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Biomedical subjects

L Schwartz

Publications and source records attributed to L Schwartz.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

The role of pain behaviors in the modulation of marital conflict in chronic pain couples.

Sixty-one married male chronic benign back patients and their spouses were recruited in order to examine the relationship between marital conflict/stress and patient pain behaviors. The results suggest that marital conflict in pain couples is associated with increases in subsequent display of pain behaviors which, in turn, are associated with greater negative affective responses and more punitive behaviors by the spouse. A positive association was found between punitive spouse behaviors and patient physical and psychosocial impairment. The findings are discussed in terms of their clinical implications and the need for further experimental study of these relationships.

Adult↗
PubMedDate not supplied

Antithrombotic and thrombolytic therapy in patients undergoing coronary artery interventions: a review.

The controlled arterial injury that occurs with balloon angioplasty and other coronary interventions is characterized by evanescent endothelial denudation and vascular disruption. As a consequence, platelet activation occurs at the treated site, and there is a risk of thrombotic occlusion. This risk is heightened by several factors including unstable clinical presentation, lesion complexity, deep injury, and dissection. Aspirin has been shown to unquestionably reduce, although not eliminate, acute complications and is now part of the routine periprocedural regimen. Heparinization with more intense anticoagulation than is conventionally used is also standard treatment and is initiated before vessel instrumentation. Adjunctive thrombolysis is rarely necessary unless refractory thrombus precedes or complicates the procedure. However, thrombolysis may have a role in the treatment of saphenous vein graft obstructive lesions in which guide wire- or catheter-induced distal thromboembolization may cause infarction in spite of successful graft recanalization. In contrast to their success in the periprocedural phase of coronary interventions, anticoagulants and a wide variety of platelet active agents have been ineffective in reducing the 30% to 40% incidence of restenosis. Only 7E3, which targets the final common pathway of platelet aggregation by irreversibly blocking the IIb/IIIa receptor, has been shown to decrease the 6-month clinical event rate after balloon angioplasty, possibly by a surface pacification mechanism. This suggests that newer more potent antiplatelet and anticoagulant agents may also find a role in the long-term management of these patients.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Coronary artery stenting: indications and cost implications.

The practice of coronary stenting is evolving rapidly, with new stent designs, deployment techniques, and adjunctive therapy. In many respects, clinical practice is changing in advance of the availability of supporting data. The consistent excellent angiographic result with stent deployment exceeds that achieved by any other previous interventional device, and the extent to which this accounts for the exponential increase in stent utilization cannot be accurately determined but is undoubtedly considerable. Controlled randomized trials have confirmed that stent deployment is superior to balloon angioplasty in certain lesion subsets or clinical scenarios. These include focal de novo native vessel lesions, lesions with late recoil after balloon angioplasty, acute closure after balloon angioplasty, and proximal left anterior descending coronary artery lesions. In addition, observational data is persuasive in focal coronary saphenous vein graft lesions and aorto-ostial lesions. On the other hand, the evidence supporting the use of stents strictly to improve on a suboptimal result, possibly the most frequent indication, is indirect and circumstantial. Stents are expensive, but it was anticipated that with the reduction in restenosis not only would they be cost-effective but also ultimately would reduce costs. This hope has not as yet been realized. However, there is little question that the introduction of intracoronary stents has been the most significant and exciting development since the introduction of percutaneous revascularization almost 20 years ago. It has revitalized the field.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

The role of spouse responses to disability and family environment in multiple sclerosis.

Research in the area of family issues and multiple sclerosis has mainly focused on the impact of multiple sclerosis on the spouse. The aim of the current study was to examine the relationship between patients' ratings of their spouses' responses to multiple sclerosis patient disability behaviors and the impact on patient psychological and physical functioning. Multiple sclerosis patients were interviewed over the telephone using standardized questionnaires to assess patient physical and psychological functioning, spouse responses to patient disability and well behaviors (i.e., how does the spouse respond when you're having difficulties related to multiple sclerosis?), and family environment factors. The study was set in a large university-based Multiple Sclerosis Clinical Center. Forty-four of 64 patients approached with definite multiple sclerosis participated in the study. Physical functioning was assessed by the Kurtzke-EDSS, SIP, SF-36, and psychological functioning was assessed by the CES-D and SF-36. Scores on the SF-36 were generally lower compared with a normative sample of individuals with major medical problems; however, mean Kurtzke scores of 5.60 reflected moderate to severe impairment. Exploring spouse responses to disability, correlation analyses revealed that solicitous spouse responses to patient disability behaviors were significantly associated with greater multiple sclerosis-related physical disability. This relationship was stronger for patients who were more depressed. Spouse negative responses to patient disability behaviors were associated with poorer mental health, whereas spouses' encouragement of patient well behaviors was associated with lower emotional distress. Poorer psychological functioning was found in patients with families who were reported to have higher conflict and/or who were more controlling. Higher levels of independence in families were associated with better psychological and physical functioning in the patients. These preliminary findings suggest that patients' perceptions of their families' responses to disability and family environment factors may be important areas for further research. The findings may also provide potential targets for clinical intervention in the future.

Activities of Daily Living↗
PubMedDate not supplied

A computer-assisted preventive maintenance system.

With the growing number of hospitals developing in-house preventive maintenance capabilities, and the increasing number of pieces of equipment and instruments needing preventive maintenance, automatic data processing has emerged as a tool to aid the clinical engineer and hospital in planning preventive maintenance programs. Such a system is CAPMS, or Computer Assisted Preventive Maintenance System. Through the use of CAPMS, the department in charge of Preventive Maintenance can keep accurate records of PM history, safety testing, and year-to-year maintenance costs. Some of the special features of CAPMS include: information of availability of equipment for servicing, priorities, and a text file that can be used to print out the procedure form for use during the PM. These additional features make CAPMS a useful tool to the clinical engineer.

Computers↗
PubMedDate not supplied

Dietary pectin and glycemic control in diabetes.

Seventeen diabetic subjects requiring insulin and who exhibited glycemic stability over a 9-12-mo control period received 5 g of pectin with each meal and at bedtime for 3 mo. Hemoglobin A1c (HbA1c) and glycosylated serum protein were measured in each patient on multiple occasions to assess glycemic control. No clear-cut change in these measurements occurred during the period of pectin ingestion. These data are not consistent with a beneficial effect of high-pectin diets in people with diabetes.

Blood Glucose↗
PubMedDate not supplied

Intraoperative conformal optimization for transperineal prostate implantation using magnetic resonance spectroscopic imaging.

PURPOSE: Recent studies have demonstrated that magnetic resonance spectroscopic imaging (MRSI) of the prostate may effectively distinguish between regions of cancer and normal prostatic epithelium. This diagnostic imaging tool takes advantage of the increased choline and creatine versus citrate ratio found in malignant, compared with normal, prostate tissue. The purpose of this report is to present our initial experience integrating MRSI data into an intraoperative computer-based optimization planning system for prostate cancer patients who underwent permanent interstitial I 125 implantation. The goal of this approach was to achieve dose escalation to intraprostatic tumor deposits on the basis of MRSI findings without exceeding the tolerance of adjacent normal tissue structures. MATERIALS AND METHODS: MRSI was obtained before surgery for four consecutive patients with clinically localized prostate cancer. The ratios of choline and citrate for the prostate were analyzed, and regions in which malignant cells were suspected to be present were identified. These ratios were calculated on a spatial grid overlying the axial MRSI of the prostate. MRSI coordinates containing these suspicious regions were registered to the intraoperative ultrasound images. A computer-based treatment planning system, which relied on a genetic algorithm, was used to determine the optimal seed distribution necessary to achieve maximal target volume coverage with the prescription dose and to maintain urethra and rectal doses within tolerance ranges. The treatment planning system was specifically designed to escalate the dose to MRS-positive voxels while at the same time achieving preferential sparing of surrounding normal tissues. Patients underwent transperineal interstitial implantation with I 125 by use of this intraoperatively generated plan. Postimplant computed tomographic scans were performed on the same day of the procedure in all cases, and dosimetric guidelines of the American Brachytherapy Society were used to assess implant quality. RESULTS: Based on the postimplant computed tomographic evaluation, the intraoperative optimization treatment planning program was able to achieve a minimum dose of 139% to 192% of the 144-Gy prescription dose to the MRS-positive voxels. The percentage of the prostate volume receiving 100% of the prescription dose ranged from 92% to 97%, and the dose delivered to 90% of the target for the target volume ranged from 96% to 124%. Despite the dose escalation achieved for the positive voxels, the urethral and rectal doses were maintained within tolerance ranges. The average and maximal rectal doses ranged from 28% to 43% and 69% to 115% of the prescription dose, respectively. The average and maximal urethral doses ranged from 66% to 144% and 118% to 166% of the prescription dose, respectively. CONCLUSIONS: Using this brachytherapy optimization system, we could demonstrate the feasibility of MRS-optimized dose distributions for I 125 permanent prostate implants. This approach may have an impact on the ability to select regions within the prostate to safely employ dose escalation for patients treated with permanent interstitial implantation and to improve outcome for patients with organ-confined prostatic cancers.

Aged↗