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Biomedical subjects

D Rosenblum

Publications and source records attributed to D Rosenblum.

14 recordsLinked to original sources
PubMed2001

Intrauterine epidermal necrosis.

BACKGROUND: Epidermal necrosis in a neonate is an uncommon event with a variety of potential cases. RESULT: We report a case of intrauterine epidermal necrosis in a preterm infant, with death occurring soon after birth. The histopathology of the denuded skin revealed full-thickness epidermal necrosis and calcification within both the epidermis and follicular structures. CONCLUSION: We believe this represents the fourth reported case of lethal intrauterine epidermal necrosis and follicular calcification.

Epidermis↗
PubMed1998

Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in diffuse large-cell lymphoma.

Although high-dose chemotherapy and a blood cell or bone marrow autotransplant are commonly used to treat people with diffuse large-cell lymphoma, there is controversy whether this is better than conventional-dose chemotherapy. Subject-selection and time-to-treatment biases preclude comparison of data from uncontrolled trials and there are few date from randomized trials. We used a Delphi-panel group judgment process to determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow transplant. Results were compared to those of randomized trials. Nine lymphoma experts from diverse geographic sites and practice settings were panelists. Boolean MEDLINE searches of lymphoma and chemotherapy and an autotransplant formed the dataset. Panelists were asked to rate appropriateness of high-dose chemotherapy and an autotransplant compared to conventional-dose chemotherapy. Clinical variables were permuted to define 80 clinical settings rated by the panelists on a 9-point ordinal scale. Results were used to determine an appropriateness index reflecting the mean and distribution of ratings. The relationship of appropriateness indices to permuted clinical variables was considered by analysis of variance and recursive partitioning. In people with initial diffuse large-cell lymphoma, autotransplants were never rated appropriate. They were rated uncertain in all settings except in people never receiving chemotherapy and in those with a complete response to chemotherapy and an international prognostic index < 3, where they were rated inappropriate. In people with recurrent lymphoma, autotransplants were rated appropriate in those with a complete or partial response to chemotherapy, uncertain in those with a less than partial response and in those not receiving re-induction chemotherapy and inappropriate in people with CNS lymphoma. These conclusions agree with results of randomized trials.

Aged↗
PubMed1998

The natural history of multiple sclerosis and its diagnosis.

The definition of multiple sclerosis (MS) provides a framework for the findings of the disease. This definition encompasses multiple lesions in the central nervous system which appear over time and emphasizes the spacial distribution of the lesions. Due to the significant degree of variability in the presentation of MS, the definition has evolved in terms of probability for the diagnosis given the findings.

Brain Diseases↗
PubMed1998

Therapeutic and symptomatic treatment of multiple sclerosis.

The treatment of multiple sclerosis (MS) is a dynamic field that is rapidly evolving. It encompasses tow main areas. The first is the direct treatment of MS itself, having evolved from using primarily steroids to the newest immunotherapies that come from the extensive research into the immune system and the role it plays in so many diseases. The second area for treatment is in the management of the effects or symptoms resulting from MS.

Fatigue↗
PubMed1995

Brain abscess and psychosis as a complication of a halo orthosis.

The halo vest orthosis is commonly used for stabilization after cervical spinal cord injury. Well-documented complications of halo use include skin breakdown, pin loosening, and loss of reduction. Brain abscess associated with halo use has been rarely reported. A case of a 23-year-old man is presented with spinal cord injury and halo stabilization. He developed extreme agitation and psychosis. Diagnostic imaging showed a brain abscess. After treatment for the abscess, his behavioral symptoms resolved. This article reviews the halo orthosis, its possible complications, and its routine management. Early recognition of important signs of symptoms in patients with halos as possible indicators of brain abscess is emphasized.

Adult↗
PubMed1994

Listening to people with cancer.

Modern oncologic treatment includes prescriptive remedies for patient-defined illnesses as well as physician-defined diseases. To obtain needed information, oncologists must be skilled as discriminative, analytical, supportive, critical, and appreciative listeners. Listening skills help to establish rapport, confirm understanding, and exchange background information. The neuropsychiatric needs of impaired patients and oncologists should be identified and remedied to improve oncologist-patient communication. Improvements in listening skills makes the oncologist's work more meaningful and helps their patients to feel more confident.

Communication↗
PubMed1993

Clonidine-induced bradycardia in patients with spinal cord injury.

Clonidine is being used increasingly for treatment of spasticity in patients with spinal cord injury. Though hypotension, dry mouth, and constipation are well-documented possible adverse effects, the possibility of clonidine-induced bradycardia is less well recognized and is rare. This report describes a patient who developed spasticity following a traumatic spinal cord injury. After clonidine was initiated, the patient's spasticity improved. However, he developed significant bradycardia. Once clonidine was discontinued, the resting heart rate returned to normal. This case illustrates an unusual adverse effect of clonidine. Possible mechanisms by which clonidine decreases spasticity are described, probable mechanisms of induced bradycardia are reviewed, and specific treatment recommendations for the use of clonidine in spinal cord injured patients are presented.

Adult↗
PubMed1975

Neutrophil alkaline phosphatase: comparison of enzymes from normal subjects and patients with polycythemia vera and chronic myelogenous leukemia.

To determine whether decreased alkaline phosphatase activity in the granules from neutrophils of patients with chronic myelogenous leukemia (CML) was due to an absence of enzyme or the production of defective enzyme, we compared the immunologic properties of granule alkaline phosphatase derived from patients with CML with that of normal subjects and patients with polycythemia vera (PRV). Antisera prepared in rabbits against granule alkaline phosphatase purified from the neutrophils of a patient with PRV produced a single precipitin line of antigenic identity when reacted with extracts of normal, PRV, and CML neutrophil granules. A histochemical stain for alkaline phosphatase activity (alpha-naphthyl acid phosphate coupled with Fast Blue RR) specifically stained the precipitin line. A variety of quantitative precipitin techniques failed to produce satisfactory precipitation of alkaline phosphatase activity. Comparative analyses were therefore performed by affinity chromatography using goat antirabbit-gammaglobulin linked to Sepharose 4B to adsorb alkaline phosphatase complexed with rabbit gamma globulin. With this method, 100% of CML, normal, and PRV alkaline phosphatase could be adsorbed. Using limiting concentrations of antibody, a proportionally smaller fraction of enzyme activity was absorbed as the concentration of PRV alkaline phosphatase or normal alkaline phosphatase was increased. Extracts of CML granules containing comparable amounts of protein but 200-fold less alkaline phosphatase activity per milligram did not specifically reduce adsorption. Thus, in CML, we found no evidence that the granulocytes contained a large amount of antigenically normal but enzymatically defective alkaline phosphatase. Examination of electron micrographs revealed no significant differences in the number or distribution of granules in the granulocytes of normal subjects or patients with PRV or CML. This suggests that the low level of neutrophil alkaline phosphatase in CML granulocytes is the result of decreased enzyme content and not a consequence of synthesis of catalytically defective enzyme.

Alkaline Phosphatase↗
PubMed1973

Granulocyte alkaline phosphatase. Studies of purified enzymes from normal subjects and patients with polycythemia vera.

To characterize the biological changes which result in increased granulocyte alkaline p-nitrophenyl phosphatase activity in patients with polycythemia vera, the enzyme was purified from granule fractions of sucrose homogenates made from dextran-sedimented leukocytes of normal subjects and patients with polycythemia vera. Polycythemic blood yielded 3-10 times as much granulocyte alkaline phosphatase per 10(9) leukocytes as did normal blood. Sodium dodecyl sulfate extracts of granules were purified by DEAE-cellulose chromatography and sucrose gradient centrifugation to apparent homogeneity as judged by polycarylamide disk gel electrophoresis. Granulocyte alkaline phosphatase from normal subjects was purified 6910-fold with a 60% yield and a specific activity of 47 U/mg. Granulocyte alkaline phosphatase from polycythemic patients was purified 1.166-fold with a 50% yield and a specific activity of 70 U/mg. The two enzymes did not differ in molecular weight; both appeared to be about 160,000 daltons by sucrose gradient centrifugation. Both appeared to be zinc metalloenzymes, in that they were specifically inhibited by o-phenanthroline. Their elution requirements when adsorbed to DEAE-cellulose suggested they were lipoproteins although the content of phosphorus was below the threshold of detection. The identity of the two enzymes was suggested by immunological studies in which antibody prepared against purified polycythemia vera enzyme gave a precipitation reaction of identity with another polycythemia vera enzyme and two pools of normal enzyme. It is possible to account for the difference in alkaline phosphatase activity between the granulocytes of patients with polycythemia vera and normal subjects by differences in the quantity of enzyme synthesized.

Alkaline Phosphatase↗
PubMedDate not supplied

The renal response to exogenous parathyroid hormone in treated pseudohypoparathyroidism.

Resistance to the renal actions of parathyroid hormone (PTH) in pseudohypoparathyroidism (PsH) may be improved after treatment with vitamin D or its metabolites, but reports conflict. We have examined the renal response to infusion of 35 micrograms of 1-38 PTH in patients with PsH type I (n = 8) and PsH type II (n = 1) during treatment and related this to prevailing endogenous serum PTH and calcium levels. Nine patients with postsurgical or idiopathic hypoparathyroidism (HP) served as controls. The urinary cAMP increase (delta cAMP) was lower (p < 0.001) in the PsH type I (175 +/- 6.4 nmol/l glomerular filtrate) than in the HP group (3251 +/- 515 nmol/l glomerular filtrate). delta cAMP in the PsH type I subjects was dependent on endogenous PTH concentrations (r = -0.76; p = 0.046) and serum calcium (r = 0.74; p = 0.037). Phosphaturic responses (expressed as % decrease in TmPO4/glomerular filtration rate) were lower (p = 0.013) in the PsH type I (28.8 +/- 3.75) compared with those of the HP patients (43 +/- 3.48). The phosphaturic responses in the PsH type I patients were strongly dependent on endogenous PTH (r = 0.94; p < 0.001) and serum calcium levels (r = 0.94; p < 0.001) so that the responses of subjects with normal or low PTH levels were no different (p = 0.16) from the HP group. Renal handling of calcium and sodium in response to exogenous PTH was identical in patients with PsH (types I and II) and HP. Renal tubular reabsorption during a calcium infusion was normal in all patients with PsH. These results emphasise the importance of the modulatory effects due to associated biochemical abnormalities in PsH on the responses to exogenous PTH. They also confirm that renal handling of calcium and sodium is probably normal in treated PsH.

Adult↗