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Biomedical subjects

R D Altman

Publications and source records attributed to R D Altman.

At least 127 records · Page 7Linked to original sources
PubMed1973

The action of cathepsin D in human articular cartilage on proteoglycans.

In recent years the lysosomal cathepsins have been implicated as important agents in the physiological degradation of various cartilages. In the present study, the nature of cathepsin present in human articular cartilage was investigated by microtechniques and a possible role for cathepsins in the cartilage degradation observed in osteoarthritis was sought. The results of this study indicated that the hemoglobin and proteoglycan-digesting activity in the human cartilage observed is predominantly that of a cathepsin D-type enzyme. This cathepsin D-type enzyme activity was present in two to three times greater amounts in yellowish or ulcerated articular cartilage from patients with primary osteoarthritis than in control "normal" human cartilages. The human cathepsin D-type enzyme, as well as a highly purified cathepsin D from bovine uterus degraded proteoglycan subunit (PGS) maximally at pH 5. Both enzyme preparations were inactive on hemoglobin at pH 6-8, but degraded PGS considerably at neutral pH. The activity of the human cathepsin extract was not affected by reagents which inhibit or activate cathepsins A and B. Neutral proteases which are active on hemoglobin or are inhibited by diisopropylfluorophosphate (DFP) were not detected in these preparations, but contamination by another type of neutral protease cannot be excluded. Chloroquine inhibited the degradation of PGS at neutral pH by the human cartilage enzyme extract.

Adult↗
PubMedDate not supplied

Report of the Council on Scientific Affairs. Use of restraints for patients in nursing homes. Council on Scientific Affairs, American Medical Association.

OBJECTIVE: To examine issues related to the use of restraints on nursing home patients, including regulations and guidelines, risks and benefits of restraint use, system problems, and measures to reduce restraint use, to determine when the use of restraints results in clinically desirable outcomes. METHODS: Sources of information included a review of published articles and reports, a survey of federal and state regulations and guidelines relating to restraint use in nursing homes, review of current legislative initiatives, and consultation with experts in the field. RESULTS: The data reveal that restraint use imposes more risk of falls and other undesirable outcomes than it prevents. In response to legislative initiatives and regulatory activities and by implementing alternatives, the prevalence of restraint use has decreased by 20% in recent years. In many states, facilities have created restraint-free environments or restraint-free policies and goals. The Council on Scientific Affairs finds that current federal and state regulations on the use of restraints have benefited the vast majority of nursing home patients. CONCLUSIONS: While guidelines are in place for the use of restraints when clinically necessary, the Council on Scientific Affairs recommends increased research to determine when the use of restraints results in desirable outcomes. Extraregulatory initiatives, such as widespread educational programs, are needed for professionals and consumers to improve awareness of the risks and benefits of restraints, as well as the rights of residents with respect to restraint use.

Accidental Falls↗
PubMedDate not supplied

Alzheimer disease. Report of the Council on Scientific Affairs.

Alzheimer disease (AD) takes a heavy economic, social, physical, and psychological toll on patients, families, and society. Because of the increasing life expectancy in the United States, AD is expected to afflict approximately 14 million people within the next few decades. There is currently no cure, only interventions that can temporarily ameliorate the profound cognitive losses and behavioral manifestations of the disorder. Community services are fragmented and underutilized. Physicians, in their traditional role as gatekeepers, can encourage more families to use supportive services. This article reviews the guidelines on the diagnosis and treatment of AD of the Agency for Health Care Policy and Research, the American Academy of Neurology, the Veterans Health Administration, and the American Psychiatric Association. Although these guidelines contain valuable information, they do not adequately address the role of the family physician and the need for continuity of care. Recommendations regarding AD from the Council on Scientific Affairs, which were adopted as American Medical Association policy in December 1997, are included in this article.

Algorithms↗
PubMedDate not supplied

Progressive systemic sclerosis in a family: case report of a mother and son and review of the literature.

Progressive systemic sclerosis (PSS) developed in a 6-year-old boy and in his 38-year-old mother 9 years later. Both parent and child had Raynaud's phenomenon, integumental sclerosis, and pulmonary involvement, but they differed in other aspects of their disease. Previous descriptions of the familial occurrence of PSS are reviewed and compared to the present case reports. Environmental and genetic factors of possible etiologic significance are discussed.

Adolescent↗
PubMedDate not supplied

Angioid streaks.

Angioid streaks are often associated with a systemic condition, most frequently pseudoxanthoma elasticum, Paget's disease of the bone, or one of the sickle hemoglobinopathies. The clinical manifestations of angioid streaks and those three systemic conditions are reviewed. A diagnostic survey is suggested for patients discovered to have angioid streaks with no known systemic disease. The results of such a survey in 50 patients are presented. In addition, separate studies of patients with Paget's disease of the bone (50 patients) and of the sickle hemoglobinopathies (100 patients) are described, and the characteristics of patients with angioid streaks as well as the incidence of streaks in these conditions is reviewed. The histopathologic and fluorescein angiographic characteristics of angioid streaks, as well as the possible benefit of photocoagulation for complications of angioid streaks is discussed.

Age Factors↗
PubMedDate not supplied

Radiographic progression of knee osteoarthritis in a Czech cohort.

OBJECTIVE: To determine the 5-year radiographic progression of osteoarthritis (OA) of the knee in a Czech cohort. METHODS: 139 patients with idiopathic OA were followed for 5 years, receiving only physical therapy and non-steroidal antiinflammatory drugs as needed. Weight-bearing radiographs of both knees were performed at the initial and final evaluation by a single technician using the same instrument and a standardized procedure. Radiographs were evaluated using the Kellgren-Lawrence scale (KL). Joint space width (JSW) was determined by 2 independent trained readers, and discrepancies re-reviewed. RESULTS: JSW decreased 0.39 +/- 0.95 mm in 5 years, or 0.078 +/- 0.19 annually. The reduction of JSW was greatest in the KL grade III radiographs (0.099 +/- 0.18 mm). The smallest reduction in JSW was seen in those with KL grade I (0.044 +/- 0.14 mm). However, only 25% of those with KL stage II or stage III demonstrated any change in JSW over the 5-year period. The reduction in JSW was not constant, being most rapid in the first year and then much slower. The coefficient of variation (CV) of the method was good (intra- and inter-observer CV 3.6%). CONCLUSION: This 5-year follow up of Czech patients with OA of the knee demonstrated a low rate of radiographic progression of JSW. The most rapid progression appeared in KL stage III. The progression was most rapid in the first year.

Adult↗
PubMedDate not supplied

Report of the American Medical Association (AMA) Council on Scientific Affairs and AMA recommendations to medical professional staff on the use of wireless radio-frequency equipment in hospitals.

In lieu of a comprehensive technical assessment, this report of the American Medical Association (AMA) Council on Scientific Affairs reviews the issue of electromagnetic interference (EMI) with medical devices caused by the use of wireless radio-frequency (RF) equipment such as cellular telephones, 2-way radios, and pagers. It identifies medical device EMI problems that have been reported and guidance that has been published to assist hospital personnel in assessing and minimizing the potential for EMI in the hospital and in making informed risk management decisions. For more-detailed information on this subject, readers are encouraged to consult publications from various scientific and health care organizations.

American Medical Association↗
PubMedDate not supplied

A rationale for combining acetaminophen and NSAIDs for mild-to-moderate pain.

Analgesic therapy that combines individual agents with different mechanisms of action has potential advantages for the management of mild-to-moderate pain in the outpatient setting. Theoretically, this approach can lead to greater efficacy and fewer adverse events. While the precise mechanism of action for the analgesic effect of acetaminophen remains uncertain, accumulating evidence suggests that its activity resides primarily in the central nervous system. In contrast, the site of action for the analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is predominantly peripheral, within injured or inflamed tissue. Several controlled clinical studies among patients with musculoskeletal conditions, dental pain, or postoperative pain have shown that combinations of acetaminophen and NSAIDs provide additive pain-relieving activity, thereby leading to dose-sparing effects and improved safety. Further studies are warranted to determine the clinical utility and safety of acetaminophen/NSAID combinations as analgesic therapy for common conditions associated with mild-to-moderate pain.

Acetaminophen↗