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Biomedical subjects

P Kaminsky

Publications and source records attributed to P Kaminsky.

At least 19 recordsLinked to original sources
PubMed2002

[Changes in hemogram parameters in infections].

PURPOSE: Leukocytosis is considered as an argument for infection. We have compared leukocytosis with the other data available with the white blood cell count. METHODS: White blood cell counts obtained from 187 patients (age: 18 to 81 years), admitted to an emergency room for abdominal pain, were analysed using an automate (Bayer Technicon H2, Dublin, Ireland), and compared with matched healthy subjects. The patients were classified into two groups: diseases of the biliary or of the urinary tract, and subsequently in two subgroups: infectious diseases (angiocholitis, cholecystis, pyelonephritis) or non-infectious diseases (hepatic and nephritic colic). RESULTS: Leukocytes and neutrophils were significantly increased, and eosinophils significantly decreased in all subjects by comparison with controls. These abnormalities were more important in infected patients. Lymphocytes were significantly decreased in infectious disease. For predicting infection, sensitivity and specificity of leukocytosis (> 1,000/mm3) were respectively 66% and 56%, while that of eosinopenia (< 100/mm3) were respectively 91% and 38%, and that of lymphopenia (< 1,200/mm3) respectively 58% and 73%. The probability of infection was less than 3% when neutrophils were less than 7,000/mm3, and eosinophils and lymphocytes respectively more than 100/mm3 and 1,200/mm3. CONCLUSION: This study shows that leukocytosis, eosinopenia or lymphopenia are poor indicators of infection, when considered alone or in combination. However, eosinopenia and lymphopenia appear as better criteria of infection than leukocytosis. A detailed analysis of the white blood cell count allows the exclusion of infection with an acceptable risk of error.

Acute Disease↗
PubMed2001

[Endocrine myopathies].

Disturbances in the endocrine system induce a myopathy by acting on protein synthesis or on energetic metabolic pathways. Thus, a proximal myopathy is seen in hypercorticism, hyper- or hypothyroidism and acromegaly. On the other hand, endocrine disorders modify the transsarcolemmal balance in electrolytes, inducing generalized paresia, as in adrenal insufficiency or in thyrotoxic periodic paralysis. The diagnosis is usually easy if a muscle disorder occurs in a complete clinical feature of endocrinopathy but a myopathy may reveal it. Moreover, the steroid myopathy induced by iatrogenic glucocorticoid excess may lead to confusion in patients treated for an inflammatory myopathy. The treatment of endocrine myopathies is based on the correction of the hormonal disorder.

Acromegaly↗
PubMed2001

[Dilated cardiomyopathy and panuveitis as presenting symptoms of Lyme disease. General review of one case].

INTRODUCTION: The clinical expression of Lyme disease is highly variable. If a patient presents clinical findings consistent with a systemic Lyme borreliosis, this disease must be considered in an endemic area because of its favorable outcome with adequate treatment. EXEGESIS: The authors report and discuss the case of a patient with an unusual history of dilated cardiomyopathy and supraventricular fibrillation followed by bilateral panuveitis. Enzyme-linked immunosorbent assay and Western blot were positive for Borrelia burgdorferi antigens. The diagnosis of Lyme disease was made after other infectious, inflammatory and autoimmune disorders were excluded by clinical, instrumental and biological investigations. The treatment by ceftriaxone and amoxicillin resolved the ophthalmologic manifestations and improved the cardiac condition. CONCLUSION: This report underlines the possibility of an unusual presentation of Lyme disease. Ophthalmologic and cardiac involvement should be known by clinicians.

Adult↗
PubMed2000

A Department of Social Work uses data to prove its case [corrected].

The introductions of managed care with its emphasis on cost containment has led a Department of Social Work Services at a large urban teaching center to better document and justify its roles. A concrete result was the saving of social work positions during budget cutbacks and downsizing. There is also information in these data to help clarify the differential roles of social workers and utilization review nurses in the hospital case management/discharge planning processes. The system came about because of concerns around cost containment, the need for more systematic discharge planning and the advent of the Prospective Payment System and Diagnosis Related Groups (DRG's) as a means of reimbursement to hospitals.

Budgets↗
PubMed1999

[Pancoast-Tobias syndrome disclosing a primary pulmonary non-Hodgkin lymphoma].

INTRODUCTION: Pancoast's syndrome is generally due to superior sulcus tumors, generally bronchial cancer. In rare cases, other causes are found, but these are potentially curable. CASE-REPORT: A 78-year old woman with a long history of tobacco intake presented with Pancoast's syndrome in the form of a locally invasive left apical lung mass. Despite her advanced age and the diagnosis of the high probability of lung cancer, a transparietal biopsy procedure was nevertheless performed, with the subsequent diagnosis of primary malignant pulmonary lymphoma. The patient was satisfactorily treated by combined chemotherapy. CONCLUSION: The present study has shown that malignant non-Hodgkin lymphomas should be considered in the etiology of the disease, and as a rare but potentially treatable cause of Pancoast's syndrome.

Aged↗
PubMed1998

Enzyme replacement therapy decreases hypergammaglobulinemia in Gaucher's disease.

We report the effects of enzyme replacement therapy in a patient with Gaucher's disease associated with a monoclonal gammopathy. Alglucerase induces a linear decline in immunoglobulin and beta 2-microglobulin levels. This observation suggests that this treatment decreases the chronic antigenic stimulation commonly found in Gaucher's disease.

Adult↗
PubMed1998

[Nervous system borreliosis with pseudo-lymphoma cells in cerebrospinal fluid].

We report the case of a 44-year-old woman, who experienced acute back pains, leg paraesthesia, and diplopia. Analysis of the cerebrospinal fluid revealed, in addition to increased protein and decreased glucose levels, an elevated number of large atypical cells, resembling lymphoma cells. Magnetic resonance imaging of the brain and spine was normal. High levels of antibodies against Borrelia burgdorferi were found in both serum and cerebrospinal fluid. The patient completely recovered with ceftriaxone therapy.

Adult↗
PubMed1996

[Gaucher disease].

Gaucher disease, a condition transmitted by autosomal recessive inheritance, results from a genetic defect in beta-glucosidase, an enzyme which degrades sphingolipids. Deficiency in beta-glucosidase leads to accumulation of its substrate, glycosylceramide, in macrophages and, in the more severe cases, in neurons. Clinically, splenomegaly, hepatomegaly, bone destruction, cytopenia, and in some cases, central neurological lesions develop. Three phenotypes have been described according to the absence (type 1) or presence of neurological involvement (type 2: severe, type 3: intermediate severity). The disease occurs in patients of all ethnic origins but type 1 is particularly well known in Ashkenese Jews and type 3 is found in the Swedish province of Norrbottnie. About forty mutations of the beta-glucosidase gene have been identified. Four account for 80% of the known mutations (1226G, 1448C, 84GG, IVS2+1). Residual enzyme activity of mutant beta-glucosidase explains some of the phenotypic variations. The phenotype resulting from the 1226G mutation has sufficient enzyme activity for degradation of gangliosides in the brain, explaining the absence of neurological involvement in patients with this allele. Treatment is based on enzyme supplemention: blood parameters return to normal and the volume of the spleen and liver are greatly reduced after 6 months. In infants with very severe disease, bone marrow graft may be used.

Gaucher Disease↗
PubMed1996

Research changes a health care delivery system: a biopsychosocial approach to predicting resource utilization in hospital care of the frail elderly.

The social work department of a large New York City teaching hospital has conducted practice research studies over the past five years to better improve the early identification of high risk elderly patients. A recent prospective study is presented of the relationship between functional capacity and discharge status/length of stay, the results of which directly led to a change in the inpatient delivery system. A sample of 250 randomly selected patients, 65 years or older, selected upon admission, were tested using the Katz ADL, the IADL and the Short Portable Mental Status Questionnaire (PMSQ) to distinguish those patients likely to remain hospitalized beyond medical necessity. Results of a logistic regression indicate that low functional capacity patients (IADL: Wald = 5.6; P < .02) were likely to remain beyond medical necessity. The model predicted group membership correctly 90.6% of the time. These findings have led the medical center to develop an acute care geriatric unit in cooperation with an affiliated nursing home.

Activities of Daily Living↗
PubMed1995

[Gaucher's disease: current aspects].

Gaucher's disease is an autosomal recessive inherited disorder, characterized by genetic deficiency of lysosomial glucocerebrosidase. Its substrate (glycosylceramide) subsequently accumulates in cells of monocyte/macrophage origin, resulting in enlargement of the spleen and liver, skeletal lesions, and, in the most severe phenotypes, in neurological disorders. Thirty-six mutations have been at present documented in the gene encoding for the glucocerebrosidase, but four of them (N370S, L444P, 84GG and IVS2+1) are really frequent, particularly in ashkenaze population. Gaucher's disease is diagnosed by the presence of Gaucher cells, especially in bone marrow aspirate, and by assessing the glucocerebrosidase activity. The prognosis has been considerably improved by enzyme replacement therapy.

Gaucher Disease↗
PubMed1995

[Physiological role of PTHrP].

Parathyroid hormone related protein (PTHrP) is the aetiological factor for the syndrome of humoral hypercalcemia of malignancy. The PTHrP gene encodes three isoforms of respectively 139, 141 and 173 amino acids with N-terminal homology to parathormone (PTH). PTHrP, which has a wide tissue distribution, appears to be a polyhormone with different physiologic functions that depend on the particular fragment secreted. PTHrP may act in an autocrine, a paracrine or an endocrine fashion. There is evidence for a role in the growth and development of both embryonic and mature tissues, in cellular differentiation, in smooth muscle relaxation, lactation and calcium and magnesium transport. The best known PTHrP functions are those mediated by the N-terminal domain fixation on the classical PTH/PTHrP receptor. Nevertheless, several other functions are mediated by different fragments of PTHrP such as midregion fragments or carboxy-terminal forms. Each of these functional forms of PTHrP has one or several physiological function(s) which is (are) mediated by his own specific receptors and signal transduction pathways, some of which may be tissue specific.

Animals↗
PubMed1994

[Lead poisoning in pregnancy].

Endemic areas of lead poisoning have recently been rediscovered raising an important public health problem, particularly for pregnant women and their offspring. Theoretically, pregnant women can no longer be exposed to occupational sources with the application of public health regulations but other sources including water contamination, wall paint, industrial wastes and automobile exhaust fumes cannot be ignored. The placental barrier is permeable to free serum lead and levels in cord blood reaches 5 to 10% of the maternal blood level. In addition, lead may be released from maternal bone reserves during pregnancy and thus become a major source of intoxication for the fetus. Lead content in fetal organs increases with gestational age and may affect the nervous system and calcium dependent organs. Moderate lead levels of 100 micrograms/L can inhibit fetal haeme and erythropoiesis. Besides the classical signs of lead poisoning, pregnant women risk spontaneous abortion and increased blood pressure. Manifestations in the fetus and newborn include prematurity, fetal hypotrophy and malformations. Other manifestations are not seen until several years after birth and include retarded mental development and muscular and behaviour disorders. Diagnosis is based on screening tests which should be used in cases of suspected accidental or environmental intoxication. Tests should include assay of zinc protoporphyrins and aminolevulinic acid dehydrase. A search for the source of the contamination should be undertaken when blood levels above 250 micrograms/L are observed. Treatment with metal chelators is not recommendable (except in extreme life-threatening cases) during pregnancy due to their teratogenic effect. Prevention is the only adequate treatment.

Bone and Bones↗
PubMed1994

Serum parathormone profile during surgical treatment of hyperfunctioning parathyroid adenoma: a multicompartmental model.

Patterns of intact parathyroid hormone (iPTH) elimination and subsequent recovery of parathyroid function were studied in seven patients undergoing surgical removal of solitary hyperfunctioning parathyroid adenoma. Using a sensitive two-site immunoradiometric assay, iPTH levels were measured pre, peri-, and postoperatively. Blood samples were taken at very early and at late stages, including 3, 6, 9, and 15 minutes and 48, 72, and 96 h after adenomectomy. A biexponential formula was calculated to fit the decreasing values of iPTH in all patients. The PTH half-life in the early phase was 1.4 +/- 1.1 minutes (95% confidence limits). The PTH half-life in the second phase was 64.45 +/- 32.19 minutes (95% confidence limits). A third phase is represented by a slow, linear increase in plasma iPTH values as a result of the recovery of healthy suppressed parathyroid glands. The extrapolation to baseline of the later phase shows that the recovery of normal parathyroid function begins as soon as 240 minutes after adenomectomy and is independent of the decrease in PTH of adenomatous origin. All individual results were consistent with this model. Five patients had iPTH values below 5 pg/ml, one had 15 pg/ml, and the last had 27 pg/ml 5 h after parathyroid adenomectomy. The recovery of the hormonal activity of the remaining glands occurred rapidly. By the postoperative hour 24 the mean serum iPTH concentration was 12.28 +/- 8.07 pg/ml. The intraoperative serum iPTH concentration offers a model to assess both recovery of hormonal secretion from functionally suppressed parathyroid glands and disappearance of parathyroid hormone.

Adenoma↗
PubMed1994

[Current diagnosis and treatment of lead poisoning].

Lead may be an industrial and an environmental hazard which becomes of greater importance every year. Classical symptoms of plumbism are rare, whenever minor clinical signs increase in frequency. Erythrocyte zinc protoporphyrin and delta-aminolaevulinic acid dehydratase are reliable indicators of the importance of the lead poisoning in individuals. The concentration of lead in blood is also a suitable biological indicator as is EDTA mobilization test. The treatment is based on the use of chelating agents such as calcium EDTA or DMSA, but the only solution is reduction or removal of the sources of lead exposure.

Accidents↗
PubMed1994

Muscle bioenergetics in obese Zucker rats.

The purpose of this study was to investigate the energetic metabolism in obese Zucker rats, using phosphorus nuclear magnetic resonance spectroscopy at rest and during a 2-Hz muscle stimulation and subsequent recovery. Animals were anesthetized with ketamine (150 mg/kg ip). Fed obese rats and 2-day-fasted obese rats were compared with their normally fed and 2-day-fasted lean litter mates. No differences were found between the two groups for ATP, total creatine, phosphocreatine (PCr), and intracellular pH. Starvation in lean rats resulted in a significant fall in inorganic phosphate (Pi), increased resting ADP level, and decreased PCr and ADP recovery after stimulation. The obese rats exhibited a decreased PCr/Pi and increased ADP at rest and a decreased PCr resynthesis and ADP metabolization rate after stimulation. Muscle stimulation in fasted obese rats induced higher PCr depletion and more pronounced acidosis. These results suggest an in vivo mitochondrial metabolism dysfunction in fasted lean as well as in fed and fasted obese rats.

Adenosine Diphosphate↗