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Biomedical subjects

R Grossman

Publications and source records attributed to R Grossman.

At least 91 records · Page 5Linked to original sources
PubMed1991

Right and left ventricular performance after single and double lung transplantation. The Toronto Lung Transplant Group.

Twelve single lung and nine double lung transplant recipients were studied before transplantation and at 3 months and 1 year after transplantation with serial right and left ventricular radionuclide angiograms. The resting right ventricular ejection fraction increased in the double lung recipients from 31% +/- 5% before transplantation to 43% +/- 11% at 3 months after transplantation (p less than 0.05) and then remained stable to 1 year. The single lung recipients also demonstrated a significant rise in ejection fraction from 25% +/- 11% before transplantation to 36% +/- 12% at 3 months after transplantation. Again, this remained stable to 1 year. The exercise right ventricular ejection fraction also showed a significant posttransplantation rise in the double lung recipients (p less than 0.005) that remained stable to 1 year. In the single lung recipients a trend was seen for a rise in the exercise right ventricular ejection fraction that did not reach statistical significance by 1 year after transplantation. Neither group had a significant change in rest or exercise left ventricular ejection fraction. The systemic blood pressure increased significantly by 1 year after transplantation in both groups. The heart rate increase with exercise at 3 months after transplantation was significantly greater in the single lung group (42 +/- 13 beats/min) than in the double lung group (14 +/- 13 beats/min) (p less than 0.005). These data indicate that a significant improvement in right ventricular function occurs after single and double lung transplantation.

Adult↗
PubMed1990

Pulmonary disease following intravesical BCG treatment.

Bacillus Calmette-Guérin (BCG) is an attenuated strain of Mycobacterium bovis that has been used in the treatment of malignant disease for over 20 years and for the treatment of bladder cancer since 1976. Major complications of this treatment are infrequent. We report two cases of systemic illness with pulmonary manifestations after treatment with intravesical BCG.

Administration, Intravesical↗
PubMed1989

Transscleral and transcorneal iontophoresis of ketoconazole in the rabbit eye.

The authors assessed the efficacy of transscleral and transcorneal iontophoresis of ketoconazole as a method of drug delivery to the aqueous humor, vitreous, and cornea of the rabbit eye. Transscleral iontophoresis (4-6 mAmps for 15 minutes) achieved peak ketoconazole concentrations in the aqueous 1 hour after treatment (10.2 micrograms/ml) and remained at fungicidal therapeutic concentrations for 8 hours; in the vitreous, a peak concentration of 0.1 microgram/ml occurred between 1 and 2 hours posttreatment. Transcorneal iontophoresis (1.5 mAmps for 15 minutes) achieved peak corneal concentration of 27.6 micrograms/ml and peak aqueous concentrations of 1.4 micrograms/ml, both 1 hour after iontophoresis. Fungicidal therapeutic drug concentrations were sustained for 2 hours both in the cornea and in the aqueous. These concentrations were compared with those obtained after subconjunctival injection (peak values): 0.8 microgram/ml in aqueous, 5.9 micrograms/ml in cornea, and 0.7 microgram/ml in vitreous, all within 1 hour of injection. Aqueous and corneal concentrations were significantly higher after transscleral and transcorneal iontophoresis than subconjunctival injection (P less than 0.05). Iontophoresis is proposed as an effective means of delivering high concentrations of ketoconazole to the anterior segment of the eye.

Animals↗
PubMed1989

Double-lung transplant for advanced chronic obstructive lung disease.

We have achieved repeated success with unilateral lung transplantation for pulmonary fibrosis and have developed an en bloc, double-lung transplant procedure for patients with advanced lung disease of an obstructive or infective nature. Six such procedures have now been performed for end-stage emphysema, and all recipients are alive and well 5 to 15 months later. A seventh transplant for primary pulmonary hypertension was unsuccessful. All recipients were judged to have a life expectancy of 12 to 18 months on the basis of the degree of disability and the documented rate of disease progression. We feel the double-lung procedure is more appropriate than the combined heart-lung transplant for patients requiring replacement of both lungs when right heart function is adequate or deemed recoverable. With this procedure, the recipient is able to retain his or her own heart, avoiding the liabilities associated with cardiac transplantation. Furthermore, the donor heart is available for a separate recipient, and this sharing of the heart and lungs greatly increases the supply of transplantable lungs for patients with end-stage lung disease. Ischemia of the donor airway has been a source of complication, including the one death to date, but this appears to be a surmountable problem.

Adult↗
PubMed1989

Clinical, biochemical, and neuropathologic findings following transplantation of adrenal medulla to the caudate nucleus for treatment of Parkinson's disease.

We transplanted autologous adrenal medullary tissue into the caudate nucleus of 3 patients with advanced Parkinson's disease. The 1st patient, a 59-year-old man with parkinsonian symptoms for 15 years, had mild improvement in his motor functioning after the operation. However, his postoperative course was characterized by prolonged drowsiness and complex visual hallucinations. The patient died suddenly 8 months after the transplant, and an autopsy revealed coronary atherosclerosis. Examination of the graft site showed necrotic adrenal medullary tissue surrounded by inflammatory cells. The 2nd patient, a 50-year-old man with a 21-year history of parkinsonian symptoms, improved the most after the procedure. The 3rd patient, a 43-year-old man with 12 years of parkinsonian symptoms, had mild improvement in his motor functioning. CSF homovanillic acid increased postoperatively in the 3 patients, but then returned to preoperative levels in all except the 2nd patient. The anatomic, neurochemical, and physiologic basis for the modest clinical improvement shown in these patients is not yet understood.

Activities of Daily Living↗
PubMed1988

Graduate primary care training: a collaborative alternative for family practice, internal medicine, and pediatrics.

The Residency Program in Social Medicine at Montefiore Medical Center is a collaborative, integrated training program for primary care pediatricians, internists, and family physicians within one interdisciplinary organization. Since 1970 we have trained more than 200 physicians, prepared them for board certification in their specialty, emphasized the psychosocial aspects and social determinants of health and illness, and shared a faculty, curriculum, and commitment to provide medical care for inner-city, underserved populations. We discuss the program's history and curriculum, administrative and academic structure, shared "cross-track" faculty units (psychosocial; social medicine; and research, education, and evaluation), and graduates' practice outcomes. The interdisciplinary character of the Residency Program in Social Medicine helps physicians successfully serve the underserved and exemplifies that interdisciplinary medical education succeeds when interdisciplinary health care teams are organized for optimal patient care. Only the federal government has the perspective and power to foster more interdisciplinary collaboration and strengthen primary care education in a period of shrinking resources.

Curriculum↗
PubMed1988

Opioid modulation of the response of preoptic neurones to stimulation of the ventral noradrenergic tract in female rats.

1. Experiments were undertaken on twenty-nine ovariectomized female rats, pretreated with oestrogen and anaesthetized with urethane, to test the hypothesis that opioid peptides regulate noradrenergic transmission in the medial preoptic area and thereby influence the neural circuitry controlling the secretion of luteinizing hormone. 2. Extracellular recordings were obtained with glass micropipettes from ninety-four neurones in the medial preoptic area. These recordings were continued whilst both the ventral noradrenergic tract, the noradrenergic projection to the medial preoptic area, and orthodromic pathways originating in the arcuate nucleus, the main source for endogenous opioid peptides in the hypothalamus, were stimulated electrically. Forty of the ninety-four neurones responded to stimulation at one or both of the test sites. 3. Electrical stimulation of the ventral noradrenergic tract excited fifteen neurones (greater than 30% change in number of action potentials recorded during the 'response time period') and inhibited a further ten cells. When the nucleus arcuatus was stimulated electrically thirteen cells were inhibited and twelve neurones showed an excitatory response. 4. The opioid antagonist naloxone (80 mM) and/or morphine (50 mM) were ejected into the immediate vicinity of eighty-six of the recorded cells by passage of balanced currents (range 15-80 nA) through a multi-barrelled electrode glued to the recording electrode. The tip of the drug-containing electrode was about 15-25 microns behind the tip of the recording electrode. 5. The ionophoretic application of naloxone, during electrical stimulation of the ventral noradrenergic tract, diminished the inhibitory response in four of ten cells and enhanced the excitatory response in nine out of fifteen neurones. By contrast, morphine diminished the excitatory response in seven of these fifteen cells tested, an effect that was prevented by the simultaneous application of naloxone. 6. Similarly, the application of naloxone during stimulation of the nucleus arcuatus reduced the inhibitory effect in eight out of thirteen cells. When four of these eight responsive neurones were exposed to morphine either the effect of naloxone was reversed or, when given alone, the inhibition was enhanced. 7. Finally, for seventeen cells categorized as non-responsive to stimulation at either site, the application of naloxone during hind brain stimulation revealed an excitatory input from the ventral noradrenergic tract in seven cases. 8 The experiments demonstrate that opioid peptides modulate the neural inputs to the medial preoptic area arising from the nucleus arcuatus and the ventral noradrenergic tract.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed1988

Oh, my back!

Explore the source record for details and available documents.

Back Pain↗
PubMed1987

A segmentational analysis of prescription drug information seeking.

Drug information-seeking proclivities were examined using data from a telephone survey of 835 individuals who had obtained new outpatient prescriptions within the previous 4 weeks. Factor analytic and clustering techniques were used to segment patients based on the source and nature of drug information received in conjunction with the prescription. A four-cluster solution appeared to represent the most stable, distinct, yet homogeneous solution for the data. The groups were named "physician reliant" (40%), "pharmacist reliant" (19%), "questioners" (7%), and "uniformed" (34%). The four groups were compared for demographic, situational, and attitudinal differences. The physician-reliant group appeared most satisfied with the direct counseling of the doctor. Although this group may have sought additional information, the information appeared to reinforce the physician's directions. The pharmacist-reliant group often obtained prescriptions at independent pharmacies and tended not to rely on magazines or reference books for additional information. The questioners were often taking multiple medications. This group tended to seek out reference information from nonprofessional sources and reported several barriers to seeking information from professionals. The uninformed group was the oldest, tended to receive little information, and was more likely than the other groups to agree that one need not ask questions if one trusts the doctor. Different types of patient education programs were recommended as appropriate for each of the four groups. Motivational messages directed to the uninformed segment appeared to be the largest unmet need in patient-oriented prescription drug education.

Adult↗
PubMed1987

Information search activities among elderly prescription drug users.

A national telephone survey was conducted to compare prescription drug information seeking by younger and elderly patients. Though the elderly were less likely to receive counseling from health professionals, they were more likely to consult mass media sources. Path analyses indicated that collateral variables (such as patient's condition and pharmacy type) moderated information-seeking patterns.

Age Factors↗
PubMed1986

Thrombocytopenia in homosexual men.

The office records of two private practices with a preponderance of homosexual patients were reviewed for cases of males with unexplained thrombocytopenia. Twenty-five patients meeting the selection criteria were found. The clinical and laboratory features of these patients were reviewed and compared to those characteristically seen in classic autoimmune thrombocytopenic purpura. The mean age of the group was 36.5 years. There was a high incidence of a history of sexually transmitted diseases. Sixty percent had another hematologic abnormality in addition to thrombocytopenia. The clinical outcomes for these 25 patients were as follows: eight (32%) had a spontaneous increase in platelets; four (16%) had a stable count not requiring therapy; 12 (48%) received high-dose prednisone; seven (28%) failed prednisone therapy and went on to splenectomy; two (8%) subsequently developed CDC-defined AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Clear cell sarcoma of the tendinous portion of the quadriceps muscle at the knee joint managed by limb-sparing surgery.

A case report of clear cell sarcoma of the tendinous portion of the quadriceps in the knee joint of a 33-year-old female is presented. This insidious, usually painless malignant tumor is often misdiagnosed and may be referred to the sports medicine specialist as a sport-related injury. The duration of symptoms and the size of the lesion are important prognostic factors. Wide excision or radical surgery is necessary to cure such tumors. With improved reconstructive techniques, including free vascularized myocutaneous flaps, limb-sparing surgery is now possible.

Adult↗