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Biomedical subjects

M Alter

Publications and source records attributed to M Alter.

At least 55 records · Page 3Linked to original sources
PubMed1986

Systemic recombinant alpha-2 interferon therapy in relapsing multiple sclerosis.

This report describes the first use of recombinant-DNA-produced human interferon in patients with multiple sclerosis (MS). Ninety-eight patients who were clinically definite for MS with two or more documented exacerbations during the preceding two years were admitted to this placebo-controlled double-blind randomized trial. Although both groups were similar, placebo patients had later MS onset. Patients injected themselves with 2 X 10(6) IU of alpha-2 interferon or placebo three times each week for up to 52 weeks. This dose of interferon was well tolerated in that side effects were minimal. During the trial, the exacerbation rate was sharply reduced in both groups. In the three-month follow-up period after stopping treatment, more patients who were receiving interferon than placebo became worse neurologically. More patients who were receiving interferon than placebo changed from exacerbating MS to progressive MS during the trial. Thus, no clear therapeutic benefit of alpha-2 interferon for MS was detected.

Adult↗
PubMed1986

Standardized incidence ratios of stroke: a worldwide review.

Comparison of stroke incidence in various parts of the world is difficult because differences in diagnostic criteria, medical facilities and age-sex distributions are often not taken into account. We calculated age-sex standardized incidence ratios (SIR) of stroke in 37 regions based on recent reports. The USA (1976) was taken as the standard population. In western countries SIRs varied from 0.8 to 2.1. In China and Japan, SIRs varied from 0.7 to 3.6. While the lowest and highest SIRs differed by a factor of 5, only 6 of the 37 studies yielded a SIR of more than 2.0 or below 0.75. Of these, 4 were from China and Japan. The highest ratios were based on a very intensive door-to-door survey and probably should not be compared to less intensive studies. We conclude that world-wide variation in age-sex adjusted stroke rates is relatively small.

Adult↗
PubMed1986

Transmissible virus dementia: evaluation of a zoonotic hypothesis.

Creutzfeldt-Jakob disease (CJD) and kuru are subacute transmissible dementing encephalopathies characterized by spongiform changes in the brain. Scrapie is a similar slow viral encephalopathy which affects sheep, goats and certain other animals. Anecdotal reports suggest that Creutzfeldt-Jakob disease could be a zoonosis. To evaluate the possibility that CJD is acquired from animals, a case-control study was conducted on 26 well-documented CJD cases and 40 controls. Data were collected on exposure to animals through occupations, hobbies, sports and pets. An excess exposure to certain animals was noted among the patients compared to controls in relation to occupation (deer, monkey, squirrel; odds ratio (OR) = 8.9; p less than 0.10) and hobbies (deer, OR = 9.0; rabbit, OR = 6.0; p less than 0.05). Similarly, exposure to animal organs was significantly greater in the CJD group (OR = 20.9; p less than 0.005). Statistically significant increased exposure to sheep or goats was not found among the patients. However, since spongiform encephalopathy has a wider host range than sheep and goats, the increased exposure to certain other animals suggests that a zoonotic source for CJD should be further explored.

Adult↗
PubMed1986

Multiple sclerosis and childhood infections.

Migration from an area where MS is common to an area where it is rare (and vice versa) affects the risk of MS, provided migration occurs in childhood. A childhood infection might explain this effect. Therefore, the age pattern of infectious diseases in different regions was examined. A higher proportion of children showed positive titers to many viral diseases early in life in areas where MS is rare compared with those where MS is common. Also, mortality rates from a variety of infectious diseases correlated negatively with the MS mortality. Thus, infection early in life may "protect" against MS, and conversely, later infection, when the immune system has partially matured, may increase risk. MS may be an age-dependent, host-immune response to childhood infection.

Asia↗
PubMed1986

Creutzfeldt-Jakob disease.

There has been significant advance in our understanding of CJD and similar spongiform encephalopathies in recent years. The range in clinical expression of the disease is better appreciated, and the existence of "atypical" cases of CJD is increasingly recognized. New ideas about the possible modes of natural transmission have been derived from case-control studies in different parts of the world.

Animals↗
PubMed1985

A case-control study of Creutzfeldt-Jakob disease. Dietary risk factors.

The mode of natural transmission of Creutzfeldt-Jakob disease remains unknown. In a case-control study conducted in 1981-1983 to evaluate possible dietary and other sources of the disease, 26 cases were ascertained in the mid-Atlantic region of the United States, 23 of which were obtained from accumulated records of the Laboratory of Central Nervous System Studies of the National Institutes of Health. Controls included 18 family members and 22 hospital-matched individuals (total sample size, 66). An increased consumption among patients was found for roast pork, ham, hot dogs (p less than 0.05), roast lamb, pork chops, smoked pork, and scrapple (p less than 0.1). An excess consumption of rare meat (p less than 0.01) and raw oysters/clams (p less than 0.1) was also reported among the patients. Liver consumption, among organ foods, was greater (p less than 0.1) among the cases. If Creutzfeldt-Jakob disease is acquired through ingestion of foods containing the agent, then the food items identified may be among those which need to be evaluated more intensively. Larger case-control studies with more focused dietary questions are warranted.

Adult↗
PubMed1985

Stroke in the Lehigh Valley: incidence based on a community-wide hospital register.

Since July 1982 a population-based study of stroke has been carried out in the Lehigh Valley, a region in Pennsylvania and New Jersey, USA, with 580,000 people. During the first year, the annual incidence rates of stroke and transient ischemic attack were 167 and 49 per 100,000 population, respectively. Cerebral thrombosis, embolus, cerebral hemorrhage and subarachnoid hemorrhage accounted for 76, 13, 8 and 3% of the strokes, respectively. The overall incidence rate and distribution of stroke by type agree well with other population-based studies. The large size of the population in the Lehigh Valley means that information on the epidemiology of stroke, as well as the effects of various therapies on stroke frequency and outcome, can be collected in a shorter period of time than in most other communities studied to date. Finally, an assessment of concordance in diagnosis between attending physicians and a neurologist using standardized criteria was possible for the entire community.

Adult↗
PubMed1985

Sheep consumption: a possible source of spongiform encephalopathy in humans.

A fatal spongiform encephalopathy of sheep and goats (scrapie) shares many characteristics with Creutzfeldt-Jakob disease (CJD), a similar dementing illness of humans. To investigate the possibility that CJD is acquired by ingestion of contaminated sheep products, we collected information on production, slaughtering practices, and marketing of sheep in Pennsylvania. The study revealed that sheep were usually marketed before central nervous system signs of scrapie are expected to appear; breeds known to be susceptible to the disease were the most common breeds raised in the area; sheep were imported from other states including those with a high frequency of scrapie; use of veterinary services on the sheep farms investigated and, hence, opportunities to detect the disease were limited; sheep producers in the area knew little about scrapie despite the fact that the disease has been reported in the area, and animal organs including sheep organs were sometimes included in processed food. Therefore, it was concluded that in Pennsylvania there are some 'weak links' through which scrapie-infected animals could contaminate human food, and that consumption of these foods could perhaps account for spongiform encephalopathy in humans. The weak links observed are probably not unique to Pennsylvania.

Abattoirs↗
PubMed1985

Creutzfeldt-Jakob disease: possible medical risk factors.

To explore possible risk factors in the past medical history of patients with Creutzfeldt-Jakob disease (CJD), we conducted a case-control study among 26 cases and 40 matched controls. Statistically significant odds ratios were obtained for intraocular pressure testing; injury to or surgery on the head, face or neck; and trauma to other parts of the body. The odds ratios were nearly significant for head trauma and procedures requiring sutures. These data suggest that the CJD agent may be acquired by inoculation through injury or during surgery, and perhaps on certain absorbable sutures of animal origin. The tonometer used for glaucoma testing may also be a vehicle of transmission.

Craniocerebral Trauma↗
PubMed1985

Hemodialyzer reuse: practices in the United States and implication for infection control.

Reuse of hemodialyzers has continued to increase dramatically. In 1983, 52% of the hemodialysis centers were reusing hemodialyzers. Use of hollow fiber hemodialyzers has paralleled this increase in hemodialyzer reuse with 63% of the hemodialysis centers reporting exclusive use of this type of hemodialyzer in 1983. Although reuse of hemodialyzers has not been associated with increased incidence of hepatitis B infection or pyrogenic reactions, an outbreak of nontuberculous mycobacteria in 27 chronic hemodialysis patients was probably associated with water used to reprocess dialyzers. Nontuberculous mycobacteria were isolated from the water in 83% of 115 hemodialysis centers surveyed across the United States and could constitute a potential infection risk because of the organisms' greater germicide resistance than most other naturally occurring water bacteria. Two percent formaldehyde is not an effective germicide for high level disinfection of hemodialyzers. Reprocessed hemodialyzers should be disinfected with 4% formaldehyde or an equivalent disinfectant.

Hepatitis B↗
PubMed1984

Inheritance of idiopathic torsion dystonia among Jews.

Idiopathic torsion dystonia (ITD) has long been considered to be genetically determined, but the pattern of inheritance has been unclear. It has been suggested that inheritance may differ in Jews and non-Jews. In the present study, data gathered in a nationwide survey of ITD in Israel were analysed. Between 1969 and 1980, 47 patients were collected, of whom 40 were of European origin. In these European Jews, the ITD frequency was about 1:23 000 live births, which was five-fold greater than in Jews of Afro-Asian origin. Assuming that all cases fit the same genetic model, an X linked or a simple autosomal recessive model of inheritance did not agree well with our data. An autosomal dominant model with low penetrance could have accounted for our observations and would yield an ITD gene frequency in European Jews of 3 to 4:100 000. In view of the increased ages of their fathers, the isolated cases may have included some new mutations. Multifactorial inheritance was also possible. However, it may be inappropriate to assume that all cases have the same genetic basis, or even that all are inherited.

Dystonia Musculorum Deformans↗
PubMed1984

Cerebral ischemia and atrial fibrillation: prospective study.

The frequency of recurrent cerebral ischemia and death was determined prospectively in 36 patients who presented with ischemic stroke and had atrial fibrillation. Patients were followed an average of 2.3 months (range, 3 weeks to 9 months). The recurrence rate for cerebral ischemia was 33%, and the mortality rate was 22%. A beneficial effect of anticoagulation, given nonrandomly, was observed when we compared treated versus untreated patients followed for a similar length of time. Nine patients (25%), however, had CT evidence of hemorrhage associated with cerebral embolic infarction.

Aged↗
PubMed1983

Bilateral enterobius vermicularis salpingo-oophoritis.

Inflammatory pelvic disease secondary to infection with Enterobius vermicularis is rare in that pinworms are usually asymptomatic inhabitants of the terminal small bowel and cecum. When these parasites do cause symptoms, however, there is a spectrum of gastrointestinal and genitourinary complaints. A case is presented of a woman with bilateral abdominal pain that was found to be due to a combination of parasitic and bacterial (Bacteroides fragilis) infection. The parasitic fallopian tube infection may have predisposed the fallopian tubes to a microbial tuboovarian abscess.

Bacteroides Infections↗
PubMed1983

Measles, measles vaccination, and risk of subacute sclerosing panencephalitis (SSPE).

Between the years 1968 and 1979, 87 cases of subacute sclerosing panencephalitis (SSPE) appeared among the Israeli-born population. The incidence of SSPE dropped sharply in 1977, 10 years (the median age at onset of SSPE) after introduction of mass antimeasles vaccination, and remained low in 1978 and 1979. Most of the SSPE cases reported measles at an age significantly younger than that of the general population. This pattern did not change after introduction of antimeasles vaccination. Incidence was significantly lower (p less than 10(-9) in the vaccinated population than in the unvaccinated population. Occurrence of SSPE in some children who were vaccinated against measles could be explained by incomplete vaccine efficacy, or by older age at vaccination, which allows the possibility of prior exposure to measles. There was no indication that measles vaccine can induce SSPE.

Adolescent↗
PubMed1982

Dopamine-beta-hydroxylase (DBH) in idiopathic torsion dystonia (ITD).

Dopamine-beta-hydroxylase (DBH) has been reported to be elevated in the serum of patients with idiopathic torsion dystonia. We have examined the levels in jewish patients suffering from that disease and found levels comparable to those of age-and sex-matched controls.

Dopamine beta-Hydroxylase↗