Biomedical subjects

Martin Feuerman

Publications and source records attributed to Martin Feuerman.

8 recordsLinked to original sources

PubMed2006

A single-center experience of endoscopic ultrasonography for enlarged pancreas on computed tomography.

BACKGROUND & AIMS: The clinical significance of "fullness" or enlargement of the pancreas (FP/EP) is not well established. The objective of this study was to report our experience with endoscopic ultrasonography (EUS) in evaluating patients referred for FP/EP found on computed tomography (CT). METHODS: Patients referred to our center for EUS evaluation of FP/EP between January 1998 and December 2003 were studied. Patient demographics, clinical history, endoscopic findings, and follow-up were recorded. Multivariate analysis was used to identify predictors of pancreatic malignancy. RESULTS: A total of 50 patients: 46% (23/50) male, mean age 59 years (range, 18-90) made up our studied population. EUS demonstrated normal findings in 42% (21/50), prominent ventral anlage (embryologic variant) in 14% (7/50), and chronic pancreatitis in 22% (11/50). In 22% (11/50), a suspicious mass was noted and fine-needle aspiration (FNA) was performed. Cytology revealed chronic inflammation in 7 patients, while adenocarcinoma was found in the remaining 4. Median follow-up was 27 months, and the diagnosis did not change in any of the 50 patients. There were no procedure-related complications. After multivariant regression analysis, the factors that were statistically associated with malignancy were a CA19-9 level >300 (P = .0002) and weight loss (P < .006). CONCLUSIONS: The majority of patients presenting with FP/EP had benign disease, but 8% had pancreatic cancer. Elevated CA19-9 and weight loss were predictive of pancreatic malignancy. EUS and EUS-FNA are safe and accurate diagnostic tests and can play an important role in evaluating patients with FP/EP.

Adult↗

PubMed2006

Optimal vitamin D status and serum parathyroid hormone concentrations in African American women.

BACKGROUND: Optimal vitamin D status for the prevention of osteoporosis has been inferred from examinations of the serum 25-hydroxyvitamin D [25(OH)D] concentration below which there is an increase in serum parathyroid hormone (PTH). OBJECTIVE: The objectives of the study were to ascertain whether a threshold for serum 25(OH)D exists below which serum PTH increases and whether persons with 25(OH)D above this threshold have lower rates of bone loss than do persons with 25(OH)D below the threshold. DESIGN: The relation of serum 25(OH)D to serum PTH was analyzed in 208 African American women studied longitudinally for 3 y. These healthy women in midlife were randomly assigned to receive placebo or 800 IU vitamin D3/d; after 2 y, the vitamin D3 supplementation was increased to 2000 IU/d. Both groups received calcium supplements to ensure an adequate calcium intake. A systematic literature review found a wide range of threshold values in part due to varied calcium intake. RESULTS: A Loess plot suggested a breakpoint between 40 and 50 nmol/L for serum 25(OH)D. A line-line model was fitted to the data, and it showed a spline knot at 44 nmol/L. A heuristic approach verified that PTH does not decline as rapidly when the serum concentration of 25(OH)D is >40 nmol/L as when it is <40 nmol/L. We found no significant difference in rates of bone loss between persons with 25(OH)D concentrations above and below 40 nmol/L. CONCLUSION: Although a threshold for 25(OH)D can be identified, we suggest that it should not be used to recommend optimal vitamin D status.

Black or African American↗

PubMed2002

Total body phosphorus in healthy women and ethnic variations.

Total body phosphorus (TBP) levels were measured in 90 black and 143 white healthy women to determine ethnic differences. The measurements were performed by in vivo delayed gamma neutron activation (DGNA) analysis at Brookhaven National Laboratory (BNL). Mean value of TBP in whites was 10.4% lower as compared with the black women (mean TBP in white women 401.4 +/- 57.5 g v. 447.7 +/- 57.7 g in black women). Both subgroups have a decrease in TBP with age with a rapid phase after the onset of menopause, which corresponds to bone loss. The decrease in TBP is similar in both ethnic groups with black women losing -1.59 g/yr (-0.33%/yr) and white women losing -2.08 g/yr (-0.45%/yr).

Adult↗

PubMedDate not supplied

Exercise myocardial perfusion imaging in elderly patients.

BACKGROUND: Exercise myocardial perfusion imaging (MPI) has significant value for risk stratification, but most patients studied have been middle-aged. In particular, the value of exercise MPI in elderly patients with interpretable electrocardiographic (ECG) stress test results has not been well defined. MEHODS AND RESULTS: Clinical, ECG stress test, MPI, and follow-up data for 626 outpatients aged 65 years or older with interpretable electrocardiograms undergoing symptom-limited exercise MPI between 1992 and 1996 were analyzed. Follow-up was 97% complete after 4.4 +/- 1.3 years. After exclusion of the 27 patients who underwent revascularization within 90 days of MPI, there were 361 men and 217 women, aged 70.7 +/- 4.4 years. By univariate analysis, male sex, increasing age, an abnormal rest ECG result, lower exercise tolerance and lower peak exercise heart rates, exercise ST-segment depression, left ventricular dilatation, and the number of ischemic regions predicted death or myocardial infarction. By multivariable modeling, only increasing patient age, male sex, limitation of exercise tolerance, and the number of ischemic segments by MPI were predictive of subsequent death or myocardial infarction. CONCLUSIONS: In elderly patients referred for exercise MPI, age, sex, exercise tolerance, and MPI ischemia provide significant prognostic information.

Age Factors↗

PubMedDate not supplied

Results of an 8-week, outpatient pulmonary rehabilitation program on patients with and without chronic obstructive pulmonary disease.

PURPOSE: To determine whether there is any difference in the effect of pulmonary rehabilitation (PR) on outcomes in patients with and without chronic obstructive pulmonary disease (COPD). METHODS: Retrospective analysis of medical records of all patients enrolling in PR over a 5-year period. RESULTS: A total of 422 patients enrolled in a multidisciplinary PR program from August 1999 to April 2004. Three hundred nine patients had COPD and 113 patients had diagnoses other than COPD. Three hundred seventy-nine patients completed the program. PR was conducted according to currently accepted guidelines. Measurements included the 6-minute walk distance (6MW) performed at the beginning and end of the program and quality of life as determined by the Chronic Respiratory Questionnaire (CRQ) at the beginning and end of the program. Both groups had significant improvements in the 6MW and all domains of the CRQ following PR. There was no significant difference in any of these outcomes between the 2 groups. The baseline forced expiratory volume in 1 second (FEV1) was not correlated with improvement in the 6MW in either group. CONCLUSIONS: There is no significant difference in improvement in exercise tolerance or quality of life following PR in COPD versus non-COPD patients. Baseline lung function does not predict improvement in exercise tolerance. PR is effective for patients with disability due to any chronic respiratory disease and not just COPD.

Aged↗

PubMedDate not supplied

Cerebral oximetry monitoring during carotid endarterectomy: effect of carotid clamping and shunting.

Cerebral oximetry is a simple method of measuring regional cerebral oxygen saturation (rSO(2)). One promising application is its use during carotid endarterectomy (CEA) to help minimize the risk of perioperative stroke. The authors used the INVOS-4100 cerebral oximeter at several steps during CEA to measure the effect of carotid clamping and shunting on rSO(2). The authors prospectively evaluated 42 consecutive CEAs in 40 patients. All had CEA under general anesthesia with the routine use of a Javid shunt. The INVOS-4100 oximeter was used to measure rSO(2) before clamping (t1), after clamping but before shunting (t2), 5 minutes after shunt insertion (t3), and after patch closure with reestablished flow (t4). The Wilcoxon signed-rank and rank-sum tests were used for analysis. Clamping of the internal carotid artery (t1 vs t2) resulted in a drop of ipsilateral rSO(2) by -12.3% (p < 0.001). Shunt insertion (t2 vs t3) increased rSO(2) by 10.9% (p < 0.001). Contralateral rSO(2) for the same time periods was insignificant. Patients with preoperative neurologic symptoms had a greater decrease in rSO(2) after clamping (-18.4%) compared with a decrease of -10.4% in asymptomatic patients (p = 0.037). Cerebral oximetry monitoring is simple and inexpensive. The study showed statistically significant changes in rSO(2) as a result of clamping and shunting of the carotid artery. Symptomatic patients had a greater drop in rSO(2).

Aged↗

PubMedDate not supplied

Open aneurysm repair in elderly patients not candidates for endovascular repair (EVAR): Comparison with patients undergoing EVAR or preferential open repair.

The authors reviewed a 2-year experience with abdominal aortic aneurysm (AAA) repair to determine if patients who were excluded from endovascular aneurysm repair (EVAR) because of anatomic criteria (Group III) represented a higher risk for subsequent open aneurysm repair than either patients undergoing EVAR (Group II) or those patients who preferentially underwent open repair (Group I). Between January 2001 and December 2003, 107 patients underwent AAA repair. Open repair was recommended in patients <70 years of age and without significant comorbidities (Group I). There were 35 patients in Group I; 72 patients were evaluated for EVAR; 29 patients underwent EVAR (Group II), and 43 were excluded and underwent open repair (Group III). Exclusion criteria were those recommended by the graft manufacturers. Patients in Group I were significantly younger than those in Groups II and III (p < 0.0001). Gender, incidence of diabetes, and hypertension were similar in all groups. Patients in Group III had a greater incidence of coronary artery disease (CAD) than those in Groups I and II, trending toward statistical significance (p = 0.06). Aneurysm size in Group II was statistically smaller than in Group I or III. Group III had significantly more complications (25.6% vs 5.7% and 6.9%) than either Group I or II (p < 0.015). Cardiac complications were similar in all groups. Three patients in Group III required prolonged intubation and 3 in Group III developed renal insufficiency. A history of CAD was predictive of complications (21.8% vs 5.8%, p < 0.024), as was inclusion in Group III. There were 2 deaths in this series, both in Group III. Length of stay was significantly less in Group II (4.17 +/-2.36 days) than in Group I (6.57 +/-1.84 days) or Group III (12.30 +/-9.82 days) (p = 0.0001). Open aneurysm repair can be safely performed in younger good-risk patients (Group I) with results equivalent to EVAR (Group II) but with slightly longer length of stay (LOS). In older patients with suitable anatomy EVAR can be performed with minimal morbidity and short LOS. Older patients not suitable for EVAR (Group III) constitute a higher risk group of patients because of increased incidence of CAD and the need for more complex repairs. However, the mortality rate in this group was only 4.6%.

Aged↗

PubMedDate not supplied

Reference range for serum parathyroid hormone.

OBJECTIVE: To determine whether the reference range for parathyroid hormone (PTH) should be lowered (from 65 pg/mL to a proposed value of 46 pg/mL) with use of the Allegro radioimmunometric assay. METHODS: We examined the reference range for PTH, adjusted for serum 25-hydroxyvitamin D (25-OHD), in 503 healthy African American and white women, who were 20 to 80 years old. We also analyzed other factors that are thought to influence PTH levels. RESULTS: Univariate predictors of PTH were identified, and a multivariate model was developed with use of the variables and PTH. Serum PTH was significantly higher in black study subjects than in white study subjects (P<0.02). Increasing PTH was also significantly correlated with increasing body mass index, age, and serum creatinine and with decreasing dietary calcium intake and serum 25-OHD levels. A stepwise multiple linear regression analysis yielded the following predictors of PTH: body mass index (R2=9.4%), age (R2=1.0%), and serum 25-OHD (R2=0.8%). In our study population, many PTH values were above the proposed new upper limit of 46 pg/mL. CONCLUSION: The upper limit of the reference range for serum PTH should not be changed. Factors to be considered in analysis of serum PTH values in the upper reference range in patients with normocalcemia include obesity, race, 25-OHD levels, advanced age, serum creatinine, and dietary calcium intake.

Adult↗