PubMed Health⌕ Search

Biomedical subjects

A Rosin

Publications and source records attributed to A Rosin.

At least 19 recordsLinked to original sources
PubMed2001

A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people.

OBJECTIVE: To compare the indications for and the outcome of long-term enteral feeding by nasogastric tube (NGT) with that of percutaneous endoscopic gastrostomy (PEG) tube. DESIGN: A prospective, multicenter cohort study. SETTING: Acute geriatric units and long-term care (LTC) hospitals in Jerusalem, Israel. PARTICIPANTS: 122 chronic patients aged 65 years and older for whom long-term enteral feeding was indicated as determined by the treating physician. Patients with acute medical conditions at the time of tube placement were excluded. MEASUREMENTS: We examined the indications for enteral feeding, nutritional status, outcome and complications in all subjects. Subjects were followed for a minimum period of six months. RESULTS: Although the PEG patients were older and had a higher incidence of dementia, there was an improved survival in those patients with PEG as compared to NGT (hazard ratio (HR)=0.41; 95% confidence interval (CI) 0.22-0.76; P=0.01). Also, the patients with PEG had a lower rate of aspiration (HR=0.48; 95% CI 0.26-0.89) and self-extubation (HR=0.17; 95% CI 0.05-0.58) than those with NGT. Apart from a significant improvement in the serum albumin level at the 4-week follow-up assessment in the patients with PEG compared to those with NGT (adjusted mean 3.35 compared to 3.08; F=4.982), nutritional status was otherwise similar in both groups. CONCLUSION: In long-term enteral feeding, in a selected group of non-acute patients, the use of PEG was associated with improved survival, was better tolerated by the patient and was associated with a lower incidence of aspiration. A randomized controlled study is needed to determine whether PEG is truly superior to NGT.

Age Factors↗
PubMed2001

Changing trends in partial nephrectomy at Walter Reed Army Medical Center.

PURPOSE: To evaluate the change in indications, frequency, complications, and outcome in patients undergoing partial nephrectomy at a single institution during a 25-year period. MATERIALS AND METHODS: A retrospective chart review was performed for patients who underwent partial nephrectomy at Walter Reed Army Medical Center from 1970 to 1995. A total of 309 patient records were reviewed for patient age, sex, and primary diagnosis. A more detailed analysis was performed on 47 records of patients who underwent partial nephrectomy from 1986 to 1996. RESULTS: The number of partial nephrectomies declined from the 1970s to the 1990s, demonstrating the trend away from nephron-sparing surgery for benign disease. Partial nephrectomies for renal cell carcinoma increased during the same period. Fifty-seven percent (12 of 21) of patients from 1986 to 1996 underwent partial nephrectomy for incidentally discovered renal tumors. Complications occurred in 25% (11 of 44) of patients, with acute renal insufficiency occurring in 4.5% (2 of 44). Twenty-two of 25 patients who underwent partial nephrectomy for renal cell carcinoma were followed for a mean of 45.6 months. The cancer-specific 5-year survival rate for partial nephrectomy was 88.1%. CONCLUSION: Trends in nephron-sparing surgery showed a movement away from performing ablating surgery for benign disease and toward nephron-sparing surgery for renal masses. Despite a higher complication rate, the curative ability of partial nephrectomy is similar to that of radical nephrectomy.

Adult↗
PubMed2000

Basal and cocaine-induced opioid receptor gene expression in the rat CNS analyzed by competitive reverse transcription PCR.

The basal mRNA levels of kappa and mu opioid receptors, as well as their regulation after 'binge' cocaine administration, were determined with competitive reverse transcription polymerase chain reaction (RT-PCR) in brain regions of male Sprague-Dawley rats. The procedure proved to be a reliable method to quantify the relative opioid receptor gene expression. The highest basal mRNA levels for the kappa opioid receptor were found in the nucleus accumbens and hypothalamus, whereas the highest basal mRNA expression for the mu opioid receptor was observed in the hypothalamus. Rats were separately treated with 'binge' (three hourly injections) cocaine HCl (45 mg/kg/day i.p.) or saline (1 ml/kg i.p.) for 2 days. A significant down-regulation of the kappa opioid receptor mRNA was detected in the nucleus accumbens. The mu opioid receptor mRNA was not affected. The data suggest a selective effect on kappa receptor expression in the nucleus accumbens as a consequence of 'binge' cocaine use.

Animals↗
PubMed2000

Surgical implications of multicentricity in renal cell carcinoma.

PURPOSE: To determine the incidence and metastatic pattern of multifocal renal cell carcinoma in radical nephrectomy specimens and to use these findings to guide the choice of operative procedure. MATERIALS AND METHODS: Pathology reports for 161 patients who underwent radical nephrectomy at Walter Reed Army Medical Center between 1980 and 1995 were reviewed to evaluate tumor size, stage, and incidence of multifocal tumors. RESULTS: Multicentric neoplasms occurred in 16 of 161 (9.9%) radical nephrectomy specimens from the same institution. Thirteen of the 16 multifocal tumors had cross-sectional diameters > or = 3.5 cm. Of the 16 multifocal carcinomas, 11 were noted in stage I tumors. Multifocal neoplasms were not identified with primary tumors of < 2 cm. CONCLUSION: Our data support previous reports that the incidence of multicentric renal malignancy is low and suggest that patients with small, unilateral masses (< 2 cm) can undergo kidney-sparing surgery with little risk of local recurrence.

Carcinoma, Renal Cell↗
PubMed1999

Downregulation of kappa opioid receptor mRNA levels by chronic ethanol and repetitive cocaine in rat ventral tegmentum and nucleus accumbens.

The combination of ethanol and cocaine is commonly abused by human addicts which has serious clinical consequences. Here, the effects of separately and concurrently administered ethanol and 'binge' cocaine on kappa opioid receptor (KOR) mRNA in the ventral tegmental area (VTA) and nucleus accumbens (NAc) of rats were studied. KOR mRNA was down-regulated in both brain regions during concurrent as well as separate treatment with these drugs. In the VTA, the most pronounced decrease was obtained following combined treatment with ethanol and 'binge' cocaine. In the NAc, the strongest decrease was observed in the 'binge' cocaine group. This profound decrease of KOR mRNA in regions important for brain reward suggests a potential role of the KOR system in the abuse of cocaine and ethanol.

Animals↗
PubMed1999

Impact of the Ottawa Ankle Rules in a U.S. Army troop medical clinic in South Korea.

The impact of the Ottawa Ankle Rules on radiograph-ordering behavior was assessed. Medical records and radiology reports for 80 consecutive patients who presented with the complaint of acute ankle pain were retrospectively reviewed for 18 variables. Twenty-two patients met the rules criteria and 45 did not. There were 10 fractures in the study group (N = 67), 3 of which were missed by the rules. All 3 fractures were 1-mm avulsion fractures of the fibula and are considered not clinically significant. Application of the Ottawa Ankle Rules by all clinic providers would have decreased the number of radiographs at our facility by 68%. The rules had sensitivity and specificity of 70% and 73%, and positive and negative predictive values of 31.8% and 93.3%, respectively. Providers at our facility did not routinely use the rules. Although the incorporation of these rules into our practice would have been significant, we recommend their use cautiously for a military population, which maintains a high intensity of physical training.

Adult↗
PubMed1998

Parenting and survival in anthropoid primates: caretakers live longer.

Most anthropoid primates are slow to develop, their offspring are mostly single births, and the interbirth intervals are long. To maintain a stable population, parents must live long enough to sustain the serial production of a sufficient number of young to replace themselves while allowing for the death of offspring before they can reproduce. However, in many species there is a large differential between the sexes in the care provided to offspring. Therefore, we hypothesize that in slowly developing species with single births, the sex that bears the greater burden in the care of offspring will tend to survive longer. Males are incapable of gestating infants and lactating, but in several species fathers carry their offspring for long periods. We predict that females tend to live longer than males in the species where the mother does most or all of the care of offspring, that there is no difference in survival between the sexes in species in which both parents participate about equally in infant care, and that in the species where the father does a greater amount of care than the mother, males tend to live longer. The hypothesis is supported by survival data for males and females in anthropoid primate species.

Animals↗
PubMed1997

Placenta growth factor: identification and characterization of a novel isoform generated by RNA alternative splicing.

We report the isolation and characterization of a third isoform of placenta growth factor (PlGF), generated by alternative splicing of its RNA transcript. This novel form of PlGF, PlGF-3, was cloned by the polymerase chain reaction technique using a human cDNA library prepared from the terminal placental tissue. PlGF-3 contains an in-frame insertion of 72-amino acids near the C-terminal portion of PlGF-1. Southern blot analysis revealed that a single gene encoded PlGF-2 and PlGF-3. Nucleic acid sequence analysis found the insertion of 216 nucleotides of PlGF-3 between exon 4 and exon 5 of the PlGF gene. Northern blot and tissue distribution studies discovered two mRNA species for PlGF-3, which were both uniquely expressed in the placenta. Transient expression of PlGF-3 cDNA in mammalian cells showed PlGF-3 was detected in the conditioned medium as both dimers and monomers. Unlike PlGF-2, PlGF-3 lacked heparin-binding affinity. Thus, alternative splicing of PlGF RNA produces at least three polypeptides with different secretion pattern, heparin-binding affinity and dimerization properties.

Alternative Splicing↗
PubMed1997

[Should physical restraints be used in an acute geriatric ward?].

A prospective study was carried out in an acute geriatric ward to determine the incidence of the use of physical restraints, the reasons for using them and the consequences. Over a period of 8 months an independent observer documented all cases in which a restraint was used and followed them until it was removed. A questionnaire was submitted to the nurses as to why they applied the restraints. 16% of patients had some form of restraint applied, in 2/3 of them for up to half of their stay in the ward. In over 90% of those restrained, functional (Barthel) and cognitive (mini-mental) scores were between 0-5. In unrestrained patients, the functional score was 0-5 in 79% and the cognitive score 0-5 in 72%. The main reason for applying restraints, usually sheets or body binders, was to prevent the patient from falling out of, or slipping from chairs, rather than to stop them from rising out of them. Other important reasons, which overlapped, were to prevent the patient from interfering with nasogastric tubes, catheters, and i.v. cannulas, each in 1/3 of the group. Restraints were discarded when deterioration did not allow the patient to sit out of bed, to decrease agitation, to allow enteral or parenteral treatment, and in 12%, when there was supervision by the family. Of 33 families interviewed, none opposed application of restraints, and most left the decision to the responsible ward staff. We conclude that restraints cannot be avoided in some acutely ill, old patients with severe physical and mental dysfunction. However, ways should be sought to minimize their use, as recommended in the literature, by demanding from the staff a specific reason, signed agreement of a physician, close follow-up, and favorable environmental conditions such as suitable chairs, occupational activity, and staff cooperation in removing the restraints.

Accidental Falls↗
PubMed1991

Cardiotoxicity of interferon. A review of 44 cases.

Cardiovascular complications have occurred in clinical trials of interferon. We review herein experience to date of cardiotoxicity with all types of interferons in cancer patients. The most common presentations of cardiotoxicity were cardiac arrhythmia, dilated cardiomyopathy, and symptoms of ischemic heart disease, including myocardial infarction and sudden death. The cardiac effects were not related to the daily dose, cumulative total dose, or period of therapy. Some of the patients in whom interferon has caused cardiovascular sequelae have had a history of coronary heart disease or have previously been given chemotherapy with drugs known to be cardiotoxic. In most of the patients, cardiac toxicity was reversible following the cessation of the drug therapy.

Adult↗
PubMed1988

Increased uric acid clearance in the syndrome of inappropriate secretion of antidiuretic hormone.

Twenty-eight elderly inpatients with severe hyponatremia were investigated prospectively to determine if fractional uric acid clearance was increased significantly in the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) compared with other causes of hyponatremia. The patients were divided into three groups: Group A--hyponatremia due to SIADH, Group B--hyponatremia due to diuretic use, and Group C--hyponatremia possibly due to a number of causes. Serum uric acid was 3.2 +/- 0.4 and 5.3 +/- 0.6 in Groups A and B, respectively (P less than 0.05). Fractional clearance of urate in Groups A and B were 43 +/- 5.1 and 16.7 +/- 1.9, respectively (P less than 0.001). In Group C six of the nine had abnormally increased fractional clearance of uric acid (31.6 +/- 3.8) in addition to accepted biochemical criteria of SIADH. In 10 patients with SIADH, urate clearance measured before water restriction was 40.2 +/- 9.0%, and after serum sodium returned to normal 11.6 +/- 1.5 (P = 0.05). Of the total 28 patients 17 had increased fractional uric acid clearance with biochemical criteria of SIADH, suggesting that this syndrome is a common cause of the increased susceptibility to hyponatremia among older patients.

Aged↗
PubMed1987

Cognitive impairment and the quality of care in long-term care institutions.

This study sought to determine whether cognitively impaired elderly in long-term care institutions receive a lower quality of care than do the non-impaired. The quality of care for each of 136 elderly in nine units for independent, frail and nursing residents was examined through the tracer method. On the basis of the MSQ test and an assessment by the ward nurse, a composite scale for measuring cognitive impairment was developed. Sixty-one percent of the elderly were found to suffer moderate to severe cognitive impairment. The cognitively impaired patients were found to receive poorer nursing care and staff were unaware of the existence of a greater proportion of their medical problems, compared with the non-impaired. The findings suggest that the lower quality care provided to the cognitively impaired is related to their greater behavioral and social problems such as aggressiveness and apathy. Staff members are apparently less inclined to have contact with patients displaying such problems. Changes of referral policies and training programs for institutional staff on the care of the cognitively impaired elderly are necessary in order to improve care for this group.

Aged↗
PubMed1986

Malignant histiocytosis in Bernese Mountain dogs.

Malignant histiocytosis was diagnosed in 10 male and 1 female Bernese Mountain Dogs. Nine of these dogs were closely related. The disease was characterized by a rapidly progressive and inevitably fatal course. Clinical signs varied, but lethargy, anorexia, weight loss, and respiratory and CNS abnormalities predominated. The lungs were the primary site of tumor involvement in 10 dogs. The eleventh dog had lymphadenopathy and severe anemia. Metastatic lesions were detected in all dogs. Anaplastic pulmonary carcinoma was diagnosed originally in 6 of the 11 cases, but this diagnosis was changed to malignant histiocytosis after electron microscopic examination of tissues and immunohistochemical identification of histiocytic markers in the tumor cells.

Animals↗
PubMed1986

Malignant histiocytosis of Bernese mountain dogs.

A second histiocytic proliferative disorder, which resembled malignant histiocytosis of man, was identified in 13 Bernese mountain dogs. Malignant histiocytosis was clearly distinct from systemic histiocytosis, which was reported earlier in this breed. Eleven cases involved male dogs. Ten dogs occurred in the same family line as the dogs afflicted with systemic histiocytosis. Clinical or radiological evidence of pulmonary involvement was present in nine dogs. Neurological disturbances were present in five dogs. Anemia was observed in five dogs and was associated with prominent erythrophagocytosis in two instances. The clinical course was rapidly progressive. Necropsy examinations revealed that infiltrates were especially frequent in the lungs and hilar lymph nodes. Other lymph nodes, liver, spleen, and central nervous system were also frequently involved. Evidence for primary pulmonary involvement was present in seven dogs. The original diagnosis in seven cases was large cell anaplastic carcinoma of the lung by light microscopy only. The infiltrates were composed of large, pleomorphic, phagocytic mononuclear cells and multinucleated giant cells which also manifested marked cytological atypia and numerous, frequently bizarre, mitotic figures. Ultrastructural studies and the immunohistochemical demonstration of lysozyme and alpha 1-antitrypsin in the tumor cells in the majority of cases were consistent with a macrophage origin.

Animals↗