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Heckman TG, Somlai AM, Peters J, Walker J, Otto-Salaj L, Galdabini CA, Kelly JA. Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care 1998; 10:365-75. [PMID: 9828979 DOI: 10.1080/713612410] [Citation(s) in RCA: 183] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
People living with HIV disease, particularly those in small towns and rural areas, face many barriers that prevent them from receiving important life-care services. We developed the Barriers to Care Scale (BACS) to delineate the problem severity of factors that impede care and service provision among a sample of 226 men and women living with HIV disease in a single midwestern state. Both urban and rural respondents indicated that major barriers to life-care services included the lack of knowledge about HIV among citizens in the community, insufficient personal financial resources, the lack of employment opportunities for people living with HIV, and the lack of supportive and understanding work environments. Rural persons living with HIV disease, compared to their urban counterparts, assigned significantly higher problem severity ratings to the following barriers: the need to travel long distances to medical facilities and personnel; a shortage of adequately trained medical and mental health professionals; a lack of personal or public transportation; and community residents' stigma toward people living with HIV. The large number of barriers to care identified in the present study indicates that innovative programmes designed to remove these barriers and improve the life quality of rural persons living with HIV are urgently needed.
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Brinkmann M, Günnicker M, Freund U, Schieffer M, Peters J. [Histamine plasma concentration and cardiovascular effects of non-depolarizing muscle relaxants: comparison of atracurium, vecuronium, pancuronium and pipecuronium in coronary surgical patients at risk]. Anasthesiol Intensivmed Notfallmed Schmerzther 1998; 33:362-6. [PMID: 9689393 DOI: 10.1055/s-2007-994264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Cardiovascular effects of four commonly used non-depolarising muscle relaxants and their ability to increase histamine plasma concentrations were studied in patients scheduled for coronary artery bypass grafting. METHODS 40 patients were included in the study after informed consent. After premedication with Flunitrazepam (2 mg p.o.) on the evening before and 1 hour prior to surgery anaesthesia was induced with Flunitrazepam (4-6 micrograms kg-1). Fentanyl (3 micrograms kg-1) und Etomidate (150 micrograms kg-1) and the patients were ventilated via face mask with 50% N2O in oxygen. Patients were randomly allocated to one of four groups, and, 15 min after induction of anaesthesia, received equipotent doses of either Pancuronium (0.09 mg kg-1, n = 10). Pipecuronium (0.08 mg kg-1, n = 10), Atracurium (0.6 mg kg-1, n = 10), or Vecuronium (0.1 mg kg-1, n = 10) injected over 20 seconds via a central venous catheter. Cardiovascular variables were determined in the awake patient, 15 min after induction of anaesthesia and following administration of the respective muscle relaxant. In addition, plasma histamine concentrations were assessed before and after relaxation. Evoked muscular response to TOF simulation of the ulnar nerve (plethysmo-mechanogram) was continuously recorded to determine the onset of neuromuscular blockade. RESULTS Heart rate, mean arterial pressure and cardiac index significantly decreased in all patients following induction of anaesthesia while systemic vascular resistance remained unchanged. Only Pancuronium caused a significant increase in heart rate (53 +/- 11 to 61 +/- 15 min-1) whereas cardiac index and mean arterial pressure did not change significantly. No other neuromuscular blocking agent caused any changes in the cardiovascular variables measured and histamine plasma concentrations remained within the reference range in all of the four groups with no differences detectable between groups. CONCLUSIONS All investigated neuromuscular blocking agents exhibited marked cardiovascular stability which permits their use, being based exclusively on pharmacodynamic and pharmakokinetic considerations even in patients with coronary heart disease. If an increase in heart rate appears beneficial Pancuronium may be advantageous.
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Wooley PH, Sud S, Langendorfer A, Calkins C, Christner PJ, Peters J, Jimenez SA. T cells infiltrating the skin of Tsk2 scleroderma-like mice exhibit T cell receptor bias. Autoimmunity 1998; 27:91-8. [PMID: 9583740 DOI: 10.3109/08916939809008039] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The T cell repertoire expressed by Tsk2 mice, a novel experimental model of systemic sclerosis, was examined to determine whether cells infiltrating the areas of involved skin exhibit a T cell receptor (TCR) bias. Reverse transcription-polymerase chain reactions (RT-PCR) were conducted using RNA extracted from lymph nodes and skin from TSk2 mice and from normal mice, with an oligonucleotide primer library specific for the variable region of the TCR (beta) chain. RT-PCR signals were observed in all lymph node cell (LNC) samples from both Tsk2 mice and control mice, with eighteen of the twenty-one Vbeta types present. In contrast, cDNA extracted from areas of involved skin from Tsk2 mice exhibited a restricted pattern, with positive Vbeta signals corresponding to eight T cell subtypes (Vbeta1, 6, 8.1, 8.2, 10, 11, 16, and 18). Band strength analysis revealed that three Vbeta subtypes dominated within this restricted pattern (Vbeta8.1, 11, and 18). Moreover, this pattern of Vbeta bias was consistent among the four skin samples from different Tsk2 mice. These data suggest that a restricted T cell population participates in the inflammatory cell infiltrate of Tsk2 skin.
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Morrell CJ, Walters SJ, Dixon S, Collins KA, Brereton LM, Peters J, Brooker CG. Cost effectiveness of community leg ulcer clinics: randomised controlled trial. BMJ (CLINICAL RESEARCH ED.) 1998; 316:1487-91. [PMID: 9582132 PMCID: PMC28546 DOI: 10.1136/bmj.316.7143.1487] [Citation(s) in RCA: 126] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usual care provided by district nurses. DESIGN Randomised controlled trial with 1 year of follow up. SETTING Eight community based research clinics in four trusts in Trent. SUBJECTS 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group. INTERVENTIONS Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nursing service (control group). MAIN OUTCOME MEASURES Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfaction with care, use of services, and personal costs were also monitored. RESULTS The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P=0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2. 03). No significant differences were found between the groups in health status. Mean total NHS costs were 878.06 pounds per year for the clinic group and 859.34 pounds for the control (P=0.89). CONCLUSIONS Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used.
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Kienbaum P, Thürauf N, Michel MC, Scherbaum N, Gastpar M, Peters J. Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after mu-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification. Anesthesiology 1998; 88:1154-61. [PMID: 9605673 DOI: 10.1097/00000542-199805000-00004] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute displacement of opioids from their receptors by administration of large doses of opioid antagonists during general anesthesia is a new approach for detoxification of patients addicted to opioids. The authors tested the hypothesis that mu-opioid receptor blockade by naloxone induces cardiovascular stimulation mediated by the sympathoadrenal system. METHODS Heart rate, cardiac index, and intravascular pressures were measured in 10 patients addicted to opioids (drug history; mean +/- SD, 71 +/- 51 months) during a program of methadone substitution (96 +/- 57 mg/day). Cardiovascular variables and concentrations of catecholamine in plasma were measured in the awake state, during methohexital-induced anesthesia (dose, 74 +/- 44 microg x kg(-1) x min(-1)) before administration of naloxone, and repeatedly during the first 3 h of mu-opioid receptor blockade. Naloxone was administered initially in an intravenous dose of 0.4 mg, followed by incremental bolus doses (0.8, 1.6, 3.2, and 6.4 mg) at 15-min intervals until a total dose of 12.4 mg had been administered within 60 min; administration was then continued by infusion (0.8 mg/h). RESULTS Concentration of epinephrine in plasma increased 30-fold (15 +/- 9 to 458 +/- 304 pg/ml), whereas concentration of norepinephrine in plasma only increased to a minor extent (76 +/- 44 to 226 +/- 58 pg/ml, P < 0.05). Cardiac index increased by 74% (2.7 +/- 0.41 to 4.7 +/- 1.7 min(-1) x m(-2)), because of increases in heart rate (89 +/- 16 to 108 +/- 17 beats/min) and stroke volume (+44%), reaching maximum 45 min after the initial injection of naloxone. In parallel, systemic vascular resistance index decreased (-40%). Systolic arterial pressure significantly increased (113 +/- 16 to 138 +/- 16 mmHg), whereas diastolic arterial pressure did not change. CONCLUSIONS Despite barbiturate-induced anesthesia, acute mu-opioid receptor blockade in patients addicted to opioids induces profound epinephrine release and cardiovascular stimulation. These data suggest that long-term opioid receptor stimulation changes sympathoadrenal and cardiovascular function, which is acutely unmasked by mu-opioid receptor blockade. Because of the attendant cardiovascular stimulation, acute detoxification using naloxone should be performed by trained anesthesiologists or intensivists.
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Chambers DM, Peters J, Abbott CM. The lethal mutation of the mouse wasted (wst) is a deletion that abolishes expression of a tissue-specific isoform of translation elongation factor 1alpha, encoded by the Eef1a2 gene. Proc Natl Acad Sci U S A 1998; 95:4463-8. [PMID: 9539760 PMCID: PMC22512 DOI: 10.1073/pnas.95.8.4463] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We have identified the mutation responsible for the autosomal recessive wasted (wst) mutation of the mouse. Wasted mice are characterized by wasting and neurological and immunological abnormalities starting at 21 days after birth; they die by 28 days. A deletion of 15.8 kb in wasted mice abolishes expression of a gene called Eef1a2, encoding a protein that is 92% identical at the amino acid level to the translation elongation factor EF1alpha (locus Eef1a). We have found no evidence for the involvement of another gene in this deletion. Expression of Eef1a2 is reciprocal with that of Eef1a. Expression of Eef1a2 takes over from Eef1a in heart and muscle at precisely the time at which the wasted phenotype becomes manifest. These data suggest that there are tissue-specific forms of the translation elongation apparatus essential for postnatal survival in the mouse.
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Kreutz R, Fernandez-Alfonso MS, Paul M, Peters J. Differential development of early hypertension in heterozygous transgenic TGR(mREN2)27 rats. Clin Exp Hypertens 1998; 20:273-82. [PMID: 9605382 DOI: 10.3109/10641969809052121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the study was to determine blood pressures in young heterozygous transgenic rats harbouring the Ren-2 mouse gene, TGR(mREN2)27, and to examine the association between blood pressure and plasma renin-angiotensin parameters during the conscious state. Two litters of heterozygous TGR(mREN2)27 rats and their normotensive Sprague-Dawley reference animals were bred in our laboratory. Cardiovascular phenotypes and blood, for the evaluation of plasma renin-angiotensin-system parameters, were obtained via arterial catheters in conscious rats 4 weeks after birth. Blood pressure values showed a high degree of interindividual variability and significant litter differences in the group of transgenic animals ranging from normotensive tohypertensive values. Plasma prorenin levels were markedly increased in TGR(mREN2)27, whereas both active renin and angiotensin II plasma concentrations were reduced independently from hypertension. Plasma prorenin levels in litter 2 of transgenic animals which exhibited significantly elevated blood pressures were significantly higher as compared to those of litter 1 which showed blood pressures that were not significantly different from SD. These data demonstrate that the development of hypertension in heterozygous TGR(mREN2)27 takes place in the fourth week of postnatal life and exhibits large interindividual variability. Moreover, development of early hypertension in young heterozygous TGR(mREN2)27 is associated with higher plasma prorenin levels.
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Peters J, Brooker C, McCabe C, Short N. Problems encountered with opportunistic screening for alcohol-related problems in patients attending an accident and emergency department. Addiction 1998; 93:589-94. [PMID: 9684397 DOI: 10.1046/j.1360-0443.1998.93458914.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To assess the value of opportunistic screening in Accident and Emergency (A&E) for patients with alcohol-related problems and provision of an intervention. DESIGN Screening of A&E attendees for the purpose of recruitment to a randomized trial of a counselling intervention. SETTING A General Hospital A&E department. PARTICIPANTS All 17,000 adult A&E attendees, during a 6-month period and all nursing staff working within the department. MEASUREMENTS Patients' self-reported alcohol consumption, responses to the CAGE questionnaire (four questions designed to identify problem drinking) and proportions offered, and taking up offer of help. FINDINGS Only 4663 (28%) adult attendees at A&E were actually screened and of these 2% declined and 25% were judged unable to answer. Of the rest, 86% drank alcohol, with 22% drinking in excess of current guidelines or with two or more positive answers to CAGE. Only 41% (264) of those drinking to excess were offered help and 88% of these declined it. This left 13 patients to be included in the trial. CONCLUSION There is a significant need for an effective intervention in this area but considerable barriers exist to testing the efficacy of potential screening strategies and interventions.
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Jalowy A, Peters J, Groeben H. [The importance of bronchial hyperreactivity in anesthesiology]. Anasthesiol Intensivmed Notfallmed Schmerzther 1998; 33:150-62. [PMID: 9581228 DOI: 10.1055/s-2007-994229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Airways of patients with bronchial hyperreactivity (BHR) are characterised by exaggerated bronchoconstriction in response to a variety of stimuli; bronchospasm may be elicited during induction and maintenance of anaesthesia. The prevalence of BHR in normal populations is approximately 10%. BHR is an important feature of clinical asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, atopy, upper respiratory tract infections and smoking. This review will outline some important aspects of the pathophysiological basis of BHR, i.e., neural and inflammatory mechanisms. Furthermore, it should assist in identifying patients at risk and update perioperative anaesthetic considerations. Prophylaxis of airway reflex activation and an appropriate anaesthetic plan should prevent airway constriction. Since tracheal intubation is the major risk factor to induce bronchospasm intubation should be avoided whenever possible and regional anaesthesia preferred. If tracheal intubation is unavoidable, propofol and ketamine can be recommended as induction agents. Prophylaxis of intraoperative bronchospasm and initial therapy, such as deepening of anaesthesia, inhalational administration of sympathomimetics and anticholinergics, and i.v. use of local anaesthetics and corticosteroids are outlined. Despite its popularity theophylline offers little benefit during anaesthesia. Adequate preoperative evaluation and preparation of the patient with BHR will contribute to optimising anaesthetic management of patients with BHR.
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Cargnelli G, Rossi GP, Pessina AC, Luciani S, Debetto P, Ganten D, Peters J, Bova S. Changes of blood pressure and aortic strip contractile responses to ET-1 of heterozygous female transgenic rats, TGR(mRen2)27. Pharmacol Res 1998; 37:207-11. [PMID: 9602469 DOI: 10.1006/phrs.1998.0287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We studied the contractile responses to endothelin-1 (ET-1) of aortic strips from female transgenic rats, TGR(mRen2)27, heterozygous for the Ren-2 mouse gene, during the phases of developing (blood pressure in rats aged 5 weeks; 156 +/- 8 mmHg), steady (blood pressure in rats aged 11 weeks: 206 +/- 27 mmHg), and reversed (blood pressure in rats aged 35 weeks: 151 +/- 17 mmHg) hypertension. These responses were compared with those of aortae from sex- and age-matched, genetically homogeneous, normotensive Sprague-Dawley (SD) rats. Aortic strips from both transgenic and SD rats were deprived of endothelium before isometrically recording developed tension to cumulatively added ET-1. Aortic strips from 5- and 11-week-old female transgenic TGR(mRen2)27 (hfTG) rats responded to ET-1 with higher Emax values and lower EC50 values than those of age-matched SD rats. Conversely, aortic strips from 35-week-old hfTG rats exhibited lower Emax and higher EC50 values than aortic strips from SD rats. Within the hfTG rats, aortic strips from 11-week-old rats showed increased Emax and decreased EC50 of ET-1 as compared with either 5- or 35-week-old hfTG rats. These data are in keeping with the hypothesis that ET-1 contributes to the hypertension of hfTG rats and suggest that an altered vascular responsiveness to the peptide may be implicated in the changes of their systolic blood pressure occurring with ageing in this animal model.
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Strobel E, Wüllenweber J, Peters J. [Demonstration os isoagglutinins in intravenously applicable immunoglobulin preparations]. BEITRAGE ZUR INFUSIONSTHERAPIE UND TRANSFUSIONSMEDIZIN = CONTRIBUTIONS TO INFUSION THERAPY AND TRANSFUSION MEDICINE 1998; 32:200-2. [PMID: 9480087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intravenous immunoglobulins (IvIg) contain not only the declared antibodies against pathogenic microorganisms but also all the other antibodies of the blood donors, e.g. against erythrocytic antigens. We tested 14 IvIg from 7 manufacturers (together 40 charges) for isoagglutinins and irregular blood group antibodies. To ameliorate the reading of our tests we used the gel-centrifugation method (ID-Microtyping System, Fa. Diamed, Bensheim, FRG). Isoagglutinins in the IvIg can influence blood group serologic tests. Therefore we point to the potential danger of misinterpretation of a positive direct antiglobulin test. In rare cases, hemolytic reactions after administration of high doses of IvIg might occur.
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Spicher G, Peters J. [Effect on the microbicidal efficacy of formaldehyde, glutardialdehyde, peracetic acid, chloramine T (N-chloro-4-toluenesulfonamide), m-cresol, ethanol and benzyldimethyldodecacylammonium bromide by blood (model experiments for chemical disinfection of instruments)]. ZENTRALBLATT FUR HYGIENE UND UMWELTMEDIZIN = INTERNATIONAL JOURNAL OF HYGIENE AND ENVIRONMENTAL MEDICINE 1998; 200:465-77. [PMID: 9531720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In a preceding paper (Zbl. Hyg. 191 [1991] 457-477) we reported on the dependence of the microbicidal efficacy of active agents of the disinfection of instruments on the amount of coagulated blood adhering to the instruments. In the present investigation, we were interested in the dependence of the microbicidal effects on the amount of blood in the solutions of the active agents. Test areas of 2 cm2 were contaminated with 50 and 100 microliters coagulating blood, respectively, containing cells of Staphylococcus aureus as test germ. The solutions of the microbicidal agents were contaminated with heparinized blood up to a concentration of 4% immediately before starting the disinfection and 24 hours before, respectively. After a period of action lasting 1 hour at 20 degrees C, the relative number of test germs capable of multiplying (N/N0) was determined. The concentration of the microbicidal substances reducing the relative number of test germs capable to multiply to 10(-4) served for estimating the dependence of the microbicidal efficacy of the agents on the blood content of the solutions. The experimental results depended on the thickness of the layer of coagulated blood. The dependence of the efficacy of the microbicidal substances on the blood content of the solutions was the higher the thinner the blood layer was. At a thickness of the layer of the coagulated blood of 0.25 mm, a blood content of the solution of 4%, and applying it immediately after adding the blood, the concentration of glutardialdehyde had to be 1.6 times that without blood to reach the same microbicidal efficacy. When applying the solution 24 hours after adding the blood, the concentration of glutardialdehyde had to be 4.2 times that without blood. The quaternary ammonium compound reacted faster with the blood than did glutardialdehyde; the respective factors were 2.6 and 4.5. The concentration factors of chloramine T were 3.3 and 3.8. Under the conditions of the test, peracetic acid exhibited small concentration factors: 1.3 and 1.6. The microbicidal efficacy of ethanol, formaldehyde and m-cresol soap solution was not or only slightly altered by the amount of blood in the solution of the microbicidal agent.
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Peters J, Thonke M, Renner P, Bräuniger S, Fischer I. [Effect of protamine on the microbicidal efficacy of formaldehyde]. ZENTRALBLATT FUR HYGIENE UND UMWELTMEDIZIN = INTERNATIONAL JOURNAL OF HYGIENE AND ENVIRONMENTAL MEDICINE 1998; 200:479-90. [PMID: 9531721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Testing the ability of commercial compounds to provide an effective disinfection of instruments requires test conditions that are close to reality which includes the proper selection of the material used to contaminate the test objects. The adhesion of the material must be strong enough to keep it attached to the test object during and after insertion into the disinfectant solution. Its characteristics should come as close as possible to those of the contaminations encountered in practice. The guideline for instrument disinfectants published by the Robert Koch-Institute recommends the use of coagulated blood. Accordingly, heparinized sheep blood is mixed with the test germs, and protamin is added to initiate coagulation. In the present investigation we compared this contamination procedure with a second one, in which coagulation was achieved by adding a CaCl2 solution to citrate blood. We also included agarose as an almost inert contaminant in our experiments. The results showed that protamine is able to increase the microbicidal efficacy of formaldehyde on staphylococci significantly. When these test germs were embedded either in citrat blood or in agarose, it took about twice the disinfectant concentrations to achieve the same microbicidal effects as with protamine blood (Fig. 1). Remarkably, the results obtained with citrate blood were the same as those with agarose, regardless of the differences in material between the two contaminants. It should also be noted that the microbicidal effect of the formaldehyde proved to be almost independent from the amount of contaminant per test area, hence, from the thickness of the layer. When M. terrae was employed as test germ, the results obtained with protamine blood and citrate blood, respectively, as contaminants were identical (Fig. 2). The same was true for the other test germs investigated, except for E. faecium (Fig. 3). The addition of even very small amounts of protamine to the embedding compound, agarose led to a substantially increased efficacy of the formaldehyde against staphylococci (Fig. 4). This effect was especially distinct in suspension (Fig. 5). Whenever the efficacy of formaldehyde-containing disinfectants is to be tested and evaluated, one should be aware of this synergism between protamine and formaldehyde. In these cases, it is advised to employ other contaminating agents, such as coagulated blood prepared by addition of CaCl2 to citrate blood.
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Ringel F, Plesnila N, Chang RC, Peters J, Staub F, Baethmann A. Role of calcium ions in acidosis-induced glial swelling. ACTA NEUROCHIRURGICA. SUPPLEMENT 1998; 70:144-7. [PMID: 9416304 DOI: 10.1007/978-3-7091-6837-0_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Tissue acidosis occurring in cerebral ischemia and traumatic brain injury is a mediator of cytotoxic brain edema. In vitro, extracellular lactacidosis induces swelling of glial cells in a dose dependent manner. pH-regulatory membrane transporters and channels have been identified which are involved in the increase of the glial cell volume. Underlying mechanisms of their activation are poorly understood, however. We have, therefore, addressed the question, whether and how Ca(2+)-ions play a role in acidosis-induced glial swelling and intracellular acidification. For that purpose C6 glioma cells were suspended and the pH in the medium was lowered from 7.4 (baseline) to 6.2 by isotonic lactic acid. Cell volume and intracellular pH (pHi) were assessed by flow cytometry. In the presence of Ca(2+)-ions the cell volume reached a maximum of 125.1% from acidosis. In experiments using a calcium-free suspension medium, cell swelling from acidosis was inhibited by 74%. Additional buffering of intracellular calcium (Ca2+i) had no further inhibitory effect on acidosis-induced cell swelling, while buffering of Ca2+i by BAPTA-AM alone did not affect the glial volume increase secondary to administration of lactic acid. pHi which was decreasing from acidosis was not affected by the experimental modifications of the Ca(2+)-concentration in the medium or cytosol. The present data indicate that lactacidosis-induced glial swelling depends on the presence of extracellular Ca(2+)-ions, while release of Ca(2+)-ions from intracellular stores does not seem to be involved.
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Staub F, Peters J, Plesnila N, Chang RC, Baethmann A. Effect of alpha-trinositol on swelling and damage of glial cells by lactacidosis and glutamate. ACTA NEUROCHIRURGICA. SUPPLEMENT 1998; 70:179-81. [PMID: 9416315 DOI: 10.1007/978-3-7091-6837-0_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The therapeutic efficacy of alpha-trinositol (D-myo-inositol-1,2,6-trisphosphate), an isomer of the intracellular messenger IP3, was analyzed for cytotoxic swelling and damage of glial cells in vitro from lactacidosis or glutamate. Lactacidosis and the interstitial accumulation of glutamate are prominent sequelae in ischemic or traumatic brain tissue. C6 glioma cells harvested from culture and suspended in a physiological medium were either exposed to pH 5.0 by administration of lactic acid, or to 1 mM glutamate at normal pH. Cell swelling and viability were quantified by blood flow cytometry. Addition of alpha-trinositol (3 mM) under control conditions at pH 7.4 resulted in transient cell shrinking to 96.5 +/- 1.3% of control within 3 min (p < 0.05). Lactacidosis of pH 5.0 led to an increase in cell volume to 139.7 +/- 1.3% within 20 min, whereas alpha-trinositol reduced the swelling response by approximately 25% (p < 0.01). In addition, cell viability was severely affected at pH 5.0 amounting to only 53.8 +/- 3.1% after 60 min. alpha-Trinositol was found to markedly improve cell viability; at 60 min 70.2 +/- 1.6% of the cells were still viable (p < 0.01). Addition of glutamate (1 mM) led to a steady increase in cell size, reaching 110% of control after 120 min, irrespective of wether alpha-trinositol was present or not. The attenuation of cell swelling may be attributed to an interference with pH-regulatory mechanisms, such as the Na+/H(+)-antiporter, while protection of cell viability might be caused be effects of alpha-trinositol on Ca(2+)-overload. On the other hand, the increase in cell volume by glutamate associated with its intracellular uptake was not influenced by alpha-trinositol.
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Plesnila N, Ringel F, Chang RC, Peters J, Staub F, Baethmann A. Effect of mild and moderate hypothermia on the acidosis-induced swelling of glial cells. ACTA NEUROCHIRURGICA. SUPPLEMENT 1998; 70:262-4. [PMID: 9416341 DOI: 10.1007/978-3-7091-6837-0_81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The effect of mild (32 degrees C) and moderate (27 degrees C) hypothermia was analyzed on the cell volume and intracellular pH (pHi) of C6 glioma cells at normal pH and during lactacidosis at pH 6.2 in vitro. The cells were suspended in an incubation chamber under continuous control of pH, PO2 and temperature. Cell swelling was quantified by an advanced Coulter-system. pHi was measured by flow cytometry using the fluorescent dye bis-carboxyethyl carboxyfluorescein (BCECF). Following a control period at 37 degrees C, the ambient temperature was decreased to 32 degrees C for 30 min, and subsequently to 27 degrees C for another 30 min. Hypothermia alone led to an immediate and significant cell volume increase of 107.3 +/- 0.4% (mean +/- SEM) of control after 30 min at 32 degrees C, and further swelling to 110.5 +/- 0.9% after 30 min at 27 degrees C. Yet, hypothermia (27 degrees C) afforded partial protection against the acidosis-induced cell swelling at pH 6.2, which was reaching to 120.4 +/- 0.9% in the normothermic control group after 60 min, while only to 111.3 +/- 0.9% at 27 degrees C. Hypothermia, however, was associated with a more pronounced decrease of the pHi during acidosis (6.3 +/- 0.04) as compared to that of the normothermic control falling then to 6.5 +/- 0.03. The results demonstrate that mild and moderate hypothermia induce glial cell swelling, but simultaneously inhibit cell swelling from acidosis. The protection against cell swelling, however, has its price as indicated by the enhancement of the intracellular acidification.
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Kirchner TH, Kirchner J, Viel K, Schneider M, Peters J, Jacobi V. [Bronchial carcinoma developing in a tuberculous scar: computer tomographic follow up]. RONTGENPRAXIS; ZEITSCHRIFT FUR RADIOLOGISCHE TECHNIK 1998; 51:448-51. [PMID: 10075577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
The development of scar is a rare complication of lung tuberculosis which was yet not often demonstrated in the radiologic literature. We report on a 71 year old male suffering by lung tuberculosis in an active stage which developed lung cancer in the region of tuberculotic scar clearly depicted on computed tomography. To the best of our knowledge this is the first reported computed computed tomography control series dealing with this problem. Additionally we report on histopathologic findings showing an early cancer in the surrounding of a tuberculotic scar.
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443
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Abstract
The literature on external prevention strategies for recurrence of venous leg ulcers is reviewed to assess the extent of existing knowledge and the effectiveness of preventive practices currently employed. Although there is some evidence that the use of compression hosiery is effective in reducing the incidence of recurrence, other strategies cited for ulcer prevention are not supported by documented research. It is also evident that patient compliance with wearing compression hosiery could be improved and that an evaluation of the effectiveness of hosiery currently available is overdue. With district nurses spending up to 50% of their time treating venous leg ulcers, not only are they in a key position to disseminate information on effective prevention to patients, but in so doing they should contribute to a reduction in their leg ulcer treatment caseload. To do this, nurses need to be more informed on aspects of venous leg ulceration and prevention strategies.
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444
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Silver LM, Nadeau JH, Brown SDM, Eppig JT, Peters J. Mammalian Genome, Incorporating Mouse Genome. Mamm Genome 1998; 9:1. [PMID: 9435276 DOI: 10.1007/s003359900669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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445
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Giebler R, Kollenberg B, Pohlen G, Peters J. Effect of positive end-expiratory pressure on the incidence of venous air embolism and on the cardiovascular response to the sitting position during neurosurgery. Br J Anaesth 1998; 80:30-5. [PMID: 9505774 DOI: 10.1093/bja/80.1.30] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We have studied prospectively the effect of 10 cm H2O of PEEP on the incidence of venous air embolism and on the cardiovascular response to change from the supine to the seated position in a large neurosurgical population. Patients were allocated randomly to receive either PEEP (10 cm H2O, n = 45) or conventional (control, n = 44) ventilation. Cardiovascular and respiratory variables were measured in the supine and sitting positions, and monitoring included precordial Doppler probe, pulmonary artery pressure and expiratory carbon dioxide concentration. Venous air embolism was assumed if changes in precordial Doppler sounds occurred, end-tidal carbon dioxide concentration decreased or air could be retrieved from a central venous multi-orifice catheter. The incidence of venous air embolism (26%) did not differ between patients undergoing conventional ventilation and those undergoing ventilation with 10 cm H2O of PEEP. Venous air embolism was always detected first by alterations in Doppler sounds. Cardiac output was significantly higher in patients undergoing conventional ventilation than in those undergoing ventilation with PEEP in the supine but not in the sitting position. Furthermore, pulmonary vascular resistance increased significantly only in the upright position in those undergoing ventilation with PEEP. The pulmonary artery wedge pressure to central venous pressure gradient did not attain negative values with PEEP or with upright positioning. We conclude that the use of PEEP during neurosurgical procedures performed in the sitting position should be abandoned as it does not decrease the incidence of venous air embolism but is associated with significant adverse cardiovascular effects.
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446
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Peters J, McCabe CJ, Hedley AJ, Lam TH, Wong CM. Economic burden of environmental tobacco smoke on Hong Kong families: scale and impact. J Epidemiol Community Health 1998; 52:53-8. [PMID: 9604042 PMCID: PMC1756610 DOI: 10.1136/jech.52.1.53] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To examine the financial cost of doctor consultations for cough, phlegm, and wheeze in children living in a home where family members smoke compared with those not exposed to environmental tobacco smoke. To model these costs to provide the Territory of Hong Kong with estimates of potentially avoidable health care resource use. DESIGN Cross sectional questionnaire survey. SUBJECTS AND SETTING All children (10,615) in classes primary 3 to 6 (aged 8-13 years) attending 27 schools in two districts of Hong Kong in 1992 and their parents. MEASUREMENTS AND MAIN RESULTS Doctor consultations during the previous three months for symptoms of either cough, phlegm or wheeze were higher in younger children, ranging from 22.9% in 8 year olds to 8.4% in those aged 12 or over. For those children living in homes with one, or more than one, smoker category (there were four categories of smokers: father, mother, siblings, others), the adjusted odds ratios (95% confidence intervals) for a doctor consultation for any of these symptoms were 1.15 (1.01, 1.31) and 1.38 (1.14, 1.67) respectively. Using US$15 as the minimum cost incurred per consultation, the expected direct cost per annum per child of doctor consultations was 14% higher for children living in a one smoker category home and 25% for two or more compared with exposure to no smokers in the home. Using these values on a territory wide basis, the annual avoidable direct cost associated with exposure to tobacco smoke in children from birth to 12 years of age ranged from US$338,042 to US$991,591. CONCLUSIONS Exposure to environmental tobacco smoke not only provides a respiratory health risk for children but also an avoidable excess cost to the family's financial resources and health service providers.
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447
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Gorga MP, Neely ST, Ohlrich B, Hoover B, Redner J, Peters J. From laboratory to clinic: a large scale study of distortion product otoacoustic emissions in ears with normal hearing and ears with hearing loss. Ear Hear 1997; 18:440-55. [PMID: 9416447 DOI: 10.1097/00003446-199712000-00003] [Citation(s) in RCA: 223] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES 1) To describe distortion product otoacoustic emission (DPOAE) measurements in large groups of subjects with normal hearing and with hearing loss, and to use these data to provide comprehensive descriptions of DPOAE test performance. 2) To describe the effects of primary frequency and audiometric threshold on the extent to which DPOAE measurements accurately identify auditory status. 3) To develop an approach that describes the probability that any measured response is coming from either a normal or an impaired ear. 4) To develop an approach for representing DPOAE data clinically. 5) To explore the relation between magnitude of hearing loss and DPOAE measurements. DESIGN DPOAE measurements were made in 1267 ears of 806 subjects, using stimulus conditions that previously had been demonstrated to result in the greatest separation between normal and impaired ears (i.e., primary levels of 65/55 dB SPL for f1/f2; Stover et al., 1996). Subjects were recruited from local clinical populations and through local advertisements. All data were analyzed using clinical decision theory, including relative operating characteristic (ROC) curves and estimates of areas under these curves (Az). In addition, cumulative distributions were constructed of response properties from both normal and hearing-impaired ears. These cumulative distributions were used to select specific probabilities that measured responses were coming from either the normal or impaired distributions, and to develop an approach for describing clinical DPOAE data. RESULTS For no conditions were the distributions of DPOAE responses from normal and impaired ears completely separated, meaning that optimal criterion values would still result in errors in identification of auditory status. Test performance, defined by Az, was best for mid and high frequencies and poorest for lower frequencies and for the highest frequency tested (8000 Hz). Performance was best when normal hearing was defined as audiometric thresholds between 20 and 30 dB HL, with poorer performance for more stringent or lax audiometric criteria. CONCLUSIONS Within the limits related to the effects of primary frequency and audiometric criterion, it appears that DPOAE measurements can be used to accurately identify auditory status. An approach is described, using the present data set, that allows one to assign to any measured DPOAE value (DPOAE amplitudes, DPOAE/noise) the probability that the response is coming either from the distribution of normal or impaired responses. In addition, DPOAE/noise systematically decreases as hearing loss increases over the range of hearing losses from 0 to about 40 to 60 dB HL (depending on frequency), thus potentially enabling one to differentiate hearing losses over this range. For hearing losses greater than 50 to 60 dB HL, ears do not produce measurable DPOAEs and thus, no predictive relationship exists.
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Scherer R, Kabatnik M, Erhard J, Peters J. The influence of antithrombin III (AT III) substitution to supranormal activities on systemic procoagulant turnover in patients with end-stage chronic liver disease. Intensive Care Med 1997; 23:1150-8. [PMID: 9434921 DOI: 10.1007/s001340050472] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Since antithrombin III (AT III) substitution to normal activities could not be shown to have major beneficial effects in patients with end-stage chronic liver disease in a variety of clinical settings, we tested the hypothesis that substitution to supranormal activities decreases systemic procoagulant turnover better in this patient group. DESIGN Controlled prospective clinical study. SETTING Operating rooms at a University Hospital. PATIENTS Twenty-four patients with histologically verified liver cirrhosis consecutively scheduled for liver transplantation. INTERVENTIONS Nineteen patients were given an antithrombin III concentrate to achieve either 100% (n = 10) or 175% (n = 9) AT III activity. Control patients (n = 5) received saline 0.9% instead. MEASUREMENTS AND RESULTS Molecular markers of coagulation activation, platelet count and aggregability, and global coagulation variables were measured prior to AT III infusion and 60 min thereafter. In both AT III-treated groups thrombin-antithrombin III-complex increased significantly (p < 0.005), whereas prothrombin fragment F1 + 2, soluble fibrin and D-dimer concentrations, as well as other variables, did not show major changes. CONCLUSIONS Despite thrombin inhibition by AT III in patients with end-stage chronic liver disease, systemic procoagulant turnover was not significantly decreased 60 min after AT III application even to supranormal activities. Replenishment of the inhibitory antithrombin III pool, decreased in chronic liver disease, should not be expected to slow down the baseline consumptive component of the haemostatic disorder in this patient group.
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Peters J, Luddington R, Brown K, Baglin C, Baglin T. Should patients starting anticoagulant therapy be screened for missense mutations at Ala-10 in the factor IX propeptide? Br J Haematol 1997; 99:467-8. [PMID: 9375777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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450
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Luddington R, Peters J, Baker P. Optical waveform analysis is a very sensitive indicator of disseminated intravascular coagulation but not 100% specific. Br J Haematol 1997; 99:469-70. [PMID: 9375779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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