Biomedical subjects
L Baker
Publications and source records attributed to L Baker.
The role of M.D.-Ph.D. training in increasing the supply of physician-scientists.
Since 1968 the number of postdoctoral research fellows with M.D.s or other professional degrees has fallen from about 4100 to 1730 in training each year. By 1980, the number of M.D. postdoctoral fellows entering and completing research training was about 850 per year. During the past 12 years, the number of M.D.-Ph.D. trainees has risen to about 650 in the federal Medical Scientist Training Program (MSTP) and about 500 in nonfederal programs. The attrition rate in non-federal M.D.-Ph.D. programs has been shown to be 44 per cent, and that from the MSTP, 9 per cent. When the length of the training program, the attrition rate, and other factors are considered, present trainees will account for about 150 M.D.-Ph.D. graduates annually in the immediate future. Current training programs can meet only about half the estimated national need for physician researchers. The federal M.D.-Ph.D. program should be expanded to ensure that the country's future research and teaching needs will be met.
The practicality of chronic hepatic artery infusion therapy of primary and metastatic hepatic malignancies: ten-year results of 124 patients in a prospective protocol.
Ten-year results are presented of 124 patients with malignancy apparently limited to the distribution of the hepatic artery, treated to prospective protocol with continuous infusion of 5-FUdR through an hepatic artery catheter. Nearly all patients had moderate to massive hepatic replacement. Of 88 patients with colorectal carcinoma, 64 (73%) had clinically objective and subjective remission. Median survival for responders was 13 months; for the entire group, ten months. Of 13 patients with hepatoma, nine had clinically significant regression with a median survival of 11 months. Ten patients had carcinoma of the gall bladder or bile duct with seven obtaining clinically significant regression. Complications encountered are discussed and are similar to other series. Of the patients experiencing clinically significant remission, all but one reached the complete independence performance status, and 84% reached normal activity levels. Thus, for hepatic localized tumor, this therapy is worthwhile and practical.
Plasma ketones in newborn infants: absence of suckling ketosis.
Explore the source record for details and available documents.
Intragastric feeding in type I glycogen storage disease: factors affecting the control of lactic acidemia.
Continuous nocturnal intragastric feeding, combined with frequent daytime feedings, has been reported to improve both linear growth and the metabolic abnormalities in patients with glucose-6-phosphatase deficiency (Type I Glycogen Storage Disease). However, elevated blood levels of lactate have persisted. The present studies explore the relationship between blood lactate concentrations in six patients with glucose-6-phosphatase deficiency and variations in the rate and composition of the intragastric feeding. Blood lactate and plasma glucose concentrations were determined at rates of dextrose administration ranging from 3-34 mg/kg/min. Dextrose infusion at 100-200% of estimated normal glucose production rates gave the best control of blood lactate concentrations. Lower rates of dextrose infusion resulted in significantly higher blood lactate levels; higher rates produced hyperglycemia, but no significant further reduction of blood lactate. At identical rates of glucose administration, a dextrose-containing infant formula and a high carbohydrate enteric feeding solution gave no significant improvement in control of blood lactate levels compared to dextrose alone. Plasma glucose levels fell more rapidly when intragastric feeding was stopped than after a mixed meal and hypoglycemia appeared to develop before counter-regulatory responses could be mobilized. These observations may account for the increased susceptibility to symptomatic hypoglycemia reported in patients treated with intragastric feeding.
Meticulous control of diabetes during organogenesis prevents congenital lumbosacral defects in rats.
Explore the source record for details and available documents.
Bioenergetics in clinical medicine. XVI. Reduction of hypertension in patients by therapy with coenzyme Q10.
Six untreated hypertensive patients and ten on therapy, but having elevated blood pressures, were treated with coenzyme Q10(CoQ10); 14/16 patients showed reductions (p less than 0.05-less than 0.001) in systolic pressures; 11/16 showed reductions (p less than 0.05-less than 0.001) in diastolic pressure; 9/10 showed reductions of elevated pressures to a normal range. By impedance cardiography and electrocardiography, there were no changes in cardiac outputs, stroke volumes and Heather Indices except for a few patients with changes of doubtful biological significance. 3/16 patients had exceptionally low basal specific activities of the succinate dehydrogenase-coenzyme Q10 reductase in blood which increased to a normal range on treatment. A greater deficiency of CoQ10 in the vascular system than in blood is likely. We consider that (1) the mechanism of reduction of elevated blood pressures by CoQ10 is based upon normalization or autoregulation of peripheral resistance rather than cardiac regulation, and (2) that the therapeutic activity of CoQ10 is not pharmacodynamic, but results from a translational increase in levels of CoQ10-enzymes in vascular tissue during ca. 4-12 weeks.
Evaluation of beta-2'-deoxythioguanosine combined with methyl-CCNU or mitomycin in advanced colorectal cancer. A Southwest Oncology Group study.
Two hundred twenty eligible patients with metastatic colorectal carcinoma were treated with a combination of beta-2'-deoxythioguanosine (BTG), plus methyl-CCNU or mitomycin. There was no significant difference in overall response (CR/PR + stable) among fully evaluable patients between the mitomycin plus BTG arm 19/96 (19.7%) and the MeCCNU arm 26/87 (29.8%). Median survival of eligible patients was 19 weeks with mitomycin plus BTG versus 21 weeks with MeCCNU plus BTG: no difference. Median survival of responders (40 weeks) and patients with stable disease (35 weeks) was significantly better than patients with increasing disease (17 weeks): p + 0.001.
Prevalence, type, and correlates of psychiatric diagnoses in 200 children with communication disorder.
The type and prevalence of psychiatric disorders were assessed in 200 children with speech and language disorders referred to a suburban speech and hearing clinic. Possible correlates of psychiatric disorder, including demographic factors, medical and developmental problems, psychosocial stressors, and speech and language factors, were also assessed. Standardized psychiatric and speech and language evaluations were done for all subjects, as were IQ and academic testing. Approximately 50% of the sample had some definable psychiatric disorder. The most common diagnoses were behavior disorders, followed by emotional disorders. The presence of psychiatric disorder was strongly correlated with speech and language factors, as well as psychosocial stressors. These findings have implications for primary care practitioners and speech and language therapists involved in planning treatment programs for such children.
In search of the Somogyi effect.
Explore the source record for details and available documents.
Psychiatric disorders in children with speech and langauge retardation. Factors associated with development.
One hundred children (mean age, 5 to 6 years) who were seen consecutively at a suburban speech and hearing clinic were systematically evaluated for speech and language disorders and psychiatric disorders. Fifty-three were found to have a psychiatric illness. The three groups were compared with the psychiatrically well group to ascertain factors associated with the presence of a psychiatric disorder. Significantly differentiating the ill group were more academic and classroom behavior problems and the presence of both speech and language problems. The two groups were not significantly different in intellectual retardation, hearing impairment, medical factors, nonlanguage development disorders, and a variety of family and demographic factors. Common in both groups were psychiatric illness in parents and first-degree relatives. The data indicate that children with speech and langauge disorders are highly at risk for the development of significant psychiatric problems, which suggests the need for proper screening and multimodal treatment planning.
Dimensions of behavior in children with speech andlanguage disorders.
The behavioral symptoms of a population of children with speech and language disorders (with a mean age of approximately 6 years) were studied with a teacher and a parent questionnaire. A factor analysis produced similar factors for both questionnaires: Hyperactivity-Conduct, Affect, and Language. An Asocial factor was also found with the teacher questionnaire. The factors of this study were in good agreement with the general factors of "Aggression" and "Withdrawal" found in other quantitative studies. Mean factor score profiles were reported for this unique population of children.
Behavior problems in children with pure speech disorders and in children with combined speech and language disorders.
Forty-six children with pure speech disorders and 53 children with disorders of both speech and language were rated by parents and teachers for behavioral problems. Both parents and teachers rated the speech- and language-disordered children as having more severe and more frequent behavioral abnormalities, particularly hyperactive behaviors and developmental problems. Somatic complaints were more pronounced in the pure speech group. Conduct disorders, emotional problems, and poor relationships did not distinguish between the two groups. The importance of these findings for speech therapists and individuals working with speech- or language-impaired children is discussed.
Behavior problems in children with speech and language retardation.
A systematic evaluation for speech and language retardation and behavioral disorders were conducted on 100 children (mean age five years, six months) presenting consecutively to a suburban speech and hearing clinic. It revealed that parents, teachers, and an examining psychiatrist agreed that these children frequently had associated behavioral problems, some quite common. This indicated the need for a speech or language therapist to systematically assess a child for possible behavioral problems in order to establish a more comprehensive and effective treatment plan for the child.
Academic failures in children with communication disorders.
Explore the source record for details and available documents.
Glycemic response to glucagon during fasting hypoglycemia: an aid in the diagnosis of hyperinsulinism.
Explore the source record for details and available documents.
Psychiatric and behavioral characteristics of children with communication disorders.
Explore the source record for details and available documents.
Gene dosage and suceptibility to insulin-dependent diabetes.
1. All members of 33 families in which two or more sibs have insulin-dependent diabetes mellitus (IDDM) were HLA-typed. The results strongly support the hypothesis that, closely linked to the HLA region, there is a locus (S) for susceptibility to IDDM. We use Sd for alleles at this locus which confer susceptibility to disease, and Sa for all other alleles. 2. Published prevalence (recurrence) rates for relatives of an IDDM proband, which are essential for the analysis, are reviewed critically, and a new estimate of prevalence at age 30 in the general population is calculated from published data. 3. The analysis allows for greater risk (penetrance) of the genotype SdSd (two doses of Sd) than of SaSd (one dose of Sd) and for recombination between the HLA region and S. With either our own data on 26 affected sib pairs or a much larger sample assembled by pooling with published data, the maximum-likelihood estimate of the two-dose penetrance is 71%, of the one dose penetrance 6.5%. The hypothesis of differential penetrance according to gene dosage provides a significantly better explanation than either simple dominant or simple recessive inheritance. 4. Estimates of the recombination fraction between HLA and S are very sensitive to the proportion of affected sib pairs sharing neither HLA haplotype, which varies considerably among the samples pooled. With the pooled data the recombination fraction is estimated as 3%, but in view of the strong associations with particular HLA alleles seen in population data, this should probably be considered an upper limit.