Biomedical subjects
Publications and source records attributed to M Ehrhardt.
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A clinical application of the NSD-concept using iso-ret plans for the recording of radiation pneumonitis is reported. The conditions of an ascertainment of tolerance values for single organs by help of the Ellis formula are discussed. Of the examined patients with Hodgkin's disease who had been exposed to irradiation of the unaffected mediastinum, 42% suffered from radiogenic lung complications. The calculated iso-ret plans reveal a limitation of the pneumonitic shadow zone identical to the 1200-ret isoline. The data in literature are in accordance with these results.
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In east central Illinois over the last three years, three hospitals in which the authors were contracted as emergency physicians have been in various stages of merger with nearby hospitals. In all, six hospitals will be merged into three "medical centers." This is a basis of experience to be shared with other emergency physicians, as consolidation of health care facilities seems to be a wave of the future due to financial constraints of the health care setting. Lessons to be learned from these experiences involve many issues, including work contract, malpractice insurance payment, physician and nurse staffing, and public information problems.
Residency programs routinely review cases involving "morbidity and mortality." It would be a valuable experience to similarly review medical malpractice cases and the associated testimony by medical experts. When available, the cases reviewed in residency programs would be those in which faculty members at the same institution had testified. The faculty member in such cases would be intimately familiar with the case and able to share the knowledge necessary to take part in the legal process. This case review process would expose residents to the legal realities of medical practice, provide a forum for peer review of legal testimony by experts, and show residents how to participate in the legal system should the need arise.
The professional standard of care has historically been defined in terms of the practice of reasonable, prudent physicians. In court, physicians are needed in most cases to testify as to what is the standard of practice and to verify the relevance of published materials that may be presented as being descriptive of the standard of care. Proposed standards have been published by many organizations and institutions. The medical literature also serves as a source of information concerning medical practices. Court cases may be decided in a way that suggests that the usual practices of physicians are inadequate.
Biosynthetic human insulin (BHI) produced by recombinant DNA technology has been proven to be identical to pancreatic human insulin. It differs from pork insulin in one carboxy-terminal amino acid of the B-chain, where alanine substitutes for threonine. This leads to a higher hydrophilicity and usually lowers the tendency of insulin molecules to aggregate. To study its biologic effect in man, the Gerritzen test was applied. BHI regular (10 IU) or purified pork insulin (PPI) (10 IU) was injected subcutaneously to evaluate the insulin action profile. The time course of plasma glucose levels under both BHI and PPI did not significantly. BHI seems to lower the blood glucose somewhat faster during the first 30 min and, during the late phase, somewhat less than pork insulin. In general, for both BHI and PPI, the onset of action occurs within 15 and 30 min; after 60 min, plasma glucose levels drop by 44.3% for BHI and by 40% for PPI. The plasma glucose minimum was reached about 2 h after injection; therefore, the slope of the plasma glucose fall after 60 min was only marginal. The minimum levels were steady over about 1.75 h. At 2.5 h postinjection plasma glucose rose gradually and reached starting levels after about 7 h. BHI was as well tolerated in the intradermal skin testing as were pork insulin and a placebo solution.
The study was concerned with the comparison of the action profile of regular and NPH preparations of human insulin (recombinant DNA) and of PPI (pork purified insulin). In addition, the action profiles of some mixtures (10:90, 15:85, 20:80, 25:75, 30:70) of regular and NPH human insulin were evaluated. The comparisons were based on the Gerritzen test. There was no statistically significant difference in the time-course of the blood glucose levels after administration of NPH human insulin and NPH PPI. A tendency was noted, however, that NPH human insulin has a faster onset of action and that the serum glucose minimum for NPH human insulin lasts longer. The serum glucose curves after the application of regular and NPH human insulin initially lie closer together than after the respective PPI preparations. In the later phase, regular human insulin interferes less with the NPH curves. This means that combinations of regular and NPH human insulin may have a clinically useful action profile. No skin reaction or other adverse reaction was detected after application of human insulin and no antibodies against human insulin and Escherichia coli protein were found.