Xanthomonas maltophilia--a growing problem in the haemodialysis population.
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Adult↗
Biomedical subjects
M Herman
Publications and source records attributed to M Herman.
A longitudinal study of substance use and abuse in a single class of medical students.
PURPOSE: A longitudinal study to ascertain the attitudes toward, and habits of, substance use among a single class of medical students. METHOD: A single class from a northeastern medical school was surveyed in both its first year (February 1991, 176 students) and its third year (May 1993, 170 students). The students were asked to report how frequently during the prior year they had used drugs or alcohol, and whether their use of each substance had increased, decreased, or remained the same since entering medical school; to identify any family members with histories of alcohol or drug problems; and to report any incidence during the prior year of ten behaviors associated with substance dependence. The students were also asked to indicate their agreement or disagreement with 11 attitudinal statements. Additional attitudinal items asked the students to identify three major deterrents to the abuse of drugs and alcohol, and what they had done if they had become aware of a classmate with a drug or alcohol problem. Chi-square analysis and two-tailed t-tests were used to compare data from the two surveys. RESULTS: The response rates in the first and second surveys were 96.9% and 81.8%, respectively. Use of licit and illicit substances was comparable to that of chronological peers and prior national studies of medical trainees. Most of the students admitted to using alcohol at least once in the prior year (91.8% and 95%, respectively). In both years marijuana was the illicit drug used most often. Although there was a slight increase over time in the use of benzodiazepines (2.4% to 5.8%) and a decrease in the use of marijuana (29.4% to 21.7%), these changes were not significant. Few of the students in their third year reported using any substance other than alcohol more than once a month. In general, a greater percentage of the students reported a decrease rather than an increase in the use of a substance since entering medical school; the primary exception was for wine. As they progressed in their training, the students became less concerned about the effect of substance use on their performance and more likely to be embarrassed about admitting to an addiction. Although in each year a few of the students appeared to be at risk for substance dependence (8.9% and 3.5%, respectively), no student came to the attention of the administration because of problems related to substance use. While most of the students were unaware of any classmate who had a problem, half of those who were aware had done nothing, and the balance had rarely sought assistance from the faculty or administration. CONCLUSION: Although there was no evidence that substance use was a major problem, a few of the students appeared to be at risk for drug or alcohol dependence. Appropriate intervention, support, and referral systems should be identified for the few who may be at risk, and increased educational efforts are needed to help all students address this issue with their peers and, ultimately, with their patients.
Adult↗
Presentation and management of hydromyelia in children with Chiari type-II malformation.
Hydromyelia in patients with myelomeningocele and Chiari-II malformation is a relatively frequent finding on MRI studies. However, not all children develop symptoms from the hydromyelia that requires treatment. Furthermore, treatment of hydromyelia in spina bifida patients is rather complex due to the associated malformations. The authors retrospectively analyzed 231 MRI studies carried out on spina bifida patients who presented neurological deterioration. Hydromyelia was found in 48.5% of the patients. Forty-five children with severe hydromyelia required treatment. These patients were first divided into 2 groups: those with holocord hydromyelia, and those with a segmental lesion. Fifteen patients presented symptoms characteristic of symptomatic Chiari-II malformation: neck rigidity; swallowing difficulty; pain in the upper extremeties; weakness or spasticity in the upper extremeties. Eighteen patients presented symptoms typical of the tethered cord syndrome: scoliosis; worsening bladder and/or bowel function; pain in the lower extremeties; weakness or spasticity in the lower extremeties. Twelve patients presented a mixed-type symptomatology. These patients subsequently underwent posterior cervical decompression, tethered cord release or insertion of a hydromyelia-pleural shunt according to the type of presenting symptoms and to the extent of the hydromyelic lesion. A pattern of successful treatment was identified for each type of presenting clinical and radiological picture. This has allowed the authors to determine an algorithm for optimal treatment of hydromyelia associated with Chiari-II malformation and myelomeningocele, which is proposed here.
Age of Onset↗
Integrating primary care and methadone maintenance treatment: implementation issues.
Linking primary medical care with methadone maintenance treatment brings critical services to drug users, many with HIV/AIDS, tuberculosis and other illnesses. However, a variety of important philosophical, ethical, and systems issues may impede the process of implementing a "linked" service delivery model. Conflicting paradigms, such as the traditional "doctor-patient" relationship with its emphasis on continuity of care and the substance abuse treatment model of limit-setting and behavioral consequences, create tension in the treatment system. This article describes these tensions and uses clinical vignettes to demonstrate how to address these implementation issues. In conclusion, solutions are proposed for successfully integrating services for medically ill substance abusers.
Adult↗
Clinical response to clozapine treatment of 11 chronic patients in a state psychiatric hospital.
The aim of this study was to evaluate the clinical response to clozapine of 11 treatment-resistant patients with schizophrenia. Nine male and two female inpatients of a state psychiatric hospital, with at least a 2-year history of unresponsiveness to adequate trials of at least three antipsychotics and from chemically distinct groups, were challenged with clozapine. Clinical assessment involved baseline and repeated post-baseline ratings using the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impressions Scale (CGI), the Nurses Observation Scale for Inpatient Evaluation (NOSIE-30), and the Abnormal Involuntary Movement Scale (AIMS). Progression to lower categories of care was used as an additional outcome measure. Statistically significant reductions were achieved in global symptomatology, positive psychotic symptoms, and hostility. A statistically significant improvement occurred on the Social Interest factor; however, improvements in the remaining negative symptoms were not statistically significant. Reductions in psychopathology enabled eight patients to progress to lower categories of care with five patients moving to community care. The results indicate that clozapine was effective in treating hospital patients with a very severe form of mental illness.
Adult↗
[Less common metastases of colorectal adenocarcinoma].
The authors present an account on four patients, treated because of colorectal carcinoma who had solitary secondaries of a colorectal tumour at less common sites. Twice a secondary in the urinary bladder wall was found once in the right cerebral hemisphere and once in the humerus.
Adenocarcinoma↗
[Magnetic resonance in cardiology--a new alternative in noninvasive diagnosis].
The authors describe their initial experience with examination of the heart by magnetic resonance (MR) and discuss its position in the diagnostic algorithm of cardiac examinations:. They made 31 MR examinations of the heart in 30 patients. Echocardiography preceded 29 examinations. MR proved to be particularly useful where echocardiography did not lead to a decisive conclusion and called for confirmation by another method, or where it could not be carried out or its result was not consistent with the patient's clinical condition or the results of other examinations. The quality of the MR image was influenced most by the possibility of ECG gating. The latter was not possible in 16 patients (51.6%). In three of these (18.8%) the images were of such poor quality that they did not provide adequate diagnostic information. Images suitable for evaluation were obtained in 28 examinations (90.3%)--in these patients the MR information was valuable for establishment of the diagnosis. Magnetic resonance is a new possible method in the non-invasive diagnosis of heart disease. In the majority of cases it follows after echocardiographic examination which remains due to its accessibility the basic non-invasive method for examination of the heart.
Adolescent↗
[Neurosarcoidosis. Role of new examination methods for early diagnosis and therapy].
BACKGROUND: Affection of the nervous system is one of the most serious forms of sarcoidosis. The objective of the present work was to evaluate the prevalence and manifestations of this disease, contemporary opportunities of its diagnosis and the importance of early adequate therapy. METHODS AND RESULTS: Neurosarcoidosis was diagnosed in seven patients (4 men and 3 women) from a total number of 211 patients with sarcoidosis in 1977 to 1993. The mean age of the patients with neurosarcoidosis was 47 years. In six patients affection of the nervous system was the first clinical manifestation of the disease. In four patients it was paresis of the facial nerve, in two instances diabetes insipidus, in two instances affection of the spinal cord with subsequent spastic triparesis or paraparesis of the lower extremities, in one instance the disease was manifested by neuralgia of the trigeminal nerve. The serious character of the disease is apparent from the fact that only in two instances complete regression of symptoms occurred. In three patients regression was partial, in one instance the affection persisted without changes and in one instance it progressed to metabolic breakdown with a fatal outcome. In the differential diagnosis examination of the nervous system by computed tomography, magnetic resonance and possibly perimyelography proved to be helpful. In all instances there was a typical finding in cerebrospinal fluid. Lymphomonocytic pleocytosis was present, a raised protein content, elevated gammaglobulin levels. The diagnosis was assisted by radiograms of the chest and biopsy. The latter was made from intrathoracic or subcutaneous nodes, in one instance from muscle. As auxiliary methods the following were used: tuberculin test, bronchoalveolar lavage, pulmonary gallium scintigraphy, serum level of angiotensin converting enzyme and immunological examination. CONCLUSIONS: The authors emphasize the necessity of early diagnosis and intensive initial treatment with corticoids or antimalaria drugs, which may prevent the development of irreversible changes. Magnetic resonance appears to be the most promising examination method in neurosarcoidosis.
Adult↗
CT and MRI findings after stereotactic resection of brain lesions.
OBJECTIVE: To describe postoperative CT and MRI findings and their time course in uncomplicated cases after stereotactic volumetric resections of brain lesions. MATERIALS AND METHODS: One-hundred twenty-eight imaging studies (CT, 86; MRI, 42), performed 6 h to 2 years after 52 stereotactic operations, were retrospectively reviewed and analyzed in relation to time of surgery in cases without complications. RESULTS: The extent of resection bed did not change during the first week after operation; reduction of size then began and continued up to 3-6 months. Mass effect and edema showed no changed during the first 4 days, then later regressed gradually. Pneumocephalus was found in 58% of cases in the first 3 weeks, but never later. Benign, surgically-induced enhancement appeared at the margins of encephalotomy and retractor at the end of the first postoperative week, became more prominent during the following weeks, and lasted up to 3-5 months. In the majority of cases enhancement prevented recognition of the residual tumor. Dural enhancement was observed at the craniotomy site very early after the operation and persisted up to 1 year. Meningeal enhancement over convexities was found in 44% of MRI studies. CONCLUSION: Extent of the resection bed, mass effect, edema, and pneumocephalus show, in uncomplicated cases, a regular regression during the postoperative period. The time course of enhancement is complex and can be a source of diagnostic misinterpretation.
Brain↗
Osteochondroma of the thoracic spine: an unusual cause of spinal cord compression.
A 24-year-old man with hereditary multiple exostoses had numbness of the lower extremities and difficulty walking. CT displayed a calcified extradural mass lesion within the spinal canal at T-8 causing cord compression. MR imaging showed it to be contiguous with the upper endplate of T-8, suggesting the diagnosis of osteochondroma, a rare cause of cord compression, and distinguishing the lesion from a calcified disk fragment.
Adult↗
Crack cocaine and HIV in the inner city.
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Crack Cocaine↗
Relationship between the gas composition of the middle ear and the venous blood at steady state.
Concomitant continuous measurements of the steady-state gas composition of the middle ear and of the venous blood were recorded by mass spectrometry in four guinea pigs. The following mean values were obtained for the partial pressures of middle ear gases; nitrogen + argon, 606.4 mm Hg; oxygen, 46.2 mm Hg; and carbon dioxide, 60.2 mm Hg. The corresponding values for the venous blood were as follows: Nitrogen + argon, 563.4 mm Hg; oxygen, 38.0 mm Hg; and carbon dioxide, 61.4 mm Hg. The similarity of the steady-state gas composition of the middle ear to that of the venous blood suggests that the partial pressures of the gases in the middle ear are controlled by interchange with gases present in the blood.
Animals↗
Direct demonstration of gas diffusion into the middle ear.
The gas composition of the middle ear differs from that of air, and resembles the gas composition of mixed venous blood. This observation suggests the existence of a bi-directional route for gas diffusion between the middle ear and blood. In an attempt to demonstrate this route in a direct way, we tracheotomized guinea pigs in such a way that they breathed freon-22 directly into the distal part of their tracheostomy. The proximal part of the trachea was sealed so that air by-passed the oropharynx and nasopharynx, thus preventing freon-22 from making contact with the eustachian tube orifice. At the same time middle ear gases were monitored with a mass spectrometer, through a measuring probe which was inserted into a hole in the bulla. The appearance of freon-22 in all middle ears--after 8 min on the average--demonstrated direct gas diffusion from the blood into the middle ear, since freon-22 could reach the middle ear only from the blood stream, i.e., by diffusion. Differences in gas diffusion rates into and from the middle ear may therefore play a role in regulating middle ear gas economy, and therefore in middle ear pressure.
Animals↗
Bilateral asymptomatic masses in posterior mediastinum. Intrathoracic extramedullary hematopoiesis.
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Adult↗
[Congenital dyserythropoietic type II anemia complicated by extramedullary hematopoiesis in the posterior mediastinum].
In a 48-year-old woman investigated on account of congenital dyserythropoietic anaemia type II (HEMPAS) on the X-ray of the chest a polycystic sharply defined shadow in the posterior mediastinum was detected and extramedullary haematopoiesis was suspected. The diagnosis was confirmed cytologically. According to the authors' knowledge this is the second case of this rare complication in CDA-II in the world and the second case of EMH in the mediastinum in this country. In the discussion the authors summarize the diagnostics of congenital dyserythropoietic anaemias. They discuss also the pathogenesis of extramedullary haematopoiesis, diagnosis and differential diagnosis of EMH in the posterior mediastinum, possible complications and treatment.
Adult↗
[Prenatal cytogenetic diagnosis of trisomy 21 using amniotic fluid cells].
BACKGROUND: Trisomy 21 is the most frequent chromosomal disorder which is associated with advanced maternal age. OBJECTIVES: The aim of our work was to examine the risk of trisomy 21 occurrence in a group of pregnant women subdued to prenatal cytogenetic examination. METHODS: The examined group consisted of 1128 pregnant women. The cells for cytogenetic analysis were obtained by means of transabdominal amniocentesis during the second trimester of pregnancy. Cultivation of amniocytes lasted 15-20 days. The chromosomes were stained by a conventional and G-striping method. RESULTS: Cytogenetic analyses have indicated that the aberrant karyotype was present in 32 (2.82%) out of 1128 fetuses. In addition the results have confirmed that trisomy represented the most frequent chromosomal aberration (60%) detected by means of prenatal cytogenetic diagnostic examinations and the risk of its incidence increased exponentially in women who were older than 35 years of age. CONCLUSIONS: The prenatal cytogenetic diagnosis represents a significant role in the prevention of hereditary conditioned chromosomal disorders. (Tab. 1, Fig. 1, Ref, 13.)
Amniocentesis↗
Integrated ambulatory care resource scheduling in oncology.
In a modern managed-care environment, the scheduling of ambulatory care activities must be viewed as a series of closely related activities rather than a group of unique and independent events. These activities must be sequenced in a logical manner, and linked with a variety of information on other clinical, operational, and administrative activities. This article focuses on such an integrated scheduling system which supports the ambulatory care services at the Johns Hopkins Oncology Center.
Ambulatory Care Information Systems↗
Interaction of cycloalkanoprogesterones with mammalian progesterone receptor: binding of pregna-D'-pentaranes in the calf uterine cytosol.
Pregna-D'-pentaranes (pentaranes) are modified progesterones with demonstrable progestational activity and contraceptive effect. We have examined the steroid binding characteristics of the two newly synthesized progesterone analogs, Pentarane A (16 alpha, 17 alpha-cyclohexanoprogesterone) and Pentarane B (6 alpha-methyl, 16 alpha, 17 alpha-cyclohexanoprogesterone), and studied the nature of their interaction with progesterone receptor (PR) from the chicken oviduct and the calf uterine cytosols. Pregna-D'-pentaranes exhibited no affinity for the chick PR but interacted with the calf uterine PR as did R5020. The pentaranes, however, bound PR less tightly. R5020- or pentarane-bound PR sedimented as an 8S moiety in 8-30% linear glycerol gradients. Thermal transformation of receptor resulted in the reduction of the 8S form, and caused an increase in the binding of R5020- and progesterone-bound PR complexes to DNA-cellulose. The pentarane-bound PR bound poorly, if at all, to DNA-cellulose. Our data suggest that pentaranes exhibit both similarities and differences with natural and synthetic progestins with respect to their interaction with calf uterine PR. The lack of pentarane binding to chicken PR is reminiscent of the general phenomenon that antiprogestins (RU486, ZK98299, and Org 31710 and Org 31806) do not interact with chicken PR. Pentaranes, therefore, represent unique steroid analogs to investigate the molecular mechanism of steroid hormone action.
Animals↗