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Biomedical subjects

B H Cohen

Publications and source records attributed to B H Cohen.

At least 91 records · Page 5Linked to original sources
PubMed1984

Risk factors associated with longitudinal change in pulmonary function.

In a longitudinal study of pulmonary function, we investigated the relationship between loss of forced expiration over time and a series of potential risk factors, as well as 4 other measures of pulmonary function at initial visit. Data on 1,912 adults tested twice, with an average of 4.7 yr between visits, were used. Of the potential risk factors examined, only age and smoking were consistently associated with increased loss of forced expiratory function in both men and women. Statistically significant differences among ABO blood types and among Pi types were also seen in women, although the direction of these differences was unexpected in that non-Z Pi variant phenotypes showed less decline in pulmonary function than did the most common Pi M phenotypes. Similar patterns of differences were seen in men, although these were not statistically significant. Of 4 initial-visit pulmonary function measures examined, only closing capacity at initial visit was consistently associated with subsequent loss of forced expiratory volume in one second (delta FEV1) in both men and women. The final predictive model for delta FEV1 accounted for a modest proportion of the total variation seen in this sample, however, limiting its potential use for predicting decline in pulmonary function over a 5-yr span in individual subjects.

ABO Blood-Group System↗
PubMed1984

Collaborative study to assess risk of lung disease in Pi MZ phenotype subjects.

We studied 143 Pi MZ heterozygous (MZ) subjects from random populations that had been examined previously for alpha 1-antitrypsin phenotype. Each Pi MZ subject was closely matched with a Pi M control subject from the same population at each of 6 centers. An expanded National Heart, Lung and Blood Institute (NHLBI) respiratory symptom questionnaire was completed by each subject. Pulmonary function tests designed to detect established as well as early obstructive airway abnormalities were administered. Multivariate analysis of the variance of data from the questionnaire and pulmonary function tests corrected for age, race, sex, and smoking history showed no significant difference (p less than 0.05) between subjects of Pi MZ and Pi M phenotype. The size of the populations studied and number of observations made for each variable were sufficient to assure that small differences could be detected with 95% power. We conclude that MZ phenotype alone carries no greater risk of developing lung disease than M phenotype.

Adult↗
PubMed1984

Risk factors, pulmonary function, and mortality.

In a genetic-epidemiologic study of obstructive airway disease (OAD), cross sectional and longitudinal data (4.7 year follow-up) were collected to investigate relationships among risk factors, pulmonary function, and mortality. In the cross sectional evaluation of 2539 non-patient adults, 11 potential risk factors were found to be significantly associated with airways obstruction. Most important among these were age and smoking. Others included: demographic variables (gender, SES, education); the intake of coffee and diet soda; genetic markers (protease inhibitor "Pi" type, ABO type, ABH secretor status); and familial pulmonary disease. Examination of combinations of risk factors in cross sectional data indicated that some of these factors were important risk factors in cigarette smokers but less evident in never smokers. For example, ABO type, familial component, coffee drinking and diet soda intake were related to marked differences in lung function in cigarette smokers, but had little impact in never smokers. Thus, interactions of factors must be considered when assessing risk of pulmonary dysfunction. In the longitudinal evaluation, 11 factors found to be significant on cross sectional study plus 4 tests of lung function (closing capacity, diffusing capacity, slope of Phase III, and flow volume curves) were examined for correlations with loss of forced expiratory volume. Consistently greater declines of lung function were noted in males, older subjects, smokers, whites, and individuals carrying the type A blood group allele. Increased initial visit closing capacity was also associated with increased deterioration. Together, however, these factors accounted for only a modest amount of observed variation in decline in lung function (17% in females and 12% in males). Initial visit characteristics were not only associated with deterioration of lung function in survivors, as described above, but with survivorship per se. Age, sex, race and cigarette smoking were associated with differences in mortality. In addition to these, pulmonary dysfunction itself at initial visit was an independent risk factor for increased mortality. For example, the mortality of unobstructed males in the 5th decade of life was 16 per thousand compared to 25 per thousand in obstructed males. For females, the mortality in the 5th decade of life was 7 per thousand if unobstructed and 12 per thousand if obstructed. We conclude: 1) In cross sectional evaluation, multiple factors are associated with airways obstruction. Of these, smoking appears to interact strongly with other factors.(ABSTRACT TRUNCATED AT 400 WORDS)

ABO Blood-Group System↗
PubMed1982

Impaired pulmonary function as a risk factor for mortality.

Prospective follow-up information obtained between 1976 and 1981 on mortality among 2539 individuals showed that pulmonary function impairment is a risk factor for short-term mortality, even when risk factors such as age, sex, and smoking are considered. Predicted risk curves for impaired individuals (those with forced expiratory volume in one second less than 68% of forced vital capacity) are consistently higher among all race-sex categories over all ages. Survival analysis using the proportional hazards model shows a steeper decline in estimated survival among individuals with poor pulmonary function compared to those with good pulmonary function, adjusted for age, race, and smoking effects. These observations are consistent with the concept that impairment of pulmonary function is a risk factor for morbidity and mortality from several nonrespiratory as well as respiratory diseases and that it acts by contributing to various pathogenic mechanisms in different organ systems.

Adult↗
PubMed1982

Aggravation and provocation of ventricular arrhythmias by antiarrhythmic drugs.

Antiarrhythmic drugs may aggravate or even induce ventricular arrhythmias. This type of adverse reaction is becoming more prevalent as the use of antiarrhythmic agents becomes more widespread. In a retrospective analysis of antiarrhythmic drug action, a worsening of arrhythmia was observed in 80 of 722 (11.1%) antiarrhythmic drug tests in 53 of 155 patients being treated for ventricular tachyarrhythmias. Aggravation of arrhythmias was defined by occurrence of a fourfold increase in the frequency of ventricular premature complexes, a 10-fold increase in repetitive forms, or the first emergence of sustained ventricular tachycardia coincident with time course of action of the particular drug under study. Such aggravation was noted with each of nine drugs tested: quinidine, procainamide, disopyramide, propranolol, metoprolol, aprindine, mexiletine, tocainide and pindolol. The frequency of this complication for a specific drug ranged from 5.9-15.8%. Blood drug concentrations were consistently in the therapeutic range. A study of the variability of ventricular arrhythmia during 48-hour Holter monitoring and exercise stress testing in no instance showed arrhythmia enhancement commensurate with that defining aggravation. Our data suggest that this potentially serious complication is not readily predictable and requires a systematic approach to antiarrhythmic drug testing before a patient is prescribed a long-range maintenance program.

Adolescent↗
PubMed1980

Spindle cell carcinoma of the conjunctiva.

Spindle cell carcinoma, a variant of squamous cell carcinoma, has long been recognized in numerous tissues (including the skin, the upper respiratory tract, the oral cavity, and the esophagus). Two cases of spindle cell carcinoma of the conjunctiva are reported here. Histopathologic examination of these cases shows the characteristic spindle-shaped cells in continuity with the overlying epithelium. Electron microscopy of one case showed desmosomes and cytoplasmic tonofibril-like material. Our direct experience with one of these two cases has shown the malignant neoplasm to be aggressive.

Adult↗
PubMed1980

Is ABH nonsecretor status a risk factor for obstructive lung disease?

In a multidisciplinary study of risk factors for chronic obstructive pulmonary disease (COPD), a significantly more impairment of forced expiration was observed in ABH nonsecretors than in ABH secretors among 1017 white adults. (ABH refers to the "A" and "B" antigens of the ABO blood group system and "H", the heterogenetic substance which is found in persons of all ABO types including type "O".) Nonsecretors had significantly lower mean values of forced expiratory volume in one second as a percentage of forced vital capacity (FEV1/FVC%) and a significantly larger proportion of them had aberrant values, defined as FEV1/FVC% less than 68. These differences remained when mean values or rates of aberrancy were adjusted for other factors reported to alter risk of airway obstruction. In view of the known COPD-peptic ulcer and nonsecretor-duodenal ulcer associations, these findings suggest that the ability to secrete ABH antigens into secretions of the respiratory and gastrointestinal tract may have a protective effect on epithelialized organs in general, or on the lung and portions of the gut specifically.

ABO Blood-Group System↗
PubMed1980

Chronic obstructive pulmonary disease: a challenge in genetic epidemiology.

The study of the genetic epidemiology of airways obstruction has suggested that not only is COPD the prototype of a multifactorial disorder in which many factors contribute to the risk of its occurrence, but also that its definitive characteristic--impaired pulmonary function--may be a multi-disease factor which acts as a key component or cofactor in a number of other disorders: a common route to multiple and diverse pathological manifestations. Further evidence is needed to confirm or refute this hypothesis both of multiple possible causes and, especially, of multiple potential effects of airways obstruction. In view of the implications of such causes and effects, we look to continuing research to obtain and analyze a variety of appropriate data to evaluate further the validity of the hypothesis presented.

Adult↗
PubMed1980

Alcohol consumption and airway obstruction.

To clarify the basis of the reported association between alcohol and pulmonary disease, the relationship between intake of alcohol and pulmonary function was examined in 2,539 community-dwelling adult participants in an ongoing longitudinal study of risk factors for airway obstruction. Forced expiratory volume in 1 s, expressed as a percentage of forced vital capacity, was used as the indicator of airway obstruction, and forced vital capacity expressed as a percentage of the predicted value was used as an index of restriction. Although crude (unadjusted) mean values of the ratio of forced expiratory volume in 1 s to forced vital capacity were significantly lower for heavy than for light drinkers, the difference disappeared when adjustment was made for numerous confounding factors (including such recognized risk factors for pulmonary disease as cigarette smoking, low socioeconomic status, male sex, and age). There was also no evidence of an association between consumption of alcohol and airway restriction. Although these findings do not rule out a possible effect of alcohol on pulmonary disease, its impact, if any, is probably the result of interaction with other factors associated with alcoholism, if not derived primarily from those other factors.

Adult↗
PubMed1980

Hypothesis: the role of the lung in stomach carcinogenesis.

It is proposed that pulmonary defense mechanisms play an important role in stomach carcinogenesis. Inhaled carcinogens reach the stomach by normal pulmonary clearance and account for the association of stomach cancer with dusty occupations. We postulate that although familial and other factors determine the susceptibility to endothelial cancer (both stomach and lung), those persons whose pulmonary clearance mechanisms are more susceptible to impairment by cigarette smoke retain carcinogens and other particulate matter in the lungs and are at increased risk for lung cancer. Those whose clearance mechanisms are not impaired continue to clear these particles from their lungs, unconsciously swallow the cleared particles, receive more of these substances in the stomach, and are at increased risk for stomach cancer. This accounts for: first, the very striking dose-response relationship between the amount of smoking and lung cancer mortality and the relatively weak relationship between smoking and stomach cancer, and second, for observed reciprocal relationships in time trends of mortality between stomach cancer and lung cancer.

Air Pollutants↗
PubMed1980

Patterns of forced expiratory flows in groups at risk for chronic obstructive pulmonary disease.

In a modified case-control study of obstructive pulmonary disease (COPD), airways obstruction has been found to be associated with age, sex, protease inhibitor type, socioeconomic status (SES) and smoking. In this paper patterns of forced expiratory flows are examined in persons demonstrating various risk factors. Two broad patterns of flow limitation emerge. The first pattern, characterized by lower flows at high lung volumes, is found in first-degree relatives of patients with COPD and subjects with a low SES. This pattern, consistent dysfunction of large airways, may reflect reversible decreases of airway caliber. The second pattern, characterized by lower flows at low lung volumes, is found in older subjects. This pattern, consistent with nonhomogeneously emptying lungs or dysfunction of small airways, may reflect more chronic irreversible changes. Smokers and male subjects exhibit both patterns of flow limitation when compared with subjects who had never smoked and female subjects. It is possible that the combination of the patterns reflects a particularly high risk for the development of COPD in male smokers.

Adult↗
PubMed1978

Is pulmonary dysfunction the common denominator for the multiple effects of cigarette smoking?

It is suggested that pulmonary dysfunction underlies the many diverse and apparently non-specific effects of cigarette smoking. The differences in degree as well as type of clinical expression probably derive not only from the multiplicity of constituents of the tobacco itself but also from the variation in vulnerability of different individuals and different target organs, which is attributable to other environmental exposures, previous history, and intrinsic susceptibility.

Bronchitis↗
PubMed1977

A common familial component in lung cancer and chronic obstructive pulmonary disease.

First-degree relatives of lung-cancer patients and of patients with chronic obstructive pulmonary disease had significantly higher age-sex-race-smoking-adjusted rates of impaired forced expiration than first-degree relatives of patients with non-pulmonary disease or community-derived comparison series (neighbourhood controls and teachers). Subclassification of the data and multiple adjustment for smoking, race, sex, and other confounding factors emphasised the consistency of the pattern. These findings strongly suggest that lung cancer and chronic obstructive pulmonary disease share a common familial component other than smoking. The clinical manifestation may depend on the presence of one or more other cofactors as yet undefined.

Adult↗
PubMed1977

Effect of a digitalis drug on ventricular premature beats.

To determine the efficacy of digitalis drugs in suppressing ventricular ectopic activity, 142 patients with frequent (greater than 1 per minute) ventricular premature beats underwent acetyl strophanthidin tolerance testing. In 65 patients (46 per cent), frequency and grade were reduced during testing. In 37 (26 per cent), the ectopic activity remained unaltered; frequency increased during testing in the remaining 40 patients (28 per cent). In the group with a suppressive effect, ventricular premature beats decreased by 82 per cent, with complete abolition of arrhythmias in 46 per cent. The three groups were not distinguishable clinically by either the type or the extent of heart disease. The antiarrhythmic action of acetyl strophanthidin did not appear to depend upon its positive inotropic action. In some patients it appears to be due to an indirect reduction of Purkinje-fiber automaticity resulting from enhanced vagus-nerve activity that thereby lessens adrenergic tone on the heart.

Adolescent↗