Reducing the length of stay in a psychiatric inpatient unit and providing community care as an alternative.
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Community Mental Health Services↗
Biomedical subjects
A Gabriel
Publications and source records attributed to A Gabriel.
Disorientation in chronic psychiatric patients.
OBJECTIVE: To explore the effect of chronic institutionalization on cognitive performance in chronic psychiatric patients with emphasis on age disorientation, a phenomenon that was found in previous research to occur in up to 25% of chronic schizophrenic patients. METHOD: One hundred and ten chronic psychiatric patients, forming 4 main groups--schizophrenic patients, nonschizophrenic patients, institutionalized, and noninstitutionalized--were examined for age disorientation (inability to give one's chronological age correctly on request), and their Minimental State scores (MMSE) were compared across the 4 groups. RESULTS: Twelve out of 43 patients (26%) who were institutionalized according to our definition were age-disoriented and had significantly lower MMSE scores than the other 3 groups. The chronic, noninstitutionalized schizophrenic group and the other chronic psychiatric patients, whether they were institutionalized or not, were negative for this phenomenon. One of the 12 age-disoriented patients was age delusional, and 5 of the 12 had a total MMSE score consistent with dementia (21 or lower). CONCLUSION: Age disorientation is a specific phenomenon that characterizes a subgroup of chronically ill and institutionalized schizophrenic patients. It is unlikely that chronicity per se or prolonged hospitalization alone will lead to cognitive impairment.
Adolescent↗
Hemostasis activation in patients undergoing brain tumor surgery.
Patients undergoing brain tumor surgery are at high risk for the occurrence of a thromboembolic event. To identify a laboratory marker suitable for risk estimation the authors studied the perioperative time pattern of routine coagulation parameters and the specific hemostasis activation marker D-dimer in 28 consecutive patients at high risk (11 patients with glioma and eight patients with meningioma) and low risk (nine patients with metastases) for thromboembolism, as previously reported. As is typical during major surgery, most of the routine parameters declined, probably because of hemodilution, and recovered postoperatively to values higher than baseline, probably because of an acute-phase reaction. On Days 2 and 7 after surgery no difference in the routine parameters was recorded between patients at high (meningioma and glioma) and low risk (metastasis). The level of D-dimer was elevated at baseline in patients with metastasis, indicating a hemostatic hyperactivity that is usual in cancer patients. During surgery a marked increase in D-dimer levels occurred in patients with meningioma and glioma (pre- and postoperative median 90/2000 and 100/1020 ng/ml, respectively), but the increase was less pronounced in patients with metastasis (320/660 ng/ml). Postoperatively, D-dimer declined in patients with metastases to lower than preoperative levels (Day 7, 270 ng/ml); in patients with meningioma or glioma, however, D-dimer levels remained elevated until Day 7 (450 and 200 ng/ml, respectively). These results indicate that levels of D-dimer correlate with the reported high risk for thromboembolism in patients with meningioma and glioma, and D-dimer should be evaluated for its use in estimating individual risk and the efficiency of its use in the control of prophylactic treatment.
Acute-Phase Reaction↗
[Assistance in a Calcutta street clinic].
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Adult↗
[A proposition for a histopathologic examination protocol of liver biopsy in diagnosis of chronic hepatitis].
The authors present a proposition of a protocol of liver specimen examination including new criteria for describing a degree of inflammatory activity and advancement fibrosis. A suggested pattern of examination protocol is based on new criteria of chronic liver diseases diagnosing issued in 1994 by World Congress of Gastroenterology and International Association For the Study of the Liver (IASL). Introducing a unified protocol of liver specimen examination according to a suggested scheme will facilitate a clinical diagnosing of patients with a suspected chronic hepatitis. A histopathologist, having received full and very detailed data, will be able to issue a more precise interpretation of an observed histopathological image as well as in some cases to use some additional diagnostic methods. Applying a contemporary division of chronic hepatitis including either descriptive or scoring criteria of inflammatory activity and fibrosis range will decrease a risk of too subjective evaluation of a sample.
Biopsy↗
[Smoking behavior of Styrian physicians--results of a 1995 questionnaire survey].
Tobacco use among all physicians registered in the state of Styria was investigated at the beginning of the year 1995 using an anonymous questionnaire. In addition to the smoking prevalence among different specialties in medicine the main interest was focused on motives for smoking as well as for stopping it. Nearly all physicians were aware of the associated health risks. The overall prevalence of smoking was 14% which lay markedly below the Austrian average of 36%. 52% started smoking before the age of 18. In addition 70% of smoking doctors wanted to reduce or stop smoking within the next 6 months. The early start of smoking during adolescence emphasizes the importance of educational and special teaching programs because even in the medical profession there is a big difference between the intention to stop smoking and the actual success in doing so.
Adolescent↗
[Osteogenesis imperfecta tarda--case report].
The case of type IA of osteogenesis imperfecta tarda was described. Following results were presented: anamnesy, physical, ophthalmic and ORL examinations, laboratory findings, radiological and densitometric data. Clinical characteristic and mentioned above examinations allowed to take the definitive diagnosis. Family data showed features of this disease in the next generations and should be a base for diagnostic evaluation in whole family. Confirmation of diagnosis ought to be the important information concerning future life style, work etc. in the next generations.
Absorptiometry, Photon↗
Retrotransposon reverse-transcriptase-mediated repair of chromosomal breaks.
The abundance of short and long interspersed nuclear sequences (SINEs and LINEs) and pseudogenes in eukaryotic genomes indicates that reverse transcriptase (RT)-mediated phenomena are important in genome evolution. However, the mechanisms involved in their spread are largely unknown. We have developed a selection system in the yeast Saccharomyces cerevisiae to test whether RT-mediated events could be linked to the repair of double-strand breaks (DSBs). Here we show that DSBs can be fixed by the insertion of complementary DNAs at the break site. In the presence of functional RT (from human L1, yeast Tyl or Crithidia CRE1), and in the absence of homologous recombination, an HO endonuclease-induced DSB at the mating type (MAT) locus is the primary site at which a marked cDNA is observed among surviving cells. The structure and junctional sequences of these insertions suggest that repair occurs primarily by non-homologous recombination. Our data support a role for endogenous retroelements in the repair of chromosomal breaks.
Animals↗
Replication infidelity during a single cycle of Ty1 retrotransposition.
Retroviruses undergo a high frequency of genetic alterations during the process of copying their RNA genomes. However, little is known about the replication fidelity of other elements that transpose via reverse transcription of an RNA intermediate. The complete sequence of 29 independently integrated copies of the yeast retrotransposon Ty1 (173,043 nt) was determined, and the mutation rate during a single cycle of replication was calculated. The observed base substitution rate of 2.5 x 10(-5) bp per replication cycle suggests that this intracellular element can mutate as rapidly as retroviruses. The pattern and distribution of errors in the Ty1 genome is nonrandom and provides clues to potential in vivo molecular mechanisms of reverse transcriptase-mediated error generation, including heterogeneous RNase H cleavage of Ty1 RNA, addition of terminal nontemplated bases, and transient dislocation and realignment of primer-templates. Overall, analysis of errors generated during Ty1 replication underscores the utility of a genetically tractable model system for the study of reverse transcriptase fidelity.
Base Sequence↗
[Therapy of carcinoids of the stomach].
Carcinoids of the stomach are rare but have gained importance since the introduction of acid secretion inhibitors. The most important type is the tumor occurring in patients with chronic atrophic gastritis with and without pernicious anemia. The tumors are benign and can be treated by local endoscopic or surgical methods. Antrectomy reduces hypergastrinemia and may cause regression of the tumor. Sporadic carcinoids of the gastric antrum are malignant, however, and require radical surgical treatment.
Adult↗
Influence of prostaglandin E1 on tissue ischemia during surgical repair of the abdominal aorta.
OBJECTIVE: To evaluate tissue protection by PGE1 during leg ischemia in patients undergoing aortic surgery. DESIGN: Randomized, controlled prospective clinical trial. SETTING: Single university hospital. PARTICIPANTS: 19 consecutive patients undergoing abdominal aortic aneurysm repair. INTERVENTIONS: Patients received infusions of 30 ng/kg/min of PGE1 or saline. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, lactate, creatine phosphokinase, and thromboxane B2 (TXB2) were measured. In the control group, the decrease in cardiac index (CI) after aortic cross-clamping (AXC) persisted until unclamping together with a decrease in femoral venous O2 content (CfvO2). In the PGE1 group, CI returned to baseline with a trend toward greater CfvO2 levels. During reperfusion in the PGE1 group, O2 consumption and lactate levels exceeded preclamp values. Pulmonary hypertension occurred equally in both groups but did not correlate with TXB2, which was not altered by surgery or by PGE1 infusion. CONCLUSIONS: Intraoperative PGE1 treatment offers no benefit and may exacerbate tissue ischemia during AXC by redistributing microcirculatory flow or limiting cellular oxygen utilization in a manner that overwhelms any possible protective effect.
Aged↗
[Cat-scratch disease as a diagnostic problem of lymphadenopathy].
The diagnosis of cat-scratch disease is based on history and clinical symptoms. We present a case of a 4-year-old girl admitted to our unit with suspicion of histiocytosis X after histologic evaluation of a submandibular lymph node biopsy. On the basis of history, clinical features and histologic reevaluation, the diagnosis of cat-scratch disease was made.
Bartonella henselae↗
A new non-LTR retrotransposon provides evidence for multiple distinct site-specific elements in Crithidia fasciculata miniexon arrays.
We have identified a new member of the family of trypanosome site-specific retrotransposons, using a degenerate oligonucleotide PCR strategy. The 9595 bp element, termed Crithidia retrotransposable element 2 (CRE2), was cloned and found to be inserted in the tandemly arrayed miniexon genes of Crithidia fasciculata. The element is flanked by 29 bp target site duplications but lacks the 3' poly dA tract characteristic of most other non-long terminal repeat retrotransposons. The amino terminal region of the single 2518-codon open reading frame contains a putative metal-binding motif and a proline-rich region similar to gag-like domains of other retrotransposons. The carboxy terminal region of this open reading frame shares sequence homology with the reverse transcriptase and putative endonuclease regions of three previously described trypanosomatid site-specific retrotransposons. All four of these retrotransposons are specifically inserted between nucleotides 11 and 12 of the highly conserved 39mer sequence of the miniexon gene. Most copies of CRE2 and the previously characterized CRE1 are located on different sized chromosomes. Additional CRE-related sequences were identified by screening Crithidia libraries. These results suggest that a particular sequence in the C. fasciculata miniexon repeat is the target for multiple distinct site-specific retrotransposon insertions.
Amino Acid Sequence↗
Post-transfusion purpura due to HPA-1a immunization in a male patient: response to subsequent multiple HPA-1a-incompatible red-cell transfusions.
We report a male patient who developed post-transfusion purpura. Thrombocytopenia did not recur when intravenous IgG was given before the transfusion of platelet-depleted washed red-cell concentrates.
Antigens, Human Platelet↗
Pattern and prevalence of oral carcinoma in a surgical unit at Cancer Institute Maharagama, 1985 to 1994.
OBJECTIVE: To determine the range and prevalence of oral carcinoma requiring surgery. DESIGN: Retrospective study. SETTING: Surgical unit I at Cancer Institute, Maharagama. PATIENTS: 353 oral cancer patients admitted and operated on during a 10 year period from 1985 to 1994 RESULTS: Lateral wall of the oral cavity (cheek and mandible) accounted for 55.6% of oral cancers. The other sites involved were as follows: tongue 33.4% (73.7% of these involved anterior tongue), maxilla 7.4%, floor of the mouth 2.6%, lip 1.1%. The male to female ratio was 3.7:1. CONCLUSIONS: Lateral wall oral cancers are the commonest requiring surgery and the lip is the most infrequent site. Of the central lesions anterior tongue is the commonest. Compared with previous figures prevalence of maxillary cancer has halved, whereas tongue cancer has increased. More women are now coming to surgery.
Adult↗
[Comparative effects of cibenzoline and hydroquinidine in the prevention of auricular fibrillation. A randomized double-blind study].
The objective of this study was to compare the efficacy and safety of cibenzoline (130 mg twice a day) and sustained-release hydroquinidine (300 mg twice a day) in the prevention of recurrent atrial fibrillation (AF). This randomized double-blind study was conducted in 87 patients, with a mean age of 62 years, presenting with a history of AF for 72 hours to a maximum of 3 years. After restoration of sinus rhythm, in order for the subjects to be included in the study, echocardiography had to reveal a left ventricular shortening fraction of more than 20%. Patients were followed for one year by clinical examination, ECG and 24-hour Holter monitoring performed 7 days after inclusion, then after 3, 6, 9 and 12 months. The two groups, treated with either cibenzoline (n = 40) or hydroquinidine (n = 44), were comparable. The AF recurrence rates with cibenzoline or hydroquinidine were 34.9% had 36.4% at 6 months, and 41.9% and 43.2% at 12 months, respectively (NS). Most recurrences occurred during the first month. Adverse effects were reported in 10 patients (23.3%) with cibenzoline and 12 patients (27.3%) with hydroquinidine. They led to discontinuation of treatment in 6 patients (14%) treated with cibenzoline and 5 patients (11.4%) treated with hydroquinidine. Serious adverse events included one death from hypoglycaemic coma and one case of persistent ventricular tachycardia with hydroquinidine. In conclusion, oral cibenzoline demonstrated the same antiarrhythmic activity as hydroquinidine in the long-term prevention of recurrent atrial fibrillation, with a similar degree of safety. This drug can therefore constitute an alternative to conventional antiarrhythmics in this context.
Adult↗
In-frame linker insertion mutagenesis of yeast transposon Ty1: phenotypic analysis.
A plasmid bearing a transpositionally functional GAL1::Ty1 fusion was mutagenized by insertion of four or five codons semirandomly throughout the plasmid. This collection of mutant plasmids was introduced into yeast cells and studied with regard to the properties of the mutant Ty1-encoded proteins and the transposition phenotypes observed. All of the transposition-inactivating mutations were previously found to be recessive with the exception of a single mutation in TYA. In this mutant, TYA protein of normal abundance is produced, but the virus-like particles containing this protein are unstable and have aberrant behavior. The effects of mutations in noncoding regions, as well as the capsid protein coding region TYA, and the regions encoding the protease, integrase and reverse transcriptase proteins are described. Effects on gene expression, types of proteins produced, proteolysis of precursor proteins, virus-like particle structure, and biochemical activities of the encoded proteins are summarized. In addition, we show that one of the mutations in the 3' LTR represents a new nonessential site into which foreign marker DNA can be inserted without compromising transposition.
Codon↗
[Regional anesthetic procedures in pediatric anesthesia].
Regional anaesthetic procedures are not popular in paediatric anaesthesia in many institutions. However, regional anaesthesia is gaining ground, especially in a "new" concept of balanced paediatric anaesthesia. The decisive argument for the use of regional anaesthesia is the prolongation of pain relief further into the postoperative phase. The minimal haemodynamic and respiratory side effects during epidural and spinal anaesthesia, the reduced narcotic requirement and the potential early mobilisation all speak in favour of practical application of these techniques. Specially adapted needles and catheters have reduced the technical limitations. The use of nerve stimulators has optimize the accuracy of needle and catheter positioning. The use of a nerve stimulator is therefore highly recommended for peripheral nerve blocks in children. On the other hand, the use of regional anaesthesia in children has potential disadvantages, which should be considered. Special knowledge and continuous training are required. Many techniques are time consuming and personnel intensive, at least temporarily, and the combination of general and regional anesthesia exposes the child to the potential risk inherent in both procedures. The aim of this paper is to discuss procedures which have gained favour in paediatric regional anaesthesia during the past few years. These include caudal, epidural and spinal anaesthesia, especially for infants with high narcotic risk, as well as fascia iliaca compartment blocks for lower extremity analgesia and penile blocks. Many peripheral nerve blocks require special experience and therefore are not discussed here, but they are used routinely by specialists in all age groups. Good anatomic and pharmacologic knowledge should be a prerequisite for all physicians who use regional anaesthetic procedures. Continuous training and critical analysis are needed for good results. Only then can such methods be introduced into routine paediatric anaesthetic practice.
Adolescent↗