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Biomedical subjects

S Feldman

Publications and source records attributed to S Feldman.

At least 37 records · Page 2Linked to original sources
PubMed2000

Effects of adrenergic and serotonergic agonists in the amygdala on the hypothalamo-pituitary-adrenocortical axis.

The effect of direct administration of adrenergic and serotonergic (5-HT) agonists into the central nucleus of the amygdala (AMG) on the hypothalamo-pituitary-adrenal (HPA) axis have been studied in intact male rats and in animals with 6-hydroxydopamine (6-OHDA) or 5, 7-dihydroxytryptamine (5,7-DHT) neurotoxic lesions in the paraventricular nucleus of the hypothalamus (PVN). In intact animals, the administration of phenylephrine, an alpha1 adrenergic agonist or 8-hydroxy-2-(di-n-propylamino)-tetralin (8-OH-DPAT) a 5-HT(1A) agonist caused depletion of median eminence corticotropin releasing hormone and a rise in serum adrenocorticotrophic hormone (ACTH) and corticosterone (CS) levels. Isoproterenol a beta agonist was more effective than phenylephrine and a 5-HT(1B) agonist CP-93, 129 was less effective than 8-OH-DPAT on the adrenocortical activity. The 6-OHDA or 5,7-DHT hypothalamic lesions prevented the stimulatory effects of phenylephrine and 8-OH-DPAT, respectively, which where injected into the AMG, on serum ACTH and CS levels. In view of our previous studies on the effects of the adrenergic and 5-HT antagonists in the AMG and the present data, it is suggested that norepinephrine and 5-HT play an important role in the stimulatory effect of the AMG on the HPA axis. These effects depend on the presence of these excitatory neurotransmitters in the PVN.

Adrenal Cortex↗
PubMed2000

Multiple adverse events with a dual chamber pacemaker.

The aim of the study was to evaluate our experience with Physiocor 400T, a dual chamber unipolar pacemaker manufactured by Sorin Biomedica. Between March 1993 and December 1994, 63 units of that model were implanted at our center. Patients were followed for 46 +/- 16 months. By the end of follow-up, 15 patients had died, 1 patient was lost to follow-up, and two units had been replaced for unrelated reasons. During follow-up the following phenomena had been observed: (1) Spontaneous backup reversion (VOO, 80 ppm) in 6 (9.5%) of 63 patients. In three patients this phenomenon was accompanied by concomitant ineffective pacing artifacts at 130 beats/min with very low pulse widths. (2) Unexpected battery depletion (EOL) occurred in 3 (5%) of 63 patients; two of the three occurred within weeks of routine evaluation that confirmed normal battery status. (3) Early elective replacement time (ERT) unpreceded by a gradual drop in magnet rate in 2 (3.2%) of 63 patients. (4) Total loss of telemetry without change in pacing mode in 1 (1.6%) of 63 patients. The estimated event-free 5-year survival of this model was 46%. In conclusion, 12 (19%) of 63 patients had adverse events with Physiocor 400T pacemakers. The potential risk of asynchronous pacing for prolonged periods and the risk of unexpected EOL warrants consideration of elective replacement of all remaining units.

Adolescent↗
PubMed2000

'Is anybody listening?' The experiences of widowhood for older Australian women.

This paper discusses preliminary findings from participants in the baseline survey of the Australian Longitudinal Study on Women's Health (Women's Health Australia: WHA) who reported their marital status as widowed. A total of 12,624 women, aged 70-75 years, completed a self-administered 260-item questionnaire, and 4335 of these women were widowed. Many of these women provided additional qualitative comments about their health, social and financial circumstances after the death of their spouse. This paper presents a thematic analysis of the qualitative comments and builds on the findings of the quantitative analysis of baseline data. The aims of this part of the study are to examine the short- and long-term effects of widowhood on the health and wellbeing of older women and to explore the process of change they experience after the death of a spouse. Preliminary findings suggest that, as a key life event, widowhood has an initial negative impact on the health and wellbeing of older women, but in the long term it may be accompanied by a positive shift into a new life phase.

Aged↗
PubMed2000

Randomized comparison of J-shaped and straight atrial screw-in pacing leads.

OBJECTIVE: To study the importance of a J shape in atrial pacing leads. PATIENTS AND METHODS: We compared in a randomized controlled study acute and chronic results with 2 steroid-eluting, polyurethane, screw-in atrial lead models that differ only in shape. A total of 208 patients were randomized to have implantation of either a straight atrial lead (n = 105) or a J-shaped atrial lead (n = 103). Patients were followed up for 1 year. RESULTS: On implantation, there were no significant differences between leads in rates of failure to implant, implant measurements, number of attempts to achieve an acceptable position, and fluoroscopy times. Before discharge and at 3-month and 1-year follow-up, electrical measurements showed no statistical differences between leads. During the first year after implantation, there were 2.9% early dislodgments (< 1 week after implantation) and 2.9% late dislodgments in the straight lead group (5.9% rate of all dislodgments) vs no dislodgments in the J-shaped lead group (P = .01). There was a trend toward higher rates of exit block and lead malfunction in the J-shaped lead group. Rates of pericardial complications, subclavian/axillary thrombosis, and chronic atrial fibrillation were the same in both groups. CONCLUSIONS: Both leads appear to have an equally favorable performance profile for 1 year of follow-up. The J-shaped lead seems to be more stable and have fewer dislodgments, although it may have a somewhat higher malfunction rate.

Adult↗
PubMed2000

Advances in psoriasis treatment.

Psoriasis is a complex disorder that negatively impacts quality of life. Treatment strategies must address both psychosocial and physical aspects of the disease. Psoriasis can be categorized into localized and generalized forms for treatment purposes. In either case, the treatment plan should include obtaining rapid control of the disease and maintaining that control. For localized disease, recent data support the combined use of topical corticosteroids with a noncorticosteroid agent (topical calcipotriene or tazarotene). For generalized disease, UVB phototherapy is an effective treatment that permits both rapid control and long-term maintenance. Use of low doses of acitretin (25mg qd or qod) potentiates both UVB and PUVA therapy. For patients unresponsive to phototherapy or who are not able to come on a regular basis, methotrexate is an effective alternative. Cyclosporine is useful, especially for short-term use in settings of acute exacerbation, but should be replaced by other modalities for long-term maintenance. Other agents that have a place in treatment of generalized psoriasis include hydroxyurea and mycophenolate mofetil.

Acitretin↗
PubMed1999

Glucocorticoid receptor antagonists in the hippocampus modify the negative feedback following neural stimuli.

The effects of local glucocorticoid receptor antagonists implanted into the dorsal hippocampus on the hypothalamo-pituitary-adrenal (HPA) axis responses following neural stimuli in freely moving rats, as well as their effects on the negative feedback exerted by dexamethasone (DEX) was studied in male rats. In animals with hippocampal cholesterol implants, photic and acoustic stimuli caused depletion in median eminence (ME) CRH-41 and a consequent rise in plasma ACTH and corticosterone levels. These effects were inhibited by systemic DEX, and the latter phenomenon was partially reversed by hippocampal implants of glucocorticoid (GR) and to a lesser degree by mineralocorticoid (MR) receptor antagonists. These data indicate that GR and MR receptors in the hippocampus play a role in the glucocorticoid negative feedback on the HPA axis, although the hippocampus may have also a modulatory effect, which does not depend on glucocorticoids.

Acoustic Stimulation↗
PubMed1999

Evidence that antisulfatide autoantibodies from rats experimentally infected with Trypanosoma cruzi bind to homologous neural tissue.

Earlier studies in Trypanosoma cruzi-infected rats revealed an increased antibody activity against sulfatide, a specific constituent of both myelin sheaths of peripheral nerves and T. cruzi epimastigotes. To investigate further the characteristics of such anti-sulfatide antibodies, we analyzed their IgG isotypes as well as their ability to bind to homologous neural host structures. Antisulfatide IgG-enriched fractions were obtained from rats acutely infected with T. cruzi. Immunoglobulin isotypes were determined by an enzyme-linked immunosorbent assay (ELISA) method to show that IgG2a and, more significantly, IgG2b were the predominant isotypes of antisulfatide autoantibodies. Further immunofluorescence studies carried out in coronal sections of the rat forebrain revealed, in turn, that antisulfatide antibodies were capable of reacting with homologous neural tissues. Specific binding of these rat autoantibodies to sulfocerebroside on cell surfaces in vivo may in theory play some detrimental role, given the reported ability of rat IgG2b to fix complement or to mediate antibody-dependent cell-mediated cytotoxicity reactions.

Acute Disease↗
PubMed1999

Please don't call me 'dear': older women's narratives of health care.

This paper foregrounds some of the central themes that a group of older women in writing workshops identified as integral to their health and overall quality of life. In particular it looks at how these women felt about their relationship to professional health care providers, and the role that both play in the maintenance of the women's health and well-being. The research that it is based on comes from narratives and autobiographical stories written by these women, which aimed both to identify the issues and concerns that affect them as older women, and to position them centrally as agents and collaborators in intellectual work. Their challenging words disrupted conventional story lines about the experiences of growing older, and confronted the narrow range of negative images of ageing and the accompanying stereotypes that currently pervade our culture.

Aged↗
PubMed1999

Rothia endocarditis in a child.

Rothia dentocariosa, an organism inhabiting the oral flora, has been reported to cause endocarditis in adults but not in children. Most patients reported with Rothia endocarditis have a history of poor dentition. We report a case of Rothia endocarditis in a child with congenital heart disease without other known risk factors.

Actinomycetaceae↗
PubMed1999

Effect of exogenous nitric oxide and inhibitors of nitric oxide synthase on the hypothalamic pituitary adrenal axis responses to neural stimuli.

It has been shown that the hypothalamic-pituitary-adrenal (HPA) axis responses to immune-derived stimuli in particular can be modulated by nitric oxide (NO). In the present study we examined the effect of endogenous and exogenous NO on the HPA axis responses to neural stimuli which are not related to immune functions. Intracerebroventricular injection of NOR-3, a donor of NO, had no effect on basal HPA axis activity but significantly attenuated the secretion of median eminence (ME) CRH-41 as well as the serum ACTH and corticosterone (CS) in response to acute photic stimulation in a dose-dependent manner. Intracerebroventricular administration of N-omega-nitro-L-arginine methyl ester (L-NAME), a general NOS inhibitor, significantly enhanced ACTH and CS responses to this stress but did not change the basal levels of these hormones. On the other hand, i.c.v. injection of aminoguanidine, an inhibitor of inducible NO synthase (NOS) but not of neuronal NOS, did not affect the HPA axis responses to photic stimulation. These results suggest that: (1) NO is involved in modulation of the HPA axis responses to neural stimuli which are not dependent on immune factors, (2) the effect of NO is mediated by inhibition of hypothalamic ME CRH-41 secretion, and (3) this effect is probably mediated by neuronal NOS and not by inducible NOS.

Adrenocorticotropic Hormone↗
PubMed1999

For richer, for poorer, in sickness and in health: older widowed women's health, relationships and financial security.

AIM: This study contrasts the health and social needs of widowed older women with needs of married older women. METHOD: 12,624 women aged 70-75 years across Australia completed baseline questionnaires for the Australian Longitudinal Study on Women's Health: 34.5% of the women were widowed, and 13.5% of these widowed women had lost their spouse within the past 12 months (recently widowed). RESULTS: Recently widowed women had particular physical and mental health needs as well as financial and practical needs relating to managing on their income. They had the lowest self-rated health, were most likely to report they were stressed about their health, and scored significantly lower than married women on all 8 sub-scales of the SF-36. Women were more likely to say they make their own decisions about their life if they were widowed than if they were married. However, stress with relationships with children or other family members was more likely to be reported by widows than other women.

Aged↗
PubMed1999

The outcome of advanced chronic nephropathy in type 1 and type 2 diabetic and non-diabetic patients: a prospective study.

To compare end-stage progression of nephropathy in type 1 and type 2 diabetic patients and non-diabetic subjects, we prospectively studied 92 patients with advanced uraemia not yet on dialysis (mean age 57.2 +/- 15.0 years), with a serum creatinine level above 200 mumol/L. The study included monthly serum creatinine (SC) measurements and quarterly outpatient follow-up (mean 10.8 +/- 7.1 months, range 1-21). Sixty subjects (65.2%) were diabetic (28 type 1 and 32 type 2). At inclusion, 95.6% of patients had anti-hypertensive medications. Drug category, dosage and combination were similar for both groups. Blood pressure (< or = 130/85 mmHg) and glucose level targets (fasting < or = 7.5 mmol/L and postprandial < or = 10 mmol/L) were obtained in all patients. Initial SC was not significantly different between diabetic and non-diabetic patients (426.5 +/- 189.4 mumol/L vs. 405.1 +/- 201.9 mumol/L). SC increased significantly faster in diabetic than non-diabetic patients (respectively 3.9 +/- 6.1% and 1.5 +/- 4.6% monthly, p < 0.05), with no difference between type 1 and type 2 diabetes. One-third (33.7%) of all patients started dialysis during follow-up (40% diabetic and 22% non-diabetic). Their weight, body mass index, age, sex ratio, treatment and aetiology were similar. During follow-up, the patients (29.4%) who sustained a major vascular event differed only in age (62.1 years vs. 55.2 years; p < 0.001). In this study, diabetic renal disease worsened significantly faster than other nephropathies, in spite of proper normalisation of blood pressure and glucose level. Therefore, it is essential to diagnose and manage Type 2 diabetes early to avoid encumbering dialysis centres with older patients.

Adult↗
PubMed1999

Clinically significant venous thromboembolism after gynecologic surgery.

OBJECTIVE: To review the incidence and outcome of clinically significant venous thromboembolism (VTE) following gynecologic surgery in a population receiving provider-specified prophylaxis. STUDY DESIGN: A computerized patient database was used to identify all patients diagnosed with VTE following gynecologic surgery from 1992 to 1997. Medical records were retrospectively reviewed. Clinically significant postoperative VTE was defined as pulmonary embolism or deep venous thrombosis, suggested by symptoms and physical findings, with subsequent confirmation by appropriate imaging study. Patients having VTE at the time of preoperative hospital admission and patients diagnosed with VTE after postoperative day 30 were excluded. RESULTS: Fifty-three patients developed postoperative VTE after > 30,000 gynecologic surgical procedures (incidence, < 1 event per 500 procedures). Forty-eight (91%) patients received some form of prophylaxis. Patients with benign disease, surgical anesthesia less than three hours and no history of prior VTE or factor V Leiden deficiency rarely developed postoperative VTE (incidence, < 1 event in 4,000 procedures). Thirteen (25%) patients had complications from anticoagulation therapy requiring prolonged hospital stay or readmission. CONCLUSION: Clinically significant VTE following gynecologic surgery is rare in the absence of malignancy, prolonged surgical anesthesia or hypercoagulation factors. Complications from anticoagulation therapy are common among gynecologic patients undergoing treatment for VTE.

Adult↗
PubMed1999

Tooth stabilization and splinting before and after periodontal therapy with fixed partial dentures.

The design and use of fixed partial dentures as a definitive restoration to stabilize and splint teeth have been reviewed. The provisionalization of the splinted patient has been described as it is incorporated into the treatment plan of patients with a weakened periodontium. The current controversy of incorporating implants in the patient requiring splinting was discussed, and recommendations are made. Dentists are encouraged to explain all potential ramifications of splinting with fixed partial dentures, including cost, frequency of office visits, and potential alterations or remakes of the prosthesis should physiologic demands surpass the capabilities of the remaining teeth.

Dental Implantation, Endosseous↗
PubMed1998

The sentinel node in breast cancer--a multicenter validation study.

BACKGROUND: Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. To confirm this finding, we conducted a multicenter study of the method as used by 11 surgeons in a variety of practice settings. METHODS: We enrolled 443 patients with breast cancer. The technique involved the injection of 4 ml of technetium-99m sulfur colloid (1 mCi [37 MBq]) into the breast around the tumor or biopsy cavity. "Hot spots" representing underlying sentinel nodes were identified with a gamma probe. Sentinel nodes subjacent to hot spots were removed. All patients underwent a complete axillary lymphadenectomy. RESULTS: The overall rate of identification of hot spots was 93 percent (in 413 of 443 patients). The pathological status of the sentinel nodes was compared with that of the remaining axillary nodes. The accuracy of the sentinel nodes with respect to the positive or negative status of the axillary nodes was 97 percent (392 of 405); the specificity of the method was 100 percent, the positive predictive value was 100 percent, the negative predictive value was 96 percent (291 of 304), and the sensitivity was 89 percent (101 of 114). The sentinel nodes were outside the axilla in 8 percent of cases and outside of level 1 nodes in 11 percent of cases. Three percent of positive sentinel nodes were in nonaxillary locations. CONCLUSIONS: Biopsy of sentinel nodes can predict the presence or absence of axillary-node metastases in patients with breast cancer. However, the procedure can be technically challenging, and the success rate varies according to the surgeon and the characteristics of the patient.

Axilla↗
PubMed1998

Risk of complications following gynecological laparoscopic surgery.

Objective: To determine the incidence and predictors of risk for operative complications, conversions to laparotomy, and postoperative admissions following laparoscopic procedures.Methods: We obtained demographic information and medical history on all 843 women who underwent laparoscopic procedures at the Brigham and Women's Hospital between January and December 1994. All major complications following surgery were recorded. Major operative complications were defined as bowel, bladder, ureter, or vascular injuries, or significant abdominal wall or other internal bleeding. Categorical analysis was used to compare differences in the rates of operative complications, conversions to laparotomy, and postoperative admissions following laparoscopy. We also estimated the influence of specific laparoscopic procedures on the risk of adverse complications following surgery.Results: Operative complications and conversion to laparotomy occurred at rates of 19.0 and 47.4 per 1,000 laparoscopic procedures, respectively. Of 843 women studied, complications included 4 bowel, 2 bladder, 1 ureteral, 2 vascular, and 5 abdominal wall injuries. There were 165 (19.6%) patients admitted postoperatively. Aside from the type of operative procedure, age was the single most important predictor of complications. Women with government or HMO insurance were somewhat more likely to have their laparoscopy converted to a laparotomy than women with private insurance. Relative to all other operative procedures, women receiving laparoscopic-assisted treatment of endometriosis and women undergoing ovarian cystectomy had generally low rates of operative complications, conversions to laparotomy, and postoperative admissions. In contrast, 12.5% of women receiving laparoscopic-assisted vaginal hysterectomy experienced operative injuries or abdominal bleeding and 90.0% were hospitalized postoperatively.Conclusion: Serious operative complications after major gynecologic laparoscopy were rare in this data set. The complexity of the laparoscopic procedure is directly proportional to the rate of operative complications, conversions to laparotomy, and postoperative admissions to the hospital.

Journal Article↗