[Tuberculosis arthritis of the sternoclavicular joint].
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Aged↗
Biomedical subjects
B Kurtz
Publications and source records attributed to B Kurtz.
Importance of inoculum size and sampling effect in rapid antigen detection for diagnosis of Streptococcus pyogenes pharyngitis.
Current recommendations suggest that negative rapid Streptococcus pyogenes antigen tests be backed up with a culture, reflecting evidence that culture may have a higher sensitivity and also that testing of a second swab may yield a different (i.e., a positive) result because of variation in sample size or distribution. If the latter is common, the sensitivities of current antigen detection tests might be improved by simply increasing the amount of sample tested. The present study assessed the effect of antigen testing of two swabs extracted together compared to independent testing of each swab extracted separately for children with clinical pharyngitis. S. pyogenes grew from one or both swabs for 198 (37%) of 537 children. The combined culture was significantly (P < 0.05) more sensitive than culture of either swab alone. Compared to combined culture, antigen testing of two swabs extracted and tested together was significantly more sensitive than two single swab extractions (94.1 versus 80%; P = 0.03); however, the specificity was decreased (81.5 versus 89.8 to 92.7%; P < 0.05). This study suggests that sample size and/or uneven sample distribution may have influenced the apparent sensitivities of prior studies that compared antigen tests to a single plate culture. A strategy, such as the one used in the present study, that increases the sample size available for antigen testing (i.e., extraction of samples from both swabs) may improve detection rates to a level that will better approximate true disease status and obviate the need for backup cultures if specificity can be improved.
Adolescent↗
Mothers' responses to care given by male nursing students during and after birth.
PURPOSE: To describe the rationale maternity patients use in determining whether to accept care by a male student nurse. Information about the activities that women are comfortable having male nursing students perform is inconsistent and the reasons for women's comfort or discomfort are unclear. Furthermore, little is known about what factors patients consider when assigned a male nursing student. Yet, knowledge of such factors can enhance understanding and guide the selection of students in maternity units. DESIGN: Focused ethnography using a purposive convenience sample of 32 women, aged 20 to 40 years, who spoke English, and who had given birth to normal newborns in one small community hospital in the mid-Atlantic region of the United States. Patients were excluded if they or their infants were in an unstable physical or mental condition. The study was conducted in 1995. METHODS: The women were interviewed using a semi-structured format. FINDINGS: Data from participants pertained to personal and contextual factors. Personal factors were perception of postpartum self and personal feelings. Contextual factors were student characteristics, establishment of relationships, nursing care activities, and partner viewpoint. CONCLUSIONS: Women during and after giving birth have definite thoughts about male student nurses caring for them. Nurse educators should consider these when assigning men. Educators should encourage professionalism and competence in their students.
Adult↗
Expression and cytogenetic localization of the human SM22 gene (TAGLN).
SM22 is a 22-kDa protein identified variously as SM22, transgelin, WS3-10, or mouse p27. Though its precise function is unknown, it is abundant in smooth muscle and so may contribute to the physiology of this widespread tissue. We found that cosmid 16b6 contains the entire 5.4-kb, five-exon human SM22 gene (HGMW-approved symbol, TAGLN), and we cytogenetically localized the gene to chromosome 11q23.2. Northern analysis of human adult tissues showed that SM22 mRNA is most prevalent in smooth muscle-containing tissues, but is also found at lower levels in heart. The human SM22 promoter contains nuclear factor-binding motifs known to regulate transcription in smooth muscle, and human SM22 promoter-luciferase reporter constructs exhibited high transcriptional activity in A7r5 or primary canine aortic smooth muscle cells, but show little activity in nonmuscle COS7 cells. In addition, human SM22 promoter activity increased by two- to threefold upon serum stimulation of nonmuscle cells.
Adult↗
Genome-wide search for asthma susceptibility loci in a founder population. The Collaborative Study on the Genetics of Asthma.
Founder populations offer many advantages for mapping genetic traits, particularly complex traits that are likely to be genetically heterogeneous. To identify genes that influence asthma and asthma-associated phenotypes, we conducted a genome-wide screen in the Hutterites, a religious isolate of European ancestry. A primary sample of 361 individuals and a replication sample of 292 individuals were evaluated for asthma phenotypes according to a standardized protocol. A genome-wide screen has been completed using 292 autosomal and three X-Y pseudoautosomal markers. Using the semi-parametric likelihood ratio chi2 test and the transmission-disequilibrium test, we identified 12 markers in 10 regions that showed possible linkage to asthma or an associated phenotype (likelihood ratio P < 0.01). Markers in four regions (5q23-31, 12q15-24.1, 19q13 and 21q21) showed possible linkage in both the primary and replication samples and have also shown linkage to asthma phenotypes in other samples; two adjacent markers in one additional region (3p24.2-22) showing possible linkage is reported for the first time in the Hutterites. The results suggest that even in founder populations with a relatively small number of independent genomes, susceptibility alleles at many loci may influence asthma phenotypes and that these susceptibility alleles are likely to be common polymorphisms in the population.
Adolescent↗
[Initial experiences with MR-mammography in after-care following surgical flap treatment of breast carcinoma].
PURPOSE: To demonstrate typical MR mammographic findings after plastic surgery of breast cancer. PATIENTS AND METHODS: Postoperative (7-38 months, median 13) MR mammographic examinations of 25 patients operated for breast cancer (11 latissimus dorsi-flaps (LAT), 14 rectus abdominis myocutaneous-flaps (TRAM)), were reevaluated. The examinations were performed with a breast coil at 1 T. The sequences applied were a fat-suppressed 2-D turbo IR-sequence proton-weighted and a T1-weighted FLASH 3-D sequence as dynamic series. RESULTS: Scars between the myocutaneous flap and the remaining breast tissue always appeared in form of a ligament or septum. Signal and perfusion characteristics of scar tissue and muscle stalk in this investigation were clearly different from those of tumour. One tumour recurrence and one fat necrosis was found and rectified by biopsy. CONCLUSION: MR mammography is a very valuable diagnostic method for postoperative evaluation of myocutaneous flap-based therapy of breast cancer.
Adult↗
[MR-mammography assessment of tumor response after neoadjuvant radiochemotherapy of locally advanced breast carcinoma].
PURPOSE: We investigated the role of magnetic resonance mammography in monitoring tumour response of locally advanced breast cancer (LABC) after neoadjuvant radiochemotherapy. MATERIAL AND METHODS: 17 patients with LABS had a magnetic resonance mammography and ultrasonography before and after neoadjuvant radiochemotherapy. RESULTS: After neoadjuvant radiochemotherapy 14 patients showed in MR-mammography less pronounced and prolonged enhancement without washout. After treatment three patients had signal intensity-time curves still characteristic for tumour. Ultrasonography was true negative in two patients, true positive in 12 and false positive in three patients. CONCLUSION: Magnetic resonance mammography is suitable for monitoring tumour response after radiochemotherapy of LABC. However, a negative MRI does not exclude a residual tumour. Ultrasonography is of limited value in monitoring therapy of LABC.
Adult↗
[MR mammography of fatty tissue necrosis].
PURPOSE: To evaluate MR-imaging for the differentiation of fatty necrosis (FN) of the breast. MATERIAL AND METHODS: In 1016 MR mammographies FN was found in 13 patients aged 44 to 69 years. In all studies we used a proton-weighted fat suppressed sequence (STIR) and serial T1-weighted gradient echo sequences before and after bolus injection of Gd-DTPA, MRI was correlated to ultrasound and in 8 cases to mammographic findings. RESULTS: All 15 FN displayed fat-isointense signal on T1-weighted and on proton-weighted, fat-suppressed sequences. They were delineated by a more or less wide rim of low signal intensity with sharp border to the center. After intravenous injection of gadopentetate dimeglumine they showed no increase of signal intensity in the centre and no increase, or only a minor increase, of the rim. Ultrasound could not distinguish FN from recurrent tumour in 6 cases. 7 FN looked like atypical cysts. CONCLUSION: MR-mammography is very promising in the diagnosis of FN.
Adult↗
Renal cell carcinoma presenting as a solitary anterior superior mediastinal mass.
Lesions of the anterior mediastinum typically include neoplasms of the thymus or thyroid, hemangioma, germ cell neoplasms, lymphoma and others. Renal cell carcinoma often presents with flank pain, hematuria, abdominal pain and/or fever. Chest cavity involvement by renal cell carcinoma typically manifests as pulmonary parenchymal disease with or without hilar lymph node involvement. We report an unusual presentation of renal cell carcinoma in a patient who presented with symptoms secondary to a large anterior mediastinal mass. A 64-year-old woman came to the hospital complaining of malaise, cough, dyspnea, weight loss and night sweats. Chest roentgenogram and computed tomography revealed a large anterior superior mediastinal mass without significant pulmonary parenchymal disease. She was also noted to have microscopic hematuria and a renal mass was found. Histology of both masses revealed renal cell carcinoma. This case suggests that renal cell carcinoma may merit consideration in the differential diagnosis of an anterior mediastinal mass and illustrates an unusual manner by which this lesion may present.
Carcinoma, Renal Cell↗
lambda 5, but not mu, is required for B cell maturation in a unique gamma 2b transgenic mouse line.
gamma 2b transgenic mice have a severe B cell defect, apparently caused by strong feedback inhibition of endogenous H-gene rearrangement coupled with an inability of gamma 2b to provide the survival/maturation functions of mu. A unique gamma 2b transgenic line, named the C line, was found to permit B cell development. When the C line is crossed with a mu-membrane knockout line, gamma 2b+ B cells develop in the homozygous knockout. In contrast, a transgenic line representative of all the other gamma 2b lines is completely B cell deficient when mu-mem is deleted. Strikingly, the C phenotype is dominant in C x other gamma 2b transgenic line crosses. There is no evidence for higher gamma 2b transgene expression or other position effects on the transgene in the C mouse. The sequences of the three gamma 2b transgene copies in the C line are identical to that of the original transgene. These results have led to the conclusion that in the C line the transgene integration constitutively induces a gene whose expression can replace mu. To more clearly delineate the stage at which the altered phenotype of the C line is expressed, C mice were crossed onto a lambda 5 knockout background. In the absence of lambda 5, the C line produces no B cells. Since it was also found that gamma 2b can associate with the surrogate light chain (sL; lambda 5/Vpre-B), the crosses between C line gamma 2b mice and lambda 5 knockout mice suggest that gamma 2b/sL is required for B cell maturation in this mouse line. Thus, gamma 2b alone is unable to replace mu for pre-B cell survival/maturation; however, in combination with an unknown factor and the sL, gamma 2b can provide these nurturing functions.
Alleles↗
Serum and milk concentrations of apramycin in lactating cows, ewes and goats.
A 20% solution of apramycin was administered intravenously (i.v.) and intramuscularly (i.m.) to lactating cows with clinically normal and acutely inflamed udders, to lactating ewes with normal or subclinically infected, inflamed udders and i.v. to lactating goats with normal udders. The i.v. disposition kinetics of apramycin was very similar in cows, ewes and goats. The elimination half-life was approximately 2 h and the steady-state volume of distribution was 1.26-1.45 L/kg. The absorption rate of the drug from the i.m. injection site was rapid, the i.m. bioavailability was 60-70% and the mean elimination half-life was 265 min in cows and 145.5 min in ewes. The binding percentage of apramycin to serum protein was low (< 22.5%). Concentrations of apramycin in milk produced by clinically normal mammary glands of cows, ewes and goats were consistently lower than in serum; the kinetic value AUCmilk/AUCserum was < 0.32. Drug penetration into the milk from the acutely inflamed quarters of cows was extensive; mastitis milk Cmax values were more than tenfold greater than the Cmax in normal milk. On the other hand, the drug had limited access to the milk produced by subclinically infected inflamed half-udders of ewes.
Animals↗
Crossing the SJL lambda locus into kappa-knockout mice reveals a dysfunction of the lambda 1-containing immunoglobulin receptor in B cell differentiation.
Mice of the SJL strain produce approximately 50 times less serum lambda 1 immunoglobulin light chains than other mouse strains. The defect is genetically linked to the lambda locus, but it is unknown whether it is due to regulatory alterations or known structural changes. We find no mutation in the SJL lambda 3-1 enhancer which regulates both lambda 1 and lambda 3. To investigate the defect further, the production of lambda light chains was amplified by crossing SJL with kappa-knockout mice. In kappa-knockout mice with the wildtype lambda locus (kappa -/- lambda +/+), the majority of serum light chains are lambda 1. In contrast, kappa-knockout mice with the SJL lambda locus (kappa -/- lambda s/s) show a pronounced expression of lambda 2 and lambda 3, with only some expression of lambda 1. The results show that the SJL defect is lambda 1 specific, since the linked lambda 3 expression is normal. As the transcription and rearrangement of lambda 1 appear normal in SJL, the defective lambda 1 synthesis is most likely due to a point mutation in the lambda 1 constant region resulting in a glycine to valine substitution. At the cellular level, in kappa-knockout mice with the SJL lambda locus there are fewer immature, and especially mature, lambda 1 B cells and the production of lambda 1 plasma cells is strongly inhibited. The lambda 1 specificity of the defect suggests that the point mutation in SJL C lambda 1 creates an immunoglobulin receptor complex which is dysfunctional in B cell differentiation.
Animals↗
Urosepsis from an atypical pathogen in a patient with babesiosis.
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Aged↗
[Invagination in adults].
Intussusceptions in adults are rare. With the increasing use of sonography, CT and improved methods for examining the small bowel, they are now diagnosed more frequently before operation. If one considers the possibility, acute invaginations can be readily diagnosed by sonography or barium examination; the CT appearances are pathognomonic. In long-standing cases it may be difficult to separate the oedematous small bowel walls from each other. The "duck bill" narrowing is a sign of chronic invagination.
Adult↗
Ultrasound diagnosis of splenic lymphoma: ROC analysis of multidimensional splenic indices.
To assess the efficacy of splenic size in the sonographic diagnosis of lymphomatous involvement of the spleen, the authors studied 31 patients with splenic lymphoma (Hodgkin's disease, 17 and non-Hodgkin's lymphoma, 14) and 218 individuals without evidence of splenic disease. All subjects were studied with both a linear and a sector transducer. The longitudinal, transverse and diagonal diameters of the spleen were measured, and two- and three-dimensional splenic indices were calculated. The analysis of the diagnostic performance of these criteria, compared by means of receiver-operating characteristic (ROC) curves, revealed that diagnosis of splenic involvement by malignant lymphoma was considerably more reliable with a sector than with a linear scanner. If the longitudinal diameter was measured with a sector scanner, sensitivities were 66% and 74%, at specificities of 95% and 90% respectively (cut-off points: 12.5 cm and 11.3 cm, respectively). For the sector scanner, there was no advantage in using other diameters or multidimensional indices. Additional ROC analysis of recently published data indicating excellent discrimination capacity of a computed tomography index revealed that these results were largely owing to patient selection. In contrast, our data suggest that the potential of current non-invasive assessment of splenic lymphoma is limited. However, ultrasound may eventually help to eliminate staging laparotomy in selected cases, e.g. in patients with low risk of abdominal disease and with increased surgical risk.
Adult↗
[Transhepatic balloon dilatation of the ductus choledochus and the removal of choledochal calculi].
In eight patients with stones in the bile duct, the concretions were removed percutaneously; in six, they were pushed into the duodenum following dilatation of the papilla and in two patients they were removed percutaneously by a transhepatic route using a Dormier basket. In two patients a stenosis at a choledocho-jejunostomy was successfully dilated by a percutaneously introduced balloon catheter. In five patients stenoses due to tumours of the bile duct were dilated percutaneously and an endoprosthesis introduced. There were no serious complications. The percutaneous transhepatic approach for the treatment of bile duct stones and of malignant obstruction is a valuable alternative to endoscopic and surgical treatment.
Aged↗
[Comparative diagnosis of focal liver changes using computed tomographic and scintigraphic methods].
The value of scintigraphic methods for the diagnosis of focal lesions of the liver (IDA, colloids, blood pool) in comparison to dynamic sequential computer tomography (CT) has been examined in this study. We found CT to be diagnostic in typical cases. For example, focal nodular hyperplasia is characterized by a rapid, strong increase and subsequent decrease after application of contrast medium (71%), whereas hemangiomas show a delayed density increase mostly at the rim (20%). In the event of deviations from the typical pattern, scintigraphic methods have to be applied which then often yield a specific diagnosis, especially in hemangiomas, focal nodular hyperplasia, and adenomas (71%). Ultrasound findings indicating the possible presence of hemangiomas or focal nodular hyperplasia should lead to scintigraphic studies prior to CT, not only for reasons of economy.
Adult↗
Diagnosis of liver cirrhosis with US: receiver-operating characteristic analysis of multidimensional caudate lobe indexes.
To assess the utility of changes in the volume of the caudate lobe in the sonographic diagnosis of liver cirrhosis, the authors studied 58 patients with histologically proved cirrhosis, 18 patients with fatty liver, 28 patients with liver metastases, seven patients with lymphomatous liver involvement, and 75 healthy individuals. The longitudinal (CL), transverse (CT), and anteroposterior (CAP) diameters of the caudate lobe and the transverse diameter of the right lobe (RL) were measured, and one-, two-, and three-dimensional caudate lobe indexes and ratios were calculated. The analysis of the diagnostic performance of these criteria, compared by means of receiver-operating characteristic curves, revealed that the ratio of the three-dimensional caudate index (CI3) to the right lobe diameter (CI3/RL = [CL X CT X CAP]/RL) was superior to all other calculated criteria. At a specificity of 95%, the sensitivity of CI3/RL was 94.7%, compared with 73.3% for CT/RL. No significant differences were found between the control group and patients with fatty liver, metastases, or lymphomatous involvement. The study suggests that CI3/RL is the most reliable quantitative criterion for the US diagnosis of liver cirrhosis.
Fatty Liver↗