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Biomedical subjects

I Cohen

Publications and source records attributed to I Cohen.

At least 127 records · Page 7Linked to original sources
PubMed1998

The use of single-group sessions in discharge planning.

In recent years we are witnessing a growing demand in the health care system for improved economic efficiency and reduction in length of hospital stay. These facts have increased the pressure for planning effective short-term therapeutic methods that will assist the patient's return to family and community life. This situation led the social workers in the internal medicine units to initiate one-session group meetings for patients and families that would provide a response to the distress of primary caregivers and increase access to social work intervention of families with discharge needs. A model of single-sessions intervention, which had been experienced for the first time in the Sheba Medical Center at Tel-Hashomer, will be presented and evaluated. The presented intervention enabled to reduce anxiety and increase the capabilities of family members to organize and cope with the situation. The intervention also enabled to identify families in need, to emphasize more on the discharge planning as part of the social work function in the hospital setting and help the multi-disciplinary team in the discharge process.

Adaptation, Psychological↗
PubMed1998

Epidemiology and clinical consequences of drug-resistant tuberculosis in a Guatemalan hospital.

STUDY OBJECTIVE: To determine the epidemiology and clinical consequences of drug-resistant TB in Guatemala. DESIGN: A prospective study conducted for 12 months. SETTING: A thoracic referral hospital in western Guatemala. PATIENTS: Three hundred and seventy-six patients with confirmed TB. RESULTS: Of 376 confirmed cases, 335 (89%) were culture-positive. Tests of drug sensitivities to four first-line antituberculous drugs were performed in 172 (51%) of the culture-positive cases. Fifty-one patients (30%) were resistant to at least one antimicrobial agent, and 26 (15%) were resistant to at least two drugs. In a multivariate model of clinically available patient characteristics, only cavitary disease (odds ratio=2.1; 95% confidence interval, 1.1-6.6) and a history of taking anti-TB medication for >2 weeks (OR=3.0; 95% CI, 1.5-10.3) were independent predictors of resistance to two or more anti-TB agents. Resistance to two or more anti-TB drugs was the single independent predictor of treatment failure (OR=6.4; 95% CI, 2.3-17.8). Twenty-four of 172 patients (14%) who denied having received prior anti-TB therapy were infected with resistant organisms, suggesting ongoing transmission of drug-resistant strains. Although 84% (69 of 82 cases) of patients with fully susceptible organisms and 89% (17 of 19 cases) with singly resistant organisms were cured, only 45% of patients (10 of 22 cases) infected with organisms resistant to two or more agents were successfully treated. CONCLUSIONS: At this sentinel site for complicated TB, a substantial subset of cases who are infected with drug-resistant bacteria cannot be easily identified or treated.

Adolescent↗
PubMed1997

Incremental prognostic value of adenosine stress myocardial perfusion single-photon emission computed tomography and impact on subsequent management in patients with or suspected of having myocardial ischemia.

We examined 1,159 consecutive patients who underwent adenosine stress dual isotope single-photon emission computed tomography (SPECT) and had follow-up performed at a mean of 27.5 +/- 9.1 months (94% complete) for hard events (cardiac death and myocardial infarction) and referral to cardiac catheterization after nuclear testing. During follow-up, 120 hard events occurred (11.0% hard event rate; 72 cardiac deaths [6.7% cardiac death rate] and 57 myocardial infarctions [5.3% myocardial infarction rate]). Cox proportional hazards analysis revealed that nuclear testing added incremental value after adjusting for clinical and historical variables (global chi-square increased 13 to 98 for cardiac death as the end point, global chi-square increased 19 to 105 for hard events as the end point; p <0.0001 for both). Kaplan-Meier analysis demonstrated that after clinical risk stratification of the patient population, the results of nuclear testing were further able to significantly stratify both low- and intermediate- to high-risk patients. Patients with both normal and mildly abnormal scans were at low risk of cardiac death (<1% cardiac death per year of follow-up) and the risk of events increased significantly with worsening scan result. Multivariable analysis revealed that the only predictor of referral to catheterization was the extent and severity of reversible defect present on the scan. Referral rates to early catheterization were very low in patients with normal scans and increased significantly as a function of worsening scan results. In patients who underwent myocardial perfusion SPECT using adenosine stress, the results of nuclear testing yielded incremental prognostic information and clinically relevant risk stratification. Referring physicians predominantly utilized nuclear information when referring patients to catheterization after nuclear testing and do so at rates comparable with those after exercise SPECT despite the higher risk of events in patients undergoing pharmacologic stress.

Adenosine↗
PubMed1997

[Osteoid osteoma of the patella].

Osteoid osteoma is a primary, benign, bone tumor with a typical X-ray appearance. The diagnosis is usually straightforward when it involves the long bones of the leg. However it may occur in unusual locations, such as in flat and cancellous bones. The following case demonstrates the difficulty in diagnosing it in an extremely rare site. A 25-year-old woman with long-standing anterior, right knee pain had had 3 interventions: 2 diagnostic arthroscopies and a distal, femoral biopsy. Since there had been no improvement in her condition, the diagnosis of osteoid osteoma of the patella was suggested, supported by recent X-ray and scintigraphic findings. This rare condition was confirmed by biopsy of the upper pole of the patella, a procedure that was followed by complete recovery. 6 years later, she is now completely free of pain and has no clinical or X-ray evidence of recurrence. Review of the literature revealed only 5 previously reported cases of osteoid osteoma of the patella. All were diagnosed relatively late and in 1 the tumor was diagnosed only after total patellectomy. Diagnosis of these rare cases that mimic much more common causes of patello-femoral pain demands a high index of suspicion.

Adult↗
PubMed1997

Repressor assembly at trp binding sites is dependent on the identity of the intervening dinucleotide between the binding half sites.

The interaction of trp repressor with its DNA targets is unusual in that specific recognition in this system does not rely exclusively on direct hydrogen bonds to the DNA bases that are crucial for sequence-specific recognition. It has been suggested that trp operators are mainly recognized by water-mediated interactions and by structural recognition of DNA deformability. Here we study the effect of the central dinucleotide on the mode of interaction of the trp repressor with its binding sites. The study was carried out on two consensus sequences: (1) trpTA, the consensus of naturally occurring trp binding sites, containing a T-A step between the two hexameric half-site sequences, ACTAGT; (2) trpAC, a consensus sequence derived from a functional selection study, containing a central A-C step. We show that the identity of the central dinucleotide does not affect the interaction of the first trp repressor molecule with the primary DNA target site, however, it influences the assembly of additional repressor molecules at adjacent sites. Central A-C steps stabilize tandem binding, whereas T-A steps destabilize it. It has been previously suggested that in vivo regulation of trp operators is due to their differential ability to bind multiple repressor molecules. The observations presented here support this model. We ascribe this ability to two sequence-dependent factors which act together: the identity and number of half-site sequences, recognized by water-mediated hydrogen bonds, and the ability of the intervening dinucleotides to form direct bidentate hydrogen bonds to the repressor. Furthermore, we measured the intrinsic and the induced bending of trp operators by the repressor. We find that the operators are straight in their free form, bent by 23 degrees when bound by a single trp repressor molecule, and bent by 30 degrees when bound by two repressor molecules.

Bacterial Proteins↗
PubMed1997

Enteropathy-associated T-cell lymphoma: a case report with radiographic and computed tomography appearance.

We report a case of enteropathy-associated T-cell lymphoma (EATL) of the jejunum in a 56-year-old man. The patient suffered for several years from nonspecific abdominal complaints, with no clinical evidence of malabsorption. The patient underwent extensive imaging procedures including barium meal and computed tomography. Computed tomography of the abdomen showed small mesenteric lymph nodes and an area of intestinal wall thickening. Barium meal demonstrated a short jejunal stricture. Histology revealed lymphoma of the jejunum, with microscopic changes distant from the lesion consistent with celiac disease. The spectrum of EATL ranges from patients with frank celiac disease, to patients with only immunohistochemical evidence of celiac disease, who develop small bowel lymphoma.

Celiac Disease↗
PubMed1997

Sonographic and Doppler flow characteristics of ovarian tumors of low-malignant potential.

OBJECTIVE: To outline the sonographic and color Doppler flow imaging characteristics of ovarian tumors of low-malignant potential (OCLMP). METHODS: Fourteen women with ovarian tumors of low-malignant potential were compared with 26 women with ovarian cystadenomas and 23 with ovarian carcinomas. RESULTS: Sonographically, more complex structures and echogenic lesions were found in the OCLMP and malignant tumors than in the cystadenomas, and the difference was statistically significant. Color blood flow imaging revealed a similar resistant index (RI) in the OCLMP (0.487 +/- 0.07) and cystadenomas (0.489 +/- 0.09) when compared with statistically significant lower RI in the ovarian carcinomas (0.391 +/- 0.05) (P < 0.001). CONCLUSIONS: Among young women, the combination of a complex ovarian mass with turbid fluid and echogenic lesions whose color Doppler flow imaging registers in the low range (RI < 0.5) should raise the suspicion of an ovarian tumor of low-malignant potential.

Adult↗
PubMed1997

Rapid reversal of no-reflow using Abciximab after coronary device intervention.

The no-reflow phenomenon is a reduction in epicardial coronary artery blood flow without mechanical vessel obstruction. Early descriptions of this syndrome involved reperfusion after myocardial infarction. More recently, the no-reflow phenomenon has been recognized after brief ischemic times associated with coronary interventions. It is clearly a negative prognostic indicator. The proposed mechanism is multi-factorial and may involve small vessel vasospasm and potentially platelet-mediated loss of capillary autoregulation. Because of the potential role of platelets in the genesis of the no-reflow state, we administered Abciximab to two patients with no-reflow phenomenon following catheter interventions. In both of these settings, rapid distal runoff was reestablished within minutes after treatment with the platelet glycoprotein 2B/3A inhibitor.

Abciximab↗
PubMed1997

In vitro production of megakaryocytes from PIXY321 versus GM-CSF-mobilized peripheral blood progenitor cells.

The generation of megakaryocytes (MK) from cultured peripheral blood progenitor cells (PBSC), harvested via apheresis, from 18 female breast cancer patients treated with either PIXY321 or GM-CSF was compared. Nonadherent mononuclear cells (MNC) were cultured in liquid suspension with 50 U/ml thrombopoietin (TPO) and 2.5% autologous heparinized plasma for 12 days. Flow cytometric analysis was used to measure the percentage of CD34+ on day 1 and CD41+ cells on day 12. The frequency of CD34+ cells was greater in GM-CSF-mobilized samples than in PIXY321-mobilized samples, and MK/MNC yields correlated directly with the number of CD34+ cells seeded, PIXY321-mobilized samples produced more MKs per CD34+ cell than GM-CSF-mobilized samples. Overall, there was no significant difference in the MK/MNC yield between PIXY321- and GM-CSF-mobilized samples. Cyclophosphamide (CY) increased the frequency of CD34+ cells and the corresponding MK/MNC yield for both cytokines, but had no effect on the MK/CD34+ yield. Compared to GM-CSF, PIXY321 mobilization resulted in increased CD34+ cell commitment to the MK lineage.

Adult↗
PubMed1997

Ovarian volume in postmenopausal breast cancer patients treated with tamoxifen.

BACKGROUND: Postmenopausal breast cancer patients treated with tamoxifen have been found to have a high incidence of ovarian tumors. Transvaginal ultrasonography is an accurate and reliable method for measuring ovarian size. The purpose of this study was to establish normal values for basal ovarian volume in postmenopausal tamoxifen-treated patients and compare them with those established for healthy, postmenopausal women in the same population with no exposure to hormone treatment. METHODS: In a prospective open pilot study, the ovaries of 65 postmenopausal breast cancer patients treated for at least 6 months with tamoxifen were measured by transvaginal ultrasonography. From the same population, 311 healthy postmenopausal women with no exposure to hormone therapy were examined and served as controls. After matching for menopausal age, ovarian volume was compared between groups. RESULTS: Mean ovarian volume of postmenopausal tamoxifen-treated patients was persistently low through the menopause, whereas the mean ovarian volume of the controls was large, gradually decreasing up to the 10th menopausal year (8.6 +/- 2.3 and 2.8 +/- 2.1 cm3, respectively). Mean ovarian volume of the tamoxifen-treated patients was significantly lower than that of the controls during the initial menopausal years. CONCLUSIONS: An ovarian volume that is considered within normal range for a specific menopausal age in a healthy postmenopausal woman is abnormal for a postmenopausal tamoxifen-treated patient.

Aged↗
PubMed1997

Value of sonohysterography in asymptomatic postmenopausal tamoxifen-treated patients.

A prospective study was performed to assess the efficacy of sonohysterography (SHG) in identifying endometrial pathologies among asymptomatic, postmenopausal breast cancer patients treated with tamoxifen. In this study the uterine cavity of 68 such patients with endometrial thickness of > or = 8 mm was prospectively evaluated by SHG. Forty-six (67.6%) patients in whom SHG did not identify any findings in the uterine cavity (negative group) were followed by diagnostic hysteroscopy. Another 22 (32.4%) who were identified by SHG to have abnormal endometrial findings, such as an echogenic or polypoid mass (positive group), were followed by operative hysteroscopy and by postoperative SHG. In the positive group the basal transvaginal sonogram revealed an endometrial echogenic mass in only 10 (45.5%). In the remaining 12 (54.5%) patients, the transvaginal sonogram identified only thick endometrium. In these latter 12 patients, histological assessment confirmed endometrial polyps in 8 (66.7%) and fibroid in 1 (8.3%). Four (18.2%) patients in the positive group had no histological endometrial pathology. Two (50%) of them had a uterine septum as diagnosed during hysteroscopy, in one (25%) operative hysteroscopy failed to resect the endometrial polyp, and in another (25%) there was a false-positive SHG diagnosis. Overall, SHG accurately diagnosed endometrial and/or other intrauterine pathology in 95.5% of these patients. In the 46 patients with "negative" basal SHG features, diagnostic hysteroscopy confirmed this diagnosis. Thus, there was no SHG false-negative diagnosis. Comparing the results of the basal SHG with those of operative hysteroscopy and/or the histopathological findings in the positive group, the sensitivity of SHG was 1.0, the specificity 0.0, positive predictive value 95.5%, and negative predictive value 0.0. It is suggested that SHG is a useful diagnostic tool for the assessment of specific endometrial pathologies in asymptomatic postmenopausal breast cancer patients treated with tamoxifen who were diagnosed by transvaginal sonography to have thick endometrium.

Antineoplastic Agents, Hormonal↗
PubMed1997

Estrogen and progesterone receptors in the endometrium of postmenopausal breast cancer patients treated with tamoxifen and progestogens.

Postmenopausal breast cancer patients who were treated with tamoxifen and progestogens showed a uniform decidual reaction of the endometrium. It is well established that progestogens antagonize the estrogen effect on the endometrium by reducing its receptors in the endometrium. To assess in vivo such a possible effect of progestogens on endometrium primarily exposed to tamoxifen, we analyzed estrogen and progesterone receptors (ER, PR) on endometrial specimens showing decidualization from nine postmenopausal breast cancer patients on tamoxifen and progestogen treatment and on endometrial polyps with areas of decidualization from two other similar patients. ER was weakly detected in the endometrial glands of four (36.4%) patients and in the endometrial stroma of one (9.1%) patient. PR was detected in the endometrial gland of only one (9.1%) patient. No PR was detected in the endometrial stroma. There was no correlation between the length of tamoxifen treatment, the tamoxifen dosage, or the length of progestogen treatment and the ER or PR content, although progestogens were administered for more than 3 consecutive months in all patients. This relatively very low ER and PR content may be attributed to the antagonistic effect of progestogens on the "priming" estrogen-like effect of tamoxifen on the endometrium.

Adult↗
PubMed1997

Estrogen and progesterone receptor expression in postmenopausal tamoxifen-exposed endometrial pathologies.

Assessment of receptor levels in tamoxifen-exposed endometrial pathologies may indicate endometrial cells potential for interaction with tamoxifen. To assess this assumption, we analyzed estrogen receptor (ER) and progesterone receptor (PR) expression by an immunohistochemical technique in endometrial specimens with benign hyperplasia, benign polyps, and carcinoma obtained from postmenopausal breast cancer patients treated with tamoxifen (study group) and from age-matched healthy postmenopausal women treated with estrogen replacement therapy (control group I) and not treated with estrogen replacement therapy (control group II). Overall gland and stromal ER expression of benign endometrial hyperplasia and of benign endometrial polyps was significantly higher in control groups I and II than that obtained from the study group (endometrial hyperplasia: P = 0.0274 and 0.00093, respectively, and P = 0.00003 and 0.00001, respectively; benign endometrial polyps: P = 0.02889 and 0.00596, respectively; and P = 0.00228 and 0.00005, respectively), while there were no differences between the two control groups. Overall gland and stromal PR expression was nearly similar in all the three groups (P = NS). There was no correlation between the length of tamoxifen treatment and the presence of ER and PR in various endometrial pathologies in the tamoxifen-treated patients. The significantly lower ER expression in most benign endometrial pathologies obtained from postmenopausal tamoxifen treated patients may further support the weak estrogen-like effect of tamoxifen on the endometrium in the menopause.

Antineoplastic Agents, Hormonal↗
PubMed1997

Agrin-induced postsynaptic-like apparatus in skeletal muscle fibers in vivo.

We find that when extrajunctional regions of denervated soleus muscles in adult rats are transfected with cDNA encoding rat agrin isoform Y4Z8, which is normally secreted by motor neurons at adult neuromuscular junctions, the myofibers express and secrete the neural agrin. Muscle fibers in the vicinity of transfection form at their surface specialized areas having extracellular, plasma membrane, and cytoplasmic protein aggregates, narrow and deep plasma membrane infoldings, and an accumulation of myonuclei, all of which are characteristic of the postsynaptic apparatus at neuromuscular junctions. We conclude that at ectopic neuromuscular junctions that form in the extrajunctional region of denervated adult soleus muscles after implantation of a foreign nerve, a single neural-derived factor, agrin, is sufficient not only to cause protein aggregation in the early stages of postsynaptic apparatus formation, as predicted by the agrin hypothesis, but also to bring about changes in conformation of the muscle fiber surface and distribution of organelles which appear as the apparatus reaches maturity.

Agrin↗
PubMed1997

Posttraumatic intestinal stenosis: radiographic and sonographic appearance.

We report a case of posttraumatic intestinal stenosis (PIS), an uncommon sequela of blunt abdominal trauma, in which injury to the mesentery and bowel wall results in later focal ischemic stricture of that segment. We include CT images at the time of trauma, and barium meal and abdominal sonography obtained during the subsequent admission. Examination of the resected bowel loop showed transmural infarct and posttraumatic changes in the adjacent peritoneal fat. This is the first report which includes both imaging at the time of trauma and sonographic appearance of the narrowed bowel loop. Posttraumatic intestinal stenosis should be considered in the differential diagnosis of a narrowed bowel loop in a patient with a history of blunt abdominal trauma.

Abdominal Injuries↗
PubMed1997

Solitary extranodal anaplastic large cell lymphoma, Ki-1+, of the eyelid.

PURPOSE: To report a rare case of solitary anaplastic large cell lymphoma, Ki-1+, of the eyelid. METHOD: Case report. A firm ulcerated mass of the lower eyelid in a 10-year-old boy was the initial and only sign of anaplastic large cell lymphoma. RESULTS: A local excision of the mass was performed. Histologic examination disclosed large lymphoid anaplastic cells that reacted positively for T-cell markers and CD30 antigen. CONCLUSION: A solitary eyelid mass can be an initial sign of anaplastic large cell lymphoma in children.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

High frequency of adenomyosis in postmenopausal breast cancer patients treated with tamoxifen.

Pathologic evaluation for adenomyosis in uterine specimens as well as demographic characteristics, health habits and risk factors for endometrial cancer were compared in 28 postmenopausal breast cancer patients with tamoxifen (TAM) treatment and in 11 similar patients without TAM treatment in order to determine the association between postmenopausal TAM exposure and the frequency of adenomyosis. The same comparison was also made between TAM-treated patients with adenomyosis and TAM-treated patients without adenomyosis. Adenomyosis was histologically diagnosed in 53.6% TAM-treated patients and in 18.2% non-TAM patients. Overall, there were no significant statistical differences in all parameters tested between the 2 groups, as well as between the TAM-treated patients with adenomyosis and the TAM-treated patients without adenomyosis. It can be concluded that adenomyosis was significantly more common among postmenopausal breast cancer patients who were treated with TAM as compared to similar patients without TAM treatment (p = 0.0186). This significant high rate of adenomyosis may be attributed to the continuous and unopposed exposure to TAM. It is, however, impossible to predict which postmenopausal breast cancer patient will develop adenomyosis after treatment with TAM.

Aged↗