Biomedical subjects
F F Holmes
Publications and source records attributed to F F Holmes.
Improving survival in patients with prostate cancer regionally spread at the time of diagnosis.
In the United States, cancer of the prostate ranks first among malignant neoplasms in elderly men. During the 20-year period 1960-1979, 5178 men with prostate cancer were registered at the Cancer Data Service of the University of Kansas. This study concerns 985 of these men in whom the cancer was regionally spread at the time of diagnosis. Survival differences were examined for four periods, i.e., 1960-1964, 1965-69, 1970-74, and 1975-79. Highly significant increases were observed in one-year and three-year survival (P less than 0.003) between the dosage of estrogen as standard therapy. Another noteworthy finding was that the initial use of radiotherapy (alone or combined) increased from 4.5 per cent in 1960-64 to 36.5 per cent in 1975-79, a period when survival had also increased significantly. In this subset of men with prostatic cancer, survival is approaching that for an age-matched male population as determined by U.S. Life Tables.
Fulminant Meningococcemia after splenectomy.
Explore the source record for details and available documents.
Cancer stage-to-age relationship: implications for cancer screening in the elderly.
In a study specifically addressing the age-stage relationship, the authors examined the distribution of 30,991 cancers by disease-stage versus patient-age at the time of diagnosis. For cancer of the bladder, breast, cervix, ovary and uterus (endometrium), a highly significant positive relationship was found between advancing stage and advancing age (P less than 0.001). For cancer of the kidney and stomach, the relationship held but was less significant (P less than 0.05). For colorectal cancer, no relationship was evident. For bronchial cancer there was a highly significant inverse relationship (P less than 0.001). After the site of origin of the cancer, the stage at the time of diagnosis was the next most important determinant for treatment and survival. These data emphasize the importance of periodic pelvic examination as a means of screening for asymptomatic cervical, ovarian, or other uterine (endometrial) cancer in elderly women. Also, the data support the importance of breast self-examination and mammography in screening for breast cancer in older women. The inverse relationship of age to stage in bronchial cancer suggests that screening by periodic chest roentgenograms and cytologic sputum examinations may be more appropriate for elderly than for younger populations in whom these screening methods have proved disappointing.
A Vibrio cholerae infection in a transient teamster.
An illness indistinguishable clinically from classical cholera but caused by a non-cholera vibrio occurred in an over-the-road truck driver. The infecting organism was not finally identified as Vibrio cholera, Smith serotype 113 toxin positive, until 4 weeks after his hospital discharge. Hospital laboratories in most parts of the United States are unlikely to identify Vibrio cholerae in stool cultures unless specifically requested to do so. If one recognizes the chronic cholera carriers have been documented, that small epidemics do occur in unlikely places, and the lack of evidence that toxigenic V. cholerae 01 differs from toxigenic V. cholerae non-01 in these two respects, then the potential for epidemics in the United States is real.
Pre-test and post-test in a medicine clerkship.
Offered the opportunity to take the previous quarter's post-test as a pre-test at the beginning of their 3-month medicine clerkship with the understanding it would have no effect on their final grades, 132 of 148 students (89%) took this opportunity. Post-test means for each quarter's group were significantly greater than pre-test means (P=0.0001). Pre-test means did not increase over the four quarters of the year of this study despite increasing student experience in other clinical disciplines. For this entire year correlations were as follows: Pre-test vs post-test r=0.591 (P=0.0001), pre-test vs clinical r=0.306 (P=0.0004), and post-test vs clinical r=0.329 (P=0.0001). By quarter these correlations were generally consistent. An interesting and unexpected finding was that students in the autumn quarter had significantly lower pre-test and clinical scores than students in the winter quarter. This may indicate that students highly motivated to medicine take this as their first clinical clerkship and those least motivated as their last first clinical-year clerkship.
Kids who really shouldn't smoke.
Explore the source record for details and available documents.
Survival in the elderly with acute leukemia.
The natural history of acute leukemia in the elderly is not well understood. There is disagreement about the value of treatment other than by supportive measures. In this study, the survival predictive power of 9 variables was analyzed in 103 patients aged 70 or older for whom a bone-marrow cytologic diagnosis of acute leukemia had been made at a referral hospital during the 30-year period, 1947--1976. When given, treatment was uniformly conservative. Blood leukocyte and platelet counts and hematocrit values at the time of diagnosis, sex, treatment, and the calendar year of diagnosis were significant (P less than 0.01) predictors of survival duration. Initial hematologic measurements, presumably reflecting the degree of leukemic cell infiltration of the bone marrow, were the strongest predictors of survival, whereas leukemic cell type had no predictive power. Survival increased significantly (P less than 0.01) during the 30-year period of the study, possibly more attributable to improved supportive care than to specific antileukemic therapy. Apparently survival is at least partly determined at the time of diagnosis, and conservative therapy often may be beneficial rather than detrimental.
A possible association of pernicious anemia with neoplasia.
7 out of 39 patients with pernicious anemia developed 9 different neoplasms during a period of 3--20 years after the diagnosis of pernicious anemia. These primary neoplasms originated from the lymph nodes, larynx, colon, stomach, kidney, meninges, maxillary sinus and eighth nerve. Treatment with vitamin B12 did not influence the development of tumor. Statistical analysis showed that the observed incidence of 9 neoplasms in this group was significantly higher than the expected 3.3 cases during the aggregate follow-up period (p = 0.002). Although a higher incidence of neoplasms in patients with other underlying diseases does not necessarily indicate an association, a high degree of suspicion for neoplastic disease is justifiable in patients with pernicious anemia.
Offspring of patients treated for cancer in childhood.
Genetic effects of cancer in childhood were examined among offspring of patients enrolled in the tumor registries of the Sidney Farber Cancer Institute and the Kansas University Medical Center. For 146 patients, 84 women and 62 men, 293 pregnancies were reported after cessation of treatment of diverse neoplasms. The outcomes of 286 completed pregnancies were as follows: 242 live births (1 set of twins), 1 stillbirth, 25 spontaneous abortions, and 19 therapeutic abortions. Seven live-born infants died during the first 2 years of life, a frequency in accord with expectation. Two offspring have developed cancer. One girl and her father had bilateral hereditary retinoblastoma. A second girl developed acute myelocytic leukemia; her mother had received radiotherapy during childhood for a brain tumor. Compared with their cousins and with published figures for the general population, the study progeny had no excess of congenital anomalies or other diseases. Chromosome and immunoglobulin studies of a few offspring did not reveal damage from preconception exposure to cancer chemotherapy and radiotherapy. Findings indicated that large collaborative studies are needed to monitor the offspring of childhood cancer survivors for inherited traits associated with the parental tumors and for mutagenic effects of therapy, particularly intense multimodality treatments.
Performance of male and female medical students in a medicine clerkship.
Little has been published about objective evaluation and comparison of performance of female and male medical students in clinical clerkships. Data were collected on objective grading and examination results of a three-month medicine clerkship involving 269 medical students, 222 men and 47 women, during 1975 and 1976. There were no significant differences in final course grades between the two sexes. Performance in wards and clinics and on written and oral examinations was also without significant differences when the two sexes' scores were compared. Thus, gender would appear to have no relationship to medical student performance in this clinical clerkship.
Pregnancy outcome of patients treated for Hodgkin's disease: a controlled study.
Normal reproduction prosepcts for Hodgkin's disease patients are unknown. This study compares the outcome of 93 pregnancies in 48 patients with 228 pregnancies in 69 sibling controls. No statistically significant differences for spontaneous abortions or abnormal offspring were noted comparing all patients with all controls or 35 irradiated patients with all controls. Pregnancy outcome of 13 patients who received both irradiation and chemotherapy prior to pregnancy appeared to be compromised compared to controls. Wives of male patients in this category were more likely to have spontnaeous abortions than wives of male controls; female patients in this category were significantly more likely to produce abnormal offspring than were female controls (p = 0.047). In this series of patients therapeutic irradiation alone did not appear to jeoparadize posttreatment reproduction in fertile Hodgkin's disease patients but in the smaller group of patients who received both irradiation and chemotherapy the reproduction picture was statistically not as good.
Measuring clinical competence of medical students.
Evidence of clinical competence for medical students entering the clinical clerkships at the University of Kansas College of Health Sciences is established by passing two different examinations: a 100 item multiple choice examination and a videotaped history and physical examination by each student of a simulated patient, being rated by that patient and two examiners. In 1976 the class of 196 medical students took an average 1.85 written examinations per student. With 70% or better constituting a passing score, 30.6% passed on the first attempt, 55.6% the second, 11.2% the third and 2.5% the fourth. Each student passed the televised practical examination and had the opportunity to review his or her videotape with a critiqued data base and the examiners' and simulated patient's evaluations in hand. Correlation coefficients for all 196 students between scores of written examinations, medicine tutors, examiners and professional patients revealed weak but significant correlations between the assessments of examiners and medical tutors and assessments of examiners and written examination scores, but not between other evaluations. This scheme of proof of competence appears to be objective and direct, and serves the convenience of both students and teaching staff.
Changing distribution of primary cancers in the large bowel.
Analysis of the changing distribution of origin site of 1,990 colorectal cancers observed at a large midwestern hospital shows a statistically significant trend of a decreasing percentage of distal (rectum, P=.0192) and an increasing percentage of proximal (cecum, P=.0015) large-bowel lesions during a period of at least 30 years. Mortality data for 11,635 colorectal cancers in the state of Kansas for this period confirm this trend (P less than .0001). The respective decrease and increase may well be the result of more than one factor. Results of digital examination of the rectum and sigmoidoscopy are less likely to diagnose large-bowel cancer as they did 30 years ago. Stool screening for occult blood, barium enema roentgenographic examination, and colonoscopy become more important diagnostic tools in light of this trend.
Connubial lymphoproliferative malignancies: a report of nine couples.
Nine marital partners with lymphoproliferative malignancies are detailed and their cases summarized in Table I. This 30-year observation represents the largest series of such associations from a single institution. A brief review of similar reported cases is presented.
Cancer Data Service: ovarian carcinoma distantly metastatic at diagnosis, 1945-1974.
Explore the source record for details and available documents.
Cancer Data Service: Breast carcinoma distantly metastatic at diagnosis, 1945-1974.
Explore the source record for details and available documents.