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Biomedical subjects

J Bernstein

Publications and source records attributed to J Bernstein.

At least 127 records · Page 7Linked to original sources
PubMed1991

Development of a model quality-of-care assessment program for adult preventive care in rural medical practices.

A four-year project of quality-of-care assessment for 37 practices in rural North Carolina used chart abstraction and formal feedback to practitioners to improve compliance standards for 13 adult health maintenance interventions. In 1987, performance of Papanicolaou (Pap) test within two years ranged from 20% to 100% (mean, 61%), mammogram 0% to 70% (mean, 20%), and influenza vaccination 0% to 90% (mean, 59%). Practices received individual results and remediation took place for those practices that performed poorly; a reaudit took place in 1989, with improvement in all measures for all practices, except the influenza vaccination. Compliance results for 1989 were 30% to 100% (mean, 67%) for the Pap test, 10% to 100% (mean, 40%) for the mammography screening, and 5% to 80% for the influenza vaccination. These results suggest that coordinated quality-of-care assessment for rural practices can be performed with a modest administrative burden and substantial benefit to the practices.

Feedback↗
PubMed1991

Renal involvement in tuberous sclerosis.

TSC in the kidney is expressed principally as renal cysts and angiomyolipomas. Both abnormalities may occur separately or together, and both are commonly multiple and bilateral. Cystic disease is sometimes so severe as to be confused with polycystic kidney disease, although the histopathologic findings are practically diagnostic of TSC. Severe cystic disease causes renal insufficiency; large angiomyolipomas predispose to life-threatening hemorrhage. Renal malignancies have been reported in what appears to be a significant number of patients. We hypothesize that the renal abnormalities result from cell hyperplasia and hypertrophy, much like the other abnormalities of tuberous sclerosis, such as cerebral tubers and cardiac rhabdomyomas. The renal abnormalities can therefore be regarded as an expression of the TSC gene, and their recognition as such carries importance for treatment and counseling.

Carcinoma, Renal Cell↗
PubMed1991

Arachidonic acid metabolites in middle ear effusions of children.

Middle ear effusions (MEEs) from 78 children (98 ears) with otitis media were examined for products of arachidonic acid (AA) metabolism, including leukotrienes B4, C4, D4, and E4 and prostaglandins D2 and E2, by high-performance liquid chromatography. Leukotrienes B4 and D4 were recovered most frequently: 59% and 54%, respectively. Leukotriene B4 was found in highest concentration, 1.29 +/- 3.46 ng/0.1 mL. The concentrations of leukotrienes B4 (p less than .03), (4 (p less than .01), and E4 (p less than .02) were significantly higher in culture-positive than in culture-negative MEEs. Neither the concentration nor the type of AA metabolite correlated with bacterial species isolated, chronicity of effusion, age of subject, or consistency of MEE. These data suggest that the AA metabolites are synthesized relatively frequently during otitis media of childhood. Leukotriene B4 is the most frequently detected AA metabolite in MEEs and is highly associated with the presence of viable bacteria.

Arachidonic Acid↗
PubMed1991

Value of dual-energy CT in differentiating focal fatty infiltration of the liver from low-density masses.

Focal (irregular, partial) fatty infiltration of the liver may simulate neoplastic or other hypodense masses on CT. On the basis of previous observations of the phenomenon that differences in X-ray attenuation diminish with increasing energy of X-rays used, we performed a preliminary study to determine if dual-energy CT could be used to discriminate between fatty infiltration and hypodense liver masses. Dual-energy CT at 140 and 80 kVp was performed in 14 patients undergoing liver biopsy and in seven control subjects with presumedly normal liver. Attenuation measurements were taken, and the changes in attenuation between 140 and 80 kVp were calculated. The mean changes in attenuation were 3.5 H for normal liver (n = 7), 2.5 H for hypodense liver masses (n = 6), 13 H for fatty liver (n = 5), 0.3 H for fatty liver combined with hemochromatosis or hemosiderosis (n = 3), and 2 H for the spleen (n = 18). The change in attenuation increased as the fat content in the liver increased. Analysis of variance showed a statistically significant difference (p less than .001) between fatty liver and the other groups. A difference greater than 10 H was unique to fatty infiltration. These results suggest that dual-energy CT may help to differentiate focal fatty infiltration of the liver from low-density neoplastic or other lesions, but only if the iron content of the liver is not increased.

Adult↗
PubMed1991

Mesangiolysis: an important glomerular lesion in thrombotic microangiopathy.

Six cases of malignancy-associated thrombotic microangiopathy and eight cases of idiopathic microangiopathy have been studied by renal biopsy. All patients of both groups had mild to severe renal impairment and microangiopathic hemolytic anemia. The renal lesions were histopathologically identical in the two groups. The most characteristic abnormalities were glomerular mesangiolysis and glomerular and arteriolar thrombosis. Subendothelial widening, presumably due to entrapment of blood components, and the formation of capillary and arteriolar thrombi may be attributed to endothelial damage. Glomerular fibrinogen was demonstrated by immunofluorescence in a majority of cases. Immunofluorescence also showed glomerular immunoglobulin M (IgM) and Clq in a majority of cases and C3 in slightly less than half. Mesangiolysis, present in every case, resulted in coalescence of capillary lumina, but mesangiolysis is a bland process, easily overlooked. The mesangial waists of the glomerular tufts seemed to unravel and come apart, with no inflammatory reaction or fibrin deposition on the luminal surface. The presence of capillary enlargement was confirmed morphometrically as an increased proportion of glomerular sectional area. In what appeared to be a late stage of mesangiolysis, the mesangium was thickened by pale fibrillary material, producing a lobulated glomerular tuft and eventual glomerular solidification. The early stages of mesangiolysis may be reflected only in glomerular capillary ectasia, whereas the late stages produce a distinctive form of glomerular sclerosis.

Adult↗
PubMed1991

Lecithin cholesterol acyltransferase deficiency: ultrastructural examination of sequential renal biopsies.

We present the renal biopsy findings in two brothers with nephrotic syndrome and lecithin:cholesterol acyltransferase deficiency. Mesangial expansion and capillary wall thickening were accompanied by numerous extracellular osmiophilic membranes within round lucent spaces, by round lamellar deposits, and by amorphous deposits containing thread-like structures with cross-striations. A second biopsy in one of the brothers, when he had developed renal insufficiency 8 yr later, showed increased mesangial and capillary wall thickening. The deposits, which had been in predominantly subepithelial and intramembranous locations, were now in a more prominent subendothelial location. The subepithelial localization of the deposits seen on initial examination may be related to their cationic charge, perhaps with binding to glomerular polyanion, and to uptake by glomerular epithelial cells. The accumulation of lipid is associated with progressive mesangial and glomerular sclerosis.

Adolescent↗
PubMed1990

Graph-set analysis of hydrogen-bond patterns in organic crystals.

A method is presented based on graph theory for categorizing hydrogen-bond motifs in such a way that complex hydrogen-bond patterns can be disentangled, or decoded, systematically and consistently. This method is based on viewing hydrogen-bond patterns topologically as if they were intertwined nets with molecules as the nodes and hydrogen bonds as the lines. Surprisingly, very few parameters are needed to define the hydrogen-bond motifs comprising these networks. The methods for making these assignments, and examples of their chemical utility are given.

Chemical Phenomena↗
PubMed1990

A comparison of attitudes and practices of episiotomy among obstetrical practitioners in New Mexico.

The routine use of episiotomy is a subject of considerable controversy. To delineate attitudes and practices, we surveyed various groups of obstetrical practitioners in New Mexico. Routine use was favored most by obstetricians, less by family practitioners, less yet by nurse midwives and least by lay midwives. Many of the reasons given both for and against routine use were the same, underscoring the lack of scientific data and prospective studies of episiotomy and its effects.

Adult↗
PubMed1990

Changes in nasopharyngeal flora during otitis media of childhood.

The nasopharyngeal flora of healthy children were compared with flora in children with otitis media caused by nontypable Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Forty healthy children were followed prospectively and compared with 70 children with 43 episodes of nontypable H. influenzae, 21 episodes of S. pneumoniae and 28 episodes of M. catarrhalis otitis media. Carriage of nontypable H. influenzae (95% vs. 65%, P less than 0.001), S. pneumoniae (91% vs. 52%, P less than 0.005) and M. catarrhalis (86% vs. 52%, P less than 0.001) increased significantly during episodes of otitis media compared with healthy periods. The quantity of nontypable H. influenzae, S. pneumoniae and M. catarrhalis in nasopharyngeal secretions also increased during active infection compared with healthy periods: 3.0 vs. 2.0, P less than 0.005; 3.2 vs. 2.1, P less than 0.001; and 3.3 vs. 2.5, P less than 0.01, respectively. At the same time, nonpathogens of the resident flora, in particular viridans streptococci, declined in carriage: 65% vs. 22%, P less than 0.001. These data suggest that respiratory pathogens become relatively more important in the microenvironment of the nasopharynx during episodes of otitis media. Furthermore the absence of a middle ear pathogen in a nasopharyngeal culture strongly suggests that the pathogen is not present in the middle ear space (negative predictive value greater than 0.96).

Bacterial Infections↗
PubMed1990

The rectus abdominis muscle flap in a combined abdominovaginal repair of difficult vesicovaginal fistulae. A report of three cases.

Conventional repairs had been tried on three patients suffering from vesicovaginal fistulas after abdominal hysterectomies. Separate vaginal and abdominal approaches had been tried and had resulted not only in failure but also in tissue loss and fibrosis. A final synchronous vaginoabdominal approach using a rectus abdominis muscle flap was used successfully in all three patients.

Abdominal Muscles↗
PubMed1990

Volume performance standards: can they control growth in Medicare services?

Congress has adopted volume performance standards (VPSs), a system using collective incentives, as a means to control costs of physicians' services under the Medicare program. Past efforts to curb expenditures failed to focus sufficiently on providing direct incentives to individual providers or consumers, and did not achieve desirable results. West German and Canadian experiences suggest that mechanisms to contain costs may work best when their scope is regional rather than national, prompting the view that the VPS system should operate on a state level. The system's efficacy may also require Medicare officials to analyze utilization patterns assiduously, and states' medical and professional organizations to monitor physicians' practices and formulate due practice guidelines.

Cost Control↗
PubMed1990

Ethanol sulfation by the pulmonary ethanol metabolizing system (PET).

Rat lung slices incubated in a Krebs Ringer bicarbonate buffer metabolized ethanol by sulfocunjugation at a rate of about 500 mumoles/g x hr when the ethanol concentration was 11 mM. Tissue slices from dog and rabbit lung also were able to metabolize this alcohol showing similar time curves and rates. In all cases ethanol metabolism showed a dependence on the concentration of ethanol which is typical of allosteric enzymes. The calculated Hill coefficient was between 1.69 and 2.07 in the three species studied. Sulfoconjugation of ethanol by rat lung slices showed a Km for ethanol of 26.59 mM and a Vmax of 11,357 mumoles/g x hr. The Km for ethanol determined with dog lung slices was 20.93 mM and Vmax was 8,052 mumoles/g x hr. In the case of rabbit lung, Km for ethanol was 20.15 mM whereas Vmax was 17,379 mumoles/g x hr. Preliminary evidence would seem to indicate that the human lung is also able to metabolize ethanol by conjugation with sulfate. These results suggest that the lung is endowed with a remarkable potential to metabolize ethanol by sulfoconjugation. In vivo, however, sulfoconjugation may be limited by substrate availability.

Animals↗