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Biomedical subjects

D Hartman

Publications and source records attributed to D Hartman.

At least 19 recordsLinked to original sources
PubMed1999

Assessment of resident knowledge: subjective assessment versus performance on the ACR in-training examination.

RATIONALE AND OBJECTIVES: The authors assessed the ability of faculty and residents to predict the ranked performance of residents on the American College of Radiology (ACR) In-Training Examination. MATERIALS AND METHODS: Radiology faculty at Penn State Geisinger Health System (PSGHS), the Medical College of Virginia (MCV), and the University of Virginia (UVA) and residents at PSGHS and MCV ranked the expected performances of residents taking the 1997 ACR In-Training Examination. Surveyed faculty and residents were blinded to the actual performances on the examination. Forty-nine residents took the examination (21 at PSGHS, 22 at MCV, six at UVA), and 37 faculty members (11 at PSGHS, 11 at MCV, 15 at UVA) participated in the study. Correlation analysis was performed to assess the agreement between the subjective and actual ranking of residents in each residency class. RESULTS: Faculty were moderately accurate in the overall ranking of resident performances (r = 0.34). High levels of concordance for ranking individual residents correlated with accuracy in only certain cases. Differences in agreement and accuracy of the respondents existed between PSGHS and MCV (P = .0001 and .0014, respectively). The concordance of respondents increased significantly from the 1st- to the 2nd-year class at MCV (P = .0002), whereas accuracy increased significantly between these classes for the PSGHS (P = .042). CONCLUSION: Faculty are only moderately successful in ranking resident performances on the ACR In-Training Examination, and a high level of agreement is not necessarily indicative of increased accuracy. The concordance and accuracy of subjective rankings differ among residency programs and classes.

Clinical Competence↗
PubMed1999

WY-50295 tromethamine: a 5-lipoxygenase inhibitor without activity in human whole blood.

The 5-LO inhibitor, WY-50295 tromethamine (T) prevented leukotriene release (LTB4 production) in calcium ionophore stimulated, purified human and rat neutrophils. However, whereas WY-50295T inhibited both in vitro and ex vivo rat whole blood leukocyte LTB4 formation (IC50= 40 microM and oral ED50 of 18 mg/kg, respectively), it did not inhibit LTB4 production in calcium ionophore stimulated human whole blood at concentrations to 200 microM. To reduce binding of WY-50295T to serum albumin, 250 microM of a naphthalene sulfonic acid (> 99.9% binding to albumin primarily at the carboxylic site) and 250 microM sulfanilamide (binding to nonspecific sites) separately or in combination were preincubated in whole blood prior to addition of WY-50295T; however, WY-50295T still did not inhibit 5-LO and free drug blood levels were unchanged. When purified human neutrophils in the presence of fatty acid saturated albumin (fraction V) was employed, the 5-LO inhibitory activity of WY-50295T was prevented. Zileuton (5 microM) inhibited LTB4 production by 99% in the presence of these albumins. Also, rat albumin presented WY-50295T to purified rat neutrophils more effectively than human albumin (i.e. WY-50295T was more active in the presence of rat albumin). These results suggest that the high affinity binding of WY-50295T to human albumin and possibly the reduction of drug uptake (passive diffusion) using purified human vs rat neutrophils may account for the inactivity of WY-50295T in the human whole blood assay.

Animals↗
PubMed1998

School can be hell

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Journal Article↗
PubMed1998

The influence of total, dialysis, and residual renal urea clearances on serum albumin in peritoneal dialysis.

Though serum albumin (SA) and Kt/V predict mortality in peritoneal dialysis (PD), the relationship between them remains unclear. We report a cross-sectional study of factors associated with SA in PD, and a prospective study of the effect of increasing dialysis dose on SA in hypoalbuminemic patients with Kt/V < 2.1. Multiple linear regression was performed in 56 subjects with dependent variable SA at 4 months after starting PD (SA2), and independent variables: age, sex, diabetes, 4h-D/Pcr, predialysis SA (SA1), nPCR, PD-duration, modality, Kt/V, Ccr, and daily volume excreted normalized to body water (Vt/V). Forward stepwise selection (alpha = 0.05) produced a model (r2 = 0.492, P < 0.001) containing predictors of SA2: SA1 and nPCR (positive), and Vt/V (negative). With Vt/V excluded, Kt/V became significant (negative). Broken into components, dialysate Kt/V was significant, but residual Kt/V was not significant. In 14 hypoalbuminemic patients with Kt/V < 2.1, PD prescription was changed, targeting a Kt/V > 2.1. After 3.3 months, Kt/V rose from 1.7 +/- 0.25 to 2.21 +/- 0.36 (P = 0.0001), and nPCR rose slightly, 0.71 +/- 0.13 to 0.78 +/- 0.19 (P = NS), with no significant change in SA, 30.5 +/- 3.0 g/L to 31.4 +/- 3.8 g/L (P = 0.268). Dialysate and urine volumes are negative predictors of SA. Volume-dependent dialysate-protein loss could account for poor correlation between Kt/V and SA, and lack of improvement in SA with increased Kt/V.

Adolescent↗
PubMed1997

Evaluation of adnexal masses using three-dimensional ultrasonographic technology: preliminary report.

The purpose of the current study was to demonstrate the ability of three-dimensional ultrasonographic technology to enhance the morphologic scoring system and further improve the ability to differentiate benign from malignant ovarian masses. We performed conventional two-dimensional and three-dimensional transabdominal and transvaginal ultrasonography on eight women with adnexal masses. All patients underwent exploratory laparotomy or diagnostic laparoscopy. The three-dimensional ultrasonographic findings were compared with the two-dimensional ultrasonograms, the intraoperative observations, and gross and histopathologic findings. The morphologic scoring system as described by Sassone and coworkers was adopted, with scores of less than 9 suggestive of benign lesions, and this system was applied in both the two-dimensional and three-dimensional ultrasonographic examinations. The morphologic scores were subsequently compared. The images were dissected in the XYZ planes, and the areas suggestive of malignancy, as suggested by two-dimensional ultrasonography, were determined to be either negative or positive and confirmatory. In each of the eight adnexal masses, three-dimensional ultrasonography confirmed the preoperative diagnoses. The morphologic scores did not differ between two-dimensional and three-dimensional ultrasonograms for the benign cysts. In one case of benign solid fibroma, both the two-dimensional and three-dimensional gray scale morphologic scores were falsely positive at greater than 9. In one case of malignant serous papillary cystadenocarcinoma the two-dimensional morphologic score was a 9, where- as the three-dimensional score was 13. This difference in scores can be attributed to the additional views available with three-dimensional volume scanning, which allowed better characterization of the pathologic conditions. In addition, three-dimensional sonographic technology had the added advantage of high-speed image acquisition and recording to decrease the time of scanning to improve patient comfort. Furthermore, three-dimensional ultrasonography allowed the real-time analysis of the acquired image data to be conducted at a later time when the patient is off the examination table. Our preliminary results suggest that three-dimensional transvaginal ultrasonographic technology can enhance and facilitate the morphologic evaluation of both benign and malignant adnexal masses.

Adult↗
PubMed1996

Normal protein folding machinery.

A highly conserved protein folding machine has been maintained in the cytosol of both prokaryotic and eukaryotic organisms and in eukaryotic mitochondria. Homologous components of this machinery have also been identified in other organelles such as the endoplasmic reticulum in which HSP70 and DnaJ-like homologs reside. The high degree of conservation presumably reflects the proficiency with which these molecules have evolved to mediate the folding of proteins to their native functional states.

Endoplasmic Reticulum↗
PubMed1995

Etodolac selectively inhibits human prostaglandin G/H synthase 2 (PGHS-2) versus human PGHS-1.

The isozymes of prostaglandin G/H synthase (PGHS) are shown to be differentially inhibited in vitro by currently marketed nonsteroidal anti-inflammatory drugs (NSAIDs) using microsomal rhPGHS-1 and rhPGHS-2. Comparison of selectivity ratios (IC50 rhPGHS-1/IC50 rhPGHS-2) demonstrated a 10-fold selectivity of etodolac (Lodine) for rhPGHS-2, whereas the other NSAIDs evaluated demonstrated no preference or a slight preference for inhibition of rhPGHS-1. In vitro enzyme results were supported by a human whole blood assay where etodolac also demonstrated a 10-fold selectivity for inhibition of PGHS-2 mediated TxB2 production. Taken together, these data may be key to explaining the clinically observed gastrointestinal safety of etodolac versus other marketed NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning.

OBJECTIVES: To review ultrasonography (US) test performance and to develop recommendations for the use of US to aid in the evaluation of potential appendicitis. METHODS: A meta-analysis was conducted using all English-language articles published since 1986 (17 studies; 3,358 patients) to ascertain sensitivity and specificity of US for diagnosing appendicitis in adults and teenagers. Calculation of the predictive value of US was performed for three groups of patients: group I--usually operated on (prevalence of appendicitis = 80%); group II--usually observed in hospital (prevalence = 40%); and group III--usually released home (prevalence 2%). RESULTS: Overall sensitivity was 84.7% (95% CI: 81.0-87.8%), and specificity 92.1% (88.0-95.2). The accuracy and usefulness of US were related to the likelihood of appendicitis. In group I, a positive test was accurate [positive predictive value (PPV) = 97.6%], but a negative study could not rule out appendicitis [negative predictive value (NPV) = 59.5%]. The converse was true for group III patients (PPV = 19.5%, NPV = 99.7%). Test performance accuracy was balanced only for group II patients (PPV = 87.3%, NPV = 89.9%). CONCLUSIONS: 1) US should not be used to exclude appendicitis for patients who have "classic" signs/symptoms, due to the underlying high false-negative rate. 2) US is most useful for patients who have an indeterminate probability of disease after the initial evaluation--if US is positive, the patient should have an operation; otherwise, he or she should be observed. 3) US is not recommended for screening patients who have a low probability of appendicitis, due to the low prevalence of disease and high false-positive rate in this group.

Adult↗
PubMed1995

Anorexia nervosa--diagnosis, aetiology, and treatment.

The aetiology, assessment and treatment of anorexia nervosa are reviewed in the light of the classical accounts of Morton, Lasègue and Gull. The core symptoms are deliberate weight loss, disturbed body image and amenorrhoea, and complications may include cardiac failure, electrolyte disturbances, hypothermia and osteoporosis. Common clinical findings are described. Disturbed brain serotonin activity is implicated in the aetiology of anorexia nervosa, but there is little support for the use of pharmacological treatments. Psychological theories of aetiology are discussed with reference to Bruch, Crisp, Palazzoli and Minuchin: the common theme is the reaction of the patient and her family to the physical and social changes of puberty. Individual and/or family psychotherapy is seen as central to the treatment of anorexia nervosa, and the relevant clinical research is reviewed. The roles of general practitioners, general psychiatrists and eating disorder specialists are discussed in the light of recent consensus treatment guidelines.

Adolescent↗
PubMed1994

Racemic epinephrine in the treatment of laryngotracheitis: can we identify children for outpatient therapy?

The purpose of this study was to identify a cohort of children with laryngotracheitis (croup) who may be safely discharged from the emergency department (ED) after treatment with nebulized racemic epinephrine (RE), corticosteroids, and prolonged observation. Consecutive children (younger than 13 years of age) presenting to the ED with the diagnosis of laryngotracheitis were evaluated prospectively according to a croup scoring system. Sixty-one patients (4 to 108 months of age) with persistent inspiratory stridor at rest after 20 minutes of mist therapy who received nebulized RE (0.05) mL/kg of a 2.25% solution) and intramuscular dexamethasone (0.6 mg/kg) were enrolled in the study. Patients were observed in the ED while croup scores were assessed at 15, 60, 120, and 180 minutes. Croup scores were significantly improved (analysis of variance, P < .01) throughout the observation period in 31 patients (51%) who were discharged from the ED. Only one patient returned within 48 hours for further cool mist therapy. The maximum benefit from RE therapy was seen at 60 minutes. If a child had persistent resting stridor or a croup score greater than 2 at that time, hospitalization was inevitable. The 30 patients admitted to the hospital were younger (19.1 v 27.8 months) and had higher pretreatment croup scores (5.7 v 4.1). This was the first prospective study to identify a subset of children who have received RE to be safely discharged home after observation in the ED.

Administration, Inhalation↗
PubMed1994

A comparison of pain experienced during hysterosalpingography and in-office falloposcopy.

OBJECTIVE: To determine patient perception of the intensity of pain during in-office falloposcopy compared with hysterosalpingography (HSG). DESIGN: A prospective quality assurance study using a formal pain scale to compare two procedures. SETTING AND PATIENTS: Patients attending a tertiary level infertility clinic. INTERVENTIONS: In-office falloposcopy or HSG using analgesics. MAIN OUTCOME MEASURES: The mean pain score and area under the pain curve experienced during each investigation. RESULTS: Using our technique, in-office falloposcopy was associated with a significantly lower mean intensity of pain and with a longer procedure. The duration of the falloposcopic examination declined significantly with physician experience. Flushing adjacent to the uterotubal ostium, ostial cannulation, and rapid eversion provoked episodes of acute pain during falloposcopy. CONCLUSION: These results support the patient acceptability of in-office falloposcopy.

Adult↗
PubMed1993

Analgesic activities of PEM-420, the active eutomer of pemedolac.

PEM-420, the active isomer of pemedolac, inhibited the writhing responses induced by phenylbenzoquinone (PBQ), acetic acid, and acetylcholine in mice with ED50's of 0.80, 0.92, and 0.075 mg/kg p.o., respectively. In the rat acetic acid writhing assay, PEM-420 exhibited an ED50 value of 8.4 mg/kg p.o. In the Randall-Selitto test, PEM-420 raised the pain threshold of the yeast-injected paw (ED50 = 0.55 mg/kg p.o.). Like other NSAIDs, PEM-420 inhibited the PBQ-induced production of PGI2 and PGE2 in the mouse peritoneal cavity, with ED50 values of 0.5 and 1.2 mg/kg p.o., respectively. It had weak ulcerogenic liability in rats (acute UD50 = 99 mg/kg p.o. in fasted rats; subacute UD50 = 74 mg/kg/day for 4 days in fed rats). The data indicate that PEM-420 is a potent and safe peripheral analgesic.

Acetates↗
PubMed1993

Pharmacological characterization of WAY-121,520: a potent anti-inflammatory indomethacin-based inhibitor of 5-lipoxygenase (5-LO)/phospholipase A2 (PLA2).

WAY-121,520 inhibited human synovial fluid PLA2 (HSF-PLA2) (IC50 = 4 microM) using arachidonic acid-labeled E. coli as substrate. Further biochemical characterization of WAY-121,520 demonstrated potent inhibition of 5-lipoxygenase (5-LO) activity in the murine macrophage (LTC4, IC50 = 4 nM) and rat PMN (LTB4, IC50 = 10 nM) and an ability to antagonize LTD4 binding to isolated guinea-pig trachea (pKB = 6.0). In vivo anti-inflammatory activity was noted in murine TPA-induced (ED50 = 91 micrograms/ear) and arachidonic acid-induced (66% inhibition at 400 micrograms/ear) ear edema and in leukotriene-dependent antigen-induced bronchoconstriction in the guinea pig (73% inhibition at 50 mg/kg, p.o.). WAY-121,520 represents a novel series of indomethacin-based inhibitors of PLA2 with anti-inflammatory activity resulting from a combination of biochemical activities (inhibition of 5-LO and PLA2 and LTD4 antagonism). This agent may provide added therapeutic efficacy over more selective inhibitors.

Animals↗