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Biomedical subjects

G Marks

Publications and source records attributed to G Marks.

At least 91 records · Page 5Linked to original sources
PubMed1989

The presence of Sjögren's syndrome is a major determinant of the pattern of interstitial lung disease in scleroderma and other connective tissue diseases.

A number of patients with scleroderma, Sjögren's syndrome and other connective tissue diseases (CTD) were assessed to ascertain the prevalence of respiratory abnormalities as defined by bronchoalveolar lavage (BAL), standard respiratory function studies and gallium scan of the lung, and the relationship of these abnormalities to the presence or absence of dyspnea. These results suggest that respiratory symptoms are very common in CTD and in scleroderma, particularly if Sjögren's syndrome is also present. Our findings also suggest the presence of 2 patterns of interstitial lung involvement in scleroderma. In scleroderma alone this appears to be characterized by the presence of increased neutrophil proportions in the BAL, decreased DLCO, and no increase in gallium uptake within the lung. Where scleroderma is associated with Sjögren's syndrome, there is an increase in the proportion of lymphocytes in the BAL and respiratory symptoms are very prominent, the latter associated with an increase in gallium uptake within the lung. This suggests that Sjögren's is a major determinant of the pattern of interstitial lung disease seen in CTD.

Bronchoalveolar Lavage Fluid↗
PubMed1988

Sphincter preservation for cancer of the distal rectum using high dose preoperative radiation.

Sphincter preservation surgery for cancer of the distal rectum is recognized as being associated with a high incidence of local recurrence. High dose preoperative radiation with new surgical techniques is described as an attempt to widen the scope of sphincter preservation in patients who by conventional management would have an abdomino-perineal resection and permanent colostomy and to reduce the incidence of local recurrence. Since 1976, 121 patients with cancers of the rectum have selectively been treated with high dose preoperative radiation (4000 cGy to 6000 cGy) followed by combined abdominotranssacral resection (56); transanal abdominotransanal resection (28); anterior resection (21), or a full thickness wide local excision (16). This report details the results of 43 patients observed for a minimum of 2 years whose tumors were located from 0-6 cm of the dentate line. All patients received the full course of preoperative radiation, a minimum dose of 4000-4500 cGy in approximately 4 1/2 weeks that was delivered using 180-250 cGy per fraction. Patients with tumor fixation were given an additional boost of 1000-1500 cGy preoperatively. Surgery was carried out 4-6 weeks following the completion of radiation. There was no perioperative mortality. Anastomotic failure occurred in 3 patients and was reconstituted in two. Sphincter function was maintained in all but 6 patients (86%), 2 of these had a subsequent abdominoperineal resection, and 3 a diverting colostomy. Seven of 43 (16%) patients with tumors below 6 cm developed a local recurrence, and 6 of the 7 recurrences occurred in patients with fixed tumors, especially those located from 0-3 cm from the dentate line. Eleven patients are dead of disease. The 5-year actuarial survival rate for this group is 72%. Results indicate that high dose preoperative radiation can significantly extend the scope of sphincter preservation to selected cancers of the disal rectum with excellent survival without increasing the risk of pelvic perineal recurrence.

Adult↗
PubMed1988

The influence of symptoms of disease and side effects of treatment on compliance with cancer therapy.

To provide a systematic analysis of how adverse symptoms of disease and side effects of cancer therapy relate to patient noncompliance with treatment, we interviewed 107 patients with hematologic malignancies at the initiation of therapy and 6 months later to collect information on the type, frequency, and difficulty of unpleasant physical effects experienced. Level of compliance was monitored (biochemically and with self-report) on a monthly basis for oral self administration of allopurinol and prednisone. Appointment-keeping to receive infused chemotherapy was also monitored. Nausea was the most frequent side effect experienced. Nausea, fever, and pain were the most difficult physical effects to tolerate when they occurred. Complex treatment regimens and severe diseases related to reports of more physical effects. Younger patients had a more difficult time dealing with these effects than did older patients. Neither the occurrence, frequency, or difficulty dealing with any of the effects related to noncompliance with either of the two self-administered medications. Difficulty with particular effects did relate to noncompliance with clinic appointments to receive infused chemotherapy.

Adult↗
PubMed1988

Circadian characteristics of dialyzable and non-dialyzable human urinary electrolytes, trace elements and total solids.

Seven clinically-healthy men ranging in age from 21 to 25 years participated in this study. Urine samples were collected at 3 hr intervals over a single 24 hr span. Urines were pooled by using 20% of the total volume collected from each subject over a 3 hr collection span. The resulting 8 pools were analyzed for pH, specific gravity, osmolality, urea N, creatine, uric acid, glucose, phosphorus, chlorides, sodium, potassium, calcium, magnesium, silicon, aluminum, zinc and total solids. Each of the 8 pools was serially dialyzed at pH 7.35 against ammonium-barbituric acid buffer. The non-dialyzable portions were then re-analyzed for the remaining solids, sodium, potassium, calcium, magnesium, silicon, aluminum and zinc. Aliquots of the non-dialyzable fraction were examined by high performance liquid chromatography. Up to twelve discernable fractions were observed in each 3 hr urine by monitoring ultraviolet light absorbance at 280 nm wavelength. Range of change throughout the 24 hr (lowest to highest value) for most variables was 100% or more. In the eight 3 hr pooled urine samples, statistically-significant circadian variation could be described for volume, pH, osmolality, urea nitrogen, creatinine, uric acid, glucose, phosphorus, chlorides, for five of eight non-dialyzed (total) components (Na, K, Ca, Si and solids) and for five of twelve non-dialyzable solid fractions, as well as for total non-dialyzable solids. Single cosinor analysis resulted in description of a significant circadian rhythm in osmolality, urea nitrogen, creatinine, glucose, phosphorus, chlorides, total Na, K, Si and solids; non-dialyzable Si and solids; dialyzable Na, K, Si and solids; and for total solids, as well as their fractions at 23.4 and 25.9 min. These observations are furnished in order to further document the extreme circadian rhythmicity in all aspects of kidney function and as reference for future work which uses any of the investigated urinary endpoints whose circadian time structure is herein described.

Adult↗
PubMed1987

Complications of flexible fiberoptic sigmoidoscopy. A conceptual approach.

This paper presents an overview of the potential risks associated with the use of the flexible fiberoptic sigmoidoscope. A reasonable review of the literature on endoscopy reveals few instances of admitted complications. We draw upon a decade of personal observations and experience with over 10,000 examinations to substantiate the actual and potential hazards of flexible fiberoptic sigmoidoscopy. A conceptual approach to recognizing and avoiding the consequences of complications is presented.

Diagnostic Errors↗
PubMed1987

Frequency and adequacy of breast cancer screening among elderly Hispanic women.

Studies have demonstrated that Hispanic (relative to Anglo) women are at greater risk for late-stage breast cancer diagnosis. Screening irregularity may be a factor contributing to late-stage diagnosis, yet virtually nothing is known about the breast cancer-screening behavior of Hispanic women. We interviewed 600 elderly Hispanic women residing in Los Angeles to collect information on frequency of physician breast examinations and mammography and on regularity and competence of breast self-examination. Predictors of screening were also examined. Fifty percent of our sample indicated that they had had a breast exam within the past year; 12.5% had had a mammogram within the past year (74% never had had a mammogram); and 47% reported that they had performed breast self-examination within the past month. Few of the women were able to demonstrate adequate breast self-examination technique on a foam breast model, and only 1% found all five lumps present. Thus, although the observed frequency of screening and self-examination is comparable to national norms, it is unlikely that our subjects' attempts at self-examination would lead to early breast cancer detection. Age, educational level, emotional reactions to screening, and media cues predicted screening behavior. Physician instruction in breast self-examination increased the frequency and adequacy of self-examination. Perceived susceptibility to cancer, perceived benefits of early detection, and level of acculturation were not strong predictors. The extent to which our results generalize to other subpopulations of Hispanic women is discussed.

Aged↗
PubMed1987

Path model of multidimensional compliance with cancer therapy.

Patients newly diagnosed with hematologic malignancies were followed for a 6-month treatment period to assess compliance with three regimen requirements for cancer therapy: anti-neoplastic medication self-administered intermittently, supportive medication self-administered daily, and monthly clinic appointments. The effect on compliance of three intervention "packages" (some combination of education, shaping of pill-taking behavior, and home restructuring) and the extent that patient satisfaction, knowledge, and uncertainty about illness-related events mediated the effects of the interventions were also examined. Blood levels of the drugs and self-report measures indicated that compliance with daily pill taking was higher for each intervention group compared to a control group. Similar results were obtained for compliance with clinic appointments. No improvement in intermittent self-medication was found. Although each intervention package increased patient knowledge and satisfaction, path analyses demonstrated that knowledge did not affect any aspect of compliance, whereas satisfaction was associated with increased appointment keeping only. Daily pill taking was influenced directly by the behavioral components of the interventions. Uncertainty did not influence compliance but was associated with depression, which was negatively correlated with intermittent self-medication.

Administration, Oral↗
PubMed1987

Compliance with oral drug therapy in patients with hematologic malignancy.

Compliance with oral self-administered allopurinol (daily medication) and prednisone (intermittent medication) as well as compliance with monthly scheduled clinic appointments, were examined in 108 patients with newly diagnosed hematologic malignancy. Baseline levels of compliance (control group) were compared to results obtained after implementation of three intervention packages, whose aim was to increase compliance. The packages included combinations of education, home psychologic support and restructuring, and training in pill taking. A 24-hour profile of the two drugs and their metabolites was first determined. Serum samples were then obtained monthly over 6 months and analyzed for presence of the drugs. Control patients were fully compliant with allopurinol only 16.8% of the time. This rate increased significantly (44% to 48% of the time) for those who received any one of the intervention programs. With respect to prednisone, control patients were compliant 26.8% of the time, with no real improvement after interventions. Finally, self reports overestimated compliance by a factor of two when compared to drug analysis. The results indicated that full compliance with oral medications was remarkably low among our patients who have treatable and in some cases curable hematologic malignancy. However, compliance can be significantly improved by the use of various intervention packages.

Administration, Oral↗
PubMed1987

Health behavior of elderly Hispanic women: does cultural assimilation make a difference?

The role of cultural assimilation in Hispanic health behavior has received little empirical examination. Prior studies have operationalized assimilation primarily in terms of language preference and have obtained weak or no effects. We interviewed 603 elderly Hispanic women residing in Los Angeles to evaluate the usefulness of cultural factors as predictors of preventive health behavior (e.g., physical examination, screening for breast cancer) more rigorously. Factor analysis of responses yielded four dimensions of cultural assimilation: "language preference", "country of birth", "contact with homeland", and "attitudes about children's friends." After controlling for education and age, no dimension of assimilation associated strongly or consistently with health behavior. Of the four dimensions, use of English language associated most closely with increased screening, although most of the effects for language were small in magnitude. These findings, coupled with those of other studies, strongly suggest that cultural factors may have little impact on the health behavior of Hispanics. Access to and availability of services, affective reactions toward screening, and sociodemographic factors are stronger determinants of Hispanic health practices.

Aged↗
PubMed1986

Role of health locus of control beliefs and expectations of treatment efficacy in adjustment to cancer.

We examined the effects of health locus of control beliefs (self-, doctor, and chance control) and expectations of treatment efficacy on short-term psychological adjustment in a sample of newly diagnosed cancer patients. The role of these beliefs and expectations in moderating the relation between (perceived and actual) disease severity and depression was also examined. The data were collected within one week of diagnosis. The relation between perceptions of disease severity and depression was weaker for those who believed that they could personally control their health and for those who held positive expectations about the effects of complying with medical treatment. Similar patterns were found when disease severity was defined in terms of prognosis for survival. Strong negative correlations between self-control/treatment expectations and depression were found for those who perceived that their illness was very severe. The results for chance and doctor control were less consistent. The stability of health control beliefs and treatment expectations over the course of a serious long-term illness is discussed.

Adaptation, Psychological↗
PubMed1986

Endorectal sonographic prospective staging of rectal cancer.

Endorectal sonography was used to evaluate and prospectively stage rectal cancers in 59 patients. All patients were studied without knowledge of findings of other diagnostic studies, including sigmoidoscopic, computed tomographic (CT), and digital rectal examinations. Sonographic interpretation was established blindly and compared with CT and with pathological staging after surgery for the rectal cancer. Results demonstrate that endorectal sonography is more accurate in detecting the site of rectal cancer and in defining perirectal fat infiltration and perirectal lymph node involvement as compared with CT. The experience suggests endorectal sonography is a useful adjunct in the diagnosis and prospective staging of rectal cancer.

Adult↗
PubMed1986

[Centralized treatment of patients with stomach cancer].

An analysis of surgical results versus the specialization of medical establishments was carried out on the basis of 6,220 primary cases of stomach cancer registered in the GDR in 1976. Operability and radical resectability accounted for 56.0 and 21.0%, respectively. Postsurgical lethality was 20.6%. Relative and absolute 5-year survival were 24.7 and 5.1%. In the establishments of the first group (1-4 radical operations per year), operability and resectability were 53.7 and 13.2%; in the second group (5-19 radical operations per year) -65.2 and 28.2%, and in the third group (more than 20 radical operation per year) -80.9 and 38.5%, respectively. The following distinct differences in postoperative death rates versus patients' age and surgical procedure were obtained: after distal resection, postoperative mortality was 20.7 (group 1), 16.8 (group 2) and 10.1% (group 3), respectively. Priesching s index of efficacy based on long-term survival data was 35 (group 1), 6.8 (group 2) and 11.3 (group 3). Although not all the evidence elicited by the present study was statistically significant, it pointed to distinct tendency of better results being obtained at specialized establishments with a higher turnover of surgical cases.

Aged↗
PubMed1985

Results of adjuvant radiation therapy in cancer of the rectum. Thomas Jefferson University Hospital experience.

From 1972 to 1981, 174 patients with cancer of the rectum surgically staged as B2 or C disease, underwent surgical resection of the tumors for cure. Eighty-eight patients received surgery only with no further adjuvant therapy, and the remaining 86 patients were treated with a combination of radiation and surgery. Twenty-nine patients received low-dose preoperative radiation (500 rad in one fraction); 26 patients received postoperative radiation (4500 rad in 5 weeks); and 31 patients received combined low-dose preoperative radiation (500 rad) and postoperative radiation (4500 rad in 5 weeks). This experience was analyzed to determine the patterns of failure and the impact of adjuvant therapy on survival. Patients undergoing surgery alone had a 26% incidence of local failure in the pelvis and a 57% incidence of distant metastasis. Patients receiving low-dose preoperative radiation had a reduction in the rate of distant metastasis (24%), but no effect on local failure (34%). On the other hand, patients receiving postoperative radiation had a reduction in the local failure rate (11%), with no effect on distant metastasis (50%). Patients who received the combined preoperative and postoperative treatment had a reduction in both the local recurrence rate (7%), and the rate of distant metastasis (13%), and these patients also had a substantial improvement in survival over surgery alone. Survival of patients undergoing surgery alone was 34% at 5 years and was not substantially different for patients undergoing low-dose preoperative irradiation (48%), or for patients receiving postoperative irradiation (29%). Survival in patients receiving combined preoperative and postoperative irradiation was substantially better (78%) than the other groups of patients.

Humans↗
PubMed1985

Preoperative radiation therapy and sphincter preservation by the combined abdominotranssacral technique for selected rectal cancers.

In an attempt to reduce the incidence of local recurrence and maintain normal sphincteric function in selected patients treated for rectal cancer, a clinical experience using full dose preoperative radiation therapy and a combined abdominotranssacral technique was begun in 1976. The first 24 of 55 patients treated have now been followed for 20 to 84 months, the median follow-up period being 39 months; sufficient data related to their clinical courses are available for analysis. Cancers were selected on the basis of unfavorability and location in the rectum (3- and 7-cm levels). Clinical staging of the disease was accurate and allowed selection and treatment of only those cancers considered unfavorable (stages B2 and C), thereby avoiding unnecessary radiation of more favorable tumors. One anastomotic disruption required reconstruction, but perioperative complications were otherwise unremarkable. Local recurrence in this group of highly unfavorable cancers has not been observed. Normal and sphincteric function has been preserved in each instance. Preliminary results indicate that full dose preoperative radiation therapy for selected unfavorable and low level cancers permits safe and effective sphincter preservation surgery by the combined abdominotranssacral technique. When proper precautionary measures are observed, surgery can be conducted with the expectation of normal continence and significant reduction in local recurrence.

Adult↗
PubMed1985

Is dose/time fractionation important in treating rectal cancer?

In a study to evaluate the effect of increasing dose per fraction on radiation response in rectal cancer, two groups of 29 patients each, matched for extent and size of disease, were evaluated. Group A was treated with conventional dose/fraction (180-200 cGy) X 5 days/week and Group B was treated with 250 cGy/fraction X 4 days/week. Total dose was reduced by 10% in Group B patients to allow comparison of biologically equivalent doses. Two categories of patients were analyzed in each group: patients receiving planned high dose preoperative radiation (4000-4500 cGy); and patients receiving high dose radiation for post-surgical recurrent tumors or locally advanced inoperable tumors (5500-6000 cGy). Tumor regression was markedly better in patients treated with the 250 cGy/fraction. Overall response (greater than 50% regression) was 35% (10/29) in Group A and 62% (18/29) in Group B. Nine of 10 patients in Group B, treated preoperatively, had greater than 50% regression in tumor size, with two patients having no evidence of disease on surgico-pathological evaluation. Six of 10 similar patients in Group A had greater than 50% tumor regression.

Adenocarcinoma↗