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Biomedical subjects

K McDermott

Publications and source records attributed to K McDermott.

28 records · Page 2Linked to original sources
PubMed1991

Detection of hepatic metastases from colorectal carcinoma using indium-111 (111In) labeled monoclonal antibody (mAb): MSKCC experience with mAb 111In-C110.

Sixteen patients with colorectal carcinoma and a rising serum carcinoembryonic antigen (CEA) level and no evidence of extra-abdominal disease were administered 5 mg of an anti-CEA monoclonal antibody (mAb), C110, labeled with approx. 5 mCi of 111In. All patients subsequently underwent exploratory laparotomy, and samples of tumor and normal tissue were obtained. Hepatic lesions (confirmed by histopathology) were visualized as areas of increased radiotracer uptake in 13 of 16 patients. Single photon emission computed tomography (SPECT) considerably aided detection, being positive in two patients with normal planar images. Ten of the 16 patients had positive x-ray computed tomographic (CT) images. The radioimmunodiagnostic study was falsely negative in 3 of 16 patients with subsequently proven hepatic disease, in one of whom CT was also normal. The antibody study was positive in 80% of lesions, thus being, in this small series, significantly more sensitive (P less than 0.01) than CT. 111In-C110 is a promising monoclonal antibody for the detection of hepatic metastases from colorectal carcinoma; this is the first study to show consistently greater concentration of 111In-labeled antibody in hepatic lesions than in surrounding normal hepatic parenchyma.

Adult↗
PubMed1991

Metabolic consequences of (regional) total pancreatectomy.

Little information has been reported on the metabolic characteristics of the totally pancreatectomized patient or the efficacy of medical management after radical pancreatic surgery. The prospective evaluation of 49 such patients, with 31% followed for 48 or more months, forms the basis of this report. The major immediate postoperative challenge is control of diarrhea and weight stabilization. Chronically patients have an increased daily caloric requirement (mean +/- SE, 56 +/- 1 kcal/kg), not wholly explained by moderate steatorrhea (fecal fat excretion, 16% +/- 2% of unrestricted fat intake). Despite persistent malabsorption, deficiencies in fat-soluble vitamin, magnesium, and trace element serum levels can be prevented in most patients. Pancreatogenic diabetes is characterized by (1) absence of the major glucoregulatory hormones insulin and glucagon, (2) instability, and (3) frequent hypoglycemia, with the latter parameters improving with rigorous home glucose monitoring. No patient has developed clinically overt diabetic micro- or macrovascular disease. Performance status in long-term survivors has been reasonable. However adverse chronic sequelae of the operation occur and include an unusual frequency of liver disease, characterized by accelerated fatty infiltration, and osteopenia, with an 18% reduction in radial bone mineral content noted in pancreatectomized patients studied more than 5 years after surgery.

Adenocarcinoma↗
PubMed1988

Bone mineralization in women following successful treatment of Hodgkin's disease.

PURPOSE: Women with Hodgkin's disease in whom a cure has been achieved may be at risk for osteoporosis because of therapy-induced premature menopause. Our objective was to gather information regarding the integrity of bone mass in such long-term cancer survivors. SUBJECTS AND METHODS: Bone mineral density was measured using photon absorptiometry in five groups of women: 11 patients with Hodgkin's disease and ovarian failure (Group I); six patients with Hodgkin's disease and ovarian failure who received estrogen replacement (Group II); 15 patients with Hodgkin's disease and normal ovarian function (Group III); 16 premenopausal control subjects (Group IV); and 11 postmenopausal control subjects (Group V). All patients with Hodgkin's disease were in remission and had completed treatment more than five years earlier. RESULTS: Subjects in Group I were found to have significantly decreased radial (p = 0.0009), lumbar spine (p = 0.002), and femoral neck (p = 0.0001) bone mineral density measurements compared with those in subjects in Group IV; the bone mineral density measurements at all sites of subjects in Group I were no different than those of subjects in Group V. Subjects in Group III had bone density measurements that were similar to those in Group IV, although the radial bone mineral density value was significantly lower (p = 0.0004). Determination of serum gonadotropins and estradiol was consistent with the menstrual status defining the five groups. No secondary causes for decreased bone mineral density values could be detected, since the mean serum levels of parathyroid hormone, calcium, phosphorus, and vitamin D metabolites were similar among the groups, and all prolactin levels were normal. CONCLUSION: We have identified a new population of patients with a high risk of osteoporosis, and these results emphasize the importance of treatment-related ovarian failure in the pathogenesis of osteoporosis.

Adult↗
PubMed1986

Community health and reform in Hong Kong.

In this paper I argue that the health crisis in the underdeveloped world today is not primarily one of shortages of services, but is a result of lack of power and control over economic, political and social institutions by the majority of the population. Hong Kong is presented as a case study in which a plural medical system is dominated by a political economy that shapes patterns of both sickness and health care. As an advanced capitalist colony, a financial center for the Pacific Basin, and a neutral area for China's foreign negotiations, social policies in Hong Kong aim at promoting business growth, often at the expense of the health of the population. Further, government and voluntary agencies attempts at reforming the health system have done little more than further solidify biomedicine and its social relations. Finally an attempt is made to define potential vehicles for change.

Delivery of Health Care↗
PubMed1986

Basal glucagon replacement in chronic glucagon deficiency increases insulin resistance.

To evaluate the role of glucagon in insulin-mediated glucose metabolism, we studied four men and four women, ranging in age from 30-73 yr (mean +/- SEM, 54 +/- 5) who had undergone complete pancreatic resection for cancer or chronic pancreatitis 16-58 mo previously. The patients had undetectable C-peptide levels and established lack of biologically active 3500 mol wt glucagon. Euglycemic insulin clamp studies were performed with a 40 mU X m-2 X min-1 insulin infusion in the basal, post-absorptive, insulin-withdrawn state, before and during the last 3 h of a 72-h glucagon replacement-dose infusion (1.25 ng X kg-1 X min-1). In four patients, hepatic glucose production was determined by a primed-constant infusion of 3-[3H]glucose. Monocyte insulin-binding studies, pre- and postglucagon, were performed in all patients. The 72-h glucagon infusion, resulting in mean plasma glucagon levels of 124 +/- 7 pg/ml, caused a significant rise in the mean plasma glucose level (249 +/- 8 versus 170 +/- 13 mg/dl preglucagon) and a sixfold increase in mean 24-h glucose excretion. Both with and without glucagon, euglycemic hyperinsulinemia achieved identical and complete suppression of hepatic glucose production. The mean glucose utilization rate (4.70 +/- 0.36 mg X kg-1 X min-1 preglucagon) was significantly decreased by glucagon replacement (3.83 +/- 0.31 mg X kg-1 X min-1, P less than 0.02). Mean glucose clearance was also diminished with glucagon (4.49 +/- 0.32 versus 5.73 +/- 0.45 ml X kg-1 X min-1 preglucagon, P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Compensatory hyperplasia in the rat liver as a result of cytoplasmic atrophy.

A protracted process of hepatocyte atrophy was induced in the anterior lobes of the rat liver by portal vein ligation (PVL), and within 3 days the combination of atrophy in the anterior lobes and compensatory hyperplasia of the posterior lobes had resulted in the anterior lobes comprising only about 20% of the total liver weight. Apart from an initial fall in the total liver weight due to atrophy of the anterior lobes without any corresponding growth reaction in the posterior lobes, the total liver weight remained close to normal throughout the first 3 days. Surprisingly, increases in posterior lobe DNA synthesis after PVL were triggered almost as rapidly (15-18 h post-operatively) as occurs after anterior lobe resection, though subsequently the level of proliferative activity was generally lower than is found after partial hepatectomy. The rapidity of the proliferative response to PVL suggests the proliferative signal is generated by a minimal cytoplasmic deficit and/or the increased rate of portal blood perfusion.

Animals↗
PubMedDate not supplied

Patient-determined glycosylated hemoglobin measurements: an aid to patient education.

The feasibility of patient determination of fast fraction hemoglobin (HbA1) was evaluated. In the laboratory, the fast fraction method correlated well with known mixed standards of between 0 and 40% hemoglobin A1c (r2 = 0.97, slope 1.19) and reasonably well with radioimmunoassay (r2 = 0.78, slope 1.09), although prepackaged columns performed poorly about 18% of the time. Sixteen patients practicing home blood monitoring performed the determination of HbA1 on their own blood obtained from fingerstick. Two hours of patient training were required for the procedure. The correlation of patient determination of HbA1 with the results obtained by the laboratory on venous blood was reasonable (r2 = 0.81 with a slope of 0.88). Patient performance of HbA1 was useful in (1) providing enhanced reinforcement for self-monitoring programs, (2) engaging patients in groups in the monitoring process, and (3) providing an educational tool with which to teach pathophysiologic principles involved in diabetes mellitus.

Adolescent↗
PubMedDate not supplied

The role of insulin purification: an overview.

Besides the obvious toxicity of overdosage and hypoglycemia, insulin administration may also be complicated by a variety of local cutaneous reactions and systemic allergic complications. Although these responses are by no means universal among patients injecting insulin, they may pose significant clinical problems. This is particularly true for the localized skin reactions such as lipoatrophy and the systemic insulin allergy leading to insulin resistance. Most commercially available insulin preparations are extracts of pork or beef pancreas. One approach to reducing insulin complications is to improve the homogeneity of commercial preparations by further purification, which has been afforded by recent technology. A priori, the preparations most resembling human insulin with the fewest contaminants should provide the optimal therapy for diabetic patients. Whether this will prove to be the case remains to be documented.

Drug Contamination↗
PubMedDate not supplied

The chief of nursing practice: a model for nursing leadership.

The role and structure of the Canadian Health Care System and its facilities are changing rapidly. Regionalization, decentralization, and flattening of hierarchical structures have occurred in governments and institutions. Traditional management roles, including the Vice President/Director of Nursing have been eliminated. There is a need to create a new model of nursing leadership if nurses are to continue to provide quality patient care. This article describes the initiative at Women's College Hospital to meet the expressed needs of nurses by developing a unique nursing role. The development of the chief of nursing practice role is defined within the context of the changing environment and Kanter's theory of empowerment. The position of the chief of nursing practice is a role model for nursing leadership and one that is pivotal for the professional identity of nursing, and for the provision of high quality patient care.

Canada↗