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At least 19 recordsLinked to original sources
PubMed1992

A clinicopathologic study on the diffuse malignant lymphoma--a morphologic and immunophenotypic analysis in 62 patients at Harbor-UCLA Medical Center.

In order to compare the prognoses of patients with diffuse malignant lymphomas on the basis of histology and immunophenotypes, we retrospectively studied 62 cases of diffuse lymphoma arising in lymph nodes. We also evaluated the reactivity patterns of monoclonal antibodies (MoAb) LN1, LN2 and LN3 to determine the criteria for making a differential diagnosis in B cell lymphomas. The immunologic phenotypes were determined by the avidin biotin peroxidase complex method, using frozen or paraffin fixed tissues. The majority (66.3%) were B cell with the remaining 20.9% being T cell and 12.9% were non-B, non-T cell lineage. Immunological heterogeneity was found especially in the mixed small and large cell and the immunoblastic lymphomas. There was no significant difference between B- and T-cell lymphomas with respect to survival and death (P > 0.05). Histologically 79% (49/62) of the lymphoma was large cell and 21% (13/62), small cell lymphoma. There was a difference in prognosis between low, intermediate and high-grade of lymphomas. However there were no significant differences among the subtypes of the diffuse aggressive lymphomas. Factors associated with poor prognosis were advanced stages (P < 0.025) and histology of the malignant lymphomas. MoAb LN1, LN2 and LN3 gave positive staining in 83.3%, 91.7% and 60% of B cell lymphomas, respectively. The most common phenotypic pattern in B cell lymphomas was LN1+, LN2+, LN3+/-, suggestive of follicular center cell origin. As a panel, phenotypic patterns of MoAb LN1, LN2 and LN3 may be useful in differentiation of follicular center cell lymphoma from others.

Adolescent↗
PubMed1989

Triage: a subspecialty of emergency nursing.

Triage nursing is evolving as a subspeciality of emergency nursing. Of the five major types of triage systems in use, four utilize nursing personnel. The Advanced Triage System is the most comprehensive system and is utilized in the Emergency Department at Harbor-UCLA Medical Center. This article defines the process of triage, reviews various types of triage systems and discusses the role of the triage nurse in the Advanced Triage System utilized at Harbor-UCLA Medical Center.

Emergencies↗
PubMed1983

Amebic liver abscess. The surgeon's role in management.

Hepatic amebic abscess presented as an acute abdominal illness in 71 patients seen at the Harbor-UCLA Medical Center during the past 10 years. Most of the patients were young, Mexican and male, and half had coexistent medical diseases. The correct diagnosis was made by ultrasonography in 27 patients, laparotomy in 6, and radionuclide scan in 38. More than half (38 patients) were diagnosed accurately within 24 hours of admission. Sixty-seven abscesses were located in the right or both lobes; only 4 were limited to the left lobe, all of which had caused perforation. Operative findings in 20 patients were ruptured abscess in 12 and unruptured abscess in 2; abscesses were missed during exploration in 6 patients, one of whom had acute cholecystitis and another, a small bowel infarction. Other complications were intrathoracic rupture in four and intrapericardial rupture in one. Metronidazole was successful as initial drug therapy in 64 patients. Ultrasonographically-guided percutaneous drainage was used as a diagnostic and therapeutic adjunct to management in 15 patients. In a metropolitan population, the surgeon must consider amebic abscess in the evaluation of a febrile patient with right upper quadrant illness. With ultrasonography or radionuclide scanning, he can establish a reliable diagnosis in 24 hours. Although medical therapy is effective, surgery is required in 20 percent of patients for drainage of the ruptured abscess or treatment of a coexistent surgical condition. An unruptured abscess should be sought in an apparently negative exploration. A solitary abscess of the left lobe is rare but has a particular propensity to cause perforation.

Adolescent↗
PubMed1984

Pulmonary embolism secondary to venous thrombosis of the arm.

Pulmonary embolism is described as an infrequent complication of axillary and subclavian vein thrombosis. We have reported our recent clinical experience with 14 patients admitted to the Harbor-UCLA Medical Center who had a clinical diagnosis of axillary and subclavian vein thrombosis documented by phlebography of the thrombosed arm. The causes of thrombosis were effort (three patients), trauma (three patients), drug abuse (four patients), underlying neoplastic disease (three patients), and congenital venous malformation (one patient). Pulmonary emboli were diagnosed by arteriogram, ventilation perfusion scans, and arterial blood gas abnormalities in five patients with respiratory symptoms for an incidence of 35.7 percent. Immediate anticoagulation with heparin, then switching to warfarin sulfate after 5 days, was the standard therapy in all patients. Follow-up examinations between 3 and 24 months demonstrated mild postphlebitic syndrome consisting of pain and minimal swelling in two patients. We conclude that pulmonary emboli may be a more frequent complication of axillary and subclavian vein thrombosis than has generally been recognized.

Adolescent↗
PubMedDate not supplied

Assessment of suicide potential by nonpsychiatrists using the SAD PERSONS score.

We were unable to validate the predictive ability of a previously described mneumonic (SAD PERSONS score, SPS) for determining the need for hospitalization of patients who have expressed suicidal ideation or behavior. After reviewing published studies on the subject, we arrived at a modification of this scale (MSPS). The MSPS obtained by nonpsychiatric and psychiatric house staff was compared and correlated with patient disposition for 100 consecutive adult patients presenting to the Harbor-UCLA Medical Center emergency department for the assessment of suicidal behavior. We were unable to correlate the MSPS with patient disposition. However, four criteria were found to correlate with the need for hospitalization (P less than .001). After weighting the MSPS, giving two points for each of these four criteria, and one point for each of the other six, we found that a score of greater than or equal to 6 had a sensitivity of 94% and a specificity of 71% in identifying need for hospitalization. A score of less than or equal to 5 had a negative predictive value for hospitalization of 95%. When two nonsuicidal patients, admitted for situational reasons only, were eliminated, a score of greater than or equal to 6 had a 100% sensitivity and a score of less than or equal to 5 had a 100% negative predictive value in identifying patients requiring hospitalization. Subsequent use of the weighted MSPS for an additional 82 patients confirmed these results. Follow-up of 97.5% (116/119) of all patients discharged from the emergency department at 6 to 12 months found no mortalities. Using a weighted MSPS, nonpsychiatrists can quickly and easily obtain the objective information necessary to make an initial assessment of suicidality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Perinatal bacterial infection after prolonged rupture of amniotic membranes: an analysis of risk and management.

Chi-square and logistic stepwise multiple regression analysis of perinatal determinants of infant bacterial infection following prolonged rupture of amniotic membranes for 24 hours or more prior to delivery was applied in 33 infected infants and 66 matched control infants from the NINCDS Collaborative Project. In order of statistical significance, the most important variables were placental inflammation (P = 0.002), gestational age less than 34 weeks (P = 0.008), gestational age 34 to 37 weeks (P = 0.013), male sex (P = 0.015), Apgar score less than 6 at 5 minutes (P = 0.023), and clinical amnionitis (maternal fever, fetal tachycardia, or amniotic or gastric fluid leukocytes or bacteria) (P = 0.044). Duration of labor during PROM, race, and maternal age and parity were insignificant. Using these predictive variables, identification of infected infants for either microbial surveillance (superficial and systemic cultures) or microbial surveillance and anticipatory antibiotic therapy (discontinued after 3 days of negative cultures) was highly significant (P = 0.0001). Incorporating these variables and derived coefficients from multivariate analysis, a mathematical model was used for evaluation and prediction of perinatal bacterial infection with a sensitivity of 82% and specificity of 70%. Analysis of 46 infants prior to and 310 infants after implementation of this process at Harbor-UCLA Medical Center indicated significant improvement in the appropriate management of these infants at risk (from 59% to 87% of the population, P less than 0.05). Inappropriate antibiotic therapy decreased from 35% to 10% (P less than 0.05). In the absence of a shift in the median days of hospitalization of non-PROM infants, determination of the grand median days of PROM infant hospital stay showed a decrease (P less than 0.01) after initiation of this evaluation and management scheme.

Amnion↗
PubMedDate not supplied

Periorbital cellulitis in infancy.

To our knowledge, no previous study of periorbital cellulitis has focused on its specific characteristics in infants only (less than 1 year of age.) We retrospectively studied 30 cases of infantile periorbital cellulitis treated at Harbor-UCLA Medical Center from 1977 to 1988. Characteristics of the disorder in our infants older than 1 month were similar to earlier reports of older children in terms of etiology, radiological and bacteriological findings, and course. However, compared with our older infants, our seven neonates (7 to 30 days old) had a higher incidence of ruptured dacryocele (29% vs 0%) and unknown source of the infection (43% vs 4%); but a lower incidence of preceding upper respiratory infection (14% vs 78%), abnormal sinus films (0% vs 22%), and positive blood cultures (14% vs 30%). Of the positive cultures, Hemophilus sp was the most common pathogen among the older infants (35%), while Streptococcus and Staphylococcus were the most frequent among the neonates (71%). All infections remained preseptal and responded well to intravenous antibiotics.

Cellulitis↗
PubMed1991

Telephone T.A.L.K.: a telephone communication program.

Twenty-four percent of all medical care contacts are made on the telephone. Practicing pediatricians and emergency physicians often manage children's illnesses by telephone. Studies have shown that there is a need for improved communication between physicians and patients, and it is believed that quality of, and satisfaction with, health care services will improve with increased emphasis on interpersonal communication skills in medical training. The Department of Pediatrics at Harbor-UCLA Medical Center includes interpersonal telephone communication as part of residency training. This article describes the telephone program, which differs from other programs in medical settings in that it focuses on communication process skills only. A conceptual framework around the acronym T.A.L.K. is outlined. Topic sessions in the pediatric emergency department and individual resident review sessions are discussed. The guidelines designed to follow the conceptual framework are presented.

Clinical Protocols↗
PubMedDate not supplied

Periorbital cellulitis in infancy.

To our knowledge, no previous study of periorbital cellulitis has focused on its specific characteristics found only in infants (less than 1 year of age.) We retrospectively studied 30 cases of infantile periorbital cellulitis treated at Harbor-UCLA Medical Center from 1977 to 1988. Characteristics of the disorder in our infants older than 1 month were similar to earlier reports of older children in terms of etiology, radiological and bacteriological findings, and course. However, compared with our older infants, our seven neonates (7 to 30 days old) had a higher incidence of ruptured dacryocele (29% vs 0%) and unknown source of the infection (43% vs 4%); but a lower incidence of preceding upper respiratory infection (14% vs 78%), abnormal sinus films (0% vs 22%), and positive blood cultures (14% vs 30%). Of the positive cultures, Hemophilus sp was the most common pathogen among the older infants (35%), while Streptococcus and Staphylococcus were the most frequent among the neonates (71%). All infections remained preseptal and responded well to intravenous antibiotics.

Cellulitis↗
PubMed1988

Fine-needle aspiration cytology in the diagnosis of primary breast cancer.

To evaluate the role of fine-needle aspiration (FNA) cytology in the diagnosis of primary breast cancer, we reviewed our experience over a recent 5-year period at Harbor-UCLA Medical Center. A total of 590 aspirates with subsequent follow-up were documented. One hundred thirty-three primary cancers were histologically proved. Of the 133 cancers, 91 (68%) were diagnosed as malignant by aspiration cytologic examination; another 22 (17%) were reported as suspicious. Of the cancers, 8 (6%) had a benign cytologic diagnosis and 12 (9%) had unsatisfactory smears. No cytologic tests positive for malignancy were found to be benign on histologic examination. With an absolute sensitivity of 75% and a specificity of 100%, we conclude that FNA cytologic examination is highly accurate in the diagnosis of breast cancer. With no false-positive studies, the finding of a clearly malignant cytologic condition obviates the need for biopsy before mastectomy.

Adult↗
PubMed1984

Nonsurgical ovum transfer as a treatment in infertile women. Preliminary experience.

This report summarizes our experience with nonsurgical ovum transfer at Harbor-UCLA Medical Center. In 29 attempts, 12 ova have been recovered and transferred. Two ongoing intrauterine recipient pregnancies have resulted from this preliminary research. There were two complications: one ectopic pregnancy in a recipient woman and one retained pregnancy in a donor woman who aborted spontaneously.

Adult↗
PubMed1989

Attitudinal survey of sperm donors to an artificial insemination clinic.

Donors (n = 42) to an artificial-insemination-by-donor sperm clinic were surveyed to ascertain individual motivations and attitudes regarding participation. Responses were compared to those of a matched control group (n = 50) of nondonors. Donors were motivated by money, with the majority (69%) unwilling to participate if financial incentives were withdrawn. Anonymity was desired, and donors did not favor disclosure of information to a national registry tracking insemination outcomes. However, donors and controls did endorse providing sperm for an infertile brother. Donors and controls differed significantly in response to 2 of 15 questions asked, with differences due to perceptions of donor motivation. Although perceived as altruistic by peers, donors did not envision themselves as such, and most considered donating semen similar to donating blood or organs.

Adult↗