis, splenectomy emerged as an independent factor predictive of decreased postoperative survival (p = 0.02), in addition to pathologic lymph node status (p = 0.0002), tumor diameter (p = 0.0004), and tumor differentiation (p = 0.007). Tumor location within the pancreas and the type of pancreatectomy were not independent prognostic factors influencing survival. CONCLUSIONS: After pancreatectomy for pancreatic cancer, splenectomy has no significant measurable impact on postoperative recovery, but has a negative influence on longterm survival independent of disease-related factors. Unless required because of tumor proximity or invasion, splenectomy should be avoided in the operative treatment of exocrine pancreatic cancer at any location.

Adenocarcinoma↗
PubMed1995

A three year follow up of self expanding metal stents in the endoscopic palliation of longterm survivors with malignant biliary obstruction.

Effective palliation of malignant biliary obstruction with conventional 10 or 12 French gauge straight polyethylene endoprostheses is limited by stent occlusion, which typically occurs four to five months after insertion. Short term follow up studies of self expanding metal stents (Wallstent, Schneider, UK) in the treatment of patients with malignant biliary obstruction have shown that their use is associated with fewer episodes of stent occlusion compared with plastic stents. There are few data, however, on the longterm patency and durability of metal stents in malignant disease. Between May 1989 and May 1992, metal stents were inserted in 28 patients with malignant bile duct strictures secondary to ampullary tumour (n = 10), pancreatic carcinoma (n = 10), cholangiocarcinoma (n = 7), and porta hepatis nodes from colorectal carcinoma (n = 1). The follow up of these patients until May 1993 is reported with a median follow up of 14.6 months. Twenty two of 28 (78.6%) patients remained free of jaundice or cholangitis. The median period of stent patency was 8.2 months (range 1.0-32.5). Thirteen patients represented with jaundice or cholangitis and endoscopic retrograde cholangiopancreatography showed evidence of stent occlusion due to tumour ingrowth. Successful clearance of metal stents was achieved by balloon trawling, or insertion of a polyethylene stent. In conclusion, metal stents provide improved longterm palliation for patients with malignant biliary strictures with fewer episodes of occlusion compared with conventional stents.

Adult↗
PubMed2000

Adsorbed serum proteins responsible for surface dependent human macrophage behavior.

Substrate specific cellular responses are the result of a complex biological system that includes protein adsorption, receptor-ligand binding, and signal transduction. This investigation attempted to identify specific proteins adsorbed from human serum that may be responsible for the previously reported in vitro surface dependent behavior of human macrophages and foreign body giant cells (FBGCs). The adsorption of human albumin, alpha(2)-macroglobulin, complement factor 3b, fibronectin, IgG, thrombospondin, vitronectin (VN), and von Willebrand factor (vWF) from a 25% serum solution was quantified with (125)I-labeled protein. Adsorption substrates included clean glass, alkyl-silane modified glass, amino-silane modified glass, poly(ethylene oxide) (PEO)-coupled glass, and the reference biomaterials poly(etherurethane urea), Silastic(R), and poly(tetrafluoroethylene) (PTFE). Following quantification of 2-h adsorption, surfaces were treated with sodium dodecyl sulfate (SDS) and the level of adsorbed proteins remaining was quantified. The pre- and post-SDS adsorption were both compared to previously reported surface dependent in vitro macrophage and FBGC behavior on the same surfaces; however, no correlations could be made. Adsorption strength, defined as the percentage of initially adsorbed protein that remained adsorbed after SDS treatment, correlated well with previously reported in vitro cellular behavior indicating that adsorbed vWF, IgG, and VN may be involved in the modulation of adherent macrophage and FBGC behavior. Those surfaces that strongly adsorbed vWF also inhibited long-term macrophage adhesion, while those surfaces that strongly adsorbed IgG promoted long-term macrophage adhesion. In addition, the highest levels of FBGC formation had been observed only on those surfaces that strongly adsorbed VN. Subsequent human monocyte cultures on protein preadsorbed substrates confirmed the inhibitory effect of adsorbed vWF and the promoting effect of IgG on longterm macrophage adhesion as predicted by adsorption strength correlations. However, preadsorbed VN was not observed to modulate FBGC formation, which is in contrast to the conclusions of the adsorption correlations.

Adsorption↗
PubMed1983

Hypotensive effects of diltiazem to normals and essential hypertensives.

The hypotensive effect of acute and longterm, intravenous and oral administration of the calcium antagonist, diltiazem, was investigated in 8 normotensive volunteers and 55 patients with essential hypertension. Diltiazem i.v. infusion of 45 mg/h (0.5 mg/min, then 1.0 mg/min, each for 30 min rapidly decreased both blood pressure (BP) from 164 +/- 22/98 +/- 8 to 144 +/- 15/86 +/- 9 mmHg (mean +/- SD) and total peripheral resistance from 32.6 +/- 8.4 to 25.3 +/- 5.4 mmHg/l/min (p less than 0.001), and increased stroke volume from 58.2 +/- 9.5 to 64.2 +/- 8.6 ml/beat (p less than 0.05). It altered neither heart rate nor cardiac output in the hypertensives (n = 10). Oral diltiazem 60 mg rapidly decreased BP from 155 +/- 10/103 +/- 6 to 142 +/- 12/90 +/- 8 mmHg after 3 hours (p less than 0.01/p less than 0.001) in hypertensives (n = 8), but not in normotensives (n = 8). Diltiazem 90 mg p.o. decreased BP from 157 +/- 15/102 +/- 9 to 129 +/- 13/83 +/- 8 mmHg (p less than 0.01) in hypertensives (n = 15), and reduced the heart rate from 71 +/- 8 to 65 +/- 8 beats/min (p less than 0.01). The drug did not change plasma renin activity either in normotensives or hypertensives. The fall in diastolic BP was correlated with the plasma diltiazem concentration (r = 0.910, n = 6, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed2000

Long term persistence of anti-HBs protective levels in young patients with type 1 diabetes after recombinant hepatitis B vaccine.

The aim of the present study was to evaluate the persistence of anti-hepatitis B protective levels in young patients with type 1 diabetes, successfully immunised with a recombinant hepatitis B vaccine. We re-evaluated, after a 4 year follow-up, 54 patients and 70 age and sex-matched healthy subjects. Protective antibodies levels were found in 50/54 (92%) patients and in 67/70 (96%) controls. Moreover, anti-HBs levels were similar in diabetic patients and controls (means of log-titre and (sd); 1.95 (0.88) and 2.18 (0.64) patients and controls, respectively; P=0.11). No cases of clinical hepatitis were reported and all patients and controls remained HBc negative. These data demonstrate the persistence of anti-HBs levels in children, adolescents and young patients with type 1 diabetes after recombinant hepatitis B vaccine showing evidence of longterm immunogenity and protective effect.

Adolescent↗
PubMed1999

Comparison of costs between laparoscopic and open Nissen fundoplication: a prospective randomized study with a 3-month followup.

BACKGROUND: Laparoscopic antireflux surgery has replaced conventional operation despite the fact that currently no randomized trials have been published regarding its cost effectiveness. The objective of the present study was to compare costs and some short-term outcomes of laparoscopic and open Nissen fundoplication. STUDY DESIGN: Forty-two patients with documented gastroesophageal reflux disease were randomized between October 1995 and October 1996 to either laparoscopic (LNF) or open (ONF) Nissen fundoplication. Some short-term outcomes, Gastrointestinal Quality of Life Index (GIQLI) hospital costs, and costs to society were assessed. Followup was 3 months. RESULTS: Medians of operation times in the LNF and ONF groups were 98 min and 74 min, respectively. Hospital stay was 2.5 days shorter after laparoscopic operation (LNF 3 days versus ONF 5.5 days). Both operations were equally safe and effective, but the LNF group experienced significantly less pain and fatigue during the first 3 postoperative weeks. Improvement in the GIQLI and overall patient satisfaction were comparable between the methods. Convalescence was faster in the LNF group: return to normal life being 14 versus 31 days and return to work being 21 versus 44 days in the LNF and ONF groups, respectively. Hospital costs were similar, $2,981 and $3,140 in the LNF and ONF groups, respectively, but total costs were lower ($7,506 versus $13,118) in the LNF group as a result of an earlier return to work. CONCLUSIONS: LNF is superior in cost effectiveness, assuming that the longterm results between the methods are comparable.

Costs and Cost Analysis↗
PubMed1995

Repair and recovery following spinal cord injury in a neonatal marsupial (Monodelphis domestica).

1. Repair and recovery following spinal cord injury (complete spinal cord crush) has been studied in vitro in neonatal opossum (Monodelphis domestica), fetal rat and in vivo in neonatal opossum. 2. Crush injury of the cultured spinal cord of isolated entire central nervous system (CNS) of neonatal opossum (P4-10) or fetal rats (E15-E16) was followed by profuse growth of fibres and recovery of conduction of impulses through the crush. Previous studies of injured immature mammalian spinal cord have described fibre growth occurring only around the lesion, unless implanted with fetal CNS. 3. The period during which successful growth occurred in response to a crush is developmentally regulated. No such growth was obtained after P12 in spinal cords crushed in vitro at the level of C7-8. 4. In vivo, in the neonatal (P4-8) marsupial opossum, growth of fibres through, and restoration of, impulse conduction across the crush was apparent 1-2 weeks after injury. With longer periods of time after crushing a considerable degree of normal locomotor function developed. 5. By the time the operated animals reached adulthood, the morphological structure of the spinal cord, both in the region of the crush and on either side of the site of the lesion, appeared grossly normal. 6. The results are discussed in relation to the eventual longterm possibility of devising effective treatments for patients with spinal cord injuries.

Animals↗
PubMed2001

Lipodystrophy in patients with juvenile dermatomyositis--evaluation of clinical and metabolic abnormalities.

OBJECTIVE: Lipodystrophy and associated metabolic abnormalities are being increasingly recognized as complications of juvenile dermatomyositis (JDM). We investigated the prevalence of lipodystrophy and the extent of metabolic abnormalities related to lipoatrophic diabetes mellitus in patients with JDM. METHODS: Twenty patients with JDM were evaluated for evidence of lipodystrophy and associated lipoatrophic diabetes mellitus. All patients underwent clinical assessment, laboratory investigations, and metabolic studies (oral glucose tolerance test, lipid studies, insulin antibodies). RESULTS: We found clinical evidence of lipodystrophy and lipoatrophic diabetes mellitus in 4 of 20 patients with JDM and metabolic abnormalities known to be associated with lipodystrophy in another 8 patients. The 20 patients with JDM were categorized as follows: Group 1 (Patients 1-4) consisted of patients with lipodystrophy and either diabetes mellitus (2 patients) or impaired glucose tolerance (2 patients); Group 2 (Patients 5-12): no lipodystrophy but abnormal glucose and/or lipid studies; Group 3 (Patients 13-20): no lipodystrophy and no abnormalities of glucose and lipid studies. CONCLUSION: We found 25% of patients with JDM have lipodystrophy, and 50% present with hypertriglyceridemia and insulin resistance. Screening for metabolic abnormalities in JDM should be included in routine followup because of the effect of lipodystrophy on longterm prognosis.

Adolescent↗
PubMed1992

[Viral hepatitis A and the possible pathogenetic mechanisms of a protracted convalescence].

Metabolites of connective tissue (free serum oxyproline, protein-bound plasma oxyproline, total urine oxyproline, serum glycosaminoglycans), proteolytic enzyme elastase, proteolysis inhibitors (alpha 1-inhibitor, alpha 2-macroglobulin) were investigated in 103 patients with viral hepatitis A. It was established that connective tissue and its metabolites produce a negative effect on hepatocytic repair. Longterm convalescence is attributed to elastase hyperactivity in the presence of relative deficiency of proteolytic inhibitors.

Adolescent↗
PubMed1990

The influence of nifedipine (Corinfar) on pulmonary hypertension in chronic obstructive lung disease.

Calcium antagonists may provide an effective approach to the treatment of pulmonary hypertension disorders. Under this aspect we examined 44 patients by right heart catheterisation at rest and at exercise before and after sublingual application of a single dose of 20 mg nifedipine (Corinfar) as well as under continuous dosage of 30-60 mg daily. In patients with latent pulmonary hypertension we ascertained an efficient significant decrease of PAP, 15 of 18 patients were responders. This protective effect persists in the longterm studies after 1 year as well as after 2 years at equal magnitude. In patients with manifest pulmonary hypertension the influence on pulmonary hemodynamics was not so efficient. This behaviour is caused by morphological fixation of pulmonary hypertension. Therefore the determination of magnitude of pulmonary hypertension by right heart catheterisation is necessary for evaluation of nifedipine therapy.

Adolescent↗
PubMed1986

[Vasodilator therapy in pulmonary hypertension and chronic obstructive lung disease (COPD). Hemodynamic studies exemplified by nifedipine and nitroglycerin].

In 41 patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension, the effects of sublingual administration of 20 mg nifedipine and 0.8 mg nitroglycerin on the hemodynamics were assessed at rest and during bicycle ergometry. Additionally, in six patients, the effects of nifedipine during longterm treatment were analyzed. On acute testing, at rest and during exercise nifedipine led to decreases in mean pulmonary artery pressure of 16% and 23% and pulmonary arteriolar resistance of 23 and 35%, respectively, in 81% (17/21) of the patients. The reduction in the pulmonary vascular resistance was greater than that of the systemic resistance. In all patients, cardiac output increased. There was a similar number of responders to nitroglycerin (16/20). The reductions in mean pulmonary artery pressure and pulmonary arteriolar resistance ranging between 20 and 25% at rest and during exercise were comparable to those affected by nifedipine. In addition to the right ventricular afterload reduction, there was a decrease in cardiac output of 17%. During longterm treatment with nifedipine (average 18 months), the reduction in mean pulmonary artery pressure and pulmonary arteriolar resistance was not of the same magnitude as seen on acute testing. This may be due primarily to progression of the underlying disease since pulmonary function studies demonstrated an increase in the obstructive component. With the intention of circumventing or postponing the onset of right ventricular failure, the individual patient should undergo hemodynamic studies to delineate the optimal medication.

Exercise Test↗
PubMed1989

Morphine: some puzzles of well-known substance.

The study of morphines influence on vocalization and movement, nociceptive reactivity in rats in free behavior, during trauma of an extremity, intraperitoneal acetic acid administration and two-hour restraint allow us to reveal specific analgesic actions of this substance in doses comparable to that used for pain relief in man. This action consisted in the almost disappearance of trauma-induced hyperalgesia or a significant reduction of visceral stimulation-induced hypalgesia without any significant changes in movement reactivity depression typical to these states. Moreover, analysis or morphines influence on movement reactivity depression in free behaving rats of different groups or parts of one group previously housed in different aversive conditions allow to understand the reasons of variability in the action of opiates and the significance of previous living conditions in determination of their effects. Furthermore, the enhancement of morphines action on movement reactivity 3-4 hours after a single naloxone administration was observed, which indicates the possibility of artificial regulation of opiate effects by direct action on opiate receptors by naloxone. Subchronic naloxone administration (0.5 mg/kg, 3 times per day for 3 days) led to substantial and longterm enhancement of morphines depressive effect on movement reactivity (20 and 105 hours after the last naloxone use) and to decrease in movement reactivity depression typical to restraint stress.

Analgesics↗
PubMed1983

Longterm pergolide treatment of acromegaly.

The effect of pergolide mesylate, a new potent longacting dopamine agonist, was investigated in eight patients with active acromegaly, none of whom had received pituitary irradiation. Patients were assessed at different dose levels for clinical response and biochemical response by measuring mean fasting growth hormone (GH), mean ambulant GH and glucose-induced GH response. Six patients had definite clinical improvement. No major side effects were noted. All patients showed a statistically significant reduction in GH, although in two reduction was not below 75% of pretreatment levels. On 500 micrograms pergolide daily the overall response for the group of eight patients was a reduction of fasting serum GH, mean ambulant GH and of GH response to glucose to 55% of pretreatment values. When the daily dose was increased to 1000 micrograms there was a further significant reduction in GH in some patients; on this dose the response for the group was a decrease in fasting serum GH and mean ambulant GH to 40% of pretreatment values. In three patients GH concentrations of 5 mU/l or less were achieved. In two patients the daily dose was increased to 1500 micrograms but no extra benefit was obtained. We conclude that pergolide given once daily has a beneficial effect in acromegaly, with significant reduction in serum GH; it promises to be a useful therapeutic agent.

Acromegaly↗
PubMed1993

Pancreatic hypertrophy with acinar cell nodules after longterm fundectomy in the rat.

The effect of gastric fundectomy with hypergastrinaemia on the pancreas in rats was studied for 14 months. Rats with hypercholecystokininaemia that had had a pancreaticobiliary diversion (PBD) operation and sham operated rats served as controls. Fundectomised rats showed a significant increase in pancreatic weight and total DNA and protein content compared with sham operated rats. DNA flow cytometry showed a significantly higher ratio of tetraploid to diploid nuclei in pancreatic tissue after fundectomy than after sham operation. Mean values of all these variables were significantly lower after fundectomy than after PBD. Acidophilic atypical acinar cell foci of the pancreas were diagnosed in both fundectomised and PBD operated rats, but not in sham operated controls. The volume density and 3H-thymidine labelling index of the acidophilic atypical acinar cell foci were significantly lower after fundectomy than after PBD. Changes consistent with pancreatic adenoma were diagnosed in the PBD group only. In conclusion, fundectomy lasting about half of the life span in rats causes pancreatic hyperplasia and hypertrophy, as well as development of acidophilic atypical acinar cell foci. Although hypergastrinaemia is a prominent feature, it may not be the only factor responsible for this pancreaticotrophical effect of fundectomy.

Animals↗
PubMed1983

[Chemotherapy for metastatic lung cancer].

The effects of chemotherapy for lung metastasis in 284 cancer patients using various anti-tumor drugs, including classic ones and modern active agents for the past 18 years, were presented. Lung metastasis for lung cancer was excluded. The response was achieved in cervical carcinoma of the uterus (17/62, 27%), endometrial carcinoma of the uterus (1/7, 14%), colorectal cancer (6/39, 15%), breast cancer (5/28, 18%) and stomach cancer (4/28, 14%). A high response was achieved in myosarcoma (5/12, 42%), testicular cancer (5/11, 45%) and also in ovarian cancer (3/10, 30%). Though there were few cases, a high response was achieved in malignant melanoma (2/3), choriocarcinoma (2/4) and esophageal cancer (1/3). In total patients the response rate was 20%. In these cases a complete response was achieved in 4 cervical cancers; one testicular cancer, ovarian cancer, esophageal cancer and renal cancer, respectively. However, the effect was temporary and no longterm survivor was observed except for one case of renal cancer treated continuously with interferon (3 X 10(6) units daily) and showing complete remission after 7 months of therapy. The effect of chemotherapy for lung metastasis was compared between nodular metastasis (NM) and lymphagiosis carcinomatosa (LC). In cervical carcinoma of the uterus, the response rate in NM (39%) was higher than in LC (11%). However, no difference was observed in breast cancer (NM 15%, LC 13%) nor in stomach cancer (NM 13%, LC 18%).

Antineoplastic Agents↗
PubMed2002

The effect of a home based exercise intervention package on outcome in ankylosing spondylitis: a randomized controlled trial.

OBJECTIVE: Home based self-care is essential for successful management of ankylosing spondylitis (AS). We designed an intervention package aimed at promoting self-care and regular longterm exercise and evaluated its effect on outcome. METHOD: Members of our database (n = 4569) were randomly selected and randomized to an intervention group (IG) or a followup control group (CG). The intervention consisted of an exercise/information video, exercise progress chart, patient education booklet, and AS exercise reminder stickers. The outcome measures were function (BASFI), disease activity (BASDAI), global well being (BAS-G), exercise self-efficacy (ESE), arthritis self-efficacy (SES), and quantity of AS mobility/aerobic exercise assessed at baseline and 6 months. RESULTS: Of the 200 subjects, 155 completed the study (75 IG and 80 CG). Baseline analysis showed no differences between the CG and the IG. At 6 months, analysis revealed no statistically significant between-group differences for the BASFI, BASDAI, and BAS-G. although the p value of 0.08 for function approached significance. Self-efficacy for exercise showed a significant improvement in the IG (p = 0.045). There were no between-group differences for the SES pain and other symptoms subscales. Finally, there was a significant increase in self-reported AS mobility (p < 0.001) and aerobic exercise (p < 0.05) in the IG. CONCLUSION: An exercise intervention package designed to promote self-management in AS (1) significantly improves self-efficacy for exercise; (2) significantly improves self-reported levels of exercise; (3) reveals a trend for improvement in function (BASFI).

Disability Evaluation↗