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Biomedical subjects

A Lazarus

Publications and source records attributed to A Lazarus.

At least 73 records · Page 4Linked to original sources
PubMed1994

Opportunities for psychiatrists in managed care organizations.

Managed care organizations have used psychiatrists primarily for their patient care skills, and their potential for performing administrative and managerial services for managed care organizations has not been fully appreciated. However, the role of physician managers is likely to expand with or without federal action on health care reform. Areas of opportunity for psychiatrists include utilization and quality management, network development, provider profiling, and credentialing. In addition, psychiatrists may serve as ombudsmen for managed care organizations and support internal operations. Although formal training beyond medical school and residency is not necessary for psychiatrists to become effective managers, various educational programs are available and are highly recommended.

Career Choice↗
PubMed1994

Transferring psychiatric patients into managed care networks.

The practice of selective contracting in managed care organizations has caused frequent transfers of psychiatric patients from emergency rooms and hospitals that have been excluded from provider networks. Psychiatrists and other physicians who do not participate in these networks may be reluctant to transfer patients into unfamiliar clinical arrangements simply at the request of insurance companies. Possible reasons for such resistance include an unwillingness of physicians to disrupt treatment once it has begun, concerns about the risk of injury while transporting psychiatric patients, and the need to stabilize patients prior to transfer. Although fears of patients injuring themselves or others in transit appear to be unwarranted, certain clinical and risk management issues merit further consideration by HMOs and managed care organizations.

Adult↗
PubMed1994

Using an appeals panel to mediate mental health care UR disputes.

The certification of admission and lengthy psychiatric hospitalizations raises fundamental issues related to the appropriateness of treatment. The author presents several case examples to illustrate how an appeals panel resolves disputed utilization review decisions regarding inpatient psychiatric treatment.

Decision Making, Organizational↗
PubMed1994

[Repolarization and intraventricular conduction disorders in arrhythmogenic right ventricular dysplasia].

Right ventricular dysplasia may lead to sudden cardiac death an adolescent or adult with little or no symptoms. Identification of this condition in the high-risk population appears to be an objective to be attained in the near future. Thorough ECG analysis seems to be a non-invasive and inexpensive technique which could be used as a first approach for screening of the disorder. In a series of 50 cases of arrhythmogenic right ventricular dysplasia compared with a control group, the diagnosis of ARVD could be determined by ECG with 84% sensitivity and 100% specificity if QRS duration in leads V1, V2 or V3 was longer than 110 ms, T wave was negative in V2 or if T wave was negative in V1, but in this latter case only provided incomplete right bundle branch block was present.

Adolescent↗
PubMed1993

[Atrial flutter and tachy-systole].

Atrial flutter and tachysystoles may complicate the course of all heart diseases or may be discovered independently of any detectable cardiopathy. Functional tolerance mainly depends on the presence and severity of the associated heart disease, if any. A regular cardiac rhythm of 150 beats/minutes at rest suggests a 2:1 block flutter. Electrocardiographic identification of the disorder is usually easy and may lead, in certain cases, to vagal manoeuvres to recognize the atriogramme and the atrium-ventricle relationship. In all cases, 2:1 flutters must be reduced with amiodarone, by electrical stimulation or by electric shock. A prophylactic treatment of recurrences is often, but not always, indicated. The treatment of tachysystoles must take into account the cause of the ventricular rate.

Atrial Flutter↗
PubMed1993

Influence of percutaneous mitral commissurotomy on left atrial spontaneous contrast of mitral stenosis.

To assess the influence of percutaneous mitral commissurotomy (PMC) on left atrial spontaneous echo contrast of mitral stenosis, transesophageal echocardiography was performed before and 24 to 48 hours after the procedure, and on average, 6 months later in 82 patients. Fifty-nine patients (72%) were in stable sinus rhythm and 23 in permanent atrial fibrillation. Eleven patients (13%) had history of embolism, and 31 were on long-term anticoagulant therapy. The intensity of spontaneous contrast was graded as follows: 0 = no contrast; 1 = slight contrast; and 2 = intense contrast with the typical aspect of "smoke." PMC resulted in a twofold increase in the valve area irrespective of the method of evaluation used (2 cm2 after vs 1.05 before; p < 0.0001). Severe mitral regurgitation occurred in 3 patients who were operated on within 3 months after PMC. Left atrial spontaneous contrast was noted before the procedure in 53 patients (65%). Multivariate analysis showed left atrial size and cardiac index to be predictive factors of its presence (both p < 0.05). At early post-PMC investigation, the incidence of contrast was 50%, and at 6 months, only 28%. Sinus rhythm appeared to be the only independent predictive factor of the disappearance of contrast by multivariate analysis. In patients in atrial fibrillation, the prevalence of spontaneous contrast was 100% before PMC, 91% at early post-PMC investigation (p = NS), and 89% at the late study (p = NS); the rates were 51, 34 (p < 0.005) and 4% (p < 0.0001), respectively, in patients in sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Promoter activity of human renin 5'-flanking DNA sequences is activated by the pituitary-specific transcription factor Pit-1.

Although the renal juxtaglomerular cell is the source of circulating renin, the renin gene is also expressed at a number of extrarenal sites including lactotrope cells of human and ovine pituitaries. In the present study, we demonstrate that GC cells, a pituitary lactotrope precursor cell line, efficiently express transiently transfected hybrid genes containing human renin 5'-flanking DNA sequences -148/+11. Gel mobility shift competition analyses show that a highly conserved sequence in human and rodent renin 5'-flanking DNAs (human coordinates: -80/-58) binds a nuclear factor from GC cells, most likely the pituitary-specific factor Pit-1. Deletional and mutational analyses demonstrate that this site is a major determinant of renin promoter activity in GC cells. Transfection of a Pit-1 expression construct into HeLa cells, where activity of the human renin promoter is low, stimulates expression of cotransfected renin-luciferase constructs. Moreover, activation of the human renin promoter by co-expression of Pit-1 is dependent on an intact Pit-1 site. Taken together, these data strongly suggest that Pit-1 activates pituitary renin gene expression. This finding raises the possibility that member(s) of the POU family of transcription factors, of which Pit-1 is an archetypal member, may direct renin expression in other tissues, including the kidney.

Animals↗
PubMed1993

[Arrhythmia and syndrome of obstructive sleep apnea in adults].

Many nocturnal cardiac arrhythmias and conduction defects have been reported in the adult sleep apnoea syndrome. The most original is the great variability of the heart rate which is cyclical and related to the apnoeic episodes, and easily differentiated from simple respiratory sinus arrhythmia. It is characterised by an initial bradycardia followed by rebound tachycardia. The bradycardia is vagally dependent (inhibited by atropine) probably secondary to carotid chemoreceptor stimulation by the hypoxaemia. The tachycardia is mainly attributed to the cessation of vagal hypertonicity although catecholamine stimulation has been suggested. The origin of these changes is purely functional, regressing with treatment of apnoea (waking, tracheotomy), the maintenance of arterial oxygen concentrations with oxygen therapy and parasympathetic blockade (atropine). The intensity of the phenomenon is related to the degree of arterial desaturation, which is itself related to basal arterial saturation (SaO2) and the duration of the apnoeas. Prolonged systole due to paroxysmal sino-atrial or atrioventricular block may be observed at night in these patients. The influence of vagal overactivity is confirmed (suppression of vagotomy) with no organic pathology (diurnal absence, tracheotomy, normal electrophysiological testing) in favour of a relationship with apnoea. Though less common than conduction abnormalities, atrial arrhythmias (extrasystoles, flutter, fibrillation) are also possible complications of sleep apnoea. The absence of an organic substrate is indicated by their regression post-tracheotomy and the efficacy of atropine (again in favour of a vagally-induced mechanism). Finally, nocturnal ventricular hyper-excitabilty is sometimes observed, the probable mechanism being the association of severe hypoxaemias (SaO2 < 60%) and the increased sympathetic tone at the end of the apnoea.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Left pulmonary artery originating from the ascending aorta in tetralogy of Fallot. Therapeutic strategy].

The authors report the rare case of a 12 year old child with an anomalous origin of the left pulmonary artery from the ascending aorta associated with Tetralogy of Fallot. This complex congenital malformation was treated surgically by a Deleval anastanosis between the right subclavian and right pulmonary arteries. The result was good with a 9 year follow-up, the patient having only Grade II effort duspnoea and cyanosis. The authors discuss the advantages and drawbacks of the different possible surgical approaches to this problem in the light of the outcome of this case and a review of the literature.

Anastomosis, Surgical↗
PubMed1992

Interlimb coordination in Parkinson's disease.

This study examined the degree to which Parkinson's disease (PD) patients could "spatially link" the upper limbs to facilitate the performance of bimanual simultaneous movements. Six right-handed PD patients, and seven normal age- and sex-matched controls performed three different tasks: (a) an isotonic elbow flexion as rapidly as possible through an angle of 30 degrees; (b) an isometric contraction of the flexor muscles at the elbow joint to 40% and 60% of maximal volitional force (MVF) for a period of 5 s; (c) an isometric contraction for 2.5 s with one limb, then simultaneously performing an isotonic flexion with the contralateral limb while maintaining the isometric contraction for 2.5 s more. As expected, PD patients were significantly slower in performing the isotonic movement and produced lower peak velocities than the controls. More importantly, the two groups were differentially affected during the bimanual condition. In normals, movement time decreased and peak velocity increased in the bimanual condition. In contrast, PD patients showed increased movement times and sometimes decreased peak velocities in the bimanual condition. The results suggest that normal subjects utilize bilateral outflow to symmetrical muscle groups to synchronize the two limbs in the bimanual task, whereas PD patients dissociate the two limbs.

Aged↗
PubMed1992

Neuroleptic malignant syndrome and preexisting brain damage.

A case of neuroleptic malignant syndrome (NMS) is described in a congenitally brain-damaged deaf patient. The literature suggests that NMS in patients with organic brain syndrome is induced by a reduction of marginal stores of dopamine in the hypothalamus and basal ganglia resulting from dopamine-blocking activity of neuroleptics, even at conventionally low doses. Brain-damaged patients should be recognized as being at higher risk of developing NMS.

Adult↗