Biomedical subjects
Publications and source records attributed to M Moskowitz.
A 52-year-old woman had a fatal intracerebral hemorrhage after dental manipulation. Normotensive in the past, the initial blood pressure was high but rapidly returned to normal. Necropsy showed no vascular malformation or evidence of hypertensive vascular disease. Clinical and experimental data show that stimulation of trigeminal fibers can cause important changes in blood pressure and pulse.
A cost-benefit analysis clearly shows that the costs for screening a large population of asymptomatic women are well within the cost-benefit range that is accepted for other areas within the medical care system. If profit and loss were the only considerations, one would opt for screening with combined examination for all women age 40 and older. If medical and philosophical considerations were to be included in the equation, clinical examination alone at any age cannot be justified. However, one might be able to justify mammography screening. Bierman has stated, "ultimately, when the scent is of flesh rather than figures, even the economist concedes that it will be important to insulate the individual practitioner (from cost-benefit/cost-effectiveness analysis) on a day-to-day basis because of potential conflict with the commitment to do what is best for each patient. Here is the crux. The economist's reference to the 'nation's health' is at best ambiguous and more likely meaningless. The physician's commitment to the patient's health is neither of these: it is clear, undeniable, and profoundly meaningful." Reduction in cancer deaths is not easy to come by. When a method is available that can achieve this result, every effort should be made to make it available until it can be replaced satisfactorily by a less expensive, equally effective modality.
Congestive cardiomyopathy from endocardial fibroelastosis occurred in a 24-year-old primigravida with a twin gestation and preeclampsia. The patient was taking ritodrine for premature labor. Cardiovascular evaluation should be performed during the course of ritodrine treatment, and no patient should be discharged if she does not have normal cardiovascular function.
The extracellular response of medullary trigeminal neurons to electrical stimulation of the dura was studied in anesthetized cats. Fifty-six medullary trigeminal units were excited by stimulation sites near major dural vessels with an average latency of 11.0 ms. Many units also responded to infraorbital nerve shock and had cutaneous receptive fields that included the ipsilateral periorbital region. These cutaneous responses were either wide dynamic range or nociceptive specific in type. Electrical stimulation of the midbrain periaqueductal gray region suppressed the response of medullary trigeminal units to either dural stimulation or infraorbital nerve shock. Medullary trigeminal neurons that receive convergent inputs from dura and facial skin may provide a physiological substrate for the cutaneous referral of dural sensation.
Wolfe has described different cancer risks associated with a classification of four patterns of the breast parenchyma on mammography, but there is however little information available on the ability of radiologists to agree on the classification of the different patterns. We have assessed inter-rater agreement on the assignment of films to one of the four mammographic patterns described by Wolfe. One hundred xeromammograms were selected, copied and distributed to 10 radiologists who were experts in mammography. Films were classified according to the presence or absence of several radiological signs, according to diagnosis and recommendation, and according to mammographic pattern. Agreement was assessed after correction for agreement expected by chance, using the Kappa statistic. In general, high levels of agreement were found for the classification of mammographic pattern. Agreement on the classification of mammographic pattern was substantially greater than agreement for any other feature of mammographic interpretation, including diagnosis and recommendation.
In an earlier work, the author and colleagues predicted that the lead time gained by mammographic screening of an asymptomatic, randomly selected population of women was 2 years +/- 0.5 for women aged 35-49 years and 3.5 years +/- 0.5 for those over age 50. At the completion of long-term follow-up of 10,530 women (with a total of 111,087 "person years"), the resultant lead time actually gained seems to be 12-24 months for women aged 35-49 years at entry and 3.5-4 years for older women. Failure to take this lead time into account in the design of controlled trials may well result in failure to decrease mortality due to breast cancer. The results of the present study and those of recent Dutch and Swedish trials suggest that the most effective screening strategy may be annual mammographic and clinical examinations for women aged 40-49 years and biennial examinations thereafter.
Explore the source record for details and available documents.
Because of recent data suggesting that about 40% of patients with a positive thermogram may subsequently develop breast cancer, a review of the data from the Cincinnati Breast Cancer Detection Demonstration Project (BCDDP) was undertaken. Of the 1,260 patients with more than one positive thermogram from 1973 to 1976, 1.9% subsequently developed breast cancer from 1977 to 1983. That finding was not significantly different from the 1.3% of patients who developed cancer and never had a positive thermogram. A critical review of the recent literature on the subject reinforces the BCDDP findings.
Explore the source record for details and available documents.
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.
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.
It is estimated that mammographic and physical examination (PE) screening would cost $3,866 per person year gained; screening with PE alone would cost $4,550. Sixty thousand person years are gained with combined screening, and 24,000 with PE alone per million women screened. The cost per cancer found is $9,046; for each highly curable cancer $26,961, and for each death averted $61,100. An estimated 16 years are added to each life saved. The cost per patient screening examination, using all techniques, is $20.04.
Mammography and physical examination, usually employed as diagnostic tools, may be used to screen for early detection of breast cancer. A study of these modalities used to aggressively screen patients in Cincinnati and Milwaukee is presented and compared to more traditional methods of breast cancer detection and diagnosis as done in Louisville. For a similar-sized group over the same period, the rate of cancers detected in Louisville did not exceed that in Cincinnati-Milwaukee. Aggressive screening will not increase the overall number of detected cancers but will decrease the number of advanced cancers. Mammography as a screening device is not in itself a diagnostic tool, since its potential benefit is maximized only through the use of nondiagnostic, indirect radiographic criteria.
Because a "negative" mammogram that is followed by a biopsy diagnostic of cancer is a matter of deep concern, a retrospective review was conducted of 48 such missed diagnoses at four Breast Cancer Detection Centers. The study group comprised 40,000 women participating in breast cancer screening examinations. From 3,271 biopsies during screening, 499 cancers had been found. Biopsies in the interval between screening examinations totaled 630 and yielded 48 malignancies. These 48 interval cancers were studied in an attempt to discover why they were not found on the preceding mammographic examination. Three major categories of error were disclosed and each is discussed: (1) poor radiographic technique; (2) absence of radiographic criteria of cancer; (3a) obvious oversight by the radiologist; and (3b) lack of recognition of subtle radiographic signs. This last reason is discussed in detail in the belief that better recognition of these indirect radiographic signs will lead to more accurate diagnoses, particularly in early cancers.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.