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Biomedical subjects

L Greenberg

Publications and source records attributed to L Greenberg.

At least 37 records · Page 2Linked to original sources
PubMed1995

Current emergency department management of stroke in Houston, Texas.

BACKGROUND AND PURPOSE: This study describes emergency department (ED) management of stroke in Houston, Tex, in 1992 to identify delays and deficiencies in recognition and management of stroke patients in various hospital subtypes and to quantitate the impact of a rapid response stroke team. METHODS: ED logs of eight hospitals were retrospectively screened, and 112 patients with suspected acute stroke onset within 6 hours were identified. EDs were divided into four groups based on hospital size (175 to 979 beds), acuity, number of stroke admissions (50/y to 210/y), and availability of neurological consultations. The intervals from stroke onset to triage, examination by a physician, neurological evaluation, computed tomography (CT) and other tests, vital signs, and treatments were recorded. RESULTS: The average time from stroke to ED arrival was 115 minutes, and times from ED arrival to examination by a physician and CT scan were 28 and 100 minutes, respectively, with little variability among hospital groups except that the public hospital was slower. Neurological examinations were poorly documented in community and public hospitals. The presence of a stroke team shortened the time to examination by a physician and to CT by 13 and 63 minutes, respectively, and increased the number of patients admitted to the intensive care unit. Blood pressure was excessively lowered in 31% of hypertensive patients, and hypotonic dextrose intravenous fluids were given to 69% of all patients. CONCLUSIONS: Transport, initial evaluation, and ED care of acute stroke patients are currently slow and often inexpert in all types of hospitals. A stroke team can speed initial ED management.

Adult↗
PubMed1994

Foot care data from two recent nationwide surveys. A comparative analysis.

On the issues of incidence and prevalence: Specific Foot Problems. At the national level, ie, all respondents combined, the agreement between the NHIS and BrimmComm findings is remarkably close. Much of the difference, if not all, is believed explainable by the approximately 5% shortfall in the reported rate of problems associated with individuals who failed or refused to report their income. Where there are major differences between the NHIS and BrimmComm findings, they occur chiefly when the data are disaggregated by sex, age, or income. Technically speaking, the differences are in most cases statistically insignificant because of the generally small sample sizes associated with individual population segments in the BrimmComm survey. Injuries. Although the differences here are somewhat greater than they are for other foot problems, this may be the result of the greater emphasis being placed in the BrimmComm survey (as opposed to the NHIS) on the reporting of injuries. On the issue of utilization: Basic Treatment Patterns. Nothing in the BrimmComm data refutes the observation that podiatrists remain the provider of choice for toenail problems, corns and calluses, and bunions, and are a strong second to MDs for the treatment of foot infections. Overall Number of Visits. The BrimmComm data would indicate a total of 41.4 million visits involving patients 18 years and older in a period of 12 months. Following technical adjustments described in the text (including augmentation to include patients 17 years of age or younger), the total number of visits to podiatrists in 1990 involving civilian noninstitutionalized patients is believed to be in the vicinity of 50 million.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Work redesign: an overview.

The process of redesign offers many opportunities to staff and leadership; it can be an exciting process with the potential for positive outcomes for staff, management, and patients. The key to success is to work together as a team to design new care teams and revised systems to enhance the quality of care provided. Changes will be and are taking place in health care. Nurses have the opportunity to use their creativity and innovation to help shape the future of health care. Emergency nurses can help accomplish this transformation and maintain our tradition as patient advocates for access to care and safe, quality patient care. This article has provided an overview of the major issues that should be addressed in a redesign project. Future articles will describe the redesign projects of specific emergency departments, highlighting strategies for planning and implementation.

Emergency Nursing↗
PubMed1993

Identification of residues important for ligand binding to the human 5-hydroxytryptamine1A serotonin receptor.

The functional significance of the conserved amino acids within transmembrane regions II and VII of the human 5-hydroxytryptamine (5-HT)1A receptor was analyzed by oligonucleotide-directed mutagenesis followed by transient expression of the mutated receptor genes in COS-1 cells. The substitution of a conserved asparagine at position 396 (transmembrane region VII) with either alanine, phenylalanine, or valine resulted in a receptor that did not bind the 5-HT1A agonist 8-hydroxy-2-(di-n-[3H]propylamino)tetralin. In contrast, replacement of Asn396 with glutamine did not affect agonist binding. In addition, serine residues at positions 391 and 393 (transmembrane domain VII) were changed to alanine. Changing the less conserved Ser391 to alanine had no effect on ligand binding. However, replacement of the conserved Ser393 with alanine reduced ligand binding by 86%. Replacement of a conserved aspartate at position 82 (transmembrane region II) with alanine also produced a receptor without detectable agonist binding. Protein immunoblotting detected receptor protein of approximately 51 kDa in both wild-type and mutant receptor-expressing cells, indicating that these mutations probably did not affect expression or processing of the protein. Importantly, the sequence of the human 5-HT1A receptor described in this paper differs from the published sequence [Nature (Lond.) 329:75-79 (1987)] in transmembrane region IV. The present sequence encodes a protein of 422 amino acids, instead of the 421-amino acid protein that has been described previously [Nature (Lond.) 329:75-79 (1987)], and has a change in the sequence in transmembrane region IV from ... RPRAL ... to ... RRAAA ..., which corresponds to the published sequence [J. Biol. Chem. 265:5825-5832 (1990)] of the rat 5-HT1A receptor. Moreover, conversion of the transmembrane region IV sequence of the present clone to that of the published sequence by site-directed mutagenesis abolished ligand binding to the receptor.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed1992

Unimpaired formation of hormone-stimulated inositol trisphosphate in human mesangial cells under hyperglycemic conditions.

The relationship between bulk cellular myo-inositol content and phosphatidylinositol metabolism was evaluated in a human mesangial cell line under euglycemic and hyperglycemic conditions. Mesangial cells maintained in high glucose medium displayed a concentration-dependent fall in myo-inositol as measured by gas-liquid chromatography. Measurements of phosphatidylinositol, phosphatidylinositol 4-monophosphate and phosphatidylinositol 4,5-bisphosphate mass revealed slight but statistically insignificant increases in cells exposed to high glucose containing medium. CDP-diacylglycerol: myo-inositol 3-phosphatidylinositol transferase activity, measured in plasma membranes from mesangial cells grown under control and hyperglycemic conditions, was kinetically similar with Michaelis constants (Km values) for myo-inositol of 2.9 and 2.1 mM, respectively. Finally, hormone-stimulated intracellular calcium mobilization and myo-inositol 1,4,5-trisphosphate mass was measured from mesangial cells grown under normal and hyperglycemic conditions. Both intracellular calcium and inositol trisphosphate formation were unchanged in cells previously exposed to high glucose conditions (400 mg/dl) compared to cells grown under normal glucose concentration (100 mg/dl). These data indicate that bulk changes in myo-inositol induced by hyperglycemia are neither associated with alterations in basal levels of inositol containing glycerolipids nor with changes in hormone-stimulated calcium mobilization and inositol trisphosphate formation under conditions of short term changes in extracellular glucose.

Bradykinin↗
PubMed1992

Comparison of integrated systemic and emotionally focused approaches to couples therapy.

This study compared couples receiving two marital therapy approaches and a control group over a 10-week treatment period. Integrated systemic therapy (IST) and an emotionally focused approach (EFT) were both found to be superior to the control and to be equally effective in alleviating marital distress, facilitating conflict resolution and goal attainment, and reducing target complaints at termination. IST couples, however, showed greater maintenance of gains from termination to 4-month follow-up on marital satisfaction and goal attainment. Clients' perceptions of how change occurred and issues related to the use of a team of observers in IST are discussed.

Adult↗
PubMed1992

Family therapy in the treatment of adolescents.

A family with an adolescent must transform itself from a predominantly nurturant unit to one that can tolerate and encourage the adolescent's need to separate. When an adolescent presents with symptoms that disrupt the developmental process, the clinician who is familiar with several models of family therapy is better able to select a therapeutic and cost-effective intervention. For family assessments, the authors recommend a biopsychosocial approach, which has replaced the outdated view that families cause psychiatric problems and which acknowledges the family as a potential source of healing. The authors describe several models of family therapy--Satir's communication model, the structural model of Minuchin, Bowen's cross-generational model, and psycho-education--and examine features of these approaches useful for working with adolescents. Illustrative vignettes and some guiding principles for matching model and problem are offered.

Adolescent↗
PubMed1992

Public health.

Explore the source record for details and available documents.

Foot Diseases↗
PubMed1992

The use of electroconvulsive therapy in geriatric patients.

The use of ECT has had a resurgence in the past decade as the promise of more effective and specific pharmacotherapy has been unfulfilled. This has been especially true in the elderly in whom ECT has been frequently demonstrated to be a safe and effective intervention. The decision to use ECT in an elderly patient is a complex one, based on the patient's illness, risks of the treatment compared with alternate or no treatment, and patient and family wishes. The list of dogmatic "absolute contraindications" for ECT has been replaced with a pragmatic philosophy looking at risk/benefit ratios. Such an attitude can only serve to enhance the quality of care clinicians provide their patients.

Aged↗
PubMed1991

Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins.

BACKGROUND: Postmenopausal estrogen-replacement therapy may reduce the risk of cardiovascular disease, and this beneficial effect may be mediated in part by favorable changes in plasma lipid levels. However, the effects on plasma lipoprotein levels of postmenopausal estrogens in the low doses currently used have not been precisely quantified, and the mechanism of these effects is unknown. METHODS: We conducted two randomized, double-blind crossover studies in healthy postmenopausal women who had normal lipid values at base line. In study 1, 31 women received placebo and conjugated estrogens at two doses (0.625 mg and 1.25 mg per day), each treatment for three months. In study 2, nine women received placebo, oral micronized estradiol (2 mg per day), and transdermal estradiol (0.1 mg twice a week), each treatment for six weeks. The metabolism of very-low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) was measured by endogenously labeling their protein component, apolipoprotein B. RESULTS: In study 1, the conjugated estrogens at doses of 0.625 mg per day and 1.25 mg per day decreased the mean LDL cholesterol level by 15 percent (95 percent confidence interval, 11 to 19 percent; P less than 0.0001) and 19 percent (95 percent confidence interval, 15 to 23 percent; P less than 0.0001), respectively; increased the HDL cholesterol level by 16 percent (95 percent confidence interval, 12 to 20 percent; P less than 0.0001) and 18 percent (95 percent confidence interval, 14 to 22 percent; P less than 0.0001), respectively; and increased VLDL triglyceride levels by 24 percent (95 percent confidence interval, 8 to 40 percent; P less than 0.003) and 42 percent (95 percent confidence interval, 26 to 58 percent; P less than 0.0001), respectively. In study 2, oral estradiol increased the mean concentration of large VLDL apolipoprotein B by 30 +/- 10 percent (P = 0.05) by increasing its production rate by 82 +/- 18 percent (P less than 0.01). Most of this additional large VLDL was cleared directly from the circulation and was not converted to small VLDL or LDL. Oral estradiol reduced LDL cholesterol concentrations by 14 +/- 3 percent (P less than 0.005), because LDL catabolism increased by 36 +/- 7 percent (P less than 0.005). The oral estradiol increased the HDL cholesterol level by 15 +/- 2 percent (P less than 0.0001). Transdermal estradiol had no effect. CONCLUSIONS: The postmenopausal use of oral estrogens in low doses favorably alters LDL and HDL levels that may protect women against atherosclerosis, while minimizing potentially adverse effects on triglyceride levels. The decrease in LDL levels results from accelerated LDL catabolism; the increase in triglyceride levels results from increased production of large, triglyceride-rich VLDL.

Administration, Cutaneous↗
PubMed1991

Idiopathic trigeminal pain associated with gustatory stimuli.

We present a unique case of a patient with facial pain evoked by gustatory stimuli. Pain was typically evoked by application of sucrose to the ipsilateral anterior 2/3 of the tongue, but not to the contralateral aspect. Pain was referred to the maxillary tuberosity area and, when stronger, to the infraorbital and supraorbital regions. Sucrose was most effective in eliciting pain, whilst saline, citric acid and water had a minimal effect. Spatial or temporal summation of gustatory stimuli was associated with stronger pain of longer duration and shorter latency. Some of the pain characteristics were similar to those of idiopathic trigeminal neuralgia. Thus, pain was elicited by innocuous ipsilateral stimuli, referred out of the stimulus zone, persisted beyond the period of stimulation and could be controlled with carbamazepine. We proposed a central neural mechanism for pain induction with convergence between gustatory stimuli afferents and pain pathways in the trigeminal system.

Carbamazepine↗
PubMed1991

A comparison of three desktop chemistry analyzers for the pediatric practice.

Three desktop chemistry analyzers most frequently utilized in physicians' offices are compared for performance and precision: the DT60 (Kodak), Vision (Abbott), and Reflotron (Boehringer-Mannheim). The manufacturers' instructions were followed for all the reagents, calibrators and controls provided with each analyzer used. Precision, stability, dynamic range, interferences, and comparison of analyses of 50-100 patient samples with standard laboratory instruments were evaluated. Within-run precision on all three instruments was acceptable, the coefficient of variation (% CV) ranging from 0.8-5.4% and run-to-run precision CV of 1.1-7.3%. Within-run precision for glucose, blood urea, nitrogen, cholesterol and sodium for an experienced technologist, a clerk without any laboratory experience and a physician with no recent laboratory training were compared: the total CV varied between 1.1 and 6.3%. There are differences in the way bilirubin and hemoglobin interfere with the chemistries on the analyzers. Instrument size, available analyses, reagent cost and ease of operation were also assessed. The data suggest that all three analyzers performed well and would be suitable for the pediatric office setting.

Bilirubin↗
PubMed1990

High level expression of the envelope glycoproteins of the human immunodeficiency virus type I in presence of rev gene using helper-independent adenovirus type 7 recombinants.

The effect of rev (art/trs) gene on the level of HIV-1 envelope (env) expression using recombinant adenovirus was investigated. Recombinant adenoviruses expressing either the envelope or the rev gene of the human immunodeficiency virus type 1 (HIV-1) were constructed by inserting the gene into an expression cassette. The expression cassette contained the adenovirus type 7 major late promoter, followed by leader 1 of the adenovirus tripartite leader and a portion of intron between leaders 1 and 2, leaders 2 and 3, and a hexon polyadenylation signal. The cassette was then inserted at the terminal region between the E4 and ITR regions of the adenovirus 7 genome with a concomitant E3 region deletion (80-87 m.u.). A549 cells infected with the recombinant virus containing the env gene produced the envelope glycoproteins gp160, gp120, and gp41. HIV-1 envelope gene expression was greatly enhanced (20- to 50-fold) in the cells that were simultaneously infected with the recombinant adenovirus containing the rev gene as measured by ELISA and Western blotting. Interestingly, this effect was observed despite the lack of the 5' down splice site for rev and seems to be post-transcriptional. Another recombinant adenovirus which contains both the rev and the env genes was constructed by inserting the rev gene in the deleted E3 region and the env gene in the terminal cassette. This double recombinant virus expressed high levels of env antigen in A549 cells similar to those attained upon co-infection with two separate recombinant viruses containing the rev or env gene. Furthermore, the rev gene nucleotide sequence could be altered without altering the amino acid sequence and its sequences truncated by 17 amino acids from the C-terminus had no effect of rev function.

Adenoviridae↗