The anesthesia workstation with autopilot design.
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Anesthesiology↗
Biomedical subjects
W Johnson
Publications and source records attributed to W Johnson.
Assessing residents' performance in C-L psychiatry. Work in progress.
The scores from the Psychiatry Resident In Training Examination (PRITE) provide useful information concerning residents' acquired knowledge about consultation-liaison (C-L) psychiatry. However, a comparable method for assessment of C-L residents' clinical skills has not been developed. A task force was commissioned by the Consultation-Liaison Psychiatry Section of the Association for Academic Psychiatry to develop such an assessment system. This paper presents the work of that task force and includes a methodology for assessing clinical performance, a prototype evaluation form, and instructions for its use.
Clinical Competence↗
Treatment of the cutaneous pain of acute herpes zoster with 9% lidocaine (base) in petrolatum/paraffin ointment.
BACKGROUND: Treatment of the pain of acute herpes zoster by local anesthetic injections has drawbacks. Topical percutaneous local anesthesia (TPLA) may offer another strategy of providing regional analgesia in affected patients. OBJECTIVE: We evaluate the analgesic efficacy and safety of 9% (wt/vol) lidocaine (base) in petrolatum/paraffin ointment in patients with acute herpes zoster. METHODS: Ointment was applied to the affected skin of 22 patients. Pain, tenderness, sensitivity to pinprick and cold, and blood lidocaine concentration were measured repeatedly during a 20-hour interval and intermittently thereafter. RESULTS: Mean pain, tenderness, and cutaneous sensation scores were reduced at measurements taken from 4 to 20 hours after ointment application (p < 0.05), but not every patient obtained relief. No patient had local skin irritation or systemic toxic effects related to the local anesthetic. CONCLUSIONS: TPLA is a promising therapy for control of cutaneous pain of acute herpes zoster. Controlled studies should be performed to prove efficacy, determine optimal TPLA formulation, and define dosage limits.
Acute Disease↗
Development of a geropsychiatric unit.
Acute services to older citizens often require health care professionals to manage problems that are difficult to assess and treat. Age-related complications such as physical decline and the presence of psychiatric and medical illness together can produce an array of confusing symptoms for the physician. This study examines the diagnostic outcomes of the first 100 patients admitted to an acute care-based geropsychiatric unit. Assessment protocols and treatment interventions are described and results of patient progress are discussed.
Aged↗
Cytotoxicity of extracellular Legionella pneumophila.
Legionella pneumophila, the causative agent of Legionnaire's disease and Pontiac fever, is known to produce a cytopathic effect on macrophages. The capacity of extracellular L. pneumophila to mediate toxicity for guinea pig peritoneal macrophages and J774 mouse macrophages was assessed. Extracellular organisms were found to be capable of mediating toxicity; however, toxic activity appeared to require close proximity with the mononuclear cell surface. Serogroup 1 strains grown on supplemented Mueller-Hinton agar exhibited variable expression of toxic activity. One strain positive on supplemented Mueller-Hinton agar was cytotoxic and unable to replicate in J774 macrophages but remained virulent for guinea pigs at high doses.
Animals↗
Evaluation of a multidisciplinary treatment approach in an inpatient geropsychiatric unit.
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Activities of Daily Living↗
Evaluation of autologous shed blood for autotransfusion after orthopaedic surgery.
Autologous shed blood for autotransfusion was evaluated at four medical centers in a prospective randomized study. One hundred twenty-eight patients were studied after hip replacement, knee replacement, or spine fusion. The efficacy of autologous shed blood in reducing homologous transfusion was evaluated. The relative risk of transfusion with homologous blood was 0.4 in patients who received shed blood compared with patients who did not receive shed blood. The reinfusion of shed blood reduced the requirement for homologous blood by 60%. Two filter systems were evaluated in reinfusing autologous shed blood. The Pall RC100 filter appeared to be more effective than the Pall 40-mu screen filter in removing fat particles and white blood cells. No significant clinical abnormalities were discovered after autotransfusion with autologous shed blood. Evaluation of clotting studies showed no significant differences between patients who received shed blood and patients who received liquid-preserved red blood cells. These data indicate that unwashed autologous shed blood from orthopaedic wound drainage is a safe and effective substitute for transfusion of autologous predonated blood or homologous liquid-preserved red blood cells.
Adult↗
Case records of the Department of Medicine University of Mississippi Medical Center. Sweet's syndrome (acute febrile neutrophilic dermatosis)
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Biopsy↗
Ferric reductases of Legionella pneumophila.
Ferric reductase enzymes requiring a reductant for maximal activity were purified from the cytoplasmic and periplasmic fractions of avirulent and virulent Legionella pneumophila. The cytoplasmic and periplasmic enzymes are inhibited by zinc sulfate, constitutive and active under aerobic or anaerobic conditions. However, the periplasmic and cytoplasmic reductases are two distinct enzymes as shown by their molecular weights, specific activities, reductant specificities and other characteristics. The molecular weights of the cytoplasmic and periplasmic ferric reductases are approximately 38 and 25 kDa, respectively. The periplasmic reductase (Km = 7.0 microM) has a greater specific activity and twice the affinity for ferric citrate as the cytoplasmic enzyme (Km = 15.3 microM). Glutathione serves as the optimum reductant for the periplasmic reductase, but is inactive for the cytoplasmic enzyme. In contrast, NADPH is the optimum reductant for the cytoplasmic enzyme. Ferric reductases of avirulent cells show a 2-fold increase in their activities when NADPH is used as a reductant in comparison with NADH. In contrast, ferric reductases from virulent cells demonstrated an equivalent activity with NADH or NADPH as reductants. With the exception of their response to NADPH, the ferric reductase at each respective location appears to be similar for avirulent and virulent cells.
Chromatography, Gel↗
Characterization of a tight-binding MMP-3 inhibitor using improved fluorescence spectroscopy techniques.
Accurate kinetic characterization of stromelysin (MMP-3) inhibitors is critical in the design of potent inhibitors of this enzyme. We have successfully modified a previously described assay [1] which used an internally quenched peptide substrate (Dnp-PYAYWMR) that, upon cleavage by MMP-3, produces the products, Dnp-PYA (quiet) and YWMR (a fluorophore at 360 nm). This improved assay uses purified human MMP-3 in the presence of either 5% methanol or 5% DMSO. Fluorescence intensities associated with total hydrolysis of substrate by enzyme have been successfully mimicked using a combination of the product peptides as a standard. We have determined a Km of 39.2 microM and Kcat/Km of 4.6 microM/h for MMP-3 (in 5% MeOH) using this peptide substrate. This assay was used successfully to characterize Ro 31-4724 ((N-[(N-[2-[(N-hydroxycarbamoyl)methyl]-4-methyl-valeryl]-L-leucyl ] - L-alanine ethyl ester) as a reversible, tightly binding, inhibitor with a Ki of 26 nm.
Binding Sites↗
Group psychotherapy for patients with dementia.
Some of the goals of our group psychotherapy sessions on the inpatient unit include (1) creation of an emotional climate of acceptance and warmth that helps patients learn to accept themselves and their feelings, (2) frequent intervention by the group facilitator/therapist to help facilitate social interaction for patients whose communication ability is impaired, (3) opportunity for patients to experience the feeling of belonging, of being part of a group, (4) opportunity for patients to ventilate feelings and rediscover mutual kinds of experience, (5) opportunity for patients to reminisce about past accomplishments and give new meaning to their current lives, and (6) creation of a platform for patients to achieve a sense of self by expressing personal opinions in an environment of respect and acceptance. The outcome of group therapy for demented as well as nondemented patients should be increased ability to cope with losses at several levels, promotion of new skills, increased adaptation skills, and increased ability to accept change. We also want patients to learn to express feelings and to realize that the expression of feelings can have a positive outcome (relief from repression, clarification of ambivalence, solutions, etc).
Aged↗
Bile duct injury during laparoscopic cholecystectomy: a report of the Standards Sub-committee of the Victorian State Committee of the Royal Australasian College of Surgeons.
A survey of Victorian surgeons performing laparoscopic cholecystectomy was carried out. This report discusses the bile duct injuries identified in the survey. Twelve injuries were recorded, a rate of 0.2%. Three of the 12 required formal repair, the other 9 being treated by T-tube alone. Possible mechanisms of these injuries, the experience of the surgeon, the role of operative cholangiography and delays in recognition of the injury are discussed.
Bile Ducts↗
Testing independence of fragment lengths within VNTR loci.
Methods that were devised to test independence of the bivariate fragment lengths obtained from VNTR loci are applied to several population databases. It is shown that for many of the probes independence (Hardy-Weinberg equilibrium) cannot be sustained.
Alleles↗
Dementia: physician approaches to the caregiver's problems.
The demented patient requires medical and often psychiatric supervision, but the caregiver is often neglected. This article identifies special issues for caregivers that may need attention from the demented patient's physician. The physician's attention can benefit both the patient and the caregiver and save the physician valuable time.
Activities of Daily Living↗
Human ocular torsion during parabolic flights: an analysis with scleral search coil.
Rotation of the eyes about the visual axis is known as ocular torsion. A lateral inclination (a "roll") of the head induces ocular torsion in the opposite direction, a response known as ocular counterrolling. For six subjects, we recorded the static (head still) and dynamic (head in oscillatory roll motion) ocular torsion in normal 1 g condition and also during the microgravity and hypergravity periods of parabolic flight, using the electromagnetic scleral search coil technique. With the head still, the direction and magnitude of torsion that occurred in response to microgravity and hypergravity differed substantially from one individual to another, but there was a significant difference in torsional magnitude between the microgravity and hypergravity periods, for all static head positions including the upright position. Under normal 1 g conditions, counterrolling compensated for about 16% of (voluntary) static head roll, while dynamic counterroll was much larger, up to 36% of head roll at 0.55 Hz. With increasing frequency of head oscillation between 0.33 Hz and 0.55 Hz, the gain of counterrolling increased and there was no change in the phase relationship. The gain of dynamic counterroll (in response to voluntary head rolling) was not significantly less in hypogravity, suggesting that on the ground at these frequencies the contribution of gravity and gravity receptors to this reflex is redundant: this reflex is probably driven by the semicircular canals. In some subjects, the torsional displacement in microgravity is accompanied by micro-torsional oscillatory motion.
Adult↗
Preoperative radiation therapy produces an early and persistent reduction in colorectal anastomotic blood flow.
Preoperative external beam radiation therapy (RT) is an increasingly popular form of adjunct therapy for rectal cancer; however, little is known about its effects on healing of colorectal anastomoses. We serially evaluated colorectal anastomotic healing following moderate dose RT. Twenty-four adult female pigs were administered 4250 centiGrays (cGy) of external beam pelvic RT over 4 weeks followed by rectosigmoid resection with handsewn or circular stapled anastomosis. Groups of animals were then sacrificed at 5, 11, 60, and 120 days postoperatively. A control group (N = 24) was studied similarly but not irradiated. Perianastomotic blood flow was measured using laser doppler velocimetry at each time interval. Nonirradiated anastomoses demonstrated significantly higher blood flows compared to irradiated anastomotic segments at each study interval. In addition, early (Days 5 and 11) postoperative gross inflammatory scores and microscopic inflammatory score (all intervals) were significantly higher for irradiated animals. Anastomotic complications were more frequent in irradiated animals (7/24) vs controls (2/24, P < 0.05). These results indicate that a preoperative dose of 4250 cGy results in an early and persistent decrease in colorectal mural blood flow independent of anastomotic technique. This is the first experimental study which attempts to quantitate the effects of preoperative pelvic radiation therapy on anastomotic blood flow.
Anastomosis, Surgical↗
A comparison of three methods for estimating dental plaque removal from individual teeth.
The purpose of this study was to determine the efficiency of dental plaque removal, in vitro, by physical force. Of the 3 methods used, turbidity was the most sensitive for measuring microgram amounts of plaque. Air-dried weight and dental plaque imprint assays (DPIA) complemented turbidity measurements by providing a weight standard and a new method for visualizing plaque bacterial structure before the stained imprint was transformed into numerical data. The amount of dental plaque removed from a tooth by physical force can be measured and described as a percentage of the total removable plaque on that tooth.
Analysis of Variance↗
Effects of mood manipulation and anxiety on performance of an emotional Stroop task.
In Study 1 subjects high and low in trait anxiety were asked to identify the colour of anxiety-related, anxiety-matched neutral, happiness-related and happiness-matched neutral words. There were two types of stimulus presentation: blocked trials, where stimuli were blocked with respect to their valence, and mixed trials, where stimuli were mixed with respect to their valence. Subjects high in trait anxiety took longer to identify the colour of anxiety-related compared to matched neutral words for blocked-trial presentation only. In Study 2 subjects were exposed to either a positive or a negative mood-manipulation followed by a mixed-trial Stroop task. The mood manipulation procedure was successful in producing predicted changes in self-reported state anxiety. Analyses showed that high-trait-anxiety subjects exhibited interference effects consistent with the induced mood. No such effects were observed for the low-trait-anxiety subjects.
Adult↗