Investigators relate experience with bovine somatotropin.
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Animals↗
Biomedical subjects
M Hopkins
Publications and source records attributed to M Hopkins.
Psychosocial factors as predictors of length of stay of Medicare patients under the prospective payment system.
The Prospective Payment System methodology is designed to predict inpatient hospital resource utilization. The system sets standards based on medical diagnosis (Diagnosis Related Groups), but it ignores psychosocial characteristics which often determine discharge options and therefore, directly affect a patient's length of stay. A study is described which examined the psychosocial characteristics of 234 elderly hospitalized patients in relation to length of stay and route of admission (elective or emergency room). Such data can be very useful to discharge planners in identifying high social risk patients, as well as to health planners attempting to modify the DRG methodology to incorporate psychosocial factors.
Age Factors↗
Optimal coverage of peritoneal surface in whole abdominal radiation for ovarian neoplasms.
Patterns of failure in ovarian carcinoma include early seeding of the entire peritoneal cavity. Inability to encompass the anatomic extent of the peritoneal cavity is a possible factor leading to relapse. However, little has been published regarding technical advances in optimal coverage of the peritoneal surface in whole abdominal radiation. In the Department of Radiation Oncology at the University of Michigan, 21 consecutive patients were analyzed prospectively in regard to adequate coverage of peritoneum in the treatment of advanced ovarian carcinoma. Simulation and focused blocks were designed to treat the whole abdomen. CT treatment planning studies were obtained with the entire peritoneum identified as the target volume. Simulator designed blocks were projected over the CT scans throughout the treatment volume. Dose volume histograms were used to calculate the amount of target volume missed for each treatment plan. All treatment plans demonstrated different degrees of volume miss, ranging from 1 cm3 to 837.3 cm3 with a median of 137.9 cm3 overall. Volume missed directly correlated with increasing patient weight and flatter pelvic shape, but poorly with AP separation. This was especially evident for patients requiring treatment at extended distances in both the supine and prone positions. We conclude that bony landmarks are poor guidelines in designing pelvic blocks, especially in heavy patients and patients requiring treatment in both prone and supine positions. CT treatment planning is helpful to ensure optimal peritoneal coverage.
Abdomen↗
Clinicopathologic features of ovarian mixed mesodermal tumors and carcinosarcomas.
Over a 27-year period there were 15 patients treated at the University of Michigan Medical center for carcinosarcomas or mixed mesodermal tumors of the ovary. Overall median survival was 11 months. Median survival was 4 months in patients with carcinosarcomas and 13 months in patients with mixed mesodermal tumors (P = 0.066). Patients with a chondrosarcomatous element had a significantly longer median survival than patients with mixed mesodermal tumors lacking cartilaginous differentiation (P = 0.031). The presence of a rhabdomyosarcomatous element did not affect survival. The size of the primary tumor, presence of ascites, FIGO stage, and degree of initial resection (optimal versus suboptimal) did not affect survival. There was no difference in survival between patients receiving postoperative chemotherapy and patients undergoing postoperative irradiation.
Adult↗
A referendum on clinical trial research in multiple sclerosis: the opinion of the participants at the Jekyll Island workshop.
Sixty-two experienced multiple sclerosis (MS) investigators attending a research workshop were asked their opinions about clinical trial design, outcome measures, and treatment. Respondents favored repeated clinical observations of neurologic function (eg, Expanded Disability Status Scale or Ambulation Index) over the opinion of a blinded physician and changes on magnetic resonance imaging. There was agreement that stable MS should not be treated with immunosuppressives. Corticosteroids were rated the most effective treatment for recent disease activity. Total lymphoid irradiation and immunosuppressives were judged more potent for the long-term management of progressive disease. No treatment, however, received the support of more than 11% of the respondents for being of "considerable efficacy" in the long-term management of MS. Most favored a placebo-controlled design in future trials. In order to judge the acceptability of current trial design, participants were asked to act as patient surrogates and to indicate whether they would agree to participate in 4 randomized trials for which they would be eligible. The majority consented to participate in the 3 major trials currently under way, and most refused to enroll in the 1 trial that had never been initiated.
Clinical Trials as Topic↗
How reproducible are flow cytometry data from paraffin-embedded blocks?
The purpose of this technical report is to determine the reproducibility of flow cytometry data for ploidy and cell cycle kinetics using paraffin-embedded blocks of breast cancer tissue. One block from each of 39 tumors was studied in this report with each block having multiple sections analyzed independently. All of these sections gave ploidy analyses, while only 34 gave cell kinetic values. The standard deviation for the DNA index value in the multiple analysis study was less than 0.1 in all but three cases. The cell kinetic values gave larger variability, and the actual values were dependent on the method of analysis. Comparison of the variability for each method of analysis could not predict which procedure was superior. These results would indicate that ploidy is a reproducible value, while cell kinetic parameters should only be used as an indicator of proliferative activity that has been normalized to the mean or median of a large set of observations processed and analyzed by the same procedure.
Breast Neoplasms↗
Managed care plans: CFOs weigh the benefits.
Managed health care is one of the biggest changes to occur in the healthcare industry. It has also had one of the greatest effects on the financial viability of hospitals. By the year 2000, it is expected that 70 percent of insurance premiums will be paid to some sort of capitated managed care plan as opposed to traditional insurance. With the arrival of managed care plans comes many questions for hospital CFOs. To answer these questions and gain an understanding of how different organizations are coping with managed health care, a survey of hospital CFOs was conducted. It was concluded that managed care is definitely here to stay. While CFOs feel there are risks involved, managed care plans are an area that will provide the greatest opportunity for organizational growth.
Attitude of Health Personnel↗
A report on the EC/IC bypass study.
In 1967 the first extracranial to intracranial (EC/IC) arterial anastomosis was performed. Since that time, EC/IC bypass surgery has become a widely accepted surgical treatment for patients with intracranial stenotic or occlusive atherosclerotic lesions. In 1977 an international multicenter randomized trial was established to determine whether EC/IC bypass surgery reduced the rate of stroke and stroke-related death in patients with recent hemispheric and/or retinal ischemic symptoms. Completed and analyzed in 1985, the International Cooperative Study of Extracranial/Intracranial Arterial Anastomosis of 1,377 patients provides an evaluation of the surgical procedure for stroke prevention. This paper will discuss the study's objectives and organization, the methods employed, the trial results, and implications.
Cerebral Arteries↗
Meigs's syndrome and ovarian thecoma in pregnancy. A case report.
Ovarian thecoma is a rare tumor, accounting for less than 1% of all ovarian tumors. Thecomas occur even more infrequently during pregnancy, as evident from the fact that there are only 16 such case reports. A 16-year-old, pregnant, black woman presented with ovarian thecoma, pleural effusion and ascites at 32 weeks' gestation. To our knowledge, this was the first reported case that fulfills the criteria of Meigs's syndrome during pregnancy. Ovarian tumors in pregnancy may have very subtle clinical manifestations, making the diagnosis a challenge. Delivery by cesarean section at term is recommended in these patients for the best maternal and fetal outcome.
Adolescent↗
Relationship of flow cytometry results to clinical and steroid receptor status in human breast cancer.
Flow cytometry (FC), estrogen receptor (ER), and progesterone receptor (PR) analyses were performed on 226 breast cancers. The presence of steroid receptors was inversely proportional to proliferative index and percent aneuploidy. Within the two ER (+ and -) groups, the presence of PR did not add significantly to the comparison. The mean proliferative index for the diploid tumors was 17.5 +/- 6.8 compared to 27.8 +/- 9.8 for aneuploid tumors (p less than .001). The degree of aneuploidy, or DNA index, was not related to cell cycle kinetics or steroid receptor status. In 163 tissues analyzed for percent tumor present, a correlation between the relative number of aneuploid cells and percent tumor in the histologic review was observed. A study of the diploid tumors indicated greater than 75% had at least 10% tumor cells by histologic review. Since with FC one can observe at least 10% aneuploid cells in a tumor sample, it is our opinion that the percent aneuploidy in this study is not artifactually low due to sampling error. There was no significant relationship between nodal status or number of positive nodes and proliferative index, aneuploidy, or steroid receptor status. Metastatic tumors had a higher mean proliferative index, but this was not statistically significant. There was a relationship between age and proliferative index but not between age and ploidy status. In a small group of patients there was a trend for proliferative index and percent aneuploidy to be higher in the poorly differentiated and larger tumors when compared to the well differentiated and smaller tumors.
Age Factors↗
Malignant placental site trophoblastic tumor.
Placental site trophoblastic tumor is a rare variant of trophoblastic disease. The malignant form of this disease with metastasis and death is even more infrequent, as is evident from only five cases in the literature. A 30-year-old black woman who died from this disease is presented. Patients with metastases are at extremely high risk with no reported survivors and must be treated aggressively with chemotherapy and cytoreductive surgery. This type of trophoblastic tumor apparently exhibits a different biologic behavior as compared with choriocarcinoma.
Adult↗
Histiocytic and dendritic reticulum cells shown by a zinc iodide-osmium technique.
Structures corresponding to histiocytic and dendritic reticulum cells have been shown in human tonsillar tissue, "reactive" lymph nodes and spleens by means of a zinc iodide-osmium technique. These cell types have been shown in various locations in these tissues using paraffin and resin embedded sections produced after fixation/staining of the tissue in zinc iodide-osmium. The quality of morphology attained by this procedure is much improved compared with the demonstration of the two cell types by means of alpha-naphthyl acetate esterase reactions performed on frozen sections. The zonal architecture of the lymphoid follicle is emphasised by this technique. In lymph nodes, sinus lining cells are also shown. Lymphoid cells, polymorphs, fibroblasts, and endothelial cells are negative with the zinc iodide-osmium method. In addition, interdigitating cells are not stained. The results of this procedure are compared with those with those of other methods for the demonstration of histiocytic and dendritic reticulum cells.
Cytological Techniques↗
Conditioning of the diaphragm with phrenic nerve stimulation after prolonged disuse.
We studied the effect of electrical stimulation of the phrenic nerve on the force frequency relationship of the disused diaphragm. A high quadriplegic who had been totally ventilator dependent for 6 months following a C2 fracture received bilateral phrenic nerve stimulators. During a 6-wk period of conditioning by electrical stimulation, the force of diaphragm contraction was assessed by measurement of transdiaphragmatic pressures during stimulation of each nerve over a range of frequencies. Tidal volume as well as rib cage and abdominal motion were studied. There was an upward shift of the force frequency relationship of the diaphragm over the 4-month period of phrenic nerve pacing using repetitive stimulus trains of 14 to 28 Hz. This improvement appeared to plateau at about 11 wk. The increase in contractility was accompanied by a progressive diminution in the stimulus frequency at which fusion of the contraction occurred. The disused diaphragm, like other skeletal muscle, may be conditioned with electrical stimulation.
Aminophylline↗
Retinoic acid binding proteins and steroid receptor levels in human breast cancer.
Samples of 31 human breast cancer tissues were examined for the presence or absence of cytosolic retinoic acid binding proteins (cRABP), estrogen receptors (ER) and progesterone receptors (PR). cRABP were detected as specifically sedimenting 2S components on sucrose density gradient. Specific binding under the 2S region for cRABP and under the 8S region for ERR and PR were determined. The levels of cRABP ranged from less than 1 pmol to 14 pmol per mg of cytosol protein. Tumors containing less than 3 pmol cRABP were designed as low cRABP; tissues were considered ER- and PR- when the receptor levels were less than 10 fmol/mg protein. Approximately 60% of primary and metastatic tumors examined contained high cRABP. Tumors with well differentiated histopathology exhibited increased levels of cRABP. There was no significant correlation between the presence or absence of steroid receptors and cRABP in human mammary tumors.
Breast Neoplasms↗
The effect of orthodontic appliances on the distribution of Candida and plaque in adolescents.
The site prevalence and intra-oral density of Candidal organisms may be increased by local factors including prostheses. However, whether significant changes in Candidal carriage occurs with denture wearing is not clearly established. This study employed the imprint culture technique to assess the effects of fixed and removable orthodontic appliances on oral carriage, site prevalence and intra-oral density of Candida in adolescents. Moreover, alterations in plaque distribution were measured. Groups of 12-16 year olds without or wearing fixed and removable appliances were studied. Imprint cultures were taken from six intra-oral sites and colony counts recorded after 48 hours incubation on selective media. Plaque scores were recorded from non-appliance and removable appliance wearers. The prevalence of Candidal carriage in the groups was not significantly different being 46 per cent of non-appliance, 51 per cent of fixed appliance and 52 per cent of removable appliance wearers. However, the prevalence of Candidal recovery at some sites and Candidal densities at all sites were significantly increased in both fixed and removable appliance wearers. Thus orthodontic appliances may predispose to Candidal proliferation in oral carriers. However, the results do not permit the conclusion that appliances may change non-carriers of Candida to carriers. Plaque distribution was significantly altered in removable appliance wearers when compared with non-appliance wearers as a result of increases in palatal plaque scores. These findings again emphasize the particular need for oral hygiene instruction in patients wearing appliances or partial prostheses.
Adolescent↗
An analysis of causes of injuries in workers with leprosy and suggestions for preventive measures.
A study of 20 workers undergoing social and vocational rehabilitation and of 30 patients receiving treatment in Ulcer Ward reveals bio-social data and endeavours to uncover the causes of injuries to anaesthetic areas. Suggestions are put forward for prevention of injuries which often lead to ulcers and these suggestions are examined in the light of short trials of various methods.
Extremities↗
The role of the T cell in experimental pyelonephritis.
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Animals↗
The effect of methyldopa on creatinine estimation.
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Autoanalysis↗