Search PubMed⌕ Search

Biomedical subjects

R L Koretz

Publications and source records attributed to R L Koretz.

At least 73 records · Page 4Linked to original sources
PubMed1992

Studies within studies.

Explore the source record for details and available documents.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

Universal prenatal hepatitis B testing: is it cost-effective?

It was recently recommended that all pregnant women undergo prenatal hepatitis B screening. This change from previous policy (which advocated screening of only those individuals with recognized epidemiologic risk factors) is a very costly strategy to use in an effort to prevent the perinatal spread of hepatitis B in the "no-risk-factor" population. Inherent problems already exist in screening, related to the following: 1) the failure for disease transmission to occur in the majority of hepatitis B e antigen-negative pregnancies, 2) the lack of established efficacy of prophylaxis in the hepatitis B e antigen-negative pregnancy, 3) the preponderance of hepatitis B e antigen negativity in pregnant hepatitis B surface antigen carriers, and 4) the compliance of the mother to ensure that the prophylaxis program is accomplished. These are further magnified by the lower rates of hepatitis B surface antigen and hepatitis B e antigen positivity in the population without risk factors. The major expense of a screening program is the hepatitis B surface antigen testing of the mother. The cost to prevent a clinically important case of hepatitis B in the neonates of mothers with no risk factors is $180,000, which is 15 times the cost of preventing a case in neonates of mothers with risk factors. This price appears not to be cost-effective.

Cost-Benefit Analysis↗
PubMed1987

Is endoscopy hazardous to your liver?

In a survey of a gastrointestinal endoscopy society, 92 members (84%) filled out a questionnaire and donated serum specimens for testing for hepatitis B markers and alanine aminotransferase. The frequency of serologic evidence of exposure to hepatitis B was only slightly higher than that seen in the general population and comparable to that reported in "low-risk" health-care workers. Overall, 12% had markers of previous hepatitis B exposure and 3% had an abnormal aminotransferase determination. There was no correlation between hepatitis B exposure and endoscopic experience.

Adult↗
PubMed1986

Nutritional support: how much for how much?

Although malnutrition is associated with poor clinical outcome, it cannot be inferred that better nutrition will improve clinical outcome. Efficacy of a proposed regimen is best established by prospective, randomised, controlled trials. Cost effectiveness is only an issue if efficacy exists. Patients with long term temporary, or permanent, inadequate bowel syndrome are candidates for parenteral nutrition. Most of the prospective, randomised, controlled trials testing the value of nutritional support in other diseases, however, have failed to show that this treatment has a beneficial clinical effect. Areas where these trials have shown a possible clinical benefit include the perioperative care of patients with upper gastrointestinal cancer, elemental diet treatment of Crohn's disease, and branched chain amino acid infusions in hepatic encephalopathy. Even in these instances, it is not clear that such treatment will prove to be cost effective (compared with other currently available treatments).

Amino Acids↗
PubMed1985

Non-A, non-B posttransfusion hepatitis--a decade later.

We have followed up 69 patients who developed non-A, non-B posttransfusion hepatitis in 1972-1978. Chronic hepatitis, defined by biochemical criteria, was observed in 46 patients (67%), the majority of whom subsequently failed to resolve the abnormalities. Chronic hepatitis was a sequela of non-A, non-B posttransfusion hepatitis less often after the blood bank changed to a policy of all volunteer donors. (However, this association may be explained by other coexistent factors.) The alanine aminotransferase level was more likely to be abnormal than the aspartate aminotransferase level during the chronic phase of non-A, non-B posttransfusion hepatitis. By actuarial means it was calculated that the probability of developing normal enzymes after 6-10 yr was 0.47. However, in spite of this high incidence of biochemical disease, virtually all of the patients have remained asymptomatic. Histologic evidence of cirrhosis has been obtained in 4 of these patients, but in only 2 patients at most has clinical evidence of hepatic failure supervened.

Actuarial Analysis↗
PubMed1984

The pursuit of hepatitis in dialysis units.

Chronic hemodialysis patients were prospectively followed at monthly intervals with hepatitis B serologic (HBsAg, anti-HBs, and anti-HBc) and aminotransferase determinations. Over this 1 year, 53/176 (30%) had two or more abnormal aminotransferase values. In at least 34 of these 53 patients, viral liver disease appeared to be the responsible factor. Although patients with anti-HBc were more likely to have abnormal aminotransferases, it is probable that most viral hepatitis in dialysis units is due to non-A, non-B hepatitis. After a further 2 1/2 years of follow-up, no clinical evidence of hepatic failure was seen in any of the patients with hepatitis. The ultimate course of this disease, however, is not yet established.

Alanine Transaminase↗