Biomedical subjects
Publications and source records attributed to M A Hoffman.
By means of immunoperoxidase histochemistry through monoclonal antibodies, OKT3+ T cells were detected in the cutaneous lesion of a patient with Sezary syndrome. The majority of the infiltrating cells showed positive staining with OKT4 helper cell marker whereas a few OKT8+ cells were also seen. Many OKT6+ Langerhans' cells accumulated in the epidermis overlaying the dermal infiltrate.
Eleven cases of malignant fibrous histiocytoma were examined electron microscopically. In six of seven cases with storiform-fascicular histologic features and in two cases with a myxoid pattern, no malignant-appearing histiocyte-like cells were identified. The neoplastic cells were fibroblasts and myofibroblasts, occasionally admixed with lymphocytes and benign-appearing histiocytes. Only in the other three cases (two pleomorphic sarcomas and one tumor with a storiform-fascicular pattern) were malignant cells with the features of histiocytes identified. The authors propose that some neoplasms with a storiform-fascicular pattern would be more accurately classified as fibrosarcomas than as histiocytomas and speculate on the possible histogenesis of those tumors that do contain histiocyte-type cells.
The attitude of forty-four mothers of adolescent mothers (MAM) were assessed by interview and questionnaire. Most adolescent mothers (AM) and their infants lived with MAM. Thirty-two percent of MAM and sisters of AM had themselves experienced a pregnancy prior to seventeen years of age. The majority of MAM expressed positive feelings about AM and their infants. MAM reported little change in their own life style as a result of their daughter's pregnancy. Most MAM's provided child care and financial assistance for AM, but reported that the AM had primary child care responsibility for the infant.
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The consistently high frequency of pilot-error accidents in both military and civilian aviation programs does much to support exploratory research which might help alleviate the problem. Cattell's Sixteen Personality Factor Questionnaire (16 PF), Mehrabian Achievement Scale, and a dynamic decision making task (under risk) were given to 51 Army aviators. Accident files were then examined in order to classify the aviators as to their prior pilot-error accident involvement. Stepwise discriminant analyses revealed that the decision-making task scores and the achievement scores were unrelated to the pilot error accident groupings while the 16 PF scores were able to correctly classify 86% of the aviators as to whether or not they had been previously listed as a cause factor in a military aviation accident.
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Established principles for the management of thyroglossal duct remnants have been accepted widely since Sistrunk's description of the operative procedure in 1928. Nevertheless, inadequate excisions and troublesome recurrences still are encountered. We have reviewed 90 infants and children treated at The Children's Hospital in Boston over a 25-year period. Ten patients referred to our institution after an average of 2.4 prior operations per patient elsewhere suffered a recurrence rate of 30% after very wide reexcision. The remaining 80 patients who underwent primary excision at our institution had a 6.3% recurrence rate. All recurrences were managed successfully by further, wider excision. Histologic review demonstrated variability in patterns of drainage of the tract into the oropharynx, with accessory tracts and alveolar outpouchings off the main duct being present in 7.8% of specimens. This study demonstrates that the greatest opportunity for curative resection is at initial presentation, and that previous inadequate or unsuccessful excision is a major risk factor for further recurrence. The variability in microscopic anatomy of thyroglossal duct remnants can account for recurrent disease after lesser procedures, and underscores the importance of wide dissection above the hyoid bone. Our operative methods are illustrated.
Getting staff to continuing education programs can be difficult due to time, staffing, and cost restraints. A self-instructional module combined with a teaching poster format has had a favorable response from participants. This format has the capability of reaching a higher number of participants and is both time- and cost-effective.
To determine if there are admission criteria that predict success in graduate nursing education, an investigation was conducted of 193 graduates who had successfully completed the masters nursing program at a private eastern university. Admission criteria and other variables chosen were nursing, nonnursing, and cumulative undergraduate grade point averages (GPAs); verbal, quantitative, and combined Graduate Record Examination (GRE) scores; age at entrance; number of years intervening between attainment of the bachelors and completion of the masters degree; and, number of years intervening between the basic nursing education and the completion of the masters degree. Each variable was correlated with masters GPA for degree of association. Pearson's coefficient of correlation was used to analyze the data. Subgroups were analyzed in relation to the chosen area of clinical concentration: community health, psychiatric, medical-surgical, and maternal-child nursing; basic nursing education: diploma or generic baccalaureate; and, marital status: single or married. Nursing, nonnursing, and cumulative undergraduate GPAs were found to be weakly associated with the masters GPA except for the psychiatric subgroup which showed a moderate correlation between the cumulative under-graduate and the masters GPAs. Weak associations were found between verbal, quantitative, and total GRE scores and the masters GPA, with two exceptions: for psychiatric and community health subgroups there were moderate degrees of association between verbal GRE scores and the masters GPA. Age was not an effective criterion for predicting degree of success in the program. Both measures of intervening years were found to be weakly associated with the masters GPA.
The stability of ganciclovir sodium solutions stored in polypropylene syringes and PVC bags was tested in 0.9% sodium chloride at three concentrations 70, 200 and 350 mg/50 ml for polypropylene syringes, and two concentrations (70 and 350 mg/250 ml) for PVC bags and at three temperatures (-20 degrees C, + 4 degrees C, room temperature). The solutions, which had been initially frozen, were thawed by exposure to microwave radiations. The stability of each sample was determined by high-performance liquid chromatography. The results of this study indicate that admixtures of ganciclovir sodium at the concentration rates tested can be frozen for at least one year and are stable for at least 80 days at + 4 degrees C and 7 days at room temperature.
Usually parenteral solutions can be kept longer if they are frozen. This freezing procedure assumes one knows the stability of frozen drugs. Freezing has a few drawbacks; preparations must be labelled twice (before and after freezing), only standardized doses can be prepared, thawing procedures must be established, cost of freezer and microwave-oven and time needed for thawing and labelling. There are four main advantages; production plannings are improved because time needed for preparation is reduced, quality assurance of the preparation, availability of preparation at any time, reduce of drug wastage. Freezable drugs are listed and sorted by pharmacological class. The presentation includes drug concentration, vehicle, container, storage temperature, assay procedure and stability. Our nine months experience is presented. Three drugs are frozen; methotrexate, metoclopramide and ganciclovir. Considerable preparation time is saved and economy is about FF 150,000.
Fifty-six patients who underwent anterior fusion utilizing fibular allograft are reviewed. Thirty-two patients underwent multiple-level anterior cervical discectomy and fusion utilizing fibular strut allograft, and 24 underwent anterior lumbar discectomy and fusion using fibular strut allograft. Cervical surgery was performed via the strut technique of Whitecloud and LaRocca and lumbar surgery was performed via a transperitoneal or retroperitoneal approach. Postoperatively, patients were assigned a clinical grade based on symptomatic relief and medication usage. X-rays were visually inspected, and quantitatively digitized for Cobb angle and translation in order to assess the status of arthrodesis. In the cervical group, the rate of clinical success (87.5%) exceeded the arthrodesis rate. By inspection, 65% fused, at a mean time of 23.5 months postoperatively. In the lumbar group, the overall clinical success rate was 68%. This correlated quite strongly with a fusion rate of 58%. Smoking was a negative correlate with arthrodesis. Patients receiving Workers' Compensation were also more likely to have an unsatisfactory clinical outcome. The results of this study highlight the difference between anterior arthrodesis in the cervical and lumbar spine. The biomechanical stability afforded by the fibular strut in the cervical spine appears to outweigh the disadvantages of delayed time to union. The rate of posterior cervical fusion to salvage symptomatic pseudoarthrosis was quite low (9.3%), thus suggesting that additional posterior surgery in this particular group of patients should not be considered for a minimum of two years postoperatively. In the lumbar group, status of arthrodesis correlated closely with clinical outcome. Fusion rate in this group was disappointing, corresponding to other reports in the literature. Based on these data, primary anterior body fusion without allograft in the lumbar spine cannot be recommended, as a viable alternative to conventional autograft.
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Since September 1994, danaparoid (Orgaran), a heparinoid, has been used in our centre to treat patients with thrombocytopenia occurring during heparin therapy and who need continuing antithrombotic therapy. We carried out a retrospective study using clinical and biological data on the first 13 consecutive patients treated with danaparoid (for 1 to 18 consecutive days). The platelet count returned to normal for ten patients, but one patient died having contracted a severe sepsis and bleeding occurred in one patient with acute renal failure. In the three other cases, the diagnosis of heparin induced thrombocytopenia (HIT) was in retrospect unlikely and the death of these patients was related to severe underlying diseases which were held responsible for thrombocytopenia. We confirm that danaparoid appears to be an effective, well-tolerated substitute for heparin in HIT patients. The French regulation Temporary Authorization for Prescribing Medicines allowed the prompt use of this as yet unmarketed drug and collection of reliable and pertinent data.