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Biomedical subjects

L Laine

Publications and source records attributed to L Laine.

125 records · Page 7Linked to original sources
PubMed1986

Hepatic collagen production in the rat is unaffected by methotrexate.

Methotrexate (MTX) has been implicated in the pathogenesis of hepatic fibrosis. However, no information exists regarding the effects of MTX on hepatic collagen metabolism. Therefore, we studied the role of MTX in hepatic collagen production in vivo in rats receiving an 8-week course of varying doses of MTX. Twenty-four hours prior to sacrifice animals received an injection of [5-3H]proline. Collagen was extracted with hot trichloroacetic acid and the proteinbound [3H]hydroxyproline was used as a measure of de novo collagen production. The hepatic collagen content was essentially the same in the control and treatment groups in spite of evidence of hepatotoxicity. Similarly, no significant differences were present among the control and MTX-treated groups in the de novo absolute collagen production. In summary, we found no evidence of increased hepatic fibrogenesis in small groups of animals after 8 weeks of treatment with MTX. Data clearly supporting the claim that MTX itself is responsible for hepatic fibrosis are lacking.

Animals↗
PubMedDate not supplied

Esophageal candidiasis in patients infected with the human immunodeficiency virus. A decision analysis to assess cost-effectiveness of alternative management strategies.

BACKGROUND: Currently no consensus exists concerning the timing of upper endoscopy and the choice of antifungal therapy for patients infected with the human immunodeficiency virus who also have esophageal candidiasis. The objective of this research was to determine the clinical and economic effects of alternative management strategies for these patients. METHODS: Decision analysis was used to evaluate the outcomes, costs, and cost-effectiveness of two strategies for the diagnostic workup and treatment of patients infected with the human immunodeficiency virus with dysphagia and/or odynophagia: (1) empiric--a strategy to treat all patients empirically with an oral antifungal agent for up to 4 weeks; and (2) initial esophagogastroduodenoscopy (EGD)--a strategy to perform EGD on all patients and to treat only those with esophageal candidiasis with an oral antifungal agent for up to 4 weeks. Within each strategy, three antifungal regimens were evaluated: ketoconazole, 200 mg daily; fluconazole, 100 mg daily; and ketoconazole, 200 mg daily, for 2 weeks followed by fluconazole, 200 mg daily, for 2 weeks in nonresponders. Information on the probability of esophageal candidiasis in patients with esophageal symptoms and the efficacy of antifungal therapy was obtained from the literature. The costs for diagnostic workup were estimated using both teaching hospital charges and Medicare reimbursement payments. The costs of antifungal therapy were estimated from local pharmacy charges. The average cost per complete response and incremental cost-effectiveness were calculated and subjected to sensitivity analysis. RESULTS: Using the best available evidence for antifungal efficacy, empiric fluconazole was the most cost-effective strategy for all probabilities of esophageal candidiasis that were more than 0.55. Using teaching hospital charges in our base-case analysis, the average costs per complete response for empiric fluconazole and initial EGD and fluconazole were $2706 and $3141, respectively. The incremental cost-effectiveness of initial EGD and fluconazole compared with empiric fluconazole was $3792 per additional complete response. When the cost-effectiveness of the two strategies was compared as the cost of diagnostic workup was varied, initial EGD and fluconazole became the dominant strategy when the diagnostic workup cost fell below $710, a figure that is less than the current Medicare reimbursement payment. CONCLUSIONS: From the perspective of the payer of medical care, empiric fluconazole is the most cost-effective strategy for the initial management of patients infected with the human immunodeficiency virus with esophageal symptoms.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Randomized, prospective trial of direct current versus bipolar electrocoagulation for bleeding internal hemorrhoids.

Fifty patients with bleeding internal hemorrhoids unresponsive to 6 weeks of standard medical therapy were randomly assigned to receive treatment with direct current or bipolar electrocoagulation. Treatment groups were similar in bleeding severity and internal hemorrhoid grade. Treatment sessions were significantly longer for direct current electrocoagulation (8.8 +/- 0.2 minutes) than for bipolar electrocoagulation (0.1 +/- 0.03 minutes) (p < 0.001). When compared to the bipolar electrocoagulation group, direct current electrocoagulation patients had more procedural pain that terminated therapy (5 of 25 patients [20%] versus 0 of 25 [0%], for a difference of 20% [95% confidence interval, 4% to 36%]; p = 0.05) and prolonged pain after the procedure (4 of 25 patients [16%] versus 1 of 25 [4%], for a difference of 12% [95% confidence interval, -4% to 28%]; p = 0.35). However, more post-treatment rectal ulcerations were seen in the bipolar electrocoagulation-treated group (6 of 25 patients [24%] versus 1 of 25 [4%], for a difference of 20% [95% confidence interval, 2% to 38%]; p = 0.10). Treatment groups did not differ in number of treatment sessions or months of follow-up. The rates of success, defined as obliteration of the hemorrhoids or cessation of bleeding with reduction of the hemorrhoids to grade 1 or less, for the direct current electrocoagulation and the bipolar electrocoagulation groups were 88% and 92%, respectively. Failures in the direct current electrocoagulation group were uncontrollable bleeding (n = 1) and refusal to continue therapy because of pain (n = 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Lack of uniformity in evaluation of endoscopic prognostic features of bleeding ulcers.

Management strategies in patients with bleeding ulcers are based on ulcer appearance. We assessed the level of agreement among endoscopists regarding the labeling of endoscopic features of bleeding ulcers and also evaluated the effect of a short teaching session on the level of agreement. Two hundred two endoscopists at the 1992 American College of Gastroenterology Postgraduate Course answered multiple-choice questions using interactive keypads. They were shown 6 slides of typical ulcer stigmata of recent hemorrhage, attended a brief teaching session, and then saw 6 different slides of comparable stigmata plus 2 additional slides. Color of stigmata was assessed in 9 slides. Information on years of endoscopic experience and numbers and types of procedures performed was also obtained. The proportion of correct answers before the teaching session increased significantly with years of experience, reaching a plateau in endoscopists who were 6 years or more beyond training. The proportion of correct answers for physicians performing no more than 5 upper gastrointestinal endoscopies per month was significantly lower than for those performing more than 5 per month: 33/56 (59%) compared with 647/891 (73%), a difference of 14% (95% CI, 0.4% to 27%; p = 0.03), but performance of a greater number of endoscopies was not associated with a further increase in the rate of correct answers. The total number of correct answers increased from 845/1181 (72%) before the teaching session to 1268/1554 (82%) afterwards, a difference of 10% (95% CI, 7% to 13%; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical, Continuing↗
PubMedDate not supplied

Use of hydrochloric acid to clear obstructed central venous catheters.

Central venous catheters are being used with increasing frequency to administer drugs, and as a result, catheter obstruction caused by precipitation of poorly soluble fluid components has become a common problem. We report our first experience using 0.1 N hydrochloric acid to restore patency to central venous catheters obstructed from insolubility-induced precipitation. Precipitation was caused by drug as well as calcium and phosphorus incompatibilities. The initial use of urokinase in two cases was unsuccessful in restoring catheter patency. In all four cases, the instillation of 0.2-1.0 ml of HCl cleared the catheters. Catheter patency usually was gained immediately. No side effects were noted. Our experience supports preliminary data (JPEN 9 (suppl):255, 1985) which suggest that 0.1 N HCl is effective in clearing insolubility-induced precipitation in central venous catheters.

Acetates↗
PubMedDate not supplied

Volume of blood required to obtain central venous catheter blood cultures in infants and children.

To determine how much blood must be discarded before one can obtain a reliable central venous catheter blood culture, we prospectively cultured the blood (from 96 patients) that is ordinarily discarded before obtaining blood for such a culture. We then compared the prospective culture results with those of the actual blood culture. Three sequentially drawn aliquots of blood were aspirated from the central venous catheter and cultured. The culture results of the second aliquot were comparable to those of the third (the portion usually cultured) in overall sensitivity (94.4%), specificity (94.9%), and positive predictive value (80.9%). Thus, the amount of blood that must be discarded (infants: 0.3 mL; children: 1.0 mL) before one can obtain an accurate central venous catheter culture is less than was previously thought.

Bacteremia↗
PubMedDate not supplied

Indications, technique, and complications of balloon tamponade for variceal gastrointestinal bleeding.

Timely treatment of bleeding esophageal varices with balloon tamponade effectively achieves initial hemostatis. However, therapeutic endoscopy and sclerotherapy in patients with acute upper gastrointestinal hemorrhage is associated with better short- and long-term follow-up. We describe the technique of esophagogastric balloon insertion, as well as principles of monitoring and maintenance. The different types of balloons for tamponade are described, as well as potential complications.

Balloon Occlusion↗
PubMedDate not supplied

Prospective, randomized comparison of disposable and reusable biopsy forceps in gastrointestinal endoscopy.

We prospectively compared biopsy specimens obtained with reusable and disposable stainless steel biopsy forceps of varying sizes and configurations. Six types of forceps were used: (1) jumbo reusable forceps, (2) jumbo disposable forceps with a Teflon sheath, (3) regular reusable forceps, (4) regular disposable forceps with a Teflon sheath, (5) regular long-jaw disposable forceps, and 6) regular long-jaw disposable forceps with a Teflon sheath. "Jumbo" forceps were those requiring an endoscopic biopsy channel of at least 3.3 mm. "Regular" forceps were those requiring only a 2.8-mm channel. Two biopsy specimens were obtained with each of the six forceps from normal-appearing stomach, duodenum, and sigmoid colon (25 sets at each location). Mixed and coded specimens were scored by a single pathologist for volume (height, width, and length) and histologic depth. Reusable and disposable jumbo forceps yielded biopsy specimens of similar volumes (30 +/- 1 mm3 and 33 +/- 1 mm3, respectively) and histologic depth (grades of 3.3 +/- 0.1 and 3.5 +/- 0.1, respectively). In comparison, the regular-sized biopsy forceps gave specimens with half the volume of those obtained by the jumbo forceps (reusable, 13 +/- 1 mm3; disposable with Teflon sheath, 15 +/- 1 mm3; long-jaw, 16 +/- 1 mm2; and long-jaw with Teflon sheath, 17 +/- 1 mm3). However, the histologic depths of specimens obtained with the regular disposable forceps were the same as those of specimens obtained with the jumbo forceps. Regular reusable biopsy forceps yielded specimens with the smallest overall volume and histologic depth. We conclude that disposable forceps are equivalent to reusable forceps and that the two types can be used interchangeably in gastrointestinal endoscopy. We recommend the use of jumbo forceps whenever possible because they provide biopsy specimens that are double the size of those obtained with regular forceps.

Biopsy↗