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Biomedical subjects

H Meyers

Publications and source records attributed to H Meyers.

At least 19 recordsLinked to original sources

A multi-state outbreak of Salmonella serotype Thompson infection from commercially distributed bread contaminated by an ill food handler.

Foodborne transmission is estimated to account for 95% of non-typhoidal Salmonella infections reported in the United States; however, outbreaks of salmonellosis are rarely traced to food handlers. In August 2000, an increase in Salmonella serotype Thompson infection was noted in Southern California; most of the cases reported eating at a restaurant chain (Chain A) before illness onset. A case-control study implicated the consumption of burgers at Chain A restaurants. The earliest onset of illness was in a burger bun packer at Bakery B who had not eaten at Chain A but had worked while ill. Bakery B supplied burger buns to some Chain A restaurants in Southern California and Arizona. This outbreak is notable for implicating a food handler as the source of food contamination and for involving bread, a very unusual outbreak vehicle for Salmonella . Inadequate food-handler training as well as delayed reporting to the health department contributed to this outbreak.

Adolescent↗

No local recurrence of enchondroma after curettage and plaster filling.

INTRODUCTION: The most common treatment of enchondromas is curettage (with or without adjuvant therapy) followed by cancellous bone grafting. To avoid donor-site morbidity of the iliac crest, we applied plaster of Paris as a bone defect filler after curettage of enchondromas. MATERIALS AND METHODS: We treated 19 enchondromas of the hand and foot in 19 patients (mean age 40 years, range 21-79 years) with curettage and filling of the cavity with sterile plaster of Paris (calcium sulphate/phosphate) tablets. RESULTS: The diagnosis was histologically confirmed in all cases. After a mean follow-up of 53 months (range 15-139 months), the mean functional Muskuloskeletal Tumor Society Score was 29.1 points (97%; range 28-30). There were no local recurrences although adjuvant therapy was not utilized. CONCLUSION: Plaster of Paris appears safe and effective as a bone-filling substance after curettage of enchondroma.

Adult↗

Antiviral pressure exerted by HIV-1-specific cytotoxic T lymphocytes (CTLs) during primary infection demonstrated by rapid selection of CTL escape virus.

The HIV-1-specific cytotoxic T lymphocyte (CTL) response is temporally associated with the decline in viremia during primary HIV-1 infection, but definitive evidence that it is of importance in virus containment has been lacking. Here we show that in a patient whose early CTL response was focused on a highly immunodominant epitope in gp 160, there was rapid elimination of the transmitted virus strain and selection for a virus population bearing amino acid changes at a single residue within this epitope, which conferred escape from recognition by epitope-specific CTL. The magnitude (> 100-fold), kinetics (30-72 days from onset of symptoms) and genetic pathways of virus escape from CTL pressure were comparable to virus escape from antiretroviral therapy, indicating the biological significance of the CTL response in vivo. One aim of HIV-1 vaccines should thus be to elicit strong CTL responses against multiple codominant viral epitopes.

Acquired Immunodeficiency Syndrome↗

Ethics rounds at the nursing home: an alternative to an ethics committee.

The increased attention in US medicine to medical ethics reflects in large part the "new" demography of a growing elderly population and the conflict of whether decisions regarding medical care should be based on cost-effectiveness or "human-effectiveness." Currently, about 40 percent of the nation's elderly end up in nursing homes where they confront ethical and legal dilemmas that would not arise in their own homes. In the nursing home, difficult medical-ethical decisions generally rely on two approaches: the often used but frequently invalid concept of informed consent and little used ethics committees. At The Jewish Home and Hospital for Aged in New York City we have developed a program of "ethics rounds" as an alternative to ethics committees. We conduct the rounds in the open style of a forum or clinical conference rather than with the aura of a decision-making group. We encourage the participation of patients and family and seek to educate the staff, any one of whom may choose to attend. The rounds consist of a multidisciplinary case presentation, an interview of patient and/or family, a discussion by the staff, and an overview by an ethicist. Staff response to the educational and interdisciplinary aspects of the rounds has been remarkably positive.

Ethical Review↗

Preoperative radiation therapy for rectal cancer. An effective therapy in need of a clinical trial.

Sixty patients with locally advanced adenocarcinoma of the rectum have been treated with preoperative high-dose pelvic irradiation in an attempt to improve operability and increase local control. Fifty-six patients showed no evidence of distant metastases at surgery and their records have been analyzed with respect to recurrence patterns, survival, and complications. The results have been compared with those of a similar analysis of 106 patients treated with curative surgery alone. There was a statistically significant improvement in local control between groups, with 16% of patients in the radiotherapy group having a component of local failure compared with 40% in the surgery group. A dose response was observed, with 67% local control at 4000 rad (4000 cGy) and 91% local control at 5000 rad (5000 cGy). Despite the more advanced clinical stage of the irradiated patients, no significant difference in survival was seen between groups, with a five-year survival rate of 52% in the irradiated patients and 48% in patients treated by surgery alone. Preoperative high-dose radiotherapy was well tolerated, with a 5% incidence of major complications in both groups.

Adenocarcinoma↗

Behavioral treatment of myopia: refractive error and acuity changes in relation to axial length and intraocular pressure.

A controlled outcome study on the effects of behavioral training on several measures of visual performance was conducted. Twenty-nine myopic subjects received complete optometric evaluations before being randomly assigned to one of three experimental groups. One treatment group received a behavioral training program with a feedback and reward component, another group received behavioral training without feedback and reward, and the third group was the no-treatment control group. In addition to measuring the effects of training on visual acuity and refraction, independent measures of axial length and intraocular pressure (IOP) were obtained for all subjects before and after treatment. An analysis of covariance indicated that axial length plays a significant role in mediating the effects of training.

Adult↗

Full dentition periodontal surgery utilizing intravenous conscious-sedation. A report of 5200 cases.

A brief survey of the techniques of intravenous conscious-sedation for full dentition, all inclusive periodontal surgery is presented as used for 5200 patients. Diazepam, meperidine, and methohexital were employed in 3700 cases while diazepam plus methohexital was used in the remaining 1500 cases. Local infiltration and nerve block anesthesia were employed in all of the cases. Patients of wide age range having a physical status of I, II, or III underwent total periodontal surgery in one appointment. No major complications were noted. Patient and surgeon acceptance was excellent.

Anesthesia, Dental↗

Preliminary studies using electron radiography for mammography.

An electron radiography mammography system was used for phantom studies and to obtain 230 craniocaudal view patient studies, of which 140 were compared to xeroradiographs for their ability to visualize 7 features of diagnostic importance. The average exposure of the electron radiographs was 89 mR. The technique was considered equal or superior to xeroradiography in 58% of the compared diagnostic features, while patient dose was reduced.

Breast Neoplasms↗

Effects of a token reinforcement system on journal reshelving.

A token reinforcement program involving two levels of token value and backup reinforcers to increase journal reshelving behavior in a large university library was experimentally evaluated. Results showed that instructions (in which signs asked users to reshelve journals) had no impact. By contrast, token reinforcement contingent on reshelving behavior led to a marked increase in journals reshelved. A return to instructions-only conditions, when data were corrected for library usage, showed an increase in unreshelved journals over the token reinforcement period, though the increase was not to baseline levels. For the next 11 months, library staff maintained a modified token program. Follow-up data collected after that interval showed that number of unreshelved journals remained markedly lower than levels at baseline and the first instructions-only period, though they were slightly higher than at the token reinforcement period. Token reinforcement of the variety employed in this study constitutes an efficient, economical means of changing the behavior of library users who fail to reshelve books and journals.

Journal Article↗

Does this patient have primary open angle glaucoma?

An overview on the literature on primary open angle glaucoma that has appeared in the optometric and ophthalmological journals during the past ten years indicates a continuing reevaluation, and perhaps at times a seeming disagreement, regarding the parameters of this disease. Opinions have varied, and still do, on such matters as to whether or not the diagnosis of glaucoma is contingent upon a field defect, the existence of low tension glaucoma, the ramifications of ocular hypertension, what constitutes a glaucomatous appearance of the disc, field defects versus the appearance of the disc, field defects versus the appearance of the disc, and what constitutes an early glaucomatous field defect. Voices have been raised in some quarters that claim that waiting for a field defect to develop may not be in the best interest of the patient, and that the glaucoma suspect should be identified as early as possible. Treatment before the development of a field defect is enjoying support from some glaucoma authorities. Good clinical practice will permit the conscientious optometrist to identify those patients who have very early signs of this disease.

Diabetes Complications↗

Anatomical site and size of 222 early asymptomatic oral squamous cell carcinomas: a continuing prospective study of oral cancer. II.

The site and size of 222 asymptomatic, primarily erythroplastic, cancers of the oral mucosa in 161 patients have been prospectively documented. Of 207 intraoral lesions (excluding 15 of the lip), 201 (97.1%) were found in three locations; floor of the mouth (101), ventral or lateral tongue (36), and soft palate complex (64). Of the 101 in the floor of the mouth, 73 occurred in the anterior portion with 33 involving the papilla at exit of Wharton's Duct (submaxillary gland). Of the cancers 84.2% were 2 cm or less and 41.9% were 1 cm or less. Of the lesions 2 cm or less 70.6% were invasive carcinoma. Minimal size does not preclude invasiveness. In view of the apparent predilection of oral carcinoma for particular sites (where there is no obvious agent), rather than random occurrence, the three aforementioned sites are designated as high risk areas which deserve particular scrutiny in an examination of the oral cavity. It is incumbent upon the clinician to biopsy all asymptomatic, persisten (14 days or more) mucosal aberrations in the high risk areas, especially those with erythroplastic components, regardless of size.

Carcinoma, Squamous Cell↗

Clinical and theoretical considerations of a patient with narrow angles and shallow anterior chambers.

Clinicians must always be on the alert to identify those individuals who appear to be anatomically disposed to narrow angle glaucoma. However, it is not axiomatic that these individuals can be provoked into an attack even if a history of subacute attacks exists. In this paper, and in one other to follow, the case histories of several interesting patients that were seen by the author for routine eye examinations will be discussed. The intent of the papers is to demonstrate that the diagnosis of glaucoma, existent or potential, can be quite time consuming and is dependent on far more than just tonometry.

Female↗

Individual variation in inosine triphosphate accumulation in human erythrocytes.

Erythrocytes from 5% of a normal population accumulated relatively high amounts of radioactive inosine triphosphate (i.e., greater than 70 nmoles/10(10) cells in 2 hr) when they were incubated with [14C]hypoxanthine. The incidence of this characteristic in a mentally retarded population was 16%. Inosine triphosphate was synthesized from [14C]hypoxanthine, but not from [14C]adenine or [14C]guanine. The metabolism of [14C]adenine and [14C]guanine was the same in erythrocytes that accumulated "normal" and "high" amounts of inosine triphosphate. Inosine triphosphate did not accumulate in leukocytes.

Adenine↗