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Biomedical subjects

G Barger

Publications and source records attributed to G Barger.

8 recordsLinked to original sources
PubMed2001

Prevalence of antibodies to four herpesviruses among adults with glioma and controls.

The authors previously reported statistically significant inverse associations between adult onset glioma and histories of chickenpox and shingles among 462 cases and 443 controls in the San Francisco Bay Area Adult Glioma Study (1991--1995) and a suggestive but nonsignificant inverse association with immunoglobulin G antibodies to varicella-zoster virus in a small subset of these cases. This report considers antibodies to four common herpesviruses (varicella zoster, herpes simplex, cytomegalovirus, and Epstein Barr) among 134 cases and 165 controls that represent all subjects for whom usable blood specimens were available. The prevalences of immunoglobulin G antibodies to varicella-zoster virus, herpes simplex virus, cytomegalovirus, and Epstein-Barr virus were 90%, 71%, 57%, and 90%, respectively. After adjustment for age, White versus non-White ethnicity, and gender, glioblastoma cases were less likely than controls to have immunoglobulin G antibodies to varicella-zoster virus (odds ratio = 0.4; 95% confidence interval: 0.1, 0.9). They were also somewhat less likely to have antibodies to Epstein-Barr virus but somewhat more likely to have antibodies to herpes simplex virus and cytomegalovirus. Antibody prevalences to all four herpesviruses were similar between cases with other glioma histologies and controls. These results corroborate our previously suggestive findings of an inverse association of varicella-zoster virus antibodies with adult onset glioma.

Adult↗
PubMed2000

Discrepancies in diagnoses of neuroepithelial neoplasms: the San Francisco Bay Area Adult Glioma Study.

BACKGROUND: Valid and reliable diagnoses of disease are key both to meaningful epidemiologic and clinical investigations and to decision-making about appropriate treatment. One previous study highlighted the lack of precision in diagnosing primary brain tumors in a neuropathology referral practice. The current study explores diagnostic discrepancies in a population-based adult glioma series by hospital of origin, specialty training of the original diagnosing pathologist, and clinical significance. METHODS: To confirm patients' eligibility for the San Francisco Adult Glioma Study, the authors obtained participants' pathology specimens and conducted a uniform secondary neuropathology review. Eligible patients were all adults age 20 years or older newly diagnosed with glioma between August 1, 1991, and March 31, 1994, who resided in 1 of 6 San Francisco Bay Area counties. RESULTS: Overall, the original and secondary diagnoses were the same (concordant) for 352 (77%) of the 457 cases available for study. Twenty-six percent of the cases from community hospitals were discordant, compared with 12% of the cases from academic hospitals P= 0.004. Of the 105 discordant diagnoses, 17 (16%) were determined to be clinically significant, defined as a difference that could significantly alter patient management and/or prognosis. Sixteen of these 17 cases originated at community hospitals, and only 1 originated at a hospital with a neuropathologist. Based on the distribution of review diagnoses, subjects presenting at nonacademic hospitals were more likely than those presenting at academic hospitals to have glioblastoma (61% vs. 52%; P = 0.07). CONCLUSIONS: The percentage of cases with discrepant original and review diagnoses was higher among those originally diagnosed at community hospitals without a neuropathologist than among those originally diagnosed at an academic hospital with a neuropathologist. Clinically significant discrepancies were much more likely to have originated at a community hospital without a neuropathologist. These data highlight the importance of review of brain tumors by a neuropathologist prior to decision-making regarding treatment. A separate implication of this study is that glioma cases selected exclusively from academic or nonacademic institutions in a particular geographic area are unlikely to be representative of all cases occurring in that area.

Adult↗
PubMed1997

Familial and personal medical history of cancer and nervous system conditions among adults with glioma and controls.

The causes of glioma, the most common type of primary malignant brain tumor, are poorly understood. This study compared the personal and first-degree familial medical histories of 462 adults newly diagnosed with glioma in the San Francisco Bay Area between August 1, 1991, and March 31, 1994, with those of 443 controls who were frequency-matched on age, sex, and ethnicity. Cases and controls had equivalent personal histories of cancers other than brain cancer and most nervous system conditions, but they differed significantly regarding histories of epilepsy, seizures, or convulsions 3 or more years prior to diagnosis (odds ratio = 3.3, 95% confidence interval (CI) 1.4-7.9), chickenpox (odds ratio = 0.4, 95% CI 0.3-0.6), and shingles (odds ratio = 0.5, 95% CI 0.3-0.8). Four cases (less than 1%) and no controls had known genetic disorders (three had neurofibromatosis and one had tuberous sclerosis). Cases and controls had similar family histories of cancer and seizures. However, the odds ratio for a validated family history of primary brain tumor was 2.3 (95% CI 1.0-5.8). These results suggest that although family history of any cancer probably is not an important risk factor for adult glioma, a family history of brain tumors may play a role. Variation in exposure to or biologic response to common viral infections might play a greater role in the etiology of adult glioma than family history.

Adult↗
PubMed1997

Does prior infection with varicella-zoster virus influence risk of adult glioma?

To evaluate a possible association between varicella-zoster virus infection and glioma, the authors asked adults with glioma (n = 462) whose tumors were diagnosed between August 1, 1991, and March 31, 1994, and age-, sex-, and ethnicity-matched controls (n = 443) about their histories of chickenpox or shingles. Cases were significantly less likely than controls to report a history of either chickenpox (odds ratio = 0.4, 95% confidence interval (CI) 0.3-0.6) or shingles (odds ratio = 0.5, 95% CI 0.3-0.8). To obtain serologic support for these findings, the authors conducted double-blind enzyme-linked immunosorbent assays for immunoglobulin G antibodies to varicella-zoster virus among 167 self-reporting subjects for whom blood samples were available. Cases and controls reporting no history of chickenpox were equally likely to test positive (73% vs. 75%), but among those reporting a positive history, cases were less likely than were controls to test positive (71% vs. 85%). Despite the misclassification, an odds ratio of 0.6 was obtained using either serologic data (95% CI 0.3-1.3) or reported history of chickenpox (95% CI 0.3-1.1) in this subgroup of subjects. This suggests that adults with glioma were less likely than controls either to have had prior varicella-zoster virus infection or to have an immunoglobulin G antibody response adequate to indicate positivity. Since either explanation suggests novel mechanisms for brain tumor pathogenesis, these findings require corroboration and elaboration.

Adult↗
PubMed1987

Improving patient care through problem-solving groups.

In a competitive healthcare environment where as much attention must be given to quality of care as to cost containment, hospitals must learn to involve their lowest-paid paraprofessionals in decision making, since often these people have as much or more contact with patients than do physicians and nurses. One effective employee-involvement technique is the problem-solving group (PSG), which works to identify, analyze, choose, and implement solutions to various problems that influence the quality of patient care. A PSG project involving a typical paraprofessional unit was begun in spring 1985 at Emory University Hospital, Atlanta. The project's developmental stages were the following: Gathering data; Identifying problems; Providing feedback; Selecting PSG members; Focusing on problems; Generating solutions; Choosing the best solution; Implementing solutions; Managing successful outcomes. The PSG project was successful in addressing almost all the 15 identified problems in the department. Involving the staff in the PSG project resulted in higher morale, greater satisfaction with management, and a more favorable attitude toward their jobs.

Attitude of Health Personnel↗
PubMed1983

Improvement in survival produced by sequential therapies in the treatment of recurrent medulloblastoma.

Thirty-six patients with recurrent medulloblastoma were treated with various combination chemotherapy protocols after initial treatment (usually irradiation) failed. Use of systemic chemotherapy was limited by depressed bone marrow reserves secondary to previous craniospinal irradiation. Intraventricular and intrathecal therapies included cytosine arabinoside (Ara-C), methotrexate, and thio-tepa given as single agents. Major systemic agents used alone or in combination included CCNU, procarbazine, vincristine, and the hexitol epoxides. Patients were reirradiated with or without misonidazole when there was definite tumor progression after all other therapies failed and/or because myelosuppression was so severe that further chemotherapy was not possible. Sequential systemic or intrathecal chemotherapy and reirradiation produced median survivals of two years and 25% quartile survivals of 2.9 years. The prognosis for patients harboring recurrent medulloblastoma has improved considerably over the years because of the therapeutic approaches reported here.

Adolescent↗
PubMed1981

The association of periodic alternating nystagmus with periodic alternating gaze. A case report.

A 26-year-old man with a recurrent cerebellar medulloblastoma developed periodic alternating nystagmus. During radiation treatment, a bilateral voluntary horizontal gaze paresis appeared, and the periodic alternating nystagmus was replaced by periodic alternating gaze. Several days later, full eye movements returned, as did the periodic alternating nystagmus which had an identical periodicity to the periodic alternating gaze. The underlying pathophysiology of periodic alternating nystagmus and periodic alternating gaze is discussed.

Adult↗