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Biomedical subjects

L H Bernstein

Publications and source records attributed to L H Bernstein.

At least 19 recordsLinked to original sources
PubMed1992

Diagnostic efficiency of carcinoembryonic antigen and CA125 in the cytological evaluation of effusions.

In our previous study, the combination of the concentrations of carcinoembryonic antigen (CEA) and CA125 and the findings from cytological examination in 189 benign and malignant pleural and peritoneal effusions was useful in the diagnosis/classification of malignant effusions. Sensitivity of CEA (level, greater than 5 ng/mL) was 68%; specificity was 99% for the diagnosis of malignant effusions secondary to carcinoma of the lung, breast, gastrointestinal tract, and mucinous carcinoma of the ovary. Sensitivity of CA125 (level, greater than 5000 U/mL) was 85%; specificity was 96% for the diagnosis of malignant effusions in carcinoma of the ovary, fallopian tube, and endometrium. We now expanded the study to include 840 pleural and peritoneal effusions (benign, n = 520; malignant, n = 320) and analyzed the data by the statistical method of Rudolph and colleagues. Based on new cutoff values, ie, CEA level at 6.3 ng/mL and CA125 level at 3652 U/mL, the sensitivities for detection of malignant effusions secondary to carcinomas of the lung, breast, and gastrointestinal tract and mucinous carcinoma of the ovary varied between 75% and 100%; specificity was 98%. Sensitivity of CA125 for detection of malignant effusions from müllerian epithelial carcinoma was 71%; specificity was 99%. The elevated CEA fluid level alone helped to diagnose malignant effusions of the gastrointestinal tract in 54%, breast in 19%, and lung in 16%. The high CA125 fluid level was predictive of müllerian epithelial carcinoma. Adjunctive use of CEA and CA125 levels in fluid enhances the sensitivity of cytological diagnosis and may be predictive of the primary site in patients who present with carcinoma of an unknown primary source.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1991

Vincent's violent vertigo. An analysis of the original diagnosis of epilepsy vs. the current diagnosis of Meniére's disease.

The authors propose to correct the historical misimpression that Vincent van Gogh's medical problems resulted from epilepsy. Rather, the authors propose his main medical problem was Meniére's disease. The authors have reviewed the 796 personal letters written by van Gogh. The symptoms of his Vertigo attacks, their presentation and duration as described in these letters, taken as a whole, are consistent with the clinical picture of Meniére's disease, not epilepsy. They point out that Prosper Meniére's description of his syndrome was not well known at the time of van Gogh's death, and was often misdiagnosed as epilepsy. During the last years of his life, van Gogh was labeled epileptic, although no rigid criteria for this diagnosis are evident. This diagnosis is still prevalent in the art history literature today. His symptoms included episodic vertigo and dizziness, physical imbalance, hearing symptoms, ear noises (tinnitus) as well as a presumed secondary psychological reaction to his physical symptomatology. van Gogh's diagnosis of epilepsy is based on written diagnosis in his medical records in 1889 when he was interred (voluntarily) in St. Remy at an asylum for epileptics and lunatics.

Art↗
PubMed1991

An update on home intravenous antibiotic therapy.

Home intravenous antibiotic therapy (HIVAT) has proven to be a safe, effective, and cost-saving method to treat appropriately selected patients with bone, soft tissue, respiratory, genitourinary, and cardiac infections. Further, the acceptance of HIVAT by both physicians and patients has been enhanced by the availability of new venous access devices and home IV therapy companies. In determining when to use HIVAT, it is important to carefully consider the individual patient, the disease or medical condition, and antibiotic selection. HIVAT requires a team approach, with the physician, pharmacist, IV therapy nurse, and others playing critical roles in successful treatment plans.

Anti-Bacterial Agents↗
PubMed1990

Van Gogh had Menière's disease and not epilepsy.

We intend to correct the historical error that Vincent Van Gogh's medical problems resulted from epilepsy plus madness, a diagnosis made during his life but for which no rigid criteria are apparent. Review of 796 personal letters to family and friends written between 1884 and his suicide in 1890 reveals a man constantly in control of his reason and suffering from severe repeated attacks of disabling vertigo, not a seizure disorder. His own diagnosis of epilepsy was made from the written diagnosis by Dr Peyron, the physician at the asylum of St Remy (France), wherein on May 9, 1889, Van Gogh voluntarily committed himself to the asylum for epileptics and lunatics. However, the clinical descriptions in his letters are those of a person suffering from Meniere's disease, not epilepsy. The authors point out that Prosper Meniere's description of his syndrome (an inner-ear disorder) was not well known when Van Gogh died and that it often was misdiagnosed as epilepsy well into the 20th century.

Art↗
PubMed1990

Measurement of CA125, carcinoembryonic antigen, and alpha-fetoprotein in ovarian cyst fluid: diagnostic adjunct to cytology.

This study used CA125, carcinoembryonic antigen (CEA), and alpha-fetoprotein (AFP) to classify ovarian cysts by measuring the levels of the three antigens; this information was useful when fluid obtained through laparoscopic puncture of ovarian cysts was submitted for cytologic examination from patients for whom tissue was unavailable for classification. We studied 136 consecutive cyst fluids (108 benign, 28 malignant) and correlated the findings with the tissue diagnosis. All three antigens were very low (CEA, less than 0.5 ng/ml; CA125, 55-2,143 mu/ml; and AFP, less than 4.8 ng/ml) in follicular and lutein cysts. Markedly elevated CA125 (296-1,950,000 mu/ml) and low CEA (0.5-220 ng/ml) and AFP (less than 4.8 ng/ml) levels were seen in patients with serous neoplasms, both benign and malignant. Elevated CEA (greater than 600 ng/ml) and CA125 (56-65,330 mu/ml) levels were seen in primary mucinous cystadenoma and cystadenocarcinoma. Two patients with colonic carcinoma metastatic to the ovary had an elevated CEA (greater than 600 ng/ml) and a normal CA125. Only one patient, with a malignant teratoma, had an elevated AFP. The adjunctive use of CEA and CA125 is recommended for the classification of ovarian cysts.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1990

The provision of home health services through health maintenance organizations: the role of the physician.

The authors report the results of a comprehensive national study of the provision of home health care (HHC) through health maintenance organizations (HMOs), funded by a 1987 grant from the National Center for Health Services Research. The initial study included a literature review, interviews of 125 HHC providers and researchers, case studies of 6 HMOs, and a survey of 103 HMOs with Medicare contracts (as of March 1988). Upon discovery of controversy over the role of the HMO physician, the authors conducted an additional substudy of 30 primary care physicians. The article focuses on findings concerning the HMO physician in HHC and the implications for physicians generally, in light of what the larger study and additional data (January 1989-January 1990) show about HMO development and home health care.

Attitude of Health Personnel↗
PubMed1990

What constitutes a laboratory quality monitoring program?

A program of quality assurance for the laboratory is described that addresses both process and outcome validation. It begins by an analyses of the workload processing sequence, i.e., ordering, collecting, transporting, analyzing specimens, reporting tests results in a timely manner, and reduction of instrument, staff, and system-related errors in the generation of laboratory information. The observable medical staff requirements for effective utilization of the laboratory is the basis for defining outcome measures.

Clinical Laboratory Techniques↗
PubMed1990

Medically significant concentrations of prostate-specific antigen in serum assessed.

We used the method of Rudolph et al. (Clin Chem 1988; 34:2031-8) to find information in the data from correlated determinations of acid phosphatase (PAP, EC 3.1.3.2; DuPont aca) and prostate-specific antigen (PSA, Hybritech). We described there how we assign medical decision limits for two or more correlated variables and convert the database to a binary coded message, allowing separation of a selected disease class with minimum error. The decision point, analogous to a percentile upper limit on the ordered values of each variable in the reference group, satisfies the maximum entropy constraints of reference, producing a minimum entropy for the binary coded patient database. We found maximum entropy decision points at PAP = 0.75 U/L and PSA = 22.8 micrograms/L. Patients with PSA values exceeding 22.8 micrograms/L had no benign prostatic disease except for five patients with benign prostate hyperplasia (BPH) with adjacent colon carcinoma (95.3), BPH with infarction (27.6), BPH (23.4) 28.1), or acute prostatitis (34.6). We consider PSA exceeding 22.8 micrograms/L as indicative of carcinoma of the prostate, stage C or D, in the absence of disconfirming evidence. Another decision value for PSA is 11.3 micrograms/L. This bounds the region between 11.3 and 22.8 micrograms/L, where the frequency of BPH is 1.5 times that for adenocarcinoma. At PSA less than 11.3 micrograms/L there is a high frequency of BPH. PSA concentration is not correlated with prostatic size (mass) or with prostatitis. A metastatic carcinoma is as likely to be nonprostatic as prostatic when the PSA concentration is less than 11.3 micrograms/L.

Acid Phosphatase↗
PubMed1990

Home care of the elderly diabetic patient.

As the anticipated growth of sophisticated diabetic services continues to accelerated in homes across America, physicians must first be educated as to the potentially unlimited spectrum of diabetic home care products and services that will become increasingly available to the patients whom they serve. Second, much research must be completed to critically examine the safety, quality, and cost issues of diabetic home care, to provide the necessary data to assure that home care services will be neither under- or over-utilized and will meet the necessary acute and long-term health care needs of our diabetic patients. Third, physicians must take a leadership role in examining the pitfalls of our existing expensive and often fragmented acute care-oriented health care model, which has not effectively addressed the increasing costs and incidence of chronic diseases, such as diabetes, in our society. With computerization and the explosive mobilization of high-technology health care products and services, we are witnessing an exponential growth in the list of services available in the home setting for diabetic patients. There has never been a time in the history of medicine that we, as physicians, have needed to create new, innovative, high-quality approaches to necessary, accessible, and cost-effective alternative health care delivery systems as is the case now. I believe that the renewal of home care, with physician vision, direction, and review, will be a major step toward the highest-quality medical care provided to our diabetic patients at home.

Aged↗
PubMed1989

Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature.

We report 2 patients with myonecrosis due to Clostridium septicum and associated colon carcinoma and have reviewed the English language literature for all reported cases of atraumatic C. septicum infection. A total of 162 cases of C. septicum infection have been reported. Eighty-one percent of these patients had an associated malignancy. Thirty-four percent of all patients had associated colon carcinoma, while 40% had a hematologic malignancy. Thirty-seven percent of reported patients had an occult malignancy at the time of their infection with C. septicum. In many patients, the portal of entry was found in the large intestine. In a particularly lethal form (79% mortality) of C. septicum infection, known as "distant myonecrosis," infection metastatic from the initial site of infection causes severe myonecrosis, gangrene, and often death within hours of clinical detection. Overall, survival of patients with C. septicum infection is only 35%. Review of all cases of C. septicum infection suggests several conclusions. 1) Patients with malignancy, particularly colonic or hematologic, and patients with cyclic neutropenia who develop signs and symptoms of sepsis, especially with associated findings of abdominal pain or pain in an extremity, should be treated for possible clostridial infection. 2) C. septicum infection does not appear to be a result of a single specific defect in either humoral or cell-mediated immunity. Rather, it may occur in patients who are granulocytopenic and therefore prone to an enterocolitis. 3) Patients in whom an infection with C. septicum is found must undergo a vigorous search for malignancy following acute therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1989

Usefulness of data on albumin and prealbumin concentrations in determining effectiveness of nutritional support.

In this ongoing study, albumin and prealbumin (transthyretin) changes were compared in 40 patients managed with enteral and (or) parental support with attainment of caloric/protein goals. The concentration of prealbumin in serum changed rapidly and more accurately reflected current nutritional status of these patients than did that of albumin. We determined concentrations of albumin and prealbumin that reflected significant improvement in nutritional status, using Rudolph's approach based on Shannon information measures. Reference values for albumin and prealbumin in the treatment populations were 25 g/L and 107 mg/L, respectively. A prealbumin concentration of 135 mg/L or greater reflected a return to stable status.

Enteral Nutrition↗
PubMed1989

Diagnosis of acute myocardial infarction from two measurements of creatine kinase isoenzyme MB with use of nonparametric probability estimation.

By using bivariate probability estimation for the diagnosis of acute myocardial infarction (AMI) we show how to overcome the difficulties encountered for patients whose clinical presentation is atypical and those encountered when multiple isoenzyme determinations are treated by univariate methods. We use the values for creatine kinase isoenzyme MB measured at the time of admission and 12 h later to estimate the Bayes factors in favor of AMI. The Bayes factors are compiled into a table that the clinician can use to estimate the posterior probability that a patient has AMI. The table of Bayes factors is based on data for a sample of 802 non-AMI patients and 180 AMI patients. Further to validate the method, we randomly chose 200 of the non-AMI and 50 of the AMI patients as an evaluation sample, then used the remaining 602 non-AMI and 130 AMI patients to recompute the Bayes factors. These Bayes factors were used to find the probability of AMI for each of the 250 patients in the evaluation sample. The method resulted in only one false positive and no false negatives. For the misclassified patient the measurements at admission and 12 h later were 1 and 11 U/L; the posterior odds were 15 to 1 in favor of AMI, but in fact the patient was non-AMI.

Creatine Kinase↗
PubMed1988

Infectious diarrhea in patients with AIDS.

A multitude of opportunistic infections has been documented in virtually every organ system of patients with the acquired immunodeficiency syndrome (AIDS). Prominent among these are infections of the gastrointestinal tract. However, studies of large numbers of patients documenting the frequency of such involvement are lacking. We reviewed the records of 100 patients with AIDS and assessed the frequency and organisms causing infectious diarrhea. We found diarrhea to be more common in homosexuals (80%) than heterosexuals with a risk factor of parenteral drug use (58%). In one third of all cases, no infectious etiology was found. Mycobacterium avium intracellulare (MAI) was the most commonly identified cause of infectious diarrhea in our series, followed by cytomegalovirus, cryptosporidium, Salmonella spp., and herpes virus. In addition, bacteremia was documented in 43% of patients with infectious diarrhea and was most commonly due to MAI. Finally, we demonstrated that multiple concurrent infections are not uncommon (22%) in AIDS patients and that the diarrheal syndrome may not respond unless all pathogens are eradicated.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Information induction for predicting acute myocardial infarction.

We show how to make an unsupervised discrimination of disease and nondisease states by measuring information and using newer notions of inductive reason. We also present a new theory of group-based reference values that is based on measuring information uncertainty. We use data on the isoenzymes creatine kinase-MB (CK-MB) and lactate dehydrogenase-1 (LD1) and on the percentage of LD1 from 101 patients with acute myocardial infarction (AMI) and from 41 patients with suspected, but unfounded, infarction (non-AMI). Calculating the Shannon entropy, a concept from information theory, of the data base allows determination of a difference in entropy values ("effective information"), which determines decision cutoff values that produce binary-base patterns yielding the fewest classification errors. Redundancy in testing is important because it provides the information to approach a goal of errorless discrimination by coding the test results and meeting the conditions of the "Noisy Channel Theorem" of information theory. This redundancy improves the predictive value of diagnosis by isolating the area of equivocation to evident patterns. Results for CK-MB and LD1 are 99% correct in assigning cases to AMI and non-AMI categories; adding %LD1 increases the proportion of errorless binary patterns from 25% to 90%.

Algorithms↗