Biomedical subjects
J Sherman
Publications and source records attributed to J Sherman.
Self-help for troubled teens: Delancey Street in the desert.
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Central pigmentary sheen dystrophy.
Three members from two successive generations demonstrated a bilateral, symmetric pigmentary maculopathy consisting of a diffuse yellowish sheen of the posterior pole. The visual acuity was variable (20/25 to 10/400) and visual function tests indicated a localized disorder. Historic information suggests the disorder is slowly progressive. On the basis of mode of inheritance, fundus and angiographic appearance, and visual function testing this appears to be a newly described disorder.
The effects of fenfluramine (hydrochloride) on the behaviors of fifteen autistic children.
Fifteen autistic individuals were involved in an investigation using fenfluramine and placebo in a double-blind crossover design. Subjects were assessed using IQ tests, the Real Life Rating Scale (RLRS), the Adaptive Behavior Scale-School Edition (ABS-SE), and videotaped play data on 8 of 12 visits, including 2 follow-up visits. Serotonin level in platelet-poor plasma was assessed on all 12 visits. Serotonin levels decreased with the administration of fenfluramine, and increased with the reinstatement of placebo. Statistical tests revealed no significant differences on the IQ scores, the RLRS, or the ABS-SE for the drug versus the placebo conditions. Videotaped data favored the subjects while on placebo. Group and individual data were analyzed over time and indicated no significant improvements due to the drug. The implications of this research make it difficult to recommend fenfluramine as a treatment for autism.
Isospora belli infection: treatment with pyrimethamine.
Isosporiasis is an uncommon but important diarrheal disease of humans that, like cryptosporidiosis, is life-threatening in patients with the acquired immunodeficiency syndrome (AIDS). Isospora belli infection responds rapidly to therapy with trimethoprim-sulfamethoxazole, but patients with AIDS have a high rate of adverse reactions to this therapy. The cases of two patients with AIDS, sulfonamide allergy, and I. belli infection are reported. They were treated successfully with pyrimethamine alone, 75 mg/d, and recurrence was prevented with daily pyrimethamine therapy, 25 mg/d. In patients with AIDS with sulfonamide allergy or intolerance, pyrimethamine alone seems to be a reasonable alternative therapy for I. belli infection.
Treatment of autistic children: relative effectiveness of residential, out-patient and home-based interventions.
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Schizophrenia in a 48,XXXX child.
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Plasma neurochemistry in juvenile offenders.
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Optic pit, microphthalmos and orbital cyst.
An orbital cyst was discovered by ultrasonography behind the globe of the left eye in a five-year-old boy with a left esotropia. In addition, an optic pit was present in the optic nerve head of the same eye, which was microphthalmic relative to the right eye. Although orbital cyst has been reported in the literature, this case is of interest because of the presence of two congenital anomalies in the same eye - namely, optic pit and orbital cyst. These two conditions have never been previously reported as existing together in the same eye.
Presurgical prediction of postsurgical visual acuity in patients with media opacities.
Of the estimated 1 million patients each year in the United States who undergo surgery for media opacities, perhaps 5-10% fail to improve because of pre-existing, undiagnosed retinal and/or optic nerve disease. In this paper, the standard presurgical evaluation (case history, visual acuity, refraction, pupillary response testing, biomicroscopy, ophthalmoscopy, tonometry, visual fields and color vision) and the supplementary presurgical evaluation (entoptic phenomena appreciation, ophthalmic ultrasonography, fluorescein angiography, laser interferometry, potential acuity meter, visual evoked potential, electroretinography, contrast sensitivity and hyperacuity measurements) are reviewed.
Malpractice insurance crisis.
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Magnetic resonance planned thalamotomy followed by X-ray/CT-guided thalamotomy.
Magnetic resonance imaging (MRI) is currently the optimal neuroradiologic technique for visualizing the anterior and posterior commissure for defining the AC-PC line. CT is the optimal technique for electrode and probe guidance during stereotactic thalamotomy. Various possibilities of transferring or overlying MRI and CT are outlined which in some future might result in more refined methods of CT-MRI guidance for stereotactic surgery.
Promoting self-directed hemodialysis: measurement and cognitive-behavioral intervention.
Approximately 98% of hemodialysis patients who are treated in hemodialysis units currently use staff-directed treatment. This may well be the most expensive and most dependent mode of hemodialysis treatment. If an effective strategy were developed to enhance degree of self-directed care, millions of public health dollars might be saved while patients reap potentially substantial psychological benefits. The present research took two steps in the direction of promoting increased self-directed treatment of hemodialysis. First, a reliable and easily used behavioral observation system was developed to define and measure degree of self-directed treatment of hemodialysis. Second, a five-step cognitive-behavioral strategy to improve degree of self-directed treatment was developed and tested preliminarily. The strategy includes an initial rationale, decisional counseling, behavioral contracting, self-monitoring, and staff support/problem solving. Four nurses used this approach with 4 elderly patients (mean age = 70.5 years). A multiple-baseline-across-subjects design revealed substantial and relatively rapid improvements in degree of self-directedness associated with the intervention for the 3 patients who remained healthy throughout the study. The discussion focuses on the implications of the results for future research.
Normative data and control studies of flash VEP's for comparison to a clinical population.
The effects of aging, interocular comparisons, pupil dilation, iris pigmentation, and simulated cataracts on bright flash visual evoked potentials (VEP's) of normal observers were studied to assess the flash VEP as a potential predictor of postsurgical visual function in cataract patients. Seventy-six observers (from 20 to 80 years old) were tested for age differences in flash VEP's. Implicit time measures for transient responses increased significantly as a function of age, but neither transient nor steady-state response amplitudes were altered significantly. Moreover, no significant changes in VEP's occurred as a function of interocular comparisons, pupil dilation, or differences in iris pigmentation of normal observers. Simulation of cataracts with 14 observers did not affect implicit time measures, but did change response amplitudes significantly. Therefore, implicit time measures of cataract patients should be compared either to those of normal age-matched controls or, in the case of a unilateral problem, to the normal fellow eye. Delayed implicit time measures, after the appropriate comparison, suggest optic nerve/pathway dysfunction. However, comparisons of amplitude measures require compensation for opacity density.
Spondylolysis in Scheuermann's disease.
Increased lumbar lordosis places increased stress on the pars interarticularis. Fatigue fractures of the pars can result in spondylolysis. There was a 50% incidence of asymptomatic spondylolysis in 18 patients who had Scheuermann's kyphosis and an increased lumbar lordosis. This significant increase further confirms the pathogenesis of spondylolysis. Patients with Scheuermann's disease with low-back pain should be evaluated with oblique radiographs of the lumbar spine to rule out spondylolysis.
[Electrosurgery: basic conditions for successful use].
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Preventive medicine. Heartbeat Wales.
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Magnetic resonance imaging in partial complex epilepsy.
The yield of magnetic resonance (MR) imaging was investigated in 30 patients with partial complex epilepsy, and the results were compared with those of computed tomography (CT). Magnetic resonance imaging and CT disclosed focal cerebral abnormalities in 13 (43%) and eight (26%) patients, respectively. Two additional focal temporal lesions were identified by double-dose CT scanning, increasing the yield of CT to 33%. Magnetic resonance images were abnormal in all patients with focally abnormal CT scans, and in four patients (50%) they defined the extent of the temporolimbic lesions better than did the CT scans. Two of these patients had gliomas. In addition, MR images were focally abnormal in 85% of the patients in whom scalp electroencephalograms showed focal ictal discharges. These data indicate that MR imaging is more informative than CT in partial complex epilepsy.