Deep venous thrombosis in the ED: a case for urgent vena cava filter placement.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
B A Smith
Publications and source records attributed to B A Smith.
Eating disorders: current nutrition therapy and perceived needs in dietetics education and research.
OBJECTIVE: Research was conducted to obtain a profile of nutrition therapy currently in practice for patients with anorexia nervosa, bulimia nervosa, and anorexia/bulimia (mixed diagnosis) and to identify the areas of dietetics education and research regarding eating disorders that need more attention. DESIGN: A cross-sectional correlational survey was conducted by mailing a questionnaire composed of open- and closed-ended questions to US dietitians who work with patients who have eating disorders. SAMPLE: Of 199 dietitians selected from a list of 495 representing all geographic areas of the United States, 117 responded. The list was obtained from a national referral network for eating disorders. STATISTICAL ANALYSIS: chi 2 Analysis was completed on all closed-ended answers. Pearson's correlation coefficient with a value of P < .05 was considered significant. RESULTS: Nutrition therapy administered varied among dietitians treating inpatients, outpatients, and both. Three community groups were identified as most important to reach for prevention of eating disorders: junior high school students, coaches, and parents. Crucial areas of research were perceived by 94 dietitians to be comparative effectiveness of techniques of medical nutrition therapy (n = 55) and of techniques of prevention (n = 26) and increased understanding of etiology in relation to identification of high-risk groups and prevention (n = 21). Dietitians desired further information on multiple topics related to eating disorders. APPLICATION: Medical nutrition therapy for eating disorders is a specialization that requires education and training beyond the minimum required for dietetic registration. Some of the techniques required are unique to this specialization due, in part, to the psychological nature of the disorders. All dietitians, however, must be able to recognize and refer patients with eating disorders; these skills must be included in basic undergraduate programs and internships. This study supports the need for more research concerning the outcomes of nutrition therapy and the effectiveness of prevention programs.
Anorexia Nervosa↗
DNA adduct formation and tumorigenesis in mice during the chronic administration of 4-aminobiphenyl at multiple dose levels.
Recent studies have demonstrated the presence of DNA adducts from 4-aminobiphenyl (4-ABP) in the bladder cells of humans; however, the correlation between the concentration of these adducts and the tumorigenic response is not clear. To help elucidate this relationship, we have investigated DNA adduct formation in experimental animals continuously administered 4-ABP. Male and female BALB/c mice were treated for 28 days with 4-ABP. hydrochloride in their drinking water. DNA adducts in target tissues (liver of females and bladder of males) were identified and quantified by 32P-postlabeling analyses and radioimmunoassays. These results were compared to previously reported tumor incidences obtained from the lifetime administration of 4-ABP hydrochloride. The major adduct observed in both tissues was N-(deoxyguanosin-8-yl)-4-ABP. In the bladders of both sexes and the livers of female mice, adduct levels increased with dose at low doses, but saturation was observed at high doses. In the livers of males, the adduct levels were linearly correlated with dose throughout the entire dose range. A comparison between DNA adducts and tumorigenesis indicated a linear correlation between adduct levels and the incidence of liver tumors in female mice. In the bladders of male mice, however, the relationship was markedly nonlinear. These data suggest that adduct formation alone is insufficient for tumorigenesis in the bladder and that other factors such as cell proliferation are necessary for tumor production.
Aminobiphenyl Compounds↗
Dorsal hand laceration and swelling.
Explore the source record for details and available documents.
Adult↗
Omental pedicle used to manage a large dorsal wound in a dog.
An eight-year-old miniature schnauzer was presented with full thickness skin necrosis over most of the back, probably caused by a chemical burn. Management consisted of debridement, bandaging, hyperbaric oxygen therapy, topical application of tris-EDTA and oral administration of antimicrobials. A pedicle created from the greater omentum was used to fill the wound and provide a vascular bed for a full thickness meshed skin graft. Despite epidermal loss from the majority of the graft, the wound healed with acceptable appearance and function. This is the first clinical case described in the veterinary literature using an omental pedicle in prepare a free skin graft bed.
Animals↗
Vascular changes following mucoperiosteal flap surgery: a fluorescein angiography study in dogs.
This study was undertaken to determine the vascular changes which occur following mucoperiosteal flap surgery where two different suturing techniques were employed. In four healthy adult mongrel dogs, buccal and lingual full-thickness envelope flaps were reflected in the mandibular quadrants following intravicular incisions from the first premolar to the first molar. The flaps were immediately readapted and primary closure was achieved by the horizontal mattress suturing technique in one quadrant and the direct interrupted suturing technique in the contralateral quadrant of each dog. A simple photographic system was developed for recording the in vivo gingival circulation depicted by fluorescein angiography just prior to surgery and then after surgery on days 1, 3, 7, 10, 14, and 21. The flaps were divided into three interproximal and two mid-buccal sites for analysis and the intracapillary and diffusion extent of dye fluorescence was accurately quantified by computerized planimetry. As healing progressed, longitudinal changes relative to presurgical baseline were analyzed by paired t-test. Cross-sectional comparisons utilizing Student t-test allowed for evaluating differences between the two suturing techniques as well as differences between interproximal versus mid-buccal sites at each postsurgical day. It was found that the simple act of raising a mucoperiosteal envelope flap initiates significant vascular trauma. Statistically significant reductions in flap circulation relative to presurgical baseline lasted for at least 3 days but persisted for 7 days at the interproximal sites. Flap diffusion (extravascular leakage) recovered sooner and extended over a significantly greater area of the flap than did intracapillary flap circulation during the early period of healing.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Business growth--a perspective on home health management companies.
Running a home care agency is a complicated business. Many agencies are now turning to home care management companies to help them start up a new agency or make an existing one more efficient. What should home care agencies look for in a management company?
Contract Services↗
Congenital leukemia: comprehensive nursing care for a rare disease: a case study.
Congenital leukemia is a rare hematological disorder. The initial manifestation of the disease may be the presence of blue or gray skin nodules. The presence of these nodules along with hyperleukocytosis, anemia, hepatosplenomegaly, and central nervous system leukemic involvement are characteristic of the disease. Treatment involves the administration of chemotherapy by protocol. Response to the chemotherapy is generally poor. Infants with Down syndrome may have a transient manifestation of leukemia known as a leukemic disorder; this will resolve without chemotherapy. Other neonatal disorders can also mimic congenital leukemia; the infant must be evaluated for these, in addition to the definitive diagnosis made via bone marrow aspiration and examination. There are many nursing care interventions for the infant with suspected congenital leukemia. The family of an infant with a suspected or diagnosed leukemia requires concrete information and psychosocial support because the prognosis for these infants is grave. We describe the level of care and subsequent outcome for a premature infant who was diagnosed with congenital leukemia and treated with chemotherapy in a Level III nursery.
Humans↗
Why healthcare reform may unleash a litigation explosion.
One aspect of healthcare reform that has been largely overlooked is the expansion of antidiscrimination laws far beyond the traditional grounds of race, sex, age, and religion. Added to this is a provision giving individuals the broad right to sue over "government-guaranteed" medical treatment. What are the implications of such sweeping reforms? According to law professor Bradley A. Smith, a new wave of litigation is a real possibility.
Civil Rights↗
Anatomical and biomechanical characteristics of human meniscofemoral ligaments.
The meniscofemoral ligaments (MFL) of 26 human cadaver knees were studied to determine their structural importance. The incidence of at least one MFL in each of the specimens studied was 100%, and 46% of the specimens had both MFL ligaments (Humphry and Wrisberg). Another 23% had a single Humphry ligament, and the remaining 31% had a single Wrisberg ligament. A laser micrometer system was used to measure cross-sectional shape and area. The average cross-sectional areas of the Humphry and Wrisberg ligaments were 7.8 +/- 4.7 mm2 and 6.7 +/- 4.1 mm2, respectively. In specimens with both a Humphry and Wrisberg ligament, the larger ligament area was on average 100% greater than the smaller ligament area. The average ratios of the cross sectional areas of Wrisberg and Humphry to that for the PCL within the same knee were 12.0% +/- 7.7% and 11.9% +/- 5.7%, respectively. The structural properties of the MFL bone-ligament-meniscus complex and the mechanical properties of the MFL midsubstance were determined by uniaxial tensile testing. The average stiffness, ultimate load, and energy absorbed at failure were, respectively, 49.0 +/- 18.4 N/mm, 297.4 +/- 141.4 N and 1125.4 +/- 735.8 N/mm. The tangent modulus between 4% and 7% strain was 355.1 +/- 234.0 MPa. Our findings suggest that the MFL is a significant biomechanical structure in the knee because of its size, stiffness, and strength.
Adult↗
Benefits of health promotion in occupational health.
Explore the source record for details and available documents.
Health Care Costs↗
Cardiopulmonary and arterial baroreflex responses to acute volume expansion during fetal and postnatal development.
Recent studies demonstrated that renal denervation had no effect on the natriuretic response to volume expansion (VE) in fetal sheep, suggesting that the sensitivity of the cardiopulmonary reflex in response to VE is impaired in the fetus. To test this hypothesis, we investigated the renal sympathetic nerve activity (RSNA) and heart rate (HR) responses to 20 and 50% intravascular VE in fetal (130-135 days gestation; term 145 days) (n = 7), newborn (n = 8), and 6- to 8-wk-old sheep (n = 9). Despite similar increases in right atrial pressure (RAP) in the three groups, 20% VE had no significant effect on RSNA and HR in fetal sheep but significantly decreased RSNA in newborn (-22.8 +/- 7.3%) and 6- to 8-wk-old sheep (-32.1 +/- 11.7%). Bradycardic responses to VE were also observed in both newborn (from 237 +/- 6 to 200 +/- 12 beats/min) and 6- to 8-wk-old sheep (from 170 +/- 9 to 140 +/- 9 beats/min). A 50% VE had no significant effect on fetal RSNA and HR, whereas it increased RAP by 6.8 +/- 0.9 mmHg. In addition, we tested the hypothesis that interactions between cardiopulmonary and arterial baroreflexes in response to VE change during development. We found that 20 and 50% VE shifted the RSNA and HR arterial baroreflex response curves to the right in the fetus but had no significant effects on the gain of the arterial baroreflex curves in either fetal, newborn, or 6- to 8-wk-old sheep.(ABSTRACT TRUNCATED AT 250 WORDS)
Aging↗
Role of sympathetic activity in the generation of heart rate and arterial pressure variability in fetal sheep.
Significant fluctuation in heart rate (HR) and arterial pressure occur during fetal life. However, the mechanisms regulating this normal variability are not completely understood. To test the hypothesis that the normal variability in fetal HR and blood pressure are produced by intrinsic fluctuations in sympathetic outflow, we recorded HR, mean arterial blood pressure (MABP), and renal sympathetic nerve activity (RSNA) in conscious, chronically instrumented, near-term fetal sheep (n = 5; 132-137 d of gestation, term being 145 d) and correlated the relationships between RSNA and MABP, and RSNA and HR. RSNA, HR, and MABP were sampled at a frequency of 4 Hz and the values averaged by 5-min blocks over a 4-h period. Linear regression analysis demonstrated a positive correlation between RSNA and both HR and MABP in all five fetuses (p < 0.02). In a second group of fetuses (n = 5), ganglionic blockade with trimethaphan (150-250 mg/kg/min) significantly attenuated (p < 0.05) the coefficients of variation of HR (12.3 +/- 1.9% versus 1.7 +/- 0.6%) and MABP (5.8 +/- 0.6% versus 3.6 +/- 0.5%). These results demonstrate that, in the fetus, fluctuations in HR and MABP are mediated by changes in sympathetic outflow and suggest an important role for the autonomic nervous system in fetal cardiovascular regulation.
Animals↗
Formation of DNA adducts and induction of mutations in rats treated with tumorigenic doses of 1,6-dinitropyrene.
1,6-Dinitropyrene, a component of diesel exhaust, is a lung carcinogen in male F344 rats following a single intrapulmonary administration. In this study, rats were treated with tumorigenic doses of 1,6-dinitropyrene to establish dose-response relationships for the formation of DNA adducts in target (lung) and nontarget (liver) tissues and for the induction of 6-thioguanine-resistant mutations in spleen T-lymphocytes. One week after treatment with 0.3, 1, 3, 10, 30, 100, or 150 micrograms of 1,6-dinitropyrene, dose-responsive DNA binding was measured in lung and liver with binding in the lung being 10-fold higher than in the liver. In the lung, a 2-fold increase in dose resulted in a 1.8-fold increase in DNA binding at treatments up to 30 micrograms of 1,6-dinitropyrene, while in the liver, a 2-fold increase in 1,6-dinitropyrene produced a 2-fold increase in DNA binding at doses up to the 10 micrograms treatment. Higher doses of 1,6-dinitropyrene resulted in proportionally smaller increases in adduct formation in the two tissues. When measured 21 weeks after treatment, mutations in T-lymphocytes increased with doses up to 100 micrograms of 1,6-dinitropyrene, but the response was nonlinear throughout the dose range. These findings indicate that concentrations of 1,6-dinitropyrene that produce a dose-dependent induction of lung tumors also result in a dose-dependent formation of DNA adducts and induction of lymphocyte mutations but that the dose-response curves for DNA binding and mutations are different.
Animals↗
The effect of platelet-derived growth factor on the cellular response of the periodontium: an autoradiographic study on dogs.
Platelet-derived growth factor (PDGF) is a polypeptide growth factor considered to have a role in the proliferation and migration of fibroblasts at a wound healing site. The aim of this investigation was to determine if PDGF, when applied to root surfaces, would stimulate the proliferation of fibroblasts and further enhance regeneration. Six mongrel dogs with healthy periodontia were selected for this study. Using a closed wound surgical model, standardized 4 x 4 mm fenestration defects were created into dentin on the mid-facial of the mesial and distal roots of 4 mandibular posterior teeth in each quadrant. Each defect received either: 1) saline solution (C); 2) expanded polytetrafluoroethylene (ePTFE) membrane; 3) PDGF; or 4) ePTFE + PDGF. 3H-thymidine was administered 1 hour prior to animal sacrifice at 1, 3, and 7 days postsurgery. Each time period included 2 dogs with each dog undergoing the four different treatments. Slides were prepared for autoradiography. 3H-thymidine-labeled cells were counted and results were statistically analyzed using the Bonferroni (Dunn) t test on the SAS program. Results indicated PDGF enhanced fibroblast proliferation when compared to the groups without PDGF. Significant differences (P < 0.05) were noted at day 1 and 7 when PDGF and PDGF + GT were compared to C and GT groups. No significant differences were observed in labeled fibroblasts between the C and GT groups at any time period. These findings suggest that PDGF enhances fibroblast proliferation in early periodontal wound healing, whether used alone or in combination with the ePTFE membrane.
Analysis of Variance↗
Effect of root conditioning on periodontal wound healing with and without guided tissue regeneration: a pilot study. II. Autoradiographic evaluation.
This investigation deals with the proliferation and migration of the progenitor cells during the healing of closed periodontal wounds. Periodontal surgical defects affecting the bone and dentin were created in four mongrel dogs. The defects were treated with topical applications of citric acid, tetracycline, or sterile water with and without the placement of nonresorbable membranes. The dogs were killed at 1, 3, 7, and 21 days after surgery. One hour before they were killed, they were intravenously injected with tritiated thymidine. Tissues were processed and routinely prepared for autoradiographic studies. Labeled cells were counted at the apical, coronal, and central areas of the defects. Results suggested that the citric acid and tetracycline treatments inhibited cellular proliferation at the initial time periods of 1 and 3 days. At 7 and 21 days, differences between citric acid and tetracycline treatments were minimal, and neither showed any advantage over the application of sterile water. The placement of the nonresorbable membrane demonstrated a trend of increased labeling at 21 days for all three treatments.
Acid Etching, Dental↗
Vena caval filters.
The patient with a caval filter poses a challenge to the emergency physician. Key considerations in management are a knowledge of underlying disease processes in this patient population, indications for filter placement, potential early or delayed complications associated with these devices, and appropriate diagnostics and consultation. Diagnostic evaluation should include plain radiographs to evaluate gross structural problems, filter migration, significant filter tilting or angulation, and filter leg span splaying or retraction as well as evidence of visceral perforation or obstruction. Comparison films should be obtained, if possible. Screening laboratory tests to assess coagulation, hematologic, and renal function are indicated. The possibility of recurrent PE and a reassessment of filter protection and anticoagulation status should be considered. Advanced diagnostic imaging tools such as abdominal CT, duplex sonography, and cavography may be needed to elucidate suspected caval filter complications, or suspected new DVT or IVC occlusion. Early consultation is indicated. With new and expanded indications as well as technical improvements in caval filters, increased use of these devices can be anticipated, as can associated complications first seen and evaluated by the emergency medicine physician.
Emergencies↗
The dressing makes the difference. Trial of two modern dressings on venous ulcers.
Despite the plethora of modern dressings available for leg ulcers, and the huge financial and social cost of inappropriately treated ulcers, many are still left virtually untreated. This comparison of two modern dressings illustrates the benefits of using appropriate dressings.
Alginates↗