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Biomedical subjects

R M Moore

Publications and source records attributed to R M Moore.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

The adenylate cyclase system and prostaglandin production in human decidua parietalis.

We studied the beta-adrenergic system in the human decidua and its effect on prostaglandin E2 and F2a release from dispersed decidual cells in culture. Beta-adrenergic receptors in decidual membranes were partially characterized using (+)[125I]HYP. Specific binding was demonstrated with maximum binding capacity (Bmax) of 70 +/- 10.6 fmol/mg and an affinity (KD) of 20.85 +/- 1.86 pmol. cAMP dependent phosphoproteins in decidual cytosol were also identified. Two phosphoproteins of M(r) 42,000 and 22,000 were seen in all preparations. Three others (M(r) 39,000, 23,000 and 21,000) were identified in only some of the preparations. Phosphoproteins of similar M(r) to those seen in cytosol prepared from decidual homogenates were also identified in cytosol of cultured decidual cells. Phosphorylation of the 42,000 M(r) and 22,000 M(r) proteins was maximal (3.04 +/- 0.35-fold and 5.7 +/- 0.68-fold) with 10(-6) M cAMP. Cultured decidual cells produced prostaglandin E2 and F2a which increased in a dose-dependent manner in response to dbcAMP, forskolin or isoproterenol. The decidua contains an intact beta-adrenergic system that, when activated, is capable of phosphorylating specific proteins and modulating prostaglandin release.

Adenylyl Cyclases↗
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Cyclooxygenase inhibitors decrease apoptosis initiated by actinomycin D, cycloheximide, and staurosporine in amnion-derived WISH cells.

Apoptosis is a process by which external or developmental factors induce a specific series of events leading to cell death. Recently, apoptotic cells have been described in rat amnion membrane at late gestation, suggesting apoptosis may be involved in membrane rupture. Mechanisms controlling amnion cell apoptosis are unknown. The objective of this study was to investigate whether cyclooxygenase and prostaglandins are integral to apoptosis in amnion, as reported in intestinal epithelial cells and renal mesangial cells. Amnion-derived WISH cells underwent apoptosis in a dose- and time-dependent manner after incubation with actinomycin D, cycloheximide, or staurosporine, as determined by cell viability, DNA fragmentation analysis, and fluorescent in situ fragmentation analysis. Cells cultured with increasing doses of these agents also demonstrated concomitant increases in prostaglandin E2 output. WISH cell coincubation with these agents and the cyclooxygenase inhibitors indomethacin or piroxicam resulted in dose-dependent decreases in both prostaglandin E2 and apoptosis. Cultures incubated with 0.5 microgram/mL actinomycin D showed 80.7% cell apoptosis after 12 hours compared with 1.1% in untreated cultures. After 24 hours incubation with actinomycin D, 0.8% of the original cell number remained attached to the plate. In cultures coincubated with 0.5 microgram/mL actinomycin D and 100 mumol/L indomethacin, only 19.2%, 24.7%, and 39.3% of the cells were found to be apoptotic after 12, 24, and 48 hours in culture, respectively. Similar trends were observed after the use of cycloheximide or staurosporine in combination with indomethacin or prioxicam. These data suggest that cyclooxygenase and/or prostaglandins play a role in programmed cell death of amnion-derived WISH cells in culture.

Amnion↗
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Cecal amputation within the right ventral colon for surgical treatment of nonreducible cecocolic intussusception in 8 horses.

OBJECTIVES: To report a surgical technique for treatment of nonreducible cecocolic intussusception and outcome in 8 horses. STUDY DESIGN: Retrospective study. ANIMALS: Eight horses with nonreducible cecocolic intussusception treated by cecal amputation through a right ventral colotomy. METHODS: Data were obtained from medical records and telephone conversations by using a standardized questionnaire. The large colon was exteriorized and, if necessary, evacuated of its contents through a pelvic flexure enterotomy. A second colotomy was made on the ventral surface of the right ventral colon (RVC) centered over or immediately distal to the intussusceptum. In most horses, attempts to manually reduce the intussusception by pushing the cecum from within the RVC through the cecocolic orifice were unsuccessful. Invaginated cecum was then pulled into the RVC and amputated; the cecum was either ligated with umbilical tape or sutured proximal to the site of amputation. After amputation, the remainder of the invaginated cecum was reduced. After further resection to healthy tissue, the typhlectomy was closed with a double-inverting suture pattern. RESULTS: The median horse age was 2 years (range, 1 to 8 years). Duration of colic ranged from 6 hours to 6 months. Median surgical time was 180 minutes (range, 135 to 300 minutes). Median duration of antibiotic therapy was 7 days (range, 5 to 14 days). Median duration of hospitalization was 12 days (range, 6 to 21 days). All horses survived to hospital discharge. One horse died 3 months postoperatively; however, the remainder survived (median survival, 30 months; range, 6 to 96 months) and returned to or exceeded previous function. CLINICAL RELEVANCE: Despite some contamination during surgery, horses with nonreducible cecocolic intussusception that underwent this method of surgical treatment had a good prognosis.

Animals↗
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Physiological apoptotic agents have different effects upon human amnion epithelial and mesenchymal cells.

Foetal membrane rupture is thought to follow from gene-controlled tissue remodelling and apoptosis. We reported previously that staurosporine, cycloheximide, actinomycin D, as well as more physiological apoptotic agents (lactosylceramide, 15d-PGJ(2)) increase prostaglandin release in parallel with induction of apoptosis in WISH and amnion epithelial cells. Also, inhibition of prostaglandin release by cyclooxygenase inhibitors or PKA activators is accompanied by a parallel decrease in apoptosis. We hypothesize that amnion prostaglandin metabolism is linked with apoptosis in amnion epithelial cells and thus to membrane rupture. Amnion mesenchymal cells are also critical for membrane integrity. Their susceptibility to apoptotic agents is unknown and is the subject of this report. In amnion epithelial cells, lactosylceramide (125 microM) induced 6.5-fold, 20-fold increases in PGE(2) and NMP production (apoptosis), respectively. Conversely, in mesenchymal cells, lactosylceramide doses up to 200 microM had no effect on PGE(2) or NMP release. In both cell types, incubation with 15d-PGJ(2) (5-100 microM) demonstrated dose and time dependent increases in PGE(2) and NMP. PKA activators inhibited 15d-PGJ(2) induced PGE(2) release and apoptotis in epithelial cells, but not in mesenchymal cells, however. Major amnion cell types have different sensitivities to physiological apoptotic agents. Prostaglandin release occurs coincident with apoptosis in both amnion epithelial and mesenchymal cells.

8-Bromo Cyclic Adenosine Monophosphate↗
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Surveillance of animal-bite cases in the United States, 1971-1972.

In January 1971, the Center for Disease Control (CDC) initiated a national animal-bite surveillance program in cooperation with 15 health jurisdictions that agreed to submit data to the center. During the 2-year surveillance period (1971-1972), 196,684 animal-bite cases were reported from the 15 reporting areas. An animal-bite case was defined as any biting of a person by an animal reported to CDC by a participating health department. Data pertaining to some factors associated with animal bites were reported, including the age and sex of the bitten person, the species of the biting animal, and, in some areas, the status of the biting animal with respect to vaccination against rabies.

Age Factors↗
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Effect of hypercapnia or xylazine on lateral ventricle and lumbosacral cerebrospinal fluid pressures in pentobarbital-anesthetized horses.

Facial artery pressure, central venous pressure, heart rate, and lateral ventricle cerebrospinal fluid (CSF) pressure (LV-CSFP) were measured in 10 pentobarbital-anesthetized horses at arterial partial pressure of carbon dioxide (PaCO2) values of 40, 60, and 80 mm Hg, produced by varying the inspired carbon dioxide concentration. Variables were recorded at 5-minute intervals for 15 minutes at each level of PaCO2. Arterial blood gas analysis was performed at the end of the 15-minute time period for each level of PaCO2. Lateral ventricle CSF pressure was significantly increased (p < .05) at a PaCO2 of 80 mm Hg. Cardiovascular variables were not significantly changed by changing PaCO2. The PaCO2 was returned to 40 mm Hg; 1.1 mg xylazine/kg body weight was injected intravenously in eight horses, and data were collected for 60 minutes. No significant changes were observed. No changes were observed in two control horses not receiving xylazine. Subsequently, placement of a lumbosacral subarachnoid catheter allowed simultaneous measurement of LV-CSFP and lumbosacral CSF pressure (LS-CSFP) at PaCO2 values of 40, 60, and 80 mm Hg. The Pearson Correlation Coefficient between LV-CSFP and LS-CSFP was 0.94 (p < .0001) It was concluded that changes in CSF pressure could be detected at the lateral ventricle and the lumbosacral space; increasing PaCO2 to 80 mm Hg resulted in significant increases in LV-CSFP; xylazine does not increase LV-CSFP in pentobarbital-anesthetized, normocapnic horses; and under the conditions of this experiment, LV-CSFP and LS-CSFP were closely correlated.

Anesthesia, Intravenous↗
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Colonic luminal pressure in horses with strangulating and nonstrangulating obstruction of the large colon.

Colonic luminal pressure (median, range) measured during ventral midline celiotomy in 69 horses with strangulating obstruction (SO) of the large colon (SO; > or = 270 degrees large colon volvulus; 27 cm H2O: 2 to 80 cm H2O) was greater (P = .0023) than that measured in 37 horses with nonstrangulating obstruction (NSO) of the large colon (NSO; < or = 180 degrees volvulus or a nonstrangulating displacement; 18 cm H2O; 6 to 46 cm H2O). Sixty-five percent (45 of 69) of horses with SO and all horses with NSO survived. Survival analysis was restricted to 59 horses with large-colon SO that survived to hospital discharge or met the criteria specified for classification as nonsurvivors. Colonic luminal pressure in nonsurvivors (48.5 cm H2O; 34 to 80 cm H2O) was higher (P =.0001) than that measured in survivors (18 cm H2O; 2 to 50 cm H2O) of SO. From response operating characteristic curves, a luminal pressure of 38 cm H2O optimized the distribution of horses with SO into survivor and nonsurvivor groups. Sensitivity, specificity, and positive and negative predictive values for a colonic luminal pressure greater than 38 cm H2O in predicting nonsurvival were 0.89, 0.91, 0.72 and 0.97, respectively. Measurement of colonic luminal pressure may be useful for predicting survival in horses with colonic volvulus.

Animals↗
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Role of endothelium and nitric oxide in the response of equine colonic arterial rings to vasoconstrictor agents.

OBJECTIVE: To determine the in vitro contractile responses of equine colonic arteries to angiotensin II, histamine, serotonin, norepinephrine, prostaglandin F2 alpha, vasopressin, and a thromboxane-B2-analogue. STUDY DESIGN: The tension generated in colonic arterial rings placed in organ baths with oxygenated Tyrode's solution at 37 degrees C after exposure to the previously mentioned chemical agents was measured using force-transducers interfaced with a polygraph. SAMPLE POPULATION: Large colon arterial rings collected from eight horses. METHODS: The rings were allowed to equilibrate for 45 minutes after applying 2 g tension. Bath solution was replaced and tension reapplied at 15-minute intervals. Cumulative-concentration-responses were determined for concentrations ranging from 10(-8) M to 10(-4) M on three vessel groups namely endothelium intact, endothelium denuded, and L-NAME treated. The maximal response for each vessel was considered as 100%; responses to lower concentrations were calculated as a percentage of the maximum. The EC50 value was determined for each concentration-response relationship of each agent. RESULTS: Vessels with denuded endothelium or those incubated with L-NAME had greater contractile responses. Angiotensin, histamine, serotonin, and norepinephrine produced greater maximal responses than the other agents. Endothelium denuded rings had lower EC50 values. Responses to norepinephrine and serotonin were affected less by denudation. CONCLUSIONS: Endothelium plays an important role in modulating responses of colonic arterial rings to contractile agents. Endothelium-derived vasodilators, other than nitric oxide, may modulate contractile responses of equine colonic arteries. CLINICAL RELEVANCE: Endothelial damage associated with colonic vovulus may be a major factor for sustained reduced perfusion after surgical correction.

Angiotensin II↗
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Effect of platelet-activating factor antagonist L-691,880 on low-flow ischemia-reperfusion injury of the large colon in horses.

OBJECTIVE: To determine the effect of platelet-activating factor (PAF) antagonist L-691,880 on low-flow ischemia and reperfusion (I-R) of the large colon in horses. ANIMALS: 12 adult horses. EXPERIMENTAL DESIGN: Horses were anesthetized, and the large colon was exteriorized through a ventral median celiotomy and instrumented. Colonic arterial blood flow was reduced to 20% of baseline (BL) and maintained for 3 hours; flow was then restored, and the colon was reperfused for 3 hours. One of two solutions was administered intravenously 30 minutes before reperfusion: group 1, 10 mL/kg 0.9% NaCl; and group 2, 5 mg/kg PAF antagonist L-691,880 in 0.9% NaCl. Hemodynamic variables were monitored and recorded at 30-minute intervals. Systemic arterial and colonic venous blood were collected for measurement of blood gas tensions, oximetry analyses, packed cell volume, and total plasma protein concentrations. Colonic venous blood was collected for determination of lactate, 6-keto prostaglandin F1 alpha (6-kPG), prostaglandin E2 (PGE2), and thromboxane B2 (TXB2) concentrations. Full-thickness biopsy specimens were harvested from the left ventral colon for histological evaluation. RESULTS: There were no significant differences between the two groups for any hemodynamic or metabolic variables. Colonic venous pH decreased, and carbon dioxide tension and lactate concentration increased during ischemia but returned to BL values during reperfusion. Colonic venous 6-kPG concentration was significantly increased above BL value at 2 hours and remained increased through 6 hours in horses of both groups. Colonic venous PGE2 concentration was significantly greater in group 2 compared with group 1 throughout the study. Colonic venous PGE2 concentration was increased above BL value from 3 to 6 hours in horses of both groups. Colonic venous TXB2 concentration was not different between groups but was significantly increased above the BL value for the first hour of reperfusion. Low-flow I-R of the large colon caused significant mucosal necrosis, hemorrhage, edema, and neutrophil infiltration; however, there were no differences in histological variables between vehicle-control and PAF antagonist-treated horses. CONCLUSION: No protective effects of PAF antagonist L-691,880 were observed on colonic mucosa associated with low-flow I-R. Additionally, deleterious drug-induced effects on hemodynamic and metabolic variables and colonic mucosal injury were not observed.

6-Ketoprostaglandin F1 alpha↗
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In vitro pullout strength of screws inserted in adult equine third metacarpal bone after overdrilling a 4.5-mm threaded insertion hole.

OBJECTIVE: To determine and compare the in vitro pullout strength of 5.5-mm cortical versus 6.5-mm cancellous bone screws inserted in the diaphysis and metaphysis of adult equine third metacarpal (MCIII) bones, in threaded 4.5-mm cortical bone screw insertion holes that were then overdrilled with a 4.5-mm drill bit to provide information relevant to the selection of a replacement screw if a 4.5-mm cortical screw is stripped. STUDY DESIGN: In vitro pullout tests of 5.5-mm cortical and 6.5-mm cancellous screws in equine MCIII bones. SAMPLE POPULATION: Two independent cadaver studies each consisting of 14 adult equine MCIII bones. METHODS: Two 4.5-mm cortical screws were placed either in the middiaphysis (study 1) or distal metaphysis (study 2) of MCIII bones. The holes were then overdrilled with a 4.5-mm drill bit and had either a 5.5-mm cortical or a 6.5-mm cancellous screw inserted; screw pullout tests were performed at a rate of 0.04 mm/second until screw or bone failure occurred. RESULTS: In diaphyseal bone, the screws failed in all tests. Tensile breaking strength for 5.5-mm cortical screws (997.5 +/- 49.3 kg) and 6.5-mm cancellous screws (931.6 +/- 19.5 kg) was not significantly different. In metaphyseal bone, the bone failed in all tests. The holding power for 6.5-mm cancellous screws (39.1 +/- 4.9 kg/mm) was significantly greater than 5.5-mm cortical screws (23.5 +/- 3.5 kg/mm) in the metaphysis. There was no difference in the tensile breaking strength of screws in the diaphysis between proximal and distal screw holes; however, the holding power was significantly greater in the distal, compared with the proximal, metaphyseal holes. CONCLUSIONS: Although tensile breaking strength was not different between 5.5-mm cortical and 6.5-mm cancellous screws in middiaphyseal cortical bone, holding power of 6.5-mm cancellous screws was greater than 5.5-mm cortical screws in metaphyseal bone of adult horses. CLINICAL RELEVANCE: If a 4.5-mm cortical bone screw strips in MCIII diaphyseal bone of adult horses, either a 5.5-mm cortical or 6.5-mm cancellous screw, however, would have equivalent pullout strengths. A 6.5-mm cancellous screw, however, would provide greater holding power than a 5.5-mm cortical screw in metaphyseal bone.

Animals↗
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Mechanisms of gastrointestinal ischemia-reperfusion injury and potential therapeutic interventions: a review and its implications in the horse.

Restoration of blood flow after a period of intestinal ischemia is necessary to maintain cell function and viability; however, the reintroduction of oxygen can initiate a cascade of events that exacerbates tissue injury. Intestinal I-R injury is manifested as increased microvascular and mucosal permeability, and mucosal necrosis. Reperfusion injury begins with the accumulation of hypoxanthine from ATP metabolism and the conversion of XDH to XO during ischemia. Upon reperfusion, the XO catalyzes the conversion of hypoxanthine to superoxide radicals in the presence of oxygen. Superoxide radicals are further reduced to highly reactive hydroxyl radicals, which initiate lipid peroxidation. Lipoperoxidation causes functional and structural alterations in cell membrane lipids and can release numerous inflammatory mediators, which exacerbate tissue damage. Neutrophils are recruited into tissues during ischemia and on reperfusion; then they undergo degranulation and release destructive products (proteases and OFRs), which mediate further tissue injury. A limited number of experimental studies in the gastrointestinal tract of horses have shown I-R injury. Additional studies are necessary to further elucidate and sequence the precise pathophysiologic mechanisms occurring in the equine intestine during I-R. Therapy should be focused on prevention of I-R injury by pharmacologic or chemical inhibition or modification of these pathophysiologic pathways. Selected pharmacologic agents or drug combinations may offer novel, scientifically relevant and yet practical approaches to alleviating intestinal I-R injury in horses. This may improve survival of horses with naturally acquired intestinal strangulation obstruction.

Animals↗
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Duration of effects of phenylbutazone on serum total thyroxine and free thyroxine concentrations in horses.

The objectives of this study were to determine if phenylbutazone decreased serum thyroxine (TT4) and free thyroxine (FT4) concentrations using radioimmunoassay and equilibrium dialysis techniques in horses, and, if so, an additional objective was to determine the duration of this decreased concentration once phenylbutazone administration was discontinued. Serum TT4 and FT4 concentrations were determined before and after administration of 4.4 mg/kg of phenylbutazone i.v. bid for 5 days. Treatment with phenylbutazone caused a significant decrease in TT4 and FT4 concentrations (P < .05). Serum TT4 concentration significantly decreased after day 4 of treatment and remained significantly below baseline value for 10 days after discontinuing phenylbutazone administration; it returned to a value not different from the baseline value by the 11th day. Serum FT4 concentration significantly decreased after day 4 of treatment and remained significantly below the baseline value for only 1 day after phenylbutazone administration was discontinued; it returned to a value not different from the baseline value by the 3rd day after discontinuation of phenylbutazone. These results indicate that serum TT4 and FT4 should not be used to evaluate thyroid function in horses receiving phenylbutazone. In addition, results should be interpreted cautiously when phenylbutazone has been administered within 2 days (for FT4) or within 10 days (for TT4) of sample collection.

Animals↗
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Use of diagnostic imaging procedures and fetal monitoring devices in the care of pregnant women.

Medical devices and diagnostic imaging procedures such as ultrasound, X-rays, and electronic fetal monitoring devices are used in the medical care of many pregnant women today. The responsibility for the safety and effectiveness of these diagnostic technologies is shared by a number of Public Health Service agencies, one of which is the Center for Devices and Radiological Health (CDRH), a unit within the Food and Drug Administration. The CDRH collaborated with the National Center for Health Statistics (NCHS) in conducting a study of recent trends in the uses of diagnostic ultrasound, medical X-rays, and electronic fetal monitoring devices in the medical care of pregnant women. This study used data from the 1980 National Natality and Fetal Mortality Surveys and the 1987 pretest to the National Maternal and Infant Health Survey. Hospitals and prenatal care providers of the pregnant women contributed information regarding the use of these medical devices. Between 1980 and 1987, ultrasound use more than doubled, increasing from 33.5 percent of pregnancies in 1980 to 78.8 percent in 1987 (P less than 0.001). More ultrasound examinations were performed earlier in gestation in 1987 than in 1980, with 10.1 percent being performed during the first trimester in 1987, compared with 6.9 percent in 1980 (P less than 0.001). Use of external electronic fetal monitoring devices during delivery also increased significantly between 1980 and 1987, from 33.5 percent to 74.6 percent (P less than 0.001). Use of medical X-rays among women with live births remained relatively unchanged, 15.0 percent in 1980 and 15.3 percent in 1987 (P = .282). The implications of these trends are discussed.

Diagnostic Imaging↗
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Intraosseous ganglion of the ankle.

A case of ganglionic cystic defect in bone is presented with a review of the literature. This lesion is usually benign and found in close association with the articular cartilage of the distal metaphysis of long bones. Characteristic radiographic appearance of a ganglionic cyst is most often found eccentrically located at the end of a long bone, usually in the metaphyseal region of the tibia in young and middle aged adults. In addition to standard radiographs, other diagnostic radiographic studies such as CT (computerized tomographic) scanning or radionuclide bone imaging may be required to ascertain the extent of the lesion. Histopathologic information is derived from biopsy. Although its pathogenesis still remains unknown, surgical intervention is the most effective treatment. The purpose of this paper is to present a case of podiatric significance that grossly and histologically resembled a soft tissue ganglion, but within bone.

Adult↗
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Prevalence of artificial hip implants and use of health services by recipients.

Data from the 1988 Medical Device Implant Supplement to the National Health Interview Survey are used to summarize information about the prevalence of artificial hips among adults in the United States. The 1988 National Health Interview Survey was a cross-sectional survey of the civilian noninstitutionalized United States population, and included 122,310 persons in 47,485 households in a multistage probability sample. The supplement supplied the first population-based estimates of prevalence and morbidity of selected medical devices. Projected to the United States population, the survey results indicate that an estimated 674,000 adults were using 811,000 hip implants. Hip implant recipients were significantly more likely to be older, to be white, and to have lower educational, income, and activity levels than the general population of adults. After age-stratification, however, only differences in activity limitation and race remained. Current economic outlays for hip replacement surgery are substantial. With the aging population, use of health services by patients with artificial hips will probably increase unless measures to reduce the need for replacement surgery are instituted. These measures include reducing injuries and improving biomaterials. Further investigation is needed to examine the activity limitation and racial difference in prevalence found in this study.

Activities of Daily Living↗
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Venezuelan equine encephalitis vaccination survey in Arizona and New Mexico, 1972.

Field studies were conducted in 1972 to determine the immunization status of equines along the Mexico, Arizona, and New Mexico borders. Interviews with horse owners were conducted along roads selected at random in the counties of Santa Cruz and Yuma, Ariz., and in Dona Ana County, N. Mex. At least 450 horse owners in each county were asked about the vaccination status of their animals, and information was taken on 1,260 animals. Blood specimens were obtained from every third equine, regardless of stated vaccination status, and tested for the presence of Venezuelan equine encephalitis (VEE), western equine encephalomyelitis (WEE), and eastern equine encephalomyelitis (EEE) neutralization antibodies. Serum samples were collected from 446 equines in the 3-county area; only 227 (50.7 percent) had both a history of VEE vaccination in 1971 (including 20 vaccinated in 1972) and serum neutralization antibody against VEE. Of the remaining 220 with no detectable neutralization antibody to VEE, 197 (89.5 percent) had a history of VEE vaccination in 1971 (including 5 revaccinated in 1972), 14 (6.4 percent) had no history of vaccination, and 9 (4.1 percent) had an unknown vaccination status. Eighty-two percent (160 of 1971) of the equines with a history of VEE vaccination and presence of dectectable WEE or EEE antibodies, or both, had no detectable levels of VEE antibody. Therefore, the results of this study suggest that the presence of WEE or EEE antibodies, or both, may suppress the development of dectable vaccine-induced VEE antibody response in the equine. As a result of this investigation, the U.S. Department of Agriculture, as an added precaution, recommended the revaccination of equines in areas of the United States bordering Mexico.

Animals↗
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Cost of hospitalizations associated with sickle cell disease in the United States.

OBJECTIVE: This study estimated the number and cost of hospitalizations associated with sickle cell disease in the United States. METHODS: To estimate the number of hospitalizations per year in the United States of people with sickle cell disease, the authors used data for the years 1989 through 1993 from national hospital discharge surveys conducted by the National Center for Health Statistics. The authors derived cost estimates using data from a 1992 national hospital discharge survey conducted by the Agency for Health Care Policy and Research and a 1992 survey of physicians conducted by the American Medical Association. RESULTS: During the years 1989 through 1993, there were on average an estimated 75,000 hospitalizations per year of children and adults with sickle cell disease. The average direct cost per hospitalization (in 1996 dollars) was estimated at $6300, for a total direct cost of $475 million per year. In 66% of hospital discharge records, government programs were listed as the expected principal source of payment. CONCLUSIONS: The cost of hospitalizations associated with sickle cell disease is substantial. Because government programs pay most of this cost, further government-funded research to develop interventions that prevent complications of the disease has great potential for cost savings as well as for reducing the suffering of those afflicted with this painful genetic disorder. These national cost estimates contribute to an understanding of the impact of sickle cell disease and should be useful in establishing research priorities.

Adolescent↗