Audit of management of induced abortion. Primary care component is ignored.
Explore the source record for details and available documents.
Abortion, Induced↗
Biomedical subjects
K Stein
Publications and source records attributed to K Stein.
Immobilized enzymes as tools in food analysis.
A lot of publications described the possibilities of using selective enzymatic reactions in analysis, but not much authors described applications for the analysis of real samples. In this paper important publications, which described different applications in food analysis, are reviewed. In the first section the use of biosensors for food analysis, in the second section the combination of immobilized enzymes and flow injection analysis and in the last section the use of immobilized enzymes in combination with HPLC are described. Most of the applications described used enzymes for the determination of sugars mainly glucose, but also methods for the determination of inhibitors in foods are described.
Amino Acids↗
Asymptomatic foodhandlers as the source of nosocomial salmonellosis.
A nosocomial outbreak of salmonellosis affected 22 patients and seven staff on 14 wards in two hospitals with shared catering facilities. The outbreak was characterized by a low level intermittent infection with Salmonella enteritidis phage type 4 over a 19-day period. The epidemiology did not suggest a common source for the outbreak and there was little evidence for person-to-person spread. Extensive food and environmental sampling failed to yield salmonella. Control measures within the kitchens and on wards early in the outbreak had no effect on the rate of infection. Faecal screening of asymptomatic people demonstrated a high carriage rate among catering staff (12.3%), compared with ward staff (2.2%) or patients (0.8%). A case-control study failed to reveal any association between illness and particular meals, food types, wards, medical attendants, medical procedures, or medication. However there was an association between illness and eating meals prepared by one carrier (P = 0.02). Transmission was believed to be via intermittent contamination of occasional meals. No further cases occurred after the exclusion of infected food handlers. The identifiable costs of the outbreak amounted to approximately pounds 33,000. These results indicate that asymptomatic food handlers may be the source of nosocomial salmonella outbreaks, and that efforts should be made to identify carriers and treat them.
Carrier State↗
Reduction of vitamin K2 concentrations in human liver associated with the use of broad spectrum antimicrobials.
It is unclear whether menaquinones produced by the intestinal microflora play any role in human nutrition. Reports of coagulopathy due to vitamin K deficiency occurring in patients receiving broad spectrum antibiotics indirectly suggest that vitamin K2 produced by the gut microflora may be utilized by the host. We analyzed the vitamin K1 (phylloquinone) and vitamin K2 (menaquinone) content in a convenience sample of 22 human post-mortem liver samples, including 9 individuals who had been receiving broad spectrum antimicrobials prior to death and 13 individuals who had been victims of sudden, unexpected deaths. There were no significant differences in the mean (+/- SEM) phylloquinone content between the 2 groups [21.9 (+/- 15.5) vs. 16.0 (+/- 9.3) pmol/g wet weight (excluding those who had received supplemental vitamin K1)] but there was a significant difference (p < 0.05) in the total menaquinone (MK) content, 70.0 (+/- 23.3) vs. 423.1 (+/- 141) pmol/g between the 2 groups. These findings suggest an association between receipt of broad spectrum antibiotics and a reduction in hepatic menaquinone concentration, lending support to the hypothesis that a reduction in the gut microflora responsible for their production leads to reduced hepatic stores of this form of the vitamin.
Adult↗
The contribution of vitamin K2 (menaquinones) produced by the intestinal microflora to human nutritional requirements for vitamin K.
BACKGROUND: Coagulopathy manifest by elevation of the prothrombin time (PT) in patients receiving broad spectrum antimicrobials indirectly suggests a role for intestinal microflora synthesized menaquinone (MK) in the maintenance of normal coagulation. Nonetheless, no direct evidence is available to support this contention. OBJECTIVE: Our objective was therefore to provide evidence that bacterially produced MK may be absorbed by the distal small bowel of humans. METHODS: Using a cell harvester, Staphylococcus aureus (ATCC 29213) was grown in 12-L batches, harvested, and extracted by high performance liquid chromatography (HPLC) to obtain 8 mg of pure MK. Four normal volunteers were placed on a diet severely restricted in vitamin K1 (median 32-40 U/day), and were given warfarin to maintain an International Normalized Ratio of approximately 2.0. On the 10th day of warfarin administration, naso-ileal intubation was performed and 1.5 mg of MK was delivered into the ileum. PT, factor VII, II and serum vitamin K1 levels were monitored throughout the study. RESULTS: Mean serum vitamin K1 levels were reduced to 30% of the pre-diet value at the time of MK administration. Within 24 h of ileal MK administration, there was a significant (p < 0.05) increase in the factor VII level of 0.28 +/- 0.10 U/ml (mean +/- SEM) and a significant decrease of 2.5 (+/- 0.1) s in the PT, whereas in the control phase (during which no MK was administered), there were no significant changes in the PT or factor VII at corresponding time intervals. CONCLUSION: These data provide direct evidence for the absorption of vitamin K2 from the distal small bowel, supporting a definite role for bacterially synthesized vitamin K2 in contributing to the human nutritional requirements of this vitamin.
Adult↗
[Daily "routine chest x-ray" in ventilated surgical intensive care patients].
We investigated the relevance of daily routine chest x-ray in intensive care for therapeutical decision. A special emphasis was put on clinical laboratory parameters according to the APACHE-II-score. Within a prospective study we investigated 40 intubated patients of our surgical intensive care unit with a total of 609 x-ray films. 26% of all pictures gained influence on therapeutical procedure. Analysis of different patient subgroups showed only between those under 50 and those above 70 years of age an important discrepancy quote of relevant films (19 vs. 31%).
Adult↗
Clinical system improves physician productivity.
Explore the source record for details and available documents.
Attitude to Computers↗
Quantitative and qualitative measurements of K vitamins in human intestinal contents.
Little data are available with regard to the amount and types of bacterially synthesized menaquinones within the human intestinal tract. Quantitative reverse phase high performance liquid chromatographic (HPLC) analysis of the distal colonic contents of 10 male volunteers revealed the following: (mean +/- SEM) micrograms/g dry weight: MK-4 to MK-7 5.55 (+/- 0.27); MK-9,10 14.54 +/- 0.29; K1 1.31 (+/- 0.14). Similar analyses of the colostomy contents of subjects revealed a total menaquinone content of 8.85 micrograms/g dry weight. The total intestinal contents obtained from five subjects after isotonic saline purgation qualitatively revealed MK-4 to MK-11 with a mean (+/- SEM) content of MK-4 to MK-10 of 5.4 +/- 2.1 micrograms/g dry weight or a mean (+/- SEM) of 1.6 +/- 0.7 mg dry weight of the total contents (243 g). The quantitative mean growth for the major menaquinone producers Escherichia coli and Bacteroides species was 5.2 +/- 3.2 and 9.2 +/- 1.8 log10 CFU/g dry weight, respectively. These results indicate that menaquinones are present in significant concentration in the human intestinal tract, and a potentially large reservoir of vitamin K may be available to the host.
Adult↗
Biochemical appraisal of models for hepatic ischemia-reperfusion injury.
Since total hepatic ischemia occurs with transplantation, there has been interest in developing a model which could be used to evaluate interventions to mitigate hepatic ischemic injury. The initial model employed global ischemia of the entire liver which necessitated the placement of a portal-femoral shunt (model A). In 1982, a model of hepatic ischemia was proposed in which ischemia was produced only in the left and median lobes which obviated the need for the shunt (model B). Recently, it has been found that with this model, increased flow to the nonischemic right lobe persists after left reperfusion thus effectively "stealing" blood from the reperfusing left lobe. Occlusion (model C) or removal (model D) of the right lobe on reperfusion have been proposed as techniques to reduce the "steal". We found, that after 30 min of ischemia, the ATP recovery for model B was significantly slower than for either model C or D. Similarly, the AMP content of model B lobes was significantly higher after 15 min of reperfusion, while 30 min after reperfusion, the total adenine nucleotide content was significantly lower in model B compared with models C and D. The energy charge returned to normal within 15 min of reperfusion in model C lobes while it was delayed until 60 min of reperfusion for models B and D. This study provides support for the advantages of right lobe occlusion (model C) over model B for acute studies evaluating the effect of interventions on ischemic injury to the liver and of removal (model D) for survival studies.
Adenine Nucleotides↗
Native right atrial tamponade with the Jarvik total artificial heart.
Following a massive myocardial infarction culminating in cardiogenic shock, a 61-year-old man underwent implantation of the Jarvik 70-ml total artificial heart. On the fifth postoperative day, hemodynamic instability coupled with subtle radiographic changes and impaired mechanical right ventricular diastolic inflow were instrumental in establishing the diagnosis of localized native right atrial tamponade. To our knowledge, this report is the first detailed discussion of this phenomenon.
Cardiac Tamponade↗
Sources of inspiration.
Two recent projects by Jeffrey Hildner for a private nursing home in Princeton, New Jersey, reconcile the architect's interest in art and the client's emphasis on utility.
Architecture↗
Sensitivity of CAPD/IPD peritonitis organisms to ciprofloxacin.
Studies have suggested that oral quinolones may be useful in the treatment of peritonitis in peritoneal dialysis. We undertook a study of organisms causing peritonitis in our IPD and CAPD populations to determine if these organisms would be susceptible in vitro to Cipro. We determined the minimal inhibitory concentrations (MIC) of 62 non-duplicate isolates from episodes of peritonitis to Cipro by standard broth microdilution. Serial dilutions were done with Cipro and MIC50 and MIC90 were determined. The isolates were as follows: S, epidermidis (17), S. aureus (14), coliforms (11), Pseudomonas (8), Enterococci (8), Diphtheroids (4). The MIC50 and MIC90 for each of the isolate groups and overall are shown below.
Ciprofloxacin↗
Cardiac rhythm disturbances early after orthotopic heart transplantation: prevalence and clinical importance of the observed abnormalities.
To precisely define the incidence, type and consequences of cardiac arrhythmias early after heart transplantation, 25 cardiac transplant recipients were monitored continuously for 728 days from the day of surgery to discharge or death. A subset of 15 patients had sinus node function studies with overdrive suppression performed weekly at the time of endomyocardial biopsy. Results revealed sinus bradycardia in 10 patients (40%) and junctional bradycardia in 6 (24%). Supraventricular tachycardia in the form of atrial tachycardia, atrial fibrillation and atrial flutter occurred in 11 patients (44%). Ventricular tachycardia occurred in 15 patients (60%) and was nonsustained in all. Cardiac pacing for 1,403 h was used in nine patients with a pulse rate less than 50 beats/min; seven recovered and permanent pacing was instituted in two. In the subgroup that had sinus node function studies, seven patients were identified with clinical bradyarrhythmia; each had abnormal sinus node recovery time (greater than 1,400 ms) and abnormal corrected sinus node recovery time (greater than 525 ms) in at least one study. These seven patients also had a significantly prolonged ischemic time (236 +/- 26 versus 159 +/- 68 min, p less than 0.01). In conclusion, cardiac arrhythmias, particularly ventricular tachycardia and bradyarrhythmia, occur more commonly early after orthotopic heart transplantation than has previously been reported. Sinus node dysfunction due to prolonged organ ischemic time, antiarrhythmic drug use or surgical trauma, alone or in combination, may contribute to these arrhythmias.
Arrhythmia, Sinus↗
Approach to management of the heartbeating 'brain dead' organ donor.
In recent years, transplantation has assumed an important role in the treatment of patients with end-stage diseases of most major organ systems. However, the greatest limitation in organ transplantation today is organ supply. Among factors that can affect the organ supply favorably, donor management has received the least attention. This review addresses management of the multi-organ donor within the intensive care unit. With an increased awareness of donor management issues and the application of a rational physiological approach, the supply of functional organs for transplantation can be increased.
Age Factors↗
Pharmacokinetics of the thromboxane A2 receptor antagonist sulotroban (BM 13.177) in renal failure.
1. Ten healthy volunteers and 26 hospital in-patients with endogenous creatinine clearances of 98 to 4 ml min-1 received an oral dose of 800 mg sulotroban (BM 13.177). The plasma and urine concentrations of sulotroban were measured by gas-chromatography over 72 h and the pharmacokinetic parameters were calculated. 2. The AUC rose from 28.5 mg l-1 h in healthy volunteers to 631.4 mg l-1 h in preterminal renal failure (medians). The CLR decreased from 317.0 ml min-1 to 6.5 ml min-1 at the lowest renal capacity. 3. According to the AUC values, reduction of the dose is not necessary at CLCr greater than 50 ml min-1, a dose of 20-40% of normal is appropriate at CLCr of 20-50 ml min-1 At CLCr less than or equal to 20 ml min-1 the normal dose should be reduced to less than 20% of normal. 4. Vaginal spotting was noted in three female patients and a gastro-intestinal haemorrhage that did not require transfusion in one male patient. These may be associated with the action of sulotroban.
Adult↗
Preferential distribution of alpha-hexachlorocyclohexane into cerebral white matter.
1. Whole-body autoradiographic evidence that alpha-1,2,3,4,5,6-hexachlorocyclohexane (alpha-HCH), a racemic compound with anticonvulsant and tremorogenic activities, accumulates in cerebral white over grey matter was confirmed in rats using unlabelled compound and g.l.c. determination in tissue samples. 2. Accumulation in, and retention by, cerebral white matter after a small intravenous dose was in marked excess of what may be accounted for by solvation and was due solely to the (+)-enantiomer. 3. Similar behaviour was exhibited by the (3,6/4,5)-isomers of 1,3,4,5,6-pentachlorocyclohex-1-ene (PCCH) and 1,2,3,4,5,6-hexachlorocyclohex-1-ene (HCCH) but not by other isomers of HCH, HCCH and PCCH suggesting that stereoselective binding to, presumably, some constituent of myelin might depend on the presence of a vicinal pair of (semi)-axially oriented carbon-chlorine bonds. 4. Evidence is presented which indicates that the anti-convulsant and tremorogenic effects of alpha-HCH are unlikely to be related to this property.
Animals↗
[Development of health protection for elderly citizens in relation to territorial organization of complex management in an urban area].
Comprehensive care for the elderly is managed by boards for registration and coordination on local health authority level, in Leipzig eight boards being in existence, one at each district. Their performance was analysed by using evaluation criteria. Conclusions stress the role of the family doctor as to improve comprehensive care for old persons in need.
Aged↗
Conservative management of herniated nucleus pulposes: treatment approaches.
Herniated nucleus pulposus (HNP) is a significant cause of physical impairment to the afflicted individual and a major factor in a wide range of socioeconomic issues. This paper examines various disc herniation therapies and compares conservative treatment modes with surgical intervention. Results of a 10-yr study are reviewed and recommendations are made concerning conservative treatment management in the physician's office and at home, return-to-work considerations, preventive care and the importance of cooperation among patient, physician, employer and third-party provider. The authors conclude that conservative treatment is an acceptable, cost-effect alternative to surgery.
Humans↗