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Biomedical subjects

M S Finkelstein

Publications and source records attributed to M S Finkelstein.

At least 19 recordsLinked to original sources
PubMed1990

Hypertrophic pyloric stenosis: volumetric measurement of nasogastric aspirate to determine the imaging modality.

The authors postulated that volumetric measurement of residual gastric aspirate in neonates and infants with nonbilious projectile vomiting could enable differentiation between patients with hypertrophic pyloric stenosis (HPS) and those with gastroesophageal reflux (GER) and help to determine whether ultrasound (US) or fluoroscopy of the upper gastrointestinal tract would best confirm the diagnosis. In the 38 patients (all but two of whom had been fasting for 3-4 hours), 10 mL or more of nasogastric aspirate was considered indicative of obstruction. HPS occurred in 91.7% of patients with 10 mL of aspirate or more, whereas GER occurred in 85.7% of patients with less than 10 mL. The differences between the two groups were statistically significant. Solely on the basis of residual volume (greater than or equal to 10 mL), the cause of vomiting could be differentiated, prior to standard radiologic studies, 89.4% of the time. It is concluded that patients with projectile vomiting who have 10 mL or more of residual aspirate in the stomach should undergo US for confirmation of HPS; those with less than 10 mL should undergo fluoroscopy for confirmation of GER.

Diagnosis, Differential↗
PubMed1990

Granular cell tumor of the heel.

Although infrequently encountered, granular cell myoblastoma can occur on the foot. It should be considered in the differential diagnosis of any soft tissue nodule or mass.

Foot Diseases↗
PubMed1988

Evaluation of the musculoskeletal system with sonography.

Although musculoskeletal sonography historically has received little attention, its use in certain specific situations has clear advantages over use of other imaging techniques. The wide availability of sonography, its modest cost, and its lack of ionizing radiation are other reasons that its use in musculoskeletal conditions is expected to increase. We have reviewed potential applications; some of these applications are new and have been used in a small series of patients, and others, such as infant hip sonography, have already been used in thousands of cases. Additional applications may be possible [64]. Those learning the techniques of musculoskeletal sonography will find that progress is made most quickly when there is close cooperation between the sonographer and the clinician. While experience is being gained, each party must endeavor to understand what the technique is able to determine and what it cannot determine. Only through close cooperation, and with adequate opportunity to learn, will the sonographer and the clinician develop confidence in the technique to the point that it becomes the effective imaging alternative that best suits the needs of the patient.

Achilles Tendon↗
PubMed1987

Difficulties in estimating glomerular filtration rate in the elderly.

Estimates of glomerular filtration rate are generally obtained by measuring or estimating endogenous creatinine clearance. However, it may sometimes be difficult to obtain the necessary urine collections. Most of 19 healthy, reliable elderly outpatients were found unable to provide satisfactory 24-hour urine collections. To judge whether formulas estimating creatinine clearance from serum creatinine levels are reliable, we also compared 24-hour creatinine clearances measured in 50 inpatients with values calculated by the Cockroft-Gault equation. Only a moderate correlation was found, which may be unacceptable in the clinical situations for which the equation is used, such as drug dosing. For reasons including uncertainties in the validity of predictive formulas and unreliability of urine collections, we conclude that no acceptable method now exists for bedside estimation of glomerular filtration rate and that drug levels should be measured whenever possible in elderly patients and in those with renal insufficiency.

Aged↗
PubMed1986

Ultrasound evaluation of scrotum in pediatrics.

Scrotal abnormalities are difficult to assess using clinical criteria alone. Ultrasound provides an accurate means of demonstrating the scrotal contents so that appropriate therapy may be instituted. In a retrospective study, 119 ultrasound examinations of 96 patients (aged 4 days to 23 years) have been compared with the clinical diagnosis, surgical/pathologic findings, and other imaging modalities. The gamut of disease identified included congenital anomalies, neoplasm, trauma, torsion, varicocele, hydrocele, epididymo-orchitis, epididymal cyst/spermatocele, and post-radiation fibrosis. The ultrasound findings correlated well in 93/96 patients. In inconclusive cases, sequential imaging helps differentiate traumatic and inflammatory lesions from neoplastic processes.

Adolescent↗
PubMed1985

Aging immunocytes and immunity. Characteristics and significance.

With aging, many aspects of immune function change. Despite the greater complexity of problems and increased numbers of variables that attend research involving aged individuals, certain fundamental alterations in immune reactivity appear associated with aging. These alterations have important biologic implications. The immune changes in "healthy" octogenarians can have significant clinical effects when these individuals suffer stress or disease.

Adult↗
PubMed1984

Salivary and serum IgA levels in a geriatric outpatient population.

In two separate studies, specimens of saliva from 57 individuals over the age of 65 years (mean age, 76.7 years) and 37 persons under the age of 40 years (mean age, 28.8 years) were examined for concentrations of IgA as functions of volume, total protein, and electrolyte conductivity; some were also tested for IgG and IgM content. The results show that older persons have higher concentrations of these solutes in their saliva than do younger controls. This suggests that the ability to secrete IgA into saliva does not diminish significantly with aging.

Adult↗
PubMed1983

Pneumococcal bacteremia in adults: age-dependent differences in presentation and in outcome.

In order to evaluate the effect of age on the presentation of and response to acute bacterial infection, the hospital charts of 187 adult patients with community-acquired pneumococcal bacteremia admitted to Bellevue Hospital over a nine-and-a-half year period were reviewed. Compared with younger patients, older patients (aged 65 or older) more frequently had (1) a lower fever in response to the infection, (2) an unclear history of illness, (3) a delay in diagnosis and/or therapy, and (4) a higher risk of dying. On admission, their leukocyte counts and heart rates were similar to those in a group of younger patients, which was composed largely of alcoholic patients and those addicted to intravenous drugs. Response to therapy was also similar in surviving older patients. Lower temperature and an unclear history were features most commonly associated with both delayed diagnosis and higher mortality. When patients with a history of alcohol abuse and those dying shortly after admission (i.e., presenting in a moribund state) were eliminated from the analysis, many of these age-related differences in presentation and outcome became even more evident.

Adult↗
PubMed1982

Unusual features of infections in the aging.

Antibody responses to specific antigens are generally impaired in the elderly. This is important because older people are often the target population for influenza and pneumococcal vaccination. Poor fever response in older patients may retard diagnosis of infection and sepsis.

Aged↗
PubMed1981

Evidence of prior hepatitis B and hepatitis A virus infections in an ambulatory geriatric population.

Ninety-five randomly selected patients attending an ambulatory geriatric medical clinic were tested for the presence in their sera of hepatitis B surface antigen and of antibody to hepatitis B and A viruses. Such evidence of past hepatitis infection was correlated with current liver function and history of having received blood transfusions. The results showed that 94% of patients had antibody to hepatitis A virus, and 32% had antibody to hepatitis B virus. Patients with abnormal liver function tests, or those with a history of blood transfusions were no more likely to have hepatitis B antibody than patients with normal liver function tests or those with no history of transfusion.

Aged↗