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Biomedical subjects

J Jaffe

Publications and source records attributed to J Jaffe.

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

Chief complaint of fatigue: a prospective study.

The Dartmouth COOP Project, a primary care research network, conducted a prospective study of patients presenting to 28 primary care practices with a chief complaint of fatigue. Data were gathered on fatigue status, associated systems, health status, and origin of fatigue. Fatigue patients were demographically similar to nonfatigue patients but had significantly worse physical and mental health at study intake. Sixty-three percent of physicians and 52% of patients rated fatigue origin as primarily physical (gamma = 0.48, P less than .05), but in 41% of cases, physicians indicated there was substantial interaction between physical and psychological factors. Only two factors--depression and anxiety--separated fatigue of physical origin from fatigue of psychological origin. Clinicians must thoughtfully evaluate fatigue's often multiple causes and communicate their understanding of those causes to the patient to gain support for a reasonable treatment regimen.

Adult↗
PubMed1989

Regional distribution of cerebral arteriovenous malformations. Interactions with sex and handedness.

On the basis of clinical observation and a developmental theory of cerebral laterality, Geschwind and Galaburda suggested that cerebral arteriovenous malformations (AVMs) are more common in the left hemispheres of male patients. We tested this hypothesis by examining interactions among sex, handedness, and location of lateralized, supratentorial AVMs. Data from 112 cases were analyzed by log-linear procedures. We found that (1) females had a greater proportion of left-hemisphere AVMs, whereas males showed an opposite trend; (2) there were no interactions between sex and handedness; and (3) nondextrals showed a higher proportion of AVMs located in frontal regions, regardless of the hemispheric side of the lesion. Although these findings appear to be inconsistent with the Geschwind-Galaburda hypothesis, the inconsistency may be attributable to the embryonic stage at which this developmental abnormality occurs. In addition, the unexpected findings may also reflect our use of multivariate statistical procedures, which control for interaction effects.

Adolescent↗
PubMed1989

Placebo responses to cocaine administration in humans: effects of prior administrations and verbal instructions.

Subjective and physiological responses of eight male cocaine-using research volunteers were studied after a double-blind saline infusion (placebo) was given when subjects were instructed that a cocaine infusion might be given. Cardiovascular and subjective responses to placebo were similar in pattern and direction, though of lesser magnitude, than after a 40 mg cocaine infusion. These placebo responses were compared to responses after an earlier saline infusion condition in which subjects were instructed prior to the infusion that they would receive saline (instructed placebo). The design was thus meant to test for the effects of instructions on placebo responses to cocaine. Heart rates at baseline (pre-infusion) were significantly higher in the placebo than in the instructed placebo condition. Similar trends were found for elevated baseline placebo responses on two subjective effects measures. A comparison with an initial placebo session prior to the placebo and instructed placebo conditions described above provided evidence for conditioning of placebo responses on diastolic blood pressure and heart rate. The present results suggest that verbal instructions, as well as conditioning in the laboratory, could contribute to the observed placebo responses to cocaine infusions.

Adult↗
PubMed1989

Effects of bromocriptine pretreatment on subjective and physiological responses to i.v. cocaine.

We studied the effect of pretreatment with single doses of bromocriptine on the pattern of subjective and physiologic responses to single doses of intravenous (IV) cocaine. Placebo, bromocriptine 2.5 mg and, in five subjects only, 5 mg were administered orally 120 minutes before a dose of placebo or cocaine 40 mg IV to 9 male cocaine-using volunteers. Bromocriptine pretreatment diminished blood pressure generally, including cocaine-induced blood pressure increases, and augmented the heart rate after cocaine. It caused virtually no change in either augmentation or diminution of subjective responses including "rush" and "good feeling" scores, and scores for the MBG of the Addiction Research Center Inventory (ARCI), all measures of euphoria. However, a trend for the scores for the item "Would a dose of drug (cocaine) make you feel better?," suggested that bromocriptine may decrease the urge to use cocaine that was evoked by cocaine itself. However, this decreased desire was associated with a trend toward an increase in dysphoria as measured on the LSD scale of ARCI. These data support the view that euphoria and some forms of craving may be pharmacologically separable. We found no potentially toxic interactions of bromocriptine with cocaine in these single dose experiments.

Blood Pressure↗
PubMed1989

In vitro investigation of the priming principle for rapid neuromuscular block.

The priming principle was investigated in the rat phrenic nerve-diaphragm preparation stimulated continuously at 0.2 Hz. Tubocurarine was added to the organ bath as either a single (non-primed) or a divided (primed) dose. Priming consisted of 15% or 20% of the final dose, with priming intervals of 5 or 10 min. Priming decreased significantly the time to 80% block and was associated with mild neuromuscular block. A simple model adequately predicted the time to 50% and 80% block, using the same diffusion constant for both primed and non-primed conditions. The onset of neuromuscular block, with and without priming, depended mostly upon the distribution of the drug to its site(s) of action.

Animals↗
PubMed1988

Vocal congruence in mother-infant play.

Turn-taking is the fundamental temporal structure of adult dialogue. This structure defines two types of joint silence: intrapersonal pause (silence bounded by the vocalizations of a single speaker) and switching pause (silence bounded by the vocalizations of different speakers). Switching pauses mark the boundaries of the turn exchange. In adult conversation the mean durations of both types of pause are characteristically matched between partners. This matching, termed "vocal congruence," occurs developmentally earlier in the case of switching pauses. We hypothesized and confirmed that mothers and infants match switching pauses but not intrapersonal pauses at 4 months, even though the infants' vocalizations are prelinguistic. Second, since there are known affective correlates of vocal congruence in adult conversation, we hypothesized a similar affective correlate for mother-infant vocal congruence. We found, for the intrapersonal pause only, that the degree of matching within a dyad correlates with infant affective engagement. We conclude, from switching pause congruence, that a turn-taking dialogic structure is being regulated in the mother-infant pair at 4 months in the same way as seen in adult conversation. Thus, both the temporal structure of adult dialogue and its affective correlate are prelinguistic.

Affect↗
PubMed1988

Unitary versus multidimensional models of alcoholism treatment outcome: an empirical study.

This study examined two issues related to the distinction between unitary and multidimensional models of alcoholism treatment outcome. First, does treatment outcome vary along a variety of relatively independent dimensions? Second, how important is abstinence to improved health and psychosocial adjustment? A sample of 266 alcoholics were evaluated at intake and 1 year following inpatient treatment using an extensive battery of assessments. Correlational analysis and factor analysis provided limited support for both the unidimensional and multidimensional approaches. A synthetic measure of posttreatment drinking showed a clear linear relationship between level of consumption and lack of improvement in medical status, biological function, life stress and psychopathology. The findings are discussed in terms of the methodological difficulties in treatment evaluation and the need for more systematic research on the effect of posttreatment drinking on multiple dimensions of outcome status.

Adult↗
PubMed1986

A comparison of the effects of trazodone and amitriptyline on skills performance by geriatric subjects.

Fifteen healthy adults, aged 60 years and older, participated in a double-blind, crossover study of trazodone in comparison with amitriptyline and placebo. A battery of laboratory tests was used to measure drug effects on information processing, attention, and visual-motor skills. Amitriptyline 50 mg impaired vigilance and tracking performance and increased drowsiness. Trazodone 100 mg impaired only the most difficult tracking task. This study demonstrates that cognition and performance are less adversely affected in geriatric subjects by trazodone than by amitriptyline beginning 90 minutes after a single-dosage trial.

Administration, Oral↗
PubMed1985

Speed of color naming and degree of familial sinistrality: correlation in girls, no correlation in boys.

Twenty-nine male and 35 female right-handed children, aged 5 to 7, were assessed for the effect of familial sinistrality on a rapid color-naming task. Controlling for age and family size, a significant effect for degree of familial sinistrality was found in the girls but not in the boys. Among the girls, those with two or more left-handed or ambidextral relatives were the fastest on the color-naming task, those with no such relatives were the slowest, and those with only one left-handed or ambidextral relative scored between the other two groups in color-naming speed. It is suggested that a gene associated with left-handedness, when present in a right-hander, interacts with sex to produce the superior color-naming performance that we observed in girls but not in boys.

Age Factors↗
PubMed1985

Speed of color naming and intelligence: association in girls, dissociation in boys.

We administered a rapid naming test to a sample of prereaders. Slow performance on this task among older children is known to be associated with reading disability. Results showed a sex difference in the degree of correlation between naming performance and a test of general intelligence. The finding was replicated on an independent sample. This finding bears theoretically on the degree to which a learning disability can appear as an isolated deficit in the two sexes.

Child↗
PubMed1985

Pseudomembranous colitis following low dose trimethoprim-sulfamethoxazole.

A 94-year-old man had pseudomembranous colitis while taking low dose trimethoprim-sulfamethoxazole for recurrent urinary tract infection. The suppressive effect of low dose trimethoprim-sulfamethoxazole on normal colonic flora appeared to be a factor in the development of pseudomembranous colitis in this patient.

Aged↗
PubMed1984

Improved control of bulky prostate carcinoma with sequential estrogen and radiation therapy.

Patients with bulky prostate cancer have usually been treated by palliative measures because the likelihood of tumor control with definitive irradiation has been low and the development of distant metastases high. The addition of estrogen to irradiation has not been shown to be of value. However, we believe the method of estrogen administration may have been the cause for the apparent lack of benefit. Estrogen had been started either concurrent with irradiation or had been used for palliation and was given for long and unscheduled time periods prior to irradiation. We have used estrogen for two months prior to and concurrent with irradiation. We postulated that in those patients with estrogen responsive cancer, the reduced tumor burden prior to irradiation could enhance tumor control and survival. Between 1975 and 1980, 25 patients with bulky prostate cancer received sequential estrogen and irradiation, 12 patients irradiation alone and six patients irradiation after having become refractory to long-term estrogen use. One patient was lost to follow-up. Eighteen of 25 (72%) treated by sequential estrogen and irradiation, 14/17 (82%) with estrogen responsive cancer and 4/8 (50%) with estrogen resistant cancer had a complete tumor response. Six of 11 (55%) patients treated by irradiation alone and 2/6 (33%) treated by irradiation for estrogen refractory cancer had a complete tumor response. Disease-free survival was observed in 13/25 (52%) treated by sequential estrogen and irradiation, and 8/17 patients (47%) with irradiation. It is also possible the improved survival in the estrogen responsive group was a direct result of improved local control. Persistent local disease can act as a source for distant metastases. Distant metastases was observed in 15% of patients when the primary tumor was controlled and 30% when there was persistent or recurrent local disease. Also, progressive local disease can be an important cause of death. This was most evident in our patients with estrogen refractory cancer. Almost all patients in this group had progressive local disease that caused serious urinary bleeding and urinary infection that were considered the major cause of death. Our results suggest bulky prostate cancer should be aggressively treated when first diagnosed. The value of adjunct estrogen is unproven. Our results with the use of estrogen prior to and concurrent with irradiation is encouraging. Estrogen may shrink the cancer and allow for a more favorable geometry for external irradiation. Tumor control and survival may be thereby improved.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1984

"PALS for life!" A required trauma-oriented pediatric advanced life support course for pediatric and emergency medicine housestaff.

While advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) courses have become accepted standards for physicians who care for the critically ill and injured patient, only recently have pediatric advanced life support (PALS) courses been developed. The American Academy of Pediatrics has shown renewed interest in pediatric cardiopulmonary arrest after impressive gains made in adult resuscitation. The American Heart Association filled a void by including new chapters on Pediatric and Neonatal Resuscitation in the Textbook of Advanced Cardiac Life Support, 1981. A joint committee of AHA and AAP is seeking to unify course objectives and materials for standard curriculum. Because trauma is the most common cause of death and disability in children, pediatric trauma life support measures should be incorporated into any program directed toward emergency physicians and pediatricians who function in an emergency department or rural primary care setting. The Department of Pediatrics and Surgery and its division of Emergency Medicine has developed and implemented a PALS curriculum which is different from most other programs in that emphasis has been placed on pediatric trauma in addition to traditional cardiac (ACLS) resuscitation. This 20-hour program combines a modified ACLS curriculum with specific pediatric trauma lectures and laboratory sessions. It includes a canine surgical procedure lab and modified ATLS skill stations. At the completion of the course, students are eligible for ACLS certification. In the two years in which the course was given, 39 pediatric houseofficers were enrolled in the course.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗