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Biomedical subjects

E S Feldman

Publications and source records attributed to E S Feldman.

13 recordsLinked to original sources

Prognostic factors and patterns of treatment failure in dogs with unresectable differentiated thyroid carcinomas treated with megavoltage irradiation.

OBJECTIVE: To determine quality and duration of progression-free survival (PFS) time in dogs with unresectable thyroid carcinomas treated with definitive megavoltage irradiation and analyze prognostic factors of PFS and patterns of failure (local recurrence vs metastasis). DESIGN: Prospective clinical trial. ANIMALS: 25 dogs with locally advanced thyroid carcinomas and no evidence of metastasis. PROCEDURE: Dogs were treated with 48 Gy during 4 weeks on an alternate-day schedule of 4 Gy/fraction. RESULTS: Irradiation was safe and effective for treatment of large unresectable thyroid carcinomas. Progression-free survival rates were 80% at 1 year and 72% at 3 years. Time to maximum tumor size reduction ranged from 8 to 22 months. Factors affecting PFS were not found. Twenty-eight percent (7/25) of dogs developed metastasis. Dogs with bilateral tumors had 16 times the risk of developing metastases, compared with dogs with a single tumor. Dogs with no evidence of tumor progression had 15 times less risk of developing metastases. Radiation-induced hypothyroidism was suspected in 2 dogs 13 and 29 months after irradiation. CONCLUSIONS AND CLINICAL RELEVANCE: Irradiation is effective for local control of thyroid tumors, despite their slow regression rate. Results provided evidence that local tumor control affects metastatic outcome in dogs with thyroid carcinomas and is a strong basis for the development of new approaches that include irradiation in the management of dogs with advanced thyroid carcinomas. Improvements in local tumor control alone may be insufficient to improve survival times because of the high risk of metastatic spread before an initial diagnosis is made, which warrants initiation of early systemic treatment.

Animals↗

Approach to neurotoxicity tort cases.

This article provides the neurologist with simple methods that can be applied to all clinical neurologic evaluations, regardless of the future potential for litigation. This article defines the appropriate application and interpretation of conventional neurologic, neurophysiologic, neuropsychological, and biochemical diagnostic tests that are sensitive to neurotoxic exposures. This article also provides the neurologist with guidance in the preparation of clinical findings and tips on the recognition and use of supportive literature that is often required for admissibility of evidence at a deposition or testimony.

Algorithms↗

Transport in vitro fertilization and intracytoplasmic sperm injection: results of a collaborative trial.

OBJECTIVE: To determine whether the use of a central assisted reproduction laboratory, with gamete transport to the facility (transport assisted reproduction), would decrease oocyte quality or performance in IVF-ET and intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective clinical study. SETTING: Public and private fertility clinics. PATIENT(S): A total of 467 couples underwent transport IVF, whereas 108 underwent transport ICSI. A group of 60 couples underwent conventional IVF during the same period. All methods and protocols used were similar among centers. Oocyte pick-up was performed by ultrasound-guided vaginal puncture. INTERVENTION(S): Oocytes were transported under controlled conditions, from the site of follicular aspiration to a central laboratory. MAIN OUTCOME MEASURE(S): The fertilization and cleavage rates and clinical pregnancies were compared among the study populations. RESULT(S): The differences between the fertilization and cleavage rates of ova and the rates of clinical pregnancies produced by transport and conventional methods were not statistically significant. CONCLUSION(S): Gamete transport to a central laboratory was not harmful for oocytes or for the outcome of assisted reproduction. Transport makes the use of IVF and ICSI available to physicians who are not affiliated with an assisted reproduction program, reduces costs, and increases acceptability of the procedures to patients.

Adult↗

Hepatic mitochondrial oxidative metabolism and lipid peroxidation in experimental hexachlorobenzene-induced porphyria with dietary carbonyl iron overload.

Both human porphyria cutanea tarda and experimental hexachlorobenzene-induced porphyria are associated with hepatic injury and are potentiated by excess hepatic iron. The mechanisms whereby cellular injury occurs and the synergistic role of iron overload are unknown. In the present experiments, we studied hepatic mitochondrial function and lipid peroxidation in rats with hexachlorobenzene-induced porphyria in which iron loading was achieved by dietary carbonyl iron supplementation. Female rats were treated for 8 weeks, receiving a chow diet supplemented with hexachlorobenzene (0.2%, w/w), carbonyl iron (1.0%, w/w) or hexachlorobenzene + iron. Hepatic total porphyrins were increased 100-fold in rats receiving hexachlorobenzene (hexachlorobenzene alone and hexachlorobenzene + Fe), and total hepatic iron was increased approximately 10-fold in rats receiving iron supplementation (Fe alone and hexachlorobenzene + Fe). There was a significant increase in mitochondrial lipid peroxidation in rats treated with hexachlorobenzene alone and hexachlorobenzene + Fe. A significant reduction in mitochondrial respiratory control ratios and in oxidative phosphorylation (ADP/O ratios) using glutamate and succinate as substrates was demonstrated when rats were treated with hexachlorobenzene + iron. The reductions in respiratory control ratios were due to a combination of an inhibitory defect in electron transport as evidenced by an irreversible decrease in State 3 respiration and an uncoupling effect as evidenced by an increase in State 4 respiration. These findings suggest that lipid peroxidation and mitochondrial dysfunction may contribute to the hepatotoxicity seen in hexachlorobenzene-induced porphyria.

Animals↗

The physical fitness of elderly Nepalese farmers residing in rugged mountain and flat terrain.

This paper reports the results of a natural experimental test of the hypothesis that elderly residents of rugged terrains are more physically fit than their counterparts in flat terrains due to the additional lifelong daily exertion occasioned by the inescapable need to walk up and down steep slopes. Cycle ergometer tests of physiological response to work were undertaken by two groups of high caste Hindu male farmers, aged 50 to 79, living in Central Nepal. One comprised an experimental group resident in rugged terrain and the other a control group resident in flat terrain. No differences in heart rate and blood pressure measured at submaximal workloads, at peak effort, or during recovery from exercise were demonstrated. Measurements of physical exertion revealed that few people in either terrain engaged in activity sufficiently strenuous to raise heart rates to a level where training could occur. Despite a rural agricultural lifestyle, these men were not especially physically fit.

Aged↗

Social structure and intracohort variation in physical fitness among elderly males in a traditional Third World society.

This paper examines the relationship between physical fitness and activity among elderly males in the traditional rural community of Chetbesi, Nepal. It takes advantage of the unique character of the Hindu caste system to implement a quasiexperimental research design that approximates random assignment to high and low activity levels. The members of the Sarki caste have lower heart rates and systolic blood pressure, relative to other castes, at each of three submaximal workloads and during recovery from bicycle ergometer exercise. Direct observation and physiologic monitoring show that the Sarkis engage in more frequent and extended periods of heavy labor. Thus intracohort variation in physical fitness and activity patterns among the Chetbesi elderly is a function of birth into a socially defined group rather than of self-selection. This pattern of differential fitness may typify the process of aging in many stratified traditional and modernizing societies where socially delimited segments of the population perform the bulk of the hard work. Intrapopulation differences aside, comparison of Sarkis and non-Sarkis with other samples reveals that both lie within the reported range of variation. The rural, unmechanized, agricultural lifestyle and mountain environment of Chetbesi do not result in exceptional fitness for residents. The Chetbesi data suggest that the popular notion that aging is less debilitating in traditional agrarian societies located in rugged mountain terrains may be a myth. The demonstration of the influence of social forces on physical fitness suggests that future research might concentrate profitably on identifying social structures that produce high levels of physical fitness.

Aged↗

Magnetic-susceptibility measurement of human iron stores.

We made direct noninvasive magnetic measurements of hepatic iron stores with a specially designed superconducting quantum-interference-device (SQUID) susceptometer in 20 normal subjects and in 110 patients with liver disease, iron deficiency, hereditary hemochromatosis, or transfusional iron overload. Magnetic in vivo measurements of liver non-heme iron were closely correlated with chemical in vitro measurements in liver-biopsy specimens (r = 0.98, P less than 10(-5) up to 115 mumol per gram of liver tissue (wet weight) or more. Magnetically determined storage-iron concentrations were below 6.0 mumol per gram in iron-deficient patients and normal men and premenopausal women, but they were raised (9.7 to 31.4 mumol) in 12 of 67 patients with liver disease and were greatly increased (22.9 to 117.7 mumol) in patients with untreated hereditary hemochromatosis or transfusional iron overload. Magnetic measurements of iron stores provide a new quantitative technique for early detection of hereditary hemochromatosis and for rapid evaluation of treatment regimens for transfusional iron overload.

Female↗

Comparative tissue absorption of oral 14C-aspirin and topical triethanolamine 14C-salicylate in human and canine knee joints.

The local, articular, and systemic absorption of oral and topical salicylates was studied in dogs and humans using radioisotope techniques. Topical triethanolamine 14C-salicylate was found capable of percutaneous absorption into the knee joint and surrounding tissues. In dogs, topical salicylate application resulted in higher salicylate concentrations than oral aspirin in a number of tissues, despite lower blood levels. In patients with rheumatoid arthritis, intraarticular 14C-salicylate levels after triethanolamine 14C-salicylate cream were 60 per cent of those obtained with oral aspirin. Four of six patients reported equal improvement in local discomfort after oral and topical salicylates. A potential role for topical salicylate cream in the treatment of localized rheumatic disorders is suggested.

Absorption↗