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Biomedical subjects

J J Gonzalez

Publications and source records attributed to J J Gonzalez.

43 records · Page 3Linked to original sources
PubMed1979

Prolactin-secreting adenoma as part of the multiple endocrine neoplasia--type I (MEN-I) syndrome.

Two patients presented with the galactorrhea-amenorrhea syndrome. One patient had previously had parathyroid hyperplasia and the other an insulinoma. Preoperative evaluation of each patient revealed hyperprolactinemia and radiological evidence of an abnormal sella turcica. Pituitary adenomas were identified and removed at surgery. Immunostaining techniques confirmed the presence of prolactin-containing cells in both tumors. We propose that prolactin-secreting tumors be considered as part of the MEN-I syndrome, and that patients presenting with the galactorrhea-amenorrhea syndrome be screened and followed sequentially for evidence of other endocrine neoplasia.

Adenoma↗
PubMed1979

Renin aldosterone system and potassium levels in chronic lead intoxication.

Renin activity and aldosterone were evaluated relative to potassium levels and lead intoxication in 33 patients with a history of "moonshine" ingestion. Patients were divided into three groups: I, lead intoxicated with hyperkalemia; II, lead intoxicated without hyperkalemia; and III, not lead intoxicated without hyperkalemia. Those in group I demonstrated suppressed plasma renin activity, baseline and after furosemide, and blunted aldosterone responsiveness to furosemide. Plasma renin activity was not different in groups II and III, whereas aldosterone responsiveness was less in group II than in III. Group I patients tended to be older, had lower creatinine clearances, and six of nine had mild hyperchloremic acidosis. Diabetes and cortisol insufficiency were not present. Chronic lead intoxication due to illicit alcohol ingestion is associated with hyporeninemic hypoaldosteronism and hyperkalemia which appear to develop as the lead nephropathy progresses with duration and/or aging.

Adult↗
PubMedDate not supplied

How do women compare with internal medicine residents in breast lump detection? A study with silicone models.

OBJECTIVE: Manufactured silicone breast models were used to compare the accuracy of breast examination by 300 women and 62 internal medicine residents. DESIGN: The study design was cross-sectional. SETTING: The study took place in two teaching-hospital general medicine clinics. PATIENTS/PARTICIPANTS: Women were continuing care patients, ages 40 to 68, with no current breast complaint; 300 of 467 (66%) randomly selected women participated. Physicians were internal medicine residents with at least one-half day per week of ambulatory care practice; 62 of 64 (97%) participated. MEASUREMENTS AND MAIN RESULTS: Sensitivity equalled the percentage of 18 lumps correctly detected in examination of six silicone breast models. Specificity equalled the percentage of six models examined without a false-positive detection. Women's sensitivity was lower than physicians' (40% vs. 58%), but their specificity was higher (66% vs. 52%). For both women and physicians, sensitivity varied according to lump size, hardness, and depth, with women's sensitivity lower than physicians' for each characteristic. Examination duration was the technique most strongly and consistently related to accuracy. Physicians spent more time examining models than did women (2.5 vs. 2.1 minutes per model). For both groups duration related positively to sensitivity (r = 0.46, women; 0.55, physicians) and negatively to specificity (r = -0.35, women; -0.59, physicians). After adjusting for differences in technique, women's sensitivity remained lower than physicians', whereas specificity generally remained higher. The sensitivity of physicians with prior tactile experience with breast lumps was higher than that of physicians without such experience (60% vs. 51%, p = 0.01). Too few women (2%) had prior tactile experience to permit analysis. CONCLUSIONS: Women's and physicians' breast examination accuracies differ, but for the two groups accuracies vary similarly by lump characteristics and examination technique. Programs to improve breast examination should focus on specificity as well as sensitivity. Training that includes tactile experience may be important.

Breast↗
PubMedDate not supplied

Can residents be trained to counsel patients about quitting smoking? Results from a randomized trial.

STUDY OBJECTIVE: To evaluate the effectiveness of two teaching interventions to increase residents' performance of smoking cessation counseling. DESIGN: Randomized controlled factorial trial. SETTING: Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located in three university medical centers and four university-affiliated community hospitals. PARTICIPANTS: 261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up, and 659 (78%) were interviewed by phone at six months. INTERVENTIONS: Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention. MEASUREMENT AND RESULTS: Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only groups had used more counseling techniques (1.5-1.9) than had prompt-only or control residents (0.9). Residents in all three intervention groups advised more patients to quit smoking (76-79%) than did control group residents (69%). The tutorial had more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices. Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention groups (self-reported: 5.3-8.2%; biochemically verified: 3.4-5.7%) were higher than those for residents in the control group (self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant. CONCLUSION: A simple and feasible educational intervention can increase residents' smoking cessation counseling.

Counseling↗
PubMedDate not supplied

AIDS predictions.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Pattern of recurrence after esophageal resection for cancer.

BACKGROUND/AIMS: Surgery is still the main treatment option for esophageal cancer; however, long-term survival has remained poor, even when a curative operation is performed. The present study was undertaken to analyze the pattern and time of recurrence after a curative esophagectomy. METHODOLOGY: We studied 53 patients who underwent curative esophageal resection for cancer between 1985 and 1994. We examined number and pattern of recurrences, time after surgery, and any factor with contribution to carcinoma recurrence. RESULTS: During the follow-up period, 34 patients had tumor recurrence. The disease-free interval was 12.7 months (SD = 9.8). Twenty patients (58.9%) developed extrathoracic tumor recurrence and 23 patients (67.6%) intrathoracic. In 3 cases an esophageal stump recurrence was presented. Thirteen patients were considered for palliative treatment after recurrence. The 5-year survival rate was 13%, with median survival time between recurrence and death, 4.1 months. The recurrence of disease was always before 40 months after surgery. Any significant difference related with recurrence was observed between the analyzed factors. CONCLUSIONS: The majority of recurrences are developed before 2 years. Neoplastic recurrence is most common at the mediastinum. Palliative treatments after recurrence do not modify the progression of tumor.

Adult↗