Biomedical subjects
Publications and source records attributed to A Rubin.
A 24-year-old woman who had immigrated from India 3 years before was referred because of diarrhea, abdominal pain and weight loss. Crohn's disease was suspected, but investigation revealed active pulmonary tuberculosis and tuberculosis of the small and large intestine. She was treated with rifampicin, 600 mg/day, INH 300 mg/day, and ethambutol, 400 mg/day, and recovered fully within 6 months.
Recent literature on caring for people with serious mental illnesses reflects a growing belief in the effectiveness of case management services for this population. This article reviews recent outcome studies on case management to assess the extent to which prevailing claims that it is effective are supported empirically. Based on this review, the author concludes that the hypothesis that case management is effective remains plausible, but conclusive claims that its efficacy has been empirically demonstrated are premature. The outcome studies reflect diversity and ambiguity in the ways case management is conceptualized and implemented, problems in the research methodologies employed, and inconsistencies in outcomes. Consequently, implications for further research are drawn.
A multicentre, randomized, double-blind, placebo-controlled study was conducted to evaluate the efficacy and safety of ranitidine 150 mg and 300 mg in 342 patients with erosive oesophagitis. Treatment was given four times daily, and continued for 12 weeks or until healing (that is, normal or only erythematous mucosa). Erosive oesophagitis healing rates, as determined by endoscopy, were significantly greater in ranitidine-treated patients by 4 weeks compared with those of placebo-treated patients. By 12 weeks, erosive oesophagitis healing rates were 83 and 81% for ranitidine-treated patients (150 and 300 mg, respectively) and 58% for placebo-treated patients (P less than or equal to 0.001, ranitidine vs. placebo). Symptomatic relief was achieved within 24 hours after starting either dosage of ranitidine. Heartburn frequency (P less than 0.001) and severity (P less than 0.001), as well as antacid consumed per week (P less than 0.001), were reduced in both ranitidine groups in comparison with placebo. Healing rates and symptom relief were similar in the two ranitidine groups. Both dosages of ranitidine were well tolerated. Ranitidine (150 mg) given four times daily appears to be as effective as 300 mg ranitidine given four times daily in patients with moderate to severe oesophageal erosions.
Tufted angioma is a rare slowly progressive vascular lesion found typically in children and young adults. Cases appear sporadically and clinically have been confused with low grade angiosarcoma, Kaposi's sarcoma, and multiple glomus tumours. We report a case of a patient with tufted angioma in whom a strong family history of similar lesions is apparent, transmitted in an autosomal-dominant mode of inheritance.
Expert systems are computer programs which use inference and knowledge to solve problems which usually require the expertise of a human specialist. This paper examines the application of expert systems to histopathology and explains their construction by describing the design of an expert system 'dermdx', intended to aid in the interpretation and diagnosis of biopsies of inflammatory diseases of the skin. The system consists of an expert shell, which performs the inference, and a rule-base, which contains the knowledge with which the system operates. The system can be easily updated or adapted to other tasks.
Confidence regions for mean dioptric power can be represented by ellipsoids in a three-dimensional space called h-space. A convenient graphical representation is provided by stereo-pair drawings that, at a glance, show the estimated accuracy with which the mean power is known. As an example, a sample of autorefractor measurements made on one eye were used to construct a 95% confidence ellipsoid for the mean objective refractive status of that eye. Key dimensions of the ellipsoid are compared with those of another eye. The analysis is of fundamental importance for scientific studies of variation and change of refractive status. Its potential clinical importance is also discussed.
A sample from a population of dioptric powers may be used to estimate the distribution of dioptric powers in the population itself. This paper describes the method and shows further how one can obtain a graphical representation of the distribution. The graphical representation takes the form of ellipsoids of constant probability density. The centroid of each ellipsoid estimates the mean of the population while the size, shape and orientation show the extent and nature of the spread of the population. For illustrative purposes the theory is applied to measurements of refractive status before and after radial keratotomy. The ellipsoids are presented as stereo-pairs. They are useful for comparative and predictive purposes. Thus the ellipsoid that contains 95% of the population after surgery defines the set of refractive errors within which the refractive error of a particular eye can be expected to fall with a probability of 95%.
Patients in the early stages of breast cancer were studied one year after treatment to ascertain the psychological effects of mastectomy and a breast-conserving alternative, lumpectomy plus radiation therapy. Patients who had had a mastectomy felt less attractive, less sexually desirable, and more ashamed of their breasts. They also experienced less enjoyment in their sexual relationships than they had before treatment. Patients who had radiation therapy experienced no changes in these areas. For these reasons, half of the mastectomy patients regretted not having chosen the breast-conserving alternative.
Disposition of the H2-receptor antagonist nizatidine was studied in serum, urine, and breast milk. Five lactating women and five nonlactating women participated; the disposition of nizatidine was studied in three of the lactating women. Single and multiple doses of 150 mg nizatidine were administered orally. The disposition of nizatidine (half-life, 1 1/2 hours; apparent serum clearance, 40 L/hr; renal clearance, 27 L/hr; and apparent volume of distribution, 1.4 L/kg) was similar in lactating and nonlactating women. These pharmacokinetic results were analogous to observations for men in other studies. Nizatidine breast milk concentrations were directly proportional to corresponding serum concentrations. On average, 96 micrograms nizatidine, less than 0.1% of the maternal dose, was secreted into milk during a 12-hour interval after either single or multiple doses.
Vitamin D metabolism in elderly individuals can be compromised by several mechanisms. We previously described reduced concentrations of 1,25-dihydroxyvitamin D [1,25(OH)2D] in 30% of elderly nursing home residents. The present study assesses the effect of vitamin D supplementation on 25-hydroxyvitamin D [25(OH)D] and 1,25(OH)2D. We performed a double-blind study in which 30 elderly nursing home residents were randomly given either 50 micrograms vitamin D or a placebo daily for 6 wk. Vitamin D metabolites, immunometrically assayed parathyroid hormone (IRMA-PTH), ionized calcium, and bone Gla hormone (BGP) were measured in serum at baseline and biweekly for 6 wk. Serum 25(OH)D concentrations increased significantly (P less than 0.0001) over the 6 wk in the treatment group but were unchanged in the placebo group. Serum 1,25(OH)2D, ionized calcium, BGP, and PTH were not significantly altered by the supplement. We conclude that vitamin D supplementation results in an increase in circulating 25(OH)D but not 1,25(OH)2D; however, the long-term effect on bone mineral metabolism remains unclear.
Five cases of florid lymphoid hyperplasia of the ileocaecal region are described. This condition is characterized by large reactive germinal centres and a diffuse infiltrate of lymphoid cells and eosinophils which extends through the muscularis propria. There is a close resemblance to low-grade malignant lymphoma from which it can be distinguished only by the use of immunocytochemistry for light-chains. Using this technique it should be possible to classify all such lymphoid proliferations as either reactive or neoplastic and to eliminate ambiguous labels like pseudolymphoma.
Multicystic or sieve-like areas are frequently present in the walls of mature cystic ovarian teratomas. This histological, immunohistochemical and ultrastructural study supports the contention that such cysts arise from oleous material which has been extravasated through the cyst wall and become lodged within fibrous tissue and small blood vessels. Some cysts may also arise from degenerate sebaceous glands.
Explore the source record for details and available documents.
We studied seven subjects with certain manifestations of cobalt-induced lung disease. All worked with cobalt and were involved in either the production or use of hard metal. The mode of presentation varied from an acute hypersensitivity pneumonitis that cleared completely when exposure ceased to progressive severe interstitial fibrosis of the lungs. In one subject reexposure was followed by a recurrence of the symptoms. All subjects showed restrictive ventilatory impairment and a reduction of their diffusing capacity. The radiologic appearances varied greatly. While two subjects had clear roentgenograms with small lung volumes, others had a micronodular pattern or small blotchy nodular infiltrates, and one had diffuse reticulonodulation as is seen in cryptogenic fibrosing alveolitis. The pathologic appearances varied between desquamative interstitial pneumonia and overt mural fibrosis of the alveoli. Six of the seven patients had multinucleated giant cells in their biopsy specimens or bronchoalveolar lavage fluid.
We carried out a controlled clinical trial to examine the potential of baclofen to slow the functional decline of patients with early Huntington's disease (HD). The basis of the trial was: (1) the hypothesis that excitatory amino acid neurotransmission mediates the neuronal degeneration of HD, (2) preclinical evidence that baclofen retards corticostriatal release of glutamate and aspartate, and (3) reports that baclofen produces short-term clinical benefits in some HD patients. Sixty patients with early HD were randomized to chronic baclofen, 60 mg/day, or placebo treatments and followed systematically for up to 42 months. Total functional capacity was not favorably influenced by baclofen treatment. Factors that contributed, although nonsignificantly, to a more rapid rate of total functional capacity decline included younger age (less than 35 years), earlier stage (stage I) of illness, paternal inheritance of the HD gene, and baclofen treatment. Our patients declined at a pace slower than that observed in other prospective studies, a finding likely due to selection criteria, avoidance of neuroleptic therapy, and strong psychosocial support.
For several years women with an early diagnosis of breast cancer have been able to choose between two equally effective treatments: modified radical mastectomy and the breast-conserving treatment of lumpectomy plus radiation therapy. This study investigated the psychological factors that become involved when a woman chooses between treatments. Many more anticipatory concerns about body image, disfigurement, femininity, and the ability (or inability) to handle emotionally a mastectomy were expressed by lumpectomy/radiation therapy patients than by mastectomy patients. Those lumpectomy-radiation therapy patients who chose the treatment against medical advice were also found to be more concerned than the others about treatment effects on sexuality.