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A F Jacobson

Publications and source records attributed to A F Jacobson.

At least 19 recordsLinked to original sources
PubMed2001

Prognostic significance of the number of bone scan abnormalities at the time of initial bone metastatic recurrence in breast carcinoma.

BACKGROUND: To gain insight into the factors that contribute to the more favorable prognosis associated with recurrence limited to bone in patients with breast carcinoma, the authors analyzed the number of sites of initial involvement identified on radionuclide bone scans in relation to long term outcome. METHODS: Records of 641 patients with clinical Stage I-III breast carcinoma that originally was diagnosed in 1974-1985 were reviewed. During follow-up, 295 patients (46%) experienced distant recurrence, including 116 with bone as the sole initial site of metastatic disease. Radionuclide bone scans identified the initial site(s) of recurrence in 113 of these latter 116 patients, and these studies were categorized by the number of skeletal lesions subsequently confirmed as metastases (1, 2, or > or = 3). Survival from time of recurrence and time of original diagnosis was analyzed using Kaplan-Meier methods, and factors associated with recurrence and mortality were examined using logistic and Cox regression. RESULTS: Median survival from time of recurrence was 35 months in the patients with bone-only metastases, compared with 11-26 months for all other sites of visceral recurrence exclusive of bone. Number of positive lymph nodes and estrogen receptor status were the only predictive variables for recurrence. Median survival from time of recurrence and time of original diagnosis for the 3 bone scan categories was: 1 lesion (n = 47), 53 and 86 months; 2 lesions (n = 22), 38 and 68 months; and > or = 3 lesions (n = 44), 22 and 58 months (P < 0.0001 and P < 0.005 for 1 and 2 lesions vs. > or = 3). In the "bone-only" group, the number of scan lesions was the strongest predictor of length of survival. CONCLUSIONS: Patients with breast carcinoma who experience a recurrence in bone at only one or two sites initially have a survival advantage over those with more extensive (> or = 3 sites) skeletal metastases and those with metastatic disease involving other visceral organs.

Adult↗
PubMed2000

Association of prostate-specific antigen levels and patterns of benign and malignant uptake detected. on bone scintigraphy in patients with newly diagnosed prostate carcinoma.

The bone scan patterns of benign and malignant uptake in 432 patients with newly diagnosed prostate carcinoma were reviewed in relation to prostate-specific antigen (PSA) levels determined within 4 months of scintigraphy. Scan results were categorized in terms of likelihood of metastatic disease and anatomical locations of benign and malignant lesions were tabulated. At least one suspect focus was identified in 138 scans (32%), and metastatic bone disease was present in 38 (9%). Metastatic disease prevalence increased from 1% for PSA <20 ng x ml(-1) to 58% for PSA>100 ng x ml(-1). Among patients with PSA>20 ng x ml(-1) (n = 157), 70 (45%) had at least one bone scan finding of concern for metastases and 35 (22%) proved to have metastatic disease. Almost all scans with metastases had either limited disease (< or = 5 suspicious lesions; n = 16; 42%) or extensive metastases (> 20 abnormalities; n = 19; 50%). The majority of patients with limited skeletal metastases had PSA < 100 ng x ml(-1) (11/16; 69%), while almost all patients with extensive skeletal involvement had PSA >100 ng x ml(-1) (17/19; 89%). Among those with limited metastatic disease, most (13/16; 81%) had at least one lesion in the pelvis or sacrum; the next most common sites were in the thoracic and lumbar spine (six each; 38%). In scans with a low to moderate suspicion for bone metastases, the only anatomical site with a significantly higher prevalence of malignant than benign lesions was the pelvis.

Adult↗
PubMed1999

Review of 6-month mortality following low-probability lung scans.

BACKGROUND: Ventilation perfusion lung scanning is widely used as a diagnostic method for evaluating patients suspected of having pulmonary embolism (PE). While lung scan interpretation is traditionally performed in terms of probability of PE (usually low, moderate or intermediate, and high), in recent years concern has been raised that the term low probability may be misleading because adverse and even fatal sequelae of PE occasionally occur in such patients. To assess these concerns, a review of mortality in a large series of patients following low-probability lung scans was performed. OBJECTIVE: To determine the 6-month mortality in a consecutive series of patients following low-probability ventilation perfusion (V/Q) lung scans. METHODS: Records of all patients who had low-probability V/Q scans during a 9-year period (1987-1995) were reviewed. Causes of mortality for those patients who died during the 6-month period after the index scan were established from patients' charts, autopsy reports, and computer record data. RESULTS: Of the total 536 evaluable patients, 83 (15%) died within 6 months of the date of the lung scan; 73 (88%) died while inpatients at the Seattle Veterans Affairs Medical Center, Seattle, Wash, and the other 10 (12%) died at other facilities or at home. Pulmonary embolism was not reported as a suspected or probable contributing factor in any of the 83 deaths. Sixty-three patients (76%) who died had a diagnosis of either cancer (n = 32) or advanced cardiovascular disease (n = 31) at the time of their lung scans. Twenty-six patients (31%) underwent autopsies, and PE was not identified on examination of the lungs in any of them. Of the 27 patients who died within 1 month of the scan date, 17 (63%) underwent autopsies. CONCLUSION: Review of data from all patients with low-probability V/Q scans and a follow-up of 6 months showed no documentation to attribute any deaths to PE.

Adult↗
PubMed1999

The additive values of left ventricular function and extent of myocardium at risk to dipyridamole perfusion imaging for optimal risk stratification prior to vascular surgery.

Although the increased risk of cardiac complications in surgical patients with diminished left ventricular ejection fraction (LVEF) is well-established, this method has been supplanted in recent years by assessment of ischaemic burden using myocardial perfusion imaging (MPI). This study was conducted to determine if MPI and LVEF determination provide complementary or redundant information in preoperative evaluation of vascular surgery patients. A total of 101 patients were studied with dipyridamole MPI and radionuclide ventriculography before surgery. Single photon emission tomographic MPI images were scored for defect severity and categorized as either fixed or reflecting ischaemia. Resting left ventricular cavity was also categorized as normal or dilated. LVEF was subdivided into normal (> or = 50%) and abnormal (< 50%). Seventeen patients had cardiac events. Events were more frequent in patients with ischaemia, in patients with a LVEF < 50% and in those with dilated left ventricular chambers. The mean number of ischaemic segments was also higher in the cardiac event group. Higher event rates were seen when a combination of these factors was present. A history of myocardial infarct, congestive heart failure or coronary artery disease was also a significant predictor of subsequent events. Thus, both abnormal left ventricular function and extent of ischaemic myocardium have independent and complementary predictive power for cardiac events in vascular surgery patients.

Aged↗
PubMed1999

Controlling VRE.

Explore the source record for details and available documents.

Cross Infection↗
PubMed1998

Functionalization of a viscosity-sensitive fluorophore for probing of biological systems.

Functionalization of a viscosity-sensitive visible wavelength fluorophore 2-(1,1-dicyanopropenyl-2)-6-dimethylaminonaphthalene (DDNP), with the intent to incorporate its favorable optical properties into a probe for structural and functional imaging by fluorescence microscopy, is described. Spiperone, a highly potent ligand for the dopamine D2 receptors, was conjugated via an ethylpiperazine moiety to the fluorophore giving fluorescent probes that can be excited in the UV and Vis range.

2-Naphthylamine↗
PubMed1998

Clinical nurse researchers' perceptions of hospital nursing research committees: results of a national survey.

A growing body of literature portrays sharpening controversy over the appropriate roles and functions of hospital nursing research committees (HNRCs). This descriptive study examined 139 clinical nurse researchers' experiences with HNRCs. Nurse researchers who were members of HNRCs had more positive attitudes towards HNRCs on all three scales of the HNRC-Questionnaire than nurses who were not members of HNRCs. Researchers who were prepared with Master's degrees had more positive attitudes on the HNRC Role Scale than researchers with doctoral degrees. Narrative comments written on the questionnaire reflected a substantial diversity of opinions regarding HNRCs. The results suggest that novice, nondoctorally prepared researchers may perceive the assistance of some HNRCs as beneficial, whereas doctorally prepared researchers tend to perceive them as obstacles.

Attitude of Health Personnel↗
PubMed1998

BUN/creatinine ratios: aid to decision making about delayed imaging in Tc-99m red blood cell scans for gastrointestinal hemorrhage.

In patients with gastrointestinal hemorrhage, delayed or late scans with Tc-99m labeled red blood cells are readily performed and have prognostic impact when early images are negative. Nevertheless, there have been no indicators for the likelihood of detecting bleeding on such images. In a review of all gastrointestinal bleeding scans over an 8-year period, 73 patients had delayed images (> 3 hours) following early negative exams. For these patients, determinations of serum blood urea nitrogen (BUN) and creatinine (Cr) were evaluated as the BUN/Cr ratio and were compared against delayed scan findings and confirmed diagnoses. Patients with significant renal failure were excluded from analysis. There were 34 late positive (46%) and 39 late negative (54%) studies. Mean BUN/Cr was 26.5 and 20.0 in patients with late positive and late negative scans, respectively (p < 0.05). Occurrence of late positive scans was 38% (19/50) for BUN/Cr < 25.0 vs. 65% (15/23) for BUN/Cr > 25.0 (p < 0.05). Patients with early negative images and a BUN/Cr ratio of 25 or greater have a greater likelihood of a positive delayed image. Late imaging should be encouraged in patients with elevated BUN/Cr and early negative scintigraphy.

Adult↗
PubMed1998

On the shoulders of a giant: a mentoring experience.

This article describes the development of a mentoring relationship between the author and Elizabeth Winslow since it began in 1990. It includes numerous examples of ways in which the mentor, Dr Winslow, provided inspiration, support, and encouragement during high and low points of the author's professional development. The process by which Dr Winslow became the author's mentor and the nature of the current mentor/mentee relationship challenge commonly held beliefs about how mentoring relationships begin and unfold.

Education, Nursing, Graduate↗
PubMed1998

The value and correlates of left ventricular cavity assessment in dipyridamole 201Tl SPET studies.

Left ventricular cavity (LVC) enlargement during SPET dipyridamole 201Tl myocardial perfusion imaging studies is a proven marker of severity of coronary artery disease. Nevertheless, the influence of the extent of myocardial infarct and ischaemia on the degree of LVC enlargement both at rest and with dipyridamole has not been clearly analysed. One hundred and one patients were studied by both dipyridamole myocardial perfusion imaging and radionuclide ventriculography within 1 week. The left ventricular ejection fraction (LVEF) was 57 +/- 9 in normal resting LVC patients (group I), 43 +/- 8 in mild LVC enlargement patients (group II) and 28 +/- 5 in moderate-to-severe LVC enlargement patients (group III). The number of fixed defects was increased in patients in group II and group III, but there was no significant differences in the number of ischaemic segments among groups. The number of ischaemic segments was much higher in patients with transient cavity dilatation than those without cavity change; nonetheless, both LVEF and the numbers of fixed segments were unchanged. The degree of LVC enlargement at rest strongly reflects the resting left ventricular systolic function as well as the extent of previous myocardial infarct. On the other hand, transient cavity dilatation during dipyridamole infusion can only reflect the extent of viable myocardium at risk.

Aged↗
PubMed1997

Musculoskeletal pain as an indicator of occult malignancy. Yield of bone scintigraphy.

BACKGROUND: When musculoskeletal pain is persistent or out of proportion to clinical findings, diagnostic imaging is often used to evaluate for the presence of occult pathologic conditions. OBJECTIVE: To examine the efficacy of bone scintigraphy for identifying occult malignancy in such patients. METHODS: Bone scans of 491 patients with new or recurrent complaints of musculoskeletal pain and no previously known malignancy were retrospectively reviewed. The findings of each scan were classified into 1 of the following categories: (A) no evidence of malignancy; (B) equivocal (1-3 lesions of uncertain significance); or (C) probable metastatic disease (> 3 lesions without trauma or other benign explanation). All diagnoses of malignancy established within 6 months of the bone scan were then determined from review of radiological and clinical records. RESULTS: The distribution of scan interpretations was as follows: category A, 386 (79%); category B, 84 (17%); and category C, 21 (4%). Among the 181 patients younger than 50 years, 161 (89%) had category A and 20 (11%) had category B scans. Of the 310 patients aged 50 years or older, 226 (73%) had scans in category A, 64 (21%) in category B, and 21 (7%) in category C. Thirty patients (6%) had malignancy involving bone, 29 among those aged 50 years or older. In patients aged 50 years or older, 10 (16%) of 64 with equivocal scan findings (category B) and 19 (90%) of 21 with widespread abnormalities (category C) had malignancy involving bone. Initial radiographs of symptomatic sites showed lytic or blastic bone abnormalities suggestive of malignancy in 16 (59%) of the 29 older patients in whom this diagnosis was confirmed. CONCLUSIONS: In patients aged 50 years or older, the yield of bone scintigraphy for identification of occult malignancy (29/310; 9%) is sufficient to justify its use in the investigation of the cause of problematic bone or musculoskeletal symptoms.

Adult↗