Search PubMed⌕ Search

Biomedical subjects

T L Andres

Publications and source records attributed to T L Andres.

12 recordsLinked to original sources
PubMed1996

Finding the medically underserved: a need to revise the federal definition.

The relationship between the primary service area (PSA) of an urban community health center (CHC) program and a federally defined "medically underserved area" (MUA) was assessed. Federal guidelines that most reliably predicted medical underservice were identified. The service area was statistically defined by census tract penetration rates. The MUA was defined by an index of medical underservice (IMU) according to federal parameters of physician supply, poverty level, percentage elderly persons, and infant mortality. An index score was calculated for the country, service area, and each census tract. Analysis by tract determined the most significant discriminating parameters. By excluding two tracts concentrated with managed-care physicians, the service area qualified as an MUA. Tracts that fulfilled MUA and service area criteria were highly associated (p < 0.0001). Only poverty level and infant mortality were useful discriminating parameters. Federal indicators of demand (elderly population) and supply (physicians) did not adequately address issues to access for the medically underserved in urban neighborhoods. Other parameters that might serve as proxies of care access and underserved are discussed.

Aged↗
PubMed1996

Tracking community sentinel events: breast cancer mortality and neighborhood risk for advanced-stage tumors in Denver.

OBJECTIVES: The incidence of related sentinel events--breast cancer mortality and neighborhood-specific morbidity for advanced stage at diagnosis--were calculated for women likely to use a community health center in Denver, Colo. METHODS: For the center's service area, neighborhoods (n = 37) were defined by program use. Mortality rates and proportional hazards regression models were estimated for 4189 breast cancer cases recorded between 1979 and 1990. Neighborhood-specific standard morbidity ratios of advanced-stage tumors were based on age-specific rates applied to the entire community. RESULTS: Service area residents were more likely to present with advanced tumors (odds ratio [OR] = 1.4; 95% [CI] = 1.2, 1.5). After adjustment, advanced-stage disease and socioeconomic-demographic status, but not race-ethnicity, contributed significantly to survival. Two neighborhoods (6.5% of the population at risk) with standard morbidity ratios of 2.1 (95% CI = 1.3, 3.4) and 1.7 (95% CI = 1.2, 2.5) accounted for 42% of the excess cases of advanced-stage tumors between 1986 and 1990. CONCLUSIONS: Neighborhood variation in advanced-stage cancer can serve as the basis for efforts to improve access to breast cancer screening.

Adult↗
PubMed1983

Immunologic markers in the differential diagnosis of small round cell tumors from lymphocytic lymphoma and leukemia.

We attempted to determine the reliability of surface markers in distinguishing 21 small round cell tumors from lymphoid malignancies. Using immunofluorescence on tumor cell suspensions and immunoperoxidase on fresh frozen sections, we found that specimens of neuroblastoma (n = 7), rhabdomyosarcoma (n = 7), Ewing's tumor (n = 5), and two unclassified small round cell tumors all lacked human HLA-DR antigens. Each of eight tumors tested also lacked common leukocyte antigen (T200). In each of 13 cases studied, neither polyvalent surface immunoglobulin (sIg) nor receptors for sheep erythrocytes (E), complement (EAC), or the Fc portion of IgG immunoglobulin (EA) were found. Conversely, we found HLA-DR and/or T200 antigens, usually one or more receptors for E, EAC, or EA, and not infrequently, monoclonal sIg on malignant cells in each of 42 cases of lymphocytic lymphoma and leukemia. We conclude that study of surface DR and T200 antigens, sIg, and receptors for E, EAC, and EA aids the differential diagnosis of small round cell tumors from lymphocytic lymphoma and leukemia.

Adolescent↗
PubMed1983

T cell prolymphocytic leukemia. 2 cases having a postthymic helper phenotype with complement receptors and 14q+ chromosome abnormality.

We describe 2 elderly patients with splenomegaly and progressive bone marrow failure due to infiltration by leukemic prolymphocytes with a single prominent nucleolus. In each case the leukemia cells had a unique helper T cell phenotype with complement receptors and contained coarse blocks of acid alpha-naphthyl butyrate. A 14q+ chromosome was among the abnormalities that marked one abnormal T cell clone. Histology of the spleen showed mainly red pulp infiltration merging with periarteriolar regions and different from the pseudonodular pattern described in many cases of B cell prolymphocytic leukemia (PLL). Ultrastructurally, leukemia cells contained dense lysosomes, perinuclear clusters of 10-nm microfilaments but no distinctive cytoplasmic inclusions previously described in (B cell) PLL. We suggest that early phenotyping of leukemia cells may enable consideration of monoclonal antibody therapy in elderly patients with bone marrow failure resistant to chemotherapy.

Aged↗
PubMed1981

Immunohistochemical demonstration of Toxoplasma gondii.

A peroxidase-antiperoxidase method that demonstrates both free and encysted toxoplasmata in routinely prepared histologic sections is described. This technic and ultrastructural study were employed to confirm the presence of Toxoplasma gondii in the infected tissues of an immunosuppressed patient who had postmortem examination. An immunohistochemical method may be an aid in the diagnosis of toxoplasmosis.

Adult↗
PubMed1980

Electron-probe microanalysis. Aid in the study of skin granulomas.

Several causes of noncaseating epithelioid granulomas of the skin must be considered before the diagnosis of sarcoidosis can be made. We report here three such cases that were studied retrospectively with scanning electron microscopy in combination with backscattered electron imaging and x-ray energy spectrometry. Inorganic particles were identified in the granulomas of two patients, illustrating that these techniques are valuable aids in establishing the cause of granulomas.

Adult↗
PubMed1980

Atypical germ cells preceding metachronous bilateral testicular tumors.

This is the sixth reported case of metachronous testicular neoplasia in which a seminoma has preceded an embryonal carcinoma. Of particular note is the presence of atypical germ cells in the biopsy specimen of the gonad from which the embryonal carcinoma arose. There has developed recently an increasing awareness of germ cell atypia and carcinoma in situ. Pathologists examining testicular biopsies in the infertile patient should be alerted to this process.

Adult↗
PubMed1980

Intervertebral chondrocalcinosis: A coincidental finding possibly related to previous surgery.

Chondrocalcinosis of the intervertebral discs is a common finding in patients who have had prior surgical procedures involving the same or adjacent disc space. The crystals in the tissues have the characteristic morphologic and spectrophotometric features of calcium pyrophosphate dihydrate. None of the patients described herein had clinical or radiographic evidence of crystal accumulation in sites remote from the surgical procedure. We propose that the surgical trauma may have played a role in the induction of the crystal deposits.

Adolescent↗
PubMed1978

The pathology of Legionnaires' disease. Fourteen fatal cases from the 1977 outbreak in Vermont.

Fourteen fatal cases from the 1977 Vermont outbreak of Legionnaires' disease have been analyzed. Serious underlying diseases were present in all patients. The only consistent lesions were in the lungs. Bronchopneumonia was present in all cases and was confluent in most. No lobe of the lung was preferentially involved and consolidation was usually bilateral. Abscesses were evident macroscopically in only two cases. Microscopically, there was an extensive alveolar infiltrate of polymorphonuclear neutrophils and macrophages. Lysis of the inflammatory cells was frequently present and was associated with an increased number of bacteria. Coagulative necrosis of lung was present in a few cases, and the possibility of a bacterial toxin must be considered. Bacteria were well stained by the Dieterle stain and appeared Gram-negative in tissue imprints from the unfixed lung.

Adolescent↗