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Biomedical subjects

E B Cohen

Publications and source records attributed to E B Cohen.

At least 19 recordsLinked to original sources
PubMed1999

Deep vein thrombosis outcome and the level of oral anticoagulation therapy.

OBJECTIVE: The purpose of this study was to assess the rate of deep vein thrombosis (DVT) resolution and DVT outcomes as functions of the level of oral anticoagulation therapy achieved with warfarin. METHODS: In 33 consecutive patients, a series of 35 limbs with acute symptomatic DVT was followed throughout 1 year of anticoagulation therapy. All the patients underwent 5 days of intravenous unfractionated sodium heparin therapy that was adjusted in dose to prolong the activated thromboplastin time to 2.0 to 2.5 times the control. In addition, warfarin was administered for a period of 6 months, with a target international normalized ratio (INR) between 2.0 and 3.0. All the patients underwent venous duplex scanning and physical examination at the time of diagnosis and at 1 week, 1 month, 3 months, 6 months, and 1 year. RESULTS: At the end of the 1-year study period, the rate of complete DVT resolution was 68%. The median INR values in patients with complete DVT resolution were significantly higher than those of patients with incomplete DVT resolution after 1, 3, and 6 months of treatment with warfarin. In addition, the proportion of patients with INR values below therapeutic range was significantly higher in patients with incomplete DVT resolution than in patients with complete DVT resolution after 1, 3, and 6 months of treatment with warfarin. The presence of occlusive thrombi was associated with incomplete DVT resolution. Of the patients with occlusive thrombi, 62% had chronic venous insufficiency symptoms develop, whereas only 11% of the patients with nonocclusive thrombi (P =.003) had these symptoms develop. CONCLUSION: Despite 6 months of oral anticoagulant therapy, almost one third of thrombi did not resolve completely. The INR values were significantly higher in those patients with complete DVT resolution. These results suggest that the maintenance of an INR level between 2.0 and 3.0 throughout oral anticoagulation therapy will minimize the rate of incomplete DVT resolution.

Administration, Oral↗
PubMed1996

Oral contraceptives in the treatment of Darier-White disease--a case report and review of the literature.

In this review we illustrated the case of a woman who had perimenstrual exacerbations of Darier-White disease. The disease improved markedly with the use of continuously administered oral contraceptives. This striking improvement without side-effects supports the use of oral contraceptives in women with Darier-White disease, although its role should be investigated further using controlled studies in more patients.

Adult↗
PubMed1992

Liver biopsy versus ultrasound in methotrexate-treated psoriasis: a decision analysis.

Before starting methotrexate therapy for cases of recalcitrant psoriasis, a liver biopsy has been usual in order to exclude cirrhosis and moderate or severe fibrosis, which are contraindications for methotrexate treatment. As mortality and morbidity of liver biopsy are not negligible, and as this invasive procedure is unpleasant for the patient and urges clinical admission, we evaluated the possibility of ruling out severe liver pathology by means of ultrasonography, which we compared to liver biopsy. We made this comparison by means of a decision tree. The advantages of this analysis are the clear definition of the decision problem and its alternatives, and the possibility of calculating the risk of each alternative, thus being able to choose the best diagnostic method. In this study, the results of various research groups are discussed, in which liver biopsy and liver ultrasound were compared. In our decision tree we used some of these results and other assumptions, based on comparable studies. We varied the biopsy mortality and the sensitivity of ultrasound to show the change in the risk of each alternative. Our analysis shows that the differences of expected values between the liver biopsy branch and the ultrasonography branch are relatively small. Therefore, we advise each center, which has at its disposal a specialist in liver ultrasonography, to re-evaluate its guidelines with regard to the detection of severe liver pathology before starting methotrexate for the treatment of psoriasis.

Algorithms↗
PubMed1991

Transvenous liver biopsy in critically ill patients: adequacy of tissue samples.

In a consecutive series of 33 patients (38 biopsies), the authors analyzed the pathologic specimens obtained with their relatively new transvenous biopsy method. From the point of view of establishing a useful pathologic diagnosis, the method proved worthwhile in the series of predominantly critically ill patients. A specific diagnosis or a later confirmatory tissue diagnosis was achieved in 18 patients, and a strong clinical correlation was achieved in 10 more. There were no complications from this repeatable, technically relatively simple, and safe procedure.

Adult↗
PubMed1990

Prospective randomized study comparing the debriding effect of krill enzymes and a non-enzymatic treatment in venous leg ulcers.

The debriding potential of a recently discovered potent enzyme preparation derived from Antarctic krill (Euphausia superba) was compared to a routine non-enzymatic treatment in 31 patients with venous leg ulcers. To assure a reliable interpretation of the cleaning effect, computer image analysis was used to measure wound size and the amount of debris day by day. Krill enzyme treatment was significantly (p less than 0.01) better than the non-enzymatic treatment. The necrotic area diminished by 53%, while in the control group no reduction of the necrotic area was observed in 7 days. The median time required to clean the ulcer was 7 days in the krill group and 10 days in the control group. Afterwards the ulcers were grafted with autologous skin biopsies, which yielded similar results in both groups. No side effects were observed. It was concluded that krill enzymes fulfil criteria for effective debridement of venous leg ulcers.

Adult↗
PubMed1989

Use of the internal jugular vein for carotid patch angioplasty.

The internal jugular vein is an excellent source of autogenous tissue for carotid artery reconstruction because of its availability in the operative incision, adequate size, and ability to be harvested without morbidity. For 153 of 453 consecutive carotid reconstructions, the durability of the internal jugular vein (n = 76) and the greater saphenous vein (n = 77) as a patch angioplasty was compared. Mean postoperative follow-up was 17 months (1 to 52 months). The vein-patched carotid-bifurcation was studied by means of duplex ultrasonography to assess patency, detect restenosis, and measure cross-sectional diameter during systole. No carotid bifurcation occluded after operation. No ruptures or aneurysmal dilatations of the vein patches were observed. The maximum diameter (mean +/- SD) of the carotid patch angioplasties constructed with internal jugular vein (9.4 +/- 1.9 mm) was similar to patches made with greater saphenous vein (9.6 +/- 1.7 mm). In 95 patients serial duplex examinations demonstrated maximum diameter changes of the vein-patched internal carotid artery ranging from an increase of 3.5 mm to a decrease of 3.0 mm. Asymptomatic restenosis (greater than 50% diameter reduction) was detected in 2/95 (2.1%) patients. Because of the premium placed on the saphenous vein for peripheral arterial reconstruction and coronary artery bypass grafting, the ipsilateral internal jugular vein should be used more frequently for carotid patch angioplasty.

Adult↗
PubMed1989

Allergic contact dermatitis in children and young adults.

We evaluated the results of a 5-year period of epicutaneous testing in children and teenagers younger than 16 years of age. In an overall-tested population of 2671 persons, 67 were younger than 16 years. In 16 (23.8%) of these 67 children, a positive epicutaneous test was considered to be clinically relevant for the diagnosis allergic contact dermatitis. From the total of 44 positive tests, the most common allergen was nickel sulfate (18%), followed by balsam of Peru, Carba mix, colophony, and fragrance mix (6% each). As our test population consisted of only a few children, no conclusions were drawn in respect to children younger than 10 years. Despite our careful selection of children with allergic contact dermatitis, the prevalence of positive epicutaneous tests was no different than that reported for unselected populations of children.

Adolescent↗
PubMed1987

Primary hepatocellular carcinoma following nonspecific non-B hepatitis with tumor DNA negative for HBV DNA.

An association between non-A, non-B hepatitis and hepatocellular carcinoma has been made on the basis of negative serological markers for hepatitis B virus (HBV); however, hepatocellular carcinomas have been found to contain hepatitis B virus deoxyribonucleic acid (HBV DNA) in individuals who lack serological markers of HBV infection. Therefore, reports which ascribed a hepatocellular carcinoma to non-A, non-B hepatitis but did not examine the tumor for HBV DNA are open to question. We describe a case of chronic active hepatitis with primary hepatocellular carcinoma that lacked HBV DNA in the tumor, the nontumorous liver tissue, and serum. The individual lacked all serological markers for HBV infection. This report more fairly supports the association between hepatocellular carcinoma and chronic hepatitis not due to hepatitis B. Whether this is related specifically to a non-A, non-B hepatitis agent requires identification of the viral agents that cause non-A, non-B hepatitis.

Adult↗
PubMed1987

A rapid and improved method for generating cDNA libraries in plasmid and phage lambda vectors.

We have developed a fast and efficient procedure for generating cDNA libraries in plasmid or phage lambda vectors. We used Mo-MuLV reverse transcriptase to synthesize the first strand and directly added Escherichia coli DNA polymerase I with RNase H to synthesize the second strand. A special advantage of our procedure is the use of oligodeoxynucleotide adapters to insert the cDNA into the vector, avoiding the use of methylating enzymes and subsequent digestion with massive amounts of restriction endonucleases. This also obviates the need to tail the cDNA molecules with homopolymers, simplifying subsequent procedures such as sequencing or transfer to other vectors. Finally, we have used a rapid screening procedure to isolate full-length clones with oligodeoxynucleotide probes recognizing conserved regions at the 5' termini of the mRNA. The system is ideal for cloning and analyzing polymorphic alleles of genes, such as those of the major histocompatibility complex.

Bacteriophage lambda↗
PubMed1987

Warm ischemic damage to the epiphyseal growth plate: a rabbit model.

Warm ischemic growth plate damage was produced in the hindlimbs of 33 New Zealand white rabbits, who were 7 weeks old, by isolating the knee joint on a popliteal vascular pedicle. Zero, 3, 7, and 12 hours of warm ischemia were produced by pedicle occlusion. The 0- and 3-hour ischemic groups showed mild growth disturbances related to the surgical model and were not statistically different at 90 days postoperatively. The 7- and 12-hour ischemia groups showed severe growth disturbances and were statistically different from the 0- and 3-hour groups at all periods measured (p less than 0.05). Large central growth plate lesions were apparent by histologic examination. Twelve hours of ischemia produced a histologic picture identical to growth plate infarction. Increased warm ischemic time correlated with more severe growth retardation and evidence of increased damage to the central area of the growth plate histologically.

Animals↗
PubMed1987

Cutaneous complications in renal transplant recipients.

Systematic review of the histologic characteristics of skin lesions biopsied and/or resected in a group of 580 renal transplant recipients collected over a 16-year period showed a total of 170 specimens from 120 patients. In this group there were 41 benign tumors, 22 infections, 35 inflammatory dermatoses, and 13 miscellaneous lesions. Fifty-nine lesions were malignant, and half of these were squamous cell carcinomas (SCCs). None were lethal or metastasized, although deeply invasive local recurrences and multiple lesions were common. Comparison with SCCs from a control group showed no clearcut differences with respect to level of invasion, grade, pattern, or presence of actinic change. Most of these lesions were found in sun-exposed areas, were associated with actinic changes, and with actinic keratoses. Problems in differentiating SCC from keratoacanthoma and the clinical implications of these difficulties are discussed in conjunction with a review of the literature.

Carcinoma, Squamous Cell↗
PubMed1986

Gastrointestinal complications in renal transplant recipients.

In a 16-year study, 101 gastrointestinal (GI) lesions (16 fatal) developed in 580 renal transplant recipients seen in the authors' institution. Lesions were seen at all levels of the GI tract, but colonic lesions were the most common (42 patients) and were fatal in 8. Segmental ischemic colitis was the single most common morphologic diagnosis (14 patients). Seven of these patients had an unusual syndrome that clinically, at surgery, and on gross examination resembled inflammatory bowel disease. Lesions were segmental; involved bowel was thickened and erythematous with creeping peritoneal fat. Histologically, mucosa adjacent to the frank necrosis showed simplification and striking epithelial atypia. Specific identifiable viral infections caused 28% of the GI complications in this series. This incidence is higher than that in other reported series. Most of these infections can be diagnosed from endoscopically obtained material. These findings have therapeutic implications.

Colon↗