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PubMed1980

Primary hyperparathyroidism. A personal experience with 242 cases.

Two hundred forty-two patients with primary hyperparathyroidism operated on at Akron City Hospital are reviewed. The importance of the association of peptic ulcer and pancreatitis with primary hyperparathyroidism is stressed. Nineteen percent of the patients had associated peptic ulcer or pancreatitis. The mechanisms involved in the production of these diseases in patients with primary hyperparathyroidism are emphasized. The two deaths occurred in the small but challenging group of patients with acute parathyroid crisis and carcinoma. The decision concerning the extent of parathyroidectomy should be made by the surgeon for each patient, based on the number, location and gross appearance of the identified glands. Removal of a single enlarged gland, if the other three glands are normal, is all that needs to be done in most cases. A recurrence rate of 1 percent and an appreciable decrease in postoperative tetany support this conservative approach. Subtotal parathyroidectomy should be reserved for patients with diffuse hyperplasia.

Adenoma↗

PubMed1980

Temperature dependence of the chromatographic assay of hemoglobin A1 and application of a temperature controlled assay to clinical evaluation of diabetic control.

We investigated the temperature dependence of the cation-exchange chromatographic properties of hemoglobin A1 using the "Fast Hemoglobins Test System" obtained from Isolab, Inc., Akron, OH, U.S.A. and a temperature control chamber constructed in our laboratory. Six patient samples, two each from the "normal" range (5--8.5%, "transitional" range (8.5--12.0%) and "uncontrolled diabetic" range (12--20%) described by Isolab (as measured at 24 degrees C) were collected, hemolyzed and assayed according to product insert instructions. Each sample was assayed in triplicate in three separate runs at 20 degrees C, 22 degrees C, 24 degrees C, 26 degrees C and 28 degrees C in the temperature controlled (+/- 0.25 degrees C) chamber. Resultant mean increases in assay results of 0.8, 1.1 and 1.6% hemoglobin A1 per 2 degrees C increase in temperature for the three ranges respectively, indicate that the temperature dependence of the microcolumn assay for hemoglobin A1 is at least partially a function of the relative percentage of glycosylated hemoglobin in the sample. By controlling assay temperature we have reduced interassay variation throughout all concentration ranges by more than one-half to less than 5%. We applied this temperature controlled assay to measurement of hemoglobin A1 levels in 33 non-diabetic subjects and to the screening of hemoglobin A1 levels in 77 diabetic patients regularly attending the diabetic-endocrine outpatient clinic of this hospital. No non-diabetic subject had a HbA1 level above 8.5% and of the diabetic patients, 26% fell within the "normal" range, 43% within the "transitional" range and 31% within the "uncontrolled diabetic" range.

Adolescent↗

PubMed1993

Gastroschisis: an 18-year review.

From 1972 to 1990, 69 cases of gastroschisis were treated at Akron Children's Hospital Medical Center. Eighty-one percent of these patients underwent primary closure of their abdominal wall defect. Thirteen of 69 patients (19%) required Silastic silos with final closure in an average of 7.8 days. There was no sex predilection, the average birth weight was 2,473 g, and the mean gestational age was 36.3 weeks. Twenty-six percent had associated anomalies, the majority were intestinal atresia, volvulus, and/or undescended testicles. Seventy-seven percent of the infants were delivered vaginally. Fourteen children were delivered via cesarean section. Seven cesarean sections were done solely for prenatal ultrasonic identification of an abdominal wall defect. There was no improvement in hospital stay, complications, days until enteral feeds were tolerated, days intubated, or number of surgical procedures in this group. In 14 patients, mesh sheeting (Marlex, Silastic) was used in the final closure. Sixty-four percent of these incurred wound breakdown necessitating removal of the mesh. This compares with a 3.2% wound breakdown in the nonmesh group. The average hospital stay was 43.9 days and the average time to enteral feeds 20.2 days. Sixty-four percent of the patients required postoperative intubation for an average of 5.5 days. The overall mortality rate was 4.3%. The present data do not support gastroschisis alone as an indication for cesarean section. The data indicate that mesh be avoided in the final closure if possible and support a favorable prognosis for most babies.

Abdominal Muscles↗

PubMed1992

An integrated approach to measuring potential spatial access to health care services.

In recent years there have been several attempts to develop quantitative measures of potential spatial access to health care services which, despite their limitations, offer many positive ideas that can perhaps be integrated into a logically consistent and generally acceptable index. It is in this vein that the current paper presents an integrated approach, drawing partially from past contributions, to measuring potential spatial access to health care services. The final access index is derived as the culmination of a series of individual measures, starting with an initial gravity formulation and progressing through successive stages as new elements, consistent with the definition and conceptualization of potential spatial access, are introduced. Application of the proposed index to the ambulatory medical care system of the Akron, Ohio SMSA, demonstrates the validity of the measure, and its suitability as a potential health care planning tool.

Algorithms↗

PubMed1987

Toxic smoke inhalation: cyanide poisoning in fire victims.

The most common cause of death in fires is the inhalation of noxious gases rather than thermal injury. Hydrogen cyanide gas, the most toxic product of combustion, seldom is recognized as a significant hazard in smoke inhalation. During the first four months of 1986, toxic amounts of cyanide were found in four of the six fatalities from house fires in Akron, Ohio. These cases illustrate the increasing frequency of cyanide poisoning in household fires. Sources of cyanide toxicity include the increased use of synthetic polymers in building materials and furnishings. Prompt recognition of and therapy for cyanide intoxication may reduce the morbidity and number of delayed deaths in fire victims. The key point in the diagnosis of cyanide poisoning is a high index of suspicion. The clinical presentation of cyanide intoxication, its diagnosis, and subsequent treatment are discussed. Finally, a prehospital protocol for treating smoke-inhalation victims who may have been exposed to cyanide gas is suggested.

Aged↗

PubMed2004

Blood samples drawn from IV catheters have less hemolysis when 5-mL (vs 10-mL) collection tubes are used.

INTRODUCTION: It is common practice for emergency nurses to draw blood for laboratory analyses into vacuum tubes from newly inserted intravenous (IV) catheters, even though this technique has been associated with an increase in sample hemolysis. No clinical nursing studies have documented the effect of collection tube size on hemolysis of samples obtained via IV catheters. OBJECTIVE: To determine whether there is a difference in the hemolysis rate of blood samples drawn from IV catheters comparing 5-mL vacuum collection tubes to 10 mL vacuum collection tubes. SETTING: The study was conducted at the Emergency Department, Summa Health System, Akron, Ohio. Method This study used a 4-group, 2-period crossover design randomly assigning the order of the vacuum tube drawn. With the crossover design, each patient served as his own control. Upon receiving orders to start an IV and draw blood, each of 12 study nurses obtained an envelope with 2 vacuum tubes randomly assigned as to which tube should be drawn first and which tube should be drawn second. Samples were analyzed for hemolysis using a Hitachi automated spectrophotometer as well as by visual inspection. DATA ANALYSIS: A linear mixed model was used to test the main hypothesis of vacuum tube type effects on hemolysis. RESULTS: The 5-mL tubes showed significantly lower hemolysis than the 10 mL tubes ( P <.0001) with a substantial effect size of .6 standard deviation units. CONCLUSION: The risk of hemolyzing blood drawn from IV catheters can be significantly reduced by using 5-mL rather than 10-mL collection tubes.

Blood Specimen Collection↗

PubMed1988

The gamete and embryo compatibility of various synthetic polymers.

Several popular and well-characterized polymeric materials were evaluated for their biocompatibility toward the cells unique to reproduction. To accomplish these studies, several in vitro tests were developed that evaluated biocompatibility between the polymers and spermatozoa, ova, and embryos. The data indicated significant differences between the materials with respect to their biocompatibility toward sperm motility, the sperm's ability to penetrate zona-free hamster eggs, and the ability of two-cell mouse embryos to divide. Polytetrafluoroethylene (PTFE-Teflon; PTFE, Chemplast Inc., Wayne, NJ), polyethylene glycol (PEG), and polyhydroxyethyl methacrylate (PHEMA) appear to be the most inert of the materials studied. Polyvinyl chloride (PVC; Tygon-Norton, Akron, OH) was found to be the most detrimental material toward gametes and embryos, with gross physiologic and morphologic changes observed in the PVC-exposed cells.

Animals↗

PubMed2002

Rapid and sensitive detection of biological warfare agents using time-resolved fluorescence assays.

We have achieved sensitive, rapid and reproducible detection of three biological threat agents in a variety of biological and environmental matrices using the DELFIA time-resolved fluorometry (TRF) assay system (Perkin-Elmer Life Sciences, Akron, OH). Existing ELISA assays for the detection of Francisella tularensis, Clostridium botulinum A/B neurotoxin (BotNT A/B), and Staphylococcus aureus enterotoxin B (SEB) were converted to TRF assays. They use 100 microl of positive control or unknown per test well and require just over 2 h to run. Fluorescent signal read time is a fraction of a second per well. The assay format consists of a capture ELISA utilizing a biotinylated capture antibody, prebound to a streptavidin-coated 96-well plate and a lanthanide (Europium, Eu3+)-labeled detector antibody. The bound Eu-labeled detector antibody produces a fluorescent signal upon the addition of an enhancement solution. The signal results from the dissociation of the Europium from the antibody, creating a micelle, thus amplifying the signal nearly one million-fold. Sensitivities achieved by these assays were between 4 and 20 pg/ml in buffer. Additionally, we have tested this system in different matrices such as serum, urine, dirt, and sewage. Concentration curves generated from standard solutions produced a wide linear range making serial dilutions of unknown samples unnecessary. DELFIA TRF assays are significantly better in terms of sensitivity, linear range, and run time than standard capture ELISAs and should facilitate early detection of potential biological warfare agents in clinical and environmental samples.

Antigens, Bacterial↗

PubMed1987

Prepyloric antral diaphragm: delays in treatment.

Six cases of prepyloric antral diaphragm were encountered at Children's Hospital Medical Center of Akron between 1965 and 1985, with approximately 150 cases reported in the literature during this time. In our series, a delay from onset of symptoms to treatment existed for a period of 4 months to 6 years. We suggest that prompt endoscopic confirmation and surgical therapy for this lesion, when suspected by clinical and radiologic abnormalities, would decrease the physical and psychologic morbidity of unexplained recurrent vomiting in these children.

Child↗

PubMed1999

The narrow therapeutic window of glycated hemoglobin and assay variability.

Glycated hemoglobin is measured by a variety of assays, each of which has a unique normal level. Our purpose is to show that among the different assays available in the United States, using the same patient's blood sample, assay results may vary widely and may more or less easily achieve a glycated hemoglobin value within the normal range. The following assays were compared using the same patient's blood sample for each pair of assays: glycohemoglobin affinity assay (GHB Reader; Isolab, Akron, OH) versus gel electrophoresis assay (n = 76); Isolab versus ion capture assay (IMX; Abbott Laboratories, Irving, TX) (n = 57); monoclonal antibody assay (DCA2000; Bayer Diagnostics, Pittsburgh, PA) versus IMX (n = 100); and high-performance liquid chromatography (HPLC) assay (Bio-Rad Variant A1c; Bio-Rad Laboratories, Richmond, CA) versus IMX assay (n = 55). Our analyses indicate that a relative ranking can be established for the ease of achieving a normal glycated hemoglobin level. The ranking indicates that the most stringent or difficult assays for achieving a normal level are the Isolab and DCA2000 assays. The intermediate assays are the IMX and Bio-Rad Variant, and the easiest method for achieving a normal value is the gel electrophoresis assay. Our results indicate that various glycated hemoglobin assays vary widely and are associated with more or less difficulty for an individual patient to achieve a glycated hemoglobin level within the normal range. These results are especially significant with respect to (1) the clinically narrow therapeutic window of glycated hemoglobin values in type 1 diabetes to avoid rapidly advancing severe hypoglycemia rates and chronic microvascular complication rates, and (2) the glycated hemoglobin threshold for rapidly advancing macrovascular disease in both type 1 and type 2 patients.

Adolescent↗

PubMed1987

Home transfusion therapy: a new dimension in home care.

Visiting Nurse Service, Inc (VNS), of Akron, Ohio, has provided transfusion therapy in the home since January 1984. Home transfusion has proved a valuable alternative to inpatient treatment and to expensive, exhausting ambulance trips to the hospital for outpatient treatment for selected homebound patients, many of whom are terminally ill. The VNS program is based on detailed policies and procedures that include patient referral criteria, RN education, patient education, blood procurement and labelling, and protocols for transfusion complications. Recognizing the need for patient safety, VNS has a quality assurance program that provides for continuous monitoring and evaluation of the home transfusion therapy, especially of any adverse reactions that occur.

Blood Transfusion↗

PubMed1990

An evaluation of the Apex Locator Endocater.

The purpose of this study was to relate the relationship of the apical constriction to the anatomical apex and to determine the ability of the Endocater (Hygenic Corp., Akron, OH), using commercially bonded coated probes to locate the position of the apical constriction, in permanent teeth that were intact and had not been subjected to previous endodontic manipulation. Using local anesthesia and rubber dam isolation, conventional access cavities were prepared at ultra high speed with water coolant in teeth treatment planned for extraction. The Endocater was used to determine the working length. The probes were sealed in place with autopolymerizing composite resin and the teeth extracted. The teeth were sectioned buccolingually, and the position of the probe in relation to the anatomical apex and apical constriction was measured with the use of an ocular microscope. In 17.1% of the canals, the probes bound in the coronal portion of the canals and would not reach the apical portion of the root. In those teeth in which the probes reached the apical portion of the root, the Endocater was able to locate the apical constriction within 0.5 mm in 93.4% of the canals.

Dental Pulp Cavity↗

PubMed1999

Growth inhibition of Streptococcus anginosus (milleri) by three calcium hydroxide sealers and one zinc oxide-eugenol sealer.

The inhibition of growth of Streptococcus anginosus (milleri) by three calcium hydroxide sealers--calciobiotic root canal sealer (Hygienic Corporation, Akron, OH), Sealapex (Kerr Division, Sybron Corporation, Romulus, MI), and Apexit (Vivadent, USA, Amherst, NY)--was compared with a zinc oxide-eugenol sealer: Roth (Roth International, Chicago, IL). Sixteen brain heart infusion agar plates were inoculated with S. anginosus. Each plate was divided into five separate areas. In each area, a 0.1 ml droplet of a given sealer was placed such that each plate had five areas with the same sealer. There were four plates (for each of the four sealers) for a total of 20 observation areas to evaluate each sealer. The plates were incubated at 37 degrees C in a 5% CO2 atmosphere. After varying periods of incubation, the zones of inhibition of bacterial growth were observed and measured. Roth sealer had a statistically significant larger mean zone of inhibition than the calcium hydroxide sealers. However, all of the sealers exhibited clinically relevant antimicrobial activity. It is likely that the eugenol in the Roth sealer is responsible for its greater antimicrobial activity.

Analysis of Variance↗

PubMed2000

Angiotensin-(1-7) regulates the levels of angiotensin II receptor subtype AT1 mRNA differentially in a strain-specific fashion.

Ang-(1-7) is an effector peptide of the renin-angiotensin system with several distinct actions that are likely mediated by a specific receptor. Regulatory effects of angiotensin (Ang) peptides, Ang-(1-7) and Ang II, on Ang receptor subtype 1 (AT1) mRNA expression were investigated in vascular smooth muscle cells (VSMC) from four University of Akron (Akr) rat strains (WKY, SHR and two backcross consomic lines SHR/y and SHR/a), and in SHR and WKY cells from Charles River Laboratories (Crl). In WKY/Akr and SHR/Akr, Ang-(1-7) treatment increased the levels of AT1 mRNA. This effect was inhibited by the specific Ang-(1-7) antagonist, A-779, in WKY/Akr but not SHR/Akr. Ang II had no effect in Akr cells, but it down-regulated AT1 mRNA in WKY/Crl and SHR/Crl VSMC. Ang-(1-7) did not affect AT1 mRNA levels in Crl lines. In conclusion, Ang-(1-7) regulates the AT1 receptor either directly or indirectly in a strain-specific fashion. The Ang-(1-7) antagonist, A-779, blocks the actions of Ang-(1-7) only in VSMC from WKY/Akr rats, suggesting either that the binding sites for Ang-(1-7) have different properties in SHR/Akr and WKY/Akr cell lines, or that some of the effects of Ang-(1-7) are not receptor mediated. Further, we found differences between Akr cells and Crl cells that are consistent with their genetic heterogeneity.

Angiotensin I↗

PubMed1992

Using paramedics to identify at-risk elderly.

OBJECTIVES: To evaluate paramedics' ability to identify elderly at risk and refer them for assessment and service. DESIGN: A prospective nonrandomized open trial. SETTING: Akron, Ohio, a midsize city with a well-developed advanced life support emergency medical services system. TYPE OF PARTICIPANTS: One hundred thirty firefighter paramedics evaluated 6,000 elderly patients. Assessments were performed by trained geriatric assessors. INTERVENTION: Regardless of the reason for the call, paramedics screened all emergency medical services users age 60 and older for medical, mental health, social, and environmental problems. Identified cases were referred to the Area Agency on Aging for assessment and follow-up. MAIN RESULTS: Paramedics identified 197 people with possible problems, 124 of whom received an assessment. The remainder could not be assessed due to death, moving, referral, or transfer to a long-term care facility. Assessors confirmed the presence of a problem in 121 of 124 assessed cases, a positive predictive value of 98%. The program was useful for 94 people, 48% of those identified and assessed. CONCLUSION: Paramedics can serve as case finders for at-risk elderly, and effective linkage to service agencies can occur.

Aged↗

PubMed1983

Utilization of a freestanding emergency center by patients with and without private physicians.

We assessed the impact of a freestanding emergency center (FEC) on alternative sources of care for minor illness and injury by comparing patients who named a personal physician with those who did not, with regard to time of arrival and type of complaint (injury vs illness). Of 932 patients attending an Akron, Ohio, FEC during the study period, 71% named a primary care physician. These patients came proportionately more often with injury than did patients without a physician, and also presented more frequently with illness at times when their physicians were typically unavailable. By contrast, there was no distinction between the two groups with respect to time of arrival for treatment of injury. We concluded that the FEC may compete largely with the hospital emergency department in the treatment of patients with minor injury. In the case of patients with illness, the FEC vies with both the emergency department and the private physician.

Adolescent↗

PubMedDate not supplied

Water uptake of soft lining materials from osmotic solutions.

OBJECTIVES: The water uptake characteristics of soft lining materials are of obvious importance in that they are expected to function in the oral environment. Results for Novus (Hygenic Corp., Akron, OH, USA) show a very high uptake from distilled water. Despite this high uptake, Novus appears to function satisfactorily in the mouth. High water uptake of soft lining materials has been attributed to the presence of water soluble impurities that, on immersion, form solution droplets; the driving force for the uptake being the osmotic gradient between the droplets and the external solution. Uptake should therefore be less from ionic solutions. The object of this study was to test the applicability of this theory to Novus and two experimental soft lining materials. METHODS: Water uptake of two experimental materials and Novus has been determined from distilled water and two saline solutions (0.45 and 0.9 M). After 196 days specimens were desorbed to constant weight and then subjected to a second sorption cycle. RESULTS: Novus had the highest uptake from distilled water at approximately 18%, the experimental materials having an uptake approximately 7%. Desorptions were all rapid, minimum weight being reached within 1-2 days. Uptakes of the second sorptions from water were all higher. Uptake from saline solutions was approximately 12% for all materials, uptake from 0.9 M saline being the lowest. Second sorption results from solution were similar to the first. CONCLUSION: The results obtained support the theory that the high water uptake of elastomeric materials is osmotically driven.

Adsorption↗

PubMed1998

The economic effect of child abuse in the burn unit.

The financial burden imposed on society by abusing children through burn injury is unknown. This study retrospectively evaluates the economic impact and demographics of such abuse on patients and their families treated at Children's Hospital Medical Center of Akron (CHMCA) from four counties over a 5 year period. The inclusive group consisted of all children evaluated during the stated period referred to Social Services for possible child abuse. There were 104 children (55 females and 49 males, 46% black and 56% white) with a mean age of 3.76 years. 71% of the patients came from single parent homes (all single mothers). There were a total of 58 admissions with a mean length of stay of 10.53 days. Total cost for all patients was approximately 1.2 million dollars for health care, of which 65% was government funded. In addition to hospital costs, the perpetrators incurred court costs and jail costs, all of which were the financial responsibility of Summit County. Child abuse through burns imposes a potentially preventable financial burden. This study does not take into account the socioeconomic and psychological impact on the abused victims through life, which is incalculable. By increasing awareness about the demographics and financial burden of child abuse, this paper may serve as a focus for further study and prevention of such abuse.

Burn Units↗