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Biomedical subjects

L M Cohen

Publications and source records attributed to L M Cohen.

At least 55 records · Page 3Linked to original sources
PubMed1993

Urinary retention associated with herpes zoster infection.

BACKGROUND: Herpes zoster infection particularly involving the sacral dermatomes has been associated with bladder and bowel dysfunction, most commonly urinary retention. CASE REPORTS: We report two patients who developed acute urinary retention, one of whom also had constipation, within days of herpes zoster skin lesions of the S2-S4 dermatomes. CONCLUSIONS: Herpes zoster is a reversible cause of neurogenic bladder and bowel dysfunction and should be considered in a patient that presents with acute urinary retention and/or constipation. Sensory abnormalities and flaccid detrusor paralysis are most likely involved in the pathogenesis.

Aged↗
PubMed1992

Human papillomavirus type 11 in multiple squamous cell carcinomas in a patient with subacute cutaneous lupus erythematosus.

Squamous cell carcinoma (SCC) is a rare complication of cutaneous lupus erythematosus (LE). Aside from the documented role of ultraviolet light, SCC may arise in areas of chronic scarring, such as in lesions of discoid LE. Iatrogenic immunosuppression associated with organ transplantation also results in a predisposition to SCC, often with multiple tumors. A role for certain human papillomaviruses (HPV) in the development of squamous cell carcinoma has been documented; specifically, HPV types 5 and 8 are detected in SCCs in patients with epidermodysplasia verruciformis and in recipients of organ transplants. HPV-11 is generally found in benign genital condylomata or laryngeal papillomas, but has not yet been associated with malignancy. We describe a patient with non-scarring cutaneous LE who was treated with azathioprine and prednisone and developed multiple SCCs. HPV-11 DNA and the target oncogenes neu and Ki-ras were detected in tumor tissue with the polymerase chain reaction. The HPV may have been involved in tumor induction and the azathioprine may have been involved in tumor promotion.

Acute Disease↗
PubMed1992

Provocation of pseudoseizures by psychiatric interview during EEG and video monitoring.

OBJECTIVE: This paper discusses a new technique for diagnosing pseudoseizures. The technique consists of an intensive psychiatric interview designed to provoke a pseudoseizure during EEG and video monitoring. We wished to determine the overall efficacy of the technique and learn how our patients felt about having undergone the procedure. We were also interested in whether their seizures persisted approximately three years later. METHOD: We reviewed medical records and conducted telephone interviews with thirty of thirty-two patients who had previously undergone the procedure as part of an evaluation for unusual or intractable seizures. All evaluations had been performed on a university hospital neurology service. The patients were consecutive referrals to the consultative psychiatry service for suspicion of pseudoseizures. RESULTS: Nineteen of the thirty-two patients interviewed had a pseudoseizure under EEG and video monitoring. Of the thirty reached by telephone for follow-up, twenty-two recalled the procedure as helpful or benign. None regarded the overall psychiatric consultation negatively. Among the patients who had exhibited pseudoseizures there was a variety of psychiatric diagnoses with a preponderance of personality disorders. Two thirds of those patients without coexisting epilepsy stopped having seizures or rarely had seizures following their evaluations. CONCLUSIONS: The diagnostic technique described here is useful in patients with possible pseudoseizures. It does not appear to be harmful when employed as part of a comprehensive psychiatric consultation. How it may compare with other methods of pseudoseizure diagnosis will have to be determined by further study.

Adolescent↗
PubMed1992

Atypical melanocytic nevi. Clinical and histopathologic predictors of residual tumor at reexcision.

BACKGROUND: The appropriate method for surgical management of melanocytic lesions with disordered architecture and melanocytic atypia (formerly dysplastic nevi) has been controversial. Physicians often reexcise these lesions after primary removal because of their potential relation to malignant melanoma. The outcomes of these reexcisions and the original biopsy specimens have not been previously examined. OBJECTIVE: The purpose of this study was to examine reexcision specimens and their respective original specimens to determine whether there were any characteristics predictive of the presence of residual nevus cells (RNCs) on reexcision. METHODS: One hundred eighty-nine reexcision specimens of atypical melanocytic lesions were evaluated for this study. The original specimens were examined for specific histopathologic features without knowledge of the findings on reexcision. Clinical characteristics were also examined. RESULTS: Of the 189 reexcision specimens, 47 (24.9%) contained RNCs. The proportion of specimens with RNC on reexcision was significantly greater if the original lesion was removed by punch biopsy rather than by shave or elliptical excision (38.3% vs 22.0% vs 10.5%, respectively; p < 0.03). Lesions located on the chest had a higher likelihood of RNCs than those on the back or leg (52.2% vs 21.7%; p = 0.009; 52.2% vs 9.7%, p < 0.002, respectively). Mean age was greater in those with RNCs at reexcision than those without (43.6 vs 37.9 years, respectively; p < 0.0001). The proportion of specimens with RNCs at reexcision was greater in those that had both lateral margins involved than in those that had nevus cells in either one or neither of the lateral margins in the original biopsy specimens (39.7% vs 24.0% vs 7.8%, respectively; p = 0.0005). One of the 189 reexcision specimens (0.5%) contained melanoma, although the original histopathologic diagnosis was an atypical melanocytic nevus. CONCLUSION: We identified several clinical and histopathologic factors that are strongly associated with the presence of RNCs on reexcision.

Adolescent↗
PubMed1992

Lateral cervical radiographs and adenoid size: do they correlate?

Clinicians have questioned the value of lateral soft tissue neck x-ray (LSTN) in assessing adenoid size. Elaborate cephalometric assays have been devised to measure degree of nasopharyngeal obstruction secondary to adenoid hypertrophy. This study prospectively studied 73 children, aged 11 months to 13 years, with clinical evidence of adenoid hypertrophy to assess how well a LSTN correlates with direct intraoperative observation of adenoid size and nasopharyngeal obstruction. We found a relatively weak correlation (Pearson coefficient r = 0.34) between x-ray and operative observations. We conclude that LSTN is an appropriate examination in the preoperative assessment of children being considered for adenoidectomy. However, this test must be interpreted by recognizing the inherent limitations of evaluating a dynamic structure, such as the nasopharynx, through a non-dynamic modality.

Adenoids↗
PubMed1991

Polymerase chain reaction amplification of Trypanosoma cruzi kinetoplast minicircle DNA isolated from whole blood lysates: diagnosis of chronic Chagas' disease.

A 6 M guanidine-HCl/0.2 M EDTA solution was used to lyse and store whole blood specimens. DNA stored in guanidine-EDTA-blood (GEB) lysate was found to be undegraded after incubation at 37 degrees C for 1 month, suggesting that this represents an appropriate reagent for transport of blood samples from the field to a laboratory for analysis. Trypanosoma cruzi kinetoplast DNA in GEB lysate can be cleaved using the chemical nuclease, 1,10-phenanthroline-copper ion (OP-Cu2+). This procedure liberates linearized minicircle molecules from network catenation, distributing them throughout the lysate, and allowing a small aliquot of the original lysate to be analyzed by PCR amplification. This increases the sensitivity of the method dramatically for the detection of small numbers of trypanosomes in a large volume of blood. DNAs isolated from aliquots of T. cruzi-positive GEB lysates were polymerase chain reaction (PCR)-amplified with 3 sets of T. cruzi-specific kDNA minicircle primers, yielding the 83-bp and 122-bp conserved region fragments and the 330-bp variable region fragments. The PCR products were analyzed by gel electrophoresis and/or hybridization. Results indicate that a single T. cruzi cell in 20 ml of blood can be detected by this method. Blood samples from several chronic chagasic patients were tested. Amplification of T. cruzi kDNA minicircle sequences was obtained in al cases, even when xenodiagnosis was negative. This PCR-based test should prove useful as a replacement or complement for xenodiagnosis or serology in clinical and epidemiological studies of chronic Chagas' disease.

Animals↗
PubMed1989

Pruritic urticarial papules and plaques of pregnancy and its relationship to maternal-fetal weight gain and twin pregnancy.

Thirty women who were seen at our institution between 1984 and 1988 for pruritic urticarial papules and plaques of pregnancy (PUPPP) were retrospectively evaluated and interviewed. We found a significantly increased maternal weight gain and newborn birth weight in patients with PUPPP, compared with age and parity-matched controls. The average weight gain during pregnancy was 18.1 +/- 0.9 (SEM) kg for the patients with PUPPP (excluding twin gestations) and 14.6 +/- 1.0 kg for the controls. The mean newborn birth weight was 3.6 +/- 0.09 kg for the PUPPP group and 3.3 +/- 0.08 kg for the control group. There were three twin pregnancies (10%), compared with the twin gestation rate at our institution of 1.6%. Therefore, based on our findings of an increased maternal weight gain and neonatal birth weight, an increased twin rate, and an abdominal eruption that occurs in primigravidas in their third trimester of pregnancy, we suggest that abdominal distention or a reaction to it may play a role in the development of PUPPP.

Birth Weight↗
PubMed1988

Changes in substrate metabolism and effects of excess fatty acids in reperfused myocardium.

The purpose of these studies was to characterize the rates of fatty acid oxidation in reperfused myocardium and test the influence of excess fatty acids (FA) on mechanical function in the extracorporeally perfused, working swine heart model. Seventeen animals were prepared. Eight were untreated (LOW FA group; serum FA averaged 0.55 +/- 0.07 mumol/ml) and nine received a constant infusion of 10% Intralipid with heparin to raise serum FA to about 1.4 +/- 0.21 mumol/ml (HIGH FA group). Coronary flow in both groups was held at aerobic levels for an equilibrium period of 40 minutes, acutely reduced regionally in the anterior descending circulation by 60% for 45 minutes, and acutely restored to aerobic levels for 60-minute reflow. Appreciable mechanical depression (-47 delta% from aerobic values; p less than 0.01) during reperfusion was noted in both groups. This was associated with modest reductions in myocardial oxygen consumption (p less than 0.05) and losses of total tissue carnitine stores (p at least less than 0.02). Reperfused myocardium showed a strong preference for and aerobic use of FA during reflow such that 14CO2 production from labeled palmitate exceeded preischemic levels (+89 delta% in LOW FA hearts; +111 delta% in HIGH FA hearts). This suggested relative preservation of restoration of certain elements in mitochondrial function during reflow. The findings argue for uncoupling between substrate metabolism and energy production, accelerated but useless energy drainage, or some impairment between energy transfer and function of contractile proteins as possible explanations for the persistent depression of mechanical function (stunning) during reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Schistosoma mansoni: characterization of clones maintained by the microsurgical transplantation of sporocysts.

Five male and 5 female clones of Schistosoma mansoni were established and maintained for 3 yr by the serial microsurgical transplantation of sporocysts from infected to uninfected Biomphalaria glabrata snails. The clones were initially derived from 10 randomly selected snails with monomiracidial infections. Clones were characterized by several criteria, including their infectivities for mice and snails, their cercarial outputs, and their ability to produce immunity in mice. The mean infectivities of individual clones in mice ranged from 26 to 44%, and were highly consistent within each clone. The infectivities of cloned sporocysts in snails ranged from 44 to 100% and were also highly consistent within clones. Mean cercarial outputs from individual clones ranged from 450 to 4,300 per snail. In mice, clones differed significantly from each other in their ability to immunize and in their susceptibility to immunity. Each clone was unique and did not appear to differ with time or subpassaging through snails, suggesting that the differences had a genetic basis.

Animals↗
PubMed1987

Hepatic infarcts: new observations by CT and sonography.

Until recently hepatic infarcts were rarely diagnosed before autopsy and were nearly always fatal. Four cases of hepatic infarcts, three of them nonfatal, were diagnosed and followed by CT (three cases), sonography (two cases), arteriography (two cases), and sulfur colloid liver-spleen scan (one case). In three patients with multiple subsegmental hepatic infarcts, most of the lesions were round or oval and centrally located. Only a minority of the lesions were wedge-shaped and peripheral. The early lesion appears hypoechoic on sonography, and CT shows a poorly demarcated low-density region. Later, lesions become confluent with more distinct margins. Bile lakes are a late sequela of large infarcts. Gas formation within sterile infarcts is newly described in two cases. Hepatic infarcts have a variable appearance on CT and sonography and are not reliably distinguished from other lesions such as abscess or necrotic neoplasm.

Adult↗
PubMed1986

Dilatation of the common bile duct secondary to a hydronephrotic kidney.

Obstruction of the common bile duct secondary to hydronephrosis is uncommon. We observed common bile duct dilatation secondary to marked right hydronephrosis. Following nephrectomy the common bile duct returned to normal size, confirming the suspicion that the dilatation was due to extrinsic compression.

Adult↗
PubMed1986

Benign schwannomas: pathologic basis for CT inhomogeneities.

Four cases of pathologically proven benign schwannoma were reviewed and the histology was compared with the CT appearance. Each tumor was of mixed CT attenuation, which has been thought to be an indication of malignancy. The areas of inhomogeneity on CT in these cases may relate pathologically to confluent areas of hypocellularity adjacent to densely cellular or collagenous regions, xanthomatous change, and/or regions of cystic degeneration. It is concluded that schwannomas may have areas of mixed attenuation on CT, that these areas can probably be explained by distinct findings on pathologic examination, and that inhomogeneity can represent benign or malignant disease.

Adult↗