Biomedical subjects

Derrick J Beech

Publications and source records attributed to Derrick J Beech.

17 recordsLinked to original sources

PubMed2006

Laparoscopic revision of the gastrojejunostomy for recurrent bleeding ulcers after past open revision gastric bypass.

Late complications of open gastric bypass can include malnutrition, weight gain, stomal stenosis, and recurrent bleeding ulcers. Herein, we describe the case of a woman who had recurrent bleeding ulcers, after an open revision of a stenotic gastric bypass. She now underwent an uneventful laparoscopic revision of her gastrojejunostomy and was discharged within 72 hours. Laparoscopic revision of a gastrojejunostomy, even after an open revision following an open gastric bypass, can be done safely.

Female↗

PubMed2006

Poor knowledge of basic cancer facts of physicians-in-training.

PURPOSE: Since many physicians-in-training will play an important role in cancer screening, their understanding of cancer screening and basic cancer facts is paramount. This investigation was undertaken to determine their baseline knowledge in basic cancer facts. METHOD: A questionnaire was used to assess the knowledge of basic cancer facts of medical students, medical residents and surgical residents. Participants were asked to rank five different malignancies in their correct order for both mortality and incidence. Physicians-in-training were given separate questions for male and female patients. The questions were considered correct if at least the first three malignancies were ranked in the appropriate order. RESULTS: One-hundred-twelve second-year medical students and 78 residents were assessed. Few physicians-in-training ranked the malignancies in correct order for mortality (21% for female patients and 18% for male patients). Even fewer physicians-in-training ranked the malignancies in correct order for incidence (2% for female patients and 9% for male patients). CONCLUSION: Most physicians-in-training lack an understanding of basic cancer facts. If this poor basic cancer fact knowledge represents an overall lack of cancer knowledge, educational efforts need to be focused on cancer care for all levels and specialties of physician training.

Adult↗

PubMed2006

Ageism in breast cancer surgical options by medical students.

INTRODUCTION: The similar long-term survival of breast conservation and modified radical mastectomy in treating early invasive breast cancer has been well established. Since doctors often find themselves in the position of making operative recommendations, characterization of factors that may influence their recommendations is important. Previous investigations have demonstrated the phenomenon of ageism (i.e., between patients aged 30 versus 60 years old) in doctors and doctors-in-training. Thus, this study was undertaken to investigate any possible economic bias of doctors-in-training in breast conserving procedures. METHODS: Medical students were instructed on the efficacy of breast conservation in treating breast cancer. Then, their opinions were assessed using a questionnaire about recommendations for breast conservation as well as breast reconstruction after mastectomies in similar patients. All patients were between the ages of 41-54 years old but differed by occupation. Chi squared tests were used for statistical analysis. RESULTS: Forty-eight students participated in the study. No differences were noted between "high income" occupations and "low income" occupations. However, subtle ageism was noted even in this similarly aged population. Modified radical mastectomy was recommended in 35 percent of the "older" age group (41-48 years old) versus 15 percent of "younger" patients (49-54 years old, p < 0.002). Further, breast reconstruction was recommended in 89 percent of younger patients versus only 72 percent of older patients (p < 0.004). CONCLUSIONS: Medical students still demonstrate an age bias against older women in their recommendations of breast conservation and breast reconstruction. Educational efforts should be instituted during the medical school training to decrease this age bias in treatment of breast cancer.

Adult↗

PubMed2004

Nodular melanoma of the face: a rare finding in African Americans.

The incidence of melanoma has dramatically increased during the past several decades in the United States. Although the majority of cutaneous melanomas occur in Caucasians, African Americans are also susceptible to this malignancy. Cutaneous melanomas in African Americans typically occur on palms of the hands or soles of the feet. This report documents the rare occurrence of a nodular melanoma of the face in a dark-complexion African-American patient.

Black or African American↗

PubMed2004

Dermatofibrosarcoma protuberans and breast cancer: genetic link or coincidental association?

Dermatofibrosarcoma protuberans is a low-grade cutaneous neoplasm originating from the dermis with a high propensity for local recurrence. These malignancies are classified as soft tissue sarcoma although regional or distance metastatic spread is rare. Germ-line mutations of p53 have been described with a rare autosomal dominant syndrome in patients with soft tissue sarcoma and breast adenocarcinoma (Li Fraumeni's syndrome). The described case illustrates the rare occurrence of dermatofibrosarcoma protuberans (DFSP) and breast adenocarcinoma with an emphasis on the possibility of a molecular or genetic association.

Adult↗

PubMed2003

Human immunodeficiency syndrome and hepatitis B and C infections among homeless adolescents.

The lifestyle of homeless adolescents places them at high risk for contracting a variety of serious illnesses. The purpose of this cross-sectional study was to determine the predictors of human immunodeficiency virus (HIV) and hepatitis infections among homeless youth. Anonymous and confidential interviewer-administered psychosocial surveys were conducted with 150 homeless youth (ages 14 to 23 years; 70% male). Venous blood samples were collected as well. Most respondents (95%) had engaged in sexual intercourse, with 13 years as the median age at first coitus. Approximately 36 percent indicated they had exchanged sex for food, shelter, or drugs. Although youth reported a high rate of consistent condom use, 16 percent of the sample tested positive for HIV, 17 percent tested positive for hepatitis B (HBV), and 12 percent tested positive for hepatitis C (HCV). Homeless youth should be considered a high-risk group for contracting HIV, HBV, and HCV infections. The positive rates for HIV, HBV, and HCV observed in this study are higher than those of many previous reports among street youth. Because HIV prevention and hepatitis B vaccination programs have been targeted at school-based youth, most homeless youth are missed by these efforts. Targeted programs are needed to reach this high-risk group. Suggested guidelines for clinicians involved in the provision of medical care to homeless children and adolescents are provided.

Adolescent↗

PubMed2003

Synchronous occurrence of glioblastoma multiforme and esophageal adenocarcinoma.

Synchronous malignancies are rare occurrences for which there may be a genetic link between two cancers or which may be simply coincidental. Although glioblastoma multiforme and esophageal adenocarcinoma have few clinical similarities there are no known biochemical or genetic links between the two malignancies. This case discussion details the synchronous occurrences of these two lesions and highlights possible clinical, biochemical, and genetic commonalities.

Adenocarcinoma↗

PubMed2002

Expression of PH-20 in normal and neoplastic breast tissue.

BACKGROUND: Tumor metastasis involves a sequence of interrelated steps, of which penetration beyond the basement membrane is an essential component. Hyaluronic acid (HA) is a major structural component of the complex proteoglycans found in extracellular matrices and basement membranes. Hyaluronidase (PH-20) degrades HA, resulting in the disruption of basement membrane integrity and possible tumor dissemination. MATERIALS AND METHODS: Total RNA was extracted from samples (n = 51) of normal breast tissue (n = 12), ductal carcinoma in situ (DCIS) (n = 12), infiltrating ductal breast adenocarcinoma (n = 13), and metastatic breast cancer to lymph nodes (n = 14). RT-PCR was used to determine the relative level of PH-20 in each specimen. RESULTS: PH-20 was detected in 41/51 (80.4%) of the specimens evaluated. PH-20 was present in 12/12 (100%) normal breast tissues; 8/12 (66.7%) DCIS; 13/13 (100%) invasive breast cancers; and 8/14 (57.1%) metastases. Of those specimens in which PH-20 was detected, there were increased levels of PH-20 in metastatic breast cancer to lymph nodes compared to DCIS and invasive breast cancer. Stratification of specimen by race revealed that African American women had higher levels of PH-20 with invasive and metastatic beast cancer. CONCLUSIONS: Increased levels of PH-20 are noted in invasive and metastatic breast cancer compared to DCIS. Tumors from African American women with invasive and metastatic breast cancer demonstrated higher levels of PH-20 than Caucasians. Varying levels of PH-20 in mammary tissue may contribute to early invasion and metastasis of breast cancer.

Biomarkers, Tumor↗

PubMed2002

Education of medical students in clinical breast examination during surgical clerkship.

BACKGROUND: Medical student training in clinical breast examination is deficient at most medical schools. The use of silicone breast models may allow the education of abnormal and normal findings. This study examines the efficacy of silicone breast models to educate medical students in clinical breast examinations during their third-year surgical rotation. METHODS: Medical students were randomly selected to participate in formalized training sessions in clinical breast examination or as a control group. Presession and postsession testing with silicone breast models were performed. True positives (masses that were present and documented by the student) and false positives (masses that were not present but were documented by the student) were recorded. RESULTS: Medical students undergoing the training sessions demonstrated improved true positive scores (2.2 to 2.8; P <0.05) as well as improved false positive scores (3.0 to 2.0; P = 0.30) and total scores (-0.8 to 0.8; P = 0.07). Students who documented an increase in the number of breast examinations during their rotations had statistically lower false positive scores. CONCLUSIONS: Students after formalized clinical breast examination sessions do improve their ability to detect breast masses, although they continue to detect masses that are not present. Experience of actual breast examinations during their surgical rotations may refine their clinical skills.

Adult↗

PubMed2002

Utility of the case-method approach for the integration of clinical and basic science in surgical education.

BACKGROUND: Although students develop experience in integrating clinical and basic scientific knowledge, it may be difficult for them to do so in patient management. Formalized instructions using case discussions that involve the integration of basic science concepts may facilitate their incorporation into practice. METHODS: Third-year surgical clerkship students were pretested for baseline knowledge of information relevant to the case being discussed. Facilitators, including a faculty surgeon and a pharmacologist or physiologist, assisted in developing the case and in the coordination of questions. Following two 90-minute, student-driven sessions and student review of bibliographic resources, consensus was reached regarding the appropriate utilization of the basic science and clinical information in patient management. RESULTS: Pre- and post-tests of the students' knowledge showed improvements in their performances by the seminars. CONCLUSION: The case method permitted instructors to assess specific areas of increased knowledge and to adjust subsequent teaching to improve the one area in which performance worsened.

Adult↗

PubMed2002

Hepatitis B and C infections among homeless adolescents.

The lifestyle of homeless adolescents places them at high risk for contracting serious illnesses. This study sought to determine the hepatitis status and predictors of hepatitis infection among 150 homeless adolescents. Each participant took a psychosocial survey and provided a venous blood sample. Most respondents (95%) had engaged in sexual intercourse; approximately 36% indicated they had exchanged sex for food, shelter, or drugs. Youth reported a high rate of consistent condom use, however, 22% tested positive for hepatitis B or C. Homeless youth should be considered a high-risk group for hepatitis B or C virus infection. As hepatitis B vaccination programs have been targeted at school-based youth, most homeless youth are missed by these efforts. Targeted programs are needed to immunize this high-risk group.

Adolescent↗

PubMed2002

Self-reported differences in daily raw vegetable intake by ethnicity in a breast screening program.

PURPOSE: While the literature has no conclusive causal relationship between nutrition and breast cancer, diet is believed to play a role in the development of breast cancer. This investigation focuses on differences of dietary practice between Caucasians and African Americans in a cohort of women presenting for breast cancer screening. METHODS: Over a one-year period, 675 women presenting to the Breast Health Center at Tulane University Medical Center for an initial visit were given a self-reported health behavior questionnaire. Included in this survey were questions concerning the frequency of raw vegetable consumption and fat/oil intake. MAIN FINDINGS: The overall proportion of women who presented for breast cancer screening that reported daily raw vegetable consumption in the study group was 40%. There were statistically significant differences between proportions of Caucasian women's and African American women's consumption of daily raw vegetable (51% versus 29%, respectively; P < 0.0001). These differences were not seen in daily fat/oil intake. No differences were seen in socioeconomic measures. CONCLUSIONS: There is a substantial difference in the consumption of potentially protective foods among major ethnic groups. These dietary differences should be taken into account when investigating the ethnic differences in women with breast cancer, as well as the relationship between breast cancer and nutrition.

Adult↗

PubMedDate not supplied

Effect of a short structured session on medical student breast cancer screening knowledge.

Formalized instruction in breast cancer screening during medical school may help improve early breast cancer detection and survival. Physicians-in-training must be proficient in skills relating to breast cancer screening. This study investigates the baseline breast cancer screening knowledge of medical students, the benefit of a structured lecture session, and its effect on improving medical students' knowledge of cancer screening. A self-administrated questionnaire relating to breast cancer screening was given to third-year medical students. A 60-minute structured lecture session was given to the medical students regarding breast cancer screening. A postintervention survey was administered immediately following the session. A total of 27 medical students were evaluated. There was a statistically significant improvement following the formalized teaching session (84% to 93%; p < 0.0016). While few students (15%) reported having previous instruction in cancer screening, most students (96%) felt that a formal session should be offered during medical school. While medical student knowledge of breast cancer screening may be adequate, formalized instruction in breast cancer health practices can improve medical student knowledge. Most students had limited previous instruction in breast cancer prevention and welcomed the opportunity for structured training in breast cancer prevention, education, and detection. Until a formal course becomes a fundamental aspect of medical education, a short structured session should be instituted.

Breast Neoplasms↗

PubMedDate not supplied

Physicians-in-training recommendations for prophylactic bilateral mastectomies.

The decision to recommend bilateral prophylactic mastectomy (PBM), one treatment modality used to reduce the development of breast carcinoma, may be influenced by physician bias. This investigation tested the hypothesis that there are physician-in-training biases in recommendations of PBM. All second-year medical students, general surgical residents, and internal medicine residents at our institution participated in a survey in which they were asked at what percent risk of developing breast carcinoma the physicians-in-training would recommend PBM for 1) their patients, 2) themselves, and 3) their significant others, as applicable. A total of 198 physicians-in-training responded. Univariate analysis demonstrated an association between both the type of physician-in-training (p<0.03) and gender (p<0.004) with the percent risk for which respondents would recommend PBM. However, with multivariate analysis, only gender was associated with percent risk (p<0.05). Physicians-in-training also chose PBM at a lower risk for their significant others than for themselves (67.5% versus 57.2%; p<0.02). Respondents also chose PBM at a similar risk for themselves or significant others as for their patients (r=0.83, r=0.98; p<0.001). This investigation suggests that males (compared to females) are more likely to recommend PBM for the prevention of breast cancer.

Adult↗

PubMedDate not supplied

Paget's disease of the breast areola mimicking cutaneous melanoma.

Paget's disease of the breast nipple and areola complex represents a cutaneous manifestation of an underlying breast malignancy. The typical skin changes characteristic of breast Paget's disease are usually easily distinguished from those found of malignant melanoma. The rare finding of a pigmented cutaneous breast lesion mimicking melanoma presents a diagnostic dilemma. This case presentation describes a pigmented mammary lesion involving the areola that had undergone changes in diameter and pigmentation. The lesion was not associated with nipple drainage, nipple excoriation, dermal ulceration, or a palpable breast mass. The areola lesion was highly suggestive of a dermatologic malignancy such as malignant melanoma. As such, a biopsy was performed with initial findings suggestive of cutaneous melanoma. Upon more detailed analysis of a larger excision specimen, immunohistochemical staining was highly supportive of the diagnosis of breast Paget's disease. A total mastectomy with sentinel lymph node evaluation was performed along with immediate reconstruction. The final pathology revealed a small focus of ductal carcinoma in situ of the breast associated with the areola changes. Histologic and immunohistochemical analysis of a biopsy specimen were paramount in differentiating these two lesions.

Breast Neoplasms↗

PubMedDate not supplied

Insulin-like growth factor-I receptor activation blocks doxorubicin cytotoxicity in sarcoma cells.

More than 80% of patients with extremity sarcoma ultimately develop metastases to pulmonary sites. Doxorubicin alone or in combination with other chemotherapeutic agents may result in partial or complete tumor response for sarcoma pulmonary metastases. Regardless of the response, there has been no proven survival benefit from cytotoxic chemotherapy in the treatment of localized or metastatic soft tissue sarcoma. Insulin-like growth factor-I receptor (IGF-I-R) activation may contribute to resistance to chemotherapy in mesenchymal neoplasia. IGF-I-R activation by its ligand decreases in vitro cytotoxic response of sarcoma to doxorubicin, the most active agent against soft tissue sarcoma in adults. Furthermore, IGF-I-R is frequently overexpressed in soft tissue sarcoma and may predict poor response to traditional chemotherapy. The effect of doxorubicin on a human soft tissue sarcoma cell derived from a dedifferentiated lung metastasis was evaluated using titrated doxorubicin doses with and without exogenous IGF-I (100 ng/ml). Western blot analysis was performed to evaluate levels of phosphorylated IGF-I-R under control and experimental conditions. In vitro proliferation assays were performed. Nuclear activation through IGF-I receptor mediated pathways prior to exposing sarcoma cells to doxorubicin altered the pattern of response to doxorubicin with enhanced mitogenesis (>2-fold) and blunted doxorubicin cytotoxicity (>10% change in IC50). These data suggest that activation of IGF-I receptor in sarcoma cells is a potential mechanism for tumor resistance to doxorubicin. Inhibition of IGF-I receptor activation represents a novel approach to enhance the degree and duration of response to traditional chemotherapy against soft tissue sarcoma.

Antineoplastic Agents↗

PubMedDate not supplied

Multivariate analysis of factors associated with smoking cessation in women.

BACKGROUND: Appropriate smoking cessation techniques, including counseling patients to stop smoking, could prevent multiple health-related problems. Identification of relevant factors in patients that smoke may be beneficial in targeting smoking cessation efforts. This investigation explores various factors associated with smoking cessation, specifically in women. METHODS: All women (n = 675) presenting to a breast health center over a one year period were surveyed regarding their tobacco use. Any association between smoking cessation and various factors was determined by multivariate analysis. RESULTS: Our population consisted of 47% African American women, 43% Caucasian women, and 10% women of other ethnicities. Sixty percent of all women never smoked. Of the women who had smoked, 57% quit. Except for alcohol use and exercise, no factor, including ethnicity, was associated with never smoking. Smoking cessation was associated with being married, being Caucasian, not using alcohol, and exercising. However, only Caucasian race and marriage were independently associated with smoking cessation. DISCUSSION: In our population, African American women had a lower proportion of smoking cessation than Caucasian women. In patients with similar access to care, specifically preventive care, there are ethnic and social differences in smoking cessation.

Adult↗