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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 253 records · Page 14Linked to original sources
PubMed1999

[Vaginal hysterectomy in fibroma. Apropos of 453 cases. Retrospective comparison with 509 cases of abdominal hysterectomy].

The authors present a series of 962 hysterectomies for fibroma carried out between January 1981 and December 1995 in the Department of Gynecology and Obstetrics of CHU Toulouse-La Grave. They carried out 453 vaginal hysterectomies and 509 abdominal hysterectomies. They compared the largest series reported in the literature, between vaginal and abdominal technique. The vaginal route has the obvious advantages of speed of operation, less operative trauma, lower risk of thrombo-embolic disease and the hospital stay is shorter. Laparoscopic assistance allows to extend indications of vaginal route.

Adult↗
PubMed1999

Low molecular weight heparins in the management of unstable angina/non-Q-wave myocardial infarction.

The safety and efficacy of enoxaparin, dalteparin, and nadroparin have been studied in five major trials in the treatment of unstable angina/non-Q-wave myocardial infarction (UA/NQWMI). To date, enoxaparin is the only low molecular weight heparin (LMWH) to have demonstrated superiority over unfractionated heparin (UFH) in preventing clinical endpoints in this indication, including a composite triple endpoint of death, myocardial infarction, and need for revascularization. Equivalent clinical benefits were obtained with enoxaparin in two major phase III randomized trials (ESSENCE, TIMI 11B), and were not accompanied by any increased risk of major hemorrhage. A meta-analysis of data from TIMI 11B and ESSENCE demonstrated that enoxaparin was associated with a 20% reduction in death and serious cardiac ischemic events. The benefit appeared within a few days of starting therapy, was sustained through 43 days, and has been confirmed to persist one year after treatment. By contrast, in similar trials, neither dalteparin nor nadroparin was shown to be superior to UFH in the management of acute coronary syndromes. The benefit of enoxaparin demonstrated in the ESSENCE study extended across patient subgroups and was accompanied by substantial cost savings. Differences in trial design prevent direct comparisons between products, but prescribing decisions should be based on the available clinical trial evidence.

Angina, Unstable↗
PubMed1999

Case studies in partner violence.

Interpersonal violence and abuse, especially between relatives and domestic partners, are leading causes of morbidity and mortality. Family physicians and other professionals who provide primary care health services must deal with acute presentations and chronic sequelae of this epidemic. Many victims of abuse hesitate to seek help, while those who batter are often difficult to identify. Medical management of patients in abusive relationships can be frustrating. Evaluating injury patterns, understanding factors that increase the risk for violence and making use of specific interview questions and techniques will aid family physicians in the difficult task of assessing and managing patients living in abusive partnerships.

Adult↗
PubMed1999

Blindness as a complication of subcutaneous nasal steroid injection.

Blindness as a result of steroid injection into areas adjacent to the eyes, namely the interior of the nose and eyelids, has been described in the otolaryngologic and ophthalmologic literature but at no time in the plastic surgery literature. We describe a case of permanent visual loss at the time of injection of a long-acting steroid to the dorsum of the nose for postrhinoplasty scarring. We suggest that before steroid injection for elective procedures, the patient be informed of all possible consequences of complications even if their occurrence is very rare.

Administration, Intranasal↗
PubMed1999

Treatment of unstable angina: the role of platelet inhibitors and anticoagulants.

Thrombo-occlusive events at sites of atherosclerotic stenosis and plaque rupture are caused by exposure of the sub-endothelial layer of the vasculature to platelets and their subsequent aggregation at the locus of injury. Thrombi are generated by the activation of platelets, which are not always inhibited by aspirin or heparin. Both unstable angina and myocardial infarction are ultimately linked to thrombus formation. In addition, various invasive procedures used to re-establish patency of coronary vessels are often followed by thrombotic events that can be life threatening. New antagonists to thrombin and the development of glycoprotein (GP) IIb/IIIa platelet receptor inhibitors have been the main focus of recent large clinical trials that have demonstrated both the efficacy and safety of these new agents. The new antithrombotics include hirudin, hirulog, and the low molecular weight heparins. Representative GP IIb/IIIa receptor blockers include: abciximab, a human-murine chimeric monoclonal antibody; tirofiban, a non-peptide tyrosine derivative with a short half-life; and eptifibatide, a cyclic heptapeptide. All three are available for clinical use, but their approved indications vary. The GP IIb/IIIa receptor antagonists are anticipated to gain wide clinical acceptance by both cardiologists and internists and should have a prominent role in the management of acute coronary syndromes, most likely in combination with an antithrombin.

Abciximab↗
PubMed1999

Heparin-induced thrombocytopenia and the clinical use of low molecular weight heparins in acute coronary syndromes.

Standard unfractionated heparin has long been the mainstay of anticoagulant therapy. Despite its significant therapeutic benefits, unfractionated heparin has disadvantages in clinical usage, including the need for continuous intravenous infusion or multiple daily injections, and close laboratory monitoring of the activated partial thromboplastin time (aPTT) and/or plasma heparin concentrations, as well as risk for bleeding complications and heparin-induced thrombocytopenia (HIT). Low-molecular-weight (LMW) heparins have shown equivalent efficacy or superiority to unfractionated heparin, while permitting easier dosage and administration, and posing less risk for bleeding complications and HIT. A review of the clinical use of LMW heparins in acute coronary syndromes reveals a low incidence of HIT. However, LMW heparins are not recommended for the treatment of established HIT due to cross-reaction with 80% of antibodies generated during exposure to unfractionated heparin.

Acute Disease↗
PubMed1998

[The diagnosis and treatment of Fournier's gangrene].

We treated 2 women and 8 men suffering from Fournier's gangrene during 1990-96. 2 had diabetes, 1 suffered from ulcerative colitis and 1 was an alcoholic. In 8 of them the infection was triggered by a mixture of aerobic and anaerobic bacteria. Treatment consisted of repeated wide debridement and early colostomy. This aggressive approach resulted in relief of the septic signs within 24 hours and permitted early skin grafting of the wounds. 2 patients died due to sepsis that caused multiple organ failure. The 8 who survived were hospitalized for an average of 35 days. On follow-up examination 1-5 years later all patients had undergone closure of the colostomy and were completely rehabilitated. Fournier's gangrene is not rare in the geriatric population. We believe that early diagnosis and aggressive wide debridement, combined with early colostomy, are the keys to successful treatment.

Adult↗
PubMed1998

Rationale for the management of coronary syndromes with low-molecular-weight heparins.

The well-documented disadvantages of unfractionated heparin in the management of coronary syndromes, such as unpredictable bioavailability and maintenance of therapeutic range, has prompted several studies into the benefits of low-molecular-weight heparins (LMWHs). The favorable pharmacologic properties of LMWHs include a binding affinity for antithrombin III, anti-factor IIa activity, excellent bioavailability, minimal protein binding, predictable anticoagulant response, and clinical tolerance by patients. LMWHs are also characterized by having a specific anti-factor Xa effect and inducing only a small prolongation in general clotting tests-i.e., activated partial thromboplastin time, prothrombin time, and antithrombin activity-when used in high doses. Several studies have recently demonstrated that LMWHs are superior to placebo and are at least equal or superior to standard heparin when added to aspirin for the treatment of unstable angina and following non-Q-wave myocardial infarction. These studies, which include Thrombolysis in Myocardial Infarction (TIMI) 11A and Efficacy and Safety of Subcutaneous Enoxaparin versus intravenous unfractionated heparin in Non-Q-wave Coronary Events (ESSENCE), will be reviewed and discussed.

Aspirin↗
PubMed1998

Low-molecular-weight heparins in non-ST-segment elevation ischemia: the ESSENCE trial. Efficacy and Safety of Subcutaneous Enoxaparin versus intravenous unfractionated heparin, in non-Q-wave Coronary Events.

Combination antithrombotic therapy with heparin plus aspirin decreases the risk of recurrent ischemic events in patients with acute coronary syndromes without persistent ST-segment elevation. Compared with standard unfractionated heparin, low-molecular-weight heparin (LMWH) has a more predictable antithrombotic effect, is easier to administer, and does not require coagulation monitoring. At 176 hospitals in 3 continents, 3,171 patients with rest unstable angina or non-wave myocardial infarction were randomly assigned to either enoxaparin (a LMWH), 1 mg/kg twice daily subcutaneously, or to continuous intravenous unfractionated heparin, for a minimum of 48 hours to a maximum of 8 days. Trial medication was administered in a double-blind, placebo-controlled fashion. At 14 days, the primary endpoint, the composite risk of death, myocardial infarction, or recurrent angina with electrocardiographic changes or prompting intervention, was significantly lower in patients assigned to enoxaparin compared with heparin (16.6% vs 19.8%; odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.49; p = 0.019). At 30 days, the composite risk of death, myocardial infarction, or recurrent angina remained significantly lower in the enoxaparin group compared with the unfractionated heparin group (19.8% vs 23.3%, OR 1.23; 95% CI 1.0-1.46, p = 0.016). The rate of revascularization procedures at 30 days was also significantly lower in patients assigned to enoxaparin (27.1% vs 32.2%, p = 0.001). The 30-day incidence of major bleeding complication was 6.5% versus 7.0% (p = not significant), but the incidence of minor bleeding was significantly higher in the enoxaparin group (13.8% vs 8.8%, p <0.001) due primarily to injection-site ecchymosis. Thus, combination antithrombotic therapy with enoxaparin plus aspirin is more effective than unfractionated heparin plus aspirin in decreasing ischemic outcomes in patients with unstable angina or non-Q-wave myocardial infarction in the early (30 days) phase. The lower recurrent ischemic event rate seen with the LMWH, enoxaparin, is achieved without an increase in major bleeding, but with an increase in minor bleeding complications due mainly to injection-site ecchymosis.

Adolescent↗
PubMed1998

Late-onset sporadic progressive subcortical gliosis.

We report two sporadic cases of progressive subcortical gliosis (PSG) with onset after age 60. The presentation included slowly progressive dementia with memory loss, geographic disorientation, and personality change. Both were diagnosed clinically as Alzheimer's disease (AD) and both met NINCDS-ADRDA criteria for probable AD. Autopsy revealed generalized atrophy, predominantly involving the white matter of the frontal and temporal lobes. Microscopically, prominent fibrillary astrocytosis was present in the subcortical white matter and in the subpial and deep layers of the overlying cerebral cortex. Mild cortical neuron loss accompanied the gliosis, but no myelin loss was evident. Amyloid deposits and neuronal cytoskeletal inclusions were absent.

Aged↗
PubMed1998

Economic assessment of low-molecular-weight heparin (enoxaparin) versus unfractionated heparin in acute coronary syndrome patients: results from the ESSENCE randomized trial. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q wave Coronary Events [unstable angina or non-Q-wave myocardial infarction].

BACKGROUND: In the ESSENCE trial, subcutaneous low-molecular-weight heparin (enoxaparin) reduced the 30-day incidence of death, myocardial infarction, and recurrent angina relative to intravenous unfractionated heparin in 3171 patients with acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction). No increase in major bleeding was seen. METHODS AND RESULTS: Of the 936 ESSENCE patients randomized in the United States, 655 had hospital billing data collected. For the remainder, hospital costs were imputed with a multivariable linear regression model (R2=.86). Physician fees were estimated from the Medicare Fee Schedule. During the initial hospitalization, major resource use was reduced for enoxaparin patients, with the largest effect seen with coronary angioplasty (15% versus 20% for heparin, P=.04). At 30 days, these effects persisted, with the largest reductions seen in diagnostic catheterization (57% versus 63% for heparin, P=.04) and coronary angioplasty (18% versus 22%, P=.08). All resource use trends seen in the US cohort were also evident in the overall ESSENCE study population. In the United States, the mean cost of a course of enoxaparin therapy was $155, whereas that for heparin was $80. The total medical costs (hospital, physician, drug) for the initial hospitalization were $11 857 for enoxaparin and $12620 for heparin, a cost advantage for the enoxaparin arm of $763 (P=.18). At the end of 30 days, the cumulative cost savings associated with enoxaparin was $1172 (P=.04). In 200 bootstrap samples of the 30-day data, 94% of the samples showed a cost advantage for enoxaparin. CONCLUSIONS: In patients with acute coronary syndrome, low-molecular-weight heparin (enoxaparin) both improves important clinical outcomes and saves money relative to therapy with standard unfractionated heparin.

Acute Disease↗
PubMed1998

Cardiovascular responses to feeding in the neonate during the first four days of life.

Prior work has demonstrated acute cardiovascular responses associated with breast and bottle feeding of newborn infants that consist of increases in both blood pressure and heart rate. This current study sought to determine if the amplitude of these responses is related to the age of the infant and/or the amount of nutrient ingested during the study period. Results show that the magnitude of the feeding responses does not change over the first four days of life. In a second study it was found that changes in systolic blood pressure during feeding are positively correlated with volume of nutrient intake during the initial phase of feeding (r = +0.75, p < 0.01). These results suggest that some of the individual variability in the increase in blood pressure during feeding is related to the amount of nutrient ingested. It is not known whether these differences are due to differences in sucking effort or other aspects of feeding efficiency.

Blood Pressure↗
PubMed1998

Minocycline-related autoimmune hepatitis: case series and literature review.

BACKGROUND: Minocycline is an antibiotic commonly used in the treatment of adolescent acne. OBJECTIVES: To describe the clinical, laboratory, and histological features in 3 cases of minocycline-related autoimmune hepatitis and to review the literature of similar cases in the adolescent population. DESIGN: Case series. SETTING: Patients were cared for in the Division of Gastroenterology, Children's Hospital, Boston, Mass. RESULTS: Three adolescents (age, 15-16 years), while being treated with therapeutic doses of minocycline for periods of 12 to 20 months, met the 1993 International Autoimmune Hepatitis Group criteria for autoimmune hepatitis. All had a positive antinuclear antibody titer. Other features included hypergammaglobulinemia and a positive anti-smooth muscle antibody titer. Two patients underwent liver biopsy that revealed severe chronic lymphoplasmacytic inflammation, necrosis, and fibrosis. All other causes of liver disease were excluded. One patient had resolution of symptoms with withdrawal of the drug, while 2 required immunosuppression therapy. A review of the literature yielded only 18 similar cases, none in the pediatric literature, the majority of which contained incomplete pertinent data. CONCLUSIONS: Minocycline is related to the development of autoimmune hepatitis in some adolescents. Pediatricians who use this drug for treatment of acne should be aware of this serious potential relation and stop the drug immediately when suspicion is raised.

Acne Vulgaris↗
PubMed1998

Acute coronary syndromes in the United States and United Kingdom: a comparison of approaches. The Antithrombotic Therapy in Acute Coronary Syndromes Research Group.

BACKGROUND: Patients with coronary artery disease are managed differently in different countries. HYPOTHESIS: These variations in patient management may affect clinical outcome, a possibility that should be taken into consideration in multicenter studies. METHODS: In a binational, 3 months study of antithrombotic treatment of patients with unstable angina and non-Q-wave infarction (ATACS), we compared the experience in the four enrollment centers in the United States (US) with the three centers in the United Kingdom (UK). The 59 US patients and the 299 UK patients were similar with regard to age, rates of prior revascularization, prior positive exercise tests, medication use, and aspirin use. RESULTS: US patients were more commonly women (45 vs. 28%), diabetic (30 vs. 4%), or hypertensive (52 vs. 31%), and had a prior coronary angiogram (30 vs. 18%). After enrollment, coronary angiography was performed more frequently in the US than in the UK (61 vs. 22%). Although the distribution of coronary disease was similar, revascularization without recurrent angina (19 vs. 4%, p < 0.001), or following recurrent angina (8 vs. 3%), was significantly more frequent in the US. Combined primary end points (recurrent angina, myocardial infarction, or death) did not differ between US (29%) and UK (25%) patients. CONCLUSION: Therefore, international studies of acute coronary disease need to account for different treatments in different countries. These differences, in the small ATACS study, did not have a major impact on the composite primary outcome variables.

Adult↗