The evening urine cortisol excretion test in depression.
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Adult↗
Biomedical subjects
M Bernstein
Publications and source records attributed to M Bernstein.
A stapled S-shaped ileoanal reservoir.
An S-shaped ileoanal reservoir has the advantage of greater ease in obtaining adequate length for safe anastomosis vs. the J-pouch. The hand-sewn S-shaped pouch, however, takes considerably longer (70 vs. 20 minutes) to construct than either a hand-sewn or stapled J-pouch. Because of potential necrosis of the central bridge of tissue created between two longitudinal stapled lines in an S-pouch, the same techniques of stapling a J-pouch cannot be used in an S-pouch. The authors have developed a safe, rapid, stapling technique for construction of an S-pouch in the dog and have used it with success in four patients.
Anal Canal↗
Using spreadsheet languages to understand sequence analysis algorithms.
Spreadsheet languages have gained enormous popularity for simple numerical computations, but their power in non-numerical contexts has not been widely recognized. This paper presents spreadsheet implementations of several familiar sequence analysis tools. In many cases, spreadsheet notation clarifies the underlying algorithm, facilitating understanding of existing algorithms and promoting spontaneous experimentation. Spreadsheets also reveal, through their visible parallelism, opportunities for applying parallel processors to computationally challenging problems.
Algorithms↗
Reducing the man-machine barrier: the Sequence Analysis Workbench.
The conventional software paradigm in which the machine acts as an unintelligent but patient servant often increases the perceived distance between scientist and data. Direct manipulation offers an alternative paradigm in which the scientist uses the computer as a scientific instrument for examining and modifying the data directly, rather than by issuing instructions to an agent. The Sequence Analysis Workbench provides several experimental tools for direct manipulation of sequence data; object-oriented programming makes it possible to construct sophisticated tools quickly, and facilitates critical examination and review of scientific software.
Base Sequence↗
Microsurgical resection of solitary intramedullary spinal cord metastases.
Two cases of solitary intramedullary spinal cord metastasis treated primarily by surgical excision are presented. It has been generally thought that appropriate management for the rare metastasis within the spinal cord is radiation and corticosteroids. The excellent palliative results obtained in our patients suggest that, in selected cases, surgical removal is technically feasible and can be of considerable benefit to the patient.
Adenocarcinoma↗
Significance of hemorrhage into brain tumors: clinicopathological study.
A retrospective clinical and pathological review of 905 consecutive brain tumor cases (excluding pituitary adenoma and recurrent tumor) was conducted to identify cases in which intratumoral hemorrhage was confirmed grossly and/or pathologically. There were 132 cases so identified, for an overall tumor hemorrhage rate of 14.6%; of these, 5.4% were classified as macroscopic and 9.2% as microscopic. The presence of hemorrhage was correlated with the neurological presentation. The highest hemorrhage rate (70.0%) was found in patients with prior neurological history who experienced apoplectic deterioration (acute-on-chronic presentation). Only 57.1% of patients with acute deterioration in the absence of prior neurological symptoms had hemorrhages. The highest hemorrhage rate for primary brain tumors was 29.2% for mixed oligodendroglioma/astrocytoma, while the highest hemorrhage rate for any tumor type was 50% for metastatic melanoma. The clinical relevance of tumor hemorrhage is discussed.
Brain Neoplasms↗
Transient focal cerebral ischemia resulting from digital palpation of the carotid artery in the neck.
Complications of digital palpation of the carotid artery in the neck are uncommon. They include cardiac arrhythmias and cerebral ischemic events. A 65-year-old woman experienced transient paralysis of the left arm immediately after palpation of the right carotid artery; at surgery, a friable, atherosclerotic plaque was removed from the bifurcation of the artery. The most likely cause of a transient neurologic deficit after digital manipulation of the carotid artery in the neck is an embolus from an atherosclerotic carotid plaque. The authors review the literature on the frequency and pathogenetic mechanism of this complication.
Aged↗
Isolated vasculitis of the central nervous system in a patient with celiac disease.
A 51-year-old white man with celiac disease presented with seizures unresponsive to medical therapy. Investigations including brain biopsy revealed isolated vasculitis of the central nervous system. Treatment with prednisone and cyclophosphamide resulted in clinical and radiographic improvement. The relationship between celiac disease and vasculitis is discussed.
Biopsy↗
Computed tomography in interstitial lung disease.
The number and scope of published articles dealing with computed tomography of interstitial lung disease are limited. We present seven cases in which computed tomography detected the presence or extent of interstitial lung disease better than conventional radiography: two patients with histiocytosis X, one with bronchopulmonary dysplasia, one with bleomycin lung toxicity, and three with radiation-induced lung injury. The computed tomography appearance of histiocytosis X and bronchopulmonary dysplasia have not been previously described. Transverse computed tomography images provide information regarding stage of activity and nature of interstitial lung processes not available with standard imaging techniques. We advocate the use of computed tomography in the initial investigation and follow-up of patients with histiocytosis X. Post-radiation pneumonitis and fibrosis can be detected earlier with computed tomography as well.
Adolescent↗
Chiari malformation in adults: a review of 40 cases.
Forty adult patients (average age 40 years), with the clinical and radiological features of the Chiari malformations, were seen at the Toronto Western Hospital between 1967 and 1984. Surgical confirmation of the diagnosis was obtained in 32 cases; of these, 23 were classified as Chiari I malformation while 9 fulfilled the anatomic criteria of Chiari II. The patient population consisted of 22 males and 18 females. Common presenting symptoms included head and neck pain (60%), sensory complaints (60%), upper extremity weakness (42%), and gait disturbance (40%). Neurological findings included signs of central cord dysfunction (73%), long-tract motor and/or sensory findings (58%), brainstem signs (38%), cerebellar dysfunction (18%), and increased intracranial pressure (15%). The majority of patients underwent myelography with or without computed tomography of the cervical-medullary junction. Two recent patients had 0.15T MRI scans which helped demonstrate an intramedullary syrinx. Thirty-three patients underwent 47 operative procedures (discounting spinal fusion and CSF shunt revisions). Open surgical management was performed in 32 patients, with CSF shunting along in one patient. Five patients (15%) incurred surgical complications within a six week postoperative period. Follow-up to date, ranges from one month to 11 years. In the 33 surgically treated patients, 18 are improved (55%), 10 are neurologically stable (30%), and five have worsened clinically (15%), including one death. Based on this study it appears that the Chiari II malformation may be more common in adults than previously recognized. Surgical intervention has a favourable outcome in the majority of patients but a significant proportion continue to deteriorate.
Adolescent↗
Creative use of a nuisance.
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Creatinine↗
Neurological manifestations of intracranial dural arteriovenous malformations.
The authors describe their experience with four cases of dural arteriovenous malformation (AVM) which led them to analyze the clinical aspects of these lesions in an attempt to understand their pathophysiology. An additional 191 previously reported cases of dural AVM's were reviewed with special attention to the mechanism of intradural, central, and peripheral nervous system manifestations. Apart from the peripheral cranial nerve symptoms, which are most likely due to arterial steal, the central nervous system (CNS) symptoms appear to be related to passive venous hypertension and/or congestion. Generalized CNS symptoms can be related to cerebrospinal fluid malabsorption due either to increased pressure in the superior sagittal sinus, to venous sinus thrombosis, or to meningeal reaction resulting from minimal subarachnoid hemorrhages. These phenomena are not related to the anatomical type of venous drainage. On the other hand, focal CNS symptoms are specifically indicative of cortical venous drainage. Seizures, transient ischemic attacks, motor weakness, and brain-stem and cerebellar symptoms can be encountered depending on the territory of the draining vein or veins. Therefore, the localizing value of focal CNS symptomatology relates to the venous territory and not to the nidus or to the arterial supply characteristics of dural AVM's. Furthermore, the venous patterns of various dural AVM's at the base of the skull are expressed by differences in their clinical presentation. Dural AVM's of the floor of the anterior cranial fossa and of the tentorium are almost always drained by the cortical veins and, therefore, have a high risk of intradural bleeding. The remarkable similarities in the manifestations of dural and brain AVM's and the differences in the manifestations of dural and spinal dural AMV's are pointed out. High-quality angiograms and a multidisciplinary approach to the study of dural AVM's will provide the best understanding of their symptoms and, therefore, the most appropriate treatment strategy.
Adult↗
Aminoglycoside usage in a university teaching hospital.
A retrospective chart review examined the use of aminoglycosides in a university teaching hospital over a six month period. The study found 273 patients received 323 courses of aminoglycoside therapy. Significant issues addressed include the frequent use of aminoglycosides as surgical prophylactic agents, the prescribing of drugs to patients at increased risk of toxicity and the infrequency of appropriate monitoring. Nephrotoxicity was noted in 7% of patients.
Aminoglycosides↗
Disruption of an armoured endotracheal tube caused by biting.
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Female↗
Stimulation of 5-aminolevulinic acid metabolism by uroporphyrinogen I in rat liver homogenate.
The effect of excess uroporphyrinogens I and III, coproporphyrinogen III, and the corresponding porphyrins, on the rate of 4-14C-5-aminolevulinic acid (ALA) metabolism was studied. Experiments were performed with mitochondria-free rat liver homogenates prepared from normal rats. The consumption of labelled 5-aminolevulinic acid was followed by measuring its level in aliquots removed at intervals. The pattern of porphyrinogen synthesis was examined by high pressure liquid chromatography. Only uroporphyrinogen I had an effect; it increased the rate of conversion of ALA and porphobilinogen (PBG) to porphyrinogens. Chromatographic analysis revealed increased synthesis of uroporphyrinogen and heptacarboxylic porphyrinogen. It is believed that this mechanism might explain the lack of ALA and PBG accumulation in erythropoietic porphyria and porphyria cutanea tarda, and the absence of acute porphyria attacks in these conditions.
Aminolevulinic Acid↗
Interstitial irradiation of skull base tumours.
The rationale for interstitial irradiation of tumours in and around the skull base is reviewed, and the experience accumulated with pituitary adenomas, meningiomas, and chordomas is summarized. Intracystic irradiation for craniopharyngiomas is also reviewed.
Adenoma↗
Characterization of a gene product (Sec53p) required for protein assembly in the yeast endoplasmic reticulum.
SEC53, a gene that is required for completion of assembly of proteins in the endoplasmic reticulum in yeast, has been cloned, sequenced, and the product localized by cell fractionation. Complementation of a sec53 mutation is achieved with unique plasmids from genomic or cDNA expression banks. These inserts contain the authentic gene, a cloned copy of which integrates at the sec53 locus. An open reading frame in the insert predicts a 29-kD protein with no significant hydrophobic character. This prediction is confirmed by detection of a 28-kD protein overproduced in cells that carry SEC53 on a multicopy plasmid. To follow Sec53p more directly, a LacZ-SEC53 gene fusion has been constructed which allows the isolation of a hybrid protein for use in production of antibody. With such an antibody, quantitative immune decoration has shown that the sec53-6 mutation decreases the level of Sec53p at 37 degrees C, while levels comparable to wild-type are seen at 24 degrees C. An eightfold overproduction of Sec53p accompanies transformation of cells with a multicopy plasmid containing SEC53. Cell fractionation, performed with conditions that preserve the lumenal content of the endoplasmic reticulum (ER), shows Sec53p highly enriched in the cytosol fraction. We suggest that Sec53p acts indirectly to facilitate assembly in the ER, possibly by interacting with a stable ER component, or by providing a small molecule, other than an oligosaccharide precursor, necessary for the assembly event.
Amino Acid Sequence↗
Fanconi's anemia, medulloblastoma, Wilms' tumor, horseshoe kidney, and gonadal dysgenesis.
An 18-month-old female infant with clinically and cytogenetically documented Fanconi's anemia was found to have two neoplasms previously unreported in this syndrome to our knowledge: a medulloblastoma and a Wilms' tumor, with the latter arising in a horseshoe kidney. An additional feature was pure gonadal dysgenesis. These unusual associations are discussed in the context of certain syndromes suggestive of an axial predisposition for neoplasia (kidneys-central nervous system and kidneys-gonads).
Abnormalities, Multiple↗