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Biomedical subjects

A Steinberg

Publications and source records attributed to A Steinberg.

At least 55 records · Page 3Linked to original sources
PubMed1994

The lateral radiograph of neck in laryngo-tracheo-bronchitis (croup).

The films of 61 children who had a lateral radiograph of neck performed in the management of acute laryngo-tracheo-bronchitis were reviewed by a paediatric radiologist. He was unaware of the clinical history and the outcome of the children's illnesses. The clinical records of the same children were reviewed independently and information sought about the clinical relevance of the film results. Sixty per cent of the films were felt to be in keeping with a diagnosis of acute laryngo-tracheo-bronchitis. As judged by the information in the medical records these results did not influence the management of the children other than in one instance where a child underwent laryngoscopy. This decision was strongly influenced by the original film report. No child developed acute airway obstruction while in the Radiology Department. The findings of this study support the concept that a request for a lateral X-ray of neck in croup is an inefficient use of diagnostic facilities.

Bronchoscopy↗
PubMed1993

Evidence that substance P is utilized in medial amygdaloid facilitation of defensive rage behavior in the cat.

The present study was designed to test the hypothesis that a major excitatory mechanism for the expression of feline defensive rage behavior involves the medial nucleus of the amygdala which utilizes substance P as a neurotransmitter in a direct output pathway that supplies the medial hypothalamus. In phase I of the experiment, stimulating electrodes were implanted into the medial amygdala and cannula electrodes were implanted into the medial and lateral hypothalamus from which defensive rage and predatory attack behavior could be elicited by electrical stimulation, respectively. Response latencies for defensive rage were significantly lowered after dual stimulation of the medial amygdala and medial hypothalamus relative to single stimulation of the medial hypothalamus alone. In phase II, dose- and time-dependent decreases in medial amygdaloid-induced facilitation of defensive rage were observed after the i.p. administration of the NK1 antagonist, CP-96,345 (0.05, 2 and 4 mg/kg). In phase III of the study, the effects of microinjections of CP-96,345 placed directly into defensive rage sites within the medial hypothalamus (0.05, 0.5 and 2.5 nmol) upon medial amygdaloid modulation of this response were assessed. Again, intracerebral administration of this antagonist blocked the facilitatory effects of medial amygdaloid-induced facilitation of defensive rage in a manner parallel to that observed with peripheral administration of the NK1 antagonist. The results suggest that the medial amygdala facilitates defensive rage by acting through a substance P mechanism at the level of the medial hypothalamus. Other experiments revealed that peripheral administration of the NK1 antagonist: (1) had little upon the latency or threshold for elicitation of defensive rage, suggesting that the medial amygdaloid-substance P facilitatory mechanism acts in a phasic rather than tonic manner; and (2) also blocks the suppressive effects of medial amygdaloid stimulation upon predatory attack behavior elicited from the lateral hypothalamus. The latter finding suggest that similar neurochemical mechanisms regulate medial amygdaloid modulation of both forms of hypothalamically elicited aggression. The final aspect of this study utilized the combination of retrograde-tracing of amygdaloid neurons into the medial hypothalamus after microinjections of Fluoro-Gold into defensive rage sites, and the immunocytochemical analysis of substance P neurons within the amygdala. The data indicated that large numbers of retrogradely and immunocytochemically positive labeled cells were identified in the medial nucleus, including many that were double-labeled.(ABSTRACT TRUNCATED AT 400 WORDS)

Amygdala↗
PubMed1993

Isochromosome 18p in a mother and her child.

We present a familial case of isochromosome 18p [i(18p)] as a supernumerary chromosome. The mother, who is a mosaic for i(18p) with partial tetrasomy 18p syndrome, transmitted the isochromosome to her only child. The child has the full syndrome of tetrasomy 18p. This is the first case of mosaicism i(18p) in an adult patient with clinical manifestations.

Adult↗
PubMed1993

Dissociation between the wishes of terminally ill parents and decisions by their offspring.

OBJECTIVE: To assess the attitude and factors affecting decision-making by offspring for life-sustaining measures toward their elderly terminally ill parents. DESIGN: Survey SETTING: Acute geriatric department of a university-affiliated teaching hospital. PATIENTS AND PARTICIPANTS: 108 offspring of 48 terminally ill elderly patients were interviewed. MEASUREMENTS: The attitude of offspring regarding life-sustaining measures based on a comprehensive questionnaire, administered by face-to-face interview, that included clinical, social, and religious information for each patient and social, religious, demographic, and educational information for each family member. RESULTS: A significant majority requested the continuation of fluid, nutrition, and medication (78%, 66%, 73%, respectively). A minority of 25%-29% requested the initiation of resuscitation, mechanical ventilation, and dialysis. Active euthanasia was requested by seven offspring. Factors that significantly affected offspring's decisions were the degree of religious observance and close relationship. Approximately 50% of offspring believed they knew their parents' wishes, but most of them did not comply with the parents' wishes. The offspring's preferences for themselves differed in important aspects from the requests for their parents. The great majority stated that a family member and/or the responsible physician should be involved in the decision-making process (76% and 79%, respectively). Only 2.0% suggested the participation of an ethics committee, and the court was rejected by all. CONCLUSIONS: Basic life-sustaining measures are requested for the terminally ill parents by most of the offspring. A significant minority even requested aggressive life-sustaining measures. The degree of religiosity and closeness of relationship influenced offspring's request most strongly.

Adult Children↗
PubMed1993

A reversible case of Klüver-Bucy syndrome in association with shigellosis.

The Klüver-Bucy syndrome is characterized by psychic blindness or visual agnosia, blunted affect, hypermetamorphosis, hyperorality, bulimia, and sexual behavioral alterations. To date, there have been fewer than 10 reported cases of Klüver-Bucy syndrome in children, most of them irreversible. We describe here a reversible case of the complete Klüver-Bucy syndrome in a child suffering from Shigella encephalopathy.

Agnosia↗
PubMed1992

Cerebral oedema in congenital nephrotic syndrome.

We report an infant with congenital nephrotic syndrome who showed clinical and radiological evidence of cerebral oedema, which resolved during prolonged intravenous albumin therapy. The cerebral oedema in this case can possibly be attributed to the relative immaturity of the blood-brain barrier in early infancy.

Albumins↗
PubMed1991

Issues in providing mental health services to hearing-impaired persons.

Interest in the mental health service needs of hearing-impaired persons has expanded over the past 35 years, but the availability and accessibility of clinical services have lagged behind developments in research. Despite federal mandates, deaf Americans' psychiatric and psychosocial needs remain profoundly underserved. The author provides an overview of deaf culture and the deaf community and discusses issues in communication, including use of American Sign Language and interpreters in clinical settings. Diagnostic considerations, clinical assessment strategies, and inpatient, outpatient, educational, and early intervention treatment strategies are explored, and the needs of special populations, including mentally ill offenders, patients with multiple disabilities, and persons with hearing loss in later life are examined.

Combined Modality Therapy↗
PubMed1991

Ethical considerations in modern human experimentation.

The use of properly controlled clinical trials in medical experimentation has been of vital importance to the progress of medical science. At the same time, the new form of experimentation has also generated some of our most difficult and perplexing moral dilemmas. The solutions to the many complicated ethical problems involved in human experimentation are not straightforward, and despite numerous books, articles, codes, guidelines, and declarations, many specific issues of right and wrong in human experimentation have not yet been definitively resolved. Society today has an obligation greater than ever to control, regulate, and enforce properly balanced codes of human experimentation in order to minimize the unacceptable ethical problems and maximize the desired results of modern human experimentation. These, however, are not sufficient. The patient's greatest safeguard in experimentation is a skillful, intelligent, and conscientious physician and investigator. Thus, the investigator bears great responsibility in balancing between the common good and the individual's rights. In this article the relevant secular and Jewish ethical principles and rules concerning human experimentation are specified and methodologically organized. Particular emphasis is placed on the elucidation and evaluation of the ethical controversies surrounding randomized clinical trials.

Beneficence↗
PubMed1991

Meningomyelocele in the neonate: medical and ethical considerations.

Whether to treat or not to treat a high neural tube lesion presents a significant ethical dilemma. In the past two decades, the medical practice regarding the approach to a neonate with a neural tube defect has gone through a series of philosophical and therapeutic changes. Medical, ethical, religious, and legal systems have grappled inconclusively with the various aspects of these issues in recent years. In this article, the pros and cons of relevant medical and ethical considerations are analyzed, and a decision-making process is outlined. It is suggested that in order to enhance the ability of the responsible care provider and the parents to reach reasonable and morally defensible decisions, a properly organized decision-making process ought to be adhered to. Each individual patient should be analyzed according to the following major categories: medical data, basic ethical and religious principles, legal and/or institutional regulations, and physician-parents relationship. Based on current medical knowledge and on pertinent ethical reasoning, it is argued and recommended that almost always, if possible, aggressive management should be favored.

Decision Making↗
PubMed1990

A living systems approach to understanding the concept of stress.

In this article, the basic concepts used in conceptualizing stress and classifying its related phenomena are defined and a general conceptual framework for understanding the interrelationships among these concepts is proposed. The conceptual scheme described is intended to be applicable across disciplines including the biological and the behavioral and social sciences. This model is based largely on the living systems theory developed by Miller (1978) and the work of Selye (1950). It provides a coherent conceptual framework in which studies in the various disciplines engaged in stress research can be organized and integrated. Its use across disciplines will facilitate the sharing of information and prevent needless duplication of effort by researchers in different fields. It will also facilitate the generation and formulation of empirically testable hypotheses (including specific cross-level hypotheses), the development of more focused research designs and a clearer interpretation of findings. By understanding at which point in the stress pathway a system is when observed, a clearer picture of both the biological mechanisms involved and the psychosocial ramifications of stress may be obtained. As a consequence of this type of information becoming available, more optimal treatments for patients with stress-related disorders can be developed.

Adaptation, Psychological↗
PubMed1990

Platelet glutathione peroxidase and monoamine oxidase activity in schizophrenics with CT scan abnormalities: relation to psychosocial variables.

We have previously reported that the activity in platelets of the important antioxidant enzyme glutathione peroxidase (GPx) is inversely correlated with computed tomographic (CT) measures of brain atrophy in a population of patients with chronic schizophrenia, suggesting that low GPx may be a vulnerability factor in those schizophrenic patients with structural brain abnormalities. The significance of this finding has now been explored in a larger clinical population by examining the relation of GPx and CT parameters to psychosocial variables and to the activity of platelet monoamine oxidase (MAO), which has also been reported to be altered in certain schizophrenic populations. In the present study, low platelet GPx and high brain atrophy were found to be associated with DSM-III diagnoses of nonparanoid schizophrenia, a high degree of chronicity, and a predominance of negative symptoms. Contrary to some literature reports, atrophy also correlated with age and length of illness among the schizophrenic patients, although the contribution of these factors was less than that of low GPx, which was itself not age dependent. The ventricle-brain ratio (VBR) and atrophy were highly correlated in a control group of affective disorder patients, but not in the schizophrenic group, where large VBRs were found predominantly in the DSM-III undifferentiated subgroup. The low-GPx/high-atrophy schizophrenic patients had normal platelet MAO levels, and MAO was significantly lower only in the paranoid subgroup, consistent with reported observations. There was no evidence for a neuroleptic-induced effect on either enzyme.

Adult↗
PubMed1989

Evoked potential variation in schizophrenic subgroups.

Unmedicated chronic schizophrenic inpatients and nonpsychotic controls were tested in a paradigm designed to elicit habituated event-related potentials (ERPs) to auditory stimuli. Analysis of Variance of the ERP components recorded at bilateral frontal (F1 and F2) and temporal (T3 and T4) scalp leads revealed significant decreases in N1 component amplitudes in both frontal leads in the schizophrenic subjects. P2 and N2 amplitudes also tended to be smaller at frontal leads in the schizophrenic subjects, but these differences were not found to be statistically significant overall. The schizophrenic subjects were assigned to diagnostic subgroups following administration of the Diagnostic Interview Schedule, the Maine Paranoid Scale, and the Scale for the Assessment of Negative Symptoms. Subjects meeting DSM-III criteria for paranoid schizophrenia were assigned to one subgroup (PS subgroup), and those meeting DSM-III criteria for residual or undifferentiated schizophrenia were assigned to another subgroup (RS subgroup). The Analysis of Variance of the N1 amplitude measures was repeated with subgroup diagnosis as a factor, revealing significant decreases in N1 amplitude in the PS, but not the RS, patients. Patients in the PS subgroup were found to differ significantly from those in the RS subgroup on this ERP measure, as well as from controls. These results suggest that subgroup differences exist within the schizophrenic population that are reflected in differential changes in ERP morphology.

Adult↗