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Biomedical subjects

J M Winter

Publications and source records attributed to J M Winter.

15 recordsLinked to original sources
PubMed2005

Thirty robotic adrenalectomies: a single institution's experience.

BACKGROUND: Robotic adrenalectomy is a minimally invasive alternative to traditional laparoscopic adrenalectomy. To date, only case reports and small series of robotic adrenalectomies have been reported. This study presents a single institution's series of 30 robotic adrenalectomies, and evaluates the procedure's safety, efficacy, and cost. METHODS: Thirty patients underwent robotic adrenalectomy at the Johns Hopkins Hospital between April 2001 and January 2004. Patient morbidity, hospital length of stay, operative time, and conversion rate to traditional laparoscopic or open surgery are presented. Improvement in operative time with surgeon experience is evaluated. Hospital charges are compared to charges for traditional laparoscopic and open adrenalectomies performed during the same time period. RESULTS: Median operative time was 185 min. Patient morbidity was 7%. There were no conversions to traditional laparoscopic or open surgery. The median hospital stay was 2 days. Operative time improved significantly by 3 min with each operation. Hospital charges for robotic adrenalectomy (12,977 dollars) were not significantly different than charges for traditional laparoscopic (11,599 dollars) or open adrenalectomy (14,600 dollars). CONCLUSIONS: Robotic adrenalectomy is a safe and effective alternative to traditional laparoscopic adrenalectomy.

Adrenalectomy↗
PubMed2000

Mutations in the protein kinase A R1alpha regulatory subunit cause familial cardiac myxomas and Carney complex.

Cardiac myxomas are benign mesenchymal tumors that can present as components of the human autosomal dominant disorder Carney complex. Syndromic cardiac myxomas are associated with spotty pigmentation of the skin and endocrinopathy. Our linkage analysis mapped a Carney complex gene defect to chromosome 17q24. We now demonstrate that the PRKAR1alpha gene encoding the R1alpha regulatory subunit of cAMP-dependent protein kinase A (PKA) maps to this chromosome 17q24 locus. Furthermore, we show that PRKAR1alpha frameshift mutations in three unrelated families result in haploinsufficiency of R1alpha and cause Carney complex. We did not detect any truncated R1alpha protein encoded by mutant PRKAR1alpha. Although cardiac tumorigenesis may require a second somatic mutation, DNA and protein analyses of an atrial myxoma resected from a Carney complex patient with a PRKAR1alpha deletion revealed that the myxoma cells retain both the wild-type and the mutant PRKAR1alpha alleles and that wild-type R1alpha protein is stably expressed. However, in this atrial myxoma, we did observe a reversal of the ratio of R1alpha to R2beta regulatory subunit protein, which may contribute to tumorigenesis. Further investigation will elucidate the cell-specific effects of PRKAR1alpha haploinsufficiency on PKA activity and the role of PKA in cardiac growth and differentiation.

Abnormalities, Multiple↗
PubMed1993

Benlate. A medical and scientific controversy.

Benlate, a fungicide, has been used for over 20 years in Florida to treat agricultural crops and ornamentals. In the past few years, there have been reports of crop damage and health effects from exposure. Physicians should be aware of research findings regarding these effects.

Benomyl↗
PubMed1992

Pesticide sensitivity registry. What doctors need to know.

Commercially used lawn and home pesticides may cause a variety of symptoms in sensitive individuals. To assist those individuals considered at risk, the Florida Department of Health and Rehabilitative Services (HRS) has developed a process of registering persons sensitive to pesticides, providing they submit certification of their sensitivity by a qualified medical specialist. Pesticide applicators are required by law to inform registered persons of pesticide application to a lawn or exterior foliage on properties contiguous with or adjacent to a registered person at least 24 hours prior to application of the pesticide.

Environmental Exposure↗
PubMed1983

Effective participation in cooperative clinical trials by an independent community organization. An NCOG Model.

The NCCP has established a model for community involvement in study group clinical trials, based on the use of independent community groups as participating entities. The structure and operation of the Sacramento, California demonstration project are presented. Evaluation of the NCOG small cell lung cancer study 2061 reveals that the data submitted by the community group equalled or exceeded university-generated and group-wide data for evaluability, response rate, survival, and quality control.

Clinical Trials as Topic↗
PubMed1978

Computer assisted instruction in the continuing education of health professionals.

The rapid increase in new knowledge in health care has resulted in the implementation of continuing education requirements for many health professions. Computer assisted instruction (CAI) is one means by which continuing education opportunities can be provided for health professionals. Three main classes of reasons for using CAI are enumerated and explored. The current status of the use of CAI in the continuing education of health professionals is explored. The four major problems facing the further development and expansion of CAI in the continuing education of health professionals are identified as: (1) developing learning materials, (2) proliferation of software and hardware, (3) cost and (4) accreditation of CAI programs. Possible solutions to these problems are explored.

Computer-Assisted Instruction↗