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PubMed1998

A Simple Exsanguination Method That Minimizes Acute Pre-anesthesia Stress in the Mouse: Evidence Based on Serum Corticosterone Concentrations.

Enormous variability exists among published values for serum corticosterone concentration of mice. Exsanguination of mice is widely used and has been little-tested, but is a likely variable to affect corticosterone concentrations. Exsanguination may impose unrecognized and unnecessary distress on mice used in research. Male and female C57BL/6J mice that were 25 to 30 days old were housed separately, and blood samples were obtained between 9 and 10 a. m. Methoxyflurane and CO2 were each used to induce anesthesia. Mice were anesthetized in the housing room (to minimize environment- and transport-related stress) or in an adjacent room after a transport procedure that required 30 seconds or less. Mice were accustomed to transportation in their cages while in the housing room, and CO2 anesthesia involved placing the entire cage in a chamber flushed with CO2. Serum corticosterone concentrations, determined by radioimmunoassay, were 32 6 17, 113 6 37, 103 6 32, and 97 6 34 ng/ml (mean 6 SEM, n = 10 mice/group) for mice in anesthesia groups housing room/CO2, housing room/methoxyflurane, transport stress/CO2, and transport stress/methoxyflurane, respectively. Values for the housing room/CO2 group differed significantly (P < 0.05, two-way ANOVA; least-squares means) from values for the other groups and appeared to define the serum corticosterone concentration of quiescent laboratory mice. A subsequent study yielded a serum corticosterone concentration of 31 6 5 ng/ml (mean 6 SEM) in 16 adolescent C57BL/6J mice exsanguinated in the same manner. Finally, exsanguination of 4 groups of 5 young adult C57BL/6J mice, each group in timed sequence, by means of the housing room/CO2 procedure indicated that distress communicated by the mice did not disturb adjacent mice in the room (i. e., mice used subsequently in each sequence), as determined on the basis of the serum corticosterone concentration. Use of CO2 to induce anesthesia coupled with a familiar routine and environment constitutes an important procedural refinement in terms of reduction in acute distress preceding anesthesia in the mouse.

Journal Article↗

PubMed2003

Talent LPS AAA stent graft: results of a pivotal clinical trial.

PURPOSE: We report results of a pivotal prospective clinical trial that compared standard surgical repair with endovascular exclusion of abdominal aortic aneurysm (AAA) with the Talent LPS stent graft system. METHODS: Between March 24, 1999, and September 19, 2000, 240 patients with AAA who underwent stent graft placement and 126 patients who concurrently underwent surgery to treat AAA were enrolled at 17 centers in the United States. All patients were considered to be at low risk from aortic surgery. Patients who underwent endovascular repair received a bifurcated Talent LPS stent graft; surgical control subjects underwent standard operative techniques. Inclusion criteria were AAA larger than 4.0 cm in diameter, with proximal neck > 5 mm long and 14 to 32 mm in diameter, and a 15 mm landing zone in at least one common iliac artery. Access requirements included one external iliac artery of 7 mm caliber or larger. Preoperative anatomic evaluation included computed tomography and angiography. After stent-graft placement, evaluation involved plain radiography and computed tomography performed before discharge and at 1, 6, and 12 months and yearly thereafter. RESULTS: There was no significant difference in early (<30 days) or late mortality between the two groups. Complications were slightly higher in the surgical cohort. The stent graft group did better in terms of procedure duration, requirement for general anesthesia and blood transfusion, and intensive care unit and hospital stay. There were three access or deployment failures. Immediate surgical conversion was necessary in only 1 patient, and late conversion in 5 additional patients. There were no aneurysm ruptures. Endoleak rate detected at CT (core laboratory validated) was 14% at 1 month, 12% at 6 months, and 10% at 12 months. CONCLUSIONS: Compared with surgical control subjects, patients with AAA treated with the Talent LPS stent graft had fewer complications and the same low operative mortality. Likewise, endovascular repair performed better than surgery in the perioperative period, as measured with several key procedural indicators. Long-term follow-up of patients with the stent graft will be essential to assess durability of these early results.

Aged↗

PubMed2002

Neonatal 6-hydroxydopamine-induced hypo/hyperactivity: blockade by dopamine reuptake inhibitors and effect of acute D-amphetamine.

Five experiments were performed to assess the changes in motor activity resulting from neonatal administration of 6-hydroxydopamine (6-OHDA) on Days 1 or 2 postnatal, at doses of either 75 or 100 micro g in a volume of 10 micro l vehicle, following pretreatment with either GBR 12909 (40 mg/kg, s.c.) or amphonelic acid (4.0 mg/kg, s.c.) or saline. Motor activity was measured either over 60-min test periods on five consecutive days of testing or at 12-min intervals within a single 60-min test session. The initial extent of locomotor hyperactivity was dependent upon the neonatal dose of 6-OHDA: the 100 micro g, but not 75 micro g, dose induced marked hyperactivity from test day 1 onwards whereas the 75 micro g dose did so from test day 3 onwards. The initial hypoactivity for rearing behaviour was observed for both doses of 6-OHDA: this hypoactivity was altered over successive test days so that by test day 5 an hyperactivity by the 75 micro g, but not 100 micro g, was observed. Pretreatment with either GBR 12909 or amphonelic acid abolished the effects of both doses of 6-OHDA. In the within-60-min test session procedure, 6-OHDA treated rats (both 75 and 100 micro g) showed initial hyperactivity for locomotion that intensified, in relation to the other groups, over each 12-min interval and initial hypoactivity for rearing that developed into hyperactivity over each 12-min interval. Pretreatment with either GBR 12909 or amphonelic acid again abolished the effects of both doses of 6-OHDA. Habituation quotients derived in each case for both procedures indicated severe habituation deficits by 6-OHDA (75 and 100 micro g) rats, compared to the control groups in all four experiments. In Experiment V, a low dose of D-amphetamine abolished the hyperactivity of 6-OHDA (75 micro g) treated rats whereas a higher dose did so only transiently. Pretreatment with GBR 12909 abolished these effects. These findings underline the neuropharmacological utility of the neonatal 6-OHDA treatment for studying brain receptor system adaptive changes underlying the respective functional alterations and as a possible laboratory model for clinical disorders.

Journal Article↗

PubMed1988

Relationship between sleep inertia and sleepiness: cumulative effects of four nights of sleep disruption/restriction on performance following abrupt nocturnal awakenings.

Performance deficits are usually evident following both extended wakefulness (sleep deprivation effects) and immediately upon awakening from sleep (sleep inertia effects). In order to determine whether sleep inertia effects are qualitatively different from sleep deprivation effects, performance on addition tests, Stanford Sleepiness Scale (SSS) ratings, and return-to-sleep latencies (RSLs) were assessed during four nights of sleep disruption/restriction. Eight subjects were polygraphically monitored in the sleep laboratory for five consecutive nights, from 2400 to 0700. On the last four nights (after an adaptation night) subjects were awakened at 0040, 0140, 0240, 0340, 0440, and 0540 for a 20-min test session. Sleepiness ratings and performance on 5-min addition tests were measured at 1.5, 7.5, and 13.5 min post-awakening, and RSL was measured at the end of each test session. Analysis of addition test performance across nights revealed that both speed and accuracy of calculations were adversely affected by the sleep disruption/restriction procedure, indicating that increasing sleepiness exacerbates sleep performance deficits upon awakening. Although divergence of SSS ratings and addition test performance across nights was suggestive, there was no conclusive evidence that sleep inertia is qualitatively different from "typical" sleepiness.

Adolescent↗

PubMed2004

Pre-clinical investigation of the efficacy of an artificial tear solution containing hydroxypropyl-guar as a gelling agent.

PURPOSE: Pre-clinical studies of a new artificial tear product (Systane Lubricating Eye Drops Alcon Laboratories, Inc., Fort Worth, TX) containing the novel gelling agent hydroxypropyl-guar (HP-guar) and two demulcents, polyethylene glycol 400 (PEG) and propylene glycol (PG) were conducted to determine the ability of the product to protect ocular surface epithelial cells from desiccation in vivo and in vitro, and to promote recovery of the damaged corneal epithelial barrier in vivo. Other leading artificial tear products were also evaluated as comparators to determine the relative effectiveness of different polymer systems. METHODS: Damage due to desiccation was assessed by measuring corneal uptake of methylene blue compared to untreated corneas. Corneas of anesthetized rabbits were treated with the new artificial tear product and subjected to desiccation by holding the eyelids open for 2 hours with a speculum. Control eyes were subjected to desiccation without application of a tear formulation. To measure recovery of the corneal epithelium from damage, corneas of anethesthetized rabbits were exposed to 0.01% benzalkonium chloride (BAC) for 5 minutes to increase epithelial permeability. The corneas were exposed to the new artificial tear for 1.5 hours followed by measurement of uptake of 5,6 carboxyfluorescein (CF). In the desiccation and CF uptake experiments, the new tear product was also compared to a tear product formulation without HP-guar and to a commercially available artificial tear containing carboxymethyl cellulose (CMC) and Purite. In a third set of experiments, immortalized human corneal epithelial cells and Chang conjunctival cells in culture were exposed to the PEG/PG/HP-guar tear product, the control formulation without HP-guar, a tear formulation preserved with BAC, or the artificial tear containing CMC/Purite for 15min. The tear formulation was removed and the cells were exposed to desiccating conditions in a laboratory safety hood for 10 or 30min. Cell viability was determined using the MTT assay. RESULTS: The in vivo desiccation model, showed that the new tear product, Systane, offered complete protection of the cornea from desiccation (methylene blue uptake not different than naïve control). Following exposure to 0.01% BAC, the new artificial tear product also provided an environment in which the corneal epithelium recovered completely from damage (CF uptake not different than normal, untreated cornea). This level of protection was not observed when corneas were treated with other formulations. Results from the in vitro desiccation procedure indicated that viability of corneal epithelial and Chang cells treated with the PEG/PG/HP-guar product was significantly greater than viability of cells treated with the tear product without HP-guar or the tear products containing BAC or CMC/Purite. CONCLUSIONS: The tear product containing HP-guar, PEG 400 and propylene glycol satisfies several pre-clinical criteria for an appropriate artificial tear formulation. It gives long-term desiccation protection of the intact cornea and also epithelial cells in culture and has no apparent deleterious affects on cells. It also provides conditions in which a damaged corneal epithelium can recover normal barrier function. The combination of ingredients in the formulation appears to provide an effective mucomimetic artificial tear product. These pre-clinical data suggest that the product will be effective in providing superior relief for the dry eye sufferer.

Animals↗

PubMed1978

Pre- and postoperative uses of CEA.

CEA plasma levels obtained prior to definitive surgery in patients with colorectal cancer in our hands have predictive ability. An elevated CEA greater than 2.5 ng/ml recorded by our laboratory means an increased risk of subsequent local recurrence or of later metastatic disease. The question as to whether or not this is additive as a prognostic variable when tested against careful histopathological staging remains. As a monitor, CEA will detect recurrence. Again, the problem as to how accurate this is remains. If we use two consecutive elevations of plasma CEA greater than 2.5 ng/ml as a criteria, we encounter about 15% false positives which must be weighed against finding disease significantly earlier in about one-third of the patients followed. Our data for second-look procedures indicate clearly that when used in patients with an elevated CEA laparotomy may be useful and further studies showed the presence of disease in 11 of 14 patients with an elevation following surgery for two consecutive tests were greater than 2.5 ng/ml. Two were operable. The significance of these findings is described.

Carcinoembryonic Antigen↗

PubMedDate not supplied

Normative values and determinants of physical capacity in individuals with spinal cord injury.

We reanalyzed data from five studies with similar or identical methodology performed by our laboratory to define normative values and determinants of physical capacity in individuals with tetraplegia and paraplegia. Each study consisted of a graded wheelchair exercise test to determine peak oxygen uptake and maximal power output and could additionally include a wheelchair sprint test to determine short-term (anaerobic) power output and/or an isometric strength test. The combined subject population included 166 individuals (20 women), varying considerably for age, body mass, lesion level, time since injury, and activity level. Ranges in physical capacity parameters were extensive and normative values for individuals with tetraplegia and paraplegia were established. These physical capacity norms could be used for evaluation of fitness status and training or therapeutic interventions. Multiple regression procedures indicated that 48-80% of the variance in physical capacity could be explained by lesion level and completeness, activity level, gender, age, body mass, and time since injury. Although physical capacity is largely determined by factors that cannot be altered, such as lesion level, age, and gender, changeable factors such as activity level and body mass play an additional role.

Adult↗

PubMed2001

Whole-body positron emission tomography using 18F-fluorodeoxyglucose compared to standard procedures for staging patients with Hodgkin's disease.

BACKGROUND AND OBJECTIVES: Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers the advantage of metabolic imaging that is largely independent of morphologic criteria. In the present study we evaluated the role of (18)F-FDG PET compared to routine procedures for the staging of patients with HD. DESIGN AND METHODS: Thirty-three patients with HD underwent standard staging procedures (clinical examination, laboratory screening, chest X-ray, computed tomography (CT) of the chest and abdomen and bilateral bone marrow biopsies) and a whole-body (18)F-FDG PET study. In clinical examination, an isolated lymph node > 1 cm or multiple lymph nodes > or = 1 cm in size were considered abnormal. Positive findings at both clinical examination or CT and (18)F-FDG PET were regarded as actual locations of disease. Negative findings with both methods were regarded as true negative (no involvement by HD). In cases of discrepancy, response to treatment and follow-up data were used to assess the overall accuracy of the patient's original evaluation. RESULTS: Completely concordant results in lymph node staging were observed in 20 patients. The two staging procedures indicated complementary information in 1 patient. Conventional staging indicated more pathologic lymph node areas in 6 patients (at least 1 false positive). (18)F-FDG PET showed more sites in 6 patients. The sensitivity of (18)F-FDG PET in detecting all known pathologic lymph nodes was 83% for peripheral lymph nodes, 91% for thoracic lymph nodes and 75% for abdominal and pelvic lymph nodes. Conventional staging procedures and (18)F-FDG PET indicated the same tumor stage in 26 patients. Based on (18)F-FDG PET, downstaging was suggested in 4 patients, including a biopsy-proven case. However in 1 of these cases this was incorrect. (18)F-FDG PET suggested upstaging in 3 patients. Based on conventional staging or (18)F-FDG PET the same treatment strategy was defined in 32 patients. In one patient (18)F-FDG PET downstaged disease extension (stage IIIA-->IIA) that would have suggested radiotherapy as a possible treatment option. INTERPRETATION AND CONCLUSIONS: (18)F-FDG PET provides an easy and efficient whole-body method for the evaluation of patients with HD. (18)F-FDG PET never missed tumor masses >1 cm. (18)F-FDG PET detected additional sites of disease not seen by conventional procedures and identified absence of disease in some sites suspected to be involved. However, in our patients this did not translate into changes in treatment strategy.

Adolescent↗

PubMed2005

Executive function as a predictor of inattentive behavior after traumatic brain injury.

Emerging evidence from recent studies using laboratory and naturalistic attention tasks suggests that individuals with traumatic brain injury (TBI) may have a deficit mainly in strategic control of attention. In the present study, we tested the hypothesis that inattentive behavior after TBI could be predicted by performance on psychometric measures of executive function. A group of 37 individuals with moderate to severe TBI were assessed with previously validated naturalistic measures of attention. A battery of neuropsychological tests was also administered to assess various aspects of executive function. Seven measures of executive function and 10 variables reflecting inattentive behavior were combined to form 1 executive and 3 inattentive behavior (IB) composite scores. Three predictors (executive composite, current disability scores, and age) were associated, at the univariate level, with one of the IB composites reflecting frequency and duration of off-task episodes. A stepwise multiple regression procedure indicated that the executive composite was the only significant predictor of the IB composite. Additional post-hoc regression analyses suggested that the relationship was not likely to be mediated by processing speed. The current study supports the hypothesis that executive function, measured by commonly used neuropsychological tests, significantly predicts certain aspects of inattentive behavior in real-world tasks after TBI.

Adolescent↗

PubMed2003

Bacterial community structure and physiological state in a biofilm reactor degrading 4-chloroaniline.

Degradation of 4-chloroaniline in the presence of aniline by a microbial community in a laboratory-scale biofilm reactor was evaluated. The starter inoculum was isolated and reconstructed from a percolating column enrichment of Indonesian agricultural soil. The capacity to mineralise and detoxify 4-chloroaniline in the presence of aniline was demonstrated by the biofilm reactor when operated at high hydraulic retention time (HRT; 0.87 h). At low HRT (0.23 h and 0.39 h) 4-chlorocatechol accumulated in the effluent, accompanied by a decrease in dechlorination and detoxification. When returned to high HRT (2.14 h), the accumulation of 4-chlorocatechol stopped and the extent of dechlorination and detoxification increased. Bacteria other than the original inoculum appeared in the reactor when the operating mode was switched from closed cycle to open cycle. One of these bacteria, identified as Pseudomonas putida R1 by partial 16S rDNA sequencing, subsequently dominated the reactor at every HRT imposed. PCR-based single-strand conformational polymorphism of 16 s rDNA and traditional cultivation procedures indicated that the bacterial composition in the reactor shifted in response to applied HRT. The relationship between the bacterial abundance and the degradation capacity of the reactor is discussed.

Aniline Compounds↗

PubMed1998

Carrier-dependent suppression of the anti-phosphorylcholine plaque-forming cell response in Trichinella-infected mice is mediated by anti-hapten IgG1 antibodies.

In normal mice, the phosphorylcholine(PC)-bearing Trichinella spiralis antigen FCp induces PC-specific IgM antibodies. Infection with T. spiralis appears to suppress this response, without affecting the production of anti-PC antibodies in response to other PC-bearing antigens; the suppression can thus be considered carrier-dependent. Previous work in our laboratory has indicated that the observed suppression is due to a soluble factor present in the serum of infected mice. In the work reported here, we investigated the identity of this factor. After in vitro stimulation with FCp, spleen cells from FCp-primed infected mice showed a stronger anti-PC IgM response than spleen cells from FCp-primed uninfected mice, confirming that cell memory for FCp is unimpaired by infection. Passive transfer of serum from infected mice to normal recipients, followed by immunization of recipients with FCp or another thymus-dependent or thymus-independent PC-bearing antigen, confirmed that the suppressive agent is soluble and that its activity is carrier-dependent. The suppressive agent was retained by immunoaffinity chromatography with PC or rabbit anti-mouse Ig as ligand, showing that it is a PC-specific Ig. Gel filtration of the fractions retained by PC-immunoaffinity, and subsequent identification of Ig isotypes by an ELISA-based procedure, indicated that the suppressive Igs are of the IgG1 isotype. These findings may be relevant for understanding antibody-mediated down-regulation of the immune response.

Animals↗

PubMed1999

Fracture resistance of teeth restored with dentin-bonded crowns constructed in a leucite-reinforced ceramic.

OBJECTIVES: Laboratory studies and preliminary clinical data have demonstrated satisfactory fracture resistance of all-ceramic crowns placed using a resin-composite luting material and a dentin-bonding system. This study investigates the fracture resistance of crowns constructed in a leucite-reinforced ceramic when placed using a dentin-bonding system and a dual-cure resin composite luting material and compares this with the fracture resistance of feldspathic porcelain crowns. METHOD: Standardised preparations were carried out on 10 sound, unrestored, maxillary premolar teeth, the mean bucco-palatal width of which did not vary by more than 2.5%. Ceramic crowns (Fortress; Chameleon Dental, KS, US) were constructed using a standardised technique. Their fitting surface was etched with hydrofluoric acid. The crowns were placed using the dentin-bonding system Mirage ABC and the luting system Mirage FLC (Chameleon Dental, KS, US). The restored teeth were loaded in compression at 1 mm/min through a 4 mm steel bar placed along the midline fissure. RESULTS: A mean fracture load of 0.88 kN was recorded. Results from previous work indicate a fracture resistance of 0.77 kN for feldspathic porcelain crowns placed using the same luting systems on similarly standardised preparations. Statistical analysis by one-way ANOVA and Tukey's multiple comparison procedure indicated that there was no significant difference in the mean fracture resistance of the teeth restored using the leucite reinforced ceramic and the teeth restored with feldspathic porcelain. SIGNIFICANCE: Crowns constructed in a leucite-reinforced ceramic and placed using dentin-bonding and dual-cure resin composite luting materials may provide some increase in fracture resistance, but the results may not be significantly different from the feldspathic porcelain.

Aluminum Silicates↗

PubMed1998

Detection of Epstein-Barr virus-specific antibodies by an automated enzyme immunoassay. Performance evaluation and cost analysis.

Detection of antibodies to specific antigens of Epstein-Barr virus (EBV) has been conventionally performed by an immunofluorescence assay (IFA). The procedure is labor intensive and expensive, and interpretation of results is subjective. We evaluated an automated enzyme immunoassay (EIA) (INC-STAR Corp., Stillwater, MN, USA) using 290 serum specimens submitted for the diagnosis of acute infection with EBV. Antibodies (IgG, IgM) to EBV capsid antigen and IgG class antibodies to the nuclear antigen of the virus were obtained using the LABOTECH Automated Microplate Analyzer (BioChem ImmunoSystems Inc., Allentown, PA, USA) and were compared to the antibody profile results obtained by IFA and Western blot as the "gold standard." For detection of acute infection with EBV (presence of IgM and IgG antibodies to the capsid antigen; absence of antibodies to the nuclear antigen), the EIA had 100% sensitivity (11 of 11) and 99% specificity (275 of 279) compared to IFA and Western blot results. A cost analysis of IFA and EIA procedures, based on an estimated annual volume of 12,000 procedures, indicated that $236,000 direct cost and 1,400 h technologist time could be saved with the automated compared with immunofluorescence procedure. The automated EIA for determination of antibodies provides cost-effective, accurate diagnosis of EBV infections in laboratories processing high numbers of specimens now processed by IFA.

Antibodies, Viral↗

PubMed2003

Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns.

OBJECTIVES: Some data suggest that the clinical diagnosis of obstructive sleep apnea (OSA) in a child should be confirmed by polysomnography before adenotonsillectomy (AT), but otolaryngology literature generally does not agree and few studies have examined surgical practice patterns. METHODS: We mailed, to 603 members of two North American otolaryngology societies, surveys about children aged 5.0-12.9 years upon whom they performed ATs in the previous year. RESULTS: A total of 183 otolaryngologists estimated that they had performed 24,000 ATs. Reported major surgical indications, not mutually exclusive, included recurrent throat infections (for 42% of procedures), obstructed breathing of any type (59%), OSA (39%), poor school performance (17%), and poor attention (11%). Pre-operative evaluations included an office-based, sleep-related history in 93% of children, any objective testing for OSA in <10%, and laboratory-based polysomnography in <5%. Surgeons with academic affiliations, higher volumes of ATs, and pediatric specialization reported lower percentages of ATs performed for recurrent tonsillitis as opposed to other indications. CONCLUSIONS: As a common indication for AT, OSA now rivals recurrent throat infection. No more than 12% of school-aged children who undergo AT for OSA have polysomnography prior to the procedure. Indications for AT may depend, in part, on practice settings and otolaryngologists' backgrounds.

Adenoidectomy↗

PubMed2001

Biomaterial-associated infection of gentamicin-loaded PMMA beads in orthopaedic revision surgery.

In two-stage orthopaedic revision surgery, high local levels of antibiotics are achieved after removal of an infected prosthesis through temporary implantation of gentamicin-loaded beads. However, despite their antibiotic release, these beads act as a biomaterial surface to which bacteria preferentially adhere, grow and potentially develop antibiotic resistance. Gentamicin-loaded beads were retrieved from 20 patients with prosthesis-related infections. Excised tissue samples were taken for routine culture, while beads were analysed in an extensive laboratory procedure. Extensive culture procedures indicated the presence of bacteria on gentamicin-loaded beads in 18 of the 20 patients involved, while 12 of these 18 patients were considered free of infection by routine culture. Nineteen of 28 bacterial strains isolated were gentamicin resistant and cultures from three patients yielded highly gentamicin-resistant sub-populations. It is concluded that routine culture of excised tissues in orthopaedic revision surgery is inadequate to ascertain full eradication of infection, especially as infecting, antibiotic-resistant bacteria preferentially adhere to and grow on gentamicin-loaded beads. Extensive examination of the bead surfaces is proposed as a more reliable indication that infection has been eradicated.

Anti-Bacterial Agents↗

PubMed1982

Comparison of three assay procedures for gentamicin determination.

We examined 50 serum samples, submitted to our laboratory for gentamicin levels, by the enzyme multiplied immuno technique (EMIT), by a radioimmunoassay procedure and by a latex agglutination method. Significant differences in concentrations, rates of throughput, and costs between the latex agglutination and the other two procedures were observed. The precision of the assay ranged from 5.21 to 15.70%, whereas recovery values ranged from 83.8 to 110.0%. The latex agglutination procedure provided simplicity and speed at a relatively low cost. However, the significant analytical difference between this and the other two procedures indicates that the latex agglutination procedure is not adequate for measuring accurate gentamicin levels.

Costs and Cost Analysis↗

PubMed2003

The influence of diabetes mellitus on the practice and outcomes of percutaneous coronary intervention in the community: a report from the HCA database.

BACKGROUND: Diabetics remain a high-risk group for those undergoing percutaneous coronary intervention (PCI) using balloon angioplasty and/or intracoronary stents for myocardial revascularization. The objective of this study is to compare clinical characteristics, demographics, procedure indications, lesion characteristics, and acute and long-term outcomes between diabetic patients and non-diabetic patients in a community based PCI registry. METHODS AND RESULTS: Information on patient demographics, coronary risk factors, lesion characteristics, procedures, and outcomes were derived from an HCA, Inc. database on all patients undergoing a PCI procedure in one of four community cardiac catheterization laboratories (CCL). A total of 3,139 patients who underwent PCI procedures from July 1, 1999 through September 30, 2000 were enrolled in this study. Approximately one-third of these patients completed a follow-up survey one year after their initial encounter. Analysis was limited to those patients undergoing PCI of native vessels with stents or conventional balloon angioplasty; patients with target lesions in bypass grafts or those treated with atherectomy were excluded. Approximately 23.5% of the patients enrolled in the study were diabetic. This study found no significant difference in any acute outcome between diabetic and non-diabetic patients in the hospital episode associated with the index PCI procedure. However, data from the 1-year follow-up survey indicates diabetic patients tended to have more target lesion revascularization (TLR) (13.6% versus 8.9%; p = 0.07) and more target vessel revascularization (TVR) (17.6% versus 12.7%; p = 0.058) than non-diabetic patients. In addition, adjusted odds ratios indicate that diabetic patients were 1.6 times more likely to have a second PCI procedure in another vessel (p = 0.013), 2.4 times more likely to undergo bypass surgery (p = 0.003), 1.9 times more likely to undergo an additional revascularization procedure (p < 0.001) and 1.8 times more likely to experience any major adverse cardiac events (p < 0.001) than non-diabetic patients during the follow-up period. CONCLUSIONS: This study indicates that selected diabetic patients can be treated for myocardial revascularization using PCI procedures with acceptable acute outcomes. However, diabetic patients undergoing PCIs have significantly more disease progression and are more likely to experience the need for recurrent revascularization.

Aged↗

PubMed1992

Anatomy of a defective barrier: sequential glove leak detection in a surgical and dental environment.

OBJECTIVES: a) To determine the frequency of perforations in latex surgical gloves before, during, and after surgical and dental procedures; b) to evaluate the topographical distribution of perforations in latex surgical gloves after surgical and dental procedures; and c) to validate methods of testing for latex surgical glove patency. DESIGN: Multitrial tests under in vitro conditions and a prospective sequential patient study using consecutive testing. SETTING: An outpatient dental clinic at a university dental school, the operating suite in a medical school affiliated with the Veteran's Hospital, and a biomechanics laboratory. PERSONNEL: Surgeons, scrub nurses, and dental technicians participating in 50 surgical and 50 dental procedures. METHODS: We collected 679 latex surgical gloves after surgical procedures and tested them for patency by using a water pressure test. We also employed an electronic glove leak detector before donning, after sequential time intervals, and upon termination of 47 surgical (sequential surgical), 50 dental (sequential dental), and in three orthopedic cases where double gloving was used. The electronic glove leak detector was validated by using electronic point-by-point surface probing, fluorescein dye diffusion, as well as detecting glove punctures made with a 27-gauge needle. RESULTS: The random study indicated a leak rate of 33.0% (224 out of 679) in latex surgical gloves; the sequential surgical study demonstrated patency in 203 out of 347 gloves (58.5%); the sequential dental study showed 34 leaks in the 106 gloves used (32.1%); and with double gloving, the leak rate decreased to 25.0% (13 of 52 gloves tested). While the allowable FDA defect rate for unused latex surgical gloves is 1.5%, we noted defect rates in unused gloves of 5.5% in the sequential surgical, 1.9% in the sequential dental, and 4.0% in our electronic glove leak detector validating study. In the sequential surgical study, 52% of the leaks had occurred by 75 mins, and in the sequential dental study, 75% of the leaks developed by 30 mins. In terms of the anatomical localization, the thumb and forefinger accounted for more than 60% of the defects. There were no differences in the frequency of glove leaks between the left and right hand. Leak rates were highest for the surgeon (52%), followed by the first assistant (29%) and the scrub nurse (25%). No false negatives were noted using the electronic glove leak detector; one false positive was seen out of 225 gloves tested (0.44%), as noted in our validation studies. CONCLUSIONS: Significantly high glove leak rates were noted after surgical and dental procedures, indicating that the present day latex surgical gloves can become an incompetent barrier once they are used. Unused latex surgical gloves demonstrated a higher rate of defects than allowed by the Food and Drug Administration standards, indicating substantial noncompliance of quality control standards by manufacturers as well as inadequate governmental oversight. Double gloving, or the use of thicker latex surgical gloves, would probably reduce the frequency of glove leaks. Latex surgical gloves should be tested for patency before use and during surgical and dental procedures.

Dentistry↗