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Biomedical subjects

R Schwartz

Publications and source records attributed to R Schwartz.

At least 91 records · Page 5Linked to original sources
PubMed1996

Interferon-ribavirin combination therapy for chronic hepatitis C.

Following preliminary reports of small studies that suggested a clinically important enhanced benefit from combination therapy with interferon-alpha (IFN) and ribavirin over IFN monotherapy in chronic hepatitis C, a meta-analysis of data from these studies was performed to estimate the efficacy and tolerability of combination therapy in chronic hepatitis C. Records were obtained from 59 patients who had received combination therapy with IFN 3 MU three times weekly and ribavirin 1000-1200 mg daily for six months and were followed for six months after stopping combination therapy. Outcome measures included the percentage of patients showing ALT normalization and HCV-RNA negativity six months after therapy (sustained response) and the percentage of patients stopping therapy because of side effects. Sustained response was observed in 21% of IFN nonresponders and in 60% of patients who had relapsed after IFN. For naive patients, the estimated sustained response rate was 52%; the observed response rate was 46%. No serious adverse effects were noted; less than 10% of patients discontinued study medication. This meta-analysis of IFN-ribavirin combination therapy for chronic hepatitis C suggests that combination therapy results in a two- to threefold greater efficacy than IFN monotherapy, whereas side effects are similar to IFN monotherapy, with the exception of ribavirin-induced anemia. Interferon-ribavirin combination therapy might become the next step in antiviral therapy for chronic hepatitis C.

Antiviral Agents↗
PubMed1996

Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson's disease.

BACKGROUND & AIMS: Oral-pharyngeal dysphagia in Parkinson's disease is well recognized. The aim of this study was to establish the mechanisms of oral-pharyngeal dysphagia in these patients. METHODS: Using simultaneous videoradiography and pharyngeal manometry, we studied 19 patients with Parkinson's disease (12 with oral-pharyngeal dysphagia and 7 without oral-pharyngeal dysphagia) and compared them with 23 healthy controls. RESULTS: the clinical severity of Parkinson's disease predicted neither the presence nor the severity of dysphagia. Minor alterations in oral function were common in controls and patients, but pharyngeal dysfunction was significantly more prevalent in patients. Incomplete upper esophageal sphincter (UES) relaxation was present in 4 patients (21%), all of whom showed increased hypopharyngeal intrabolus pressure, but not all of whom had a diminished UES opening. The patients had a reduced UES diameter (P = 0.004) and a higher intrabolus pressure compared with the controls (P = 0.007). Pharyngeal contraction pressures were lower in patients, but 6 patients with dysphagia and an abnormal pharyngeal wall motion had normal peak pressures. CONCLUSIONS: An incomplete UES relaxation and a reduced UES opening, both associated with high intrabolus pressure, are prevalent in Parkinson's disease. Oral-pharyngeal dysphagia in Parkinson's disease is multifactorial, with the majority of patients showing oral and pharyngeal dysfunction, even before the clinical expression of dysphagia. Impaired pharyngeal bolus transport is the major determinant of dysphagia.

Aged↗
PubMed1996

EMLA cream as a topical anesthetic before office phlebotomy in children.

We studied the effectiveness of EMLA cream (2.5% lidocaine, 2.5% prilocaine) in reducing distress, anxiety, and pain associated with phlebotomy in pediatric outpatients. This was a randomized, double-blind, placebo-controlled study using EMLA cream or placebo 1 hour before phlebotomy. Distress, anticipatory anxiety, pain, and adverse reactions were measured. Measurements of distress and ease of procedure, as well as changes in heart rate, showed significant improvement with EMLA cream as compared with placebo. Pain was decreased with use of EMLA cream. Anticipatory anxiety levels were equal within both groups. Ratings of cream efficacy by parent/observer scales were in favor of EMLA cream.

Adolescent↗
PubMed1996

Anaesthetic management of a neonate with nesidioblastosis.

Nesidioblastosis is a disorder which is characterized by autonomous insulin secretion that is not affected by decreases in blood glucose. Patients usually present during the neonatal or infantile period with hypoglycaemia associated with hyperinsulinaemia. Most cases of nesidioblastosis are sporadic; however, familial forms appears to be inherited in an autosomal recessive manner. We discuss the anaesthetic management of a patient with nesidioblastosis who presented for near total pancreatectomy and review the literature pertinent to the anaesthesiologist.

Anesthesia, Inhalation↗
PubMed1996

The use of ondansetron to treat pruritus associated with intrathecal morphine in two paediatric patients.

Intrathecal morphine is an effective technique for providing postoperative analgesia after major surgical procedures in children. Pruritus is a common side effect associated with intrathecal morphine. We report two patients who experienced significant pruritus associated with intrathecal morphine administration and were successfully treated with ondansetron. Ondansetron appears to be a beneficial and safe method of relieving pruritus associated with intrathecal morphine.

Adolescent↗
PubMed1996

CREB and CREB-binding proteins play an important role in the IE2 86-kilodalton protein-mediated transactivation of the human cytomegalovirus 2.2-kilobase RNA promoter.

The human cytomegalovirus (HCMV) immediate-early region 2 86-kDa protein (IE2 86) is the major transactivator of the promoter for the 2.2-kb class of early RNAs (open reading frame UL 112-113). Previously, we reported that a DNA segment on this promoter between nucleotides (nt) -113 and -59 was critical for activation by IE2 86 in vivo and could be bound by IE2 86 in vitro (R. Schwartz, M. H. Sommer, A. Scully, and D. H. Spector, J. Virol. 68:5613-5622, 1994). With a set of site-specific mutations within nt -84 to -61, we have localized the essential cis-acting sequences to nt -72 to -61, which contain an ATF/CREB-binding site. The IE2 86-binding site between nt -113 and -85 is not essential for activation of the promoter by IE2 86 in transient-expression assays, but its presence can enhance the level of activation mediated through the sequences located between nt -84 and -59. Electrophoretic mobility shift assays with a segment containing nt -84 to -59 and nuclear extracts from human cells permissive for the HCMV infection revealed a complex band pattern. However, by supershift analysis with specific antibodies, we were able to identify CREB as the major ATF/CREB family member in the protein-DNA complexes. Further evidence that CREB is a target for IE2 86-mediated induction, is provided by the finding that IE2 86 activates the somatostatin promoter to high levels. Although the binding of IE2 86 to nonphosphorylated full-length CREB or deltaCREB is minimal, IE2 86 does form complexes with p300 and the CREB-binding protein (CBP), which in turn bind to CREB and can serve as adaptor proteins for CREB function. In addition, the in vivo functional relevance of the interaction between IE2 86 and CBP is indicated by the ability of IE2 86 to enhance transcriptional activation mediated by a GAL4-CBP fusion protein brought to a promoter by GAL4-binding sites.

Activating Transcription Factor 1↗
PubMed1996

Failure to thrive: an ambulatory approach.

The diagnosis and management of failure to thrive, a multifactorial condition, can be a challenge for the primary care provider. This article deals with organic failure to thrive and nonorganic failure to thrive in ambulatory settings. The complex etiology of failure to thrive is addressed relative to maternal/paternal and infant/child characteristics. Physical assessment is addressed with special attention on critical growth measurements, feeding and eating patterns, developmental delays, and psychosocial issues. Interventions in the areas of nutrition, development, and psychosocial interactions are examined with an emphasis on team management. Long-term effects of failure to thrive and primary and secondary preventive interventions are addressed.

Failure to Thrive↗
PubMed1996

[Glaucoma and aircraft pilot fitness].

Two completely different questions arise when considering glaucoma and fitness to fly: Firstly, what is the risk for a passenger with glaucoma? Secondly, what is the flight safety risk connected with pilots suffering from glaucoma? National requirements and international standards pay little regard to this disease. This is astonishing, given that the perception of flight information in the peripheral visual field is of great importance in the cockpit. On one hand, diagnostic glaucoma examinations for pilots are mainly insufficient, and on the other, progressive visual field deficiencies may go undetected because of long intervals between examinations. Intraocular pressure may increase while flying in aircraft, e.g. in the case of negative g-load. Frequent flights at high altitudes without pressurized cabin air and with decreased oxygen supply, and therefore decreased tissue oxygen saturation, may represent a risk, especially for patients with progressive nerve fibre loss.

Aircraft↗
PubMed1995

State of the art in continuous speech recognition.

In the past decade, tremendous advances in the state of the art of automatic speech recognition by machine have taken place. A reduction in the word error rate by more than a factor of 5 and an increase in recognition speeds by several orders of magnitude (brought about by a combination of faster recognition search algorithms and more powerful computers), have combined to make high-accuracy, speaker-independent, continuous speech recognition for large vocabularies possible in real time, on off-the-shelf workstations, without the aid of special hardware. These advances promise to make speech recognition technology readily available to the general public. This paper focuses on the speech recognition advances made through better speech modeling techniques, chiefly through more accurate mathematical modeling of speech sounds.

Algorithms↗
PubMed1995

Early restenosis following percutaneous transluminal balloon angioplasty for the treatment of the superior vena caval syndrome due to pacemaker-induced stenosis.

Superior vena caval syndrome (SVC) following transvenous pacemaker insertion is an uncommon complication that has been treated with percutaneous transluminal balloon angioplasty. We report a case of SVC syndrome following pacemaker implantation that was treated with angioplasty. Several days after the initial balloon dilation, the patient had recurrent symptoms and evidence of restenosis on catheterization. Following repeat balloon dilation of this restenotic lesion, the patient had a favorable clinical response evidenced on hemodynamic and angiographic follow-up at 6 months.

Adult↗
PubMed1995

Treatment of hepatic-metastatic colorectal cancer with a chemotherapeutic emulsion: interim results of a phase I trial.

BACKGROUND: Hepatic arterial infusion of 5-fluoro-2-deoxyuridine (FUdR) is associated with a 60% response rate among previously untreated patients who have hepatic-metastatic colorectal cancer. One obstacle to further dose escalation has been concomitant hepatic toxicity. We are evaluating a FUdR-containing chemotherapeutic emulsion to further dose intensify therapy without associated toxicity. METHODS: The in vitro pharmacokinetics of the emulsion were determined using high-pressure liquid chromatography (HPLC). The rate at which FUdR is released from emulsion into an overlying aqueous phase was determined in static and dynamic assays. Fifteen patients with hepatic-metastatic colorectal cancer were treated with intrahepatic arterial infusions of emulsion on a phase I dose-escalating clinical protocol. Serum collection determined systemic drug levels using HPLC. RESULTS: In vitro studies demonstrate that FUdR is slowly released from emulsion into overlying aqueous medium. The emulsion serves as a depot for FUdR. Therapy was well tolerated. Emulsion was sequestered in the liver after infusion in all treated patients. CONCLUSIONS: This Ethiodol-based, oil-in-water emulsion serves as a sustained-release preparation of FUdR. An Ethiodol-based oil-in-water emulsion is a clinically effective vehicle for delivering FUdR to hepatic-metastatic colorectal tumors.

Aged↗
PubMed1995

Dose-related activity of stavudine in patients infected with human immunodeficiency virus.

In a multicenter, randomized, open-label, dose-ranging study to determine the relative effects of three dose levels of stavudine on CD4 lymphocyte count, weight gain, and hematologic variables in patients infected with human immunodeficiency virus (HIV), 152 patients with CD4 lymphocyte counts < or = 600/mm3 received stavudine at 0.1 mg/kg/day (n = 51), 0.5 mg/kg/day (n = 53), or 2.0 mg/kg/day (n = 48). The study was designed to evaluate the activity of stavudine after 10 weeks of therapy and permitted extended dosing and follow-up for long-term safety. A significant dose effect on increases in CD4 lymphocyte counts and declines in HIV titer in peripheral blood mononuclear cells was observed. Stavudine was well-tolerated; the only dose-related, dose-limiting adverse event was peripheral neuropathy, which usually was reversible. In this trial, the most favorable therapeutic index was seen at 0.5 mg/kg/day.

Adult↗
PubMed1995

24 hour ambulatory blood pressure profiles in the acute phase of stroke.

1. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was used to evaluate the blood pressure (BP) changes in acute stroke. 2. Stroke was categorized according to the probable underlying vascular mechanism into lacunar infarction (L), thrombotic infarction (T) and intracerebral haemorrhage (ICH). A total of 37 stroke patients were studied (T = 21, L = 9, ICH = 7). Control patients (n = 15) were acute medical admissions not severely ill or in significant pain. ABPM was performed on day 1 and day 7 following admission. 3. Day 1 mean +/- s.d. 24 h systolic BP (SBP) were L (159 +/- 15.8), ICH (151 +/- 33.4), T (147 +/- 15.2) and controls (134 +/- 17.8). Day 7 mean 24 h SBP were L (138 +/- 9.8), ICH (143 +/- 26.9), T (138 +/- 19) and controls (134 +/- 14.8). In each stroke group BP fell to levels similar to control on day 7, while control mean SBP remained unchanged between days 1 and 7. The highest day 1 BP and the greatest subsequent fall on day 7 occurred for lacunar infarction. Diastolic BP showed similar changes to SBP. 4. The acute stress of hospitalization does not appear to explain elevated BP in acute stroke. Lacunar infarction appears to be particularly associated with temporary BP elevation.

Aged↗
PubMed1995

The human cytomegalovirus IE2 86-kilodalton protein interacts with an early gene promoter via site-specific DNA binding and protein-protein associations.

The 86-kDa immediate-early 2 protein (IE2 86) of human cytomegalovirus is a powerful transactivator of homologous and heterologous promoters, including the human cytomegalovirus 1.2-kb RNA early promoter. Two potential mechanisms for gene activation by IE2 86 include interaction with cellular proteins and direct DNA binding. In this report, we show that the 1.2-kb RNA promoter contains a cis-acting AP-1 site, critical for its activation by IE2 86 in vivo, and that IE2 86, purified as a glutathione S-transferase-IE86 fusion protein, can interact with c-Jun and JunB. Additionally, by coimmunoprecipitation, we document that JunB and IE2 86 do associate in vivo. Further in vitro analysis reveals that Fos proteins are able to associate with glutathione S-transferase-IE86 only when present as a Jun-Fos heterodimer. With a set of IE2 86 mutants, we demonstrate that three independent regions of the IE2 86 interact in vitro with c-Jun, two of which are essential for activation of the 1.2-kb RNA promoter in vivo. We also show that IE2 86 can bind directly to this promoter through a sequence located just upstream of the AP-1 site between nucleotides -125 and -97. This discrete domain shares sequence homology with the cis-repression signal on the IE gene.

Animals↗
PubMed1995

Respiratory syncytial virus in infants and children.

Respiratory syncytial virus (RSV) is a frequent cause of respiratory illness in infants and children, affecting almost 100% of children by the age of 3 years. Mild RSV infection usually involves only the upper respiratory tract, while the lower respiratory tract is involved in severe disease. This article addresses the epidemiology of RSV infection, transmission of the disease, predisposing conditions, clinical course, diagnosis, and management. The majority of children can be managed on an outpatient basis, while some will require hospitalization. Outpatient management, with a focus on adequate hydration, humidification, and comfort measures, is emphasized with a brief overview of the management of the hospitalized patient. Breast-feeding, crowded conditions, and hand washing are discussed relative to primary and secondary prevention.

Causality↗
PubMed1995

"Death-telling" research project.

An unexpected death is a traumatic event for everyone affected by it, especially family members. The manner in which a family is told that a death has occurred has a profound effect on their grief and bereavement process. The task of the health care professional working with these patients and their families is to assist their healing by being skilled in the "death-telling" process. This article focuses on the project that developed a teaching tool and videotape used to educate individuals about the proper way to inform families of the death of a loved one.

Death, Sudden↗
PubMed1995

[Results of cyclodialysis combined goniotomy in treatment of dysgenetic glaucoma].

This study was performed in order to investigate the results of "cyclodialysis ab interno," i.e., a combination of goniotomy and cyclodialysis, in patients suffering from dysgenetic glaucoma. From 1985 to 1993, 69 patients (98 eyes) underwent at least one cyclodialysis ab interno. The development of intraocular pressure was examined 2 days, 4 weeks, 1/2 year, 1 year and 3 years postoperatively after the first and last cyclodialysis ab interno. Additionally, we examined intraoperative bleeding, preoperative pressure level, previous operations, reoperations, age at manifestation, and monocular or binocular manifestation for their influence on the results. The effect the operation had on visual acuity was also examined. One year after the last cyclodialysis ab interno, the IOP was regulated in 77% of the eyes. The prognosis was better for eyes with preoperative pressure values of less than 30 mmHg than for eyes with pressure values of more than 30 mmHg. It was also clearly better when the glaucoma had become manifest at the age of more than one year. Previous operations, intraoperative bleeding, and monocular or binocular manifestation had no influence on the results. In comparison with the data available for goniotomy and trabeculotomy, cyclodialysis ab interno shows a tendency for better results.

Adolescent↗