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At least 847 records · Page 47Linked to original sources
PubMed2003

Central venous line-related thrombosis in children: association with central venous line location and insertion technique.

Venous thromboembolic events (VTEs) in children are associated with central venous lines (CVLs). The study objective was to assess whether CVL location and insertion technique are associated with the incidence of VTE in children. We hypothesized that VTE would be more frequent with (1). CVL location on the left body side, (2). CVL location in the subclavian vein rather than the jugular vein, and (3). CVL insertion by percutaneous technique rather than venous cut-down. This was a prospective, multicenter cohort study in children with acute lymphoblastic leukemia who had a CVL placed in the upper venous system during induction chemotherapy. Characteristics of CVL were documented prospectively. All children had outcome assessment for VTE by objective radiographic tests, including bilateral venography, ultrasound, echocardiography, and cranial magnetic resonance imaging. Among 85 children, 29 (34%) had VTE; 28 VTEs appeared in the upper venous system, and 1 was sinovenous thrombosis. Left-sided CVL (odds ratio [OR], 2.5; 95% confidence interval, 1.0-6.4; P =.048), subclavian CVL (OR, 3.1; 95% CI, 1.2-8.5; P =.025), and percutaneous CVL insertion (OR, 3.5; 95% CI, 1.3-9.2; P =.011) were associated with an increased incidence of VTE. Interaction occurred between CVL vein location and insertion technique. Subclavian vein CVL inserted percutaneously had an increased incidence (54%) of VTE compared with any other combination (P =.07). For CVL in the upper venous system, CVL placement on the right side and in the jugular vein may reduce the risk for CVL-related VTE. If subclavian vein placement is necessary, CVL insertion by venous cut-down appears preferable over percutaneous insertion.

Adolescent↗
PubMed2002

Management of acute hypoxemia during flexible bronchoscopy with insertion of a nasopharyngeal tube in lung transplant recipients.

STUDY OBJECTIVES: To assess the utility of nasopharyngeal tube insertion in the management of hypoxemia during flexible bronchoscopy (FB) in lung transplant recipients, and to determine the incidence and risk factors of upper-airway obstruction (UAO) leading to significant hypoxemia during FB. SETTING: Heart-lung transplant unit of a university hospital. PATIENTS AND METHODS: Ninety-six lung transplant recipients (47 men and 49 women; mean +/- SD age, 41.4 +/- 13.1 years) underwent 714 FB procedures from January 1997 to May 2000. INTERVENTION: A fall in oxygen saturation (< or = 90%) in patients receiving 6 L/min of oxygen via nasal prongs was treated with insertion of a nasopharyngeal tube, continued oxygen supplementation, and withdrawal of the bronchoscope to the trachea. If oxygen desaturation persisted at < 90% despite additional oxygen administration via a 7F catheter placed either just above the larynx or in the proximal trachea, the bronchoscope was withdrawn, reversal of sedation was administered, and bag and mask ventilation was instituted until satisfactory spontaneous ventilation was achieved. RESULTS: Forty-six patients (47.9%) were treated with nasopharyngeal tube insertion on 102 occasions at a mean duration of 168 +/- 178 days after lung transplantation. In 90 of 102 procedures (88.2%), significant hypoxemia due to UAO was successfully treated with nasopharyngeal tube insertion. The mean oxygen saturation after nasopharyngeal tube insertion was 97 +/- 3%. Male gender, increase in body mass index after lung transplantation, and presence of obstructive sleep apnea were significant factors associated with the need for nasopharyngeal tube insertion during FB in lung transplant recipients. CONCLUSIONS: Significant oxygen desaturation during FB in lung transplant recipients is mainly due to UAO. Insertion of a nasopharyngeal tube is a novel and a highly effective approach to the management of acute hypoxemia during FB.

Adult↗
PubMed2004

Modeling amyloid beta-peptide insertion into lipid bilayers.

Inspired by recent suggestions that the Alzheimer's amyloid beta peptide (Abeta) can insert into cell membranes and form harmful ion channels, we model insertion of the 40- and 42-residue forms of the peptide into cell membranes using a Monte Carlo code which is specific at the amino acid level. We examine insertion of the regular Abeta peptide as well as mutants causing familial Alzheimer's disease, and find that all but one of the mutants change the insertion behavior by causing the peptide to spend more simulation steps in only one leaflet of the bilayer. We also find that Abeta42, because of the extra hydrophobic residues relative to Abeta40, is more likely to adopt this conformation than Abeta40 in both wild-type and mutant forms. We argue qualitatively why these effects happen. Here, we present our results and develop the hypothesis that this partial insertion increases the probability of harmful channel formation. This hypothesis can partly explain why these mutations are neurotoxic simply due to peptide insertion behavior. We further apply this model to various artificial Abeta mutants which have been examined experimentally, and offer testable experimental predictions contrasting the roles of aggregation and insertion with regard to toxicity of Abeta mutants. These can be used through further experiments to test our hypothesis.

Algorithms↗
PubMed2000

[Drug package inserts and the adequacy of patient's drug information].

OBJECTIVE: To investigate the adequacy of the content and format of the patient information section in package inserts of commonly prescribed drugs at the internal medicine service of a school hospital. METHODS: Forty eight package inserts were collected from six pharmacies of the city of Porto Alegre in June 1998. The presence of mandatory notification and other information required by Brazilian laws that regulate inserts content was examined. RESULTS: No one package inserts contained all the notification required by law. Warnings about medication storage and expiration date were the most frequently information found in package inserts analyzed. CONCLUSION: Important information for the drug user was not presented in package inserts analyzed, limiting the purpose of inserts as an instrument for patient education.

Drug Labeling↗
PubMed2006

A search for RNA insertions and NS3 gene duplication in the genome of cytopathic isolates of bovine viral diarrhea virus.

Calves born persistently infected with non-cytopathic bovine viral diarrhea virus (ncpBVDV) frequently develop a fatal gastroenteric illness called mucosal disease. Both the original virus (ncpBVDV) and an antigenically identical but cytopathic virus (cpBVDV) can be isolated from animals affected by mucosal disease. Cytopathic BVDVs originate from their ncp counterparts by diverse genetic mechanisms, all leading to the expression of the non-structural polypeptide NS3 as a discrete protein. In contrast, ncpBVDVs express only the large precursor polypeptide, NS2-3, which contains the NS3 sequence within its carboxy-terminal half. We report here the investigation of the mechanism leading to NS3 expression in 41 cpBVDV isolates. An RT-PCR strategy was employed to detect RNA insertions within the NS2-3 gene and/or duplication of the NS3 gene, two common mechanisms of NS3 expression. RT-PCR amplification revealed insertions in the NS2-3 gene of three cp isolates, with the inserts being similar in size to that present in the cpBVDV NADL strain. Sequencing of one such insert revealed a 296-nucleotide sequence with a central core of 270 nucleotides coding for an amino acid sequence highly homologous (98%) to the NADL insert, a sequence corresponding to part of the cellular J-Domain gene. One cpBVDV isolate contained a duplication of the NS3 gene downstream from the original locus. In contrast, no detectable NS2-3 insertions or NS3 gene duplications were observed in the genome of 37 cp isolates. These results demonstrate that processing of NS2-3 without bulk mRNA insertions or NS3 gene duplications seems to be a frequent mechanism leading to NS3 expression and BVDV cytopathology.

Amino Acid Sequence↗
PubMed2006

Gilbert's syndrome: High frequency of the (TA)7 TAA allele in India and its interaction with a novel CAT insertion in promoter of the gene for bilirubin UDP-glucuronosyltransferase 1 gene.

AIM: To identify the variants in UDP-glucuronosyltransferase 1 (UGT1A1) gene in Gilbert's syndrome (GS) and to estimate the association between homozygosity for TA insertion and GS in India, as well as the frequency of TA insertion and its impact among normal controls in India. METHODS: Ninety-five GS cases and 95 normal controls were selected. Liver function and other tests were done. The promoter and all 5 exons of UGT1A1 gene were resequenced. Functional assessment of a novel trinucleotide insertion was done by in silico analysis and by estimating UGT1A1 promoter activity carried out by luciferase reporter assay of appropriate constructs in Hep G2 cell line. RESULTS: Among the GS patients, 80% were homozygous for the TA insertion, which was several-fold higher than reports from other ethnic groups. The mean UCB level was elevated among individuals with only one copy of this insertion, which was not significantly different from those with two copies. Many new DNA variants in UGT1A1 gene were discovered, including a trinucleotide (CAT) insertion in the promoter found in a subset (10%) of GS patients, but not among normal controls. In-silico analysis showed marked changes in the DNA-folding of the promoter and functional analysis showed a 20-fold reduction in transcription efficiency of UGT1A1 gene resulting from this insertion, thereby significantly elevating the UCB level. CONCLUSION: The genetic epidemiology of GS is variable across ethnic groups and the epistatic interactions among UGT1A1 promoter variants modulate bilirubin glucuronidation.

Adult↗
PubMed2003

Temporary partially-covered metal stent insertion in benign esophageal stricture.

AIM: To study the therapeutic efficacy of temporary partially-covered metal stent insertion on benign esophageal stricture. METHODS: Temporary partially-covered metal stent was inserted in 83 patients with benign esophageal stricture. All the patients had various dysphagia scores. RESULTS: Insertion of 85 temporary partially-covered metal stents was performed successfully in 83 patients with benign esophageal stricture and dysphagia was effectively remitted in all the 83 cases. The dysphagia score was 3.20+/-0.63 (mean+/-SD) and 0.68+/-0.31 before and after stent insertion, and 0.86+/-0.48 after stent removal. The mean diameter of the strictured esophageal lumen was 3.37+/-1.23 mm and 25.77+/-3.89 mm before and after stent insertion, and 16.15+/-2.96 mm after stent removal. Follow-up time was from 1 week to 96 months (mean 54.26+/-12.75 months). The complications were chest pain (n=37) after stent insertion, and bleeding (n=12) and reflux (n=13) after stent removal. CONCLUSION: Temporary partially-covered metal stent insertion is one of the best methods for treatment of benign esophageal stricture.

Adolescent↗
PubMed2006

Analysis of German package inserts.

OBJECTIVE: Package inserts have an important impact on patients compliance and thus on the effectiveness of drug use. Despite efforts of the European or national regulatory authorities and manufacturers to improve the readability and comprehensiveness of package inserts, they are still the subject of critical discussion. MATERIAL AND METHODS: 68 German package inserts were chosen for a detailed analysis of their quality and suitability based on a set of 104 quality criteria developed prior to the survey. RESULTS: In many cases package inserts available on the German drug market did not include important information or were difficult to read or understand. In 73.5% of cases, the daily maximum dose was missing and 63.2% gave no information on the measures to take for each of the interactions. 66.2% of package inserts provided no instructions about the correct storage and 58.8% gave no instructions on the appropriate storage temperature. In 13 cases, dosage instructions were provided only in milligrams of active substance instead of a number of tablets or volume of liquid. 98.5% of the 68 package inserts included non-quantifiable statements such as "high dosage" or "take 2 - 4 tablets, 1 - 3 times daily". 97.1% contained repetitious information, 83.8% included advertising elements and 8.8% contained contradictory information. CONCLUSION: Package inserts must be optimized and tested by selected groups of patients prior to approval of the drug. This will avoid misunderstandings and lack of information and ensure that use of the drug will give the best possible outcome and avoid safety risks.

Comprehension↗
PubMed1999

A remote controlled intraurethral insert for artificial voiding: a new concept for treating women with voiding dysfunction.

PURPOSE: Many patients with voiding dysfunction find clean intermittent catheterization unsatisfactory. We evaluated the efficacy of the new remote controlled intraurethral In-Flow Catheter insert for treating women with voiding dysfunction. MATERIALS AND METHODS: We evaluated the efficacy of the intraurethral insert in 92 women with a mean age of 56 years. The insert is available in various sizes to adapt to individual urethras. It comprises a valve and pump assembly. A remote control unit is operated to open the valve and activate the pump, generating active urine flow. RESULTS: In 45 patients (49%) the device was removed after a mean of 7.1 days due to local discomfort or urinary leakage around the insert. At a mean followup of 7.6 months (range 2 to 26) 47 women (51%) continued to use the device, and all are dry with complete bladder emptying. The insert was replaced periodically at a mean of 38 days to prevent salt deposits in and around it which lead to urine leakage. Asymptomatic bacteriuria developed in 22 patients (46.8%). Clinical urinary tract infections resolved in 3.9% of all patients-months with oral antibiotics. No dyspareunia was reported. All patients were satisfied with the insert and preferred it to previous treatment modalities. CONCLUSIONS: This new remote controlled intraurethral insert is safe and effective in women with voiding difficulties.

Female↗
PubMed1999

Clamping ischemia, threshold ischemia and delayed insertion of the shunt during carotid endarterectomy with patch.

BACKGROUND: Shunt insertion during carotid endarterectomy (CEA) is mandatory to avoid neurological damage due to clamping ischemia; however shunt insertion before plaque removal has many inconveniences (atheroembolism, intimal dissection, difficulty of endarterectomy). The aim of this study is to verify whether and how long shunt insertion may be safely delayed to permit plaque removal and ensure cerebral perfusion during the further time consuming manoeuvres of CEA (peeling, patch angioplasty). METHODS: From July 1990 to February 1996 383 patients underwent 411 CEAs under general anesthesia with EEG continuous monitoring and PTFE patch angioplasty. A Pruitt-Inahara shunt was routinely inserted only after atherosclerotic plaque removal. In 316 CEAs (76.9%) without EEG signs of cerebral ischemia (Group A) the mean clamping time was 10 min +/-4.8 (range 2-37 min). In 95 CEAs (23.1%) with EEG signs of cerebral ischemia (Group B) it was 7.3 min +/-3.5 (range 3-20 min). All patients had normal EEG signals after delayed shunt insertion and reperfusion (mean 21 min, range 5-45 min). RESULTS: In the short term results (within 30 days) there was a relevant neurological complication rate of 0.96% (2 major stroke and 2 lethal stroke); at awakening we observed 5 RINDs (1.21% of total) 1 in a patient of Group A (0.31%) and the other 4 in patients of Group B (4.21%). CONCLUSIONS: These data confirm the rationale of a delayed insertion of the shunt: actually the cerebral parenchyma may tolerate under general anesthesia a sufferance due to carotid clamping, EEG detectable, without neurological deficits for at least 7.3 min. This time is sufficient to perform the most difficult steps of CEA (plaque removal, distal intima checking) allowing shunt insertion in a clean operatory field, without inconveniences. Finally the shunt allows complementary time consuming steps, as patch angioplasty, with improvement of both short- and long-term results.

Aged↗
PubMed1999

Cervical ripening and labor induction with a controlled-release dinoprostone vaginal insert: a meta-analysis.

OBJECTIVE: To systematically review published randomized trials that compared efficacy of a 10-mg, controlled-release dinoprostone vaginal insert with other prostaglandins for cervical ripening and labor induction. DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify randomized clinical trials of dinoprostone vaginal inserts for cervical ripening and labor induction. METHODS OF STUDY SELECTION: We evaluated, abstracted data, and assessed the quality of randomized clinical trials on the efficacy of dinoprostone vaginal inserts as cervical ripening and labor induction agents. Only published randomized trials were included in this meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Seventeen studies were identified, eight of which met our criteria for metaanalysis. Those eight trials included 964 subjects, 490 of whom were allocated to dinoprostone vaginal inserts and 474 to other prostaglandin (PG) preparations. We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of within-study difference in means. Compared with women who received other PG preparations, those who received dinoprostone vaginal inserts had lower incidence of vaginal delivery within 12 hours of PG application (OR 0.55, 95% confidence interval 0.39, 0.79). Vaginal inserts were associated with longer intervals to vaginal delivery and lower rates of active labor. There were no differences in cesarean delivery rates, incidence of hyperstimulation, or need for oxytocin augmentation between dinoprostone and other PGs. CONCLUSION: Dinoprostone vaginal insert was less effective than other prostaglandins for cervical ripening and labor induction.

Administration, Intravaginal↗
PubMed1999

Phylogenetic signals from point mutations and polymorphic Alu insertions.

Allelic frequency data derived from five polymorphic Alu insertion loci and five point mutation polymorphic loci were compared to determine their ability to infer phylogenetic relationships among human populations. While point mutation polymorphisms inferred a monophyletic Caucasian clade that is corroborated by other studies, these data failed to support the generally accepted monophyly of Orientals with native Americans. In addition, there is less statistical bootstrap support for the maximum-likelihood tree derived from the point mutation polymorphisms as compared to those generated from either the Alu insertion data or the combined Alu insertion + point mutation data. The Alu data and the combined Alu insertion + point mutation data inferred a monophyletic relationship among the Oriental and native American populations. The Alu insertion data and the combined Alu insertion + point mutation data also displayed two separate, well defined, tight clusters of the Caucasian and the Oriental + native American populations which was not inferred from the point mutation data. These findings indicate greater phylogenetic information contained in Alu insertion frequencies than in allelic frequencies derived from point-mutations.

Alleles↗
PubMed2000

[A modified technique for insertion of the laryngeal mask airway in children].

We modified the technique for laryngeal mask airway (LMA) insertion in children. This modification involves inserting a two-thirds inflated LMA with its lumen facing laterally toward left and then rotating it 90 degrees clockwise as it passes downwards into position behind the larynx. Then the cuff is inflated fully. We conducted a survey on the use of LMA in ten consecutive children for minor superficial surgery. After slow induction, anesthesia was maintained with 3.0% of end-tidal sevoflurane concentration in 100% oxygen for 5 minutes before insertion of LMA. No muscle relaxant was used. Successful insertion was judged by the clinical integrity of the airway. The standard LMA insertion technique or another airway device was applied when three trials had failed. Traumatic insertion was observed by the attachment of blood clots to the surface of the removed LMA. A satisfactory airway was achieved in all of the children who participated in the survey. There were no significant differences in vital signs between pre- and post-insertion. Only one child was found to have attachment of blood clots on the surface of the removed LMA. We conclude that our technique would be one recommended method in pediatric practice.

Anesthesia, Inhalation↗
PubMed2000

Insertion and removal of Implanon: practical considerations.

Implanon, a novel contraceptive implant containing the progestogen, etonogestrel (68 mg), provides highly effective, well-tolerated contraception for up to 3 years. Its single-rod design, semi-rigid polymer base and convenient pre-loaded presentation mean that Implanon has potential insertion and removal advantages over the six-capsule Norplant implant. Insertion of Implanon is simple: the applicator needle is positioned subdermally and the cannula is withdrawn, leaving the implant rod in place. Implanon is removed using the 'pop out' technique, involving a 2-mm incision. A meta-analysis of data from seven open-label, randomized studies in 1,378 women compared the ease of insertion and removal of the Implanon and Norplant implants and the frequency of associated complications. It was approximately four times quicker to insert and remove Implanon than Norplant (mean insertion times 1.1 vs. 4.3 min, respectively; mean removal times 2.6 vs.10.2 min, respectively). Insertion complications were very rare with both Implanon (0.3%) and Norplant (0.0%). However, Implanon was associated with a significantly lower frequency of removal complications (0.2 vs. 4.8% with Norplant; p < 0.001). Implant site abnormalities were uncommon. The simplicity of the insertion and removal procedures with Implanon may have significant implications for contraceptive implant training programs and user counselling.

Contraceptive Agents, Female↗
PubMed2001

Role of chest radiography after the insertion of a subclavian vein catheter for ambulatory chemotherapy.

OBJECTIVE: To determine the need for routine chest radiography after the insertion of a catheter via the subclavian vein for ambulatory chemotherapy. METHODS: The case notes of all patients who had undergone catheter insertion between 1994 and 1998 were reviewed retrospectively. RESULTS: Of 3844 cases, there were 52 (1.4%) complications detected on chest radiographs after catheter insertion, 46 of which were pneumothoraces; 15 of the 46 patients had a clinical risk factor at insertion (technical difficulty or symptoms), and 14 had a risk factor after insertion (respiratory symptoms and signs). For 22 (47.8%) pneumothoraces, there was no clinical risk factor identified; 3 of these patients required intercostal drain insertion. Other complications (n = 6) included catheter malposition and kinking, and chest radiography made an important contribution to management in at least 1 of these cases. CONCLUSION: In approximately 0.1% of cases of catheter insertion in the subclavian vein, chest radiography detected a clinically occult complication significant enough to require intervention.

Adult↗
PubMed2002

A randomized trial of vaginal prostaglandin E2 for induction of labor. Insert vs. tablet.

OBJECTIVE: To compare the efficacy and safety of a prostaglandin E2 (PGE2) vaginal insert with PGE2 administered as a vaginal tablet. STUDY DESIGN: A randomized, observational study was performed. Women requiring induction of labor were randomly assigned to receive either a 10-mg PGE2 vaginal insert (group 1, n = 100) or 3-mg PGE2 tablets twice at six-hour intervals (group 2, n = 100). The primary efficacy outcome variable was vaginal delivery within 24 hours of insertion. The criteria for safety were the occurrence of uterine hyperstimulation, abnormal fetal heart rate patterns, use of beta 2-sympathomimetic drugs and fetal outcome. RESULTS: No differences in terms of vaginal delivery or cesarean section within 24 hours of induction were found. The cesarean section rate was 21% in group 1 and 22% in group 2. The interval from insertion of the induction agent to the onset of regular uterine contractions and the insertion-to-delivery interval were not different between the two cohorts. No difference in the frequency of uterine hyperstimulation, use of beta 2-sympathomimetic drugs, abnormal fetal heart rate patterns, fetal outcome, or oxytocin and analgesic requirements were found. In seven of eight patients in group 1 who experienced uterine hyperstimulation, removal of the insert was sufficient to stop it, whereas in group 2, of nine cases, eight needed medical interventions to end hyperstimulation (P = .003). CONCLUSION: The continuous release of PGE2 from the vaginal insert permits controlled induction of labor, and easy removal of the drug in cases of uterine hyperstimulation is possible.

Adult↗
PubMed2002

The efficacy of immediate post-abortion intrauterine device insertion.

Ovulation returns soon after abortion, with half of the women ovulating by 21 days after the procedure. Immediate post-abortion insertion provides immediate contraceptive protection. Clinicians have feared that rates of uterine perforation due to intrauterine devices (IUDs) and expulsion of IUDs may be higher in the post-abortal uterus due to its softness and enlargement. This study was carried out to assess the safety and efficacy of IUD insertion immediately after induced abortion compared with insertion during the first menstrual cycle after abortion. All women were counseled about a method of contraception, particularly copper T-380A, and divided into two groups: Group 1 included 226 women who preferred immediate IUD insertion, and Group 2 included 100 women who opted for interval-IUD insertion during the first menstrual cycle after abortion. All women were followed-up at two and eight weeks after insertion of the IUDs. Severe bleeding was observed 10.62% in Group 1 and 6% in Group 2. Expulsion rate was 7.08% and 8% in Groups 1 and 2, respectively, which was not statistically significant. Pelvic inflammatory disease (PID) was observed in one case in Group 1. However uterine perforation was not noted in either group. In conclusion, insertion of an IUD immediately after an induced abortion is safe and if a woman asks for a modern contraceptive method it could be offered.

Abortion, Induced↗
PubMed1992

The insertion of monoamine oxidase A into the outer membrane of rat liver mitochondria.

Human monoamine oxidase A that had been synthesized in a reticulocyte lysate translation system was capable of binding to and inserting into either rat liver mitochondria or isolated mitochondrial outer membranes. The inserted form was as resistant to proteinase K as endogenous mitochondrial monoamine oxidase A. The insertion, but not the binding, of monoamine oxidase A was prevented by depleting the reaction mixture of either ATP (with apyrase) or ubiquitin (with purified antibodies against this polypeptide). Addition of ATP or ubiquitin, respectively, to these depleted mixtures restored the insertion of the enzyme. In the absence of mitochondria, in vitro synthesized monoamine oxidase A did not catalyze its own alkylation by the mechanism-based inhibitor, [3H]clorgyline. However, both monoamine oxidase A that had been membrane-inserted in vitro and monoamine oxidase A that had been bound to the mitochondria under conditions of ATP depletion catalyzed adduct formation. Furthermore, reaction of either clorgyline or another mechanism-based inhibitor, pargyline, with the membrane-bound enzyme during ATP depletion inhibited the insertion of monoamine oxidase A when ATP was restored. These observations indicate that monoamine oxidase A acquired a catalytically active conformation on interaction with the mitochondrial outer membranes prior to its ATP and ubiquitin-dependent insertion into the membrane.

Adenosine Triphosphate↗