How long will it take? How much will it cost?: multiple regression and neural network programs at ED triage.
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Emergency Service, Hospital↗
Biomedical subjects
J M Howell
Publications and source records attributed to J M Howell.
Comparison of tensile strength of cyanoacrylate tissue adhesive closure of lacerations versus suture closure.
STUDY OBJECTIVE: To compare the tensile strength of lacerations closed with cyanoacrylate tissue adhesive, with suture, and with a combination of tissue adhesive and suture. DESIGN: Randomized, controlled animal model study. SETTING: Animal care facility. PARTICIPANTS: Sixteen albino guinea pigs. INTERVENTIONS: Four incisions to deep fascia were created on the dorsum of each animal. Lacerations were closed with either tissue adhesive alone, tissue adhesive with subcutaneous suture, percutaneous suture alone, or percutaneous suture with subcutaneous suture. After 4 days, the breaking strengths of all wound closures were measured. RESULTS: Wound closures made with cyanoacrylate tissue adhesive alone exhibited significantly less tensile strength at 4 days than closures made by the other three methods. Wound closures made with combined percutaneous and subcutaneous sutures were significantly stronger than all other groups. CONCLUSION: Wound closures made with cyanoacrylate tissue adhesive alone have less tensile strength at 4 days than those made with tissue adhesive and subcutaneous suture or those closed by traditional suture methods.
Animals↗
Effect on medical education of computerized physician order entry.
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Clinical Clerkship↗
Evidence of molecular heterogeneity for generalised glycogenosis between and within breeds of cattle.
Northern analyses revealed normal levels of acidic alpha-glucosidase mRNA in cultured fibroblasts from a Shorthorn calf affected with glycogenosis but a gross deficiency in an affected Brahman calf. Analyses of acidic alpha-glucosidase activity, relative to that of other lysosomal enzymes, in blood mononuclear cells revealed greater variation within and between Brahman herds than Shorthorn herds. A Msp1 restriction fragment length polymorphism associated with glycogenosis in Brahmans was not found in Shorthorns. These results are considered in relation to molecular heterogeneity for AAG deficiency in cattle and its implications for disease control programs.
Animals↗
Comparison of effects of suture and cyanoacrylate tissue adhesive on bacterial counts in contaminated lacerations.
We studied the effects of closing lacerations with suture or cyanoacrylate tissue adhesive on staphylococcal counts in inoculated guinea pig lacerations. Wounds closed with adhesive alone had lower counts than wounds containing suture material (P < 0.05). The results of a time-kill study were consistent with a bacteriostatic adhesive effect of the adhesive against Staphylococcus aureus.
Animals↗
Host response to multiple skin lacerations on the albino guinea pig.
Investigators have studied methods of treating skin lacerations by placing multiple incisions on each albino guinea pig. Theoretically, host responses to laceration sites may differ on the basis of anatomic location and local cytokine effects. We used cytokine values and histologic examination to identify differences when multiple lacerations were placed on each animal. Four 3-cm lacerations were made on the dorsum of each male albino guinea pig: two incisions on either side and parallel to the spine. Each laceration was closed with staples. In five animals a sponge technique was used to assay wound cytokines 48 h later. In an additional four animals, wounds were excised at 96 h and stained for cells and new collagen. We identified no statistically significant differences among laceration sites based on polymorphonuclear and mononuclear cellularity, number of fibroblasts, new collagen deposition, or wound interleukin (IL)-6 activities. Using this model minimizes the number of animals needed to generate statistically significant findings in wound research.
Animals↗
Bovine glycogenosis type II: the molecular defect in Shorthorn cattle.
The molecular defect in Shorthorn cattle affected with glycogenosis type II was studied. Polyclonal and monoclonal antibodies specific for bovine skeletal muscle acid alpha-glucosidase were raised and used to study the molecular and biochemical defect in seven affected animals. Cultured normal bovine fibroblasts pulsed and chased with [3H] leucine produced a 130 kDa precursor form of acid alpha-glucosidase which was processed via several 100 kDa intermediate forms to the 65 kDa mature form within 26 h. Fibroblasts from affected animals were labelled in vitro and were shown to produce a cross-reactive protein which was identified as the precursor form of the enzyme. The mature form of the enzyme was not found. The precursor form of the enzyme was demonstrated in Western blots of muscle tissue extracts from affected animals. Glycogenosis type II in Shorthorn and Brahman cattle must be caused by a different, independent maturation, since Brahman cattle lack the cross-reactive protein for acid alpha-glucosidase.
Animals↗
The pathology and trace element status of the toxic milk mutant mouse.
The toxic milk (tx) mouse is a mutant in which copper metabolism is abnormal. Homozygous tx adults do not show overt signs of disease, but litters born to such parents are deficient in copper and die at about 2 weeks of age unless copper is provided. The results reported here clearly indicate that adults accumulate copper in the liver, kidney, spleen, brain, muscle, serum and red blood cells. The concentration of zinc is also elevated in liver, brain and muscle. In adult animals there is damage to hepatocytes with marked changes to the nuclei. Haemolysis occurs with subsequent deposition of haemosiderin in the kidney. This mutant provides a useful model for studies of the pathogenesis and treatment of copper toxicity in animals and man.
Animals↗
Effect of the ingestion of heliotrope and copper on the concentration of zinc, selenium and molybdenum in the liver of sheep.
Merino wethers were used to examine the effect of feeding heliotrope, with and without additional copper (Cu), on the development of clinical signs, lesions in the liver and concentration in the liver of Cu, zinc (Zn), selenium (Se) and molybdenum (Mo). The feeding of heliotrope reduced liver concentrations of Zn (P < 0.05) and Mo (P < 0.01), but Cu ingestion had no effect on these parameters. The concentration of Se in the liver was only increased when heliotrope was given with copper (P < 0.01); it had previously been shown that Cu and heliotrope ingestion is followed by an interaction which results in a marked increase in the concentration of Cu and the production of extensive lesions in the liver. The increase in liver Se may therefore have represented a passive or active response to liver necrosis, whereas effects on Zn and Mo represented specific metabolic disturbances attributable to heliotrope feeding.
Alkaloids↗
Enzymic preparation of (3R-cis)-3-(acetyloxy)-4-phenyl-2-azetidinone: a taxol side-chain synthon.
A key chiral intermediate [(3R-cis)-3-(acetyloxy)-4-phenyl-2-azetidinone (2)] for the semi-synthesis of paclitaxel (taxol; 5), an anti-cancer compound, was prepared by an enzymic process. The stereoselective enzymic hydrolysis of cis-3-(acetyloxy)-4-phenyl-2-azetidinone (1) to the corresponding (S)-(-)-alcohol (3) was carried out using various lipases. Lipase PS-30 (Pseudomonas cepacia) and BMS (Bristol-Myers Squibb) lipase (Pseudomonas sp. SC13856) catalysed hydrolysis of the undesired enantiomer of racemic compound 1, producing the (S)-(-)-alcohol (3) and the desired (R)-(+)-acetate (2). Reaction yields of > 96% and optical purities of > 99.5% were obtained. For a very efficient enzyme source (BMS lipase), a lipase fermentation using Pseudomonas sp. SC13856 was developed. In a fed-batch process using soybean oil, the fermentation resulted in 1500 units of extracellular lipase activity/ml. Crude BMS lipase (1.7 kg, containing 140,000 units/g) was recovered from the filtrate by ethanol precipitation. BMS lipase and commercially available lipase PS-30 were independently immobilized on Accurel polypropylene. These immobilized lipases were re-used (ten cycles) without loss of enzyme activity, productivity or optical purity of the product. The enzymic reaction process was scaled up to 75 and 150 litres using immobilized BMS lipase and lipase PS-30 respectively. From the reaction mixture, compound 2 was isolated in 88-90 mol% yield and 99.5% optical purity. A purity of 99.9 (area %) was demonstrated by g.c. for isolated compound 2.
Antineoplastic Agents↗
Posttraumatic seizures.
Posttraumatic epilepsy is one of the most clinically disturbing and, to date, difficult predictive factors associated with head trauma. The risk of developing seizures after head trauma depends on several factors. This article explores the mechanisms and biochemical effects of brain injury, their relationship to developing seizures, antiepileptic prophylaxis, and neuroprotective pharmacologic therapy.
Anticonvulsants↗
Obtaining access in patients with indwelling vascular access devices.
Chronic indwelling catheters are used increasingly for outpatient and inpatient therapy. Because more patients care for indwelling devices at home, indwelling lines are available to emergency department staff to draw blood and administer medications, blood products, and intravenous fluids. This article discusses the indications, complications, and methods of accessing chronic indwelling venous catheters.
Catheterization, Central Venous↗
Effect of thiomolybdate and ammonium molybdate in pregnant guinea pigs and their offspring.
Groups of eight guinea pigs and their offspring were given drinking water containing molybdenum as ammonium molybdate (AM) or thiomolybdate (TM) throughout and subsequent to pregnancy. All adult females had oestrous cycles and conception rates were unaffected. Fetal death was common in groups given the high dose of TM. The concentration of copper in liver was reduced in all groups at all ages except for pups killed at birth from animals given AM. The concentration of molybdenum was elevated in liver and kidney of all groups and was statistically significant in the majority. The concentration in plasma of copper, molybdenum and copper insoluble in trichloroacetic acid was elevated in all groups. Superoxide dismutase activity was significantly reduced in dams and six-week-old pups in which TM administration commenced before mating. Histological damage occurred in the pancreas of animals given AM or TM. The effects on the fetus and pancreas were considered to result from copper deficiency rather than molybdenum toxicity.
Administration, Oral↗
A radiographic comparison of short-arm cast and plaster and fiberglass wrist splints.
Prepackaged plaster and fiberglass splints are used in many emergency departments. This study evaluated the effectiveness of short-arm cast (SAC), volar fiberglass wrist splint (FWS), and volar plaster wrist splint (PWS) in limiting wrist range of motion. Ten healthy male volunteers between the ages of 18 and 35 years were included. Each wrist on each volunteer was immobilized with SAC, FWS, and PWS. Wrist radiographs were taken with each appliance and angular motion measured by two radiologists. PWS performed better than FWS in flexion, extension, radial deviation, and ulnar deviation (all P < .05). PWS was not statistically different than SAC in limiting flexion, extension, or radial deviation, although SAC performed better in ulnar deviation (P < .05). PWS limits wrist motion more effectively than FWS and performs in a similar manner to SAC in flexion, extension, and radial deviation.
Adolescent↗
The effect of scrubbing and irrigation with normal saline, povidone iodine, and cefazolin on wound bacterial counts in a guinea pig model.
This study examines the effects of povidone iodine, normal saline, and cefazolin alone and after scrubbing on bacterial counts in contaminated animal lacerations. Twelve albino guinea pigs each received four lacerations inoculated with a standard inoculum of Staphylococcus aureus. Twelve hours after inoculation, each wound was biopsied to ensure contamination and then either treated or left as an untreated control. One wound on each animal was an untreated control. The remaining three lacerations on six pigs were irrigated with cefazolin (CZ) solution, normal saline, or 1% (wt/vol) povidone iodine solution (PI). Three lacerations on another six pigs were treated with 20% poloxamer 188 scrub (scrub) alone, scrub followed by PI irrigation (SCR/PI), or scrub followed by CZ irrigation (SCR/CZ). Quantitative bacteriology was performed on tissue biopsies 2 hours (time 1), 7 hours (time 2), and 12 hours (time 3) after irrigation. Posttreatment counts for PI, CZ, and normal saline irrigation were not different from control or one another (P > .05). Bacterial counts for SCR/PI were significantly lower than control (P < .05) for all posttreatment biopsies (1.8 to 2.9 mean log(10) decrease). SCR/CZ was significantly lower than control (P < .05) at times 2 and 3 only (1.7 to 2.0 mean log(10) decrease). In this guinea pig model, cleansing 12-hour-old lacerations contaminated with S aureus using SCR/PI or SCR/CZ significantly reduced bacterial counts over 12 hours.
Animals↗
Effect of scrubbing and irrigation on staphylococcal and streptococcal counts in contaminated lacerations.
We studied the effects of scrubbing with poloxamer 188 (SCR), irrigating with povidone iodine (PI), and scrubbing followed by irrigation (SCR-PI) on staphylococcal and streptococcal counts in inoculated guinea pig lacerations. PI irrigation and SCR-PI significantly lowered streptococcal counts (P < 0.05). Staphylococcal counts were not different from those in controls.
Animals↗
Multi-university residency training.
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District of Columbia↗
The effect of copper and heliotrope on the composition of bile in sheep.
The effects of interrupting the enterohepatic circulation (EHC) of bile salts for seven hours and of feeding copper and heliotrope alone and combined for 13 weeks, on bile flow and excretion of copper, zinc, iron and alpha-mannosidase were studied in sheep. Interruption of EHC reduced bile flow rate and increased the concentration of copper, zinc, iron and bile acids while alpha-mannosidase's activity remained stable. Changes in concentration were related to changes in bile volume for copper and zinc only. Total output per hour was not changed. Biliary concentration of copper correlated with alpha-mannosidase's activity in control sheep and those given copper or heliotrope, supporting the hypothesis that lysosomes are involved in biliary secretion of copper in sheep. Increasing the intake of copper increased the rate of excretion of copper in bile. Copper output was lower when heliotrope was fed alone.
Animals↗