Search PubMed⌕ Search

Biomedical subjects

D Green

Publications and source records attributed to D Green.

At least 163 records · Page 9Linked to original sources
PubMed1995

The role of ethanol in heroin deaths.

The purpose of this study was to evaluate the role of ethanol in deaths due to heroin intoxication. Over a 12 month period, all cases investigated by the Office of the Chief Medical Examiner, State of Maryland where a blood screen by Roche Abuscreen radioimmunoassay (RIA) was positive at a cutoff of 100 ng/mL were included in the study. Free morphine was quantitated using the Coat-A-Count RIA and ethanol was quantitated by head space gas chromatography. All presumptive morphine positive cases were confirmed by gas chromatography/mass spectrometry. Seventy of the 119 cases where death was attributed to narcotic or alcohol and narcotic intoxication had blood ethanol concentrations (BAC) greater than or equal to 0.02 g/dL; 48 had BAC > or = 0.10 g/dL. Only 3 of 45 cases where morphine was identified but was unrelated to death had BAC > or = 0.02 g/dL. At all ranges of free morphine concentrations, there was a greater percentage of narcotic deaths when ethanol was present. From the data, we conclude that 1) the use of even small amounts of ethanol with heroin is clearly a risk factor in deaths due to heroin, 2) there are some heroin deaths where no free morphine is identified in the blood. In these deaths, ethanol is unlikely to be present, 3) at blood ethanol concentrations between 0.20 and 0.29 g/dL, the morphine concentrations in heroin deaths increased significantly, 4) at blood ethanol concentrations greater than 0.30 g/dL, morphine became less of a factor than the ethanol in causing death.

Alcoholic Intoxication↗
PubMed1995

Patient assessment for day surgery.

Following medical selection of a patient for day surgery in either a hospital out-patient clinic or general practitioner surgery, the patient requires assessment. This is usually achieved in one of two ways. The patient may be sent a postal questionnaire which is followed up on the telephone if a query occurs or he or she attends an assessment interview in the day surgery unit (D.S.U.) with a member of the nursing staff. From personal experience as a nurse teacher, patient assessment for day surgery is the one area of concern for theatre nurses if they are asked to work in the day surgery unit. This article is a brief overview of this area. Initially, assessment will be defined. Following this, patient assessment in the theatre setting will be compared with assessment of a patient about to undergo day surgery. To conclude, a summary of selected nursing competencies will be listed for successful day surgery patient assessment.

Ambulatory Surgical Procedures↗
PubMed1995

Relationship among Lewis phenotype, clotting factors, and other cardiovascular risk factors in young adults.

An increased risk of ischemic heart disease has been reported in men with the Lewis blood group phenotype Le(a-b-). We have investigated the relationship between Lewis phenotype and cardiovascular risk factors in 1714 participants in the Coronary Artery Risk Development in Young Adults Study, an ongoing investigation on life-styles and evolution of cardiovascular risk factors. No significant differences were observed among Lewis phenotypes for body mass index, blood lipid levels, blood pressure, or clotting factors VII and fibrinogen. However, in white men with blood groups A, B, or AB, and the Le(a-b-) phenotype, significantly higher levels of factor VIII (p < 0.01) and von Willebrand factor (p < 0.03) were observed than in those with other Lewis phenotypes (Le[a+b-] or Le[a-b+]). Two-way analysis of variance indicated a significant interaction between blood group and Lewis phenotype (p = 0.0053) in terms of relationship to factor VIII. A similar trend was observed in black men with blood type A, B, or AB, and phenotype Le(a-b-) for factor VII/von Willebrand factor and in women with blood type A, B, or AB, and phenotype Le(a-b-) for factor VIII. Our data suggest that the Le(a-b-) phenotype and blood groups A, B, and AB, by virtue of their association with raised levels of factor VIII and von Willebrand factor, may be risk markers for future atherothrombotic disease.

ABO Blood-Group System↗
PubMed1995

Personal and situational factors in drug use as perceived by kibbutz youth.

Sixteen 17-year-old kibbutz members, seven of them smokers, and nine nonsmokers of hashish, assessed the probability that a young person of similar background would use drugs. Two sources of information were manipulated bifactorially: personal predisposition (curiosity, risk-taking, and existential meaning) and the level of group pressure to smoke hashish. It was found that hashish smokers assigned meaningful importance to a combined influence of the two factors, while the nonsmokers considered only group pressure to be important. A tool based on the measurement method examined in this study is proposed for predicting the probability of drug use among adolescents.

Adolescent↗
PubMed1994

Structural characterization and alternate splicing of the gene encoding the preadipocyte EGF-like protein pref-1.

Preadipocyte factor 1 (pref-1), a member of the EGF-like protein family, is a transmembrane protein with six tandem EGF-like repeats in the putative extracellular domain. Expression of pref-1 is abolished during the in vitro differentiation of 3T3-L1 preadipocytes to adipocytes, and constitutive expression of pref-1 in preadipocytes inhibits their differentiation [Smas, C.M., & Sul, H.S. (1993) Cell 73, 725-734]. In the present studies, we have isolated and characterized genomic clones for pref-1 and have identified multiple pref-1 transcripts generated by alternate splicing. The pref-1 gene consists of five exons and four introns spanning approximately 7.3 kb. By primer extension analysis, the transcription start site was determined to be 169 bp upstream from the translation initiation codon. We have identified functional promoter sequences by transient transfection using a 2.1 kb fragment of the pref-1 5' flanking region linked to a luciferase gene; the pref-1-luciferase fusion gene construct gave 20-fold higher promoter activity as compared to the promoterless vector. Analysis of exon-intron junctions reveals that unlike the majority of the mammalian EGF-like genes, EGF-like repeats of pref-1 are not encoded by discrete exons. Through RT-PCR and the isolation and analysis of multiple pref-1 cDNA clones, we have identified, in addition to full-length pref-1, five alternately spliced forms with various in-frame deletions of all or a part of the sixth EGF-like repeat, juxta-membrane, and predicted transmembrane domains.(ABSTRACT TRUNCATED AT 250 WORDS)

3T3 Cells↗
PubMed1994

Preclinical evaluation of WR-151327: an orally active chemotherapy protector.

Clinical trials are in progress to evaluate radio- and chemoprotection by the aminothiol 2-[(3-aminopropyl)amino]ethanethiol-dihydrogen phosphate ester (WR-2721; amifostine). Phase II and III clinical studies have demonstrated that i.v. administered WR-2721 protects against the toxicities of cis-diamminedichloroplatinum (II) and cyclophosphamide. In preclinical murine studies, we have now further characterized the chemoprotective properties of WR-2721, and have evaluated the protective ability of the related aminothiol S-3-(3-methylaminopropylamino)propylphosphorothioic acid (WR-151327) following p.o. administration. The P388 leukemia (i.p. tumor-i.p. cytotoxic drug on Day 1 after tumor) was used to determine antitumor efficacy. Single dose pretreatment with i.p. WR-2721 protects normal mouse tissues against the chemotoxicities of mitomycin C, cis-diammine(cyclobutanedicarboxylato)platinum (II), and doxorubicin. Bone marrow suppression and cytotoxic drug-induced lethality were reduced, without compromising P388 antitumor activity. Pretreatment with a single p.o. dose of WR-151327 was as effective as i.p. WR-2721 in protecting against the myelotoxicity and lethality of mitomycin C, cis-diamminedichloroplatinum (II), and cis-diammine(cyclobutanedicarboxylato)platinum (II), while P388 antitumor activity was maintained. These data support the clinical development of WR-151327 as a p.o. administered chemotherapy protector.

Administration, Oral↗
PubMed1994

Prevention of thromboembolism in spinal cord injury: role of low molecular weight heparin.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute spinal cord injury. Our preliminary studies indicated that low molecular weight heparin (LMWH) was significantly more effective than standard heparin in preventing these complications. We have now extended these studies by screening an additional 122 patients and treating 60 who met predefined criteria with LMWH in a dose of 3,500 anti-Xa U given subcutaneously once daily for 8 weeks. All patients were examined daily at bedside and had regularly scheduled venous ultrasonography; those with abnormalities had confirmatory venography and lung scans. Postmortem examinations were conducted in those who died. Forty completed the trial without incident, 6 had DVT (4 proximal and 2 distal), 1 had a fatal PE, 1 had postoperative bleeding requiring discontinuation of the LMWH, 10 were transferred or discharged, and 2 died of respiratory failure. The percentage of patients free of thrombosis or bleeding after 8 weeks of treatment was 85.9 +/- 5.0% standard error of mean (SEM). Thirty-three patients entered a follow-up observation period of 4 weeks without thromboprophylaxis; 2 weeks into this period 1 had a proximal DVT and 1 had a fatal PE; the course of the remainder was uneventful. We conclude that LMWH compares favorably with standard heparin in preventing venous thromboembolism, and is associated with significantly less bleeding. Eight weeks of prophylaxis seems adequate for most patients.

Adult↗
PubMed1994

An evaluation of intravenous immunoglobulin in the treatment of human immunodeficiency virus-associated thrombocytopenia.

BACKGROUND: Anecdotal evidence suggests that high-dose intravenous immunoglobulin (IVIG) is useful in the management of human immunodeficiency virus (HIV)-associated thrombocytopenia. STUDY DESIGN AND METHODS: To rigorously evaluate this therapy, a crossover study was designed to compare IVIG, given at 1 g per kg per day for 2 consecutive days each week for 4 weeks, with intravenous saline placebo administered according to the same schedule. Subjects were randomly assigned to receive either IVIG or saline during the first 4 weeks; if IVIG was given, there was a 4-week period of no therapy before beginning placebo administration. Criteria for eligibility were platelet count of less than 50,000 per microL (50 x 10(9)/L), elevated platelet-associated IgG levels, increased megakaryocytes in the bone marrow, and positive HIV antibody test. Twelve patients (11 men, 1 woman) were studied. Seven patients completed the full protocol. Four dropped out: after 2, 5 (2 patients), and 8 weeks that included at least 2 weeks of IVIG. RESULTS: All patients sustained an increase in platelet count in response to IVIG, with increments ranging from 15,000 to 358,000 per microL (15 to 350 x 10(9)/L) (mean, 180,000/microL [180 x 10(9)/L]; median, 174,000/microL [174 x 10(9)/L]). No patient had an increase after placebo infusions. There were no adverse effects of treatment, and weekly chemical analyses showed no new abnormalities except for mild elevations in the serum protein. The duration of responses ranged from 2 to 10 weeks. No patient demonstrated refractoriness to IVIG. CONCLUSION: IVIG consistently raises platelet counts in patients with HIV-associated thrombocytopenia.

Adult↗
PubMed1994

Hemostatic factors in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

Elevated levels of factor VII (FVII) and fibrinogen (Fb) have been reported as risk factors for coronary heart disease in middle-aged and older adults. The purpose of this study was to determine whether increased levels of these and other hemostatic factors (FVIII, von Willebrand factor [vWF]) were associated with other coronary risk factors in young adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Hemostatic factors were measured in 1724 participants aged 23 to 35 years who were roughly balanced by sex and race (black/white). Fb was greater in women than men (black, 288 versus 253 mg/dL; white, 267 versus 240 mg/dL; overall P < .05 by Scheffé multiple-comparison test), and FVIII and vWF were higher in blacks than in whites (FVIII in men, 103% versus 88%, and in women, 104% versus 91%; vWF in men, 114% versus 98%, and in women, 117% versus 99%; P < .05). The latter factors were lower in those with blood group O, but within each blood group (except group A), blacks had significantly higher levels of FVIII and vWF. Fb was positively correlated with body mass index (r = .27 to .48, P < .001), total cholesterol (r = .13 to .17, P < .05), and low-density lipoprotein cholesterol (r = .15 to .22, P < .01) in all groups and with blood pressure, triglycerides, and cigarette smoking in white men. FVII correlated positively with cholesterol (r = .12 to .29, P < .05) and triglycerides (r = .23 to .32, P < .001) in all groups and with low-density lipoprotein in whites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Fatal pulmonary embolism in spinal cord injury.

Fatal pulmonary embolism (PE) is a major cause of mortality in patients with spinal cord injury. In order to ascertain those characteristics that might predict this event, we reviewed the records of all patients with autopsy-proven massive PE admitted to a regional spinal cord care center over a 5-year period. The information analyzed included patient age, sex, race, height, weight, type of accident, prior use of tobacco, alcohol, or narcotic drugs, level of injury, presence of spasticity, surgical procedures, infections, transfusions, and type of anticoagulant prophylaxis. Forty-two concurrently hospitalized patients with spinal cord injury served as control subjects. Significant differences between cases and control subjects were observed for level of injury (fewer thoracic and lumbar injuries in cases, p = 0.04), less spasticity in cases (p = 0.01), and greater body mass index in cases (p = 0.01). There was also a trend toward more advanced age in the cases (p = 0.1) and more frequent serious infections (p = 0.08). Lastly, low molecular weight heparin had been used as thromboprophylaxis in a greater proportion of control subjects than cases (60 percent vs 22 percent, p = 0.07), suggesting that low molecular weight heparin may be more effective in preventing fatal PE than unfractionated heparin.

Adult↗
PubMed1994

Prevalence of human T cell lymphotropic virus type II in American Indian populations of the southwestern United States.

We investigated the seroprevalence of human T cell lymphotropic virus type II (HTLV-II) using a screening enzyme-linked immunosorbent assay (ELISA) and immunoblot confirmation among the predominant tribes (Pueblo and Athapaskan) served by two large Indian Health Service facilities in New Mexico. Among persons being treated for sexually transmitted diseases, eight (3.2%) of 250 were seropositive for HTLV II, compared with eight (2.1%) of 385 women attending prenatal clinics. In a survey of unselected patients at one of the facilities, 15 (3.4%) of 446 were seropositive. Of 31 seropositive subjects, 25 were infected with HTLV-II and six infections could not be typed. Sera from nine (29%) of the 31 infected subjects had absorbance values less than the manufacturer's cutoff in the ELISA. Both Pueblo and Athapaskan groups had similar overall seroprevalences, but women tended to have a slightly higher seroprevalence than men, and seroprevalence tended to increase with age. These data show that HTLV-II infection is present among diverse groups of American Indians in the southwestern United States. Present ELISA screening tests, such as those used in this study, lack sensitivity to HTLV-II infection unless a reduced absorbance cutoff is used.

Adolescent↗
PubMed1994

Epiphysiodesis in juvenile hallux abducto valgus. A preliminary retrospective study.

Juvenile hallux abducto valgus manifested prior to physeal plate closure was treated by lateral epiphyseal stapling and modified McBride bunionectomy in nine children (15 feet) from 1984 to 1992. The prevalent preoperative symptoms were significantly reduced postoperatively. The intermetatarsal angle decreased an average of 6.6 degrees (initial decrease was 2.7 degrees with an additional 3.9 degrees occurring over time). The hallux abducto valgus angle decreased an average of 19.6 degrees (initial decrease was 10.7 degrees with an additional 8.9 degrees occurring over time).

Adolescent↗
PubMed1994

The paradigm shift: behavioral home care.

Home care agencies looking to compete in today's competitive market must learn to target their services to market niches and to keep their eyes on marketplace trends. This article examines the changes occurring in behavioral home care and how agencies can tailor their services to their communities.

Clinical Protocols↗