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Biomedical subjects

M Bernstein

Publications and source records attributed to M Bernstein.

At least 109 records · Page 6Linked to original sources
PubMed1996

Reproductive characteristics of a population of urban Swiss women.

OBJECTIVE: To describe the variability of reproductive life, from menarche to menopause, in the Geneva female population. DESIGN: Women's Health Survey, 1992-1993. SETTING: Mobile epidemiology unit of a University Hospital. SUBJECTS: One thousand and thirty-two women aged 30 to 74 years, resident in Geneva, Switzerland. MAIN OUTCOME MEASURE: Menstrual and reproductive history. RESULTS: A 'typical' woman of Geneva has her menarche at 13 years, regular 28 day cycles with 5 days of menstrual flow. She is 26 years old when she first gives birth and has her last baby (which is typically the second) at age 31. She has 37 years of potential fecundity and a natural menopause at age 50. In addition, 11% of the women have tried to be pregnant during two years without success, 67% have ever used oral contraceptives, 20% had a first birth at age 30 or more and 23% were nulliparous. Younger women reported earlier ages at menarche. Women with lower education tended to be a younger age at the birth of her first child. CONCLUSIONS: In this first study of the reproductive characteristics of women in Geneva, nulliparity and a late first birth appeared unusually frequent, especially when compared with American or Chinese women. The observed distributions of reproductive history are compatible with the very high incidence rate of breast cancer in the Geneva population.

Adult↗
PubMed1996

Brain tumour surgery in the elderly: a brief reappraisal.

Brain tumour surgery in the elderly has a relatively poor outcome and a high complication rate. In spite of this, well-selected patients can benefit substantially from aggressive intervention, and the health care team must individualize treatment in every case. Using two case reports and a review of the relevant literature, the author presents a neurosurgical approach to selected elderly patients with brain tumours.

Aged↗
PubMed1996

Antithrombotic therapy for patients with stroke symptoms. Guidelines for family physicians.

Anticoagulant therapy to halt or limit a potentially devastating stroke carries both risk and an unproven benefit. Two case reports highlight potential pitfalls. Antiplatelet agents are indicated for ischemia secondary to artery-to-artery embolism. Anticoagulation should be undertaken only when a demonstrated cardiac embolic source places a patient at ongoing risk of repeated embolic stroke. This article reviews rational approaches to anticoagulation for neurologic patients.

Anticoagulants↗
PubMed1995

Screening for neuroblastoma in North America. Preliminary results of a pathology review from the Quebec Project.

BACKGROUND: The Quebec Neuroblastoma Screening Project was initiated to assess clinical and biologic aspects of neuroblastomas detected by screening infants born in the province of Quebec from May 1, 1989, to April 30, 1994. METHODS: Infants were screened for preclinical detection of neuroblastoma by determination of catecholamine metabolites, vanillylmandelic acid (VMA), and homovanillic acid (HVA). Patients with tumors discovered through this screening as well as patients in the same birth cohort with clinically detected tumors were referred to Quebec Oncology Centers for further investigation, diagnosis, and treatment. Pathology specimens were submitted to Childrens Hospital Los Angeles for central review. Tumors were histopathologically classified according to the Shimada system. RESULTS: As of August, 1993, 340,000 infants were screened at 3 weeks and 245,000 of them were retested at 6 months of age. Thirty-one tumors were detected through this screening and removed. Histologic material was available for 27 cases: 14 were detected at 3 weeks of age and 13 at 6 months of age. Twenty-six patients had tumors with favorable histology (FH), and one patient had a Stage I tumor with unfavorable histology (UH). At the time of this writing, all mass screening patients are alive, including one child with relapsed disease. During this period, 48 tumors were detected clinically in the same birth cohort, 40 of which were evaluated histologically. Of these 40 cases, 28 of 29 tumors diagnosed in patients up to age 12 months indicated an FH, whereas 9 of 11 tumors diagnosed in patients older than age 12 months indicated a UH. All patients with FH tumors are alive including a child with relapsed disease. The single patient with UH diagnosed before age 12 months died of disease. Of the nine patients with UH diagnosed after age 12 months, four died of disease, one relapsed, and four are alive (including one treated with bone marrow transplantation) after variable follow-up periods. CONCLUSIONS: The tumors detected by mass screening, similar to those tumors detected through clinical examination before age 12 months, were predominantly FH with good prognosis. However, those tumors that were missed by screening and were detected clinically after the patient was 12 months of age were predominantly UH, with serious clinical problems. This subgroup of patients not detectable by the current screening system presents an immediate and important clinical challenge that should be addressed in future studies.

Age Factors↗
PubMed1995

A phase I study of acivicin in refractory pediatric solid tumors. A Pediatric Oncology Group study.

Forty-two patients with progressive solid tumors and brain tumors were entered in this Phase I study of the glutamine antagonist acivicin given intravenously over thirty minutes daily for five days. The major toxicities encountered were myelosuppression and central nervous system toxicity (nightmares and somnolence). The maximum tolerated dosage on this schedule was 26 mg/M2 daily for five days. Six patients including three patients with brain tumor had stable disease.

Adolescent↗
PubMed1995

[Consumption of calcium-rich food in the adult population of French-speaking Switzerland and of Tessin].

Food intake high in calcium content is important in the development of skeleton and the prevention of osteoporosis. From a public health perspective, it is therefore important to know the dietary calcium intake of a population. Two population surveys in the French and Italian parts of Switzerland (MONICA, 1988-1989, and Geneva, 1991), were combined to study nutritional habits related to calcium intake. A random population sample, aged 35 et 65 years, answered to a 24 hour recall questionnaire, either self-administered (MONICA, cantons of Vaud, Fribourg and Tessin, N = 2734) or by phone (canton of Geneva, N = 475). In the 4 cantons, for the previous day, 60% of participants ate dairy products, particularly whole milk and cheese. They drunk 3-4 dl/day of milk. A significant proportion (10%) of french and italian speaking Swiss did not consume any food high in calcium content. In Geneva, the mean daily calcium intake was 656 mg in men and 489 mg in women. In conclusion 1) eating habits related to calcium intake are similar across cantons; 2) women consume dairy products more frequently than men, but in smaller quantities; 3) about 60% of men and 80% of women do not get the daily amount of calcium recommended for the prevention of osteoporosis.

Adult↗
PubMed1995

The changing clinical presentation of complete molar pregnancy.

OBJECTIVE: To determine if the clinical presentation of complete hydatidiform mole has changed in recent years compared with historic controls (1965-1975). METHODS: Chart review of all 74 patients referred to the New England Trophoblastic Disease Center for the primary management of complete hydatidiform mole during 1988-1993 was performed and comparison made to historic controls (1965-1975). RESULTS: Vaginal bleeding remained the most common presenting symptom, occurring in 62 of 74 (84%) current patients, compared with 297 of 306 (97%) controls (P = .001). However, anemia was present in only four of 74 (5%) current patients, compared with 165 of 306 (54%) controls (P = .001). Excessive uterine size, preeclampsia, and hyperemesis occurred in only 21 of 74 (28%), one of 74 (1.3%), and six of 74 (8%) current patients, respectively, compared with 156 of 306 (51%), 83 of 306 (27%), and 80 of 306 (26%), respectively, of historic controls (P = .001). No cases of clinical hyperthyroidism or respiratory distress were found in recent years. Ultrasound diagnosed complete hydatidiform mole before the onset of clinical symptoms in seven of 69 (10%) current patients. Among patients not receiving chemoprophylaxis, persistent gestational trophoblastic tumor developed in 23% of current patients and 18.6% of historic controls. CONCLUSION: Fewer current patients with complete hydatidiform mole present with the traditional symptoms of complete hydatidiform mole (excessive uterine size, anemia, preeclampsia, hyperthyroidism, or hyperemesis) when compared with historic controls. However, there has been no statistically significant change in the development of persistent gestational trophoblastic tumor in current patients compared with historic controls.

Adolescent↗
PubMed1995

Brachytherapy for recurrent single brain metastasis.

Of 112 stereotactic high-activity iodine-125 implants for malignant brain tumors done as of July 1, 1994, ten have been done for recurrent single brain metastasis and constitute the study group described herein. All patients had initially undergone craniotomy for tumor resection followed by fractionated external beam whole brain radiation and recurred at the same site in the brain. The interval between initial cancer therapy and occurrence of the brain metastasis was 13-156 weeks (median: 63 weeks). The interval between initial treatment of the brain metastasis and its recurrence treated with brachytherapy was 13-69 weeks (median: 35 weeks). Minimum brachytherapy dose administered was 70 Gy at a median dose rate of 67 cGy/hour. Eight patients have died. Two died suddenly at 2 and 13 weeks post-implant of presumed pulmonary embolus. Five died of recurrence of the brain metastasis at 20, 39, 52, 103, and 143 weeks post-implant, and one died of systemic metastases at 40 weeks post-implant. Two patients remain alive 183 and 324 weeks post-implant. High-activity iodine-125 brachytherapy appears to be of benefit for selected patients with recurrent single brain metastasis but larger, and preferably randomized studies are needed.

Adult↗
PubMed1995

Laparoscopic Resection for Colorectal Cancer: A USA Perspective.

Laparoscopic surgery has gained in popularity in the last few years. As the technology for minimally invasive surgery improves and surgeons' laparoscopic skills progress, more advanced surgical procedures are being attempted with the laparoscope. The role of the laparoscope in the field of colon and rectal surgery is still being defined. Of particular controversy is the issue of laparoscopic colon resection for malignancy. The long-term effect of laparoscopic colectomy on either local or distant recurrence is not obvious in the immediate postoperative period, and how the use of the laparoscope for resection of colorectal malignancy will affect survival is unknown. This chapter reviews the published "USA Experience" with laparoscopic resection for colorectal cancer.

Journal Article↗
PubMed1995

Transposon insertions causing constitutive Sex-lethal activity in Drosophila melanogaster affect Sxl sex-specific transcript splicing.

Sex-lethal (Sxl) gene products induce female development in Drosophila melanogaster and suppress the transcriptional hyperactivation of X-linked genes responsible for male X-chromosome dosage compensation. Control of Sxl functioning by the dose of X-chromosomes normally ensures that the female-specific functions of this developmental switch gene are only expressed in diplo-X individuals. Although the immediate effect of X-chromosome dose is on Sxl transcription, during most of the life cycle "on" vs. "off" reflects alternative Sxl RNA splicing, with the female (productive) splicing mode maintained by a positive feedback activity of SXL protein on Sxl pre-mRNA splicing. "Male-lethal" (SxlM) gain-of-function alleles subvert Sxl control by X-chromosome dose, allowing female Sxl functions to be expressed independent of the positive regulators upstream of Sxl. As a consequence, SxlM haplo-X animals (chromosomal males) die because of improper dosage compensation, and SxlM chromosomal females survive the otherwise lethal effects of mutations in upstream positive regulators. Five independent spontaneous SxlM alleles were shown previously to be transposon insertions into what was subsequently found to be the region of regulated sex-specific Sxl RNA splicing. We show that these five alleles represent three different mutant types: SxlM1, SxlM3, and SxlM4. SxlM1 is an insertion of a roo element 674 bp downstream of the translation-terminating male-specific exon. SxlM3 is an insertion of a hobo transposon (not 297 as previously reported) into the 3' splice site of the male exon, and SxlM4 is an insertion of a novel transposon into the male-specific exon itself. We show that these three gain-of-function mutants differ considerably in their ability to bypass the sex determination signal, with SxlM4 being the strongest and SxlM1 the weakest. This difference is also reflected in effects of these mutations on sex-specific RNA splicing and on the rate of appearance of SXL protein in male embryos. Transcript analysis of double-mutant male-viable SxlM derivatives in which the SxlM insertion is cis to loss-of-function mutations, combined with other results reported here, indicates that the constitutive character of these SxlM alleles is a consequence of an alteration of the structure of the pre-mRNA that allows some level of female splicing to occur even in the absence of functional SXL protein. Surprisingly, however, most of the constitutive character of SxlM alleles appears to depend on the mutant alleles' responsiveness, perhaps greater than wild-type, to the autoregulatory splicing activity of the wild-type SXL proteins they produce.

Amino Acid Sequence↗
PubMed1995

Stereotactic high-activity brachytherapy for malignant intra-axial brain tumors. Status report as of March, 1995.

Over the last several decades in Europe and 15 years in North America, numerous centers have used stereotactic high-activity brachytherapy for patients with malignant brain tumors. A number of nonrandomized series have contributed information regarding the efficacy compared to historical controls for patients with de novo and recurrent malignant gliomas and metastases. Two randomized studies for patients with de novo malignant astrocytoma and glioblastoma are nearing completion. Based on the author's personal experience with 115 patients and the reported literature, we conclude that brachytherapy is appropriate for a minority of patients with malignant brain tumors, that reoperation is frequently required, and complications of therapy can be significant. However, a proportion of highly selected patients benefit significantly from this therapy.

Astrocytoma↗
PubMed1995

Failed stereotactic biopsy in a series of 518 cases.

Failed stereotactic biopsy is one in which a definitive histological or microbiological diagnosis is not achieved based on the tissue obtained. Of 518 consecutive CT-guided stereotactic biopsies of intra-axial mass lesions, 42 (8.1%) cases were failed biopsies. Inflammatory changes were seen in 10 cases (24%); gliosis was seen in 11 cases (26%); 9 cases (21%) yielded necrotic specimens; normal brain was retrieved in 7 cases (17%); blood/hemorrhagic brain was seen in 3 cases and in 2 cases, no tissue could be obtained. Variables that significantly influenced the diagnostic success included the immune status (HIV positive; p < 0.001). The complication rate in the failed biopsy group was significantly higher. The subsequent management and outcome of patients who suffered a failed stereotactic biopsy are discussed.

Adolescent↗
PubMed1995

Rosai-Dorfman disease mimicking multiple meningioma: case report.

Rosai-Dorfman disease is a rare idiopathic histioproliferative disease affecting the lymph nodes. Extranodal involvement has also been recognized, but central nervous system manifestations are extremely rare. Only 12 patients with intracranial involvement have been reported previously, and they all presented with clinical and radiological findings suggestive of meningioma. We report multiple meningeal nodules in a patient presenting with seizures whose pathological findings at surgery confirmed the diagnosis of Rosai-Dorfman disease. A review of all previously reported intracranial lesions is presented.

Diagnosis, Differential↗
PubMed1995

C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy.

Posterior wiring techniques are the most commonly used methods of achieving C1-C2 arthrodesis. Recently, transarticular screw fixation and interlaminar clamping have been advocated to achieve more secure fixation. A retrospective review of patients undergoing C1-C2 fusion for nonneoplastic disease was undertaken at the University of Toronto Hospital, with the aim of determining the long-term outcome of the selected procedures. Thirty-two patients underwent 36 procedures from 1986 to 1992, with a mean follow-up of 4.7 +/- 2.2 years (range, 2.0-8.0 yr). The most common disease processes were odontoid fracture (18 patients), transverse atlantal ligament injury (5 patients), os odontoideum (5 patients), and rheumatoid C1-C2 instability (3 patients). Thirty-one Gallie fusions, one Brooks-Jenkins fusion, two transarticular screw fusions, and two Halifax clamp applications were performed. Six (19%) of Gallie/Brooks-Jenkins fusions failed. These occurred with os odontoideum (three patients), Type II odontoid fracture (two patients), and transverse atlantal ligament injury (one patient). All transarticular screw and Halifax clamp procedures resulted in successful fusions. Two procedures (6%) resulted in new neurological deficit; both of these patients underwent posterior wiring for os odontoideum. This study suggests that Type II odontoid fractures may be successfully managed by a posterior wiring technique alone. Rheumatoid C1-C2 instability may be managed by posterior wiring supplemented with halo immobilization. Transarticular screw fixation has several potential advantages as a technique for C1-C2 arthrodesis and, in particular, may be appropriate for os odontoideum that had a high failure rate (75%) with conventional posterior wiring, even when this was supplemented with halo bracing.

Adolescent↗