Search PubMed⌕ Search

Biomedical subjects

J Silverstein

Publications and source records attributed to J Silverstein.

At least 37 records · Page 2Linked to original sources
PubMed1993

A comparison of growth rates of acoustic neuromas: nonsurgical patients vs. subtotal resection.

A conservative approach to the management of acoustic neuromas in elderly patients has been used since 1971. Elderly patients without symptoms of brain stem compression are initially treated by observation and yearly radiographic imaging. A translabyrinthine radical-subtotal resection is performed if brain stem compression is present or if tumor is growing rapidly. Twenty-three patients, ages 65 to 86 years, had initial nonsurgical management of their tumors. Growth rates could be determined for 16 patients. Thirteen patients not requiring surgery had an average tumor growth rate of 0.6 mm/yr. Three patients with an average growth rate of 6.8 mm/yr eventually required surgery. No patient whose tumor was < 15 mm at initial evaluation has experienced brain stem symptoms or demonstrated rapid tumor growth. Twenty-four patients ages 65 to 86 years underwent planned subtotal tumor excision. Eighteen patients followed postoperatively for more than 1 year demonstrated an average rate of regrowth of tumor of 0.7 mm/yr.

Aged↗
PubMed1993

Middle ear air injection after chronic ear surgery.

In the early period after chronic ear surgery, the reasons for conductive hearing loss may be difficult to determine. Patients who cannot autoinflate the middle ear after 3 weeks, or who have a negative Rinne test result with the 512 Hz tuning fork, are treated with a transtympanic injection of 0.5 cc of air with a 27-gauge needle and tuberculin syringe. This represents 20% of patients who had chronic ear surgery. Results show that hearing may be immediately improved, the sensation of pressure in the ear may be reduced, and fluid may be cleared from the middle ear. Other benefits may include the release of adhesions. The surgeon is better able to assess the thickness of the graft, and the status of the ossicular chain reconstruction can be determined. There have been no complications of middle ear infection or failure of the micropuncture site to heal. In our practice, middle ear air injection is a routine procedure in patients with inadequate eustachian tube function after chronic ear surgery. This report describes the results of 100 patients over 14 years who received middle ear air injections after chronic ear surgery compared with a control group of 100 patients who did not meet the criteria for requiring air injection. Hearing was immediately improved in 74% of patients as determined by Rinne testing. Audiograms were performed in 25 of these patients, documenting a mean improvement in pure-tone average of 16 dB. The long-term hearing results in patients undergoing air injection, who by definition had evidence of poor eustachian tube function, are similar to the results in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗
PubMed1992

Behavioral treatment of nocturnal enuresis in children with insulin-dependent diabetes mellitus.

Examined whether a well-established treatment program for functional enuresis, the urine alarm procedure, would be useful for children with both enuresis and diabetes. 5 children between the ages of 7 and 14 whose pretreatment physical examination suggested no neurological impairment were treated. A multiple baseline design across children indicated that the urine alarm procedure was successful in stopping enuretic episodes for all 5 children with treatment gains maintained for the 4 children available for assessment at 2-month follow-up. These results suggest that if no diabetes-related organic impairment is evident, behavioral treatment for enuresis can be beneficial for children with diabetes.

Adolescent↗
PubMed1992

The death of a child with diabetes from neglect. A case study.

This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.

Child↗
PubMed1991

Assessing daily management of childhood diabetes using 24-hour recall interviews: reliability and stability.

Conducted 24-hr recall interviews concerning daily diabetes management with seventy-eight 6- to 19-year-old patients and their parents. Patients and parents were interviewed independently nine times over 3 months. Data obtained were used to construct 13 adherence measures. All measures yielded statistically significant estimates of parent-child concordance. Parent-child agreement was higher for weekday versus weekend behaviors and when based on nine versus three interviews. For the sample as a whole, parent-child concordance remained stable over the course of the study. Compared to the older patients, the 6- to 9-year-olds exhibited poorer parent-child agreement on measures involving time (e.g., injection and exercise-duration measures). This deficit disappeared, however, as the children became more practiced with the interview procedure. The dietary and glucose-testing measures exhibited moderate stability over the 3-month study. Lower stability estimates were obtained for the exercise and injection measures.

Activities of Daily Living↗
PubMed1991

Insulin dependent diabetes 1991.

Insulin dependent diabetes (IDD) most often results from the autoimmune destruction of pancreatic beta cells. During this process, autoantibodies to islet cell constituents (islet cell cytoplasm, 64KDa protein [GAD]) and to insulin arise and can be used for disease prediction if found before onset or for classification at onset in cases in which type of diabetes is not clear. Approximately 4-5% of immediate family members have at least one of these antibodies. The younger the age and the higher the antibody titer, the greater the chance of IDD developing. Because studies using immunosuppression in newly-diagnosed IDD have shown transient prolongation of beta cell function, efforts to use such therapies prior to diabetes onset may prevent beta cell destruction and clinical disease. A multicenter trial is underway in Florida to screen relatives for diabetes-related antibodies and then to enter those found positive and at increased risk in a study to prevent diabetes. Details of the study and its rationale are presented.

Autoimmune Diseases↗
PubMed1990

Assessing daily diabetes management by 24-hour recall interview: the validity of children's reports.

The current investigation examined the accuracy of diabetic children's 24-hr recall data by comparing the 7- to 12-year-old children's reports to direct observations of their behavior. Observers' data evidenced sufficient reliability to serve as an acceptable standard to which the children's 24-hr recall data could be compared. The children exhibited excellent agreement with the observers' data on all measures of the occurrence/nonoccurrence of events, including insulin injections, exercise periods, glucose tests, meal, type and amount of insulin injected. Although somewhat poorer reporters on some behaviors, differences were small. Children underreported most dietary behaviors and some exercise behaviors.

Blood Glucose Self-Monitoring↗
PubMed1990

Adherence-health status relationships in childhood diabetes.

Used 24-hr recall interviews to assess adherence in a sample of seventy-eight 6- to 19-year-olds with insulin-dependent diabetes mellitus over a 3-month period. Thirteen adherence measures were quantified and grouped into six adherence factors (Injection, Exercise, Diet Type, Testing/Eating Frequency, Calories Consumed, and Concentrated Sweets). Prevailing glucose levels over a 2- to 3-month interval were indexed by glycosylated hemoglobin A1c (HA1c) and glycosylated serum protein (GSP) assays. Fasting triglycerides (TRIG) and total cholesterol (CHOL) assays were used to estimate lipid metabolism. Adolescents were generally less adherent than their young counterparts. Using hierarchical multiple-regression techniques, HA1c and GSP were not reliably predicted by most of the adherence factors; only Calories Consumed showed any predictive power. No significant regression equations emerged for CHOL. In contrast, TRIG was significantly associated with five of the six adherence factors; in all cases, adherence interacted with the patients' metabolic status (as defined by HA1c) at study entry, suggesting that adherence had different effects for youngsters in good versus poor diabetes control.

Adolescent↗
PubMed1989

Psychological and physiological responses to acute laboratory stressors in insulin-dependent diabetes mellitus adolescents and nondiabetic controls.

Thirty 11- to 18-year old adolescents with insulin-dependent diabetes mellitus (IDDM) of at least 1-year duration and 15 nondiabetic controls were subjected to three laboratory stressors: a venipuncture and two public-speaking tasks. Half of the IDDM participants were in good metabolic control prior to the inception of the experiment and half were in poor control. The IDDM adolescents in poor control and the nondiabetics were matched to the well-controlled IDDM group on the basis of age, sex, and race. The two IDDM groups were also matched on disease duration. Self-report, behavioral, and physiological measures of anxiety or arousal were monitored during the stress.

Adolescent↗
PubMed1988

Immunosuppression with azathioprine and prednisone in recent-onset insulin-dependent diabetes mellitus.

We randomly assigned 46 patients (mean age, 11.7 years; range, 4.5 to 32.8) with newly diagnosed insulin-dependent diabetes mellitus within two weeks of beginning insulin to receive either corticosteroids for 10 weeks plus daily azathioprine for one year or no immunosuppressive therapy. Half the 20 immunosuppressed patients completing the one-year trial had satisfactory metabolic outcomes (hemoglobin A1c less than 6.8 percent; stimulated peak C peptide greater than 0.5 nmol per liter; insulin dose less than 0.4 U per kilogram of body weight per day) as compared with only 15 percent of the controls. Three of 20 immunosuppressed patients, but no controls, were insulin independent at one year. Two of these continue to receive azathioprine without insulin after more than 27 months of follow-up. The response to immunosuppression correlated with older age, better initial metabolic status, and lymphopenia (less than 1800 lymphocytes per cubic millimeter) resulting from immunosuppression. The side effects of azathioprine included vomiting in one patient and mild hair loss in several others. Prednisone use resulted in a transient cushingoid appearance, weight gain, and hyperglycemia. The growth rate remained normal in all patients. We conclude that early immunosuppression with short-term use of corticosteroids plus daily azathioprine can improve metabolic control in some patients with insulin-dependent diabetes mellitus, but results from this unblinded study are preliminary and require further confirmation and long-term follow-up.

Adolescent↗
PubMed1988

The prodrome of bullous pemphigoid.

Bullous pemphigoid is an autoimmune bullous dermatosis that can be preceded by a prodromal phase, usually lasting weeks to months, during which the cutaneous changes are dermatitic rather than bullous. Two cases of unusually long prodromal periods, 18 months and 6 years, are reported.

Aged↗
PubMed1988

Inherited susceptibility to insulin-dependent diabetes is associated with HLA-DR1, while DR5 is protective.

Of the HLA allelic associations with insulin-dependent diabetes (IDD) reported to date. DR3 and DR4 have been the most positive and DR2 the most negative. In 952 Caucasian proband patients reported here, only 57 or 6% had no DR3 or DR4 alleles. When these 57 patients were compared to 249 Caucasian controls similarly lacking DR3 and DR4 antigens, there were excesses of DR1 (P = 0.13) and DRW8 (P = 0.01) and deficiencies of DR2 (P = 0.03) and DR5 (P = 0.03) in the patient group. The most common phenotype in this group of patients was DR1/DR7 (12.3%). Only four DR-homozygous patients involving alleles other than DR3 and DR4 were found by genotyping, and all were DR1 homozygotes. Among 506 patients wuth DR3/DRX or DR4/DRX phenotypes, DR1 was more frequent (P = 0.001; Bonferronni P = 0.006), and DR2 (P = 0.001) and DR5 (P = 0.001) less frequent than 243 HLA-matched controls. Of 187 patients with a single DR3 and no DR4, DR1 was more frequent (P = 0.02), with DR2 (P = 0.001) and DR5 (P = 0.02) less frequent than 94 HLA DR-compatible controls. Among 319 patients with a single DR4 but no DR3, DR1 was again more frequent (P = 0.01) and DR2 (P = 0.001) and DR5 (P = 0.001) less frequent than 149 HLA-matched controls. We conclude that DR1 is an additional risk DR allele for IDD to that of DR3 and DR4, and DR5 an additional protective DR allele to that of DR2.

Adolescent↗
PubMed1986

Changes in insulin-like growth factors I and II and their binding protein after a single intramuscular injection of growth hormone.

The concentrations of insulin-like growth factors I and II (IGF-I and IGF-II) and their binding proteins in serum were measured in 10 GH-deficient patients before and after a single 6-IU injection of GH. Serum IGF-I concentrations were initially low, increased significantly by 8 and 24 h, and decreased to pretreatment levels 48 and 72 h after GH administration. Serum IGF-II concentrations also were low initially and did not increase by 8 and 24 h, but were, however, significantly higher 48 and 72 h after GH administration. In GH-deficient patients before GH administration, binding of IGF-I or IGF-II to serum proteins was restricted primarily to proteins of 50K mol wt. Little or no binding to proteins of 150,000 mol wt was found. By 8 and 24 h after GH injection, IGF-I, but not IGF-II, bound primarily to a protein(s) of 150K mol wt, as in normal subjects. IGF-II remained bound to a 50K mol wt protein. By 48 and 72 h after administering GH, however, the binding pattern was reversed, and IGF-II, but not IGF-I, bound predominantly to a protein(s) of 150K mol wt. Our data demonstrate both a temporal dissociation in the responses of IGF-I and IGF-II to GH and a similar temporal dissociation in the binding of IGF-I and IGF-II to the large mol wt (150K) binding protein. This dissociation, particularly the latter, may provide a means for better characterization of protein fractions in binding IGF, particularly in terms of specificity.

Adolescent↗
PubMed1984

Renal function in rats chronically exposed to high altitude.

Chronic exposure of rats to a simulated altitude of 18,000 ft (5,500 m) results in severe polycythemia and consequent reduction of the plasma fraction. However, glomerular filtration rate is usually well maintained. This study was conducted to determine whether an increase in effective renal blood flow (ERBF) plays a role in maintaining a normal glomerular filtration rate in the chronically hypoxic rats. Various measurements of renal function were made in conscious trained and chronically catheterized animals. After exposure to high altitude for 30 days, hematocrit ranged from 64 to 77%. Despite this severe reduction in the plasma fraction, however, renal plasma flow decreased by only 25%, primarily owing to an increase in ERBF. The glomerular filtration rate was within the normal range. Since blood pressure remained unchanged, the increase in ERBF must have resulted from renal vasodilation. Acute removal of the hypoxic stimulus did not reverse the increased ERBF, suggesting that the vasodilation may have been of structural origin.

Altitude↗