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Biomedical subjects

B Erickson

Publications and source records attributed to B Erickson.

18 recordsLinked to original sources
PubMed1996

CT-guided interstitial implantation of gynecologic malignancies.

PURPOSE: To establish the efficacy of computed tomography (CT)-based planning and analysis of transperineal implants. METHODS AND MATERIALS: For patients with bulky disease or geometrically unfavorable anatomy, transperineal interstitial implantation of gynecologic tumors offers an alternative to standard intracavitary techniques. Control of dose rate and total dose distributions to produce a homogenous, low dose rate implant presents a challenge to the radiation oncologist in these complex implants, as does the relationship of these distributions to the patients's anatomy. We have used CT imaging following needle implantation, prior to source loading, in 25 patients (28 implants), as an aid in both the planning of the implant and the analysis of the dosimetry. RESULTS: The spatial relationship between the needles and the normal anatomy can be clearly defined, despite the presence of some artifacts. Tumor volume is less clearly visualized but the adequacy of needle placement can be assessed and adjusted if necessary. Modifications of the planned source placement, based upon the location of specific needles and critical structures, can be made prior to loading the patient. Dose rate and total dose distributions are displayed with the appropriate anatomy on axial images and on reconstructed sagittal and coronal planes. Multiple points of dose specification for the rectum and the bladder are easily defined. Dose rate adjustment can be made by selectively changing the activity associated with a particular needle or needles. Multiple implants as well as external beam irradiation can also be integrated. CONCLUSIONS: CT-based dosimetry has permitted intelligent planning decisions to be made prior to and during these implants. It has further allowed more accurate anatomically based dosimetric analysis, with visualization and control of dose rate and total dose distributions displayed together with the patient's anatomy. This more elaborate analysis should ultimately lead to a better understanding of the reasons for local control and complications and their relationships to dose rate, total dose, and volume.

Brachytherapy↗
PubMed1996

The last word?

Explore the source record for details and available documents.

Animals↗
PubMed1995

Comparison of high dose-rate and low dose-rate dose distributions for vaginal cylinders.

PURPOSE: The identification of appropriate high dose-rate parameters required to produce a "uniform" dose distribution on the surface of a vaginal cylinder. The high dose-rate dose distribution is then compared to the traditional low dose-rate dose distributions obtained with Burnett cylinders. METHODS AND MATERIALS: Dose distributions were calculated for 2, 3, and 3.5 cm diameter Burnett cylinders with and without crossing sources. Three models for the high dose-rate cylinders were developed and compared. High dose-rate dose distributions were calculated for 2, 3, and 3.5 cm diameter cylinders with and without anisotropic corrections for various dose specification points. RESULTS: Low dose-rate distributions are not uniform over the surface of the applicator. The exact distribution depends upon cylinder diameter and upon the exact source loading. High dose rate dose distributions can be configured to provide for a "uniform" dose on the surface, if an apex dose specification point is used together with dose specification points on the surface of the applicator opposite each dwell position. CONCLUSIONS: The conversion of low dose rate techniques to high dose rate techniques for vaginal cylinders involves an appreciation of the details of dose distributions of both approaches. The comparison between traditional low dose-rate distributions and high dose-rate distributions shows that, unlike the low dose-rate distributions, a relatively uniform high dose-rate distribution can be obtained independent of cylinder diameter. The clinical significance of the differences in the low dose-rate and high dose-rate dose distributions remains to be determined by long-term follow up of patients treated with high dose-rate techniques.

Carcinoma↗
PubMed1994

Seroconversion in patients attending sexually transmitted disease clinics.

OBJECTIVES: To characterize recent HIV seroconverters in a sexually transmitted disease (STD) clinic population, and examine changing transmission patterns. METHODS: We conducted a case-control study nested within a retrospectively defined cohort of individuals attending Baltimore STD clinics between January 1988 and July 1990. Seroconverters, who tested HIV-positive after having a negative test, were compared to both HIV-negative controls, who were also tested twice, and a second, prevalent HIV-positive control group. Controls were matched 2:1 by sex, clinic, and month of HIV test. RESULTS: Forty-nine out of 6175 (0.79%) patients tested at least twice had documented HIV-1 seroconversion. On multivariate analysis, seroconversion was significantly associated with self-reported injecting drug use [odds ratio (OR), 7.3; 95% confidence interval (CI), 2.3-23)], with being a man who has had sex with other men (OR, 3.5%; 95% CI, 1.2-10), or with having sex with a known HIV-infected person (OR, 11; 95% CI, 1.3-96). Thirty-five per cent of seroconverters did not report a risk for HIV infection, and a higher proportion of recent seroconverters also reported no risk. Compared to the prevalent positive control group, more seroconverters reported no risk and a lower proportion reported recognized risks. A diagnosis of gonorrhea was also significantly associated with seroconversion (OR, 2.5; 95% CI, 1.1-5.7). CONCLUSIONS: These data suggest increasing heterosexual transmission of HIV in this inner-city STD clinic population. Incident STD, in particular gonorrhea, may increase a patient's risk for HIV infection, suggesting that patients with STD should be targeted aggressively for HIV prevention activities.

Adult↗
PubMed1994

Interdisciplinary team approach in the rehabilitation of hip and knee arthroplasties.

Use of an interdisciplinary case management team approach in the treatment of patients with hip or knee arthroplasty has resulted in a decrease in length of stay and achievement of functional outcomes at the authors' center. Case management was used to standardize patient care and to measure each patient's progress toward independence against established criteria of treatment outcomes. Outcomes established for physical therapy were ambulation distance, performance of a home exercise program, stair climbing, amount of active knee flexion (for knee arthroplasties), and incorporation of hip precautions. Outcomes for occupational therapy were bed mobility, chair transfers, toilet transfers, and activities of daily living with emphasis on lower extremity dressing. The case management team consists of an occupational therapist, an occupational therapy assistant, a physical therapist, and two nurses. The specific role of the occupational therapy personnel in this team approach is to maximize, by discharge, a patient's functional level of independence in activities of daily living. Data from a 6-month period indicated that occupational therapy goals were achieved for 79% of the 33 knee arthroplasty patients and 73% of the 37 hip arthroplasty patients.

Activities of Daily Living↗
PubMed1993

Characteristics of epidemic hepatitis A in Baltimore City: implications for control measures.

In 1988, a hepatitis A epidemic began in Baltimore, Maryland. A total of 607 cases were reported to the Baltimore City Health Department between the period November 1, 1988, and December 31, 1989. The health department conducted case investigations to identify factors important to the development of control measures. Immunoglobulin was given to appropriate contacts, and an educational campaign was initiated. Of the 607 reported cases, 63% were white and 57% were male. Cases were geographically clustered within 5 of Baltimore's 23 zip codes. Among the 242 adults interviewed, 43% self-reported drug use and 44% were unemployed. Twenty-one percent of the adults and 56% of the children reported contact with either a suspected or confirmed case of hepatitis. Despite control efforts, the epidemic continued through 1990. Barriers to implementing traditional control measures resulted in continuing transmission of hepatitis A in the community.

Adolescent↗
PubMed1992

Effect of HIV posttest counseling on STD incidence.

OBJECTIVE: To evaluate the effectiveness of human immunodeficiency virus (HIV) testing and posttest counseling in reducing subsequent high-risk behavior. METHODS: The incidence of sexually transmitted diseases (STDs) in the Baltimore, Md, public STD clinic population after HIV testing and counseling was determined by chart review and was compared in two groups, 868 HIV-seropositive patients and 1104 HIV-seronegative patients, matched by age, sex, and month in which HIV test was conducted. Patients were observed for incident STDs at intervals of 6 through 23 months. Patients with incident STDs were classified hierarchically after being notified of the HIV test result and receiving posttest counseling. RESULTS: Of HIV-seropositive patients, 615 (71%) returned for their test results and received posttest counseling; 694 HIV-seronegative patients (63%) returned. Of all those who returned for results and posttest counseling, 60 (9.7%) of 615 HIV-seropositive patients and 61 (8.8%) of 694 HIV-seronegative patients were diagnosed at least once with definite STD (syphilis, gonorrhea, or trichomoniasis) (P, not significant). Twenty-four HIV-seropositive patients (3.9%) and 71 HIV-seronegative patients (10.2%) returned with probable STD (nongonococcal urethritis or pelvic inflammatory disease) (P less than .001). Nine HIV-seropositive patients (1.5%) and 23 HIV-seronegative patients (3.3%) returned having had an STD-infected sexual partner (P less than .03). Age, sexual orientation, and drug use behavior did not predict return with STD. CONCLUSIONS: Both HIV-seropositive and HIV-seronegative patients showed high rates of repeat STDs after posttest counseling, an important public health challenge in creating effective high-risk behavior prevention strategies.

Counseling↗
PubMed1991

Twice-daily tapering dexamethasone treatment during cranial radiation for newly diagnosed brain metastases.

Twenty evaluable patients with newly diagnosed brain metastases underwent treatment with a novel dose/schedule of dexamethasone aimed at reducing steroid toxicity during palliative radiation therapy. All patients received twice daily dexamethasone starting at 8 mg bid for four days then 4 mg bid for four days then 2 mg bid until the last day of radiation therapy. The radiation prescriptions were not standardized varying from 2000 cGy/5 fractions to 5800 cGy/29 fractions. Fourteen patients received dexamethasone for a minimum of 24 hours before their first radiation treatment and 7 (50%) experienced improvement in neurologic symptoms/signs prior to starting radiation treatments. Fourteen patients completed the planned course of radiation and dexamethasone. Only 1 patient needed to restart dexamethasone within 30 days of finishing radiation because of steroid reversible neurologic deficits. Steroid toxicity was mild including hyperglycemia (1), candida esophagitis (1), steroid pseudorheumatism (2), peripheral edema (1) and steroid withdrawal syndrome (1). Only two toxic events were recorded in patients receiving steroids less than 21 days. Twice daily dexamethasone appears to provide good clinical results with minimal morbidity.

Administration, Oral↗
PubMed1990

The treatment of anemia with low-dose recombinant human erythropoietin.

Recombinant human erythropoietin is effective therapy for the anemia of chronic renal failure. Hypertension, seizures, dialysis access thromboses, and clotted dialyzers have been reported as problems associated with the use of this drug. To test the hypothesis that low-dose erythropoietin is effective and safe, we gave 37 chronic hemodialysis patients this compound (3,000 units, i.v.) three times each week for 3 months. Before and for 3 months during therapy, we measured hemoglobin, hematocrit, blood transfusions, blood pressure, access thromboses, seizures, and clotted dialyzers. After 2 months of treatment, mean hemoglobin concentration and mean hematocrit increased significantly. Five patients had no increase in either value. In 4 of these 5 nonresponders, blood loss accounted for treatment failure. Neither blood pressure nor the incidence of access thromboses, seizures, and clotted dialyzers changed during the 3 months of therapy. We conclude that recombinant human erythropoietin is effective as treatment for the anemia of chronic renal failure at much lower doses than have been reported previously. The low incidence of adverse events may be related to the low dose used.

Anemia↗
PubMed1989

Cancer-associated hemolytic-uremic syndrome: analysis of 85 cases from a national registry.

A registry of suspected cases of cancer-associated hemolytic-uremic syndrome (C-HUS) was established in May 1984. Records of 85 patients from the registry, all with history of cancer, hematocrit less than or equal to 25%, platelet count less than 100,000, and serum creatinine greater than or equal to 1.6 mg/dL were subjected to in-depth analysis. Eighty-nine percent of patients had adenocarcinoma, including 26% with gastric cancer. Microangiopathic hemolysis was reported in 83 patients; coagulation studies were normal with rare exception. Bone marrow examination ruled out chemotherapy-induced myelosuppression in 68 of 85. Thirty-five percent of patients were without evident cancer at time of syndrome development. Mitomycin (MMC) was part of the treatment regimen in 84 patients; all but nine received a cumulative dose greater than 60 mg. Pulmonary edema, generally noncardiogenic, developed in 65% of patients, often after blood product transfusions. C-HUS has a high mortality: over 50% of patients died of or with syndrome, most within 8 weeks of syndrome development. Conventional treatment was ineffective, although ten of 21 treated with staphylococcal protein A (SPA) immunopheresis showed significant responses. Statistical analysis found only absence of obvious tumor and treatment with SPA to suggest favorable prognosis. C-HUS is distinguishable from related syndromes such as childhood HUS, thrombotic thrombocytopenic purpura (TTP), consumption coagulopathy, and microangiopathic hemolysis associated with advanced carcinoma. MMC is likely involved in the development of C-HUS; the risk of developing C-HUS after treatment with MMC is between 4% and 15%. However, possible bias in patients referred to the registry and reports of non-MMC C-HUS cases must be remembered. Recommendations include careful monitoring of renal and hematologic function in patients treated with MMC, aggressive nontransfusion in patients with suspected C-HUS, and consideration of treatment with SPA immunopheresis in patients with definite syndrome.

Adenocarcinoma↗
PubMed1985

Sexual behavior frequency and biphasic ovulatory type menstrual cycles.

College students whose menarche had occurred 7 years previously, prospectively recorded menstrual and sexual behavior history for 14 weeks as well as basal body temperatures. Regular weekly coital activity associates with the highest incidence of fertile type cycles in this sample of young women as follows: (1) Regular weekly heterosexual behavior was associated with 29.5 +/- 3 day menstrual cycle length. Less frequent sexual activity (sporadic) and celibacy were associated with an increased frequency of aberrantly short and long cycle lengths. (2) Either of two heterosexual behaviors (coitus and/or genital stimulation by a man) were behaviors which were adequate as associates of 29.5 +/- 3 day cycles. (3) Self-stimulation (masturbation to orgasm) was inadequate as an associate of the above-described pattern of menstrual cyclicity. (4) Women with regular weekly coital activity had the highest incidence (90%) of fertile type basal body temperature (BBT) rhythms. Sporadically active women had the next highest incidence (55%) of fertile type BBT rhythms. Celibate women had the lowest incidence (44%) of fertile type BBT's.

Adolescent↗
PubMed1980

A study of drug-induced kinetic perturbations in the marrow of a patient with neuroblastoma.

The kinetic perturbations induced by vincristine, cyclophosphamide, and adriamycin were studied in the bone marrow of a patient with neuroblastoma. Serial marrow samples were studied by dual parameter (Coulter volume and DNA content), flow cytometry, and radioautography, and findings were correlated with cytomorphologic changes. Multiparameter studies were useful in sorting out the various sequences of drug-induced kinetic changes. Distinctive effects of vincristine were observed at 2 and 24 hours after drug administration. An early drug-induced proliferative response was observed between 2 and 48 hours after initiation of therapy. Cell damage was apparent on day 4, with recovery in cell proliferative rate observed on days 6 through 9. The kinetics of perturbation may be useful in identifying temporal windows for optimum scheduling of chemotherapeutic agents in man.

Adolescent↗
PubMedDate not supplied

Concomitant adjuvant chemotherapy and radiotherapy for high risk breast cancer patients.

Thirty four patients treated with mastectomy and axillary node dissection for potentially curable breast cancer received a seven month combined adjuvant chemotherapy and radiation therapy program. These patients were considered to be at high risk for recurrence because they had either three or more positive axillary lymph nodes or their primary tumor was greater than 5 cm in diameter. The chemotherapy given at 3-week intervals consisted of cyclophosphamide, 600 mg/m2, Adriamycin 40 mg/m2, and methotrexate 40 mg/m2 during cycles 1 through 3 and 7 through 9. Radiation therapy was administered during cycles 4 through 6 with concomitant administration of 5-fluorouracil 600 mg/m2, vincristine 1.4 mg/m2, and prednisone 40 mg/m2 for 7 days. Median follow up time from initiation of study is 60 months (range 36-93). Seventeen of 34 patients (50%) remain free of recurrent breast cancer. Distant metastases and local-regional recurrence have occurred in 16 (47%) and 4 (12%) patients, respectively. Significant myelosuppression and infections requiring hospitalization were seen in 4 patients, with 1 treatment-related death. Adriamycin-containing chemotherapy and post-operative radiotherapy can thus be combined in an adjuvant treatment program with acceptable toxicity.

Adult↗
PubMedDate not supplied

Routine voluntary HIV screening in STD clinic clients: characterization of infected clients.

Since January 25, 1988, the Baltimore City Health Department has offered routine, confidential, human immunodeficiency virus (HIV) testing to clients of the city's two sexually transmitted disease (STD) clinics. During the first 11 months of the program, testing was offered at 20,843 patient visits and was accepted at 15,181 (73%) of these; 612 (4%) individual clients had results that were positive for HIV. Four hundred thirty-seven (71%) seropositive clients returned for test results, post-test counseling, and further evaluation. Most HIV-infected clients were single, and black men accounted for 75% of seropositive individuals. HIV-infected women tended to be younger than infected men (7% of the female clients were adolescents). Although homosexual activity, intravenous drug use, and sex with a partner at risk were common risk factors for seropositive clients, after two interviews 17% of men and 38% of infected women did not report traditional risk factors for HIV infection. Most clients were asymptomatic or had generalized lymphadenopathy at the time of HIV diagnosis. Health care resources for these individuals were limited; 62% of men and 85% of women either had no health insurance or received public assistance. Routine, voluntary, confidential HIV counseling and testing is a practical, effective means to identify HIV-infected individuals among clients being treated at STD clinics. Identification of these individuals early in the course of infection provides opportunities to implement early follow-up and therapy, to counsel clients to help prevent further spread of infection, and to obtain useful information for projecting future health care needs and policy.

AIDS Serodiagnosis↗
PubMedDate not supplied

Characterization of patients accepting and refusing routine, voluntary HIV antibody testing in public sexually transmitted disease clinics.

BACKGROUND AND OBJECTIVES: To determine the proportion of HIV-infected sexually transmitted disease (STD) clinic patients identified during routine, voluntary HIV counseling and testing and to characterize patients accepting and refusing counseling and testing, we linked data from a blinded HIV seroprevalence survey to data from the HIV counseling and testing program. GOAL OF THIS STUDY: This study characterizes patients accepting and refusing routine HIV counseling and testing in two public STD clinics. STUDY DESIGN: A cross-sectional, blinded HIV seroprevalence survey was conducted of 1,232 STD clinic patients offered HIV counseling and testing. RESULTS: HIV seroprevalence was higher among patients who refused voluntary testing (7.8% versus 3.6%, P = 0.001). Patients who refused testing were more likely to report a prior HIV test (45.6% versus 27.2%; P < 0.001). Among patients reporting a prior HIV test, differences were noted between reported prior results, both positive and negative, and blinded results. CONCLUSIONS: HIV-infected STD patients may not be detected by routine HIV testing, and self-reported HIV results should be confirmed.

AIDS Serodiagnosis↗