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Biomedical subjects

M Weinberg

Publications and source records attributed to M Weinberg.

At least 55 records · Page 3Linked to original sources
PubMed1988

Ceftizoxime vs. cefotaxime--a comparative randomized multicenter study.

One hundred and fourteen hospitalized patients with moderate or severe infections were assigned at random, in four medical centers, to receive either ceftizoxime or cefotaxime, administered intravenously in a dosage of 1 to 2 g every 8 h. Of 96 patients evaluable for efficacy, 24 (25%) had bacteremia, 46 (48%) had urinary tract infections and 9 (9%) had pneumonias. Half the patients had been treated ineffectively by other antibiotics prior to the study drug treatment. The overall clinical efficacy was 90% in both treatment groups and 83% in both groups with bacteremia. All patients with urinary tract infection were cured by both agents. Bacteriological eradication rate was 95% in both groups. Adverse reactions, though mild, were more frequent in the cefotaxime group (13.5%) than in the ceftizoxime group (6.8%); superinfection rate was higher in the ceftizoxime group. Both antibiotics were highly and equally efficacious in the therapy of severe infections in hospitalized patients.

Adult↗
PubMed1987

Effects of changing salt and water balance on renal kallikrein, kininogen and kinin.

The kallikrein-kininogen-kinin system (KKK) has been implicated in the renal sodium excretion response to changes in dietary sodium. However, both increases and decreases in the activity of this system have been observed when urinary sodium excretion is augmented by a variety of maneuvers. To further evaluate the potential physiologic role of this system, we measured three components of the KKK system in urine. Total kallikrein, intact kininogen, and kinin were measured twice in normal individuals during balance on both a high (250 mEq/day) or low (10 mEq/day) sodium intake. A consistent and significant reduction in the activity of all three components of the KKK system was noted during the high salt intake. Furthermore, during the high sodium intake, further acute reductions in components of this system were observed when an acute saline but not water load was administered. The consistent response of the various components of the KKK system to both acute and chronic sodium loading suggests that the system is physiologically linked to the regulation of sodium balance. However, the directional changes argue against a primary natriuretic effect of this system.

Aldosterone↗
PubMed1986

Isoelectric focusing variant thyroxine-binding globulin in American blacks: increased heat lability and reduced serum concentration.

Three major bands of T4-binding globulin (TBG) at pH 4.3-4.5 are seen after isoelectric focusing (IEF) of serum. Daiger et al. detected a cathodal shift of all IEF bands in some American blacks, and found that the inheritance of this variant TBG (TBG-S) is X-chromosome linked. However, the properties of the TBG-S molecule and its possible association with changes in thyroid function have not been studied. Based on IEF analysis of 114 serum samples from adult American blacks, the gene frequency of TBG-S was 12.0%, and the genotype distribution was consistent with X-chromosomal linkage. TBG-S and the common type TBG (TBG-C) co-occurred exclusively in sera from women, whereas sera from men had only TBG-C or TBG-S, confirming the X-linked inheritance of this variant TBG. At 60 C, TBG-S was denatured with a mean t1/2 of 4.7 +/- 0.9 (+/-SD) min compared to 6.8 +/- 1.1 min for TBG-C (P less than 0.001). Heterozygous females with TBG-CS had an intermediate rate of heat denaturation (t1/2, 5.2 +/- 0.7 min). In vitro mixtures of TBG-S and TBG-C also had intermediate t1/2 values, indicating that the heat lability of TBG-S is inherent to the variant TBG molecule. Heat denaturation resulted in loss of T4-binding activity, which was proportional among corresponding IEF bands for each of the two TBG types. Larger amounts of added T4 were required to protect against the heat-induced denaturation of TBG-S. No changes in the affinity of TBG-S for T4 could be demonstrated by analysis of binding kinetics at O C. Thyroid function tests were carried out in 10 black men with TBG-S and 10 age-matched black men with TBG-C. The mean concentration of total T4 (TT4) of 6.8 +/- 1.5 micrograms/dl in the group of TBG-S men was lower (P less than 0.02) than that in the group of TBG-C men (8.5 +/- 1.3 micrograms/dl). The finding of lower levels of TT4 in men with TBG-S was best explained on the basis of a concomitant reduction of serum TBG concentration (1.41 +/- 0.30 vs. 1.72 +/- 0.23 mg/dl; P less than 0.05). This conclusion was confirmed when no significant difference in mean TT4 concentration was found between the group with TBG-S and another with TBG-C matched by serum TBG concentration.(ABSTRACT TRUNCATED AT 400 WORDS)

Autoradiography↗
PubMed1986

Herpes encephalitis during pregnancy: failure of acyclovir and adenine arabinoside to prevent neonatal herpes.

A gravid woman with herpes Type II encephalitis delivered an infant with herpes neonatorum despite therapy with acyclovir. Acyclovir was not measurable in the baby's serum 10 h after birth. The viral isolate was sensitive to acyclovir in vitro, and the neonatal infection responded to treatment with the drug. Prenatal antiviral therapy may be ineffective in preventing intrauterine herpesvirus infection.

Acyclovir↗
PubMed1983

Disruption of aortic arch branches due to nonpenetrating chest trauma.

From 1967 through 1979, six patients sustained non-penetrating chest trauma with disruption of the Innominate, carotid, and subclavian arteries. Diagnosis was established in each case by aortography. Two patients with subclavian artery injuries underwent exploration through lateral thoracotomies, and three patients underwent sternotomy for innominate artery disruptions. A cervical approach was used for a common carotid artery disruption. One patient had innominate and left common carotid artery disruption. Two patients with subclavian injuries had associated bronchial disruptions. Cardiopulmonary bypass was used in one patient and should be available in all cases. One patient died with multiple vessel and bronchial disruption. A variety of repairs were used, varying from simple oversewing of the subclavian artery to elaborate graft replacement of the innominate and left common carotid arteries.

Accidents, Traffic↗
PubMed1983

Alkaline phosphatase immuno-enzymatic technique in the diagnosis of pemphigus vulgaris.

Alkaline phosphatase was used in an immuno-enzymatic procedure to detect tissue-bound and circulating antibodies in pemphigus vulgaris. Pemphigus antibodies were revealed by a direct method using alkaline phosphatase conjugated goat anti-human IgG. Cryostat sections were incubated with the specific antiserum, and alkaline phosphatase activity was then revealed histochemically either by Gomori's technique or by the azo dye method. The sections were examined by light microscopy and intercellular staining was demonstrated in the epidermis. The indirect method, in which the patient's serum was incubated with sections of normal skin, gave similar results. Using parallel sections, an immunofluorescent technique was used to demonstrate tissue-bound and circulating antibodies. The alkaline phosphatase method appeared to be slightly less sensitive than the immunofluorescent method.

Alkaline Phosphatase↗
PubMed1983

Coronary revascularization in septuagenarians.

Despite a 15 year experience with the aorta-coronary bypass operation, indications for its use remain unsettled, especially in the elderly. Between January, 1974, and June, 1980, 2,667 patients underwent coronary artery revascularization with an overall mortality of 3.8% (101/2,667). During the last 12 months the mortality has decreased to 1%. There were 2,562 patients below the age of 70, with a mortality of 3.5% (90/2,562), in contrast to 105 patients over the age of 70, with a mortality of 10.5% (11/105) (p = 0.002). In patients less than 70 years of age there was a significant difference between the mortality of men, 3.12% (67/2,146), and that of women, 5.53% (23/416) (p = 0.015). This disparity of operative risk was far more pronounced in patients over 70 years of age: men 6% (5/84) and women 28.6% (6/21) (p = 0.002). The overall operative mortality of women, 6.6% (29/437), was significantly different from the overall mortality of men, 3.2% (72/2,230) (p = 0.001). An in depth analysis of past medical history, risk factors, and catheterization data is presented in those patients over the age of 70. The average number of vessels bypassed was 2.40: men 2.47 and women 2.09 (p = NS). The ages varied from 70 to 81 years with a mean of 72.5. Smoking (p = 0.012) and diabetes (p = 0.0078) were significant risk factors for coronary disease. Smoking (p = 0.032) and abnormal pulmonary artery pressures (p = 0.0429) were significant variables affecting mortality. A 97.1% follow-up was obtained up to 78 months. Coronary artery revascularization can be performed in men below the age of 70 with acceptable mortality, but there is a twofold increase above the age of 70. Women can undergo revascularization below the age of 70 with a significantly higher risk than males. Those above the age of 70 are at severe risk and should undergo revascularization only after careful selection.

Age Factors↗
PubMed1982

A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain.

To determine whether data available to physicians in the emergency room can accurately identify which patients with acute chest pain are having myocardial infarctions, we analyzed 482 patients at one hospital. Using recursive partitioning analysis, we constructed a decision protocol in the format of a simple flow chart to identify infarction on the basis of nine clinical factors. In prospective testing on 468 other patients at a second hospital, the protocol performed as well as the physicians. Moreover, an integration of the protocol with the physicians' judgments resulted in a classification system that preserved sensitivity for detecting infarctions, significantly improved the specificity (from 67 per cent to 77 per cent, P less than 0.01) and positive predictive value (from 34 per cent to 42 per cent, P = 0.016) of admission to an intensive-care area. The protocol identified a subgroup of 107 patients among whom only 5 per cent had infarctions and for whom admission to non-intensive-care areas might be appropriate. This decision protocol warrants further wide-scale prospective testing but is not ready for routine clinical use.

Adult↗
PubMed1981

Coarctation of the aorta: four unusual instances.

Four unusual instances of coarctation of the aorta are presented. Three coarctations were located proximal to the left subclavian artery, and the other was in the normal location with a patent ductus arteriosus and an anomalous distal right subclavian artery. Unusual coarctations can be identified on physical examination on the basis of variations of blood pressure and pulses in the upper extremities. Unilateral rib notching may be noted on chest roentgenogram, and an aortogram can delineate its exact location. Four separate means of surgical repair are described.

Adolescent↗
PubMed1980

Lyme carditis: cardiac abnormalities of Lyme disease.

We studied 20 patients, mostly young adult men, with cardiac involvement of Lyme disease. The commonest abnormality (18 patients) was fluctuating degrees of atrioventricular block; eight of them developed complete heart block. Thirteen patients had evidence of more diffuse cardiac involvement: electrocardiographic changes compatible with acute myopericarditis (11 patients), radionuclide evidence of mild left ventricular dysfunction (five of 12 patients tested), or frank cardiomegaly (one patient). Heart involvement was usually preceded by erythema chronicum migrans and sometimes accompanied by meningoencephalitis, facial palsy, arthritis, elevated serum IgM levels, or cryoglobulins containing IgM. The duration of cardiac involvement was usually brief (3 days to 6 weeks). The clinical picture in these patients has similarities to acute rheumatic fever; but in Lyme disease, complete heart block may be commoner, myopericardial involvement tends to be milder, and valves seem not to be affected.

Adult↗
PubMed1979

Interrupted aortic arch operation in the first week of life: hemodynamic and angiographic evaluation one year later.

Operation for interrupted aortic arch (IAA) was successful in 2 infants during the first week of life. Both had postoperative hemodynamic and angiographic evaluation at one year of age. The first infant had a type A IAA, and prostaglandins were infused to prevent ductal closure prior to the insertion of a graft between the two ends of the interrupted aorta. The second infant had a palliative operation for type B IAA (pulmonary artery banding and graft from main pulmonary artery to descending aorta). These patients represent the ninth and tenth successful operations for IAA in this age group and are reported with long-term reevaluation.

Age Factors↗
PubMed1979

Prevention of air embolism after mitral valve replacement with a porcine heterograft prosthesis.

The production of prosthetic valve incompetence during atriotomy closure is among the operative maneuvers utilized to prevent air embolism in mitral valve replacement. The leaflets of a porcine bioprosthesis may be retracted safely and effectively, thereby producing temporary valve incompetence, by placing three polypropylene sutures through the valve orifice and around the sewing ring to encircle the leaflets. These traction sutures are eaily pulled out through the atriotomy suture line after all air has been displaced from the heart. The technique has been effective, easily accomplished, and without complications.

Animals↗