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Biomedical subjects

M A Cohen

Publications and source records attributed to M A Cohen.

At least 19 recordsLinked to original sources
PubMed1997

Pelvic computed tomography of breast carcinoma patients. Should it routinely be added to abdominal computed tomography?

BACKGROUND: This study was conducted to determine if pelvic computed tomography (CT) should routinely be appended to abdominal CT in the workup of patients with breast carcinoma. METHODS: The abdominal-pelvic CTs of 139 breast carcinoma patients (195 exams) were reviewed. Scans were grouped by indication and whether pelvic pathology was known before CT. Pelvic CT results were correlated with their effect on patient management. RESULTS: Among the 119 patients without pre-CT evidence of pelvic disease, a nonosseous pelvic metastasis was identified in only 1; this patient also had liver metastases and management was not changed. No unsuspected pelvic CT finding altered therapy for breast carcinoma. However, three patients underwent surgery for asymptomatic masses discovered on pelvic CT; all were benign. CONCLUSIONS: Pelvic CT is unlikely to affect the management of patients with breast carcinoma by detecting occult metastatic disease.

Abdominal Neoplasms↗
PubMed1997

Is there a causal relationship between alcohol use and violence? A synthesis of evidence.

This chapter reviews the evidence bearing on the question of whether those individuals who consume alcohol have an increased probability of subsequent violent behavior. Four bodies of relevant research are examined: experimental studies with animals, experimental studies with humans, individual-level correlational studies, and macro-level correlational studies. All these research approaches provide some evidence of an association between alcohol consumption and violent behavior, but no firm conclusion can be drawn about whether alcohol plays a causal role in such behavior. Various limitations, deficiencies, and ambiguities of available research that contribute to this state of affairs are discussed.

Alcohol Drinking↗
PubMed1997

Costs of gunshot and cut/stab wounds in the United States, with some Canadian comparisons.

This article estimates the costs of U.S. gunshot and cut/stab wound by intent. It also compares U.S. to Canadian gunshot experience. Incidence data are from published sources, the National Hospital Ambulatory Medical Care Survey (NHAMCS), and cause-coded emergency department discharge and hospital discharge data systems. Medical care payments and lost earnings per case come from National Crime Survey data, a literature review, and weighting of costs by diagnosis from Databook on Nonfatal Injury-Incidence. Costs, and Consequences by Miller et al. (The Urban Institute Press, Washington, DC. 1995) with the diagnosis distribution of penetrating injuries from the discharge data systems. Quality of life losses are estimated primarily from jury awards to penetrating injury victims. In 1992, gunshots killed 37,776 Americans; cut/stab wounds killed 4095. Another 134,000 gunshot survivors and 3,100,000 cut/stab wound survivors received medical treatment. Annually, gunshot wounds cost an estimated U.S. $126 billion. Cut/stab wounds cost another U.S. $51 billion. The gunshot and cut/stab totals include U.S. $40 billion and U.S. $13 billion respectively in medical, public services, and work-loss costs. Across medically treated cases, costs average U.S. $154,000 per gunshot survivor and U.S. $12,000 per cut/stab survivor. Gunshot wounds are more than three times as common in the U.S. than in Canada, which has strict handgun control. With the same quality of life loss per victim, gunshot costs per capita are an estimated U.S. $495 in the U.S. vs U.S. $180 in Canada. Per gun, however, the costs are higher in Canada, Gunshot wound rates rise linearly with gun ownership.

Canada↗
PubMed1997

Impact of core biopsy on the surgical management of impalpable breast cancer.

OBJECTIVE: The purpose of this study was to compare impalpable breast carcinomas revealed by core biopsy with those revealed by surgical biopsy with respect to the frequency of performing a single surgical procedure and finding tumor at the margins of the lumpectomy specimen. MATERIALS AND METHODS: Retrospective review found 197 solitary impalpable breast carcinomas revealed by core biopsy using a 14-gauge needle (n = 90) or surgical biopsy after needle localization (n = 107). Lumpectomy was the surgical treatment in 62 (69%) of the 90 cancers revealed by core biopsy and in 74 (69%) of the 107 cancers revealed by surgical biopsy. Records were reviewed to determine the number and type of surgeries performed on each patient and the histopathologic findings at surgery. Lumpectomy margins were considered positive if tumor was present at the inked margins of a lumpectomy performed as a separate procedure after the diagnostic biopsy. RESULTS: A single surgical procedure was performed 76 (84%) of the 90 patients who underwent core biopsy versus 31 (29%) of the 107 patients who underwent surgical biopsy. This difference was statistically significant (p < .00001). Tumor was present at the lumpectomy margins in five (8%) of the 62 cancers revealed by core biopsy versus four (5%) of the 74 cancers diagnosed by surgical biopsy. This difference was not statistically significant (p = .7). CONCLUSION: A single surgical procedure was performed significantly more often in patients in whom impalpable breast cancer was revealed by core biopsy. The likelihood of obtaining tumor-free margins at lumpectomy did not differ significantly for cancers revealed by either method. These data indicate that core biopsy provides the information necessary to plan surgical treatment and could decrease the number of surgical procedures required in patients with impalpable breast cancer.

Biopsy↗
PubMed1997

The changing face of long-term care insurance in 1994: profiles and innovations in a dynamic market.

This study examines buyers and nonbuyers of long-term care insurance. The findings show that consumers purchased more comprehensive products in 1994-95 than they did in 1990, and that they appeared to get better value for the premium dollar. While annual sales are increasing at a rate of 25%, the market for long-term care insurance remains small, and many of the market barriers that existed four to five years ago persist today. These include confusion about public coverage, concerns about the adequacy of products and how to choose them, policy cost, and inadequate information about potential risk for needing long-term care. As states target limited public funds toward the indigent, older middle-class people will have to deal with exposure to risk for long-term care, and insurance may be one way to minimize this exposure.

Age Factors↗
PubMed1997

Does the BJGP need more fizz and pop?--A Midland Faculty readership survey.

BACKGROUND: The British Journal of General Practice (BJGP) is the leading primary care journal in the world. By impact factor, it ranks 24th of all medical journals. However, despite major changes in the journal since its inception in 1954, there have been no published readership surveys since a limited report in 1969. AIM: To canvass members of the Midland Faculty and to add to the debate about the future of the BJGP. METHOD: A postal questionnaire was sent to a random sample of 299 members, fellows and associates of the Midland Faculty asking for their views about the BJGP. RESULTS: Two hundred replies were received (a response rate of 67%). The median year of qualification of responders was 1981, and 32 (16%) held academic posts. Ninety-nine (49%) disagreed with the present format of the BJGP, which compared poorly with the British Medical Journal (BMJ) in simple rank order of importance. Readership was equal to that of the BMJ (93% reading it within 28 days of arrival), but fewer people read it within a week of receiving it. The most popular sections were the editorials, original articles and letters; least popular were the book reviews and the pull-out magazine, Connection. All sections were rated excellent to average. Readers wished for an expansion of the BJGP to include clinical reviews, medical politics and humorous pieces. Most responders felt that Connection should remain separate. There was dissatisfaction with the delay between submission and publication of original articles, particularly among the academic general practitioners (GPs). Academics and fundholders did not differ from other readers in their views of the content or style of the BJGP. Half of the responders stated that the BJGP should be self-financing and should be open to more advertising. Responders' free comments largely related to improving the style of articles and expanding the BJGP. CONCLUSION: There is a view that the present BJGP is not relevant to the non-academic GP. This is probably due to style rather than content. Simple comparisons with a weekly multi-disciplinary journal may not be valid. The style could be updated to improve retention of information and to highlight areas of particular relevance. Readers are satisfied with the core content of the BJGP but want it to expand to include humour, clinical reviews and medical politics, for example. There is no evidence that the BJGP is more appealing to the academic GP. This study supports an expanded BJGP with an improved style.

Data Collection↗
PubMed1996

Androgen-induced proliferation in the developing larynx of Xenopus laevis is regulated by thyroid hormone.

Exposure to exogenous androgen regulates cell number in the developing larynx of Xenopus laevis and hormone-regulated laryngeal development requires secretion of thyroid hormone (TH). We sought to determine whether exposure to TH is both sufficient and necessary for androgen-evoked cell proliferation (androgen competency) in developing larynx. Androgen competency was not observed in the premetamorphic larynx (tadpole stage 53, before TH secretion) but was present just prior to metamorphic climax (stage 58, during TH secretion). However, when TH is administered precociously (between stages 48 and 50), androgen competency can be observed at stage 53. The stage 52 larynx expresses high levels of the mRNA for TH receptor alpha. The duration of TH exposure required at tadpole stage 48 is greater than 2 days; studies in juveniles indicate that TH exposure need not be maintained in order for androgen competency to persist. The effects of exposure to TH on androgen competency are long lasting and perhaps permanent. While organotypic cultures obtained from tadpoles during premetamorphosis (stage 52) can proliferate in vitro and proliferation is augmented by TH exposure as it is in vivo, precocious exposure to TH does not induce androgen competency. In contrast, androgen does evoke cell proliferation in cultures obtained from metamorphosing (stage 58) tadpoles; proliferation is confined to the cartilage component. Thus, unlike larynges in vivo, muscle will not proliferate in response to androgen, indicating the necessity for an additional factor not present in vitro. Androgen receptor mRNA expression, believed required for androgen competency, was assessed in vivo and in vitro. The tadpole larynx strongly expresses AR mRNA, expression does not require exposure to TH nor is expression diminished in culture.

Animals↗
PubMed1996

Androgen receptor mRNA expression in Xenopus laevis CNS: sexual dimorphism and regulation in laryngeal motor nucleus.

Using Northern analysis, in situ hybridization, and nuclease protection assays, the expression and regulation of androgen receptor messenger RNA (AR mRNA) was examined in the CNS of juvenile Xenopus laevis. Only one of the AR mRNA isoforms expressed in X. laevis is transcribed in the CNS as shown by Northern blot analysis. Nuclease protection assays demonstrate that the expression of AR mRNA is higher in the brain stem than in the telencephalon and diencephalon. Although expression of AR mRNA is widespread throughout the CNS, cells of cranial nerve nucleus IX-X (N.IX-X) and spinal cord display the highest in situ hybridization signals in their cytoplasm. Double labeling using horseradish peroxidase and digoxigenin labeled AR probes reveals that laryngeal and anterior spinal cord motor neurons express AR mRNA. More cells express AR mRNA in N.IX-X of males than of females. The number of AR expressing cells in N. IX-X decreases following gonadectomy in both sexes, and dihydrotestosterone (DHT) treatment for 1 month reverses this effect. Increased expression of AR mRNA in the brain of DHT treated animals is also apparent in nuclease protection assays. Sex differences in number of AR expressing cells and hormone regulation of AR mRNA expression in motor nuclei may influence neuromuscular systems devoted to sexually differentiated behaviors.

Animals↗
PubMed1996

Sparfloxacin worldwide in vitro literature: isolate data available through 1994.

Sparfloxacin is a piperazinyl, cyclopropyl-fluoroquinolone with broad-spectrum antibacterial activity. Compared to other quinolones, sparfloxacin displays improved activity against a variety of pathogens including Staphylococcus, Streptococcus, Enterococcus, Chlamydia, Mycoplasma, Ureaplasma, and Mycobacteria species. Other susceptible organism group include Haemophilus, Legionella, Moraxella, Neisseria, Aeromonas, Acinetobacter, Bordetella, Brucella, Campylobacter, Gardnerella, and Helicobacter species. Most Enterobacteriaceae are also susceptible, whereas most isolates of Pseudomonas aeruginosa are not. Sparfloxacin is bactericidal. Activity is generally stable to variations of inoculum, pH, and cation concentration, and it is unchanged in the presence of 5% sodium cholate or 70% human serum. Susceptibility to the drug is diminished in urine. Cross-resistance, although incomplete, has been documented with other quinolones, but not with other antimicrobic classes.

Anti-Infective Agents↗
PubMed1996

Pseudoangiomatous stromal hyperplasia: mammographic, sonographic, and clinical patterns.

PURPOSE: To analyze the mammographic, ultrasonographic (US), and clinical patterns of pseudoangiomatous stromal hyperplasia (PASH). MATERIALS AND METHODS: Preoperative mammographic and US images, clinical records, and histologic assessments were reviewed in seven cases of PASH as the sole component or dominant stromal component of a clinically or mammographically defined mass lesion. In five, a PASH tumor was diagnosed at image-guided 14-gauge core-needle biopsy; in two, it was diagnosed at surgical excisional biopsy. RESULTS: Four women were premenopausal, two were postmenopausal, and one 40-year-old patient had iatrogenic primary amenorrhea. Four of seven masses were palpable; three were discovered at mammography. Four masses enlarged over 6 months to 5 years. At mammography, all masses lacked calcifications; six were well defined, and one was spiculated. One was inapparent at US; the remaining six were well defined and hypoechoic. CONCLUSION: The diagnosis of this rare lesion with image-guided breast biopsy or surgical biopsy is consistent with a well-defined uncalcified mass at mammography and a solid hypoechoic mass at US, usually in a premenopausal woman.

Adult↗
PubMed1996

Benign and malignant phyllodes tumors: mammographic and sonographic findings.

PURPOSE: To characterize imaging findings that suggest the benign or malignant histologic nature of phyllodes tumors. MATERIALS AND METHODS: Clinical and imaging findings were retrospectively reviewed in 46 women with 51 phyllodes tumors (32 benign, 19 malignant) identified at preoperative mammography. Thirty of these tumors were also evaluated with preoperative sonography. RESULTS: Mammography showed nonspiculated soft-tissue masses in 49 tumors. Four masses contained calcifications; three of these masses were benign. The tumors were 1-20 cm in diameter; tumors 3 cm or larger were statistically significantly more likely to be malignant (P < .004). Sonography showed solid, hypoechoic masses in 28 cases. At sonography, cystic areas were more often seen in malignant than in benign tumors, but the difference was not statistically significant. CONCLUSION: There is substantial overlap in the imaging characteristics of benign and malignant phyllodes tumors. A tumor diameter of 3 cm or greater appears to be associated with a higher likelihood of malignancy.

Adult↗
PubMed1996

Power injection of intravenous contrast material through central venous catheters for CT: in vitro evaluation.

PURPOSE: To determine the feasibility of use of a power injector to deliver contrast material through central venous catheters for computed tomographic (CT) examinations. MATERIALS AND METHODS: Ioversol 240 and iothalamate meglumine 43% were separately injected through three 9.6-F Hickman catheters and three 10.0-F Leonard catheters with a power injector in an in vitro study. Flow rates of 1.0, 1.5, 2.0, and 2.5 mL/sec were tested. Peak pressures were mechanically recorded from two sites. A 95% prediction interval was calculated for each peak pressure, and the upper limits at the prediction interval were evaluated to determine if it was less than the recommended limit of 25 psi (175 kPa). RESULTS: Contrast medium, flow rate, and catheter type each statistically significantly affected the measured peak pressures (P = .0001). For each flow rate tested, the upper limits of the prediction interval for the peak pressure at the connection between the coiled tubing and the catheter were below the manufacturer's specified peak pressure. CONCLUSION: In vitro analysis demonstrates that power injection of intravenous contrast medium through central venous catheters does not exceed the pressure limits of these catheters at the flow rates tested. In vivo testing to evaluate the safety and efficacy of power injection through central venous catheters is necessary.

Analysis of Variance↗
PubMed1996

Core needle biopsy of synchronous ipsilateral breast lesions: impact on treatment.

OBJECTIVE: The purpose of this study was to evaluate the role of core biopsy in the diagnosis of multiple synchronous ipsilateral breast lesions and to determine the impact of this information on patients' management. MATERIALS AND METHODS: Of 371 patients who underwent core-needle breast biopsy under stereotaxic (n = 278) or sonographic (n = 93) guidance, 20 (5%) underwent core biopsy of two mammographically separate lesions in the ipsilateral breast on the same date. Fourteen of these 20 patients subsequently underwent surgery. We retrospectively reviewed the medical, radiographic, and histopathologic records in these 14 patients and in 91 patients with single mammographic lesions diagnosed as carcinoma by means of core biopsy during the same period. RESULTS: In 11 patients, core biopsy revealed two sites of carcinoma. Core biopsy findings in these 11 patients were two areas of infiltrating ductal carcinoma (n = 5), one infiltrating ductal carcinoma and one infiltrating lobular carcinoma (n = 2), one infiltrating ductal carcinoma and one ductal carcinoma in situ (n = 1), and two foci of ductal carcinoma in situ (n = 3). All 11 patients with two core biopsy-proven foci of carcinoma underwent mastectomy. Patients were significantly more likely to be treated with mastectomy if core biopsy revealed two rather than one site of carcinoma (100% versus 38%, p < .001). CONCLUSION: Core-needle biopsy is useful in diagnosing multiple synchronous ipsilateral breast lesions. By showing whether carcinoma is present in one or more sites in the breast, core biopsy can provide information of critical importance in making treatment decisions.

Adult↗
PubMed1995

The synthesis, structure-activity, and structure-side effect relationships of a series of 8-alkoxy- and 5-amino-8-alkoxyquinolone antibacterial agents.

A series of 1-cyclopropyl-6-fluoro-8-alkoxy (8-methyoxy and 8-ethoxy)-quionoline-3-carboxylic acids and 1-cyclopropyl-5-amino-6-fluoro-8-alkoxyquinoline-3-carboxylic acids has been prepared and evaluated for antibacterial activity. In addition, they were also compared to quinolones with classic substitution at C8 (H, F, Cl) and the naphthyridine nucleus in a phototoxicity and mammalian cell cytotoxicity assay. The series of 8-methoxyquinolones had antibacterial activity against Gram-positive, Gram-negative, and anaerobic bacteria equivalent to the most active 8-substituted compounds (8-F and 8-Cl). There was also a concomitant reduction in several of the potential side effects (i.e., phototoxicity and clonogenicity) compared to the most active quinolones with classic substitution at C-8. The 8-ethoxy derivatives had an even better safety profile but were significantly less active (2-3 dilutions) in the antibacterial assay.

Animals↗
PubMed1995

Predicted secondary and supersecondary structure for the serine-threonine-specific protein phosphatase family.

A bona fide consensus prediction for the secondary and supersecondary structure of the serine-threonine specific protein phosphatases is presented. The prediction includes assignments of active site segments, an internal helix, and a region of possible 3(10) helical structure. An experimental structure for a member of this family of proteins should appear shortly, allowing this prediction to be evaluated.

Amino Acid Sequence↗
PubMed1995

Perirectal abscess.

STUDY OBJECTIVE: To review clinical features of perirectal abscesses and to determine appropriate management. DESIGN: Retrospective analysis of medical records. SETTING: Urban teaching hospital. PARTICIPANTS: Ninety-two patients with the discharge diagnosis of perirectal abscess over a 4-year period. RESULTS: Perirectal pain was the most common presenting symptom, being present in 98.9% of cases. External perianal and digital rectal examination identified an abscess in 94.6% of patients. A variety of aerobic and anaerobic bacteria from skin, bowel, and, rarely, vagina were identified as causative agents, with mixed infections common. The major complications of perirectal abscesses included formation of extensive abscesses and urine retention. Abscess resolution occurred in all patients after adequate drainage. Antibiotics appeared to be useful only as adjunct therapy. CONCLUSION: Effective management of perirectal abscess involves early, adequate drainage, with antibiotics in an adjunct role.

Abscess↗