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PubMed1987

The response of regenerating peripheral neurites to a grafted optic nerve.

Optic nerves, both viable (fresh or pre-degenerate) or non-viable (frozen-thawed) were grafted between the proximal and distal stumps of freshly transected sciatic nerves, using either 10/0 sutures or strips of nitrocellulose paper. The majority of regenerating peripheral neurites, always in association with Schwann cells, avoided the viable optic nerve grafts, growing along the outside of the grafts in well vascularized minifascicles until they gained the distal stumps. A very small number of axons entered the grafts and grew, for distances typically less than 2 mm, between layers of astrocyte processes. The number of axons entering was not increased by using predegenerate grafts or by blocking Schwann cell proliferation in the proximal stumps by pre-treating the latter with mitomycin C. There was no evidence of a continuous cellular-acellular partition between graft and host during the outgrowth phase of the neurites: it was concluded that axons failed to enter the grafts as a result of inhibitory interactions between Schwann cells and astrocytes. When grafts were rendered acellular, all structured debris, including recognizable components of the extracellular matrix, was rapidly removed and the space thus vacated was invaded by manifascicles of Schwann cells and regenerating neurites. Glial fibrillary acidic protein-positive astrocytes and carbonic anhydrase II-positive oligodendrocytes persisted within viable grafts for 17 months; they did not migrate into the surrounding nerve.

Animals↗
PubMed1988

Reinstatement of synaptic connectivity in the striatum of weaver mutant mice following transplantation of ventral mesencephalic anlagen.

Ventral mesencephalic anlagen survive following grafting to the striatum of weaver mutant mice and reinnervate the dopamine-depleted basal ganglia of the recipients. The aim of the present study was to examine the pattern of connectivity established by graft-deriving dopamine afferents in the host striatum. Grafts were obtained from normal embryos at a gestational age of 14-15 days and implanted into a surgical cavity overlying the dorsal striatum of adult weaver recipients. Tissue was processed for electron microscopic immunocytochemistry using a primary antiserum against tyrosine hydroxylase. At the time of examination, recipient weaver mutants were 8.5 months old and the grafts had survived for 4.5 months. Grafts were found to contain an estimated 100-1000 tyrosine hydroxylase immunoreactive neurons. Tyrosine hydroxylase immunoreactive fibres, displaying characteristic varicosities, innervated the dorsal striatum to a depth of 1000 micron. In the non-grafted striatum, 8% of the contacts of tyrosine hydroxylase immunoreactive nerve terminals were junctional. That proportion contrasted with the corresponding value of normal animals, which is 27%. In the grafted striatum, 29% of the contacts were junctional. That percentage approximated the value found in normal animals. By applying a stereological correction, it can be estimated from those numbers that the true proportion of junctional contacts in the non-grafted striatum of 8.5-month-old mutants may be 26%, whereas that in the grafted side may be 91%, which is close to the normal situation. The majority of contacts in the reinnervated striatum (84%) were made with dendrites and spines. However, the proportion of total axosomatic contacts in the reinnervated striatum was twice as high as that found in the striatum of normal animals, and the proportion of junctional synapses was three times higher than that found normally. We conclude that: (1) in spite of a genetically determined degenerative process, the dorsal neostriatum of weaver mutant mice is receptive to synaptic investment by dopamine afferents originating in normal donor tissue. (2) In repopulating the denervated weaver striatum, graft-deriving dopamine afferents display a connectional selectivity, i.e. they establish synaptic relations preferentially with those cellular domains that are normally innervated by dopamine nerve terminals. In this context, it is possible that dopamine fibres originating in the grafts invest postsynaptic sites that had either been vacated from the intrinsic dopamine input or had never received such an input. (3) The striatal connectivity following transplantation may retain features of immaturity as suggested by t

Animals↗
PubMedDate not supplied

Melanoma and sun exposure: contrasts between intermittent and chronic exposure.

The evidence relating cutaneous malignant melanoma to previous sun exposure is now very strong. Major northern hemisphere studies consistently show increases in melanoma in association with recreational and vacation activities related to intermittent sun exposure. These studies have also recorded amounts of sun exposure from such activities. Several studies suggest an increased risk related to short periods of intensive exposure in early adult life. In contrast, regular outdoor occupation confers a decreased risk in these same studies. Australian studies, in populations with much higher levels of total sun exposure, do not show such a clear distinction between intermittent and chronic exposure. The evidence is consistent with a complex relationship of melanoma risk to sun exposure, the risk being increased by intermittent exposure to levels of sun which are higher than normal for that individual, but no increased risk or even a decreased risk related to long term chronic exposure. Possible biological mechanisms for this complex relationship are discussed. In the Western Canada Melanoma Study the effects of occupational and recreational exposure are different in form and are independent. The increased risks seen with various measures of sun exposure do not appear to be systematically different for individuals who have a good tanning response as compared to individuals who do not.

Environmental Exposure↗
PubMed1981

[Therapy of obese children].

Behavioural group treatment for families with obese children is presented: after analysing their actual living situation (eating-drinking, habits, physical activities, school situation etc.) parents and children work out changes and train these together. Included in this one-year program is a 3-week vacation-camp for the children.

Adolescent↗
PubMedDate not supplied

Cyclospora cayetanensis: first imported infections in Germany.

Over the last decade increasing numbers of enteritis cases have been attributed to infection with a new coccidian species that was named Cyclospora cayetanensis in 1993. Diarrhea caused by this agent is clinically indistinguishable from cryptosporidiosis, isosporiasis and microsporidiosis, but Cyclospora infections are often very prolonged (up to 15 weeks) and may cause severe weight loss. Diagnosis of infection is important because, in contrast to diarrhea caused by Cryptosporidium and microsporidia, treatment with co-trimoxazole is effective. Here we report the cases of two female patients, aged 70 and 58 years old, respectively, who suffered from severe, prolonged diarrhea after a vacation in Singapore, Java and Bali. Routine microbiological laboratory diagnostics were unable to demonstrate the presence of known enteropathogenic bacteria. Modified Ziehl-Neelsen staining of fecal smears revealed oocysts of Cyclospora cayetanensis, and treatment of the patients with co-trimoxazole was promptly effective. We would like to increase awareness of the possibility of Cyclospora infections in patients with prolonged diarrhea who have travelled to endemic areas.

Aged↗
PubMed1996

Reinnervation of frog sympathetic ganglia after selective denervation of B or C neurons.

Selective transection of the B or C preganglionic nerve fibres respectively innervating the B and C sympathetic neurons was carried out on the last two ganglia of the sympathetic chain of the frog Rana esculenta. At different times thereafter, the cross-reinnervation of one type of denervated neuron by nerve endings sprouting within the ganglia from intact fibres innervating the other type was investigated by both the quantitative morphology of the synaptic contacts and related structures and electrophysiological recordings of ganglionic transmission. As there are no fine ultrastructural criteria for distinguishing B from C neurons, the overall density of synapse, simple contact, and 'vacated' postsynaptic differentiation profiles was measured in the two cases of selective section and compared with the values for normal ganglia, therefore permitting the progress of cross-reinnervation with time for each type of neuron to be followed. At ten days after section of the C preganglionic fibres, immunocytochemistry showed that there were no anti-LH-RH-like peptide containing fibres within the ganglia. The B myelinated preganglionic fibres were able to reinnervate the denervated C neurons, with return to normal values of synaptic density and fully efficient transmission at two months in all tested C neurons. However, the latency of orthodromic action potentials was close to that of normally innervated B neurons. In contrast, the C non-myelinated preganglionic fibres reinnervated the denervated B neurons with limited efficiency, the synaptic density being two-thirds the normal value after five months, while subthreshold excitatory postsynaptic potentials or action potentials were only recorded in 44% of the tested B neurons. The latency of these orthodromic responses was close to that of normally innervated C neurons. It is postulated that the poor cross-reinnervation of B neurons could be due to insufficient sprouting of C fibres and/or lack of 'affinity' between C fibres and B neurons. In addition, these experiments demonstrated that the subsynaptic apparatus, fairly characteristic of frog ganglionic synapses, is present in both types of sympathetic neurons, although predominantly in B neurons.

Animals↗
PubMed1986

The effect of propranolol on whole-body microvibrations during examination stress.

Whole-body microvibrations (MV) in three dimensions were measured in 51 volunteers, all medical students, 26 without and 25 with beta-receptor blockade (propranolol), immediately before a practical physiology examination and during the ensuing vacation. Propranolol impeded the increase in MV values in all three axes, significantly those in the z axis (vertical), the differences in MV values between the two measurements being minimal in the beta-receptor blocked group. On the other hand, propranolol enhanced MV in the x axis (anteroposterior) and the y axis (transverse), the y axis difference being significant only in females. Propranolol obviously relieves examination stress: the majority of candidates (52%) felt "quieter" in the examination with than in other similar situations without beta-receptor blockade. Propranolol was, however, without effect on the examination results. The rectified impulse in the z axis when related to body weight (Jz) correlates linearly with the calculated cardiac output. Propranolol, however, reduced cardiac output more than Jz, pointing to a Jz component non-sensitive to beta-receptor blockade. The part played by muscle tonus, mainly reflected in the y axis, thus remains unknown. The large and slow oscillations in the x and y axes, observed particularly in beta-receptor blocked females, might be attributed to diminution in standing ability.

Adult↗
PubMed1999

Administration of docosahexaenoic acid influences behavior and plasma catecholamine levels at times of psychological stress.

The purpose of the present research was to clarify the effect of docosahexaenoic acid (DHA) intake on behavior and plasma catecholamines (CA). In Study 1, 42 students took either DHA-rich oil capsules containing 1.5-1.8 g DHA/d or control oil capsules containing 97% soybean oil plus 3% of another fish oil for 3 mon in a double-blind fashion. They took a psychological test (PF Study) at the start and end of the study. This study started at the end of summer vacation and ended just before the final exams. In the control group, external aggression (aggression against others) in PF Study was significantly increased at the end of the study as compared with that measured at the start (+8.9%), whereas it was not significantly changed in the DHA group (-1.0%). In a similar double-blind study (Study 2), we measured external aggression under nonstressful conditions. External aggression slightly decreased in the control group, whereas there were no significant changes in the DHA group. In Study 3 with 14 students, plasma CA were measured at the start and end of capsule administration period of 2 mon. Subjects were under continuous stress of the final exams that lasted throughout the whole study period. The ratio of plasma epinephrine to norepinephrine concentrations was significantly increased in the DHA group (78%), whereas it stayed at the same level in the control group. In Study 4, mice were fed either DHA-deficient diet or -sufficient diet for 4 wk, and their rearing frequency (an anxiety index) was measured. In the DHA-sufficient group, the rearing frequency was significantly less than in the other group. These effects of DHA intake may be applied to people in an attempt to ameliorate stress-related diseases.

Adult↗
PubMedDate not supplied

General internal medicine practice trends in large multispecialty clinics.

OBJECTIVE: To assess practice trends in the general internal medicine departments of large multispecialty clinics. DESIGN: A survey questionnaire addressing the following issues: 1) department size and rate of growth, 2) services provided, 3) patient population, 4) individual clinical workload, 5) call arrangements, 6) time away from practice, and 7) benefits and salary. PARTICIPANTS: 22 multispecialty clinics, with a mean of 279 physicians. MEASUREMENTS AND RESULTS: Mean general internal medicine department physician expansion was 28% over the preceding three years. Primary care, clinic system access, care of patients laterally shifted from subspecialty internists, and preoperative evaluations were the four major services provided. The mix of fee-for-service, Medicare/Medicaid, and prepaid-plan patients was diverse. Mean outpatient clinical scheduling was 35 hours per week exclusive of hospital practice, administrative time, and paperwork. Study of call arrangements revealed a definite trend toward a group practice model of shared responsibility during the day as well as nights and weekends. Mean meeting and vacation time was 35 days per year. Salary was set by committee, formula, or both. Department stresses and dissatisfactions were also reported. CONCLUSIONS: Rapid expansion of general internal medicine departments and services will continue as subspecialists back away from providing primary care. The evolution of general internal medicine practice must be anticipated and managed for optimal patient and departmental outcomes.

Ambulatory Care Facilities↗
PubMed1988

Computerized Anesthesia Personnel System.

CAPS, (Computerized Anesthesia Personnel System), is a personnel management system for a large anesthesia department. It is written in BASIC for the IBM PC or IBM-compatible computer using 2 or more 5 1/4 inch disk drives or a hard disk. CAPS is designed to facilitate assignment of up to 30 attending anesthesiologists, 40 residents, 15 CRNAs, 5 interns, 5 anesthesia assistants, and up to 15 medical students to the operating room schedule. The system supports part-time personnel, regular laboratory/office/reading days, and resident rotations inside the operating suite, outside the operating suite, and to secondary hospitals. CAPS generates an availability list each day, listing all persons available for the operating room and the rotations and call days assigned. It then lists all persons not available that day and the reason for the absence. CAPS also tracts vacation, meeting, administrative and compensatory time for all members of the department, and maintains an absence record for each person listing sick times and all other absences. CAPS generates a weekly staffing list showing days each person is available to the operating room and the total number of attendings, residents, CRNAs, and assistants available each day. This article discusses why the program was developed, how it was designed, and how well it has met the objectives of the designers.

Anesthesia Department, Hospital↗
PubMed2001

How many people does it take to operate a picture archiving and communication system?

The most frequently asked question without a correct answer is: "Just how many people does it take to operate a picture archiving and communication system (PACS)?" At Texas Children's Hospital, our consensus is that we do not yet know. As soon as we felt we had adequate staffing to provide timely response for routine services, we found that including the Intensive Care Units (ICUs) increased our demand for urgent response beyond our capacity. The addition of inpatient bedside imaging to PACS also increased the demand for round-the-clock and weekend PACS services. Our answer to the staffing question changes every year, in accordance with changes in the scope of services that our PACS is expected to provide. Our administration drew up a 5-year plan for PACS implementation, concentrating on purchase and installation of equipment, but neglected to estimate requirements for full-time equivalents (FTEs) for PACS. Our administration reasonably assumed that existing employees would be galvanized into PACS personnel. It is now clear that new FTEs need to be created strictly for the PACS service. Our 5-year plan also did not anticipate significant changes in the extent of our healthcare enterprise. Our PACS accommodates limited remote service: providing a PACS Analyst to travel to the site when a problem is not resolved remotely is another demand on staffing. Our PACS service was formed using staffing numbers based on assumptions about the minimum number of employees needed to perform routine duties, field trouble calls, conduct training, and work on special projects, such as adding new acquisition modalities or troubleshooting longstanding problems. This staffing was based on a single shift operation, with on-call coverage for second, third, and weekend shifts. The number of employees also considered absences for vacation, sick leave, and training. The service has administrative overhead that should be covered by a secretary. Someone is also needed to supervise the team. Once the number of personnel is determined, detailed definition of qualifications and responsibilities is required. Each job description must accurately reflect what is expected of the employee, but must be constructed in such a way to be graded appropriately by Human Resources, without excluding potentially desirable applicants. In addition to competitive pay, other factors play an important role in recruiting and retention. These include training that the hospital provides, opportunities for advancement, relief from menial duties, adequate working space and facilities, and opportunities for self-development. There is high turnover of personnel in computer services, and we are in a highly competitive market. The correct number of FTEs must consider that we will have to operate the PACS during periods when one or more positions are open or occupied by "greenhorns." In our case, where the vendor provides on-site service engineers, we are able to operate with fewer FTEs. The more distant and tenuous our vendor support, the more we would need to depend on hospital FTEs. While remote vendor maintenance is helpful, it is not useful in reducing the number of FTEs. Instead of adding PACS responsibilities to supervisors of imaging services, we are creating new PACS FTEs outside the PACS service. The idea is to give imaging supervisors the assets they need to perform the additional tasks involving PACS, such as first-line response to trouble, user training, and quality-control oversight. It also frees up PACS service personnel to deal with training and problems with customers outside the Radiology Department.

Humans↗
PubMed2004

[Calculation of the incidence of primary care visits due to acute respiratory infections].

Data collected by the German influenza sentinel of the Working Group on Influenza (AGI) do not allow calculation of the incidence of primary care visits due to acute respiratory infections (ARI). Because patients do not have to register with a particular general practitioner, the population covered by primary care physicians is unknown. Until now the incidence of primary care visits due to ARI is estimated indirectly by extrapolating the sentinel sample of physicians to the total number of primary care physicians caring for the total population. However, distortions of the estimated incidence occur in weeks with public holidays (particularly around Christmas and New Year) and when many physicians close their practice simultaneously because of vacation. We have attempted to quantify the shortage of medical services and established thresholds to correct for situations where service by medical providers is extraordinarily reduced. The suggested method avoids distortions to a large extent and makes interpretation of data during those critical periods possible. A second subject of the paper is the validation of the estimated ARI incidence in primary care practices by comparing the data to other sources such as sick leave statistics of health insurance as well as ICD-based data from a primary care network. We found that the estimated ARI incidence in primary care practices was in line with data from other sources and appears plausible.

Acute Disease↗
PubMed2003

[Sun protection during holidays].

Ultraviolet radiation is causally involved in induction of skin cancer, premature skin aging and photodermatoses. The longing of our western society for a "healthy tanning" as well as the unbroken trend to spend the holidays in sunny regions lead to the fact that human skin is increasingly exposed to ultraviolet radiation and its detrimental effects. Because of the socio-political importance of the vacation period as the "most beautiful and most important time of the year", effective prevention of these unwanted UV effects has an enormous importance to the general population. In this article the most important methods for effective sun protection are critically discussed.

Adult↗
PubMed2004

[Identification of geophilic and zoophilic dermatophytes in siblings with tinea capitis. A pathogenic factor or contamination?].

Two siblings of African origin presented with multiple scaling patches and alopecia on the scalp four weeks after returning from a vacation in Eritrea. Direct KOH examination revealed fungal elements; Trichophyton mentagrophytes and Trichophyton terrestre were identified in the fungal culture. We discuss the putative pathogenic role of both microorganisms in causing disease. Although infection with Microsporum canis currently accounts for almost fifty percent of all cases of tinea capitis in Germany, other fungi have gained importance due to tourism and increasing migration.

Alopecia↗
PubMed2007

[Occupational inhalant allergy to the common housefly (Musca domestica)].

Isolated allergy to the common housefly (Musca domestica) has only been described in four cases. Predisposing factors include high concentrations of allergens and prolonged exposure time. Two pharmaceutical industry workers, 59 and 34 years of age, both without atopy, presented with recent onset of allergic rhinitis. Their symptoms appeared about 30 minutes after exposure to Musca domestica in the closed breeding rooms. They were symptom-free with other insects, on weekends and on vacation. Skin prick tests with common inhalant allergens were negative. Prick testing with crushed Musca domestica adults, hatched eggs, contaminated nets and sand, as well as fly feces were all positive. One patient had specific IGE antibodies against Musca domestica. Both patients lacked specific IgE antibodies against other insect species and common aeroallergens. In these two patients there was a species-specific sensitization without relevant cross reactions to other arthropods. The patients were transferred to new work sites where they had no contact with Musca domestica and became symptom-free. Thus this common insect can be a relevant occupational aeroallergen.

Adult↗
PubMed1995

[Complications of synthetic hair implantation].

Five men (average age 35 years) suffering from the sequelae of hair implants were examined in the course of claims for legal compensation. Polyether amide hair fibres had been implanted, 1000 per patient and session. In all cases the improved implantation technique with a fine needle and subcutaneous knotting had been used in a total of three institutions. Three patients developed bacterial folliculitis after 4-8 weeks; in the other two patients this developed later, after 3-6 months. In two patients the possible triggering event was the wearing of a motorcycle helmet and a vacation in a tropical climate respectively. In another patient the artificial hair curled considerably after he visited a sauna. The implanted hair had fallen out almost completely in all cases (100% in two patients after 9-12 months, 50-75% in three patients after 7 months to 2 years). All patients showed cosmetically disturbing small scars and pigmentary changes. Despite an apparently improved complication rate, the new technique of hair fibre implantation remains a doubtful procedure and cannot be recommended in view of possible permanent sequelae.

Adult↗
PubMed1996

[Diagnosis, clinical aspects and therapy of early chromoblastomycosis in a case example].

Despite the availability of modern antimycotics, which produce high cure rates in early infections, the therapy of advanced chromoblastomycosis is still unsatisfactory. An initial chromoblastomycosis caused by a hitherto unidentified species of the genus Phialophora was diagnosed in a 46-year-old teacher. The organism was isolated twice at an interval of 6 weeks from a partly psoriasiform, partly verrucous lesion on the 4th toe. The infection was apparently acquired 4 years ago during a holiday at Cape Verde. Treatment with itraconazole (Sempera). 200 mg/day, and amphotericin B (Ampho-Moronal) cream for 6 weeks initially resulted in rapid regression. However, 4 weeks after cessation of therapy, the Phialophora species was cultured again from skin scrapings. Complete healing was achieved after re-treatment with itraconazole for 20 weeks at the same dosage in combination with topical amorolfine and local hyperthermia. Until now, no relapse has occurred. The present case demonstrates that this rare disease, which mainly occurs as a traumatic mycosis in the rural population of tropical regions, must be included in the differential diagnosis of psoriasiform or verrucous skin lesions and also included in the list of diseases which may be acquired while on vacation in exotic locations.

Administration, Topical↗
PubMed1996

[Diagnostic radiology in the cost development spectrum in medicine].

Health care costs have risen considerably since 1970 in all industrialized countries. This has several causes: changes in demographic structure, the large number of physicians, increased personnel needs resulting from generous vacation and special leave privileges, wage increases and--last but not least--medical progress. Advances in medical technology are often regarded as one of the main reasons for spiraling costs in health care. Careful analyses reveal, however, that the high costs of imaging services are due to conventional radiography rather than to high-technology (CT, MR) imaging. The legitimate demands for cost reduction have to be met with improved cost efficiency while optimal quality standards must also be maintained. Relevant suggestions, such as generally accepted examination strategies, should be realized with the help of the scientific societies.

Cost Control↗