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Biomedical subjects

Richard Jaffe

Publications and source records attributed to Richard Jaffe.

6 recordsLinked to original sources
PubMed2003

Early endocrine, metabolic, and sonographic characteristics of polycystic ovary syndrome (PCOS): comparison between nonobese and obese adolescents.

Approximately half of all women with polycystic ovary syndrome (PCOS) are overweight or obese, and studies have reported endocrine and metabolic differences between lean and obese women with PCOS. PCOS has not been as extensively investigated in the adolescent population. The objectives of our study were to further characterize early endocrine and metabolic alterations in adolescents with PCOS and to determine whether differences between nonobese and obese women with PCOS are present early in its course. We studied an ethnically heterogeneous group of 48 adolescents: 11 nonobese with PCOS [age, 16.1 +/- 1.9 yr; body mass index (BMI), 22.5 +/- 1.5 kg/m(2)], 22 obese with PCOS (age, 15.5 +/- 1.4 yr; BMI, 35.9 +/- 6.2 kg/m(2)), and 15 obese controls (age, 14.4 +/- 1.5 yr; BMI, 35.8 +/- 7.1 kg/m(2)). Fasting levels of glucose, insulin, proinsulin, hemoglobin A1c, testosterone, SHBG, Delta4-androstenedione (Delta4-A), dehydroepiandrosterone sulfate (DHEAS), LH, FSH, IGF-I, IGF binding protein-1, free IGF-I, and lipids were measured. Six of the 11 nonobese PCOS subjects, 11 of the 22 obese PCOS subjects, and six of the 15 controls underwent standard oral glucose tolerance testing. The insulin response to the oral glucose tolerance test was measured by the insulin area under the curve (I(AUC120)). Measures of insulin sensitivity were calculated as the fasting glucose to insulin ratio, quantitative insulin sensitivity check index, and composite insulin sensitivity index. The nonobese adolescents with PCOS demonstrated higher levels of LH, SHBG, Delta4-A, DHEAS, dihydrotestosterone, free IGF-I, and high-density lipoprotein, and lower low-density lipoprotein, compared with the obese PCOS group. Fasting levels of insulin and proinsulin, I(AUC120), and log I(AUC120) were higher, and the fasting glucose to insulin ratio, quantitative insulin sensitivity check index, and composite insulin sensitivity index were lower in the obese compared with the nonobese PCOS subjects. Greater levels of LH and androgens, including total and free testosterone, Delta4-A, and DHEAS, and lower SHBG levels were found in the obese PCOS group compared with the obese controls. Adolescents with PCOS manifest clinical, metabolic, and endocrine features similar to those of adult women, and differences between nonobese and obese women with PCOS may be detected in adolescence. Our findings indicate a more pronounced alteration in the hypothalamo-pituitary-adrenal axis in nonobese adolescents with PCOS and a more marked dysregulation of insulin levels and impairment of insulin sensitivity in their obese counterparts. Our data also suggest differences in the IGF system between nonobese and obese adolescents with PCOS.

Adolescent↗
PubMed2002

Identification of fetal growth abnormalities in diabetes mellitus.

Gestational diabetes complicates 3% to 5% of all pregnancies. Shoulder dystocia and fetal injuries are associated with macrosomia, a complication often encountered in diabetic pregnancies. The route of delivery is often planned in advance and based on estimated fetal weight. Fetuses of diabetic mothers are prone to macrosomia due to increased subcutaneous adipose tissue deposits, and perinatal complications are more frequent in these fetuses. For this reason, particular effort should be directed toward the diagnosis of fetal growth abnormalities in fetuses of diabetic mothers. There are numerous formulas for estimating fetal weight, and they are all error prone. An effort should be made to follow these high-risk pregnancies in a longitudinal fashion to detect any developing growth abnormality as early as possible. Whether macrosomia or intrauterine growth restriction, early detection and careful planning of mode and time of delivery is the foundation of successful lowering of perinatal morbidity and mortality.

Diabetes Mellitus↗
PubMed1990

Outpatient Electroconvulsive Therapy: Efficacy and Safety.

Thirty-two outpatients with a mean age of 68 years were observed in a naturalistic study of outpatient electroconvulsive therapy (ECT) for the management of recurrent mood disorder. Sixty-nine percent of the patients responded favorably to ECT and were either discharged well from therapy or continue in treatment. A rehospitalization rate of 9% supports the efficacy of this treatment. We find outpatient ECT safe for the long-term management of recurrent depressive illness in elderly patients. The low dropout rate demonstrates that patient acceptance is equal to that of other outpatient treatments.

Journal Article↗
PubMed1990

Caffeine-Associated Cardiac Dysrhythmia During ECT: Report of Three Cases.

Caffeine is increasingly being used by ECT practitioners to augment seizure duration in selected patients. We note one report of adverse cardiovascular effects with this procedure. We report three cases of severe cardiac dysrhythmia, all appearing in the present of caffeine. The three patients were elderly, with a prior history of cardiac illness. The authors recommend the use of nonpharmacologic alternatives for the treatment of brief seizures, and careful review of each patient's cardiac history before utilizing caffeine. They further urge continued monitoring in those patients for whom caffeine is introduced. Further prospective studies are needed to assess carefully the risk of caffeine pretreatment in patients with cardiac disease.

Journal Article↗