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Biomedical subjects

D L Katz

Publications and source records attributed to D L Katz.

At least 37 records · Page 2Linked to original sources
PubMed1999

Does acid suppression by antacids and H2 receptor antagonists increase the incidence of atrophic gastritis in patients with or without H. pylori gastritis?

Currently there is controversial evidence that suggests that the accepted incidence of atrophic gastritis of 1.2 to 3.3% in patients with Helicobacter pylori gastritis may be increased by the long-term suppression of acid by a proton pump inhibitor (omeprazole). The purpose of this study is to show whether lesser forms of acid suppression by antacids or H2 receptor antagonists may have an influence on the development of atrophic gastritis. The authors recently reported a study in which a cohort of 36 patients with symptoms of dyspepsia were followed clinically for a period of 7 to 19 years. In that report all subjects underwent upper endoscopy with two biopsy specimens each from the antrum and fundus, on at least two occasions, 7 to 19 years apart. A diagnosis of atrophic gastritis was based on the interpretation of these biopsies by two gastrointestinal pathologists. The presence of H. pylori colonization was determined by tissue sampling and by a campylobacter-like organisms test of the antrum. Of the 36 patients in the authors' previous report, 33 had adequate baseline and follow-up data on medications consumed throughout the period of the study. In their current report they now present the findings of a retrospective review in which they correlate the presence of atrophic gastritis with the sole use of antacids and H2 receptor antagonists throughout the period of the study. In the cohort of 33 patients evaluated from the previous report, the authors found that atrophic gastritis had developed in all 28 patients positive for H. pylori, and in none of the 5 patients negative for H. pylori (p < 0.0001). A retrospective analysis of this previously studied cohort of 33 patients revealed that the use of antacids and H2 receptor antagonists did not predict the development of atrophic gastritis in either H. pylori-negative or -positive subjects. In a retrospective analysis of a cohort of 33 patients followed for an average of 11.7 years, atrophic gastritis developed in H. pylori-positive but not in H. pylori-negative subjects, irrespective of the use and duration of antacids or H2 receptor antagonists.

Aged↗
PubMed1999

Preventable inpatient time: adequacy of electronic patient information systems.

OBJECTIVES: This study assessed hospital electronic patient information systems (EPIS) for inclusion of variables associated with avoidable and extended hospitalization (preventable inpatient time). METHODS: We searched MEDLINE and HealthSTAR databases to identify predictors of preventable inpatient time. We then audited the admissions process and the handwritten medical record at 1 hospital, and the EPIS at all hospitals, affiliated with the Yale University School of Medicine for inclusion of the predictors. RESULTS: Whereas the written medical record included all 58 predictors, the EPIS of the 10 hospitals surveyed included an average of only 38% of the predictors. CONCLUSIONS: The conventional approach to information gathering during hospital admission is highly inefficient. Revising EPIS to include predictors of preventable inpatient time could enhance efficiency and quality, while reducing costs, of hospital care.

Connecticut↗
PubMed1999

Weight loss counseling by health care providers.

OBJECTIVES: This study explores the pattern of weight loss counseling by health care providers in Connecticut and the associated weight loss efforts by patients. METHODS: Data from the 1994 Connecticut Behavioral Risk Factor Surveillance System survey were analyzed to determine (1) the frequency of weight management counseling by health care providers of overweight adults with and without additional cardiovascular risk factors and (2) the current weight loss practices of overweight subjects. RESULTS: Only 29% of all overweight respondents and fewer than half with additional cardiovascular risk factors, reported that they had been counseled to lose weight. CONCLUSIONS: The findings suggest a need for more counseling of overweight persons, especially those with cardiovascular disease risk factors.

Adolescent↗
PubMed1998

Dilutional hyponatremia in pre-eclampsia.

OBJECTIVE: The objective of this report is to describe a defect in water metabolism, characterized by hyponatremia, in patients with pre-eclampsia-induced nephrotic syndrom. STUDY DESIGN: This was an observational study of 3 women. RESULTS: Hyponatremia was observed in 3 women with pre-eclampsia characterized by various extrarenal manifestations, as well as by nephrotic syndrome with normal or nearly normal renal function. Restriction in water intake partially corrected hyponatremia before delivery in each case, and no complications were observed in the neonates. The mechanism of impaired excretion of water in these patients is proposed to involve persistent and inappropriate production of vasopressin through stimulation of the nonosmotic mechanism for vasopressin secretion in response to a reduction in effective plasma volume. CONCLUSIONS: These results indicate for the first time that women with pre-eclampsia are, at least when nephrotic, at risk for development of dilutional hyponatremia, which can cause neurologic complications that simulate those of eclampsia.

Adult↗
PubMed1998

Long-term symptom patterns, endoscopic findings, and gastric histology in Helicobacter pylori-infected and -uninfected patients.

There is a paucity of data on the long-term behavior of dyspepsia, endoscopic findings, and gastroduodenal histology in patients with or without Helicobacter pylori colonization. We evaluated these parameters during a period of 7 to 19 years (average, 12.3 years) by baseline and follow-up studies. In 36 patients studied, the pattern of gastroduodenal dyspepsia and esophagogastroduodenoscopy findings remained essentially unchanged in 67% and 56% respectively. Dyspepsia patterns did not correlate significantly with either endoscopic or histologic findings, including the severity or location of gastritis in the fundus or antrum, or the presence or absence of H. pylori gastritis. Of 36 patients with adequate biopsies of the fundus and antrum, H. pylori colonization with gastritis was present in 73% but not in 27%. Progression to various degrees of atrophic gastritis was noted in 100% with, and in none without, H. pylori gastritis. In the fundus, atrophy progressed from 14% to 56%, but intestinal metaplasia did not change. In the antrum, atrophy increased from 22% to 64% and intestinal metaplasia increased from 17% to 36%. No patient demonstrated dysplasia, but severe atrophy was seen in the fundus (6%) and antrum (11%). Only two patients (5%) had severe loss of glandular elements and very low pepsinogen I, and thus can be considered to have developed advanced gastric atrophy.

Adult↗
PubMed1995

Fat-free mass index in users and nonusers of anabolic-androgenic steroids.

We calculated fat-free mass index (FFMI) in a sample of 157 male athletes, comprising 83 users of anabolic-androgenic steroids and 74 nonusers. FFMI is defined by the formula (fat-free body mass in kg) x (height in meters)-2. We then added a slight correction of 6.3 x (1.80 m - height) to normalize these values to the height of a 1.8-m man. The normalized FFMI values of athletes who had not used steroids extended up to a well-defined limit of 25.0. Similarly, a sample of 20 Mr. America winners from the presteroid era (1939-1959), for whom we estimated the normalized FFMI, had a mean FFMI of 25.4. By contrast, the FFMI of many of the steroid users in our sample easily exceeded 25.0, and that of some even exceeded 30. Thus, although these findings must be regarded as preliminary, it appears that FFMI may represent a useful initial measure to screen for possible steroid abuse, especially in athletic, medical, or forensic situations in which individuals may attempt to deny such behavior.

Adipose Tissue↗
PubMed1994

Time trends in the incidence of renal carcinoma: analysis of Connecticut Tumor Registry data, 1935-1989.

Recent trends in the incidence of renal cancer, stratified by histology, have not been reported. This study utilized data from the Connecticut Tumor Registry (CTR), the oldest population-based cancer registry in the United States, to establish time trends in the incidence of adenocarcinoma and transitional cell carcinoma of the kidney and urinary tract. All 10,209 incident cases of renal cancer reported to the CTR between 1935 and 1989 were analyzed. Regression modelling was employed to determine the effects of age, period, and birth cohort on incidence rates, and to project future trends. The incidence rate of adenocarcinoma increased in females from 0.7/100,000 in 1935-39, to 4.2/100,000 in 1985-89; and in males, from 1.6/100,000 in 1935-39, to 9.6/100,000 in 1985-89. The reported incidence of transitional cell carcinoma increased in males from 0.5/100,000 in 1950-54 to 2.8/100,000 in 1985-89, and in females from 0.2/100,000 to 1.1/100,000 over the same period. Regression modelling revealed that both net and recent drift, the sum of period and cohort slopes, were positive for adenocarcinoma in both sexes, largely due to a positive cohort effect. While the net drift for transitional cell carcinoma was positive, recent drift was negative in both sexes due primarily to a negative cohort effect. Incidence rates of adenocarcinoma are likely to rise in the immediate future, with the rate of rise in females possibly exceeding that in males. Incidence rates of transitional cell carcinoma will stabilize.

Adult↗
PubMed1994

Psychiatric and medical effects of anabolic-androgenic steroid use. A controlled study of 160 athletes.

BACKGROUND: We sought to expand on preliminary findings suggesting that anabolic-androgenic steroids produce psychiatric effects in some athletes who use them. METHODS: We compared 88 athletes who were using steroids with 68 nonusers, using the Structured Clinical Interview for DSM-III-R to diagnose psychiatric syndromes occurring in association with steroid use (if applicable) and in the absence of steroid use. Demographic, medical, and laboratory measures were also performed. RESULTS: Steroid users displayed more frequent gynecomastia, decreased mean testicular length, and higher cholesterol-high-density lipoprotein ratios than nonusers. Most strikingly, 23% of steroid users reported major mood syndromes--mania, hypomania, or major depression--in association with steroid use. Steroid users displayed mood disorders during steroid exposure significantly more frequently than in the absence of steroid exposure (P < .001) and significantly more frequently than nonusers (P < .01). Users rarely abused other drugs simultaneously with steroids. CONCLUSION: Major mood disturbances associated with anabolic-androgenic steroids may represent an important public health problem for athletes using steroids and sometimes for the victims of their irritability and aggression.

Adult↗
PubMed1991

Perry v. Louisiana: medical ethics on death row--is judicial intervention warranted?

The following note considers the complex case of Perry v. Louisiana, in which the Louisiana Supreme Court ordered an insane defendant on death row to be medicated against his will in order to render him sane, and therefore capable of being executed. In so doing the court pit judicial interests in effecting punishment of certain murderers against the physician's Hippocratic Oath, "first do no harm." In considering this conflict, the note identifies "first do no harm" as a guiding principle, explores the societal values underlying this basic principle, and concludes the judiciary must provide legal support for this medical ethical imperative. Similarly the legal profession must identify its organizing principles, its "first do no harm" proscriptions, and consider the application of those principles in the context of representing the insane. Some of the conflicts confronting the physician in the Perry situation have parallels for the attorney representing an insane client. Should the client be medicated in order to proceed to trial? Is it in the best interests of the client to remain a prisoner of her mental illness rather than to risk the possibility of conviction? How should the attorney address the paradoxical reality that a heavily medicated client may indeed become more lucid without becoming more competent? By publishing this note, the Journal hopes to engender discussion and clarification of the vague and sometimes incoherent guidance offered by the Medical Rules of Professional Responsibility, the Model Code of Professional Conduct, and the Criminal Justice Mental Health Standards for legal work with mentally disturbed clients.

Beneficence↗
PubMed1990

Homicide and near-homicide by anabolic steroid users.

The authors describe three men, all with benign premorbid psychiatric histories, no evidence of antisocial personality disorder, and no history of violence, who impulsively committed violent crimes--including murder--while taking anabolic steroids. Structured psychiatric interviews of each man suggested that steroids played a necessary, if not primary, role in the etiology of the violent behavior. Although the men conceivably might have exaggerated their reports of the effects of steroids in the hopes of improving their legal positions, information from external sources consistently corroborated their accounts in each case. These observations raise the possibility that steroid-induced violence may pose a little-recognized public health problem.

Adult↗
PubMed1988

Affective and psychotic symptoms associated with anabolic steroid use.

To assess the frequency of affective and psychotic symptoms in athletes taking anabolic steroids, the authors performed structured interviews of 41 body-builders and football players who had used steroids. According to DSM-III-R, nine subjects (22%) displayed a full affective syndrome, and five (12%) displayed psychotic symptoms in association with steroid use. These findings suggest that major psychiatric symptoms may be a common adverse effect of these drugs.

Adolescent↗