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Biomedical subjects

M J Cohen

Publications and source records attributed to M J Cohen.

At least 19 recordsLinked to original sources

High ligation of the greater saphenous vein for treatment of lower extremity varicosities: the fate of the vein and therapeutic results.

This study was carried out to determine the subsequent fate of the greater saphenous vein and the efficacy of its high ligation along with surgical excision or sclerotherapy of varicosities. From 1988 to 1990, 22 patients underwent high ligation and sclerotherapy, 22 underwent high ligation and varicose vein excision, and four underwent high ligation alone. There were 36 women and 12 men patients. The average patient age was 48. Sixty limbs were scanned by duplex ultrasound pre- and postoperatively to determine the status of the greater saphenous vein. Average follow-up time was 10 months. Patients and surgeons rated the results of therapy for ablation of varicosities and alleviation of symptoms. Surgical complications were evaluated. At postoperative scan, 47 greater saphenous veins (78%) were found to be completely patent, nine (15%) were thrombosed for a short segment (less than 10 cm) and four (7%) were more significantly thrombosed. Those limbs in which high ligation and sclerotherapy were performed had the highest complete patency rate (96%). Patient and surgeon satisfaction was good to excellent in every case. The only complications were three symptomatic greater saphenous vein thromboses. Although follow-up is relatively brief, complete patency of the ligated greater saphenous vein was found in most cases. High ligation allows preservation of a patent greater saphenous vein, which can be used as an arterial conduit at a later date and gives therapeutic results comparable to stripping without the additional morbidity.

Combined Modality Therapy

Event-related brain potentials during orienting to auditory and visual stimulation in spinal cord injured humans.

In intact humans, deprivation of somatosensory and kinesthetic sensations result in significant alterations in perception and information processing. There have been very few studies to discover if the loss of sensation with spinal cord injury (SCI) in humans affects perceptual operations. We hypothesized that the SCI participant would either exhibit arousal, perceptual, and information processing alterations similar to experimentally sensory deprived subjects (who provide the closest human analogue), or that the somatosensory cortex would show reorganization for the processing of other modalities of stimulation. The subjects consisted of 16 paraplegic, 13 quadriplegic, and 22 non SCI controls. Subjects received an auditory orienting task consisting of a 500 Hz tone presented 20 times each at 66, 75, 88, and 101 db and a visual orienting task incorporating light flashes of 115, 123, 131, and 140 lux presented 20 times each. EEG information processing data were recorded from C3 and C4 for 100 msec prior to and 500 msec post stimulation. Information processing variables, analyzed as event-related potentials, indicated that the somatosensory cortex of SCI groups had a flattened response to auditory stimulation. The control group had a significantly larger P2 component. We concluded that these data signified that the somatosensory cortex did not reorganize function in response to chronic deafferentation nor was the SCI subject hyperresponsive to stimulation.

Acoustic Stimulation

Activation, attention, and visuospatial learning in adults with and without a family history of alcoholism.

While recent evidence shows visuospatial information processing deficits to be present in chronic alcoholics, it remains unclear whether such deficits are present prior to alcohol abuse in persons at risk for developing alcoholism. If present, it is also unclear whether the information processing mechanisms underlying these deficits are the same in alcoholics and persons at risk for alcoholism. This study investigated visuospatial information processing psychophysiological activation in adults with and without a family history of alcoholism. Thirty matched nonalcoholics served as participants. Fifteen persons were from families in which at least one biologic parent and one other relative had a history of alcoholism. Another group of 15 persons had no family history of alcoholism. In addition to displaying atypical patterns of learning-contingent physiological activation, participants with a family history of alcoholism displayed visuospatial learning that was significantly poorer than persons with no family history of alcoholism. The learning and physiological activation displayed by the participants with a family history of alcoholism were similar to those displayed by previously studied alcoholics using a similar learning task. The data suggest that visuospatial learning deficits may reflect an antecedent to, rather than a consequence of, chronic alcohol abuse.

Adult

Spatial learning deficits in adult children of alcoholic parents.

This study investigated whether the visuospatial deficits displayed by chronic alcoholics are present in persons at risk for alcoholism. Participants were 34 matched social drinkers, half of whom were children of alcoholic parents and half of whom had no family alcoholism history. Ss with a family history of alcoholism displayed visuospatial learning that was significantly poorer than that displayed by Ss with no family alcoholism history. The learning patterns displayed by those with a family alcoholism history were similar to those displayed by previously studied detoxified alcoholics and young children of alcoholics using a similar learning task. Data suggest that visuospatial learning deficits may reflect an antecedent to rather than a consequence of chronic alcohol abuse.

Adult

Rasch analysis of functional assessment scales: an example using pain behaviors.

Functional assessments associated with rehabilitation frequently rely on scoring systems based upon a limited set of categorical values, arranged in order and intended to represent an underlying performance continuum. Making sense of data generated by these scales is a challenge well met by the Rasch measurement model, which allows detailed investigation of how individuals are likely to perform on a given occasion and indicates whether changes in performance occur in orderly patterns over repeated occasions. Additionally, the Rasch measurement model allows study of the quality of measurement and the degree to which the scoring adequately reflects the underlying, but not directly measurable, continuum. Data gathered at admission and discharge from 330 patients attending a rehabilitation program for chronic low back pain were evaluated using the Rasch measurement model, and the results were contrasted with those from the best available nonparametric technique, ridit analysis.

Back Pain

Digital radiography can reduce scoliosis x-ray exposure.

Digital radiology is a new computerized system of acquiring x-rays in a digital (electronic) format. It possesses a greatly expanded dose response curve that allows a very broad range of x-ray dose to produce a diagnostic image. Potential advantages include significantly reduced radiation exposure without loss of image quality, acquisition of images of constant density irrespective of under or over exposure, and reduced repeat rates for unsatisfactory films. The authors prospectively studied 30 adolescents with scoliosis who had both conventional (full dose) and digital (full, one-half, or one-third dose) x-rays. They found digital made AP and lateral image with all anatomic areas clearly depicted at full and one-half dose. Digital laterals were better at full dose and equal to conventional at one-half dose. Cobb angles were easily measured on all one-third dose AP and on 8 of 10 one-third dose digital laterals. Digital clearly depicted the Risser sign at one-half and one-third dose and the repeat rate was nil in this study, indicating digital compensates well for exposure errors. The study indicates that digital does allow radiation dose to be reduced by at least one-half in scoliosis patients and that it does have improved image quality with good contrast over a wide range of x-ray exposure.

Adolescent

Spatial learning of visual 'nonsense figures' during experimental ethanol intoxication.

The interaction of alcohol and visuospatial learning was evaluated during two experimental sessions. During one session, participants were experimentally intoxicated to obtain a blood alcohol concentration of at least 0.10%. During another session, a nonalcohol placebo was administered. The learning task consisted of a paired-associate paradigm requiring participants to learn the distinct spatial positions of 6 visually presented "nonsense shapes." The visuospatial learning of participants in the placebo condition was generally superior to their learning while intoxicated. However, intercorrelations of performance measures indicated that the relation between alcohol ingestion and performance differences across conditions was not linear.

Adult

Neuropsychologic impairment in children with sickle cell anemia.

In this study, the neuropsychologic functioning of 21 children with sickle cell anemia and 21 sibling controls, age range 7 through 16 years, with no history of neurologic disease, was examined. Outcome measures included tests of intelligence, constructional praxis, memory, and academic learning. On the Wechsler Intelligence Scale for Children--Revised, the sickle cell group had a mean Full Scale IQ of 77.7 (SD 12.4) compared with 94.3 (SD 11.0) for the control group. The profile of test scores was similar for the two groups, with the sickle cell group scoring significantly lower than the control group on almost all cognitive measures. Both groups showed academic achievement to be commensurate with their measured intellectual ability. These results suggest that subtle but significant and widespread neuropsychologic deficits are associated with sickle cell anemia even in the absence of neurologic complications. When and by what process this neuropsychologic impairment is caused needs to be determined.

Adolescent

Sprouts emerging from the dendrites of axotomized lamprey central neurons have axonlike ultrastructure.

We have examined the dendritic and axonal ultrastructure of intact anterior bulbar reticulospinal neurons (ABCs) in the CNS of the larval sea lamprey and compared it with that of the dendrites and neuritic sprouts from ABCs examined 2 months following axotomy. Dendrites and axons of intact ABCs are distinguishable from one another by several ultrastructural criteria: (1) the predominance of microtubules in the dendritic cytoskeleton and neurofilaments in that of the axon, (2) the exclusively postsynaptic status of the dendrites versus the presynaptic status of the axon, and (3) the presence of polyribosomes and large numbers of mitochondria in the dendrites and their respective absence and scarcity in the axon. The ultrastructure of axonal sprouts evoked by axotomy of ABCs 1-1.5 mm from their somata ("intermediate axotomy") in many ways resembled that of intact axons. Axonal sprouts were presynaptic to other neurons, and their cytoskeletons consisted mainly of neurofilaments. They also exhibited some features not seen in either axons or dendrites, such as numerous clusters of small vesicles that were not associated with synapses and, in some cases, close associations with glial elements. We also examined sprouts emerging from the dendrites of ABCs following axotomy within 500 microns of their somata ("close axotomy") and found that such "dendritic" sprouts closely resembled axonal sprouts; they possessed neurofilament-dominated cytoskeletons, were presynaptic to other neurons, and were often associated with glial elements. The dendrites of ABCs undergoing dendritic sprouting retained their normal gross morphology but possessed a mixture of "axonal" and "dendritic" ultrastructural characteristics, exhibiting neurofilament-dominated cytoskeletons while remaining entirely postsynaptic to other neurons. However, there were significantly fewer synapses on the dendrites of axotomized cells than were found on the dendrites of intact ABCs. We conclude that sprouts evoked by axotomy are intrinsically axonal in character whether they originate from the axon stump or from the dendritic tree. Our results also suggest that the materials necessary for axonal regeneration may displace elements of the dendritic cytoskeleton as they are transported through the dendrites to the emerging "dendritic" sprouts following close axotomy.

Animals

Event-related brain potentials in intoxicated and detoxified alcoholics during visuospatial learning.

Event-related potentials and visuospatial learning performance were examined to understand the effects of chronic alcohol use on complex information processing. A total of 18 alcoholic male in-patients in an alcohol treatment program served as participants. Nine persons were seen at time of admission to the program while intoxicated (mean BAC = 18.0 mg/dl). The second group of nine persons was seen detoxified after 4 weeks in the treatment program. Learning consisted of a paired-associate paradigm requiring participants to learn the distinct spatial positions of six, randomly presented "nonsense" shapes. The visuospatial learning performance of the intoxicated alcoholics was superior to that of the detoxified alcoholics. Evaluation of event-related potentials during the visuospatial learning task indicated that while both groups displayed greater right hemisphere amplitudes of P3, P2, N1, and N2-P3 components, the amplitudes of the latter three components were significantly greater in the intoxicated alcoholics. The overall results suggest that compared to the intoxicated alcoholic, the detoxified alcoholic may suffer a disruption in attentional mechanisms related to visuospatial information processing, providing support for a theory that alcohol ingestion serves to balance information processing in the chronic alcoholic.

Adult

Comparison of electromyographic response patterns during posture and stress tasks in chronic low back pain patterns and control.

Activity of the paraspinals, abdominals, and hip extensor muscles, heart rate, and skin conductance were measured in 13 chronic low back pain patients (CLBP) and 13 controls during static postures and psychological stress. After 10 min of baseline-rest, a subject was tested during standing, 45 degrees bend, maximum bend, posterior and anterior pelvic tilts, sitting, and supine with knees up, followed by mental arithmetic and the cold pressor. The postures were grouped into supported, balanced, and unbalanced categories. Multivariate analyses of variance revealed differences due to posture categories, but not due to group membership. It was concluded that while work is needed to understand normal muscle function during common movements, there is no compelling evidence that back muscle functioning in CLBP patients differs significantly from control subjects.

Adult

Synaptic regeneration in identified neurons of the lamprey spinal cords.

Identified reticulospinal neurons whose giant axons were severed after spinal cord transection were filled with horseradish peroxidase. Whole mounts and serial-section light and electron micrographs show axon regeneration across the spinal lesion and the formation of new synapses. Normal swimming activity returns in the spinally transected animals, although the regenerated synapses are in atypical regions of the spinal cord.

Animals

Abuse of amitriptyline.

Amitriptyline hydrocholride (Elavil) is frequently used in treating mild to moderate depressive states. A survey of 346 persons enrolled in a methadone maintenance program showed that 86 (25%) had admitted taking amitriptyline with the purpose of achieving euphoria. Thin-layer chromatography of random urine specimens over five months showed that 34% of the patients had a positive result for amitriptyline at least once during this time. These results suggest that misuse of amitriptyline is not uncommon and should be carefully considered prior to prescribing this agent to narcotic dependent persons.

Amitriptyline

Evidence for physiological response stereotypy in migraine headache.

Several biological theories of psychosomatic disorders predict that susceptible individuals will have stereotypic physiological responses to stress. This hypothesis was tested in a sample of 13 migraine headache subjects by observing their head and hand temperature, frontal electromyography (EMG), heart rate, skin conductance level, and finger pulse amplitude under the conditions of rest, orienting to a tone, time estimation, reaction time, and mental arithmetic. Thirteen nonheadache cohorts served as a control group. For the migraine group, analyses of variance revealed significantly warmer head and hand temperatures and lower frontal EMG. Range-corrected data, which allow comparisons among the physiological measures, showed the migraine group to have a more stereotypic response pattern across tasks. Discriminant analyses, using both untransformed and range-corrected data made excellent post-dictions of group membership.

Acoustic Stimulation