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Biomedical subjects

D Sloan

Publications and source records attributed to D Sloan.

At least 55 records · Page 3Linked to original sources
PubMed1986

The impact of fine-needle aspiration biopsy on surgery for single thyroid nodules.

Biopsy by fine-needle aspiration has emerged as the most effective single technique for the investigation of single thyroid nodules. A comparison was made of patients who underwent surgery for single nodules in 1979 (before the introduction of fine-needle aspiration biopsy to this Department) and in 1984, after this technique had become fully established. Biopsy by fine-needle aspiration proved to be reliable in the selection of patients for surgery. The incidence of malignancy in each category was: malignant, 83%; atypical, 26%; inadequate, 7%; and benign, none. This contrasted with nuclear scanning and ultrasound techniques that were in use over that period, where the malignancy rate of nodules that showed no uptake of radioisotope was 11% and that of an ultrasound scan that demonstrated a "solid" or "cystic/solid" was 16%. Similarly, nodules that showed an uptake of radioisotope or an ultrasound scan that demonstrated a "cystic" image did not exclude malignancy reliably. As a result of fine-needle aspiration biopsy, there was a 60% reduction in the number of thyroidectomies for single nodules during its use with a higher yield, but no change in the absolute number, of patients with malignancy of the thyroid gland.

Adult↗
PubMed1978

The emotional and psychosexual aspects of hysterectomy.

The emotional sequelae of hysterectomy have long been suggested as a concern of the gynecologist. A review of the literature reveals that there are surely concrete changes in the functioning, attitudes, and behavior of patients who undergo this procedure. Since the gynecologist acts as the "uterus remover," it is our specialty that should be dealing with these women patients to carry them through the possible effects of such surgery. In addition, it would be wise for all of us to examine our own indications for this procedure in order to be confident when faced with criticisms that our specialty considers the uterus less valuable than other organs, rendering it more vulnerable to the unthinking surgeon.

Attitude to Health↗
PubMed1976

Rape: the gynecologist's role.

The rape victim is a product of both a sexual and violent crime; the patient, in becoming the gynecologist's responsibility, must be received in a manner uniquely adapted to fit this situation. The physician must maintain his or her role as a healer and has no place acting as a lawyer or law enforcement officer. However, by obtaining the necessary, basic knowledge of the community's law, the physician can enable the patient to avoid unnecessary personnel, who tend to interview her at the most traumatic moment. It is best to do the minimum needed so that the patient realizes she is being treated as a troubled individual and not as a part of a future medicolegal case. In addition, the physician can practice good preventive medicine by alerting patients to clues about how to avoid rapists' attacks and yet do all they can to prevent the injuries which, although not primary, are part of many rapes. Our patients need a friend, a physician and a counselor all in one. The gynecologist should be all three.

Female↗
PubMedDate not supplied

Bone marrow metastases from small cell cancer of the head and neck.

BACKGROUND: Primary small cell carcinoma of the head and neck is rare. Although the larynx is the most prevalent site of head and neck small cell carcinoma (SCC), this report will concentrate on SCC of the major salivary glands and paranasal sinuses. In all, 33 cases of paranasal sinus and 43 cases of major salivary gland SCC have been reported in the literature. METHODS: We report two patients, one with submandibular gland SCC and the other with maxillary sinus SCC. A literature review of all known paranasal sinus and major salivary gland SCC with inclusion of data from these two new cases is undertaken. Discussion of all past and present cases concentrates on sites of metastasis, treatment, and survival. RESULTS: Paranasal sinus SCCs predominantly arise from the nasal cavity, whereas the parotid gland is the primary site in three fourths of major salivary gland SCCs. One half of major salivary gland and three fourths of paranasal sinus SCCs have only local disease at presentation. Both patients in this report developed bone marrow metastases, a feature heretofore not observed in SCC from these primary sites. The patient with maxillary sinus SCC developed the syndrome of inappropriate antidiuretic hormone (SIADH). CONCLUSION: The paranasal sinus and major salivary glands are rare primary sites for SCCs. Long-term survival with local therapy in patients with local disease can occur, but in patients with metastatic disease survival mirrors metastatic pulmonary SCC.

Bone Marrow↗
PubMedDate not supplied

The effects of levonantradol hydrochloride on tumor growth and therapy.

The effects of levonantradol on tumor growth, both directly and in combination with the cytotoxic agent cyclophosphamide, were determined. Levonantradol hydrochloride administered alone had no effect on the progression of either murine sarcoma 180J or leukemia L-1210. Likewise, the increased survival obtained in both tumor systems with cyclophosphamide was not altered by concurrent administration of levonantradol hydrochloride. Levonantradol did not affect the incidence or extent of artificial melanotic lung metastases, nor did it modify lymphoreticular cell stimulation. These data support the use of levonantradol in conjunction with chemotherapy in cancer patients.

Animals↗
PubMedDate not supplied

Co-abuse of opiates and benzodiazepines.

The objective of the study was to assess what differences exist between individuals who are dependent on opiates and benzodiazepines and compare to those who are dependent on opiates. A questionnaire was compiled and administered to patients who had been consecutively admitted to an inpatient drug treatment unit. The prevalence of benzodiazepine dependency was 54 per cent [n = 34]. Patients dependent on benzodiazepines and opiates were significantly older, had been admitted for methadone stabilisation and were more likely to have been prescribed a methadone maintenance programme prior to admission. They had used heroin longer, benzodiazepines more frequently, at larger doses for a longer duration of time and tended to use more drugs in general. They were found to be more psychologically vulnerable than those not dependent on benzodiazepines as they were significantly more likely to have described a past experience of depression and a past episode of deliberate self harm.

Adolescent↗
PubMedDate not supplied

Risk factors for pain after mastectomy/lumpectomy.

PURPOSE: Careful study of risk factors that predispose an individual to developing postmastectomy pain (PMP) after breast cancer surgery has not been reported. This study examined potential risk factors for PMP including demographic, disease, and treatment variables, as well as surgical factors, such as surgical technique and number of lymph nodes removed. DESCRIPTION OF THE STUDY: Data were collected via telephone interviews and review of medical records. Pain was assessed using the Brief Pain Inventory. The sample included 134 breast cancer survivors who were a mean age of 55 years (SD = 9) and a mean of 35 months postsurgery (SD = 19). RESULTS: Women with PMP (n = 36) were not significantly different from women without PMP (n = 98) on demographic, disease, treatment, or surgical variables. PMP intensity was not significantly associated with age at diagnosis, time postsurgery, or time post-treatment. Contrary to expectation, PMP was found in women postlumpectomy without axillary dissection, women whose intercostobrachial nerve was spared, and women without documented postoperative complications. CLINICAL IMPLICATIONS: Findings suggest that cases of PMP cannot uniformly be identified based on the presence or absence of certain factors. Findings also underscore the need to screen all women for PMP after breast cancer surgery, particularly given the availability of effective pain management therapies.

Adult↗
PubMedDate not supplied

Implementing cancer pain education for medical students.

PURPOSE: The purpose of this study was to develop and pilot a cancer pain education course for medical students, using a structured home hospice visit. DESCRIPTION OF STUDY: A 1-hour home hospice visit was presented to 57 senior medical students. The content and objective criteria for the structured home hospice visit were developed by a multidisciplinary group of experts. During a 1-hour interview, students completed a cancer pain history, performed a focused physical examination, and received feedback and teaching regarding the essentials of cancer pain management from the hospice nurse. All students and hospice patients completed a multi-item evaluation questionnaire with a 5-point Likert scale (1=strongly disagree; 5=strongly agree) regarding the structured home hospice visit. RESULTS: Most students agreed strongly that the home hospice visit was a positive experience (mean +/- SD 4.8 +/- 0.44) that helped them to understand the management of cancer pain (mean 4.7 +/- 0.46) and opioid-related side effects (mean 4.5 +/- 0.57). Most patients enjoyed visiting with the students (mean 4.90 +/- 0.30), agreed that the visit was not tiring (mean 4.81 +/- 0.51), and felt that they benefited from participating (mean 4.76 +/- 0.54). CLINICAL IMPLICATIONS: The authors concluded the following: 1) that medical students benefited from learning about cancer pain assessment and management through the use of a structured home hospice visit; 2) that a structured home hospice visit helped the students to learn the basics of cancer pain management; 3) that patients enjoyed their role as teacher for medical students; and 4) that senior hospice nurses provided excellent instruction for medical students in the management of cancer pain.

Curriculum↗
PubMedDate not supplied

Evaluation of a fetal risk-scoring system.

A population of 2029 pregnant women (929 primiparas; 1100 multiparas) has been used to examine aspects of the calculation of obstetric risk scores from the presence of individual risk factors. The findings have been related to fetal outcome in these pregnancies and the following conclusions were reached: (1) the use of Bayes theorem for the calculation of a risk score is superior to the simple addition of weighted risk factors; (2) the diagnostic efficiency of a risk score is somewhat reduced when the data base used for calculation of the score is derived from a population different from that of the current pregnancy; (3) there is almost total overlap of risk scores in women with satisfactory and unsatisfactory fetal outcome. It is concluded that risk scores can be used to identify a small group of women at particularly high risk; in the remainder of the population scores are unhelpful except perhaps to indicate the women who do not require an intensive program of antenatal care.

Bayes Theorem↗