Biomedical subjects
Publications and source records attributed to D Bernstein.
Schizotypal patients were found to have a significantly higher mean plasma HVA concentration than normal comparison subjects. Furthermore, plasma HVA concentration positively correlated with "psychotic-like" schizotypal symptoms. These results implicate dopaminergic mechanisms modulating the psychotic-like symptoms of schizotypal personality disorder.
To determine whether the hemodynamic responses to adrenergic agonists are altered during chronic hypoxemia secondary to an intracardiac right to left shunt, we studied seven lambs with surgically created pulmonic stenosis and atrial septal defect and nine controls during infusions of isoproterenol at 0.1 and 0.5 micrograms/kg/min and dopamine at 5 and 20 micrograms/kg/min. Isoproterenol increased heart rate by 89 +/- 17% in control but only 46 +/- 6% in experimental lambs (p less than 0.05). However, because resting heart rate was higher in experimental lambs (213 +/- 7 versus 177 +/- 12 beats/min, p less than 0.05), maximal heart rates were similar (310 +/- 7 versus 326 +/- 6 beats/min; NS). Cardiac output increased during isoproterenol from 219 +/- 20 to 425 +/- 54 mL/min/kg in experimental lambs (p less than 0.05) and, similarly, from 180 +/- 20 to 425 +/- 71 in controls (p less than 0.05) (experimental versus control; NS). Dopamine also increased cardiac output similarly in both groups, at both doses, but without changing heart rate. Isoproterenol did not alter aortic oxygen saturation and increased systemic oxygen transport more than oxygen consumption. In contrast, dopamine at both doses decreased aortic oxygen saturation in experimental lambs (rest, 71 +/- 2% versus dopamine, 59 +/- 2%; p less than 0.05). With dopamine, the increase in systemic oxygen transport was equalled by an increase in oxygen consumption. Thus, circulatory responses to isoproterenol are similar in lambs with experimental cyanotic heart disease and controls, although higher resting heart rate in the experimental lambs reduces chronotropic reserve.(ABSTRACT TRUNCATED AT 250 WORDS)
Narcotics are used in neuro-anesthesiology according to their pharmacology and their effects on cerebral physiology. New narcotics (fentanyl, sufentanil, alfentanil) fulfill the requirements of modern neurosurgical anesthesiology looking for quick awakening.
Propofol combined with Alfentanil was used for intracranial aneurysm surgery in 145 patients. These anaesthetic agents prevent blood pressure increase. They facilitate induced hypotension. The effect upon intracranial pressure is moderate. This technique is versatile. The speedy awakening make the postoperative neurological supervision easier.
The long-term results of pediatric heart transplantation were evaluated in 53 patients, aged 0.25 to 18.94 years, who received transplants at Stanford University Medical Center between 1974 and 1989. Indications for transplantation were idiopathic cardiomyopathy (68%), congenital heart disease (21%), endocardial fibroelastosis (8%), and doxorubicin cardiomyopathy (3%). Immunosuppression was achieved with combinations of cyclosporine, prednisone, and azathioprine. Thirty-seven of 42 recipients leaving the hospital after transplantation were alive and in New York Heart Association class I at study's end. Cumulative survival was 79% at 1 year, 76% at 3 years, and 69% at 5 years. Fourteen recipients have survived more than 5 years (5.1 to 12.4 years). Hospital readmission for illness has been infrequent, decreasing from 6.8 days to 0.9 days per year over 5 years. Eleven patients have required no rehospitalization. Posttransplant deaths were due to infection (19%), rejection (4%), pulmonary hypertension (4%), coronary artery disease (2%), and lymphoproliferative disease (2%). Retransplantation was required for intractable rejection in 4 patients and advanced coronary artery disease in 2. Hypertension and elevated blood urea nitrogen and creatinine levels were common in individuals receiving cyclosporine. Growth was often impaired in prepubertal children receiving daily prednisone. Based on this 15-year experience, it is concluded that heart transplantation represents a reasonable alternative for selected young patients with end-stage cardiac disease.
Ebstein's anomaly appearing during the neonatal period carries a high mortality rate. These infants exhibit cyanosis, acidosis, and congestive heart failure. The pathophysiologic characteristics consist of severe tricuspid regurgitation and functional pulmonary atresia. As a result of the inability of the right ventricle to generate forward flow through the pulmonary arteries, these infants remain dependent on ductal patency. Since May 1988, five newborn infants with severe Ebstein's anomaly have been admitted for treatment at our institution. At initial examination, they weighed 3.6 +/- 1.8 kg and had a mean oxygen tension of 29.6 +/- 2.3 mm Hg and a mean pH of 7.20 +/- 0.05. Chest roentgenography demonstrated a mean cardiothoracic ratio of 0.81 +/- 0.02. As determined by echocardiography, the right atria were massively enlarged, severe tricuspid regurgitation was present in all patients, and the pulmonary valves were not opening. All infants were dependent on prostaglandin E1 and attempts to wean them from this drug were unsuccessful. Palliative treatment consisted of tricuspid closure with autologous pericardium and an aortopulmonary shunt of 4 mm polytetrafluoroethylene tubing. There were no operative or late deaths. At discharge, mean oxygen tension was 42.2 +/- 0.85 mm Hg and mean systemic oxygen saturation was 83.2% +/- 1.94%. Infants have grown satisfactorily during the follow-up period. Three infants have since returned for further surgical intervention. One infant, at 11 months of age, underwent a Glenn anastomosis for progressive oxygen desaturation. Two infants have returned, at ages 23 and 22 months, for Fontan procedures, which represent their definitive operative management. We believe this new procedure offers excellent palliative treatment for Ebstein's anomaly in critically ill neonates. Feasibility of later definitive correction is demonstrated by the good results obtained with the Fontan procedure in two infants.
We studied the interrelationships among myocardial oxygenation, cardiac output, and systemic oxygenation during acute progressive hypoxemia in the paralyzed and mechanically ventilated lamb. Fractional inspired concentration of oxygen was reduced in five steps to a minimum of 0.05, decreasing arterial oxygen content (CaO2) from 10.9 +/- 2.4 to 2.8 +/- 0.5 ml/dl. Heart rate and stroke volume did not change at any step so that systemic oxygen transport decreased with CaO2. Systemic oxygen consumption fell at CaO2 less than 6 ml/dl. Left ventricular blood flow at maximal hypoxemia increased 277% (249 +/- 27 to 938 +/- 118 ml.min-1.100 g-1) so that left ventricular oxygen delivery and oxygen consumption were maintained. Evidence of anaerobic metabolism occurred when CaO2 was less than four (increase in arterial lactate and hypoxanthine), whereas at this level there was no evidence of inadequate myocardial oxygenation as determined by normal subepicardial: subendocardial blood flow and absence of net lactate production, although coronary sinus PO2 decreased. Although myocardial, cerebral, and adrenal blood flows increased, there was no redistribution of blood flow away from the viscera and skin.
To determine whether chronic hypoxemia secondary to an intracardiac right-to-left shunt alters regulation of the myocardial beta-adrenergic receptor/adenylate cyclase system, we produced chronic hypoxemia in nine newborn lambs by creating right ventricular outflow obstruction and an atrial septal defect. Oxygen saturation was reduced to 65-74% for 2 wk. Eight lambs served as normoxemic controls. beta-receptor density (Bmax) and ligand affinity (KD) were determined with the radio-ligand [125I]iodocyanopindolol and adenylate cyclase activity determined during stimulation with isoproterenol, sodium fluoride (NaF), and forskolin. During chronic hypoxemia, Bmax decreased 45% (hypoxemic, 180.6 +/- 31.5 vs. control, 330.5 +/- 60.1 fmol/mg) in the left ventricle (exposed to hypoxemia alone) but was unchanged in the right ventricle (exposed to hypoxemia and pressure overload). KD was not different from control in either ventricle. Left ventricular isoproterenol-stimulated adenylate cyclase activity was decreased by 39% (30.0 +/- 4.3% increase vs. 44.1 +/- 9.5% increase) whereas right ventricular adenylate cyclase activity was unchanged. Stimulation of adenylate cyclase with NaF or forskolin was not different from control in either ventricle. Circulating epinephrine was increased fourfold whereas circulating and myocardial norepinephrine were unchanged. These data demonstrate a down-regulation of the left ventricular beta-adrenergic receptor/adenylate cyclase system during chronic hypoxemia secondary to an intracardiac right-to-left shunt.
The authors compared three instruments used to diagnose borderline personality disorder--the Diagnostic Interview for Borderline Patients (DIB), the Schedule for Interviewing Borderlines, and the Structured Interview for DSM-III Personality Disorders--in 56 patients with personality disorders. A borderline diagnosis was made according to the DIB in 30%, the Structured Interview for DSM-III Personality Disorders in 48%, and the Schedule for Interviewing Borderlines in 55% of the patients. Diagnostic agreement was only 52%, which has implications for the generalizability of results of validation studies of the borderline diagnosis. Improvement in diagnostic agreement requires modification of current criteria sets and/or the use of dimensional models.
The purpose of this work was to assess the in vitro antiviral effectiveness of a mouthrinse (Peridex) containing 0.12% chlorhexidine gluconate (CH) on several viruses that are associated with the oral cavity. These included herpes simplex virus (HSV), cytomegalovirus (CMV), influenza A, parainfluenza, polio, and hepatitis B (HBV). Virucidal assays in tissue cultures were performed on all viruses except HBV. The virucidal effect on HBV was assessed by inactivation of the DNA polymerase contained within the Dane particle of HBV. The CH mouthrinse had virucidal activity against all of the viruses, except polio, in as little as 30 s. The virucidal activity increased with time. However, there were differences in the responses of these viruses to the challenge of the CH mouthrinse, probably due to subtle differences in the physical/chemical structures of the virus envelopes. Results on DNA polymerase of the HBV virus were similar to those on the other viruses, except polio, suggesting a common mechanism. With respect to this mechanism, it was proposed that CH exerted its antiviral effect on the envelopes of these viruses, and that the absence of an envelope on polio precluded effectiveness against this virus.
Heart transplantation has been performed successfully in the pediatric age group for just over 10 years, yet early results are encouraging, and this procedure has moved from the realm of experimental therapy to that of accepted medical practice for certain specific conditions. In infants and children with cardiomyopathies or with congenital heart disease for which no reasonable standard surgical alternative exists, heart transplantation offers the best hope for long-term survival. Most important, in those patients surviving heart transplantation, rehabilitation has been almost universally complete. Although the long-term prospects for pediatric heart transplant patients are still unknown, we have now accumulated sufficient experience in adults suggesting the potential for decades-long survival. Future improvements in diagnosis and treatment of rejection and prevention of the complications of immunosuppressive therapy will continue to improve the prospects for lifelong survival in these patients.
This paper focuses on the female experience of her own body, the unique anxieties that arise from the nature of the female genitals and the role of the female body in female development. Following Freud's theories of the importance of integrating body experiences in the development of psychic structures, the girl's body and her efforts to integrate it are seen as uniquely feminine. Three anxieties are described--access, penetration and diffusivity. These represent dangers to body integrity comparable to, but different from, boys' experience of castration anxiety. Not only do different genitals give rise to different anxieties, the different body experiences give rise to different modes of mastery (defence) shaping different character structures. While males can readily form discrete, concrete mental representations of their genitals, females cannot. While the boy can rely on direct sensory experience, the developing girl must rely on proprioceptive experiences, symbolization, and on other people to aid her in defining her elusive genital experience. This interpretation of the female genital experience provides a psychoanalytic framework for the object embeddedness long observed as part of the feminine character.
The oral glucose tolerance test (OGTT) has been the recommended method of screening for the diagnosis of gestational diabetes. Based on the glycemic index of common foods, a standard meal was designed as a substitute meal test (SMT). It consisted of 3 slices of toast (75 g) with 60 g of jam, 11 g of sugar in a cup of tea, and 150 g of canned puree sweetened with sugar (8%), for a total of 118 g of available carbohydrate and a total of 518 cal. Plasma glucose concentrations of 46 pregnant women in the 2nd and 3rd trimesters were determined at 20 minute intervals for 3 hours after ingestion of this SMT, and were compared with those after a 100 g OGTT meal. There was a high correlation (r = 0.96, p less than 0.001) between comparable glucose concentrations after the 2 tests. With the SMT there were significantly fewer side-effects (nausea and vomiting), a higher level on preference scoring and reduced interassay variability of glucose levels after 2 hours. 6 gestational diabetics were diagnosed by the OGTT. In these patients glucose concentrations were higher than 3 standard deviations above the mean 2 hours after ingestion of the SMT. We propose the SMT as a side-effect-free, reliable and convenient alternative to the OGTT in pregnancy.
The potential carcinogenic effect of inhaled automobile exhaust emissions was examined in rodents. Both rats and hamsters were exposed to the emissions from (1) a gasoline engine, (2) a gasoline engine fitted with a three-way catalytic converter, (3) a diesel engine and (4) a diesel engine with particle filtration. Exposures were for 16 hours per day, 5 days per week, for 2 years. All hamsters were sacrificed at the end of the 2-year exposure period, whereas the rats surviving after 2 years of exposure were maintained for a further 6-month observation period without additional exposure to emissions. Some of the hamsters in each treatment group were pretreated with diethylnitrosamine to induce respiratory tract tumours. No statistically significant changes were seen in the incidence of respiratory tract tumours in emission-exposed hamsters compared to controls. This lack of a treatment-related effect was seen in both the nitrosamine pretreated and the non-pretreated hamsters. There was no increase in the incidence of lung tumours in rats exposed to filtered diesel exhaust or to the exhaust from the gasoline or gasoline-catalyst engines. There was a statistically significant increase in the incidence of lung tumours in rats exposed to diesel engine emissions compared to controls. A clear dose response was evident in both males and females, although the incidence of lung tumours was markedly higher in females (96% in rats surviving beyond 2 years) than in males (44% in rats surviving beyond 2 years). An increased incidence of lung tumours was observed only in rats exposed to mean concentrations of diesel soot particles of either 2200 or 6600 micrograms/m3.(ABSTRACT TRUNCATED AT 250 WORDS)
Ten women with tubal ectopic pregnancy were treated by the injection of methotrexate into the gestational sac under direct laparoscopic vision followed by a course of intramuscular therapy including folinic acid rescue. One course of treatment induced resolution of the extrauterine pregnancy in eight women. Complete resolution (beta-hCG less than 10 miu/ml) was achieved within 6-47 days (mean 14.5 days). Serum beta-hCG levels started to decline 3.4 days from the beginning of therapy. Length of hospital stay was 5-11 days (mean 6.4 days). Treatment failed in two patients. One woman had a laparoscopic tubal clip sterilization concomitantly with methotrexate treatment. Tubal patency was demonstrated in all the other seven women (100%) tested subsequently. There is a need to establish criteria for patient selection before methotrexate becomes a routine treatment for tubal pregnancy.
Diurnal variations in plasma unconjugated estriol and urinary estriol were assessed in 12 pregnant women during the 3rd trimester of uncomplicated pregnancies. Commercially available 125I-labelled radioimmunoassay kits were used. The preliminary data presented here support the hypothesis that there is no circadian rhythm of unconjugated plasma estriol in normal late pregnancy. Total urinary estriol reaches a nadir during the sleep hours (24.00-6.00). A biological carrier 'stick' for estriol measurements might serve as test of choice in the monitoring of high-risk pregnancy as well as for identifying pregnancies complicated by chromosomal abnormalities (e.g., Down's syndrome).
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The cardiovascular adaptations to chronic anemia were studied in the newborn lamb and then compared with the adaptations to chronic hypoxemia. Eight chronically instrumented newborn lambs underwent repeat isovolemic exchange transfusions to maintain their Hb concentrations at 60% of normal for age. Hemodynamic studies were performed twice weekly for 2 wk after which time regional blood flows were measured using radionuclide-labeled microspheres. The major compensatory responses after 2 wk of anemia were moderate increases in heart rate (229 +/- 20 versus 187 +/- 15 beats/min) and cardiac output (226 +/- 36 versus 165 +/- 38 ml/kg/min), an increase in fractional extraction of oxygen (65 versus 40%), and a redistribution of regional blood flow. Blood flows to the heart and brain increased whereas blood flows to the viscera and carcass did not change. These compensatory responses were different from those that occur during chronic hypoxemia: specifically, cardiac output did increase, growth was not suppressed, and the pattern of redistribution of regional blood flows was different. The dissimilar effects of anemia (decreasing systemic oxygen content) versus hypoxemia (decreasing systemic oxygen tension) on local tissue receptors and peripheral chemoreceptors may account for these differences.