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Biomedical subjects

S Finkelstein

Publications and source records attributed to S Finkelstein.

11 recordsLinked to original sources
PubMed1992

The relation between experience and outcome in heart transplantation.

BACKGROUND: Current policies related to organ transplantation in the United States are designed to ensure that centers and physicians with experience in transplantation perform these procedures. It is essential to confirm the validity of such policies, since they may limit access to transplantation services. METHODS: To determine the relation between experience with heart transplantation and mortality after the procedure, we merged data from the registry of the International Society for Heart and Lung Transplantation with data from a survey that provided additional information about patients and transplantation centers. Our study included 1123 patients who received a heart transplant at one of 56 hospitals in the United States from 1984 through 1986. We used univariate and bivariate techniques, as well as logistic regression, to analyze our data. RESULTS: We observed an institutional learning curve for heart transplantation. Patients who received one of a center's first five transplants had higher mortality rates than patients who received a subsequent transplant (20 percent vs. 12 percent; P = 0.002; relative risk = 2.2; 95 percent confidence interval, 1.6 to 3.4). In addition, we found a correlation between the training of key personnel on the transplantation team and mortality at new transplantation centers. For example, new centers staffed by cardiologists with previous training in heart transplantation had lower mortality rates among heart-transplant recipients than centers without experienced cardiologists (7 percent vs. 16 percent; P = 0.001; relative risk = 2.7; 95 percent confidence interval, 1.3 to 5.9). By contrast, the previous training of the surgeons who performed transplantations was not related to the mortality rate associated with the procedure. CONCLUSIONS: Experience with heart transplantation is associated with a better outcome for patients after that procedure. Opportunities exist to refine transplantation policies on the basis of the experience of a center and its transplantation team and to develop similar policies for other forms of organ transplantation.

Cardiac Care Facilities↗
PubMed1991

Hypnotically assisted preparation of the anxious patient for medical and dental treatment.

Hypnotic preparation of patients for medical or dental procedures has various aspects. It is important to encourage the patient's cooperation in assessing problem areas and determining the order of dealing with those problems. The therapist can adapt treatment strategies to new areas of concern as the patient verbalizes them. The severity and number of patient concerns and fears, along with motivation factors, will determine the direction and number of therapy sessions. The case history presented illustrates one approach for an apprehensive patient who felt a dental experience had triggered her fear of surgery. Self-hypnosis, ego strengthening, and mental rehearsal during the 11 sessions made it possible for the patient to proceed with needed surgery.

Adaptation, Psychological↗
PubMed1978

Broca aphasia: pathologic and clinical.

The speech disturbance resulting from infarction limited to the Broca area has been delineated; it differs from the speech disorder called Broca aphasia, which results from damage extending far outside the Broca area. Nor does Broca area infarction cause Broca aphasia. The lesions in 20 cases observed since 1972 were documented by autopsy, computerized tomography, or arteriogram; the autopsy records from the Massachusetts General hospital for the past 20 years and the published cases since 1820 were also reviewed. The findings suggest that infarction affecting the Broca area and its immediate environs, even deep into the brain, causes a mutism that is replaced by rapidly improving dyspraxic and effortful articulation, but that no significant distrubance in language function persists. The more complex syndrome traditionally referred to as Broca aphasia, including Broca's original case, is characterized by protracted mutism, verbal stereotypes, and agrammatism. It is associated with a considerably larger infarct which encompasses the operculum, including the Broca area, insula, and adjacent cerebrum, in the territory supplied by the upper division of the left middle cerebral artery.

Adult↗
PubMed1978

Serologic responses in amebiasis.

Serologic tests for amebiasis, utilizing antigens prepared from Entamoeba histolytica HK-9, axenic culture in Diamond's media, have demonstrated reproducible results with good clinical correlation. The indirect hemagglutination test was positive in 100 per cent of all cases with hepatic abscess, in 99 per cent of cases of amebic dysentery and in 60 per cent of asymptomatic carriers. A population of uninfected subjects yielded less than 1 per cent of individuals with demonstrable amebic antibodies. Similarly, the complement fixation test was 100 per cent positive for the liver abscess, 91 per cent positive for patients with amebic dysentery, 23 per cent positive for asymptomatic carriers, and 0 per cent positive for the uninfected control group. The antibody responses to amebic antigens are discussed.

Amebiasis↗
PubMed1976

Lysyl oxidase: a pituitary hormone-dependent enzyme.

Aldehyde-deficient non-crosslinked collagen obtained from lathyritic rats and collagen from penicillamine-treated rats, which is not deficient in aldehydes but the crosslinking of which is also inhibited, were implanted into the peritoneal cavity of hypophysectomized rats using the diffusion chamber technique. The enzyme lysyl oxidase which catalyses the aldehyde formation in certain lysyl residues of collagen and elastin was extracted from the skin of hypophysectomized rats. The activity of the enzyme was determined following its incubation with an L-[4,5-3H] lysine-labeled elastin substrate prepared from aortas of 17-day-old chick embryos. The result showed that the aldehyde deficient collagen did not crosslink while in the hypophysectomized animal indicating the lack of active lysyl oxidase in the rats. The enzyme activity in the skin of hypophysectomized animals was markedly reduced as compared with the controls indicating directly the dependance of lysyl oxidase activity on pituitary gland hormones.

Amino Acid Oxidoreductases↗
PubMed1975

Absorption of digoxin in children with cystic fibrosis.

The absorption of digoxin in cystic fibrosis was evaluated in 16 subjects by assessing the relationship between dosage expressed in mug/kg/day and serum digoxin concentration. The results indicate that the same relationship exists between maintenance dosage and serum levels in these patients and in patients without cystic fibrosis. Thus, no evidence of impaired absorption was found.

Adolescent↗
PubMed1975

Lymphographic Demonstration of a Retroperitoneal Lymphangioma.

Lymphangiomas are rare, benign tumors which may become opacified during lymphography and may be confused with malignant lymph node disease. A case is reported in which lymphography showed focal collections of contrast material retained for several days in dilated lymphatic spaces which initially simulated metastatic disease.

Female↗