Biomedical subjects
Publications and source records attributed to T Anderson.
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Thirty four patients treated with mastectomy and axillary node dissection for potentially curable breast cancer received a seven month combined adjuvant chemotherapy and radiation therapy program. These patients were considered to be at high risk for recurrence because they had either three or more positive axillary lymph nodes or their primary tumor was greater than 5 cm in diameter. The chemotherapy given at 3-week intervals consisted of cyclophosphamide, 600 mg/m2, Adriamycin 40 mg/m2, and methotrexate 40 mg/m2 during cycles 1 through 3 and 7 through 9. Radiation therapy was administered during cycles 4 through 6 with concomitant administration of 5-fluorouracil 600 mg/m2, vincristine 1.4 mg/m2, and prednisone 40 mg/m2 for 7 days. Median follow up time from initiation of study is 60 months (range 36-93). Seventeen of 34 patients (50%) remain free of recurrent breast cancer. Distant metastases and local-regional recurrence have occurred in 16 (47%) and 4 (12%) patients, respectively. Significant myelosuppression and infections requiring hospitalization were seen in 4 patients, with 1 treatment-related death. Adriamycin-containing chemotherapy and post-operative radiotherapy can thus be combined in an adjuvant treatment program with acceptable toxicity.
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Adult viral free Sprague-Dawley rats were compared with non-viral free rats of the same strain and supplier for their sleep-time and hypothermic response to an acute injection of ethanol (3.5 g/kg, IP). Viral free animals were found to be significantly more sensitive to the sleep-time and hypothermic properties of ethanol than the non-viral free animals. This increased sensitivity was accompanied by higher blood alcohol concentrations in viral free animals for up to four hours after ethanol injection. These results indicate that animals born and raised in a viral free environment differ markedly in their sensitivity to ethanol compared to non-viral free animals derived from the same genetic stock. Such differences may be due to decreased metabolic clearance of ethanol in viral free animals. These findings suggest that the use of viral free animals in developmental, behavioral, pharmacological or toxicological studies of the effects of ethanol may be an important consideration.
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We sought to assess the feasibility of recording the myocardial velocity gradients (MVGs) and mean myocardial velocities (MMVs) measured by color M-mode tissue Doppler imaging (TDI) in the free wall of unsedated normal cats (n = 18) with a 7.4-MHz probe equipped to record TDI images. The peak MVG and MMV values during the different phases of the cardiac cycle corresponded to certain color velocity patterns occurring in the left ventricular free wall (LVFW). Biphasic shifts were recorded in the tracings of both the MVG and MMV during early diastole (E1 and E2) as well as during the isovolumic relaxation (IVR) and isovolumic contraction (IVC) phases. Stepwise regression analysis showed that age was the only significant predictor for the peak MVG values during the 2nd phase of early diastole (E2) (r = -0.79, r2 = 0.63, and P < .001). The peak late diastolic MVG values were associated positively with age (r = 0.50, r2 = 0.25, and P < .05). The peak MMV values showed a negative association with age during E2 (r = -0.71, r2 = 0.50, and P < .001) as well as during early systole (Se) (r = -0.55, r2 = 0.30, and P < .05) and late systole (SI) (r = -0.62, r2 = 0.39, and P < .01). A positive association was found between age and the peak MMV values during late diastole (r = 0.54, r2 =- 0.29, and P < .05). The MVG values showed cyclic variations consistent with wall thickness changes. The accuracy of velocity determination and the spatial resolution of the system used were validated with a phantom. To our knowledge, this study is the 1st report of the application of this technique to the myocardium of cats,providing insights into the physiology of myocardial motion. It provides reference ranges of the peak MVG and MMV values for future studies of feline myocardial diseases.
The urinary and urothelial effects of the frequent handling necessary for obtaining fresh-voided urine specimens were evaluated in 5-wk-old male F-344 rats fed control diet or diet containing 7.5% sodium saccharin. Frequent handling consisted of holding rats by the back of the neck in a position to obtain fresh-voided urine directly into centrifuge tubes 3 times per week for 10 weeks, whereas seldomly handled control rats received this treatment only twice during the entire 10 weeks. The urothelium of frequently handled rats fed control diet showed superficial necrosis and regenerative hyperplasia as observed by light and scanning electron microscopy. These changes were not observed in rats fed control diet that were seldomly handled. The necrosis and hyperplasia were not as pronounced in frequently handled rats fed control diet as in seldomly handled, sodium-saccharin-treated rats, but handling also potentiated the severity of the changes produced by sodium saccharin feeding. The urothelial exfoliation and consequent regenerative hyperplasia are likely secondary effects of stress.
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CONTEXT: Projected cost for lansoprazole, the formulary proton pump inhibitor (PPI) at our institution, was $1.8 million in 1999. While some patients require PPI therapy, many could control their symptoms with a histamine H2-receptor antagonist blocker (H2 blocker) at a much lower cost. OBJECTIVE: To evaluate a practice-based approach to converting patients from PPIs to H2 blockers. DESIGN: Before-after study. SETTING: Portland Veterans Affairs Primary Care Clinics. INTERVENTION: We developed guidelines and educated clinicians about the use of PPIs and H2 blockers. To help physicians convert appropriate patients from PPIs to H2 blockers, we gave them a list of their patients receiving PPIs, form letters for patients explaining the conversion, and structured prescription forms. Patient lists and e-mail reminders, as well as feedback on institutional performance, were sent to clinicians during the intervention period. OUTCOME MEASURES: Number of PPI and H2 prescriptions per enrollee and pharmacy costs. RESULTS: The average number of PPI prescriptions per enrollee at our institution decreased from 0.39 in the 9 months before the intervention to 0.27 in the 9 months after the intervention. The associated pharmacy costs decreased from an average of $43 to $28 per enrollee per quarter, a difference of $15 or a savings of $80,000 per quarter. Accounting for the decrease in medication prices during the study, this difference was $11 per patient per quarter, corresponding to a savings of about $60,000 per quarter. With respect to the conversion process, more than 70% of clinicians felt the intervention had a big impact on how they prescribed PPIs and H2 blockers. Eighty-two percent of clinicians converted patients from PPIs to H2 blockers during clinic time; 56% did so during administrative time. Overall, more clinicians considered the intervention to be helpful rather than a hassle. CONCLUSIONS: The number of PPI prescriptions decreased during the intervention and was sustained at least three quarters afterward. This low-intensity, practice-based intervention may serve as a model for other health care systems.
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