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Biomedical subjects

M Randall

Publications and source records attributed to M Randall.

At least 37 records · Page 2Linked to original sources
PubMed1994

Comparative voice results after laser resection or irradiation of T1 vocal cord carcinoma.

OBJECTIVE: To compare voice results following laser resection or radiation therapy for T1a glottic carcinomas. DESIGN: Objective recordings of acoustical data that were analyzed and calculated by an acoustic analyzer and subjective scores by patients, speech therapists, surgeons, and radiation therapists are compared. SETTING: Academic medical center speech laboratory at an institution where patients had been treated. Archival files were searched and patients were solicited by letter to participate in this analysis. PATIENTS: Men treated at least 6 months previously and who were without active laryngeal disease. Criteria were unilateral vocal cord carcinomatous involvement with no subglottic, anterior commissure, or arytenoid extension and tumor invasion clinically judged to be less than half of the cordal depth. INTERVENTIONS: Thirteen patients had received approximately 63 Gy in 28 fractions, five fractions a week, with laterally opposed fields using a linear accelerator. Eleven patients had had resection of less than half of the cordal depth by using a carbon dioxide laser with a 300-microns spot size working at a 400-mm distance; 13- to 15-W power intensity with a one tenth of a second burn in a noncontinuous mode. RESULTS: No statistically significant differences between the two study groups were found. Patients and physicians subjectively rated (1 indicates normal; 5, aphonic) the quality of voices of patients in the irradiation group (1.5 and 2.0) as slightly better than the quality of voices of patients in the laser group (2.0 and 2.4). Speech pathologists rated the voices of patients in the laser and irradiation group as indistinguishable and mildly abnormal (2.75 and 2.73). CONCLUSION: Voice quality in highly selected patients with vocal cord carcinoma treated by laser resection can be as good as that in patients whose cancer was similarly staged after radiation therapy.

Carcinoma, Squamous Cell↗
PubMed1994

Can you trust patient self-reports of drug use during treatment?

This study compared two frequently used measures of drug use, urine testing and self-report in a sample of subjects currently enrolled in methadone treatment for a minimum of six months. A comparison between the percentage of positive opiate urine screens and subjects' self-reported opiate use indicated that more patients self-reported opiate use (80%) than had been detected by urinalysis (57%). Similar results were found for cocaine use. We present arguments that a more inclusive method of measuring drug use during treatment should include the combination of both urinalysis and self-reports.

Adult↗
PubMed1994

Infection in immunocompromised patients with malignant blood disorders in a district general hospital.

The pattern and management of infection in immunocompromised patients over a period of 3 years in a district general hospital has been studied. A total of 222 positive cultures was obtained in 607 episodes of suspected infection all involving patients with malignant blood disorders. Febrile episodes requiring intravenous antibiotics occurred in 248 instances involving 107 patients. The pattern of organisms cultured and the responses to various antibiotic regimes are reported. The costs of antibiotic therapy are considered in the light of the overall response. Of the patients studied, 54 died, infection having a likely causative or contributory part in 21 of them (less than 10% of infective episodes). We conclude that the infective complications of these disorders, particularly in older patients, can be efficiently managed in a district general hospital when full supportive facilities are available.

Adult↗
PubMed1990

Patterns of failure in patients with stage I, grade 3 carcinoma of the endometrium.

Patients with high grade, early stage endometrial carcinoma are reported to have worse survival and local control rates than those with low grade carcinomas. To define failure patterns further in patients with FIGO Stage I, grade 3 endometrial carcinomas, the patients from three institutions who received adjuvant or definitive radiation (RT) were analyzed. Of 119 patients meeting the criteria of Stage I, grade 3 endometrial carcinoma, 57 patients received preoperative radiation, 49 patients received postoperative radiation, and 10 patients received definitive radiation with 5-year actuarial survival rates of 64%, 73%, and 65%, respectively. Three additional patients received both preoperative and postoperative treatment. The overall local control rate was 88% with a median follow-up of 70 months. Of 36 patients who failed, 14 had a component of local failure, and 31 had a component of distant failure. Eighteen of 31 distant failures involved metastatic spread to the abdominal cavity. Recurrence patterns by method of treatment are documented. Patients with high grade tumors do have a propensity for distant metastasis. Clinical investigation into the value of systemic therapy is necessary.

Adenocarcinoma↗
PubMed1987

An increase in in vitro fertilization ability of low-density human sperm capacitated by multiple-tube swim-up.

Comparison was made of the efficacy of multiple-tube swim-up (MT-SU) and single-tube swim-up (ST-SU) preparations on inducing human sperm fertilization ability in semen samples of less than 60 million motile sperm/ml. Two parallel groups of in vitro fertilization (IVF) patients possessing sperm density of this category had their sperm capacitated by MT-SU or ST-SU. The MT-SU patients' sperm fertilized 71 +/- 6.0% of eggs retrieved in comparison to 39 +/- 7.9% in the parallel ST-SU patients (P less than 0.001). Similarly, MT-SU increased the rate of human sperm penetration into zona-free hamster eggs. The increased fertilization rate of MT-SU sperm was not from acceleration of the acrosome reaction, but may be attributed to the higher efficiency of MT-SU in removing antifertility factors present in the seminal plasma from sperm.

Acrosome↗
PubMed1986

Brain-tumor cell kinetics correlated with survival.

In a review of 38 glioblastoma patients for whom fresh tissue kinetic data were available before any therapy was instituted, no correlation between the labeling index and survival time could be statistically determined. This relationship seems entirely consistent with the published theoretical determinants of tumor behavior: that is, altered ability for growth arrest and differentiation, constantly evolving mutant sublines, genetic instability, and an ever-changing metabolic and vascular environment.

Brain Neoplasms↗
PubMed1984

Marital separation and health: stress and intervention.

Marital separation is a stressful life event implicated in much current thinking and practice in mental health, health psychology and psychosomatic medicine. This study examines marital separation in a controlled, prospective design. The participants were 314 Health Maintenance Organization (HMO) subscribers followed over a two year period. Marital separation was experienced by 127 of these participants early in the two-year study period. A stratified random half of these separated individuals participated in a short-term psychoeducational group intervention, "Seminars for the Separated." Measures of psychosocial adjustment and medical utilization were analyzed to describe correlates of marital separation and to evaluate the intervention. Statistically significant increases in medical utilization by people experiencing marital separation were observed in comparisons with married control subjects. Much of this increased utilization occurred in the year surrounding the actual separation and may be accounted for by mental health visits as well as nonmental health contacts with the health plan. The effects of the intervention were not evident until controls for baseline levels of medical utilization were introduced into the multivariate analysis. Even then, intervention effects were slight. Methodological problems and implications for further study are presented.

Adaptation, Psychological↗
PubMed1982

The stress of marital separation: intervention in a Health Maintenance Organization.

Relationships between life stress and illness form the basis of much current thinking and practice in psychosomatic medicine. This study examines a particular life stress, marital separation, in a controlled, prospective design. Participants are 237 Health Maintenance Organization [HMO] subscribers followed over a two-year period. Marital separation was experienced by 117 of these participants early in the two-year study period. A stratified random half of these separated individuals participated in a short-term psychoeducational group intervention, "Seminars for the Separated." Measures of psychosocial adjustment and medical utilization were analyzed to describe correlates of experiencing marital separation and to evaluate the intervention. Statistically significant increases in medical utilization by people experiencing marital separation were observed in comparisons with married control subjects. Much of this increased utilization is in the year surrounding the actual separation and is accounted for by mental health visits. Effects of the intervention were not evident until controls for baseline levels of medical utilization were introduced. Even then, intervention effects were slight. Methodological problems and implications for further study are presented.

Adult↗
PubMed1978

Opiates, catecholamines, behavior, and mood.

Indirect evidence has linked opioid reinforcement with changes in noradrenergic metabolism secondary to drug administration. Methodological precedents for biobehavioral correlations in depressive illness have suggested an important association between changes in mood and biogenic amine excretion patterns in the urines of patients during depression and recovery. This paper presents preliminary data on the possible relationship between changes in catecholamine excretion that were observed and the changes in behavior, mood, psychiatric status, and cardiorespiratory physiology secondary to heroin administration and methadone-assisted withdrawal. This study focuses on the urinary excretion of MHPG, since an appreciable fraction of this metabolite is probably derived from norepinephrine originating in the brain. The subjective changes in mood associated with heroin use, the decrease in respiratory rate, and the behavioral and mental status effects associated with opiate intoxication were observed only in the individuals whose MHPG excretion increased during the period of opiate administration.

Adult↗
PubMed1976

Changes in shape, ossification and quality of bones in children with spina bifida.

Changes in the cross-sectional shape, size, bone mass and amount of unmineralised osteoid tissue were studied in 17 dissected tibiae from spina-bifida babies who died with paralysis and foot deformities and in 14 tibiae from non-spina bifida controls of matching age. In addition, 12 tibiae from young experimental rats with myotomy of foot dorsiflexors and foot plantiflexors were double-labelled with bone-seeking markers and studied in order to find the role of experimental muscle imbalance in the dynamic remodelling of the developing long bones. It was found that in tibiae from spina-bifida children with paralysis the total area of cortical bone, its thickness, number of Haversian systems and number of large remodelling cavities are diminished. Significant changes in the cross-sectional shape of the midshaft of the tibia were found, ranging from the triangular shape seen in normal babies and in those with spina bifida and calcaneus-type foot deformity, to the circular shape of tibiae from babies with spina-bifida paralysis and no foot deformity or with spina bifida and equinovarus-type of deformity. Results of experimental myotomy on growing rats showed the direct influence of working muscles on the remodelling process of growing tibiae. On the side of myotomy the flat cortex resumed a bulging convex shape and the centre of gravity shifted towards the myotomised side. These principles cannot on their own explain the specific changes in the shape of human tibiae found during anatomical studies. There is, however, a common denominator in these apparently contradictory findings. This is the combined action of two factors previously reported: the combination of paralysis of the growing limb and mechanical intra-uterine pressure acting on it. The findings in the present study also indicate that they played a major role in the production of deformities. The total amount of osteoid tissue in spina-bifida paralysed bone is increased. This delay of mineralisation of newly laid-down bone matrix would lead to softening of the new bone matrix and osteoid-rich subepiphyseal and metaphyseal regions. This 'paralytic rickets', together with the diminished total bone mass found, could probably be the cause of the common spina-bifida fractures in these regions.

Animals↗
PubMed1976

Aftercare on narcotic antagonists: prospects and problems.

This study examines the problems and prospects of aftercare of the multiple treatment failure opiate addict who is being treated with narcotic antagonists (primarily naltrexone). At the time of this paper, 21 patients had been admitted to the Drug Addiction Research Project at McLean Hospital, with a retention rate of 42%. "Completers," "noncompleters," and "dropouts" could not be differentiated on the basis of demographic or psychiatric variables, thus making it impossible to define the population most suited for antagonist treatment. The degree of carry-over into the first month in the community, for those who successfully completed the inpatient segment of the program, disappeared over time. The nonreinforcing (lack of euphoric effect) properties of the antagonists and the resultant high level of motivation necessary for the continuation of its use by the patient make this form of treatment suitable for only a small percentage of the "hard core" addict population.

Adult↗