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Biomedical subjects

M Fisher

Publications and source records attributed to M Fisher.

At least 469 records · Page 26Linked to original sources

Status epilepticus and Epstein-Barr virus encephalopathy. Diagnosis by modern serologic techniques.

Three patients had status epilepticus appearing de novo as the presenting manifestation of Epstein-Barr virus (EBV) encephalopathy. Clinical findings of infectious mononucleosis were absent and EBV-specific serologic tests made or confirmed the diagnosis in each case. Epstein-Barr virus should be considered as a potential cause when status epilepticus occurs in the absence of previous seizures or an identified cause of seizures. The diagnosis may be made in some cases only with the use of EBV-specific serologic testing.

Adult↗

Pyramidal tract deficits and polyneuropathy in hyperthyroidism, Combination clinically mimicking amyotrophic lateral sclerosis.

Generalized weakness, intermittent dysphagia, and a 40-pound weight loss developed in an elderly man over a six-month period. Examination revealed weakness, atrophy and fasciculations of extremity musculature, pseudobulbar speech, hyperactive upper extremity reflexes, and extensor toe signs without sensory loss. Results of electrodiagnostic studies were consistent with an axonal polyneuropathy. Endocrinologic results were compatible with hyperthyroidism. Radioiodine therapy resulted in resolution of clinical neurologic symptoms and signs within seven months. This case illustrates a previously undescribed concurrence of hyperthyroid associated polyneuropathy and pyramidal tract dysfunction that led to an initial clinical diagnosis of amyotrophic lateral sclerosis.

Aged↗

Are adolescents able and willing to pay the fee for confidential health care?

We studied the ability and willingness of adolescents attending a suburban-based Adolescent Health Service to pay a fee for health care. Self-administered, anonymous questionnaires were distributed to 180 predominantly middle-class adolescent patients prior to the establishment of a fee-for-service payment plan. One hundred sixty-five respondents planned to continue as patients of the Adolescent Health Service; of these, 155 (94%) indicated that they would be able and willing to pay a fee. All of the 155 respondents indicated they could pay $5 per visit, two thirds could pay as much as $10, half could pay $15, and one fifth could pay $20 or more. Sources of fee money would be job earnings, a friend, allowance, and savings; 75% of respondents planned to pay without any help from parents. Analysis revealed few significant correlates of ability and willingness to pay with demographic, socioeconomic, and attitudinal factors. These data demonstrate that, although few of these middle-class adolescent patients indicated that they were able and willing to pay a full fee of $20 or more, most were able and willing to pay more than a token amount for health care.

Adult↗

The relation of drinking and smoking habits to diet: the Lipid Research Clinics Prevalence Study.

The relation of cigarette smoking and alcohol use to diet was examined in a general population of adults ages 20-59 years enrolled in the Lipid Research Clinics (LRC) Prevalence Study. There was a positive association between cigarette and alcohol use, but little relation between these habits and the nutrient intake. The total energy from food was about the same whether or not a person drank or smoked; alcohol was simply added to food intake. However, persons who drank received slightly less of their food energy from carbohydrate than persons who did not drink and persons who smoked received slightly more of their food energy from fat than did nonsmokers. Both persons who drank and persons who smoked weighed less than would be expected from their total energy intake. While these relationships were similar for men and women, among women they were stronger for those using gonadal hormones than among those not using these hormones.

Adult↗

The use of freeze frame (slow scan) video for health professional education.

Continuing education in the professions is receiving increased emphasis and the economic and effective delivery of programmes must be a priority for the future. Freeze frame video, one of the newer telecommunication technologies, is a promising method for delivering continuing medical education (CME) over distance for those who have difficulty in regularly attending educational update programmes, especially for those in rural and isolated areas. The system uses two telephone lines to transmit both voice and a still picture simultaneously to one or several sites. The video portion can be a view of the patient, text, 35-mm slides, microscopic slides, or any other still object. Five years' experience with a slow-scan system as used for education is outlined. Three types of programme formats were all presented with this technology; consultations; discussion/case presentations; and lectures. The best use of the system was for small groups, with discussion of their unique problems. The fully interactive nature of the slow-scan system assisted in the presentations and allowed all sites in multisite conferences to be fully involved. Because most teachers are not familiar with the technology in their everyday life it requires more orientation and experience to accomplish a skilled programme than with other telecommunication systems such as the telephone or television.

Community Health Workers↗

Alloimmunisation to HLA antigens following transfusion with leucocyte-poor and purified platelet suspensions.

24 previously non-transfused patients were given three transfusions of 200 X 10(8) platelets at 14-day intervals. Group I (12 patients) received leucocyte-poor platelet suspensions with a mean contamination of 15 X 10(6) leucocytes per transfusion. Group II (12 patients) received platelets with less than 5 X 10(6) leucocytes per transfusion. 5 patients in group I and no patients in group II developed lymphocytotoxic antibodies (p = 0.037). Platelets with fewer than 5 X 10(6) leucocytes did not seem to stimulate a response to major histocompatibility antigens, but with a small contaminating dose of leucocytes appeared to be highly immunogenic.

Adolescent↗

Characterization of lymphadenopathy by magnetic resonance relaxation times: preliminary results.

The purpose of this study was to evaluate the ability of magnetic resonance (MR) to enable characterization of disease within lymph nodes and differentiation between benign and malignant lymph nodes. Ninety-three patients were examined. Normal and malignant lymph nodes were excised from seven patients, and the T1 and T2 relaxation times were analyzed in vitro using spectroscopy. In 86 patients, T1 and T2 relaxation times of the lymph nodes were determined from MR images. Spectroscopic analysis revealed an increase in the T1 and T2 values of nodes involved by neoplasm compared with uninvolved nodes in an individual case. Comparison of measurements from 28 lymph nodes analyzed in vitro using spectroscopy showed an overlap of the T1 and T2 values between normal and malignant lymph nodes. T2 relaxation times and relative spin density values were greater for acute inflammatory nodes than for nodes involved by granulomatous diseases (tuberculosis and sarcoidosis) or nodes replaced by lymphoma or metastasis. Changes in T1 relaxation values were not specific. The measurements of T1 and T2 relaxation times and relative spin density showed an overlap between nonspecific lymphadenopathy, nodes involved by granulomatous diseases, and malignant nodes. Differentiation between these various nonacute types of enlarged lymph nodes could not be achieved using current MR parameters.

Adolescent↗

Gated MR imaging of the heart: intracardiac signals in patients and healthy subjects.

The appearance of intraluminal signal in the cardiac chambers, the descending aorta, and blood vessels was studied in healthy subjects and patients with myocardial disease on first and second spin-echo gated magnetic resonance images. Signal was present in the cardiac chambers and the aorta at various phases of the cardiac cycle when physiological or pathological slow flow conditions are expected in healthy subjects and in patients. Healthy individuals tended to show signal in the ventricles and aorta during end-diastole, and signal was less likely to be present at higher heart rates and in systolic images. In patients with regional or global left ventricular dysfunction, intraventricular signal tended to persist into systole. Surprisingly, intraventricular signal was not present with increased frequency adjacent to infarcted regions of the myocardial wall. Thus, the mere presence of intracavitary signal cannot be used as an indicator of either regional or global cardiac contraction abnormalities. In the left atrium, signal was often present during systole. Physical factors determining the appearance of signal of flowing blood are discussed in an Appendix.

Adult↗

Cerebral vasculitis and hemorrhage associated with phenylpropanolamine.

A 20-year-old woman using an oral diet aid preparation containing phenylpropanolamine presented with an intracerebral hemorrhage and angiographic evidence of cerebral vasculitis. Gas chromatography demonstrated phenylpropanolamine in the urine. Even when used within recommended guidelines, phenylpropanolamine usage should be included in the differential diagnosis of patients presenting with intracranial hemorrhage.

Adult↗

Arteriography of the carotid bifurcation: oblique projections.

Atherosclerotic plaques may not be demonstrated adequately by standard anteroposterior (AP)-lateral projections of carotid arteriography. We evaluated selective carotid arteriography in oblique projections for 60 individual carotid arteries. Two neuroradiologists evaluated arteriograms in four separate sessions devoted to AP-lateral views alone and in combination with oblique projections. The lumen surface was characterized as "smooth," "irregular," or "ulcerated." When oblique projections were added to AP-lateral views, there was a significant shift of radiologic diagnosis from smooth to irregular or ulcerated. Addition of oblique projections to standard AP-lateral views increases the radiographic diagnosis of carotid artery lesions that may be the source of emboli.

Angiography↗

Bilateral visual loss in carotid artery disease.

Bilateral, simultaneous visual loss usually indicates vertebral-basilar insufficiency. We report the case of a patient who experienced transient, bilateral, simultaneous, asymmetrical visual loss. Arteriography revealed flow-restrictive lesions in both internal carotid arteries. The most likely cause for this symptom is bilateral ophthalmic artery hypoperfusion distal to high-grade stenotic lesions of the internal carotid arteries.

Aged↗

Cholestyramine-induced changes in low density lipoprotein composition and metabolism. I. Studies in the guinea pig.

In previous animal studies, bile acid sequestrant resins have been shown to increase the fractional catabolic rate (FCR) of a low density lipoprotein (LDL) tracer isolated from a normal donor animal and to increase hepatic LDL-receptor activity. In addition, in man, these resins are known to alter LDL composition such that low density lipoproteins are smaller, more dense, and have a decreased cholesterol:protein ratio. To determine whether metabolic consequences resulted from these changes in LDL composition, we fed cholestyramine chow (2% resin by weight) to guinea pigs, which lowered LDL cholesterol levels by 55%. LDL was isolated from control donors (C-LDL) and from cholestyramine-treated donors (CH-LDL). Compared to the C-LDL, the CH-LDL were smaller in size, depleted of cholesteryl ester and phospholipid, and had a marked decrease in their cholesterol:protein ratio. To determine whether the clearance of the altered CH-LDL was different from that of C-LDL, we labeled the two LDL preparations with 125I or 131I and simultaneously injected them into control and cholestyramine-treated guinea pigs. In 27/29 animals studied, the FCR of the CH-LDL was slower than that of C-LDL, demonstrating that the compositional changes alter the metabolism of CH-LDL. When C-LDL was used as the sole tracer in both control and treated animals, cholestyramine treatment increased the FCR by 41%; when CH-LDL was used as sole tracer, the increase in FCR on treatment was only 26%. This suggested that C-LDL was cleared more rapidly by the LDL-receptor pathway than was CH-LDL. Further support for this idea came from observations that C-LDL was degraded more readily by cultured fibroblasts and that nonenzymatic glucosylation abolished the difference in FCR between C-LDL and CH-LDL. These studies show that the effects of bile sequestration are complex and that the compositional changes produced have profound metabolic consequences. The implications of these observations for interpretation of LDL turnover studies are discussed.

Animals↗

A new method for rapid determination of sperm concentration in bull and ram semen.

A simple method for rapid evaluation of bull and ram sperm concentration is described. In this technique, a sample from an undiluted specimen was placed in a special 10-mum counting chamber and examined either by an ordinary or a phase-contrast microscope. The pattern distribution of the observed spermatozoa was matched as closely as possible with one of five pictures of a standard scale. This scale was prepared from serial photomicrographs that ranged from 100 to 1500 million per ml. The number that appeared at the corresponding photograph immediately indicated the sperm concentration of the tested specimen. In this way values up to 1500 million per ml could be determined rapidly with no further procedures. More concentrated specimens needed slight dilution to make them suitable for direct evaluation. Accuracy and reliability were statistically evaluated; the mean deviation from the conventional method was less than 15.2% with confidence level of 95%.

Journal Article↗