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Biomedical subjects

M Rosman

Publications and source records attributed to M Rosman.

At least 19 recordsLinked to original sources
PubMed2001

Retinal detachment in Chinese, Malay and Indian residents in Singapore: a comparative study on risk factors, clinical presentation and surgical outcomes.

PURPOSE: To evaluate the risk factors, clinical presentation and surgical outcomes of retinal detachment (RD) among Chinese, Malay and Indian residents in Singapore. METHODS: A retrospective descriptive study from January 1995 to December 1998. All RD operations performed at a tertiary ophthalmic center in Singapore were initially identified from a computerized audit database. Case records data of all Malay and Indian patients as well as a 10% randomized sample of Chinese patients were retrieved and analyzed. Tractional and exudative RD's were excluded. RESULTS: Of the Singapore residents who had a RD operation over the 4-year period, 597 (89.6%) were Chinese, 47 (7.1%) were Malays and 22 (3.3%) were Indians. The age (mean: 46.1 +/- 15.5 years), gender distribution (70.5% males) and presenting visual acuities were similar in the 3 races. The most common site of the retinal break(s) was the superotemporal retina (44.9%), followed by the inferotemporal retina (15.3%). Chinese patients were more likely to have multiple or indeterminate breaks (p = 0.09) and macula-on RD (p = 0.04), compared to Malays and Indians. The distribution of known risk factors (myopia, lattice degeneration, prior cataract surgery and prior ocular trauma) was similar between the three races. The majority of patients required a scleral buckling operation either in isolation (71.3%), or in combination with vitrectomy (19.4%), and only 10 (7.8%) had vitrectomies without buckles. At 6 months postoperatively, anatomical success (defined as an attached retina on ocular examination) and functional success (defined as visual acuities of 6/60 or better) were achieved in 108 (94.7%) and 62 patients (54.4%), respectively, with no significant racial variation seen. The overall rate of redetachment after the initial operation was low (9.3%). CONCLUSION: Variation in risk factors, clinical presentations and postoperative outcomes of retinal detachment appears to be minimal among Chinese, Malays and Indians in Singapore.

Adult↗
PubMed2000

Genotype-phenotype correlations in families with deletions in the von Hippel-Lindau (VHL) gene.

Von Hippel-Lindau (VHL) disease is a hereditary tumor syndrome characterized by predisposition for bilateral and multi-centric hemangioblastoma in the retina and central nervous system, pheochromocytoma, renal cell carcinoma, and cysts in the kidney, pancreas, and epididymis. We describe five families for which direct sequencing of the coding region of the VHL gene had failed to identify the family-specific mutation. Further molecular analysis revealed deletions involving the VHL gene in each of these families. In four families, partial deletions of one or more exons were detected by Southern blot analysis. In the fifth family, FISH analysis demonstrated the deletion of the entire VHL gene. Our results show that (quantitative) Southern blot analysis is a sensitive method for detecting germline deletions of the VHL gene and should be implemented in routine DNA diagnosis for VHL disease. Our data support the previously established observation that families with a germline deletion have a low risk for pheochromocytoma. Further unraveling of genotype-phenotype correlations in VHL disease has revealed that families with a full or partial deletion of the VHL gene exhibit a phenotype with a preponderance of central nervous system hemangioblastoma.

Adolescent↗
PubMed1998

Involutional lower eyelid entropion: results of a combined approach.

BACKGROUND AND OBJECTIVE: To evaluate the effect of adding horizontal eyelid tightening and the removal of orbital fat to reinsertion of the lower eyelid retractors to correct involutional entropion. PATIENTS AND METHODS: During 6 consecutive years, 266 cases (229 patients) were treated. Of these, 240 cases (207 patients) showed horizontal laxity, in which reinsertion of the lower eyelid retractors was combined with lower eyelid tightening in the lateral canthal angle. In 60 of these cases (47 patients), prolapsing orbital fat was removed during the operation. In 26 cases (22 patients), no horizontal laxity was found. Their treatment consisted of reinserting the lower eyelid retractors without eyelid tightening. Follow-up of 28 weeks postoperatively was available in all cases. In 213 cases (178 patients), follow-up of 5 months or longer (range 5 to 80 months, average 42 months) was available. RESULTS: The most common complication of surgery was persistent ectropion, which occurred in 12 cases (5.6%). It occurred significantly more often after reinsertion without horizontal eyelid tightening than after combined reinsertion and horizontal tightening (P = .04). Adding the excision of orbital fat to the latter procedure did not significantly influence the results. Transient ectropion also occurred significantly more often after retractor reinsertion alone than after combined retractor reinsertion and horizontal tightening (P = .01). The entropion recurred in 9 cases (3.3%), 5 of which within 24 months (2.4%). The authors found no difference in recurrence rate between the three groups. A disadvantage of eyelid tightening is tenderness, which was reported by 42 (29%) of the patients. In 9 patients this had persisted longer than 4 months. CONCLUSION: Horizontal eyelid laxity is common in involutional entropion. Tightening of the lower eyelid in the lateral canthus, added to reinsertion of the lower eyelid retractors, significantly lowers the incidence of surgical overcorrection, but has no effect on the recurrence rate. A disadvantage of eyelid tightening in the lateral canthus is that it may lead to mostly transient eyelid tenderness.

Adipose Tissue↗
PubMed1995

Six elderly suicides in a 1-year period in a rural midwestern community.

In a 1-year period, 6 of 11 suicides in a rural Wisconsin county were committed by people over the age of 60. At the request of the local coroner, the American Medical Association sent a team of investigators to perform psychological autopsies. Family member survivors, friends, and attending physicians were interviewed. The majority of suicide victims had evidence of major depressive episodes, delusions that they had a terminal physical illness, and knowledge of family/friends who had committed suicide. Most had seen their physician within 48 hours before their death. Continuing education efforts focused on increasing a physician's abilities to recognize depression and suicidal ideation have ensued, based on this experience.

Aged↗
PubMed1994

Prognostic indicators for poor risk epithelial ovarian carcinoma.

BACKGROUND: The objective of this study was to identify factors that categorize patients with epithelial ovarian carcinoma into favorable and unfavorable prognostic groups at the time of initial treatment. METHODS: Data were analyzed from 51 women who were treated at Yale University, had an evaluable CA 125 half-life (t1/2), and were followed for disease recurrence for at least 2 years. RESULTS: Grade, maximum level of CA 125, and histology did not provide useful prognostic information. Stage, residual disease, minimum CA 125, and CA 125 t1/2 individually were predictive of persistent disease or recurrence within 3 years of diagnosis with sensitivities of 97, 70, 34, and 49%, respectively, and specificities of 33, 83, 100, and 83%, respectively. When these factors are combined, defining an unfavorable prognostic group as those patients having residual disease greater than 1 cm, CA 125 t1/2 greater than 12 days, or minimum CA 125 never falling below 35 U/ml, sensitivity and specificity were 96 and 65%, respectively, at 1 year of follow-up and 91 and 75%, respectively, at 3 years of follow-up. 75%, respectively, at 3 years of follow-up. CONCLUSIONS: In those patients in whom residual small volume disease after primary surgery indicates a good prognosis, minimum CA 125 and CA 125 t1/2 during chemotherapy can further categorize patients into favorable and unfavorable prognostic groups.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1992

Diagnostic efficiency of carcinoembryonic antigen and CA125 in the cytological evaluation of effusions.

In our previous study, the combination of the concentrations of carcinoembryonic antigen (CEA) and CA125 and the findings from cytological examination in 189 benign and malignant pleural and peritoneal effusions was useful in the diagnosis/classification of malignant effusions. Sensitivity of CEA (level, greater than 5 ng/mL) was 68%; specificity was 99% for the diagnosis of malignant effusions secondary to carcinoma of the lung, breast, gastrointestinal tract, and mucinous carcinoma of the ovary. Sensitivity of CA125 (level, greater than 5000 U/mL) was 85%; specificity was 96% for the diagnosis of malignant effusions in carcinoma of the ovary, fallopian tube, and endometrium. We now expanded the study to include 840 pleural and peritoneal effusions (benign, n = 520; malignant, n = 320) and analyzed the data by the statistical method of Rudolph and colleagues. Based on new cutoff values, ie, CEA level at 6.3 ng/mL and CA125 level at 3652 U/mL, the sensitivities for detection of malignant effusions secondary to carcinomas of the lung, breast, and gastrointestinal tract and mucinous carcinoma of the ovary varied between 75% and 100%; specificity was 98%. Sensitivity of CA125 for detection of malignant effusions from müllerian epithelial carcinoma was 71%; specificity was 99%. The elevated CEA fluid level alone helped to diagnose malignant effusions of the gastrointestinal tract in 54%, breast in 19%, and lung in 16%. The high CA125 fluid level was predictive of müllerian epithelial carcinoma. Adjunctive use of CEA and CA125 levels in fluid enhances the sensitivity of cytological diagnosis and may be predictive of the primary site in patients who present with carcinoma of an unknown primary source.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1988

Central fracture-dislocation of the hip in a child.

A case report of a 10-year-old child with a central fracture-dislocation of the hip, managed by open reduction is presented, with a long-term result. The rarity of this injury in children is discussed, with the possible complications of inadequate joint congruity and potential growth injury.

Acetabulum↗
PubMed1988

The role of chemotherapy in non-small cell lung cancer: the community perspective.

In the past decade, several drugs have been identified that possess activity in treating non-small cell lung cancer (NSCLC). The combination of mitomycin C, vinblastine, and cisplatin (MVP) was studied in 56 previously untreated patients with advanced NSCLC in Bridgeport Hospital from 1981 to 1984. In a selected patient population, 73% of 52 evaluable patients had complete (four patients) or partial (34 patients) responses. Response rate was 88% in epidermoid carcinoma, 70% in adenocarcinoma, and 50% in undifferentiated carcinoma. Median survival was 10 months in responding patients v 4 months in nonresponders. Performance status was the most important factor predictive of prolonged survival. MVP cannot be recommended for patients with poor performance status but may offer worthwhile palliation to patients with advanced NSCLC. Active drug combinations must now be studied as part of a multidisciplinary approach to the primary management of patients with clinically localized NSCLC.

Adult↗
PubMed1984

Sternoclavicular epiphyseal separation with adjacent clavicular fracture.

An unusual case of a double fracture of the medial left clavicle in a 15-year-old male hockey player is presented. One fracture was an epiphyseal separation through the medial growth plate and the second a transverse fracture of the medial one-third of the same clavicle with displacement of the fragment into the chest. Radiographic and computed tomographic descriptions are presented. The injury was managed with open reduction and fixation. A discussion of sternoclavicular epiphyseal separations and intrathoracic displacement is given, with a review of the literature.

Adolescent↗
PubMed1984

Bunions in children: treatment with a modified Mitchell osteotomy.

Modifications to the original Mitchell osteotomy of the first metatarsal for bunions in children are described. The reasons for these modifications are stressed, and the results of the modified version of the operation in 45 feet are discussed. Long-term cosmetic and functional results with this operation have been excellent in growing children.

Adolescent↗
PubMed1984

Disc protrusion in the growing child.

Long-term follow-up studies of surgically treated herniation of lumbar intervertebral discs demonstrate both similarities and interesting differences between the disorder in children and adults. Failure to respond to conservative treatment is relatively common in children. Long-term follow-up evaluation demonstrates a relatively high incidence of excellent clinical results.

Adolescent↗
PubMed1978

Missed, maluniting, and malunited fractures of the lateral humeral condyle in children.

Five cases of fracture of the lateral humeral condyle in children are described to illustrate the importance of recognition and proper management of this injury. The cases represent different degrees of severity of this injury. Failure of recognition of this fracture leads to serious late complications. Management of missed and maluniting fractures is discussed. It is our practice to internally fix these injuries.

Casts, Surgical↗
PubMed1975

Biochemical approaches to the combination chemotherapy of colon cancer.

The employment of biochemical concepts to select drugs for use in the treatment of colorectal cancer is advocated. It is stressed that new drug mixtures, even those employing agents inactive alone, with unique mechanisms of action may be fashioned through biochemical design. Following delineation of activity in animal model systems, these drug combinations then become candidates for use in man. It is emphasized that 6-thioguanine is a particularly attractive agent for consideration as a component of new combinations of drugs to be used in patients with cancer. The desirability of this agent derives from (a) the known, albeit weak, activity of 6-thioguanine against colorectal neoplasms of man, thereby providing some inherent activity to be joined by additional materials; (b) a knowledge of several major biochemical and pharmacologic determinants of tissue susceptibility to its cytotoxic action, possibly allowing the ultimate selection of patients with a high probability of response; and (c) the availability of four different agents or classes of agents which synergistically interact with 6-thioguanine to inhibit the growth of malignant cells by diverse biochemical mechanisms.

Antineoplastic Agents↗