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At least 361 records · Page 20Linked to original sources
PubMed2004

New onset of herpes simplex virus epithelial keratitis after penetrating keratoplasty.

PURPOSE: To report a series of patients with no previous history of herpes simplex virus (HSV) infection who had new onset of herpetic keratitis after penetrating keratoplasty (PK). DESIGN: Noncontrolled, retrospective case series. METHODS: We included in the study the patients who had new onset of herpetic keratitis after penetrating keratoplasty for corneal diseases unrelated to HSV infection who were seen at the Cornea Service at Wills Eye Hospital (Philadelphia, Pennsylvania) from January 1996 to December 2002. The diagnosis of HSV epithelial keratitis was based on clinical characteristics of either a classic herpetic dendrite, a geographic ulcer, or a nonhealing epithelial defect that responded only to antiviral therapy. RESULTS: Fourteen patients were included in the study. Eight of these (57%) had presented with a geographic ulcer whereas six patients (43%) had a classic dendrite. The most common primary corneal disease that led to PK was pseudophakic bullous keratopathy (36%), followed by keratoconus (29%), Fuchs dystrophy (21%), and corneal scar unrelated to HSV (14%). CONCLUSIONS: The ophthalmologist should be aware of the possibility of herpetic keratitis in eyes after PK, even in patients with no previous history of HSV infection.

Acyclovir↗
PubMed2006

Discursive practices in the documentation of patient assessments.

AIM: This paper reports a study analysing the various functions of nurses' documentation of patient assessments. BACKGROUND: Modes of documentation have received much attention in the nursing press since the integration of the nursing process and nursing models. Previous research has shown that current documentation practices do not consistently promote effective communication and evaluation of patient care. A recent systematic review found no evidence that any particular system of documentation improved this situation. However, nurses' documentation serves not only to communicate information to others, but also has a political function as a presentation of what is important and ethically 'right' to report. METHOD: A Foucauldian approach to discourse analysis was used to analyse 45 patient records. FINDINGS: The findings indicate that nurses employ three discernible discursive practices in the documentation of patient assessments: medical, nursing and informal. Each practice has an effect on the presentation of nursing in the documentation. Because of the complex interplay between these practices, nurses present themselves as aligned with the medical profession, as distinct and professional, and as informal in their descriptions of non-biological information. The use of these practices appears to be motivated by the type of information being reporting. CONCLUSION: Existing literature highlights the functional aspects of nursing documentation. In contrast, this paper explores the way in which nurses, through their documentation, constitute themselves and the nursing profession. In this way, nursing documentation is viewed as a social practice and a conduit through which particular power effects are produced and reproduced, rather than simply a matter of, for example, knowledge, individual choice or good practice.

Attitude of Health Personnel↗
PubMed1986

Essential trace element provision to patients receiving home intravenous nutrition in the United Kingdom.

The methods of provision of essential trace elements to patients receiving long-term home intravenous nutrition in the U.K. have been reviewed and their trace element status has been assessed. Over a 2 year period, 57 patients based on 15 hospitals throughout the country were studied. Although biochemical abnormalities of trace element status were frequent, related clinical complications were apparently rare. Zinc provision from commercial preparations generally required further supplementation. Copper requirements were variable. Manganese provision from trace element mixtures and chromium provision from contaminants of other parenteral nutrient solutions were excessive in many cases. Aluminium contamination is not significant in the nutrient solutions currently used in the U.K. The most common depletion state is for selenium which should probably be provided on a routine basis. The clinical consequences of long-term under- or over-provision of trace elements by the intravenous route requires further study.

Journal Article↗
PubMed1988

Measurement of myoglobin diffusivity in the myoplasm of frog skeletal muscle fibres.

1. Experiments were carried out on intact, single skeletal muscle fibres from frog in order to estimate the apparent diffusion constant of myoglobin (denoted DAPP) in the myoplasm of living muscle cells. An optical technique was employed to measure myoglobin concentration along the fibre axis following injection of metmyoglobin (denoted metMb) at a point source. The concentration profiles were fitted by the one-dimensional diffusion equation to give estimates of DAPP. The method relied on the fact that myoglobin is normally absent from these frog fibres, thus permitting resolution of the myoglobin-related absorbance above the intrinsic absorbance of the fibre. 2. One complication in the method was that metMb became significantly reduced to oxymyoglobin (denoted MbO2) during the elapsed time before measurement of the concentration profile. The rate of reduction was evaluated by fitting myoglobin-related absorbance spectra, measured at different times following injection of metMb, with in vitro absorbance spectra of metMb and MbO2. Results from four experiments indicated that reduction could be described by a first-order, irreversible reaction having an average rate constant of 0.0164 min-1 (22 degrees C). The effect of reduction on the fitting of DAPP was taken into account. 3. DAPP was determined under three fibre conditions: (1) long sarcomere spacing (3.6-3.8 microns) at 16 degrees C, (2) long sarcomere spacing at 22 degrees C, and (3) normal sarcomere spacing (2.4-2.7 microns) at 22 degrees C. The average values for DAPP under these conditions were: (1) 0.12 (n = 5); (2) 0.17 (n = 5); and (3) 0.15 (n = 7) x 10(-6) cm2 s-1. The average value at 22 degrees C, 0.16 x 10(-6) cm2 s-1, is about 4 times smaller than values for myoglobin diffusivity at 20 degrees C commonly assumed in models of facilitated transport of oxygen by myoglobin. 4. In order to test the possibility that the unexpectedly low value of DAPP found in intact fibres might be due to the binding of myoglobin to relatively immobile sites in myoplasm, experiments were carried out in a cut-fibre preparation using a technique described by Maylie, Irving, Sizto & Chandler (1987 b) for determining the diffusion constants and degree of myoplasmic binding of absorbance dyes. Values for DAPP and the factor (denoted 1 + beta) by which the total myoglobin concentration exceeded the free myoglobin concentration were obtained by fitting the absorbance data by solutions of the one-dimensional diffusion equation.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2005

No pathogenic mutations identified in the COL8A2 gene or four positional candidate genes in patients with posterior polymorphous corneal dystrophy.

PURPOSE: To identify the genetic basis of posterior polymorphous corneal dystrophy (PPCD) through screening of four positional candidate genes and the COL8A2 gene, in which a presumed pathogenic mutation has previously been identified in affected patients. METHODS: DNA extraction, PCR amplification, and direct sequencing of the COL8A2, BFSP1, CST3, MMP9, and SLPI genes were performed in 14 unrelated, affected patients and in unaffected family members. RESULTS: In the COL8A2 gene, the previously identified, presumed pathogenic mutation (Gln455Lys) was not discovered in any of the affected patients. A missense mutation, Thr502Met, was identified in 2 of the 14 affected probands, although it was not considered to be pathogenic, as it has been identified in unaffected individuals. Although several novel and previously identified single nucleotide polymorphisms producing synonymous and missense amino acid substitutions were identified in the COL8A2, BFSP1, CST3, MMP9, and SLPI genes, no presumed pathogenic sequence variants were found. CONCLUSIONS: No pathogenic mutations were identified in the COL8A2 gene or in several positional candidate genes in a series of patients with PPCD, indicating that other genetic factors are involved in the development of this autosomal dominant corneal dystrophy.

Collagen Type VIII↗
PubMed1989

The 1H NMR visibility of intracellular lactate in Streptococcus faecalis.

1H NMR studies of glycolysis in washed cell suspensions of Streptococcus faecalis indicated that intracellular lactate is not 1H NMR visible. Evidence for this was gained from time course studies of glycolysis at increasing concentrations of glucose. A close correlation existed between the relative increase in the lactate integral and the enzymatically determined extracellular lactate concentration [Lo]. When ionophores which cause the collapse of the positive intracellular/extracellular lactate gradient were added to cell suspensions following fermentation of 5, 10 and 50 mM glucose, the increase in the lactate integral was proportional to the respective increase in [Lo]. A more direct method for determining the origin of the lactate signal involved centrifugation of a cell suspension after fermentation of 50 mM glucose and measurement of lactate in the extracellular and intracellular fluid. 1H spectra of the cell suspension, supernatant and sonicated pellet revealed that the lactate observed in the cell suspension was equivalent to the lactate in the supernatant alone. The intracellular lactate contained in the pellet represented 42% of the total lactate, indicating that only 58% of lactate is detected by in vivo 1H MRS of S. faecalis. This result is in contrast with the high percentage (70-90%) of in vitro lactate which is detected by in vivo 1H MRS of mammalian brain tissue (Williams S. R. et al. Magn. Res. Med. 7, 425-431, 1988). This may be due to a higher proportion of extracellular lactate in mammalian tissue or differences in the intracellular environments of bacterial and mammalian cells.

Enterococcus faecalis↗
PubMedDate not supplied

Method for combined FDG-PET and radiographic imaging of primary breast cancers.

The purpose of the study was to demonstrate the feasibility of a hybrid functional/anatomic breast imaging platform with biopsy capability for facilitating lesion detection and diagnosis. This platform consists of an investigative dedicated positron emission mammography (PEM) device mounted on a stereotactic X-ray mammography system, permitting sequential acquisition of mammographic and emission images during a single breast compression. There is automatic coregistration of images from both modalities, and these results can be successfully correlated with histopathologic findings. The potential utility of functional images correlated to anatomic images would include noninvasively detecting clinically and radiographically occult cancers, assessing response to therapy, discriminating between benign and malignant breast masses, and ultimately reducing the number of invasive and costly surgical interventions. A spot-digital mammogram and subsequent PEM image, collected over a 4-minute period, were obtained in a single patient with the breast in compression after intravenous injection of (F-18)-2-deoxy-2-fluoro-D-glucose (FDG) at the time of stereotactic biopsy. The authors conclude that FDG-based lesion localization information may be combined with the lesion X-ray attenuation characteristics using this common imaging platform.

Breast Neoplasms↗
PubMed2003

Transverse arch hypoplasia may predispose patients to aneurysm formation after patch repair of aortic coarctation.

BACKGROUND: Thoracic aortic aneurysm after patch repair of aortic coarctation is a potentially lethal complication. We hypothesized that transverse arch hypoplasia in association with patch repair of aortic coarctation predisposes aneurysm formation. METHODS: A retrospective analysis was performed on all patients undergoing isolated aortic coarctation repair at the University of Virginia Health Systems between 1970 and 1995. Of 244 repairs, 38 patients underwent patch repair. These 38 patients were divided into two groups. The aneurysm group (n = 15) had aortic aneurysms develop at the repair site, which required aneurysmectomy. The nonaneurysm group (n = 23) did not have any aneurysms develop. Univariate analysis and Fisher's exact text were used to identify factors that independently predict aneurysm formation. RESULTS: Univariate analysis demonstrated aortic arch hypoplasia associated with patch repair independently predicts future aneurysm formation (p < 0.01). Patients who had an aneurysm develop also had a similar incidence of bicuspid aortic valves, mild restenosis, and late hypertension compared with patients in the nonaneurysm group. CONCLUSIONS: Aneurysm formation after patch repair of aortic coarctation develops into a subgroup of patients. Aortic arch hypoplasia associated with coarctation independently predicts future aneurysm formation.

Aorta, Thoracic↗
PubMed2002

Adenosine A2A analogue improves neurologic outcome after spinal cord trauma in the rabbit.

BACKGROUND: ATL-146e, an adenosine A2A agonist, reduces paralysis after spinal cord ischemia-reperfusion. We hypothesized that systemic ATL-146e could improve neurologic outcome after blunt spinal cord trauma. METHODS: Twenty rabbits survived a thoracic spinal cord impact of 30 g-cm. One group received 0.06 microg/kg/min ATL-146e for the first 3 hours after impact (A2A group), whereas a second group received saline carrier (T/C group). Neurologic outcome was measured using the Tarlov scale (0-5). Histologic sections from the A2A and T/C groups were compared for neuronal viability. RESULTS: There was significant improvement in Tarlov scores of A2A animals compared with T/C animals at 12 hours (p = 0.007), with a trend toward improvement at 36 (p = 0.08) and 48 (p = 0.09) hours after injury. There was decreased neuronal attrition in A2A animals (p = 0.06). CONCLUSION: Systemic ATL-146e given after spinal cord trauma results in improved neurologic outcome. Adenosine A2A agonists may hold promise as a rapidly acting alternative to steroids in the early treatment of the spinal cord injured patient.

Animals↗
PubMed2003

Validation of a urine-based PCR-enzyme-linked immunosorbent assay for use in clinical research settings to detect Trichomonas vaginalis in men.

Trichomonas vaginalis infection is highly prevalent worldwide and is associated with urethritis, prostatitis, and urethral strictures in men. However, the natural history and importance of T. vaginalis in men are poorly understood, in part because of difficulties in diagnosing infection. Traditional detection methods rely on culture and wet-mount microscopy, which can be insensitive and time consuming. Urethral swabs are commonly used to detect T. vaginalis in men, but discomfort from specimen collection is a barrier to large studies. One thousand two hundred twenty-five Malawian men attending sexually transmitted disease and dermatology clinics were enrolled in this cross-sectional study to validate detection by urine-based PCR-enzyme-linked immunosorbent assay (ELISA) with urine and urethral swab culture as the reference standard. This assay for detection of amplified T. vaginalis DNA in first-catch urine (< or = 30 ml) performed with a sensitivity of 92.7%, a specificity of 88.6%, and an adjusted specificity of 95.2% compared to culture of urethral swabs or urine sediment. For clinical research settings in which urethral swabs are not available and culture is not feasible, the urine-based PCR-ELISA may be useful for detection of trichomoniasis in men.

Adolescent↗
PubMed2005

Incidental lung cancers identified at coronial autopsy: implications for overdiagnosis of lung cancer by screening.

BACKGROUND: The extent to which overdiagnosis occurs in lung cancer screening programmes has been debated. Overdiagnosis refers to the detection by screening of cancers that would not have become clinically apparent or symptomatic before that individual died of other causes. METHODS: A retrospective review of coronial autopsies performed in Victoria between April 1991 and February 2002 was conducted to determine the rate of incidental lung cancer in individuals who died of natural causes. RESULTS: A total of 24,708 autopsy reports were searched electronically. We estimated that in 56% of these death was from natural causes. Amongst individuals who died naturally there were 167 cases of lung cancer, 47 of these were incidental including five carcinoid tumours, three small cell tumours, 11 cases of carcinoma in situ and 28 invasive nonsmall cell lung cancers. Of the incidental invasive nonsmall cell lung cancers, 86% were stage I. CONCLUSIONS: Although incidental lung cancer is uncommon, there are some lung cancers that remain undetected during life and do not contribute to death. These findings support the hypothesis that some lung cancers detected by screening may never progress to cause symptoms or death in that individual's lifetime and therefore may be overdiagnosed by screening.

Adolescent↗
PubMed1999

Dynamic measurement of myosin light-chain-domain tilt and twist in muscle contraction.

A new method is described for measuring motions of protein domains in their native environment on the physiological timescale. Pairs of cysteines are introduced into the domain at sites chosen from its static structure and are crosslinked by a bifunctional rhodamine. Domain orientation in a reconstituted macromolecular complex is determined by combining fluorescence polarization data from a small number of such labelled cysteine pairs. This approach bridges the gap between in vitro studies of protein structure and cellular studies of protein function and is used here to measure the tilt and twist of the myosin light-chain domain with respect to actin filaments in single muscle cells. The results reveal the structural basis for the lever-arm action of the light-chain domain of the myosin motor during force generation in muscle.

Animals↗
PubMed2004

Clinicians required very high sensitivity of a bacteremia prediction rule.

BACKGROUND AND OBJECTIVE: Efforts to improve blood culture practice have focused on developing clinical prediction rules to identify patients at risk for bacteremia. However, no such models have been accepted into general clinical use. The goal of this study was to determine physicians' criteria for acceptability of a bacteremia clinical prediction rule. METHOD: We conducted a survey of all medical and surgical house officers as well as all infectious diseases physicians at the University of Pennsylvania to identify physician requirements for the sensitivity of a bacteremia clinical prediction rule. RESULTS: Of 225 eligible physicians, 149 (66.2%) completed the survey, including 110 house officers and 39 infectious disease physicians. The median (95% confidence interval) sensitivity of a bacteremia prediction rule required by respondents was 95% (95% confidence interval, 95.9%). Furthermore, 29 (19.5%) respondents required the sensitivity of a prediction rule to be at least 99%. The median required sensitivity was significantly higher for infectious diseases physicians than for house officers (98% and 95%, respectively) (P=.04). CONCLUSION: Our survey of house staff and infectious diseases physicians demonstrates that the sensitivity of any bacteremia prediction rule must be extremely high (i.e., 99% to 100%) to be widely accepted by practicing clinicians. Elucidation of physician criteria for acceptability of clinical predictive models will be invaluable in future efforts to develop such prediction rules.

Attitude of Health Personnel↗
PubMed2002

Ischemia-reperfusion injury after lung transplantation increases risk of late bronchiolitis obliterans syndrome.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is the most common cause of long-term morbidity and mortality after lung transplantation. Our hypothesis was that early ischemia-reperfusion injury after lung transplantation increases the risk of BOS. METHODS: Data on 134 patients who had lung transplantation between January 1, 1990 and January 1, 2000, was used for univariate and multivariate logistic regression analysis. RESULTS: After lung transplantation, 115 patients (115 of 134, 86%) survived more than 3 months. In that group, 41 patients developed BOS, of which 23 had progressive disease. Univariate analysis revealed that ischemia-reperfusion injury (p = 0.017) and two or more acute rejection episodes (p = 0.032) were predictors of BOS onset, whereas ischemia-reperfusion injury (p = 0.011) and cytomegalovirus infection (p = 0.009) predicted progressive BOS. Multivariate logistic regression analysis showed that ischemia-reperfusion injury was an independent predictor for both BOS development and BOS progression. Two or more acute rejection episodes were also an independent predictor of BOS development, whereas cytomegalovirus infection was an independent predictor of progressive BOS. CONCLUSIONS: Ischemia-reperfusion injury increases the risk of BOS after lung transplantation.

Adolescent↗
PubMed1998

Hepatitis G virus infection in lymphoma and in blood donors.

AIMS: To determine whether the recently described flavivirus, hepatitis G virus (HGV), might contribute to the pathogenesis of lymphoma by testing for the presence of HGV RNA in sera from patients attending lymphoma clinics; to compare the incidence of HGV RNA in lymphoma patients with that in normal blood donors; and to look for potential risk factors for HGV infection and for evidence of hepatic disease in the HGV positive patients. METHODS: Sera were examined from 76 patients with lymphoma and 100 blood donors for the presence of HGV RNA using reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: HGV RNA was detected in 10% of patients' sera, but only in 1% of blood donor samples. HGV infection was found in patients with various different types of lymphoma, including Hodgkin's disease and non-Hodgkin's lymphoma. The majority (75%) of patients who were HGV PCR positive had undergone transfusion, but only 30% of those who were HGV PCR negative had received blood products. In addition, the number of donor exposures per HGV positive patient was approximately twice that of the HGV negative group. CONCLUSIONS: The data suggest (1) that HGV is present in the normal blood donor population; (2) that patients with lymphoma are at risk of acquiring HGV because of their exposure to blood products; and (3) that persistent HGV infection does not appear to cause serious liver disease in these patients.

Adult↗
PubMed2001

Serum levels of the antiinflammatory cytokine interleukin-10 are decreased in patients with unstable angina.

BACKGROUND: Proinflammatory cytokines play a role in acute coronary events. However, the potential role of antiinflammatory cytokines in the modulation of the atherosclerotic process remains unknown. Interleukin (IL)-10, which is expressed in human atherosclerotic plaques, has potent deactivating properties in macrophages and T cells. The aim of this study was to assess whether serum concentrations of IL-10 differed between patients with unstable and stable angina pectoris. METHODS AND RESULTS: A total of 95 patients with angina pectoris and angiographically documented coronary artery disease were studied. Of these, 50 patients had chronic stable angina (with stable symptoms over 3 months), and 45 patients had Braunwald class IIIB unstable angina with ST-segment changes. Serum IL-10 and IL-6 concentrations were measured on admission using commercially available immunoassays. Serum IL-10 concentrations were lower in unstable angina patients compared with those who had chronic stable angina (28.4 versus 14.0 pg/mL; 95% CI, 9.8 to 19.0; P<0.0001), even after adjustment for variables that were significantly different on univariate analysis. IL-6 concentrations were higher in the unstable angina group (20.9 versus 11.4 pg/mL; 95% CI, 1.0 to 12.6; P=0.04). CONCLUSIONS: Patients with unstable angina had significantly lower serum IL-10 concentrations than did patients with chronic stable angina. This important finding is in keeping with previous data from animal model studies that suggest that IL-10 has a protective role in atherosclerosis.

Acute Disease↗
PubMed1997

Somatic neurofibromatosis type 2 gene mutations and growth characteristics in vestibular schwannoma.

BACKGROUND: The growth of hereditary and sporadic vestibular schwannomas shows wide variation, but what determines this is poorly understood. HYPOTHESIS: In neurofibromatosis type 2 (NF2), there is some correlation between the nature of the germline NF2 gene mutation and phenotype. Somatic mutations in the NF2 gene occur in sporadic tumors, but their relation to tumor behavior is unknown. METHODS: This study has investigated the molecular pathogenesis of vestibular schwannoma by looking for NF2 gene mutations. The authors have screened 17 exons of the NF2 gene in 91 sporadic vestibular schwannomas, 2 NF2, and 1 vagal schwannoma. These data have been correlated with a clinical growth index and a tumor cell proliferation index, determined using a monoclonal antibody to the proliferating cell nuclear antigen. RESULTS: Of the 94 tumors studied, 40 somatic gene mutations (38%) have been sequenced in 36 tumors. The mutations included 36 protein truncating mutations, 1 in-frame deletion, 2 splice site mutations, and 1 missense mutation. Regression analysis showed no correlation between the nature of the NF2 gene mutation and either the clinical (R2 = 0.006) or the proliferative index (R2 = 4 x 10(-8). CONCLUSION: The results of this study show no association between the nature of the intragenic NF2 gene mutation and tumor behavior. It is likely therefore that NF2 gene inactivation is not the only determinant of tumor behavior in vestibular schwannoma.

Adult↗
PubMedDate not supplied

A comparison of four methods of normal newborn temperature measurement.

PURPOSE: The purpose of this study was to: (a) compare newborn temperature measurements obtained by digital disposable, electronic, and tympanic thermometers with glass mercury thermometers, and (b) compare financial implications of each method. METHODS: In this correlational study, 12 perinatal and neonatal nurses obtained temperature measurements of 184 newborns between 1 and 168 hours of age. The stratified convenience sample was selected using medical records numbers. Temperature instruments included glass thermometer, tympanic thermometer, electronic thermometer, and a digital thermometer. Data were analyzed by Pearson r coefficients, mean, standard deviation, and range using an SPSS statistical package. RESULTS: The glass thermometer, electronic thermometer, and digital thermometer temperature assessments were highly correlated (0.748-1.0). The tympanic thermometer had a low correlation coefficient (0.35). Use of the glass thermometer had the highest accompanying cost. Tympanic thermometers were the most cost effective. CLINICAL IMPLICATIONS: In healthy newborns, the use of electronic and digital thermometers can be encouraged if there is concern about using glass thermometers. These results cannot be extrapolated to sick infants. While tympanic thermometers had the lowest associated cost, their lack of correlation with the gold standard glass thermometers for accurate temperature assessment makes them a poor choice for healthy newborns.

Body Temperature↗