Search PubMed⌕ Search

Biomedical subjects

F I Gilbert

Publications and source records attributed to F I Gilbert.

At least 37 records · Page 2Linked to original sources
PubMed1993

The superiority of antimicrosomal over antithyroglobulin antibodies for detecting Hashimoto's thyroiditis.

BACKGROUND: Antimicrosomal (anti-M) and antithyroglobulin (anti-Tg) antibodies are commonly measured together to detect Hashimoto's thyroiditis. Since this nearly doubles the cost of testing for one antibody, we wished to determine whether significant diagnostic loss would occur if the two tests were replaced by anti-M alone. METHODS: Both tests were performed in 2030 consecutive patients referred by general internists and endocrinologists. RESULTS: With a positive result defined as either test being positive at a 1:100 dilution, anti-M was much more sensitive than anti-Tg. Anti-M was positive in 99% (823/831) of all patients with positive tests, while anti-Tg was positive in 36% (302/831). Anti-M was the only positive test in 64% of all patients with positive tests, while anti-Tg was the only positive test in 1%. With a cutoff point of 1:400 dilution, the results were similar. CONCLUSIONS: Anti-M alone appears sufficient to detect autoimmune thyroid disease at about one half the cost of routinely performing both anti-M and anti-Tg studies. The widespread practice of performing both tests increases the cost without an offsetting diagnostic gain.

Adolescent↗
PubMed1993

Mammographic calcifications and risk of subsequent breast cancer.

BACKGROUND: Women with proliferative benign breast lesions are at increased risk of breast cancer, and some studies have provided evidence that microscopic calcifications in such lesions enhance the risk. PURPOSE: This study was performed to determine whether calcifications on mammograms are predictive of subsequent breast cancer. METHODS: Data for this study were collected on women enrolled at four of the clinics that participated in the Breast Cancer Detection and Demonstration Project (BCDDP). The presence, morphology, and distribution of calcifications visualized on baseline mammograms for 686 women who developed breast cancer over a 7- to 10-year period of follow-up were compared with those for 1357 controls who remained cancer free. We also compared presence and types of calcifications in breasts in which cancer subsequently developed with those in the contralateral breast. RESULTS: Calcifications were evident at baseline in at least one breast in 381 (55.5%) of 686 cases and in 606 (44.7%) of 1357 controls. The estimated relative risk (RR) of breast cancer was 1.68 in women with calcifications, compared with those having none. There was a statistically significant trend of increasing risk with number of breasts with calcifications; RR increased from 1.28 to 2.14 in women with calcifications in one and both breasts, respectively. In women with unilateral calcifications, RR was greater for the breast in which the calcification occurred (1.48) than for the opposite breast (1.08). The elevated risk persisted for more than 6 years from identification of the calcification, suggesting that these lesions were not indicative of existing carcinomas detected later. Risk was greatest in women with clustered calcifications of any morphology or linearly distributed punctate calcifications (RR = 3.64), and the cancer in women with such calcifications was 4.65 times more likely to occur in the involved breast than in the contralateral breast. Multiple and scattered punctate calcifications, and those of any number or distribution that were ring-shaped or linear, were also associated with subsequent risk of breast cancer (RR = 2.09 and 1.76, respectively) but were not strongly predictive of the side on which the breast cancer occurred. Risk was not altered in women with single punctate or large conglomerate calcifications, although the cancers that subsequently occurred in women with the latter lesions were over three times more likely to develop in the breast with the calcification than in the opposite breast. CONCLUSIONS: These findings are consistent with previously reported relationships between breast cancer and specific histologic types of noninvasive breast lesions. Some types of mammographic calcifications appear to be independent risk factors for breast cancer. IMPLICATIONS: If these results are confirmed by other investigators, mammographic calcifications could serve as an additional indicator of women at high risk for breast cancer who may benefit from intensified follow-up.

Breast Diseases↗
PubMed1993

The case for restructuring health care in the United States: the Hawaii paradigm.

Health care in the United States is plagued by many problems. This includes excessive specialization with too few generalists, burdensome bureaucratic federal rules and regulations, and outlandish malpractice awards--all contributing to costs of care that exceeds all other nations. Cost has erroneously been identified as the cause of the problem rather than being one of many results of a failing system. Rather than repetitive unsuccessful efforts to tinker with cost as the cause, it makes far more sense to design and build a better structure of health care including expanding the existing biomedical model into a broader biomedical-psychosocial model. Hawaii, with virtually 100% of its population insured, is closer to this model than most states. It also manages to be ranked the healthiest state with one of the lowest health care costs in the nation.

Cost Control↗
PubMed1991

Estimating the sensitivity of breast cancer screening--experience with the Honolulu BCDDP data.

The 'capture-recapture' models for estimating breast cancer screening sensitivity can be generalized to include factors that affect sensitivity such as cancer size. Including such factors can help reduce the covariance between mammographic and physical exam sensitivity, which will improve the estimates. One model relating sensitivity to cancer length is presented and tested using data from the Honolulu Breast Cancer Detection Demonstration Project (BCDDP). The model predicts sensitivity fairly well for large breast cancers, but underestimates sensitivity for small cancers. Using both mammography and physical examination, the total screening sensitivity is estimated as 0.91 +/- 0.03 for cancers longer than 12 mm (for the second through fifth screenings for Honolulu and Tucson screening data combined). Limited data suggest similar screening sensitivities for Orientals and Caucasians in Hawaii. Shortcomings of the BCDDP data include inaccurate measurements of cancer length. Suggestions to improve data for future work are given.

Breast Neoplasms↗
PubMed1991

Painful subacute thyroiditis in Hawaii.

Between 1960 and 1982 we prospectively studied 269 patients with painful subacute thyroiditis to determine the demographic characteristics, seasonality, and natural course of the disease. The mean age for all patients was 37.1 years. The female:male ratio was 6.7:1. At the first visit, disease was bilateral in 69%. No epidemic or seasonal pattern was identified. The mean duration of thyroid tenderness was 2.2 months and that of palpable thyroid lumps was 2.8 months. This time difference, sometimes lasting many months, left a painfree "window" during which the palpable hard residual mass of subacute thyroiditis may be confused with other thyroid problems, especially cancer.

Age Factors↗
PubMed1991

Optimal iodine-131 dose for eliminating hyperthyroidism in Graves' disease.

Since hypothyroidism is commonplace after treatment of Graves' disease with radioiodine, the goal should be cure of hyperthyroidism rather than avoidance of hypothyroidism. To find the optimal dose to accomplish cure, we treated 605 patients with stepwise increasing doses of 3, 4, 5, 6, 8, and 10 mCi, analyzing the relationship of dose, age, sex, gland weight, and thyroidal uptake to cure. Estimates of cure at doses above 10 mCi were made from the literature. Cure was directly related to dose between 5 and 10 mCi. There was no significant relationship between cure and age (chi-square, p = 0.74), sex (chi-square, p = 0.12), and 24-hr uptake if over 30% (chi-square for slope, p greater than 0.10). Cure and gland weight had an inverse relationship (chi-square for slope, 0.01 less than p less than 0.02). We concluded that the optimal 131I dose for curing hyperthyroidism is approximated by starting with 10 mCi and increasing it for unusually large glands or for special patient circumstances.

Adult↗
PubMed1990

Management of primary hypothyroidism.

Primary hypothyroidism is a common condition requiring lifelong treatment and monitoring. The type and amount of thyroid hormone replacement, selection of laboratory tests, and timing of office visits are all important for optimizing patient well-being and reducing the costs of medical care. The aim of treatment is to bring the patient to the euthyroid state. Currently this is defined as a normal serum concentration of TSH by recently developed sensitive and specific immunometric assays, and is accomplished by titrating the dose of levothyroxine and changing it not more often than at 4- to 6-week intervals. As an indicator of euthyroidism, the sensitive TSH assay has advantages over tests of serum T4, FT4I, T3, FT4, and TSH by RIA because it is independent of TBG changes that result from pregnancy, birth-control pills, and estrogen replacement, is not spuriously elevated by the levothyroxine treatment itself, and is the only test that detects both subclinical hypothyroidism and subclinical hyperthyroidism. Additional serum tests are not usually necessary but have advantages under special circumstances. Once the optimal replacement dose is determined, monitoring can be done yearly or even bi-yearly, depending on the adequacy of patient education and patient compliance.

Humans↗
PubMed1990

The appropriate use of technology (particularly in medical problems of the elderly).

Technology, particularly "high" technology, with little solid data, is often blamed for much of our increasing cost of health care. Politics and emotions are poor substitutes for accurate information needed for rational solutions. By targeting the desired outcome and studying the process needed to reach the outcome, we can make better decisions. The methods of designing, conducting and funding the studies needed to answer the difficult questions posed by the use of high technology in the elderly are available. Do we have the wisdom to use them?

Aged↗
PubMed1988

Graves' disease. Influence of age on clinical findings.

To determine the influence of age on the signs and symptoms of hyperthyroidism we prospectively examined 880 patients and matched them by age, sex, race, and visit date with similarly examined euthyroid control subjects. Many signs and symptoms showed little change with age until after the fifth decade of life when they began to decrease gradually. Findings that increased with age were weight loss and atrial fibrillation, while those that decreased most markedly with age were increased appetite and weight gain. The diagnosis is more difficult as age progresses because there are fewer findings and because the significance of those present may not be appreciated. Identification of the most sensitive and specific signs and symptoms in each age decade should improve the early detection of hyperthyroidism.

Adolescent↗
PubMed1985

Wolfe mammographic parenchymal patterns. A study of the masking hypothesis of Egan and Mosteller.

Wolfe defined four different classes of breast parenchymal patterns and claimed that they were associated with different risks for the subsequent development of breast cancer. Egan and Mosteller suggested that these patterns did not constitute a true risk factor, rather the effect was caused by the greater difficulty of detecting breast cancers in the dense (P2, DY) patterns compared with the fatty (N1, P1) patterns. Similarly, Mendell believed that a bias was introduced into Wolfe's work by requiring a negative mammogram before a patient entered the study. This study of 221 prevalent and 706 incident cancers followed for up to 10 years indicates that a masking effect does exist, but that it operates in addition to a difference in risk of breast cancer within the four Wolfe classes. Wolfe's hypothesis is found to be valid.

Breast Neoplasms↗
PubMed1985

The relationship between Wolfe's classification of mammograms, accepted breast cancer risk factors, and the incidence of breast cancer.

Data collected between 1973 and 1984 on 696 incident cases of breast cancer and 1,376 matched controls from four Breast Cancer Detection Demonstration Project clinics in the United States were used to assess the role of mammographic parenchymal pattern as a risk factor and its relationship with other, accepted, risk factors. The data confirm previous reports of the influence of benign breast biopsy, age at first live birth, family history of breast cancer, and duration of menstruation on the incidence of breast cancer. Height is also found to be an influential factor. Parenchymal pattern is found to be a risk factor with effects comparable in magnitude to the other factors studied. It operates separately from them, except for its relationship with height and weight. After adjustment for parenchymal pattern, weight is seen to have a significant effect on breast cancer incidence, and height is no longer needed in a model for risk. A model which simultaneously incorporates all of the risk factors considered, including parenchymal pattern, is presented. While these factors are of interest in the epidemiology of breast cancer, it is demonstrated that they are insufficient to allow reliable prediction of the disease in an individual woman.

Body Height↗
PubMed1985

Wolfe's mammographic classification and breast cancer risk: the effect of misclassification on apparent risk ratios.

The effect of misclassification of Wolfe's mammographic classifications was investigated using data from two radiologists. If there are only two risk groups (high and low), the apparent relative risk expected from typical surveys would be around 2 or 3, even if the true relative risk is very high. If each of Wolfe's four classes has its own risk, the difference between N1 and P1, on the one hand, and P2 and DY on the other, would be almost lost due to misclassification. Published surveys in which the observed relative risks for the high-risk group (P2 and DY) are low are not inconsistent with Wolfe's original finding of a high relative risk: misclassification can greatly distort estimates of relative risks. If misclassification can be managed by restricting uncertain mammograms to one class (or by removing them from the study altogether), the bias can be greatly reduced.

Breast Neoplasms↗
PubMed1985

Factors associated with mammographic pattern.

Wolfe's criteria were assigned to mammograms of 202 women without breast cancer. Parity decreased the frequency of P2 patterns but not DY. P1 and N1 patterns apparently increased at the expense of P2 patterns. For every birth, the probability that a P2 pattern changed to P1 or N1 was roughly 7 or 8%. This effect was not limited to the first pregnancy, but also held for additional pregnancies. Low body weight was associated with dysplasia and prominent duct patterns. Reported declines of radiographic density with increasing age and/or menopause were confirmed. Ethnic group was unrelated to parenchymal pattern.

Body Height↗
PubMed1983

Reproducibility and consistency in classification of breast parenchymal patterns.

The Wolfe Classification System of evaluating risk of developing breast cancer from analysis of mammographic parenchymal patterns (MPP) has received worldwide attention. In addition to confirming its validity, it is necessary to establish the ability of radiologists to apply the classification of mammograms consistently and reproducibly. This paper reports the results of 12 radiologists associated with the former Breast Cancer Detection Demonstration Projects (BCDDP) in Ann Arbor, Honolulu, Seattle, and Tucson. The participating radiologists had all had some experience with classifying mammograms, then were exposed to more intensive instruction, and finally worked with atlases developed at each institution. The results reported here show the comparisons of the radiologists' readings with Dr. Wolfe in a series of three separate exercises and also three tests of intraobserver consistency. Two of the participating institutions used xeromammograms and two, film mammograms. The study was designed and supervised by an independent data coordinating center with masking of mammograms, without benefit of information of previous readings and no information available except age. The results indicate that this group of radiologists could classify mammograms in the method of Wolfe at an acceptable level compared to other similar exercises.

Breast Neoplasms↗