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Biomedical subjects

L D Roi

Publications and source records attributed to L D Roi.

At least 19 recordsLinked to original sources

Obstetric ultrasound training for family physicians. Results from a multi-site study.

A practical program to train family physicians in obstetric ultrasound was tested with 13 family physicians. Each physician completed 6.5 days of course work and ultrasound laboratory apprenticeship prior to beginning a clinical preceptorship of approximately 14 months' duration. During the clinical preceptorship the physicians performed ultrasound studies in their own offices. All studies were reviewed by a local consultant radiologist utilizing examination data sheets and videotapes. At the conclusion of the training program, the physicians took a combined practical and written proficiency examination administered by an independent sonographer. Eight physicians completed the training, performing during the preceptorship an average of 78 examinations. The rated performance of the physicians improved markedly over the course of the preceptorship. During the last segment of the preceptorship the radiologist preceptors rated 94 percent of the ultrasound studies as acceptable, compared with 79 percent rated acceptable at the beginning of the preceptorship. Seven of the eight physicians completing the protocol took the proficiency examination: all passed. This study can provide a blueprint for an individual family physician to design his own training, or it can guide an academic department of family medicine in developing and evaluating ultrasound training programs for residents and practicing physicians.

Education, Medical, Continuing↗

Needle aspiration and core biopsy of prostate cancer: comparative evaluation with biplanar transrectal US guidance.

Biplanar, transrectal ultrasound (US) guidance of needles was used in the transperineal biopsy of possibly malignant prostatic lesions in 80 patients (83 biopsies). A 22-gauge cytologic needle was used to locate and fixate the lesion, and aspiration specimens for cytologic and histologic evaluation were obtained (with 22- and 14-gauge needles, respectively). Twenty-one 19-gauge needle core biopsies were also performed. Forty-nine patients (61%) had histologically prove adenocarcinoma. The rate of cancer diagnosis was 53% with cytologic evaluation and 54% with histologic evaluation (combined yield, 61%). This included 34% of cancers less than 1.0 cm in diameter and 56% of those 1.0-1.5 cm. Thirteen of 23 (57%) of these lesions were nonpalpable or equivocal on digital rectal examination. These results suggest that transrectal US guidance of thin-needle biopsies is useful in diagnosing early prostate cancer.

Adenocarcinoma↗

A placebo-controlled, double-blind trial of erythromycin in adults with acute bronchitis.

Sixty-three otherwise healthy adults with acute productive cough and no clinical evidence of pneumonia were randomized to receive a ten-day course of erythromycin or placebo. Fifty-seven of these patients returned completed symptom diaries or returned for a two-week follow-up visit. Patients treated with erythromycin reported a more rapid improvement in subjective ratings of cold symptoms, general health, sputum production, and a mean symptom score. Fewer patients in the erythromycin group required cough or cold medications or were congested by day 10 (P less than .05). The treatment group was also less likely to have purulent sputum (9 percent vs 36 percent, P less than .05) and abnormal lung examinations (0 percent vs 29 percent, P less than .01) at a two-week follow-up visit. These results support the use of erythromycin in acute bronchitis.

Acute Disease↗

Medical care and demographic characteristics of 'difficult' patients.

This pilot study describes the medical care and demographic characteristics of "difficult" patients as compared with randomly selected patients of a community-based family practice center. Ninety-two difficult patients were identified by asking physicians to indicate those patients whose care they considered difficult. Charts of 166 randomly selected patients were then compared with those of the difficult patients. The difficult patient group was older, more often divorced or widowed, and had a higher percentage of women than the random patient group. The difficult patient group also had more acute problems, chronic problems, medications, x-ray examinations, blood tests, physician referrals, and visits to the family practice center. After covariance analysis adjusting for age and sex, significant differences remained between the two groups for chronic problems, blood tests, medications, and visits to the family practice center. The two patient groups did not differ significantly in household composition, payment status, or provider continuity. The data suggest that, although there are different types of difficult patients, there may be certain medical and demographic features that are common to many of them. Many physicians suspect that difficult patients suffer from a "thick-chart syndrome," a syndrome confirmed to exist by this study.

Adult↗

Effects of peptides and steroid hormones on cell kinetic parameters of normal human breast tissue in organ culture.

Several studies have shown the importance of different hormones in the regulation of mammary tissue growth. The use of organ culture techniques has shown tremendous value for the knowledge of cell proliferation in human breast tissue. Therefore, the purpose of these studies was to analyze the length of the cell cycle, DNA-labeling index, mitotic index, and growth fraction under the effects of insulin, hydrocortisone, and 17-beta estradiol in 5-d organ culture. Normal tissues obtained from patients who underwent breast surgery for benign lesions were individually cultured at 37 degrees C (95% air: 5% CO2 in Medium 199). Autoradiographic studies indicated that the hormones shortened the length of cell cycle of normal breast tissue in 5-d organ cultures. From the growth fraction studies we concluded that the hormones may have stimulated the cells to reenter the cell cycle from Go because these values were increased by the hormones used. Estrogen can alter the S phase duration with a consequent increase in the rate of DNA synthesis which may explain the high DNA-labeling index observed in the present studies.

Adult↗

The effect of angiotensin II on human mononuclear cell reactivity: suppression of PHA-P-induced thymidine incorporation.

Recent evidence suggests that angiotensin II may participate in the regulation of inflammation. We therefore studied the effects of angiotension II on human peripheral blood mononuclear cell reactivity. Peripheral blood mononuclear cell suspensions stimulated with PHA-P revealed decreased thymidine incorporation when simultaneously cultured for 48 or 72 hours with angiotensin II. Experiments were next conducted to determine whether angiotensin II acted directly on lymphocytes. Complete monocyte depletion (greater than 99.5%) resulted in low PHA-P-induced reactivity which was still inhibited by the addition of angiotensin II. Purified (greater than 99.5%) lymphocytes incubated with angiotensin II prior to reconstitution of mixed mononuclear cell suspensions led to reduced PHA-P-stimulated thymidine incorporation. These findings suggest that angiotensin II can effect mononuclear cell uptake possibly through actions on the lymphocyte population.

Adult↗

Captopril enhances in vitro human lymphocyte thymidine incorporation.

Angiotensin-converting enzyme activity is present in human sarcoid as well as murine schistosome granulomas. Inhibition of angiotensin-converting enzyme by captopril results in decreased granuloma size in animals. Since captopril is used clinically to treat hypertension, its effect on human lymphocyte thymidine incorporation was determined. It was found that 5 X 10(-5) M and 10(-4) M captopril enhances lymphocyte thymidine uptake induced by 25 micrograms/ml phytohaemagglutinin-P. This suggests that captopril can alter immunological reactivity in man and that angiotensin-converting enzyme may have an immunological function.

Captopril↗

Mortality differences and speed of wound closure among specialized burn care facilities.

Burn patient mortality rates at 11 major American burn care units were investigated and were found to differ substantially after carefully adjusting for patient mix at each participating burn facility. The adjusted mortality rates differed by as much as a factor of two. Institution speed of full-thickness burn wound closure was found to be significantly associated with mortality experience, with lower mortality associated with quicker wound closure. The data analyzed were from the National Burn Information Exchange (12,000 cases).

Adolescent↗

Peripheral lymphocyte and eosinophil counts as indicators of prognosis in primary breast cancer.

As a part of a major study on the pathophysiologic indices for recurrence of human breast cancer, preoperative eosinophil and lymphocyte counts were determined on 419 and 581 primary breast cancer patients, respectively. Patients with lymphocyte counts less than or equal to 1500/mm3 and/or eosinophil counts of less than 55/mm3 had significantly higher risk of recurrent disease than those patients who had normal or high levels of eosinophils and/or lymphocytes. These findings may indicate that the immunologic activities of eosinophils and lymphocytes enhance the patients' ability to respond against disease.

Adult↗

Interrupted pregnancy as an indicator of poor prognosis in T1, 2, N0, M0 primary breast cancer.

We examined the records of women with primary breast cancer for a history of pregnancy and live births. The patients were all histopathologic T1, 2, N0, M0 white females, untreated post modified radical mastectomy. Patients with a history of interrupted pregnancies have a significantly shorter time to recurrence than those with normal pregnancy history. A trend toward a lower incidence of highly differentiated histological pattern is also observed in cancers from these patients.

Abortion, Spontaneous↗

Methods of cancer case selection: implications for research.

The race, age, and sex differences between clinically and microscopically diagnosed cancer cases for a total of 63,301 incident cases for 18 sites are reported. The cases, diagnosed during 1973-1978, were drawn from the Cancer Surveillance Section in the Division of Epidemiology at the Michigan Cancer Foundation in Detroit, a participant in the Surveillance, Epidemiology, and End Results (SEER) program. Although microscopically diagnosed cases and those diagnosed by other methods differed by race and sex for a few sites, the two case groups differed by age for 15 of the 18 sites examined. Cases without microscopic diagnoses (i.e., clinical diagnoses) tended to be older than microscopically confirmed cases. These findings indicate that in studies of certain cancer sites, the method of case selection could affect results pertaining to age differences in exposure to and effects of relevant risk factors.

Adolescent↗

Two new burn severity indices.

Two new severity indices for burned patients based on the combined experience of 11,200 patients in 12 major U.S. burn centers are presented. Each index estimates the risk of death utilizing the patient's age, sex, size of burn, perineum involvement, and time from burn to admission, and is suitable for use with patients admitted within 2 weeks of the burn. The two indices differ in the specificity of the burn size information used. The first index utilizes only the per cent of total body surface burned. The second index, in addition, uses the amount of full-thickness burn. The more detailed index provides a somewhat more accurate estimate and may be used if an adequate estimate of the area of full-thickness burn is available. Applications include patient prognosis estimation and retrospective evaluation of new treatments. Methods for the computation and use of both indices are described together with illustrative examples.

Age Factors↗

Comparison of cultures of human lymphocytes obtained following NH4Cl induced red blood cell lysis and Ficoll-Hypaque density gradient centrifugation.

Lymphocyte thymidine uptake in leucocytes prepared by NH4Cl induced RBC lysis was compared with that of lymphocytes obtained following Ficoll-Hypaque centrifugation using polynomial regression dose response curves which adjusted for inherent subject variability. Eleven male subjects were studied. Heparinized blood was either layered in Ficoll-Hypaque or treated with 0.87% NH4Cl to induce RBC lysis. Phytohemagglutinin-P (PHA) dose response curves were determined for each subject using triplicate 5 day cultures. For each subject, at each Pha concentration ranging from 12.5 to 167micrograms/ml, triplicate mean cpm of Ficoll-Hypaque treated lymphocytes and NH4Cl treated lymphocytes were compared by the 2 tailed Student's T test. Responses of cultures of NH4Cl treated lymphocytes were significantly different (less than 0.05) from the responses of cultures of Ficoll-Hypaque treated lymphocytes for at least 2 PHA doses in 8 of the 11 subjects. The quadratic dose response curves were also significantly different (p less than 0.05) for 9 of the 11 subjects. A repeated measures quadratic regression was used to determine the best fit dose response curves for each of the experimental conditions. For Ficoll-Hypaque treated lymphocytes, mean cmp=44,977+1400.4 (PHA concentration)-5.90 (PHA concentration)2+ subject effect; s.e.=22,256; for NH4Cl treated lymphocytes, mean cpm=58,039+1022.8(Pha concentration)-5.32 (PHA concentration)2+ subject effect; s.e.=37,966. The p values from the F tests for significance of these quadratic regressions are different, F=1.91, d.f.=30,30; p less than 0.001. The lack of significance of the NH4Cl treated lymphocytes' does response quadratic regression and its larger s.e. indicates that the NH4Cl treated lymphocyte culture dose response curve is less predictable than that of Ficoll-Hypaque treated lymphocytes.

Ammonium Chloride↗

Quantitative selectivity of contact-mediated intercellular communication in a metastatic mouse mammary tumor line.

We have examined contact-mediated intercellular communication by measuring the transfer of thioguanine sensitivity to a hypoxanthine phosphoribosyltransferase (EC 2.4.2.8)-negative clone (66cl-4) selected from one subline isolated previously from a spontaneously arising mammary tumor of a BALB/cfC3H mouse. We tested other sublines from the same tumor and unrelated cell types for their ability to serve as 6-thioguanine nucleotide donors to 66cl-4 cells. The degree of communication, measured by the number of donor cells required to reduce the number of thioguanine-resistant colonies, varied with the donor cell type. The 66cl-4 line communicated with the parent cell line from which the thioguanine-resistant cell was selected and with other sublines from the parent tumor, with some unrelated tumor cells, and with some nonneoplastic cells (3T3, hamster kidney and lung fibroblasts, and mouse mammary epithelial cells). There was a quantitative difference in the amount of communication which took place with the various cells tested, but no pattern of difference could be discerned. Line 66cl-4 did not preferentially communicate with cells of epithelial versus fibroblast morphology, nor with tumor versus nontumor cells. The 66cl-4 cells retained the ability of their parent line to form metastatic tumors when injected s.c. into BALB/c mice. A quantitative selectivity of communication is thus expressed in these malignant metastatic cells, but it is apparently unrelated to either the morphological or malignant phenotype of the donor. Contact-mediated communication between tumor subpopulations may differentially affect growth and drug sensitivity within a tumor.

Animals↗

Prognostic significance of serum IgE levels in primary breast cancer.

Serum IgE was measured in presurgical sera from 166 nonallergic women admitted to a comprehensive, multidisciplinary study of primary, operable breast cancer. During the follow-up period, which averaged 48 months, there were 71 recurrences. Patients were divided into two groups: those with IgE levels greater than the geometric mean value of 24 I.U. and those with levels less than the mean. The rate of tumor recurrence was significantly greater for the IgE greater than 24 group (p less than 0.03). IgE remained a significant prognostic indicator when evaluated by Cox regression analysis in conjunction with other known prognostic factors including: number of positive lymph nodes, clinical stage, menopausal status, estrogen receptor status, mitotic grade, tumor diameter, breast feeding history, and age of patient (p less than 0.015). IgE was not correlated with any of these known prognostic factors in individual analyses. We conclude that serum IgE level is a significant, independent prognostic indicator in primary breast cancer.

Actuarial Analysis↗

A severity grading chart for the burned patient.

A graphical method for the quick computation of admission severity for the burned patient is described. The method is easily used by non-technical personnel and requires only the patient's age, an estimate of the percentage body surface area burned, and knowledge of the presence or absence of a perineal burn. The severity estimate is obtained by simply applying a straight-edge to the provided chart and reading the severity score from the scale crossed by the straight-edge. The severity score used is an estimate of the patient's mortality risk and is based on an extensively validated multiple logistic model which was developed using the combined experience of 11,200 patients at 12 major United States burn units. This severity score can be used with other severity and treatment factors to determine the level of care needed, and as an aid in triage decisions.

Age Factors↗

Monotonic dichotomous regression estimates: a burn care example.

Methods for estimating a dichotomous response regression function are discussed. A smoothed nonparametric monotonic estimator is developed and a procedure for estimating its variance is given. In an institutional differences study, the probability of death from a burn injury is related to the severity of the burn injury for patients treated at several specialized burn care units.

Burns↗