Is interpleural analgesia better than thoracic epidural analgesia after thoracotomy?
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Analgesia, Epidural↗
Biomedical subjects
M Kruger
Publications and source records attributed to M Kruger.
Staging of twin-twin transfusion syndrome.
OBJECTIVE: The purpose of this study was to evaluate the prognostic value of sonographic and clinical parameters to develop a staging classification of twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Severe TTTS was defined as the presence of polyhydramnios (maximum vertical pocket of > or = 8 cm) and oligohydramnios (maximum vertical pocket of < or = 2 cm). Nonvisualization of the bladder in the donor twin (-BDT) and absence of presence of hydrops was also noted. The middle cerebral artery, umbilical artery, ductus venosus, and umbilical vein in both fetuses were assessed with pulsed Doppler. Critically abnormal Doppler studies (CADs) were defined as absent/reverse end-diastolic velocity in the umbilical artery, reverse flow in the ductus venosus, or pulsatile flow in the umbilical vein. TTTS was staged as follows: stage I, BDT still visible; stage II, BDT no longer visible, no CADs; stage III, CADs; stage IV, hydrops; stage V, demise of one or both twins. Laser photocoagulation of communicating vessels (LPCV) or umbilical cord ligation was performed depending on the severity of the condition. The study was approved by the Institutional Review Board of St. Joseph's Hospital in Tampa and by the Fetal Therapy Board at Hutzel Hospital, Detroit, and all patients gave informed consent. RESULTS: A total of 80 of 108 referred patients met criteria for surgery, but only 65 were treated surgically: 48 with LPCV and 17 with umbilical cord ligation. Complete Doppler data were obtainable in 41 of 48 LPCV patients. Survival rates by stage for one or two fetuses were statistically different (chi-squared analysis = 12.9, df = 6, p = 0.044). Neither percent size discordance nor gestational age at diagnosis were predictive of outcome. CONCLUSION: Staging of TTTS using the proposed criteria has prognostic significance. This staging system may allow comparison of outcome data of TTTS with different treatment modalities.
Amniocentesis↗
Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial.
BACKGROUND: Deficiencies of iron, iodine, and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren. OBJECTIVE: The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children. DESIGN: Micronutrient status was assessed in 115 children aged 6-11 y before and after consumption of biscuits (fortified with iron, iodine, and beta-carotene) for 43 wk over a 12-mo period and was compared with that in a control group (n = 113) who consumed nonfortified biscuits. Cognitive function, growth, and morbidity were assessed as secondary outcomes. RESULTS: There was a significant between-group treatment effect on serum retinol, serum ferritin, serum iron, transferrin saturation, and urinary iodine (P <0.0001) and in hemoglobin and hematocrit (P <0.05). The prevalence of low serum retinol concentrations (<0.70 micromol/L) decreased from 39.1% to 12.2%, of low serum ferritin concentrations (<20 microg/L) from 27.8% to 13.9%, of anemia (hemoglobin <120 g/L) from 29.6% to 15.6%, and of low urinary iodine concentrations (<100 microg/L) from 97.5% to 5.4%. There was a significant between-group treatment effect (P <0.05) in cognitive function with the digit span forward task (short-term memory). Fewer school days were missed in the intervention than in the control group because of respiratory- (P = 0.097) and diarrhea-related (P = 0.013) illnesses. The intervention had no effect on anthropometric status [corrected]. CONCLUSIONS: Fortified biscuits resulted in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [corrected].
Anthropometry↗
Post-thoracotomy pain control.
Publications on post-thoracotomy pain control obtained by Medline search were reviewed from June 1997 to July 1998. The main focus points in the past year were the effect of new surgical techniques on analgesia after thoracic surgery and the use of extrapleural catheters in the paravertebral space as a method of continuous intercostal nerve block. Epidural and patient-controlled analgesia techniques are still widely used and are mostly effective, but some patients may still have unacceptable levels of pain in the first 24 hours.
Journal Article↗
Biodiversity assessment and conservation strategies
The efficient representation of all species in conservation planning is problematic. Often, species distribution is assessed by dividing the land into a grid; complementary sets of grids, in which each taxon is represented at least once, are then sought. To determine if this approach provides useful surrogate information, species and higher taxon data for South African plants and animals were analyzed. Complementary species sets did not coincide and overlapped little with higher taxon sets. Survey extent and taxonomic knowledge did not affect this overlap. Thus, the assumptions of surrogacy, on which so much conservation planning is based, are not supported.
Journal Article↗
Atherosclerosis: aortic lipid changes induced by diets suggest diffuse disease with focal severity in primates that model human atheromas.
Atherosclerosis in Vervet or African Green monkeys (Cercopithecus aethiops) models the morphology and cytology of the disease of humans, and it is well established that the rate of atherogenesis in Vervets is influenced by diet. Aortic intimal concentrations of lipids and phospholipids known to be major components of atheromas were determined in female Vervets fed for 4 years on either an atherogenic (AD) or a prudent Western diet (PD). Lipid concentrations detectable microscopically as cholesterol crystals and foam cells were confirmed biochemically. In addition, the AD was associated with diffuse, invisible accumulation of lipids throughout aortic tissue to the extent that tissue with no fatty streaks or plaque (AD) contained the same or more lipids than visible fatty streaks (PD). Correlations between lipid concentrations and atherosclerosis were highly positive, which supports known correlations between aortic, plasma, and dietary lipids during atherogenesis, and validates the aortic lipid analysis. These aortic lipid concentration results imply that atherosclerosis is not confined to focal pathologic anatomy, but in terms of lipid components of the disease, it develops throughout the arterial system of Old World omnivorous primates. If the results are applicable to people, they provide new insight and emphasize the need to minimize dietary sources of atherogenic lipids.
Animals↗
Analysis of low-dose digital lateral cephalometric radiographs.
OBJECTIVE: To examine the effects of the dose reduction obtained with photostimulable phosphor computed radiography (CR) on the identification of cephalometric landmarks. METHODS: Dose reductions of 50% and 75% respectively were obtained by placing three storage phosphor image plates in the same cassette. Lateral cephalograms were exposed on ten patients. Seven observers identified 14 anatomical landmarks on the images. RESULTS: The location of anatomical landmarks on the lateral cephalograms was not effected by the decreased dose (P > 0.05). Interobserver variation was the major influence. CONCLUSION: A dose reduction of 75% does not effect the localization of anatomical landmarks in lateral cephalograms obtained with CR.
Adolescent↗
Reproducibility of cephalometric landmarks on conventional film, hardcopy, and monitor-displayed images obtained by the storage phosphor technique.
The aim of the present study was to evaluate and compare the reproducibility of cephalometric landmarks on (1) conventional films, and images acquired by storage phosphor digital radiography both on (2) hardcopy and (3) monitor-displayed versions. The material consisted of 19 cephalograms for each image modality. The phosphor plates were scanned in an image reader and the 10-bit normalized, raw data digital images were converted to 8-bit TIFF images for PC monitor-display. The digital hardcopies were produced in a laser printer. Six observers were asked to record 21 cephalometric landmarks on each conventional film, hardcopy, and monitor-displayed image. For the films and hardcopies, the landmark co-ordinates were recorded via a digitizing tablet. For the monitor-displayed images, the co-ordinates were recorded directly from the monitor using a dedicated Windows-based cephalometric program. Reproducibility was defined as an observer's deviation (in mm) from the mean between all observers. Differences between the image modalities and between the observers were tested by two-way analysis of variance for each landmark. There was a statistically significant difference between the reproducibility of film, hardcopy and monitor-displayed images in 11 of the 21 landmarks. There was no unequivocal trend that one modality was always the best. For a full cephalometric recording (the sum of all 21 landmarks), the monitor-displayed images (mean = 25.3 mm) had a lower precision than film (P < 0.005) and hard-copy (P < 0.02). There was no significant difference between film (mean = 21.8 mm) and hardcopy (mean = 22.8 mm). The lower reproducibility seen for the monitor-displayed images is most probably of little clinical significance.
Adolescent↗
Plasma and red blood cell total phospholipid fatty acid status of nonpregnant female Vervet monkeys (Cercopithecus aethiops) on a high carbohydrate maintenance diet.
Nonhuman primates are of interest as models of human physiology to study the effect of multiple pregnancies on birth weight. Reference plasma and red blood cell (RBC) total phospholipids fatty acids were established in nonpregnant breeding female Vervet monkeys. Twenty-three clinically healthy nonpregnant Vervet monkeys (Cercopithecus aethiops), contained in a controlled closed environment and consuming a high carbohydrate diet (68 E%) that contained 20 E% fat and 12 E% protein were sampled for blood during a cross-sectional study. A low intake of omega3 fatty acids was reflected by a high omega6/omega3 ratio (66:1) of the diet. Inverse relations were seen between plasma and RBC total phospholipid fatty acids, 18:2omega6, 20:3omega6, and 20:4omega6, which suggested selective incorporation in membranes. Low levels of 20:5omega3 and 22:6omega3 of plasma and RBC total phospholipids render Vervet monkeys as ideal subjects to study the effect of omega3 fatty acid supplementation on pregnancy outcomes.
Animals↗
Osteomyelitis following epidural analgesia in an immunocompromised patient.
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Analgesia, Epidural↗
What do physicians know and say about fetal alcohol syndrome: a survey of obstetricians, pediatricians, and family medicine physicians.
Pediatricians, obstetricians, and family practice physicians in Michigan were surveyed by mail for their knowledge and opinions about Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). Physicians said that about 67% of their patients raised questions about drinking during pregnancy but only 2% specifically referred to FAS or FAE. Most physicians were uncertain about whether their colleagues were sufficiently aware of FAS, whether FAS could be diagnosed at birth, or if physicians were acquainted with the syndrome's major criteria. However, most believed FAS was not being overdiagnosed and believed that making a diagnosis of FAS at birth could lead to improved treatment of an affected child. Physicians also believed that physician counseling was a more effective way of reducing the incidence of FAS/FAE than warning labels. Forty-one percent of the physicians placed the threshold for FAS at one to three drinks per day and 38% placed the threshold at one or fewer drinks a day. Thirty-five percent placed the estimated incidence of FAS at 1 to 2 per 1000 in the United States. We conclude that physicians are in relative agreement about the effects of drinking during pregnancy and the value of physician counseling but are misguided as to what constitutes a true risk level of drinking as far as the etiology of FAS is concerned.
Adult↗
Images in cardiovascular medicine. Impending paradoxical embolus.
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Echocardiography↗
Treatment of hepatitis B-related polyarteritis nodosa with famciclovir and interferon alfa-2b.
BACKGROUND: The association between polyarteritis nodosa and viral hepatitis B infection is well established and still remains a therapeutic challenge. Famciclovir--a new nucleoside analog--has a broad spectrum of antiviral activity against herpes viruses and the human hepatitis B virus. CASE REPORT: A 56-year-old man with hepatitis B-related polyarteritis nodosa presented with symptoms correlating to high levels of HBV DNA. The patient did not respond to treatment with steroids (prednisolone started with 100 mg daily) and two courses of interferon alfa-2b (5 x 10(6) units 3 times per week for 6 months). Therefore, a combination therapy of interferon alfa-2b (5 x 10(6) units 3 times per week) and famciclovir (500 mg tid, orally) was started; 5 mg daily prednisolone was given at this time. Under this regimen HBV DNA rapidly declined, with a reduction of 79% after the first week (HBV DNA 53 pg/ml), and 88% after the second week (29 pg/ml), accompanied by a significant improvement in clinical symptoms. After 1 year of famciclovir treatment, HBeAg-anti-HBe seroconversion was noted; HBsAg still remained positive. Long-term famciclovir therapy has been continued at a reduced dose of 125 mg tid for 3 years now. HBV DNA values have been stable below 100 pg/ml, transaminases have normalized and clinical symptoms of polyarteritis nodosa have disappeared. CONCLUSIONS: Famciclovir has been successfully administered to a patient with hepatitis B-related polyarteritis nodosa. A reduction in viral replication and an improvement of symptoms were noted within 4 weeks of starting famciclovir. The oral nucleoside analog famciclovir is effective and well tolerated, even in long-term therapy, and might offer new treatment options in immunosuppressed patients for whom hepatitis B replication is critical for the disease process.
2-Aminopurine↗
Thresholds and kinetics of fatty acid replacement in different cellular compartments in rat liver as a function of dietary n-6/n-3 fatty acid content.
The kinetics of fatty acid (FA) replacement in different membrane compartments in the rat liver were investigated using diets with varying n-6/n-3 FA ratios. Rats at different stages of growth, i.e. after weaning and at 150 g body weight, were either fed a modified AIN 76A diet containing sunflower oil as fat source or the same diet containing sunflower oil and fish oil to achieve n-6/n-3 FA ratios of 12:1 and 6:1 (diets A and B, respectively). In the adult rats, fed diet A for 8 weeks, C18:2n-6 increased significantly at week 2 in the phosphatidylcholine (PC) fraction of the plasma membranes, microsomes and plasma but not in phosphatidylethanolamine (PE), C20:3n-6 increased significantly at week 2 in the plasma membrane and microsomal PC, but did only increased in PE of both compartments by week 8. C20:4n-6 and the n-3 FAs significantly decreased and increased, respectively, at week 2 in PC and PE of both membrane compartments and plasma PC. The experimental diets led to a change in the plasma membrane fluidity but not in the microsomes. The FA changes in the weaned rats followed a similar pattern as in the adult rats although the changes were greater, depending on the phospholipid fraction and specific FA. The decrease in C20:4n-6 was significantly greater in the microsomal PC and PE and plasma PC but not in the plasma membrane PC and PE. The n-3 FAs increased significantly above the adult levels in the plasma membrane PC and PE respectively but not in the microsomal phospholipid fractions. A plateau for maximal n-3 and n-6 FA incorporation was achieved in the adult rats fed diet A in the microsomes after 2 weeks with no further alterations occurring with diet B. In the plasma PC and plasma membranes most of the n-3 FAs achieved a threshold incorporation after 2 weeks on diet A, except for C22:6n-3 in the plasma membranal PE and certain n-6 FAs in the plasma membrane PC and PE. The present data shows that differences exist in the kinetics of FA incorporation and replacement depending on the specific phospholipid fraction, membrane compartment, age and to a certain extent the dietary n-6/n-3 FA ratio.
Aging↗
Iron, folate and vitamin B12 status of an elderly South African population.
OBJECTIVES: To determine the prevalence of anaemia and the haemopoietic nutrient status of older mixed ancestry (coloured) South Africans. DESIGN: A cross-sectional analytic study. SUBJECTS: A random sample of 200 non-institutionalized subjects aged > or = 65 y of age, resident in urban Cape Town, was drawn using a two-stage cluster design. METHODS: Trained fieldworkers interviewed subjects to obtain demographic and lifestyle data. Dietary intake was assessed using a validated food frequency questionnaire. Fasting blood samples were drawn for the determination of haematological parameters, serum vitamin B12, serum folate, RBC folate and a full blood count. RESULTS: The prevalence of anaemia was 13.9. Eight of the 26 cases of anaemia (31) were associated with suboptimal haemopoietic nutrient status; 2(25) and 3(38) cases of these 8 anaemic subjects had suboptimal vitamin B12 and folate status, respectively. Iron deficiency anaemia accounted for 5(63) of the subjects with nutrition-related anaemia. Ten men and two women (6.5 of subjects) had raised serum ferritin concentrations, half of whom had abnormal biochemical parameters indicative of alcohol abuse. CONCLUSIONS: Older coloured South Africans, particularly women, should be encouraged to eat diets with a high nutrient density and to consume adequate amounts of foods high in iron, folate and vitamin B12. Further investigation regarding the high prevalence of hyperferritinaemia found in the men in this population is indicated.
Aged↗
Hierarchical expression of desmosomal cadherins during stratified epithelial morphogenesis in the mouse.
Desmosomes contain two heterogeneous families of specialized cadherins (desmogleins or Dsgs and desmocollins or Dscs), subtypes of which are known to be expressed in tissue-specific and differentiation-dependent patterns in adult epithelial tissues. To examine the temporal and spatial order in which the individual desmosomal cadherins are expressed during stratified epithelial development we have obtained partial cDNA clones of all six murine desmosomal cadherins and have carried out in situ hybridization analysis on E12.5 to E16.5 mouse embryos. The results indicate that the type 2, type 3 and type 1 desmosomal cadherin messages are not obligatorily expressed as pairs during stratified epithelial morphogenesis. Instead the individual genes appear to be transcribed in hierarchical, overlapping temporal and spatial patterns extending from DSG2 to DSC1. DSG2 was the most uniformly expressed message in all E12.5 epithelia, gradually becoming confined to the basal cell layers during epithelial stratification indicating that its transcription was restricted to undifferentiated cells. In contrast, DSC2 message was expressed variably in early epithelia and was strongly upregulated in the suprabasal cell layers during the stratification of wet-surfaced epithelia. DSC3 message was expressed before that of DSG3 in the dental and lingual epithelium where its spatial distribution matched that of DSG2, but after DSG3 in the non-glandular gastric epithelium. DSC3 transcripts became confined to the lower layers of stratifying epithelia but were usually less basally restricted than those of DSG2. Like DSC2, DSG3 mRNA was strongly upregulated in the suprabasal layers of wet-surfaced epithelia as they stratified. Upregulation of DSG1 message was temporally linked to that of DSG3 in all tissues apart from the non-glandular gastric epithelium.
Amino Acid Sequence↗
Response to an iron fortification programme in relation to vitamin A status in 6-12-year-old school children.
Plasma retinol and indices of iron status were measured in 148 school children (6-12 years) receiving a soup fortified with iron and vitamin C for a period of 15 weeks. The most significant change in serum iron (P = 0.0005) and transferrin saturation (P = 0.0002) was seen in subjects with plasma retinol > or = 40 micrograms/dl, while subjects with plasma retinol < 20 micrograms/dl showed no response. Serum ferritin improved most in the retinol categories < 40 micrograms/dl, suggesting that the absorption of iron was not impaired by marginal vitamin A status, but that it was rather the mobilisation of iron from stores that was affected. Changes in vitamin A status correlated positively and significantly with changes in serum iron (r = 0.37; P = 0.0001) transferrin saturation (r = 0.27; P = 0.004) and haemoglobin (r = 0.21; P = 0.03), but negatively with serum ferritin (r = -0.28; P = 0.003). The presence of marginal vitamin A deficiency in a community may limit the effectiveness of an iron intervention programme and vitamin A status should therefore also be considered when such programmes are planned.
Ascorbic Acid↗
Genetic distinctions between types 1 and 2 autoimmune hepatitis.
OBJECTIVES: Our aim was to determine whether alleles affecting susceptibility to type 1 autoimmune hepatitis in the United States occur as commonly in German patients with type 2 disease. METHODS: DNA specimens from 12 German patients with type 2 autoimmune hepatitis were tested for class II alleles of the major histocompatibility complex by polymerase chain reaction using sequence specific primers. Eighty-six American patients with type 1 disease and 102 Caucasoid normal subjects from the United States were tested in a similar manner. RESULTS: American patients with type 1 autoimmune hepatitis had DRB1*03 alleles more commonly than the German patients with type 2 disease (51% vs 17%, p = 0.03) and DRB1*0301 occurred more frequently in the type 1 patients (51% vs 17%, p = 0.03). The frequency of DRB1*04 alleles was also higher in the type 1 patients after exclusion of the DR1*03 alleles (64% vs 20%, p = 0.01). In contrast, patients with type 2 disease more commonly had DRB1*07 (p = 0.003), DRB1*15 (p = 0.004), and DQB1*06 (p = 0.0004). DRB1*07 (p = 0.005), DRB4*01 (p = 0.03), and DQB1*06 (p = 0.03) also occurred more frequently in the type 2 patients from Germany than in the normal subjects from the United States, although none of these frequencies were statistically significant by an adjusted p value. CONCLUSIONS: German patients with type 2 autoimmune hepatitis do not have the same susceptibility alleles as American patients with type 1 disease. Regional differences in prevalence may reflect the genetic profiles of the populations at risk.
Adult↗