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Biomedical subjects

J Stern

Publications and source records attributed to J Stern.

269 records · Page 15Linked to original sources
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Zygomycosis orbital apex syndrome in association with a solitary lung carcinoma.

We describe a patient who presented with orbital apex syndrome. Sphenoidectomy and biopsy revealed invasive zygomycosis. The patient had no obvious risk factors for the development of zygomycosis, but was subsequently found to have a solitary, occult lung carcinoma. The unusual clinical features of this case are discussed, and the English language literature on zygomycoses in patients with solid tumours is reviewed. Possible predisposing factors are discussed.

Adenocarcinoma↗
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Necrotizing Candida enterocolitis in AIDS: CT features.

An unusual case of necrotizing enterocolitis secondary to invasive candidiasis in acquired immunodeficiency syndrome is reported. Computed tomography showed significant small bowel dilatation, high density intestinal contents, extensive ileal pneumatosis intestinalis, and air in the intrahepatic branches of the portal vein. Mucosal ulcerations and extensive transmural necrosis associated with invasive candidiasis were detected in the distal ileum and right colon in the resected pathology specimen.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

MRI of pouch-related fistulas in ulcerative colitis after restorative proctocolectomy.

PURPOSE: Our purpose was to determine the value of MRI in diagnosing pouch-related fistulas in patients with ulcerative colitis and to compare pulse sequences with and without contrast enhancement in their performance of visualization. METHOD: Forty-four patients with pelvic symptoms after restorative proctocolectomy underwent MRI. All 26 patients with pouch-related fistulas were treated surgically; 18 patients with pouchitis were treated conservatively. MRI was performed at 1.0 T with T1-weighted FLASH sequences before and after administration of Gd-DTPA, T2-weighted and proton density-weighted turbo SE sequences, and a T2-weighted fat saturation sequence. Images were analyzed for the presence of fistula; pulse sequences were additionally compared for best visualization on a four point scale of diagnostic confidence. RESULTS: MRI detected 23 of 26 cases of fistulas; there were no false-positive diagnoses. Surgery revealed fistulas in three cases in which no pathology was found on MRI. Two patients had a short sinus tract at the pouch-anal anastomosis, and a third patient had a pouch-vaginal fistula. The Gd-enhanced FLASH sequence obtained the highest score, and second best was the T2-weighted fat saturation technique. CONCLUSION: MRI is a valuable technique for diagnosing pouch-related fistulas, However, there are limitations in detection of short sinus tracts and pouch-vaginal fistulas. Highest diagnostic confidence is obtained with a Gd-enhanced FLASH sequence, which might be helpful after pelvic surgery or if the fact saturation technique is equivocal.

Adult↗
PubMedDate not supplied

Telemedicine applications in otolaryngology.

Under suitable technical and clinical conditions, remote interactive fiber-optic NPL can be used to evaluate a range of commonly occurring pathologies with a high degree of reliability. A clinical protocol appropriate for interactive and store-and-forward fiber-optic NPL was proposed for further evaluation. Additional applications of telemedicine in otolaryngology were outlined, including otoscopy, intra-oral examination, and evaluation of external facial pathology. We envisage tele-otolaryngology taking place in a variety of ways: Interactions between rural-based PCPs and specialists (routine evaluation of hoarseness, dysphagia), using store-and-forward techniques. Consults from emergency medicine physicians at a general service hospital to a specialist (laryngeal trauma, acute peritonsillar abscess, TM perforations) using interactive means. Case discussions between specialist and sub-specialist using a combination of store-and-forward and interactive technologies. Potentially, there are at least three significant benefits from widespread acceptance of telemedicine in the field of otolaryngology, or indeed in any of the medical specialties: Saved lives and reduced medical costs due to early detection of serious pathology (in this case, head and neck cancers). Reduced unnecessary referrals to specialists, and consequent savings to the patient and health-care insurer, accompanied by more efficient usage of specialist time. Enhanced level of medical education and interaction, as the link between the referring and consulting physician is more immediate and direct [27]. For these reasons, combined with the high number of visits at the primary-care level related to issues in otolaryngology-head and neck surgery, tele-otolaryngology is poised to be a leading telemedicine application within the next few years.

Computer Communication Networks↗
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New concepts in ovarian regulation: an immune insight.

The purpose of the ovary is to produce eggs. In the human, oocyte production occurs cyclically at monthly intervals. The control of egg production is provided by both the endocrine and immune systems. Successful oocyte production is the result of sophisticated communication between the two systems. These interactions allow adaptive processes necessary for continuation of the species.

Activins↗
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Hypersensitive dentinal pain attenuation with potassium nitrate.

Dentinal hypersensitivity occurs when gingival recession exposes dentin at the cervical margins of teeth. Twenty-four periodontal patients, with postoperative hypersensitive dentin were treated by burnishing saturated potassium nitrate (KNO3) to relieve pain. Using a visual analogue scale with participants acting as their own control, a subjective assessment of pain was measured and compared before and after KNO3 application. Thirty-six regions involving 98 teeth were assessed. A significant reduction of sensitivity and pain was achieved by using a saturated KNO3 solution (p < .0001 Student-t).

Dentin↗
PubMedDate not supplied

Influence of serum progesterone levels at the time of hCG on the release of ova during hMG cycles.

A study was designed to monitor release of ova by sonography in hMG-treated patients following hCG and to determine if failure to release ova correlates with critically low or high progesterone levels. This was a retrospective study of 292 consecutive patients treated with hMG. The requirement for treatment was that hCG be given when at least one follicle attained a 17-mm diameter with a serum estradiol level of at least 200 pg/mL per mature follicle. If the serum progesterone assay was greater than or equal to 1.8 ng/mL, then hCG would be given as long as there was at least one dominant follicle and a serum estradiol level greater than 200 pg/mL. The patients were divided into four groups for study based on the progesterone level at the time of hCG administration. There were no statistically significant differences in the ability to achieve ova release whether serum progesterone was very low or close to 2 ng/mL when hCG was given. The rise in the progesterone level prior to ovulation has been proposed to enhance egg release. However, the data presented herein do not support the necessity for a critical level of serum progesterone at the time of hCG injection in hMG-treated women.

Anovulation↗
PubMedDate not supplied

Prediction of the left ventricular ejection fraction response to doxorubicin using a multiple linear regression model.

The aim of this study was to develop a model for predicting clinically significant deterioration in the left ventricular ejection fraction due to chronic doxorubicin administration. Twenty-six patients were monitored during their courses of doxorubicin chemotherapy with serial gated equilibrium radionuclide angiography. Multiple linear regression analysis was used to derived the best combination of clinical and radionuclide angiographic predictors of resting left ventricular ejection fraction at any point during the course of chemotherapy. The final model consisted of five variables: left ventricular ejection fraction at the previous monitoring point; cumulative dose of doxorubicin achieved at the previous monitoring point; increment in dose from the previous monitoring point; age of the patient; and time to peak left ventricular emptying at the previous monitoring point. The cumulative dose, the ejection fraction at the previous monitoring point and the final model, respectively, explained 11%, 33% and 53% of the variability in ejection fraction determinations during the 26 patient courses. The final model also forecast a potentially very low resting left ventricular ejection fraction (less than 35%) at the cumulative doses of doxorubicin which provoked serious clinical cardiotoxicity in two patients. A multivariate model is a useful aid in timing discontinuation of doxorubicin prior to the development of a clinically significant deterioration in left ventricular ejection fraction.

Computer Simulation↗
PubMedDate not supplied

Telephone versus face to face interviewing as a means of collecting data relevant to the management of diabetes among general practitioners in France: a randomized design.

Successful patient education requires planed programs with specific target populations. As general practitioners see 85% of noninsulin-dependent diabetics in France, this study was designed to test the feasibility of the telephone as a method for data collection within the context of a random sample of general practitioners in the Paris region. In addition, data were collected assessing physician's perceptions of various barriers and facilitators to the management of this illness. The study demonstrated the feasibility of phone interviews among general practitioners, as no significant differences were found in response rates or for any single variable collected on the telephone versus "face-to-face". Treatment patterns were described and results indicated that 77% of general practitioners agreed to participate in a subsequent study and, of these 93% agreed to the participation of their noninsulin-dependent patients.

Data Collection↗
PubMedDate not supplied

Urinary gonadotropin peptide (UGP) as a marker of gynecologic malignancies.

Urinary gonadotropin peptide (UGP) was measured in 866 urines from normal women and women with benign and malignant gynecologic disease using the Triton UGP enzyme immunoassay. The greatest level of overexpression of the marker was observed in patients with ovarian cancer. Using a cutoff of 4 fmol/mg creatinine, UGP was overexpressed in samples from 2% of normal premenopausal women, 15% of normal postmenopausal women, 5% of women with benign gynecologic disease, and 59% of women with ovarian cancer. UGP expression was independent of the histologic type of ovarian cancer. The expression of UGP and CA 125 were not correlated and use of the two markers in tandem increased the sensitivity of detection of disease by greater than 20% over that which was observed using each marker individually. UGP levels were correlated with clinical status, and doubled in value in 67% of patients with progressive disease, and were halved in 93% of patients who were in remission at the time of the study.

Biomarkers, Tumor↗