Ultrasonographic evaluation of the endometrium in postmenopausal tamoxifen-treated patients.
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Endometrium↗
Biomedical subjects
I Cohen
Publications and source records attributed to I Cohen.
Adnexal torsion: the contribution of color Doppler sonography to diagnosis and post-operative follow-up.
Ovarian torsion is often difficult to diagnose due to non-specific clinical and clinical and ultrasonographic findings. We demonstrated the use of color Doppler for the early diagnosis of ovarian torsion and for post-operative follow-up until the normalization of the preserved ovary was confirmed by subsequent viable pregnancy. Color Doppler flow assessment can be useful as both a diagnostic tool and for evaluating the recovery of the affected ovary after conservative surgical treatment.
Adnexal Diseases↗
Incremental prognostic value of exercise thallium-201 myocardial single-photon emission computed tomography late after coronary artery bypass surgery.
OBJECTIVES: This study assessed the incremental prognostic value of exercise thallium-201 myocardial perfusion single-photon emission computed tomography (SPECT) performed > or = 5 years after coronary artery bypass surgery. BACKGROUND: Thallium-201 scintigraphy has shown significant prognostic value in a variety of populations with suspected and known coronary artery disease. However, its value in patients with previous bypass surgery remains unknown. METHODS: We studied 294 patients who were prospectively followed up. Cox proportional hazards models for prediction of "hard" events (cardiac death and nonfatal infarctions) were constructed, with variables considered for inclusion in hierarchic order: clinical and exercise data first, followed by scintigraphic information. RESULTS: Mean (+/- SD) follow-up duration after scintigraphy was 31 +/- 11 months. There were 20 cardiac deaths and 21 nonfatal acute myocardial infarctions. Twenty-nine patients had late (> 60 days after thallium-201 SPECT) revascularization procedures or underwent repeat bypass surgery or percutaneous transluminal angioplasty. Shortness of breath and peak exercise heart rate were the most important clinical predictors of hard events. Two scintigraphic variables added significant prognostic information to the clinical model: the thallium-201 summed reversibility score (summation of segmental differences between stress and redistribution scores) and the presence of increased lung uptake of the radiotracer. The global chi-square statistic for this model was twice as high as that for the clinical/exercise model alone (49.7 vs. 24.2). When a second multivariate Cox model was built adding "soft" events (i.e., late revascularization procedures) as outcomes of interest, the summed reversibility score was selected as an independent scintigraphic predictor of events. The global chi-square statistic for this model was 50.7, three times as high as that for the clinical/exercise model alone. CONCLUSIONS: After evaluation of treadmill and exercise data, thallium-201 myocardial perfusion SPECT provided incremental prognostic information in patients late after bypass.
Aged↗
Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography.
OBJECTIVES: This study assessed the incremental prognostic implications of normal and equivocal exercise technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) and sought to determine its incremental prognostic value, impact on patient management and cost implications. BACKGROUND: The prognostic implications of Tc-99m sestamibi SPECT are not well defined, and risk stratification using this test has not been explored. METHODS: We studied 1,702 patients referred for exercise Tc-99m sestamibi SPECT who were followed up for a mean (+/- SD) of 20 +/- 5 months. Patients with previous percutaneous transluminal coronary angioplasty or coronary artery bypass surgery were excluded. The SPECT studies were assessed using semiquantitative visual analysis. Cardiac death and myocardial infarction were considered "hard" events, and coronary angioplasty and bypass surgery > 60 days after testing were considered "soft" events. RESULTS: Of the 1,702 patients studied, 1,131 had normal or equivocal scan results. A total of 10 events occurred in this group (1 cardiac death and 1 myocardial infarction [0.2% hard events]; 4 coronary angioplasty and 4 bypass surgery procedures [0.7% soft events]). The rates of hard events and referral to catheterization after SPECT were similarly low in patients with a low (< 0.15), intermediate (0.15 to 0.85) and high (> 0.85) post-exercise treadmill test (ETT) likelihood of coronary artery disease. With respect to scan type, patients with normal, probably normal or equivocal scan results had similarly low hard event rates. In the 571 patients with abnormal scan results, there were 43 hard events (7.5%) and 42 soft events (7.4%) (p < 0.001 vs. 1,131 patients with normal scan results for both). When the complete spectrum of scan responses was considered, SPECT provided incremental prognostic value in all patient subgroups analyzed. However, the nuclear scan was cost-effective only in patients with interpretable exercise ECG responses and an intermediate to high post-ETT likelihood of coronary artery disease and in those with uninterpretable exercise ECG responses and an intermediate to high pre-ETT likelihood of coronary artery disease. CONCLUSIONS: Normal or equivocal exercise Tc-99m sestamibi study results are associated with a benign prognosis, even in patients with a high likelihood of coronary artery disease. Although incremental prognostic value is added by nuclear testing in all patient subgroups, a testing strategy incorporating nuclear testing proved to be cost-effective only in the groups with an intermediate to high likelihood of coronary artery disease before scanning.
Aged↗
Oxyphil cell carcinoma of the parathyroid: a rare cause of hyperparathyroidism.
Oxyphil carcinoma of the parathyroid is an extremely rare tumour, only two previous patients having been reported. We report a 55-year-old woman with this condition, who presented with a picture of hyperparathyroidism, including hypercalcaemia, hypercalciuria, hypophosphataemia, increased alkaline phosphatase, and bony lesions. Biopsy of a bone lesion was consistent with brown tumour. Fine needle aspiration cytology and subsequent operative histology of the parathyroid lesion showed an oxyphil cell tumour with malignant characteristics. Following excision, the patient made a good recovery, complicated only by postoperative hypocalcaemia.
Adenocarcinoma↗
Tamoxifen treatment and its consequences.
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Antineoplastic Agents, Hormonal↗
The pattern of HMB-45 antibody staining in compound Spitz nevi.
We studied the staining pattern of HMB-45 antibody in 29 compound Spitz nevi (SNs) of the epithelioid cell variety, 17 of which showed extension of nevus cells into the reticular dermis (i.e., "deep"); 20 ordinary compound nevi (CNs), all with a deep dermal component; and 22 primary cutaneous invasive malignant melanomas (MMs) (excluding the desmoplastic and spindle cell types), 12 of which extended into Clark level IV or V. Of the 29 SNs, eight (28%) stained negatively; five (17%), including two deep SNs, stained in the epidermal component only; and 16 (55%), including 10 deep SNs, stained in both the epidermal and dermal components. Of the latter 10 deep SNs, eight stained in the upper dermis only, and in the remaining two lesions, a smaller number of positively stained nevus cells were detectable in the lower dermis as well; these two SNs were not atypical histologically. Of the 20 CNs, four (20%) stained negatively, two (10%) stained in the epidermal component only, and 14 (70%) stained in the epidermal component and the upper dermis only. Of the 22 MMs, one stained negatively, and 21 (95%) stained positively in both the epidermal and dermal components. The pattern was variable in frequency of both staining and distribution, but showed no stratification. We conclude that the majority of our positively stained deep compound SNs showed a stratified pattern of HMB-45 staining, similar to ordinary CNs and different from MMs, and that this pattern might be used as an adjunct in the histopathologic differential diagnosis of compound SN and MM, in the proper clinicopathological context.
Adolescent↗
Case study: deterioration, autism, and recovery in two siblings.
Two siblings whose functioning deteriorated in the second year of life met criteria for autism. They recovered after a form of behavior modification that was successful in a previous study. Follow-up of that study and of the siblings demonstrated that recovery was enduring. It is hypothesized that such therapy succeeds by modifying a still-plastic neural circuitry.
Autistic Disorder↗
Measurement of the reaction 12C( nu micro, micro-)X near threshold.
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Journal Article↗
Ovarian volume in postmenopausal women--suggestions to an ovarian size nomogram for menopausal age.
BACKGROUND: Transvaginal ultrasonography is an accurate and reliable technique for measuring ovarian size. However, there is no consensus as to the normal ovarian size in post-menopausal women. The purpose of this study was to establish normal values for ovarian volume in postmenopausal age. METHODS: A prospective study was undertaken, in which the ovaries of 311 healthy post-menopausal women were examined by transvaginal ultrasonography. Menopausal age ranged from one to more than 15 years. Three dimensions of each ovary were measured and ovarian volume of every menopausal year was calculated. RESULTS: Curvilinear relationships were found between ovarian volume and menopausal age. Ovarian volume (as plotted on the nomogram) shows a progessive decrease from 8.6 +/- 2.3 cm3 in the first menopausal year, to 2.2 +/- 1.4 cm3 after more than 15 years after the menopause. CONCLUSIONS: These data represent a comprehensive characterization of normal ovarian volumes related to postmenopausal age. These baseline values provide the data which will assist the physician to obtain the sonographic diagnosis of abnormal ovarian size, thus eventually establishing early diagnosis of ovarian tumors.
Aged↗
Transvaginal color flow imaging in the diagnosis of ovarian tumors.
Transvaginal ultrasonography and color flow imaging, performed to investigate whether there is any diagnostic advantage, were assessed over a 3 year period in 217 patients with adnexal masses prior to explorative laparotomy. Gray scale sonography and color Doppler flow were performed 1 day prior to surgery. Benign tumors were found in 165 patients and flow was detectable in 82 (49.7%); 14 patients had tumors of low malignant potential, 12 (85.7%) of whom showed detectable flow, and 38 had malignant tumors, in 25 (65.8%) of whom flow was detectable. Blood flow velocity was evaluated by the calculation of the resistance index prior to surgery. Mean resistive index was 0.39 +/- 0.05 for malignant tumors, compared with 0.49 +/- 0.06 and 0.55 +/- 0.07 for the low malignant potential and benign tumors, respectively. These differences were statistically significant (P < 0.01). When a resistive index of 0.47 was considered the cut-off value, the sensitivity was 88% and the specificity was calculated to be 85% (using color Doppler flow as the only diagnostic method). With our large cohort of patients, we demonstration the contribution of color Doppler flow examination in differentiating benign from malignant ovarian tumors prior to surgery.
Adolescent↗
International health training. The Tulane experience.
At the heart of imminent healthcare reform are the future physicians of this decade. Medical educators will want to stimulate a desire within students to practice humanitarian, cost-effective, community-oriented primary care. Further studies to examine the effects of medical student experiences in international electives should be encouraged.
Education, Medical↗
[Malignant mesothelioma in families of asbestos workers].
Malignant mesothelioma is primarily an occupational disease of asbestos workers. While there is usually a latent period of 20-40 years between exposure and appearance of the tumor, the duration of exposure may be as short as a single month. Rarely, it may appear in family members and others living with asbestos workers who might be exposed to asbestos from work clothes during laundering, or from fibers on the skin or hair of the asbestos worker. Attention should therefore be paid to those with nonoccupational contact with asbestos. We report 2 cases of pleural mesothelioma in families of asbestos workers. In both cases the laundering of work clothes was done at home. The first was a 33-year-old man; during his childhood his father worked with asbestos boards for 5 years. The second was a 76-year-old woman whose husband worked in an asbestos factory for 32 years, up to 18 years before diagnosis.
Adult↗
Prediction by a modified mixed leukocyte reaction assay of graft-versus-host disease and graft rejection after allogeneic bone marrow transplantation.
In this report we describe a modified, sensitive MLR test that appears to detect fine antigenic disparities between HLA-identical siblings confirmed as such by serology and the standard MLR test. In a group of 40 consecutive allogeneic bone marrow transplants, reactivity detected by the modified MLR test correlated with the development of rejection of matched marrow grafts and onset of acute graft vs. host disease (aGVHD). Thus, 13/15 positively reacting patient/donor pairs developed one of these complications (P < 0.001), while only 2/25 developed aGVHD in the negatively reacting group. This test may be useful for selecting the most compatible donor when several potential donors are available.
Acute Disease↗
Generic modelling of cooperative growth patterns in bacterial colonies.
Bacterial colonies must often cope with unfavourable environmental conditions. To do so, they have developed sophisticated modes of cooperative behaviour. It has been found that such behaviour can cause bacterial colonies to exhibit complex growth patterns similar to those observed during non-equilibrium growth processes in non-living systems; some of the qualitative features of the latter may be invoked to account for the complex patterns of bacterial growth. Here we show that a simple model of bacterial growth can reproduce the salient features of the observed growth patterns. The model incorporates random walkers, representing aggregates of bacteria, which move in response to gradients in nutrient concentration and communicate with each other by means of chemotactic 'feedback'. These simple features allow the colony to respond efficiently to adverse growth conditions, and generate self-organization over a wide range of length scales.
Bacteria↗
Vimentin immunoreactive glial cells in the fish optic nerve: implications for regeneration.
The poor regenerative ability of neurons of the central nervous system in mammals, as compared with their counterpart in fish or amphibians, is thought to stem from differences in their immediate nonneuronal environment and its response to axonal injury. We describe one aspect of the environmental response to axonal injury in a spontaneously regenerating system--the fish optic nerve. The aspect under investigation was the reaction of glial cells at the injury site. This was examined by the use of antibodies that specifically recognize vimentin in fish glial cells. In the present study, affinity-purified vimentin antibodies were raised against a nonconserved N-terminal 14-amino acid peptide, which was predicted from the nucleotide sequence of vimentin. These antibodies were found to react specifically with glial cells in vitro. Moreover, the antivimentin antibodies stained both the optic nerve and the optic tract, but with different patterns. Specificity of the antibodies was verified by protein immunoblotting, tissue distribution, and labeling patterns. After injury, vimentin immunoreactivity initially disappeared from the site of the lesion due to cell death. Early signs of glial cell migration toward the injury site were evident a few days later. It is suggested that the reappearance of vimentin-positive glial cells at the site of injury is associated with axonal elongation across it, and that they contribute to the regenerative ability of the fish optic nerve.
Amino Acid Sequence↗
Endometrial changes with tamoxifen: comparison between tamoxifen-treated and nontreated asymptomatic, postmenopausal breast cancer patients.
Endometrial thickness, as evaluated by vaginal ultrasonography, and endometrial histologic findings, as well as demographic characteristics, health habits, and risk factors for endometrial cancer, were compared between 93 asymptomatic postmenopausal breast cancer patients who had been on tamoxifen treatment and 20 patients who had not. The mean ultrasonographic endometrial thickness in the women on tamoxifen treatment was 13.1 +/- 10.4 mm, which was significantly thicker than the 4.0 +/- 3.2 mm found in the nontreated women (P = 0.001). The frequency of endometrial pathological findings was remarkably high (35.5%) among the tamoxifen-treated patients, compared with nontreated patients (20.0%), with a P value of 0.058 and an odd ratio of 4.6. Thus, it is suggested that the remarkably high prevalence of pathological endometrial changes was due to the continuous and unopposed exposure of the endometrium to tamoxifen.
Aged↗
Continuous tamoxifen treatment in asymptomatic, postmenopausal breast cancer patients does not cause aggravation of endometrial pathologies.
Adjuvant tamoxifen therapy for breast cancer patients has been found to be associated with various endometrial pathologic conditions, including endometrial cancer. This preliminary case control study evaluated whether prolonged and continuous exposure to tamoxifen in the menopause may aggravate existing endometrial pathologies. Two vaginal ultrasound evaluations of endometrial thickness and histologic findings of two endometrial biopsies, performed 18 months apart, were evaluated for 25 asymptomatic, postmenopausal breast cancer patients who were continuously treated with tamoxifen. In the first endometrial biopsy, 4 patients (16.0%) were found to have endometrial pathologies: 2 patients had proliferative endometrium, 1 had hyperplastic endometrium, and 1 had an endometrial polyp. In the second endometrial biopsy, none of these patients showed any endometrial pathologies. Another patient (4.0%) with no endometrial pathology in the first visit had endometrial hyperplasia in the second visit. None of the patients developed endometrial cancer, and generally there was no increase in ultrasonographically-measured endometrial widths. The results of this preliminary study may suggest that there is no increased risk of development of endometrial pathologies during an additional 18 months of continuous tamoxifen therapy nor is there aggravation of already existing endometrial pathologies.
Aged↗