The physician as educator.
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Decision Making↗
Biomedical subjects
I Cohen
Publications and source records attributed to I Cohen.
A case report of meningitis caused by penicillin resistant Streptococcus pneumoniae.
We report a case of invasive disease caused by penicillin resistant Streptococcus pneumoniae. The prevalence of penicillin and multiple drug resistant pneumococcal strains is increasing worldwide. We must assume that the incidence of clinically significant illness caused by these agents will also increase. Based on this assumption, we make suggestions as to how clinicians should alter their therapeutic approach to pneumococcal illness.
Ampicillin Resistance↗
In response to Timothy B. Norbeck.
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Health Services Misuse↗
Paecilomyces lilacinus infection in an immunocompromised patient.
Systemic infections caused by saprophytic fungi are being diagnosed more frequently. We describe the second reported instance of Paecilomyces lilacinus causing infection in an immunocompromised host. The diagnosis and treatment of this unusual pathogen are discussed.
Child↗
Nonenzymatic glycation of human blood platelet proteins.
We studied 11 diabetic patients, all of whom had severe atherothrombotic disease, and 11 normal controls. Overall glycation was assessed by the extent of incorporation of [3H]-NaBH4 into fructosyl lysine separated from whole platelet proteins following aminoacid analysis. Fructosyl lysine represented 5.7% +/- 1.0 S.D. of the total radioactivity in the normal whole platelet samples. Increased glycation was observed in platelets from 5 of the 11 diabetics. Platelet glycation did not correlate with glycation of hemoglobin or albumin. The pattern of glycation of various platelet proteins in whole platelets, as determined by the incorporation of [3H]-NaBH4 into electrophoretically separated proteins did not display selectivity, although myosin and glycoproteins IIb and IIIa showed relatively increased levels of [3H]-NaBH4 incorporation. Artificially glycated platelet membranes exhibited glycation mainly in proteins corresponding to the electrophoretic mobility of myosin, glycoproteins IIb and IIIa.
Amino Acids↗
The effect of peptides and monoclonal antibodies that bind to platelet glycoprotein IIb-IIIa complex on the development of clot tension.
The development of tension in platelet-rich clots is a manifestation of fibrin polymer binding to platelets as well as platelet contractile activity. Arg-Gly-Asp(RGD)-containing peptides of fibrinogen alpha-chain and gamma-400-411 of fibrinogen gamma chain increased clot tension considerably, especially when it developed under isometric conditions. Morphometry revealed increased confluence of oriented fibrin and platelet aggregates. Monoclonal antibodies directed against different epitopes on the glycoprotein IIb-IIIa complex had varying effects on clot tension development. Monoclonal antibodies A2A9 and 7E3 inhibited clot tension while T10 and 10E5 increased it. Since neither peptides nor antibodies affected the platelet actomyosin ATPase activity, their effect on tension must reflect the interaction between platelets and polymerizing fibrin. We conclude that gamma-400-411 and RGD-peptides increase platelet-polymerizing fibrin interaction. This suggests that clot tension requires a platelet receptor for polymerizing fibrin, which is different from the fibrinogen receptor domain required for aggregation. The results with the monoclonal antibodies support this hypothesis.
Antibodies, Monoclonal↗
Advanced primary ovarian carcinoma in pregnancy.
A case of advanced ovarian carcinoma in pregnancy is described. The entity is usually difficult to diagnose; when it does occur, the objective should be to optimize both fetal and maternal outcome.
Adult↗
Evaluation of pulsed Doppler echocardiography for measurement of aortic blood flow in the fetal lamb.
The purpose of this study was to assess the accuracy of a quantitative, range-gated, two-dimensional Doppler echocardiography method for measurement of blood flow in the fetal lamb descending aorta. Comparison was made between this method and measurements determined by an electromagnetic flowmeter placed directly on the aorta in the chest of the fetus. Stroke volume was manipulated acutely either by the removal of blood, the addition of fluid by injection, or by pharmacologic means. During each procedure, descending aortic blood flow was estimated by the Doppler ultrasonography method and compared to the flowmeter recording. The size of the lumen of the aorta determined by echocardiography was correlated with direct measurement during surgery and at autopsy. A total of 359 flow measurements were obtained in 15 fetuses. Doppler ultrasonographic flow studies and electromagnetic flowmeter measurements were found to be highly correlated (r = 0.93). The study demonstrates the accuracy and reliability of the two-dimensional pulsed Doppler echocardiography method for measurement of blood flow in the descending aorta in the fetal lamb.
Animals↗
Control of prostaglandin induced uterine hyperactivity with intravenous ritodrine.
The prostaglandins, F2 alpha and E2, are in extensive local use for the induction of labor. The main concern with oral and vaginal administration is the difficulty in controlling rapidly progressing labor and uterine hyperactivity. Herein we present a case where intravenous ritodrine was given as soon as hyperactivity and fetal heart rate decelerations were detected. With this treatment, the hyperactivity was controlled, fetal heart rate returned to normal and labor progressed normally to the birth of a healthy infant.
Adult↗
Perforated adenocarcinoma of the colon during pregnancy.
Performated carcinoma of the colon in pregnant women is a rare event. Only six cases have been reported in the literature, all except one in the recto-sigmoid. We present a case of perforated adenocarcinoma of the colon located above the peritoneal reflection and discuss the problem of diagnosis and management.
Adenocarcinoma↗
Safe harbors from Medicare fraud and abuse sanctions.
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Crime↗
Major cities and disease crises: a comparative perspective.
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Acquired Immunodeficiency Syndrome↗
Teaching medical students to use simple language when talking with patients.
Physicians know much about health and illness. The information is often complicated and difficult to understand. Part of the physician's task is to help the patient understand the information so that the patient may help himself. The accurate transfer of the information requires that physicians have excellent communication skills. One such skill is the ability to use language which is easily understood by the patient. This study suggests that, after preclinical medical students assume a formal teaching role in secondary schools, they are more likely to use simpler language when talking with patients during their final undergraduate year.
Communication↗
Comparative accuracy of clinical tests for diagnosis and prognosis of coronary artery disease.
The discriminant accuracy of 14 variables derived from clinical evaluation, cardiac fluoroscopy, exercise electrocardiography, thallium scintigraphy and radionuclide angiography was assessed with respect to the diagnosis of angiographic coronary artery disease (CAD) among 607 patients undergoing coronary angiography, and with respect to the prognosis of subsequent cardiac death or nonfatal infarction among 4,104 patients followed for 1 year after testing. Discriminant accuracy (quantified in terms of the area under a receiver-operating characteristic curve for each variable) ranged from 50 to 73% for diagnosis, and from 54 to 77% for prognosis. Although there was a great deal of variability from test to test, variables representing direct or indirect manifestations of myocardial ischemia tended to correlate better with prognosis. Thus, variables derived from radionuclide angiography and thallium scintigraphy tended to have more prognostic accuracy than diagnostic accuracy, while fluoroscopy tended to have more diagnostic accuracy than prognostic accuracy. The pattern associated with clinical evaluation and exercise electrocardiography was less discernable. Accordingly, the accuracy of noninvasive tests with respect to diagnosis and prognosis of CAD should be separately determined based on individual empiric observation.
Adult↗
Typing of HLA class II and class I antigens using PHA-activated, IL-2-propagated T lymphocytes.
We describe here a simple procedure, by which HLA class II antigens can be accurately and reliably identified in those patients where there is minimal or absent expression of HLA-DR,DQw antigens on B cells, or when the total number of leukocytes recovered from the patients do not permit reliable typing. Ficoll-Hypaque-separated peripheral blood mononuclear leukocytes, fresh or cryopreserved, were activated by PHA and then propagated in IL-2-containing medium until enough cells for typing were obtained (usually 7-14 days). At this stage, the cultured cells were shown to be primarily T cells (greater than 90% CD3+). Since the activated T cells propagate in the presence of IL-2, even a small number (10(4] of fresh or cryopreserved patients' cells suffice for this protocol. To date we have been able to successfully HLA-DR,DQw type 34/34 bone marrow transplantation candidates and 12/12 long-term dialysis patients, who were untypable using fresh cells. HLA-DR,DQw antigens on activated T cells from normal individuals were identical to those found on their uncultured B cells. In addition, class I antigens that were undetectable on the uncultured cells of one patient could be identified on activated T cells. The HLA antigens identified on the patients' activated T cells were confirmed by phenotypic analysis of cells from family members.
B-Lymphocytes↗
[Premature contractions and Chlamydia trachomatis infection].
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Adult↗
Transplacental effects of vitamin A on fetal bones in mice--follow-up studies on postnatal recovery.
Pregnant mice were injected with pharmacological doses of vitamin A during days 11-19 of gestation with the purpose of studying the long bones of offspring up to the age of 1 week. Tibiae were collected for routine light microscopic examination and tranmission electron microscopic examination. In addition, biochemical studies were conducted to determine the calcium, phosphorus, and magnesium content as well as the hydroxyproline and protein content of the bones. Treatment with vitamin A resulted in reduced weight and length of the long bones, as well as the presence of excessive calcification throughout the hypertrophic zone of the cartilaginous epiphyses. Matrix vesicles, many of them containing hydroxyapatite crystals, were observed and found to be distributed within the cartilaginous epiphyses in a similar pattern as in untreated control mice offspring, but mineral crystals were also observed unassociated with the matrix vesicles. The calcium, phosphate, magnesium, and hydroxyproline content was reduced in the vitamin A offspring. However, the percentage of these minerals expressed per dry weight bone was higher than in controls, verifying the morphological findings that although vitamin A inhibits bone growth, it enhances calcification in the growth plate.
Animals↗