Biomedical subjects
Publications and source records attributed to L H Bernstein.
Prospective reimbursement is forcing laboratories across the country to reduce their expenditures. Following are an analysis of the direct and indirect costs in the laboratory and mathematical equations that can be used for predicting them.
Which hospitals have the greatest test load? Which tests are required most frequently in short turnaround times, and which medical services are requesting them? The following investigation uncovered the answers to these and other questions and may be of help in modifying test ordering practices.
As DRG pressures mount, the clinical laboratory needs to find ways to maintain the quality of its service while operating more profitably. Many laboratories have decided to focus on reducing the volume of testing. How effective and medically appropriate is this approach, and what are the alternatives? This article is adapted from Dr. Winkelman's presentation at the Bridgeport Symposium entitled "Performance Requirements for Clinical laboratories Under Prospective Reimbursement and DRGs." The Nov. 15-16, 1984 symposium was sponsored by Bridgeport Hospital, Bridgeport, Conn.
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We examined data on adenylate kinase (EC 2.7.4.3) activity and other clinical chemical values from patients with renal transplants by analysis of variance and discriminant analysis, using various combinations of variables in an attempt to find a predictor of transplant rejection. Some typical data are presented. We conclude that the combination of urinary adenylate kinase and creatinine clearance is the best predictor for identifying patients with transient or destructive renal transplant crises.
Emergency combined angiographic and endoscopic Neodymium-YAG laser treatment is described in an elderly patient with massive hemorrhage from the afferent limb stump of a Billroth II anastomosis after surgical resection of a gastric carcinoma. In patients with bleeding lesions, who are not operative candidates, such an approach can be life-saving.
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Studies have shown metronidazole to be useful in the treatment of colonic Crohn's disease, especially for perineal complications. It appears to equal sulfasalazine in effectiveness and to offer hope to patients who fail to respond to that drug. However, exacerbation of perineal disease is to be expected on discontinuation of therapy. The only troublesome side effect is paresthesia, which apparently is dose-related and not progressive. Although no studies exist showing the drug to be mutagenic, teratogenic, or carcinogenic in humans, animal and laboratory tests raise concern of this possibility. For this reason, metronidazole therapy should be stopped in two to six months if ineffective and stopped periodically when disease is controlled to see if it can be discontinued.
Positive correlations were found among the appearance of adenylate kinase activity in the urine and the existence of bacteriuria, the Fairley test, and other criteria of urinary infection. Since the adenylate kinase isozymes of human tissues are organ specific and can be distinguished from one another, the appearance of adenylate kinase isozymes in urine was used in this study to identify the existence of infection in bladder or kidney. The findings suggest the usefulness of measuring the appearance of urinary adenylate kinase isozymes for the purpose of detection and differential diagnoses of urinary infections, particularly since adenylate kinase is absent or found in low concentrations in urine and serum under normal conditions.
A 60-year-old woman presented with recurrent ileostomal hemorrhage 29 years after proctocolectomy for ulcerative colitis. Ileal varices were demonstrated by selective mesenteric angiography, and a portasystemic shunt was performed with control of the bleeding. Stomal varices typically present with repeated episodes of bleeding at and proximal to the mucocutaneous junction of the ileal stoma and attempts at local corrective measures generally meet with only temporary success. A portasystemic shunt to diminish portal hypertension in this situation is currently the most widely accepted therapy for this entity.
A prospective study of 12 patients with the diagnosis of polymyositis or dermatomyosiois was initiated to determine the characteristics of the esophageal manometric patterns in this group. All of the patients were women between the ages of 30 to 80 years and met three of four of Bohan's diagnostic criteria for these diseases. The patients' conditions were classified according to Rose and Walton's muscle weakness index. Almost two thirds of our patients exhibited distal esophageal dysfunction by manometry. Based on our roentgenographic and manometric data, we conclude that in addition to the well-described abnormalities in the striated portion of the esophagus, smooth-muscle dysfunction occurs with a high frequency in this patient population.
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