Biomedical subjects
R Weiner
Publications and source records attributed to R Weiner.
Evaluation of multi-allergen dipstick screening test.
In order to determine the diagnostic performance of the Quidel Allergen Screen (QAS), 43 patients characterized by standard skin prick test and intradermal testing for atopic sensitivity were evaluated, in parallel, using Phadebas RAST and QAS to detect the presence of serum IgE. The Quidel Allergen Screen and RAST were compared with the investigator's clinical assessment. The differences between QAS and RAST are not statistically significant. The QAS appears to be equal to the Phadebas RAST in sensitivity and specificity and thus offers a rapid, easily interpreted in vitro method for the detection of specific serum IgE.
[Clinico-experimental studies of the effect of the form of anesthesia on the postoperative small intestinal absorption].
The behaviour of the small bowel absorption in the immediate postoperative phase after cholecystectomy was tested in 20 patients by means of the modified D-xylose-test. Either the conventional insufflation anesthesia with halothane or the neuroleptic analgesia was used in 10 patients in each case. Characteristic changes of the small bowel absorption were provable after the operation. The postoperative restriction of the absorption was not changed statistically significantly in dependence on the different anesthesia methods. An absorption without restriction exists in both groups at the beginning of the 3rd post-operative day.
Cancer of the male breast with prolonged survival.
A retrospective review of patients suffering from male breast cancer was carried out at the Shands Teaching Hospital of the University of Florida. Thirteen evaluable cases were analyzed. Three patients were in Stage I, two patients in Stage II, none in Stage III, and eight in Stage IV. Two of the patients with Stage IV disease have had remarkably prolonged survivals of 194 months and 128 months. Such prolonged survivals are unusual. It is possible that the biology of male breast cancer is different from the female, and the disease should be approached more optimistically than it has in the past.
Assessment of global and regional left ventricular function in ischemic heart disease using ultrafast computed tomography.
Contrast-enhanced ultrafast computed tomography (CT) of the left ventricle was done in the long axis and short axis within one day of cardiac catheterization in 14 males with ischemic heart disease and a mean age of 58 years. Imaging was R wave-triggered at 58-msec intervals (13/level). Left ventriculography was performed in 30 degrees right anterior oblique (RAO) and 60 degrees left anterior oblique (LAO) caudal 12 degrees. CT left ventricular ejection fraction was measured using a modified Simpson's reconstruction of end-systolic and end-diastolic slices. Catheterization left ventricular ejection fraction was measured by area-length method. Six left ventricular segments (septal, apex, anterior, lateral, inferior, and posterior) were scored by different paired observers as follows: dyskinesis (-1), akinesis (0), moderate-severe hypokinesis (1), mild hypokinesis (2), and normal (3). Correlations of left ventricular ejection fraction for catheterization vs. long-axis CT and short-axis CT were r = .83 and r = .86, respectively. Seven of eight patients with transmural myocardial infarction were identified on CT by akinetic/dyskinetic segments. Eighty-four segments were scored. There was agreement (normal vs. abnormal) in 76 (90%). CT detected 47 normal segments vs. 51 by catheterization (92%), 11 akinetic/dyskinetic segments (92%), and 14 hypokinetic segments vs. 21 (67%). Wall motion scores between CT and catheterization differed by greater than 1 in 6 of 84 segments (7%). Therefore, ultrafast CT can accurately assess global and regional left ventricular function.
Activation of anterior pituitary folliculo-stellate cells in the formation of estrogen-induced prolactin-secreting tumors.
The response of folliculo-stellate (FS) cells of the anterior pituitary to estrogen has been studied in two strains of rat which differ in estrogen responsiveness. Fischer 344 (F344) rats are highly estrogen-responsive in comparison to Sprague-Dawley (S-D) rats. Ovariectomized adults were implanted with silastic capsules containing 17 beta-estradiol benzoate. Control and experimental animals were sacrificed 10 and 20 days after implantation of the silastic capsules. Most FS cells of F344 rats revealed dramatic changes, i.e. activation as phagocytes, after 10 and 20 days of estrogen treatment. These activated FS cells separated themselves from adjacent parenchymal cells and frequently contained phagosomes which included portions of granulated cells, mostly somatotrophs and lactotrophs. They also contained a variety of lysosomal dense bodies and dilated cisterns of endoplasmic reticulum. Endfeet processes abutting the parenchymal basal lamina contained large aggregates of dumbbell-shaped granules and tubulo-vesicles. Subjacent to the endfeet processes the basal lamina was often discontinuous, and profiles suggesting uptake of fragments of the basal lamina by FS cells were evident. Most FS cells of estrogen-treated S-D rats either were identical to those of controls or were only minimaly modified. However, a few activated FS cells were present and these contained a variety of lysosomal dense bodies and phagosomes, as well as lipid inclusions and dilated endoplasmic reticulum. Endfeet projections at the parenchymal basal lamina contained very few dumbbell-shaped granules or tubulo-vesicles, and the basal lamina was intact.(ABSTRACT TRUNCATED AT 250 WORDS)
Morphological evidence for the presence of arteries in human prolactinomas.
This study was undertaken to clarify the vascular anatomy of human prolactinomas and specifically to determine whether arteries were present. Sixteen prolactinomas were studied by electron microscopy. The presurgical diagnosis of the tumors as prolactinomas was based on the findings of hyperprolactinemia and radiographic abnormalities, and was confirmed by the electron microscopic features of the specimens as well as by immunocytochemical staining for PRL. In addition to the presence of fenestrated endothelial cells, which are characteristic of the normal capillaries of the anterior pituitary, 13 of the 16 prolactinomas contained arteries. These arteries ranged from well formed vessels with multiple layers of smooth muscle cells to abnormal terminal arterioles, i.e. vessels with fenestrated endothelium surrounded by a variable number of smooth muscle cells. Arteries were not found in anterior pituitaries from 8 patients with no pituitary disease. In the prolactinomas, smooth muscle cells also were found, either isolated in the pericapillary connective tissue space or in small cords some distance from the vessel lumen. The results suggest that vascular changes, including arteriogenesis, occur in prolactinomas (and possibly other types of pituitary tumor). The arteries entering the anterior pituitary directly could be congenital or develop during formation of the tumor. An arterial blood supply to a region of the anterior pituitary could result in the escape of that area from hypothalamic regulation, since systemic blood contains negligible levels of hypothalamic hormones. In the case of PRL-secreting cells, which are tonically inhibited by the hypothalamic hormone dopamine, this would result in hypertrophy, hyperplasia, and possibly tumorigenesis.
[Postoperative small intestine absorption--principles for enteral nutrition].
The intestinal absorption of nutrients is disturbed to an extent dependent on the degree of trauma in the immediate postoperative period. In a clinical study, the d-xylose absorption was investigated in 3 groups of patients after cholecystectomy. On the day of surgery a significant restriction of the absorption could be observed after intraduodenal administration. After gastric and duodenal administration of d-xylose and simultaneous enteral early nutrition a significant restriction of absorption could be observed on the day surgery was carried out. Optimal conditions for early nutrition can be achieved by combining intraduodenal feeding and a continuous decompression of the stomach. In cases of a gastric drainage an improvement of the postoperative absorptive function can be supported by the results of the nitrogen balance. In 4 pigs (type: country race) the step-by-step normalization of the absorptive kinetics could be demonstrated after catheters were implanted into the portal and subclavian veins.
Certification of pharmacists involved in pain management.
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[Ileus caused by ileocecal invagination of a leiomyofibroma].
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[Resorbate kinetics in the pre- and posthepatic blood compartment in the immediate postoperative phase in swine].
Catheters were implanted in the portal vein by the superior mesenteric vein in pigs for valuation of the absorbant kinetics of enterically applied substances in the mesenteric veins. The blood level kinetics after applying 10 g D-xylose into the jejunum was measured continuously simultaneously in the pre- and posthepatic blood compartment 6, 24, 36, 48, and 72 hours after the operative procedure. An enteric resorption of the pentose is provable already 6 hours after the operation, with their utter normalization in the next 36 hours. The differences between the pre- and the posthepatic concentration-time-graphs admits conclusions on the metabolism of the absorbant in the liver.
Estrogen-induced tumors: changes in the vasculature in two strains of rat.
The influence of estrogen on the vasculature of the pars distalis has been studied in two strains of rat that differ in estrogen responsiveness. (Fischer 344 rats are highly estrogen-responsive in comparison to Sprague-Dawley rats.) Ovariectomized adults were implanted with silastic capsules containing 17 beta-estradiol benzoate. Control and experimental animals were sacrificed 10 and 20 days after implantation of the silastic capsules. Pituitary weights and plasma prolactin were elevated dramatically in estrogen-treated Fischer rats in comparison to more moderate increases in Sprague-Dawley rats. Although both strains exhibited the hypertrophy of mammotrophs expected after estrogen stimulation, the vasculature in Fischer rats were dramatically altered from normal. The pars distalis of the 20-day, estrogen-treated Fischer rats contained well-formed arteries. In addition, capillaries frequently were disrupted, contributing to the formation of hemorrhagic lakes unlined by an endothelium. Even in intact capillaries, basal laminae delimiting the pericapillary spaces often were disrupted or absent. Perivascular connective tissue cells were prominent within the perivascular spaces and often contained numerous, large lysosomal dense bodies as well as clusters of small dumbbell-shaped bodies. These granule clusters also were apparent adjacent to the perivascular space within parenchymal cells, most frequently within follicular cells. The vasculature of Sprague-Dawley rats maintained a more normal appearance after estrogen treatment, although perivascular connective tissue cells did appear activated and basal laminae delimiting the pericapillary spaces were disrupted occasionally. However, no capillaries were disrupted, nor were any hemorrhagic lakes evident, and no arteries were present.(ABSTRACT TRUNCATED AT 250 WORDS)
Pain facility certification standards.
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[Assessment of risk status using nutrition diagnostic studies in surgical patients. 1. Determination of preoperative risk status in patients with stomach cancer].
The diagnosis of the nutritional state is an essential component in determining the risk in patients with carcinoma of the gastrointestinal tract. Based on the results of multivariate, statistical analyses of numerous biochemical, anthropometric and immunologic parameters in 63 patients with gastric carcinoma, we can now simplify the determination of the nutritional state considerably. With the help of cluster analysis and together with clinical aspects, the nutritional state can be divided into 2 groups ('normal' and 'disturbed'), in contrast to the former classification ('normal' and several degrees of disturbed). Using discrimination analysis, a combination of parameters was found which allows a sufficiently good classification of subjects into either the 'normal' group or the 'disturbed' group, and in this way characterizes the nutritional state. Classification of the patients is accurate in 97% of the cases. 6 practically relevant parameters were determined with the discrimination analysis: serum albumin, serum transferrin, hemoglobin, upper arm circumference, triceps skin fold thickness, and the intracutaneous skin test quotient. The nutritional quotient, EQ2, can be determined from these values (in comparison to the nutritional quotient, EQ1, which is based on the 33 point evaluation scale), thus enabling a quantification of the nutritional state. The use of only individual parameters yields major differences from the results obtained with 6 parameters. However, a relation between the nutritional state and the existing immuno-competence can be suspected when the results - especially of the skin test reactions - are in agreement with the results of the lymphocyte transformation. The test results of cell-mediated immunity in particular represent the extent of a reduced immunological reaction as opposed to the results of humoral immunity. Inclusion of less complex immunological investigation procedures must be reserved for future studies. The determination of daily urea production (urea production rate; dependent on protein supply) can be implemented as a practically relevant and reliable supplemental test for the evaluation of the existing metabolic state.
[Postoperative low-calorie parenteral feeding].
In parenteral nutrition a distinction can be made between hypocaloric, normocaloric, and hypercaloric forms, depending on the amount of energy supply. Hypocaloric parenteral nutrition has been specifically adjusted to the conditions of postoperative metabolism. Doses between 1.2 g and 1.5 g/kg body weight/d of amino acids are the most important components of peripheral venous nutrition. The economy of amino acid utilisation, primarily by patients not adapted to fasting or to ketone body utilisation, can be improved by a low dosage of 2.5 g of carbohydrates to 1 g of amino acids. Polyols were found to be decisively superior to glucose as energy carriers by taking into much closer consideration the mechanisms of autoregulation in postoperative metabolism and by favouring synthesis of intrahepatic functional proteins to peripheral synthesis. Hypocaloric peripheral venous parenteral nutrition has proved to be effective therapeutic concept by which to bridge the early postoperative phase in elective surgery.
[Ultrasound diagnosis in ileus].
Unspecific clinical symptoms and negative general X-ray findings from the abdominal region have often been characteristic of early ileus stages and have caused delay in prognosis-enhancing surgery. These early stages can be more reliably identified by means of abdominal sonography. Ileus was detected by means of general abdominal sonography from three of 14 of the authors' own patients from whom negative findings had been recorded by X-ray examinations. Their ileus was eliminated by immediate surgical intervention.
Bone marrow transplantation for advanced acute lymphoblastic leukemia in young people: a comparison of two conditioning regimens.
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[Heterotopic pancreatic tissue in the corpus of the stomach].
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