Same patients, different systems: clinical implications for the care of the elderly.
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Biomedical subjects
Publications and source records attributed to S Gold.
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We report a case of white fibrous papulosis of the neck in a 70-year-old Iranian woman. To date this recently reported entity has only been described in Japanese patients. This asymptomatic eruption characteristically affects the posterior neck. The pale papules are round to oval 2-3 mm in diameter, and not follicular. Histology shows thickened collagen bundles in the superficial and mid-dermis with a normal elastic pattern.
The ability of 27 pairs of mildly mentally retarded and normally achieving 6- through 8-year-old students to apply an oddity rule to an experimental set of letter and word oddity problems was assessed. The mildly retarded group evidenced a markedly lower level of performance on all five experimental oddity problems, but they did evidence successful generalization to oddity arrays that visually were very different from those used in training. High levels (greater than 90%) of sensitivity, specificity, positive predictive accuracy, and negative predictive accuracy were observed using only six cards. Only slightly lower (greater than or equal to 85%) values were obtained when using a cut-off score. This subset of six cards is, therefore, an excellent candidate for inclusion in a cognitive preschool screening test being developed for the early detection of children with mild mental retardation.
The widespread availability of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty presents important treatment options for the older patient. The findings from a number of surgical series of coronary artery bypass grafting and percutaneous transluminal coronary angioplasty are summarized. Certain trends are evident. Perioperative mortality, cardiovascular morbidity, and other complications, while declining, remain somewhat higher in elderly patients. However, the impact of age alone is slight. In both coronary artery bypass grafting and percutaneous transluminal coronary angioplasty, complications are more closely correlated with the presence of serious concomitant disease. Long-term survival and pain relief after coronary artery bypass grafting are excellent in older patients, and percutaneous transluminal coronary angioplasty may be the treatment of choice in some elderly patients with coronary artery disease. As in younger patients, prolongation of survival should not be the exclusive goal. Rather, a focus on quality of life and freedom from dependency should be seriously considered.
The lesions known as lymphocytic vasculitis, polymorphic reticulosis (midline malignant reticulosis, lethal midline granuloma), lymphomatoid granulomatosis, and angiocentric lymphoma form what have been collectively termed the angiocentric immunoproliferative lesions (AIL). Because of recent reports demonstrating clonal rearrangements of the T-cell receptor in these lesions, the AIL are now thought to represent a continuous spectrum of post-thymic T-cell non-Hodgkin's lymphoma (NHL). NHL associated with the acquired immune deficiency syndrome (AIDS) represents intermediate or high-grade B-cell malignancies in HIV-infected patients that may be etiologically related to the Epstein-Barr virus (EBV). There have been reports of EBV-associated T-cell NHL, AIL, and large granular lymphocyte (LGL) proliferations, as well as HIV-associated T-cell neoplasia, LGL/T-cell proliferations, and AIL. We describe a case of polymorphic reticulosis (lethal midline granuloma) arising in an HIV-infected individual, who later progressed to AIDS, and review the literature on HIV-associated and EBV-associated T-cell neoplasia, LGL/T-cell proliferations, and AIL. The etiology of this AIL/T-cell NHL, especially in relation to EBV and HIV, is discussed.
Rats were exposed for 2 h either to 115 dB SPL noise, to 5% oxygen in nitrogen (hypoxia) or to both hypoxia and noise. Auditory nerve-brainstem evoked responses (ABR) to 80 dB HL clicks and threshold were recorded prior to exposure, immediately (5-10 min) after the exposure, 2 h after and 2 weeks after the exposure. The findings in each experimental animal were compared to those in the control (non-exposed) group and to those in the other groups. Thresholds were elevated in each of the experimental groups, but these were temporary threshold shifts, since 2 weeks following the exposure, threshold had returned to normal. Latencies (wave I and the IV-I interpeak latency difference- (IPLD] were prolonged in the groups exposed to hypoxia (hypoxia alone and hypoxia + noise). These results are discussed in view of possible mechanisms of these noise and hypoxia induced temporary threshold shifts.
A somatic cell hybrid mapping panel and molecular probes have been developed for human chromosome 3. This panel defines 11 regions for the short and long arms of the chromosome. Four hundred thirty-two probes have been mapped using these hybrids. One hundred thirty-one of these probes were derived from EcoRI and HindIII flow-sorted libraries. The remaining 301 probes were isolated from NotI boundary and random (partial MboI) libraries constructed from a hybrid that provided a relative enrichment in 3p DNA sequences. For some regions of the chromosome, significant differences in the distribution of probes were noted. This was observed for both the unique sequence flow-sorted and NotI probes. These differences are in agreement with previous suggestions that Giemsa light bands are GC-rich, and therefore gene-rich (especially housekeeping genes), and that the Giemsa dark bands may contain DNA that is more highly condensed. The isolation of probes from different types of libraries, or by different screening strategies, appears to reduce deficiencies that might arise from the use of probes derived with a more limited approach. These hybrids and probes should facilitate the construction of physical and genetic linkage maps to identify various disease loci involving chromosome 3.
The ability of Erwinia chrysanthemi to cause soft-rot diseases involving tissue maceration in many plants has been linked to the production of endo-pectate lyase E. chrysanthemi EC16 mutant UM1005, however, contains deletions in the pel genes that encode the known endopectate lyases, yet still macerates plant tissues. In an attempt to identify the remaining macerating factor(s), a gene library of UM1005 was constructed in Escherichia coli and screened for pectolytic activity. A clone (pPNL5) was identified in this library that contained the structural gene for an exopolygalacturonate lyase (ExoPL). The gene for ExoPL was localized on a 3.3-kb EcoRV fragment which contained an open reading frame for a 79,500-Da polypeptide. ExoPL was purified to apparent homogeneity from Escherichia coli DH5 alpha (pPNL5) and found to have an apparent molecular weight of 76,000 with an isoelectric point of 8.6. Purified ExoPL had optimal activity between pH 7.5 and 8.0 and could utilize pectate, citrus pectin, and highly methyl-esterified Link pectin as substrates. A PL- ExoPL- mutant of EC16 was constructed that exhibited reduced growth on pectate, but retained pathogenicity on chrysanthemum equivalent to that of UM1005. The results indicate that ExoPL does not contribute to the residual macerating activity of UM1005.
Extended high-frequency (HF) audiometry and auditory-nerve brain-stem-evoked responses (ABR) were carried out on two groups of subjects with normal hearing sensitivity. The experimental group comprised 17 subjects with tinnitus, while the control group consisted of age- and sex-matched subjects, not suffering from tinnitus. The aim of the study was to determine whether extended HF audiometry or ABR might reveal significant differences between these two groups of subjects with normal hearing sensitivity. In addition, the characteristics of tinnitus in subjects with normal audiograms were discussed. The results of extended HF audiometry showed no significant differences between the subjects with and without tinnitus. The ABR parameters considered were also within normal limits bilaterally. Based on the methods employed in this study, tinnitus in normal listeners does not appear to reflect appreciable damage in the cochlea or in the brain-stem auditory pathways. The authors present some suggestions for future research.
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Exposure to noise is unfortunately inevitable in military training. The incidence of hearing loss due to basic training was examined in a sample of 1000 recruits before enlistment and after 4 months of basic training. Audiometric tests and personal questionnaires revealed that after basic training 33.7% had developed hearing loss in the high frequency range (6-8 KHz), 3% had noise-induced hearing loss (2-5 KHz), while 60% still had normal hearing and 3.5% had hearing impairment due to various other causes. The left ear was more often affected and there was a tendency towards greater damage to hearing in lightly pigmented subjects. An initial hearing loss at 6-8 KHz may be related to individual susceptibility to noise-induced hearing loss.
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Reports on a potential relationship between noise-induced hearing loss (NIHL) and cardiovascular as well as biochemical measures are controversial. This study compares the means of certain cardiovascular and biochemical measures in subjects with NIHL with those in subjects exposed to similar occupational noise, but demonstrating normal hearing. This might indicate certain predisposing factors for NIHL. Eight hundred noise-exposed subjects were divided into two age-matched hearing groups (NIHL and normal hearing). The results showed that the mean values of all the variables examined in both hearing groups were within the normal range. No significant differences were found between the two groups in terms of the distribution of subjects for the indices measured.
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From the myth of Prometheus to the trial of Galileo, history and literature are replete with examples of the clash between institutionally-bound power structures which exploit ignorance and ignore reality, and those that attempt to develop some movement towards scientific and personal truth. Within society as we know it, the genius or messiah figure and the establishment are bound together in an attempt to establish a relationship which can be of constructive relevance to both. The challenge of incorporating new and disruptive, though not necessarily disintegrative thought on the one hand, is contrasted with an uncompromising attack upon those who would lay claim to the previously exclusive rights of the established organisation and the power which accrued from them. Psychoanalysis today is joined in the battle with internal and external prohibitions against the acquisition of knowledge, which may in time point towards the truth of human personality, behaviour and existence.
The pelA and pelC genes from Erwinia chrysanthemi EC16 were sequenced and overexpressed in Escherichia coli cells. These genes and two others from the same strain that were characterized previously encode catalytically related pectate lyase proteins that are involved with the maceration and soft-rotting of plant tissue. The pel genes of strain EC16 were organized as two loosely linked clusters, with two structurally homologous genes in each. The pelA/E cluster also contained the remains of an additional pel gene, the 5' portion of which had been removed by a prior deletion event. Each of the four functional pel genes but not the deleted one contained an efficient rho-independent transcriptional terminator after the translational stop. These and other data indicate that the pel genes are all independently regulated despite their structural homology and tandem clustered organization. Two of the genes, pelA and pelE, encoded proteins that differed greatly in their isoelectric points and ability to macerate plant tissue. A recombinant gene constructed with the 5' portion of pelE and the 3' portion of pelA yielded a chimeric protein with high pectate lyase activity but relatively low maceration activity. This result raised the possibility that the poor maceration ability of the pelA gene product may involve other properties in addition to its low isoelectric point.
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