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Biomedical subjects

L E Klein

Publications and source records attributed to L E Klein.

At least 37 records · Page 2Linked to original sources
PubMed1985

Diagnosing dementia. Univariate and multivariate analyses of the mental status examination.

Investigators have reported poor recognition of dementia by primary physicians. For this reason, mental status examinations were performed on 72 demented and 144 nondemented medical inpatients to assess the sensitivity, specificity, and predictive value of components of this examination in the diagnosis of dementia. Sensitivity of individual level-of-orientation items was low (15.3 to 56.9%), though specificity was high (91.7 to 100%). Sensitivity of several nonorientation items was high (80.6 to 100%), though specificity was low. A multivariate discriminant equation using both orientation and nonorientation items achieved high sensitivity (89.6% test cases, 87.5% validation cases) and specificity (78.1% test cases, 87.5% validation cases). Adding the easily obtained patient characteristic of age to the equation further increased sensitivity (95.8%, 91.3%), while maintaining specificity (82.3%, 85.4%). From these results, it is concluded that the level-of-orientation screening examination used by clinicians to detect dementia is unacceptably insensitive. In contrast, a composite decision rule including nonorientation items achieves high sensitivity with relatively high specificity.

Adult↗
PubMed1985

Thyroidal regulation of rat thymic and splenic (Na+ + K+)-adenosine triphosphatase.

The present studies concern the effects of triiodothyronine (T3) on rat thymic and splenic NaK-ATPase activities. When hypothyroid rats were given a single injection of T3 (250 micrograms/100 g body weight), thymic NaK-ATPase activity increased by 18% at 24 h (p less than 0.005), and remained at this peak at 72 h. Injection of T3 (250 micrograms/100 g body weight, on alternate days X 3) significantly augmented NaK-ATPase activity from the thymus and spleen of hypothyroid rats by 19 and 49%, respectively. Two weeks of daily injections of T3 (1 microgram/100 g body weight) to hypothyroid rats significantly increased NaK-ATPase activity in the thymus and the spleen by 14 and 28%, respectively. Reverse T3 had no significant effect of thymic and splenic NaK-ATPase activities. Mg-ATPase and 5'-nucleotidase activities were not significantly affected by T3 in either tissue under different thyroid states. The lack of response of thymic and splenic NaK-ATPase to reverse T3, and Mg-ATPase and 5'-nucleotidase to T3, substantiates the specificity of the hormone action on NaK-ATPase. To investigate whether the T3-dependent increase in NaK-ATPase activity is a result of an increase in the number of enzyme units, the effect of T3 on the quantity of phosphorylated intermediate of NaK-ATPase was assessed in the partially purified membrane fraction. In the euthyroid state, NaK-ATPase activity and phosphorylated intermediate units were 33 and 43% higher, respectively than in the hypothyroid state, implying that the T3-dependent increase in NaK-ATPase activity is a result of an increase in the number of NaK-ATPase units.

Animals↗
PubMed1984

Bullous lichen sclerosus et atrophicus: treatment by tangential excision.

The bullous variant of lichen sclerosus et atrophicus (LSA) is a rare disorder for which there is no satisfactory treatment. A patient is reported with extensive plaques of bullous LSA on the pretibial skin that did not respond to sharp debridement, vigorous local care, or intralesional corticosteroid injections. Tangential partial-thickness excision of diseased tissues resulted in an extended remission. To our knowledge this approach has not been previously employed for bullous LSA, and it offers an encouraging surgical alternative to other therapeutic modalities.

Aged↗
PubMed1984

The distribution of melanocytes in the leptomeninges of the human brain.

The purpose of this study was to determine the qualitative and quantitative distribution of melanocytes in human leptomeninges by histochemical and ultrastructural techniques and to search for melanocytes in the mesothelial linings of the pleural and peritoneal cavities. Knowledge of the extracutaneous distribution of pigment cells will facilitate the interpretation of systemic symptoms in depigmentation disorders, such as vitiligo and the Vogt-Koyanagi-Harada syndrome. In 15 brains examined, leptomeningeal pigment cells were found principally over the ventrolateral surfaces of the medulla oblongata. Only isolated pigment-containing cells were found in the meninges covering other parts of the brain. The mean number of pigment cells in the medullary meninges of 5 brains was 325/mm2 +/- 96. The presence of melanosomes as single, membrane-bound granules in all stages of melanization confirms that the melanin-containing dendritic cells of the leptomeninges are melanocytes and not macrophages. No pigmented cells were observed in the pleural or peritoneal samples examined.

Brain↗
PubMed1984

Effect of thyroid hormone on carbohydrate content of Na+-K+-adenosine triphosphatase.

The effect of L-3,5,3'-triiodothyronine (T3) (50 micrograms/100 body wt) on the incorporation of labeled glucosamine and fucose into the subunits of Na+-K+-ATPase was examined by gel electrophoresis in sodium dodecyl sulfate. T3 augmented the incorporation of glucosamine into the alpha- and beta-subunits by 51 and 58%, respectively, in the 22-h chase experiments. Similarly T3 augmented the incorporation of fucose into the alpha- and beta-subunits by 58 and 43%, respectively. Reverse T3 did not alter the incorporation of labeled fucose in either subunit. The effect of T3 on the rate constant of degradation of renal cortical Na+-K+-ATPase was assessed. The rate constant of degradation (Kd) of the [3H]fucose labeled alpha- and beta-subunits for the hypothyroid rats were both 0.20, and for T3-treated rats, the Kd of the alpha- and beta-subunits were 0.23 and 0.18, respectively, suggesting that T3 enhanced fucose incorporation into the subunits of Na+-K+-ATPase rather than retarding the degradation of this enzyme.

Animals↗
PubMed1984

Corticosterone and triiodothyronine control of myocardial Na+-K+-ATPase activity in rats.

Experiments were carried out to examine the effects of corticosterone and triiodothyronine on rat myocardial Na+-K+-ATPase activity. Corticosterone increased Na+-K+-ATPase activity when administered intravenously in multiple doses, a single dose, and different dosages. The possibility that enhancement of myocardial Na+-K+-ATPase activity by corticosterone is mediated by early changes in intracellular Na+ and K+ was investigated. Following a single dose of corticosterone (1 mg/100 g body wt), the increase in Na+-K+-ATPase activity preceded the changes in intracellular Na+ and K+. Corticosterone did not change the transition temperature and activation energy of the reaction in myocardial Na+-K+-ATPase. This implies that corticosterone does not act by altering the lipid matrix in the microenvironment of the Na+-K+-ATPase system. The interaction between the effects of corticosterone and triiodothyronine on myocardial Na+-K+-ATPase activity was examined. Our studies indicated that corticosterone and triiodothyronine regulate Na+-K+-ATPase activity via parallel independent pathways.

Adenosine Triphosphatases↗
PubMed1984

Regulation of rat renal (Na+ + K+)-adenosine triphosphatase activity by triiodothyronine and corticosterone.

The present study concerns the effects of corticosterone and T3 on renal cortical and outer medullary NaK-ATPase activities in the rat. The results show that corticosterone increases cortical and outer medullary NaK-ATPase activities when administered as either a single or multiple doses. Corticosterone and T3 are known to enhance NaK-ATPase activity. We investigate the possibility of interaction between the effects of corticosterone and T3 on renal NaK-ATPase activity. Our studies indicate that corticosterone and T3 regulate renal cortical NaK-ATPase activity via parallel independent pathways, and that corticosterone appears to regulate medullary NaK-ATPase activity without participation by thyroid hormone.

Adenosine Triphosphatases↗
PubMed1984

Recognition of dementia among medical patients.

To determine how accurately dementia was diagnosed among medical inpatients, we compared the judgments of medical interns with diagnoses based on standard criteria. Fifty-seven interns rendered opinions regarding the presence of dementia in 380 medical inpatients who were simultaneously examined by physician-investigators applying criteria derived from DSM III. The sensitivity and specificity of diagnosis by interns were 79% and 80%, respectively. Patients who were misdiagnosed as demented were less likely to be high school graduates than their correctly classified nondemented counterparts, and those with unrecognized dementia were more likely to be younger than 65 years than patients whose dementia was recognized by house staff. It is concluded that misdiagnosis is related to age and educational status and that attention to these factors may improve diagnostic accuracy.

Adult↗
PubMed1984

Medication problems among outpatients. A study with emphasis on the elderly.

When patients ascribe adverse symptoms to their medications, the medical care process can be affected. To investigate how often medical outpatients link various adverse symptoms with their medications and to learn what actions they take in response, 299 randomly selected medical outpatients were interviewed. Thirty percent of the subjects identified at least one medication as causing an undesirable symptom. Subjects 65 years or older attributed a lower mean number of adverse symptoms to their medications than did younger subjects. Subjects rarely reported modifying their medication regimens due to adverse symptoms, a finding supported by multiple regression analysis. Approximately one in four subjects did not discuss their symptoms with their providers. These results have important implications for medical care in general, and for the elderly in particular.

Aged↗
PubMed1983

Effect of corticosterone and triiodothyronine on (Na+ + K+)-adenosine triphosphatase activity in rat submandibular gland.

The present study concerns the effect of glucocorticoids and triiodothyronine (T3) on rat salivary (Na+ + K+)-adenosine triphosphatase (NaK-ATPase). The results indicate that corticosterone increases submandibular gland NaK-ATPase activity with a single dose of hormone and with two daily doses on three successive days. Multiple injections of dexamethasone also increases submandibular and sublingual gland NaK-ATPase activity. The effect of glucocorticoids on salivary NaK-ATPase is selective since Mg-ATPase shows no significant differences under different steroidal states. We subsequently investigate the possibility of interaction between the effects of corticosterone and triiodothyronine on submandibular gland NaK-ATPase activity. Our studies indicate that each of these hormones increases NaK-ATPase activity in the absence of the other.

Adenosine Triphosphatases↗
PubMed1983

The preoperative consultation. Response to internists' recommendations.

Preoperative consultations are frequently performed; however, little is known about the way requesters respond to the recommendations offered. For this reason, 90 consecutive preoperative consultations, performed by a general medical unit, were reviewed and compared with 66 consecutive nonpreoperative consultations, performed by the same unit during the same period. Analysis disclosed that recommendations made during preoperative consultation were often not followed and were less likely to be followed than were those made during nonpreoperative consultation (53.9% v 68.9%). Controlling for the type of consultative advice offered and for the type of surgical service requesting the consultation did not alter this relationship. These results highlight the particular importance of consultant follow-up for recommendations made during preoperative consultations.

Consultants↗
PubMed1982

Knowledge of and compliance with drug regimens in the elderly.

In an interview study of 545 patients recently discharged from The Johns Hopkins Hospital, data were collected on the patients' knowledge of their diseases, knowledge of drug purpose, and compliance with the prescribed drug regimen. The interrelationships of these variables were compared in patients under age 65 and patients aged 65 or older. Age-related factors and trends were sufficiently important to warrant further investigation. Knowledge of and compliance with drug regimens may reflect doctor-patient relationships. Understanding the patterns of drug use offers a potential for appropriate strategies in clinical practice.

Age Factors↗