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Biomedical subjects

A Rappaport

Publications and source records attributed to A Rappaport.

At least 19 recordsLinked to original sources
PubMed2002

Outcomes following unilateral uterine artery embolisation.

Uterine artery embolisation has been described as successful only when both arteries are embolised. However, results in patients with one congenitally absent or previously ligated artery are unknown. Women suffering from symptomatic uterine myomata were treated at a university teaching hospital, a community hospital and an outpatient surgery centre. Retrospective review of patient response to embolisation was assessed by chart review and questionnaire. Uterine and dominant fibroid size response was assessed by comparing pre- and post-embolisation ultrasound examinations. This study analysed three patient groups within the general population: those who underwent unilateral embolisation because of technical failure, those who ultimately underwent bilateral embolisation after initial technical failure and those who underwent unilateral embolisation because of an absent uterine artery. 12 patients underwent unilateral embolisation, 4 of whom underwent this procedure because of an absent uterine artery. Three of these four patients had a congenitally absent uterine artery arising from the internal iliac artery and all three experienced successful outcomes. The fourth patient had a previously ligated internal iliac artery and her symptoms worsened after the procedure. Eight patients had unilateral embolisation due to technical failure. Five of these patients underwent a subsequent procedure during which the contralateral uterine artery was embolised. Four of these five patients had successful outcomes and one was lost to follow-up. Another of the eight patients suffered an arterial injury leading to technical failure, and was lost to follow-up. Of the two remaining patients with unilateral technical failure, only one had a successful outcome. This study concluded that patients who undergo unilateral embolisation for technical reasons should be offered a second embolisation procedure shortly after the initial procedure. Patients with a congenitally absent uterine artery may respond with similar success to those who underwent bilateral embolisation. In contrast, the patient with a previously ligated internal iliac artery failed. The numbers in this study are too small for statistical analysis and subsequent studies should be performed to confirm these findings.

Angiography↗
PubMed2001

Sweet's syndrome in association with Crohn's disease: report of a case and review of the literature.

A 41-year-old woman developed a skin rash as part of Sweet's syndrome concurrent with the first episode of Crohn's disease of the colon. Sweet's syndrome, acute febrile neutrophilic dermatosis, may be associated with inflammatory, infectious, or neoplastic diseases. Its association with Crohn's disease is very rare, and when reported it has been mainly associated with Crohn's colitis. This association has been described in various stages of the disease. Sweet's syndrome may be considered one of the extraintestinal manifestations of Crohn's disease. Early diagnosis of this dermatosis may be important because of the prompt response to treatment with corticosteroids. The value of metronidazole should be considered because this medication may enhance response to treatment.

Adult↗
PubMed2001

Pregnancy following uterine fibroid embolization.

OBJECTIVE: This paper seeks to evaluate the ability to deliver term pregnancies following uterine fibroid embolization, and to identify impediments to pregnancy in the embolization procedure. STUDY DESIGN: Four physicians performed embolization procedures at various facilities. Patients were asked if fertility was an issue prior to embolization. We measured follicle-stimulating hormone levels before and after embolization. Clinical follow-up, six months following embolization was obtained by interview. Patients were questioned regarding attempts to conceive, menstrual history, and subsequent pregnancy. MAIN OUTCOME MEASURES: Complications were calculated upon the entire patient population, whether or not fertility was identified as a goal. Fertility risks from embolization were identified. We measured radiation exposure in a random consecutive group of 50 women undergoing embolization. All patients who conceived were asked the details of the pregnancy. RESULTS: Four hundred women underwent uterine fibroid embolization between 1996 and 1999. One hundred and thirty nine patients stated a desire for fertility after embolization. Of these, 52 were <40 years old. Seventeen pregnancies have been reported in 14 women. Five spontaneous abortions were observed. Ten women have had normal term deliveries and two women are currently pregnant. No perfusion problems, either during the pregnancy or labor, were reported. The average radiation dosage calculated for 50 women undergoing embolization was 14 rads. Four women under 45 years old suffered premature menopause (10/1000). Two women underwent hysterectomy as a complication of embolization (5/1000). CONCLUSION: The risks of infertility following embolization, premature menopause, and hysterectomy are small, as is the radiation exposure during embolization. These risks compare favorably with those associated with myomectomy. Fertility rates appear similar to patients undergoing myomectomy. No problems, either during pregnancy or delivery, have been observed after embolization. The course of pregnancy and delivery was normal after embolization with no maternal or fetal complications reported. These findings confirm results from other centers. Desire for future pregnancy is not a contraindication to fibroid embolization.

Abortion, Spontaneous↗
PubMed2000

An integrated laser trap/flow control video microscope for the study of single biomolecules.

We have developed an integrated laser trap/flow control video microscope for mechanical manipulation of single biopolymers. The instrument is automated to maximize experimental throughput. A single-beam optical trap capable of trapping micron-scale polystyrene beads in the middle of a 200-microm-deep microchamber is used, making it possible to insert a micropipette inside this chamber to hold a second bead by suction. Together, these beads function as easily exchangeable surfaces between which macromolecules of interest can be attached. A computer-controlled flow system is used to exchange the liquid in the chamber and to establish a flow rate with high precision. The flow and the optical trap can be used to exert forces on the beads, the displacements of which can be measured either by video microscopy or by laser deflection. To test the performance of this instrument, individual biotinylated DNA molecules were assembled between two streptavidin beads, and the DNA elasticity was characterized using both laser trap and flow forces. DNA extension under varying forces was measured by video microscopy. The combination of the flow system and video microscopy is a versatile design that is particularly useful for the study of systems susceptible to laser-induced damage. This capability was demonstrated by following the translocation of transcribing RNA polymerase up to 650 s.

Calibration↗
PubMed2000

Variation of employee benefit costs by age.

Health care, pension, and disability plans account for the bulk of employers' benefit costs, as defined in this article. Because those costs tend to rise as employees get older, the age structure of the workforce affects not only employers' costs but ultimately their competitiveness in global markets. How much costs vary depends in large part on the structure of the benefits package provided. The method a company chooses to finance benefits generally varies with its size. This article focuses primarily on the benefit practices of large, private employers. In the long run, such employers pay the costs associated with the demographics of their workers, whereas small employers can often pool costs with other companies in the community. In addition, small employers often offer fewer benefits, and the costs and financing of those benefits are subject to the insurance markets and state regulations. The discussion of benefit packages is illustrated by case studies based on benefits that are typical for three types of organizations--a large traditional company such as steel, automobile, and manufacturing; a large financial services company such as a bank or health care organization; and a medium-sized retail organization. The case studies demonstrate the extent to which the costs of typical packages vary and reveal that employers differ radically in the incentives they offer employees to retire at a specific time. An employer can shift the variation in cost by age by changing the structure of the benefit program. The major forces that drive age differences in benefit costs are the time value of money (the period of time available to earn investment income and the operation of compound interest) and rates of health care use, disability, and death. Those forces apply universally, in the United States and elsewhere, and they have not changed in recent years. However, the marketplace and the prevalence of various types of benefit programs have changed, and those changes have generally resulted in less cost variation by age and more frequent employer selection of benefit packages that exhibit less variation by age.

Adult↗
PubMed1998

Laparoscopic cholecystectomy for acute cholecystitis performed by residents in surgery: a risk factor for conversion to open laparotomy?

Recent observations point to a seemingly high conversion rate to laparotomy in cases of laparoscopic operations for acute cholecystitis that are performed by surgical residents. The purpose of the study is to evaluate those observations. In a retrospective nonrandomized study, conducted between February 1992 and December 1997, 285 laparoscopic operations for acute cholecystitis were analyzed. Those performed by attending surgeons were compared with those performed by residents assisted by attending surgeons. Of 123 laparoscopic operations performed by laparoscopic surgeons between February 1992 and September 1995, 20.3% were converted to laparotomy, compared with 41.3% of the 29 operations performed by the residents (p < 0.017), with no increase in complication rate. Factors like male sex, duration of upper abdominal pain, and severity of the inflammatory process were not significantly different in both groups. The residents' seniority did not influence the conversion rate. A constant and significant decrease in conversion rate to laparotomy was observed over the course of time, as the study proceeded to December 31, 1997 (p < 0.01). We conclude that the performance of difficult laparoscopic cholecystectomy by residents with the assistance of attending surgeons is feasible, but carries a higher conversion rate to laparotomy for reasons that are not entirely clear. The possibility of a learning curve of the residents is suggested.

Acute Disease↗
PubMed1997

Splenogonadal fusion diagnosed by spleen scintigraphy.

Splenogonadal fusion (SGF) is a rare congenital malformation characterized by fusion of the spleen and a gonad (almost always the left one) frequently associated with orofacial and/or limb developmental abnormalities. Only 125 cases were reported between 1883 and 1994. This report concerns a case of SGF in a 20-yr-old woman with an accidental finding of a splenic space-occupying lesion protruding into the lower abdomen in ultrasound and CT. Radiocolloid spleen scintigraphy and SPECT proved to be the best procedure to establish the correct diagnosis of SGF. As SGF is often asymptomatic, more liberal use of splenic scintigraphy is suggested in patients with congenital limb and/or orofacial anomalies. SGF should be included among the differential diagnoses of left abdominal, pelvic or scrotal masses.

Adult↗
PubMed1996

Laparoscopic management of acute cholecystitis. Prognostic factors for success.

BACKGROUND: Laparoscopic cholecystectomy for acute cholecystitis is considered feasible and safe, but it is associated with a higher rate of conversion to laparotomy than elective cholecystectomy because of technical reasons and anatomical changes related to the inflammatory process. The value of several factors that might influence its successful completion has not been studied completely yet, including the role of residents in operating such cases under attending-surgeon surveillance. METHODS: In a retrospective nonrandomized study, the medical charts of 182 patients that were operated for acute cholecystitis (94 of whom via the laparoscopic approach) were studied. The study was also conducted to study the effect of residents as operators. RESULTS: Male sex, duration of right upper abdominal pain, and the severity of the inflammatory process have all been significantly and independently correlated with increased conversion rate to laparotomy. Operation time was not longer than that of the open approach, and hospital stay and complication rate were lower. Operations performed by residents were associated with twofold conversion rate to laparotomy, without increased complication rate (p < 0.012). CONCLUSIONS: Laparoscopic management of acute cholecystitis is feasible and safe. Considering the factors discussed above, lowering the threshold for conversion is necessary in selected cases to maintain low morbidity rate. Integrating laparoscopic cholecystectomy for acute cholecystitis into surgical residency should be studied.

Acute Disease↗
PubMed1996

Taking the problem oriented medical record forward.

The problem oriented medical record (POMR) has proved to be very successful in providing a structure that helps doctors record their notes about patients, and view those notes subsequently in a manner that quickly gives them a good understanding of that patients history. This approach has been validated by the American Institute of Medicine. With the increased use of computer systems that implement the POMR by doctors, the limitations of this structure have become apparent, and there is clearly scope for developing the model further to improve the quality of the data recorded, and adding meaning to it. This paper describes some of the limitations of the POMR, and discusses a number of areas in which it may be extended. Crucially, this is done in a manner which is both implementable, and usable. The extensions explored include some types of entity including encounters, episodes and subproblems; and an alternative view-the Timeline. The terminology used for the extensions is clarified. Mechanisms by which these extensions have been implemented are described. Ways in which systems can manage these extensions automatically are suggested. Such implementations are constrained by the need not to allow the demands of the computer to intrude into the patient encounter. They are also constrained by the requirements for reporting by professional and governmental institutions, and by what is pragmatically feasible in software and hardware.

Computer Systems↗
PubMed1994

The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers.

BACKGROUND: Although levonorgestrel implants (Norplant) would appear to be a good contraceptive option for adolescent mothers, there is little information about the use of Norplant in this population. METHODS: We studied 100 postpartum adolescents who chose a contraceptive method at an urban teaching hospital between September 1991 and July 1992. Structured interviews were conducted and medical records were reviewed soon after delivery and at a mean (+/- SD) of 15.5 +/- 2.9 months post partum. RESULTS: Forty-eight of the adolescent mothers chose Norplant, 50 chose oral contraceptives, and 2 (not further studied) chose barrier methods of contraception. The factors significantly associated with the choice of Norplant were older age (16.7 years among those who chose Norplant, vs. 16.2 years among those who chose oral contraceptives), multiparity (24 subjects vs. 6 subjects), and previous use of oral contraceptives (34 subjects vs. 21 subjects). During follow-up, there were no differences between the Norplant group and the oral-contraceptive group in the frequency of clinic visits (an average of 2.3 visits per subject in each group), failure to return after the postpartum visit (9 subjects vs. 11 subjects), or the incidence of sexually transmitted diseases (42 percent vs. 36 percent). At follow-up, 95 percent of the subjects in the Norplant group and 33 percent of those in the oral-contraceptive group were still using the method they had chosen (P < 0.001). During the first postpartum year 1 subject in the Norplant group and 19 in the oral-contraceptive group became pregnant (P < 0.001). Norplant users did not differ from all other adolescents studied with regard to sexual activity or condom use. CONCLUSIONS: The selection of Norplant by adolescent mothers as a method of contraception is associated with higher rates of continued use and lower rates of new pregnancy than the selection of oral contraceptives and does not affect the use of health care services, sexual activity, condom use, or the rate of sexually transmitted diseases.

Adolescent↗
PubMed1991

Low-dose intermittent trimethoprim-sulfamethoxazole for prevention of Pneumocystis carinii pneumonia in patients with human immunodeficiency virus infection.

The important role of chemoprophylaxis for the prevention of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus type 1 (HIV)-infected patients is undisputed. The most cost-effective regimen, however, is unknown. We reviewed our experience at two hospitals in the New York City area in which low-dose, intermittent therapy with the combination of trimethoprim and sulfamethoxazole was used to prevent PCP in HIV-infected patients. During a total of 202 months of primary prophylaxis in 32 patients and 319 months of secondary prophylaxis in 35 patients, PCP was diagnosed only once. More than 80% of patients were receiving zidovudine concomitantly. Adverse reactions to trimethoprim-sulfamethoxazole occurred in 31% and 52% of those receiving primary or secondary prophylaxis, respectively. When those patients who were considered ineligible to receive trimethoprim-sulfamethoxazole prophylaxis (principally based on a prior adverse drug reaction) are also factored in, then approximately 50% of HIV-infected patients are candidates for long-term trimethoprim-sulfamethoxazole prophylaxis. The projected cost savings of this prophylaxis regimen, compared with those currently recommended by the US Public Health Service, are enormous.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Postherpetic neuralgia: clinical experience with a conservative treatment.

Ninety-seven consecutive cases of postherpetic neuralgia (PHN) were retrospectively reviewed. Patients comprised 49 women and 48 men with a mean age of 71.6 years. The most common painful locations were the chest and upper back (34%), abdomen and lower back (25.2%), and face (20.2%). Burning pain was the most common type of pain (61.3%). Lancinating pain was reported by 40% and throbbing pain by 22.6%. Treatments included drugs (mainly tricyclic antidepressant, anticonvulsant, and neuroleptic drugs), transcutaneous electrical nerve stimulation (TENS), and dry needling of muscles in the affected dermatomes. Positive response to treatment occurred in 18.5% of the patients after one visit. In 9.3% of the patients, the pain still could not be controlled after 10 visits of 2-week intervals. TENS proved to be effective in patients whose skin sensation was preserved. It was concluded that in most PHN cases, pain can be effectively controlled by conservative noninvasive therapy.

Adult↗
PubMed1988

Effect of alpha 1-adrenoceptors blockade with prazosin in canine narcolepsy.

The role of central alpha 1-adrenergic receptors in cataplexy was investigated in 4 narcoleptic poodles and 6 genetically narcoleptic Doberman pinschers. Treatment of narcoleptic dogs with prazosin, a selective alpha 1-adrenergic receptor blocker, exacerbated cataplexy in both narcoleptic dog breeds. Control and heterozygous Dobermans were not affected by the drug. Binding studies using [3H]prazosin revealed an increase in alpha 1-receptor binding apparently limited to the amygdala. The present study suggests that central alpha 1-adrenoceptors, whose role is still mostly unknown, play a fundamental role in controlling mechanisms involved in cataplexy and REM sleep.

Animals↗
PubMed1988

Role of central alpha-1 adrenoceptors in canine narcolepsy.

The role of central alpha-1 adrenergic receptors in cataplexy was investigated in genetically narcoleptic Doberman pinschers. Treatment of narcoleptic dogs with 25-600 micrograms/kg prazosin, a selective alpha-1 adrenergic receptor blocker, exacerbated cataplexy, whereas treatment with the alpha-1 agonist, methoxamine, ameliorated it. Subsequent studies showed that the beneficial effects of classical treatments of human narcolepsy (amphetamines and tricyclic antidepressants) are antagonized by prazosin, suggesting that these drugs are active through an indirect alpha-1 stimulation (via an increase of norepinephrine in the synaptic cleft). Other studies confirmed that the observed effects were not due to peripheral alpha-1 cardiovascular involvement. Atropine, a central anticholinergic agent, but not methylatropine, a peripheral one, completely suppressed the prazosin effect, which suggests that adrenergic and cholinergic systems act sequentially and not independently to generate cataplexy. Little is known about the physiological role of central alpha-1 adrenoceptors. This series of experiments implicates these receptors in narcolepsy-cataplexy.

Animals↗
PubMed1985

Regulation of central alpha-adrenoceptors by serotoninergic denervation.

Alpha 1- and alpha 2-adrenoceptors were assessed by binding studies using [3H]prazosin and [3H]p-aminoclonidine as ligands in membrane preparations from the cortex, hippocampus and hypothalamus of rats, 3 weeks after intracerebroventricular injection of the neurotoxin 5,7-dihydroxytryptamine. Cortical alpha 1 and hippocampal alpha 2 adrenoceptors were significantly increased. Treatment also affected the affinity of cortical alpha 2 adrenoceptors. These results suggest a heterologous, region-specific regulation of both subtypes of central alpha-adrenergic receptors by serotonin.

5,7-Dihydroxytryptamine↗