Biomedical subjects
Publications and source records attributed to E Kaufman.
Maple syrup urine disease is a rare inborn error of metabolism that manifests mainly by neurologic deterioration, coma, and death in early childhood. Oral manifestations described in this article were mostly gingival enlargement and rampant caries, while histopathologic findings revealed a picture compatible osteomyelitis.
A model of psychotherapy with dual diagnosis patients is presented. This therapy is divided into 3 phases: achieving sobriety, maintaining abstinence, and advanced recovery. In each of these phases, dual diagnosis patients require many specialized techniques, which are discussed. After sobriety, psychotherapy is behavioral and supportive. When abstinence is stabilized, then psychodynamic principles can be integrated into an approach that recognizes the role played by potential return to substance abuse. Abstinence is even more critical in dual diagnosis patients than in uncomplicated substance abusers. In advanced recovery, more traditional psychotherapy can be done, particularly in nonpsychotic patients.
The authors conducted a survey of psychiatric education in alcoholism and drug abuse in the United States. Ninety-seven percent of 106 undergraduate training programs and 91% of 169 residency programs offered curriculum units in this field. Most of these programs also provided supervised clinical care. Areas of reported faculty dissatisfaction included problems with attitude and interest of psychiatric faculty and with the amount of curriculum time allotted. The authors conclude that although the amount of curriculum time devoted to training in alcoholism and drug abuse is growing, further investment in developing faculty and fellowships is warranted to increase the quality of teaching commitment.
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A contemporary approach to the family treatment of substance abuse is presented. This approach involves developing a method for establishing and maintaining a substance-free state, a workable system of family therapy, sufficient attention to the family after substance abuse has stopped, and an individualized, integrated approach which takes into consideration a variety of family factors.
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Two girls, aged 3 and 6 years, were treated for precocious pseudopuberty associated with a follicular ovarian cyst. Both patients had breast enlargement, areolar pigmentation, and elevated serum estradiol levels. In one girl, a normal displaced uterus was palpated; in the other, an ovarian cyst was identified by ultrasonography. Surgical treatment consisted of limited resection of the follicular cysts. Rapid regression of breast hypertrophy and return of estradiol levels to normal occurred in both children, who were followed for six and 1.5 years. We believe that a conservative operation that preserves normal ovarian tissue bilaterally is the procedure of choice for treating this condition.
Acute surgical abdomen is a very serious situation that arises in various medical conditions. Common among them are appendicitis, foreign-body ingestion, and intestinal obstruction or perforation. These complications usually require emergency abdominal surgery. A case of rectal bleeding accompanied by acute surgical abdomen following the accidental ingestion of a toothpick is described in this report.
Intraligamentary dental anesthesia is considered to be an efficient and clinically safe anesthetic technique, and as a result, is widely used. The present study evaluates histologically any possible damage to the periodontal apparatus, in baboon monkeys. The damage induced by the injection needle and/or the anesthetic solution, which was injected under high pressure, was localized, minor and reversible. In most of the specimens, all signs of damage disappeared within 8 days following injection. In others, some granulation tissue was evident in the lamina propria 15 days following injection. However, no bone or cemental damage was observed.
Three local anesthetic agents (Xylocaine 2%, Xylocaine 2% with epinephrine 1:50,000, and Marcaine 0.5 with epinephrine 1:200,000) were injected intraorally using an intraligamentary injection technique. The study used a double-blind design and electrical tooth pulp stimulation to examine the duration of pulpal anesthesia. Patterns of recovery from each drug, subjective discomfort associated with each drug, pain of injection, and pain in comparison with local infiltration were also measured. The extent and duration of adjacent soft tissue anesthesia were recorded. Xylocaine 2% with epinephrine 1:50,000 produced the longest pulpal anesthesia. The decay pattern of this particular drug was less abrupt than that of the two others. No difference in discomfort or pain was found across the various drugs. There was no significant difference in pain at injection when intraligamentary anesthesia was compared with local infiltration. Post-injection pain was slightly lower with local infiltration. The extent of soft tissue anesthesia was significantly related to vasoconstrictor levels in the drugs. The study shows that duration of pulpal and soft tissue anesthesia can be tightly controlled by the operator and tailored specifically to planned dental procedures.
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The effect of naloxone on gamma-hydroxybutyrate (GHB)-induced cerebral metabolic depression was studied in rats with the 2-[14C]deoxyglucose method. Naloxone pretreatment statistically significantly antagonized the cerebral metabolic effect of GHB in 10 of 38 structures examined. These results are consistent with previous data showing reversal of the dopaminergic, electroencephalographic, and behavioral effects of GHB by naloxone and suggest that some of the neuropharmacological effects of GHB are mediated by the endogenous opiate system.
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Dental care of hemodialysis and renal-transplant patients involves various psychological parameters. Their basic illness affects their dental anxiety, self-image, active motivation to cope with difficulties, and appreciation of oral health. These parameters were measured by four specific questionnaires in fifty subjects: 25 renal patients and 25 matched controls. Renal patients showed significantly less dental anxiety than did controls, and also less concern about oral health. Patients' coping with difficulties was equal to controls, while their self-image was even more stable. The unusual findings in these patients demonstrate the importance of dentists' cooperation with nephrologists and psychiatrists.