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PubMed1975

The diagnosis and treatment of transvestites and transsexuals.

Transvestism and transsexualism are defined. The incidence of both as well as male versus female ratios are discussed. Etiology of each is considered. Psychotherapists can be used for proper diagnosis and couseling and, on occasion, for therapy for transvestites. Methods for this therapy are suggested. The need for establishing rapport is emphasized, and items to cover in a sex history are enumerated. Reality factors in sex changes are items that the therapist must grapple with. Factors that delineate differential diagnosis of transvestism and transsexualism are pointed out. Prevention of transsexualism in younger children is discussed.

Behavior Therapy↗
PubMedDate not supplied

A framework for the continual improvement of behavioral healthcare. Part II--Policy for leadership.

In the first part of this article, published in the November/December 1993 issue of Behavioral Healthcare Tomorrow, the authors presented a framework for understanding the process of continuous quality improvement in the behavioral healthcare setting. Four elements of continual improvement were identified: underlying knowledge, policy for leadership, tools and methods, and daily work applications. They showed how traditional professional knowledge of one's subject, discipline and values must be augmented by improvement knowledge--which quality improvement guru W. Edwards Deming calls "the system of profound knowledge." In Part II, they focus on the second element of continual improvement, the importance of organizational leadership.

Decision Making, Organizational↗
PubMed1984

An in-vitro test for the duration of action of insulin suspensions.

A method is described which measures the prolongation effects of commercial insulin suspensions by monitoring the rate of solution of an insulin suspension into a phosphate buffer, pH 7.4, at 37 degrees C. The method can rapidly categorize an insulin into the clinical classifications of either fast, intermediate or slow acting. It offers advantages of speed and sensitivity over the British Pharmacopoeial test for prolongation of insulin effect in fasted animals. Large differences between the dissolution rates of commercial samples of isophane insulin were observed which suggested a lack of bioequivalence.

Animals↗
PubMed1976

A comparison of laparoscopy and culdoscopy for internal sterilization.

In recent years, the increased demand for sterilization by women who have achieved their desired family size has emphasized the need to improve both existing methods of tubal occlusion and the means of access to the Fallopian tubes. Utilization of diagnostic instruments such as the laparoscope and culdoscope to perform sterilization minimizes the trauma associated with standard laparotomy and colpotomy and promises to reduce morbidity occurring as a result of sterilization. In order to evaluate and compare the improved techniques of laparoscopy and culdoscopy for elective interval sterilization, 722 women were studied between January and August of 1973 at the Siriraj Hospital in Bangkok. For 279 patients (Group I), sterilization was performed by culdoscopic tubal ligation using a modified Pomeroy technique; for 443 patients (Group II), the procedure used was laparoscopic tubal cauterization and cutting. All procedures were performed using local anesthesia on an outpatient basis. Complication rates and required surgical time were similar for both procedures and compared favorably with rates reported by other investigators. Because of a low incidence of complications and the elimination of the need for general anesthesia and hospitalization, both endoscopic procedures appear to be of particular value in developing countries where hospital facilities and physician time are in short supply.

Adult↗
PubMed1982

Minilaparotomy or laparoscopy for sterilization: a multicenter, multinational randomized study. World Health Organization, Task Force on Female Sterilization, Special Programme of Research, Development and Research Training in Human Reproduction.

A multicenter, multinational randomized comparison of minilaparotomy and modified Pomeroy tubal ligation and laparoscopy with tubal electrocoagulation for interval sterilization of women was conducted in eight centers. Results were analyzed for 791 women in the minilaparotomy group and 819 in the laparoscopy group. Major complications occurred in 1.5% of women in the former group and 0.9% in the latter. Technical problems or major anesthetic complications occurred in 0.5% of subjects undergoing minilaparotomy and 0.9% of subjects undergoing laparoscopy. For minor complications the figures were 11.6% and 6.0%, respectively, while for minor complaints the rates were 34.1% and 26.5%, respectively. It is concluded that the two methods of approach to the fallopian tubes are similar in their complication rates. Because of its more simple requirements in terms of equipment and training, minilaparotomy is the preferred approach for services provided away from a major institution.

Adult↗
PubMed1996

[Minilaparotomy tubal ligation in the immediate post-partum after vaginal delivery. A retrospective analysis of 253 cases in the maternity service of the Yaounde University Hospital Center (Cameroon)].

The authors report the results of a retrospective study of 253 cases of tubal ligation collected between January 1985 and December 1989 in the maternity unit of the Yaounde Teaching hospital. The tubal ligations were done through minilaparotomy with local anesthesia using the technique of Pomeroy. The frequency of tubal ligation evaluated at 3,8 per cent did not change during the period of this study. The authors note that the majority of patients in this study wished a tubal ligation only when they have 5 or more surviving children. We had no post-operative death, but our complication rate of 1,6 % can be improved upon by paying more attention to operative details. The authors conclude that because of poorly equipped medical infrastructures in the context of developing countries tubal ligation through minilaparotomy should be promoted as a contraceptive method in family planning programs.

Adult↗
PubMed1991

Detection of flaviviruses by reverse-transcriptase polymerase chain reaction.

RNA sequences of five flaviviruses were detected by a modified polymerase chain reaction (PCR) that incorporated a reverse transcriptase and RNase inhibitor. Oligonucleotide primer pairs were synthesized to amplify sequences from St. Louis encephalitis (SLE), Japanese encephalitis (JBE), yellow fever (YF), dengue 2 (DEN-2), and dengue 4 (DEN-4) viruses. The amplified products were visualized as bands of appropriate size on ethidium bromide-stained agarose gels. The identity of these products was confirmed by restriction endonuclease cleavage to generate fragments of predicted lengths. The reverse-transcriptase PCR (RT-PCR) successfully amplified flavivirus sequences from cell cultures, frozen brain tissue, and formalin-fixed, paraffin-embedded brain tissue. The reactions were highly specific, and the method compared favorably to two conventional assays of viral infectivity. RT-PCR followed by PCR with nesting primers (N-PCR) was 1,000-fold more sensitive in detecting virus than classical infectivity titration by intracerebral inoculation of suckling mice and nearly 1,000-fold more sensitive than amplification of virus in cell culture followed by inoculation of mice.

Aedes↗
PubMed1991

Enzyme-linked immunosorbent assay for the detection of Salmonella enteritidis infection in chickens.

An ELISA was developed and tested for its ability to detect antibodies against Salmonella enteritidis in chickens. Various features of the ELISA were evaluated and optimized. The outer membrane protein antigens selected by use of the protein immunoblotting method made the assay specific and sensitive. The assay was evaluated in chickens experimentally infected with S enteritidis. Blood samples collected at weekly intervals after experimental infection with S enteritidis were analyzed by ELISA. Results of the ELISA were compared with those of conventional serum plate and microagglutination tests. The ELISA was more sensitive and specific in the detection of S enteritidis infection than the other 2 conventional tests.

Animals↗
PubMed1998

Preoperative hyperbaric oxygen therapy for radiation induced injuries.

PURPOSE: We present our experience with preoperatively administered hyperbaric oxygen therapy to patients who have sustained significant therapeutic radiation induced soft tissue injuries and subsequently undergo planned abdominal intervention/surgery. MATERIALS AND METHODS: From February 1993 to May 1997, 5 patients with a history of complications following therapeutic radiation were prospectively treated with hyperbaric oxygen before a planned abdominal operation. RESULTS: All patients had uneventful hospital courses. An additional procedure was eventually necessary in 2 patients but with fewer radiation related problems following hyperbaric oxygenation. CONCLUSIONS: Hyperbaric oxygenation may improve postoperative outcomes when given before planned open operations in patients with previous therapeutic pelvic irradiation and a history of radiation related complications.

Adult↗
PubMed1989

Strategies for ultrastructural visualization of biotinated probes hybridized to messenger RNA in situ.

A progressive development of the application of in situ methodology to ultrastructural procedures has resulted in the ability to detect individual molecules of mRNA with high probability. Beginning with whole-mount cells and then developing myotubes, both in culture and detergent extracted before fixation, we were able to progress to methods which allow detection of mRNA in tissue sections. Initial results confirm that the detection of mRNA in thin-sectioned tissue is very similar to observations on the extracted, cultured cells, and that the same methods of data analysis apply. Current work is devoted to the application of the methodology to other cellular structures, such as the nucleus, and to other tissue-probe systems, such as brain. Acknowledgements. The authors appreciate the skilled help from John McNeil and Shirwin Pockwinse in the laborious and time-consuming preparations of material and photography. FS was on sabbatical leave from the Department of Pathology at Southwestern Medical Center.

Animals↗
PubMed1982

Leukocyte migration inhibition in chickens inoculated with Salmonella typhimurium.

Leukocyte migration-inhibition tests were conducted in chickens infected with Salmonella typhimurium. A relatively new and simple method that involves the migration of leukocytes under agarose gel was used. Migration distance was projected onto a white background at 40X magnification, using a microprojector. Quantitation of migration was done by measuring the linear distance the cells had moved from the margin of the agarose wells. The details of the technique and the importance of it in studies of cell-mediated immune response are discussed. Chickens inoculated with S typhimurium had a significant leukocyte migration inhibition.

Animals↗
PubMed1979

Salpingitis associated with the presence of nonmedicated IUDs.

Fallopian tube tissue obtained at Pomeroy sterilization of 75 normally cycling women, 75 women 2 to 3 days postpartum, and 75 asymptomatic women who had used a nonmedicated IUD for at least a year was examined histologically. There was an increased frequency of tissue edema and congestion in the postpartum group only. The frequency and extent of acute inflammatory changes in the three groups was not significantly different.

Adult↗
PubMed1996

Search for viral nucleic acid sequences in brain tissues of patients with schizophrenia using nested polymerase chain reaction.

BACKGROUND: We used polymerase chain reaction to search for nucleic acid sequences of several viruses in DNA and RNA extracted from brain tissues of schizophrenic and control subjects. METHODS: We extracted DNA and RNA templates from frozen brain specimens of 31 patients with schizophrenia and 23 nonschizophrenic control patients with other diseases. The extracts were subjected to polymerase chain reaction with oligonucleotide primers for 12 different viruses (cytomegalovirus, Epstein-Barr virus, herpes simplex virus type 1, human herpesvirus type 6, varicellazoster virus, measles virus, mumps virus, rubella virus, the picornavirus group, influenza A virus, human T-cell lymphotropic virus type I, and St Louis encephalitis virus), several of which have been suspected of involvement in schizophrenia. Nested primers were used to increase the sensitivity of the method. RESULTS: No amplified nucleic acid sequences encoded by the selected viral genomes were detected in extracts of any brain specimens from either schizophrenic or control patients. CONCLUSIONS: These data agree with previous studies that failed to find sequences of a number of viruses in the cerebrospinal fluid or selected areas of the brains of schizophrenic patients. Additional efforts should be undertaken to identify other known and unknown pathogens in schizophrenia, sampling more areas of the brain from subjects with a variety of clinical types of schizophrenia.

Brain↗
PubMed1983

Cellular toxicity of urinary catheters.

The cellular compatibility of each of several brands of urinary catheters available on the Australian market was measured by means of cell-culture methods, a rabbit intramuscular implant test, and the traditional mouse systemic toxicity test. Good agreement was obtained between the in-vitro tests and the rabbit implant tests (although the cell-culture tests were simpler, more rapid, more sensitive, and quantitative). The mouse systemic toxicity test was insensitive, and detected no toxic samples. The cell-culture and rabbit-implant test results indicated that some urinary catheters can release substances harmful to mammalian cells. Such substances may contribute to the clinical reactions of urethritis and strictures after urethral catheterization.

Animals↗
PubMed2026

Select Contemporary Statistical Concepts in Heart Failure Clinical Trials: Insights From the Heart Failure Collaboratory.

Evolving statistical concepts and innovative trial designs for heart failure (HF) clinical trials seek to improve the conduct, efficiency, and likelihood of meaningful evidence generation crucial for advancing therapeutic development and optimizing patient care. HF trials with conventional statistical frameworks often require large sample sizes, long follow-up times, and high cost to generate sufficient evidence. Novel statistical methodologies would be of interest if they could address these issues while retaining or enhancing the clinical relevance and reliability of results. The HFC (Heart Failure Collaboratory), comprising clinical investigators, clinicians, statisticians, patients, government representatives, payors, and industry collaborators, leads efforts to improve HF research methodologies. HFC discussions have included statistical concepts such as the estimand framework, HR drift, and analytic methods, including the win ratio and restricted mean survival time, that have not been used frequently in HF trials. The estimand framework encourages precise definition and alignment of trial objectives with trial design. The win ratio method attempts to incorporate and prioritize multiple clinically meaningful outcomes by using a hierarchy of clinical importance. The restricted mean survival time provides an alternative to the HR as a measure of therapeutic effect by quantifying the mean time gained or lost during a fixed time after randomization. This paper provides a critical review of some evolving HF trial design methodologies and statistical concepts for the HF community as discussed within the HFC. Our goal is to foster collaboration among diverse stakeholders and advance the development of effective treatments and improve patient care outcomes.

Heart Failure↗
PubMed1975

Antibiotic dipping studies in relation to uptake, embryonic development and Arizona hinshawii recoveries from turkey hatching eggs.

Antibiotic dipping with gentamicin sulfate by means of the temperature-differential method was effective in reducing but not completely eliminating Arizona hinshawii (7:1, 7, 8) from artificially infected turkey hatching eggs. Embryonic development was well maintained. The antibiotic dip solution intake was variable from egg to egg. Removal of cuticle by means of either 0.2 N HCl or a 10% disodium salt of ethylene diamine tetraacetic acid enhanced egg weight gains and maintained good embryonic development. Complete elimination of A. hinshawii was achieved in one experiment out of four. Correlation studies between egg weight gains and gentamicin concentrations of the contents of the turkey hatching eggs indicated a statistically significant relationship between these two parameters.

Animals↗
PubMed1980

Technical failures in tubal ring sterilization: Incidence, perceived reasons, outcome, and risk factors.

Six centers participated in comparative studies of female sterilization conducted by the international Fertility Research Program. The incidence of technical failures (or failed attempts) was compared between patients sterilized with the tubal ring and those sterilized with other tubal occlusion techniques. The tubal ring was associated with a higher failure rate than electrocoagulation, the Rocket clip, or the modified Pomeroy technique. Of 1,035 tubal ring sterilizations, there were 38 technical failures. Reasons given by the operators for the failures, by frequency of occurrence, were surgical complications, conditions preexisting in the patients, and problems with the instruments. Most of these failures were remedied by changing to other techniques. In two patients, the procedure was completed by changing the approach from laparoscopy to laparotomy. In five others, sterilization was not completed. Case-control analysis was performed and three risk factors were delineated: obesity, prior use of an intrauterine contraceptive device and previous abdominal operations.

Abdomen↗
PubMedDate not supplied

In vivo validation of a cell culture test for biocompatibility testing of urinary catheters.

Biocompatibility tests have been compared for their suitability as routine safety tests for urinary catheters. Latex catheters from five manufacturers were tested by each of the following four methods: (1) a cell culture cytotoxicity assay of catheter extracts, (2) intracutaneous injection of the extracts into rabbits, (3) intramuscular implant of catheter pieces into rabbits, (4) catheterization of sheep (mucous membrane irritation). The rabbit intracutaneous and intramuscular tests are both current pharmacopoeial methods for ascertaining the suitability of polymers for medical use. The four tests each showed a cell or tissue response ranging from no detectable change to severe damage, according to the catheter batch or brand, and they each identified the same samples as most toxic and least toxic. However, they differed in sensitivity. The sheep test and the cell culture assay discriminated between catheters of intermediate toxicity and ranked as toxic catheters not identified as such by the two pharmacopoeial tests. The sheep test most closely approximates clinical usage, but is impractical for routine use. The cell culture assay is a suitable alternative. It also has the advantages of a clearly defined endpoint, good sensitivity, reproducibility, speed, and reduced animal usage.

Animals↗