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Biomedical subjects

H Cohen

Publications and source records attributed to H Cohen.

At least 361 records · Page 20Linked to original sources
PubMed1989

Pelvic inflammatory disease in adolescents.

Clinical, laboratory, and sonographic data were collected prospectively from 100 female adolescents hospitalized with acute pelvic inflammatory disease (PID). The endocervical isolation rates for Chlamydia trachomatis and Neisseria gonorrhoeae were 44.7% and 36.4%, respectively. In comparison with adolescents with chlamydia-associated PID, those with gonococcus-associated PID had a shorter duration of pain before admission (p less than 0.05), higher mean maximum temperatures (p less than 0.01), and higher leukocyte counts (p less than 0.01). Pelvic ultrasound studies showed adnexal enlargement or tubo-ovarian abscess (TOA) in 85.2% of the patients. Of the 88 adolescents in whom adequate sonograms were obtained, 17 (19.3%) had TOA. In 12 of the 17 adolescents, the abscesses were identified sonographically before being diagnosed clinically. With clinical criteria alone, only the leukocyte count and prior history of PID differed significantly between those with TOA and those with uncomplicated PID. These findings support a more liberal use of pelvic ultrasound studies in teenagers with PID. Our high detection rate of C. trachomatis and the difficulty in predicting the cause of the infection in an individual patient support treating all adolescents with PID with agents effective against both C. trachomatis and N. gonorrhoeae.

Adolescent↗
PubMed1989

Separate cis-regulatory elements confer expression of phosphoenolpyruvate carboxykinase (GTP) gene in different cell lines.

The gene encoding cytosolic phosphoenolpyruvate carboxykinase (GTP) [PEPCK; GTP:oxaloacetate carboxy-lyase (transphosphorylating), EC 4.1.1.32], a key enzyme in gluconeogenesis and glyceroneogenesis, is expressed in tissues that arise from different embryonal origins: the gluconeogenic liver arises from endoderm, whereas the gluconeogenic kidney cortex and glyceroneogenic adipose tissue arise from the mesoderm. To identify the cis-regulatory elements conferring the differential gene expression, PEPCK chimeric genes were transfected into two rat hepatoma cell lines (H4IIEC3 and HTC-M1.1) and mouse adipocytes (3T3F442A), which express the endogenous gene, and into myoblasts and preadipocytes, which do not express it. The results demonstrate that 597 base pairs of the 5' flanking region of the PEPCK gene are sufficient to confer cell-specific gene expression in the PEPCK-expressing hepatoma cells and adipocytes. However, different elements within this 597-base-pair region enhance the gene expression in the hepatoma cells (endoderm) and adipocytes (mesoderm). In the hepatocytes, expression is conferred by two elements--one 5' of position -362 and the other 3' of position -98 with respect to the transcription start site. The region in between these two elements (from -362 to -98), which seems to inhibit the gene expression in the hepatocytes, confers enhanced expression in the adipocytes. Moreover, the distal positive regulatory element of the hepatocytes seems to be orientation and PEPCK promoter dependent. In contrast, the positive regulatory element of the adipocytes seems to act as a more typical enhancer. These results suggest that separate cis-regulatory elements confer cell-specific expression of the PEPCK gene.

Animals↗
PubMed1989

The Developmental and Family Services Unit--a model AIDS project serving developmentally disabled children and their families.

This paper describes a model program that uses a multidisciplinary team to assess the developmental and psychosocial needs of HIV-infected children and their families. The objective of the program is to assess the needs of the children, in order to provide rehabilitative and psychosocial services; and to improve the quality of life by optimizing developmental functioning. The team includes developmental pediatricians, social workers, psychologists, a medical ethicist, physiatrist, psycho-educational specialist, and occupational, physical, and language therapists, each of whom perform complete evaluations. A weekly conference results in the formation of an individual Family Service Plan for each child and family. Forty children have been evaluated and are in program. Family compositions were varied and non-traditional. The disabilities and rehabilitative needs differed as well. The most frequently required services were occupational therapy and psychosocial intervention, to increase parental coping skills in handling disabled, chronically ill children. Children with HIV infection are living longer and will have serious deficits. The need to develop services to address the unique developmental and psychosocial needs of the children and families iS paramount.

Child↗
PubMed1989

Cachectin/tumor necrosis factor-alpha alters red blood cell kinetics and induces anemia in vivo.

Chronic inflammatory diseases are often associated with decreased red blood cell (RBC) mass. The cytokines cachectin/tumor necrosis factor-alpha (TNF) and interleukin 1 (IL 1) are produced by monocytes/macrophages in response to many inflammatory stimuli and have been implicated in the anemia of chronic disease. This study was undertaken to evaluate the mechanisms by which cachectin/TNF, IL 1, or endotoxin induce anemia. Hematologic parameters and RBC kinetics were quantitated in rats given chronic sublethal quantities of either recombinant human cachectin/TNF, recombinant human IL 1 alpha, or Salmonella endotoxin for 7 days. Cachectin/TNF or endotoxin treatment resulted in a 25 or 31% decrease, respectively, in total RBC mass, whereas RBC mass was unchanged by IL 1 administration. Anemia associated with either chronic cachectin or endotoxin administration was characterized by normal mean corpuscular volume, mean corpuscular hemoglobin content, and reticulocyte numbers. [59Fe]RBC survival was significantly shortened in animals given cachectin, IL 1 or endotoxin, but the magnitude of the response was greatest in cachectin/TNF-or endotoxin-treated rats. Although cachectin/TNF-IL 1-, or endotoxin treatment resulted in similar hypoferremia and shortened plasma iron half-life, endotoxin or cachectin/TNF treatment (but not IL 1) significantly reduced the incorporation of plasma 59Fe into newly synthesized RBCs. We conclude that chronic cachectin/TNF administration produces anemia by decreasing RBC synthesis and reducing the life span of circulating RBCs. An endogenous cachectin/TNF response during inflammatory disease may contribute to an associated anemic state, whereas the modestly reduced red cell life span induced by IL 1 does not lead to a net reduction in RBC mass, presumably owing to a preserved RBC synthetic rate.

Anemia↗
PubMed1989

Reversible zidovudine-induced pure red-cell aplasia.

The treatment of patients with AIDS and AIDS-related complex (ARC) with zidovudine is limited by major haematological toxicity. In an open study of the use of zidovudine, 10 out of a total of 81 patients developed a severe anaemia within the first 3 months of treatment. In five of these 10 patients the mean cell volume did not increase but remained within the normal range. Bone marrow examination of three of these five showed a pure red-cell aplasia. In all five patients the anaemia resolved on discontinuation of the drug and in three that were re-challenged, the anaemia recurred. Zidovudine-induced anaemia has usually been reported as macrocytic and megaloblastic, but in our experience erythroid aplasia appears to be a major cause of anaemia occurring within the first 3 months of treatment. The earliest sign is anaemia with a stable or only a slight increase in the mean cell volume (MCV).

Acquired Immunodeficiency Syndrome↗
PubMed1989

Vascular endothelial cell function and ultrastructure in thrombotic microangiopathy following allogeneic bone marrow transplantation.

We report studies on vascular endothelial function and ultrastructure in 2 cases of fatal cyclosporin (CS)-associated thrombotic microangiography following allogeneic bone marrow transplantation (BMT). Spontaneous vascular release of prostacyclin (PGI2) from a vein sample ex vivo was absent, and scanning electron microscopy (SEM) showed surface changes indicative of vascular endothelial damage (case 1). PGI2 release from cultured human umbilical vein endothelial cells incubated with patients' serum in vitro was normal in both cases. Plasma von Willebrand factor (vWF) antigen and ristocetin cofactor activity levels were raised in both patients, 5.06 and 7.02 (case 1) and 3.60 and 2.01 (case 2) (normal ranges 0.59-1.57 and 0.42-1.74 U/ml), respectively, but multimer patterns were normal. The SEM appearances coupled with the absent PGI2 release and raised vWF levels suggest that vascular endothelial damage is central to the pathogenic process in thrombotic microangiopathy following allogeneic BMT but the mechanisms appear to be distinct from those in the haemolytic uraemic syndrome and de novo thrombotic thrombocytopenic purpura. The precise role of CS in this process remains to be identified.

Adult↗
PubMed1989

Lupus anticoagulant, anticardiolipin antibodies, and human immunodeficiency virus in haemophilia.

The prevalence of lupus anticoagulant, using the dilute Russell's viper venom time (DRVT), was determined in 22 patients with mild to severe haemophilia A to see if there was any association with the presence of viral disease. Twelve haemophiliacs (58%) were lupus anticoagulant positive, with a mean patient:control ratio of 1.24 (range 1.15-1.52, normal range 0.84-1.06 which partially corrected with lysed, washed platelets). Nine of these patients were IgG or IgM, or both, anticardiolipin antibody positive and nine were human immunodeficiency virus (HIV) antibody positive, but associations between lupus anticoagulant, anticardiolipin antibodies, and HIV antibody positivity were not significant. Mixing studies of normal plasma and immune depleted factor VIII deficient plasma showed that the DRVT ratio increased when the factor VIII concentration fell below 0.15 IU/ml. There was no significant association between plasma factor VIII concentration and positive DRVT results in haemophiliacs. The addition of porcine factor VIII concentrate produced no correction in eight of the 12 with DRVTs indicative of lupus anticoagulant, suggesting that these were prolonged by antiphospholipid activity. It is concluded that the presence of lupus anticoagulant and anticardiolipin antibodies in haemophiliacs may represent an antiphospholipid response to viraemic challenge, not only to HIV but also to other viral antigens, and that a very low factor VIII concentration may produce a false positive DRVT result.

Adolescent↗
PubMed1989

Impact of race on treatment response and cardiovascular disease among hypertensives.

To determine the effect of race on cardiovascular disease occurrence among treated hypertensive patients, the experience of 1,807 black and 2,962 white hypertensive patients who entered a union/management--sponsored, worksite-based treatment program (1973-1985), was evaluated. Participants had similar socioeconomic profiles, equal access to health benefits, and received standard treatment. Median duration of observation was 42 months. Blacks had 48, and whites 129, of the 177 morbid (strokes and heart attacks) or mortal cardiovascular disease outcomes. At baseline, blacks had more electrocardiographic abnormalities (32% vs. 19%, p less than 0.0001), lower mean cholesterol (218 vs. 230 mg%, p less than 0.001), smoked more (35% vs. 30%, p less than 0.001), and were less likely to be treated for hypertension before entering the program (53% vs. 58%, p less than 0.01) than whites. They were also more likely than whites to belong to unions employing less skilled workers (p less than 0.0001). Overall, all-cause mortality rates between the races were similar. However, total cardiovascular disease morbidity and mortality rates were 10.5 (whites) and 6.4 (blacks) per 1,000 person years (p less than 0.005); the difference was largely explained by higher myocardial infarction rates among older (55 years or older) white men (15.6 vs. 7.5, p less than 0.05). That advantage was not present amongst younger black persons. In fact, blacks lost more years of life before age 65 (102 vs. 64 years/1,000 persons, p less than 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

Oral administration of the prostaglandin enisoprost induces uterine activity and softens the cervix during first trimester pregnancy.

48 patients in the first trimester of pregnancy received a single oral dose of placebo or enisoprost (prostaglandin E1 analogue): 10, 25, 50, 100, 200 or 400 micrograms. Uterine activity was recorded for 1 h before and for 4 h after administration of the study drug with a Millar microtransducer. There was a dose-related increase in mean resting and active pressure, but not in frequency of pressure cycles. At the highest dose used, namely 400 micrograms, all 6 subjects bled. Enisoprost dilated the cervix and any further dilatation required was easy to accomplish.

Abortion, Induced↗
PubMed1989

Current concepts of the vestibular system reviewed: 1. The role of the vestibulospinal system in postural control.

This paper reviews the research findings that support the presence of vestibulospinal reflexes in corrections for head and body instability. Studies of the importance of labyrinthine inputs to the central nervous system organization of eye, head, and body movements demonstrate that the vestibular nuclei are more than a simple relay station for labyrinthine activity. At all levels of the vestibular system beyond the primary vestibular afferents, parallel processing of labyrinthine signals occurs with input from other sensory systems. Thus, output of the vestibular nuclear complex (VNC) is not equivalent to the labyrinthine input. It is the VNC output that influences motor behavior. Various sensory inputs are available to the nervous system to detect and correct postural instability. Most notably, vestibular, visual, and proprioceptive signals contribute significantly to the stabilizing responses in humans. The intent of this paper is to review experimental results rather than to discuss treatment interventions. Wherever possible, conclusions are drawn as to the clinical implications of current research findings.

Ear, Inner↗
PubMed1989

Current concepts of the vestibular system reviewed: 2. Visual/vestibular interaction and spatial orientation.

The vestibular system contributes to the generation of conjugate eye movements, spatial orientation, and postural control. The functional connections of the vestibular end-organs and of the descending vestibulospinal pathways and their importance to postural control were reviewed in the previous paper by Keshner and Cohen (pp. 320-330). This paper reviews the ascending vestibular pathways, the visual/vestibular interactions, and the role of the vestibular system in oculomotor control and spatial orientation.

Eye Movements↗
PubMed1989

[Hepato-splenic hemangiosarcoma: presentation of a clinical case].

A 65-year-old farmer who had used arsenic as a plaguicide for many years developed a hepatosplenic hemangiosarcoma with metastasis in the colonic serosa, mesentery and omental. The tumor was complicated with intraabdominal hemorrhage originated by spontaneous intraperitoneal rupture. The echographic and post-mortem findings are presented. This is the first case of hepatic hemangiosarcoma reported in Uruguay.

Aged↗
PubMed1989

[Acute bilateral glaucoma in an LAV-positive subject].

A bilateral angle-closure glaucoma is described in a homosexual man, with a positive HIV serology. This angle closure is secondary to an anterior rotation of the ciliary body at the scleral spur following development of an inflammatory cilio-choroidal detachment: which is itself connected with a massive uveal-retinal effusion. The cause of this uveal effusion appears to be cytomegalovirus. This unusual syndrome was the initial manifestation of AIDS (Acquired Immune Deficiency Syndrome). A symptomatologic treatment with cycloplegics and prednisolone and a specific one with DHPG (9-1, 3-dihydroxy-2-propoxymethyl guanine), resulted in rapid regression of the local lesions; his overall clinical condition however deteriorated rapidly over two months following onset of syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Campylobacter pylori: associations with antral and fundic mucosal histology and diagnosis by serology in patients with upper gastrointestinal symptoms.

We obtained a sample of serum and mucosal biopsies from the antrum and usually from the corpus of the stomach from 35 symptomatic patients during routine endoscopy to analyze for the relationship between Campylobacter pylori infection, inflammation, and the diagnostic utility of a C. pylori IgG antibody assay. C. pylori was identified prospectively by culture and/or silver stain in gastric biopsies from 24 patients, and the antibody was detected in 19 (79%) of these patients. The antibody assay was positive in three other patients, two of whom had C. pylori, on reexamination of their biopsies. The accuracy of the antibody assay was 83%. Inflammation was detected in all C. pylori-positive antral biopsies (N = 19). However, five (71%) of seven antral biopsies from patients in whom all tests were C. pylori negative, also had inflammation, constituting 17% of all patients with antral gastritis (N = 30). Both antral and fundic mucosa were obtained from 26 patients and, in this group, C. pylori was detected in fundic mucosa from all patients in whom the organism also was present in the antrum (N = 15). In significant (p less than 0.001) contrast to C. pylori-positive antral histology, fundic mucosal histology was normal in 6 (40%) of 15 C. pylori-positive biopsies, all from patients with peptic ulcer disease. We conclude that C. pylori antibody assays will be useful for epidemiological studies and initial screening of the C. pylori status of individual patients. In addition, there is a high concordance rate between antral and fundic mucosa for the prevalence of C. pylori, but in contrast to the probable etiological role of C. pylori in antral gastritis, the organism appears to be only a commensal of fundic mucosa. Moreover, C. pylori infection is not evident in all patients with type B gastritis.

Adult↗