Biomedical subjects
Publications and source records attributed to K Miller.
Recognizing that one of the elderly population's primary needs is better access to information about aging and related services, the Visiting Nurse Services in Seattle developed two programs: ElderCare, which offers information about aging and caregiving; and Consultations in Aging, a private case management program.
Differences in hemodynamic stability and fluid requirements were examined in patients randomly assigned to receive either normal saline crystalloid solution (N = 10) or hetastarch colloid solution (N = 11) after coronary artery bypass or valve operation. Both solutions were administered in the same manner for 8 hours after surgery, with hourly assessment of hemodynamic parameters and intake/output data. Infusion rates and 8-hour intake were higher for the group receiving normal saline solution (p less than 0.001), as was postoperative weight gain (p less than 0.01), although urine and chest tube outputs did not differ. Despite lower filling pressures, subjects receiving hetastarch exhibited higher systolic blood pressures and cardiac outputs (p less than 0.05). Hematocrits on postoperative day 1 were lower in the group given hetastarch (p less than 0.001), suggesting prolonged intravascular expansion. The subjects given hetastarch also required significantly less time in the intensive care unit (p less than 0.001). Thus, cardiac surgical patients receiving colloids exhibited reduced fluid requirements, superior hemodynamic performance, and shortened intensive care stay when compared with those given crystalloid resuscitation.
It is generally assumed that a disturbance of microcirculation is the common pathogenic pathway of various cochleovestibular disorders. Several studies have demonstrated that hydroxyethyl starch (HES) has better rheological effects than dextran 40, and fewer side-effects. Therefore, we changed from dextran 40 to hydroxyethyl starch in 1987 for the treatment of several otoneurological disorders. However, some patients complained of general pruritus after 1 or 2 weeks of therapy with HES. Therefore, a retrospective study was performed using a questionnaire of 491 patients treated for various cochleovestibular disorders. We received answers from 94 (20%): 25 of 59 (42.4%) patients treated with HES complained of pruritus compared with only 4 of 35 (11.4%) patients treated with dextran 40. The difference was significant (P less than 0.01). Critical points are the retrospective study design and the small number of patients, so that no conclusions can be drawn about the incidence of pruritus after therapy with HES. However, we would like to focus attention on this side-effect, which has been neglected in the literature but is extremely uncomfortable and socially embarrassing for some patients.
We have previously identified a class of non-polyadenylated hnRNA molecules (CLASS IA-) which hydrogen bond to polyadenylated hnRNA molecules. Characterization of clones from a Drosophila Class IA- cDNA library reveals that 18S rRNA and transcripts derived from intermediate repeat DNA constitute the bulk of such molecules. The most abundant non-ribosomal clone in the library derives from the antisense strand of the Copia retrotransposon and occurs in Drosophila Kc cell Class IA- hnRNA as non-polyadenylated transcripts of 10 and 15 kb.
Although extracorporeal shock wave lithotripsy has become the standard therapy for urolithiasis, there are still indications for endoscopic stone treatment. Laser lithotripsy in association with flexible or semirigid "miniscopes" has become increasingly important for this form of therapy. So far the Nd: YAG and the pulsed dye laser have been used for laser lithotripsy in clinical applications. Since each system has its specific drawbacks, the new solid state alexandrite laser was developed to combine the advantages of the two existing systems. In order to evaluate the lithotriptic potential of the alexandrite laser, a stone model and eight human calculi were exposed to the laser in an experimental setting. Results with the stone model were comparable to those obtained with a reference Nd: YAG system. Adequate destruction was possible in all the human calculi except for one monohydrate stone. In the second part of the study, bladder and ureteric wall were exposed to the laser in ten female pigs, with different numbers of shock waves at various energy levels. While there was a relatively high incidence of early changes, late histological specimens 4-5 weeks after the exposure did not reveal any significant pathology. There was no stricture-formation in the ureter. Finally 12 patients were treated with ureteroscopical laser lithotripsy, and 8 of these were evaluatable. All were stone free without any additional lithotripsy and did not develop any secondary changes in the ureter. The alexandrite laser can therefore be expected to become a safe, reliable and cost-effective alternative for endoscopic stone treatment.
A new familial case of paracentric inversion of chromosome 14 inv(14)(q24.1q32.1) ascertained by multiple abortions in a female carrier is presented. A review of the literature revealed 14 cases of paracentric inversion 14 recorded so far. According to the different breakpoints, two major groups of inversions of the long arm of chromosome 14 can be recognized.
Cholinergic synaptic vesicles purified from the electric organ of the marine ray, Discopyge ommata, contain 2 different size classes of GTP-binding proteins: one or more with an apparent molecular weight (MW) between 37 and 41 kDa, and 3 major and at least 2 minor proteins with MW between 20 and 29 kDa. These GTP-binding proteins were detectable using the alpha 32P-GTP overlay technique and covalent modification with bacterial toxins. The higher MW GTP-binding proteins are ADP-ribosylated by pertussis toxin and 2 of the lower MW GTP-binding proteins are sensitive to botulinum toxin.
UNLABELLED: The subjective incommodation of the patient by the well established methods of colonic cleansing for operation or endoscopic examination gave a reason to evaluate the efficacy of a new mechanical method in a prospective randomized study. 60 patients were divided in two groups: Colonic preparation was performed by YAL-irrigation in group 1, by oral lavage with PEG (polyethylene glycol electrolyte) in group 2. We found no fecal residue in 29.6% of the YAL group compared to 22.2% in the PEG group, a small amount of liquid stool in 29.6% (YAL) compared to 48.1% (PEG), a large amount of liquid stool in 25.9% of both groups and a solid stool in 14.8% (YAL) compared to 3.7% (PEG). The examination of the mucosal surface was hindered by solid or large amounts of liquid stool in 14.8% of group 1 and in 11.1% in the PEG group, particularly localized in the right hemicolon. In group 1, a significantly better valuation in subjective patient tolerance was found: 18.9% (YAL) compared to 77.8% (PEG) (p less than 0,0001) showed symptoms of patient discomfort. IN CONCLUSION: The simple mechanical preparation with YAL has been shown not to be as safe as with the PEG lavage. However, the YAL method seems to be a useful alternative in patients with suspected stenosis, tendency for vomiting as well as for examination or operation of the left hemicolon.
Between January 1983 and December 1988, 317 patients with fractures near the hip joint were operated upon. In a retrospective study we compared 180 patients with general anesthesia (AN) and 137 patients with spinal anesthesia (RA). The average age of patients with RA was 80.5 and with AN 79.8 years. The preoperative management was done by an internist. The operation followed at an average of 2.8 days (Tables 1, 2). All patients were placed into 3 risk groups, based on after preoperative cardiac and pulmonary risk scores, as modified by Goldman (Table 3). Spinal anesthesia was performed with 2 ml 4% hyperbaric mepivacaine (80 mg mepivacaine hydrochloride, 190 mg glucose monohydrate). The AN was induced with thiopental (3-5 mg/kg) and maintained with N2O and enflurane. Fentanyl (0.05-0.15 mg) was given for analgesia. The statistical examination was done using the chi-square test (Fisher-exact or Pearson). The groups were compared for age, time of operation, and risk score (Table 4). The mortality in operations with protection of the femoral head (FP) (Ender pinnings, Böhler pinnings and dynamic hip screws) was significantly higher after RA (13.8%), than with AN (6.5%). In operations with hip prostheses (HP), the mortality for RA (19.0%) was also significantly higher then for AN (4.2%) (Fig. 1). The mortality in group I (4-20 points) was 1.7% in patients with AN (FP 1.4%, HP 2.1%) and 3.7% for RA (FP 4.1%, HP 0%).(ABSTRACT TRUNCATED AT 250 WORDS)
Word processing is currently the most frequent application for personal computers, and a wide variety of standard software is available. The capabilities of modern word-processing software includes the convenient typing and correction of all routine correspondence, as well as the professional layout of scientific manuscripts. The decision to purchase a certain word-processing programm should be made according to local needs and prerequisities. Three to six months may be necessary to fully adapt the organization of a clinic or private practice to the new technology.
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From April 1986 to April 1989 an ileal neobladder was constructed in 101 male patients for complete bladder substitution following radical cystectomy. The patients were retrospectively stratified by age: 86 were over, 15 under the age of 70. No major differences were found in terms of early and late postoperative complications. However, the functional results differed markedly: whereas 89% of the younger patients achieved complete daytime and nighttime continence, only 50% of the older patients reached the same status. It is concluded that strict indications should be observed for complete continent bladder substitution in the elderly.
A series of 224 patients with fractures near the hip joint underwent internal fixation with conservation of the femoral head. Between January 1983 and December 1987 the operations with conservation of the femoral head were performed with Ender pins and Böhler nails. From January 1988 to December 1988 dynamic hip screws (DHS) were used exclusively for conservation of the femoral head. The patients were divided into three risk groups by preoperative cardiac and pulmonary risk score. In a retrospective study we compared different osteosyntheses for lethality, complications and duration of stay in hospital. The lethality with DHS was lower in risk groups II and III. The complication rate was significantly lower (P less than 0.05) in the group with DHS. The duration of hospital stay was significantly shorter (P less than 0.001) in the group in which DHS were used.
Haemoglobin electrophoresis and chromosome analysis indicate that the widely used multimammate rat (chamois coloured) as experimental animal belongs to the species Mastomys coucha (Smith, 1836) and not, as commonly assumed, to Mastomys natalensis (Smith, 1834).
The creation of an ileal neobladder or another continent bladder substitute can improve the psychological well-being of patients who need cystectomy. The excellent surgical outcome and continence that can be obtained with an ileal neobladder mean it can be constructed for reversal of diversion even in cystectomized male patients. Selection, indications and results in five patients with reversal of diversion are presented.
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