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Biomedical subjects

R Abraham

Publications and source records attributed to R Abraham.

At least 19 recordsLinked to original sources
PubMed2001

Redo left anterior descending artery grafting via left anterior small thoracotomy: an alternative approach.

Reoperative left anterior descending artery (LAD) revascularization can be performed through a left anterior small thoracotomy (LAST approach) in patients requiring isolated LAD revascularization. If the left internal mammary artery has been previously used, however, the operation is generally performed either through a median sternotomy or through a full posterolateral thoracotomy for the necessity of connecting the vein graft to the ascending aorta or to the descending thoracic aorta, thus losing the advantages of a minimally invasive approach. In the case reported herein, we describe a technique in which reoperative revascularization of the LAD is accomplished through the LAST approach, using the stump of the left internal mammary artery as the inflow site of a saphenous vein coronary graft to the LAD.

Humans↗
PubMed2000

Susceptibility locus for Alzheimer's disease on chromosome 10.

The apolipoprotein E (APOE) gene is the only genetic risk factor that has so far been linked to risk for late-onset Alzheimer's disease (LOAD). However, 50 percent of Alzheimer's disease cases do not carry an APOE4 allele, suggesting that other risk factors must exist. We performed a two-stage genome-wide screen in sibling pairs with LOAD to detect other susceptibility loci. Here we report evidence for an Alzheimer's disease locus on chromosome 10. Our stage one multipoint lod score (logarithm of the odds ratio for linkage/no linkage) of 2.48 (266 sibling pairs) increased to 3.83 in stage 2 (429 sibling pairs) close to D10S1225 (79 centimorgans). This locus modifies risk for Alzheimer's disease independent of APOE genotype.

Age of Onset↗
PubMed2000

Dental post-operative sensitivity associated with a gallium-based restorative material.

INTRODUCTION: This study forms part of a 2-year longitudinal clinical trial to compare the performance of a gallium-based restorative material (Galloy) with a high copper, mercury based (Dispersalloy) control material. METHOD: Following Ethical Committee approval, 25 galloy restorations and 25 Dispersalloy controls were placed in 14 adult patients, by a single operator. The cavities were of moderate size, indicating the use of amalgam as the restorative material. All restorations were polished within 1 week of placement, photographed and a silicone impression of the tooth and restoration recorded. In addition, a visual analogue scale (VAS), indicating the extent of any post-operative sensitivity, was completed by each patient for each restoration, immediately prior to polishing. A score of 0 indicated no sensitivity, while a score of 10 indicated the greatest possible sensitivity. At 6-month recall, the VAS scores, silicone impressions and photographs were repeated. RESULTS: The mean sensitivity scores for the galloy and Dispersalloy restorations at 1 week were 5.1 (+/- 3.4) and 1.0 (+/- 1.5), respectively and at 6 months, 1.8 (+/- 3.0) and 0.2 (+/- 0.1) respectively. The differences between these means at 1 week and at 6 months were significant (P < 0.01). CONCLUSION: Galloy restorations were associated with a much greater severity of post-operative sensitivity than Dispersalloy restorations.

Adult↗
PubMed2000

High dose chemotherapy and autologous blood stem cell support in women with breast carcinoma and isolated supraclavicular lymph node metastases.

BACKGROUND: The prognosis of patients with isolated supraclavicular lymph node (SCN) metastases is similar to patients with metastatic breast carcinoma involving other sites. Because these patients have a lower disease burden compared with women with distant metastases, their outcome after high dose chemotherapy (HDCT) may be superior. METHODS: The authors evaluated event free survival (EFS) and overall survival in a series of 20 consecutive women with SCN metastases as the only site of metastatic disease who were treated with HDCT and peripheral blood stem cell transplantation at The Toronto Hospital. All patients had responded to 4-6 cycles of induction CT using either an anthracycline-containing regimen or a single agent taxane, and received intensive therapy comprised of mitoxantrone, 64 mg/m(2); cyclophosphamide, 6000 mg/m(2); and carboplatin, 800-2000 mg/m(2), each divided over 4 days followed by the infusion of autologous peripheral blood stem cells. Involved field radiation therapy (RT) was administered when possible after transplantation to the supraclavicular fossa and tamoxifen was given to previously untreated patients if they were hormone receptor positive or if their hormone receptor status was unknown. RESULTS: At a median follow-up of 28 months, 13 of the 20 women were alive, 11 of whom (55%) remained in continuous complete remission. There were no treatment-related deaths. The median overall survival was 37 months and the median progression free survival was 32 months from the date of transplantation. Consolidative RT was delivered to 11 women and on univariate analysis was found to be significantly associated with better EFS (P = 0.02). CONCLUSIONS: The long term outcome of women with breast carcinoma and isolated SCN metastases whose disease is sensitive to CT appears to be favorable; whether this result is superior to that achieved with standard therapy alone remains to be confirmed in prospective, randomized trials.

Adult↗
PubMed2000

Stroke in octogenarians undergoing coronary artery surgery with and without cardiopulmonary bypass.

BACKGROUND: Myocardial revascularization in elderly patients is associated with a morbidity and a mortality substantially higher than those observed in younger patients. The aim of this study was to analyze the potential benefits of coronary artery bypass grafting without cardiopulmonary bypass (CPB) for octogenarians. METHODS: Of 269 octogenarians who underwent coronary artery bypass grafting at our institution between January 1995 and May 1999, 172 had the operation with CPB (CPB group) and 97, without CPB (off-pump group). Revascularization of the circumflex system or right coronary artery were not considered contraindications to off-pump grafting. Demographic data, preoperative risk factors, comorbid conditions, angiographic findings, postoperative complications, and outcomes were compared. RESULTS: The groups were comparable for age, sex, Canadian Cardiovascular Society class, operative priority (elective, urgent, or emergent), preoperative risk factors, and left ventricular ejection fraction. A significantly higher proportion of reoperations was observed in the off-pump cohort (16 of 97, 16.5%) compared with the CPB cohort (8 of 172, 4.7%) (p = 0.002). There was a trend toward a higher graft-patient ratio in the CPB group (3.3 versus 1.8; p = not significant). Freedom from postoperative complications was significantly higher in the off-pump group than in the CPB group (83 of 97, 85.6%, versus 129 of 172, 75%; p = 0.04). The incidence of stroke was 0% in the off-pump cohort compared with 9.3% (16 of 172) in the CPB cohort (p < 0.0005). Although there was a trend toward higher 30-day and risk-adjusted mortality rates in the off-pump group than in the CPB group (10.3% versus 5.2% and 2.8% versus 1.8%, respectively), the differences were not significant. The length of hospitalization was slightly lower in the off-pump group (9.1 versus 10.8 days; p = not significant). CONCLUSIONS: This investigation suggests that patients 80 years of age and older undergoing off-pump coronary artery bypass grafting can experience significantly lower rates of perioperative stroke and overall complications compared with those undergoing the same procedure with CPB, although a trend toward higher mortality rates was observed in the off-pump group.

Age Factors↗
PubMed2000

Overview of autologous stem cell transplantation.

There has been a dramatic increase in the number of autologous peripheral blood stem cell transplants over the last decade. Faster recovery of cell counts, lesser transplant morbidity, shorter hospital stay and reduced cost compared with marrow autografts have been the main advantages of autologous peripheral blood cell over marrow transplants. In this paper we attempt to review the advances in the biology and mobilization of stem cells, and focus on clinical results of autologous peripheral stem cell and marrow transplants for disease specific sites such as breast cancer, myeloma, autoimmune diseases, germ cell tumors, the acute and chronic leukemias, the non-Hodgkin's lymphomas and Hodgkin's disease. We also discuss transplant related complications, gene therapy and the different methods of purging. This review was intended for autologous peripheral stem cell transplants, however, unavoidably, it also discusses autologous marrow transplantation and aspects common to both procedures.

Bone Marrow Purging↗
PubMed2000

The role of job control as a moderator of emotional dissonance and emotional intelligence-outcome relationships.

Job control may be defined as the latitude to make decisions and the freedom to select the most appropriate skills to complete the task. Emotional dissonance may be defined as the conflict between expressed and experienced emotions. In this study, job control and self-efficacy were theorized to jointly affect emotional dissonance. Individuals with high self-efficacy were found to be more satisfied under conditions of little job control, whereas those with low self-efficacy favored high job control. The impact of job control on emotional intelligence was also studied. Emotional intelligence may be defined as the set of skills that contribute to accurate self-appraisal of emotion as well as the detection of emotional cues in others and the use of feelings to motivate and achieve in one's life. Emotional intelligence and job control explained significant amounts of the variance in both job satisfaction and organizational commitment. Theoretical and practical implications are discussed.

Adult↗
PubMed2000

Clinical standards for inpatient specialist rehabilitation services in the UK.

OBJECTIVE: To develop a set of clinical standards for specialist inpatient rehabilitation services in the UK and to undertake a preliminary survey of consultants who provide those services. DESIGN: The proposed set of standards was developed by group consensus followed by an iterative consultation process. A postal survey was conducted on behalf of the British Society for Rehabilitation Medicine (BSRM) amongst its consultant members in the UK (n = 163), who were asked to assess their services in relation to these standards, and to comment on the standards themselves, their usefulness and applicability. RESULTS: The response rate was 61%, of which 81 respondents ran an inpatient rehabilitation service. Overall, the standards appeared to be acceptable to most, and mainly struck the right level, being attained by the majority of services. Specific suggestions were incorporated into the revised standards. Further work is required to establish agreed outcomes that are systematically measured and recorded: only half the respondents (50%) routinely recorded a standardized outcome measure, and only a quarter (26%) routinely reviewed patients to record long-term outcome. CONCLUSIONS: Clinical standards have been developed for specialist inpatient rehabilitation services in the UK. The BSRM proposes to adopt these standards for a test period of 2-3 years in the first instance. It is likely that they will require further refinement with time, and modification is required to adapt them to different subspecialities and settings.

Guideline Adherence↗
PubMed2000

Organizational cynicism: bases and consequences.

Organizational cynicism is the belief that an organization lacks integrity, which, when coupled with a powerful negative emotional reaction, leads to disparaging and critical behavior. In this article, the author attempts to theoretically clarify the process by which five forms of cynicism develop in the workplace and to empirically relate them to affective outcomes. Societal, employee, and organizational change cynicisms may be attributed to psychological contract violations; work cynicism may be related to burnout; and person-role conflict and personality cynicism may be related to innate hostility. Empirically, personality cynicism emerged as the strongest predictor of organizational cynicism, adversely affecting all of the criteria. Other forms of cynicism had more selective effects. Organizational change cynicism induced job dissatisfaction and alienation, and employee cynicism affected organizational commitment. Societal cynicism actually increased both job satisfaction and commitment. Both personality and work cynicisms were related to organizational citizenship indirectly, through alienation. Theoretical and practical implications are discussed.

Adult↗
PubMed1999

Cardiac effects of high-dose epirubicin and cyclophosphamide in women with poor prognosis breast cancer.

PURPOSE: To prospectively evaluate the long term cardiac effects of high-dose epirubicin and cyclophosphamide given to women with early stage, poor prognosis breast cancer. PATIENTS AND METHODS: Women with stage 2 breast cancer and 10+ nodes or 4+ nodes and estrogen receptor negative tumor, or stage 3 breast cancer received three cycles of epirubicin 200 mg/m2 and cyclophosphamide 4 gm/m2 with peripheral blood progenitor cell and filgrastim support. Treatment was given every 28 days (n = 79) or 21 days (n = 20). Fifty patients received radiotherapy to the chest wall or breast, 25 of to the left side. Patients were assessed clinically regularly during chemotherapy and at least three times yearly after completion of treatment. Cardiac left ventricular ejection fraction (LVEF) was assessed by radionuclide scan before therapy, after each cycle of chemotherapy, three months and six months after completion of chemotherapy, and yearly thereafter until relapse. RESULTS: Ninety-nine women were treated, and 92 completed all three cycles of chemotherapy. The median age was 43 years (range 24 to 60 years). All patients were included in this analysis. The median relapse-free survival was 39 months (11 to 68 months). There was a significant fall in LVEF during chemotherapy. In general, there was no further deterioration in cardiac function from the third month after cessation of treatment, however there was substantial variation between individuals. 35 patients had at least one LVEF measure less than normal (< 50%), but the LVEF returned to normal in 20 of these with further follow-up. Cardiac dysfunction was not increased in women who received radiotherapy and was not different between cohorts given chemotherapy every three or every four weeks. One patient died of acute myocardial necrosis following the third cycle of chemotherapy. Two patients developed clinical evidence of cardiac failure, and another had radiological signs but was asymptomatic. One woman died of progressive cardiac failure, one recovered clinically but also developed recurrent breast cancer, while the third recovered after commencement of medical therapy. CONCLUSIONS: During follow-up after high-dose epirubicin and cyclophosphamide as delivered in this study, the LVEF fell to below normal in approximately one third of patients. However, in over half of these patients the LVEF subsequently recovered to the normal range, and the incidence of clinically evident chronic cardiac failure was low. Further follow-up is required to assess the long-term safety. A randomized comparison with standard-dose anthracycline-based chemotherapy is needed to determine whether this regimen is associated with an increased risk of clinical cardiac toxicity.

Adolescent↗
PubMed1999

Intensification of the stem cell transplant induction regimen results in increased treatment-related mortality without improved outcome in multiple myeloma.

Randomized trials conducted by the Intergroupe Française du Myelome (IFM) demonstrate that the use of high-dose chemotherapy (HDCT) and stem cell transplantation (SCT) improves event-free (EFS) and overall survival (OS) in younger patients with multiple myeloma (MM). Nevertheless, current HDCT regimens remain inadequate as all patients ultimately relapse following SCT. In an attempt to improve the OS of MM patients post-SCT we used an escalated HDCT regimen incorporating both intensified melphalan (160 mg/m2) and fractionated total body irradiation (12 Gy) to maximize the dose response of myeloma cells to these agents and included infusional etoposide 60 mg/kg in an attempt to eradicate clonal B cells potentially contributing to the myeloma clone. One hundred patients with MM received this intensified SCT regimen. The 100-day treatment-related mortality was 12% predominantly reflecting the development of interstitial pneumonitis (IP) in 28% of patients of whom 7/28 (25%) died. The predicted 5-year OS and EFS following the diagnosis of MM were 60% and 35%, respectively. The median OS from the time of transplant is 41 months and the median EFS is 28 months. More than two prior chemotherapy regimens, previous radiation therapy (RT) and the presence of an abnormal karyotype involving chromosomes 11 or 13 were significantly predictive of poor outcome. Interferon maintenance was not associated with improved outcome. Intensification of the HDCT regimen utilizing etoposide together with escalated melphalan and TBI increases morbidity and mortality without increasing OS beyond that reported with less toxic regimens.

Adult↗
PubMed1999

Negative affectivity: moderator or confound in emotional dissonance-outcome relationships?

This study was an examination of the impact of negative affectivity on relationships between emotional dissonance, job satisfaction, and emotional exhaustion. Negative affectivity is the predisposition to view life in negative terms. Emotional dissonance originates from the conflict between expressed and experienced emotions. In organizations that require the expression of positive emotions, high negative affectivity individuals may experience conflict between expressed, positive emotions and felt, negative emotions. A moderator effect exists when high negative affectivity individuals experience greater job dissatisfaction and emotional exhaustion. Alternatively, negative affectivity may exert a confounding effect through its relationship to both emotional dissonance and its outcomes. Empirical tests showed that negative affectivity moderated the emotional dissonance-job satisfaction relationship and confounded the emotional dissonance-emotional exhaustion relationship.

Adolescent↗
PubMed1999

The relationship between differential inequity, job satisfaction, intention to turnover, and self-esteem.

This study was an examination of differential inequity or underreward in working conditions, originating from the discrepancy between individual working conditions and those of comparative referents. In its exploration of the outcomes of inequity in working conditions, the study fills a gap in the literature because most such studies have been primarily devoted to investigations of pay inequity. Empirically, it is an investigation of elements of differential inequity as antecedents of job satisfaction and intentions to turnover and of self-esteem as a moderator of inequity-criteria relationships. Significant relationships between system and age inequity and job satisfaction and between company inequity and intention to turnover were found. Self-esteem significantly moderated the global inequity-job satisfaction and global inequity-intention to turnover relationships.

Adult↗
PubMed1999

The impact of emotional dissonance on organizational commitment and intention to turnover.

In the workplace, emotional dissonance is the conflict between experienced emotions and emotions expressed to conform to display rules. This study is an empirical examination of the impact of emotional dissonance on organizational criteria and its moderation by self-monitoring and social support. Emotional dissonance was theorized to stimulate turnover intentions, either solely through job dissatisfaction or through both job dissatisfaction and reduced organizational commitment. Job dissatisfaction was found to be the sole mediator. Emotional dissonance resulted in job dissatisfaction, which, in turn, stimulated withdrawal intentions. Self-monitoring and social support exerted moderator effects, albeit in opposing directions. Emotional dissonance aroused feelings of job dissatisfaction and reduced organizational commitment among high self-monitors. In contrast, social support lessened the negative impact of emotional dissonance on organizational commitment.

Adaptation, Psychological↗
PubMed1999

Determinants of the first decade of bone loss after menopause at spine, hip and radius.

This study documented bone loss at three different sites in the early postmenopausal period, and examined potential predictors. Forty-three women underwent repeated measurements of bone density at the lumbar spine, proximal femur and distal radius for up to 14 years. Individual rates of bone loss were calculated for the spine and hip; for radial trabecular bone, rates were calculated separately for two time periods, earlier and later after menopause. In the spine and radius, initially high rates of loss diminished with time after menopause. No positive correlations for bone loss were found between the three sites, suggesting that faster than average bone loss was specific to individual bones. High body mass index (BMI) was significantly protective against fast bone loss at the spine and radius; in the spine, each unit increase in BMI was associated with a approximately 5% reduction in the rate of bone loss. Of the other variables measured (maximum oxygen consumption, lean body mass, fat mass, mean psoas muscle area at the L3 level, hand grip strength as well as anthropometry) only bone densitometry was sufficiently predictive to help guidance on hormone replacement or other prophylactic therapy. The data suggest that the known relationship between excessive leanness and risk of osteoporosis and vertebral fracture after menopause might in part be due to fast post-menopausal bone loss. Because bulk of psoas muscle was associated with low spine loss rates, the data also support a role for applied muscular loading in local maintenance of bone density.

Adult↗
PubMed1998

Modulation of T cell cytokine profiles and peptide-MHC complex availability in vivo by delivery to scavenger receptors via antigen maleylation.

We have previously shown that conversion of proteins to scavenger receptor (SR) ligands by maleylation increases their immunogenicity. We now show that maleyl-Ag-immune spleen cells make relatively more IFN-gamma and less IL-4 or IL-10 than native Ag-immune cells. This is also reflected in the IgG1:IgG2a ratios in Abs generated in vivo. SR engagement on macrophages does not alter their surface levels of the adhesive/costimulatory molecules CD11a/CD18, CD11b/CD18, CD24, CD54, or CD40, nor does it enhance their ability to support anti-CD3-driven proliferation of naive T cells in vitro. Costimulatory molecules implicated in differential Th1/Th2 commitment--CD80, CD86, and IL-12--are not inducible by SR ligation. In addition to macrophages and dendritic cells, B cells also show receptor-mediated uptake and enhanced presentation of maleyl-Ags. Using a monoclonal T cell line to detect peptide-MHC complexes expressed on spleen cells in Ag-injected mice, we find that higher levels of these complexes are generated in vivo from maleyl-proteins and they persist longer than those generated from the native protein. Together, these data suggest that in certain situations, the levels of cognate ligand available and/or the time course of their availability may play a major role in determining the cytokine profiles of the responding T cells in addition to the costimulatory signals implicated so far.

Animals↗
PubMed1998

Factitious quinine-induced thrombocytopenia.

A 57-year-old man presented on multiple occasions to various hospitals with thrombocytopenia and complaints of easy bleeding. Despite his repeated denials of quinine use, laboratory investigations confirmed a diagnosis of quinine-induced thrombocytopenia. He appeared to have factitious disorder and to have discovered a novel means of precipitating symptoms.

Hospitalization↗