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Biomedical subjects

J Martell

Publications and source records attributed to J Martell.

17 recordsLinked to original sources
PubMed2005

Predicting postoperative morbidity by clinical assessment.

BACKGROUND: The aim of this study was to determine the accuracy of prediction of the surgeon's 'gut-feeling' in estimating postoperative outcome. METHODS: A prospective series of 1077 consecutive patients undergoing major hepatobiliary or gastrointestinal surgery were studied. Patients having elective (n = 827) and emergency (n = 250) procedures were included. The surgeon predicted the development of postoperative complications immediately after completion of surgery on a scale from 0 to 100 percent. These predictions were compared with the actual outcome and with predictions made using the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). The Portsmouth predictor equation (P-POSSUM) was applied for the estimation of mortality. RESULTS: The observed morbidity and mortality rates were 29.5 and 3.4 percent respectively. POSSUM predicted a morbidity rate of 46.4 percent and P-POSSUM a mortality rate of 6.9 percent. The surgeon's gut-feeling was more accurate in the prediction of morbidity at 32.1 percent. On the basis of gut-feeling, surgeons overpredicted morbidity in elective surgery, but underestimated the risk of complications in the emergency setting. The (P)-POSSUM scoring system overpredicted morbidity and mortality for elective and emergency operations. CONCLUSION: The surgeon's gut-feeling is a good predictor of postoperative outcome, especially after elective surgery. (P)-POSSUM overpredicted morbidity and mortality in this series of major gastrointestinal and hepatobiliary operations.

Attitude of Health Personnel↗
PubMed2001

The effect of cytokine gene polymorphisms on pediatric heart allograft outcome.

BACKGROUND: Cytokines play a major role in the inflammatory and immune responses that mediate allograft outcome. Several studies have shown that the production of cytokines varies among individuals and these variations are determined by genetic polymorphisms, most commonly within the regulatory region of the cytokine gene. The aim of this study was to assess the effect of these allelic variations on acute rejection after pediatric heart transplantation. METHODS: We performed cytokine genotyping using polymerase chain reaction-sequence specific primers in 93 pediatric heart transplant recipients and 29 heart donors for the following functional polymorphisms: tumor necrosis factor-alpha (TNF-alpha) (-308), interleukin (IL)-10 (-1082, -819, and -592), TGF-beta1 (codon 10 and 25), IL-6 (-174), and interferon-gamma (INF-gamma) (+874). The distribution of polymorphisms in this population did not differ from published controls. The patients were classified as either non-rejecters (0 or 1 episode) or rejecters (> 1 episode) based on the number of biopsy proven rejection episodes in the first year after transplantation. RESULTS: Forty-two of the 69 TNF-alpha patients (61%) in the low producer group were non-rejecters, while 9 of the 24 (37.5%) with high TNF-alpha were non-rejecters (p = 0.047). In contrast, IL-10 genotype showed the opposite finding. Forty-two of the 66 patients (64%) in the high and intermediate IL-10 group were non-rejecters, while 9 of the 26 (35%) in the low IL-10 group were non-rejecters (p = 0.011). The combination of low TNF-alpha with a high or intermediate IL-10 genotype was associated with the lowest risk of rejection (34/49 or 69% non-rejecters). Neither the distribution of the IL-6, INF-gamma, and TGF-beta1 genotype in recipients nor the donor genotype showed any association with acute rejection. CONCLUSION: Genetic polymorphisms that have been associated with low TNF-alpha and high IL-10 production are associated with a lower number of acute rejection episodes after pediatric heart transplantation.

Adolescent↗
PubMed2000

[Pericardial tamponade during installation of a central venous catheter].

A case report demonstrates the complication of pericardial tamponade during the installation of a central venous catheter via the subclavian vein. To reduce the high mortality of this rare complication, quickly applicable diagnostic measures and adequate therapy of pericardiocentesis are indicated. Prompt recognition and treatment of pericardial tamponade are imperative if a disastrous outcome is to be prevented.

Adolescent↗
PubMed2000

The John Charnley Award. Wear is a function of use, not time.

Polyethylene wear (linear penetration) in 37 hip replacements was assessed from digital images using a validated two-dimensional, edge detection-based computer algorithm. Patient activity was assessed with a pedometer, a step activity monitor and a simple visual analog scale. Joint use was related to wear at the 90% confidence level. Without three recognized outliers, wear was highly correlated to use. The visual analog scale activity rating was significantly related to wear for the 24 hip replacements with standard polyethylene. Univariate regression analysis indicated that male gender, height, weight (which were both highly correlated to male gender) and hip center of rotation were significantly correlated to wear. Multivariate regression analysis indicated that male gender, femoral off-set, and Hylamer were significantly correlated to wear. Based on the wear and activity data from the 24 hip replacements with standard polyethylene, the average volumetric wear rate per million cycles with a 70 kg patient weight was 30 mm3. This unique in vivo result can be considered a target wear rate for standard polyethylene in hip simulator studies.

Aged↗
PubMed1997

HLA and cross-reactive antigen group matching for cadaver kidney allocation.

BACKGROUND: Allocation of cadaver kidneys by graded human leukocyte antigen (HLA) compatibility scoring arguably has had little effect on overall survival while prejudicing the transplant candidacy of African-American and other hard to match populations. Consequently, matching has been proposed of deduced amino acid residues of the individual HLA molecules shared by cross-reactive antigen groups (CREGs). We have examined the circumstances under which compatibility with either method impacted graft survival. METHODS: Using Cox proportional hazards regression modeling, we studied the relationship between levels of conventional HLA mismatch and other donor and recipient factors on primary cadaver kidney survival between 1981 and 1995 at the University of Pittsburgh (n=1,780) and in the United Network for Organ Sharing (UNOS) Scientific Registry during 1991-1995 (n=31,291). The results were compared with those obtained by the matching of amino acid residues that identified CREG-compatible cases with as many as four (but not five and six) HLA mismatches. RESULTS: With more than one HLA mismatch (> 85% of patients in both series), most of the survival advantage of a zero mismatch was lost. None of the HLA loci were "weak." In the UNOS (but not Pittsburgh) category of one-HLA mismatch (n=1334), a subgroup of CREG-matched recipients (35.3%) had better graft survival than the remaining 64.7%, who were CREG-mismatched. There was no advantage of a CREG match in the two- to four-HLA incompatibility tiers. Better graft survival with tacrolimus was observed in both the Pittsburgh and UNOS series. CONCLUSIONS: Obligatory national sharing of cadaver kidneys is justifiable only for zero-HLA-mismatched kidneys. The potential value of CREG matching observed in the one-HLA-mismatched recipients of the UNOS (but not the Pittsburgh) experience deserves further study.

Adolescent↗
PubMed1997

Clostridial gas gangrene of the abdominal wall after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is associated with a considerable rate of infectious complications of up to 2.8%. Such infections are usually of minor clinical importance. However, we observed a case of life-threatening Clostridial gas gangrene centering around the right lateral port site and developing across all of the right-sided abdominal wall, causing septic shock and severe multi-organ failure. Considering the overall infection rate and the possibility of even severe morbidity, we advocate perioperative antibiotics in laparoscopic cholecystectomy.

Abdominal Muscles↗
PubMed1996

Assessing risk in liver transplantation. Special reference to the significance of a positive cytotoxic crossmatch.

OBJECTIVE: The authors determined the impact of a positive cytotoxic crossmatch on the outcome of liver transplantation. SUMMARY BACKGROUND DATA: Liver allografts rarely undergo hyperacute rejection, but transplants performed across a positive cytotoxic crossmatch tend to follow a different clinical course, with higher intraoperative blood use, postoperative graft dysfunction, and, in some cases, graft loss. How this affects overall graft survival has not been determined. METHODS: The authors provide a retrospective analysis of 1520 liver transplants performed between November 1989 and December 1993, with a minimum follow-up of 1 year. All cases had a cytotoxic crossmatch using serum pretreated with dithiothreitol. RESULTS: There were 1390 negative crossmatch and 130 positive crossmatch cases. There was no difference in overall graft survival, although early survival rates were lower in the positive crossmatch group, with the maximum difference at 6 months: 0.76 (95% confidence interval, 0.74-0.78) for a negative crossmatch versus 0.68 (95% confidence interval, 0.61-0.77) for a positive crossmatch. These differences become negligible by the 2-year mark. Using stepwise logistic regression, the authors identified seven variables independently associated with outcome: 1) donor age, 2) donor gender, 3) prior liver transplant, 4) medical urgency status, 5) ischemia time, 6) indication for transplantation, and 7) primary immunosuppressant. CONCLUSIONS: The cytotoxic crossmatch is not statistically associated with overall graft survival after liver transplantation. However, early failure rates are higher in the positive crossmatch cases, a difference that disappears by the second year.

Adult↗
PubMed1995

Physiological augmentation of amino acid-induced insulin secretion by GIP and GLP-I but not by CCK-8.

It was the aim of this study to test insulinotropic actions of cholecystokinin octapeptide (CCK-8), gastric inhibitory polypeptide (GIP), and glucagon-like peptide I (GLP-I)-(7--36) amide at basal glucose but physiologically elevated amino acid concentrations. Therefore, in nine fasting healthy volunteers, an amino acid mixture was infused intravenously (12.6 g/h over 120 min). On separate occasions, from 30 to 120 min, placebo (0.9% NaCl-1% human serum albumin), synthetic sulfated CCK-8 (0.5 pmol.kg-1.min-1), human GIP (1 pmol.kg-1.min-1), or GLP-I-(7--36) amide (0.3 pmol.kg-1.min-1) was infused intravenously to mimic physiological increments after a meal. The amino acid infusion lead to a small increment in plasma glucose from 4.8 +/- 0.2 to 5.0 +/- 0.2 mmol/l and significantly elevated insulin and C-peptide concentrations. GIP and GLP-I-(7--36) amide further stimulated insulin (1.8-fold, P = 0.0001 and 0.004, respectively) and C-peptide (1.3-fold, P = 0.0003 and 0.013, respectively), with a subsequent slight reduction in plasma glucose (P < 0.0001). Insulin and C-peptide then decreased again in parallel. CCK-8 was without effect on insulin and C-peptide levels. In conclusion, GIP and GLP-I-(7--36) amide are not only able to interact with elevated plasma glucose but are insulinotropic also with physiologically raised amino acid concentrations. Such an interaction could play a role after the ingestion of mixed meals. Cholecystokinin, on the other hand, is not a physiological incretin also under these conditions.

Adult↗
PubMed1995

Health promotion priorities of economically stressed cities.

The authors surveyed the local health officers (LHOs) of 436 northeastern and midwestern cities about their priorities for promoting health through prevention. LHOs of the most economically stressed cities identified the following as the five most important public health prevention goals that are amenable to intervention: reducing the incidence of HIV infection and AIDS, improving maternal and infant health, controlling sexually transmitted diseases, reducing violent and abusive behavior, and immunizing against infectious diseases. Their judgments were almost identical to those of LHOs of the least economically stressed cities and of a sample of African American political and public health leaders. LHOs of the most stressed cities were more pessimistic than their counterparts about achieving the objectives. The results of this survey can be used by federal, state, and local governments as well as private organizations as a guide for allocating scarce resources.

Adult↗
PubMed1991

Cementless Gustilo-Kyle and BIAS total hip arthroplasty: 2- to 5-year results.

We conducted extensive radiographic and clinical examination of 58 cementless total hip arthroplasties. Forty BIAS femoral stems had heads made of Co-base F 75 alloy and 18 Gustilo-Kyle femoral stems had Ti6A14V alloy heads. The cross-sectional geometry and location of the porous coating pads of the two stem types was identical, the BIAS component being slightly shorter. At the last follow-up, 27.8% of the Gustilo-Kyle femoral components and 2.5% of the BIAS femoral components were unstable. None of the acetabular components in the BIAS group as against 38.9% of the acetabular components in the Gustilo-Kyle group demonstrated wear of more than 1 mm. All unstable components which did not suffer intraoperative fracture had also acetabular wear of more than 1 mm. The only case with endosteal erosion was seen in a patient with an unstable implant displaying the most extensive wear. Nonparametric statistical analysis showed that the patients with Ti6A14V/polyethylene bearing surfaces had a statistically significantly higher extent of wear and a statistically significant higher incidence of femoral component loosening than patients with CrCoMo/polyethylene bearing surfaces.

Adult↗
PubMed1990

Penetration of ciprofloxacin into the cerebrospinal fluid of patients with uninflamed meninges.

Nine patients with external ventriculostomy and suffering from hydrocephalus, due to non-inflammatory central nervous system diseases, were given ciprofloxacin (200 mg twice daily iv). Ciprofloxacin concentrations in serum and CSF were measured by HPLC. Single-dose pharmacokinetics were determined in three patients, and 60 and 600 min post-dose levels after repeated administration in six patients. CSF concentrations were maximal 60-120 min after the end of the infusion. The CSF elimination half-life was 260-430 min compared with 145-170 in serum. Post-dose levels at 60 min ranged from 0.042 to 0.223 mg/l (median = 0.110). Repeated administration did not lead to substantial increases in serum and CSF concentrations. With respect to MIC90 values reported for bacteria involved in CNS infections, the CSF concentrations of ciprofloxacin obtained under our experimental conditions would be considered subtherapeutic. Thus ciprofloxacin therapy of CNS infections may be inadequate when only minor impairment of the blood-CSF barrier exists.

Adult↗
PubMed1990

T and Tk transformation in hemolytic uremic syndromes.

In two cases of hemolytic uremic syndrome (HUS) the bacterial pathogenesis of the disease could be elucidated by lectin red cell agglutination tests. The possible role of anti-T and anti-Tk antibodies is discussed. Transfusions of fresh plasma had no adverse effects. The fatal outcome in one case was caused by disseminated intravascular coagulation (DIC).

Agglutination Tests↗
PubMed1989

[Hemodynamic characteristics of necrotizing pancreatitis].

Seventy-one patients with necrotizing pancreatitis in stages II and III were treated at the surgical intensive care unit in the authors' hospital, between 1982 and 1986. Pathological courses in 23 patients were so severe that a pulmonary catheter had to be applied to monitor haemodynamic changes. Seventeen of these 23 patients died (73.9 per cent), while six survived. The gravest difference between these two groups was relating to vasculopulmonary resistance, which went up strongly in the first group (428 +/- 19 dyn X sec X cm-5) and stayed moderate in the second (201 +/- 13 dyn X sec X cm-5). The left-ventricular stroke work index in the first group was lower with significance than that in the second, the values being 33.4 +/- 2 g X m/m2 versus 44 +/- 4.6 g X m/m2.

Acute Disease↗
PubMed1988

Ciprofloxacin concentration in the rabbit aqueous humor and vitreous following intravenous and subconjunctival administration.

12 mg (6 ml) ciprofloxacin were intravenously administered to rabbits. Using high-pressure-liquid-chromatography the concentration in serum, aqueous humor and vitreous were measured after 1, 4, 10 and 24 h. The mean serum levels were 0.698 mg/l and 0.0425 mg/l after 1 and 10 h, respectively. The drug reached mean levels in the aqueous humor of 0.0595 mg/l and 0.0073 mg/l, respectively. Concerning the subconjunctival application 1 mg (0.5 ml) ciprofloxacin was injected either epibulbar near the limbus corneae or under the conjunctiva of the lower fornix. The mean aqueous humor levels were 0.887 mg/l and 0.094 mg/l after 1 and 10 h, respectively, following epibulbar injection. In contrast, the "fornix-injection" produced mean levels of 0.0267 mg/l and 0.025 mg/l in the aqueous humor after 1 and 10 h, respectively. The concentration of ciprofloxacin in the vitreous was near the detection limit following every method of administration of the drug. The importance of differentiating between epibulbar subconjunctival application and the injection under the conjunctiva of the fornix is discussed.

Animals↗
PubMed1987

Ciprofloxacin concentrations in human aqueous humor following intravenous administration.

16 patients received an intravenous infusion of 200 mg ciprofloxacin 1, 2, 3 and 6 h, respectively, before cataract extraction. This dosage produced mean aqueous humor levels of 0.165 +/- 0.09 and 0.126 +/- 0.028 microgram/ml after 1 and 3 h, respectively. The mean serum levels were 1.760 +/- 0.873 and 0.854 +/- 0.283 microgram/ml after 1 and 3 h, respectively. These levels are above the minimum inhibitory concentration of ciprofloxacin for sensitive organisms.

Aqueous Humor↗
PubMedDate not supplied

Ethical dilemmas and solutions for risk assessment scientists.

A sample survey of U.S. scientists who belong to the Society for Risk Analysis (SRA) was made to ascertain their observations of unethical behavior in the workplace and their opinions of the likely success of programs to prevent misconduct. SRA, an international organization with almost 1,700 U.S. members, includes toxicologists, epidemiologists, industrial hygienists, engineers, and social scientists, as well as experts in exposure assessment, statistics, and risk communications. Respondents reported relatively low rates of clearly unethical acts such as data destruction and fabrication (7%); however, 21% reported at least one observation of plagiarism. Reporting of other problematic behaviors ranged from less than 4% for human subjects violations to 51% observing deliberate overstatement of positive and deliberate understatement of negative results. SRA members did not think that government intervention would be effective in reducing misconduct. They were more supportive of formal education, seminars, videotapes, and a hotline that could be called for advice. We offer suggestions to ISEA and its members for developing a proactive approach to ethical misconduct.

Ethics, Professional↗