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Biomedical subjects

J Markowitz

Publications and source records attributed to J Markowitz.

At least 55 records · Page 3Linked to original sources
PubMed1989

Home nocturnal supplemental nasogastric feedings in growth-retarded adolescents with Crohn's disease.

We hypothesized that supplemental nutritional support delivered at home by nocturnal nasogastric feedings would result in accelerated growth in growth-retarded adolescents with Crohn's disease. Eight Tanner stage I adolescents with Crohn's disease, mean age 14 yr 5 mo, had a mean weight gain of 0.38 kg and height gain of 1.4 cm for the year before initiation of nasogastric feedings. All had been either asymptomatic or had only minimal symptoms in the year before the study, but were ingesting only 55%-80% of their daily required caloric intake. The subjects were taught to pass by themselves a nasogastric feeding tube, through which 1000-1500 ml of commercial, nonelemental isocaloric formula was infused during sleep to supplement their usual dietary intake. After 12 mo of nocturnal feedings, the subjects had a mean weight gain of 11.75 kg and a mean height gain of 6.98 cm. Six control subjects, matched for age and degree of growth and sexual retardation at the beginning of the study period, but who had refused the nasogastric feedings, had no change in weight and height during the same period of observation. We conclude that home nocturnal nasogastric feedings can achieve dramatic improvement in weight gain and linear growth in motivated adolescents with Crohn's disease and growth retardation.

Adolescent↗
PubMed1989

Does proctosigmoiditis in inflammatory bowel disease presage the imminent onset of symptoms?

This study was undertaken to determine if asymptomatic children and adolescents with inflammatory bowel disease and moderate to severe anorectosigmoid inflammation might remain symptom-free for at least 12 months without specific intrarectal therapy. We prospectively studied 13 asymptomatic patients 6-21 years of age (four with Crohn's disease and nine with nonspecific colitis) with previously documented anorectosigmoid inflammation. Of these 13, four had moderate to severe anorectosigmoid inflammation both endoscopically and histologically. These four patients (two with Crohn's disease and two with nonspecific colitis) were entered into the second phase of the study. Three were receiving sulfasalazine, and one received methylprednisolone, 4 mg/day, and 6-mercaptopurine, 50 mg/day. None received intrarectal therapy. Clinical evaluation revealed that all four remained asymptomatic for 12 months despite the continued presence of moderate to severe anorectosigmoid inflammation. These results indicate that in children and adolescents with inflammatory bowel disease, the presence of inflammation of the anorectosigmoid does not necessarily correlate with or presage the onset of symptoms of proctosigmoiditis. Therefore, active inflammation of the anorectosigmoid is not the sole prerequisite for intrarectal therapy. The clinician should be guided by the symptoms of the patient, not by the presence or absence of active anorectosigmoid inflammation.

Adolescent↗
PubMed1989

Amyloidosis in children with inflammatory bowel disease.

Reactive systemic or secondary amyloidosis occurs in 1-29% of adults with Crohn's disease, but only sporadic cases of amyloidosis have been recognized in children with inflammatory bowel disease. We therefore have studied operative specimens (ileal, ileocolonic, and colonic) from 46 children (30 with Crohn's disease and 16 with ulcerative colitis) to determine the frequency of amyloid deposits. Sections of bowel, skin, and lymph nodes (n = 940) were stained by Congo red and examined by light microscopy and by polarized light. Amyloid deposits were found in only one of 46 subjects, an 18-year-old girl who had had Crohn's disease for 6 years. Intestinal amyloid deposits, present 16 months before the clinical diagnosis of amyloidosis, were patchy and seen predominantly in the intestinal mucosa. We conclude that amyloidosis is rare in children requiring surgery for Crohn's disease and ulcerative colitis. Examination of Congo red-stained sections can detect even subclinical amyloidosis. The amyloid deposits in our patient, which were both patchy and consistently mucosal, suggest that multiple endoscopic biopsy samples, not necessarily containing submucosa, are sufficient for diagnosis.

Adolescent↗
PubMed1989

Prognostic significance of epithelioid granulomas found in rectosigmoid biopsies at the initial presentation of pediatric Crohn's disease.

The prognostic significance of epithelioid granulomas in Crohn's disease (CD) remains controversial. We have determined the prognostic significance of epithelioid granulomas noted in endoscopic rectosigmoid biopsies obtained from untreated pediatric patients at initial presentation of CD. Data collected from 19 subjects with rectosigmoid granulomas and inflammation (Group 1) were compared to those obtained from another 37 subjects (Group 2) with CD of the rectosigmoid, but in whom no granulomas were present. Both groups had similar ages at disease onset [Group 1: 11.6 +/- 3.6; Group 2: 10.4 +/- 4.0 years (X +/- SD)]. At diagnosis, Group 1 had more extensive CD (small bowel and colon involvement, with Group 1 74% versus Group 2 30%; isolated rectosigmoid involvement, with Group 1 11% versus Group 2 35%; p less than 0.01). Perianal disease was also more common in Group 1 (58% versus 27% Group 2; p less than 0.05). However, CD activity scores and clinical laboratory findings were comparable. Duration of follow-up was identical (5.6 +/- 3.3 years) for both groups. By the end of the period of follow-up, 43% of Group 2 had developed small bowel involvement, but Group 1 continued to have more extensive CD (p less than 0.05). Perianal fistulae and abscesses and anal stenosis were more frequent in Group 1. Throughout this period, the need for oral and parenteral corticosteroids, 6-mercaptopurine, and nutritional support modalities were similar in the two groups. Although the number of subjects requiring hospitalization and the number of hospitalizations per patient were similar in both groups, Group 1 had more surgery (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1989

Diagnostic criteria for dysthymic disorder.

The DSM-III (American Psychiatric Association 1980) criteria for dysthymic disorder selected a heterogeneous group of patients who overlapped with major depression and personality disorders in ways that were difficult to interpret. DSM-III-R (American Psychiatric Association 1987) revised the dysthymia criteria by (1) distinguishing early from late age of onset; (2) providing separate designations for primary and secondary states of dysthymia; (3) including a category of chronic major depression; and (4) revising the specific content of criteria. The performance characteristics of the new criteria set are yet to be tested--a necessary next step to inform the discussions that will culminate in DSM-IV. The remaining areas of greatest controversy are whether (1) early onset, primary dysthymic disorder should be redefined as depressive personality and placed on Axis II; (2) "double-depression" represents a real clinical phenomenon or a definitional artifact; and (3) the content of the diagnostic criteria can be made more specific for chronic depressions. The implications of possible changes and the workings of the DSM-IV Affective Disorders Work Group are discussed.

Depressive Disorder↗
PubMed1988

Factors associated with premature medication discontinuation among responders to an MAOI or a tricyclic antidepressant.

The charts of 80 outpatients who responded to antidepressants were reviewed to determine if there was a higher rate of premature medication discontinuation with phenelzine than with imipramine. The phenelzine responders had a significantly (p less than .01) higher rate of drug discontinuation, mainly because of side effects. Controlled studies of long-term use are needed to better explain the problem of attrition.

Adolescent↗
PubMed1987

Berry aneurysms, cirrhosis, pulmonary emphysema, and bilateral symmetrical cerebral calcifications: a new syndrome.

Familial idiopathic nonarteriosclerotic cerebral calcification (FINCC) constitutes a rare but pathologically well defined disorder. Thus far, central nervous system symptoms and signs have been the only recorded expression of this disease. Autosomal dominant and autosomal recessive inheritance have both been postulated as cause. We describe three sibs who had symmetrical cerebral calcifications, but three also had cirrhosis and pulmonary emphysema; two had congenital cerebral aneurysms. All were male and of short stature; they also had delayed development and seizures, and two had other neurologic deficits. One sib died at age 3 years of hepatic failure and portal hypertension. Ruptured cerebral aneurysms led to the death of the other two boys at ages 8 and 13 years. The cerebral calcifications symmetrically involved the basal ganglia and thalami, the dentate nucleus, and the cortical and subcortical areas of the cerebrum. The liver was studied by sequential biopsies in two of the children and in all three by autopsy. Fatty degeneration and portal fibrosis preceded a periportal and micronodular cirrhosis. Severe bilateral pulmonary emphysema was present in one sib at age 12 years, whereas all three had bullae and cysts at autopsy. Ruptured left middle cerebral artery aneurysms were demonstrated in two sibs, and one also had aneurysms of the anterior and posterior communicating arteries. We conclude that in this family FINCC is a complex pleiotropic mendelian mutation, either of autosomal or X-linked recessive nature, whose basic pathogenesis remains unknown but may involve a metabolic defect. This form of FINCC may be a previously undescribed syndrome or a form of FINCC in which extraneural manifestations were previously overlooked.

Adolescent↗
PubMed1987

Reduced length and cost of hospital stay for major depression in patients treated with ECT.

To investigate the effect of treatment modality on length of hospital stay, the authors retrospectively studied 86 admissions of 74 patients with major depression. All 19 patients who received ECT recovered, in contrast to only 27 (49%) of 55 patients given tricyclic antidepressants or other medication. The 28 patients who had not responded to antidepressants recovered after treatment with ECT. Treatment modality had a highly significant effect on length of hospital stay: patients given ECT stayed a mean of 13 fewer days, saving more than $6,400 per patient at current rates. These findings of significant economic and therapeutic benefits in the use of ECT raise issues about treatment selection for depressed inpatients.

Aged↗
PubMed1987

A comparative study of the electrocardiographic effects of phenelzine, tricyclic antidepressants, mianserin, and placebo.

Although the electrocardiographic effects of the tricyclic antidepressants have been extensively investigated, there are fewer data on the effects of monoamine oxidase inhibitors and tetracyclics on cardiac conduction. This study used high speed recordings of the electrocardiogram to investigate the cardiographic effects of phenelzine and mianserin and to compare these to the effects of imipramine, amitriptyline, and placebo. Phenelzine caused significant slowing of the heart rate, while mianserin showed little effect on heart rate compared to the increases in rate seen with tricyclics. In clinically effective doses, neither phenelzine nor mianserin caused changes in conduction, while both tricyclics studied caused the expected prolongation of conduction. These data suggest that phenelzine and mianserin deserve further study in patients with disease of the cardiac system as they may be less likely to cause heart block in these patients.

Adult↗
PubMed1986

Functional vision in patients with neovascular maculopathy and poor visual acuity.

Central visual function is characteristically reported as Snellen acuity at distance and near. We performed functional tests in a group of patients with visual acuity of 20/100 or worse due to macular disease to determine whether there was a relationship between Snellen acuity and functional performance among these patients with poor visual acuity. Our tests of functional performance included currency discrimination, color recognition, reading a clock, and reading large print. Our results suggest that there is a correlation between Snellen acuity and functional vision, even among patients with poor visual acuity. Hence, therapeutic efforts to keep patients' visual acuity at 20/200 rather than 20/400, for example, appears to be justifiable in that better acuity levels seem to be associated with improved functional performance.

Aging↗
PubMed1986

A case report of dissociative pseudodementia.

The authors report the case of a patient admitted to a medical hospital for seizures and considered for more than 1 month to be demented. Psychiatric examination revealed a fluctuating cognitive capacity, suggesting a psychogenic etiology. Following a sodium amytal interview, the patient's symptoms dramatically resolved. Diagnosis, treatment, and the importance of considering dissociative pseudodementia are discussed.

Amnesia↗
PubMed1986

Psychiatric interventions for AIDS-spectrum disorders.

Although the medical and psychosocial problems posed by acquired immune deficiency syndrome (AIDS) are unique, interventions to treat AIDS-related psychiatric disorders are currently available. The depression, delirium, and denial that occur in medically hospitalized patients with AIDS respond to standard psychotherapeutic and psychopharmacological approaches. Outpatients with AIDS or AIDS-related complex benefit from clarification, abreaction, and support if the therapist accepts the regression associated with the sick role, focuses initially on somatic rather than on psychological concerns, and overcomes unwarranted fears of contagion. Patients with AIDS-related dementia are helped considerably by early diagnosis and planning, and patients with antibodies to the AIDS virus require a psycho-educational approach that includes stress inoculation and problem-solving techniques. The authors describe the above interventions as well as common countertransference responses that impede their implementation.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Linear growth following surgery in children and adolescents with Crohn's disease: relationship to pubertal status.

Studies of the effect of surgery on growth failure in adolescents with Crohn's disease have revealed conflicting data. To better determine the role of surgery for growth delay, growth data from 26 patients with Crohn's disease with intestinal resections and/or ileostomies were reviewed, 3 of whom had surgery twice. Operations were performed on 14 Tanner Stage I, 1 Tanner II, 1 Tanner III, and 13 Tanner IV or V patients. In the prepubertal group, 13 of the 14 had growth impairment, only one of whom had surgery primarily for that growth failure. One year after operation, 11 of 13 Tanner I growth failure patients experienced an increase in height velocity of 5.38 +/- 1.18 cm/yr (mean +/- SE;P less than 0.01); 9/11 achieved normal height velocity for Tanner I. Two attained their preillness height percentiles at one year follow-up, while 5 patients attained their preillness height percentiles 2.5 to 10 years following surgery. Of the four who failed to achieve normal height velocity, 3 had early recurrence of active disease. The Tanner Stage II and III patients both had growth failure, and both had a growth spurt following surgery. Of those who were Tanner Stage IV or V at the time of surgery, 5 of 13 had growth failure. Following surgery, none had an increase in height velocity. These data suggest that when patients with Crohn's disease and growth failure are prepubertal and surgery is performed primarily because of failure of medical therapy and/or other complications, a postoperative growth spurt may be expected within one year.

Adolescent↗
PubMed1985

Sulfasalazine and renal tubular function: lack of an effect.

Sulfasalazine (SASP) is frequently used in the treatment of chronic inflammatory bowel disease (IBD), particularly colitis. Because the drug poses a theoretical risk for renal tubular damage, 26 patients, 8-18 years of age, with Crohn's ileocolitis were studied. Thirteen children were receiving SASP while 13 served as disease controls. Renal tubular function was assessed by measurement of urinary beta 2-microglobulin and n-acetylglucosaminidase activity. No abnormalities were found on routine measurement of renal function. Similarly, urinary beta 2-microglobulin and n-acetylglucosaminidase activities were within normal limits for patients receiving SASP, as well as for disease controls. Although there is a theoretical risk for renal tubular damage from the prolonged use of SASP, this study would suggest that IBD patients receiving the drug are at no greater risk for renal injury than their counterparts not receiving the medication.

Adolescent↗
PubMed1985

Placebo-controlled study of mianserin in depressed outpatients.

Ninety-two outpatients with depressive disorders which met Research Diagnostic Criteria were treated either with mianserin or placebo in a 6-week controlled trial. Twenty-four of 42 (57%) mianserin-treated patients were rated responders to mianserin treatment while 15 of 50 (30%) were rated responders to placebo treatment (chi 2 = 6.89, p less than 0.01). This rate of drug response was comparable to that achieved with a tricyclic antidepressant in a similar study done in our clinic, supporting the use of mianserin in mildly depressed outpatients.

Adolescent↗