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PubMed1982

The aminopyrine breath test as a measure of liver function. A quantitative description of its metabolic basis in normal subjects.

The APBT is used widely as a measure of liver function. The development of the APBT into a liver function test of greater diagnostic value requires quantitative information on the processes involved in aminopyrine disposition and metabolism in man and on how APBT values reflect changes in these processes. A dual-isotope kinetic study of aminopyrine disposition and metabolism has been carried out on five normal adult subjects. Oral administration of 13C-aminopyrine (2 mg/kg) accompanied by simultaneous intravenous injection of 14C-aminopyrine was followed by serial measurements of aminopyrine and monomethylaminopyrine in plasma and urine over 6 hr. Timed collections of respiratory CO2 were analyzed for the content of excess 13CO2 and for 14CO2. On separate days, an intravenous bolus of 13C-labeled NaHCO3 was administered to obtain estimates of the kinetic parameters of CO2 elimination in each subject. These data were fitted simultaneously to a multicompartmental model that, in addition to providing hitherto unavailable quantitative information, has revealed that (1) demethylation is the major elimination pathway for aminopyrine; (2) a major alternative pathway not involving demethylation exists for monomethylaminopyrine; and (3) only 50% of the labeled carbon generated by demethylation eventually is oxidized to HCO3-. The sensitivity of seven types of APBT scores to 50% reductions in the rates of aminopyrine absorption, metabolism of monomethylaminoantipyrine, intermediate carbon metabolism, and bicarbonate kinetics was evaluated with breath test curves simulated using the APBT model. Every APBT score currently in use was affected by variations in both gastrointestinal output of aminopyrine and bicarbonate kinetics. There is a need for further development of selective scoring methods in the aminopyrine breath test.

Adult↗
PubMed2003

Biological effects of asbestos: New York Academy of Sciences 1964.

BACKGROUND: In 1964, the New York Academy of Sciences held a conference on asbestos that was to promote the slow decline in the fortunes of asbestos. It brought together a Who's Who of international scientists who had conducted and reported on experimental and human studies of the effects of asbestos. Very little new data were presented at the conference, but by bringing together a compendium of knowledge of the adverse effects of asbestos, it served further notice to asbestos-using industry of the major public health problem that they had created. With the assistance of its employees and certain scientists, industry mounted public relations exercises to counter the adverse publicity of lung cancer and malignant mesothelioma. Attempts were made to minimize the impact of these diseases by suggesting that their alleged associations with asbestos were spurious, and by diversionary ad hominem attacks on Professor Irving J. Selikoff who had played an important role in the organization of the conference. METHODS: Consideration of the contents of the meeting program, other previously published information and documents revealed through legal discovery by Chase Manhattan Bank provide the sources on which this paper is based. CONCLUSIONS: Today, asbestos is no longer seen as a material indispensable on technical grounds and a mainstay of industry and the economy. Its progressive banning in developed countries may be seen as the consequence of the momentum initiated in New York in 1964.

Academies and Institutes↗
PubMed1998

The effect of intraoperative ventilation strategies on perioperative atelectasis.

Several methods of ventilation have previously been shown to reduce intraoperative atelectasis and alveolar to arterial oxygen gradient (A-a DO2) in healthy patients. This study was designed to show firstly the relative intra-operative benefit and secondly if any method had an effect on atelectasis postoperatively. Using a factorial design we randomized 24 patients to each of the four ventilatory interventions (manual inflations, large tidal volumes, PEEP, and pressure control inverse ratio ventilation (IRV)). The A-a DO2 was used as the measure of atelectasis and data collected intra- and postoperatively for 24 hours. The mean pre-induction A-a DO2 was 80 mmHg. This study demonstrated that PEEP and IRV were most effective in reducing intraoperative A-a DO2 (P < 0.05 ANCOVA). Using more than one intervention did not improve the A-a DO2. No method had any effect on postoperative A-a DO2.

Aged↗
PubMedDate not supplied

Octreotide and postoperative enterocutaneous fistulae: a controlled prospective study.

Nineteen patients with postoperative enterocutaneous fistulae were randomised, in a double blind fashion, to receive either 12 days of octreotide (100 micrograms tds) by subcutaneous injection or 12 days of placebo injections. Fistula output for 7 days before and during all 12 days of treatment was recorded for each patient. Fistula losses before entering the trial were similar for both the placebo group (n = 8; range of daily medians: 202 mls to 400 mls) and the group of patients randomised to receive octreotide (n = 11; range of daily medians: 252 mls to 550 mls). There was no significant difference in fistula output between the two groups of patients while receiving either 12 days of placebo injections or 12 days of subcutaneous octreotide therapy. Fistula closure, defined as no fistula output for 2 successive days during the 12 days "therapy" period, was seen in only 1 patient given octreotide and in 3 patients given the placebo. In a double blind prospective study of 19 patients with enterocutaneous fistulae, octreotide therapy was neither associated with a significant reduction in fistula losses nor an increased rate of spontaneous fistula closure.

Adult↗
PubMed2004

Are single fractions of radiotherapy suitable for plantar fasciitis?

The use of radiotherapy for plantar fasciitis has never been reported in Australasia and is scarcely found in the English language medical literature, but it is commonly used in Europe, especially in Germany. In Europe, treatment courses consisting of multiple small fractions have been associated with high levels of pain relief. In the present report, the use of single fractions or radiotherapy was evaluated by reviewing seven consecutive patients referred for treatment and by applying objective and subjective criteria for pain relief. One patient died of unrelated causes soon after treatment and one declined to receive radiotherapy. Four patients each received a single dose of 8 Gy resulting in complete pain relief. One patient was treated with 8 Gy and 12 weeks later was retreated achieving partial pain relief. A follow-up interview was conducted after a mean of 15.6 months, ranging from 1.5 to 30 months. No acute or late effects occurred; however, the possibility that delayed effects may yet occur, particularly carcinogenesis, cannot be excluded. Radiotherapy for this common condition should be investigated further as it might be safer and more effective than other methods currently in use.

Adult↗
PubMed2003

Screening for lung cancer: a systematic review and meta-analysis of controlled trials.

BACKGROUND: Lung cancer is a substantial public health problem in western countries. Previous studies have examined different screening strategies for lung cancer but there have been no published systematic reviews. METHODS: A systematic review of controlled trials was conducted to determine whether screening for lung cancer using regular sputum examinations or chest radiography or computed tomography (CT) reduces lung cancer mortality. The primary outcome was lung cancer mortality; secondary outcomes were lung cancer survival and all cause mortality. RESULTS: One non-randomised controlled trial and six randomised controlled trials with a total of 245 610 subjects were included in the review. In all studies the control group received some type of screening. More frequent screening with chest radiography was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23). A non-statistically significant trend to reduced mortality from lung cancer was observed when screening with chest radiography and sputum cytological examination was compared with chest radiography alone (RR 0.88, 95% CI 0.74 to 1.03). Several of the included studies had potential methodological weaknesses. Controlled studies of spiral CT scanning have not been reported. CONCLUSIONS: The current evidence does not support screening for lung cancer with chest radiography or sputum cytological examination. Frequent chest radiography might be harmful. Further methodologically rigorous trials are required before any new screening methods are introduced into clinical practice.

Controlled Clinical Trials as Topic↗
PubMed2004

Mifepristone does not induce cervical softening in non-pregnant women.

BACKGROUND: Many techniques have been developed to soften the cervix to reduce complications following surgical dilatation. Progesterone inhibits myometrial contractility and its secretion during pregnancy ensures cervical competence. We used the progesterone antagonist mifepristone as a cervical ripening agent and evaluated its effect prior to office hysteroscopy. METHODS: Fifty-eight healthy non-pregnant women aged 18-50 were studied in a randomized double-blind study. They received mifepristone (200 mg) or placebo 30 h prior to hysteroscopy. A Hegar test was performed prior to drug administration and again before hysteroscopy. A visual analogue pain scale was used to assess pain. RESULTS: Medical history, physical examination and blood tests were similar in both groups, except for serum progesterone which was higher in the study group. Hegar measurement prior to drug ingestion was similar in both groups and after a mean time of 30.3 h increased in both groups. Neither the DeltaHegar measurement nor the pain scale was different in the two groups. There was also no effect of the high progesterone levels. CONCLUSIONS: Unlike its dramatic effect in the pregnant uterus, mifepristone administered 30 h prior to hysteroscopy was not effective in ripening the cervix of non-pregnant women.

Adult↗
PubMedDate not supplied

Extending the reach of nutrition education for older adults: feasibility of a Train-the-Trainer approach in congregate nutrition sites.

Low-income older adults are difficult to reach with nutrition education. This study examines the feasibility of a Train-the-Trainer approach using congregate nutrition site (CNS) managers to deliver nutrition education. The study suggests that CNS managers were receptive to the role of trainer, CNS participants were satisfied with this method, and the acceptability of managers as trainers did not vary with participants' levels of risk of malnutrition. Although the sample size (53 participants and 4 managers) and convenience sampling method limit generalizability, the promising results suggest the potential benefits of this method and the need for further study.

Aged↗
PubMed1989

Poland and US collaborative study on cardiovascular epidemiology. I. Introduction and baseline findings.

The Poland-US Agreement for Health Cooperation has as its goal the sharing of scientific information in cardiovascular disease epidemiology between the two countries. Patterns of cardiovascular disease and identification of risk factors were investigated through two large epidemiologic studies, the Pol-Monica Study in Poland and the US Lipid Research Clinics Program Prevalence Study in the United States. These two studies are described with regard to methodological issues, comparability of data collection procedures, and demographic and behavioral characteristics of the two populations involved. Mean blood pressure, lipids, and body mass indices of participants in these studies are also compared.

Adult↗