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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 1,189 records · Page 66Linked to original sources
PubMedDate not supplied

Dichotic consonant-vowel (CV) testing in the diagnosis of learning disabilities in children.

The performance of normal and learning-disabled children on a dichotic listening task using 30 paired consonant-vowel (CV) syllables was investigated in a series of studies. The effects of gender, developmental level, and prestimulus cuing on assessed auditory asymmetries were examined. In addition to providing normative data, the results of these studies are discussed as they relate to theoretical notions of cerebral asymmetries in normal and learning-disabled children and as they pertain to clinical diagnosis of childhood learning disabilities.

Age Factors↗
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The role of tissue expansion in the reconstruction of secondary burn defects.

Tissue expansion has become firmly established as an acceptable and useful modality in the treatment of various soft tissue defects. This article relates our experience with this technique for the reconstruction of secondary burn deformities in 26 patients. Details of expander placement and use are discussed, as well as the results and complications in this series. The advantages of this method, including a superior quality reconstruction, limited donor site morbidity, and cost-effectiveness, are discussed. The disadvantages of several operative steps, multiple office visits, and the objectionable appearance during expansion are enumerated. Guidelines for patient selection and technique refinements are also considered to reduce complications and to achieve an optimal functional and aesthetic result.

Adult↗
PubMedDate not supplied

HIV and syphilis seroprevalence among clients with sexually transmitted diseases attending a walk-in clinic at Cook County Hospital.

BACKGROUND AND OBJECTIVES: To determine the HIV and syphilis seroprevalence in a patients with suspected sexually transmitted diseases at an urban walk-in clinic. METHODS: Between January and November 1991, 515 patients with suspected sexually transmitted diseases were simultaneously tested for syphilis and HIV antibodies. RESULTS: The cohort studied was young (85% were < 40 years), 81% were black, 11% Hispanic, and 71% reported heterosexual contact as the primary HIV risk factor. HIV seroprevalence was 8% (41/515), (95% confidence interval [95% CI], 5.66%, 10.34%). Syphilis seroprevalence rate was 21.4% (110/515), (95% CI 17.86%, 24.94%). Syphilis seroprevalence in those who were HIV positive was 31.7% (13/41), (95% CI 17.46%, 45.94%) as compared to 5.9% (28/574), (95% CI 3.78%, 8.02%) in those who were HIV negative. CONCLUSION: The HIV seroprevalence among patients with sexually transmitted diseases who are screened for syphilis was disturbingly high. Patients who were seropositive for HIV had a significantly higher rate of syphilis than those who were HIV negative.

Adult↗
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Relationship between increased peak oxygen uptake and modifications in skeletal muscle metabolism following rehabilitation after myocardial infarction.

PURPOSE: Rehabilitation after myocardial infarction produces an increased peak oxygen uptake (VO2peak). This study investigates the relationship between the modifications in skeletal muscle metabolism and the modification in VO2peak induced by a standard program of physical training following a myocardial infarction. METHODS: Seventeen patients (14 male, 3 female) were studied by phosphorus 31(31P) magnetic resonance spectroscopy after the acute phase of a myocardial infarction and after 2 months of rehabilitation. Changes in calf muscle pH, phosphocreatine, and inorganic phosphates were measured at rest and during a plantar flexion-type incremental workload protocol. Calf muscle pH, phosphocreatine/(phosphocreatine + inorganic phosphates), and inorganic phosphates/phosphocreatine ratios were compared at the highest identical workload attained in both studies. The VO2peak (mL/kg/min) was determined during a cycle stress test. RESULTS: At the highest identical workload attained in both tests, the ratio phosphocreatine/(phosphocreatine + inorganic phosphates) was significantly higher (0.48 +/- 0.15 to 0.57 +/- 0.18: P < .001), and the ratio inorganic phosphates/phosphocreatine was lower (1.38 +/- 1.14 to 0.99 +/- 0.87: P < .01). After rehabilitation, no difference was observed for the pH at stress (6.83 +/- 0.16 to 6.91 +/- 0.14: not significant [NS]). The increase in the VO2peak was significant after rehabilitation (24 +/- 9 to 29 +/- 11 mL/kg/min: P < .001). The VO2peak improvement induced by the physical training was correlated with the increase in the phosphocreatine/(phosphocreatine + inorganic phosphates) (r = 0.818, P < .001). CONCLUSIONS: The reduction in phosphocreatine depletion indicated that the oxidative capacity of the skeletal muscle was improved during the rehabilitation. The good correlation between the indexes of skeletal muscle metabolism and VO2peak suggests the peripheral effect of training.

Adaptation, Physiological↗
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Effects of low-frequency electrical stimulation of quadriceps and calf muscles in patients with chronic heart failure.

PURPOSE: The aim of this preliminary study was to evaluate the effects of low-frequency electrical stimulation of quadriceps and calf muscles on global exercise capacities, skeletal muscle metabolism, calf muscle volume, and cardiac output in patients with chronic heart failure. METHODS: Fourteen patients with chronic heart failure (mean age of 56.4 years +/- 9.1 SD; mean radionuclide left ventricular ejection fraction of 22.3% +/- 8.8 SD) underwent 5 weeks (1 hour per day, 5 days per week) of low-frequency electrical stimulation of quadriceps and calf muscles. RESULTS: Low-frequency electrical stimulation was well tolerated. Exercise capacity and the calf muscles volumes increased significantly after rehabilitation in comparison with prior rehabilitation (the peak oxygen consumption increased from 17.2 mL/(kgmin) +/- 5.3 SD to 19.6 mL/(kgmin) +/- 5.9 SD; the anaerobic threshold increased from 12.3 mL/(kgmin) +/- 3.2 SD to 15.2 mL/(kgmin) +/- 3.3 SD; the 6-minute walking test increased from 419 m +/- 122 SD to 459 m +/- 114.3 SD; the gastrocnemius volume increased from 259.4 cm3 +/- 58 SD to 273.4 cm3 +/- 74 SD, and the soleus volume increased from 319 cm3 +/- 42.9 SD to 338 cm3 +/- 52.5 SD). The New York Heart Association class was improved after rehabilitation. The P-31 nuclear magnetic resonance spectroscopy of gastrocnemius muscle data were not significantly modified after rehabilitation, thereby inferring that no significant improvement of the muscle metabolism occurred. These data reinforce the hypothesis of an increased muscle mass during stimulation. It is noteworthy that the electrical stimulation did not increase cardiac output at any stage; an enormous asset in favor of this mode of rehabilitation. CONCLUSION: These results suggest that low-frequency muscular electrical stimulation is well tolerated, induces an increased exercise capacity in patients with chronic heart failure, without an undesirable increase in cardiac output.

Cardiac Output↗
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Comprehensive cardiac rehabilitation improves the control of dyslipidemia in secondary prevention.

BACKGROUND: Secondary prevention is an important goal of cardiac rehabilitation in patients with coronary heart disease (CHD). Dyslipidemia is one of the major risk factors that is important to control to reduce the incidence of future ischemic coronary events. The aim of the present study was to assess whether control of dyslipidemia, in secondary prevention, could be improved by a comprehensive cardiac rehabilitation program. METHODS: Fifty-two newly diagnosed hyperlipidemic men, who had experienced a recent CHD event, were separated in two equal groups of 26 patients: group CR+, in which patients were included in a 2-month cardiac rehabilitation program including an extensive educational program on cardiovascular risk factors, lipids, and diet, and group CR-without any cardiac rehabilitation. Mean age, body mass index, initial levels of total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and LDL/HDL ratio were not significantly different between the 2 groups. In both groups, each patient was referred to a dietitian and to the same lipidologist to start an appropriate hypolipidemic treatment. Treatment of coronary event, type of hyperlipidemia, and hypolipidemic treatment were not different between the two groups. RESULTS: Lipid measurements, performed 3 months after the beginning of the hypolipidemic treatment, showed that patients from the CR+ group, compared with those from the CR-group, had a significantly greater reduction of total cholesterol (23% versus 13%; P < 0.001), of LDL cholesterol (28% versus 12%; P < 0.001), of LDL/HDL ratio (34% versus 13%; P < 0.01) and of triglycerides (33% versus 21%; P = 0.05). CONCLUSIONS: Patients with CHD included in a comprehensive cardiac rehabilitation program showed a significantly better response to the hypolipidemic treatment than patients without cardiac rehabilitation. These results could be attributable to the extensive educational program on secondary prevention performed during cardiac rehabilitation, leading to optimized knowledge on lipid-lowering diet and to improved diet and drug adherence. A secondary prevention educational program must be an important part of any comprehensive cardiac rehabilitation program in patients with CHD.

Adult↗
PubMedDate not supplied

The Trauma Program Manager role: a current examination.

PURPOSE: To describe the history and define current application of the Trauma Program Manger (TPM) role. To suggest that a professional networking group can assist a TPM to accomplish the significant demands of the role. SIGNIFICANCE TO CARE: Improved understanding of the current role. Enhanced effectiveness in fulfilling the current functions of the TPM role through networking. DESIGN: Literature review on the role of the TPM, discussing the growth, development and progression to its current form. Evaluation of one professional group of TPMs and how it aided members in accomplishing the significant demands of the role. METHODS OF EVALUATION: A 6-year retrospective review of the administrative records for a professional networking group of TPMs was conducted. Meeting content was sorted and tabulated into the 10 functional requirements of the TPM role. TPMs who were members of the group during the same 6-year period were surveyed regarding the perceived value of group participation relative to accomplishing each of the TPM role functions. CONCLUSIONS: The current form of the TPM role is significant and encompasses at least 10 distinct functions. A professional group of TPMs is a useful tool to aid individuals in fulfilling their TPM roles. This may be true for both novice and experienced TPMs. The professional group may serve as an adjunct to obtaining formal role education.

Attitude of Health Personnel↗
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Intraspinal abnormalities and congenital spine deformities: a radiographic and MRI study.

Forty-two patients with congenital spinal deformity were studied by magnetic resonance imaging (MRI). Sixteen patients had intraspinal abnormalities consisting of a tethered cord in 10, diastematomyelia in four, diplomyelia in three, syringomyelia in four, a low lying conus in three, and a teratoma of the sacrum in one patient. In seven patients, intraspinal anomalies were suspected based on routine spinal radiographs and physical findings. We recommend MRI in patients undergoing spinal stabilization procedures and in all patients with lumbosacral kyphosis and those with pain, neurologic findings, or cutaneous hairy patch.

Child↗
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Reducing the frequency of errors in medicine using information technology.

BACKGROUND: Increasing data suggest that error in medicine is frequent and results in substantial harm. The recent Institute of Medicine report (LT Kohn, JM Corrigan, MS Donaldson, eds: To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 1999) described the magnitude of the problem, and the public interest in this issue, which was already large, has grown. GOAL: The goal of this white paper is to describe how the frequency and consequences of errors in medical care can be reduced (although in some instances they are potentiated) by the use of information technology in the provision of care, and to make general and specific recommendations regarding error reduction through the use of information technology. RESULTS: General recommendations are to implement clinical decision support judiciously; to consider consequent actions when designing systems; to test existing systems to ensure they actually catch errors that injure patients; to promote adoption of standards for data and systems; to develop systems that communicate with each other; to use systems in new ways; to measure and prevent adverse consequences; to make existing quality structures meaningful; and to improve regulation and remove disincentives for vendors to provide clinical decision support. Specific recommendations are to implement provider order entry systems, especially computerized prescribing; to implement bar-coding for medications, blood, devices, and patients; and to utilize modern electronic systems to communicate key pieces of asynchronous data such as markedly abnormal laboratory values. CONCLUSIONS: Appropriate increases in the use of information technology in health care- especially the introduction of clinical decision support and better linkages in and among systems, resulting in process simplification-could result in substantial improvement in patient safety.

Decision Support Systems, Clinical↗
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Introduction of partner referral and treatment for control of sexually transmitted diseases in a poor Haitian community.

Focus group discussions were held with women attending slum-based antenatal clinics and with male partners of pregnant women separately to evaluate knowledge and attitudes regarding sexually transmitted diseases (STDs) and acceptability of a proposed antenatal STD screening and treatment programme, including partner management. Subsequently, antenatal women found to have a STD were asked to refer their partner(s) for STD treatment. The institution's routine procedure of internal referral to the curative center was evaluated for loss to follow-up. Focus group participants described common STD syndromes, knew that a pregnant woman could transmit a STD to her child, and knew that all sex partners needed to be treated for STDs. Discussion participants disagreed on the possibility of asymptomatic STDs and mentioned other ways of contracting STDs beside sexual transmission. The response to the proposed programme was positive. Of 331 male partners named by antenatal women who were found to have at least one STD, 101 (30%) presented at the clinic through index referral, and an additional 38 (11.5%) presented because of health worker referral. Of the 59 men sent to the curative center for care, only 26 (44%) received treatment. The study demonstrated that in Haiti, partners of antenatal STD patients can be treated without apparent adverse effects. However, internal referrals to separate treatment centres should be avoided. Following this study, education efforts have emphasized the curable nature of STDs, the threat of vertical transmission, and frequent asymptomatic presentation of STDs to promote prevention and treat more partners of STD patients.

Contact Tracing↗
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Allergic reaction to latex: a risk factor for unsuspected anaphylaxis.

Allergic reactions to latex, including anaphylaxis may be a problem in certain individuals exposed to latex. Four atopic patients with symptoms of rhinitis, asthma, anaphylaxis, and/or urticaria upon contact with latex products were studied. The patients showed IgE binding to latex RAST disks ranging from 1.0 to 27.3 times the negative control. Latex products (gloves, balloons, and condoms) directly bound IgE from all four patients. Eluted proteins from the latex products inhibited IgE binding to commercial latex RAST disks. SDS-PAGE demonstrated multiple latex protein bands by Coomassie Blue staining between 14 and 66 kD. Immunoblotting showed specific IgE binding to latex proteins at 30 and 66 kD. These results indicate that latex-allergic patients have IgE directed against specific latex proteins. Allergy to latex can pose a substantial health risk to susceptible individuals.

Adult↗
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The effect of multiple sclerosis on pure tone thresholds.

The pure tone audiograms of 44 multiple sclerosis (MS) and 44 matched neurological control patients were studied with a view to finding out whether demyelinating disease is associated with decreased acuity to pure tones. The results show that MS patients have essentially normal hearing but auditory acuity at some of the low frequencies was found to be significantly worse in the MS group compared to the control patients. No correlation was found between the affected frequencies and the patients' age, sex and duration of the disease. The differences in thresholds between the control and MS patients were confined to the 25 patients who had clinical evidence of brain stem lesions suggesting that the cause of the abnormality in thresholds is in the brain stem.

Adolescent↗
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Central auditory processing disorder as the presenting manifestation of subtle brain pathology.

The objective of this case-report study was to assess the presence of central auditory impairment in a patient with a normal neurological examination. This subject was a 45-year-old female with gradually deteriorating hearing difficulties over a period of 5 years and a borderline normal audiogram. Behavioural central auditory tests were used, including Dichotic Sentence Identification Test, Competing Sentences Test, and auditory event-related potentials (mismatch negativity). Behavioural central auditory tests and mismatch negativity results were abnormal and indicated disordered central auditory processing. Subsequent magnetic resonance imaging of the brain identified subtle changes consistent with small-vessel ischaemic disease. Adult patients who present with hearing difficulties that cannot be explained on the basis of their audiogram should undergo central auditory assessment, as the auditory symptoms may be the first and only manifestation of central nervous system pathology.

Audiometry, Pure-Tone↗
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Incidence, CT findings and rehabilitation outcome of patients with communicative hydrocephalus following severe head injury.

Communicative hydrocephalus (CH) is considered as one of the late sequelae of severe craniocerebral injury. However, as most of the series of patients with CH described in the literature deal with the results of various shunting procedures, the incidence of post-traumatic communicative hydrocephalus is not documented. We have found that almost 3.9% of 335 severe craniocerebral-injured patients develop communicative hydrocephalus. These patients were unconscious for various periods of time, therefore the triad described by Hakim and Adams cannot by itself lead the clinician to suspect possible development of communicative hydrocephalus. It is suggested that in prolonged coma, or in the presence of arrest in clinical progress in conscious craniocerebral-injured patients, communicative hydrocephalus should be suspected.

Activities of Daily Living↗
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Convergence insufficiency in brain-injured patients.

Disorders of eye movements are relatively common in brain-injured patients. Some of these disturbances are caused by direct trauma to the orbital content, cranial nerves and other brain areas. Convergence, which is a part of the near-vision complex and depends on the integrative function of the cortical and subcortical areas, is commonly affected by traumatic brain injury. Intact vergence needs the integrative function of brain structures associated with acquisition of information on one side and intact mesencephalic function, including function of a vergence integrator, and their interconnections. Clinical investigation of vergence function in 26 traumatically brain-injured patients examined as early as possible after trauma revealed disturbances in over a third of the examinees. A follow-up of 72 patients some 3 years after injury revealed vergence insufficiency in 42%. Convergence insufficiency was associated with longer periods of coma (p less than 0.001), presence of cognitive disturbances (p less than 0.005) and patients' failing to find work in the open market (p less than 0.01). It is suggested that the presence of disturbed vergence several years after trauma, and its close association with prolonged coma and cognitive disturbances, is an expression of permanent damage to mesencephalic and cortical brain structures and can serve as an important aid in evaluation of these patients. This paper describes the close relationship between vergence state and over-all rehabilitation outcome as evaluated by patients' occupational status.

Adult↗
PubMedDate not supplied

Polytrauma associated with traumatic brain injury: incidence, nature and impact on rehabilitation outcome.

The rehabilitation outcome of patients with severe traumatic brain injury (TBI) is well documented and is highly correlated to the neurobehavioural sequelae of CNS damage. However, many of these patients suffer from polytrauma involving systems other than the CNS and to systems involved in acquisition of external information. In the present series of 328 patients with severe TBI, 58% had associated trauma, mostly in the skeletal system. The presence of one single associated trauma had no additional effect on rehabilitation as evaluated by actual work placement. In contrast, multiple lesions were liked with a less favourable outcome, probably due to a greater severity of the initial CNS damage. Disturbances in the various information-acquiring systems (e.g. disturbances in eye movements, visual field defects and severe bilateral auditory deficits) were associated with poor outcome. Presence of peri-articular new bone formation and communicating hydrocephalus, usually associated with prolonged periods of unconsciousness, indicated a poor rehabilitation outcome as well.

Abdominal Injuries↗
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Childhood pulmonary blastoma: a pleuropulmonary variant of the adult-type pulmonary blastoma.

Two fatal childhood cases of the rare pulmonary blastoma are reported. One was associated with a congenital cystic adenomatoid malformation. Both neoplasms extended to involve visceral pleura and were entirely composed of blastemal and mesenchymal elements without recognizable neoplastic epithelial components. The mesenchymal component in both instances consisted of malignant rhabdomyoblasts, undifferentiated mesenchyme, and differentiated, apparently benign, cartilage. Review of the literature suggests that these features may be specific for the childhood forms of pulmonary blastoma. It is further suggested that pulmonary blastoma, malignant mesenchymoma of the lung, and primary pulmonary rhabdomyosarcoma may have a common pathogenetic origin.

Carcinoembryonic Antigen↗