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Biomedical subjects

J A Singer

Publications and source records attributed to J A Singer.

At least 19 recordsLinked to original sources
PubMed1998

Racial identity of children in integrated, predominantly white, and black schools.

Fourth-grade children in three school settings (integrated, Black, and White) were assessed by 3 methods: the Draw-A-Person test, the spontaneous self-concept test, and the picture test. The effect of school's population on a child's racial identity was studied. The children in the integrated school setting mentioned race and ethnicity significantly more often than did children in either of the other two settings. The children from both the integrated and the predominantly White schools also chose more friends from the outgroup than did the children in the predominantly Black school. The children in the non-integrated schools disliked other races more. All groups chose their own race when asked to indicate which child looked most like them. Contrary to the research hypothesis, the children in the predominantly White school produced drawings that depicted their race more obviously than did children from either of the other schools.

Child↗
PubMed1998

Primary lymphoma of the thyroid.

Primary lymphoma is an uncommon malignancy of the thyroid, comprising between 0.6 and 5 per cent of thyroid cancers in most series. This report is presented because of a 10 per cent (6 of 60) incidence of this cancer at one institution. A short history of a rapidly enlarging neck mass often associated with dyspnea, difficulty swallowing, or voice change is the hallmark presentation of thyroid lymphoma. The majority of patients are women with a mean age in the 6th decade. Although fine-needle aspiration has become the procedure of choice for the diagnosis of a thyroid nodule, it has yielded mixed results with the presence of lymphoma. The majority of thyroid lymphomas are diffuse, large cell lesions of B-cell origin. Controversy remains as to the role of surgery in thyroid lymphomas. Within the improvement in results with the use of radiotherapy and chemotherapy alone or in combination, some authors have advocated relegating surgery to the role of diagnosis only. This can be accomplished by fine-needle aspiration, core biopsy, or open biopsy. Others have favored a more aggressive surgical approach, showing that the amount of residual disease after debulking procedures was directly correlated with local and distant recurrences. A lack of randomized prospective studies makes it difficult to resolve this issue. The rates of complications of surgery, including hypocalcemia and recurrent laryngeal nerve damage, are higher than for operations for other types of thyroid malignancy. Improved prognosis has been associated with the following factors: disease limited to the thyroid, the absence of dysphagia, primary mass less than 10 cm, tumors without necrosis, and tumors consisting of plasmacytomas.

Age Distribution↗
PubMed1998

Retrosternal goiter: a six-year institutional review.

Retrosternal goiter is defined as any goiter in which at least 50 per cent of the thyroid resides below the level of the thoracic inlet. The incidence of retrosternal goiter varies from 3 to 20 per cent with respect to thyroidectomy patients. A retrospective chart review from June 1991 to December 1997 found 232 thyroidectomies performed at our institution. Sixteen patients were found to have retrosternal goiters (6.9%). The mean age was 57.8 years (range, 34-92). All were of benign pathology. Symptoms included shortness of breath (68.8%), hoarseness (37.5%), dysphagia (31.3%), and superior vena cava obstruction (6.25%). Thirteen patients were female (81.3%). Fifteen patients had surgical intervention (93.8%). Total thyroidectomy was performed in nine cases (60%), whereas lobectomy was performed in six cases (40%). All treated patients had complete resolution of symptoms. A cervical incision alone was used in 13 cases (86.7%). Complications consisted of one postoperative pleural effusion and in one case a traumatic C5 nerve root compression occurred. There were no instances of long-term vocal cord paralysis or hypoparathyroidism. There was no perioperative mortality. In the majority of patients with retrosternal goiter, surgery can be done expeditiously through a cervical incision with minimal morbidity and mortality.

Adult↗
PubMed1995

Seeing one's self: locating narrative memory in a framework of personality.

Individuals confront the continuing challenge of attending to the competing demands of internal and external stimuli. The emerging I-Self applies three principles of evaluation, categorization, and subsidiation to organize these informational demands. These principles guide the development of the five systems of personality--cognition, affect, motivation, behavior, and psychophysiology. These systems interact to create various Me-Selves that comprise the different roles and contexts of the personality. Each Me-Self contains evaluations (valenced responses to self and others), categories (self- and other representations), and sequences in time (the self and others in past, present, and future). Narrative is the perceptual expression of a particular Me-Self in consciousness. Narrative memory allows for meaningful analysis by consciousness of specific Me-Selves and the cognitions, affects, and goals associated with those selves. Applications of this position to research and psychotherapy are discussed.

Affect↗
PubMed1994

Depression and memory narrative type.

Research with autobiographical memories has distinguished between memory narratives of specific events and summaries of many events blended together. Depression has been associated with a reduced ability to retrieve and orally relate specific positive memories. This study explored the hedonic bias in memory through collection of written autobiographical memories from 90 nonclinical college students whose mood was assessed for depression. Participants with higher depression scores recalled significantly more summary memories in response to a request for a positive self-defining memory than did participants with lower depression scores. There were no significant differences in the number of single-event and summary memories when participants were asked for a negative memory. We used J. A. Singer and K. H. Moffitt's (1991-1992) scoring system to distinguish between summarized and specific memory narratives.

Adolescent↗
PubMed1994

Laparoscopic cholecystectomy for acute or gangrenous cholecystitis.

Over the past 4 years, laparoscopy has become the preferred approach for cholecystectomy in the majority of patients. Most of the early articles described laparoscopic cholecystectomy for chronic cholecystitis or presented only a limited number of patients with an acute process. This paper reviews our experience with laparoscopic cholecystectomy for acute and gangrenous cholecystitis. There were 460 attempted laparoscopic cholecystectomies, including 44 for acute nongangrenous cholecystitis and 24 for gangrenous cholecystitis. The conversion rate to open cholecystectomy was 2.8 per cent for chronic cholecystitis, 13.6 per cent for acute, and 75 per cent for gangrenous cholecystitis. The length of operation for laparoscopic compared with open cholecystectomy for acute cholecystitis was not significantly different. For gangrenous cholecystitis, the laparoscopic approach took significantly longer than the open method. The length of stay for acute cholecystitis was significantly shorter for laparoscopy compared with the open method. There was no significant difference in length of stay for gangrenous cholecystitis. With a conversion rate of 75 per cent, no shorter length of stay, and a significantly longer operation, the use of the laparoscopic approach when gangrenous cholecystitis is suspected should be questioned.

Acute Disease↗
PubMed1993

Residual breast cancer at a distance from the primary tumor.

Excision of a primary breast cancer followed by irradiation is an accepted method of definitive treatment for stage I and II breast cancer. There is controversy as to the importance of tumor free margins and the presence of residual disease. This study prospectively evaluated 25 mastectomy specimens for residual tumor adjacent to and away from the primary biopsy site. Sixty per cent of the specimens contained residual tumor. In the patients with a primary diagnosis of infiltrating ductal cancer, 44 per cent had residual disease, whereas 100 per cent of patients with an intraductal component in addition to the infiltrating cancer had residual tumor. In one mastectomy specimen, tumor was present in nonadjacent areas of the breast even though there was no residual tumor close to the original biopsy site. This situation is an unusual finding.

Biopsy↗
PubMed1992

Axillary versus combined axillary and pectoral drainage after modified radical mastectomy.

Initial attempts to obliterate dead space and minimize fluid accumulation in patients after mastectomy using closed suction drainage, used insertion of a single axillary drain. Today, surgeons often insert two drains in the postoperative wound, one in the axilla and the other beneath the pectoral flaps. The current study was done to determine whether or not there is an advantage in using two drains rather than a single axillary drain after mastectomy. A randomized, clinical trial was conducted with 84 women undergoing modified radical mastectomy. Thirty-seven patients had one axillary drain and 47 had two drains placed postoperatively, one in the axilla and the other beneath the pectoral flaps. Follow-up results were obtained four weeks postoperatively for complication data, including seroma and hematoma formation, flap necrosis and infection. The average total drainage was 870.4 milliliters per patient in the group with one drain and 997.4 milliliters per patient in the group with two drains (p value not significant). The overall complication rate in the group with one drain was 35.0 percent compared with a rate of 31.9 percent for all complications observed in the group with two drains. These differences did not reach statistical significance. Comparing the frequency of each complication in the two groups again showed no significant difference. However, the data suggest a trend toward an increased incidence of flap necrosis in the group with two drains that used a drain beneath the pectoral flaps. Use of a single axillary drain after modified radical mastectomy seems to result in no increase in postoperative complications, is less costly and may assist in reducing the incidence of flap necrosis.

Adult↗
PubMed1992

Subtotal colectomy as a last resort for unrelenting, unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases.

A 7-year experience involving 12 cases of massive, unrelenting lower gastrointestinal hemorrhage is presented. In these patients, the bleeding could not be localized by multiple diagnostic modalities and was managed by blind subtotal colectomy. While the procedure was efficacious in arresting bleeding in all cases, a resultant mortality of four cases (33%) ensued. Morbidity among the survivors was significant. Only three patients (25%) survived without complications, which enabled an early discharge from the hospital. Diverticulosis was the most common cause (83%) of uncontrollable and preoperatively undiagnosed bleeding in this group of patients. These 12 cases of blind subtotal colectomy for massive lower gastrointestinal bleeding represent one of the larger series in the literature. These data are consistent with more recent reports that indicate that subtotal colectomy for lower gastrointestinal bleeding is an effective but a formidable procedure. This is contrary to the earlier published results.

Aged↗
PubMed1991

Frown incision for minimizing induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation.

A new technique, the frown incision, was developed and a series of 62 eyes with 6 mm and 7 mm incisions for intercapsular phacoemulsification and implantation of a 6 mm or 7 mm one-piece biconvex poly(methyl methacrylate) (PMMA) posterior chamber intraocular lens with single horizontal mattress suture closure was prospectively evaluated for induced astigmatism. A prior series of 34 eyes that had a similar procedure with 6 mm and 7 mm standard scleral pocket incisions closed with an infinity suture or a horizontal running single-knotted suture containing three loops was retrospectively reviewed and compared with the frown incision trial. Vector analysis calculations of diopters (D) of mean induced keratometric astigmatism for the frown incision versus the scleral pocket incision groups were 0.80 D versus 1.19 D (P = .0263) at one day; 0.74 D versus 1.03 D (P = .0547) at one week; 0.71 D versus 1.07 D (P = .0057) at four weeks; 0.84 D versus 1.15 D (P = .0072) at six months; 0.82 D versus 1.30 D (P = .0144) at one year. The frown incision group consistently had a lower standard deviation from the mean induced astigmatism than the scleral pocket incision group. Using regression analysis and Pearson product-moment correlations, the frown incision group had a higher degree of linear dependence of postoperative astigmatism on preoperative astigmatism. Recent modifications of the frown incision have reduced its chord length for insertion of any given optic size. Results suggest that the frown incision may provide many of the benefits of a 4 mm scleral pocket incision for flexible optic lenses.

Astigmatism↗
PubMed1987

Insulinoma and gastrinoma in Wermer's disease (MEN I).

The association of gastrin- and insulin-producing tumors of the pancreas is rare. In the 30 years' experience of Zollinger and others, of 40 patients with gastrinoma none had insulin-producing tumors. In contrast to patients with Zollinger-Ellison syndrome, of whom 15% to 26% are classified as having multiple endocrine neoplasias type I (MEN I), only 3% to 4% of patients with insulinomas have other endocrine neoplasms. Insulinomas in patients with MEN I are usually single tumors that usually can be cured with enucleation of the tumor. In contradistinction, gastrinomas in patients with MEN I are diffuse in nature and resection only rarely can be accomplished. Long-term management of gastric hypersecretion is best accomplished by H2-receptor antagonists. If the patient does not respond to H2-receptor antagonists or is unwilling to take the drug indefinitely, he or she will be a candidate for total gastrectomy.

Adenoma, Islet Cell↗
PubMed1987

Red blood cell homeostasis: recognition of distinct types of damaged homologous red blood cells by a mouse macrophage cell line.

The mouse macrophage (M phi) cell line IC-21 preferentially ingests a subpopulation of homologous red blood cells (MRBC) from normal mice. This subpopulation presumably bears the so-called transfusion lesion, a consequence of damage acquired during the drawing and processing of blood. To determine if all damaged MRBC were recognized by a common receptor site on IC-21 M phi, we prepared suspensions of MRBC damaged in vitro by treatment with tannic acid and compared the phagocytic uptake of these cells with those bearing the transfusion lesion. Trypsin treatment of IC-21 M phi rendered them unable to recognize MRBC bearing the transfusion lesion; but it had no effect on the uptake of tannic acid-damaged MRBC, showing that IC-21 M phi have separate recognition sites for these two populations of damaged MRBC.

Animals↗
PubMed1987

Diverticular disease of the cecum and ascending colon. A review of 881 cases.

A total of 881 cases of diverticula of cecum and the ascending colon were reviewed, including 30 new cases at the authors' institution. The average patient age was 43.6 years. The preoperative diagnosis was correct in only 7 per cent of the cases. Appendicitis accounted for 68 per cent of the preoperative diagnoses. Even at the time of surgery, the diagnosis was correct in only 58.7 per cent. Carcinoma was incorrectly diagnosed in 37.2 per cent. Operative procedures varied markedly. Diverticulectomy was performed in 28.2 per cent of the cases, 3.6 per cent had invagination of the diverticula, and 37.6 per cent had right hemicolectomy. The overall mortality rate was 2.5 per cent. The authors advocate local resection of the diverticulum, when possible, and a right hemicolectomy or segmental resection when the diagnosis is in doubt or when local resection or invagination will jeopardize the ileocecal valve or the blood supply to the intestine.

Adolescent↗
PubMed1987

Mesenteric cysts.

Mesenteric cysts continue to be of special interest because of their diverse presentation and the lack of definitive diagnostic tests. Nine patients with mesenteric cysts were treated at St. Agnes Hospital between 1973 and 1984. The most common location was in small bowel mesentery (67%) followed by the mesocolon (33%). The mesenteric cysts were incidental findings in four of the nine patients (45%). Enucleation was the treatment of choice in eight patients (88%), followed by right hemicolectomy in one patient. Two patients had complications, one wound infection and one urinary tract infection. Simple enucleation has proven to be adequate treatment in most instances. Large bowel resection may be necessary when mesenteric cysts are located in the mesocolon and enucleation is not feasible without compromising the blood supply to the adjacent bowel.

Adolescent↗
PubMed1986

Erythrocyte homeostasis: antibody-mediated recognition of the senescent state by macrophages.

We tested the hypothesis that the accumulation of bound autologous antibody on a "senescent epitope" identifies aged erythrocytes for phagocytic removal by macrophages. Erythrocytes were collected from mice maintained on a hypertransfusion protocol designed to yield cells of defined age. The mouse erythrocytes were assayed for the presence of bound antibody by measuring their susceptibility to ingestion by macrophages from mouse peritoneal exudates and by flow cytofluorometry. Both assays disclosed that only the oldest mouse erythrocytes bore detectable levels of antibody. Flow cytofluorometric analysis revealed that the frequency distribution of IgG isotypes bound to the cells reflected their levels in normal serum. Finally, treatment with trypsin abolished the ability of the macrophages to ingest erythrocytes aged in vivo. These findings support the hypothesis that antibody mediates the clearance of senescent mouse erythrocytes from the circulation and demonstrate that the presence of a trypsin-sensitive recognition structure on macrophages is an essential requirement in this homeostatic process.

Animals↗