The editor as public authority: interpreting Margaret Sanger.
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Contraception↗
Biomedical subjects
E Katz
Publications and source records attributed to E Katz.
[Focal and segmental glomerulosclerosis in renal transplantation].
In 179 patients subjected to 186 renal transplants, 30 renal biopsies were performed due to the presence of a proteinuria over 3.5 g/24 h or due to a reduction in glomerular filtration rate. Six of these biopsies, coming from 5 patients, disclosed morphological alterations compatible with focal segmental glomeruloesclerosis. Five of these were due to recurrence of the primary disease (in four patients) and in all, massive proteinuria appeared from 1 to 23 days after transplantation. Two patients with three transplants, evolved to renal failure and required dialysis in a period 12 months as a mean. The third patient, developed a nephrotic syndrome without renal failure and died 14 months after the renal transplant due to a stroke. In the fourth patient, the nephrotic syndrome disappeared 38 days after the transplant and remained with minimal proteinuria until his last follow up visit two years later. The primary disease of the fifth patient is unknown; the nephrotic syndrome appeared 68 months after the transplant and remitted spontaneously in 2 months. The renal biopsy showed focal and segmental lesions with partial effacement of epithelial foot processes. It is concluded that focal segmental glomerulosclerosis recurrence in renal transplant occurs with early massive proteinuria and frequently leads to renal failure and graft loss in no more than two years.
Adolescent↗
Preservation injury in clinical liver transplantation: incidence and effect on rejection and survival.
The distribution of the severity of preservation injury (PI), its association with acute early rejection, and its effect on graft and patient survival were examined in 151 patients transplanted between 9/88 and 12/91. PI was graded into mild, moderate and severe using prothrombin time (PT) on the 2nd POD and peak AST and ALT levels of the first 3 days after transplant. Of the 151 patients, 104 (68.8%) had minimal, 24 (15.9%) had moderate, and 23 (15.3%) had severe PI. The rate of early rejection, within 21 days after transplant, (54.8% vs 54.2% vs 52.2%) and its timing (10.0 +/- 0.5 vs 8.8 +/- 0.8 vs 8.9 +/- 1.4 days) as well as the incidence of steroid-resistant rejection (21.4% vs 33% vs 30%) did not differ significantly among groups. Graft survival was significantly lower in the severe PI group than among patients with minimal PI at 3 months and 24 months (65.2% vs 86.2%; p < 0.05 and 58.3% vs 82.7%; p < 0.05, respectively). Patient survival at 3 and 24 months was similar among the groups (91.1% vs. 95.8% vs 86.9% and 81.9% vs 91.1% vs. 74.3%). We conclude that the cellular damage associated with preservation injury does not predispose to development of acute rejection.
Alanine Transaminase↗
Laparoscopic tubal anastomosis. A pilot study.
Five previously sterilized patients underwent laparoscopically guided tubal anastomosis. Patency was documented in at least 5 of 10 tubes operated on. The crude pregnancy rate was 50%.
Adult↗
The National Institute of Art and Disabilities: an art center for adults with developmental disabilities.
The National Institute of Art and Disabilities (NIAD) is an innovative art center for people with disabilities. It encompasses an art studio, exhibitions by artists with disabilities, research, and professional training. Artist-teachers are practicing artists. The center was founded and implemented by an artist and a psychologist. At least 21 similar centers have used this approach in providing community-based creative art experiences for individuals with disabilities.
Art↗
Synthesis of some acylphosphonate thiosemicarbazones and evaluation of their antiviral activity.
Reaction of dimethyl acylphosphonates (1) with thiosemicarbazide afforded the corresponding dimethyl acylphosphonate thiosemicarbazones (4). Lithium methyl acylphosphonate thiosemicarbazones (5) could be prepared either by monodealkylating compounds 4 by lithium bromide or by reacting lithium methyl acylphosphonates with thiosemicarbazide. Dihydrogen acylphosphonate thiosemicarbazones (6) could be obtained by reacting acylphosphonic acids (3) with thiosemicarbazide. The alternative approach to 6 by di-dealkylating compounds 4 using bromotrimethylsilane was limited by the solubility properties of esters 4. Compounds of types 5 and 6 did not show antiviral activity against herpes simplex type 1 and 2, or toward vaccinia virus.
Antiviral Agents↗
Flushing with autologous blood improves intraoperative hemodynamic stability and early graft function in clinical hepatic transplantation.
Hemodynamic instability and hyperkalemia are common after reperfusion and may cause ischemic damage on the hepatic allograft. Two techniques for flushing hepatic grafts before reperfusion were studied to evaluate their effects on intraoperative hemodynamic and metabolic status and on early graft function in 83 consecutive adult hepatic transplantations. In the first 41 patients (group 1), the hepatic grafts were rinsed with 500 milliliters of lactated Ringer's solution (LR). In the subsequent 42 patients (group 2), in addition to LR rinse, the first 500 milliliters of portal blood to flush and reperfuse the liver were drained through the cannula inserted into the donor vena cava before unclamping the vena cava. After reperfusion, the mean arterial pressure decreased 30 +/- 4 percent in group 1 versus 17 +/- 2 percent in group 2 (p < 0.02), and serum K+ increased by 1.9 +/- 0.2 in group 1 versus 0.8 +/- 0.2 milliequivalents per liter in group 2 (p < 0.01). Hyperkalemic cardiac arrest was only seen in two patients in group 1. The K+ concentration in the first 100 milliliters of discarded blood was found to be 40 +/- 2 milliequivalents per liter. The 500 milliliters of discarded blood contained 8.3 +/- 0.4 milliequivalents, which was correlated with graft liver weight (p < 0.001). Early graft function, as measured by serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, total bilirubin and prothrombin time on postoperative day No. 2, was significantly better in group 2 than in group 1 (p < 0.05). The six-month graft and patient survival rates in group 1 were 66 and 75 percent, versus 90 and 95 percent in group 2 (p < 0.01 and p < 0.02, respectively). Further flushing with 500 milliliters of autologous portal blood resulted in smaller intraoperative shifts in serum K+, greater hemodynamic stability, better graft function and improved graft and patient survival.
Adult↗
[Interrelation between liver and bowel involvement in ulcerative colitis patients undergoing liver transplantation].
Of 10 patients with ulcerative colitis 2 had primary sclerosing cholangitis and 1 had cirrhosis due to chronic active hepatitis. All 3 underwent successful orthotopic liver transplantation due to severe portal hypertension and deteriorating liver function. The interrelations between liver transplantation, immunosuppressive therapy and bowel disease are described.
Adult↗
The potential relevance of growth hormone to female reproductive physiology and pathophysiology.
OBJECTIVE: To assess possible interfacing between the somatotrophic and reproductive axes. DESIGN: Literature review. MAIN OUTCOME MEASURES: Ovarian growth hormone reception and action. RESULTS: The available literature strongly supports a permissive role for the somatotrophic axis in the reproductive process. CONCLUSIONS: Although a role for growth hormone in reproductive biology appears highly likely, its relevance to the process of puberty and to the normal workings of the menstrual cycle, as well as its possible application in reproductive pathology must await further investigation.
Female↗
Injury prevention instruction in the emergency department.
STUDY OBJECTIVE: To describe preventable pediatric injuries and the proportion receiving documented injury prevention instruction by emergency department personnel. DESIGN: Retrospective chart review. SETTING: A rural Level I trauma center. TYPES OF PARTICIPANTS: All injured children aged birth through 15 years presenting to our hospital from January 1, 1987, through December 31, 1987. MEASUREMENTS AND MAIN RESULTS: During the study period, 1,449 injuries presented to the trauma center. Motor vehicle crashes caused the largest number of preventable injuries (71), although the proportion of preventable injuries was higher among poisonings, burns, and pedestrian-automobile collisions. Among the 1,313 patients available to ED personnel at discharge, injury prevention instruction was indicated in 27% of cases but documented in the medical record in only 3%. ED personnel were more likely to document instruction for preventing poisoning than other causes of injury. CONCLUSION: Most preventable pediatric injuries treated and released by ED personnel do not receive documented injury prevention instruction.
Adolescent↗
The multicentre transcervical balloon tuboplasty study: conclusions and comparison to alternative technologies.
Transvaginal tubal catheterization procedures have been suggested as an alternative to microsurgery and in-vitro fertilization (IVF) in the treatment of women with proximal tubal occlusion. A transcervical balloon tuboplasty (TBT) catheter was specifically developed and tested in a prospective multicentre trial. A total of 151 women with confirmed bilateral or unilateral tubal occlusion were studied. The primary study population included 106 women who, after exclusion of patients for protocol violations, represented those females who were treated for complete tubal occlusion with TBT. TBT is an ambulatory, minimally invasive catheter procedure, performed under paracervical block or mild sedation, which utilizes a co-axial balloon catheter under fluoroscopic guidance. Re-canalization, pregnancy and reocclusion rates following the procedure were documented. A total of 28 patients demonstrating uni- or bilateral tubal patency after either hysterosalpingography and/or selective salpingography represented the control population. TBT established tubal patency of at least one Fallopian tube in 95/106 patients (90%) and in 167/205 obstructed oviducts (82%). Clinical pregnancies occurred in 37/106 females (35%), with a life table adjusted rate of 37%. Patients without distal disease had significantly higher pregnancy rates than those with bipolar tubal disease (49% versus 12%, life table adjusted rate; P = 0.0002) but pregnancy rates were independent of underlying aetiology for tubal disease. Pregnancy rates in control patients who did not reach TBT because of tubal patency after hysterosalpingography and/or selective salpingography were significantly lower than in those successful treated with TBT (P = 0.027), and occurred only for four cycles after hysterosalpingography and with approximately a 1 year delay after selective salpingography.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Liver resection under total vascular isolation. Variations on a theme.
Total vascular isolation (TVI) of the liver was employed during parenchymal transection in 16 patients undergoing hepatic resection for large tumors (mean diameter, 10.7 cm) located near hilar structures, hepatic veins, or the inferior vena cava (IVC). In 14 cases, TVI was achieved by clamping the suprahepatic and infrahepatic IVC and the porta hepatis, with or without aortic occlusion; in two, selective hepatic vein clamping was possible, obviating IVC occlusion. Procedures included standard and extended right and left lobectomies and caudate lobe resections. Concomitant resection and reconstruction of the portal vein (one case), IVC (one case), and bile duct (three cases) was required. Postoperative hepatic and renal failure did not occur. Mean intensive care unit and hospital stays were 2.8 +/- 1.9 and 12.5 +/- 5.2 days, respectively. There were two perioperative deaths. Total vascular isolation permits safe resection of large, critically located tumors that would otherwise present prohibitive operative risks.
Adolescent↗
The use of growth hormone treatment for ovulation induction.
The use of growth hormone in enhancing the ovarian response to gonadotropins is reviewed. The data support the utility of growth hormone in reducing the effective gonadotropin dosage and in most cases, increasing the ovulatory quota.
Anovulation↗
Use of anencephalic infants as organ donors.
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Anencephaly↗
The arcuate ligament syndrome in liver transplantation.
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Adult↗
Specific in vitro biological activity of snake venom myotoxins.
Some snake venoms contain toxins that are reported to be selective for damaging muscle. This specificity can be used to design experiments intended to eliminate muscle. We studied the small myotoxins and fractions IV and V of Bothrops nummifer venom to evaluate their direct effect on cultured muscle cells, neurons, macrophages, and a fibroblast cell line. The small myotoxins, at 100 micrograms/ml for 2 h, had no effect in vitro, contrary to the in vivo applications. Fractions IV and V were both myotoxic and, at 100 micrograms/ml, destroyed all cell types. However, at 10 micrograms/ml the effects of fraction IV were more selective for muscle. Vacuolation of the sarcoplasmic reticulum and T-tubules was first seen in the poisoned muscles, without initial lesions in the nuclei, sarcolemma, mitochondria, and rough endoplasmic reticulum. Fractions IV and V have different toxic activity in cells other than muscles and are a mixture of two basic proteins (i and ii). Protein ii is predominant in fraction IV and protein i is predominant in fraction V. The toxic effects may be mediated by the formation of nonspecific ionic pores in the sarcolemma and/or T-tubule muscle membrane.
Animals↗
Subtotal colectomy with primary ileocolonic anastomosis for obstructing carcinoma of the left colon: valid option for elderly high risk patients.
During a period of 4 years, 20 patients with obstructing carcinoma of the left colon were treated by subtotal colectomy with primary ileocolonic anastomosis. Thirteen patients (65%) were 65 years of age or older. All patients presented to the emergency room with large bowel obstruction. Twelve patients (age > 65) suffered other systemic diseases (chronic obstructive pulmonary disease, ischemic heart disease, morbid obesity), placing them in a high risk category. The mortality rate was 5% (1/20), 7.6% if only high risk patients are considered. The one-stage procedure in the treatment of obstructing carcinoma of the left colon offers the patient a number of advantages over stage intervention elimination of colostomy, namely removal of occult lesions in the resected colon, shorter hospitalization and low morbidity and mortality. We found this procedure to be a valid option also in the elderly (> 65) high risk patient. Metastatic disease in our view is not a contraindication, since the elimination of colostomy will improve the quality of life of these patients.
Adult↗
A high-sensitivity electrochemiluminescence-based detection system for automated PCR product quantitation.
A high-sensitivity nonisotopic system has been developed for post-PCR product detection. The probe-based detection system exploits a chemiluminescent reaction that takes place on the electrode surface in an electrochemical cell. The detection system incorporates a biotin-streptavidin capture reaction onto a solid support that permits fast post-PCR product detection at the attomole level. The system precision is within 5% relative standard deviation over a linear dynamic range of greater than three orders of magnitude. In this paper, the principles and features of the electrochemiluminescent-based detection system, together with its application to PCR product quantitation, are described in detail.
Autoanalysis↗