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PubMed1989

[Personal experiences concerning the usefulness of the exercise test in the diagnosis of ischemic heart disease in aged patients with atypical symptomatology].

Present-day therapeutic possibilities, both medical and surgical, make it mandatory for the practitioner to identify elderly patients with ischemic heart disease which in these patients often presents with atypical symptoms. Twenty elderly patients with not clear-cut symptoms of coronary disorder were submitted to an exercise test on a walking belt. In 14 (70%) the test was positive and in 8 of these 14 cases previous dynamic electrocardiography had not yielded signs of ischemia. The authors consider correctly performed exercise testing the best means for identifying the often not diagnosed coronary impairment of elderly subjects.

Age Factors↗
PubMed1995

Results of space experiments.

Life science research in space was started in Europe with the first Biostack experiment flown onboard Apollo 16 in 1972. Biostack was designed to investigate the biological effects of single heavy ions of cosmic radiation. Among several undertakings towards this goal, the Biostack achieved the highest precision in the determination of the spatial correlation of the observed biological response of single test organisms to the passage of single heavy ions, which is the mandatory requirement. It also provided information on the influence of additional spaceflight factors, such as microgravity, on radiation effects and measurements of the spectrum of charge and energy of the cosmic radiation. The experiment was performed as an international cooperation effort. This report gives a summary of the biological data accumulated in this and the follow-on experiments of the Biostack program.

Animals↗
PubMed1986

Penetrating wounds of the thorax.

While penetrating wounds of the thorax are rather uncommon in The Netherlands, they are frequently encountered in the emergency centres of the United States. Thoracic wall penetration may occur during times of warfare, during social altercations or as a result of industrial accidents. In civilian practice, such wounds are most often the result of injury with guns, knives or other sharp objects. Patients with penetrating thoracic wounds should be expeditiously transported to a trauma centre. Pre-hospital intravenous fluids, pleural decompression and anti-shock garments are contraindicated. On arrival in the emergency room, establishment of a patent airway, administration of intravenous fluids, pleural decompression and early X-ray examination of the chest are mandatory.

Diagnostic Tests, Routine↗
PubMed2006

German guidelines for reprocessing endoscopes and endoscopic accessories: guideline compliance in Frankfurt/Main, Germany.

Guidelines for reprocessing flexible endoscopes have been published in many countries. The present survey investigated compliance with German guidelines in all hospitals and private practices in Frankfurt/Main, Germany. In 2003, all endoscopic units in Frankfurt/Main [15 hospitals and 23 private practices (10 large practices performing >1,000 endoscopies/year and 13 small practices performing <1,000 endoscopies/year)] were visited by members of the Public Health Service and assessed using a checklist based on the recommendations of the German guidelines. In 2004, a re-evaluation took place, either by analysing the written reports of the institutions or by visiting them again. Meanwhile, one hospital had closed and three small practices had ceased performing endoscopy, so the re-evaluation encompassed 14 hospitals and 20 private practices. In 2003, hospital compliance with the guidelines was satisfactory but many problems were identified in private practices. Between 2003 and 2004, great improvements were made. By the end of 2004, 90% of private practices had adequate storage facilities for reprocessed endoscopes, and were performing reprocessing of bottles and tubes for air-/water-channel flushing correctly (2003: adequate storage 52%; correct reprocessing 74%). Sterilization of endoscopic accessories was satisfactory, and routine testing of endoscopes after reprocessing was performed in all private practices at the end of 2004 (2003: sterilization of accessories 57%; microbiological control tests 56%). In 2003, although hospital compliance with the guidelines was satisfactory, mandatory improvements were required in private practices, notably in smaller units. Infection control advice and the control of public health regulations resulted in the correction of most processing faults between 2003 and 2004.

Endoscopes↗
PubMed2005

Electromyographic investigation on handling forces of mechanically counterbalanced and sensor-servomotor-supported surgical microscopes.

BACKGROUND: Recent developments in sensor-servomotor-driven microscopes again initiated a discussion on the value of such technology for practical use in neurosurgery. The need for less force in moving a motor-supported microscope is advantageous. However, questions remain if well-known difficulties in the past such as resonance phenomenon, loss of natural feeling, and unequal handling forces in different situations have been overcome by the new generation of sensor-servo-supported surgical microscopes. METHODS: Handling forces of a mechanically counterbalanced neurosurgical microscope (Zeiss NC4, Zeiss, Oberkochen, Germany) were compared with those of a sensor-servo-supported neurosurgical microscope (Moeller HiR 20-1000, Moeller, Wedel, Germany). Handling forces were correlated with the surface electromyogram measurement of the muscle activity of 4 neurosurgeons. The activity of the forearm muscles was measured while handling the 2 different microscopes in standardized tests. RESULTS: The electrophysiologic measurement revealed that significantly less muscle activity was required to handle the sensor-servo-driven microscope in all directions. The untrained surgeons profited less than the skilled ones. Differences were most evident with disbalanced microscopes. CONCLUSIONS: With this technology, the neurosurgeons exerted less effort, especially in strenuous test situations where the single-handed use of the microscope was mandatory. The reduced muscle forces that move the sensor-servo-type microscope and the continuously balanced state that might help prevent unwanted correction movements will ease intraoperative handling in general.

Arm↗
PubMed1998

Is a mandatory general surgery rotation necessary in the surgical clerkship?

BACKGROUND: Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question. METHODS: We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were assessed by written examination, objective structured clinical examination (OSCE), ward evaluations, self-assessment objectives questionnaire, and satisfaction survey. RESULTS: Data for 54 students showed no differences in scores between groups on any parameter. No specific concerns related to the absence of general surgery were identified. CONCLUSIONS: Effective undergraduate surgical education can be offered in many specialty settings. Removal of the requirement for general surgery in clerkship may lead to a more effective use of all educational opportunities. A careful analysis of local programs and facilities is necessary before suggesting this change to other institutions.

Attitude↗
PubMed1998

[Acute orbital myositis and idiopathic inflammatory pseudotumor in children: three cases].

UNLABELLED: Orbital pseudo-tumors account for approximately 8% of the orbital tumors. They are scarcely described in children and raise diagnostic dilemas, especially when they present as an isolated extra-ocular muscle swelling called idiopathic orbital myositis (IOM). CASE REPORTS: A diagnosis of inflammatory orbital pseudotumors (IOPT) was made in three children aged 7, 13 and 14 years from clinical and CT scan and/or MRI findings associated with histological data in two of them. Two of these IOPT presented as IOM. Analysis was made in a effort to eliminate intra-orbital tumors, especially rhabdomyosarcoma. CONCLUSION: The abrupt onset of the orbital signs, often related in the literature, was not a specific diagnostic criterion regarding to embryonic rhabdomyosarcoma. The inconstant presence of inflammatory signs and the absence of local osseous defect could be more discriminating. Although diagnostic procedure, including histological documentation, was difficult, even dangerous, surgical biopsy should be recommended. Eventually, considering the mandatory multidisciplinary care, steroid therapy response should be evaluated as a diagnostic test.

Adolescent↗
PubMed2004

Whipple's disease.

Whipple's disease is a rare multisystemic infectious disorder affecting predominantly middle-aged men. Clinical manifestations are very variable with a very long, insidious, prediagnostic course. Weight loss, chronic diarrhea, arthralgias, and low-grade fever are characteristic features in most patients. Although gastrointestinal compromise is very common, atypical clinical forms are being increasingly recognized. Although a bacterial cause was strongly suggested for many years, the infectious agent was elusive until recently. The bacillus that was classified as an actinomycete was named Tropheryma whipplei and has singular characteristics. It presents affinity for the periodic acid-Schiff stain, but it is negative for Ziehl-Neelsen staining and has a characteristic trilamellar cell wall. Its genetic material has been recently sequenced, and culture was finally performed on a human fibroblast cell line. Pathological specimens show macrophage infiltration with mostly intracellular invasion of live bacteria. Immunologic factors, such as a subtle defect of cellular immunity possibly specific for the Whipple's bacterium, are believed to play a role in pathogenesis. The diagnosis requires the histologic assessment of diseased tissue, showing the characteristic infiltration, as a first approach, and confirmatory tests such as electron microscopy and/or polymerase chain reaction. Antibiotic treatment is mandatory and leads to a rapid clinical improvement and remission in most patients. Although the rationale for treatment is largely empiric, current recommendations include a 2-week parenteral therapy (third generation cephalosporin) followed by a long-term therapy with trimethoprim-sulphamethoxazole. This approach has been shown to reduce the number of relapses and was effective for prevention and/or treatment of the neurologic compromise.

Anti-Bacterial Agents↗
PubMed1999

Vascular surgical society of great britain and ireland: thrombelastography can differentiate ischaemic from haemorrhagic stroke

BACKGROUND: Thrombolysis could be a major step forward in the treatment of acute ischaemic stroke. Early treatment is essential to maximize therapeutic benefit. Imaging by computed tomography (CT) or magnetic resonance imaging is mandatory to exclude haemorrhagic stroke before initiation of therapy. Thrombelastography (TEG), a test of global haemostasis, produces a characteristic tracing over 15-30 min. The potential of TEG to differentiate patients with ischaemic from haemorrhagic stroke was investigated. METHODS: Fifteen patients with a clinical diagnosis of acute stroke were studied. Fibrinogen levels and lipid profiles were measured, and CT of the brain, coagulation screens and TEG were performed. The CT scans were interpreted by a single radiologist. TEG data were classified as normal (index less than 2), hypercoagulable (index 2-3) or profoundly hypercoagulable (index greater than 3). RESULTS: There was no correlation between any of the parameters studied other than TEG with CT findings. Both patients with a haemorrhagic stroke showed normal findings on TEG. Eleven of the 12 patients with ischaemic stroke were hypercoagulable or profoundly hypercoagulable. CONCLUSION: TEG is capable of differentiating haemorrhagic from ischaemic stroke. It has the potential to target thrombolytic therapy for those patients most likely to benefit.

Journal Article↗
PubMed1989

Exercise in the elderly.

Regular physical activity in the elderly delays decline in physical abilities, improves quality of life, and enhances functional capacity. As medical costs rise, preventive measures such as exercise are attaining great importance. Physicians should encourage their patients to participate in routine exercise and assist them in selecting an appropriate program. Preexercise evaluation is mandatory and should include a history and physical examination, an exercise stress test, and appropriate laboratory tests.

Aged↗
PubMed1991

General deterrence of drunk driving: evaluation of recent American policies.

A testable hypothesis of deterrence theory is that efforts to increase the expected cost of criminal activity by increasing the threat of punishment should, other things being equal, reduce the crime rate. In this paper, we examine whether the incidence of drinking and driving is responsive to escalation of the punitive threat. The recent national campaign against drunk driving provides a natural experiment in which to test the predictions of deterrence theory. Using state level data over the 1975-1986 period, we report no conclusive evidence that any specific form of punitive legislation is having a measurable effect on motor vehicle fatalities. We report suggestive evidence that multiple laws designed to increase the certainty of punishment (e.g., sobriety checkpoints and preliminary breath tests) have a synergistic deterrent effect. The most striking finding is that mandatory seat belt use laws and beer taxes may be more effective at reducing drunk driving fatalities than policies aimed at general deterrence.

Accidents, Traffic↗
PubMed1973

Microdilution antibiotic susceptibility test: examination of certain variables.

A semiautomated microdilution susceptibility test is described. The effect of certain parameters such as inoculum size, growth media, incubation conditions, and inoculum dispensing systems was studied. Both medium type and inoculum size caused significant variations in the minimum inhibitory concentrations (MIC) of certain antibiotic-organism combinations. No effect on MIC was observed as a function of incubator type. Efforts to read a reproducible MIC value in less than 12 h failed. A commercially available wire pronged inoculator was determined to be inaccurate and unsafe. Disposable dropper pipettes proved to be economical, accurate, and precise. Although a standard method for microdilution antibiotic susceptibility testing is not proposed, data are presented which show that future attempts at standardized procedures are mandatory if inter- and intralaboratory reliability is desired.

Adenine↗
PubMed2002

Active surveillance for scrapie by third eyelid biopsy and genetic susceptibility testing of flocks of sheep in Wyoming.

Control of scrapie, an ovine transmissible spongiform encephalopathy or prion disorder, has been hampered by the lack of conventional antemortem diagnostic tests. Currently, scrapie is diagnosed by postmortem examination of the brain and lymphoid tissues for PrP(Sc), the protein marker for this group of disorders. For live, asymptomatic sheep, diagnosis using tonsil or third-eyelid lymphoid tissue biopsy and PrP(Sc) assay has been described. To evaluate the feasibility and efficacy of third-eyelid testing for identification of infected flocks and individual infected sheep, 690 sheep from 22 flocks were sampled by third-eyelid lymphoid tissue biopsy and immunohistochemistry. Sheep were further evaluated for relative genetic susceptibility and potential contact exposure to scrapie. Third-eyelid testing yielded suitable samples for 80% of the sheep tested, with a mean of 18.1 lymphoid follicles (germinal centers) per histologic section. Three hundred eleven of the sheep were sampled through passive surveillance programs, in which only sheep with potential contact with an infected sheep at a lambing event were tested, regardless of their scrapie susceptibility genotype. In addition, 141 genetically susceptible sheep with no record of contact with an infected animal at a lambing event were sampled through a targeted active surveillance program. Ten PrP(Sc)-positive sheep were identified through the passive surveillance program, and an additional three PrP(Sc)-positive sheep, including two from flocks with no history of scrapie, were identified through the active surveillance program. All PrP(Sc)-positive sheep had the highly susceptible PrP genotype. Third-eyelid testing is a useful adjunct to flock monitoring programs, slaughter surveillance, and mandatory disease reporting in a comprehensive scrapie eradication and research program.

Animals↗
PubMed1998

Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates.

Hormonal and morphological data were investigated in 202 consecutive patients with adrenal incidentalomas (171 unilateral and 31 bilateral) in an attempt to assess subclinical hyperfunction or malignancy. In addition to the classical evaluation, scintiscan was carried out in a large number of these patients. In unilateral incidentalomas, 83% showed normal hormonal function, whereas 17% had biochemical signs of adrenal overactivity (hyperaldosteronism in 3, hypercortisolism in 17, medullary hyperfunction in 9). [75Se]Methylnorcholesterol scintigraphy depicted malignant, space-occupying lesions as decreased or absent radiotracer uptake by the mass, and cortical adenomas as increased or normal uptake. In cortical adenomas a relationship between radiocholesterol uptake and degree of functional autonomy was demonstrated. [123I]Metaiodobenzilguanidine scintiscan visualized 7 of 8 pheochromocytomas. In bilateral incidentalomas, abnormal adrenal function was more frequent, accounting for 29% of cases (hyperaldosteronism in 3, hypercortisolism in 3, adrenal insufficiency in 2, and congenital adrenal hyperplasia in 1). Malignant lesions were not scintigraphically visualized. [75Se]Methylnorcholesterol scan also provided functional information in the case of a cortisol-secreting adenoma and an aldosteronoma with a concomitant contralateral nonhypersecreting adenoma, showing the greatest uptake in the hyperfunctioning adenomas. In both unilateral and bilateral lesions, endocrine testing failed to differentiate benign from malignant tumors. Although hormonal assessment is mandatory to clarify the functional patterns, only morphofunctional examination by scintiscan seems to provide more data about the likelihood of malignancy.

17-alpha-Hydroxyprogesterone↗