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Biomedical subjects

J Ginsburg

Publications and source records attributed to J Ginsburg.

At least 19 recordsLinked to original sources
PubMed1999

Teleconsultation in otolaryngology: live versus store and forward consultations.

OBJECTIVE: To evaluate the relative strengths and weaknesses of interactive and delayed teleconsultations in otolaryngology. SETTING: Ambulatory clinic at an urban tertiary care facility. SUBJECTS: Forty-five adult patients with known or suspected upper aerodigestive tract pathology. INTERVENTION: Patients were interviewed by an otolaryngology chief resident (CR) using a standardized protocol; the results were presented to a board-certified otolaryngologist present locally (LBCO) and a remote physician viewing the encounter by video-conferencing elsewhere in the hospital (RBCO). The CR performed a complete otolaryngologic examination, including fiberoptic nasopharyngolaryngoscopy. The CR and LBCO viewed the examination on a video monitor; the RBCO viewed the same image on the video-conferencing monitor. Each physician independently recorded findings and rendered a diagnosis. A third board-certified otolaryngologist, who reviewed the stored data file (text and stored images) in a delayed fashion (DBCO), documented his findings and made a diagnosis. RESULTS: The CR and LBCO agreed on diagnosis in 92% (36 of 39) of cases. The LBCO and RBCO arrived at the same diagnosis in 29 of 34 (85%) cases. The DBCO agreed with the LBCO for 18 of 28 (64%) diagnoses. Agreement on management recommendations between the LBCO/DBCO pair were also lower than for the LBCO/RBCO pair. CONCLUSIONS: Both interactive and delayed techniques can be used to provide relatively accurate clinical consultations in otolaryngology. Telemedicine can be applied for subspecialty consultations, screening programs, remote emergency triage, second opinions, and resident education.

Adult↗
PubMed1998

Metabolic effects of tibolone in postmenopausal women with non-insulin dependent diabetes mellitus.

OBJECTIVE: Postmenopausal women with non-insulin dependent diabetes (NIDDM) are frequently obese, hypertensive and hyperlipidaemic and hence at particular risk of coronary heart disease (CHD). They might therefore benefit from menopausal therapy. In view of the improvement in insulin sensitivity and the reduction in triglyceride levels induced by tibolone in healthy postmenopausal women we evaluated the effects of 12 months of tibolone on glycaemic control, serum insulin and lipid levels in postmenopausal women with NIDDM. DESIGN: A prospective 12 months before/after intervention study. PATIENTS: Fourteen postmenopausal women (mean age 58.14 +/- 1.25 years; mean duration of menopause 121.21 +/- 13.42 months; mean BMI: 26.55 +/- 0.97) with NIDDM (mean duration of diabetes 113.79 +/- 13.89 months). MEASUREMENTS: Fasting and postprandial blood glucose levels were assessed monthly, serum fructosamine, fasting and postprandial insulin every 3 months and serum lipids (total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol) every 6 months. RESULTS: Changes in blood glucose, both fasting and postprandial, were not statistically significant during the treatment period. Serum fructosamine concentration increased significantly after 9 months. A significant decrease in fasting and postprandial insulin concentrations was observed after 9 months. A non-significant decrease was observed in total cholesterol, LDL cholesterol and triglyceride but no change in HDL cholesterol. Body weight did not change during the period of observation. CONCLUSION: A slight deterioration in glycaemic control, a fall in insulin concentration and no change in serum lipids were observed in women with NIDDM during 12 months treatment with tibolone.

Anabolic Agents↗
PubMed1998

Norplant consensus statement and background review.

This review has highlighted the attributes of a very important new method of contraception. The signatories to this document agree that, with the provision of appropriate information and instruction for the user, Norplant is a good contraceptive choice to be made available worldwide in family planning programs that have the resources for appropriate training and counseling. The signatories to this document are acting in their own personal capacity and not as representatives of any particular organization.

Contraceptive Agents, Female↗
PubMed1998

Telemedicine applications in otolaryngology.

A prospective study of the use of realtime and store-and-forward teleconsulting was carried out in patients who presented to the New York Eye and Ear Infirmary for otolaryngology care. Forty-five patients were seen in the study. There were no significant differences between local and remote otolaryngologists when interpreting the examinations, indicating that transmission did not affect the ability of a qualified physician to make an accurate diagnosis. In the store-and-forward examinations only 62% of the electronic records provided sufficient information for a confident diagnosis. Records were judged inadequate primarily due to poor selection, or an insufficient number of stored images. The study demonstrates that both interactive and store-and-forward techniques can be used to provide accurate clinical consultations in nasopharyngolaryngoscopic examinations. However, since store-and-forward consultations include less information and do not provide immediate feedback, as well defined clinical protocol for assembling the electronic consultation is needed.

Humans↗
PubMed1998

Treatment of symptomatic chronic adenotonsillar hypertrophy with amoxicillin/clavulanate potassium: short- and long-term results.

OBJECTIVE: To evaluate the short- and long-term effects of treatment of symptomatic chronic adenotonsillar hypertrophy (CATH) with a 30-day course of amoxicillin/clavulanate potassium (AMOX/CLAV). PATIENTS: Children 2 to 16 years of age with obstructive symptoms attributable to CATH, who did not have a history of recurrent adenotonsillitis. DESIGN: A prospective, randomized, double-blinded, placebo-controlled trial. SETTING: Ambulatory clinic of a tertiary care hospital. INTERVENTION: Patients were randomly treated with 30-day courses of either placebo (PLAC) or AMOX/CLAV (40 mg/kg in 3 divided doses daily). OUTCOME MEASURES: Patients' signs and symptoms were assessed by physical examination and by both physician and parental forced-choice questionnaires 1, 3, and 24 months after treatment. The decision to proceed to surgery or to continue expectant management was made for all patients by the same physician, based on reported symptoms and physical findings. RESULTS: Treatment with a 30-day course of AMOX/CLAV significantly reduced the need for surgery in the short term compared with PLAC (37.5% vs 62.7%) at 1-month follow-up). The reduced need for surgery in the AMOX/CLAV-treated group persisted at 3 months (AMOX/CLAV 54.5% vs PLAC 85.7%) and 24 months (AMOX/CLAV 83.3% vs PLAC 98.0%). CONCLUSIONS: A 30-day course of AMOX/CLAV significantly reduces the need for surgery in children with obstructive adenotonsillar hypertrophy at 1-month follow-up. This relative reduction persists at 3 and 24 months posttreatment, although the absolute percentages of patients requiring surgery increased in both groups as time after treatment increased. The reduction in symptoms in AMOX/CLAV-treated patients is modest but significant even in long-term follow-up. The precise role of this treatment for CATH is yet to be determined; however, our results suggest that a 30-day course of AMOX/CLAV can be used in situations when a temporary relief in symptoms is desirable or surgery would incur unacceptable risk.

Adenoids↗
PubMed1997

The effect of tibolone on cardiac flow in postmenopausal women with non-insulin dependent diabetes mellitus.

OBJECTIVE: Postmenopausal women with non-insulin dependent diabetes (NIDDM) are frequently obese, hypertensive and hyperlipidaemic and hence at particular risk of coronary heart disease (CHD). They might therefore benefit from menopausal therapy. In view of the fact that oestrogen replacement increases cardiac flow but not limb flow whilst tibolone dilates forearm flow in healthy postmenopausal women, a study was undertaken to evaluate the effects of tibolone on cardiac flow in postmenopausal women with NIDDM. DESIGN: A prospective 12 months before/after intervention study. PATIENTS: 15 postmenopausal women (mean age 58.36 +/- 1.25 years; mean duration of menopause 115.20 +/- 13.97 months; mean BMI: 26.22 +/- 1.02) with NIDDM (mean duration of diabetes 106.07 +/- 15.66 months). MEASUREMENTS: Cardiac flow was measured every 6 months for 1 year by pulsed Doppler echocardiography. The parameters assessed were: stroke volume (SV), cardiac output (CO), ejection fraction (EF), pre-ejection time (PEP), ejection time (ET), peak systolic flow velocity (PFV), acceleration time (AT), flow velocity integral (FVI), mean acceleration (MA), early diastolic filling time (Ei), atrial filling time interval (Ai), peak velocity of the early diastolic filling (E) and peak velocity of the early atrial filling (A). Blood pressure was also recorded during Doppler echocardiography. RESULTS: Stroke volume, cardiac output and ejection fraction increased significantly after 6 months. There was also a significant increase in peak flow velocity (PFV), flow velocity integral (FVI) and mean acceleration (MA) together with a significant increase in early diastolic filling time (Ei) and peak velocity of the early diastolic filling (E). Blood pressure was unchanged throughout the 12-month study period. CONCLUSION: The significant increase in stroke volume, cardiac output and flow velocity over the aortic valve parallel the effects of oestrogens in healthy postmenopausal women. The fact that tibolone improved left ventricular relaxation suggests the drug might help prevent or at least defer the development of cardiac dysfunction in diabetic women.

Anabolic Agents↗
PubMed1996

Cause of vaginal bleeding in postmenopausal women taking tibolone.

OBJECTIVE: To determine the cause of vaginal bleeding in postmenopausal women treated with tibolone. SUBJECTS: Forty seven consecutive unselected women who bled in the course of treatment with tibolone between 1986 and 1995. STUDY METHODS: Clinical evaluation and pelvic ultrasound scanning in all women and additional Doppler flow assessment in 12. Hysteroscopy was performed in 20 women and D and C in nine. RESULTS: An endometrial polyp was found responsible for the bleeding in 11 women and uterine fibroids in seven. Thickened endometrium was seen on ultrasound in six women; there was no histological abnormality in three of these women, two had benign simple hyperplasia and the remaining woman had an early carcinoma in situ. Carcinoma in situ was also found in another woman as an incidental finding in the endometrial curettings taken at hysteroscopy in the course of polypectomy. In over half, however, (24 women), no intrauterine cause could be found to account for vaginal bleeding. The occurrence of vaginal bleeding after tibolone clustered in two groups; 30 women who bled within 4 months of starting tibolone (of whom 17 had recently taken oestrogens) and 17 who bled after at least a years' therapy. CONCLUSION: Bleeding after tibolone requires investigation. A morphological abnormality may be present even in women who have recently taken oestrogens and experienced cyclical bleeding. Despite full investigation, no cause for bleeding was however found in over half the group. The majority (37 women) of those who reported bleeding nevertheless continued on tibolone after completion of investigations with no recurrence of bleeding.

Aged↗
PubMed1996

Comparative effects on bone mineral density of tibolone, transdermal estrogen and oral estrogen/progestogen therapy in postmenopausal women.

The aim of the study was to assess the comparative effects on bone mineral density (BMD) in routine clinical practice of tibolone and estrogen (given either unopposed or combined with cyclical progestogen) in postmenopausal women who had not previously received estrogen or other menopausal therapy. BMD was measured in the spine and hip by dual energy X-ray absorptiometry (DEXA) at 12-month intervals over 3 years in 82 consecutive postmenopausal women referred for climacteric therapy. Of these, 35 women received tibolone, 24 transdermal estradiol alone and 12 conjugated equine estrogens together with cyclical progestogen; 11 received no therapy other than calcium. BMD increased significantly in the spine in those taking tibolone over 3 years (p < 0.0001 at 1 year; p < 0.0001 at 2 years; and p = 0.03 at 3 years). In those treated with conjugated equine estrogens and cyclical progestogen, BMD in the spine also increased significantly over the first 2 years (p = 0.03 at 1 year; p = 0.004 at 2 years), but not at 3 years. However, although BMD in the spine also rose over 3 years in the women treated with transdermal estradiol alone, the increase was not statistically significant. No significant change in the BMD of either the spine or the hip was observed in the control group. A significant difference in the increase of BMD in the spine between the different treatment groups was observed at 2 years (p = 0.004) in favor of those taking tibolone or conjugated equine estrogens, compared to women who received transdermal estradiol. The highest proportion of individual responders to therapy after 2 years' treatment was observed in those receiving tibolone or conjugated equine estrogens. There was no significant change in the BMD of the hip over 3 years, irrespective of the therapy taken, although there was a tendency towards a progressive increase in the women on tibolone. Neither the age of the women, their body mass index or pretreatment BMD had a significant effect on changes in bone density. Since tibolone effected a greater increase in spine BMD than did either conjugated equine estrogen with progestogen or transdermal estradiol alone, it is particularly suitable for older women who often have more advanced osteoporosis and who would not accept a return of cyclical bleeding.

Administration, Cutaneous↗
PubMed1995

Clinical experience with tibolone (Livial) over 8 years.

Tibolone (Livial), a synthetic steroid, relieves climacteric symptoms and maintains skeletal integrity in postmenopausal women. We have been using this compound for 8 years and have now reviewed our clinical experience in 301 postmenopausal women. The majority (65.12%) had not previously received climacteric therapy; 34.55% had previously received oestrogen/progestogen therapy. A significant proportion of those started on tibolone were specifically referred for consideration of non-oestrogenic therapy because of a past history of breast dysfunction--27 women with benign breast disease and 11 women who had undergone surgery for carcinoma of the breast. Overall tibolone was well tolerated and climacteric symptoms were relieved within 3-5 weeks. The major side effect was weight gain and/or a tendency to bloating and oedema which occurred in 11.28% of our women. Vaginal bleeding occurred in 33 women (12.69%) but in 17 of these women the bleeding was due to recent oestrogen therapy. Bleeding resulted from a polyp or fibroid in 11 women; no cause was found in the remaining five. Breast symptoms were reported by only 7.52% and no breast symptoms were reported in any of the 27 women referred because of benign breast disease. The total 'drop-out-rate' due to side effects was only 2.66% (eight women).

Aged↗
PubMed1995

The effects of the somatostatin analogue octreotide on ovulatory performance in women with polycystic ovaries.

The elevated luteinizing hormone (LH) and androgen concentrations characteristic of women with polycystic ovaries (PCO) are considered crucial factors in their infertility. The somatostatin analogue octreotide lowers LH and androgen concentrations in women with PCO. The effects of octreotide given concurrently with human menopausal gonadotrophin (HMG) were therefore compared with that of HMG alone in 28 infertile women with PCO resistant to clomiphene. In 56 cycles of combined HMG and octreotide therapy there was more orderly follicular growth compared with the multiple follicular development observed in 29 cycles in which HMG was given alone (mean number of follicles > 15 mm diameter on the day of human chorionic gonadotrophin (HCG) administration: 2.5 +/- 0.2 and 3.6 +/- 0.4 respectively; P = 0.026). There was a significantly reduced number of cycles abandoned (> 4 follicles > 15 mm diameter on day of HCG) in patients treated with octreotide+HMG, so that HCG had to be withheld in only 5.4% of cycles compared to 24.1% with HMG alone (P < 0.05). The incidence of hyperstimulation was also lower on combined treatment. Octreotide therapy resulted in a more 'appropriate' hormonal milieu at the time of HCG injection, with lower LH, oestradiol, androstenedione and insulin concentrations. Although growth hormone concentration was similar on both regimens, significantly higher insulin growth factor-I concentrations were observed on the day of HCG in women on combined therapy than on HMG alone.

Adult↗
PubMed1995

Osteopenia as a feature of the androgen insensitivity syndrome.

OBJECTIVE: The syndrome of androgen insensitivity, a paradigm of a hormone resistance syndrome, manifests as failure of masculinization despite normal or high concentrations of serum testosterone. The defect in these 46 XY patients resides in the androgen receptor gene, with consequent defective androgen action and abnormal sexual differentiation. We sought to evaluate whether the adverse sequelae of androgen resistance may extend to skeletal tissue by measuring bone mineral density in six patients with androgen insensitivity. DESIGN: A cross-sectional retrospective study. MEASUREMENTS: Bone mineral density was measured by means of a Dexa (Hologic QDR 1000 scanner). The diagnosis of androgen insensitivity was confirmed in each patient by karyotype and assay of sex hormones. RESULTS: The five adult patients with androgen insensitivity had been exposed to both defective androgen action and variable periods of oestrogen deficiency. The latter resulted from the low circulating oestrogen concentrations (for premenopausal females) before gonadectomy and inadequate oestrogen replacement after gonadectomy. All five adults with androgen insensitivity had osteopenia in both the lumbar spine (T-score -1.52 to -3.85) and femoral neck (T-score -1.34 to -4.91). CONCLUSIONS: Osteopenia in patients with androgen insensitivity may relate to defective androgen action, oestrogen deficiency or a combination of the two. These observations have implications for the management of patients with androgen insensitivity and may provide insight into the effects of androgens on the female as well as the male skeleton.

Adolescent↗
PubMed1995

Cardiac flow velocity in women with the polycystic ovary syndrome.

OBJECTIVE: Women with the polycystic ovary syndrome (PCOS) often have several of the known risk factors for cardiovascular disease, including hyperinsulinaemia. We have therefore investigated variables of cardiac flow in young women with PCOS and related them to blood levels of reproductive hormones (LH, FSH, oestradiol and testosterone) and also of insulin. DESIGN: A prospective study. PATIENTS: Twenty-six young women with PCOS (mean age 22.8 +/- 0.9 years; mean BMI 23.0 +/- 0.8) and 11 healthy age matched women with regular ovulatory cycles (mean age 26.3 +/- 1.7 years; mean BMI 22.9 +/- 0.9). MEASUREMENTS: Cardiac flow was measured by pulsed wave Doppler echocardiography in the follicular phase of the cycle in controls and oligomenorrhoeic women; there was no special timing for amenorrhoeic women. The indicators assessed were: ejection fraction (EF), pre-ejection time (PEP), ejection time (ET), peak systolic flow velocity (PFV), acceleration time (AT), flow velocity integral (FVI), mean acceleration (MA), diastolic time (DT), early diastolic filling time (Ei), atrial filling time interval (Ai), peak velocity of the early diastolic filling (PE) and peak velocity of the atrial filling (PA). Serum LH, FSH, oestradiol, testosterone, SHBG and insulin concentrations were analysed by standard RIA. RESULTS: Significantly lower PFV (1.055 +/- 0.025 vs 1.242 +/- 0.054, P = 0.0006) and MA (17.06 +/- 0.57 vs 23.00 +/- 1.49, P = 0.0001) and longer AT (0.063 +/- 0.001 vs 0.056 +/- 0.004, P = 0.026) were found in women with PCOS as compared to age matched controls. Significant negative correlation between serum fasting insulin concentration and EF (r = -0.725, P = 0.002), PFV (r = -0.719, P = 0.0025), FVI (r = -0.654, P = 0.008) and MA (r = -0.757, P = 0.001) was observed in the 15 women with PCOS in whom insulin was measured. CONCLUSION: An inverse relation between serum fasting insulin level and left ventricular systolic outflow parameters suggests that insulin is associated with the decreased systolic flow velocity observed in women with PCOS.

Adult↗