Persistent gastrocutaneous fistula after percutaneous gastrostomy tube removal.
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Cutaneous Fistula↗
Biomedical subjects
S Peter
Publications and source records attributed to S Peter.
[Influence of vital dyes on the function of the outer blood-retinal barrier in vitro].
BACKGROUND: The use of vital dyes in "chromovitrectomy" allows the easier removal of less recognizable structures like epiretinal membranes (EM) or the inner limiting membrane (ILM). In recent years numerous studies demonstrated the use of indocyanine green (ICG), trypan blue (TB) and patent blue (PB) for this indication. Reports of the possible risk of these dyes, i. e. especially ICG, in respect of reduced visual acuity results, possible visual field defects or alterations of the retinal pigment epithelium (RPE) resulted in limitations in their application. MATERIAL AND METHODS: Human RPE cells and choroidal endothelial cells were cultured in monolayers on semipermeable membranes representing an in vitro model of the outer blood-retinal barrier. By measurement of the transepithelial electrical resistance (TER) the stable barrier function was determined. Two different models representing an air-filled and a fluid-filled eye were tested on the one hand by addition of the dye to the culture medium and, on the other, by direct application on the cell monolayer. In these two models ICG (5 mg/ml, 0.5 mg/ml, 0.125 mg/ml), TB (1.5 mg/ml, 0.15 mg/ml) and PB (2.4 mg/ml, 0.24 mg/ml) were applied for three minutes and the influence on the barrier function was determined. RPE cell growth was also tested in these two models after the application of ICG, TB and PB. Finally, monolayers of RPE cells were evaluated by transmission electron microscopy (TEM). RESULTS: After application of TB, PB and the lowest concentration of ICG of 0.125 mg/ml, the TER remained stable in both models. In contrast, ICG in a concentration of 5 mg/ml and 0.5 mg/ml caused a significant TER decrease in the model of the air-filled eye, whereas no influence on the function of the outer blood-retinal barrier was noted in the model of the fluid-filled eye. RPE cell growth rates were not influenced by the addition of the vital dyes, with the exception of ICG in a concentration of 5 mg/ml in the model of the air-filled eye, resulting in a temporary reduction of the cell count. In good correspondence to these results also in TEM intercellular blisters were noted after application of 5 mg/mL ICG for 3 minutes in the model of the air-filled eye. However, damage to the RPE cells themselves was not obvious. No pathological changes in the TEM were noted after application of TB and PB. CONCLUSIONS: The use of PB and TB at the posterior eye segment seems to be safe concerning damage to the PRE and its barrier function. In contrast, ICG in higher concentrations and with longer application times may cause a toxic effect on RPE morphology and function.
Blood-Retinal Barrier↗
Congenital adrenal hyperplasia in the Bahamas due to 21-hydroxylase deficiency.
OBJECTIVE: To determine the frequency of 21-hydroxylase deficiency in The Bahamas and the spectrum of this disorder METHODS: Patients referred for evaluation of virilization, precocious puberty, ambiguous genitalia and salt wasting had blood taken for 17-hydroxyprogesterone (17-OH progesterone) which was measured by Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS: Nine patients had elevated 17-OH progesterone levels--confirming 21-hydroxylase deficiency. Range of levels was 174.9 nmol/l to 81678.7 nmol/L (normal less than 13 nmol/L). There were six females and three males and the age at diagnosis ranged from 21 days to 16 years. Five had precocious development, three had salt wasting, and there was one with virilization. One of the salt wasters had ambiguous genitalia. Incidence of 2l-hydroxylase deficiency--20/100,000; salt wasting--35/100,000; the prevalence of 21-Hydroxylase deficiency 10/100,000). CONCLUSION: The frequency of 21-Hydroxylase deficiency in The Bahamas is one of the highest worldwide.
17-alpha-Hydroxyprogesterone↗
[Transient visual decrease after photodynamic therapy].
BACKGROUND: After photodynamic therapy (PDT) some patients complain about a transient decrease of visual acuity during the first postoperative week. PATIENTS AND METHODS: Prior to and at 2 days and 1 week after PDT the following parameters were measured: (1) best corrected visual acuity (VA), (2) changes in refraction, and (3) A scan ultrasound biometry was carried out. Linear and 3-D optical coherence tomography was performed in three cases. A total of 53 PDT treatments were followed-up in 24 patients. RESULTS: Comparison of the pre- and postoperative refraction demonstrated a mean hyperopic shift of +0.35 diopters (dpt) in 43% of treatments (23/53) on the second postoperative day. The hyperopic shift reduced to +0.07 dpt after 1 week. The best corrected VA remained stable or was even better in 68% (36/53) on the second postoperative day. A decrease in VA could be noticed in 32% (17/53) at this time which declined to 23% (12/53) after 1 week. Measurement of the cornea-retina distance using A-scan ultrasound biometry disclosed a mean axial reduction of 0,13 mm at the second postoperative day. This correlates closely with an average hyperopic shift of 0,35 dpt. OCT examination disclosed a transient macular edema in the treated retinal areas. CONCLUSIONS: A transient hyperopic shift can be measured in 43% on the second postoperative day. The subjective decrease in visual acuity measured over the postoperative days was mainly due to a transient hyperopic shift in our patients. OCT findings disclosed a transient macular edema of the retina treated with PDT, which may relate to a hyperopic shift.
Aged↗
A prospective evaluation of leflunomide therapy for cytomegalovirus disease in renal transplant recipients.
AIM: A preliminary observation suggests leflunomide is effective in the treatment of cytomegalovirus (CMV) disease in renal transplant recipients. A prospective evaluation was conducted in renal transplant recipients to study the efficacy of leflunomide in the treatment of CMV disease. PATIENTS AND METHODS: With prior approval and informed consent for therapy and follow-up, 17 consecutive consenting renal transplant recipients with proven CMV disease were treated with leflunomide. CMV disease was defined as a clinical syndrome of fever and/or symptoms of organ involvement, leukopenia, and a positive nested CMV quantitative PCR test at 0.001 microg/5 microL template input, with or without histologic evidence of tissue invasion. Leflunomide metabolite concentrations (A77 1726) were monitored. RESULTS: Of the 17 patients, 14 patients were treated for 6 months for CMV disease the first time; the remaining 3 received leflunomide treatment for relapse after ganciclovir treatment, for a year. Seven patients had fever with viremia and no organ involvement, nine had viremia with involvement of gastrointestinal tract, and one had fever with CMV inclusions in the allograft, with no demonstrable viremia. The three patients with relapse treated with leflunomide responded. Overall, 15 patients (88%) clinically responded to leflunomide therapy and with viral clearance from blood and healing of involved organs. The cost of therapy with intravenous ganciclovir (Cymevene, Roche) for 2 weeks was US 721 dollars while that of leflunomide (Cleft, Cipla Ltd) for 6 months was US 64 dollars. CONCLUSION: Leflunomide treatment for CMV disease in renal transplant recipients is effective, simple, and economical.
Adult↗
Sterilisation of extracted human teeth for educational use.
Sixty intact, non-carious and unrestored teeth extracted due to periodontal disease were used to determine the most effective method of sterilisation. The teeth were divided into six groups, each containing 10 teeth. Group 1 teeth were immersed in 10% formalin for seven days, group 2 teeth were immersed in 3% hydrogen peroxide for seven days, group 3 teeth were immersed in 2.6% sodium hypochlorite for seven days, group 4 teeth were boiled in water at 100 degrees C for 20 minutes, group 5 teeth were autoclaved at 121 degrees C at 15 lbs psi for 30 minutes, and group 6 teeth were immersed in normal saline for seven days. After the treatment, the teeth were individually inoculated into trypticase soy broth and incubated for 48 hours. A questionnaire survey was also conducted to determine the awareness of dental students regarding infection due to extracted human teeth and the common disinfection/sterilisation methods used. Autoclaving at 121 degrees C, 15 lbs psi for 30 minutes and immersion in 10% formalin for seven days were effective in disinfecting/sterilising extracted human teeth. Chemicals such as 2.6% sodium hypochlorite, 3% hydrogen peroxide and boiling in water were not effective. The results indicate that autoclaving for 30 minutes or immersion in 10% formalin for seven days could be effectively used for disinfection/sterilisation of extracted human teeth.
Dental Disinfectants↗
Colonic malignancy with recurrent bacteraemia presenting as pyrexia of unknown origin.
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Adult↗
Antiplaque and antigingivitis efficacy of toothpastes containing Triclosan and fluoride.
OBJECTIVE: To compare the reduction of plaque and gingivitis from the following three toothpaste formulations containing: 0.3% Triclosan, 1,000ppm fluoride and 0.13% calcium glycerophosphate in a natural calcium carbonate base (a new paste); 0.2% Triclosan and 1,000ppm fluoride in a precipitated calcium carbonate base; 0.3% Triclosan, 1,000ppm fluoride and Gantrez in a silica base. A control group was maintained, which used commercially available toothpastes without the above actives. METHODS: A double-blind, four-cell, stratified, parallel group design study. Subjects brushed twice daily with their allocated toothpaste for 12 weeks. Plaque, MGI and gingival bleeding assessments were carried out at baseline, after 6 and 12 weeks of product use. RESULTS AND CONCLUSION: An analysis of covariance of the 12-week results showed significant differences between products [p<0.0001] for plaque, MGI and gingival bleeding. The new toothpaste formulation containing 0.3% Triclosan, 1,000ppm fluoride and 0.13% calcium glycerophosphate in a natural calcium carbonate base was shown to be significantly more effective in reducing plaque and gingivitis than the other toothpaste formulations in the study.
Adolescent↗
Stressors, emotional exhaustion and aversion to patients in residents and chief residents - what can be done?
QUESTIONS UNDER STUDY: The goal of the study was to identify (1) specific stressors in the work of residents and chief residents (R and CR) and their consequences, and (2) possibilities for improvement. METHODS: Written questionnaire of 80 physicians at a Swiss public primary and secondary referral center and teaching hospital surveying stressors and resources in the working conditions as well as associated subjective strains. Selective observation of work activities of 14 representative R and CR. RESULTS: Stressors: R and CR reported a deficit in 6 out of 10 expectations regarding their work (greatest deficits: lack of time off, lack of future career prospects and of clear management). The deficits for the R/CR group differed in part highly significantly from deficits reported by directing physicians and medical directors. Work intensity was experienced as high or too high in 72% of R and 67% of CR. Strains: 41% of R and 43% of CR met criteria for emotional exhaustion, and 34% of R and 14% of CR reached critical values for aversion to patients. These strains correlated significantly with the stressors "overburdened through heavy workload", "subjective work intensity", "inadequate leisure time", and "lack of a right to a say in important matters" (all p between <0.001 and <0.01). CONCLUSIONS: Work-related emotional exhaustion and aversion to patients reached a critical mass in R and CR and was underestimated by both physicians and hospital management. The significant correlations between stressors and strains point to the main areas for improvement: reduction in work intensity and workload, change in style of leadership and management, development of new work models.
Burnout, Professional↗
Assessing the severity of hepatic encephalopathy.
The diagnosis of hepatic encephalopathy (HE) is based mostly on clinical criteria. It is important to assess the severity of HE quantitatively for both clinical practice and research; however, this remains a difficult and challenging problem. Modalities like psychometric tests, electroencephalography, evoked potentials, and several innovative biochemical indices have shown promise in this regard. No single parameter or index has yet been shown to be infallible in assessing the severity of HE.
Ammonia↗
Presence of B7--2 (CD86) and lack of B7--1 (CD(80) on myelin phagocytosing MHC-II-positive rat microglia is associated with nondestructive immunity in vivo.
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Animals↗
How is the liver primed or sensitized for alcoholic liver disease?
This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Hidekazu Tsukamoto and Yoshiyuki Takei. The presentations were (1) Tribute to Professor Rajendar K. Chawla, by Craig J. McClain; (2) Dysregulated TNF signaling in alcoholic liver disease, by Craig J. McClain, S. Joshi-Barve, D. Hill, J Schmidt, I. Deaciuc, and S. Barve; (3) The role of mitochondria in ethanol-mediated sensitization of the liver, by Anna Colell, Carmen Garcia-Ruiz, Neil Kaplowitz, and Jose C. Fernandez-Checa; (4) A peroxisome proliferator (bezafibrate) can prevent superoxide anion release into hepatic sinusoid after acute ethanol administration, by Hirokazu Yokoyama, Yukishige Okamura, Yuji Nakamura, and Hiromasa Ishii; (5) S-adenosylmethionine affects tumor necrosis factor-alpha gene expression in macrophages, by Rajendar K. Chawla, S. Barve, S. Joshi-Barve, W. Watson, W. Nelson, and C. McClain; (6) Iron, retinoic acid and hepatic macrophage TNFalpha gene expression in ALD, by Hidekazu Tsukamoto, Min Lin, Mitsuru Ohata, and Kenta Motomura; and (7) Role of Kupffer cells and gut-derived endotoxin in alcoholic liver injury, by N. Enomoto, K. Ikejima, T. Kitamura, H. Oide, Y. Takei, M. Hirose, B. U. Bradford, C. A. Rivera, H. Kono, S. Peter, S. Yamashina, A. Konno, M. Ishikawa, H. Shimizu, N. Sato, and R. Thurman.
Animals↗
Prevalence of dental disease amongst 5-6 and 12-13 year old school children of Puttur municipality, Karnataka State-India.
A survey was conducted among 5-6 and 12-13 years old school children of Puttur municipality, Karnataka State, India, to assess the prevalence of dental caries, malocclusion and dental calculus. A sample size of 200 subjects was taken for each age group and cluster-sampling method was used to select those schools which were to be included in the sample frame. Data collection was done using the Basic Oral Health Survey (WHO) form. The deciduous dentition alone was considered for 5-6 year old subjects while the permanent dentition alone was considered for those aged 12-13 years. A total of 427 subjects from 7 schools were studied. Results indicated that 81.25% of 5-6 year old subjects had dental caries (mean dmft = 4.86 +/- 4.16 S.D.) as compared to 59.6% of 12-13 year old (mean DMFT = 1.87 +/- 2.01 S.D.). The prevalence of malocclusion was 1.79% and 36.95% among those aged 5-6 year and 12-13 year, respectively. None of the 5-6 years old subjects had calculus on their teeth while 47.78% of 12-13 year old subjects exhibited the presence of dental calculus. Overall the prevalence of dental caries was found to be significantly higher among 5-6 year old subjects compared to 12-13 year old subjects. The prevalence of malocclusion and dental calculus was significantly higher among 12-13 year old subjects compared to 5-6 year old subjects.
Adolescent↗
Pericardial patch for atrial septal defect closure.
Pericardium is an eminently suitable material for the closure of atrial septal defects. However, when it is not treated with glutaraldehyde, it is difficult to handle because of curling in of the edges. A technique is described by which pericardium can be used to close atrial septal defects with minimal handling and assistance, and without chemical pretreatment.
Heart Septal Defects, Atrial↗
Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis.
BACKGROUND: Intestinal tuberculosis and Crohn's disease are chronic granulomatous disorders that are difficult to differentiate histologically. AIMS: To characterise distinctive diagnostic features of tuberculosis and Crohn's disease in mucosal biopsy specimens obtained at colonoscopy. METHODS: Selected histological parameters were evaluated retrospectively in a total of 61 biopsy sites from 20 patients with tuberculosis and 112 biopsy sites from 20 patients with Crohn's disease. The patients were chosen on the basis of clinical history, colonoscopic findings, diagnostic histology, and response to treatment. RESULTS: The histological parameters characteristic of tuberculosis were multiple (mean number of granulomas per section: 5.35), large (mean widest diameter: 193 microm), confluent granulomas often with caseating necrosis. Other features were ulcers lined by conglomerate epithelioid histiocytes and disproportionate submucosal inflammation. The features characteristic of Crohn's disease were infrequent (mean number of granulomas per section: 0.75), small (mean widest diameter: 95 microm) granulomas, microgranulomas (defined as poorly organised collections of epithelioid histiocytes), focally enhanced colitis, and a high prevalence of chronic inflammation, even in endoscopically normal appearing areas. CONCLUSIONS: The type and frequency of granulomas, presence or absence of ulcers lined by epithelioid histiocytes and microgranulomas, and the distribution of chronic inflammation have been identified as histological parameters that can be used to differentiate tuberculosis and Crohn's disease in mucosal biopsy specimens obtained at colonoscopy.
Adult↗
Monitoring of remission status by fluorescence in situ hybridisation in chronic myeloid leukaemia patients treated with interferon-alpha.
Interferon-alpha (IFN-alpha) can be considered as treatment of choice for patients with chronic myeloid leukaemia (CML) in chronic phase. With this treatment major cytogenetic responses can be achieved in 30% to 50% of patients. Regular monitoring of cytogenetic response is essential for the therapeutic management of these patients. As conventional cytogenetics is not always successful, especially under IFN-alpha treatment, molecular cytogenetic methods have been established for the examination of interphase nuclei for the presence of the BCR-ABL fusion gene, the molecular counterpart of the Philadelphia chromosome. To demonstrate the value of these new methods we have analysed interphase nuclei from sequentially cultured bone marrow cells from 14 CML patients who were treated with IFN-alpha and whose bone marrow was investigated regularly during therapy. Dual-colour FISH with a breakpoint spanning BCR-YAC and a flanking cosmid from the ABL region was applied. When compared with conventional cytogenetics the results achieved by FISH were favourable. The most evident advantage of FISH analysis is that in case of failure of conventional cytogenetics a reliable determination of the remission status can be done. Together with other recent studies our results illustrate the advantages and limitations of the interphase FISH method for monitoring CML patients.
Adult↗
Prolactin response to the severity of surgical insult.
Prolactin levels are elevated significantly during the recovery process from surgical insult, implying a role for prolactin in the neuroendocrine immune network. This study examined the importance of severity of surgical insult to the prolactin response. Two groups of surgical patients were chosen consecutively and studied prospectively. Seven patients scheduled for "clean" elective surgery, i.e., herniorrhaphy and laparoscopic cholecystectomy, were compared with seven patients scheduled for prolonged abdominal exploration. Blood was drawn for prolactin and cortisol at 8:00 AM on the day of surgery and on postoperative days one, three, and five. Using a two-tailed test, preoperative prolactin levels and levels on postoperative days three and five were significantly different in the prolonged surgery group (.012 and .002, respectively). There were no statistically significant differences in preoperative and postoperative prolactin levels in the clean surgery group. Cortisol levels were not significantly elevated in either group. These results indicate that the prolactin response to surgery is related to the severity of the surgical insult.
Case-Control Studies↗
Prevalence of dental caries among school children of Moodbidri.
This survey was carried out among 2902 children aged between 5 and 12 years attending 13 primary schools in various areas of Moodbidri, in Udupi district. The oral health status was assessed using the simplified WHO Oral Health Assessment Form. The caries prevalence was found to be 76.9%. The mean DMFT was 0.78 and the mean deft was 3.48. Although the mean DMFT score between males and females did not show any significant difference, the mean deft was found to be higher among males compared to females. It was also found that the mean DMFT score increased with age whereas the mean deft score decreased with age.
Age Distribution↗