Health and hospitals in critical condition.
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Chicago↗
Biomedical subjects
M Cohen
Publications and source records attributed to M Cohen.
Urinary fluoride as an exposure index in aluminum smelting.
Urinary fluoride was evaluated as an exposure index for a prospective study of asthma in an aluminum smelter. Two studies were conducted to evaluate the relationship between airborne exposure and urinary excretion over a workweek, and to describe exposures among jobs and over time. Thirty-two subjects were evaluated on Days 1 and 3 of a 3-day workweek. On each day, spot urine samples were collected prior to the start of work and again at the end of the shift. Samples were analyzed for fluoride and expressed as milligrams fluoride per gram of creatinine. Airborne exposures to total particulate, fluoride particulate, and hydrogen fluoride (HF; using a 37-mm filter cassette containing a filter and treated back-up pad) were also evaluated on each subject. In the second study, postshift urine samples were collected from asthma study volunteers in three surveys extending over 1.5 years and analyzed for fluoride. Average airborne exposures were 15.7, 4.1, and 0.7 mg/m3 for particulates, particulate fluorides and HF, respectively, and were substantially higher among carbon setters than other workers. However, average urine fluorides among the same workers were reasonably low, 1.3 and 3.0 mg/g creatinine in pre- and postshift urine samples, respectively. Carbon setters, who routinely wore respiratory protection during high exposure periods, had urinary fluoride levels similar to those of other potroom personnel. A significant variation in dose, as expressed by postshift urinary fluoride levels, was observed between potroom and nonpotroom jobs and over three survey periods. These results suggest that postshift urinary fluorides provide a reasonable exposure index for surveillance of exposure levels for an epidemiologic study, and that a substantial variation of exposure occurs between jobs and over time. Although urinary fluorides may be used for exposure surveillance, additional details on individual exposure agents and patterns of exposure over time are required for complete assessment.
Air Pollutants, Occupational↗
[Factors associated with hyperhomocysteinemia in Crohn's disease].
AIMS: The incidence of thromboembolic disease is increased in patients with inflammatory bowel disease. Hyperhomocysteinemia is one of the risk factors for thrombosis. The aims were: 1) to assess the prevalence of hyperhomocysteinemia in a large series of patients with Crohn's disease; 2) to search for clinical and biological factors associated with hyperhomocysteinemia. PATIENTS AND METHODS: One hundred seventy-one patients with Crohn's disease (64 males, 107 females), median age 31 years (range: 16-82), were studied. The median duration of the disease was 7 years. The concentrations of homocysteine, folate, cobalamin and C-reactive protein were measured in serum from blood sample of each patient. RESULTS: The mean concentration of seric homocysteine was 14.8 micromol/L (N: 4.4 - 12.4 micromol/L). Hyperhomocysteinemia was observed in 89 patients (52%). It was significantly associated with age, sex, smoking habit, serum cobalamin level and history of ileal surgical resection (P<0.05). In the group of operated patients, there was a statistically significant association between hyperhomocysteinemia and the length of small bowel resected. In multivariate analysis, sex and smoking were associated with hyperhomocysteinemia. CONCLUSION: More than half of the patients with Crohn's disease have hyperhomocysteinemia. This result stresses the need for preventing reversible factors associated with hyperhomocysteinemia, such as smoking and cobalamin deficiency, in order to lower the thrombotic risk of patients with Crohn's disease.
Adolescent↗
Verapamil-sensitive left ventricular tachycardia in patients with coronary artery disease: clinical and electrophysiologic features consistent with triggered activity.
This is a retrospective review of three male patients with verapamil-sensitive left ventricular tachycardia, severe coronary artery disease, and past myocardial infarction. Each patient had severe left ventricular dysfunction (mean ejection fraction 34%). Each tachycardia had a right bundle branch block/left axis deviation morphology, which was sustained with isoproterenol. One patient had incessant tachycardia 3 days after coronary bypass surgery. Electrophysiology and clinical parameters were suggestive of triggered activity rather than reentry. Each tachycardia was terminated with verapamil but failed with adenosine, beta blockers, and class I/III antiarrhythmics. Prior cases of verapamil-sensitive ventricular tachycardia have been seen in patients without organic heart disease, and the putative mechanism appears to be reentry. These patients with ischemic coronary artery disease may exhibit a mechanism of triggered activity in the Purkinje system region, which is responsive to calcium channel blockade. Successful radiofrequency ablation was guided by Purkinje potentials.
Aged↗
Syncope and preexcitation: a case of a Kent and fasciculoventricular Mahaim fibers.
A case involving an 8-year-old girl with syncope and preexcitation on a surface electrocardiogram (ECG) that was suggestive of Wolff-Parkinson-White syndrome is presented. An intracardiac electrophysiologic study revealed a posteroseptal bidirectionally conducting Kent fiber. Radiofrequency ablation of the Kent fiber was successful, but the patient had a residual short His-ventricular (HV) interval and a new preexcitation pattern. Atrial extra stimuli and ventricular pacing revealed a fixed, preexcited QRS. Nodal block and loss of preexcitation was provoked with adenosine. The surface QRS and electrophysiologic features are consistent with a left septal fasciculoventricular Mahaim fiber.
Child↗
Sudden cardiac death and coronary spasm: a case report.
A case involving a 55-year-old man with documented ventricular fibrillation is presented. Invasive evaluation revealed no inducible ventricular arrhythmia, and nonobstructive coronary disease. Ejection fraction and results of nuclear treadmill test and signal-averaged electrocardiogram were normal. An automatic cardiodefibrillator was implanted. In-hospital symptoms that replicated symptoms preceding sudden death revealed anterior ST segment elevations, which were treated with sublingual nitroglycerin. Follow-up after 27 months of calcium blocker and nitroglycerin therapy was uneventful and without device activity. Patients with unexplained sudden death may have unsuspected coronary spasm as the primary substrate. Combination drug and device therapy may be appropriate in such patients.
Amlodipine↗
Radiofrequency catheter ablation: the first decade.
Radiofrequency catheter ablation (RFCA) has become a safe and effective procedure for treatment of supraventricular and ventricular arrhythmia in children and adults. Anatomic data and mapping experience obtained from surgical and direct current ablation procedures paved the way for radiofrequency ablation. Radiofrequency energy is a power source well suited to place focal catheterization lesions. A large variety of supraventricular tachycardias can be successfully cured with a high success rate with minimal complications. Also, a growing number of ventricular tachycardias can be cured or palliated with this procedure. Ongoing research may increase the scope of this procedure to provide primary cures for atrial fibrillation and ventricular tachycardia associated with coronary artery disease. These procedures are highly complex and should be performed in a high-volume center.
Arrhythmias, Cardiac↗
Hypertension: development, classification, and treatment. Involvement of pharmacists in outpatient hypertensive therapy: an existing service.
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Antihypertensive Agents↗
Pediatric radiofrequency ablation for tachyarrhythmias: the Westchester Medical Center experience.
Radiofrequency ablation, first performed in the late 1980s, has become a standard therapeutic procedure for tachyarrhythmias in children and adults. This procedure can achieve a high degree of success with minimal complications. This report describes the pediatric radiofrequency ablation experience at Westchester Medical Center, including 89 consecutive children who have undergone 104 ablations of 96 arrhythmia substrates with an overall success rate of 95%. The series is analyzed in the context of previously published series of pediatric radiofrequency ablations. Unresolved issues in pediatric ablation related to anesthesia, learning curve, necessity for hospital admission, anticoagulation protocol, and technical aspects of the procedure are discussed.
Adolescent↗
Homebound rehabilitation: preparing the way.
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Persons with Disabilities↗
A modification of the Regnauld procedure for hallux limitus.
Surgical correction of hallux limitus can be challenging to the foot surgeon. The procedures available to date are numerous. Satisfactory results require proper candidate selection, and other procedures must be weighted carefully. The Regnauld procedure has become an accepted technique in this extensive surgical armamentarium. This manuscript describes a means of fixation that eliminates many of the complications associated with the original nonfixed technique, and allows for early range of motion to be initiated.
Bone Transplantation↗
Heart transplantation for end-stage cardiomyopathy caused by an occult pheochromocytoma.
Dilated cardiomyopathy has been found in patients with pheochromocytoma. The cardiomyopathy and resultant congestive heart failure can be progressive and fatal, or reversible, if the source of the excess catecholamines is removed. Histologic and autopsy studies revealed a characteristic focal myocarditis and contraction band necrosis, indicating that the circulating catecholamine excess secreted by the pheochromocytoma is the cause of the cardiomyopathy.
Adrenal Gland Neoplasms↗
Engineering controls.
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Communicable Disease Control↗
Panmetatarsal head resection and transmetatarsal amputation versus solitary partial ray resection in the neuropathic foot.
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Aged↗
Gender differences in practice patterns of Ontario family physicians (McMaster medical graduates).
This study examined the extent to which physician gender influences practice patterns. Data came from the Ontario Hospital Insurance Plan billing profiles of general practitioner and family medicine graduates of McMaster University School of Medicine. The women physicians studied were more likely to be certified in family medicine than the men and a higher proportion of their patients were female. Women were more likely to be working part time, billed during fewer months of the year, earned less, and saw fewer patients. They provided greater numbers of services in psychotherapy and counselling and ordered more laboratory tests; associated with this were higher costs per service and per patient. Women offered a less diverse mix of services than men. They provided fewer hospital, emergency room, and intrapartum services and a lower proportion of women included house calls, after-hours work, hospital, emergency room, surgical or intrapartum services in their service mix. Thus these women appeared more likely to restrict their practices to the office setting and to provide a higher proportion of psychosocial care. The overall impact of these sex differences in practice patterns on the health care system requires further exploration.
Family Practice↗
[Calcified lipogranuloma after gomenoleo oil injection: "paraffinoma" 60 years later].
The authors describe one case of calcified lipogranuloma observed in the forearm tissues of a 67 year old patient. This lesion seems to be due to a long term treatment by S.C injection of gomenoleo oil 60 years before. The analysis by high performance liquid chromatography of fat parts of the lesion identified the original olive oil (excipient).
Adipose Tissue↗
Undifferentiated primary malignant soft tissue tumor.
A rare case of a malignant, undifferentiated, soft tissue neoplasm is presented. A thorough podiatric and medical evaluation is essential in the proper diagnosis and treatment of soft tissue tumors. This evaluation includes appropriate consultation with the various medical specialists.
Algorithms↗