Comparison of two commercial enzyme immunoassays with cytotoxicity assay and culture for the diagnosis of Clostridium difficile related diarrhea.

184 stool samples were analysed for the presence of Clostridium difficile and toxins using the Meridian Premier Toxin A and TechLab Tox-A EIA kits, selective culture and cytotoxin assay. Of the 184 samples 36 stools tested positive for cytotoxin. In comparison the sensitivity and specificity of the EIAs and culture were as follows: Meridian, 72 and 87, TechLab, 64 and 95, and selective culture, 83 and 96%, respectively.

Functional heterogeneity of human term cytotrophoblasts revealed by differential sensitivity to extracellular Ca2+ and nucleotides.

We have prepared purified cytotrophoblasts from human term placentas and examined the sensitivity of fura-2 loaded cells to the nucleotides ATP and UTP and to changes in extracellular Ca2+ concentration ([Ca2+]o). Purified cytotrophoblasts were obtained by collagenase digestion and separation according to density using self-generated Percoll gradients. The cytotrophoblast fraction was free of red cell and largely free of white cell contamination (as assessed by uniformly negative staining for vimentin and the failure of > 90% of fura-2 loaded cells to respond to the chemotactic peptide fMet-Leu-Phe).

Effect of vitamin-antioxidant micronutrients on the frequency of spontaneous and in vitro gamma-ray-induced micronuclei in lymphocytes of donors: the age factor.

The effect of prolonged consumption of a vitamin-antioxidant mixture (VAM) on the frequency of spontaneous and in vitro gamma-radiation-induced micronuclei (MN) in peripheral blood lymphocytes in donors of various ages was investigated. Three groups of donors were recruited: (i) 56-83 years old (35 subjects), (ii) 23-30 years old (13 subjects), and (iii) 63-82 years old (12 subjects). Blood was sampled every 4 months for one year in all donors of the three groups.

Occurrence of validating clinical findings in the hospital record for appendectomy, cholecystectomy and intervertebral disc excision patients: comparisons among hospitals and among surgeons.

This study examines the variation among 36 Pennsylvania hospitals, and the individual surgeons practicing in them, in the proportion of appendectomy, cholecystectomy and intervertebral disc excision patients with clinical findings in the hospital record that validate the need for surgery. Using admissions from January 1990 through June 1991, we performed logistic regressions on the probability of validating clinical findings controlling for patient age, sex, admission severity of illness, and Medicaid and Health Maintenance Organization membership. Our results show that hospitals, and surgeons, vary significantly in their validation rates for cholecystectomy and disc surgery and, to a lesser extent, appendectomy.

The effect of dietary supplements on gene expression in mice tissues.

Exposure of living organisms to various environmental stresses induces the synthesis of so-called shock/stress proteins; many of them can provide either immediate stress protection or participate in cellular repair processes. In the present study we focused our attention on the potential effect of dietary vitamins and microelements with antioxidant properties on stress protein gene expression. The analysis of gene expression in tissues of antioxidant-fed mice shows hsp-70 gene overexpression in liver and brain, but not in spleen and lung.

Dietary supplements of antioxidants reduce hprt mutant frequency in splenocytes of aging mice.

The level of spontaneous and gamma-radiation-induced mutations in the hypoxanthine-guanine phosphoribosyl-transferase (hprt) locus as well as the decrease in frequency of these mutations in mice of various age pretreated with dietary supplements of an antioxidant mixture (vitamins C, E, beta-carotene, rutin, selenium, zinc) were studied in splenocytes of young (8-14-week-old) and aged (102-110-week-old) male C57BL/6 mice. The frequency of spontaneous mutations in splenocytes of 102-110-week-old mice was higher by 68-88% than that in mice aged 8-14 weeks. On gamma-irradiation (0.

Indications for hysterectomy: variation within and across hospitals.

This study investigates the factors associated with the probability of finding specific clinical indicators (benign or malignant tumor, cancer in situ, fibroid, abscess/empyema, or positive culture of salpinx, fallopian tube, fetus, or uterus) that validate necessity for hysterectomy. Data for the 4,660 cases in the study come from 42 Pennsylvania hospitals. The probability that validating indicators were present varied significantly at the hospital level but not at the level of individual surgeons within hospital, suggesting that physicians in different hospitals adopted different practice styles.

Admission severity of illness and resource utilization: comparing Medicaid and privately insured patients.

This study compares Medicaid patients and privately insured patients. Regression analyses examine the effect of Medicaid status on hospital admission severity, length of stay, and ancillary charges for 14,557 patients in ten medical DRGs and ten surgical procedures. The results show that Medicaid patients were significantly sicker on admission, especially the medical patients.

Infection associated with central venous catheters: a prospective survey.

Objective: To assess the incidence of local and systemic infection caused by central venous catheters in a general hospital population.

Setting: Concord Repatriation General Hospital, Sydney, April to August 1991 inclusive.

Design: A prospective survey of all patients with in situ central venous catheters.

Pyogenic vertebral osteomyelitis: analysis of 20 cases and review.

The diagnosis of vertebral osteomyelitis is easily missed, particularly for the elderly in whom signs of sepsis may not manifest. The case records of 20 patients with vertebral osteomyelitis who were treated at our hospital between January 1989 and April 1993 were reviewed. The average age of the patients was 72 years.

Surgeon volume and hospital resource utilization.

This study examines whether surgeons who perform a particular procedure more often incur lower hospital charges and shorter lengths of stay than surgeons with less volume. The 43 Pennsylvania hospitals included in the 1991 MedisGroups Comparative Hospital Database form the study hospitals. The analysis looks at four frequently occurring surgical procedures: cholecystectomy, prostatectomy, hysterectomy, and intervertebral disc excision.

Relating hospital health outcomes and resource expenditures.

This study addresses the question of whether hospitals with better health outcomes for their patients spend more or less to accomplish these results. Adult medical service admissions to 43 Pennsylvania hospitals are analyzed. Health outcomes and resource expenditures are adjusted for admission severity of illness and other patient variables.

New nonpeptide angiotensin II receptor antagonists. 3. Synthesis, biological properties, and structure-activity relationships of 2-alkyl-4-(biphenylylmethoxy)pyridine derivatives.

A novel series of nonpeptide angiotensin II (AII) receptor antagonists is reported, derived from linkage of the biphenylyltetrazole moiety found in previously described antagonists via a methyleneoxy chain to the 4-position of a 3-substituted 2,6-dialkylpyridine. When evaluated in an in vitro binding assay using a guinea pig adrenal membrane preparation, compounds in this series generally gave IC50 values in the range 0.005-0.

Comparing surgical efficiency in independent practice association HMOS and traditional insurance programs.

This study examines the effect of Independent Practice Association (IPA) HMO membership on hospital total charges, ancillary charges and length of stay (LOS) for surgical patients. Intrahospital comparisons of IPA and traditional insurance patients are made after adjusting for surgical procedure, admission severity of illness, age, sex and year of admission. Our multiple regression model indicates that IPA patients undergoing 12 frequently occurring surgical procedures have lower resource use.

Comparing low-severity hospital admissions in IPA HMOs and indemnity-type programs.

This study compares the proportion of low-severity hospital patients in independent practice association (IPA) HMOs and indemnity-type programs. The length of stay of such low-severity patients is also studied. Admissions of IPA patients under age 65 to ten hospitals are compared with admissions to the same hospital of patients covered by Blue Cross and Blue Shield plans or commercial insurance programs.

Predicted probabilities of hospital death as a measure of admission severity of illness.

This paper evaluates a new method for assessing hospital admission severity of illness based on disease-specific models (logistic regression) of the probability of in-hospital mortality. Results for the 26 disease groups in MDC 4--Diseases of the Respiratory System, MDC 5--Diseases of the Circulatory System, and MDC 6--Diseases of the Digestive System are presented using data on all 1991 admissions from 111 hospitals throughout the United States. These disease models are empirically derived using clinical findings from laboratory, radiology, pathology, diagnostic procedures, patient history and physical exam, as well as patient age and sex.

Inter-hospital mortality and morbidity variation in Pennsylvania.

A 1986 Pennsylvania law requires the public disclosure of hospital mortality and morbidity rates. This study of hospital admissions in 1989 and 1990 examines the variation in these health-outcome indicators for the 10 most frequently occurring DRGs in the adult medical service in a sample of 20 Pennsylvania hospitals. These mortality and morbidity rates are adjusted for admission severity, DRG, age, and sex, using a logistic regression model.

New nonpeptide angiotensin II receptor antagonists. 2. Synthesis, biological properties, and structure-activity relationships of 2-alkyl-4-(biphenylylmethoxy)quinoline derivatives.

A novel series of nonpeptidic angiotensin II (AII) receptor antagonists is reported, derived from linkage of the biphenylcarboxylic acid or biphenylyltetrazole moiety found in previously described antagonists via a methyleneoxy chain to the 4-position of a 2-alkyl quinoline. When evaluated in an in vitro binding assay using a guinea pig adrenal membrane preparation, compounds in this series generally gave IC50 values in the range 0.01-1 microM.