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S Finkelstein

Publications and source records attributed to S Finkelstein.

At least 37 records · Page 2Linked to original sources
PubMed1997

p53 and K-ras mutational genotyping in pulmonary carcinosarcoma, spindle cell carcinoma, and pulmonary blastoma: implications for histogenesis.

In an attempt to understand the molecular pathogenesis of biphasic pulmonary neoplasms, the authors studied 25 cases of carcinosarcoma, spindle cell carcinoma, and pulmonary blastoma using a combined immunohistochemical and topographic genotyping approach for the presence of p53 abnormalities within the different epithelial and mesenchymal components of these tumors. Genotyping involved a search for point mutational damage in p53 exons 5-8, which was correlated with p53 immunoreactivity. This analytical approach demonstrated p53 missense point mutations in four of nine cases of spindle cell carcinoma with a 100% concordance rate between p53 immunopositivity and the presence of DNA mutational damage. One of six carcinosarcomas, heterologous in type, exhibited a p53 mutation. The concordance rate among carcinosarcomas was also 100%. However, the concordance rate among classic biphasic pulmonary blastomas was only 43%, with one of seven cases demonstrating a p53 mutation by DNA genotyping. The lack of concordance in pulmonary blastomas was possibly due to the existence of genotypically distinct subsets of tumor cells likely bearing mutations among largely nonmutated cells. In a similar fashion, among three well-differentiated fetal type adenocarcinomas, no p53 mutations were detected despite the presence of focal p53 immunopositivity in one of the cases. No K-ras mutations were detected in any of the 25 tumors examined. Monoclonal histogenesis from a single totipotential cell in a subset of these neoplasms (six of 22 cases) was supported by the finding of p53 overexpression and identical p53 mutational genotype in both the epithelial and spindle elements of the tumors. Furthermore, the finding of a small percentage of p53-positive tumor cells within one or both components suggests late acquisition of p53 mutational change in a subset of pulmonary blastomas.

Aged↗
PubMed1996

Sexual experience of the chronic peritoneal dialysis patient.

The actual and desired frequency of intercourse was studied in 68 randomly selected chronic peritoneal dialysis (CPD) patients. The results were correlated with standard measures of depression (Beck Depression inventory), anxiety (Patient Related Anxiety Scale), physical symptoms (Kupfer-Detre System 2), adequacy of dialysis (KT/Vurea) and nutrition (serum albumin level). In addition, patients assessed their quality of life (PAQOL) using an 1 to 10 analog scale. The mean +/- SD age of all patients studied was 54 +/- 11 yr, the mean dialysis duration was 24 +/- 24 months; 46% of the patients were female, and 34% were diabetic. Sixty-three percent of the patients reported never having intercourse (Group 1), 19% reported having intercourse < or = two times per month (Group II), and 18% reported having intercourse > two times per month (Group III). Dialysis duration, serum albumin level, KT/Vurea, and age were not significantly different among the three groups. Nearly 50% of patients in Group I desired to have intercourse, and 54% of the patients in Group II desired to have intercourse more frequently, Group I patients had significantly higher depression and anxiety scores, more physical symptoms, a poorer overall PAQOL, and less satisfaction with their sexual activity than Group III patients. These results suggest that there is a high prevalence of sexual difficulties in CPD patients. Patients not having intercourse have a poorer quality of life and higher degree of depression and anxiety than patients having intercourse more than two times per month.

Adult↗
PubMed1995

Primary biliary cirrhosis diagnosed during pregnancy. Does it have a different outcome?

Pregnancy in women with primary biliary cirrhosis (PBC) is uncommon, and once it occurs it usually does not worsen the liver disease. First manifestation of PBC during pregnancy in women with no known liver disease at the time of conception is very rare, and the natural history of this disease in such cases is yet unknown. Herein we describe a woman who had been diagnosed with PBC during the third trimester of pregnancy and, while she gave birth to a normal healthy child, her disease rapidly deteriorated and she has been listed for liver transplantation. It appears that PBC that is first noted during pregnancy might have a different course than that of PBC diagnosed before pregnancy.

Adult↗
PubMed1995

Noninvasive pulse wave analysis for the early detection of vascular disease.

A noninvasive technique has been developed and validated for calculating capacitive and oscillatory systemic arterial compliance with the use of pulse wave analysis and a modified Windkessel model. Application of the technique to subjects with hypertension, postmenopausal women with symptomatic coronary artery disease, and appropriate control subjects has confirmed a reduction of oscillatory compliance in the disease states and an increase in capacitive and oscillatory compliances in response to vasodilator drugs. This method should be useful in screening subjects for early evidence of vascular disease and in monitoring the response to therapy.

Blood Pressure↗
PubMed1994

Medical cost savings from pentoxifylline therapy in chronic occlusive arterial disease.

This article assesses the direct medical cost savings associated with therapeutic dosages of pentoxifylline therapy compared with lower dosages in treating chronic occlusive arterial disease (COAD). The savings accrue from elimination of invasive diagnostic measures or a number of surgical procedures received by patients with COAD during hospital admissions. Findings are based on a secondary analysis of results presented in a previously published report of a population based historical cohort study. Patients in this study were severely enough afflicted by the disease that most were under the care of vascular specialists and many underwent surgery to restore normal blood flow. Costs are based on charges from Medicare expenditures in 4 US states in 1989. A case-mix adjustment procedure was applied and a sensitivity analysis was conducted on key assumptions and variables in the cost savings model. Pentoxifylline therapy reduced average hospital costs per patient by $US1173 per year (1989 dollars). After further adjustment for the costs of outpatient visits, other related drugs and the drug acquisition cost, an overall saving of $US965 would still be realised with a patient who received the full therapeutic dose of pentoxifylline. Sensitivity analysis suggests total annual direct medical cost savings between $US69 and $US3090 per patient. Hence, under the most plausible assumptions regarding choice of procedures, study design and patient population, and considering the possibility that diagnostic and surgical costs are delayed but not prevented, pentoxifylline therapy substantially reduces direct medical costs.

Adult↗
PubMed1993

Vascular abnormalities in non-insulin-dependent diabetes mellitus identified by arterial waveform analysis.

PURPOSE: The arterial pressure waveform is derived from the complex interaction of the left ventricular stroke volume and the physical properties of the arterial circulation. Widespread abnormalities in the physical characteristics of the arterial vessels associated with diabetes mellitus can produce consistent changes in the shape of the pressure pulse waveform, providing information about arterial structure and tone that can be quantitated by pulse contour analysis. PATIENTS AND METHODS: We analyzed intraarterial brachial artery waveforms in 28 patients with non-insulin-dependent diabetes mellitus and 22 control subjects matched for age and sex. A computer-based assessment of the diastolic pressure decay and a modified Windkessel model of the circulation were employed to quantify changes in arterial waveform morphology in terms of the large-artery compliance (C1), the oscillatory diastolic waveform (C2), inertance, and systemic resistance. RESULTS: No differences were found in heart rate, mean arterial pressure, cardiac output, or stroke volume between groups. The mean oscillary arterial compliance estimate was significantly reduced in diabetic subjects versus controls: 0.02 (95% confidence interval [CI], 0.01 to 0.03) mL/mm Hg versus 0.08 (95% CI, 0.04 to 0.12) mL/mm Hg (p < 0.001). Oscillatory compliance values were uniformly reduced in the diabetic subjects regardless of the presence or absence of physical complications of the disease. No differences in large-artery compliance, inertance, or systemic resistance were found between groups. No positive correlations were found between indices of glycemic control, the known duration of diabetes, and any of the hemodynamic variables. CONCLUSIONS: Quantitative changes in the arterial pressure pulse waveform, reflected by a reduced oscillatory compliance estimate, were found in patients with non-insulin-dependent diabetes mellitus. This estimate appears to act as an early marker for the vascular abnormalities associated with diabetes before complications of the disease become clinically apparent. By contrast, no changes in large-artery compliance were found in this patient population free from clinically obvious macrovascular disease.

Adult↗
PubMed1993

Clonidine patch ingestion in an adult.

OBJECTIVE: To report a case of deliberate ingestion of a clonidine hydrochloride patch in an adult. CASE SUMMARY: A patient at a psychiatric hospital with a diagnosis of major depression and polysubstance abuse was administered a clonidine patch for opiate detoxification. The patient subsequently chewed and swallowed the patch (total clonidine content: 5 mg); he was subsequently transferred to a nearby general medical hospital for management of obtundation and profound sinus bradycardia. DISCUSSION: The use of clonidine in withdrawal states is discussed. The primary adverse effects attributable to clonidine overdose, hypotension, and profound sinus bradycardia, may be managed symptomatically. Accidental ingestion of clonidine patches by infants and children has previously been reported in the literature. This is the first reported case of deliberate ingestion of a clonidine patch in an adult. CONCLUSIONS: Before initiating topical clonidine therapy for chemical withdrawal states, patients should be evaluated carefully for suicide potential and a history of previous suicide attempts. If a patient expresses suicidal ideation or has attempted suicide in the past, he is probably not a candidate for topical clonidine therapy in either the inpatient or outpatient setting.

Administration, Cutaneous↗
PubMed1993

Toxic shock syndrome as the AIDS-defining diagnosis.

Toxic shock syndrome (TSS) has been infrequently reported as a complication of AIDS. We present the case of a 24-year-old man, previously unknown to be positive for the human immunodeficiency virus, presenting in septic shock. The literature on TSS in AIDS is reviewed and the association between the two diseases is presented.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The relation between experience and outcome in heart transplantation.

BACKGROUND: Current policies related to organ transplantation in the United States are designed to ensure that centers and physicians with experience in transplantation perform these procedures. It is essential to confirm the validity of such policies, since they may limit access to transplantation services. METHODS: To determine the relation between experience with heart transplantation and mortality after the procedure, we merged data from the registry of the International Society for Heart and Lung Transplantation with data from a survey that provided additional information about patients and transplantation centers. Our study included 1123 patients who received a heart transplant at one of 56 hospitals in the United States from 1984 through 1986. We used univariate and bivariate techniques, as well as logistic regression, to analyze our data. RESULTS: We observed an institutional learning curve for heart transplantation. Patients who received one of a center's first five transplants had higher mortality rates than patients who received a subsequent transplant (20 percent vs. 12 percent; P = 0.002; relative risk = 2.2; 95 percent confidence interval, 1.6 to 3.4). In addition, we found a correlation between the training of key personnel on the transplantation team and mortality at new transplantation centers. For example, new centers staffed by cardiologists with previous training in heart transplantation had lower mortality rates among heart-transplant recipients than centers without experienced cardiologists (7 percent vs. 16 percent; P = 0.001; relative risk = 2.7; 95 percent confidence interval, 1.3 to 5.9). By contrast, the previous training of the surgeons who performed transplantations was not related to the mortality rate associated with the procedure. CONCLUSIONS: Experience with heart transplantation is associated with a better outcome for patients after that procedure. Opportunities exist to refine transplantation policies on the basis of the experience of a center and its transplantation team and to develop similar policies for other forms of organ transplantation.

Cardiac Care Facilities↗
PubMed1992

Power in top management teams: dimensions, measurement, and validation.

Top managers' power plays a key role in strategic decision making. However, although numerous scholars have recognized its importance, very few have attempted to measure the phenomenon. In this article, I present a set of dimensions measuring top managers' power and suggest a measurement methodology to facilitate empirical inquiry. Data from a group of 1,763 top managers in three industries were used to assess the validity and reliability of the power dimensions in three studies. Results demonstrate strong support for the proposed power dimensions.

Administrative Personnel↗
PubMed1991

Hypnotically assisted preparation of the anxious patient for medical and dental treatment.

Hypnotic preparation of patients for medical or dental procedures has various aspects. It is important to encourage the patient's cooperation in assessing problem areas and determining the order of dealing with those problems. The therapist can adapt treatment strategies to new areas of concern as the patient verbalizes them. The severity and number of patient concerns and fears, along with motivation factors, will determine the direction and number of therapy sessions. The case history presented illustrates one approach for an apprehensive patient who felt a dental experience had triggered her fear of surgery. Self-hypnosis, ego strengthening, and mental rehearsal during the 11 sessions made it possible for the patient to proceed with needed surgery.

Adaptation, Psychological↗
PubMed1988

Distribution of anionic sites on the capillary endothelium in an experimental brain tumor model.

The distribution of anionic domains on the capillary endothelium of experimental brain tumors was determined using cationic ferritin (CF) in order to ascertain whether the pattern of these domains is different from that on normal cerebral capillaries. Tumors were induced by stereotaxic injection of cultured neoplastic glial cells, A15A5, into the caudate nucleus of Sprague-Dawley rats. Following a 14-21 day growth period tumors appeared as vascularized, sharply circumscribed masses which caused compression of the surrounding brain tissue. Anionic domains were distributed in a patchy and irregular pattern on the luminal plasma membrane of the endothelia of blood vessels in the tumors. Some variability in this pattern was observed infrequently in limited regions of the tumor where there was either a continuous layer of CF or an absence of CF binding. Plasmalemmal vesicles, coated vesicles, coated pits, multivesicular bodies, and some junctional complexes showed varying degrees of labeling with the probe. Capillaries in the tumor periphery and normal cerebral vessels showed a uniform distribution of anionic groups. These results indicate that there is an altered surface charge on the endothelial luminal plasma membrane of blood vessels in brain tumors. A correlation may exist between the altered surface charge and the degree to which the blood-brain barrier is impaired in these vessels.

Animals↗