Fetal myocardial calcification associated with maternal cocaine use.
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Calcinosis↗
Biomedical subjects
J Glaser
Publications and source records attributed to J Glaser.
[Risk of liver biopsy].
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Biopsy, Needle↗
[Chronic granulomatosis: a rare differential diagnosis in liver granulomas in adulthood].
A now 43-year-old man was known since childhood to have mesenteric and subcutaneous lymphadenopathy. Histological examination of liver biopsies and excision of some lymph nodes when an adult showed epithelioid granulomas, in places with Langhans giant cells. Diagnostic splenectomy revealed no pathological findings. His present admission to hospital was for an infection with high fever. On auscultation moist rales were audible over the apex of the left lung. The chest radiography showed pneumonic infiltration. Blood culture grew Pseudomonas aeruginosa. Ultrasound demonstrated hypoechogenic homogeneous and smoothly circumscribed round foci in the liver hilus and around the coeliac trunk. The upper lobe pneumonia healed under antibiotic treatment. As chronic granulomatosis was suspected, the nitroblue tetrazolium and superoxide production tests were performed. They demonstrated that the capacity of the granulocytes to form oxygen radicals was markedly diminished. Chronic granulomatosis is an inherited disorder of granulocyte function linked to the X-chromosome. It must be included in the differential diagnosis of any unclear granulomatous disease even in adults.
Adult↗
[Incidence of ultrasound detectable liver hematomas after ultrasound controlled fine needle puncture with the 0.95 mm cutting biopsy cannula in comparison with percutaneous liver biopsy with the 1.4 mm Menghini needle].
BACKGROUND: Recently, a high incidence of ultrasound-detected hepatic hematomas due to percutaneous liver biopsy has been reported. Until yet, little is known about the incidence of asymptomatic hepatic hematomas following sonographically guided fine-needle biopsy. PATIENTS AND METHODS: For that reason, we carried out a prospective study with sonographic examinations before and after liver biopsy in 160 patients. 51 patients, aged 50 to 83, median 67 years, with focal liver lesions had ultrasound-guided liver biopsy using the 0.95 mm-cut biopsy-needle, in 109 patients (17 to 80, median 49 years) with diffuse liver disease percutaneous liver biopsy with the 1.4 mm-needle of Menghini was performed. RESULT: After fine-needle biopsy none of the 51 patients with focal liver lesions displayed liver hematoma on ultrasonography. In the group of patients who underwent percutaneous Menghini biopsy a liver hematoma, sized up to 12 x 5 cm in diameter, occurred four times (3.7%). CONCLUSION: The results of this study indicate that fine-needle biopsy of the liver is a particularly safe diagnostic procedure, when compared with percutaneous Menghini biopsy.
Adolescent↗
A rapid and sensitive method of identification of HTLV-II subtypes.
There are 2 subtypes of human T-cell lymphoma/leukemia virus type II (HTLV-II), A and B. HTLV-II is increasingly associated with rare forms of lymphocytic neoplasia and a neurodegenerative disorder, characterized by hyperspasticity and ataxia. We have used PCR to amplify, clone and sequence 140 bp of the pol gene from many isolates of HTLV-IIA and HTLV-IIB from around the world. Analysis of these and other published sequence established that all HTLV-IIA sequences contained a unique Hinf I site and all HTLV-IIB sequences a unique Mse I site. A rapid and specific oligomer restriction (OR) assay was developed utilizing the primer pair SK110/SK111 and subsequent digestion with these enzymes. Concordance between sequenced and OR-based subtyping of DNA amplified by PCR was absolute among 22 HTLV-II isolates tested. Further OR or sequence analyses on an additional 30 other isolates indicated that the majority of North American non-indian HTLV-II isolates were subtype A, while all Paleo-Amerindian samples, including those from the Seminole of Florida; the Guaymi from Panama; and the Toba, Chorote, Wichi, and Chulupe of Argentina, belonged to subtype B. The SK110/SK111 PCR-OR format should facilitate molecular epidemiology studies of HTLV-II infection and allow for subtype stratification in assessing the sensitivity and specificity of HTLV detection formats and HTLV-II disease association.
Argentina↗
Database construction and use issues.
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Humans↗
Continuous versus multiple rapid infusions of indomethacin: effects on cerebral blood flow velocity.
OBJECTIVE: Therapeutic administration of indomethacin for patent ductus arteriosus (PDA) closure has been documented to decrease cerebral blood flow velocity which may be harmful to the vulnerable premature neonate. We have therefore compared the effects of administering indomethacin by rapid injection versus slow, continuous indomethacin infusion at the same total therapeutic dose on middle cerebral artery (MCA) systolic and diastolic flow velocity, resistance index, and cerebral blood flow (as reflected by the integrated area under the curve). METHODS: Premature neonates (< 1750 g) documented echocardiographically to have a PDA were randomized to receive indomethacin either by three rapid injection doses or by continuous intravenous infusion over the ensuing 36 hours, providing an equivalent total dose. Echocardiograms and transcranial color flow mapping of the MCA flow velocity were measured at baseline and serially following initiation of therapy in both groups. Effects on cerebral blood flow velocity are presented. RESULTS: Eighteen infants [rapid injection-1.2 +/- 0.3 kg (n = 9) and continuous-1.1 +/- 0.2 kg (n = 9)] were studied. In the rapid injection treated infants decreased flow velocity in the MCA as manifested by abrupt, significant decreases in systolic (to 70 +/- 8% baseline) and diastolic (to 65 +/- 13% baseline) flow velocity and area under the curve (to 60 +/- 10% of baseline) were evident by 4 minutes and progressed to 30 minutes after treatment initiation. These changes were not observed in the group treated with continuous indomethacin. Both therapeutic modalities were equally successful in closing the ductus, although the numbers are too small to definitively determine therapeutic efficacy. CONCLUSIONS: Slow, continuous infusion eliminated the decrease in cerebral flow velocity and appears to be effective in closing the PDA.
Blood Flow Velocity↗
[The risk of liver biopsy].
Complications have been reported to occur in 0.14 through 0.29% of all patients undergoing liver biopsy. The total incidence of complications is lower in laparoscopically guided biopsy when compared with percutaneous liver biopsy. On the other hand fatal complications appear to be more frequent with laparoscopy (0.038%) than with percutaneous biopsy (0.009-0.017%). Nevertheless, laparoscopic biopsy should be preferred particularly in patients with suspected liver cirrhosis, since laparoscopy is more sensitive for this diagnosis. Until now, the significance of the type of biopsy needle used has not definitively been clarified. The results that are available however indicate, that biopsy with the Tru-cut needle is accompanied by a particularly high bleeding risk. Regarding the results of retrospective studies concerning needle diameter, less serious complications appear to occur after fine needle biopsy when compared with standard needles. Thus, fine needle biopsy should be preferred in patients with focal liver lesions, since the bleeding risk is assumed to be higher in these cases.
Biopsy, Needle↗
[Prospective study of the incidence of ultrasound detectable liver hematomas after laparoscopically controlled liver puncture with the Silverman needle].
BACKGROUND: A high incidence of hepatic haematomas detected at sonography following percutaneous liver biopsy and laparoscopy-guided liver biopsy has recently been reported. PATIENTS AND METHODS: Prompted by this report, we carried out a prospective study on 71 patients aged between 20 and 79 years (median age: 51 years). The patients were examined by ultrasound prior to and following laparoscopy-guided biopsy with the Silverman needle. RESULTS: Only two of the 71 patients (3%) had a hepatic haematoma after biopsy. The haemangiomas had a maximum diameter of 2.6 cm, caused no pain, and disappeared again within ten days at the latest. No therapeutic measures were required. CONCLUSION: The results of this study indicate that laparoscopy-guided liver biopsy with the Silverman needle is associated with relatively few complications.
Adult↗
Diagnosis of chronic pancreatitis by means of a sonographic secretin test.
The pancreatic duct can be demonstrated today by sonography in about 90% of all persons examined. In 159 persons, aged 18-79 yr, we measured sonographically the pancreatic duct diameter before and after intravenous secretin injection. After secretin stimulation, 20 healthy controls and 90 patients without pancreatic disease showed a distinct pancreatic duct dilatation of 93 and 94% of basal duct diameter lasting only several minutes. No distinct secretin-induced duct enlargement was observed in 35 of 40 patients with chronic pancreatitis. Patients with chronic pancreatitis and circumscript duct stenosis even had a marked and longer-lasting duct dilatation of 156% of basal duct diameter after secretin stimulation. This study showed a high reliability of the sonographic secretin test in the diagnosis of chronic pancreatitis--even in an early stage--recording a sensitivity of 92.5%, a specificity of 93%, and a predictive value of 84%.
Adolescent↗
Developing a clinical information system: the role of the chief information officer.
BACKGROUND: Chief information officers (CIOs) must play a pivotal role in the formation and implementation of a clinical information system, the subset of an organizational information system that deals specifically with support of clinical care activities. MAJOR ELEMENTS OF A CLINICAL INFORMATION SYSTEM: Major elements include the applications software, technology and data architecture, databases, and analysis. The organizational structures and processes that manage the development of improvement activities, including the clinical information system itself, are just as vital to the design of an information system as the hardware and software. THE ROLE OF THE CIO: To develop, sustain, and advance an information infrastructure, the CIO must help establish certain organizational precursors, such as medical staff involvement, experience with quality improvement, and ability to meet data needs. The CIO must then work with the senior administrative and medical leadership in developing a vision for the information system. The CIO must also create new roles and knowledge for information system and medical staff members. Interaction between information services and medical staff is vitally important to the success of a clinical information system. Organizational committees and structures that Brigham and Women's Hospital in Boston put in place to formalize the relationship between information systems and medical staff include the Clinical Initiative Development Program and the Center for Applied Medical Information Systems Research. CONCLUSION: Improving the clinical management of care and the efficacy of care processes involves complex changes in organizational culture and processes, medical practice and information system applications, technologies, staff, and data.
Academic Medical Centers↗
Prospective study of the incidence of ultrasound-detected hepatic hematomas due to percutaneous Menghini needle liver biopsy and laparoscopy-guided Silverman needle biopsy.
Recently, a high incidence of sonographically detected hepatic hematomas following percutaneous liver biopsy and laparoscopy-guided liver biopsy has been reported. For this reason a prospective study in 178 patients was performed. The patients were examined by ultrasound before and 24 hours after percutaneous liver biopsy using the 1.4 mm-Menghini needle (n = 107) and by laparoscopically-guided biopsy with the 2.5 mm-Silverman needle (n = 71). Four of the 107 patients (4%) who underwent percutaneous Menghini biopsy displayed hepatic hematoma on ultrasonography, and in 2 of these cases the hematoma was > 6 cm in diameter and persisted for more than seven months. In the group of patients who underwent laparoscopy-guided Silverman biopsy (n = 71) a liver hematoma occurred twice (3%). Both hematomas were small and disappeared within several days. There was no need for special therapeutic interventions due to complications. In contrast to recent data about Tru-cut and JAM-Shidi biopsy, the results of this study indicate that percutaneous Menghini biopsy and laparoscopy-guided Silverman biopsy are relatively safe diagnostic procedures.
Adult↗
[The nursing situation in the old and new parts of the Federal Republic of Germany: a comparison of requirements, obstacles and nursing autonomy].
Differences with regard to demands, obstacles and elbow room, affecting nursing activities in general hospitals are examined. An instruments measuring various facets was devised (TAA KH). The results reveal that in all three areas there are significant differences between activities of nursing staff in East and West German Hospitals. The differences are being discussed against the background of the situation in the new Bundesländer.
Germany, East↗
[Organization of socially acceptable working hours in nursing].
Three dimensions in the structure of the working hour system of nurses, rendering them socially acceptable, are becoming important: duration of the working day, the time of day which is being worked and the distribution of working hours. The latter two are of particular importance because flexible shift is becoming the dominant pattern in nursing. Six indicators are discussed as criteria for social acceptability: security of employment which includes access to the labour-market, level of income, health, opportunity for social relationships, social participation, and autonomy. Responses of 297 nurses in one General Hospital taking part in a study, were analysed to examine empirically the concept of 'socially acceptable structure of the working hours'. Ideal and factual patterns are considered first. Secondly aspects of autonomy are considered and the way this depends on time, thirdly the criteria used to define 'social acceptability' are examined for validity. Results show firstly the cross contrast between the hospital's expectation and the nurses' wishes with regard to working hours. Furthermore, inspite of the demand for flexibility, staff have very little choice and there is little sign of joint decision making. Thirdly results show that health, interpersonal and social aspects are of special importance and that, correspondingly, in the view of nurses, financial and practical problems are of lesser importance in their every day life.
Humans↗
Diastolic function in children and adolescents on dialysis and after kidney transplantation: an echocardiographic assessment.
Thirty-seven children and adolescents on renal replacement therapy (11 on haemodialysis, 14 on continuous ambulatory peritoneal dialysis and 12 after renal transplantation) were studied by echocardiography, echo-Doppler and phonocardiography. Right and left ventricular (R/L V) diastolic functions were measured by transmitral and transtricuspid flow velocities and by LV isovolumic relaxation time (LVIRT). Thirty-seven age- and sex-matched healthy subjects served as controls. R/L V diastolic dysfunction was only observed in the dialysis patients. In these patients LVIRT was prolonged. LV and RV peak inflow velocities were increased both in early (E) and late (A) diastole with a reduction in the E/A ratios. This pattern of diastolic dysfunction is compatible with the combined effects of a hypercirculatory state (volume overload, anaemia, arteriovenous fistula) and an abnormality of cardiac relaxation. The transplant patients showed no major cardiac abnormalities.
Adolescent↗
A characteristic continuous wave Doppler signal in cor triatriatum?
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Cor Triatriatum↗
Effects of corticotropin-releasing factor on isolated rat heart activity.
We investigated effects of bolus administration of corticotropin-releasing factor (CRF) on parameters of cardiac activity in isolated working rat hearts. Effects at a dose of 5 micrograms of CRF were compared in hearts perfused with Krebs-Henseleit solution, norepinephrine (NE, 10(-9) M), propranolol (3 x 10(-6) M), NG-nitro-L-arginine (L-NNA, 3 x 10(-5) M), or indomethacin (3 x 10(-5) M). CRF increased coronary flow for > 30 min (P < 0.01) with maximum increases of 31.7%, suggesting a prolonged vasodilatory action of the peptide. CRF, in addition, induced transient (lasting < 10 min) increases in maximum aortic pressure and oxygen consumption (P < 0.01), suggesting an inotropic action of the peptide. Perfusions of NE and propranolol did not change the cardiac response to CRF. L-NNA, inhibiting release of endothelium-derived relaxant factor (EDRF), and indomethacin diminished the vasodilatory response to CRF, as indicated by significantly shortened increases in coronary flow after CRF (P < 0.05). Indomethacin also enhanced peak increases in maximum aortic pressure after CRF (P < 0.01). The data confirm direct effects of CRF on cardiac activity. They also suggest that the mediation of coronary vasodilation by CRF involves the endothelial release of prostacyclin and EDRF.
Animals↗
[Prognostic value of long-term pH-metry in the B-II resected stomach].
In a prospective study we investigated the clinical value of ambulatory 24-hour pH monitoring in the stomach after Billroth-II-resection. Recorded data of 10 patients with and 11 patients without ulcer recurrence after gastric resection were compared. The pH medians of the record periods "total time", "supine", "upright", "fasting" and "postprandial" were evaluated. Further the cumulative recording time of pH levels pH < 1, pH < 2, etc. was determined and compared in both groups. A pH median less than 2.8 "supine" indicated a postoperative ulcer recurrence with a sensitivity of 90% and specificity of 81%. A pH median less than 2.6 "fasting" predicted an ulcer relapse with a sensitivity of 90% and specificity of 72% (p < 0.001). In patients with ulcer recurrence pH was < 4 in more than 30% of total recording rime, pH < 5 in more than 45% and pH < 6 in more than 75% (sensitivity 90%, specificity 100%). According to these findings 24-hour pH monitoring seems to be useful for the prognostic assessment of the further course of ulcer disease after B II-surgery of the stomach. Thus pH monitoring results may be helpful in defining patient groups which may be candidates for acid reducing therapy to prevent ulcer recurrence.
Adult↗