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This case demonstrates the use of brainstem auditory evoked potentials (BAEPs) to monitor cranial nerve function. Changes in BAEPs were associated with cranial nerve dysfunction in the trigeminal nerve on the ipsilateral side and the facial nerve on the contralateral side.
OBJECTIVE: Elevated maternal temperature in labor is associated with adverse immediate and long-term neonatal outcomes. Conventional methods of temperature measurement may not reflect the intrauterine temperature, which constitutes the fetal environment. The purpose of this study was to ascertain the most reliable noninvasive method of temperature monitoring in labor that would best reflect changes in intrauterine temperature. METHODS: Women in labor receiving epidural analgesia had temperature readings taken every 10 seconds from the uterine cavity, ear canal, and skin surface of the leg and abdomen and hourly from the mouth. RESULTS: Eighteen patients were studied for a mean of 228 minutes (range 56-464 minutes). The best indicator of intrauterine temperature was oral temperature, with a mean intraclass correlation coefficient of 0.6 (95% confidence interval 0.42, 0.77). On average, oral temperature underestimated intrauterine temperature by 0.8 degrees C (95% confidence interval 0.7 degrees C, 1 degrees C). Allowing for this, oral temperature greater than 37.2 degrees C detected an intrauterine temperature greater than 38 degrees C with a sensitivity of 81% and a specificity of 96%. The intraclass correlation coefficients of all other sites with intrauterine temperature were poor (0.1 or less). As expected, the temperature at all sites increased as labor progressed. CONCLUSION: Oral temperature, measured carefully, has an acceptable correlation with intrauterine temperature and is recommended for routine detection of maternal pyrexia in labor. Continuous skin and external auditory canal temperature measurements did not correlate well. LEVEL OF EVIDENCE: II-3
For individuals with diabetes mellitus, CBGM provides a more accurate picture of daily glucose fluctuation than urine glucose testing (1-9). As a result, CBGM is the preferred method to assess short-term glucose control and provide data for management decisions and insulin adjustment (10-16). Moreover, the wide availability of glucose monitoring systems designed for patient use has made SMBG the standard of care in diabetes management for all capable persons with insulin-requiring diabetes and an appropriate management tool for persons with non-insulin-requiring diabetes (13-20). In spite of the relative accuracy of current CBGM systems in measuring blood glucose levels, a recent study by the FDA suggests that user-procedural errors can cause inaccurate results (21). Inaccurate data affect patients efforts to achieve good metabolic control and, if used as the basis for regimen adjustment, may endanger health (21-42). Therefore, until reliable, technique-free systems are available, the accuracy of data with this technology must be improved through reduction of user error. This article presents strategies to accomplish this goal recommended by a national group of experts, the NSCQA in CBGM.
Diagnosis of myocardial ischemia requires integration of ECG, pulmonary artery pressures, and TEE data. ST depression of 1 mV or elevation of 2 mV remains the mainstay of diagnosis of ischemia. Increases of pulmonary artery pressures of 5 mm Hg are common but not reliably diagnostic of ischemia. Transesophageal echocardiography is the most sensitive monitor of ischemia, where the spectra of SWMA evolve. Diastolic dysfunction (elevations in LVEDP) is a more sensitive marker of ischemia, but requires measurement of several Doppler patterns. After diagnosis, treatment should include optimization of hemodynamics (beginning with beta-blockers and nitrates), anesthesia, and oxygen-carrying capacity (e.g., normothermia, oxygen saturation, hematocrit more than 28%).
Since GER in infancy tends to disappear as patients grow, operation should be selected carefully. Data of the pH-monitoring collected from 114 cases for last 8 years were analysed. Thirty five cases were observed without operation in view of their younger age (under 6 months) or mild degree of GER evaluated on the basis of clinical signs, radiological, manometric, pH-metric and fiberscopic examination. Four in 5 aggravating cases were compared with 8 improving cases selected from the non-operated 60 cases. The four pH-subscores calculated by Johnson's method were compared between 2 groups. The means and standard deviations of the subscores of the number of the pH less than 4.0 greater in duration than 5 min. were 42.4 +/- 14.791 in the aggravating and 5.7 +/- 0.766 in the improving: those of the duration of the longest episode of pH less than 4.0 were 7.4 +/- 1.996 and 2.5 +/- 0.335. Difference between the both subscores were statistically significant (p less than 0.05). Therefore those subscores can be used as a parameter by which early operation may be chosen rather than subjecting the patient to a prolonged no-operative treatment.
The accuracy of 24-h blood pressure values obtained by ambulatory monitoring via the Spacelabs 5300 device was evaluated by comparison with simultaneous 24-h intra-arterial blood pressure recording from the contralateral arm. The comparison was made in eight essential hypertensive subjects in whom non-invasive blood pressure was measured every 15 (day) or 30 min (night). The measurements were automatically and visually edited to eliminate artefactual readings and hourly and 24-h means were calculated separately for systolic and diastolic blood pressure. The corresponding intra-arterial blood pressure means were also calculated. In the group as a whole, hourly means obtained by the non-invasive device were similar or only slightly different from those recorded intra-arterially. The 24-h systolic blood pressure mean obtained non-invasively was not significantly different from that obtained intra-arterially (138.4 +/- 9.1 and 142.9 +/- 9.2 mmHg, respectively), nor were the corresponding 24-h diastolic blood pressure means significantly different (83.5 +/- 4.5 and 80.6 +/- 3.5 mmHg, respectively). However, in spite of these similarities, there were contrasting and often large discrepancies between non-invasive and intra-arterial values in individual subjects. For the 24-h systolic blood pressure mean the discrepancies ranged from 7.6 +/- 1.1 to 16.1 +/- 2.2 mmHg and for the 24-h diastolic blood pressure mean, from 3.5 to 13.2 mmHg. Thus, the Spacelabs 5300 device has a limited ability to correctly estimate ambulatory blood pressure in individual subjects. It may be better suited for the estimation of group blood pressures, but only because errors are smoothed by the summation of individual errors of opposing signs.
The antihypertensive efficacy of once- and twice-daily losartan was evaluated in a randomized, double-blind, placebo-controlled, parallel-group trial using ambulatory 24-h blood pressure monitoring in 122 patients with mild to moderate essential hypertension. Data are reported for 112 patients who completed the active treatment phase. Losartan exerted a sustained 24-h antihypertensive effect at all doses studied (50 or 100 mg once daily, or 50 mg twice daily). Losartan demonstrated a smooth, gradual onset of action, did not affect normal circadian variations on blood pressure, and had no significant effect on heart rate. An additive antihypertensive effect was obtained by adding low-dose hydrochlorothiazide to losartan monotherapy at all doses of losartan studied. Losartan was well tolerated during the study with a frequency of adverse events comparable with placebo. No major adverse events were recorded. The results of this study indicate that losartan is an effective and well-tolerated antihypertensive agent that provides 24-h blood pressure-lowering efficacy from a single daily dose of 50 mg.
Drug-induced liver diseases are potentially avoidable. Hepatotoxic drugs can mimic virtually any form of liver disease. Among all voluntary adverse drug reaction reports to central registries, 4-7% refer to drug-induced liver diseases. We analyze all cases of coumarin-induced hepatic injuries reported on a voluntary basis to the Swiss Drug Monitoring Centre (SANZ) and the Pharmacovigilance Centre (IKS) from 1981 to 1995. During this period the SANZ collected 9720 reports, 674 of which (6.9%) referred to the liver and the biliary tract. In only 11 reports an oral anticoagulant was involved. In 8 cases we assumed at least a possible causal relationship. 2 more cases were reported directly to the IKS. Among these 10 cases 7 were related to phenprocoumon and 3 to acenocoumarol. In 4 cases elevated concentrations of liver enzymes were measured 2-7 days after the beginning of therapy. In the remaining 6 cases the clinical picture was so severe that the patients had to be hospitalized. These 10 cases are discussed and compared with the cases published in the literature. According to our data, hepatic disorders induced by coumarin-anti-coagulants are rare. If hepatitis is diagnosed in a patient treated with oral anticoagulants, the differential diagnosis of a coumarin-induced hepatic injury has to be considered. Crossreactions between the coumarin derivatives phenprocoumon and acenocoumarol are possible.
OBJECTIVE: To validate a non-invasive apparatus for non-hospital monitoring of blood pressure, the Spacelabs 90207 model. DESIGN: A comparative cross-sectional study. SETTING: Primary Care. "La Orden" Health Centre in Huelva. PATIENTS: 90 people, 34 men, of all ages, hypertensive or not and without any treatment for Hypertension, and selected at random from the on-demand consulting room. MEASUREMENTS AND MAIN RESULTS: Four blood pressure (BP) readings measured with the standard manual apparatus (mercury sphygmomanometer) were compared with three obtained in sequence with the Spacelabs 90207, validated in line with the recommendations of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). Average age was 51.31 +/- 16.5, with SP between 102 and 200 mmHg and DP between 60 and 100 mmHg. Means and standard deviations of manual and automatic BP readings were worked out: 129.13 +/- 19 mmHg and 130.50 +/- 19 for SP, and 77.97 +/- 11 and 76.64 +/- 11 for DP. CONCLUSIONS: Spacelabs 90207 fulfills the validation criteria of the BHS and AAMI.
The onset of the zona pellucida-induced acrosome reaction in mouse sperm is marked by loss of the pH gradient existing in acrosome-intact sperm between the acidic acrosomal lumen and the suspending medium, due to pore formation between outer acrosomal and plasma membranes. In earlier work, it was shown that this pH gradient loss occurred in single sperm bound to structurally intact zonae pellucidae with a half-time of 2.1 min; the extended kinetics of this loss determined in a sperm population bound to intact zonae was due to a 180-min range of variable lag times. We hypothesized that this lag time range was due to steric constraints imposed by the three-dimensional structure of the structurally intact zona pellucida, and that this constraint should be removed in solubilized zonae. The fluorescent probe, Dapoxyl(TM) (2-aminoethyl)sulfonamide (DAES) allowed a test of this hypothesis in a population of sperm cells. It is a weak base that is non-fluorescent in aqueous solution, but which accumulates in the acidic acrosomal compartment due to the pH gradient with highly enhanced fluorescence; loss of the pH gradient leads to a decrease in fluorescence. The half-time for DAES fluorescence loss in a population of capacitated, acrosome-intact sperm in response to solubilized zona pellucida protein was 2.13 +/- 0.10 min (SEM, n = 9). The agreement between single cell and cell population kinetics validates the hypothesis of steric constraint in the structurally intact zona pellucida. The change in intracellular Ca(2+) concentration in response to solubilized zona pellucida, as monitored with fluo-3, was a rapid increase, followed by a decrease, with a half-time of 0.85 +/- 0.09 min (SEM, n = 6) to a steady state level higher than the initial level, indicating this Ca(2+) transient as the precursor reaction to onset of the zona-induced acrosome reaction.
An evaluation of the INRatio Prothrombin Time Monitoring system for determination of INR was done in two centers with a total of 5 healthy subjects and 77 subjects on oral anticoagulation. The INRatio and the Coaguchek S were compared with an established laboratory method. The correlation coefficient of the comparison with the laboratory was r=0.954 for INRatio and r=0.937 for Coaguchek S. The mean relative deviation from the lab method calculated according to Hill was 6.87% for INRatio, which is rated "very goo", and 9.72% for Coaguchek S ("goo"). The imprecision in the normal range (INR=1.1) showed a coefficient of variation (CV) of 7.8% and a standard deviation (SD) of 0.09. In the therapeutic range (INR 3.9) the CV was 5.4%, the SD 0.21 and above therapeutic range (INR 5.3), the CV was 8.4% (SD 0.44), rated satisfactory. The concordances of the compared methods with the routine were 81% for INRatio and 79% for Coaguchek S, which is considered state-of-the-art. Most of the patients' perceptions of the INRatio were very positive. In the hands of professionals the INRatio demonstrated very good accuracy and precision and an excellent technical reliability. Further studies using INRatio for self testing by patients are warranted.
A free latissimus dorsi muscle transfer, which required anastomotic revision on two occasions within twenty-four hours of operation, illustrates how the change in response of electrically induced muscle contraction to ischaemia can be used as a rapid and sensitive method of monitoring free muscle transfers. It is a response that has the great merit of being easily recognised by untrained observers because it relies on an absolute rather than a relative change in the measured modality. Furthermore it is not influenced by the clinical condition of the patient or by changes in the flap's environment. Its potential is discussed.
A method for the determination of hexahydrophthalic acid, a metabolite of hexahydrophthalic anhydride, in human urine has been developed. The urine was worked-up by liquid-solid extraction, esterified with boron trifluoride-methanol, and analysed by capillary gas chromatography and selected-ion monitoring. Hexadeuterium-labelled hexahydrophthalic acid was used as the internal standard. The precision was 4% at 0.7 microgram/ml and 5% at 0.07 microgram/ml. The recovery of the acid for the overall method was 101% at 0.07 micrograms/ml of urine (with a coefficient of variation of 4%) and 95% at 0.7 microgram/ml (coefficient of variation 2%). The limit of detection was 20 ng/ml urine.
A capillary gas chromatographic (GC) method was developed for the determination of 1,6-hexamethylenediamine (HDA) in hydrolysed human urine. The method was based on a derivatization procedure with heptafluorobutyric anhydride. The amides formed were determined using capillary GC with selected ion monitoring in the chemical ionization mode with ammonia as reagent gas. The overall recovery was 34% for a concentration of 100 micrograms/l of HDA in urine. The minimum detectable concentration in urine was below 0.5 microgram/l. The precision of the method was 5% (n = 9). Deuterium-labelled HDA [H2NC2H2(CH2)4C2H2NH2] was used as the internal standard. A male subject was exposed to hexamethylene diisocyanate (HDI) for 7.5 h in a test chamber. The average air concentration of HDI was ca. 30 micrograms/m3, which corresponds to ca. 85% of the threshold limit value in Sweden (35 micrograms/m3). The half time of urinary levels of HDA was ca. 1.4 h and more than 90% of the urinary elimination was completed within 4 h after the exposure. The amount of HDA excreted in urine was ca. 10 micrograms, corresponding to ca. 10% of the estimated inhaled dose of HDI.
The novel use of ultrasound as a detector in pilot- and production-scale chromatography is described. The difficulties in packing production scale chromatography columns using an integral packing valve are reviewed. Results are presented from the packing of 400- and 600-mm diameter columns with various medias. From these results it is proposed that when packing large columns using a packing valve, for a given medium and column size, there is an ideal rate and pattern (or control "corridor") by which the bed builds in order to give optimum performance. Ultrasound was shown to be able to monitor the building of such a column bed as the medium was pumped into the column. It was found that the ultrasound detector was sensitive to bed compression, mobile phase composition and components such as acetone, albumin, casein and monoclonal antibodies while on the chromatography bed. This enabled the visualisation, by ultrasound, of these components as they were chromatographed through the column.
We determined the levels of the stable urinary metabolites of thromboxane A2 and prostacyclin, 11-dehydro-thromboxane B2 (11-dehydro-TXB2) and 2,3-dinor-6-keto-prostaglandin F1alpha (2,3-dinor-6-keto-PGF1alpha) in patients with retinal vascular occlusion (RVO) to elucidate the change of the thromboxane A2/prostacyclin (TX/PGI) ratio with this disease and the effect of low-dose-aspirin therapy. 11-Dehydro-TXB2 and 2,3-dinor-6-keto-PGF1alpha were converted to 1-methyl ester-propylamide-9,12,15-tris-dimethylisopropylsilyl ether derivative and 1-methyl ester-6-methoxime-9,12,15-tris-dimethylisopropylsilyl ether derivative, respectively, and applied to a gas chromatography/selected ion monitoring. The average level of 11-dehydro-TXB2 in 30 patients with RVO was 1038 +/- 958 pg/mg creatinine. It was significantly higher than that of 27 healthy volunteers, which was 616 +/- 294 pg/mg creatinine (p < 0.05 with unpaired t-test). However, 2,3-dinor-6-keto-PGF1alpha levels were not significantly different between these two groups. The average ratio of TX/PGI in the RVO patients was 32 +/- 26 and it was significantly higher than that of healthy volunteers, 17 +/- 10 (p < 0.01). Patients with central retinal artery occlusion or branch retinal artery occlusion showed greatly high 11-dehydro-TXB2 levels and TX/PGI ratios, although the number of patients was limited in the current study. After the administration of low-dose aspirin (40 mg/day) for about 1 month, the TX/PGI ratio decreased to around the normal level. Following the levels for up to 10 months, they also remained at the normal level. These observations suggested that the 11-dehydro-TXB2 levels and the TX/PGI ratio reflect the pathological conditions of RVO and are useful markers of the treatment.
[reaction: see text] Although boronic acids are widely used in metal-catalyzed reactions, it is difficult to assay their consumption. As such, we developed a reversible fluorescent sensor that is activated upon binding a boronic acid. The sensor can be used to monitor consumption of a boronic acid in Suzuki-Miyaura reactions. Importantly, only a standard handheld long-wave UV lamp (365 nm) is required and fluorescence is easily detectable with the naked eye without disturbing the reaction mixture.
OBJECTIVE: This study examines whether unintended pregnancy is associated with physical abuse of women occurring around the time of pregnancy, independent of other factors. METHODS: In 1996-1997, state-specific population-based data were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 39,348 women in 14 states who had delivered a live-born infant within the previous 2-6 months. The study questionnaire asked about maternal behaviors and characteristics around the time of pregnancy. RESULTS: Women who had mistimed or unwanted pregnancies reported significantly higher levels of abuse at any time during the 12 months before conception or during pregnancy (12.6% and 15.3%, respectively) compared with those with intended pregnancies (5.3%). Higher rates of abuse were reported by women who were younger, Black, unmarried, less educated, on Medicaid, living in crowded conditions, entering prenatal care late, or smoking during the third trimester. Overall, women with unintended pregnancies had 2.5 times the risk of experiencing physical abuse compared with those whose pregnancies were intended. This association was modified by maternal characteristics, the association was strongest among women who were older, more educated, White, married, not on Medicaid, not living in crowded conditions, receiving first trimester prenatal care, or nonsmoking during the third trimester. CONCLUSIONS: Women with unintended pregnancies are at increased risk of physical abuse around the time of pregnancy compared with women whose pregnancies are intended. Prenatal care can provide an important point of contact where women can be screened for violence and referred to services that can assist them.