Babesiosis in a patient with sickle cell anemia.
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Adult↗
Biomedical subjects
P Klein
Publications and source records attributed to P Klein.
Urban-rural differences in prehospital care of major trauma.
OBJECTIVES: To compare differences in response times, scene times, and transport times by advanced life-support-trained paramedics to trauma incidents in urban and rural locations. METHODS: This report was a prospective cohort study of professional emergency medical services conducted in a five-county area in the state of Washington. Ninety-eight percent of trauma transports are provided by professional paramedics trained in advanced life support. Subjects were included in this study if they qualified as a major trauma victim and were transported or found dead at the scene by one of the region's advanced life support transport agencies between August 1, 1991, and January 31, 1992. The severity of injury was rated using the Prehospital Index. Incident locations were defined as "rural" if they occurred in a US Census division (a geographic area) in which more than 50% of the residents resided in a rural location. RESULTS: During the 6-month data collection period, advanced life support agencies responded to a total of 459 major trauma victims in the region. A geographic locations was determined for 452 of these subjects. Of these, 42% of subjects were injured in urban areas and the remainder in rural areas. The severity of injuries, as determined both by the triage classification (p = 0.17) and the distribution of Prehospital Index scores (p = 0.92), was similar for urban and rural major trauma patients. Twenty-six (5.7%) subjects died at the scene. About one quarter of both groups had a severe injury, as indicated by Prehospital Index score of more than 3. The mean response time for urban locations was 7.0 minutes (median = 6 minutes) compared with 13.6 minutes (median = 12 minutes) for rural locations (p < 0.0001). The mean scene time in rural areas was slightly longer than in urban areas (21.7 vs. 18.7 minutes, p = 0.015). Mean transport times from the scene to the hospital were also significantly longer for rural incidents (17.2 minutes vs. 8.2 minutes, p < 0.0001). Rural victims were over seven times more likely to die before arrival (relative risk = 7.4, 95% confidence interval 2.4-22.8) if the emergency medical services' response time was more than 30 minutes. CONCLUSIONS: Response and transport times among professional, advanced life-support-trained paramedics responding to major trauma incidents are longer in rural areas, compared with urban areas.
Algorithms↗
Three patterns of catamenial epilepsy.
PURPOSE: On the basis of the neuroactive properties of estradiol and progesterone and the menstrually related cyclic variations of their serum concentrations, we propose the existence of three hormonally based patterns of seizure exacerbation. Because previous reports both support and refute the concept of catamenial epilepsy, we test the hypothesis by charting seizures and menses and measuring midluteal serum progesterone levels to estimate the frequency of epileptic women with catamenial seizure exacerbation. METHODS: One hundred eighty-four women with intractable complex partial seizures (CPS) charted their seizure occurrence and onset of menstruation on a calendar for one cycle during which they had a midluteal blood sample taken for serum progesterone determination on day 22. Levels >5 ng/ml were considered ovulatory. The cycle was divided into four phases with onset of menstruation being day 1: menstrual (M) = -3 to +3, follicular (F) = 4 to 9, ovulatory (O) = 10 to -13, and luteal (L) = -12 to -4. Average daily seizure frequency for each phase was calculated and compared among phases by repeated-measures analysis of variance (ANOVA) and the Student-Newman-Keul's test, separately for ovulatory and anovulatory cycles. RESULTS: The 1,324 seizures recorded during 98 ovulatory cycles occurred with significantly greater (p < 0.001) average daily frequency during the M (0.59) and O (0.50) phases than during the F (0.41) and L (0.40) phases, offering support for perimenstrual (catamenial 1) and preovulatory (catamenial 2) patterns of seizure exacerbation. The 1,523 seizures recorded during 86 anovulatory cycles occurred with significantly lower (p < 0.001) average daily frequency during the F phase (0.49) than during all other phases (M = 0.78, O = 0.74, L = 0.74), offering support for seizure exacerbation throughout the second half of inadequate luteal phase cycles (catamenial pattern 3). Although 71.4% of the women with ovulatory cycles and 77.9% with inadequate luteal phase cycles had seizure exacerbation in relation to one of the three patterns of catamenial epilepsy, approximately one third of the women showed at least a twofold increase in average daily seizure frequency. We propose a twofold or greater increase as a reasonable definition of catamenial epilepsy. CONCLUSIONS: Charting of seizures and menses and determination of day 22 progesterone levels during each cycle may be sufficient to establish the existence of three distinct patterns of catamenial epilepsy. Approximately one third of women with intractable CPS may have catamenial epilepsy.
Adolescent↗
Emerging applications of hormonal therapy of paroxysmal central nervous system disorders.
Gonadal and adrenal steroidal hormones and their related neuropeptides affect seizures. Seizures, in their turn, may affect the functioning of these endocrine systems. Both these sets of effects may be clinically important and open to therapeutic manipulation. Recent advances in understanding the effects of these hormones and their metabolites on neuronal excitability have opened the way for a number of new, hormonally-based therapeutic approaches to seizure management. Some of these have reached various stages of clinical trials, while others are still in the preclinical stages of testing. Similarly, treatment of some of the hormonal consequences of seizures has recently been explored and will be discussed.
Journal Article↗
Toxicity of white phosphorus to waterfowl: acute exposure in mallards.
As part of an effort to understand extensive, white phosphorus (P4)-induced waterfowl mortality at Eagle River Flats, Fort Richardson, Alaska (USA), we conducted a number of acute toxicity tests using penned mallards (Anas platyrhynchos) in 1993 and 1994. The 24-hr median lethal dose (LD50) for P4 dissolved in oil was 6.46 mg/kg in adult males and 6.96 mg/kg in adult females. Although the median lethal doses were not statistically different, the female dose-response curve had a statistically shallower slope than that of males. The LD50 for the ecologically more relevant pelletized form of P4 in adult males was 4.05 mg/kg. In mallards, one mechanism of P4 toxicity caused rapid (3 to 10 hr) mortality and had signs consistent with anoxia. A second, slower acting mechanism resulted in hepatic and renal pathology including extensive fat deposition in the liver and cellular necrosis. White phosphorus accumulated in adipose tissues, but only for a few days.
Adipose Tissue↗
Association between preoperative acute phase response and postoperative complications.
OBJECTIVE: To find out if there is an association between the acute phase response preoperatively and the development of postoperative infective complications. DESIGN: Prospective open study. SETTING: Teaching hospital Germany. SUBJECTS: 229 patients who were to undergo major abdominal operations. INTERVENTIONS: Measurements of serum concentrations of interleukin 6 (IL-6), alpha-1-antitrypsin, C-reactive protein (CRP), albumin, and prealbumin. MAIN OUTCOME MEASURES: Abnormal values of substances measured. RESULTS: Serum concentrations of IL-6, alpha-1-antitrypsin and CRP were raised, and those of albumin and prealbumin were reduced in 5% to 14% of patients. 25 (11%) developed major complications, of whom 9 (4%) died. 9 Patients (4%) had a severe systemic inflammatory response caused by infective complications that did not result from technical failure of the operative technique. Of these 9 patients, 7 (78%) already had signs of an increased acute phase response before operation that was significantly different from the incidence among patients who recovered without complications (21/204. p < 0.001) CONCLUSION: These data suggest that if there are signs of an acute phase response preoperatively the patient's response to operation and infection during the postoperative period may be adversely affected.
Acute-Phase Reaction↗
Human recombinant anti-Rh(D) monoclonal antibodies: improvement of biological properties by in vitro class-switch.
Therapeutic use of human monoclonal antibodies has so far been hampered by their poor availability. Recent developments in recombinant DNA technologies are expected to fill this gap; the variable and constant sequences of antibodies can be selected independently and then subsequently joined to express whole antibodies. We assessed here the potential of this methodology to obtain novel anti-D antibodies with improved biological characteristics. The sequences coding for heavy and light chains of two anti-Rh(D) monoclonal antibodies (one IgG1 and one IgG3) were isolated and co-expressed into murine myeloma cell P3X63.Ag8.653, either directly (parental antibodies) or after exchange of constant heavy chain sequences (class-switched antibodies). Parental antibodies produced either by transfectomas or by hybridomas behaved similarly in analysis of biochemical, binding and effector properties. Class-switched antibodies displayed altered functional properties over parental antibodies. Of particular interest, one of them showed improved phagocytosis potencies over both parental antibodies. Additionally, these results indicate that functional properties do not always simply reflect the addition of properties of constant and variable parts but that interactions between constant and variable regions may interfere.
Amino Acid Sequence↗
[Secure anastomoses of the large intestine (especially with transanal drainage].
The results of colonic resections were investigated in 356 patients in a retrospective analysis. Special attention was directed to the effectiveness of a transrectal tube, leading to decompression of the anastomosis for the first five days. Under elective conditions, the overall complication-rate was 12.7%. In emergency cases, these complications were 51.5% (one third of these cases had a decompression-tube). The clinical relevant leakage-rate under elective conditions ranged to 1.7%. Postoperative mortality related to surgical complications turned out to be 1.5% under elective conditions. The emergency operations had a high mortality which ranged to approximately 15.2%. No patient with leakage of a colorectal anastomosis died when the transrectal decompression-tube was applied. Such a safety in anastomotic healing of colon and rectum anastomoses can otherwise only be achieved by using the protection of a diverting colostomy or ileostomy. The use of the transrectal decompression-tube also avoids stomal complications and the second operation. There is no indication for the decompression-tube in emergency operations with purulent or faecal peritonitis. In these cases a fundamentally different treatment is mandatory.
Adenomatous Polyposis Coli↗
[Verifying routine preoperative diagnosis between private practice and the surgical university clinic].
In an attempt to shorten the preoperative in-patient period and to avoid unnecessary investigations, a cooperative patient management model was established for a number of surgical operations at the University Department of Surgery, Anaesthesiology and their referring Specialist and General Practitioners. The latter were requested to carry out the previously defined preoperative routine investigations, which allowed for a marked reduction in hospital diagnostics. Ambulatory preoperative patient management and a new admission routine resulted in a 57% decrease of the average preoperative in-patient stay for the observed procedures.
Cost Savings↗
[Electronic data processing in ward management--possibilities for rationalization and cost control].
Electronic data processing in ward management increases cost and time efficiency. Nurses and doctors will have more time to concentrate their genuine rather than administrative duties. Therefore the presented model has gained high acceptance.
Cost-Benefit Analysis↗
Inelastic and elastic processes in the transmission of F+, F-, and F2- from PF3/Ru(0001) through thin rare-gas films.
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Journal Article↗
Comparison of classical and tight-binding molecular dynamics for silicon growth.
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Journal Article↗
Long-term benefits of aggressive treatment for primary colorectal cancer.
The long-term follow up of 128 colorectal cancer patients is reported. Seventy-nine percent (101/128) of the patients had curative resections: 70 patients had radical lymphadenectomies with wide removal of tumor-adjacent nodes, and 31 patients had standard resections. The 5-year overall survival rates for Dukes' stage B and C patients and for all rectosigmoid cancer patients significantly favored radical resection (60% vs. 38%, 57% vs. 29%, respectively, P < 0.05). Tumor-free survival rates were also higher after radical lymphadenectomy but did not reach statistical significance. Eleven percent (14/128) of the patients required multiorgan resections, and/or preoperative radiation to render fixed cancers resectable, and these patients had a 10-year tumor-free survival rate of 45%, compared to zero % 5-year survival for the 27 patients who underwent palliative procedures (P < 0.01). These results confirm that many colorectal cancer patients will be cured with aggressive treatment and they support the need for a controlled trial for evaluation of lymphadenectomy for this disease.
Adult↗
Coordination of protein and mRNA abundances of stromal enzymes and mRNA abundances of the Clp protease subunits during senescence of Phaseolus vulgaris (L.) leaves.
Our objective was to determine the coordination of transcript and/or protein abundances of stromal enzymes during leaf senescence. First trifolioliate leaves of Phaseolus vulgaris L. plants were sampled beginning at the time of full leaf expansion; at this same time, half of the plants were switched to a nutrient solution lacking N. Total RNA and soluble protein abundances decreased after full leaf expansion whereas chlorophyll abundance remained constant; N stress enhanced the decline in these traits. Abundances of ribulose-1,5-bisposphate carboxylase/oxygenase (Rubisco; EC 4.1.1.39), Rubisco activase and phosphoribulokinase (Ru5P kinase; EC 2.7.1.19) decreased after full leaf expansion in a coordinated manner for both treatments. In contrast, adenosine diphosphate glucose (ADPGlc) pyrophosphorylase (EC 2.7.7.27) abundance was relatively constant during natural senescence but did decline similar to the other enzymes under N stress. Northern analyses indicated that transcript abundances for all enzymes declined markedly on a fresh-weight basis just after full leaf expansion. This rapid decline was particularly strong for the Rubisco small subunit (rbcS) transcript. The decline was enhanced by N stress for rbcS and Rubisco activase (rca), but not for Ru5P kinase (prk) and ADPGlc pyrophosphorylase (agp). Transcripts of the Clp protease subunits clpC and clpP declined in abundance just after full leaf expansion, similar to the other mRNA species. When Northern blots were analyzed using equal RNA loads, rbcS transcripts still declined markedly just after full leaf expansion whereas rca and clpC transcripts increased over time. The results indicated that senescence was initiated near the time of full leaf expansion, was accelerated by N stress, and was characterized by large decline in transcripts of stromal enzymes. The decreased mRNA abundances were in general associated with steadily declining stromal protein abundances, with ADPGlc pyrophosphorylase being the notable exception. Transcript analyses for the Clp subunits supported a recent report (Shanklin et al., 1995, Plant Cell 7: 1713-1722) indicating that the Clp protease subunits were constitutive throughout development and suggested that ClpC and ClpP do not function as a senescence-specific proteolytic system in Phaseolus.
Adenosine Triphosphatases↗
[Ropivacaine for spinal anesthesia. A dose-finding study].
UNLABELLED: Several clinical studies have demonstrated the efficacy of ropivacaine in different regional anaesthesia techniques, e.g., epidural anaesthesia. However, the efficacy of ropivacaine for spinal anaesthesia has only been demonstrated in animal experiments up to now. The objective of this study was the investigation of the efficacy and appropriate dosage of isobaric ropivacaine for spinal anaesthesia in humans. METHODS: In a randomised, double-blind study, spinal anaesthesia with ropivacaine was performed in two groups of 20 patients each (group I: ropivacaine 0.5%, 3 ml = 15 mg; group II: ropivacaine 0.75%, 3 ml = 22.5 mg). Spinal anaesthesia was performed with a 25 G needle in the midline at the L3-4 level with the patient sitting up, preceded by local infiltration of 2 ml mepivacaine 0.5%. Spread and regression of sensory block were assessed by testing loss of sensation to cold. Development of motor block was concurrently recorded by means of a modified Bromage scale (motor block was assessed in the hip, knee and ankle joints and recorded as complete or incomplete according to degree). The findings are presented as mean values. RESULTS: Onset of analgesia to L5 and S1 was 2 min in both groups, and to T12 and T10 8 and 12.5 min, respectively, in group I and 12.5 and 13 min, respectively, in group II; these differences were not statistically significant. Mean maximum spread was to T10 in group I and T8 in group II. Onset of maximum cranial spread was 24 min in group I and 32 min in group II. Duration of analgesia in the segments relevant to the performed operations varied in group I between 1.5 and 5.7 h (S3 4.9, S1 5.7, L4 5.4, L2 3.0, T12 2.0, T10 1.6, T8 1.5 h) and in group II between 1.8 and 5.9 h (S3 5.4, S1 5.9, L4 5.7, L2 4.1, T12 2.9, T10 2.3, T8 1.8 h). These differences were significant in the segments S3, L3, L2, L1, T12, and T10. In 5 patients (20%) in group I adequate analgesia for the planned surgical intervention was not obtained. In 4 of these 5 patients the required spread of the spinal block was not reached; in 2 general anaesthesia had to be performed and in 2 the required analgesia could be obtained by administration of an analgesic (fentanyl). In the 5th patient the level of spinal block was sufficient for the planned operation, however, the quality of analgesia was not, i.e., additional analgesics were required. In the group that received the 0.75% solution additive analgesics were necessary in 1 patient (5%) because a sufficient level of anaesthesia for the planned operation was not obtained. In group I all patients had a complete motor block in all three joints (hip, knee, and ankle); in group II, however, the motor block was incomplete in 6 patients. This difference between the 2 groups was statistically significant. Onset of motor block of hip, knee, and ankle joints occurred after 10, 15, and 15 min, respectively, in group I and 10, 12 and 15 min, respectively, in group II. These differences were not statistically significant. Duration of motor block in the three joints was significantly longer (3.4, 2.8, and 3.8 h) in group II than in group I (2.4, 1.9, 2.7 h). Statistically significant changes in systolic and diastolic blood pressures (BP) and heart rate (HR) were recorded in both groups in the course of the study period. Relative BP changes were assessed in the individual patients. There were no statistically significant changes between the two groups with regard to relative changes in systolic and diastolic BP and HR. Bradycardia occurred a total of 13 times in 10 patients in group I and in 11 patients in group II. A BP decrease of > 20% was measured in 1 patient in each group. Twelve of the 40 patients complained a headache in the first 6 days; in this respect the groups did not differ significantly. There was no difference between male and female patients with regard to side effect profile. CONCLUSION: At concentrations of 0.5% and 0.75%, ropivacaine results in long-lasting spinal anaesthesia. (A
Amides↗
[Reconstruction of scar hernias--intraoperative tensiometry for objective determination of procedure of choice].
The reappearance of incisional hernias after reconstruction depends on the size and tension of the hernia. An additional risk factor is the number of operations that have been performed before. There are two decisive factors that influence the rate of recurrence: the operation technique and the tension applied. To reach a functional reconstruction the incisional hernia must be closed and the abdominal wall must be joined together in an anatomical way. The technique used must be able to tolerate the tension which is necessary to close the abdominal wall. Application of arbitrary tension produces a high rate of recurrence, irrespective of the kind of reconstruction used. Through the intraoperative measurement of the tension applied one can match each hernia (according to size, value and tension) to the most suitable technique. Here the inlay/onlay technique tolerates the highest tension, up to 3.5 kp. With this method and a maximum tension of 3.5 kp we achieved a complete functional reconstruction in 65% of cases and our rate of recurrence amounted to 2.3%.
Abdominal Muscles↗
Moment arm length variations of selected muscles acting on talocrural and subtalar joints during movement: an in vitro study.
The tendon excursion method was applied to estimate the moment arm length of triceps surae, flexor hallucis longus, tibialis posterior, tibialis anterior, peroneus brevis and peroneus longus at talocrural and subtalar joints of 10 anatomical preparations. Orthogonal polynomials were fitted to the tendon excursion data and by derivation with respect to the joint angle, the instantaneous moment arm length for any joint position was evaluated. Both joints were investigated separately. Individual data, the mean moment arm together with the significant moment arm coefficients of the polynomials are presented. Considering their moment arm, the most important plantar flexor were triceps surae, flexor hallucis longus and to a much lesser extent peroneus longus, peroneus brevis and tibialis posterior. Results suggest a partially new insight into the muscle action at the subtalar joint. Although displaying a mean inversion moment arm of about -5.3 mm over the whole range of motion, triceps surae had an inversion moment arm in eversion and an eversion one in inversion. Tibialis posterior exhibited the most important inversion moment arm (-19.1 mm), whereas tibialis anterior had a very low one (-3.8 mm). For some specimens this muscle was found to have an eversion moment arm. Peronei longus and brevis had a nearly identical moment arm at the subtalar joint (21.8 and 20.5 mm).
Algorithms↗