Late severe rejection of intestinal allografts: risks and survival outcome.
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Adult↗
Biomedical subjects
D Martin
Publications and source records attributed to D Martin.
Enjoyable activity for everyone.
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Adolescent↗
Prehospital use of pulse oximetry in rotary-wing aircraft.
A prospective study of 200 patients was conducted to evaluate the use of pulse oximetry as an adjunct to clinical monitoring of clinically ill patients transported by rotary-wing aircraft with non-pressurized cabins. Thirty-four subjects (17%) were found to have significant hemoglobin desaturation of less than 90%, as defined by pulse oximetry (SpO 2). Data were recorded continuously for later review. Desaturation often was noted prior to alterations in vital signs or clinical appearance. In 32 of 34 hypoxemic subjects (94%), therapeutic interventions corrected the low SpO 2. The use of pulse oximetry permitted measures for cardiorespiratory support to be instituted and assessed more rapidly than otherwise would have been possible. The availability of a continuous record of SpO 2 facilitated detailed review of case management. It is concluded that the use of pulse oximetry is a practical and valuable adjunct for monitoring critically ill patients transported by rotary-wing aircraft.
Adolescent↗
Haploidentical stem cell transplantation in patients with pediatric solid tumors: preliminary results of a pilot study and analysis of graft versus tumor effects.
Pediatric patients with relapsed metastatic tumors have a poor prognosis and new treatment strategies are warranted. We present preliminary results of a pilot study, evaluating the feasibility and toxicity of transplantation of haploidentical T and B cell depleted grafts with high numbers of NK cells. 6 patients with relapsed metastatic neuroblastomas (n = 4), rhabdomyosarcoma (n = 1) or Ewing's sarcoma (n = 1) after previous autologous transplantation received CD3/CD19 depleted grafts from mismatched family donors with a median number of 16 x 10 (6)/kg stem cells, 167 x 10 (6)/kg Natural Killer cells and only 5.4 x 10 (4)/kg residual T cells. A melphalan-based, reduced intensity conditioning was used. Despite pretransplant chemotherapy, patients entered transplantation with significant tumor burden. Primary engraftment occurred in 6/6 patients. One patient had secondary graft failure. Hematopoietic recovery was rapid (ANC > 0.5 x 10 (9)/L: 11 days (9-12); independence from platelet substitution: 8 days (7-11)). Four patients had acute GvHD grade II, limited chronic GvHD was observed in 2 patients. No transplant-related mortality and only low toxicity occurred. Four patients died from progression, two patients are alive. Overall median survival time is 6 months (2-11) to date. Analysis of posttransplant NK cell function revealed stable cytotoxic activity against K562 targets, whereas activity against neuroblastoma targets was low. Stimulation with cytokines and use of appropriate antibodies clearly enhanced specific lysis in vitro. In summary, these preliminary results indicate the feasibility and low toxicity even in intensively pre-treated patients with neuroblastomas/sarcomas. This approach may form the basis for posttransplant immunomodulation and other therapeutic strategies. Further experience is warranted to evaluate the method.
Acute Disease↗
A preparation to study simultaneous arterial and venous thrombus formation in rabbits.
Injury to an artery induces formation of a platelet-rich thrombus, while stasis or trauma to a vein induces a fibrin-rich thrombus. We have implemented preparations for evolving both platelet-rich and fibrin-rich thrombi simultaneously in rabbits for use to define the efficacy of novel antithrombotic agents. For platelet-rich thrombosis, a carotid artery and contralateral jugular vein were dissected and an arteriovenous shunt inserted distally to prevent cerebral infarction during thrombus formation. The shunted artery was then instrumented with a proximal Doppler probe for measuring flow velocity and a distal transluminal needle electrode. Electrical injury to the artery was induced by application of 250 microA of anodal current to the indwelling needle electrode. Thrombotic occlusion was consistently observed within 60 min, permitting measurements of the effects on the incidence and time of occlusion of antithrombotic agents administered over 2 h. For fibrin-rich thrombosis, an external jugular vein was dissected, including the distal bifurcation. One of the branches was catheterized and a copper wire with cotton threads attached was advanced through the catheter into the superior vena cava, allowing exposure of the threads to flowing blood. A 25- to 30-mg thrombus was formed within 2 h, permitting reliable measurements of effects on thrombus weight of antithrombotic agents administered during this interval. Implementing both arterial and venous thrombosis simultaneously did not change measurements compared with either method alone. This approach may facilitate recognition of differences in efficacy of selected agents against thrombi of diverse composition.
Animals↗
Optimizing census geography: the separation of collection and output geographies.
"This paper reviews the changing way in which census geography has been treated with the increasing automation of census data processing. A four-stage model of modern census geography development is presented. In the context of this model, current practice is reviewed, and new opportunities for automated census geography design presented, culminating in a current prototype for the separation of purpose-designed data collection and output geographies. The narrative is presented primarily from a British perspective, but focuses on internationally relevant issues such as the implementation of census geography design, and the influence of census output geography on data analysis."
Censuses↗
Contamination of illicit phencyclidine with 1-piperidinocyclohexanecarbonitrile.
A retrospective study of illicit phencyclidine (PCP), which consisted of 94 different cases or 213 individual samples, has shown that one third of both the powder/tablets and green plant material contained the synthetic contaminant 1-piperidinocyclohexanecarbonitrile (PCC). The mole % PCC/PCP ranged from 1 to 68%. The method of analysis was gas chromatography (3% OV-7, 205 degrees C) and in preparation for analysis the sample was dissolved directly in chloroform or extracted from a strongly acidic solution (0.1 N HCl). Using these extraction conditions PCC was found not to undergo measurable decomposition.
Chromatography, Gas↗
Assessment of the pregnant trauma patient.
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Female↗
Approximate molecular weight of envelope protein 1 and colony opacity of Neisseria gonorrhoeae strains isolated from patients with disseminated or localized infection.
The patterns of electrophoretic (SDS-PAGE) migration of the major outer membrane protein I of 35 strains of Neisseria gonorrhoeae causing disseminated gonococcal infections (DGI) were compared, and the proportion of colonies expressing the transparent phenotype on a solid medium was determined. Thirty-one of these DGI strains had a protein I of very similar apparent molecular weight (approximately 36,000 daltons), and at least 75% of their colonies on a translucid medium expressed the transparent phenotype. Strains responsible for localized infections and isolated from patients in the same geographic area (Montreal) showed a greater heterogeneity in both apparent molecular weight of protein I and colonial opacity than did strains from patients with DGI. In particular, most prototrophic strains obtained from patients with localized infection had proteins I with molecular weights varying from 35,000 to 38,000 daltons and gave predominantly opaque colonies.
Bacterial Outer Membrane Proteins↗
Educating speech-language pathologists for a multicultural world.
This paper presents critical elements and current needs in educating speech-language pathologists for a multicultural world. A proposed paradigm shift in clinical teaching using the UK model is also introduced. In addition, a case study on the American Speech Language Hearing Association's efforts in implementing the Multicultural Action Agenda by networking with the Asian Pacific Islander caucus is described. A survey of multicultural elements in programs in Australia and New Zealand is included. Finally, suggestions for collaboration with those in established professional bodies to meet the increasing needs of a multicultural world are provided.
Cultural Diversity↗
Adaptive ammoniagenesis in chronic renal failure.
The role of gamma-glutamyltransferase (gamma-GT) in renal ammoniagenesis, glutamine (Gln), and glutathione (GSH) utilization was evaluated in the intact functioning rat kidney of subtotal nephrectomy (SNX) model of chronic renal failure (CRF). NH4+ derived from extracellular gamma-GT hydrolysis of Gln and GSH was differentiated from the intramitochondrial phosphate-dependent glutaminase by using acivicin, a gamma-GT-specific inhibitor. In the control (C) group Gln extraction accounted for 61% of total NH4+ production (sum of renal venous and urinary NH4+), but only 41% in SNX group. In the SNX group GSH extraction accounted for 10% of total NH4+ production, but only 1% in the C group. Acivicin inhibited 44% and 33% of total NH4+ production in SNX and C group respectively, as compared to baseline before acivicin. In CRF, gamma-GT a key enzyme of the gamma-glutamyl cycle plays a significant role in adaptive ammoniagenesis.
Ammonia↗
Survey of GPs' views of learning disability services.
This survey aimed to examine GPs' awareness of the learning disabilities services in Sandwell, West Midlands, and their attitudes towards them. Sixty-two per cent of GPs participated in the study which involved completion of a short questionnaire or interview. The questionnaire was either administered to the GP during a short interview, or completed by a GP who returned the completed questionnaire to the researcher. Only information obtained in response to the questionnaire has been used in collating the data for this survey. The results show that GPs are very confused about what constitutes a learning disability and have only a limited knowledge of the specialist services available to this client group; furthermore, where they were aware of the services available, accessing them was often problematic. Reasons for these findings, along with recommendations, are discussed.
Community Health Services↗
An educational initiative in anaesthetic nursing practice.
The National Board for Nurses, Midwives and Health Visitors in Northern Ireland (NBNI) has adopted the principles of the UKCC's recommendations for specialist nursing practice and Incorporated these within their continuing education framework. Stage two of this framework decrees the standard required for specialist nursing practice (NBNI, 1995) and, as a result, a specialist anaesthetic nursing course has been instigated. The course extends over 44 weeks and includes 8 weeks of consolidation practice, comprising seven modules at degree and diploma level. The course gives the students an opportunity to deepen their knowledge, skills and attitudes in the field of anaesthetic nursing. Nurses were taught the necessary skills to work in collaboration with other professionals, patients and families in order to coordinate a patient-centred approach to perianaesthetic care. The role of the anaesthetic nurse specialist should be viewed as complementary to that of the anaesthetist. This course facilitates and encourages practitioners to move beyond registered practice on qualifying to a more specialized role where care is delivered in an innovative and creative manner.
Clinical Competence↗
Plasma levels of tricyclic antidepressants in panic disorder.
Five patients with panic disorder were placed on low doses of imipramine. All patients had shown dramatic improvement after three weeks of treatment, when plasma levels of imipramine and desipramine were measured. Plasma levels corresponded to the low doses being administered. This result implies that the mechanism of action of tricyclic antidepressants is different in patients with panic disorder than in patients with depressive disorder.
Adult↗
emm typing and validation of provisional M types for group A streptococci.
This report discusses the following issues related to typing of group A streptococci (GAS): The development and use of the 5' emm variable region sequencing (emm typing) in relation to the existing serologic typing system; the designation of emm types in relation to M types; a system for validation of new emm types; criteria for validation of provisional M types to new M-types; a list of reference type cultures for each of the M-type or emm-type strains of GAS; the results of the first culture exchange program for a quality control testing system among the national and World Health Organization collaborating centers for streptococci; and dissemination of new approaches to typing of GAS to the international streptococcal community.
Antigens, Bacterial↗
The role of the principal clinical coordinator in the Health Care Financing Administration's Health Care Quality Improvement Initiative.
The Health Care Quality Improvement Initiative (HCQII) is the Health Care Financing Administration's latest approach to quality management by peer review organizations (PROs) of the health care delivered to Medicare beneficiaries. The principal clinical coordinator (PCC) of each PRO, a physician with both clinical and methodological expertise, has the overall responsibility for all HCQII-related activities. The PCC works with a clinical coordinating team to analyze patterns of care and provide feedback about these patterns to the medical community for the purpose of improving the quality of care. Each PRO provides its PCC with the necessary infrastructure and expertise to conduct pattern analyses and implement the dissemination process. However, the effectiveness of the HCQII will depend largely on the PCC's ability to maintain the full support and cooperation of the local medical community. The success of the PCC role under the HCQII may enable it to serve as a useful model of physician leadership in the quality oversight organizations that will accompany national health care reform.
Cardiology Service, Hospital↗
Creating a preferred future: the challenge is ours.
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Canada↗
Clinical intestinal transplantation in 1998: Pittsburgh experience.
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Adolescent↗