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PubMedDate not supplied

[Determination of the degree of severity of cerebral contusions].

Three degrees of severity of the brain contusion are generally distinguished today for working out the most rational and purposeful treatment. It is quite difficult to judge the severity of the contusion from the neurological picture alone because neurological manifestations of the brain contusions are very diverse and dynamic in character. The authors analysed 630 case records of patients with contusion of the brain and disclosed signs most characteristic of each degree of contusion. In appraising the severity of the contusion, the authors recommend resorting to the laboratory and instrumental diagnostic methods accepted currently in neurosurgical practice in addition to the neurological examination. The complex method of appraising the patients' condition makes the determination of the degree of severity of the brain contusion more trustworthy and objective.

Brain Concussion↗

PubMed1996

Consensus minimum standards for use in a trainer's report for summative assessment in general practice.

BACKGROUND: Summative assessment of general practitioner registrars is to be introduced in September 1996, one component of which will be a report by the trainer. Standards must be set and guidance provided as to the most appropriate ways of obtaining evidence for the trainer's assessment. AIM: The first aim of this study was to set consensus minimum standards for 30 items that are likely to form the content of a trainer's report; the second aim was to provide a consensus view on the most appropriate methods of assessment to be used by trainers. METHOD: A consensus conference was held in March 1995 during which the 30 items were discussed by a group of 30 general practitioners, of whom 27 were experienced trainers. This resulted in a draft document that was circulated to the conference attenders and other experts for consultation. RESULTS: Draft minimum standards were produced for all 30 items after the consensus conference with a mean of 2.5 standards for each item. Of those involved in the consultation exercise, 82% replied. Most of the revisions suggested at this stage were of a minor nature; the only major revision was to divide one item into two, resulting in a final total of 31 items. All but one of the 80 standards could be assessed by direct observation; 41 (51%) could be assessed by tutorial-based discussion and 61 (76%) by methods specific to that standard. Trainers or their practice partners were viewed as acceptable sources of evidence for all items and hospital consultants and primary health care team members were viewed as acceptable for just over half of the items. CONCLUSION: Standards for use by trainers when providing a general practitioner report for the summative assessment of registrars have been developed by consensus conference and have been subjected to review by consultation. Acceptable methods by which registrars could be assessed against these standards, and suitable personnel who could provide evidence, have also been suggested.

Education, Medical, Graduate↗

PubMed1994

Improved method for analysis of whole bone torsion tests.

Structural tests, such as whole bone torsion tests, have become widely accepted methods for assessing average bone material properties. To simplify interpretation of these tests, the nonuniform bone geometry is often analyzed as a tube with a constant cross section (prismatic) and the areal properties of the smallest bone section. This approach may not adequately represent the true torsional behavior of the cross section and does not account for any lengthwise variations in bone geometry. The errors introduced by these approximations are particularly significant when comparing bones of different sizes and geometries. In this paper, we examine the effects of approximating the cross-sectional torsional behavior and of neglecting lengthwise variations in bone geometry. We then present a simple, standardized procedure utilizing a FORTRAN computer program for accurate determination of material properties. We examine first simple idealized bone geometries and then a complex three-dimensional model of the femur from a 26-day-old male Sprague-Dawley rat. For these models, the conventional methods for interpreting torsion tests introduce errors of up to 42% in the shear modulus and up to 48% in the maximum shear stress; a straightforward extension of these methods reduces the errors to within 3%.

Animals↗

PubMed1995

Application issues in bioanalytical method validation, sample analysis and data reporting.

Although some degree of consensus has been reached concerning the requirements for acceptable method validation, the procedures used to establish them vary significantly between laboratories. Also, issues arising from application of these requirements during validation and subsequent sample analysis need to be addressed. The purpose of this paper is to discuss application issues concerning prerequisites to method validation, and all validation criteria for evaluation of method reliability and overall performance. Other poorly addressed issues such as re-validation, cross-validation, partial sample volume, multicomponent analysis and reporting will also be discussed. Although many issues discussed are of a general nature, the scope of this presentation is primarily to address issues arising from the validation and routine application of chromatographic methods.

Animals↗

PubMed1983

Migration of human leukocytes from soft agarose droplet: a simplified method for studying chemotaxis and spontaneous migration.

Studies of in vitro chemotaxis and spontaneous migration of human leukocytes using the accepted method with the Boyden-chamber-filter are troublesome, because of the need for specially constructed vessels as well as the difficulties caused by the use of membrane filters. We describe a new and simplified method for measuring human leucocyte chemotaxis, which is a modification of the recently described underagarose migration method and which is based upon spontaneous migration of cells from a soft agarose droplet and in response to a chemotactic gradient. We examined suspensions of leukocytes, purified granulocytes, and mononuclear cells from 10 healthy normal adults and from 10 samples of cord blood using E Coli O111B4 endotoxin-activated human serum as attractant. Our results showed that the mean chemotactic indices (C.I.-chemotaxis/migration) for purified granulocytes and for mononuclear cells from normal individuals were 3.0 +/- 1.2 and 2.7 +/- 1.5, respectively. Chemotaxis was significantly reduced when unwashed leukocytes were studied, indicating a detrimental effect of autologous plasma on leukocytic response to a chemotactic stimulus in this system. Cord blood cells showed normal spontaneous migration, but significantly decreased chemotaxis. This preliminary report shows that the technique is simple, rapid, and reproducible, and can detect abnormalities of chemotaxis in both granulocytes and mononuclear cells.

Adult↗

PubMed1992

Laparoscopic varicocelectomy: preliminary report of a new technique.

The use of varicocelectomy for the treatment of subfertility seems to be incontrovertible. However, there is a difference of opinion as to the proper surgical method of varicocele ablation. The inguinal and high retroperitoneal approaches are the most commonly accepted methods to date. However, significant postoperative morbidity is common and return to normal activity often is prolonged. Also, bilateral operations are being performed more commonly. These considerations have prompted many to search for alternative techniques. We developed a laparoscopic procedure that is as simple and effective as more traditional methods. In addition, it offers lower morbidity, allows for microscopic dissection with preservation of the spermatic artery and is amenable to bilateral ligation without a second incision. Ten patients 16 to 54 years old underwent laparoscopic ligation of the spermatic veins at the internal inguinal ring. The diagnosis was based on physical examination. Indications for the operation were infertility with a stress sperm pattern in 5 patients, testicular atrophy in 4 and scrotal pain in 1. Four patients underwent bilateral ligation. Preliminary followup showed resolution of the varicocele in all patients and disappearance of pain in the patient treated for this symptom. No morbidity related to this procedure has been encountered and all patients resumed normal activity within 2 days. We believe that this new method is a viable alternative for varicocelectomy.

Adolescent↗

PubMed1999

Effect of sterilisation methods on the structural integrity of artificial enamel caries for intra-oral cariogenicity tests.

Enamel blocks bearing artificial caries are used in intra-oral appliances for cariogenicity tests. These blocks are often sterilised to prevent the possibility of cross-infection via this route. This study therefore aimed to determine the effect of sterilisation methods on the structural integrity of artificial enamel caries used for intra-oral cariogenicity tests. Four experimental groups were devised. Ten bovine incisors were used in each group. Artificial caries was produced in each tooth which was subsequently cut into two halves. One half of each tooth was reserved as control while the other was sterilised. The four groups were subjected to respective sterilisation methods: gamma irradiation (approximately equal to 25 KGy), steam autoclaving (121 degrees C for 15 min), sodium hypochlorite (12% w/v for 24 h) and povidone-iodine (7.5% w/v for 24 h). The control and sterilised specimens in each group were examined for microbial growth after incubation in nutrient broth for up to 7 days at 37 degrees C under aerobic and anaerobic conditions. Mineral loss and lesion depth were quantified from microradiographs of sections from control and sterilised specimens using transverse microradiography. Data were analysed statistically by paired Student's t-test. Microbial growth was observed only in control specimens. Gamma irradiation and NaOCL caused cream discolouration and bleaching of the enamel surface, respectively. Autoclaving, sodium hypochlorite and povidone-iodine resulted in further demineralisation of the lesions. The four sterilisation methods were all effective sterilants for artificial caries. However, gamma irradiation appears the most acceptable method considering the more adverse effects of the other methods with regards to cariogenicity tests.

Animals↗

PubMed1981

Comparison of minimum inhibitory concentration values determined by three antimicrobic dilution methods for Pseudomonas aeruginosa.

This investigation compares minimum inhibitory concentration measurements by three antimicrobic dilution methods for Pseudomonas aeruginosa versus seven antimicrobics. Minimum inhibitory concentrations were measured for 650 P. aeruginosa clinical isolates and for repeated tests with P. aeruginosa ATCC 27853 versus gentamicin, tobramycin, amikacin, netilmicin, sisomicin, carbenicillin, and ticarcillin, using the macro-broth, micro-broth, and agar dilution methods. For all antimicrobics, it was found that the micro-broth and agar dilution methods produced comparable minimum inhibitory concentration measurements, which were found to lie 1 to 2 double dilution steps below those determined by the macro-broth method. Acceptably replicability was found for both the macro-broth and the agar dilution methods. The micro-broth method showed less replicability, with 4.7% of minimum inhibitory concentration values lying +/- 2 or more double dilution steps from the modal value. It is important to recognize such differences if micro-broth or agar dilution methods are substituted for the macro-broth method.

Aminoglycosides↗

PubMed1998

Treating headache from an evidence base: the Cochrane Collaboration.

The Cochrane Collaboration uses rigorous and widely accepted methods, together with peer-review, to produce systematic reviews of all data of acceptable scientific quality relating to specified aspects of healthcare. Review Groups exist for a number of areas of medicine and surgery, but at present not headache. It is argued that there should be a Cochrane Collaborative Review Group for Headache, and that the International Headache Society should foster its creation. Some principles are set out. The step from establishing the evidence-base to incorporating it in treatment guidelines should be taken circumspectly.

Evidence-Based Medicine↗

PubMedDate not supplied

[Use of the pulsimetric method for estimating energy value of food rations for miners in deep coal mines].

Pulsimetry proved to be the most acceptable method for estimating energy requirements of miners working under extreme conditions with constantly changing ergometric parameters. It has been established that the mean daily energy requirements of miners working in deep coal mines under conditions of high temperature comprise 3500 kcal. Energy requirements for the main types of the physical activity of workers in deep mines have been calculated, basing on basal metabolism, metabolic constants for varying activities have been determined.

Coal Mining↗

PubMed1994

An unexpected fetal outcome following a severe maternal motor vehicle accident.

BACKGROUND: Maternal motor vehicle injury occurs commonly and can cause serious fetal injury. Optimum pregnancy management at the time of maternal presentation following trauma requires reliable methods of fetal assessment. In this report, we present a case in which currently accepted methods of fetal assessment initially failed to demonstrate catastrophic fetal brain injury following a maternal motor vehicle accident. CASE: A 28-year-old primigravida woman at 27 weeks' gestation was in a pedestrian motor vehicle accident, suffering a closed head injury and multiple fractures. Initial fetal assessment included cardiotocographic monitoring for 24 hours fetal ultrasound, both of which were normal, as was a biophysical profile done on the fifth day after the accident. These were repeated at intervals, but definite evidence of fetal brain injury was not seen until unilateral ventricular dilatation was documented on ultrasound at 35 weeks' gestation. Postnatal imaging showed microcephaly, hydrocephalus ex vacuo, and multiple hemispheric hypodensities, likely representing post-traumatic hemorrhages with secondary infarction. At the age of 4 years, the child is cortically blind, epileptic, and quadriparetic. CONCLUSION: This pregnancy outcome was unexpectedly poor despite the reassuring initial assessment. We caution that these methods may not provide accurate early fetal assessment, especially when fetal brain stem function is spared.

Accidents, Traffic↗

PubMedDate not supplied

The management of ocular herpesvirus infections.

The many treatment methods in current use for every known complaint only seem to aggravate the difficulty of treating ocular herpes simplex virus (HSV) infections, which are generally self-limited in the immunocompetent host. The cornea is already a somewhat immune-deficient tissue since its lack of blood vessels separates it partially from the host, and treatment with glucocorticoids, which are immunosuppressive, increases the risk of damaging complications such as scarring, prolonged morbidity, bacterial or fungal superinfection, and the occasional corenal perforation. Accepted methods of treatment of specific lesions, are discussed, as are some methods that are not yet accepted, but which seem promising. Herpes zoster may result in scarring and significant loss of vision even without the use of glucocorticoids, the disease often manifesting itself in the already compromised host. The major complication is postherpetic neuralgia. None of the available treatment methods has been fully satisfactory, and every effort should be made to prevent eye lesions in patients with early infection of the ophthalmic branch of the trigeminal nerve. Stimulation of cellular immunity by various means appears to offer some new promise for control of the disease. Management of varicella, cytomegalovirus, and infectious mononucleosis are also discussed.

Animals↗

PubMedDate not supplied

Identification of muscle spindles by direct and indirect electrical stimulation of intrafusal muscle fibers.

In two series of acute experiments on 25 anesthetized cats methods of rapid identification of muscle spindles based on electrical stimulation either of fusimotor nerve fibers or directly of the intrafusal muscle fibers were tested. The methods used are more reliable tests for the identification of muscle spindles than the generally accepted method of investigating the velocity of conduction of excitation along a single afferent fiber, for receptors both of the joints and of the deep tissues may also be innervated by fibers of the same diameter.

Animals↗

PubMed1980

Canine retraction with J hook headgear.

Several methods have been described for accomplishing distal movement of canines without losing posterior anchorage. An accepted method in canine retraction is the use of headgear with J hooks. Since it incorporates extraoral anchorage, it is most effective in maximum-anchorage cases. It was the purpose of this study to analyze the distribution of force transmitted to the alveolus and surrounding structures by means of photoelastic visualization, utilizing J hook headgear for maxillary canine retraction. A three-dimensional model representing a human skull was used. This model was constructed with different birefringent materials to simulate bone, teeth, and periodontal membranes. Three different vectors of force were applied representing high-, medium-, and low-pull headgear, which were placed at angles of 40, 20, and 0 degrees to the occlusal plane. The photoelastic analysis was made by means of a circular-transmission polariscope arrangement, and the photoelastic data were recorded photographically. The stress areas created by the three different vectors of force were associated with various degrees of canine tipping. This effect was greater with the low-pull force component than with the medium-pull traction. The high-pull headgear produced the least tipping tendency, being closer to a bodily movemment effect. Further, stresses were transmitted to deeper structures of the simulated facial bones; these regions were the frontozygomatic, zygomaticomaxillary, and zygomaticotemporal sutures.

Alveolar Process↗

PubMed1979

Management of portal vein injuries.

Injuries to the portal vein are associated with a high mortality because of a high incidence of concomitant injury to surrounding structures and refractory shock. Repair of the portal vein injury is often difficult or impossible because of massive hemorrhage. The key to successful management of a portal vein injury is rapid blood volume resuscitation and obtaining rapid and adequate exposure. The optimal exposure for repair consists of reflection of the hepatic flexure of the colon with mobilization of the root of the mesentery, pancreas, and duodenum. Lateral venorrhaphy is the preferred method of management, but in hemodynamically unstable patients, ligation of the portal vein is an acceptable method of treatment.

Arteriovenous Shunt, Surgical↗

PubMed1991

Detection of coliform bacteria and Escherichia coli by multiplex polymerase chain reaction: comparison with defined substrate and plating methods for water quality monitoring.

Multiplex polymerase chain reaction (PCR) and gene probe detection of target lacZ and uidA genes were used to detect total coliform bacteria and Escherichia coli, respectively, for determining water quality. In tests of environmental water samples, the lacZ PCR method gave results statistically equivalent to those of the plate count and defined substrate methods accepted by the U.S. Environmental Protection Agency for water quality monitoring and the uidA PCR method was more sensitive than 4-methylumbelliferyl-beta-D-glucuronide-based defined substrate tests for specific detection of E. coli.

Base Sequence↗

PubMed1976

Controversy in organ preservation.

Renal preservation has contributed to improvements in human cadaver kidney transplantation in terms of viability testing and logistics. Unfortunately, the antigenicity of a kidney has not been reduced by our present preservation methods; consequently, immunologic problems in cadaver kidney transplantation still remain. Simple cold storage is an acceptable method for kidneys subjected to minimal warm ischemia. It can be used where anticipated storage time will not exceed 10 to 15 hours. Pulsatile or nonpulsatile machine perfusion will give better results especially when kidneys have sustained up to 60 minutes warm ischemia. Where there is also a need for storage time longer than 15 hours, perfusion should be used. Cryoprecipitated millipore-filtered plasma remains the most commonly used perfusate. Preservation really begins before the harvesting. Present preservation techniques cannot revive a dying kidney. No single test will determine the degree of viability of a kidney. A systematic multidisciplinary effort is needed to augment our understanding and knowlege about the effect of hypothermia on organs. Hopefully these efforts will result in the development of an organ bank whereby many more kidneys will be available for transplantation.

Animals↗

PubMed1999

The sonde exam.

Sonde-type enteroscopy has made it possible to potentially examine the entire depths of the small intestine. A relatively high diagnostic yield has been obtained by the sonde method in patients with obscure gastrointestinal bleeding. These features have made sonde enteroscopy a clinically accepted method. However, sonde-type enteroscopy has also some disadvantages making it less then a perfect endoscopy method. This article focuses on the technical aspects of sonde enteroscopy, but also summarizes the indications and the outcome of clinical studies.

Endoscopes, Gastrointestinal↗