[Refusing in vitro fertilization after a single attempt].
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Decision Making↗
Biomedical subjects
J Silva
Publications and source records attributed to J Silva.
A gene map of the human genome.
The human genome is thought to harbor 50,000 to 100,000 genes, of which about half have been sampled to date in the form of expressed sequence tags. An international consortium was organized to develop and map gene-based sequence tagged site markers on a set of two radiation hybrid panels and a yeast artificial chromosome library. More than 16,000 human genes have been mapped relative to a framework map that contains about 1000 polymorphic genetic markers. The gene map unifies the existing genetic and physical maps with the nucleotide and protein sequence databases in a fashion that should speed the discovery of genes underlying inherited human disease. The integrated resource is available through a site on the World Wide Web at http://www.ncbi.nlm.nih.gov/SCIENCE96/.
Amino Acid Sequence↗
Genome maps 7. The human transcript map. Wall chart.
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Chromosome Mapping↗
Practice variations in treating urban minority asthmatics in Chicago.
This study explores provider adherence to national guidelines in treating Latino and African-American asthmatics. We hypothesized that there would be more variations in asthma treatment existing for minorities as a result of variation in physician's adherent to the guidelines. A 96-item survey was administered to 138 Latino and African-American asthmatics attending a hospital emergency department. Data were obtained on demography, severity, access, patient satisfaction, and patient's assessment of physician asthma management. Results were analyzed by ethnicity, gender, practice site of regular provider, and severity. Variation in physician practice was found in these variables. Asthma treatment received by Latino and African-American respondents was deficient compared to guidelines. Regression analyses showed that Latinos fared more poorly on the number of prednisone bursts taken, use of written crisis plans and dispensation of peak flow meters controlling for gender, practice site and severity. African-Americans expressed less dissatisfaction in obtaining services, while both groups expressed high degrees of satisfaction with their providers.
Adolescent↗
EEG delta activity: an indicator of attention to internal processing during performance of mental tasks.
In previous papers we proposed that an increase in delta EEG activity during mental tasks might be related to an increase in subjects' attention to internal processing. In this paper we have made a narrow band analysis to detect those EEG frequencies that change selectively during the performance of a mental task that requires attention to internal processing. Two different experiments were performed: (1) a difficult mental calculation task and a control stimulus with the same physical characteristics as the arithmetical symbols were presented in random order; (2) the Sternberg paradigm for the analysis of short term memory using a memory set of 5 or 3 digits was also presented in random order. Referential recordings to linked ears were obtained in all leads of the 10/20 system. In the first experiment, the increase of power from 1.56 to 5.46 Hz was observed only during the performance of the task and not during the control condition. In the Sternberg paradigm, the increase of power from 1.56 to 3.90 Hz was greater during the difficult than during the easy condition. These results support our hypothesis that an increase in delta activity may be related to attention to internal processing during the performance of a mental task.
Adult↗
Subcutaneous tissue oxygen pressure: a reliable index of peripheral perfusion in humans after injury.
The usual initial life-threatening effect of injury is hypovolemic shock. In the hierarchical physiologic response to hypovolemia, perfusion of peripheral tissues is sacrificed early and restored late. But the usual hemodynamic and metabolic measurements of blood pressure, urine output, and base deficit are not reliable indices of peripheral perfusion. Although the Clark electrode can quantitate tissue oxygen pressure and thereby serve as an index of perfusion, its use is compromised by several technical deficiencies. Recently, an optical method (optode) using fluorescent technology has been developed for measurement of oxygen tension in subcutaneous tissue (P sgO2). Our studies compared this device with the Clark electrode in the laboratory and tested its value in both animal and clinical studies of hypovolemic shock. The results of these several studies demonstrated that: (1) the new oximeter tracked a rapid fall or rapid rise of oxygen tension between room air (150 mm Hg) and 0 mm Hg ( a glucose oxidase/catalase solution) as well as the Clark electrode without encountering its technical problems; (2) with an acute hemorrhage to 20% of base line, the PsgO2 was found to decline rapidly in parallel with the decline of mean arterial pressure (MAP). Although the MAP rapidly returned to normal after immediate complete return of all shed blood, the PsgO2 did not reach normal levels for at least 2 hours, suggesting persistent peripheral vasoconstriction. (3) Studies in progress suggest that between 35 and 78% of trauma patients (n = 18) adequately resuscitated for hypovolemia b customary criteria have a decreased level of PsgO2 for as long as 60 hours after resuscitation for injury. If care is taken to prevent other causes of catecholamine induced vasoconstriction such as pain, fear, cold, and arterial hypoxia, these several results suggest that a certain number of injured patients are inadequately resuscitated despite the return to normal of conventional hemodynamic measurements. The serial analysis of PsgO2 may assist in managing patients and promote better understanding of the responses to injury.
Animals↗
Coronary restenosis.
Return of angina within 6 months of a catheter-based treatment of coronary artery disease usually reflects restenosis due to an overly aggressive local healing response to the procedure-related arterial injury. The restenotic lesion should be treated aggressively. Patients with preexisting diabetes mellitus, renal failure requiring hemodialysis, and left anterior descending artery lesions should be considered to be at exceedingly high risk for clinically significant restenosis. Exercise testing is indicated for all patients who experience a return of their angina within 6 months of an interventional procedure. Nurse practitioners in the primary care setting may be the first clinicians to hear of the return of angina. Patients should always be reassured that repeat intervention is almost always possible and is generally effective in providing long-term relief. New devices (in particular the Palmaz-Schatz stent) may help reduce the likelihood of restenosis, to the extent that they provide a large acute post-treatment lumen diameter that is more tolerant of intimal hyperplasia without producing significant narrowing. Until adjunctive drug therapy is found that effectively reduces the local tissue response to interventional therapy, all clinicians involved in caring for patients following such procedures will need to be vigilant and knowledgeable about recognizing and treating restenosis.
Angioplasty, Balloon, Coronary↗
Detection of Cryptosporidium parvum DNA in human feces by nested PCR.
Cryptosporidium parvum is a coccidian protozoan that causes diarrhea in humans, often chronic and severe in patients with AIDS. Conventionally, diagnosis is made by concentration of stools followed by acid-fast staining (AF) or immunofluorescent staining. The threshold of detection in human stool specimens by these methods may require the presence of 50,000 (immunofluorescent staining) to 500,000 (AF) oocysts per g of stool. In this study, a nested PCR assay was developed to detect C. parvum DNA directly from stool specimens. After extraction of DNA from formalinized stool, a 400-bp fragment of C. parvum DNA was amplified with two 26-mer outer primers. The amplicon from this reaction was amplified with a second primer pair. With these nested primers, a 194-bp DNA fragment was amplified and confirmed as C. parvum DNA by internal probing with an enzyme-linked chemiluminescence system. This PCR-based test allowed the detection of 500 oocysts per g of stool or 100 ng of C. parvum DNA. Studies indicate that the primers utilized are specific for the DNA of C. parvum. DNA sequences were also detected in stool specimens from 4 of 28 patients previously reported negative by AF. In summary, a rapid, sensitive, and specific assay for the detection of C. parvum directly from stool specimens has been developed. This test has the potential for detecting asymptomatic infection, monitoring the response to therapy, and detecting the organism in environmental sources.
AIDS-Related Opportunistic Infections↗
Community-acquired pneumonia--is it time for the penicillin bullet to be replaced?
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Community-Acquired Infections↗
[Hepatocellular carcinoma. General aspects of diagnosis and treatment].
Hepatocellular carcinoma is the most frequent form of primary hepatic cancer and has a high dissemination capacity. About 90% of tumors develop over a pre-existing cirrhosis but they also may occur in a normal liver. It has a higher frequency among males and 80% of tumors have clinical manifestations. It is associated to hepatitis B and C virus infection, alcoholism, cirrhosis of any etiology, consumption of aflatoxin Bl, oriental race and familial history. Patients are staged using classifications proposed by Okuda, Child-Pugh and the performance status test. Alpha feto protein is useful for diagnosis and follow up Abdominal ultrasound, hepatic scintiscan, angiography with lipiodol, CAT scan and nuclear magnetic resonance have a high diagnostic yield. Non surgical therapeutic alternatives include intratumoral alcoholization, chemoembolization and other such as tamoxifen and monoclonal antibodies. Surgical treatment is based on hepatic resection, whose magnitude depends on hepatic function. Hepatic transplantation is a new therapeutic alternative for patients in whom resection is not feasible and have a single small tumor without metastases.
Biomarkers, Tumor↗
[Pancreas divisium as a cause of chronic pancreatitis. Clinical case].
We report a 6 years old girl with chronic pancreatitis, presenting as recurring bouts of abdominal pain and hyperamylasemia, secondary to a lack of communication between the main papilla and pancreatic duct (pancreas divisium). The diagnosis was made during an intraoperative pancreatography and treatment consisted in a sphincteroplasty of the secondary papilla.
Child↗
An STS-based map of the human genome.
A physical map has been constructed of the human genome containing 15,086 sequence-tagged sites (STSs), with an average spacing of 199 kilobases. The project involved assembly of a radiation hybrid map of the human genome containing 6193 loci and incorporated a genetic linkage map of the human genome containing 5264 loci. This information was combined with the results of STS-content screening of 10,850 loci against a yeast artificial chromosome library to produce an integrated map, anchored by the radiation hybrid and genetic maps. The map provides radiation hybrid coverage of 99 percent and physical coverage of 94 percent of the human genome. The map also represents an early step in an international project to generate a transcript map of the human genome, with more than 3235 expressed sequences localized. The STSs in the map provide a scaffold for initiating large-scale sequencing of the human genome.
Animals↗
EEG activation patterns during the performance of tasks involving different components of mental calculation.
In this study we demonstrate the existence of different patterns of EEG activation during the performance of 4 different tasks involving different components of mental calculation in normal subjects. The EEG was recorded in all monopolar leads of the 10/20 system using linked ear lobes as reference. Absolute and relative power were calculated in the delta (1.5-3.5 Hz), theta (3.5-7.5 Hz), alpha (7.5-12.5 Hz) and beta (12.5-19 Hz) bands. The tasks were presented randomly and the EEG segments preceding presentation of the stimulus were considered as the rest corresponding to the task requested by the stimulus. Tasks were of 4 different types, involving number comprehension, recognition of mathematical symbols, the calculation process and the spatial component. ANOVAs between the rest periods showed no differences in any band. Neither did ANOVAs between tasks. However, other variables (task minus rest), which were calculated as the differences in power between task and rest respectively, showed significant differences between tasks in the delta and beta bands in the frontal lobes. In addition, new variables were calculated as the difference between tasks, since many factors were common across several tasks. These variables correspond to the EEG change due to a specific component of mental calculation. Significant differences were obtained in delta and theta bands in right posterior areas and in the beta band in frontal areas. We concluded that the EEG differences observed during different components of mental calculation suggest the participation of different networks.
Adult↗
Comparison of Z and multivariate statistical brain electromagnetic maps for the localization of brain lesions.
Conventional Z maps provide probability statements about the deviation of observed values from the norm. Galán et al. (1994) introduced Simultaneous Significance Probability Scales to detect abnormalities over the whole map, making use of the information provided by the topographic structure of dependencies. They also described multivariate brain electromagnetic (MBE) maps for compact presentation of complex spatio-temporal information. In this paper, using the distance-based localization receiver operating characteristic curves (DL-ROC curves), we compare the localization provided by computed tomography with that provided by Z and MBE maps in 61 patients with brain lesions. Maps were calculated for absolute power and relative power in delta, theta, alpha and beta bands for voltage and current source densities (CSD). In each patient, all maps were compared and the map with the highest value of the area of the DL-ROC curve was considered to be the "best map." Z maps of CSD were the "best maps" in 24 patients. In the voltage montage, we observed that multivariate maps add some information not contained in the Z maps. However, for CSD, Z maps were more accurate than multivariate maps. A very consistent finding was the observation that lesions were better detected by maps analyzing the delta band, while edema was better represented by maps in the theta range.
Brain Damage, Chronic↗
Longitudinal quantitative EEG study of children with different performances on a reading-writing test.
In a previous paper, using the same test for the evaluation of reading-writing abilities, Harmony et al. (1990b) reported that children with severe difficulties had more delta in fronto-temporal regions, and this was interpreted as a sign of underlying cerebral dysfunction. Children with severe and minor difficulties in the test had more diffuse theta absolute and relative powers and less alpha relative power. As theta decreases with age, while alpha increases, these results suggested that children with minor and severe difficulties in reading had a maturational lag with respect to those with normal performance. We conducted this study in order to test this hypothesis. Two different EEG records were obtained with an interval of 2.58-3.15 years in 49 children classified in 3 groups according to their performance in a reading-writing test. Group 1: adequate performance for age and degree (control group); group 2: below level performance with minor difficulties; and group 3: below level performance, with severe difficulties. The mean age of the groups in the first study was 9 years. Absolute (AP) and relative powers (RP) in the delta, theta, alpha and beta bands were computed for each session. In general, groups 3 and 2 showed greater changes than group 1 from session to session. ANOVAs performed by session clearly demonstrate many significant differences between groups in the first study, while few significant differences in parieto-occipital regions in theta RP were observed in the second session. These results point toward a maturational spurt of children from groups 2 and 3.
Brain↗
Electroencephalographic coherences discriminate between children with different pedagogical evaluation.
The relationship of reading-writing ability and EEG coherences was studied in 84 subjects from two age groups 7.0-8.9 and 9-11.2 years old. All children were divided into three groups according to their performance on a pedagogical test: ped1, normal children; ped2, children with mild problems; ped3, children with reading-writing disability. The following results were obtained: in general, children showed higher coherences in groups with poor performance in the delta, theta and beta bands. In the alpha band, higher coherence values were related to better performance. The exceptions to this general pattern were rare. Group ped2 had higher coherences in delta, theta and alpha bands than ped1 and ped3, in left temporal leads. In older children the same tendency was observed, but group differences in the theta, alpha and beta bands were few. In this age range, the significant group differences were almost all interhemispheric coherences. The discriminant analysis that classified subjects by their coherence values gave very good results, fact that demonstrates, that EEG coherence is a highly sensitive measurement indicating not only the existence of a reading-writing problem, but also the degree of its severity.
Age Factors↗
Laparoscopic cholecystectomy and gallbladder cancer.
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Cholecystectomy, Laparoscopic↗
Clostridium difficile-associated diarrhea and colitis.
OBJECTIVES: To review and summarize the status of diagnosis, epidemiology, infection control, and treatment of Clostridium difficile-associated disease (CDAD). DIAGNOSIS: A case definition of CDAD should include the presence of symptoms (usually diarrhea) and at least one of the following positive tests: endoscopy revealing pseudomembranes, stool cytotoxicity test for toxin B, stool enzyme immunoassay for toxin A or B, or stool culture for C difficile (preferably with confirmation of organism toxicity if a direct stool toxin test is negative or not done). Testing of asymptomatic patients, including those who are asymptomatic after treatment, is not recommended other than for epidemiologic purposes. Lower gastrointestinal endoscopy is the only diagnostic test for pseudomembranous colitis, but it is expensive, invasive, and insensitive (51% to 55%) for the diagnosis of CDAD. Stool culture is the most sensitive laboratory test currently in clinical use, but it is not as specific as the cell cytotoxicity assay. EPIDEMIOLOGY: C difficile is the most frequently identified cause of nosocomial diarrhea. The majority of C difficile infections are acquired nosocomially, and most patients remain asymptomatic following acquisition. Antimicrobial exposure is the greatest risk factor for patients, especially clindamycin, cephalosporins, and penicillins, although virtually every antimicrobial has been implicated. Cases of CDAD unassociated with prior antimicrobial or antineoplastic use are very rare. Hands of personnel, as well as a variety of environmental sites within institutions, have been found to be contaminated with C difficile, which can persist as spores for many months. Contaminated commodes, bathing tubs, and electronic thermometers have been implicated as sources of C difficile. Symptomatic and asymptomatic infected patients are the major reservoirs and sources for environmental contamination. Both genotypic and phenotypic typing systems for C difficile are available and have enhanced epidemiologic investigation greatly. INFECTION CONTROL: Successful infection control measures designed to prevent horizontal transmission include the use of gloves in handling body substances and replacement of electronic thermometers with disposable devices. Isolation, cohorting, handwashing, environmental disinfection, and treatment of asymptomatic carriers are recommended practices for which convincing data of efficacy are not available. The most successful control measure directed at reduction in symptomatic disease has been antimicrobial restriction. TREATMENT: Treatment of symptomatic (but not asymptomatic) patients with metronidazole or vancomycin for 10 days is effective; metronidazole may be preferred to reduce risk of vancomycin resistance among other organisms in hospitals. Recurrence of symptoms occurs in 7% to 20% of patients and is due to both relapse and reinfection. Over 90% of first recurrences can be treated successfully in the same manner as initial cases. Combination treatment with vancomycin plus rifampin or the addition orally of the yeast Saccharomyces boulardii to vancomycin or metronidazole treatment has been shown to prevent subsequent diarrhea in patients with recurrent disease.
Bacterial Proteins↗