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Biomedical subjects

R R Turner

Publications and source records attributed to R R Turner.

80 records · Page 5Linked to original sources
PubMed1981

Testicular lymphomas: a clinicopathologic study of 35 cases.

Thirty-five patients with malignant lymphoma of the testis were reviewed. The lymphomas were classified by the Rappaport criteria and the recently introduced Working Formulation of non-Hodgkin's Lymphomas. The great majority of cases were diffuse histiocytic lymphoma (Rappaport), and these could be further subclassified by the Working Formulation. Significant differences in survival were observed between histologic subgroups of the Working Formulation and this effect was independent of stage, which also had a significant effect on survival. Of 23 clinically evaluable patients who presented with testicular lymphoma, eight of 17 patients with intermediate-grade lymphomas are alive and well, in contrast to none of six patients with high-grade lesions. The recognition of histologic subtype as a prognostic factor independent of clinical stage is important for postorchiectomy management of these patients.

Adult↗
PubMed1981

The relationship between problem solving and activity level in the elderly.

Research stemming from disengagement and activity theory has recently focused on individual differences in establishing and maintaining interpersonal relationships. A specific intervening variable which has been hypothesized to be related to social activity level is interpersonal cognitive problem solving skills (ICPS). The present study identified two groups of elderly veterans on the basis of their ICPS skills. Those who generated a high number of solutions to interpersonal problems reported significantly more time spent in social and isolated goal-directed tasks than the group generating fewer solutions when age, educational level, and length of institutionalization had been covaried. The results suggest the potential usefulness of the ICPS approach as a means of identifying socially active individuals and as an intervention or training technique for less able institutionalized residents.

Aged↗
PubMed1981

Toward a model of person-environment congruence: development of the EPPIS.

The Person Environment (P-E) Congruence model represents an approach to understanding the impact of the environment on the well-being and adjustment of elderly which may also provide information for the development of intervention programs at individual, group and/or institutional levels. Assessment of P-E congruence, or fit between the person and his/her environment, was operationalized in two studies through the development of the Environmental Perception, Preference and Importance Scale (EPPIS). the EPPIS provides scales to assess environmental perceptions, individual environmental preferences and the important or salience of the environment on 15 empirically derived, commensurate dimensions. In a third study, the four-month test-retest reliability of the overall P-E congruence score of the EPPIS, defined as the absolute difference between the perceived and preferred environment weighted by importance, was .78 while the unweighted model reliability was .76. Also, the 15 dimensions of the EPPIS were observed to be significant predictors of well-being. It was proposed that the EPPIS may be used both to determine areas of intervention which the elderly themselves feel are important and as a means to evaluate the effectiveness of interventions intended to reduce P-E incongruence and increase psychological well-being.

Aged↗
PubMedDate not supplied

Color doppler imaging of the gallbladder wall in acute cholecystitis: sonographic-pathologic correlation.

BACKGROUND: The purpose of this study was to evaluate the usefulness of color Doppler imaging (CDI) in suspected cases of acute cholecystitis. METHODS: Twenty-two patients suspected of having acute cholecystitis were prospectively evaluated over a 12-month period using gray-scale and color Doppler technique. Gallbladder wall thickness was greater than 2 mm in all patients included in the study. Pathologic correlation was obtained in 17 patients, with clinical or sonographic follow-up in five for a period of 6-/011001/months. CDI was considered positive only if the mid to fundal wall demonstrated flow. Sonographic Murphy's sign and laboratory values were recorded. RESULTS: Eight patients had acute cholecystitis. All had positive color Doppler flow. Wall thickness in these patients ranged between 4 and 10 mm. Three patients with necrotizing acute cholecystitis had no flow within 6-8-mm walls. Six patients with pathologically proven chronic cholecystitis had no evidence of increased flow within thickened walls. Five patients with presumed chronic cholecystitis (thickened wall without increased color flow) were treated medically, and their symptoms resolved. CDI was more sensitive in predicting acute cholecystitis than was the sonographic Murphy's sign and/or laboratory values. CONCLUSION: CDI demonstrates hyperemic changes in thickened gallbladder walls and is an important adjunct in the diagnosis of acute cholecystitis.

Acute Disease↗
PubMedDate not supplied

Is the node of Cloquet the sentinel node for the iliac/obturator node group?

PURPOSE: Some surgeons question the survival advantage of ilioinguinal lymphadenectomy for metastatic melanoma because they believe that deep nodal involvement signifies a poor prognosis that is unchanged by surgery. However, several series, including our own, have reported 5-year survival rates reaching 30%. New adjuvant therapies may further improve survival after ilioinguinal lymphadenectomy, but this applies only to nodal basins with metastatic disease. We hypothesized that the node of Cloquet accurately reflects the pathologic status of the iliac/obturator nodes, allowing deep pelvic lymphadenectomy to be selectively performed. PATIENTS AND METHODS: Between 1972 and 1998, 691 patients with primary cutaneous melanoma underwent both elective and therapeutic complete (superficial and deep) ilioinguinal lymphadenectomy. Of the 204 (30%) patients with tumor-positive inguinal and/or iliac/obturator nodes, 68 had a node of Cloquet identified during pathologic review of the lymphadenectomy specimen. Chart and computer database review of these 68 patients was undertaken to determine the association between the tumor status of Cloquet's node and that of deep pelvic nodes. Immunohistochemical analysis was performed on eight of 11 negative Cloquet's nodes in patients with positive iliac/obturator nodes. Paraffin blocks of the other three negative nodes of Cloquet were unavailable for immunohistochemistry, and they were excluded from analysis. RESULTS: Tumor-positive deep nodes were identified in the lymphadenectomy specimen from 20 of 30 (67%) patients with a positive Cloquet's node and from eight of 35 (23%) patients with a negative Cloquet's node (P = 0.0019). Re-examination of these eight tumor-negative Cloquet's nodes using immunostaining with S-100 and HMB45 identified tumor in 3 nodes, increasing the sensitivity of Cloquet's node for predicting deep nodal metastases from 71% to 82%. The 6.8 odds ratio of positive iliac/obturator nodes given a positive node of Cloquet increased to 12.4 after immunohistochemical analysis. The positive and negative predictive values were also enhanced from 67% to 70% and 77% to 84%, respectively. DISCUSSION: The tumor status of the node of Cloquet significantly reflects the tumor status of the iliac/obturator nodes, particularly when Cloquet's node is examined by immunohistochemical analysis. The node of Cloquet assumes the role of the sentinel node in patients whose superficial inguinal lymph nodes drain through Cloquet's node to the iliac/obturator nodes.

Adult↗
PubMedDate not supplied

Universal application of intraoperative lymphatic mapping and sentinel lymphadenectomy in solid neoplasms.

PURPOSE: Regional lymph node involvement is the most important prognostic indicator in patients with solid tumors. Conventional lymph node dissection has not been shown to affect survival and is often associated with considerable morbidity. Intraoperative lymphatic mapping and sentinel lymph node dissection were therefore designed as a minimally invasive alternative to routine elective lymph node dissection in patients with primary cutaneous melanoma. This study examined whether introperative lymphatic mapping and sentinel lymph node dissection were accurate in staging patients with other solid malignancies. PATIENTS AND METHODS: Between 1985 and 1998, 107 patients with breast cancer, 17 with thyroid tumors, 14 with gastrointestinal/gynecologic cancers, six with Merkel cell cancers, and five with squamous cell carcinomas of the head and neck have undergone mapping and sentinel lymph node dissection at the John Wayne Cancer Institute. RESULTS: The sentinel node was identified in 96% of patients (98% melanoma). In 36% of patients the sentinel node was the only tumor-positive node (71% melanoma). Eighteen percent of sentinel nodes were negative by hematoxylin and eosin staining but were positive by immunohistochemical staining (15% melanoma). CONCLUSION: These data suggest that many solid neoplasms have a primary lymphatic channel and lymph node to which it drains. Although sentinel lymph node dissection has been popularized in melanoma therapy, we have found it feasible for treatment of other solid malignancies. This technique may ultimately replace conventional dissection with more accurate staging.

Adult↗