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Biomedical subjects

M Martin

Publications and source records attributed to M Martin.

At least 505 records · Page 28Linked to original sources
PubMed1993

The effect of a physician education program on hospital length of stay and total patient charges.

An experimental-control group study was carried out in a large community hospital in which the experimental variable consisted of a one-time exposure of physicians to clinical and financial specifics regarding their individual treatment and management of pneumonia patients. A computerized report generating technology was used to create individualized reports for physicians detailing their practice patterns with respect to pneumonia patients. It was found that providing physicians with specific information about their practice behavior resulted in these same physicians using fewer hospital resources as expressed in total billed charges and Length of Stay. At the same time there was no compromise in outcomes for patients as measured by mortality, readmission rates, and infection/complication rates. The improvement in resource utilization was observed for two years following the provision of practice specific data to the experimental physicians.

Cost Control↗
PubMed1993

[Ultra-high dose streptokinase in treatment of arterial occlusions of leg arteries in advanced age].

In a retrospective study, the data of 218 patients (age 65-91) with obstructions of leg-arteries were evaluated, who underwent short-term ultrahigh fibrinolytic treatment. Some of the patients were also treated with percutaneous transluminal angioplasty after fibrinolysis. The overall patency-rate was 69 percent in the younger age group (65-74 years) and 46 percent in the group aged > or = 75. It could be shown, however, that the patency-rate was affected positively by concomitant factors (especially at least two patent calf arteries). These factors were less frequently found in the older age group, resulting in a lower patency-rate. Most likely the underlying reason is not age per se, because it could be shown, that the reason, which led to fibrinolytic treatment changed with age: In the younger age-group, Fontaine-stage II led to treatment in the vast majority of cases (71%). There was a shift to stage III (26%) and IV (27%) in the group > or = 75 years. This progression of artery disease usually leads to a reduced success rate of fibrinolytic treatment, because adverse concomitant factors prevail.

Aged↗
PubMed1993

[Lysis block technique--a new method of fibrinolytic treatment with tissue-type plasminogen activator (rt-PA)].

With lysis-block technique an over-systolic tourniquet is put on the thigh or upper arm. The fibrinolytic substance is injected into a dorsal foot vein or forearm vein. By using this strictly local lysis it was possible to remove distal venous and arterial occlusions. During over-systolic blockade there was only a minimal link between the blocked part of the limb and systemic circulation. By choosing a lytic substance with a short half-life-period (rt-PA) the systemic effect after loosening the blockade was small. LBT is a new and interesting method for the fibrinolytic treatment of peripheral venous and arterial occlusions. The procedure is characterized by minimal systemic reactions and it can probably be applied in those patients with contraindications for systemic lysis.

Adult↗
PubMed1993

Effect of valproate, sodium 2-propyl-4-pentenoate and sodium 2-propyl-2-pentenoate on renal substrate uptake and ammoniagenesis in the rat.

Experiments were carried out in the intact functioning rat kidney to study the effect of valproate (VPA), a widely used antiepileptic drug and an hyperammonemic agent, but usually without clinical relevance, and of two of its metabolites, sodium 2-propyl-4-pentenoate (4-en-VPA) and sodium 2-propyl-2-pentenoate (2-en-VPA), on the renal production of ammonia and on the renal uptake of glutamine, glutamate and of inhibitors of renal ammoniagenesis; mainly lactate, fatty acids, ketone bodies and alpha-ketoglutarate. Administration of VPA and 4-en-VPA stimulated the uptake of glutamine and glutamate and the production of ammonia by the rat kidney, resulting in an increase in the renal venous release of ammonia and in a hyperammonemia. By contrast, no hyperammonemia was observed after the administration of 2-en-VPA which stimulated renal ammoniagenesis to a lesser extent than VPA and 4-en-VPA, resulting in no stimulation of the renal venous release of ammonia. The three compounds tested caused, in a qualitatively different but, in terms of substrate carbons, in a quantitatively similar manner, a significant diminution of the renal uptake of fatty acids, ketone bodies and alpha-ketoglutarate. These results suggest that, in the rat kidney, VPA, 4-en-VPA and 2-en-VPA stimulate the production of ammonia at least in part by reducing the renal uptake and metabolism of ammoniagenesis inhibitors; the more potent stimulation of renal ammoniagenesis caused by VPA and 4-en-VPA also suggest that these compounds exert their stimulatory effect by an additional mechanism.

Ammonia↗
PubMed1993

Purtscher's retinopathy: a case of visual impairment associated with multiple trauma.

This case study describes a patient with multiple trauma associated with acute visual impairment. Funduscopic examination revealed scattered and confluent cotton wool exudates bilaterally. This retinopathy was first described by Othmar Purtscher, an Austrian ophthalmologist, in 1910, which he later referred to as "angiopathia retinae traumatica."

Accidents, Traffic↗
PubMed1993

Evaluation and revision of a vasopressin/nitroglycerin protocol for use in variceal bleeding.

BACKGROUND: Continuous infusion of IV vasopressin have been widely used to lower portal pressure and reduce bleeding from esophageal varices. Recently, the combination of vasopressin and nitroglycerin has been noted to be superior to vasopressin alone. This is due to the ability of nitroglycerin to reduce the detrimental effects of vasopressin while preserving its beneficial effects. In September 1989 the authors initiated a protocol in the medical intensive care unit of a large university teaching center that directed caregivers in the simultaneous use of vasopressin and nitroglycerin for use in variceal bleeding. OBJECTIVE: To determine whether the protocol was being used correctly and whether the addition of nitroglycerin produced the desired cardiovascular effects. METHOD: Nineteen patients (25 separate episodes) assigned to the vasopressin/nitroglycerin protocol were monitored retrospectively over a 20-month period for a total of 1068 hours of vasopressin/nitroglycerin infusion. Twenty-four patients received nitroglycerin at 10 to 50 micrograms per minute, 13 at 50 to 100 micrograms per minute and 6 at 100 to 400 micrograms per minute. RESULTS: Nitroglycerin dosage was not advanced appropriately in 78% of episodes despite evidence of bradycardia, hypertension and peripheral vasoconstriction. CONCLUSIONS: Revision of the protocol, giving additional guidance to clinicians on assessment and nitroglycerin advancement, was necessary and was accomplished.

Bradycardia↗
PubMed1993

[Lysis block technique. Local fibrinolytic treatment of venous and arterial occlusions].

With lysis-block technique an oversystolic tourniquet is put on the thigh or upper arm. The fibrinolytic substance is injected into a dorsal foot vein or forearm vein. By using this strictly local lysis it was possible to remove distal venous and arterial occlusions. During oversystolic blockade there was only a minimal link between the blocked part of the limb and systemic circulation. By choosing a lytic substance with a short half-life-period (rt-PA) the systemic effect after loosening the blockade was small. LBT is a new and interesting method for the fibrinolytic treatment of peripheral venous and arterial occlusions. The procedure is characterized by minimal systemic reactions and it can probably be applied in those patients with contraindications for systemic lysis.

Anesthesia, Conduction↗
PubMed1993

How do health workers see community participation?

A survey of health workers in Rwanda suggested that they were somewhat reluctant to accept the involvement of lay people in the promotion and implementation of primary care programmes. Various obstacles to community participation were identified by the health workers, who, however, suggested general rather than specific remedies for the situation as they saw it.

Attitude of Health Personnel↗
PubMed1993

Bispecific monoclonal antibody-mediated targeting of an indium-111-labeled DTPA dimer to primary colorectal tumors: pharmacokinetics, biodistribution, scintigraphy and immune response.

Eleven patients with primary colorectal carcinoma tumors (4 +/- 2 cm) were given intravenous injections of 1-10 mg of an anti-CEA, anti-In-DTPA bispecific Fab'-Fab monoclonal antibody, and 2-8 days later, were injected with 1.2-4.2 nmol of an 111In-labeled DTPA dimer (6 mCi). The bispecific antibody exhibited good stability and F(ab)'2-like pharmacokinetics. After injection, the 111In-DTPA dimer distributed in a large volume (88 ml/kg-180 ml/kg) and cleared through the kidneys (mean residence time in the whole body: 9 hr-16 hr). Uptake of 111In by the tumor using this two-step technique (1.8%-17.5% injected dose ID/kg, measured from surgical samples 48 hr after hapten injection) was not found significantly lower than that achieved with our reference 111In-labeled anti-CEA F(ab)'2 1 to 4 days after injection in six patients with similar clinical status (5.5%-30.2% ID/kg). In addition, tumor-to-blood and tumor-to-liver uptake ratios were significantly improved (blood 7.8 versus 4.2, liver 2.8 versus 0.8). As a result, low background images allowed detection of 12 of 13 lesions, 4 hr and 24 hr after hapten injection. However, 7 of 11 patients developed HAMA.

Adenocarcinoma↗
PubMed1993

Temporal modulation of TGF-beta 1 and beta-actin gene expression in pig skin and muscular fibrosis after ionizing radiation.

Although radiation-induced fibrosis has long been characterized by excess fibroblast proliferation and extracellular matrix deposition, the origin of cell activation in these complications of radiotherapy or radiation accidents is still controversial. The present work was designed to test the hypothesis that the abnormal production of TGF-beta 1 in irradiated tissues results in continuous signals for tissue repair and long-term cell activation. We examined gene expression of this growth factor in a well-characterized pig model of radiation-induced fibrosis, using Northern-blot and slot-blot hybridizations and indirect immunofluorescence. We found that the TGF-beta 1 mRNA level was increased 19-fold in the irradiated skin during the early erythematous phase, which started 3 weeks after irradiation. During the later phases of fibrosis, from 6 to 12 months after irradiation, the TGF-beta 1 gene was highly expressed in the repaired skin and the underlying muscular fibrotic tissue, with 10- and 8-fold maximal increases, respectively. In addition, we found that the beta-actin mRNA level was increased in the fibrotic tissue. Immunostaining for TGF-beta 1 revealed the presence of the protein in endothelial cells of capillaries, in myofibroblasts, and in the collagenous matrix of the fibrotic tissue. These results suggest that TGF-beta 1 may be one of the key cytokines involved in the cascade of events that leads to radiation-induced fibrosis, at both early and late stages.

Actins↗
PubMed1992

Chromosomal anomalies in radiation-induced fibrosis in the pig.

R-banded karyotypes were established on fibroblasts from fibrotic tissues derived from experimental fibrosis induced in pigs, either surgically or by 64 Gy of gamma-rays from iridium-192. No chromosome aberrations were observed in the surgical fibrosis. In radiation-induced fibrosis, the high frequency of abnormal karyotypes and the frequent complexity of the chromosomal rearrangements suggest that the fibroblasts originated either from the 64-Gy area, or from the penumbra, but certainly not from non-irradiated areas. At early passages in vitro, almost all karyotypes were different, demonstrating a multiclonal origin of fibrotic tissue. At late passages (above 24), the situation was quite different, with the persistence of one or two clones only, demonstrating a strong selective pressure occurring in vitro.

Animals↗