Localization in rats of genetic loci regulating susceptibility to experimental erosive arthritis and related autoimmune diseases.
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Animals↗
Biomedical subjects
J Hoffman
Publications and source records attributed to J Hoffman.
Emergency department evaluation and treatment of the shoulder and humerus.
The shoulder girdle is a versatile anatomic structure with a wide range of mobility and function. Its soft tissue and skeletal components are subject to a variety of injuries spanning from overuse syndromes to acute trauma. This article reviews the key historical and physical examination techniques of the shoulder, and special attention is paid to proper imaging in the emergency department, which aids in the diagnosis of specific disorders. This article also reviews the various therapeutic options, including surgery.
Bursitis↗
Role of FDG-PET in the Pre-Operative Evaluation of Surgical Resection of Hepatic Metastases from Colorectal Cancer.
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Journal Article↗
Biological markers of risk in nipple aspirate fluid are associated with residual cancer and tumour size.
We previously demonstrated that nipple aspirate fluid (NAF) can be obtained from virtually all non-Asian women between the ages of 30 and 72. The focus of this report is to (1) determine the association of candidate markers of breast cancer risk in NAF obtained from fresh mastectomy specimens with residual breast carcinoma, and (2) evaluate the association of the markers with breast tumour progression. Nipple aspiration was performed on 97 specimens. Cytology, DNA index (including % hypertetraploid cells), cell cycle parameters (S phase fraction, % cells in G2/M), prostate-specific antigen (PSA), epidermal growth factor (EGF), testosterone, carcinoembryonic antigen (CEA) and prostaglandin D synthase (PGDS) were evaluated in NAF for their association with (1) residual ductal carcinoma in situ (DCIS) or invasive cancer, and (2) pathologic tumour size. NAF was obtained from 99% (96/97) of specimens. Atypical and malignant NAF cytology were significantly associated with residual DCIS or invasive cancer (P = 0.001) and with larger tumours (P = 0.004). One hundred per cent and 88% of subjects with malignant and atypical NAF cytology, respectively, had residual carcinoma. The percentage of cells in G2/M and DNA index were associated both with risk of residual carcinoma (P = 0.01 for each) and larger tumour size (DNA index, P = 0.03; G2/M, P = 0.05), although neither biomarker improved the ability of NAF cytology, to predict residual breast cancer. Higher DNA index was associated with atypical cytology (P = 0.0001). In summary, atypical and malignant NAF cytology are associated with larger tumour size, and are highly predictive of residual carcinoma after needle or excisional biopsy of the breast.
Adult↗
Ranitidine bismuth citrate, tetracycline, clarithromycin twice-a-day triple therapy for clarithromycin susceptible Helicobacter pylori infection.
BACKGROUND: Although many combination therapies have been proposed, there is still interest in identifying simple, inexpensive, effective protocols that have high rates of success. AIM: To investigate the role of the new soluble form of bismuth, ranitidine bismuth citrate, in twice-a-day therapy for Helicobacter pylori infection. METHODS: Patients with histologically and culture proven H. pylori infection received ranitidine bismuth citrate 400 mg, tetracycline HCl 500 mg, and clarithromycin 500 mg, each b.d. for 14 days, followed by 300 mg ranitidine once a day for 4 additional weeks. Outcome was assessed 4 or more weeks after the end of antimicrobial therapy by repeat endoscopy with histology and culture (49 patients) or urea breath testing (14 patients). RESULTS: Sixty-three patients completed the therapy, 59 men and four women (average age 56.7 years; range 31-75 years). All patients had clarithromycin-susceptible strains prior to therapy. H. pylori infection was cured in 94% (95% CI: 85-98%). There was a therapy failure in one patient who took the medicine for only 1 day and stopped because of side-effects. Three of the isolates from treatment failures were available post-failure; two were clarithromycin-resistant and one was susceptible. Side-effects were severe in two patients (3%) and moderate in three (primarily diarrhoea). CONCLUSIONS: Twice-a-day ranitidine bismuth citrate, tetracycline, clarithromycin triple therapy was well tolerated and effective for the treatment of H. pylori infection in patients with clarithromycin-susceptible H. pylori.
Adult↗
Cushing's syndrome in pregnancy due to an adrenocorticotropin secreting islet cell tumour.
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Journal Article↗
Rural hospitals and the local economy: a needed extension and refinement of existing empirical research.
The relationship between the health care sector and the rural economy is of increasing importance. Much additional research is needed to fully understand this relationship and to address some of the limitations of the modest amount of research that already exists. In this study, data from Nebraska were used to create a four-part typology of rural hospitals. Input-output analysis was used to assess the economic effects of each type of hospital on the local economy and to simulate the effects of three different changes or scenarios: an increase or decrease in hospital utilization; the elimination of local purchases of nonlabor inputs; and a change in the mix or configuration of services provided. While the hospital is an important contributor to local economies, this contribution is not constant across hospital types. The total job-related effects ranged from 77 jobs for the smallest type of rural hospital to 1,332 for the largest type. Service and trade (retail plus wholesale) are the two sectors of the local economy most heavily influenced by the presence of a hospital. In today's changing and challenging environment, there is a great need for researchers to create and evaluate the economic effects of a variety of relevant and realistic scenarios (other than hospital closure).
Community-Institutional Relations↗
Postmenopausal hormone replacement therapy: effect on diagnosis and outcome in early-stage invasive breast cancer treated with conservative surgery and radiation.
PURPOSE: To compare the pretreatment characteristics and outcome of postmenopausal women with stage I-II breast cancer treated with conservative surgery and radiation who had a history of hormone replacement therapy (HRT) with those who had never received HRT. MATERIALS AND METHODS: From 1979 to 1993, 485 postmenopausal women underwent excisional biopsy, axillary dissection, and radiation for stage I-II breast cancer. The median follow-up was 5.9 years. One hundred forty-one patients reported a history of HRT. The median length of use was 5 years. Three hundred forty-four patients reported no history of HRT. RESULTS: Statistically significant differences between the two groups were observed for median age (HRT 60 years v no HRT 64 years; P =.0009), median weight (HRT 142 lbs v no HRT 152 lbs; P =.004), clinical tumor size < or = 2 cm (HRT 77% v no HRT 66%; P =.02), and the use of re-excision (HRT 62% v no HRT 49%; P =.01). The method of detection by mammogram only (HRT 52% v no HRT 42%; P =.06) was of borderline statistical significance. The HRT patients had a statistically significant increased cumulative incidence of ipsilateral breast tumor recurrence (8% v 2%; P =.02), a statistically significant decreased cumulative incidence of distant metastases (HRT 6% v no HRT 17%; P =.01), and a borderline statistically significant improvement in cause-specific survival at 10 years (HRT 92% v no HRT 86%; P =.07). Postmenopausal women with a history of HRT did not have an increased risk of contralateral breast cancer or second non-breast cancer malignancy. CONCLUSION: This study failed to identify an adverse effect of HRT on breast cancer mortality in patients with stage I-II disease treated with conservative surgery and radiation.
Adult↗
Varicella complicated by group A streptococcal sepsis and osteonecrosis.
A 5-year-old boy presented with primary varicella zoster virus infection, group A streptococcal sepsis, toxic shock, and multisite osteonecrosis. An association between osteonecrosis and group A streptococcal sepsis has not been previously reported. Clinical recognition with supportive radiologic and pathologic findings are presented. Therapeutic guidelines are suggested.
Bacteremia↗
Prognostic value of CA 19-9 levels in patients with carcinoma of the pancreas treated with radiotherapy.
PURPOSE: CA 19-9 has been identified as a tumor marker for pancreatic carcinoma and has been shown to have some utility in predicting outcome in surgically treated patients. The purpose of this study was to evaluate its usefulness as a prognostic indicator in patients treated with radiotherapy. MATERIALS AND METHODS: A retrospective review of all patients treated with radiotherapy of definitive intent (n = 104) for carcinoma of the pancreas at Fox Chase Cancer Center from 1980-1994 was undertaken. Patients were categorized into four groups: Planned preoperative radiation with resection (n = 25); planned preoperative radiation without successful resection (n = 35); postoperative radiation (n = 21); and radiation without planned resection (n = 23). For each group, except those treated without planned resection, median dose for external beam radiotherapy was 50.4 Gy (range = 21.6-63.0 Gy). Those in the remaining fourth group were treated with a median dose of 55.8 Gy (range = 36.0-60.4 Gy). 97% of patients in the first three groups were also treated with 5-FU-based chemotherapy, as were 61% of those in the fourth group. Pretreatment and follow-up CA 19-9 levels were available for 69 patients. RESULTS: Median survival time for all groups was 10 months (range = 1-67 months). Univariate analysis showed significant differences in survival among the groups: Preop with resection 22 months; preop without resection 10 months, postop 17 months; and without planned resection 12 months (p = 0.0005). Overall, patients who underwent resection had a median survival time of 19 months, compared to 11 months in those who did not (p = 0.0006). CA 19-9 level at diagnosis was found to be a significant prognostic indicator on univariate analysis, with a median survival time of 8 months in those having a level greater than the median of 680 U/ml, compared to 20 months in those who did not (p = 0.0003). Similarly, the posttreatment nadir was significant, with a median survival time of 11 months in those with levels above the median of 162.5 U/ml, vs. 26 months in those with levels below 162.5 U/ml (p = 0.001). The median survival time for patients whose CA 19-9 levels decreased in response to treatment by more than 75% was 23 months (range = 6-34 months) vs. 8 months (range = 3-21) in those with 75% or less response (p = 0.003). On stepwise multivariate analysis, pretreatment CA 19-9 level was found to be a significant predictor of survival (p = 0.005). Other potential indicators of outcome, including age, gender, KPS, prediagnosis weight loss, location of tumor, clinical TNM staging, size of lesion, vascular involvement on angiography, and sequence of radiation with respect to resection, were evaluated and were not found to be significant. CONCLUSION: CA 19-9 was demonstrated to be a useful prognostic indicator in patients treated with radiotherapy; other, more traditional, indicators of outcome were of less utility.
Aged↗
Treatment systems guidelines for primary rectal cancer from the 1996 Patterns of Care Study.
PURPOSE: The Patterns of Care Rectal Cancer Committee was formed to develop consensus recommendations for patients with adenocarcinoma of the rectum limited to the pelvis. METHODS AND MATERIALS: The Committee was composed of a multidisciplinary group of oncologists, and clinical scenarios were chosen to address most of the major treatment controversies in the combined modality treatment of rectal cancer. A literature search was then conducted and the major articles were identified. A modified Delphi technique was used to arrive at consensus. Serial surveys were conducted by distributing questionnaires to the Committee members to consolidate expert opinion. Voting was conducted using a scoring system and opinions were unified to the highest degree possible. RESULTS: Consensus voting was performed for 4 clinical scenarios. Acceptability ratings for treatment were grouped into 3 broad categories: not acceptable, acceptable, and most acceptable. Based on the treatment options, a decision tree was developed that reflects the consensus of the committee. CONCLUSION: These options may help guide treatment decisions in rectal cancer.
Adenocarcinoma↗
Clinical utility of the MMPI-A content scales and Harris-Lingoes subscales in the assessment of suicidal risk factors in psychiatric adolescents.
This study of 143 inpatient adolescents (68 boys and 75 girls) investigated the clinical utility of the MMPI-A in assessing suicidal risk factors by examining the unique contribution of the content scales and Harris-Lingoes subscales beyond what is provided by the basic clinical scales. The results of the regression analyses indicated that for boys, the Depression, Psychopathic Deviate and Hypomania scales; Alienation and Anxiety content scales: and Subjective Depression. Self Alienation, Imperturbability, and Amorality Harris-Lingoes subscales contributed significantly to the prediction of suicide probability. For girls, the Depression, Psychopathic Deviate, and Hypomania scales; Family Problems, Conduct Problems, School Problems, Depression, and Social Discomfort content scales; and the Subjective Depression, Self Alienation, Psychomotor Acceleration, and Imperturbability Harris-Lingoes subscales contributed significantly to the prediction of suicide probability.
Adolescent↗
Intraoperative ultrasound does not improve detection of liver metastases in resectable pancreatic cancer.
BACKGROUND: In colorectal cancer, intraoperative ultrasound (IOUS) is superior to other imaging studies in characterizing hepatic metastases. The value of IOUS in detecting liver metastases from pancreatic cancer has not been evaluated previously. METHODS: Between 1990 and 1995, IOUS was prospectively employed to evaluate the liver for metastases in 32 patients with resectable pancreatic adenocarcinoma. Preoperatively, all patients had computed tomography (CT) and 22 patients had CT portography. RESULTS: At exploration, 5 of the 32 patients (15%) had extrapancreatic disease, 3 (9%) with liver implants. IOUS did not identify any additional hepatic metastases. Four preoperative studies were suspicious for metastatic disease in the liver. In these 4 patients, no hepatic metastases were identified by exploration or intraoperative ultrasound. CONCLUSIONS: We no longer routinely perform hepatic IOUS when evaluating patients with pancreatic adenocarcinoma for pancreaticoduodenectomy. When a preoperative study indicates possible hepatic involvement, IOUS can confirm the presence or absence of liver metastases.
Adenocarcinoma↗
Radiation therapy for rectosigmoid and rectal cancer: results of the 1992-1994 Patterns of Care process survey.
PURPOSE: To determine the US national practice standards for patients with adenocarcinoma of the rectum treated in radiation oncology facilities. MATERIALS AND METHODS: A national survey of 57 institutions identified 507 eligible patients who received radiation therapy as a component of their treatment for rectal cancer. A stratified two-stage cluster sampling with simple random sampling at each stage for each stratum was used and on-site surveys were performed. RESULTS: Of the 507 patients, 378 (75%) received postoperative therapy, 110 (22%) received preoperative therapy, 17 (2%) received both preoperative and postoperative therapy, and less than 0.5% received intraoperative radiation alone. To more accurately assess the utilization of modern radiation techniques as well as recommendations of the National Cancer Institute (NCI)-sponsored, randomized, postoperative, adjuvant combined modality therapy rectal cancer trials into current practice, the analysis was limited to the 243 (48%) patients with tumor, node, and metastasis staging system classification T3 and/or N1-2M0 disease who underwent conventional surgery with negative margins. Although only 7% were treated on a clinical trial, 90% received chemotherapy for a median of 21 weeks. Most were treated with modern radiation treatment techniques. In contrast, techniques to identify and help exclude the small bowel from the radiation field were not routinely used. CONCLUSION: Despite the fact that only 7% of patients with T3 and/or N1-2M0 disease were treated on a clinical trial, such trials appear to have resulted in a positive influence on the standard of practice within the oncology community. Although there are still some deficiencies, the majority of these patients received combined modality therapy and were treated with modern radiation therapy techniques.
Adenocarcinoma↗
Music therapy and home care.
As home care looks to alternative programs to serve the community and generate income, one service that is beginning to attract more attention is music therapy. As a means to relaxation and healing, this therapy can help patients heal from within and even strengthens the immune system.
Home Care Services↗
Examination of changes in interpersonal stress as a factor in disease exacerbations among women with rheumatoid arthritis.
OBJECTIVE: This study examined the effects of change in interpersonal stress on disease activity among 41 women with rheumatoid arthritis (RA). METHODS: Measures of everyday stressful events and perceived stress were collected weekly for twelve weeks and related to disease activity in a series of pooled time-series regression analyses. RESULTS: Increases in the number of interpersonal stressors in the same week and one week prior were associated with increases in disease activity. Pain from joint tenderness also was significantly related to a decrease in stressful events one week later. A subgroup of 20 patients showed a significant increase in interpersonal stress from baseline during the course of the study. For this group, significant elevations in DR + CD3 cells, sIL-2R, clinician's rating of disease, and self-reports of joint tenderness were found during the week of increased interpersonal stress. CONCLUSIONS: Interpersonal stress appears to be associated with increases in disease activity among RA patients.
Adult↗
Safety and efficacy of flumazenil in the reversal of benzodiazepine-induced conscious sedation. The Flumazenil Pediatric Study Group.
OBJECTIVE: To determine the safety and efficacy of flumazenil when given for reversal of benzodiazepine-induced conscious sedation in children. DESIGN: Multicenter study conducted in emergency departments and pediatric endoscopy, bronchoscopy, or oncology suites. PATIENTS: One hundred seven children (median age, 6 years; range, 1 to 17 years) who received intravenous benzodiazepine for an invasive procedure. INTERVENTIONS: Flumazenil was given in increments of 0.01 mg/kg (0.2 mg maximum) at 1-minute intervals to a maximum total dose of 0.05 mg/kg (1.0 mg maximum). MEASUREMENTS: Clinical efficacy was assessed by the Clinical Global Impression Scale and Observer's Assessment of Alertness/Sedation Scale. The OAA/S, vital signs, lead II electrocardiogram, and clinical assessments were recorded at 0, 10, 30, 60, 90, and 120 minutes after flumazenil was given. RESULTS: All children received midazolam (mean total dose, 0.18 mg/kg) for sedation. One hundred (96%) patients achieved a complete or partial response to flumazenil by 10 minutes after its administration, on the basis of their CGIS scores (the mean dose of flumazenil administered at the time of the first complete response was 0.017 +/- 0.010 mg/kg). Seventy-one of 93 (76%) patients with a baseline OAA/S score < or = 3 (1 = deep sleep, 5 = alert) experienced an increase of > or = 2 points at 10 minutes after flumazenil administration, and 81 of 93 (87%) had a score of 4 or 5 after flumazenil administration. Seven patients, all within the 1- to 5-year age range, experienced resedation after initially responding to flumazenil. Thirty-seven of 107 patients (35%) experienced a total of 56 adverse events, most of which were considered to be unrelated to flumazenil administration. The most frequently occurring adverse events were abnormal crying, dizziness, nausea, fever, and headache. There were no clinically significant changes in vital signs or ECG tracings. No adverse events resulted in premature termination of drug administration. CONCLUSIONS: Flumazenil promptly and effectively reverses the central nervous system depressant effects of midazolam in children undergoing conscious sedation, with no significant adverse effects. Because of the potential for resedation, children who receive flumazenil should be monitored for 1 to 2 hours after its administration.
Adolescent↗