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Biomedical subjects

S Michael

Publications and source records attributed to S Michael.

At least 37 records · Page 2Linked to original sources
PubMed1995

Infections complicating tunneled intraspinal catheter systems used to treat chronic pain.

Tunneled intraspinal catheters and catheter-pump systems are increasingly common treatments for severe chronic pain, but these long-term catheters have caused meningitis, epidural abscesses, and other serious infections. At a cancer referral center, 81 catheters were placed in 72 patients over a 7-year period. There were seven catheter-associated infections: two were meningeal (one was accompanied by an epidural abscess and one by a pocket infection and bacteremia), four were associated with a pocket, and one was associated with a tunnel. The infection rate was 0.77 per 1,000 catheter-days. Pathogenic organisms that were isolated were primarily normal skin flora. By multivariate Cox analysis, the only factor significantly associated with catheter infection was prolonged catheter placement surgery, i.e., a procedure lasting at least 100 minutes (RR, 8.8; 95% CI, 1.6-50). Three patients were cured by removal of the catheter and treatment with antibiotics, and symptoms were satisfactorily suppressed in four patients with antibiotics alone. Considering the severity of illness in catheter recipients, the infection rate was relatively low. Removal of the catheter does not appear mandatory when the goal is suppression of infection-related symptoms, especially when the infection has not spread to the CNS, the infecting organism has an intrinsically low virulence, and the infected patient is terminally ill.

Abscess↗
PubMed1994

Patient adherence to guidelines for diabetes eye care: results from the diabetic eye disease follow-up study.

Early detection and treatment of diabetic eye disease can prevent blindness, yet many persons with diabetes lack regular eye care. This study followed 569 people with diabetes participating in blindness prevention programs during 1985 through 1987; it was found that 35% of subjects received dilated eye examinations before entering the programs, in comparison with 60% afterward. About 85% of participants referred for proliferative retinopathy treatment began such treatment, and, of these, 85% completed treatment. A lack of knowledge about the disease and limited finances were primary reasons for nonadherence. To improve the effectiveness of prevention programs, eye care providers and program staff must strive to eliminate these educational and financial barriers.

Black People↗
PubMed1994

Effect of ursodeoxycholic acid on in vivo and in vitro toxic liver injury in rats.

BACKGROUND: Benefits of ursodeoxycholic acid (UDCA) in cholestatic disorders have been well documented. However, the therapeutic potential of UDCA in parenchymal liver disease is unclear. METHODS: We tested UDCA in rat models of hepatotoxicity: (a) in subacute liver injury induced by repetitive CCl4 and dietary ethyl alcohol (ETH) over seven weeks while receiving oral UDCA; and, (b) in liver slides incubated with CCl4, ETH or p-acetaminophen (APAP) when UDCA was added to the incubating solution. RESULTS: Experiment 1: CCl4 combined with ETH reduced the body weights and resulted in 43% mortality. There was a significant rise in serum ALT, alkaline phosphatase, lipoperoxides (LPO) and in hepatic weight, triglycerides, LPO and histological scores of liver injury. Experiment 2: When liver slides were incubated with hepatotoxins there was an increased transfer of AST and LPO from the tissue into the incubate and a reduction in the valine and thymidine incorporation into the liver proteins or DNA. In none of these situations, whether the liver damage was severe or mild, in vivo or in vitro, UDCA did abolish these hepatotoxic effects. CONCLUSION: In contrast to clinical cholestatic disorders where the reported benefits of UDCA depend on replacement of the accumulated hydrophobic bile acids, these bile acids have a less prominent role in toxic liver injury and UDCA is ineffective.

Acetaminophen↗
PubMed1994

Ursodeoxycholic therapy in chronic liver disease: a meta-analysis in primary biliary cirrhosis and in chronic hepatitis.

OBJECTIVES: to determine whether ursodeoxycholic acid (UDCA) is effective in improving primary biliary cirrhosis (PBC) or chronic hepatitis (CH). METHODS: Meta-analysis (MA) was performed on nine papers and three abstracts describing PBC and on nine papers and two abstracts with CH that were published between 1985 and 1992 and were identified through MEDLINE. Studies were included if they fulfilled established quality criteria and the patients had at least liver histology at the start and two to three relevant laboratory tests repeated after UDCA. A total of 800 patients with PBC were treated for 6-48 months. In CH, 285 patients were treated for 1-21 months. RESULTS: In PBC, an average daily UDCA of 13 mg/kg.day improved the liver tests AST, ALT, ALP, and GGT (all p < 0.001). The effect on serum bilirubin was too heterogeneous to evaluate. When evaluated individually, the studies showed an indeterminate effect on histologic progression and treatment failure. When pooled in MA, UDCA improved the liver histology (p < 0.001) and prevented treatment failure (p < 0.04). In CH, UDCA at an average of 11 mg/kg.day improved AST, ALT, GGT, and total bilirubin (all p < 0.001) and also ALP (p = 0.014). There was no effect on histology of CH and no data on treatment failure. CONCLUSIONS: MA confirmed a beneficial effect of UDCA in PBC on liver tests, histology, and treatment failure. In CH, there was an improvement in liver tests, but the evidence for histologic effect was sparse and insignificant. Future studies in PBC must explore the disease after UDCA is discontinued. Trials in CH should distinguish between the diagnostic subgroups, document patient compliance with UDCA, and include histology and treatment failure as end points.

Hepatitis, Alcoholic↗
PubMed1993

Faculty research productivity in allied health settings: a TQM approach.

Faculty research productivity in colleges of allied health has often been discussed in the literature over the last five years. Articles have focused on the problem of faculty research productivity from various viewpoints, but none have used a theoretical framework to analyze the problem. The total quality management (TQM) framework is currently being used in health care to improve quality and productivity. This article uses the TQM framework to synthesize literature concerning faculty research productivity and verifies the current relevance of synthesis findings using an allied health faculty survey. These analyses show that the TQM framework is useful in suggesting ways to increase faculty research productivity in colleges of allied health.

Allied Health Personnel↗
PubMed1992

Pharmacokinetics of lignocaine in children after infiltration for cleft palate surgery.

We have studied the pharmacokinetics of lignocaine in children after local infiltration for cleft palate surgery. After induction of anaesthesia, lignocaine 2.5 mg kg-1 with adrenaline 1:200,000 was injected into the palate. Blood samples were collected before and at 2, 5, 10, 15, 20, 30, 60 and 120 min after infiltration. Plasma concentrations of lignocaine were measured by a gas-liquid chromatographic technique. There were no signs of systemic toxicity on routine monitoring of the patients and the peak plasma concentrations were less than the accepted toxic values. Mean half-life was 72.9 (SEM 9.9) min, similar to that found previously in adults and children. However differences in mean clearance (24.6 (2.04) ml kg-1 min-1) and volume of distribution (0.80 (0.07) litre kg-1) were found between this and previous studies.

Anesthesia, General↗
PubMed1992

Protective effect of oral acetylcysteine against the hepatorenal toxicity of carbon tetrachloride potentiated by ethyl alcohol.

Considering the well-documented protection of acetylcysteine (AC) in hepatotoxicity related to acetaminophen, we studied the preventive potential of AC against mild hepatotoxicity of CCl4, potentiated with ethyl alcohol (ETH) and the role of tissue glutathione. Rats fed a liquid diet with 30% of energy from ETH, had-intraperitoneal CCl4 administered in three injections, at 7-day intervals. AC was ingested at the level for acetaminophen overdose. ETH markedly potentiated the injury induced by CCl4, as evidenced by higher values of serum alanine aminotransferase (ALT), urinary bile acids (BA), serum creatinine, histological score of liver cell necrosis, mortality and by lower body weights and lower liver glutathione, when compared with CCl4 alone. Protective effect of AC consisted of a lesser hepatocytic necrosis, better body weights and higher liver glutathione. We conclude, that AC favorably modifies liver damage induced by CCl4 and potentiated with ETH. There is a preventive role for AC in subjects who combine ETH overuse with exposure to hepatotoxic xenobiotics, whose toxicity is modified by tissue glutathione.

Acetylcysteine↗
PubMed1991

Policies for oral intake during labour. A survey of maternity units in England and Wales.

A postal survey was conducted to gain information on the use of policies on oral intake, selection of mothers and type of intake given during established labour by all maternity units in England and Wales. A response rate of 91.6% (351 out of 383) was achieved; 79.5% of units had a written policy for oral intake, 96.4% of units allowed mothers some form of oral intake and 68.3% of these units selected mothers according to risk categories. Of the 268 units allowing oral intake, 67.2% gave drink only and 32.8% drink and food. Of those allowing food, all but 13.6% had a selection policy. Of the 85 units not selecting mothers, 78.8% gave water only; the remaining 21.2% gave water and other drink or food. This survey demonstrates a wide variation in policies for oral intake during labour.

Anesthesia, Obstetrical↗
PubMed1990

Intra-operative pulmonary embolism. Detection by pulse oximetry.

A case is presented of a 49-year-old patient who had a pulmonary embolism during ovarian cystectomy. The only evidence of its occurrence was a sudden, marked reduction in arterial oxygen saturation as detected by a pulse oximeter. The diagnosis was confirmed 24 hours later by a chest radiograph and a ventilation perfusion scan. Anticoagulant treatment was instituted.

Female↗
PubMed1989

A comparison between open-end (single hole) and closed-end (three lateral holes) epidural catheters. Complications and quality of sensory blockade.

A randomised, single-blind study was conducted on 802 parturient women who required epidural analgesia, to compare open-end (single hole) with closed-end (three lateral holes) epidural catheters. The complication rate after catheter insertion was not statistically different between the two groups, but the number of unsatisfactory blocks was significantly higher in the open-end group (p less than 0.001). The closed-end catheters were easier and less painful to place, but gave a higher incidence of bloody taps. The open-end catheters caused sensory blockade to be more frequently unilateral and more frequently missed sensory segments. This resulted in a significantly higher number of open-end catheters that required replacement (p less than 0.001). Open-end catheters despite their theoretical advantages in the detection of intravenous and subarachnoid placement caused an unacceptably high incidence of unsatisfactory sensory blockade.

Adolescent↗
PubMed1989

Absorptive capacity for dietary fat in elderly patients with debilitating disorders.

To determine the effectiveness of vigorous realimentation with dietary fat, 17 subjects aged 64.0 +/- 2.1 years (mean +/- 1 SEM) were pump-fed via a nasogastric tube for an average of 22 days. The diet was liquid and nutritionally complete, high in unsaturated fat (67% of energy) and in the caloric density (12.6 kJ/mL or 3 Kcal/mL) [corrected]. Advanced malnutrition was manifested by 74% of the ideal body weight, subnormal anthropometric measurements, and low serum protein levels. At an intake of 17,986 +/- 945 kJ (4068 +/- 225 Kcal [corrected]) and 344 +/- 18 g of fat per day, the rate of nutrient absorption was 93% for energy and fat and 88% for protein. An increase in the daily fecal fat to 23 +/- 6 g was not associated with diarrhea. While serum triglyceride levels remained unchanged, the total cholesterol level decreased, with a relative increase in the high-density lipoprotein level. Effective utilization of nutrients resulted in a positive nitrogen balance and increases in body weight, triceps skinfold, the midarm muscle circumference, total iron binding capacity, and serum urea nitrogen level.

Aged↗
PubMed1988

Random urine bile acids in prediction of liver abnormality in asymptomatic alcoholics.

We evaluated bile acids for prediction of abnormal serum liver profile in a random sample of urine (URNBA). Seventy-four subjects with excessive alcohol intake, self-referred for outpatient detoxification, had no history or physical findings of liver disease. Surprisingly, in 49% (36/74) of alcoholics, two or more of these were elevated: serum bile acids, aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase (ALP), and/or total bilirubin. All subjects were subdivided into 39 URNBA normal and 35 URNBA abnormal, using 2.6 mumol/g of creatinine as a dividing value. Serum tests confirmed the subgrouping made with URNBA. Compared with alanine aminotransferase, URNBA had better sensitivity, specificity, and overall diagnostic accuracy predicting abnormal serum bile acids, AST, and alkaline phosphatase values. A predictive potential for a multivariate discriminant function of laboratory tests, known to best identify biopsy-documented mild liver disease, was only mildly inferior for URNBA when compared with AST. Multiple abnormalities of liver test results are unexpectedly frequent in asymptomatic alcoholics. The URNBA are helpful in the detection of liver abnormality in its clinically latent phase, because of the convenience of testing a spot sample of urine.

Adult↗
PubMed1987

Cytogenetic study of a testicular tumor in a translocation (13;14) carrier.

We performed chromosomal analysis of a primary testicular tumor from an individual who, on subsequent analysis of peripheral blood, was found to have a balanced (13q14q) translocation. Histologically, the tumor was a mixed germ cell neoplasm, predominantly embryonal carcinoma, with some teratomatous elements. The modal chromosome count of the tumor cells was 62, with most counts ranging from 54 to 66. In addition to a t(13q14q) chromosome (of constitutional origin), nine nonrandomly acquired chromosomal abnormalities were identified, including an abnormal chromosome #1 and a probable i(12p). These findings are further discussed and compared with cytogenetic data on human testicular neoplasms from the literature. This case is also discussed with regard to the possible association of a constitutional t(13q14q) and various malignancies and related disorders.

Adult↗
PubMed1986

Bile acid levels in diagnosing mild liver disease. Fasting and postcholecystokinetic values.

In ten healthy controls and in ten patients with biopsy-proved mild liver disease, we studied fasting and postcholecystokinetic bile acid levels to assess their diagnostic value compared with standard liver tests. Cholecystokinetic bile acid elevation was standardized by evacuating the gallbladder with intramuscular ceruletide diethylamine (cholecystokinin decapeptide) in a double-blind, randomized, placebo-controlled crossover design. Radioimmunoassay of primary conjugated bile acids was adequately sensitive to separate controls from patients even on the basis of fasting serum bile acid levels. In both controls and patients, the 180-minute postcholecystokinetic bile acid time curve was significantly higher after ceruletide than after placebo. Nevertheless, neither this response nor any of the 30-minute postcholecystokinetic interval bile acid levels separated controls from patients better than the fasting bile acid values, which discriminated better than standard liver tests or the indocyanine green clearance at 20 minutes. Alanine aminotransferase separated the two groups with a sensitivity equal to fasting bile acid levels.

Bile Acids and Salts↗
PubMed1983

Ovulation and pregnancy after pulsatile administration of gonadotropin releasing hormone.

Twenty-seven patients with primary or secondary amenorrhea were treated with gonadotropin releasing hormone (GnRH). They were given 20 micrograms of GnRH in 50 microliter solution i.v. every 90 min by means of a peristaltic pump (Zyklomat, Ferring GmbH, Kiel). Two days after a rise in basal body temperature and when a ferning test on cervical mucus was negative the Zyklomat was removed and injections of hCG (2,500 IU) were given on alternate days until three injections had been administered. Ovulation occurred in 32 out of 40 treatment cycles and 11 patients conceived. Three of them miscarried at 6, 8, and 15 weeks of gestation. There were no severe complications of treatment and we did not encounter ovarian hyperstimulation and multiple pregnancy.

Adult↗