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Biomedical subjects

R Berkowitz

Publications and source records attributed to R Berkowitz.

At least 19 recordsLinked to original sources
PubMed1992

Anaerobic threshold detection in patients with congestive heart failure.

Anaerobic threshold measurements determined either invasively by analysis of arterial lactate concentration (lactate threshold) or noninvasively by respiratory gas exchange analysis (ventilatory threshold) were compared in patients with chronic congestive heart failure. Sixteen patients performed symptom-limited maximal exercise on a bicycle ergometer using a continuous ramp protocol with measurement of arterial lactate concentration at 1 minute intervals, and continuous breath-by-breath analysis of respiratory gas exchange. A specific lactate threshold point was detected in only 7 patients. These 7 patients had significantly greater peak oxygen uptake than did the 9 in whom no specific lactate threshold point was detected (15.9 +/- 1.0 vs 10.5 +/- 0.5 ml/kg/min; p less than 0.05). Ventilatory threshold significantly correlated with lactate threshold in these 7 patients. In the remaining 9 patients, neither lactate nor ventilatory threshold could be reliably determined with methods used in the present study.

Aged↗
PubMed1992

The psychological, social, and sexual consequences of gestational trophoblastic disease.

Seventy-six women diagnosed with gestational trophoblastic disease (GTD) from 1985 to 1989 completed questionnaires evaluating their status on mood disturbance, marital satisfaction, sexual functioning, psychosocial response to illness, and report of the most stressful event occurring within the past year. Multivariate analyses of variance (MANOVA) were conducted on dependent measures to examine differences between diagnostic groups (partial mole, complete mole, persistent disease), time from diagnosis (less than 1 year, 1-2 years, or 3-5 years from diagnosis), and follow-up status (active disease or remission). MANOVAs revealed no significant differences in the dependent measures based on time from diagnosis, type of medical treatment received, or type of molar disease. The metastatic disease group displayed significantly greater mood disturbance (F(1, 66) = 17.63, P less than 0.0001) and reported suffering clinically significant levels of distress and significantly greater levels of distress in response to the illness (F(33, 39) = 2.32, P less than 0.006). Women with active disease also reported significantly greater levels of distress in response to the illness (F(33, 39) = 2.76, P less than 0.001). Across disease types, GTD patients experience clinically significant levels of anxiety, anger, fatigue, confusion, and sexual problems and are significantly impacted by pregnancy concerns for protracted periods of time.

Adaptation, Psychological↗
PubMed1992

Magnetic resonance imaging evaluation of calcaneal fat pads in patients with os calcis fractures.

Destruction of the calcaneal fat pad has been implicated as a source of chronic pain following fractures of the os calcis. Several investigators postulate that the initial trauma that produces a calcaneal fracture also results in destruction of the U-shaped fibrous septa that maintain the piston-like organization of the fat columns. Fibrosis and loss of the protective cushioning provided by the fat pad may eventually occur. The authors report on the largest series of magnetic resonance images of the calcaneal fat pad in the heels of patients with calcaneal fractures. A prospective consecutive study utilizing magnetic resonance imaging was performed on 22 heels with calcaneal fractures. Ten contralateral heels without calcaneal fracture and the heels of five normal subjects were scanned as controls. No signal changes suggestive of increased fat pad edema, fibrosis, or fatty release were detected. In addition, the vertical septa were well visualized and found to be intact in all cases. The height of the fat pad was measured, with no changes noted as compared with the contralateral heel. In those patients with acute fractures, signal changes suggestive of hematoma were well visualized in the soft tissue surrounding the calcaneus. In two of these cases, there was extension beneath the plantar fascia, but no penetration into the fat columns. Magnetic resonance imaging allows excellent detailed visualization of the calcaneal fat pad and surrounding structures. No evidence is found to support the hypothesis that marked damage to the gross structure of the fat pad occurs at the time of injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1991

Family therapy outcome research: a trial for families, therapists, and researchers.

This article describes the process of an evolving research project. Initially conceived as a study investigating outcome measures and their sensitivity to change after a course of family therapy, the project soon changed its focus. As unexpected results were recorded, the clinical research team became destabilized and the individual team members responded by making their own "sense" of the data, reflecting their respective clinical and scientific positions. As clinicians and researchers began to challenge each other's belief systems, the project entered a new stage. The interactions within the team became of increasing interest and themselves objects of research. The recursive nature of re-search was demonstrated, and the act of writing this report completed the circle, as the various authors tried to achieve a balance between reporting the content and the process of this project.

Family Therapy↗
PubMed1991

Dental trauma in children: a survey.

The purpose of this investigation was to determine the type and prevalence of injuries presenting to the pediatric dental service of the Child Nat Med Ctr. During the 12 months survey, 227 patients presented. This patient group consisted of 159 males (M) and 68 females (F) (2.34 M to 1.0 F); 96 (62 M, 34 F) were less than 5 y age; 85 (64 M, 21 F) were 5 to 12 y age; 46 (33 M, 13 F) were greater than or equal to 13 y age. The leading cause of injury was falls (105/227; 46%). Approx 50% (115/227) of the injuries occurred between May and September; 132 children sustained soft tissue injury (88 intraoral; 20 extraoral; 24 intra and extraoral); 61 permanent teeth were fractured in 44 children; 36 primary teeth were fractured in 31; 133 permanent teeth in 63 and 148 primary teeth in 79 patients sustained a displacement type of injury; 13 presented with an alveolar fracture. These observations extend earlier information regarding the epidemiology of dental injuries in childhood.

Accidental Falls↗
PubMed1990

Educating relatives of schizophrenic patients.

An education programme given to relatives of schizophrenic patients in the context of other social interventions is described. The findings show that although relatives remember relatively little one month after receiving the education, it is an important intervention. Several reasons are suggested, one of which is that education is a somewhat neutral but engaging beginning to the therapeutic relationship. At the later nine months follow up several positive changes in relatives' attitude were shown.

Attitude to Health↗
PubMed1990

A trial of family therapy versus a relatives' group for schizophrenia. Two-year follow-up.

The results are reported of a two-year follow-up of a trial of family sessions in the home (including patients) (12 families) versus a relatives' group (excluding patients) (11 families). Subjects were patients with schizophrenia living in high face-to-face contact with high-EE relatives. Patients were maintained on neuroleptic drugs for two years where possible. Relatives' critical comments and hostility were significantly lowered by nine months, but no significant changes occurred subsequently. Relatives' overinvolvement reduced steadily throughout the trial, and reduction in relatives' EE, either alone or in combination with reduced face-to-face contact, appeared to be associated with a lower relapse rate. The relapse rates for patients in the family-therapy and relatives'-group streams were 33% and 36% at two years. When these data were combined with the results of a previous trial, it was found that patients in families assigned to any form of social intervention had a two-year relapse rate of 40%, significantly lower than the 75% relapse rate for patients whose families were offered no help. We therefore recommend that relatives' groups are established in conjunction with some family sessions in the home for patients at high risk of relapse.

Communication↗
PubMed1989

Antenatal treatment of fetal alloimmune cytopenias.

The antenatal use of intravenous immunoglobulin (IVG) was explored in 9 cases of alloimmune cytopenias affecting fetuses. In 7 cases of alloimmune thrombocytopenia, IVG at a dose of 1 gm/kg/week appeared to be uniformly effective in elevating the fetal platelet count and preventing a recurrence of antenatal intracranial hemorrhage (2 cases). In 2 cases of Rh disease the results were more equivocal. There did not appear to be any significant toxicity associated with its use. The mechanism of IVG effect in the successfully treated cases remains uncertain.

Erythroblastosis, Fetal↗
PubMed1989

A trial of family therapy v. a relatives group for schizophrenia.

Schizophrenic patients living in high contact with relatives having high expressed emotion (EE) were recruited for a trial of social interventions. The patients were maintained on neuroleptic medication, while their families were randomly assigned to education plus family therapy or education plus a relatives group. Eleven out of 12 families accepted family therapy in the home, whereas only six out of 11 families were compliant with the relatives group. Non-compliance was associated with a poorer outcome for the patients in terms of the relapse rate. The relapse rate over nine months in the family therapy stream was 8%, while that in compliant families in the relatives group stream was 17%. Patients' social functioning showed small, non-significant, gains. The data from the current trial were compared with data from a previous trial. The lowering of the relapse rate in schizophrenia appears to be mediated by reductions in relatives' EE and/or face-to-face contact, and is not explained by better compliance with medication. Reduction in EE and/or contact was associated with a minuscule relapse rate (5%). Very little change occurred in families who were non-compliant with the relatives group. On the basis of these findings, we recommend that the most cost-effective procedure is to establish relatives groups in conjunction with family education and one or more initial family therapy sessions in the home. It is particularly important to offer home visits to families who are unable to or refuse to attend the relatives groups.

Adolescent↗
PubMed1989

Human chorionic gonadotropin and free subunits' serum levels in patients with partial and complete hydatidiform moles.

Serum levels of hCG and its free subunits were measured in patients with partial and complete hydatidiform moles and in women with normal 10-week pregnancies. whereas complete moles had higher levels of percent-free beta-hCG than partial moles (2.4 versus 1.0; P less than or equal to .005), partial moles had higher levels of percent-free alpha-hCG than complete moles (0.85 versus 0.17; P less than or equal to .005). Normal 10-week pregnancies had lower levels of both percent-free beta-hCG and percent-free alpha-hCG than partial moles (0.40 versus 1.0, P less than or equal to .005 and 0.27 versus 0.85, P less than or equal to .005, respectively). Percent-free beta-hCG and beta-hCG levels did not distinguish which patients with complete mole were more likely to develop persistent post-molar tumor. The trophoblastic cells in complete and partial moles differ significantly in the manner in which they secrete the free subunits of hCG.

Chorionic Gonadotropin↗
PubMed1988

Insulin-like growth factor-I is an essential regulator of the differentiation of 3T3-L1 adipocytes.

Murine 3T3-L1 preadipocytes proliferate normally in medium containing fetal calf serum depleted of insulin, growth hormone, and insulin-like growth factor-I (IGF-I). However, the cells do not differentiate into adipocytes in the presence of the hormone-depleted serum. Supplementation of the growth medium with 10-20 nM IGF-I or 2 microM insulin restores the ability of 3T3-L1 cells to develop into adipocytes. The cells acquire an adipocyte morphology, accumulate triglycerides, and express a 450-fold increase in the activity of the lipogenic enzyme glycerol-3-phosphate dehydrogenase. The increase in glycerol-3-phosphate dehydrogenase activity is paralleled by the accumulation of glycerol-3-phosphate dehydrogenase mRNA and mRNA for the myelin P2-like protein aP2, another marker for fat cell development. IGF-I or insulin-stimulated adipogenesis in 3T3-L1 cells is not dependent on growth hormone. Occupancy of preadipocyte IGF-I receptors by IGF-I (or insulin) is implicated as a central step in the differentiation process. The IGF-I receptor binds insulin with a 70-fold lower affinity than IGF-I, and 30-70-fold higher levels of insulin are required to duplicate the effects of an optimal amount of IGF-I. The effects of 10-20 nM IGF-I are likely to be mediated by high affinity (KD = 5 nM) IGF-I receptors that are expressed at a density of 13,000 sites/preadipocyte. In undifferentiated cells the IGF-I receptor concentration is twice that of the insulin receptor. After adipocyte differentiation is triggered, the number and affinity of IGF-I receptors remain constant while insulin receptor number increases approximately 25-fold as developing adipocytes become responsive to insulin at the level of metabolic regulation. Thus, preadipocytes have the potential for a maximal response to IGF-I, whereas the accumulation of more than 95% of adipocyte insulin receptors and the appearance of responsiveness to insulin are consequences of differentiation. IGF-I or insulin is essential for the induction of a variety of abundant and nonabundant mRNAs characteristic of 3T3-L1 adipocytes.

Adipose Tissue↗
PubMed1988

Differential production of human chorionic gonadotropin and free subunits in gestational trophoblastic disease.

Serum levels of human chorionic gonadotropin (hCG) and its free subunits (alpha hCG and beta hCG) were determined by means of highly sensitive and specific monoclonal and antipeptide-based monoclonal immunoradiometric assays. During normal pregnancy, the beta hCG to hCG ratio appears constant at approximately 0.5% after 5 weeks of gestation. In contrast, gestational choriocarcinoma was characterized by absolute serum beta hCG levels varying from three to 280 times greater than the maximum values observed during pregnancy and by exceedingly high beta hCG to hCG ratios. In complete hydatidiform mole, this ratio was intermediate between normal pregnancy and choriocarcinoma. The ratios of free beta hCG to hCG will distinguish normal from complete molar pregnancy (p less than 10(-8)), hydatidiform mole from choriocarcinoma (p less than 10(-4)), and choriocarcinoma from normal pregnancy (p less than 10(-8)) with high probability. Finally, it was found by means of the high sensitivity hCG immunoradiometric assays (less than 0.02 ng/ml) that this assay predicted very early tumor recurrence in patients with gestational choriocarcinoma.

Adult↗
PubMed1988

Need for theophylline in severe steroid-requiring asthmatics.

Concern about side-effects of theophylline prompted us to investigate whether this drug could be eliminated from the multi-medication regimen of severe asthmatics. We studied patients with a demonstrated requirement for systemic steroids who were taking most other available anti-asthma medications in an attempt to reduce systemic steroids while maintaining clinical stability. Five in-patients, 12-15 years old, completed a double-blind, cross-over trial of theophylline vs placebo. All were stable for 4 weeks prior to the study with normal spirometry and mildly elevated lung volumes. Regular medications consisted of long-acting theophylline with levels between 12 mcg/ml and 16 mcg/ml, and prednisone 10-30 mg on alternate days. In addition, they were all taking inhaled metaproterenol, cromolyn sodium, atropine sulphate, and beclomethasone dipropionate four times daily (qid). Patients received either theophylline or placebo during two drug periods. All other medications were unchanged. Parameters measured were symptom score, number of extra respiratory treatments (prn RTs), increase in steroid dosage, and daily spirometry. During the placebo period, all five patients required increased steroids, daily spirometry decreased and three patients developed severe exacerbations unrelated to viral infection. A marked increase in symptom score occurred within 48 hr of discontinuing theophylline in all. These findings emphasize that theophylline is beneficial in a subset of severe asthmatics who cannot be controlled with all other available bronchodilators, cromolyn, and inhaled and systemic steroids.

Adolescent↗
PubMed1987

Expressed emotion in individual and family settings: a comparative study.

Expressed emotion ratings were performed, in two separate settings, on the parents of 20 children suffering from anorexia nervosa. Ratings were made on conventional individual interviews and on videotapes of a family interview. Comparison of ratings in the two settings showed a very high correlation for 'critical comments'. Findings on the other scales were harder to interpret, but significant correlations as well as differences were noted. Expressed emotion rated in family interviews provides new possibilities for the study of families.

Adolescent↗
PubMed1986

Correlation between outer-membrane lysis and susceptibility of mitochondria to inhibition by adriamycin and polyamines.

Pretreatment of rat liver mitochondria with digitonin or osmotic shock increases their susceptibility to respiratory inhibition by adriamycin and polyamines. Since enhanced inhibitor sensitivity coincides in each case with lysis of the mitochondrial outer membranes, the possibility is raised that this membrane represents a permeability barrier to certain polar, organic cations.

Animals↗