Biomedical subjects
B A Cohen
Publications and source records attributed to B A Cohen.
Tinea pedis in children.
OBJECTIVE: To demonstrate that tinea pedis should be considered in the differential diagnosis of children with foot dermatitis. DESIGN: Patient series. SETTING: Outpatient dermatology practice at the Children's Hospital of Pittsburgh (Pa). PARTICIPANTS: Children with culture-proven tinea pedis from 1987 until 1990. MEASUREMENTS/MAIN RESULTS: Fungal cultures were used to identify 13 girls and 13 boys ranging in age from 17 months to 18 years with tinea pedis. A parent was the probable source of infection in at least 25% of cases. CONCLUSIONS: Tinea pedis is not a rare occurrence in children and should be considered in any patient with a foot rash.
Behavioral adjustment and self-concept of young children with hemangiomas.
This study was conducted to determine the behavioral responses and self-concepts of young children with self-limited but transiently disfiguring capillary hemangiomas involving the head and neck. Nineteen children with hemangiomas, age 3 to 5 years, and their parents were compared with an age-matched control group without lesions. Responses to a parental checklist, informal interview, and self-concept test showed few differences between young children with hemangiomas and those without this neoplasm.
The diagnostic utility of elevation in cerebrospinal fluid beta 2-microglobulin in HIV-1 dementia. Multicenter AIDS Cohort Study.
We measured serum and CSF beta 2-microglobulin (beta 2M) levels in HIV-1 seropositive individuals with and without dementia to determine the frequency and diagnostic utility of elevation of CSF beta 2M. We compared 34 samples from 27 patients with HIV-1 dementia with 110 samples from 54 HIV-1 seropositive participants in the Multicenter AIDS Cohort Study, none of whom had progressive dementia. Neurosyphilis and CNS opportunistic processes were excluded in all subjects. We stratified the nondemented subjects by duration of HIV seropositivity and peripheral blood CD4 count. Compared with the nondemented group, demented subjects had significantly higher CSF total protein, IgG%, and CSF albumin/serum albumin ratios. A highly significant association was found between elevated CSF beta 2M and reduced CD4 count (p less than 0.0001). No significant differences were noted between the demented and nondemented groups in CSF WBC count or in the frequency of CSF HIV-1 isolation. The mean CSF beta 2M was 1.9 mg/l in the nondemented subjects compared with 4.2 mg/l in those with dementia (p less than 0.0001). We derived a cutoff of 3.8 mg/l from the distribution of CSF beta 2M in the nondemented group. The determination of CSF beta 2M had a sensitivity of 44%, specificity of 90%, and a positive predictive value of 88% for diagnosis of HIV dementia when compared with nondemented subjects with CD4 counts less than 200. In those without dementia, there was a strong correlation between serum and CSF beta 2M (r = 0.50, p less than 0.0001), but in demented subjects CSF beta 2M was elevated independently of serum levels, suggesting that CSF beta 2M is produced within the brain in HIV dementia. In the absence of CNS opportunistic processes, elevated CSF beta 2M greater than 3.8 mg/l is a clinically useful marker for HIV dementia.
Cavernous sinus syndrome and systemic lupus erythematosus.
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A mobile acute trauma battalion aid station: practical application during the Persian Gulf War.
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Hemorrhagic stroke due to cerebral vasculitis and the role of immunosuppressive therapy.
Cerebral vasculitis may occur in isolation or in conjunction with a systemic illness. Although a relatively infrequent cause of intracerebral or subarachnoid hemorrhage, it should be considered in a setting of relevant systemic symptoms, an unexplained progressive neurologic disorder, or in a patient lacking risk factors for hemorrhagic stroke. Diagnosis may be difficult because the results of most studies may be normal or nonspecific. Because treatment is effective in many of the cerebral vasculitides, vigorous pursuit of the diagnosis is warranted.
Juvenile xanthogranuloma and neurofibromatosis.
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Peripheral nervous system involvement in multiple sclerosis.
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Predictability of adequacy of spinal root decompression using evoked potentials.
Dermatomal evoked potentials are being used to obtain accurate information concerning the viability of specific nerve root pathways and the quality and extent of nerve root decompression. Twelve patients with quantifiable weakness were selected and tested before, during, and after surgery. Nine patients showed dramatic intraoperative electrical improvement, including decreased latencies and/or increased amplitudes; all had postoperative relief of pain and motor return. Three patients showed variable intraoperative electrical responses with complete pain relief but no motor improvement. No patients had false-negative findings. Intraoperative monitoring of dermatomal evoked potentials appears to be of value in predicting the quality of spinal decompression. Similar monitoring of somatosensory evoked potentials alone cannot provide the specificity for individual root levels that is available by monitoring individual dermatomes.
Pudendal nerve evoked potential monitoring in procedures involving low sacral fixation.
Pudendal nerve evoked potentials were used in orthopaedic surgical procedures involving fixation below the S1 level. Pudendal nerve stimulation was used to monitor 154 patients. Eleven patients (7.14%) had responses that were either difficult or impossible to interpret in that they were not consistently replicable. In one case (0.65%), responses were lost during surgery, and there were no subsequent neurologic sequelae (false-positive response). No patients had postoperative deficit to the sacral roots or to the global cord. Although it is possible to obtain definitive dermatomal responses down to S1, the use of pudendal nerve stimulation was found to provide additional means of monitoring lower sacral roots. Since the pudendal nerve is intimately associated with bowel, bladder, and sexual dysfunction, easily obtainable routine monitoring of this nerve can provide significant safety that the conventional somatosensory and dermatomal responses give to higher spinal levels.
Generalized eruption in a liver transplant patient. CMV.
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Urticarial skin eruption in a child. Leukemia cutis.
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Anogenital warts in children. Clinical and virologic evaluation for sexual abuse.
Seventy-three children with anogenital warts were examined for sexual abuse during a 2-year period. Our data suggest that nonsexual transmission is common, particularly in children under 3 years of age. Approximately 25% of these children were younger than age 1 year, and another 50% were between the ages of 1 and 3 years. No evidence of sexual abuse was detected in 66 children.
Purpuric vesicular eruption in a 7-year-old girl. Vesicular pityriasis rosea.
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Chromosome mosaicism in hypomelanosis of Ito.
Our finding of chromosome mosaicism with a ring 22 in a retarded black boy with hypomelanosis of Ito prompted a review of this "syndrome." Most patients have a variety of non-dermal defects, particularly those affecting CNS function. Among karyotyped patients, most are chromosome mosaics of one sort or another. Hypomelanosis of Ito turns out to be a causable non-specific phenotype, i.e., a clinical marker for chromosome mosaicism of all different types in individuals with a dark enough skin to show lighter patches. Consequently, cytogenetic evaluation is indicated in all patients with this skin finding.
Congenital choroid plexus papilloma and giant nevomelanocytic nevus: report of a case.
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Neuropsychological performance in HIV-1-infected homosexual men: The Multicenter AIDS Cohort Study (MACS)
We administered a battery of standardized neuropsychological measures to assess cognitive functions in a group of 769 HIV-1 seronegative, 727 asymptomatic HIV-1 seropositive (CDC Groups 2 and 3), and 84 symptomatic HIV-1 seropositive (CDC Group 4) homosexual/bisexual men enrolled in the Multicenter AIDS Cohort Study (MACS). Measures included tests of attention, memory, and psychomotor speed. Comparison of group means revealed significant differences in performance between HIV-1 seronegative and symptomatic HIV-1 seropositive subjects on measures of memory and on measures with strong motor and psychomotor timed components. These findings support the sensitivity of these neuropsychological instruments for detecting cognitive changes that may be related to HIV-1, and are consistent with other reports of neuropsychological abnormalities in symptomatic HIV-1-infected individuals. Asymptomatic seropositive men, on the other hand, did not differ significantly from seronegative subjects on any of the neuropsychological measures. Only 5.5% of the asymptomatic HIV-1 seropositive men showed abnormal performance on individual tests. This proportion did not differ significantly from that of seronegative controls. Further, among asymptomatic seropositive subjects, we found no statistically significant differences as a function of duration of HIV infection or level of immune system functioning. Thus, results from this study support the hypothesis that the frequency of neuropsychological abnormalities in asymptomatic HIV-1-infected homosexual men is low, and not statistically different from that of seronegative controls.