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Biomedical subjects

R Kaplan

Publications and source records attributed to R Kaplan.

At least 91 records · Page 5Linked to original sources
PubMed1992

Obstructive sleep apnoea and depression--diagnostic and treatment implications.

Sleep apnoea (OSA), a common sleep disorder, is well recognised as a cause of morbidity including psychiatric disorders. There is increasing recognition of the link between OSA and depression. Sleep changes are intrinsic to depressive disorders, most notably disturbances of REM sleep; OSA causes predominantly REM sleep disturbances. The neuro-vegetative features of depression are similar or identical to the symptoms of OSA-an issue which has not achieved wide clinical recognition. A growing number of studies confirm the statistical link between the two conditions. The implications are twofold: OSA needs to be excluded in cases of chronic or resistant depression and treatment of OSA will make it easier to treat the primary depressive disorder. A new method of treatment for OSA, the Sullivan continuous positive airway pump (CPAP), raises the theoretical possibility of treating depression by this means as well.

Adult↗
PubMed1992

Glycosylated serum ferritin in patients with hematological malignancies before and after bone marrow transplantation.

Glycosylated and total serum ferritin levels were monitored in patients with acute leukemia and lymphoma undergoing bone marrow transplantation (BMT). Serum ferritin was high in relapsing patients and normal in most patients in complete remission (CR). In patients with an uncomplicated course, levels of ferritin increased during the first month after BMT with subsequent decrease. Three patients with lymphoma and five with acute leukemia had high serum ferritin levels despite achieving apparent complete hematological remission which was of short duration. The results were compared with groups of lymphoma patients at presentation and during remission and with healthy normal controls. In all the lymphoma patients and in 3 of the 5 leukemia patients the percent of ferritin glycosylation was normal at CR. It was low at the time of diagnosis in all patients. Thus, the percent glycosylation proved a more reliable marker for clinical remission than total serum ferritin. During follow up after BMT in uncomplicated cases, the percent of glycosylated ferritin returned to normal levels earlier than the total serum ferritin. These findings indicate that the evaluation of the amount of glycosylated ferritin may provide useful information in hematological patients in whom there is a discrepancy between high serum ferritin levels and the clinical condition.

Bone Marrow Transplantation↗
PubMed1992

The Yankton Model Program.

Changes in medical education towards a student-centered, problem-based learning, with continuity care experience in ambulatory settings have been recommended. The University of South Dakota School of Medicine has developed such an educational model for third year medical students named the Yankton Model Program and is herein described.

Curriculum↗
PubMed1991

Bullous pyoderma gangrenosum after granulocyte colony-stimulating factor treatment.

The hematopoietic growth factors are under investigation for the treatment of patients with chemotherapy-induced bone marrow suppression. One such trial at the University of California, Los Angeles involves chemotherapy with or without granulocyte colony-stimulating factor (G-CSF) in patients with small cell lung cancer. The authors report a case of a patient who had bullous pyoderma gangrenosum at the site of previous eczema during treatment with G-CSF. The lesions resolved promptly when the drug was discontinued. Other investigators have recently reported inflammatory complications of G-CSF and granulocyte-macrophage colony-stimulating factor (GM-CSF) but this is the first case report of biopsy-proven neutrophilic dermatosis associated with administration of a hematopoietic growth factor. Patients should be monitored for development of inflammatory processes during G-CSF therapy and this therapy should be given with caution to those patients with existing inflammatory conditions.

Carcinoma, Small Cell↗
PubMed1991

Bilateral burning foot pain: monitoring of pain, sensation, and autonomic function during successful treatment with sympathetic blockade.

We describe a patient with burning pain in both feet associated with local autonomic disturbances following bilateral traumatic sciatic mononeuropathies. The diagnosis of a sympathetically maintained pain was confirmed through a prompt response to sympathetic blockade. Although a mild alcohol-nutritional neuropathy was found, the clinical findings strongly suggested a diagnosis of bilateral causalgia. Clinical evaluation and quantitative sensory testing were performed prior to and after successive unilateral lumbar sympathetic nerve blocks. After unilateral blockade, bilateral improvement was recorded in measures of pain, sudomotor function, and foot temperature. Other measures of autonomic function showed variable responses to sympathetic blockade. Quantitative sensory testing revealed a dramatic alteration in the contralateral limb's thermal sense following unilateral block. This case underscores the potential for bilateral causalgia and provides additional evidence for a central mechanism operating in this disorder. The relationship between bilateral causalgia and the "burning feet syndrome" in alcoholic neuropathy is discussed.

Adult↗
PubMed1991

Molecular cloning and expression of biologically active human glia maturation factor-beta.

Glia maturation factor-beta, a protein found in the brains of all vertebrates thus far examined, appears to play a role in the differentiation, maintenance, and regeneration of the nervous system. Using oligonucleotide probes based on the sequences of three tryptic peptides derived from bovine glia maturation factor-beta, we screened a human brainstem cDNA library in lambda gt11. A 0.7-kb clone was isolated, sequenced in its entirety, and found to encode a polypeptide of 142 amino acids which contained regions identical to the three bovine peptides. This polypeptide, human recombinant glia maturation factor-beta, has been expressed in Escherichia coli and found to possess structural characteristics and biological activity indistinguishable from those of the native bovine protein.

Amino Acid Sequence↗
PubMed1991

Posterior cortical dementia with alexia: neurobehavioural, MRI, and PET findings.

A progressive disorder of relatively focal but asymmetric biposterior dysfunction is described in a 54 year old right handed male. Initial clinical features included letter-by-letter alexia, visual anomia, acalculia, mild agraphia, constructional apraxia, and visuospatial compromise. Serial testing demonstrated relentless deterioration with additional development of transcortical sensory aphasia, Gerstmann's tetrad, and severe visuoperceptual impairment. Amnesia was not an early clinical feature. Judgment, personality, insight, and awareness remained preserved throughout most of the clinical course. Extinction in the right visual field to bilateral stimulation was the sole neurological abnormality. Early CT was normal and late MRI showed asymmetrical bioccipitoparietal atrophy with greater involvement of the left hemisphere. Results from positron emission tomography (PET) showed bilaterally asymmetric (left greater than right) occipitotemporoparietal hypometabolism. The metabolic decrement was strikingly asymmetric with a 50% reduction in glucose consumption confined to the left occipital cortex. The picture of occipitotemporoparietal compromise verified by MRI, PET, and neurobehavioural testing would be unusual for such degenerative dementias as Alzheimer's (AD) and Pick's disease, although atypical AD with predominant occipital lobe involvement cannot be excluded. This case supports the concepts of posterior cortical dementia (PCD) as a clinically distinct entity and for the first time documents its corresponding metabolic deficit using PET.

Atrophy↗
PubMed1991

The benefits of nearby nature for elderly apartment residents.

Few studies have examined the potential value of nearby nature for elderly adults. In the current study, elderly residents of two apartment complexes were interviewed about the availability of and the importance of different nearby natural settings. They were also asked how involved they were with various "nature compensations"--indoor activities, such as growing houseplants or watching nature programs on television, which might substitute for more strenuous outdoor activities. The results indicate that elderly adults consider access to nature near their homes to be very important. Nature compensations were frequently pursued but did not affect satisfactions. Satisfaction levels were significantly higher among residents whose apartments overlooked natural settings, and among those who lived closer to certain kinds of outdoor settings.

Aged↗
PubMed1991

Peer review.

Explore the source record for details and available documents.

Character↗
PubMed1990

Photochemotherapy of hypervascular dermal lesions: a possible alternative to photothermal therapy?

Continued improvement in the results of laser treatment of port wine stain, with reduction in scarring, will depend on the ability to use lasers to induce selective injury of only the abnormal blood vessels in the dermis while sparing the normal overlying epidermis. Photodynamic therapy, using an exogenous photosensitizing drug specifically activated by certain wavelengths of light, may be used to destroy selectively certain targets in biological systems. The current study demonstrates, in the chicken comb model, that photochemotherapy can be used to treat hypervascular dermal lesions while leaving the normal overlying epidermis completely intact.

Animals↗
PubMed1990

Prehospital use of nifedipine for severe hypertension.

The prehospital management of severe hypertension is limited by a paucity of pharmacologic agents suitable for field use. This prospective study was designed to test the safety and efficacy of intraoral nifedipine therapy in 50 patients with severe hypertension being transported by an urban emergency medical service system. Ten milligrams of nifedipine were administered. Serial blood pressure determinations were obtained at 3, 5, 10, and 15 minutes and patients were observed for possible side effects. A marked effect on systolic blood pressure (SP), diastolic blood pressure (DP), and mean arterial pressure (MAP) was evident and was statistically significant in all three categories by 3 minutes. MAP decreased from 169 to 129 mm Hg (delta MAP of 40 mm Hg) at 15 minutes with parallel changes in the SP (55 mm Hg) and delta DP (32 mm Hg). These changes were highly significant (P less than .01) when compared with those of 50 historical controls. No evidence of severe adverse effects were noted. Nifedipine appears to be a promising agent for the prehospital treatment of severe hypertension, but its proper role is not yet defined.

Administration, Oral↗
PubMed1990

Effect of scavenging on ambient levels of nitrous oxide in ambulances.

Nitrous oxide scavenging devices have not been tested in the prehospital setting. We studied two nitrous oxide scavenging devices and their effect on ambient levels of nitrous oxide in the patient compartment of a stationary ambulance. We compared the ambient levels of gas when nitrous oxide scavenging was in use versus when it was not. In addition, we evaluated the effect of two different mask designs on ambient levels of nitrous oxide. With eight healthy male volunteers acting as their own controls using a series of mask/scavenger combinations, we found that there was a significant difference in the ambient levels of nitrous oxide when a scavenger was in use. The mean time-weighted average was 776 parts per million/min when no scavenger was used. When gas scavenging was in use, the mean time-weighted average never exceeded 150 parts per million/min. (P less than .0001). There was no significant difference between nitrous oxide scavengers or between the masks tested in their effect on nitrous oxide ambient levels in the atmosphere. We conclude that nitrous oxide scavengers are effective in lowering nitrous oxide ambient levels in the prehospital setting and merit consideration as adjuncts to nitrous oxide delivery systems in this setting.

Air Pollutants, Occupational↗
PubMed1990

Nasotracheal intubation using a flexible lighted stylet.

Nasotracheal intubation is an essential skill for clinicians involved in the care of acutely ill or injured patients. Unfortunately, it has the dangers and difficulties of any blind technique. Although usually performed in the awake patient, nasotracheal intubation has also been used in the apneic patient. Transillumination of the soft tissues of the neck with a lighted stylet has been shown to be a reliable method of orotracheal intubation. The usefulness of a longer, flexible lighted stylet as an aid to nasotracheal intubation in the apneic patient has been examined. Eighty patients, who were paralyzed, apneic, and about to undergo nasotracheal intubation for elective ear, nose, and throat or maxillofacial surgery were randomized to be nasotracheally intubated blindly or with a stylet by an emergency medicine resident or anesthesiologist. Sixty-three percent intubated in the lighted-stylet group and 41% in the blind nasotracheal intubation group were successfully intubated. There were no significant differences in the time needed to intubate or the number of attempts. There were notable differences in the success rates of individual intubators with each technique. Although not statistically significant, our results suggest a useful role for the lighted stylet in nasotracheal intubation in the apneic patient.

Adolescent↗