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At least 397 records · Page 22Linked to original sources
PubMed2005

Variation in Medicare's local coverage policies: content analysis of local medical review policies.

OBJECTIVE: To assess variation in the content of Medicare's local medical review policies. STUDY DESIGN: Six case studies to compare differences in coverage policies by diagnosis codes, procedure codes, and indications for use. METHODS: All carrier policies from 48 carrier contracts (n = 5213) posted to the Centers for Medicare & Medicaid Services Web site were downloaded on May 31, 2001. All policies in the data set were coded based on a typology: new technology (NT), extensions of new technology (TE), and utilization management (UM) of widely used procedures. We identified policies addressing the same procedure or technology. We required at least 20 separate policies in each case study to allow meaningful comparisons. We randomly selected 1 case study of a diagnostic and 1 for a treatment modality from each policy type (NT, TE, and UM). RESULTS: Given previous research on local carriers, we expected to find variations among policies in each case study. We found substantial similarity, however, among policies covering the NT and TE types. We found significantly more variation among our UM-type case studies. CONCLUSIONS: Medicare legislation has called for greater coverage policy consistency in Medicare. This analysis on variation in policy content, part of a larger study on variation in Medicare's local coverage process, provides data on policy content differences. Policy reform should reflect the nature of and reasons for policy variation as suggested by the findings of this research.

Humans↗
PubMed2005

[Bioprotection by local and whole-body preheating--bioprotection of damage to mice tongue from burning by local preheating of oral cavity and of radiation damage of small intestine from whole-body preheating].

We have reported the cytoprotective effects of HSP 70 on various stress damage induced by mild heating. In this study, we examined the cytoprotective effects of HSP 70 induced by the local preheating of the oral cavity of mice at 42 degrees C for 30 min, and the following results (1-4) were obtained. We also examined the cytoprotective effects against radiation injury by whole-body preheating at 41.3-41.6 degrees C for 30 min (5-6). 1) The concentration of HSP 70 in lymphocytes was increased 2 days after preheating, but not significantly. 2) The concentration of HSP 70 in masseter muscle was significantly increased 2 days after preheating. 3) Under non-heat stress (control), tongue muscle was strongly stained with immunoblotting of HSP 72 antibody, an antibody of induced-type HSP 70. 4) Tongue damage and weight loss of the mice in the preheating group, whose tongues were burned, were less than in the control group. These results showed that HSP 70 induced by local preheating of the oral cavity protected against tongue damage from burning. 5) Radiation injury of the small intestine on HE stain of whole-body radiated mice was obviously reduced by whole-body preheating. 6) Decrease of the ratio of the villus length to the crypt of whole body-irradiated mice was significantly improved by whole-body preheating. From these results, it was concluded that local and whole-body preheating were useful for cytoprotection from stressful damage.

Animals↗
PubMed2005

Is radical prostatectomy in thai men a high morbidity surgery for localized or locally advanced prostate cancer?

OBJECTIVE: To assess the morbidity of radical prostatectomy in Thai patients with localized or locally advanced prostate cancer MATERIAL AND METHOD: A total of 151 patients with prostate cancer underwent radical prostatectomy at Faculty of Medicine Siriraj Hospital, Bangkok, between 1994 to 2003. Operative complications and long term morbidity were evaluated with clinical stage T1, T2 and T3. RESULTS: Mean operative duration, blood loss and blood transfusion were 162 minutes (range 71-540), 1088 ml (range 200-4000) and 1.7 unit (range 0-12), respectively. Of 151 patients, 139 (92.6%) did not have perioperative complications and 42 (2 7.8%) did not have blood transfusion. Of 12 patients with morbidity, all patients were safely managed. There was no mortality. Of 140 patients with follow up results, 131 (93.7%) had no incontinence. Seven patients had mild stress incontinence. Only 2 patients had a significant incontinence. Eight patients had stricture of anatomosis. Strictures were simply managed with dilatation. There was no significant difference of operative time, blood loss, blood transfusion, incontinence and stricture parameters among clinical T stage (all p value > 0. 05). CONCLUSION: Radical prostatectomy in Thai men is not a high morbidity surgery in terms of immediate complications and long term morbidity. For clinical T3 prostate cancer, morbidity is not significantly higher than in patients with clinical localized disease.

Aged↗
PubMed1990

[Primitive digestive localizations of malignant non-Hodgkin's lymphoma. Prognostic factors of locally advanced disease: stage II. Report of 67 cases].

Sixty-seven patients with non-Hodgkin's lymphoma of the digestive tract with locally advanced disease (stage II) were analyzed to determine the main factors influencing survival. There were 19 patients with stage II E1 and 48 with stage II E2 disease (Musshoff classification). According to the Kiel classification, 46 percent were low grade, 46 percent were high grade, and 8 percent were unclassified. The principal sites involved included the stomach: 11 cases, small intestine: 21 cases, colon: 12 cases, and mesentery: 11 cases. Lymphoma was unique in 45 cases (67 percent). Treatment consisted of laparotomy in 61 of 67 cases: partial resection was achieved in 21 cases, complete resection in 27 cases, and exploration only in 13 cases. Chemotherapy, according to histopathological subtypes, was employed in 90 percent of cases. Radiation therapy was applied in 25 patients (37 percent), essentially when there was residual disease after surgery (17 patients). Therapeutic indications were dependent on histological subtype, extension, and the therapy regimen in use at the time of treatment. Five patients were treated by surgery only, 2 by surgery and radiation therapy, 37 by surgery followed by chemotherapy, and 23 by all three treatment modalities. Overall survival was 62 percent at 5 years. Univariate analysis showed that 5-year survival rates were not influenced by sex, age, histopathological subtype (low grade: 69 percent; high grade: 59 percent; NS) or local extension (stage II E1: 76 percent vs stage II E2: 59 percent; NS). In contrast, complete surgical excision (p = 0.06) and radiation therapy in case of local residual disease (p = 0.02) seemed to improve survival. The main prognostic factor was the achievement of a complete therapeutic response (CR) (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Fibrinogen and glycoprotein IIb/IIIa localization during platelet adhesion. Localization to the granulomere and at sites of platelet interaction.

Platelet membrane glycoprotein IIb-IIIa plays a focal role in primary hemostasis by serving as the cell surface receptor for fibrinogen. Recent studies by several groups have suggested that GPIIb-IIIa, which is dispersed randomly in the resting cell, undergoes migration leading to receptor clustering after platelet activation. The authors have investigated this activation-dependent relocation of fibrinogen receptors on platelets adherent to a standardized artificial surface. The correlative use of immunogold electron microscopy, ligand-gold binding, and stereo (three-dimensional) electron microscopy (EM) revealed specific localization of fibrinogen and its receptor at points of platelet to platelet interaction. Fibrinogen distribution on the plasma membrane, studied through the use of fibrinogen-gold conjugates with whole-mount adherent platelets, was primarily over the granulomere and at the cell periphery corresponding to sites of platelet-platelet interaction. Compared with the general hyalomere, fibrinogen density over the granulomere and at contact regions was increased 12-fold and 22-fold, respectively, and the specificity of binding at these sites was verified by positive competition with native fibrinogen, one of its degradation products (Fragment D1), and by monoclonal antibodies (HP1-1d and AP-2) specific for GPIIb-IIIa. The distribution of receptor antigens, localized by immunogold EM using antibodies against GPIIb-IIIa, also was localized over the hyalomere, where fibrinogen did not bind. To understand this apparently nonfunctional hyalomere GPIIb-IIIa further, correlative immunocytochemistry was performed using polyclonal and monoclonal antibodies for GPIIb and GPIIIa simultaneously. Colocalization of the antigens was observed consistently over the granulomere and at regions of cell contact, whereas the hyalomere antigens tended to be nonassociated. The studies document GPIIb-IIIa as a function complex at sites of cell interaction where fibrinogen binds.

Cell Communication↗
PubMed1989

Heparan sulfate proteoglycan of murine glomerular basement membrane: relationship between localization of the core protein and localization of fixed negative charges.

Antibodies to a 250,000 molecular weight heparan sulfate proteoglycan (HSPG) core protein purified from PYS-2 cells were prepared in the rabbit. After absorption with laminin, the anti-HSPG serum (AHSPGS) was specific for HSPG by enzyme-linked immunoabsorbent assay (ELISA). Immunoelectron microscopy showed that AHSPGS reacted with the mouse glomerular basement membrane (GBM) or, more precisely, with three HSPG rich layers, i.e., (i) the lamina rara interna in a discrete or interrupted-linear pattern, (ii) the interface between the GBM and the soles of the foot processes, and (iii) the lamina rara externa in a finely discrete pattern. The localization of HSPG in the GBM was very similar to that of the fixed negative charges detected with polyethyleneimine (PEI). When mice were treated with heparitinase, binding of PEI was seen only on the cell surface including the foot process soles (ii) but not in the GBM (i and iii), while the localization of HSPG core protein was unaltered. These results suggest that the localization of the HSPG core protein was correlated with that of the fixed negative charges in the GBM (i and iii). The foot process base (ii) seems to be a complicated zone since the PEI binding in this area was less affected by heparitinase treatment, while this area has been reported to have a lower sialic acid content than the foot process surface facing the urinary space.

Animals↗
PubMed1989

[Local extension of epithelioma of the glottic floor; anatomo-clinical correlations and study of local failure. Apropos of 432 patients treated by partial laryngeal surgery].

The authors have studied real tumoral extension in 432 cases with N0 M0 epidermoid carcinoma of the glottic floor treated by partial laryngeal surgery over the period extending from 1972 to 1984. This retrospective study defines the limits and the errors of preoperative assessment of local extension. Clinical examination and direct suspension laryngoscopy are needed. T classification cannot be used as a sole reference in the selection of the surgical technique. The difficulties encountered in the evaluation of real tumor extension in this type of neoplasia calls for great caution on the part of the surgeon in selecting the procedure for partial laryngeal surgery. The study of the incidence of local failures in cases of real tumor extension emphasizes the need for an appropriate surgical technique for the local management of tumoral extension. The authors identify the respective place held by such techniques as thyrotomy associated with internal subperichondrial degloving and partial vertical laryngectomy with cartilage resection, and its many variants, and partial horizontal subcricoid laryngectomy (of the cricohyoepiglottopexy-type).

Adult↗
PubMed1989

[A CT localization frame--an improved method for preoperative localization of intracranial processes].

A new CT localization equipment for cerebral processes is presented. As compared to the methods used until now it offers the advantage that no direct marking on the shaven skull must be provided. The parameters resulting during the CT examination with applied localization frame enable the preoperative localization at any desired time. A precondition is the use of an identical device by the surgeon. The use of the methods is explained.

Brain Neoplasms↗
PubMed1981

Relief from pain localized to the lower back in early labour. A double blind trial of ketocaine, a new, highly effective, local, cutaneous analgesic (A 2358, Ane-Pad), and placebo.

Pain localized to the lower back in the first stage of labour in 47 primiparous women was treated by epicutaneous application of ketocaine or placebo compresses. Twenty-three patients were treated with ketocaine compresses (Ane-Ped), and 24 patients with compresses soaked with isotonic saline. The pain relieving effect was almost the same in both treatment groups. Pain localized to the lower back was reduced in about 50% of the patients after one hour's application of ketocaine or placebo compresses. Supplementary analgesics had to be administered in about 60% of the patients in each group. No maternal or foetal systemic side effects related to the treatment were registered. Local erythema on the application area was only reported in the ketocaine group. The frequency of feeling of warmth during the application of compresses of ketocaine were high compared to the placebo group, 78% and 29% respectively.

Adult↗
PubMed1984

[Quantitative double tracer autoradiographic technique for the simultaneous measurement of local cerebral blood flow and local cerebral glucose utilization using 14C-IAP and 18F-FDG].

We have reported a quantitative double tracer autoradiographic technique for the simultaneous measurement of local cerebral blood flow (LCBF) and local cerebral glucose utilization (LCGU) using 14C-IAP and 18F-FDG respectively. Six awake normal rats and 3 left middle cerebral artery (MCA) occluded rats were used for this experiments. A 50-hold greater radioactivity of 18F was administered and the first exposure was done for 2 hours to obtain a 18F image. Three days later (39 half-lives of 18F), a second exposure was done for 5 to 6 days to obtain the 14C image. Tissue concentration of 14C was measured relative to the commercially available 14C-methyl methacrylate standards. 18F standards were prepared in each experiment. Cross contamination of 14C in the first exposure was less than 2% in the normal state and less than 4% even in the uncoupling condition. The values obtained by this methods for LCBF and LCGU agreed closely with those obtained by a single tracer technique previously reported in the literature. The technique outlined in this paper also provided local glucose utilization flow ratio (LGFR) for the first time. LGFR was obtained by dividing the LCGU image by LCBF image and was expressed as percent mumol/ml. The mean LGFR of control rats was 76 +/- 8% mumol/ml. In a MCA occlusion group, LGFR of ischemic cortex increased until 2 to 3 times higher than that of contralateral non-ischemic cortex. Oxygen glucose index image which was obtained from the LCGU and A-V differences of O2 showed that approximately half of the glucose was metabolized anerobically.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

[Method of local hyperthermia combined with gamma therapy in patients with locally disseminated rectal cancer].

Altogether 32 patients with locally disseminated rectal cancer received thermoradiotherapy. Local hyperthermia was used in combination with preoperative radiotherapy in a single focal dose of 4 Gy up to a summary focal dose of 40 Gy. Starting from the third session preliminary heating of a tumor was done using a VHF-unit with a wave length of 33 cm, frequency of 915 MHz. Temperature was controlled in the rectal lumen on the tumor surface with the help of a thermocouple. The temperature of 42-43.5 degrees was maintained for 1 hour. Therapeutic efficacy was assessed after 4 weeks and compared to the results in a similar group of 74 patients who received radiotherapy by the same scheme but without hyperthermia. The results were assessed by the regression of a primary focus: complete (tumor resorption); pronounced (50% and more of the initial volume); insignificant (a decrease in the size up to 50% of the initial volume); the absence of effect (including the progression of a process). In thermoradiotherapy a complete regression was noted in 7 patients (21.9%), pronounced in 18 (56.2%), insignificant in 6 (18.8%) and the absence of effect in 1 (3.1%). In the group of patients who received radiotherapy only no complete regression was noted, pronounced regression was observed in 25 patients (33.8%), insignificant in 31 (41.9%) and the absence of effect in 18 (24 3%). Radiation reactions were more frequently observed with thermoradiotherapy in the form of rectites (62.5 and 42.9% respectively). The first experience with the use of combined thermoradiotherapy in patients with locally disseminated rectal cancer holds promise for the development of the above trend.

Combined Modality Therapy↗
PubMed1994

Histopathology of localized prostate cancer. Consensus Conference on Diagnosis and Prognostic Parameters in Localized Prostate Cancer. Stockholm, Sweden, May 12-13, 1993.

Future handling of patients with localized prostate cancer will undoubtedly depend upon a more sophisticated prognostication than that available today. The basis will continue to be the histopathological evaluation of tumor size, grade, localization and distribution within the gland. The aim of this section is to summarize current concepts of the morphological characteristics of localized prostate cancer and their prognostic implications as well as to give guidelines for standardization of the methods involved in morphological evaluation. First, baseline recommendations for the tissue processing procedures are given: Needle core biopsies, taken in a systematic way, potentially contain the information necessary for estimation of grade, size, distribution and extension to seminal vesicles, and could yield material for DNA-measurements, cytogenetic and genetic information. For TUR specimens it is suggested that at least 10 grams should be embedded or 8 to 10 cassettes employed minimally. The prostatectomy specimens should be carefully examined. Material should be frozen both from tumor tissue and from other areas eg by taking 'mapping' biopsies in a standardized way. After fixation (in 10% buffered formalin for at least 24 hours) and appropriate inking of surgical margins, whole mount sections at 2.5-5 mm intervals should be cut. The extension of the tumor should be outlined and at least the two largest tumors should be graded. Capsule penetration and extension to surgical margins and seminal vesicles should be indicated. Grading of malignancy should always include the Gleason grade and where possible Gleason score (ie the sum of the dominant and the secondary grade or pattern). The WHO and the Boecking systems combine a grading of glandular architecture with a grading of the nuclear atypia. It is stressed that in core biopsies the amount of cancer is sometimes scanty, which limits the possibility to find dominant and secondary patterns. In such cases, a grading of glandular differentiation and of nuclear grade seems rational. Also, for comparison with cytological grading, the WHO system is suitable, since in both cases both tissue differentiation and nuclear atypia are judged. The future need for objective techniques is recognized. Prostatectomy pathology includes important features with high correlation to postoperative prognosis: eg capsular penetration. The extent of capsular penetration and the extent of involvement of the surgical margins is of importance. Only focal penetration or focal involvement of the margin carry a relatively low risk of of progression.(ABSTRACT TRUNCATED AT 400 WORDS)

Biomarkers, Tumor↗
PubMed1977

Local immunity in the pig respiratory tract. II. -- Relationship of serum and local antibodies.

Antibody passage from blood to respiratory secretions was studied on pigs. The animals were passively immunized and have a high anti-hog cholera serum antibody titer. With normal animals as with swine influenza animals, no serum antibody could be recovered neither in buccopharyngeal secretions nor in lung washings: it seems that in such conditions no detectable transudation occurs from blood to local secretions. Following intranasal inoculation of swine influenza virus or intramuscular injection of live attenuated hog cholera virus, local antibodies appear, which are considered to be locally produced.

Animals↗
PubMedDate not supplied

[Generalized and local changes in the choline sensitivity of snail (Helix lucorum taurica Kryn) neurons after the single or tetanic local applications of acetylcholine].

Single or tetanic local applications of acetylcholine to the soma of command Helix lucorum identified neurons LPa3 and RPa3 induce general and local changes in somatic cholinosensitivity. The general decrease in cholinosensitivity depends on a distance of the tested membrane zones to the site of conditioning stimulation and its intensity. The qualitative and quantitative differences in general and local chemosensitivity have been revealed which can determine the selectivity in changes of chemoreceptor membrane reactivity.

Acetylcholine↗
PubMed1992

[Local anesthetics. 99. Synthesis and local anesthetic actions of alkoxyphenylcarbamates].

Within the framework of studying the influence of alterations of the connecting chain in the group of local anaesthetics a series of 24 compounds of 1-propoxymethyl-2-(1-pyrrolidinyl), 2-(1-piperidino)-, and 2-(1-perhydroazepinyl)-ethyl esters of o- and m-alkoxyphenylcarbamic acid were prepared. Studied compounds show a high index of relative local anaesthetic activity as compared to the standards cocaine and procaine, at a relatively low acute toxicity.

Anesthetics, Local↗
PubMed1982

Primary procedure in carcinoma of the tongue: local resection versus combined local resection and radical neck dissection.

Whether to perform local resection alone (LR) or to combine local resection with ipsilateral radical neck dissection (LR and RND) as primary treatment for carcinoma clinically confined to the tongue is controversial. To compare the outcomes of the two procedures, we reviewed the records of 502 patients treated for carcinoma of the tongue from 1949 to 1974, 128 of whom had no evidence of disease beyond the tongue. Immediate LR and RND was performed in 39; 16 (41%) had recurrences, and 14 (36%) died. On the other hand, 89 patients underwent LR alone; 43 (48%) had recurrences, and 29 (31%) died. All were followed for a minimum of 5 years or until their deaths. There was no statistical difference between the two procedures in recurrence or outcome. The two groups were compared with respect to tumor size according to the TNM classification, and no significant differences in recurrence or survival were apparent. LR alone appears to be adequate primary treatment for patients with no evidence of metastatic disease, provided close postoperative follow-up is observed. LR and RND may result in increased morbidity and certainly in disfigurement, and fails to improve prognosis or survival.

Adult↗
PubMed2004

Localization of HB9 homeodomain protein and characterization of its nuclear localization signal during chick embryonic skin development.

We detected HB9 protein during tarsometatarsal scale skin and late feather development. Immunofluorescent analyses with N-terminal 14 amino acids antiserum revealed that HB9 was strongly expressed in epidermal basal cells of the outer scale face in tarsometatarsal scale skin. Specific expression was also detected in dermal cells at the root region of the feather and around the feather follicle. Furthermore, we observed precise distribution of HB9 protein by immunoelectron microscopy. We detected HB9 protein not only in the nucleus, but also in the cytoplasm in tarsometatarsal scale skin. However, in feather skin HB9 protein was found in the nucleus but not in the cytoplasm. Cytoplasmic localization of HB9 protein in tarsometatarsal scale skin was observed especially in the endoplasmic reticulum and the Golgi apparatus. To address the mechanism of nuclear-cytoplasmic translocation, we determined the nuclear localization signal (NLS) sequences by using eukaryotic green fluorescent protein fusion protein in primary keratinocyte culture. Chick HB9 homeoprotein has two types of the NLS sequences in its homeodomain. One of them is a bipartite type as representatively found in Xenopus nucleoplasmin. The other is very similar to hexapeptide NLS sequences identified in pancreatic duodenum homeobox 1 (PDX1). These sequences functioned not only in keratinocytes but also in dermal fibroblasts. They are conserved in Xenopus, mouse, and human HB9 ortholog. These results indicate that HB9 protein might be involved in chick tarsometatarsal scale and feather development and that nuclear import of HB9 protein might be regulated by these NLS sequences in the homeodomain.

Amino Acid Sequence↗
PubMed2005

The role of molecular structure in the crystal polymorphism of local anesthetic drugs: crystal polymorphism of local anesthetic drugs, part X.

PURPOSE: This report is the résumé of a comprehensive investigation on the solid-state properties and the crystal polymorphism of the structurally homogenous class of local anesthetic drugs. The goal is to explore the relationship between crystal polymorphism and molecular structural features. METHODS: A salt form (mostly the hydrochloride) as well as the free base of 24 local anesthetics has been characterized by means of thermomicroscopy, differential scanning calorimetry, pycnometry, Fourier transform infrared, Fourier transform Raman, and solid-state NMR spectroscopies, as well as X-ray diffraction methods (single crystal, powder). RESULTS: Based on the thermochemical data, the relative thermodynamic stabilities of the different crystal forms of each polymorphic system were evaluated and visualized as semiquantitative energy/temperature diagrams. CONCLUSION: This study is the first step in recognizing relationships between the structure and the solid-state properties within this limited group of active substances with common structural elements. The results clearly show that there are certain relationships, but, to understand the phenomenological behavior in more detail on a molecular level, more structural information must be collected and analyzed by computational methods.

Adsorption↗