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Biomedical subjects

D Berman

Publications and source records attributed to D Berman.

At least 55 records · Page 3Linked to original sources
PubMed1989

Midazolam versus diazepam for combined esophogastroduodenoscopy and colonoscopy.

This study compares the effects of two different benzodiazepines used for conscious sedation during combined upper gastrointestinal endoscopy (EGD) and colonoscopy. Subjects were assessed for their degree of analgesia and amnesia for the procedure, prior experience with endoscopy, and willingness to undergo another similar procedure should such be necessary. The patients were randomized single blind to receive either midazolam or diazepam for their preprocedure sedation. The amount of preprocedure sedation utilized was determined by titration of the dose to achieve slurring of speech. Prior to receiving either agent, the subjects were shown a standard card containing pictures of 10 common objects, were asked to name and remember them, and were told they would be "quizzed" (at 30 min and 24 hr) after being sedated for their recollection as to the objects pictured on the card. Each subject filled out a questionnaire addressing their perceived discomfort during the endoscopic procedure and their memory of the procedure 24 hr after the procedure. Sixty-three percent of the midazolam-sedated subjects reported total amnesia for their colonoscopy vs 20% of diazepam-sedated patients (P less than 0.001). Fifty-three percent of midazolam-sedated patients reported total amnesia of their upper gastrointestinal endoscopy vs only 23% of diazepam-sedated subjects (P less than 0.05). The midazolam-sedated subjects reported experiencing less pain with both upper gastrointestinal endoscopy (P less than 0.05) and colonoscopy (P less than 0.001) than did the diazepam-sedated group. Most importantly, the midazolam group was more willing to undergo another similar endoscopic procedure should they be asked to do so by their physician (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Quantitative single photon emission computed thallium-201 tomography for detection and localization of coronary artery disease: optimization and prospective validation of a new technique.

One hundred eight-three men underwent stress-redistribution thallium-201 myocardial perfusion tomography. After evaluation of various preprocessing filters in a phantom study, the Butterworth filter with a frequency cutoff of 0.2 cycles/pixel, order 5 (which provided optimal filter power) was used in the back projection algorithm of the patient studies. All short-axis and apical portions of vertical long-axis images were quantified by dividing each myocardial slice into 60 equal sectors and displaying the maximal count per sector as a linear profile. In a pilot group consisting of 20 normal men (less than 5% likelihood of coronary artery disease) and 25 men with coronary artery disease (greater than or equal to 50% coronary stenosis by angiography), profiles representing the lowest observed value below the mean normal profiles provided the best threshold for defining normal limits. Abnormal portions of the patient profiles were plotted on a two-dimensional polar map. The polar map was divided into 102 sectors, and sectors with a probability of greater than or equal to 80% for disease of each one of the three major coronary arteries were clustered to represent specific coronary artery territories. Receiver operating characteristic curve analysis for defect size showed that the optimal threshold for defining a definite perfusion defect was 12% for the left anterior descending and left circumflex and 8% for the right coronary artery territories. These criteria were prospectively applied to an additional 92 patients with angiographic coronary artery disease, 18 patients with normal coronary arteriograms and 28 patients with less than 5% likelihood of coronary disease. Sensitivity, specificity (in patients with normal coronary arteriograms) and normalcy rate (in patients with less than 5% likelihood of coronary artery disease) for overall detection of coronary disease were 96%, 56% and 86%, respectively. Sensitivity and specificity for identification of individual diseased vessels were, respectively, 78% and 85% for the left anterior descending, 79% and 60% for the left circumflex and 81% and 71% for the right coronary artery. These results were not significantly different from those of the pilot group. An optimized quantitative method for interpretation of stress thallium-201 myocardial perfusion tomography has been developed. Prospective application of this method indicates that the technique is accurate for the overall detection of coronary artery disease and identification of disease in individual arteries.

Coronary Circulation↗
PubMed1989

Spontaneous spinal epidural hematoma in a 7-year-old girl. Diagnostic value of magnetic resonance imaging.

The authors report a 7-year-old girl who developed neck pain and stiffness over a four-day period. There was no fever, trauma, systemic illness or headache. Physical examination demonstrated subtle neurologic deficits indicative of cervical cord compression. CAT scan and subsequent Magnetic Resonance Imaging (MRI) of the cervical spine demonstrated a spinal epidural hematoma, which was evacuated surgically. Post-operative angiography failed to demonstrate a vascular abnormality. The child recovered without neurologic deficit. MRI proved to be a sensitive tool in identifying the nature and extent of this lesion, and may be considered in lieu of myelography.

Child↗
PubMed1988

Inactivation of particle-associated coliforms by chlorine and monochloramine.

Sieves and nylon screens were used to separate primary sewage effluent solids into particle fractions of less than 7- or greater than 7-micron size. The efficiency of separation was determined by using a particle counter. Indigenous coliforms associated with the particle fractions were tested for their resistance to chlorine and monochloramine. Coliforms associated with the less than 7-microns fraction were inactivated more rapidly by 0.5 mg of chlorine per liter at 5 degrees C and pH 7 than coliforms associated with the greater than 7-microns fraction. Homogenization of the greater than 7-microns fraction not only resulted in an increase in the number of less than 7-microns particles, but also increased the rate of inactivation to a rate similar to that of the less than 7-microns fraction. With 1 mg of monochloramine per liter at 5 degrees C and pH 7, particle size had no appreciable effect on the rate of inactivation. At pH 8, however, the less than 7-micron fraction was inactivated more rapidly than the greater than 7-micron fraction. The time required for 99% inactivation of the particle fractions with monochloramine at pH 7 or 8 was 20- to 50-fold greater than the time required for the same amount of inactivation with chlorine at pH 7. The results indicate that coliforms associated with sewage effluent particles are inactivated more rapidly with 0.5 mg of chlorine per liter than with 1.0 mg of monochloramine per liter. However, greater than 7-micron particles can have a protective effect against the disinfecting action of chlorine.

Chloramines↗
PubMed1986

Noninvasive quantification of the extent of jeopardized myocardium in patients with single-vessel coronary disease by stress thallium-201 single-photon emission computerized rotational tomography.

In 22 patients with single-vessel coronary artery disease and no history of infarction, stress Tl-201 rotational tomography was used to quantify the extent of jeopardized myocardium. The vertical long- and short-axis tomograms were quantified by means of maximum-count circumferential profile analysis. The scintigraphic extent of jeopardized myocardium was expressed as the percentage of profile points falling 2.5 standard deviations below a previously established mean normal profile and was correlated to a quantitatively expressed angiographic extent of jeopardized myocardium. The extent of jeopardized myocardium varied from 1% to 55% by tomography and 8% to 50% by angiography and correlated with an r = 0.79 and a 10% standard error of the estimate. Defect intensity, reflecting the mean depth by which the abnormal points fell below the normal value of greater than or equal to 10%, was 100% specific for a coronary stenosis of greater than or equal to 70%. In conclusion, this study demonstrates that: patients with single-vessel disease have highly variable extents of hypoperfused myocardium defined by Tl-201 tomography and coronary arteriography, there is a fair relationship between angiographic jeopardy score and perfusion defects by Tl-201 tomography during exercise, and Tl-201 tomography may be used to noninvasively determine the extent of hypoperfused myocardium in coronary artery disease.

Aged↗
PubMed1986

High-dose corticosteroids as adjunct therapy in severe Pneumocystis carinii pneumonia.

Three patients with severe Pneumocystis carinii pneumonia and acquired immunodeficiency syndrome, not responding to specific therapy with trimethoprim/sulfamethoxazole, were treated with a 24-hour course of high-dose methylprednisolone. Rapid improvements in the clinical status and the chest X-rays were detected. In two of the patients, in whom lung biopsy was performed before initiation of corticosteroids, an intense interstitial mononuclear cell infiltrate was seen. In the one patient who had lung biopsy after corticosteroid therapy, a scanty amount of mononuclear cells was demonstrated in the interstitium. Our experience suggests that corticosteroids may be useful as adjunctive agents in the treatment of severe P. carinii pneumonia not responding to specific anti-Pneumocystis therapy. This may be a result of inhibition of mononuclear cell accumulation within the lung by the steroid therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Quantitation of extent, depth, and severity of planar thallium defects in patients undergoing exercise thallium-201 scintigraphy.

Previous quantitation of exercise-redistribution planar 201TI scintigraphy has shown high sensitivity and specificity in the detection of coronary artery disease and improved detection of individual coronary stenoses over visual analysis. By using similar methodology based on the circumferential profile method, we studied 133 patients to quantitatively assess the extent, depth, and severity of thallium defects compared with consensus visual analysis. These quantitative measurements are objective, requiring only three operator interactions. In comparing quantitative and visual results, a close correlation was found for measurement of extent of thallium defect (r = 0.73) and severity of defect (r = 0.79). In detecting patients with the high-risk scintigraphic pattern of a severe stress thallium defect, a quantitative depth score of greater than or equal to 36 had an 81% sensitivity and an 82% specificity. Thus, this nearly automatic, computerized quantitative method allows objective determination of extent, severity, and depth of planar 201TI defects.

Aged↗
PubMed1985

A format for integrating the interpretation of exercise ejection fraction and wall motion and its application in identifying equivocal responses.

The conventional interpretation of ejection fraction change with exercise may be limited because it does not consider the rest value, define equivocal responses or integrate wall motion data reproducibly. Thus, a format was developed for combined interpretation of rest and exercise radionuclide ejection fraction and wall motion by reviewing the reported data for the exercise responses of patients without prior myocardial infarction. The ejection fraction data of 202 normal patients and of 259 patients with coronary artery disease were first fitted to beta distributions. The true positive and false positive rates for coronary disease for each combination of rest and exercise ejection fraction were then determined directly from these distributions. A given rest/exercise ejection fraction combination was "normal" if the false positive rate was greater than the true positive rate, or "abnormal" if the true positive rate was greater than the false positive rate, and "equivocal" when the rates were similar (within a 50% confidence interval). This analytic format, which predicted an inverse relation between rest ejection fraction and the change required with exercise, was then validated prospectively in 854 patients without myocardial infarction (557 with and 297 without angiographic coronary artery disease). Using the conventional criterion of an abnormal test result (less than 0.05 absolute rise in ejection fraction with exercise or a wall motion abnormality), sensitivity was 85 +/- 2% and specificity only 42 +/- 3%. The statistical format had a sensitivity of 70 +/- 2% and specificity of 70 +/- 3%, resulting in a twofold increase in information content. This format has at least two advantages over conventional interpretation: 1) it provides an explicit definition of equivocal responses; and 2) it reproducibly integrates discordant ejection fraction and wall motion responses and allows for the combined analysis of other nonscintigraphic observations, such as age and sex.

Adult↗
PubMed1985

Children's perception of death in humans and animals as a function of age, anxiety and cognitive ability.

This study investigated the impact of age, cognitive level and anxiety level on children's conception of death in humans and animals. Children from three age groups (6-7; 8-9; 10-11) were divided into high and low anxiety levels and high and low cognitive abilities. Then, the children were administered two questionnaires on human and animal death. The findings show that there was a main effect of age, anxiety and cognition on the conception of both animal and human death. Human death scores were higher than animal death scores. The interactions indicate that anxiety has a stronger impact on cognitively high subjects than on cognitively low subjects and that cognition affects the animal death concept more than the human death concept.

Anxiety↗
PubMed1984

Inactivation of simian rotavirus SA11 by chlorine, chlorine dioxide, and monochloramine.

The kinetics of inactivation of simian rotavirus SA11 by chlorine, chlorine dioxide, and monochloramine were studied at 5 degrees C with a purified preparation of single virions and a preparation of cell-associated virions. Inactivation of the virus preparations with chlorine and chlorine dioxide was studied at pH 6 and 10. The monochloramine studies were done at pH 8. With 0.5 mg of chlorine per liter at pH 6, more than 4 logs (99.99%) of the single virions were inactivated in less than 15 s. Both virus preparations were inactivated more rapidly at pH 6 than at pH 10. With chlorine dioxide, however, the opposite was true. Both virus preparations were inactivated more rapidly at pH 10 than at pH 6. With 0.5 mg of chlorine dioxide per liter at pH 10, more than 4 logs of the single-virus preparation were inactivated in less than 15 s. The cell-associated virus was more resistant to inactivation by the three disinfectants than was the preparation of single virions. Chlorine and chlorine dioxide, each at a concentration of 0.5 mg/liter and at pH 6 and 10, respectively, inactivated 99% of both virus preparations within 4 min. Monochloramine at a concentration of 10 mg/liter and at pH 8 required more than 6 h for the same amount of inactivation.

Animals↗
PubMed1984

Round robin investigation of methods for recovering human enteric viruses from sludge.

To select a tentative standard method for detection of viruses in sludge the American Society for Testing and Materials D19:24:04:04 Subcommittee Task Group initiated round robin comparative testing of two procedures that, after initial screening of several methodologies, were found to meet the basic criteria considered essential by the task group. Eight task group member laboratories agreed to perform round robin testing of the two candidate methods, namely, The Environmental Protection Agency or low pH-AlCl3 method and the Glass or sonication-extraction method. Five different types of sludge were tested. For each particular type of sludge, a single laboratory was designated to collect the sludge in a single sampling, make samples, and ship it to the participating laboratories. In most cases, participating laboratories completed all the tests within 48 h of sample arrival. To establish the reproducibility of the methods, each laboratory tested each sludge sample in triplicate for the two candidate virus methods. Each processed sludge sample was quantitatively assayed for viruses by the procedures of each individual round robin laboratory. To attain a more uniform standard of comparison, a sample of each processed sample from all laboratories was reassayed with one cell line and passage number by a single laboratory (Environmental Protection Agency Environmental Monitoring and Support Laboratory, Cincinnati, Ohio). When the data were statistically analyzed, the Environmental Protection Agency method was found to yield slightly higher virus recoveries for all sludge types, except the dewatered sludge. The precisions of both methods were not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum↗
PubMed1983

Acute hemodynamic effect of oral nifedipine in severe chronic congestive heart failure.

The temporal hemodynamic effects of oral nifedipine after a single dose of 20 to 40 mg were evaluated in 11 patients with severe chronic congestive heart failure (left ventricular ejection fraction 0.22 +/- 0.7 [mean +/- standard deviation]). Nifedipine significantly reduced systemic vascular resistance, from 1,850 +/- 493 to 1,315 +/- 398 dynes s cm-5 at 1 hour (29%), to 1,410 +/- 246 at 3 hours and to 1,523 +/- 286 at 6 hours (p less than 0.05). Cardiac index increased 21%, from 2.07 +/- 0.46 to 2.51 +/- 0.83 liters/min/m2 at 1 hour, to 2.38 +/- 0.53 liters/min/m2 at 3 hours (p less than 0.05) and to 2.24 +/- 0.41 liters/min/m2 at 6 hours. The group response of stroke volume to nifedipine was smaller. A peak increase of 17% was seen 3 hours after initiation of therapy (22.6 +/- 7.2 versus 25.5 +/- 6.1 ml/m2). This difference did not reach statistical significance. Mean blood pressure declined significantly, from 94 +/- 20 to 80 +/- 13 mm Hg at 1 hour, to 83 +/- 15 mm Hg at 3 hours and to 86 +/- 17 mm Hg at 6 hours (p less than 0.05) and was associated with no significant change in heart rate. The marked decrease in blood pressure resulted in a decrease in rate-pressure product from 12,272 +/- 4,230 to 10,500 +/- 2,074 mm Hg/min at 1 hour, to 10,374 +/- 2,735 mm Hg/min at 3 hours and to 11,047 +/- 3,813 mm Hg/min at 6 hours (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

The declining specificity of exercise radionuclide ventriculography.

Although exercise radionuclide ventriculography was initially reported to be a highly specific test for coronary-artery disease, later studies reported a high false-positive rate. To verify this turnabout, we analyzed the responses in 77 angiographically normal patients; 32 were studied from 1978 to 1979 (the early period), and 45 from 1980 to 1982 (the recent period). Most patients studied in the early period had normal responses (94 per cent for ejection fraction and 84 per cent for wall motion). In contrast, normal responses were less frequent in patients studied in the recent period (49 per cent for ejection fraction and 36 per cent for wall motion, P less than 0.001). The probability of coronary disease before testing was higher in these patients (38 vs. 7 per cent, P less than 0.001). More patients studied in the recent period underwent radionuclide ventriculography before angiography (78 vs. 22 per cent, P less than 0.001), and more of these prior studies had abnormal results than those performed after angiography (55 vs. 6 per cent, P less than 0.0001). Thus, two factors are responsible for the temporal decline in specificity: a change in the population being tested (pretest referral bias) and a preferential selection of patients with a positive test response for coronary angiography (post-test referral bias).

Adult↗