PubMed Health⌕ Search

Biomedical subjects

J K Robinson

Publications and source records attributed to J K Robinson.

At least 55 records · Page 3Linked to original sources
PubMed1997

Effectiveness of a skin cancer control educational intervention for internal medicine housestaff and attending physicians.

OBJECTIVES: To evaluate the effects of a brief educational program on beliefs, knowledge, and behaviors related to skin cancer control among internal medicine housestaff and attending physicians. DESIGN: Randomised controlled trial. SETTING: Urban academic general medicine practice. PARTICIPANTS: Internal medicine housestaff and attending physicians with continuity clinics at the practice site. INTERVENTION: Two 1-hour educational seminars on skin cancer control conducted jointly by a general internist and a dermatologist. MEASUREMENTS AND MAIN RESULTS: Self-reported attitudes and beliefs about skin cancer control, ability to identify and make treatment decisions on 18 skin lesions, and knowledge of skin cancer risk factors were measured by a questionnaire before and after the teaching intervention. Exit surveys of patients at moderate to high risk of skin cancer were conducted 1 month before and 1 month after the intervention to measure physician skin cancer control practices reported by patients. Eighty-two physicians completed baseline questionnaires and were enrolled in the study, 46 in the intervention group and 36 in the control group. Twenty-five physicians attended both sessions, 11 attended one, and 10 attended neither. Postintervention, the percentage of physicians feeling adequately trained increased from 35% to 47% in the control group (p = .34) and from 37% to 57% in the intervention group (p = .06). Intervention physicians had an absolute mean improvement in their risk factor identification score of 6.7%, while control physicians' mean score was unchanged (p = .06). Intervention and control physicians had similar increases in their postintervention lesion identification and management scores. Postintervention, the mean proportion of patients per physician stating they were advised to watch their moles increased more among intervention physicians than control physicians (absolute difference of 19% vs -8%, p = .04). Other changes in behavior were not significant. CONCLUSIONS: Although we observed a few modest intervention effects, overall this brief skin cancer education intervention did not significantly affect primary care physicians' skin cancer control attitudes, beliefs, knowledge, or behaviors. A more intensive intervention with greater participation may be necessary to show a stronger impact on attitudes and knowledge about skin cancer control among primary care physicians.

Clinical Competence↗
PubMed1996

Galanin microinjected into the medial septum inhibits scopolamine-induced acetylcholine overflow in the rat ventral hippocampus.

Galanin-like immunoreactive terminals hyperinnervate the basal forebrain cholinergic neurons in Alzheimer's disease. To investigate the hypothesis that galanin acts directly on basal forebrain cell bodies, in vivo microdialysis studies were conducted in awake rats which analyzed the actions of galanin on acetylcholine release. Microinjection of galanin into the cholinergic cell body region of the medial septum-diagonal band (MS-DBB) inhibited acetylcholine release in the ventral hippocampus. These results are consistent with an interpretation that galanin terminals synapsing on cholinergic cell bodies of the basal forebrain may serve to inhibit the release of acetylcholine in the terminal fields of the cholinergic neurons.

Acetylcholine↗
PubMed1996

DNA ploidy in nonmelanoma skin cancer.

BACKGROUND: Patients with head and neck squamous cell carcinoma die of locoregional recurrence and those with basal cell carcinoma suffer cosmetic and functional changes from its treatment. Prognostic factors are based upon tumor characteristics and host factors. Flow cytometry can assist with prognostic characterization of nonmelanoma skin cancer. METHODS: Specimens from 40 sequential patients with head and neck nonmelanoma skin cancers were prospectively obtained at the time of surgery. The patients were followed for four years for local recurrence and metastasis to regional lymph nodes. Samples were prepared from frozen specimens using a modification of the Vindelov procedure. RESULTS: DNA aneuploidy or tetraploidy and histology of well differentiated squamous cell carcinoma were significantly associated with metastasis to regional lymph nodes. Direct extension of tumor below the adipose tissue was associated with an S-phase greater than 4.1 and a proliferative fraction greater than 5.5. No tumors recurred at the site of surgical resection. CONCLUSIONS: The measurement of DNA ploidy of well differentiated squamous cell carcinoma, and proliferative capacity or S-phase of both basal cell and squamous cell carcinomas assists in predicting the biologic proclivity for locoregional invasion or metastasis of nonmelanoma skin cancer. Identification of aggressive tumors at the time of surgery may offer the opportunity for prevention of lethal metastasis by using adjunctive therapy.

Adult↗
PubMed1996

Genital herpes: an integrated approach to management.

This review of epidemiologic, clinical, and psychosocial/psychobehavioral data related to genital herpes simplex virus infection details the increasing incidence of herpes simplex virus infection in the United States and summarizes the data regarding the safety and efficacy of chronic and acute antiviral therapy with acyclovir. It additionally establishes the validity of psychosocial intervention as an adjunct to pharmacologic therapy for patients with recurrent genital herpes.

Acyclovir↗
PubMed1996

Bowen's disease of the distal digit. Outcome of treatment with carbon dioxide laser vaporization.

BACKGROUND: Bowen's disease (squamous cell carcinoma in situ) is an intraepithelial neoplasm that can transform into invasive squamous cell carcinoma. The preferred method of eradication for Bowen's disease is surgical excision. However, when Bowen's disease occurs on the digit, surgical removal can lead to scar contracture and loss of use of the finger. OBJECTIVE: To assess the utility of carbon dioxide (CO2) laser vaporization in eradicating Bowen's disease of the finger while maintaining the full range of motion and use of the digit. METHODS: Five patients were treated with CO2 laser vaporization for Bowen's disease of the digit. Patients were followed postoperatively for recurrence, clinical appearance, especially for scar formation, and function of the involved joints over a 6-month to 3-year period. RESULTS: Four of five patients had no recurrence. Healing resulted in only modest alterations in the cosmetic appearance in comparison with the surrounding untreated skin. Posttreatment biopsy showed slight thinning of the epidermis and mild fibroplagia limited to the papillary dermis. Patients reported only mild post-procedure discomfort and no patients had any loss of function of the digit. CONCLUSIONS: CO2 laser vaporization may be a safe and effective means by which to eradicate Bowen's disease of the finger without the risk of scar contracture and loss of function of the digit.

Adult↗
PubMed1995

Comparative studies of transcytosis and assembly of secretory IgA in Madin-Darby canine kidney cells expressing human polymeric Ig receptor.

Epithelial transport of polymeric IgA (pIgA) from its site of synthesis to the mucosal lumen is mediated by the polymeric Ig receptor (pIgR). During transcytosis, a disulfide bond forms between pIgR and pIgA, resulting in secretion of a covalently linked complex. To dissect further the intracellular processing and functions of pIgR, we have expressed the entire coding sequence of human pIgR cDNA in Madin-Darby canine kidney (MDCK) cells. Cloned transfected cells express human pIgR, as detected by immunofluorescence and by quantification of the cleaved extracellular domain of pIgR in culture supernatants. The function of transfected pIgR was confirmed by measuring vectorial transcytosis of 125I-labeled pIgA and its disulfide bonding to pIgR. Species specificity of transcytosis was determined by comparing transport of human, rat, and mouse pIgA in MDCK cells expressing either human or rabbit pIgR. pIgA from all three species was transported by both human and rabbit pIgR, with rat pIgA being transported to the greatest extent in each case. However, disulfide bonding was observed only with human pIgR, and was found to occur mainly inside the cell. Our results suggest that conformational differences between human and rabbit pIgR may account for differences in disulfide bonding to pIgA, and show that efficient transcytosis of pIgA is correlated better with noncovalent than covalent binding to pIgR.

Animals↗
PubMed1995

Skin cancer risk and sun protection learning by helpers of patients with nonmelanoma skin cancer.

BACKGROUND: Knowledge-based skin cancer risk and prevention educational interventions by physicians and nurses were directed to subjects who had a nonmelanoma skin cancer. These high-risk patients asked relatives or friends to assist with postoperative care rendered after surgical removal of the skin cancer. The patient's experience with the nonmelanoma skin cancer was expected to raise the awareness of the helper. The study examined whether the patient became a source of information, risk assessment, and skills training for his or her helper. METHODS: Sequential patients between 30 and 60 years of age and their designated helpers completed a self-report questionnaire prior to the intervention and 1 year after the intervention. The questionnaire examined: (a) knowledge of skin cancer and sun protection; (b) individual susceptibility as determined by ease of sunburning or tanning; (c) attitudes about self-esteem, sun exposure, and health locus of control; (d) intentions to use sun protection; and (e) behaviors of sun protection used. RESULTS: Over the course of 1 year, 200 pairs were entered into the study. Both patients and helpers demonstrated an increase in knowledge after the educational intervention with the patients. There was a change in the self-reported intention to use sun protection and the behaviors of sun protection used in both patients and helpers after the intervention; however, there was no attitudinal change demonstrated in pre- and post-tests for either patients or helpers. Among both patients and helpers, gender-specific differences in attitudes, intentions, and behaviors existed. Women expressed a greater likelihood of taking precautions, including the use of sunblock; however, men reported the protective strategy of wearing a hat more than women did. Men valued a tan more than women and had greater outdoor exposure, which they restricted after the intervention. Women helpers ceased using indoor tanning devices after the intervention. Behavioral change in use of sun protection measures, including protective clothing or sunblock use and decrease in hours of outdoor sun exposure or use of indoor tanning devices, was dependent upon the patient or helper's own reported susceptibility as determined by his or her history of poor tanning and ease of sunburning. CONCLUSION: Patients transferred knowledge to their helpers. Intention to change behavior and behavioral change were strongly correlated with the individual's reported susceptibility to easy sunburning and poor tanning. Despite a lack of change in attitudes, changes in both intention to change behavior and behavior itself occurred in those who perceived themselves to be at risk. While the attitudes of participants in this study reflected popular beliefs, targeted education of high-risk adults with a nonmelanoma skin cancer caused changes in sun protection behaviors in both the patients and their helpers.

Adult↗
PubMed1995

Skin cancer control practices among physicians in a university general medicine practice.

Physician counseling about sun protection and routine screening for skin cancer in high-risk individuals have been widely recommended. The purpose of this study was to assess the skin cancer control practices and knowledge among physicians in a university-based general medicine practice. Fifty-two physicians completed a survey on attitudes toward, behaviors in, and knowledge of skin cancer control. In addition, the ability of general medicine residents and attending physicians to correctly identify and make biopsy recommendations for ten photographed skin lesions was compared with that of third-year medical students and dermatology residents and attendings. The results of the survey illustrate a need for improving primary care physicians' knowledge and identification of skin cancer risk factors, and increasing the frequency and consistency with which they perform skin cancer prevention counseling and complete skin examination in high-risk patient groups.

Counseling↗
PubMed1995

Socioeconomic status and attitudes of 51 patients with giant basal and squamous cell carcinoma and paired controls.

BACKGROUND: Giant nonmelanoma skin cancers are disfiguring and clearly visible. This prospective study examined tumor characteristics, ie, location, tumor type, duration, and the socioeconomic status and attitudinal characteristics of these patients and their interactions with the medical community. DESIGN: From 1979 through 1993, preoperative questionnaires about age, sex, tumor duration, prior treatment, socioeconomic status, and attitudinal concerns were completed by 51 patients with giant tumors and randomly matched controls. Additional data completed by the physician included tumor type, location, and preoperative clinically apparent diameter of the tumor. RESULTS: Giant tumors were more frequent on the scalp in men. Lower socioeconomic status and infrequent physician visits were characteristic of those with giant lesions. Those with giant lesions were less concerned about their general health, had a greater sense of shame about their appearance, had greater belief that since prior treatment did not help the problem then nothing else would, and had an increased frequency of perceived prior reassurance. Women and those younger than 65 years of both sexes were more concerned about economic costs and/or the time lost from work or caring for others. CONCLUSIONS: Health promotion by early detection and treatment of these nonmelanoma skin cancers in elderly men could prevent extensive surgical efforts later in the course of the disease. Skin screening examinations by all physicians and better public awareness of the signs of skin cancer, especially among elderly men, would enhance early detection; however, it is not clear that early detection by physicians enables treatment. Strategies to assist individuals in overcoming their barriers to accessing care need to be provided.

Adult↗
PubMed1994

Epithelial transcytosis of monomeric IgA and IgG cross-linked through antigen to polymeric IgA. A role for monomeric antibodies in the mucosal immune system.

We recently demonstrated that the polymeric IgR (pIgR) mediates epithelial transcytosis of immune complexes (IC) containing dimeric IgA (dIgA). In vivo, this "excretory" pathway could allow direct elimination of IgA IC at the mucosal sites where they are likely to form. In contrast, IC containing only monomeric IgA (mIgA) were not transported, consistent with the specificity of pIgR for polymeric IgA. However, the potential exists in vivo that monomeric Ig like mIgA or IgG could become associated through binding to multivalent Ag with IC containing dIgA, and that such mixed IC could act as ligands for pIgR. In the present work, using Madin-Darby canine kidney epithelial cells that express pIgR, we showed that 125I-labeled anti-DNP mIgA or IgG in the same IC with unlabeled dIgA antibody and DNP-BSA Ag was vectorially transported from the basolateral to the apical surface and then released. However, 125I-mIgA IC or 125I-IgG IC (without dIgA) and 125I-mIgA or 125I-IgG in the presence of dIgA antibody (but without Ag) were not transported, demonstrating the necessity for monomeric Ig to be in an IC with dIgA to be transported. Transcytosis of mixed mIgA/dIgA or IgG/dIgA IC was mediated by pIgR because no transport was observed in untransfected, wild-type Madin-Darby canine kidney cells lacking pIgR. The data demonstrate that mIgA and IgG can participate along with dIgA in the "excretory" pathway for local elimination of IgA IC, thus providing a means by which monomeric antibodies have the potential to participate in the mucosal immune system.

Animals↗
PubMed1994

Adjuvant radiotherapy after excision of cutaneous squamous cell carcinoma.

Most cutaneous squamous cell carcinomas (SCCs) of the trunk and extremities are small enough to be cured by simple surgical excision. Because the risk of metastasis of SCCs of the head and neck arising from mucosal surfaces is higher than the risk of metastasis of SCCs arising from cutaneous surfaces, it may be more appropriate to review case reports of the trunk and extremities separately from those of the head and neck when seeking prognostic indicators. A small group of advanced lesions, however, is more difficult to treat and has an increased risk of local recurrence or metastasis and a poorer prognosis. We describe a patient with high-risk cutaneous SCC who is disease-free 1 year after adjuvant radiotherapy subsequent to excision by Mohs micrographic surgery. This report discusses prognostic indicators of cutaneous SCC and suggests adjuvant modalities for the treatment of high-risk disease after surgical excision. Radiotherapy is a rational choice as adjuvant therapy for the treatment of high-risk cutaneous SCC after excision.

Aged↗
PubMed1994

Margin control for lentigo maligna.

BACKGROUND: Lentigo maligna is an in situ malignant melanoma for which the treatment of choice is surgical excision. The current recommendation is local resection with a 0.5 to 1.0 cm margin of normal skin. Because many lesions occur on the face, the narrowest possible margin reduces the amount of scarring. Controversy surrounds the use of Mohs micrographic surgery to preserve normal skin and resect the lentigo maligna. OBJECTIVE: The purposes of this prospective study were to determine the narrowest possible margin of resection of lentigo maligna and the accuracy of frozen and fixed histologic specimens from those margins. In addition, the benefit of adjunctive immunoperoxidase staining with antibodies to S-100 protein and HMB-45 monoclonal antibody was examined retrospectively. METHODS: A Wood's light was used to delineate the clinical margin in 16 cases of lentigo maligna that were resected with serial excisions 0.3, 0.6, 1.0, and 1.3 cm from the clinical border of the tumor. Frozen sections were confirmed by fixed histopathologic specimens. Subsequently these tissue blocks were examined with antibodies to S-100 protein and HMB-45 monoclonal antibodies. Patients were observed 5 to 9 years. RESULTS: One of the 16 patients had a recurrence 8 years after surgery. Although lesions with a diameter less than 2.0 cm had narrower margins of resection, the majority of lesions were resected with a margin of 0.6 to 1.0 cm. Lesions larger than 3.0 cm in diameter required a margin of resection greater than 1.0 cm. The antibody to S-100 protein was neither sensitive nor specific enough to assist with identification of the process. HMB-45 monoclonal antibody was sensitive and assisted in the identification of atypical melanocytes. CONCLUSION: The modifications of Mohs micrographic surgery including the use of fixed histopathologic specimens and the use of HMB-45 monoclonal antibody to help delineate atypical melanocytes offer the possibility of narrower margins of resection for lentigo maligna.

Aged↗
PubMed1994

Analysis of anatomical sites at which galanin impairs delayed nonmatching to sample in rats.

Galanin, a neuropeptide that coexists with acetylcholine in the septohippocampal pathway of the rat, impairs operant delayed nonmatching to sample (DNMTS) when administered intracerebroventricularly. Microinjection experiments were conducted to determine the anatomical site or sites at which galanin acts to disrupt DNMTS. Galanin (0.1, 0.4, or 1.6 nmol) was microinjected into the ventral hippocampus, amygdala, nucleus basalis magnocellularis, prefrontal cortex, or entorhinal cortex. Galanin disrupted DNMTS in a dose-dependent manner when microinjected into the ventral hippocampus but not at the other sites tested. These findings are consistent with the ability of galanin to inhibit physiological and biochemical actions of acetylcholine in the ventral hippocampus.

Acetylcholine↗
PubMed1993

Galanin antagonists block galanin-induced feeding in the hypothalamus and amygdala of the rat.

Galanin significantly increased food intake when microinjected into the region of the central nucleus of the amygdala as well as into the paraventricular nucleus of the hypothalamus. In the amygdala this effect was specific to feeding; no change in grooming, resting, or other behaviour was observed after galanin treatment. These results provide evidence that the amygdala may be an important site in the mediation of galanin-induced feeding. The galanin receptor antagonists, C7 and M40, antagonized galanin-induced feeding, while having no effect alone on food consumption in free-feeding rats. These new galanin receptor antagonists provide useful tools for further investigating the role of endogenous galanin in the regulation of feeding.

Amino Acid Sequence↗
PubMed1993

Galanin receptor antagonists M40 and C7 block galanin-induced feeding.

Two peptide antagonists of the galanin receptor, M40 (galanin[1-13]-Pro-Pro-[Ala-Leu]2-Ala amide) and C7 (galanin[1-13]-spantide amide), significantly inhibited galanin-induced consumption of a palatable wet cookie mash, when microinjected intraventricularly to satiated rats. Antagonists were effective at doses equimolar to or less than the active doses of galanin. Feeding induced by an overnight fast was not significantly different in rats microinjected with saline as compared to M40 or C7, at doses which inhibited galanin-induced feeding. The activity of the chimeric compound, C7, did not appear to be linked to the properties of its C-terminal spantide-like sequence, as C7 did not induce barrel rolling at doses which inhibited galanin-induced feeding. The IC50 for displacement of 125I-[Tyr26]-porcine galanin 1-29 binding in rat hypothalamic membranes was 15 nM for M40, and 0.2 nM for C7, as compared to 0.8 nM for unlabelled porcine galanin(1-29). These two structurally different galanin antagonists, both demonstrating antagonist activity in vivo in awake, behaving rats, provide promising tools for further analyses of the functional activity of galanin in the mammalian brain.

Amino Acid Sequence↗
PubMed1993

Anandamide, an endogenous ligand of the cannabinoid receptor, induces hypomotility and hypothermia in vivo in rodents.

Anandamide (arachidonylethanolamide), an arachidonic acid derivative isolated from the porcine brain, displays binding characteristics indicative of an endogenous ligand for the cannabinoid receptor. The functional activity of anandamide was tested in vivo using behavioral and physiological paradigms in laboratory rodents. At IP doses from 2 to 20 mg/kg in mice, anandamide significantly decreased spontaneous motor activity in a Digiscan open field. Rectal body temperature significantly decreased at doses of 10 and 20 mg/kg in rats. At doses from 0.03 to 30 mg/kg, anandamide had no significant effect on chow consumption in ad lib fed rats. Over the dose range of 2-20 mg/kg, anandamide did not show anxiolytic properties in the mouse light<-->dark exploration model of anxiety. Over the dose range of 0.3-3 mg/kg, anandamide had no effect on choice accuracy or session duration in the delayed nonmatching to sample memory task (DNMTS) in rats. These results demonstrate that anandamide has biological and behavioral effects in awake rodents, some of which are similar to the reported actions of THC.

Amides↗
PubMed1993

The role of galanin in cholinergically-mediated memory processes.

1. Galanin, a 29 amino-acid neuroactive peptide, has been shown to affect diverse processes throughout the nervous system and to coexist with several "classical" neurotransmitters, including norepinephrine, serotonin, and acetylcholine. 2. Galanin coexists with acetylcholine in neurons of the medial septum, diagonal band, and nucleus basalis of Meynert, cells which degenerate during the course of Alzheimer's disease. 3. In the ventral hippocampus, galanin inhibits the release of acetylcholine and inhibits carbachol stimulated phosphatidyl inositol hydrolysis. 4. Galanin impairs choice accuracy in learning and memory paradigms in rats, and is therefore hypothesized to be a contributory factor in the memory and cognitive disabilities found in Alzheimer's patients. 5. Newly developed galanin antagonists, by eliminating putative inhibitory effects of endogenous galanin on cholinergic function, may serve as useful therapies for memory disorders.

Animals↗