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Biomedical subjects

J Herman

Publications and source records attributed to J Herman.

At least 37 records · Page 2Linked to original sources
PubMed2002

Limited versus total stripping of vena saphena magna.

BACKGROUND: There are two different ways to operate on patients with varicose veins. OBJECTIVES: Prospective evaluation of two groups of patients operated on in two different ways to find out more convenient procedure for varicose veins surgery. METHODS: The results of 577 patients operated on for lower limbs varicose veins were evaluated. The patients were divided into two groups. The first group comprised of 125 patients in whom limited stripping of vena saphena magna was performed. The second group comprised of 397 patients in whom total stripping of vena saphena magna was applied. In the remaining 55 patients an operation other than VSM was performed in the venous system of lower limbs. During the follow-up three months after the operation the main attention was paid to a possible neurological disturbance. RESULTS: Much better results were observed in the group of patients treated with the method of limited stripping. Neurological disturbances occurred in two patients only (i.e. 1.6%). Within the other group disturbances were encountered in 28 patients (i.e. 7%). CONCLUSIONS: Limited stripping of vena saphena magna results in lower number of neurological disturbances. (Tab. 1, Ref. 10.).

Adult↗
PubMed2001

Hydrotherapy in labor.

Maternal anxiety and pain prolong labor and contribute to fetal distress. Hydrotherapy during labor may promote relaxation and decrease pain without the risks caused by other treatments. In this pilot study the psychophysiological effects of hydrotherapy on maternal anxiety and pain during labor were examined. Using a randomized, pretest-posttest control group design with repeated measures, 18 term parturients were assigned to a control or an experimental group. Experimental subjects were placed in a tub of 37 degrees C water for 1 hr during early labor. The Wilcoxon two-sample test revealed statistically significant effects. At 15 min bathers' anxiety and pain scores were decreased compared to nonbathers. At 60 min bathers' pain scores were decreased compared to nonbathers. After 15 min of immersion, bathers had a significantly greater increase in plasma volume than nonbathers. No significant differences were found in urine catecholamines or maternal-fetal complications. The small sample limits conclusions, but the findings offer preliminary support for the therapeutic effects of bathing in labor for acute, short-term anxiety and pain reduction.

Adult↗
PubMed2001

Recent advances and future prospects in intestinal and multi-visceral transplantation.

From an experimental procedure, intestinal transplantation (ITx) has evolved over the last 10 yr into a treatment option for patients suffering from short bowel syndrome and who develop life-threatening complications from total parenteral nutrition (TPN) (e.g. liver dysfunction, line sepsis, shortage of venous access, etc.). One-year survival rates are approximately 70% and thus similar to lung Tx. However, the intestine remains the most challenging abdominal organ to transplant. This is because of the severe immune response (mostly rejection) that is produced, and therefore the need for profound immunosuppression with its attendant complications (sepsis, lymphoma, direct drug toxicity). Unlike other organs, graft loss as a result of acute rejection can occur late after transplantation (more than 1 yr post-transplant). With regard to the actual immunosuppressive regimens, considerable experience in patient management is required to optimize outcome of those complex transplants, which are permanently at risk of rejection and infection. ITx remains an unfinished product, and the application of ITx to patients doing well on TPN warrants further research in the understanding of the rejection process, in the development of less toxic and more efficient immunosuppressive protocols, and in the development of immunomodulatory strategies, to better control rejection and thereby reduce the need for immunosuppression.

Adjuvants, Immunologic↗
PubMed2001

Severe cutaneous ulceration following treatment with thalidomide for GVHD.

We report two cases of severe leg ulcerations in patients being treated with thalidomide for graft-versus-host disease following bone marrow transplantation. Local wound care and debridement were attempted, but one patient required skin grafting to ensure healing. We propose that this complication may be due to the antiangiogenic properties of thalidomide and urge careful attention to skin breakdown in patients being treated with this compound.

Adult↗
PubMed2001

Primary malignant melanoma of the esophagus treated by endoscopic ablation and interferon therapy.

Primary malignant melanoma of the esophagus is a rare illness accounting for 0.1-0.2% of malignant diseases of the esophagus; however, the incidence of the disease appears to be rising. The average survival time is between 10 and 15 months. The authors describe the 25 month follow up of a patient with primary malignant melanoma of the esophagus which was treated with endoscopic ablation followed by interferon therapy. No other focus was found and the patient is undergoing regular endoscopic check-ups, currently without any problems.

Biopsy, Needle↗
PubMed2001

The association between funding by commercial interests and study outcome in randomized controlled drug trials.

BACKGROUND: Previous studies limited to specific drugs or journal types have shown an association between the source of funding of research and the published results. OBJECTIVE: The aim of the present study was to determine the association between source of support of research and published outcomes of randomized controlled drug trials in general interest medical journals. METHODS: Randomized controlled drug trials (n = 314) published in five general interest medical journals over a 2-year period were reviewed. Study outcome was classified as positive or negative. Support was classified as pharmaceutical industry or non-industry. Association between source of support and outcome was tested with the chi-squared statistic. RESULTS: Positive findings were found in 77% of studies, negative findings in 20% and an uncertain outcome in 3%. Support from commercial sources was found in 68% of trials. Negative findings were found in 13% of industry-supported studies and in 35% of non-industry-supported studies (chi-squared = 18.36, P < 0.0001, odds ratio = 3.54, 95% confidence interval 1.90-6.62). CONCLUSIONS: An association was found between the source of study support and the published outcome. Though the reason for this association cannot be determined from the data collected, future studies may clarify the importance of this finding for readers concerned with the relationship of funding bodies to the publication of research outcomes.

Conflict of Interest↗
PubMed2001

Comparison of fluorescein break-up time measurement reproducibility using standard fluorescein strips versus the Dry Eye Test (DET) method.

PURPOSE: To compare the repeatability of fluorescein break-up time (FBUT) measurements determined with either a standard fluorescein strip or the Dry Eye Test (DET) modified fluorescein strip methods. METHODS: This was a prospective, randomized contralateral study of 100 patients, in which FBUT measurements were determined with a standard FUL-GLO fluorescein strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) in one eye and a DET strip (Akorn, Inc., Buffalo Grove, IL, U.S.A.) for the contralateral eye. Three consecutive measurements were made immediately after fluorescein instillation. The second eye was evaluated 1 minute after completion of the first eye. Data from patients with FBUT values less than 20 seconds were included in the data analysis, because measurements greater than 20 seconds are not diagnostically significant. RESULTS: Seventy-five patients met enrollment and FBUT measurement criteria. For three consecutive FBUT measurements, the DET values were within 3 seconds for 72 of the 75 patients (96%). Eighty percent of patients reported no sensation with the DET strip, 20% reported mild sensation, and no patient reported moderate sensation. With FUL-GLO strips, measurements were within 3 seconds for 53 of the 75 patients (71%) (p <0.005). The standard fluorescein strip method elicited reports of no sensation from 31% of patients, mild sensation from 60%, and moderate sensation from 9% (p <0.001). CONCLUSIONS: The DET strip provides a significant reduction in sensation upon application, improved single measurement reliability, and enhanced measurement precision, compared with a conventional fluorescein strip.

Adult↗
PubMed2001

Aberrant methylation of the adenomatous polyposis coli (APC) gene promoter 1A in breast and lung carcinomas.

The adenomatous polyposis coli (APC) gene is a tumor suppressor gene associated with both familial and sporadic cancer. Despite high rates of allelic loss in lung and breast cancers, point mutations of the APC gene are infrequent in these cancer types. Aberrant methylation of the APC promoter 1A occurs in some colorectal and gastric malignancies, and we investigated whether the same mechanism occurs in lung and breast cancers. The methylation status of the APC gene promoter 1A was analyzed in 77 breast, 50 small cell (SCLC), and 106 non-small cell (NSCLC) lung cancer tumors and cell lines and in 68 nonmalignant tissues by methylation-specific PCR. Expression of the APC promoter 1A transcript was examined in a subset of cell lines by reverse transcription-PCR, and loss of heterozygosity at the gene locus was analyzed by the use of 12 microsatellite and polymorphic markers. Statistical tests were two-sided. Promoter 1A was methylated in 34 of 77 breast cancer tumors and cell lines (44%), in 56 of 106 NSCLC tumors and cell lines (53%), in 13 of 50 SCLC cell lines (26%), and in 3 of 68 nonmalignant samples (4%). Most cell lines tested contained the unmethylated or methylated form exclusively. In 27 cell lines tested, there was complete concordance between promoter methylation and silencing of its transcript. Demethylation with 5-aza-2'-deoxycytidine treatment restored transcript 1A expression in all eight methylated cell lines tested. Loss of heterozygosity at the APC locus was observed in 85% of SCLCs, 83% of NSCLCs, and 63% of breast cancer cell lines. The frequency of methylation in breast cancers increased with tumor stage and size. In summary, aberrant methylation of the 1A promoter of the APC gene and loss of its specific transcript is frequently present in breast and NSCLC cancers and cell lines and, to a lesser extent, in SCLC cell lines. Our findings may be of biological and clinical importance.

Adenomatous Polyposis Coli Protein↗
PubMed2001

Cues to participation in prostate cancer screening: a theory for practice.

PURPOSE/OBJECTIVES: To develop and test the Cues to Participation in Prostate Cancer Screening Theory, which proposes that exposure to information from certain sources cues or triggers screening. DESIGN: Descriptive correlational. SETTING: 11 counties of a southeastern state. SAMPLE: Convenience sample of 1,867 men at risk for prostate cancer (72% African American; 28% Caucasian). METHODS: Recent exposure to prostate cancer information was measured. Men were offered free screening by prostate specific antigen (PSA) and digital rectal exam (DRE). MAIN RESEARCH VARIABLES: Demographic variables (race, age, education, income, and marital status), exposure (electronic media, print media, healthcare provider recommendation, and interpersonal interactions), and screening as measured by PSA and DRE. FINDINGS: Several major propositions of the Cues to Participation Theory were supported. General exposure to prostate cancer information significantly predicted screening participation. Hearing about prostate cancer from a healthcare provider was the best predictor of screening. CONCLUSIONS: Men's demographic characteristics should be considered when providing information about prostate cancer. Hearing about prostate cancer from family and friends was not significantly related to screening behavior. IMPLICATIONS FOR NURSING PRACTICE: The importance of recommendations for prostate cancer screening is underscored.

Adult↗
PubMed2001

Dysplasia of tubular cells in a kidney- transplanted patient treated with recombinant human growth hormone.

After renal transplantation (Tx), children with growth retardation can be successfully treated with recombinant human growth hormone (rhGH). However, the impact of this treatment on kidney allograft function remains a source of concern. We report on one boy who received a cadaveric kidney transplant at 12 yr of age, after developing end-stage focal and segmental glomerulosclerosis and hyalinosis. The early post-transplant period was complicated by thrombosis of an arterial branch of the graft and two acute rejection episodes. Because of poor growth, the boy was treated with rhGH starting 22 months after the Tx. The renal function remained relatively stable for 22 months after initiation of rhGH therapy and then progressively deteriorated over a period of 10 months, with the patient ending up on dialysis. Several biopsies, performed for rejection episodes or before the start of rhGH, or to elucidate the deterioration of the renal function, were analyzed. Histologically, a progressive increase in the amount of hypertrophy of the tubules and of the glomeruli was seen after initiation of rhGH. Hyperplasia of the tubular epithelium with crowding of cells of the proximal tubules, hyperchromasia and irregularities in the shape of the nuclei, and abrupt changes of chromatism along the tubuli, were also observed. These lesions of tubular dysplasia are extremely unusual in transplanted kidneys and are unlikely to be caused by compensatory hypertrophy secondary to destruction of renal tissue. They may be an effect of rhGH treatment. The prognostic significance of these lesions is unknown but merits attention.

Child↗
PubMed2001

Pediatric renal transplantation: a single Belgian center experience over 20 years.

Between 1980 and 2000, 100 renal transplantations were performed in 91 children at the pediatric unit of the University Hospital Leuven. The proportion of living-related donors (LRD) was 20%. Patient survival rates were 94% at 3 yr, 91% at 5 yr, and 87% at 10 yr. The commonest causes of death were bacterial infections and cardiovascular complications, which underscores the need for aggressive preventative procedures in this area after transplantation. The overall actuarial graft survival was 82% at 3 yr (n = 73), 74% at 5 yr (n = 53), and 56% at 10 yr (n = 29). In the LRD group, the graft survival was 10% better than the overall actuarial graft survival rate. The overall incidence of acute rejection was 55% but has shown a decrease to 34% in more recent years (1993-99). The major causes of graft failure were chronic rejection and recurrence of the initial disease, and these remain a major concern. Improvement of these results could be achieved by tight immunosuppression management, early aggressive treatment of infection and rejection, and careful educational and psychological support.

Adolescent↗
PubMed2001

[Contribution of coloured duplex ultrasonography to preoperative examination of patients with chronic venous insufficiency].

In a prospective study the authors examined by coloured duplex sonography 76 patients (93 extremities) with chronic venous insufficiency (CVI), before a planned operation of the veins of the lower extremities. Attention was focused on the site of the reflux ( superficial, deep venous system, perforators) and the importance of perforators and congenital venous anomalies in CVI. In the investigated group of patients with CVI a combined reflux was present in several venous systems concurrently, confirmed in 69 extremities (74.2%). In 25 extremities the authors found insufficiency of the saphenofemoral junction along with femoropopliteal reflux. This high grade of reflux coincidence in these two neighbouring anatomical areas indicates so-called secondary reflux. Dilated perforators were found in 65 extremities (70%). These insufficient perforators were most frequently on the median side of the leg, regardless whether in the proximal or distal half. Obviously there is direct correlation between the grade of CVI according to the international clinical classification and the number of incompetent perforators. The ratio of inborn venous anomalies in the development of CVI in the authors group of patients was not statistically significant.

Adult↗
PubMed2000

Specifics on the refinement and application of two serological assays for the detection of antibodies to HHV-8.

BACKGROUND: Serologic assays for the detection of antibodies to human herpesvirus type 8 (HHV-8) are important for epidemiological studies and to further investigate the proposed pathogenesis of the virus in cancer. Although a variety of assays are available, a lack of optimization and standardization makes their usefulness uncertain, and may be responsible for the controversy concerning the prevalence of infection. OBJECTIVES: To refine an indirect immunofluorescent assay (IFA) for the detection of latent antibodies and a recombinant ORF 65 ELISA for the detection of lytic antibodies in order to increase their ability to differentiate individuals at higher and lower risk for HHV-8 infection. STUDY DESIGN: Sera from Kaposi's sarcoma (KS) patients and blood donors (BDs) were used to modify assay parameters in an attempt to better discriminate between the two populations. Modifications included methods of substrate fixation, incubation times, sample dilution, and antigen/conjugate concentrations. RESULTS: Optimal modifications to the latent IFA included acetone fixation of substrate, and dilution of sera to 1:64 which enhanced detection of HHV-8 antibodies from 68 to 92% in the KS population. Similarly, successful refinement of the ORF 65 ELISA to increase the signal-to-noise ratio included the use of 88 ng of ORF 65 antigen per well and serum dilutions of 1:50. Optical density-to-cut-off ratios directly correlated with titers, thereby introducing a strategy to predict antibody concentrations. The ORF 65 ELISA and the latent IFA were both able to discriminate between the two populations but with different efficiencies. CONCLUSIONS: Although neither the latent IFA nor the ORF 65 ELISA produced perfect test indices, improvement in their performances was noted following the optimization strategies. The ELISA produced better detection of antibodies to the virus than the IFA and permitted prediction of sample titers, thus improving cost and time effectiveness.

Antibodies, Viral↗
PubMed2000

Evaluation of anti-human leukocyte antigen allo-immunization in pediatric cadaveric kidney transplantation.

Forty-eight pediatric cadaveric renal transplantations, performed between May 1986 and February 1997, were retrospectively screened, pre- and post-transplant, for antibodies to human leukocyte antigen (anti-HLA) using complement-dependent cytotoxicity (CDC) assay and enzyme immunoassay (EIA). The correlation between anti-HLA immunization and graft outcome was investigated. The combined analysis of CDC and EIA enabled the differentiation between complement-fixing and non-complement-fixing, anti-HLA class I and anti-HLA class II antibodies. The median post-transplant follow-up for all patients with a functioning graft was 86 months (range 10-138 months). In the whole population, 16 grafts were lost: six following a non-immunologic complication; and 10 as a result of rejection. Of these 10 grafts lost, eight were in patients with pre- and/or post-transplant donor antigen specific (DAS) anti-HLA class I or class I + II antibodies; and two were in patients with DAS anti-HLA class II antibodies only. Three of these grafts were lost in patients with weak pre-existing DAS anti-HLA class I antibodies. Immunological graft loss appeared at a median post-transplant time of 38 months (range 2-68 months). All patients without DAS anti-HLA antibodies had a good graft outcome. The presence of pre- and post-transplant DAS anti-HLA antibodies, especially if directed against HLA class I, were associated with a poor graft outcome. A systematic search for, and identification of, anti-HLA antibodies should therefore be part of a pretransplant evaluation to allow the identification of 'unacceptable' donor HLA antigens, following which the impact of the HLA-cross-match on graft outcome will improve. Screening for DAS anti-HLA antibodies post-transplant could be helpful for detecting patients with an increased risk for graft loss following rejection episodes.

Cadaver↗
PubMed2000

Reading for empathy.

As our preoccupation with empathy grows, we cast about for means of inculcating it. Literature has been proposed as an enabling factor for physicians in developing a creative imagination. This essay, using a number of examples, points out that reading for pleasure in areas not necessarily related to medicine, can yield insights into its practice. Thus, sensitizing students and young physicians to the nuances of human interaction described by great writers could constitute part of basic and continuing medical education and might be one way of instilling empathy.

Education, Medical↗