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Biomedical subjects

M Rotenberg

Publications and source records attributed to M Rotenberg.

At least 19 recordsLinked to original sources
PubMed2001

Interindividual variability in sensitivity to warfarin--Nature or nurture?

BACKGROUND: Interindividual variability in responses to warfarin is attributed to dietary vitamin K, drug interactions, age, or genetic polymorphism in the cytochrome P4502C9 enzyme (CYP2C9) (allelic variants 2C9*2 and 2C9*3 ) linked with impaired metabolism of the potent enantiomere S-warfarin. PATIENTS AND METHODS: We quantified the relative effects of age and of simultaneously determined CYP2C9 genotype, plasma warfarin and vitamin K concentrations, and concurrent medications on warfarin maintenance doses in 156 patients at optimized stable anticoagulation. RESULTS: Allele frequencies for CYP2C9*1, CYP2C9*2, and CYP2C9*3 were 0.84, 0.10, and 0.06. Warfarin doses were 6.5 +/- 3.2, 5.2 +/- 2.4, and 3.3 +/- 2.0 mg/d in the 3 genotype groups (P < .0001). Warfarin doses decreased with age as follows: 7.7 +/- 3.7 versus 4.9 +/- 2.9 mg/d at < 50 years and >66 years (P < .001), mainly as a result of decreased plasma warfarin clearance (2.8 +/- 1.4 mL/min versus 1.9 +/- 0.8 mL/min; P < .001). Vitamin K (1.6 +/- 1.1 ng/mL) did not differ among the age or genotype groups. Patients >or=66 years old with the CYP2C9*3 allele required only 2.2 +/- 1.2 mg/d compared with 7.9 +/- 3.7 mg/d in those <or=65 years old bearing the CYP2C9*1 allele (P < .001). On multiple regression, warfarin maintenance doses were independently associated with plasma warfarin (reflecting its metabolic clearance) (r (2) = 0.26), age (possibly reflecting increased intrinsic sensitivity) (r (2) = 0.12), and genotype (reflecting S-warfarin levels) (r (2) = 0.10) but not with plasma vitamin K. CONCLUSIONS: At optimized steady state, individual sensitivity to warfarin is determined by CYP2C9 genotype and age with no effect of vitamin K. Prospective studies will determine the impact of these findings in clinical practice.

Adult↗
PubMed2001

Serious adverse events of mefloquine in relation to blood level and gender.

Mefloquine is widely used for prophylaxis in areas with chloroquine-resistant falciparum malaria. As the use of mefloquine has increased, so have the reports on its adverse effects. We sought to evaluate the possible association between serum levels of mefloquine and serious side effects caused by this drug by means of a case-control design study. The study population included 17 patients who presented to emergency rooms or travel clinics with symptoms suggesting serious adverse effects of mefloquine and 28 controls (healthy people, still taking mefloquine after travel). The mean age of the patients and the controls was 31.5 +/- 11.6 years and 34 +/- 12.2 years, respectively. The percentage of women among the patients was higher than in the control population (76% versus 40%, respectively; P = 0.03). Most of the complaints were related to the central nervous system (13 of 17); 5 patients interrupted their trip and 2 others were hospitalized. No difference in the level of mefloquine in the blood was found between the patients and the control groups. Also, no significant difference was found between mefloquine levels in the blood of men and women. These results suggest that blood levels of mefloquine do not correlate with its severe adverse events. Women tended to be more susceptible than men, despite having similar blood levels of the drug.

Adult↗
PubMed2000

[Analysis of the development of the arch form after treatment using "ARCAD'Image" software].

The dental arch post-therapeutic modification plays a significant role in relapse phenomenon. This article describes the design work of the dental arches used as a base for the study of modifications that have arisen during orthodontic treatment then during the retention stage using pre-formed arch wires. ARCAD'Image software tries to design the patients dental arches by submitting a linear regression mathematical design on some characteristic landmarks of a photograph of the buccal impression. The designed dental arch can then be considered as being the closest/nearest to the patients morphology. This model enables the practitioner to bend the arch wire and is used as a base for the study of arch shape modifications. Our study shows that the term "relapse" appears to be used excessively; it would be more matter of evolution due to changes in neuro-muscular balance along with facial aging.

Aging↗
PubMed1999

The pharmacokinetics of morphine and lidocaine in critically ill patients.

OBJECTIVE: To evaluate the pharmacokinetic parameters of morphine and lidocaine after a single intravenous dose in critically ill patients. DESIGN: Prospective, clinical study. SETTING: General intensive care unit (ICU) in a university hospital. PATIENTS: Patients admitted to the ICU with severe systemic inflammatory response syndrome of various etiologies. INTERVENTIONS: A single intravenous dose of morphine (0.025 mg/kg) and lidocaine (1.5 mg/kg) were given separately 12-36 h after admission, and arterial blood samples for serum drug levels were taken. MEASUREMENTS AND RESULTS: Morphine pharmacokinetics were studied in 30 patients. The clearance (Cl) was found to be 5.7+/-2.3 ml/kg per min, volume of distribution of the central compartment (Vc) 0.16+/-0.12 l/kg and volume of distribution at steady state (Vss) 1.08+/-0.69 l/kg. These values are lower then those described previously for healthy volunteers (33.5+/-9 ml/kg per min, 1.01+/-0.31 l/kg, and 5.16+/-1.4 l/kg, respectively), and similar to those described in trauma and burned patients. Lidocaine pharmacokinetics were tested in 24 subjects. The Cl was 6.9+/-3.8 ml/kg per min, Vc 0.25+/-0.1 l/kg and Vss 0.78+/-0.26 l/kg. These values are not different from parameters published previously for healthy volunteers (10 ml/kg per min, 0.53 l/min and 1.32 l/min, respectively). No correlation was found between clinical variables and pharmacokinetic parameters of both drugs (ANOVA). CONCLUSIONS: Both morphine and lidocaine have a reduced volume of distribution in critically ill patients. The normal lidocaine clearance indicates preserved hepatic blood flow and suggests that other mechanisms are involved in the reduced morphine clearance. These findings may have application for the treatment of ICU patients.

Adult↗
PubMed1999

The pharmacokinetics of morphine and lidocaine in nine severe trauma patients.

STUDY OBJECTIVE: To study the pharmacokinetic parameters of morphine and lidocaine after a single intravenous (i.v.) bolus in severe trauma patients. DESIGN: Clinical case study. SETTING: Department of Anesthesiology and Intensive Care of a university hospital. PATIENTS: Nine patients, ages 24 to 91 years (mean 54.4 yrs), admitted to the hospital with severe trauma (Injury Severity Score > 20) were included in the study. INTERVENTIONS: After initial evaluation and stabilization, a single i.v. dose of morphine 0.025 mg/kg and lidocaine 1.5 mg/kg was given separately, and blood samples were drawn for each drug serum concentration. MEASUREMENTS AND MAIN RESULTS: Morphine pharmacokinetics was studied in eight patients, lidocaine pharmacokinetics in seven patients, and both drugs were studied in six patients. Morphine clearance 2.5 to 10 ml/kg/min (6 +/- 2.6, mean +/- SD) and volume of distribution 0.28 to 3.30 L/kg (1.4 +/- 1.0) were found to be lower than values described previously for healthy volunteers (33.5 +/- 9 ml/kg/min and 5.16 +/- 1.40 L/kg, respectively), and are similar to those described in trauma patients (5 +/- 2.9 ml/kg/min and 0.9 +/- 0.2 L/kg, respectively). In contrast, lidocaine clearance 4.5 to 9.4 ml/kg/min (6.7 +/- 1.7) and volume of distribution 0.39 to 1.20 L/kg (0.72 +/- 0.28) were similar to the value described in healthy volunteers (10 ml/kg/min and 1.32 L/kg, respectively). CONCLUSION: Changes in pharmacokinetics of drugs eliminated by the liver may occur in patients with severe trauma. The preserved lidocaine clearance indicates an almost normal hepatic blood flow and suggests that other mechanisms may be involved in the lower morphine clearance. The findings may have applications for the treatment of severe trauma patients and suggest that drug monitoring might be needed in some instances so as to avoid toxicity.

Adult↗
PubMed1995

Evaluation of the decarbamylation process of cholinesterase during assay of enzyme activity.

The activity of carbamylated cholinesterase increases continuously during assay, suggesting that progressive decarbamylation takes place. The following effects of assay conditions on the observed decarbamylation were studied: the effect of the sulfhydryl group of nitrobenzoate produced in the course of Ellman assay, the effect of substrate and the effect of sample dilution during assay. This study indicates that sample dilution is the main trigger to the decarbamylation observed during assay of cholinesterase activity. The process was described as a first-order reaction during which the inhibited enzyme gives place to the active form. Kinetic constants for decarbamylation of human pseudocholinesterase (EC 3.1.1.8) at 30 degrees C were approximately 0.005 min-1 for dimethylcarbamates and 0.010 min-1 for monomethylcarbamates, when 1 mmol/l propionylthiocholine was used as substrate.

Aldicarb↗
PubMed1995

Differentiation between organophosphate and carbamate poisoning.

We propose a novel and simple assay for the real-time differentiation between carbamate and organophosphate inhibition of cholinesterase, based on our observations of the kinetic behavior of inhibited enzyme. The assay of carbamylated cholinesterase activity over time follows a non-linear kinetic pattern, whereas that of phosphorylated enzyme activity is linear. This feature can be exploited to differentiate between carbamate and organophosphate cholinesterase inhibition. The non-linear pattern characteristic of carbamates is easily discernible at degrees of inhibition of 40% or more. In this setting, cholinesterase activity ought to be measured continuously for about 1 h to obtain the kinetic pattern of enzyme activity. The initial activity, measured during the first 5 min of assay, represents the activity of enzyme in vivo. In vitro reactivation of inhibited cholinesterase allows the estimation of full potential activity of enzyme prior to poisoning, so that percentage of inhibition can be calculated. Reactivation of carbamylated cholinesterase is obtained by the incubation of diluted enzyme at 37 degrees C for 2.5 h prior to assay, whereas phosphorylated (non-aged) enzyme is reactivated by a 30 min incubation with oximes. In cases of mild exposure to cholinesterase inhibitors (< 40% inhibition), the response of enzyme to in vitro reactivation serves as a complementary test for exposure and for the nature of the inhibitor. All the results presented in this work refer to plasma cholinesterase. Erythrocyte cholinesterase was found to behave very similarly to plasma enzyme and its results have not been reported here.

Adolescent↗
PubMed1994

Electroporation of the photosynthetic membrane: structural changes in protein and lipid-protein domains.

A biological membrane undergoes a reversible permeability increase through structural changes in the lipid domain when exposed to high external electric fields. The present study shows the occurrence of electric field-induced changes in the conductance of the proton channel of the H(+)-ATPase as well as electric field-induced structural changes in the lipid-protein domain of photosystem (PS) II in the photosynthetic membrane. The study was carried out by analyzing the electric field-stimulated delayed luminescence (EPL), which originates from charge recombination in the protein complexes of PS I and II of photosynthetic vesicles. We established that a small fraction of the total electric field-induced conductance change was abolished by N,N'-dicyclohexylcarbodiimide (DCCD), an inhibitor of the H(+)-ATPase. This reversible electric field-induced conductance change has characteristics of a small channel and possesses a lifetime < or = 1 ms. To detect electric field-induced changes in the lipid-protein domains of PS II, we examined the effects of phospholipase A2 (PLA2) on EPL. Higher values of EPL were observed from vesicles that were exposed in the presence of PLA2 to an electroporating electric field than to a nonelectroporating electric field. The effect of the electroporating field was a long-lived one, lasting for a period > or = 2 min. This effect was attributed to long-lived electric field-induced structural changes in the lipid-protein domains of PS II.

Biophysical Phenomena↗
PubMed1994

Pardes and PaRDeS: towards a psychotherapeutic theory.

The Hebrew term Pardes has two meanings in Jewish study: the Paradise entered by four eminent Rabbis in search of mystical truth, and PaRDeS, four levels of interpreting Biblical texts. By combining the legend of Pardes with the hermeneutic system of PaRDeS, a psychological theory is presented as a set of propositions which endeavor to demonstrate the following: 1) The combination of Pardes and PaRDeS may be used as a bridge between the rational and mystic approaches to life and death. 2) The rational and the mystic stages each contain two phases: the negative break and the positive possibility of the symbolic "forty years old" more mature active remedy. 3) The "Acher-Akiva" and the "Ben Zoma-Ben Azai" dimensions do not necessarily represent four psychological personality types, but rather inner psychological struggles which may be experienced by one person in part or in full during different phases of his or her life cycle. The successful resolution of these inner psychological struggles may be facilitated by people's ability and motivation to find their one or more personally suitable "faces" from the "seventy" that are available for them. Thus, the road to "Pardes-paradise" is paved by people's own intentions.

Adaptation, Psychological↗
PubMed1994

Carbamate poisoning and oxime treatment in children: a clinical and laboratory study.

OBJECTIVE: (1) Retrospective evaluation of the clinical course of carbamate poisoning and the effect of oxime therapy in children. (2) In vitro study of the effect of oximes on the reactivation of carbamylated cholinesterase. DESIGN: (1) Clinical survey: The records of 26 children intoxicated with carbamates were examined retrospectively. The poisoning agents in all cases were positively identified as methomyl or aldicarb by gas chromatography-mass spectrometry. (2) Laboratory study: The direct effect of obidoxime and of pralidoxime on acetylcholinesterase activity in vitro was investigated in normal human packed red blood cells pretreated with an organophosphate (paraoxon) or a carbamate (aldicarb or methomyl). CLINICAL SETTING: Pediatric intensive care unit of a teaching hospital. PATIENTS: Twenty-six infants and young children (aged 1 to 8 years) admitted to the pediatric intensive care unit with severe carbamate intoxication. INTERVENTIONS: All cases had been treated with repeated doses of atropine sulfate (0.05 mg/kg) administered every 5 to 10 minutes until muscarinic symptoms disappeared. Obidoxime chloride (Toxogonin, 6 mg/kg) was administered on admission, and again after 4 to 5 hours. RESULTS: Predominant symptoms were related to central nervous system and nicotinic effects. All the patients showed marked improvement within several hours and recovered completely within 24 hours. None of the children deteriorated and none showed exacerbation of cholinergic symptoms after obidoxime treatment. In vitro, oximes reactivated acetylcholinesterase inhibited with paraoxon, whereas no significant effect of oximes on carbamylated enzyme activity was observed. CONCLUSIONS: Based on the recovery of all cases, as compared with other reports of carbamate poisoning treated with atropine alone, it is concluded that, in the case of aldicarb or methomyl poisoning, oxime therapy apparently does not contribute to the recovery of poisoned patients. In cases of poisoning by an unknown pesticide or of mixed poisoning, oxime therapy can prove beneficial because no negative effects of the therapy can be discerned.

Aldicarb↗
PubMed1993

Reversal of lung maturational delay in the fetus of the diabetic rat using triiodothyronine or dexamethasone.

Administration of glucocorticoids and thyroid hormone can accelerate fetal lung development. To investigate whether the delayed fetal lung maturation seen in the diabetic rat gestation could be reversed by dexamethasone (DEX) or triiodothyronine (T3), control and streptozotocin-diabetic dams were injected daily from day 18 of gestation with either saline, 0.5 mg/kg DEX, or 1 mg/kg T3 until sacrifice on day 21 or day 22. While DEX did not change glucose levels in diabetic animals, T3 resulted in a slight reduction in both maternal (474 +/- 25 vs. 539 +/- 17 mg%; p < 0.07) and fetal (354 +/- 43 vs. 404 +/- 26 mg%; p < 0.05) serum glucose concentrations. DEX therapy exaggerated the reduction in body and lung weight seen in fetuses of streptozotocin-diabetic dams. Fetal lung phosphatidylcholine and disaturated phosphatidylcholine levels were significantly reduced in saline-treated diabetic animals as compared with controls. However, fetuses of T3- or DEX-treated diabetic rats had significantly increased lung phosphatidylcholine and disaturated phosphatidylcholine levels were significantly reduced in saline-treated diabetic animals as compared with controls. However, fetuses of T3- or DEX-treated diabetic rats had significantly increased lung phosphatidylcholine and disaturated phosphatidylcholine levels as compared with fetuses of untreated diabetic rats; these data suggest that maternal DEX or T3 therapy reverses the delayed fetal lung maturation seen in the diabetic rat gestation. Since glucocorticoids can exacerbate maternal diabetes, treatment with thyroid hormone may be more appropriate, although risks must be weighed against potential benefits.

Animals↗
PubMed1993

Decreased serum cholesterol level after snake bite (Vipera palaestinae) as a marker of severity of envenomation.

In 44 patients bitten by snakes (Vipera palaestinae), admission serum cholesterol levels were negatively correlated with severity of envenomation (mean +/- SD, 175 +/- 49, 137 +/- 36, and 96 +/- 40 mg/dl, respectively, in cases with mild, moderate, and severe clinical manifestations [p < 0.0001]). Concomitant decreases in serum albumin were not significant. These findings were supported by experimental results in rabbits, in which low, medium, and high doses of purified V. palaestinae venom (all in the non-lethal range), led to dose-dependent decreases in serum cholesterol, at 180 minutes, of 9.5% +/- 8.9%, 18.6% +/- 10.1%, and 32.7% +/- 11.8%, respectively (p < 0.01). This rapid decrease in serum cholesterol level is only partially explained by transcapillary lipoprotein leakage and probably indicates changes in lipoprotein transport and metabolism caused by the phospholipase A2 component of V. palaestinae venom. Admission total serum cholesterol level may serve as an indicator of severity of envenomation in patients bitten by snakes of the Vipera genus before full development of the clinical syndrome.

Adult↗
PubMed1992

The use of C6-NBD-PC for assaying phospholipase A2-activity: scope and limitations.

Determination of phospholipase A2 (PLA2) activity is of special interest in view of the abundance of this enzyme in various organelles of all cells, and its role in many cell functions, especially in eicosanoid production. Assaying PLA2 activity is therefore of special importance to cell biology. However, it is a complicated and non-trivial task for several reasons including the critical dependence of PLA2 activity on the physical state of the lipid substrate, the complex kinetics of its action, the low activity of most intercellular and membrane-bound enzymes and the metabolism of the fatty acid products, when applied to intact cell. In recent years the fluorescent analogue of phosphatidylcholine, C6-NBD-PC, has been used for determination of the activity of soluble and membrane-bound PLA2. In the present study we evaluate the use of this method for continuous monitoring of PLA2 activity, based on time-dependent changes in the fluorescence intensity which results from the hydrolysis of C6-NBD-PC into NBD-caproic acid and lysolecithin. The fluorescence intensity of aggregated C6-NBD-PC is reduced due to self-quenching which is maximal in systems containing no additional lipids, when NBD-PC forms micelles. In these systems the hydrolysis increase the fluorescence intensity due to de-quenching, since the NBD caproic acid products dissolves in water in the form of monomers. In contrast, in the presence of additional lipids (mixed micelles, membrane vesicles, lipid emulsion particles or lipoproteins), the probe partitions into lipidic compartments where its fluorescence is only partially quenched (if at all) and its quantum yield is much higher. Consequently, the hydrolysis is accompanied by a decrease in fluorescence. The time course of this change is a complex function of the additional lipid concentration(s) and of physical processes which follow the hydrolysis. Due to this complexity, the assay of PLA2 activity by continuous monitoring of fluorescence is ambiguous. Furthermore, the rate of NBD-PC hydrolysis is very different from that of the 'host' lipid bilayer or monolayer and is less sensitive to the physical state of the lipids. Under various conditions it follows very different kinetics, depending on the ratio of NBD-PC to the host PC. Therefore, it can not be used as a general assay for PLA2 in lipid-containing systems.

Fluorescent Dyes↗
PubMed1992

[Injection of collagen in recurrent paralysis after thoracic surgery].

The author describes a new technique of treatment of recurrent laryngeal nerve paralysis by intra-cordal injection of collagen after thoracic surgery. After description of the collagen used and the technique of injection, the author presents the results. It is a new method, simple, efficient, well tolerated, giving patients a voice, and treating their swallowing troubles.

Collagen↗
PubMed1991

Physico-chemical characterization of Intralipid emulsions.

Fat emulsions containing soy triacylglycerols (100-300 g/l) and egg-yolk phospholipids (12 g/l) are often used for intravenous feeding. Previous studies have shown that these emulsions contain chylomicron-like emulsion particles of diameters of 300-400 nm and excess phospholipids aggregated as vesicles (liposomes), which remain in the infranatant upon floatation of the emulsion particles by ultracentrifugation. This work is devoted to the characterization of the commercial lipid emulsions commonly denoted Intralipids, with special emphasis on the presently ill-defined liposomes. The lipid particles composing commercial lipid emulsions (10%, 20% and 30% Intralipids, Kabivitrum Nutrition) were characterized by the combined use of physical and chemical methods. Each of the emulsions was fractionated by ultracentrifugation in saline into a 'cream' layer which floats to the top of the dispersion upon ultracentrifugation and a relatively transparent infranatant. The cream layer contains large emulsion particles of diameters ranging from 300 to 400 nm, in agreement with theoretical considerations based on their chemical composition as determined by chemical analysis. The infranatants contain about 1 g/l triacylglycerols in addition to phospholipids (from 7.2 g/l in 10% Intralipid to 2.4 g/l in 30% Intralipid) in the form of smaller particles of 70-100 nm diameter. Cryo-transmission electron microscopy shows that the infranatants contain vesicles (mostly unilamellar) at the side of residual small emulsion particles. This conclusion is also consistent with the distribution of phospholipids between outer and inner lamellae, as determined by 31P-NMR.

Fat Emulsions, Intravenous↗
PubMed1991

Effects of cholesterol on the function and thermotropic properties of pure UDP-glucuronosyltransferase.

The effects of cholesterol on the activity and thermal properties of a pure, delipidated isoform of UDP-glucuronosyltransferase were examined after incorporation of enzyme into unilamellar bilayers of distearoylphosphatidylcholine (DSPC) or dioleoylphosphatidylcholine (DOPC). Cholesterol, in bilayers of DSPC, decreased enzyme activity and lowered the temperature (from 37 to 30 degrees C) for a reversible transition from the active form of the enzyme to a less active form. These effects could be separated from each other in that the effect on reversible inactivation of the enzyme occurred at lower concentrations of cholesterol than the effect on activity of the active form of the enzyme. In addition, cholesterol in bilayers of DSPC stabilized UDP-glucuronosyltransferase against irreversible thermal inactivation. The extent of stabilization increased with increasing concentration of cholesterol in the bilayers. The effects of cholesterol on UDP-glucuronosyltransferase depended, however, on the nature of the bilayer containing cholesterol. Cholesterol had small effects, if any, on the properties of UDP-glucuronosyltransferase in bilayers of DOPC.

Animals↗