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Biomedical subjects

C Cohen

Publications and source records attributed to C Cohen.

At least 163 records · Page 9Linked to original sources
PubMed1996

Procreation after death or mental incompetence: medical advance or technology gone awry?

OBJECTIVE: To review our experience with semen retrieval in men who are incompetent or dead and to formulate general medical, legal, and ethical guidelines for practitioners. DESIGN: Case series and literature review. SETTING: Academic. PATIENT(S): Seven incompetent or neurologically dead individuals in whom sperm retrieval was requested. INTERVENTION(S): Electroejaculation. RESULT(S): Seminal emission was induced in the two men who underwent electroejaculation. Sperm suitable for cryopreservation was obtained in one of these men. Review of the legal and ethical implications of such procedures led to development of general guidelines for determining whether gamete retrieval should be performed when requested. Issues of procreational autonomy, consideration of the decedent's wishes, and assurance of the well-being of any new life created were considered most strongly in the formation of these guidelines. CONCLUSION(S): Although the retrieval of sperm from deceased or incompetent individuals may be achieved readily, it is incumbent upon the practitioner to consider the legal and moral implications of these procedures before proceeding.

Adolescent↗
PubMed1996

Image cytometric analysis in pathology.

Image cytometry (ICM) is used in surgical pathology to quantify nuclear DNA content, nuclear and cytoplasmic immunostain. DNA aneuploidy is shown to be an independent negative prognostic factor in malignant melanoma, small cell carcinoma of the lung, esophageal, ovarian, endometrial, prostatic, urinary bladder, and papillary thyroid carcinoma. On bladder washings, DNA ploidy by ICM is used as an aid in diagnosis and management of recurrent transitional cell carcinoma of the bladder. Quantitation of nuclear immunostain for proliferation markers by ICM has clinical significance in prognosis and management of solid tumors of bladder, breast and ovary, astrocytoma, lymphoma, and malignant melanoma. Angiogenesis, measured by microvessel density is a predictor of prognosis in breast carcinoma and an independent predictor of metastasis for breast carcinoma, malignant melanoma, non-small cell lung carcinoma, and prostate carcinoma. Quantitated by ICM, angiogenesis is predictive of the presence or subsequent development of regional lymph node metastases in head and neck squamous carcinomas. Future prospects for ICM in pathology include the standardization of ICM techniques; extended clinical use of DNA ploidy for diagnosis, prognosis and as a help with therapeutic decisions; development of neural networks and quantification of fluorescence in situ hybridization to distinguish benign from malignant lesions of low malignant potential, and three-dimensional reconstruction of morphology from two-dimensional sections measured for prognostic parameters.

DNA, Neoplasm↗
PubMed1996

Emotional expression during mid- to late-stage dementia.

This study examined the quality of emotional responsivity in mid- to late-stage dementia patients. Eighty-two nursing home patients with a DSM-III-R diagnosis of primary degenerative dementia of the Alzheimer type served as subjects. Patients were staged using the Global Deterioration Scale. The level and type of patient affectivity were assessed by family reports, aide reports, and direct observation and coding of patient facial expressions during a family visit. All three measures indicated that patients with Alzheimer's disease expressed a range of affective signals. Some showed an intact and functional emotion system even during the last stage of the disease; one third of end-stage dementia patients expressed sadness at the departure of their relatives as coded by an objective facial affect coding system.

Affective Symptoms↗
PubMed1996

Characteristics of psychogeriatric patient visits to a general hospital emergency room.

OBJECTIVE: This study describes psychogeriatric patients who visit the Emergency Room (ER) in a teaching hospital with a comprehensive psychogeriatric service. METHOD: A survey assessing demographic and clinical characteristics was completed for every psychiatric ER patient during a 2-year period. RESULTS: One hundred and seventy-three ER patients aged over 60 (mean age 71.2) were assessed. Fifty-three percent were previously known to the psychogeriatric service. The majority of these previously known psychogeriatric patients who used the ER suffered from mood disorders. The majority of new psychogeriatric patients seen in the ER had an organic brain syndrome (OBS). CONCLUSIONS: Few OBS patients who visited the ER were previously known to the psychogeriatric service, but many new OBS patients accessed the psychogeriatric service via the ER. For patients with mood disorders, particularly if suicidal, the ER was used as part of their service delivery system.

Adult↗
PubMed1996

Old problem, different approach: alternatives to physical restraints.

Individualized care, resident assessment by a multidisciplinary team, and rehabilitation enhance functional independence in nursing home residents. Creativity in choosing alternatives to restraints was important in successful restraint reduction. Residents free of restraints had higher ADL levels, were more continent, and sustained fewer serious injuries, all of which are important quality of life indicators.

Aged↗
PubMed1995

Target sequence recognition by the calmodulin superfamily: implications from light chain binding to the regulatory domain of scallop myosin.

Some of the rules for how members of the calmodulin (CaM) superfamily bind to target peptides are revealed by the crystal structure of the regulatory domain of scallop myosin. The structure shows that the IQ motif of the heavy chain in this invertebrate myosin imposes constraints on both the positioning and conformation of the individual lobes of the light chains. In contrast, analysis of the contact residues in the targets bound by Ca(2+)-CaM reveals how the structure of CaM accommodates a broader range of sequences consonant with this protein's functional diversity.

Amino Acid Sequence↗
PubMed1995

A phase I trial of cyclosphosphamide and carboplatinum combined with interleukin-3 in women with advanced-stage ovarian cancer.

The hematopoietic growth factor, recombinant human interleukin-3 (rhu IL-3), stimulates production of both leukocytes and platelets, and thus potentially has greater utility than growth factors that solely stimulate leukocytes production when employed with dose-intensive chemotherapeutic regimens. To determine the optimal schedule for administration of rhu IL-3 in combination with cyclophosphamide and carboplatin, an aggressive regimen for the treatment of advanced ovarian cancer, a phase I trial was initiated by the New York Gynecologic Oncology Group. Following surgical debulking, all patients received cyclophosphamide and carboplatin for 6 cycles. rhu IL-3 was administered at 50, 250, or 500 microgram subcutaneously for 5 days either immediately prior to or after administration of chemotherapy. Cohorts of six patients were treated at each dose level (three pre- and three postchemotherapy). Eighteen patients received 91 cycles of treatment. The major toxicities attributable to rhu IL-3 included fevers, chills, malaise, nausea, and headache, but were not dose-limiting at the doses of rhu IL-3 employed. The major finding of this study was that rhu IL-3 administered after chemotherapy offered greater platelet protection than rhu IL-3 administered prior to chemotherapy as assessed by median platelet nadir and duration of platelet counts < 50,000/mm3. A second major finding was a dose-response relationship for rhu IL-3: the two higher doses employed, 250 and 500 micrograms, offered more effective platelet protection than the lower dose employed, 50 micrograms. rhu IL-3 had no significant effects on leukocyte nadirs or duration of nadirs at any schedule or dose employed. rhu IL-3 may reduced the thrombocytopenia associated with aggressive treatment with cyclophosphamide and carboplatin, although this remains to be confirmed in a randomized, placebo-controlled trial. The effects of rhu IL-3 are dose- and schedule-dependent.

Adult↗
PubMed1995

DNA index and ploidy distinguish normal human parathyroids from parathyroid adenomas and primary hyperplastic parathyroids.

BACKGROUND: The goal of this study was to identify factors that might aid in diagnosis and intraoperative management of hyperparathyroidism. METHODS: We analyzed biopsy specimens of 242 parathyroids from 159 patients by use of flow cytometry and image cytometry (ICM) for DNA index (DI), defined as the content of nuclear DNA compared with that expected for a DNA diploid standard, for proliferative index (PI), and for ploidy (diploid versus aneuploid or tetraploid). RESULTS: True normal and normal parathyroids from patients with solitary adenomas were uniformly diploid. Abnormal ploidy (aneuploidy or tetraploidy) was identified frequently in adenomas and occasionally in hyperplasias with the exception that multiple endocrine neoplasia (MEN) biopsy specimens were uniformly diploid. DI for adenomas was similar to that for hyperplasias, and DI of both was higher than for normal glands. ICM-DI correlated positively with flow cytometry-DI and patient age and inversely with serum parathyroid hormone. PI was relatively low in all groups but was higher for hyperplasias versus normal parathyroids from patients with solitary adenomas and MEN versus non-MEN. PI correlated inversely with patient age. CONCLUSIONS: DI by ICM differentiates normal from abnormal parathyroids. DI might influence extent of resection in two- and three-gland hyperplasia and selection of the most appropriate gland for autografting and cryopreservation in patients with four-gland hyperplasia.

Adenoma↗
PubMed1995

Management of alternate level of care patients using a computerized database.

The term "alternate level of care" (ALC) refers to the status of hospitalized patients who are no longer acutely ill but cannot be discharged because posthospital plans are not yet in place. ALC is a major problem for patients, families, and hospitals. This article describes the experiences of an urban teaching hospital with ALC and the development of a computerized database to better manage the ALC population. Among the findings were that age, waiting for a nursing home placement, family-related discharge problems, and pending Medicaid eligibility all significantly contributed to length of stay beyond the acute phase of the illness. Using these data, the hospital developed an innovative program in which the preparation of Medicaid applications was transferred from the Department of Finance to the Department of Social Work Services.

Aged↗
PubMed1995

Endometrial adenocarcinoma with choriocarcinomatous differentiation in an elderly virginal woman.

A 70-year-old virginal woman underwent hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. Gross examination of the surgical specimen showed normal ovaries and fallopian tubes, an enlarged uterus with several intramural leiomyomata, an endometrium completely carpeted by cancer, and, additionally, a necrotic and hemorrhagic nodular mass that protruded into the endometrial cavity. Histologic examination showed a widespread and superficially invasive, moderately differentiated endometrial adenocarcinoma that merged with a choriocarcinoma. Immunohistochemical studies showed cytoplasmic staining for human chorionic gonadotrophin in syncytiotrophoblast cells, cytotrophoblast-like cells and rare adenocarcinoma cells. A discussion of previously reported similar cases and possible mechanisms of dual differentiation in tumors, as well as comments on histogenesis are included.

Adenocarcinoma↗
PubMed1995

Caregiving and dementia: predicting negative and positive outcomes for caregivers.

A sample of 118 caregivers, maintaining relatives with dementia at home, were interviewed and completed questionnaires at initial and follow-up assessment six months later. All dependents received a cognitive assessment. The results of LISREL analysis of the data supported a model of caregiving in which negative outcomes of burden and impaired health reduced positive outcomes of enjoyment of aspects of caregiving. Caregivers with larger social support networks were more satisfied with their support, reducing feelings of impaired health, although as caregiving became more difficult, satisfaction with support decreased. The retrospective perception of the premorbid relationship as more difficult lead to the appraisal of the patient's symptoms as presently being more extensive and increased burden. Women caregivers reported both greater feelings of burden and more aspects of caregiving as enjoyable.

Adaptation, Psychological↗
PubMed1995

Histopathology, morphometry, and nuclear DNA content of iris melanocytic lesions.

PURPOSE: To compare the histologic, morphometric and nuclear DNA content of a group of benign and malignant melanocytic lesions of the iris. METHODS: Forty-four surgically excised melanocytic lesions of the iris were histologically classified as nevus or melanoma. Morphometric analysis using a digital filar micrometer (LaSICO 1602N-10 and 5-4A) measured the mean size of the 10 largest nucleoli, and Feulgen staining and image cytometry (CAS 200 Cell Analysis Systems) analyzed the nuclear DNA ploidy in the lesions. Patient follow-up information was obtained whenever possible. RESULTS: Sixteen cases were histologically classified as nevi and twenty-eight cases as melanoma. The mean of the 10 largest nucleoli of the nevi was smaller than the mean among the melanomas (1.772 microns [SD = 0.366] and 2.773 microns [SD = 0.565], respectively). Feulgen staining revealed that all lesions were diploid, with the exception of two hyperdiploid and two hypodiploid melanomas. Of the patients with follow-up information available, none with nevi developed a metastasis and two with melanoma died of metastatic disease. CONCLUSIONS: The histologic classification of iris melanocytic lesions (i.e., nevus versus melanoma) correlates to nucleolar size (P < 0.001) but not to nuclear DNA ploidy.

Adolescent↗
PubMed1994

DNA image cytometric analysis of paraffin-embedded sections of small renal cortical neoplasms.

DNA ploidy analysis of neoplasms is most frequently performed by flow cytometry of single nuclear suspensions or image analysis of Feulgen-stained cytologic specimens. To assess the prognostic significance of ploidy in renal adenomas (less than 3 cm in diameter), nuclear DNA content of 21 renal cortical neoplasms was analyzed by image cytometry (CAS 200, Cell Analysis Systems, Inc., Elmhurst, IL) on Feulgen-stained 5 microns fixed embedded tissue sections. Five (36%) of 14 small neoplasms (so-called renal adenomas; (mean diameter, 7.2 mm; range, 2-24 mm) were in the aneuploid range. Four (57%) of seven carcinomas (mean diameter, 6.3 cm; range, 3.5-10 cm) were aneuploid, a frequency not significantly different from that in the adenomas (P = 0.4). Mean DNA index (1.38) for aneuploid adenomas and carcinomas was identical. Diploid renal adenomas (mean diameter, 5.9 mm) were smaller, although not significantly so (P > 0.05), than the aneuploid ones (mean, 9.7 mm). Size of diploid (mean, 6.7 cm) and aneuploid (mean, 6.1 cm) renal carcinomas was similar. Clinical follow-up studies to evaluate utility of DNA ploidy and proliferative activity in prognosis and management of small renal cortical neoplasms are indicated.

Adenoma↗
PubMed1994

Congenital melanocytic nevi and DNA content. An analysis by flow and image cytometry.

BACKGROUND: Potential risk factors for the development of melanoma in congenital melanocytic nevi (CMN) are not well established. DNA aneuploidy may constitute such a risk factor but has not been sufficiently studied in CMN. METHODS: In the present study, DNA analysis of eight giant CMN, nine medium CMN (1.5-20 cm), and eight small CMN (< 1.5 cm) was assessed by flow cytometry and selected lesions (six nevi) by DNA image cytometry. DNA content was correlated with patient age, nevus size, and degree of cytologic atypia. RESULTS: DNA aneuploidy was detected by flow cytometry in two giant CMN from adult patients and in a small CMN from a child. DNA aneuploidy was not observed in any of the six CMN studied by image cytometry, although an increased S-phase was noted in a markedly atypical giant CMN. No DNA aneuploidy was detected in medium-sized CMN or in the CMN of nine patients 1 year of age or younger. CONCLUSION: In contrast to previous studies, it was observed that abnormal DNA content does tend to correlate with cytologic atypia, particularly in giant CMN with atypia or melanoma, in adults. Conversely, frank DNA aneuploidy in any CMN in children younger than 1 year of age, irrespective of histologic findings, was not detected. Finally, based on these limited studies, greater sensitivity of image over flow cytometry for detection of DNA aneuploidy cannot be verified.

Adolescent↗
PubMed1994

Structure of the regulatory domain of scallop myosin at 2.8 A resolution.

The regulatory domain of scallop myosin is a three-chain protein complex that switches on this motor in response to Ca2+ binding. This domain has been crystallized and the structure solved to 2.8 A resolution. Side-chain interactions link the two light chains in tandem to adjacent segments of the heavy chain bearing the IQ-sequence motif. The Ca(2+)-binding site is a novel EF-hand motif on the essential light chain and is stabilized by linkages involving the heavy chain and both light chains, accounting for the requirement of all three chains for Ca2+ binding and regulation in the intact myosin molecule.

Amino Acid Sequence↗