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PubMed2000

Eighteen years of experience with adult and pediatric liver transplantation at the University of Tennessee, Memphis.

1. Since its inception, the liver program at UT Memphis has been striving to serve its population by stressing access, technical innovation, and by its focus on quality of life. The results for both adult and pediatric transplants over the past 18 years demonstrate that small and medium-sized programs can function efficiently and are valuable for their local communities. 2. Patient and graft survival rates exceeded 85% in the pediatric population in the first year with the 5-, 10-, and 15-year results above 75%. 3. Patient and graft survival rates in adults were 83% at one year, 68% at 5 years, and 60% at 10 years. 4. Innovative techniques in liver transplantation have had a dramatic impact on accessibility of pediatric recipients to liver transplantation and recently are becoming crucial for select populations of adults requiring expedited transplantation.

Adult↗
PubMed2002

Racial differences in the incidence of gliomas: a retrospective study from Memphis, Tennessee.

This study records the incidence of glioblastoma multiforme, astrocytoma and oligodendroglioma in the white and Black patients in the Memphis Statistical Metropolitan Area (MSMA) during a 10.5-year period from 1 January 1984 through 30 June 1994. During this time, only six hospitals performed craniotomy and computer tomography (CT) scanning was routine in each of the hospitals. A total of 824 histologically confirmed first diagnoses were made at these six area hospitals. Based on the zip code listed as the home address, we determined patient's locale and identified 373 patients (232 glioblastoma multiforme, 106 astrocytomas and 35 oligodendroglioma) who resided in the area during the study interval. There were 50 black and 323 white patients. The background population for the area was obtained from the US Census Bureau's statistics for the year 1990. These statistics indicated that 40.5% of the population identified themselves as black and 57.9% as white. Age adjusted incidence rates were 1.550 (p < 0.001) for other astrocytomas, and 0.106 and 0.461 (p = 0.003) in the black and white populations, respectively. There was no significant difference in survival between the two populations. This study confirms a significant disparity in incidence rates for the three most common gliomas between the black and white populations and this disparity is higher than predicted by previous reports.

Adolescent↗
PubMedDate not supplied

Baptist Memorial addresses national shortage of emergency room space. Campaign by Memphis, Tenn., system points to minor med facilities.

At Baptist Memorial Health Care, Memphis, Tenn., patients expressed some discontent with emergency room procedures. Baptist's public relations team addressed issue, along with the national crisis in emergency room overcrowding. They developed a public service campaign to help the public make correct choices. The campaign also included an education program about St. Mary's ER procedures and the development of a specialized ER volunteer corps, all aimed at having positive long-term results.

Choice Behavior↗
PubMed1991

Human erythrocyte band 3 polymorphism (band 3 Memphis): characterization of the structural modification (Lys 56----Glu) by protein chemistry methods.

Band 3 variants occur rather frequently in different populations. Based on sodium dodecyl sulfate (SDS)-polyacrylamide electrophoretic properties, a widespread polymorphism (band 3 Memphis) has been previously described. It corresponds to a protein that has been hypothesized to be elongated in its N-terminal cytoplasmic domain. Band 3 from a heterozygote subject for this polymorphism and that displays a normal reactivity towards stilbene disulfonates has been isolated and its primary structure determined by protein chemistry. Reverse-phase high performance liquid chromatography tryptic peptide mapping showed, as the only difference with controls, that the enzymatic cleavage between the two N-terminal peptides did not occur, yielding a 69 residue-long fragment. Further cleavages of this peptide (cyanogen bromide, V8 protease), amino acid composition, and sequence analyses demonstrated that the lysine at position 56 was replaced by a glutamic acid. Thus, surprisingly, a single amino acid change is responsible for the large difference in the electrophoretic behavior. This result suggests that single amino acid substitutions may similarly be involved in the structural modification of several other protein variants, described as elongated or shortened based only on SDS-polyacrylamide electrophoresis studies. When deletions/insertions were confirmed by sequence analysis, their extent was often different from that expected from electrophoresis.

Anion Exchange Protein 1, Erythrocyte↗
PubMed1978

[Results of Memphis-study VII ("Pinkel-Therapy") in 659 children with acute lymphoblastic leukemia. Cooperative therapeutic study of the German working group on childhood leukemia with participation of 42 hospitals].

659 children with acute lymphoblastic leukemia from 42 German hospitals were diagnosed from January 1, 1971 until December 31, 1974, treated according to Memphis study VII or VIII2, and observed until December 31, 1976. At diagnosis 16,1% of the patients had a leukocyte count over 50 000/mm3, 8,5% a mediastinal enlargement, 2,0% a CNS-leukemia and 1,8% a Down-syndrome. After a treatment time of 2 1/2 years and an observation time of maximal 6, minimal 2 years 329 children (= 50,0%) were living, 257 (= 39,1%) in continuous complete remission, most of these 1-3 years after cessation of therapy. A primary relapse in the bone marrow occured in 36,3%, in the CNS in 10,0% of the patients. A cranial irradiation dose of 1800 rad in 120 patients yielded a CNS-relapse rate of 7,5%. 49 of the 659 children (= 7,4%) died in continuous complete remission, the main causes being interstitial pneumonia and varicella. No difference in initial features and treatment results was found between 7 centres with many patients and 35 hospitals with fewer patients.

Age Factors↗
PubMed1988

Cocaine and homicide in Memphis and Shelby county: an epidemic of violence.

In Memphis and the surrounding county, there were a record number of homicides (179) in 1986. During the same year, there was a marked increase in medical examiner cases where tests were positive for cocaine or its metabolites. Review of medical examiner and toxicology records from 1980 to 1986 found 87 cocaine related deaths; 46 of these were homicides. In 1986 alone, there were 53 cocaine related deaths, all manners, and 31 cocaine related homicides. In this year, 17.3% of the homicides were positive for cocaine or metabolite. The cocaine related homicides were similar to other homicides in terms of age, race, sex, blood ethanol concentration, and cause of death being due most often to firearms. In homicide cases in which an abuse drug was detected, cocaine accounted for the entire increase in 1986. Police records indicated that cocaine directly contributed to the homicide in 39% of the cases in which the drug was found. In other cases, we speculate that cocaine altered behavior may have contributed to the victim's being murdered either during the drug "high" or during the posteuphoric depression or withdrawal phase.

Adult↗
PubMed1986

Evaluation of the CDC gravid trap for the surveillance of St. Louis encephalitis vectors in Memphis, Tennessee.

Collections with CDC Gravid Mosquito Traps on 954 trap-nights from May through September 1983 are compared to 2,608 concurrent resting site collections made in the same area of Memphis, Tennessee. Gravid Traps yielded 88 times more Culex per collection and 96 times more Culex per man hour. The total Gravid Trap catch was 135,724 mosquitoes, 99% of which were either Culex pipiens or Cx. restuans, whereas these species comprised only 63% of the 6,613 mosquitoes collected from resting sites. Gravid Traps also collected significant numbers of Aedes aegypti and Ae. triseriatus. On most nights, more than 95% of mosquitoes in the Gravid Trap catch were gravid females. These results demonstrate that the trap is an effective and efficient device for collecting several important vector species. The preponderance of gravid mosquitoes should enhance the probability of encountering pathogens acquired by blood-feeding.

Animals↗
PubMed2005

Student Research Award in the Undergraduate Degree Candidate category, 30th Annual Meeting of the Society for Biomaterials, Memphis, Tennessee, April 27-30, 2005. Monocyte/lymphocyte interactions and the foreign body response: in vitro effects of biomaterial surface chemistry.

To determine the effect of biomaterial surface chemistry on leukocyte interaction and activity at the material/tissue interface, human peripheral blood monocytes and lymphocytes were cultured on a series of poly(ethylene terephthalate) (PET)-based biomaterials. Both monocytes and lymphocytes were isolated from whole human blood and separated by a nonadherent density centrifugation method before being plated on PET disks, surface modified by photograft copolymerization to yield hydrophobic, hydrophilic, anionic, and cationic surface properties. Monocytes and lymphocytes were cultured separately, to elicit baseline levels of activity, in direct coculture, to promote direct cell surface interactions, or in an indirect coculture system with both cell types separated by a -0.02-microm Transwell apparatus, to promote indirect paracrine interactions. Monocyte adhesion, macrophage fusion, and lymphocyte proliferation were measured on days 3, 7, 10, and 14 of culture. Results demonstrated that the presence of monocytes increased the activity of cocultured lymphocytes at the biomaterial/tissue interface, while the corresponding presence of lymphocytes increased the activation and fusion of indirectly cocultured monocytes. Biomaterial surface chemistry was also found to have a significant effect on monocyte adhesion and activation, and lymphocyte activity. Hydrophilic surfaces significantly inhibited both initial and longterm monocyte adhesion, and inhibited lymphocyte proliferation at longer time points. Anionic and cationic surfaces both exhibited mild inhibition of monocyte adhesion at prolonged time points and increased levels of macrophage fusion, while cationic surfaces decreased levels of lymphocyte proliferation and inhibited monocyte activity. These results elucidate the complex role of juxtacrine and paracrine interactions between monocytes and lymphocytes in the foreign body response, as well as promote the consideration of hydrophilic surfaces in future designs of implantable biomedical devices and prostheses.

Biocompatible Materials↗
PubMed2006

St. Jude Children's Research Hospital, Memphis, Tennessee: gestational choriocarcinoma.

This paper describes a recent tumor board presentation conducted at our institution involving an adolescent with gestational choriocarcinoma. Despite its rarity in pediatrics, gestational choriocarcinoma offers unique diagnostic, treatment and off-therapy considerations in adolescent patients who have become pregnant. Key features and findings of the case as well as important management issues will be discussed.

Adolescent↗
PubMed1984

Cervical cancer occurrence in Memphis and Shelby County, Tennessee, during 25 years of its cervical cytology screening program.

This review of the cytologic history of 430 women with histologically proved invasive cancer of the uterine cervix indicates that several significant subgroups can be defined. One major subgroup consists of 142 patients or 33% of the total group in whom invasive cancer developed within 1 to 5 years, with an average of 2.6 years, after one or more negative cytologic findings. This appears to be a significant proportion of the occurrence of invasive cervical cancer and warrants consideration in the recommendation of screening intervals. The second major subgroup, consisting of 88 patients (20.5%), had a delay in diagnosis averaging 9.9 years after the first abnormal cytologic finding. In some of these patients either the cytologic examination results reverted to negative for a period or the biopsy material did not confirm the cytologic abnormalities. The disease progressed to invasion. These findings appear to bear out the importance of close follow-up of patients with any abnormal cytologic finding in the intraepithelial neoplasia category even though intermittent cytologic studies may appear negative.

Adult↗
PubMed1997

Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: the Memphis experience.

PURPOSE/OBJECTIVE: To evaluate the feasibility, response rates, and toxicity of a Phase II study using targeted supradose cisplatin and concurrent radiation therapy in unresectable Stage III-IV head and neck squamous cell carcinoma. METHODS AND MATERIALS: Sixty patients presenting between 6/93-9/94 were enrolled, 44 (73%) of whom had T4 and/or N2-N3 nodal disease. All patients were treated with rapid targeted superselective intraarterial infusions of cisplatin (150 mg/m2 weekly x 4) and simultaneous sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. Concurrent (day 1) daily radiation therapy was delivered to the primary tumor and overt nodal disease to 66-74 Gy while the uninvolved lower neck received 50 Gy, at 2.0 Gy/fraction. RESULTS: Fifty-one (85%) patients completed the full RADPLAT protocol as planned. Fifty-seven of 60 patients were evaluable for response. Histological (n = 50) or clinical (n = 7) assessment of primary site revealed a complete response (CR) in 52 patients, partial response (PR) in 4, and stable disease (SD) in 1. Of the 40 patients presenting with nodal metastases, pathological (n = 31) or clinical (n = 6) assessment revealed a CR in 25, PR in 11, and SD in 1, while 3 were unevaluable. Overall, for both primary site and nodal disease, CR was attained in 44 (75%), PR in 12 (23%), and SD in 1 (2%) of the 57 evaluable patients. Only 2 (4%) of 57 evaluable patients have recurred above the clavicle, 1 in the primary site and 1 in the regional lymph nodes. Twelve patients (23%) have failed in distant sites. Grade III/VI toxicity has included gastrointestinal in 6, hematologic in 6, mucosal in 12, vascular in 4, and neurological in 4 patients. CONCLUSION: Concurrent radiation therapy and targeted supradose cisplatin (i.e., RADPLAT) can be safely delivered with high response rates and excellent loco-regional control in advanced Stage III/IV head and neck squamous cell carcinoma.

Adult↗