Biomedical subjects

M L Lesser

Publications and source records attributed to M L Lesser.

At least 55 records · Page 3Linked to original sources

PubMed1989

Clinical trial of single-dose intravenous gamma globulin in acute Kawasaki disease. Preliminary report.

Gamma globulin administered in a single dose of 1 g/kg of body weight intravenously caused prompt clinical improvement in 27 of 32 consecutive children with Kawasaki disease treated by the 12th day of illness. Response was equally good for the 20 children treated in the first week and the 12 treated in the second week. Fever and clinical signs abated within the first day after treatment, the mean white blood cell count normalized by 48 hours, and the sedimentation rate continued to be elevated for about 2 weeks, while the platelet count rose during the first 2 weeks after treatment and returned to normal approximately 1 month after treatment. Five children with incomplete relief needed more than the single dose before resolution of signs and symptoms occurred. Coronary aneurysms in 2 patients before treatment regressed by 2 weeks. No patient developed coronary aneurysms. No child had sequelae of Kawasaki disease at a follow-up of 2 to 31 months. We believe that although this was a one-arm, uncontrolled pilot study, the results suggest that this protocol provides a safe, flexible, and effective treatment for acute Kawasaki disease.

Acute Disease↗

PubMed1989

Nursery privileges of the private attending pediatrician in the care of critically sick neonates in New York state.

To determine the role of the private attending pediatrician in caring for newborns who require intensive, intermediate, or continuing care in New York state, a request was sent to New York state institutions to select the statement best describing private attending pediatrician privileges. Privileges were graded from 1 to 6 with category 1 allowing the private attending pediatrician to care for all newborns and category 6 not allowing the private attending pediatrician to care for any newborns. Nurseries were classified (per New York State Department of Health) as regional, nonregional intensive care, intermediate care, and continuing care centers. A total of 97% (88/90) of institutions responded, representing 2,040 private attending pediatricians. In 95% (79/83) of the New York state institutions with staff private attending pediatricians, the pediatricians' privileges were limited. In 18% (15/83), the private attending pediatrician does not supervise any newborns receiving special care, whereas in an additional 77%, pediatricians' privileges have been limited. Despite this, the majority of institutions encourage the private attending pediatrician to continue communication with the family. Limited hospital privileges coupled with continued family communication may be the future trend for private attending pediatricians in the hospital setting.

Communication↗

PubMed1989

Rug shampoo and Kawasaki disease.

Following personal interviews with 63 families of children with Kawasaki disease and with 63 control families with children paired for race, sex, and age, no epidemiologic differences were seen except for use of rug shampoo within 1 month of onset in 16 episodes in 15 children with Kawasaki disease in 14 families (24% of children, 22% of families) compared with two families of control children (3%, P less than .005). Explanations for this strong association of recent rug shampoo and Kawasaki disease include the question of recall bias as well as the possibility that an agent in the shampooing process does cause or does contribute to illness.

Allergens↗

PubMed1989

Epidemiologic aspects of Kawasaki disease in a Manhattan hospital.

Epidemiologic and clinical features of Kawasaki disease in 106 patients seen between 1980 and 1986 at The New York Hospital in midtown Manhattan were compared with those in large series from the United States, Canada, and Japan. Dissimilarities in our Kawasaki disease experience included ethnic heterogeneity of our patients (50% white, 18% black, 16% Hispanic, and 16% Oriental) and, in comparison with the Japanese experience, an older mean age (3 1/2 vs 1 1/2 years) with fewer children less than 2 years of age (32% vs 50% to 60%). In comparison with the general population of the geographic urban and suburban referral area for our hospital and in comparison with our general pediatric population, Oriental children with Kawasaki disease were overrepresented (16% vs 2%). More families of children with Kawasaki disease were members of the upper and middle class (73%) than were the population seen in general pediatrics (31.7%) at our hospital. Personal interviews with 63 families of children with Kawasaki disease and 63 control families with children paired for ethnic group, sex, and age revealed no epidemiologic differences except for use of rug shampoo within 1 month of onset in 16 episodes in 15 children with Kawasaki disease in 14 families (22% of families) compared with two families of control children (3%) (P less than .001).

Age Factors↗

PubMed1988

Use of diastolic velocity ratios to predict significant carotid artery stenosis.

Duplex scanning of the carotid bifurcation has emerged as an accurate noninvasive means of predicting and quantifying carotid arterial stenoses. Compared with the more widely reported measurements of spectral broadening and peak frequency ratios, measurements of diastolic velocity ratios have theoretical advantages in predicting carotid artery stenosis. The use of diastolic velocity ratios between the internal and common carotid arteries was prospectively studied in 30 consecutive patients to determine its accuracy in predicting significant stenosis of the internal carotid artery when compared with angiography. A total of 55 carotid bifurcations were studied, and the use of diastolic velocity ratios correctly predicted high-grade stenosis (greater than or equal to 75% diameter reduction) in 52 cases (95%). We conclude that diastolic velocity ratios may be used to accurately detect significant internal carotid artery stenosis.

Adult↗

PubMed1988

Early seizures following intracerebral hemorrhage: implications for therapy.

Seizures occurred in 19 of 112 patients (17%) with nontraumatic, supratentorial intracerebral hemorrhage (ICH). All seizures occurred at ICH onset; patients without seizures at hemorrhage onset remained seizure-free until the last recorded follow-up. Seizures were significantly associated with extension of blood into the cerebral cortex. We found no association between seizures and hemorrhage size or the presence of subarachnoid or intraventricular blood. These data suggest that (1) seizures, in ICH, occur at hemorrhage onset, (2) patients without seizures at hemorrhage onset are at very low risk for subsequent seizures during their hospitalization, (3) hemorrhage involving the cerebral cortex, regardless of site of origin, predisposes to seizures, and (4) the prophylactic use of anticonvulsants in the acute management of these patients appears unwarranted, especially in patients without cortical extension.

Adolescent↗

PubMed1987

Female external genitalia and müllerian duct derivatives in a 46,XY infant with the smith-lemli-Opitz syndrome.

We report on a 46,XY newborn infant with Smith-Lemli-Opitz (SLO) syndrome with female external genitalia, intraabdominal testes with epididymides and deferent ducts and a normally shaped uterus and vagina. Polydactyly, cleft palate, and several internal organ malformations were also present, and the patient died shortly after birth. Data on six reported male infants with SLO syndrome and female external genitalia suggest a correlation between degree of genital involvement and overall degree of severity. Scoring systems to quantify overall degree of severity (SLO score) and degree of genital involvement in males (genital score) were devised and applied to 122 reported cases from the literature. Statistical analyses showed a unimodal distribution of the SLO severity scores, and positive correlations between the SLO score and the genital score in males, the presence of polydactyly, and the presence of cleft palate. In 19 multiplex families the affected sibs were generally similar in their SLO scores. The above analyses suggest that the wide phenotypic variability in the SLO syndrome is determined by variable expressivity of the same entity as opposed to genetic heterogeneity. The observed phenotypic correlations naturally determine that males with complete feminization are among the more severe patients and tend to have polydactyly and cleft palate.

Abnormalities, Multiple↗

PubMed1987

Lobar vs thalamic and basal ganglion hemorrhage: clinical and radiographic features.

One hundred and twelve patients with spontaneous supratentorial intracerebral hemorrhages were reviewed to identify features which distinguish lobar intracerebral hemorrhage (LH; n = 42) from thalamic or basal ganglionic hemorrhage (TGH; n = 70). Chronic hypertension occurred more commonly in TGH (TGH 67%; LH 48%) while bleeding diathesis was more common in LH (LH 19%; TGH 6%). Clinical presentations were extremely variable and not associated with the type of hemorrhage. Bleeding into the ventricles and hydrocephalus occurred more often with TGH. At last follow-up, there were minimal differences between LH and TGH in overall mortality and functional outcome of the survivors. Alertness on admission was associated with a good outcome regardless of the type of hemorrhage, while a low Glasgow Coma Scale score, coma, ataxic respiration, abnormal pupil reactions, acute hypertension, large hemorrhage size and intraventricular blood were associated with a poor outcome. These data confirm etiological distinctions between LH and TGH, but fail to confirm previously reported differences in clinical presentation and outcome.

Basal Ganglia Diseases↗

PubMed1987

Intracerebral haemorrhage: a model for the prediction of outcome.

The hospital charts and CT scans of 112 patients with spontaneous supratentorial haemorrhage were retrospectively reviewed to evaluate factors important to prognosis. A low Glasgow Coma Scale score, coma, ataxic respiration, abnormal pupils, acute hypertension, large haemorrhage size and intraventricular extension of blood were associated with a poor outcome. Multivariate analysis using the technique of logistic regression identified three variables, the Glasgow Coma Scale score, haemorrhage size and intraventricular extension of blood, which were most predictive of outcome. A model was developed from this analysis which accurately estimates the probability of good outcome and the risk of poor outcome based on data available on presentation. With additional validation, this model may be useful in choosing patients for surgical evacuation of haematomas.

Cerebral Hemorrhage↗

PubMed1987

Intraoperative outflow resistance as a predictor of late patency of femoropopliteal and infrapopliteal arterial bypasses.

To evaluate the efficacy of intraoperative outflow resistance (OR) measurements in predicting late graft patency rates (PR) for femoropopliteal (FP) and femoroinfrapopliteal (FD) bypasses, we have reviewed 134 such cases performed during the past 3 years at our institution. Of these, 64 bypasses were FP (13 autogenous saphenous vein [ASV] and 51 polytetrafluoroethylene [PTFE]) and 70 were FD (43 ASV and 27 PTFE). Total and distal OR measurements (measured in millimeters of mercury per milliliter per minute) were divided into four groups each for all infrainguinal bypasses combined and for FP and FD bypasses separately. The relationship of PR to total and distal OR measurements were analyzed according to the product limit method. Overall 1- and 2-year PRs were 64% and 56%, respectively. For FP bypasses the same PRs were 78% and 67% whereas for FD bypasses, they were 52% and 45%, respectively. The 1-year PRs for FP and FD bypasses within each respective OR group were analyzed. For FP bypasses in the lowest to the highest total OR groups, the 1-year PRs were 86%, 75%, 78%, and 62% (NS), and for FD bypasses they were 72%, 89%, 23%, and 22% (p less than 0.001). Similar trends were observed when distal OR measurements were analyzed. For infrainguinal PTFE bypasses, both total and distal OR measurements were significant predictors of patency, whereas for those with ASV only distal OR measurements were predictive. These data reaffirm our early experience with OR measurements. Although a trend for predicting graft patency was noted for FP bypasses, OR measurements were highly predictive only for FD bypasses.

Adult↗

PubMed1986

Lack of transmission of HTLV-III/LAV infection to household contacts of patients with AIDS or AIDS-related complex with oral candidiasis.

To determine the risk of transmission of human T-cell lymphotropic virus Type III/lymphadenopathy-associated virus (HTLV-III/LAV) to close but nonsexual contacts of patients with the acquired immunodeficiency syndrome (AIDS), we studied the nonsexual household contacts of patients with AIDS or the AIDS-related complex with oral candidiasis. Detailed interviews, physical examinations, and tests for serum antibody to HTLV-III/LAV were performed on 101 household contacts of 39 AIDS patients (68 children and 33 adults), all of whom had lived in the same household with an index patient for at least three months. These contacts had shared household items and facilities and had close personal interaction with the patient for a median of 22 months (range, 3 to 48) during the period of presumed infectivity. Only 1 of 101 household contacts--a five-year-old child--had evidence of infection with the virus, which had probably been acquired perinatally rather than through horizontal transmission. This study indicates that household contacts who are not sexual partners of, or born to, patients with AIDS are at minimal or no risk of infection with HTLV-III/LAV.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Outcome of subsequent pregnancies following antibiotic therapy after primary or multiple spontaneous abortions.

The course of the subsequent pregnancy and the maternal and fetal complications were evaluated in 254 couples who were seen in an infertility clinic after primary or multiple spontaneous abortions. The 100 couples who were treated with antibiotics after pregnancy loss showed a significantly better chance of achieving a subsequent pregnancy. The outcome of pregnancy was significantly better in the antibiotic treated group and the rate of spontaneous abortion recurrence was significantly lower (10 versus 38 per cent). The number of maternal complications was significantly less in the treated group--premature rupture of membranes, three (4 per cent) versus 30 (46 per cent), and postpartum fever, three (4 per cent) versus 23 (35 per cent), respectively. The untreated group experienced a significantly lower percentage of vaginal delivery (56 versus 69 per cent) (p less than 0.001). In the antibiotic treated group, there were significantly lower rates of fetal complications, including fetal distress, meconium, respiratory distress syndrome, neonatal infection and hyperbilirubinemia. The mean birth weight of infants in the antibiotic treated group was significantly higher (3,529 versus 3,090 grams; p less than 0.001). Prematurity and postdatism were significantly less frequent in the antibiotic treated group, and the corresponding Apgar scores were significantly better. We, thus, postulate that certain spontaneous abortions may be caused by bacteria present in the genital tract at the time of conception. These bacteria may have an adverse effect on the course of pregnancy and result in increased maternal and fetal complications.

Abortion, Incomplete↗

PubMed1985

Juvenile papillomatosis and breast carcinoma.

Juvenile papillomatosis (JP) is a breast tumor of young women featuring atypical papillary duct hyperplasia and numerous cysts, first described as a clinicopathologic entity in 1980. The disease is of interest because of the youth of these patients and the fact that the pathologic elements resemble those considered to be precancerous in older women. This report summarizes the findings in 180 patients enrolled in the Juvenile Papillomatosis Registry. The mean age at diagnosis was 23 years (range, 12-48 years; median, 21 years; mode, 18 years). No relationship was found with parity, age of menarche, or use of birth control pills. Fifty patients (28%) reported that one or more relatives had had breast cancer. Twelve (7%) patients reported a first degree relative (mother, 10; sister, 2), whereas in 38 (21%) breast cancer was limited to one or more secondary relatives, most often maternal (23/39 or 59%). Persistent (or recurrent) JP was found in 25 patients who had a subsequent biopsy, and 8 patients had bilateral JP. Pathologic analysis revealed focal epithelial necrosis, a feature often associated with carcinoma, in 30 (17%) cases predominantly in those with the most severe cytologic atypia of hyperplastic duct lesions (77%). Positive family history was reported by 33% (10/30) of women with epithelial necrosis and 27% (40/150) without this finding. Seven patients (4%) had breast carcinoma diagnosed concurrent with JP (ipsilateral, 5 cases; contralateral, 2 cases). A previously unreported finding is the diagnosis of carcinoma subsequent to JP in two cases (contralateral intraductal and ipsilateral microinvasive duct, respectively) with intervals of 8 and 9 years, respectively. The nine patients with carcinoma and JP tended to be slightly older at the time JP was diagnosed (mean, 27 years) and had a higher frequency of positive family history (56%) than those without breast cancer (mean age, 23 years; positive family history, 26%). These findings confirm earlier evidence that JP is a marker for families at risk and now indicate that the patient with JP may herself be in jeopardy of developing breast cancer coincidentally or at a later date. Wide local excision is adequate to control the lesion in most cases. Careful clinical surveillance is indicated for any woman who has juvenile papillomatosis and for her female relatives. The early age of onset of this unusually florid proliferative disease, and family history association, suggest there may be an underlying hormonal disturbance or genetic abnormality.

Adolescent↗

PubMed1985

Breast carcinoma at the extremes of age: a comparison of patients younger than 35 years and older than 75 years.

We assessed the prognosis of patients with breast carcinoma at the extremes of the age distribution of the disease. The groups examined were 166 women 35 years or less and 169 at least 75 years old. Analysis of recurrence and survival showed no significant difference between the groups as a whole or when they were stratified by nodal status. Life expectancy of elderly women with breast carcinoma was significantly reduced when compared with a "normal" age-matched population. Medullary carcinoma was more frequent in young women while a relatively higher proportion of colloid and invasive lobular carcinoma occurred in elderly women. Bilateral carcinoma was found with nearly equal frequency in both age groups. However, elderly women were more likely to have been treated previously for contralateral carcinoma while young women tended to develop asynchronous, subsequent carcinoma.

Adult↗

PubMed1985

Collateral back pressure--is it a valid predictor of infrainguinal bypass graft patency?

While it is generally thought that collateral back pressure (CBP) is a reliable predictor of graft patency, this correlation has not yet been validated. We have used a new, simple technique to measure CBP without direct puncture of the recipient artery. After the distal anastomosis is completed, the graft is filled with saline and clamped proximally. A transducer connected needle is then inserted into the distal portion of the graft for CBP measurements (mm Hg). These were obtained in 84 grafts (43 femoropopliteals [FP] and 41 femorodistals [FD]). Outflow resistance (OR) measurements (mm Hg/ml/min) were also obtained in 70 (36 FP; 34 FD) of these grafts by a previously described technique. The mean CBP for FP and FD bypasses was 41 +/- 17 and 26 +/- 19 mm Hg, respectively (P less than 0.001). Although early graft patency (3 months) (13 occluded, 71 patent) did not correlate with angiographic findings of popliteal runoff or integrity of pedal arch, it did significantly relate to CBP. Mean CBP for occluded grafts was 22 +/- 17 mm Hg and for patent grafts it was 36 +/- 19 mm Hg (P less than 0.01). Similarly, mean OR was significantly related to patency, 1.29 +/- 0.23 mm Hg/ml/min for occluded grafts and 0.36 +/- 0.23 mm Hg/ml/min for patent grafts (P less than 0.0001). Moreover, only OR was a significant predictor of infrapopliteal graft patency (P less than 0.01). OR was found to be a better predictor of graft patency than CBP by stepwise logistic regression analysis (P less than 0.0001). We conclude that CBP is a more reliable predictor of graft outcome than angiographic criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1985

Gleason grading of prostate cancer: a predictor of survival.

The Gleason grading system was employed in the pathologic assessment of 82 patients with carcinoma of the prostate diagnosed between 1962-1965 and subsequently followed to death. The data suggest that the Gleason grade gives long-term prognostic information independent of stage with a direct correlation between increasing Gleason grade and cancer death rate index. Furthermore, the sum of clinical stage plus Gleason grade is a more significant prognostic factor than either stage or grade alone.

Aged↗

PubMed1984

Components of outflow resistance and their correlation with graft patency in lower extremity arterial reconstructions.

We have used a simple reproducible method to measure total outflow resistance (OR) and its proximal and distal components in 101 bypasses (46 femoropopliteal [FP] and 55 femorodistal [FD]). All bypasses with a distal OR greater than 1.2 mm Hg/ml/min failed within 3 months and all with distal OR less than 1.2 mm Hg/ml/min remained patent for at least 3 months. To evaluate the contribution of vasospasm to OR and its role in graft failure, 60 bypasses (29 FP, 31 FD) had OR measurements before and after local infusion of papaverine hydrochloride (60 mg). Within 3 months, nine grafts (all FD) occluded and 51 remained patent. All nine failures had distal OR greater than 1.2 mm Hg/ml/min before papaverine infusion. After infusion, the mean percentage decrease in both total and distal OR for all grafts was 30% and 31%, respectively. However, there was no significant difference between these papaverine-induced decreases in OR and 3-month graft failure or success. Moreover, in three bypasses, even though papaverine lowered the distal OR from greater than 1.2 to less than 1.2 mm Hg/ml/min, early occlusion occurred. In six grafts (1 FP, 5 FD) when total and distal OR before and after papaverine was greater than 1.2 mm Hg/ml/min, the graft was extended to a second distal artery as a sequential bypass. These six grafts have remained patent over 3 months. Thus measurement of OR and particularly distal OR is a most accurate predictor of early graft success or failure. Pharmacologic manipulation does not enhance the predictive value of the OR measurement. OR measurements also help to select those FD bypass cases in which extension to a second distal artery as a sequential bypass improves patency.

Aged↗

PubMed1984

Segmental levels of anaesthesia following the extradural injection of 0.75% bupivacaine at different lumbar spaces in elderly patients.

Segmental anaesthesia levels were determined in 80 elderly patients following the extradural injection of 0.75% bupivacaine 15 ml at four separate lumbar interspaces. Mean levels were T11 in the L5-S1 group, T7 in the L4-5, T5 in L3-4 and T3 in the L2-3 group (P less than 0.001). Varying the lumbar interspace at which the extradural anaesthesia is performed is recommended as a means of adjusting the levels of anaesthesia for different surgical procedures.

Abdomen↗