Biomedical subjects
J Weissman
Publications and source records attributed to J Weissman.
Letter: Neurotoxicity of 5-fluorouracil.
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Failure of certain inhibitors to prevent absorbance decreases of mitochondrial suspensions induced by hypotonicity and carbon tetrachloride.
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Jugular foramen syndrome as a complication of metastatic melanoma.
INTRODUCTION: The jugular foramen (Vernet) syndrome with neuropathy of cranial nerves IX-XI is more commonly due to metastatic lesions than primary neoplasms. Hypoglossal nerve involvement is referred to as the Collet Sicard variant of the jugular foramen syndrome. MATERIALS AND METHODS: We report an elderly man who presents with dysphagia, dysarthria, hoarseness, and a 12-pound weight loss. Examination demonstrated paralysis of the right vagus and hypoglossal nerve. Communication and collaboration with the radiologist resulted in identification of the lesion. Computed tomographic (CT) guided needle aspiration confirmed metastatic melanoma. DISCUSSION: The onset of cranial neuropathy may allow the site of lesion to be predicted based on knowledge of the cranial base and neural anatomy. Diagnostic evaluation is tailored to evaluate the area in question. Active, multidisciplinary collaboration is essential for success.
Computed tomographic and magnetic resonance imaging characteristics of laryngocele and its variants.
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The therapeutic aspects of acceptance.
PROBLEM: What does acceptance mean to hospitalized adolescents? METHODS: Using a phenomenological research approach, the authors asked hospitalized adolescents (N = 6) on a psychiatric unit to describe how acceptance from psychiatric-mental health nurses was experienced by them. FINDINGS: Three essential themes emerged: (a) the nurse who shows acceptance is seen as a friend, (b) acceptance generates a sense of well-being, and (c) acceptance produces feelings of comfort with the nurse. CONCLUSIONS: In acceptance, adolescents experience nurses as unique individuals who provide comfort and nurturing. This relationship connection helps adolescent clients to use their inner strength to gain a sense of well-being.
The role of reluctance to give up life in the measurement of the values of health states.
Questions that involve willingness to risk or give up life often are used to measure the values of health states. In the Boston Health Study, interviews with 291 patients who had AIDS included questions about health status and current desire for resuscitation, and a series of hypothetical questions about desire for life-extending efforts if the patients found themselves in undesirable states, such as being chronically nauseous or blind. An index, "reluctance to give up life" was made from five such questions. The desire for resuscitation was related to current health status, but the general reluctance to give up life was not. Desire to be resuscitated was significantly related to current health status only when "reluctance to give up life" was "low." For people reluctant to say they will give up any life at all, questions that involve risking or trading life seem likely to be poor measures of the values of health states.
Case mix and resource utilization by uninsured hospital patients in the Boston metropolitan area.
Rising competitive pressures may place uninsured patients at risk for receiving fewer services than insured patients with similar medical conditions. To examine this possibility we studied the case mix, length of stay, and number of procedures for 65,032 patients listed as self-pay or free care, Blue Cross, or Medicaid at 52 hospitals in the Boston, Mass, area during 1983. We found that the overall case mix severity index (based on expected length of stay per diagnosis related group) for uninsured patients was 30% higher in public hospitals and 8% higher in major teaching hospitals compared with other institutions. Across all hospitals, the severity index of uninsured patients was similar to that of insured patients. However, after adjusting for diagnosis related group case mix, uninsured patients had, on average, 7% shorter stays (5.36 vs 5.79 days) and underwent 7% fewer procedures (1.16 vs 1.25) than Blue Cross patients, the differences varying with hospital type. Uninsured patients also had shorter stays on average than Medicaid patients (5.36 vs 5.87 days), but they underwent a similar number of procedures. These results suggest that patients who lack insurance may receive unequal treatment even after being hospitalized.
Rehabilitation medicine and the hemophilic patient.
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Side effects after ketamine anesthesia: transient blindness.
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Metabolism-dependent inactivation of liver microsomal enzymes by phencyclidine.
Incubation of phencyclidine (PCP) with rabbit liver microsomes resulted in NADPH-dependent loss of N-demethylase activity accompanied by reduction in microsomal cytochrome P-450 content. This effect was concentration-dependent, exhibited pseudo-first order kinetics, and was irreversible, thus exhibiting characteristics of "suicide substrate" inhibition. Cyanide ions at low concentrations, which have been used to trap the iminium intermediate of PCP metabolism as its cyano adduct, antagonized the inhibition of N-demethylase by PCP. PCP iminium ions were effective inhibitors of microsomal enzyme activity but required NADPH. These results support our suggestions that iminium ion formation is an intermediary step in the bioactivation of PCP leading to reactive electrophilic species.
Clinical research in medical schools: seizing the opportunity.
Academic medical centers (AMCs) face challenges to the achievement of their potential in clinical research. These challenges include reduced support of research from clinical revenue, cultural impediments to clinical research within the traditional value system of research-intensive AMCs, and potential problems of patient access to clinical research in intensive managed care environments. This article considers options to strengthen clinical research that have been developed at some medical centers. While much attention is being directed to the expansion of clinical trials in many AMCs, this effort needs to be linked to a cohesive strategy for clinical research being conducted in an academic environment. The article also addresses the subject of training and career development. It concludes with the opinion that the "crisis" in clinical research in academic medical centers provides the opportunity to define, more explicitly, the nature and scope of the investment in clinical research, and to define strategies that will bring added value to knowledge generated from basic research and to the teaching and patient care missions of these centers.