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Biomedical subjects

J Feldman

Publications and source records attributed to J Feldman.

At least 37 records · Page 2Linked to original sources
PubMed2000

Bleeding and spontaneous abortion after therapy for infertility.

OBJECTIVE: To determine the incidence of early-pregnancy bleeding and spontaneous abortion (SAB) after various treatments for infertility and to assess whether bleeding is predictive of SAB. DESIGN: An historic cohort study of women who conceived after various treatments. SETTING: Hospital-based private practice. PATIENT(S): We studied 418 patients in whom 500 consecutive clinical pregnancies occurred. INTERVENTION(S): Patients were grouped according to the method of conception: ovulation induction, IVF, and other. The latter category included interventions not requiring ovulation induction, such as surgery and insemination. A fourth group of subjects who conceived independently of treatment was used as the control. MAIN OUTCOME MEASURE(S): Bleeding and pregnancy outcome (SAB, ectopic pregnancy, or ongoing pregnancy). RESULT(S): Rates of SAB did not differ among the treatment groups. SAB occurred significantly more often after bleeding than when bleeding did not occur (30.8% versus 19.8%, respectively). Bleeding was predictive of SAB only in patients <35 years old (odds ratio 2.4). CONCLUSION(S): Infertile women who conceive after reproductive therapy are not at increased risk for SAB compared with women who conceive naturally. There appears to be no association between previous diagnosis or treatment and the occurrence of SAB in previously infertile women. Bleeding is associated with a twofold relative risk of SAB.

Abortion, Spontaneous↗
PubMed2000

Endometrial stripe thickness in tubal and intrauterine pregnancies.

OBJECTIVE: To evaluate endometrial stripe thickness (EST) among patients with tubal pregnancy (TP) and intrauterine pregnancy (IUP). DESIGN: Historical cohort. SETTING: City hospital. PATIENT(S): Ninety-four women suspected to have TP. INTERVENTION(S): Serum betaHCG and sonographic EST measurements. MAIN OUTCOME MEASURE(S): Comparison of age, gestational age (GA), EST, and log beta HCG. RESULT(S): The two groups of women, 65 with TP and 29 with IUP, had similar mean ages (+/-SD) of 28.6 +/- 5.7 and 28.6 +/- 6.1, respectively. The median values of GA in the 2 groups were similar, 46.6 and 44.6 d, respectively. The mean values for EST (+/-SD), adjusted for GA, were significantly different: 9.9 +/- 5.9 mm in the TP group and 12.6 +/- 5.3 mm in the IUP group. The mean values (+/-SD) of log beta HCG in the 2 groups also differed significantly: 6.90 +/- 1.29 and 7.52 +/- 0.97, respectively. No correlation was found between EST and GA or log beta HCG within either group. CONCLUSION(S): The mean EST in women with TP was significantly smaller than in women with IUP. The wide range of EST values and their overlap precludes the utilization of EST as a single feature in the diagnosis of a tubal pregnancy.

Adult↗
PubMed2000

Imidazoline receptors: a challenge.

The hypotensive effect of imidazoline-like drugs (IMs) directly injected into the rostroventrolateral part of the brainstem (NRL/RVLM) was shown to involve non-adrenergic imidazoline specific receptors (IRs). Some IMs caused hypotension when injected there, irrespective of their affinity and selectivity for any alpha-adrenoceptor subtype. Compounds, such as LNP 509, S 23515, S 23757 or benazoline with very high selectivities for IRs over alpha 2-adrenoceptors (A2Rs), became available recently. Some of these compounds (LNP 509, S 23515) caused hypotension when injected alone into the NRL/RVLM region. Nevertheless, high selectivity for IRs will not predict by its own the capability of IMs to elicit hypotension as some of these substances behaved as antagonists towards the hypotensive effects of the latter. As far as hybrid drugs, i.e., with mixed binding profiles (I1/alpha 2), were concerned, a significant correlation has been reported between their central hypotensive effect and their affinity for IRs. Imidazoline antagonists, such as idazoxan, were repeatedly shown to competitively prevent and reverse the centrally induced hypotensive effect of IMs. The sole stimulation of A2Rs within the NRL/RVLM region was not sufficient to decrease blood pressure as much as IMs did, as shown by the lack of significant blood pressure lowering effect of alpha-methylnoradrenaline (alpha-MNA). No correlation was observed between affinity of IMs for A2Rs and their central hypotensive effects. It is also noticeable that yohimbine, an A2Rs antagonist, was repeatedly shown to abolish the hypotensive effect of hybrids but usually in a non-competitive manner. Mutation of A2Rs was shown to prevent the hypotensive effects of centrally acting drugs. It is concluded that (i) drugs highly selective for I1Rs over A2Rs can reduce blood pressure by their own; (ii) the central hypotensive effect of IMs needs implication of IRs and appears to be facilitated by additional activation of A2Rs; and (iii) this effect requires intact A2Rs along the sympathetic pathways.

Animals↗
PubMed2000

Saccadic localization of occluded targets.

Saccadic eye movements are able to localize spatially-extended targets, including patterns of random dots and simple shapes, with a high degree of precision [McGowan, Kowler, Sharma & Chubb (1998). Vision Research, 38, 895-909; Melcher & Kowler (1999). Vision Research, 39, 2929-2946]. This paper investigates the representations of object shape that guide saccades. We studied saccadic localization of partially-occluded triangles (two or three vertices removed) to find out whether saccades have access to a representation of the full shape, despite the missing portions. Targets were configured so that they could be seen either as triangles, which were partially occluded by polygons, or as fragments in front of the same polygons. Subjects tried to saccade to the inferred full triangle and a discrimination paradigm was used to evaluate their success. Occlusion cues were ineffective in that saccades directed to the occluded triangles landed near the center of the visible fragment, even when it was configured as a triangle behind occluders. Removing the occluders and leaving only three segments of the triangle (vertices removed) helped somewhat, but performance never resembled that achieved with either a full triangle or a 3-dot configuration. We conclude that the saccadic system is insensitive to at least some cues that can be used to infer the shape of objects. For occluded targets, the representation used by saccades may be closer to the configuration of the retinal image.

Form Perception↗
PubMed2000

Use of complementary and alternative medicine among Dominican emergency department patients.

This small, pilot study examined presenting complaint, brief health history, use of complementary and alternative medicine (CAM), and sociodemographic characteristics, among patients attending the emergency department (ED) of a large urban hospital. The sample (n = 50) was primarily Dominican and of low socioeconomic status. Almost half had used CAM for their presenting complaint or another health problem during the past year, most commonly in the form of medicinal plants made into herbal teas. CAM users were more likely to be female, longer-term residents of the United States, and to have also used religious practices for health problems. Subjects who had used CAM for any problem other than the presenting complaint during the past year rated its effectiveness higher than subjects who had used CAM for their presenting complaint. In conclusion, it is likely that a significant proportion of Dominican ED patients use CAM, suggesting that they should be asked about their CAM use during triage.

Adult↗
PubMed2000

Bias toward regular form in mental shape spaces.

The distribution of figural "goodness" in 2 mental shape spaces, the space of triangles and the space of quadrilaterals, was examined. In Experiment 1, participants were asked to rate the typicality of visually presented triangles and quadrilaterals (perceptual task). In Experiment 2, participants were asked to draw triangles and quadrilaterals by hand (production task). The rated typicality of a particular shape and the probability that that shape was generated by participants were each plotted as a function of shape parameters, yielding estimates of the subjective distribution of shape goodness in shape space. Compared with neutral distributions of random shapes in the same shape spaces, these distributions showed a marked bias toward regular forms (equilateral triangles and squares). Such psychologically modal shapes apparently represent ideal forms that maximize the perceptual preference for regularity and symmetry.

Adult↗
PubMed2000

Perception of animacy from the motion of a single object.

We demonstrate that a single moving object can create the subjective impression that it is alive, based solely on its pattern of movement. Our displays differ from conventional biological motion displays (which normally involve multiple moving points, usually integrated to suggest a human form) in that they contain only a single rigid object moving across a uniform field. We focus on motion paths in which the speed and direction of the target object change simultaneously. Naive subjects' ratings of animacy were significantly influenced by (i) the magnitude of the speed change, (ii) the angular magnitude of the direction change, (iii) the shape of the object, and (iv) the alignment between the principal axis of the object and its direction of motion. These findings are consistent with the hypothesis that observers classify as animate only those objects whose motion trajectories are otherwise unlikely to occur in the observed setting.

Adult↗
PubMed2000

Planning for the evaluation of a pediatric end-of-life curriculum.

BACKGROUND: Decision making at the end of life can be complex and emotionally challenging for healthcare providers, particularly in pediatrics. Unfortunately, few undergraduate and graduate medical education curricula adequately address these issues. In this article, we describe the plan and progress to date of the design, implementation, and evaluation of an end-of- life curriculum for pediatric residents. NEEDS ASSESSMENT: Prior to the development of a formal end-of-life curriculum, a survey was given to a single cohort of residents four times over the course of their training to assess their attitudes toward end-of-life issues and their experience with the informal curriculum in residency. Entering pediatric residents felt relatively uncomfortable dealing with death and dying, but by the end of training, residents felt more comfortable dealing with these issues. Residents were relatively ambivalent about the degree to which their education helped them to deal with end-of-life issues. CURRICULUM DEVELOPMENT AND EVALUATION PLAN: A number of curricular interventions were developed including a noon conference series, grand rounds presentations, a 3-hour seminar on giving bad news, and written information for the housestaff manual. The curriculum was implemented in the fall of 1999. The impact of the curriculum will be assessed using a single interventional group with historical control study design. The evaluation instruments will include the previously used survey and an objective written examination. The 3-hour seminar will be assessed with a pre-test post-test crossover design using standardized patients. DISCUSSION: This rigorous, feasible, and cost-effective approach to curriculum development is intended to serve as a model for end-of-life education in pediatric residencies.

Journal Article↗
PubMed2000

Imidazoline receptors in cardiovascular and metabolic diseases.

The site of the hypotensive action of imidazoline compounds, such as clonidine, was first identified within the rostroventrolateral part of the brainstem. Afterwards, it was shown that imidazolines reduced blood pressure when applied in this area, whereas no catecholamine was capable of such an effect. These data led us to suggest the existence of receptors specific for imidazolines different from the alpha-adrenergic receptors. Soon after, the existence of imidazoline binding sites (IBS) was reported in the brain and in a variety of peripheral tissues including pancreatic gland and kidney. As expected, these specific binding sites do not bind the catecholamines. The IBS are classified in two groups: the I1 type, sensitive to clonidine and idazoxan; and the I2 type, sensitive to idazoxan and largely insensitive to clonidine. Imidazoline receptors were shown to be involved in several physiological regulations and pathological processes such as hypertension, diabetes mellitus and some mood disorders. Evidence for their implication in the nervous regulation of blood pressure and in the insulin secretion control will be presented. The hypotensive effects of clonidine-like drugs involve imidazoline receptors (I1Rs), while their most frequent side-effects only involve alpha2-adrenergic receptors. A new class of centrally acting antihypertensive drugs selective for I1Rs is now available. At hypotensive doses, these drugs are devoid of significant side effects. It was shown that the good acceptability of these drugs is likely due to their selectivity for I1Rs.

Animals↗
PubMed2000

Accommodative and vergence findings in ocular myasthenia: a case analysis.

Myasthenia gravis (MG) is a neuromuscular disorder that affects skeletal muscles, in particular, the extraocular muscles. Response variability is a hallmark sign. Detailed findings are described in a patient with MG in which the presenting sign was accommodative insufficiency. Objective accommodative findings were recorded 3 years before the onset of myasthenia, soon after the initial diagnosis was made, and then after the treatment commenced with pyridostigmine. In addition, clinical measurements were obtained periodically at different times of the day for various binocular motor functions, including near point of convergence, phoria, fusional and accommodative amplitudes, and relative accommodation. The disease adversely affected all accommodative and vergence findings, with fatigue being the primary disturbance. The therapeutic administration of pyridostigmine improved static measurements of accommodation and vergence and reduced asthenopia. The objective dynamic measurements of accommodation, vergence, and versions were less affected. These findings provide a clear demonstration that both intrinsic and extrinsic ocular muscles may be affected in the prepresbyopic myasthenic patient.

Accommodation, Ocular↗
PubMed2000

Determinants of incident vulvovaginal candidiasis in human immunodeficiency virus-positive women.

OBJECTIVE: Mucosal infections including vulvovaginal candidiasis are a common problem for women with human immunodeficiency virus (HIV) infection. Our objective was to determine which factors predict the development of symptomatic disease among HIV-infected women. MATERIALS AND METHODS: In a prospective study from 1991 to 1995, 205 HIV-positive women were evaluated every 6 months for occurrences of vulvovaginal candidiasis. Included in the study were all initially asymptomatic women, whether they were fungal-culture-positive or -negative at baseline. Excluded from the study were all women with symptomatic vulvovaginal candidiasis at the initial visit, those who developed trichomonas vaginitis at any visit, and those who used any antifungal agents. RESULTS: The risk of the development of vulvovaginal candidiasis did not differ between women who were asymptomatically colonized at baseline and those who were fungal-culture-negative. However, the risk of developing vulvovaginal candidiasis was increased 6.8 times for women with CD4 counts less than 200 cells/mm3 at baseline. CONCLUSIONS: Fungal culture is not predictive of the development of symptomatic vulvovaginal candidiasis. Women infected with HIV who have CD4 counts below 200 cells/mm3 should be monitored more carefully for vulvovaginal candidiasis.

AIDS-Related Opportunistic Infections↗
PubMed2000

Improving the selective use of plain radiographs in the initial evaluation of shoulder pain.

OBJECTIVE: In a previous retrospective study, we had found that shoulder radiographs were overused in the initial evaluation of patients presenting to the emergency department with shoulder pain. Our objective was to prospectively define clinical criteria that identify patients who have a low risk of radiographic findings that influence the management of the initial evaluation of shoulder pain in the emergency department. METHODS: All adult patients presenting to the emergency department of a university teaching hospital with shoulder pain were eligible to participate. Patients with deformities, penetrating wounds, referred pain, and those presenting for followup were excluded. Data were recorded prospectively using a standardized form. All radiographs were classified as therapeutically uninformative (TU) except fracture, acromioclavicular joint separation (> or =Grade 3), infection, or malignancy. A classification tree was used for analysis. RESULTS: Two hundred six patients had shoulder radiographs, of which 88% were TU. The model yielded 3 sets of low risk patients with a high percentage of TU radiographs: (1) no fall, no swelling (99% TU: 106 TU, 1 radiograph with lytic lesions in a cancer patient); (2) a fall, but no swelling, and no pain at rest (100% TU, n = 18); (3) a fall and pain at rest, but no swelling and normal range of motion (100% TU, n = 10). Not performing radiographs on these low risk patients would have decreased radiograph utilization from 52 to 18% of all shoulder patients seen. CONCLUSION: Our findings suggest that specific clinical criteria are able to identify patients who do not need radiographs as part of the initial management of shoulder pain. Prospective validation of these criteria are needed to confirm that these low risk patients can be safely evaluated without radiographs.

Adult↗
PubMed2000

Intermittent exotropia: stimulus characteristics affect tests for retinal correspondence and suppression.

BACKGROUND AND PURPOSE: Prior studies have reported various sensory responses in subjects with intermittent exotropia [X(T)]. These varying responses have been proposed due to differences in stimulus targets, backgrounds, or even a lack of control of binocular alignment. This study investigated the effects of varying target and background stimuli while controlling binocular alignment. METHODS: Eight X(T)s of the divergence excess or basic type were presented dichoptic computer generated visual stimuli while an infra red eye movement monitoring system determined horizontal eye position of each eye. Target and background were varied to assess their effect on sensory responses during latent and manifest exotropia. RESULTS: Most of our X(T)s demonstrated, while tropic, a consistent, i.e., dominant, type of retinal correspondence, i.e. a response that occurred on most tests, independent of the stimulus or background used for testing. Four subjects demonstrated harmonious anomalous retinal correspondence (HARC) while three subjects demonstrated normal retinal correspondence (NRC) with three out of four of the tests. In two out of four stimuli used for testing, one subject demonstrated NRC and another HARC. CONCLUSIONS: Complex backgrounds resulted in the largest number of suppressions, whereas blank backgrounds decreased the number of reported suppressions.

Adaptation, Ocular↗
PubMed2000

Dismal rehabilitation in predominantly type II diabetics on dialysis in Inner-City Brooklyn.

AIM: In order to define their demographics and medical conditions, 218 diabetic patients undergoing hemodialysis in Brooklyn were interviewed and their charts reviewed. METHODS: Patient rehabilitation was assessed with the Karnofsky score, and the urea reduction rate as well as serum albumin and hematocrit levels evaluated adequacy of hemodialysis. RESULTS: The majority of patients (167) were African-American, 25 were Whites, 19 patients were Hispanic and 6 were Asian. One patient was a Native American. The mean age was 60.5 years (range 16-88), and the majority, 52%, were women. Rehabilitation was poor, the mean Karnofsky score being 65.1+/-20.8, and only 6% of patients were working. By linear regression, there was no difference in the Karnofsky score according to gender, age, race, type of diabetes, education, family income or hematocrit level. Only the patients' self-perception of their psyche function, or how well they thought they were doing, was significant. CONCLUSION: Further work is needed to examine the reasons for the poor rehabilitation of diabetics on dialysis in Brooklyn.

Diabetes Mellitus, Type 1↗
PubMed2000

Visual-field defects in well-defined retinal lesions using Humphrey and Dicon perimeters.

BACKGROUND: This study was undertaken to correlate field defects in patients having well-defined retinal lesions within the central 30 degrees using Humphrey and Dicon perimetry standard threshold programs and to compare these results against the standard of fundus photography. METHODS: Eleven eyes of 11 patients had various well-defined retinal lesions. Ten of those subjects had best-corrected visual acuity of 20/25 or better. Subjects had either one previous field or no previous experience with any automated perimeter and were tested using either the 30-2 Full Threshold or SITA Standard program of the Humphrey Field Analyzer (HFA) Model 750 and the Central Grid Threshold program (#9) (a full-threshold program) of the Dicon LD-400 perimeter. Defects were scored and compared with fundus photographs scored by an independent observer. RESULTS: Significant high positive correlation coefficients were found between Humphrey, Dicon, and fundus photography, for mean number of significant field defects and for mean deviations. There were no significant differences between the mean scores, mean deviations, or fixation loss percentages. The time the patient occupied a perimeter was 56% less with the Dicon perimeter than with the Humphrey perimeter when the Full Threshold test was used and 8% less when the SITA Standard was used. CONCLUSION: In this study of patients with well-defined retinal lesions, both Humphrey and Dicon Central Threshold field programs exhibited an equally high positive correlation in mapping scotomas of expected size and depth when compared with fundus photography, with no significant difference in fixation loss frequency. However, the total testing time was less with Dicon perimetry than with Humphrey perimetry.

Adolescent↗
PubMed1999

[Left ventricular outflow tract obstruction without left ventricular hypertrophy treated with ACE inhibitors].

We describe a very unusual case of sudden, severe worsening of congestive heart failure which was caused by ACE inhibitors. Diagnosis was made by echocardiogram showing a typical picture of dynamic, left ventricular outflow tract obstruction without left ventricular hypertrophy, which disappeared on discontinuing ACE inhibitors. This phenomenon has already been described as a complication of other drugs such as nitrates, commonly used as provocative tests for latent obstructive cardiomyopathy. To our knowledge ACE inhibitors have not been described as a causative factor.

Aged↗