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Biomedical subjects

M S Jacobson

Publications and source records attributed to M S Jacobson.

At least 37 records · Page 2Linked to original sources
PubMed1995

Effects of dietary modification and fish oil supplementation on dyslipoproteinemia in pediatric systemic lupus erythematosus.

OBJECTIVE: To determine if a program of dietary modification and fish oil supplementation is effective in treating the dyslipoproteinemia in pediatric systemic lupus erythematosus (SLE). METHODS: Prospective clinical trial where each patient serves as his/her own control. Twenty-four consecutive adolescents fulfilling SLE classification criteria were screened with fasting lipid profiles. Patients were identified as having dyslipoproteinemia of active disease or of corticosteroid therapy. Patients were treated for 6 weeks with dietary modification and if dyslipoproteinemia did not normalize with another 6 weeks of dietary modification and fish oil supplementation. RESULTS: Seventeen patients (71%) had dyslipoproteinemia; 10 of active disease, 4 of steroid therapy; 3 with a combined pattern. Eleven patients underwent dietary modification. There was a significant decrease in serum triglyceride concentrations (p < 0.05). Total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol did not change significantly. A further significant decline in serum triglycerides was achieved with fish oil supplementation (p < 0.05). Five of the 11 patients who underwent treatment continued to have dyslipoproteinemia. CONCLUSION: Dyslipoproteinemia is common in pediatric SLE. Dietary modification and fish oil supplementation appear to be effective in improving serum lipid profiles, and blinded studies are warranted. a significant number of patients may require pharmacologic therapy for persistent dyslipoproteinemia to prevent complications of premature atherosclerosis.

Adolescent↗
PubMed1994

Disturbances in growth hormone secretion and action in adolescents with anorexia nervosa.

Women in whom anorexia nervosa develops during adolescence have failure of linear growth associated with low levels of insulin-like growth factor I (IGF-1). To investigate the pathophysiology of growth retardation in adolescents with anorexia nervosa, we measured basal growth hormone (GH), growth hormone-binding protein (GHBP), IGF-1, and insulin-like growth factor binding protein-3 (IGFBP-3) in three groups of patients: (1) 28 recently hospitalized female adolescents with anorexia nervosa, (2) 23 of the same patients after partial weight restoration, and (3) 28 healthy control subjects matched for age, sex, and pubertal stage. Fasting GH levels in group 1 did not differ significantly from those in group 3. In contrast, serum GHBP (p < 0.001), IGF-1 (p < 0.001), and IGFBP-3 (p < 0.01) were significantly lower in group 1 than in group 3. Serum GHBP and IGFBP-3 levels were positively correlated with body mass index. Serum GHBP levels were low in patients in all five pubertal stages and even in those shown to have adequate GH secretion. In group 2 (after refeeding) the serum IGF-1 concentration increased significantly and GHBP and IGFBP-3 returned to normal. We conclude that patients with anorexia nervosa have diminished GH action resulting in decreased secretion of IGF-1. The positive correlation with body mass index and the reversibility with refeeding suggest that these changes are secondary to malnutrition. Altered GH function that occurs during the years of active growth can explain the growth retardation seen in anorexia nervosa.

Adolescent↗
PubMed1994

Rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts.

OBJECTIVE: To ascertain the rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts, differing in criterion weight gain required to earn increasing privileges. DESIGN: Follow-up comparison of cohorts receiving different interventions. SETTING: Eating disorders service, operating on a general adolescent medicine unit. PATIENTS: Patients admitted consecutively who met the following criteria: (1) weight at least 15% less than that expected for age, sex, and height; (2) female gender; (3) absence of chronic medical illness; (4) hospital stay of at least 28 days. Twenty-two patients meeting these criteria were treated between July 1987 and October 1988, when contract 1 was in effect. This cohort of patients was compared with a group of 31 patients, also meeting the these criteria, who were treated between November 1988 and December 1991, when contract 2 was in effect. INTERVENTIONS: The behavioral contract, signed by the patient on admission, specifies the minimum 4-day weight gain necessary to earn increasing ward privileges, such as use of phone, frequency of visits, etc. Contracts 1 and 2 differed only in the 4-day weight gain criterion: 0.8 lb (0.36 kg) and 1.2 lb (0.55 kg), respectively. RESULTS: The results of analysis of covariance, with admission weight as the covariate, revealed a significant interaction between contract and day, such that patients receiving contract 2 gained weight more rapidly (0.36 lb/d) than those receiving contract 1 (0.20 lb/d). There was no confounding difference between groups in the use of psychotropic medication, and no complications of refeeding in either group. CONCLUSION: Increasing the 4-day criterion weight gain from 0.8 to 1.2 lb in a behavioral contracting intervention was associated with a significant increase in the rate of weight gain, without an accompanying increase in complications of refeeding. This result simultaneously: (a) provides support for the efficacy of behavioral contracting and (b) reveals malleability in the rate of gain based on the targeted gain specified in the contract.

Adolescent↗
PubMed1993

Adolescent obesity and cardiovascular risk: a rational approach to management.

Ten obese adolescents, referred because of elevated cardiovascular disease risk, were treated in a pediatric atherosclerosis prevention center. The focus of treatment was an increase in exercise tolerance and aerobic capacity and a decrease in the percentage of fat in the diet. Weight loss was not a goal of treatment, but continued growth with a slowing of the rate of weight gain was emphasized. All patients were at elevated cardiovascular risk at the entry to the study, and nine of the ten had significant improvements in one or more of their cardiovascular risk parameters. Furthermore, with regard to body composition, eight of the ten patients were able to improve their body mass index. On average, triceps skinfold thicknesses declined 25 percent. Total cholesterol declined 14%, triglycerides declined 33%, LDL cholesterol declined 13%, and HDL cholesterol did not change with this form of treatment. As for systolic and diastolic blood pressure, four of the ten patients who had elevated blood pressures at the initiation of treatment were able to decrease their blood pressure, in absolute terms and on the basis of their percentiles for age and sex. We conclude that, in obese adolescents, improved diet and body composition, a slowed rate of weight gain, and a reduction of cardiovascular risk shown through lipid profiles and blood pressures can be achieved from a multidisciplinary treatment program focused on achievable goals. These goals include (1) increased habitual exercise and increased aerobic exercise and (2) a decrease in the percentage of energy intake from fat and saturated fat, with a concomitant decrease in the balance of energy intake to energy output. It is important to remember that we did not focus on weight loss per se and that the treatment was individualized to the developmental stage of the adolescent.

Adolescent↗
PubMed1993

Survival and half-life of red cells salvaged after hip and knee replacement surgery.

The survival of autologous red cells collected intraoperatively has been reported previously. This study measures the survival and half-life of red cells collected 3 hours after hip and knee arthroplasty. For six patients, four having knee replacements and two having hip replacements, the salvaged red cells were labeled with radioactive 51Cr. Peripheral blood was simultaneously labeled with nonradioactive 52Cr. There was no significant difference in the survival or half-life of the salvaged and the venous blood.

Chromium Radioisotopes↗
PubMed1993

Inhibition of macrophage superoxide generation by dehydroepiandrosterone.

To understand the anti-atherosclerotic mechanism of the steroid dehydroepiandrosterone (DHEA), the effect of DHEA on rat peritoneal macrophage superoxide generation was studied. Dehydroepiandrosterone (12.5 to 50 microM) inhibited digitonin-stimulated superoxide production in a dose-dependent manner, with 100% inhibition achieved at 50 microM. Dehydroepiandrosterone also inhibited macrophage superoxide production stimulated with phorbol myristate acetate, A23187 (calcium ionophore), sodium fluoride, and arachidonate. Dehydroepiandrosterone did not affect the activity of nicotinamide-adenine dinucleotide phosphate oxidase, which generates superoxide. Dehydroepiandrosterone inhibited superoxide formation in the presence of nicotinamide-adenine dinucleotide phosphate, potassium cyanide, and 2,4-dinitrophinal, suggesting that DHEA does not exert its effects by inhibiting glucose-6-phosphate dehydrogenase activity or mitochondrial respiration. Of the several steroids tested, epiandrosterone was as effective as DHEA in inhibiting macrophage superoxide production. Estrogen, androstenedione, and dihydroxytestosterone showed 25% inhibition, whereas pregnenolone, progesterone, testosterone, etiocholanolone, androstenediol, and DHEA-sulfate had minimal effect. The steroids cortisol and corticosterone had slight stimulatory effect. These results suggest that the anti-atherosclerotic effect of DHEA may be the result of inhibition of superoxide generation in macrophages.

Animals↗
PubMed1991

A randomized clinical trial of feeder vessel photocoagulation of sickle cell retinopathy. A long-term follow-up.

Long-term follow-up of patients enrolled in a randomized prospective trial of feeder vessel photocoagulation for proliferative sickle retinopathy has been completed. Of the 44 patients enrolled in Chicago, nearly a decade follow-up has been achieved on 29 patients (45 eyes). There were 20 control untreated eyes and 25 argon laser-treated eyes. Prolonged loss of visual acuity was rare in both groups. Argon laser photocoagulation has had a sustained effect on reducing the incidence of vitreous hemorrhage and visual loss from vitreous hemorrhage. Nine (45%) of 20 control eyes had vitreous hemorrhage, and it was recurrent in six (66%) of these nine eyes. A single episode was the only hemorrhagic event in the treated eyes. The laser-induced complications of choroidal neovascularization or retinal detachment were not associated with long-term visual sequelae. New sea fan evolution in 47% of study eyes suggests that these patients require long-term surveillance.

Adolescent↗
PubMed1991

[A new approach for transfusion of neocytes: the Neocel system].

Young red cells (neocytes) were prepared in a double transfer pack having a long, narrow separation bag that allows for a density gradient column to be established during centrifugation. The lighter fraction of red cells (neocyte fraction) was then expressed into a second delivery bag. Phthalate ester density distribution curves showed that 87.1% of the neocyte units had greater than 85% enrichment, i.e. more than 85% of the cells had densities lower than the midpoint density of the original red cell unit, thalassemic patients receiving neocytes had an average decrease of 21.1% in red cells per kg/yr as compared to their frozen red cell requirement, and an average of 6.9% fewer transfusions.

Blood Transfusion↗
PubMed1991

Passive smoking alters lipid profiles in adolescents.

Although cigarette smoking is associated with elevation of plasma lipid levels and changes in lipoprotein distribution, it is not known whether passive smoking is associated with an alteration in lipid profiles. The relation between plasma cotinine, a marker of exposure to tobacco smoke, and lipid profiles was studied in healthy adolescents from a suburban New York high school district who were undergoing preparticipation sports physicals. Forty-four percent of the adolescents reported that one or both parents currently smoked. Eleven percent of the adolescents had plasma cotinine concentrations greater than or equal to 2.5 ng/mL, the level considered indicative of exposure. Adolescents with two smoking parents had significantly higher plasma cotinine concentrations after adjustment for other factors than adolescents whose parents did not smoke. Plasma cotinine concentration greater than or equal to 2.5 ng/mL was associated with an 8.9% greater ratio of total cholesterol to high-density lipoprotein cholesterol (P less than .003) and a 6.8% lower high-density lipoprotein cholesterol (P less than .03). These results suggest that passive smoking, like active smoking, leads to alterations in lipid profiles predictive of an increased risk of atherosclerosis.

Adolescent↗
PubMed1991

Sympathetic ophthalmia associated with anterior chamber intraocular lens implantation.

We describe a rare case of sympathetic ophthalmia associated with intracapsular cataract extraction and anterior-chamber intraocular lens implantation. This occurred three months after an immediate postoperative complication of pupillary block, flat anterior chamber, and wound dehiscence with one of the lens haptics dissecting into the subconjunctival space. Both eyes developed granulomatous panuveitis, which partially responded to medical treatment. Removal of the anterior-chamber intraocular lens and pars plana vitrectomy resulted in control of the uveitis with significant visual improvement. A pathologic examination of material from the anterior chamber and vitreous showed lymphocytes, histiocytes, and pigment cells contributing to the diagnosis of sympathetic ophthalmia. To the best of our knowledge, this is the first report of an intraocular lens implicated as a cause of sympathetic ophthalmia.

Aged↗
PubMed1990

Correlation of electroretinographic findings and peripheral retinal nonperfusion in patients with sickle cell retinopathy.

This study examined the relationship between the proportion of peripheral retinal nonperfusion and electroretinogram measures in one untreated eye of 44 patients with sickle cell retinopathy. The proportion of peripheral retinal nonperfusion was derived from fluorescein angiographic frames covering 180 degrees of the temporal periphery. The extent of peripheral retinal capillary nonperfusion was greater in patients with peripheral retinal neovascularization compared with those without neovascularization. Reductions in electroretinogram a- and b-wave amplitudes were found in patients with and without neovascularization. However, such reductions were of greater frequency and magnitude in patients with neovascularization. Electroretinogram abnormalities were restricted to reductions in amplitude; implicit times were generally normal. In terms of the variables of the b-wave luminance-response function, abnormalities were restricted to reductions in the amplitude variable Rmax; values of logK and n were generally within the normal range. Across all patients, there was a significant negative correlation between electroretinogram amplitude measures and capillary nonperfusion, indicating that the electroretinogram provides information about the functional consequences of peripheral capillary nonperfusion in sickle cell retinopathy.

Adolescent↗
PubMed1990

Blunted growth hormone responses to clonidine in adolescent girls with early anorexia nervosa. Evidence for an early hypothalamic defect.

We studied growth hormone (GH) levels in 14 adolescents with anorexia nervosa (AN), 12-20 years of age. All had amenorrhea and the duration of symptoms ranged from 2-24 months. There was no difference in unstimulated GH between the girls with AN and endocrinologically normal girls. However, the GH response to the alpha-adrenergic agent clonidine was blunted (less than 10 ng/ml) in 11 of 14 girls with AN. Our results of a normal basal GH level and blunted response to stimulation is in contrast to some reports of high basal GH levels and an exaggerated response to pituitary stimulation although it agrees with other studies. Our patient population was younger and at an earlier stage of the disease (12 with symptoms for less than 1 year) than the AN patients previously reported to have elevated GH secretion. In view of studies that report an elevated GH response to growth hormone releasing factor, our results suggest that the AN patient's abnormalities in GH secretion may result from an abnormal hypothalamic response to adrenergic stimuli. This hypothalamic abnormality might also contribute to the growth failure seen in adolescent girls with AN.

Adolescent↗
PubMed1990

Effect of weight restoration on the dyslipoproteinemia of anorexia nervosa.

Dyslipoproteinemia, a risk factor for atherosclerosis, has been described in anorexia nervosa (AN). To assess whether dyslipoproteinemia is present in our AN population, and to investigate the effect of controlled refeeding, we prospectively examined lipid profiles in 16 hospitalized adolescents with anorexia nervosa on admission and at discharge with a body weight of 90% of ideal. Healthy high school females served as controls. Total cholesterol concentration was not different from controls at either time, and there was no change with weight restoration. Triglyceride levels decreased significantly with treatment, and at discharge, levels were significantly lower than controls. High-density lipoprotein-cholesterol (HDL-C) levels increased significantly with weight gain, and were significantly higher than controls at discharge. Apoprotein A1, the major structural protein of high-density lipoprotein, was also significantly higher among the AN patients after weight gain. Low-density lipoprotein-cholesterol (LDL-C) values did not change, but apoprotein B was significantly higher than controls at discharge. The dyslipoproteinemia demonstrated in our patients was characterized by elevated HDL-C and apoprotein A levels with normal LDL-C and low triglyceride concentrations. These changes were accentuated by restoring body weight.

Adolescent↗
PubMed1990

Birth weight outcomes for repeat teenage pregnancy.

To investigate the outcomes for repeat teenage pregnancy and the effect of interpregnancy interval on birth weight, birth certificate data were reviewed from all mothers under 26 years delivering their second baby during 1981-1983 at an urban teaching hospital. Initially, 409 mothers who had delivered their first baby at the same hospital were identified. Mothers were divided into three groups: mothers under 20 years for both births; mothers under 20 years for the first birth, with the second birth delayed until 20 to 25 years; and mothers 20-25 years for both births. Group 1 mothers had high but identical rates of low birth weight (17.5%) for both parities, high rates of very low birth weight infants (less than 1501 g), and no change in mean birth weight between the two pregnancies. Group 2 mothers were older at first birth and had better outcomes for first and second births than group 1 mothers. For group 1 mothers, the initiation of prenatal care was delayed at second pregnancy compared to first pregnancy (46% receiving first trimester care versus 59% at first delivery). In contrast, groups 2 and 3 showed improvement in accessing prenatal care for the second pregnancy. Interpregnancy interval had no influence on the birth weight of the second infant in any group.

Adolescent↗
PubMed1990

Microbial challenge of a blood cell separator outside-seal bowl system.

The ability to store platelets beyond 24 hours requires a functionally closed system. This study tested the ability of a cell separator bowl seal system to resist penetration of microbial contamination under normal running conditions and under extreme environmental stress. Three test organisms, Micrococcus luteus, Serratia marcescens, and Staphylococcus epidermidis, were applied directly to the bowl at the edge of the seal or aerosolized and passed through the centrifuge chamber while the cell separator was run through a simulated platelet collection. A sterile, bacteriologic nutrient medium was perfused through the tubing set, thus simulating the flow of blood fractions. Following the procedure, the medium was examined for microbial growth. The concentration of aerosolized bacteria ranged from 5.2 x 10(1) to 3.9 x 10(3) colony-forming units (CFU) per mL, and the concentration of bacteria applied to the edge of the seal ranged from 1.9 x 10(5) to 2.8 x 10(9) CFU per mL. The positive control, direct inoculation of S. marcescens into the circulating medium (50 CFU/500 mL), resulted in recovery of the identical organism after 24 hours' incubation. No contamination of the system was detected in 40 experiments with aerosolized bacteria or in 32 experiments in which bacteria were applied directly to the seal. This study demonstrates that this sealed-bowl system resists microbial contamination.

Aerosols↗