Low molecular weight heparins in the cardiac catheterization laboratory.
Explore the source record for details and available documents.
Abciximab↗
Biomedical subjects
M Cohen
Publications and source records attributed to M Cohen.
Safety and efficacy of outpatient transseptal radiofrequency ablation of atrioventricular accessory pathways.
A retrospective analysis of 60 consecutive patients who underwent outpatient transseptal radiofrequency ablation of left sided accessory pathways at Westchester County Medical Center/New York Medical College from September 1994 to December 1997 was performed. Patients were followed for a mean duration of 22 months. No complications either local or related to the transseptal method were observed. All patients had successful ablation of the accessory pathway. One patient had a recurrence of symptoms. This study suggests transseptal radiofrequency ablation of the left sided accessory pathways to be safe, feasible and an effective procedure when performed in an outpatient setting. These results were obtained at a high volume center with experience using the transseptal technique.
Adult↗
Regulation of carotenoid biosynthesis during tomato fruit development: expression of the gene for lycopene epsilon-cyclase is down-regulated during ripening and is elevated in the mutant Delta.
The red colour of tomato (Lycopersicon esculentum) fruits is provided by the carotenoid pigment lycopene whose concentration increases dramatically during the ripening process. A single dominant gene, Del, in the tomato mutant Delta changes the fruit colour to orange as a result of accumulation of delta-carotene at the expense of lycopene. The cDNA for lycopene epsilon-cyclase (CrtL-e), which converts lycopene to delta-carotene, was cloned from tomato. The primary structure of CRTL-E is 71% identical to the homologous polypeptide from Arabidopsis and 36% identical to the tomato lycopene beta-cyclase, CRTL-B. The CrtL-e gene was mapped to a single locus on chromosome 12 of the tomato linkage map. This locus co-segregated with the Del gene. In the wild-type tomato, the transcript level of CrtL-e decreases at the 'breaker' stage of ripening to a non-detectable level in the ripe fruit. In contrast, it increases approximately 30-fold during fruit ripening in the Delta plants. The Delta mutation does not affect carotenoid composition nor the mRNA level of CrtL-e in leaves and flowers. These results strongly suggest that the mutation Del is an allele of the gene for epsilon-cyclase. Together with previous data, our results indicate that the primary mechanism that controls lycopene accumulation in tomato fruits is based on the differential regulation of expression of carotenoid biosynthesis genes. During fruit development, the mRNA levels for the lycopene-producing enzymes phytoene synthase (PSY) and phytoene desaturase (PDS) increase, while the mRNA levels of the genes for the lycopene beta- and epsilon-cyclases, which convert lycopene to either beta- or delta-carotene, respectively, decline and completely disappear.
Amino Acid Sequence↗
Newer antithrombin agents in acute coronary syndromes.
Thrombin, through its procoagulant and prothrombotic actions, plays a central role in the pathogenesis of unstable angina and acute myocardial infarction. Antithrombin therapy with unfractionated heparin has several important disadvantages, such as a variable anticoagulant effect, sensitivity to platelet factor 4, an inability to inhibit clot-bound thrombin, and the potential to cause thrombocytopenia. Alternative approaches have focused on novel anticoagulants, including direct antithrombins (eg, hirudin) and low-molecular-weight heparins (eg, enoxaparin). Direct antithrombins bind tightly to thrombin without requiring the cofactor antithrombin. Low-molecular-weight heparins display enriched anti-factor Xa activity, improved bioavailability, and facilitated administration versus unfractionated heparin. Recent trials demonstrate that direct antithrombins reduce rates of death and myocardial infarction early in patients without ST elevation, but the treatment effect diminishes over time. In contrast, treatment with enoxaparin shows superiority versus unfractionated heparin, and the treatment effect is durable over time. Whether thrombolysis with adjunctive treatment with low-molecular-weight heparins will show efficacy in patients with ST-segment elevation is the subject of ongoing trials.
Acute Disease↗
Incidence of sexual dysfunction in TBI patients during the early post-traumatic in-patient rehabilitation phase.
OBJECTIVE: The aim of the study is to find whether sexuality and intimacy dysfunction are already present at the early rehabilitation phase of TBI patients. METHODS: Forty-four consequent severe TBI patients were studied. The GCS and the duration of unconsciousness determined the initial severity of the injury. Patients' function regarding motor, language, cognition and behaviour were assessed by an interdisciplinary team. Sexuality and intimacy were evaluated by using a special closed questionnaire. RESULTS: Regarding self confidence 81% of patients described themselves as having high or average self confidences; 78% described themselves as having high or average feeling of being sexually appealing; mood level was average or high in 80% of patients. Only 7.7% of patients reported having sexual dysfunction at that phase of rehabilitation. CONCLUSIONS: Sexual dysfunction in Severe TBI patients is uncommon at the early post-traumatic phase. It is suggested that sexual dysfunction appearing during later stages of recovery is most probably related to reactive behavioural changes.
Adolescent↗
Multiplex-FISH for pre- and postnatal diagnostic applications.
For >3 decades, Giemsa banding of metaphase chromosomes has been the standard karyotypic analysis for pre- and postnatal diagnostic applications. However, marker chromosomes or structural abnormalities are often encountered that cannot be deciphered by G-banding alone. Here we describe the use of multiplex-FISH (M-FISH), which allows the visualization of the 22 human autosomes and the 2 sex chromosomes, in 24 different colors. By M-FISH, the euchromatin in marker chromosomes could be readily identified. In cases of structural abnormalities, M-FISH identified translocations and insertions or demonstrated that the rearranged chromosome did not contain DNA material from another chromosome. In these cases, deleted or duplicated regions were discerned either by chromosome-specific multicolor bar codes or by comparative genomic hybridization. In addition, M-FISH was able to identify cryptic abnormalities in patients with a normal G-karyotype. In summary, M-FISH is a reliable tool for diagnostic applications, and results can be obtained in </=24 h. When M-FISH is combined with G-banding analysis, maximum cytogenetic information is provided.
Chromatin↗
Distraction osteogenesis of free interpositional membranous bone: experimental design.
The purpose of this study is to explore the possibility of bone formation in distraction osteogenesis of the free interpositional membranous bone. Three canine dogs were used as subjects. Two mandibular osteotomies were made in the mandibular body. The oral soft tissue and periosteum of the segment between the two osteotomies were freed from periosteum and the surrounding soft tissue as a free interpositional bone graft 2 cm wide was created. The free interpositional bone was fixed to the proximal mandibular body with a miniplate. The external fixation device was applied to the proximal mandibular body and the distal mandibular body. Mandibular distractions were performed postoperatively at a rate of 1 mm/day for a total of 10-mm distraction for 10 days. The latency period was 1 week in Dog 1, 2 weeks in Dog 2, and 3 weeks in Dog 3. Three dogs were killed 6 weeks after distraction, and interpositional bone specimens were obtained. In Dogs 1 and 2, the free interpositional bone showed severe resorption and had no new bone formation at the distracted area. However, in Dog 3, new bone developed along the distracted gap. Our study demonstrated the possibility of distraction osteogenesis in the free interpositional membranous bone and suggested that free interpositional membranous bone be allowed, under rigid fixation device, to have enough revascularization from surrounding tissue to have osteogenesis for at least 3 weeks or even more.
Animals↗
Study of the outcome of patients transferred to a level I hospital after stabilization at an outlying hospital in a rural setting.
OBJECTIVE: To determine the characteristics and outcome of transferred trauma patients in a rural setting. METHODS: We conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures. RESULTS: RTTPs (39.4%) spent an average of 182+/-139 minutes at the outlying hospital and 72+/-42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1+/-8.5; Acute Physiology and Chronic Health Evaluation II 16.2+/-5.8; Revised Trauma Score 7.44+/-1.1) than the trauma patients admitted directly (ISS 7.9+/-5.3; Acute Physiology and Chronic Health Evaluation II 13.1+/-6.3; Revised Trauma Score 7.8+/-0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473). CONCLUSION: Rural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.
APACHE↗
Financial aspects of providing trauma care at the extremes of life.
BACKGROUND: Children and the elderly are more likely to be underinsured compared with the general population of trauma patients. We performed financial analysis on all trauma patients admitted during an 18-month period to a Level I adult and pediatric trauma center to evaluate the financial impact of providing trauma care for children and the elderly. METHODS: Patients were categorized by age: PEDI<17 years, GERI>64 years and MID = 17 to 64 years. Reimbursement ratio (RR = reimbursement/cost; RR>1 = profit, RR<1 = loss), length of stay (LOS), and Injury Severity Score (ISS) were calculated for each age group. RESULTS: RR for GERI (RR = 0.99) was significantly lower than for PEDI (RR = 1.15) and MID (RR = 1.16). There was no difference in ISS, but the LOS of GERI was greater than that of PEDI and MID (p<0.05). Cost per patient and LOS were less in PEDI versus MID and GERI (p<0.05). CONCLUSION: Trauma care reimbursement for the elderly is inadequate, whereas pediatric trauma care costs less to deliver and is profitable to the trauma center.
Accounting↗
Cleft-palate repair by modified Furlow double-opposing Z-plasty: the Children's Hospital of Philadelphia experience.
Although the optimal technique of cleft-palate repair remains controversial, several small series have suggested that superior speech results may be obtained with the Furlow double-opposing Z-plasty. To examine speech outcome in a large series of Furlow palatoplasties performed at a single center, we retrospectively reviewed the records of 390 cleft-palate patients who underwent Furlow palatoplasty at The Children's Hospital of Philadelphia from 1979 to 1992. Speech outcome at 5 years of age or greater was available for 181 nonsyndromic patients and was scored using the Pittsburgh Weighted Values for Speech Symptoms Associated with Velopharyngeal Incompetence. No or mild hypernasality was noted in 93.4 percent of patients, with 88.4 percent demonstrating no or inaudible nasal escape and 97.2 percent demonstrating no errors in articulation associated with velopharyngeal incompetence. Secondary pharyngeal flap surgery was required in just 7.2 percent of patients. Age at palatoplasty, cleft type, and experience of the operating surgeon had no significant effect on speech results, although there was a trend toward better outcome in those undergoing palatal repair before 6 months of age and toward poorer outcome in those with Veau class I and II clefts. Overall, Furlow palatoplasty yielded outstanding speech results, with rates of velopharyngeal dysfunction that seem to improve upon those reported for other techniques.
Child, Preschool↗
Symptomatic atrioventricular dual pathway double responses: a role for slow pathway ablation.
Two patients with symptomatic fast/slow pathway double responses were evaluated with electrophysiology studies. Chronic palpitations were resistant or worsened by medical therapy. No reentry tachycardias were induced. A nonreentrant paroxysmal supraventricular tachycardia was documented. Radiofrequency ablation of the slow pathway was safely and successfully performed. Patients remain asymptomatic for 16-18 months. Ablation of the slow pathway for this substrate is a viable option.
Adult↗
The crescentic shelf osteotomy.
Explore the source record for details and available documents.
Bone Screws↗
An epidemiological evaluation of the use of microbiological tools for identifying gonorrhoea infection networks.
We aimed to assess the utility of various techniques for identifying gonorrhoea infection networks. All residents of a non-metropolitan North Carolina county visiting a sexually transmitted disease (STD) clinic during a 17-month period were screened for gonorrhoea. Infection networks were estimated by serovar type combined with antibiotic resistance, arbitrarily primed polymerase chain reaction (AP-PCR), or temporal clustering. The residential addresses of infected patients were geocoded and mapped. Among 2 serovar types, the presence of distinguishing characteristics of a network, based on questionnaire data, was assessed with prevalence ratios and 95% confidence intervals (CIs) relative to those not in the network. Twenty-five serovar types were identified among 759 gonorrhoea infections. In one serovar, the networks further delineated by temporal clusters correlated with particular AP-PCR types. In most instances, however, different typing techniques painted different network pictures. No refined serovar network stood out as having a particular set of characteristics that could be used to shape intervention. Teasing out an individual infection network with unique characteristics will require the development and use of other microbiological tools.
Adult↗
Bronchiectasis in systemic diseases.
Explore the source record for details and available documents.
Acquired Immunodeficiency Syndrome↗
Cost-effectiveness analysis of enoxaparin versus unfractionated heparin for acute coronary syndromes. A Canadian hospital perspective.
OBJECTIVE: To determine the cost effectiveness of enoxaparin therapy versus unfractionated heparin (UFH) therapy for patients with unstable coronary artery disease from the perspective of a Canadian hospital. DESIGN: A predictive decision analysis model using published clinical and economic evaluations and costs of medical care in Canada. PATIENTS: A hypothetical cohort of patients presenting to hospital with unstable angina or non-Q-wave myocardial infarction as defined by the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) trial. INTERVENTIONS: Two antithrombotic treatment strategies were compared: (i) enoxaparin 1 mg/kg subcutaneously every 12 hours, and (ii) UFH intravenous bolus and constant infusion adjusted to maintain a therapeutic activated partial thromboplastin time. Both treatment strategies included 100 to 325 mg of oral aspirin daily. Enoxaparin or UFH was continued for a minimum of 48 hours to a maximum of 8 days. Cumulative outcomes were considered up to 30 days after initial presentation to hospital. RESULTS: At 30 days, 19.8% of patients who received enoxaparin compared with 23.3% of patients who received UFH reached one of the primary composite events. There was no difference in major bleeding between the 2 treatment groups (6.5% enoxaparin vs 6.8% UFH). The average total direct medical cost per patient was $Can848 with the enoxaparin strategy versus $Can892 with the UFH strategy (1999 values). Therapy with enoxaparin was, therefore, considered to be the dominant strategy. Univariate sensitivity analysis indicated that the decision model was not robust to changes in the 30-day composite end-point, probability of recurrent angina, or base costs for treatment of recurrent angina or enoxaparin therapy. CONCLUSION: Enoxaparin is the dominant antithrombotic pharmacotherapeutic strategy for patients with unstable coronary artery disease.
Acute Disease↗
Differential processing of neuropeptides influences Drosophila heart rate.
Peptides that play critical physiological roles are often encoded in precursors that contain several structurally-related gene products. Differential processing of a precursor by cell-specific processing enzymes can yield multiple messengers with diverse distributions and activities. We have reported the isolation of SDNFMRFamide, DPKQDFMRFamide, and TPAEDFMRFamide from adult Drosophila melanogaster. The peptides are encoded in the FMRFamide gene and have a common C-terminal FMRFamide but different N-terminal extensions. In order to investigate the processing of the FMRFamide polypeptide protein precursor, we generated antisera to distinguish among the structurally-related neuropeptides. Utilizing a triple-label immunofluorescent protocol, we mapped the distribution of the peptides. Each peptide has a unique, non-overlapping cellular expression pattern in neural tissue suggesting that the precursor is differentially processed. In order to identify a biological activity of the peptides, we established an in vivo heart rate assay. SDNFMRFamide decreases heart rate but DPKQDFMRFamide and TPAEDFMRFamide do not, indicating that the N-terminal residues are critical for this activity. SDNFMRFamide immunoreactivity is present in the aorta, implying that SDNFMRFamide acts locally to affect heart rate; DPKQDFMRFamide and TPAEDFMRFamide antisera do not stain cardiac tissue. Our data support the conclusion that Drosophila contains cell-specific proteolytic enzymes to differentially process a polypeptide protein precursor resulting in unique expression patterns of structurally-related, yet functionally distinct neuropeptides.
Analysis of Variance↗
Neural dynamics of perceptual order and context effects for variable-rate speech syllables.
How does the brain extract invariant properties of variable-rate speech? A neural model, called PHONET, is developed to explain aspects of this process and, along the way, data about perceptual context effects. For example, in consonant-vowel (CV) syllables, such as /ba/ and /wa/, an increase in the duration of the vowel can cause a switch in the percept of the preceding consonant from /w/ to /b/ (J.L. Miller & Liberman, 1979). The frequency extent of the initial formant transitions of fixed duration also influences the percept (Schwab, Sawusch, & Nusbaum, 1981). PHONET quantitatively simulates over 98% of the variance in these data, using a single set of parameters. The model also qualitatively explains many data about other perceptual context effects. In the model, C and V inputs are filtered by parallel auditory streams that respond preferentially to the transient and sustained properties of the acoustic signal before being stored in parallel working memories. A lateral inhibitory network of onset- and rate-sensitive cells in the transient channel extracts measures of frequency transition rate and extent. Greater activation of the transient stream can increase the processing rate in the sustained stream via a cross-stream automatic gain control interaction. The stored activities across these gain-controlled working memories provide a basis for rate-invariant perception, since the transient-to-sustained gain control tends to preserve the relative activities across the transient and sustained working memories as speech rate changes. Comparisons with alternative models tested suggest that the fit cannot be attributed to the simplicity of the data. Brain analogues of model cell types are described.
Attention↗
Penetrating cardiac injuries.
Our objective was to determine the influence of several clinical factors on the survival of patients with penetrating wounds to the heart. A retrospective review of 80 consecutive penetrating cardiac injuries treated in a Level II urban trauma center from 1980 through 1994 were examined. Thirty-six patients (45%) had gunshot wounds (including 1 shotgun wound), and 44 (55%) had stab wounds. Intervention consisted of emergency room (ER) or operating room thoracotomy. We measured the effect of several clinical factors on morbidity and patient survival. Survival rate was 17 of 36 (47%) in gunshot injuries and 35 of 44 (80%) in stab injuries, with an overall survival rate of 52 of 80 patients (65%). The average age was 24 years (range, 9-53), and there were 3 female patients. Twelve patients (15%) had multiple cardiac injuries, and 63 (79%) had other associated injuries. Fourteen patients (17%) presented with no blood pressure, and 55 (69%) were hypotensive on admission. ER thoracotomy was performed on 7 of 52 survivors (13%) and 24 of 28 nonsurvivors (86%). Survival after ER thoracotomy was 7 of 31 patients (22%). A selective approach is recommended, because ER thoracotomy has a limited role in penetrating cardiac injury. A high index of suspicion, prompt resuscitation, and immediate definitive surgical management resulted in a high survival rate for these frequently lethal injuries.
Adolescent↗