The influence of 3-4-dihydroxyphenylethylamine (dopamine) on the VFT of the cat heart was checked with different doses in comparison to metaproterenol (Alupent). In the therapeutical doses dopamine has no significant influence on the VFT in contrast to metaproterenol. The clinical relevance of our findings seems to be that dopamine can be applied in therapeutical doses without running the risk of inducing serious cardiac arrhythmia.

Animals↗

PubMedDate not supplied

Video-intuboscopic assistance is a useful aid to tracheal intubation in pediatric patients.

PURPOSE: To evaluate the efficacy of video-intuboscopic assisted tracheal intubation in a difficult intubation setting. METHODS: In 50 pediatric patients (mean age 12.8 +/- 3.1 yr, range 6-16 yr) a grade 3 direct laryngoscopic view was simulated. Eight certified registered nurse anesthetists without experience in endoscopic intubation performed tracheal intubation on five or more patients using the video-optical intubation stylet. Time from insertion of the tube into the oral cavity until the tip had passed the vocal cords was recorded. Failed intubation was defined as intubation >60 sec, arterial oxygen saturation <92% or esophageal intubation. Subjective degree of difficulty was asked from the operators using a Likert-scale. RESULTS: Forty-six of the 50 patients were successfully intubated within 60 sec and without arterial oxygen desaturation. In four patients, video-assisted tracheal intubation failed due to prolonged intubation time. Intubation times ranged from 10-40 sec (median 15 sec). Mean intubation time in the first patient (24.5 +/- 17.3 sec) appeared longer than for the fifth patient (20.8 +/- 10.9 sec), but the difference was not statistically significant (P=0.87). Mean estimated degree of difficulty was 3.9 +/- 2.1. Subjective estimates of difficulty increased with intubation times (P=0.001). CONCLUSION: The video-optical intubation stylet can be considered a valuable aid for tracheal intubation in pediatric patients with a difficult airway.

Adolescent↗

PubMedDate not supplied

A pharmacoeconomic evaluation of intravenous fosphenytoin (Cerebyx) versus intravenous phenytoin (Dilantin) in hospital emergency departments.

The cost of emergency department services has become a major concern for patients, providers, and payers. Solid economic information is needed to provide a rationale for the selection of therapeutic options and the provision of care that is both clinically and financially prudent. To assess the full cost of care for patients with seizures who are treated in an acute care setting, a modified activity-based cost-accounting model was developed. The model was populated with data from a double-masked, parallel-group, single-dose, multicenter clinical trial designed to investigate the safety and tolerability of phenytoin (Dilantin) and fosphenytoin (Cerebyx) given intravenously in equivalent loading doses according to established recommendations. A total of 52 patients were enrolled in the trial; 13 were given phenytoin and 39 were given fosphenytoin. Salaries and benefits of emergency medical services personnel, drug acquisition costs, and direct and indirect overhead expenditures common to a large hospital emergency department comprised the total costs to treat enrolled patients and manage adverse events. The average cost to treat patients with fosphenytoin was lower than the cost to treat similar patients with phenytoin based on the frequency of adverse events associated with each comparator and the resources (human and material) consumed in the management of those events.

Adult↗

PubMedDate not supplied

Nosocomial infection in a high risk cohort: an illustration of a sampling method.

Patients in two acute care university hospitals were entered into the study using the following method: twenty patients were selected each day from all floors/units in each hospital until the hospital communities had been surveyed only once. A total of 762 hospital patients were identified for the study, and the history of each patient was then abstracted from their charts. The data were analyzed as an historical cohort study design. The two hospital samples were compared to show the effects of the nonrandom sampling method using one hospital as a comparison group for the other. Expected associations between nosocomial infection and known risk factors were compared and contrasted between the hospitals using cumulative incidence rates and relative risk ratios. The average length of stay of the group of patients in each hospital was extended from a mean of ten days to a mean of 30 days. The only significant difference between the two hospital cohorts was an age effect. The advantages and disadvantages of this method for selecting a long staying cohort at high risk for nosocomial infection in acute care facilities are detailed.

Age Factors↗

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Genetic linkage of Meleda disease to chromosome 8qter.

Meleda disease (mal de Meleda) MIM *248300 is an autosomal recessive disorder, clinically characterised by transgressive palmoplantar keratoderma, hyperhidrosis and perioral erythema. It was first described on the Adriatic island of Meleda, where it was relatively common. The prevalence in the general population is estimated to be 1 in 100,000. Linkage analysis of two large consanguineous families from Algeria, including 10 affected individuals, showed strong evidence for localisation of Meleda disease to chromosome 8qter with a maximum two-point lod score for D8S1751 of 8.21 at theta = 0. Analysis of homozygosity regions and recombination events places the gene in a region of at least 3 cM, telomeric to D8S1727. A common haplotype was observed in the two families, suggesting a founder effect.

Chromosomes, Human, Pair 8↗

PubMedDate not supplied

[Outpatient rehabilitation of alcohol dependent patients in a day clinic: initial results of a comparative follow-up study of day clinic and inpatient treatment].

This article describes the development of an outpatient concept for the day-clinic withdrawal treatment of alcohol dependent persons in a Hamburg institution for addiction aid. It reports the initial, selected results of a comparative follow-up study of patients discharged during the years 1998-2000, who either receive ambulatory treatment in the day clinic (n = 270) or inpatient treatment in the institution's special clinic (n = 462). Assessable questionnaires are available from 131 outpatients of the day-clinic treatment and 173 patients of the inpatient treatment form. The response rate - with reference to the group of those who were reachable - was 57.2 % for patients of the day clinic and 53.2 % for patients of the special clinic. The results of the study arrive at the conclusion that both treatment forms can be seen as thoroughly comparable with regard to primary outcome measurements (for example reduction of psychological stress, abstinence rates, reintegration into occupational life). Rehabilitants treated in the inpatient setting more frequently report that they had already contacted centres for further treatment and self-help groups during the rehabilitation phase, which however doesn't lead to a change of participation behaviour following the rehabilitation phase. This serves to confirm the assumption that an additional offer of a day-clinic service in the area of addiction rehabilitation provides a further, effective treatment concept that sensibly supplements the otherwise inpatient-oriented treatment landscape. The results indicate the quality of the work performed in the day clinic studied (as well as in the inpatient clinic) and should encourage the funding agencies and employees of other day clinic institutions in the field of addiction rehabilitation to participate in evaluation and quality assurance measures, thus continuing to bridge the gap between the (theoretical) state of knowledge concerning outpatient rehabilitation and the degree to which it can be successfully realized.

Adult↗

PubMedDate not supplied

[Osteoneogenesis in callus and epiphyseal distraction].

X-rays were reviewed after callus distractions (50 cases) and distraction epiphysiolysis (10 cases) in 45 patients. With the aid of a computerized digitization system for analogue films, the relative x-ray density of the distraction area was determined in the medial, lateral, ventral and dorsal surface areas, and in the median line of the callus tissue. Bone formation became evident within 21.7 +/- 3.7 days post-distraction in the thigh and 25.4 +/- 4.9 days in the shank. The lowest density values were found at the end of the distraction phase followed by a continual increase in x-ray density in the fixation phase. There was a significant decrease in callus x-ray density in the shank from lateral to medial and from dorsal to ventral, and in the thigh from medial to lateral and from dorsal to ventral. When the corticotomized callus distraction is compared to the distraction epiphysiolysis without corticotomy it becomes apparent that the differences between lateral-medial x-ray densities and dorsal-ventral x-ray densities were significantly greater in the group with callus distraction. The deminished bone formation in the ventromedial area of the shank and the ventrolateral area of the thigh seems to be due to soft tissue damage and disturbances in local bone blood supply after the operative approach for corticotomy.

Adolescent↗

PubMedDate not supplied

Haematopoietic transplant potential of unrelated and related cord blood: the first six years of the EUROCORD/NETCORD Bank Germany.

To date, human umbilical cord blood (CB) has been employed successfully in well over 1000 allogeneic (unrelated and sibling) stem cell transplantations. Because of primary limitations in volume and cell numbers, over 90% of these transplantations were performed in children. Therefore requests for well standardised cord blood units of high quality are now increasing constantly. Examination and standardisation of unrelated and related cord blood stem cell preparations and banking as well as their biological characterisation was already initiated in Düsseldorf in 1992. Hitherto a total of 3236 CB samples with a mean volume of 89 +/- 25 ml, a mean total number of nucleated cells (NC) of 10 +/- 5 x 10(8) and a mean number of CFU-GM of 6 +/- 5 x 10(5) have also been validated by haematological, immunological and microbiological criteria. In addition to that, 97 directed CB donations of siblings with a clinical indication have been characterised and banked along the same lines. All CB units were collected from the umbilical cord vein immediately after vaginal full term delivery or caesarean section, then frozen and stored in liquid nitrogen. 1940 CB units were stored unseparated, the other 1296 were volume reduced using Hetastarch (HES) with a mean recovery of 85 +/- 13% of the nucleated cells, 86 +/- 12% and 84 +/- 13% for CFC and CD34+ cells, respectively. Only 5.0 ml of a CB sample is required for routine laboratory testing as there are HLA-class I typing, HLA-class II typing by sequence specific oligonucleotide probes (PCR-SOP), ABO typing, sterility control, assessment of progenitor and stem cells by colony forming assays, and CD34+ status as well as certain viral infections such as CMV, Hepatitis B, C, HIV, Parvo B19 by PCR technology before releasing the CB unit for transplantation. For apparent viral infections, maternal sera obtained at birth were tested for HBsAg, anti-HBc, anti-HCV, -HAV-(IgG, IgM), -HIV-1-2, -EBV- (IgG, IgM), -HTLVI-II, -CMV (IgM, IgG), toxoplasmosis and syphilis. Within the last three years a total of 4860 preliminary searches and 680 extended unit reports were submitted to the CB bank Düsseldorf by fax or World Wide Web. So far 68 unrelated and 3 related CB units were delivered. From these 70 have been transplanted in 30 different transplant centres world-wide. Until now the evaluation of the first 53 unrelated CB-transplantations was performed together with the EUROCORD transplant registry. Three patients were excluded from the analysis, since they received an unrelated CB-transplant for non-engraftment after previous allotransplants. The median patient age of these 50 patients was 5.0 years (range 0.3-44), the median weight 18 kg (range 4-70 kg). The majority of the patients transplanted for malignancies (66%) suffered from ALL (n = 19), AML (n = 7), CML (n = 4) and lymphoma (n = 2) with two third (75%) in an intermediate (2nd CR) or advanced stage of disease (> 2nd CR); 13 patients had metabolic diseases and immunodeficiencies and three had aplastic anaemia. All CB samples as well as the patients' blood samples were typed in Düsseldorf for HLA-class I by serology confirmed by PCR-SSP and by high resolution DNA typing for HLA-DRB1 and HLA-DQB1 alleles. 96% of the 50 patients receiving unrelated CB were mismatched at one or more HLA-antigens. 41 of the 50 patients transplanted with unrelated CB from Düsseldorf were evaluable for engraftment with an overall engraftment rate of 83%. According to the defined criteria of EUROCORD, 9 of the 50 patients were not evaluable for engraftment, since they died before day 60. The present median follow-up time is 14 months (1.4-38). The Kaplan-Meier estimate of survival at one year is 42 percent. The three paediatric patients after sibling CB transplantations (ALL, amegakaryocytic thrombocytopenia and CML) are alive with a follow-up time of 350, 379 days and 531 days. (ABSTRACT TRUNCATED)

Adolescent↗

PubMedDate not supplied

Treatment of the traumatic cerebral vasospasm with the calciumchannel blocker nimodipine: a preliminary report.

Five patients with severe head injury, rating between 3 and 5 on the Glasgow Coma Scale, were treated with the calciumchannel blocker nimodipine continuously for up to 12 days (2 mg/h) because of severe spasm of cerebral arteries. All cases involved the intracranial carotid artery and the first segments of the medial and anterior cerebral arteries. Control angiograms performed in 4 cases showed improved or normalized vessel calibre after the treatment. Intracranial pressure as well as blood pressure were not altered during nimodipine treatment. EEG improved within 7 days after treatment in all cases. Repeated CT scans showed reduction of cerebral edema. Hypothalamic disorders observed in 3 cases were stabilized. Based on these preliminary results, calciumchannel blocker reverses traumatic vasospasm and ameliorates physiologic function of the brain structures after severe head injury.

Adolescent↗

PubMedDate not supplied

Early recognition and treatment of post-traumatic pulmonary microembolism.

There is a special form of pulmonary dysfunction which most often occurs following massive tissue damage, such as major fractures accompanied by hypovolemia. This syndrome may be appropriately called post-traumatic pulmonary microembolism to distinguish it from other causes of respiratory failure. We believe that pathophysiology is initiated at the time of trauma and consists of platelet aggregation and fibrin deposition in the pulmonary microcirculation caused by release of tissue-thromboplastin products. Whether this acute traumatic pulmonary microembolism will progress to a fully developed post-traumatic pulmonary microembolism with respiratory symptoms depends upon the magnitude and duration of tissue-thromboplastin release and the efficiency of the fibrinolytic system to clear the lungs. The early microembolic effects on the lungs consist mainly of ventilatory derangements with a low ventilation/perfusion ratio; not until a later stage does true shunting of mixed venous blood across fluid-filled alveoli and small airways occur. Frequently determinations of Pao2 and AaDO2 during air breathing ("air-test") to reveal a low ventilation/perfusion ratio is, therefore, preferable to true shunt determinations in patients who may develop this syndrome; caution must be exercised in giving room air to critically ill patients. These ventilatory variables, combined with frequent platelet counts, allow early recognition of post-traumatic pulmonary microembolism.

Adult↗

PubMedDate not supplied

When is an albumin infusion needed?

Albumin infusions can help some critically ill patients, but when to use them is controversial. This protocol can help guide the decision.

Algorithms↗

PubMedDate not supplied

Behavior modification: changing hyperactive behavior in a children's group.

Explore the source record for details and available documents.

Behavior Therapy↗

PubMedDate not supplied

Vascular smooth muscle cell phenotype influences glycosaminoglycan composition and growth effects of extracellular matrix.

Rat neonatal and neointimal vascular smooth muscle cells differ dramatically from adult medical vascular smooth muscle cells in their growth properties, with the neonatal and neointimal cells exhibiting growth in the absence of exogenously added growth factors. Since it has been hypothesized that extra-cellular matrix proteoglycans may influence the growth and differentiation of vascular smooth muscle cells, we examined the ability of matrix derived from these cells to influence vascular smooth muscle cell proliferation. To produce test matrices, cells were grown to confluence and removed by brief alkali treatment. Test cells were seeded onto these matrices and the rates of growth in a growth-factor-deficient medium determined. Compared to plastic wells, matrix from neonatal or neointimal cells stimulated the growth of vascular smooth muscle cells. Interestingly, matrix from adult cells was less efficient at promoting growth. Enzymatic digestion of extracellular matrix heparan sulfate, but not of other glycosaminoglycans, further increased the growth-stimulatory effect of extracellular matrix, suggesting that matrix heparan sulfate acts as a growth inhibitor. Consistent with this, biochemical analysis showed that the adult matrix contained a higher percentage of heparan sulfate compared with neonatal or neointimal matrix. These results suggest that autocrine production of heparan sulfate proteoglycans may play an important role in growth regulation of vascular smooth muscle cells during normal vascular development and differentiation as well as in pathological response to injury.

Age Factors↗

PubMedDate not supplied

Portable blood pressure measurements: performance of Korotkov sound analysis techniques.

Noninvasive portable blood pressure systems (PBPS) are typically based on korotkov sound technique. The performance of related Korotkov sound analysis techniques was assessed in PBPS data obtained from nine normotensive and nine hypertensive men. Multiple-seated PBPS measurements were taken, each following 1 minute of quiet rest, moderate walking, and stair climbing; each PBPS measurement was accompanied by a simultaneous auscultatory measurement in the same arm. In subsequent manual PBPS data analysis, PBPS systolic and diastolic BPs were within 4 mm Hg of corresponding auscultatory BPs 86% and 88% of the time; BPs following rest and walking showed greater accuracy, while those following stair climbing were less accurate. Interestingly, automated analysis of diastolic PBPS data (using selective bandpass filtering, amplitude normalization, and comparator decision ratios) provided a level of accuracy similar to that obtained from manual data analysis. Overall, both manual and automated Korotkov sound analysis techniques can provide BP results that agree quite well with auscultatory determinations.

Adult↗