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Biomedical subjects

I I Kessler

Publications and source records attributed to I I Kessler.

At least 19 recordsLinked to original sources
PubMed1998

Teledermatology and in-person examinations: a comparison of patient and physician perceptions and diagnostic agreement.

OBJECTIVE: To compare physician and patient impressions and interphysician diagnostic agreement between live teledermatology and in-person examinations. DESIGN: Paired video and in-person examinations with different dermatologists. SETTING: An urban Veterans Affairs dermatology clinic. PATIENTS: One hundred thirty-nine patients. MAIN OUTCOME MEASURES: Satisfaction questionnaires and interphysician diagnostic agreement. RESULTS: Patient and physician satisfaction was high. Agreement between video and in-person diagnoses was 80%. CONCLUSIONS: Physicians and patients were satisfied with teledermatology examinations. Diagnostic agreement between in-person and video dermatologists was high.

Attitude of Health Personnel↗
PubMed1990

A community laboratory for studies on low-risk cancer agents.

This paper presents the concepts underlying the establishment of a community epidemiological laboratory that could serve the diverse needs of investigators worldwide who are involved in a variety of studies on low-risk lung cancer agents. The desiderata for selecting a specific geographically defined community are suggested together with a discussion of practical applications.

Environmental Exposure↗
PubMed1989

Predictors of rehabilitation outcome among patients with SCI.

Because rehabilitation medicine has undergone major changes with respect to patient management and case mix since 1980, it is important to determine whether the factors predictive of rehabilitation outcomes also have changed over time.

Activities of Daily Living↗
PubMed1987

Is diabetes mellitus a teratogen or a coteratogen?

The risk of major and minor congenital malformations was compared in the offspring of diabetic (n = 2,639) and nondiabetic (n = 2,144) women who delivered at the Johns Hopkins Hospital in Baltimore, Maryland, between January 1, 1946 and December 31, 1970. In spite of ample power, there was little evidence of an increased malformation risk in offspring born prior to the onset of overt diabetes in the mother. In offspring born after onset, the overall malformation risk was not increased, but severe multi-organ birth defects occurred at approximately twice the control group rate. It is postulated, therefore, that diabetes may act as a coteratogen enhancing the teratogenic effect of other insults but may not itself cause malformations. That some of its effects may be specific is suggested by the especially high risk of vertebral, lower limb, and urogenital defects, a pattern similar to that reported for the caudal dysgenesis syndrome. To better understand the teratogenic effects associated with diabetes, it may be necessary to consider interactions with other factors and to explore the association between maternal diabetes and caudal dysgenesis.

Adult↗
PubMed1987

Etiological concepts in cervical carcinogenesis.

Substantial progress has been made in elucidating the etiology and epidemiological distribution of cervix uteri cancers in women. Foremost among the advances is a clarification of the role of the herpes genitalis virus as a necessary, though not sufficient, causal factor. The epidemiological data in the United States confirm the essential role of exfoliative cytological screening in the successful control of this disease.

Age Factors↗
PubMed1986

Data sources for penetrating trauma.

Three city data sources (CDSs)--police reports, ambulance reports, and medica examiner (ME) logs--were evaluated for their usefulness in epidemiologic studies of trauma. The CDSs were employed to identify all cases of penetrating injury to the chest and/or abdomen severe enough to require care in a medical institution during 1979 and 1980 in Baltimore city. The percent of cases identified by source was: police, 66.8%; ambulance, 47.9%; ME, 16.6%; police plus ambulance, 89.4%; police plus ME, 82.9%; and ambulance plus ME, 50.1%. Hospital admissions to six study hospitals due to chest and/or abdomen penetrating injury were located and matched to the CDS reports: 89.2% of the hospitalized cases were reported in one or more CDS, and 34.7% of the cases identified by one or more CDS could not be located in the hospital records. Using hospital records as the standard, each source was determined to have the following completeness of case reporting: police, 66.2%; ambulance, 72.9%; and ME, 92.2%. The authors conclude that existing CDSs should be used with caution, and that the usefulness of data from multiple sources far outweighs that from any single source.

Abdominal Injuries↗
PubMed1985

Cigarette smoking and nasopharyngeal carcinoma.

A case-control study was undertaken to investigate possible etiologic factors in nasopharyngeal cancer, a rare tumor in the United States. Data from 39 nasopharyngeal cancer cases and the same number of matched controls showed significantly more cases born in Asia than controls, supporting the notion that exposure in early life has a prolonged carcinogenic effect. Cases also smoked significantly more cigarettes than controls, indicating a need for investigating the role of cigarette smoking and other exposures in the etiology of nasopharyngeal cancer in western countries.

Adolescent↗
PubMed1985

Epidemiology of cancer of the vulva. A case-control study.

Few epidemiologic studies have been undertaken to investigate the etiology of cancer of the vulva. To identify risk factors associated with this cancer, a case-control study was conducted in 149 patients with histologically proven vulvar carcinoma and the same number of control patients matched for age, race, marital status, and hospital from five U.S. metropolitan areas. As previously suspected, we found prior histories of leukoplakia of the vulva, inflammation of the vulva or vagina, and urogenital cancer to be significantly associated with vulvar cancer. In addition, we found moderately high odds ratios associated with occupational histories of private household maids and servants, and work in laundry, cleaning, and other garment services. A slightly increased odds ratio was associated with coffee consumption and a dose-response effect was demonstrated. The findings suggest that environmental exposures may play a role in vulvar carcinogenesis.

Adult↗
PubMed1985

Risk factors for male breast cancer.

To investigate risk factors in male breast cancer, a case-control study of 52 histologically diagnosed cases and 52 controls--matched for age, race, marital status, and hospital--was conducted in 5 U.S. metropolitan areas. Cases were significantly more likely to be Jewish than were the controls, supporting earlier suggestions of an increased risk in Jewish males. A significant association of male breast cancer with mumps infections at age 20 years or older, along with the possible association with antecedent testicular injury and the excess frequency of mumps orchitis among cases, suggests that testicular factors may be important in the development of breast cancer among males. An increased frequency of breast cancer among persons who have worked in blast furnaces, steel works, and rolling mills is of interest because of the possible testicular effect of high environmental temperatures. The observed association between breast cancer and a prior history of swollen breast is difficult to interpret because of potential recall bias, and a possible relationship with military service needs further confirmation.

Adult↗
PubMed1982

Assessment of hospital performance by use of death rates. A recent case history.

This article discusses an analytical approach for integrating hospital death rates. A study of patient mortality in four hospitals in a large metropolitan areas demonstrates the principles underlying this approach. One hospital, which experienced an annual crude death rate almost twice that of the other three, was suspected of providing an inferior quality of care. Case-mix differences among the hospitals introduced a serious bias, however, and were later taken into account. The patients' primary diagnosis was found to be the most important case-mix variable, with a potential for biasing death rate comparisons. After readjustment for case mix, the maximum difference in death rates among the four hospitals was reduced from 19 to four deaths per 1,000 patients. Further analysis of diagnosis-specific mortality supported the thesis that the observed mortality excess was largely attributable to patient referral patterns in the community.

Adolescent↗
PubMed1981

Viruses and gynecologic cancers: herpesvirus protein (ICP 10/AG-4), a cervical tumor antigen that fulfills the criteria for a marker of carcinogenicity.

The studies associating infections by herpes simplex virus type 2 (HSV-2) with carcinoma of the human uterine cervix are reviewed within the context of three possible interpretations. Extensive seroepidemiologic evidence indicates that the virus does not grow preferentially in neoplastic tissue, nor is the association of HSV-2 with cervical carcinoma a reflection of their independent relationship to promiscuity. While a number of infectious agents, including other viruses, are associated with cervical atypia, only HSV-2 is a significant risk factor for CIS. In vitro transformation data supporting the oncogenic potential of the virus are summarized, and evidence is presented that an antigen designated ICP 10/AG-4 is a valid candidate for the role of a virus-encoded protein involved in the maintenance of a transformed phenotype. Antibody to AG-4 is IgM, and it is detected by microquantitative complement fixation. With this assay, it is demonstrated that conversion to anti-AG-4 occurs during primary infection with HSV-2; however, it is transient. In testing 1325 patients, a correlation was observed between antibody to AG-4 and cervical carcinoma. Thus, whereas only 11.7% of controls and 7.7% of patients with cancer at other sites are AG-4 seropositive, as many as 49.6% of patients with dysplasia, 63% of those with CIS, and 72.7% of those with invasive cancer are positive for the antibody. Antibody to AG-4 is related to tumor growth. This is evidence by 1) retrospective analyses demonstrating that the proportion of AG-4 seropositive individuals is directly correlated to the state of the disease and 2) prospective study of 209 patients demonstrating loss of antibody in patients with a successfully removed tumor mass and reappearance of AG-4 antibody in cancer recurrence. The possible use of AG-4 (or its antibody) in the diagnosis and monitoring of cervical carcinoma and its treatment is discussed.

Antibodies, Neoplasm↗
PubMed1981

A multifactorial model for pancreatic cancer in man. Epidemiologic evidence.

In the past 30 years, the incidence of pancreatic cancer has increased substantially. The disease now causes more deaths than all other malignant neoplasms, except those of the colorectal region, lung, and breast. A study in over 115 hospitals in five metropolitan areas showed that males with pancreatic cancer were more often employed in the dry cleaning business or in occupations involving close exposure to gasoline, increasing the risk for pancreatic cancer up to five times. Females at risk for pancreatic cancer were more likely to smoke cigarettes, to have uterine myomas, and to have undergone oophorectomy or spontaneous abortions. Generally, these patients were of higher social class and drank more wine and decaffeinated coffee than demographically similar controls. Assessment of the effects of several factors showed that relative risks increased 34-fold among females and nearly sixfold among males. While no single factor accounts for the preponderance of pancreatic cancer, a combination of factors--each associated with a relatively small risk enhancement--may very well do so.

Adolescent↗