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Biomedical subjects

S Cohen

Publications and source records attributed to S Cohen.

At least 451 records · Page 25Linked to original sources
PubMed1991

Heart rate response to an i.v. test dose of adrenaline and lignocaine with and without atropine pretreatment.

In order to evaluate the sensitivity of an adrenaline test dose for detecting intravascular injection and the effect of atropine pretreatment, 90 ASA physical status I and II patients were allocated randomly to two groups, to receive i.v. saline 1 ml (n = 46) or i.v. atropine 0.5 mg (n = 44). Five minutes later, all patients received an i.v. test dose of 2% lignocaine 3 ml with adrenaline 15 micrograms at a rate of 1 ml s-1. The groups were similar with respect to basal heart rate (HR). HR remained unchanged after saline injection, but increased slightly 5 min after atropine injection (mean 78 (SD 15) beat min-1 vs 87 (20) beat min-1 (P less than 0.05). After the test dose of lignocaine with adrenaline, HR increased significantly in both groups at 30 s, 1 and 2 min, and remained increased at 3 min in the atropine group. The maximum increase in HR was greater in the atropine group than in the saline group (31 (4) beat min-1 vs 26 (11) beat min-1 (P less than 0.05). However, when individual maximum HR changes are considered, five patients in the saline group and four in the atropine group had an increase less than or equal to 10 beat min-1, and three patients in the saline group had no change or a decrease in HR. Defining a positive result to a test dose as an increase in HR of greater than 10 beat min-1, the sensitivity of the adrenaline test dose was 83 (5.5)% in the saline group and 91 (3.5)% in the atropine group (ns).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Fluconazole failure in the treatment of invasive mycoses.

Fluconazole is a recently licensed antifungal agent that has gained widespread use in the medical community. Despite a lack of controlled trials in invasive fungal infections, this agent is often prescribed because of ease of administration and concern over amphotericin B toxicity. Three cases of systemic fungal infections in which fluconazole use resulted in unambiguous microbiologic and clinical failure are reported.

Amphotericin B↗
PubMed1991

The deep inferior epigastric rectus abdominis muscle and myocutaneous free tissue transfer: further applications for head and neck reconstruction.

The rectus abdominis muscle and myocutaneous free tissue transfer is a well-recognized donor site for reconstruction of complex head and neck defects. Four composite deformities were successfully managed using this donor site. The rectus abdominis myocutaneous "sandwich" flap was used for closure of a pharyngocutaneous fistula and to provide intraoral lining and external coverage for a composite mandibular defect. The rectus muscle flap was used to obliterate a compound frontal sinus injury and an orbitomaxillary defect. All flaps were based on the deep inferior epigastric vascular pedicle.

Abdominal Muscles↗
PubMed1991

Stress responses after pediatric bone marrow transplantation: preliminary results of a prospective longitudinal study.

This paper reports the preliminary findings of a longitudinal prospective study of young children undergoing bone marrow transplantation. Symptoms of post-traumatic stress were seen in these children up to 12 months after transplant. The bone marrow transplantation survivors demonstrated more denial and avoidance and fewer arousal symptoms than has been noted in children traumatized by a violent life threat, such as a sniper attack. These data suggest the use of post-traumatic stress as a model in understanding some of the symptoms of pediatric bone marrow transplantation survivors and may be applicable to other children exposed to the double life threat of serious illness and intensive medical intervention.

Adaptation, Psychological↗
PubMed1991

The control of class II expression on T cells is independent of the regulation of Tac and the induction of proliferation.

In order to define the association between class II expression and other markers of T cell activation we tested the ability of various modes of stimulation to induce the expression of class II, Tac, and to stimulate proliferation. Stimulation of T cells with phytohaemagglutinin (PHA) in the presence of accessory cells strongly induced proliferation, Tac and the class II antigen DR. When purified T cells without accessory cells were stimulated with the phorbol ester, PdB, and the calcium ionophore, ionomycin, strong proliferation and Tac expression were induced, but only low levels of surface class II were observed. In contrast, stimulation of the same cells with PHA resulted in weak proliferation, strong Tac, but again low class II levels. The addition of PdB to the PHA increased the proliferative response, but did not affect Tac expression, which remained high, or class II expression, which remained low. Subsequent culture in conditioned medium of purified T cells which had been activated with either PdB and ionomycin or with PHA resulted in increased surface class II levels in both cases. Additional experiments suggested that neither IL-2, IL-4, nor interferon-gamma (IFN-gamma) alone was responsible. These results demonstrate that class II expression can be separated from the induction of proliferation and the upregulation of Tac and that the mode of T cell stimulation influences the resulting activation pathway. Furthermore, they suggest that the control of class II expression on T cells is more tightly regulated than it is on other cells.

Antigens, Differentiation, T-Lymphocyte↗
PubMed1991

The louse Trinoton anserinum (Amblycera: Phthiraptera), an intermediate host of Sarconema eurycerca (Filarioidea: Nematoda), a heartworm of swans.

The role of the louse Trinoton anserinum (F) as an intermediate host of Sarconema eurycerca (Wehr) was investigated in swans. 8.3% of healthy swans carried one to twelve lice per bird, dispersed contagiously. Injured and lead-poisoned swans were more heavily infected. The mouthparts appear designed to penetrate the hosts' skin; the mandibles are robust and asymmetric, and the maxillae have a serrated intercutting surface. 22% fed exclusively on blood and 33% on both blood and feather. All life-cycle stages fed upon blood and the barbs and barbules from down feathers; hooklets from contour feathers were only found in adults. 9% of lice were infected with developing nematode larvae in the head, thorax or abdomen. Lice labelled with Technetium 99 m moved towards the scapulas and the wings. Lice were found to be highly active and were mobile.

Animals↗
PubMed1991

Extradural block in obstetric patients: review of experience with gravity administration.

Charts of 2284 obstetric patients who received extradural block with gravity administration of local anaesthetic were evaluated retrospectively. Despite a 1.3% incidence of vascular puncture and a 1.8% incidence of dural puncture, accidental intravascular or intrathecal injection of local anaesthetic did not occur. We propose that this method may be safer than the traditional "injection by needle" technique, and has a high degree of "visualization" of the otherwise "blind" extradural block procedure.

Anesthesia, Epidural↗
PubMed1991

Adjuvant effects of dimethyl dioctadecyl ammonium bromide, complete Freund's adjuvant and aluminium hydroxide on neutralizing antibody, antibody-isotype and delayed-type hypersensitivity responses to Semliki Forest virus in mice.

Outbred mice were inoculated subcutaneously with inactivated Semliki Forest virus (SFV) in saline and combinations of the virus with complete Freund's adjuvant (CFA) aluminium hydroxide (Al) and dimethyl dioctadecyl ammonium bromide (DDA). The immune response was evaluated for delayed-type hypersensitivity, for total ELISA antibodies and antibody-isotypes and for neutralizing antibodies. DDA was the most efficient adjuvant in inducing DTH, CFA the second and Al induced a DTH response that was only slightly higher (statistically not significant) than that induced by the inactivated virus without adjuvants. All adjuvants enhanced the production of ELISA antibodies to similar levels. However, the levels of neutralizing antibodies induced were low in mice which were inoculated with the inactivated SFV alone or mixtures of the virus with Al. DDA induced high levels of neutralizing antibodies and CFA induced intermediate levels. The pattern of antibody-isotypes induced by DDA and CFA was different from the pattern induced by the inactivated virus or by the virus mixed with Al: DDA and CFA induced low amounts of IgG1 antibodies and relatively higher amounts of IgG2a and IgG2b antibodies while the inactivated virus and the mixture of the virus with Al induced higher proportions of IgG1 antibodies. In sera from convalescent mice the majority of antibody activity resided in the IgG2a and IgG2b immunoglobulin subclasses, while IgG1 antibodies were undetectable.

Adjuvants, Immunologic↗
PubMed1991

Tardive dyskinesia in the mentally retarded: comparison of prevalence, risk factors and topography with a schizophrenic population.

Thirty mentally retarded patients treated with neuroleptics for aberrant behavior were compared with 30 neuroleptic-treated schizophrenics for the presence, topography and risk factors associated with tardive dyskinesia (TD). In the total sample (n = 60), female sex, schizophrenic diagnosis and increasing age were associated with TD. The length of neuroleptic treatment and current neuroleptic dose were not significantly associated with TD. The only topographical difference in TD presentation was that the mentally retarded group had significantly more tongue involvement.

Adult↗
PubMed1991

Failure of Micro Media FOX Microdilution System to detect decreased susceptibility of Streptococcus pneumoniae to penicillin.

Twelve isolates of Streptococcus pneumoniae with decreased susceptibility by oxacillin screen were susceptible by the FOX panel (Micro Media Systems, Cleveland, Ohio), a commercial microdilution system designed for fastidious organisms. These organisms were found to be moderately susceptible or resistant by broth macrodilution and agar dilution methods. This discrepancy indicates that the FOX panel is not reliable for susceptibility testing of S. pneumoniae.

Diagnostic Errors↗
PubMed1991

Acute eosinophilic pulmonary disease associated with the ingestion of L-tryptophan-containing products.

A series of four patients with pulmonary infiltrates, pleural effusions, hypoxemia, peripheral eosinophilia, and symptoms of dyspnea, fatigue, and weakness is reported. Lung tissue obtained in three patients revealed interstitial pneumonitis, small-to-medium-vessel mixed-cell vasculitis, and alveolar exudate of histiocytes and eosinophils. All patients reported ingestion of L-tryptophan-containing products at a time when an association between L-tryptophan and the eosinophilia-myalgia syndrome was established. This clinical pattern of pulmonary involvement may be part of the continuum of the eosinophilia-myalgia syndrome. The pathophysiology of this syndrome and the relationship with the ingestion of L-tryptophan-containing products have not yet been identified.

Adult↗
PubMed1991

Chemotherapy of metastatic Merkel cell cancer.

Out of 16 cases of Merkel cell cancer identified in the records of the Mt. Sinai Medical Center or affiliates, 11 patients developed systemic metastases. Literature review confirms the substantial possibility of dissemination. Both in our series and in the literature, cytotoxic chemotherapy produced a high rate of usually short-lived response, although one of our patients with disseminated metastases achieved complete remission for two years.

Adult↗
PubMed1991

Fibrous myopathy from butorphanol injections.

We describe an unusual, and probably underrecognized manifestation of intramuscular narcotic abuse. Fibrous myopathy is a deforming, fibrous infiltration of the muscles used for injection over a prolonged period. It is usually associated with pentazocine or meperidine injections, and to our knowledge, this is the first report of butorphanol causing the entity.

Adult↗
PubMed1991

Professional careers of 258 graduates of a 'fifth pathway' program.

Two hundred fifty-eight graduates (80%) of a fifth pathway program provided information about their professional careers. Fifty-nine percent practice primary care medicine, 25% are surgeons, and 16% are in support services such as psychiatry and radiology. Fifty-four percent are board certified, many of whom are doubly-board certified and some of whom hold prestigious academic positions. We conclude that properly educated fifth pathway graduates can become productive and respected members of the medical profession and contribute significantly to meeting the health-care needs of the patients and communities they serve.

Career Choice↗