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Biomedical subjects

L H Bernstein

Publications and source records attributed to L H Bernstein.

At least 37 records · Page 2Linked to original sources

Home care of the elderly diabetic patient.

As the anticipated growth of sophisticated diabetic services continues to accelerated in homes across America, physicians must first be educated as to the potentially unlimited spectrum of diabetic home care products and services that will become increasingly available to the patients whom they serve. Second, much research must be completed to critically examine the safety, quality, and cost issues of diabetic home care, to provide the necessary data to assure that home care services will be neither under- or over-utilized and will meet the necessary acute and long-term health care needs of our diabetic patients. Third, physicians must take a leadership role in examining the pitfalls of our existing expensive and often fragmented acute care-oriented health care model, which has not effectively addressed the increasing costs and incidence of chronic diseases, such as diabetes, in our society. With computerization and the explosive mobilization of high-technology health care products and services, we are witnessing an exponential growth in the list of services available in the home setting for diabetic patients. There has never been a time in the history of medicine that we, as physicians, have needed to create new, innovative, high-quality approaches to necessary, accessible, and cost-effective alternative health care delivery systems as is the case now. I believe that the renewal of home care, with physician vision, direction, and review, will be a major step toward the highest-quality medical care provided to our diabetic patients at home.

Aged↗

Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature.

We report 2 patients with myonecrosis due to Clostridium septicum and associated colon carcinoma and have reviewed the English language literature for all reported cases of atraumatic C. septicum infection. A total of 162 cases of C. septicum infection have been reported. Eighty-one percent of these patients had an associated malignancy. Thirty-four percent of all patients had associated colon carcinoma, while 40% had a hematologic malignancy. Thirty-seven percent of reported patients had an occult malignancy at the time of their infection with C. septicum. In many patients, the portal of entry was found in the large intestine. In a particularly lethal form (79% mortality) of C. septicum infection, known as "distant myonecrosis," infection metastatic from the initial site of infection causes severe myonecrosis, gangrene, and often death within hours of clinical detection. Overall, survival of patients with C. septicum infection is only 35%. Review of all cases of C. septicum infection suggests several conclusions. 1) Patients with malignancy, particularly colonic or hematologic, and patients with cyclic neutropenia who develop signs and symptoms of sepsis, especially with associated findings of abdominal pain or pain in an extremity, should be treated for possible clostridial infection. 2) C. septicum infection does not appear to be a result of a single specific defect in either humoral or cell-mediated immunity. Rather, it may occur in patients who are granulocytopenic and therefore prone to an enterocolitis. 3) Patients in whom an infection with C. septicum is found must undergo a vigorous search for malignancy following acute therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

The cost impact of decentralized testing.

Analysis of satellite laboratory expenses, in support of a same-day surgery program, demonstrates dramatic savings over service by a centralized lab.

Ambulatory Surgical Procedures↗

Usefulness of data on albumin and prealbumin concentrations in determining effectiveness of nutritional support.

In this ongoing study, albumin and prealbumin (transthyretin) changes were compared in 40 patients managed with enteral and (or) parental support with attainment of caloric/protein goals. The concentration of prealbumin in serum changed rapidly and more accurately reflected current nutritional status of these patients than did that of albumin. We determined concentrations of albumin and prealbumin that reflected significant improvement in nutritional status, using Rudolph's approach based on Shannon information measures. Reference values for albumin and prealbumin in the treatment populations were 25 g/L and 107 mg/L, respectively. A prealbumin concentration of 135 mg/L or greater reflected a return to stable status.

Enteral Nutrition↗

Diagnosis of acute myocardial infarction from two measurements of creatine kinase isoenzyme MB with use of nonparametric probability estimation.

By using bivariate probability estimation for the diagnosis of acute myocardial infarction (AMI) we show how to overcome the difficulties encountered for patients whose clinical presentation is atypical and those encountered when multiple isoenzyme determinations are treated by univariate methods. We use the values for creatine kinase isoenzyme MB measured at the time of admission and 12 h later to estimate the Bayes factors in favor of AMI. The Bayes factors are compiled into a table that the clinician can use to estimate the posterior probability that a patient has AMI. The table of Bayes factors is based on data for a sample of 802 non-AMI patients and 180 AMI patients. Further to validate the method, we randomly chose 200 of the non-AMI and 50 of the AMI patients as an evaluation sample, then used the remaining 602 non-AMI and 130 AMI patients to recompute the Bayes factors. These Bayes factors were used to find the probability of AMI for each of the 250 patients in the evaluation sample. The method resulted in only one false positive and no false negatives. For the misclassified patient the measurements at admission and 12 h later were 1 and 11 U/L; the posterior odds were 15 to 1 in favor of AMI, but in fact the patient was non-AMI.

Creatine Kinase↗

Infectious diarrhea in patients with AIDS.

A multitude of opportunistic infections has been documented in virtually every organ system of patients with the acquired immunodeficiency syndrome (AIDS). Prominent among these are infections of the gastrointestinal tract. However, studies of large numbers of patients documenting the frequency of such involvement are lacking. We reviewed the records of 100 patients with AIDS and assessed the frequency and organisms causing infectious diarrhea. We found diarrhea to be more common in homosexuals (80%) than heterosexuals with a risk factor of parenteral drug use (58%). In one third of all cases, no infectious etiology was found. Mycobacterium avium intracellulare (MAI) was the most commonly identified cause of infectious diarrhea in our series, followed by cytomegalovirus, cryptosporidium, Salmonella spp., and herpes virus. In addition, bacteremia was documented in 43% of patients with infectious diarrhea and was most commonly due to MAI. Finally, we demonstrated that multiple concurrent infections are not uncommon (22%) in AIDS patients and that the diarrheal syndrome may not respond unless all pathogens are eradicated.

Acquired Immunodeficiency Syndrome↗

Information induction for predicting acute myocardial infarction.

We show how to make an unsupervised discrimination of disease and nondisease states by measuring information and using newer notions of inductive reason. We also present a new theory of group-based reference values that is based on measuring information uncertainty. We use data on the isoenzymes creatine kinase-MB (CK-MB) and lactate dehydrogenase-1 (LD1) and on the percentage of LD1 from 101 patients with acute myocardial infarction (AMI) and from 41 patients with suspected, but unfounded, infarction (non-AMI). Calculating the Shannon entropy, a concept from information theory, of the data base allows determination of a difference in entropy values ("effective information"), which determines decision cutoff values that produce binary-base patterns yielding the fewest classification errors. Redundancy in testing is important because it provides the information to approach a goal of errorless discrimination by coding the test results and meeting the conditions of the "Noisy Channel Theorem" of information theory. This redundancy improves the predictive value of diagnosis by isolating the area of equivocation to evident patterns. Results for CK-MB and LD1 are 99% correct in assigning cases to AMI and non-AMI categories; adding %LD1 increases the proportion of errorless binary patterns from 25% to 90%.

Algorithms↗

Immunoradiometric assay of CA 125 in effusions. Comparison with carcinoembryonic antigen.

The levels of CA 125 antigen were measured in 167 effusions from 150 patients using radioimmunoassay, and the results compared with the levels of carcinoembryonic antigen (CEA) in the fluids. This study was carried out to test a hypothesis that measuring the combined levels of selected tumor associated antigens in effusions could predict the primary source of malignancy. The results indicate that an elevated fluid CA 125 level (greater than 14,000 U/ml-68,000 U/ml) and a negative fluid CEA level (less than 5 ng/ml) is suggestive of serous and endometrioid carcinoma of ovary, and adenocarcinoma of the endometrium and fallopian tube. Alternatively, an elevated fluid CEA level (14 ng/ml-600 ng/ml) and a negative CA 125 level (20-5000 U/ml) is seen in metastatic carcinomas of breast, lung, gastrointestinal tract, and mucinous cystadenocarcinoma. Lymphomas, melanomas, and benign effusions are negative for both antigens. The combined use of CEA and CA 125 antigen in fluids is useful in the differential diagnosis of adenocarcinoma of unknown primary.

Adenocarcinoma↗