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Benchmarking↗
Biomedical subjects
C Zimmerman
Publications and source records attributed to C Zimmerman.
[Recognition of case histories by a third party].
A case report of psittacosis during pregnancy resulting in death of the child was published in this journal. The item was taken up by a newspaper, whereupon the owners of the birds that had been implicated realised that they were being described. They now felt responsible for the tragedy and complained. Anonymising patient information will never prevent recognition by the patient himself or herself. When publishing a patient history, the authors must be aware that third parties may be involved as well.
Confidentiality↗
Music and the brain: the impact of music on an oboist's fight for recovery.
A 20-year-old female, alias Sara, was an aspiring professional oboist who studied music performance at college level. While wading across a river she lost her balance, was swept down river, and suffered profound injuries including severe hypothermia, cardiac arrest, and hypoxic brain injury. While recovering, her family and friends surrounded Sara with music. Her oboe teacher placed Sara's oboe in her hand and played tapes of Sara's past performances. Her mother played recordings of her favourite music in hopes that the music would remind her of her life's passion and, thus, stimulate her mind and soul while she recovered. Two years post-injury, Sara continues to strive to improve her quality of life. In this case study, Sara's musical and medical recovery is detailed using quantitative and qualitative data. This data gathered allows one to provide an analysis of the powerful role of music in Sara's fight to recover.
Activities of Daily Living↗
Mass volume measurement in severe head injury.
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Anthropometry↗
Clinical and economic effectiveness of an inpatient anticoagulation service.
We conducted a prospective cohort study to evaluate clinical and economic end points achieved by a pharmacist-managed anticoagulation service compared with usual care (50 patients/group). The primary therapeutic end point was the time between starting heparin therapy and surpassing the activated partial thromboplastin time therapeutic threshold. The primary economic end point was the direct variable cost of hospitalization from admission to discharge. No significant differences between groups were noted for the primary therapeutic end point. Total hospital costs were significantly lower for patients receiving pharmacist-managed care than for those receiving usual care ($1594 and $2014, respectively, 1997 dollars, p=0.04). Earlier start of warfarin (p=0.05) and shorter hospital stay (5 and 7 days, p=0.05) were associated with the pharmacist-managed group.
Anticoagulants↗
[A very serious course of psittacosis in pregnancy].
A 33-year-old pregnant woman was admitted because of atypical pneumonia. She developed adult respiratory distress syndrome complicated by premature birth and perinatal mortality. The diagnosis 'psittacosis' was established on clinical grounds and confirmed serologically (complement fixation test). She was treated with doxycycline 200 mg i.v. daily for 3 weeks and was discharged in good condition after three months. Indirect case history revealed infected birds from the neighbours as the likely source of infection. Psittacosis is caused by Chlamydia psittaci and is acquired after inhalation of dry secreta or excreta from infected animals. Retrospective direct questioning often reveals contact with birds. Diagnostic delay can be considerable. Doxycycline is contraindicated in pregnant women, but erythromycine can be prescribed. Pregnant women should be advised to avoid contact with infected birds as they run an increased risk of a severe disease course.
Adult↗
Regulation of E2F4 mitogenic activity during terminal differentiation by its heterodimerization partners for nuclear translocation.
E2F/DP heterodimers play a pivotal role in the regulation of cell growth and differentiation. A decrease in E2F/DP activity occurs during cell cycle arrest and differentiation. However, very little is known about the specific role of the various E2F/DP members along the transition from proliferation to terminal differentiation. We have previously shown that E2F4 accounts for the vast majority of the endogenous E2F in differentiating muscle cells. Here, we show that E2F4, which lacks a nuclear localization signal (nls), is distributed in both the nucleus and the cytoplasm, in either asynchronously growing myoblasts or differentiated myotubes. E2F4 nuclear accumulation is induced by the binding in the cytoplasm with specific partners p107, pRb2/p130, and DP3delta, an nls-containing spliced form of DP3, which provide the nls. Although overexpression of E2F4/DP3delta reactivates the cell cycle in quiescent cells, the E2F4 nuclear accumulation induced by pRb2/p130 and p107 correlates with cell growth arrest Moreover, E2F4/DP3delta-induced cell cycle reactivation is efficiently counteracted by either p107 or pRb2/p130 overexpression. Reinduction in quiescent cells of DNA synthesis by E2F1/DP1 overexpression is abrogated by coexpression of pRb and is hampered by MyoD overexpression. Both pRb2/p130 and pRb, as well as MyoD, are up-regulated in myotubes. Accordingly, multinucleated myotubes, which are induced to reenter the S-phase by oncoviral proteins, are refractory to cell cycle reactivation by forced expression of E2F4/DP3delta or E2F1/DP1. Thus, E2F/DP repression represents only one of multiple redundant circuits that control the postmitotic state in terminally differentiated cells and that are targeted by adenovirus E1A and SV40 large T antigen.
Animals↗
Constitutive expression of Bcl-xL or Bcl-2 prevents peptide antigen-induced T cell deletion but does not influence T cell homeostasis after a viral infection.
We examined the CD8+ T cell response to lymphocytic choriomeningitis virus (LCMV) in mice doubly transgenic for an LCMV-specific TCR and for either bcl-xL or bcl-2. Clonal down-sizing of the anti-viral CD8+ T cell response and the generation of T cell memory was not influenced by constitutive expression of these anti-apoptotic proteins in T cells. Expression of Bcl-xL or Bcl-2 did, however, prevent LCMV peptide-induced peripheral deletion of mature CD8+ T cells in vivo and apoptosis of activated LCMV-specific effector T cells in vitro. The CD8+ T cells "rescued" by Bcl-xL or Bcl-2 from peptide antigen-induced cell death were anergic and this could not be reversed by addition of IL-2 in vitro or by adoptive transfer into antigen-free recipient mice followed by LCMV infection in vivo. Taken together, we show here that 1) Bcl-xL or Bcl-2 are functionally equivalent in their ability to modulate CD8+ T cell survival in vivo, 2) distinct apoptosis signaling pathways exist in CD8+ T cells, one that can be inhibited by Bcl-2 or Bcl-xL and one that cannot be blocked, and 3) apoptosis of CD8+ effector T cells during the declining phase of an immune response is not prevented by constitutive expression of the anti-apoptotic proteins Bcl-xL and Bcl-2.
Animals↗
Prior experience and complex procedures.
The role of prior knowledge in learning complex procedures was investigated in a transfer task in which subjects learned two related procedures in sequence. In Experiment 1, we manipulated the conceptual and structural similarity between the two procedures; in Experiment 2, we manipulated whether the order of the steps within subprocedures was the same or different during training and transfer, or whether the order of the subprocedures was the same or different. The results lead us to hypothesize that transfer in complex procedures is mediated primarily by a memory for specific steps rather than by conceptual understanding or problem solving. In particular, we were able to model the results precisely on the assumption that subjects use superficial similarity to retrieve the sequences of steps needed to perform segments of the procedure.
Humans↗
Response of primary leptomeningeal melanoma to intrathecal recombinant interleukin-2. A case report.
BACKGROUND: Primary leptomeningeal melanomas are rare tumors that originate in the leptomeninges and are associated with a poor prognosis and no response to radiation and chemotherapy. These tumors rarely metastasize outside the central nervous system. Recombinant interleukin-2-(rIL-2) is a cytokine that activates natural killer cells and lymphokine-activated killer cells, augments their antitumor effects, and recruits and activates cytotoxic T lymphocytes. We have hypothesized that rIL-2 may prolong disease free survival in a patient with primary leptomeningeal melanoma. METHODS: The patient was treated with intrathecal rIL-2 via lumbar puncture daily for 5 days, the weekly for 5 weeks. To investigate whether rIL-2 induced a favorable clinical response, the following parameters were monitored: survival, neurologic status, cerebrospinal fluid (CSF) analysis, visual fields, and magnetic resonance imaging (MRI) of the lumbosacral spine. RESULTS: The patient is still alive and disease free 15 months after receiving rIL-2, and his neurologic status remains unchanged. The CFS glucose concentration, undetectable prior to therapy, has become normal. Repeated cytologic examinations of CSF were negative for malignant cells. The visual field examinations have remained unchanged. MRI scans of the lumbosacral spine have shown the development of arachnoiditis, but no recurrence of the mass lesion. CONCLUSIONS: The tumor response in this patient, as measured by remarkable disease free survival and normalization of the CSF glucose concentration, illustrates the potential benefits of intrathecal rIL-2 in the treatment of patients with this otherwise rapidly fatal disease.
Animals↗
Visualization, characterization, and turnover of CD8+ memory T cells in virus-infected hosts.
The cellular basis of T cell memory is a controversial issue and progress has been hampered by the inability to induce and to trace long-term memory T cells specific for a defined antigen in vivo. By using the murine model of lymphocytic choriomeningitis virus (LCMV) infection and an adoptive transfer system with CD8+ T cells from transgenic mice expressing an LCMV-specific T cell receptor, a population of authentic memory T cells specific for LCMV was generated and analyzed in vivo. The transgenic T cells that have expanded (1,000-fold) and then decreased (10-fold) in LCMV-infected C57BL/6 recipient mice exhibited the following characteristics: they were (a) of larger average cell size than their naive counterparts but smaller than day 8 effector cells; (b) heterogeneous with respect to expression of cell surface "memory" markers; and (c) directly cytolytic when isolated from recipient spleens. The time-dependent proliferative activity of these LCMV-specific memory T cells was analyzed in the recipients by bromodeoxyuridine labeling experiments in vivo. The experiments revealed that LCMV-specific CD8+ memory T cells can persist in LCMV-immune mice for extended periods of time (>2 mo) in the absence of cell division; the memory population as a whole survived beyond 11 mo.
Amino Acid Sequence↗
A controlled trial of remacemide hydrochloride in Huntington's disease.
We conducted a randomized, double-blind, placebo-controlled tolerability study of a N-methyl-D-aspartate (NMDA) glutamate receptor ion-channel blocker, remacemide hydrochloride, in 31 independently ambulatory patients (18 men, 13 women) with Huntington's disease (HD). Subjects were randomized to receive either placebo or active remacemide at dosages of 200 mg/day or 600 mg/day. The primary outcome measure was the proportion of subjects able to complete the study with the assigned treatment. Remacemide was generally well tolerated, and no significant differences between the treatment arms were found in the primary outcome measure. A trend toward improvement in chorea was observed among subjects administered remacemide 200 mg/day. Based on the tolerability and safety demonstrated during this short-term trial, remacemide warrants more extended controlled investigation in patients with HD.
Acetamides↗
Assessment of coenzyme Q10 tolerability in Huntington's disease.
We performed a 6-month open-label trial to evaluate the tolerability and efficacy of coenzyme Q10 (CoQ) in 10 patients with Huntington's disease (HD). Subjects were evaluated at baseline, 3 months, and 6 months using the HD Rating Scale (HDRS), the HD Functional Capacity Scale (HDFCS), and standardized neuropsychological measures. Adverse events (AEs) were assessed by telephone interview every month. CoQ doses ranged from 600 to 1,200 mg per day. All subjects completed the study, although four subjects reported mild AEs, including headache, heartburn, fatigue, and increased involuntary movements. There was no significant effect of the treatment on the clinical ratings. The good tolerability of CoQ suggests that it is a good candidate for evaluation in long-term clinical trials designed to slow the progression of HD.
Activities of Daily Living↗
Psychogenic status epilepticus induced by a provocative technique.
We report a patient who developed sustained psychogenic seizures after undergoing a provocative technique (PT) for the diagnosis of psychogenic seizures. Because patients are at risk for severe agitation with PT, these diagnostic maneuvers should be used selectively, and the clinician should be prepared to deal with this complication.
Adult↗
Functional decline in Huntington's disease.
We prospectively evaluated 129 patients with manifest Huntington's disease (HD) to determine the rate of illness progression and the clinical features that correlate with functional decline. A single examiner evaluated each patient using the HD Functional Capacity Scale. Standardized motor performance was also assessed in 94 of the patients (73%) using the HD Rating Scale. Total Functional Capacity declined at a rate of 0.63 +/- 0.75 U per year. As functional capacity worsened, chorea lessened, and dystonia intensified. There was no correlation between rate of functional decline and age at onset of HD, body weight, gender of affected parent, or history of neuroleptic use.
Adolescent↗
Trinucleotide repeat length and progression of illness in Huntington's disease.
The genetic defect causing Huntington's disease (HD) has been identified as an unstable expansion of a trinucleotide (CAG) repeat sequence within the coding region of the IT15 gene on chromosome 4. In 50 patients with manifest HD who were evaluated prospectively and uniformly, we examined the relationship between the extent of the DNA expansion and the rate of illness progression. Although the length of CAG repeats showed a strong inverse correlation with the age at onset of HD, there was no such relationship between the number of CAG repeats and the rate of clinical decline. These findings suggest that the CAG repeat length may influence or trigger the onset of HD, but other genetic, neurobiological, or environmental factors contribute to the progression of illness and the underlying pace of neuronal degeneration.
Adolescent↗
Utilization patterns of total parenteral nutrition in a university hospital. A methodological approach.
To study the utilization of total parenteral nutrition, using methodology recommended by the World Health Organization, classification of components in accordance with the anatomical therapeutic chemical classification and defined daily dose system is necessary. Anatomical therapeutic chemical indices are available but defined daily dose values have not been established yet. In this article, a methodology to study both the total utilization of total parenteral nutrition, the utilization of individual substances and the composition of total parenteral nutrition is presented. To validate the proposed methodology, the utilization of total parenteral nutrition in a teaching hospital is studied, based on pharmacy computer data. The total utilization of total parenteral nutrition in the hospital in 1990 is 1.4 defined daily doses/100 bed-days. The composition of total parenteral nutrition varied greatly between the clusters. In this study we showed that utilization of total parenteral nutrition can be measured with the proposed methodology, using a defined daily dose for total parenteral nutrition in concurrence with a defined daily dose for the individual components.
Diet↗
Thrombosis of a flexible coil coronary stent: frequency, predictors and clinical outcome.
OBJECTIVES: The aim of this study was to evaluate the predictors and clinical sequelae of stent thrombosis. BACKGROUND: Although coronary artery stenting is being increasingly applied, the major unique complication of stent thrombosis is not well characterized. METHODS: We studied 145 patients who underwent coronary artery stenting with the Gianturco-Roubin flexible coil design for abrupt vessel closure or to prevent restenosis. There were 17 stented vessel closures (11.7%), 7 as a result of acute (< 24 h) and 10 of subacute (days 1 to 21) thrombosis. RESULTS: In seven patients successful coronary recanalization was achieved with thrombolytic agents and balloon angioplasty. Creatine kinase was significantly elevated in 13 patients, with a Q wave myocardial infarction in 11 and emergency coronary artery bypass grafting in 8. Comparisons (multivariate analysis) with a control cohort (n = 33) of patients without thrombosis matched for age, gender and vessel stented revealed lesion eccentricity (p = 0.003), unstable angina (p = 0.048) and indication for stent implantation (abrupt closure versus restenosis) (p = 0.002), as predictors of thrombotic occlusion of stented vessels. Subtherapeutic anticoagulation (activated partial thromboplastin time < 2 times control value, prothrombin time < 1.4 control value) occurred at least once during the hospital stay in all 10 patients with subacute thrombosis and in 20 of 33 control patients (p = 0.047). In 2 patients with subacute thrombosis and 11 control subjects, subtherapeutic anticoagulation was necessitated by bleeding. CONCLUSIONS: Early thrombosis after coronary stenting was relatively common (> 10%), occurring predominantly in eccentric lesions and in patients with unstable angina pectoris. This complication is associated with significant adverse clinical outcomes and may be reduced by more intensive anticoagulation yet, in a delicate balance, can be precipitated by inadequate heparin therapy.
Angina, Unstable↗