Liver transplantation for fulminant hepatic failure.
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Cell Transplantation↗
Biomedical subjects
S Edelstein
Publications and source records attributed to S Edelstein.
Hepatic resections.
Hepatic resection is the treatment of choice for many secondary and primary hepatic tumors. With improvement in surgical techniques and earlier recognition of hepatic tumors, there has been a renewed interest in performing hepatic resections. In this operative review, we will describe the techniques for performing right-sided and left-side hepatic resections. A major hepatic resection can be performed with less than 5% mortality and approximately a 5% to 15% morbidity. Special mention will be made of performing a hepatic resection without vascular inflow occlusion. This is necessary in performing a hepatic resection for use in live donor liver transplantation.
Hepatectomy↗
Long-term prognosis of acute pulmonary oedema--an ominous outcome.
BACKGROUND: Acute pulmonary oedema (APOE) is a major health problem, leading to poor hospital and long-term outcomes. There is a relative paucity of studies describing prognosis of consecutive unsolicited patients diagnosed with APOE and hospitalized in internal medicine departments. AIMS: To describe the clinical profile and outcome (in hospital and 1-year prognosis) of successive unselected patients with APOE, in a prospective observational study. METHODS AND RESULTS: The study population included 150 consecutive unsolicited patients (90 men, 60 women; median age 75 years) with APOE all hospitalized in an internal medicine department, in a 900-bed care centre. Ischaemic heart disease (IHD), hypertension and diabetes were present in 85%, 70% and 52% of patients, respectively. The most common precipitating factors for APOE included high blood pressure (29%), rapid atrial fibrillation (29%), unstable angina pectoris (25%), infection (18%) and acute myocardial infarction (MI; 15%). Eighteen patients (12%) died in hospital, with 82% of these deaths attributed to cardiac pump failure. Predictors for an increased in-hospital mortality included: diabetes (P<0.05), orthopnoea (P<0. 05), echocardiographic finding of depressed global left ventricular systolic function (P<0.001), acute MI during hospital stay (P<0.001), hypotension/shock (P<0.05), and the need for mechanical ventilation (P<0.001). After a median hospital stay of 10 days, 132 patients were discharged home. The 1-year mortality was 40%. Only the presence of pleural effusion was found as a predictor for 1-year mortality. CONCLUSION: Most patients with APOE in this study are elderly, and have IHD, hypertension, diabetes and a previous history of APOE. The overall mortality is high (in-hospital, 12%: 1-year, 40%). Left ventricular dysfunction was associated with high in-hospital mortality, but not with long-term prognosis.
Adult↗
Brain nicotinic receptors: structure and regulation, role in learning and reinforcement.
The introduction, in the late sixties, of the concepts and methods of molecular biology to the study of the nervous system had a profound impact on the field, primarily through the identification of its basic molecular components. These structures include, for example, the elementary units of the synapse: neurotransmitters, neuropeptides and their receptors, but also ionic channels, intracellular second messengers and the relevant enzymes, cell surface adhesion molecules, or growth and trophic factors [21,78,81, 52,79]. Attempts to establish appropriate causal relationships between these molecular components, the actual organisation of neural networks, and a defined behavior, nevertheless, still must overcome many difficulties. A first problem is the recognition of the minimum levels of organisation, from the molecular, cellular, or multicellular (circuit) to the higher cognitive levels, that determine the given physiological and/or behavioral performance under investigation. A common difficulty (and potential source of errors of interpretation) is to relate a cognitive function to a network organization which does not possess the required structural complexity and vice-versa. Another problem is to distinguish, among the components of the system, those which are actually necessary and those which, taken together, suffice for a given behavior to take place. Identification of such a minimal set of building blocks may receive decisive insights from the elaboration of neurally plausible formal models that bring together, within a single and coherent 'artificial organism', the neuronal network, the circulating activity, and the behavior they determine (see [42,43,45,72,30]). In this communication, we shall attempt, still in a preliminary fashion, to bring together: (1) our recent knowledge on the molecular biology of brain nicotinic receptors (nAChRs) and their allosteric properties and (2) integrated behaviors, such as cognitive learning, investigated for instance with delayed-response or passive avoidance tasks that are likely to involve nAChRs in particular at the level of reinforcement (or reward) mechanisms (see [18,29,135]).
Allosteric Regulation↗
Weight loss precedes dementia in community-dwelling older adults.
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Aged↗
[Bacterial (pyogenic) sacroiliitis].
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Arthritis, Infectious↗
The metabolism of vitamin D3 in response to testosterone.
Sex steroids were suggested as regulators of vitamin D metabolism. While considerable data is available regarding interaction between estradiol and vitamin D, very little is known about interactions between testosterone and vitamin D. A similar gap exists with regard to the involvement of the vitamin D endocrine system in the pathogenesis of the female versus the male osteoporosis syndrome. In the present study we studied the effect of long-term treatment with testosterone on the metabolism of vitamin D in vitamin D3 replete sexually immature male chicks. We were able to show under this treatment, circulating levels of 1,25-dihydroxy vitamin D3 (1,25(OH)2D3) are significantly reduced, but intestine and bone concentrations are significantly increased. The increased concentration of 1,25(OH)2D3 in bone was accompanied by an increase in the ash content of this tissue. The reduction in serum 1,25(OH)2D3 was not dependent on reduced activity of the renal 25-hydroxy vitamin D3 - alpha - hydroxylase. Based on these findings it is proposed that testosterone is involved in the stimulation of the biological response to vitamin D in the classical target-organs, such as intestine and bone, and this observation may provide partial explanation to the pathogenesis of osteoporosis in hypogonadal men.
Animals↗
Physician resource utilization after geriatric trauma.
OBJECTIVE: As health care resources become increasingly strained, the value of physician consultation has come under heightened scrutiny. This report reviews the value of early consultation by the physical medicine and rehabilitation (PMR) service to an integrated trauma service for geriatric patients with multiple trauma. METHODS: We retrospectively reviewed the records of 110 geriatric trauma patients (age > 60 years) with an Injury Severity Score > or = 15 to evaluate the effects of PMR consultation. Patients in group 1 were admitted to a general surgical service, and those in group 2 were admitted to a multidisciplinary trauma service. Demographic and physiologic factors, as well as short-term and long-term outcomes, were evaluated, and a subgroup analysis was performed to compare early (< or =3 days) versus late (>3 days) consultation by PMR. RESULTS: Although there were significant differences in Glasgow Coma Scale score and length of stay, no differences were found within groups in other demographic, physiologic, or outcome data. Focused review of PMR intervention based on early versus late consultation revealed no significant difference between the two groups. Furthermore, an after-discharge phone survey revealed no significant group differences in dependence on a care provider or nursing home placement, readmission to hospital, employment status, or current functional activity status. CONCLUSIONS: Long-term patient functional outcome and the in-house rehabilitation process are not affected by integration of PMR into a multidisciplinary trauma team or early PMR consultation.
Aged↗
Superior vena cava syndrome as a primary manifestation of Behçet's disease. A case report.
Superficial thrombophlebitis is a common finding in Behçet's disease. However, the potential life-threatening complication of superior vena cava (SVC) syndrome due to thrombotic occlusion is a rare manifestation and usually occurs several years after the onset of the diagnosis. The authors describe a twenty-nine-year-old Arab man who had an acute thrombosis of the SVC as the presenting manifestation of his Behçet's disease. The patient was successfully treated with thrombolytic and anticoagulant therapy, and during follow-up no relapse was observed. Behçet's disease should be suspected in young patients presenting with thrombosis of the SVC and without evidence of a hypercoagulable state.
Adult↗
Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study.
This study examines the associations between endogenous sex steroids and bone mineral density (BMD), using data from a geographically defined cohort in Rancho Bernardo, California. Participants were community-dwelling women and men aged 50-89 years who took part in a study of endogenous sex steroid measurement between 1984-1987 and who had BMD measured in 1988-1991. Those taking corticosteroids or estrogen at the time of sex steroid determination were excluded. The main study outcomes were BMD of the ultradistal radius, midshaft radius, lumbar spine, and total hip by sex steroid level, adjusted for age, body mass index, cigarette smoking, alcohol consumption, leisure exercise, use of thiazides, thyroid hormones, and former estrogen use (women only). At the time of the hormone measurements, the mean age of the 457 women was 72.1 years and that of the 534 men was 68.6 years. A statistically significant positive relation was seen between bioavailable estradiol and BMD at all sites in women and men. Total estradiol was significantly associated with BMD at all sites in women and at all but the ultradistal radius in men. Estrone had a global effect on BMD in women and was not measured in men. Higher bioavailable (but not total) testosterone levels were associated with higher BMD of the ultradistal radius, spine, and hip in men and the ultradistal radius in women. Dehydroepiandrosterone was positively associated with BMD of the midradius, spine, and hip in women and was not associated with BMD at any site in men. Of the sex steroids tested, bioavailable estrogen was most strongly associated with BMD in both women and men. We conclude that endogenous sex steroid levels are significantly related to bone density in older women and men. Individual variation in age-related bone loss may be partially accounted for by alterations in sex steroid levels with aging. Further study to elucidate safe environmental and medical methods to maintain optimal sex steroid levels in old age is needed.
Absorptiometry, Photon↗
Hypercalcemia during pulse vitamin D3 therapy in CAPD patients treated with low calcium dialysate: the role of the decreasing serum parathyroid hormone level.
Oral pulse therapy with vitamin D is effective in suppressing parathyroid hormone (PTH) secretion in continuous ambulatory peritoneal dialysis patients with secondary hyperparathyroidism (2'hpt). However, this treatment often leads to hypercalcemia. The goals of the study were: (1) to examine whether the incidence of hypercalcemia decreases when dialysate calcium is reduced from 1.25 to 1.0 mmol/L; (2) to determine the relative role of the factors involved in the pathogenesis of hypercalcemia; and (3) to study the efficacy of a low oral pulse dose of alfacalcidol in preventing the recurrence of 2'hpt. Fourteen continuous ambulatory peritoneal dialysis patients with 2'hpt were treated with pulse oral alfacalcidol and calcium carbonate and dialyzed with a 1.0-mmol (n = 7) or a 1.25-mmol (n = 7) dialysate calcium. The response rate (87%) and the incidence (71%) and severity of hypercalcemia were similar in both groups. In the early response stage, PTH decreased by 70% in both groups, and serum ionized calcium (iCa) increased from 1.18 +/- 0.02 to 1.27 +/- 0.04 mmol/L (P < 0.005) in the 1.0 group and from 1.19 +/- 0.02 to 1.29 +/- 0.02 mmol/L in the 1.25 group (P < 0.005). Nine of the 12 responders had a further decrease in serum PTH, which was associated with an additional increase in iCa from 1.28 +/- 0.02 to 1.47 +/- 0.04 (P < 0.005). Multivariate analysis showed that the early increase in iCa was positively correlated with alfacalcidol dosage (r = 0.69). In contrast, the late increase in iCa was mostly accounted for by the decrease in serum PTH (r = -0.93). This occurred while calcium carbonate, alfacalcidol dosage, and serum 1,25 hydroxy D3 remained unchanged compared with the early response stage. Finally, an alfacalcidol dose of 1 microg twice weekly was unable to maintain serum PTH at an adequate level in the long term. These data show that a reduction in dialysate calcium from 1.25 to 1.0 mmol does not reduce the occurrence of hypercalcemia and suggest that lowering serum PTH reduces the ability of the bone to handle a calcium load within a few weeks, thus causing hypercalcemia.
Adult↗
Cognitive and functional status of the oldest old.
OBJECTIVE: To compare the cognitive performance and functional status of the normal oldest old (85 + years) with that of normal older persons aged 65 to 84 years to identify age-associated changes in cognition in individuals considered clinically normal. BACKGROUND: Advancing age appears to be a risk factor for dementia. DESIGN/METHODS: Analysis of performance on an extensive neuropsychological battery and the Pfeffer Outpatient Disability Scale in 243 normal individuals age 65 to 99 years. RESULTS: Fifty-two normal subjects who were 85 years of age and older (mean age 88.2 +/- 3.1) and 191 normal subjects aged 65-84 years (mean age 75.8 +/- 5.0) were compared. Mean education for both groups was not statistically different. No significant differences in functional disability were found between the two groups. Normal subjects aged 85 years and older performed significantly less well than their younger counterparts on verbal and nonverbal memory, psychomotor/executive tasks, and category verbal fluency. CONCLUSIONS: Advancing age in normal subjects is accompanied by a decrease in cognitive function, measured by various neuropsychological tests, but is not accompanied by functional impairment.
Activities of Daily Living↗
GHb is a better predictor of cardiovascular disease than fasting or postchallenge plasma glucose in women without diabetes. The Rancho Bernardo Study.
OBJECTIVE: To examine the relation between GHb, fasting plasma glucose (FPG), postchallenge plasma glucose (PCPG), and mortality from cardiovascular disease (CVD) and ischemic heart disease (IHD) in older adults. RESEARCH DESIGN AND METHODS: A community-based study of 1,239 nondiabetic older adults followed for an average of 8 years, from baseline (1984-1987) to 1993. RESULTS: GHb, but not FPG or PCPG, was significantly related to CVD and IHD mortality in women but not men. The age-adjusted relative hazard for those in the highest quintile of GHb (> or = 6.7%) compared with women with lower levels was 2.37 for fatal CVD (95% CI = 1.30-4.31, P = 0.005) and 2.43 for IHD (95% CI = 1.12-5.25, P = 0.024). This association persisted after adjustment for all covariates (age, systolic blood pressure, BMI, LDL, HDL, triglycerides, cigarette smoking, antihypertensive medication use, and estrogen use). GHb was significantly associated with LDL and HDL levels in women, but the association between GHb and CVD or IHD persisted after adjustment for these lipoproteins. CONCLUSIONS: We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.
Adult↗
Structure and distribution of mini-titins.
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Amino Acid Sequence↗
Lifetime leisure exercise and osteoporosis. The Rancho Bernardo study.
Between 1988 and 1991, the relation between leisure time physical activity, bone mineral density (BMD), and osteoporotic fracture was evaluated in a cohort of community-dwelling California adults (1,014 women and 689 men) with a mean age of 73 years. By means of a modified Paffenbarger questionnaire, participants were asked to report exercise from the past year and to recall their level of exercise during three other periods: the teenage years, age 30 years, and age 50 years. The survey asked the number of times strenuous (e.g., jogging), moderate (e.g., fast walking), or mild (e.g., golfing) exercise was undertaken in an average week. A summary score was constructed to represent lifetime exercise. Analysis of the exercise-fracture and exercise-BMD associations were performed using logistic and linear regression analyses, respectively. Linear regression models were controlled for age, body mass index, sex, diagnosis of arthritis, dietary calcium intake, and use of cigarettes, alcohol, thiazides, and estrogen (women only). No association between current or former exercise and BMD at the radius, wrist, or spine was found. A positive association between current exercise and BMD was found at the total hip (p = 0.001) and at each hip component--greater trochanter (p = 0.02), intertrochanter (p = 0.001), and femoral neck (p = 0.02). Mean hip bone densities of strenuous (p = 0.004) and moderate (p = 0.004) current exercisers were higher than those of mild or less than mild exercisers. Lifetime exercise was also positively associated with BMD of the total hip (p = 0.008) and hip components, and demonstrated a borderline-significant association (p = 0.06) with spine BMD. At the hip, each pairwise comparison between the highest and lowest tertiles of lifetime exercise showed a significant difference (p < or = 0.007). Exercise was unassociated with minimal trauma fracture occurring at any site between 1972 and 1991. These data suggest a protective effect of current and lifelong exercise on hip BMD, but not on osteoporotic fracture, in older men and women.
Aged↗
A role of Sep1 (= Kem1, Xrn1) as a microtubule-associated protein in Saccharomyces cerevisiae.
Saccharomyces cerevisiae cells lacking the SEP1 (also known as XRN1, KEM1, DST2, RAR5) gene function exhibit a number of phenotypes in cellular processes related to microtubule function. Mutant cells show increased sensitivity to the microtubule-destabilizing drug benomyl, increased chromosome loss, a karyogamy defect, impaired spindle pole body separation, and defective nuclear migration towards the bud neck. Analysis of the arrest morphology and of the survival during arrest strongly suggests a structural defect accounting for the benomyl hypersensitivity, rather than a regulatory defect in a checkpoint. Biochemical analysis of the purified Sep1 protein demonstrates its ability to promote the polymerization of procine brain and authentic S.cerevisiae tubulin into flexible microtubules in vitro. Furthermore, Sep1 co-sediments with these microtubules in sucrose cushion centrifugation. Genetic analysis of double mutant strains containing a mutation in SEP1 and in one of the genes coding for alpha- or beta-tubulin further suggests interaction between Sep1 and microtubules. Taken together these three lines of evidence constitute compelling evidence for a role of Sep1 as an accessory protein in microtubule function in the yeast S.cerevisiae.
Animals↗