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Biomedical subjects

A Zimmerman

Publications and source records attributed to A Zimmerman.

At least 19 recordsLinked to original sources
PubMed2006

Assessment of pancreatic malignancy with laparoscopy and intraoperative ultrasound.

BACKGROUND: Staging laparoscopy for pancreatic malignancy is controversial. This study aimed to assess the efficacy of laparoscopy with intraoperative ultrasound in the management of patients with pancreatic carcinoma. METHODS: The study involved patients undergoing laparoscopy and intraoperative ultrasound over a period of 42 months. The entry criteria specified radiologic (computed tomography) diagnosis of pancreatic carcinoma and no evidence of metastases. RESULTS: The study enrolled 100 patients (52 men and 48 women) ages 21 to 83 years (mean, 63 years). On the basis of imaging, 75 patients had lesions judged to be operable, and 25 patients had a pancreatic head lesion larger than 4 cm radiologically, considered to be unresectable, but with no evidence of metastatic disease. At laparoscopy, three patients had a normal examination, with no evidence of a pancreatic mass, and an additional seven patients had other pathology including one lymphoma, one ampullary tumor, two cases of chronic pancreatitis, and three sarcomas. Of the patients with radiologically inoperable disease, 16% had previously undetected metastases, but 24% were judged to be suitable for curative resection. Half of these patients underwent successful resection. Of the patients with radiologically operable disease, undetected liver or peritoneal metastases were found in 20% of the body or tail lesions and in 26% of the pancreatic head lesions. Of the pancreatic head tumors, 12% were found to be larger than 4 cm and therefore unsuitable for curative resection. Consequently, only 53% were confirmed to be suitable for resection. Of the patients explored with a view to curative resection, 42% actually underwent resection, with clearance of resection margins achieved in 77.8%. CONCLUSION: Of the patients thought to have a resectable tumor on the basis of good quality preoperative imaging, 44% had their management approach altered after laparoscopy and avoided an open procedure. Laparoscopy should therefore be used in the preoperative staging of pancreatic tumors.

Adult↗
PubMed2005

Staphylococcus aureus positive for Panton-Valentine leukocidin genes but susceptible to methicillin in patients with furuncles.

A total of 75 Staphylococcus aureus isolates obtained from patients with either recurrent skin abscesses or furuncles (n=48) or chronic infections from other body sites (n=27) were screened for the presence of the lukS-PV and lukF-PV genes encoding Panton-Valentine leukocidin. Significantly more isolates (70.8% vs. 7.4%, p<0.001) from patients suffering skin abscesses or furuncles were positive for lukS-PV and lukF-PV. These isolates belonged to the accessory gene regulator (agr) group Ia (9/48), group III (13/48), or group IV (19/48). In contrast with results of other investigations, none of the isolates positive for the Panton-Valentine leukocidin genes in this study exhibited methicillin resistance.

Abscess↗
PubMed2002

Laminaria dilatation and evacuation for pregnancies with mid-trimester premature rupture of membranes: a retrospective cohort study.

OBJECTIVE: To assess the efficacy and risk of chorioamnionitis with laminaria tents and uterine evacuation in patients with mid-trimester premature rupture of membrane (MPROM). STUDY DESIGN: A retrospective cohort study of 34 women, admitted between January 1995 and May 1999 with confirmed mid-trimester (14-23 weeks) PROM and 34 controls matched for gestational age, undergoing elective termination. All women underwent cervical dilatation by the use of laminaria tents followed by uterine evacuation (D approximately equals E). Perioperative complications were retrieved from the medical records and long-term ones by telephone questionnaire. RESULTS: Apart from one case requiring a change in antibiotic, no short- or long-term complications were reported. Although, in 8 out of 19 study cases (42%) endocervix culture was positive. The number of laminaria tents used was similar in both groups. The future pregnancy rate was higher in the study group but included four early spontaneous abortions and one ectopic pregnancy. CONCLUSION: Evacuation of uterus following cervical dilatation by laminaria tents in patients presenting with MPROM is safe, and probably not associated with future adverse pregnancy outcome.

Abortion, Induced↗
PubMed2001

Impact of a targeted asthma intervention program on treatment costs in patients with asthma.

OBJECTIVE: To evaluate the impact of a targeted asthma intervention on treatment costs, utilization of medical services, number of prescription drugs filled, and trends of medication use from a third-party perspective. STUDY DESIGN: Longitudinal population-based study. METHODS: Study asthmatic patients were classified into intermittent and persistent asthma groups according to the Health Plan Employer Data and Information Set (HEDIS) 2000 asthma measurement. The intervention instituted appropriate asthma drug therapy according to National Heart, Lung, and Blood Institute guidelines. A paired t test and analysis of covariance were used to compare treatment costs and the number of prescriptions dispensed in the 9 months before and the 9 months after the intervention. RESULTS: The study patients (n = 1616) included 566 with intermittent asthma and 1050 with persistent asthma. After the intervention, treatment costs per patient increased significantly by $122 in the intermittent asthma group (P = .001) but decreased significantly by $247 in the persistent asthma group (P < .001). Costs incurred by patients with persistent asthma decreased by $149 for hospitalization (P = .003), $16 for emergency room visits (P < .001), $82 for physician visits (P < .001), and increased by $1 for asthma medications (P = .938). The number of asthma medication prescriptions per patient increased by 0.72 prescriptions in the intermittent asthma group (P < .001), whereas the persistent asthma group had a per patient reduction of 0.99 prescriptions (P < .001). CONCLUSION: A targeted asthma intervention resulted in decreased hospitalization, emergency room, and physician visit costs in patients with persistent asthma.

Adolescent↗
PubMed2001

Sedation in pediatric endoscopy.

The increase in diagnostic, radiologic, and minor surgical procedures performed on pediatric patients outside of the traditional surgical suite setting has resulted in a marked increase in the use of conscious sedation. Not long ago, pediatric gastroenterologists were reticent about using intravenous sedation for pediatric endoscopy. With increased experience, careful screening, and the specialization of pediatric gastroenterology, however, endoscopy can now be performed safely with intravenous sedation on almost all patients.

Anesthesia, General↗
PubMed2000

Analysis of linkage disequilibrium in gamma-aminobutyric acid receptor subunit genes in autistic disorder.

Autistic disorder (AD) is a neurodevelopmental disorder characterized by abnormalities in behavior, communication, and social interactions and functioning. Recently, Cook et al. reported significant linkage disequilibrium with an AD susceptibility locus and a marker, GABRB3 155CA-2, in the gamma-aminobutyric acid(A) (GABA(A)) receptor beta3-subunit gene on chromosome 15q11-q13. This linkage disequilibrium was detected using a multiallelic version of the transmission/disequilibrium test (TDT) in a sample of nuclear families having at least one child with autistic disorder. In an attempt to replicate this finding we tested for linkage disequilibrium with this marker, as well as with three additional markers in and around the GABA(A) receptor beta3-subunit gene, in an independent, clinically comparable set of AD families. Unlike Cook et al., we failed to detect significant linkage disequilibrium between GABRB3 155CA-2 and AD in our sample. We did, however, find suggestive evidence for linkage disequilibrium with a marker, GABRB3, approximately 60 kb beyond the 3' end of beta3-subunit gene. This finding lends support for previous reports implicating the involvement of genes in this region with AD. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:43-48, 2000

Autistic Disorder↗
PubMed1998

Biliary cystadenocarcinoma of the liver: the need for complete resection.

We report on a patient with biliary cystadenocarcinoma and review 112 previously published cases of this rare cystic hepatic neoplasm. This tumour mainly occurs in women at a ratio of 62% (female) to 38% (male), and at an average age of 56.2 years (range 18-88 years). The origin of these neoplasms is intrahepatic in 97% of cases and extrahepatic in the remaining 3%. The clinical symptoms are nonspecific and are not distinctive from benign cystic liver lesions unless invasive growth of the tumour occurs or distant metastases are present. Sonography and computed tomography (CT), as well as magnetic resonance imaging (MRI) demonstrate the multilocular nature of the tumour with septal or mural nodules. Discrete soft tissue masses, thick and coarse calcifications and varying density on CT or intensity on MRI within the loculi are additional non-specific imaging findings. The best therapeutic result with a 5-year survival rate of 100% and a recurrence rate of only 13% was achieved by complete excision (n = 16). Surgical removal of the tumour by complete excision is, therefore, the treatment of choice for biliary cystadenocarcinomas.

Aged↗
PubMed1996

The mouse thymosin beta 4 gene: structure, promoter identification, and chromosome localization.

Thymosin beta 4 (T beta 4) is an actin monomer sequestering protein that may have a critical role in modulating the dynamics of actin polymerization and depolymerization in nonmuscle cells. Its regulatory role is consistent with the many examples of transcriptional regulation of T beta 4 and of tissue-specific expression. Furthermore, lymphocytes have a unique T beta 4 transcript relative to the ubiquitous transcript found in many other tissues and cells. To determine how T beta 4 gene expression is regulated and how the alternative transcripts are derived, we cloned the mouse T beta 4 gene. We established that there is a single mouse T beta 4 gene and found that the lymphoid-specific transcript is generated by extending the ubiquitous exon 1 with an alternate downstream splice site. The transcription start site is defined by primer extension analysis, and the 5'-flanking region has many of the characteristics of a promoter. It is pyrimidine-rich and contains typical promoter elements, including a GC box, an initiator site, and consensus transcription factor binding sites. The mouse T beta 4 gene locus (Ptmb4) is located by interspecific backcross mapping to the distal region of the mouse X chromosome, linked to Btk and Gja6.

Alternative Splicing↗
PubMed1994

Effect of chronic ANG I-converting enzyme inhibition on aging processes. I. Kidney structure and function.

The effect of angiotensin I-converting enzyme inhibition (ACEI) on the age-related changes in the kidney structure and function was investigated in rodents. Normotensive male Wistar (WAG)/Rij rats were treated with perindopril from the age of 6 mo to the day of killing at 12, 24, or 30 mo. Mean blood pressure, constant from 6 to 30 mo, was reduced by 19 mmHg in treated animals. With age, the major functional modifications were a decrease in glomerular filtration rate and in renal blood flow, a rise in intrarenal vascular resistance (IVR), a reduced tubular reabsorption of salts, and a progressive increase in proteinuria. ACEI significantly reduced IVR and proteinuria. From a structural point of view, the glomeruli showed 1) an increase in size, 2) a decrease in capillary surface, 3) a diffuse thickening of the glomerular basement membrane, 4) an expansion of the mesangial matrix, and 5) an accumulation of albumin droplets in podocytes inducing 6) a dispersed focal and segmental glomerulosclerosis which, at 30 mo, affected < 2% of glomeruli. Of these six age-related structural changes, ACEI delayed the appearance of the three latter changes.

Aging↗
PubMed1992

Orbital cellulitis caused by Eikenella corrodens.

Eikenella corrodens is a gram-negative, facultative anaerobic bacillus with specific culture and growth requirements and unusual antibacterial susceptibilities. It has only recently been recognized as a human pathogen. Ocular and adnexal infections with this organism are rare especially in children. We treated two children with orbital cellulitis caused by E. corrodens. One was an 8-year-old boy; the other was an 11-year-old girl. Orbital cellulitis in both patients occurred after an upper respiratory tract infection. Sinusitis and a subperiosteal abscess were present in both patients. Eikenella corrodens and Streptococcus viridans were isolated from the boy; E. corrodens was the sole isolate in the girl. Intravenous ampicillin, prolonged hospitalization, and surgical drainage of the orbit were required to control the infection in both patients. Eikenella corrodens must be considered in the differential diagnosis of orbital cellulitis in children, and ophthalmologists must become familiar with the characteristics of this peculiar organism.

Ampicillin↗
PubMed1991

The paradox of adult respiratory distress syndrome in neonates.

Six full-term newborn infants are described who suffered from severe adult respiratory distress syndrome (ARDS). The triggering event was intrauterine/perinatal asphyxia in five, and group B streptococcal (GBS) septicemia in three. All had severe respiratory distress/failure and were ventilated mechanically with high concentrations of inspired oxygen and positive end-expiratory pressure. Radiography of the chest showed dense bilateral consolidation with air bronchograms and reduced lung volume. Persistent pulmonary hypertension (PPH) was documented in all cases. The coincidence of ARDS and PPH rendered respiratory management extremely difficult. For this reason high-frequency ventilation was instituted in all patients in order to improve CO2 elimination and induce respiratory alkalosis. Acute complications of respiratory therapy were encountered in five patients (pneumothorax, pulmonary interstitial emphysema, pneumopericardium). Three infants died (irreversible septic shock, progressive severe hypoxemia, and sudden cardiac arrest) after 17, 80, and 175 h of life. Histologic examination of the lungs was possible in all fatal cases and revealed typical changes of acute to subacute stages of ARDS. Three infants survived, the mean time of mechanical respiratory support being 703 h. Two patients were still dependent on oxygen after 1 month of life, and all survivors had increased interstitial markings and increased lung volumes on their chest roentgenograms at this time.

Asphyxia Neonatorum↗
PubMed1991

Childhood lead poisoning: a Rhode Island perspective.

The Rhode Island Department of Health recognizes lead exposure as the State's most important environmental health problem. Historically, the program has relied on secondary prevention strategies consisting primarily of screening, case-finding, limited environmental intervention and medical management. While secondary prevention of lead toxicity identifies existing cases in a preclinical stage, it does not prevent exposure to lead hazards. The sources of lead exposure need to be appropriately identified and abated if exposures and re-exposures are to be prevented. Because of the ubiquity of lead and practical limitations of available resources, a large number of children with elevated blood lead levels will continue to go unscreened and undetected unless more effective screening strategies are implemented. Present reliance on the free erythrocyte protoporphyrin (FEP) test as a primary screening tool is recognized as an insensitive way to identify children with blood lead levels below 40 micrograms %. With growing evidence of toxicity and long term health effects associated with blood lead levels in the range between 10 and 40 micrograms %, blood lead analysis will need to become part of the routine method of screening.

Child↗
PubMed1989

Primary lateral sclerosis in a child.

Primary lateral sclerosis (PLS), previously undescribed in children, is characterized by a spastic motor deterioration and pathologic demonstration of corticospinal tract degeneration. We report an infant who, before 12 months of age, developed a progressive motor disease characterized by generalized spasticity. He died at 47 months, and neuropathologic examination revealed only corticospinal tract degeneration. We conclude that this child had typical clinical and pathologic findings for PLS.

Amyotrophic Lateral Sclerosis↗