Biomedical subjects
Publications and source records attributed to L Kaiser.
An algorithm, readily adaptable to microcomputers, is given for computing paternity indexes. A closed-form expression based only on gene frequencies and phenotype structures is derived for the paternity index for a given mother/child/alleged father trio and any blood group system. This above work is applied to the problem of estimating gene frequencies from sample data.
Aluminum exposure in man is unavoidable. The occurrence of dialysis dementia, vitamin D-resistant osteomalacia, and hypochromic microcytic anemia in dialysis patients underscores the potential for aluminum toxicity. Although exposure via dialysate and hyperalimentation leads to significant tissue aluminum accumulation, the ubiquitous occurrence of aluminum and the severe pathology associated with large aluminum burdens suggest that smaller exposures via the gastrointestinal tract and lungs could represent an important, though largely unrecognized, public health problem. It is clear that some aluminum absorption occurs with the ingestion of small amounts of aluminum in the diet and medicines, and even greater aluminum absorption is seen in individuals consuming large amounts of aluminum present in antacids. Aluminum absorption is enhanced in the presence of elevated circulating parathyroid hormone. In addition, elevated PTH leads to the preferential deposition of aluminum in brain and bone. Consequently, PTH is likely to be involved in the pathogenesis of toxicities in those organs. PTH excess also seems to lead to the deposition of aluminum in the parathyroid gland. The in vitro demonstration that aluminum inhibits parathyroid hormone release is consistent with the findings of a euparathyroid state in dialysis patients with aluminum related vitamin D-resistant osteomalacia. Nevertheless, it seems likely that hyperparathyroidism is at least initially involved in the pathogenesis of aluminum neurotoxicity and osteomalacia; the increases in tissue aluminum stores are followed by suppression of parathyroid hormone release, which is required for the evolution of osteomalacia. Impaired renal function is not a prerequisite for increased tissue aluminum burdens, nor for aluminum-related organ toxicity. Consequently, it is likely that these diseases will be observed in populations other than those with chronic renal disease.
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PURPOSE: To evaluate the psychometric properties and patterns of decline on the total score and item scores of the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog) in patients with Alzheimer Disease (AD). METHODS: We analyzed data from 536 AD outpatients randomized to the placebo group in two identical 26-week multicenter drug trials. RESULTS: Mean deterioration at week 26 on the ADAS-Cog total score for subjects with moderate dementia was 84% greater than that for those with milder severity ( p < 0.001). After adjusting for this effect, age ( p = 0.015) and educational level ( p = 0.01) also predicted cognitive decline. In a model, absolute change for most individual ADAS items was less than 10% of the possible change, and it was generally smaller than one-third of the standard deviation of the measure. Measurement error variability was greatest for word recognition and the "placebo" effect was greatest for word recall. Variability increased with trial duration in a model. CONCLUSIONS: There is a relationship between baseline severity and magnitude of cognitive decline. In 6-month trials, measurement error makes a substantial contribution to the variance in ADAS-Cog change scores. Sensitivity to intervention effects will therefore depend both on the variability and magnitude of change. Such data must be considered when designing future trials to minimize measurement error variability and increase sensitivity for specific populations.
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BACKGROUND/AIMS: The incidence of tuberculosis is rising again in the Western world, due to the emergence of new groups of patients at risk. This paper intends to describe the various patterns of surgical presentation of abdominal tuberculosis in an industrialized country. METHODOLOGY: A retrospective study was made of all patients admitted to our surgical institution, and in whom a diagnosis of abdominal tuberculosis was established. Eleven patients were identified. Ten of them were migrants from countries endemic for tuberculosis. RESULTS: Six patients presented with acute abdominal pain (3 in right lower quadrant) and had surgery in emergency. Two patients had elective surgery for diagnostic purposes. Two patients underwent other invasive diagnostic and/or therapeutic procedures. One patient was treated conservatively. Unusual presentations included 2 patients with periportal lymphadenitis and compressive features on the main bile duct and/or the portal vein, and 1 patient with acute duodenal tuberculous perforation. The main localization of disease was lymph nodes for 5 patients, intestinal for 4 and peritoneal for 2. CONCLUSIONS: Surgeons must be aware of the wide clinical spectrum of abdominal tuberculosis and have a high index of suspicion when confronted with patients from an endemic area and presenting with unclear abdominal symptoms.
What did our five panelists predict for the next iteration of managed care? What do they see happening now? What will the health care industry look like in ten years? Employers will shift an increasing share of rising medical and prescription drug costs to consumers through higher co-pays and defined contributions. Some providers may market their services to attract these consumers. Tightly managed HMOs will provide access to lower-income consumers. So for, e-health is helping managed care organizations cut administrative costs, but not medical expenses. Genetic testing and therapies will not be commercially available for ten to 15 years. Based on demographic trends and labor shortages, demand is likely to exceed the capacity of the health care system within the next three decades. Our five experts caution that managed care is as unpredictable and chaotic as ever, but they do their best to tell you how they think it'll all play out in the near term.