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Biomedical subjects

D K Payne

Publications and source records attributed to D K Payne.

At least 19 recordsLinked to original sources
PubMed2001

Lymphedema: strategies for management.

An important sequela of cancer treatment is lymphedema. Management of this condition must be based on the physiologic functioning of the lymphatic system and tailored to the individual patient's presentation of the disease. Early diagnosis and treatment are essential to prevent worsening of the condition and to help assuage the psychologic impact of the disease. A review of the normal and impaired lymphatic system is presented in this article. Current assessment and treatment options are described, including education of patients in precautions, positioning, exercise, compression garments and bandages, pneumatic pumps, and lymphatic massage. Also included is a discussion of the psychologic impact of the disease as well as management of psychologic symptoms. Various strategies for management of the physical aspects of lymphedema are available. Studies have shown that use of physical treatments such as exercise, compression, and lymphatic massage are effective in reducing the amount of swelling in affected limbs. The specific type, amount, and combination of these treatments continues to be debated. The development of lymphedema is commonly associated with significant psychologic distress that can impact on compliance with physical treatments. Because there is no consensus as to the optimal treatment approach for management of lymphedema, additional research must ensue to determine the efficacy of existing treatments and to develop new management techniques. Clinicians must be attuned to the signs and symptoms of lymphedema in order to make prompt referrals for treatment.

Bandages↗
PubMed2000

Women's regrets after bilateral prophylactic mastectomy.

BACKGROUND: Primary prevention strategies such as chemopreventive agents (e.g., tamoxifen) and bilateral prophylactic mastectomy (PM) have received increasingly more attention as management options for women at high risk of developing breast cancer. METHODS: A total of 370 women, who had registered in the Memorial Sloan-Kettering Cancer Center National Prophylactic Mastectomy Registry, reported having undergone a bilateral PM. Twenty-one of these women expressed regrets about their decision to have a PM. A psychiatrist and psychologist interviewed 19 of the women about their experiences with the PM. RESULTS: A physician-initiated rather than patient-initiated discussion about the PM represented the most common factor in these women. Psychological distress and the unavailability of psychological and rehabilitative support throughout the process were the most commonly reported regrets. Additional regrets about the PM related to cosmesis, perceived difficulty of detecting breast cancer in the remaining breast tissue, surgical complications, residual pain, lack of education about the procedure, concerns about consequent body image, and sexual dysfunction. CONCLUSIONS: Although a PM statistically reduces the chances of a woman developing breast cancer, the possibility of significant physical and psychological sequelae remains. Careful evaluation, education, and support both before and after the procedure will potentially reduce the level of distress and dissatisfaction in these women. We discuss recommendations for the appropriate surgical and psychiatric evaluation of women who are considering a PM as risk-reducing surgery.

Adult↗
PubMed2000

Topographic quantitative analysis of the intrinsic alpha rhythm in chronic obstructive pulmonary disease.

Twenty-two patients with documented COPD and no other significant illnesses were studied to assess the effect of varying degrees of COPD on the intrinsic alpha rhythm. The severity of COPD was determined by spirometry with assessment of FEV1, FVC, and FEV1/FVC. The alpha frequency for COPD patients was slower than that which characterizes age equated normals and averages 1.6 S.D. below normative data base mean values (range -0.43 S.D. to -1.85 S.D.). Impairment of pulmonary functioning significantly correlated with the degree of alpha frequency slowing over the posterior cortical regions, and the slowest alpha frequencies occurred in those COPD patients with the lowest FEV1/FVC ratios. Impairment of cognitive functioning is thus an important clinical consideration in treatment of patients with COPD but may go unrecognized until late in the course of the disease.

Aged↗
PubMed1999

A randomized comparison of indwelling pleural catheter and doxycycline pleurodesis in the management of malignant pleural effusions.

BACKGROUND: The purpose of this study was to compare the effectiveness and safety of a chronic indwelling pleural catheter with doxycycline pleurodesis via tube thoracostomy in the treatment of patients with recurrent symptomatic malignant pleural effusions (MPE). METHODS: In this multi-institutional study conducted between March 1994 and February 1997, 144 patients (61 men and 83 women) were randomized in a 2:1 distribution to either an indwelling pleural catheter or doxycycline pleurodesis. Patients receiving the indwelling catheter drained their effusions via vacuum bottles every other day or as needed for relief of dyspnea. RESULTS: The median hospitalization time was 1.0 day for the catheter group and 6.5 days for the doxycycline group. The degree of symptomatic improvement in dyspnea and the quality of life was comparable in each group. Six of 28 patients who received doxycycline (21%) had a late recurrence of pleural effusion, whereas 12 of 91 patients who had an indwelling catheter (13%) had a late recurrence of their effusions or a blockage of their catheter after the initially successful treatment (P = 0.446). Of the 91 patients sent home with the pleural catheter, 42 (46%) achieved spontaneous pleurodesis at a median of 26.5 days. CONCLUSIONS: A chronic indwelling pleural catheter is an effective treatment for the management of patients with symptomatic, recurrent, malignant pleural effusions. When compared with doxycycline pleurodesis via tube thoracostomy, the pleural catheter requires a shorter hospitalization and can be placed and managed on an outpatient basis.

Catheters, Indwelling↗
PubMed1999

Issues of regret in women with contralateral prophylactic mastectomies.

BACKGROUND: Patients with a history of carcinoma of one breast have an estimated risk of 0.5% to 0.75% per year of developing a contralateral breast cancer. This risk prompts many women to consider contralateral prophylactic mastectomy (CPM) as a preventive measure. Virtually nothing is known about patient acceptance following CPM. We have developed a National Prophylactic Mastectomy Registry comprised of a volunteer population of 817 women from 43 states who have undergone prophylactic (unilateral or bilateral) mastectomy. METHODS: Of the 346 women with CPM who responded to national notices, 296 women returned detailed questionnaires. The information obtained included patient demographics, family history, reproductive history, ipsilateral breast cancer staging and treatment, as well as issues involving the CPM. RESULTS: At median follow-up of 4.9 years, the respondents were primarily married (79%), white (97%) women who had some level of college education or above (81%). These women cited the following reasons for choosing CPM: (1) physician advice regarding the high risk of developing contralateral breast cancer (30%); (2) fear of developing more breast cancer (14%); (3) desire for cosmetic symmetry (10%); (4) family history (7%); (5) fibrocystic breast disease (4%); (6) a combination of all of these reasons (32%); (7) other (2%); and (8) unknown (1%). Eighteen of the 296 women (6%) expressed regrets regarding their decision to undergo CPM. Unlike women with bilateral prophylactic mastectomies, regrets tended to be less common in the women with whom the discussion of CPM had been initiated by their physician (5%) than in the women who had initiated the discussion themselves (8%) (P = ns). Family history and stage of index lesion had no impact on regret status. The reasons for regret included: (1) poor cosmetic result, either of the CPM or of the reconstruction (39%); (2) diminished sense of sexuality (22%); (3) lack of education regarding alternative surveillance methods or CPM efficacy (22%); and (4) other reasons (17%). CONCLUSIONS: To minimize the risk of regrets in women contemplating CPM, it is imperative that these women be counseled regarding an estimation of contralateral breast cancer risk, the alternatives to CPM, and the efficacy of CPM. In addition, these women should have realistic expectations of the cosmetic outcomes of surgery and understand the potential impact on their body image.

Adult↗
PubMed1999

The pathogenesis of chronic obstructive pulmonary disease.

Cigarette smoking is the main risk factor for the development of chronic obstructive pulmonary disease (COPD). An accelerated rate of lung function decline that causes clinically significant COPD, however, is present in only a minority of smokers. In addition to the cumulative amount of cigarettes smoked, other environmental and genetic properties contribute to this variable physiological response. This article reviews the role of airway hyperresponsiveness, mucus hypersecretion, infection, and proteases in the development of COPD.

Bronchi↗
PubMed1999

Outpatient management of chronic obstructive pulmonary disease.

The outpatient management of chronic obstructive pulmonary disease (COPD) is designed to limit the decline in respiratory function over time, to relieve the symptoms and improve the patient's functional status, and to manage complications when they arise. Factors that predispose to airway inflammation, including cigarette smoking and respiratory infections, are prevented by behavioral modification programs, measures such as exercise and nutrition to improve general health, and regular vaccination. Symptoms are relieved by bronchodilator and anti-inflammatory therapy, based upon the specific needs of the patient. Hypoxemia and acute infections are treated with oxygen administration and the use of antibiotics when necessary. The management of acute exacerbations of COPD is addressed elsewhere in this symposium (ie, choice of antibiotics is not discussed here). Also, certain aspects of management, such as surgical procedures, chest physical therapy, and other aspects of pulmonary rehabilitation, are also subjects of subsequent articles in this series. Although none of these modalities, except for smoking cessation and oxygen administration, have been shown to alter the course of COPD, the careful choice of the therapeutic measures discussed here can lead to significant relief of symptoms in the patient with chronic airway obstruction.

Ambulatory Care↗
PubMed1999

Surgical treatment of chronic obstructive pulmonary disease.

Over the past several decades, a number of surgical techniques have been developed for the treatment of chronic obstructive pulmonary disease. Many of these procedures have been abandoned because of lack of efficacy and/or high morbidity and mortality. At the present time, lung transplantation, reduction pneumoplasty for giant bullous emphysema, and lung volume reduction surgery are being performed in a number of centers. Data concerning the effectiveness of these procedures is accumulating and will ultimately need careful analysis to determine long-term outcomes in this group of patients.

Humans↗
PubMed1999

Auditory and visual P300 cognitive evoked responses in patients with COPD: relationship to degree of pulmonary impairment.

Twenty-two subjects with documented COPD and no other significant illnesses were studied to assess the effect of varying degrees of COPD on cognitive P300 auditory and visual evoked potentials. The severity of COPD was determined by spirometry with assessment of FEV1, FVC, and FEV1/FVC. Auditory P300 latency was significantly correlated with the FEV1/FVC ratio (Pearson Product Moment correlations r = -.56, N = 20, probability level = 0.1), indicating that increasingly severe airflow impairment is associated with longer auditory P300 latencies. There was no significant association of FEV1/FVC with visual P300 latency or with auditory or visual evoked potential amplitude measures. Progressive impairment of the auditory P300 evoked potential latency occurs with increasing severity of COPD. This impairment is present even in patients with mild COPD, suggesting some degree of accompanying cognitive decline early in the course of COPD with worsening as the disease progresses.

Electroencephalography↗
PubMed1998

Vascular permeability factor/vascular endothelial cell growth factor-mediated permeability occurs through disorganization of endothelial junctional proteins.

Vascular permeability factor/vascular endothelial growth factor stimulates endothelial proliferation, angiogenesis, and increased vascular permeability in vivo. We investigated mechanisms of vascular permeability factor-mediated endothelial monolayer permeability changes in vitro. [14C]Albumin flux across endothelial monolayers was measured following a 90-min exposure to vascular permeability factor (660 pM). Vascular permeability factor increased albumin flux to 3.4 times that of control albumin flux. Endothelial monolayers were also incubated for 90 min with vascular permeability factor plus Gö6976 (10 nM), staurosporine (1 microM), wortmannin (10 nM), AG126 (1 and 2.67 microM), and PD98059 (20 microM). Vascular permeability factor-mediated permeability was not blocked by Gö6976, an antagonist of "classical" protein kinase C, staurosporine, a pan-protein kinase C antagonist, nor wortmannin, a PI3-kinase blocker, but was blocked by incubation with AG126 or PD98059, inhibitors of mitogen-activated protein kinase activation. Immunofluorescent staining of the junctional proteins VE-cadherin and occludin showed a loss of these proteins from the endothelial junction that was prevented by co-incubation with AG126 or PD98059. These data demonstrate that vascular permeability factor increases albumin permeability across endothelial monolayers in vitro and suggests that permeability increases through rearrangement of endothelial junctional proteins involving the mitogen-activated protein kinase signal transduction pathway.

Androstadienes↗
PubMed1997

A psychosocial intervention for patients with soft tissue sarcoma.

Support groups have increasingly been demonstrated to be an effective intervention in reducing psychological difficulties and emotional problems in patients with cancer. This report describes a pilot support group intervention based upon a modified version of Cain and colleagues' (1986) thematic counseling model for patients who have been treated for soft tissue sarcoma and are free of disease. The modified thematic counseling model consisted of eight group sessions that focused on providing information about soft tissue sarcoma, management of stress, relaxation techniques, and coping skills. In addition, time was set aside for general discussion of personal concerns. Common themes reported by patients were: communication with family, friends and physicians, anxiety about lack of information about soft tissue sarcoma, and major financial disruption because of their illness. At the conclusion of the eighth session, patients were given an informal survey and asked to rate the value of different aspects of the program for them. They reported that feelings of isolation, anger, depression, and anxiety significantly decreased; and their level of self-confidence increased dramatically. This pilot support group intervention is recommended as a model for enhancing the quality of life of patients with soft tissue sarcoma.

Adaptation, Psychological↗
PubMed1996

Translational regulation of vascular permeability factor by eukaryotic initiation factor 4E: implications for tumor angiogenesis.

Studies aimed at elucidating the function of the protein synthesis factor eukaryotic initiation factor 4E (elF-4E) have demonstrated that overexpression of this protein results in marked cell phenotypic and proliferative changes, including neoplastic transformation of cells. These data suggest that elF-4E may somehow participate in the development and progression of tumors in vivo. In order to determine how elF-4E exerts its transforming effects, we examined vascular permeability factor (VPF) levels in cells transfected with an elF-4E vector. Cells overexpressing elF-4E showed an increase in intracellular, and an average 130-fold increase in secreted VPF protein levels (CHO 0.13+/-0.12 ng/ml; CHO-4E 20.5+/-12.5 ng/ml) over control cells. HUVEC growth induction revealed these VPF levels to be biologically active. Northern analysis revealed no difference in VPF transcript between the 2 cell lines. Polysome analysis showed that the VPF message in elF-4E-transfected cells was associated with the heavy polysomal regions, whereas the VPF message was associated with light polysomes in control cells. These data strongly suggest that enhanced VPF expression is achieved through translational regulation rather than transcriptional regulation in cells overexpressing elF-4E. This indicates that elF-4E-induced VPF expression may be an important factor in some forms of tumor angiogenesis and development.

Animals↗
PubMed1996

Early albumin leakage in pulmonary endothelial monolayers exposed to varying levels of hyperoxia.

We assessed the effect of varying levels of hyperoxia on 14C-albumin flux across bovine pulmonary artery endothelial cell (BPAEC) monolayers. Endothelialized nitrocellulose filters were mounted in Ussing-type chambers which were filled with cell culture medium (M 199). Equimolar amounts of 14C-labeled and unlabeled albumin were added to the "hot" and "cold" chambers, respectively, and the monolayers were exposed to 3 hours of varying levels of oxygen (16%, 30%, 40%, 60%, and 95%). When compared to 16% O2, exposure to hyperoxic gas mixtures of 40% or greater progressively increased albumin permeability across endothelial monolayers within 3 hours to a value 2.5 times higher at 95% O2 compared to 16% O2 (p < 0.001). Hyperoxia-induced permeability increases were prevented by catalase, superoxide dismutase, desferrioxamine, and allopurinol. Our data indicate that hyperoxia induces endothelial permeability changes more rapidly than previously reported even at O2 concentrations as low as 40%.

Albumins↗
PubMed1996

Women's psychological reactions to breast cancer.

Breast cancer is the cancer most studied in terms of psychological and psychosocial aspects because of the high prevalence and mortality of the disease and the psychological effects of surgery on an organ rich in meaning. The diagnosis of breast cancer, treatment, and treatment sequelae are major stressors for any woman; however, the psychological impact of the diagnosis and women's emotional responses vary considerably depending on medical parameters of the disease, the patient's psychological make-up and coping abilities, and the availability of emotional and financial support. We document the experience of breast cancer at all phases of the disease for a majority of psychologically healthy women and describe the emotional responses of women who are at high genetic risk of developing breast cancer. Having a comprehensive understanding of psychologically healthy women's reactions to breast cancer is necessary as we attempt to define standards of care and treatment guidelines for both psychologically healthy women with breast cancer and for those with psychiatric disorders that antedate or complicate breast cancer treatment.

Adaptation, Psychological↗
PubMed1994

Modulation of endothelial cell permeability by lung carcinoma cells: a potential mechanism of malignant pleural effusion formation.

This study examined the hypothesis that tumor cells metastatic to the pleura secrete a soluble factor(s) that directly increases endothelial cell permeability. Nitrocellulose filters were endothelialized with bovine pulmonary artery endothelial cells and exposed to conditioned media from either human lung adenocarcinoma (Calu-3), human lung squamous cell carcinoma (SK-MES-1), or control media for 16 h. The diffusional permeability (Pd x 10(-5) cm/sec) to [14C]albumin was then determined for each monolayer with Ussing-type chambers. Both adenocarcinoma conditioned media (ACCM) and squamous cell carcinoma conditioned media (SCCM) caused a two- to threefold increase in endothelial monolayer permeability. The addition of indomethacin (10 micrograms/ml) blocked the observed permeability increase in ACCM but not in SCCM, suggesting that the increase in permeability by ACCM was secondary to the production of prostaglandins. To confirm this, a variety of prostanoids previously shown to be produced by the Calu-3 cell line were added directly to the endothelial monolayer. Prostaglandin F2 alpha (PGF2 alpha) in both low (10 ng/ml) and high (100 ng/ml) concentrations for 16 h resulted in a three- to fourfold increase in permeability. Prostaglandin E2 (PGE2) resulted in a small increase in [14C]albumin permeability but only at high concentrations (100 ng/ml). PGF2 alpha production by the two tumor cell lines was measured using radioimmunoassay. Baseline adenocarcinoma production of PGF2 alpha was 117.5 pmol/10(6) cells and fell to 24.2 pmol/10(6) cells hours following incubation with indomethacin. The decrease in PGF2 alpha occurred in parallel with the changes in permeability. Concomitant, reversible changes in cell shape and F-actin distribution were detected in endothelial cells exposed to ACCM. No significant production of PGF2 alpha by the squamous cell carcinoma cell line was detected. These results suggest that both adenocarcinoma and squamous cell carcinoma secrete a soluble factor(s) that directly increases endothelial cell permeability to albumin and that in the case of adenocarcinoma this soluble factor may be a prostanoid such as PGF2 alpha.

Adenocarcinoma↗
PubMed1994

Heparin-induced thrombotic thrombocytopenia.

OBJECTIVE: To report a case of heparin-induced thrombotic thrombocytopenia (HITTS) and discuss the incidence, possible mechanisms, complications, and treatment for this syndrome. DATA SOURCES: Case reports and review articles identified by MEDLINE from 1980 through 1991. Older articles located by manual searches. DATA EXTRACTION: Data were extracted and reviewed from published sources. Cases were selected on the basis of case presentation, time of disease onset, pathophysiology of disease, and therapeutic options. SETTING: A 600-bed university teaching hospital and an affiliated community hospital. PATIENT: A 36-year-old woman with insulin-dependent diabetes mellitus, sepsis, adult respiratory distress syndrome, diabetic ketoacidosis, oliguric renal failure developed HITTS and subsequent gangrene of her right arm. INTERVENTION: Immediate cessation of all heparin use and amputation of the patient's right arm. RESULTS: The patient's condition improved progressively over the following 60 days and she was discharged to outpatient care. CONCLUSIONS: Heparin has been associated with thrombocytopenia and thrombotic events. Laboratory tests for HITTS are unreliable and the diagnosis is usually suspected by the clinical presentation of the patient. Platelet counts should be monitored closely during heparin use. In the event of a marked decrease in platelet count associated with venous or arterial thrombosis, heparin therapy should be stopped immediately. If further anticoagulation is necessary, oral anticoagulants such as warfarin may be used instead. As the onset of warfarin may take several days to become therapeutic, aspirin, dipyridamole, or both may be used effectively. Healthcare workers should be aware that in these patients, the use of even small amounts of heparin can produce catastrophic results.

Adult↗
PubMed1992

Oxygen toxicity.

OBJECTIVE: The objective of this article is to provide an overview of the biochemistry of oxygen metabolism, including the formation of free radicals and the role of endogenous antioxidants. Pathophysiologic correlates underlying the clinical manifestations of oxygen toxicity are reviewed and management strategies are outlined. DATA SOURCES: References from basic science and clinical journals were selected from the authors' files and from a search of a computerized database of the biomedical literature. STUDY SELECTION: Articles selected for review included both historical and current literature concerning the biochemistry and pathophysiology of oxygen toxicity in animals and humans. DATA SYNTHESIS: The benefits of oxygen therapy have been known for many years; however, its potential toxicity has not been recognized until the last two decades. The lungs, the eyes, and, under certain conditions, the central nervous system are the organs most affected by prolonged exposure to hyperoxic environments. Free radical formation during cellular metabolism under hyperoxic conditions is recognized as the biochemical basis of oxygen injury to cells and organs. Endogenous antioxidants are a primary means of detoxifying reactive oxygen species and preventing hyperoxia-induced cellular damage. When this defense fails or is overwhelmed by the excessive production of hyperoxia-induced free-radical species, distinctive morphologic changes occur at the cellular level. The amount of hyperoxia required to cause cellular damage and the time course of these changes vary from species to species and from individual to individual within the same species. Age, nutritional status, presence of underlying diseases, and certain drugs may influence the development of oxygen toxicity. CONCLUSIONS: There is currently no reliably effective drug for preventing or delaying the development of oxygen toxicity in humans. Use of the lowest effective oxygen concentration, the avoidance of certain drugs, and attention to nutritional and metabolic factors remain the best means currently available to avoid or minimize oxygen toxicity. Research is continuing into more effective ways to prevent, diagnose, and treat this disorder.

Animals↗