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Cohen W. Keeping the nation's newborns safe. U.S. NEWS & WORLD REPORT 2000; 128:32. [PMID: 11184121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
BACKGROUND Prior investigations have demonstrated a link between quality of life (QOL) deficits and depression. This report elaborates on prior investigations findings by implementation of formal assignment of the diagnosis of depression and a hierarchical approach to assessment of QOL. METHODS A masters or doctoral level mental health clinician used the SCID to confirm a diagnosis of major depression in ninety psychiatric inpatients. Function was assessed with the PSMS (a measure of ADL), the IADL scale, and the "daily living and role functioning" and the "relation to self and others" subscales of the Basis-32. RESULTS Patient age and severity of depression were the most consistent predictors of QOL deficits, although the direction of the age-effect on QOL depended on the specific measure of QOL. Increasing severity of depression was consistently associated with worse QOL, and remained significant after adjusting for age. LIMITATIONS The cross-sectional method of this study limits the inference of causality between depression severity and poor QOL. CONCLUSIONS QOL deficits in acutely depressed hospitalized patients occur at multiple strata in the hierarchy of behavior and are most consistently influenced by age and severity of depression. The effect of age on QOL in depressed inpatients is complex, and age is not uniformly associated with poor QOL.
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Temkin NR, Dikmen SS, Anderson GD, Wilensky AJ, Holmes MD, Cohen W, Newell DW, Nelson P, Awan A, Winn HR. Valproate therapy for prevention of posttraumatic seizures: a randomized trial. J Neurosurg 1999; 91:593-600. [PMID: 10507380 DOI: 10.3171/jns.1999.91.4.0593] [Citation(s) in RCA: 261] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Seizures frequently accompany moderate to severe traumatic brain injury. Phenytoin and carbamazepine are effective in preventing early, but not late, posttraumatic seizures. In this study the authors compare the safety and effectiveness of valproate with those of short-term phenytoin for prevention of seizures following traumatic brain injury. METHODS The study was a randomized, double-blind, single-center, parallel-group clinical trial. Treatment began within 24 hours of injury. One hundred thirty-two patients at high risk for seizures were assigned to receive a 1-week course of phenytoin, 120 were assigned to receive a 1-month course of valproate, and 127 were assigned to receive a 6-month course of valproate. The cases were followed for up to 2 years. The rates of early seizures were low and similar when using either valproate or phenytoin (1.5% in the phenytoin treatment group and 4.5% in the valproate arms of the study; p = 0.14, relative risk [RR] = 2.9, 95% confidence interval [CI] 0.7-13.3). The rates of late seizures did not differ among treatment groups (15% in patients receiving the 1-week course of phenytoin, 16% in patients receiving the 1-month course of valproate, and 24% in those receiving the 6-month course of valproate; p = 0.19, RR = 1.4, 95% CI 0.8-2.4). The rates of mortality were not significantly different between treatment groups, but there was a trend toward a higher mortality rate in patients treated with valproate (7.2% in patients receiving phenytoin and 13.4% in those receiving valproate; p = 0.07, RR = 2.0, 95% CI 0.9-4.1). The incidence of serious adverse events, including coagulation problems and liver abnormalities, was similar in phenytoin- and valproate-treated patients. CONCLUSIONS Valproate therapy shows no benefit over short-term phenytoin therapy for prevention of early seizures and neither treatment prevents late seizures. There was a trend toward a higher mortality rate among valproate-treated patients. The lack of additional benefit and the potentially higher mortality rate suggest that valproate should not be routinely used for the prevention of posttraumatic seizures.
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McCall WV, Cohen W, Reboussin B, Lawton P. Pretreatment differences in specific symptoms and quality of life among depressed inpatients who do and do not receive electroconvulsive therapy: a hypothesis regarding why the elderly are more likely to receive ECT. J ECT 1999; 15:193-201. [PMID: 10492857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Electroconvulsive therapy (ECT) is among the most commonly performed medical procedures requiring general anesthesia in the United States. Nevertheless, very little is known about the characteristics of depressed patients who receive ECT and how they differ from depressed patients receiving psychotropic medication. We conducted a detailed examination of demographic, clinical, and quality-of-life (QOL) measurements in a group of 90 depressed inpatients, and we then used these measurements to contrast the 31 patients who received ECT with the 59 who received alternative therapies. The ECT group did not differ from the non-ECT group in gender composition, marital status, race, education, employment status, overall severity of depression, chronicity of depression, adequacy of prehospitalization antidepressant treatment, extent of physical illness, or extent of social support. The ECT group was older. Furthermore, the ECT group had greater weight loss, worse functioning in activities of daily living (ADLs), and worse functioning in instrumental activities of daily living (IADLs). The differences in weight loss, ADL, and IADL scores disappeared after age adjustment. However, statistical adjustment for age revealed that the ECT group reported worse capacity in their daily living and role functioning than did the non-ECT group. We conclude that the decision to pursue ECT is based in part on the perceived effect of the depression on QOL, as well as the severity of specific symptoms such as weight loss. The elderly seem particularly vulnerable to depression-related functional deficits and weight loss, and this may explain why prior studies showed a differential use of ECT in the elderly.
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Van Someren EJ, Swaab DF, Colenda CC, Cohen W, McCall WV, Rosenquist PB. Bright light therapy: improved sensitivity to its effects on rest-activity rhythms in Alzheimer patients by application of nonparametric methods. Chronobiol Int 1999; 16:505-18. [PMID: 10442243 DOI: 10.3109/07420529908998724] [Citation(s) in RCA: 376] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sleep-wake rhythm disturbances in patients with Alzheimer's disease (AD) make a strong demand on caregivers and are among the most important reasons for institutionalization. Several previous studies reported that the disturbances improve with increased environmental light, which, through the retinohypothalamic tract, activates the suprachiasmatic nucleus (SCN), the biological clock of the brain. The data of recently published positive and negative reports on the effect of bright light on actigraphically assessed rest-activity rhythms in demented elderly were reanalyzed using several statistical procedures. It was demonstrated that the light-induced improvement in coupling of the rest-activity rhythm to the environmental zeitgeber of bright light is better detected using nonparametric procedures. Cosinor, complex demodulation, and Lomb-Scargle periodogram-derived variables are much less sensitive to this effect because of the highly nonsinusoidal waveform of the rest-activity rhythm. Guidelines for analyses of actigraphic data are given to improve the sensitivity to treatment effects in future studies.
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Chassin D, Andrieu M, Cohen W, Culmann-Penciolelli B, Ostankovitch M, Hanau D, Guillet JG. Dendritic cells transfected with the nef genes of HIV-1 primary isolates specifically activate cytotoxic T lymphocytes from seropositive subjects. Eur J Immunol 1999; 29:196-202. [PMID: 9933101 DOI: 10.1002/(sici)1521-4141(199901)29:01<196::aid-immu196>3.0.co;2-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The HIV-1 Nef protein down-modulates surface expression of MHC class I proteins. Primary infected T lymphocytes thus escape lysis by cytotoxic T lymphocytes (CTL). In contrast, during HIV-1 infection there are strong CTL responses to several HIV proteins, and there is mounting evidence that CTL are critical for controlling the virus. The present study was carried out to assess Nef protein-cell interaction as it occurs in naturally infected antigen-presenting cells. To evaluate the presentation of peptides derived from viral antigen to CTL, we transfected nef genes obtained from peripheral blood mononuclear cells of HIV-1-seropositive subjects into dendritic cells isolated from monocytes of healthy donors. We demonstrate that expression and subsequent processing of Nef by transfected dendritic cells did not alter the presentation of an immunodominant epitope of Nef to CTL of HIV+ subjects. However, mutations in nef gene sequences from primary isolates may abolish this presentation by a mechanism that probably interferes with protein processing.
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Reifler BV, Cohen W. Practice of geriatric psychiatry and mental health services for the elderly: results of an international survey. Int Psychogeriatr 1998; 10:351-7. [PMID: 9924830 DOI: 10.1017/s1041610298005444] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The authors conducted a survey of members of the International Psychogeriatric Association (IPA) to determine the state of development of both the profession of geriatric psychiatry and services for mentally ill elderly. Ratings for both issues were based on a scale of 1 to 4, with 1 being little to no development and 4 being the highest. A rating of 2 was set as the desired minimum, and 12 countries met this goal in both categories, with 6 more countries reaching this goal in service development only. We conclude that although the field of geriatric psychiatry and services for mentally ill elderly are still underdeveloped in much of the world, in many countries they are developed sufficiently enough that the IPA is in an excellent position to provide both information and technical assistance to nations wishing to advance.
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Le Roux PD, Elliott JP, Eskridge JM, Cohen W, Winn HR. Risks and benefits of diagnostic angiography after aneurysm surgery: a retrospective analysis of 597 studies. Neurosurgery 1998; 42:1248-54; discussion 1254-5. [PMID: 9632182 DOI: 10.1097/00006123-199806000-00026] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cerebral angiography performed after aneurysm surgery can identify causes of morbidity and mortality that may be corrected. The risks and benefits of angiography that is performed after aneurysm surgery, however, have not been clearly defined. We therefore reviewed our experience with postoperative angiography to determine its dangers and benefits. METHODS During 10 years, 543 consecutive patients received treatment for cerebral aneurysms. A retrospective analysis of 597 diagnostic angiograms obtained after aneurysm surgery for 494 of these patients was performed. RESULTS Catheter-induced vessel spasm and dissection, occurring most frequently in the internal carotid artery, were observed in seven (1.2%) and six (1%) studies, respectively. No angiography-associated strokes were identified. No association between age, smoking, hypertension, blood pressure, atherosclerosis, or severe vasospasm and angiographic complications was observed. Aneurysm remnants were identified in 36 (5.7%) of the 637 aneurysms that were surgically treated. Atherosclerosis (P < 0.01) or multiple clip applications (P < 0.01) were significantly associated with aneurysm remnants. Angiographic vessel occlusion was observed in 28 (5.7%) patients and resulted in stroke in 14 of these patients. Vessel occlusion was significantly associated with increasing aneurysm size (P < 0.001), atherosclerosis (P < 0.001), temporary clips (P < 0.001), multiple clips (P=0.03), multiple clip applications (P=0.001), and a new postoperative neurological deficit (P=0.002). Severe vasospasm and newly identified aneurysms were observed in 51 and 16 patients, respectively. CONCLUSION Angiography after aneurysm surgery is safe and can be routinely performed. Angiography after aneurysm surgery should be particularly considered for patients with large aneurysms or cerebrovascular atherosclerosis and for those who develop new postoperative neurological deficits.
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Cohen W, Waters D, Hewlett N. DDK rates in the paediatric clinic: a methodological minefield. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 1998; 33 Suppl:428-433. [PMID: 10343732 DOI: 10.3109/13682829809179463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
There are substantial differences in the norms reported for speech diadochokinetic (DDK) rates among several published studies. These may well be due to differences in type of data used, methods of data collection and DDK rate calculation. Such differences doubtless also exist in the calculation of DDK rate in routine clinical assessment. Methodological problems in DDK rate measurement are identified and discussed and a detailed protocol for DDK measurement is described.
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Cleves MA, Weiner JP, Cohen W, Athon C, Banks N, Boress L, Bratzler DW, Cangialose C, Zaar G, Ziegenhagen DM. Assessing HCFA's Health Care Quality Improvement Program. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 1997; 23:550-60. [PMID: 9383674 DOI: 10.1016/s1070-3241(16)30339-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In 1992 the Health Care Financing Administration introduced the Health Care Quality Improvement Program (HCQIP), through which quality improvement projects are conducted in partnership with quality improvement organizations (QIOs), hospitals, health plans, or physicians. An evaluation of HCQIP began in May 1996 in response to the QIOs' request for an independent assessment of their activities. METHODOLOGY The methodology and objectives of the evaluation were determined by an independent panel. The QIOs' full cohort of 970 HQIP projects could not be reviewed in the 10-month time frame available, but two topics were chosen: the management of warfarin or aspirin in patients with atrial fibrillation and the management of community-acquired pneumonia. FINDINGS Analyses were limited to the 49 of the 68 projects that had progressed to the "improvement plan implemented" stage. However, only 39 of these 49 projects had information on outcomes, organization changes, and/or changes in process of care--and only 20 of the 49 had moved beyond the "improvement plan implemented" phase. Feedback of data led hospitals collaborating on improvement projects to revise or create processes of care. DISCUSSION Although the assessment is the most comprehensive of its type to date, it should be viewed as a pilot study of some of the methods that could be incorporated in a more extensive and rigorous future evaluation of the impact of the HCQIP projects. Specific recommendations include random sampling of HCQIP projects across all clinical areas, conducting both prospective and retrospective assessments, developing uniform process and outcome program impact measures, and developing sustainable, ongoing automated data abstraction and analysis systems.
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Colenda CC, Cohen W, McCall WV, Rosenquist PB. Phototherapy for patients with Alzheimer disease with disturbed sleep patterns: results of a community-based pilot study. Alzheimer Dis Assoc Disord 1997; 11:175-8. [PMID: 9305504 DOI: 10.1097/00002093-199709000-00011] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We examined the entraining effects of phototherapy delivered by light visors on disturbed sleep patterns of community-dwelling research subjects with Alzheimer disease (AD). The pilot project used a single subject design and activity monitoring as the primary outcome measures. The protocol consisted of a 5-day baseline monitoring period, followed by 10 consecutive days of phototherapy (2,000 lux of full spectrum bright light) delivered by light visors for 2 hours each morning; this was followed by an additional 14 days of activity monitoring. Cosinor analyses found no consistent changes in acrophase, mesor, or amplitude. Observed changes in acrophase were consistent with phase advancement of the rest-activity cycle and consistent with the biological intervention. Changes in the number of nighttime awakenings were not found. One subject had a significant increase in total sleep time, whereas another had a significant decrease in total sleep time. Failure to find a consistent biological effect of light on AD subjects may be secondary to: (1) insufficient duration of light exposure; (2) timing of light administration (given at a time when circadian rhythm is refractory to the effects of light); (3) advanced stages of AD making the Y circadian pacemaker in the suprachiasmatic nucleus of the hypothalamus insensitive to the biological effects of light; and (4) inadequacy of light visors as a means of providing light.
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Maizels M, Scott B, Cohen W, Chen W. Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial. JAMA 1996; 276:319-21. [PMID: 8656545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of intranasal lidocaine for treatment of acute migraine headache. DESIGN Prospective, randomized, double-blind, placebo-controlled trial. SETTING Community urgent care department. PATIENTS A total of 81 patients (67 women and 14 men; median age, 42 years; range, 19-68 years) with a chief complaint of headache who fulfilled criteria of the International Headache Society for migraine participated. Patients were excluded if headache had lasted more than 3 days or if the frequency of severe headache was more than once per week. INTERVENTION Patients were randomized in a 2:1 ratio to receive a 4 percent solution of intranasal lidocaine or saline placebo, respectively. MAIN OUTCOME MEASURES The primary outcome measure was at least 50 percent reduction of headache within 15 minutes after treatment. Secondary measures include reduction in nausea and photophobia, use of rescue medication, relapse of headache, and change in headache disability scores. RESULTS Of 53 patients who received intranasal lidocaine, 29 (55 percent) had at least a 50 percent reduction of headache compared with 6 (21 percent) of 28 controls (P=.004). Nausea and photophobia were significantly reduced (P=.03 and P=.001, respectively). Rescue medication for headache relief was needed in 15 (28 percent) of 53 patients in the lidocaine group vs 20 (71 percent) of 28 controls (P<.001). Among those with initial relief of headache, relapse of headache occurred in 10 (42 percent) of 24 in the lidocaine group vs 5 (83 percent) of 6 in the control group (P=.17), usually within the first hour after treatment. CONCLUSIONS Intranasal lidocaine provides rapid relief of headache in approximately 55 percent of ambulatory patients with migraine. Relapse of headache is common and occurs early after treatment.
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Cohen W, Hage D, Black RF, Collins S. Fiscal state of the states. U.S. NEWS & WORLD REPORT 1995; 118:38-43. [PMID: 10139899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Davis RL, Mullen N, Makela M, Taylor JA, Cohen W, Rivara FP. Cranial computed tomography scans in children after minimal head injury with loss of consciousness. Ann Emerg Med 1994; 24:640-5. [PMID: 8092590 DOI: 10.1016/s0196-0644(94)70273-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
STUDY OBJECTIVE To assess the need for cranial computed tomography (CT) in the emergency department evaluation of children with Glasgow Coma Scale (GCS) score of 15 after mild head injury with loss of consciousness. DESIGN Retrospective case series of children aged 2 to 17 years with documented loss of consciousness after head injury from January 1, 1988, to July 31, 1992. All had a GCS score of 15 on initial ED evaluation and were further categorized according to physical examination findings, neurologic status, and whether the head injury was isolated or nonisolated. Recursive partitioning was used to identify variables predictive of the presence and absence of intracranial hemorrhage. SETTING ED in two settings: a regional tertiary care trauma center and a community children's hospital. RESULTS Of the 185 patients who met study criteria, 17 had evidence of depressed or basilar skull fractures on physical examination or had a ventriculoperitoneal shunt in place before head injury. In the remaining 168 patients, recursive partitioning identified two variables (neurologic status and head injury type) associated with intracranial hemorrhage. Overall, 12 of 168 patients (7%) had intracranial bleeding. However, none of the 49 neurologically normal children with isolated head injury had intracranial hemorrhage (95% confidence interval, 0.0 to 6.0). CONCLUSION The prevalence of intracranial hemorrhage in children with mild closed-head injury appears to vary with the presence of neurologic abnormalities and other noncranial injuries. After isolated head injury with loss of consciousness, children older than 2 years who are neurologically normal and without signs of depressed or basilar skull fracture may be discharged home from the ED without a cranial CT scan after careful physical examination alone.
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Abstract
A judicial hanging occurred in the state of Washington. Neck injuries were studied by MRI (Magnetic Resonance Imaging) and CT (Computed Tomography). In addition, vertebral arteriograms were performed to evaluate the nature of the neck injury. This report details the anatomical changes produced by judicial hanging.
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Mann FA, Cohen W. Occipital condyle fracture: significance in the assessment of occipitoatlantal stability. AJR Am J Roentgenol 1994; 163:193-4. [PMID: 8010212 DOI: 10.2214/ajr.163.1.8010212] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Claypoole KH, Townes BD, Collier AC, Marra C, Longstreth WT, Cohen W, Martin D, Coombs RW, Goldstein D, Sanchez P. Cognitive risk factors and neuropsychological performance in HIV infection. Int J Neurosci 1993; 70:13-27. [PMID: 8083020 DOI: 10.3109/00207459309000557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Almost all investigations examining the effects of early HIV infection on neuropsychological functioning in homosexual males have excluded subjects with cognitive risk factors such as recreational drug use and head injury. While insuring that results reflect the influence of the virus on cognition, this selection bias limits the ability to generalize findings. Comprehensive neuropsychological evaluations were compared between two groups of homosexual males with a variety of cognitive risk factors. Subjects were 132 HIV seropositive males (108 CDC class II & III and 24 CDC class IVA & IVC2) and 65 HIV seronegative controls. Recreational drug use in the six months prior to exam was found to interact with HIV infection and was associated with selective areas of cognitive decline and a significantly worse overall neuropsychological performance. Although significantly lower functioning in the domains of Verbal Memory and Attention and Speed of Information processing was noted for subjects with CDC class IVA and IVC2 compared to seropositives with CDC class II & III, overall neuropsychological performance was similar in these two groups. At this early stage of HIV infection, we did not find indication of association between neuropsychological performance and decreased immunological status. A history of head injury and recent recreational drug use emerged as primary cognitive risk factors associated with decreased neuropsychological performance. As 50% of our HIV seropositive subjects reported active recreational drug use, this cognitive risk factor in particular may contribute to the appearance of HIV-related cognitive deficits during early stages of HIV infection.
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Schmidt RH, Grady MS, Cohen W, Wright S, Winn HR. Acute cauda equina syndrome from a ruptured aneurysm in the sacral canal. Case report. J Neurosurg 1992; 77:945-8. [PMID: 1432139 DOI: 10.3171/jns.1992.77.6.0945] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The case is presented of a young woman with acute cauda equina syndrome from a ruptured aneurysm in the sacral canal. The lesion was associated with pathological enlargement of the lateral sacral arteries bilaterally, which presumably occurred to provide cross-pelvic collateral flow in response to the diversion of the right internal iliac artery for renal transplantation. The patient presented with signs and symptoms of spontaneous spinal epidural hemorrhage. The radiographic features of this lesion are described. In addition to angiography and partial embolization of the vascular supply, contrast-enhanced high-resolution computerized tomography was essential in the diagnosis and treatment of this unique aneurysm.
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Abstract
Physicians, carefully adhering to the definitions of Physicians' Current Procedural Terminology (CPT) billing codes, used the same CPT codes to denote evaluation and management services that varied widely in work and used different codes for services whose work was the same. As payment shifted to the Medicare Fee Schedule, it was important that the coding system be redefined so that codes consistently reflect the resource costs of these services. Redefining these codes for a resource-based payment system required an understanding of how verifiable predictors relate to physician work. Using data obtained from the Resource-Based Relative Value Scale (RBRVS) study regarding 377 services surveyed among physicians in 31 specialties, multiple regression analyses of the relationship of different variables to the mean values of work were performed. Intraservice time, which accounted for 90% of the variance, was the most important predictor of intraservice work. Specification of time, which previously had not been an element in the definitions of CPT codes for evaluation and management services, was useful in refining these codes so that their value corresponds more closely to resource costs. Other predictors of work were site of service or visit type, patient status (new/initial, established/subsequent), and referral status (consultation, nonconsultation).
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Budorick TE, Anderson PA, Rivara FP, Cohen W. Flexion-distraction fracture of the cervical spine. A case report. J Bone Joint Surg Am 1991; 73:1097-100. [PMID: 1874776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Cohen W. Recent developments in the imaging of neuraxis trauma. CURRENT OPINION IN RADIOLOGY 1990; 2:34-9. [PMID: 2201360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Polich J, DeFrancesco DP, Garon JF, Cohen W. Hemispheric differences in visual search of simple line arrays. PSYCHOLOGICAL RESEARCH 1990; 52:54-61. [PMID: 2377726 DOI: 10.1007/bf00867212] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effects of perceptual organization on hemispheric visual-information processing were assessed with stimulus arrays composed of short lines arranged in columns. A visual-search task was employed in which subjects judged whether all the lines were vertical (same) or whether a single horizontal line was present (different). Stimulus-display organization was manipulated in two experiments by variation of line density, linear organization, and array size. In general, left-visual-field/right-hemisphere presentations demonstrated more rapid and accurate responses when the display was perceived as a whole. Right-visual-field/left-hemisphere superiorities were observed when the display organization coerced assessment of individual array elements because the physical qualities of the stimulus did not effect a gestalt whole. Response times increased somewhat with increases in array size, although these effects interacted with other stimulus variables. Error rates tended to follow the reaction-time patterns. The results suggest that laterality differences in visual search are governed by stimulus properties which contribute to, or inhibit, the perception of a display as a gestalt. The implications of these findings for theoretical interpretations of hemispheric specialization are discussed.
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Cohn JA, McMeeking A, Cohen W, Jacobs J, Holzman RS. Evaluation of the policy of empiric treatment of suspected Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome. Am J Med 1989; 86:521-7. [PMID: 2712059 DOI: 10.1016/0002-9343(89)90378-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE This study was designed to measure response rates and survival in patients with acquired immunodeficiency syndrome (AIDS) and suspected Toxoplasma encephalitis treated empirically and in AIDS patients treated for biopsy-proven toxoplasmosis. PATIENTS AND METHODS AIDS patients identified at Bellevue Hospital between August 1985 and May 1986, who had abnormal computed tomographic scans of the brain and who received empiric treatment for toxoplasmosis, constitute the empirically treated cohort. A cohort with biopsy-proven toxoplasmosis was identified from Bellevue Hospital neuropathology records spanning 1981 through 1986. Patient records were reviewed with a standardized data form, and tomograms were evaluated by neuroradiologists unaware of the identity of the scans. Survival analysis was performed by the product limit method. RESULTS Of 38 empirically treated patients, 26 responded clinically and radiographically within four weeks of initiation of therapy. Four of nine patients who underwent biopsy responded to treatment. There was no difference in these response rates (68% versus 44%, p = 0.24). The median survival of the empirically treated responders, from first diagnosis of AIDS to last follow-up, was 422 days. Among the 30 responders, five patients discontinued therapy and four of them had relapses. No relapses occurred in the 25 patients who continued full-dose therapy indefinitely (p = 0.0004). Sixteen of 30 patients (53%) receiving continuous therapy developed toxicity, which required a change in medication. There was no difference in the survival of patients who continued to receive sulfadiazine and pyrimethamine compared with those in whom clindamycin was substituted for sulfadiazine (median, 311 days versus 422 days, p = 0.25). CONCLUSION A policy of empiric treatment of suspected Toxoplasma encephalitis is satisfactory, and patients who respond to such therapy and continue to take full therapeutic doses of anti-Toxoplasma drugs have relatively long survivals.
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Fink JK, Barton N, Cohen W, Lovenberg W, Burns RS, Hallett M. Dystonia with marked diurnal variation associated with biopterin deficiency. Neurology 1988; 38:707-11. [PMID: 2452381 DOI: 10.1212/wnl.38.5.707] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Two pairs of siblings with severe dystonia with marked diurnal fluctuation had both reduced CSF concentration of biopterin and marked symptomatic improvement of the dystonia in response to levodopa. Whether the reduced concentration of biopterin reflects focal abiotrophy of biopterin-containing neurons or deficiency of biopterin synthesis is uncertain. A fifth individual, who had a systemic deficiency of biopterin synthesis, shared the features of reduced biopterin in CSF, marked diurnal variation in the degree of dystonia, and clinical improvement in response to levodopa. Generalized dystonia with marked diurnal fluctuation was therefore shared by the four patients in whom biopterin deficiency was limited to the CNS and the patient with systemic deficiency of biopterin.
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Hernanz-Schulman M, Cohen W, Genieser NB. Sonography of cerebral infarction in infancy. AJR Am J Roentgenol 1988; 150:897-902. [PMID: 3279737 DOI: 10.2214/ajr.150.4.897] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Six infants with cerebral infarcts were examined prospectively with real-time sonography to determine the sonographic characteristics of infarcts and their evolution. Patients' ages ranged from 1 day to 7 months, and serial sonographic and/or CT scans were obtained over a period of 2 weeks to 14 months in the survivors. Among our patients the most characteristic sonographic findings of infarction were absence of gyral definition, absence of vascular pulsations, altered parenchymal echogenicity, and territorial distribution. Mass effect, reflected in ventricular size and shift of midline structures, may also be seen and largely parallels the extent of the infarction. Evolution of infarcts was seen sonographically as gradual return of arterial pulsations and concurrent development of cystic spaces. Sonography was found to be a valuable tool in the diagnosis of infarction in infancy and in monitoring its evolution, although CT was necessary for adequate initial evaluation in older infants.
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