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Biomedical subjects

D K King

Publications and source records attributed to D K King.

11 recordsLinked to original sources
PubMed1997

Female urologists: a growing population.

PURPOSE: Although urology continues to be a male dominated field, the participation and influence of women within the specialty are growing. In the United States as of July 1995, 56 of 1,339 urology residents (4.2%) and 97 of 8,227 board certified urologists (1.2%) were women. The demographics of this group, including age, board certification, fellowship experience and practice patterns, are unknown. Mentorship and motivations leading to urology as a specialty choice for women are also unreported. MATERIALS AND METHODS: We surveyed 161 female urologists by mail. RESULTS: Of the women surveyed 80% responded. Female urologists tend to be young and board certified, 39% are fellowship trained and 22% hold full-time academic positions. Women were discouraged from selecting urology as a specialty because of gender. Many women had male (59%) or no (35%) mentors throughout the training years, 70% were married and 44% had children. Of the 25 respondents who had children during residency most (84%) felt supported by the program director and resident peers. Despite obstacles 94% of female urologists would encourage other women to enter urology. CONCLUSIONS: Female urologists are young, well educated and career oriented. Although most did not have mentors during training, there is a high level of job satisfaction and low attrition after training.

Female↗
PubMed1996

Renal cryoablation in a canine model.

OBJECTIVES: To assess the potential safety and utility of cryoablation for treatment of selected renal tumors in a canine model. METHODS: Ultrasound and direct physical measurements (depth and width) of five cryolesions were compared. Cryolesions were examined histologically in 6 animals, which were killed at 4 hours, 2 days, 1 week, 3 weeks, 6 weeks, and 12 weeks. Mortality/morbidity was assessed in 12 animals over a 1-month interval, where 6 animals received small (approximately 2 cm) cryolesions and 6 animals received large (one third to one half of kidney) cryolesions. Laparoscopic cryoablation was performed in 2 animals. RESULTS: A statistically significant association of physical and ultrasound dimensions was observed (correlation coefficient R = 0.9295; P = 0.0001). Histologic studies in animals killed up to 1 week after cryoablation revealed complete coagulative necrosis within the cryolesion. The boundary transition from normal to complete tissue necrosis occurred in 1 to 2 mm. Animals killed 3 weeks to 3 months after cryoablation revealed progressive organization with granulation tissue, chronic inflammation, hemosiderosis, fibrosis, and contraction of the cryolesion with parenchymal loss. Untreated renal tissue was histologically normal in all kidneys. No mortality or morbidity was detected in the 12 animals followed for 30 days regardless of the size of the cryolesion. Laparoscopic cryoablation was performed successfully in 2 animals without modification of standard laparoscopic methods. CONCLUSIONS: Sonographic, histologic, and laparoscopic data in a canine model suggest that cryoablation may be a safe, feasible, and useful method for treatment of selected renal neoplasms.

Animals↗
PubMed1993

Adrenal cortical carcinoma. Epidemiology and treatment with mitotane and a review of the literature.

BACKGROUND: Adrenal cortical carcinoma is rare; the authors have treated only eight patients with the disease at Good Samaritan Regional Medical Center since 1974. No exhaustive collection of cases of this cancer has been done since 1952. METHODS: The authors retrospectively reviewed the medical records of their eight patients with adrenal cortical carcinoma. They also searched the English literature from 1952 to 1992 for reports of patients with the disease. They treated each report as a series if two or more previously unreported patients were reported. They paid special attention to patients for whom stage of disease was noted at diagnosis, treatment with mitotane (o,p'-DDD) was used, and the outcome was reported. RESULTS: Five were male and three were female patients. Five had nonfunctional tumors. None were pediatric. The authors found 1891 cases in the English literature. Adrenal cortical carcinomas are more common in women (58.6%) than in men (41.4%). The age distribution of tumors is bimodal, with peaks in the first and fifth decades. Tumors in children are more commonly functional (83.5% in female patients, 85.6% in male patients), although nonfunctional tumors are more common in older patients (84.7%). Most (68%) of these tumors are diagnosed late in disease when surgery is no longer curative. Only 35% of patients treated with mitotane had a clinical response. CONCLUSIONS: Adrenal cortical carcinomas are diagnosed most often in children because of functionality and older men because of mass effect. Most tumors are discovered too late for curative resection. Treatment of metastatic disease with mitotane has limited success.

Adolescent↗
PubMed1989

Wheezing on maximal forced exhalation in the diagnosis of atypical asthma. Lack of sensitivity and specificity.

STUDY OBJECTIVE: To determine whether wheezing on maximal forced exhalation is a predictor of asthma in persons with normal or nearly normal baseline spirometry. DESIGN: Prospective study of patients referred for methacholine challenge testing. SETTING: Pulmonary function laboratory at a hospital. PATIENTS: Forty-four patients referred for methacholine challenge testing because of the clinical suspicion of cough variant or otherwise difficult to diagnose asthma, with normal or nearly normal baseline spirometry and without wheezing on routine lung auscultation during quiet breathing. INTERVENTIONS: We listened for wheezing on maximal forced exhalation. Wheezing was defined as a continuous sound with a musical quality. Methacholine challenge testing was done. The concentration of methacholine required to produce a 20% fall in baseline FEV1 (PC20) of less than 8 mg/mL was considered a positive test for asthma. MEASUREMENTS AND MAIN RESULTS: Wheezing was present on maximal forced exhalation in 8 of 14 patients with a positive methacholine challenge test (sensitivity = 57%) and absent in 11 of 30 patients with a negative test (specificity = 37%). Furthermore, wheezing on maximal forced exhalation was present in 13 of 27 patients with a PC20 greater than 16 mg/mL and absent in 2 of 7 with a PC20 less than 4 mg/mL. CONCLUSIONS: Wheezing on maximal forced exhalation is neither sensitive nor specific for airway hyperreactivity.

Adult↗
PubMed1981

Sexual dimorphism and the effects of the X-linked Tfm locus on hexobarbitone metabolism and action in mice.

1 Normal males of the testicular feminized strain of mice (Tfm) had longer hexobarbitone-induced sleeping times than females, and hepatic hexobarbitone hydroxylase activity different in that the Km was higher and the Vmax lower in the male. 2 Castration and androgen replacement studies indicated that testicular androgens were responsible for the sexual differences in drug metabolism found in this mouse strain. 3 Hepatic hexobarbitone metabolism and action were feminized in the intact, androgen-insensitive, genetically male Tfm mouse. Furthermore, hexobarbitone hydroxylase activities were less responsive to large doses of testosterone in Tfm mice than in normal males. 4 The Tfm mouse with a deficiency in androgen receptors responded to the enzyme-inductive effects of phenobarbitone and softwood bedding, indicating that these inducers do not act through the androgen receptors.

Androgen-Insensitivity Syndrome↗
PubMed1977

Fatal pneumonitis and septicemia after fiberoptic bronchoscopy.

This report describes the development of fatal pneumococcal pneumonia and septicemia following fiberoptic bronchoscopic examination and endobronchial biopsy of a patient with severe chronic congestive heart failure. Although a causal relationship has not been proven, the temporal sequence seems to favor this over a coincidental nosocomial infection. This case emphasizes that significant and occasionally fatal infectious complications may occur following fiberoptic bronchoscopic examination.

Aged↗
PubMedDate not supplied

Improving breast self-examination compliance: a Southwest Oncology Group randomized trial of three interventions.

BACKGROUND: Only 20-40% of U.S. women conduct breast self-examination (BSE). This Southwest Oncology Group experimental study compared the impact of three interventions on BSE compliance. METHODS: Subjects were randomly assigned to one of three arms: (1) physician message; (2) physician message and BSE class; or (3) physician message, BSE class, and reinforcement (phone and postcard). Compliance (frequency and accuracy) was measured by interview at intake and at 6 months and by phone contact at 1 year. Logistic and multiple regression were employed. RESULTS: This analysis included 2,233 subjects from six institutions. At 1 year the percentages of women doing BSE were 59, 62, and 78% for Arms 1-3, respectively; gains over intake frequency (27% average) were significant within each arm (P < or = 0.0001). At both 6 months and 1 year the differences between Arm 1 and Arm 2 average accuracy scores and the differences between Arm 2 and Arm 3 in the percentage of women doing BSE were significant (P < or = 0.0001). Findings within institutions were consistent with the overall findings. CONCLUSIONS: The addition of a BSE class increased accuracy over physician message alone; physician message, BSE class, and reinforcement gave the highest percentage of women doing BSE.

Adult↗
PubMedDate not supplied

Quantitative B-hCG levels less than 1000 mIU/mL in patients with ectopic pregnancy: pelvic ultrasound still useful.

The purpose of this study was to determine if pelvic ultrasound was useful in suggesting the diagnosis of ectopic pregnancy in patients with a quantitative B-hCG level less than 1000 mIU/mL. We performed a retrospective review of all patients evaluated and diagnosed with ectopic pregnancy in the emergency departments of seven area hospitals during a ten month period. Sixty-four patients with a confirmed diagnosis of ectopic pregnancy, a pelvic ultrasound, and a quantitative B-hCG level were included in the study. Eighteen (28%) of these patients had a quantitative B-hCG less than 1000 mIU/mL. Sixteen of the eighteen patients (89%) with a B-hCG level less than 1000 mIU/mL had sonographic findings suggestive of ectopic pregnancy, such as fluid in the cul-de-sac, or a complex adnexal or cystic mass. Overall, 25% of all patients diagnosed with an ectopic pregnancy during this time period had a quantitative B-hCG level less than 1000 mIU/mL and an ultrasound suggestive for ectopic pregnancy. Pelvic ultrasound is useful as a screening tool in the initial evaluation of suspected ectopic pregnancy, even when the quantitative B-hCG level is below 1000 mIU/mL.

Adolescent↗