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Biomedical subjects

A Steiner

Publications and source records attributed to A Steiner.

At least 271 records · Page 15Linked to original sources
PubMedDate not supplied

Economic evaluation and the shifting balance towards primary care: definitions, evidence and methodological issues.

Current UK government policy places considerable emphasis on shifting the balance of health care provision from secondary towards primary care. Despite this emphasis, however, there has been very little economic evaluation of initiatives designed to achieve this shift. In view of this deficiency, our article has three main aims. First, it offers a working definition of shifts in the balance of care at the primary-secondary care interface. Second, it systematically reviews the existing literature on the cost-effectiveness of initiatives designed to shift the balance of care. Third, it identifies a range of methodological issues that need to be addressed if future economic evaluations in this area are to be carried out satisfactorily.

Costs and Cost Analysis↗
PubMedDate not supplied

Demonstration of luteotrophic responses of human recombinant gamma interferon in porcine corpora lutea using an in-vivo microdialysis system.

Conceptuses from several mammalian species prior to implantation secrete proteins belonging to the family of interferons. The main species of interferons known to be secreted by the pig blastocyst is interferon gamma (IFNgamma), the precise role of which is unclear. We decided to explore its effects on corpus luteum (CL) function using the novel microdialysis technique in vivo. Six cycling miniature pigs were monitored for estrus by daily plasma progesterone analysis and visual symptoms. On day nine of the cycle (day zero being the day of ovulation) the animals underwent surgery, and microdialysis tubing (vitafiber, Amicon U.S.A, cut off mol. wt. 1 million) were implanted in 17 corpora lutea. The inlets and outlets of all tubings were exteriorized and the entry and exit points of tubings in the CLs sealed with tissue glue. The afferent extension tubings were connected to a fraction collector and the system was continuously flushed with Ringer at a flow rate of 2.4 ml/h. After an initial flushout phase of 8 h, fractions were collected every half hour over 3 days. On days 10, 11 and 12 post estrus 12 CLs were stimulated for 4 h with 10(-7) M, 2 x 10(7) M and 4 x 10(-7) M human recombinant IFNgamma (Pharma Biotechnologie) respectively. Simultaneously, fractions were also collected from the remaining five unstimulated corpora lutea which served as controls. Progesterone concentrations in the dialysates were estimated by a sensitive enzymeimmunoassay (EIA). A significant increase (P < 0.01) in progesterone release was observed in all 3 days following stimulation. The progesterone increase was more marked on the first day of stimulation (1 x 10[-7] M) with the hormone levels rising further even after the end of stimulation. The overall increase in progesterone concentration was 2-fold on day 10 in comparison to 15-30% on subsequent days even though IFN concentrations for stimulation were 2- and 4-fold higher. In the unstimulated CLs, a gradual decline (P < 0.01) in progesterone levels were observed over days. In conclusion, these data provide evidence that the early conceptus signals its presence by way of IFNgamma to maintain the CL in pigs.

Animals↗
PubMedDate not supplied

Long-term results of bovine mandibular fractures involving the molar teeth.

OBJECTIVE: To evaluate postoperative complications and long-term outcome of simple mandibular fractures involving the molar teeth in cattle. ANIMAL POPULATION: Seventeen cattle with mandibular fractures involving the molar teeth with disruption of the occlusal surface. METHODS: Treatment consisted of application of AO/ASIF-Pinless External Fixators (Synthes, Paoli, PA) in 14 cows, interdental wire stabilization in 1 cow, and conservative treatment in 2 cows. Long-term outcome was determined by telephone contact with the owners, and whenever possible, cows were reevaluated by physical, intraoral, and radiographic examination of the fracture site. RESULTS: Loosening of the fixation device (4 cattle) and bone sequestration (11 cattle) were the most commonly encountered complications. Oral incontinence during rumination was a minor complication in 1 cow. The mean (+/- SD) time the cattle were in production was 26 (+/- 14) months, with 10 cows still alive at follow-up examination; 9 cows were reevaluated. On intraoral examination there was a step in the occlusal surface at the level of the healed fracture site in 3 cows, wave and shear mouth formation in 3 cows, and enamel point formation in 1 cow. Radiographically, all the reevaluated fractures had healed, and there were no signs of tooth root infection. CONCLUSIONS: Complications during healing were bone sequestration and loosening of the fixator. None of the cows was removed from production because of fracture-associated complications, but decreased milk yield occurred in 2 cows. Tooth abnormalities developed in 6 cows, but function of the mandible was not altered. CLINICAL RELEVANCE: Mandible fractures involving the molar teeth carry a good prognosis for return to normal function. Radiographic follow-up is necessary to detect bone sequestration.

Animals↗
PubMedDate not supplied

Marsupialization of umbilical vein abscesses with involvement of the liver in 13 calves.

Omphalophlebitis with liver involvement was diagnosed by ultrasonography in 13 calves. In the initial surgical procedure, the infected umbilical vein was marsupialized by cranial translocation in a median celiotomy and was flushed daily until healing occurred. In a second surgical procedure, the contracted umbilical vein was removed. Nine calves were clinically healthy after treatment. One had reformation of two abscesses because of inadequate post-surgical treatment. One calf was euthanatized because of an intussusception of the small intestine, and two calves had adverse reactions and developed septic shock when some of the lavage fluid, which was applied under pressure, entered the systemic circulation. It was concluded that umbilical vein abscesses should not be flushed under pressure in calves younger than 2 months of age. The principal advantages of cranial translocation of the umbilical vein in a median celiotomy are that only one abdominal incision is required and that the infected umbilical vein tissue does not have to be passed intraabdominally to a paramedian position.

Abscess↗
PubMedDate not supplied

A comparative review of the adverse effects of treatments for hyperlipidaemia.

Various lipid-lowering drugs have been shown to reduce serum cholesterol and serum triglycerides effectively. In view of trials indicating that lipid-lowering drugs may reduce cardiac morbidity and mortality but not the overall mortality in the study group, increased attention must be focused on potential harmful side effects during treatment with these agents. The adverse effects of many of the principal drugs in this category are discussed. Gastrointestinal symptoms, usually self-limited and reversible, are the most common side effects. Potential harmful adverse effects include drug interactions (cholestyramine), myopathy and hepatic injury (HMG-CoA reductase inhibitors), and increased gallstone formation and ventricular arrhythmias (clofibrate). Not all lipid-lowering drugs have been studied adequately on a long term basis, so that medications given for an indefinite period must be reevaluated frequently. However, there are several agents that lower serum lipid levels effectively and that have been used for more than 20 years without serious side effects.

Cholestyramine Resin↗
PubMedDate not supplied

Immunohistochemical localization of cyclic nucleotides during testicular development.

The potential role of cyclic nucleotides in rat testicular development was evaluated by measuring tissue levels of cyclic AMP and cyclic GMP during a time of rapid testicular growth. The levels of the nucleotides were correlated with their distribution in various cell types as well as intracellularly by an immunocytochemical technique. The concentration of cyclic AMP was high during the infantile phase, fell steadily to a nadir prior to puberty and then increased through sexual maturation. Cyclic GMP levels were also elevated during the infantile phase and decreased steadily through sexual maturation. Early in development the distribution patterns for the two cyclic nucleotides were quite similar with fluorescence in almost all cell types. With maturation, cyclic AMP was localized within tubules, primarily in Sertoli cells and spermatogenia, and was observed in cells in the intertubular area. In the mature testis, cyclic GMP fluorescence was associated with cells representative of most stages of spermatogenesis. Cyclic GMP was localized in nuclear elements of many cell types: in nucleoli of Sertoli cells, spermatogonia and of cells in the intertubular area. Staining was also observed along pachytene chromosomes and in a reticular nuclear pattern in a number of cell types. Cyclic AMP was seen in nuclear elements of certain cells, particularly early in testicular development, but the staining pattern was more indistinct than that of cyclic GMP. The distribution patterns of nucleotides at several stages of testicular development suggest that these compounds may be associated with cellular events related to hormone-dependent maturation of the testis.

Aging↗
PubMedDate not supplied

Improvement of the diagnostic accuracy in pigmented skin lesions by epiluminescent light microscopy.

Epiluminescent light microscopy (ELM) represents a technique which permits to examine details of the surface of the skin and also--in by using the oil immersion technique--of the dermal-epidermal junction zone. Criteria are described which allow the distinction of benign from malignant growth patterns of pigmented skin lesions; thus ELM adds considerably to the diagnostic armamentarium of pigmented skin lesions at the clinical level.

Humans↗