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Biomedical subjects

D Cohen

Publications and source records attributed to D Cohen.

At least 181 records · Page 10Linked to original sources
PubMed1999

[Visual acuity and ocular diseases in aged residents of nursing homes: study of 219 persons in Orléans].

PURPOSE: To measure the visual acuity and to determine the etiological causes of visual impairment in the elderly residing in nursing homes. METHODS: 219 elderly persons residing in nursing homes were examined in the residence. The ophthalmological examination consisted in a visual acuity measurement, a slit-lamp examination and a fundus examination. RESULTS: This study included 145 women and 74 men. Mean age was 79.1 years (range 41-101 years). Visual acuity could be measured in 181 subjects (82.6%): it was 1/10 or worse in the better eye in 23 of them (13%) and 2/10 to 3/10 in 36 patients (20%). In 21 (17.6%) out of the 119 patients aged over 74 years, visual acuity was 1/10 or worse in the better eye. Visual impairment significantly increased with age (p < 0.05). There was no difference between men and women in the prevalence of visual impairment. Among the 55 subjects with visual impairment, the main causes of vision loss were: cataract in 36 patients (66%), age-related macular degeneration in 9 patients (16%) and optic neuropathies in 5 patients (9%). Only one (2.8%) out of the 36 patients with cataract could be operated. CONCLUSION: The rate of visual impairment of people in nursing homes was higher than in corresponding age groups in the general population. The main cause of vision loss was cataract; however, only a few patients could benefit from an operation. These results confirmed that a systematic ophthalmologic examination should be performed before general health problems prevent patients from being operated.

Adult↗
PubMed1999

[Vaginal hysterectomy for non-prolapse uterus].

Vaginal hysterectomy in the treatment of non prolapsed uterus without malignant disease is a well codified technique. Per operative complications, post operative morbidity are less frequent and less serious than by abdominal surgery and convalescent time is less extended. Financial cost is lower compared with laparoscopic hysterectomy. The successful result of the vaginal way is determined by anatomic factors: volume and mobility of the uterus, accessibility of the vagina, but above all by the training of the surgeons. A rate of seventy per cent of hysterectomies performed by the vaginal way in the case of this indication is a realistic aim in a hospital center.

Adult↗
PubMed1999

[Direct communication between the lower urinary tract and the hip joint complicating acetabular fracture. A case report].

INTRODUCTION: Urinary complications are rare in acetabular fractures (3.5 p. 100). They can lead to immediate, secondary or late complications. CASE REPORT: The authors report the case of an uretro-acetabular fistula in a complex acetabular fracture. Intravenous urography showed the fistula with opacification of the hip joint. Surgical treatment of the fracture was contra-indicated due to the septic risk. Post traumatic degenerative joint disease appeared in our patient and a total hip arthroplasty was performed at 18 months post injury. At 6 months follow-up, clinical biological and radiographical status was good. DISCUSSION AND CONCLUSION: Hip joint contamination with urines due to uretroacetabular fistula could be responsible for septic hip arthritis and late joint deterioration. Urine drainage using a cystocatheter as in our observation is recommended. Primary and secondary treatment of the acetabular fracture remains difficult.

Acetabulum↗
PubMed1999

Benchmarking cardiac catheterization laboratories: the impact of patient age, gender and risk factors on variable costs, device costs, total time and procedural time in 53 catheterization laboratories.

Coronary catheterization laboratories (CCLs) are the cornerstones of the delivery system for many cardiovascular procedures performed in the United States. However, few comprehensive data exist benchmarking physician activities in CCLs. This study benchmarks cost and time data on 82,548 consecutive patient encounters in 53 CCLs for the 18-month period of January 1997 through June 1998. The data are compiled from the OEP program, a relational database developed by Boston Scientific/Scimed (Maple Grove, Minnesota) for use in CCLs. CCL productivity (total time and procedure time) and cost (variable costs and device costs) benchmarks are created for: 1) left heart catheterization; 2) right and left heart catheterization; 3) percutaneous transluminal coronary balloon angioplasty (PTCA); 4) atherectomy; and 5) coronary stents. Results show the variable costs (those costs that vary in direct proportion to changes in CCL activities) for the five procedures are: $308, left heart catheterization; $395, right and left heart catheterization; $841, PTCA; $2,768, atherectomy; and $3,186, coronary stent. These variable costs are lower than the typical average costs reported for these procedures because they do not include hospital, laboratory, and physician costs, only the procedure-specific activity-related costs most directly controlled and/or influenced by CCL physicians or administrators. The total time for the left heart catheterization averaged 64 minutes and 84 minutes for the right and left heart catheterization, respectively, and procedural times averaged 25 and 32 minutes, respectively. For the major interventional procedures N PTCA, atherectomy, and coronary stents, total times averages were 102, 135, and 117 minutes, respectively. Procedural times for these procedures averaged between 60 and 65 percent of the total time. The major implications of these findings are discussed and limitations noted.

Age Factors↗
PubMed1999

Prevalence of antibodies to West Nile fever, sandfly fever Sicilian, and sandfly fever Naples viruses in healthy adults in Israel.

BACKGROUND: The arbovirus infections West Nile fever (WNF) and sandfly fever (SFF) are both endemic in the Middle East. Despite the fact that the mosquito and sandfly vectors of these viruses are still found in Israel, SFF has not been reported since 1948, whereas outbreaks of WNF occur periodically. It is suspected that some of the cases of nonspecific febrile illnesses in Israel may in fact be either WNF or SFF. AIM: To determine the extent of past arbovirus infections in subgroups of Israeli soldiers. METHODS: Sera from random samples of three groups of healthy soldiers aged 18-20 (n=273), 21-30 (n=497), and 40-55 years (n=285) were examined for IgG and IgM antibodies to West Nile virus (WNV), sandfly fever Sicilian virus (SFSV), and sandfly fever Naples virus (SFNV), using an ELISA method. RESULTS: The prevalence of antibodies increased with age for all three viruses examined, and ranged from 7.0%, 0, and 2.8%, for WNV, SFSV, AND SFNV, respectively, in soldiers aged 18-20 years, to 41.9%, 23.7%, and 30.8%, in those aged 40-55 years. The percentage of seropositives for IgG who were also IgM positive were 1.0%, 5.9%, and 3.4%, for WNV, SFSV, AND SFNV, respectively. 17.5% of the seropositives for WNV were also positive for SFSV, as compared with 5.7% among the WNV-seronegatives. Among the seropositives for WNV, 23.99% were positive for SFNV, compared with 9.1% of WNV seronegatives. 48.2% of seropositives for SFSV were positive for SFNV, as compared with 8.4% for SFSV-seronegatives. In the age agroup 40-55 years, there were significantly higher prevalence rates in those born in Israel compared with those born abroad. CONCLUSIONS: There is still significant exposure to WNV, SFSV, and SFNV in Israel. Arborviruses are probably responsible for many cases of non-specific febrile illness in this region.

Adolescent↗
PubMed1999

[Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases].

INTRODUCTION: Pure posterior dislocation of the elbow is frequent in young subjects. The objective of treatment must be to reduce the dislocation and avoid complications, the most frequent being stiffness, but also elbow instability. The objective of this prospective study was to evaluate the functional and anatomical characteristics of two treatment modalities: plaster immobilization and early mobilization. MATERIAL AND METHODS: 50 cases of pure posterior dislocation of the elbow were included in a prospective study and randomized to two groups: Group I: twenty six cases were treated by reduction under general anaesthesia and plaster immobilization for three weeks, followed by rehabilitation. Group II: twenty four cases were treated by reduction under general anaesthesia, followed by early mobilization. RESULTS: We evaluated our results in terms of loss of amplitude of elbow movement (particularly extension), stiffness, instability, relapses, pain and ossification. This study demonstrated better recovery of elbow function in patients treated by early mobilization: 96% of good results with recovery of normal extension in group II versus 81% of cases in group I. Stiffness was observed in 19% of patients in group I versus 4% in group II; this difference was very significant. Comparison of pain revealed no significant difference and no relapses, instability or ossifications were observed in either of the two groups. DISCUSSION AND CONCLUSION: Early mobilization is superior to plaster immobilization, as it allows recovery of better quality elbow function without inducing instability or recurrence.

Adolescent↗
PubMed1999

[An uncommon occupational accident: tuberculous tenosynovitis of the extensor tendons of the hand].

We present a case of tuberculous tenosynovitis of the extensor tendons of the hand. Our patient was a young doctor working in the respiratory medicine department. He was injured on the dorsal aspect of the hand with a needle used for pleural aspiration. The clinical features consisted of gradually swelling, mild pain and stiffness of the metacarpophalangeal joint. The diagnosis was made after synovectomy. Histological and bacteriological examinations revealed tuberculosis. Treatment consisted of synovectomy and appropriate antibiotics. The clinical course was excellent after one year follow-up. Tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis occurring in fewer than 5% of all cases of skeletal tuberculosis. Thickening of the tendon or synovial sheath and local accumulation of fluid are the characteristic manifestations. The diagnosis must be confirmed by surgical biopsy. Antibiotics and synovectomy achieve a good functional result.

Antibiotics, Antitubercular↗
PubMed1999

Empirical, ethical, and political perspectives on the use of methylphenidate.

The case for methylphenidate (MPH) (Ritalin) rests on claims that Attention Deficit Hyperactivity Disorder (ADHD) is a disorder, that ADHD is biologically rooted, that MPH is effective against ADHD, that nontreatment is developmentally hazardous, and that MPH is a relatively innocuous rather than dangerous treatment. It will be found that the case for MPH rests on the hope that ADHD is a biological disorder and on MPH's short-term suppression of disruptive behavior. The explosion of MPH use on this flimsy evidential base can be explained within a political economy analysis but is difficult to justify ethically. It suggests a disturbing reliance upon drugs to solve problems stemming from a combination of inadequate support for families in modern societies and educational systems pushed to do more with less. Reliance upon a psychoactive medication to make children "ready to learn" is not only unsupported by the evidence, it teaches children incorrect lessons about how to meet the stresses and challenges of life.

Attention Deficit Disorder with Hyperactivity↗
PubMed1999

Multiplex developmental disorders. The role of communication in the construction of a self.

This article discusses the integration of various aspects of the child's development, particularly the development of language and communication and the way in which these developments interact to enable the child to construct a coherent sense of self. Multiplex developmental disorder is presented as an example of a disorder that affects several of these crucial strands of development. Recent research and controversies regarding the diagnostic descriptions of multiplex and other pervasive developmental disorders are presented. This discussion is used to illustrate the ways in which such disorders affect not only the individual aspects of development, but the child's ability to form a cohesive sense of self. The implications of these difficulties in self-definition for treating children with disorders that affect a variety of aspects of development are also discussed.

Child↗
PubMed1998

Patches of synchronized activity in the cerebellar cortex evoked by mossy-fiber stimulation: questioning the role of parallel fibers.

The discrepancy between the structural longitudinal organization of the parallel-fiber system in the cerebellar cortex and the functional mosaic-like organization of the cortex has provoked controversial theories about the flow of information in the cerebellum. We address this issue by characterizing the spatiotemporal organization of neuronal activity in the cerebellar cortex by using optical imaging of voltage-sensitive dyes in isolated guinea-pig cerebellum. Parallel-fiber stimulation evoked a narrow beam of activity, which propagated along the parallel fibers. Stimulation of the mossy fibers elicited a circular, nonpropagating patch of synchronized activity. These results strongly support the hypothesis that a beam of parallel fibers, activated by a focal group of granule cells, fails to activate the Purkinje cells along most of its length. It is thus the ascending axon of the granule cell, and not its parallel branches, that activates and defines the basic functional modules of the cerebellar cortex.

Animals↗
PubMed1998

CAG/CTG and CGG/GCC repeats in human brain reference cDNAs: outcome in searching for new dynamic mutations.

CAG and CGG expansion is associated with 10 inherited neurological diseases and is thought to be involved in other human genetic diseases. To identify new candidate genes, we have undertaken a large-scale screening project for CAG/CTG ([CAG]n) and CGG/GCC ([CGG]n) repeats in human brain reference cDNAs. Here, we present the final classification for 597 cDNAs selected by CAG and CGG hybridization from two libraries (100,128 clones) and the updated characterization of [CAG]n- and [CGG]n-positive cDNAs (repeat polymorphism and cDNA localization). We have selected 124 CAG and 83 CGG hybridization-positive clones representing new genes, from which 49 CAG and 7 CGG repeats could be identified. New [CAG]n and [CGG]n with more than seven to nine units were rare (1/2000), and perfect [CAG]n 9 were more likely polymorphic. Overall, highly polymorphic to monomorphic new [CAG]n > 9 and [CGG]n > 7 were characterized. The comparison of our data with other [CAG]n and [CGG]n resources suggests that the screening of reference cDNAs leads to unique sources of new [CAG]n and [CGG]n and will enhance the study of enlarged triplet repeats in human genetic diseases.

Brain↗
PubMed1998

Characterization of P-glycoprotein transport and inhibition in vivo.

The P-glycoprotein is an energy-dependent efflux pump capable of decreasing the intracellular concentration of a broad range of chemotherapeutic agents. [99mTc]Sestamibi, a P-glycoprotein transport substrate, is a sensitive probe of P-glycoprotein function both in vitro and in vivo. A human tumor model in nude mice was evaluated to determine whether [99mTc]Sestamibi could detect in vivo differences in P-glycoprotein expression and P-glycoprotein modulation by the reversal agent SDZ PSC 833. Differential [99mTc]Sestamibi accumulation based upon P-glycoprotein expression was demonstrated in xenografts in vivo. Dose-dependent inhibition of P-glycoprotein function was achieved with SDZ PSC 833. Administration of the reversal agent increased [99mTc]Sestamibi accumulation in the xenografts expressing P-glycoprotein. These observations show that [99mTc]Sestamibi as capable of detecting the modulation of P-glycoprotein in a solid tumor model by the reversal agent SDZ PSC 833.

ATP Binding Cassette Transporter, Subfamily B, Mem↗