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PubMed1999

A case-crossover analysis of air pollution and mortality in Philadelphia.

This study reassessed Schwartz and Dockery's analysis of daily mortality from nonexternal causes among residents of Philadelphia, Pennsylvania, over 8 years, from 1973 to 1980 [American Review of Respiratory Disease 145:600-604 (1992)]. A Poisson regression analysis using the same model found that a 100-microg/m(3) increment in the 48-hr mean concentration of total suspended particulates (TSP) was associated with increased all-cause mortality [rate ratio = 1.069; 95% confidence interval (CI), 1.043-1.096) after adjustment for quadratic trend, season, year, previous day's mean temperature, dew point, winter temperature, and indicators of hot (temperature > 80 degrees F) and humid days (dew point > 66 degrees F). Critics suggested that time-varying factors such as season and day of week were not sufficiently controlled in this analysis and subsequent studies in other locations. We used a conditional logistic regression analysis with a case-crossover design to reanalyze the data, with air pollution in the prior and subsequent weeks to the day of death serving as referent periods. The case-crossover approach controls for season and day of week by design rather than modeling. We found that a 100-microg/m(3) increment in the 48-hr mean level of TSP was associated with increased all-cause mortality [odds ratio (OR) = 1.056; CI, 1.027-1.086) after adjustment for the same weather variables as above. Similar associations were observed for deaths in individuals over 65 years of age (OR = 1.074; CI, 1. 037-1.111) and for deaths due to cardiovascular disease (OR = 1.063; CI, 1.021-1.107). The current case-crossover analysis confirms the general conclusion of the previous Poisson regression analysis of an association of TSP with daily mortality in Philadelphia, Pennsylvania.

Adolescent↗
PubMed2003

Why support a women's medical college? Philadelphia's early male medical pro-feminists.

The male founders and early faculty of Philadelphia's Woman's Medical College were mostly abolitionist physicians, zealous moralists for whom medical feminism formed only one of the cherished causes they could "manfully" and righteously defend. Male faculty of the late nineteenth century comprised "self-made" men, mostly new specialists, for whom strict sexism probably seemed inconsistent with progressive medicine. For some of these physicians-obviously a small minority-defending medical women and breaking the barriers of fraternity could be consistent with "manly" responsibility. The outcome of the collaboration of women and the dissident men physicians in nineteenth-century Philadelphia amounted to another seeming paradox: the majority of the male medical profession, both locally and nationally, tyrannically hindered women's entry into the profession, yet medicine opened its doors in advance of law and the clergy; and where this first occurred, such as in the community centered on Woman's Medical College, a novel gender rearrangement arose based on collaboration and friendship.

Female↗
PubMed2004

Neighborhood poverty, mortality rates, and excess deaths among African Americans: Philadelphia 1999-2001.

We used vital statistics and census data to determine whether mortality rates in Philadelphia were associated with neighborhood poverty, and to what extent excess mortality among African Americans was associated with neighborhood poverty. Gender-specific, age-adjusted mortality rates for 1999-2001 were strongly associated with neighborhood poverty among both women and men overall, and among both African Americans and non-Hispanic whites. The actual number of deaths among African Americans was 5,305 higher than it would have been if African Americans had had the same gender- and age-specific mortality rates as the average for non-Hispanic whites in Philadelphia, and 1,944 higher than if African Americans had had the same gender- and age-specific rates as non-Hispanic whites in the same neighborhood poverty categories. The excess mortality associated with neighborhood poverty and the socioeconomic factors that force large numbers of African Americans into poverty and high-poverty neighborhoods appear to be major factors in excess mortality among African Americans.

Black or African American↗
PubMed2000

Multiplex in-cell reverse transcription-polymerase chain reaction for the simultaneous detection of p210 and p190 BCR-ABL mRNAs in chronic myeloid leukemia and Philadelphia-positive acute lymphoblastic leukemia cell lines.

We designed a novel multiplex in-cell reverse transcription-polymerase chain reaction method for the simultaneous detection and differentiation of p190 and p210 BCR-ABL mRNAs within single cells from the human chronic myeloid leukemia and Philadelphia positive acute lymphoblastic leukemia. Human K562 chronic myeloid leukemia and SUP B-15 Ph+ acute lymphoblastic leukemia cell lines were used as positive controls for p210 and p190 BCR-ABL mRNAs, respectively. HL60 cell line was used as a negative control. After the leukemia cells were fixed and permeabilized, without extracting nucleic acids, the mRNAs were reverse transcribed to cDNAs, and the cDNAs were amplified by multiplex polymerase chain reaction with fluorescent primers specific for p190 and p210 BCR-ABL mRNAs. After transfer onto glass slides by cytospin, the amplified cells were detected by fluorescence microscopy. Fluorescence microscopy after propidium iodide or 4',6-diamidino-2-phenylindone counterstaining showed that the positive K562 cells exhibited a yellow-green fluorescent cytoplasm around a red nucleus, and that the positive SUP B-15 cells exhibited an orange cytoplasm around a blue nucleus. Only the red or blue nucleus was visible in respective negative HL60 cells. The specificity of amplification was confirmed by the absence of a signal when control experiments were performed either with RNase digestion of mRNA or without reverse transcriptase/Taq polymerase. We conclude that the multiplex in-cell reverse transcription-polymerase chain reaction method is capable of simultaneously detecting and differentiating the p210 and p190 BCR-ABL mRNAs of chronic myeloid leukemia and Philadelphia-positive acute lymphoblastic leukemia cells, and that it may be useful in quantitatively monitoring the minimal residual disease during therapy.

DNA Primers↗
PubMed2004

Aleukemic leukemia cutis in a patient with Philadelphia chromosome-positive biphenotypic leukemia.

Aleukemic leukemia cutis is a rare condition characterized by the invasion of leukemic blasts into the skin before their appearance in the peripheral blood. Leukemia cutis usually occurs in patients with myeloid leukemia, especially the myelomonocytic and monocytic types of acute myeloblastic leukemia. We describe the case of a 62-year-old woman with aleukemic leukemia cutis who developed Philadelphia-positive acute leukemia 1 month after skin involvement. Leukemic cells expressed both myeloid and B-cell lineage surface markers, and monoclonal rearrangement of the immunoglobulin heavy chain was detected by Southern blot analysis. This report is the first of a case of aleukemic leukemia cutis preceding Philadelphia-positive biphenotypic leukemia.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Crack users in east Harlem, New York and Philadelphia, Pennsylvania: HIV-related risk behaviors and predictors of serostatus.

Crack use has been associated with increased risk for HIV seropositivity. This study was undertaken to examine HIV-related risk behaviors among crack users in East Harlem, New York and Philadelphia, Pennsylvania, two northeastern communities which have reported extensive crack use. Crack users recruited in East Harlem (n = 1434) and Philadelphia (n = 694) were compared on demographics, drug and sex-related risk behaviors, health-related behaviors, and HIV serostatus. Many significant differences were found, and seropositivity was higher in the New York sample (25% vs. 11%, chi 2 = 36.28, p < .001). Being a recent drug injector was a significant predictors of seropositivity in both communities, and differences between communities were found in additional predictors of serostatus. Results suggest that tailored HIV interventions may be needed for different communities. In addition, aggregate data across communities, even those that may be in geographical proximity, may obfuscate differences important to incorporate in developing prevention/intervention efforts.

Adult↗
PubMed2001

Development of the Spitz-Holter valve in Philadelphia.

The history of the treatment for hydrocephalus dates back to the Fertile Crescent thousands of years ago. Despite three millennia of management, significant advances in the surgical treatment of the disease have been infrequent. During the 1950s, a milestone occurred at the Children's Hospital of Philadelphia, with the successful development of the first working shunt valve for the treatment of hydrocephalus. In this historical vignette, based on recent interviews with John Holter, D.Sc. (Hon) and Eugene Spitz. M.D., and on a review of the available literature, the authors narrate the exciting story of the development of the Spitz-Holter valve, which took place in Philadelphia during the early 1950s.

Cerebrospinal Fluid Shunts↗
PubMed1999

Fin-de-siècle Philadelphia and the founding of the Medical Library Association.

Philadelphia at the time of the founding of the Medical Library Association (MLA) is described. Several factors that promoted the birth of the association are discussed, including the rapid increase in the labor force and the rise of other health related professions, such as the American Hospital Association and the professionalization of nursing. The growth of the public hygiene movement in Philadelphia at the time of Sir William Osler's residency in the city is discussed. Finally, the rapid growth of the medical literature is considered a factor promoting the development of the association. This article continues the historical consideration of the MLA begun in the author's article on the three founders of the association. The background information is drawn from the items listed in the bibliography, and the conclusions are those of the author.

Health Occupations↗
PubMed2000

Philadelphia positive acute lymphoblastic leukaemia (ALL): clinico-haematologic characteristics, molecular analyses and 3-year follow up--a single institution study.

INTRODUCTION: The Philadelphia chromosome is one of the commonest chromosomal aberration in adult acute lymphoblastic leukaemia (ALL) patients. We present the results of a 3-year prospective study to look at the clinico-haematologic, immunophenotypic, cytogenetic and molecular profile of 13 adult patients with Philadelphia (Ph) positive ALL out of 35 newly diagnosed ALL seen at our institution over the past 3 years. MATERIALS AND METHODS: Thirty-five adult ALL patients seen between 1996 and 1998 comprised the study group. Marrow samples were obtained for immunophenotyping and karyotypic analysis at diagnosis. Samples were also obtained simultaneously for molecular testing for Ph chromosome. RESULTS: Thirteen patients were found to be Ph positive by molecular analysis while cytogenetic studies identified the chromosomal abnormality in 9 of these patients. The median age of our Ph positive patients was similar to those without Ph chromosome. Pre-B phenotype appears to be common in this group of patients. In concordance with other studies, Ph positive ALL was associated with a poor prognosis in our patients. CONCLUSION: Identification of Ph chromosome is important in the management of patients with ALL as it is an important prognostic marker.

Adolescent↗
PubMed2002

North Philadelphia Health System employs handhelds to check data.

Quality control professionals typically do their work after patients have been seen and treated. But North Philadelphia Health System (NPHS) in Philadelphia, PA, is using wireless technology to collect and analyze data while the patient is still in the hospital, giving the quality control department the opportunity to improve care on the spot.

Computer Peripherals↗
PubMed1992

AIDS prevalence by income group in Philadelphia.

We sought to track recent changes in AIDS incidence and prevalence in the city of Philadelphia (PA, U.S.A.) using morbidity and mortality data reported to the health department. We stratified the data by the mean per capita income in census tracts where people with AIDS resided. Estimates made without adjustment for the time lag between events and their entry into the database undercount both recent AIDS diagnoses and recent AIDS deaths. Therefore, we used a previously published method to adjust for the lag in reporting diagnoses and developed a method to adjust for the lag in reporting deaths. We calculated prevalent cases as the difference between cumulative cases and cumulative deaths. Between 1988 and 1990, annual AIDS incidence per 100,000 Philadelphia residents increased by 21% (from 25.9 to 31.4) and AIDS prevalence per 100,000 population increased by 62% (from 30.2 to 48.8). AIDS prevalence increased 113% (from 29.8 to 63.6) in low-income tracts, 88% (from 27.8 to 52.3) in middle-income tracts, and 14% (from 32.5 to 37.2) in high-income tracts. The 62% increase in AIDS prevalence and the shift toward people in poorer neighborhoods imply a need for public funding for AIDS care that is far larger than would be suggested by the general 21% increase in AIDS incidence over the same period.

Acquired Immunodeficiency Syndrome↗
PubMed1965

PHILADELPHIA'S MEDICAL LIBRARIES.

Philadelphia medical libraries embrace the past, the present, and the future. Typifying the expansion in medical communications, area libraries cover the broad spectrum of medical and paramedical fields. Serving workers in these fields are the College of Physicians Library, the five medical school libraries, and a host of hospital and special libraries. Many of these libraries date from the early years of this country. Pharmaceutical firms and governmental institutions in the city, as well as medical libraries in neighboring states, contribute to the area's rich resources. The cooperative efforts and outlook of all these libraries are reflected in the strength of the Regional Group of the Medical Library Association and the plans being made for the future of medical libraries in the Philadelphia area.

Humans↗
PubMed2000

Pictures of Episcopal hospital, Philadelphia, PA: part I (1851-1926).

The merit of images, often posed, often retouched, as historical documents has been debated by numerous scholars. Nonetheless, portraits, illustrations, and photographs form one of the more delightful avenues for recapturing elements of medical care as it was practiced in the past. Part one of this two-part photo-essay records the first cycles of growth and contraction that characterized the history of one of Philadelphia's foremost medical institutions: The Hospital of the Protestant Episcopal Church of Philadelphia.

Ambulances↗
PubMed2005

Late relapse of Plasmodium ovale malaria--Philadelphia, Pennsylvania, November 2004.

Approximately 1,300 cases of malaria are reported each year in the United States; nearly all of these cases occur in travelers, many of whom fail to receive or adhere to prescribed chemoprophylaxis or do not follow recommendations for prevention of mosquito bites. Malaria can persist if not treated or if treated incorrectly (e.g., with an ineffective drug or an incorrect dosage of an effective drug). Early treatment is required to avoid severe illness or death. Although malaria typically becomes clinically apparent within 1 month of infection, cases can occur years after the last presumed exposure. In November 2004, CDC received a report of a late relapse of malaria in a Nigerian man aged 23 years in Philadelphia, Pennsylvania. His malaria was determined to have been caused by Plasmodium ovale, one of the four species of Plasmodium parasite that are transmitted by mosquitoes and cause malaria. The patient had been treated for malaria in Nigeria on multiple occasions, most recently 6 years before onset of his illness in the United States. This report describes the Philadelphia case, which underscores the importance of taking a detailed travel and immigration history when evaluating unexplained fever and considering malaria in the differential diagnosis.

Adult↗
PubMed1990

[Cytogenetic and clinical features of Philadelphia chromosome positive leukemias].

The Philadelphia chromosome defines chronic myeloid leukemia, and is mostly based on a translocation t(9;22) with a typical BCR-ABL rearrangement which also occurs in so called atypical translocations. The transformation of chronic myeloid leukemia is associated with clonal evolution in 80% of cases. The appearance of an isochromosome 17q unequivocally heralds the onset of a myeloid type of blast crisis. Treatment of Ph-positive CML has still to be considered palliative except for allogeneic bone marrow transplantation. The Philadelphia chromosome is also found in about 20% of patients with acute lymphoblastic leukemia and in about 2% of patients with nonlymphoblastic leukemia. It is associated with a poor prognosis. Molecular and cytogenetic findings help differentiating between de novo acute leukemia and blast crisis of chronic myeloid leukemia.

Blast Crisis↗
PubMed1990

P190 BCR/ABL transcript in a case of Philadelphia-positive multiple myeloma.

Philadelphia positive multiple myeloma is a very rare event and, so far, no molecular data about the involvement of the BCR and C-ABL genes are available. We report here the case of a 64-year-old woman presenting with a typical multiple myeloma and a complex Philadelphia (Ph) chromosome that we investigated at a molecular level using conventional DNA techniques and the polymerase chain reaction (PCR). No rearrangement was observed within the major breakpoint cluster region (M-BCR) although she was found to have a P190 BCR/ABL hybrid transcript using PCR. As far as we know, this is the first description of a P190-type mRNA in a patient with a chronic lymphoid disorder. Since P190 is almost always associated in man with acute forms of hematological malignancies, this suggests that other factors may play a role in determining the phenotype of the disease.

Base Sequence↗
PubMed1989

[Allogeneic bone marrow transplantation in a case of acute lymphoblastic leukemia with positive Philadelphia chromosome].

A 12-year-old boy with Philadelphia chromosome positive acute lymphoblastic leukemia received bone marrow transplantation (BMT) from an HLA identical sibling during the second remission. The diagnosis was made at the age of nine. Laboratory examination on admission revealed remarkable leukocytosis (92,000/microliters) with 93% lymphoblasts in the peripheral blood. Blastic cells were FAB L1 common ALL. Chromosomal study on both peripheral blood and bone marrow cells showed that lymphoblasts had an abnormal karyotype of 47, XY, inv (9), t(9; 22), +17. One month later he achieved remission by induction therapy consisting of vincristine, L-asparaginase, doxorubicin, and prednisolone. He was given intrathecal injection of methotrexate and cranial irradiation of 24 Gy for CNS prophylaxis. The cells with Philadelphia chromosome disappeared during remission. Hematological relapse occurred twenty one months later after first remission on April, 1986. He received re-induction therapy including L-Asp VDP, and high-doses of cyclophosphamide, methotrexate and araC. He obtained karyotypic remission on October 1986. Subsequently, bone marrow transplantation was performed following high-dose araC, CY and TBI as preconditioning on December 18, 1986. Methotrexate and cyclosporin A were given intravenously to prevent GVHD. On day 14, karyotypic conversion was detected, suggesting the successful bone marrow grafting. Acute GVHD appeared on day 25, and was treated with prednisolone and cyclosporin A. Prednisolone was tapered by day 80. On day 91, cyclosporin A was discontinued because herpes zoster occurred. Acyclovir was effective, but skin GVHD reappeared. With low-dose prednisolone, skin GVHD improved. Sicca syndrome soon appeared and was followed by chronic GVHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Molecular analysis of interferon-induced suppression of Philadelphia chromosome in patients with chronic myeloid leukemia.

Treatment with recombinant human interferon alpha-A (Roferon-A) is associated with stable suppression of the population of cells that display the Philadelphia (Ph1) chromosome in some patients with chronic myelogenous leukemia (CML) as defined by cytogenetic analysis. Southern blot analyses employing a 3' breakpoint cluster region (bcr) probe (Pr-1) were performed to confirm a complete suppression of the Ph1+ chromosome-positive clone of cells at the DNA level. The complete disappearance of rearranged restriction fragments of the bcr gene, which were a characteristic of the disease prior to Roferon-A therapy, was accompanied by the restoration of normal bone marrow and achievement of durable ongoing complete remission for 9 and 6 months, respectively, in two patients with Philadelphia-positive (Ph1+) CML. Molecular analysis is a valuable probe for monitoring the clinical course of disease in patients with Ph1+ CML.

Adult↗