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Biomedical subjects

D Lieberman

Publications and source records attributed to D Lieberman.

At least 73 records · Page 4Linked to original sources
PubMed1995

Q-fever pneumonia in the Negev region of Israel: a review of 20 patients hospitalised over a period of one year.

BACKGROUND: Three-hundred and forty-six patients with community acquired pneumonia were included in a prospective study of patients hospitalised over a 12-month period in the Soroka Medical Center in Beer-Sheva, Israel. Q-fever pneumonia (QFP) was diagnosed in 20 patients (5.8%). A detailed epidemiological and clinical description of this disease, is presented. METHODS: QFP was diagnosed by conventional criteria using a commercial immunofluorescent assay. RESULTS: The age of patients was 41 +/- 14 years (mean +/- S.D., range 20-69). Twelve of the patients were males. No concomitant or chronic disease was present in 16 patients. Chest radiograms revealed alveolar or air space pneumonia in 10 patients, bronchopneumonia in nine and interstitial pneumonia in one patient. The mean febrile period was 10.5 +/- 5.3 days. There was serological evidence of co-infection with Mycoplasma pneumonia in six patients, and with Legionella pneumophila in one patient. Patients treated with beta-lactam antibiotics recovered as quickly as those treated with tetracyclines or erythromycin. CONCLUSIONS: The Negev region of Israel is an endemic area for Q-fever. The diagnosis of QFP can be made only on the basis of a specific serological test. Clinical, radiologic or laboratory findings are not diagnostically definitive. The importance of specific therapy is unclear.

Adult↗
PubMed1995

Chlamydia pneumoniae-induced ciliostasis in ciliated bronchial epithelial cells.

The ciliary activity of ciliated bronchial epithelial cells was studied after infection with Chlamydia pneumoniae (strain TW-183) and Chlamydia trachomatis (biovar L2 [434/Bu]). C. pneumoniae, known to cause respiratory infections, had a marked ciliastatic effect, completely aborting ciliary motion within 48 h. This effect was not inhibited by inactivation of C. pneumoniae elementary bodies (EBs) by UV irradiation. In contrast, inactivation of EBs by heat (56 degrees C, 30 min) or by rabbit-specific immune sera to TW-183 antigen blocked the ciliastatic effect induced by C. pneumoniae infection. The effect of C. pneumoniae was specific. C. trachomatis, which causes sexually transmitted disease, did not block ciliary motion by 48 h after infection. A decrease in ciliary activity of ciliated bronchial cells produced by C. pneumoniae can contribute to both initiation and pathogenesis of respiratory infections induced by this pathogen.

Antibodies, Bacterial↗
PubMed1995

Maternal directiveness and infant compliance at one year of age: a comparison between mothers and their developmentally-delayed infants and mothers and their nondelayed infants.

Maternal directiveness and infant compliance at one year of age were observed in social interactions between mothers and their handicapped and nonhandicapped infants. Eleven nondelayed, typically developing infants, and nine developmentally delayed infants, matched for chronological age, were observed in a free play situation with their mothers. Mothers of the delayed infants attempted to direct their children's play significantly more than those with nondelayed infants, and they engaged more frequently in social play involving physical contact with their infants. Nondelayed infants complied with their mothers' directives more than the developmentally delayed infants. Further study of infant capabilities and maternal affect and behaviors with this age group is suggested.

Cooperative Behavior↗
PubMed1995

Influence of estrogen replacement therapy on airway reactivity.

The effect of estrogen on smooth muscle in various organs is unpredictable. Little is known about the effect of estrogen on respiratory tract smooth muscle, particularly in humans. In the present study we used the histamine challenge test (HCT) to assess the effect of estrogen replacement therapy (ERT) on airway reactivity in postmenopausal women who did not suffer from respiratory disease. Thirty-six women who were undergoing treatment at the postmenopausal clinic completed the study. All participants were nonsmokers whose pulmonary function tests were normal. HCT was performed twice before the inception of ERT, and a third time 4-6 weeks after ERT was begun. None of the 36 women demonstrated a 20% decrease in FEV1 values (PC20) after inhaling histamine at a concentration of 8 mg/ml, either before or during ERT. The maximal decrease in FEV1 values in response to the maximum concentration of histamine was significantly lower during ERT compared to the pretreatment period. The average maximal decrease in FEV1 during ERT was 2.63 +/- 2.72% (mean +/- DS) compared to 5.21 +/- 4.47% and 6.57 +/- 5.28% on the 2 tests prior to therapy (p < 0.0002). We conclude that ERT has an inhibitory effect on the bronchial reactivity of respiratory smooth muscle. There is no cause for concern about increased airway reactivity as an adverse effect of this therapy.

Estrogen Replacement Therapy↗
PubMed1995

Psychological distress in patients with gastroesophageal reflux disease.

BACKGROUND: Psychological factors play a role in a variety of gastrointestinal illnesses, including esophageal diseases. The role of psychological factors in gastroesophageal reflux disease (GERD) is not known. The purpose of this study was to determine if psychological distress is present in patients with reflux disease. METHODS: We performed psychological assessments in 51 patients with documented gastroesophageal reflux disease and in 43 age-matched controls using a battery of instruments. RESULTS: Patients with reflux differed from controls on scales of depression, somatization, anxiety, and intensity of reporting symptom distress. However, a secondary analysis revealed that it was a subset of reflux patients (30%) that accounted for the differences between the two groups. CONCLUSIONS: These results suggest that although most patients with GERD are psychologically similar to patients without GERD, a subset of psychologically distressed patients are more likely to be found among patients with GERD. They suffer from general psychological distress rather than a specific psychiatric disorder. This psychological factor could affect the clinical manifestations of reflux disease in these individuals. Recognition and management of psychological distress in this subgroup may aid in the management of reflux disease.

Gastroesophageal Reflux↗
PubMed1995

The intermediate care unit as a cost-effective option for the treatment of medical patients in critical condition.

Since the limited accessibility of general intensive care units creates a situation in which medical patients in critical condition continue to be cared for in the regular wards, we conducted a retrospective cohort study to assess the treatment outcomes in such patients referred to the medical intermediate care unit (MICU). At the Soroka Medical Center, a facility with 810 beds, of which 170 beds are in medical wards, including an 8-bed intensive cardiac care unit and a 5-bed general intensive care unit, 119 patients were referred to the MICU, directly from the emergency room or from medical wards, during the first half of 1994. Eighty percent of the patients were admitted to the MICU directly from the emergency room. The mean disease severity, as measured by the APACHE II score, was 12.9, and the mean intensity of care for these patients, as measured by the TISS scale, was 12.6. Twenty-one of the 119 patients died during hospitalization (17.6%). This mortality rate conformed to the mortality risk of 15.5%, which was calculated using prognostic formulae. The ratio of nursing staff to patient in the MICU was approximately 1:3, compared to 2:3 in the general intensive care unit and 1:12 in the wards. The mean cost of one day of hospitalization in the MICU was one-third that in the general intensive care unit and double the cost in a ward. Medical patients in critical condition can be treated in an MICU, with a savings in expenses and without impairing the patient's chances for survival.

APACHE↗
PubMed1994

Effects of gliosis on dopamine metabolism in rat striatum.

Neuroimplantation is inevitably accompanied by gliosis. Although graft-induced trophic effects on host neurons may be mediated by glial cells, the effects of gliosis on dopamine (DA) metabolism remains unclear. To examine these effects, basic fibroblast growth factor (bFGF) was directly infused into the striatum of 12 male rats (250-280 g). One week later, substantial gliosis was demonstrated in the infused striatum by immunochemical staining for glial fibrillary acidic protein (GFAP) and quantified by GFAP Western blot analysis. One week after bFGF infusion, extracellular DA and its metabolites were measured by in vivo microdialysis using HPLC. Infusion of L-dopa through the dialysis probe resulted in a 60% reduction in the L-dopa-induced DA peak in the gliotic striatum compared with the normal side. After L-dopa infusion, dihydroxyphenylacetic acid (DOPAC) levels were similar between the gliotic and normal striatum. In contrast, homovanillic acid (HVA) levels were 26% higher in the gliotic striatum. Enzyme assays demonstrated that aromatic L-amino acid decarboxylase activity was unchanged in the gliotic striatum, but both MAO-A and MAO-B activities increased by 23% and 21%, respectively. These results suggest that the reduced striatal DA peak in the gliotic striatum after L-dopa administration was due to accelerated DA catabolism through enhanced MAO activity. The bFGF-induced striatal gliosis may serve as a model to study neurotransmitter metabolism in the gliotic brain caused by disease processes, aging, or tissue grafting.

Animals↗
PubMed1994

Screening/early detection model for colorectal cancer. Why screen?

Colon cancer is a leading cause of cancer death in the United States, causing approximately 60,000 deaths each year. Ideal screening would identify high risk patients and screen them with sensitive tests. Most cancers evolve from adenomatous polyps. There is now evidence that detection and removal of adenomas can prevent cancer. Unfortunately, our ability to identify high risk patients is limited. Screening of asymptomatic, average-risk individuals has been advocated, with the goal of reducing colon cancer mortality by detecting cancers at an early, curable stage or preventing cancer by detecting and removing adenomatous polyps. Recent data have suggested that screening populations older than age 50 with sigmoidoscopy and fecal occult blood tests can reduce colon cancer mortality. These reports are encouraging but also highlight significant limitations of this form of screening. Screening itself is designed merely to identify something that, once identified, needs further evaluation. Therefore, any discussion of colon screening must include consideration of how physicians will approach positive test results. The strategies for dealing with positive test results are costly and invariably lead to further surveillance. Current data suggest that patients with large polyps (> 1 cm) or villous adenomas have a high risk of colon cancer and are likely to benefit from full colonoscopy and subsequent surveillance. The benefits are far less clear for patients with small polyps. The subject of colon screening becomes even more complicated as consideration is given to when to start and stop screening, and how often to perform screening exams. There is clearly a need to improve upon the ability to identify patients most likely to develop colon cancer and design strategies to prevent cancer in this group. In the future, it may be possible to identify the high risk patient with some precision using genetic or biologic markers.

Adenoma, Villous↗
PubMed1993

Anxiety during pregnancy at the time of the Gulf War: comparison of anxiety of Israeli women with normal pregnancies and those with "at-risk" pregnancies.

81 pregnant women were interviewed at the time of the Gulf War. One group was interviewed before the missile attacks began in Israel, and the second group during the period of the attacks. Of the women interviewed, 53 women had "high-risk" pregnancies and 28 had normal pregnancies. Despite the hypothesis that women with "at-risk" pregnancies would report a greater rise in anxiety during the missile attacks, it was found that the women with normal pregnancies reported a significantly greater rise in anxiety during missile attacks. It is suggested that the already-stressed "high-risk" group "shut out" the additional anxiety generated by the dangers from the missile attacks.

Adult↗
PubMed1993

Gastrointestinal bleeding: initial management.

Acute bleeding from the gastrointestinal tract remains a common problem and may be life threatening. The initial evaluation should include an assessment of the amount of blood loss and the activity of bleeding and correction of intravascular volume depletion. Endoscopy of the gastrointestinal tract is used to determine the site of bleeding and, in some cases, to treat the bleeding site.

Acute Disease↗
PubMed1992

Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices.

BACKGROUND: Endoscopic sclerotherapy is an accepted treatment for bleeding esophageal varices, but it is associated with substantial local and systemic complications. Endoscopic ligation, a new form of endoscopic treatment for bleeding varices, may be safer. We compared the effectiveness and safety of the two techniques. METHODS: In this randomized trial we compared endoscopic sclerotherapy and endoscopic ligation in 129 patients with cirrhosis who had proved bleeding from esophageal varices. Sixty-five patients were treated with sclerotherapy, and 64 with ligation. Initial treatment for acute bleeding was followed by elective retreatment to eradicate varices. The patients were followed for a mean of 10 months, during which we determined the incidence of complications and recurrences of bleeding, the number of treatments needed to eradicate varices, and survival. RESULTS: Active bleeding at the first treatment was controlled by sclerotherapy in 10 of 13 patients (77 percent) and by ligation in 12 of 14 patients (86 percent). Slightly more sclerotherapy-treated patients had recurrent hemorrhage during the study (48 percent vs. 36 percent for the ligation-treated patients, P = 0.072). The eradication of varices required a lower mean (+/- SD) number of treatments with ligation (4 +/- 2 vs. 5 +/- 2, P = 0.056) than with sclerotherapy. The mortality rate was significantly higher in the sclerotherapy group (45 percent vs. 28 percent, P = 0.041), as was the rate of complications (22 percent vs. 2 percent, P less than 0.001). The complications of sclerotherapy were predominantly esophageal strictures, pneumonias, and other infections. CONCLUSIONS: Patients with cirrhosis who have bleeding esophageal varices have fewer treatment-related complications and better survival rates when they are treated by esophageal ligation than when they are treated by sclerotherapy.

Esophageal and Gastric Varices↗
PubMed1992

Identification of a critical period for motor development in neonatal rats.

Manipulation of the developing nervous system has provided valuable insights into nervous system function. One important concept to arise from this type of study has been the identification of specific "critical periods" for the development of various functions. A critical period has been most clearly shown for the visual system where monocular eye closure for a few weeks led to functionally significant changes in visually guided behaviors and the connectivity of the visual cortex. Critical periods have also been defined for other sensory systems. Although studies of the effect of manipulating sensory systems during development are sometimes difficult to interpret (e.g. Ref. 7), this difficulty is compounded in the case of the motor system. Problems arise because manipulations of the postnatal motor system are difficult to implement and usually require invasive procedures such as tenotomy, neurotomy, and nerve crush (for review, see Ref. 17). We have approached the problem of manipulating the motor environment by adapting a paradigm widely used to study the experimental effects of simulated weightlessness in adult rats: namely, tail suspension. This method has several advantages for manipulating the motor system: (i) because it is noninvasive, it is less discomforting than neurotomy, tenotomy or nerve crush; (ii) it does not immobilize the animals, they move about the cage and extend and flex their hindlimbs; and (iii) it specifically examines the importance of load-bearing on the development of antigravity muscles and their neuronal circuits.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1992

Silicone-covered expandable metallic stents in the esophagus: an experimental study.

Modified silicone-covered Gianturco expandable metallic stents were placed in the normal esophagus of six young pigs. Following endoscopic examination, the stents were placed using endoscopic and fluoroscopic control. The animals were observed for eating behavior and weight gain. Stents appeared to be tolerated well based on these parameters. Three stents remained in position for the full study period, and three stents migrated into the stomach during the study. The pigs were sacrificed at four weeks and postmortem examination performed. Esophageal wall thickening and nodular inflammation were noted at the sites where the wire skirts penetrated the mucosa. Injury was limited to the region of the wire skirts and there was no injury due to the radial force of the stent body. There was no free perforation. This preliminary study suggests that endoscopic and fluoroscopic placement of modified silicone-covered Gianturco stents in the esophagus is feasible and safe. More extensive animal studies, followed by clinical investigation for palliation of malignant strictures, are warranted.

Animals↗
PubMed1992

Oral status and resident well-being in a skilled nursing facility population.

We studied the relationship between oral status and well-being in dentate and edentulous institutionalized residents through interviews with and dental examinations on 58 men and women. Oral status (measured by oral function, dental problem self report, soft tissue anomalies, and dry mouth) and well-being (measured by affect balance, self-esteem, health status, and nurse's ratings) were similar for dentate and edentulous subjects. Multiple regression analyses indicated oral status was significantly related to well-being. Unexpectedly, the extent of caries and plaque was also positively related to well-being, suggesting complex relationships between oral status markers and well-being in institutional settings.

Aged↗