Disease state management: reality or mythology.
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Biomedical subjects
Publications and source records attributed to M D Henderson.
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Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.
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The immunologic specificity of human prostatic acidphosphatase has been established by several previous investigations as well as in this study. An apparent exception to this specificity was observed--a case of pancreatic islet cell carcinoma metastasized to the liver produced acid phosphatase that was immunologically indistinguishable from the prostatic acid phosphatase. In this case, the possibility of prostatic involvement was convincingly ruled out by clinical follow-ups and by postmortem pathologic studies. Highly purified prostatic acid phosphatase and this tumor acid phosphatase exhibited very similar Km values and identical molecular weights. Immunochemical analysis of the two enzymes using antiprostatic acid phosphatase sera showed that enzymes are antigenically identical. The implications of our observation are discussed in relation to clinical application of immunoassays for prostatic phosphatase in the future and to the molecular basis of human acid phosphatase polymorphism.
Hypertrichosis lanuginosa is a pathologic state characterized by an excessive, new growth of fine, fetal hair. Two cases of hypertrichosis languinosa with malignancy (lymphoma and uterine cancer) are presented and added to the 9 in the literature. Lymphoma and uterine cancer are previously unreported as associated with hypertrichosis osis lanuginosa. Review of the 11 cases of hypertrichosis lanuginosa revealed the following characteristics: females were predominant; none was below the 4th decade; all had advanced neoplastic disease; all malignancies except one were of epithelial origin; and there were no demonstrable endocrine abnormalities. Despite an attempt to find etiologic factors in our patients and in the literature, none could be elicited.
Citrobacter diversus is a gram-negative rod member of the Enterobacteriacease family. A patient is described from whom this organism was isolated twice in pure culture from empyema fluid. Our isolates of Citrobacter diversus were resistant to ampicillin and carbenicillin and sensitive to cephalothin. Citrobacter diversus should be distinguished from Citrobacter freundii, Enterobacter cloacae and Klebsiella pneumoniae. This organism joins Streptococcus pyogenes, bacteroids species, anaerobic streptococci and Escherichia coli as a cause of slight pneumonia with extensive empyema.
Of the 89 patients with disseminated carcinoma of the breast treated with combination or sequential cyclophosphamide, fluorouracil and vincristine, 63 had received evaluable course of endocrine therapy and chemotherapy. The response to endocrine therapy, regardless of its nature or duration, failed to predict response to subsequent chemotherapy. Selection of the patients on the basis of pretreatment disease free interval, menopausal status or metastatic pattern showed the groups of patients to be homogeneous in distribution. In addition, evaluation for a disease free interval greater or less than two years, menopausal status and visceral or nonvisceral metastasis did not allow identification of groups predicting responsiveness to combination chemotherapy.
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