The American Sign Language/English Studies Project: a progress report.
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Adult↗
Biomedical subjects
H Cohen
Publications and source records attributed to H Cohen.
The changing world of group health insurance.
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Competitive Bidding↗
How to read a research paper.
A research paper includes several sections, each section having a particular purpose and containing a particular kind of information. This paper is a guide to reading a research paper. It describes the prototypical research paper and explains the purpose for each section. Issues for the astute reader to note are indicated and illustrated with examples from a research paper published in this issue of the journal.
Reading↗
The clinical significance of Campylobacter pylori.
Campylobacter pylori has recently been isolated from gastric mucosal biopsy specimens. Campylobacter pylori has many attributes in common with other campylobacters but it may represent a new genus. It produces abundant quantities of urease, and this property has been used to develop a rapid diagnostic test. The organism is found predominantly beneath the gastric mucus layer that lines the surface epithelium of the stomach. Infection with C. pylori causes an acute histologic gastritis which may become chronic. The bacterium is the etiologic agent in type-B gastritis. Prevalence of the organism in asymptomatic persons appears to be age related. Campylobacter pylori is found commonly in patients with peptic ulcer disease, always in association with chronic gastritis. Eradication of the organism is associated with healing of the gastritis and a lower relapse rate in duodenal ulcer disease. A role for the organism in other upper gastrointestinal diseases is unproven.
Animals↗
Fate of polyoma origin of replication after its direct introduction into mice.
Recently we have developed a method for direct introduction of calcium phosphate-precipitated DNA into newborn rats. To examine whether the foreign DNA can replicate, a plasmid containing a polyoma origin of replication was injected into newborn mice. The plasmid was found intact in liver and spleen and able to transform bacteria. The foreign DNA had disappeared by the seventh day after injection. Yet, the plasmid DNA containing the polyoma origin of replication had undergone replication in both the liver and the spleen.
Animals↗
Purification and characterization of human plasma glutathione peroxidase: a selenoglycoprotein distinct from the known cellular enzyme.
Glutathione peroxidase (GSHPx), (glutathione:H2O2 oxidoreductase, EC 1.11.1.9) was purified to homogeneity from human plasma. This resulted in a 6800-fold purification of the enzyme with a 2.8% yield. The purification process involved ammonium sulfate fractionation, DEAE-cellulose batch and column chromatographies, hydroxyapatite, and Sephadex G-200 and DEAE-Sephadex A-25 chromatographies. The major peak on DEAE-Sephadex A-25 column chromatography was found to be homogeneous on polyacrylamide gel electrophoresis in the presence or absence of sodium dodecyl sulfate (SDS). Relative mobility in nondenaturing polyacrylamide gel electrophoresis at pH 8.2 was 0.5 for the purified enzyme as detected by both protein staining and enzyme activity compared with 0.38 for erythrocyte GSHPx. The molecular weight of the plasma enzyme as determined by gel filtration was found to be approximately 100,000. SDS-gel electrophoresis of the plasma enzyme gave a subunit molecular weight of approximately 23,000. This suggests that the plasma enzyme exists as a tetramer in its native state, similar to that seen for the erythrocyte enzyme, but with slightly different mobility on SDS-gel electrophoresis. Plasma GSHPx, like the erythrocyte enzyme, was found to contain approximately four atoms of selenium per mole of protein. Utilizing iodinated concanavalin A, it was found that plasma GSHPx, but not the erythrocyte GSPx, is a glycoprotein. Purified plasma enzyme catalyzes both the reduction of tertiary butyl hydroperoxide and hydrogen peroxide. The apparent Km of plasma GSHPx for GSH is 5.3 mM and for tertiary butyl hydroperoxide it is 0.57 mM. Copper, mercury, and zinc strongly inhibit the enzyme activity of plasma GSHPx. Rabbit antibodies directed against the human erythrocyte GSHPx do not precipitate the enzyme activity of the purified plasma enzyme. Radioimmunoassay utilizing erythrocyte GSHPx and anti-erythrocyte GSHPx antibodies showed that less than 0.13% of the antigenically detectable protein is found in the purified GSHPx from plasma.
Cations, Divalent↗
Protection by misoprostol against naproxen-induced gastric mucosal damage.
The protective effect of misoprostol against naproxen-induced gastric mucosal damage was the subject of a double-blind, randomized, parallel-group study. Thirty-two healthy subjects were treated with naproxen 500 mg twice daily and either misoprostol 200 micrograms or matching placebo twice daily for seven days. Gastroscopy was performed before and after the treatment period and the mucosa was assessed for erosive and petechial lesions according to a predetermined scoring scheme. Of 25 evaluable subjects, 12 were treated with misoprostol and 13 were treated with placebo. The mean overall endoscopic score was 1.24 +/- 0.09 with placebo and 0.26 +/- 0.07 with misoprostol. The difference, 0.98, was highly significant (p less than 0.001), with 95 percent confidence limits of 0.74 to 1.22. All subjects in the placebo group had higher mean scores than any in the misoprostol group. The scores for erosive and bleeding lesions in the antrum and corpus/fundus of the stomach were all reduced by administration of misoprostol. In conclusion, the results clearly demonstrate that misoprostol protects the gastric mucosa of humans against naproxen-induced damage.
Adolescent↗
Influence of proteinuria on vascular disease, blood pressure, and lipoproteins in insulin dependent diabetes mellitus.
Patients with insulin dependent diabetes mellitus who develop proteinuria may die prematurely, whereas those who do not develop this complication have a comparatively normal life span. The excess mortality in diabetics with proteinuria is from cardiovascular as well as renal disease, but the reason is unclear. Risk factors for vascular disease were therefore assessed in 22 insulin dependent diabetics with proteinuria, but not renal failure, who were matched for sex, age, duration of diabetes, and glycated haemoglobin (HbA1) values with a similar number who had normal urinary albumin excretion rates. Macrovascular disease (ischaemic heart disease and peripheral vascular disease) was present in 10 patients with proteinuria but in only three with normal albumin excretion rates, and proliferative retinopathy was detected in 11 and four patients in the two groups. There was no significant excess of smokers in the group with proteinuria. Blood pressure was, however, higher in the patients with proteinuria--mean systolic pressure 161 (SD 18) mm Hg compared with 135 (19) mm Hg (95% confidence interval of difference between means 15 to 38 mm Hg); mean diastolic pressure 90 (SD 12) mm Hg compared with 79 (15) mm Hg (confidence interval 3 to 19 mm Hg). The concentration of serum high density lipoprotein (HDL) cholesterol isolated by precipitation was lower in the patients with proteinuria (confidence interval 0.02 to 0.41 mmol/l). Their concentration of HDL2 cholesterol isolated by ultracentrifugation was also decreased (confidence interval 0.02 to 0.40 mmol/l), whereas HDL3 cholesterol tended to be increased (confidence interval -0.01 to 0.23 mmol/l). There was also a trend for serum cholesterol concentrations to be higher in the presence of proteinuria (confidence interval -0.39 to 1.20 mmol/l). The aggregation of risk factors for atherosclerosis in insulin dependent diabetes mellitus complicated by proteinuria helps to explain the increased prevalence of ischaemic heart disease and peripheral vascular disease reported in these patients. Early renal disease in insulin dependent diabetes may have an important role in hypertension and altered lipoprotein metabolism.
Adult↗
The use of pelvic ultrasonography in the evaluation of adolescents with pelvic inflammatory disease.
To evaluate the use of pelvic ultrasonography in the diagnosis and management of female adolescents with pelvic inflammatory disease (PID), sonograms of 60 patients with PID were compared with those of 40 age-matched controls. Sonograms were evaluated for adnexal volume, adnexal adherence, uterine size, and the presence of cul-de-sac fluid. Eleven (19.3%) of the 57 patients with PID, in whom adequate sonograms were obtained, had tubo-ovarian abscesses; in seven of these patients, the abscesses were diagnosed ultrasonographically before suspected clinically. Even in those patients without tubo-ovarian abscesses, the mean (+/- SD) adnexal volume in the PID group was significantly larger than that of the control group (11.0 +/- 6.8 cm3 vs 5.2 +/- 2.7 cm,3 respectively). Adnexal adherence, uterine size, and the presence of cul-de-sac fluid were not useful in differentiating patients with PID from normal controls. Pelvic ultrasonography can be a useful adjunct in the diagnosis and management of PID in adolescents and may, in some instances, provide diagnoses in the absence of clinical findings.
Adolescent↗
Blue rubber bleb nevus syndrome presenting with recurrences.
An unusual patient with blue rubber bleb nevus syndrome is presented. At birth a single abdominal wall hemangioma was noted, and over a 21-year follow-up the full syndrome developed, including many cutaneous and intestinal lesions and anemia. Our long-term follow-up of this patient allows an understanding of the natural history of this condition, especially regarding recurrence of lesions after excision.
Abdominal Neoplasms↗
Cecal perforation following fiberoptic flexible sigmoidoscopy.
The superiority of flexible to rigid sigmoidoscopy is resulting in its increasing utilization by primary care physicians. The procedure is relatively risk-free, but complications including perforations may occur. An unusual case of cecal perforation as a result of flexible sigmoidoscopy is presented in order to draw attention to this complication.
Cecum↗
The effects of cefotetan disodium on haemostasis.
A 7-day course of intravenous cefotetan disodium was given to nine patients. No significant changes were observed in haematological or biochemical parameters and serum vitamin K1 levels, prothrombin times, factor VII levels, thrombin times and activated partial thromboplastin times remained within the normal ranges throughout the treatment period in all patients. There was no evidence of clinical bleeding in any patient although in two the bleeding time was prolonged up to 13.0 min after 7 days' therapy. Notably, adenosine-5-diphosphate (ADP)-induced platelet aggregation responses were significantly increased (P less than 0.05) at the end of the treatment period. These data indicate that cefotetan disodium at a dose of up to 4 g daily can be used without risk of a bleeding diathesis. In situations associated with vitamin K1 deficiency, potential prolongation of the prothrombin time should be avoided by prophylactic vitamin K1 administration.
Adult↗
Acute thrombosis of subclavian artery during CPR.
The case of a 73-year-old man who developed acute thrombosis of the left subclavian artery during CPR is presented. The patient was known to have severe chronic obstructive lung disease, hypertension, coronary artery disease, and severe peripheral vascular disease. He was admitted with ventricular fibrillation. CPR was successful, and the ECG revealed acute extensive anterior and recurrent inferior wall myocardial infarctions. Soon after, acute occlusion of the left subclavian artery was diagnosed. Thrombectomy was performed and circulation was restored to the left upper limb. The patient died 12 hours later from severe bradycardia and asystole.
Aged↗
Low serum cobalamin levels occur frequently in the acquired immune deficiency syndrome and related disorders.
Low serum cobalamin levels in 10 patients with AIDS or AIDS-related complex led us to also prospectively survey 40 homosexual men in our AIDS clinic. 8 of the latter (20%) had low cobalamin values. We found no evidence of megaloblastic changes in the blood or bone marrow. Assessment disclosed malabsorption of cobalamin in only 1 of 6 cases tested for it. 6 of the patients were treated with cobalamin and had no hematologic response. It appears that low serum cobalamin levels in AIDS and related disorders do not usually represent overt cobalamin deficiency. While malabsorption is occasionally responsible for the low cobalamin level, in most cases the cause is unknown and may reflect a serum abnormality similar to that in multiple myeloma. AIDS and related disorders should be considered in the differential diagnosis of unexplained low cobalamin levels.
AIDS-Related Complex↗
Thyroid-hypophyso-hypothalamic axis of the genetically hypoprolactinemic rats (IPL nude rats).
In order to evaluate thyrotropin function in the genetically hypoprolactinemic rat, (IPL nude), we measured by radioimmunoassay TRH hypothalamic content, pituitary TSH content and serum TSH, T3, T4, both in IPL nude and control rats at various times over the 24-hour period. Compared to normal rats, the hypothalamic TRH content in the IPL nude rat showed similar variations during the day, whereas a slight increase was observed during the night characterized by a significant difference at 20.00 h. Pituitary weight and TSH content were doubled in IPL nude rats; however, when expressed as micrograms TSH/micrograms protein or DNA, a significant increase was found only at 17.00 and 20.00 h. Serum TSH and total serum T3, T4 depicted similar variations although they were minute but nonetheless significant modifications, i.e. an increase of TSH at 17.00 and 23.00 h and a decrease of T4 at 11.00 h. However, only FT4 concentrations (and not-FT3) were slightly but significantly decreased in IPL rats over the experimental times. In conclusion, the slight increase in hypothalamic TRH and pituitary TSH contents and the absence of main associated variations of serum TSH, T3 and T4 do not lend support to the hypothesis that TRH could be the cause of the hypoprolactinemia of these rats. On the contrary, the observed thyrotropin axis variations might be rather interpreted as the consequence of it.
Animals↗
AIDS and self-organization among intravenous drug users.
Gays and intravenous (i.v.) drug users are the two largest risk groups for AIDS. Gays, unlike drug users, have formed many organizations to deal with AIDS. Data are presented indicating that gay individuals have more risk-reducing behavioral changes than have i.v. drug users. It is also shown that i.v. drug users are more likely to protect themselves if their acquaintances do so. It is suggested that collective self-organization can lead to peer support for risk reduction and that this can help i.v. drug users to reduce their risks on an ongoing basis. Difficulties that face i.v. drug users' attempts to organize collectively and examples of i.v. drug user collective organization to deal with AIDS and other problems are discussed.
Acquired Immunodeficiency Syndrome↗
Epidural hydromorphone: a double-blind comparison with intramuscular hydromorphone for postcesarean section analgesia.
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Cesarean Section↗
Development of AIDS, HIV seroconversion, and potential co-factors for T4 cell loss in a cohort of intravenous drug users.
A cohort of 334 intravenous (IV) drug users from New York City drug treatment programs were followed over a mean 9-month period. Among the 165 who were seropositive at enlistment, four developed clinical AIDS, for an annual rate of 3%. Elevated IgA was a significant predictor of developing AIDS. Among 72 subjects who were initially seronegative and who were re-interviewed, four were seropositive at follow-up, for a seroconversion rate of 7% per year among seronegatives. Among seropositive subjects who did not develop AIDS or fatal AIDS related complex (ARC), continued drug injection was associated with rate of T4 cell loss, and there was a non-significant trend for males to lose T4 cells more rapidly than females. While it was not possible to distinguish the mechanism underlying the relationship between continued drug injection and T4 cell loss, seropositive IV drug users should be warned that continued injection may lead to increased HIV-related immunosuppression as well as, if injection equipment is shared, risking viral transmission to others.
Acquired Immunodeficiency Syndrome↗