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Biomedical subjects

L Bernstein

Publications and source records attributed to L Bernstein.

At least 343 records · Page 19Linked to original sources
PubMedDate not supplied

Diagnostic bronchoalveolar lavage in children with AIDS.

Between October, 1985 and May 1987, 29 children (mean age 22 +/- 22 months, range 2-54 months) with AIDS or ARC developed acute respiratory illness. The initial diagnostic procedure was flexible fiberoptic bronchoscopy, with bronchoalveolar lavage (BAL). BAL was positive for Pneumocystis carinii in 14 and for respiratory syncytial virus, Staphylococcus aureus, and Escherichia coli in 3 additional patients. Subsequent lung tissue analysis and/or clinical course suggested no false negative lavages. Complications possibly related to the procedure occurred in two patients. We find BAL an effective diagnostic technique in these patients, offering a less invasive alternative to open lung biopsy.

AIDS-Related Complex↗
PubMedDate not supplied

Physiological basis of salt tolerance in plants.

For most plants, and under most field conditions, osmotic effects of salinity greatly predominate in restricting growth and yields. In certain cases, however, specific ion effects may be decisive. These may involve either nutrition, as in calcium deficiency in some lettuce varieties, tomato, and bell peppers, or direct toxicity (chloride or sodium toxicity, or both) in tree and vine crops. Rootstocks, or varieties that restrict the uptake of toxic ions, increase the salt tolerance of some susceptible fruit crops. Salinity-induced nutritional imbalance can, in some cases, be corrected by selecting better adapted varieties and in others by the use of foliar nutrient sprays. Recent evidence indicates simple single-gene control over uptakes of chloride and sodium, but the more general osmotic effects appear to be complex and under multigenic control.

Biological Transport↗
PubMedDate not supplied

Pain perception and serum beta-endorphin in trauma patients.

Acute traumatic injury engenders the production of beta-endorphin (BE) and other endogenous opioids. Elevated BE concentration putatively correlates with pain perception in trauma patients. The authors examined traumatic injury severity, pain perception, and BE concentration in patients admitted to an urban trauma center. Brief rating instruments for pain and unpleasantness were administered, and blood was drawn for BE analysis in 48 trauma admissions and 33 age-, gender-, and race-matched control subjects for comparison. The authors found no correlation between severity of pain perception and BE, but a significant correlation was found between BE and patient body weight (P < 0.05), physician pain rating (P < 0.01), and Injury Severity Score (P < 0.001). The results suggest that past findings associating trauma pain perception and BE concentration are spurious.

Adolescent↗
PubMedDate not supplied

An informational approach to likelihood of malnutrition.

Unidentified protein-energy malnutrition (PEM) is associated with comorbidities and increased hospital length of stay. We developed a model for identifying severe metabolic stress and likelihood of malnutrition using test patterns of albumin (ALB), cholesterol (CHOL), and total protein (TP) in 545 chemistry profiles. Pattern classes were derived by converting decision values to a number code using cutoff values for nonmalnourished (0), moderate (1), and severe (2) of: ALB 35, 27 g/L; TP 63, 53 g/L; and CHOL 3.9, 2.8 mumol/L. Patterns defined by combinations of normal and abnormal laboratory results had decreased the likelihood of PEM from an all-2 to all-0 pattern. They were compressed to four final classes. ALB (F = 170), CHOL (F = 21), and TP (F = 5.6) predicted PEM class (r2 = 0.806, F = 214; P < E-6), but pattern class was the best predictor (r2 = 0.900, F = 1200, P < E-10). Kruskal-Wallis analysis of class by ranks was significant for pattern class (E-18), ALB (E-18), CHOL (E-14), and TP (2E-16). The means and SEM for tests in three PEM classes (mild, moderate, severe) were: ALB-35.7, 0.8; 30.9, 0.5; 24.2, 0.5 g/L; CHOL-3.93, 0.26; 3.98, 0.16; 3.03, 0.18 mumol/L, and TP-68.8, 1.7; 60.0, 1.0; 50.6, 1.1 g/L. We classified patients at risk of malnutrition using truth table comprehension. The pattern classes formed by the tests are a better classifier than the tests themselves.

Biomarkers↗
PubMedDate not supplied

A controlled trial of a behavioral and educational intervention following coronary artery bypass surgery.

PURPOSE: Patients who have undergone coronary artery bypass graft surgery (CABG) are obvious candidates for rehabilitation programs because of the potential for progression of disease. Such programs have been shown to foster risk-factor modification, improve quality of life, and prolong survival among post-myocardial infarction (MI) patients. However, the efficacy of these programs has not been established among patients who have undergone CABG. METHODS: A randomized controlled trial was employed to evaluate whether a behavioral and educational cardiac rehabilitation program was effective in modifying cardiovascular disease risk factors and improving quality of life in a cohort of 86 patients after CABG. Patients were recruited from the cardiac ward of a large teaching hospital and were block-randomized to either an intervention group or routine care. Subjects in the intervention group attended 6 weekly group sessions following hospital discharge, and booster sessions at 8 months and 1 year. They also received a personalized behavior modification program based on their baseline risk factors. Risk factor and quality of life measures were recorded at baseline (6 weeks after surgery), 4 months, 8 months, and 1 year. RESULTS: The results indicated few differences between the study groups. However, the intervention group's aerobic capacity (VO2max) improved over that of the routine care group. With regard to the quality of life variables, all patients tended to improve steadily over time. CONCLUSIONS: The relatively moderate success of this intervention program compared with various post-MI studies may be indicative of differences between the treatment needs of patients after acute myocardial infarction or CABG. Future post-CABG rehabilitation research should explore these patients' unique treatment needs, and investigate a variety of program strategies.

Behavior Therapy↗
PubMedDate not supplied

Percutaneous reduction of displaced radial neck fractures in children.

Various techniques have been used for reduction of displaced radial neck fractures in children. Eighteen children with displaced radial neck fractures were treated by percutaneous reduction with a Steinmann pin after failing closed reduction. Reduction was successfully accomplished for 15 patients. The three patients failing percutaneous pin reduction had comminuted radial head and neck fractures (two patients) or a completely rotated and displaced radial head (one patient). Percutaneous pin reduction of angulated and displaced radial neck fractures is a simple, safe alternative to open reduction.

Adolescent↗
PubMedDate not supplied

A randomized controlled trial of weight reduction and metoprolol in the treatment of hypertension in young overweight patients.

The effects of weight reduction and metoprolol (100 mg, b.d.) in the treatment of hypertension (diastolic blood pressure 90-109 mmHg) in 56 young, overweight patients were investigated in a randomized placebo controlled trial. After a 4-week baseline, subjects were followed up for 21 weeks. In the weight reduction group, the fall in systolic and diastolic blood pressure (13/10 mmHg), associated with a mean group weight loss of 7.4 kg, was greater (P less than 0.001) than that in the placebo group (7/3 mmHg); the fall in diastolic pressure but not systolic pressure was also greater than that in the metoprolol group (10/6 mmHg). At the end of follow-up, 50% of the weight reduction group, 39% of the metoprolol group and 17% of the placebo group had a diastolic blood pressure of less than 90 mmHg. In the weight reduction group there was a fall in total cholesterol and the ratio of total to HDL-cholesterol (P less than 0.001); in the metoprolol group there was a fall in HDL-cholesterol and an increase in the ratio of total to HDL-cholesterol (P less than 0.001). The results suggest that in the first step of treatment for hypertension in overweight patients, modest weight reduction produces significant and clinically important reductions in blood pressure, without incurring the adverse effects on plasma lipids and lipoproteins often associated with the first step of drug therapy.

Adult↗
PubMedDate not supplied

Association of p53 mutations and a codon 72 single nucleotide polymorphism with lower overall survival and responsiveness to adjuvant radiotherapy in endometrioid endometrial carcinomas.

p53 Genetic alterations are associated with advanced stage and aggressive tumors in a variety of human malignancies. The aim of this study was to examine p53 for genetic alterations and to evaluate the association of these alterations with clinical outcome and response to adjuvant radiotherapy in endometrioid endometrial carcinomas. p53 mutations in exons 2-11 were assessed in 59 endometrioid carcinomas by polymerase chain reaction-single-strand conformational polymorphism and sequence analysis. Twelve mutations (20.3%) and nine polymorphisms were identified. Seven of the nine polymorphisms were codon 72 single nucleotide polymorphisms (SNP) with an Arg/Pro allelotype. Women harboring either a mutation or an Arg/Pro allelotype at codon 72 had a lower overall survival rate than women whose tumors lacked alterations in the p53 gene (P= 0.0029). Women were stratified based on p53 genetic alterations (p53 mutation or p53 codon 72 SNP) and whether or not they received adjuvant radiation therapy. Women with p53 genetic alterations who did not receive adjuvant radiotherapy had the lowest survival rate (P= 0.0005). Treated women with p53 genetic alterations and untreated women with no p53 alteration had similar rates of survival. Among women with p53 alterations, adjuvant radiotherapy substantially increased survival (P= 0.035). In multivariate analyses, the group of women with p53 genetic alterations who did not receive adjuvant radiation therapy had a 5.9-fold increased risk of death (95% confidence interval: 1.5-22.7) compared to women whose tumors lacked p53 alterations and did not receive adjuvant radiation therapy.

Adult↗
PubMedDate not supplied

Linking costs and quality improvement to clinical outcomes through added valued.

A byproduct of outcome measures is the provision of financial benefit to the healthcare providers while ensuring healthcare access and quality to the patient. Consequently, a framework for measuring outcomes must integrate the "customer's perspective" of perceiving value of the services provided, the "provider's perspective" of acting as the patient's fiduciary, and the "business's perspective" of achieving net income. Value-based cost management (VBCM) accomplishes this integration by linking several measures with three financial tools: activity-based costing, value-added analysis, and cost of quality. This article illustrates the use and benefit of VBCM to the laboratory as a partner in the delivery of healthcare services with an example of chest pain triage.

Chest Pain↗
PubMedDate not supplied

Transpalatal excision of the odontoid process.

A patient with platybasia of the skull and temporomandibular joint ankylosis is presented. Relief of brain stem compression by the impingement of the odontoid through a soft, hypoplastic clivus was done by first doing a mandibular condylectomy to open the mouth. A transoral-transpharyngeal route was then employed to excise the odontoid process.

Adult↗
PubMedDate not supplied

Effective resource management using a clinical and laboratory algorithm for chest pain triage.

BACKGROUND: Bridgeport Hospital recently compared the use of a clinical algorithm with unaided physicians for the triage of 200 emergency department (ED) patients with chest pain for coronary care unit (CCU) admission. HYPOTHESIS: Cardiac troponin-T may be an effective adjunct to an established clinical algorithm for accurate selection of patients who are admitted to the CCU for suspected acute myocardial infarction (AMI). It is elevated 6 hours earlier than lactate dehydrogenase fraction 1 (LD1) and may be the most effective test for confirming non Q-wave AMI (usually with ST-T changes and LD1/lactase dehydrogenase > 35%). It is elevated in class 3 angina with a high risk of fatal arrhythmia. STUDY DESIGN: Clinical and electrocardiogram criteria for triage are as defined by Goldman et al. (see references 6 and 11). The exclusion of non-AMI within 4 hours of ED visit using troponin-T (or an alternative test) should allow more rapid treatment of non-AMI patients at a lower intensity of hospital service (e.g., telemetry versus ICU). This should translate into shorter length of stay for non-AMI patients and facilitate thrombolytic therapy with significant resultant medical and cost benefits. LABORATORY DATA: Creatine kinase and its MB isoenzyme (CK-MB) are measured at the time of clinical triage and 4, 8, and 12 hours later. LD1 and total lactase dehydrogenase are measured 12 hours after initial sampling. Cardiac troponin-T is measured at the time of ED arrival and 4 hours later. ANALYSIS OF BENEFIT: The first thing to consider is reducing the cost from stress thalliums for low risk evaluation. The second is the evaluation of active ischemia--unstable angina and diagnosis of missed AMI. The Goldman algorithm eliminates unnecessary admissions to the CCU for chest pain, including unstable angina. There is a difference between AMI and triage for CCU admission (200 patients). CK-MBs allowed for the elimination of 37 non-AMIs. However, we missed eight cases of AMI that would have been LD1 positive (troponin positive) and gained 10 cases of unstable angina that should have been assigned to CCU or a monitored bed. Troponin found six more cases of unstable angina that were CK-MB negative but should have been class 3 unstable angina that could be assigned to at least a telemetry bed. This makes 14 cases of AMI or unstable angina unaccounted for by CK-MB (5.6%). All of the cases were at risk of ventricular arrhythmia within 36 hours. The only question was whether to assign them to CCU or to monitored beds. The third point in the analysis is to examine the savings in operating costs by substitution. The cost model, in selecting a strategy, takes test costs, clinical outcomes, and the cost of clinical algorithms into consideration.

Algorithms↗
PubMedDate not supplied

A modified pharyngeal flap operation.

A modification of the standard, superiorly based, pharyngeal flap operation is presented. The results of this procedure are given for 27 patients and they appear to be superior to those reported by the author for the standard operation.

Adolescent↗