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Radioguided parathyroidectomy is equally effective for both adenomatous and hyperplastic glands.

OBJECTIVE: To determine the utility of radioguided parathyroidectomy for patients with hyperparathyroidism, we studied the properties of 180 resected, hyperfunctioning parathyroid glands. SUMMARY AND BACKGROUND DATA: Radioguided resection of hyperfunctioning parathyroid glands has been shown to be technically feasible in patients with parathyroid adenomas. Radioguided excision may obviate the need for intraoperative frozen section because excised parathyroid adenomas uniformly have radionuclide ex vivo counts >20% of background. The feasibility and applicability of radioguided techniques for patients with parathyroid hyperplasia are unclear. METHODS: Between March 2001 and September 2002, 102 patients underwent neck exploration for primary (n = 77) and secondary/tertiary (n = 25) hyperparathyroidism. All patients received an injection of 10 mCi of Tc-99m sestamibi the day of surgery. Using a gamma probe, intraoperative scanning was performed, looking for in vivo radionuclide counts > background to localize abnormal parathyroid glands. After excision, radionuclide counts of each ex vivo parathyroid gland were determined and expressed as a percentage of background counts.RESULTS Although patients with single adenomas had higher mean background radionuclide counts, the average in vivo counts of all enlarged glands were higher than background. Notably, in vivo counts did not differ between adenomatous and hyperplastic glands, suggesting equal sensitivity for intraoperative gamma detection. Ectopically located glands were identified in 22 cases and all were accurately localized using the gamma probe. Postresection, mean ex vivo radionuclide counts were highest in the single parathyroid adenomas and lowest in hyperplastic glands. Importantly, in all hyperplastic glands, the ex vivo counts were >20%. CONCLUSIONS: In patients with hyperparathyroidism, radioguided surgery is a sensitive adjunct for the intraoperative localization of both adenomatous and hyperplastic glands. In this series, all 180 enlarged parathyroids were located with the gamma probe. We have also shown that the ">20% rule" for ex vivo counts not only applies to parathyroid adenomas but also to hyperplastic glands. Therefore, radioguided resection is equally effective and informative for both adenomatous and hyperplastic glands.

Adenoma↗

[Variant component analysis of bacterial count in milk. 2. Consequences for the preparation of microbiological inspection plans].

Results of the repeated testing of pasturized and raw milk to determine the bacterial count deviation in parallel samples were described in the first communication. Using the same data, the second communication demonstrates the influence of the observed bacterial count variation on the decision-making process of the simultaneously performed microbiological sampling plan. Analysis of the 3-class sampling plans under applied conditions showed that little attention was paid to the real variation of the criterion and in some plans, too much weight was placed on the possible outliers. Due to theoretical considerations, the difference between m and M in sampling plans with n = 5 and c(m) = 2 should at least amount to 1.85 times the standard deviation. This premise corresponds to the half of a tenth power in milk with homogenous bacterial population. It seems absolutely unwarranted to interrupt the examination of raw milk when the first random sample with n = 1 is lower than the GMP-limit. Examples show that in borderline cases where the bacterial counts are close to the cut-off value, the application of this strategy leads to the acceptance of numerous rejectable batches. Because of the few coliform counts in fresh, raw milk and especially in pasteurized milk, examination procedures with a detection limit of 1 cfu/ml are not advised and the quality assessment of a lot based on single random samples is not possible.

Animals↗

[The action of aqueous solutions of dicaine and pyromecaine on the epithelium of the oral mucosa].

Buccal mucosa epithelium was studied by the cytological method in 70 patients before and after applications of 3% dicain and 2% pyromecain solutions. A statistically significant increase in the count of dissociated cells with altered nuclei and lysed cells were observed after application of 3% dicain, particularly so in the patients with aggravated case histories (i.e. with a history of multiple surgeries, with concomitant diseases). Applications of 2% pyromecain solution did not result in epitheliocyte changes in the patients with nonaggravated anamnesis; in the patients with aggravated anamnesis the count of cells containing catabolism products increased.

Adolescent↗

A computer program for the analysis of over-dispersed counts and proportions.

Over-dispersed binary and count data occur frequently in many fields of application. Examples include occurrence of cavities in one or more teeth, and development of tumors in one or more animals of a litter. Methods of statistical analyses that ignore correlation between observations underestimate the standard errors. Consequently, coverage proportions of confidence intervals and significance levels of tests are distorted. To implement methods for the analysis of correlated binary or count data requires a level of sophistication for data analysis such that one can specify a model for over-dispersion and the correlation between observations. To analyze the over-dispersed binary or count data, one could postulate a specific statistical model and use maximum likelihood methods for the estimation of parameters. However, it may be preferable to employ an approach that does not rely on modeling because the true model is hard to know with confidence. Rao and Scott (J.N.K. Rao and A.J. Scott, Biometrics 48 (1992) 577-585)y and Scott and Rao (A.J. Scott and J.N.K. Rao, submitted for publication, 1995) proposed simple methods for analyzing correlated binary and count data exhibiting over-dispersion relative to a binomial and homogeneous Poisson model. This paper presents the SAS program to implement their methods to analyze over-dispersed binary and count data. To demonstrate the implementation and the usefulness of their methods, we present an application involving sensitivity of a monoclonal antibody and the number of mammary tumors developing in rats.

Animals↗

Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis.

Peri-implantitis is considered to be a multifactorial process involving bacterial contamination of the implant surface. A previous study demonstrated that a combination of toluidine blue O (100 microgram/ml) and irradiation with a diode soft laser with a wavelength of 905 nm results in an elimination of Porphyromonas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia), and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans) on different implant surfaces (machined, plasma-flame-sprayed, etched, hydroxyapatite-coated). The aim of this study was to examine the laser effect in vivo. In 15 patients with IMZ implants who showed clinical and radiographic signs of peri-implantitis, toluidine blue O was applied to the implant surface for 1 min and the surface was then irradiated with a diode soft laser with a wavelength of 690 nm for 60 s. Bacterial samples were taken before and after application of the dye and after lasing. The cultures were evaluated semiquantitatively for A. actinomycetemcomitans, P. gingivalis, and P. intermedia. It was found that the combined treatment reduced the bacterial counts by 2 log steps on average. The application of TBO and laser resulted in a significant reduction (P<0.0001) of the initial values in all 3 groups of bacteria. Complete elimination of bacteria was not achieved.

Adult↗

[Effect of the isolation medium and isolation conditions on the isolation of the bacterial species spectrum in drinking water].

With the method of colony-count estimation according to German standards (Trinkwasserverordnung, TVO), bacteria of the genera Aeromonas, Shewanella, Pseudomonas etc. and (if present) representatives of the family Enterobacteriaceae can be detected. Longer incubation and application of low nutrient media enhance the colony counts up to 100-fold, and other bacteria can be isolated, in most cases belonging to the genera Pseudomonas, Alcaligenes, Acinetobacter, Flavobacterium etc.. For the detection of hygienically relevant bacteria (e.g. indicator bacteria) the methods of TVO are sufficient and their routine use is recommended. For further microbiological-ecological studies on the habitat drinking water, the nutrient poor biotope has to be considered and the applied media and methods should be adapted to these requirements.

Aeromonas↗

Consequences count: against absolutism at the end of life.

BACKGROUND: There has been a considerable amount of debate in the nursing literature about euthanasia, and especially the distinctions between acts and omissions, and killing and letting die. These distinctions are required by opponents of euthanasia to justify allowing some cases of passive euthanasia while forbidding all cases of active euthanasia. AIM: This paper adds to the debate by arguing that the position that absolutely forbids euthanasia is theoretically inconsistent. METHODS: The paper first considers the place of moral theory in analysing moral problems, within the framework of the principles of biomedical ethics. It is argued that despite a moral pluralism that operates in many areas, the legal status of euthanasia is based upon an absolute deontological position against deliberate killing, which cannot be overridden by appeals to favourable consequences. In order that certain forms of passive euthanasia can be allowed, this position allows distinctions within three pairs of concepts--acts and omissions, killing and letting die, and ordinary and extraordinary means. A further method of justifying certain actions near the end of life is the doctrine of double effect. These paired concepts and the doctrine of double effect are analysed with special reference to their consequences. CONCLUSION: The application of the doctrine of double effect and the three distinctions relies on consideration of their consequences, allowing in practice what in theory is denied. This is important because it weakens the absolute case against euthanasia, which disallows any direct consequentialist appeal. If consequences count in the application of the doctrine and the distinctions, then they should also count directly prior to their application. This strengthens the argument for active euthanasia in certain cases.

Ethical Analysis↗

The measurement of trabecular bone mineral density using coherent and Compton scattered photons in vitro.

A photon scattering method for measuring the trabecular bone mineral density (TBMD) in vitro is described. This method involves the measurement of the ratio of coherent to Compton 90 degrees scattered photons from Am-241 by using a narrow beam geometry with an intrinsic germanium detector. The feasibility of using smaller scattering angles for better counting efficiency and the associated problems in their application for in-vivo measurements were investigated. Calibration of the system with fresh trabecular bone samples showed a linear relationship between the coherent to Compton ratio R of the detected counts and the TBMD (r = 0.94). The effect of the overlying soft tissue on the R ratio was significant while the effect of self-attenuation by the trabecular bone itself and the cortical layer was negligible. It was found that the marrow fat content could alter the value of the R ratio. Our results show that for a 10% increase in the fat content in the interstices of the trabecular bone there is a 2.5% decrease in the R ratio. This technique together with soft tissue corrections will enable us to measure the TBMD of the calcaneum in vivo, assuming a small variation in the trabecular fat content. The estimated absorbed dose to the bone marrow is about 139 mrad.

Americium↗

[Blood picture changes following single and prolonged oral application of ALG in the dog].

Mongrel dogs were orally treated with 20 mg/kg ALG or NHG respectively. A significant decrease of the peripheral lymphocyte count was observed not only during 6 hours after the application of ALG but also during longtime observation. This lymphocytopenia was found to be between 30% and 50%. The effect of ALG after oral administration is smaller than after i. v. application. All other blood cells remained essentially unaffected by ALG as well as NHG. Whereas the efficacy of i. v. applied ALG is reduced by antibody formation, this cannot be expected to the same degree during oral administration, because the antibody formation is markedly reduced by the oral route of application.

Administration, Oral↗

IgE antibody-mediated shock reaction caused by topical application of chlorhexidine.

A case of an anaphylactic shock following topical application of chlorhexidine preparation is reported. Specific skin-sensitizing antibodies against chlorhexidine were demonstrated in the serum from the patient by a passive transfer test. IgE antibodies against chlorhexidine were also detected by radioallergosorbent technique (RAST). Paper discs conjugated with chlorhexidine-HSA (human serum albumin) significantly bound the IgE antibodies. Furthermore, all of the sera from seven other patients with shock reactions following the topical application of chlorhexidine preparation also showed high RAST counts. Both chlorhexidine gluconate and chlorguanide which represents approximately half a molecule of chlorhexidine inhibited the reaction in a dose-dependent fashion. It is suggested that the shock reactions following topical application of chlorhexidine are mediated by IgE antibodies against chlorhexidine and that chlorhexidine and chlorguanide share the same antigenic determinant.

Administration, Topical↗

Immunobiologic staging of patients with carcinoma of the head and neck.

For decades immunologic deficiencies have been documented in patients with carcinoma, and many investigators have attempted to utilize this information in determining prognosis more accurately. Determining prognosis more accurately would be most helpful with Stage III patients, since at present there are no useful guidelines as to which Stage III patients would benefit from aggressive surgery and/or radiation therapy and which would not. Assays of cellular immunity--such as skin testing, determining peripheral T-lymphocyte counts, and assessing lymphocyte reactivity--have achieved extremely limited clinical application. These assays are too expensive and/or too difficult to perform in the routine clinical setting. Total lymphocyte counts, however, are readily available in the clinical setting and can be helpful in determining prognosis. Other readily available clinical information, such as age and pretreatment serum immunoglobulin levels, can also be of value in determining prognosis. In this study, logistic regression was utilized to determine the prognostic implications of stage, age, and pretreatment total lymphocyte counts in 132 patients with carcinoma of the head and neck. Although each variable determined prognosis accurately less than 70% of the time, the stage, age, lymphocyte prognostic index (SALPI) accurately predicted outcome at 3 year follow-up 80% of the time (Pr. less than .0001). Discriminant function analysis was utilized to determine the prognostic implications of pretreatment serum immunoglobulins in 243 patients with head and neck carcinoma. A serum immunoglobulin prognostic index (SIPI) was derived which was based on the observations that elevated levels of immunoglobulin A (IgA) indicated a poor prognosis, while elevated levels of immunoglobulin E (IgE) and immunoglobulin D (IgD) indicated a favorable prognosis (Pr. less than .009). The SIPI was not as accurate as the SALPI in determining prognosis; however, when the indices were used simultaneously, concurring indices predicted the outcome of Stage III patients correctly 86% of the time.

Adult↗

Reactivation and/or growth of fecal coliform bacteria during centrifugal dewatering of anaerobically digested biosolids.

Fecal coliform bacteria are used as indicator organisms for the presence of pathogens. In sludges, it has often been assumed that the counts of fecal coliforms after digestion (where the sludges may also be called biosolids) are representative of the counts when the sludge is disposed or recycled, such as by land application. The possibility has been raised, however, that dewatering processes can lead to increased counts of fecal coliforms and, by inference, human pathogens. This paper presents data from previous studies of this possibility; the results were inconsistent but showed observable increases in fecal coliforms at one treatment plant. Additional studies were then performed at another treatment facility, which showed statistically significant increases in fecal coliform counts after dewatering and two days of aging. The increases exceeded two orders of magnitude and included two centrifuge types and two biosolids types. Artifacts of media type and enumeration method have been excluded, and shearing of the material by commercial blender did not produce the same effects.

Anaerobiosis↗

Change-point analysis of neuron spike train data.

In many medical experiments, data are collected across time, over a number of similar trials, or over a number of experimental units. As is the case of neuron spike train studies, these data may be in the form of counts of events per unit of time. These counts may be correlated within each trial. It is often of interest to know if the introduction of an intervention, such as the application of a stimulus, affects the distribution of the counts over the course of the experiment. In such investigations, each trial generates a sequence of data that may or may not contain a change in distribution at some point in time. Each sequence of integer counts can be viewed as arising from a Poisson process and are therefore independently distributed or as an integer-valued time series that allows for correlations between these counts. The main aim of this paper is to show how the ensemble of sample paths may be used to make inference about the distribution of the instantaneous times of change in a given population. This will be accomplished using a Bayesian hierarchical model for these change-points in time. A bonus of these models is they also allow for inference about the probability of a change in each unit and the magnitude of the effects, if any. The use of such change-point models on integer-valued time series is illustrated on neuron spike train data, although the methods can be applied to other situations where integer-valued processes arise.

Action Potentials↗

Video microscopy as an alternative method for somatic cell count in milk.

This paper presents an alternative method to estimate somatic cell count (SCC) in cows' milk. SCC is an important indicator in the detection of inflammatory reactions within the udder in cows and Direct Optical Microscopy (DOM) is the present reference method for SCC but, owing to its dependence on human operators, it is extremely costly, time-consuming and potentially subjective. The industrial method of choice is Epifluorescence (EF), which has the potential for impressive throughput and acceptable precision, but requires huge inversions and handling of highly toxic reactives and waste. In this paper, an advantageous method that involves application of a low-cost Video Microscopy (VM) system is analysed and discussed, including a comparison between DOM and VM, and an example of application of both methods to evaluate EF counts. We conclude that VM is sufficiently precise and very cheap to implement and operate.

Animals↗

[Modification of radiogenic leukopenia].

In our investigations on rats was proofed the qualification of substances 2-Cyanoethyl Urea (CEH), Thymus-Extract and Lithium-carbonate for a potential reducing or shortening of the leucocyte-depression after whole-body irradiation. Intravenous applications of 2-Cyanoethyl Urea in Wistar rats showed no effect not only in the increase of leucocytes but also in variation in portions of leucocytes. In our investigations we could not influence radiogenic phase of leucopenia by application of CEH after 7 Gy whole-body irradiation. Intramuscular injections of thymus extract don't influence the number of leucocytes in peripheral blood in irradiated Wistar rats. The differential blood-count was uninfluenced. Increase in concentration of thymus extract and also higher frequency of the applications effect no changes in blood-count. Leucocyte depression after whole-body irradiation was independent of the application modus of thymus extract. Lithium-carbonate shows a significant increase of leucocytes in peripheral blood in dependence of dosage and frequency of application. After whole-body irradiation with 7 Gy under lithium therapy it was shown that on day 6th after irradiation leucocyte number was significantly higher than in controls. Radiogenic leucopenia phase was reduced significantly by lithium.

Aerosols↗

Dengue and its vectors in Thailand: calculated transmission risk from total pupal counts of Aedes aegypti and association of wing-length measurements with aspects of the larval habitat.

Working in a village dengue focus in Chachoengsao Province, Thailand, aedine mosquito larvae and pupae were counted in all containers of 10 houses per month. The wings of female Aedes aegypti (L.) emerging from pupae were measured. Number of pupae and size of emerging females increased in containers with qualities that favored availability of larval food sources (e.g., uncovered containers). The small size of most mosquitoes compared with those raised in the laboratory indicated that the larval population as a whole was under nutritional stress. Applying the number of pupae per house and measurement of air and water temperature with an existing model, the risk of dengue transmission was greatest in May and June. The estimated number of female Ae. aegypti per house was well above the threshold for increasing transmission in all months but December through February. A phased approach to sampling immature aedine mosquitoes in Thailand is proposed, which would consist of routine surveillance of larval index and occasional total counts with measurement of wing size. Such a system would combine the benefits of the simple application of larval surveillance with the valuable data gathered from pupal counts and wing measurements.

Aedes↗