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Biomedical subjects

J D Beck

Publications and source records attributed to J D Beck.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

[Ultrasound study of congenital mesoblastic nephroma].

The mesoblastic nephroma is the most common renal tumor among newborn and young infants. The tumor is benign, and metastatic growth has only been described in individual cases. Three patients suffering from histologically proven mesoblastic nephroma were examined with an ultrasonic device. Sonographically, the mesoblastic nephroma is manifest as solid and homogeneous tumor of a fine to medium coarse basic texture and of a medium echogenity which may show individual small cystic areas. The tumor cannot be delimited sharply from the healthy renal tissue although uneventful tissue which often caps the kidney is proved. A secure differential diagnosis against a Wilms' tumor is not possible if metastases cannot be detected sonographically or by means of an excretory urogram. The echopattern and the relation of the mesoblastic nephroma to the kidney in combination with an excretory urogram should, however, make the delimitation of a neuroblastoma possible.

Female↗
PubMedDate not supplied

[Prognosis, treatment completion, and complications in nonresponders in the study AML-BFM87].

BACKGROUND: Nonresponders (NR) are patients (pts.) with no or insufficient response to initial treatment, which may be caused by either initial risk factors or poor therapy realization. In study AML-BFM 87, 49 NR of 307 patients (16%) did not achieve remission until the end of intensive chemotherapy and were analysed to assess the specific contribution of prognostic factors, therapy realization and complications of therapy. THERAPY AND METHODS: Therapy started with an 8-day induction therapy followed by a 6-week consolidation and two 5-day intensification blocks with high-dose cytosine-arabinoside and VP-16. Maintenance therapy was given for a total duration of 1.5 years. To evaluate the impact of treatment intensity in NR, we compared the dose compliance (DC = dose given/intended dose), the dose intensity (DI = dose per time given), the treatment results, and toxicity of the individual therapy phases in responders (CR) and NR. RESULTS: In 19 of 49 NR therapy was stopped before starting intensification blocks. Twenty-six NR received at least one block of intensification, and seven patients between three and six intensification blocks. Six children entered maintenance therapy. Twelve patients received a bone marrow transplant (9 allogeneic, 3 autologous). Six (5 after bone marrow transplantation) of 49 NR are still alive for 64 to 108 months. In nearly all patients induction therapy could be applied according to protocol (mean DC: 98%, range 85%-100%), whereas therapy realization was more difficult in the 2nd phase of therapy (mean DC: 92%, range 12%-113%). Deviations from the protocol in the treatment blocks (changes of dose and/or schedule) were mainly attributable to persistence of blasts (n = 33) and septic complications (n = 24). The mean relative DI of 1.01 was according to protocol. Bleeding and infectious complications in the individual therapy phases varied from 7% to 61%. NR compared to CR patients suffered significantly more often from bleeding during the first and second part of consolidation and from infections during the second part of consolidation. Withdrawal from protocol in NR was mainly due to persistence of blasts (n = 16), followed by bone marrow transplantation or other therapies (n = 13), and sepsis (n = 11). CONCLUSIONS: It is difficult to discriminate between nonresponse associated with blast persistence followed by complications and subsequent discontinuation of therapy and nonresponse due to insufficient therapy in patients with complications. Our analyses revealed that therapy with 2 intensifications according to protocol was feasible in 13 NR. Patients' condition permitting, therapy should not be stopped prematurely, in order to sustain the option of BMT after blast cell reduction.

Acute Disease↗
PubMedDate not supplied

[Late sequelae of CNS recurrence of acute lymphoblastic leukemia in childhood].

Study objective was to evaluate retrospectively central nervous system (CNS) morbidity of children with acute lymphoblastic leukemia treated with intensive chemotherapy and cranial radiotherapy for a first isolated or combined CNS relapse. Neurological (Touwen), neuropsychological (CFT 20, Wechsler scales, d2 attention test) and neuromorphological (CT, MRI) assessments were performed in 17 children (9 girls, 8 boys) aged between 7 and 14 years. Patients were off therapy for median 4 years; cranial radiotherapy for CNS relapse (12-24 Gy) was given to all patients 2 to 9 years ago (median 5.5 years). Ten patients had received preventive cranial radiotherapy during front-line treatment, previously. In this group, the cumulative radiation dose ranged between 30 and 39 Gy. Patients received 12 to 30 intrathecal methotrexate doses (median 22). Compared with normative levels for age (100 points) performance IQ (89.9) and full scale IQ (92.0), Culture Fair IQ (88.3) and attention and concentration (90.9) were significantly impaired. Verbal IQ (95.5) was not significantly different from normal expectations. Neurological investigations of 16 patients showed mild signs in 7 (44%) of them, mostly of fine-motor skills and coordination, but no major motor disability. In MRI and CT, white matter changes or ventricular enlargement were noted in 10 of 16 patients (63%). Parent-completed questionnaires indicated problem behaviors in 5 children. Cumulative doses of methotrexate correlated significantly with neuropsychological test results. Children irradiated twice as well as girls had poorer cognitive functions, not being statistically significant. Despite pathological test results, all children attended a normal school and did not exhibit obvious impairment in daily life. In conclusion, CNS relapse and attendant therapy, mostly consisting of a second course of cranial radiotherapy, caused measurable intellectual deficits and CNS morbidity, which did not result in severely impaired performance. Periodic psychological und clinical examinations are recommended for recognition of delayed morbiditiy and early intervention.

Adolescent↗
PubMedDate not supplied

[Endocrinologic after-care of brain tumor patients: initial retrospective analysis of HIT-study documented auxologic and endocrine parameters].

BACKGROUND: In 1987, a pilot trial (HIT 88/89) was initiated by GPOH to investigate the effectivity and toxicity of intense preradiation chemotherapy. The aim of this study was to improve the treatment of children with malignant brain tumors, but provided no standardized recording of auxological and/or endocrinological parameters. In 1993 a sub-project, "Endocrinological late effects", was started during the ongoing study to examine the late effects of treatment, and a retrospective evaluation was performed in order to standardize parameters. PATIENTS: We considered auxological and hormonal data from those patients (n = 133; 78 m, 55 f) who were alive at the time of the survey, and had completed tumor therapy. RESULTS: Analysis of the growth pattern of the children after the end of therapy indicate impaired growth. Group 1 (n = 77, CA < 10 yrs): Mean height SDS at tumor diagnosis was +0.32 (n = 77), and fell constantly after completion of therapy to -0.75 (n = 16) after 3-4.5 yrs. Group 2 (n = 56, CA > 10 yr): Height SDS-CA fell from +0.24 (n = 45) at the time of diagnosis to -0.62 (n = 14) after 3-4.5 yrs. Unfortunately, only body height and weight were recorded regularly, data on sitting height, pubertal stage and bone age were incomplete. Endocrine evaluation after end of therapy was insufficient. CONCLUSIONS: A standardization of endocrinological follow up is necessary as soon as possible, for an adequate description of the endocrinological late effects.

Adolescent↗
PubMedDate not supplied

[After-care of children and young adults surviving cancer. Initial recommendations by the late sequelae study group].

An increasing number of children suffering from cancer has been treated successfully during the last 25 years using therapy protocols of the Gesellschaft für Pädiatrische Onkologie und Hämatologie. The patients had to undergo an interdisciplinary treatment modality and a mostly intensive chemotherapy. Late effects could result from this approach for the now 20,000 survivors in the Federal Republik of Germany. The executive committee of the GPOH founded a working group for the detection of late effects stretching over all therapy studies. The first report of this group describes a spectrum of relevant late effects and proposes investigations for their detection.

Adolescent↗
PubMedDate not supplied

Dental service use by older people living in long-term care facilities.

Since 1980, a mobile program has delivered dental care to 14 different long-term care facilities that care for frail and functionally dependent older persons. These facilities lie within a 60-mile radius of the University of Iowa College of Dentistry. This paper reports comparisons between characteristics of users versus nonusers of dental care in the program. Of the 853 residents in the long-term care facility who were screened, it was determined that 66% would benefit from some type of dental care. When the residents and their families were approached for treatment permission, 48% of those recommended permitted treatment; treatment was completed on 38% of those persons recommended for treatment. No differences were observed in the distribution or diagnoses of major medical problems for the users versus nonusers of care. Recommended treatment was similar for users and nonusers in nursing homes. The majority of nonusers refused treatment because they or their families did not perceive a need for dental care.

Aged↗
PubMedDate not supplied

Clinical decision making in evaluating patients: a process study.

A volunteer patient was examined by five dentists experienced in caring for geriatric patients. The patient and dentist interaction was videotaped and reviewed to evaluate a previously generated hypothesis regarding the diagnosis process. This descriptive study suggests that dentists experienced in geriatric care did assess and evaluate a wide range of patient characteristics. However, they did not follow the previously hypothesized process in arriving at an appropriate treatment plan. Instead, they relied heavily on past experiences with similar situations. The possible implications of this process for treatment planning and teaching of geriatric dentistry are discussed.

Aged↗
PubMedDate not supplied

The accuracy of oral self-perceptions in a dentate older population.

A random sample of 1,016 subjects aged 65 and older were interviewed and examined in their own homes. The sample was stratified by race and place of residence. As part of the interview, the 821 dentate subjects were asked to rate their mouth appearance, chewing ability, and mouth health. Most subjects responded positively to these questions. The self-perception of mouth health was most related to the presence of anterior teeth. Perception of chewing ability was most related to the number of anterior teeth present, total number of teeth present, and the need for extractions. Subjects also were asked about their perceived dental needs. A small proportion of subjects thought they needed restorations, periodontal treatment, or teeth replacement. Subjects generally were not able to define the extent of their treatment needs, but their self-perceptions of mouth appearance, chewing ability, and mouth health had some relationship to their oral health.

Aged↗
PubMedDate not supplied

Streptococcus mutans, lactobacilli, and caries experience in older adults.

This study investigated salivary levels of Streptococcus mutans, lactobacilli, and caries experience in a random sample of 448 black and 362 white older dentate adults living in North Carolina. Significant proportions of the participants had stimulated salivary flow rates less than 1.0 mL/min, salivary buffering capacity less than 4.0, S. mutans levels of 10(5) cfu/mL or more in stimulated whole saliva, or lactobacilli levels of 10(5) cfu/mL or more. Each of these factor levels could be considered, on a clinical basis, to increase caries risk. In general, people with higher levels of S. mutans or lactobacilli had more untreated coronal and root caries, but not greater total caries experience.

Aged↗
PubMedDate not supplied

Use of medications with potential oral adverse drug reactions in community-dwelling elderly.

Prevalence and indicators of medication use with potential oral health implications among 4,163 people from the Duke Established Populations for Epidemiologic Studies of the Elderly were studied. Medications were grouped into seven potential oral adverse drug reaction (POADR) categories. Eighty percent of participants were taking at least one medication from any of the seven categories. Drugs with the potential to cause xerostomia were taken by 56.1%, abnormal hemostasis by 51.7%, soft tissue reactions by 23.4%, taste changes by 11.0%, alteration in host resistance by 8.7%, gingival overgrowth by 5.0%, and movement disorders by 2.4% of participants. Race-stratified analyses revealed that medication use with any POADR was significantly associated (p < 0.001) with being female for both races. Among nonblacks, being > or = 75 years old was associated with higher POADR use. Blacks who had a dental visit in the previous six months were more likely to take medications with POADR than those who did not. POADR medication use was not related to place of residence. Elderly often take medications with potential oral health impact.

Black or African American↗
PubMedDate not supplied

[Ocular findings in leukemia in childhood].

A 6 1/2 years old boy got completely blind within 3 days. Ophthalmoscopically regular findings suggested a retrobulbar opticus infiltration in a pediatric-diagnosed acute myeloic leukemia FAB-M2. A quick diagnosis and prompt cytostatic therapy combined with irradiation of the retrobulbar space opened the way for complete remission with bilateral optic atrophy. The ophthalmoscopic examination of 12 other leukemic children showed once more the involvement of the central nervous system with bilateral papilloedema, 2 times retinal hemorrhages and one vitreous bleeding; 8 children had no ocular symptoms. Comparing these findings to those described in literature, the authors point out the value of ophthalmoscopy to exclude ophthalmologic damages and to avoid side-effects of cytostatic therapy, fortunately not observed till now.

Adolescent↗
PubMedDate not supplied

The use of pit and fissure sealants in private dental practices.

Ninety percent of a stratified sample of 240 general dentists and thirty-two pedodontists in fulltime private practice in Iowa responded to a questionnaire about the use of sealants, attitudes and knowledge about sealants, and reasons for not using sealants. Approximately a third of the generalists and a half of the pedodontists use sealants regularly. Many negative attitudes about sealants were found, as well as a large degree of misinformation about them. Most dentists not using sealants thought that they did not last long or that amalgam restorations were more economical.

Attitude of Health Personnel↗