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Biomedical subjects

E Rosenthal

Publications and source records attributed to E Rosenthal.

At least 73 records · Page 4Linked to original sources
PubMed2000

A cosmetic approach for pectoral pacemaker implantation in young girls.

Pectoral placement of pacemaker generators, combined with use of a redundant intravascular lead portion, reduces the need for endocardial lead advancement during growth in children. While the use of small generators and submuscular pockets has contributed to cosmetic acceptability, the conventional subclavicular incision may occasionally form a keloid scar that is unacceptable in young girls. A modified implantation technique was used in five girls (age 2.6-13.3 years) during implantation of VDD (n = 2), VVIR (n = 2), and DDDR (n = 1) pacemakers. A 5-cm incision was made in the axilla along the line of the pectoralis major and dissection was continued below the muscle to create a pocket for the generator. Subclavian vein puncture was performed from the axillary incision and beneath the pectoralis major muscle using standard or extra long needles with a needle guard. Peel away sheaths were used for lead positioning. The generator was placed in the submuscular pocket and the wound closed with absorbable sutures. At follow-up, pacemaker function was excellent and neither the scars nor pacemakers were visible from the front. In conclusion, the axillary incision with direct subclavian vein puncture from below the pectoralis major muscle offers the advantages of pectoral pacemaker implantation through a single cosmetic incision.

Adolescent↗
PubMed2000

Diagnostic maxillofacial coronal images reformatted from helically acquired thin-section axial CT data.

OBJECTIVE: This study was undertaken to determine the sensitivity and specificity of coronal images reformatted from helical thin-section axial CT data obtained for the evaluation of maxillofacial fractures. MATERIALS AND METHODS: Multiple fractures were created in nine cadaver heads by blunt trauma and were then evaluated using a late-generation helical CT scanner. Two neuroradiologists then independently evaluated the axial and reformatted coronal maxillofacial images. Subsequently, they reviewed the axial and direct coronal CT images, which were considered the criterion standard. RESULTS: A total of 87 fractures were identified. An experienced neuroradiologist failed to identify one displaced fracture and two nondisplaced fractures when evaluating the reformatted coronal and direct axial images for an overall sensitivity of 97%. A less experienced neuroradiologist failed to identify a total of five minimally displaced or nondisplaced fractures for an overall sensitivity of 94%. For each radiologist, no significant difference in the time required to interpret the direct versus the reformatted coronal images was seen. CONCLUSION: Interpretation of axial and reformatted coronal images resulted in accurate identification of displaced maxillofacial fractures in cadavers. This study suggests that the added cost and radiation exposure associated with incremental direct coronal CT may not be necessary for detection of clinically significant maxillofacial fractures and that further evaluation of this protocol in live trauma patients is warranted. However, because nondisplaced fractures were not routinely detected using reformatted coronal images, physical examination and clinical suspicion will still also remain necessary to determine the need for further imaging.

Facial Bones↗
PubMed2000

Neoplastic cell activation and proliferative response to CD40-ligand characterize recurrent leukemic bouts in an unusual case of low grade lymphoma.

Spontaneous fluctuations in activity of low-grade B cell lymphomas are common but not understood. An explanation may be offered by studying an atypical SLL/CLL case characterized by recurrent cycles of leukemic phase alternating with spontaneous remission (1). During remissions, residual IgMkappa+ leukemic cells exhibited resting phenotype, low proliferative response to CD4O-ligand and delayed apoptosis. In contrast, the acute phase counterparts were phenotypically activated, underwent rapid apoptosis in culture and proliferated extensively in response to membrane-anchored CD40-ligand. Transient bursts of serum TNFalpha and IL-10 preceded the acute phases, which were characterized by the co-existence of CD40-ligand+ T lymphocytes and lymphoma cells in the bone marrow. Based on ex-vivo and in-vitro data, we suggest that changes in the lymphoma milieu affect the neoplastic cell activation status, rate of proliferation in response to activated T cells and rate of apoptosis. These responses may underlie both the induction and spontaneous regression of the acute phases in this unique lymphoma. Our findings raise the possibility that part of this mechanism may have evolved during transformation of indolent common CLL to its more aggressive form.

Apoptosis↗
PubMed2000

Lymphoproliferative diseases and hepatitis C virus infection.

The putative role of hepatitis C virus (HCV) infection in the pathophysiology of lymphoproliferative diseases (LPD) is supported by north-American and south-European studies reporting high HCV seroprevalence in patients with B-cell-non-Hodgkin lymphoma (NHL). However, controversial data were reported from other areas. The review of available reports to data on HCV-associated LPD points to some features: predominance of low-grade malignant lymphoma, frequent involvement of extranodal sites, absence of particular HCV genotype distribution (except in Italy for genotype 2), important geographical seroprevalence discrepancies. In our experience in 43 cases of HCV-associated LPD in France, we noted a predominance of B-cell NHL (31/43 cases), and the frequency of LPD among HCV-infected patients approximates 2.5%. Pathophysiology hypotheses are discussed, particularly in view of the lympho tropism of HCV. HCV is frequently associated with type II mixed cryoglobulinemia, a benign monoclonal lymphoproliferation which sometimes evolves to overt B-cell lymphoma. The recent finding of HCV binding on CD81, a surface-expressed protein present on lymphocyte membrane, enhances the putative role of HCV in lymphomagenesis. Further investigations are needed to characterize interaction between B lymphocytes and HCV, and to determine putative cofactors involved in the multistep process leading to clonal lymphoproliferation in HCV patients.

Antigens, CD↗
PubMed2000

[Hyperferritinemia].

Many causes provoke elevated serum ferritin levels including not only iron overload, but also many pathological situations where hyperferritinemia or modified isoferritin profiles have no direct relationship with body iron stores. There are five general categories of hyperferritinemia: hemochromatosis, inflammatory syndromes, cytolysis, hemophagocytosis, Still's disease, and other etiologies.

Ferritins↗
PubMed1999

[Visceral leishmaniasis associated with Wegener disease. Use of lipid complex amphotericin B and liposomal amphotericin B].

BACKGROUND: Leishmaniasis in a patient with Wegenerís disease raises the problem of amphotericin toxicity further compromising the pre-existing renal disorder. CASE REPORT: An anemic patient treated for Wegenerís disease developed visceral leishmaniasis. This renal failure patient was treated with lipid complex amphotericin B and liposomal amphotericin B. We report outcome at 10 months follow-up. DISCUSSION: The new formulations of amphotericin B allow effective treatment of visceral leishmaniasis in renal failure patients. Long-lasting results are probably favored by the interruption of immuno-suppressive therapy.

Acute Kidney Injury↗
PubMed1999

Celiac disease-associated alopecia in childhood.

We report the association of celiac disease and alopecia in 3 children. In one, the alopecia developed after 4 years' nonadherence to a gluten-free diet; the other 2 patients presented with alopecia. Administration of a gluten-free diet resulted in partial regrowth of hair in the first child and complete hair growth in the others.

Adolescent↗
PubMed1999

[1977 mortality rate in HIV-infected patients presenting with hepatitis C cirrhosis. Results of the GERMIVC multicenter survey conducted in French departments of internal medicine or infectious disease].

PURPOSE: Hepatitis C (HCV) has a high prevalence (10-30%) among human immunodeficiency virus (HIV)-infected patients. However, little information is available regarding the impact of hepatitis C on survival. The objective of our study was to determine the incidence of hepatitis C-related deaths in HIV-HCV co-infected patients. METHODS: The study was a retrospective (1-year), multicenter cohort survey conducted in 63 departments of either internal medicine or infectious diseases in France. It included 26,497 HIV-infected patients, of whom 4,465 (16.8%) presented coinfection due to the hepatitis C virus. The following parameters were studied for the year 1997: total number of deaths, number of deaths related to either AIDS, cirrhosis, hepatocellular carcinoma, or other causes. RESULTS: Among the 26,497 patients, 543 deaths (incidence: 2%) were observed in 1997; 543 deaths were due to AIDS (incidence: 1.7%), 36 to cirrhosis and/or hepatocellular carcinoma (incidence: 0.13%), and 48 (incidence: 0.18%) to another cause. In the subgroup including 4,465 HIV-HCV-coinfected patients, 29 deaths (incidence: 0.64%) were due to either HCV-related cirrhosis or hepatocellular carcinoma. These results were compared with those of a previous similar survey conducted in 1995, before the era of highly active antiretroviral therapy. The only significant difference is the dramatic regression of deaths due to AIDS. CONCLUSION: The impact of hepatitis C virus on the mortality among HIV-infected patients whose follow-up took place in departments of either internal medicine or infectious diseases in France was very low in 1997. The expected increase in the life span in these patients could modify these results in the future, due to recent improvements in the HIV infection treatment.

Adult↗
PubMed1999

Developmental characterization of the gene for laminin alpha-chain in sea urchin embryos.

We describe the isolation and characterization of a cDNA clone encoding a region of the carboxy terminal globular domain (G domain) of the alpha-1 chain of laminin from the sea urchin, Strongylocentrotus purpuratus. Sequence analysis indicates that the 1.3 kb cDNA (spLAM-alpha) encodes the complete G2 and G3 subdomains of sea urchin a-laminin. The 11 kb spLAM-alpha mRNA is present in the egg and declines slightly in abundance during development to the pluteus larva. The spLAM-alpha gene is also expressed in a variety of adult tissues. Whole mount in situ hybridization of gastrula stage embryos indicates that ectodermal and endodermal epithelia and mesenchyme cells contain the spLAM-alpha mRNA. Immunoprecipitation experiments using an antibody made to a recombinant fusion protein indicates spLAM-alpha protein is synthesized continuously from fertilization as a 420 kDa protein which accumulates from low levels in the egg to elevated levels in the pluteus larva. Light and electron microscopy identify spLAM-alpha as a component of the basal lamina. Blastocoelic microinjection of an antibody to recombinant spLAM-alpha perturbs gastrulation and skeleton formation by primary mesenchyme cells suggesting an important role for laminin in endodermal and mesodermal morphogenesis.

Animals↗
PubMed1999

Successful human umbilical cord blood stem cell transplantation without conditioning in severe combined immune deficiency.

A 2-month-old girl with severe combined immunodeficiency (SCID), presented with mild staphylococcal skin infection, lymphopenia, low T cell number, absence of B cells, high number of NK cells, and a negligible response to mitogens. Since her older brother died as a result of SCID 2 years earlier, cord blood was harvested from a sister born 2 1/2 years earlier, who was normal and fully matched both by serology and molecular typing. In view of her clinical condition and in spite of a high number of NK cells with normal activity, HUCBT without preparative conditioning was performed. No G-CSF was administered. Engraftment with mixed chimerism was evident 3 weeks post transplantation. There were no peritransplantation complications. Eighteen months post transplantation, the girl is in excellent condition, blood counts are normal, T cell engraftment is complete, B cell engraftment is proceeding gradually, and the mitogen stimulation tests are normal. Due to the unique nature of HUCB hematopoietic cells, engraftment without conditioning may be possible in patients with SCID with fully matched donors. This is the first HUCBT performed without conditioning.

Female↗
PubMed1999

Pacing lead adhesions after long-term ventricular pacing via the coronary sinus.

Left ventricular pacing via the coronary sinus is being increasingly used. There is little data to guide possible lead extractions that might be required in the future. Significant adhesions to the coronary veins were found 12 years after placing a pacing lead in the posterolateral coronary vein in a man with double inlet left ventricle and severe subpulmonary stenosis who had undergone a Fontan operation. The appearances suggest that percutaneous extraction from the proximal coronary sinus may be feasible but that difficulty may be encountered if the lead tip is placed into the distal coronary veins.

Adult↗
PubMed1999

Stent implantation for aortic coarctation and recoarctation.

OBJECTIVE: To determine the early results of balloon expandable stent implantation for aortic coarctation or recoarctation. DESIGN: Prospective observational study. SETTING: Two paediatric cardiology tertiary referral centres. PATIENTS: 17 patients, median age 17 years (range 4.4 to 45) and median weight 61 kg (17 to 92). Six had native aortic coarctation and 11 had aortic recoarctation; 14 had upper limb systolic hypertension. Of those with recoarctation, eight had had at least one previous balloon dilatation attempt and two of these patients also had further surgical interventions. INTERVENTION: Balloon expandable Palmaz iliac stent implantation. MAIN OUTCOME MEASURES: Systolic pressures gradients, minimum aortic diameter, upper limb blood pressures, and incidence of aneurysm formation. RESULTS: 18 stents were implanted during 18 procedures in the 17 patients. Mean peak systolic pressure gradient fell from 26 mm Hg (95% confidence interval (CI), 21 to 31 mm Hg) before to 5 mm Hg (2 to 8 mm Hg) after stent implantation (p < 0.001), and mean minimum aortic diameter increased from 7 mm (95% CI, 6 to 8 mm) before to 11.3 mm (10 to 12.6 mm) after implantation (p < 0.001). Complications occurred in five patients (bleeding in two, stent migration in two, and aneurysm formation in one). Two patients remained borderline hypertensive and eight were receiving antihypertensive treatment at most recent assessment. CONCLUSIONS: Stent implantation for aortic recoarctation and native coarctation gives good immediate results. Careful follow up is necessary to evaluate complications and the long term effect on blood pressure.

Adolescent↗
PubMed1999

Implementing the right to community integration for children with disabilities in Russia: a human rights framework for international action.

Human rights organizations have documented a widespread pattern of abuse in Russia's orphanages and institutions for children with disabilities. Community integration is critical to attack the underlying causes of discrimination and abuse of children in institutions. While there is an immediate need to protect children in institutions, investment in improving orphanages may inadvertently strengthen an outmoded system of segregated services, delaying long-term reform. This article describes a response to abuses in institutions based on the internationally recognized right to community integration for all children, including children with mental and physical disabilities. While tailored to Russia, the framework for action described here applies to many countries in which children and adults with disabilities are similarly segregated from society in closed institutions.

Child↗
PubMed1998

[Hospital medical students: a population at risk for accidental exposure to blood].

OBJECTIVE: Infections transmitted by blood such as viral hepatitis B and C or human immunodeficiency virus (HIV) are a true threat to health care workers. As medical students are exposed to accidental contamination during their hospital activities, we conducted a survey among medical students in Nice France to determine the frequency and circumstances of needle prick accidents and how the risk of blood exposure is managed. METHODS: A survey was conducted between December 1 and December 15, 1996 among second cycle medical students. An anonymous questionnaire was proposed to all students attending mandatory faculty classes. A blood-exposure accident was defined as a needle prick or a cut caused by another sharp object which occurred in the hospital. RESULTS: Among the 237 students enrolled in the classes, 200 (84%) responded to the survey. Among these, one-quarter had experienced a blood-exposure accident by needle prick. For students terminating their second cycle, this rate was 37%. In 58% of the cases, the accidents had occurred when the students were on duty (excepting hospital training courses). Blood drawing for gas measurements was the most frequent circumstance (44%). Only 39% of the students had declared the accident and 51% had had a serology control within 2 months. The serological status of the source patient was unknown to the students in nearly half the cases. Only one out of two students applied elementary safety measures systematically (gloves, not recapping the needle). Only 13% of the students stated they had received information about blood-exposure accidents and their prevention and less than 50% had a correct notion of the risk of hepatitis B and C and HIV transmission by needle pricks. CONCLUSION: The incidence of blood-exposure accidents in hospital medical students is high and probably underestimated by official statistics due to the low declaration rate. Measures should rapidly implemented to inform and train students on prevention. Our units are currently working with students, the medical faculty and the occupational medicine unit to reach these objectives.

Accidents, Occupational↗