Treatment of pseudotumor cerebri by primary and secondary optic nerve sheath decompression.
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Humans↗
Biomedical subjects
R L Anderson
Publications and source records attributed to R L Anderson.
Thermotolerance in the absence of induced heat shock proteins in a murine lymphoma.
Three murine lymphoma cell lines, CH1, a B-cell lymphoma, and VL3 and RDM4, both T-cell lymphomas, were tested for their ability to induce heat shock protein synthesis and thermotolerance after heat shock. All three lines could develop thermotolerance, but the persistence of tolerance was less than can be measured in nonlymphoid cell lines. Analysis of protein synthesis patterns by one-dimensional gel electrophoresis suggested that only the VL3 cells were capable of the induction of heat shock proteins. After two-dimensional gel analysis, however, the induction of one heat shock protein was evident in RDM4 cells. No induced heat shock proteins could be detected in the CH1 cells. These data provide strong evidence that, while the induction of heat shock proteins may be sufficient for development of thermotolerance, they are not necessary and that another mechanism is available to cells.
Animals↗
The toxicity of purified cellulose in studies with laboratory animals.
The available literature has been reviewed for studies in laboratory animals using purified cellulose, as the production of purified cellulose may result in trace organochlorine contamination. The chronic ingestion of purified cellulose over the entire lifespans in rats and mice does not result in any increase in spontaneous disease or neoplasia. Further, purified cellulose does not display promotional activity in the mammary gland, the colon, or the bladder of rats and does not significantly alter the absorption or the metabolism of dietary components. No adverse effects were found on reproduction or neonate development in rats and mice. Therefore, no adverse health effects in humans are expected from exposure to purified cellulose.
Animals↗
Warfarin necrosis.
Skin and subcutaneous tissue necrosis is a rare complication of warfarin therapy. Although the incidence is low, with increased use of warfarin family physicians need to be aware of this potentially catastrophic event. This article reviews the history of warfarin necrosis and discusses its clinical presentation. The histologic findings with necrosed lesions are described, with emphasis on the possible pathogenesis of this disorder. Treatment options based on existing clinical experience as outlined in the literature are discussed.
Humans↗
Peroxidase-amplified assay of sialidase activity toward gangliosides.
Sialidase assays were carried out with the substrate, ganglioside GD1a, coated onto enzyme immunoassay plate wells. Following the incubation of GD1a with sialidase from V. cholerae, the amount of ganglioside GM1 produced was measured as follows: cholera toxin B subunit conjugated to horseradish peroxidase was added to specifically bind to GM1, and then the amount of bound peroxidase was determined in a colorimetric enzymatic assay. In the absence of detergent, linearity for the detection of GM1 was 0 to 0.5 pmol per well, and the sensitivity for sialidase detection was about 3 fmol of product formed per minute. The addition of detergent (Triton CF-54) to the assay reduced the sensitivity and increased the amount of substrate required. Application of this assay for the detection of cell-derived neutral (pH 6.5) sialidase activities in the conditioned medium of human skin fibroblasts is described.
Chromatography, Gel↗
Complications associated with alloplastic implants used in orbital fracture repair.
BACKGROUND: The treatment of orbital wall fractures involves observation and/or surgical reduction with repositioning of herniated orbital tissues. To prevent reherniation of tissue and development of enophthalmos, the orbital floor or wall defect is commonly covered with an alloplastic implant. Complications associated with these implants are infrequent and generally appear as isolated case reports. METHODS: The authors reviewed the files of four consultative oculoplastic surgeons and searched for individuals with complications secondary to their alloplastic implants used during orbital fracture repair. FINDINGS: Seventeen patients were identified with a variety of complications related to their alloplastic implant. CONCLUSION: Although these implants are relatively inert and develop a fibrous capsule walling them off from the surrounding orbit, they remain foreign bodies and are thus subject to possible complications at any time. The authors review the spectrum of complications occurring with various alloplastic implants.
Adult↗
The Thomas shunt revisited.
During a 10-year period, 57 external Thomas femoral shunts (TS) were placed in 43 patients for chronic hemodialysis access. Median shunt survival was 28 months (range, 0.5 to 132). Sixty-three percent (36/57) of shunts are presently functional or functioned until the time of patient death from unrelated cause or removal after renal transplantation. The remaining 37% (21/57) failed after a mean duration of 18 months (range, 2 to 40). Causes of failure were thrombosis (57%), refractory infection (24%), and failure during surgical revision (19%). There were no shunt-related deaths. Race, sex, the presence of diabetes mellitus or hypertension, and prior surgical revision of access did not adversely affect shunt survival. These results support the TS as a viable means of chronic vascular access for hemodialysis patients who cannot receive further upper arm accesses.
Adult↗
A cluster of severe postoperative bleeding following open heart surgery.
OBJECTIVE: To investigate a cluster of postoperative bleeding following open heart surgery. DESIGN: A cohort and case/control study. SETTING: Palo Alto Veterans Administration Medical Center, Palo Alto, California. PARTICIPANTS: Six (21.4%) of 28 patients undergoing open heart surgery who developed severe, nonsurgical, postoperative bleeding from July 1 through August 30, 1988 (outbreak period). All case-patients had chest tube drainage of greater than or equal to 1000 ml within 4 hours of surgery but did not have identifiable bleeding vessel(s) on exploration. RESULTS: Upon comparison of the pre-outbreak (January 1986 through June 1988) and the outbreak period, a significant increase was found in the incidence of postoperative nonsurgical bleeding (5/440 versus 6/28, p = .0006), but not of postoperative surgical bleeding (8/440 versus 0/28, p = 1.0). Of all patients undergoing open heart surgery during the outbreak period, case patients were found to be older (67.8 versus 60.6, p = .02) and to have received a larger volume of hetastarch (HES), a synthetic colloidal plasma-volume expander (mean = 19.4 ml/kg versus 14.1 ml/kg, p = .02). CONCLUSIONS: We conclude that the use of large volumes of HES during surgery in the elderly open heart surgery patient may increase the risk for severe, nonsurgical postoperative bleeding, probably caused by alterations of the coagulation system. As the incidence of open heart surgery increases among the elderly, surgeons and anesthesiologists should be alert to possible adverse reactions from exposures not associated with adverse reactions in younger patients.
Aged↗
Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia.
In 1989 we investigated the first instance of Pseudomonas cepacia infections due to intrinsic contamination of a povidone-iodine product. Six patients in a Texas pediatric facility had P. cepacia infection or pseudoinfection (three, peritonitis; one, pseudoperitonitis; and two, pseudobacteremia). Epidemiological studies showed one risk factor for infection of peritoneal fluid with P. cepacia: performance of peritoneal dialysis in the dialysis unit with use of one lot of povidone-iodine later found to be intrinsically contaminated (4/5 vs. 0/16, P = .001). Blood cultures yielded P. cepacia after nurses wiped the tops of blood culture bottles with the povidone-iodine solution before inoculation. P. cepacia was cultured from three povidone-iodine containers used at the hospital and from four containers of the same lot obtained from other health-care facilities in Texas and California. Isolates from patients and the povidone-iodine had similar antibiograms, identical plasmid profiles, and identical DNA banding patterns on the basis of results of ribonucleotide typing. This investigation demonstrates that intrinsic contamination of povidone-iodine solution with P. cepacia can result in infections in addition to colonization and/or pseudoinfection.
Bacteremia↗
Therapeutic bioequivalency study of brand name versus generic carbamazepine.
We performed a randomized double-blind crossover therapeutic bioequivalency study of a generic (Epitol) versus a brand name (Tegretol) carbamazepine product under steady-state conditions in 40 epileptic patients. Each patient received 90-day supplies of Epitol or Tegretol and placebo, which replaced the usual dosage of the alternate product. Group A consisted of 20 seizure-free (from 5 months to 2 years) patients and group B of 20 patients with seizures refractory to drug therapy. In group A, four patients had seizures, two on both Epitol and Tegretol and two on Tegretol. In group B, the average seizure frequencies were 0.25 seizures per day on Epitol and 0.22 seizures per day on Tegretol. Average seizure frequencies were statistically the same (at a 20% difference, p less than 0.05). Areas under the curve were statistically the same (at a 20% difference, p = 0.05). Average peak heights were statistically the same (at a 20% difference, p less than 0.05). Average time to peak was earlier with Epitol. Epitol and Tegretol performed equally well in clinical efficacy and bioequivalency.
Adolescent↗
Pulse oximetry: would further technical alterations improve patient outcome?
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Humans↗
A comparison of three pulmonary artery oximetry catheters in intensive care unit patients.
OBJECTIVE: To compare the clinical performance of three pulmonary artery oximetry catheters (Oximetrix 3, SAT-2, and HEMOPRO2) in intensive care unit (ICU) patients. DESIGN: Unblinded comparison of performance over 24 h using an IL-282 CO-oximeter as a criterion standard. SETTING: Multispecialty adult ICU at a university teaching hospital. PATIENTS: Thirty critically ill patients selected from those requiring hemodynamic monitoring for medical management. MEASUREMENTS AND MAIN RESULTS: By all measures, performance of the Oximetrix 3 and SAT-2 systems were comparable; bias +/- precision were -1.98 +/- 3.07 and +1.80 +/- 3.49, respectively, vs -2.28 +/- 5.24 for the HEMOPRO2. The Oximetrix 3 and SAT-2 systems demonstrated consistent performance over the range of saturations tested, though Oximetrix 3 tended to underestimate and SAT-2 tended to overestimate the CO-oximeter value. The HEMOPRO2 underestimated the CO-oximetry-derived saturation, although this was not constant across the range of values tested. The 95 percent confidence limits based on intrasubject variability were similar (+/- 4.59, +/- 5.66, and +/- 6.56 for the Oximetrix 3, SAT-2, and HEMOPRO2, respectively); however, the 95 percent confidence limits based on total variability, while similar for Oximetrix 3 (+/- 6.03) and SAT-2 (+/- 6.86), were larger for the HEMOPRO2 (+/- 10.30). The expected SD was similar for the three systems (2.03, 2.50, and 2.90 for the Oximetrix 3, SAT-2, and HEMOPRO2 systems, respectively). None of the systems equaled or exceeded (p greater than 0.05) the manufacturers' published specifications, which, in all cases, are listed as +/- 2 percent (saturation; 1 SD) when compared with bench oximetry. CONCLUSIONS: Although each system measures mixed venous oxygen saturation, the Oximetrix 3 and SAT-2 systems demonstrate closer agreement with CO-oximetry. However, none of these catheters provided statistically significant evidence that they would perform within +/- 2 percent of CO-oximetry. As a continuous monitor used to detect changes or trends, any of the three may be acceptable.
Calibration↗
The epidemiology of low back pain in an adolescent population.
We assessed the prevalence of low back pain (LBP) in a cohort of 1242 adolescents (aged 11 through 17) currently participating in a 4-year prospective study of medically treated injuries. Overall, 30.4% of the adolescents reported LBP. The impact of LBP in adolescents was considerable, with one third resulting in restricted activity and 7.3% seeking medical attention. Life-table analysis demonstrated that by age 15, the prevalence of LBP increased to 36%. There were few differences by gender or race. These results suggest that LBP in adolescents is a serious public health problem.
Absenteeism↗
Cosmetic eyelid surgery and the problem eyelid.
The human eyelid is an amazingly complex structure that is responsible for protecting, moisturizing, and reconstituting the external surface of the eye. Compromise of any of the tarsoligamentous supporting structures of the eyelids can result in eyelid malposition, corneal compromise, and even blindness. Failure to recognize these abnormalities in patients seeking cosmetic eyelid surgery can lead to disastrous results. The most common structural eyelid abnormalities encountered in patients seeking cosmetic eyelid surgery and prophylactic and reconstructive surgical techniques to deal with these difficult problems are discussed.
Eyelids↗
Modifications to the semicircular flap technique in eyelid reconstruction.
The most common reconstructive procedure in the upper and lower eyelid is direct closure of the lid margin. When additional mobilization of tissue is needed to close a defect, lateral canthotomy and cantholysis is suggested. Mobilization of tissue beyond the lateral orbital rim is occasionally required. We have found that in the lower eyelid the mobilized tissue is much better supported if the initial incision is made vertically toward the eyebrow rather than temporally, as is suggested with the semicircular flap technique. We describe modifications to this technique, which we refer to as the vertical-temporal advancement flap, and present the results in 28 consecutive patients followed for 8 months to 3 years.
Eyelid Neoplasms↗
The pigtail probe protected by silicone intubation: a combined approach to canalicular reconstruction.
We have devised a method of single-eyelid canalicular reconstruction using the pigtail probe to facilitate identification of the proximal canalicular segment following silicone stent intubation of the normal, uninjured canaliculus. A series of seven acute and two long-standing canalicular lacerations were successfully reconstructed using this technique, which minimizes the risks associated with the use of the pigtail probe.
Eye Injuries↗
Decentralized operating room pharmacy services in a military teaching hospital.
The development, initiation, and evaluation of a decentralized pharmacy satellite within the operating room, requiring neither additional capital funding nor any major construction, is described. The satellite offers numerous programs to aid the operating room staff. Included in this effort is the complete management of all controlled substances within the operating room, post-anesthesia-care unit, and same-day-surgery unit. Pharmacists function as pharmaceutical resources playing a major role in the pain service unit. Success of the satellite is assessed via a number of parameters including staff survey response, quality assurance impact, and inventory management.
California↗
Hypoxia and resistance to hydrogen peroxide confer resistance to tumor necrosis factor in murine L929 cells.
The mechanism whereby tumor necrosis factor (TNF) kills mammalian cells is not well understood, although oxidative damage has been suggested by several investigators. Further, it is not known why cells vary in their responsiveness to TNF. We show that the cytotoxic effect of TNF toward TNF-sensitive L929 cells is blocked under hypoxic conditions, suggesting a critical role of molecular oxygen and reactive oxygen species. To test whether cellular resistance to reactive oxygen species could provide resistance to TNF, we derived a variant strain from L929 cells by chronic exposure to an oxidizing agent, hydrogen peroxide (H2O2). These cells exhibit marked resistance to TNF as well as to H2O2. This cross-protection provides additional evidence that mechanisms of resistance to oxidative damage are causally related to TNF-induced cell death. Scatchard analysis of TNF binding did not reveal significant differences between the H2O2-resistant line and the wild-type L929 line. On the other hand, analyses of antioxidant enzymes and glutathione levels in cells of the wild-type and the H2O2-resistant lines revealed several potentially important differences. Before exposure to TNF, the H2O2-resistant variants have elevated catalase activity, decreased activity of total glutathione-S-transferase (GST), and similar superoxide dismutase (SOD) activities. Exposure to TNF led to alteration in CuZnSOD activity, and much more so in the variants than in the wild-type L929 cells. However, no significant change in MnSOD activities in cells of either cell line was observed. Total GST activity was not altered appreciably by TNF in either cell line, but Western analysis showed that the level of alpha GST isozyme was increased and mu GST isozyme decreased in the H2O2-resistant variants. Furthermore, alterations in total glutathione content were observed in both the control and the variant cells.
Animals↗