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Biomedical subjects

D Harari

Publications and source records attributed to D Harari.

17 recordsLinked to original sources
PubMed1996

Bowel habit in relation to age and gender. Findings from the National Health Interview Survey and clinical implications.

BACKGROUND: Constipation is widely considered to be a common problem among the elderly, as evidenced by the high rate of laxative use in this population. Yet, age-related prevalence studies of constipation generally do not distinguish between actual alteration in bowel movement frequency and subjective self-report of constipation. OBJECTIVE: To determine the relationship between advancing age and bowel habit. METHODS: We employed data collected on 42,375 subjects who participated in the National Health Interview Survey on Digestive Disorders based on interviews with a random nationwide sample of US households. We examined the following characteristics reported by this population according to selected age groupings by decade: constipation, levels of laxative use, and two bowel movements per week or less. RESULTS: Contrary to conventional wisdom, there was no age-related increase in the proportion of subjects reporting infrequent bowel movements. Nonetheless, the prevalence of self-report of constipation increased with advancing age, with a greater proportion of women reporting this symptom than men across all age groups. Laxative use also increased substantially with aging; while women were more likely to use laxatives than men, this effect attenuated with advancing age. A U-shaped relationship was observed between advancing age and bowel habit in men and women; 5.9% of individuals younger than 40 years reported two bowel movements per week or less compared with 3.8% of those aged 60 to 69 years and 6.3% of those aged 80 years or older. This relationship persisted after adjusting for laxative use. CONCLUSION: These findings suggest that a decline in bowel movement frequency is not an invariable concomitant of aging. In elderly patients who report being constipated, it is essential to take a careful physical, psychological, and bowel history rather than to automatically assume the need for laxative use.

Adult↗
PubMed1996

The resolution of palatally impacted canines using palatal-occlusal force from a buccal auxiliary.

Palatally impacted canines can usually be mechanically drawn directly to the labial arch wire after they have been surgically exposed. Occasionally, the direct line between the impacted tooth and the arch wire is obstructed by the presence of the root of the lateral incisor, or the tooth is very superiorly displaced, which makes direct traction ill-advised and impractical. In this situation, it is recommended that the tooth be erupted vertically downward, through the palatal tissue on the palatal side of the dental arch, as a first stage and, only then moved buccally into its place in the arch. This article describes a method whereby an auxiliary spring is placed on the buccal side of the arch to produce the vertical and palatal traction needed. There are no palatal accessories, and the auxiliary is tied in, "piggy-back" fashion, over the main base arch, by using the multibracketed appliance already present.

Cuspid↗
PubMed1996

Dens evaginatus of anterior teeth. Literature review and radiographic survey of 15,000 teeth.

Case reports published between 1970 and 1995 that describe the characteristics of dens evaginatus of anterior teeth were reviewed. In addition, a radiographic survey of 15,000 anterior teeth was conducted to determine the occurrence of this developmental malformation. In this survey, dens evaginatus was found in about 1% of the anterior dentition and was more frequent in the maxilla, particularly in the lateral incisor. This anomaly was less frequent in the mandible.

Adult↗
PubMed1995

Constipation in the elderly.

Management is not as straightforward as it appears. Patients often have associated conditions that predispose to or result from constipation. An OTC laxative habit may confound the workup and frustrate treatment. Overall evaluation is required, lest constipation progress to a medical crisis that requires hospital admission.

Aged↗
PubMed1995

Correlates of regular laxative use by frail elderly persons.

PURPOSE: To examine the demographic, clinical, and pharmacological correlates of regular laxative use in elderly persons residing in a long-term care setting. METHODS: This was a cross-sectional study using retrospective record review undertaken in an academically affiliated long-term care facility in the United States. All individuals residing in the institution for at least 1 month (n = 694) were characterized regarding use of laxatives. Regular laxative use was defined as more than 30 doses of laxatives, stool softeners, or enemas taken over the most recent 1-month period. RESULTS: Residents with regular laxative use (n = 349) were compared with those who received no laxatives (n = 227). Factors significantly associated with regular laxative use at the P < 0.05 significance level were simultaneously included in a multiple logistic regression model. Factors associated with regular laxative use were immobility, Parkinson's disease, diabetes mellitus, and use of iron supplements, calcium channel blockers, and antidepressants with moderate to strong anticholinergic properties. CONCLUSION: Regular laxative use is often associated with neurologic dysfunction that directly or indirectly affects the gut, or medications known to depress colonic motility. Identification of potentially modifiable correlates of regular laxative use in older individuals may suggest management strategies to avoid or reduce laxative, stool softener, and enema requirements, improve constipation symptoms, and enhance quality of life for the frail elderly population.

Aged↗
PubMed1994

An age-related investigation of urinary tract symptoms and infection following urodynamic studies.

One hundred and thirty-nine patients undergoing urodynamic investigation were studied. Urine samples taken at the time of the test and at 72 hours afterwards were cultured and data on symptoms following the test were collected. The overall infection rate was 15.8%. Men and women aged over 70 years were no more likely than younger subjects to become infected. A high residual urine volume was not associated with an increased risk of infection. The only clinical feature associated with infection following the test was an increase in incontinence. These findings were all in contradiction to previous studies on smaller numbers of patients.

Adult↗
PubMed1994

Constipation: assessment and management in an institutionalized elderly population.

OBJECTIVES: To examine prescribing and utilization patterns of laxatives, stool softeners, and enemas in a large, long-term care facility, to compare self-reports of constipation with specific, bowel-related symptoms in residents of this facility, and to examine concordance between bowel symptoms reported by residents and the assessments of the nursing staff. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: All individuals residing in an academically oriented long-term care facility in the United States for at least 1 month (n = 694). MEASUREMENTS: Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews regarding bowel-related symptoms were conducted with all able participants (n = 456 (66%)) and their respective primary nurses, and concordance was determined. The study definition of symptom-specific constipation was no more than 2 bowel movements per week and/or straining on more than 1 in 4 bowel movements. RESULTS: Fifty percent (n = 367) of all residents used at least 1 daily laxative, stool softener or enema during a 1-month study period. Over half of all laxative users (n = 200) took more than 60 doses per month. Stool softeners were most commonly prescribed, followed by saline laxatives, stimulant laxatives, hyperosmolar laxatives, and bulk laxatives. Forty-seven percent (n = 213) of the 456 interview responders reported constipation ("self-reporters"), but only 62% of self-reporters met the study criteria for symptom-specific constipation. Concordance between resident's and nurse's report regarding specific bowel symptoms was only fair to slight (kappa 0.12-0.38). Self-reporters of constipation took almost twice as many laxatives, stool softeners, and enemas as residents who did not report constipation.

Aged↗
PubMed1993

Constipation in the elderly.

OBJECTIVE: To explore the distinction between true clinical constipation and the subjective complaint of constipation in elderly people and to review the pathophysiology, symptoms, diagnosis, causes, and treatment. DATA SOURCES: A computer-assisted and manual search of the English language literature using MEDLINE 1966-1991, Index Medicus 1988-1992, reference lists of selected articles, and relevant textbooks. STUDY SELECTION: Studies that provide information on lower bowel function and laxative and enema use in the elderly subjects were reviewed. Article selection was not limited by study design. DATA EXTRACTION: Relevant data were abstracted from the results of physiological, cohort and case-control studies, and clinical trials. The text discusses the methodological strengths and flaws of these studies and excludes management approaches formulated from uncontrolled clinical observation. RESULTS OF DATA SYNTHESIS: Constipation of the elderly is not well defined in the current literature. Self-reported constipation and laxative use increase with age, while a similar escalation in true clinical constipation is not shown. Physiological changes in the lower bowel predisposing toward constipation do not occur with normal aging. Patient selection criteria for studies examining the pathophysiology of constipation differ in their definition of constipation and their inclusion of coexisting chronic illness. Nevertheless, there is consistent evidence for prolonged transit through the sigmoid colon and rectum, especially in frail elderly patients, and reduced rectal tone with impaired sensation, particularly in patients with rectal impaction. Few studies rigorously examine "risk factors" and non-pharmacological interventions in constipation. The results of most laxative trials require cautious interpretation because of inclusion of patients without diagnostically proven constipation, use of combined laxative preparations, and unreliable outcome measures. Certain laxative agents however appear more appropriate for use in elderly people. CONCLUSION: Although the subjective complaint of constipation and habitual laxative use increase with age, the epidemiological data suggest that true clinical constipation does not. Physiological changes predisposing toward constipation are not an inevitable consequence of aging, but appear to be specific to the condition. The available data do not confirm many suspected "risk factors" nor the benefits of commonly used non-pharmacological and pharmacological treatments, but they do provide enough information to formulate a practical approach to constipation in elderly persons.

Aged↗
PubMed1991

Plasma exchange in the treatment of Refsum's disease (heredopathia atactica polyneuritiformis).

Five cases of heredopathia atactica polyneuritiformis (HAP--Refsum's disease) were treated by serial plasma exchanges. In all patients a reduction in calorie intake and body weight had been associated with a rise in plasma phytanic acid, followed by an exacerbation of the ataxia and neuropathy. Lowering the plasma phytanic acid by plasma exchange produced a rapid clinical improvement. The main indication for plasma exchange in HAP is a severe or rapidly worsening clinical condition. A lesser indication is failure of dietary management to reduce a high plasma phytanic acid level.

Adult↗
PubMed1990

The management of empyema thoracis by thoracoscopy and irrigation.

A technique of irrigation for the management of empyema thoracis is described. Initial thoracoscopy using a laparoscope under general anaesthesia enabled adequate debridement and breakdown of loculi within the empyema cavity under direct vision. Following this procedure irrigation of the cavity with two tubes was started and continued until three consecutive cultures of drained irrigation fluid became sterile. The procedure was then discontinued. The results in 14 patients are presented using this method, irrigation was required for an average of 14 days. Patients remained in hospital for an average of 4.8 weeks. Tuberculous empyema was not found to be a contra-indication to the irrigation technique.

Adult↗
PubMed1985

Recovery of the dental and periodontal tissues of the rat incisor following application of continuous intrusive loads: a long-term study.

The present investigation deals with the functional recovery of the rat incisor periodontium following application of optimal intrusive loads for a period of 2 weeks and addresses the relationship between function and integrity of dental and periodontal tissues. The daily rate of eruption served as an indicator of the functional capacity of the rat periodontal ligament (PDL), while the condition of the PDL was evaluated by means of serial histologic sections. The left mandibular incisors of thirteen experimental and seven control rats were shortened to prevent occlusion, and calibrated loads of 19 +/- 1.6 grams were applied to the teeth of the experimental animals. Following removal of the springs, the daily rate of eruption of all teeth was measured during a recovery period of 80 days. In all experimental animals, prolonged impairment of the eruptive potential had occurred: In 50% the rate of eruption was fully restored 8 weeks after removal of the loads, and in these animals the histologic evaluation showed an almost normal PDL. In the remaining 50% gross impediment in the eruption rate persisted throughout the entire experimental period. The intratissue forces operating during the recovery period had sufficient strength to cause a degree of periodontal injury equivalent to that ensuant on direct loading. Extensive newly developed necrotic lesions were evident in the initially stretched mesial PDL. Areas of dentin resorption, denuded cementum, and injured enamel appeared a considerable time after load removal. Periodontal injury included disorientation and loss of attachment of collagen fibers, presence of scarlike tissue, and infiltration of inflammatory cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

The management of empyema thoracis by thoracoscopy and irrigation.

A technique of irrigation for the management of empyema is described. Initial thoracoscopy under general anesthesia enabled full debridement and division of loculi within the empyema cavity under direct vision. Irrigation with two tubes was instituted until three consecutive cultures of irrigation fluid became sterile; then the chest drains were removed. The results in 12 patients are presented. Using this method, irrigation was required for an average of 14 days and chest drains were removed after an average of 20 days. Patients remained in the hospital for an average of 4.8 weeks. Tuberculous empyema was not found to be a contraindication to the irrigation technique.

Adult↗
PubMed1985

Characteristics and stability of spaced dentition.

A serial study of changes in spacing between teeth during the period of facial maturation, finding tendencies toward closure of buccal spaces and opening of anterior spaces. Spacing in females is equally distributed between upper and lower arches; in males it is more prevalent in the upper arch.

Adolescent↗
PubMed1985

Plaque inhibition by sustained release of chlorhexidine from removable appliances.

We studied the effectiveness of a sustained-release delivery system for chlorhexidine in plaque prevention. A clinical trial in a group of eight students wearing orthodontic appliances coated by ethyl cellulose polymer containing the drug demonstrated that plaque accumulation was decreased for a period of four days. All oral procedures had been withdrawn during the clinical study. No side-effects of chlorhexidine, such as tooth staining and unpleasant taste, were observed.

Adult↗
PubMed1983

Long-term effect of intrusive loads of varying magnitude upon the eruptive potential of rat incisors.

The present investigation deals with the functional recovery of the periodontium following application of intrusive loads of varying magnitudes to continuously growing rat incisors. The daily rate of eruption of these teeth served as an indicator of the functional capacity of their periodontal ligament. The left mandibular incisor was shortened to prevent occlusion in thirty experimental and ten control rats. The experimental animals were divided into three groups and constant, calibrated axial loads of 8 Gm./cm.2 (light), 15 Gm./cm.2 (medium), and 26 Gm./cm.2 (heavy) were applied to their incisors by means of closed-coil springs for a period of 2 weeks. The daily eruption rate of all teeth was measured for 80 days following removal of the springs. In all experimental animals, severe and long-lasting impairment of the eruptive potential occurred. The least impairment was seen in the group with the light loads, their eruption rate being fully restored 64 days after removal of the loads, by which time 165 percent of all dental and periodontal tissues was renewed. In the medium-load group, renewal of the tissues reached 140 percent, while a gross impediment in normal eruption rate persisted throughout the entire experimental period. The teeth subjected to heavy loads received a diminished impact of the axially directed loads due to the strong horizontal component of force; consequently, they behaved like the incisors of the light-load group. The light loads proved to cause the least impairment and were the most beneficial to functional recovery.

Animals↗