Biomedical subjects

J DeRosa

Publications and source records attributed to J DeRosa.

4 recordsLinked to original sources

PubMed2003

Stroke Impact Scale-16: A brief assessment of physical function.

OBJECTIVES: To 1) develop a short instrument (Stroke Impact Scale-16 [SIS-16]) to assess physical function in patients with stroke at approximately 1 to 3 months poststroke using items from the composite physical domain of the Stroke Impact Scale (SIS) version 3.0, and 2) compare the SIS-16 and a commonly used disability measure, the Barthel Index (BI), in terms of their ability to discriminate disability. METHODS: A total of 621 subjects enrolled in the GAIN Americas randomized stroke trial were included in this study. Rasch analysis, which models the probability of a subject's response to an item using both subject ability and item difficulty, was used to construct the SIS-16, describe its properties, and compare its ordering and range of item difficulties to those of the BI. Box plots and analysis of variance were used to examine differences in BI and SIS-16 scores across modified Rankin categories. RESULTS: The study sample had an average age of 68 +/- 12.4 years and 56% were men. Stroke diagnoses were classified as minor in 91 patients (NIH Stroke Scale score [NIHSS] 0 to 5), moderate in 304 (NIHSS 6 to 13), and major in 226 (NIHSS >/= 14). Twelve of the original 28 items in the SIS version 3.0 composite physical domain were eliminated to produce the SIS-16, with a minimal loss of reliability. As compared to the BI, the SIS-16 contains more difficult items that can differentiate patients with less severe limitations, and therefore has less pronounced ceiling effects. SIS-16 scores were significantly different across Rankin levels 0 to 1, 2, 3, 4, and 5, whereas BI was significantly different only across Rankin levels 0 to 2, 3, 4, and 5. CONCLUSION: Compared to the BI, the SIS-16 is an excellent collection of items suitable for assessing a wide range of physical function limitations of patients with stroke at 1 to 3 months poststroke. Because of a less pronounced ceiling effect, the SIS-16 can differentiate lower levels of disability as compared to the BI.

Aged↗

PubMed1995

The natural history of idiopathic subfoveal choroidal neovascularization.

PURPOSE: To study the long-term natural history of idiopathic subfoveal choroidal neovascularization (CNV) in young patients. METHODS: A retrospective survey of 19 consecutive patients with idiopathic subfoveal CNV diagnosed in an urban eye hospital and a single practice. RESULTS: Twenty-three (26%) of 87 consecutive patients with idiopathic CNV demonstrated subfoveal CNV. Nineteen patients with subfoveal involvement were followed for a median of 87 months (range, 5-230 months). On initial examination, the median best-corrected Snellen visual acuity was 20/100 (range, 20/40-counting fingers); at final examination, the median visual acuity was 20/70 (range, 20/20-counting fingers). A total of 95% of patients had stable or significantly improved visual acuity, whereas only 5% had significant visual loss. Size of the CNV was the only variable associated with long-term final visual acuity. Lesions 1 disc area or smaller at the time of initial fluorescein angiography were more likely to be associated with a final visual acuity of 20/60 or better and less likely to be associated with a final visual acuity of 20/200 or worse (P = 0.038) as compared with larger lesions. These results were confirmed with multiple logistic regression analysis (P = 0.027). Fellow eyes remained unaffected during the follow-up period. CONCLUSIONS: The natural history of idiopathic subfoveal CNV is not necessarily associated with a profound loss of vision. Therapies for this type of subfoveal lesion must take into consideration the possibility of a favorable natural course.

Adult↗

PubMed1995

Modulatory impact of acid and pepsin on esophageal hydrophobicity in humans.

OBJECTIVES: The role of hydrophobicity in the pathophysiology of the gastrointestinal tract is well established as a protective mechanism against the impact of lumenal acid and pepsin. Hydrophobic properties of esophageal secretion in humans remain largely unknown. METHODS: We have studied, therefore, hydrophobicity by using fluorescence probe in human esophageal secretion, elaborated under the impact of saline followed by HCl, HCl/pepsin, and final saline. RESULTS: Basal hydrophobicity of human esophageal secretion, elaborated during mucosal exposure to saline, was 237 +/- 32. This value, however, declined 72% during mucosal exposure to HCl (66 +/- 14 vs 237 +/- 32; p < 0.001) and 87% during mucosal exposure to acid supplemented with pepsin (30 +/- 4 vs 237 +/- 32; p < 0.001). Moreover, hydrophobicity upon perfusion with HCl/pepsin was 55% lower than after perfusion with HCl alone (30 +/- 4 vs 66 +/- 14), although the result was insignificant. Substitution of saline for HCl/pepsin solution during the last perfusion period resulted in a partial recovery of hydrophobicity in esophageal secretion (131 +/- 30 vs 30 +/- 4; p < 0.001), although this value was lower than the basal hydrophobicity value (131 +/- 30 vs 237 +/- 32; p = 0.028). In addition, we continuously observed a significant shift in the fluorescence emission maximum from 508 +/- 6.4 to 486 +/- 0.9 (p < 0.001) during perfusion with starting saline, to 492 +/- 1.6 (p < 0.001) during exposure to HCl, to 493 +/- 1.1 (p < 0.001) during perfusion with HCl/pepsin, and to 488 +/- 0.9 (p < 0.001) during infusion of final saline. The maximum emission wavelength after esophageal exposure to initial saline also was significantly lower than the maximum emission upon perfusion with HCl (492 +/- 1.6 vs 486 +/- 0.9; p < 0.05) and HCl/pepsin (493 +/- 1.1 vs 486 +/- 0.9; p < 0.05). Although basal hydrophobicity in males was similar to corresponding values recorded in females, mucosal exposure to HCl (pH 2.1) resulted in an 84% decline in females but only 60% in males. Therefore, the hydrophobicity value in females during the perfusion period with HCl was 52% lower than in males (p = 0.129). CONCLUSIONS: Esophageal secretion exhibits its hydrophobic nature presumably through the presence of mucus components such as mucin and mucin-associated phospholipids. The inhibitory impact of HCl and HCl/pepsin solutions on esophageal hydrophobicity may play a role in the pathogenesis of mucosal damage by gastroesophagel refluxate.

Adult↗

PubMed1991

External cephalic version of term singleton breech presentations with tocolysis: a retrospective study in a community hospital.

External version with the use of tocolysis in low-risk patients has been shown to be relatively safe and effective. A retrospective analysis was undertaken to see if version was practical for a smaller community-based hospital. Thirty-two antepartum external cephalic versions with ritodrine tocolysis during a 4-year period were reviewed. Successful version occurred in 59.4% of attempts. Of patients with a successful version, 68.4% delivered vaginally. One successful version occurred spontaneously with ritodrine tocolysis alone. A stillbirth due to abruptio placentae occurred 20 hours after a failed version attempt.

Adult↗