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L D Britt

Publications and source records attributed to L D Britt.

At least 19 recordsLinked to original sources
PubMed2006

Cyclosporine inhibits endotoxin-induced vasodilation of isolated rat resistance arterioles.

BACKGROUND: An isolated arteriole fails to dilate in response to endotoxin unless a segment of aorta is included in the perfusion system. The unknown substance released by the aorta after exposure to endotoxin is dependent upon the NF-kappaB pathway and induces inducible nitric oxide synthase (iNOS) in the arteriole. The purpose of this study was to determine if cyclosporine A (CSA) that inhibits both NF-kappaB and iNOS would prevent the vasodilatory response to endotoxin. MATERIALS AND METHODS: Rats were injected with either 10 mg/kg of CSA or oil vehicle followed by the removal of a cremaster muscle. The feeding arteriole was isolated from the cremaster and mounted on micropipettes and pressurized to 70 mmHg in a superfused tissue bath. After an hour equilibration to develop spontaneous tone, a 1 cm segment of aorta was placed in the superfusion system upstream from the arteriole and Salmonella enteriditis endotoxin was added to the buffer at a concentration of 2.5 microg/mL (ET) or continued infusion of buffer alone. Internal diameters of cannulated arterioles were measured with videomicroscopy and videocalipers for an additional hour. RESULTS: Arterioles downstream from an aorta exposed to vehicle but not endotoxin developed 22.8 +/- 3.7% tone that remained unchanged over the following hour. Arterioles exposed to endotoxin started with 22.5 +/- 2.8% spontaneous tone and this fell over the following hour to 11.8 +/- 3.6%, P < 0.05. Pre-treatment of the rats with CSA tended to increase resting tone and completely prevented the loss of tone after endotoxin. CONCLUSIONS: Pre-treatment of the aortic segment with CSA resulted in the development of increased tone in the downstream arteriole and completely blocked the vasodilatory response to endotoxin. These results suggest that CSA or a similar compound may be useful in the treatment of septic shock.

Animals↗
PubMed2006

Corticosteroid use in the intensive care unit: at what cost?

HYPOTHESIS: Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU). DESIGN: Case-control study. SETTING: Burn-trauma ICU in a level 1 trauma center. PATIENTS: All patients who received corticosteroids while in the ICU from January 1, 2002, to December 31, 2003 (n = 100), matched by age and Injury Severity Score with a control group (n = 100). INTERVENTIONS: None. MAIN OUTCOME MEASURES: We considered the following 7 outcomes: pneumonia, bloodstream infection, urinary tract infection, other infections, ICU length of stay (LOS), ventilator LOS, and mortality. RESULTS: Cases and controls had similar APACHE II (Acute Physiology and Chronic Health Evaluation II) scores and medical history. In univariate analysis, the corticosteroid group had a significant increase in pneumonia (26% vs 12%; P<.01), bloodstream infection (19% vs 7%; P<.01), and urinary tract infection (17% vs 8%; P<.05). In multivariate models, corticosteroid use was associated with an increased rate of pneumonia (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.21-5.75) and bloodstream infection (OR, 3.25; 95% CI, 1.26-8.37). There was a trend toward increased urinary tract infection (OR, 2.31; 95% CI, 0.94-5.69), other infections (OR, 2.57; 95% CI, 0.87-7.67), and mortality (OR, 1.89; 95% CI, 0.81-4.40). Patients in the ICU who received corticosteroids had a longer ICU LOS by 7 days (P<.01) and longer ventilator LOS by 5 days (P<.01). CONCLUSIONS: Corticosteroid use is associated with increased rate of infection, increased ICU and ventilator LOS, and a trend toward increased mortality. Caution must be taken to carefully consider the indications, risks, and benefits of corticosteroids when deciding on their use.

Adult↗
PubMed2006

Effects of hemorrhagic shock on adrenal response in a rat model.

INTRODUCTION: There is a documented association between critically ill patients who are in refractory shock and adrenal insufficiency. The underlying pathophysiology may be related to ischemia, necrosis, reperfusion, or resuscitative dilution. We hypothesize this blunted adrenal response is due to ischemia and necrosis of the adrenal parenchyma. METHODS: Thirty Sprague-Dawley rats were intravascularly catheterized and hemorrhagic shock induced to a mean arterial pressure of 65 mm Hg. After 4 hours of hypotension, fluid resuscitation was initiated with a crystalloid solution (Lactated Ringers). A control group underwent catheterization without hemorrhage. Serum corticosterone levels were measured and adrenal glands harvested for histologic evaluation of hemorrhagic necrosis. RESULTS: Baseline corticosterone was 30.8 ng/mL in control animals and 35.3 ng/mL in hemorrhagic animals (P = 0.10). One hour after hemorrhage, corticosterone was maximally stimulated at 406.2 ng/mL and in control animals was 35.0 ng/mL (P = 0.0001). In experimental animals after 4 hours of hypovolemia, corticosterone dropped to 308.9 ng/mL (P = 0.0001). At 6 hours, corticosterone levels dropped to 149.0 ng/mL in experimental animals (P = 0.0001). Adrenal microscopy showed 1.5+ hemorrhagic necrosis in experimental animals compared with 0.0+ in controls (P = 0.004). CONCLUSION: Our model suggests that ischemia and necrosis of the adrenal glands may be responsible for the adrenal insufficiency seen in patients with hemorrhagic shock. Further research may enable clinicians to discern earlier which patients will benefit from adrenal corticoid replacement.

Adrenal Glands↗
PubMed2006

The influence of an auditory distraction on rapid naming after a mild traumatic brain injury: a longitudinal study.

OBJECTIVE: The purpose of this investigation was to examine speeded performance over time and the impact of a common auditory distraction on performance after a mild traumatic brain injury (MTBI). METHODS: Fourteen adults (ages 18-53) treated for a MTBI and 14 age and education-matched controls were asked to perform two speeded naming tasks. Both tasks were presented with or without the presence a common auditory distraction. The MTBI group was tested within 5 days, 30 days, 60 days, and 6 months postinjury. Latency (ms) and accuracy of response were recorded. RESULTS: Initially, the MTBI group demonstrated significantly longer response latencies and lower accuracy levels for both tasks. Similar results were found at 30 days postinjury. At 60 days postinjury, no significant difference was found for task 1 accuracy. Significant differences remained for task 1 latency, task 2 latency, and task 2 accuracy. At 6 months postinjury, no significant differences were found. The presence of an auditory distraction differentially affected the MTBI group for task 2 accuracy upon initial testing and at 30 days postinjury only. CONCLUSIONS: The MTBI group performed both tasks significantly slower and less accurately than the control group upon initial testing and at 30 days postinjury. The presence of pop music further influenced accuracy of complex processing. At 60 days postinjury, accuracy of simple processing returned to preinjury levels and the auditory distraction no longer differentially influenced the MTBI group. All performance differences were resolved at 6 months postinjury.

Acoustic Stimulation↗
PubMed2006

Aggressive surveillance and early catheter-directed therapy in the management of intra-abdominal hypertension.

INTRODUCTION: Trauma patients represent a heterogeneous group at risk for the development of both primary and secondary abdominal compartment syndrome (ACS). Our study aims at identifying these individuals early in their course and placing an intra-abdominal catheter to reduce intra-abdominal pressure before the serious hemodynamic consequences of ACS occur. METHODS: During a 10-month period, 12 patients were identified who developed intra-abdominal hypertension. Patients who received 12 L or more of intravenous fluids in the first 24 hours of their resuscitation or received 500 mL/hr of intravenous fluids for more than 4 consecutive hours were considered at risk and had intra-abdominal pressure readings via bladder catheters every 4 hours. After resuscitation, patients were given a physical examination and intra-abdominal pressures were taken every 4 hours or when clinically necessary. When abdominal compartment pressures (ACPs) exceeded 20 mm Hg or the abdominal perfusion pressure (APP = mean arterial pressure-ACP) fell below 50 mm Hg, a diagnostic peritoneal lavage catheter was placed. Fluid volume and type drained, abdominal pressures, heart rate, mean arterial pressure, and pulmonary compliance were recorded. If adequate control of abdominal compartment pressures was not achieved, the patients were managed with a traditional decompressive laparotomy. RESULTS: Readings taken 30 minutes after placement of the peritoneal catheter showed an average decrease in ACP of 8.0 mm Hg (p = 0.01); an increase in APP of 13.8 mm Hg (p = 0.14); an increase in static pulmonary compliance of 8.1 mL/cmH2O (p = 0.16); and an increase in mean arterial pressure of 5.8 mm Hg (p = 0.52). Ten of the twelve patients were managed nonoperatively. Four patients failed to have their APP improve to >50 mm Hg with the catheter. Two of these patients underwent laparotomy, with one survivor and one mortality secondary to infarcted small bowel. Two did not undergo laparotomy, with one dying of cerebral herniation and the other having care withdrawn. Eight of the twelve patients required intra-abdominal catheters early in their admission (in the first 32 hours), with 7 of 8 surviving. Four patients received intra-abdominal catheters later than day 4 in their admission. All of those four patients died, three within 24 hours. Overall, 5 of the 12 patients died. CONCLUSIONS: Intra-abdominal catheter placement is a reasonable first step in the early management of ACS. It may prevent a portion of patients from progressing to hemodynamically significant ACS and prevent the complications of managing an open abdominal wound. Also, the late intra-abdominal hypertension may be a prognostic indicator of an impending rapid clinical deterioration. Further prospective investigation is warranted to determine whether this method reduces overall morbidity and mortality in critically ill patients.

Abdomen↗
PubMed2006

Syneture stainless STEEL suture. A collective review of its performance in surgical wound closure.

Syneture (division of U.S. Surgical, division of Tyco Healthcare, Norwalk, Connecticut, USA) STEEL sutures are monofilament stainless steel sutures composed of 316L stainless steel conforming to ASTM Standard F138 grade 2 (" Stainless steel bar and wire for surgical implant"). STEEL sutures meet all requirements established by the United States Pharmacopeia (USP) for nonabsorbable surgical sutures. Steel sutures are for use in abdominal wound closure, intestinal anastomosis, hernia repair, sternal closure, and skin closure. They are attached to the following types of surgical needles: Roto-Grip Needles and SCC Needle. The sutures and needles are packaged in a Mylar/Tyvek outer envelope. The purposes of this clinical review are two fold. First, we will report the performance of the Syneture STEEL suture product in the largest studies of suture performance ever reported in the literature. In addition, we will provide comprehensive information from the surgical literature that highlights the unique benefits of stainless steel sutures for the following wound closure techniques: sternal fixation, abdominal wound repair, inguinal hernia repair, and skin wound closure. Consorta Inc. (Rolling Meadows, Illinois), a leading healthcare resource management group purchasing organization, and Syneture, jointly with a clinician task force, designed a reproducible surgical evaluation program for needles and sutures in a large cooperative of healthcare systems. Because of the subjective nature of the more commonly used suture selection techniques, a nonexperimental observational study approach was designed to replace perception of performance characteristics with actual clinical experience. In a report involving 19 Consorta shareholder hospitals, they discussed the preliminary part (Phase I) of a large nonexperimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by Syneture that were evaluated in 3407 surgical procedures included packaging/ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, clinically acceptable determinations, and clinically unacceptable determinations. In this preliminary study, the surgeons concluded that the needles and sutures were clinically acceptable in 98.1% of the evaluations. Armed with this favorable experience, we wanted to expand this observational study to an entirely new group of shareholder hospitals that had a larger number of participating hospitals (Phase I, 19 hospitals; Phase II, 42 hospitals). This more than doubling of hospital observational base dramatically increased the number of patients and performance evaluations. In the Phase II expanded program involving 42 hospitals, the number of patients (8939) and the number of evaluations (25,545) were more than twofold the preliminary study. In the phase I multicentric evaluation of Syneture surgical sutures, the performance of 9266 sutures was evaluated. Of these performance evaluations, 130 evaluations focused on Syneture STEEL sutures. The surgeons were especially pleased by the performance of this suture product, with 129 Syneture STEEL products being judged as clinically acceptable in their performance. Only one Syneture STEEL suture was judged to be unacceptable in its performance, resulting in a 99.2% acceptability rating. In the expanded phase II evaluation of Syneture suture products, the performance evaluation involved 25,545 surgical suture evaluations. The performance of Syneture STEEL sutures was judged in 215 cases. Of these product performance evaluations, 207 were judged to be clinically acceptable in their performance (96.3%). It is important to emphasize that the phase I and phase II observational studies evaluated the performance of other sutures besides monofilament steel sutures. These comprehensive suture and needle performance evaluations included the following additional sutures: Plain Gut, Mild Chromic Gut, Chromic Gut, DEXON II, DEXON S, MAXON, BIOSYN, SOFSILK, SURGILON, BRALON, MONOSOF, DERMALON, SURGIDAC, POLY-SORB, TI.CRON, SURGIPRO, SURGIPRO II, NOVAFIL, VASCUFIL, and FLEXON. Finally, we provide a collective review of the literature that shows the reliable performance of monofilament stainless steel sutures in the following wound closure techniques: sternal fixation, abdominal wound closure, inguinal hernia repair, and skin wound closure.

Humans↗
PubMed2006

Revolutionary advances in medical waste management. The Sanitec system.

It is the purpose of this collective review to provide a detailed outline of a revolutionary medical waste disposal system that should be used in all medical centers in the world to prevent pollution of our planet from medical waste. The Sanitec medical waste disposal system consists of the following seven components: (1) an all-weather steel enclosure of the waste management system, allowing it to be used inside or outside of the hospital center; (2) an automatic mechanical lift-and-load system that protects the workers from devastating back injuries; (3) a sophisticated shredding system designed for medical waste; (4) a series of air filters including the High Efficiency Particulate Air (HEPA) filter; (5) microwave disinfection of the medical waste material; (6) a waste compactor or dumpster; and (7) an onboard microprocessor. It must be emphasized that this waste management system can be used either inside or outside the hospital. From start to finish, the Sanitec Microwave Disinfection system is designed to provide process and engineering controls that assure complete disinfection and destruction, while minimizing the operator's exposure to risk. There are numerous technologic benefits to the Sanitec systems, including environmental, operational, physical, and disinfection efficiency as well as waste residue disinfection. Wastes treated through the Sanitec system are thoroughly disinfected, unrecognizable, and reduced in volume by approximately 80% (saving valuable landfill space and reducing hauling requirements and costs). They are acceptable in any municipal solid waste program. Sanitec's Zero Pollution Advantage is augmented by a complete range of services, including installation, startup, testing, training, maintenance, and repair, over the life of this system. The Sanitec waste management system has essentially been designed to provide the best overall solution to the customer, when that customer actually looks at the total cost of dealing with the medical waste issue. The Sanitec system is the right choice for healthcare and medical waste professionals around the world.

Equipment Design↗
PubMed2006

Avian Flu pandemic in the United States. The Sanitec Industry's solution.

On the basis of the extensive testing of the Sanitec Industries, Inc. waste management system by the North Carolina State University, the authors of this Editorial strongly recommend the immediate implementation of the Sanitec medical waste disinfection system throughout the United States to prevent the potential pandemic of the Avian Flu viral infection.

Animals↗
PubMed2006

Adrenal insufficiency in the critically III trauma population.

Acute adrenal insufficiency has been demonstrated in a number of patients with shock. This study was designed to evaluate the rate of occult adrenal insufficiency in the critically ill trauma population and to determine the impact of hypoproteinemia on the use of random cortisol levels as a marker for adrenal insufficiency. Forty-four patients were prospectively enrolled on admission to the trauma intensive care unit, with three excluded, for a total n of 41. Random total serum cortisol and albumin levels were drawn on hospital Days 1, 4, 8, and 14. Occult adrenal insufficiency was defined as a cortisol less than 25 mcg/dL in the setting of an albumin greater than 2.5 g/dL. The prevalence of cortisol less than 25 mcg/dL ranged from 51 to 81 per cent during the study period, and peaked on Days 4 and 8. Albumin 2.5 g/dL or less ranged from 37 to 60 per cent, and this prevalence also peaked on Days 4 and 8. The patients with a low albumin had a high prevalence of low cortisol, ranging from 67 to 100 per cent. The prevalence of adrenal insufficiency, with low cortisol and normal albumin, ranged from 41 to 82 per cent during the study period. None of our patients with occult adrenal insufficiency were treated with steroids, which was a decision made by the treating physicians. Among the patients with occult adrenal insufficiency, survival was 100 per cent. Occult adrenal insufficiency is common in critically ill trauma patients, and is a dynamic entity that can be acquired and even resolved during critical illness. Random cortisol of 25 mcg/dL may actually not be an adequate marker of occult adrenal insufficiency. Low albumin predicts a low cortisol. Hemodynamically stable occult adrenal insufficiency should not be treated with steroid replacement in the critically ill trauma patient, as survival in our series was 100 per cent without replacement.

Adrenal Insufficiency↗
PubMed2006

Adrenal insufficiency in hemorrhagic shock.

Adrenal insufficiency during sepsis is well documented. The association between hemorrhagic shock and adrenal insufficiency is unclear and may be related to ischemia, necrosis, or resuscitation. This study was designed to determine the incidence of relative adrenal insufficiency in hemorrhagic shock. A retrospective review of a prospectively gathered database for patients admitted to the trauma intensive care unit with hemorrhagic shock was undertaken. A random serum cortisol of <25 mcg/dL defined relative adrenal insufficiency. All of the cortisol levels were drawn within the first 24 hours of admission. Data analyzed included demographics, length of stay, injury mechanism, infections, and mortality. Fifteen patients presented with hemorrhagic shock, with 14 of 15 meeting the criteria for relative adrenal insufficiency. The average serum cortisol level was 15.8 (9-26.8). The average APACHE II score was 18.3 (4-33), and the average Injury Severity Score was 22.5 (8-41). The mechanism was blunt trauma in 10 patients and penetrating trauma in 5. The average intensive care unit and hospital length of stay were 13.2 and 27.4 days, respectively. There were five urinary tract infections, four blood stream infections, and two wound infections. Two of the 15 patients died. Relative adrenal insufficiency appears to be common in hemorrhagic shock. Future research is warranted to elucidate the pathophysiology, as well as to prospectively determine which patients may benefit from steroid replacement.

Adolescent↗
PubMed2005

Resident operative experience during the transition to work-hour reform.

HYPOTHESIS: The operative volume of chief residents would decrease with work-hour reform by the Accreditation Council for Graduate Medical Education (ACGME). DESIGN: Mixed-design study performed during July and December 2003. Collected data were from programs experimenting with work-hour reform and programs that had not yet implemented reform. New York programs were also included. SETTING: University-, community/university-, and community-based surgical residency programs. OTHER PARTICIPANTS: Telephone conversations occurred with 10 randomly selected program directors. MAIN OUTCOME MEASURES: Operative logs from chief residents graduating in 2002 and 2003 and a survey requesting information on programmatic changes. RESULTS: Of the 80 programs that responded, statistical analyses revealed the following findings: (1) there were no significant differences in the operative volume of chief residents based on work-hour model, program setting, or graduating class; (2) there was no significant difference in chiefs' operative volume between programs that experimented with work-hour reform and programs that did not experiment with work-hour reform during 2002-2003; (3) there was no relationship found between work hours and volume of operative cases; and (4) there was an inverse relationship found between work hours and operative volume for residents in New York programs. CONCLUSION: Several correlates must be considered for effective assessment and evaluation of the impact of work-hour reform on surgical training and education.

Adult↗
PubMed2005

Brief communication of the Residency Review Committee-Surgery (RRC-S) on residents' surgical volume in general surgery.

BACKGROUND: The Residency Review Committee-Surgery (RRC--S), 1 of 10 surgical specialties of the Accreditation Council for Graduate Medical Education (ACGME) has monitored the surgical volume of all general surgical residents closely. As a consequence of the reduction of duty hours with the limitation of an 80-hour work-week (averaged over 4 weeks), we were interested in the impact of these restrictions on surgical (volume) experience since its first year of implementation (2003--2004). Therefore, we evaluated the surgical volume of general surgical services since the implementation of the ACGME duty-hour restrictions and compared this volume with that of previous years without these duty limits. METHODS: The Biostatistical Management Section of the ACGME implemented prospective analysis of categorized data for total surgical procedures and Chief Resident cases. The study interval included all resident surgical procedures completed from 1997 to 2004. We were interested particularly in evaluating trends and outcomes after the first year of successful full compliance of the 80-hour work week. Specific evaluations included the impact on surgical programs for total major procedures and Chief Resident cases requisite for application to the American Board of Surgery. RESULTS: The average number of total major procedures for both resident and program averages were noted to increase steadily through the academic years of evaluation (1997--2001). A sharp decrease was evident in the total major procedures for the academic year 2001--2002 that relates to a correction of the biostatistical database implemented by the ACGME to correct a system conversion that began in the academic year 2001--2002. Despite significant changes to the system data mappings, beginning in the academic year 2001, this reduction is explained by the total counted surgeries as major that were eliminated in a revised counting methodology. It was evident on evaluation of the average (of averages) for major surgical procedures per resident (per program) in academic years 1997 to 2004 that the number of procedures was not statistically different in the academic years evaluated when compared with the year for implementation of duty-hour standards (2003--2004). Data analysis further indicates that the average procedures (per resident) performed as Chief Resident in general surgery remained stable from 1997 to 2004; the use of tiered t tests comparing Chief Resident averages (per program) for the academic years 2002--2003 versus 2003--2004 indicated that data remained consistent and confirmed no statistical variance in volumes during this interval (P=0.43). Because some general surgery programs have exceptions for duty-hour requirements (n=15) to allow an 88-hour week averaged over 4 weeks, these differences were of interest to evaluate programs with and without these duty-hour exceptions. Preliminary data with these limited parameters of evaluation suggest no detrimental outcomes related to the duty-hour restrictions for total major procedures per resident or for surgical procedures as Chief Residents for programs with and without these approved exceptions. CONCLUSIONS: RRCs that evaluate general surgery and surgical specialties have responded aggressively and professionally to implement the duty-hour standards per the ACGME. This brief report should be considered an interim communication to evaluate the surgical experience impact for programs currently under the restriction of duty-hour limits. The data provided in the first year of evaluation since the implementation of the 80-hour work-week restriction policy suggest that there has been no significant change in the overall surgical experience for major procedures (per resident), nor has there been a negative impact on Chief Resident surgical experience. A continuum of the prospective evaluation process is required by the RRC-S and other surgical specialties to ensure that requisite surgical volume is maintained throughout the entire 5 years of clinical surgery.

Accreditation↗
PubMed2005

Endotoxin releases a substance from the aorta that dilates an isolated arteriole by up-regulating INOS.

BACKGROUND: Loss of vascular tone in resistance arterioles has been implicated as the cause of hypotension in septic shock. It is believed that the overproduction of nitric oxide (NO) by the inducible isoform of nitric oxide synthase (iNOS) results in the vasodilatation seen in septic shock. However, we have shown that endotoxin has no effect on vascular tone of an isolated resistance vessel unless the endotoxin flows over a segment of aorta or vena cava upstream in the superfusion line. The aim of this study was to determine if the subsequent vasodilation was due to the release of a direct vasodilator or production of NO in the arteriole and if its source was iNOS by using its selective inhibitor, aminoguanidine. MATERIALS AND METHODS: First-order rat cremaster arterioles (n = 36) were isolated and cannulated onto micropipettes, superfused with physiological buffer at 34 degrees C, pressurized to 70 mm Hg, and allowed to gain spontaneous tone over 90 min. A segment of abdominal aorta was then placed in series with the arteriole so that the superfusate passed over the aorta and then into the tissue bath containing the isolated arteriole. The vessels were allowed to equilibrate over 60 min. During this interval, the arteriole was exposed to l-NAME (100 mum), aminoguanidine (100 mum), or buffer. The aorta and arteriole were then superfused with endotoxin (Salmonella enteritidis 2.5 mug/ml). Internal diameters of cannulated arterioles were measured and recorded with videomicroscopy and videocalipers at a resolution of +/-1 mum every 15 min for 1 h. Six groups were created with n = 6 for each group: Group 1, endotoxin; Group 2, control; Group 3, l-NAME and endotoxin; Group 4, l-NAME; Group 5, aminoguanidine and endotoxin; and Group 6, aminoguanidine. RESULTS: After the 60-min equilibration period, there was no significant difference in resting tone among the six groups. At t = 120, the percentage of tone in the control group was 42.7 +/- 0.4% (mean +/- SEM) and this was not changed by treatment with aminoguanidine (42.2 +/- 0.7%). However, exposure to l-NAME alone resulted in vasoconstriction with a gain in tone to 49.5 +/- 1.6% (P > 0.05). Endotoxin alone caused arteriolar tone to fall to 33.5 +/- 1.2% (P < 0.05). Arterioles treated with aminoguanidine did not lose tone (42.6 +/- 1.7%) when exposed to endotoxin and arterioles treated with l-NAME retained their elevated tone (46.0 +/- 2.2%) after treatment with endotoxin. CONCLUSIONS: This study demonstrates that the aorta exposed to endotoxin releases a substance that vasodilates resistance arterioles through the up-regulation of iNOS. Aminoguanidine prevented the fall in tone following exposure to endotoxin, while use of the nonselective NOS inhibitor, l-NAME, not only blocked the fall due to endotoxin but increased basal tone by blocking the constitutively active eNOS.

Animals↗
PubMed2005

Racial disparities in emergency surgical care.

Socioeconomic factors and differences in access to health care systems, perhaps more so than physiologic differences, play a significant role in race-based differences faced by acute care practitioners.

Black or African American↗
PubMed2005

Vaccine information statements. Revolutionary but neglected educational advances in healthcare in the United States.

The purpose of this report is to provide further information about vaccine information statements (VISs) that are revolutionary but neglected educational advances in the United States. Because the use of VISs is mandated by the Federal Government in every individual being immunized, it is the goal of this report to further awaken health professionals and society to the mandatory use of these superb educational statements. With the passage of the National Childhood Vaccine Injury Act of 1986, the Federal Government required that VISs would be given to all vaccine recipients. As of September 2001, the VISs that must be used are diphtheria, tetanus, pertussis, (DTaP); diphtheria, tetanus (Td); measles, mumps, rubella (MMR); polio (IPV); hepatitis B; Haemophilus influenzae type b (Hib); varicella; and pneumococcal conjugate. Copies of the VISs are available at www.cdc.gov/nip/publications/VIS. The National Childhood Vaccine Injury Act of 1986 mandated that all health care providers report certain adverse events that occur following vaccination. As a result, the Vaccine Adverse Events Reporting System (VAERS) was established by the FDA and the Centers for Disease Control and Prevention (CDC) in 1990. In order to reduce the liability of manufacturers and healthcare providers, the National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program (NVICP). This program is intended to compensate those individuals who have been injured by vaccines on a no-fault basis. While the use of VISs has been mandated since 1996, a national survey of private practice office settings has revealed that many immunized patients do not receive the VISs. When these forms were used, physicians rarely initiated discussions regarding contraindications to immunizations or the National Vaccine Injury Compensation Program. Fortunately, the state boards of medical examiners, like the one in Oregon, are taking a strong stand for the use of VISs, with the warning that failure to use a VIS may result in disciplinary action. Our nation and practicing physicians must be awakened to the importance of the use of VISs to ensure that every vaccinated individual receives this statement at the time of vaccination.

Adverse Drug Reaction Reporting Systems↗