Biomedical subjects
M Brawer
Publications and source records attributed to M Brawer.
Effect of age, educational status, ethnicity and geographic location on prostate symptom scores.
We evaluated the effect of patient age, educational status, ethnicity and geographic location upon the American Urological Association benign prostatic hyperplasia symptom scores. Using patients attending Prostate Cancer Awareness Week, we collected additional data on the symptom score and also on education received. A total of 2,245 records was obtained from 4 different centers. Of the population 72% were white and 13% were black. Regression analysis of patient age versus symptom score demonstrated an increase with patient age from 4.59 at age 40 years to 8.17 at age 70 years. Analysis of covariance revealed significant differences in age-adjusted scores between sites from 6.24 in New Orleans, Louisiana to 8.58 in Madison, Wisconsin. No effect was noted for education or ethnicity on symptom scores.
New relationships between prostatic intraepithelial neoplasia and prostatic carcinoma.
Our group has been studying the progressive molecular changes in prostatic epithelium which precede the invasive phenotype. Initial studies revealed similar alterations in cytoskeletal proteins between high grade prostatic intraepithelial neoplasia (PIN) lesions and invasive carcinoma. Specifically we observed an increased expression of certain cytokeratins and decreased expression of vimentin. We also noted a change in glycosylation as detected by Ulex europaeus staining. Using the latter technique we were able to microdissect and isolate nuclei from areas of low and high grade PIN lesions as well as from invasive carcinoma for morphometric analysis. Similarities in nuclear size, chromatin heterogeneity, and nuclear DNA content between low and high grade PIN and invasive carcinoma in carcinomatous specimens were noted. In contrast, these parameters were significantly different in low grade PIN lesions obtained from benign prostatic transurethral resection (TURP) specimens. In addition, DNA histograms revealed similar proliferative indices between high grade PIN and invasive carcinoma, which differed significantly from low grade PIN. Parameters thought to be relative to the invasive phenotype were also examined, such as the members of the metalloproteinase family; although normal luminal cells fail to express detectable levels of these enzymes, invasive carcinoma and even low grade PIN lesions express both the 72 kDa and 92 kDa type IV collagenase. Taken together, these data indicate that the dysplastic cells of PIN lesions and carcinomas are similar in nuclear and genomic features as well as protease expression. Our current working hypothesis is that these cells are already armed with the necessary proteases to invade the basal lamina but in an inactive form. Tumor progression requires an additional event of protease activation.
What's in a teaspoon? Underdosing with acetaminophen in family practice.
A study was made of 100 paediatric encounters in which an accompanying parent stated that the child had been given acetaminophen syrup during the preceding 24 hours. In 80% of cases a household teaspoon had been used to determine the amount of medication required. The volumes of these spoons were measured using a syringe. The range was from 1.5 to 5 cm3 with 79% containing 2 to 3 cm3. The mean volume was 2.95 cm3 (SD 0.79) and the median was 2.5 cm3. The mean dose administered was 62% of that recommended when the calculation was made according to age and 64% according to body weight. Much of the underdosing observed was due to parents' assumption that a household teaspoon contains 5 cm3 of acetaminophen syrup and also to a failure to correct for advancing age and increasing weight.
Osteogenic sarcoma after retinoblastoma radiotherapy.
Development of osteogenic sarcoma after retinoblastoma radiotherapy in three patients, two of whom were siblings, is reported. Pluridirectional tomography and plain skull radiography demonstrated soft tissue masses, sinus opacification, and bone destruction and sclerosis in all three patients. Computed tomography reliably indicated the presence or absence of intracranial tumor extension in the two patients in whom it was performed. Radionuclide bone scanning was a useful adjunct for osteosarcomatous detection.
Modeling the impact of prostate cancer early diagnosis on managed care plans.
Efforts to improve decisions about the appropriate use of new and existing technologies have prompted the development of technology assessment committees and advisory panels within managed care plans. As part of this development, plans are using a variety of sophisticated tools to aid their decision making. One such tool is the actuarial model, a method of quantitatively estimating the risk associated with providing care to specified populations.
An actuarial model approach to assessing the impact of serial testing for prostate cancer using the Tandem PSA assay.
This article summarizes an analytical approach to modeling prostate cancer detection scenarios that health-care plans, i.e., managed care organizations, can use to assist them in making early detection policy decisions. The actuarial modeling approach incorporates current variations in clinical practice with costs for the purpose of generating per member per month outputs. The intent of this approach is to provide laboratories with a tool to provide a value-added service to their managed care customers. The model can be tailored to an array of managed care plans and payer financial arrangements. Included here is a summary of an oral presentation from the Outcomes Conference at the CLMA meeting in Minneapolis, Minnesota in August of 1995. This material was presented by Robert Parson.