PubMed Health⌕ Search

Biomedical subjects

J M Holland

Publications and source records attributed to J M Holland.

At least 19 recordsLinked to original sources
PubMed2000

Prevention of local recurrence after surgical debulking of nodal and subcutaneous melanoma deposits by hypofractionated radiation.

BACKGROUND: Local recurrence (LR) after surgical debulking of nodal or subcutaneous melanoma deposits defeats the purpose of operation and may worsen prognosis if the procedure was performed for stage III disease. To decrease LR rates in this setting, we extended the previously described role of hypofractionated radiation for melanoma deposits of the neck to all situations where the patient was felt to be at high risk for postoperative relapse after resection of bulky disease. METHODS: Hypofractionated external beam radiation was administered in 6-Gy doses for 5 fractions (total dose 30 Gy, given over a median of 15 elapsed days) to 42 resected melanoma deposit sites in 41 patients. RESULTS: Stages of the 41 patients at the time of treatment were: 22 stage III and 19 stage IV. All patients had complete gross resection of disease at the radiation site before radiation. Mean time between operation and initiation of radiation was 4 weeks. The 42 sites of treatment included 27 neck, 9 axilla, 3 groin, and 3 subcutaneous deposits. There were no treatment-related deaths; side effects were minimal and self-limited. Transient erythema, desquamation, fibrosis, telangiectasias, and mucositis, parotiditis, and xerostomia (for head and neck radiation) were reported, but no patient required interruption of therapy for these events. Of the 42 treated sites, only 2 recurred in the treatment field (one neck, one axilla) during the mean follow-up time of 22.4 months, for a treatment failure rate of 4.8%. This represents improved local control compared with patients treated with surgery alone at our institution and with published recurrence rates. CONCLUSIONS: The addition of hypofractionated radiation therapy after resection of nodal and subcutaneous melanoma deposits at a variety of sites is a rapid and well-tolerated method of providing excellent local control.

Adult↗
PubMed2000

Cranial neuropathy following curative chemotherapy and radiotherapy for carcinoma of the nasopharynx.

Cranial nerve damage following head and neck radiotherapy is an unusual event. Cranial neuropathy following concurrent chemotherapy and radiotherapy is unreported. The authors report a case of a 54-year-old man treated with curative chemotherapy and radiotherapy for a stage III nasopharyngeal carcinoma who developed an unilateral hypoglossal nerve palsy five years after therapy. Follow-up examination and magnetic resonance imaging (MRI) show no evidence of recurrent disease. Hypoglossal nerve injury occurring after head and neck radiotherapy is an indirect effect due to progressive soft tissue fibrosis and loss of vascularity. This process develops over years leading to nerve entrapment and permanent damage. Cranial nerve palsies, including damage to the hypoglossal nerve, can develop years after therapy with no evidence of tumour recurrence. Chemotherapy and radiotherapy have improved progression-free and overall survival in advanced nasopharyngeal cancer. As more patients achieve long-term tumour control following chemotherapy and radiotherapy, we must be cognizant of potential late injury to cranial nerves.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Molecular detection of prostate epithelial cells from the surgical field and peripheral circulation during radical prostatectomy.

PURPOSE: Prostate cancer progression despite organ confined pathological assessment has been reported in a variable number of men after radical retropubic prostatectomy. To study this phenomenon, we used the prostate specific antigen (PSA) reverse transcriptase-polymerase chain reaction assay. MATERIALS AND METHODS: We prospectively assayed the peripheral venous blood before, during and after surgical manipulation as well as the intraoperative field blood for PSA reverse transcriptase-polymerase chain reaction-positive cells in 22 men undergoing radical retropubic prostatectomy. RESULTS: PSA reverse transcriptase-polymerase chain reaction-positive cells were identified in 20 of the 22 operative field samples (91%) and 4 of 16 (25%) had evidence of intraoperative hematogenous dissemination (p = 0.046). No significant association was identified among Gleason score, pathological stage and the PSA reverse transcriptase-polymerase chain reaction result. CONCLUSIONS: Our results suggest that tumor cell spillage and less frequently hematogenous dissemination may be associated with operative manipulation of the prostate during radical retropubic prostatectomy and may potentially represent mechanisms of failure after radical retropubic prostatectomy.

Adenocarcinoma↗
PubMed1995

Service coordinators in senior housing. An exploration of an emerging role in long-term care.

The evolving role of service coordinators in federally subsidized senior housing offers a new opportunity to enhance service delivery to older adults who are aging in place. Senior housing occupies an unrecognized but important niche in the long-term care continuum. The Department of Housing and Urban Development has acknowledged the need for housing-based social services by developing and funding service coordinator positions. Efforts by visionary agencies have demonstrated that an on-site social service professional improves access to needed supportive services and assists housing staff to understand age-related issues. Although the need and efficacy of housing-based services have been substantiated, the day-to-day practice has not been widely examined. This article offers a description of the unique dynamics of providing social services in a housing setting, based on the experiences of service coordinators in the San Francisco Bay area.

Aged↗
PubMed1994

Phantom orchalgia.

Chronic scrotal pain is most commonly explained by the radiculitis that is caused by low back strain. The diagnosis is made chiefly by taking a careful history and by excluding other causes. Treatment directed to relieve sensory nerve root irritation at the T10 to L1 levels is often successful.

Afferent Pathways↗
PubMed1994

Emergency department patterns in psychiatric visits during the holiday season.

STUDY OBJECTIVE: To determine the prevalence of psychopathology during the holiday season and which subpopulations are at greatest risk for holiday decompensation. DESIGN: A retrospective analysis of emergency department records. SETTING: ED of a university-affiliated hospital located in a mixed urban-agricultural catchment area in North Carolina. PARTICIPANTS: Eight thousand seven hundred fifty-six patient visits to the ED, with subsequent triage for psychiatric evaluation, for a 6-year period (1987 to 1993), were analyzed. RESULTS: We observed seasonal patterns in visits, with a general decrease in visits preceding holidays followed by an increase afterward. Substance abusers, men, and black patients were more likely to visit the ED than expected, particularly during the weeks surrounding Christmas. CONCLUSION: These results support the existence of a "Christmas effect" on ED visitations by patients with psychiatric symptoms. Understanding of these patterns may help emergency physicians predict the seasonal variation of such patient visits and apply preventive measures accordingly.

Emergency Service, Hospital↗
PubMed1994

Tolerance of patients with human immunodeficiency virus and anal carcinoma to treatment with combined chemotherapy and radiation therapy.

PURPOSE: To evaluate treatment tolerance in patients with and without the human immunodeficiency virus (HIV) who were undergoing treatment of anal cancer. MATERIALS AND METHODS: The authors retrospectively reviewed the medical records of 62 patients with anal cancer who received radiation treatment. Seven patients had HIV, four of whom had acquired immunodeficiency syndrome. Fifty-five patients were HIV negative, including 11 patients identified as being at high risk for HIV infection whose status was unknown. RESULTS: Thirty of the 55 (55%) patients who were HIV negative required treatment breaks of a mean duration of 16.7 days. Four of those 55 (7%) patients required hospitalization. Three of 42 (7%) patients who were HIV negative receiving chemotherapy required chemotherapy dose reduction. All seven patients with HIV required treatment breaks of a mean duration of 21.7 days. Three of the seven (43%) patients required hospitalization. Four of the seven (57%) patients required chemotherapy dose reduction. CONCLUSION: Patients with HIV undergoing treatment of anal cancer have increased toxic reactions to chemoradiation. Treatment must be individually tailored on the basis of extent of disease and degree of compromise of the immune system.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Extragonadal seminoma involving urinary bladder and arising in the prostate.

The authors report the first instance of a patient with seminoma probably arising from the prostate but also involving the bladder. A 58-year-old man presented with symptoms and signs of prostatic enlargement. Cystoscopy revealed a fungating neoplasm, probably arising from the prostate and surrounding the bladder neck. The biopsy was consistent with the diagnosis of seminoma. The patient experienced complete remission after chemotherapy with bleomycin, cisplatin, and etoposide.

Diagnosis, Differential↗
PubMed1990

Effects of irradiation on nuclear protein synthesis in G2 phase of the cell cycle.

A method was developed to determine the synthesis of nuclear proteins throughout the cell cycle which was resolved into six compartments on the basis of DNA and nuclear protein content (i.e., early and late G1, early and late S, etc). Using this technique cell-cycle-specific synthesis of certain nuclear proteins was observed. Of particular interest was a 170-kDa protein(s) whose synthesis was initiated in early S phase and reached a maximum rate in late G2. Following irradiation with 6.8 Gy of 137Cs gamma rays the synthesis of the 170-kDa protein(s) declined in the G2 population with near total inhibition seen by 24 h. Synthesis of the 170-kDa protein(s) appeared to be slightly enhanced, and the postirradiation inhibition of its synthesis was reversed, in the presence of 3 mM caffeine. Also, the synthesis of 55-kDa nuclear protein(s) was stimulated throughout the cell cycle in the presence of 3 mM caffeine. These observations suggest new possibilities regarding the mechanism of the X-ray-induced G2 block and its reversal by caffeine. However, the exact role of these nuclear proteins in cellular events remains to be ascertained.

Caffeine↗
PubMed1989

Minoxidil stimulates mouse vibrissae follicles in organ culture.

Minoxidil, a potent vasodilator, stimulates the growth of terminal hair from vellus or miniaturized follicles in balding scalp. To study minoxidil's action on isolated follicles we developed and validated an organ culture system using mouse whisker follicles. Control follicles cultured without minoxidil showed macroscopic changes including kinking of the hair shafts and bending of the follicles. Necrosis was evident in the differentiating epithelial elements forming the cuticle, cortex, and inner root sheath. These abnormalities were eliminated or greatly reduced in minoxidil-treated follicles. The morphology of these follicles was consistent with the production of new hair during culture. Direct measurement demonstrated that minoxidil-treated follicles grew significantly longer than control follicles during the 3-d culture. Minoxidil increased the incorporation of radiolabeled cysteine and glycine in follicles compared with control treatment. Doses of minoxidil up to 1 mM caused increased cysteine incorporation, while higher doses were inhibitory. Experiments with labeled thymidine indicated that minoxidil induced proliferation of hair epithelial cells near the base of the follicle. Autoradiography also showed that cysteine accumulated in the keratogenous zone above the dermal papilla. These studies demonstrate that organ cultured follicles are suitable for determining minoxidil's mechanism of action and may be useful for studying other aspects of hair biology. The results also show that minoxidil's effect on hair follicles is direct. This suggests that minoxidil's action in vivo includes more than just increasing blood flow to hair follicles.

Animals↗
PubMed1989

Comparative effects of caffeine on radiation- and heat-induced alterations in cell cycle progression.

The effects of 3 mM caffeine on cell cycle progression of HeLa S3 cells exponentially and asynchronously growing in suspension culture were studied following exposure to 6.8 Gy gamma irradiation or 30 min at 45 degrees C hyperthermia. The stathmokinetic method, in which cells are grown in the presence of colcemid for the duration of experiment, in combination with two flow cytometric techniques, propidium iodide staining of DNA and acridine orange staining following acid denaturation of chromatin, were used to determine the fraction of cells in four cell cycle compartments, G1, S, G2, and M. Radiation and caffeine acted in a complementary manner, in which radiation reduced the caffeine-induced delays in cell cycle progression and caffeine prevented completely the radiation-induced accumulation of cells in G2 and mitotic delay. Heat and caffeine had additive effects on alterations in cell cycle progression. Cells containing spontaneous prematurely condensed chromatin were observed transiently immediately following heat exposure. These cells appeared to be in G2 and late S phase.

Caffeine↗
PubMed1988

Prostatic aspiration biopsy: an assessment of accuracy based on long-term observations.

We present the results of transrectal thin needle aspiration biopsy of the prostate in 133 patients. Test specificity was 94 per cent and sensitivity also appeared to be high initially. However, with repeated rectal examinations and biopsies during an 11-year period a number of additional false negatives became apparent, which resulted in an apparent test sensitivity of 82 per cent, lower than most previously published reports. Our data suggest that aspiration biopsy has specificity and sensitivity similar to core biopsy, it is important to re-test patients who have a palpable abnormality and an initially benign biopsy, and aspiration biopsy simplicity allows for a low threshold of suspicion of subtle abnormalities and for repeating biopsies after negative findings.

Biopsy, Needle↗
PubMed1985

Reduction in prostatic concentration of endogenous dihydrotestosterone in rats by hyperprolactinemia.

Persistently high levels of circulating prolactin can be achieved in male rats when pituitaries from female donors are grafted under the renal capsule. Enhanced growth of the lateral prostate can be accomplished by an apparent synergistic effect of excess prolactin with subphysiologic doses of testosterone. To define this effect we measured the endogenous dihydrotestosterone (DHT) concentrations in rat prostate lobes. Twenty Sprague-Dawley male rats (250 g) were castrated and given subcutaneous implants of silastic tubing filled with 1 cm of crystalline testosterone. Ten of these rats simultaneously received two pituitary grafts under the renal capsule. The remaining ten rats received intrarenal skeletal muscle grafts as controls. Four weeks later, the weight (mg +/- SE) of the ventral and dorsal lobes were not significantly different between the two groups, while the lateral lobe was significantly (P less than 0.01) heavier in rats with pituitary grafts (121.4 +/- 7.5) than in controls (81.7 +/- 10.4). Endogenous DHT in the tissue extracts was determined by radioimmunoassay following KMnO4 treatment to eliminate testosterone. The concentration of DHT (ng/g tissue +/- SE) was significantly (P less than 0.01) lower in the lateral prostate of graft-bearing animals (4.40 +/- 0.29) than in the controls (5.98 +/- 0.34). These results indicate that, in the rat, hyperprolactinemia induced by pituitary grafts is associated with a heavier lateral prostate and a lower concentration of endogenous DHT in that tissue. These results also suggest that the action of prolactin in the rat prostate is not mediated through the action of androgen.

Animals↗
PubMed1985

Epidural hematoma as a cause of postpneumonectomy paraplegia.

Postpneumonectomy paraplegia developed in a woman admitted for resection of bronchogenic carcinoma. Postpneumonectomy paraplegia is an uncommon, but catastrophic, event that is thought to be caused primarily by ischemia to the spinal cord; in this instance an epidural hematoma was the cause. Recommendations for prevention are presented.

Carcinoma, Squamous Cell↗
PubMed1985

Accidental and homicidal death in a psychiatric emergency room population.

To identify potentially preventable mortality other than suicide among psychiatric emergency room patients, the authors compared the rates of accidental and homicidal death among 5,284 consecutive psychiatric emergency room patients with those expected for an age-, sex-, and race-matched sample of the general population. The rate of accidental death was two and one-half times and the rate of homicidal death nearly twice the expected rate for the matched general population. Diagnostic and demographic analyses indicated that increased risk of death from either cause was highest among alcoholics, schizophrenic patients, and males. The implications of the findings for clinical care are discussed.

Accidents↗
PubMed1985

Prescribing practices among nurse practitioners in adult and family health.

Data derived through log recordings of 89 nurse practitioners (NPs) in adult/family practice on 7,086 prescriptions issued during 890 clinical days were analyzed to describe prescribing practices of NPs who held prescriptive authority from the licensing regulatory boards of five western states. Results showed drug utilization to be similar to physician prescribing data, and intensity of prescribing to be less than that of physicians. The distributions of prescriptions by drug category and in relation to health problems underlying prescriptions are reported. Confidence with prescribing by type of drugs was parallel to incidence of prescriptions within drug category. Physician consultation prior to prescribing occurred with highest incidence for health problems treated with least frequently prescribed drugs. Physician consultation or referral was reported for 14.3 per cent of prescriptions.

Consumer Behavior↗