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Biomedical subjects

B Schwartz

Publications and source records attributed to B Schwartz.

At least 235 records · Page 13Linked to original sources
PubMed1991

Increased preferential optic disc asymmetry in ocular hypertensive patients compared with control subjects.

The authors determined asymmetrical differences in optic disc cupping and pallor between the right and left eyes of 57 control subjects and 75 patients with ocular hypertension. Photogrammetry was used to measure the optic disc cup, and computerized image analysis was used to measure the optic disc pallor for the total disc and its quadrants. Generally, for control and ocular hypertensive eyes, the median values of cupping and pallor were significantly larger in the left eye than in the right, except for depth in the inferior quadrant (right eye minus left eye = 9.3%, P = 0.000) and pallor in the nasal quadrant (right eye minus left eye = 21.3%, P = 0.01), which were preferentially larger in the right eye than in the left in ocular hypertensive eyes. Ocular hypertensive eyes also showed a greater difference between the right and left eyes compared with control eyes for inferior depth (P = 0.06) and nasal pallor (P = 0.02). Detection of optic disc differences as a sign of ocular hypertension between the right eye and the left should evaluate the inferior and nasal quadrants of the disc.

Aged↗
PubMed1991

Glaucoma-like discs with subsequent increased ocular pressures.

Four patients with glaucoma-like discs, normal visual fields, and normal ocular pressures (less than 21 mmHg), first detected by direct ophthalmoscopy, were followed without treatment. Increased ocular pressures (greater than or equal to 21 mmHg) subsequently developed in these patients at an average of 8.1 years after the recognition of their glaucoma-like discs. Before the increased ocular pressure developed, two patients showed retinal nerve fiber layer loss and one showed optic disc hemorrhages. There are two possible hypotheses to explain this sequence of events. The first is that the optic discs and nerve fiber layer defects were produced by abnormal diurnal levels of ocular pressures or levels of ocular pressure, although less than 21 mmHg, which may be abnormal for the optic disc. The second hypothesis is that there are two independent events, one producing abnormalities in the optic disc and nerve fiber layer and a second producing the increased ocular pressure.

Aged↗
PubMed1991

Delusional parasitosis associated with phenelzine.

A woman developed delusional parasitosis when taking phenelzine. The delusion occurred in an agitated hypomanic state and was preceded by an intense pruritus. It completely remitted following withdrawal of phenelzine combined with a low dose of haloperidol (1 mg/day) for several days. This unusual psychopathology is probably encountered more by dermatologists than by mental health professionals.

Aged↗
PubMed1991

Apophysitis of the fifth metatarsal base. Iselin's disease.

Apophysitis of the fifth metatarsal base, or Iselin's disease, is an overuse osteochondrosis seen in growing children. Although amenable to treatment, it is a self-limiting disorder, disappearing spontaneously with completion of growth.

Adolescent↗
PubMed1991

Severe illness associated with group A-hemolytic streptococcal infections.

The Wisconsin Division of Health (DOH) began surveillance for severe illnesses associated with group A beta-hemolytic streptococcus (GABS) infections in late 1989 to describe the current epidemiologic features and clinical spectrum of these infections in the state. Severe illness was defined by the isolation of GABS from the blood or by the development of one or more of the following in a patient infected with GABS: shock, extensive tissue injury, desquamating rash, disseminated intravascular coagulation, renal failure, adult respiratory distress syndrome, or death. Case reports involving 28 patients with severe GABS-related illnesses with onset from November 1989 through October 1990 were received by the DOH. The majority of the case-patients had sepsis (57%), cellulitis (50%) or both. Nine (32%) cases were fatal. Those who died were older than those who survived (median age 74 years v 43 years, p = 0.002) and were more likely to have clinical diagnoses that included pneumonia (relative risk [RR] 3.0, 95% confidence interval [CI] 1.2, 7.3) or necrotizing fasciitis/myositis (RR 3.7, 95% CI 1.5, 9.0). The median interval from illness onset to hospitalization was similar for fatal cases (1 day) and non-fatal cases (2 days), suggesting that early intervention after the appearance of clinical illness may not improve the outcome.

Adolescent↗
PubMed1991

Changing immunization referral patterns among pediatricians and family practice physicians, Dallas County, Texas, 1988.

Family practice physicians and pediatricians in Dallas County, Texas, were surveyed to determine how recent vaccine price increases have changed immunization referral patterns. A total of 73% of responding physicians referred some pediatric patients for immunization in 1988. Public health clinics were the largest referral source with more responding pediatricians (84.4%) referring patients than did responding family practitioners (66.5%). Referrals to the clinics were most often made when patients were unable to afford immunizations in a private practice setting. Between 1979 and 1988, the number of responding pediatricians and family practitioners making immunization referrals increased by 193% and 391%, respectively. The percentages of children referred for immunization increased by 693% during the same decade. It was suggested by our survey of Dallas County physicians that a new influx of patients are using public sector immunizations, potentially creating additional financial stress for public health programs. In addition, this shift to the public sector may undermine the health departments' ability to provide new vaccines or protect greater numbers of children with immunization.

Costs and Cost Analysis↗
PubMed1991

Increased plasma noncortisol glucocorticoid activity in open-angle glaucoma.

Total biologic plasma glucocorticoid activity of normal, ocular hypertensive, and open-angle glaucoma patients was compared using a glucocorticoid receptor-based competitive binding assay. Multiple linear-regression analysis was used to adjust for the effects of significant ocular and nonocular variables, including therapy for glaucoma. The glaucoma patients had significantly greater plasma glucocorticoid activities than did normal subjects. A comparison of receptor-based assay values to values obtained with a cortisol radioimmunoassay showed that significant amounts of biologic glucocorticoid activity in the plasma of the glaucoma patients could not be explained by cortisol alone. In the normal and ocular hypertensive groups, however, virtually all of the plasma glucocorticoid activity could be accounted for by cortisol. These results suggest that in open-angle glaucoma patients, noncortisol glucocorticoids are responsible for elevating biologic plasma glucocorticoid activity. Thus, open-angle glaucoma may be associated with a disturbance of the hypothalamic-pituitary-adrenal axis that produces increased plasma levels of both cortisol and other noncortisol glucocorticoids.

Aged↗
PubMed1990

Changing epidemiology of group A streptococcal infection in the USA.

To see whether changes in the epidemiology of group A streptococcal disease in the USA have been accompanied by a corresponding change in serotype distribution, epidemiological and M-typing and T-typing data for 5193 strains sent to the Centers for Disease Control, Atlanta, between 1972 and 1988 were analysed. The proportions of M-types 1, 3, and 18 increased significantly during the study period. These M-types were more likely to be invasive, to cause fatal infection, and to occur in a cluster of infections than were other types. By contrast, the proportions of M-types 4 and 12 decreased; they were less invasive and were less likely to be found in clusters than were other types. These data suggest that changes in the epidemiology of group A streptococcal disease may be related to changes in the distribution of M-types causing infection.

Adult↗
PubMed1990

Alpha-interferon structure and natural killer cell stimulatory activity.

Expression vectors for human alpha-interferon (Hu-IFN-alpha) J1, a site-specific mutant [Ser116]Hu-IFN-alpha J1, and Hu-IFN-alpha J/C or Hu-IFN-alpha C/J hybrids were constructed and expressed in Escherichia coli. These interferons and others were purified by immunoaffinity chromatography with a monoclonal antibody against human alpha-interferon. Their antiviral activity and ability to stimulate natural killer cell activity were determined in comparison to several other human interferons. These results provide some insight into structure-activity relationships for stimulating natural killer cells and confirm our previous conclusions that antiviral activity cannot be used to predict other activities for an individual IFN-alpha species. The observations suggest that the tertiary structure rather than any specific linear sequence of amino acids regulates the ability of the interferons to stimulate natural killer cell activity.

Amino Acid Sequence↗
PubMed1990

Successful treatment of hairy cell leukemia with beta-ser interferon.

Twelve patients with hairy cell leukemia underwent treatment with beta-ser interferon, a type I interferon with potent antiproliferative activity. Ten of the 12 patients had had prior therapy and the median time from diagnosis to initiation of treatment was 8.5 months (range 1 month to 18 years). Bone marrow involvement ranged from 90-100% hairy cells. Beta-ser interferon was administered as an intravenous injection of 90 million units per dose, three times weekly. Dose reductions were by dose and by frequency in individual patients. Ten of 12 patients (83%) responded, including 7 complete (CR) and 3 partial (PR) responses. The median time to at least PR was 6 months and the median time to CR was 12 months. The median duration of overall response (PR + CR or PR) is 31+ months (range 26(+)-40+ months). Of the 6 patients who underwent dose reductions due to toxicity or poor tolerance, 4 CR patients reverted to PR, and 2 PR patients have increased the number of hairy cells in the marrow, while maintaining normal peripheral blood counts. One each of these has regained CR and PR status after an increase in dose.

Adult↗
PubMed1990

The visual field in chronic open angle glaucoma: the rate of change in different regions of the field.

Using automated perimetry the distribution of visual field loss in 40 chronic open angle glaucoma eyes (40 patients) was found to be predominantly in the nasal, supranasal, and superotemporal regions. The rate of change of visual field threshold values in seven regions of the field was measured by trend analysis over 44.9 +/- 17.9 months. Seventeen eyes had a significant rate of field loss in one or more regions of the field with the remaining eyes either showing improvement or stability. Seven of the 17 eyes with significant regional field loss had stable overall fields. The greatest rate of field loss occurred in the temporal and superotemporal regions. The correlation between the mean threshold value of the initial field test and the rate of change of field over time was significant in the temporal region and of borderline significance in the superotemporal region. The relationship was such that the greater the initial threshold value, the greater the subsequent rate of field loss.

Eye↗
PubMed1990

The spectrum of clinical and laboratory findings resulting from human herpesvirus-6 (HHV-6) in patients with mononucleosis-like illnesses not resulting from Epstein-Barr virus or cytomegalovirus.

Recently, the morphologic, immunologic, and molecular makeup of a new virus designated human herpesvirus-6 (HHV-6) has been described. Because cell cultures of HHV-6-infected mononuclear cells showed prominent lymphocytic changes, it could be anticipated that mononucleosis-like illnesses or lymphoproliferative disorders would turn out to be manifestations of active HHV-6 infection. In the present study, blood samples from 27 patients previously categorized as having non-Epstein-Barr virus (non-EBV)/noncytomegalovirus (non-CMV) heterophil-negative mononucleosis-like illnesses were tested for IgM and IgG antibodies to HHV-6. Eight of these patients (30%) had serologic evidence of active HHV-6 infection. The clinical spectrum includes a short-lived febrile illness, mild cervical lymphadenopathy, laboratory data suggestive of active viral hepatitis in two patients, and a prolonged febrile illness in a single patient with previously documented positive anti-HIV serology. The viral studies revealed the presence of fourfold HHV-6-specific IgG titer increases by immunofluorescent assay (IFA) in seven serially studied cases and positive IgM serology on one or more samples tested by IFA or enzyme-linked immunosorbent assay (ELISA) in all eight cases. The authors could not determine whether the illnesses represented primary HHV-6 infections in susceptible individuals or reactivation of latent virus. HHV-6 serologic studies may be indicated in patients with mononucleosis-like illnesses with atypical lymphocytosis when EBV and CMV test results are nondiagnostic.

Adolescent↗
PubMed1990

Analysis of clinical and food-borne isolates of Listeria monocytogenes in the United States by multilocus enzyme electrophoresis and application of the method to epidemiologic investigations.

To investigate the microbiology and epidemiology of the 1,700 sporadic cases of listeriosis that occur annually in the United States, we developed a multilocus enzyme electrophoresis (MEE) typing system for Listeria monocytogenes. We studied 390 isolates by MEE. Eighty-two electrophoretic types (ETs) were defined. Two distinct clusters of ETs, ET group A (ETGA) and ET group B (ETGB), separated at a genetic distance of 0.440, were identified. Strains of ETGB were associated with perinatal listeriosis (P = 0.03). All strains of H antigen type a were in ETGA, while all strains of H antigen type b were in ETGB. Among 328 clinical isolates from cases of literiosis, 55 ETs of L. monocytogenes were defined. Thirty-four ETs were identified among 62 isolates from food products. The mean number of strains per ET (5.2) was significantly higher among clinical isolates than among food-borne isolates. Examination of isolates from outbreaks further documented the link between cases and contaminated food products. In one investigation, we found 11 different ETs, ruling out a single common source as a cause of that outbreak. By examining a large number of isolates collected over a specified time in diverse geographic locations in the United States, we have begun to establish a baseline for the study of the epidemiology of listeriosis by MEE.

Bacterial Typing Techniques↗
PubMed1989

Glaucomalike disks without increased intraocular pressure or visual field loss.

We studied 48 patients who had glaucomalike disks with increased cupping and pallor, superior or inferior extension of cupping and pallor and asymmetry of cupping and pallor between eyes without increased intraocular pressure or visual field loss, and open angles. We compared these patients with a randomly selected group of 48 patients with primary open-angle glaucoma. The mean age of the patients with glaucomalike disks (45.1 +/- 16.1 years) was significantly younger than the group with open-angle glaucoma (63.8 +/- 11.3 years). Of the patients with glaucomalike disks, 11 (23%) had a family history of glaucoma, 75% of 22 eyes with optic disk fluorescein angiograms had abnormal readings, and 59% of 43 eyes with retinal nerve fiber layer defects had abnormal readings. Photogrammetric measurements of the left disk cups were compared in 22 of the patients with glaucomalike disks to 16 matched patients with primary open-angle glaucoma. The only statistically significant difference was that the patients in the glaucoma group showed a larger cup area (surface opening) of the inferior quadrant. Our findings suggest that some glaucomalike disks may be one variant of primary open-angle glaucoma.

Adult↗
PubMed1989

Intercontinental spread of an epidemic group A Neisseria meningitidis strain.

Electrophoretic enzyme typing revealed that a single group A Neisseria meningitidis clonal complex, designated III-1, was responsible for recent epidemics in Nepal, Saudi Arabia, and Chad. Epidemiological investigations and enzyme typing profiles indicated that this clone was brought from South Asia to the Middle East by Muslims making their pilgrimage (haj) to Mecca, Saudi Arabia, in 1987. Pilgrims who became group A carriers introduced this clonal group into sub-Saharan Africa on their return from the haj. The introduction of this clonal group into sub-Saharan Africa may be responsible for the current wave of epidemics affecting the region. Although the findings suggest that clonal virulence is an important factor in the development of epidemics of meningococcal disease, other factors also seem to be necessary for the development of an epidemic.

Chad↗
PubMed1989

Investigation of an outbreak of Moraxella conjunctivitis at a Navajo boarding school.

In 1986, an outbreak of Moraxella follicular conjunctivitis occurred in girls attending a Navajo boarding school in New Mexico. We diagnosed 19 cases of culture-proven, and 21 of clinical conjunctivitis based on isolation of Moraxella from conjunctival cultures and the occurrence of symptoms significantly associated with positive culture. Sharing eye makeup was significantly associated with Moraxella-positive conjunctivitis (odds ratio [OR] = 7.2, P = .004) and showed a trend toward significance in those with clinical conjunctivitis (OR = 2.9, P = .09). Eyeliner and eye shadow were implicated (OR = 4.1, P less than .05). We cultured samples of 13 students' makeup; one third of the eyeliners were positive for Moraxella. Nasal carriage of Moraxella was found in 35 (44%) of the 79 female boarders and in 20 (21%) of 97 Navajo patients at two nearby clinics. In a prospective evaluation of the effect of patient education and rifampin therapy on the occurrence of conjunctivitis during an 11-month follow-up period, both types of intervention were successful in significantly reducing the rate of conjunctivitis when compared with that in a control group.

Adolescent↗