Biomedical subjects

R Klein

Publications and source records attributed to R Klein.

At least 991 records · Page 55Linked to original sources

PubMedDate not supplied

A pilot study of glaucoma visual field screening in diabetes.

Because people with diabetes may be at increased risk of glaucoma, we performed a pilot study using automated visual field testing for screening them. One hundred and seventy-six diabetic persons who had participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy were tested with the Armaly-Drance screening pattern on the Humphrey Visual Field Analyzer. Individuals with moderate diabetic retinopathy or worse tended to have lower sensitivity of the central visual field and missed more points than those with no or only mild retinopathy. People with a history of glaucoma had slightly less sensitivity and missed more points than controls. These preliminary findings suggest that although people with diabetes and glaucoma may more frequently have visual field defects than people with diabetes but no glaucoma, a larger study is needed. This pilot study shows that such a study would be feasible and should be designed to indicate the sensitivity, specificity, and cost-benefit ratio of a screening program so as to assess the utility of the screening visual field test for finding glaucoma amongst people with diabetes.

Adult↗

PubMedDate not supplied

Lp(a) is not related to retinopathy in diabetic subjects.

PURPOSE: To examine the association between Lp(a) concentrations and the severity of retinopathy in 22 younger-onset and 48 older-onset diabetic subjects from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR), a population-based study of diabetic retinopathy. METHODS: We used a subset of the WESDR population with standardized protocols and stereoscopic color fundus photography to determine the severity of diabetic retinopathy in relation to Lp(a) concentrations. Lp(a) concentrations were measured by a monoclonal anti-Lp(a) antibody. RESULTS: Lp(a) levels were not significantly different between younger-onset or older-onset subjects with and without retinopathy. CONCLUSION: Our results do not support a link between higher levels of Lp(a) and severe retinopathy in either younger-onset or older-onset diabetic subjects but this needs confirmation in larger prospective studies.

Adult↗

PubMedDate not supplied

Why Britain is reorganizing its national health service--yet again.

The Labour government's 1997 plans for Britain's National Health Service (NHS) have been presented as a reaction to the reforms introduced by its Conservative predecessor in 1991. But to a large extent they build on the Conservative legacy. The centerpiece of the Labour reform--managed care organizations based on groups of primary care physicians--is based on the Conservative experiment with general practitioner fund holding. Welcomed when published, Labour's plans may arouse opposition in implementation, for they imply greater central control and threaten medical autonomy. If the political costs are to be contained, Labour may have to choose between increasing spending on the NHS or making concessions to the medical profession--and quite possibly have to do both.

Economic Competition↗

PubMedDate not supplied

Longitudinal measure of glycemic control and diabetic retinopathy.

In a population-based study, 5431 diabetic people in southern Wisconsin who were mature at onset of diabetes were identified, and their charts were reviewed. Recent glycemic control was evaluated from these charts. An index of recent glucose control with at least three glucose determinations abstracted from the doctor's chart was constructed. A sample of 1370 of the 5431 individuals was examined as part of this study. An index of glucose control could be derived for 568 of 674 people using insulin and for 565 of 696 nonusers of insulin. Correlation of the index with the glycosylated hemoglobin obtained at the time of study was significant in insulin users and nonusers. Patients with the poorest blood glucose control as described by index of past control or by current glycosylated hemoglobin had higher rates of retinopathy compared with patients who had the best control. When both the index of past control and current glycosylated hemoglobin values were combined, rate ratios for retinopathy for people with poorest control compared with those with best control were slightly better than when each measure was used alone. These analyses suggest that in planning programs, health-care impact may be increased if past and current data are considered.

Aged↗

PubMedDate not supplied

Is aspirin use associated with lower rates of cataracts in diabetic individuals?

The relationship between a history of aspirin use and cataracts in diabetic individuals is examined in this report from a population-based study of 1370 individuals who developed diabetes after 30 yr of age. After pupil dilation lenses were examined for the presence and severity of nuclear sclerotic and posterior subcapsular cataracts and for surgical aphakia. A history of aspirin usage was obtained. Seven hundred eighty-four individuals had used aspirin in the month before the exam. There was no relationship between such usage and cataracts. For 338 people who reported using aspirin daily for at least 3 mo while having diabetes, there was also no association. These data suggest that aspirin usage as measured here has little effect on the prevalence of cataract in older-onset diabetic patients.

Adult↗

PubMedDate not supplied

Is aspirin usage associated with diabetic retinopathy?

The relationship between the history of aspirin usage and diabetic retinopathy is examined in this report. The study population consists of a sample of people (n = 1370) who developed diabetes mellitus after 30 yr of age, who lived in south-central Wisconsin, and who participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. These participants were questioned about recent and past use of aspirin. There was no association between the number of aspirin used in the month before the exam and the severity of diabetic retinopathy. Three hundred thirty-eight of these individuals reported taking aspirin daily for at least 3 mo since they were diagnosed as having diabetes. There was no association between the severity of retinopathy and having used aspirin in this way. These analyses suggest that aspirin usage, as herein described, is unrelated to the severity of diabetic retinopathy in older-onset diabetic patients.

Aspirin↗

PubMedDate not supplied

New management concepts for timely diagnosis of diabetic retinopathy treatable by photocoagulation.

Diabetic retinopathy is a leading cause of blindness in the United States. Photocoagulation has been shown to reduce visual loss from macular edema and proliferative retinopathy. Because serious diabetic retinopathy may be asymptomatic and its detection difficult, several recommendations have been made by the National Diabetes Advisory Board for routine ophthalmologic examinations to ensure timely treatment. In geographic areas devoid of ophthalmologists, alternate approaches are necessary. These include intensive training of primary-care physicians in ophthalmoscopy, use of objective recording of retinopathy by fundus photography with interpretation of fundus photographs by retinal specialists, and better communication between primary-care physicians and retinal specialists.

Blindness↗

PubMedDate not supplied

An approach to the prevention of blindness in diabetes.

Diabetic eye disease is the leading cause of new cases of legal blindness in American adults under the age of 65 yr. Diabetic persons are at risk for visual loss due to diabetic retinopathy, glaucoma, and cataracts. Better understanding of the natural histories of these complications and recent advances in treatment have provided a rationale for developing an approach to prevent visual loss. This approach requires that diabetic patients who are at high risk for visual loss, and not under the care of ophthalmologists, be systematically screened, referred, and treated.

Adult↗

PubMedDate not supplied

A population-based study of diabetic retinopathy in insulin-using patients diagnosed before 30 years of age.

In a population-based study of the prevalence and severity of diabetic retinopathy in southern Wisconsin, 1210 insulin-taking persons who were diagnosed to have diabetes before 30 yr of age and who were receiving primary medical care in the area were identified in 1979-80. From 1980 to 1982, 996 patients were examined. Fundus photographs revealed that 72% of diabetic women and 69% of diabetic men had retinopathy. More men (12%) than women (7%) had severe proliferative retinopathy. Longer duration of diabetes, higher glycosylated hemoglobin, older age at examination, higher diastolic blood pressure, male gender, and presence of proteinuria all contributed significantly to describing increasing severity of retinopathy.

Age Factors↗

PubMedDate not supplied

Retinopathy in young-onset diabetic patients.

The relative importance of duration of diabetes before and after 13 yr of age as a risk factor for retinopathy was investigated using data from 200 persons who were younger than 26 yr of age. These persons were identified in a population-based study of diabetic retinopathy in southern Wisconsin in 1980-1982. Retinopathy was found in 9% of persons who were younger than 13 yr and in 34% of persons who were 13 yr or older and had been diagnosed at or after 13 yr. Presence of retinopathy was more strongly associated with the duration of diabetes after 13 yr of age than before it.

Adolescent↗

PubMedDate not supplied

Accuracy of self-reported hearing loss.

The purpose of this study was to assess the accuracy, in older adults, of questions assessing hearing loss. Study participants (n=3,556), aged 48-92 years, were examined in a population-based study of age-related hearing loss in Beaver Dam, Wisconsin. Self-report data from the ten-question Hearing Handicap Inventory for the Elderly-screening Version (HHIE-S), and four additional questions were compared with hearing loss as measured by pure-tone air conduction audiometry. The single question, 'Do you feel you have a hearing loss?' was the most sensitive question (sensitivity=71 per cent); its overall and gender-specific prevalence estimates were within 3.2 per cent of prevalence measures derived audiometrically, although age-group specific estimates were not as accurate. Using an HHIE-S total score >8 resulted in low sensitivity (34 per cent) and inaccurate prevalence estimates. These results indicate that, for some applications, one simple question may be sufficient for prevalence surveys of hearing loss among older adults.

Adult↗

PubMedDate not supplied

Platelet activating factor and thromboxane B2 production after cardiopulmonary bypass.

Platelet-activating factor (PAF) is believed to have a central role in the pathogenesis of ischemia-reperfusion injury. The purpose of this study was to investigate the relationships among production of PAF, thromboxane B2 (T alpha B2), and cardiopulmonary sequelae in patients undergoing coronary artery bypass graft surgery (CABGS). Venous blood from nine patients (eight men, one woman) undergoing scheduled CABGS, was sampled from central venous catheters before anesthetic induction, pre-cardiopulmonary bypass (CPB), 10 and 30 minutes post-CPB, 10 and 30 minutes post-aortic declamping, and 120 minutes and 24 hours after the conclusion of CPB. Plasma levels of PAF and T alpha B2 were determined by radioimmunoassay kits (Amersham Canada Ltd.). PAF and T alpha B2 were significantly different between high-risk patients (group I; Canadian Cardiovascular Society class 3-4; n = 4) and low-risk patients (group II; Canadian Cardiovascular Society class 2; n = 5): group I PAF = 960 pg/mL, group II PAF = 159 pg/mL (P = 0.0029); group I T alpha B2 = 320 pg/mL, group II T alpha B2 = 229 pg/mL (P = 0.0262). Group I PAF was significantly greater than group II PAF: before CPB = 825 pg/mL (group I), 138 pg/mL (group II); during initiation of CPB = 1600-2015 pg/mL (group I), 158-200 pg/mL (group II) (P = 0.0143). Correlations between duration of CPB and peak PAF (r = 0.7049, P = 0.0339), peak PAF level, and time to extubation (r = 0.8863, P = 0.0079) were significant. PAF levels were different in patients requiring postoperative epinephrine (2124 +/- 700 pg/mL) or dopamine (667 +/- 266 pg/mL) (P = 0.0042). The production of PAF is determined by preoperative patient characteristics and duration of CPB. Increased levels of PAF in patients with unstable angina, left main coronary artery disease, or recent myocardial infarction are associated with the need for increased inotropy and prolonged ventilatory support following CABGS. The degree of PAF production during CPB may be a factor in postoperative instability in high-risk patients.

Aged↗

PubMedDate not supplied

A new VEP system for studying binocular single vision in human infants.

Visual evoked potentials (VEPs), that provide unequivocal objective evidence of cortical binocularity have been recorded from adults and young infants using a new VEP system developed for this purpose. The system uses alternating field stereoscopy (AFS) to present separate visual stimuli to each eye. With this system, the binocular image pairs to the right and left eyes alternate at a high rate on a single video monitor. The subject wears spectacles incorporating light-scattering liquid crystal lenses which alternate electronically between opaque and clear modes in synchrony with the video monitor. To detect cortical binocularity, the system analyzes VEP activity mathematically and identifies significant responses at test frequencies reflecting binocular cortical interactions exclusively. Three types of binocular stimuli were presented: (1) dynamic random dot correlograms (correlograms); (2) dynamic random dot stereograms (stereograms); and (3) dichoptic checkerboard stimuli. The correlograms are generated when moving random dot patterns presented to each eye alternate between two phases, correlated and anticorrelated. With the stereograms, portions of random dot patterns presented to each eye are shifted horizontally relative to each other at a fixed rate, alternately producing crossed and uncrossed binocular disparities. Subjectively, these patterns appear to shift in depth. Dichoptic checkerboard stimuli are regular checkerboard patterns which reverse at different rates (frequencies) for each eye. Binocular VEPs are generated due to cortical interactions at the difference (beat) frequency. Using this VEP system, we have recorded binocular VEPs from 10 normal adults and more than 40 infant subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

The familial ovarian cancer registry: progress report.

BACKGROUND: Ovarian cancer can be cured if detected early enough, but usually has already metastasized when diagnosed. A family history of ovarian cancer is still the strongest known risk factor. OBJECTIVE: To identify women at risk for ovarian cancer and design a program of surveillance. METHODS: Prospective registry of women with a family history of ovarian cancer. RESULT: From April 1991 to July 1993, 137 women (119 families), mean age 43, registered with the Familial Ovarian Cancer Registry. The 119 pedigrees revealed 171 cases of ovarian cancer. Only one family is undocumented by pathology. Forty of 137 registrants have more than one relative with ovarian cancer. Six percent of pelvic examinations were abnormal for potential adnexal disease. In 4% of registrants, initial CA125 concentrations were abnormal. Ultrasound examinations were abnormal in ovarian size (5%), in morphology (3%), and by resistive indices (4%). Four ultrasounds were repeated earlier than routine. Using "standard" fees, the total cost to diagnose the one case of ovarian cancer discovered was $68,848. CONCLUSIONS: This approach still cannot be considered cost-effective. We are continuing to search for genetic and molecular markers of disease in women at greatest risk and in their affected relatives.

Adult↗

PubMedDate not supplied

Are you brand savvy? A self-assessment report card.

Aurora Healthcare in Wisconsin gets high marks in the marketing community for conveying a strong and consistent image to its potential customers. Here, the VP for business development and market planning for Aurora's St. Luke's Medical Center offers a way to think through how your organization sells itself.

Guidelines as Topic↗

PubMedDate not supplied

Association of leisure-time noise exposure and hearing loss.

The purpose of this study was to investigate the association of noisy leisure activities with hearing loss. Participants (n=3571) were examined in a population-based study of age-related hearing loss conducted in Beaver Dam, Wisconsin. Hearing thresholds were determined by audiometry. Hearing loss was defined as the pure-tone average of the frequencies 500, 1,000, 2,000, and 4,000 Hz greater than 25 dB HL in either ear. Information regarding exposure to leisure-time noise was obtained by interview. After adjusting for potential confounders, individuals who engaged in leisure activities with average sound levels greater than 90 dBA were significantly more likely to have a hearing loss than participants who did not engage in noisy leisure activities (OR=1.11, 95 per cent CI=1.01-1.22). Individuals who engaged in woodworking were 30 per cent more likely to have a hearing loss than those who had never done woodworking. There was a 6 per cent increased risk of hearing loss for each 5-year period of participation. Health care professionals should consider counseling their patients who engage in noisy leisure activities about the risk of noise-induced hearing loss.

Aged↗

PubMedDate not supplied

Induction of T helper cell type 1 response and elimination of HBeAg during treatment with IL-12 in a patient with therapy-refractory chronic hepatitis B.

This study reports the increase of immunoregulatory T helper cell type 1 response and elimination of HBV-DNA during IL-12 therapy in a patient with chronic hepatitis B virus infection who had not responded to three previous interferon-alpha therapies and one treatment with Famciclovir over a period of 6 years. The patient received IL-12 at a dose of 0.5 microgram/kg bodyweight weekly. Peripheral blood mononuclear cells were isolated before and during IL-12 application and incubated for 7 days with specific type 1 (purified protein derivative) and type 2 (tetanus-toxoid) TH cell antigens as well as with a macrophage/monocyte activating antigen (Bacille Calmette-Guérin). In the supernatants cytokines were determined by a double-sandwich ELISA. After 8 weeks HBV-DNA became negative and HBeAg seroconversion to anti-HBeAg occurred. Immunologically the loss of viremia was accompanied by a strong increase of the purified protein derivative-induced production of the type 1 cytokine interferon-gamma (1219 pg/mL before, 13,138 pg/mL after IL-12 therapy). Furthermore, Bacille Calmette-Guérin-induced secretion of the macrophage/monocyte-associated cytokines IL-1, tumor necrosis factor-alpha and granulocyte-macrophage colony-stimulating factor was higher at the end of therapy. This case indicates that IL-12 enhances type 1 T helper cell activity which may be a predisposition for elimination of HBeAg and successful treatment of hepatitis B.

Adjuvants, Immunologic↗

PubMedDate not supplied

Long-term response of primary biliary cirrhosis (stage I) to therapy with ursodeoxycholic acid.

We report about a 56-year-old asymptomatic female patient, who was examined in April 1991 for an increase of biochemical parameters of the liver. Based on the biochemical and serological results (abnormal cholestatic liver function tests, positive antimitochondrial antibodies) as well as liver biopsy primary biliary cirrhosis stage I was diagnosed. Therapy with ursodeoxycholic acid (12mg/kg body-weight/die) was started. Follow-up examinations indicated that cholestatic parameters had normalized and antimitochondrial antibodies became negative. In a further biopsy of the liver nearly regular liver parenchyma was demonstrated. Thus, therapy with ursodeoxycholic acid was stopped. However, in November 1992 cholestatic parameters increased again and, antimitochondrial antibodies recurred (subtype anti-M9: positive) without any clinical symptoms. Ursodeoxycholic acid therapy was reintroduced again. Within 3 months cholestatic parameters returned to normal and antimitochondrial antibodies were eliminated again. Since then ursodeoxycholic acid has been given continuously and a long-term remission as defined by clinical, serological and histological criteria could be maintained until today. This case report indicates a serological remission and a marked histological improvement in a female patient with an early stage of primary biliary cirrhosis (stage I) during therapy under ursodeoxycholic acid. It has to be discussed whether certain early stages of primary biliary cirrhosis with benign antimitochondrial antibody-profile (anti-M9: positive) respond well to long-term treatment with ursodeoxycholic acid.

Bile Ducts, Intrahepatic↗