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Biomedical subjects

E Lerner

Publications and source records attributed to E Lerner.

At least 37 records · Page 2Linked to original sources
PubMed1990

Increasing incidence of cecal and sigmoid carcinoma. Data from the Connecticut Tumor Registry.

We have studied both the distribution and incidence of colorectal cancer using The Connecticut Tumor Registry, the oldest tumor registry in the United States. During the time period 1973 to 1985, left-sided colon cancers accounted for 63% of the cancers, right-sided cancers 33%, and cancers with unspecified sites 4%. Indeed, this pattern of distribution has remained constant for 25 years. For the period 1935 to 1985, we calculated the sex-specific, age-adjusted (normalized to the 1970 U.S. Census) incidence. Age-adjusted incidence of rectal cancer has remained stable for 50 years: for men, 22.8 cases/100,000/year, and for women, 13.9 cases/100,000/year. During these 50 years, the age-adjusted incidence of cecal carcinoma for men has increased from 3.6 to 16.7 cases/100,000/year, while for women, it has increased from 4.9 to 14.2 cases/100,000/year. Sigmoid carcinoma for men has increased from 8.8 to 18.7 cases/100,000/year, and for women, it has increased from 7.7 to 12.8 cases/100,000/year. The incidence of colon cancer at each site has been and continues to be increasing at a constant rate. Age-adjusted incidence for all colorectal cancers has increased from 35.2 to 70.2 cases/100,000/year for men and from 32.1 to 49.2 cases/100,000/year for women. Thus, distribution of colorectal cancers by site in Connecticut has remained stable for 25 years. More importantly, however, the age-adjusted incidence of colon cancer has continued to increase for 50 years, whereas that of rectal cancer has remained relatively stable.

Cecal Neoplasms↗
PubMed1990

Feasibility spectrum for Doppler flowmetry of splanchnic vessels. In normal and cirrhotic populations.

The calculation of absolute blood flow by Doppler flowmetry requires adequate visualization of a vessel in both transverse and longitudinal planes and an insonating angle less than 60 degrees. The percentage of the splanchnic vessels in a given population in which these criteria could be fulfilled (ie, the feasibility spectrum) is not known. To identify this spectrum in our patient sample, 100 consecutive nonselected patients (58 female, 42 male) and 34 cirrhotics (31 male, three female) were prospectively studied. In addition, from the group of 42 nonselected patients, 31 males with no evidence of liver disease were matched for age, weight, and height with the 31 male cirrhotics. The echo-Doppler feasibility (EDF; success percentage) was determined for the hepatic, superior mesenteric, and splenic arteries and portal, superior mesenteric, and splenic veins. In the nonselected sample, the EDF varied from 86% for the portal vein to 60% for the superior mesenteric artery. In cirrhotics, the EDF ranged from 88% for portal vein to 29% in splenic artery. The total EDF for the nonselected sample (68%) was significantly higher than the EDF for cirrhotics (54%; P less than .001). Physical factors (weight, age, height, and sex) affected the EDF in the nonselected patient sample but not in cirrhotics. We conclude that analysis of EDF of splanchnic vessels in these groups clearly demonstrates that the composition of the patient sample has an important bearing on the feasibility spectrum of Doppler study. Female subjects who are thin, young, and short and lighter male patients are better candidates for abdominal Doppler flowmetry.

Adolescent↗
PubMed1989

A comparison of pregnancy outcome in overweight and normal weight women.

From a population of singleton pregnancies, 152 overweight women (greater than 110% of standard) were matched with normal weight women (95-110%) for age, height, parity, race, and smoking habits. Comparisons were made of initial weight (weight at the first prenatal visit) and gestational weight gain and pregnancy outcome. Mean birth weights and gestational ages of infants of normal and overweight women were not significantly different. For normal weight women birth weight increased significantly as height, initial weight, and body mas index increased (p less than 0.01), but no such relationship existed for overweight women. The lack of effect of initial weight on birth weight in overweight women is attributable, in part, to the significantly less gestational weight gains of these mothers (6.3 kg vs 8.2 kg). When normal and overweight gravida had gestational weight gains of less than 7 kg, offspring of overweight mothers were significantly heavier. Gestational weight gain was positively correlated with birth weight for both normal (p less than 0.0001) and overweight women (p less than 0.001). Within the overweight and normal weight groups, smokers had lower initial weights and gestational weight gains than nonsmokers. Offspring of normal weight smokers had a mean birth weight 232 g less than that of nonsmokers (p less than 0.01). The difference in birth weight between overweight smokers and nonsmokers (135 g) was not statistically significant. While there is substantial data to support a weight gain of 10-12 kg in normal weight gravida, it would appear that a gain of approximately 7 kg in overweight middle class women does not impair fetal growth as measured by birth weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Weight gain and pregnancy outcome in underweight and normal weight women.

The relationship of antenatal weight gain to pregnancy outcome was studied in 362 pairs of underweight women (less than 90% Metropolitan Relative Weight) and normal weight (90% to 110%) women who were matched for age, occupation, height, parity, race, and smoking habits. The mothers, selected from a study of pregnancy outcome in 1,080 middle-class women, had early and regular prenatal care. Regression analyses within each initial weight category revealed that there was no relationship between initial weight of mothers and birth weight of their infants, but birth weight increased significantly with antenatal weight gain (p less than .0001). A 1-kg maternal increase in weight was associated with a 12.85-gm increase in birth weight in offspring of underweight women and an 8.59-gm increase in offspring of normal weight women. Underweight women had significantly larger prenatal weight gains (9.3 vs. 8.5 kg), but there were no statistically significant differences in mean birth weight, gestational age, or Apgar scores between infants of women in the two weight groups. Very underweight women (less than 80% MRW) had lower-birth-weight infants, more preterm infants, and more infants with medical complications. Antenatal weight gain accounted for the greatest variation in birth weight among infants of underweight and normal weight women. When underweight mothers gained less than 9 kg, their infants had mean birth weights 361 gm less than the mean birth weights of infants of underweight women who gained more weight.

Adult↗
PubMed1988

Feeding patterns of urban black infants.

Feeding patterns of 116 urban black infants were studied from 3 weeks to 6 months of age. Dietary data were collected using a diet history and a food frequency checklist completed by trained interviewers at each well child clinic visit at 3 weeks and at 2, 4, and 6 months of age. At 3 weeks, 20% of the infants were solely breast fed, 58% were formula fed, and 22% were partially breast fed. Twenty percent of 3-week-old infants were receiving baby foods. This increased to 48% at 2 months, and to 72% at 4 months. By 6 months of age, 98% of infants received baby foods. Nursing mothers tended to introduce baby foods later than formula-feeding mothers. This is consistent with other studies. Commercially prepared baby foods were used much more commonly than were foods prepared at home. Infant cereal was most often introduced first, followed by strained juices, strained fruits, strained vegetables, combination dinners, desserts, and plain meats, in that order. Table foods contributed very little to caloric intakes of infants less than 4 months of age. Liberal amounts of water and sugar water were given to infants in this cultural group.

Adult↗
PubMed1987

Effects of cyclosporine on chronic cytomegalovirus infection in the guinea pig.

Following establishment of chronic guinea pig cytomegalovirus (GPCMV) infection, animals received by gavage either cyclosporine (CS), 20-33 mg/kg, or drug vehicle daily for 28 days. At sacrifice the frequency of CMV isolation from tissues of GPCMV-infected animals was 20% for the immunosuppressed group versus 12% for controls (difference, NS). GPCMV isolation rates from lymphoid tissues (thymus, spleen, cervical lymph nodes) of experimental animals was 7 of 69 (10%) vs. 0 of 42 (0%) from controls (p less than 0.05). Although CS immunosuppression was associated with increased rates of GPCMV isolation from lymphoid tissues of chronically infected animals, it was not accompanied by detectable systemic disease.

Animals↗
PubMed1987

Factors that influence the outcome of pregnancy in middle-class women.

A retrospective analysis was made of 1,080 singleton pregnancies of middle-class women to identify factors that influence outcome as measured by birth weight, gestational age, Apgar scores, and the incidence of complications. Increased birth weight was associated with increases in weight gain, maternal age, gestational age, maternal initial body weight, maternal hemoglobin and hematocrit values at 3 months, hemoglobin levels at 7 months, and socioeconomic status. For women whose initial weights were 90% to 135% of the standard, highest birth weights occurred when weight gains exceeded 29 lb. A 1 lb gain in maternal weight was associated with a 6 gm increase in birth weight. Birth weight was negatively correlated with a complicated obstetrical history and maternal cigarette smoking. Infants of heavy smokers weighed an average of 156 gm less than infants of nonsmokers. One-minute Apgar scores were significantly lower for infants of mothers who consumed alcohol and those who had had a complicated obstetrical history. Initial maternal weight and the husband's occupation positively influenced gestational age. There was no relationship between the incidence of maternal or infant complications and independent variables.

Adolescent↗
PubMed1986

Predictors of outcome in massive upper gastrointestinal hemorrhage.

We reviewed 100 consecutive cases of massive upper gastrointestinal hemorrhage (UGIH). The criteria for inclusion were a decrease in hematocrit greater than or equal to 6%, unstable vital signs, and greater than or equal to units of blood transfused (16 +/- 18 units, mean +/- SD). A multiple regression analysis of 96 variables was employed to determine the most accurate predictors of outcome. The overall mortality was 35%. Hospital status (whether the patient was an inpatient or outpatient when the UGIH began) showed a striking association with mortality (70% for inpatients vs. 22% for outpatients, p less than 0.001). Nonsurvivors also had a greater number of life-threatening diseases than survivors (1.4 +/- 1.1 vs. 0.3 +/- 0.5, p less than 0.001) and greater transfusion requirements (27 +/- 20 units vs. 10 +/- 13 units, p less than 0.001). Age, the presence of cirrhosis, and recent excessive alcohol intake were not important risk factors. At presentation, the most reliable predictor of a fatal outcome was the brevity of the interval between the onset of bleeding and the initiation of a medical work-up. The primary predictor when considering the entire hospitalization was the number of life-threatening diagnoses. Our data indicate that stratification for hospital status and for other potentially predictive risk factors should be incorporated in future trials of therapy for UGIH.

Aged↗
PubMed1985

Demographic study of clinically atypical (dysplastic) nevi in patients with melanoma and comparison subjects.

We examined 296 patients with a history of melanoma and 145 controls for the presence of atypical (dysplastic) nevi. We found that 34% of patients with melanoma and 7% of controls had clinically atypical (dysplastic) nevi. Patients and controls with atypical (dysplastic) nevi had more nevi than the subjects without. The number of nevi varies negatively and significantly with age (r = 0.37, P less than 0.001). Ten % of patients and controls had hypopigmented halos around one or more nevi. Both patients and comparison subjects with atypical (dysplastic) nevi tended to have this subtle variant of halo nevi more often than those without (r = 0.17, P less than 0.01). The number of nevi on the irides of melanoma patients was greater than that in the comparison group. The results of this study suggest that patients with a melanoma exhibit more commonly cutaneous and ocular pigmentary lesions than comparison subjects without a melanoma.

Adolescent↗
PubMed1983

Effects of metoclopramide and bethanechol on delayed gastric emptying present in gastroesophageal reflux patients.

Gastric emptying has been reported to be delayed in a significant percentage of patients with gastroesophageal reflux. The rationale for the use of metoclopramide and bethanechol in gastroesophageal reflux has been based on their ability to stimulate lower esophageal sphincter pressure and enhance acid clearance mechanisms. In this study, we investigated the comparative efficacies of metoclopramide and bethanchol in improving the rate of gastric emptying in gastroesophageal reflux patients in whom delayed emptying was present. Gastric emptying studies used an isotope-labeled mixed solid-liquid meal. Thirteen reflux patients with delayed gastric emptying received metoclopramide, 10 mg intramuscularly, and subcutaneous bethanechol, 0.07 mg/kg, in a randomized single-blind fashion. Eleven additional reflux patients with delayed gastric emptying received oral metoclopramide, 10 mg, in an open-labeled fashion. After parenteral metoclopramide, gastric emptying was significantly (p less than 0.05) faster compared with both the initial basal day and the bethanechol treatment day. Compared with the normal gastric emptying rate established in 26 control subjects, metoclopramide accelerated gastric emptying into the normal range. Bethanechol did not increase gastric emptying. Metoclopramide orally also significantly improved gastric emptying. Our study indicates that metoclopramide, both parenterally and orally, increased the rate of gastric emptying in those reflux esophagitis patients in whom it was delayed, while bethanechol did not improve the degree of gastric retention in the same patients. Our results extend the rationale for the therapeutic efficacy of metoclopramide in gastroesophageal reflux disease.

Bethanechol↗
PubMed1983

Molecular and antigenic nature of isolated Sm.

The Sm antigen was isolated and purified from calf thymus nuclear extract by affinity chromatography. The affinity columns were made with serum antibodies from an SLE patient or an anti-Sm monoclonal antibody derived from a hybridoma cell line. Proteins eluted from these two columns had m.w. of 58,000 and 35,000 by SDS polyacrylamide gel electrophoresis. The natural conformation of this antigen appears to be 95,000 in m.w. with the 58,000 particle containing the Sm antigenic determinant. The affinity column-purified antigen detected by the human anti-Sm antibodies is also recognized by anti-Sm antibodies in murine lupus serum, as shown by solid-phase radioimmunoassay. This study 1) demonstrates the molecular and antigenic nature of the Sm antigen and 2) compares the anti-Sm binding capabilities of antibody populations present in sera from SLE patients and from MRL lpr/lpr mice.

Animals↗
PubMed1981

A humoral factor in the plasma of dogs with hemorrhagic hypotension causing histopathologic changes when infused into normals.

The presence of circulating factors in the plasma of shocked dogs which would be capable of causing lung lesions when infused into normotensive dogs was demonstrated by light and electron microscopy. Light microscopy only identified significant differences in atelectasis, vascular congestion, and interstitial edema in the shock and shock-plasma recipient animals. On electron microscopy, interstitial edema and disruption of collagen bundles were consistently found in shocked dogs and in dogs that had received shocked plasma. There was a consistent increase in pulmonary interstitial sodium in both shock and shock-plasma recipient groups. It is concluded that a plasma factor present in the serum of shocked dogs may be transferred to other dogs and cause histopathologic changes seen in the lungs of shocked animals.

Animals↗
PubMed1981

Gastric emptying in patients with gastroesophageal reflux.

Delayed gastric emptying of liquids and/or solids was hypothesized as a mechanism which could increase the volume of gastroduodenal contents and could contribute to the pathogenesis of gastroesophageal reflux. Gastric emptying of an isotope-labeled mixed solid-liquid meal was compared in a study of 20 age-matched gastroesophageal reflux patients and 20 normal subjects whose sex distribution and weight were similar; and also in a study of 100 reflux patients and 26 normals. The 20 GER patients emptied isotope from the stomach at a slower rate than age-matched normals at 30 min (p < 0.10); 60 min (p < 0.05, one-tailed t-test); and 90 min (p < 0.05). Using the range established from 26 normal subjects for percent of isotope remaining in the stomach after 90 min (mean +/- 2 SD), 53% of the 100 reflux patients evaluated were within the "normal" range of the controls; 41% had delayed gastric emptying exceeding the upper limit of isotope retention; and 6% emptied isotope rapidly. The means for LES pressure, age, and weight among the slow and "normal" emptying reflux esophagitis patients were similar. Based on the composition of the test meal, it is hypothesized that motor functions of the stomach may be abnormal in a high percentage (41%) of GER patients. The results also suggest a rationale for employing agents which enhance gastric emptying in the therapeutic approach to gastroesophageal reflux.

Adult↗
PubMed1980

Effect of portacaval anastomosis on hypersplenism.

Leukopenia, thrombocytopenia, and hemolytic anemia occur commonly in advanced cirrhosis. Some investigators have reported that portacaval anastomosis (PCA) abolished hypersplenism while others have not found PCA to be uniformly beneficial. We compared the frequency of hypersplenism before and after admission to a controlled investigation of the effects of PCA in 52 unoperated control subjects and 38 patients with patent PCA. The two groups were followed for an average period of 5 1/2 years. On admission to the study leukopenia was present in about 2% of patients, thrombocytopenia in 6%, and hemolytic anemia in 4%. Splenomegaly was present in 48% and hypersplenism in 11%. After randomization splenomegaly disappeared more frequently in the shunted group. In addition, fewer patients with PCA developed splenomegaly for the first time after inclusion into the study than did unoperated control subjects. Leukopenia, thrombocytopenia, and hemolytic anemia, when present at inclusion into the study, disappeared with equal frequency in the shunted and unshunted patients, and appeared with equal frequency in both groups after randomization in previously unaffected patients. In no instance was hypersplenism clinically significant nor was splenectomy considered or carried out in any of these 90 patients. In additional uncontrolled studies we observed that therapeutic PCA did not affect hypersplenism differently from prophylactic PCA. We conclude that PCA has neither clinically nor statistically significant effects on hypersplenism.

Anemia, Hemolytic↗
PubMed1979

Analysis of ascitic fluid in cirrhosis.

In order to determine the composition of "normal" ascitic fluid, the results of analysis of the first paracentesis on 347 consecutive cirrhotic patients with ascites at the West Haven Veterans Administration Hospital between 1955 and 1976 were examined. The ascites was considered "normal" in 259 patients. Bacterial peritonitis was present in 51, malignant ascites in 18, pancreatitic ascites in 15, and ascites of other types in 4 patients. Normal ascites is sterile, usually clear, and contains 281 +/- 25 leukocytes/mm3 (mean +/- SEM), 27 +/- 2% of which are polymorphonuclear. In spontaneous bacterial peritonitis the fluid is usually cloudy, contains 6084 +/- 858 white blood cells/mm3, 77 +/- 4% of which were PMN and culture is positive for a single bacterial species, usually enteric in origin. Malignant and pancreatitis ascites are sterile, often cloudy, and contain an average of 696 +/- 273 and 1821 +/- 833 leukocytes/mm3, respectively, about half of which are polymorphonuclear. Amylase activity is increased in pancreatitic ascites, but not in other types of ascites. Stained smears of sediment for bacteria are often positive in bacterial peritonitis, but not in the other categories. Neither the specific gravity, protein concentration, nor glucose level is useful in the differential diagnosis of ascites. Based on the critical number of leukocytes alone, (500/mm3), one can accurately differentiate infected from uninfected fluid in over 90% of ascitic patients.

Amylases↗
PubMed1978

The yale cervical orthosis: an evaluation of its effectiveness in restricting cervical motion in normal subjects and a comparison with other cervical orthoses.

The Yale cervical orthosis is a lightweight polyethylene foam Philadelphia collar with molded fiberglass extensions over the thorax. This orthosis was studied on 17 normal subjects in the extremes of the ranges of flexion, extension, rotation, and lateral bending using roentgenograms and axial photographs to assess how effectively it limited motion of the neck. Overall, it satisfactorily controlled cervical motion and was similar to the most effective rigid cervical orthoses. Flexion and extension ranges were compared at different segmental levels of the spine. The Yale orthosis was most successful in restricting flexion in the area of the middle and lower cervical spine and was acceptable in controlling extension range. The orthosis was least effective in controlling motion in the upper spine, particularly at the atlantoaxial articulation. The Yale orthosis is recommended for postsurgical protection of the middle and lower cervical spine and in select situations of spinal instability, but it is not recommended for control of odontoid fractures or atlantoaxial subluxation.

Adult↗