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Biomedical subjects

J Cohen

Publications and source records attributed to J Cohen.

At least 1,189 records · Page 66Linked to original sources
PubMed1987

Nursing home reimbursement: implications for cost containment, access, and quality.

The individual states have many options in designing Medicaid reimbursement systems for nursing homes. Each option has a differential effect on incentives--and outcomes--for containing costs, providing quality care, and maintaining access to care. The mix and consequences of specific choices are analyzed in a framework that disaggregates costs into three components. Tradeoffs among competing elements will be inevitable, but reimbursement policy can maximize both efficiency and equity.

Cost Control↗
PubMed1987

From oocyte to embryo: a model, deduced from in vitro fertilization, for natural selection against chromosome abnormalities.

A cytogenetical analysis was performed on 151 unfertilized oocytes, 22 fertilized eggs at the pronuclear stage, and 108 cleaved embryos obtained in the course of in vitro fertilization (IVF). Thirty-two per cent of unfertilized oocytes were abnormal, carrying nullisomies or disomies, mainly of D and G chromosomes, and a structural anomaly (Gq-) in one case. Fertilized eggs showed frequent asynchronism in the development of pronuclei and only 2 out of 8 karyotyped pronuclei were normal. Cleaved embryos were classified according to the number of pronuclei observed 17 hours after insemination. One per cent displayed a single pronucleus, and haploid chromosome complements were found in the corresponding cleaved embryos which were considered to be parthenotes. The rate of chromosome abnormalities of diploid eggs depended on their morphological aspect. Healthy cleaved embryos carried 12.5% of anomalies while this rate reached 37% in fragmented embryos (p less than 0.05). Lastly, 6% of fertilized eggs displayed three pronuclei or more. Only 41% of the corresponding embryos were triploid. Diploidy or diploidtriploid mosaicism were often encountered. This leads to a 21% rate of abnormalities in the preimplantation embryos. Parental karyotyping and HLA typing were carried out in a series of eight couples with in vitro idiopathic infertility or recurrent embryo degeneration in vitro. No abnormality was noted. According to these results, a model of natural selection of normal conceptuses is proposed.

Aneuploidy↗
PubMed1987

Comparative diets of a idiopathic senile cataract and normal population: dietary risk factors in cataractogenesis.

A survey was carried out contrasting the diets of population with senile cataracts and control populations. Results failed to confirm the reports of others suggesting that ingestion of moderate amounts of seafood containing mercury or excess amounts of milk and milk products represent risk factors for senile cataractogenesis. Several dietary differences were noted lending credence to the prophylatic values of riboflavin enrichment to decrease risk of cataractogenesis and suggesting areas for further study.

Aged↗
PubMed1986

A child in trust.

Explore the source record for details and available documents.

Child Abuse↗
PubMed1986

Recurrence-free survival time for surgically treated soft tissue sarcoma patients. Multivariate analysis of five prognostic factors.

A staging system, based upon the experience of 1215 patients, was published by the American Joint Committee Task Force on Soft Tissue Sarcoma in 1977. A subset of these patients, 594, was selected to study recurrence-free survival time. The authors found 331 patients with a recurrence within 5 years (100 local only, 123 metastatic only, and 108 local + metastatic); median months to recurrence was 9.7. Within 5 years, recurrence was clearly associated with mortality: among the 331 patients who experienced a recurrence, 245 died, whereas only 31 died among the 263 who had no recurrence. To further evaluate the utility of the published staging system, a multivariate analysis of five factors was carried out for 297 of the 594 patients (patients with unknown information for any one of these factors were excluded). Factors in addition to grade that exerted a significant influence on recurrence were: direct extension, symptoms, and location of tumor when survival was measured to the first of any recurrence, and tumor size, measuring survival to the first metastatic recurrence. It is therefore recommended that these factors be taken into account in staging this disease. Estimates of probable recurrence-free survival time based upon the multivariate model (Weibull) are also presented.

Analysis of Variance↗
PubMed1986

Diagnosis of schizophrenia. Prediction of short-term outcome.

Seven systems for the diagnosis of schizophrenia were compared in their ability to predict short-term outcome at follow-up: with each other, with selected specific symptoms, and with a simple additive composite symptom score. None of the systems nor the symptoms predicted strongly, but DSM-III and Schneiderian First Rank Symptoms and the composite score performed somewhat better than the other predictors.

Female↗
PubMed1986

Anorexia nervosa. Treatment efficacy of cyproheptadine and amitriptyline.

Patients with anorexia nervosa have concurrent problems of emaciation and depression. Therefore, treatment with medications affecting both weight gain and depression seemed reasonable. Seventy-two anorectic patients were randomly assigned in a double-blind study to receive cyproheptadine hydrochloride, a weight-inducing drug, amitriptyline hydrochloride, a tricyclic antidepressant, or placebo. Overall, cyproheptadine had a marginal effect on decreasing the number of days necessary to achieve a normal weight. There was a differential drug effect present in the bulimic subgroups of the anorectic patients: cyproheptadine significantly increased treatment efficiency for the nonbulimic patients and significantly impaired treatment efficiency for the bulimic patients when compared with the amitriptyline- and placebo-treated groups. The differential cyproheptadine effect on the anorectic bulimic subgroups is the first pharmacologic evidence of the validity of these subgroups. Cyproheptadine had an anti-depressant effect demonstrated by a significant decrease in the Hamilton depression ratings.

Adolescent↗
PubMed1986

A randomized clinical trial of oral ursodeoxycholic acid in obstructive jaundice.

Forty patients with obstructive jaundice (bilirubin greater than 100 mumol/l) were entered into a randomized trial of oral ursodeoxycholic acid for 48 h before surgery versus no additional therapy. Pre-operative venous and operative portal total bile salt concentrations were higher in the bile salt treated patients (P less than 0.001). Portal endotoxaemia during operation was reduced in ursodeoxycholic acid treated patients (P less than 0.05). There was no significant difference in systemic venous endotoxaemia, renal function or postoperative morbidity or mortality. This study suggests pre-operative oral bile salt therapy may be of no clinical benefit in patients with obstructive jaundice.

Administration, Oral↗
PubMed1986

Urinary candidiasis: a prospective study in hospital patients.

In a prospective study of 29 hospital inpatients with candiduria, yeasts were frequently isolated from the urine in the absence of symptoms and no serious deep fungal infection occurred. The prevalence of diabetes mellitus and urinary catheterisation was significantly increased in this group compared to the general hospital population. There was a high incidence of yeast species other than Candida albicans in the urine, non-albicans species constituting 39% compared with 18% from other sites (p less than 0.01).

Adolescent↗
PubMed1986

Factors affecting survival and implantation of cryopreserved human embryos.

Five- to ten-cell embryos and expanded blastocysts from 68 patients were thawed in an attempt to establish pregnancy. Three fresh embryos had been replaced unsuccessfully in these patients. Forty-five patients had intact freeze-thawed embryos replaced and 12 became clinically pregnant. Ten of these pregnancies have now advanced beyond week 24. The preliminary results presented here demonstrate that significantly more expanded blastocysts survive cryopreservation than cleaving embryos. Faster-growing embryos did not survive better than slowly growing embryos, but the incidence of implantation was higher with faster-developing embryos. Significantly more blastocysts with a "normal" morphology survived cryostorage than those scored as "irregular" (77 versus 7%). A similar trend was observed when normal and irregular cleaving embryos were frozen, but the difference was not significant. The severity of contraction of blastocysts upon the addition of cryoprotectant increased the incidence of survival. The proportion of patients whose embryos had holes in the zona pellucida following cryopreservation was significantly higher when embryos were frozen at the cleaving stage (39%) rather than the expanded blastocyst stage (16%). Almost all embryos with damaged zonae degenerated. The proportion of cleaving embryos that survived cryostorage was inversely correlated with the number of follicles aspirated.

Blastocyst↗
PubMed1986

Follicular aspiration using a syringe suction system may damage the zona pellucida.

The incidence of the formation of cracks in the zona pellucida during aspiration was assessed by comparing two methods of aspirating follicular contents by suction: manual aspiration by syringe and mechanical aspiration by pump. Of 36 patients whose follicles were evacuated manually using syringes, 18 had at least one damaged oocyte. Of 38 other patients whose follicles were aspirated by pump, only one had an oocyte with a cracked zona pellucida. Four patients had their oocytes aspirated by both syringe and pump. In all four, the oocytes were intact when aspirated by the pump, but one oocyte was damaged in three of four cases when the follicles were aspirated using syringes.

Cell Separation↗
PubMed1986

Ultrastructure of the human preovulatory oocyte.

The ultrastructure of preovulatory human oocyte-cumulus complexes was described after inducing maturation by clomiphene, human menopausal gonadotropin (hMG), human chorionic gonadotropin (hCG) treatment. The majority of the oocytes was at metaphase II of meiosis, with a radially orientated spindle. The oocyte surface was covered by a multitude of microvilli. Cortical granules were nonuniformly distributed along the cortex. A cytoplasmic polarization was observed. The cytoplasmic organelles were in general uniformly dispersed, with the exception of a narrow segment within which cytoplasmic membranes and mitochondria formed clusters. The spindle was usually found at the borderline between the two regions of the cytoplasm. The functional significance of this polarization is not yet known.

Chorionic Gonadotropin↗
PubMed1986

Transvaginal sonographically controlled ovarian puncture for oocyte retrieval for in vitro fertilization.

Two hundred twenty-two patients took part in a trial of follicle puncture via the transvaginal route under sonographic control for the purpose of in vitro fertilization (IVF). Induction protocols were mainly human menopausal gonadotropin (hMG) + human chorionic gonadotropin (hCG) and clomiphene + hMC + hCG. In 79.7% oocyte aspiration could be achieved without difficulty via the transvaginal route. An average number of 4.7 oocytes per attempt was obtained; 10.7% evolutive pregnancies were obtained. No major incident was noted. This technique offers several crucial advantages: it reduces surgical risk, reduces the length of the patient's stay in hospital as well as the overall cost of the procedure, and it also makes possible puncture in some cases hitherto regarded as excluded.

Female↗
PubMed1986

Release of endotoxin from bacteria exposed to ciprofloxacin and its prevention with polymyxin B.

An in vitro system for studying the phenomenon of antibiotic-induced release of endotoxin from gram-negative bacteria is described. Endotoxin was measured by a quantitative limulus lysate microassay. Using a strain of Escherichia coli, ciprofloxacin was shown to cause an immediate and sustained increase in endotoxin release compared to control cultures whereas gentamicin did not, despite an equally rapid bactericidal effect. The potential value of the anti-endotoxin effect of polymyxin B was examined using a polymyxin B resistant strain of Klebsiella aerogenes. Ciprofloxacin alone caused endotoxin release, but when given with polymyxin B significantly less endotoxin was detected. These results indicate that in antibiotic-induced endotoxin release, the rate of cell death is less important than the site of antibiotic effect, and suggest that ciprofloxacin may act directly on the cell wall as well as on DNA gyrase. It is possible that polymyxin B could be used to reduce the extent of endotoxin release, and that this would be of clinical benefit.

Cell Wall↗