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Biomedical subjects

B Kaplan

Publications and source records attributed to B Kaplan.

At least 235 records · Page 13Linked to original sources
PubMed1997

Normal intrauterine pregnancy is unlikely in emergency department patients with either menstrual days > 38 days or beta-hCG > 3,000 mIU/mL, but without a gestational sac on ultrasonography.

OBJECTIVE: To determine whether the absence of a gestational sac on transvaginal ultrasonography in patients with a quantitative beta-human chorionic gonadotropin (beta-hCG) > 3,000 mIU/mL and/or menstrual days > 38 excludes the diagnosis of a normal intrauterine pregnancy (IUP). METHODS: A retrospective analysis was performed of ED patients evaluated from August 1991 to December 1994 at an urban teaching hospital. Patients presented with abdominal pain and/or vaginal bleeding and had a positive serum beta-hCG test. Patients who had transvaginal ultrasonographies performed during the ED visit that were read as indeterminate were reviewed. Menstrual days were determined by subtracting the date of the last normal menstrual period (LMP) from the ED visit date. ED beta-hCGs were quantified. Patients were excluded if the LMP or quantitative beta-hCG result was not available or if the final diagnosis could not be definitively determined. RESULTS: 248 patients met eligibility criteria; of these, 54 were excluded. Therefore, 194 patients were enrolled. Menstrual days ranged from 5 to 151, with a median of 54 days. Of 143 patients with menstrual days > 38 and no gestational sac by ultrasonography, only 4 (2.8%) had a final diagnosis of normal IUP. The menstrual days for the 4 normal IUPs were 39, 41, 42, and 59 days. beta-hCGs ranged from 19 to 151,926 mIU/mL, with a median of 2,410 mIU/mL. None of the 74 patients with a beta-hCG > 3,000 mIU/mL and no gestational sac by ultrasonography had a final diagnosis of normal IUP. CONCLUSION: In patients with either a beta-hCG > 3,000 mIU/mL or menstrual days > 38 and no gestational sac by transvaginal ultrasonography, the likelihood of a normal IUP is low.

Adult↗
PubMed1997

Clinical evaluation of a new model of a transcutaneous electrical nerve stimulation device for the management of primary dysmenorrhea.

Transcutaneous electrical nerve stimulation (TENS) has been proven effective in pain relief of primary dysmenorrhea (PD). We evaluated the efficacy of a new TENS device (Freelady, Life Care, Tiberias, Israel), designed to correct disadvantages of older models used in previous studies, in 102 nulliparous women with PD, who were treated with various types of pain relief medications. Marked pain relief was reported by 58 patients (56.9%) and moderate relief by 31 (30.4%). These subjective findings were supported by the fact that the same number of patients (58 and 31) either stopped analgesic use altogether during the trial or reduced the quantity of analgesics, respectively. The device examined proved to be efficient and safe in controlling the pain and disability caused by PD.

Adolescent↗
PubMed1997

Patient characteristics and lifestyle recommendations in the treatment of gastroesophageal reflux disease.

BACKGROUND: The objectives of this study were to describe the patient-reported frequency with which health care providers recommend lifestyle changes to patients with GERD (gastroesophageal reflux disease) with respect to patient characteristics, eg, sex, age, body mass index, tobacco use, alcohol use, type of health insurance, and clinic location (rural vs urban). METHODS: The study was conducted in a five-center, university-based family practice in southeastern West Virginia. The first 50 patients enrolled in a prospective quality-of-life study of patients with GERD were used as the sample population. Telephone surveys administered immediately following the diagnosis of GERD included seven specific questions on lifestyle modification that may have been recommended by primary health care providers during the clinic visit. Patient-reported data were obtained from baseline surveys. RESULTS: Five of seven (71%) lifestyle modification recommendations were reported by less than 50% of patients as being received from health care providers. Patients aged 60 years or older were less likely to report receiving recommendations than those younger than 60 years (P = .0002), and patients with a body mass index greater than 30 were more likely to report receiving eating-related recommendations (P = .047). Heavier smokers were more likely to report receiving recommendations than lighter smokers (P = .0001). CONCLUSIONS: Based on patient report, health care providers recommended lifestyle modifications to a modest percentage of patients with GERD and modified counseling for specific patient characteristics, such as age, body mass index, smoking, and alcohol consumption. Additional prospective research using physician report and observation as well as patient report, and more numerous patient cohorts, is needed.

Adult↗
PubMed1997

Detection of melanoma by monitoring the intracellular fluorescein fluorescence polarization changes in lymphocytes.

The effectiveness of detecting melanoma by measuring the intracellular fluorescein fluorescent polarization (IFFP) of patients' SCM (structuredness of the cytoplasmic matrix)-responding lymphocytes was examined. SCM-responding lymphocytes from 46 melanoma patients and 32 healthy volunteers were labeled with fluorescein diacetate and challenged with different stimuli, and the resulting polarization was determined. The polarizations (P) obtained upon stimulation with nothing (P-0), encephalitogenic factor (P-EF), phytohaemagglutinin (P-PHA), or melanoma antigen (P-MEL), and the ratios RR(ef) (P-EF/P-PHA) and RR(mel) (P-MEL/P-PHA) were lower for SCM-responding lymphocytes from the patients as a group than for those of the controls. The specificity and sensitivity of the IFFP tests (using cutoff values) to detect melanoma were 90.6 and 73.9%, respectively. The IFFP tests may facilitate the discrimination between melanoma patients and healthy subjects, and may be used in follow-up of patients with melanoma.

Algorithms↗
PubMed1997

Transcutaneous electrical nerve stimulation (TENS) as a pain-relief device in obstetrics and gynecology.

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological and non-invasive pain-relief method that has been proven effective for a variety of conditions. Electrical therapy has been recognized for a long time but its practical clinical application in the form of TENS has been evaluated only during the last 30 years as a result of several theories on pain. The most known of these with regard to TENS development is the "gate theory", although several others have also played a role. In obstetrics and gynecology, TENS has been found to be effective in alleviating labor pain and in the treatment of primary dysmenorrhea. It has also been used successfully following obstetric and gynecologic surgery. In order to be effective in clinical use for obstetric and gynecologic indications, a TENS device must have certain properties, which are detailed in this review. Although new TENS devices that meet all the necessary requirements have been developed and tested, their use is still far from widespread. Patients and medical staff should be encouraged to try the TENS device for obstetric and gynecologic indications, since it is non-invasive, efficient, and easy to use.

Dysmenorrhea↗
PubMed1996

[Follow-up of intrauterine contraceptive devices].

The intrauterine contraceptive device (IUCD) is the most popular, reversible contraceptive method, worldwide. Leaving an IUCD in-utero even beyond the time recommended by the manufacturer has been found both safe, and effective in terms of contraceptive ability. In 1995 we screened the medical records of the gynecologic infirmaries of 4 agricultural settlements (kibbutzim) and found 78 women who had worn an IUCD continuously for more than 5 years. All had been regularly examined every 6 months. Most of the IUCDs (63, 80.7%) were copper-containing. Mean IUCD wear was 7.9+/- 2.6 years (range, 5-17 years). At the time of the study, 38 (48.7%) of the IUCDs were still in utero. Related complications were 3 cases of dysmenorrhea (3.8%) and 20 of metrorrhagia. No pregnancies or pelvic infections were recorded. This study also shows that wearing an IUCD beyond the time recommended by the manufacturer is not associated with loss of contraceptive effectiveness. Furthermore, the rate of IUCD-related complications after 5 years of wear was not higher than during the first 5 years. To support these findings further studies with larger samples are needed.

Female↗
PubMed1996

[Chorionic villus sampling in multiple pregnancies].

Prenatal genetic diagnosis is recommended in multiple pregnancies because of the increased prevalence of genetic abnormalities in such fetuses. It can be done early by chorionic villus sampling or later by amniocentesis. Several studies have demonstrated the efficacy and safety of chorionic villus sampling in multiple pregnancies. Our study describes the results of this method in a twin pregnancy and in 3 triplet pregnancies, which represent 3% of the chorionic villus samplings performed in our ultrasound unit during 1989-95. All genetically deformed fetuses in these pregnancies were identified by chorionic villus sampling and the method was not associated with fetal loss. Our results confirm the safety and efficacy of chorionic villus sampling as expressed in the world literature.

Chorionic Villi Sampling↗
PubMed1996

Frequency of hyperkalemia in recipients of simultaneous pancreas and kidney transplants with bladder drainage.

Hyperkalemia is the most frequent electrolyte abnormality found in whole organ transplant recipients receiving either cyclosporine (CsA) or tacrolimus (FK506). Recipients of a simultaneous pancreas kidney (SPK) transplant with bladder drainage may be particularly susceptible to hyperkalemia secondary to sodium loss from the bladder-drained pancreas, leading to decreased sodium delivery to potassium secretory sites of the kidney. We looked at the incidence of hyperkalemia in 34 type I diabetic SPK recipients transplanted at our center over the period from 1993 to 1995 and compared this with a cohort of 25 type I diabetic recipients of a kidney alone (K(Tx)) transplant. The incidence of hyperkalemia was 73.5% in recipients of an SPK, while it was 44% in K(Tx) recipients (P<0.05). CsA levels were higher, on average, in the SPK group (339 ng/ml+/-62 versus 272 ng/ml+/-58 in the K(Tx) group, P<0.05). However, CsA levels were not different between groups at the time of hyperkalemia, 320+/-74 versus 298+/-49 for SPK and K(Tx), respectively. CsA levels at the time of hyperkalemia were not different from those at the time of normokalemia. Other medications, serum bicarbonate, and renal function were not different in the groups. SPK recipients appear to have a greater incidence of hyperkalemia than kidney alone transplant recipients. This difference cannot be explained by higher acute CsA levels, other medications, or worse renal function. The increased incidence of hyperkalemia may, in part, be secondary to decreased sodium delivery to the transplanted kidney.

Adult↗
PubMed1996

Acyclovir triphosphate inhibits the diagnostic polymerase chain reaction for cytomegalovirus.

Immunocompromised patients are frequently treated with guanine analogs such as acyclovir and ganciclovir. Acyclovir triphosphate, the active intracellular metabolite of acyclovir, exerts its antiviral effect by inhibiting herpesviral DNA polymerases through premature chain termination. PCR has recently been used for early detection of cytomegalovirus. However, we and others have experienced false-negative results for cytomegalovirus-PCR in patients on both acyclovir and ganciclovir. The impact of these agents on PCR assay is unknown. In an attempt to investigate the role of guanosine analogs in these false-negative results, we exposed the DNA-PCR for murine beta-actin, a murine CMV IE gene sequence, and a human CMV IEA1 product, to phosphorylated acyclovir derivatives. Varying concentrations of acyclovir-5'-triphosphate (final: 70-6000 microM) in the reaction mix resulted in an absence of detectable product at or above 490-670 microM. Inhibition was not observed with up to 1400 microM acyclovir-monophosphate. Increasing the Taq concentration to 10 units/100 microL stopped the inhibition. Our data demonstrate that acyclovir-5'-triphosphate inhibits PCR amplification of various gene products in a concentration-dependent manner. Furthermore, this inhibition appears to be specifically directed against the Taq polymerase and can be completely reversed by higher concentrations of the enzyme. Thus, false-negative PCR results for a viral gene product in patients under prophylaxis/treatment with acyclovir could potentially be due to contamination by acyclovir triphosphate. Therefore, negative PCR results in these patients need be interpreted with caution.

Actins↗