Twins, probably monozygotic, displaying Down's syndrome, physical and functional mirror-imaging, and discordance for congenital heart disease.
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Biomedical subjects
Publications and source records attributed to M Bergman.
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The long-term visual outcome and complications related to the use of a semiflexible open-loop all-PMMA anterior chamber intraocular lens were evaluated in 40 eyes in which the capsular support was lost. The mean follow up time was 2.3 years (range 6 months to 6.7 years). 55% of the eyes had exfoliation syndrome. 68% (27 of 40 eyes) obtained a visual acuity of 0.5 or better, and only in one of the remaining eyes decreased visual acuity was related to cataract surgery (cystoid macular oedema). No cases of corneal decompensation, uveitis-glaucoma-hyphaema syndrome or retinal detachment have developed, and no IOLs have been explanted. Based on these results, the use of a modern anterior chamber intraocular lens can be suggested at least in old persons, if the capsular support is lost.
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Oxidative damage plays a key role in septic shock induced by the endotoxin lipopolysaccaride (LPS) by enhancing the formation of reactive oxygen species such as superoxide anion radicals, peroxides, and their secondary product, malondialdehyde, especially in the liver. In this study, histopathologic changes in several organs were compared among groups of male Wistar rats that had been injected with LPS following prophylactic pretreatment with either of 2 antioxidants, a group that had been injected with LPS without pretreatment with antioxidants, an untreated control group, and groups that had been injected with either of the 2 antioxidants only. The antioxidants used were a water-soluble natural antioxidant from spinach (NAO) and the NADPH oxidase inhibitor apocynin. Hematoxylin-and-eosin-stained slides were prepared, and lesions were semiquantitatively scored. Exposure to LPS alone was associated with multifocal hepatocellular necrosis and acute inflammation, thymic and splenic lymphoid necrosis, ocular retinal hemorrhage and acute endophthalmitis, adrenal medullary vacuolation and necrosis and acute inflammation, and decreased adrenal cortical cytoplasmic vacuolation (consistent with depletion of steroidal hormone contents). Results indicated that pretreatment with both antioxidants for 8 days reduced, in some organs, the necrotic and inflammatory changes associated with the LPS challenge. These findings suggest a potential therapeutic application for these antioxidants in clinical sepsis.
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A simple-to-use classification system is presented for expressing the hearing loss resulting from acoustic trauma. They system is based upon the implications for social hearing as seen the pure tone air conduction hearing test, which is classified according to specifically segmented areas of the audiogram. A study of the audiometric results of 102 ex-army men with AcT and 25 controls with normal hearing included a detailed questionnaire to relate the patients' functional complaints to their audiograms, and the clinical picture was then completed by the administration of speech audiometry tests both in quiet backgrounds of various signal-to-noise ratios. Three main severity categories of hearing impairment were established. These are described and illustrated.
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BACKGROUND: Taxoids are new chemotherapeutic agents effective in the treatment of breast cancer. Paclitaxel treatment has been reported to cause some cardiac side effects and both paclitaxel and docetaxel to cause mild, mainly sensory, peripheral neuropathy. Autonomic function tests are sensitive measures of autonomic neuropathy and cardiac regulation. The purpose of this study was to find out whether docetaxel changes neural cardiovascular regulation in breast cancer patients previously treated with anthracyclines. PATIENTS AND METHODS: Nine women treated for metastatic breast cancer with docetaxel were studied prior to the docetaxel treatment and after the third or fourth course. Autonomic cardiovascular function tests were performed and heart rate and blood pressure variability were assessed with power spectrum analysis. RESULTS: Heart rate variability or the heart rate responses to the autonomic function tests did not change after docetaxel treatment. The blood pressure response to standing was enhanced and systolic blood pressure variability decreased after three to four cycles of docetaxel. CONCLUSIONS: Docetaxel treatment did not deteriorate vagal cardiac control in breast cancer patients after exposure to epirubicin. The observed changes in blood pressure responses suggest that docetaxel changes sympathetic vascular control. However, these changes seem to be related to altered cardiovascular homeostasis rather than peripheral sympathetic neuropathy.
UNLABELLED: Clinical practice in chemotherapy of breast cancer is undergoing changes. This study investigated the efficacy and toxicity of docetaxel, a novel chemotherapeutic agent in metastatic breast cancer. Focus was on the effect of the cumulative dose of previous anthracycline treatment on response rate, toxicity and survival in our own patients; published data were reviewed. PATIENTS AND METHODS: Thirty-one women, (median age 52 years, range 40-65) treated for metastatic breast cancer with docetaxel were included. RESULTS: The overall response rate was 48%, with 3 complete and 11 partial responses (95% CI 29-66). The duration of response was 7 months (range 2 to 16 months), the median overall survival after docetaxel 13.7 months for responding patients, 14.3 months in no-change patients and 6.5 months in patients with progressive disease. The mean cumulative anthracycline dose prior to docetaxel was 860 mg (range 200-1760 mg); in the case of responders, the previous cumulative total epirubicin doses were 200-1575 mg (median 766 mg.). Total dose or schedule of previous epirubicin treatment had no impact on docetaxel response rate, toxicity or survival. The response seen in this study is within the published range (24 to 60%) observed for docetaxel in anthracycline-treated patients. CONCLUSION: We conclude that docetaxel is active in metastatic breast cancer even as third- line treatment. Previous treatment with, or response to, epirubicin does not influence the response to docetaxel and this promising new drug is currently being tested for adjuvant use in breast cancer.
The HAQ has become the pre-eminent patient questionnaire used in rheumatology. It is easily completed by patients, but not easily reviewed and scored in standard clinical care and has some minor psychometric limitations, as do all questionnaires. Modifications of the HAQ been made to facilitate use in standard care, particularly to include 8-10 activities of daily living, along with scores for pain and global status and other information on one side of one page for rapid review by the clinician. A patient questionnaire for standard care should be limited to 2 sides of 1 page, in a format amenable to "eyeball" review by the clinician in 5 seconds or less. It can be scored formally in 15-20 seconds or less, and is useful in patients with all rheumatic diseases. The current version of a multi-dimensional HAQ (MDHAQ) includes scoring templates on the questionnaire to allow formal scoring in less than 15 seconds by a rheumatologist or an assistant, for possible entry onto a paper and/or computerized flow sheet. Various versions of the MDHAQ may also include a "constant" region of physical function, pain and patient global status, and "variable" regions of fatigue, morning stiffness, psychological distress, change in status, a review of systems, a rheumatoid arthritis disease activity self-report joint count (RADAI), review of recent health events, and review of medications. The MDHAQ can be used in the infrastructure of rheumatology care to include quantitative data in standard care of all patients with all rheumatic diseases.
A proposed approach is presented to recognise a status of "near-remission" in a patient with rheumatoid arthritis (RA) on the basis of patient self-report questionnaire data without formal joint counts or laboratory tests. Indices of patient-reported outcome (PRO) measures distinguish active from control treatments in RA clinical trials at levels similar to American College of Rheumatology (ACR) or disease activity score (DAS) 28 improvement levels. PRO measures on a multidimensional health assessment questionnaire (MDHAQ) can be compiled into a routine assessment of patient index data (RAPID) score. RAPID 3 includes the three PRO measures from the ACR Core Data Set - physical function, pain, and global estimate. RAPID 4 adds a self-report joint count from a rheumatoid arthritis disease activity index (RADAI). RAPID 5 adds a physician estimate of global status. RAPID cores may be classified into four preliminary proposed categories, as "near-remission" (0-1), "low severity" (1.01-2), "moderate severity" (2.01-4), and "high severity" (> 4), analogous to the four categories of the DAS28 of "remission" (< 2.6), as well as "low" (2.6-3.19), "moderate" (3.2-5.1), and "high" (> 5.1) disease activity. RAPID scores are correlated significantly with DAS28 (rho = 0.64-0.67, p < 0.001), and about 75% of patients with DAS < 2.6 have RAPID scores < 2, while about 75% of patients with DAS > 5.1 have RAPID scores > 4. RAPID data are available on one side of one page, and are feasible to collect in standard clinical care. RAPID 3 scores may be calculated in about 10 seconds, and RAPID 4 and RAPID 5 scores in 20 to 30 seconds. RAPID scores every 3 months or more on simple flowsheets can be a basis for a "continuous quality improvement" strategy in standard clinical care to recognise a need for aggressive therapy, an inadequate response to a therapy, and "near- remission" status.