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Biomedical subjects

A Shulman

Publications and source records attributed to A Shulman.

At least 55 records · Page 3Linked to original sources
PubMed1998

Tinnitology, Tinnitogenesis, Nuclear Medicine, and Tinnitus Patients.

Since the 1970s, clinical interest in otolaryngology and audiology for both diagnosis and treatment of the symptom of tinnitus has witnessed the evolution of a new discipline: tinnitology. Tinnitology is an integrated discipline of basic sciences, neuroscience, and clinical medicine for the understanding of aberrant auditory phenomena unrelated to an external source of sound. To patients with subjective idiopathic tinnitus, nuclear medicine techniques of positron emission tomography and single-photon emission computed tomography provide correlation of structure and function, which improves the accuracy of the tinnitus diagnosis. Additionally, they provide a monitoring system to establish the efficacy of modalities of therapy attempting to provide tinnitus relief. Further, they provide information of neuroreceptors and neurochemistry in brain underlying or accompanying basic mechanism for production of specific clinical types and subtypes of tinnitus. This study reports the application of nuclear medicine techniques for a new clinical neuropharmacology protocol for tinnitus treatment highlighted by intratympanic drug therapy in predominantly cochlear-type tinnitus. We further report a neuroprotective drug therapy to control tinnitogenesis, an auditory epileptiform phenomenon. Additionally, we report the hypothesis of a benzodiazepine deficiency syndrome.

Journal Article↗
PubMed1998

Noise, Calpain, Calpain Inhibitors, and Neuroprotection: A Preliminary Report of Tinnitus Control.

Frequently, noise-induced hearing loss is associated with the symptom of tinnitus. Preliminary results in the animal model after noise exposure suggest that the calpain inhibitor leupeptin may protect against noise-induced hearing loss. A final common pathway for cell destruction and cell death (i.e., apoptosis) is the calpain hypothesis. Calpain is a normal, intracellular, cytosolic protease activated by excess intracellular calcium. Calpain inhibitors (AK275, AK295) have been shown to provide neuroprotection in the central nervous system. A collaboration of basic science and clinical research efforts focusing on calpain antagonists and inhibitors was established in New York in 1997; the initiators are attempting to develop neuroprotective drug therapy regimens for hearing and balance system complaints, particularly hearing loss, tinnitus, and vertigo. Both calpain inhibitors and antagonists are being developed and are being investigated wth perfusion techniques of the inner ear, in vitro and in vivo, for their effects on peripheral and central portions of the cochleovestibular system.

Journal Article↗
PubMed1998

Calcium channel blocking drugs in the management of drug dependence, withdrawal and craving. A clinical pilot study with nifedipine and verapamil.

OBJECTIVE: To determine if the calcium channel blocking agents (CCBs), nifedipine and verapamil are safe and effective therapeutic adjuncts in the management of withdrawal and craving in patients with chronic dependence on opiates, ethanol, amphetamine, benzodiazepines and marijuana. METHOD: Oral rapid acting nifedipine or verapamil was administered for 2 weeks (together with oral methadone in decreasing daily doses and specific symptomatic treatment, if appropriate), to patients with chronic dependence on various drugs of addiction. Several objective and subjective parameters were quantified to provide information about the patient's basic condition and progressive response to treatment, both before and after each CCB treatment. Patients also completed a daily questionnaire concerning their withdrawal intensity and provided a daily urine analysis. RESULTS: Both nifedipine and verapamil appeared to be safe and effective therapeutic adjuncts in the management of withdrawal and craving in 24 patients who successfully completed the trial. Although comparable in therapeutic efficacy in the doses used, verapamil produced far fewer and milder side effects than nifedipine. None of the verapamil side effects resulted in suspension or termination of treatment and it was the preferred agent, especially in patients presenting with a low blood pressure. CONCLUSIONS: In this pilot study nifedipine and verapamil appeared to be effective for the in-patient management of withdrawal and craving in a broad spectrum of chronic drug addicts. Verapamil produced fewer disturbing side effects compared with nifedipine and it may prove a safe, non-addicting and rational treatment in the long term management of chronic dependence, withdrawal and craving. As such, it may be especially valuable in offering the motivated chronic addict help and hope for the long term management of this problem in a community setting. The present results warrant the establishment of a verapamil based, double-blind, drug-matched or placebo-controlled clinical trial to test the validity and significance of these preliminary findings.

Adult↗
PubMed1997

The role of a human chorionic gonadotropin burst in in vitro fertilization.

FINDINGS: No oocytes were found during four ovum pickups (OPU), despite a satisfactory ovarian response to controlled ovarian hyperstimulation. After the first attempt failed in the fourth case, five eggs were retrieved, fertilized, and cleaved after cycle rescue with hCG. CONCLUSIONS: Whenever oocytes are not aspirated during OPU due to a lack of hCG administration, the cycle may be rescued if 10,000 IU of hCG is injected immediately and OPU planned for 33-36 hr later.

Adult↗
PubMed1997

Induction of artificial endometrial cycles with s.c. oestrogen implants and injectable progesterone in in-vitro fertilization treatment with donated oocytes: a preliminary report.

Endometrial preparation for embryo implantation in oocyte recipients with retained ovarian function presents a special problem. In all, 10 women with preserved ovarian function received donated oocytes in an in-vitro fertilization programme. In the preparatory cycles with oral oestrogens, all failed to develop adequate secretory endometrium because of ill-timed early luteinization occurring during the proliferative phase of the cycle. Subsequently the patients were treated with s.c. 17-beta oestradiol implants and injectable progesterone. The implants successfully induced complete down-regulation of the hypothalamus, pituitary axis, and prevented luteinizing hormone (LH) surge. In these preparatory cycles, all the treated patients produced adequate secretory endometrium. Clinical trials of 27 oocyte donation cycles yielded one biochemical and eight clinical pregnancies.

Adult↗
PubMed1997

Medical Significance of Tinnitus.

The medical significance of a symptom or disease process in a patient is defined as a clinical manifestation of abnormal function of a living cell, tissue, organ or organ system(s). Tinnitus, an aberrant perception of sound unrelated to an external source of sound, has been identified to have a medical significance. The medical significance of tinnitus has been identified with a Medical Audiologic Tinnitus Patient Protocol since 1979. The highlights of this clinical experience include for diagnosis: tinnitus not to be a unitary symptom; the identification of clinical type and subtypes of tinnitus and a Final Common Pathway for Tinnitus of all clinical types particularly of the severe disabling type. For treatment a multidisciplinary approach has evolved including neurology, otology and psychiatry; a combined treatment protocol of drug therapy and instrumentation, based on differentiation between the components of the symptom of tinnitus i.e. sensory, affect, and psychomotor. Two diagnostic categories are identified: otologic/neurotologic and neurologic. The application of SPECT Imaging of Brain which has identified a Final Common Pathway for tinnitus and provides an increased diagnostic accuracy for tinnitus and a basis for selection of a neuropharmacology for tinnitus is discussed.

Journal Article↗
PubMed1997

Neuroprotective Drug Therapy: A Medical and Pharmacological Treatment for Tinnitus Control.

The role of neuroprotective agents for maintaining or improving inner ear function, specifically for the symptom of tinnitus, is presented on the basis of neurootological, neurological, and neurosurgical clinical experiences. These clinical experiences involved the use of calcium channel blockers, free radical scavengers, corticosteroids, antagonists of glutamate at N-methyl-D-aspartate (NMDA) and non-NMDA receptors, and various thrombolytic agents for the etiologies of ischemia, trauma, and hemorrhage. A pharmacological basis for such drug efficacy includes a property described as neuroprotection. A pathology-based protocol for drug selection is proposed for tinnitus control. The goal of this article is to introduce to the neurootologist or otologist and other professionals attempting tinnitus control neuroprotective drug therapies that are being applied to such central nervous system pathological processes as ischemia, trauma, hemorrhage, and neurodegeneration. The innovative application of such drug therapies for treating the symptom of tinnitus of the severe disabling type is considered. The use of neuroprotective drugs in intratympanic drug therapy via the round window, for treatment of inner ear complaints of hearing loss, tinnitus, and vertigo, is discussed.

Journal Article↗
PubMed1996

The significance of an early (premature) rise of plasma progesterone in in vitro fertilization cycles induced by a "long protocol" of gonadotropin releasing hormone analogue and human menopausal gonadotropins.

OBJECTIVE: Our purpose was to assess and clarify the mechanism of whether an early progesterone rise in cycles with gonadotropin-releasing hormone agonist (GnRH-a) is associated with an impairment of IVF outcome. METHODS: Seven hundred eighty-six cycles were induced with GnRH-a and human menopausal gonodotropin (hMG) ("long protocol"). Plasma progesterone (PP) levels on the day of human chorionic gonadotropin (hCG) administration were divided into three groups: < 0.9 ng/ml (Group A), 1-2 ng/ml (Group B), and > 2 ng/ml (Group C). We also analyzed the pregnancies achieved in our egg donation protocol in relation to the PP levels of each donor on the day of hCG administration. RESULTS: Group A involved 525 cycles, Group B had 223, and Group C had 38. The overall pregnancy rate per egg transfer was 19.2%, with the highest for Group A (22.3%), declining for Groups B (14.3%) and C (7.9%) (A = B = C; P < 0.005). The embryo implantation rate was found to be negatively correlated with the PP levels on the day of hCG administration. In contrast, there was an opposite trend between PP levels and the chance of conception in 30 pregnancies achieved by egg donation. CONCLUSION: Since premature luteinization is very unlikely to occur under the conditions of this study, our findings suggest that an early PP rise has a negative impact on endometrial receptivity but not on egg and embryo quality.

Adult↗
PubMed1996

Sonographic assessment of cervical changes during pregnancy and delivery: current concepts.

Correct detection of premature contractions and incompetent uterine cervix is still a challenging obstetrical problem since these factors remain a major cause of perinatal loss. Ultrasonography offers additional important data for the prediction of these pathologies which have common sonographic patterns; shortening of the cervical length, funneling of the membranes and dilatation of the endocervical canal. The first section of this review highlights sonography of normal cervical anatomy, while the second section focuses on recent advances in sonographic detection of premature contractions and incompetent cervix. It is believed that due to its accuracy and reproducibility, this noninvasive technique should become more integrated into this aspect of antenatal care.

Cervix Uteri↗
PubMed1996

A follicular scoring system for monitoring ovulation induction in polycystic ovary syndrome patients based solely on ultrasonographic estimation of follicular development.

OBJECTIVE: To assess the predictive value of a follicular scoring system for monitoring ovulation induction in polycystic ovary syndrome (PCOS) patients, solely with ultrasound (US). DESIGN: Ultrasound measurements were performed on alternate days to define a serial follicular score for monitoring ovulation induction with hMG alone, as well as GnRH analogue and hMG, in comparison with E2 concentration obtained on the same day. SETTING: Outpatient Infertility Clinic, Department of Obstetrics and Gynecology. PATIENTS: Thirty-four consecutive PCOS patients treated for 63 cycles. MAIN OUTCOME MEASURE: The follicular score was established considering the summation of points obtained after measuring the mean diameter of each follicle > 5 mm, as follows: 5 to 8 mm = 1 point, 9 to 12 mm = 1.5 points, 13 to 16 mm = 2 points, > or = 17 mm = 3 points. RESULTS: Follicular score correlated positively with E2 concentrations. A score of > or = 30 points was associated with E2 levels of concentration that reached > 1,500 pg/mL (conversion factor to SI unit, 3.671) and could predict ovarian hyperstimulation. A lower follicular score allowed hCG administration. CONCLUSIONS: A follicular scoring system may be a safe, simple, and highly efficient method to replace serial E2 measurements in monitoring ovulation induction. Moreover, ovarian hyperstimulation may be predicted.

Adult↗
PubMed1996

Three-dimensional saline contrast hysterosonography and surface rendering of uterine cavity pathology.

A new technique that combines saline contrast hysterosonography with three-dimensional surface rendering for the visualization of uterine intracavitary pathologies is described. A total of 32 patients suspected of having uterine cavity pathologies on the basis of previous ultrasonography, hysterosalpingography or hysteroscopy were involved in the study. They were examined by three-dimensional high-frequency endovaginal probes (Combison 530, Kretztechnik, Zipf, Austria), with normal saline used as an expander and contrast medium. Three perpendicular planes could be evaluated simultaneous, and surface renderings were readily available. Following the instillation of normal saline, the uterine cavity appears as an echo-free, well-defined structure, and the endometrium appears as an echogenic homogeneous lining around the cavity. Data acquisition time is short and images can be stored for later evaluation. Surface rendering of polypoid structures shows echogenic masses on a pedicle protruding into the uterine cavity. Submucous fibroids appear as mixed echogenic sites bulging into the cavity. Intrauterine synechiae appear as bands of varying thickness traversing the uterine cavity. Simultaneous display of the zone of interest in three perpendicular planes enhances imaging capabilities, while surface rendering provides a comprehensive overview of the surface area of the findings and their topographical orientation. Further research using this new technique is required to document its real contribution to ultrasonographic imaging.

Contrast Media↗
PubMed1996

Serial color Doppler flow of uterine vasculature combined with serum beta-hCG measurements for improved monitoring of patients with gestational trophoblastic disease. A preliminary report.

Weekly serum beta-hCG measurements and transvaginal ultrasound scans coupled with color Doppler flow were performed on 8 patients with hydatidiform mole. Two patients later developed persistent trophoblastic disease, necessitating chemotherapy. The correlation coefficients between Doppler flow indices, systolic-diastolic (S/D) ratio and pulsatility index (PI) with log beta-hCG were -0.96 and -0.97, respectively. The weekly S/D and PI indices were plotted on an individual curve. Only the 2 patients who developed persistent gestational trophoblastic disease had PI index levels of < or = 1.5 as early as 2 weeks after molar evacuation. At that stage their serum beta-hCG levels were not different from some of the other patients. In this preliminary report, the regression of the disease could be reliably assessed by observing the changes in low resistance flow which paralleled the gradual decrements in serial beta-hCG levels. Thus, the contribution of this noninvasive imaging technique encourages the authors to further investigate Doppler flow monitoring among a larger sample of patients suffering from various gestational trophoblastic diseases.

Adult↗
PubMed1996

SPECT of Brain and Vertigo - A Case Report.

Vertigo has been identified as a complaint associated with the symptom of tinnitus; as well as a specific clinical type of tinnitus i.e., vestibular tinnitus. Classically, the clinical diagnosis of Ménière's Disease includes a quadrad of complaints, highlighted by episodic vertigo, ear blockage, a gradual progressive sensorineural hearing loss, and an associated complaint of a "low frequency tinnitus". Diagnostic and etiologic difficulties for Ménière's Disease have resulted in multiple diagnostic entities, e.g., Ménière's Syndrome, Cochlear Ménière's Disease; Vestibular Ménière's Disease, etc. Single Photon Emission Computed Tomography (SPECT) imaging of brain is a technique which has been reported to improve the diagnostic accuracy of patients with the symptom of tinnitus; and has now been applied for recurrent persistent vertigo. A case report, diagnosed classically as Ménière's Disease, is presented to demonstrate the increased diagnostic accuracy provided by SPECT of brain for the chief complaint of vertigo. SPECT revealed significant perfusion asymmetries in brain. The medical significance of the SPECT findings and its application for both diagnosis and treatment are presented.

Journal Article↗
PubMed1996

Tinnitus - Hyperacusis and the Loudness Discomfort Level Test - A Preliminary Report.

This paper is a preliminary report from the Tinnitus Center, HSCB-SUNY, of hyperacusis in a patient population who request consultation for tinnitus of the severe disabling type. Forty-two consecutive patients seen from January to August 1995 were reviewed for this preliminary report. There is a positive correlation between tinnitus and hyperacusis as well as a positive correlation between hyperacusis and the loudness discomfort level test (LDL). Hyperacusis is an increased sensitivity to sound that occurs with/without a hearing loss in individuals with tinnitus of the severe disabling type. The present method of assessment for hyperacusis includes pure tone audiometry, LDL's, Feldmann Masking Curves and the Metz test for recruitment. A classification system exists for hearing loss and a similar system is suggested for hyperacusis.

Journal Article↗
PubMed1996

A Final Common Pathway for Tinnitus - Implications for Treatment.

A final common pathway for tinnitus is hypothesized to exist for all patients with tinnitus. Its function is the transition of the sensory to the affect component of the symptom of tinnitus. Single Photon Emission Computerized Tomography (SPECT) with the radio isotope TC99-HMPAO has identified side to side perfusion asymmetries highlighted by that of the amygdala - hippocampal complex. It is hypothesized that a fundamental function of the amygdala - hippocampal structures is the establishment of a paradoxical auditory memory for tinnitus i.e., an aberrant auditory signal. It is a result of alteration in normal auditory masking; and found in all tinnitus patients. Underlying mechanisms are hypothesized to exist and to be highlighted by a diminution of inhibition mediated by gamma aminobutyric acid (GABA) due to disconnection from excitatory (glutamate) inputs. Blockage of GABA mediated inhibition results in Tinnitogenesis, a epileptiform auditory phenomenon. Significant neurochemistry implications for treatment are suggested by the Final Common Pathway for Tinnitus. The overall hypothesis of a final common pathway for tinnitus; and the clinical implications for treatment are presented.

Journal Article↗
PubMed1995

The impact of different types of anesthesia on in vitro fertilization-embryo transfer treatment outcome.

OBJECTIVE: Our objective was to evaluate retrospectively the influence of different types of anesthesia on the outcome of ovum retrieval. METHODS: Sedation combined with local anesthesia was used on 120 occasions (Group I), epidural block in 139 ovum retrievals (Group II), and general anesthesia in 173 cycles (Group III). RESULTS: No differences were found in embryo yield or number or the quality of the embryo transferred. Of 99 pregnancies achieved, 66 live deliveries were recorded. Significantly lower clinical pregnancy rates were found in Group III (14.5%) compared with Group II (23.7%; P = 0.018) or Group I (25.8%; P = 0.0074). Highly significant differences were found in the delivery rates between Group III (8.7%), Group II (20.11%; P = 0.0017), and Group I (19.2%; P = 0.0043). CONCLUSION: The use of general anesthesia, especially nitrous oxide, for oocyte retrieval has an adverse effect on IVF outcome. This deleterious effect manifests itself only after embryo transfer and leads to lower pregnancy and delivery rates.

Adult↗