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PubMed2000

Changing times: reflections on a professional lifetime: an interview with Paul Beeson. Interview by Richard V. Lee.

Paul Bruce Beeson is a child of the American frontier, the younger son of a dedicated general practitioner. Dr. Beeson's adventure was academic medicine; he studied at McGill University, the University of Pennsylvania, the Rockefeller Hospital in New York, and the Peter Bent Brigham Hospital in Boston. He became the Professor and Chair of the departments of medicine at Emory University and Yale University, and then, in Oslerian fashion, was appointed Nuffield Professor of Medicine at Oxford University. His legacy is his pupils, a Who's Who of 20th-century medicine. Dr. Beeson embodies the caring mission of medicine. He prefers to emphasize the patient-physician relationship and the social obligations of medicine; for example, Beeson was a founding member of Physicians for Social Responsibility. It seemed entirely appropriate that his memories and thoughts about 20th-century medicine, which he experienced and exemplified, should be a feature of the first issue of Annals in the year 2000.

Clinical Medicine↗
PubMed2004

[Thirty years of the balloon catheter--A. Grüntzig and percutaneous balloon angioplasty].

Percutaneous transluminal coronary angioplasty--PTCA--will forever be linked with A. Gruentzig's name. Building on the work of Charles Dotter and Malvin Judkins be developped novel technique of revascularisation and established a new speciality - interventional cardiology. The aim of this article is to sum up the most important data on Gruentzig's revolutionary work. Andreas Roland Gruentzig was born on June 25, 1939 in Dresden, Germany. In 1957 he received his B. A. in Leipzig (German Democratic Republic). In 1958, Andreas emigrated to the German Federal Republic, received another B. A. in Heidelberg, and entered the Medical School in Heidelberg where he qualified in 1964. In 1969 he moved to Zurich, Switzerland, in the Dept of Angiology of the University Hospital. He soon appreciated the potential of recanalising partially occluded lower limb arteries using the Dotter-Judkins catheter but also recognised its risks. In 1972-1973 he developped his balloon catheter and performed the first femoral angioplasty in February 12, 1974, and in January 23, 1975 the first one using his new double-lumen catheter. The first experimental coronaroplasty in a dog followed in September 24, 1975. He presented his results with balloon catheters in November 15, 1976 in Miami. After a further period of arduous experimental research--stil manufacturing the catheters with his small crew in the kitchen--he dilated a stenosed coronary artery in a 37-year-old man on September 16, 1977 in Zurich, with immediate relief of symptoms. The results of PTCA in five first patients were published in the February 14, 1978 issue of Lancet; the coronarography in the first patient, on April 10, 2000, revealed normal patency of the site that had been dilated (Prof. B. Meier, Bern). However, the news in Zurich 1978 was received with a certain incredulity and Gruentzig was unable--in spite of Professor A. Senning's support--to obtain facilities to expand his research program and clinical activities. In September 1980 he accepted the Chair of Medicine (Cardiology) and Radiology with the additional title of Director of the Dept of Interventional Cardiology at Emory University in Atlanta, Georgia. Prof. Hurst gave him half of his office suite at Emory and later even further facilities to expand his program. Here, at Emory, Gruentzig gave 10 angioplasty courses and performed with Dr. S. King and Dr. J. Douglas 5000 PTCAs till 1985. Before reaching the peak of his scientific carrier, he died in a flying accident, with his second wife Margareth Ann, near Forsythe, Monroe County, Georgia, on October 27, 1985. His work was appreciated in tributes from the U.S.A., U.K., Switzerland and Germany, by many international awards and honors; numerous interventional laboratories in the world carry A. R. Gruentzig's name.

Angioplasty, Balloon↗
PubMed1993

Health risk appraisal differences between well elderly and university students.

A descriptive/correlational study was undertaken to compare lifestyle behaviors between the well elderly attending a nurse-managed clinic and students attending a university wellness center. The purpose of this study was threefold: (a) to determine current health behaviors of both well elderly and students, (b) to identify high-risk health practices among these two populations, and (c) to compare differences in health behaviors between the two groups. The Carter Center of Emory University Health Risk Appraisal (HRA) was used to measure the occurrence of selected health behaviors. The sample consisted of 173 well elderly and 110 students. Results of the study indicate that when age-related physiologic variables were removed, both groups were highly involved in risk preventive behaviors. Most differences could be explained by culture and age. Additional studies are needed to measure the effect of risk preventive behaviors on quality-of-life.

Adult↗
PubMed2004

Myofibrosarcoma treated with Mohs micrographic surgery.

BACKGROUND: Myofibrosarcoma is a rare malignant mesenchymal tumor composed predominantly of differentiated myofibroblasts. These tumors occur in both children and adults alike and are most commonly located on the head and neck. Recurrences rates range from 44% to 75%, and metastatic disease has been reported in up to 44% of cases. OBJECTIVE: The objective was to present a case of a myofibrosarcoma treated with Mohs micrographic surgery and discuss the use of ultrastructural evaluation in the diagnosis of this rare tumor. METHODS: A 31-year-old African American woman who presented to the Emory University Dermatologic Surgery Clinic with a 4-month history of a 2.5 x 2.5-cm indurated firm painful right upper lateral thigh nodule. A prior biopsy revealed a proliferation of somewhat bland spindled cells with large zones of necrosis with prominent mitotic figures, changes compatible with a cellular dermatofibroma. Because the lesion exhibited clinically suspicious characteristics such as rapid growth and deep infiltration, the patient was subsequently referred to Emory for further evaluation. There was no evidence of lymphadenopathy and a chest X-ray was unremarkable. RESULTS: A two-staged (five and four sections, respectively) uneventful Mohs micrographic surgery procedure was performed resulting in a defect measuring 3.5 x 3.5 x 1.0 cm. Primary closure was achieved with no complication, and the final scar measured 10 cm. Because of the suspicious clinical behavior of this tumor debulking specimen was sent for permanent section. Histopathologic interpretation of these sections was consistent with a fibrosarcoma with myofibroblastic differentiation. No clinical recurrence noted after 14-month follow-up. CONCLUSION: Mohs micrographic surgery is a technique that has been shown to provide superior cure rates in the treatment of many mesenchymal tumors. Here, we report the first case of myofibrosarcoma treated with Mohs micrographic surgery. Myofibrosarcoma is a rare but aggressive tumor that can be difficult to distinguish from other somewhat less aggressive malignancies such as dermatofibrosarcoma protuberans or malignant fibrous histiocytoma. Specific histopathologic criteria are reviewed. We recommend including Mohs micrographic surgery in the armamentarium for the treatment of this rare tumor.

Adult↗
PubMed2000

Indications for therapeutic plasma exchange at a university hospital and a regional blood center.

The AABB guidelines for therapeutic plasma exchange (TPE) are divided into four categories: I. TPE is "standard and acceptable therapy," II. "generally accepted," III. "insufficient evidence to evaluate efficacy," and IV. "data suggest no therapeutic efficacy." Since little is known about the implementation of these guidelines, and since the indications for TPE may vary, depending upon an institution's patient mix, this study reviewed the indications and their categories for two co-located institutions. A retrospective review of the indications for all patients undergoing TPE from January 1, 1994 to December 31,1997 at Emory University Hospital (EUH), a tertiary-care teaching hospital, and the American Red Cross (ARC), a regional blood center, using AABB criteria (ASFA criteria used when not rated [NR] by AABB) was conducted. Categories I/II represented 75% and 88% of cases (EUH and ARC, respectively), while Categories III/IV/NR (NR as used below is "not rated" by both AABB and ASFA criteria; n is number of patients) were 25% and 12% of indications, respectively (P =0.002). Cases at EUH (n=101) were I, 62%; II, 13%; III, 3%; IV, 13%; and NR, 9%. Cases at ARC (n=359) were I, 77%; II, 11%; III, 9%; IV, 0%; and NR, 3% (P<0.001). No Category IV patients underwent TPE at ARC (13% at EUH). Thrombotic thrombocytopenic purpura (TTP) was the most common indication for TPE at both centers. The majority of the procedures were "appropriate" (Categories III/); several disorders ( approximately 10%) for which TPE was utilized at both centers were NR by both AABB and ASFA guidelines. Indications for TPE may differ, depending on the type of requesting institution. Physicians requesting TPE for patients with disorders in Categories III/IV/NR should be more strongly encouraged to enter their patients into controlled trials to best evaluate the efficacy of TPE in inadequately-studied clinical situations. This might best be accomplished at university hospitals, where requests for Category III/IV/NR may be higher. A need exists for periodic updating of the AABB guidelines to include those diseases for which new information is available with regard to the potential therapeutic role of TPE.

Hospitals, University↗
PubMed1995

A critical assessment of neurological risk during warm heart surgery.

A prospective randomized trial comparing retrograde warm blood cardioplegia with cold oxygenated crystalloid cardioplegia in coronary bypass patients at Emory University revealed an increased risk of adverse neurological events in the warm group (4.5% vs 1.4%, p < 0.005). Multivariant analysis found four variables to be independent predictors of adverse neurological outcome: congestive heart failure (p = 0.002); age (p = 0.002); aortic cross-clamp time (p = 0.02); and randomization to the warm group (p = 0.026). In Toronto, a prospective randomized trial compared antegrade warm blood cardioplegia with antegrade cold blood cardioplegia. Compared to the Emory trial, the Toronto series contained fewer female patients (16% vs 25%), fewer patients older than age 70 (16% vs 30%), and fewer redo operations (4% vs 14%). The other prominent differences between the Emory series and the Toronto series were: extensive use of retrograde cardioplegia in the Emory series; mild hypothermia in the warm group in the Toronto series; and elevated serum glucose in the warm group in the Emory series. The Toronto series showed no difference in adverse neurological events comparing cold versus warm cardioplegia groups. A comparison of these two series suggests that mild hypothermia in the Toronto series, elevated glucose in the Emory series, or the use of retrograde cardioplegia may be operative in the elevated incidence of adverse neurological events seen in the Emory series in addition to a relatively larger number of high-risk patients (female, elderly, and redo) in the Emory series.

Cardiopulmonary Bypass↗
PubMed1988

Management of variceal bleeding in patients with noncirrhotic portal vein thrombosis.

Since 1971, 70 patients have been seen at Emory University Hospital with gastroesophageal varices secondary to extrahepatic portal vein thrombosis (PVT). Thirty-seven of these patients had had prior major operative therapy. In only three patients (8%) was shunt surgery successful, and there was a high incidence of rebleeding, other morbidity, and mortality. Of especial note are the serious consequences of simple splenectomy; splenomegaly and thrombycytopenia should rarely, if ever, be used as indication for splenectomy in portal hypertension. In 1977, the use of selective distal splenorenal shunt (DSRS) was begun at Emory in this population and a selective shunt has been possible in 24 of 29 patients (83%) who had had no prior operative therapy. Results have been excellent with a greater than 90% patency rate, long-term portal perfusion in all, no encephalopathy, and late rebleeding in one patient. Quantitative studies at 3-6 years show stability of liver function, significant decrease in spleen size, and rise in platelet count. However, long-term follow-up (greater than 15 years) is required in PVT patients before definitive assessment can be obtained. A specific problem of the PVT patient is late shunt stenosis which requires close observation; dilatation of the shunt was performed in six of the 24 patients with a patent shunt. Poor results with non-shunt operative procedures in PVT were again documented. The proper role of endoscopic variceal sclerotherapy is not yet clear, but appears to be an excellent addition to the therapeutic options. In conclusion, for patients with a patent splenic vein, initial therapy should be a selective shunt; for patients without a patent splenic venous system, endoscopic sclerotherapy is the procedure of choice.

Adult↗
PubMed2004

Synthesis and biological evaluation of novel curcumin analogs as anti-cancer and anti-angiogenesis agents.

A series of novel curcumin analogs were synthesized and screened for anti-cancer and anti-angiogenesis activities at Emory University and at the National Cancer Institute (NCI). These compounds are symmetrical alpha,beta-unsaturated and saturated ketones. The majority of the analogs demonstrated a moderate degree of anti-cancer activity. Compounds 10, 11, and 14 exhibited a high degree of cytotoxicity in the NCI in vitro anti-cancer cell line screen. In addition, this screen revealed that these compounds inhibit tumor cell growth with a higher potency than the commonly used chemotherapeutic drug, cisplatin. In independent in vitro screens conducted at Emory, the same compounds plus 4, 5, 8, 9, and 13 exhibited a high degree of cytotoxicity to tumor cells. Analogs that were effective in the anti-cancer screens were also effective in in vitro anti-angiogenesis assays. Compounds 4, 9, 11, and 14 were most effective in the anti-angiogenesis assays run at Emory. In the assays conducted by the NCI, compound 14 was almost as potent as the anti-angiogenic drug TNP-470, which has undergone clinical trials. Based on the favorable in vitro anti-cancer and anti-angiogenesis results with 14, further in vivo tests were conducted. This compound effectively reduced the size of human breast tumors grown in female athymic nude mice and showed little toxicity. This data, coupled with the remarkable in vitro data, suggests that compound 14 may potentially be an effective chemotherapeutic agent. As a follow-up, a 3D quantitative structure relationship based on 14 has been developed. It shows a cross-validated r2(q2) and a predictive r2(p2) = 0.71. COMPARE analysis suggests the compound to be a possible RNA/DNA antimetabolite, but also implies that the compound's cytotoxicity may arise from a presently unknown mechanism.

Angiogenesis Inhibitors↗
PubMed1995

Normal range prostate-specific antigen versus age-specific prostate-specific antigen in screening prostate adenocarcinoma.

OBJECTIVES: Prostate-specific antigen (PSA) has become the most useful serum tumor marker in the diagnosis and screening of prostate adenocarcinoma. The currently cited reference range of normal (0 to 4.0 ng/mL monoclonal) lacks both the sensitivity and specificity to be universally accepted as a screening test, and alternatives to serum PSA have been proposed, such as PSA density, PSA velocity, and age-adjusted PSA. Age-adjusted PSA takes into account the facts that as men grow older the prostate enlarges and that screening should have maximum sensitivity in younger men and maximum specificity in older men. METHODS: A population of 4,710 men with no known history of prostate adenocarcinoma underwent 5,629 examinations by transrectal ultrasound of the prostate (TRUS) from 1987 to 1994. This population consists of Mobile Urology Group, Mobile, Alabama, and Emory University, Atlanta, Georgia, patient databases. We have examined our data to determine the sensitivity, specificity, and positive predictive values for normal range PSA (0 to 4 ng/mL) versus age-specific PSA values. RESULTS: A total of 2040 patients had an abnormal digital rectal examination (DRE) and 3581 procedures were performed for an elevated PSA and a normal DRE. Biopsies were performed in 2,657 patients with 945 (35.6%) positive for cancer. Criteria for biopsy included elevated PSA (more than 4 mg/mL), PSA density more than 0.15 abnormal DRE, or suspicious TRUS. Patients were grouped according to decade: group 1 (ages 40 to 49 years, n = 183), group 2 (ages 50 to 59 years, n = 1018), group 3 (ages 60 to 69 years, n = 2358), and group 4 (ages 70 to 79 years, n = 1687). CONCLUSIONS: Use of the age-specific range for PSA increases the sensitivity in younger men more likely to benefit from treatment, and decreases the biopsy rate in older patients who may not be candidates for aggressive treatment. Age-adjusted PSA is the most valuable for patients over the age of 70 years of whom 22% would be spared TRUS with biopsy.

Adenocarcinoma↗
PubMed1987

PTCA--clinical aspects.

At Emory University Hospital, 7,000 coronary angioplasty procedures have been performed since 1980. The overall success rate remains around 90% despite extensive broadening of the indications. Complications include emergency surgery in 2.5%, acute infarction in 2.5%, and a mortality of 0.2%. Major problems are acute closure and recurrence of stenosis. Factors predisposing to acute closure include lesion length, female gender, bend in the artery at the area of stenosis, branch point location, thrombus in the artery and other lesions in the same vessel. Therapy for acute closure includes prolonged balloon inflations, the use of the bail-out catheter, and for the future, intracoronary stenting devices. Restenosis occurs in approximately 25% of the patients and is influenced by male gender, unstable angina, total occlusion, location of the lesions, and incomplete results of angioplasty. Attempts at modifying restenosis included anti-platelet therapy, anticoagulation and calcium antagonists. At the present it is felt that more potent antiplatelet agents will be required to make additional improvements in the restenosis rate. Long-term follow-up of the Emory cohort reveals a 4 1/2 year survival of over 96% with 89% free from death, myocardial infarction or the need for coronary bypass surgery. In order to identify the proper role of angioplasty in multivessel disease, a prospective randomized trial is now being instituted at Emory to evaluate the relative merits of angioplasty and coronary bypass surgery.

Angioplasty, Balloon↗
PubMed2000

Physician disclosure of healthy personal behaviors improves credibility and ability to motivate.

CONTEXT: While some studies have shown that physicians with healthy personal habits are especially likely to discuss prevention with their patients, to our knowledge no one has published information testing whether physician credibility and patient motivation to adopt healthier habits are enhanced by physician's disclosures of their own healthy behaviors. DESIGN: Two brief health education videos about improving diet and exercise were produced and shown to subjects (n1 = 66, n2 = 65) in an Emory University general medical clinic waiting room in Atlanta, Ga. In one video, the physician revealed an additional half minute of information about her personal healthy dietary and exercise practices and had a bike helmet and an apple visible on her desk (physician-disclosure video). In the other video, discussion of personal practices and the apple and bike helmet were not included (control video). RESULTS: Viewers of the physician-disclosure video considered the physician to be generally healthier, some-what more believable, and more motivating than did viewers of the control video. They also rated this physician to be specifically more believable and motivating regarding exercise and diet (P < or = .001). CONCLUSION: Physicians' abilities to motivate patients to adopt healthy habits can be enhanced by conveying their own healthy habits. Educational institutions should consider encouraging health professionals-in-training to practice and demonstrate healthy personal lifestyles.

Adult↗
PubMed1984

Clostridium difficile. Colonization and toxin production in a cohort of patients with malignant hematologic disorders.

We examined 45 (80%) of 56 consecutive adult patients with malignant hematologic disorders who were hospitalized during a 15-week period at Emory University Hospital, Atlanta. Stool samples for Clostridium difficile culture and cytotoxin assay were obtained on admission and then weekly during each patient's hospitalization. On admission, four patients had detectable C difficile in their stool samples, which was associated with prior antimicrobial use but not with prior cancer chemotherapy. One of the four patients with positive stool samples also had toxin present in the stool sample and was the only one with diarrhea. Eight (36%) of 22 patients hospitalized for one or more weeks had C difficile isolated from at least one stool specimen. The positive cultures showed no clustering in time, and no risk factors were identified for colonization. Only seven of 15 culture-positive stool samples and three of seven toxin-positive samples were associated with diarrhea.

Adult↗
PubMed2004

Loss of apolipoprotein E receptor LR11 in Alzheimer disease.

BACKGROUND: Genetic, epidemiologic, and biochemical evidence suggests that apolipoprotein E, low-density lipoprotein receptors, and lipid metabolism play important roles in sporadic Alzheimer disease (AD). OBJECTIVE: To identify novel candidate genes associated with sporadic AD. DESIGN: We performed an unbiased microarray screen for genes differentially expressed in lymphoblasts of patients with sporadic AD and prioritized 1 gene product for further characterization in AD brain. SETTING: Emory University, Atlanta, Ga. SUBJECTS: Cell lines were used from 14 patients with AD and 9 normal human control subjects. RESULTS: Six genes were differentially expressed in lymphoblasts of 2 independent groups of patients with probable AD and autopsy-proven AD. We hypothesized that 1 of the genes, termed low-density lipoprotein receptor relative with 11 binding repeats (LR11) (reduced 1.8- and 2.5-fold in AD lymphoblasts vs controls), might be associated with sporadic AD on the basis of its function as neuronal apolipoprotein E receptor. We found dramatic and consistent loss of immunocytochemical staining for LR11 in histologically normal-appearing neurons in AD brains. This reduction of LR11 protein was confirmed by quantitative Western blotting (P =.01). CONCLUSIONS: There is loss of the microarray-derived candidate, LR11, in neurons of AD brains. This study shows that microarray analysis of widely available lymphoblasts derived from patients with AD holds promise as a primary screen for candidate genes associated with AD.

Adaptor Proteins, Vesicular Transport↗
PubMed1984

Peritoneovenous shunts. Lessons learned from an eight-year experience with 70 patients.

The peritoneovenous shunt (PVS) is preferred over other treatment modalities in the treatment of the cirrhotic patient who has intractable ascites. The favorable effects on nutrition, pulmonary, and renal function, in addition to prompt control of ascites, frequently overshadow potentially life-threatening complications. We summarized our experience with the PVS in 70 patients with portal hypertension at Emory University, Atlanta, and identified the perioperative complications and operative mortalities. Late complications of sepsis and variceal hemorrhage were frequent and often were fatal. Of the multiple preoperative clinical and laboratory determinants, only the serum bilirubin level (greater than or equal to 3 mg/dL) was predictive of the operative mortality and longevity of survivors. The PVS should be reserved for patients with disabling, truly refractory ascites.

Adolescent↗
PubMed2000

Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood.

CONTEXT: Evidence suggests that early adverse experiences play a preeminent role in development of mood and anxiety disorders and that corticotropin-releasing factor (CRF) systems may mediate this association. OBJECTIVE: To determine whether early-life stress results in a persistent sensitization of the hypothalamic-pituitary-adrenal axis to mild stress in adulthood, thereby contributing to vulnerability to psychopathological conditions. DESIGN AND SETTING: Prospective controlled study conducted from May 1997 to July 1999 at the General Clinical Research Center of Emory University Hospital, Atlanta, Ga. PARTICIPANTS: Forty-nine healthy women aged 18 to 45 years with regular menses, with no history of mania or psychosis, with no active substance abuse or eating disorder within 6 months, and who were free of hormonal and psychotropic medications were recruited into 4 study groups (n = 12 with no history of childhood abuse or psychiatric disorder [controls]; n = 13 with diagnosis of current major depression who were sexually or physically abused as children; n = 14 without current major depression who were sexually or physically abused as children; and n = 10 with diagnosis of current major depression and no history of childhood abuse). MAIN OUTCOME MEASURES: Adrenocorticotropic hormone (ACTH) and cortisol levels and heart rate responses to a standardized psychosocial laboratory stressor compared among the 4 study groups. RESULTS: Women with a history of childhood abuse exhibited increased pituitary-adrenal and autonomic responses to stress compared with controls. This effect was particularly robust in women with current symptoms of depression and anxiety. Women with a history of childhood abuse and a current major depression diagnosis exhibited a more than 6-fold greater ACTH response to stress than age-matched controls (net peak of 9.0 pmol/L [41.0 pg/mL]; 95% confidence interval [CI], 4.7-13.3 pmol/L [21.6-60. 4 pg/mL]; vs net peak of 1.4 pmol/L [6.19 pg/mL]; 95% CI, 0.2-2.5 pmol/L [1.0-11.4 pg/mL]; difference, 8.6 pmol/L [38.9 pg/mL]; 95% CI, 4.6-12.6 pmol/L [20.8-57.1 pg/mL]; P<.001). CONCLUSIONS: Our findings suggest that hypothalamic-pituitary-adrenal axis and autonomic nervous system hyperreactivity, presumably due to CRF hypersecretion, is a persistent consequence of childhood abuse that may contribute to the diathesis for adulthood psychopathological conditions. Furthermore, these results imply a role for CRF receptor antagonists in the prevention and treatment of psychopathological conditions related to early-life stress. JAMA. 2000;284:592-597

Adrenocorticotropic Hormone↗
PubMed1998

Increased frequency of cystic fibrosis among infants with jejunoileal atresia.

There appears to be an increased frequency of cystic fibrosis (CF) among infants with jejunoileal atresia (JIA). However, the figures vary widely, and no population-based data exist. The purpose of this study was to quantitate the magnitude of the association between JIA and CF in Atlanta using population-based data from 1968 to 1995. Case subjects included all infants with isolated JIA born during 1968-1995 to mothers residing in the five-county metropolitan Atlanta area at the time of birth. To ascertain cases, we reviewed records of the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects registry. Caucasian JIA cases were cross-referenced with patients in the CF registry at the Egleston Cystic Fibrosis Center at Emory University to more completely ascertain the diagnosis of CF among JIA cases. During 1968-1995, MACDP ascertained a total of 94 isolated JIA cases, for a birth prevalence of 1.8/10,000 live births. Among the cases, 38 were Caucasian, 52 were African-American, and 4 were of Asian or Hispanic ethnicity. Four of the 38 Caucasian JIA cases (11%) also had CF. The expected number of JIA cases with CF is 0.019 based on the estimated population incidence of 1/ 2,000 for CF. The observed to expected (O/E) ratio of Caucasian JIA cases with CF is greater than 210 (P<0.0001). Caucasian infants with JIA have more than 210 times the risk for CF compared with Caucasian infants in the general population. The results of this study have implications for the management of infants born with JIA and genetic counseling for families with affected infants.

Academic Medical Centers↗
PubMed1996

Permanent tooth calcification in chimpanzees (Pan troglodytes): patterns and polymorphisms.

Tooth calcification is an important developmental marker for use in constructing models for early hominid life history, particularly for its application to the fossil record. As chimpanzees are commonly utilized in interspecific comparisons in such research, this study aims to improve available baseline data for tooth calcification patterns in chimpanzees (Pan troglodytes), and to quantify basic patterns and polymorphisms. We present an analysis of developmental patterns for the left mandibular dentition (I1-M3) based on intraoral radiographs obtained from a cross-sectional sample of chimpanzees (58 males, 60 females) housed at LEMSIP (NYU Medical Center) and Yerkes (Emory University). No significant differences with previous descriptions of the basic sequences of tooth calcification in chimpanzees were found, but variation in such patterns was documented for the first time. In the overall sequence, polymorphisms between the canine and the group (M2 P4 P3) reached significant levels. This is due to the relative delay in canine crown formation compared to other teeth. Differences in the basic sequence between males and females were recorded, but are due to minor shifts in the percentages of occurrence for polymorphic sequences which are common to both genders. Perhaps our most important findings are that a) different polymorphic sequences occur in tooth calcification and tooth emergence in chimpanzees, and b) developmental relationships among teeth fluctuate throughout tooth calcification. Thus, characterizations of dental developmental patterns based on particular stages of development cannot necessarily be extrapolated to other stages without supporting data.

Animals↗
PubMed1996

Twenty-year review of a breast cancer screening project. Ninety-five percent survival of patients with nonpalpable cancers.

BACKGROUND: In 1973, the Breast Cancer Detection Demonstration Project at the Georgia Baptist Medical Center began screening supposedly asymptomatic women for breast cancer. The project has been reviewed and now 20 years later, the follow-up of those women with detected cancer who were matched with a group of the original cohort with negative screens is reported. Early criticism of the project was its "lead-time bias," which, after 20 years, should pose no problem. METHODS: Approximately 9043 women were screened for 5 years. The remainder of the total of 10,000 women were screened at the Emory University Department of Radiology. The 128 patients who were found to have breast cancer were observed for over 20 years. A matched group of 1609, who had negative results when originally screened, were also observed for 20 years. RESULTS: After 20 years, approximately 86% of the 128 women diagnosed with breast cancer were still free of disease, including 88.3% of women with lesions of less than 1.1 cm and 95.1% of those with nonpalpable carcinomas. CONCLUSIONS: Over 95% of the 67 women with nonpalpable lesions were alive after 20 years of follow-up. Women not screened yearly tend to have larger lesions than those screened on a regular basis. Regular screening is currently the best way to control this disease.

Adult↗