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Biomedical subjects

S Klein

Publications and source records attributed to S Klein.

At least 307 records · Page 17Linked to original sources
PubMed1989

Respite program gives care givers a break. Collaborative effort involves hospitals, nursing homes, and parishes.

When professionals and volunteers who work with older adults in Catholic hospitals, nursing homes, social service agencies, and parishes in the Cleveland diocese decided to develop a program of home-based respite services, they did it one step at a time. They first identified the needs, defined the goals and chose the people to accomplish those goals, then raised the money--enough to fund five three-year demonstration projects. The model they established is based on these projects. It centers on the relationship among care giver, care recipient, and respite volunteer. Without respite services, care giver and care recipient are bonded in a constant relationship. With respite, the volunteer intervenes to provide "protective," or supervisory, companionship to the older adult and a break for the care giver. The goals of this model are to prevent or delay care giver exhaustion, avert or postpone the care recipient's institutionalization, and develop cost-effective services that allow incapacitated older adults to remain in the least restrictive environment and to live as normally as possible.

Aged↗
PubMed1989

[Immunoregulation of tumor growth in a murine model].

Different spleen and tumor cell factors modifying tumoral and metastatic growth were studied. Spleen cell culture supernatants (SCS) from small and large tumor-bearing mice enhanced tumor growth. After tumor surgery, tumor enhancement was only mediated by supernatants from large tumor resected mice. Tumor facilitation and angiogenic response were mediated by the same supernatants; different fractions for these two activities were characterized. T and non-T cells, depending on tumor burden, were responsible for the enhancing activity; but angiogenesis depended only on T cells. While augmentation of metastatic spread was produced by tumor antigens (soluble tumor extracts, tumor-cell supernatants, formolized tumor cells), primary tumor development was not modified by tumor-cell supernatants. Increased incidence of metastases was also mediated by SCS from tumor resected mice which had previously been inoculated with tumor antigens. Immune status of tumor-resected mice was evaluated by delayed-type hypersensitivity reaction. Tumor cell membranes enriched with cholesterol-hemisuccinate were able to increase anti-tumor immune response.

Adenocarcinoma↗
PubMed1989

The presentation and management of the acute abdomen in the patient with sickle-cell anemia.

Sickle crises frequently manifest as abdominal pain that may simulate intra-abdominal infection. To establish parameters to distinguish these, we retrospectively studied 53 patients with sickle-cell anemia who had abdominal pain (genotype SS 62%, SC 15%, SA 11%, S-other 11%; 30% men and 70% women; mean age 23). A vaso-occlusive crises was responsible for the pain in 57 per cent; 23 per cent had a surgical entity and 20 per cent had a nonsurgical genitourinary disorder. Of the surgical conditions, 9 of 12 patients (95%) had cholecystitis and 4 of 12 patients (33%) had acute appendicitis (one patient had both). Vaso-occlusive crises were diffuse in 15 of 30 patients (50%), compared with proven surgical conditions, and was more often associated with remote pain such as limbs and chest (23 of 30 [77%] P less than 0.005). The pain of vaso-occlusive crises simulated prior crises in 21 of 30 patients (70%) compared with 1 of 12 patients (8%) who had surgical abdominal pain (P less than 0.005). A precipitating event (especially upper respiratory infection) was found in 50 per cent of abdominal vaso-occlusive crises versus 0 per cent of surgical abdomens (P less than 0.010). The pain was relieved with hydration and oxygen in 97 per cent of sickle crises within 48 hours versus 0 per cent of surgical abdomens (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen, Acute↗
PubMed1988

Hematuria following blunt abdominal trauma. The utility of intravenous pyelography.

To clarify the indications for intravenous pyelography (IVP) and nephrotomography (NT) in the evaluation of patients with hematuria following blunt thoracoabdominal trauma, we performed a retrospective analysis of patients admitted during a one-year period who had undergone IVP and NT for suspected renal injury. One hundred thirty-four patients were reviewed, and the findings of IVP and NT correlated with the magnitude of hematuria on urinalysis, associated injuries, management, and outcome. Sixty-two (46%) of 134 patients had fewer than ten red blood cells per high-power field (RBCs/HPF) on urinalysis (group 1), 19 (14%) of 134 patients had 10 to 30 RBCs/HPF (group 2), and 53 (40%) of 134 patients had greater than 30 RBCs/HPF (group 3). Twenty-seven patients had renal injuries detected by IVP and NT, two in group 2 and 25 in group 3. We conclude that IVP and NT should be reserved for patients with greater than 30 RBCs/HPF on admission urinalysis.

Abdominal Injuries↗
PubMed1988

Choledochal fungal ball. An unusual cause of biliary obstruction.

A 31-year-old patient with sickle-cell disease who had previous cholecystectomy developed acute onset of jaundice and abdominal pain. An endoscopic retrograde cholangiography demonstrated multiple filling defects within the bile ducts. Microscopic examination of "calculi" removed at surgery revealed that a fungal ball composed of Candida was the cause of biliary obstruction in this case. The patient eventually recovered after removal of the fungal masses and intrabiliary instillation of amphotericin.

Adult↗
PubMed1988

The effects of nicotine on basal and stimulated gastric secretions in the conscious cat and in isolated guinea pig gastric mucosal cells.

Intravenous (i.v.) administration of nicotine in conscious cats significantly stimulated basal gastric acid output. The effect was completely blocked by atropine and ranitidine. Submaximally stimulated gastric acid secretion was not further increased by nicotine. In isolated guinea pig parietal cells nicotine significantly increased basal acid secretion by about 20% and potentiated the response to maximally effective concentrations of histamine but had no influence on the carbachol response. In isolated parietal cells stimulated either by nicotine, histamine or both, atropine pretreatment increased or inhibited the acid response in concentration-dependent manner. From these data, it is concluded that nicotine had direct stimulatory effects on isolated parietal cells and potentiated the histamine mediated response in the isolated cell preparation but not in the intact animal model.

Animals↗
PubMed1988

Effect of elevated free fatty acids on glucose oxidation in normal humans.

In vitro studies indicating an inverse relationship between free fatty acid (FFA) availability and glucose oxidation led to proposal of the glucose-fatty acid cycle. In vivo studies have yielded conflicting results regarding the effect of FFA on glucose oxidation. In the present study the effect of FFA on glucose oxidation was determined in six normal volunteer subjects. The rate of glucose uptake was fixed by using a constant glucose infusion to suppress endogenous glucose production. Glucose was infused continuously overnight and during the four hour study at 8 mg/kg X min to ensure use of glucose as an energy substrate by virtually all tissues. Following a two-hour baseline glucose infusion, infusion of 20% IV fat emulsion at 1.0 mL/min plus heparin was added to the constant glucose infusion for two additional hours. Total carbohydrate oxidation was determined by indirect calorimetry, and the direct oxidation of the infused (plasma) glucose was measured by the use of U-13C-glucose. Glycogen oxidation was calculated as the difference between total carbohydrate oxidation and the oxidation of plasma glucose. Glucose uptake was calculated from the infusion rate, corrected for any changes in plasma and/or urine glucose concentration. Glucose uptake closely approximated the rate of IV glucose infusion and was unchanged by fat infusion. The percent of CO2 production from U-13C-glucose oxidation (74.5 +/- 12.3, mean +/- SD) was not affected by FFA, nor was the percent of glucose uptake oxidized (37.5 +/- 4.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Hepatobiliary abnormalities associated with total parenteral nutrition.

Hepatobiliary abnormalities occur often in patients receiving TPN. Although TPN use may be important in their pathogenesis, many other factors could also be involved. In any individual patient it may be difficult to separate the contribution of TPN itself from that of the other precipitating causes. The most worrisome observation to date is the development of severe progressive liver disease in a small number of patients receiving long-term TPN. Further work is needed to determine whether the use of TPN actually contributes to this condition or is simply an associated finding.

Cholelithiasis↗
PubMed1988

The impact of body composition on the regulation of lipolysis during short-term fasting.

Lipolytic rates were determined in normal-weight young adult (low body fat), normal-weight elderly (moderate body fat), and obese young adult (high body fat) subjects after an overnight (12-15 hr) and short-term (60-87 hr) fasting period. A simultaneous infusion of [1-13C] palmitate acid and [2H5]glycerol was used to measure the inflow of palmitate and glycerol into the bloodstream, and H2 18O dilution was used to measure body composition. The amount of body fat differed between the young adult (11 kg), elderly (23 kg) and obese (49 kg) subjects. Total lean body mass was similar in the normal-weight young adult (60 kg) and obese (63 kg) groups, but was lower in the elderly (46 kg). Lipolytic rates per unit of fat mass decreased in each group relative to the increase in the amount of body fat. Lipolytic rates, expressed as a function of lean body mass, however, were the same in all three groups. These results suggest that body composition contributes to the regulation of lipolysis during fasting. The decreased rate of lipolysis in subjects who have excess body fat may reflect the decreased need, per unit fat mass, for lipolysis to meet the energy requirements of the lean body mass.

Adipose Tissue↗
PubMed1988

Interaction of nod and exo Rhizobium meliloti in alfalfa nodulation.

Among the genes of Rhizobium meliloti SU47 that affect nitrogen-fixing symbiosis with alfalfa are nod genes, in which mutations block nodule induction, and exo genes, in which mutations allow nodule formation but block rhizobial exopolysaccharide production as well as nodule invasion and nitrogen fixation. To investigate whether an exo+ bacterium can "help" (that is, reverse the symbiotic defect of) an exo mutant in trans, we have coinoculated alfalfa with pairs of rhizobia of different genotypes. Coinoculant genotypes were chosen so that the exo+ helper strain was nif while the exo "indicator" strain was nif+, and thus any fixation observed was carried out by the exo coinoculant. We find that a nod exo+ coinoculant can help an exo mutant both to invade nodules and to fix nitrogen. However, a nod+ exo+ coinoculant cannot help an exo mutant: Few exo bacteria are recovered from nodules, some bacteroids differentiate into bizarre aberrant forms, and the nodules fail to fix nitrogen. In a triple coinoculation, the effect of nod+ helper supersedes that of nod helper. Implications of these results for interaction of nod and exo gene products are discussed.

Genes, Bacterial↗
PubMed1988

The metabolic impact of active ulcerative colitis. Energy expenditure and nitrogen balance.

Resting energy expenditure and nitrogen balance were measured shortly after admission and shortly before discharge or colectomy in eight adult males hospitalized for active ulcerative colitis. The measured resting energy expenditure was 19% higher than that predicted by the Harris-Benedict formula (p less than 0.01). Fecal and urinary nitrogen losses were 2.1 +/- 1.5 g/day and 13.6 +/- 3.8 g/day, respectively. During the early hospitalization period, daily intakes of calories (1,826 +/- 1,050 kcal) and protein (1.5 +/- 0.4 g/kg) were not sufficient to maintain energy (-548 +/- 964 kcal/day) and nitrogen (-1.5 +/- 3.9 g/day) balances. Energy expenditure and nitrogen losses at the end of the study were similar to the values obtained on admission, but because of a voluntary increase in caloric (by 42%) and protein (by 37%) intake during the hospitalization both energy balance (+434 +/- 409 kcal/day) and nitrogen balance (+4.6 +/- 6.5 g/day) (p less than 0.05) improved. These results suggest that, although the metabolic impact of active ulcerative colitis is mild, it does result in negative energy and nitrogen balances. Dietary intake can be voluntarily increased during hospitalization to improve energy and nitrogen equilibrium.

Adult↗
PubMed1988

All nod genes of Rhizobium meliloti are involved in alfalfa nodulation by exo mutants.

Nodulation of alfalfa by exoB mutants of Rhizobium meliloti occurred without root hair curling or infection thread formation. nod exoB double mutants had the same nodulation deficiency as single nod mutants. Therefore, all the known nod genes are involved in nodule induction by exoB mutants, which apparently occurs via intercellular invasion.

Chromosome Deletion↗
PubMed1988

Effect of isotope infusion and sampling sites on glucose kinetics during a euglycemic clamp.

The importance of the location of isotope infusion and blood sampling on calculating glucose kinetics was studied in five mongrel dogs in the basal state and when glucose turnover was increased during a hyperinsulinemic euglycemic clamp. [U-14C]glucose was infused into the pulmonary artery, unlabeled glucose was infused into a femoral vein to maintain euglycemia, and blood was sampled from the right atrium (AV mode) and the femoral artery (VA mode). In the basal state there was no difference between the AV or VA mode in plateau specific activity; hence, the calculated rate of appearance of glucose was the same with either mode. During the euglycemic clamp procedure, plateau specific activity of the AV mode was significantly lower than that of the VA mode (P less than 0.05). The rate of appearance of glucose calculated from the VA mode was almost identical to the rate of infusion of unlabeled glucose (13.0 +/- 1.4 vs. 12.6 +/- 1.4 mg.kg-1.min-1, respectively), but the rate of appearance of glucose calculated from the AV mode was 12% greater. This study demonstrates that the calculation of glucose kinetics is sensitive to differences in sampling site when the turnover rate is high relative to the mass flow rate (cardiac output times substrate concentration).

Animals↗
PubMed1988

Extraintestinal manifestations in patients with diverticulitis.

Three patients had diverticulitis and extraintestinal manifestations of arthritis and pyoderma gangrenosum. In each, a mistaken diagnosis of idiopathic inflammatory bowel disease was first made because of extraintestinal complaints associated with the gastrointestinal symptoms of diverticular disease. The joint and skin manifestations were refractory to various treatments, including oral and intradermal steroids, immunosuppressive agents, and hyperbaric oxygen. Segmental resection of the involved colon promptly and completely resolved all symptoms, without recurrence 26 to 38 months after surgery. Microscopic examination of the resected specimens showed only diverticulitis without any evidence of chronic idiopathic inflammatory bowel disease. Patients with diverticulitis may have extraintestinal manifestations as do patients with other inflammatory diseases of the colon. The failure to recognize this relationship may result in misdiagnosis and prolonged medical therapy, whereas segmental colonic resection may be curative.

Aged↗
PubMed1987

Exogenous ATP antagonizes the actions of phospholipase A2, local anesthetics, Ca2+ ionophore A23187, and lithium on glucose-1,6-bisphosphate levels and the activities of phosphofructokinase and phosphoglucomutase in rat muscle.

ATP, added externally to the incubation medium of rat diaphragm muscles, abolished the decrease in the levels of glucose-1,6-bisphosphate (Glc-1,6-P2), the powerful regulator of carbohydrate metabolism, induced by phospholipase A2, local anesthetics, Ca2+ ionophore A23187, or lithium. Concomitantly to the changes in Glc-1,6-P2, the potent activator of phosphofructokinase (the rate-limiting enzyme in glycolysis) and phosphoglucomutase, the activities of these enzymes were reduced by the myotoxic agents and restored by exogenous ATP, when assayed under conditions in which these enzymes are sensitive to regulation by Glc-1,6-P2. These findings suggest that ATP may have broad therapeutic action, as it may stimulate the impaired glycolysis in muscle induced by various drugs and conditions which cause muscle weakness or damage.

Adenosine Triphosphate↗
PubMed1987

Electron microscopic and immunolabeling studies of the lesional and normal skin of patients with mycosis fungoides treated by total body electron beam irradiation.

Biopsy specimens were taken from lesional and normal skin of nine patients with mycosis fungoides before and after total body electron beam therapy. By electron microscopy, lesional skin had one and one-half to ten times as many epidermal Langerhans cells and indeterminate cells as did the normal skin. In successfully treated lesional skin 1 month after the end of electron beam therapy, the density of epidermal Langerhans cells and indeterminate cells had decreased markedly. In incompletely resolved lesions, Langerhans cells and indeterminate cells were still at pretreatment levels. Epidermal T6 and Ia antigens showed the same pattern of response. Epidermal cell suspensions from lesional and normal skin before and after electron beam therapy were assayed for epidermal thymocyte activating factor. The values of production of this factor did not correlate with the source of the epidermal cells, response to therapy, or the patient's disease course. Skin lesions resembling xerosis and parapsoriasis and histologically lacking the criteria for mycosis fungoides appeared during clinical remissions. These nonspecific skin lesions had densities of epidermal Langerhans cells, indeterminate cells, and T6-positive and Ia-positive cells comparable to levels found in pretreatment lesional skin.

Antibodies, Monoclonal↗
PubMed1987

Laser vascular welding--how does it work?

This study evaluated the histology and electron microscopy of four samples of 2 cm long venotomies and artery-vein anastomoses formed in canine femoral arteries and veins using the argon laser (0.5 W power, 1 800 J/cm2, 4 min exposure/1 cm length of anastomosis). Welds were continuously irrigated with saline during the procedure to limit maximal temperatures to 44.2 +/- 1.6 degrees C (mean +/- SD), and the specimens were removed immediately following fusion and preserved for examination. Histologic and electron microscopic examination of different areas of the welds revealed various mechanisms of fusion including a) apposition of denatured collagen and elastin in the media and adventitia; b) bonding of vein medial collagen and elastin to the internal elastic membrane of the artery; and c) fusion consisting of a coagulum of platelets and fibrin depending on the alignment and apposition of the vessel edges. This study demonstrates that vascular tissue fusion by the argon laser occurs by various mechanisms. Future experiments should delineate which types of seal produce the optimal strength at the time of fusion, and enhance long-term healing.

Animals↗