Impotence: should primary care physicians give penile injections?
Explore the source record for details and available documents.
Dose-Response Relationship, Drug↗
Biomedical subjects
C Andrews
Publications and source records attributed to C Andrews.
Concept formation vs. logistic regression: predicting death in trauma patients.
This paper discusses two classification models, one based on concept formation and the other using standard logistic regression. The models are first explained in some detail and then evaluated on the same population of trauma patients. The goal of both systems is to predict the outcome of those patients. The results are summarized and explained in terms of differing algorithms of the two models.
Artificial Intelligence↗
Flu vaccination of the elderly: room to improve.
Explore the source record for details and available documents.
Aged↗
Normal colonic epithelium adheres to carcinoembryonic antigen and type IV collagen.
BACKGROUND/AIMS: Human colorectal carcinoma cells bind to collagen and laminin in the basement membrane as well as to carcinoembryonic antigen (CEA) on neighboring cells. The purpose of this study was to determine whether normal colonic epithelial cells bind to CEA, collagen, or laminin. METHODS: Intact colonic crypts were isolated from normal mucosa in 13 specimens resected for colorectal carcinoma or colonic diverticulitis. Colonocytes were released from the crypts by treatment with collagenase and deoxyribonuclease and tested for adhesion to CEA, type IV collagen, and laminin in a solid-phase adhesion assay. RESULTS: Twelve percent to 25% of colonocytes in all specimens bound to CEA. Colonocytes from seven specimens also bound to type IV collagen, but none of the colonocyte preparations bound significantly to laminin. Monoclonal antibodies to CEA and to the hyaluronate receptor CD44 and enzymatic removal of membrane CEA blocked the adhesion of colonocytes to CEA. CONCLUSIONS: First, colonocytes use the same epitopes on CEA and CD44 as colorectal carcinoma cells to adhere to solid-phase CEA. Second, colonocytes bind to solid-phase CEA through CEA-to-CEA homophilic binding. Third, CEA and type IV collagen, but not laminin, are adhesion ligands for human colonocytes.
Antibodies↗
The OR suite as a unique trauma resuscitation bay.
Trauma is the fourth leading cause of death in the United States, and trauma injuries affect more than 50 million Americans annually. Inadequate care of trauma patients can cause unnecessary patient deaths. To decrease death and disability caused by trauma, one Denver hospital developed a trauma OR based on the "Golden Hour" principle (ie, the sooner a patient receives treatment, the more likely the patient will survive). Since 1977, this hospital has performed 1,838 trauma resuscitations in the trauma OR suite. This article discusses the importance of triage and recants the history of trauma patient transportation. The authors detail the trauma procedures at their hospital, including the specific roles of trauma team members and the necessary equipment, and provide demographic information on the trauma resuscitations performed at the hospital since 1988. The article also discusses the extensive and continuous orientation necessary for trauma team members and explains the quality improvement strategies implemented by this hospital.
Adolescent↗
A control/experimental trial of an operant treatment for early stuttering.
A preliminary study (Onslow, Costa, & Rue, 1990) suggested that a parent-conducted program of verbal response-contingent stimulation would be an effective treatment for stuttering children younger than 5 years. The present study was designed to expand those preliminary findings by using a larger group of children and by comparing them to a control group of children. Twelve children in the experimental group achieved median percent syllables stuttered (%SS) scores below 1.0 for a 12-month posttreatment period. The children's treatments were completed in a median of 10.5 1-hour clinic sessions and a median of 84.5 days from the start of treatment. The majority of parents of the control children withdrew from the study and elected to have treatment begin for their child. These results suggest that the program may be a cost-effective method for managing a clinical caseload of stuttering children younger than 5 years. It is suggested that controlled clinical trials cannot be used validly or ethically to determine the number of cases of early stuttering who recover without formal intervention.
Age Factors↗
Stromal tumors of the stomach: prognostic value of the PCNA index.
Reliable indicators of behavior in stromal tumors of the gastrointestinal tract have yet to be elucidated. Aggressive behavior has been associated with large size, hypercellularity, tumor necrosis, nuclear atypia, and high mitotic rate. Recently, new methods of measuring proliferation have been developed that exploit the phenomenon of cell cycle specific protein synthesis. In this study the expression of the S-phase specific nuclear protein proliferating cell nuclear antigen (PCNA) is tested as an indicator of malignancy. Sixteen stromal tumors of the stomach were reviewed for tumor size, cellularity, nuclear atypia, mitotic rate, necrosis, vascular invasion, and predominant cell type. Local recurrence and/or mortality were ascertained with a minimum follow-up of 5 yr. An immunohistochemical assay for PCNA was performed on a paraffin section of tumor and the percentage of positively stained cells ("PCNA index") was determined. Among the nine men and seven women, age 37 to 80 (median 66) yr, two had local recurrences that were treated surgically with no metastases. Only positive resection margin correlated with local recurrence. Two other patients developed distant metastases at 8 and 15 mo and died. Mortality did not correlate with age, sex, size, cellularity, necrosis, cell type, and vascular invasion. High grade nuclear atypia (2/2 versus 1/14, P = 0.02) and high mitotic rate (20.5 versus 5.5 per 40 hpfs, P = 0.01) did correlate with mortality. PCNA index did not correlate with local recurrence, but was sharply higher in fatal cases (6.4 versus 1.2, P = 0.001). Both fatal tumors had PCNA values above 6.0, and all others had values of 4.0 or less. The PCNA index is a proliferative marker that may have prognostic value in gastric stromal tumors.
Adult↗
Variability of cardiac output as determined by impedance cardiography in pacemaker patients.
Hemodynamic assessment of pacemaker patients is necessary for gauging responses to changes in programming or other conditions affecting circulation. Impedance cardiography permits noninvasive determinations of cardiac output at short intervals but data regarding variability of this method in patients with pacemakers is unavailable. Thirty-eight patients with pacemakers (24 with DDD and 14 with VVI devices) and 6 normal subjects were studied. Each patient was studied in the supine position and repeated impedance measurements were obtained. Fourteen patients were studied during sinus rhythm, 24 were studied during DDD pacing, and 32 patients were studied during VVI pacing. Variability was assessed by methods that analyzed both serial measurements and variability between 2 consecutive and nonconsecutive measurements. The mean indexes and coefficients of variation of 2 and serial measurements in sinus rhythm and DDD were 4%; in VVI it was 6%. The precision of impedance cardiography in all pacing modes, as demonstrated by analysis of variability, indicates that detected changes of stroke volume and cardiac output > 7% on serial (2 and more) measurements, performed by the same operator and during the same session, represent true hemodynamic alterations with 95% confidence. The precision of impedance cardiography demonstrated may be comparable or superior to other frequently used techniques, and the data obtained are valuable both investigationally and clinically.
Adult↗
Pharmacokinetics of nevirapine: initial single-rising-dose study in humans.
Nevirapine, a nonnucleoside inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase, was administered for the first time to humans in a pilot study designed to investigate the pharmacokinetics and tolerance of the drug following single-dose administration to 21 HIV-1-infected individuals. The study followed a parallel design. Different groups of three subjects each were given one of seven dose levels (2.5 to 400 mg) in sequential order, starting with the lowest dose. Each subject received only one dose. Nevirapine was rapidly absorbed at all doses from a tablet formulation. Peak concentrations in plasma were generally achieved within 90 min of dose administration. Secondary peaks were also noted between 3 and 12 h or between 24 and 28 h, the latter being noted mainly in subjects receiving the higher doses. After 24 h, concentrations in plasma declined in a log-linear fashion. The terminal half-life and mean residence time exceeded 24 h in all but one subject, indicating a prolonged disposition time in this population. Both peak concentrations in plasma and areas under the plasma concentration-time curves increased proportionally with increasing dose from 2.5 to 200 mg; however, the increase in the peak concentration in plasma and the area under the plasma concentration-time curve appeared to be less than proportional at the 400-mg dose level in this small number of subjects. This observation may be due to increased clearance or decreased absorption at the highest dose or population differences in absorption or clearance between doses. Studies with a cross-over design are planned to resolve these issues. The pharmacokinetic characteristics of nevirapine are appropriate for once-daily administration. A daily 12.5-mg dose is predicted to achieve trough concentrations in plasma in the range required to totally inhibit replication of wild-type HIV-1 in human T-cell culture.
Acquired Immunodeficiency Syndrome↗
DDD pacing mode survival in patients with a dual-chamber pacemaker.
Dual-chamber (DDD) pacing mode survival was assessed by reviewing 486 consecutive initial transvenous DDD pacemaker implantations between December 1981 and December 1988 inclusive, with a mean follow-up time of 33 months. The patients' mean age was 71.4 years and 55% were male; 38% had dominant sinoatrial and 62% had dominant atrioventricular (AV) node disease. Nineteen patients (4%) underwent secondary operative intervention for lead dislodgement (n = 11), lead or pulse generator malfunction (n = 6) or infection (n = 2). During follow-up, 87 patients (18%) had their device permanently reprogrammed out of the DDD mode and 10 others (2%) required temporary reprogramming out of this mode; 12 patients who required device reprogramming were managed in other dual-chamber or atrial pacing modes. Reasons for reprogramming included atrial fibrillation (n = 48; 10%); loss of atrial sensing (n = 26; 5%); recurrent "endless loop" tachycardia (n = 5; 1%); lead dislodgement without repositioning (n = 4; 1%); pulse generator malfunction (n = 1; 1%) and other (n = 5; 1%). The occurrence of atrial fibrillation was associated with dominant sinoatrial disease and a prior history of atrial fibrillation; 19% of atrial sensing loss was attributable to early or faulty pacemaker technology. The DDD mode survival rate at 1, 2, 3, 4 and 5 years was, respectively, 90%, 88%, 84%, 79% and 78%.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
The clinical relevance of electromyopotential oversensing in current unipolar devices.
UNLABELLED: Electromyopotential oversensing of unipolar pacemakers was first appreciated 20 years ago, but its prevalence in present day devices is less well defined. Thirty-four pacemaker patients, only two with symptoms suggestive of oversensing, were evaluated in unipolar settings to assess the frequency of provocation of oversensing in one or, if present, both pacing channels. The sensing threshold of each patient, whenever possible, was recorded as well. RESULTS: Atrial oversensing occurred in 11/18 patients (61%), all at sensitivities in the 0.4-1.0 mV range. Ventricular oversensing was noted in 13/33 patients (39%), with all but one programmed to settings of 1.25 mV or more sensitive (i.e. < 1.25 mV). Twenty six of 26 patients amenable to testing had ventricular sensing thresholds of at least 4.0 mV or more. Of the 15 patients amenable to atrial sensing threshold testing, 4 had a threshold of 1.0 mV or < 1.0 mV, 6 had thresholds between 1.0-2.0 mV, and 5 sensed at settings > 2.0 mV. CONCLUSION: Electromyopotential oversensing remains a relevant issue in current day unipolar pacemakers. Most patients do not describe symptoms related to electromyopotential interference, yet such interference is frequently provoked. Oversensing is common at high sensitivities typically utilized for atrial sensing, but quite unusual at settings necessary for adequate ventricular sensing. Programming unipolar devices to unnecessarily high sensitivities should be avoided or serious consequences may result.
Cardiac Pacing, Artificial↗
Removal of infected transvenous leads requiring cardiopulmonary bypass or inflow occlusion.
Infection, although uncommon, can be the most lethal of all potential complications after transvenous pacemaker implantation. The infection rate at our institution has been 0.56% (42 implants) during the preceding 17 years for 7435 transvenous pacemakers implanted in 4333 patients. Four of the 42 patients required use of cardiopulmonary bypass or inflow occlusion to remove the infected transvenous leads. Seven patients had their pacemakers implanted elsewhere and were transferred to our medical center for treatment. One patient died postoperatively because of persistent sepsis from a retained lead segment. All other patients survived, and none had recurrent infection. We recommend removal of all hardware if there is infection of the pacemaker system. If traction or other methods fail to remove the transvenous portion of the pacemaker system, open methods of removal, although rarely required, are safe and effective and should be used without delay.
Adolescent↗
Pacemaker infection with Mycobacterium avium complex.
A 21-year-old. HIV negative, malnourished, homeless woman with congenital heart block had a pacemaker implanted at 7 years of age and multiple procedures thereafter. The most recent of these procedures was replacement of a pulse generator in the right pectoral region. Four months later she had fever, pain, and swelling over the implant site resulting from infection with mixed flora and Mycobacterium avium complex. The pacemaker system was removed by thoracotomy via a median sternotomy and a new DDD pacemaker simultaneously implanted. She was treated with systemic antibiotics--isoniazid, rifampin, ethambutol--for 2 weeks. Six months later she was healthy, pacing well, and apparently free of infection, off all medications.
Adult↗
Clinical predictors and natural history of atrial fibrillation in patients with DDD pacemakers.
Effective DDD pacing requires that patients remain free of atrial fibrillation (AF). Four hundred eighty-nine consecutive patients undergoing initial transvenous DDD implants were reviewed to determine the incidence of postimplant AF in this population and to assess what factors, known at implant, predicted the later development of AF. The variables analyzed included age, sex, indication for implant (dominant SA or AV node disease), history of AF, atrial electrogram characteristics and pacing threshold, and the status of retrograde conduction. Forty-eight patients (9.8%) developed AF a mean of 23 months postimplant, and 11 of these patients returned to sinus rhythm and were managed once again in DDD for significant periods. A prior history of AF and the presence of dominant sinoatrial disease were far more prevalent in the patients who developed AF (P less than 0.001) though the vast majority of patients with these two independent risk factors remained in sinus rhythm through much or all of their follow-up period. We conclude that the incidence of AF is not of a magnitude to preclude DDD pacing in the vast majority of patients in sinus rhythm at implant.
Aged↗
Concierge concept eases family fears.
Explore the source record for details and available documents.
Anxiety↗
Landslide response to handbook for kids.
Explore the source record for details and available documents.
Child↗