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PubMedDate not supplied

Legibility of doctor's signatures: novel approaches to improving an age-old problem.

UNLABELLED: In today's medico-legal environment, the importance of identification of the authors of notes in patient medical charts cannot be overemphasized. We evaluated three different techniques of signing patient notes, over a one month period, in order to determine which technique was the most effective in identifying the author of the note. Surgical NCHDs in our hospital were divided into three groups. Group 1 was asked to sign the notes as they normally would. Group 2 was asked to print their name in block capitals after their signature and Group 3 was given pens with a personal self inking stamp to be used in addition to signing the notes. The number of signatures in all the charts, compliance with the assigned technique and the legibility of signatures were calculated. RESULTS: in Group 1, all NCHDs signed their name when writing notes (100% compliance), however the NCHD's signature was identified only 37% of the time. In Groups 2 (who signed in block capitals) and Group 3 (who used the pen with personalised stamp) the author was identifiable 100% of the time when the respective signing method was used. Using the pen with personalised self inking stamp was significantly more popular (77% compliance) compared to signing in block capitals (46% compliance). In conclusion the pen, with personalised self inking stamp, provides a fast and effective means to clarify signatures of NCHD's documentation, which is not only important in a day to day patient management, but is essential from a medico-legal stand point.

Handwriting↗
PubMed2006

[Histologic demonstration of adrenal macrophages as a member of mononuclear phagocytic system in guinea pig models].

Macrophages as mononuclear phagocytes, function in removing foreign substances and in the initiation of the immune response. Although some tissue-specific macrophages such as Kupffer's cells and alveolar macrophages are well-known, any knowledge about the adrenal macrophages are not yet documented in the textbooks. The aim of this study was to demonstrate the resident macrophages in the adrenals of a total 16 (8 pregnant, 8 non-pregnant) guinea pigs. Four of the animals were injected with India ink (no intervention for the other animals), and after sacrificing all animals, removed adrenals were fixed in Bouin's solution, and embedded in paraffin. Sections were stained with haematoxylin-eosin (HE) and periodic acid-Schiff (PAS) methods. Many macrophages with yellowish-brown cytoplasm in HE slides, especially adjacent to sinusoids, were observed primarily in the zona reticularis, suggesting that they are rich in lipofuscin pigment. These cells were also PAS positive. Adrenals of India ink-injected animals demonstrated perisinusoidal macrophages phagocytosing the ink. Much more adrenal macrophages were seen in the pregnant animals in comparison with the non-pregnants. It has been previously reported that the number of human macrophages increases with rising concentrations of estrogen during pregnancy. Thus, higher number of adrenal macrophages in pregnant animals was an expected result. Since they secrete cytokines, macrophages are favorable cells in terms of interactions of the neuro-endocrine organs with the immune system. Some cytokines released by macrophages have been stated to induce adrenocortical steroidogenesis independent from adrenocorticotropic hormone through medullary catecholamines. Thus, macrophages may have a significant role in the immune-adrenocortical communications within the adrenal. Finally, resident macrophages of the adrenals wait to be documented in the textbooks.

Adrenal Glands↗
PubMed1975

Attempts to differential hepatitis B from hepatitis A infection by newly developed serological tests.

An immune Indian ink micro-agglutination method has been evolved for the detection of an antigen present in the blood associated with infectious hepatitis (called IHxAg). In previous studies 86% of serum samples taken from children with hepatitis A proved to be positive by this technique. Present studies were related to 239 adult in-patients with a clinical diagnosis of hepatitis A (123 cases) or hepatitis B (116 cases). Blood samples taken serially during the illness were tested for IHxAg, HBsAg and anti-HBsAg. The results were in accordance with the clinical diagnosis in 60% in contradiction in 30%, whilst all tests brought negative results in 10%. The clinical laboratory findings (SGPT, thymol turbidity) were more in harmony with our laboratory results than with the clinical diagnoses. Rheumatoid factor did not disturb the immune Indian ink reaction, labile serum proteins caused, however, non-specific reaction in 30% of serum samples. When durocytes were used instead of Indian ink the rate of false positive results dropped to 10%. Sera taken in convalescent phase from patients with IHx antigenemia in the acute phase of illness contained an antibody against IHxAg. A crude gammaglobulin preparation from a pool of convalescent sera gave a precipitation line in agarose gel with an antigen present in the fecal extract of children with hepatitis A. This precipitation line proved to contain virus-like particles with an approximate diameter of 25 nm when tested by electronmicroscopy. No precipitation could be seen when sera of the same patients were tested against the same gammaglobulin preparation.

Adult↗
PubMed1990

Treatment of cryptococcal meningitis with five anti-fungal drugs: the role of amphotericin B.

Experiments are described of the treatment of two patients with cryptococcal meningitis using antifungal drugs and amphotericin B. The first patient was a 56-year-old man with a slight azotaemia caused by hypertensive nephrosclerosis. Lumbar puncture revealed a positive India ink stain and a positive culture for Cryptococcus neoformans; serum titre for cryptococcal antigen was elevated. Amphotericin B was not administered because of the patient's slight azotaemia. After admission, the patient received oral and intravenous fluconazole (400 mg per day), for a total dose of 40 g of fluconazole over 103 days from October 1 while simultaneously receiving treatment with oral itraconazole (200 mg per day) from October 1 to December 5. In addition, he was given intravenous miconazole (600-1000 mg per day, total 74.4 g) and intrathecal miconazole (5-20 mg per day, total 375 mg) from December 1 to March 4 1990. Concomitantly, oral flucytosine (6 g per day) was given from December 5 to March 1 1990. Lumbar puncture performed at the completion of these treatments indicated the India ink stain still was positive and the serum titre for cryptococcal antigen high. Finally, amphotericin B alone was administered to the patient intravenously and intrathecally from March 4 to May 1, with an initial dose of 5 mg i.v. gradually increasing by 5 mg increments up to 50 mg per day. The patient's clinical symptoms immediately improved; the India ink stain became negative for the first time after admission and the serum titre for cryptococcal antigen also gradually decreased. On May 1, the patient was completely cured of cryptococcal meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Amphotericin B↗
PubMed1980

Ontogeny of the inflammatory response in the fetal rat.

Fetal rats of 16, 17 and 18 days gestation (dg) were injected with turpentine or Streptococcus faecalis in 1% India ink. Specimens of peritoneal tissues and exudates were collected at 24, 48 and 96 h after injection. Inflammation was present in some of the youngest animals (16 dg) 24 h after injection with bacteria. The response consisted of infiltrates of polymorphonuclear (PMN) and mononuclear (MN) cells in tissues adjacent to the peritoneum. Inflammatory cells were also found within the peritoneal cavity. Phagocytosis of ink particles and bacteria was noted in these cells and in cells of the serosa and adjacent mesenchyme. Free peritoneal cells were not seen in littermate controls. Phagocytosis was also noted in PMNs and MNs in the exudates collected at 48 h. A more marked granulocytic response was seen in animals sacrificed 24 h following bacteria-ink injection at 17 dg. Inflammation was more extensive and consistent by 19 dg. The reaction to turpentine was associated with the variable degree of tissue injury noted in histologic sections. The gestational age at time of injection was a more important determinant of the magnitude and character of response than was the duration of the lesion.

Animals↗
PubMed1981

Genetic analysis of prophage effects on heteroimmune superinfection in Serratia marcescens.

Plaque formation of phage kappa on Serratia marcescens strain HY normally depends on the presence of either a psi or y prophage in the indicator bacteria. Bacterial ink mutants allowing kappa growth in the absence of either prophage were isolated from the doubly cured strain HY (psi, y)--. By means of a kappa mutant, named gdy, an active participation of kappa in antagonizing inhibition of its own growth on HY (psi, y)-- was demonstrated. The gdy mutation is closely linked to gene cIII coding for the kappa repressor. The prophages psi and y enable kappa to grow undisturbed probably by modifying the kappa DNA during replication in such a way that it is not susceptible to the ink+ effect. Whereas kappa grown on HY (psi, y)--ink-- gave only rare productive infections of HY (kappa, y)--, psi and y grown on the same strain were fully infective. The interference exerted by a kappa prophage on vegetative propagation of y is based upon a multi-component mechanism, the interference being removed, or diminished by mutations residing either inside or outside of the kappa prophage. The responsive phage gene iny+ is dominant over its mutant allele iny--; hence it codes for a diffusible product. Both on the vegetative and the prophage genome iny is located near gene lI responsible for lysogenic conversion of bacteria to non-adsorption of kappa. The restriction-modification system of HY is not involved in the growth inhibition of kappa by HY (psi, y)--. Contrary to the other phages used in this work y is refractory to restriction.

Bacteriophages↗
PubMed1980

Lymph drainage of the major joints of the porcine forelimb.

The lymph drainage of the major joints of the porcine forelimb was subjected to a critical examination. Commercial India ink was injected into the left elbow joint and right shoulder joint of an experimental pig. The shoulder joint was approached craniolaterally, the injection site being at the cranial border of the tendon of insertion of the infraspinatus muscle. The elbow joint was approached from the dorsolateral aspect. A suitable site for intra-articular injection into the elbow joint was found to be within an imaginary triangle formed caudal to the lateral epicondyloid crest of the humerus, the ventral border of the lateral head of the M. triceps brachii, and a line just dorsal to the olecranon. The lymph nodes of the neck and shoulder region were carefully exposed and examined for any discoloration due to the ink. The dissection of the lymph vessels and lymph nodes showed that the Lnn, axillares primae costae drained the elbow and shoulder joint after the intra-articular injection of India ink.

Animals↗
PubMed1980

The use of specific thromboxane inhibitors to preserve the dermal microcirculation after burning.

Selective thromboxane inhibitors were evaluated as a pharmacological agent in the prevention of progressive dermal ischemia after burning. Standardized partial-thickness burns were inflicted on guinea pigs. Burned guinea pigs were separated into four groups: one served as a control, one was treated with Imidazole, one with dipyridamole, and the other with methimazole. Histology and depth of dermal perfusion were evaluated by the India ink perfusion technique. Untreated controls showed progressive dermal ischemia with complete absence of India ink-filled vessels in the dermis by 24 hours. Imidazole, dipyridamole, and methimazole improved dermal perfusion as suggested by relative levels of India Ink filling. Preservation of dermal appendages was seen secondarily to improved dermal microcirculation with an eight-fold increase in hair follicles in treated guinea pigs compared with controls. This study suggest that thromboxane plays a role in progressive dermal ischemia. Selective inhibition of thromboxane avoids the side effects associated with complete suppression of the metabolism of arachidonic acid.

Animals↗
PubMed1995

[Experimental study on effects of omental transposition in cats with spinal cord injury].

The effects of autogenous omental transposition on spinal cord injury in cats were examined using a cord crush injury model produced by a modification of Allen's weight-dropping technique. Twenty-three cats were divided into two groups: an omental transposition group, and a control group. The animals were sacrificed at 1, 2, 3, and 4 weeks after injury. The injured cords were examined histologically using India ink perfusion, morphometry of the spinal cord cavities and also by somatosensory evoked potential (SEP) studies. After 1 week, hemorrhagic necrosis, cavitation and demyelination of almost the same extent and severity were noted in both groups. These changes diminished with time in the omental transposition group, but tended to persist in the control group. In the omental transposition group, fibrous coats of Goldsmith were newly formed on the injured cord between the incised dura edges. After 3 weeks, the fibrous coat was thickened with active proliferation of fibroblasts and collagen fibers. India ink particles were noticed within the fine vessels of the omentum, fibrous coat and injured cord at 4 weeks. No India ink particles were found in the control group even after 4 weeks. In the somatosensory evoked potentials, biphasic or triphasic waves noted before injury were absent immediately after trauma. At 3 and 4 weeks, 3 of 5 cats with the omentum showed reappearance of the waves, whereas no wave-reappearance was noted in the controls. These results suggest that autogenous omental transposition helps to accelerate the healing process after crush injury to the spinal cord.

Animals↗
PubMed1994

Variations in strength of the porcine aorta as a function of location.

Dissecting aneurysms split the wall of the aorta and other large arteries to create a false lumen in parallel with the true lumen. Experiments were designed to determine the pressure required to tear the media and the work required per unit area to propagate the dissection once it started. India ink was injected into the media of 17 opened porcine aortas through a needle inserted parallel to the lumen of opened aortas placed in a saline bath. The ink was infused at 0.9 ml/min with a constant infusion pump as the pressure was monitored with a pressure transducer. The size of the bleb formed by the ink in the media was recorded with a video camera mounted perpendicular to the lumenal surface. All data were recorded on a computer. The pressure-volume curve was used to obtain the distensibility of the media (the upslope), the peak pressure, the tearing pressure, and the work of dissection (the area under the P-V curve once tearing occurred). The projected area of the bleb was calculated from the video images, and the work/area was calculated. The peak pressures were always extremely high, and ranged from 634 +/- 204 (SD) mmHg for the lower abdominal aorta to 816 +/- 145 mmHg for the lower thoracic aorta. The work/area ranged from 1.88 +/- 0.89 mJ/cm2 for the upper abdominal aorta to 11.34 +/- 4.05 mJ/cm2 for the lower abdominal aorta. An ANOVA showed that the lower abdominal aorta tore at lower pressures initially, but required much more energy to propagate the dissection. We believe that this is because of structural differences in the elastin pattern in the abdominal aorta.

Animals↗
PubMed1975

Ultrastructure of pulmonary macrophagic system.

A mature AMF, ready for phagocytosis, is a relatively large cell with an oval nucleus, with indentations of a nuclear envelope of varying depth. Evenly distributed chromatin forms beneath the nuclear envelope a rim of heterochromatin. There is a prominent nucleus with a distinct nucleolonemma. The cytoplasm is differentiated into a continuous ectoplasmic zone with numberous finger-like processes and pseudopodia. The organelles are formed by scattered round or oval mitochondria, a description is given of the Golgi apparatus in the juxtanuclear position, in certain sites multifocal in form, of the centriolar apparatus, scarce profiles of endoplasmic granular reticulum, dispersed free polyribosomes and microfilaments in varying amounts. The most outstanding feature is the rich lysosomal apparatus of varying structure depending on the functional state. Dynamics of the maturation of AMF was studied in intermediate phases, described here. The peribronchovascular connective tissue is the seat of free macrophages of a structure analogous with that of AMF. Fixed macrophages are anchored in the loose connective tissue by processes of different shape and length. The prevailing component of the cytoplasm are numerous vesicular structures and vacuoles as well as a marked lysosomal apparatus. Fixed macrophages phagocytize foreign material in situ. The septal cell exists in normal state as an element with numerous intricated processes pervading the fibrillar substrate. Numerous free polyribosomes and vacuoles are its most marked component. Activation of septal cells was demonstrated under experimental conditions. Their transformation into free macrophages is probable. In the pulmonary intersitium, in the perivascular loose connective tissue particularly free cells of a similar structure as blood monocytes were shown in normal state. Under experimental conditions an increased number of monocytes is present in pulmonary capillaries, e.g. 24 hours after an intratracheal instillation of India ink colloid solution. At the same interval a number of free cells of the monocyte structure was found in the perivascular connective tissue and also in the alveolar lumen, with phagocytized carbon. An increased number of monocytes transforming into macrophagic cells was visualized in this localization as late as 14 days after the instillation of India ink colloid solution. The experimental study with an intratracheal instillation of India ink colloid solution in the mouse gave evidence of a high readiness of AMF. The carbon particles were seen phagocytized at an interval of 5 minutes after instillation. In all intervals during which free carbon particles were present in the alveolar epithelium mature AMF were observed with no or very low phagocytic activity, their lysosomal apparatus being prominent. On the contrary, in the phagocytizing AMF, the lysosomal apparatus disappeared in the greatest part of the cytoplasm. The clearance of AMF occurs predominantly by the air route...

Animals↗
PubMed2004

Vascular supplies differ in regenerating and nonregenerating amputated rodent digits.

Bone regenerates following amputation through the level of the nail, but bone is capped following amputation through more proximal levels. Because osteogenesis requires an ample blood supply, we postulated that a restricted vascular supply might be correlated with restricted regenerative ability at proximal levels. More than 40 rats and mice were injected with ink or resin to visualize vascular supplies of intact, regenerating, and nonregenerating rat and mouse digits. Ink-injected specimens were viewed as histological sections or cleared whole mounts. Partially digested resin casts were viewed using scanning electron microscopy. Contrary to our hypothesis, prior to amputation, proximal sites are more vascular than distal sites. At both proximal and distal levels, endosteal and periosteal vascular systems are evident. However, in proximal phalanges, additional subcutaneous and dermal layers encircle the bone. Beneath the distal nail, these layers are absent, and a single layer of vessels provides both periosteal and cutaneous supplies. After amputation at both levels, new vessels sprout profusely in osteogenic areas of both endosteum and periosteum. However, at proximal levels, the additional hypodermal and dermal vessels contribute to a vascular plexus that, paradoxically, may impair bone regrowth by contributing to the formation of dermal scar rather than bone.

Acrylic Resins↗
PubMed2004

Micropatterned agarose gels for stamping arrays of proteins and gradients of proteins.

We describe a method for repetitive and rapid formation of planar microarrays and gradients of proteins using patterned agarose stamps. It demonstrates: (i) micropatterning of agarose gels with feature sizes as small as 2 microm; (ii) inking of posts (diameter 50-1000 microm) on patterned agarose stamps with one or multiple (here, eight) proteins and repetitive stamping of patterns (>100 times in the case of one protein) and arrays (20 times in the case of eight proteins) without the need for intermediate re-inking; (iii) transferring spots of proteins with good homogeneity in surface coverage to glass slides; (iv) applying this technique to surface-based immunoassays; (v) stamping that requires only sub-nanomolar amounts of protein (typically approximately 3 microg in approximately 0.6 microL of solution); (vi) stamping without the need for drying of the proteins, as opposed to stamping with stamps made of poly(dimethylsiloxane); and (vii) patterning gradients of proteins by allowing two proteins to diffuse toward each other in an agarose stamp, followed by printing the protein gradients onto a surface.

Gels↗
PubMed1975

[Experimental study on the lymphatic and cerebrocervical drainage and changes therein caused by ultrasound (author's transl)].

After indian ink or ferritin are introduced into the cerebral hemispheres or subdural space these substances can be found in the deep cervical lymph nodes. The transport of these substances can be enhanced and accelerated by the treatment of deep cervical lymph nodes by ultrasound. Treatment of the paravertebral region with ultrasound after the introduction of ferritin or indian ink subdurally is followed by the appearance of these substances in the suprarenal gland, the testis, epididymis and the prostate gland where they are conveyed by the lymphatic pathways. Thirty minutes after the injection of ferritin into an afferent lymphatic channel of a deep cervical lymphatic node pretreated with ultrasound, ferritin can be found in the pia and arachnoid membranes of the cerebral hemispheres. Ultrasound treatment of the cervical lymph nodes not only seems to enhance the drainage of this substance from the brain but if the dose of ultrasound is high the direction of the lymphatic flow may be reversed.

Animals↗
PubMed1991

Black substrate for spectrophotometric determination of cellulase activity in coloured solutions.

A simple procedure for spectrophotometric determination of cellulase activity in coloured solutions is described. CM-cellulose, cross-linked with epichlorhydrin in the presence of black drawing ink, is used as an insoluble chromolytic substrate. The absorbance of reaction mixture filtrates are read in the near infra-red region (at 800-900 nm) where the absorbances of contaminating coloured substances are substantially lowered; by contrast, black drawing ink released from the substrate during the action of cellulases absorbs strongly at these wavelengths.

Carboxymethylcellulose Sodium↗
PubMed2004

Inflow of ocular surface fluid through clear corneal cataract incisions: a laboratory model.

PURPOSE: To evaluate the self-sealing properties of standard clear corneal cataract incisions during two events: (1) application of mechanical external pressure, or (2) controlled fluctuation of intraocular pressure (IOP). DESIGN: Laboratory investigation. METHODS: Eight fresh human donor globes were prepared for Miyake video microscopy. A standard two-plane 3-mm clear corneal incision was created and a 3 x 3-mm sponge soaked with India ink was placed on the wound surface. One globe with a sutured corneal wound served as the control. A transcleral cannula was inserted and connected to a bottle of saline. Intraocular pressure was modified varying the bottle height. External pressure was applied through manual contact on different regions of cornea. RESULTS: Four of seven eyes demonstrated intraocular presence of ink, three of them after external manipulation and another after varying the IOP. CONCLUSION: Self-sealing properties of unsutured clear corneal wounds were compromised in our model. These data may give insight into the possible mechanisms involved in the inflow of extraocular fluid into the eye through clear corneal cataract incisions.

Body Fluids↗
PubMed2005

Novel use of ultrasound-guided surface marking of head and neck tumors invading facial skin.

Malignant tumors of deep head and neck structures can invade skin, but the tumor periphery is difficult to assess clinically. The surgeon's dilemma is achieving tumor clearance with safe margins while at the same time minimizing skin loss on the face. We show, in 2 cases involving the face, that high-resolution diagnostic ultrasound was superior to CT scan in demonstrating the periphery of the tumor. The tumor was distinguished from surrounding edema by its lower echogenicity and homogeneous echotexture. The maximum contour of the tumor was marked on the skin surface with ink under ultrasound guidance. The ink marking aided excision and reconstruction planning. Subsequent histology showed the surgical margins were clear of tumor. The patients remained tumor-free for more than 3 years. Ultrasound imaging therefore shows good potential for planning surgical resection with a safe margin and for aiding decisions on donor site and type of flap for reconstruction.

Adenocarcinoma↗
PubMed1984

Experimental pancreatitis in the rat. Ductal factors in sodium taurocholate-induced acute pancreatitis.

Spreading of injected material and ductal resistance were studied in the rat pancreas after intraductal injection of Indian ink, human serum or sodium taurocholate. Indian ink filled the main pancreatic duct and small ductules revealing the lobular structure in macroscopic preparation. Escape into the interstitium was observed both in the macroscopic preparations and in histologic sections. Human IgG was demonstrated immunohistochemically in single acinar cells and around acinar cells after intraductal injection of human serum. The changes were most pronounced at 15 min and at 6 h after the injection but were almost resolved at 24 h. The intraductal pressure was registered during sodium taurocholate infusion. The pancreatic duct ruptured at the pressure of 82 mm Hg in average. It was concluded that in the ductal model of experimental acute pancreatitis the infusion causes ruptures in pancreatic ducts and the infusate escapes into the interstitium where it remains for several hours.

Acute Disease↗