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Biomedical subjects

M Rosenthal

Publications and source records attributed to M Rosenthal.

At least 91 records · Page 5Linked to original sources
PubMed1997

Neuropsychological prediction of psychosocial outcome after traumatic brain injury.

The ability of neuropsychological tests to predict later psychosocial outcome on the Community Integration Questionnaire (CIQ; WiIler, Rosenthal, Kreutzer, Gordon, & Rempel, 1993) was examined. A previous investigation by Millis, Rosenthal, and Lourie (1994) found that the Trail Making Test (TMT; Lezak, 1995) and the Rey Auditory Verbal Learning Test (RAVLT; Lezak, 1995) were related to performance on the CIQ at 1 year postinjury. The RAVLT and the TMT Parts A and B (TMT-A, TMT-B) in conjunction with age at time of injury significantly predicted psychosocial outcome as measured by individual self-report. When self-reported functioning was examined by domain, these variables significantly predicted home and social adaptation. These variables were applied to significant others' reports of community integration, where age and the TMT remained significant predictors of psychosocial outcome. These results underscore the utility of neuropsychological measures in the prediction of later community integration after traumatic brain injury.

Journal Article↗
PubMed1997

Delivery of comprehensive children's dental services using portable dental clinics in NYC public schools. A six-year analysis.

In 1990, the Bureau of Dental Health Services of the New York City Department of Health launched a major initiative to modernize a network of school-based dental clinics located throughout the city. Since 1913, the bureau has provided dental care to public school children; however, the clinics were not properly maintained or upgraded, and were in a state of disrepair and obsolescence. Anticipating that the survival of the program was in question, the school program was converted to a fleet of state-of-the-art portable dental clinics permitting targeting of underserved, high-risk poor and immigrant populations. Demographics had changed dramatically over the years; the program could now situate services where they were needed most, and provide a broader array of care where access was a problem. This paper presents a six-year analysis of the program and builds a strong case to show that a portable delivery system can equal or in many ways surpass the effectiveness and capabilities of a fixed-state approach.

Child↗
PubMed1997

Primary hyperparathyroidism: neuropsychiatric manifestations and case report.

We describe an elderly patient with primary hyperparathyroidism and dementia who was admitted to a psychogeriatric department because of delusions of new onset. While hospitalized he had three episodes of delusions that coincided with mild hypercalcemia. Treatment for the hypercalcemia resulted in rapid remission of the delusional state, but did not induce any change in his cognitive abilities or in the severity of dementia. We review the relevant literature and offer recommendations for treatment and follow-up of elderly patients with hyperparathyroidism associated with a delusional state.

Aged↗
PubMed1996

Anoxic preconditioning in hippocampal slices: role of adenosine.

Prior studies have shown that sublethal anoxic/ischemic insults may "precondition" and thereby protect tissues such as heart and brain from subsequent insults. In hippocampal slices, we examined two hypotheses: (i) that anoxic preconditioning improves the ability of slices to recover synaptic activity following a second anoxic insult and (ii) that anoxic preconditioning involves adenosine receptors. Hippocampal slices were preconditioned by short periods of anoxia prolonged only until the onset of anoxic depolarization. The slices were then reoxygenated for 30 min, after which a second ("test") anoxic insult was induced. Amplitudes of evoked potentials recovered significantly better after "test" anoxic insults in preconditioned slices. In control slices, transient superfusion with adenosine or an adenosine A1 receptor agonist (2-chloroadenosine) 30 min prior to "test" anoxia markedly improved evoked potential recovery. Administration of 8-cyclopentyl-1,3-dipropylxanthine, an A1 receptor antagonist, blocked the protection afforded by preconditioning. These data support the hypothesis that adenosine, probably by its activation of A1 receptors, is involved in the neuroprotection afforded by anoxic preconditioning in hippocampal slices. Preconditioning insults may have a significant clinical impact, since certain surgical procedures may require, or produce, multiple periods of brain ischemia.

Adenosine↗
PubMed1996

Functional outcomes of older adults with traumatic brain injury: a prospective, multicenter analysis.

OBJECTIVE: To investigate improvement rates and medical services costs in older brain injured adults relative to younger patients. DESIGN: Descriptive statistics were computed in a prospective comparative study of 50 patients 55 years and older and 50 patients 18 to 54 years old matched for gender and injury severity (number of days in coma, admission Glasgow Coma Score, intracranial pressure). Independent t tests were performed to examine differences between the two samples on specific variables. SETTING: Five medical centers in the federally sponsored Traumatic Brain Injury Model Systems Project that provide emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. PARTICIPANTS: Patients were selected from a national database of 531 rehabilitation inpatients admitted to acute care within 8 hours of traumatic brain injury between 1989 and 1994. MAIN OUTCOME MEASURES: Disability Rating Scale, Functional Independence Measure, Rancho Los Amigos Levels of Cognitive Functioning Scale, length of stay, acute care and rehabilitation charges, and discharge disposition. RESULTS: Older persons averaged a significantly longer rehabilitation length of stay, higher total rehabilitation charges, and a lower rate of change on functional measures. No significant differences between groups were found for acute care length of stay, daily rehabilitation charges, acute care charges (daily or total), or discharge disposition. CONCLUSIONS: Although older persons demonstrated functional changes, the cost of change was substantially higher than for younger patients, coincident with longer lengths of stay. These higher overall charges and slower rates of change may effect changes in referral and management patterns.

Activities of Daily Living↗
PubMed1996

Neurometric QEEG studies of crack cocaine dependence and treatment outcome.

This paper presents an overview of the quantitative electrophysiological (QEEC) research on cocaine dependence conducted at Brain Research Laboratories of New York University Medical Center. These studies have demonstrated that subjects with DSM-III-R cocaine dependence (without dependence on any other substance) evaluated in the withdrawal state, have replicable abnormalities in brain function when evaluated at baseline (approximately 5 to 10 days after last crack cocaine use), which are still seen at one and six month follow-up evaluations. These abnormalities were characterized by significant excess of relative alpha power and deficit of absolute and relative delta and theta power. Abnormalities were greater in anterior than posterior regions, and disturbances in interhemispheric relationships were also observed. In addition, QEEC subtypes were identified within the population of cocaine dependent subjects at baseline, and these subtypes were found to be significantly related to subsequent length of stay in treatment. The relationship between these QEEG findings and the neuropharmacology of cocaine dependence is discussed.

Adolescent↗
PubMed1996

Severe small airways disease resistant to medical treatment in a child with cystic fibrosis.

At the age of 12, a child with cystic fibrosis developed severe small airways obstruction of unknown aetiology, in the absence of significant bronchiectasis. He remained resistant to medical treatment until, following an exacerbation of allergic bronchopulmonary aspergillosis 18 months later, he responded to high dose oral steroids. He now remains steroid-dependent, and suffering from multiple side-effects. Possible aetiology and further therapeutic strategies are discussed.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1995

Relation of thickening of colon wall to pancreatic-enzyme treatment in cystic fibrosis.

Fibrotic strictures of the colon in association with colon-wall thickening on abdominal ultrasound have been described in children with cystic fibrosis. We determined the prevalence of colon-wall thickening in 99 children with cystic fibrosis (aged 6 months to 17 years, 45 male) and 38 healthy controls (aged 1 month to 39 years, 21 male). In controls, peristalsis was uniformly rapid and maximum wall thickness of the fully relaxed colon was 0.8 mm (median 0.6 mm). 24% of the patients had a colon-wall thickness of 1.5 mm or more (maximum 3.4 mm); 48% of children on high-strength pancreatin receiving more than 265 units/kg per day of protease had thickening of more than 1.5 mm compared with less than 12% of children on any other dose. Children on high-strength pancreatin were 5.2 (95% CI 1.2-21) times more likely to have colon-wall thickness of 1.5 mm or more than children taking less than 265 units/kg per day of protease in a standard-strength preparation. This risk rose to 10 (2.5-39) times more likely if laxatives were taken with a high-strength preparation. Lipase or amylase intake, age, sex, genotype, and other medical or drug history were not significantly associated with colon-wall thickening. 1 child required a hemicolectomy for bowel obstruction and another developed haemorrhagic colitis. In 17 children, 2 months after stopping high-strength, high protease, preparations and efforts to reduce enzyme intake, colon-wall thickness had regressed from a median 2.0 mm (range 1.0-3.4) to 1.8 mm (0.9-2.7) (p = 0.005). The use of high-strength pancreatin preparations in conjunction with a high protease intake probably causes thickening of the wall of the colon.

Adolescent↗
PubMed1995

Comparison of cardiopulmonary adaptation during exercise in children after the atriopulmonary and total cavopulmonary connection Fontan procedures.

BACKGROUND: There are several potential physiological differences between the atriopulmonary (AP) and the total cavopulmonary connection (TCPC) Fontan circulations. Studies suggest that the TCPC reduces energy loss due to turbulence and may have more dependence on respiratory movement for pulmonary blood flow. We compared cardiopulmonary physiology during rest and exercise in patients who had undergone the AP Fontan procedure with those who had undergone the TCPC Fontan procedure. METHODS AND RESULTS: Forty-three children were studied more than 6 months after undergoing a Fontan procedure (23 AP and 20 TCPC); 106 healthy children were also studied as a control group. Measurements of effective pulmonary blood flow, stroke volume, arteriovenous oxygen difference, minute ventilation, heart rate, and oxygen and carbon dioxide consumption were made with an Innovision quadrupole mass spectrometer. Data from the control group allowed calculation of z scores for the Fontan groups matched for age, sex, pubertal stage, and body surface area. Maximal exercise performance was equal in the two Fontan groups, but it was below normal. However, adaptation to exercise was different in the Fontan groups. After 9 minutes of exercise, pulmonary blood flow rose less in the AP group than in the TCPC group (P < .01), and the stroke volume in the AP group also tended to be lower (P = .057) and their arteriovenous oxygen difference was significantly greater (P < .01). Although minute ventilation per unit of carbon dioxide production was similar in the Fontan groups at this level of exercise, children in the TCPC group breathed faster by approximately 10 breaths per minute (P < .005). CONCLUSIONS: At submaximal exercise, children who had undergone the TCPC Fontan procedure had pulmonary hemodynamics superior to those of children who had undergone the AP procedure, largely because of respiratory adaptation that permitted blood to be "sucked" into the lungs. To achieve the same maximal exercise performance, children who had undergone the AP procedure had a superior metabolic adaptation to exercise stress.

Adaptation, Physiological↗
PubMed1995

A double-blind, randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder.

A large multi-center, double-blind, parallel trial to assess the efficacy of brofaromine in the treatment of post traumatic stress disorder (PTSD) failed to show a significant difference between the brofaromine and placebo treatment groups. The placebo response rate in this study was higher than that in previously published double-blind, placebo-controlled studies of PTSD.

Adult↗
PubMed1995

Mitochondrial hyperoxidation signals residual intracellular dysfunction after global ischemia in rat neocortex.

Reperfusion after global ischemia (10-60 min in duration) in rat neocortex most commonly provoked transient hyperoxidation of mitochondrial electron carriers, tissue hyperoxygenation, and CBF hyperemia. These responses were normally accompanied by recovery of K+ homeostasis and EEG spike activity. Goals of this research were to understand putative relationships among these postreperfusion events with special emphasis on determining whether mitochondrial hyperoxidation results from intracellular changes that may modulate residual damage. The amplitude of postischemic mitochondrial hyperoxidation (PIMHo) did not increase when CBF increased above an apparent threshold during reperfusion, and tissue hyperoxygenation was not required for PIMHo to occur or to continue. These findings suggest that PIMHo is not merely a response to increased CBF and tissue hyperoxygenation; rather, PIMHo is modulated, at least in part, by residual intracellular derangements that limit mitochondrial electron transport. This suggestion was supported by observations that NAD became hyperoxidized after reoxygenation in anoxic hippocampal slices. Also, PIMHo occurred and subsequently resolved in many animals, but K+o never was cleared fully to baseline and/or EEG spike activity never was evident. One suggestion is that PIMHo signals or initiates residual intracellular derangements that in turn impair electrical and metabolic recovery of cerebral neurons after ischemia; an alternative suggestion is that PIMHo and tissue hyperoxygenation are not the sole factors modulating the immediate restoration of electrical activity after ischemia. Present data also support the following: Decreased oxygen consumption, despite adequate oxygen delivery, likely contributes to tissue hyperoxygenation after ischemia; and mitochondrial hyperoxidation is modulated by a limitation in the supply of electrons to the mitochondrial respiratory chain.

Animals↗
PubMed1995

Patients requiring sedation.

Recent advances in the pharmacology of sedative drugs have expanded their use in the intensive care unit. Indications and endpoints for sedation, however, often are defined poorly and are difficult to assess. Nevertheless, the complications of sedative drug administration are real. New indications for sedation have been proposed in recent years, including enforcing sleep/wake cycles, manipulating cellular metabolism, and preventing myocardial ischemia. The evidence supporting the efficacy of these new indications is not yet complete.

Procedural Sedation↗
PubMed1994

Weight/height2.88 as a screening test for obesity or thinness in schoolage children.

We wished to determine a weight for height measure for use as a simple screening test throughout the schoolage years for obesity or thinness similar to the body mass index in adults but not correlated with either height or age. Single measurements of height, weight, pubertal stage and two site skinfold thickness were collected on 979 healthy London schoolchildren (559 male) aged 4.6-18.8 years from 11 schools by one anthropometrist. Weight/height2.88 was uncorrelated with height or age in either sex. The median (95% confidence interval of the median) value for boys (12.74, 12.58-12.90) did not vary within this age group, height or pubertal stage. In girls the median value 12.46 (12.20-12.61) was valid for all girls less than breast stage 4 but rose sharply to 13.64 (13.21-14.06) thereafter. Percentile charts and nomograms are provided. Conclusion Weight/height2.88 may be a simple screening test for obesity or thinness throughout the schooling years and that its independence of age and height greatly simplifies longitudinal assessment.

Adipose Tissue↗
PubMed1994

Photothrombotic infarction triggers multiple episodes of cortical spreading depression in distant brain regions.

The purposes of this study were to determine whether cortical spreading depression occurs outside of the infarct produced by photothrombotic vascular occlusion, and also the direction of spreading. Focal cerebral thrombotic infarction was produced by irradiating the exposed skull of anesthetized rats with green light (560 nm) following systemic injection of rose bengal dye. At proximal sites (approximately 2 mm anterior to the infarct border), transient, severe hyperemic episodes (THEs) lasting 1-2 min were intermittently recorded. THE frequency was greatest in the first hour and declined over a 3-h period. THEs were accompanied (and usually preceded) by a precipitous rise in [K+]0 (from approximately 3 to > 40 mM) and were associated with increases in local tissue oxygen tension (tPO2). Following the rise in [K+]0, clearance of [K+]0 to its pre-THE baseline preceded baseline recovery of CBF. These data indicate that THEs were reactive to physiologic events resembling cortical spreading depression (CSD), which provoked increased demand for oxygen and blood flow, and which spread from proximal sites to areas more distal (approximately 4 mm) from the rim of the evolving infarct. MK-801 (1 mg/kg, i.v.) inhibited subsequent CSD-like episodes. We conclude that photothrombosis-induced ischemia provoked CSD which was triggered either within the infarct core or in the infarct rim and spread to more distal sites. Whether multiple episodes of CSD during infarct generation are responsible for the remote consequences of focal brain injury remains to be determined.

Animals↗