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Biomedical subjects

J Schachter

Publications and source records attributed to J Schachter.

At least 73 records · Page 4Linked to original sources
PubMed1997

Evaluation of the Vidas Chlamydia test to detect and verify Chlamydia trachomatis in urogenital specimens.

The Vidas Chlamydia test (CHL) is an automated enzyme-linked immunofluorescence assay for the detection of Chlamydia trachomatis. Positive and equivocal results are confirmed with a blocking assay. A mouse monoclonal antibody directed against the chlamydial lipopolysaccharides was used for the test. The CHL assay is widely used in Europe, but U.S. experience with it is limited. Three clinical test sites (The Arlington Hospital, Arlington, Va., Indiana University, Indianapolis, and the University of California, San Francisco) compared CHL with tissue culture (TC) for the identification of chlamydia in urogenital specimens (2,453 females and 850 males). True positives (TP) were defined as either TC positive or TC negative and CHL positive by a positive direct fluorescent-antibody assay or PCR test. Overall prevalence was 5.5% for females, 10.3% for male urethral swabs, and 10.7% for combined male TC urethral swabs and CHL with first catch urine (FCU) specimens. Compared to TP, CHL and TC had sensitivities of 89.6 and 94.1% with female cervical swabs and 90.9 and 86.4% with male urethral swabs, respectively. CHL sensitivity was 81.2 for male FCU specimens and 77.7% for matching male TC swabs. There were relatively few false-positive results, with all specificities being >99.4%. With the blocking assay, Vidas CHL specificity was >99.7%. However, male FCU specimen sensitivity was compromised because 9.2% (7 of 76) of the TP were initially positive but were not confirmed. An improvement in the Vidas blocking assay is needed before we can recommend its use with male urine. Alternatively, one could argue that the specificity of the test is so high that a confirmatory assay is not needed. For male and female swabs, the Vidas CHL assay has a performance that is similar to that of TC.

Bacteriological Techniques↗
PubMed1997

Clinical experience with psychoanalytic post-termination meetings.

The authors describe post-termination meetings in order to examine the controversial issue of the proper relationship between analyst and patient at this stage. In the first case the meetings facilitated the patient's re-entering treatment, leading to significant further growth. In the second and third cases, the meetings re-ignited mourning for the analyst and furthered analytic gains. The authors' overall impression was that the post-termination contacts were helpful for all three patients. Their limited data contradicted the long-standing assumption that all post-termination contact, unless specified as a course of further treatment, is harmful to the patient. The authors suggest that such meetings stabilise analytic gains, provide a joint assessment of analytic outcome from a useful later perspective and provide an opportunity for further analytic work. The consideration of any post-termination changes in the patient allows for a more inclusive evaluation of the analysis than was possible earlier. While acknowledging the need to consider such meetings thoughtfully in order to avoid any harmful enactment of wishes by the patient or the analyst, the authors encourage analysts to explore and report such meetings to replace unexamined assumptions and develop a body of clinical data about the effects of post-termination contacts.

Adult↗
PubMed1996

Chlamydia pneumoniae infection in patients with cystic fibrosis.

The prevalence of atypical community-acquired infections as acute pulmonary exacerbations in patients with cystic fibrosis was prospectively studied. Thirty-two patients admitted to the hospital because of acute pulmonary exacerbations and 24 clinically stable patients seen for their routine visits were examined. The prevalence of infection with Chlamydia pneumoniae was assessed by culture and serology, and the presence of IgE to C. pneumoniae was studied by immunoblotting. A subgroup of patients was also examined for the presence of Mycoplasma pneumoniae infection. C. pneumoniae was isolated from four patients presenting with acute pulmonary exacerbations (12.5%) and from none of the stable patients; all patients for whom cultures were positive also had IgE to C. pneumoniae. Polymerase chain reaction analysis for M. pneumoniae was not positive for any patient, and only one patient with an acute exacerbation had an antibody titer compatible with a recent infection. We conclude that infection with C. pneumoniae is associated with acute pulmonary exacerbations in some patients with cystic fibrosis and that it may trigger the production of IgE specific to C. pneumoniae, thus leading to bronchial reactivity in these patients.

Adolescent↗
PubMed1996

Failure to detect Chlamydia pneumoniae in coronary atheromas of patients undergoing atherectomy.

To further investigate a proposed relationship between Chlamydia pneumoniae and coronary heart disease, coronary atheromas were collected from patients undergoing percutaneous atherectomy. Fifty-eight atheroma specimens were examined by culture and polymerase chain reaction (PCR) and 22 by electron microscopy. All were negative for C. pneumoniae, except a single specimen that was PCR-positive. These results differ from studies in other populations, in which this organism was identified by nonculture methods within coronary atheromas obtained at autopsy. Anti-C. pneumoniae antibody titers from 65 of the patients were compared with those of 28 asymptomatic controls. IgG titers were higher in controls than in patients. There is no evidence that C. pneumoniae exists within atheromas in this study population, nor does seroprevalence correlate with the presence of coronary disease in these patients.

Adult↗
PubMed1996

Correlation between tumour and serum beta 2m expression in patients with breast cancer.

HLA class I antigens are composed of a major histocompatibility complex (MHC) encoded heavy chain that is associated non-covalently with a light chain beta-2 microglobulin (beta-2m). When the HLA complex is metabolized, beta-2m is shed into the serum. A large variety of human and experimental tumours have altered MHC class I expression. In a previous study we observed elevated mean beta-2m serum levels in breast cancer patients, as compared to controls. To study the relationship between tumour expression and serum levels, we examined 54 patients with breast cancer. Tumour beta-2m was determined by immunohistochemistry and serum levels by the ELISA technique. Of the 54 patients, 38 had low and 16 had high beta-2m expression on the tumour. There was a significant correlation between tumour beta-2m and serum beta-2m levels (P = 0.02), with patients whose tumours expressed high beta-2m having high serum beta-2m levels. There was an inverse correlation between tumour grade and tumour beta-2m expression which approached statistical significance (P = 0.06). These findings suggest that in a substantial number of patients the high serum levels derive from shedding of beta-2m from tumour cells. These levels may have implications for tumour growth and metastases due to influences on immunological responses.

Adult↗
PubMed1996

Is urine leukocyte esterase test a useful screening method to predict Chlamydia trachomatis infection in women?

We evaluated the use of the leukocyte esterase test (LET) on first-catch urine specimens from women as a screening test to predict infection with Chlamydia trachomatis. For diagnosis, we used Abbott's ligase chain reaction (LCR) on urine specimens and isolation by tissue culture (TC) on cervical brushes. Of 4,053 women attending sexually transmitted disease and family planning clinics, 4.3% (n = 174) were positive by TC and 5.9% (n = 239) were positive by LCR. When LET was compared to TC, the sensitivity, specificity, positive predictive value, and negative predictive value were 54.0, 67.0, 6.8, and 97.0%, respectively. The corresponding performance of LET versus LCR was 53.1, 67.3, 10.1, and 95.8%. Almost half of the laboratory-confirmed chlamydial infections were negative by LET. The low specificity probably reflects multiple causes of pyuria in women and results in a low positive predictive value. LET is neither sensitive nor specific as a predictor of chlamydial infection and cannot be recommended for use as a screening test for C. trachomatis with first-catch urine samples from females from low- or moderate-prevalence populations.

Chlamydia Infections↗
PubMed1996

Familial hypothyroidism with autosomal dominant inheritance.

Three generations of a family with clinical and subclinical hypothyroidism caused by thyroid stimulating hormone (TSH) unresponsiveness are described. Findings were low to normal serum thyroxine, raised serum TSH, and low radioiodine uptake; goitre was notably absent. This family is the first evidence of an autosomal dominant mode of transmission of TSH unresponsiveness and may enable identification of the precise defect by genetic linkage study.

Adolescent↗
PubMed1995

[Epidemiology and prognostic factors in cutaneous malignant melanoma].

207 patients with primary cutaneous malignant melanoma were admitted between August 1, 1988 and July 31, 1992 for local excision and treatment. The female to male ratio was 1.4:1 and the peak age was in the seventies. The most frequent site in males was the back and in females the legs. Superficial spreading melanoma was the most frequent type (40%); there was also a high rate of nodular melanoma (20%), particularly in males. Thin melanomas accounted for most of the cases. On follow-up 27 (13%) developed metastases in transit or in regional lymph nodes and 10 (5%) developed distant metastases; 2 (1%) had locally recurrent melanoma and 2 died of metastatic melanoma. There was a significant positive correlation between Breslow thickness, Clark's level of invasion, histopathological ulceration, nodular and acral lentiginous type of lesion and development of metastases. These data may be valuable for public and professional education and in the prediction of outcome of melanoma.

Aged↗
PubMed1995

Diagnosis of Chlamydia trachomatis genitourinary infection in women by ligase chain reaction assay of urine.

Genitourinary infection with Chlamydia trachomatis is a common and potentially serious sexually transmitted disease. Diagnosis of C trachomatis infection in women typically relies on culture of endocervical swabs, an invasive and expensive procedure. The ligase chain reaction (LCR) is an in-vitro nucleic acid amplification technique that exponentially amplifies selected DNA sequences. We have compared an LCR-based assay to detect C trachomatis plasmid DNA in first void urine with culture of endocervical swabs for matched specimens from 1937 women from four geographic regions. Discordant specimen pairs were further tested by direct fluorescent antibody staining for elementary bodies and an alternative LCR assay based on the chlamydial outer membrane protein gene. An "expanded gold standard" was defined to include all culture-positive as well as culture-negative, confirmed LCR-positive women. The sensitivity and specificity of the LCR assay with first void urine samples compared with the expanded gold standard were 93.8% and 99.9%, respectively; the corresponding values for culture were 65.0% and 100%, respectively. Thus, an automated LCR assay of readily obtained urine samples showed a detection rate for infected women almost 30% greater than that of endocervical swab culture. The LCR assay was highly effective for the detection of C trachomatis in urine from women with or without signs or symptoms of chlamydial genitourinary tract infection.

Bacterial Outer Membrane Proteins↗
PubMed1995

Plasma cell endometritis in women with symptomatic bacterial vaginosis.

OBJECTIVE: To evaluate the endometrial microbiology and histopathology in women with symptomatic bacterial vaginosis but no signs or symptoms of upper genital tract disease or other vaginal or cervical infections. METHODS: Endometrial biopsies were performed on 41 women complaining of vaginal discharge or pelvic pain at a sexually transmitted disease clinic. These women had neither culture nor serologic evidence of Neisseria gonorrhoeae or Chlamydia trachomatis infection. Twenty-two women with bacterial vaginosis diagnosed by Gram stain examination of vaginal fluid, but with neither signs nor symptoms of upper genital tract infection, were compared with 19 women who had no evidence of bacterial vaginosis on vaginal fluid Gram stain. Endometrial biopsies were evaluated for histopathologic evidence of plasma cell endometritis and were cultured for N gonorrhoeae, C trachomatis, aerobic and anaerobic bacteria, Mycoplasma species, and Ureaplasma urealyticum. RESULTS: Ten of 22 women with bacterial vaginosis had plasma cell endometritis, compared with one of 19 controls (odds ratio [OR] 15, 95% confidence interval [CI] 2-686; P < .01). Bacterial vaginosis-associated organisms were cultured from the endometria of nine of 11 women with and eight of 30 women without plasma cell endometritis (OR 12.4, 95% CI 2-132; P = .002). CONCLUSION: Plasma cell endometritis was frequently present in women with bacterial vaginosis and without other vaginal or cervical infections. This suggests the possibility of an association between bacterial vaginosis and nonchlamydial, nongonococcal, upper genital tract infection.

Biopsy↗
PubMed1995

Cognitive-behavioral group psychotherapy for agoraphobia and panic disorder.

Agoraphobia is a complex disorder characterized by substantial personal, social, and occupational disability. This paper presents a cognitive-behavioral model of group psychotherapy for agoraphobia treatment wherein group members are taught active coping skills to reduce anxiety and behavioral avoidance. Therapy occurs in the context of a supportive group, which aids in reducing the social isolation and alienation attendant on this severe anxiety disorder. The model of treatment is amenable to both time-limited and open-ended group therapy formats.

Agoraphobia↗
PubMed1995

Allogeneic human liposomal melanoma vaccine with or without IL-2 in metastatic melanoma patients: clinical and immunobiological effects.

The aim of this pilot study was to assess the clinical and immunological effects of human allogeneic liposomal melanoma vaccine alone or combined with Interleukin-2 (IL-2) in patients with metastatic melanoma. Four concurrent treatment arms were included: vaccine alone (A); vaccine combined with systemic IL-2 (B); vaccine combined with low-dose liposomal regional IL-2 (C); and low-dose regional IL-2 as in group C but without vaccine (D). Vaccine was prepared from semisynthetic phospholipids (dimyristol phosphatidylcholine and dimyristol phosphatidylglycerol) and membranes of six human melanoma cell lines. The latter were chosen as expressing MHC class I and II antigens and a "mosaic" of melanoma-associated antigens (MAAs) as detected by MoAbs R24, p97, CF21 and TA99. Nine of the 24 patients had objective clinical responses: of the ten patients treated with liposomal vaccine and low dose regional IL-2 (arm C), three had complete responses (CR) and three had partial responses (PR); of the five patients treated with liposomal, low-dose regional liposomal IL-2 only (arm D), three had PRs. No clinical responses were seen in patients treated by vaccine alone (A) nor in patients treated by vaccine and systemic IL-2 (B). Patients' in vivo and in vitro cellular immune responses were closely monitored. Conversion to positive cutaneous delayed type hypersensitivity (DTH) to membrane vaccine (without liposomes) was induced only in the six clinical responders of arm C. Positive DTH correlated with augmented in vitro proliferative lymphocyte responses stimulated by melanoma cell lines and membrane preparation and with the augmented cytolytic activity against melanoma cell lines.

Adult↗
PubMed1995

Prevalence of asymptomatic nasopharyngeal carriage of Chlamydia pneumoniae in subjectively healthy adults: assessment by polymerase chain reaction-enzyme immunoassay and culture.

Although Chlamydia pneumoniae is a well-described and common respiratory tract pathogen, up to 90% of infections with this organism are thought to be asymptomatic. Because asymptomatic infection with C. pneumoniae has not been studied in a systematic manner, we conducted a prospective study of healthy adults to establish the prevalence of asymptomatic infection. Nasopharyngeal swab specimens were obtained from 104 subjectively healthy people and evaluated by culture and polymerase chain reaction-enzyme immunoassay (PCR-EIA) for the presence of the organism. Serum obtained from 103 of these individuals was tested by microimmunofluorescence for the titer of specific antibody to C. pneumoniae. For two individuals, C. pneumoniae was identified in nasopharyngeal specimens by culture and/or PCR-EIA; one of these individuals had an IgG titer of 1:256, whereas the other had no detectable antibody. Of the remaining 101 individuals with negative culture and PCR-EIA results, 19 fulfilled presently accepted serological criteria for acute infection; i.e., the IgM titer was > or = 1:16, the IgG titer was > or = 1:512, or both. On the basis of our findings, we conclude that asymptomatic upper airway infection and carriage with C. pneumoniae occur among subjectively healthy persons; we also propose that such individuals may represent a reservoir for this organism in the community. Further, this study demonstrates that currently available diagnostic tests for C. pneumoniae may be unable to accurately distinguish between infection responsible for respiratory tract disease and that representing carriage.

Adult↗
PubMed1995

Molecular identification of an avian strain of Chlamydia psittaci causing severe keratoconjunctivitis in a bird fancier.

A healthy female bird fancier developed progressive follicular keratoconjunctivitis despite topical treatment with antibiotics and steroids. Although bacterial, viral, and chlamydial cultures were negative, direct fluorescent antibody staining of conjunctival scrapings revealed chlamydial lipopolysaccharide; however, this procedure failed to detect the major outer membrane protein (MOMP) of Chlamydia trachomatis. The polymerase chain reaction (PCR) used with species-specific primers to the MOMP gene detected DNA of Chlamydia psittaci. Genotype analysis of the infecting strain revealed a nucleotide homology of 96% with C. psittaci avian strain 6-BC. Serum IgG titers were measured at 1:512 by microimmunofluorescence at 6 weeks, and they remained elevated for 3 months. A 10-week course of treatment with doxycycline was required for eradication of the infection. This case illustrates the importance of PCR/genotyping for direct detection and typing of Chlamydia species when chlamydial infections are suspected. To our knowledge, this is the first report of a naturally occurring ocular infection due to an avian strain of C. psittaci.

Amino Acid Sequence↗