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Biomedical subjects

L Bernstein

Publications and source records attributed to L Bernstein.

At least 145 records · Page 8Linked to original sources
PubMed1991

Epidemiology of adenocarcinomas of the small intestine: is bile a small bowel carcinogen?

Using pathology reports and other data from the Cancer Surveillance Program, the population-based cancer registry of Los Angeles County, we evaluated demographic characteristics and the detailed subsite distribution of adenocarcinomas of the small intestine for the period 1972-1985. The most striking finding was the great preponderance of these tumours in the duodenum, especially in comparison with other histologic types of small bowel cancers. Fifty percent of all small intestinal adenocarcinomas occurred at this location, even though the duodenum comprises just 4% of the entire length of the small bowel. Furthermore, after excluding those cases occurring in the duodenum but with indeterminate subsite, 57% of these duodenal primaries could be mapped to the 2nd portion of the duodenum, a six to seven centimeter segment containing the Ampulla of Vater. We could pinpoint the location for 48 of the 77 tumours (62%) occurring in this segment, specifically to areas adjacent to the Ampulla. We also confirmed the high male to female ratio of small bowel adenocarcinomas in blacks and non-Latino whites, but could find no evidence of such an effect in Latinos or Asians; however, the number of cases was not large in these latter two racial-ethnic groups.

Adenocarcinoma↗
PubMed1991

Successful management of intractable cryptosporidial diarrhea with intravenous octreotide, a somatostatin analogue.

A 38-year-old man with AIDS and intractable large-volume diarrhea due to a cryptosporidial infection was successfully treated with intravenous octreotide, a somatostatin analogue. The volume of diarrhea, 10-12 liters with 8-13 movements per day, was reduced to three to four semi-formed to formed stools per day when the patient was treated with 400 micrograms intravenous octreotide daily. The patient's intravenous hyperalimentation was discontinued and he returned to oral feeding. He quickly regained his normal weight and has now resumed his normal activities. For those patients who cannot tolerate subcutaneous administration, intravenous octreotide therapy may not only be life-saving but may also markedly increase the quality of life. Roxithromycin, a macrolide antibiotic, was also administered to this patient with cryptosporidiosis but efficacy was not demonstrated.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Possible underestimation of the incidence rate of prostate cancer in Japan.

We adjusted the prostate cancer incidence rate in Japan for differences between Japan and the US in the proportion of latent prostate carcinoma identified at autopsy and of localized tumors among all carcinomas of the prostate. The adjusted incidence rate of prostate cancer in Japanese in Japan by this method is estimated to be between 24.9 and 33.3 per 100,000 population, based on incidence rates from the population-based cancer registries of Miyagi, Japan, and Los Angeles and Hawaii, USA. The rate estimated here is almost 3-4 times greater than the rate reported previously. The difference in the incidence rates of prostate cancer between Japanese in Japan and the US (32.2-49.8 per 100,000) may therefore be substantially smaller than previously thought.

Humans↗
PubMed1991

Emergency coronary artery bypass surgery following coronary angioplasty--favourable medium term outcome after eight years' experience.

The clinical characteristics, perioperative complications and medium term outcome were analysed for patients undergoing emergency coronary artery bypass surgery (CABG) following failed coronary angioplasty (PTCA). Seven hundred and twenty PTCAs were performed from June 1981 to June 1989, of which 30 (4.2%) resulted in CABG within four hours of PTCA. The perioperative course and follow-up were compared to 30 patients undergoing elective CABG, matched retrospectively for age, sex, month of operation and number of grafts. The emergency group had a tendency to more post operative bleeding, but no increased incidence of early reoperation for bleeding, and had a high incidence of periprocedural Q wave infarction (20% vs 3%, p less than 0.05). The emergency group had shorter bypass time and decreased use of the internal mammary artery (7% vs 50%, p less than 0.05). There was one in-hospital death in the emergency group. At medium term follow-up (3.4 +/- 2.4 years, range two months to eight years) there was one late death in each group, and seven patients in each group had return of angina or congestive heart failure. Twenty-one patients in the emergency group and 22 patients in the elective group were asymptomatic on no cardiac medications. We conclude that patients with failed PTCA requiring emergency CABG are more likely than an elective group to have post operative bleeding but no increased risk of early reoperation, and have a higher incidence of perioperative Q wave infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Target organs in chronic bioassays of 533 chemical carcinogens.

A compendium of carcinogenesis bioassay results organized by target organ is presented for 533 chemicals that are carcinogenic in at least one species. This compendium is based primarily on experiments in rats or mice; results in hamsters, nonhuman primates, and dogs are also reported. The compendium can be used to identify chemicals that induce tumors at particular sites, and to determine whether target sites are the same for chemicals positive in more than one species. The Carcinogenic Potency Database (CPDB), which includes results of 3969 experiments, is used in the analysis. The published CPDB includes details on each test, and literature references. Chemical carcinogens are reported for 35 different target organs in rats or mice. More than 80% of the carcinogens in each of these species are positive in at least one of the 8 most frequent target sites: liver, lung, mammary gland, stomach, vascular system, kidney, hematopoietic system, and urinary bladder. An analysis is presented of how well one can predict the carcinogenic response in mice from results in rats, or vice versa. Among chemicals tested in both species, 76% of rat carcinogens are positive in mice, and 71% of mouse carcinogens are positive in rats. Prediction is less accurate to the same target site: 52% of rat carcinogens are positive in the same site in mice, and 48% of mouse carcinogens are positive in the same site in rats. The liver is the most frequent site in common between rats and mice.

Animals↗
PubMed1990

ST monitoring for myocardial ischemia during and after coronary angioplasty.

We performed 12-lead electrocardiographic monitoring in 97 patients during coronary angioplasty (PTCA) of a single vessel to correlate ischemic ST changes with clinical, angiographic and coronary hemodynamic variables and to determine the optimum lead or combination of leads for their detection. Ischemia (chest pain or ST change, group A) occurred in 79 patients (80%), but in only 15 of 23 patients (65%) with collaterals (p less than 0.05). Ischemia occurred more often in left anterior descending and left circumflex PTCA than right coronary PTCA, but pain was the only manifestation more often in left circumflex and right coronary PTCA. Ischemic ST change was silent in 16% and this proportion did not differ in clinical or angiographic groups except for diabetes with 3 of 5 (60%) having silent ischemia (p less than 0.05). Patients in group A (ischemia) compared to group B (no ischemia) had less severe lesions (85 +/- 9 vs 91 +/- 7%, p less than 0.01), higher transstenotic gradients (62 +/- 19 vs 53 +/- 9 mm Hg, p less than 0.05) and lower distal occluded pressures (24 +/- 11 vs 33 +/- 10 mm Hg, p less than 0.01), suggesting less collateral flow. Compared with a 12-lead electrocardiogram, the best single lead for detecting ST change during PTCA in each artery had a sensitivity of 80% and this increased to 93% using the best 2 leads. The best 3 leads (V3/III/V5 for left anterior descending and III/V2/V5 for right coronary and left circumflex) increased sensitivity to 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Epidemiology of hairy cell leukemia in Los Angeles County.

The descriptive epidemiological characteristics of hairy cell leukemia (HCL), a rare chronic lymphoproliferative disorder, were examined by using incidence data collected from 1972 to 1987 by the Cancer Surveillance Program, the population-based cancer registry for Los Angeles County. During the study period, 208 incident cases of histologically confirmed HCL were diagnosed. HCL comprised 2% of all leukemias diagnosed in Los Angeles County during the study period. HCL risk was concentrated in white males; there were few black and Asian patients for analysis. Overall, the age-adjusted incidence rate of HCL for men (2.9/million population) was 4.8 times greater than that for women (0.6/million population). Using data from all cancer patients diagnosed during the study period, Jewish men had significantly greater risk of HCL than Protestant men (odds ratio (OR) = 3.0, P less than 0.0001); there was no significant variation in risk of HCL by religion for women. For men, the OR was significantly elevated for professional and technical workers (OR = 2.1, P = 0.001); within this category of occupations, risk was significantly elevated for engineers (OR = 3.3, P less than 0.0001) and university faculty and school teachers (OR = 4.0, P = 0.0008). HCL patients were more than twice as likely to have multiple primary cancer diagnoses as other cancer patients. Since the majority of the other primary cancer diagnoses occurred prior to (greater than 1 year) or concurrent with (less than or equal to 1 year) the HCL diagnosis, this greater frequency of multiple primaries in HCL patients may be due to impaired immune function.

Adult↗
PubMed1990

Stroke in pediatric acquired immunodeficiency syndrome.

In a 4 1/2-year period, 4 of 68 children in a longitudinal study of neurological complications of human immunodeficiency virus (HIV) infection had clinical and/or neuroradiological evidence of stroke, yielding a clinical incidence of stroke in this population of 1.3% per year. During this period, 32 subjects died, and permission for autopsy was granted in 18 of the patients, including 3 of 4 who had clinical evidence of stroke. The prevalence of cerebrovascular pathological features in our consecutive autopsy series was higher than the clinical incidence. At autopsy cerebrovascular disease was documented in 6 (24%) of 25 children with HIV infection, including all 3 children who had clinical evidence of stroke. Four patients had intracerebral hemorrhages, 6 patients had nonhemorrhagic infarcts, and 3 had both. Hemorrhage was catastrophic in 1 child and clinically silent in 3 children, all of whom had immune thrombocytopenia. One child had an arteriopathy that affected meningocerebral arteries. In another child, the arteries of the circle of Willis were aneurysmally dilated. Two children had coexisting cardiomyopathy and subacute necrotizing encephalomyelopathy with vascular proliferation. These results suggest that stroke should be considered when children with HIV infection develop focal neurological signs.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Serum hormone levels in pre-menopausal Chinese women in Shanghai and white women in Los Angeles: results from two breast cancer case-control studies.

To assess whether risk of breast cancer in young women is associated with differences in luteal-phase hormone production and to attempt to explain differences in risk of breast cancer of young Shanghai Chinese and Los Angeles white women, two concurrent case-control studies of serum hormone concentrations were conducted. Both studies were carefully controlled for the possible confounding effects of age, weight, height, pregnancy history, and day of the menstrual cycle, by individually matching cases and controls on these factors. Case eligibility was limited to women with localized breast cancer. Sixteen of 39 Shanghai breast-cancer cases were sampled prior to the histologic diagnosis of their disease. The remaining 23 Shanghai cases and all 42 Los Angeles cases were diagnosed, and treated by surgery only, at least six months prior to hormonal evaluation. All subjects were sampled on day 22 of the menstrual cycle. Overall, cases had 13.5% higher serum estradiol concentrations (p = 0.038) with a case-to-control excess of 16.6% in Shanghai subjects (p = 0.089) and 10.8% in Los Angeles subjects (p = 0.23). There were no appreciable differences in amounts of sex-hormone binding globulin between cases and controls. Cases had lower progesterone levels than controls, but the situation was reversed when the analysis was restricted to subjects with evidence of ovulation. Los Angeles controls had 20.6% greater estradiol concentrations than Shanghai controls (p = 0.036); adjustment for body weight accounted for only 25.7% of this difference.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Predictors of failed attempted abortion with the antiprogestin mifepristone (RU 486).

The experience of 271 patients who received mifepristone (RU 486) in experimental protocols from July 1984 to January 1989 was analyzed by logistic regression methods. The regimen used was the strongest predictor of failure, followed by Quetelet's index and initial beta-human chorionic gonadotropin level. The relative risk of failure was 2.3 times with 7-day regimens and 6.3 times with the other regimens that obtained with regimens of 600 mg given once or twice. The relative risk of failure increased with increasing Quetelet's index; women in the top quartile were 2.9 times more likely to fail to abort than were women in the bottom quartile. The risk of failure increased with increasing initial beta-human chorionic gonadotropin level; those with an initial level greater than 19,800 mIU/ml were 2.8 times more likely to fail to abort than were women with an initial value less than or equal to 6350 mIU/ml. Body mass appears to influence the likelihood of abortion with mifepristone.

Abortifacient Agents↗
PubMed1990

A prospective study of risk factors for traumatic deaths in a retirement community.

We examined possible predictors of traumatic deaths by means of a case-control study nested within a large ongoing cohort study of residents of a Southern California retirement community. Baseline information was collected by means of a detailed mailed health survey completed by 11,888 residents in 1981-1982. In multivariate logistic regression analysis, being widowed or divorced (RR = 6.4, P = 0.009), sleeping 9 or more hours per night (RR = 4.6, P = 0.02), and drinking more than three alcoholic beverages a day (RR = 3.5, P = 0.04) were significant predictors of suicide risk. However, the strongest predictor of suicide was a mental outlook assessment summary score calculated from responses to seven questions derived from the Zung self-rating depression scale. Individuals in the poorest summary score category were 23 times more likely to commit suicide than individuals in the best summary score category (P = 0.004). Women who regularly practiced breast self-examination were also at very low risk for suicide (RR = 0.1, P = 0.0005). The mental outlook assessment summary score was also a predictor of accidental deaths, although the relative risk estimates were lower than those for suicide and the individual questions best predicting risk were different. A history of a serious chronic disease (RR = 2.6, P = 0.01) and moderate alcohol intake of less than two drinks per day (RR = 0.3, P = 0.01) were also predictors of accidental deaths. Estrogen use in women did not predict risk of traumatic deaths.

Accidents↗
PubMed1990

Serum oestrogen levels in postmenopausal women: comparison of American whites and Japanese in Japan.

Serum oestrone (E1), oestradiol (E2) and sex hormone binding globulin (SHBG) levels were studied in postmenopausal Japanese women in Japan (n = 91) and postmenopausal American white women (n = 38). The Japanese women were deliberately chosen to be from a rural agricultural area in order to get samples which represent as closely as possible the traditional Japanese 'lifestyle' that gave rise to the low rates of breast cancer in Japan. E1 levels were 47%, and E2 levels 36%, greater in the American women; these differences were only reduced to 43% and 27% after adjustment for the lower weight of the Japanese. These results were all statistically highly significant. There was little difference in SHBG levels between the Japanese and the American women. These results for E1 and E2 could be an important part of the explanation why Japanese and American breast cancer rates continue to diverge further after the menopause.

Aged↗
PubMed1990

The effect of in utero ethinyl oestradiol exposure on the risk of cryptorchid testis and testicular teratoma in mice.

Epidemiological findings indicate that both cryptorchid testis and testicular germ cell cancer may be a result of high maternal oestrogen levels early in pregnancy. An experiment was conducted with a mouse strain (129 Sv-S1 C P) in which the males are susceptible to testicular teratomas to determine if the frequency of undescended testis and testicular teratoma in male offspring could be increased by administration of ethinyl oestradiol (EE) to pregnant mice before day 13 of gestation. This point in gestation marks the completion of the migration of germ cells to the gonadal ridge in mice and other studies with these mice have shown that the tumours are initiated in this critical time period. EE mixed with corn oil was administered by subcutaneous injection in doses of 0.02 (n = 76) and 0.2 (n = 102) mg kg-1 of body weight on gestational days 11 and 12. These mice were allowed to deliver their offspring and the males were killed at 15 days of age. Since the tumours are present from birth, this amount of time was allowed to permit the tumours to reach sufficient size for easy visual identification. Compared to controls (n = 63), who received corn oil alone, the treated mothers produced offspring who were significantly more likely to have a cryptorchid testis (P = 0.0001) and who had an increased risk, although not significant, of a testicular teratoma.

Animals↗
PubMed1990

Hormone levels in older women: a study of post-menopausal breast cancer patients and healthy population controls.

Hormone concentrations in blood and total 12 h urine values were compared between 40 post-menopausal women with breast cancer and 40 control women in a study which carefully controlled for the possible confounding effects of age, weight and pregnancy history by individually matching cases and controls on these factors. Breast cancer cases had received only surgical treatment for their localised disease, which was diagnosed from 1 to 9 years before hormonal evaluation. Cases had 15% higher serum oestradiol levels (P = 0.02), 40% more urinary oestradiol (P = 0.03) and 44% more urinary oestriol (P = 0.04) than control women. Cases also had higher levels of serum and urinary oestrone, but these differences were not statistically significant. The percentages of serum oestradiol not bound to albumin or sex-hormone binding globulin did not differ between cases and controls, nor were there statistically significant differences in the serum levels of prolactin, sex-hormone binding globulin or dehydroepiandrosterone sulphate. These results provide further support for the hypothesis that breast cancer risk is determined in part by post-menopausal serum oestrogen concentration.

Aged↗
PubMed1989

The effect of cyclosporine on the use of hospital resources for kidney transplantation.

Over the past decade the clinical results of kidney transplantation have improved substantially, with much of the benefit being attributed to the introduction in late 1983 of the immunosuppressive drug cyclosporine. To assess the effect of cyclosporine on the use of hospital services, we studied 702 patients who received kidney transplants at the University of California, San Francisco, between July 1982 and June 1986. All services were priced in constant 1985 dollars, and multiple regression analysis was used to adjust for changing patient and hospital characteristics. The introduction of cyclosporine for patients receiving kidneys from cadavers was associated with a significantly shorter adjusted mean postoperative stay (26.4 days as compared with 37.0 for patients not taking the drug; P less than 0.0001) and lower adjusted mean hospital charges ($28,649 as compared with $37,895; P less than 0.0001), although cyclosporine was not associated with changes in the use of services by patients who received transplants from living related donors. Cyclosporine was also associated with a reduction in the use of certain ancillary services, such as laboratory tests and radiographic procedures. In patients without diabetes who received cadaver kidneys, a sequential cyclosporine regimen (in which a combination of antilymphoblast globulin, prednisone, and azathioprine was given before cyclosporine) reduced the use of hospital services even more than did a cyclosporine regimen in which the combination was not given. The results suggest that new medications, such as cyclosporine, that reduce the frequency of complications and improve outcomes may also reduce the use of hospital resources.

Adult↗