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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 649 records · Page 36Linked to original sources
PubMed1989

Rehabilitation outcome after anoxic brain damage.

Outcome was analyzed in a group of 31 patients who were comatose for more than 24 hours after cardiopulmonary arrest and were thereafter referred for inpatient rehabilitation. Seventeen regained functional ambulation, 20 regained oral communication, and 13 regained full independence in activities of daily living. Two regained their approximate previous cognitive level, and one regained his previous level of employment. These outcomes are strikingly inferior to those of patients with prolonged coma after craniocerebral trauma who were hospitalized in the same center during the same period. Both age and coma duration were correlated with outcome. The relatively better outcomes were seen in patients who were 25 years or younger at the time of anoxic injury, and whose coma lasted less than 24 hours.

Activities of Daily Living↗
PubMed1988

Absence of expression of a human endogenous retrovirus is correlated with choriocarcinoma.

We examined the RNA expression of a human endogenous provirus, termed ERV3, in 170 human tissue and cell specimens. The highest expression was found in normal placental chorionic villi as mRNAs of 9, 7.3, and 3.5 kb. The 7.3-kb RNA species was found only in the placenta. ERV3 mRNA was expressed in most other normal and malignant tissues at a level which was 2-10% of that seen in placenta. However, several tissues and tumor cell lines had higher transcriptional levels, equal to 10-60% of the placental level. In contrast, an almost complete abrogation of ERV3 mRNA expression was noted in choriocarcinoma cell lines and in an invasive hydatidiform mole tissue biopsy. This abrogation was not linked to deletions or rearrangements of the ERV3 genome. It appeared to be unassociated with methylation because the ERV3 provirus was similarly methylated in the DNA of placental chorionic villi and choriocarcinoma cells, and ERV3 transcription in choriocarcinoma cells was not induced by 5-azacytidine. These results suggest that the loss of ERV3 mRNA expression is associated with susceptibility to choriocarcinoma.

Choriocarcinoma↗
PubMed1988

Ultra-high-frequency jet ventilation in a bronchopleural fistula model.

High-frequency ventilation techniques have been demonstrated to be useful in decreasing gas loss from bronchopleural fistulas. We performed the present study to evaluate the impact of a new jet ventilator design and ventilatory frequency on hemodynamics, gas exchange, and bronchialstump gas flow in an animal model of bronchopleural fistula. Ten pigs underwent a right-sided thoracotomy and right-sided upper pulmonary lobectomy with cannulation of the upper lobe bronchus for measurement of bronchial fistula flow rate. Animals underwent a random sequence of conventional ventilation (12 to 20 breaths per minute), conventional high-frequency jet ventilation (120 breaths per minute), and ultra-high-frequency jet ventilation (UHFJV; 450 breaths per minute). Hemodynamic measurements were similar in the three ventilatory modes, but oxygenation was best with UHFJV. Bronchial fistula flow was lowest with UHFJV and greatest with conventional ventilation. Ultra-high-frequency jet ventilation demonstrated superior oxygen loading, adequate carbon dioxide elimination, and the least flow through the fistula, suggesting that both ventilator design and frequency are important therapeutic variables in the management of major airway disruption.

Animals↗
PubMed1988

ERV3 human endogenous provirus mRNAs are expressed in normal and malignant tissues and cells, but not in choriocarcinoma tumor cells.

Messenger RNA expression of a human endogenous provirus, ERV3, has been characterized in 170 specimens of normal and malignant human tissues and cells. In contrast to the high expression in first-trimester and full-term placental chorionic villi, most other human tissues expressed ERV3 mRNAs at a level of 2-30% of placenta. However, ERV3 mRNAs were not detected in choriocarcinoma tumor cell lines. These studies suggest that the ERV3 provirus may have been preempted for a biological function and disruption of its mRNA expression results in choriocarcinoma.

Cells, Cultured↗
PubMed1988

Merkel tumor of the lower lip: a case report and updated review of the literature work performed at the University of Illinois.

An unusual case of Merkel cell carcinoma of the lower lip with metastasis to the submental nodes is presented. Clinical similarities and the histopathologic and prognostic differences between this tumor and basal or squamous cell carcinomas of the head and neck area are discussed and the current thoughts for treatment are presented. The capricious clinical course and the aggressive nature of the Merkel cell tumor is emphasized. A review of the existing literature is also included in an effort to familiarize the head and neck surgeon with this relatively new but potentially lethal pathological cutaneous entity.

Carcinoma↗
PubMed1988

Infants with cystic fibrosis: pulmonary function at diagnosis.

Meconium ileus (MEC), failure to thrive (FTT), and a combination of FTT and pulmonary symptoms (COMB) are the most frequent symptoms of cystic fibrosis (CF) at the time of diagnosis. The purpose of this study was to compare to normal controls (NC) the pulmonary function of CF infants at the time of diagnosis, when grouped by these symptoms. The measurements of pulmonary function included oxygen saturation (SaO2), functional residual capacity (FRC), mixing index (MI), total respiratory system compliance (Crs), and maximal flow at FRC (VmaxFRC). Compared to NC (n = 33), the MEC group (n = 5) had a higher MI (54 vs. 42%) and no difference in SaO2, Crs or VmaxFRC. There were no significant differences between FTT (n = 8) and NC groups although there was a tendency for Crs to be lower in the FTT group (5.1 vs. 6.8 ml/cm H2O). When compared to all other groups, the COMB group (n = 11) had significantly lower SaO2, MI, Crs, and VmaxFRC. The normal lung function in the MEC group is consistent with the normal anatomy reported in CF infants dying secondary to meconium ileus. Longitudinal evaluation of the infants in this study, following initiation of care as patients with a diagnosis of CF, may allow us to determine whether symptoms at diagnosis remain an important determinant of lung function in infancy.

Cystic Fibrosis↗
PubMed1988

The chronically mentally ill case management--more than a response to a dysfunctional system.

The service systems which assist the long-term mentally ill to function in the community have been routinely described as fragmented and uncoordinated. The development and implementation of case management has been seen as one response to this dysfunctional system. This article examines case management from the perspective that case management is a needed function no matter how coordinated and integrated the system. From this perspective, case management is driven by the clients' goals and not the systems' goals. Case management is viewed as a process by which the person with severe psychiatric disability is supported in negotiating for the various services that they want and need. Four unique activities are identified as performed by the case manager: Connecting with Clients, Planning for Services, Linking Clients with Services, and Advocating for Service Improvements. Case management must be seen as a uniquely human response to the client's specific service needs and overall goals. For persons with long-term psychiatric disabilities, case management brings to life the human dimension of the human service system.

Chronic Disease↗
PubMed1988

The Revised Conners Parent Rating Scale: factor structure replication with a diversified clinical sample.

The Revised Conners Teacher Rating Scale was completed as part of a comprehensive evaluation of 135 consecutive new patients seen in the Pediatric Neurology Learning Disability Clinic at the Medical College of Georgia. The questionnaires were subjected to principal components analysis with varimax rotation. Item analysis was conducted on the obtained subscales, and convergent validity was determined by correlation with the Revised Behavior Problem Checklist (Quay & Peterson, 1987). Finally, comparisons of the diagnostic groups were carried out across the subscales.

Adolescent↗
PubMed1988

Electronic fetal heart rate monitoring during cesarean section.

Fetal heart rate (FHR) response to cesarean section was studied in 65 patients. Induction of anesthesia, skin, fascial, peritoneal and bladder flap incisions were not associated with a change in FHR. Abdominal preparation was associated with FHR decelerations in 15% of cases. Myometrial incision was followed by FHR deceleration in 11% of cases. No correlation between the incision/delivery (I-D) interval and FHR changes was seen.

Anesthesia, Epidural↗
PubMed1988

Treatment of urethral diseases with neodymium:YAG laser.

Over a thirty-month period, a wide variety of common urethral problems were treated on an ambulatory basis, with the neodymium:yttrium-aluminum garnet (Nd:YAG) laser. When used discriminately, laser treatment appears to be an effective modality for the management of selected urethral strictures. Thus far, excellent results have been obtained in 30 of 31 cases of short strictures where laser urethrotomy was performed as the first stricture procedure (average follow-up 10 months). Furthermore, in a series of 36 cases of secondary bladder neck contractures, all of the evaluated patients responded well (average follow-up 7 months). Good results were obtained in only 11 of 48 complicated strictures (average follow-up 14 months). However, while most of these extensive strictures were not eradicated, laser therapy generally produced a documented clinical improvement, comparable to urethrotomy or dilatation, in 15 of these cases. A series of 24 condylomata involving the urethra were treated satisfactorily, with no recurrences (average follow-up 13 months). Laser treatment also has been used successfully for the management of several urethral caruncles, urethral polyps, two meatal hemangiomas, one urethral carcinoma, and a distal duplicated urethra. Recently, the Nd:YAG laser has been applied to the prostatic urethra with vaporization of obstructing median bar hyperplasia. Favorable results have been achieved in 5 of 6 cases treated with a newly developed technique that utilizes direct laser contact. Retrograde ejaculation has not been encountered in these patients (average follow-up 6 months). All of these procedures have been accomplished in the office, largely without urethral catheterization. Lidocaine jelly occasionally supplemented with intravenous sedation provided satisfactory anesthesia.

Adult↗
PubMed1988

Reversal of chronic ischemic myocardial dysfunction after transluminal coronary angioplasty.

From a cohort of patients referred for elective transluminal coronary angioplasty, a subset of patients was evaluated to determine whether revascularization using coronary angioplasty could salvage chronically ischemic myocardium. Reversible chronic ischemic left ventricular dysfunction was identified by a severe wall motion abnormality at rest and at least one of the following: 1) persistent angina pectoris; 2) postextrasystolic ventricular contraction potentiation of motion in the asynergic zone on baseline ventriculogram; and 3) thallium-201 uptake in the asynergic zone. Twelve patients were identified as having reversible chronic ischemia and underwent coronary angioplasty. Their mean age was 63 +/- 11 years and duration of symptoms 8.3 +/- 9.7 weeks. Immediate pre- and postangioplasty left ventriculograms were obtained. Regional wall motion was analyzed using a radial axis model, and global ejection fraction was calculated. After angioplasty, tension development (heart rate-systolic pressure product) increased in the absence of an increase in left ventricular end-diastolic pressure. Global ejection fraction increased from 46 +/- 20 to 62 +/- 19% (p less than 0.005). The percent of left ventricular diastolic perimeter showing asynergy decreased from 29 +/- 11 to 10 +/- 13% (p less than 0.005). During follow-up ranging from 6 to 51 months, sudden death occurred in one patient who had had no improvement in wall motion after angioplasty, repeat angioplasty was performed in three patients and eight patients remained asymptomatic. Application of easily obtainable clinical data identifies a subset of patients with chronically ischemic myocardium. Coronary angioplasty in such patients is useful in salvaging hibernating myocardium.

Adult↗
PubMed1988

Hyperfractionated radiotherapy in brain stem tumors: results of a Pediatric Oncology Group study.

Between September 1984 and January 1986, 38 patients were entered onto the first phase of a Pediatric Oncology Group study designed to test the feasibility of treating children with brain stem tumors with hyperfractioned (twice daily) radiotherapy, to assess the early and late morbidity and efficacy of such treatment, and to test the feasibility of dose escalation in this group of patients. Of the 34 patients considered eligible after neuroradiology review, two did not complete planned radiotherapy because of progressive disease; both died of disease at 4 weeks and 9 months following initiation of treatment. The remainder were treated with 1.1 Gy twice daily, with an interval of 4 to 6 hours, to a total dose of 66 Gy in 60 fractions over 6 weeks. The majority of patients (24/34, 71%) improved clinically during the course of treatment; two remained stable, seven deteriorated, and for one the clinical response was unknown. By CT scan and/or MRI, no patient showed complete regression of disease; five showed a partial response to treatment, twenty fell into a stable disease category, eight patients developed progressive disease by the time of their first follow-up radiologic examination, and one patient was not evaluable for response, having been lost to follow-up immediately after completion of treatment. All five patients who achieved partial response and 17/20 patients in the stable, disease category subsequently progressed, after a median interval of 6.5 months. The median survival time was 11 months and survival at 1 year was 48% (SE 0.08). Morbidity of treatment consisted of an enhanced skin reaction in three patients, otitis media and/or externa in nine, and complications related to steroid intake in four, including diabetic ketoacidosis (two patients), Pneumocystis pneumonia (one patient), and disseminated varicella (one patient). Protracted use of steroids in 13 patients was associated in all instances with non responding or progressive disease. No patient developed signs or symptoms suggestive of CNS damage, and tissue obtained by biopsy at the time of progression in three patients and at autopsy in five failed to demonstrate any evidence of injury attributable to the radiotherapy. A dose escalation to 70.2 Gy in 60 fractions over 6 weeks was implemented as planned.

Adolescent↗