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Biomedical subjects

S J Farber

Publications and source records attributed to S J Farber.

At least 19 recordsLinked to original sources
PubMed1999

Issues in end-of-life care: family practice faculty perceptions.

BACKGROUND: Issues in end-of-life care in the United States are receiving increasing discussion in light of the aging population and the documented need to improve the quality of care for dying patients and their families. Family practice faculty are in a key position to contribute valuable information, given their missions to model necessary values, attitudes, and skills and directly teach quality end-of-life care. METHODS: We conducted interviews with 20 family practice faculty members in 3 residencies, and verbatim transcripts were coded by the authors. We held a second round of 12 interviews in 3 different residencies to check validity and expand the themes emerging from the original interviews. Corrected and elaborated themes were presented to focus groups from 2 other residencies. RESULTS: Themes of reaching consensus; establishing a treatment plan; mobilizing a caregiving system; dealing with relationships with patients, families, and the treatment team; and issues of personal domain were described as important in end-of-life care. CONCLUSIONS: The discussion of quality end-of-life care and how to provide it emphasized traditional medical concerns of diagnosis and prognosis, treatment, and caregiver support. Opportunities for innovation and improvement exist within the less explored areas of the relationship between the provider, patient, and family, and issues of personal meaning and experience.

Adult↗
PubMed1998

Regression of HIV encephalopathy and basal ganglia signal intensity abnormality at MR imaging in patients with AIDS after the initiation of protease inhibitor therapy.

PURPOSE: To determine whether protease inhibitors cause regression of periventricular white matter signal intensity abnormalities in patients with human immunodeficiency virus (HIV) encephalopathy and whether the changes on magnetic resonance (MR) images correlate with cognitive improvement. MATERIALS AND METHODS: MR images were retrospectively and prospectively analyzed in 16 adult patients with HIV encephalopathy. White matter and basal ganglia signal intensity abnormalities on initial long repetition time (TR) images were compared with those on subsequent long TR images in patients who received and in patients who did not receive protease inhibitors. Clinical correlation was obtained. RESULTS: Of the nine patients receiving protease inhibitors, four showed nearly complete regression, four showed interval stability, and one showed slight progression. Thus, eight patients (89%) demonstrated either stability or improvement in white matter disease, which correlated with cognitive improvement. Of the seven patients not receiving protease inhibitors, six (86%) showed marked progression with a decline in cognitive function and one had no interval change. The difference between the two groups was statistically significant. Of the two patients receiving protease inhibitors who initially had basal ganglia signal intensity abnormalities, one demonstrated resolution and one nearly complete resolution subsequently. CONCLUSION: Although the patient population is small, protease inhibitors may cause regression of periventricular white matter and basal ganglia signal intensity abnormalities in HIV encephalopathy and may have a role in treatment.

AIDS Dementia Complex↗
PubMed1993

Comparison of arterial and capillary bilirubin values in neonates with arterial lines.

To determine whether arterial and capillary values for bilirubin agree in neonates, we analyzed 35 simultaneously sampled capillary and arterial specimens from 13 infants. We found a high correlation between arterial and capillary bilirubin values (r = 0.993). We conclude that arterial bilirubin samples may be substituted for capillary samples in newborn infants.

Arteries↗
PubMed1992

Automated total and neonatal bilirubin values in newborns: is a distinction clinically relevant?

Guidelines for managing hyperbilirubinemia in newborns were developed by using diazo methods that measure total and direct-reacting bilirubins and calculate an indirect fraction. The automated Kodak Ektachem system allows for measuring serum bilirubin by either of two dry-slide methods: TBIL, involving a modified diazo method, and NBIL, involving a dual-wavelength colorimetric method that fractionates and directly measures the unconjugated (Bu) and conjugated (Bc) bilirubins (Bu+Bc = neonatal bilirubin). The manufacturer recommends that NBIL be used in newborns less than 15 days old, which is impractical in a large, busy hospital laboratory. We compared NBIL and TBIL in 500 paired serum samples from infants less than 15 days old. We noted a statistically significant difference between TBIL and NBIL values (162.9, SD 70.4, vs 164.6, SD 69.2, mumol/L; P less than 0.0001), which was small and of no clinical significance. We conclude that TBIL values may be used with caution for newborn bilirubin screening. Furthermore, NBIL measurements are an acceptable alternative to diazo measurements for neonatal care, allowing the use of previously developed guidelines with NBIL values.

Automation↗
PubMed1991

Three rapid immunoassays for the determination of creatine kinase MB: an analytical, clinical, and interpretive evaluation.

We present analytical and clinical studies of three commercial immunoassays for the determination of the creatine kinase MB isoenzyme (CK-MB). All methods are compared with the presently-accepted reference method, agarose gel electrophoresis. We find that each of the immunoassay methods offers diagnostic sensitivity and specificity similar to those of electrophoresis, while none experiences detectable interference from high concentrations of the creatine kinase BB isoenzyme (CK-BB) or the so-called "atypical" bands. The presence of atypical bands can cause electrophoresis to yield inaccurate quantification or even misidentification of CK-MB. Because the immunoassay approaches are more rapid than electrophoresis and require less technical expertise, it is possible to evaluate patients in a more timely and cost-effective manner. Further, since immunoassay results can be available in approximately 1/2 hour, rapid real-time decisions can be made regarding the desirability of initiating or continuing such valuable but dangerous procedures as thrombolytic therapy.

Antibodies, Monoclonal↗
PubMed1989

The effect of hemolysis on creatine kinase determination.

Hemolysis can cause falsely elevated creatine kinase (CK) values when spectrophotometric methods of measurement are used. This apparent increase in CK is due to the red blood cell enzyme adenylate kinase. In an attempt to reduce this interference, most commercial CK kits employ adenosine monophosphate and/or diadenosine pentaphosphate as adenylate kinase inhibitors. To determine whether hemolyzed specimens should be accepted for testing, we measured the CK values of 26 serum samples, each with six different concentrations of added hemolysate. The results showed that hemolysis had an additive effect on CK, with an average increase in CK of approximately 10 U/L for every 1 g/L of hemoglobin. In most settings, this increase is not clinically significant. In the case of massive hemolysis, the hemoglobin concentration of the serum can be measured to correct the apparent CK value. The exclusion of hemolyzed specimens is unnecessary.

Creatine Kinase↗
PubMed1987

Production of eicosanoids by the killifish gills and opercular epithelia and their effect on active transport of ions.

Gills and opercular epithelia of the killifish (Fundulus heteroclitus) homogenized and incubated with radiolabeled arachidonic acid were found to produce prostaglandins, leukotrienes, and hydroxyeicosatetraenoic acids. These metabolites were identified using thin-layer chromatography, autoradiography, reverse-phase high-performance liquid chromatography, and ultraviolet spectroscopy. Addition of glutathione and epinephrine to the incubation mixture caused a diminution in the production of most eicosanoids (cyclooxygenase and lipoxygenase products) whereas indomethacin decreased only the cyclooxygenase metabolites. The effects of eicosanoids on short-circuit and potential difference across opercular epithelia mounted in a Ussing-type chamber were examined. Prostaglandin E2 had an inhibitory effect on ion transport whereas the sulfidopeptide leukotrienes (LTC4, LTD4, and LTE4) had a stimulatory effect. These results indicate that gills and opercular epithelia have the capacity to synthesize eicosanoids and that some of these metabolites may play a role in the regulation of ion transport in the kill fish.

Animals↗
PubMed1986

Inhibition of eicosanoid formation by prazosin in the rabbit renal cortex.

The influence of the oral administration of prazosin (an alpha 1-adrenergic blocker) and propranolol (a beta-adrenergic blocker) on eicosanoid formation in renal cortices and papillae was evaluated in rabbits maintained on a high cholesterol diet. Rabbit renal microsomal fractions were incubated with radiolabeled arachidonic acid (AA) and glutathione (GSH) and the levels of metabolites were determined by thin layer chromatography (TLC), autoradiography and reverse phase-high performance liquid chromatography (RP-HPLC). Rabbits on a high cholesterol diet showed no significant differences in total eicosanoid production compared to rabbits on a normal diet. Prazosin was found to significantly inhibit the formation of all eicosanoids in the renal cortex. In contrast, propranolol had no such inhibitory effect in the renal cortex. Neither drug had a significant effect on eicosanoid formation in the renal papilla. While oral administration of prazosin effectively inhibited the formation of all eicosanoids in the cortex, the addition of prazosin in vitro at physiological concentrations showed no such effect. These findings may have reflected alpha-receptor mediated event(s) which resulted in an alteration in eicosanoid formation in the kidney, suggesting an interaction between the sympathetic nervous system and the AA cascade.

Animals↗
PubMed1983

Biosynthesis of cyclooxygenase and lipoxygenase metabolites of arachidonic acid by rabbit renal microsomes.

Production of radiolabeled arachidonic acid (AA) metabolites by microsomal fractions obtained from rabbit renal papillae and cortices was investigated. It was determined that in addition to the cyclooxygenase products synthesized, the papillary fractions and the cortical fractions each produced 5-hydroxy-6,8,11,14-eicosatetraenoic acid (5-HETE), 12-hydroxy-5,8,10,14-eicosatetraenoic acid (12-HETE) and three leukotrienes (LT). The LT of greatest polarity showed an ultraviolet (UV) spectrum of a conjugated triene chromophore and coeluted with standard LT C4 on reverse phase high performance liquid chromatography (RP-HPLC). Amino acid analysis revealed the presence of a glutathionyl moiety, whereas mass spectrometric analysis of the trimethylsilyl ether and methyl ester derivative of this LT indicated the lipid portion to be 5-hydroxy-arachidic acid. In addition, this LT was found to contract guinea pig ileum. The other LTs were found to lack bioactivity on guinea pig ileum but contained a glutathionyl moiety. These findings indicate that rabbit renal microsomes possess lipoxygenase activity capable of producing hydroxy acids, such as 5-HETE, 12-HETE and LT.

Animals↗