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Biomedical subjects

S Zierler

Publications and source records attributed to S Zierler.

At least 55 records · Page 3Linked to original sources
PubMed1988

Increased prevalence of atopic dermatitis in Kawasaki disease.

Atopic dermatitis is associated with immunoregulatory abnormalities similar to those observed in acute Kawasaki disease. We investigated whether the prevalence of atopic dermatitis is increased among children who acquire Kawasaki disease. In a case-control telephone survey 83 Kawasaki disease patients and 83 children with innocent heart murmurs were matched for age and time between clinic visit and interview. The interviewer was blinded to the hypothesis of the study. Nine (11%) Kawasaki disease patients but only one (1%) unaffected child had atopic dermatitis; the incidence of atopic dermatitis among children with Kawasaki disease was 9 times greater than that of controls (95% confidence limits, 1.6 to 49.4). Serum immunoglobulin E concentrations were significantly higher (P = 0.02, Mann-Whitney) in 44 unselected Kawasaki disease patients (median, 22; range, less than or equal to 4 to 900 IU/ml) studied 6 to 12 months after onset than in 27 children of similar age (median, less than or equal to 4; range, less than or equal to 4 to 164 IU/ml). We observed that there is a strong association between atopic dermatitis and Kawasaki disease.

Child, Preschool↗
PubMed1987

Perinatal events and necrotizing enterocolitis in premature infants.

Among 2123 premature infants monitored during a large multicenter study of patent ductus arteriosus, necrotizing enterocolitis (NEC) was diagnosed in 121 (5.7%) of these infants. Rates ranged from 13.5% among infants with a birth-weight (BW) of 500 to 749 g to 2.9% among infants whose BW was between 1500 and 1750 g. The presence of a hemodynamically significant patent ductus arteriosus did not alter the incidence of NEC. Of a large number of perinatal events and conditions considered, only BW and maternal toxemia were found to be associated with the rate of NEC, both relating inversely. Thus, these data do not support a relationship between NEC and a variety of perinatal factors previously postulated as potential determinants of the disorder.

Birth Weight↗
PubMed1986

Type of disinfectant in drinking water and patterns of mortality in Massachusetts.

Chlorination has been the major strategy for disinfection of drinking water in the United States. Concern about the potential health effects of the reaction by-products of chlorine has prompted use of alternative strategies. One such method is chloramination, a treatment process that does not appear to have carcinogenic by-products, but may have less potent biocidal activity than chlorination. We examined the patterns of mortality of residents in Massachusetts who died between 1969 and 1983 and lived in communities using drinking water that was disinfected either by chlorine or chloramine. Comparison of type of disinfectant among 51,645 cases of deaths due to selected cancer sites and 214,988 controls who died from cardiovascular, cerebrovascular, or pulmonary disease, or from lymphatic cancer showed small variation in the patterns of mortality. Bladder cancer was moderately associated with residence at death in a chlorinated community (mortality odds ratio = 1.7, 95% confidence interval = 1.3-2.2) in a logistic regression analysis using controls who died from lymphatic cancer. A slight excess of deaths from pneumonia and influenza was observed in communities whose residents drank chloraminated water compared to residents from chlorinated communities, as well as to all Massachusetts residents (standardized mortality ratio = 118, 95% confidence interval = 116-120 for chloraminated communities, and standardized mortality ratio = 98, 95% confidence interval = 95-100 for chlorinated communities). These results are intended to be preliminary and crude descriptions of the relationship under study.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Perinatal risk assessment for patent ductus arteriosus in premature infants.

Data from 2107 inborn premature infants monitored for hemodynamically significant patent ductus arteriosus were used to develop means for clinically assessing at birth the risk of developing patent ductus arteriosus during the first 30 days of life. The overall 30-day incidence rates in birth weight categories 500 to 999, 1000 to 1499 g, and 1500 to 1750 g were 41, 17, and 7%, respectively. At-birth risk estimates obtainable from the derived multivariate functions ranged from 0 to 78% for the 500 to 999 and 1000- to 1499-g categories, and from 0 to 20% for the 1500- to 1750-g category. The derived risk functions provide for enhanced selectivity in the application of measures for the prevention of patent ductus arteriosus.

Adolescent↗
PubMed1986

Electrocardiogram of the premature infant at 1 year of age.

ECGs were examined from 461 premature infants at 1 year of age. Data from those without a history of bronchopulmonary dysplasia were generally similar to published norms for healthy 1-year old infants. History and persistence of residual lung disease were reflected in the ECG by a high prevalence of findings suggestive of right ventricular hypertrophy. Clinically significant patent ductus arteriosus during the neonatal period did not influence the 1-year ECG findings. The data expand the published experience with follow-up ECGs from premature infants and suggest that the ECG may be a useful tool in follow-up of chronic residual lung disease in this population.

Bronchopulmonary Dysplasia↗
PubMed1985

Congenital heart disease in relation to maternal use of Bendectin and other drugs in early pregnancy.

To clarify the association of Bendectin and other drugs used in early pregnancy with the occurrence of congenital heart disease, we interviewed 298 mothers of children with congenital heart disease and 738 mothers of healthy controls. Differential recall of drug use by mothers of affected children and mothers of controls was evaluated by comparison of information collected by interview with that recorded in the prenatal record. Data derived from maternal interviews were generally consistent with the record data. Reported Bendectin use was minimally associated with congenital heart disease (prevalence odds ratio, 1.1; 90 per cent confidence interval, 0.8 to 1.5). The data from this study were consistent with previously reported associations of other drugs with congenital heart disease. In particular, aspirin use in early pregnancy was associated with about a twofold increase in the frequency of defects in septation of the truncus arteriosus (prevalence odds ratio, 2.1; 90 per cent confidence interval, 1.1 to 3.9).

Acetaminophen↗
PubMed1985

Risk factors for retrolental fibroplasia: experience with 3,025 premature infants. National Collaborative Study on Patent Ductus Arteriosus in Premature Infants.

The rate of retrolental fibroplasia in relation to prenatal and neonatal characteristics was explored on the basis of a cohort of 3,025 neonates with birth weight less than 1,750 g. The overall rate of retrolental fibroplasia of any degree at hospital discharge was 11%, varying from 43% for those with birth weight between 500 and 749 g to 3% for those in the 1,500- to 1,750-g category. Among the potential determinants, the main interest was in nonhyperoxic characteristics, conditional on measures of prematurity and oxygen supplementation. Maternal diabetes and antihistamine use during the last 2 weeks of pregnancy were associated with significantly higher rates of retrolental fibroplasia, whereas toxemia was associated with lower rates. Frequent apneic spells, bronchopulmonary dysplasia, and sepsis in the neonate were also associated with significantly higher rates. On the other hand, the data indicate no independent role of low Apgar score, intraventricular hemorrhage, exchange transfusion, patent ductus arteriosus, or certain other characteristics previously postulated as risk factors.

Anemia↗
PubMed1985

Maternal drugs and congenital heart disease.

Congenital heart disease comprises one-third of all major birth defects. Prevalence estimates depend on the definition of the disease and the postnatal period when the disease is diagnosed. The studies with the longest follow-up estimate that 0.9% of infants are afflicted. The cause of these cardiac defects is largely unknown. The effect of embryonic exposure to maternal drugs during cardiogenesis has been widely studied, and the evidence suggests that maternal use of ethanol, anticonvulsants, lithium, and exogeneous female hormones may increase the risk of congenital heart disease. An antiemetic agent containing doxylamine has been implicated in the courts. This review offers an analysis of the epidemiologic evidence of the occurrence of congenital heart disease in relation to maternal drug use during pregnancy. The evidence indicates that the vast majority of heart malformations cannot be attributed to these pharmacologic agents.

Amphetamines↗
PubMed1984

Clinical course to 1 year of age in premature infants with patent ductus arteriosus: results of a multicenter randomized trial of indomethacin.

Reported are 1-year follow-up results of a randomized clinical trial comparing three strategies of managing clinically significant patent ductus arteriosus at the time of diagnosis in premature infants: (1) immediate administration of a three-dose course of intravenously administered indomethacin in addition to usual medical therapy (fluid restriction and use of diuretics or digitalis or both), with surgery as a backup measure, (2) usual medical therapy alone initially, with indomethacin as the first and surgery as the final backup measure, and (3) usual medical therapy alone initially, with surgery alone as backup. Of primary concern were the relative merits of these three managements strategies in the terms of the long-term occurrence of a wide range of health problems. Although at the time of neonatal hospitalization there was a significant excess of bleeding episodes in infants receiving indomethacin as part of initial treatment, and a significantly higher rate of retrolental fibroplasia in the those given usual medical therapy with surgery as backup, there were no statistically significant differences at 1 year of age related to these intermediate outcomes. In other regards, too, the treatment strategies appeared interchangeable in terms of the 1-year outcome.

Bronchopulmonary Dysplasia↗
PubMed1984

Surgical closure of patent ductus arteriosus in 268 preterm infants.

Over a 2 year period ending in April, 1981, 268 premature infants with birth weight below 1,750 gm underwent operation for a "hemodynamically significant" patent ductus arteriosus. Operations were performed in 13 centers participating in a collaborative study, which was primarily designed to evaluate the role of indomethacin in the management of patent ductus arteriosus. No patient died during the operations, which were done at a median age of 10 days. Eight infants (3%) died within 36 hours after operation. In only one was the death directly attributable to the operative procedure. Hospital mortality (23%) and postoperative morbidity, which included bronchopulmonary dysplasia, pneumothorax, and sepsis, were unrelated to birth weight, age at operation, and degree of preexisting pulmonary disease or preoperative treatment of the infant with indomethacin. Results indicate that surgical ligation is a safe and effective procedure for treating patent ductus arteriosus with large left-to-right shunting in small premature infants.

Clinical Trials as Topic↗
PubMed1982

Methotrexate used for psoriasis and the risk of noncutaneous or cutaneous malignancy.

Using case-control methods, we separately evaluated the risk of noncutaneous and cutaneous malignancy associated with exposure to methotrexate as it is used in the treatment of severe psoriasis. An analysis of 26 cases of noncutaneous cancer and 104 matched controls revealed no association between the development of noncutaneous malignancy and exposure to methotrexate (relative risk = 0.96; upper bound 95% confidence interval = 2.0). An analysis of 80 cases of nonmelanoma skin cancer and 297 matched controls revealed a relative risk of 1.2 for the development of cutaneous malignancy among those with exposure to methotrexate (upper bound 95% confidence interval = 1.9). Our data suggest that methotrexate, as it is used in the treatment of severe psoriasis, does not increase the risk of noncutaneous or cutaneous malignancy.

Adult↗
PubMed1982

Psoriasis and the risk of cancer.

To test the validity of the common hypothesis that patients with psoriasis have an inherently lower susceptibility to cancer, we prospectively studied 1367 patients with severe psoriasis who enrolled in a clinical trial of oral methoxsalen photochemotherapy for treatment of psoriasis for an average of 3.2 yr. The incidence of non-cutaneous cancers and the number of deaths from such cancers were slightly but not significantly higher than that expected for the general population (relative risk = 1.1; standard mortality ratio = 1.3). Among 318 patients (23%) in this cohort who were over 35 yr of age and who lacked appreciable exposure to suspected cutaneous carcinogens, the observed incidence for cutaneous carcinoma was 1.4 times that expected, based on rates for the general population (90% confidence interval = .8 to 2.7). These data suggest that patients with psoriasis have a risk of systemic and cutaneous cancer that is comparable to the risk for the general population.

Adult↗
PubMed1980

Skin carcinoma in patients with psoriasis treated with topical tar and artificial ultraviolet radiation.

A case-control study, consisting of 59 skin cancer patients with severe psoriasis, was conducted to evaluate the effect of treatment with tar and/or artificial ultraviolet radiation on the risk of developing cutaneous carcinoma. Using 924 unmatched controls, we estimated that the crude rate of skin cancer was 2.4-fold for patients with high exposure to tar and ultraviolet radiation, compared with those lacking high exposure. Using a control series of 126 patients matched for age, skin type, region of residence, sex, history of exposure to ionising radiation, and number of 8-methoxypsoralen photochemotherapy treatments, we observed a stronger association (relative rate = 4.7, 95% confidence limits = 2.2 to 10.0). The magnitude of the relative rates argues for continued surveillance for tumours among patients with psoriasis who receive long-term tar or artificial ultraviolet radiation therapy.

Dose-Response Relationship, Drug↗
PubMedDate not supplied

Bladder cancer in Massachusetts related to chlorinated and chloraminated drinking water: a case-control study.

Consumers of chlorinated drinking water have a small excess of bladder cancer. Risk may have been underestimated because of confounding and misclassification of exposure status. To address these problems, we undertook a case-control study. Detailed residential histories were obtained by telephone interviews with informants of 614 individuals who died of primarily bladder cancer and 1,074 individuals who died of other causes. Their surface water has been disinfected with chlorine or a combination of chlorine and ammonia (cloramine) since 1938. The mortality ratio for bladder cancer among individuals who resided only in communities supplied with drinking water disinfected with chlorine, relative to individuals who resided only in communities supplied with drinking water disinfected with chloramine, was 1.6 (95% confidence interval = 1.2-2.1), using all controls; when the comparison group was restricted to individuals who died of lymphoma, the mortality odds ratio was 2.7 (95% confidence interval = 1.7-4.3).

Aged↗
PubMedDate not supplied

Quality of community drinking water and the occurrence of spontaneous abortion.

To investigate the relationship between community drinking water quality and spontaneous abortion, we compared trace element levels in the drinking water of 286 women having a spontaneous abortion through 27 wk gestation with that of 1,391 women having livebirths. Trace element levels were gathered from routine analyses of public tap water supplies from the communities where the women resided during pregnancy. After adjustment for potential confounders, an increase in the frequency of spontaneous abortion was associated with detectable levels of mercury; high levels of arsenic, potassium, and silica; moderately hard water, and surface water. In contrast, a decrease in the frequency of spontaneous abortion was associated with high levels of alkalinity and sulfate, and any detectable level of nitrate. These results require further corroboration because there is a paucity of data investigating this issue.

Abortion, Spontaneous↗
PubMedDate not supplied

Quality of community drinking water and the occurrence of late adverse pregnancy outcomes.

The relationship between community drinking water quality and the occurrence of late adverse pregnancy outcomes was investigated by conducting a case-control study among women who delivered infants during August 1977 through March 1980 at Brigham and Women's Hospital in Massachusetts. The water quality indices were compared among 1,039 congenital anomaly cases, 77 stillbirth cases, 55 neonatal death cases, and 1,177 controls. Trace element levels were gathered from routine analyses of public water supplies from the communities in which the women resided during pregnancy. It was observed that, after adjustment for confounding, the frequency of stillbirths was increased for women exposed to chlorinated surface water (OR 2.6 95% CI 0.9-7.5) and for women exposed to detectable lead levels (OR 2.1; 95% CI 0.6-7.2); the frequency of cardiovascular defects was increased relative to detectable lead levels (OR 2.2, 95% CI 0.9-5.7); and the frequency of central nervous system defects was increased relative to the highest tertile of potassium (OR 6.3, 95% CI 1.1-37.3). The frequency of ear, face, and neck anomalies was increased in relation to detectable silver levels (OR 3.3, 95% CI 0.9-12.2), but the frequency decreased relative to high potassium levels (OR 0.2, 95% CI 0.1-0.7). The frequency of neonatal deaths was decreased relative to detectable fluoride levels (OR 0.4, 95% CI 0.2-1.0), and the frequency of musculoskeletal defects was decreased relative to detectable chromium levels (OR 0.4, 95% CI 0.2-1.0). The majority of these associations were not stable statistically. Further research is needed to corroborate these findings.

Case-Control Studies↗
PubMedDate not supplied

Entangled epidemics: cocaine use and HIV disease.

Over the past decade, two epidemics have had a severe impact on public health in this country. These health problems involve cocaine abuse and AIDS (or HIV disease). The processes of these two conditions are clearly not independent of each other and may be quite complex. Understanding of this relationship has been hampered by a myriad of social, biological and behavioral variables that are entangled with the basic cocaine-HIV association. This article presents a paradigm for discussion of the interaction between cocaine exposure and HIV disease based on three mechanisms: the relationship between cocaine exposure and increased opportunity for HIV exposure, the direct role that cocaine plays in altering susceptibility to HIV infection, and the influence that cocaine use has on the progression of HIV disease. The goal of this structured approach is to enhance conceptual understanding of the cocaine-HIV relationship while recognizing the complexity of the issue and the limitations of current research efforts. This model will serve as a framework for the discussion of implications for future research, clinical practice, and public policy.

Cocaine↗