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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 505 records · Page 28Linked to original sources

Sequence learning in individuals with behavioural limitations.

The production of sequences by two mentally retarded adults and a normally capable preschooler was assessed after each was trained to touch five physically dissimilar and nonrepresentative forms in an experimenter-specified order (denoted A1-->A2-->A3-->A4-->A5). Performance on the 10 constituent two-term sequences was examined (e.g. A-->A2, A2-->A3, A1-->A3 and A2-->A4). The probe data were largely consistent with the five-term sequence performance trained explicitly and suggest the formation of stimulus relations based on relative position rather than a rote stimulus-response chain. The procedures and results were replicated with a second five-term sequence (B1-->B2-->B3-->B4-->B5). The subjects' performances were also assessed on trials in which mixtures of the two sets of stimuli were presented as either two-term probes (e.g. A2-->B4 and B2-->A4; with all three subjects) or five-term probes (e.g. A1-->B2-->A3-->B4-->A5; with the two adult subjects). Again, the subjects' performances were consistent with their baseline training. The mixed-probe data extend prior research on sequence production and suggest the formation of classes of mutually substitutable sequence stimuli. The overall findings highlight the importance of experiential variables in the formation of ordinal relations in developmentally limited individuals.

Child, Preschool↗

Thyroid dysfunction in rheumatoid arthritis: a controlled prospective survey.

OBJECTIVES: To determine whether thyroid dysfunction is found with increased frequency in patients with rheumatoid arthritis (RA). METHODS: A controlled prospective survey was conducted on a cohort of patients with RA derived from a hospital clinic and a private surburban rheumatology practice. A control group with similar demographic features was generated from the same sources and included subjects with either osteoarthritis or fibromyalgia. Consecutive patients were evaluated over a six month period. The evaluation included a complete history and physical examination, and determination of serum thyroxine, free thyroxine, triiodothyronine, thyroid stimulating hormone (IRMA), antinuclear antibodies, and rheumatoid factor. RESULTS: Of the 91 women with RA evaluated, 29 (30%) had evidence of thyroid dysfunction compared with 10 (11%) of 93 controls. The excess thyroid dysfunction is due to either hypothyroidism or Hashimoto's thyroiditis and was independent of age, increasing duration of disease, rheumatoid factor, and antinuclear antibodies. CONCLUSIONS: Thyroid dysfunction is seen at least three times more often in women with RA than in women with similar demographic features with non-inflammatory rheumatic diseases such as osteoarthritis and fibromyalgia.

Adult↗

The locus ceruleus and dementia in Parkinson's disease.

We compared numbers of neuronal profiles in the locus ceruleus (LC) from sections of brainstem in 13 patients with Parkinson's disease (PD) without concurrent Alzheimer's disease (AD) with counts from age-matched controls and from patients with PD and concurrent AD. We also evaluated the relationships between presence of dementia or LC neuronal loss and additional pathologic measures related to dementia in PD. Among patients with PD without concurrent AD, the presence of dementia was associated with significantly lower LC neuronal counts (at all anatomic levels); greater neuronal loss within the ventral tegmental area, nucleus basalis of Meynert, and possibly the medial (but not the lateral) substantia nigra pars compacta; and more Lewy bodies in the anterior cingulate gyrus. Correlations between lower LC neuronal counts and these other pathologic measures were generally positive and often significant. We conclude that dementia in PD is associated with pathologic involvement of multiple extranigral neuronal populations.

Aged↗

Late CT findings in brain trauma: relationship to cognitive and behavioral sequelae and to vocational outcome.

OBJECTIVE: The purpose of this study was to determine the degree of correlation between cerebral atrophy observed on CT scans after severe blunt brain trauma and later neuropsychological status, as well as to evaluate the relative prognostic values of a number of indexes of cerebral atrophy. MATERIALS AND METHODS: The study group comprised 32 previously healthy men 18-65 years old who had severe blunt trauma of the brain (initial scores on Glasgow coma scale of 7 or less). Their cognitive and behavioral statuses were evaluated when the patients were discharged from the hospital, which occurred when the recovery process showed a plateau. Overall vocational status was evaluated 1 year after discharge. The clinical evaluation was performed by a multidisciplinary team. Multiple linear indexes derived from brain CT scans obtained about 3 months after injury in patients with blunt brain trauma were correlated with cognitive and behavioral sequelae of brain damage and with vocational placement, as evaluated by a rehabilitation team about 1 year after trauma. RESULTS: A high correlation was found between the width of the third ventricle and outcome. The prognostic value of the width of the third ventricle was superior to that of any other index studied, and it correlated best with late cognitive status (Spearman r = .57, p < .01). CONCLUSION: The width of the third ventricle is a useful prognostic index in cases of diffuse brain trauma. It indicates diencephalic atrophy, caused either by diffuse axonal injury or by hypoxia. It may indicate a role of diencephalic structures in higher cortical functions.

Adolescent↗

Effectiveness of acoustic reflex threshold criteria in the diagnosis of retrocochlear pathology.

This study examines the acoustic reflex threshold criteria, derived from a large group of patients with cochlear hearing loss proposed by Cohen & Prasher (1992), in order to evaluate their effectiveness in differentiating between cochlear and retro-cochlear lesions. This criterion was tested on 63 patients with surgically confirmed cerebello-pontine angle (CPA) lesions. The false results obtained with this and other criteria were compared. The best balance between the false positive and negative results in the cochlear and retrocochlear group is provided by the criterion of any two adjacent test frequencies (proposed in the companion paper) having an upper limit of 105 dB for hearing below 60 dB and 110 dB for hearing over 60 dB. This study has also singled out the interaural difference criterion as the best diagnostic indicator with the lowest false results with only 1 false negative from 63 CPA cases and 3 false positive cases from 61 cochlear lesions with hearing thresholds over 55 dB.

Acoustic Stimulation↗

[Indications for botulinum toxin in laryngectomy].

The botulinum toxin is a highly potent neurotoxin, used since several years in the treatment of the focal musculary dystonias. We define the laryngeal dystonia as a clinical entity, which is represented by a spasmodic dysphonia or an inspiratory dyspnea without dysphonia, related to a specific dystonia of the thyroarytenoid muscles. The laryngeal functional exploration (i.e. fibroscopy, videostroboscopy, acoustic analysis, computerized voice analysis), the neurological and electrophysiological assessment allow to make diagnosis and evaluation of the therapeutical results of this rare laryngeal neurologic disease which was relatively misunderstood until now. There are several clinical types of spasmodic dysphonia: adductor form (with a jerky voice, pitch beaks, vocal arrests and pneumophonatory incoordination); abductor form (with a breathy voice of very low intensity) and mixed types which can be difficult to identify. Since 1989, we have treated 55 laryngeal dystonias with local intra-muscular botulinum toxin injection: 48 spasmodic dysphonia and 7 inspiratory dyspnea without dysphonia, with hyperactivity of the thyroaryténoïd muscles. We present our therapeutical protocol and results which are good in 87% of cases.

Aged↗

The effects of inhaled corticosteroids on chronic airflow limitation.

A placebo-controlled, double blind, cross-over study of inhaled budesonide was carried out to examine its effectiveness in the treatment of chronic airflow limitation (CAL). Fourteen patients (11 males, mean age 66 years) with stable CAL received placebo treatment for four weeks followed by inhaled budesonide 400 micrograms BD for eight weeks. Response was assessed by measuring forced expiratory volume in one second (FEV1). There was no significant improvement in the overall spirometric measurements and symptom scores except a reduction in daily peak expiratory flow rate fluctuation (p < 0.05). However, individual patients showed significant increase in FEV1. Two patients (14%) had greater than 30% increase in FEV1 in response to inhaled corticosteroids. This response could not be predicted from history of allergy, skin test, bronchial challenge test, peripheral blood or sputum eosinophilia. We conclude that only a minority of patients with stable CAL may respond to inhaled budesonide. Nonetheless, patients who are symptomatic despite treatment with maximum doses of bronchodilators may have a trial of inhaled corticosteroids in order to demonstrate any additional benefit.

Administration, Inhalation↗

Leveling of the occlusal plane during model surgery.

A level occlusal plane is a prerequisite for success in all orthognathic surgical procedures. Occlusal plane leveling must be obtained at the time of model surgery and splint manufacturing or an occlusal cant will be translated to the operating theater. We describe the use of a small-scale flat-line level, utilized during model surgery for two jaw procedures, to level the occlusal plane accurately and quickly.

Dental Articulators↗

Controlled delivery of krypton-81m boli in normal subjects: results and implications.

Interregional sequential filling potentially affects lung ventilation imaging, depending on the distribution of the tracer within the inspired volume. We investigated its importance quantitatively under near tidal breathing conditions in the upright lung using a short-lived radioactive tracer. Ten normal volunteers performed two runs of 900-ml breaths (from functional residual capacity) in which 100 ml of 81mKr boli were delivered "early" or "late" in inspiration, i.e., 50 ml or 450 ml volumetric depth. Apex-to-base gradients in the vertical profile were -106 +/- 22 (s.e.) counts/cm (early) and -187 +/- 24 (s.e.) counts/cm (late). Ratios of upper-to-lower regional ventilation (U/L) were 0.88 +/- 0.01 (s.e.) (early) and 0.81 +/- 0.01 (s.e.) (late). Simulations with a compartment model show that a simple pattern of sequential filling can by itself account for the experimental results observed. Control over 81mKr delivery can be important to physiologically accurate assessment of ventilation-perfusion matching. Controlled delivery techniques could also modify effectiveness and targeting of other inhaled agents including therapeutic aerosols.

Administration, Inhalation↗

Secondary (intermediate) alveolar bone grafting.

Secondary bone grafting of the maxilla and the residual alveolar clefts at the stage of transitional dentition, and in conjunction with orthodontic treatment, has become a well-accepted treatment modality. This article discusses the goals of the procedure, the timing of the bone graft, and the design of the flap for soft-tissue coverage of the bone graft.

Adolescent↗

Orthodontic management of the cleft lip and palate patient.

The importance of the dentition and contribution of the orthodontist to the care of cleft patients from infancy to adulthood are presented. Close communication between orthodontists and surgeons is emphasized. The orthodontic treatment plan is developed around the anatomic, functional, and developmental needs of the patient.

Cephalometry↗

Adenoid cyst-like carcinoma of the prostate gland.

Adenoid cyst-like carcinoma of the prostate is a rare but distinctive variant of prostatic adenocarcinoma. Adenoid cystic carcinoma is most commonly encountered in the salivary glands, and the cell of origin is thought to be the myoepithelial cell. Electron microscopic studies of the human prostate have not revealed myoepithelial differentiation. Myoepithelial cells of the human prostate are thought to arise in seromucinous ectopic glands. A case of adenoid cyst-like carcinoma of the prostate gland is documented, and the histological, immunohistochemical, and electron microscopic features of this tumor are discussed. These features are compared with five cases of classic salivary gland adenoid cystic carcinoma. To define the myoepithelial cell population of the prostate gland, 12 normal prostate glands were studied. Prostatic adenoid cyst-like carcinoma differs from adenoid cystic carcinoma of salivary gland origin, and it is therefore postulated that the behavior of these tumors may likewise differ.

Adenocarcinoma↗

[Spontaneous coronary dissection. Apropos of 2 cases].

Spontaneous coronary dissection is a rare and still poorly understood pathological disease entity; the authors report two cases in which the diagnosis was reached in the context of incipient necrosis in young patients. A review of the literature reveals the main characteristics of this problem: the clinical aspect is generally that of acute coronary failure with the constitution of an infarction. The subjects are young with no risk factor but some cases of combination with a disease affecting the elastic tissue have been described. Female gender and the post-partum phase are promoting factors. Diagnosis was long established by means of autopsy but can now be based on coronary angiography. Histologically, the lesion is a hematoma which dissects the arterial wall between the internal two thirds and external third of the media. The main etiological hypothesis is acquired or congenital fragility of the media, which promotes the formation of a dissecting hematoma, however the triggering phenomenon remains poorly understood.

Adult↗

[Subcutaneous emphysema complicating laparoscopic cholecystectomy].

Laparoscopy using carbon dioxide has been a standard gynecological procedure for many years. During the past 3 years, it has become commonly used in general surgery as well. Laparoscopic cholecystectomy is rapidly spreading world-wide. Although minor and major complications have been attributed to this procedure, their frequency is low. We report a case of subcutaneous emphysema following laparoscopic cholecystectomy.

Adult↗

Stridor and focal laryngeal dystonia.

Fibreoptic laryngoscopy in 6 patients with laryngeal stridor showed immobile vocal cords in a paramedian position but no other local cause. Thus a diagnosis of Gerhardt's syndrome, usually ascribed to paralysis of vocal-cord abductor muscles, was made in 3 patients who had no other signs or symptoms of dystonia, and in 3 patients who had multifocal dystonia. Electromyography (EMG) showed evidence of overactivity of vocal-cord adductors, with no evidence of denervation in the abductor muscles. Botulinum toxin injection of the overactive thyroarytenoid muscles abolished stridor. These clinical and EMG findings indicate that Gerhardt's syndrome is not caused by paralysis of vocal-cord abductors, but represents a focal laryngeal dystonia which may be treatable by botulinum toxin injections of vocal-cord adductor muscles rather than by arytenoidopexy or tracheostomy.

Aged↗