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Biomedical subjects

M Polansky

Publications and source records attributed to M Polansky.

At least 55 records · Page 3Linked to original sources
PubMed1996

Inattentive behavior after traumatic brain injury.

Clinicians and families report that traumatic brain injury results in a variety of attention deficits. Numerous laboratory studies have documented slowing of information processing, alteration in event-related potentials, or difficulty attending to specific relevant task dimensions in the presence of redundant information. However, little is known about how these information processing abnormalities relate to observable behaviors in daily living or work environments, which presumably form the basis for clinicians' and families' reports. We developed a quantitative assessment of behavioral inattentiveness in both quiet and distracting environments, and demonstrated excellent interrater reliability. Using this assessment, we have studied 20 patients with recent traumatic brain injury and 20 demographically comparable control subjects. We have confirmed marked differences in behavioral attentiveness between patients and controls in both distracting and nondistracting environments.

Activities of Daily Living↗
PubMed1996

Prospective study of a PACS: information flow and clinical action in a medical intensive care unit.

PURPOSE: To prospectively compare efficiency and outcome of a standard film-only system with those of a digital picture archiving and communication system (PACS). MATERIALS AND METHODS: The film-only system, which used either analog film or computed radiography (CR) hard copy, was compared with a PACS, which used CR images displayed on a multiviewer in the radiology department and a workstation in the medical intensive care unit. A random sample of nonroutine, bedside chest radiographs was studied. RESULTS: Within 20 minutes of completion of radiography, 246 of 328 (75%) of the images were available at the workstations; it took 1.8 hours for 238 of 317 (75%) of the images to be displayed on the multiviewer. When the workstation was used, the staff did not access the image information earlier, but clinical actions were initiated more promptly in response to imaging findings. Consultation with radiologists decreased from 507 of 561 (90%) images with hard copies to 70 of 249 (28%) with the workstation. CONCLUSION: Use of a PACS improves the delivery of chest images, facilitates the initiation of clinical actions, and decreases input by radiologists.

Computer Systems↗
PubMed1996

Increased serum concentration of the soluble interleukin-2 receptor in cutaneous T-cell lymphoma. Clinical and prognostic implications.

BACKGROUND AND DESIGN: The serum concentration of soluble alpha-chain receptor for interleukin-2 (sIL-2R) was determined in 101 patients with cutaneous T-cell lymphoma (CTCL). RESULTS: The serum concentration of sIL-2R correlates positively with CTCL tumor burden as determined by several clinical parameters (ie, clinical subtype of disease, extent of skin involvement, T rating, and stage), by serum lactate dehydrogenase concentration, and by Sézary cell counts in erythrodermic disease. The median value of sIL-2R in erythrodermic CTCL was more than threefold higher than that of classic mycosis fungoides (MF). The proportion of patients with elevated sIL-2R concentration (> 1000 U/mL) also increased in CTCL in a similar fashion according to the clinical type of disease (MF patch phase, 15%; MF plaque phase, 33%; MF tumor phase, 47%; and erythrodermic variants, 90%). However, no correlation was found between sIL-2R serum concentration and expression of membrane-bound IL-2R alpha chain (CD25) on lymphoid cells in skin lesions and peripheral blood. Significantly, multivariate analysis of various prognostic factors demonstrated that in erythrodermic CTCL, sIL-2R serum concentration correlated best with survival and was a better predictor of prognosis than stage, Sézary cell counts, or lactate dehydrogenase values. CONCLUSIONS: These findings document the usefulness of the measurement of the sIL-2R serum concentration to determine tumor burden and prognosis in patients with CTCL.

Adult↗
PubMed1995

Risk factors for gallbladder cancer. An international collaborative case-control study.

BACKGROUND: Gallbladder cancer has an unusual geographic and demographic distribution, suggesting many possible etiologies. METHODS: A case-control study was undertaken at four hospitals in La Paz, Bolivia, and at one hospital in Mexico City, Mexico. Eighty-four patients with newly diagnosed, histologically confirmed gallbladder cancer were compared with 126 control subjects without stones and with 264 control subjects with cholelithiasis or choledocholithiasis without cancer. All study subjects underwent abdominal surgery. Study subjects were interviewed regarding demographic characteristics, medical history, family history, diet, and exposure to agents presumed to be risk factors for biliary cancer. RESULTS: Virtually all subjects in Mexico were judged to be mestizos (i.e., persons of mixed ancestry) In contrast, race was a very strong risk factor for gallbladder cancer in Bolivia. Relative to mestizos who spoke neither language, the odds ratio (95% confidence interval [CI]) for cases versus control subjects without stones for those who spoke Aymara well was 15.9 (CI, 1.9-179), whereas it was 1.4 (CI, 0.2-8.2) for those who spoke Quechua well. An increased risk was also noted for elevated maximum body mass index (P = 0.03), family history of gallstones (odds ratio [OR] = 3.6 [CI, 1.3-11.4]), and physician-diagnosed typhoid (OR = 12.7 [CI, 1.5-598]). An increased risk was also seen with elevated maximum body mass index; compared with those with a body mass index less than 24 kg/m2, those with an index of 24-25 kg/m2, 26-28 kg/m2, and greater than 28 kg/m2 had odds ratios of 1.6 (CI, 0.4-7.6), 1.3 (CI, 0.3-5.6), and 2.6 (CI, 0.5-18.6), respectively (asymptotic test for trend, P = 0.03). Finally, a number of associations were noted with certain dietary and cooking habits. CONCLUSIONS: Patients with gallbladder cancer differed from control subjects in race, body mass, physician-diagnosed typhoid, and certain dietary patterns. These findings may provide useful clues to the pathogenesis of gallbladder cancer, but given the number of analyses performed, additional cases need to be studied.

Adult↗
PubMed1995

A double-blind trial of oral progesterone, alprazolam, and placebo in treatment of severe premenstrual syndrome.

OBJECTIVE: To determine the effectiveness of oral micronized progesterone, alprazolam, and placebo in premenstrual syndrome (PMS) treatment and the effect of clinical contact on treatment responses. DESIGN: Randomized, double-blind, placebo-controlled 3-month parallel treatment arms with flexible dosage and with the length of clinical contact randomized within each treatment group. SETTING: University hospital PMS medical treatment outpatient program in obstetrics/gynecology department. SUBJECTS: Among volunteers for PMS treatment, 444 were evaluated and 185 meeting defined PMS criteria were randomized to treatment; treatment data are available for 170. There were no medical withdrawals for adverse events. INTERVENTION: A double-blinded protocol in which 300 mg of oral micronized progesterone, 0.25 mg of alprazolam, or placebo was administered four times a day from day 18 of the menstrual cycle through day 2 of the next cycle, including taper. The mean daily dose at the third treatment was 1760 mg of progesterone or 1.5 mg of alprazolam. Subjects were randomized to brief (< 20 minutes) or extended (50 minutes) visits. MAIN OUTCOME MEASURES: Daily symptom report (DSR) scored for total DSR symptoms, four DSR factors. RESULTS: Alprazolam was significantly better than placebo or progesterone for total premenstrual symptoms and DSR factors of mental function, pain, and mood. Thirty-seven percent of the alprazolam group experienced a 50% reduction in total DSR scores. There were no clinically significant withdrawal symptoms when alprazolam administration was restricted to the luteal phase. Oral micronized progesterone therapy was no better than placebo. Brief vs extended visits had no effect on treatment outcome. Treatment response was associated with severity of premenstrual symptoms at baseline but with no other diagnostic variables. CONCLUSIONS: Alprazolam has a role in PMS treatment and offers a therapy limited to the luteal phase. Oral micronized progesterone is ineffective for PMS.

Administration, Oral↗
PubMed1995

Sustained arousal and attention after traumatic brain injury.

Clinicians report that patients with traumatic brain injury (TBI) often have difficulty with tasks requiring sustained attention, and there are neuroanatomical and neurophysiological reasons to expect such deficits. Nevertheless, laboratory measures of sustained attention or vigilance in TBI have produced conflicting results. These inconsistencies may be due to patient heterogeneity as well as the fact that vigilance performance is dependent on highly specific features of the task design. We developed a visual vigilance task in which the influence of non-attentional factors was minimized and task difficulty for patients and controls made comparable. Performance was characterized with respect to vigilance level as well as vigilance decrement, using measures of perceptual discrimination, response bias, reaction time and reaction time variability. Twenty-six patients with recent TBI and 18 control subjects were tested on this task. A MANOVA of ranked scores revealed significantly different patient and control performance overall. Initial level of performance (vigilance level) was slower and more variable for patients than controls, and patients showed more conservative response biases. Deterioration over time (vigilance decrement) was steeper for patients than controls for reaction time, reaction time variability, and response bias. Deterioration in accuracy (D') did not differ significantly between patients and controls. Performance was not related to available measures of injury severity. Hypotheses relating arousal mechanisms to vigilance performance are discussed.

Adolescent↗
PubMed1995

Mechanisms of platelet dysfunction and response to DDAVP in patients with congenital platelet function defects. A double-blind placebo-controlled trial.

To examine the impact of the underlying defective platelet mechanism on the response to 1-desamino-8-D-arginine vasopressin (DDAVP, Desmopressin), we studied the effect of intravenous infusion of 0.3 microgram/kg of DDAVP in a randomized double blind placebo-controlled trial with cross-over in 18 carefully characterized patients with congenital platelet defects (CPD) and BT > or = 9 min. Eleven patients had normal dense granule stores and normal thromboxane A2 (TxA2) production (Group I), 3 patients had normal granule stores but impaired TxA2 production (Group II), and 4 had delta-storage pool deficiency (Group III). DDAVP shortened BT at 50 min (DDAVP 14.6 +/- 2.2 vs placebo 19.6 +/- 2.3 min; n = 18; mean +/- SE; p = 0.003) and 4 h (17.0 +/- 2.2 vs 19.6 +/- 2.1 min, p = 0.055), and raised plasma FVIIIC and von Willebrand factor (vWF). At 50 min DDAVP shortened BT by > or = 5 min in 8 of 11 Group I patients (mean 9.7 +/- 1.3 vs 16.3 +/- 2.8 min; p < 0.008), 1 of 3 Group II patients (11.9 +/- 3.9 vs 17.7 +/- 6.6; p = NS) and none of Group III patients (mean 30 min both arms). Ten patients (Group I or II) were managed successfully during surgical procedures with DDAVP alone. We conclude that DDAVP shortens BT in majority of CPD patients with normal dense granule stores and suggest that BT response may be dependent on the underlying platelet defect. DDAVP is a useful modality in management of selected patients, particularly those with normal dense granule stores.

Bleeding Time↗
PubMed1994

Patterns of asthma mortality in Philadelphia from 1969 to 1991.

BACKGROUND: The rate of mortality from asthma has increased substantially in the United States since 1978. We analyzed the patterns of the rates of death from asthma in Philadelphia between 1969 and 1991. METHODS: The rates of death from asthma were analyzed and compared with trends in the concentrations of major air pollutants: ozone, carbon monoxide, nitrogen dioxide, particulate matter (particles < 10 microns in diameter), and sulfur dioxide. Univariate and multivariate analyses were used to study the rates of death from asthma from 1985 to 1991 and their association with race, poverty, sex, and other factors. RESULTS: The rate of death from asthma decreased from 1.68 per 100,000 people in 1969 to 0.68 per 100,000 in 1977, but then increased to 0.92 per 100,000 in 1978 and 2.41 per 100,000 in 1991. Between 1965 and 1990, the concentrations of major air pollutants declined substantially. From 1985 to 1991, 258 people were identified for whom asthma was the primary cause of death. According to multivariate analysis, the rates of death from asthma from 1985 to 1991 were significantly higher in census tracts with higher percentages of blacks (P = 0.032), Hispanics (P = 0.013), female residents (P < 0.001), and people with incomes in the poverty range (P < 0.001). CONCLUSIONS: The rates of death from asthma have increased in Philadelphia, whereas concentrations of major air pollutants have declined. The rates are highest in census tracts with the highest percentages of poor people and minority residents, particularly blacks. Public health efforts should target urban areas where the risk of death from asthma is highest.

Adolescent↗
PubMed1994

Pressure ulcers in extended care facilities: report of a survey.

A survey including 15 extended care facilities with access to ET nurse consulting services was conducted to assess current wound care protocols, practices, and educational backgrounds as well as requirements. Sixty-seven percent of facilities surveyed used a system to describe pressure ulcers. Wound care was provided by licensed practical nurses in 90% of the institutions and product decisions were made by the physician in 65% of facilities surveyed. Gauze-type dressings were used most frequently on all stages and types of pressure ulcers. A significant correlation between ulcer type and dressings used was found for stage II pressure ulcers only. Hydrocolloid and polyurethane film dressings were more likely to be used on stage II ulcers without exudate than on any other type of ulcer (p < 0.001). The ET nurse and a variety of other professionals, including product manufacturer representatives, were consulted to assess complicated wounds. In 9 of 15 instances, the ET nurse was rated as the best source of practical wound care information. Respondents preferred wound care meetings that were practical, included all levels of health care providers, focused equally on treatment and prevention, and were not expensive to attend.

Bandages↗
PubMed1994

Predictors of time to healing deep pressure ulcers.

Time to healing analysis methods (Kaplan-Meier time until healing curves) were used to compare time to healing deep pressure ulcers as a function of patient and wound characteristics at baseline and after two weeks of treatment. Time to healing was significantly reduced in patients who had a good nutritional status. Patients who were alert and coherent were also found to heal more expediently; however, mental status was not independently predictive of time to healing in the multivariable model. Larger wounds took longer to heal (median 20 days) than smaller wounds, but the difference was not statistically significant. After two weeks of treatment, ulcers in patients who were 60 to 70 years old, who had a good nutritional status at baseline and whose ulcers reduced at least 39 percent in size after two weeks, were found to heal much more expediently. Cox regression models showed that these factors were independently predictive of time until healing (Likelihood ratio statistic on 5 DF = 26.485, p < 0.001). Clinical assessments, both at baseline and regular intervals thereafter, may predict treatment outcome of full-thickness pressure ulcers.

Aged↗
PubMed1993

Electrophysiological-anatomic correlates of ATP-triggered vagal reflex in dogs.

To test the hypothesis that afferent traffic of the ATP-triggered vagal reflex travels mainly in the right vagus nerve, we quantitated the response of the sinus node pacemaker activity and atrioventricular (AV) nodal conduction to increasing doses of intra-atrial ATP under baseline conditions, in the presence of aminophylline, and subsequently after either right followed by left cervical vagotomy or vice versa. In addition, the effect of right vagal C-fiber afferent blockade on the action of ATP in the sinus node was also determined. Because vagal efferent traffic to the sinus and AV nodes travels mainly via the right and left vagus nerves, respectively, the working hypothesis predicted that left vagotomy would have a much smaller effect than right vagotomy on the negative chronotropic action of ATP in the sinus node and predicted similar effects of left vs. right vagotomy on the negative dromotropic action of ATP on AV nodal conduction. ATP suppressed sinus node automaticity and AV nodal conduction in a dose-dependent manner. The attenuation of the action of ATP on the sinus node by right vagotomy was much more pronounced than that caused by left vagotomy, while the negative dromotropic action of ATP in the AV node was similarly attenuated by right vs. left vagotomy. In addition, sinus node automaticity, which was only mildly attenuated by left vagotomy, was markedly suppressed by right vagal C-fiber afferent blockade. It was concluded that in the dog, afferent vagal traffic triggered by intra-right atrial ATP travels under these experimental conditions mainly via the right vagus nerve.

Adenosine Triphosphate↗
PubMed1993

Sonographic brightness of the flexor tendons and ligaments in the metacarpal region of horses.

Sonographic observations were made of the image mean gray scale (MGS) of the flexor tendons and ligaments in the left and right metacarpal regions of each of 10 clinically normal horses. In images made in the dorsal and sagittal planes, the MGS was measured at multiple sites in the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), accessory ligament (AL), and suspensory ligament (SL), and at single sites in the medial and lateral limbs of the SL, and the palmar ligament. Relative sonographic brightness of each tendon and ligament was calculated by dividing the value of its MGS by the mean value for the MGS of images of 3 soft tissue equivalent phantoms. When a multivariate repeated-measures of ANOVA of the relative brightness values was statistically significant (P < or = 0.05), Tukey's method of multiple comparisons was used to determine which values were significantly different from each other. In the dorsal plane, the SL was significantly brighter than the DDFT, SDFT, and AL; relative brightness of the DDFT and SDFT were similar, as were those of the SDFT and AL. In the sagittal plane, the SL again was the significantly brightest structure, followed by the AL, and similar brightness of the DDFT and SDFT. In dorsal images made 25 cm distal to the accessory carpal bone, relative brightness of the SDFT, DDFT, and the medial and lateral limbs of the SL were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

The impact of falls in an inner-city elderly African-American population.

OBJECTIVE: To describe the impact of falls in an elderly African-American urban community and to identify predictors of poor recovery from falls. DESIGN: Prospective cohort study. SETTING: Emergency departments of 11 hospitals in western Philadelphia. SUBJECTS: Interviews were conducted with 197 African-American persons 65 years and older residing in West Philadelphia who were treated at an emergency department because of a fall. Second interviews were conducted a median of 7 months after the fall with a sample of 70 patients who had not recovered at the time of the first interview. MAIN OUTCOME MEASURES: Information abstracted from emergency department medical records and information on recovery obtained from two subsequent interviews. RESULTS: A median of 8 weeks after the fall occurred, 43% of persons reported continued pain or restriction in their usual activities as a result of the fall. Predictors of poor recovery included the presence of grandchildren in the household, hearing impairment, severity of the injury, and injury to the lower extremities. Having someone present at the time of the fall was associated with a lower risk of poor recovery. Forty-one percent of the 70 persons interviewed a second time reported continued pain or restriction in usual activities a median of 7 months after the fall occurred. However, only 7% and 39% had received the services of a home health aide or physical therapist, respectively, and only 14% reported that a physician or other health professional had been particularly helpful since the fall had occurred. CONCLUSIONS: A large proportion of elderly African-American persons treated at emergency departments for falls experience continued pain and restriction of activities after the fall. Many individuals have not recovered 7 months or longer after the fall and few persons report that a physician or other health professional has been particularly helpful since the fall occurred. We suggest that follow-up programs be developed for elderly persons in minority communities who come to emergency departments after a fall.

Accidental Falls↗
PubMed1991

The relationship between recent cocaine use and pregnancy outcome.

We conducted urine screening for cocaine metabolite in 500 consecutive women admitted to a labor and delivery unit. The pregnancy outcome of 411 of the women was determined at that admission. The prevalence of cocaine-positive urines was 15.3% (95% confidence interval 11.8-18.8%). A subset of this population that had not received prenatal care had a prevalence of 62% (95% confidence interval 47.2-76.6%). Women with positive urines were almost four times more likely to have preterm labor and over twice as likely to deliver a premature infant or one with a 1-minute Apgar score of 6 or lower. Our findings support the concept that urine drug screening for cocaine and/or other drugs of abuse should be considered in patients who present with no prenatal care, premature labor, premature delivery, and delivery of an infant with a 1-minute Apgar score of 6 or less. This strategy may enable us to identify and bring to therapy a population of women that could potentially go unrecognized.

Adult↗
PubMed1991

Blood pressure patterns in the first three days of life.

Current blood pressure data for healthy newborn infants consist primarily of single measurements of systolic and diastolic pressure in the first 48 hours of life. The purpose of this study was to determine if blood pressure levels are stable or are changing during the first few days of life. To determine blood pressure level and trend, indirect blood pressure was measured on day 1 through day 3 of life in all infants admitted to the well newborn nursery at Hahnemann University Hospital in Philadelphia. Systolic pressure correlated significantly with birthweight on day 1 of life (P less than .03). Repeated measures analysis of variance demonstrated a significant increase in both systolic and diastolic pressures over the first 72 hours of life (P less than .001). There was no difference in blood pressure among racial groups (black, Hispanic, white, Asian). In healthy newborns, there was no correlation of blood pressure with maternal conditions: toxemia, diabetes, substance abuse. These data demonstrate that blood pressure correlates with birthweight in well newborns. There is, however, a significant progressive increase in both systolic and diastolic blood pressure over the first 3 days of life, regardless of birthweight or maternal conditions.

Analysis of Variance↗
PubMed1990

Ineffectiveness of progesterone suppository treatment for premenstrual syndrome.

Progesterone is the most widely used treatment for premenstrual syndrome. To answer definitely the question of whether progesterone suppositories are effective for the treatment of premenstrual syndrome, a randomized, placebo-controlled, double-blind crossover study of 168 women, receiving progesterone in doses of 400 and 800 mg or placebo, was carried out. Premenstrual symptoms were not significantly improved by progesterone compared with placebo in any measure used in the study, including daily symptom reports maintained throughout treatment, clinician evaluation of improvement, and patient global reports of symptoms severity, relief, and disruption of daily activity. No symptom cluster or individual symptom differed significantly between progesterone and placebo treatment. These treatment results were not significantly affected by fluctuations in response during the placebo washout period, pretreatment levels of depression or anxiety at either postmenstrual or premenstrual times, or any of 19 other background, medical history, or symptom variables examined individually as covariates with treatment.

Adult↗
PubMed1989

Inhibition of 7,12-dimethylbenz[a]anthracene-initiated and 12-O-tetradecanoylphorbol-13-acetate-promoted skin papilloma formation in mice by dehydroepiandrosterone and two synthetic analogs.

Previous work has demonstrated that the adrenal steroid, dehydroepiandrosterone (3-beta-hydroxy-5-androsten-17-one, DHEA), has broad spectrum tumor chemopreventive activity in laboratory mice and rats, inhibiting the development of spontaneous breast cancer and chemically induced tumors of the lung, colon, skin, thyroid and liver. DHEA treatment produces specific side-effects, including estrogenic and androgenic action and an increase in liver weight, which could limit its use as a cancer chemopreventive drug. It is now shown that oral administration of the synthetic steroid 16 alpha-fluoro-5-androsten-17-one, which lacks the side-effects of DHEA treatment, to CD-1 mice inhibits 7,12-dimethylbenz[a]anthracene-initiated and 12-O-tetradecanoylphorbol-13-acetate-promoted skin papilloma formation at both the initiation and promotion stage. The synthetic steroid is more potent as an inhibitor of papilloma formation than comparably administered DHEA.

9,10-Dimethyl-1,2-benzanthracene↗