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Biomedical subjects

S Shapiro

Publications and source records attributed to S Shapiro.

At least 163 records · Page 9Linked to original sources
PubMed1996

Polymerase chain reaction search for viral etiology of vulvar vestibulitis syndrome.

OBJECTIVE: Our purpose was to assess the prevalence of infections by human papillomavirus, herpes simplex virus, and cytomegalovirus among women with severe vulvar vestibulitis. STUDY DESIGN: Eighty-six women referred for dyspareunia and diagnosed as having severe vestibulitis underwent perineoplasty, including surgical removal of the sensitive vestibule. Controls included 25 age-matched patients without dyspareunia undergoing vaginal operations for various benign causes or undergoing repair of an episiotomy. Polymerase chain reaction analysis was carried out to determine the presence of viral genes. RESULTS: The prevalence of herpes simplex virus and cytomegalovirus among the subjects tested was nil, whereas human papillomavirus was detected in 46 cases (54%). The human papillomavirus present was not of types 6, 11, 16, 18, or 33. Only one woman of the 25 asymptomatic controls (4%) had human papillomavirus deoxyribonucleic acid in the vestibule (p < 0.001). CONCLUSION: Our data provide support for the idea that vulvar vestibulitis is associated with human papillomavirus deoxyribonucleic acid in more than half of cases.

Adolescent↗
PubMed1996

Cloning and characterization of a glycogen synthase cDNA from human endometrium.

One major human uterine response to post-ovulatory progesterone is the accumulation of glycogen by the endometrium. A temporally related increase in glycogen synthase activity has been documented, but the isozyme responsible has not yet been identified. We have amplified a glycogen synthase (GS) complementary DNA (cDNA) from human endometrium by reverse transcription-polymerase chain reaction (RT-PCR). Overlapping clones of the PCR products provided a cDNA that is 3534 base pairs (bp) long, including a 22-bp poly(A)+ tail, and an open reading frame that encodes a 737 amino acid protein with a molecular weight of 83936. This cDNA is almost identical to that of human striated muscle GS. Differences include a double nucleotide substitution at 1983-1984 and five single nucleotide substitutions located, respectively, at positions 379, 2457, 2470, 2477, and 2553. These differences only alter the predicted amino acid sequence from that of the striated muscle protein by a single substitution at position 608. A 5'-end fragment plus an internal fragment of human myometrial GS cDNA were also analysed and were shown to have identity with the endometrial GS cDNA. Northern blot hybridization, using a human muscle-derived cDNA probe, detected the presence of a 4.0-kb GS messenger RNA (mRNA) in the endometrium and myometrium. Our results establish that the GS of human Mullerian tissues is, essentially, identical to that reported for human striated muscle.

Amino Acid Sequence↗
PubMed1996

A mucopyocele of the clivus: case report.

OBJECTIVE AND IMPORTANCE: There are increasing reports of nasal sinus mucopyoceles eroding the base of the cranium and causing the rapid onset of neurological complications. Uncommon presentations can mimic tumors, but the infectious nature mandates an urgent surgical decompression. It is important to document these uncommon presentations. CLINICIAL PRESENTATION: A mucopyocele of the clivus is reported in a patient with a frequent history of sinusitis. Diplopia caused by an acute sixth nerve palsy prompted the radiological diagnosis with computed tomography and magnetic resonance imaging. INTERVENTION: Transsphenoidal drainage of the lesion lead to marked improvement in the patient. CONCLUSION: This is the third reported case of a clival mucocele. Mucoceles of nasal sinuses can erode intracranially, causing neurological sequalae, and clival involvement is extremely rare. Early drainage leads to marked improvement.

Adult↗
PubMed1996

An historical perspective on the roots of managed care.

To most people, managed care and managed competition are terms of relatively recent origin, but the concepts are far from new. The use of these terms and their principal predecessors, prepaid group practice and medical care foundations, are symbolic of the underlying problems of the health care systems identified in the United States. With the passage of time, the individuals who first spoke loudly and well on the subject have come and gone, but the central theme of what they had to say was that major changes in the organization, financing, and delivery of health care are absolutely essential if high-quality preventive, diagnostic, and therapeutic care are to be available to the population at an acceptable cost. This paper reviews the early years of recognition of the need for change and the sporadic start of the changes. The presentation leaves out details on the recent growth of managed care and the political turmoil caused by the high level of medical costs, the inadequate documentation of the quality of care, and the large numbers of people who have no insurance or at best inadequate insurance.

Health Maintenance Organizations↗
PubMed1996

The inhibitory action of fatty acids on oral bacteria.

Saturated and unsaturated fatty acids and fatty acid derivatives were examined for their growth-inhibitory effects towards three selected oral bacteria: Porphyromonas gingivalis, Selenomonas artemidis, and Streptococcus sobrinus. Of the 45 compounds surveyed, only one, myristoleic acid, was inhibitory towards S. artemidis at a concentration < 100 micrograms/ml. cis-Hexadecenoic and cis-octadecenoic acids were generally inhibitory towards P. gingivalis and S. sobrinus, but there was no correlation between the position of the double bond and the minimum inhibitory concentration. Supra-minimum inhibitory concentrations of palmitoleic acid did not promote leakage of intracellular materials from either P. gingivalis or S. sobrinus, nor was L-isoleucine uptake by S. sobrinus inhibited. Fatty acids and derivatives were also examined for prospective synergistic or antagonistic interactions with thymol vis-à-vis growth inhibition of the test strains. Lauric acid and myristic acid each behaved synergistically with thymol to inhibit the growth of at least one test strain, whereas cis-10-heptadecenoic acid and thymol were noticeably antagonistic towards the growth of S. sobrinus.

Bacteria, Anaerobic↗
PubMed1996

Drugs in the aetiology of agranulocytosis and aplastic anaemia.

Agranulocytosis and aplastic anaemia are rare but serious conditions known to be caused by numerous drugs. Most of what is known or suspected about the aetiology is based on case reports, with only a few formal epidemiological studies that provide quantitative estimates of risk. Updated results have been obtained from a combined analysis of data from 3 case-control studies that used similar methods: the International Agranulocytosis and Aplastic Anemia Study (IAAAS), conducted in Israel and Europe; a study conducted in the northeast US; and a study conducted in Thailand. Totals of 362 cases of agranulocytosis, 454 cases of aplastic anaemia and 6458 controls were included in the analyses. The IAAAS and Thai study were population-based, providing estimates of the incidence of the 2 dyscrasias. The overall annual incidence of agranulocytosis in the ambulatory population was 3.4/10(6) in the IAAAS and 0.8/10(6) in Thailand; by contrast the incidence of aplastic anaemia was 2.0/10(6) in the IAAAS and 4.1/10(6) in Thailand. A total of 21 compounds were significantly associated with an increased risk of agranulocytosis in the IAAAS and US studies. Excess risks ranged from 0.06 to 13 cases/10(6) users/wk; the most strongly associated drugs were procainamide, anti-thyroid drugs and sulphasalazine. An association with drugs that had previously been suspected was also seen in Thailand. The overall aetiologic fractions of agranulocytosis due to drug use were 62% in the IAAAS, 72% in the US and 70% in Thailand. Eleven drugs were significantly associated with an increased risk of aplastic anaemia, with excess risks ranging from 1.4 to 60 cases/10(6) users in a 5-month period. The most strongly associated drugs were penicillamine, gold and carbamazepine. Aetiologic fractions were 27% in the IAAAS, 17% in the US and 2% in Thailand, which paralleled the prevalence of use of associated drugs in the 3 populations. The present results confirm that agranulocytosis is largely a drug-induced disease, with similar proportions accounted for in 3 disparate geographic regions. By contrast, although many of the expected associations were observed for aplastic anaemia, most of the aetiology is not explained by drugs. For all associated drugs, the excess risks are sufficiently low that blood dyscrasias should not figure prominently in the balancing of risks and benefits.

Agranulocytosis↗
PubMed1996

Management of subarachnoid hemorrhage patients who presented with respiratory arrest resuscitated with bystander CPR.

BACKGROUND AND PURPOSE: The sudden death rate from aneurysmal subarachnoid hemorrhage (SAH) is 10%. Since 1989, 26 SAH patients who were witnessed to collapse into coma with respiratory arrest and required cardiopulmonary resuscitation (CPR) at the scene survived to reach the hospital and be diagnosed. Although reports on hospital management of grade V SAH suggest improved outcome, no report has previously addressed the issue of respiratory arrest after acute SAH. We analyze our experience with this unique subgroup of aneurysmal SAH patients. METHODS: This is a retrospective analysis of 26 consecutive SAH patients who collapsed at the scene and required CPR for respiratory arrest and survived to reach the hospital and be diagnosed. Statistical analysis was performed using the t test and Mann-Whitney rank-sum test. RESULTS: All patients were grade V on arrival at the emergency department. Twenty-one patients received mouth-to-mouth resuscitation only, and 5 received chest compressions as well. The mean duration of bystander CPR was 12 to 15 minutes. CT scan showed diffuse, thick SAH in all patients, an associated subdural hemorrhage in 2, and an intraparenchymal hemorrhage in 4. After CT scan, an intracranial pressure (ICP) monitor was placed in 24, and 2 were taken to emergency surgery for subdural and intracerebral hemorrhage. ICP was elevated in 24 patients (mean, 54 mm Hg), and a ventriculostomy was placed in all 24. ICP was unresponsive in 12, and all suffered brain death. ICP lessened to < 25 mm Hg in 12, and all underwent angiography. All 12 had an aneurysm and underwent emergency surgical clipping. Time to surgery from SAH was < or = 11 hours in all 12 patients. All were managed with calcium channel blockers and hyperdynamic therapy in addition to aggressive control of ICP. The outcome at 12 months in the 14 surgical cases was normal in 3 patients (21%), good in 2 (14%), vegetative in 1 (7%), and death in 8 (57%). CONCLUSIONS: Aneurysmal SAH patients that present with respiratory arrest present as grade V patients with elevated ICP. Bystander CPR coupled with early retrieval, diagnosis, and therapy can lead to 20% functional survival in what used to be sudden death from aneurysmal SAH.

Adult↗
PubMed1996

Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy.

Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12-30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.

Adult↗
PubMed1996

What difference does it make to be treated in a clinical trial? A pilot study.

OBJECTIVE: Pilot study to characterize treatment differences between patients treated in clinical trials and those treated in a clinical setting. Previous studies have shown higher survival rates for participants in trials of cancer therapy. This difference is observed even after rates are adjusted for important covariates such as age and stage of disease. DESIGN: Retrospective chart review. SETTING: Oncology outpatient department in a tertiary care hospital. PATIENTS: Ninety women 18 to 70 years of age with early-stage breast cancer who were diagnosed in 1990. Fifty-one of the women were treated through clinical trials and 39 were treated outside of clinical trials. OUTCOME MEASURES: Number of blood tests, telephone calls, clinic visits and imaging procedures as well as intensity of chemotherapy and use of radiation therapy. The age of the patient and the stage of disease were important covariates. RESULTS: After the analysis was controlled for patient age and stage of disease, patients treated through a clinical trial were more likely to receive standard-dose chemotherapy (p = 0.020, 95% confidence interval 1.20 to 200.73) and more frequent blood tests (p < 0.001, 95% confidence interval 1.02 to 1.13) than other patients treated in the clinic. CONCLUSIONS: Our results provide a plausible mechanism for the observed survival advantage for participants in clinical trials in oncology. Further study is called for. If these results are confirmed, they have important implications for informed consent to participate in clinical trials and for clinical practice.

Adolescent↗
PubMed1996

Epidemiologic studies of the association of L-tryptophan with the eosinophilia-myalgia syndrome: a critique.

In 1989 and 1990, 2 reports of a new disease labeled the eosinophilia-myalgia syndrome (EMS) and attributed to L-tryptophan (LT) were published. In subsequent studies a putative contaminant was implicated. In this review the following studies are considered: the initial 2 reports of the overall association, one report of an association between LT and eosinophilic fasciitis, and one report describing the scale of the apparent epidemic of LT induced EMS. Of the 2 initial studies, one included previously reported exposed cases, failed to rule out the possibility that early symptoms of EMS could have caused LT use rather than the reverse, and failed to adhere to the methods, as published. The 2nd study has not been published in a peer reviewed journal. The study of eosinophilic fasciitis was subject to information bias and misclassification of the timing of LT use. The apparent epidemic could have been an artefact of waxing and waning enthusiasm for reporting exposed cases to an EMS registry, corresponding with the timing and the amount of publicity given to the topic. The questionable validity of these studies considerably weakens the claim that LT or a contaminant caused EMS.

Case-Control Studies↗
PubMed1995

System delay in breast cancer in whites and blacks.

Survival differences have been noted between black women and white women with breast cancer. It is hypothesized that a prolonged interval between initial medical consultation and establishment of a diagnosis (system delay), resulting in a more advanced stage of disease at diagnosis, might explain part of this survival difference. This study was performed to determine whether system delay differs between black and white breast cancer patients, and to examine predictors of delay in blacks and whites. The study population consisted of 996 female breast cancer patients from the National Cancer Institute's Black/White Cancer Survival Study, a cohort study carried out in 1985-1986 in the metropolitan areas of Atlanta, Georgia, New Orleans, Louisiana, and San Francisco/Oakland, California. The median system delay was slightly longer for blacks than for whites--2.7 weeks versus 2.1 weeks--but this difference was not statistically significant. Having a palpable lump at diagnosis was associated with reduced system delay in both races, while use of a public clinic increased system delay for blacks. Older women were less likely to be subject to longer system delay than younger women, and this effect was somewhat more pronounced in whites. Survival differences between blacks and whites are probably not due to differences in system delay. However, many women had delays of at least 3 months. Given that younger age and the absence of a palpable lump were the factors most predictive of significant system delay, interventions should be targeted specifically toward reducing system delay in younger women who present without the classical painless lump.

Adult↗
PubMed1995

Complexity of the cytokine and antibody response elicited by immunizing mice with Plasmodium yoelii circumsporozoite protein plasmid DNA.

The number, type, and location of cytokine- and Ab-secreting cells activated in mice immunized and boosted with plasmid DNA encoding the circumsporozoite protein of the malarial parasite Plasmodium yoelii (PyCSP) were monitored. The initial humoral response was localized to the draining lymph nodes and was characterized by production of IgG1 anti-PyCSP Abs and the Th2 cytokine IL-4. In contrast, the secondary response was dominated by IFN-gamma production (a Th1 cytokine) and the secretion of IgG2a anti-PyCSP Abs in the spleen. PyCSP DNA and mRNA were detected only in the quadriceps muscles (sites of plasmid injection), yet these sites lacked either cytokine- or Ab-secreting cells. These findings indicate that circulating lymphocytes encounter plasmid-encoded Ag in the muscle bed, initiate a humoral response in the draining lymph nodes, and then seed distal lymphoid organs. Profound differences were observed between the primary and secondary immune responses induced by plasmid immunization, which may influence vaccine efficacy.

Animals↗
PubMed1995

Relation of benzodiazepine use to the risk of selected cancers: breast, large bowel, malignant melanoma, lung, endometrium, ovary, non-Hodgkin's lymphoma, testis, Hodgkin's disease, thyroid, and liver.

Some animal data have raised the possibility that benzodiazepines influence the risk of selected cancers. With data collected in 1977-1991 in a US hospital-based study, the authors assessed the relation of benzodiazepine use to the risk of 11 cancers: breast (6,056 patients), large bowel (2,203), malignant melanoma (1,457), lung (1,365), endometrium (812), ovary (767), non-Hodgkin's lymphoma (382), testis (314), Hodgkin's disease (299), thyroid (111), and liver (37). Cases were compared with cancer controls (3,777 patients with other cancers) and noncancer controls (1,919 patients admitted for acute nonmalignant disorders). Relative risks were estimated for benzodiazepine use at least 4 days a week for at least 1 month, initiated at least 2 years before admission (sustained use) by multiple logistic regression with control for confounding factors. Results derived with noncancer controls were similar to those derived with cancer controls. For sustained benzodiazepine use relative to no use, relative risk estimates for all 11 cancers were compatible with 1.0 at the 0.05 level of significance. Relative risk estimates for durations of at least 5 years were also compatible with 1.0, with the exceptions of an increased estimate, of borderline statistical significance, for endometrial cancer, and a decreased estimate for ovarian cancer. Relative risk estimates both for sustained use that continued into the 2-year period before admission and for sustained use that ended up to > or = 10 years previously were compatible with 1.0, suggesting a lack of tumor promotion and no increase in the risk after a latent interval. Results were also null for diazepam, chlordiazepoxide, and other benzodiazepines considered separately. The results suggest absence of association between benzodiazepine use and the cancers considered, with the evidence stronger for the cancers with larger numbers of subjects. The similarity of results derived with cancer and noncancer controls suggests that benzodiazepines do not influence the risk of cancer as a whole.

Adolescent↗
PubMed1995

Monitoring clinical research: an obligation unfulfilled.

The revelation that data obtained for the US-based National Surgical Adjuvant Breast and Bowel Project (NSABP) from subjects enrolled at Hôpital Saint-Luc in Montreal was falsified has eroded public trust in research. Institutions can educate researchers and help prevent unethical research practices by establishing procedures to monitor research involving human subjects. Research monitoring encompasses four categories of activity: annual reviews of continuing research, monitoring of informed consent, monitoring of adherence to approved protocols and monitoring of the integrity of data. The authors describe characteristics of research projects that may call for monitoring procedures in each category. The form taken by such monitoring depends on the nature of the protocol. Although appropriate research monitoring requires substantial investment of personnel and financial resources, it is required under guidelines regulating research involving human subjects in Canada. Research monitoring is a step forward in re-establishing public confidence in medical research.

Canada↗
PubMed1995

Adult height and risk of breast cancer among US black women.

Adult height has been positively associated with the risk of breast cancer in a number of recent investigations. The authors assessed height in relation to breast cancer risk in a case-control study of US black women aged 25-69 years; 674 hospital patients with newly diagnosed breast cancer and 1,155 controls hospitalized for nonmalignant conditions unrelated to height were interviewed. After control for multiple confounders, the relative risk estimate for women < 61 inches (< 154.9 cm) tall was 0.5 (95% confidence interval (Cl) 0.3-0.7) relative to the median height of 64-65 inches (162.6-165.1 cm). Among women > or = 61 inches (> or = 154.9 cm) tall, there was little indication of any variation in risk with increasing height. The findings suggest that short stature is associated with a decreased risk of breast cancer in US black women.

Adult↗