F uptake and F release by root dentin after brushing with F-containing and F-free dentifrice in vitro.
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Dentifrices↗
Biomedical subjects
M Goldstein
Publications and source records attributed to M Goldstein.
The medical and financial costs associated with termination of a nutrition support nurse.
BACKGROUND: Cost-containment pressures have adversely affected hospital nutrition support team staffing. We determined the effect of termination of a nutrition support nurse responsible for patients receiving total parenteral nutrition (TPN) on quality assurance and financial indicators. METHODS: A retrospective review of all 1,093 patients receiving TPN from fiscal year (FY) 1992 through FY 1998 in a tertiary care community hospital. We documented the changes in care during years when the nutrition support nurse position was staffed, terminated, and restored. Indicators studied included inappropriate TPN, central venous line sepsis, TPN wastage, and estimates of preventable costs. RESULTS: When the nurse was present, 8.6% of TPN patients had a functional gastrointestinal (GI) tract and inappropriately received TPN compared with 12.1% when the nurse was absent, a risk difference of 3.5% points (95% confidence interval [CI], -.06 to 8.3; p = .069). Risk of TPN-associated line sepsis increased from 8.8% of patients when the nurse was present to 13.2% when the nurse was absent, a difference of 4.4% points (95% CI, 0.06 to 9.2; p = .028). In the absence of the nurse, 26.3% of TPN patients had preventable charges vs 17.5% when the nurse was present (p < .0001). Total preventable charges were higher in the years without a nurse (p < .003). Total preventable costs increased by $38,148 to $194,285 (depending on the estimate for sepsis) in the year after termination. Reinstatement of the nurse resulted in a decrease in costs between $34,485 and $156,654. CONCLUSIONS: Adequate staffing of a nutrition support team reduced inappropriate TPN and complications of TPN. Financial savings of the same order of magnitude as the nurse's compensation accompany substantial decreases in patient morbidity.
Cost-Benefit Analysis↗
Feeding tube-induced pneumothorax.
A case of accidental bronchial perforation by the metal stylet of a silastic feeding tube is reported. The misplacement of the feeding tube resulted in a pneumothorax. This is a previously unreported complication of enteral feeding in adults. Pulmonary complications of enteral feeding and recommendations for prevention of these complications are discussed.
Aged↗
Impact of nutritional status on DRG length of stay.
A prospective audit of 100 admissions to a general medical unit was performed to determine the relationship of the initial nutritional status of the patients to the actual length of stay and hospital charges. These data then were compared with the allowed length of stay and estimated reimbursement under the prospective payment system of diagnosis-related groups (DRGs). Forty-five percent of the malnourished patients were hospitalized longer than that allowed under DRGs, compared to 30% for normal patients and 37% in the borderline group. The average length of stay was 15.6 +/- 2.2 days in the malnourished group compared to approximately 10 days in the other two groups (p less than 0.01). Although the estimated base DRG reimbursement was similar in all three groups ($4352-$5124), the actual hospital charges were significantly greater in the malnourished ($16,691 +/- 4389) and borderline ($14,118 +/- 4962) groups compared to normals ($7692 +/- 687), (p less than 0.01). The DRG system will have an adverse financial impact in the care of malnourished patients. It is suggested that early recognition of malnutrition and aggressive treatment may lead to a decrease in the length of stay and cost deficit incurred by malnourished patients.
Aged↗
Effects of overfeeding in children with muscle dystrophies.
In muscle dystrophies as in other muscle-wasting diseases and states, a progressive loss of muscle protein occurs, probably as a result of an imbalance between muscle protein synthesis and degradation. In the present study we examined whether this progressive muscle wasting and reduced functional capacity so damaging to patients with muscular dystrophies, can be reduced or even reversed by nightly overfeeding with 1000 ml of Osmolite in addition to the voluntary daytime dietary intake. In the Duchenne muscle dystrophy (DMD) group (six patients) body weight increased significantly accompanied by a 14% increase in midarm muscle circumference with only minimal changes in triceps skin fold, indicating a relative build up of muscle mass. In the congenital muscular dystrophy (CMD) group (four patients) no changes occurred in body weight or any of the three anthropometric measurements performed. Baseline nitrogen balance was mildly positive in both groups and improved significantly in the DMD group during the 3-month experimental period of refeeding, with no changes in urinary 3-methylhistidine excretion, suggesting improved muscle protein synthesis with no change in muscle protein degradation. No changes were detected in hematological and biochemical parameters, liver function tests, pulmonary function tests, or a general activity index during the study period. Our results suggest that a reduced rate of protein synthesis rather than an increased rate of protein degradation occur in muscle dystrophies, and that overfeeding might offer promising nutritional effects, at least in DMD patients.
Adolescent↗
Axial length, refractive error, and keratometry in patients with branch retinal vein occlusion.
PURPOSE: To evaluate ocular parameters that may predispose to the development of branch retinal vein occlusion (BRVO). METHODS: This prospective study included patients with unilateral BRVO evaluated in the authors' clinic. The mean period from the acute phase was 2.29 +/- 1.57 years (range 1-6 years). All patients underwent a complete ophthalmologic examination including subjective refraction, axial length measurements, and keratometry readings. The fellow eye served as a control in each patient. The variables of interest were compared between the affected eye and the fellow eye using the parametric t-test and the nonparametric Wilcoxon test. RESULTS: Twenty-four consecutive patients (14 women, 10 men, mean age 62.4 years) were included in the study. The mean axial length in the affected eye was significantly shorter compared to the mean fellow eye length. No difference was found between the two eyes in mean subjective refraction or mean keratometry readings. CONCLUSIONS: The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient.
Aged↗
Germ cell apoptosis and endothelial nitric oxide synthase (eNOS) expression following ischemia-reperfusion injury to testis.
There is evidence to suggest that reactive oxygen species (ROS) are involved in ischemia-reperfusion injury to the testis. Nitric oxide (NO), a ubiquitous free radical produced by the nitric oxide synthases (NOS), has been implicated in physiologic and pathologic interactions with ROS. We examined the effect of testicular ischemia on germ cell apoptosis and endothelial NOS (eNOS) expression. Adult rats were subjected to unilateral 720 degrees testicular torsion for 1 or 3 hours and 24 hours later, testes were harvested for immunohistochemical studies. Apoptosis was detected by in situ 3' end-labeling of DNA with digoxigenin-ddUTP and eNOS protein was detected using an eNOS monoclonal antibody. Tests subjected to 3 hours of torsion had a threefold increase in apoptotic germ cells per cross-sectional area compared to sham testes (P < .05). In addition to its known expression in Leydig, Sertoli, and vascular endothelial cells, eNOS was detected in the cytoplasm of degenerating germ cells. Consecutive testis sections stained for eNOS and cellular DNA fragmentation demonstrated co-localization of eNOS protein and germ cell apoptosis. The detection of strong immunostaining in apoptotic germ cells supports a role of eNOS in germ cell degeneration after testicular ischemia-reperfusion and suggests that NO is associated with germ cell apoptosis.
Animals↗
Application of cyclopentolate 1% to the medial canthus in children.
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Administration, Topical↗
Maintenance of collegiality.
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Academic Medical Centers↗
Expression of tyrosine hydroxylase-like immunoreactivity in cell bodies in intraocular spinal cord grafts: a comparison with classical Falck-Hillarp histochemistry.
Earlier classical monoamine fluorescence histochemical and immunohistochemical studies describing the distribution of catecholamine neurons in the central nervous system led to the conclusion that all catecholamine fibre systems in the spinal cord have a supra-spinal origin. However, recent reports describing catecholamine neurons in upper cervical segments and at the lumbosacral junction have modified this picture. Isolated intraocular grafts of spinal cord offer a possible model with which to evaluate the presence of intrinsic monoamine neurons. Using immunohistochemistry with antiserum to tyrosine hydroxylase (TH) and Falck-Hillarp fluorescence histochemistry, such grafts from lower cervical segments were found to contain TH-immunoreactive perikarya. However, it was not possible to visualize cell bodies in grafts processed for fluorescence histochemistry. These findings raise questions about the sensitivity of the monoamine fluorescence histochemical method, and about the specificity of TH-immunohistochemistry. Perhaps TH-positive, catecholamine-negative neurons are more common than previously held or alternatively, TH expression in non-catecholamine neurons is induced by perturbations such as grafting brain tissue.
Animals↗
Changes in pCO2 during and after hemodialysis.
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Bicarbonates↗
Distribution of glutamic acid decarboxylase messenger RNA-containing nerve cell populations of the male rat brain.
The distribution of glutamic acid decarboxylase (GAD) mRNA was investigated throughout the rat brain by means of in situ hybridization. Hybridization was carried out with a 35S-radiolabeled cRNA probe transcribed from a cDNA from cat occipital cortex and cloned in a SP6-T7 promoter-containing vector. Fixed tissue sections were hybridized with 35S GAD probe (0.6 kb length). Signal was detected by means of film or emulsion autoradiography. The autoradiograms were semiquantitatively evaluated by means of computer-assisted image analysis. The results obtained with this evaluation were correlated with the results of the semiquantitative analysis of GAD immunoreactivity performed by Mugnaini and Oertel. Specific labeling was only observed in neuronal cell bodies, whereas no labeling was found over neuropil, glial and endothelial cells. The highest labeling was found in the bulbus olfactorius (internal plexiform and granular layers) and in the caudal magnocellular nucleus of the hypothalamus. Strong labeling was observed in the Purkinje layer of the cerebellar cortex, the interpeduncular nucleus, the interstitial nucleus of Cajal, the nucleus of Darkschewitsch and the suprachiasmatic nucleus. Intermediate or low levels of GAD mRNA were present in various brain nuclei, where gamma-aminobutyric acid (GABA)-containing cell bodies had been observed with other techniques. Interestingly, a low level of GAD mRNA was found in the caudate-putamen and nucleus accumbens, where the vast majority of nerve cells is known to contain GAD immunoreactivity. Only a poor correlation was found between the present semiquantitative measurements of GAD mRNA content and previous analyses of the number of GAD-immunoreactive cell bodies. The present study demonstrates that there exists a differential regional expression of GAD mRNA. The comparison with cell counts performed by immunocytochemistry suggests that some brain areas, such as caudate-putamen and nucleus accumbens, contain a large number of GAD-immunoreactive cell bodies which express a low level of GAD mRNA. The opposite seems to be true for other nuclei, such as the globus pallidus, the zona reticulata of the substantia nigra and the inferior collicle, where few GAD-immunoreactive cell bodies contain high levels of GAD mRNA. In conclusion, the present study gives a low magnification map of GAD mRNA levels in the adult male rat brain. Marked biochemical heterogeneities may be present among GABA neuronal populations based on their expression of GAD mRNA. The comparison between the present in situ hybridization and previous immunocytochemical studies suggests that there may exist at least two populations of GABA neurons in the brain, having high and low levels respectively of both GAD mRNA and GAD enzyme.
Animals↗
Kt/V and hemodialysis morbidity revisited.
Analysis of the National Cooperative Dialysis Study (NCDS) showed that dialysis morbidity was related to Kt/V. Recently, various formulae have been shown to be accurate for easier calculation of Kt/V. We calculated Kt/V in an outpatient unit utilizing Kt/V = -In (R - 0.03 - UF/W) in 51 patients. Kt/V was less than 0.8 in 16 patients (Group A), 0.8-1.0 in 20 (Group B), and greater than 1.0 in 15 (Group C). There was no difference in hematocrit (Hct), BUN, creatinine, serum phosphorus, and albumin. Ratio of men to women was 11/5, 15/5, and 4/11; mean age was 54, 63, and 58 years; mean body weight 177, 144, and 122 lb in Groups A, B, and C, respectively. Dialysis-related hospital admissions were similar (p greater than 0.05). These data suggest patients with higher body weights, and men, frequently had a Kt/V less than 0.8. Kt/V that did not influence biochemical parameters or hospitalizations in this population. This indicates that Kt/V may not be a good predictor of morbidity, and/or some heavier patients may do fairly well even with a Kt/V less than 0.8. The search for a better index of dialysis adequacy should be continued.
Blood Flow Velocity↗
Do tyrosine hydroxylase-immunoreactive neurons in the ventrolateral arcuate nucleus produce dopamine or only L-dopa?
Dopamine (DA) was early demonstrated in the arcuate nucleus by means of the formaldehyde-induced histofluorescence method. In the present study we have investigated the distribution of cell bodies in the arcuate nucleus with antisera against tyrosine hydroxylase (TH), aromatic L-amino acid decarboxylase (AADC) and DA. The results indicate that TH-immunoreactive cells in the dorsomedial part of the arcuate nucleus also contain immunoreactivity for both AADC and DA. However, TH-positive cells in the ventrolateral arcuate nucleus lacked AADC- and DA-immunoreactivity with the sensitivity of the present methods. The findings raise the question whether the ventrolateral cells synthesize L-DOPA or DA as endproducts.
Animals↗
Coexistence of TRH with other neuroactive substances in the rat central nervous system.
Colocalization of thyrotropin-releasing hormone-like immunoreactivity with other neuroactive substances was examined immunohistochemically in colchicine-treated rat brains using double-staining or elution-restaining methods. Thyrotropin-releasing hormone-like immunoreactivity was shown to be located in the same neurons as: 1. enkephalin-, gamma-amino butyric acid- and tyrosine hydroxylase-, but not somatostatin-like immunoreactivity in the glomerular layer of the olfactory bulb 2. oxytocin- and cholecystokinin-, but not vasopressin-like immunoreactivity in the supraoptic nucleus 3. cholecystokinin-like immunoreactivity in posterior pituitary 4. enkephalin-like immunoreactivity in the perifornical area of the hypothalamus and 5. neuropeptide Y- and neurotensin-like immunoreactivity in the periaqueductal central grey. These findings provide further examples of coexistence of thyrotropin-releasing hormone with classical neurotransmitters and/or peptides in the rat central nervous system.
Animals↗
[Effect of "anti-thrombosis" stockings on the venous hemodynamics of the lower extremities. Study using mercury gauge plethysmography].
Study by plethysmography with mercury gauge. The authors have analyzed the effects of "anti-thrombosis" stockings on venous hemodynamics of 18 lower extremities, by plethysmography with mercury gauge (Periflow J.S.I.). With this method, they delineate the limits of efficacy of the use of only elastic stockings as prophylactic treatment of the thrombo-embolic disease in immobilized patients.
Clothing↗
[Clinical diagnosis of pulmonary embolism].
Pulmonary embolism, a major complication of thromboembolic disease, remains an important cause of mortality, both in surgical and medical practice. In recent literature, one finds two different currents: the first one asserts that pulmonary embolism is overdiagnosed and, therefore, "overtreated" with iatrogenic hemorrhagic complications, when other authors assert that pulmonary embolism is underdiagnosed and "undertreated". It is obvious that clinical diagnosis of non massive, acute pulmonary embolism remains difficult and that the classical triad pleuritic chest pain, hemoptysis and signs of deep venous thrombosis is not frequently found. The clinician should be attentive to the different symptoms and clinical signs which might arouse a suspicion of pulmonary embolism. A large range of investigations is available to confirm the clinical diagnosis. In deep venous thrombosis preceding or accompanying pulmonary embolism, treatment should be instituted at the first signs of venous attack. A precise diagnosis will secondarily be confirmed by phlebography. Any delay in effective early treatment of thromboembolic disease will increase the risk of pulmonary embolism and of the mortality inherent in this dreadful complication.
Diagnosis, Differential↗
[Arteriovenous fistulas. Apropos of 5 cases].
An arterio-venous fistula can be defined as being a vascular anomaly in which there are one or more direct or indirect communications between an artery and a vein, without the capillary network being involved, this latter therefore being short-circuited. After the presentation of five cases, the authors review the literature on the subject.
Adult↗