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Biomedical subjects

A Steiner

Publications and source records attributed to A Steiner.

At least 127 records · Page 7Linked to original sources
PubMed1994

[Patient compliance/noncompliance, determining factors, physician-patient interaction].

In the second part of this three-part review on patient compliance we attempt to outline the term of noncompliance in its various aspects. Noncompliance may arise on one hand by misunderstandings in the communication between physician and patient. Furthermore, compliance can be refused, or the patient may for various reasons be incapable of compliant behaviour. Patients who are aware of the mode of action of a drug usually take their medicine more reliably. The essential factors influencing compliance are explained and discussed. The interaction between patient and physician is, also by its multilayered complexity, an important component of patient compliance.

Adult↗
PubMed1994

[Patient compliance--concept formation, assessment methods].

The topic of patient compliance is presented synoptically in a three-part review. In this first part the definition as well as the methods for the measurement of compliance are treated. Patient compliance is a problem that concerns every physician and patient. The phenomenon is not new and is the term for an old central problem of cooperation between physician and patient. Compliance is the intention to follow a medical advice. Noncompliance is common, occurs in all kinds of diseases and is expensive. There are several methods of different accuracy that allow to assess the extent of compliance or noncompliance, respectively. Direct and indirect procedures are distinguished. Questionnaires offered to patients, 'pill-counting', 'appointment-keeping' as well as registration of drug effects represent indirect methods. The direct approach includes measurement of drugs or metabolites in urine or serum. The next issues feature on factors determining compliance, interactions between physician and patient as well as methods for the determination of compliance.

Adult↗
PubMed1994

Removal of the preputial diverticulum in swine.

A new technique for removal of the preputial diverticulum in swine was performed on 33 sexually intact male potbellied pigs, 12 domestic boar cadavers, and 4 domestic swine (2 sexually intact males and 2 barrows). With each pig under general anesthesia, the body and horns of the diverticulum were everted through the preputial orifice and excised. In some cases, the stump of the diverticulum was sutured. Remaining tissues were allowed to retract through the preputial orifice. The technique was more rapid than the conventional method because skin incision and blunt dissection were unnecessary. Although the technique was developed as a preventive sanitary procedure to accompany routine castration of pet pigs, it has application to domestic swine practice.

Anesthesia, General↗
PubMed1994

Ultrasonographic diagnosis of urachal cyst in three calves.

In 3 calves with irreducible umbilical swelling attributable to urachal cyst, ultrasonography was helpful in establishing a definitive diagnosis. After surgical resection of the persistent urachus, 2 calves recovered without complications. In 1 calf in which the urachus had ruptured subcutaneously during forceful diagnostic palpation, additional surgical debridement of severe skin necrosis, caused by subcutaneous accumulation of urine in the umbilical region, was required. Most irreducible masses of the umbilical area of calves can be classified as attributable to infection, hematoma, or incarcerated umbilical hernia. Urachal cyst should always be considered in the differential diagnosis of an irreducible umbilical mass. Careful palpation of the umbilicus is indicated to avoid the potential complication of iatrogenic rupture of a urachal cyst.

Animals↗
PubMed1994

A home-based geriatric assessment, follow-up and health promotion program: design, methods, and baseline findings from a 3-year randomized clinical trial.

Controlled trials in a number of countries have documented benefits from different types of in-home assessment and treatment programs for various subgroups of elderly persons. We have developed a program to test, using a randomized controlled design, the concepts of in-home comprehensive geriatric assessment (CGA) coupled with follow-up, health education, and preventive care in an urban United States community. The intervention includes yearly in-home CGA by geriatric nurse practitioners (GNPs), who provide, following discussions with physician geriatricians, lists of specific recommendations for health and well-being enhancement. The GNPs provide follow-up visits quarterly and regular telephone contacts to improve compliance. We recruited for our trial 414 home-living subjects aged 75 years and over, 215 randomized to the intervention group and 199 to the control group. Subjects were generally representative of the overall elderly population of the city of Santa Monica, a seaside suburb of Los Angeles. Extensive baseline data (medical, functional, psychosocial and environmental) were collected from subjects prior to randomization, using validated instruments whenever possible. Follow-up data were collected from each subject every 4 months by trained research assistants throughout the 3-year intervention follow-up period. Our study was designed to assess effects of the intervention on the hypothesized outcomes of health status, functional status, psychosocial parameters, and service utilization. Careful documentation of the intervention will enhance our ability to make process-outcome comparisons. Preliminary analysis reveals that the in-home CGA uncovered many important health deficits for most subjects resulting in a number of substantial recommendations. We are confident that when it is completed, this study will succeed in answering important remaining questions about the feasibility and effectiveness of establishing a geriatric in-home prevention and health promotion program in the United States based on principles of CGA.

Aged↗
PubMed1994

Accuracy, alarm limits and rise times of 12 oxygen analysers.

The Comité Européen de Normalisation recently proposed a new standard for 'the particular requirements of oxygen monitors for medical use'. The feasibility of this proposed standard was tested in respect of (1) accuracy of alarm activation (2) accuracy of oxygen display value during both continuous and cyclical gas flows (3) rise time during rapid changes in oxygen concentration in the following 12 analysers: Datex Capnomac II and Servomex 570A (paramagnetic); Brüel & Kjaer 1304 (magnetoacoustic); Criticare Poet II, Multinex, Dräger Oxydig, Dräger PM 8030, Megamed 046A (part of the Megamed 700 ventilator), Ohmeda 5120, Spacelabs Multigas, Teledyne TED 200 (galvanic); Kontron OM 810 (polarographic). All the analysers tested displayed an oxygen reading which was within +/- 3 vol% of the actual oxygen concentrations of the test gases (15, 21, 40, 60 and 100 vol%). A cyclical pressure of between -1.5 to +8 kPa did not affect the measured oxygen concentration as displayed by the Brüel & Kjaer 1304, Datex Capnomac II and Servomex 570A analysers. The remainder, however, showed, depending on their measuring principle, a display error of between -1 and +6 vol%. After exposure to high pressure all the oximeters functioned normally. Some of the tested devices showed more than 2% of deviation between their alarm activation and the preset alarm limits. Only the Kontron OM 810, the Megamed 046A and the Spacelabs Multigas monitors satisfied the requirements at all the tested oxygen concentrations. The time required by the oxygen analyser to display the rise from 29 to 92 vol % after a sudden change of concentration from 21 to 100 vol % O2 is defined as "rise time" and must not, according to the Comité Européen de Normalisation standard proposal, exceed the manufacturers' specification by more than a factor of 1.15.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗
PubMed1994

Application of an artificial neural network in epiluminescence microscopy pattern analysis of pigmented skin lesions: a pilot study.

In vivo epiluminescence microscopy (ELM) is a non-invasive technique which improves the clinical diagnosis of naevi and malignant melanoma by providing diagnostic criteria that cannot be appreciated by the naked eye. The present study investigated whether ELM criteria pattern analysis can be employed in an objective, observer-trained, computer-aided diagnostic system, and whether artificial neural networks (ANN) can be applied to the diagnosis of pigmented skin lesions (PSL). The ELM criteria patterns of 200 PSL oil immersion images (60 common naevi, 60 dysplastic naevi, and 80 malignant melanomas) were analysed using a standardized questionnaire. One hundred randomly assigned PSL were used as a training set for an ANN, the remaining 100 PSL serving as the test set. The ANN was trained by backward propagation according to the histological diagnosis, and its performance was compared with that of human investigators. Out of the test set the human investigators correctly diagnosed 88% of PSL and the ANN 86%. In a dichotomized model comparing common, compound, and dysplastic naevi vs. malignant melanoma, i.e. benign vs. malignant PSL, the sensitivity and specificity of human diagnosis was 95 and 90%, respectively, whereas the sensitivity and specificity of the ANN diagnosis was 95 and 88%. Our data indicate that artificial neural networks can be trained to diagnose PSL at a human expert level, based on patterns provided by ELM criteria. We suggest that this technique offers a new approach to the diagnosis of PSL.

Diagnosis, Computer-Assisted↗
PubMed1994

Colic motor complex of the cecum and proximal loop of the ascending colon observed in an experimental cow with large intestinal obstruction.

Myoelectric activity of the cecum and proximal loop of the ascending colon (PLAC) and the effect of xylazine on motility of this intestinal segment in an experimental cow with large intestinal obstruction are described and compared with the normal motility pattern. During obstruction, three major observations were made in the prestenotic area. (i) Mean spike duration, overall duration of spiking activity (expressed as percentage of total recording time), number of spikes propagated from the cecum towards the obstruction site, and velocity of propagated spikes were substantially increased. (ii) The spike frequency was in the physiologic range. (iii) A single injection of xylazine, administered intravenously at a dose of 0.05 mg/kg markedly reduced the mean spike duration, the overall spiking activity, and the number of propagated spike sequences, and abolished signs of abdominal discomfort. Our data indicate that obstruction of the bovine colon causes a similar pattern of prestenotic hypermotility (colic motor complex) as described for the small intestine of the horse. Xylazine may be a suitable drug to disrupt prestenotic hypermotility and alleviate abdominal discomfort during proximal colonic obstruction in cattle.

Animals↗
PubMed1994

Myoelectric activity of the cecum and proximal loop of the ascending colon in cows.

Six Jersey cows were implanted with 8 pairs of bipolar electrodes: 1 in the jejunum, 1 in the ileum, 3 in the cecum, and 3 in the proximal loop of the ascending colon (PLAC). Myoelectric activity was recorded at 2- to 3-day intervals, 3 times for 8 hours or 4 times for 6 hours, using a computer-based oscillograph and data-acquisition program. Mean (+/- SD) duration of the migrating myoelectric complex (MMC) in the ileum was 84.52 +/- 4.87 minutes. Phases I and II of the MMC lasted significantly (P < 0.05) longer than phase III. Two types (A and B) of cyclic activity were found in the cecum and PLAC. Cyclic activity type A was observed predominantly in the cecum, and type B was observed exclusively in the PLAC. Phase III of the MMC in the ileum was accompanied by hyperactivity type A at the level of the ileocecocolic junction in 60.90 +/- 12.65% of the MMC. Twenty-seven types of orally and aborally propagated spike sequences, involving the cecum and PLAC, were found. They were most frequent when an MMC phase III was observed in the ileum, and least frequent when an MMC phase I was observed in the ileum (P < 0.05). All electrode sites of the cecum and PLAC served as pacemaker areas. Propagated and nonpropagated spikes were found at all electrode sites of the cecum and PLAC. Although propagated spikes lasted significantly (P < 0.05) longer than nonpropagated spikes, a clear distinction on the basis of duration could not be defined between the 2 spike types because broad overlapping of duration existed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Ultrasonography of the umbilicus in calves. Part 2: Ultrasonography, diagnosis and treatment of umbilical diseases.

In 80 calves presented with clinical signs of umbilical disease, the umbilicus was examined by palpation and by ultrasonography using a 5 Mhz or a 7.5 Mhz sector scanner. Diagnosis was confirmed during surgery or at post mortem examination. The various diseases of the intraabdominal umbilical structures found in these calves and the therapeutic procedures performed are described in detail by use of schematic representations, photographs of anatomical preparations, and ultrasonograms. In 29 calves with an enlarged extraabdominal umbilicus, ultrasonographic examination provided additional information to determine the choice of therapy, and it was particularly helpful in calves with irreducible hernias and with umbilical abscesses. In 51 calves with diseases of the intraabdominal umbilical structures, an exact description of the extent of the disease and of the involvement of other structures, as the liver and the urinary bladder, was made possible by ultrasonography. In calves with omphalitis, early recognition of the involvement of intraabdominal umbilical structures could be determined. Umbilical ultrasonography can be performed easily and is a very reliable and informative aid not only in the diagnosis of umbilical disease but also in determining the choice of therapy. Additionally, the owner can be informed in advance about the expense and the prognosis of the planned therapy.

Animals↗
PubMed1994

Estimation of the volume-weighted mean nuclear volume discriminates Spitz's nevi from nodular malignant melanomas.

BACKGROUND: Spitz's nevi are benign melanocytic skin tumors that are usually differentiated from nodular malignant melanomas by histopathologic criteria. Often, however, the architectural pattern and cytologic features of Spitz's nevi and nodular melanomas are similar. Hence, Spitz's nevi may be confused with nodular malignant melanomas at the histopathologic level. EXPERIMENTAL DESIGN: The determination of volume-weighted mean nuclear volume (Vv) uses a technique that permits an unbiased and efficient estimation of nuclear volumes in tissues. In this study, Vv was determined in 13 Spitz's nevi and 14 nodular malignant melanomas to investigate whether this stereologic approach may be of use in the differentiation of these two tumors. Vv was determined by computer-assisted image analysis (IBAS 20, Kontron, Germany) on Feulgen-stained sections using stereologic estimation of the Vv. RESULTS: The Vv (+/- SD) of Spitz's nevi was 491.6 micron3 (SD +/- 175.1), whereas nodular malignant melanomas exhibit a significantly higher (p < 0.001) Vv of 775.2 micron3 (SD +/- 205.4). This difference was even more pronounced when the deeper portions of the lesions (Spitz's nevi: 443.1 micron3, SD +/- 142.4; nodular malignant melanomas: 864.1, SD +/- 169.6) were investigated. In addition, we found that in relation to the depth of the lesions the mean Vv decreased in Spitz's nevi, whereas it increased in nodular melanomas. CONCLUSIONS: We found that (i) nodular malignant melanomas reveal a larger Vv than Spitz's nevi in general, and (ii) in contrast to malignant melanomas, the Vv of nevomelanocytes in Spitz's nevi decreases in the deeper portions of the dermis. Thus, Vv may be regarded as a helpful tool for the differential diagnosis of Spitz's nevi and nodular malignant melanomas.

Cell Nucleus↗
PubMed1993

[Diarrhea, erythema nodosum, arthralgia].

Following antibiotic treatment of febrile tonsillitis, a 20-year old man developed watery diarrhea during military service. He was admitted to the infirmary by the medical officer. During the last year the patient had traveled to Spain. The history of recent food intake was not remarkable. The clinical investigation revealed a slightly tender liver. A markedly elevated ESR, a consecutively developing erythema nodosum on both lower legs and arthralgias opened a broad spectrum of differential diagnoses that are discussed here. Stool cultures grew salmonella typhimurium. The clinical picture, the treatment and possible complications of this salmonellosis are discussed.

Adult↗
PubMed1993

End-to-end anastomosis of the jejunum by use of a biofragmentable anastomosis ring in a calf.

A radiopaque biofragmentable anastomosis ring was used for end-to-end anastomosis in a 3-month-old calf with a nonreducible umbilical hernia and partial small intestinal obstruction. Recovery was normal, and the ring degraded to several small fragments that passed in the feces between days 18 and 26 after surgery. The calf had normal weight gain; thus, it was slaughtered 9 months after surgery. Adhesions were found to involve 60% of the circumference of the intestine at the site of anastomosis. At histologic examination, the muscular layers were bridged by fibrous tissue. Double-contrast radiography revealed that the luminal diameter at the site of anastomosis corresponded exactly to the ID of the biofragmentable anastomosis ring. This was 69% smaller than the ID of healthy small intestine, because the normal intestine had grown substantially during the 9 months after surgery.

Anastomosis, Surgical↗
PubMed1993

Statistical evaluation of epiluminescence microscopy criteria for melanocytic pigmented skin lesions.

BACKGROUND: Epiluminescence microscopy (ELM) is a noninvasive technique by which the clinical diagnosis of pigmented skin lesions (PSL) can be improved. Many ELM criteria have been described, but their significance in the differential diagnosis of PSL has not yet been established. OBJECTIVE: The purpose of this study was to determine the value of ELM criteria in the differential diagnosis of PSL. METHODS: Two hundred one melanocytic PSL (61 common nevi, 60 dysplastic nevi, and 80 melanomas) were investigated with ELM for the presence of certain ELM criteria; their significance was determined by calculating the odds ratios. RESULTS: Individual ELM criteria have different weights of significance in the differential diagnosis of melanocytic PSL. Selected patterns of ELM criteria adjusted to the distinct types of PSL considerably improve the diagnostic accuracy of melanocytic PSL. CONCLUSION: The prevalence of certain distinct ELM criteria in a given melanocytic PSL has statistical value in differential diagnosis.

Confidence Intervals↗
PubMed1993

In vivo epiluminescence microscopy: improvement of early diagnosis of melanoma.

The majority of pigmented skin lesions can be diagnosed correctly on the basis of clinical criteria; however, there remain a surprisingly high number of small pigmented lesions in which the distinction between melanocytic and non-melanocytic and benign and malignant lesions, and thus between melanoma and non-melanoma, is difficult or impossible to make with the naked eye. Epiluminescence microscopy is a non-invasive technique that, by use of oil immersion, makes sub-surface structures of skin accessible for in vivo microscopic examination and thus provides additional criteria for the diagnosis of pigmented lesions. The technique of epiluminescence microscopy is reviewed, and the significant improvement in the clinical diagnosis of pigmented skin lesions and, in particular, melanoma by this technique is documented.

Humans↗
PubMed1993

Human serum albumin conformational changes as induced by tenoxicam and modified by simultaneous diazepam binding.

The binding of tenoxicam to human serum albumin has been shown by affinity chromatography proton titration and equilibrium dialysis to be dependent on the neutral to basic conformational change of the protein. The influence of diazepam on the interaction was also investigated using the same techniques, suggesting that diazepam increases the association of tenoxicam to albumin. Affinity chromatography revealed that the reciprocal effect also occurs. Displacement studies indicated that diazepam causes a significant increase in the affinity of tenoxicam to its main binding site, albumin site I, which is different from the diazepam site (site II). Tenoxicam seemed to cause an allosteric change in the conformation of the protein during its own binding, as did warfarin. The mechanism of this effect was a pH-dependent conformational change of albumin induced by electrostatic forces within the protein. Diazepam induced a distant accommodation of the protein, an effect accompanied by an enhanced inhibition of the release of protons from albumin.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Compliance to treatment.

One major challenge of hypertension management is to achieve a compliance rate as high as possible in order to guarantee a successful long-term antihypertensive therapy. Clinical studies have shown that the drop-out rate may represent an indirect parameter for patient compliance. As having a negative influence on long-term compliance drug related side effects are best known but newer results indicate that there are also other factors like age, sex, psychological features and quality of life do have important influence on compliance. For achieving the therapeutic aim strategies like simple prescription, few concomitant medication and cautious dose-titration have shown to be efficient. Additional blood pressure self-measurement and profound instruction are essential to optimize hypertension management in terms of compliance to treatment.

Antihypertensive Agents↗