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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 667 records · Page 37Linked to original sources
PubMed1988

Comparison of propofol and thiamylal for induction and maintenance of anaesthesia for outpatient surgery.

In an open, randomized study we have compared the safety and efficacy of propofol with thiamylal for induction and maintenance of anaesthesia supplemented by nitrous oxide in elective termination of pregnancy. Induction of anaesthesia was achieved with either propofol 2.5 mg kg-1 or thiamylal 4.0 mg kg-1 followed by maintenance with 70% nitrous oxide in oxygen and repeat boluses of 25% of the induction dose i.v. as indicated clinically. Both drugs induced and maintained anaesthesia reliably, with some minor differences. Recovery from propofol was significantly more rapid. The patients in the propofol group were alert and orientated early in the postoperative period, with less nausea or vomiting. Propofol has properties that are of particular benefit in anaesthesia for ambulatory surgery.

Abortion, Induced↗
PubMed1988

Salvage of esophageal cripple with a lined pectoralis major tube flap.

A staged reconstructive procedure is described for the reconstruction of the entire thoracic esophagus. All primary alternatives for esophageal reconstruction were not applicable. The patient's thoracic esophagus was successfully reconstructed in two stages with a lined pectoralis major muscle tube, and it remains, eight months postoperatively, in good general condition without clinical or radiological evidence of any fistula, stricture, or obstruction. He enjoys an oral diet without restrictions and has gained a total of 19 pounds in the postoperative period.

Anastomosis, Surgical↗
PubMed1988

Students' sexual knowledge, attitudes toward sex, and willingness to treat sexual concerns.

In the research reported here, the authors examined the relation of 82 medical students' feelings about sex to their level of sexual knowledge, willingness to treat patients with sexual concerns, and participation in an elective sex education course. The results showed that the erotophobic students (those with negative feelings about sexuality) had significantly lower levels of sexual knowledge and were significantly less likely to participate in an elective human sexuality course than the erotophilic students (those with positive feelings about sexuality). Moreover, the erotophobic students who took part in the sexuality course benefited from it less than did the erotophilic students as measured by their willingness to treat patients with sexual concerns. Finally, although the students overall were relatively knowledgeable about sex and were relatively willing to treat patients with sexual concerns, troubling gaps in specific sexual knowledge and in willingness to treat patients with certain sexual concerns (such as acquired immune deficiency syndrome) were identified. Medical schools need to structure sex education in ways that take account of students' ambivalent feelings about sex and need to provide sex education that increases both sexual knowledge and willingness to treat patients with sexual concerns.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Tissue expansion for the reconstruction of burn defects.

Tissue expansion has emerged recently as an alternative reconstructive procedure and has been used for the treatment of a variety of defects. This paper presents our experience with the use of tissue expansion exclusively for the treatment of secondary burn defects. The technique was used in 22 consecutive patients. The technical aspects of the procedure are described. The advantages of tissue expansion, including the superior quality of reconstruction, cost effectiveness, and absence of donor site scar are presented. The disadvantages, including the need for two stages, multiple office visits, its application for relatively small defects, and the objectionable temporary appearance, are discussed. Finally, patient selection, and refinements of the technique and tailoring of the expanded flaps to achieve the best possible reconstructive and esthetic results and limit the possibility of complications are discussed.

Adolescent↗
PubMed1988

Immediate and long-term management of gunshot wounds to the lower face.

The steadily increasing level of urban violence and attempted suicides in the recent past has resulted in large numbers of gunshot injuries to the face from small-caliber weapons. Our experience with 35 consecutive cases of civilian gunshot wounds involving primarily the lower face is presented. Initial management included securing of the airway, control of bleeding, and treatment of coexisting injuries. After clinical and radiologic evaluation and conservative debridement of all devitalized tissues, the mandibular fractures were reduced and stabilized appropriately. Large bony defects were treated by stabilization of the mandibular segments followed by secondary bone grafting. Intraoral soft tissues were then repaired with local mucosal flaps or tongue flaps when necessary. Finally, the soft tissues were repaired by primary closure or local flaps. Distant flaps were used only as a secondary procedure. Our results are presented, the differences between civilian and military injuries are discussed, and the principles of gunshot ballistics are described. We conclude that most of these wounds can be treated in a relatively conservative manner immediately after the injury with good functional and cosmetic results.

Adolescent↗
PubMed1988

Postpsychotic depression and negative symptoms: an investigation of syndromal overlap.

The authors studied 46 patients with the operationally defined syndrome of postpsychotic depression following episodes of schizophrenia or schizoaffective disorder. Half of these patients were also found to satisfy criteria for negative symptoms. The patients with negative symptoms were rated as more severely ill on global measures, but there was only limited evidence that they were more depressed. Nevertheless, in a randomized double-blind trial of imipramine versus placebo as an adjunct to the fluphenazine decanoate and benztropine regimens of the patients with negative symptoms, the patients who received imipramine seemed to show more improvement.

Adolescent↗
PubMed1988

Precordial T-wave polarity changes in acute inferior infarction. A poor indicator of associated disease of the left anterior descending coronary artery.

T-wave polarity in V1 to V3 was examined in 70 patients with acute inferior wall myocardial infarctions (IWMI) as an indicator of significant disease in the left anterior descending coronary artery (LAD). Fifty-three percent (37/70) had precordial T-wave inversions, and of these 38 percent (14/37) had angiographically significant LAD disease. Conversely, 47 percent (33/70) had upright T waves in V1 to V3, and of these, 52 percent (17/33) had significant LAD disease. Likewise, 41 percent of the patients with ST segment depression in V1 to V3 had significant LAD disease, while 50 percent of those with isoelectric ST segments were similarly affected. Finally only 39 percent of those patients with both precordial ST segment depression and T-wave inversion had significant LAD disease. We conclude that neither anterior ST depression, T-wave inversion, nor a combination of both is a sensitive or specific indicator of LAD disease in patients with acute IWMI.

Aged↗
PubMed1988

Uterine and umbilical blood flow during cesarean section under epidural anesthesia.

Umbilical and uterine blood flow velocity waveforms were studied in 22 women undergoing elective cesarean section under epidural anesthesia. The measurements were taken prior to initiation of anesthesia (baseline levels), after the appropriate level of anesthesia had been achieved (prior to the onset of surgery), and intraoperatively immediately prior to the uterine incision and after the delivery (uterine blood flow). Achievement of the therapeutic level of epidural anesthesia was not associated with altered umbilical and uterine blood flow. Intraoperatively, however, 2/3 of the women manifested increased resistance in the utero-fetal circuit, judging by the rise in S/D ratios. Under normal circumstances (absence of fetal distress and maternal complications prior to the cesarean section, adequate maternal hydration and oxygenation, etc.) these changes did not cause any neonatal compromise as evidenced by normal Apgar scores and freedom from complications during the neonatal period.

Anesthesia, Epidural↗
PubMed1988

The value of combining auditory brainstem responses and acoustic reflex threshold measurements in neuro-otological diagnosis.

Acoustic reflex thresholds (ART) and auditory brainstem responses (ABR) were measured in 69 patients referred to the Neuro-otological clinic on the suspicion of a retrocochlear lesion. The pure-tone selection criterion was an average hearing loss of less than 60 dB at 0.5, 1, 2, and 4 kHz, with no thresholds exceeding 70 dB and only one threshold exceeding 60 dB. Both tests proved independently to be most effective in the diagnosis of cerebello-pontine angle (CPA) tumours and to a lesser extent for brainstem lesions. The ABR was positive in 100% of CPA group and 90% in the brainstem group compared with 93% and 70% respectively for the ART. The combination of the two tests provides patterns of abnormality which are more disease specific. In the CPA cases the most common and consistent patterns of abnormality were the unilateral delay of Wave V or III and V of the ABR associated with a vertical ART pattern indicative of an abnormality of the ipsi and contralateral reflexes on stimulating the affected side. Intrinsic brainstem lesions most commonly resulted in bilateral ABR abnormalities combined with the full-house ART pattern indicative of bilateral abnormalities of both ipsi and contralateral reflexes.

Adolescent↗
PubMed1988

The effects on auditory function of damage to the pontine olivo-cochlear bundle in man.

A patient with multiple sclerosis (MS) in whom a lesion developed in the pons between successive nuclear magnetic resonance image scans (MRI) is described. The patient developed intolerance of loud sounds, with distorted perception of speech and music, and abnormalities of stapedius reflex threshold, masked speech audiometry, and masking level difference assessment in the presence of an unchanged pure tone threshold. These abnormalities partially resolved over a number of months. It is postulated that the efferent olivo-cochlear bundle was involved on one side of the pons and the abnormalities are interpreted in terms of bilateral removal of inhibition from the hair cells of the cochlea.

Adult↗
PubMed1988

Billing patterns of general practitioners and family physicians in Ontario: a comparison of graduates of McMaster Medical School with graduates of other Ontario medical schools.

This descriptive study which uses data obtained from the Ontario Health Insurance Plan has identified a number of differences in the style of practice chosen by general practice/family medicine (gp/fm) physicians who graduated from McMaster medical school from that of other contemporary Ontario gp/fm graduates who are practicing in Ontario. McMaster gp/fms were more likely to be certified in Family Medicine, saw fewer patients per month than the comparison group, and billed less services but the cost per service billed was somewhat higher.

Curriculum↗
PubMed1988

Bjork-Shiley cardiac valves long term results: Winnipeg experience.

Between April 1970 and December 1984, 1183 Bjork-Shiley cardiac valve prostheses were implanted in 915 patients (470 males, 445 females). Four types of valves were used; Delrin disc prostheses in 75 patients, pyrolytic carbon spherical disc valves in 645 patients, the 60 degrees convexo-concave disc model in 197 patients and the 70 degrees model in seven patients. Isolated mitral valve replacement was performed in 278 patients, isolated aortic valve replacement in 363 and double valve replacement in 153. Concomitant surgery was performed in 121 patients, including a modified Bentall procedure in 15. Perioperative mortality was 6.4% (nine patients undergoing isolated aortic valve replacement; 16 in mitral valve group, 18 with double valve replacement and 16 undergoing concomitant surgery). The cumulative follow-up was 4592 patient-years, to a maximum of 15 years. There were 130 late deaths, 60% due to cardiac events. Actuarial survival for the mitral valve group was as follows: four of six patients with Delrin disc valves were alive at 13.4 years; in the pyrolytic group, survival was 82% at 10 years; in the 60 degrees convexo-concave group survival was 87.5% at seven years. In the aortic valve replacement group, 83% of patients with pyrolytic valves were alive at 10 years and 85.7% of the 60 degree convexo-concave group were alive at seven years. For patients undergoing double valve replacement, 72% were still alive after seven years. Thromboembolic events averaged 1.4 per 100 patient-years. There were seven complete valve thromboses in the mitral position requiring reoperation; six of these patients were long term survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Usefulness of the laser in post-radiotherapy arytenoid edema].

Laser treatment of post-radiotherapy arytenoid edema was applied to two groups of patients with either laryngeal mobility or immobility. When mobility was normal the technic was simple, since only resection of the arytenoid edema was necessary and results were always excellent. In the second group, resection of arytenoid edema must be combined with partial or total resection of arytenoid, but in this case there is a risk of chondritis. Results in this series were excellent and only one case of post-laser radionecrosis was noted.

Arytenoid Cartilage↗