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Biomedical subjects

L Moskowitz

Publications and source records attributed to L Moskowitz.

18 recordsLinked to original sources
PubMed1999

Lightning strikes at a mass gathering.

Among natural disasters, lightning is a leading cause of morbidity and mortality throughout the world. A well-informed bystander and an astute physician can make the difference between an outcome of death or lifelong disability versus complete or near-complete recovery. What is done in the first few minutes after such an event is the predominant predictor of success. This case report describes a young woman who was struck by lightning while talking on a cellular telephone at a mass gathering in an outdoor stadium. The discussion that follows the case centers on the pathophysiology of being struck by lightning and on issues unique to being struck in a stadium full of people.

Adult↗
PubMed1999

Cardiac disease and hypertension. Considerations for office treatment.

This article focuses on four classifications of cardiac disease in an effort to provide the information necessary to recognize, process, and react appropriately to either a patient's symptoms or medical history. Each section covers relevant demographic data, discusses pathophysiology, and describes what the practicing dentist must know about the underlying illness to make treatment decisions about patients. Management issues on cardiac patient care are also discussed.

Dental Care for Chronically Ill↗
PubMed1996

Psychological management of postsurgical pain and patient adherence.

The advantages of proper management of postsurgical pain include fewer postoperative complications; increased early ambulation and mobilization; decreased opportunity for chronic pain syndromes to occur; shorter, less complicated rehabilitation; greater patient satisfaction; and increased patient adherence to prescribed regimens. In turn, greater adherence positively affects pain management and, therefore, patients, satisfaction with their surgeon. A variety of approaches may be used for the management of acute pain, and the "psychological preparation" of the patient prior to surgery plays a significant role. Specific approaches include (1) cognitive-behavioral (such as diaphragmatic breathing, positive visualization rehearsal, and autogenic training); (2) hypnosis; (3) biofeedback; and (4) microelectrostimulation. Some of these approaches to pain management apply during surgery and the recovery and rehabilitation periods. Many of the approaches can be carried out relatively easily by the physician and his or her staff; in some cases, specialists, such as psychologists trained in behavioral medicine, are needed. Variables that affect patient adherence, both positively and negatively, include patient motivations, the nature and chronicity of the disorder, treatment variables, and the quality of the patient-doctor relationship. Physician behaviors may encourage or discourage patient adherence.

Biofeedback, Psychology↗
PubMed1994

Hyaluronate distribution in the regenerating retinal pigment epithelium of the rabbit: a study using confocal laser scanning microscopy.

The distribution of hyaluronate (HA) in regenerating retinal pigment epithelium (RPE) of the rabbit was examined using immunohistochemistry and confocal laser scanning microscopy. The goal was to determine if there is a correlation between differentiation and HA expression, like that seen in developing tissues, where HA accumulates and then disappears as the tissue matures. In normal RPE cells HA is associated mainly with the apical surface. In regenerating RPE (produced by i.v. injection of sodium iodate to damage the epithelium, regeneration arising from spared cells), HA exhibits a patchy distribution among the more immature cells and is especially prominent where they overlap or pile up on each other. Where cells are more mature and form a compact monolayer of cells, HA is expressed mainly on the apical surface, as in normal RPE. The accumulation of HA among the more immature cells in the regenerating epithelial sheet supports the hypothesis that HA influences differentiation by suppressing cell-cell associations until the proper time for their formation.

Animals↗
PubMed1990

Extranodal T-cell lymphoma mimicking malignant histiocytosis.

We report a case of extranodal T-cell lymphoma with fever, hepatosplenomegaly, pancytopenia, and diffuse sinusoidal infiltration of the spleen, liver, and bone marrow by the tumor cells, mimicking malignant histiocytosis. This is the second case of T-gamma (T-cell suppressor) lymphoma resembling the case reported by Kadin et al. [N Engl J Med 304:648, 1981]. The lack of lymph node involvement in this case supports the theory that this type of lymphoma arises in the spleen. This paper draws attention to the extranodal T-cell lymphoma groups that mimic malignant histiocytosis and the need of immunophenotyping for a correct diagnosis. The causes for the absence of T-cell receptor gene rearrangement in T-cell tumors are discussed.

Adult↗
PubMed1990

Directional atherectomy in the treatment of stenotic dialysis access fistulas.

Directional atherectomy has proved useful in the treatment of peripheral vascular occlusive disease, and the authors have begun using this modality in the treatment of patients with failing hemodialysis access fistulas. The authors describe their initial experience with 13 patients in whom directional atherectomy was used to treat stenotic hemodialysis fistulas. Directional atherectomy was the sole treatment modality for eight patients. Three patients underwent atherectomy after unsuccessful percutaneous transluminal angioplasty (PTA). In two patients, unsuccessful atherectomy necessitated subsequent PTA. Directional atherectomy was successful in 10 of 13 patients. In seven of these 10 patients who are still alive, the dialysis fistulas remain patent. Directional atherectomy is a safe and useful technique in the percutaneous treatment of hemodialysis fistula stenosis. Early data indicate patency rates that may be higher than those reported with PTA.

Arteriosclerosis↗
PubMed1987

Neurologic disease as the presenting manifestation of acquired immunodeficiency syndrome.

Neurologic disease was the harbinger of the acquired immunodeficiency syndrome (AIDS) in 26 (20%) of 132 patients and ultimately developed in 83 (63%). The most common neurologic disorder heralding AIDS was toxoplasmic encephalitis (17 cases) followed by cryptococcal meningitis (six), retinitis (three), progressive multifocal leukoencephalopathy (two), neuropathy (one), myopathy (one), and subacute "viral" encephalitis (one). In four patients, more than one neurologic disorder coexisted at presentation. Recognition of underlying human T cell lymphotropic virus type III (HTLV-III) infection may allow a more expedient determination of the cause of the neurologic disease. Our study emphasizes the importance of testing for the presence of HTLV-III antibody and assessing the immunologic status of all patients at risk for AIDS who have neurologic illness.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Pathology of the heart in acquired immunodeficiency syndrome.

Data on 54 persons who died of acquired immunodeficiency syndrome were reviewed for lesions of the heart. These persons met the criteria of the Centers for Disease Control (Atlanta) for acquired immunodeficiency syndrome. Pathologic changes were seen in 30 patients (55%). Changes were seen in the endocardium (17%), myocardium (83%), and epicardium (3%). The most frequent finding was lymphocytic myocarditis. Six of these were due to Toxoplasma myocarditis. Only one patient succumbed to cardiac arrest.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Immediate causes of death in acquired immunodeficiency syndrome.

We evaluated the immediate causes of death in 54 adults who underwent an autopsy and were diagnosed as having died of the acquired immunodeficiency syndrome between April 1980 and October 1983. The study group included 25 Haitians, 19 homosexual men, five intravenous drug abusers, two hemophiliacs (type A), and three with no known risk. Fourteen died of central nervous system diseases: 11 of Toxoplasma encephalitis, one of progressive multifocal leukoencephalopathy, one of viral encephalitis, and one of intracerebral hemorrhage. Thirty died of respiratory failure; 16 of Pneumocystis carinii pneumonia, ten of cytomegalovirus pneumonia, one of multiple infections, one of interstitial pneumonia, and two of bacterial pneumonia. Two died of overwhelming generalized infections: one of Mycobacterium avium-intracellulare and one of listeriosis. Six died of disseminated Kaposi's sarcoma, while the remaining two persons died of Toxoplasma myocarditis (one) and one of shock resulting from a percutaneous liver biopsy, respectively. There were differences in the immediate causes of death between Haitians and homosexuals as follows: 63% of homosexual men died of either P carinii pneumonia or Kaposi's sarcoma vs 20% of Haitians. In contrast, 72% of Haitians died of other opportunistic infections as compared with 21% of homosexuals. There has not been an increase in the proportion of cases diagnosed premortem since 1982 and overall, only 32 (58%) were diagnosed premortem; the rest were diagnosed only at autopsy. This study provided evidence that 42% died of currently untreatable diseases.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Glomerular lesions in the acquired immunodeficiency syndrome.

Between January 1982 and December 1983, 75 patients with the acquired immunodeficiency syndrome were identified in our hospitals: 35% used intravenous drugs, 50% had proteinuria in excess of 0.5 g/dL, and 10% were nephrotic. Glomerular changes seen at autopsy in 36 patients included frequent mesangial lesions and deposits associated with mild asymptomatic proteinuria. Focal and segmental glomerular sclerosis was found in 5 patients and 4 of these had the nephrotic syndrome. Whereas reversible episodes of acute renal failure were not uncommon, terminal episodes of acute renal insufficiency occurred in 14 patients. The short survival of these patients may prevent the development of chronic renal failure.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Disseminated Mycobacterium avium-intracellulare infection appearing as a panniculitis.

A 34-year-old woman had wide-spread panniculitis due to a disseminated infection with Mycobacteria avium-intracellulare. The patient had previously received treatment with high dosages of corticosteroids. Suppurative lesions teeming with acid-fast bacilli and without formation of granulomas were found in many organs, including the skin, mediastinum, spleen, liver, and gastrointestinal tract. Both the appearance of disseminated M avium-intracellular infection resembling panniculitis and the involvement of mediastinum have not previously been reported, to our knowledge.

Adrenal Cortex Hormones↗
PubMed1982

Postmortem vitreous humor in fatal acute iron poisoning.

The postmortem level of iron in the vitreous humor was assayed in a case of treated fatal iron poisoning. An antemortem serum iron level was 9060 micrograms/dL and postmortem blood level was 2920 micrograms/dL. A postmortem vitreous humor specimen collected by a standard technique had an iron level of 80 micrograms/dL whereas 23 controls had a mean of 12.8 +/- 4.2 micrograms/dL (range, 6 to 21 micrograms/dL). Although this elevated value could reflect some serum contamination, it may be a reflection of the toxic state.

Death↗
PubMedDate not supplied

Nasopharyngeal angiofibromas: staging and management.

We propose a system for staging nasopharyngeal angiofibromas based on clinical evaluation and computerized tomography. Twenty-three patients with this pathologic diagnosis have been managed at the University of Miami/Jackson Memorial Medical Center in the past two decades. In 13 patients, the clinical diagnosis was confirmed by transnasal biopsy as a minor outpatient procedure. This avoided unnecessary diagnostic studies, shortened the hospital stay, and expedited treatment. Computerized tomography has replaced conventional x-ray studies and routine tomography, although angiography is still necessary for proper evaluation of larger tumors. Stage groupings recommended on the basis of this experience are stage I--tumor confined to nasopharynx; stage II--tumor extending into nasal cavity and/or sphenoid sinus; stage III--tumor extending into one or more of the following: antrum, ethmoid sinus, pterygomaxillary and infratemporal fossae, orbit, and/or cheek; and stage IV--tumor extending into cranial cavity. Surgical excision is recommended for stages I, II, and III. Stage IV tumors require surgical resection and/or radiation therapy with the possible addition of hormonal therapy.

Adolescent↗
PubMedDate not supplied

Vasodilator therapy in acute myocardial infarction.

In the context of these studies, the evidence indicates that cardiac performance can improve significantly during vasodilator therapy in acute MI complicated by pump failure. Although the clinical course in uncomplicated patients is good, even without active therapeutic interventions, prognosis in patients with pump failure treated by standard methods (digitalis and diutetics) is discouraging. Hospital mortality approaches "40 per cent in patients with moderately depressed cardiac function and may reach as high as 100 per cent in patients with severe pump failure and/or cardiogenic shock." The evidence presented suggests that early and cautious vasodilator therapy may significantly alter this poor prognosis by its beneficial effects on both LV function and the determinants of myocardial oxygen consumption.

Blood Pressure↗
PubMedDate not supplied

Congenital syphilis and necrotizing funisitis.

During the past 5 years we encountered 16 cases of necrotizing funisitis, a deeply seated inflammatory process within the matrix of the umbilical cord, and established that all of them were associated with maternal and congenital syphilis. During that time necrotizing funisitis was not found to be associated with any other infection. The relationship was unexpected on the basis of current knowledge of the condition, but we found the older medical literature documents syphilis as the virtually specific cause of deep funisitis with angiophlebitis. Necrotizing funisitis has a characteristic macroscopic appearance, the "barberpole" cord, that permits the presumptive diagnosis of congenital syphilis at the time of birth.

Autopsy↗