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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 289 records · Page 16Linked to original sources
PubMed1998

Surgical correction of unilateral cleft lip nasal deformity.

Fifty-five patients with unilateral cleft lip nasal deformities were operated on from March 1992 to June 1996. Thirty-one patients were male and 24 were female. Three patients were 2 to 5 years of age, 7 patients were 6 to 10 years old, 12 patients were 11 to 15 years old, 13 were 16 to 20 years old, and 20 were greater than 21 years of age. The average follow-up period was 16 months. Combined operative procedures, depending on the severity of the cleft lip nasal deformity, were the following: (1) a reverse-U incision and Z-plasty for a mild vestibular web, (2) a reverse-U incision and V-Y plasty for a moderate vestibular web, (3) open rhinoplasty incision combined with a reverse-U incision and V-Y plasty for severe flattening or buckling of the cleft lower lateral cartilage, (4) lower lateral cartilage suspension or repositioning with or without an onlay cartilage graft, (5) alar base advancement, (6) bone graft on the piriform aperture, (7) septoplasty and corrective rhinoplasty, and (8) columella lengthening with an auricular composite graft. A nasal splint was applied for 3 to 6 months in every patient to maintain the corrected nostril contour. Most patients were satisfied with their surgical results. We suggest that to achieve a good contour of the nose, bony and cartilaginous deformities should be corrected simultaneously with correction of the soft tissue.

Adolescent↗
PubMed1998

Abnormal liver test results in myotonic dystrophy.

Myotonic dystrophy (DM) is an autosomal dominant multisystem disorder. Little evidence suggests the existence of liver damage in a small number of patients. We have prospectively evaluated liver and gallbladder function in 53 patients with DM in relation to clinical and genetic parameters. None of the patients had an enlarged liver, signs of cirrhosis, or portal hypertension. All were free of medication, and none were pregnant or had a history of alcohol abuse. In 35 (66%) patients, serum activity of at least one of six liver enzymes assayed was abnormal. An elevated level of alkaline phosphatase was found in 50.9%, of gamma-glutamyltransferase in 52.8%, of 5' nucleotidase in 43.4%, of serum aspartate aminotransferase in 35.8%, of serum alanine aminotransferase in 33.9%, and of lactate dehydrogenase in 37.7%. Liver function test results did not correlate with severity of muscle weakness, disease duration, or serum levels of creatine kinase, glucose, or lipids. Motility of gallbladder and abdominal ultrasonography were normal. Cytosine-thymidine-guanine repeat expansion by southern blot did not correlate with liver enzyme abnormalities. We conclude that elevation of liver enzymes is frequent in DM and should be included as an additional laboratory finding of the disease.

Blotting, Southern↗
PubMed1998

Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS.

BACKGROUND: Risk stratification of patients in the intensive care unit (ICU) is an important tool because it permits comparison of patient populations for research and quality control. Unfortunately, currently available scoring systems were developed primarily in medical ICUs and have only mediocre performance in surgical ICUs. Moreover, they are very expensive to purchase and use. We conceived a simple risk-stratification tool for the surgical ICU that uses readily available International Classification of Diseases, Ninth Revision, codes to predict outcome. Called ICISS (International Classification of Disease Illness Severity Score), our score is the product of the survival risk ratios (obtained from an independent data set) for all International Classification of Diseases, Ninth Revision, diagnosis codes. METHODS: A total of 5,322 noncardiac patients admitted to a surgical ICU during an 8-year period had their Acute Physiology and Chronic Health Evaluation (APACHE) II scores compared with their ICISS as predictors of outcome (survival/nonsurvival, length of stay, and charges). RESULTS: ICISS proved to be a much better predictor of survival than APACHE (receiver operating characteristic (ROC) APACHE = 0.806; Hosmer-Lemeshow (HL) APACHE = 22.56; ROC ICISS = 0.892; HL ICISS = 12.06) or the APACHE survival probability (ROC = 0.836; HL = 34.47). These differences were highly statistically significant (p < 0.001). ICISS was also better correlated with ICU length of stay (APACHE R2 = 0.06; ICISS R2 = 0.32) and ICU charges (APACHE R2 = 0.07; ICISS R2 = 0.39). When combined in a logistic model with ICISS, APACHE II added slightly to the predictive power of ICISS alone (combined ROC = 0.903) but degraded the calibration of the model (combined HL = 16.29; p = 0.038). CONCLUSION: Because ICISS is both more accurate and much less expensive to calculate than APACHE II score, ICISS should replace APACHE II score as the standard risk stratification tool in surgical ICUs.

APACHE↗
PubMed1998

Recommended guidelines for optimal design of a plastic surgery service during mass casualty events.

OBJECTIVE: The objectives of the study were to evaluate the pattern of plastic surgery (PS) team intervention during the first 12 hours after a mass casualty blast. METHODS: The records of 272 civilians injured from 1994 to 1997 in Tel Aviv were reviewed. Patients' injuries were classified according to the nature of their PS injury and the type of PS intervention. The procedure time and number of plastic surgeons involved were recorded in 20-minute intervals. The average and standard deviation of the peak demand (PD) timing for PS intervention were calculated. Linear correlation between the PD and the total number of wounded transferred to the Tel Aviv Sourasky Medical Center was evaluated by the correlation coefficient. RESULTS: A distinct "double-peak" and five phases pattern of PS team intervention were observed. A linear correlation and a 1:5 ratio were found between the total number of wounded transferred to the Tel Aviv Sourasky Medical Center and the PD for PS intervention. CONCLUSIONS: PS involvement has a predicted pattern related to the patient volume. Guidelines based on the conclusions drawn from this study can ensure an ordered, efficacious level of PS care during these events. A triple team plan is suggested, and adjustments in medical resources according to the specific nature of the event are described.

Adolescent↗
PubMed1998

Prenatal counseling for cleft lip and palate.

Prenatal diagnoses of cleft lip and palate can occur during both routine screening obstetrical ultrasound and high resolution obstetrical ultrasound done for other reasons. The affected family or obstetrician may request prenatal consultation with the plastic surgeon. To define this population, a survey was done of all families who were referred to our cleft program with a prenatal diagnosis of cleft between 1990 and 1994. Of 80 newborn referrals, 13 had a prenatal diagnosis of cleft. These children had a higher incidence of bilateral cleft than our average population (53.8 percent versus 28.7 percent, p < 0.03, chi square test). No isolated cleft palates were identified. Nine families were available for follow-up. Only one-third of the families felt that they had been given adequate information about clefts from their obstetrician or ultrasonographer. All who had prenatal contact with the cleft team felt it was valuable. A review of prenatal diagnosis of cleft is given including limitations. Specific counseling information is discussed.

Cleft Lip↗
PubMed1998

Clinical-radiological evaluation of poststernotomy wound infection.

The presumption that computed tomography is the "gold standard" imaging method for diagnosing poststernotomy sternal wound infection was never validated. This study was designed to evaluate the accuracy and role of computed tomography in diagnosing the extent of infectious complications following sternotomy. A high postoperative infection recurrence rate in our earliest cases (30 percent, 1984 to 1988) motivated us to assess whether this modality enables the surgeon to choose the optimal surgical approach, which will make it possible to reduce morbidity and mortality rates. Two-hundred three patients with poststernotomy sternal wound infections were operated upon between 1984 and 1993. All pertinent clinical and radiological data of these patients were collected retrospectively and reinterpreted by an unbiased radiologist; the radiological data were correlated both to the intraoperative clinical findings and to histological interpretation of the surgical specimens. The study group available for statistical analysis included 160 patients. Predictive statistical analysis confirmed that computed tomography is a highly reliable imaging method for identifying the different pathologies as soft tissue, sternum mediastinal infections, in sternal wound infection with overall sensitivity of 93.5 percent and specificity of 81.7 percent. New radiographic findings were identified for the distinction of costochondral infection. This complication was, and still is, a major deceptive clinical problem in these patients and the major contributor to recurrences. We propose a sternal wound infection classification system that outlines the recommended approach for each clinical-radiological condition. Since computerized tomography was found to be a highly accurate modality, we strongly believe that the surgeon should take its pathological-radiographic findings into serious consideration, even if there are no "clear-cut" clinical signs for an existing or recurring infection.

Adolescent↗
PubMed1998

Plastic surgery of the face in Byzantium in the fourth century.

Oribasius was an eminent Byzantine physician who lived in the fourth century. His greatest contribution to medical history was his anthology of all important medical works of his time, entitled Synagogue Medicae. This complete medical encyclopedia of his era consisted of more than 70 volumes. A significant part of this work has been lost. What remains, however, allows us to glimpse the surprising richness and knowledge of ancient medicine. Chapters 25 and 26 of the original 42nd book of Oribasius are of specific interest to the plastic surgeon, because they deal with reconstruction of facial defects. Reconstructive procedures for defects in the eyebrows, forehead, cheeks, nose, and ears are described. Advancement flaps are suggested for the reconstruction, and recommendations are made about debridement, flap design, and thickness of flaps. It becomes obvious from these texts that Greek, Roman, and Byzantine surgeons had the knowledge and experience to perform several reconstructive procedures of the face and nose. This knowledge was passed to the Arabs and then to Western Europe in the 15th century and became part of the foundation for modern plastic surgery.

Byzantium↗
PubMed1998

Hepatitis C virus infection in Chicago women with or at risk for HIV infection: evidence for sexual transmission.

BACKGROUND AND OBJECTIVES: The importance of sexual transmission of hepatitis C virus (HCV) infection is unclear. We attempted to define its role in women with or at risk for HIV infection. GOAL OF THIS STUDY: To ascertain if high-risk sexual behavior was independently associated with HCV infection. STUDY DESIGN: Risk factors were assessed cross-sectionally in Chicago women newly enrolled in the Women's Interagency HIV Study. Women who had (n = 243) or were at risk for HIV infection (n = 53) were tested for HCV antibodies (Ab). RESULTS: Of 296 women, 123 (42%) were HCV Ab positive; prevalence was 90% in women who injected drugs (IDU) compared with 12% in noninjectors (odds ratio [OR], 64.0, 95% confidence interval [CI], 29.9 to 137.0). A multivariate model showed associations with IDU (OR, 110.3, 95% CI, 33.3 to 365.8), prior gonorrhea (OR, 3.6, 95% CI, 1.4 to 8.9), and sex with a male IDU (OR, 2.7, 95% CI, 1.1 to 7.0). CONCLUSION: Injection drug use is the strongest predictor of HCV infection, but sexual risk factors are also independently associated.

Adult↗
PubMed1998

Post-transcriptional suppression of cytosolic ascorbate peroxidase expression during pathogen-induced programmed cell death in tobacco.

As a means to eliminate pathogen-infected cells and prevent diseases, programmed cell death (PCD) appears to be a defense strategy employed by most multicellular organisms. Recent studies have indicated that reactive oxygen species, such as O2.- and H2O2, play a central role in the activation and propagation of pathogen-induced PCD in plants. However, plants contain several mechanisms that detoxify O2.- and H2O2 and may inhibit PCD. We found that during viral-induced PCD in tobacco, the expression of cytosolic ascorbate peroxidase (cAPX), a key H2O2 detoxifying enzyme, is post-transcriptionally suppressed. Thus, although the steady state level of transcripts encoding cAPX was induced during PCD, as expected under conditions of elevated H2O2, the level of the cAPX protein declined. In vivo protein labeling, followed by immunoprecipitation, indicated that the synthesis of the cAPX protein was inhibited. Although transcripts encoding cAPX were found to associate with polysomes during PCD, no cAPX protein was detected after in vitro polysome run-off assays. Our findings suggest that viral-induced PCD in tobacco is accompanied by the suppression of cAPX expression, possibly at the level of translation elongation. This suppression is likely to contribute to a reduction in the capability of cells to scavenge H2O2, which in turn enables the accumulation of H2O2 and the acceleration of PCD.

Acetates↗
PubMed1998

Major rectal perforations caused by enema: is surgery mandatory?

BACKGROUND: Current methods of large bowel preparation prior to colonoscopy, barium enema and surgery are extremely effective in cleaning the bowel of feces. We rationalize, therefore, that under these conditions rectal perforations secondary to barium and cleansing enema could be treated expectantly, namely either defer or completely avoid immediate surgery. PATIENTS: Two female patients with major rectal perforations secondary to barium and cleansing enema who had thoroughly prepared large bowel were treated conservatively. RESULTS: Both patients did well without surgery and were discharged without any long-term sequela. CONCLUSION: Since a large number of iatrogenic perforations of the rectum occur in patients with well-prepared and clean bowel immediate surgery can be deferred or avoided all together without compromising them.

Aged↗
PubMed1998

Screening for tumour suppressor p16(CDKN2A) germline mutations in Israeli melanoma families.

Approximately ten percent of patients with malignant melanoma have family histories of the disease, suggesting a genetic predisposition. Germline mutations in tumour suppressor p16 gene have been implicated as disease causing mutations in some of the melanoma families. The frequency of families with p16 germline mutations among melanoma prone families varies from eight to fifty percent. The range of the variability is influenced apparently by the number of melanoma affected individuals within the family, as well as by other, yet unidentified factors. Ethnic background is known to determine both the frequency and the nature of germline alterations. Recently, specific mutations in tumour suppressor genes involved in breast cancer and in colon cancer were found at elevated frequency among Ashkenazi Jews. This report describes results of a screening for p16 germline alterations in a collection of Israeli melanoma families. We have analyzed genomic DNA from thirty one Ashkenazi and non-Ashkenazi Jewish melanoma families, as well as from thirty melanoma patients without an apparent family history of the disease. The entire coding region of the p16 gene was screened by single strand conformation polymorphism analysis and direct DNA sequencing. We have detected a number of carriers with the Ala148 Thr polymorphism at the end of the second exon and several instances of 500(G=>C) substitution at the 3' untranslated portion of the gene.

Female↗
PubMed1998

Maxillary dental development in complete unilateral alveolar clefts.

OBJECTIVE: This study was conducted to determine whether development of individual maxillary teeth in subjects with complete unilateral alveolar clefts was significantly different from that found in unaffected children. DESIGN: Retrospective, mixed longitudinal. SETTING: Craniofacial Center, university based. MATERIALS AND METHODS: A sample of 179 panoramic radiographs obtained during the mixed dentition from 79 subjects (47 males, 32 females) with complete alveolar clefts was analyzed. After visual evaluation of root development of the permanent maxillary teeth from radiographs, a score from 0 to 5 was assigned utilizing a predefined scoring system. Statistical analyses were performed between the cleft and unaffected reference groups available in the literature. RESULTS: The cleft side dentition was found to be significantly delayed in development relative to the noncleft side (p < .05). Compared to the reference group, the cleft side lateral incisor demonstrated a mean difference in development of 1.59 years followed by the canine (1.39 years), the central incisor (0.96 years), the first premolar (0.94), and the second premolar (0.78). CONCLUSION: Teeth directly adjacent to the cleft site were shown to be the most delayed. The lateral incisors and canines were observed to be the most variable when compared to their corresponding antimeres. The information obtained from this study may assist the orthodontist in selecting the appropriate time to initiate orthodontic treatment in order to prepare the permanent dentition prior to alveolar bone grafting.

Adolescent↗
PubMed1998

The association between alveolar bone loss and pulmonary function: the VA Dental Longitudinal Study.

The effect of oral conditions on medical outcomes is not well understood. The purpose of this epidemiological investigation was to examine whether the risk for chronic obstructive pulmonary disease (COPD) is enhanced among individuals with a history of periodontal disease as assessed by radiographic alveolar bone loss (ABL). Subjects were selected from the VA Dental Longitudinal Study, a long-term study of aging and health in male veterans who were medically healthy at baseline. Subjects are not VA patients. Those subjects with a forced expiratory volume in 1 second (FEV1) less than 65% of predicted volume were categorized as having COPD. ABL was assessed by using full-mouth series periapical films measured by a Schei ruler. Bone loss at each interproximal site was measured in 20% increments, and the mean whole-mouth bone loss score was calculated. Logistic regression analysis was used to determine the independent contribution of bone loss measurement at baseline to the subsequent risk of developing COPD over a 25-year follow-up period. Covariates included measures of smoking, height, age, education, and alcohol consumption. Of the 1,118 medically healthy dentate men at baseline, 261 subsequently developed COPD. We found that ABL status at baseline was an independent risk factor for COPD, with subjects in the worst population quintile of bone loss (mean ABL > 20% per site) found to be at significantly higher risk (OR = 1.8; 95% CI = 1.3, 2.5). The results of this analysis indicate that increased ABL is associated with an increased risk for COPD

Adult↗
PubMed1998

Specificity of dysuria and discharge complaints and presence of urethritis in male patients attending an STD clinic in Malawi.

OBJECTIVE: This study evaluated the specificity of discharge and dysuria for laboratory confirmed urethritis in symptomatic men presenting to an urban STD clinic in Malawi for treatment and returning for follow up evaluation. METHODS: Clinical treatment trial where consecutive consenting men with urethritis were enrolled and administered a questionnaire, examined, tested, and given one of five urethritis treatments with an efficacy range of 33-95%. Men returning for follow up were questioned, examined, and tested. RESULTS: The presence of both discharge and dysuria were highly specific for laboratory confirmed urethritis (over 90%). Compared with men who had complaints of both discharge and dysuria, men with complaints of dysuria alone were more likely to have reported prior treatment, 72% v 48% (p = 0.003), and less likely to have had gonorrhoea, 64% v 83% (p = 0.04). Men with complaints of discharge or dysuria without evidence of discharge were rare but half of them had documented urethritis. Among men who returned for follow up, 72% had no symptoms of either discharge or dysuria. However, among the 238 men with no symptoms at follow up, laboratory documented gonorrhoea occurred in 9% and non-gonococcal urethritis in 21%. DISCUSSION: In this population of men discharge or dysuria were specific symptoms for urethritis. The symptom of dysuria should be added as an entry criterion for evaluation for urethritis in the World Health Organisation's treatment recommendations. The high prevalence of asymptomatic infection at follow up in a population of men who received suboptimal antimicrobial therapy suggests that the most effective therapy available should be given at the first visit.

Adolescent↗
PubMed1998

A new era in halitosis and periodontal treatment.

An effective, 12 hour, anti-halitosis remedy is a spectacular breakthrough in the dental field and a significant step toward improving the lives of millions of people in the United States who suffer from chronic halitosis and the resultant psychological trauma. The technology contained in TriOral Anti-Halitosis Treatment Rinse, along with its significant research, will provide dentists with the ability to accelerate their halitosis treatment success curve. I am excited to present the science of this product and resulting research in my upcoming seminar series, and I view this as one of my greatest contributions to other dental professionals and their patients.

Bacteria, Anaerobic↗
PubMed1998

Technetium-99m-MIBI scintimammography in palpable and nonpalpable breast lesions.

UNLABELLED: The aim of this study was to determine the diagnostic accuracy of 99mTc-MIBI scintimammography in patients with palpable and nonpalpable breast cancer. METHODS: One hundred and forty patients with a clinically palpable breast mass and/or suspicious mammographic finding had prone scintimammography after the intravenous injection of 740 MBq 99Tc-MIBI within 5 days before open biopsy or surgery. All patients had mammography within 2 mo before the scintimammography. The mammography was read as probably benign, probably malignant or indeterminate. The scintimammography was read as positive or negative for breast cancer. The scintigraphic studies were correlated with mammographic findings and with histopathology. RESULTS: Histopathological studies showed that the mean tumor size for 61 palpable tumors was 2.57 cm with a range of 1-6 cm, and for 24 nonpalpable tumors the mean size was 1.34 cm with a range of 0.5-3 cm. Mammography had an overall sensitivity of 91.58% and a specificity of 42.87%; the sensitivity was 90.16% and 95.45% and specificity was 57.14% and 32.14% for palpable and nonpalpable tumors, respectively. Eight cases were considered indeterminate. Scintimammography was true-positive for 71 breast cancers, true-negative for 47, false-positive for 8 and false-negative for 14. The overall sensitivity was 83.5% and the specificity 85.4%. In the patients with palpable masses, sensitivity was 95.1% and specificity 75%; in those with nonpalpable lesions, sensitivity was only 54.2% and specificity, 93.5%. Among 18 cases of palpable abnormalities with probably benign mammography, six had true-positive scintimammography. Of eight patients with indeterminate mammography, one was true-positive on scintimammography. CONCLUSION: Scintimammography is an accurate and clinically useful tool for evaluating patients with palpable breast abnormalities when mammography is negative and in the cases of indeterminate mammography. A significant improvement in lesion detectability is necessary in nonpalpable breast abnormalities.

Breast Neoplasms↗