Search PubMed⌕ Search

Biomedical subjects

S Hellman

Publications and source records attributed to S Hellman.

243 records · Page 14Linked to original sources
PubMedDate not supplied

Reversible brachial plexopathy following primary radiation therapy for breast cancer.

Reversible brachial plexopathy has occurred in very low incidence in patients with breast carcinoma treated definitively with radiation therapy. Of 565 patients treated between January 1968 and December 1979 with moderate doses of supervoltage radiation therapy (average axillary dose of 5000 rad in 5 weeks), eight patients (1.4%) developed the characteristic symptoms at a median time of 4.5 months after radiation therapy. This syndrome consists of paresthesias in all patients, with weakness and pain less commonly seen. The symptom complex differs from other previously described brachial plexus syndromes, including paralytic brachial neuritis, radiation-induced injury, and carcinoma. A possible relationship to adjuvant chemotherapy exists, though the etiology is not well-understood. The cases described demonstrate temporal clustering. Resolution is always seen.

Adult↗
PubMedDate not supplied

Primary radiation therapy in the treatment of early breast cancer.

The results of the treatment of 184 breast cancers in 176 patients are reported. Local recurrence occurred in 5% of Stage I patients and 7% of Stage II patients. Local control was significantly greater in those who received an iridium implant. By combining these data with those for Stage II breast cancer patients, local control could be shown to occur with a greater likelihood and at a lower dose when gross tumor excision preceded the radiation.

Brachytherapy↗
PubMedDate not supplied

Reversal of donor myocardial dysfunction by triiodothyronine replacement therapy.

Triiodothyronine deficiency after brain death can result in progressive deterioration of cardiac function in potential organ donors. We report on the use of triiodothyronine replacement in improving myocardial function, allowing the use of donor hearts that might have been considered unsuitable for transplantation. From July to September 1992, of 24 organ procurements and transplantations, six donors were receiving high doses of inotropes with elevated left-sided filling pressures. Donor characteristics were as follows: five were male donors and one was a female donor, with mean age 16.50 +/- 7.50 years (8 to 30 years), mean weight 49.17 +/- 13.64 kg (25 to 63 kg), average time from clinical brain death to procurement 94.50 +/- 73.53 hours (49 to 240 hours), and two donors had arrest periods of up to 10 minutes. Despite large inotrope infusions, echocardiograms showed depressed left ventricular function (mean ejection fraction 39.17 +/- 5.85) and hemodynamic instability was present with elevated ventricular filling pressures. Triiodothyronine replacement (maximal dose 0.6 microgram/kg) was initiated an average of 139.17 +/- 32.00 minutes (115 to 185 minutes) before procurement. At the time of procurement, ventricular filling pressures were lower, hemodynamic condition stabilized, and pressor requirements decreased. Hearts were preserved in University of Wisconsin solution with a mean ischemic time of 188.83 +/- 36.86 minutes (149 to 237 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMedDate not supplied

Prostate-specific antigen levels in African-Americans correlate with insurance status as an indicator of socioeconomic status.

PURPOSE: African-Americans have a higher age-adjusted incidence and a higher disease-specific mortality than whites. Two potential causes are differences in biology or socioeconomic status, the latter leading to differences in access, delivery, or utilization of health care. In this study, we compare serum prostate-specific antigen (PSA) levels for comparable stage and grade-disease, as well as individual insurance status. PSA is a demonstrated indicator of the size and virulence of tumor and is correlated with prognosis. Insurance status has been linked with income and education and is an indicator of access to medical care. PATIENTS AND METHODS: All patients were referred to the University of Chicago Center for Radiation Therapy (UCCRT) with stages A-C (T1-4) prostate cancer. They were seen in four different facilities, designated A through D, and were evaluated and staged by the faculty of UCCRT using the same criteria. Hospitals A and B are large teaching hospitals located within the city of Chicago; C and D are suburban and urban community hospitals, respectively. A total of 341 patients seen between May 1987 to November 1992 are included in this study. RESULTS: In univariate analysis, PSA levels were significantly associated with stage, grade, and race. Higher mean PSA levels were seen with increasing clinical stage and grade. African-Americans had higher mean values than whites. Private insurance and managed care patients had lower values than Medicare-only patients. Within each race, the above results were reproduced, except for insurance status, which was significant only in African-Americans. In multivariate analysis, stage, grade, and insurance status were significant in African-Americans, whereas only stage and grade were significant in whites. Within comparable insurance status, stage, and grade, no racial differences were found, except among Medicare-only patients, with African-Americans who had stage B or grade 2 disease having higher mean PSA levels than whites. Racial differences were seen at hospital B, but not at hospital A. No racial comparisons could be made at hospitals C or D due to an insufficient number of African-American patients. At hospital A, whites and African-Americans had comparable private plus HMO insurance distributions (81.1% and 86.9%, respectively); at hospital B, the distribution was quite different--only 4.4% of whites had Medicare-only insurance while 31.8% African-Americans had no supplementary insurance. For all patients in the multivariate analysis, racial difference was seen only among Medicare-only patients. CONCLUSIONS: Our results suggest that socioeconomic differences are responsible for the racial differences noted in prostate cancer. Our findings of higher PSA levels in African-American Medicare-only patients may result from the many African-Americans disproportionately uninsured throughout their lives compared with whites and thus using services at later stages of disease. A second possible explanation is cultural or ethnic differences in care-seeking behavior, with poorer African-Americans less likely to pursue care for disease until it has progressed. Our findings can explain the dichotomy of poorer overall outcome among African-Americans with prostate cancer, but comparable stage-adjusted outcome with comparable treatments between African-Americans and whites.

Aged↗
PubMedDate not supplied

A new use for focus groups--building and empowering a culturally diverse team.

BACKGROUND: The success of a cultural diversity training program in an acute care health facility was due in large part to the use of the focus group method. METHOD: This method enabled us to identify sensitive issues to be addressed in educational programs for staff. Some of the criteria for successful use of the focus group method applied to our situation. RESULT: We found that much of the traditional wisdom did not necessarily apply in a diversity program. CONCLUSION: Several additional benefits such as ethnic group empowerment and the enhancement of a more team-oriented approach made use of the focus group method a very worthwhile venture for this project.

California↗
PubMedDate not supplied

Breast cancer metastatic phenotype as predicted by histologic tumor markers.

PURPOSE: Two clinical characteristics of the metastatic cancer phenotype are virulence-which reflects the pace of disease growth, clinical manifestation, and dissemination-and metastagenicity, the ultimate likelihood of distant metastasis. Molecular markers may allow distinguishing between these two cancer phenotypes. The purpose of this study is to determine whether proliferating cell nuclear antigen (PCNA) and tumor nuclear grade are markers of virulence or metastagenicity. PATIENTS AND METHODS: PCNA and tumor nuclear grade were determined in patients with extensive follow-up, treated only with mastectomy, for whom archival paraffin-embedded tissue was available. RESULTS: There is no significant difference in long-term disease-free survival (DFS) as a function of PCNA, but after only 5 years of analysis there are significant differences that gradually disappear with further follow-up, reflecting differences in virulence. While the likelihood of recurrence is the same, in patients with high PCNA 80% of disease recurrences become evident in the first 2 to 3 years, whereas in patients with low PCNA it takes more than 10 years for 80% of metastases to become clinically detectable. There was a significant difference in 20-year DFS for nuclear grade 1 compared with nuclear grade 2 and 3 tumors, indicating a difference in metastagenicity. The differences in DFS between nuclear grade 2 and 3 tumors decrease as the length of follow-up increases; thus, like PCNA, these grade differences are also a marker of virulence. Eighty percent of the metastasis became evident within 4 years in grade 3 tumors and within 12 years in grade 2 tumors. DISCUSSION: PCNA and nuclear grade (2 vs 3) are markers of virulence. We have previously shown angiogenesis to be a marker of metastagenicity as is, in this study, the difference between nuclear grade 1 and nuclear grades 2 and 3. Both phenotypic characteristics, virulence and metastagenicity, are important to understanding the natural history of the tumors and may influence the nature of the therapy.

Adult↗
PubMedDate not supplied

Race and the Will Rogers phenomenon in prostate cancer.

PURPOSE: With the introduction of prostate-specific antigen testing, the "Will Rogers phenomenon"--stage migration associated with more sensitive diagnostic and staging procedures--seemed likely to occur. MATERIALS AND METHODS: Yearly values of prostate-specific antigen from 1988 to 1995 were determined for whites (n = 34) and African-Americans (n = 321). Pretreatment levels were used as objective surrogates of tumor cell burden. Changes in clinical stage and pathological grade by calendar year also were determined. RESULTS: There was a statistically significant yearly decline in levels of prostate-specific antigen for African-Americans (12.2% per year). There was no significant decline among whites. Similar trends were seen on multivariate analysis that adjusted for stage and grade. There was clinical stage migration for whites and African-Americans. There was also a shift in tumor grade for both whites and African-Americans. DISCUSSION: Over the past decade, African-Americans have shown a decline in tumor cell burden at the time of diagnosis as reflected by a decline in mean levels of prostate-specific antigen. For whites and African-Americans, there has been a shift to early clinical stages. The Will Rogers phenomenon, as demonstrated in African-Americans by decline in prostate-specific antigen and in whites and African-Americans by clinical stage migration, indicates lead-time and length biases, resulting in a more favorable disease profile at diagnosis for both groups. The decline in prostate-specific antigen among African-Americans indicates that the initial higher tumor cell burden seen in the past was caused by socioeconomic factors rather than inherited differences, and is likely to be ameliorated with widespread prostate-specific-antigen screening.

Black or African American↗