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At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

[Descending Necrotizing Mediastinitis. Results of Medical-Surgical Treatment in 17 Cases ].

UNLABELLED: Descending necrotizing mediastinitis (DNM) is a serious disease of the mediastinum; early diagnosis and treatment may lower the high mortality rate of this disease. OBJECTIVE: To know the frequency of DNM in an intensive respiratory care unit. MATERIAL AND METHODS: This is a retrospective, transversal, and observational trial of a series of consecutive cases. In a period from January 1, 1990 to December 31, 2000, among 1,560 patients, we found 17 patients with DNM according with selection criteria. RESULTS: Fifteen males and two females, mean age 38.9 years SD +/- 14.5 years, were studied. In 10, tracheostomy was practiced previously. Seventeen cases had different kinds of previous abscesses, seven periodontal (47%), six retropharyngeal (35.5%), and four (23.5%) submaxillary. All cases were subject to thoracotomy. The most frequent postoperative complications were septic shock in 10 cases (58.8%), eight acute pulmonary damage (47%), six gastrointestinal bleeding (35.6%) and three acute respiratory insufficiency syndrome (11.6%). Seven deaths were registered and 10 patient survived. CONCLUSIONS: Statistical significance found between survival patients vs those who died was 31.9 +/- 8.6 vs 48.1 +/- 14.1 (p < 0.05) and in those with early tracheostomy 8.0 vs 28.6 (p = 0.68). Death occurred most frequently due to septic shock, specific mortality in this group of patients was 29%. Although DNM is a rare entity, 1.08% of all reviewed cases, must be treated immediately due to high mortality. The importance of early antimicrobial and surgical treatments is stressed.

Abscess↗
PubMedDate not supplied

[Occupational asthma and biological damage: adequate compensation?].

The evaluation of the damage to biological and relational capacities of the subject is the novel approach of the Italian Insurance Regulation Decree N(o) 38/2000 for compensating occupational asthma (OA). In this study we aimed to apply retrospectively the novel rating system to mild OA. From a data base of 201 diagnosis of OA collected in the 1987-97 decade 85 eligible consecutive cases of mild asthma according to the criteria of NIH/WHO guidelines on asthma were studied. Records on compensation were documented for 41 subjects. The average difference between novel scales and the actual rating individually assessed by Italian National Agency for compensation through criteria used at that time was 45.6 +/- 20%. The average difference between novel scales and rating calculated with guidelines considering the measurement of non-specific bronchial hyperreactivity developed by international experts and American Thoracic Society, endorsed by American Medical Association, was 41.5 +/- 12%. Within the actual rating individually assessed with previous Italian Insurance criteria no significant relationship (r=-0.20, p=0.2) was shown with bronchial responsiveness to methacoline expressed as provocative dose causing a 20% fall in FEV1 (PD20FEV1 microg of mch). A significant (p<0.05) relationship was observed with age at the time of OA diagnosis (r=0.37, p=0.017) and with duration of exposure (r=0.34, p=0.034). This study suggests that scales of the Insurance Regulation Decree N(o) 38/2000 grading mild OA underevaluate biological damage/impairment with reference both to previous practice in Italy and to international criteria guidelines. Among the parameters of evaluation methacoline challenge should be considered an adequate tool in measuring biological damage in OA for medicolegal purpose.

Asthma↗
PubMed2005

Population-based evaluation of the management of antithrombotic therapy for atrial fibrillation.

BACKGROUND: Oral anticoagulation is an effective therapy for the prevention of cardioembolic complications in patients with atrial fibrillation. However, previous practice reviews have indicated that oral anticoagulants are often underused in this setting. Most of those reports have focused on reviews of hospitalized and institutionalized patients, or small geographical areas. OBJECTIVES: To determine the use of antithrombotic therapy for the treatment of atrial fibrillation in Nova Scotia and to survey the knowledge of antithrombotic therapy for atrial fibrillation among a concurrent cohort of primary care and specialist physicians involved in the management of patients with atrial fibrillation. PATIENTS AND METHODS: Patients with atrial fibrillation were identified through outpatient electrocardiography clinics held throughout Nova Scotia. Following consent of the primary care physicians, patients were contacted and completed a survey about their current management. Family physicians and specialists in Nova Scotia were also surveyed about the management of atrial fibrillation with antithrombotic therapy through the receipt of one of four case scenarios. RESULTS: Four hundred twenty-five patients participated in the cross-sectional survey. The mean patient age was 70.6 years, 255 (60%) were male and 398 (93.6%) had at least one risk factor for stroke in addition to atrial fibrillation. Two hundred ninety-four patients (69.2%) were receiving oral anticoagulants either alone (61.9%) or in combination with acetylsalicylic acid (ASA) (7.3%). An additional 85 patients (20%) received ASA alone. There was no difference in the rates of prescription of oral anticoagulants between elderly patients (75 years of age and older) and those younger than 75 years (71.7% versus 67.3%, 95% CI -13.1% to 4.5%; P=0.34). Overall, 72.0% of patients were receiving antithrombotic therapy in accordance with the 2001 guidelines of the American College of Chest Physicians, with no difference in the rates between individuals younger than 75 years (72.2%) and those over 75 years of age (71.7%) (absolute difference -0.5%, 95% CI -9.2% to 8.1%). Physician responses to case scenarios indicated that knowledge was high among both general practitioners and specialists regarding the appropriate use of oral anticoagulants for the prevention of thrombotic complications associated with atrial fibrillation. CONCLUSIONS: The appropriate use of oral antithrombotic therapy for the prevention of thrombotic complications of atrial fibrillation occurs in approximately 72% of patients studied in Nova Scotia, and physician knowledge about this indication is high. There was no bias against prescribing oral anticoagulants to elderly patients. The findings suggest that with time, education and evidence have positively impacted the use of antithrombotic therapy in these patients.

Administration, Oral↗
PubMed2005

[Prevention of periprocedural myocardial damage in patients undergoing percutaneous coronary intervention].

Myocardial injury during coronary intervention occurs in 10-40% of cases and is often characterized by a slight increase in the markers of myocardial necrosis, without symptoms, electrocardiographic changes or impairment of cardiac function. However, even small increases in creatine kinase (CK)-MB levels are an expression of a true and detectable infarction and may be associated with a higher follow-up mortality. The cause of CK-MB elevation in case of procedural complications is obvious; however, most cases of minor CK-MB elevation occur in patients with uncomplicated procedures with excellent final angiographic results. It has been suggested that the main mechanism explaining the occurrence of myocardial necrosis during otherwise successful coronary intervention may be distal microembolization of plaque components, an enhanced inflammatory state or total plaque burden and/or instability. Different treatments have been proposed to prevent myocardial injury during coronary intervention, including nitrate infusion, intracoronary beta-blockers, adenosine and IIb/IIa inhibitors, but none of these (apart from the use of IIb/IIIa inhibitors) have been routinely introduced into clinical practice. Previous observational studies suggested a beneficial effect of pre-treatment with statins in this setting; the ARMYDA (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) trial is the first prospective, randomized, placebo-controlled study, evaluating the effects of 7-day therapy with 40 mg/day of atorvastatin on post-procedural release of markers of myocardial damage in patients with stable angina undergoing percutaneous intervention. In this study therapy with atorvastatin was associated with an 80% risk reduction in the occurrence of periprocedural myocardial infarction, as well as with a significant reduction in post-intervention peak levels of all markers of myocardial damage. The mechanisms underlying the beneficial effects of atorvastatin may be an inflammatory action reducing myocardial injury necrosis due to microembolization, an improvement in endothelial function on microcirculation, and direct myocardial protection.

Actuarial Analysis↗
PubMed2006

Molecular imaging with 123I-FIAU, 18F-FUdR, 18F-FET, and 18F-FDG for monitoring herpes simplex virus type 1 thymidine kinase and ganciclovir prodrug activation gene therapy of cancer.

UNLABELLED: The ability to monitor tumor responses during prodrug activation gene therapy and other anticancer gene therapies is critical for their translation into clinical practice. Previously, we demonstrated the feasibility of noninvasive in vivo imaging with 131I-5-iodo-2'-fluoro-1-beta-D-arabinofuranosyluracil (131I-FIAU) for monitoring herpes simplex virus type 1 thymidine kinase (HSV1-tk) cancer gene expression in an experimental animal model. Here we tested the efficacy of SPECT with 123I-FIAU and PET with 5-18F-fluoro-2'-deoxyuridine (18F-FUdR), 2-18F-fluoroethyl-L-tyrosine (18F-FET), and 18F-FDG for monitoring tumor responses during prodrug activation gene therapy with HSV1-tk and ganciclovir (GCV). METHODS: In the flanks of FVB/N female mice, 4 tumors per animal were established by subcutaneous injection of 1 x 10(5) cells of NG4TL4 sarcoma cells, HSV1-tk-transduced NG4TL4-STK cells, or a mixture of these cells in different proportions to model different efficacies of transfection and HSV1-tk gene expression levels in tumors. Ten days later, the animals were treated with GCV (10 mg/kg/d intraperitoneally) for 7 d. Gamma-Imaging with 123I-FIAU and PET with 18F-FUdR, 18F-FET, and 18F-FDG were performed before and after initiation of therapy with GCV in the same animal. RESULTS: Before GCV treatment, no significant difference in weight and size was found in tumors that expressed different HSV1-tk levels, suggesting similar in vivo proliferation rates for NG4TL4 and NG4TL4-STK sarcomas. The accumulation of 123I-FIAU at 24 h after injection was directly proportional to the percentage of NG4TL4-STK cells in the tumors. The 123I-FIAU accumulation at 4 and 7 d of GCV therapy decreased significantly compared with pretreatment levels and was proportional to the percentage of HSV1-tk-positive tumor cells. Tumor uptake of 18F-FUdR in all HSV1-tk-expressing tumors also decreased significantly compared with pretreatment levels and was proportional to the percentage of HSV1-tk-positive tumor cells. The accumulation of 18F-FET decreased minimally (about 1.5-fold) and 18F-FDG decreased only 2-fold after 7 d of GCV therapy, and the degree of reduction was proportional to the percentage of HSV1-tk-positive tumor cells. CONCLUSION: We have shown that gamma-camera imaging with 123I-FIAU was the most reliable method for prediction of tumor response to GCV therapy, which was proportional to the magnitude of HSV1-tk expression in tumor tissue. 123I-FIAU imaging can be used to verify the efficacy of elimination of HSV1-tk-expressing cells by therapy with GCV. PET with 18F-FUdR reliably visualizes proliferating tumor tissue and is most suitable for the assessment of responses in tumors undergoing HSV1-tk plus GCV prodrug activation gene therapy. PET with 18F-FDG or 18F-FET can be used as additional "surrogate" biomarkers of the treatment response, although these radiotracers are less sensitive than 18F-FUdR for monitoring tumor responses to prodrug activation gene therapy with HSV1-tk and GCV in this sarcoma model.

Animals↗
PubMed1990

[Blood bank dictionary, definition of the concept and blood unit status for blood recipients--an electronic data processing system].

The definition of terms using the blood bank data dictionary results in a number of advantages in practice. Previously vague terms could be clearly defined when they are broken down into their constituent parts. The relationships within a blood bank can be more precisely documented by working with standard terms. The descriptions within the specification are thereby unambiguous and in this way a precise program specification can be achieved. Standardized terms facilitate the functional comparison of programs from different authors or different software sources. The use of defined terms within wards and the blood bank area results in more transparency even before the introduction of data processing.

Blood Banks↗
PubMedDate not supplied

[Strategy of multiplex analysis of STR-loci polymorphism of Y-chromosome on the basis of "minimal haplotype"].

A molecular-genetic analysis of Y chromosome is a convenient tool of paternal affinity determination. This method is now widely introduced in expert practice. Previous experience in typing of Y chromosome is outlined. Strategy of development and experience in operating a multiplex system for a simultaneous analysis of seven STR loci of Y chromosome is discussed.

Chromosomes, Human, Y↗
PubMed1991

[Salt fluoridation--present knowledge, results, experiences].

On the occasion of the introduction of salt fluoridation in Germany a survey of international results and experiences of salt fluoridation is given. Recommendations for successful caries prevention result from salt consumption dates and previous practice of dental prevention.

Dental Caries↗
PubMedDate not supplied

AIDS-related risk factors, medical diagnosis, do-not-resuscitate orders and aggressiveness of nursing care.

Three variables were experimentally manipulated through simulation in six case study vignettes: AIDS-related risk factors (gay v. IVDU), medical diagnosis (AIDS v. non-AIDS), and DNR orders (DNR order v. no DNR order). Following each vignette, the same 13-item, 6-point Likert-type Aggressiveness of Nursing Care Scale (ANCS) was used to measure nurses' attitudes toward aggressiveness of nursing care. Questionnaires were randomly assigned to 600 acute care nurses. Although AIDS-related risk factors were not found to influence ANCS scores, a non-AIDS medical diagnosis and DNR orders significantly reduced aggressiveness of nursing care attitudes. Study findings did not vary according to nurses' age, academic preparation, or previous practice experience with persons with AIDS or DNR orders.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Treatment of torture survivors and their families: the nurse's function.

Torture has always existed. Whereas it was previously practiced publicly to warn citizens of a similar fate if they violated the law, today torture takes place mostly behind closed doors. The responsible authorities and governments deny its existence. And the survivors rarely talk about what they have been exposed to. Thus a wide misbelief as to the real extent of torture and the ensuing physical and psychological problems of the torture survivors who are in dire need of professional help. In keeping with ICN's concern for human rights and its emphasis on the ethical responsibilities of nurses, ICN requested the following article on torture and the nurse's role in the treatment of torture survivors and their families. It is hoped that it will stimulate discussion by nurses and be used as a basis for teaching about torture in nursing schools.

Denmark↗
PubMed1987

[Acute arthroscopy in children].

The diagnostic value of arthroscopy in hemarthrosis of unknown origin of the knee joint in children is analysed on the basis of reports in the literature and our own patients. Of a total of 325 acute arthroscopies, 12 were carried out in children. 14 individual findings were made: 3 ruptures (non osseous) of anterior cruciate ligament, 4 meniscal tears, 4 osteochondral lesions, 1 cartilage damage in spontaneously repositioned patellar luxation and 2 other findings. Surgical treatment was indicated in 7 out of the 12 children. Acute arthroscopy is rarely employed in children. This is because corresponding injuries are very much rarer as a whole and not because the conditions are less serious. In our opinion, acute arthroscopy is called for in a greater number of pediatric patients than previously practiced.

Adolescent↗
PubMed1980

Loudness growth of musically complex stimuli.

Young adults (N = 11) with musical training, and with previous practice in the use of direct magnitude estimation of loudness for pure tones, judged the loudness of 3 orchestral excerpts each lasting 15-25 sec, varied in 5 -db steps over a 35 -db range. Excerpt I was relatively constant in both pitch and loudness; Excerpt II varied in loudness but did not change greatly in pitch; and Excerpt III changed both in pitch and loudness. The slopes of power functions for loudness judgments as a function of SPL fell within the usual range for pure-tone and for white-noise stimuli, as did indexes of determination; but both measures differed significantly from those in the literature for continuous speech. Apparently the acoustic variability in speech is an insufficient explanation for the difference between speech and non-speech stimuli in these areas, a finding which points to the contribution of non-acoustic parameters, such as semantic meaning, in loudness judgments for speech.

Acoustic Stimulation↗
PubMed1997

Gout and risk for subsequent coronary heart disease. The Meharry-Hopkins Study.

BACKGROUND: Patients with gout are encountered frequently in clinical practice. Previous studies have suggested that hyperuricemia and gout may represent risk factors for coronary heart disease (CHD), the most common cause of death in American men. METHODS: Prospectively collected data from 2 longitudinal cohort studies of former medical students--371 black men in the Meharry Cohort Study and 1181 white men in the Johns Hopkins Precursors Study--were analyzed. The development of gout and of CHD was determined by physician self-report, and validated by using published criteria. The risk for CHD associated with gout was evaluated using Cox proportional hazards analysis. RESULTS: During a median follow-up of 30 years, there were 38 gout cases and 44 CHD events among the Meharry men, and 68 gout cases and 138 CHD events among the Hopkins men. Prior gout was not associated with an increased risk for incident CHD (relative risk = 1.20; 95% confidence interval, 0.37-3.92) among the Meharry men or among the Hopkins men (relative risk = 0.66; 95% confidence interval, 0.24-1.79). Multivariate analysis adjusted for known CHD risk factors did not alter these findings. CONCLUSION: These results, in black and white male physicians, do not suggest a role in men for targeting gout identification in the primary prevention of CHD.

Adult↗
PubMed2003

Measuring plant diversity in the tall threetip sagebrush steppe: influence of previous grazing management practices.

In July 2000, a 490-ha wildfire burned a portion of a long-term grazing study that had been established in 1924 at the US Sheep Experiment Station north of Dubois, Idaho, USA. Earlier vegetation measurements in this tall threetip sagebrush (Artemisia tripartita spp. tripartita) bunchgrass plant community documented significant changes in vegetation due to grazing and the timing of grazing by sheep. A study was initiated in May 2001 using 12 multiscale modified Whittaker plots to determine the consequences of previous grazing practices on postfire vegetation composition. Because there was only one wildfire and it did not burn all of the original plots, the treatments are not replicated in time or space. We reduce the potential effects of psuedoreplication by confining our discussion to the sample area only. There were a total of 84 species in the sampled areas with 69 in the spring-grazed area and 70 each in the fall- and ungrazed areas. Vegetation within plots was equally rich and even with similar numbers of abundant species. The spring-grazed plots, however, had half as much plant cover as the fall- and ungrazed plots and the spring-grazed plots had the largest proportion of plant cover composed of introduced (27%) and annual (34%) plants. The fall-grazed plots had the highest proportion of native perennial grasses (43%) and the lowest proportion of native annual forbs (1%). The ungrazed plots had the lowest proportion of introduced plants (4%) and the highest proportion of native perennial forbs (66%). The vegetation of spring-grazed plots is in a degraded condition for the environment and further degradation may continue, with or without continued grazing or some other disturbance. If ecosystem condition was based solely on plant diversity and only a count of species numbers was used to determine plant diversity, this research would have falsely concluded that grazing and timing of grazing did not impact the condition of the ecosystem.

Agriculture↗
PubMed2004

Neonatal transfusion practice.

Many previously widely accepted neonatal transfusion practices are changing as neonatologists become more aware of the risks to their patients of multiple blood product transfusions. Recent literature and research on neonatal transfusion practice are here reviewed, and practical guidelines and trigger thresholds for blood products commonly used in neonatal medicine are proposed.

Albumins↗
PubMed1998

Availability of color fundus photographs from previous visit affects practice patterns for patients with diabetes mellitus.

OBJECTIVE: To determine whether access to color fundus photographs from a patient's previous visit would alter the recommendations rendered to a cohort with diabetic retinopathy. PATIENTS AND METHODS: One hundred sixty patients with diabetic retinopathy returning for a follow-up visit and who had color fundus photographs obtained at a previous visit were evaluated by trained retina specialists. Their clinical impression and recommendations regarding management of diabetic retinopathy were recorded without reference to previous photographs. Color fundus photographs from the patient's most recent visit were then reviewed and new recommendations with regard to appropriate treatment and follow-up were recorded. RESULTS: In 21% of cases, after reviewing the patient's most recent color fundus photographs, the clinical recommendation changed. In 14% of cases, photographs clearly demonstrated that the patient's condition was stable or improved, resulting in a change from recommending treatment to recommending deferral of treatment. In 4% of cases, photographs clearly demonstrated clinical worsening and the recommendation was changed from observation to treatment. In 3% of cases, review of photographs prompted a change in the recommended follow-up interval. CONCLUSION: Access to color fundus photographs from a patient's previous visit frequently changed the clinical recommendations made to patients with diabetic retinopathy regarding appropriate treatment and follow-up. Availability of color fundus photographs therefore has implications about quality of care and may affect the cost of care.

Adult↗
PubMed1997

The effects of a 0.12% chlorhexidine-digluconate-containing mouthrinse versus a placebo on plaque and gingival inflammation over a 3-month period. A multicentre study carried out in general dental practices.

Several previous studies have evaluated the effects of 0.12% chlorhexidine digluconate (ChD) mouthrinses on plaque and gingival inflammation. However, previously, none have been based in general dental practices. The aim of this study was to evaluate the potential to conduct controlled periodontal clinical trials in co-operation with general dental practitioners (gdps). The project took place in 5 general dental practices in the South of England. 121 healthy subjects (24 at 4 sites and 25 at the 5th), aged 18-65 years, mean 35 +/- 12) years participated in a double-blind, randomised study during which they received full mouth assessments for plaque and gingival bleeding at baseline, 6 and 12 weeks. 60 subjects were randomly assigned to use the 0.12% ChD mouthwash and 61 the placebo. The assessments were carried out by 5 gpds, who had previously achieved inter-examiner kappa scores of 0.78-0.85 (mean 0.81) for the plaque index (PII), and of 0.73-0.94 (mean 0.87) for a modified gingival index (mGI), and who maintained kappa scores of 0.51-0.90 for PII and of 0.73-1.00 for mGI during the 12 months required to complete the study. 98 subjects (48 ChD and 50 placebo) completed the study. Even though the baseline levels of plaque and gingivitis were low, by week 12, mean whole mouth plaque score of the ChD mouthwash users had fallen from 1.33 at baseline to 0.96 and was significantly lower (p < 0.001) than for the placebo users, 1.31 at baseline to 1.13. Whole-mouth gingival bleeding score fell from 0.56 to 0.42 in the ChD mouthwash group but was unchanged (0.54-0.55) in the placebo group. A subsidiary data analysis which considered the effects at sites indicated that within these overall differences, the ChD users experienced almost 2 x the reduction from plaque score 2 at baseline at proximal molar sites over a 12-week period (50.6% ChD versus 27.6% placebo). It was concluded that 0.12% ChD mouthwash reduced plaque accumulation by 28% and gingival inflammation by 25% over a 12-week period, that it is feasible for a group of gdps to maintain high levels of inter-examiner consistency in the use of PII and mGI, that it is also feasible to carry out such a multicentre study in general dental practice, and that the use of mean mouth scores per subject to analyse the effects of mouthrinses may well mask variations in response throughout the mouth.

Adolescent↗
PubMed1999

Survey on repeat prescribing for acid suppression drugs in primary care in Cornwall and the Isles of Scilly.

BACKGROUND: Repeat prescriptions for acid suppression therapy represent an important burden on health care resources. AIM: To determine the prevalence of acid suppression therapy and its indications by general practitioners (GPs) in a larger sample of practices than previous studies. METHOD: Practices in Cornwall and the Isles of Scilly were invited to identify the number of patients on repeat prescription for acid suppression drugs in their practice, to review the indication for treatment in a sample of 50 patients, and to indicate the mode of review of these patients. RESULTS: Out of 77 practices, 42 (55%) participated in the study. Overall, 5% of patients were authorized to receive a repeat prescription for acid suppression drugs. Repeat rates varied between practices, from 1.68% to 11.11%. Repeat rates increased with age and were higher in men than in women. Only 41% of patients had a proven diagnosis of gastro-oesophageal reflux disease or peptic ulcer. A review of notes was the most frequent way (36%) stated by GPs to review acid suppression therapy. CONCLUSION: The repeat rate found in our study was higher than that found in previous studies. A high proportion of older patients in Cornwall, as well as a continuing increase in the prescription of acid suppression drugs, may account for these results.

Adolescent↗