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Biomedical subjects

M Lipkin

Publications and source records attributed to M Lipkin.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

Modulation of abnormal colonic epithelial cell proliferation and differentiation by low-fat dairy foods: a randomized controlled trial.

CONTEXT: Before the development of human colonic neoplasms, colonic epithelial cells showed altered growth and differentiation. These alterations characterized mucosa at risk for cancer formation and were termed intermediate biomarkers of risk. Modifications of the mucosa toward more normal features by nutrients or drugs are putative approaches to chemoprevention of colon cancer. OBJECTIVE: To determine whether increasing calcium intake via dairy products alters colonic biomarkers toward normal. DESIGN: Randomized, single-blind, controlled study. SETTING: Outpatient clinic. PARTICIPANTS: Seventy subjects with a history of polypectomy for colonic adenomatous polyps. INTERVENTION: Low-fat dairy products containing up to 1200 mg/d of calcium. Subjects were randomized to 4 strata by diet (control vs higher calcium) and age (<60 vs > or = 60 years). MAIN OUTCOME MEASURES: Changes in total colonic epithelial cells and number and position of thymidine-labeled epithelial cells and changes in the ratio of sulfomucins (predominantly secreted by distal colorectal epithelial cells) to sialomucins and expression of cytokeratin AE1, 2 markers of colonic cell differentiation. RESULTS: During 6 and 12 months of treatment, reduction of colonic epithelial cell proliferative activity (P<.05), reduction in size of the proliferative compartment (P<.05), and restoration of acidic mucin (P<.02), cytokeratin AE1 distribution (P<.05), and nuclear size (P<.05) toward that of normal cells occurred. Control subjects showed no differences from baseline proliferative values at 6 and 12 months (P>.05). CONCLUSION: Increasing the daily intake of calcium by up to 1200 mg via low-fat dairy food in subjects at risk for colonic neoplasia reduces proliferative activity of colonic epithelial cells and restores markers of normal cellular differentiation.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Somatization in primary care: patients with unexplained and vexing medical complaints.

Somatizing patients experience or express emotional discomfort and psychosocial distress as physical symptoms. Somatization occurs in a broad spectrum of illnesses, in association with a wide variety of mental disorders, including depression, anxiety, and the somatoform disorders. Primary care providers must detect and treat these patients. Diagnosis is based on positive criteria. Care rests upon conservative medical management and evaluation; a physician-patient relationship based on acceptance, caring, and trust; reinforcement of positive behaviors and elimination of destructive ones; and the gradual use of the relationship to promote healthy relating in the patient.

Anxiety Disorders↗
PubMedDate not supplied

The medicalization of normal variants: the case of mitral valve prolapse.

Mild mitral valve prolapse, hypoglycemia, irritable colon, and premenstrual syndrome are examples of anatomico-physiologic phenomena that largely overlap with normal. Such "overlap syndromes" become labeled disease entities by the medical community through a process called medicalization. This report uses mitral valve prolapse (MVP) to exemplify the effects of medicalization on patients, physicians, and society. Ascertainment bias and insufficient controlled clinical studies have led to the description of a clinical entity replete with false associations (e.g., mitral valve prolapse syndrome) and overly pessimistic prognostication (e.g., risk of sudden death or endocarditis), leading to clinical overreaction, overtreatment, and unnecessary induction of disability. Though some physical complications may be prevented by recognizing severe MVP, there is substantial risk of iatrogenic harm by attributing complex symptoms and illness behavior to mild MVP, which is probably a normal variant. A three-dimensional analysis of illness experience is presented that may be of use in conceptualizing the clinical approach to overlap syndromes such as mild MVP. Conservative criteria for the diagnosis of significant MVP have been developed at the National Institutes of Health. Treatment of patients with mild MVP must emphasize that it is a normal variant without serious consequences. Because the risks of overmedicalization are so substantial, the impact of diagnostic labels on individual patients and society must be analyzed continually.

Adult↗
PubMedDate not supplied

Presbycusis and communication.

Impaired hearing, so common among older people, often has disastrous consequences. The infirmity, too frequently concealed or unknown by the patient, is invisible to others. Disability and frustration can be lessened considerably by greater awareness on the part of medical and lay people about various helpful measures, which are currently under-utilized. We offer some practical suggestions: Well-trained audiologists can help with both hearing aids and rehabilitation; groups for the hard of hearing can be supportive. The number and varieties of helpful devices increase steadily. Medical personnel, families, and the general public need to learn more about communicating with these people, who need help, often desperately.

Aged↗
PubMedDate not supplied

Evaluating evaluation: assessment of the American Board of Internal Medicine Resident Evaluation Form.

The American Board of Internal Medicine suggests use of a standard form to rate residents on nine dimensions (such as clinical judgment and overall clinical competence) on a scale of 1 to 9. The authors examined the psychometric evidence for reliability and validity of 1,039 ratings of 85 residents by 135 attendings in a single internal medicine residency program. Of these ratings, 95.6% were from 6 to 9. Factor analysis revealed that high correlations among the nine dimensions (r ranged from 0.72 to 0.92) resulted from a single global factor accounting for 86% of the variance. The study also examined whether the form reliably distinguishes among residents scoring between 6 and 9. Agreement among attendings rating the same individual was weak (average reliability = 0.64, by the method of James). The rating method fails to discriminate dimensions of clinical care and has low reliability for distinguishing among competent residents.

Clinical Competence↗
PubMedDate not supplied

Abnormal cell proliferation and p52/p35-CSK expression in the colons of aging rats.

In rodents and in humans, aging is associated with increased gastrointestinal epithelial cell proliferation and an expanded crypt proliferative compartment similar to that seen in the preneoplastic bowel. We have compared the distribution of a series of cytoskeletal antigens that are modified when colonic cancer cells differentiate in vitro in the colon of young (4-7 month) and aging (22-26 month) Fischer 344 rats. Two such proteins, p52 and p35, (that are increased in cultured senescent cells) differ in their position in the crypt axis and subcellular localization between young and aging rats. In young rats, immunoreactive p52 protein is present solely near the colonic crypt surface epithelium but in aging rats p52 expressing cells are found deeper in crypts. The intracellular localization of p35 also differs markedly in young and aging animals. The distribution of these proteins appears to be a reproducible biomarker of aging. Antigenic changes similar to those observed in aging colons also are seen in crypt cells of patients with ulcerative colitis and in the flat colonic mucosa of patients with adenomatous polyps and colon cancer. The combination of proliferative and differentiation changes suggest that the flat mucosa of the colon of aging rats has preneoplastic features.

Aging↗
PubMedDate not supplied

Health-care seeking by men in their spouse's pregnancy.

This study compares the health-care seeking by 212 married male members of a health maintenance organization of 36,000 whose wives were pregnant, with a group of 212 " nonexpectant " married men matched for age, number of prior children, and HMO membership. Retrospective, blind chart review was used to examine the number and timing of medical visits and the types of symptoms, diagnoses, testing, and treatments recorded over the 21-month period surrounding and including each wife's pregnancy. Contrary to prior reports, the expectant fathers had a significantly lower group visit rate during the nine months of pregnancy when compared to their visit rates before conception and after delivery (p less than 0.01). The control group had a constant visit rate over the same time intervals. The types of symptoms and diagnoses recorded in the medical record over time were comparable in the two groups. The study suggests that expectant fatherhood, a clearly defined psychosocial event for a male, significantly influences health-care seeking but not the types of symptoms presented or diagnoses made.

Adaptation, Psychological↗