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At least 379 records · Page 21Linked to original sources

High-frequency ultrasonographic imaging of the endothelium-dependent flow-mediated dilatation (FMD) in a brachial artery: normative ranges in a group of low CV risk subjects of different ages.

High-frequency ultrasonographic imaging of flow-mediated dilatation (FMD) in a brachial artery, as non-invasive technique, was used for the clinical evaluation of endothelial function (EF) in 115 subjects (ages 44.19+/-12.23 (26 to 83) free of coronary heart disease or its equivalents. Our aim was to study the normative ranges for FMD in subjects of different age groups with low cardiovascular risk factors. The mean FMD was 8.23+/-4.51% (0 to 20.9). Multivariate analysis revealed that there were only two independent predictors of FMD: resting vessel diameter (r = -0.45, p<0.0001) and age (r = -0.55, p<0.0001). The multiple regression equation for this data was FMD = 25.5-0.17 x age-2.6 x resting vessel diameter. Our study demonstrates that FMD in low cardiovascular risk patients inversely correlates with age as well as brachial artery diameter. Normative ranges of FMD could be predicted for different age groups. In addition to conventional methods for the assessment of cardiovascular risk by using a population-based approach (score indexes such as SCORE, FRAMINGH, PROCAM), high-frequency ultrasonographic imaging of flow-mediated dilatation (FMD) in the brachial artery is now becoming an accepted method for the assessment of an individual patient's cardiovascular risk. Although preliminary guidelines have been published, this technique has interpretive limitations. In a study that was published earlier, the authors estimated diameter-related normal ranges of FMD. Several articles reported cut points between control and diseased groups. Data about the impact of age on FMD are also available in the literature. However, this is the first attempt to classify normal values into groups according to age and diameter.

Adult↗

[Role of lymphography in determining a lymph flow blockage and the level of lympholymphatic shunting in edema of the extremities].

Different lymphographic methods were used for determining the disturbances of the lymph flow and the levels of the lympho-lymphatic shunts in 139 patients having edema of the upper (70) and lower (69) extremities. A conclusion is made that the generally accepted method of lymphography by means of the administration of a contrast substance into the vessels of one collector in some cases can not reveal the first symptoms of partial block of the lymph flow in clinical manifestation of edema. The successive lymphography of several collectors is necessary. With its aid the author has found that under normal conditions and in mild edemas they fulfil drainage separately, and in the expanded zone of edema they compensate the activity of one another.

Adolescent↗

[Comparison of psychodiagnostic methods for dementia and deterioration].

Several cognitive impairment/dementia diagnostic methods were examined concerning their results: (a) in the differentiation of accidental and pathological ability changes; (b) in the demonstration/exclusion of cognitive impairment; and (c) the degree of dementia. Sixty-five patients suffering from brain damage were examined with five accepted methods of diagnosing dementia (Syndrom-kurztest, KAI-MWT-Methode, Demenz-Test, Mini-Mental-Status-Test, Wurzer-Methode) and a comprehensive performance test battery as an external criterion for valid determination of the degree of dementia and definite differentiation of accidental and pathological performance changes. The five methods of diagnosing dementia differ appreciably in determining the degree of severity (r = 0.44). They are effective in registering accidental performance changes in comparison with the outer criterion, but pathological changes are inaccurately registered (hit rate 88%/53%); the results concerning the degree of cognitive impairment are identical: between 25 and 43% (r = 0.43). High rates (58%) of false-negative diagnoses are especially apparent in the range of slight and intermediate cognitive impairment. The methods examined are only useful for the demonstration and not for the exclusion of severe cognitive impairment (dementia) and in no circumstances for the registration of slight/intermediate cognitive impairment. Valid diagnosis of cognitive impairment/dementia necessitates the use of test batteries that differentiate functions including the premorbid performance level.

Adult↗

An investigation of factors influencing the measurement of creatine phosphokinase activity in serum using coupled enzymatic methods.

1. The factors influencing the measurement of creatine phosphokinase (CPK) activity in serum by coupled enzymatic methods were investigated to establish optimum conditions for this type of assay. Such a study was indicated following observations by the authors of poor performance of commerically produced reagent kits together with the failure of most of the established an well accepted methods to operate under true optimum zero order kinetics in the reaction phase state. 2. The factors invested were the effects of pH, substrate concentrations (creatine phosphate, glucose and NADP+), added auxiliary (hexokinase) and indicator (glucose-6-phosphate dehydrogenase) enzymes, dithiothreitol (DTT) as an activator and conditions of storage of substrate stability. DTT was found to be a suitable activator but not a reactivator of the reaction. The optimum concentrations of creatine phosphate, glucose and NADP+ were found to be 20.0, 20.0 and 2.0 mmol/litre, respectively. Optimum activieies of the enzymes, glucose-6-phosphate dehydrosenase and hexokinase were 1000 and 2000 units/litre, respectively. 3. The between-day precision of the method for measuring serum at pH 6.8 and 30 degrees C at three activity levels under the optimum conditions developed was excellent yielding coefficients of variation ranging from 2.0 to 2.7%.

Creatine Kinase↗

Calculating bone-lead measurement variance.

The technique of (109)Cd-based X-ray fluorescence (XRF) measurements of lead in bone is well established. A paper by some XRF researchers [Gordon CL, et al. The Reproducibility of (109)Cd-based X-ray Fluorescence Measurements of Bone Lead. Environ Health Perspect 102:690-694 (1994)] presented the currently practiced method for calculating the variance of an in vivo measurement once a calibration line has been established. This paper corrects typographical errors in the method published by those authors; presents a crude estimate of the measurement error that can be acquired without computational peak fitting programs; and draws attention to the measurement error attributable to covariance, an important feature in the construct of the currently accepted method that is flawed under certain circumstances.

Analysis of Variance↗

Diabetic home blood glucose monitoring using a direct reading glucose sensitive test strip.

The aim of this study was to assess the performance of the BM Test Glycemie 20-800. Twelve diabetic patients were studied using the BM Test Glycemie 20-800, compared with one of the commonly available reflectance meters. The correlation coefficient for the BM 20-800 strip versus reference blood glucose result was significantly better than the reflectance meter (p = 0.01). In a separate study, laboratory staff tested both methods and achieved results which were similar to those of the patients using the BM Test Glycemie 20-800, but better than those of the patients using the reflectance meters. The BM Test Glycemie 20-800 is a cheap, reliable and acceptable method for the measurement of blood glucose levels.

Adolescent↗

Tests alternative to the rabbit bioassay for pyrogens.

The rabbit bioassay is currently the only legally acceptable method to test for pyrogenic contamination of parenteral preparations and medical devices designed to enter the parenterum. However, research efforts have recently made available alternative procedures to test for pyrogens which may have significant value in quality control. Part of the reluctance to accept tests other than the rabbit test may be due to the low visibility of emerging understanding of a significant theory of testing in which it is contended that the parameters of sensitivity and specificity are inversely related and that accuracy is an ideal. The rabbit pyrogen assay will detect 1 to 10 ng of enterobacteriaceal endotoxin (ET). The limulus test will detect 0.01 to 0.1 ng/ml of ET; some of the other tests approach the rabbit assay in sensitivity. Since it is current dogma that pyrogen is equivalent to ET, the basis for the use of ET to standardize pyrogen tests is rationalized. The source of ET in practice is bacterial contamination; therefore, numbers of bacteria that contaminate parenteral preparations can be directly related to potential pyrogenicity. Further, viable counts of bacteria in parenteral preparations, prior to sterilization, is a reliable test for pyrogens. Other tests such as nitroblue tetrazolium reduction and actinomycin-D enhancement of lethality of pyrogen for mice deserve consideration in quality control procedures. The limulus test, the most practical of currently available alternative tests for detection of ET and therefore, of pyrogen has application where the rabbit test cannot be used. Therefore, control personnel must learn of the availability, performance and interpretation of the limulus test. Practical considerations must govern the choice of an alternative test when the use of a test other than the rabbit bioassay is indicated.

Animals↗

Lower-extremity amputations in patients with diabetes: pre- and post-surgical decisions related to successful rehabilitation.

BACKGROUND: Peripheral vascular disease and diabetes account for the majority of lower-extremity amputations in the adult population. Whenever a patient presents to a surgeon regarding a diseased limb, the initial basic decision is to determine whether to attempt limb salvage or proceed with an amputation. Unfortunately, limb salvage is not an option for many of these patients. Once amputation is chosen as a treatment option, the optimal level of amputation has to be determined by the surgeon, who is then faced with selecting the optimal level of amputation compatible with wound healing and subsequent prosthetic fitting. METHODS: Methods for objectively determining optimal amputation level include vascular evaluations, assessing the level of cellulites or osteomyelitis, or intra-operatively, by looking at the amount of bleeding in skin flaps. RESULTS: The net outcome is that there is currently no universally accepted method for determining the level of amputation for successful wound healing or for preventing subsequent higher amputations. CONCLUSIONS: What is generally recognized is that there are disparities in the rates of amputation for type 1 versus type 2 diabetic patients, for different ethnic groups and for patients with multiple co-morbidities. However, with advances in surgical techniques and with modern prosthetics, all categories of patients are benefiting from surgeries in which a longer residual limb can be kept (within surgical constraints related to proper wound healing), and where appropriate biomechanical considerations are taken into account.

Amputation, Surgical↗

Traumatic colonic perforation. Review of 16 years' experience.

The surgical management of colon injuries in civilian practice requires individualization. Primary repair, either by debridement and suture or resection and anastomosis, is a safe method of management in selected cases and results in a shorter hospital stay, less morbidity and a complication rate that is no higher. In this series, over half of the colon injuries were managed in this way. Exteriorization and proximal colostomy are accepted methods of management, but possibly should be reserved for the more severely injured patient. The criteria for individualization are briefly summarized.

Adult↗

An evaluation of different methods for the recovery of meticillin-resistant Staphylococcus aureus from environmental surfaces.

Although the association between environmental surfaces contaminated with meticillin-resistant Staphylococcus aureus (MRSA) and hospital infection rates is not fully understood, monitoring programmes can provide an objective starting point for the development and assessment of infection control strategies incorporating improved cleaning. There is, however, no universally accepted method for the recovery of MRSA from environmental surfaces, and the aim of this study was to evaluate a selection of currently available methods. Using five clinical isolates of MRSA and seven protocols, known numbers of bacteria were inoculated on to a stainless steel surface and either recovered immediately (without drying or adsorption) or recovered after 30min (with drying at room temperature and adsorption of cells to the surface). Surfaces were either swabbed or sampled directly by contact methods, and four nutritive media (blood, tryptone soya, oxacillin and meticillin-resistant agars) were tested. Relative sampling efficiencies were determined and the sensitivity of each method per 100cm(2) was calculated. Wide variation in the ability to recover MRSA was found between the different protocols. In the recovery of dried (adsorbed) cells, direct contact methods demonstrated higher sampling efficiency than swabs. The sensitivity of all methods was lower in recovering adsorbed cells from surfaces than unadsorbed cells. Sampling methods consistently proved to be more important than the choice of medium. Dipslides coated with selective agar are recommended for recovering MRSA from flat environmental surfaces.

Bacteriological Techniques↗

Comparison of radiometric and microbiological assays for the determination of folate in fortified gruel and porridge.

The results obtained by a radiometric assay of folate in fortified gruel and porridge, using a commercially available radioassay kit, were compared with those obtained by a standard microbiological assay with Lactobacillus casei. A lower level of folate was found with the radiometric assay. Comparison of the results obtained with the two methods gave a correlation coefficient of 0.991 when the analysis was performed on samples extracted at the same time. A lower correlation coefficient was obtained between the result if the extractions were carried out on different occasions. The radiometric assay is a acceptable method for the routine determination of folate in fortified gruel and porridge.

Edible Grain↗

Assessment of myocardial perfusion by magnetic resonance imaging.

Magnetic resonance imaging (MRI) has proven useful for anatomic and functional evaluation of the heart. However, until recently assessment of myocardial perfusion has not been possible by MRI. Using newly developed ultrafast imaging sequences, images can be acquired rapidly with a high temporal resolution, which is a prerequisite for imaging the initial passage of a bolus of MR-contrast medium through the myocardium. Only gadolinium chelates, which rapidly diffuse out of vascular space, are currently approved for clinical use. The first pass of a bolus of one of these agents through hypoperfused myocardium distal to a coronary artery stenosis enhances this area less as compared to normally perfused areas. This different myocardial enhancement is often visible when looking at the series of MR images. However, intensity differences are rapidly decreasing as MR-contrast media are diluted in the systemio circulation after the first pass and diffuse to the interstitium. Therefore, only the first pass is of interest for MR-perfusion imaging. Additional and often more precise information can be derived by measuring parameters of the signal intensity time curve such as mean transit time, maximum signal intensity increase, upslope, downslope, and delay before reaching maximum signal intensity. Temporal resolution is the crucial factor in MR-perfusion imaging because it takes only 20 to 60 seconds for the contrast medium to pass through the myocardium. Therefore, this dynamic process must be imaged with a high temporal resolution. Moreover, image acquisition must be fast enough to minimize motion artefacts and to maximize the spatial coverage of the ventricle. Ultrafast gradient echo techniques and echo planar imaging are in principle capable to fulfill these demands. While ultrafast gradient echo sequences enable one to acquire a maximum of 2 slices per heartbeat, echo planar sequences need only 30 to 50 msec to completely acquire one image and are thus able to image the entire ventricle within one heartbeat. However, they are also more susceptible to image artefacts. As gradients capable of producing high quality echo planar images are not widely available, ultrafast gradient echo techniques are commonly used for MR-perfusion imaging. A good correlation between quantitative estimates of myocardial perfusion by MRI after injection of an intravascular contrast agent and microsphere measurements has been shown in animal experiments but quantitative MR perfusion measurements have not yet been performed in humans. Clinical studies have until now focused on visual and parametric analysis of signal intensity time curves. From these studies, sensitivities and specifities in the range of 60 to 90% as compared to x-ray coronary angiography and scintigraphy were reported despite the fact that only parts of the left ventricular myocardium could be assessed. However, a generally accepted method of acquiring and analysing MR perfusion images does not yet exist. Therefore, future improvements of hardware and pulse-sequences as well as the development of new blood pool contrast agents are necessary before MR-perfusion imaging will become a widely accepted and clinically useful diagnostic procedure.

Artifacts↗

A fluorometric determination of urinary 17-hydroxycorticosteroids using benzamidine.

A fluorometric determination of urinary 17-hydroxycorticosteroids using a reaction of benzamidine with compounds carrying the dihydroxyacetone side chain is described. The fluorescent compounds have excitation and emission maxima at 370 and 480 nm, respectively. The method includes enzymatic hydrolysis with beta-glucuronidase (EC 3.2.1.31, from Escherichia coli) and extraction with methylene chloride and generation of fluorescence in alkaline solution (pH 13.4). The specificity of the reaction was examined and the results were compared with those of an accepted method based on the Porter-Silber reaction (C. C. Porter and R. H. Silber, 1950, J. Biol. Chem. 185, 201-207). The coefficient of correlation was 0.945 with regression line of y = 0.91x + 0.7 mg/day (y, present method; x, Porter-Silber reaction method). Sensitivity of the reaction was 0.5 microgram/ml of standard or sample, mean recovery of cortisol added to five urine samples (5-micrograms addition) was 95%, and the coefficient of variation of the method (five repeated assays of sample with a value of 5.2 mg/liter) was 6.2%.

17-Hydroxycorticosteroids↗

Further studies with the fluorescent treponemal antibody-absorption double-staining procedure.

A double-staining procedure for the fluorescent treponemal antibody-absorption test, using fluorescein isothiocyanate as a label for the class-specific anti-human globulin and tetramethylrhodamine isothiocyanate as a label for a counterstain reagent, has been described. This method requires the addition of a KP560 barrier filter, with a microscope equipped with vertical illumination, to exclude the rhodamine emission in reading the fluorescein fluorescence. The present study evaluated reversing the dye label for each conjugate in the double-staining procedure, thus eliminating the need for the KP560 filter. It also considered the possibility of shortening the counterstaining time and compared various methods for preparing antigen slides in an attempt to establish a method that increases the number of treponemes per microscopic field. The results indicate that a rhodamine-labeled class-specific anti-human globulin as a primary stain, and a fluorescein-labeled anti-treponemal globulin as a counterstain, provide an acceptable method for performing the fluorescent treponemal antibody-absorption double-staining procedure. Nonfixed antigen slides were held for 16 days in a desiccator or stored in plastic bags with silica gel for 3 weeks; then, with methanol fixation, they were used satisfactorily in the double-staining procedure. A shortened incubation time for the counterstain allowed more rapid slide processing.

Antigens, Bacterial↗

The management of arthrogryposis.

Arthrogryposis has an evil reputation among orthopedic surgeons, for the deformities are known to be resistant to correction and relapse during growth is common. It is suggested that many of these difficulties have been due to a delay in initiating treatment, to the use of unsuitable methods such as manipulation, and to a lack of appreciation of the pathologic changes. The author's experience with a large number of personally treated cases has convinced him that aggressive surgical treatment in infancy and early childhood is more successful than previously accepted methods of care (Figs. 22, 23).

Arm↗

Ocular anomalies of individuals with mental illness and dual diagnosis.

BACKGROUND: Oculo-visual findings commonly associated with persons diagnosed as having mental illness and/or dual diagnosis (i.e. mental illness with mental retardation) have not been fully investigated. This study determines the most common eye and vision anomalies associated with these disorders and discusses the similarities and differences between these two unique populations. METHODS: Data were obtained by the random selection of 88 patient records from the Illinois Eye Institute/Easter Seal Society of Metropolitan Chicago Eye Care and Treatment Program (Illinois College of Optometry). Results from the most recent oculo-visual evaluation were reviewed. Commonly accepted methods of assessing the eyes and vision of patients with disabilities were used. RESULTS: Individuals with mental illness frequently exhibited uncorrected refractive error, strabismus, blepharitis, pigmentary retinopathy, and cataracts. Those with mental retardation and mental illness (dual diagnosis) demonstrated similar findings with the exception of cataracts. A statistically significant amount of compound astigmatism was seen in those with mental illness. CONCLUSIONS: Many of the ocular anomalies found among the mentally ill and those with dual diagnosis were common to both groups but occurred with different frequencies. Appropriate spectacle correction and individually designed therapy programs should play an important role in the developmental and intellectual habilitation of these patients.

Adolescent↗

[Streptokinase: correlation between different methods of biological evaluation].

A study was carried out to establish an appropriate method for streptokinase (SK) potency determination (biological assay) in order to fulfil the main function of the Instituto Nacional de Medicamentos respecting products marketed in Argentina. The potency of different commercial samples of SK was determined against the International Standard, and three internationally accepted methods were used for this purpose: fibrin plate, clot lysis and chromogenic method. The analysis of results suggests that the fibrin plate method is the least precise and reproducible. The clot lysis and chromogenic methods demonstrated great precision and reproducibility, giving a correlation coefficient of 0.99. It is concluded that both of these methods are best suited to determine potency of SK commercial products.

Animals↗

Randomized single blind trial of two low-volume bowel preparations for screening computed tomographic colonography.

BACKGROUND: Bowel preparation is an important part of computed tomographic colonography (CTC); we evaluated two small-volume preparations for screening CTC with regard to quality of preparation and patient acceptability. METHODS: Asymptomatic subjects at average risk for colorectal cancer from a community-based CTC screening program were randomized to bowel preparation comprising magnesium/bisacodyl/picolax or polyethylene glycol (PEG)/picolax. CTC images were evaluated by a blinded investigator for residual feces and fluid; subjects completed a questionnaire regarding acceptability of the preparation. RESULTS: In 176 subjects randomized to magnesium/bisacodyl/picolax (n = 82) or PEG/picolax (n = 94), the former preparation was discontinued because of syncope or presyncope in four (5%) subjects. Another 137 subjects received PEG/picolax without a significant adverse event. There were no other major differences in acceptability of the preparations as reported by subjects. The quality of bowel preparations for reporting CTC was similar. CONCLUSION: For subjects having screening CTC, both small-volume bowel preparations are generally well tolerated and result in minimal fluid and fecal residue; however, the magnesium/bisacodyl/picolax preparation was accompanied by an unacceptable incidence of syncope and is no longer used by us.

Bisacodyl↗