ICBM - a solution to the problem of informed consent.
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Comprehension↗
Biomedical subjects
D Cohen
Publications and source records attributed to D Cohen.
Significance of depression and cognitive impairment in patients undergoing programed stimulation of cardiac arrhythmias.
Although depression and cognitive impairment have been associated with excess mortality following heart surgery, the relationship of these factors to death following treatment for cardiac arrhythmias is unknown. We prospectively examined the associations between biobehavioral factors, mortality, and arrhythmia manageability in 88 patients undergoing programed electrical stimulation for the diagnosis and treatment of supraventricular and ventricular tachyarrhythmias or syncope of unknown origin. Statistically significant relationships were identified between depression and mortality, and between cognitive impairment and mortality. No relationships were observed between cognitive impairment or psychologic profile and arrhythmia severity or treatment efficacy. Our data suggest that arrhythmia morbidity and mortality may in part be a function of cognitive and emotional impairments that lessen the individual's capacity to comply with lifesaving therapy, maintain a stable physiologic milieu, and continue an adaptive emotional life. Failure to recognize the clinical significance of these impairments in patients at risk for sudden cardiac death will contribute to the current difficulty reducing the death and disability associated with cardiac arrhythmias.
Adaptation, Psychological↗
Congenital tracheal stenosis.
Twenty-one cases of congenital tracheal stenosis seen at the Royal Alexandra Hospital for Children 1971 through 1980 were reviewed with regard to the clinical features, associated anomalies, endoscopic findings and radiological evaluation. Congenital tracheal stenosis was usually a serious problem often associated with other major anomalies of the respiratory tract, esophagus, or skeleton. There was no set pattern of presentation. The presenting features included: persistent wheeze or stridor, atypical "respiratory distress," and atypical "croup" or "bronchiolitis." Documentation of the nature and extent of the stenosis by endoscopy and, if necessary, tracheobronchogram was important for prognosis and to direct treatment. Congenital tracheal stenosis must be considered in infants who present with atypical respiratory tract obstruction, especially where there is an H-type tracheoesophageal fistula, pulmonary hypoplasia or skeletal abnormalities such as hemivertebrae or a thumb abnormality.
Child↗
Urinary free cortisol (UFC) values in newborns under stress.
UNLABELLED: Children with adrenocortical insufficiency are commonly instructed to increase three to five times baseline glucocorticoid replacement dose during periods of stress such as surgery or febrile illness. The present study was undertaken to determine whether these recommendations reflect the actual change in urinary free cortisol (UFC) output during stress in neonates and to test the effect of stress on the diurnal variation of cortisol in this age group. DESIGN AND PATIENTS: Twenty-four hour urinary free cortisol (UFC) excretion was determined in 75 neonates during the first 2 days of life. Thirty were healthy and 45 were neonates with respiratory distress. In 60 babies the 24-h UFC was collected in 6-h fractions for the determination of diurnal variation of urinary cortisol. RESULTS: The mean change in UFC was 4.5 times higher in the sick babies than in the controls. A distinct diurnal variation of UFC was noted in both healthy and sick babies. CONCLUSIONS: In contrast with previous publications a distinct diurnal pattern was noted in the majority of neonates.
Birth Weight↗
Comparison of earlobe and promontorium recording sites in electrocochleography.
A compound cochlear action potential can be recorded in man from the promontorium, after perforation of the tympanic membrane. This same cochlear action potential (along with the responses of the brain stem auditory nuclei) can also be recorded by means of earlobe-vertex electrodes. Recordings were made in patients with chronic perforations of the tympanic membrane from the promontorium and simultaneously from the earlobe (-vertex) in order to see if there is a difference in response threshold. As click intensity was decreased, the responses disappeared in both recordings at about the same stimulus intensity (threshold). At near-threshold click intensities, the response seen in the promontorium recording was the compound cochlear action potential while in the earlobe vertex recording, the response often seen was seen was that from the inferior colliculus. Thus, in most cases, there is no real advantage to be gained by perforating the tympanic membrane in order to record from the promontorium since an identical response threshold can be obtained using surface electrodes.
Acoustic Stimulation↗
Interstitial thermoradiotherapy for recurrent or persistent tumours.
Between 1984 and 1986, 31 sites in 27 patients with biopsy proven tumours were treated with a combination of interstitial microwave hyperthermia (HT) and iridium 192 implants (RT). The 31 sites treated included fifteen (48 per cent) head and neck, six (20 per cent) breast, four (13 per cent) vagina and cervix, and six (20 per cent) others. All patients had prior surgery, RT, or chemotherapy. Of the 31 sites treated, 19 (61 per cent) had complete response (CR) with no recurrence in the volume treated. Additionally, eight patients remained free of tumour from 3 to 24 months. Partial response (PR) was seen in 11 (36 per cent) sites while one (3 per cent) had lesser degree tumour regression. Tumour control rate correlated well with the dose of radiation, p = 0.02, and tumour volume, p = 0.02, but not with thermal dose. Treatment complications of significance occurred in one (3 per cent) site, which developed soft tissue necrosis. This study again has demonstrated the effectiveness of RT-HT combination in treatment of recurrent tumours.
Adult↗
Microwave applicator for transurethral hyperthermia of benign prostatic hyperplasia.
An applicator for heating the prostate gland using a transurethral approach is described. This technique uses three microwave antennas and a thermometry sensor attached to the outer surface of a balloon (Foley) type urological catheter. Each microwave antenna also includes a built-in thermistor to control temperature and balance power. The balloon catheter assures rapid and reproducible localization of the antennas in the prostatic urethra. The two-dimensional SAR and steady-state temperature distributions surrounding the applicator in tissue equivalent phantom are reported. Longitudinal temperature distributions measured in situ at the applicator-urethral interface and the longitudinal and radial temperature distributions measured in normal canine prostate are presented and discussed. The technique appears to be capable of elevating temperature to greater than 42 degrees C in a cylindrically symmetrical volume up to 5 cm length and 0.5 cm radial penetration surrounding the applicator.
Hot Temperature↗
Aspirin enhances multidrug resistance gene 1 expression in human Molt-4 T lymphoma cells.
BACKGROUND: We recently found that aspirin induces the expression of P-glycoprotein (P-gp), a protein mediating drug resistance, in human prostate cancer cells. The purpose of this study was to evaluate the effect of aspirin on the expression of P-gp in a different human cancer type, i.e., T lymphoma. Furthermore, we analyzed this effect at the level of the gene encoding P-gp, MDR1, and of the transcription factor (NF-IL6), regulating this gene. MATERIALS AND METHODS: NF-IL6 was assayed by the electrophoretic mobility shift assay, MDR1 mRNA was assayed by the reverse transcriptase polymerase chain reaction (RT-PCR), and P-gp was assayed by Western blotting. RESULTS: aspirin, at plasma attainable levels, induced NF-IL6 DNA-binding activity, and increased MDR1 mRNA expression (by up to 140%), as well as the expression of P-gp, in Molt-4 cells. CONCLUSIONS: This study suggests that treatment with aspirin induces a cellular signal culminating in the enhancement of P-gp expression in T lymphoma Molt-4 cells.
ATP Binding Cassette Transporter, Subfamily B, Mem↗
[Microdeletion 22q11: apropos of case of schizophrenia in an adolescent].
Deletion of chromosome 22q11 concerns nearly 1/5.000 births, and is the most frequent interstitial microdeletion. The deletion generates various phenotypes which were initially regarded as distinct syndromes. 1) Di George syndrome was described in 1962 by immunologists, and associates thymic and parathyroid hypoplasia, cardiac malformation, and dysmorphic face; the prognosis is severe, as Di George syndrome is a life-threatening condition. 2) The velocardiofacial syndrome was described in 1978 by stomatologists, and associates palate abnormalities, cardiac malformations, dysmorphic faces, and learning disabilities. 3) The Takao syndrome was described in the late seventies by cardiologists as a clinical condition associating cardiac abnormalities and dysmorphic faces. During the nineties, a common molecular etiology was identified, and a new name proposed: CATCH 22, an acronyme for Cardiac abnormalities, Abnormal face, Thymic hypoplasia, Cleft palate, Hypocalcemia, deleted chromosome 22. Furthermore, new phenotypes have been recently recognized, most of them belonging to the psychiatric spectrum. Descriptive studies of large samples of children with 22q11 deletion, conducted, both in the United States and european countries, have shown the following pattern of associated symptoms:--abnormal face (100%), which expression varies with age, and can be discrete;--cardiac abnormalities (84%), including cardiac malformations of conotroncal types;--mouth abnormalities (49%), including cleft palate (14%), and velar dysfunction (20%);--urinary tract abnormalities (36%), including ureteric reflux, lung dysplasia;--transitory hypocalcemia (60%) mostly during infancy, and due to transitory hypoparathyroid dysfunction;--seizures (21%), which are usually a consequence of hypocalcemia;--immunodeficiency (1%), which worsens the prognosis. Deletion of chromosome 22q11 has been also associated with various psychiatric phenotypes, which can be classified into two groups, developmental abnormalities and psychiatric conditions. The great majority of patients with the deletion exhibit impairment of language and motor development, mild mental retardation, persistent coordination deficits, and poor academic performance. The deletion of chromosome 22q11 is also associated with high frequency of behavioral disorder with attention deficit during childhood, and with high frequency of psychotic disorder (bipolar disorder, and schizophrenia) during adolescence and young adulthood. The link between the 22q11 deletion and schizophrenia has been also supported by recent studies showing that the rate of 22q11 deletion in adults with schizophrenia (2%) is higher than it is in the general population. The rate may even be higher (6%) in subjects with childhood onset schizophrenia. The present work reviews the psychiatric literature associated with 22q11 deletion. We also report a case of 22q11 deletion in a 17-year-old girl that was initially diagnosed as paranoid schizophrenia. We will discuss the diagnostic, prognostic, and therapeutic consequences that such a genetic diagnosis implies. In the case reported here, transitory hypocalcemia induced: 1) dystonic symptoms that was believed to be catatonic symptoms or neuroleptic secondary effects, by clinicians; 2) a poor response to neuroleptic medication.
Adolescent↗
College quality. The same old way (not!).
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Curriculum↗
Rapid method for mapping morbidity and mortality during epidemics.
A rapid method for mapping health information during epidemics is described. We divided maps of cities into coded squares and assigned a code to each street which corresponded to its location on the map. Thus, health data information could be easily transferred from the field by indicating the number of cases in each square and readily transferring this information onto a map. By applying density data of the civilian population in each neighborhood it was possible to calculate incidence and prevalence rates at any given time.
Communicable Disease Control↗
An outbreak of enteritis associated with enteroinvasive E. coli in an Israeli military base.
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Disease Outbreaks↗
Developing epidemiological markers for Shigella sonnei: a proposed phage-typing scheme.
BACKGROUND: Shigella sonnei isolates are homogeneous when examined by serological methods. Since this micro-organism is one of the common isolates in outbreaks of shigellosis, a strong necessity was felt to find a sub-division of it, useful in epidemiological studies. METHODS: 103 phages previously found to be active on various groups of Enterobacteriaceae were tested on 129 strains of S. sonnei. Among 47 phages active on S. sonnei, eight were selected as giving the best differentiation between the isolates and clear-cut reactions. RESULTS: Twelve main phage-types were identified. Among the strains of phage-type 1, some showed full sensitivity to all the eight phages; others showed minor differences in the sensitivity to one or some of them. The significance of these minor phage-types has to be further analyzed. CONCLUSIONS: A tentative phage-typing scheme appropriate for S. sonnei has been proposed. This method provides a potentially useful tool for epidemiological study of this organism. Further validation of the scheme using local isolates is necessary.
Bacteriophage Typing↗
Pooled pasteurized breast milk and untreated own mother's milk in the feeding of very low birth weight babies: a randomized controlled trial.
It has been shown that milk derived from mothers with term infants is not optimal for premature babies. There is also concern about the effect of heat sterilizing breast milk. At Baragwanath Hospital, the majority of mothers remain with and care for their premature babies. Over many years, pooled pasteurized breast milk has been fed to these babies before direct breast feeding is instituted. A study was done to compare feeding pooled pasteurized breast milk and untreated own mother's milk to very low birth weight babies. There was a significantly more rapid weight gain both in terms of regaining birth weight and, from this point, to reaching a weight of 1,800 g when using untreated own mother's milk. This occurred in spite of the fact that there was little difference, especially in terms of energy content, between the two types of breast milk. This was due to the fact that the pooled pasteurized milk was also largely obtained from mothers of premature babies. It is suggested from our data that slower weight gain in the group receiving the pooled pasteurized milk could be due to the pasteurization, which probably destroys heat-labile milk lipase.
Body Weight↗
Hope for heroin addicts.
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Heroin Dependence↗
[Neurolinguistic remarks on a case of agrammatism].
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Aphasia↗
Psychotropic drug use in relation to psychiatric symptoms in community-living persons with Alzheimer's disease.
We attempted to determine the relationship between psychiatric symptoms and psychotropic drug use in persons with Alzheimer's disease based on a multicenter patient registry of 671 community-living persons diagnosed with the disease by published criteria. Logistic regression was performed to determine which symptoms were associated psychotropic use after controlling for age, sex, and Mini-Mental Status Examination (MMSE) score. At least one psychotropic drug was reported by 31% of patients, and 66% had at least one psychiatric symptom. Antipsychotics were associated with a lower MMSE score (odds ratio = 0.92, 95% confidence interval 0.88-0.97), emotional lability (OR = 4.52, 95% CI 1.69-11.94), and hallucinations (OR = 6.54, 95% CI 2.99-14.26). Antidepressants were associated with depressive symptoms (OR = 5.8, 95% CI 2.61-13.46), and benzodiazepines with a lower MMSE score (OR = 0.93, 95% CI 0.90-0.97). Community-living persons with Alzheimer's disease are frequently prescribed psychotropic drugs; however, more than 50% of patients with a psychiatric symptom did not report taking one of these agents. This suggests that alternative therapies and no treatment are also prevalent.
Aged↗
Influencing spermicide use among low-income minority women.
Spermicides reduce the risk of a variety of sexually transmitted diseases (STDs) and hold promise for reducing the risk of human immunodeficiency virus (HIV) transmission. Many high-risk women are unaware that they are at risk for STDs and are unfamiliar with spermicides, however. A program promoting spermicides for the prevention of STDs was tested in a controlled intervention among low-income minority women seeking services in a public health family planning clinic. Women exposed to the intervention had more positive attitudes toward spermicides and used spermicides more than three times as often, on average, as control subjects. The best predictor of spermicide/condom use was knowledge of how to use spermicides correctly (OR 3.2, 95% CI 2.0, 5.0). Fear of acquired immune deficiency syndrome (AIDS) or STDs did not predict spermicide use. This study demonstrates that brief interventions in waiting areas of public health clinics can have a significant impact in helping women protect themselves from HIV and STDs.
Female↗