Biomedical subjects
Publications and source records attributed to M W Morgan.
Renal cell carcinoma represents 3% of all adult malignancies. Metastases occur most frequently in the bone and lung. Four cases of renal cell carcinoma metastasizing to the thyroid gland are described here. A literature review is presented and guidelines for the management of this rare condition are suggested.
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Health care has taken advantage of computers to streamline many clinical and administrative processes. However, the potential of health care information technology as a source of data for clinical and administrative decision support has not been fully explored. This paper describes the process of developing on-line analytical processing (OLAP) capacity from data generated in an on-line transaction processing (OLTP) system (the electronic patient record). We discuss the steps used to evaluate the EPR system, retrieve the data, and create an analytical data warehouse accessible for analysis. We also summarize studies based on the data (lab re-engineering, practice variation in diagnostic decision-making and evaluation of a clinical alert). Besides producing a useful data warehouse, the process also increased understanding of organizational and cost considerations in purchasing OLAP tools. We discuss the limitations of our approach and ways in which these limitations can be addressed.
Radial Scars/Complex Sclerosing Lesions are benign breast lesions that are seen more frequently now with the advent of screening mammography. These lesions need to be excised surgically in the absence of classical diagnostic features.
We conducted a preliminary community survey for diabetes in the Bo district of southern Sierra Leone. Five hundred and one subjects comprising 256 rural adults in two villages and 245 urban adults in Bo town were randomly selected and screened for diabetes using random capillary blood glucose according to WHO criteria. There were 6 diabetics, all in the urban area, giving a prevalence of 2.4% in the urban population, and 0% in the rural villages. The mean (s.d.) capillary random blood glucose (RBG) concentration was 5.7 +/- 1.7 mmol/l for the entire study population, while concentrations for the urban and rural populations were 5.8 +/- 2 and 5.5 +/- 1.4 mmol/l respectively (P > 0.05). RBG increased significantly with age. The mean (s.d.) body mass index (BMI) was 22.3 +/- 4.9 kg/m2 for the total population while those for the urban and rural populations were 23.0 +/- 5.8 and 21.6 +/- 3.6 respectively (P < 0.01). Only 5% of the population were obese, i.e. BMI > or = 30 kg/m2. Dietary habits were similar in both town and country. According to this survey, the prevalence of diabetes is very low in rural Sierra Leone, but urban areas may be experiencing increasing prevalence. Mechanisms for effective screening and promotion of proper diet and exercise must be incorporated into existing health services to prevent an escalation of diabetes in urban Sierra Leone.
The wound infection incidence during inpatient stay was compared with the post-discharge infection incidence for 1 month using audit data and a patient questionnaire. The true infection rate was found to be 20% compared with an apparent rate of 2.4% (P < 0.001). The study highlights the problems of postoperative monitoring in the context of shorter inpatient stays and fewer routine outpatient appointments.
OBJECTIVE: To assess the effect of a single randomized clinical trial, the National Surgical Adjuvant Breast Project (NSABP) B-06, on the surgical management of breast cancer in women. DESIGN: Retrospective cohort study. SETTING: All hospitals in Ontario. PATIENTS: A consecutive sample of 37,447 women with breast cancer newly diagnosed from Jan. 1, 1980, to Dec. 31, 1989, linked to a surgical procedure record in the Ontario Cancer Registry. MAIN OUTCOME MEASURE: The most invasive surgical procedure used within 90 days of diagnosis. RESULTS: Unilateral breast-ablative surgery (BAS) was performed in 57.3% of the women and breast-conserving surgery (BCS) in 31.6%. The annual rate of BAS declined from 77.5% in 1980 to 44.2% in 1989 and the rate of BCS rose from 12.5% in 1980 to 43.5% in 1989. The decline was linear from 1980 to 1984 and then accelerated significantly in 1985 (p < 0.0001), after the results of the NSABP B-06 trial were published. CONCLUSION: One randomized clinical trial can have an immediate and profound effect on medical practice.
One route by which Chlamydia trachomatis is internalized into host endometrial epithelial cells is receptor-mediated endocytosis. Although this implies an adhesin-receptor interaction exists, specific chlamydial surface molecules have not been identified. We are investigating potential adhesin molecules using an in vitro functional assay to select for chlamydial recombinant Escherichia coli expressing an adherent phenotype. We have previously shown that E. coli JM109(pPBW58) attaches to epithelial cells by a specific process paralleling C. trachomatis and expresses at least three plasmid-encoded proteins (18, 28, and 82 kDa; Schmiel, D. H., Knight, S. T., Raulston, J. E., Choong, J., Davis, C. H., and Wyrick, P. B. (1991) Infect. Immun. 59, 4001-4012). In this report, we demonstrate that (i) the 82-kDa protein is associated with the outer membrane of both E. coli JM109-(pPBW58) and C. trachomatis serovar E elementary bodies; (ii) the plasmid-encoded protein is identical to the native chlamydial protein by mass, charge, antigenicity, and partial proteolytic peptide profiles; (iii) a highly homologous protein is present in C. trachomatis biovariant lymphogranuloma venereum; (iv) the 82-kDa protein is not covalently linked by disulfide bonds to other protein species in either E. coli JM109(pPBW58) or C. trachomatis; (v) sequence analysis of the open reading frame indicates this protein is a relative of the heat shock 70 family of proteins; and (vi) the inferred amino acid sequence contains a contiguous 73-amino acid region having 51% identity with the extracellular sperm receptor binding domain in Strongylocentrosus purpuratus (Foltz, K. R., Partin, J. S., and Lennarz, W. J. (1993) Science 259, 1421-1425). The potential involvement of an hsp70 protein in attachment may provide new insight on adherence mechanisms by obligate intracellular pathogens.
This paper describes Dr. Hofstetter's early family life and the influences which shaped his attitudes to his friends, his work, and his profession. It chronicles his early experiences as a young professor of optometry and later as a highly successful administrator.
To evaluate the accuracy of computerized medical-record coding for human immunodeficiency virus (HIV), medical charts were reviewed in six sites. In 7601 hospital and 867 Medicaid records with a listed diagnosis of HIV, the predictive value for HIV was 91% or higher. HIV was identified in 34% of 1155 Medicaid records listing immune disorder or illness in the acquired immunodeficiency syndrome (AIDS) surveillance definition (without an HIV code). In hospital and Medicaid records, AIDS was identified both in records listing AIDS and records listing HIV without AIDS. HIV codes on hospital and Medicaid records were highly predictive for HIV; undercoding of HIV occurred in Medicaid records.
Fibroblasts from patients with Niemann-Pick Type II disease, including the panethnic type C (NPC) and Nova Scotia Acadian type D (NPD) forms, exhibit reduced or delayed stimulation of cholesterol esterification by low density lipoprotein (LDL). Based on recent evidence that cholesterol esterification can also be stimulated by cell surface sphingomyelin hydrolysis, we have compared the response of normal, NPC and NPD fibroblasts to treatment with exogenous sphingomyelinase (SMase). Staphylococcus aureus SMase (greater than 0.05 U/ml) hydrolyzed over 90% of endogenous sphingomyelin within 1 h and increased incorporation of [3H]oleic acid into cholesterol-[3H]oleate after an initial lag in all three cell types. However, normal levels of cholesterol esterification were not observed for NP Type II fibroblasts: four NPD cell lines exhibited an average of 32% of normal response while cholesterol esterification was only 20% in two well-characterized NPC lines. A third NPC line exhibited normal response to SMase despite greater than 90% impairment of LDL-stimulated cholesterol esterification. Incubation of fibroblasts with LDL followed by SMase produced a synergistic response, particularly in NPC cells where there was little response to either treatment alone. Chloroquine abolished LDL-stimulated cholesterol esterification in normal fibroblasts but had no effect on the response to SMase, indicating that lysosomal enzymes may not be involved in SMase-mediated cholesterol esterification. These results suggest that intracellular processing of cholesterol derived from either LDL or release from the plasma membrane (by sphingomyelin hydrolysis) is affected in Niemann-Pick Type II cells and that these pathways can complement one another in the stimulation of cholesterol esterification.
OBJECTIVES: The purpose of this study was to evaluate the completeness of acquired immunodeficiency syndrome (AIDS) case reporting. METHODS: Statewide or hospital-specific 1988 medical records were linked with AIDS surveillance in six sites. Medical records were reviewed for persons who had diagnoses suggesting human immunodeficiency virus (HIV) infection or AIDS but were not reported to AIDS surveillance by September 1989. RESULTS: Among 4500 hospitalized persons diagnosed with AIDS through 1988 in the six sites, completeness of reporting was 92% (95% CI = 89%, 96%; range across sites = 89% to 97%). Completeness of reporting was high in males (92%), females (95%), Whites (95%), Blacks (90%), Hispanics (92%), men reporting sexual contact with men (92%), persons reporting injecting-drug use (91%), and persons exposed to HIV through heterosexual contact (99%). In Medicaid enrollees (two states), completeness of reporting was 99% (95% CI = 95%, 99%) in inpatients and 90% (95% CI = 79%, 90%) in outpatients. Of previously reported persons with AIDS, 82% were reported within 5 months of diagnosis. CONCLUSIONS: Completeness of AIDS reporting was high, overall and in each major demographic and HIV exposure group. These results demonstrate that current surveillance data in these six sites provide timely and accurate information regarding persons with AIDS.
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The classification of convergence as described by Maddox in The Clinical Use of Prisms is discussed. Maddox believed that the vergence system could be analyzed in terms of additive components designated according to their sensory origin: tonic vergence, accommodative vergence, reflex, or disparity (fusion), vergence, and proximal, or psychic, vergence. This description is brought into perspective with current-day descriptions of components of the binocular vergence system.
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Primary monolayer cultures of nonproliferating adult human adrenocortical cells have been used to screen 18 cytotoxic drugs used in cancer chemotherapy for direct effects on corticosteroidogenesis. None of the drugs tested, with the exception of 5-fluorouracil (5-FU) and its metabolite 5-fluorodeoxyuridine, showed significant activity at levels compatible with cortical cell viability and/or likely to be encountered during therapy. These two antimetabolites, however, resulted in a slow but long-lived reversible suppression of corticosteroidogenesis in both ACTH- and monobutyryl cyclic AMP-stimulated, as well as unstimulated cultures of human cells. Thus 10 micrograms/ml resulted in less than 80% inhibition after seven days treatment without any evidence of overt cytotoxicity. High-pressure liquid chromatography showed a suppression of all UV-absorbing steroids secreted. Examination of the ultrastructure of the treated cells showed significant changes in mitochondrial morphology, suggesting a possible site of action for the antisteroidogenic effects of 5-fluorouracil. These in vitro results suggest the possibility of adrenal suppression in vivo during long-term or high dose infusion 5-FU chemotherapy.
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