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PubMed1991

Low molecular weight hydroxyethyl starch 6% compared to albumin 4% during intentional hemodilution.

Intentional normovolemic hemodilution was chosen as the model to compare a 6% low molecular weight hydroxyethyl starch (LMW HES) to 4% albumin. The study ran over the plasma exchange period for 24 h. Nine patients, scheduled for abdominal aortic surgery, were included in each group. After basal measurements, blood was withdrawn and simultaneously replaced by either 4% albumin (Group 1) or 6% LMW HES (Group 2) to achieve a final hematocrit of approximately 30%. Hemodynamic blood oxygen gas and hormonal plasma levels were determined before hemodilution then at 30 min, 1, 2, 3, and 24 h after the end of hemodilution. Basal value for total blood volume was 4377 +/- 162 ml in group 1 and 4138 +/- 315 ml in group 2. As in both groups the decrease in blood cell volume was exactly compensated by the increase in plasma volume, no significant change in total blood volume (respectively 4432 +/- 159 and 4305 +/- 267 ml) was observed. Throughout the study, in both groups, no significant change in mean arterial and right atrial pressures was observed. In group 2 (LMW HES), a significant increase of pulmonary capillary wedge pressure was noted 120 min after hemodilution. After hemodilution, despite a significant decrease in arterial oxygen O2 content, systemic oxygen transport did not significantly vary until 24 h in relation to the increased cardiac index. An increase in O2 extraction was observed after the exchange but no further increase was observed until the 24 h. No significant changes either in global O2 consumption or in lactate concentration were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Predicting the intentions and behavior of exercise initiates using two forms of self-efficacy.

The general objective of the study was to examine the influence of various aspects of self-efficacy on the exercise attendance of novice exercisers. This objective had three distinct features. First, self-efficacy was operationalized as both perceptions to overcome barriers and appraisals of ability to schedule regular exercise sessions. Second, a more unstructured, less regimented, form of exercise that required greater personal control was examined-the forms of activity chosen and self-regulated by novice participants. Third, individuals in the initiation stage of their exercise history were studied. Results indicated that both forms of efficacy (barrier and scheduling) significantly predicted behavioral intention (BI) throughout the exercise program (R2 changes = .13-.26, p's < .02). BI was found to be the best predictor of the first 2 months of attendance (R2 change = .12, p < .05), while scheduling efficacy and past behavior best predicted attendance during the last 2 months (R2 change = .16 and .24, p < .02 and p < .001, respectively). A model combining both social cognitive variables (efficacy beliefs) and behavioral variables (past attendance) captured more variation in predicting the last 2 months of attendance than a model involving only social-cognitive variables.

Adaptation, Psychological↗
PubMed1994

Comparison of muscle flaps and delayed secondary intention wound healing for infected lower extremity arterial grafts.

Selective preservation of infected arterial grafts is an alternative to graft excision. The purpose of this study was to compare the outcome and cost of treating infected lower extremity arterial grafts with either muscle flaps (MFs) or delayed secondary intention (DSI) wound healing. Between 1985 and 1991 we treated 28 graft infections by graft preservation. All grafts (19 polytetrafluoroethylene, 8 autologous vein, and 1 Dacron) were patent with intact anastomoses and showed no signs of sepsis. Wounds in 18 patients were treated by repeated, aggressive operative debridement and allowed to heal by DSI. Wounds in 10 patients were treated with MFs (4 sartorius, 3 gracilis, 1 rectus abdominis, 1 semimembranous, and 1 gastrocnemius). Costs included anesthesiologists' and surgeons' fees, operating room charges, and daily semiprivate and ICU bed charges. Four (14%) patients died from cardiac complications (1 DSI and 1 MF), sepsis (1 MF), and anastomotic hemorrhage (1 DSI). Of the 24 survivors, 4 patients treated by DSI required graft excision for nonhealing wounds (2), graft thrombosis (1), and recurrent infection (1). However, 3 of these 4 patients were not candidates for MFs because the wounds were not considered acceptable for a flap. Twenty (83%) grafts in survivors were successfully preserved after long-term follow-up (mean 26 mo). No survivors required an amputation. Twenty patients who did not require graft removal were compared for treatment by MF (n = 8) or DSI (n = 12). Two MFs (both sartorius) in survivors necrosed and a new flap was required to successfully preserve the graft.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children.

OBJECTIVE: To evaluate the risk of fulminant hepatic failure in relation to paracetamol overuse with therapeutic intent in febrile children. METHODS: It was a case control study. Paracetamol ingestion for the current febrile illness was compared between 25 cases of fulminant hepatic failure and 33 hospital age matched controls. RESULTS: Supra-therapeutic doses of paracetamol (mean 145 mg/kg/day) were consumed by all 25 cases compared to none in the control group. Mean paracetamol level in the cases and controls were, respectively, 26.84 mg /dl and 0.051 mg /dl (p< 0.001). The mean duration of paracetamol intake prior to admission in cases was 3. 45 days compared to 1.85 days in the control group. Nineteen, 5 and 3 were, respectively, graded as hepatic encephalopathy grade 1, 2 and 3. All six patients in grade 2 and 3 had hepatomegaly compared to 78% in the grade 1. Four had jaundice and all were in grade 2 or 3. Mean alanine aminotransferase was 2781 U/L None of the randomly selected cases (6) had serological evidence of Hepatitis A, Hepatitis B or Dengue. Three cases died. CONCLUSION: Exposure to multiple supratherapeutic doses of paracetamol is a risk factor to develop fulminant hepatic failure in children with an acute viral like febrile illness.

Acetaminophen↗
PubMed2004

Failure of radioiodine treatment in Graves' disease intentionally caused by a patient: suspected Munchausen syndrome.

We experienced a case with Graves' disease in which radioiodine treatment failed probably because of intentional spitting out of capsules of radioactive iodide. Chemical analysis of the substances collected from the trash in the treatment room demonstrated that its profile was the same as that of the capsules for radioiodine administration. Measurement of the iodine concentrations in a blood sample obtained at 24 h after the administration of radioiodine indicated that the patient showed iodine excess. These findings suggest that this may be a case of Munchausen syndrome.

Adult↗
PubMed1997

Intentional on-line control of propulsive forces in human gait.

In locomotion, the capability to control and modulate intentionally the propulsive forces is fundamental for the adaptation of the body's progression, both in speed and direction. The purpose of this experiment was to determine how human beings can achieve such control on-line. To answer this question, four subjects walking steadily were faced with a linear increase in resistance (impeding forward displacement), lasting 3 s, once per minute. At the end of the variation, the new resistance was maintained. There were two tasks; in both tasks, in the initial steady state, the subjects had to walk steadily at 1.3 m s-1. As the resistance increased, subjects were either required to maintain their walking speed (compensation task) or to let the walking speed and amplitude adapt freely (no-intervention task). This provided an estimate of the effects of the perturbation alone. Throughout the experiment, the stride frequency (114 step min-1) was fixed by a metronome. Subjects maintained their stride frequency on both tasks. In the no-intervention task, walking speed was 1.3 and 1 m s-1 under normal and high resistance respectively. In the compensation task, under high steady resistance, walking speed was maintained by an increase in the activation gain of the neuromuscular synergy: all recorded muscles increased their EMG activity, but without any change in the shape of their activation profile throughout the cycle. During the transitional phases, however, as the resistance began to increase, the walking speed decreased temporarily (-2%) before returning rapidly to its initial value. By contrast, at the end of the resistance increase, no such changes in speed were observed. During the transitional phases, the on-line compensation for the resistance increase induced modifications in the shape of the activation burst in the medial gastrocnemius such that the transitional cycles clearly differed from the steady state cycles. The results observed in the compensation task suggest that the subjects used two different modes of control during steady states and transitional phases. In stable dynamic conditions, there appears to be an "intermittent control" mode, where propulsive forces are globally managed for the entire stance phase. As a result, no compensation occurred at the beginning of the perturbation. During the resistance increase, subjects appeared to switch to an "on-line control" mode in order to continuously adapt the propulsive forces to the time course of the external force, resulting in an observable compensation at the end of the resistance change.

Adaptation, Physiological↗
PubMed2005

Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies.

Most osteoporosis treatments have proven efficacy in reducing the risk of vertebral fractures, whereas evidence is less straightforward for prevention of non-vertebral fractures. Conclusions as to the efficacy of a treatment should be based primarily on analyses of the intention to treat (ITT) population rather than on exploratory subgroup analyses; however, non-vertebral anti-fracture efficacy has been largely derived by post-hoc subgroup analyses. This review and meta-analysis was performed to assess non-vertebral anti-fracture efficacy of several osteoporosis therapies, including a more stringent assessment of the ITT populations. Data on non-vertebral anti-fracture efficacy, a defined endpoint of the ITT analyses and confirmed by radiographs, were obtained from randomized, placebo-controlled, phase III clinical trials of at least 3-year duration. Meta-analyses were performed for the two bisphosphonates, alendronate and risedronate. Relative risks (RR), 95% confidence intervals (CI) and statistical significance for active treatment compared with placebo were calculated. Eleven clinical trials met the criteria for review, three of which showed statistically significant ( P < or =0.05) non-vertebral anti-fracture efficacy in the ITT population: two trials with risedronate and one trial with strontium. A meta-analysis showed significant reductions in the relative risk of non-vertebral fracture for both alendronate (RR=0.86; 95% CI: 0.76-0.97, P =0.012) and risedronate (RR=0.81; 95% CI: 0.71-0.92, P =0.001). Risedronate and strontium ranelate were the only treatments to show non-vertebral anti-fracture efficacy in this robust assessment of anti-fracture efficacy of osteoporosis therapy using ITT populations in trials of 3 years or more in duration. Risedronate was the only agent shown to demonstrate efficacy in more than one trial. Meta-analysis showed that both alendronate and risedronate provide non-vertebral anti-fracture efficacy.

Aged↗
PubMed2006

The influence of rTMS over the right dorsolateral prefrontal cortex on intentional set switching.

High frequency (HF) repetitive transcranial magnetic stimulation (rTMS) has an excitatory effect on neurons of a specific brain area. The dorsolateral prefrontal cortex (DLPFC) has been associated with executive functions, such as task set switching. One important experimental paradigm for investigating such higher order cognitive control is the task-switching (TS) paradigm. A TS paradigm requires switching between two conditional response tasks with mutually incompatible response-selection rules. In the present study, the influence of HF rTMS over the right DLPFC in healthy female volunteers on a modified TS paradigm was investigated. As expected, reaction time on cued switching trials decreased significant after rTMS, as compared to non-cued switch trials. No changes emerged after the placebo sham condition. Mood remained unchanged after rTMS. These findings demonstrate the role of the right DLPFC in cued intentional set switch initiation.

Adolescent↗
PubMed1998

Intravenous injection of India ink with suicidal intent.

We describe the case of a 33-year-old man who injected 4 ml of India ink into one of the median cubital veins with suicidal intent. He was hospitalized in good general condition 10 h after the injection. Abnormal laboratory test results were a leukocytosis, an oximetrically determined methemoglobin level of 36.9% (normal range: 1.5%) and a free hemoglobin level of 74 mumol/L (normal range: < 25 mumol/L). Toxicological examination showed the presence of nitrobenzene in blood and urine. Intravenous administration of vitamin C and tolonium chloride plus forced diuresis led to an improvement in cyanosis and a fall in the methemoglobin concentration. Repeated increase in the concentration of aminobenzene were successfully treated by hemodialysis with a high-flux dialyzer.

Adult↗
PubMed2001

Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum.

BACKGROUND: Within a 5-year period, 380 rectal carcinoma patients undergoing laparoscopic abdominoperineal excision or laparoscopic anterior resection were recruited to a multicenter study by 23 institutions in Germany and Austria. This study was initiated by the Laparoscopic Colorectal Surgery Study Group. RESULTS: One hundred forty-nine patients (39.2%) underwent abdominoperineal resection (APR), and 231 patients (60.8%) were treated by anterior resection (AR). The mean operating time was 208 min, and the conversion rate was 6.1%. Intraoperative complications, mostly vascular or bowel injuries, were observed in 22 patients (5.8%). Overall, a total of 257 postoperative complications and problems occurred in 143 patients, resulting in a morbidity rate of 37.6%. In the AR group, the anastomotic leakage rate increased as the distance of the tumor from the anal verge decreased. The perioperative mortality rate was low (6/1.6%). Most of the patients received a high transsection of the inferior mesenteric artery with radical lymph node dissection (342/90.0%); the mean number of recovered lymph nodes was 13.0, with considerable variation among the individual institutions. Intraoperative tumor cell spillage was reported in 12 patients (3.2%). Sufficient follow-up findings are available for 288 (77%) patients. To date, 19 patients have sustained a local recurrence (6.6%), and 30 (10.4%) have developed distant metastases. Within the (admittedly limited) mean follow-up of 24.8 months, the overall survival rate is 86.6%, the disease-free survival (freedom from both local recurrence and distant metastases) rate is 62.4% for APR, with the corresponding rates for AR being 71.7 and 54.8%, respectively, as established by the Kaplan-Meier function. These data show no alarmingly high recurrence rates at this time. CONCLUSION: In principle, laparoscopic anterior resection with curative intent generates considerably more reservations than laparoscopic abdominoperineal resection, which is technically much easier to perform.

Abdomen↗
PubMed2006

Frozen-section diagnosis of small adenocarcinoma of the lung for intentional limited surgery.

PURPOSE: To determine if Noguchi's classification can be evaluated accurately by frozen-section diagnosis before limited surgery. METHODS: We performed frozen-section diagnosis in 31 of 343 patients who underwent excision of primary lung cancer at our hospital between 1993 and 2004. All 31 patients had pulmonary adenocarcinoma, with a tumor diameter of < or = 20 mm. There were 20 men and 11 women, ranging in age from 42 to 79 years (mean, 63.2 years). We assessed the rate of correct Noguchi's classification by categorizing all lesions into the following three groups on the basis of tumor diameter: < or = 10 mm, 11-15 mm, and 16-20 mm. RESULTS: The overall rate of correct frozen-section diagnosis during surgery was 67.7%; being 100%, 41.7%, and 70% in the < or = 10 mm, 11-15 mm, and 16-20 mm groups, respectively. CONCLUSION: Limited surgery for primary lung cancer can be performed when the tumor diameter is < or = 10 mm, by confirming it as either type A or B according to Noguchi's classification, using frozen-section diagnosis. Thus, examination of frozen sections might be an important diagnostic procedure before intentional limited surgery for lung cancer.

Adenocarcinoma↗
PubMed2003

Intentional marginal excision of osteosarcoma of the proximal fibula to preserve limb function.

Three cases of osteosarcoma (stage IIB) of the proximal fibula were successfully treated by marginal excision that preserved the common peroneal nerve and lateral stabilizers of the knee joint. Caffeine-assisted chemotherapy was administered to three boys, ages 15, 17, and 11 years, and resulted in a complete response. Two patients initially presented with peroneal nerve palsy that resolved completely with preoperative chemotherapy. The subsequent intentional marginal procedures resulted in preservation of the common peroneal nerves, lateral collateral ligaments, and biceps femoris tendons. In two cases the collateral ligament and biceps tendon were reattached to the tibia with a spike washer or suture anchors, and in the third case they were reattached by suture only to the ligamentous and capsular structure of the tibia. All three patients have normal ankle and knee joint function without evidence of recurrence 122, 120, and 61 months after surgery, respectively. Preservation of limb function without compromising the principles of tumor surgery is a desirable goal in any patient but particularly in young patients. For patients with osteosarcoma of the proximal fibula, this approach provides a better quality of life than conventional wide excision.

Adolescent↗
PubMed2005

Chimpanzee (Pan troglodytes) intentional communication is not contingent upon food.

Studies of great apes have revealed that they use manual gestures and other signals to communicate about distal objects. There is also evidence that chimpanzees modify the types of communicative signals they use depending on the attentional state of a human communicative partner. The majority of previous studies have involved chimpanzees requesting food items from a human experimenter. Here, these same communicative behaviors are reported in chimpanzees requesting a tool from a human observer. In this study, captive chimpanzees were found to gesture, vocalize, and display more often when the experimenter had a tool than when she did not. It was also found that chimpanzees responded differentially based on the attentional state of a human experimenter, and when given the wrong tool persisted in their communicative efforts. Implications for the referential and intentional nature of chimpanzee communicative signaling are discussed.

Animal Communication↗
PubMed2006

Comparison of outcomes in Z-plasty and delayed healing by secondary intention of the wound after excision of the sacral pilonidal sinus: results of a randomized, clinical trial.

PURPOSE: Pilonidal sinus is a common disease, mostly among young males. Although the conventional surgery, secondary repair of the wound after wide excision with or without curettage, is not technically difficult, it takes a long time, weeks or months, for a wound to heal. In this study, we compared outcomes and complications of Z-plasty repair with outcomes and complications of delayed healing by secondary intention (conventional surgery). METHODS: In a randomized, clinical trial, we recruited 72 patients in each arm. All of the patients were operated on by a general surgeon and were followed up for variable periods. Patients in the Z-plasty arm were followed for a mean period of 22.01 months. Patients conventional surgery arm were followed for a mean period of 22.23 months. The main studied outcomes were healing of the wound and disease recurrence during the follow-up period. The main complications that were taken into account were bleeding, hematoma, infection, and recurrence. RESULTS: The two arms were comparable in the age and gender distributions, duration of disease, and history of any types of operations. The duration of hospitalization after the operation was shorter in the conventional surgery group (1.76+/-0.75 days vs. 2.86+/-0.73 days, P<0.001). However, wounds healed much faster in the Z-plasty group (15.4 vs. 41 days, P<0.001). Moreover, it took longer for patients in the conventional surgery group to return to normal activity (17.5 vs. 11.9 days, P<0.001). There was no difference in postoperative complications regarding bleeding, hematoma, infection, or recurrence during the follow-up period in two arms. CONCLUSIONS: Healing was considerably faster in patients who were treated with Z-plasty technique of wound closure. This procedure can be used as a desirable treatment for pilonidal sinus, which is a noncomplex method without increased rate of complications. Nonetheless, it might slightly increase the duration of hospitalization.

Adult↗
PubMed2006

Destination, future intentions and views on practice of British-based pharmacists 5 and 10 years after qualifying.

OBJECTIVES: The first ever Pharmacy Workforce Census of pharmacists in Great Britain (GB) was conducted in 2002, and repeated in 2003. Both census surveys aimed to gather empirical data on the employment profile of pharmacists to aid the workforce planning process. The aim of this paper is to compare the work profile and employment destination of two graduate cohorts of pharmacists to explore what changes take place in employment practices and how quickly they occur. SETTING: GB-based pharmacists. METHODS: A two-page postal questionnaire was sent to 38,000 GB-registered pharmacists in August 2003, to provide various data on employment patterns, intentions to work abroad, and desire to practise pharmacy. The pharmacists were contacted using addresses stored on the Pharmaceutical Register, a statutory record of all pharmacists and pharmacy premises held by the Royal Pharmaceutical Society of Great Britain (RPSGB). A sub-set of this large data set--pharmacists who qualified in 1992 and those who qualified in 1997--was selected for comparison. MAIN OUTCOME MEASURE: Sector of employment and strength of desire to practice. RESULTS: A response rate of 75% was achieved for the overall census, while the response rate from the two graduation cohorts was 62% and 58%. Larger proportions of women compared with men, even after only 5 years of working as a pharmacist, are either not working or work part-time. Among the women, these patterns increase significantly for those with a greater number of years on the Pharmaceutical Register. There is evidence that pharmacists move out of the two main sectors of practice (hospital and community) with increasing years on the Register, and some gender differences in job mobility are observed. The School of Pharmacy from which pharmacists graduate appears to have some effect on practice patterns although more research is needed to explore this further. Desire to practise pharmacy is weaker among those practitioners who work in the community sector of practice, and younger pharmacists are more likely to intend working abroad. CONCLUSIONS: Part-time work patterns are implemented fairly quickly after qualifying, particularly among the women pharmacists. Given that female students account for over 60% of all intake onto pharmacy courses current supply problems will continue if work patterns continue along this trajectory. The ability of the profession to meet current, never mind extended roles, is thus called into question.

Adult↗
PubMed1992

Determinants of intention to commit driving violations.

Ajzen's theory of planned behaviour was used to measure the attitudes and intentions of a large stratified sample of drivers (N = 881) towards four driving violations. Measures were taken of respondents' attitudes to four imaginary scenarios depicting their commission of the four violations concerned. Demographic subgroups of drivers within the sample were differentiated on the basis of their beliefs about and evaluations of their commission of the violations. We were able to identify attitude items differentiating the younger, statistically more "accident liable" drivers in the sample from their older, and statistically safer counterparts. The implications of using this approach to inform future road safety campaigns are discussed.

Adolescent↗
PubMed1979

Silicosis due to intentional inhalation of abrasive scouring powder. Case report with long-term survival and vasculitic sequelae.

Silicosis due to inhalation of abrasive scouring powder is now an unusual event. We report a nonindustrial case of acute silicosis due to intentional inhalation of commercial, silica-containing scouring powder. This case is unique in that the patient had a 20 year survival (after onset of symptoms) with typical roentgenographic and histopathologic changes of silicosis, and evidence of immune complex disease in extrapulmonary tissues.

Adult↗
PubMed1978

Relationships between sensory input, motor output and unit activity in interpositus and red nuclei during intentional movement.

The relationship between unit activity in interpositus (8 units) and red nuclei (11 units) and the EMG activity of the biceps during intentional elbow flexion movements was investigated by means of cross-correlation analysis. This analysis showed that there were long-lasting (200 msec) changes in the probability of EMG activity both before and after a single spike in neurons which covaried with the motor output. The dependence of the activity of these units on sensory inputs was investigated by (1) calculating the quantitative relationship between angular displacement and unit activity and (2) recording unit activity after the sensory input from peripheral afferents had been eliminated by dorsal rhizotomy.

Action Potentials↗