Carcinoid syndrome presenting as acute right heart failure.
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Female↗
Biomedical subjects
R Arnold
Publications and source records attributed to R Arnold.
Alterations in crevicular fluid flow during healing following gingival surgery.
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Gingiva↗
[A contribution to Presinol therapy in general practice].
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Adolescent↗
Health care professionals' grief: a model based on occupational style and coping.
Many publications address grief in terminally ill patients and their loved ones. In contrast, this paper proposes a hypothetical model for grief reactions in health care professionals (HCPs) working with terminally ill patients. The model integrates three literatures: burnout, coping and personality/occupational interests. Grief-related job stress can culminate in burnout that affects over 50% of physicians treating the terminally and critically ill. Coping behaviors that attenuate burnout differ among HCPs, suggesting that nurses prefer different coping strategies when compared with physicians. The personality and occupational interests literatures provide a rationale for coping differences in HCPs. Personality characteristics associated with occupational preferences provide insight into HCPs' natural propensities for coping with stress. The model addresses personality/occupational differences among health care disciplines, thus providing a plausible explanation for coping differences among HCPs, as well as potential interventions that facilitate HCPs' adjustment to the deaths of their patients.
Adaptation, Psychological↗
[Microbiological studies before and after endoscopic papillotomy (EPT)].
A microbiological check-up was made on 17 patients with choledocholithiasis while they were undergoing EPT and control ERCP. The endoscopes were contaminated in 56% of the 34 procedures. In 9% of the interventions there were indications that mouth flora had been transferred to the duodeno-biliary region. Bacteriaemia occurred in 3 (17%) patients in connection with EPT. After a mean of four months following EPT, the colony count and the number of germs in the duodenal and biliary juice tended to increase; bacteria of the Klebsiella-Enterobacter-Serratia group became dominant. More than 80% of the bile and blood isolates were sensitive to cefotaxime, cefamandole and co-trimoxazole. To minimize the risk of infection following EPT and ERCP, repeated controls of the disinfection of the endoscopes and periendoscopic antibiotic prophylaxis are suggested.
Adult↗
Infectious complications after allogeneic bone marrow transplantation with and without T-cell depletion of donor marrow.
The infectious complications during different time intervals after allogeneic bone marrow transplantation (BMT) (day 0 to day 30, 31 to 100, 101 to 365, 366 to 730) were reviewed in 67 adult patients, 27 of whom received transplants without T-cell depletion (TCD) using methotrexate or cyclosporin A for prophylaxis of graft-versus-host disease (GvHD) and 40 of whom received donor marrow with TCD using the monoclonal anti-lymphocyte antibody campath-1 and human complement. The use of TCD reduced the incidence and severity of GvHD significantly (p less than 0.01), but was associated with an increased rate of graft rejections. During all time intervals patients with TCD had a similar, lower or statistically significantly lower number of bacterial, fungal or viral infections and a statistically significantly lower number of lethal infections (p = 0.05) as compared with patients without TCD. This finding might be explained by the fact that with TCD immunological reconstitution can take place unimpaired by GvHD or its prophylaxis or treatment, resulting in a decreased incidence of infections.
Adult↗
Somatostatin analog sandostatin and inhibition of tumor growth in patients with metastatic endocrine gastroenteropancreatic tumors.
A prospective study was performed to determine the efficacy of octreotide (Sandostatin; SMS 201-995) 200 micrograms tid in controlling tumor growth. The study included 21 patients with metastasized endocrine GEP tumors: 6 gastrinomas, 8 carcinoid syndromes, 7 nonfunctioning tumors. Treatment was performed for 3 to 59 months (median 15 months). Evaluation of the response to octreotide was facilitated in 12 patients by a pretreatment observation period of 3 to 47 months (median 17 months) during which the natural growth behavior was determined. Based on the presence or absence of a control period prior to treatment, 5 patients were considered to be responders, 7 as questionable responders (no pretreatment phase available), and 9 as nonresponders. None of the 21 patients had documented shrinkage of the tumor mass. The most favorable response was tumor standstill. In all but one responder an escape to an initially favorable response occurred after 6 to 28 months (median 14 months). Proved inhibition of growth was paralleled by a reduction of serum and urine hormone parameters, whereas unaltered progression of tumor growth was observed also in the presence of hormone suppression. Tumor growth and hormone release was inhibited in the absence and presence of somatostatin receptors on the tumor. It is concluded that octreotide exerts a limited effect on metastatic GEP tumor growth. The evaluation of a response to octreotide is facilitated by an observation period prior to the drug that provides information on growth characteristics of the tumor. The presence of octreotide receptors does not predict the success of therapy.
Adenoma, Islet Cell↗
Mechanical occlusion of the patent ductus arteriosus with Jackson coils.
The effectiveness and safety of a protocol for transcatheter patent ductus arteriosus (PDA) closure was assessed. Our goal is complete mechanical occlusion of the PDA in the catheterization laboratory by adding coils until it is no longer possible to cross the PDA with a guidewire. Detachable coil closure of a PDA with a narrowest diameter of 2.4 +/- 0.1 mm was attempted in 83 patients with a median age of 2.8 years (0.7 to 27.8 years) and whose median weight was 14.5 kg (6 to 61.6 kg). Coils were successfully implanted in 82 of 83 patients, and in 1 patient a large Rashkind double umbrella was used instead. Complete closure was obtained in 80 (97.6%) patients, 48 of those (59%) received more than one coil. Reintervention for residual shunting was required in only 1 patient and another patient has a trivial residual shunt. Device embolization occurred in three cases. Despite the use of multiple coils there was no evidence of significant left pulmonary artery stenosis. The fluoroscopy time increased from 14.0 +/- 2.0 minutes for a single coil to 25.3 +/- 2.9 minutes for multiple coils (p < 0.01). Attempting to obtain complete mechanical occlusion of the PDA during the implant procedure by adding extra coils reduces the need for reintervention for residual or recurrent shunting.
Adolescent↗
Letting go: family willingness to forgo life support.
OBJECTIVE: To describe the process of family decision making about life support in the critical care setting. DESIGN: Descriptive, exploratory. SETTING: A northeastern United States university-affiliated medical intensive care unit. SAMPLE: Thirty family members of 16 critically ill patients. RESULTS: Letting go or becoming willing to forgo life support involved three interrelated and complex processes: (1) family members sought out, obtained, and tried to understand information about the critical illness; (2) they reviewed the life story of the patient, seeking meaning in the patient's life and the critical illness; and (3) they struggled to maintain family roles and relationships. For most families, interpersonal and intrapsychic work during each process created a reframing of the issues related to the critical illness: (1) they came to believe that they had done all that could be done and were able then to relinquish the goal of recovery for acceptance of a peaceful death; (2) they reviewed the patients's life, finding some meaning and a sense that, given the situation, the patient would not want to continue on life support, and then they moved toward closure; and (3) they were able to bring about (at least within a small group of the closest family members) a sense of doing the "right thing", and they were able to develop some sense that forgoing life support for the ill relative would not destroy important family relationships. For a few other families this movement toward resolution did not occur, and although family members attempted to deal with the issues of life support, their efforts were fraught with conflict and prolongation of the end-of-life period. CONCLUSIONS: Little is known about the actual experience of family members as they are involved in life-support decision making. Identification of the needs of family members to work through the decision-making experience cognitively, emotionally, and morally is essential to communicating effectively about the ill relative's condition and to providing understanding and support to families involved in life-support decision making in the critical care unit.
Adult↗
GLP-1 release in man after lower large bowel resection or intrarectal glucose administration.
BACKGROUND: This study addresses the question whether the insulinotropic gut hormone, glucagon-like peptide-1 (GLP-1), is released from the lower large bowel upon oral or rectal glucose uptake. METHODS: It was evaluated whether rectum or sigmoid colon resection alters glucose homeostasis or the plasma levels of the insulinotropic gut hormone, gastric inhibitory polypeptide (GIP), or GLP-1. Six men and 3 women (age 63 +/- 8 years, BMI 25.4 +/- 4.0 kg/m2) with normal preoperative fasting glucose values were treated before and after resection of large bowel segments. Fasting oral glucose tolerance (OGT, 75 g glucose/300 ml) tests were performed both before and 10 days postoperatively. Another approach aimed to clarify whether luminal glucose stimulation in the rectum/sigmoid colon increases GLP-1 plasma levels. Ten healthy volunteers (4 males, 6 females, age 25 +/- 2 years, BMI 22.1 +/- 2.4 kg/m2) received enemas with both saline and, 7 days later, 1 g/kg body weight glucose (70% glucose solution) intrarectally. RESULTS: Neither rectum nor sigmoid colon resection led to significant changes in the pre- and postoperative glucose responses to OGT testing, or insulin, GIP and GLP-1 release. Intrarectal glucose instillation increased blood glucose by about 10 mg/dl with parallel small elevations in immunoreactive insulin and immunoreactive C peptide. However, plasma GLP-1 levels remained unaltered. CONCLUSION: Our data make it unlikely that GLP-1 derived from the lower large bowel contributes significantly to maintain normal glucose tolerance.
Administration, Rectal↗
Expression of vesicular monoamine transporters in endocrine hyperplasia and endocrine tumors of the oxyntic stomach.
BACKGROUND: Gastric enterochromaffin-like (ECL) cells selectively express the vesicular monoamine transporter (VMAT) VMAT2, and enterochromaffin (EC) cells the VMAT1 isoform. AIMS: We investigated whether VMAT isoform selection indicates the origin of endocrine hyperplasia and neoplasia from oxyntic ECL or EC cells and may be of prognostic significance in different types of gastric carcinoids. METHODS: Tissue from patients with chronic atrophic gastritis (CAG), Zollinger-Ellison-syndrome (ZES), gastric carcinoids and neuroendocrine carcinoma (NEC) was investigated by immunohistology and in situ hybridization. RESULTS: Endocrine cells forming diffuse, linear, and micronodular hyperplasia in CAG and ZES, as well as oxyntic microcarcinoids expressed both VMAT2 and chromogranin A (CgA) but neither VMAT1 nor serotonin. In five of six sporadic carcinoids VMAT2 and CgA but not VMAT1 were detected. One carcinoid was copositive for VMAT1 and serotonin but negative for VMAT2. Electron microscopy confirmed the VMAT2-positive tumors as ECLoma and the VMAT1-immunoreactive carcinoid as EComa. CONCLUSIONS: VMAT2 and VMAT1 are reliable markers for differentiation of gastric endocrine hyperplasia and neoplasia from ECL and EC cells, respectively. The significance of VMAT2 and VMAT1 as prognostic markers lies in the relatively poor prognosis for EComa compared to ECLoma, characterized by VMAT2 positivity. The absence of both VMAT2 and VMAT1 in NEC may indicate poor prognosis.
Adult↗
Hypothetical mechanisms of action of an H1-antihistamine in asthma.
Some recent clinical studies carried out with the potent H1-antihistamine cetirizine (CTZ) suggest that this drug could be useful for the treatment of mild to moderate asthma and even for the prevention of the disease. Besides a potent antagonism of H1-receptors at bronchial level, this drug was also shown to exert a large series of anti-inflammatory effects in in vitro, ex vivo and in vivo pharmacological models and also in clinical situations in atopic subjects. All the data collected up to now suggest the possible existence in the molecule of a central key mechanism of action on resident cells especially involved in cell trafficking and bronchial inflammation, i.e a down-regulating effect on the nuclear factorKappaB (NFkappaB). This hypothesis was tested on human endothelial cells and a human epithelial pulmonary cell line using different experimental methods. The results showed that CTZ down-regulates the TNF-alpha-induced hyperactivation of NFKappaB in these two different resident cells at physiological concentrations.
Adult↗
Tamoxifen or cyproterone acetate in combination with buserelin are ineffective in patients with pancreatic adenocarcinoma.
Experimental evidence and preliminary clinical data suggest a responsiveness of pancreatic adenocarcinoma to sex hormones and LH-RH agonists. In this study, we investigated the effect of the antiestrogen tamoxifen and the antiandrogen cyproterone acetate in combination with the LH-RH agonist buserelin in 9 patients with unresectable pancreatic adenocarcinoma. In all patients the disease was progressive under this therapeutic regimen. In conclusion, complete androgen blockade and antiestrogens in combination with LH-RH agonist cannot be recommended in patients with widespread pancreatic adenocarcinoma.
Adenocarcinoma↗
Expression of adhesion molecules (ICAM-1, LFA-3) on human epithelial cells (A549) after respiratory syncytial virus infection.
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Antigens, CD↗
Contractor must know healthcare and construction.
A successful contractor-hospital relationship in a building project requires more than willingness and knowledge of one's own craft from both parties. As Touro Infirmary's Robert Arnold found out, it helps if the contractor has an intimate understanding of the priorities and problems in providing health care, as well as knowing his own territory.
Contract Services↗
[Importance of the trypsin radioimmunoassay in pancreatic diagnosis].
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Humans↗
[Coping with bone marrow transplantation. A contribution to adaptive vs. maladaptive coping].
The coping strategies of 36 adult leukemia patients admitted for bone marrow transplantation have been investigated systematically by trained raters using audio-taped material from semi-structured interviews. So-called long term survivors with a median survival time of 978 days after BMT displayed significantly lower passive-stoic acceptance and resignation than non-survivors who died within a median time of 229 days after BMT. These copings were of high prognostic value prior to all treatment regimes in strong correlation with a negative hematological prognosis and age. Non-survivors showed significantly higher passive-stoic acceptance and resignation coping. Form of leukemia and other sociodemographic variables or stress had neither a significant impact on coping intensity nor on coping quality. Consequences for further coping research and possible treatment interventions prior to or immediately after BMT are being discussed.
Adaptation, Psychological↗
Social class, health and aging: socioeconomic determinants of self-reported morbidity among the noninstitutionalized elderly in Canada.
Despite the vast amount of literature on the relationship between social class and health, little work has been done on postretirement populations. Using the 1991 General Social Survey, a sample of respondents (N = 1,943) aged 65 to 99 were selected for analysis. Three social class variables, income adequacy, education and occupation, were used along with several lifestyle variables and demographic controls to predict six different measures of health status. The findings supported a "condition-specific" approach to the study of class differences in morbidity. Income adequacy was the most consistent class predictor of these health measures in this sample. As well, 'risky' lifestyle variables were used to test the hypothesis that such factors may mediate the relationship between class and health. This hypothesis was not well supported in these data.
Aged↗