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Biomedical subjects

M Moskowitz

Publications and source records attributed to M Moskowitz.

At least 37 records · Page 2Linked to original sources
PubMed1987

Cost-benefit determinations in screening mammography.

A cost-benefit analysis clearly shows that the costs for screening a large population of asymptomatic women are well within the cost-benefit range accepted for other areas within the medical care system. Reduction in cancer deaths is not easy to come by. When a method is available which can achieve this result, every effort should be made to make it available until it can be replaced satisfactorily with a less expensive, equally effective method.

Breast Neoplasms↗
PubMed1987

Occult breast cancer: prevalence and radiographic detectability.

The radiographic detectability of occult breast cancer has been difficult to determine. A prospective study of breast disease was carried out that involved the performance of subcutaneous mastectomies in 519 consecutive cases of traumatic or initially unexplained death in New Mexico. Routine mammograms and radiographs of 1-cm specimens were obtained. At least 18 biopsies were performed in each subject. Carcinoma was identified in ten subjects; one subject had metastatic carcinoma from the lung, and two subjects had bilateral breast cancer, for a total of 11 breast cancers identified with microscopic examination. Two of the cancers were seen on whole-breast mammograms, and six were seen on radiographs of thin-section specimens. Four of the 11 breast cancers were apparent only on histologic study of breast tissue that was not suggestive of malignancy. No cancer was found in subjects under the age of 39 years. Five carcinomas were found in the 40-69-year age group; six were found in the 70-year and over age group. No correlation was noted between the radiographic Wolfe parenchymal patterns and the prevalence of breast cancer.

Adolescent↗
PubMed1987

Dental chair intracerebral hemorrhage.

A 52-year-old woman had a fatal intracerebral hemorrhage after dental manipulation. Normotensive in the past, the initial blood pressure was high but rapidly returned to normal. Necropsy showed no vascular malformation or evidence of hypertensive vascular disease. Clinical and experimental data show that stimulation of trigeminal fibers can cause important changes in blood pressure and pulse.

Cerebral Hemorrhage↗
PubMed1987

Costs of screening for breast cancer.

A cost-benefit analysis clearly shows that the costs for screening a large population of asymptomatic women are well within the cost-benefit range that is accepted for other areas within the medical care system. If profit and loss were the only considerations, one would opt for screening with combined examination for all women age 40 and older. If medical and philosophical considerations were to be included in the equation, clinical examination alone at any age cannot be justified. However, one might be able to justify mammography screening. Bierman has stated, "ultimately, when the scent is of flesh rather than figures, even the economist concedes that it will be important to insulate the individual practitioner (from cost-benefit/cost-effectiveness analysis) on a day-to-day basis because of potential conflict with the commitment to do what is best for each patient. Here is the crux. The economist's reference to the 'nation's health' is at best ambiguous and more likely meaningless. The physician's commitment to the patient's health is neither of these: it is clear, undeniable, and profoundly meaningful." Reduction in cancer deaths is not easy to come by. When a method is available that can achieve this result, every effort should be made to make it available until it can be replaced satisfactorily by a less expensive, equally effective modality.

Breast Neoplasms↗
PubMed1987

Peripartum congestive cardiomyopathy and endocardial fibroelastosis associated with ritodrine treatment. A case report.

Congestive cardiomyopathy from endocardial fibroelastosis occurred in a 24-year-old primigravida with a twin gestation and preeclampsia. The patient was taking ritodrine for premature labor. Cardiovascular evaluation should be performed during the course of ritodrine treatment, and no patient should be discharged if she does not have normal cardiovascular function.

Adult↗
PubMed1986

Response of brainstem trigeminal neurons to electrical stimulation of the dura.

The extracellular response of medullary trigeminal neurons to electrical stimulation of the dura was studied in anesthetized cats. Fifty-six medullary trigeminal units were excited by stimulation sites near major dural vessels with an average latency of 11.0 ms. Many units also responded to infraorbital nerve shock and had cutaneous receptive fields that included the ipsilateral periorbital region. These cutaneous responses were either wide dynamic range or nociceptive specific in type. Electrical stimulation of the midbrain periaqueductal gray region suppressed the response of medullary trigeminal units to either dural stimulation or infraorbital nerve shock. Medullary trigeminal neurons that receive convergent inputs from dura and facial skin may provide a physiological substrate for the cutaneous referral of dural sensation.

Animals↗
PubMed1986

Observer variation in the classification of mammographic parenchymal patterns.

Wolfe has described different cancer risks associated with a classification of four patterns of the breast parenchyma on mammography, but there is however little information available on the ability of radiologists to agree on the classification of the different patterns. We have assessed inter-rater agreement on the assignment of films to one of the four mammographic patterns described by Wolfe. One hundred xeromammograms were selected, copied and distributed to 10 radiologists who were experts in mammography. Films were classified according to the presence or absence of several radiological signs, according to diagnosis and recommendation, and according to mammographic pattern. Agreement was assessed after correction for agreement expected by chance, using the Kappa statistic. In general, high levels of agreement were found for the classification of mammographic pattern. Agreement on the classification of mammographic pattern was substantially greater than agreement for any other feature of mammographic interpretation, including diagnosis and recommendation.

Breast Neoplasms↗
PubMed1986

Breast cancer: age-specific growth rates and screening strategies.

In an earlier work, the author and colleagues predicted that the lead time gained by mammographic screening of an asymptomatic, randomly selected population of women was 2 years +/- 0.5 for women aged 35-49 years and 3.5 years +/- 0.5 for those over age 50. At the completion of long-term follow-up of 10,530 women (with a total of 111,087 "person years"), the resultant lead time actually gained seems to be 12-24 months for women aged 35-49 years at entry and 3.5-4 years for older women. Failure to take this lead time into account in the design of controlled trials may well result in failure to decrease mortality due to breast cancer. The results of the present study and those of recent Dutch and Swedish trials suggest that the most effective screening strategy may be annual mammographic and clinical examinations for women aged 40-49 years and biennial examinations thereafter.

Adult↗
PubMed1985

Thermography as a risk indicator of breast cancer. Results of a study and a review of the recent literature.

Because of recent data suggesting that about 40% of patients with a positive thermogram may subsequently develop breast cancer, a review of the data from the Cincinnati Breast Cancer Detection Demonstration Project (BCDDP) was undertaken. Of the 1,260 patients with more than one positive thermogram from 1973 to 1976, 1.9% subsequently developed breast cancer from 1977 to 1983. That finding was not significantly different from the 1.3% of patients who developed cancer and never had a positive thermogram. A critical review of the recent literature on the subject reinforces the BCDDP findings.

Breast Neoplasms↗
PubMed1984

Breast cancer screening: significance of minimal breast cancers.

Analysis of cancers occurring during an aggressive screening program indicates: (1) In our study, during 3 years of active incidence screening of women under the age of 50 years, 24 cancers occurred, 14 of which were minimal. In the 3 years that there has been very limited screening, 23 cancers occurred, only five of which were minimal (p = 0.02393). (2) We projected that 110 breast cancers should have occurred in the incidence years of observation of this self-selected population of 10,531 women. In our screened population, 124 cancers occurred. This is not significantly different from the expected number. (3) In a similar period of observation of a similar sized screened population 112 cancers occurred in Louisville and 113 cases of cancer occurred in Seattle. There is no significant difference from the 124 cases reported in Cincinnati nor from the 110 cases expected. However, of all forms of cancer (prevalent, incident, interval) in Cincinnati, 67 cases were minimal, as against 35 in Louisville and 23 in Seattle (p = less than 0.0001). All in all, these data supported the concept that screening for breast cancer does not in any significant way increase the number of cancer cases detected, it only advances the stage of detection. The data also suggest that, for an aggressive screen, length-biased sampling does not seem to be an insurmountable obstacle.

Adult↗
PubMed1984

Screening for breast cancer in Europe: achievements, problems, and future.

Several breast cancer screening programmes are being carried out in Europe. Clinical examination in combination with mammography is the screening method used in Guildford and Edinburgh (United Kingdom) as well as in Utrecht (Netherlands). Mammography is the only screening modality in the Swedish programmes of Falun (Kopparberg County), Linköping (Ostergötland county), and Malmö and in Nijmegen (Netherlands). Clinical examination is the initial screening method in Turku (Finland). The Swedish programmes are population-based, controlled, and randomised. They are designed to assess the impact of screening on the mortality of breast carcinoma. Comparing the results of all the European screening programmes is expected to give some answers to the hitherto unanswered questions concerning the screening method and ideal interval in different age groups. The results achieved so far indicate that although mammography is a sensitive method for the detection of early breast cancer, clinical examination and an aggressive biopsy policy may be necessary to reduce mortality from breast cancer in certain age groups. It is also evident that there is no universally applicable ideal screening method or rescreening interval for all age groups.

Adult↗
PubMed1984

Mammography to screen asymptomatic women for breast cancer.

Despite the lack of absolute confirmation from a properly controlled clinical trial, there is now sufficient evidence to permit the working assumption that screening mammography beginning at age 40 will play a substantial role in controlling breast cancer. An analysis of available data indicates that the benefits of mammographic screening far exceed potential risk, and that earlier detection of cancer will actually add years to life rather than simply permit an earlier diagnosis. American radiologists are now challenged to provide screening mammography in an easily accessible and inexpensive form, so that it is effectively available to all women over age 40.

Adult↗
PubMed1983

The predictive value of certain mammographic signs in screening for breast cancer.

Prospective evaluation of aggressive screening for breast cancers which are either 5 mm in size or, alternatively, wholly intraductal or in situ lobular, was performed. Twenty-one percent of all cancers were identified by the presence of microcalcifications; 71% of these were minimal and the predictive value of microcalcifications was 11.5% (+/- 1.7). The probability of cancer given a radiographically benign, dominant mass over 1 cm in size, palpable or not, was 2% (+/- 0.8) and two-thirds of these cancers were minimal. If diagnosis had not been established by biopsy for these benign appearing lesions six percent of all cancers would not have been detected. Had clinical examination been omitted from screening, 32 cancers (16%) would have been eliminated, 13 of which were minimal. However, the false-positive rate would have been halved. The range of predictive values, true-positive rates, and percent of minimal cancers detected are presented for each of several mammographic signs when clinical examination was either positive or negative.

Biopsy↗