Academic health centers in an era of managed care.
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Academic Medical Centers↗
Biomedical subjects
L Simon
Publications and source records attributed to L Simon.
A case of membranous glomerulonephritis associated with Recklinghausen's neurofibromatosis.
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Glomerulonephritis, Membranous↗
[Neurofibromatosis (von Recklinghausen disease) and carcinoid tumor in Vater's ampulla].
The localization of the carcinoid tumors of the gastrointestinal tract--as a part of the APUD system--is extremely seldom at the region of ampulla of Vater. A case of congenital neurofibromatosis is reported in a 49-year-old male patient, with a carcinoid tumor of the ampulla of Vater in the background of long-standing, atypical biliary complaints. Periampullary neoplasm of neural-crest origin are very rare, up to this time 73 cases of Vater papilla carcinoid tumors were described. Regarding the development of VP carcinoid in neurofibromatosis, our patient is the 21st reported case in the world literature, and the first one in Hungary. The authors review the literature, giving special attention to the risk of periampullary neoplasms in von Recklinghausen's disease, the need of accurate diagnosis and the correctly selected operative intervention.
Ampulla of Vater↗
[Management of Oddi sphincter dyskinesis. Results of drug therapy and sphincterotomy].
UNLABELLED: In a retrospective evaluation, the outcome of the long term treatment of the sphincter of Oddi dyskinesia (OD, type III. dysfunction) has been analysed. PATIENTS AND METHOD: Therapeutic results of 64 cholecystectomised patients with OD were evaluated by means of regular follow-up and questionnaire filled in either by the patients or their practitioners. RESULTS: Conservative treatment (nitroglycerin, calcium channel blocker or both) resulted in symptom-free condition or improvement with 53% of the patients (37/64). Out of 27 patients whose condition did not improve by combined drug therapy, in 20 cases endoscopic sphincterotomy (EST) and in 1 case transduodenal sphincterotomy were performed. Having followed sphincterotomy, out of 21 patients only 9 became symptom-free and 5 improved. CONCLUSIONS: Therapeutic benefit of sphincter relaxants fail in nearly half of the cases with OD, and even sphincterotomy can lead to symptomless condition only in a portion of OD. Regarding the high incidence of complications following EST in OD, it can only be recommended after failure of the conservative therapy in correctly diagnosed cases. The results emphasise a need for a prospective randomised controlled clinical study to seek for the optimal therapeutic regimen.
Adult↗
[Management of hypertensive dyskinesia of Oddi's sphincter. Correlation between the frequency of complications from endoscopic sphincterotomy and the diameter of the common bile duct].
OBJECTIVES: to evaluate the treatment possibilities in different forms of sphincter of Oddi dysfunction (SOD), in particularly that of the hypertonic sphincter of Oddi dyskinesia (HOD, biliary type group III). In the first part of retrospective evaluation the higher complication rate of endoscopic sphincterotomy (EST) and its probable causes were analysed. MATERIAL AND METHODS: The frequency and reasons of post-EST complications were retrospectively evaluated in a three-year (1990-1992) EST material of two gastroenterological departments using identical treatment principles and methods. Endoscopic sphincterotomies performed for bile duct stone extraction or treatment of HOD in cholecystectomized patients were included only. The data of 308 patients were analysed regarding two areas: 1. EST was performed for HOD treatment in 20 patients, and in 288 patients for stone removal, 2. the diameter of common bile duct was found non-dilated in 40 patients, and dilated in 268 patients, respectively. RESULTS: 1. The frequency of complications in the group of patients with EST for HOD treatment was significantly higher: 8/20 (40%) vs. 17/288 (5.9%) (p < 0.01). 2. There was also a significant difference in the percentage of total complications between the patients of nondilated bile ducts and those patients with dilated bile ducts: 8/268 (3.3%) vs. 17/40 (42.50%) (p < 0.01), detailed: bleeding: 4/268 vs. 6/40, pancreatitis: 4/268 vs. 10/40, and perforation: 0 vs. 1/40. CONCLUSIONS: Therapeutic endoscopic sphincterotomy is more hazardous in patients with non-dilated bile ducts, thus evidently also in patients suffering from the biliary III. type (hypertonic Oddi-sphincter dyskinesia) of sphincter of Oddi dysfunctions.
Biliary Dyskinesia↗
[Epidemiology of Helicobacter pylori infection in Hungary (comparative sero-epidemiologic study)].
In the last decade pathogenetical role of Helicobacter pylori infection has been proved in development of gastroduodenal alterations. DNA-RNA hybridisation and protein profile studies proved that Helicobacter pylori is an organism distinct from other bacteria. Therefore serology became a useful method to study the epidemiology of Helicobacter pylori infection in various populations. In Hungary sera were collected from adults aged 20-60 in blood banks (Military Hospital, Tolna County Hospital) in 1993. The samples were classified in 5 year increment groups and questionnaires were filled out. Anti-H. pylori IgG were tested using Cobas Core kit (Roche Diagnostic). The overall rate of seropositivity was 63.3%. The prevalence according to age was the following: 20-24 yrs = 44%, 25-29 yrs = 40%, 30-34 yrs = 52%, 35-39 yrs = 64%, 40-44 yrs = 75%, 45-49 yrs = 73%, 50-54 yrs = 77%, 55-59 yrs = 83%. There were no statistical difference between gender, living in urban or rural areas at the time of collection or in childhood, between the level of education, type of labour or social status. However we found statistical correlation between anti-H. pylori seropositivity and epigastric symptoms. The same characteristics of Helicobacter pylori infection were found in Hungary as well as in other countries. In groups between 20 and 30 years has been proved lower prevalence in Hungary than in Poland, Bulgaria.
Adult↗
Pagetic vertebral ankylosis and diffuse idiopathic skeletal hyperostosis.
STUDY DESIGN: A retrospective radiologic analysis of Paget's disease of the spine. OBJECTIVES: The prevalence, anatomic distribution, mechanisms of formation of Pagetic vertebral ankylosis (PVA) and the possibility of a relationship to diffuse idiopathic skeletal hyperostosis (DISH) were assessed in a large population of persons with Paget's disease. SUMMARY OF BACKGROUND DATA: Acquired vertebral ankylosis is not a common feature of the Paget's disease of the spine and its mechanisms of formation remain unknown. In some reports, PVA was associated with radiographic signs of DISH. METHODS: Of 337 Pagetic patients monitored in the Division of Rheumatology from 1961 to 1990, all 245 who had entire spine radiographs were selected for study. Radiographs were studied for signs of Pagetic vertebral lesions and for spinal lesions of DISH. RESULTS: The study group contained 156 men with a mean age of 68 years (range 37-92) and 89 women with a mean age of 71 years (range 50-89). Fourteen PVA were observed on the radiographs of 11 men (mean age 68 years; range 60-76). One PVA was cervical, eight were thoracic, one thoracolumbar, three lumbar, and one lumbosacral. Eighty of the two hundred forty-five patients (32.6%) had characteristic features of DISH. Eight out of the eleven patients with PVA also had evidence of spinal lesions of DISH and radiographic features of DISH were observed contiguous to ten of the fourteen PVA. CONCLUSIONS: The scarcity of PVA reported in the literature and in our study (4.4% of 245 patients) suggests that constant progression of the disease from one vertebra to another by invasion of intervertebral disc space is rare. However, the higher incidence of PVA in men, their preferential location at the thoracic spine and their association with lesions of DISH suggest that progression of Pagetic lesions by invasion of bridging osteophytes may be an important mechanism for the intervertebral spread of Paget's disease.
Adult↗
The relationship between osteoarthritis of the hands, bone mineral density, and osteoporotic fractures in elderly women.
To study the relationship between osteoarthritis (OA) and osteoporosis (OP), radiographic osteoarthritis lesions of the hands (HOA) were quantified in 300 healthy women, aged 75 years or more, as a subgroup of a cohort originally recruited for a multi-centre study of risk factors for femoral neck fracture. The HOA combined score (i.e. the sum of the grades of joint-space narrowing, osteophytes, erosions and joint misalignment), the osteophytosis score and the joint-space narrowing score were calculated on a radiograph of both hands. Bone mineral density (BMD) was measured using dual-energy X-ray absortiometry (Lunar DPX) at the femoral neck, Ward's triangle and the total body. BMDs of the total spine, lumbar spine, and the upper and lower limbs were derived from the regional analyses of the total body measurement. Correlations between bone mass, HOA scores and other variables were explored by multiple linear regression and stepwise logistic regression analysis. The HOA combined score was positively correlated with increasing age but not with body mass index. In the multiple regression analyses the HOA combined score positively correlated with BMD and the joint-space narrowing score. According to stepwise logistic regression and after off adjustment of BMD for age, women with an HOA combined score higher than 20 had significantly higher BMD values at all skeletal sites. Sixty-nine women (23%) reported a history of osteoporotic fracture; among them, 20 (6.6%) reported a history of vertebral fracture. The OA score of both subgroups was significantly lower than that of women with no history of fracture. These data suggest that in elderly women the severity of HOA is positively correlated with bone mass and that women with a higher score of HOA more rarely report a history of osteoporotic fracture.
Aged↗
Translocation of particulates across the gut wall--a quantitative approach.
The translocation of latex particles across the epithelium of the rat small intestine and their transfer to internal organs was determined and quantified. The rate of particle uptake was also established. Particle uptake from the gut lumen to internal tissues was rapid as they were detected in all tissues examined within 30 minutes of oral administration. The maximum number of particles per gram tissue was detected in tissues of the small intestine. Particle number in spleen, kidney, lung, liver and brain increased with time, and in mesenteric lymph node, and heart tissues they decreased with time. Particles were also detected in bone marrow samples. These findings suggest that this animal model is useful in the evaluation and quantification of particle uptake and the determination of the tissues to where they are transported.
Animals↗
Basic cerebellar events relating sensorimotor adaptation--structural analysis on extracellular records of Purkinje cells.
The heterosynaptic facilitation or suppression of synaptic efficacy between parallel fibers and the dendritic spines of Purkinje cells (PCs) in the cerebellar cortex has been for decades the basic idea of sensorimotor adaptation. Great efforts in order to get direct evidence failed, or were not accepted as direct proofs. A new facility was introduced with the structural analysis of intradendritic records of the PC. These records reveal a generally double (rarely single, triple or quadruple) rhythmic pattern of small spikes, which are proposed to be prespikes of dendritic origin. Moreover, they may take their origin at functionally separated dendritic compartments resulting in a nonlinear, phase-sensitive integrative process, performed by the compound spike generating mechanism of the cerebellar PC.
Action Potentials↗
Coronary and hemodynamic effects of S 16257, a new bradycardic agent, in resting and exercising conscious dogs.
The effects of (7,8-dimethoxy 3-[3-([(1S)-(4,5-dimethoxybenzocyclobutan-1-yl)methyl]methylamino) - propyl]1,3,4,5-tetrahydro-2H-benzapin 2-one hydrochloride) (S 16257), a new bradycardic agent acting through inhibition of the hyperpolarization-activated I(f) current in the sino-atrial node, on arterial blood pressure, cardiac output, left ventricular pressure and dP/dt, epicardial coronary artery diameter and coronary blood flow velocity were investigated at graded doses (0.1 to 1 mg/kg) and compared to those of propranolol (1 mg/kg) and saline in chronically instrumented conscious dogs. At rest, S 16257 induced a dose-dependent bradycardia that was significant at 0.5 (-16% +/- 3%) and 1 mg/kg (-23% +/- 3%). At 0.5 mg/kg, S 16257 decreased both resting HR and treadmill exercise-induced tachycardia to a similar extent as propranolol. However, in contrast to propranolol, S 16257 (0.5 mg/kg) did not affect the increase in mean coronary blood flow velocity and the decrease in coronary vascular resistance observed during a control exercise performed under saline. In addition, S 16257 did not affect resting epicardial coronary artery diameter and only attenuated its increase during exercise, whereas propranolol reduced it at rest and maintained a significant constriction of these large vessels throughout the exercise period. Propranolol, but not S 16257, decreased left ventricular dP/dt at each stage of exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Acute polyarthritis after BCG-therapy for bladder carcinoma in a patient with ankylosing spondylitis.
A case of polyarthritis following intravesical administration of bacillus Calmette-Guérin (BCG) for bladder carcinoma is reported in a patient with long-standing ankylosing spondylitis. Possible links between BCG-therapy and joint manifestations are discussed in the light of data from the literature. Patients who develop joint manifestations after BCG-therapy are often HLA B27-positive.
Acute Disease↗
[Hemodynamic effects of sub-chronic NO synthase inhibition in conscious dogs: role of EDRF/NO in muscular exertion].
Acute and chronic administration of nitric oxide (NO) synthase (NOS) inhibitors increase mean arterial blood pressure (MAP) in rats but their hemodynamic effects in other species remain unknown. Moreover, the role of NO in the control of exercise-induced vasodilation is still debated. To answer these questions, six dogs were instrumented for the continuous measurement of cardiac output (CO, electromagnetic flow probe on the aorta), MAP (aortic catheter) and left ventricular pressure (Konigsberg gauge). Total peripheral resistance (TPR) was calculated as MAP/CO ratio and dP/dt was used as an index of cardiac inotropism. The dogs were treated from day 0 (D0) to 7 (D7) by the NOS inhibitor, N omega-nitro-L-arginine (L-NNA), 20 mg/kg/day (IV). Such a dose regimen resulted in NOS inhibition evidenced (a) in vivo by a reduction of the hypotensive responses to graded doses of acetylcholine and bradykinin, (b) ex vivo by a decrease in the relaxation of the femoral artery to acetylcholine (EC 50 = 2.2 +/- 0.6 10(-7) M after L-NNA vs 2.2 +/- 0.8 10(-8) M in controls). One month after instrumentation, the dogs being conscious, MAP measured at rest remained unchanged following one week L-NNA treatment (from 90 +/- 2 at D0 to 91 +/- 5 mmHg at D7). However, TPR increased (from 3,600 +/- 290 at D0 to 6,300 +/- 510 dyn.s.cm-5 at D7) and CO decreased (from 2.1 +/- 0.2 at D0 to 1.2 +/- 0.1 l/min at D7) (all p < 0.01), partly as the result of a marked bradycardia (from 100 +/- 7 at D0 to 60 +/- 7 beats/min at D7). L-NNA induced-increase in TPR was completely reversed by a bolus injection of nitroglycerin (10 micrograms/kg). During treadmill exercise (12 km/h), heart rate (251 +/- 9 at D0 vs 226 +/- 11 beats/min at D7), CO (6.3 +/- 0.9 at D0 vs 4.3 +/- 0.7 l/min at D7) and stroke volume remained significantly lower, and TPR significantly higher (1,662 +/- 278 at D0 vs 2,621 +/- 489 dyn.s.cm-5 at D7) after L-NNA than in the control state. Thus, NOS inhibition in resting conscious dogs by L-NNA markedly increases peripheral resistance but does not increase arterial pressure. In addition, L-NNA blunts both exercise-induced peripheral vasodilation and increase in cardiac output, despite metabolic vasodilation.
Acetylcholine↗
Adult lumbar scoliosis. Epidemiologic aspects in a low-back pain population.
The frequency and characteristics of definite lumbar scoliosis in an adult common low-back pain population (n = 671) were assessed by a clinical and radiologic prospective study. The prevalence was 7.5% (N = 50), increasing with age: 2% before 45 years; 15% after 60 years. Scoliosis was revealed by low-back pain in adulthood in 86% of the cases. The mean Cobb angle was 21 +/- 11.4 degrees. A Cobb angle of more than 30 degrees was noted in 16% of the scoliotics, thus 1% of the entire population. The proportion of women increased with the severity of the scoliosis. Right and left side scolioses were equally noted. A correlation between the Cobb angle and age was found (0.3 degrees/yr; P < 0.05). Rotatory olisthesis was noted in 34% of the cases, more often in right side curves (P < 0.01). The lumbar scoliotic patients were distinguished by a more advanced age (62 +/- 12.4 yr vs. 49.6 +/- 15.5 yr; P < 0.001), a greater proportion of women (72% vs. 48%; P < 0.01), and a more likely involvement of L3 and L4 radicular pain (P < 0.05). Radicular thigh pain was related to unstable curves (P < 0.01). The lumbar scoliotic patients thus constitute a subgroup within the low-back pain population.
Adult↗
Role of consciousness and accessibility of death-related thoughts in mortality salience effects.
On the basis of terror management theory, research has shown that subtle mortality salience inductions engender increased prejudice, nationalism, and intergroup bias. Study 1 replicated this effect (increased preference for a pro-U.S. author over an anti-U.S. author) and found weaker effects when Ss are led to think more deeply about mortality or about the death of a loved one. Study 2 showed that this effect is not produced by thoughts of non-death-related aversive events. Studies 2 and 3 demonstrated that this effect occurs only if Ss are distracted from mortality salience before assessment of its effects. Study 4 revealed that although the accessibility of death-related thoughts does not increase immediately after mortality salience, it does increase after Ss are distracted from mortality salience. These findings suggest that mortality salience effects are unique to thoughts of death and occur primarily when such thoughts are highly accessible but outside of consciousness.
Affect↗
What strategies can be tried to keep costs of antibiotics and other high-priced drugs from becoming true budget busters?
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Anti-Bacterial Agents↗
[Mechanisms of spinal block formation in Paget disease of bone. Radiographic study based on 14 cases].
Vertebral bridging occurs in approximately 10% of patients with spinal pagetic lesions. Diffuse idiopathic skeletal hyperostosis has been reported in patients with pagetic block vertebras and may facilitate vertebral fusion and extension of pagetic lesions. High prevalences of diffuse idiopathic skeletal hyperostosis have been found in patients with Paget's disease. To determine how pagetic block vertebras develop and to investigate relationships between Paget's disease and diffuse idiopathic skeletal hyperostosis, 244 patients with Paget's disease were studied retrospectively. Diagnostic criteria for diffuse idiopathic skeletal hyperostosis were the presence of flowing ossification along the anterolateral aspect of at least three contiguous vertebral bodies or presence of at least two anterolateral intervertebral bony bridges in the same spinal segment. Eight (33%) of the 244 patients had diffuse idiopathic skeletal hyperostosis. Two-thirds of patients with both conditions were male. There was no statistically significant association between presence of diffuse idiopathic skeletal hyperostosis and spinal involvement by Paget's disease. Fourteen pagetic block vertebras were identified in 11 male patients. Eight of these 11 patients had involvement of the fused vertebras or adjacent vertebras with diffuse idiopathic skeletal hyperostosis. Our findings confirm that diffuse idiopathic skeletal hyperostosis is common in patients with Paget's disease. The statistically significant association between diffuse idiopathic skeletal hyperostosis and pagetic vertebral fusion in the same site suggests that the former condition may be a risk factor for pagetic vertebral bridging.
Adult↗
Effect of animal age on the uptake of large particulates across the epithelium of the rat small intestine.
A quantitative investigation into the transfer of latex polystyrene particles across the epithelium of the small intestine has been carried out using male weanling, adult and aged Sprague-Dawley rats. Orally administered polystyrene particles, 2 microns in diameter, were transferred from the lumen of the small intestine into the gut associated lymphoid tissues (Peyer's patches). No significant difference in the number of particles transported across the gut epithelium was detected between animals of different age groups. The concentration of particles detected in Peyer's patches excised from the proximal and distal regions of the small intestine of particle-treated animals did not differ significantly, except in aged rats. Particle concentration was significantly higher in Peyer's patch tissue than in adjacent Peyer's patch-free tissues of the small intestine in treated animals of all age groups. The assay method described here may be used for quantitative investigation of the transepithelial transport of large particulates.
Aging↗