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Biomedical subjects

A Geller

Publications and source records attributed to A Geller.

At least 19 recordsLinked to original sources
PubMed1995

Diagnosis of foregut duplication cysts by endoscopic ultrasonography.

BACKGROUND & AIMS: Foregut duplication cysts are rare congenital anomalies of enteric origin found most commonly in children and rarely in adults. They are usually found in adults on routine radiological studies and represent a challenging diagnostic problem. Conventional imaging tests do not lead to a conclusive diagnosis. With endoscopic ultrasonography, it is possible to distinguish between cystic and solid masses and to accurately establish the location of the cyst in relation to the gastrointestinal wall and to the mediastinum. METHODS: Seven patients who had endoscopic ultrasonography performed because of differentiation between a cystic or solid mass lesion in the chest or abdomen could not be made with conventional radiological methods are described. RESULTS: In all patients, a definite diagnosis was established by endoscopic ultrasonography. The diagnosis was confirmed in 2 patients after surgical excision. CONCLUSIONS: Surgery can be avoided in patients with asymptomatic enteric duplication cysts diagnosed by endoscopic ultrasonography.

Adult↗
PubMed1994

Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons.

BACKGROUND: Low serum thyrotropin concentrations are a sensitive indicator of hyperthyroidism but can also occur in persons who have no clinical manifestations of the disorder. We studied whether low serum thyrotropin concentrations in clinically euthyroid older persons are a risk factor for subsequent atrial fibrillation. METHODS: We studied 2007 persons (814 men and 1193 women) 60 years of age or older who did not have atrial fibrillation in order to determine the frequency of this arrhythmia during a 10-year follow-up period. The subjects were classified according to their serum thyrotropin concentrations: those with low values (< or = 0.1 mU per liter; 61 subjects); those with slightly low values (> 0.1 to 0.4 mU per liter; 187 subjects); those with normal values (> 0.4 to 5.0 mU per liter; 1576 subjects); and those with high values (> 5.0 mU per liter; 183 subjects). RESULTS: During the 10-year follow-up period, atrial fibrillation occurred in 13 persons with low initial values for serum thyrotropin, 23 with slightly low values, 133 with normal values, and 23 with high values. The cumulative incidence of atrial fibrillation at 10 years was 28 percent among the subjects with low serum thyrotropin values (< or = 0.1 mU per liter), as compared with 11 percent among those with normal values; the age-adjusted incidence of atrial fibrillation was 28 per 1000 person-years among those with low values and 10 per 1000 person-years among those with normal values (P = 0.005). After adjustment for other known risk factors, the relative risk of atrial fibrillation in elderly subjects with low serum thyrotropin concentrations, as compared with those with normal concentrations, was 3.1 (95 percent confidence interval, 1.7 to 5.5; P < 0.001). The 10-year incidence of atrial fibrillation in the groups with slightly low and high serum thyrotropin values was not significantly different from that in the group with normal values. CONCLUSIONS: Among people 60 years of age or older, a low serum thyrotropin concentration is associated with a threefold higher risk that atrial fibrillation will develop in the subsequent decade.

Age Factors↗
PubMed1994

Control of polycythaemia vera with photochemotherapy in a patient with cutaneous T-cell lymphoma.

We report the use of photochemotherapy in a patient with polycythaemia vera (PV) and cutaneous T-cell lymphoma (CTCL). The patient was diagnosed with PV and required monthly phlebotomy. Subsequently he was diagnosed with CTCL and was started on photochemotherapy. A clinical improvement in both conditions, with haematocrit stabilizing at a level of 50%, eliminated the need for further phlebotomy. It is conceiveable that photochemotherapy induced the clinical and laboratory improvement in PV by targeting the aberrant clonal haemopoietic cell, similar to the mechanism thought to be operative in CTCL, a clonal helper T cell malignancy.

Aged↗
PubMed1992

Mesenteritis ossificans.

A unique finding of an extraskeletal pseudomalignant osseous lesion of the mesentery and omentum was detected in a 63-yr-old insulin-dependent diabetic man, following aortic bifemoral bypass and two subsequent laparotomies at 2-wk intervals for intractable intestinal obstruction. An analogy is made to myositis ossificans and fasciitis ossificans. The histogenesis of new bone formation from connective tissue following chemical or physical stimuli supports a metaplastic mechanism. Our review of the literature reveals no prior report of a similar case.

Diagnosis, Differential↗
PubMed1991

Infection of cultured striatal neurons with a defective HSV-1 vector: implications for gene therapy.

Several neurological diseases which affect the corpus striatum are candidates for gene therapy. We have developed a defective Herpes Simplex Virus (HSV-1) vector system to introduce genes into postmitotic cells, such as neurons. The prototype vector, pHSVlac, contains a transcription unit which places the E. coli Lac Z gene under the control of the HSV-1 immediate early (IE) 4/5 promoter, a constitutive promoter. We now demonstrate that a HSV-1 vector can deliver a gene into striatal neurons. Infection of cultured rat striatal neurons with pHSVlac virus resulted in stable expression of beta-galactosidase for at least two weeks, without cell death. The potential to replace the Lac Z gene with other genes of interest, such as the gene responsible for Huntington's Disease, once it is isolated, may lead to insights about the pathogenesis of this genetic neurodegenerative disease, and may provide a method for performing gene therapy on this disease. Similarly, introduction of the tyrosine hydroxylase gene, which encodes the rate-limiting enzyme in the conversion of tyrosine to dopamine, into striatal neurons might provide a novel gene therapy approach towards treating Parkinson's Disease.

Animals↗
PubMed1991

Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism.

We studied a large population (n = 2575) of unselected ambulatory persons older than 60 years to determine the prevalence of a low serum thyroid-stimulating hormone (TSH) level, ie, of less than 0.1 mU/L using a sensitive assay, a level suggestive of hyperthyroidism in younger adults. One hundred one persons (3.9%) had a low serum TSH level. About half of them (51/101) were taking thyroid hormone. Of the remainder, 44 were not hyperthyroid did not become so during up to 4 years of follow-up. Forty-one of the 44 euthyroid persons had a serum thyroxine level of less than 129 nmol/L; repeated testing showed a serum TSH level of more than 0.1 mU/L in the three euthyroid persons with a serum thyroxine level of more than 129 nmol/L. Only six were hyperthyroid or became so during the follow-up period; all had a serum thyroxine level of more than 129 nmol/L. Routine clinical examination was not a sensitive indicator of hyperthyroidism and did not permit discrimination from euthyroidism. A low value of serum TSH alone, while it had high sensitivity and specificity for hyperthyroidism, had a low positive predictive value (12%) for this diagnosis; addition of the thyroxine assay raised the predictive value fivefold to 67%. A low value of serum TSH is far more common in older persons than is hyperthyroidism. Low values in euthyroid persons are accompanied by a clearly normal serum T4 concentration (less than 129 nmol/L) or by a serum TSH level of more than 0.1 mU/L on repeated testing. We recommend measurement of the serum TSH thyroid concentration, using a sensitive assay, as the initial step in testing any older person for possible hyperthyroidism. Measurement of the serum T4 concentration or the free T4 index on the same sample would be needed only in the approximately 2% with a serum TSH level of less than 0.1 mU/L; alternatively, the TSH assay in these could be repeated at a later time.

Aged↗
PubMed1989

The aging thyroid. The use of thyroid hormone in older persons.

The overall prevalence of thyroid hormone use in an unselected population of older adults (n = 2575; average age, 68.6 years) was 6.9% (10.0% in women and 2.3% in men). Eighty-one percent of women taking it were doing so for appropriate indications, eg, hypothyroidism, while 12% were not, eg, for obesity or high serum cholesterol; more men (29%) were taking it inappropriately. Inappropriate use was associated with desiccated thyroid more than with thyroxine. After follow-up averaging 6.9 years, 58% of inappropriate users were still taking it. Underuse also occurred. Thirty-seven percent of those definitely hypothyroid had a clearly elevated serum thyrotropin level (greater than 10 mU/L) despite thyroid therapy. Thyroid therapy is common in the elderly; most is appropriate. When inappropriate use occurs, it is more common in men and more often associated with desiccated thyroid, still commonly used in this age group. In chronic users of thyroid hormone, it is important to review currently appropriate indications and to measure serum thyrotropin levels to assess the adequacy of treatment of primary hypothyroidism.

Age Factors↗
PubMed1989

Serum prolactin and aging: basal values and changes with estrogen use and hypothyroidism.

We studied basal serum prolactin in older (greater than age 50) men (N = 501) and women (N = 384) using younger adults for comparison and excluding those taking medications. Serum prolactin rose slightly with increasing age in men; it fell slightly in women until age 80, when it rose slightly. Men and women were not different except for the higher value in women at age 20 to 29. Serum prolactin did not fall after the menopause, while estrogen treatment had no effect on older women and caused only a slight rise in older men. Thyroid deficiency had only a minimal effect and did not raise the serum prolactin above 25 ng/ml. The prevalence of clearly elevated values (greater than 20 ng/ml) was only 1.3% in women and 0.6% in men above age 50; there is little evidence for a significant prevalence of prolactin-secreting adenomata in older persons. In older persons, prolactin-secreting tumors are uncommon, and neither thyroid failure nor estrogen therapy are good explanations for a clearly elevated serum prolactin.

Adult↗
PubMed1987

Differential effects of the anxiolytic drugs, diazepam and buspirone, on memory function.

The effects of the anxiolytic drugs diazepam (5 mg) or buspirone (5 or 10 mg) were studied in comparison with placebo on memory function in 39 subjects diagnosed with generalized anxiety disorder. Neither drug altered the immediate recall of a list of 16 nouns or impaired digit span, a second test of immediate memory. Diazepam selectively impaired the recall of nouns after a 20 min delay when compared with placebo. In contrast, neither dose of buspirone altered the delayed recall of the word list. The implications of such different effects of anxiolytic drugs on memory function for the clinical treatment of anxiety are discussed.

Anti-Anxiety Agents↗
PubMed1984

The social, psychological and medical management of intoxication.

Intoxicated persons appear frequently in substance abuse centers and in general hospital settings. The severity of their condition ranges from mild impairment to coma or delirium. The prominent features of intoxication with the major classes of abused drugs are described. Staff responses to intoxication are discussed. Guidelines are presented for systematic management of this condition.

Arrhythmias, Cardiac↗
PubMed1982

A preliminary report: nutritional levels and cognitive performance in chronic alcohol abusers.

The relationship between vitamin levels, alcohol intake and cognitive status was examined in a group of 19 chronic alcoholics who had just begun to withdraw from alcohol. The results indicate that during this stage of detoxification levels of folic acid are the best predictors of cognitive performance. Alcohol intake, as measured by either total life consumption or years of alcohol abuse, was only weakly associated with neuropsychological tests scores. It is suggested that the cognitive recovery that occurs during the first weeks of abstinence may be related to nutritional variables, whereas the longer-lasting neuropsychological impairments of alcohol abusers may be related to the direct neurotoxic effects of alcohol.

Adult↗