Improvements in assessment of human failed fertilization oocytes using the supravital dye Hoechst 33342.
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Benzimidazoles↗
Biomedical subjects
R D Powers
Publications and source records attributed to R D Powers.
Open trial of oral fleroxacin versus amoxicillin/clavulanate in the treatment of infections of skin and soft tissue.
In a multicenter, prospective, randomized trial, fleroxacin was compared with amoxicillin/clavulanate potassium (AMX/CP) for the treatment of infections of skin and soft tissue. Fleroxacin was given at a dosage of 400 mg once daily, and AMX/CP was given at a dosage of 500 mg/125 mg three times a day. Each was administered for 4-21 days. Adult patients with the clinical diagnosis of skin or soft tissue infections were eligible for enrollment. Patients were randomized in a 2:1 ratio. A total of 191 patients were enrolled; 126 took fleroxacin, and 65 took AMX/CP. Of these patients, 42 in the fleroxacin group and 26 in the AMX/CP group were evaluable for both clinical and bacteriologic efficacies. Patients with abscesses comprised the largest single category in each group. Principle reasons for exclusion included: patients lost to follow-up (17 [13%] fleroxacin, 12 [18%] AMX/CP); failure to isolate a causative pathogen (19 [15%] fleroxacin, 9 [14%] AMX/CP); and resistance to study drug (11 [9%] fleroxacin, 2 [3%] AMX/CP). Staphylococcus aureus was the most commonly isolated pathogen. Streptococcus group A, Staphylococcus coagulase-negative, Escherichia coli, and Proteus species, in decreasing order, were the next most common pathogens. Clinical and bacteriologic efficacy was excellent in both groups, with a cure rate of > or = 90%. There were two bacteriologic failures in each group. Patients taking fleroxacin complained of slightly more adverse events, which involved primarily the digestive and central nervous systems. The rate of withdrawal from the study because of adverse events was 4% in both groups. Fleroxacin, 400 mg given once daily, is safe and as effective as AMX/CP in the treatment of skin and soft tissue infections in adults.
Administration, Oral↗
Use of metyrapone to treat pituitary-dependent hyperadrenocorticism in a cat with large cutaneous wounds.
Metyrapone, a drug that inhibits cortisol production, was used to lower plasma cortisol concentration and alleviate skin lesions caused by pituitary-dependent hyper-adrenocorticism in a cat. Plasma cortisol concentration was documented by ACTH stimulation test results. During metyrapone treatment, alopecia, thin skin, and large cutaneous wounds resolved. Metyrapone was administered orally at a dosage of 65 mg/kg of body weight, every 12 hours. Metyrapone may be used in conjunction with surgery in the management of pituitary-dependent hyperadrenocorticism in cats.
Adrenalectomy↗
Progestins inhibit murine oocyte meiotic maturation in vitro.
The in vitro culture of fully grown mammalian oocytes results in spontaneous meiotic maturation from prophase arrest to metaphase II. This maturation can be inhibited by steroid hormones in both murine and porcine oocytes. Using selected steroids, we have examined the structure-activity relationships of steroids and oocyte inhibition. Experiments with androgens, estrogens, glucocorticoids, and progesterone revealed that at least one steroid from each class was inhibitory. Progesterone, however, was two to three times more effective than steroids from other classes. Examination of a variety of progestins showed that most substitutions decreased or abolished the inhibitory activity. Hydroxy group substitutions at different carbon atoms and substitutions at the 4-ene group lessened the inhibitory effectiveness, with the exception of 5 beta-dihydroprogesterone, which was as effective as progesterone. However, several steroids with substitutions at the C17 acetyl group were more active than progesterone, including 20 beta-dihydroprogesterone which was the most inhibitory steroid tested (ID50 = 5 microM). The progesterone agonist R5020 was also very active (ID50 = 8 microM). This is the first report of a detailed examination of the steroid-induced inhibition of murine oocytes. A comparison between the results reported here and previous reports of steroid-induced inhibition in porcine oocytes reveals differences in the response of oocytes from the two families. The structure-activity relationships of the inhibitory steroids examined here suggest that the steroids are acting via a receptor-mediated system.
Animals↗
Aeromedical evacuation of rural victims of nontraumatic cardiac arrest.
STUDY OBJECTIVES: To determine if the deployment of a helicopter-borne nurse/paramedic team contributed to survival of victims of nontraumatic cardiac arrest in a rural setting. DESIGN: Retrospective chart review. SETTING: A university hospital-based helicopter aeromedical program serving a primarily rural region with a volunteer basic life support/advanced life support ground emergency medical services system. PARTICIPANTS: Victims of nontraumatic cardiac arrest, older than 15 years, in cardiac arrest at the time of request for air evacuation. MEASUREMENTS AND MAIN RESULTS: Eighty-four patients were identified who met the study inclusion criteria between January 1, 1986, and December 31, 1989. Basic life support care was always available before aeromedical crew arrival; advanced life support care was available in 58% of cases before helicopter arrival. Resuscitative efforts were terminated in the field in 55 cases; of 29 patients transported to the emergency department, only ten (12%) survived to hospital admission. Only one patient (1%) survived to hospital discharge; this patient was resuscitated by ground advanced life support providers before helicopter arrival. CONCLUSION: Despite providing improved availability of advanced life support care in some cases, deployment of aeromedical teams had a negligible effect on patient survival from nontraumatic cardiac arrest in a rural setting.
Adolescent↗
Free segmental paw pad grafts in dogs.
After removal of 1 metatarsal pad and formation of a granulation tissue bed, free segmental 6- x 8-mm grafts from digital pads were sutured into recessed same-size recipient sites in the granulation tissue. In 5 dogs, the grafted area had been denervated by excision of a segment of the tibial nerve at the level of the tarsus. The grafted area was not denervated in the remaining 5 dogs. In both groups of dogs, the grafts placed around the periphery of the wound healed, blocked ingrowth of delicate epithelium from the surrounding skin, and provided a tough keratinized epithelium that covered the wound's center. As healing progressed, the grafts coalesced as the wounds contracted. Weight bearing resulted in graft expansion to provide functional weight-bearing tissue. Dogs of the denervated group had clinical and histologic evidence of collateral sensory reinnervation of the denervated area. However, with the exception of 1 dog, results of sensory nerve action potential tests indicated that reinnervation may not have been by way of regeneration across the excisional gap in the nerve. Evaluation of reinnervation of the tibial autonomous zone in 2 additional dogs revealed clinical evidence that collateral reinnervation began between 19 and 28 days after nerve excision and progressed proximad to distad. Results of sensory nerve action potential tests indicated that reinnervation may not have been via regeneration across the excision site. Results of fluorescent tracer studies did not have positive findings regarding the route of collateral reinnervation. Segmental paw pad grafts can be used effectively to provide weight-bearing tissue on a dog's limb. With local nerve damage on the distal portion of the limb, collateral innervation can grow into the area to reinnervate tissues, including pad grafts.
Animals↗
The greyhound dog as a model for studying pressure ulcers.
Because of their angular conformation, short hair, and thin skin, greyhounds are particularly subject to development of pressure ulcers. Greyhounds, therefore, can serve as a model to study pressure ulcers, either naturally occurring pressure ulcers or induced dermal pressure lesions. A method for inducing dermal pressure lesions was developed using a short-limb walking cast on one pelvic limb of the dog. Physical characteristics, dermal thromboxane B2 concentrations, and histopathologic changes were used to determine the severity of the lesions. Different lesion severities can be induced over the calcaneal tuberosity depending upon the amount of padding in the cast and the length of time the cast is in place. The technique for inducing a mild dermal pressure lesion is described.
Animals↗
A multifactorial analysis of the pregnancy outcome in a successful embryo cryopreservation program.
OBJECTIVE: To determine which factor, or factors, may influence the success of an embryo-freezing program. DESIGN: Prospective. SETTING: An established, private IVF clinic. PATIENTS: This study comprises data from 185 consecutive thaw cycles (161 patients) that resulted in embryo replacement. The influence of the following factors, with regard to pregnancy outcome, was specifically addressed: embryo quality, day of the endogenous LH surge, number of thawed embryos replaced, length of time frozen, E2 level at the time of the hCG trigger in the stimulated cycle, and patient age at the time of freezing. RESULTS: An overall pregnancy rate (PR) of 27.6% per ET was achieved in this study. Regardless of the day of the LH surge, patients who had at least one good quality embryo (the "sponsoring embryo") conceived 35% of the time. Patients who lacked a sponsoring embryo frozen conceived 15% of the time. Patients who were 39 years of age or younger had a PR of 31% per transfer. None of the 22 patients who were 40 or older conceived. No other factor examined had any effect on pregnancy outcome. CONCLUSIONS: Good quality frozen/thawed embryos are a major factor in achieving a consistently high PR. Poorer quality embryos are capable of implantation but at a significantly reduced rate. Patient age was also found to be significant in predicting pregnancy. Neither the day of the LH surge, number of embryos transferred, length of time frozen, nor the E2 level appears to have any effect on the establishment of pregnancy.
Adult↗
Severe renal oxalosis in five young Beefmaster calves.
Severe renal oxalosis was diagnosed in 4 male and 1 female purebred Beefmaster calves from herds in southeastern and northwestern United States. Clinical signs included weakness, anorexia, lethargy, alopecia, dehydration, and diarrhea. Results of serum biochemical analysis for 2 calves were consistent with end-stage renal disease. Calves died 2 days to 6 weeks after birth. At necropsy, renal calyces were dilated and contained pale yellow granular calculi. Histologically, there was renal interstitial fibrosis, and cortical and medullary tubules were distended with calcium oxalate crystals. Oxalate crystals were also in the tracheal glands of 1 calf. Severe renal oxalosis in young purebred calves, on widely varied diets, with no known exposure to exogenous oxalates is suggestive of an inherited metabolic defect resulting in primary hyperoxaluria.
Animals↗
Prevalence of folate deficiency in emergency department patients with alcohol-related illness or injury.
To assess the prevalence of folate deficiency in emergency department patients with alcohol-related illness or injury, a prospective, nonconsecutive case series with nonrandomized controls was used. All patients presenting to a 60,000-visit public hospital emergency department with alcohol-related illness or injury were eligible; patients were excluded if they had received folate in our health care facility within the previous 4 months. An alcohol and brief dietary history was obtained, and a complete blood cell count and red blood cell folate level was performed on each patient. Analysis was undertaken by chi 2 to evaluate the prevalence of folate deficiency in the alcohol-related versus the control population. One hundred three patients were entered into the study. Three patients were subsequently excluded from analysis. Of 52 study patients, three (5.8%) were found to be folate deficient. Of 48 controls, two (4.2%) were found to be folate deficient. This difference is not statistically significant (P greater than .05, chi 2; mean difference 1.6%, 95% confidence interval -6.9% to 10.1%). The prevalence of folate deficiency in patients presenting to this emergency department with alcohol-related illness or injury is low, and does not differ from the general emergency department population. Empiric folate therapy in these patients is not indicated.
Adult↗
Effect of "standard order" deletion on emergency department coagulation profile use.
STUDY OBJECTIVES: To determine whether the test ordering of physicians working in a teaching hospital emergency department could be influenced by modification of automated laboratory order sets. DESIGN: Prospective, using data from the same ED before and after intervention. SETTING: A 58,000-visit public university hospital ED. TYPE OF PARTICIPANTS: Emergency physicians caring for adult patients admitted from the ED to the ward medical services. INTERVENTION: Beginning July 1, 1989, coagulation studies were deleted from the automated admission order sets used in the study hospital ED. MEASUREMENTS AND MAIN RESULTS: Patient charts were examined to assess the effect of coagulation study deletion on the frequency and appropriateness of coagulation test ordering. A tripling of the percentage of patients who did not receive coagulation parameter testing was noted (P less than .0001, chi 2). In no case were the tests omitted when a high-yield indication for their use was present. This resulted in an estimated reduction of $20,000 per year in patient charges. CONCLUSION: Modification of ED "standard orders" can result in reduction of laboratory use without an adverse effect on patient care.
Adolescent↗
Ofloxacin versus cephalexin for treating skin and soft tissue infections.
Patients with acute localized skin or soft tissue infections were randomized to receive either ofloxacin (300 mg orally, b.i.d.) or cephalexin (500 mg orally, b.i.d.). Among 401 enrolled patients, 382 were evaluable for safety and 148 for microbiologic response. Microbiologic cure occurred in 93.4% of ofloxacin-treated patients and in 94.0% of those treated with cephalexin. Clinical cure or improvement, respectively, was found in 85.2% and 11.1% of patients treated with ofloxacin, and 83.6% and 14.9% of patients receiving cephalexin. Adverse effects (primarily associated with the gastrointestinal tract and central nervous system) were considered to be drug-related in 7.9% of those receiving ofloxacin and 4.8% of those receiving cephalexin. Thus, ofloxacin is as effective and well tolerated as cephalexin and a good alternate antibiotic for treating skin and skin structure infections caused by a variety of pathogens.
Cephalexin↗
Healing of segmental grafts of digital pad skin in dogs.
Pad grafts would be indicated in instances of severe paw trauma when there has been loss of the major weight-bearing pads (ie, metatarsal and metacarpal pads) as well as loss of the digital pads. A practical technique for replacing pad tissue on the remaining paw tissue could avert limb amputation for lack of weight-bearing tissue in the area. Small segmental digital pad grafts were placed in granulation tissue beds in dogs. Although the grafts were from thick pad skin, they healed well. However, intervening wound areas did not become covered with the heavier keratinized epithelium of the pads. The thinner, more rapidly growing, less keratinized epithelium from the wound edges covered most of the wound.
Animals↗
Development of hypoparathyroidism after excision of laryngeal rhabdomyosarcoma in a dog.
An uncommon neoplasm of the larynx, rhabdomyosarcoma, was diagnosed in a 6-year-old 14-kg neutered female Spitz. In addition to the progressive onset of expected clinical signs of the tumor (exercise intolerance, respiratory stridor, inability to bark), the dog experienced hyperthermic crisis. Laryngectomy was successful in eradicating the local neoplastic tissue; however, unusual postoperative complications developed and included acute complications of pharyngotracheal fistula and hypoparathyroidism, and long-term complications of periodic collapse of the tracheal stoma and intolerance to heat. Probable causes and successful management of these complications are described. At 22 months after laryngectomy, the dog was admitted for a solitary hepatic metastasis. While hospitalized, the dog died of apparent asphyxiation attributable to stoma collapse.
Animals↗
New directions in the diagnosis and therapy of urinary tract infections.
Urinary tract infections are among the most common bacterial infections. To provide appropriate and cost-effective treatment, physicians need to stratify patients with urinary complaints into uncomplicated or complicated categories. This can be accomplished by the history, presenting symptoms, risk factors, and physical examination. Complicated urinary tract infections occur in patients with a history of recurrent infections, signs or symptoms of upper tract disease, or coexisting conditions such as pregnancy, immunosuppression, or structural anomalies of the urinary tract. Uncomplicated urinary tract infections occur in otherwise healthy women who have a history of lower tract symptoms of short duration. Symptoms of urinary tract infection include some combination of dysuria, frequency, urgency, hematuria, and suprapubic pain. An uncomplicated urinary tract infection is not accompanied by fever or flank pain. The microbiology of uncomplicated urinary tract infection is predictable, with Escherichia coli and other Enterobacteriaceae, Staphylococcus saprophyticus, and Enterococcus causing more than 90% of urinary tract infections. A history, brief physical examination, and urinalysis are all that is necessary to diagnose a urinary tract infection. Some of the specialized dipsticks and rapid screens are as accurate as microscopic examination in detecting urine white cells. A presumptive diagnosis can be made when a patient has clinical symptoms and some combination of pyuria, hematuria, or bacteriuria. Urine cultures are unnecessary in uncomplicated urinary tract infections and add substantially to the cost of therapy. Pitfalls in the diagnosis include other entities causing dysuria, such as vaginitis, vulvar lesions, physical or chemical irritants, and sexually transmitted diseases. Appropriate therapy requires selection of a drug and determination of the length of treatment. A minor infection should be treated with easy, safe, cost-effective therapy. For urinary tract infections, there are too many antibiotic options, ranging from a single, parenteral dose to a 14-day course of oral medication. Early optimism about single-dose oral therapy has been replaced by evidence suggesting that 3 days of therapy is probably the best. This will eradicate simple urinary tract infections in virtually all patients and decrease the incidence of relapse, whereas patients who are treatment failures usually have occult upper tract infection. Drug choices for short-course therapy include representatives from the penicillin, sulfa, and quinolone families. Selection of a specific drug requires consideration of costs, allergies, side effects, and spectrum of activity. A knowledge of local microbial sensitivity profiles and individual patient tolerance is helpful in guiding the clinician to the appropriate therapeutic regimen.
Anti-Infective Agents, Urinary↗
Real-time ultrasound for the detection of deep venous thrombosis.
PURPOSE: Accurate diagnosis of deep venous thrombosis (DVT) is a clinical problem in emergency practice. A prospective trial was conducted comparing real-time ultrasound with contrast venography in the diagnosis of proximal DVT. METHODS: Seventy patients whose clinical presentations mandated diagnostic evaluation for DVT had real-time ultrasound of the involved leg followed by contrast venography. Initial readings of ultrasound and venography were compared with each other and with final readings to assess reliability of interpretation. RESULTS: Final ultrasound readings agreed with final venogram readings in all patients. Negative initial ultrasound readings agreed with final venogram readings in 56 of 56 patients (negative predictive value, 100%; 95% confidence interval, 94 to 100). Eighteen patients had positive initial ultrasound readings compared with 14 who had positive final venogram readings (positive predictive value, 78%; 95% confidence interval, 55 to 91). CONCLUSION: Negative real-time ultrasonography reliably excludes proximal DVT. Positive ultrasound reliably diagnoses proximal DVT only in experienced hands.
Adult↗
Soft tissue infections in the emergency department: the case for the use of 'simple' antibiotics.
Cellulitis, infected wounds, abscesses, and other bacterial infections of skin and soft tissue are commonly seen in the practice of emergency medicine. Informal observations in a teaching hospital suggest that newer agents having a broader antibiotic spectrum are frequently used for empiric outpatient treatment of mild to moderate soft tissue infections, so information from a prospective study was analyzed to determine whether this practice is appropriate. Healthy adult volunteers were enrolled in a study of the aerobic bacteriology and response to treatment of skin and soft tissue infections. Patients were randomized to receive a 10-day regimen of cephalexin (500 mg bid or qid) or ofloxacin (300 or 400 mg bid). Clinical response was assessed on two follow-up visits. Of 72 patients enrolled, 45 (63%) had cultures positive for pathogens. Cultures in 31 patients (43%) were positive for Staphylococcus aureus, five (7%) grew gram-negative rods, and five (7%) grew streptococcal species. Clinical response rates exceeded 95% in both the cephalexin- and ofloxacin-treated patients. Pathogens isolated from skin and soft tissue infections treated in the emergency department are not exotic or multiply resistant. The bacteriologic profile and clinical course of uncomplicated soft tissue infections indicate that treatment with a "simple" antibiotic, such as cephalexin, will result in resolution of the infection in nearly all cases. Broader spectrum antibiotics are not required for initial treatment of soft tissue infections in the emergency department.
Adult↗
Metastatic thyroid solid-follicular carcinoma in the cervical portion of the spine of a dog.
A metastatic thyroid solid-follicular carcinoma in the cervical portion of the spine was responsible for severe tetraparesis in a dog. Myelography revealed an extradural compressive lesion dorsal and to the right of the midline of C3. Histologic examination was used to diagnose the mass as a solid-follicular thyroid carcinoma. The primary tumor was not evident on cervical palpation or radiography. A dorsal laminectomy centered over C3 was performed, and all visible tumor was removed from the spine. The owner declined any further treatment for the dog.
Adenocarcinoma↗