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Biomedical subjects

E Kaplan

Publications and source records attributed to E Kaplan.

At least 19 recordsLinked to original sources
PubMed1992

Combined modality therapy for stage III non-small cell lung carcinoma: results of treatment and patterns of failure.

Patients with Stage III non-small cell lung carcinoma continue to pose a therapeutic problem with dismal cure rates. In an effort to improve on these results, 129 patients with biopsy-proven clinical Stage III non-small cell lung carcinoma from November 1982 through November 1987, were entered into two consecutive Phase II studies at Rush-Presbyterian-St. Luke's Medical Center. Treatment in the first study consisted of Cisplatin and 5-Fluorouracil infusion with concomitant split course radiation; in the second Etoposide was added. Radiation and chemotherapy were given simultaneously on days one through five of each cycle in a preoperative fashion for four cycles in patients considered eligible for surgery and in a definitive fashion for six cycles in patients considered ineligible for surgery. Radiation was given in 2 Gy fractions for a planned preoperative dose of 40 Gy and a definitive dose of 60 Gy. Surgical resection was attempted four to five weeks later in patients treated preoperatively. Thus, 83 patients were treated preoperatively and 46 definitively. Eighty-three patients (64%) had IIIA disease and IIIB disease was found in the remainder of the patients. Sixty-two patients (75%) in the eligible for surgery group had a thoracotomy after the combined treatment with a resectability rate of 97% and an operative mortality rate of 5%. There were 17 patients (27%) with no evidence of residual cancer in the resected specimen. Three-year survival for the eligible for surgery group at 40% was significantly better than 19% observed in the ineligible for surgery group (p = 0.003). Seventy-six percent of the patients with no residual cancer in the resected specimen are recurrence-free at three years compared to 34% of the patients with gross residual. A total of 81 patients have failed after their treatment; 49 (59%) in the eligible for surgery group and 32 (70%) in the ineligible for surgery group. Of all the patients who failed, local failure alone and as a component occurred in 21 (26%) and 36 (44%) patients, respectively. Failure in distant sites alone was noted in 56% of the overall failures. Severe toxicity was unusual. There were three treatment related deaths (2%). Radiation esophagitis and pneumonitis were only mild to moderate seen in less than 10% of the patients. Survival rates and patterns of failure according to the stage of the disease, histology, treatment group and pathologic response will be presented in detail.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Contrast gain control in the primate retina: P cells are not X-like, some M cells are.

Primate retinal ganglion cells that project to the magnocellular layers of the lateral geniculate nucleus (M) are much more sensitive to luminance contrast than those ganglion cells projecting to the parvocellular layers (P). We now report that increasing contrast modifies the temporal-frequency response of M cells, but not of P cells. With rising contrast, the M cells' responses to sinusoidal stimuli show an increasing attenuation at low temporal frequencies while the P cells' responses scale uniformly. The characteristic features of M-cell dynamics are well described by a model originally developed for the X and Y cells of the cat, where the hypothesized nonlinear feedback mechanism responsible for this behavior has been termed the contrast gain control (Shapley & Victor, 1978, 1981; Victor, 1987, 1988). These data provide further physiological evidence that the M-cell pathway differs from the P-cell pathway with regard to the functional elements in the retina. Furthermore, the similarity in dynamics between primate M cells and cat X and Y retinal ganglion cells suggests the possibility that P cells, being different from either group, are a primate specialization not found in the retinae of lower mammals.

Animals↗
PubMed1992

Neuropsychological and neuroanatomical dimensions of ideomotor apraxia.

Fifty-five right-handed men with left hemisphere stroke were systematically investigated for ideomotor apraxia of various body parts. Standardized aphasia and apraxia examinations in all cases, and appropriately timed CT in 28 cases, were used for analysis of psychological and anatomical properties of ideomotor apraxia. It is not possible to ignore the modality of eliciting the movement (command or imitation) and the body part being moved (buccofacial, limb or whole body) from any comprehensive theory about ideomotor apraxia. Different levels of performance are seen with different body parts to different modalities in different aphasic groups. Some subtypes of ideomotor apraxia (buccofacial) have highly specified anatomical basis. Some (limb) have apparently distributed anatomies, and others (whole body) have as yet unknown bases.

Adult↗
PubMed1992

Distribution of polysaccharide side chains of lipopolysaccharide determine resistance of Escherichia coli to the bactericidal activity of serum.

The lipopolysaccharide (LPS) of serum-sensitive strains of Escherichia coli was compared with LPS derived from serum-resistant clones. Polysaccharide O-antigen side chains (PSSC) of LPS from serum-resistant clones contained 12%-40% more of the longer carbohydrate molecules (L-PSSC) than did LPS from serum-sensitive parent strains; in contrast, 12%-27% more of the shorter PSSC (S-PSSC) were found in LPS from serum-sensitive strains. The sensitivity or resistance to the bactericidal activity of human serum correlated with the distribution and the length of PSSC fractions of LPS. This was demonstrated in a liposome model in which LPS was incorporated into simulated bacterial membranes. The incubation of serum with liposomes incorporated with various ratios of S-PSSC-to-L-PSSC concentrations resulted in liposomal lysis at S-PSSC-to-L-PSSC ratios greater than 2:1. These findings demonstrate the importance of the length of carbohydrate side chains of LPS in determining sensitivity or resistance to the bactericidal activity of human serum.

Blood Bactericidal Activity↗
PubMed1992

Randomized phase II trial of high-dose 4'-epi-doxorubicin + cyclophosphamide versus high-dose 4'-epi-doxorubicin + cisplatin in previously untreated patients with extensive small cell lung cancer.

One hundred and eleven previously untreated patients with extensive small cell lung cancer were included in a prospective randomized study with the aim to assess the efficacy and tolerance of high-dose epirubicin (120 mg/m2) in combination with either cyclophosphamide (800 mg/m2; arm 1) or cisplatin (60 mg/m2; arm 2). Ninety-six patients were evaluable for response and toxicity and additional 12 patients for toxicity only. The overall response rate (CR+PR) in arm 1 and 2 were 61.4 (27/44) and 67.3% (35/52), respectively. The mean duration of remission was 4.4 months (arm 1) and 4.9 months (arm 2). The mean survival time was 6.6 months in arm 1 and 7.7 months in arm 2. WHO grade 4 toxicity was encountered in 25.5 and 15.8% of patients in arm 1 and 2, respectively. One case of cardiotoxicity resulting in the patient's death was observed in arm 1. Both combinations showed considerable antitumor activity. Toxicity was acceptable.

Adult↗
PubMed1991

Medical and judicial perceptions of the risks associated with use of antipsychotic medication.

To determine whether occupational perspective influences the decision to prescribe antipsychotic medications, we presented a group of psychiatrists and judges with a hypothetical case involving a potentially psychotic patient. The subjects were asked what probability of drug-induced tardive dyskinesia they would accept in order to prevent psychotic decompensation. The subjects were then asked to estimate the actual probability that tardive dyskinesia would occur if the patient received antipsychotic medications. From the responses to these questions we inferred their treatment decisions. Although the psychiatrists and judges agreed on an acceptable level of risk, they differed significantly in their estimates of the actual risk involved and, by inference, their decisions concerning treatment. Our findings have several implications for adjudication of cases involving treatment decisions and the right to refuse treatment.

Antipsychotic Agents↗
PubMed1979

[Unusual autoimmune and neoplastic associated diseases in Sjogren's syndrome].

In an unselected series of 12 patients with Sjögren's syndrome the following autoimmune diseases were observed: severe myxedema due to Hashimotos thyroiditis in four, subclinical thyroid hypofunction in one, diffuse hyperthyroidism in one, glomerulonephritis in two, chronic active hepatitis in one, lupus erythematodes disseminatus in three (one with idiopathic thrombocytopenic purpura), classical rheumatoid arthritis in two. A rare familial occurrence was seen in two sisters. The only male in this group exhibited coexistence of a benign adenolymphoma of the parotid gland (Warthin's tumor) with a malignant non-Hodgkin lymphoma.

Adult↗
PubMed1979

Use of a glucose controlled insulin infusion system (artificial beta cell) to control diabetes during surgery.

An artificial beta cell has been used to achieve and maintain a preset plasma glucose concentration in five diabetic patients undergoing surgery. These subjects were compared to control groups of normal subjects receiving either saline or glucose, and diabetics receiving glucose intraoperatively. Hyperglycaemia during surgery was seen in normals (mean plasma glucose +/- SEM: 185 +/- 16 mg/dl) and, to a greater degree, diabetics (247 +/- 36 mg/dl) receiving glucose. Insulin and C-peptide levels did not increase during 2 hours of operation in any of the control groups, suggesting beta cell suppression during surgery. As C-peptide levels declined similarly in normal subjects whether they received saline or glucose, the hyperglycaemia seems to be due to an inability to use exogenous glucose. This is confirmed by a correlation of maximal plasma glucose to glucose infusion rate (r = 0.78, p less than 0.01). The artificial beta cell was able to achieve the same plasma glucose after 2 hours of operation (128 +/- 21 mg/dl) as normal subjects receiving saline (110 +/- 7 mg/dl). The artificial beta cell proved to be a safe, convenient and effective way of monitoring and controlling the hyperglycaemia seen in diabetic patients undergoing surgery.

Blood Glucose↗
PubMed1979

Instrumental analysis of trace elements in thumbnails of human subjects.

Human thumbnails were analyzed for trace elements by instrumental analysis using thermal neutron activation technique. The average concentration of metals studied in clinically symptom-free adult female and male subjects were: zinc, 184 vs. 153 ppm; chromium, 6.8 vs. 4.2; selenium, 0.9 vs. 0.6; gold, 2.6 vs. 0.4; mercury, 1.9 vs. 0.4; silver, 0.7 vs. 0.3; cobalt, 0.07 vs. 0.04. A summary of literature reported concentration of metals in human nail is also presented.

Adult↗
PubMed1979

Effects of dark adaptation on spatial and temporal properties of receptive fields in cat lateral geniculate nucleus.

1. We studied the effect of dark adaptation on the spatial organization of receptive fields of single cells in the lateral geniculate nucleus l.g.n. of the cat. 2. Contrary to previous reports, we found that in many l.g.n. cells the ability of the receptive field surround to suppress the response of the centre was diminished following dark adaptation. 3. The degree of reduction of the surround antagonistic strength varied from cell to cell, and was independent of the various classifications of visual neurones (X/Y, ON/OFF, layer, A/layer, A1 and central/peripheral). 4. Most cells also showed an increase in the apparent size of the excitatory centre upon dark adaptation. On the average, the width of the most effective bar stimulus located at the centre of the receptive field increased more than twofold. 5. We also studied the effect of dark adaptation on the temporal properties of l.g.n. receptive fields. In many cells dark adaptation changed the temporal modulation transfer function: it flattened the amplitude function, and changed the phase relationship between the centre response and the surround response. 6. Retinal ganglion cells showed qualitatively similar behaviour to that of l.g.n. neurones. 7. Our data do not support the notion that retinal ganglion cell centres converge on l.g.n. cells to form their surround mechanism.

Action Potentials↗
PubMed1979

Continuous monitoring and control of plasma glucose during operation for removal of insulinomas.

A glucose-controlled insulin and glucose infusion system (Biostator system, Miles Laboratories Inc., Elkhart, Ind.) was used during operation for removal of four suspected insulinomas. In two patients the Biostator system continuously monitored plasma glucose levels and, through a computer-controlled feedback mechanism, automatically infused insulin or glucose as needed. In this way plasma glucose could be kept at approximately 110 mg/dl throughout the procedure. In one patient a rise in insulin infusion rate and a fall in glucose infusion rate followed removal of the tumor. In the other, absence of these findings was consistent with the clinical suspicion that the source of hypoglycemia had not been removed. In two other patients the Biostator system continuously monitored the patient's plasma glucose, without feedback-controlled administration of insulin or glucose. This demonstrated that, in these patients, tumor manipulation and removal did not lead to severe hypoglycemia, and thus eliminated any need to prophylactically infuse large amounts of glucose. Successful tumor removal was followed by a rise in blood glucose levels in both of these individuals. The glucose-controlled insulin and glucose infusion system appears to be a useful instrument for intraoperative management of patients with suspected insulinomas.

Adenoma, Islet Cell↗
PubMed1978

Gonadal dysgenesis in a phenotypic female with an XY chromosomal constitution.

A phenotypic female with an XY karyotype and pure gonadal dysgenesis is described. Bilateral streak gonads may be found in patients with features of Turner's syndrome and also in phenotypic females without the somatic abnormalities described in Turner's syndrome. Mixed gonadal dysgenesis refers to the presence of a unilateral streak gonad and contralateral testis in a phenotypic female. Dysgenetic gonads are more liable to undergo malignant change, especially in patients with an XY karyotype, and in those with mixed gonadal dysgenesis. Laparotomy and removal of the dysgenetic gonads is indicated in patients with an XY karyotype. If a 46,XX chromosomal pattern is present, the malignant potential is probably less, but laparotomy is still indicated to enable a prognosis to be given regarding fertility.

Adult↗