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Biomedical subjects

R A Schmidt

Publications and source records attributed to R A Schmidt.

At least 55 records · Page 3Linked to original sources
PubMed1998

Breast conservation for mammographically occult carcinoma.

OBJECTIVE: Preoperative mammography is an essential part of the evaluation of patient eligibility for breast conserving therapy. SUMMARY BACKGROUND DATA: It is uncertain whether factors that contribute to the nonvisualization of carcinoma on mammograms are indications for mastectomy. The purpose of this study was to determine if the failure to identify clinically evident carcinoma on a mammogram is a contraindication to breast conserving therapy. METHODS: An analysis of 268 women with 269 clinically evident carcinomas who were treated from June 1988 to September 1993 was performed. Contraindications to breast preservation included multicentric tumors, diffuse indeterminate microcalcifications, pregnancy, prior irradiation to the breast region, the inability to achieve negative margins after two surgical procedures, and a large tumor to breast ratio. RESULTS: Mammographically occult tumors (MO) were present in 52 patients (19%). The mean age of patients with MO tumors was 52 versus 57 for mammographically evident (ME) tumors (p = 0.009), but the incidence by decade did not vary. Special histologic tumor types were more frequent among MO than ME tumors (13.5% vs. 1.8%, p < 0.001). Tumor size, the incidence of axillary node metastases, and stage did not vary. An equal proportion of patients with MO and ME tumors were candidates for breast preservation (67% vs. 70%), and a large tumor to breast ratio was the most common contraindication in both groups. CONCLUSIONS: Even with modem mammographic technology, MO tumors remain a significant problem. This study did not demonstrate an association between MO tumors and factors such as size, unfavorable histology, or multicentricity which would preclude the use of breast conserving therapy. These results support the treatment of MO tumors with breast conserving surgery after a detailed clinical evaluation.

Breast Neoplasms↗
PubMed1998

Neurostimulation and neuromodulation: a guide to selecting the right urologic patient.

Sensory input has an important influence on the integrity of neural circuitry. Central nervous system circuitry is programmed and reinforced by everyday experience. Even the simplest of behaviors participate in this process. A balance between inhibition and facilitation must be maintained for the CNS to function normally. For example, the bladder stores urine because of the inhibition from a closed sphincter, and relaxation of the sphincter disinhibits the bladder to permit voiding. This synergistic 'seesaw' in reflex neural activity preserves the functional and anatomical integrity of the lower urinary tract. Dysfunction and anatomical change results when an unnatural bias develops between inhibitory and facilitatory neural activity. Neurostimulation has an inherent conditioning effect on neural excitability and can restore the neural equilibrium. Voiding diaries are very useful in documenting these changes.

Electric Stimulation Therapy↗
PubMed1998

Neurogenically mediated cystitis in rats: an animal model.

PURPOSE: Pseudorabies virus (PRV) is a useful tool for mapping the control circuitry of the spinal cord. In the process of mapping CNS regulatory pathways for the lower urinary tract, a hemorrhagic change in the bladder was observed that was not overtly evident in other pelvic organs. The relationship between the appearance of hemorrhagic changes in the bladder and the evolution of PRV induced changes in the spinal cord was therefore explored. MATERIALS AND METHODS: Sprague-Dawley rats were injected with PRV into the ACD tail-muscle. Bladder and CNS fixation were achieved by transcardial perfusion with formaldehyde. Multi-level sections were obtained from T8 through S4. Fixed tissue was stained and evaluated by light microscopy. Immunohistochemical stains were carried out for PRV and iNOS on spinal cord tissue. We were therefore able to evaluate the relationship between the manifestation of the hemorrhagic cystitis, appearance of the PRV in the spinal cord and evidence of CNS inflammation. RESULTS: The evolution of hemorrhagic cystitis paralleled the evidence of inflammation in the thoraco-lumbar and sacral cord. These bladders contained 5 to 9 ml. of bloody urine (a normal rat bladder contains 1 to 2 ml.). On cystomanometry (CMG) the bladders were acontractile. No PRV could be cultured in the hemorrhagic bladders. The histological changes observed in the bladder represent true inflammation. CONCLUSION: There was no obvious explanation for these changes other than the associated inflammatory changes in the spinal cord. The findings are consistent with the hypothesis that a spinal cord stress, via an unknown metabolic pathway, can result in dramatic, neurogenically mediated changes in the bladder.

Animals↗
PubMed1997

Head and neck osteosarcoma at the University of Washington.

BACKGROUND: Head and neck osteosarcoma is a comparatively rare and aggressive malignancy. Our goal was to examine the experience of head and neck osteosarcoma patients seen over a 15-year period at the University of Washington Medical Center and compare this with the published experience of other centers in terms of demographics, histology, treatment, and survival rate. METHODS: We reviewed surgical pathology slides and clinical treatment records of 13 patients who were treated at the University of Washington Medical Center between 1981 and 1996. A total of 17 cases from 13 patients (13 primary tumors and 4 recurrences) were studied. RESULTS: There was a slight male predominance, with a male:female ratio of 1.6:1, and median age at diagnosis of 40.9 years (range 22 to 75 years), both slightly higher than has been generally reported. Three of 13 patients had recognized risk factors for the development of osteosarcoma: 2 with a history of prior radiotherapy and 1 with Paget's disease. All surgical pathology specimens were examined independently by two pathologists for histologic grading and typing. At initial presentation, 9/13 (69%) cases had conventional (osteoblastic) histology; 2/13 (15%) were fibroblastic, 1 chondroblastic (8%) and 1 parosteal (8%). Eight of 13 (62%) cases were high grade at initial presentation. Four of 13 (30%) of the primary tumors were low grade 2, of which did not recur over a median follow-up period of 24 months. The other 2 low-grade tumors later recurred locally, as high-grade osteosarcomas, after disease-free intervals of 1 year and 14 years, respectively. One patient had an intermediate-grade tumor which has not recurred as of last follow-up. Combined-modality treatment, including surgery with or without radiotherapy and/or chemotherapy, was given depending on the histologic grade, surgical margins, and recurrence. Some patients with low-grade tumors had surgery only. There were 5 local recurrences, 1 of these following a disease-free interval of 14 years. One patient had 3 separate recurrences at the same site. Ten of 13 (77%) are alive and disease-free. Of the 3 deaths, 1 was related to radiation-induced brain necrosis, without evidence of recurrent tumor. The project 5-year overall survival in this series is 72%, with a mean follow-up of 58 months (median, 36 months). Of those receiving neoadjuvant chemotherapy, 6/7 have survived to the present. CONCLUSION: Given the limitations of a small patient population, our data suggest that neoadjuvant chemotherapy may provide benefit in terms of survival. Longer follow-up will be necessary to support this conclusion. Our data also show that our population has a higher-than-average age of onset, low presence of risk factors, and better survival rate in comparison with the published series from other institutions.

Adult↗
PubMed1997

Antibody-mediated depletion of tumor necrosis factor-alpha impairs pulmonary host defenses to Legionella pneumophila.

Tumor necrosis factor-alpha (TNF-alpha) has been shown to stimulate the resistance of alveolar macrophages and neutrophils to Legionella pneumophila in vitro. To determine whether endogenous TNF-alpha is necessary for host defense against legionellosis in vivo, anti-TNF-alpha IgG or control IgG was administered to rats exposed to aerosolized L. pneumophila. Treatment with anti-TNF-alpha neutralized >90% of the intrapulmonary TNF-alpha response to infection, resulting in persistent pneumonitis and failure to clear L. pneumophila from the lungs. Depletion of TNF-alpha limited the recruitment of mononuclear cells to the lungs and resulted in a progressive increase in the proportion of alveolar macrophages that were infected; neutrophil recruitment and phagocytosis were not impaired. Both systemic and intrapulmonary IFN-gamma levels were significantly higher in rats depleted of TNF-alpha. These observations indicate that TNF-alpha is required for the prompt resolution of pneumonic legionellosis and point to a direct role for TNF-alpha in the activation of phagocytes.

Animals↗
PubMed1997

Sarcoidosis associated with recurrent pancreatitis.

A 56-year-old previously healthy man had two episodes of unexplained pancreatitis in the setting of constitutional symptoms, recurrent palsy of the right seventh cranial nerve, and bilateral parotitis. Chest radiography revealed marked bilateral hilar lymphadenopathy, and sarcoidosis was diagnosed by bronchoscopy with transbronchial biopsy showing noncaseating granulomas. The pancreatitis and sarcoidosis responded to corticosteroid therapy but recurred after corticosteroid dosage was reduced. Retreatment with a higher dosage of corticosteroids led to resolution of pancreatitis; 3 months later, the patient remained well and without further recurrence of pancreatitis while taking the higher dose of corticosteroids. Clinically significant pancreatitis should be included as an unusual manifestation of sarcoidosis, and corticosteroid therapy should be considered in the management of pancreatitis associated with sarcoidosis.

Diagnosis, Differential↗
PubMed1997

Continuous concurrent feedback degrades skill learning: implications for training and simulation.

In two experiments we investigated the role of continuous concurrent visual feedback in the learning of discrete movement tasks. During practice the learner's actions either were or were not displayed on-line during the action; in both conditions the participant received kinematic feedback about errors afterward. Learning was evaluated in retention tests on the following day. We separated (a) errors in the fundamental spatial-temporal pattern controlled by the generalized motor program from (b) errors in scaling controlled by parameterization processes. During practice concurrent feedback improved parameterization but tended to decrease program stability. Based on retention tests, earlier practice with continuous feedback generally interfered with the learning of an accurate motor program and reduced the stability of time parameterization. Continuous feedback during acquisition degrades the learning of not only closed-loop processes in slower movements (as has been found in earlier studies) but also motor programs and their parameterization in more rapid tasks. Implications for feedback in training and simulation are discussed.

Analysis of Variance↗
PubMed1997

Specificity of detection of Chlamydia pneumoniae in cardiovascular atheroma: evaluation of the innocent bystander hypothesis.

Chlamydia pneumoniae has been detected in atherosclerotic plaque, raising the question of whether this detection is specific to atheromatous tissue. To evaluate this question, we tested cardiovascular and non-cardiovascular tissue samples from 38 autopsy cases by polymerase chain reaction and immunocytochemistry. We also tested 33 granuloma biopsy specimens, as the organism has been detected in macrophages. C. pneumoniae was detected in coronary artery tissue from 13 (34%), lung from 5 (13%), liver from 4 (10%), and spleen from 2 (5%) of the 38 autopsy cases (P < 0.05 for comparison of proportion of positive coronary arteries with that of each of the other types of tissue). Of the 21 cases with at least one positive tissue sample, 11 had only a positive cardiovascular tissue (coronary artery, venous bypass graft, or myocardium), 7 had both cardiovascular and non-cardiovascular positive tissues, and 3 had only a non-cardiovascular positive tissue. C. pneumoniae was thus detected relatively infrequently in non-cardiovascular tissues, and its detection in these tissues was usually in association with its detection in cardiovascular tissue from the same patient. The organism was also infrequently detected in granulomatous tissue (3/33 specimens). These findings demonstrate that C. pneumoniae is more frequently found in atherosclerotic than normal tissue and support the hypothesis that C. pneumoniae has a role in the pathogenesis of atherosclerosis.

Adolescent↗
PubMed1996

An improved computer-assisted diagnostic scheme using wavelet transform for detecting clustered microcalcifications in digital mammograms.

RATIONALE AND OBJECTIVES: We evaluated the potential usefulness of a computer-assisted diagnostic (CAD) scheme incorporating the wavelet transform for detecting clustered microcalcifications in mammograms. METHODS: A wavelet transform technique was applied to the detection of clustered microcalcifications. We examined several wavelets to study their effectiveness in detecting subtle microcalcifications. We used a database consisting of 39 mammograms containing 41 clusters of microcalcifications. The performance of the wavelet-based CAD scheme was evaluated using free-response receiver operating characteristic analysis. RESULTS: The CAD scheme with the wavelet transform was useful in detecting some of the subtle microcalcifications that were not detected by our previous scheme, which was based on the difference-image technique. When the two schemes were combined, the overall performance was improved to a sensitivity of approximately 95%, with a false-positive rate of 1.5 clusters per image. CONCLUSION: The wavelet transform approach can improve the detection of subtle clustered microcalcifications.

Calcinosis↗
PubMed1996

Average KR degrades parameter learning.

In the present study, the effects of average knowledge of results (KR) about a set of trials on the learning of a spatiotemporal movement pattern were examined. Participants (N = 85) practiced 3 movement patterns with the same relative and absolute timing and the same relative amplitudes but with varied absolute amplitudes. Five groups of participants practiced under 1 of the following 5 conditions: KR after every trial (100% KR); average KR after every 3rd trial (average); average KR after every trial about the last 3 trials (running-average); KR after every 3rd trial (33% KR); and KR after every trial; plus average KR after every 3rd trial (both). Although there were no differences between groups in the learning of the fundamental movement pattern (or generalized motor program), average feedback (average, running-average) clearly degraded subjects' ability to learn to properly parameterize the actions in amplitude.

Journal Article↗
PubMed1996

Measuring tree-ring increments on tree bole sections with a video-based robotic positioner.

We report on the design and performance of a system that speeds measurement of radial tree-ring increments on tree stem disks; this method replaces the usual binocular microscope with a video image, and automates the measuring and recording processes. The system was used to measure bole sections cut from stems at various heights to determine volume growth of representative trees in an old-growth ponderosa pine stand. The objective of the measurement system was to speed acquisition of annual growth increments from a large number of disks. A personal computer controls the location of a video camera in a 3-axis positioning system. The operator views the sample on a video monitor and positions the camera over each ring by selecting it with a computer-driven mouse. The computer measures and records the distance that the camera moves between each ring. Task selection is facilitated by menu-driven software that also formats, checks and organizes data files. Measurements have a resolution of 0.026 mm; however, finer resolution could be obtained with a different camera lens. Tests of measurement variability (repeated measurements by individual operators on a single radius) indicated standard errors of 0.006 mm or less for the first measurement sets for four operators. Correlation coefficients among four radii per bole section were as low as 0.66 for a whole tree, suggesting that measurements on single radii may provide poor estimates of radial growth for old trees. This system also offers the potential for automatic ring detection and measurement.

Journal Article↗
PubMed1996

An improved shift-invariant artificial neural network for computerized detection of clustered microcalcifications in digital mammograms.

A shift-invariant artificial neutral network (SIANN) has been applied to eliminate the false-positive detections reported by a rule-based computer aided-diagnosis (CAD) scheme developed in our laboratory. Regions of interest (ROIs) were selected around the centers of the rule-based CAD detections and analyzed by the SIANN. In our previous study, background-trend correction and pixel-value normalization were used as the preprocessing of the ROIs prior to the SIANN. A ROI is classified as a positive ROI, if the total number of microcalcifications detected in the ROI is greater than a certain number. In this study, modifications were made to improve the performance of the SIANN. First, the preprocessing is removed because the result of the background-trend correction is affected by the size of ROIs. Second, image-feature analysis is employed to the output of the SIANN in an effort to eliminate some of the false detections by the SIANN. In order to train the SIANN to detect microcalcifications and also to extract image features of microcalcifications, the zero-mean-weight constraint and training-free-zone techniques have been developed. A cross-validation training method was also applied to avoid the overtraining problem. The performance of the SIANN was evaluated by means of ROC analysis using a database of 39 mammograms for training and 50 different mammograms for testing. The analysis yielded an average area under the ROC curve (A(z)) of 0.90 for the testing set. Approximately 62% of false-positive clusters detected by the rule-based scheme were eliminated without any loss of the true-positive clusters by using the improved SIANN with image feature analysis techniques.

Biophysical Phenomena↗
PubMed1996

STATUS OF CACAO WITCHES' BROOM: biology, epidemiology, and management.

Origins of Theobroma cacao and Crinipellis perniciosa occurred in the Amazon Basin region of South America, and their interaction, the witches' broom disease, was first described in the late 1700s. The 100 years of scientific investigations of witches' broom of cacao that began in the 1890s developed the present state of knowledge of the biology and epidemiology of witches' broom that are discussed. Recommended management to reduce the deleterious effects of witches' broom on cacao production include the use of phytosanitation (removal of diseased plant parts), applications of chemical fungicides, and the use of host resistance. At present, there is a paucity of resistant planting materials, and efforts to evaluate germplasm for resistance to witches' broom are described. Research topics to augment present knowledge about witches' broom of cacao are presented with the hope that disease management can be improved.

Journal Article↗
PubMed1996

Density correction of peripheral breast tissue on digital mammograms.

When digital mammograms are viewed on video displays, evaluation of the skin and subcutaneous tissue is often difficult and may require special window settings. An algorithm has been developed for selective enhancement (ie, density correction) of the dark peripheral portions of the breast on mammograms. After an automated segmentation of the digital mammogram and identification of the skin line, a fitted enhancement curve is generated to selectively enhance all pixels within a certain distance from the skin to match the density of the center part of the breast. After enhancement, skin and breast parenchyma can be evaluated simultaneously without the need for different window settings. When tested on a set of 400 digitized mammograms, the density correction algorithm significantly (P < .0001) increased the maximum area of breast tissue visualized simultaneously at window width settings of 0.5-2.0 delta OD (optical density). Artifacts interfering with interpretation were observed in less than 1%. The algorithm for correcting the density of peripheral breast tissue substantially facilitates and improves the display of digital mammograms and thus will be a valuable component of an integrated workstation for computer-aided diagnosis in mammography.

Algorithms↗
PubMed1996

Malignant and benign clustered microcalcifications: automated feature analysis and classification.

PURPOSE: To develop a method for differentiating malignant from benign clustered microcalcifications in which image features are both extracted and analyzed by a computer. MATERIALS AND METHODS: One hundred mammograms from 53 patients who had undergone biopsy for suspicious clustered microcalcifications were analyzed by a computer. Eight computer-extracted features of clustered microcalcifications were merged by an artificial neural network. Human input was limited to initial identification of the microcalcifications. RESULTS: Computer analysis allowed identification of 100% of the patients with breast cancer and 82% of the patients with benign conditions. The accuracy of computer analysis was statistically significantly better than that of five radiologists (P = .03). CONCLUSION: Quantitative features can be extracted and analyzed by a computer to distinguish malignant from benign clustered microcalcifications. This technique may help radiologists reduce the number of false-positive biopsy findings.

Breast Diseases↗
PubMed1996

Interviewing pharmacists for positions in patient-focused health care organizations.

Providing pharmaceutical care requires pharmacists to have the personal attributes necessary to function as part of a health care team. Assessing candidates' personal or behavioral values during the employment interview can be a valuable tool to determine future performance. The use of a structured interviewing format designed to identify predetermined key behavioral indicators as an assessment tool is described. Through detailed probing, candidates' previous actions in specific situations are used as predictors of future performance by the interviewing organization. Use of the interviewing tool described improves the likelihood of selecting candidates with behavioral values deemed important to the organization.

Clinical Competence↗