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Biomedical subjects

M Rothman

Publications and source records attributed to M Rothman.

At least 55 records · Page 3Linked to original sources
PubMed1994

Cerebral mucormycosis associated with intravenous drug use: three case reports and review.

We describe three cases of cerebral mucormycosis in intravenous drug users and review 22 previously reported cases. Involvement of the basal ganglia was demonstrated in all but two cases. Seven of the 10 patients tested for antibodies to the human immunodeficiency virus (HIV) were seronegative. Eight of the 25 patients survived and were discharged from the hospital; for 7 of 10 patients, cultures of brain lesions yielded Rhizopus arrhizus. The radiographic findings varied, and in most cases, no or minimal contrast enhancement was seen in the initial computed tomography scans. Although uncommon, the diagnosis of cerebral mucormycosis should be considered when basal ganglia lesions are present in an intravenous drug user, regardless of previous exposure to HIV.

AIDS-Related Opportunistic Infections↗
PubMed1993

Use of a direct antithrombin, hirulog, in place of heparin during coronary angioplasty.

BACKGROUND: Since the inception of coronary angioplasty, heparin with or without aspirin has been routinely given intraprocedurally to avoid coronary thrombotic complications. Recently, the direct thrombin inhibitor hirulog has been demonstrated to inactivate clot-bound thrombin. The present study was a multicenter dose escalation of hirulog to determine its appropriate dose and feasibility as the sole anticoagulant during coronary angioplasty. METHODS AND RESULTS: At 11 participating centers, 291 patients undergoing elective coronary angioplasty and pretreated with 325 mg aspirin daily were enrolled in sequential groups of intravenously administered hirulog instead of heparin as follows: group 1: bolus, 0.15 mg/kg; infusion, 0.6 mg.kg-1.hr-1 (54 patients); group 2: bolus, 0.25 mg/kg; infusion, 1.0 mg.kg-1.hr-1 (53 patients); group 3: bolus, 0.35 mg/kg; infusion, 1.4 mg.kg-1.hr-1 (44 patients); group 4: bolus, 0.45 mg/kg; infusion, 1.8 mg.kg-1.hr-1 (74 patients); and group 5: bolus, 0.55 mg/kg; infusion, 2.2 mg.kg-1.hr-1 (54 patients). The hirulog infusion was maintained for 4 hours; the primary end point was abrupt vessel closure within 24 hours of the initiation of the procedure. Activated clotting times (ACT) and activated partial thromboplastin times (aPTT) were serially monitored. Abrupt vessel closure occurred in 18 patients (6.2%). By intention to treat, the abrupt closure event rate for groups 1-3 was 11.3% compared with 3.9% in groups 4 and 5 (p = 0.052). There were no significant bleeding complications except for one patient in group 1, who received a two-unit transfusion. A dose-response curve of both ACTs and aPTTs was noted; no coronary thrombotic closures occurred in the small number of patients with ACT > 300 seconds. CONCLUSIONS: The present study documents for the first time that it is possible to perform coronary angioplasty with an anticoagulant other than heparin in aspirin-pretreated patients. Hirulog was associated with a rapid onset, dose-dependent anticoagulant effect, minimal bleeding complications, and at doses of 1.8-2.2 mg/kg, a rate of 3.9% for abrupt vessel closure.

Adolescent↗
PubMed1992

[Initial treatment of urinary tract infection with augmentin].

Urinary tract infections have been treated empirically according to the development of bacterial resistance, and semisynthetic penicillins have been out of favor. Only 12% (4/34) of our patients treated with augmentin failed to respond, compared with 20% of those on a combination of gentamicin and ampicillin.

Amoxicillin↗
PubMed1992

Health-related quality of life assessment and the pharmaceutical industry.

Concerns about cost containment in healthcare and interest in the impact of medical treatment on patient health status and well-being have increased the emphasis on health-related quality of life (HRQOL) research. HRQOL assessment as part of the development and evaluation of pharmaceuticals is a reality and is likely to increase over time. HRQOL studies may assist industry in the regulatory approval process, for marketing purposes, and to assist physicians and healthcare managers in making decisions about alternative drug therapies. HRQOL studies provide physicians with complete information about the benefits and risks of drug treatments in terms of patient physical, psychological, and social functioning and well-being. HRQOL measures, especially health utility assessments, can contribute to defining health outcomes in cost-effectiveness analyses. HRQOL studies need to be planned early in the drug development process and careful attention must be made to selecting comparative medical treatments, instrumentation, data collection protocols, length of follow-up, and sample size for these studies. It is important to address issues of investigator and other sources of bias. There is evidence that the pharmaceutical industry is increasing the use of HRQOL outcomes in clinical studies. Healthcare decision-makers, physicians and patients are demanding that industry demonstrate the impact of a new drug on patient HRQOL in addition to safety and efficacy. Clearly, HRQOL represents an important indicator of the benefit of pharmaceuticals.

Cost-Benefit Analysis↗
PubMed1990

Identification of a high risk subgroup of patients with silent ischaemia after myocardial infarction: a group for early therapeutic revascularisation?

Asymptomatic ("silent") ischaemia has been shown to be of prognostic significance in patients with stable and unstable angina and more recently in patients recovering after myocardial infarction. No therapeutic regimen has yet been shown to improve the prognosis of patients with silent ischaemia after infarction, which can be found in as many as a third of these patients. Attempts to achieve therapeutic revascularisation in all these patients may be undesirable, but early revascularisation could be especially beneficial in some selected high risk patients. Two hundred and fifty consecutive clinically stable survivors of myocardial infarction who had predischarge submaximal exercise tests were followed up for a year. Silent ischaemia was found in 27% of these patients; 15% had symptomatic ischaemia. Patients with a positive exercise test were prescribed a beta blocker before discharge. Mortality in patients with silent (9.4%) and symptomatic (5.4%) ischaemia in the first year after infarction was not significantly different. Patients with symptomatic ischaemia were more likely to have undergone coronary artery bypass grafting in the first year. Patients with silent ischaemia were, however, significantly more likely to die than patients with a negative exercise test (relative odds 12:1). Patients with silent ischaemia and an abnormal blood pressure response or who could not complete a submaximal exercise protocol were at particularly high risk, being 32 times more likely to die than those with a negative test (95% confidence interval from 3.3 to 307 times more likely). First year mortality in this group was 22%. The benefits of therapeutic revascularisation in this high risk group need to be studied.

Coronary Angiography↗
PubMed1988

A survey of extubation practices following orthognathic surgery.

The incidence of respiratory complications following orthognathic surgery was investigated by a survey of 234 private oral and maxillofacial surgeons and residency programs to determine if prolonged postoperative intubation is warranted. The results showed no significant increase in such complications when patients were extubated within 8 hours following surgery compared to longer intubation times.

Humans↗
PubMed1988

Relative power of clinical, exercise test, and angiographic variables in predicting clinical outcome after myocardial infarction: the Newham and Tower Hamlets study.

The interrelations of clinical, exercise test, and angiographic variables and their relative values in predicting specific clinical outcomes after myocardial infarction have not been fully established. Of 302 consecutive stable survivors of infarction, 262 performed a predischarge submaximal exercise test. In the first year after infarction patients with a "positive" exercise test were 13 times more likely to die, 2.8 times more likely to have an ischaemic event, and 2.3 times more likely to develop left ventricular failure than patients with negative tests. Patients with positive exercise tests underwent cardiac catheterization. Features of the history, 12 lead electrocardiogram, in-hospital clinical course, exercise test, and left ventricular and coronary angiograms that predicted these clinical end points were identified by univariate analysis. Then multivariable analysis was used to assess the relative powers of all variables in predicting end points. Certain features of the exercise test remained independent predictors of future ischaemic events and the development of overt left ventricular failure, but clinical and angiographic variables were more powerful predictors of mortality. Because the exercise test is also used to select patients for angiography, however, the results of this study strongly support the use of early submaximal exercise testing after infarction.

Adult↗
PubMed1984

DNA repair and induction of plasminogen activator in human fetal cells treated with ultraviolet light.

We have tested human fetal fibroblasts for development associated changes in DNA repair by utilizing nucleoid sedimentation as an assay for excision repair. Among skin fibroblasts the rate of excision repair was significantly higher in non-fetal cells than in fibroblasts derived from an 8 week fetus; this was evident by a delay in both the relaxation and the restoration of DNA supercoiling in nucleoids after irradiation. Skin fibroblasts derived at 12 week gestation were more repair proficient than those derived at 8 week gestation. However, they exhibited a somewhat lower rate of repair than non-fetal cells. The same fetal and non-fetal cells were also tested for induction of the protease plasminogen activator (PA) after u.v. irradiation. Enhancement of PA was higher in skin fibroblasts derived at 8 week than in those derived at 12 week gestation and was absent in non-fetal skin fibroblasts. These results are consistent with our previous findings that in human cells u.v. light-induced PA synthesis is correlated with reduced DNA repair capacity. Excision repair and PA inducibility were found to depend on tissue of origin in addition to gestational stage, as shown for skin and lung fibroblasts from the same 12 week fetus. Lung compared to skin fibroblasts exhibited lower repair rates and produced higher levels of PA after irradiation. The sedimentation velocity of nucleoids, prepared from unirradiated fibroblasts, in neutral sucrose gradients with or without ethidium bromide, indicated the presence of DNA strand breaks in fetal cells. It is proposed that reduced DNA repair in fetal cells may result from alterations in DNA supercoiling, and that persistent DNA strand breaks enhance transcription of PA gene(s).

Cell Line↗
PubMed1983

Immunocytochemical localization of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and human chorionic gonadotropin (HCG) in cervical neoplasia.

Sixty-one cases of invasive cervical carcinoma and 40 cases of dysplasia and carcinoma in situ were studied by peroxidase-antiperoxidase method (PAP) for the presence of carcinoembryonic antigen (CEA). Forty-two cases (13 carcinomas in situ and 29 invasive carcinomas) also were tested for alpha-fetoprotein (AFP) and human chorionic gonadotropin hCG. CEA was not detected in normal cervical epithelium but was present in 90% of the neoplastic lesions. Not mere presence, but a pattern of CEA tissue distribution emerged as the main differential point between noninvasive and invasive lesions. Twenty-nine of 51 invasive squamous carcinomas (57%) contained CEA-positive cells at the stromal edge of epithelium, while this feature was not found in dysplasia and carcinoma in situ. Adenocarcinomas and adenosquamous carcinomas all were positive for CEA, while clear-cell carcinomas were negative. AFP was present only in a case of poorly differentiated adenosquamous ("glassy cell") carcinoma. hCG has not been revealed in any of the tumors.

Adenocarcinoma↗
PubMed1982

Patients released after psychiatric commitment evaluation: comparison with the committed.

The authors retrospectively analyzed two groups of patients who were evaluated for involuntary commitment. Based on the psychiatrist's evaluation, one group (N = 39) was committed and the other group (N = 39) was released. The committed patients were significantly younger and diagnosed psychotic. No significant differences between groups were found in sex, race, petitioner, treatment history and presenting behavior. Psychiatrists regardless of experience tended not to commit the non-psychotic patient, with the released patients constituting a unique subgroup of the outpatient population.

Adolescent↗
PubMed1981

Prostacyclin: haemodynamic and metabolic effects in patients with coronary artery disease.

The therapeutic potential of prostacyclin was evaluated in 10 patients with angina pectoris and angiographically proved coronary artery disease. Platelet aggregation and coronary and systemic haemodynamic effects were examined before and after intravenous infusions of 2, 4, 6, and 8 ng/kg/min of prostacyclin and were dose related. At 8 ng/kg/min the ADP concentration required to induce 50% of maximum platelet aggregation increased from 1.8 to 4.5 mumol/l (p less than 0.001). Heart rate and cardiac index rose from 77 to 93 beats/min and 2.47 to 3.48 l/min/m2, respectively (p less than 0.01). Mean blood pressure and systemic and pulmonary resistances fell from 107 to 92 mm Hg and 1704 to 1048 and 80 to 45 dyn s cm-5, respectively (p less than 0.01). Coronary vascular resistance also fell from 0.95 to 0.73 units (p less than 0.01). Mean atrial pacing time to angina rose from 142 to 241 s (p less than 0.05), while lactate production during rapid atrial pacing was decreased, lactate extraction ratio rising from -25 to -9% (p less than 0.05). These coronary and systemic vasodilator effects and the prolongation of pacing time to angina indicate an acute beneficial effect of prostacyclin on angina. Since prostacyclin has been shown to prevent platelet accumulation and progression to total occlusion in animals with experimental coronary stenoses, the observed inhibition of platelet aggregation suggests that prostacyclin should be further evaluated in unstable angina.

Angina Pectoris↗
PubMedDate not supplied

Antibacterial effect of chlorhexidine on bacteria adsorbed onto experimental dental plaque.

The most common method used to examine the antibacterial effect of antiplaque agents is the minimal inhibitory concentration (MIC) method, which is tested on bacteria in suspensions. Examining the antibacterial effect on bacteria adsorbed onto dental surfaces models is not as popular, although it is clear that such models reflect the conditions in the oral cavity far more accurately than the conventional MIC method. The antibacterial effect of chlorhexidine (CHX) on bacteria adsorbed onto experimental dental plaque model was investigated. Hydroxyapatite beads were coated with human saliva. Next, cell-free fructosyltransferase (FTF) and glucosyltransferase (GTF) were adsorbed onto the beads, and sucrose was added to allow the synthesis of polysaccharide by the surface-bound enzymes. Following adsorption of Streptococcus sobrinus to the experimental dental plaque (EDP), the EDP was exposed to CHX at concentrations between 0.008 to 0.0002% at pH values of 5.5, 6.5, and 7.5. After 150 min incubation, growth of the adsorbed bacteria was measured by their incorporation of 3H-uridine or 3H-thymidine. Comparison of bacterial growth on the EDP with that in suspension showed that the surface-bound bacteria were less sensitive to CHX than were the bacteria in suspension. At all tested CHX concentrations, the antibacterial effect was independent of pH. In addition, under our experimental conditions, the use of 3H-uridine as an indicator of bacterial viability proved to be more sensitive than 3H-thymidine. The antibacterial effect of an agent in a model closely mimicking the tooth surface should generate results that are more relevant to the in vivo conditions than are conventional methods, thus bearing significant information concerning clinical applications of CHX.

Adult↗