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PubMed1982

Parietal cell vagotomy in a surgical training program.

Parietal cell vagotomy was performed in 48 patients at the Parkland Memorial Hospital and the Dallas Veterans Administration Hospital between April 1977 and January 1981. The maximum follow-up time was 50 months and the average was 28 months. Seventy-five percent of the patients were followed for more than 1 year. There were no operative deaths. Four patients (8.3 percent) had persistent postoperative side effects including two documented ulcer recurrences (4.2 percent). Acid secretion studies were reviewed to characterize the longterm effect of parietal cell vagotomy. These studies demonstrated marked postoperative reductions in gastric acid secretion. The results of this study suggest that with the simplified technique described in this paper, parietal cell vagotomy can be performed with minimal mortality and morbidity by surgical residents under direct staff supervision.

Adolescent↗
PubMed2006

Long-term hemodynamic benefit of biventricular pacing depending on coronary sinus lead position.

BACKGROUND: Acute studies in cardiac resynchronization therapy (CRT) showed that hemodynamic effects may depend on the coronary sinus (CS) lead position. However, there are no data on the longterm effect of CS lead position. METHODS: In 45 heart failure patients with left bundle branch block and QRS >150 ms (age 59+/-10 years, 17 dilative cardiomyopathy, 23 ischemic, 5 valvular), biventricular pacemakers were implanted. CS leads were positioned in posterior (P, n=15), lateral (L, n=19) or, if no other option available, anterior (A, n=11) side branches. Before and 6 months after implantation, clinical state, echocardiography, brain natriuretic peptide (BNP) and right heart catheterization were evaluated. RESULTS: Baseline parameters were similar between groups. After 6 months, there were 32/34 responders in groups P and L compared to 7/11 responders in group A (94 vs groups P and L: Arterial pressure +8 and +9% vs +2%; PCWP -23 and -15% vs -4%, pulmonary pressure -18 and -12% vs -3% (p<0.01 for A vs P+L); cardiac index +21 and +12% vs +11% (p=0.03 for A vs P). BNP was reduced by 55, 35, and 27% (p=0.05 for A vs P). Ejection fraction increased in P and L by 40 and 41%, respectively, but only by +19% in A (p<0.03 for A vs P+L). CONCLUSION: Chronic CRT improves ejection fraction, BNP and hemodynamic measurements predominantly in patients with lateral and posterior CS lead positions. Anterior lead positions should be avoided.

Aged↗
PubMed1978

Effects of essential amino acid deficiencies on syngeneic tumor immunity and carcinogenesis in mice.

The present study was designed to evaluate in a syngeneic system the longterm effect of dietary reduction of each of three essential amino acids on carcinogenesis with methylcholanthrene (MCA) and immunity to a transplanted MCA tumor. Inbred mice were provided a standard amino acid diet or a diet deficient in isoleucine, leucine, or phenylalanine-tyrosine. In the carcinogenesis experiment, MCA pellets were implanted in each mouse and weekly records were maintained of body weight, tumor incidence, tumor size, and death rate. Mice in the immunity study were inoculated with syngeneic tumor cells; tumors were excised when the largest tumor in the control group reached 12 mm and each animal then received a second challenge of tumor cells. The available data suggest that (1) restriction of the selected amino acids does not inhibit chemical carcinogenesis with MCA, (2) phenylalanine-tyrosine deficiency may actually enhance chemical carcinogenesis with MCA, and (3) selected essential amino acid deficiencies do not enhance immunity to a transplanted MCA tumor.

Amino Acids, Essential↗
PubMed1994

Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands.

OBJECTIVE: Yoga and relaxation techniques have traditionally been used by nonmedical practitioners to help alleviate musculoskeletal symptoms. The objective of this study was to collect controlled observations of the effect of yoga on the hands of patients with osteoarthritis (OA). METHODS: Patients with OA of the hands were randomly assigned to receive either the yoga program or no therapy. Yoga techniques were supervised by one instructor once/week for 8 weeks. Variables assessed were pain, strength, motion, joint circumference, tenderness, and hand function using the Stanford Hand Assessment questionnaire. RESULTS: The yoga treated group improved significantly more than the control group in pain during activity, tenderness and finger range of motion. Other trends also favored the yoga program. CONCLUSION: This yoga derived program was effective in providing relief in hand OA. Further studies are needed to compare this with other treatments and to examine longterm effects.

Aged↗
PubMed2006

Quality initiative in rectal cancer strategy: a qualitative study of participating surgeons.

BACKGROUND: The Quality Initiative in Rectal Cancer (QIRC) Strategy randomized 16 hospitals across Ontario to the QIRC strategy versus minimal intervention. The strategy included a workshop, recruitment of a local opinion leader (OL), operative demonstrations, postoperative checklists, audit, and feedback. Surgeons at each intervention hospital used a standardized approach to select a local OL from their ranks. We assessed the experiences of OL and non-OL surgeons in the QIRC strategy. STUDY DESIGN: Semi-structured qualitative telephone interviews were completed with 8 OLs and 8 non-OL surgeons. Interviews were guided by Grounded Theory. Initial interviews were assessed to ensure that domains of interest were fully explored. Two investigators (FW, MF) independently reviewed all final transcripts and identified themes. Consensus among all investigators was achieved for final themes. RESULTS: All approached surgeons participated in interviews. Seven themes were identified: surgical OLs with subspecialist expertise were supported; surgical OL requires technical expertise; limited role for local OL on changing physician practice in rectal cancer operations; limited effect of identifying local OL on local interactions; operative demonstrations supported; characteristics of operative demonstrator were important; and perceived positive effect of the QIRC strategy on practice. CONCLUSIONS: The experience of local OLs in this trial appears to be mixed. Although some of the themes support the concept of a local OL, other themes suggest the local OL had a limited role and effect. The overall QIRC strategy, and in particular the operative demonstration, was viewed positively and was perceived to have a positive longterm effect on participants' practice.

Attitude of Health Personnel↗
PubMed1992

Blood rheology in arterial hypertension.

DETERMINANTS OF BLOOD RHEOLOGY: Blood flow depends on driving pressure and a resistance factor, the latter being related to geometrical hindrance and to the intrinsic viscosity of the blood. Since whole blood is non-Newtonian in nature, blood viscosity is strongly dependent on shear conditions. Low-shear areas occur in cardiovascular disease, and therefore the interaction between blood viscosity and flow conditions may affect vascular disorders. Increased shear stress secondary to increased viscosity may produce endothelial activation and release of endothelium-derived relaxing factors, leading to flow-dependent vasodilation. All the determinants of blood rheology, including plasma protein and erythrocyte factors may be altered in patients with arterial hypertension. BLOOD RHEOLOGY IN HYPERTENSION: A hyperviscosity state is created which is associated with an unfavourable prognosis, since it is correlated with blood pressure levels and the severity and complications of the disease including left ventricular hypertrophy. The mechanisms of haemorheological abnormalities in hypertension are still unclear. It is not known whether blood rheology is an independent variable in patients with hypertension or whether it is a covariable with other established indices of heterogeneity. However, many aetiopathological changes identified in hypertensive disease may contribute to the observed changes in blood rheology. Haemorheological changes in hypertension, through complex interactions with platelet activation and endothelial function, may contribute to the development of thrombosis and atherosclerosis. Moreover, in acute and chronic ischaemia and other conditions where compensatory mechanisms such as collateral formation and vasodilation are limited, rheological factors may become important determinants of blood flow and tissue oxygenation. TREATMENT EFFECTS: Many antihypertensive agents have direct or indirect potential effects on haemorheological variables. However, to date, most studies that have investigated the effects of therapy on rheological variables have not been performed in clinically relevant situations. Controlled studies that monitor both the acute and longterm effects of antihypertensive drugs on relevant haemorheological variables are required to show whether specific therapeutic approaches can correct abnormalities in blood rheology.

Antihypertensive Agents↗
PubMed1999

Anterior lesser curve seromyotomy using a stapling device and posterior truncal vagotomy for the treatment of chronic duodenal ulcer: longterm results.

BACKGROUND: Recently, gastric stapling with posterior truncal vagotomy has been performed, either by conventional or laparoscopic surgery, as an alternative to highly selective vagotomy and the Taylor procedure for the treatment of chronic duodenal ulcer. Our aim was to investigate the longterm effects after a stapling-modified Taylor procedure, conventional and laparoscopic, on gastric secretion and emptying and on clinical indices and recurrence rates in patients treated for duodenal ulcer before 1994. STUDY DESIGN: Thirty-one patients, aged 40 to 76 years (mean 53 years), were treated between 1986 and 1993, 21 by conventional and 10 by a laparoscopic stapling-modified Taylor procedure. Outcomes were studied for gastric acid secretion, solid and liquid gastric emptying, euterogastric reflux, endoscopic findings, and clinical indices using the Visick grading. RESULTS: Endoscopy revealed a healing ulcer in 29 patients. Two patients showed signs of chronic ulcerative disease with mild symptoms, without gastritis or pyloric stenosis indicative of progressive ulcerative diathesis, and were classified as Visick III. Twenty-four patients were classified as Visick I and 5 as Visick II. The enterogastric reflux index ranged from 0% to 27%, and basal and peak acid output were 1.5+/-0.6 mmol H+/h and 12.2+/-6.4 mmol H+/h, respectively. The half-emptying time of solid and liquid meals was 78+/-9 minutes and 18+/-6 minutes, respectively. These results are likely to be similar to those obtained from the series of patients who underwent highly selective vagotomy or Taylor procedure and are close to those achieved in healthy controls. CONCLUSIONS: This modification of the original Taylor operation (conventional and laparoscopic) allows a more rapid, technically easier, and radical performance of the operation with excellent longterm results and should be considered an effective alternative for the treatment of duodenal ulcer.

Adult↗
PubMed1989

[Hormetic effects of exposure to low doses of ionizing radiation].

In view of the possible hormetic effects of low-level radiation in humans, the author discusses the controversial interpretations which could be made about the results of her investigation of the longterm effects of occupational exposures of 531 healty workers in Bosnia and Hercegovina during a life-span of up to 20 years. Assuming that the frequency of the subjects with binuclears in their lymphocyte count at different cumulative doses would be distributed along a line of linear energy transfer (LET), she correlated the corresponding values for her subjects, but did not obtain the expected positive correlation (Tab. 1). Contrary to the expectation, the frequencies of the distribution of the rates of subjects having binuclears in lymphocyte count demonstrated a supralinear dose-response (Graph. 1) with 94.8% of subjects having frequencies above the LET, 3.7% on that line and only 1.5% below. That finding could be interpreted as an argument that there is no safe threshold limit below which the ionising radiation is not dangerous, but also that the dose response might be increased as the LET approaches the minimum dose rate. However, the data about the rates of binuclears per 10(4) lymphocytes in subjects having them, compared between the groups with different cumulative doses, could be interpreted in an opposite way. The values of binuclears per 10(4) lymphocytes were distributed more or less homogenously around a median of 3.1. The value of 3 binuclears per 10(4) lymphocytes is in Yugoslavia permitted for the new entrants in the occupations involving the exposure to ionising radiation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cell Nucleus↗
PubMed1983

Dose-response relationships for bone cancers from plutonium in dogs and people.

The risk of bone cancers developing from internally deposited plutonium must be estimated from studies in laboratory animals because no plutonium-induced cancers have been observed in people. Studies of the effects of 226Ra and 239Pu injected into beagle dogs at the University of Utah and 238PuO2 inhaled by beagle dogs at the Inhalation Toxicology Research Institute provide a key link to understanding the longterm effects of inhaled alpha-emitting radionuclides in people. Injected radium and plutonium are rapidly deposited in bone whereas plutonium deposited in lung by inhalation is translocated to bone more slowly, depending on its chemical form. The development of bone cancers is a late occurring effect seen after either injection of plutonium or radium or inhalation of plutonium. The incidence of bone cancers from alpha radiation to the skeletons of dogs was compared to bone cancer incidences in radium dial painters to estimate bone cancer risk from inhaled plutonium in people. A risk factor of 1200 bone cancers/10(6) rad to skeleton (average dose) was estimated.

Age Factors↗
PubMed1976

Fenoprofen in patients with rheumatoid arthritis receiving maintenance gold therapy.

Thirty patients with active definite or classic rheumatoid arthritis (RA), participated in a double-blind crossover study comparing fenoprofen calcium with placebo. All patients were receiving maintenance gold therapy. Fenoprofen was administered in doses ranging from 200 to 800 mg every six hours. The median daily dose was 1.8 gm. During this 16-week trial, most parameters of efficacy showed fenoprofen to be significantly more effective than placebo. Adverse reactions, which were minimal, suggest that fenoprofen will be useful in the management of patients with RA, particularly in those with gastrointestinal intolerance to the usually employed drugs. The longterm effectiveness in RA, and the side effects associated with chronic administration remain to be assessed.

Adult↗
PubMed1990

A randomised controlled trial of counseling in a workplace setting for coronary heart disease risk factor modification: effects on blood pressure.

This paper reviews a prospective study of occupational factors in coronary heart disease risk incorporated in a randomised controlled trial of a worksite based occupational health nurse counseling program for reducing coronary heart disease risk factors. The aim of the trial was to evaluate the longterm effectiveness of the counseling program in persons with mildly elevated risk factor levels. Of the 2,489 Australian government employees with mildly elevated risk factor levels who entered the intervention trial, 1,937 (78%) attended a followup examination three years later. This paper reports on changes in systolic and diastolic blood pressure. Multiple linear regression models were used with three-year blood pressure reduction as the dependent variable, intervention status as the main determinant, and sex, age, initial risk level and initial blood pressure as covariates. Although systolic and diastolic blood pressure fell in both the intervention and control groups, intervention was significantly associated with systolic blood pressure change only.

Adult↗
PubMed1989

Effects on an adult of incest in childhood: a case report.

Recognition of the widespread incidence of overt incest in childhood has significantly increased in recent years. The described long-term effects range from severe psychopathology and behavioral disorder to mild and subtle manifestations. The interplay of the child's sexual developmental processes and intrapsychic fantasies with the overtly incestuous behaviors adds complexity to the understanding of longterm effects. In this case presentation successful analysis revealed previously repressed extensive father-daughter incest resulting in typically autoplastic neurotic symptomatology and character formation. Effects on ego development and function were traced, and an attempt was made to develop recognition of cues suggestive of past overt incest. The case suggests that many additional factors contribute to the final long-term effects of overt incest in childhood.

Defense Mechanisms↗
PubMed2005

Response of the lung to pulmonary insulin dosing in the rat model and effects of changes in formulation.

BACKGROUND: The hope that pulmonary insulin will provide increased patient compliance and quality of life has created great interest in patients with diabetes, the medical community, and the general public. A pulmonary insulin product is becoming a reality with clinical trials indicating comparable glycemic control with no change in pulmonary function. However, the longterm effects of pulmonary insulin dosing are not known, and as more pulmonary formulations for insulin and other proteins are rapidly being developed the need for further safety data continues to grow. METHODS: Using gene microarrays, we compared differences in the levels of mRNAs in the lung tissue of rats that were administered a subcutaneous injection or a pulmonary instillation of insulin, as well as rats receiving an pulmonary instillation of insulin and a drug delivery agent. RESULTS: While the insulin doses achieved comparable blood glucose depression and serum insulin concentrations, 30 mRNAs were differentially regulated in response to pulmonary dosing, including 10 mRNAs associated with an immune response and four associated with the lung's response to injury, as well as ion channels and transcription factors. When disodium 8-((N-salicyloyl-2-amino-4-chloro)phenoxy)octanoate, a drug delivery agent known to facilitate pulmonary absorption, was instilled in combination with the pulmonary insulin dose, an attenuation of this response was observed. CONCLUSIONS: These findings suggest that undesirable effects of pulmonary dosing may be avoided by changes in formulation and that further evaluation of the effects of chronic pulmonary administration of insulin is warranted.

Adenosine Deaminase↗
PubMed1999

[Questionable effectiveness of autologous platelet growth factors (PDWHF) in treatment of venous ulcers of the leg].

Chronic venous insufficiency (CVI) can cause ulcers of the lower limb having the character of a full thickness wound involving the subcutaneous tissues and fat. Healing requires wound contraction, connective tissue formation and finally reepithelialization. To induce wound healing, on an underlying disturbed environment due to longterm effects of CVI, artificial stimuli may be needed. In a placebo controlled study we tried topical application of autologous PDWHF (platelet derived wound healing factors), to achieve ulcer healing and improve the microangiopathy surrounding of the ulcer area, as there are decreased number of skin capillaries and reduction in cutaneous vascular reserve. Alterations of cutaneous circulation during the course of the study were documented by capillaroscopy, transcutaneous oxygen pressure and laser Doppler flux (LDF) measurements. We were able to recruit 15 patients a I suffering from chronic nonhealing venous stasis ulcers. Eleven of the 15 patients agreed to participate in a placebo-controlled double blind study, whereas 4 patients agreed to participate only if they would be treated with PDWHF. The median age and duration of ulceration of the 6 patients (3 male/3 female) treated with placebo were 71 years and 1089 days. The median age and duration of ulceration of the 9 patients (1 male/8 females) treated with PDWHF were 66 years and 732 days. Duration of therapy for the PDWHF group was 91 days, as compared to 154 days for the placebo group. Despite 2 completely healed ulcers, the expensive treatment did not reveal any significant clinical advantage. In den PDWHF group an ulcer area of 26.9 cm2 was measured at the beginning, of 26.2 cm2 at the end; in the placebo group, 34.7 cm2 and 35.5 cm2. The nonsignificant increase of the capillary density at the ulcer border in the active group as well as the increase in the tcPO2, in contrast to little change in both parameters in the placebo group, suggests neoangiogenic abilities to PDWHF, secondarily leading to a better blood distribution with higher oxygen tension.

Aged↗
PubMed2000

Genetic factors modulate effects of C-section birth on dopaminergic function in the rat.

Genetic predisposition and environmental factors such as perinatal complications are believed to contribute to the etiology of schizophrenia, a disorder involving enhanced CNS dopaminergic activity. This study used a rat model to test whether genetic factors and a minor birth complication, i.e. Caesarean section (C-section) birth, interact in producing longterm effects on dopamine-mediated behavior. For this, we compared the effects of vaginal and C-section birth on amphetamine (AMPT)-induced locomotor activity in strains of rats differing in genetic composition. In Sprague-Dawley rats, C-section birth increased AMPT-induced locomotion compared with vaginal birth. By contrast in Lewis rats, C-section birth reduced AMPT-induced locomotion compared with vaginal birth. In Fischer rats, AMPT-induced locomotion was increased by C-section under maternal anesthesia but decreased by C-section after maternal decapitation, compared with vaginal birth. It is concluded that a minor birth complication like C-section can have differing long-term effects on dopaminergic function in the rat, depending on the genetic composition of the individual.

Amphetamine↗
PubMed1993

[Theophylline in therapy of obstructive sleep apnea?].

We examined the effect of 375 mg theophylline at night in 95 patients (14 women, 81 men) with obstructive sleep apnoea. The apnoea-hypopnoea index decreased significantly from 20.9 +/- 17.2 to 13.5 +/- 15.8/hour, the nadir of oxygen saturation increased from 80.6 +/- 8.5 to 82.4 +/- 8%. A survey of the longterm effects of theophylline in 16 initially responding patients revealed after 31-922 (190 +/- 217) days therapy no statistically significant change of the apnoea-hypopnoea index; however, the nadir of oxygen saturation was lower compared to the beginning of the therapy (83.8 +/- > 79.3 +/- 7.6%). We believe that theophylline is useful in single cases of patients with obstructive sleep apnoea, but is necessary to reconfirm the positive effect.

Adult↗
PubMed1989

[Acute and chronic effects of UDCG 115 BS (pimobendan) in patients with advanced myocardial failure].

In a double-blind, placebo-controlled cross-over study acute hemodynamic effects of oral UDCG 115 BS (5 and 10 mg) were investigated in myocardial heart failure before (n = 16) and after (n = 13) chronic treatment (4 weeks). Before chronic treatment, UDCG 115 BS induced a similar increase in cardiac index with both doses (5 mg: from 2.4 +/- 0.7 to 3.5 +/- 0.7 l/min/m2, p less than 0.001; 10 mg: from 2.5 +/- 0.6 to 3.6 +/- 0.9 l/min/m2, p less than 0.001). Both right atrial pressure and pulmonary capillary wedge pressure were clearly reduced (p less than 0.001). Heart rate increased slightly only after 5 mg (p less than 0.05). Systemic vascular resistance was reduced (p less than 0.001), whereas mean blood pressure did not change. After chronic treatment (2 x 5 or 2 x 10 mg/d) and cessation of medication for 24 h there was no difference for control hemodynamic values as compared to placebo. Acute hemodynamic effects were considerably attenuated in comparison with the results obtained before chronic treatment. NYHA-classification, however, clearly (p less than 0.05) improved during administration of UDCG 115 BS as compared to placebo. Two patients died on placebo, whereas no patient expired on verum. This might indicate a therapeutic longterm effect of UDCG 115 BS, despite the observed development of partial tolerance.

Adult↗
PubMed1997

Adolescent risk factors and the prediction of persistent alcohol and drug use into adulthood.

Adolescence is a time of heightened risk for relatively intensive alcohol and other drug use behaviors. However, heavy use is often "adolescence-limited," giving way to moderation or cessation in adulthood. We examined individual differences in risk factors at age 18 that were predictive of alternative alcohol and drug use trajectories from adolescence to adulthood. Data were collected prospectively on four occasions from participants in the Rutgers Health and Human Development Project. Subsets of individuals representing three prototypical trajectories of (1) consistently low alcohol and drug use during adolescence and early adulthood; (2) heavier alcohol or drug use during adolescence, but not during adulthood; and (3) persistent heavier alcohol or drug use from adolescence into adulthood were found to differ significantly on a number of intrapersonal, behavioral, and environmental risk factors, with the adolescence-limited group consistently scoring between the other two groups. Based on these results, a composite risk index was constructed. In the total sample, however, when the effect of alcohol and drug use behaviors at age 18 was controlled, the composite risk index was unrelated to adult (age 28 to 31) levels of alcohol and drug use and consequences. Thus, in this community sample, well-documented risk factors assessed in adolescence did not exhibit any direct, longterm effects on use intensity and problems in adulthood. It is concluded that the assessed risk factors (disinhibition, cognitive structure, play, deviant coping, friends' deviance, and stressful life events) are not immutable, but subject to individual and normative changes during the transition from adolescence to adulthood. More research is needed to determine the long-term stability of risk factors, and how changes in risk factors over time, discontinuities in what constitutes risk in adolescence versus adulthood, and proximal adult protective factors that compensate for early risk contribute to developmental patterns of use.

Adolescent↗