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PubMed1994

Glutathione S-transferase M1 and its variants A and B as host factors of bladder cancer susceptibility: a case-control study.

Glutathione S-transferase M1 (GSTM1) is a foreign compound-metabolizing enzyme with a heritable complete lack of activity in about 50% of Caucasians. GSTM1 deficiency may predispose individuals to urinary bladder cancer. Thus, a hospital-based case-control study was performed with 296 patients with bladder cancer and 400 controls, investigating this GSTM1 deficiency in relation to environmental risk factors and types of bladder cancer. Frequencies of the GSTM1 gene deletion (genotype, GSTM1*0/0) and of the allele variants A (mu) and B (psi) of the GSTM1-active trait were determined using an internal standard-controlled polymerase chain reaction technique. Moreover, in all patients GSTM1 expression was quantified in blood by an immunoassay. Of the cases, 59.1% had the GSTM1*0/0 genotype, in contrast to 50.7% of the controls (odds ratio, 1.40; 95% confidence limits, 1.02-1.92; P = 0.017). The odds ratio after adjustment for age and gender by logistic regression analysis was 1.54 (95% confidence limits, 1.12-2.13). Occupational risk was defined as previous employment in occupations with known increased bladder cancer risk, but the impact of GSTM1*0/0 was not significantly different in individuals with risk jobs versus those without. The greater proportion of the GSTM1-deficient individuals in the group with cancer was due to a lower frequency of carriers of GSTM1A. The odds ratio for the subgroup of individuals with the GSTM1B phenotype versus carriers of the GSTM1A phenotype in cases versus controls was 1.65 (95% confidence limits, 0.976-2.78; two-tailed Fisher's exact P = 0.057). Analysis of functional GSTM1 activity in a subset of 370 blood samples with the model substrate trans-stilbene oxide confirmed the genetic results and showed that 9 of 10 individuals with mu/psi heterodimers (genotype, GSTM1*A/B) had activities above the median of all genetically GSTM1-active individuals (24 pmol/min/1 x 10(6) lymphocytes; P < 0.01), indicating a gene dose relationship for GSTM1. GSTM1 expression in the urinary bladder endothelium detected by immunoassay and immunohistology corresponded to the genotype of the patients. It may be concluded from this study that the heritable GSTM1 deficiency is responsible for 17% (etiological fraction; 95% confidence limits, 2-30%) of bladder cancer cases.

Aged↗
PubMed1992

Capsazepine: a competitive antagonist of the sensory neurone excitant capsaicin.

1. Capsazepine is a synthetic analogue of the sensory neurone excitotoxin, capsaicin. The present study shows the capsazepine acts as a competitive antagonist of capsaicin. 2. Capsazepine (10 microM) reversibly reduced or abolished the current response to capsaicin (500 nM) of voltage-clamped dorsal root ganglion (DRG) neurones from rats. In contrast, the responses to 50 microM gamma-aminobutyric acid (GABA) and 5 microM adenosine 5'-triphosphate (ATP) were unaffected. 3. The effects of capsazepine were examined quantitatively with radioactive ion flux experiments. Capsazepine inhibited the capsaicin (500 nM)-induced 45Ca2+ uptake in cultures of rat DRG neurones with an IC50 of 420 +/- 46 nM (mean +/- s.e.mean, n = 6). The 45Ca2+ uptake evoked by resiniferatoxin (RTX), a potent capsaicin-like agonist was also inhibited. (Log concentration)-effect curves for RTX (0.3 nM-1 microM) were shifted in a competitive manner by capsazepine. The Schild plot of the data had a slope of 1.08 +/- 0.15 (s.e.) and gave an apparent Kd estimate for capsazepine of 220 nM (95% confidence limits, 57-400 nM). 4. Capsazepine also inhibited the capsaicin- and RTX-evoked efflux of 86Rb+ from cultured DRG neurones. The inhibition appeared to be competitive and Schild plots yielded apparent Kd estimates of 148 nM (95% confidence limits, 30-332 nM) with capsaicin as the agonist and 107 nM (95% confidence limits, 49-162 nM) with RTX as agonist. 5. A similar competitive inhibition by capsazepine was seen for capsaicin-induced [14C]-guanidinium efflux from segments of adult rat vagus nerves (apparent Kd = 690 nM; 95% confidence limits, 63 nM-1.45 microM). No significant difference was noted in the apparent Kd estimates for capsazepine in assays on cultured DRG neurones and vagus nerve as shown by the overlap in the 95% confidence limits.6. Capsazepine, at concentrations up to 1O microM, had no significant effects on the efflux of 86Rb+ from cultured DRG neurones evoked either by depolarization with high (50 mM) K' solutions or by acidification of the external medium to pH 5.0-5.6. Similarly capsazepine had no significant effect on he depolarization (50 mM KCl)-induced efflux of [14C]-guanidinium from vagus nerve preparations.7. Ruthenium Red was also tested for antagonism against capsaicin evoked ['4C]-guanidinium release from vague nerves and capsaicin induced 45Ca2" uptake in cultures of DRG neurones. In contrast to capsazepine the inhibition by Ruthenium Red (10-500nM in DRG and 0.5-10microM in vagus nerve experiments) was not consistent with a competitive antagonism, but rather suggested a more complex,non-competitive inhibition.

Adenosine Triphosphate↗
PubMed2005

Cytogenetic biodosimetry of an accidental exposure of a radiological worker using multiple assays.

A technician involved in the maintenance of X-ray equipment visited the occupational medicine service with complaints of skin lesions, apparently caused by an accidental exposure three months earlier. To estimate the dose received by the technician in the accident, biodosimetry was performed 6 and 18 months post-exposure with the dicentric and micronucleus assays. Part of the latest blood sample was also used for retrospective dosimetry by fluorescence in situ hybridisation (FISH) analysis for translocations. The data obtained 6 and 18 months post-exposure indicate that both dicentrics and micronuclei disappear with a half-time of 1 y. After correction for delayed blood sampling, dose values of 0.75 Gy (95% confidence limits 0.56-1.05 Gy) from dicentrics and 0.96 Gy (95% confidence limits 0.79-1.18 Gy) from micronuclei were obtained. FISH analysis of translocations resulted in a dose estimate of 0.79 Gy (95% confidence limits 0.61-0.99 Gy). The satisfactory agreement between the three cytogenetic endpoints supports the use of the micronucleus assay for triage purposes in the case of large scale radiological accidents and provides further evidence for the valid use of FISH for translocations as a reliable retrospective biological dosimeter.

Adult↗
PubMedDate not supplied

Testosterone treatment of men with alcoholic cirrhosis: a double-blind study. The Copenhagen Study Group for Liver Diseases.

A double-blind, placebo-controlled multicenter trial was conducted to determine the efficacy of oral testosterone treatment (200 mg three times daily) in men with alcoholic cirrhosis. By skewed randomization (3:2), 134 patients received testosterone and 87 placebo. Patients were followed from 8 to 62 months (median = 28 months). In the testosterone group, 33 patients died (25%; 95% confidence limits = 18 to 33%) as compared to 18 (21%; 95% confidence limits = 13 to 31%) in the placebo group. Taking age and significant prognostic variables into consideration, this corresponds with a relative mortality risk of 1.17 (95% confidence limits = 0.65 to 2.15) in the testosterone group vs. the placebo group. Testosterone treatment did not significantly affect liver biochemistry, prevalence of complications to cirrhosis or causes of death. Patients treated with testosterone developed significantly (p less than 0.05) higher serum testosterone and blood hemoglobin concentrations and significantly (p less than 0.05) lower plasma IgM concentrations as compared to the placebo group. The prevalence of gynecomastia decreased significantly (p less than 0.05) in the testosterone group as compared to the placebo group. We conclude that oral testosterone treatment has no beneficial effect on survival and liver biochemistry in men with alcoholic cirrhosis, and adverse effects cannot be excluded.

Adult↗
PubMed1987

Menopause and the risk of coronary heart disease in women.

To determine the relation of menopause to the risk of coronary heart disease, we analyzed data on a prospective cohort of 121,700 U.S. women 30 to 55 years old who were followed from 1976 to 1982. Information on menopausal status, the type of menopause, and other risk factors was obtained in 1976 and updated every two years by mailing questionnaires. Through 1982, the follow-up rate was 98.3 percent for mortality and 95.4 percent for nonfatal events. After we controlled for age and cigarette smoking, women who had had a natural menopause and who had never taken replacement estrogen had no appreciable increase in the risk of coronary heart disease, as compared with premenopausal women (adjusted rate ratio, 1.2; 95 percent confidence limits, 0.8 and 1.8). Again compared with premenopausal women, the occurrence of a natural menopause together with the use of estrogens did not affect the risk (rate ratio, 0.8, 95 percent confidence limits, 0.4 and 1.3). Women who had undergone bilateral oophorectomy and who had never taken estrogens after menopause had an increased risk (rate ratio, 2.2; 95 percent confidence limits, 1.2 and 4.2). However, the use of estrogens in the postmenopausal period appeared to eliminate this increased risk among these women as compared with premenopausal women (rate ratio, 0.9; 95 percent confidence limits, 0.6 and 1.6). These data suggest that, in contrast to a natural menopause, bilateral oophorectomy increases the risk of coronary heart disease. This increase appears to be prevented by estrogen-replacement therapy.

Adult↗
PubMed1992

A comparison of expiration dating period estimation methods.

Two methods of estimating expiration date have been compared. For a drug whose potency is expected to decrease with time, method 1 fits a linear regression line to the stability data, calculates a 95% lower confidence limit of the true degradation line, and estimates the expiration date by comparing the confidence limit with the lower specification limit. Method 2 calculates a 95% lower confidence limit b1 of the slope of the true degradation line, constructs a new line y" using b1 as its slope, and finally estimates the expiration date by comparing y" with the lower specification limit. In this work we show that in most practical situations, method 1 estimates greater expiration date than method 2.

Chemistry, Pharmaceutical↗
PubMed2006

Reliability of multilocus sequence typing of the Burkholderia cepacia complex in cystic fibrosis.

INTRODUCTION: Infection with the Burkholderia cepacia complex is an important cause of morbidity and mortality in cystic fibrosis (CF). We investigated the molecular clock speed of the seven genes used in the multilocus sequence typing (MLST) scheme for these bacteria. METHODS: At least two isolates, separated by months to years, from each of 20 patients were typed using MLST. In total 41 isolates, providing 128 isolate-years, were analyzed. Mutation and recombination rates were estimated assuming a Poisson distribution. RESULTS: Out of 20 patients, 15 had no change in sequence type over time (mean 7.07 years, range 1.09 to 14.24). One patient had strain replacement. Three patients had evidence of recombination involving one of the seven housekeeping genes, and one patient had evidence of recombination of two genes. The mutation rate was estimated as 2.36x10(-6) per nucleotide per year (50% confidence limit) and 1.02x10(-5) per nucleotide per year (upper 95% confidence limit). The rate of nucleotide changes due to recombination events was estimated as 0.676 to 0.839 per year (95% confidence limits). CONCLUSIONS: B. cepacia complex housekeeping genes have a slow molecular clock speed and MLST provides a robust and reliable typing technique for isolates from this complex. A low rate of point mutation was found, with a higher rate of recombination events, in keeping with previous cross-sectional epidemiological data. The study also demonstrated, for the first time, recombination in a longitudinal in vivo study.

Bacterial Typing Techniques↗
PubMed1996

Prevalence of shigellosis in the U.S.: consistency with dose-response information.

Every year there are estimated 300000 cases of Shigella in the United States (Bennett et al., 1987, Am. J. Prev. Med. 3, 102-114). A beta-poisson model was fit to human dose-response information on pathogenic Shigella using the Maximum Likelihood Estimation technique (Haas, 1983, Am. J. Epidemiol. 118, 573-582). Pooled and separate data sets for the Shigella species were fit to the beta-Poisson model and 95% confidence limits and regions were calculated. Shigella dysentariae and Shigella flexneri confidence regions and limits overlapped with each other and with the pooled data set, suggesting that this model can describe Shigella in general. The pooled Shigella model as well as the upper and lower confidence limits of the three data sets showed average exposures based on the estimated U.S. caseload of pathogenic Shigella of 0.01 to 0.014 organisms (confidence limits 0.001-0.05) for a 7-day per annum period of exposure and ranges from 0.07 to 0.1 organisms (confidence limits 0.006-0.4). for a 1-day per annum period of exposure. The plausibility of the pooled dose-response model was then evaluated by comparison with two known cruise ship outbreaks. The pooled model estimated that the two outbreaks studied could have been due to ingestion of 344 (confidence limits 72-915) Shigella cells per meal and 10.5-12 (confidence limits 1-44) Shigella cells per glass of water by passengers.

Dysentery, Bacillary↗
PubMed2001

DDPH inhibited L-type calcium current and sodium current in single ventricular myocyte of guinea pig.

AIM: To investigate the effects of 1-(2, 6-dimethylphenoxy)-2-(3,4-dimethoxyphenyl-ethylamino)propane hydrochloride (DDPH) on L-type calcium current (ICa) and sodium current (INa), and to compare its inhibitory potency with verapamil and mexiletine. METHODS: Whole-cell patch clamp technique was used to record ICa and INa in a single ventricular myocytes of guinea pig. RESULTS: (1) DDPH (3 - 300 micromol . L-1) decreased ICa at 0 mV in a concentration-dependent manner with an IC50 value of 28.5 micromol . L-1 (95 % confidence limits: 14.3 - 42.7 micromol . L-1, n = 8 cells from 8 guinea pigs). Verapamil (0.3 - 30 micromol . L-1) reduced ICa with an IC50 value of 1.8 micromol . L-1 (95 % confidence limits: 1.3 - 2.3 micromol . L-1, n = 6 cells from 6 guinea pigs). Mexiletine 100 micromol . L-1 did not affect ICa (n = 5 cells from 5 guinea pigs, P > 0.05). The degree of use-dependent blocking effect of DDPH 30 micromol/L on ICa was 58 % +/- 13 % (n = 5 cells from 5 guinea pigs, P < 0.01) at 1 Hz and 76 % +/- 11 % (n = 5 cells from 5 guinea pigs, P < 0.01) at 3 Hz. (2) DDPH (20 - 320 micromol . L-1) could also block INa in a concentration-dependent manner with an IC50 value of 89.0 micromol . L-1 (95 % confidence limits: 68.7 - 109.3 micromol . L-1, n = 9 cells from 9 guinea pigs). The IC50 value of mexiletine was 32.2 micromol . L-1 (95 % confidence limits: 11.7 - 52.7 micromol . L-1, n = 5 cells from 5 guinea pigs). Verapamil at the concentration of 10 micromol . L-1 did not affect INa (n = 5 cells from 5 guinea pigs, P > 0.05). The blocking effect of DDPH 80 micromol/L on INa was non use-dependent. CONCLUSION: DPH exhibited inhibitory effects on both ICa and INa, but its inhibitory effect on ICa was weaker than verapamil, and on INa was weaker than mexiletine.

Animals↗
PubMed1994

Assessment of cardiorespiratory function using oscillating inert gas forcing signals.

A theoretical model (Hahn et al. J. Appl. Physiol. 75: 1863-1876, 1993) predicts that the amplitudes of the argon and nitrous oxide inspired, end-expired, and mixed expired sinusoids at forcing periods in the range of 2-3 min (frequency 0.3-0.5 min-1) can be used directly to measure airway dead space, lung alveolar volume, and pulmonary blood flow. We tested the ability of this procedure to measure these parameters continuously by feeding monosinusoidal argon and nitrous oxide forcing signals (6 +/- 4% vol/vol) into the inspired airstream of nine anesthetized ventilated dogs. Close agreement was found between single-breath and sinusoid airway dead space measurements (mean difference 15 +/- 6%, 95% confidence limit), N2 washout and sinusoid alveolar volume (mean difference 4 +/- 6%, 95% confidence limit), and thermal dilution and sinusoid pulmonary blood flow (mean difference 12 +/- 11%, 95% confidence limit). The application of 1 kPa positive end-expiratory pressure increased airway dead space by 12% and alveolar volume from 0.8 to 1.1 liters but did not alter pulmonary blood flow, as measured by both the sinusoid and comparator techniques. Our findings show that the noninvasive sinusoid technique can be used to measure cardiorespiratory lung function and allows changes in function to be resolved in 2 min.

Animals↗
PubMed1991

Confidence intervals for weighted sums of Poisson parameters.

Directly standardized mortality rates are examples of weighted sums of Poisson rate parameters. If the numbers of events are large then normal approximations can be used to calculate confidence intervals, but these are inadequate if the numbers are small. We present a method for obtaining approximate confidence limits for the weighted sum of Poisson parameters as linear functions of the confidence limits for a single Poisson parameter, the unweighted sum. The location and length of the proposed interval depend on the method used to obtain confidence limits for the single parameter. Therefore several methods for obtaining confidence intervals for a single Poisson parameter are compared. For single parameters and for weighted sums of parameters, simulation suggests that the coverage of the proposed intervals is close to the nominal confidence levels. The method is illustrated using data on rates of myocardial infarction obtained as part of the WHO MONICA Project in Augsburg, Federal Republic of Germany.

Adult↗
PubMed1999

Urological complaints in relation to indinavir plasma concentrations in HIV-infected patients.

OBJECTIVE: To assess the relationship between indinavir-associated urological complaints and indinavir plasma concentrations. DESIGN: Case series, comparing indinavir plasma concentrations in cases with average concentrations in a control group. METHODS: Patients taking 800 mg indinavir three times a day (tid), who presented with overt urological complaints (renal colic, flank pain or haematuria) were selected for the study. Plasma indinavir concentrations were measured by means of a standardized high performance liquid chromatography (HPLC) method. Plasma samples taken at 1.5-8 h after the last indinavir ingestion were included for evaluation. Results were compared with the full pharmacokinetic curves of indinavir plasma concentrations from a control group of 14 patients taking 800 mg indinavir tid without urological complaints, and were expressed as concentration ratios. A ratio of 1 indicated a plasma concentration equalling the average concentration in the control population at the same point in time after the ingestion of indinavir. RESULTS: Seventeen patients (five women) were enrolled and the indinavir concentrations of 15 patients could be evaluated. Fourteen (93%) patients had a concentration above the mean of the controls, 12 (80%) patients had a concentration above the upper 95% confidence limit, and one (7%) patient had a concentration below the lower 95% confidence limit. The mean indinavir concentration in patients with urological complaints (ratio range 0.55-11.49) was significantly higher than the average concentration and the upper 95% confidence limit of the control group (P < 0.05). The results could not be explained by differences in weight, sex or drug interactions. Two patients had chronic active hepatitis B infection. In six patients with indinavir concentrations above the upper 95% limit, indinavir was reduced to 600 mg tid. Upon repeat measurement after the dose adjustment, their indinavir plasma concentrations fell within the 95% confidence interval around the mean of the control population. All six patients remained asymptomatic and had viral loads of less than 500 copies per ml after a follow-up of 5-16 months. CONCLUSIONS: Urological complications occurring during indinavir treatment were associated with elevated indinavir plasma concentrations in 80% of patients in this study. Indinavir plasma concentrations should be monitored upon presentation of urological complaints, on the basis of which dose reductions may be applied if brief interruption and increased hydration are ineffective.

Adult↗
PubMed2002

Effects of benzyltetrahydropalmatine on potassium currents in guinea pig and rat ventricular myocytes.

AIM: To investigate the effects of benzyltetrahydropalmatine (BTHP) on rapidly activating component (I(Kr)), slowly activating component (I(Ks)) of delayed rectifier potassium current, inward rectifier potassium current (I(K1)), and transient outward potassium current (I(to)) in single ventricular myocytes. METHODS: Whole-cell patch clamp technique was used to record ionic currents. RESULTS: (1) BTHP 30 micromol/L reduced I(Kr) and I(Kr,tail) by 31 %+/-4 % and 36 %+/-5 % (n=6, P <0.01), respectively and inhibited I(Ks) and I(Ks,tail) by 40 %+/-6 % and 45 %+/-5 % (n=7, P <0.01), respectively. I(Kr) and I(Ks) were blocked by BTHP 1-100 micromol/L in a concentration-dependent fashion (IC50 value was 13.5 micromol/L and 95 % confidence limit: 11.2-15.8 micromol/L for I(Kr), 9.3 micromol/L and 95 % confidence limit: 7.8-11.8 micromol/L for I(Ks), respectively). (2) BTHP 5 micromol/L inhibited I(to) by 63 %+/-6 % (n=6, P <0.01). BTHP 1-100 micromol/L reduced I(to) in a concentration-dependent manner (IC50 value was 3.6 micromol/L and 95 % confidence limit: 2.9-4.3 micromol/L). (3) BTHP 200 micromol/L did not affect I(K1). CONCLUSION: BTHP inhibited I(Kr), I(Ks), and I(to), but not I(K1). The antiarrhythmic effects of BTHP may be mainly due to its blockade on potassium channels.

Animals↗
PubMed1991

Genotoxicity of 1-nitronaphthalene in Chinese hamster V79 cells.

1-Nitronaphthalene (1-NN) has been identified in the U.S. National Toxicology Program as a non-carcinogen showing some evidence of in vitro genotoxicity. We tested this compound in Chinese hamster V79 cells at 20-80 micrograms/ml with two endpoints: sister-chromatid exchange (SCE) and thioguanine resistance (TGR), with 5 repeat experiments. The SCE values in the presence of rat or hamster hepatocytes were consistently above the 95% and usually the 99% upper confidence limits for the corresponding control. Without hepatocyte activation, the control upper confidence limits were not exceeded except in one experiment in which the control SCE value was unusually low. TGR was scored both as proportion of plates with mutant colonies and as number of mutant colonies per plate. In 2 of 5 experiments, these values exceeded control 95% or 99% upper confidence limits; on the other hand, these values were substantially lower than those of the positive controls, dimethylbenz[a]anthracene (2.6 micrograms/ml) with activation and ethyl methanesulfonate (155 microgram/ml), which is direct-acting. For TGR, activation of 1-NN by either rat or hamster hepatocytes produced inconsistent results. Overall we would consider this compound to be a weak genotoxin, to which a cancer bioassay would be expected to be relatively insensitive.

Animals↗
PubMed1983

The effect of different types of intrauterine devices on the risk of pelvic inflammatory disease.

A case-control study of 155 women with pelvic inflammatory disease (PID) and 305 controls with other conditions was carried out. Compared with other methods of contraception, the age-adjusted relative risk estimate for use of any intrauterine device (IUD) within one month of admission was 8.6 (95% confidence limits, 5.3 and 13.8); for past use, the estimate was 1.6 (confidence limits, 0.6 and 4.0). The estimated risk was highest for users of the Dalkon Shield (11 cases and two controls), lowest for users of copper-containing devices (40 cases and 34 controls), and intermediate for users of other IUDs, principally the Lippes Loop (32 cases and 23 controls). Compared with copper-containing IUDs, the relative risk estimate for the Dalkon Shield was 6.5 (confidence limits, 1.5 and 27.5). When the Dalkon Shield and copper-containing IUDs were compared, in turn, with the Lippes Loop, the estimated risk was increased for the former and reduced for the latter, but the differences were not statistically significant. Nine of the 11 cases using the Dalkon Shield (82%) had severe PID (diagnosed at surgery or because of purulent cervical discharge), compared with 12 of 40 copper device users (30%) and nine of 32 Lippes Loop users (28%). The risk of PID did not seem to be related to duration of use of any of the three IUDs. This study confirms that IUD use increases the risk of PID. It also suggests that the Dalkon Shield is more harmful than other devices.

Adult↗
PubMed1993

The effects of alcohol abuse on readmission for trauma.

OBJECTIVE: To determine the effect of admission for trauma with concurrent acute alcohol intoxication or chronic alcohol abuse on the risk of subsequent recurrence of trauma. DESIGN: Prospective cohort study. SETTING: Level I regional trauma center. PATIENTS: A total of 2578 patients 18 years or older admitted with blunt or penetrating trauma within 24 hours of injury and surviving to discharge. All patients had a blood alcohol concentration (BAC) test, a gamma-glutamyltransferase (GGT) test, and the short Michigan Alcohol Screening Test (SMAST) performed on admission. MAIN OUTCOME MEASUREMENT: Readmission to the trauma center for new trauma. Average follow-up was 28 months (range, 16 to 40 months). RESULTS: The overall rate of readmission for new injuries was 1.3 per 1000 patient-months of follow-up. Patients who were intoxicated on the initial admission (BAC > 22 mmol/L [100 mg/dL]) were 2.5-fold as likely to be readmitted than those not intoxicated (95% confidence limits, 1.6, 3.9). The relative risks for patients with positive SMAST scores and abnormal GGT values were 2.2 (95% confidence limits, 1.4, 3.5) and 3.5 (95% confidence limits, 2.2, 5.5), respectively. The increased risks remained significant for intoxication and abnormal GGT values after adjustment for gender, race, Medicaid status, and mechanism of injury. CONCLUSION: Alcohol abuse is associated with an increased risk of readmission for new trauma. Trauma patients should be screened for alcohol problems; referral of problem drinkers for appropriate care may decrease their risk of admission for subsequent trauma.

Adult↗
PubMed2001

International Council of Emboli Management (ICEM) Study Group results: risk adjusted outcomes in intraaortic filtration.

BACKGROUND: The Multicenter Study of Perioperative Ischemia (McSPI) developed and validated a Stroke Risk Index for estimating the likelihood that patients undergoing isolated coronary artery bypass grafting will experience major perioperative neurologic events. The International Council of Emboli Management (ICEM) Study Group has suggested that use of intraaortic filtration reduces adverse neurologic events. OBJECTIVE: The objective of the present study was to compare predicted and observed neurologic outcomes in patients receiving intraaortic filtration. PATIENTS AND METHODS: From February 1999 to August 2000, 962 patients were enrolled consecutively in a prospective, nonvoluntary registry of intraaortic filtration in 15 European centers. Of these, 447 underwent isolated coronary artery bypass grafting, the target population for applying the McSPI Stroke Risk Index. Forty-five had incomplete data, yielding a study group of 402 patients. The Stroke Risk Index was calculated for each patient, and the sum across patients yielded an expected number of neurologic events. These were compared to observed events by confidence limits and goodness of fit. RESULTS: Six neurologic events were observed (1.5%; 95% confidence limits 0.6-3.4%), roughly half the 13.7 predicted by the Stroke Risk Index (3.4%; 95% confidence limits 2.0-5.8%), P=0.03. CONCLUSIONS: Adverse neurologic events associated with coronary artery bypass grafting in which intraaortic filtration was used were rare and fewer than expected on the basis of the Stroke Risk Index. Rare occurrence of clinically relevant events precludes their use as primary endpoints for randomized clinical studies; however, the Stroke Risk Index provides a valuable benchmark in the absence of such studies.

Aorta↗
PubMed1994

A noninvasive strategy for the treatment of patients with suspected pulmonary embolism.

BACKGROUND: Pulmonary embolism has historically presented a formidable diagnostic problem because of the nonspecificity of the clinical findings associated with this disorder and the diagnostic uncertainties and challenges presented by both ventilation-perfusion lung scanning and pulmonary angiography. We have reported previously that serial noninvasive leg testing provides a practical noninvasive alternative to pulmonary angiography in patients with non-high probability (nondiagnostic) lung scans and adequate cardiorespiratory reserve. We have reevaluated this observation prospectively to (1) confirm or refute our original observation in an independent cohort and (2) to increase the numbers sufficiently to provide narrow confidence limits for the observed outcomes. METHODS: A prospective comparative study in 1564 consecutive patients with suspected pulmonary embolism who underwent ventilation-perfusion lung scanning and objective testing for proximal-vein thrombosis. RESULTS: On long-term follow-up of 627 patients with the following characteristics: (1) abnormal, nondiagnostic lung scans, (2) not taking anticoagulant therapy, and (3) serial noninvasive test results negative for proximal-vein thrombosis, only 12 patients (1.9%; 95% confidence limits, 0.8% to 3.0%) had venous thromboembolism. By comparison, venous thromboembolism on follow-up occurred in four (0.7%) of 586 patients (95% confidence limits, 0.02% to 1.3%) with normal lung scans in whom anticoagulant therapy was withheld and in eight (5.5%) of 145 patients (95% confidence limits, 1.8% to 9.2%) with high probability lung scans who received anticoagulant therapy. CONCLUSIONS: Our findings indicate that the clinician has a practical noninvasive strategy in patients with adequate cardiorespiratory reserve and nondiagnostic lung scans that (1) avoids pulmonary angiography, (2) identifies patients with proximal-vein thrombosis who require treatment, and (3) avoids the need for treatment and further investigation in the majority of patients.

Adolescent↗