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Biomedical subjects

A Jaffe

Publications and source records attributed to A Jaffe.

At least 37 records · Page 2Linked to original sources
PubMed1996

Erectile dysfunction in hypertensive subjects. Assessment of potential determinants.

Hypertension is often cited as a risk factor for erectile dysfunction. To clarify the relation between hypertension and erectile dysfunction, we evaluated 32 consecutive hypertensive and 78 normotensive impotent men with respect to multiple potential determinants and parameters of erectile function, including medical and sexual history, depression, hormonal profile, penile nocturnal tumescence, penile vascular supply, and pudendal nerve conduction. The hypertensive men were older, had higher body mass index, and used more medications than the normotensive men. The groups were not different with respect to the prevalence of smoking and peripheral vascular disease, but the hypertensive men had a marginally higher rate of ischemic heart disease (P = .06). The prevalence of depression, abnormal nocturnal penile tumescence, anomalous pudendal nerve conduction, and impairment in arterial supply as determined by penile brachial index were similar in the two groups. Testosterone and bioavailable testosterone levels were lower in the hypertensive men. After stratification by age and body mass index, hypertensive men younger than 50 years with body mass index less than 30 kg/m2 had significantly lower testosterone levels (12.0 +/- 1.7 versus 21.3 +/- 1.4 nmol/L, P < .02) but not bioavailable testosterone levels (3.9 +/- 0.7 versus 6.4 +/- 0.7 nmol/L, P < .17) than the corresponding normotensive group. Prolactin, follicle-stimulating hormone, and luteinizing hormone levels of the two groups were not significantly different. Contrary to common belief and with the exception of lower circulating testosterone levels, the overall analysis showed little difference between hypertensive and normotensive men with respect to a wide range of classic determinants of erectile function. Direct study of the local vascular erectile apparatus appears necessary for further elucidation of the mechanisms underlying erectile dysfunction in hypertensive men.

Adult↗
PubMed1995

The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases.

The role of the low dose (1 microgram) ACTH stimulation test in the evaluation of patients with pituitary diseases was systematically assessed by relating its results to those obtained on gold standard tests of hypothalamo-pituitary-adrenal (HPA) reserve, such as insulin-induced hypoglycemia or a metyrapone challenge. Ten patients with pituitary diseases (8 men and 2 women) and proven impairment of HPA function and 9 patients (5 men and 4 women) with similar pituitary pathologies but preserved HPA function were studied (pituitary controls). A group of 7 normal volunteers (3 men and 4 women) served as normal controls. None of the subjects was taking glucocorticoids on a chronic basis or had been taking any recently. All subjects underwent ACTH tests at 0800 h with 3 different levels of stimulation (1, 5, and 250 micrograms), and serum cortisol was assayed 0, 30, and 60 min after injection. A pass result was defined as a peak cortisol value of 497 nmol/L or more. Basal cortisol values were indistinguishable among the groups. Pituitary controls did not differ from normal controls for any of the challenges. In healthy controls, peak cortisol levels attained with the low dose stimulation were clearly lower than with the standard dose (670 +/- 39 vs. 919 +/- 50 nmol/L; P = 0.002). However, every normal control passed the low dose stimulation, whereas none of the patients with impaired HPA function did (P = 0.00005). Although the cortisol values achieved on the standard (250 micrograms) dose by the subjects with impaired HPA function were significantly lower than those in normal controls (P < 0.005), they were generally normal in absolute terms. Indeed, using the peak value criterion, 7 of these 10 patients would have qualified as pass on the 5-micrograms challenge, and 9 of 10 would have passed the 250-micrograms test. Thus, the low dose ACTH test appears to perform better than the standard pharmacological test. As we have shown that this test correlates well with reference tests of HPA function, it is suggested that it should replace the standard ACTH test in the diagnosis of secondary adrenal insufficiency.

Adrenocorticotropic Hormone↗
PubMed1994

Minor depression and functional impairment.

OBJECTIVE: To describe a method of assessing minor depression and its effects on functional status, medical co-morbidity, seasonality, and demographic variables. DESIGN: A survey administered to a nonrandom sample of 302 patients. SETTING: A university-based family practice outpatient center. PATIENTS: Patients who were seen for routine ambulatory care were asked to complete the Inventory to Diagnose Depression scale and a modified version of the Dartmouth COOP Functional Assessment Charts, including a measure of seasonality. MAIN OUTCOME MEASURES: Six categories of functional impairment were examined across two categories of depression (major and minor) and the nondepressed. Major depression is defined strictly by criteria in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Minor depression is defined as depressed mood or anhedonia and one other of the nine depression symptoms. RESULTS: Forty-seven patients (15.6%) had minor depression. Using chi 2 analysis, significant differences were found among the three levels of depression for each functional status category. Logistic regression analysis showed patients with minor depression to have greater odds of more impairment in feelings (odds ratio [OR], 4.01; 95% confidence interval [CI], 1.75 to 9.19), pain (OR, 2.58; 95% CI, 1.18 to 5.63), and social activities (OR, 2.48; 95% CI, 1.19 to 5.17) compared with the nondepressed patient. The cluster of impairment distinguishing minor from major depression differed somewhat, with more impairment in daily activities (OR, 19.6; 95% CI, 3.45 to 112.00) and feelings (OR, 24.4; 95% CI, 1.78 to 333.00) and greater lung disease (OR, 13.7; 95% CI, 2.19 to 80.00) and seasonality (OR, 5.9; 95% CI, 1.10 to 32.1 for highest seasonality) in patients with major depression. CONCLUSIONS: There appears to be significant functional disability associated with the presence of minor depression. Seasonality was also present in those with minor depression, although it was of greater importance among those with major depression. Despite lack of national consensus on the definition of minor depression, limitations owing to sampling method, and statistical modeling, there is evidence that patients with minor depression reveal a different constellation of impairment than do those with major depressive disorder.

Activities of Daily Living↗
PubMed1994

Effect of 5-alpha-reductase inhibition on sex-hormone-binding globulin in elderly men.

In this study we examined the possibility that chronic reduction in serum dihydrotestosterone (DHT) attained by pharmacologic inhibition of 5 alpha-reductase modulates serum sex-hormone-binding globulin (SHBG) levels in elderly men. Twenty-one men, ages 58-79 years (mean 66) with benign prostatic hypertrophy were treated with the 5 alpha-reductase inhibitor finasteride (5 mg daily) for 12 months. Serum DHT declined by 80% (p < 0.001) and total testosterone rose by 14% (p < 0.05). Serum SHBG concentration remained unchanged (44.1 +/- 4.5 vs 45.2 +/- 5.7 nmol/l for pre- and post-therapy levels, respectively). Thus, the conversion of testosterone to DHT is not required to maintain the androgenic effect on serum SHBG concentration in elderly men.

Aged↗
PubMed1994

Morality and AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Erythropoietin therapy obviates the need for recurrent transfusions in a patient with severe hemolysis due to prosthetic valves.

Erythropoietin has been proved extremely effective in ameliorating the anemia of chronic renal failure and is currently under intensive investigation. We describe a patient with severe anemia and secondary hemochromatosis due to prosthetic valves, who has been successfully treated with erythropoietin. During 12 months' follow-up, an acceptable hemoglobin level was maintained without any need for blood transfusions; in addition, there was evidence indicating regression of hemochromatosis. This patient illustrates that erythropoietin therapy might prove beneficial for similar cases.

Anemia, Hemolytic↗
PubMed1991

[Sedural toxicity].

Phenazopyridine (Sedural) is widely used in the treatment of dysuria. It is considered a benign drug and most physicians are unaware of its potential toxicity. A 24-year-old woman who developed methemoglobinemia, acute renal failure and hemolytic anemia following a single 1 g dose of the drug is presented.

Acute Kidney Injury↗
PubMed1991

Three years of a required geriatrics module for third-year medical students.

The Parker Jewish Geriatric Institute, a teaching nursing home at which an accredited internal medicine geriatrics fellowship is based, co-developed with the Department of Family Practice of the medical school at the State University of New York at Stony Brook a mandatory geriatrics module for third-year medical students. The module's implementation over a three-year period (1985-1987) with 278 medical students is described. The authors conclude that if time and effort are given to the development of a geriatrics curriculum, and if appropriate instructors are chosen, then learning geriatrics in long-term-care settings can be as rewarding and exciting an experience for medical students as their experiences in other clinical settings, even when that learning is required.

Adult↗
PubMed1990

The state of leukocyte adhesiveness/aggregation in the peripheral blood of patients with respiratory tract infections.

The state of leukocyte adhesiveness/aggregation (LAA) in the peripheral blood has been employed as a marker of inflammation. In the present study we examined patients with varying intensities of inflammation caused by respiratory tract infections to further investigate the reliability of the state of LAA for the detection and assessment of the severity of disease activity. The study includes 140 controls, 46 patients with upper respiratory tract infection, 30 with bronchitis, 27 with suspicion of pulmonary infiltrate, and 39 with small and 18 with large pulmonary infiltrate. Assessment was based on assuming an increasing severity of inflammation from the 1st to the 6th diagnostic category and by making use of discriminant analysis. It was found that the state of LAA proved to be the best variable to classify the patients into their diagnostic category (F to enter 27), followed by erythrocyte sedimentation rate at the 1st h (F to enter 20.8) and total white blood cell count (F to enter 8.3). These studies were followed by animal experimentation. A highly significant correlation (p = 0.005) was found between the state of LAA in the peripheral blood and the degree of pulmonary leukostasis in a model of endotoxemia in rabbits. These results suggest that the state of LAA is not an epiphenomenon and represents the tendency of the white blood cells to stick to the endothelium which facilitates their migration into the tissues.

Adolescent↗
PubMed1988

Thrombolysis in Myocardial Infarction (TIMI) Trial--phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase.

Two hundred ninety patients with acute myocardial infarction were treated according to random assignment with an intravenous infusion of either 80 mg of recombinant tissue plasminogen activator (rt-PA) over 3 h or 1.5 million units of streptokinase over 1 h. Patients received an intravenous bolus of heparin (5,000 U [USP]) before pretreatment coronary angiography and a continuous infusion (1,000 U/h) starting 3 h later. The frequency of major and minor hemorrhagic events (33% rt-PA, 31% streptokinase) and associated transfusions (22% rt-PA, 20% streptokinase) were comparable in both groups. More than 70% of bleeding episodes in each group occurred at catheterization or vascular puncture sites. Precipitable fibrinogen levels, measured in plasma samples collected in the presence of a protease inhibitor (aprotinin), declined in rt-PA and streptokinase groups by averages of 26 and 57% at 3 h and by 33 and 58% at 5 h, respectively (rt-PA versus streptokinase, p less than 0.001). At 5 h the plasma plasminogen declined by 57% (rt-PA) and 82% (streptokinase) (p less than 0.001); plasma fibrin(ogen) degradation products were higher in streptokinase-treated patients (244 +/- 12 micrograms/ml, mean +/- SE) than in rt-PA-treated patients (97 +/- 9 micrograms/ml, p less than 0.001). At 27 h, plasma fibrinogen and plasminogen levels were lower and fibrin(ogen) degradation products higher than pretreatment levels in both groups. The frequency of hemorrhagic events was higher in patients with greater changes in plasma factors at 5 h; within treatment groups the levels of fibrin(ogen) degradation products correlated with bleeding complications (p less than 0.005). Thus, in the doses administered, rt-PA induces systemic fibrinogenolysis that is substantially less intense than that induced by streptokinase. The high frequency of bleeding encountered is related to the protocol used, including vigorous anticoagulation, arterial punctures and thrombolytic therapy. These findings emphasize the need for avoidance of invasive procedures and for meticulous care in the selection and management of patients subjected to thrombolytic therapy.

Clinical Trials as Topic↗
PubMed1988

Alcoholism training in a family medicine residency.

The literature in alcoholism education for the health professions reveals that despite some strides in the development of training programs, both medical students and practicing physicians exhibit negative attitudes toward alcoholics that may adversely affect the care offered to these patients. This paper presents a program of alcoholism identification and management training for family practice residents which has been developed to supplement an existing drug abuse treatment program. Residents spend four half-day sessions engaged in seminars, outpatient experiences, and inpatient rotations under the direction of a clinical psychologist specializing in substance abuse and under the direction of the medical staff of a voluntary hospital well-known as a center of alcoholism treatment. Training activities include participation in group therapy sessions with alcoholic patients, interviewing patients in the early stages of rehabilitation, participation in an adolescent alcoholism treatment program and attendance in seminars on the prevention, identification, and treatment of alcoholism. Residents' evaluations of the experience reveal overall satisfaction with the program and their roles in its conduct, but they indicate a need for more active roles in the hands-on management of emergency cases.

Alcoholism↗
PubMed1988

A one-year follow-up of fatigued patients.

To better understand the complaint "fatigue" and the characteristic features of patients who present with this problem, a one-year follow-up study was performed in a county health center. One hundred-fifteen fatigued adults were identified using scores on the Rand Index of Vitality (RIV). One hundred thirty-nine patients of similar age, sex, and socioeconomic status were identified as nonfatigued. One year later, these patients were followed up with a chart review, reassessment of fatigue (by RIV score), and a telephone interview. Seventy-three (64 percent) fatigued and 72 (53 percent) nonfatigued patients provided this information. On the RIV, 31 patients moved from the fatigued group to nonfatigued, and 15 nonfatigued patients' scores changed to the fatigued category. Patients categorized as fatigued in 1984 (by RIV score) returned for office visits more often (mean of 3.85 vs 2.51, P less than .05), and developed significantly more new diagnoses (2.75 vs 1.68, P less than .05) over the follow-up year, compared with those not fatigued. Fatigued patients also had a greater proportion of diagnoses containing a psychologic component than nonfatigued patients. Persistence of fatigue over the year was significantly associated with race and education (nonwhites and those completing high school remaining fatigued). No significant association between marital status, age, sex, employment status, and either the resolution or development of fatigue over the year was found.

Adolescent↗