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Biomedical subjects

J Harvey

Publications and source records attributed to J Harvey.

At least 289 records · Page 16Linked to original sources
PubMedDate not supplied

Simultaneous chemoradiation in advanced non-small cell lung cancer.

We designed our study to evaluate the safety and efficacy of simultaneous chemoradiation therapy in an accelerated, twice-a-day schedule to improve local control and survival in advanced lung cancer patients. Forty-one patients were entered into the study. Twenty-three had stage IIIB and 18 had stage IIIA disease. They received cisplatin 30 mg/m2, VP-16 80 mg/m2, and 5-Fluorouracil (5-FU) 900 mg/m2 in iv infusion. Radiation therapy consisted of 2G twice a day for 5 days, followed by a 2-week rest. This cycle was repeated 3 times. Patients were evaluated for surgical resection after the second cycle. Acute toxicity was acceptable: 3 patients expired (1 congestive heart failure, 1 sepsis, 1 pulmonary embolism). The 1-year actuarial survival was 60.3%; the 2-year actuarial survival was 55.3%. Our results show that this regimen is well tolerated and that the 2-year actuarial survival appears to be comparable to that reported in the literature.

Actuarial Analysis↗
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How accurate are faculty evaluations of clinical competence?

OBJECTIVE: To determine the degree and sources of variability faculty evaluations of residents for the American Board of Internal Medicine (ABIM) Clinical Evaluation Exercise (CEX). DESIGN: Videotaped simulated CEX containing programmed resident strengths and weaknesses shown to faculty evaluators, with responses elicited using the open-ended form recommended by the ABIM followed by detailed questionnaires. SETTING: University hospital. PARTICIPANTS: Thirty-two full-time faculty internists. INTERVENTION: After the open-ended form was completed and collected, faculty members rated the resident's performance on a five-point scale and rated the importance of various aspects of the history and physical examination for the patient shown. MEASUREMENTS AND MAIN RESULTS: Very few of the resident's strengths and weaknesses were mentioned on the open-ended form, although responses to specific questions revealed that faculty members actually had observed many errors and some strengths that they had failed to document. Faculty members also displayed wide variance in the global assessment of the resident: 50% rated him marginal, 25% failed him, and 25% rated him satisfactory. Only for performance areas not directly related to the patient's problems could substantial variability be explained by disagreement on standards. CONCLUSIONS: Faculty internists vary markedly in their observations of a resident and document little. To be useful for resident feedback and evaluation, exercises such as the CEX may need to use more specific and detailed forms to document strengths and weaknesses, and faculty evaluators probably need to be trained as observers.

Clinical Competence↗
PubMedDate not supplied

The risk of contralateral lymphatic metastases for cancers of the larynx and pharynx.

PURPOSE: This study was undertaken to determine the risk of cervical metastases to the contralateral side in patients treated for carcinoma of the larynx and pharynx. PATIENTS AND METHOD: Retrospective evaluation of 846 patients treated between 1962 and 1981 with carcinoma of the supraglottis, transglottis, and pyriform sinus were reviewed. Lesions were classified as either transglottic with fixed vocal cord (TG-F), transglottic with mobile vocal cords (TG-M), central supraglottic (SG-C), marginal supraglottic (SG-M), glossoepiglottic cancers of the suprahyoid epiglottic, vallecula, and tongue base (SG-GE), and cancers of the pyriform sinus (PS). RESULTS: Contralateral lymph node metastases were identified at presentation or later developed in SG-GE 26%, SG-M 14%, PS 13%, SG-C 7%, TG 4%. Contralateral metastases were significantly higher in patients with ipsilateral metastasis. The risk of contralateral metastasis was unrelated to the primary tumor size. CONCLUSIONS: All but 79 patients received variable doses of irradiation to the contralateral neck. Therefore, the risk of metastatic disease is probably higher than reported. Parotid-sparing radiation technique is suggested for centrally located cancers of the supraglottis and transglottis when ipsilateral nodes are not involved because the risk of contralateral neck involvement is sufficiently low that opposite neck irradiation may be safely avoided.

Dose-Response Relationship, Radiation↗
PubMedDate not supplied

Technetium-99-labeled leukocytes in diagnosing diabetic osteomyelitis in the foot.

Hexamethylpropylamineoxine (HMPAO)-labeled leukocytes were studied to examine the scintigraphic significance of the procedure in diagnosing bone infection in patients with chronic nonhealing foot ulcerations. Fifty-two patients were scanned with Technetium-99-labeled white blood cells and scintigraphic results were compared with histological analysis, bone culture, and radiographic findings. Twenty-one patients demonstrated positive uptake with imaging and focal accumulation of leukocytes at the area of suspected infection. Sensitivity, specificity, and accuracy were calculated and found to be 86%, 90%, and 88%, respectively. Thirty-one members of the population were also scanned with Tc-99 methylene diphosphate (MDP) triphasic scintigraphy. Sensitivity equaled 91% and specificity was found to be significantly lower (40%) when compared with the leukocyte-labeled scans. Technetium-99 (HMPAO) leukocyte scintigraphs demonstrated a significantly higher specificity and accuracy rate when compared with Technetium-99 (MDP) triphasic scans.

Aged↗
PubMedDate not supplied

The effect of seminal plasma on macrophage function--a possible contributory factor in sexually transmitted disease.

The present studies confirm that small doses of human seminal plasma inhibit mitogen induced lymphocyte transformation and experiments in a murine model suggest this effect may be mediated through accessory macrophages. They also reveal that seminal plasma interferes with the attachment, spreading and phagocytic activity of C. parvum elicited murine peritoneal macrophages and the release of reactive oxygen species from zymosan triggered human peripheral blood monocytes and neutrophils. As macrophages are known to programme various aspects of the immune response our results may be relevant to the acquired immune deficiency syndrome (AIDS), the genesis of antisperm antibodies and the response to prostatic and cervical cancer.

Acquired Immunodeficiency Syndrome↗
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Serum agglutinating and immobilising sperm antibodies in men attending a sexually transmitted diseases clinic.

The tray slide agglutination test (TAT) and micro immobilisation test (MIT) to detect antisperm antibodies were carried out on serum samples from 217 men attending a clinic for sexually transmitted diseases (STD), 151 fertile men requesting vasectomy and 645 men with a marriage with primary infertility. There was no difference in results between the fertile men and the men attending the clinic for sexually transmitted diseases although both sets of results differ from those of the infertile men. These results make it unlikely that venereal disease will trigger antisperm antibody production.

Autoantibodies↗
PubMedDate not supplied

Complete ligation of extrahepatic congenital portosystemic shunts in nonencephalopathic dogs.

OBJECTIVE: To evaluate lack of encephalopathy as a positive prognostic factor for complete ligation of extrahepatic congenital portosystemic shunts in dogs. STUDY DESIGN: Retrospective analysis of case records. ANIMALS: Dogs with extrahepatic congenital portosystemic shunts treated at the Veterinary Medical Teaching Hospital of the College of Veterinary Medicine, Cornell University, from 1985 to 1996. METHODS: The ability to completely ligate the shunting vessel in 12 nonencephalopathic dogs was compared with that in 44 encephalopathic dogs with similar shunts. RESULTS: Clinical signs in the 12 nonencephalopathic dogs were related to ammonium biurate urolithiasis. All 12 dogs had single extrahepatic shunting vessels. The rate of complete ligation in the nonencephalopathic dogs was 92%, whereas the rate of complete ligation in the 44 encephalopathic dogs with single extrahepatic shunts was 59%. The ability to completely ligate the shunt in nonencephalopathic dogs was significantly better (P = .04) than in the encephalopathic dogs. CONCLUSION: Lack of encephalopathy is a positive prognostic factor for complete ligation of single extrahepatic congenital portosystemic shunts. CLINICAL RELEVANCE: In most affected dogs, extrahepatic congenital portosystemic shunts in nonencephalopathic dogs can be completely ligated.

Animals↗
PubMedDate not supplied

Evaluation of an Australian miscarriage support programme.

Miscarriage is a frequent and distressing event for women who often require admission to a gynaecology unit for the evacuation of the products of conception. Most women are admitted for day surgery or an overnight stay. The short time frame limits the time nursing staff have to provide support and information for women who have experienced loss through miscarriage. This article presents the qualitative evaluation of a telephone follow-up service provided as part of the Miscarriage Support Programme of Care conducted by staff of the gynaecology inpatient services in an Australian public hospital. The data from this evaluation indicate that miscarriage does have a varying degree of impact on a woman's inpatient experience and emotional recovery. The primary themes of emotional recovery, support after discharge, inpatient experience of care, and usefulness of the literature given to women before discharge, will guide the ongoing development of support and discharge planning by staff of gynaecology inpatient services for women who have experienced miscarriage.

Abortion, Spontaneous↗