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Biomedical subjects

M Moskowitz

Publications and source records attributed to M Moskowitz.

At least 19 recordsLinked to original sources
PubMed1992

Overview of guidelines for screening.

Controlled trials of screening for breast cancer have proven that (1) for women older than 50 years of age, screening with single-view or two-view mammography, at intervals of 1 to 3 years, with or without clinical examination reduces mortality; (2) annual screening with two-view mammography and clinical examination and emphasis on breast self-examination (BSE) can reduce mortality for women from 40 to 49 years of age; (3) screening this age group with single-view mammography, at intervals of 20 months or longer, without clinical or BSE results in excess mortality in women screened; (3) screening this age group annually with poor quality mammography, weakly interpreted, with some clinical examination results in excess deaths in screened women. If screening women 40 to 49 years of age is to be suggested there is no reason to suggest a model that has been proven to be counterproductive.

Breast Neoplasms↗
PubMed1992

Guidelines for screening for breast cancer. Is a revision in order?

Screening women over the age of 50 for breast cancer has clearly been proven to be capable of reducing population mortality from breast cancer. Population based screening for women aged 40 to 49 has not been shown to be effective, and in several trials there is an early excess breast cancer mortality in the screened population. Because tumors tend to grow more rapidly in younger women than in older women, those trials performed at biannual intervals will detect only the intermediate and slower growing lesions. The more rapidly growing tumors will occur between screens. Furthermore, maintaining a high positive predictive value will lead to a lower sensitivity rate. If the screening interval is too long or the positive predictive value too high, the reassuring effect of a false-negative screening examination may contribute to delay in diagnosis beyond even the usual clinical detection threshold. This may cause more deaths in the study population than in the control population. Guidelines that take the various factors into account have been proposed.

Age Factors↗
PubMed1991

Expert learning system network for diagnosis of breast calcifications.

Breast calcification diagnosis was studied by using clinical findings and computerized image processing of a mammogram in a network of trained expert learning systems (Outcome Advisor [OA]). The system was tested with records not used for training and performance was compared with radiologist. The network was 72% accurate in classifying clusters of calcifications as malignant or benign over a set of test cases radiologists had considered "hard-to-diagnose calcifications," and referred for biopsy. The radiologists had decided to conduct biopsy by selecting an equal number of positive and negative cases for the test group; thus the radiologists' performance with respect to categories of benign versus malignant was constrained to be 50/50. Statistical analysis shows only a 2% probability that the observed accuracy of 72% was a chance performance in recognizing whether a cluster is benign or malignant. The feasibility of developing a network of OAs for diagnosing breast cancer integrating digital image processing of mammograms is promising.

Breast Diseases↗
PubMed1990

Feasibility of a randomized trial of a low-fat diet for the prevention of breast cancer: dietary compliance in the Women's Health Trial Vanguard Study.

The Women's Health Trial Vanguard Study was conducted to examine the feasibility of a nationwide, randomized multicenter intervention trial to test the hypothesis that a low-fat diet followed for a period of 10 years will reduce breast cancer risk. Women ages 45-69 years at increased risk of breast cancer were randomized into intervention (low-fat diet, n = 184) and control (usual diet, n = 119) groups. On the basis of 4-day food records, baseline fat intakes were comparable in the two groups, averaging 1,718 kcal with 39% of energy as fat. Intervention women reported substantially lower fat intake at 6 (20.9% kcal), 12 (21.6%), and 24 months (22.6% kcal). In contrast, control women reported only slight reductions in fat intake (37.3% kcal at 12 months and 36.8% kcal at 24 months). Evidence that these women were indeed complying with the low-fat dietary intervention comes from (a) the reasonable nature of reported nutrient changes within food groups in the intervention women and (b) agreement between observed and expected differences in plasma total cholesterol between the control and the intervention groups. At 12 months, the observed control - intervention plasma cholesterol difference was 13.1 +/- 4.6 mg/dl while the expected difference based on the Keys equation was 15.1 +/- 1.1 mg/dl; at 24 months, the observed difference was 15.5 +/- 4.3 mg/dl and the expected difference was 12.0 +/- 1.2 mg/dl. These analyses indicate that the intervention women made substantial dietary changes and have successfully maintained these changes over a 2-year period. This study thus demonstrates the feasibility of a randomized trial with an intensive low-fat dietary intervention.

Aged↗
PubMed1990

Canadian National Breast Screening Study: assessment of technical quality by external review.

Mammograms from the Canadian National Breast Screening Study (NBSS) were reviewed by three external experts to provide an objective evaluation of their technical quality, to establish a model for auditing mammograms in a screening program, and to assess whether NBSS mammograms improved over time. The sample reviewed included 10 randomly chosen mammograms from each of 15 screening centers for each calendar year of their operation between 1980 and 1987. All 830 mammograms were reviewed on two consecutive days in randomized sequence by each reader, and rated 0-3 for each of four criteria including positioning and image quality, with a total possible score of 0-12. Although the mammograms were not in temporal sequence when reviewed, the scores assigned by each reader were significantly higher for mammograms dating from later years. Subjects' ages at entry (40-49 vs 50-59 years) did not affect the score. The largest increase in scores was associated with a 1985 protocol change in which mediolateral oblique positioning replaced straight mediolateral positioning. This study reinforces the importance of monitoring technical quality in screening programs and establishes that the NBSS benefited from technical improvements during its operation. A retrospective review of NBSS mammography by three external reviewers confirmed that technical quality improved from 1980 to 1987. This improvement was associated with improved technology (film, processing, and units) and with the quality assurance programs operating during the NBSS, which identified problems and offered remedies.

Adult↗
PubMed1990

Growth factor expression after stroke.

Fibroblast growth factors are polypeptides with potent trophic effects on central nervous system cells. Both acidic and basic forms of fibroblast growth factor are found in the mammalian brain. We have examined the expression of these factors after focal brain injury or stroke. After infarction of the lateral cerebral cortex in the mature rat brain, we found a twofold to threefold increase during the first 3 weeks after stroke in levels of fibroblast growth factors in tissue surrounding infarcts. This increase persisted for at least 2 months and appeared mainly to be due to increased levels of basic, but not acidic, fibroblast growth factor. Because of its gliotrophic, angiogenic, and neuronotrophic properties, basic fibroblast growth factor may play an important role in the cascade of cellular reactions that contributes to wound healing and functional recovery after stroke.

Animals↗
PubMed1990

Results of a randomized feasibility study of a low-fat diet.

A 2-year randomized clinical trial was conducted to test whether free-living women aged 45 to 69 years can reduce the fat content of their diet from the typical US level of approximately 39% to 20% of energy from fat, using readily available foods, when given nutritional and behavioral counseling and social support. Three clinical units randomized 303 selected volunteers into intervention (low-fat eating plan) or control (customary diet) groups. The two groups were comparable at baseline. The intervention group received nutrition instruction and behavioral counseling largely in permanent groups of 12 to 15 participants meeting weekly, then biweekly, and finally monthly. At 6 months, they had substantially reduced the mean proportion of total energy from fat from 39.1% to 20.9%, compared with the control group's nonsignificant reduction from 39.0% to 38.1%. At 12 and 24 months, they sustained the reduction of energy from fat. Weight loss and plasma cholesterol level changes in the intervention group supported the self-recorded dietary intake changes. Attendance at intervention sessions averaged 75% during the first 6 months and, subsequently, 60% to 70%. Four-day food records for the randomized women were obtained at 6 and 12 months from approximately 95% and at 24 months from 87%. A clinical trial of a low-fat diet is feasible in women.

Aged↗
PubMed1989

[Massive pericardial effusion following minoxidil].

Minoxidil is a potent antihypertensive which is reserved for severe cases. A 58-year-old man admitted for evaluation of progressive dyspnea and peripheral edema had been taking Minoxidil, Normiten and Lasix for severe hypertension. Echocardiography disclosed a massive pericardial effusion but there were no signs of tamponade. Discontinuation of Minoxidil resulted in complete clearance of the pericardial fluid within 3 months. Awareness of this potentially fatal side-effect of Minoxidil is mandatory.

Echocardiography↗
PubMed1979

Clinical examination of the breasts by nonphysicians: a viable screening option?

After four years of annual screening 10,566 women, physical examination (PE) by nurse clinicians is as effective in detecting suspect cases as is the examination of surgeons and the general medical community of Cincinnati. Carefully performed physical examination has found 45% of the extant cancers detected. Twenty-eight percent of the cancers detected by PE were minimal lesions. One-third of all the minimal cancers currently detectable were discovered by PE.

Breast Neoplasms↗
PubMed1979

Growth and G1 arrest of sarcoma virus trnasformed cells in serum free media.

Rous-sarcoma transformed BHK cells can be continuously cultured in a medium containing Eagle's Minimal Essential Medium, iron and biotin. The rate of cell multiplication increased when serine, or serine plus other non-essential amino-acids were added to the medium. With biotin deleted from the medium there is a reduction in DNA synthesis and most cells are blocked in G1.

Amino Acids↗