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Biomedical subjects

B Frank

Publications and source records attributed to B Frank.

At least 19 recordsLinked to original sources
PubMed1997

Is duplex venous surveillance worthwhile after arthroplasty?

Deep venous thrombosis (DVT) complicates 60% of knee and 80% of hip arthroplasties performed without prophylactic therapy. Routine postoperative duplex ultrasound surveillance has been proposed for the detection of venous thrombosis following arthroplasty. In order to determine whether surveillance represents an effective strategy to detect postoperative DVT when prophylaxis is used, surveillance duplex exams obtained after primary or revision hip or knee arthroplasty were analyzed using decision analysis techniques. DVT was suspected clinically after 95 of 738 (13%) arthroplasties, with no symptoms suggestive of DVT after the remaining 643 procedures. Surveillance duplex scans were performed within 2 weeks of 371 procedures, while no surveillance studies were performed after the remaining 272 procedures. In these asymptomatic patients only 2 (0.5%) surveillance duplex studies were positive for DVT. In contrast, 4 of 37 (11%) duplex exams and 5 of 62 (8%) contrast phlebograms performed among symptomatic patients were positive for DVT. The overall incidence of DVT after arthroplasty in the entire population was 1.4% (10/738) with no pulmonary emboli. Patient follow-up averaged 162 +/- 285 days. Using the 1995 Medicare reimbursement of $163 for venous duplex, the incremental cost was $35,000 to detect 1 additional unsuspected DVT and $110,000 per additional quality-adjusted life-year gained. The low incidence of clinically significant DVT and pulmonary emboli with current prophylaxis does not justify an aggressive screening program. Decision analysis suggests that a greater incidence of DVT is required for screening to be worthwhile.

Adolescent↗
PubMed1997

Polymyositis with cytochrome oxidase negative muscle fibres. Early quadriceps weakness and poor response to immunosuppressive therapy.

We evaluated 10 patients with histologically typical polymyositis except for an excess of muscle fibres with absent cytochrome oxidase (COX) staining. No biopsies had vacuoles or congophilic material in muscle fibres. All patients presented with a history of slowly progressive weakness. The average age of onset was 9 years older than a group of polymyositis patients with normal COX staining of muscle fibres. Selective weakness of knee extension was a prominent and disabling feature in most patients. Serum creatine kinase was usually mildly elevated (363 +/- 115 U/l) but at levels lower than those in other patients with polymyositis. Mitochondrial DNA analysis showed multiple deletions in 90% of muscles from patients with excessive numbers of COX-negative muscle fibres, a prevalence significantly greater than the 22% figure for controls (P = 0.005). As a group, the patients responded poorly to immunosuppressive therapy. We conclude that patients with polymyositis and an excess of COX-negative muscle fibres, but no inclusion bodies, have common features including selective quadriceps weakness, mitochondrial pathology by histochemical and DNA analysis and a poor response to immunosuppressive therapy. Some of these features are shared with inclusion body myositis (IBM) and this entity cannot be entirely excluded as vacuoles may not be present in all muscle tissue in IBM patients. Evaluation of the COX activity in muscle fibres of patients with inflammatory myopathies provides useful prognostic information regarding the likelihood of improved strength after immunosuppressive treatment.

DNA, Mitochondrial↗
PubMed1996

Cocaine trends and other drug trends in New York City, 1986-1994.

Cocaine, mainly in the form of crack, continues to dominate New York City's illicit drug scene. Trends in cocaine-involved deaths, hospital emergencies, arrest and treatment admissions are reviewed from the late 1980s to the early 1990s. Also, street studies conducted at drug coping areas throughout New York City during this period yield ethnographic insights. At the same time that cocaine trends were showing increases in the 1990s, heroin trends and marijuana trends were also showing decisive increases. An upsurge in heroin activity may be directly related to cocaine activity. Heroin's ameliorative effects for the cocaine user are the most direct association. The sequence-first cocaine, then heroin-has been documented by historians in the field. The association between cocaine trends and marijuana trends is less direct, and may represent the substitution of or a retreat to marijuana, a drug that is perceived as much safer.

Cocaine↗
PubMed1996

Report of the American Diabetes Association's Task Force on standardization of the insulin assay.

Recent large-scale epidemiological studies demonstrate that blood concentrations of immunoreactive insulin predict the development of NIDDM and IDDM and are associated with the risk of several degenerative diseases, such as coronary and peripheral vessel atherosclerosis, hypertension, and dyslipidemia. The reliability of these measurements is dependent on a biological assay that has not been well standardized between laboratories. Recognizing this, the American Diabetes Association organized a task force to assess comparability of blood insulin measurements between laboratories and to suggest techniques to improve comparability. The task force found that identical serum and plasma samples measured in different laboratories produced widely disparate values that were unacceptable for population comparisons. Use of a single reference standard did little to improve comparability. Assay characteristics such as linearity, recovery, accuracy, and cross-reactivity to proinsulin and its primary conversion intermediates varied among the laboratories, and they did not readily explain differences in the measurements made from assay to assay. Use of the same assay kit in different laboratories did not always ensure comparable measurements. Linear regression of assay results from one laboratory to an arbitrarily chosen reference assay greatly improved comparability and demonstrated the potential value in comparing each assay to a reference method. The task force report defines acceptable assay characteristics and proposes a three-step process of insulin assay proficiency and comparability. A central reference assay and ongoing sample exchange will be needed to allow reliable comparisons of insulin measurements made in different laboratories. Rigorous quality control and continuous quality improvement are needed to maintain reliability of the insulin measurement.

Diabetes Mellitus↗
PubMed1996

Sole haemorrhages in tied heifers in early gestation as an indicator of laminitis: effects of diet and flooring.

The influence of feeding a high concentrate diet and of different types of floor surface on the prevalence and severity of haemorrhages of the sole horn was studied in 60 Swedish Friesian heifers during early pregnancy. For 4 weeks, out of a total observation period of 17 weeks, half the animals were offered 6.5 kg/day of concentrates while the others were fed a standard diet consisting mainly of roughage. Half the animals were kept on rubber mats and half on a concrete floor. The hooves were trimmed and the soles were photographed at the start and at the end of the experiment. The photographs were evaluated, each claw was scored for sole haemorrhages, and the total score for all 8 claws was calculated. No differences were observed between the groups in the scores of sole haemorrhages at any trimming. The scores were significantly higher at the first than at the second trimming, probably as a consequence of an abrupt change of floor surface 2-3 months before the first trimming. The study provides indirect evidence that events relating specifically to calving are likely to be crucial risk factors for sole haemorrhages and laminitis.

Animal Feed↗
PubMed1996

Sole haemorrhages in tied primiparous cows as an indicator of periparturient laminitis: effects of diet, flooring and season.

Fifty-six tied heifers calving in autumn (trial I) and 21 tied heifers calving in late spring (trial II) were fed either a high or a low concentrate diet from 3 weeks before expected calving until 13 weeks after calving. Half the heifers in trial I were kept on concrete floors and the others were kept on rubber mats; all the heifers in trial II were on concrete floors. The hooves were trimmed and the soles were photographed 3 weeks before expected calving and again 13 weeks after calving. The photographs were evaluated, each claw was scored for sole haemorrhages, and the total score for all 8 claws was calculated. Before calving there were no differences between the groups of heifers within trial I or trial II, but the heifers in trial II had higher scores than those in trial I. Thirteen weeks after calving the scores had increased in both trials. In trials I the animals fed the high concentrate diet and kept on concrete floors had the highest score, and the type of floor had a greater influence than the level of concentrates fed. The heifers calving in the autumn had higher scores than those calving in the spring. The sudden change from being at pasture to being housed, and the events related to the periparturient period were the most significant factors for the development of sole haemorrhages.

Animal Feed↗
PubMed1995

Laser-excited fluorescence studies of mitochondrial function in saponin-skinned skeletal muscle fibers of patients with chronic progressive external ophthalmoplegia.

The functional behavior of mitochondria in skeletal muscle of patients with chronic progressive external ophthalmoplegia was studied by laser-excited fluorescence measurements of NAD(P)H and flavoproteins in saponin-skinned fibers. Variations in the mitochondrial content and the presence of partially respiratory chain-inhibited mitochondria can be detected using this novel method.

DNA, Mitochondrial↗
PubMed1995

One-stage surgery of coronary arteries and abdominal aorta in patients with impaired left ventricular function.

BACKGROUND: Coronary artery disease (CAD) is common in patients with abdominal aortic aneurysms (AAA). Some patients will present with the combination of unstable angina, impaired left ventricular function, and a large symptomatic (ie, leaking, expanding) AAA. In this subgroup of high-risk patients, aortic cross-clamping may have a deleterious effect on cardiac function, whereas coronary artery bypass graft surgery before aneurysmectomy (staged operation) carries the risk of perioperative aneurysm rupture. One-stage surgery, ie, myocardial revascularization and simultaneous aortic aneurysm repair, has been proposed in this situation. This article summarizes our results with the combined one-stage approach in patients with symptomatic CAD, impaired left ventricular function, and large symptomatic aortic aneurysms or severe aortic occlusive disease. As yet, this cohort is the largest reported in the English literature. METHODS AND RESULTS: In 25 patients (24 men) with a mean age of 69.4 years (range, 55 to 80 years), we performed combined open heart and intra-abdominal aortic surgery. Eighteen patients had severe three-vessel disease and impaired left ventricular function (ejection fraction, < 35%). In addition, 3 of these patients had severe aortic valvular stenosis and/or insufficiency. Seven patients had one- or two-vessel disease with a low left ventricular ejection fraction in the range of 15% to 30%. All patients were in New York Heart Association functional class III or IV. Twenty-one of 25 patients had symptomatic infrarenal AAA (perianeurysm hematoma was present in 9 patients, and 12 patients had signs of beginning perforation). Four patients with aortoiliac occlusive disease and limb ischemia were simultaneously operated on. The surgical procedure started with the performance of coronary artery bypass graft surgery. After completion of myocardial revascularization, aortic aneurysm repair was performed while extracorporeal circulation was continued for mechanical cardiac assist until aortic surgery was fully accomplished. An average of 3.3 (3 to 5) coronary bypass grafts were placed, including 17 internal thoracic artery grafts. In addition, three aortic valves were replaced. In the abdominal aortic position, 12 straight tube grafts and 13 bifurcation grafts were implanted, and three renal and two carotid arteries were simultaneously repaired. The total time of surgery varied from 2.3 to 8.5 hours, with a mean time of 3.9 +/- 1.4 hours. One intraoperative myocardial infarction occurred despite open grafts. Intensive care unit treatment lasted 1 to 13 days, with a mean of 3.6 +/- 2.5 days. Three patients (12%) died after surgery--1 because of acute renal failure induced by an adverse reaction to heparin, 1 because of myocardial infarction, and 1 because of multiorgan failure. One-year actuarial survival rate was 88%, which compares favorably with survival after isolated AAA surgery in this high-risk patient subgroup and equals survival in patients with severe CAD and severely depressed myocardial function. CONCLUSIONS: One-stage surgery is a possible approach to highly symptomatic patients with severe multivascular disease and has acceptable early morbidity and mortality. Patients with severely impaired left ventricular function and unstable CAD carry a high risk of left heart failure and/or myocardial infarction during abdominal aortic surgery. Extracorporeal circulation protects the heart from the hemodynamic changes after aortic clamping or declamping during abdominal aortic surgery. The present study demonstrates that one-stage procedure is a reasonable option for this patient subgroup.

Aged↗
PubMed1995

Changes in health behaviors made by pregnant substance users.

A descriptive survey was conducted with 31 pregnant women who were substance users enrolled in a perinatal treatment program. The purpose of the study was to determine the women's health behaviors by using open-ended questions. Most of the women were between 20 and 29 years of age, Hispanic, not married, unemployed, and had partial or completed high-school education. The women had multiple pregnancies with few living children. The majority of the women were 4 to 6 months pregnant and all had received prenatal care. The women made health behavior changes during pregnancy related to nutrition, substance use, self-care, exercise, lifestyle, and seeking counseling. Over 52% of the women reported they made these behavioral changes because they wanted a healthy baby.

Adolescent↗
PubMed1995

[Determining patient staff with regard to needs and requirement profile for neuropsychologists, speech therapists and occupational therapists of acute care neurologic clinics in Germany].

The directors of neurological emergency-care departments were asked about the number and work profile of psychologists, occupational and speech therapists in their institutions. A majority of departments in West Germany employed their own speech and occupational therapists. In East Germany, a majority had their own psychology service. Work profiles and demands for personnel did not differ between the East and West. On the basis of the results, recommendations are made for the number of therapists required in neurological emergency-care departments.

Acute Disease↗
PubMed1994

Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992.

OBJECTIVES: To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. DESIGN AND SETTING: Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. PARTICIPANTS: Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. INTERVENTIONS: Community-based AIDS prevention programs, including underground syringe exchanges. MAIN OUTCOME MEASURES: Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. RESULTS: The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. CONCLUSIONS: The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission.

Adult↗
PubMed1993

Needs assessment in substance misuse: a comparison of approaches and case study.

Public policy practitioners are often confronted with the problem of "needs assessment." But needs can be defined and measured in many ways, and often in pursuit of fundamentally different ends. This paper provides a brief paradigmatic comparison of two alternative approaches to the problem of needs assessment in the area of substance misuse, and it concludes with a case study describing the implementation of a model developed by the New York State Division of Substance Abuse Services.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Phantom perception and phantom pain].

"Phantom limb" is a well-known phenomenon following loss or amputation of a limb. The limb still seems to be present, although it is no longer there, but the sensation is not associated with pain. Less well-known are the phenomena of autosomatognosis and pain after the loss of other parts of the body such as the genital parts or after partial or complete deafferentiations as in a traumatic transverse syndrome, lesion of the brachial plexus, or lesions of the CNS. Although many hypotheses have been advanced to explain the pathophysiological mechanisms resulting in these phenomena, the pathogenetic fundamentals have not been properly clarified to date. That is also why manifold approaches have evolved to treat phantom limb pain. The authors survey the literature published so far on this subject and report on their own studies. This gives an overall view of the many aspects of autosomatognosis, phantom limb pain, hypotheses on pathophysiology, and the currently employed treatment strategies.

Afferent Pathways↗
PubMed1992

Renal cortical endosomes participate in the degradation of insulin.

It has long been thought that metabolism of insulin by kidney proximal tubule cells takes place only in lysosomes. But previous studies with the perfused rat kidney and a proximal tubule-like cultured kidney cell line suggested that insulin degradation occurred in a nonlysosomal compartment. In this study we show that endosomes isolated from rat kidney cortex degrade insulin and that this process is ATP and pH dependent.

Adenosine Triphosphate↗