Bank on it. Thrift, theft or confusion? Medical savings accounts may bring all three.
Explore the source record for details and available documents.
Cost Sharing↗
Biomedical subjects
H Meyer
Publications and source records attributed to H Meyer.
Let the games begin ... again.
Brace yourself for a new round of Medicare politics. Behind bipartisan smiles lurk deep divisions. Whatever the makings--or breakings--of a deal between President Clinton and the Republican Congress, you can count on this: a clash of political titans.
Budgets↗
Managed care. Will U.S. HMOs play in Pretoria?
Explore the source record for details and available documents.
Entrepreneurship↗
Physicians. Home-grown HMOs.
Explore the source record for details and available documents.
Health Maintenance Organizations↗
Characterization of a cowpox-like orthopox virus which had caused a lethal infection in man.
In August 1990 an orthopox virus (OPV) had been isolated from a severe case of a generalized infection with lethal outcome in an immunosuppressed 18-year-old man. In this communication we present a detailed characterization of the causative virus strain. Based on distinct epitope configurations detected by various monoclonal antibodies the isolate could be differentiated from other OPV species and was classified as a cowpox virus (CP). This classification was confirmed by a species-specific PCR assay and by establishing physical maps for the restriction enzymes HindIII and XhoI. Based on serological data of neutralization assays, blocking-ELISAs and Western blotting analysis evidence is provided that the infection had been acquired from a stray cat.
Adolescent↗
Somatostatin receptor scintigraphy in patients with pituitary adenoma.
Presence of high-affinity somatostatin (SST) receptors in most endocrine tumor cells allow in vivo scintigraphic visualization of these neoplasms after intravenous administration of a radionuclide-labeled somatostatin analog. 111In-octreotide is at present the most often used substance for imaging of the SST receptor expression in vivo. The aim of this study is to investigate the correlation between presence of in vivo scintigraphically detectable SST receptors in pituitary tumors and clinical parameters such as patients' age, tumor size, hormonal hypersecretion, and response to octreotide therapy. Forty-two-consecutive patients were enrolled in this trial. Twenty-five of them had nonsecreting pituitary tumors, 11 were acromegalic, and 6 had macro- or microprolactinoma. Scintigraphic images of the head were obtained at 10 min and 24 hours after injection of the radionuclide. In 23 patients, no specific binding of 111In-octreotide was found. Five patients showed a weak positive, 5 had a positive, and 9 a strong positive signal in the region of interest. Uptake of octreotide was significantly correlated with tumor size and age (p < 0.01). Small-size pituitary adenomas were most likely to be scintigraphically receptor-negative, while large suprasellar tumors tended to exhibit a rather strong receptor positivity. Statistical analysis of the data could not confirm the hypothesized correlation between endocrine activity of the pituitary tumors and the scintigraphically proven SST receptor expression in vivo. A positive Octreoscan was not predictive for the result of octreotide therapy.
Acromegaly↗
Primary malignant rhabdoid tumours of the central nervous system: an immunohistochemical and ultrastructural study.
Three cases of primary rhabdoid tumour of the CNS (RT-CNS) are presented. In case 1 a hemispheric tumour developed in a 10.5 months old girl, who survived for 6 months after incomplete resection, radio- and polychemotherapy. Case 2 was a 4 years and 8 months old boy with a large IIIrd ventricle tumour, who died of leptomeningeal tumour dissemination 7 months after diagnosis despite radiotherapy. In case 3 a pineal mass occurring in a 14 month old female was radioresistant and totally exstirpated. The child died due to tumour recurrence two months later. Autopsy examination revealed widespread leptomeningeal dissemination. All three cases fulfilled light and electron microscopic criteria of RT-CNS including abundant eosinophilic cytoplasm, vesicular nuclei with large nucleoli and conspicuous anti-vimentin positive filaments. Extensive immunohistochemical studies showed expression of epithelial (EMA, KL1), macrophage (alpha-1 antichymotrypsin), neuro-ectodermal (GFAP, NSE, beta-tubulin III) and myogenic markers (desmin, actin). Different stress proteins (alpha-B crystallin, HSP70) were also expressed. Tumour cells showed a proliferation (MIB1) index of 28.4% (case 1) and 33.4% (case 2). From our study it can be concluded that RT-CNS reveals significant immuno-morphological heterogeneity thus supporting the view that it is not a specific pathological entity but merely a phenotypic appearance of different neoplasms, some of which are linked to primitive neuro-ectodermal tumours.
Biomarkers, Tumor↗
[Anatomic and functional hypoplastic left heart syndrome and its surgical Norwood and Fontan treatment].
UNLABELLED: The surgical therapy of newborns with hypoplastic left heart syndrome (HLHS) is still regarded with some distrust. The complete heart conserving palliation includes not only the Norwood operation during the newborn period but also the complete separation of both circuits by the Fontan operation some time later. Our experiences with each surgical step are presented. From 1989 to 1996, 43 infants with anatomical (n = 33) or functional (n = 10) HLHS underwent the Norwood operation. Functional HLHS were: Mitralatresia with double outlet right ventricle and subaortic stenosis (n = 2), atrioventricular septal defect with hypoplastic left ventricle, subaortic stenosis, and aortic coarctation (n = 1), hypoplastic, subaortic right ventricle with restrictive ventricular septal defect and aortic hypoplasia (n = 7). The median age at operation was 15 days (5 to 182 days), mean weight was 3.3 kg (3.0 to 4.9 kg). Total operative mortality was 32% (n = 14) with 16% since 1994 (3/19 patients). Five infants (12%) died 2 weeks to 6 months later, and 2 patients underwent cardiac transplantation. Up to now, 19 out of the 22 long term survivors underwent the bidirectional cavopulmonary anastomosis (Hemi-Fontan) at a median age of 7 months (2 to 14 months). Two infants died (10%). Up to now, 12 out of the remaining 17 survivors received the total cavopulmonary anastomosis after a mean period of 12 months. All children survived, and they are now completely palliated. The longest follow up after the complete Fontan operation is 6 years. CONCLUSION: With increasing experience the results of the Norwood operation improved. The following two-stage Fontan procedure bears only a low risk and leads to good quality of life.
Female↗
The long QT syndrome: a novel missense mutation in the S6 region of the KVLQT1 gene.
The Romano Ward long QT syndrome (LQTS) has an autosomal dominant mode of inheritance. Patients suffer from syncopal attacks often resulting in sudden cardiac death. The main diagnostic parameter is a prolonged QT(c) interval as judged by electro-cardiographic investigation. LQTS is a genetically heterogeneous disease with four loci having been identified to date: chromosome 11p15.5 (LQT1), 7q35-36 (LQT2), 3p21-24 (LQT3) and 4q25-26 (LQT4). The corresponding genes code for potassium channels KVLQT1 (LQT1) and HERG (LQT2) and the sodium channel SCN5A (LQT3). The KVLQT1 gene is characterized by six transmembrane domains (S1-S6), a pore region situated between the S5 and S6 domains and a C-terminal domain accounting for approximately 60% of the channel. This domain is thought to be co-associated with another protein, viz. minK (minimal potassium channel). We have studied a Romano Ward family with several affected individuals showing a severe LQTS phenotype (syncopes and occurrence of sudden death). Most affected individuals had considerable prolongations of QT(c). By using haplotyping with a set of markers covering the four LQT loci, strong linkage was established to the LQT1 locus, whereas the other loci (LQT2, LQT3 and LQT4) could be excluded. Single-strand conformation polymorphism analysis and direct sequencing were used to screen the KVLQT1 gene for mutations in the S1-S6 region, including the pore domain. We identified a Gly-216-Arg substitution in the S6 transmembrane domain of KVLQT1. The mutation was present in all affected family members but absent in normal control individuals, providing evidence that the mutated KVLQT1-gene product indeed caused LQTS in this family. The mutated KVLQT1-gene product thus probably results in a dominant negative suppression of channel activity.
DNA Mutational Analysis↗
Gene for A-type inclusion body protein is useful for a polymerase chain reaction assay to differentiate orthopoxviruses.
Orthopoxvirus species were identified and differentiated by polymerase chain reaction amplification of genome DNA using a single primer-pair based on sequences coding for the major protein component of the cowpox virus acidophilic-type inclusion body (ATI). DNA available for 6 of 8 Old World (cowpox, variola, monkeypox, camelpox, ectromelia and vaccinia viruses) and 3 New World (skunkpox, volepox, and raccoonpox) resulted in amplicons that ranged in size from 510 to 1673 base pairs depending on the species, except for raccoonpox virus DNA which did not amplify. XbaI digest gel electrophoresis profiles of the amplicons improved resolution of the differences.
Animals↗
Importance of the serovar-specific plasmid for virulence of salmonella strains in calves.
To evaluate the influence of serovar-specific plasmids on salmonella virulence in calves, experiments were performed involving infection, by the oral route, with mixtures of strains containing equal counts of a plasmid-carrying and a plasmid-free strain of the same serovar. The concentration ratio between the plasmid-carrying and the plasmid-free strain which had developed in the organs of the infected animals was used for a comparative evaluation of virulence and pathogenetic behaviour of the strains. While in the S. typhimurium strains studied, the presence of the plasmid was accompanied by a significantly increased colonization and multiplication of the agent in the host's body, examination of S. enteritidis and S. dublin revealed that the plasmid-free strains exhibited identical or even significantly higher bacterial counts than the plasmid-carrying strains in organs. The fact that plasmid-free salmonella strains with a high virulence for calves have been found demonstrates that the presence of a serovar-specific plasmid is not an indispensable requirement for the development of salmonellosis in calves.
Animals↗
Heart transplantation for end-stage heart failure caused by iron overload.
Few reports exist concerning heart transplantation in recipients with end-stage myocardiopathy-associated heart failure caused by iron overload occurring with beta-thalassaemia, Diamond-Blackfan syndrome or haemochromatosis. Seven potential transplant candidates (six male, one female, mean age 26 years) with such heart failure, following desferrioxamine application subcutaneously over a number of years, and intravenously during their hospitalization before transplantation, were retrospectively analysed. Five were New York Heart Association (NYHA) class IV, three experienced one or more resuscitations immediately before transplantation could be performed. Continuous, high-volume, veno-venous haemofiltration was necessary in two patients. One of these two candidates additionally had to be bridged, first with a right ventricular, then with a biventricular assist device. Five of the seven patients survived, two with haemochromatosis, one with beta-thalassaemia major and one with Diamond-Blackfan syndrome following transplantation. One non-transplanted candidate with beta-thalassaemia major has been recompensated for 5 years. Survival was 14-74 months. Our results demonstrate the feasibility and indication of transplantation in patients with such heart failure and the satisfying outcome of immunosuppression is described.
Adolescent↗
Inactivation of hepatitis A virus in plasma products by vapor heating.
BACKGROUND: The transmission of hepatitis A virus (HAV) has been associated with the use of a number of solvent/detergent-treated factor VIII concentrates and possibly a factor IX concentrate. These reports have emphasized the necessity of using virus-inactivation methods for plasma products that are capable of inactivating nonenveloped viruses such as HAV. STUDY DESIGN AND METHODS: A simple, highly accurate titration procedure for HAV, which allows extensive kinetic investigations of virus-inactivation procedures, has been developed. This system has now been used to evaluate the efficacy of vapor heating in inactivating HAV after the addition of the virus to a range of human plasma products. RESULTS: It was demonstrated that HAV was significantly more thermostable than other picornaviruses, which reinforced the fact that such viruses cannot be used as model viruses for HAV-inactivation studies. A one-step vapor-heating procedure was demonstrated to inactivate between 5.9 and > 6.3 log10 of HAV in different products. A two-step vapor-heating procedure had the capacity to inactivate between > 8.7 and > 10.4 log10 of HAV. Both procedures were more effective in inactivating HAV than was the pasteurization procedure used for virus inactivation in human albumin solutions. CONCLUSION: These data demonstrate the efficacy of vapor heating in inactivating high-titer HAV after the spiking of plasma products with virus. This study confirms and explains the results of controlled clinical trials and long-term clinical usage with respect to the lack of HAV transmission by such vapor-heated products.
Hepatitis A↗
Preileal digestibility of coconut fat and soybean oil in horses and their influence on metabolites of microbial origin of the proximal digestive tract.
Three horses (approximately 190 kg BW) fitted with a permanent fistula at the end of the jejunum were used. To a control diet (1/3 hay, 2/3 mixed feed) one of two fat types (coconut fat or soybean oil) were added at 2 levels resulting in fat intakes of 0.1 g (control diet) to 0.5 or 1 g/kg BW 0.5 d, respectively. Each experimental period consisted of 2 weeks adaptation, 2 days of breath tests (before and hourly after the morning meal) and 5 days sampling of chyme. Crude fat, crude protein, concentrations of organic acids (SCFA, lactic acid), pH, and the minerals calcium, magnesium and phosphorus were determined in the chyme; H2 and CH4 in the expired air. The following results were obtained: 1) Fat feeding significantly (P < 0.01) stimulated (independent of amount or kind of fat) the jejunoileal flow of chyme. 2) Preileal fat digestibility increased significantly (P < 0.01) from 30-38% during the control periods to 73-80% (moderate fat intake) and 82-86% (high fat intake). Differences between the fat sources were not significant. 3) Fat addition resulted dose dependent in a reduction (P < 0.05) of lactic acid as well as SCFA concentrations of chyme (at 5th h postprandial). 4) Fat intake caused a reduction in the H2-concentration of the exhaled air (P < 0.05). Such effect was not found with the CH4-concentration, except the high soybean oil level which tended to reduce the concentration. 5) The addition of fat had no significant effects on preileal net absorption of magnesium and calcium, whilst the net secretion of phosphorus significantly increased (P < 0.01). 6) The preileal protein digestibility (control periods 48-53%) was slightly decreased (P < 0.05), due to the fat inclusion.
Animals↗
Specific detection of mousepox virus by polymerase chain reaction.
Polymerase chain reaction was applied to the rapid identification and detection of mousepox virus. This was accomplished by selection of primers targeting the A-type inclusion body protein gene. By investigating 20 strains belonging to five different species of the genus Orthopoxvirus, amplification was achieved only with the seven mousepox virus strains examined. The size of the resulting DNA fragment accounted for 116 base pairs and contained a recognition site for the restriction enzyme HindII, thus confirming its viral origin. Amplification of mousepox virus specific sequences was also possible from infected mouse lung tissue and serum.
Animals↗
Don't get stung by a sweet outsourcing deal.
Explore the source record for details and available documents.
Contract Services↗
[Examination of commercial hedgehog feed for its quality (acceptance, digestibility, and nutritional composition)].
Six commercial hedgehog feedstuffs were evaluated (palatability, composition and digestibility of crude nutrients and minerals). 14 healthy adult hedgehogs were fed these products and one self mixed diet based on minced beef and egg. The composition of all commercial diets was very similar. The components used mostly were cereal products but also animals like insects and prawns were seen. Gross energy was between 1.9 and 2.3 MJ/100 g DM. The concentrations of the minerals were partly very low (Ca, P) and in some products the relation between Ca and P was unsuitable. Even with individual differences between the animals the palatability of the self mixed diet was generally higher. Contrary to the self mixed diet the digestibility of crude protein of the commercial feed was moderate (93 vs. 73-77%). Crude fat was highly digestible (80-92%). In spite of a low activity of amylase in pancreas and chyme the digestibility of the nitrogen free extracts was very high (67-86%), probably due to thermal processing of the cereals. Since crude fibre has a negative effect on total digestibility (r = -0.78) its concentration should be under 3% in the whole diet. The average net absorption rates of minerals were: Ca: +/-0%; P: 50%; Mg: 24%; K: 85% and Na: 80%. Based on this knowledge first recommendations for the composition of nutritionally balanced complete feeds are given.
Animal Feed↗
[Development of nutrition science in veterinary medicine as an example of the School of Veterinary Medicine Hannover].
Animal nutrition is not a main subject in veterinary medicine training, nevertheless it has been taught in the Tierärztliche Hochschule Hannover since its foundation in 1778. In the very beginning only a few lectures about feedstuffs and toxic plants for horses and feeding technique have been presented. During the 19th century animal nutrition was taught about 20 h under the general topic: Gesundheitspflege or Dlätetik. Diätetik included in that time all factors which are important for health as soil, water, climate, stable, hamess and nutrition, too. Textbooks about "Gesundheitspflege" from that time, in particular HAUBNERs book (1st ed. 1845, 4th ed. 1881) give an impression about the extent and the level of the matter presented (table 2). The students had to learn about feedstuffs, feed deterioriation, poisonous plants or feeding techniques, accumulated by experiences during the last centuries. On the other side the informations about digestive physiology as well as the metabolism of nutrients were poor although the knowledge grew up very rapidly during the last part of the 19th century. The lectures touched mainly problems in horses, cattle and sheep, to a lesser extent to pigs. No other domesticated animals were mentioned. After the turn of the century the "Gesundheitspflege" was split in hygiene and feeding. The latter was then lectured by teachers for animal production, which included genetics, breeding, and housing, too. Altogether about 40 h (lectures and practicals) were given on animal nutrition (up to 1967). There was no time to demonstrate specific interactions to the tasks of a veterinarian. After a new training plan, established in 1967, students had to absolve about 120 h (lectures and practical courses) on animal nutrition. Parallelly the Tierärztliche Hochschule Hannover established an own chair and institute about animal nutrition. In the lectures basic informations on nutrition of all domesticated animals (including horses, dogs, cats, cage birds etc.) were presented as well as aspects related to clinical problems (nutritional induced diseases), food quality, diets or animal welfare. In the practical courses the student should gain experience in: judging feed quality (which presumes knowledge about standards of normal feeds and food), estimating nutrient content of feeds, controlling and correcting rations, diagnosis of nutritional shortcomings, calculating rations for sick animals etc. In future in veterinary animal nutrition the last mentioned aspects will become greater importance in lecturing and research. Furthermore the nutritionists have to look for parameters to control a species specific correct nutrition especially in food producing animals.
Animal Nutritional Physiological Phenomena↗