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Biomedical subjects

N Wolff

Publications and source records attributed to N Wolff.

8 recordsLinked to original sources
PubMed1995

Tumor cells in blood shed from the surgical field.

OBJECTIVES: To analyze blood shed from the surgical field during oncologic surgery for tumor cells and to assess functional characteristics of these cells. DESIGN AND PATIENTS: Series of 61 patients with cancer who underwent surgery for an abdominal, orthopedic, urological, gynecological, or head and neck malignant tumor, and blinded comparison with 15 patients with benign diseases undergoing surgery. SETTING: A 500-bed tumor center and a tertiary care hospital. MAIN OUTCOME MEASURES: Tumor cells were isolated from intraoperatively salvaged and washed blood by density gradient centrifugation. They were identified in cytospin specimens by their content of cytokeratins and nucleolar organizer regions with a sensitivity of 10 cells in 500 mL of blood. Clonogenicity was tested in a cell colony assay; invasiveness, in Boyden chambers; and tumorigenicity, in nude mice. RESULTS: In 57 of 61 patients, tumor cells were detected in the blood shed during oncologic surgery. They demonstrated proliferation capacity, invasiveness, and tumorigenicity. The total number of tumor cells identified ranged from 1 x 10(1) to 7 x 10(6), with no close correlation to the amount of blood loss. Circulating tumor cells were demonstrated in only 26% of these patients and in small numbers. CONCLUSIONS: Malignant cells identified regularly in the blood shed during tumor surgery and different from circulating tumor cells are of concern, since at the surgical site they may cause local tumor recurrence, or in the salvaged blood they may cause hematogenic metastasis after retransfusion. Therefore, the contraindication of intraoperative autotransfusion in tumor surgery is strongly supported, and a review of surgical procedures and adjuvant therapy may be indicated, as the passage of the identified cells to the shed blood is yet unknown.

Blood Loss, Surgical↗
PubMed1995

Estimated societal costs of assertive community mental health care.

OBJECTIVE: The study used a societal costs model to estimate costs of assertive community treatment for persons with severe mental illness. METHODS: Resource use and cost data were collected for mental health, health, social, and law enforcement, and other maintenance services and family services for 94 clients enrolled in a mobile community treatment program in Madison, Wisconsin. Data sources included self-reports of clients and family members, private and public agency records, and insurance claims files. To make more precise estimates, outcome definitions were broadened, data sources were cross-validated, and prices of services were calculated independently of agencies' charges for such services. RESULTS: Average societal costs for participants in the study were estimated at $23,061 in 1988 ($29,965 in 1994 dollars). Use of a less sophisticated model with less careful costing methods would have resulted in an estimated average cost at least 30 percent lower. Maintenance costs (cash payments from government programs, subsidies, and in-kind services) were the largest cost component, followed by mental health treatment, family burden, indirect treatment, and law enforcement. Most of the financing for these services came from the public sector (85 percent). CONCLUSIONS: Accurate, reliable, and consistent measurement of societal costs will aid in the complex task of rationing fixed health and mental health care budgets.

Adult↗
PubMed1992

[Detection of embryonic mortality in cattle using sonography].

In 70 pregnant cattle the diameter of conceptus, the size of embryo and corpus luteum were estimated with a 5 MHz-linear array scanner on days 22, 25, 28, 35 and 42 (+/- 1 day) after insemination. Additionally, the milk progesterone level was determined. Embryonic mortality was found in 7 cases, in 3 cows on day 35, in 4 cows on day 42. The lack of embryonic heart beat was the first sign; later in pregnancy significant differences in sizes of conceptus and embryo compared with physiological pregnancies occurred. Membranes and bubble-like structures became visible in the lumen of the conceptus. The conceptus could be detected until the following oestrus, which began 8 to 42 days after embryonic death. The corpus luteum remained until proestrus. This correlated positively with the progesterone levels.

Animals↗
PubMed1989

Treatment patterns for schizophrenia in psychiatric hospitals.

This paper analyzes the patterns of clinical treatments prescribed to patients diagnosed with schizophrenia who were admitted to state and county mental hospitals, private for-profit psychiatric hospitals, and private nonprofit psychiatric hospitals in July 1980. Treatment patterns were specified by examining the distribution of treatment types provided to patients over a 3-month period through standard tabular arrays and matrix analysis that holds constant the number of treatment types received by the patients. Data for this study are based on nationwide patient sample surveys and facility enumerations conducted in 1980 by the Survey and Reports Branch, National Institute of Mental Health. Clear differences and similarities emerged among the three types of hospitals in terms of the number and type of treatments provided to patients with schizophrenia. In general, patients with schizophrenia admitted to private psychiatric hospitals received a more comprehensive care regimen (generally inclusive of individual therapy) than similarly diagnosed patients admitted to state and county mental hospitals; private nonprofit psychiatric hospitals had marginally discernible treatment patterns from private for-profit psychiatric hospitals, especially with respect to assignment of group and self-care skill training.

Activities of Daily Living↗
PubMed1989

Professional uncertainty and physician medical decision-making in a multiple treatment framework.

This paper develops a new microanalytic approach to physician medical decision-making treatment setting. Physician medical decision-making is modelled as a two-stage sequential process. In Stage 1, the patient's illness is diagnosed and the health outcomes for all illness-related restoration options are identified. In Stage 2, an "optimal" restoration option is selected. This model provides new insights into physician medical decision-making and the complexity of proving physician-induced demand in a medical care market where professional uncertainty and consumer heterogeneity exist.

Clinical Competence↗
PubMed1984

DRG panic.

The authors describe the successful development and implementation of a multi-use nursing information system. Developed under the direction of nursing administration, this system serves as a database for statistical analysis, utilization review, and budget management. The intent of the article is to encourage nursing administrators with information systems to use them to the fullest possible extent.

Administrative Personnel↗