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Biomedical subjects

A Frank

Publications and source records attributed to A Frank.

At least 91 records · Page 5Linked to original sources
PubMed1997

A measure of readiness for substance abuse treatment. Psychometric properties of the RAATE-R interview.

The Recovery Attitude and Treatment Evaluator-Research (RAATE-R) scale is a structured interview that assesses readiness for substance abuse treatment in five subscales: resistance to treatment, resistance to continuing care, bio-medical acuity, psychological acuity, and environmental/ social problems. Psychometric properties, based on an interrater reliability analysis of 23 raters and administration of the scale to 116 cocaine-dependent outpatients, included high interrater reliability, high internal consistency, independence of subscales, and a factor structure that partially supports the scale's original design. The authors discuss limitations of these conclusions and the lack of concurrent validity with a self-report measure of therapy readiness.

Attitude to Health↗
PubMed1997

[Association of plasmapheresis and high doses of intravenous immunoglobulins in the treatment of myasthenia gravis].

INTRODUCTION: In the past decade good therapeutic results have been reported with high dosage of intravenous immunoglobulins (Ig i.v.) in various autoimmune disorders, including myasthenia gravis (MG). Plasmapheresis has been used successfully in this disorder on indications similar to those described for the use of Ig i.v.. We have used sequential treatment of plasmapheresis followed by high doses of intravenous gammaglobulin in MG, seeking complementary benefits from the two kinds of treatment. MATERIAL AND METHODS: The sample included 10 patients with MG (7 of Osserman's grade II-B, 1 of II-A and 2 of III). We began treatment with plasmapheresis, and then continued with an i.v. infusion of Ig at a dose of 400 mg/Kg/day for 5 days. To evaluate the response to treatment, we used the classification system for muscle weakness based on the Virginia University modification of Osserman's grades, on the clinical involvement grade scales and on functional activity. RESULTS: All patients showed statistically significant improvement of the parameters studied. Improvement started between the first and sixth day, following administration of Ig i.v. and persisted for the following 16 weeks. CONCLUSIONS: We consider that combined treatment with plasmapheresis and Ig i.v. may synergically potentiate the immunological effects since they have different mechanisms of action. The indication for this is limited to serious clinical conditions resistant to other treatment, to speed recovery.

Adult↗
PubMed1996

Vanadium poisoning of cattle with basic slag. Concentrations in tissues from poisoned animals and from a reference, slaughterhouse material.

In northern Sweden, 23 heifers out of 98 cattle died of acute vanadium toxicity in a 10-day period. Eight months earlier a pasture had been fertilized with basic slag, containing 3% vanadium. The fertilizer was laid on the surface without being ploughed in. Mainly heifers, and some cows, were fed with basic slag-contaminated fresh hay. The first signs of illness appeared 11 days later, and the first case of death appeared 14 days after the initial clinical signs. The signs were diffuse and difficult to interpret. Inappetence, black diarrhea, lethargy, dehydration and spontaneous abortions occurred. Further, pulmonary lesions, conjunctivitis, neurological disturbances such as depression, leg incoordination, and paralysis of the hind limbs and face were also noted. Although feeding with the contaminated hay was stopped at the outbreak of the toxicity, the 23 animals died or had to be slaughtered, and at necropsy of another heifer 4 weeks later, large amounts of basic slag were still found in the alimentary tract. High vanadium concentrations were found in the liver, kidneys, spleen and urine, 5.9, 5.5, 1.9 and 4.8 mg/kg w.w., respectively. In bone tissue (coccygeal vertebrae), the highest value in an acutely poisoned heifer was 0.680 mg/kd d.w., in the same range as that of an experimentally poisoned sheep. Surviving heifers were more affected than cows; the state of health of these heifers gradually deteriorated and, therefore, a few were slaughtered 3 months later. Because of residual neurological disturbances and decreased milk production, the rest of the herd was slaughtered 5 months after the outbreak, and samples were collected and analyzed. Elevated vanadium concentrations were found in the organs, especially in the spleen, where values of 1.40 and 1.42 mg/kg w.w. were found in 2 heifers at 3 months. The values in heifers (n = 6) were decreased 5 months after the outbreak. The median concentrations were somewhat higher in the liver than in the spleen, and lowest in the kidney (0.244, 0.213 and 0.058 mg/kg w.w., respectively). In the organs of the cows (n = 24), which were less exposed, the corresponding values were 0.012, 0.095 and 0.013 mg/kg w.w., respectively. Vanadium concentrations were also determined in livers of cows and calves at regular slaughter in four geographic regions of Sweden. In one of the regions, where basic slag (with 3% vanadium) had been used for many years, the values were significantly higher than those in the other regions. In a material of 293 specimens, an upper reference limit of 0.012 mg/kg liver w.w., with a 90% confidence interval of 0.011-0.019 mg/kg w.w., was found to be normal for cattle in Sweden. Concentrations above the Highest Swedish Reference Value, 0.019 mg/kg liver can be considered elevated. Vanadium-containing basic slag used as fertilizer caused poisoning in a herd of cattle and its regional use was detectable in livers from cattle at regular slaughter. Such fertilizer must be applied in a proper way. It should be ploughed in and any direct contact of grazing animals with the hazardous fertilizer should be prevented.

Abattoirs↗
PubMed1996

[How can the success of a glaucoma operation be predicted?].

PURPOSE: The effect of glaucoma surgery can simply be measured in terms of intraocular pressure (IOP) reduction. However, IOP reduction is not the final goal of glaucoma surgery, but rather long-term visual field preservation. Visual field preservation, on the other hand, can only be judged many years after surgery. Therefore, a formula that could be used to define the success of a pressure-lowering operation soon after surgery should take account of IOP reduction, but the correlation between "successful IOP reduction" and "long-term visual field preservation" should be as high as possible. METHODS: In an attempt to find such a formula, we examined the long-term course with reference to both IOP and visual field in 108 patients (mean follow-up 7.9 years). Several criteria were tested for their ability to predict the long-term visual field preservation. RESULT: The best correlation was obtained by a combined criterion specifying both an absolute upper limit and a relative IOP decrease (i.e. IOP postoperatively < 0.8*IOP preoperatively and IOP postoperatively < 21 mmHg). CONCLUSION: We recommend use of this criterion whenever the effect of a pressure-lowering operation has to be estimated shortly after surgery.

Aged↗
PubMed1996

Cluster headache syndrome associated with middle cerebral artery arteriovenous malformation.

Cluster headache (CH) is an idiopathic cephalalgic syndrome, although several pathological processes have been described in association with this syndrome. We report two cases of cluster headache in hospitalized patients with middle cerebral artery dependent arteriovenous malformation (AVM). After surgical removal of the AVM the headache completely resolved, suggesting that complementary studies and treatment of the underlying aetiology may be indicated for secondary forms of cluster headache.

Cerebral Arteries↗
PubMed1996

Cerebrospinal fluid ceftazidime kinetics in patients with external ventriculostomies.

Ceftazidime has proven to be effective for the treatment of bacterial meningitis caused by multiresistant gram-negative bacteria. Since nosocomial central nervous system infections are often accompanied by only a minor dysfunction of the blood-cerebrospinal fluid (CSF) barrier, patients with noninflammatory occlusive hydrocephalus who had undergone external ventriculostomy were studied (n = 8). Serum and CSF were drawn repeatedly after the administration of the first dose of ceftazidime (3 g over 30 min intravenously), and concentrations were determined by high-performance liquid chromatography by using UV detection. The concentrations of ceftazidime in CSF were maximal at 1 to 13 h (median, 5.5 h) after the end of the infusion and ranged from 0.73 to 2.80 mg/liter (median, 1.56 mg/liter). The elimination half-lives were 3.13 to 18.1 h (median, 10.7 h) in CSF compared with 2.02 to 5.24 h (median, 3.74 h) in serum. The ratios of the areas under the concentration-time curves in CSF and serum (AUCCSF/AUCS) ranged from 0.027 to 0.123 (median, 0.054). After the administration of a single dose of 3 g, the maximum concentrations of ceftazidime in CSF were approximately four times higher than those after the administration of 2-g intravenous doses of cefotaxime (median, 0.44 mg/liter) and ceftriaxone (median, 0.43 mg/liter) (R. Nau, H. W. Prange, P. Muth, G. Mahr, S. Menck, H. Kolenda, and F. Sörgel, Antimicrob. Agents Chemother. 37:1518-1524, 1993). The median AUCCSF/AUCS ratio of ceftazidime was slightly below that of cefotaxime (0.12), but it was 1 order of magnitude above the median AUCCSF/AUCS of ceftriaxone (0.007) (Nau et al., Antimicrob. Agents Chemother. 37:1518-1524, 1993). The concentrations of ceftazidime observed in CSF were above the MICs for most Pseudomonas aeruginosa strains. However, they are probably not high enough to be rapidly bactericidal. For this reason, the daily dose should be increased to 12 g in cases of P. aeruginosa infections of the central nervous system when the blood-CSF barrier is minimally impaired.

Adult↗
PubMed1996

Early sensitization to farming-related antigens among young farmers: analysis of risk factors.

It was the aim of this study to investigate the prevalence of and risk factors for IgE- and IgG-mediated allergy in young farmers. We investigated 147 young men attending a farming college in the Austrian Tyrol and 57 age-matched pupils at a grammar school. All individuals completed a questionnaire and had spirometry, skin prick tests, total and specific IgE analysis, and testing for precipitins against thermophilic actinomycetes and true fungi. In the farming group, a family history of atopy or asthma was reported less frequently than in the control group (p < 0.001) but there were no differences in the frequencies of actual respiratory symptoms. Forced expiratory volume in the first second (FEV1) was slightly lower in the farmers than in the pupils (p < 0.05). There was no difference in the prevalence of IgE-mediated allergy. Nine of the farmers but none of the pupils had precipitating antibodies against Faeni rectivirgula (p < 0.05). Overall reactivity (as defined by at least one positive finding with the skin prick test, specific IgE, or precipitins) was associated with larger farming estates, lack of a haydrying device, use of mouldy hay, and positive family history of asthma (p < 0.05). We conclude that in farmers, precipitin formation may occur at an early age and that even in younger age groups there is a clear relationship between allergic sensitization and occupational allergen exposure.

Adolescent↗
PubMed1996

[Gleno-humeral arthroscopic arthrolysis for shoulder stiffness. Apropos of 26 cases. Société Française d'Arthroscopie].

UNLABELLED: Shoulder stiffness is a problem which covers many different conditions. In fact there is still a semantic and pathogenetic confusion. The words: capsulite retractile, frozen shoulder, adhesive capsulitis, stiff shoulder contracture have been successively used and this ambiguity renders the literature difficult to interpret. Moreover the cause of the stiffness which depends on the aetiology, is not always clearly known: capsular contraction, capsular adhesion, capsular scarring following trauma or surgery, extra capsular phenomenons in the subacromial bursa, muscles or tendons. MATERIALS AND METHODS: 26 shoulders (25 patients) were reviewed with a follow up of 21 months using the Constant's scoring system. Patients had an average duration of symptoms for 13 months (1 to 27). Pre op passive motion was: abduction: 74 degrees, external rotation: 6 degrees, forward flexion: 84 degrees. The average motion core was 12.9/40. We distinguished three groups: primary frozen shoulder (13 cases) ; bipolar stiffness (3 cases) due to rotator cuff disease ; acquired "surgical" stiffness, (10 cases). The capsular release was performed, at the anterior rim of the glenoid fossa, purely anterior or anterior and inferior, followed by gentle manipulation. If external rotation was not improved the coraco-humeral ligament was detached from its coracoid attachment. Additional procedures were performed:acromioplasty (5 cases), bursectomy (3 cases), SLAP lesion debridement (1 case). Only 2 out 13 primary shoulders required an additional procedure. RESULTS: 1-There were no intra-operative complications (vascular or neural). 2-Range of Motion: the average gain under anesthesia was: abduction: 72 degrees, external rotation: 34 degrees, forward flexion: 86 degrees. Final result was obtained with a mean duration of seven months. There was no difference according to the aetiology. Gain was more important in the primary group (9.69 to 34.9 vs 15.8 to 30.6). 3-Subjective results were better in the primary group. 4-Objective results demonstrated an absolute Constant's score of 70.3, that is to say 83.4 per cent of the contralateral supposed healthy shoulder. There were 3 excellent, 5 very good, 7 good, but 11 fair or poor results. The relative Constant's score was 91 per cent in the primary group and only 76 per cent in the acquired group. The difference was due to the pain and strength which were greatly improved in the primary group. DISCUSSION: Arthroscopic release of shoulder contracture is feasible, safe and effective. For primary frozen shoulder, there is usually spontaneous recovery. Indications for surgery are very few. There is no evidence that arthroscopic release shortens spontaneous evolution. Therefore, we propose it in very selected cases of dramatically limited motion. One year of evolution is an acceptable time. For bipolar stiffnesses, arthroscopy allows one to recognize the exact cause of the stiffness and to treat it, especially the subacromial pathology. In this occurrence, buroscopy must be performed and cuff pathology treated. For acquired surgical stiffnesses, gain of motion is significant. Subjective and objective results are less satisfactory than those of primary frozen shoulder, due to persistance of pain and lack of strength. The alternative is open release, but arthroscopic release has less morbidity. It can be proposed early as soon as capsular tissue has healed (for instance 6 months).

Adult↗
PubMed1995

Survey of bioavailable selenium in Sweden with the moose (Alces alces L.) as monitoring animal.

Liver tissues were collected from moose (Alces alces L.) from the regular hunting seasons of 1981 and 1982. The material (from about 4300 animals) was stored at -20 degrees C at the National Veterinary Institute (SVA). From this material, 2080 specimens from 12 counties representing 14 regions were analyzed for selenium. The counties included were Norrbotten, Västernorrland (northern region), Uppsala, Kopparberg, Gävleborg, Jämtland (central region), north and south Kalmar (eastern region), Halland, north and south Alvsborg (western region), and Blekinge, Kristianstad and Malmöhus (southern region). The analysis was performed by a combination of continuous hydride generation using a flow-injection technique and atomic absorption spectrometry. The median selenium concentration in the liver in the entire material was 0.15 and the mean (+/- S.D.) 0.25 +/- 0.29 (range: 0.03-3.1) mg/kg wet wt. The highest median values obtained were 0.26, 0.28 and 0.29 mg/kg, in the counties of Gävleborg (central region) and north and south Alvsborg (western region), respectively. The lowest medians, 0.09-0.10 mg/kg, were found in the counties of Uppsala (central region), north and south Kalmar (eastern region), and Jämtland (central region). Intermediate median values were obtained in the other counties: 0.13 mg/kg in the county of Västernorrland (northern region), 0.15-0.16 mg/kg in the counties of Blekinge and Malmöhus (southern region) and Norrbotten (northern region), 0.18 mg/kg in the county of Halland (western region), and 0.23 mg/kg in the counties of Kristianstad and Kopparberg (southern and central regions, respectively). Selenium concentrations < 0.1 mg/kg in the liver of cattle are considered to be deficient. In some of the regions, 50-60% of the moose livers showed values below this level. The results indicate that the moose is useful for monitoring the amount of selenium available for wild-grazing animals and confirm that the Swedish environment is poor in selenium.

Animals↗
PubMed1995

Decision logic for retreatment of asymptomatic lung cancer recurrence based on positron emission tomography findings.

PURPOSE: The purpose of the study was to determine if Positron emission tomography (PET) 2-[F-18] fluoro-2-deoxy-D-glucose (FDG) imaging could detect subclinical local lung cancer recurrence and whether retreatment of such recurrence was feasible and beneficial. METHODS AND MATERIALS: Twenty patients with biopsy proven lung cancer were studied with Positron emission tomography for the purpose of detecting subclinical lung cancer recurrence over a period of 4.25 years. All patients were treated with external radiation as part or all of their therapy. Twenty patients had baseline PET and computed tomography (CT) studies for comparison with later studies. Surviving patients had a total of 40 sequential PET scans and 35 CT scans. The follow-up interval ranged from 5 to 40 months posttreatment. The differential uptake ratio (DUR) was determined for regions of interest of increased FDG uptake. RESULTS: The median DUR value of the 20 baseline PET studies was 5.59. The DUR value of greater than 3 was empirically selected as being positive for tumor detection. On baseline studies, PET had a 100% correlation with the CT findings in regard to detection of the site of primary tumor involvement. Four of 20 patients showed areas of discordance in the mediastinal and hilar areas on initial PET and CT studies. Seven of 17 patients showed discordant posttreatment PET-CT findings. Two false positive PET studies were due to radiation pneumonitis and one to macrophage glycolysis in tumor necrosis. For detection of asymptomatic tumor recurrence, analysis of sequential PET and CT studies, biopsy results, and the patient's clinical course suggested that PET had a sensitivity of 100%, specificity of 89.3%, and accuracy of 92.5%. Computerized Tomography was found to have a sensitivity of 67%, specificity of 85%, and accuracy of 82% for detection of such early-stage recurrence. Five patients went on to have retreatment with external irradiation based upon the PET evidence. Four retreated patients had biopsies that corroborated the positive PET findings, and one patient was retreated on the basis of the qualitative appearance of the posttreatment PET study. Two of the five retreated patients remain alive without evidence of tumor to 34 months following initial therapy. CONCLUSION: Positron emission tomography scanning appears to be effective in detecting and following the progression of recurrent lung cancer. Retreatment of patients with asymptomatic recurrent tumor has resulted in absent or decreased FDG activity. Monitoring of patients with PET may provide prolonged survival in patients who otherwise would fail treatment because of local tumor recurrence.

Adenocarcinoma↗
PubMed1995

[Long-term reduction of intraocular pressure by goniotrepanation or laser trabeculoplasty].

BACKGROUND: Reports concerning the long term efficacy of goniotrephination or lasertrabeculoplasty are still rather inconsistent. Therefore we once again investigated the long term IOP reduction of these two procedures. PATIENTS AND METHODS: In 1983 we started a prospective monitoring of patients having either goniotrephination or lasertrabeculoplasty. We now reinvestigated the patients originally included in this study (mean follow up 7.7 years, n = 116 patients/143 eyes). IOP reduction was defined to be successful if the following two criteria were met simultaneously: 1. IOP post op < 25 mm Hg. 2. IOP post op < 0.8 x IOP prä op. RESULTS: According to the criteria given above the long term success rate of goniotrephination was 67%, the long term success rate of lasertrabeculoplasty was 32%. There were no severe complications. The frequency of mild complications during the early postoperative period was the same for eyes with successful long term IOP reduction as for eyes with unsuccessful long term IOP reduction. When eyes with glaucoma chronicum simplex and eyes with secondary glaucomas were evaluated separately the following success rates were found: goniotrephination in eyes with glaucoma chronicum simplex 68%, goniotrephination in eyes with secondary glaucomas 67%, lasertrabeculoplasty in eyes with glaucoma chronicum simplex 37%, lasertrabeculoplasty in eyes with secondary glaucomas 18%. The correlation between successful lasertrabeculoplasty in the first eye and successful lasertrabeculoplasty in the fellow eye was marginally significant (p = 0.1). CONCLUSIONS: The long term IOP reduction is clearly more pronounced after goniotrephination than after lasertrabeculoplasty. However, long term IOP reduction after lasertrabeculoplasty is still better than expected. Mild complications during the early postoperative period obviously do not influence the long term results of both procedures. The success rate of lasertrabeculoplasty in eyes with secondary glaucomas is clearly worse compared to eyes with glaucoma chromicum simplex. There is no difference between these two groups when goniotrephination was performed. The success of lasertrabeculoplasty in the first eye cannot really predict the success of the same procedure in the fellow eye.

Aged↗