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Biomedical subjects

A Bornstein

Publications and source records attributed to A Bornstein.

13 recordsLinked to original sources

Familial cutaneous malignant melanoma and tumors of the nervous system. A hereditary cancer syndrome.

BACKGROUND: Excessive risk of cutaneous melanoma as a second cancer has been associated with benign or malignant tumors of the nervous system. Cutaneous melanoma and nervous system tumors may independently aggregate in families. There are, however, no previous reports of increased likelihood of tumors of the nervous system in families of patients with cutaneous melanoma or--of cutaneous melanoma in families with tumors of the nervous system. METHODS: The occurrence of nervous system tumors as second cancers was examined in a series of 904 patients with cutaneous melanoma and/or their family members. RESULTS: Fifteen families with 17 members with cutaneous melanoma from this series had one or more additional relatives with tumors of the nervous system, including astrocytoma, medulloblastoma, glioblastoma multiforme, ependymoma, glioma, meningioma, and acoustic neurilemmoma. Another subgroup of 10 patients with cutaneous melanoma had either a meningioma (n = 9) or acoustic neurilemmoma (n = 1) as a second tumor. The pattern of atypical melanocytic nevi occurring in the majority (20/25) of cutaneous melanoma patients in our series and in additional first degree relatives of 9 of 11 of the affected families, has been previously associated with the Familial Atypical Multiple Mole-Melanoma syndrome. CONCLUSIONS: This unusual familial and personal occurrence of tumors, showing differentiation toward tissues of the neural crest, neuroepithelium, and/or mesenchymal derivation, supports a putative association with a hereditary cancer susceptibility trait.

Adolescent↗

Assessment of the cardiac effects of hemodialysis with systolic time intervals and echocardiography.

The acute effects of hemodialysis on left ventricular (LV) function were studied with the use of externally recorded LV systolic time intervals and echocardiography; 10 patients with normal or near-normal predialysis LV function and no circulatory congestion were studied. Hemodialysis significantly decreased the LV ejection time (LVET) from 270 +/- 9 ms to 237 +/- 10 ms (p less than 0.001); no significant change was noted in the preejection period (PEP). The PEP/LVET ratio increased from 0.41 +/- 0.05 to 0.45 +/- 0.06 (p less than 0.05). The LV end-diastolic dimension decreased from 5.3 +/- 0.3 cm to 4.8 +/- 0.3 cm (p less than 0.001). Fractional shortening and ejection fraction did not change significantly, but hemodialysis slightly increased mean VCF from 1.2 +/- 0.1 s-1 to 1.4 +/- 0.1s-1 (p less than 0.005). Hemodialysis was associated with a 17% decrease (87 +/- 8 ml to 72 +/- 7 ml; p less than 0.001) in LV stroke volume as calculated from echocardiographic data. Small changes in heart rate and blood pressure were insignificant. We conclude that the postdialysis reduction in stroke volume was due primarily to an acute decrease in LV preload; dialysis also appears to be associated with a small increase in the LV contractile state.

Adult↗

Fracture of pacing electrode mimicking failure of pulse generator.

To our knowledge, this is the first reported case of spontaneous fracture of a pacing electrode with decreased amplitude of the pacing artifact, failure to capture, and intact sensing. We postulate that the difference in impedance of the pacemaker for sensing and stimulation may account for this phenomenon.

Aged↗

Postexercise left ventricular function: a comparative assessment by different noninvasive imaging modalities.

The variety of noninvasive imaging modalities now available permits assessment of different aspects of left ventricular function in the postexercise state. Some of these modalities, such as first-pass radionuclide ventriculography, permit a nearly instantaneous assessment of left ventricular function in the early postexercise state. These modalities indicate that most exercise-induced left ventricular wall motion abnormalities resolve quickly after exercise. Resting wall motion abnormalities may also improve in the postexercise period; this response indicates the presence of hibernating myocardium capable of improving in response to myocardial revascularization procedures. On the other hand, all imaging techniques indicate that a certain percentage of exercise-induced wall motion abnormalities may persist into the postexercise period, and this finding signifies that severe coronary disease subtends the region of persisting wall motion abnormality. Further, if there is increased left ventricular size after exercise, both extensive and severe coronary disease are present. A conceptual framework for unifying these disparate findings is provided. These results underscore the importance of postexercise imaging in enhancing clinical assessment and imply that there are important technical considerations to contemplate when performing certain tests such as postexercise echocardiography.

Echocardiography↗

Cardiac effects of hemodialysis: noninvasive monitoring by systolic time intervals.

The effects of hemodialysis on cardiac performance were evaluated by systolic time intervals measured blindly in 15 chronic renal failure patients maintained free of circulatory congestion. After a mean dialysis of 8.7 hours, levels of blood urea nitrogen, serum creatinin, and potassium and body weight showed statistically significant decreases and serum calcium and hematocrit values increased; heart rate and both diastolic and systolic blood pressure did not change significantly. Left ventricular ejection time (LVET) and ejection time index (ETI) were significantly shorter, falling from within normal limits to below normal. Pre-ejection period (PEP) rose significantly. These changes are consistent with a two-fold immediate effect of hemodialysis: (1) reduction of stroke volume as reflected by decreased ETI; and (2) reduced Starling effect, with or without decreased contractility, as reflected by increased PEP.

Adolescent↗