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Biomedical subjects

E Cohen

Publications and source records attributed to E Cohen.

At least 235 records · Page 13Linked to original sources
PubMed1989

Schizophrenia and affective disorder in black and white patients: a methodologic note.

Contrary to many published reports of higher rates of schizophrenia and lower rates of affective disorder among blacks, this analysis of data collected over a ten-year period in a psychiatric clinic that serves a predominantly black population found minimal differences between the two ethnic groups. Methodologic considerations that reduce spurious black-white differences are discussed. The authors urge proper caution in evaluating such reported differences and propose screening measures to identify biased diagnostic procedures.

Adolescent↗
PubMed1989

Effect of protein synthesis inhibitors on formation and degradation of tight junctions in HT 29 adenocarcinoma cells.

The human colon adenocarcinoma cell line HT 29 grows in DMEM virtually without tight junctions (TJ). Fascia occludens type TJ can be induced in these cells by treatment with a variety of proteases or with hypertonic ammonium sulfate solution. The induced formation of TJ is not affected by pretreatment of the cells with cycloheximide or puromycin. The induced TJ are almost completely degraded within 2 h at 37 degrees C both in the absence and presence of the inhibitors studied. With ammonium sulfate as the initial inducing agent, it was possible to induce a second round of TJ formation as early as 2 h after the initial treatment, i.e., immediately after the degradation of the TJ formed in the first round. The same result was obtained in cells treated with cycloheximide. Similar results were also obtained when TJ were initially induced by a very mild trypsin treatment. However, if the initial induction involved a more rigorous proteolytic treatment, the cells needed a recovery period of several h before TJ could be induced again. Under these conditions, recovery from the protease treatment was impaired by the addition of protein synthesis inhibitors at any time prior to complete recovery. It follows that proteolytic treatment of cells not only induces TJ formation but also destroys cell surface proteins which must be available for the formation of TJ strands. It seems possible that these proteins mediate cell adhesion events which may be a prerequisite for, but not a part of the actual TJ formation.

Adenocarcinoma↗
PubMed1989

From forms to focus. A new teaching model in ambulatory medicine.

We have developed a simple generalizable model of teaching ambulatory medicine that adopts successful elements of inpatient teaching and addresses deficiencies in traditional ambulatory forums. This model combines resident analysis of the patient encounter via a "clinical encounter form" (CEF) with faculty-led ambulatory medicine rounds (AMR). Its objectives are to integrate teaching and quality assessment; be explicit about the relation between the record and the physician's clinical thinking; teach around every patient; focus on selected aspects of a case in limited time; and permit appropriate rounds preparation by faculty. The CEF-AMR model, like inpatient rounds, allows teaching to be focused on real patient issues; all patients are reviewed and quality is assured, and interesting teaching points can be selected, prepared, and discussed efficiently in limited time. It is the "classroom" complement to faculty "bedside" precepting and has made teaching ambulatory medicine feasible, clinically relevant, and well-informed. Perhaps most importantly, the CEF-AMR model encourages self-analysis of clinical decisions and makes explicit the key elements of clinical judgment.

Ambulatory Care↗
PubMed1988

The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis.

We evaluated the use of the urinary anion gap (sodium plus potassium minus chloride) in assessing hyperchloremic metabolic acidosis in 38 patients with altered distal urinary acidification and in 8 patients with diarrhea. In seven normal subjects given ammonium chloride for three days, the anion gap was negative (-27 +/- 9.8 mmol per liter) and the urinary pH under 5.3 (4.9 +/- 0.03). In the eight patients with diarrhea the anion gap was also negative (-20 +/- 5.7 mmol per liter), even though the urinary pH was above 5.3 (5.64 +/- 0.14). In contrast, the anion gap was positive in all patients with altered urinary acidification, who were classified as having classic renal tubular acidosis (23 +/- 4.1 mmol per liter, 11 patients), hyperkalemic distal renal tubular acidosis (30 +/- 4.2, 12 patients), or selective aldosterone deficiency (39 +/- 4.2, 15 patients). When the data on all subjects studied were pooled, a negative correlation was found between the urinary ammonium level and the urinary anion gap. We conclude that the use of the urinary anion gap, as a rough index of urinary ammonium, may be helpful in the initial evaluation of hyperchloremic metabolic acidosis. A negative anion gap suggests gastrointestinal loss of bicarbonate, whereas a positive anion gap suggests the presence of altered distal urinary acidification.

Acid-Base Equilibrium↗
PubMed1988

Oxygenation and hemodynamic changes during one-lung ventilation: effects of CPAP10, PEEP10, and CPAP10/PEEP10.

The effects of 10 cm H2O positive end-expiratory pressure (PEEP10), 10 cm H2O continuous positive airway pressure (CPAP10), and their combination (CPAP10/PEEP10) on oxygenation and hemodynamics were studied in 20 patients undergoing one-lung ventilation (OLV) with 50% nitrous oxide, isoflurane, and oxygen. Compared to OLV alone, CPAP10 and CPAP10/PEEP10 significantly increased PaO2 (from 80 +/- 6 to 125 +/- 11 and 137 +/- 17 mmHg, respectively); increased SaO2 (from 93.9 +/- 0.8 to 97.1 +/- 0.5 and 97.0 +/- 0.6%, respectively); and decreased Qs/Qt% (from 36.4 +/- 1.6 to 26.2 +/- 2.0 and 23.2 +/- 2.0%, respectively). Although not statistically significant, PEEP10 caused an increase in PaO2 (to 105 +/- 12 mmHg) and a decrease in Qs/Qt% (to 27.6 +/- 2.1%), which are of clinical significance. However, CPAP10/PEEP10 caused a significant decrease in cardiac output (from 4.50 +/- 0.26 to 3.83 +/- 0.22 L/min), stroke volume (58.6 +/- 3.0 to 52.8 +/- 2.9 mL/beat), and oxygen delivery (653 +/- 39 to 590 +/- 38 mL/min). Application of CPAP10, PEEP10 or their combination had no significant effect on heart rate, arterial, pulmonary arterial, mean pulmonary capillary wedge or central venous pressures, systemic or pulmonary vascular resistances, or mixed venous oxygen saturation. Overall, CPAP10 had the most beneficial effect on oxygenation and hemodynamics during OLV with 50% N2O, isoflurane and oxygen.

Aged↗
PubMed1988

A risk profile comparison of runaway and non-runaway youth.

All initial visits (N = 765) to an outpatient medical clinic during calendar year 1985 were analyzed. Six hundred and fifty-five of these visits made by non-runaway youth were compared to 110 visits made by runaways. Based on data from the Childrens Hospital Adolescent Risk Profile Interview, runaway street youth are at greater risk for a wide variety of medical problems and of health-compromising behaviors including suicide and depression, prostitution, and drug use. The implications for public health and social policy are discussed.

Adolescent↗
PubMed1988

Patterns of metabolic acidosis in patients with chronic renal failure: impact of hemodialysis.

The type of metabolic acidosis in patients with chronic renal failure was studied prospectively over a three-month period in 32 stable patients on chronic hemodialysis using acetate. All patients had pre-dialysis metabolic acidosis (mean TCO2 = 16.6 +/- 0.4 mEq/l, range 10 to 23 mEq/l). The patterns of metabolic acidosis were defined using the ratio: delta AG/delta TCO2 where delta AG is the increment in plasma anion gap above normal and delta TCO2 the decrement in plasma bicarbonate below normal. The group as a whole showed a mixed hyperchloremic and high anion gap pattern with a mean delta AG/delta TCO2 ratio of 53.3 +/- 7.1%. The individual distribution of patterns ranged from a pure hyperchloremic acidosis (24%) to a pure high anion gap acidosis (30%) with the mixed pattern being the most frequent (46%). An inverse correlation between the TCO2 change (y) during the dialysis procedure and the TCO2 (x) prevailing at the start of dialysis was found by linear regression analysis: y = -0.51x + 11, r = -0.54, p less than 0.01. Thus, before acetate conversion to bicarbonate was fully completed, patients gained bicarbonate during dialysis if TCO2 was less than 21 mEq/l and lost it when the pre-dialysis TCO2 was above this level. On average, the delta AG was reduced to a greater extent than the delta TCO2 so that the delta AG/delta TCO2 ratio fell significantly (from 53 +/- 7.1 to 11 +/- 8.8%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1988

Prostheses and orthoses for the foot and ankle.

The general nature and function of the AFO has been presented. These devices encompass the foot and leg crossing the ankle joint. They may insert into the shoe or attach to the shoe. The more recent AFOs are made of polypropylene and were formerly composed of steel. The indications for an AFO are for a basically ambulatory patient with problems walking, including various pathologic gaits especially drop-foot and spastic equinus. Other primary indications include ankle arthritis, Charcot foot, fractures, and post-surgery. Given the basic employment of AFOs to treat problems directly related to the foot, it is hoped that this introduction has stimulated practitioners to begin using this essential tool as an integral component of their practice.

Adult↗
PubMed1988

Treatment of severe vernal keratoconjunctivitis with cyclosporine A eyedrops.

Twenty-one children (4 to 12 years old) with severe vernal keratoconjunctivitis refractive to treatment with corticosteroid eyedrops and/or 2% disodium cromoglycate (Optic-rom, Fisons) were treated with CsA 2% eyedrops in oil solution. Eighteen patients (86%) experienced a rapid relief of their subjective symptoms three to four days after initiation of treatment. This was accompanied by objective improvement of ocular manifestations and visual acuity within a week. Sixteen of the children (76%) remained controlled during the 6-week period of treatment. However, only five patients (24%) did not need any additional therapy 2 months after discontinuation of the CsA eyedrops. These findings can be interpreted as an indication for the possible involvement of interleukin secretion in the clinical manifestations of vernal keratoconjunctivitis. Alternatively, the beneficial effects of CsA in this disease may be due to a direct effect on the mast cells preventing the release of their mediators.

Child↗
PubMed1988

Treatment of endogenous uveitis with cyclosporine A.

Thirty patients suffering from severe sight-threatening bilateral chronic endogenous uveitis were treated with initial dosages of 10 mg/kg/d of CsA. After 1 month of therapy, all patients but one demonstrated a rapid decrease of the intraocular inflammatory processes along with an arrest of the deterioration of vision. After 1 year (or more) of treatment, most patients still show the same visual acuity achieved after 1 month. During the 3-year span of this study, attempts at tapering off the CsA dosage to less than 5 mg/kg/d induced a temporary flare-up in 20 of the 24 patients followed without interruption for more than 6 months. Nonetheless, control of the intraocular inflammation was finally achieved by 5 mg CsA/kg/d or less in 14 of the 25 patients. In six of these 14 patients the CsA dosage was further tapered to total discontinuation. Two of the six patients showed a rapid reactivation of the intraocular inflammatory processes with a profound decrease in vision within 1 and 3 weeks, respectively. In four patients, control of the intraocular inflammation and preservation of good visual acuity have been observed for a period of up to 18 months.

Behcet Syndrome↗