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Biomedical subjects

S Frankel

Publications and source records attributed to S Frankel.

At least 91 records · Page 5Linked to original sources
PubMed1995

Measurement of breast implant volume with magnetic resonance imaging.

In principle, tomographic imaging of breast implants provides the information needed to compute implant volume. We have investigated the reliability of this measurement as a means of diagnosing the loss of gel from the implant. We find that measurement errors, postimplantation changes of the implant, uncertainties in the patients' records, and lack of knowledge of the implant temperature in the body can lead to significant discrepancies, making this measurement unreliable as a diagnostic tool.

Breast Implants↗
PubMed1995

MRI findings in subjects with breast implants.

One-hundred and nineteen implants were imaged in an open-sided low-field magnetic resonance imaging system. Thirty-four of these implants were removed, and postoperative reports were made available. We found a variety of signs associated with the implants, including internal structures, loss of saline in double-lumen implants, intracapsular and extracapsular fluid accumulations, signal dropout regions most likely associated with calcifications, and debris and fluid in the silicone, as well as degradation of the silicone, disruptions of the capsule and bulging, and extracapsular silicone. Conclusions of intact versus ruptured were made on the basis of these findings and found to be confirmed in 32 of 34 cases, with 1 false-positive and 1 false-negative result. Based on MRI criteria for a broad sample of the population, 27 percent of the implants were considered ruptured.

Adult↗
PubMed1995

The hospital admissions study in England: are there alternatives to emergency hospital admission?

STUDY OBJECTIVE: To assess the potential for substituting alternative forms of care for admission to an acute hospital in particular groups of patients. DESIGN: A screening tool, the intensity-severity-discharge review system with adult criteria (ISD-A), developed for hospital utilisation review in the USA, was used in a cohort of hospital admissions to identify a group of patients who could potentially have been treated outside the acute hospital. These patients were further assessed by a panel of general practitioners (GPs) to determine the most appropriate alternative form of care. A cost analysis was performed on the results obtained. SETTING: General medicine and geriatric specialties in one acute hospital in the south western region. PATIENTS: Patients comprised a sample of 701 admitted to general medical and geriatric specialties. MAIN RESULTS: The screening tool identified 19.7% of admissions for whom there was potential for treatment outside the acute hospital. Assessment by the GP panel reduced this potential to between 9.8% and 15.0% of emergency admissions. The alternatives most frequently identified as "most appropriate" were the community hospital/GP bed and the urgent outpatient assessment (within either 24 or 48 hours). Potential resource savings based on the average cost were relatively small. This potential seemed to be greater for the alternative of the urgent outpatient assessment. CONCLUSIONS: Potential exists for treating a proportion of patients in lower intensity alternatives to the acute hospital. If this potential were exploited few resource savings would occur.

Cohort Studies↗
PubMed1995

Outpatients revisited: subjective views and clinical decisions in the management of general surgical outpatients in south west England.

STUDY OBJECTIVE: To assess the scope for reducing unnecessary outpatient reattendances, using a benchmark an acute specialty at a site recognised to have an especially low ratio of repeat to new attendances. DESIGN: This was a survey of the re-attendance workload at general surgery outpatient clinics over a three month period. Patient re-booking and discharge rates for different grades of staff; clinicians' perception of the ability of the GP to have managed the patient; perception of the value of individual re-attendances; reason given for discharging/re-booking; and outcome of attendance for patients in relation to diagnostic category were determined. SETTING: General surgery outpatients clinics with re-attendance rates that were 50% below average, in Taunton and Somerset Hospital, a non-teaching district general hospital. PATIENTS: Altogether 454 patients who made 470 second or subsequent visits (re-attendances) within the same episode of outpatient care. MAIN RESULTS: Thirty eight percent (178/470) of visits were perceived as manageable by the GP, 45% (79, 17% of total re-attendances) of which were also thought to have been of marginal or little value. A substantial group of patients was being followed up largely for reasons of convention and traditional policy. Re-booking rates were higher among junior staff. Subjective views of the value of attendance at the hospital outpatient clinic and the ability of the GP to have seen the patient varied systematically between consultants and junior staff. Judgements varied to some extent according to the diagnostic group. CONCLUSION: The numbers of patients being followed up equivocally at most general surgical outpatient departments will be 50% more an average than those in this benchmark department. A department seeing 2000 new patients per annum will have 3600 reattendances, 25.5% (918) of which may be avoidable on the basis of these results. A variety of approaches can be used to increase the proportion of patients seen appropriately by GPs. In some cases this might be achieved without the intensive commitment required to plan and develop shared care protocols or new formal discharge guidelines, but by encouraging GPs to manage some patients, increasing of hospital clinicians' access to knowledge of local general practices, and internal clinic review of 'routine' follow up policies as shown in this study. This type of review of outpatient practice can also help prioritise conditions likely to repay the effort of developing and implementing clinical management guidelines and local protocols.

Delivery of Health Care↗
PubMed1994

Prevention of suicide: aspirations and evidence.

The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at risk. No single intervention has been shown in a well conducted randomised controlled trial to reduce suicide. The greatest potential seems to arise from limiting the availability of methods. In particular it is likely that the introduction of the catalytic convertor will lead to reduced lethality of care exhausts and reductions in suicide using this method. General practitioner education programmes, the effectiveness of lithium and maintenance antidepressants, and limits on the quantity of medicines available over the counter or on prescription should all be evaluated. Particular high risk groups include people recently discharged from psychiatric hospitals and those with a history of parasuicide. Many social processes affect suicide rates and these rather than specific interventions may help or hinder the ability to realise the Health of the Nation targets. Well conducted trials are essential to distinguish complex social processes from the effects of specific interventions for suicide prevention. This review of the available evidence offers little support for the aspiration that the posited targets can be achieved on the basis of current knowledge and current policy.

Family Practice↗
PubMed1994

Identification of a divergent actin-related protein in Drosophila.

The actin-related proteins (ARPs) have primary sequence homology to actin, have no homology to other proteins and, unlike the conventional actins, are clearly divergent. We have identified an ARP in Drosophila that has approximately 30% amino acid identity to most actins, making it the most divergent yet reported. It is also quite divergent from all other ARP sequences. When the Drosophila ARP is aligned with actin it contains sequence insertions, as is the case with all other ARPs. The unique location of the insertions, as well as its overall divergence, indicates it may represent a new isotype. Only one gene was detected by hybridization to both genomic DNA and polytene chromosomes; the location of the gene is 13E on the X chromosome. A transcript of 1350 bases was detected at all stages of development. This transcript was relatively abundant during early embryogenesis, decreasing during the later stages of embryogenesis and increasing again in larvae and adults.

Actins↗
PubMed1994

Characteristics of magnetic resonance sequences used for imaging silicone gel, saline, and gel-saline implants at low field strengths.

RATIONALE AND OBJECTIVES: Low-field magnetic resonance imaging (MRI) evaluation of breast implants is described, with emphasis on the capabilities provided by different imaging sequences. METHODS: Open architecture MR images using a .064-T permanent magnet and three-dimensional Fourier transform and inversion recovery sequences were obtained. A breast coil was designed and built for this project. Symptomatic and asymptomatic patients with silicone, saline-silicone and saline implants, and phantoms were part of this study. Phase images were used to differentiate protons in silicone, water, and fat. RESULTS AND CONCLUSIONS: Low-field MRI permitted differentiation of silicone, water, and fat. Implant anatomy and surrounding pathology could be imaged and identified.

Adult↗
PubMed1993

Differences in dendritic cells in congenital and acquired cholesteatomas.

Cholesteatomas are histologically benign, though biologically invasive lesions that arise from the migration of squamous epithelium of the ear. Acquired cholesteatomas usually arise in an antigenically active environment, i.e., a chronically and/or recurrently inflamed middle ear. In contrast, congenital cholesteatomas occur in an uninflamed environment. The potential role of dendritic cells (DCs) in the evolution of this lesion has not been thoroughly studied. By staining for S-100 protein, the authors evaluated the presence and distribution of DCs in cholesteatomas. Sixteen cases of cholesteatomas diagnosed from 1987 to 1989 were selected for this study. The formalin-fixed, paraffin-embedded sections were processed by a standard avidin-biotin peroxidase-antiperoxidase method for S-100 protein and for leukocyte common antigen (LCA). The presence and distribution of S-100 protein-positive DCs was evaluated and compared to canal wall skin. DCs were present in all cases. Nine acquired cholesteatomas had 5 to 16 epithelial DCs per high-power field (HPF). Seven congenital cholesteatomas were examined. Four with isolated congenital pearl-like cholesteatomas had 1 to 3/HPF epithelial DCs. In contrast, the three inflamed congenital cholesteatomas had 6 to 12/HPF DCs. The control uninflamed canal wall skin had only 1 to 3/HPF DCs. All DCs were LCA negative, as expected.

Adolescent↗
PubMed1992

The limits of lifestyle: re-assessing 'fatalism' in the popular culture of illness prevention.

This paper is concerned with the development of preventive medicine in the field of Coronary Heart Disease. It is based on an in-depth, ethnographic investigation into the popular culture of prophylactic behaviour carried out in South Wales (U.K.) during 1988 and 1989. The focus of the data and analysis presented here is the operation of cultural norms and practices related to the understanding and explanation of the cause and distribution of illness and death from heart ailments. The paper illustrates how the everyday cultural practice of 'lay epidemiology' is involved in accounting for illness misfortune and in assessing the potential benefits of prophylactic behaviour change. A central issue dealt with here is the relationship of lifestyle to environment in the popular understanding of chronic disease. Lay notions of luck, fate, destiny, randomness and chaos in the distribution of heart disease are explored. In conclusion, some implications for health education in this field are put forward.

Adult↗
PubMed1991

Potential availability of cadaver organs for transplantation.

OBJECTIVE: To determine the potential number of cadaver kidney donors by applying defined donor criteria to people dying in hospital. DESIGN: Prospective study of all deaths occurring in 21 hospitals from 1 September 1988 to 31 August 1989. Questionnaires were administered to medical and nursing staff and families of potential donors aged 1-69. SETTING: Acute care hospitals in Gwent, South Glamorgan, Mid Glamorgan, West Glamorgan, Pembrokeshire, and East Dyfed health authorities, serving a population of 2.2 million. MAIN OUTCOME MEASURES: Cause of death, age, ventilation at time of death, diagnosis of brain death, and consideration of consent. RESULTS: Adequate data were available for 9840 of 10,095 hospital deaths (97.5% coverage). 188 patients aged 0-69 were identified as potential organ donors (widest definition), and of these 108 died without being ventilated at the time of death. Tests of brain stem death were formally completed in 57 cases, and organ donation was considered by the families of 47 of these potential donors. 26 patients became organ donors. Patients aged 50-69 with stroke were less likely to be ventilated than those aged less than or equal to 49 (21/96 v 24/34). Families of potential donors aged 20-39 were least likely to give permission. CONCLUSIONS: The supply of donor organs (specifically kidneys) could be increased by altering the management of patients aged 50-69 dying of severe cerebrovascular disease in general medical wards, in particular by increasing the proportion ventilated. The ethics of elective ventilation for the purposes of organ donation require discussion.

Adolescent↗
PubMed1991

The use of sarkosyl in generating soluble protein after bacterial expression.

Actin, like many other proteins, is highly insoluble after expression in Escherichia coli. In order to understand the origin of insoluble aggregates, we asked whether morphological inclusions were always correlated with insolubility. The strain expressing actin was compared to one that expresses part of the myosin tail; the latter strain yields soluble protein after various cell lysis or disruption procedures. Morphological inclusions were observed in both strains, indicating there is no obligate relationship between solubility and inclusions. Studies presented here suggest that extreme insolubility results from coaggregation of the actin with bacterial outer membrane components upon bacterial lysis. The properties of the outer membrane have been exploited in the development of nondenaturing procedures that yield soluble actin. One procedure involves the disruption of coaggregates with sarkosyl detergent (N-laurylsarcosine); another prevents the formation of coaggregates by lysing in the presence of sarkosyl. These methods may be useful for other proteins that become insoluble after bacterial expression.

Bacterial Outer Membrane Proteins↗
PubMed1991

A xanthogranulomatous histiocytosis in a child presenting with short stature.

We evaluated a 7-year-old boy presenting with a neck mass that was diagnosed as juvenile xanthogranuloma on excisional biopsy. Despite this diagnosis, an exhaustive evaluation was undertaken because of marked short stature. Examination revealed growth hormone deficiency and diabetes insipidus, as well as widespread lesions in the head, mediastinum, retroperitoneum, skeleton, and elsewhere. Biopsies of the lesions in the mediastinum and right tibia suggested a diagnosis of xanthoma disseminatum with bony involvement, suggesting the Erdheim-Chester variant of xanthogranulomatous histiocytosis, previously reported only in adults. The diagnosis is contrasted to the more common clinical entities of juvenile xanthogranuloma and the Langerhans' cell histiocytoses. This case illustrates the gravity with which otherwise unexplained short stature should be considered.

Child↗