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Biomedical subjects

R Rosenthal

Publications and source records attributed to R Rosenthal.

At least 19 recordsLinked to original sources
PubMed1991

Safety of immediate treadmill testing in selected emergency department patients with chest pain: a preliminary report.

To determine the feasibility and safety of an immediate, symptom-limited, treadmill test on selected emergency department (ED) patients, a convenience sample of 28 patients underwent an exercise treadmill test (ETT) within the first several hours after hospital arrival using the modified Bruce protocol. Patients were included in the study if they presented with otherwise unexplained chest pain consistent with (but not characteristic for) angina pectoris and had a normal electrocardiogram. A negative ETT was seen in 23 of 28 patients, and five of 28 patients had a positive ETT. No patients had serial enzyme or electrocardiogram evolution suggestive of myocardial ischemia, and all patients with a negative ETT were discharged after a full inpatient evaluation designed to rule out unstable coronary disease. At a mean follow-up period of 6.1 months there has been no cardiac morbidity or mortality in the patients with negative ETTs. It was concluded that early ETTS of selected ED patients with chest pain is safe, and an exercise test administered during the ED visit which is negative can preclude unnecessary hospitalization.

Adult↗
PubMed1990

Pygmalion in the nursing home. The effects of caregiver expectations on patient outcomes.

Several characteristics of nursing home care can diminish rather than enhance the clinical status of older residents. In view of evidence from other settings that "interpersonal expectancy effects" can influence outcomes in a variety of relations, we conducted a randomized controlled trial to test the effects of caregiver expectations on the clinical status of nursing home residents. Within 2 weeks of admission, 63 older residents at six nursing homes were given a comprehensive assessment of cognitive, functional, and emotional status. Residents were then randomly assigned to a "high-expectancy" or "average-expectancy" condition. Nurses and aides were told that, in comparison with other residents having similar problems, residents in the high-expectancy group were predicted to perform above average in their rehabilitation. The assessment was repeated 3 months later; information on the health and psychosocial status of residents was drawn from their medical records covering the same period. Aides reported having higher expectations for treatment group residents. When assessed by a blinded research assistant, residents in the high-expectancy group experienced greater relief of depressive symptoms but showed greater decrements in functional independence in comparison with control residents. Treatment group residents were admitted significantly less frequently to hospitals despite a comparable number of emergency ward visits, suggesting a lower incidence of severe illness despite comparable medical surveillance. There was also a trend toward improved performance in mental status testing among the high-expectancy residents compared with controls (P = .08). Additional research is needed to define further the magnitude and mechanisms of expectancy effects in relations between nursing home caregivers and residents.

Activities of Daily Living↗
PubMed1990

The effects of dihydropyridine derivatives on force and Ca2+ current in frog skeletal muscle fibres.

1. The effects of dihydropyridine (DHP) derivatives on current through the slow Ca2+ channel and on isometric force were investigated in short toe muscle fibres of the frog (Rana temporaria). The experiments were performed under voltage-clamp conditions with two flexible internal microelectrodes. 2. The non-chiral DHP derivative nifedipine was used mainly because it allowed control measurements after the inactivation of the drug with UV light. 3. In a TEA sulphate solution containing 4 mM-free Ca2+, nifedipine (1 microM) caused no relevant alterations in the time course of successive contractures induced by depolarizing steps to 0 mV of 3.5 min duration followed by a restoration time at -90 mV of 1.5 min. 4. When external Ca2+ was replaced by Mg2+, nifedipine caused a dose-dependent shortening of contractures. The effect reached saturation at about 50% of shortening with 1-5 microM-nifedipine. In the absence of divalent cations and with Na+ being the only metallic cation in the solution, shortening became more pronounced and maximum force decreased. 5. The application of 2 microM-nifedipine to a Ca2(+)-free, Mg2(+)-containing solution shifted the voltage dependence of force inactivation by 5-10 mV to more negative potentials. 6. Force activation was facilitated by nifedipine. In the presence of 2 microM-nifedipine in a Ca2(+)-containing solution, threshold potentials (rheobase) as negative as -75 mV were measured under microscopical observation. UV irradiation shifted the threshold potential back to the normal value of about -50 mV. 7. The slow Ca2+ inward current was blocked almost completely by approximately 5 microM-nifedipine, even when induced from negative holding potentials (-90 to -120 mV), i.e. under conditions where normal phasic contractures could still be observed. 8. Nifedipine (0.8 microM) caused a shift of the voltage dependence of current inactivation (V0.5) by 4 mV from -26 to -30 mV and at negative holding potentials (-90 mV), a reduction of maximum current by 35%. 9. The voltage dependence of current activation was not significantly altered by nifedipine (2 microM). 10. It is assumed that nifedipine binds with low affinity to the resting state of the DHP receptor (KD 0.8 microM) and with high affinity (KD 1 nM) to the inactivated and the active state (or to a precursor of this state). These assumptions could explain the relatively small shift of the inactivation curves (points 5 and 8) to more negative potentials and the facilitation of force activation (point 6).

Animals↗
PubMed1990

Disseminated Mycobacterium fortuitum successfully treated with combination therapy including ciprofloxacin.

We report a case of disseminated Mycobacterium fortuitum in a 76-yr-old male with no identifiable predisposing factors except chronic interstitial lung disease. Recurrent, progressive pulmonary symptoms and radiographic findings were followed by the development of multiple, culture-positive peripheral lesions. The patient responded rapidly and completely to combination therapy consisting primarily of ciprofloxacin, minocycline, and surgical drainage. Our experience supports the cautious use and further study of fluorinated quinolones for M. fortuitum infections caused by susceptible isolates.

Aged↗
PubMed1989

[The spontaneous course of bronchial cancer. A study of survival time].

In order to assess the success of therapy in cases of bronchial carcinoma, the clinical course of 38 untreated patients was studied retrospectively. We were unable to demonstrate a significant difference in the survival rate between patients who underwent radical therapy and those who were not treated at all.

Adenocarcinoma↗
PubMed1989

The effect on gait of lengthening of the medial hamstrings in cerebral palsy.

The purpose of this study was to analyze the effect of lengthening of the medial hamstrings on the gait of patients who had spastic cerebral palsy. Thirty-one patients had preoperative and postoperative gait analyses. Standard parameters, such as velocity, cadence, and stride length, were evaluated, as were motion graphs of the hip, knee, and ankle. There was little difference between the preoperative and postoperative mean values for velocity, cadence, and stride length, which were expressed as percentages of normal for the patient's age. The contours of the postoperative motion graphs of the knees changed very little compared with those of the preoperative graphs; when a graph showed restricted motion preoperatively, it did so postoperatively. Although extension of the knee in stance phase improved postoperatively, the improvement was accompanied by decreased flexion of the knee during swing phase. When spasticity of both the hamstrings and the quadriceps was noted on the preoperative electromyogram, motion of the knee in the sagittal plane was markedly restricted.

Adolescent↗
PubMed1987

A preliminary study on the evaluation of asparaginase. Polyethylene glycol conjugate against canine malignant lymphoma.

Thirty-seven dogs with malignant lymphoma were treated with either polyethylene glycol conjugated (PEG) asparaginase alone (10-30 IU/kg intraperitoneally [IP] weekly--20 dogs) or PEG-asparaginase combined with one cycle of chemotherapy (vincristine, cyclophosphamide, methotrexate, and prednisone), followed by maintenance PEG-asparaginase (30 IU/kg, IP weekly--17 dogs). In the 20 dogs (eight were chemotherapy resistant) treated with PEG-asparaginase alone, seven had a complete response (CR), seven had a partial response (PR), five had no response (NR), and one was not evaluable (NE). The duration of response (CR + PR) ranged from 14 to 102 days (median, 48 days). In the eight chemotherapy-resistant dogs (seven were previously resistant to L-asparaginase) four had responses (one CR and three PR). In the 17 dogs treated with combined PEG-asparaginase and chemotherapy, 13 had a CR, two had a PR, and two had NR. None of the dogs had had prior chemotherapy, and the duration of response (CR + PR) ranged from 7 to 840+ days, with a median of 126+ days. Four dogs are still on maintenance PEG-asparaginase at 16+, 21+, 26+, and 28+ months. Toxicity consisted of death due to massive tumor breakdown (two dogs), disseminated intravascular coagulation (DIC--one dog), hypersensitivity reaction (one dog), vomiting (three dogs) and soft stools (three dogs). Four normal dogs were given very high doses of PEG-asparaginase (200 IU/kg and 1200 IU/kg) once weekly for two treatments without any significant toxicity. These results indicate that PEG-asparaginase has antitumor activity in dog with spontaneously occurring malignant lymphoma.

Animals↗
PubMed1987

[Cystic craniopharyngiomas: computed tomography in the pretherapeutic evaluation and control of treatment results following intracystic contact irradiation].

A report is given on the treatment planning by computed tomography and monitoring in 37 cases of preponderantly cystic craniopharyngiomas with different solid tumor parts. Colloidal yttrium 90 silicate was used for the intracystic contact irradiation. Two pretherapeutic forms of the solid tumor parts were found in CT examination which correlated with different courses: 1. the polymorphic type and 2. the type with a smooth outline. A posttherapeutic decrease of the cystic volume was observed in 74% of type 1 cases (n = 19) and in 89% of type 2 cases (n = 18). An increase in volume was only found in type 1 (21%). An increase of the solid tumor part was also found exclusively in the polymorphic type (68%). An additional external irradiation should be considered for this CT manifestation of the tumor, as the solid tumor part is not exposed in intracystic contact irradiation.

Brachytherapy↗
PubMed1986

Comparison of a videotape instructional program with a traditional lecture series for medical student emergency medicine teaching.

An emergency medicine faculty has reported that the use of the videotape medium for presenting curricular material to medical students is both cost effective and well suited to the educational milieu of the emergency department. In order to compare the effectiveness of videotape instruction with that of a traditional lecture, groups of students received instruction in one topic by videotape and in another topic by lecture. The students' retention of material was tested by a multiple-choice examination administered ten days later. The students scored 76.1% (683 of 898 questions) on material taught by lecture and 76.2% (673 of 883 questions) on material taught by videotape (P greater than 0.7). We conclude that videotape instruction is as effective an educational tool as the traditional lecture for an emergency medicine course.

Curriculum↗
PubMed1986

Counselor and client personality as determinants of counselor expectancy effects.

Seventy-eight students enrolled in summer-session college courses were randomly assigned to serve either as counselors or as clients for a 20-min, role-played peer counseling session. All of the subjects completed a battery of standardized personality measures. Each counselor interacted with two clients. Prior to the sessions, the counselor was led to believe that one of the clients was especially introverted and that the other client was especially extraverted. Dependent measures were based on clients' change scores on a mood adjective rating scale administered before and after the peer counseling sessions. Analyses showed that counselors who were more successful at biasing their clients in the direction of their expectancies (a) scored higher on measures of Dogmatism, Nurturance, and Social Recognition, (b) scored lower on Impulsivity, and (c) were more likely to be women. Clients who were more susceptible to counselor bias scored higher on the Self-Monitoring Scale, the Self-Monitoring Other-Directedness subscale, and Social Recognition. These results are discussed in light of previous research and their implications for research on interpersonal expectancy effects.

Adolescent↗
PubMed1986

A review of scalp split-thickness skin grafts and potential complications.

A review of 113 patients who underwent 178 scalp split-thickness skin graft procedures is presented. Although our study confirms some of the work of previous authors, we found that the scalp donor site has potential complications which should be considered. These complications are minor in the adult population. In the pediatric population, however, excessive blood loss due to the relatively large surface area of the scalp limits the use of the scalp as a preferred donor site.

Adolescent↗
PubMed1986

Rumination, heartburn, and daytime gastroesophageal reflux. A case study with mechanisms defined and successfully treated with biofeedback therapy.

A 31-year-old man with a 19-year history of rumination developed frequent episodes of heartburn and regurgitation associated with acid gastroesophageal reflux that occurred predominantly during the day. This reflux and its attendant symptoms resulted from abdominal muscle contractions at the time of gastroesophageal pressure equilibration (i.e., common cavity phenomena) consistent with the egress of air from the stomach to the esophagus. A voluntary pharyngeal maneuver unassociated with swallowing but simultaneous with the abdominal contraction resulted in a decrease in upper esophageal sphincter pressure. This lowered pressure facilitated acid esophagopharyngeal regurgitation at a velocity of 100 cm/s. Biofeedback therapy directed at relaxing the abdominal muscles during eating and avoiding the pharyngeal maneuver resulted in a decrease in reflux and marked improvement in symptoms.

Adult↗
PubMed1986

[Pancreatic pseudoaneurysm and spurious aneurysm of the splenic artery--diagnosis by angio-CT and ultrasound].

Pseudoaneurysm of the pancreas is a severe complication secondary to pancreatitis. The splenic artery is most often involved, followed by the pancreaticoduodenal vessels and the gastroduodenal artery. Selective arteriography is considered the method of choice in preoperative diagnosis. In a patient with chronic pancreatitis angio-CT and ultrasound allow a definitive diagnosis of pseudoaneurysm of the splenic artery.

Adult↗
PubMed1986

[Mediastinal metastases of extrathoracic tumors--important findings in mediastinoscopy].

From 700 mediastinoscopies performed between 1976 and 1985, 11 revealed metastases from extrathoracic malignancies. Primary tumours were eventually located in the gastrointestinal tract (5), the breasts (2), the kidneys (2) and the thyroid gland (1). All lymphatics join within the mediastinum. Therefore mediastinal secondaries from tumours of all body regions may be encountered. Mediastinoscopy facilitates safe biopsy and histological diagnosis. It is essential for adequate therapy.

Adult↗