Operating room cost awareness committee. A model for collaboration

Kaiser Santa Rosa (KSRO), a small facility in the Kaiser Permanente health maintenance organization, was found to have an unfavorably high non-payroll cost per surgical hour as compared with other Kaiser facilities. An Operating Room Cost Awareness Committee was formed to address the problem and has now become a standing committee at KSRO. The committee is composed of surgeons, nurses, materiel management personnel and administrative representatives. Through a spirit of cooperation and the authority to approve and deny all OR supply requests, the committee has been able to bring its OR costs in line with other Kaiser facilities.     

Functionally intact in vitro preparation generating respiratory activity in neonatal and mature mammals

The present report describes a novel rhythmically active brainstem slice preparation that generates respiratory activity spontaneously in both mice and rats of varying maturational states. The brainstems of neonatal (0–4 days) and mature (3–8 weeks) mice and rats were isolated and a 600- to 750-m thick slice cut to include the dorsomedial and the ventrolateral regions of the complete rostro-caudal extent of the medulla. This plane of section we have termed tilted-sagittal. Rhythmically discharging neurones were recorded extracellularly from both the dorsal and ventral regions of the slice. The recording sites of these neurones were found in the hypoglossal motonucleus (XII) and in areas of the ventrolateral medulla that includes the ventral respiratory group (VRG) region. Histological examination revealed the preservation of neuronal structures important for cardiorespiratory regulation and reflex control including the nucleus of the solitary tract as well as the nucleus ambiguus. In addition, pontine structures including the A5 region were also preserved. Rhythmic activity was found only in slices where the ambiguual column was preserved in its entirety. The mean frequency of discharge of XII neurones was 20 and 10 bursts per minute in neonates and mature rodents respectively. In preparations of mature animals we demonstrate that this frequency increased significantly (P<0.05) by either raising temperature from 29°C to 38°C (54%), elevating extracellular potassium concentration from 4 to 7.5 mM (52%), blocking potassium channels (20%) or decreasing pH from 7.4 to 7.0 (18%). The burst duration to frequency ratio of XII and VRG rhythmic neurones was similar and therefore indicative of a common brainstem oscillator. Consistent with this finding was that rhythmic activity in the VRG persisted despite removal of the dorsomedial region of the slice. In contrast, rhythmic XII neurones became tonic following mechanical disconnection of the VRG.     

Growth hormone attenuates tumor necrosis factor alpha in burned children

BACKGROUND: Recombinant human growth hormone (rhGH) has been shown to favorably modulate the acute-phase response and may improve the clinical outcome. OBJECTIVE: To examine whether rhGH attenuates the elevated tumor necrosis factor alpha (TNF-alpha) levels that correlate with increased multiorgan failure and mortality in burned adults and children. DESIGN: Twenty children with burns of greater than 40% of the total body surface area were randomly divided into 2 groups to receive placebo (n = 10) or rhGH, 0.2 mg/kg per day intramuscularly (n = 10). SETTING: Pediatric burn hospital. MAIN OUTCOME MEASURE: Serum TNF-alpha levels by enzyme-linked immunoassay at baseline (day 0) and at 21 and 42 days after injury. For statistical analysis, we used the Kruskal-Wallis and Friedman tests. RESULTS: No significant differences in age (mean +/- SD, 6.2+/-1.6 vs 5.0+/-1.2 years) or percentage of total body surface area burn (mean +/- SD, 65.1%+/-8.2% vs 57.1%+/-5.2%) could be shown between the groups given rhGH and placebo. Baseline TNF-alpha levels were elevated from reference values in both groups. Twenty-one and 42 days after rhGH administration, serum TNF-alpha levels were significantly decreased from those at baseline (P<.05). No significant decrease in TNF-alpha levels was observed in the placebo group (P = .5). CONCLUSIONS: Recombinant human growth hormone significantly lowers serum TNF-alpha levels after burn injury. This is consistent with the beneficial effect that rhGH has on the acute-phase response.     

Carbohydrate availability of arroz caldo with lambda-carrageenan

Total available carbohydrate (sugars and starches) and total dietary fiber (soluble and insoluble) make up the total carbohydrate content of a food. Soluble fiber decreases the availability of glucose by delaying its absorption in the proximal small intestine, thus reducing the postprandial glucose levels (Jenkins et al., 1978; Schneeman, 1987a). Carrageenan, a seaweed extract, is a good source of soluble fiber (Monta?o et al., 1985). This study aimed to determine the effect of carrageenan incorporation into arroz caldo on carbohydrate availability by monitoring the postprandial blood glucose levels of normal subjects. Control and experimental arroz caldo samples were prepared and subjected to proximate analysis and feeding studies. The total dietary fiber (TDF) content of the experimental (2.03%) was about thrice that of the control (0.68%). Using randomized crossover design, preweighed 55 g available carbohydrate serving portions of control and experimental arroz caldo samples, with 3.45 and 14.84 g TDF, respectively, were fed to ten fasting normal subjects then their postprandial blood glucose levels were determined at 15, 30, 45, 60 and 90 min intervals. Results of the short-term in vivo study showed that the mean postprandial glycaemic responses of subjects after consuming the experimental sample were significantly lower than the levels after consuming the control at 15, 45, and 90 min (P < or = 0.05) and at 30 min (P < or = 0.001). Likewise, the mean glucose area under the curve was significantly lower (P < or = 0.01) after consumption of experimental (69.22 +/- 32.94) arroz caldo than control (147.29 +/- 53.34). The hypoglycaemic effect of carrageenan may prove useful in the prevention and management of metabolic conditions such as diabetes.     

Rapid inhibition of rat brain mitochondrial proton F0F1-ATPase activity by estrogens: comparison with Na+, K+ -ATPase of porcine cortex

Our earlier studies have identified oligomycin sensitivity-conferring protein (OSCP), a subunit of proton F0F1-ATPase/ATP synthase in the mitochondrial inner membranes, as a new estradiol binding protein. This finding suggests that mitochondrial ATPase/ATP synthase could be a potential target for estradiol or compounds with similar structures. Here, we report that estradiol and several other compounds inhibited F0F1-ATPase activity of detergent-solubilized rat brain mitochondrial preparations in a following decreasing order: diethylstilbestrol (half-inhibition concentration, IC50 of 10-25 microM) > alpha-zearalenol, 4-hydroxyestradiol (1C50 of 55 microM) >2-hydroxyestradiol (IC50 of 110 microM), 17beta-estradiol, 17alpha-estradiol > beta-zearalanol > estriol, testosterone, 16alpha-hydroxyestrone > corticosterone, progesterone, dehydroepiandrosterone, dehydroepiandrosterone 3-sulfate, cholesterol (less than 10% inhibition at 140 microM). On the other hand, Na+, K+ -ATPase of porcine cortex showed different sensitivity to the compounds tested above. At 70 microM, the rank of inhibitory potency in decreasing order was as follows: 2-hydroxyestradiol (IC50 of 70 microM) > diethylstilbestrol> 4-hydroxyestradiol > progesterone > alpha-zearalenol, while other compounds had little effect (less than 5%). The data indicate that the ubiquitous mitochondrial F0F1-ATPase is a specific target site for estradiol and related estrogenic compounds; however, under this in vitro condition, the effect seems to require pharmacological concentrations.     

Antibiotic streamlining: development and justification of an antibiotic streamlining program

Several techniques can be applied to streamline or optimize antimicrobial therapy in the hospitalized patient. As soon as there is a documented clinical response to intravenous therapy, the antibiotic can be switched to the oral route of administration. This antimicrobial streamlining technique is called switch therapy. This article presents the development of the switch therapy concept, the good clinical outcome obtained with switch therapy in patients with community and nosocomial pneumonia, as well as the cost-savings to our institution after the implementation of this program.     

Synovial sarcoma of the neck associated with previous head and neck radiation therapy.

Synovial sarcoma is a rare neoplasm that uncommonly arises in the neck. Fourteen years after facial and neck radiation therapy for acne, synovial sarcoma of the neck developed in a young man. Possible radiation-induced benign and malignant neoplasms that arise in the head and neck region, either of thyroid or extrathyroid origin, remain a continuing medical problem.     

RNA release from isolated brain cell nuclei: influence of the postnatal cerebral development

A method to measure the "in vitro" RNA release from rat brain cell nuclei was described. Nuclear RNA was prelabelled "in vivo" for 30 or 120 min. In the first case the released RNA was heterogeneous and its electrophoretic mobility was similar to that of cytoplasmic messenger RNAs; nuclei prelabelled for 120 min mostly released the two major species of ribosomal RNAs. The release of mRNAs from the nuclei increased during cerebral development while that of the ribosomal RNAs did not. The increased capacity of the nuclei to release "radidly labelled" RNA with age neither determined an increase of the polysomal population, nor seemed to be dependent on cytoplasmic macromolecules.