Biomedical subjects
A J Berry
Publications and source records attributed to A J Berry.
Are some types of needles more likely to transmit HIV to health care workers?
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Work hours of residents in seven anesthesiology training programs.
Medical educators and credentialing organizations recently have called attention to the long hours that some house staff are required to spend in the hospital during training. To determine the average duration of in-hospital work hours of anesthesiology residents, 148 residents at seven, university-affiliated training programs kept daily logs of their activities for one week. Residents in clinical anesthesia years 1, 2, and 3 spent an average of 66, 65, and 64 hours per week, respectively, in the hospital with a range of 43 to 104 hours per week. Although there was not a difference in in-hospital work time among years of training, there was a statistical difference between two of the seven programs studied. The largest portion of the in-hospital time was devoted to patient care activities in the operating room. Residents had time for educational activities, conferences, and reading while in the hospital. The overall work hours of the residents in the anesthesiology training programs included in this survey appeared to be within current guidelines.
Calculated risk of human immunodeficiency virus infection in anesthesiologists.
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The use of needles in the practice of anesthesiology and the effect of a needleless intravenous administration system.
Anesthesia personnel are at risk for occupationally acquired blood-borne infections transmitted through needlestick injuries. To formulate strategies for the prevention of needlestick injuries, it is necessary to identify the types of needles used by anesthesia personnel and the devices associated with injuries. The introduction of a needleless intravenous (i.v.) administration system provided an opportunity to assess its effect on needle usage in the practice of anesthesiology. The contents of needle disposal containers placed in the preoperative holding area and five operating rooms before (control) and after the introduction of a needleless administration system (study) were categorized by needle type. The information on needles used by anesthesia personnel was compared with that on needles purchased for the entire hospital. During the control period, most of the needles used were 18-23-gauge hollow needles (51.6%), i.c. catheter stylets (23%), and 25-26-gauge small-bore hollow needles (17.1%). There was no difference in the total number of needles collected after the introduction of the needleless administration system, but there was an increase in capped 18-23-gauge hollow needles. Anesthesia personnel used a relatively greater number of small-bore hollow needles (25-26 gauge), i.v. catheters, and spinal and epidural needles, but fewer hollow needles (18-23 gauge) than were purchased for hospital-wide use. Small-bore hollow needles (25-26 gauge) were responsible for 31.6% of the 19 needlestick injuries reported by anesthesia personnel to the Employee Health Service.(ABSTRACT TRUNCATED AT 250 WORDS)
Initiating a crystallographic study of a class II fructose-1,6-bisphosphate aldolase.
We have reproducibly crystallized the metal-dependent Class II fructose-1,6-bisphosphate aldolase from Escherichia coli. Crystals in the shape of truncated hexagonal bipyramids have unit cell dimensions of a = b = 78.4 A, c = 290.6 A and are suitable for a detailed structural analysis. The space group has been identified as P6(1)22 or enantiomorph. Data sets to approximately 2.9 A resolution have been recorded using both the Rigaku R-AXIS IIc image plate area detector coupled to a copper target rotating anode X-ray source and using the MAR image plate systems with synchrotron radiation at the EMBL outstation DESY in Hamburg, and at S.R.S. Daresbury. Diffraction beyond 2.5 A has been observed when large freshly grown crystals are used with the synchrotron beam. A data set to this resolution has been collected. Several putative heavy-atom derivative data sets have also been measured using synchrotron radiation facilities and analysis of these data sets is in progress.
The risk of needlestick injuries and needlestick-transmitted diseases in the practice of anesthesiology.
Anesthesiologists are at risk for acquiring blood-borne infections through contact with blood or body fluids. From prospective studies, the greatest risk of transmission is through a percutaneous exposure such as needlestick injury. Personal protective equipment such as gloves and gowns do not completely prevent these exposures. Although educational efforts can reduce the frequency of recapping of needles, they generally have not decreased the incidence of needlesticks. Therefore, in addition to practicing universal precautions, anesthesiologists can attempt to reduce their risk of needlestick injuries by eliminating nonessential unprotected needle use, through the use of needleless or protected needle devices (engineering controls) and by modifying anesthetic procedures requiring needles (work practice controls). Needleless or protected needle products are commercially available for use in many procedures performed by anesthesiologists. For tasks that require the use of needled devices, the practitioner should use safe techniques for handling (i.e., one-handed recapping if recapping is needed) and disposal (i.e., puncture-resistant containers) of these devices. Evaluation of the efficacy, cost, and safety of needleless or protected needle products should be continued as they are introduced into wider use. Additionally, anesthesiologists should be encouraged to report needlestick injuries so that appropriate postexposure treatment can be given and so that the incident can be studied to permit design of a work protocol or device to prevent similar accidents in the future.
Use of high-dose fluconazole as salvage therapy for cryptococcal meningitis in patients with AIDS.
Eight patients with AIDS were treated orally with 800 mg of fluconazole daily for cryptococcal meningitis for a mean duration of 4.5 months. Previous antifungal treatment had failed for all of the patients. No major toxicity was observed. Three patients died from cryptococcal infection. High-dose fluconazole may be effective salvage therapy for cryptococcal meningitis.
Lack of polymorphism on the Drosophila fourth chromosome resulting from selection.
Evolutionary processes can be inferred from comparisons of intraspecific polymorphism and interspecific divergence. We sequenced a 1.1-kb fragment of the cubitus interruptus Dominant (ciD) locus located on the nonrecombining fourth chromosome for ten natural lines of Drosophila melanogaster and nine of Drosophila simulans. We found no polymorphism within D. melanogaster and a single polymorphism within D. simulans; divergence between the species was about 5%. Comparison with the alcohol dehydrogenase gene and its two flanking regions in D. melanogaster, for which comparable data are available, revealed a statistically significant departure from neutrality in all three tests. This lack of polymorphism in the ciD locus may reflect recent positive selective sweeps on the fourth chromosome with extreme hitchhiking generated by the lack of recombination. By simulation, we estimate there to be a 50% chance that the selective sweeps occurred within the past 30,000 years in D. melanogaster and 75,000 in D. simulans.
An alternative strategy for infection control of anesthesia breathing circuits: a laboratory assessment of the Pall HME Filter.
Contaminated breathing systems have been responsible for nosocomial upper respiratory tract and pulmonary infections in patients undergoing general anesthesia. The current infection control guidelines for anesthesia breathing circuits require single-patient use or high-level disinfection of breathing tubes, y-connector, and reservoir bag. An alternative infection control strategy has been suggested that incorporates placement of a microbial filter downstream from the y-connector between the circuit and the patient. This laboratory study assessed the capacity of the Pall HME Filter as a bidirectional barrier to transmission of bacteria between the y-connector of an anesthesia circle breathing system and a test lung. The investigators modified a sterile circle system to allow aerosolization of a suspension of 10(9) Micrococcus luteus over 5 h into the inspiratory limb proximal to the y-connector or downstream from the filter into the test lung. Cultures indicated that the Pall HME Filter placed between the y-connector and the test lung completely prevented transmission of bacteria in both directions. The results of this study suggest that the Pall HME Filter could be used as an effective microbial barrier between the anesthesia circle breathing system and the patient as part of an alternative strategy for infection control.
The value of pulmonary artery and central venous monitoring in patients undergoing abdominal aortic reconstructive surgery: a comparative study of two selected, randomized groups.
One hundred two patients undergoing abdominal aortic reconstructive surgery were prospectively, randomly allocated to two groups, one of which was monitored with a central venous catheter and the other with a pulmonary artery catheter. Patients with uncompensated cardiopulmonary or renal disease were excluded from the study. General anesthesia was administered for the surgical procedure, and the patients were followed through hospital discharge. No statistically significant differences occurred between the two groups with regard to morbidity (perioperative cardiac, pulmonary or renal sequelae), mortality rate, duration of intensive care, postoperative hospital stay, or cost of hospitalization. The one statistically significant difference between groups was the professional fee charged for anesthetic care, which was higher for patients with pulmonary artery catheters than for those with central venous catheters. In conclusion, we prospectively gathered data from most patients presented for abdominal aortic reconstructive surgery. Our data seem to indicate that the choice of central venous catheter or pulmonary artery catheter monitoring makes little difference in outcome after abdominal aortic reconstructive surgery, and that for many patients pulmonary artery catheters are not necessary to give appropriate, adequate care. Because of the size of the sample, however, declarations of epidemiologic significance would be unfounded. Therefore large-scale, multicenter studies addressing such outcomes remain necessary.
Eflornithine for the treatment of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome: a preliminary review.
Pneumocystis carinii pneumonia (PCP) is the most common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). Eflornithine is an antiprotozoal agent active against P. carinii. It acts by inhibiting ornithine decarboxylase, an enzyme that is essential for cellular function. The drug is initially administered intravenously, followed by oral therapy. Eflornithine has been used on a compassionate basis in AIDS patients with PCP who were intolerant of or unresponsive to traditional agents. Overall, the response rate has been about 35%; however, conclusions are difficult to make since patients had different stages of disease and received treatment for varying periods of time. Side effects include depression of bone marrow function, diarrhea, hearing loss, seizures, alterations in liver function tests, and rash. While the need for safer and more efficacious antipneumocystis drugs grows, widespread use of seemingly promising agents should be based on well-conducted clinical trials.
The prevention of infection with Staphylococcus aureus in continuous ambulatory peritoneal dialysis.
We describe the control of wound infection with Staphylococcus aureus in patients undergoing continuous ambulatory peritoneal dialysis at St. Thomas' Hospital. Forty-nine percent of 61 catheters inserted in 1985 and 1986 became infected, and the majority of these infections were acquired in hospital. Infection was impossible to eradicate and was frequently associated with the subsequent development of S. aureus peritonitis, which was the most important cause of catheter loss. Strict adherence to aseptic techniques for catheter insertion and care, combined with eradication of S. aureus carriage, reduced the infection rate to 12% for the 50 catheters inserted in 1987, abolished hospital-acquired infection and reduced the S. aureus peritonitis rate tenfold, without the use of prophylactic antibiotics. S. aureus infection is a serious but avoidable complication of continuous ambulatory peritoneal dialysis.
Intraoperative urinary output and postoperative blood urea nitrogen and creatinine levels in patients undergoing aortic reconstructive surgery.
Urinary output has been used as a measure of adequate renal perfusion during anesthesia and surgery. In this study, 40 consecutive patients undergoing elective aortic reconstruction were studied to determine whether intraoperative urinary output was predictive of postoperative renal function as measured by blood urea nitrogen (BUN) and creatinine concentrations on postoperative days 1, 3 and 6, or 7. Pulmonary capillary wedge pressures or central venous pressures were kept at or above preoperative values. All patients received 22.5 g of mannitol IV prior to aortic crossclamping. No significant correlation was noted between either mean intraoperative urine output or lowest hourly urine output and postoperative BUN and creatinine concentrations. Complete interruption of renal blood flow in nine of the 40 patients had no significant effect on the correlations. Consequently, intraoperative urine output does not appear predictive of postoperative renal insufficiency in patients undergoing elective aortic reconstruction.
Tissue-specific regulatory differences for the alcohol dehydrogenase genes of Hawaiian Drosophila are conserved in Drosophila melanogaster transformants.
Naturally occurring regulatory variation is a source of genetic variability that is well documented but poorly understood. Two members of the Hawaiian picture-winged Drosophila, D. affinidisjuncta and D. hawaiiensis, display markedly different levels of alcohol dehydrogenase (alcohol: NAD+ oxidoreductase, EC 1.1.1.1) in the larval midgut and Malpighian tubules. To analyze the regulation of the alcohol dehydrogenase genes from these two species, their homologous alcohol dehydrogenase genes were cloned and introduced, via P element-mediated transformation, into the germ line of Drosophila melanogaster. Histochemical and electrophoretic analyses of larval transformants demonstrate that major differences in the tissue-specific levels of alcohol dehydrogenase production are characteristic of the alcohol dehydrogenase genes themselves. While these results do not directly address possible species-specific differences in the tissue distribution of trans-acting regulatory components, they indicate that demonstrable differences in cis-dominant regulatory information are sufficient to account for the observed regulatory variation.
Prevention of blood-borne infections in anesthesia personnel.
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Laboratory diagnosis of peritonitis in patients on continuous ambulatory peritoneal dialysis.
The clinical course and laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis was studied in 32 consecutive episodes. Peritonitis was associated with a failure in aseptic technique in eight episodes and with an exit-site infection in four episodes. Intraperitoneal vancomycin and ceftazidime were safe, effective, and convenient. Most patients administered their antibiotics at home, and symptoms usually resolved by day 4. Culture of the deposit obtained by centrifugation of 50 ml of effluent after leukocyte lysis provided the best rate of recovery (84% culture positive) but was technically demanding. Filtration of the same volume without leukocyte lysis was simple to perform and almost as effective. Enrichment was less satisfactory (65% culture positive) owing to the presence of antibiotic or infection with fastidious microorganisms. Culture of 50 ml of effluent after concentration by a commonly used laboratory technique, centrifugation without leukocyte lysis, performed poorly (59% culture positive at 48 h), as this method caused sequestration and death of microorganisms within the leukocytes. Culture of nearly 1 liter of effluent from 33 asymptomatic patients by the same techniques yielded no microorganisms.
Medical care costs of patients with acquired immunodeficiency syndrome in Richmond, Va. A quantitative analysis.
This study examines inpatient charges for 52 adult patients with the acquired immunodeficiency syndrome (AIDS) who had 102 admissions to the Medical College of Virginia Hospitals, Richmond, from October 1983 through December 1986. Complete charge data were available for 81 hospitalizations; the mean charge per hospitalization was +13,830 (SD, +13,610), the average length of stay was 14.8 days (SD, 13.1 days), and the mean per diem charge was +1058 (SD, +802). For patients who received all their AIDS-related medical care at the Medical College of Virginia Hospitals, total lifetime hospital charges averaged +27,264, the mean number of hospital stays was 2.29, and the average length of stay was 12 days. The average length of hospital stay, total charges per hospitalization, and average charge per day of hospitalization decreased over the study period. These findings suggest that inpatient costs of treating individual patients with AIDS are less than initially estimated and are decreasing due to the ability to more effectively manage these patients.