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Biomedical subjects

M Black

Publications and source records attributed to M Black.

At least 109 records · Page 6Linked to original sources
PubMed1993

Expression of the pro-opiomelanocortin gene in lung neuroendocrine tumours: in situ hybridization and immunohistochemical studies.

Neuroendocrine tumours of the lung may be associated with the ectopic adrenocorticotrophin (ACTH) syndrome and may synthesize and secrete ACTH-related peptides in the absence of the syndrome. However, immunocytochemical analysis may not confirm these biochemical findings, particularly in small cell carcinoma, which is poorly granulated. To investigate further the morphological evidence for expression of the pro-opiomelanocortin (POMC) gene in neuroendocrine lung tumours, we have examined a series of 46 small cell carcinomas and 13 carcinoid tumours of the lung by in situ hybridization for POMC mRNA using a digoxigenin-labelled oligoprobe. We have compared the findings with the immunocytochemical detection of ACTH and beta-endorphin. In situ hybridization was positive in 15 of 46 small cell carcinomas (33 per cent) and in 8 of 13 carcinoid tumours (62 per cent). Immunocytochemical staining was positive in only one carcinoid tumour. These in situ hybridization studies have corroborated biochemical data indicating POMC gene expression in a high proportion of lung neuroendocrine tumours. This suggests that the low levels of expression detected by immunocytochemistry may be due to low levels of hormone storage. Multivariate analysis showed a weak negative association between POMC expression and survival in small cell carcinomas, although this did not reach statistical significance.

Adrenocorticotropic Hormone↗
PubMed1993

A comparison of visual and automated methods of analyzing fetal heart rate tests.

OBJECTIVES: Our objective in this study was to compare evaluation and clinical implications of visual versus computerized analysis of nonstress tests. METHODS: Nonstress tests of 575 high-risk patients were analyzed visually and by a computer using the Oxford Sonicaid System 8000. Standard reactivity criteria were used for visual assessment; the System 8000 used an algorithm with the Dawes-Redman criteria. RESULTS: Ninety-six percent of nonstress tests that met Dawes-Redman criteria were reactive by visual analysis; 93% of reactive nonstress tests met Dawes-Redman criteria. Only 30% of tests that failed Dawes-Redman criteria were nonreactive, whereas 44% of nonreactive tests failed to meet Dawes-Redman criteria. Sensitivities, specificities, and positive and negative predictive values were similar for both approaches. Additional tests or interventions would have occurred in 9% of the cases analyzed by System 8000 and in 49% of the cases analyzed visually. CONCLUSIONS: Although these approaches rate nonstress tests differently, their diagnostic performances are similar. Automated fetal heart rate testing may become an acceptable alternative to conventional visual analysis.

Female↗
PubMed1993

Prenatal drug exposure: neurodevelopmental outcome and parenting environment.

Examined neurodevelopmental patterns and caregiving environment among 20 infants prenatally exposed to cocaine and 20 drug-free infants. The Brazelton Scale was administered 4 times. Drug-exposed infants had less optimal neurodevelopment than comparison infants at birth, but by 6 weeks only differences in autonomic stability were apparent. Neurodevelopmental performance was related positively to the child-centered quality of the environment. Though support buffered stress in both groups, the effect was more robust among drug-free mothers. Findings support the need to consider neurodevelopmental recovery and the caregiving environment in evaluations of developmental outcome among drug-exposed infants.

Developmental Disabilities↗
PubMed1993

Mycobacterial infections of the head and neck.

Despite the decline of pulmonary tuberculosis in the Western world, the incidence of cervical mycobacterial infections has remained relatively unaffected. A retrospective review was conducted of 20 patients treated for head and neck tuberculosis from 1984 to 1991. They were mostly an immigrant group coming from underdeveloped countries close to the equator. All cases were treated with antituberculous chemotherapy; 18 patients also underwent surgical excision of their lymphadenopathy. Sixteen patients showed complete response to combined treatment and one relapse was successfully retreated with antituberculous medication. Three patients died from unrelated causes--two from human immunodeficiency virus infection and one from nasopharyngeal carcinoma. The most reliable indicator of mycobacterial infection was the pathologic specimen, making the need for surgical intervention an important diagnostic consideration. As with other reports, most patients in our series had negative chest x-ray films, variable responses to skin testing, and negative cultures. The epidemiology, pathogenesis, and management of this disease are discussed.

Adult↗
PubMed1993

Preceptor workshops: a collaborative model.

Educational programs for nurses are becoming increasingly reliant on clinicians in hospitals and other health care agencies to act as preceptors for their students. Often there is no formal preparation for this role, nor are rewards provided by the educational institutions. This paper describes a collaborative effort between a university and a college program to prepare and reward nurses who work as preceptors with students in their settings.

Education, Nursing, Baccalaureate↗
PubMed1993

Early initiation of sex and its lack of association with risk behaviors among adolescent African-Americans.

OBJECTIVE: High rates of adolescent homicide, pregnancy, substance abuse, and sexually transmitted diseases underscore the importance of interventions designed to reduce problem behaviors. However, the definition of "problem" behavior and the association with other activities may change between youth cultures. Therefore, greater attention to defining the "problem" behaviors to be targeted will permit more effective utilization of primary vs secondary intervention strategies and identification of high-risk individuals. DESIGN: Two studies of African-American adolescents regarding sexual intercourse, school truancy, substance abuse, and drug trafficking are presented. The first study involved 57 youths (10 to 14 years of age) from a pediatric primary health center and gathered data through pile-sorting. The second study of 300 youths (9 to 15 years of age) from six public housing sites used a questionnaire administered by a "talking" computer. Both studies assessed different self-reported behaviors, feelings about engaging in specific behaviors, and perceptions of friends' behaviors. RESULTS: While 40% of subjects reported having had sex, substantially smaller proportions reported school truancy (14%), illicit drug use (2% to 6%), or drug trafficking (6%). Analyses of reported behaviors, feelings, and perceived peer norms revealed that sex was consistently depicted as forming a different domain from other problem behaviors. CONCLUSIONS: Interventions that rely on primary prevention strategies for sexual intercourse and that identify sexually active youths as at risk for problem behaviors may not be appropriate for African-American adolescents growing up in resource-depleted urban areas.

Adolescent↗
PubMed1992

The diagnosis of child sexual abuse.

OBJECTIVE: To examine how the history, psychological evaluation, medical examination, and child's response to the examination contributed to a diagnosis of child sexual abuse by an interdisciplinary team. DESIGN: Patient series. SETTING: Subspecialty clinic for evaluating prepubertal children alleged to have been sexually abused. PARTICIPANTS: One hundred thirty-two children alleged to have been sexually abused and their parents or guardian, evaluated consecutively in a subspecialty clinic between September 1989 and June 1990. MEASUREMENTS/MAIN RESULTS: A social worker interviewed the parents, a psychologist interviewed the child, and a pediatrician obtained a medical history and examined the child. Parents completed a Child Behavior Check list and the child's response to the physical examination was noted. Both a disclosure by the child and abnormal physical findings were significantly and independently associated with the team's diagnosis of sexual abuse, whereas the presence of sexualized behavior, somatic problems, and the child's response to the examination did not make an additional contribution to the diagnosis. CONCLUSIONS: The findings support the need for a skilled psychological interview and a medical examination of a child alleged to have been sexually abused to make the diagnosis of sexual abuse. An interdisciplinary team appears to be a valuable approach for evaluating these children and their families.

Baltimore↗
PubMed1991

Split skin grafting and bullous pemphigoid.

We present a case of a 73-year-old Caucasian female with known recent mild generalized bullous pemphigoid who underwent a forearm-to-palm split skin graft as part of a fasciectomy for Dupuytren's contracture. Histologically confirmed bullous pemphigoid blistering occurred extensively around the donor site 5 weeks post-operatively and required systemic corticosteroids for adequate control.

Aged↗
PubMed1991

Spatial correlation between thyroid epithelial cells expressing class II MHC molecules and interferon-gamma-containing lymphocytes in human thyroid autoimmune disease.

In this immunohistochemical study we addressed the question whether aberrant class II MHC expression by thyroid epithelial cells (thyrocytes) in established thyroid autoimmune disease is the result of release of interferon-gamma (IFN-gamma) by adjacent lymphocytes. Thyroids from eight cases of Hashimoto's thyroiditis, 13 cases of Graves' disease and 10 cases of focal thyroiditis were studied. Both thyrocytes expressing class II MHC and lymphocytes containing immunoreactive IFN-gamma were found in all 31 autoimmune thyroids. In a serial section study of these thyroids, IFN-gamma-expressing lymphocytes were found within 50 microns of class II MHC-positive thyrocytes in 89% of 282 randomly selected fields. Conversely, class II MHC-positive thyrocytes were found within 50 micron of aggregates of IFN-gamma-positive lymphocytes in 82% of 272 randomly selected fields. These findings support the view that in established thyroid autoimmune disease expression of class II MHC by thyrocytes is the result of local release of IFN-gamma.

Autoimmune Diseases↗
PubMed1991

Paradoxic air embolism in the absence of an intracardiac defect.

A 58-year-old man experienced paradoxic air embolism with passage of air from the systemic venous to the systemic arterial circulation with subsequent stroke and death. No intracardiac shunt was present. Pulmonary fibrosis concomitant with severe pulmonary arterial hypertension appears to have been responsible for the air traversing the pulmonary capillary bed. This unusual outcome of a complicated central venous catheterization must be borne in mind and guarded against in similar patients.

Catheterization, Swan-Ganz↗
PubMed1991

Sentence processing deficits: a replication of therapy.

This paper describes the replication of a therapeutic programme originally used by one of the authors, Byng (Cognitive Neuropsychology, 1988, 5, 629-676) to remediate a specific sentence processing deficit. Our patient is shown to have similar although not identical deficits to those of one of the patients (JG) described in that programme. Sentence comprehension and production both improved as a result of therapy. The pattern of results observed gave further insights into both the nature of the patient's deficit and the mechanism of therapy.

Aged↗
PubMed1991

Failure-to-thrive: lessons from animal models and developing countries.

To better understand the complex associations between undernutrition and poverty in determining behavioral outcome for infants with failure-to-thrive (FTT), we have reviewed findings from research in undernutrition among animal models and among children in developing countries, where rates of infant undernutrition are extremely high. The associations among undernutrition, poverty, and family functioning persist in both animal and human research, whether manipulated in laboratory settings or observed in natural settings. Although environmental support and stimulation appear to ameliorate many of the negative consequences associated with undernutrition, infants with a history of nutritional deprivation are at increased risk for behavioral and emotional problems. Recommendations for prevention and intervention follow an ecological framework and include adequate access to food, knowledge of nutritional requirements and feeding approaches, support for parents and families, and a nurturant environment for infants.

Child, Preschool↗
PubMed1991

Teaching pediatric residents about child maltreatment.

Child maltreatment is a growing problem faced by pediatricians; however, there are many deficiencies in pediatricians' relevant knowledge and skills. Residency programs typically have included limited teaching in the area of child maltreatment. Fifty pediatric residents participated in an evaluation of a model educational course in child maltreatment developed by an interdisciplinary faculty. The course resulted in significant short-term improvements in knowledge and skills as well as a greater sense of competence in managing cases of child maltreatment. The importance of teaching pediatric residents about the "new morbidity" is discussed.

Adult↗
PubMed1990

Hepatocellular carcinoma associated with erythrocytosis and hypoglycemia in a yearling filly.

A yearling Arabian-type filly with a history of poor growth, erythrocytosis, hypoglycemia, and high liver enzyme activities was admitted to the hospital for evaluation. Three days after admission, the filly collapsed, deteriorated rapidly despite treatment, and was euthanatized. A metastatic hepatocellular carcinoma with capsular rupture and hemoperitoneum were found at necropsy. Primary liver tumors are rare in horses, and hepatocellular carcinoma has been reported in only 1 other horse. The systemic manifestations of the tumor in this filly included weakness, weight loss, inappetence, erythrocytosis with tumor production of erythropoietin, persistent hypoglycemia with normal serum insulin concentrations, serum alpha-fetoprotein (normally present only during fetal life), and terminal massive hemoperitoneum, all features of the syndrome in man.

Animals↗