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PubMed1990

Detection of rejection in renal allografts. Evaluation with duplex sonography and DTPA renal scintigraphy with kidney/aorta perfusion ratios.

Duplex sonography and technetium-99m DTPA renal scintigraphy have been used to distinguish acute rejection from other forms of renal allograft dysfunction. In this study, duplex sonography and renal scintigraphy were compared as methods to detect rejection. Eighty-four episodes of renal allograft dysfunction that had concurrent duplex sonography and renal scintigraphy over a 17-month period were reviewed. During the duplex sonography examinations the resistive index (RI) was measured from the renal cortex. Scintigrams were evaluated for allograft perfusion and function. The kidney to aorta (K/A) ratio was calculated from the upstroke of the perfusion curve. All diagnoses were established by clinical criteria. Histologic proof was available in 49 cases. There were two episodes of hyperacute rejection, 30 episodes of acute rejection, 14 episodes of chronic rejection, and 38 episodes of dysfunction without rejection. Using an RI greater than or equal to 0.70, the sensitivity and specificity for detecting acute rejection were 90% and 76%, respectively, compared with 37% and 76% for renal scintigraphy. The K/A ratio was not helpful in the diagnosis of rejection.

Aorta↗
PubMed1999

Enteral nutrition in clinical practice.

Enteral nutrition has, at long last, found its place in the modulation of disease. Because of its importance in terms of both anabolic and catabolic processes, today's clinician must have a working knowledge of the types of enteral formulations, their delivery and the therapeutic considerations (particularly concomitant medications) that impact on the safety and efficacy of enteral nutrition. The advantages and disadvantages of this therapeutic intervention must be carefully weighed by the clinician, in concert with sound medical principles. Despite the widespread belief that enteral nutrition is superior to parenteral nutrition in humans, data does suggest that there is little difference between the two. Also, associated costs of enteral nutrition in contrast to parenteral nutrition need to be reappraised based on more invasive enteral access and falling parenteral nutrition prices. Although the enteral route is presumed to be the best feeding modality, the clinician must be ever vigilant about the shortcomings of using the gut, especially in the setting of severe inflammation, stenosis or sepsis. The best feeding modality, then, must blend a knowledge of the patients' anatomy, physiology, and disease with considerations of enteral access, timing of delivery, complications, and a myriad of other therapeutic variables (to include concurrent medication administration) that impact on the enteral feeding regimen. This article reviews the basic principles of enteral nutrition in clinical practice. It describes nutritional assessment, routes of administration, selection of feeding formulas based on nutritional needs, interactions with medications, as well as possible complications of enteral feeding.

Cost-Benefit Analysis↗
PubMedDate not supplied

Morphohistometric analysis of advancing tumor fronts in malignancies associated with oral submucous fibrosis.

The objective of this study was to address retrospectively the invasive tumor fronts of epithelial neoplasms associated with OSF and non-associated tumors. Review of a data base of 25 OSF patients who have had concurrent oral squamous cell carcinoma served as the test sample. The controls constituted an equal number of age standardized (roughly) squamous cell carcinomas, non-associated with OSF. The diagnsis and grading were performed based on established criteria. Altogether a total of 8 histopathological variables were evaluated related to the advancing tumor fronts. After selection of cut-off levels, single parameter analysis by means of univariate test revealed significant result in none. A Total Malignancy Score (TMS) of 14.98 and 15.13(mean) were recorded for test and control respectively. Multivariate analysis showed that degree of nuclear plemorphism (p=0.015) and the pattern of invasion (p=0.003) were the only two variables which significantly affected the TMS. OSF associated tumors did not show features unique to it and therefore its response to therapy need not vary significantly from conventional cases.

Areca↗
PubMed1992

Biochemical modulation of fluorouracil by dipyridamole: preclinical and clinical experience.

In the HCT 116 human colon carcinoma cell line, dipyridamole, an inhibitor of nucleoside transport, increases the toxicity of 5-fluorouracil (5-FU) in a dose-dependent manner. While dipyridamole inhibits thymidine transport, interference with thymidine salvage did not appear to be a critical factor. Dipyridamole altered 5-FU metabolism, producing a selective increase in fluorodeoxyuridine monophosphate levels by blocking the efflux of fluorodeoxyuridine. Deoxyuridine monophosphate levels were greatly increased when cells were exposed to 5-FU alone, and were even larger with the addition of dipyridamole. Dipyridamole did not alter the absolute amount of 5-FU incorporated into either RNA or DNA. Exposure to either 5-FU or dipyridamole alone was associated with the generation of alkaline labile sites in newly synthesized DNA. Concurrent exposure to 5-FU with dipyridamole resulted in a striking increase in the alkaline labile sites. Thus, increased DNA damage appears to correlate with the enhanced cytotoxicity of this combination. The results of a clinical trial evaluating concurrent intravenous infusion of 5-FU with dipyridamole over 72 hours are reviewed. At maximally tolerated doses of infusional dipyridamole, the steady-state concentration of bioactive, non-protein-bound drug is in the range of 25 nM. While this concentration may be sufficient to perturb thymidine salvage in some cell types, it is 20-fold lower than the optimal concentration of bioactive dipyridamole needed to modulate 5-FU toxicity, metabolism and DNA damage in the HCT 116 tissue culture model. In addition, an unexpected pharmacokinetic interaction was seen: dipyridamole increased 5-FU clearance and decreased its steady-state plasma concentration. It remains to be determined whether dipyridamole with 5-FU alone or with leucovorin will translate into an improved therapeutic outcome.

Colonic Neoplasms↗
PubMed2005

[Local failure-related factors of esophageal carcinoma after concurrent chemoradiotherapy].

BACKGROUND & OBJECTIVE: Concurrent chemoradiotherapy is the standard treatment for unresectable esophageal carcinoma. Local failure and recurrence are main reasons of treatment failure. This study was to discuss the factors related with local failure and recurrence of unresectable esophageal carcinoma after concurrent chemoradiotherapy. METHODS: Records of 132 patients with esophageal carcinoma, treated with concurrent chemotherapy in our hospital from Jan. 1996 to Dec. 2003, were reviewed. The patients received the first cycle of chemotherapy at the beginning of radiotherapy, and the second cycle of chemotherapy when radiation dose escalated to 40 Gy. Local failure-related factors were analyzed by binary logistic regression. RESULTS: To the terminal of follow-up, of the 132 patients, 54 had local failure or in-fields recurrence, 20 had in-fields recurrence and lymph nodes or distant metastasis, 5 had out-fields recurrence. Logistic regression analysis showed that short-term effect and irradiation dose were correlated with local failure and recurrence. Local failure and recurrence rate was lower in patients with complete remission (CR) than in patients with partial remission (PR) after chemoradiotherapy (44.9% vs. 79.6%, P < 0.001); and the mean time to recurrence was longer in CR patients than in PR patients (12.9 months vs. 6.1 months, P=0.002). When irradiated with 50-60 Gy,60.1-69.9 Gy, >/=70 Gy of x-ray, the local failure rates of the patients were 69%, 61%, and 52% (P=0.027), respectively, the mean time to recurrence were 5.3, 9.1, and 10.3 months, respectively. CONCLUSION: Radiation dose and short-term effect may influence local control of unresectable esophageal carcinoma.

Adult↗
PubMed1991

Primary hyperparathyroidism and monoclonal gammopathy.

Coexistent primary hyperparathyroidism and monoclonal gammopathy, although rare, has been reported previously by a number of investigators. We report four patients with such an occurrence who were seen between 1976 and 1988. Another patient with primary hyperparathyroidism also had multiple myeloma and was in remission for 12 years. These patients represent approximately 1% of the 386 patients with primary hyperparathyroidism seen during the same 12-year period. Although several mechanisms have been proposed to explain this concurrence, we believe it is the result of a chance occurrence. A review of the literature, an estimate of the chance occurrence of coincidental monoclonal gammopathy, benign or malignant, in patients with primary hyperparathyroidism, and some practical implications of this interesting coexistence are presented.

Aged↗
PubMedDate not supplied

Acid hydrolysis of proteins for chromatographic analysis of amino acids.

The conditions used to hydrolyze proteins are vital in determining amino acid compositions because they necessarily represent a compromise aimed at yielding the best estimate of amino acid composition. Variations in ease of peptide bond cleavage, differences in amino acid stabilities, and matrix effects from nonproteinaceous components all militate against a single set of hydrolysis conditions that quantitatively hydrolyze every peptide bond and concurrently cause no destruction of any amino acid. This presentation summarizes and reviews an extensive study which evaluated a number of variations in the techniques and procedures of the classical 6N HCl, 110 degrees C, 24 h hydrolysis of protein. The objectives of the recent investigation were: to compare hydrolysis at 145 degrees C, 4 h with 110 degrees C, 24 h for proteins in a wide range of different sample matrixes; to compare protein hydrolysis at 110 degrees C, 24 h conducted in sealed glass ampoules after vacuum removal of air with hydrolysis in glass tubes with Teflon-lined screw caps after removal of air by vacuum, nitrogen purge, and sonication; to evaluate a performic acid oxidation procedure before hydrolysis for the analysis of cystine and methionine in the different sample matrixes; to evaluate multiple hydrolysis times at 145 degrees C; to evaluate the variation of interlaboratory hydrolysates prepared at 145 degrees C, 4 h in 2 different laboratories on the amino acid analysis of an array of protein-containing matrixes.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acids↗
PubMed1995

Transection of the accessory ligament of the superficial digital flexor muscle for the treatment of superficial digital flexor tendinitis in standardbreds: 40 cases (1988-1992).

Medical records of 40 racing Standardbreds with superficial digital flexor tendinitis that underwent transection of the accessory ligament of the superficial digital flexor (SDF) muscle (superior check desmotomy) were reviewed. Surgery was performed bilaterally in 32 horses and unilaterally in 8. Concurrent palmar annular desmotomy was performed in 8 horses in which tendinitis involved the distal metacarpal region and confinement of the deep and SDF tendons by the annular ligament was suspected. Follow-up information was obtained for 32 horses, by telephone, and racing results were available for 39 horses (1 horse is currently in training, but had a qualifying race prior to surgery). Tendinitis recurred in 8 of 32 (25%) horses that returned to training. Thirty-five of 38 (92%) horses started at least 1 race after surgery. Mean +/- SD time between surgery and first race was 237 +/- 86 days. Overall, 33 of 38 horses completed 5 or more races after surgery; however, SDF tendinitis recurred in 6, and treatment was, therefore, considered to be successful in 27 horses. Horses started a median of 18 races after surgery. Median amount of money won per start after surgery (median, $418; range, $0 to $4,626) was significantly less than median amount won per start before surgery (median, $1,155; range, $0 to $14,603). Inflammation of the interosseous muscle (suspensory ligament) developed in 5 horses with bilateral SDF tendinitis and in 2 horses with unilateral SDF tendinitis. All horses with inflammation of the interosseous muscle had undergone bilateral superior check desmotomy.

Animals↗
PubMed1995

Fibromuscular dysplasia associated with intracranial giant aneurysm: report of a case.

Although the correlation between fibromuscular dysplasia (FMD) and intracranial aneurysm is well established, the combination of FMD with a giant aneurysm is rare. This paper reports a patient with extracranial FMD associated with a giant intracavernous aneurysm compromising the trigeminal and abducens nerve. A review of the literature uncovered only four documented cases of FMD with concurrent giant intracranial aneurysms. The present case adds further weight to the argument for including FMD in the differential diagnosis list when confronted with a patient with a giant intracranial aneurysm. Absence of adequate collaterals in this patient eliminated ligation as a treatment strategy for the aneurysm.

Adult↗
PubMed1997

[The Italian reform, 18 years after: history, execution and consequences].

In 1978 a radical psychiatric reform was passed in Italy, that revolutionized the mental health delivery system. The reform has attracted international attention for its resolute commitment to getting rid of the traditional state hospital and implementing a nationwide mental health system without this type of hospital. The paper begins by depicting its preparation, then after charting the main features of the reform and its implications, it moves on to providing data on the implementation. In the following years relevant legislation has supplemented the reform and is covered in the paper. Other concurrent elements of the implementation process are mentioned and existing empirical studies reviewed.

Health Care Reform↗
PubMed1997

A first report of familial visceral myopathy with additional chylous ascites in two siblings.

BACKGROUND: Familial visceral myopathy in two siblings, involving the intestine with concurrent chylous ascites and chylous pleural effusion, is reported. In this connection a review of the recent gastroenterologic literature was performed. PATIENTS: In two siblings, admitted between 1992 and 1995 with increasing ascites, loss of weight, and attacks of subileus, the diagnosis of familial visceral myopathy was established. CASE ONE: During the initial preoperative examination hepatogenous ascites was diagnosed. Visceral myopathy and chylous ascites were subsequently established by means of an explorative laparotomy in conjunction with histologic examination of specimens taken from the small-bowel wall. CASE TWO: The patient's brother was admitted 3 years later with similar symptoms. Complaints of chylous ascites and chylous pleural effusion in connection with attacks of subileus are still present. OUTCOME: The female sibling was discharged from hospital with unchanged complaints and died only a few months later; the male sibling is still alive, but with unchanged complaints. CONCLUSIONS: Rare cases of familial and sporadic myopathy have been reported in the recent literature, but to our knowledge these are the first cases with concurrent chylous ascites and chylous pleural effusion in this uncommon disorder.

Aged↗
PubMedDate not supplied

A validity study of the Evaluation Tool of Children's Handwriting-Cursive.

OBJECTIVES: This study examined concurrent validity of the Evaluation Tool of Children's Handwriting-Cursive (ETCH-C) by comparing ETCH-C total legibility percentage scores with handwriting grades from teachers. The study also identified the legibility percentage score discriminating between satisfactory and unsatisfactory handwriting. METHOD: The participants were 101 fourth graders who completed two handwriting instruments. Three teachers sorted the Cursive Practice and Review work sheets into A, B, C, and unsatisfactory groups to establish handwriting grade. The study compared ETCH-C total legibility percentage scores with teacher grading, using personal judgment of handwriting on the Cursive Practice and Review work sheet. RESULTS: Mean legibility percentage scores increased significantly as handwriting grade increased. The concurrent validity coefficients were .61 for ETCH-C total words and .65 for ETCH-C total letters and handwriting grade. ETCH-C legibility percentage scores discriminating satisfactory from unsatisfactory handwriting ranged from 73% to 82% on ROC (receiver operating characteristic) curves. CONCLUSION: Results support the concurrent validity of the ETCH-C with handwriting grades. A 75% word legibility percentage score discriminated satisfactory and unsatisfactory handwriting.

Analysis of Variance↗
PubMed2005

Kidney insufficiency and nutrient-based modulation of inflammation.

PURPOSE OF REVIEW: Patients with chronic kidney disease have a high cardiovascular mortality rate. Despite recent advances in dialysis techniques, over 20% of US dialysis patients die every year. Protein-energy malnutrition and inflammation are common and usually concurrent in chronic kidney disease patients, and have been implicated as the main cause of high mortality. We reviewed the pathophysiology of the malnutrition-inflammation complex syndrome and its potential modulation by dietary and other nutritional interventions in chronic kidney disease patients. RECENT FINDINGS: The malnutrition-inflammation complex syndrome is a main cause of the atherosclerotic cardiovascular disease epidemic in chronic kidney disease. This may be by virtue of the syndrome's inflammatory components. Malnutrition and inflammation lead to weight loss over time, i.e. cachexia in slow motion, and result in decreased serum cholesterol and homocysteine levels. A 'reverse epidemiology' of cardiovascular risk factors is observed in chronic kidney disease, in that obesity, hypercholesterolemia and hyperhomocysteinemia are paradoxically associated with better survival. Among the possible etiologies of the malnutrition-inflammation complex syndrome, anorexia, low nutrient intake and oxidative stress are theoretically amenable to dietary modulation; however, the bulk of findings are epidemiological. SUMMARY: There is no consensus as to how to correct the malnutrition-inflammation complex syndrome in chronic kidney disease patients. Because the malnutrition-inflammation complex syndrome is multifactorial, its correction probably requires a battery of simultaneous interventions, rather than one single modality. Clinical trials focusing on the syndrome are currently non-existent and are therefore urgently required to improve poor clinical outcome in chronic kidney disease patients.

Humans↗
PubMedDate not supplied

Dental fusion and dens evaginatus in the permanent dentition: literature review and clinical case report with conservative treatment.

This clinical case report describes concomitant developmental disorders in the permanent dentition. The concurrence of bilateral dens evaginatus and dental fusion is a rare dental anomaly. Dental fusion is characterized by the union of 2 adjacent teeth at the crown level, which produces the formation of an enlarged clinical crown. Dens evaginatus is an enamel elevation similar to a cusp, generally located in the main groove of molars and premolars. The etiology of both anomalies is uncertain. The purpose of this paper was to review the related literature and present a clinical case where both anomalies are present.

Adolescent↗
PubMed1994

Diagnostic validity of schizophreniform disorder.

OBJECTIVE: The author examined the validity of schizophreniform disorder as defined in DSM-III and DSM-III-R by critically reviewing the current literature. METHOD: Thirty publications that met specific inclusion criteria were identified and reviewed. To organize information relevant to the question of validity, the data were divided into three general classes of validators: antecedent, concurrent, and predictive. When possible, meta-analyses of specific validators were performed according to the summary odds ratio method of Mantel-Haenszel. RESULTS: The findings of this review failed to provide support for the validity of schizophreniform disorder, as it is currently defined, as a distinct diagnostic entity. In addition, the review did not provide strong support for schizophreniform disorder as representing a subtype of schizophrenia or affective illness. Instead, the data suggest that the current diagnostic criteria for schizophreniform disorder identify a heterogeneous group of patients with new-onset schizophrenia, schizoaffective disorder, and atypical affective disorder and a small subgroup with a remitting nonaffective psychosis. CONCLUSIONS: This review suggests that the diagnosis of schizophreniform disorder has limited clinical utility. Patients meeting criteria for schizophreniform disorder should instead be diagnosed as having psychotic disorder not otherwise specified until additional clinical information (e.g., course of illness) becomes available. Future research will require prospective longitudinal follow-up of patients with new-onset affective and nonaffective psychoses to identify the subgroup with "true" schizophreniform disorder, i.e., a remitting nonaffective psychosis.

Confidence Intervals↗
PubMed1988

Monoamine oxidase inhibitors and anaesthesia. A review.

There has been a recent renewal of interest in the use of monoamine oxidase inhibitors in psychiatry. The concurrent administration of anaesthetic agents, particularly narcotic analgesics, is often a cause for concern. Although many monoamine oxidase inhibitor-drug interactions have been reported, in practice it is only the interaction with pethidine which has led to fatalities. What is not appreciated is that the monoamine oxidase inhibitor-pethidine interaction has two distinct forms-"excitatory" and "depressive". It is this lack of appreciation that has led to much confusion when dealing with patients taking monoamine oxidase inhibitors.

Anesthesia↗
PubMed2000

Perioperative deaths: a further comparative review of coroner's autopsies with particular reference to the occurrence of fatal iatrogenic injury.

INTRODUCTION: In previous triennial reviews of Coroner's perioperative autopsies conducted during the periods 1989 to 1991 and 1992 to 1994, it was observed that the necropsy incidence of such deaths rose from 2% to 2.6% (P < 0.05). Concurrently, the rate of iatrogenic deaths had nearly doubled from 15.2% to 28.8% (P < 0.02). These findings spurred a review of the subsequent triennium (1995 to 1997), in order to monitor the apparent rise in these trends and to study the frequency and occurrence of iatrogenic deaths in relation to the number of invasive procedures performed, as well as during emergency and elective procedures. MATERIALS AND METHODS: A retrospective (descriptive and comparative) study, comprising a clinico-pathological review of a series of 270 perioperative deaths (defined as deaths occurring during or after invasive therapeutic or diagnostic procedures, up to a week after discharge, and excluding cases of major trauma from suicides, homicides, as well as road and industrial accidents) reported to the Coroner, for which autopsies were conducted at the Department of Forensic Medicine from 1995 to 1997. RESULTS: The necropsy incidence of 4.4% (270/6074) represented a significant rise over the previous triennia (P < 0.01). As in previous years, there was a predominance of males (M:F = 1.65:1) and middle-aged to elderly patients (range 0 to 92 years, mean 55.8 years, median 63 years), most of whom had died after a variable, but usually brief, postoperative interval [0 to 97, 4.2, 1 day(s)] and a more variable period of hospitalisation (< 1 to 289, 12.6, 7 days). A total of 408 invasive procedures were performed, amounting to an average of 1.5 per patient; 101 patients (37.4%) underwent multiple (> 1) interventions, which were initially classified as elective procedures in 27 cases. There were 66 (24.4%) iatrogenic deaths, of which 2 (0.7%) were due to anaesthetic mishaps; 18/64 iatrogenic deaths, unrelated to anaesthesia, occurred after the first postoperative day. The proportions of such deaths amongst patients subjected to multiple interventions, or initial elective procedures, were more than twice as high as amongst those undergoing single procedures, and those initially classified as emergencies (35.6% versus 16.6% and 33.3% versus 13.2%, respectively; P < 0.01). Only 51/66 (77.3%) iatrogenic deaths received Coroner's verdicts of misadventure; no verdict of criminal negligence was recorded during the period in question. CONCLUSIONS: There appears to have been a steady increase in the number of perioperative deaths reported to the Coroner over the previous triennia (1989 to 1997) for which autopsies were conducted. While this observation may not denote an increase in perioperative morality rates per se, it may be indicative of an increasingly "aggressive" or defensive approach to the clinical management of seriously ill patients, particularly over the past decade. Although the rate of iatrogenic deaths appears to have stabilised, it is too early to say whether this apparent trend will persist in the future. It is perhaps not surprising that the risk of iatrogenic injury appears to increase with the number of interventions performed; however, it is not clear why initial, supposedly elective, interventions should be associated with an apparently greater risk of iatrogenic injury than those classified as emergency procedures. The substantial divergence between the autopsy finding of an iatrogenic death and the corresponding Coroner's verdict of misadventure may be comforting to clinicians, but certainly warrants further examination.

Adolescent↗
PubMed2002

Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review.

BACKGROUND: Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most western countries. This has resulted in an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of younger people experience more than one chronic illness. Large numbers of these may require repeated admissions to hospital for acute or episodic care that is superimposed upon the needs of their chronic conditions. AIM: To explore the issues that circumscribe the complexities of caring for people with concurrent chronic illnesses, or comorbidities, in the acute care setting and postdischarge. METHODS: A literature review to examine the issues that impact upon the provision of comprehensive care to patients with comorbidities in the acute care setting and postdischarge. FINDINGS: Few studies have investigated this subject. From an Australian perspective, it is evident that the structure of the current health care environment has made it difficult to meet the needs of patients with comorbidities in the acute care setting and postdischarge. This is of major concern for nurses attempting to provide comprehensive care to an increasingly prevalent group of chronically ill people. CONCLUSION: Further research is necessary to explore how episodic care is integrated into the on-going management of patients with comorbidities and how nurse clinicians can better use an episode of acute illness as an opportunity to review their overall management.

Acute Disease↗