Biomedical subjects
R Berkowitz
Publications and source records attributed to R Berkowitz.
A controlled trial of social intervention in the families of schizophrenic patients.
A study is reported of a controlled trial of social intervention in the families of schizophrenic patients at high risk of relapse. The patients were selected for being in high contact with high Expressed Emotion relatives. All patients were maintained on neuroleptic drugs. One half of the 24 families were randomly assigned to routine out-patient care, while the other half received a package of social interventions. This comprised a programme of education about schizophrenia, a group for the relatives, and family sessions for relatives and patients. The relapse rate in the control group was 50 per cent compared with nine per cent in the experimental group (P = 0.04). The stated aims of the therapeutic interventions were achieved in 73 per cent of experimental families. In these families, no patient relapsed. The results provide evidence for the causal role of relatives' expressed emotion (EE) in schizophrenic relapse, as well as for the therapeutic effectiveness of social intervention combined with drug treatment.
Soluble and stroma-bound globin chains in mild and severe beta thalassemia.
In mild beta thalassemia hemoglobin levels are much higher than in severe beta thalassemia, yet black patients with the mild syndrome are as deficient in beta chain synthesis as severe thalassemia patients. The following studies were undertaken to determine if differences in the precipitation of excess alpha chain distinguishes these two groups of beta thalassemia homozygotes. The percentages of radioactive globin chain bound to erythroid cell stroma were determined in mild and severe thalassemia patients. Only the cells of splenectomized severe patients contained large amounts of stroma-bound globin radioactivity, the percentages in five such patients ranging from 6.7 to 13.9 (mean = 9.9). In four splenectomized patients with mild thalassemia the percentages ranged from 1.0 to 3.5 (mean = 1.9; p less than 0.005). This is the first observed difference in globin chain metabolism between these two groups of patients.
Circulating immune complex levels in patients with gestational trophoblastic neoplasia.
The clinical course, human chorionic gonadotropin (HCG) levels, and serial circulating immune complex (CIC) levels in 21 patients with gestational trophoblastic neoplasia (GTN) were correlated for the evaluation of the relationship between CIC levels and trophoblastic tumor burden. CIC levels were normal in 18 of 21 patients at the time of presentation, and 2 of 3 patients who presented with elevated CIC levels had significant comorbid disease (toxemia and hepatitis). Nine patients were followed into gonadotropin remission, and all 9 developed an increase in CIC levels at the time of remission. It was concluded that CIC, at least as measured by two antigen-nonspecific techniques, is generally not elevated at initial presentation in the patient with GTN; this lack of an elevation is probably due to marked tumor antigen excess. Thus the in vivo importance of CIC as a "blocker" of host antitumor response at this stage is doubtful. After effective treatment as HCG levels return to normal, the demonstrated elevation in serial levels of CIC may reflect a return of adequate host immune response at a time of minimal tumor burden.
Idiopathic segmental infarction of the greater omentum: case report.
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The distinction between paranoid and non-paranoid forms of schizophrenia.
The distinction between paranoid and non-paranoid forms of schizophrenia is discussed. The different methods of making the distinctions are examined as well as some of the different variables to which it has been applied. It is suggested that the grounds on which the distinction is made are often questionable and that there is a case for saying that they may not even be tenable.
Psychophysiological responses of schizophrenic patients to high and low expressed emotion relatives.
Measurements of spontaneous fluctuations in skin conductance in 20 acutely ill schizophrenic patients were made in a video-tape studio. Recordings were made initially with the patient talking to an interviewer, then during a video-taped interview conducted with the patient's key relative. The Expressed Emotion (EE) of the patient's key relative had been measured previously. Significant differences in the type of spontaneous fluctuation activity between patients who had low EE and high EE relatives were demonstrated when the relative was present, but not when the relative was absent. The findings were not related to phenothiazine medication.
Estrogen production as a tumor marker in patients with gonadotropin-producing neoplasms.
Urinary estradiol production rates, plasma estradiol, and peripheral conversion of dehydroepiandrosterone sulfate (DHEAS) to estradiol were explored in patients whose neoplasms made human chorionic gonadotropin and/or human chorionic gonadotropin beta fragments. In five men with choriocarcinoma, estradiol production was elevated, plasma estradiol was high, and DHEAS conversion to estradiol ranged from 0.5 to 11.7%. In six patients with "ectopic" gonadotropin-producing tumors, originating from lung, stomach, and liver, estradiol production was elevated to a lesser degree. Sera from 154 of 864 patients (16.8%) with a wide variety of advanced neoplastic disorders were noted to have minimal elevations of human chorionic gonadotropin beta subunit in their sera but had normal luteinizing hormone assays. Plasma estradiol levels in these patients were not elevated, and in only one of ten patients studied was there slight elevation of the estradiol production rate. Similarly, in only one of ten patients was there measurable conversion of DHEAS to estradiol. We conclude that, in patients whose neoplastic disorders are associated with major elevations of human chorionic gonadotropin, there is concordant extragonadal production of estradiol via DHEAS, presumably representing an associated trophoblastic function. However, estrogen production is not a sensitive tumor marker in those patients whose neoplasms are associated with minimal elevations of human chorionic gonadotropin beta fragments only.
Plasticity in adult rat visual cortex: an examination of several cell populations after differential rearing.
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Dental trauma in children and adolescents.
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Embolization of pelvic arteries for control of postpartum hemorrhage.
Two cases are presented in which postpartum hemorrhage was controlled by Gelfoam embolization via an angiographic catheter. The advantages of embolization over surgery are discussed. It is suggested that an attempt be made to control severe postpartum hemorrhage by this means before resorting to surgery.
Increased estrogen production in obese men.
Serum estrone (E1) and 17beta-estradiol (E2) were noted to be 2-fold elevated in a group of morbidly obese men. Urinary E1 and E2 production rates were elevated in proportion to the degree of obesity, with values as high as 127 and 157 micrograms/day, respectively. Although serum testosterone (T) concentrations were reduced in obese men, averaging 348 +/- 35 vs. 519 +/- 42 ng/dl in lean controls, the dialyzable T fractions were elevated and, hence, the calculated free T concentrations were normal in obese men. Further, the obese men exhibited normal serum LH, FSH, and T responses to clomiphene citrate, indicating intact hypothalamic-pituitary-Leydig cell axes. MCRs of T and peripheral conversion of T to E2 and androstenedione (delta) to E1 were all increased in obese men in proportion to the percentage above ideal weight. Although the obese mean exhibited increased blood levels and production rates of estrogens, there were no signs of feminization, increased T-estrogen-binding, globulin levels, or suppressed basal gonadotropin levels, suggesting a lack of biological effect. We postulate that obese men exhibit defective estrogen receptors, leading to decreased T-estrogen-binding globulin, increased clearance of androgenic hormones, and elevated estrogen production rates.
Common duct stones in infancy.
The term "bile ascites" is used when the bilirubin content of the ascitic fluid is higher than it is in the serum. Two cases of newborn infants with bile ascites associated with common duct stones are reported. Review of the literature reveals 11 additional cases of common duct stones that presented as bile ascites. The surgical treatment of bile ascites and common duct stones is described. In spite of the severity of the problem, the outcome is successful in most cases (83.3% survival in this review).
The effect of hypertonic ointments on corneal alkali burns.
Alkali-burned rabbit corneas were treated with 40% glucose or 5% sodium chloride ophthalmic ointments 3 times daily for 6 weeks and examined clinically and histologically. Treatment with hypertonic ointment as compared to untreated controls demonstrated decreased corneal neovascularization and ulceration. The possible nutritional advantage of hypertonic glucose did not prove beneficial compared to hypertonic sodium chloride.
Intraocular lysozyme in experimental uveitis in rabbits: aqueous and vitreous assay.
We determined normal aqueous and vitreous lysozyme levels in rabbit eyes and induced experimental uveitis to record the uppermost aqueous and vitreous lysozyme levels. The normal aqueous humor of the rabbit eye contained 1.05 mug per milliliter lysozyme and the normal vitreous humor contained 0.45 mug per milliliter. After the intravitreal administration of a foreign protein, the aqueous and vitreous lysozyme levels rose within one day, reaching maximum values of 38.4 mug per milliliter and 114 mug per milliliter, respectively, at 14 days, and subsequently declining to minimal values by 28 days after injection.
Gallbladder perforation into the lesser sac.
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Management of diffuse hemorrhage from gastric mucosa. Pathophysiology and microcirculatory responses in diffuse gastric hemorrhage controlled by arterial embolization.
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Traumatic aorto-right atrial fistula and interventricular septal defect: a case report.
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