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Biomedical subjects

A Leibovitz

Publications and source records attributed to A Leibovitz.

72 records · Page 4Linked to original sources

Human neoplastic and normal cells in tissue culture. I. Cell lines derived from malignant melanomas and normal melanocytes.

Forty-six cell lines derived from 31 human melanomas obtained from 28 patients were cultured. Fourteen of 16 lines have produced malignant tumors when injected into nude (thymus-deficient) mice. Tumors in 5 of the nude mice metastasized to distant lymph nodes and/or to the lungs of the mouse host. Extreme variability from line to line was observed for doubling time (34 to 106 hr), plating efficiency (0-86%), and melanin production. All tested lines had type B glucose-6-phosphate dehydrogenase, thereby excluding HeLa cell contamination. HeLa cells have been grown for some time in our laboratory. Our results clearly demonstrated that HeLa cell contamination does not occur invariably in heteroploid lines growing in a laboratory simultaneously with Hela cells, provided that proper care is taken to avoid such occurrence. Multiple cell lines derived from the same tumor had identical phosphoglucomutase enzyme phenotype, which suggested a lack of significant cross-contamination between the lines. Four long-term cultures of normal human uveal embryo melanocytes have also been established and characterized. Although all produced melanin after reaching saturation density, they differed from the melanoma cells morphologically; they were flat, not refringent, and lacked piling up and plating ability. When melanoma cells were exposed to bromodeoxyuridine (BUDR) for long periods, a phenotypic change toward non-neoplastic characteristics was observed. Cells became flat and not refringent and, when injected into nude mice, tumors appeared after a long latent period. These changes were completely reversible in vitro and in vivo. The BUDR-treated cultures were undistinguishable from the untreated mother cultures after 2 to 3 passages. Lines derived from tumors in nude mice (obtained by injection of BUDR-treated cells) were again indistinguishable from the untreated mother line. Normal melanocytes were mostly euploid; all the melanoma cells were aneuploid. All 29 cell lines derived from 14 patients had an average chromosome number higher than 46. Detailed group-by-group chromosome analysis always showed an excess of C chromosomes, which suggested that hyperreduplication of one or more C chromosomes is a specific characteristic of human melanomas.

Adult↗

Classification of human colorectal adenocarcinoma cell lines.

Eleven human colorectal adenocarcinoma cell lines established in this laboratory were classified into three groups based on morphological features (light and electron microscopy), modal chromosome number, and ability to synthesize carcinoembryonic antigen (CEA). Group 1 cell lines contained both dedifferentiated and differentiating cells growing in tight clusters or islands of epithelium-like cells; their modal chromosome number was about 47, and they synthesized small to moderate amounts of CEA. Group 2 cell lines were more dedifferentiated, were hyperdiploid, and synthesized small amounts of CEA. Group 3 cell lines were morphologically similar to those of Group 1 by light microscopy. They differed ultrastructurally by containing microvesicular bodies; the modal chromosome number varied from hyperdiploid to hypertriploid or they had bimodal populations of hypodiploid and hypertriploid cells, and they synthesized relatively large amounts of CEA. No correlation could be found between Broder's grade or Duke's classification of the original tumor and modal chromosome number or ability to synthesize CEA. These findings support Nowell's hypothesis that the stem line is different for each solid tumor, which makes it difficult to relate chromosomal changes to the initiation of the neoplastic state.

Adenocarcinoma↗

Effects of anesthesia in elective surgery on the memory of the elderly.

The effects of anesthesia in elective operations on the cognitive functioning of the elderly, was examined in 88 patients aged 60-90 years. These patients were assessed pre-operatively and at a week and three months post-operatively. Forty patients (44.5%) received general anesthesia and 48 (54.5%) received regional anesthesia. The results show no significant difference between the two anesthetic methods. Differences were noted in remote memory index between the three examination time periods. (In contrast to a later work, it was found that patients whose cognitive state had been low deteriorated more than others). The only differences found between younger and older patients were in remote, recent and immediate memory. One of the major conclusions was that the effects of the methods of anesthesia, general and regional, are no different in young and elderly patients.

Journal Article↗

Seasonal variation in the incidence of delirium among the patients of a geriatric hospital.

Delirium syndrome is common in the hospitalized elderly population. However, data on its numerous etiological factors are scarce. Clinical observations suggest that delirium incidence could be related to seasonality. In order to evaluate the seasonal influence on the incidence of delirium syndrome among the patients of a geriatric hospital, we performed a retrospective study reviewing the medical records of 5218 patients aged 65 years and older, who were hospitalized in three medical wards between the years 1991 and 1997. The diagnoses of delirium were made according to ICD-9-CM. Of the 4929 subjects enrolled, 3548 (72%) were referred for assessment to the psychiatric or neurologic specialist, because of acute changes in their mental or behavioral status. Of those patients, 312 (6.3%) were diagnosed with delirium at admission, and 234 (4.7%) developed delirium during their hospitalization. Statistical analysis of incidence revealed a seasonal variation, with higher rates in the winter than in the summer months (P<0.001). This study suggests a seasonal influence on delirium syndrome incidence and a possible etiological relation with seasonal factors like the light -dark cycle.

Journal Article↗

Barium enema in frail elderly patients.

BACKGROUND: Barium enema (BE) examinations for the investigation of suspected colonic disease are often unsuccessful in elderly patients. OBJECTIVE: The purpose of this study was to evaluate the success rate of BE in hospitalized frail elderly patients. METHODS: Four hundred and seventy-two elderly patients hospitalized for different reasons underwent BE examinations. The medical charts and radiological reports were retrospectively reviewed. RESULTS: One hundred and ninety-two (41%) BE examinations were considered inadequate; mostly (32%) because of inappropriate preparation. Sixty-seven patients (14%) were not cooperative and could not retain the contrast material, and in 25 patients (5%), the examination failed due to both these reasons. The characteristics associated with unsuccessful BE examination were the mean number of medical problems (p < 0.001), the mean number of scheduled medications (p < 0.05) and in particular the long-term use of laxatives (p < 0.01) or antiparkinsonian drugs (p < 0.01). Of great significance in predicting an inadequate BE were the patient's functional status (p < 0.001) and the presence of dementia (p < 0.001). CONCLUSIONS: The high percentage of unsuccessful BEs in the frail elderly suggests that clinicians should carefully consider the need for that examination in these patients. We suggest that only in patients where there is a clear suspicion of a bleeding or obstructing tumor should a BE examination be performed, and even in these cases, colonoscopy or CT may be preferable as the initial examination in the frail elderly.

Aged↗

Rhinoscleroma in an octogenarian woman.

Rhinoscleroma, a granulomatous infection caused by Klebsiella rhinoscleromatis and usually afflicting young adults, was diagnosed in an 81-year-old woman. Treatment was started with orally administered antibiotics but was soon halted because of side effects. She was treated instead by local spread of a 3% rifampin ointment. After 6 weeks, the lesion cleared up and she improved remarkably. There was no recurrence during 18 months of follow-up. The current report is the second published case of rhinoscleroma in an elderly person and the first report on its cure by local treatment with a 3% rifampin ointment. This favorable experience contributes to the limited knowledge on rhinoscleroma in the elderly.

Journal Article↗

Preliminary evaluation of a convalescence cardiac unit for older patients as a model of "transitional facility" from hospital to home.

OBJECTIVES: The increasing number of older cardiac patients combined with the tendency to reduce hospital stays created the need for a Convalescence Cardiac Unit (Con.CU). It functions as a transitional facility for elderly patients discharged from hospitals after cardiac events, and was established within a geriatric medical center using existing infrastructure and staff. METHODS: Patients from 5 neighboring general hospitals (including 23 internal medicine wards and 3 departments of cardiac surgery) were offered the option of one week stay in the Con.CU after discharge. During the stay in the unit they received medical supervision as well as counsel on matters of nutrition and physical activity. RESULTS: 78 patients were admitted during the first 14 months. Forty patients were after coronary artery bypass grafts (CABG) (51%)30 after acute myocardial infarction (MI) (38%). The average age was 75 +/- 2.5 (SD). Medical complications developed in 57%. Most of these patients were treated by the local staff. Five cases had to be readmitted to the hospital they came from. Elderly cardiac patients that chose the option of Con.CU and their families expressed high appreciation regarding this experience and its contribution in facilitating return home. CONCLUSION: This innovative model is aimed to improve continuity of care for elderly cardiac patients and provide them with a new service in this era of "early discharge" from hospitalization. Geriatric settings striving to diversify their services, and medical directors required to contribute to policy development may learn from this experience.

Journal Article↗

A 10-year perspective on the patients referred to a geriatric rehabilitation complex: the influence of managed care.

OBJECTIVE: In the past 10 years, HMOs have used managed care to reduce patients referrals for rehabilitation in our Geriatric Rehabilitation Complex (GRC). DESIGN: This study compares data regarding patients referred for rehabilitation for 4 months in 1998 with data from a similar study we performed in 1989. SETTING: The GRC, which is part of a 396-bed geriatric hospital, includes a 36-bed ward complemented by departments of physical and occupational therapy, a speech therapy unit, and a rehabilitation psychologist. It is supported by modern rehabilitation equipment and facilities and is staffed by experienced, highly qualified academic personnel. RESULTS: The overall number of patients referred for rehabilitation decreased by 36% during this period. However, the average age of patients is higher, the number of patients with Recc. Stroke dominates, and length of stay was reduced by 20%. CONCLUSION: Although the rehabilitation needs of older people are increasing, fewer patients are referred to our GRC. Those who are referred are older, and their condition is more complicated; nevertheless, their length of stay has also been reduced. These are the results of HMO policies to refer older patients to new "rehabilitation settings" that charge lower prices while offering services of still unproved quality. As geriatricians, it is our duty to prevent cost considerations from overtaking the need to maximizing functional recovery.

Journal Article↗

Skilled nursing facilities as a setting for comprehensive care of older people with advanced cancer: a model of care in the post oncologic stage.

METHODS: We surveyed the elderly cancer patients admitted to the Skilled Nursing Wards of Shmuel Harofe Hospital, Geriatric Medical Center, during a 5-year period. RESULTS: The 304 elderly patients admitted with advanced cancer represented 16% of the skilled nursing patients admitted during this period. Their average time of survival was 4.2 months, ranging from 9.1 for breast cancer to 1.8 months for gastric cancer. Ninety-five percent were severely dysfunctional, and all had a high rate of medical complications. CONCLUSIONS: Our study reveals the benefits of a skilled nursing system that provides comprehensive care, flexibility, and continuity of care at a difficult and demanding stage of this illness. This model functions at reasonable cost, and we recommend it for the care of elderly patients with advanced cancer in the post oncologic stage.

Journal Article↗