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Biomedical subjects

G S Cooper

Publications and source records attributed to G S Cooper.

At least 109 records · Page 6Linked to original sources
PubMed1994

Central nervous system Whipple's disease: relapse during therapy with trimethoprim-sulfamethoxazole and remission with cefixime.

The central nervous system (CNS) is frequently involved in patients with Whipple's disease and is the most common site of disease relapse. Antibiotics such as trimethoprim-sulfamethoxazole (TMP-SMX) that have reliable CNS penetration, are therefore recommended as first-line therapy. We report a patient with Whipple's disease who was treated with TMP-SMX and presented 14 months after initiation of therapy with visual decline and severe headaches. The patient was also treated concurrently with low-dose weekly methotrexate for severe psoriasis. Evaluation by magnetic resonance imaging revealed bilateral posterior white matter abnormalities that pathologically were consistent with Whipple's disease. He was ultimately treated with cefixime, an orally administered third-generation cephalosporin. Visual function improved on this regimen and follow-up magnetic resonance imaging showed regression of the lesions. This case represents the first report of both CNS relapse during therapy with TMP-SMX and successful treatment with cefixime. We also speculate that methotrexate, which impairs cell-mediated immunity, may have contributed to the relapse.

Cefixime↗
PubMed1994

Intraabdominal infection: differences in presentation and outcome between younger patients and the elderly.

Although the elderly account for a disproportionate number of patients with intraabdominal infections, few studies have compared these patients with younger patients in terms of presentation and outcome. Therefore, we conducted a retrospective cohort study of 131 patients at an urban university hospital that included 88 patients (67%) < or = 65 years of age and 43 (33%) > 65 years of age, all of whom had culture-proven intraabdominal infections. Geriatric patients presented more frequently without the typical symptoms and signs of abdominal pain, nausea and vomiting, diarrhea, and fever and had symptoms for a longer period before presentation. Diagnosis on admission was more often unknown or considered to be of an extraabdominal nature for the elderly patients, and sources of infection were more commonly biliary or pancreatic. Mortality was not significantly different between the groups, but length of stay and duration until normalization of body temperature were longer for the older patients. We concluded that elderly patients with intraabdominal infections frequently present atypically and have a more-protracted course of illness than their younger counterparts.

Abdominal Abscess↗
PubMed1994

Galactose consumption, metabolism, and follicle-stimulating hormone concentrations in women of late reproductive age.

OBJECTIVE: To test the hypothesis that high galactose consumption and low activity of galactose-1-phosphate uridyl transferase (transferase) is associated with early ovarian senescence among nongalactosemic women. DESIGN: Cross-sectional study. Data collection consisted of a self-administered questionnaire with sections on diet (food frequency data to measure galactose consumption), reproductive, and medical histories. One blood sample was collected to measure FSH and transferase activity; FSH was used as a measure of ovarian senescence. Among women who were having menstrual periods at least every 8 weeks, the blood sample was drawn in the early follicular phase (days 2 to 4) of a menstrual cycle. PARTICIPANTS: Two hundred ninety-five women volunteers ages 38 to 49 years who had not had a hysterectomy or oophorectomy were recruited through posters and advertisements. MAIN OUTCOME MEASURE: Serum FSH concentrations. RESULTS: Controlling for age, smoking, and body mass, transferase activity and FSH were unrelated. However, FSH levels were 29% higher (95% confidence intervals, 9% to 52%) among women who reported consuming > or = 6 g galactose/d. CONCLUSION: These data do not support the hypothesis that low transferase activity represents a genetic predisposition for early ovarian senescence, as measured by FSH levels in women ages 38 to 49 years. However, the hypothesized positive association between galactose consumption and FSH was supported.

Adult↗
PubMed1994

Indications and contraindications for upper gastrointestinal endoscopy.

Upper endoscopy is currently one of the most frequently performed procedures. The most common indications for diagnostic EGD include dyspepsia unresponsive to medical therapy or associated with systemic signs, dysphagia or odynophagia, persistent gastroesophageal reflux symptoms, occult gastrointestinal bleeding, and surveillance for malignancy. These guidelines, however, are largely based on consensus opinion, and few controlled trials have evaluated the effect of endoscopy on patient outcome, medical expenditures, and management. It appears that the benefits of therapeutic upper endoscopy for such conditions as acute gastrointestinal bleeding, foreign-body removal, and stricture dilatation are more well defined. Future studies should be directed at the most cost-effective and beneficial management strategies for many of these common conditions.

Contraindications↗
PubMed1993

Management of gallstones in diabetic patients.

The management of gallstones in diabetic patients has traditionally been considered problematic. Autopsy findings and uncontrolled studies have documented a higher prevalence of cholelithiasis in diabetics, and early reports showed dramatically increased perioperative morbidity and mortality for treatment of diabetics with acute cholecystitis. As a result, some authorities have recommended prophylactic cholecystectomy for diabetic patients with asymptomatic gallstones, which is in contrast to recommendations for nondiabetics. More recent investigators have shown comparable rates of operative morbidity and mortality for biliary surgery in diabetics when compared with the general population. Recent studies have questioned whether diabetes is an independent risk factor for gallstone formation. Decision analyses using these new data have shown that prophylactic cholecystectomy is not of clear benefit and should not be routinely recommended for diabetics with asymptomatic gallstones. We believe that available data, although limited, indicate that asymptomatic patients with diabetes do not benefit from screening for gallstones and that cholecystectomy should only be performed in cases of symptomatic cholelithiasis, as is the case in the general population.

Age Factors↗
PubMed1992

How well do internal medicine faculty members evaluate the clinical skills of residents?

OBJECTIVE: To determine the accuracy of faculty evaluations of residents' clinical skills and whether a structured form and instructional videotape improve accuracy. DESIGN: Randomized, controlled trial. SETTING: Twelve university and community teaching hospitals. PARTICIPANTS: A total of 203 faculty internists. INTERVENTIONS: Participants watched a videotape of one of two residents performing new patient workups. Participants were assigned to one of three groups: They used either an open-ended evaluation form or a structured form that prompted detailed observations; some participants used the structured form after seeing a videotape showing good evaluation techniques. MAIN OUTCOME MEASURES: Faculty observations of strengths and weaknesses in the residents' performance were scored. An accuracy score consisting of clinical skills of critical importance for a competent history and physical examination was calculated for each participant by raters blinded to the participants' hospital, training, subspecialty, and experience as observers. RESULTS: When observations were not prompted, participants recorded only 30% of the residents' strengths and weaknesses; accuracy among participants using structured forms increased to 60% or greater. Faculty in university hospitals were more accurate than those in community hospitals, and general internists were more accurate than subspecialists; the structured form improved performance in all groups. However, participants disagreed markedly about the residents' overall clinical competence: Thirty-one percent assessed one resident's clinical skills as unsatisfactory or marginal, whereas 69% assessed them as satisfactory or superior; 48% assessed the other resident's clinical skills as unsatisfactory or marginal, whereas 52% assessed them as satisfactory or superior. Participants also disagreed about the residents' humanistic qualities. The instructional videotape did not improve accuracy. CONCLUSIONS: A structured form improved the accuracy of observations of clinical skills, but faculty still disagreed in their assessments of clinical competence. If program directors are to certify residents' clinical competence, better and more standardized evaluation is needed.

Clinical Competence↗
PubMed1992

Gastrointestinal involvement in L-tryptophan (L-Trp) associated eosinophilia-myalgia syndrome (EMS).

We report a 45-year-old female who had symptomatic gastrointestinal involvement, eosinophils in the cellular infiltrate, and who proved to have L-tryptophan-associated eosinophilia-myalgia syndrome. This case illustrates that gastrointestinal disease can be a major, seemingly primary clinical presentation in this syndrome, and that a drug history, specifically L-tryptophan, needs to be included in the differential diagnosis of "eosinophilic gastroenteritis."

Biopsy↗
PubMed1990

Polymicrobial bacteremia in the late 1980s: predictors of outcome and review of the literature.

Although polymicrobial bacteremia has been described in several previous series, there has been no recent study of patients using rigorous statistical analysis. Our objective was to characterize a present-day patient population with polymicrobial bacteremia and to define factors prognostic of survival. Polymicrobial bacteremia accounted for 6% of all positive blood cultures at a university hospital and a Veterans Administration hospital over a 2 1/2 year period in the late 1980s. The majority of these patients were elderly with significant underlying diseases, notably malignancies, and 56% of all episodes were nosocomially acquired. Enterobacteriaceae have remained the most common organisms, though the frequency of gram-positive cocci isolated has increased compared to older studies. Gastrointestinal, genitourinary, and skin and soft-tissue sources were the most common, although the incidence of infections due to central venous catheters appeared to be increasing. The source of 25% of bacteremia was not identified despite newer diagnostic techniques. By univariate analysis, mortality, which was 36% overall, correlated with thrombocytopenia, respiratory failure, disseminated intravascular coagulation, encephalopathy, severity of underlying disease, hemolysis, adult respiratory distress syndrome, use of steroids, renal insufficiency, institution, presence of central lines, and nosocomial acquisition. Using stepwise logistic regression analysis, mortality was predicted by respiratory failure, severity of underlying disease, and hemolysis. We conclude that polymicrobial bacteremia remains an important entity in the present-day hospitalized population, with an increasing frequency of gram-positive organisms and catheter sources, and a large proportion of undiagnosed etiologies.

Humans↗
PubMed1987

Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success.

Radiologically guided balloon catheters were used to dilate 94 gastrointestinal strictures in 92 patients over a 6-year period. Fifty strictures were esophageal and 44 nonesophageal (22 gastroenterostomies, 11 antral-pyloric strictures, four colorectal strictures, four enteroenterostomies, and three miscellaneous strictures). Factors influencing the success of stricture intubation included patient age, stricture location (esophageal vs. nonesophageal and proximal vs. distal esophageal), and association with a surgical anastomosis. Malignancy was associated with greater postdilation irregularity and a smaller increase in stricture diameter, as measured radiographically. Procedural failures occurred in 8% of cases (2% of esophageal and 30% of nonesophageal lesions). Two small, asymptomatic mucosal tears were seen after dilation (one esophageal and one colonic); no other procedural complications occurred. Following successful dilation, 16 patients (17%; six with esophageal and ten with non-esophageal strictures) had recurrence of symptoms during short-term (30-day) follow-up.

Constriction, Pathologic↗
PubMed1987

Radiologically guided balloon dilation of gastrointestinal strictures. Part II. Results of long-term follow-up.

Balloon dilation catheters were used to treat 94 gastrointestinal strictures in 92 patients over a 6-year period. Long-term follow-up data were obtained for 80 of these patients, with a mean follow-up period of 389 days. Overall, of the patients who underwent a successful dilation procedure, 83% remained symptom free after 1 year, and 69% after 2 years. The location of the stricture did not significantly influence the long-term outcome, nor did procedure characteristics, aside from primary technical failure. Both patients with malignant strictures and those whose strictures were associated with an anastomosis were more likely than other patients to have recurrent symptoms.

Constriction, Pathologic↗
PubMed1986

An analysis of the costs of infertility treatment.

For 597 couples receiving care at an infertility clinic in Nova Scotia, the average cost of diagnosis and treatment per successful pregnancy is $10,700. This is compared to the costs of alternatives to infertility treatment. Adoption costs generally range from $3,000 to $10,000, and surrogate mother arrangements are much higher (around $20,000). This study demonstrates the feasibility and value of a systematic analysis of the costs of infertility.

Adoption↗