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Biomedical subjects

G Rosen

Publications and source records attributed to G Rosen.

At least 37 records · Page 2Linked to original sources
PubMed2000

Management of benign thyroid nodules based on the findings of fine-needle aspiration.

Fine-needle aspiration (FNA) biopsy is a safe, simple, and inexpensive procedure that is particularly applicable for lesions of the head and neck. In our department, it is widely used for the evaluation of thyroid nodules. A total of 189 patients participated in a prospective study of benign thyroid nodules. Our aim was to verify the modality of treatment used in our department and the reliability of benign cytologic results of colloid goiter. All patients had cold nodules on thyroid scanning. The patients were divided into two groups, the first comprising 93 patients who did not undergo thyroid surgery and were followed up for 5 to 11 years. One case of malignancy was found in this group during the follow-up. The second group was comprised of 96 patients who were operated on despite FNA results of colloid goiter. Among them, five cases of malignancy were found. Four of these five cases could not be regarded as FNA failure. Our study confirms that the combination of clinical findings with those of the FNA is a reliable approach to the management of benign thyroid nodules. Nevertheless, long-term follow-up is mandatory and repetitive aspirations should be considered.

Adult↗
PubMed2000

Phantom limb pain in the human brain: unraveling neural circuitries of phantom limb sensations using positron emission tomography.

Pain and other phantom limb (PL) sensations have been proposed to be generated in the brain and to be reflected in activation of specific neural circuits. To test this hypothesis, hypnosis was used as a cognitive tool to alternate between the sensation of PL movement and pain in 8 amputees. Brain activity was measured using positron emission tomography. PL movement and pain were represented by a propagation of neuronal activity within the corresponding sensorimotor and pain-processing networks. The sensation of movement was significantly (corrected for multiple comparisons) related to activity in the supplementary motor area and the primary sensorimotor cortex. The sensation of a painful PL posture activated the same brain areas but was weaker and less extended in the supplementary motor area. In contrast to the sensation of movement, pain was significantly related to activity in the thalamus, anterior cingulate, and lateral prefrontal cortex. Subjectively rated PL pain sensation correlated positively to activations in the anterior and posterior cingulate. These findings provide evidence that PL sensations are produced by the same central nervous processes that underlie the experience of the body when it is intact and that the corporeal awareness of PL pain is encoded in a thalamocortical network.

Adult↗
PubMed1999

Large, deep, high-grade extremity sarcomas: treating tumors of the flexor fossae.

Limb salvage is now possible for the majority of patients with extremity sarcomas. Although overall prognosis is primarily based on tumor size and histologic grade, complete surgical excision and local control is essential for cure. There are, however, certain anatomic locations such as the flexor fossae in which a complete surgical margin is difficult to attain, and surgery without adjuvant therapy has a high local failure and amputation rate. We have found that preoperative adjuvant therapy consisting of chemotherapy and radiation followed by surgical excision with tumor-free margins has been successful in treating flexor fossa sarcomas with high limb salvage (96%), local control (89%) and overall survival rates (70%). These results are comparable to patients with similar large, high-grade extremity tumors in other compartmental locations.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Fluorine-18 fluorodeoxyglucose splenic uptake from extramedullary hematopoiesis after granulocyte colony-stimulating factor stimulation.

Two patients with sarcoma, one with recurrent osteosarcoma of the spine and the other with metastatic synovial cell sarcoma, were treated with high-dose chemotherapy that produced severe leukopenia. The patients received granulocyte colony-stimulating factor (G-CSF) to stimulate the bone marrow (480 mg given subcutaneously twice daily for 5 to 7 days); their responses were seen as a marked increase in peripheral leukocyte count with no change in the erythrocyte or platelet counts. The patients had fluorine-18 fluorodeoxyglucose (F-18 FDG) imaging 24 hours after the end of G-CSF treatment. Diffusely increased uptake of F-18 FDG was seen in the bone marrow in both patients. In addition, markedly increased uptake in the spleen was noted in both, indicating that the spleen was the site of extramedullary hematopoiesis. The patients had no evidence of splenic metastases. The first patient had a history of irradiation to the dorsal spine, which was less responsive to G-CSF administration than was the nonirradiated lumbar spine.

Adult↗
PubMed1999

Multiple forms of the major phenylalanine specific protease in Treponema denticola.

The 160, 190 and 270 kDa outer sheath proteases of Treponema denticola ATCC 35404 were found to be multiple forms of the major 91 kDa phenylalanine protease (PAP) by immunoblotting using anti-91 kDa specific antibodies. Multiple forms of the phenylalanine protease were also found in 2 other T. denticola strains studied, ATCC 33520 and the clinical isolate GM-1. Protein, proteolytic and Western blot analyses using antibodies against the PAP and the major outer sheath protein (MSP) indicated that the 190 and 270 kDa proteases were protein complexes formed by the MSP and the PAP. These complexes dissociated by storage in 0.3% or higher SDS concentrations. The purified PAP was found to completely degrade keratin, but was unable to degrade native actin either in its monomeric or polymerized form. The association of the MSP adhesin with a protease capable of degrading host native proteins may benefit the obtention of protein-based nutrients necessary to support the growth of these treponemes. These complexes may also play a role in the structural organization of T. denticola outer sheath.

Actins↗
PubMed1999

Activation of murine macrophages by lipoprotein and lipooligosaccharide of Treponema denticola.

We have recently demonstrated that the periodontopathogenic oral spirochete Treponema denticola possesses membrane-associated lipoproteins in addition to lipooligosaccharide (LOS). The aim of the present study was to test the potential of these oral spirochetal components to induce the production of inflammatory mediators by human macrophages, which in turn may stimulate tissue breakdown as observed in periodontal diseases. An enriched lipoprotein fraction (dLPP) from T. denticola ATCC 35404 obtained upon extraction of the treponemes with Triton X-114 was found to stimulate the production of nitric oxide (NO), tumor necrosis factor alpha (TNF-alpha), and interleukin-1 (IL-1) by mouse macrophages in a dose-dependent manner. Induction of NO by dLPP was at 25% of the levels obtained by Salmonella typhosa lipopolysaccharide (LPS) at similar concentrations, while IL-1 was produced at similar levels by both inducers. dLPP-mediated macrophage activation was unaffected by amounts of polymyxin B that neutralized the induction produced by S. typhosa LPS. dLPP also induced NO and TNF-alpha secretion from macrophages isolated from endotoxin-unresponsive C3H/HeJ mice to an extent similar to the stimulation produced in endotoxin-responsive mice. Purified T. denticola LOS also produced a concentration-dependent activation of NO and TNF-alpha in LPS-responsive and -nonresponsive mouse macrophages. However, macrophage activation by LOS was inhibited by polymyxin B. These results suggest that T. denticola lipoproteins and LOS may play a role in the inflammatory processes that characterize periodontal diseases.

Animals↗
PubMed1998

[Treating hospitalized children in severe pain with oral methadone].

Pain relief is usually inadequate in hospitalized patients, especially in children, either after surgery or with various medical conditions. Among other reasons, this is due to suboptimal use of available analgesic drugs. In the past 2 years oral methadone has become our opioid of choice for severe pain in hospitalized children who can take oral medication. More than 70 babies and children, aged 8 months to 9 years, who suffered mainly from pain due to burns or cancer, were treated by the in-hospital pain service. They received 0.1% methadone syrup, 0.2-0.4 mg/kg/day, for from a few days to more than a month. In most there was significant pain relief with no serious side-effects. In some, treatment could be changed to parent-controlled analgesia after a few days, with no adverse effects. We describe 5 of the children who present the advantages of oral methadone over other opioids.

Administration, Oral↗
PubMed1998

Full polysomnographic evaluation of the infant airway.

BACKGROUND: There is little information regarding full polysomnographic examination of infants for the evaluation of stridor or stertor. OBJECTIVE: To determine the usefulness of polysomnographic examination in the evaluation of airway disorders in infants. DESIGN: Case review series. SETTING: Tertiary pediatric care center and sleep disorders center. PATIENTS: Younger than 10 months. INTERVENTION: Full polysomnography and treatment with a positive-pressure assistive device or surgery if indicated. MAIN OUTCOME MEASURES: Electroencephalographic findings, amount and length of apnea, percentage of desaturation and carbon dioxide retention, sleep architecture, amount of hypopnea as well as sleep arousals, episodes of gastroesophageal reflux, and clinical follow-up. RESULTS: Of 60 full pediatric polysomnograms performed at our institution each year, only 17 were obtained in children younger than 10 months for determination of symptoms of stridor or stertor over the past 8 years. In several cases, interpretation of 4-channel studies led to the wrong conclusions and inadequate treatment. Diagnoses made using full polysomnography included 3 children with seizure disorders, 1 with disorganized brain activity, 2 with gastroesophageal reflux, and 7 with anatomical obstructions, 3 of whom were successfully treated with a positive-pressure assistive device and 4 of whom were treated surgically. CONCLUSIONS: Full polysomnography provides physiological data that complement anatomical data obtained via endoscopy and is a useful tool for evaluating the significance of airway disorders in infants.

Bronchoscopy↗
PubMed1998

Oral methadone for the treatment of severe pain in hospitalized children: a report of five cases.

OBJECTIVE: Pain relief is still inadequate in many hospitalized patients, especially children in whom suboptimal use of analgesic drugs is still common. In the past 2 years, oral methadone has been used extensively in our institution for treating children with persistent pain from cancer, burns, or trauma who were capable of oral intake and whose pain was not relieved by nonopioid medications. SETTING: Tertiary university hospital. PATIENTS: Of the 70 children treated thus far with oral methadone, five are described in the present report. MAIN OUTCOME MEASURE: Pain relief, acceptability, and side effects of oral methadone in children with pain. RESULTS: Treatment with oral methadone (0.1% in 10% glucose, dose range of 0.2-0.6 mg/kg/day) for time periods of up to 6 weeks resulted in a rapid onset and stable pain relief, with no major side effects. No adverse responses were encountered after discontinuation of treatment. In three of the children, a parent-controlled analgesia regimen was successfully employed. CONCLUSIONS: Oral methadone can be recommended for babies and children who have severe pain that is not alleviated by nonopioid medications and who are capable of oral intake.

Administration, Oral↗
PubMed1997

The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children.

The safety of performing tonsillectomy as an outpatient procedure is still questionable. This study determined whether there was an increased risk of postoperative bleeding by performing tonsillectomy as an outpatient procedure. A six years' retrospective chart review was made of 363 children who underwent tonsillectomy. Out of 363 children, 43 had been selected as an inpatient group before the operation, 264 patients were discharged home 6 h after the operation and were the outpatient group, and 56 children had to be kept overnight because of complications that had occurred. We compared the haemorrhage rate in the outpatient and the inpatient groups. We found no increase in the postoperative haemorrhage rate in the outpatient group. No statistically significant correlations were found between the children's ages, indication for surgery, type of operation or intra-operative complications and the risk of postoperative haemorrhage. Only children who had haemorrhage in the recovery room were identified as a high risk subgroup for recurrent bleeding. On the basis of our findings we believe that tonsillectomy can be performed as an outpatient procedure regardless of age, indication for surgery, or type of procedure, as long as good recovery room supervision exists for 4 to 6 h.

Adolescent↗
PubMed1997

[An in-hospital pain service: present activity and future trends].

Although significant progress has been made in the past 2 decades in our understanding of pain pathophysiology and in the development of new analgesic drugs and techniques, many patients still experience considerable pain during hospitalization. Unrelieved pain is common not only among patients undergoing surgery, but also in those with a variety of other medical problems. These findings led to the development of our in-hospital acute pain service. This in-hospital pain service has been active since the late eighties, treating both postoperative pain and non-surgical pain in hospitalized patients. During 1995, 2140 patients were treated totaling 8717 treatment days in 18 different medical units and departments. Overall success was more than 75%. We review our experience in treating in-patients who suffer from pain and discuss future trends and need for such a specialized service.

Forecasting↗
PubMed1997

The indications for polysomnography and related procedures.

This paper is a review of the literature on the use of polysomnography in the diagnosis of sleep disorders in the adult. It is based on a search of MEDLINE from January 1966 through April 1996. It has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association and provides the background for the accompanying ASDA Standards of Practice Committee's Parameters for the Practice of Sleep Medicine in North America. The diagnostic categories reviewed are: sleep-related breathing disorders; other respiratory disorders; narcolepsy; parasomnias and sleep-related epilepsy; restless legs syndrome and periodic limb movement disorders: insomnia; and circadian rhythm sleep disorders. Where appropriate, previously published practice parameters papers are cited and discussed. The relevant published peer-reviewed literature used as the basis for critical decisions was compiled into accompanying evidence tables and is analyzed in the text. In the section on the assessment of sleep apnea syndrome, options for estimating pretest probability to select high risk patients are also reviewed. Sleep-testing procedures other than standard polysomnography are also addressed (daytime polysomnography, split-night studies, oximetry, limited full respiratory recordings, and less-than-full respiratory recording) and treatment-related follow-up studies are discussed.

Adult↗
PubMed1997

Lipoproteins of Treponema denticola: their effect on human polymorphonuclear neutrophils.

The presence of lipoproteins and lipooligosaccharides in Treponema denticola, an oral spirochaete associated with periodontal diseases, was investigated. T. denticola ATCC 35404 and the clinical isolate GM-1 were metabolically labeled with [3H]-cis-9-octadecenoic acid and extracted with the non-ionic detergent Triton X-114. The extract was phase separated, precipitated with acetone and delipidated to remove non-covalently bound lipid (dLPP). In T. denticola ATCC 35404, sodium dodecyl sulfate polyacrylamide electrophoretic separation followed by autoradiography showed [3H]-cis-9-octadecenoic acid incorporation in bands with apparent molecular masses of 14, 20, 26, 31, 38, 72 and 85 kDa and a broad band running from 113 kDa to the top of the gel. This last band resolved into a 53 kDa [3H]-cis-9-octadecenoic acid band upon heating for 10 min, at 100 degrees C. The structural relationship of the outer sheath major oligomeric polypeptide of strain ATCC 35404 and the 53 kDa protein was demonstrated immunologically. Antibodies against the 113 kDa component of the oligomer cross-reacted with the 53 kDa protein. Proteinase K degraded the [3H]-cis-9-octadecenoic acid bands with the exception of the 14 kDa. The 14 kDa was also the major [3H]-fatty acid labeled compound found in the water phase following phenol-water extraction of whole T. denticola ATCC 35404 cells. This compound was purified from the water phase by gel filtration followed by hydrophobic chromatography. Chemical analysis showed that hexadecanoic acid was the predominant fatty acid bound to T. denticola lipoproteins. In the GM-1 strain [3H]-cis-9-octadecenoic acid incorporation was observed in the 116 kDa and 14 kDa bands. dLPP from strain ATCC 35404 caused an enhanced (0.8-8 micrograms/ml) luminol dependent chemiluminiscence (LDCL) effect in human polymorphonuclear neutrophils (PMN) which could be related to protein concentration. The addition of dLPP to PMN together with FMLP at submaximal concentration (1 microM) resulted in a synergistic activation of LDCL. At 21 micrograms/ml, dLPP also induced lysozyme release by the PMN at approximately 30% of the release induced by the chemotactic peptide at 1 microM. In addition, dLPP (21 micrograms/ml) increased additively the release of lysozyme caused by 1 microM FMLP. The release of beta-glucuronidase was not affected. The modulation of neutrophil activity was abolished by preincubation of dLPP with proteinase K. The purified 14 kDa had no effect on either LDCL or exocytosis of lysosomal enzymes of PMN. These data strongly suggest that T. denticola possesses several lipoproteins including outer sheath major oligomeric polypeptides (113-234 kDa) and a lipooligosaccharide of molecular mass of 14 kDa. In addition, an enriched lipoprotein fraction from this oral spirochaete modulates oxygen dependent and independent mechanisms for controlling microorganisms by human PMN.

Antibodies↗
PubMed1997

Immunoreactive gonadotropin-releasing hormone (GnRHir) is associated with vestibular structures in the green anole (Anolis carolinensis).

The distribution of immunoreactive gonadotropin-releasing hormone (GnRHir) in relation to endocrine and behavioral pathways is not well established for lizards. To more completely understand the GnRHir distribution and its possible function in a lizard, we investigated the brain of Anolis carolinensis, a species whose visual courtship displays, mating postures and gonadal cycles are well known. Using antisera that recognize multiple GnRH forms, we observed no GnRHir cells or fibers in the forebrain. In the midbrain, however, GnRHir cells occurred along the medial border of the medial longitudinal fasciculus. These cells appeared to project GnRHir fibers to nuclei of cranial nerve III and IV. In the hindbrain, positive fibers were observed in the area of the vestibular nuclei and dorsal funiculus. These hindbrain fibers were followed to their terminals in the cerebellum. The GnRHir midbrain distribution suggests an association of GnRH with eye movements, whereas the hindbrain distribution suggests a GnRH-vestibular association. The lack of GnRHir in the forebrain of Anolis could reflect the minimal role of the vomeronasal system in mediating reproduction in this species. Thus, our study cannot verify hypothalamic GnRH control of the pituitary in A. carolinensis, but it does indicate GnRH control of oculomotor and vestibular nuclei, which might play a role in Anolis reproductive behaviors.

Animals↗
PubMed1997

Tumor quantitation and monitoring in whole-body planar technetium-99m-sestamibi imaging.

UNLABELLED: We have developed a completely automatic software package to normalize, rigidly register and elastically match serial whole-body planar images from patients with limb tumors. Variations in tumor uptake and size are analyzed and quantitated by the software. METHODS: The software consists of a chain of modules incorporating several automatic algorithms. A rigid registration algorithm aligns images by translation and rotation based on feature points corresponding to the patient's neck and bladder. An elastic matching algorithm generates a grid for each image in a sequence by combining thresholding and local feature analysis in the head, torso and leg regions. A linear warping algorithm then interpolates pixel values and locations to make the grid points in all images coincide with the grid points of one of them (the reference image). All images in a sequence are normalized based on brain uptake. Quantitation of tumor uptake and size is performed in all images using an ROI automatically determined from a single user-selected seed point. RESULTS: The software was tested on four 2-image and one 3-image sequences from five patients (11 images). Quantitative measurements of body contour overlap show an average intrasequence agreement of 73.4%, 78.7% and 91.5% for unregistered, rigidly registered and rigidly registered + matched images, respectively. CONCLUSION: Our method represents an objective, quantitative tool to measure tumor activity in sequential whole-body scintigraphic images, and may help assess tumor response to chemotherapy or radiation therapy.

Algorithms↗
PubMed1997

Safety of topical ear drops containing ototoxic antibiotics.

OBJECTIVE: Topical application of ear drops containing ototoxic antibiotics is commonly used for treatment of middle ear diseases. Because of their ototoxic potential, we evaluated the safety of these ear drops in clinical use. METHODS: The study included 446 children who underwent myringotomy and the insertion of tympanostomy tubes. Three hundred and fifty-eight received preventive treatment after the operation with polymyxin B-neomycin-dexamethasone ear drops for 2 weeks; 88 did not receive any ear drops. Audiometric tests were performed before the operation and up to 3 months following it. RESULTS: All 446 children had a normal sensorineural hearing threshold before and after the operation. There was no sensorineural hearing loss in the group that was treated with ear drops. CONCLUSIONS: Our experience leads us to believe that topical ear drops containing ototoxic antibiotics are clinically safe to use for a short period of time.

Anti-Bacterial Agents↗