PubMed Health⌕ Search

Biomedical subjects

S M Weiss

Publications and source records attributed to S M Weiss.

At least 19 recordsLinked to original sources
PubMed1996

Patient satisfaction with decision-making for breast cancer therapy.

BACKGROUND: Many sources have suggested that mastectomy is inappropriately performed too frequently for breast cancer, leading to excessive patient dissatisfaction and unnecessary mutilation. Hurried decision-making based on inadequate information has been proposed as an explanation. METHODS: After confirming the diagnosis of breast cancer, patients were informed of the diagnosis, prognosis, and treatment options according to a standard protocol. The protocol was similar to that used by many surgeons in similar circumstances. Six months after completion of either mastectomy or breast conservation therapy, patients were surveyed about their satisfaction with the decision-making process and choice of treatment. RESULTS: The majority of patients, whether they had undergone mastectomy or breast conservation, thought they had been adequately informed of treatment options and that they had made the appropriate choice of therapy. A significant percentage of mastectomy patients found that procedure more disfiguring than anticipated, but still thought they had made the appropriate choice of therapy. Despite having been informed to the contrary, most patients said their chosen treatment provided the best chance for cure. CONCLUSIONS: When informed of the diagnosis and treatment options in an unhurried, supportive setting, and when encouraged to seek further consultations as desired, breast cancer patients make appropriate therapeutic choices about mastectomy or breast conservation therapy.

Breast Neoplasms↗
PubMed1996

Exploration and predation models of anxiety: evidence from laboratory and wild species.

The current article addresses several issues within the context of issues within the context of modeling human anxiety disorders in the laboratory. First, evidence is presented to support the suggestion that behavior in exploration models of anxiety may be motivated by apprehension relating to intraspecific encounters rather than interspecific, predator/prey interactions, which has consequences for the interpretation of findings generated using these tests. Second, data are reviewed concerning the use of stimuli indicating the presence of a predator in the context of anxiety modeling, and it is suggested that tests involving the reactions of animals following exposure to such stimuli may be more closely related to pathologic anxiety mechanisms than tests employing observations during contact with these stimuli. Third, comparative studies, using wild-caught rodents, are outlined that show that, although there are similarities in the defensive strategies adopted by these animals in response to the call of an owl, there are also important differences. Finally, the suggestion is made that the distance-dependent-defense-hierarchy may be of important heuristic value in the interpretation of these data and that, perhaps more significantly, it may also provide a mechanism that allows animal defensive strategies and human anxiety disorders to be placed within the same conceptual framework.

Animals↗
PubMed1996

Failure to detect Chlamydia pneumoniae in coronary atheromas of patients undergoing atherectomy.

To further investigate a proposed relationship between Chlamydia pneumoniae and coronary heart disease, coronary atheromas were collected from patients undergoing percutaneous atherectomy. Fifty-eight atheroma specimens were examined by culture and polymerase chain reaction (PCR) and 22 by electron microscopy. All were negative for C. pneumoniae, except a single specimen that was PCR-positive. These results differ from studies in other populations, in which this organism was identified by nonculture methods within coronary atheromas obtained at autopsy. Anti-C. pneumoniae antibody titers from 65 of the patients were compared with those of 28 asymptomatic controls. IgG titers were higher in controls than in patients. There is no evidence that C. pneumoniae exists within atheromas in this study population, nor does seroprevalence correlate with the presence of coronary disease in these patients.

Adult↗
PubMed1996

Neuralgia after inguinal hernia repair.

Severe chronic pain after groin hernia repair is uncommon but potentially debilitating. Fifteen patients with this condition were retrospectively reviewed. All patients had severe pain, which prevented their working or normal activity and was refractory to nonoperative treatment. Essentials of therapy included 1) a preoperative attempt to identify the involved nerve and 2) high ligation and division of the involved nerve identified at exploration. Twelve patients obtained excellent results and were able to return to normal activity with no requirement for analgesia. Understanding of the typical nerve anatomy, as well as the individual variation in nerve anatomy, can help prevent this complication and is essential for correction if the complication does develop.

Adult↗
PubMed1995

Visible burrow system as a model of chronic social stress: behavioral and neuroendocrine correlates.

In mixed-sex rat groups maintained in visible burrow systems (VBS), consistent asymmetries in offensive and defensive behaviors of male dyads are associated with the development of dominance hierarchies. Subordinate males are characterized by particular wound patterns, severe weight loss, and a variety of behavioral changes, many of them isomorphic to target symptoms of clinical depression. In two VBS studies, subordinate males showed increased basal levels of plasma corticosterone (CORT), and increased adjusted adrenal and spleen weights compared to controls, and often, to dominants as well. Thymus weights and testosterone levels of subordinates were not reliably different in one study using highly aggressive males, but were reduced, along with testes weights, in a second study using unselected males. Glucocorticoid receptor binding levels in hippocampus, hypothalamus, and pituitary were not different, nor were aldosterone levels. When tested in a restraint stress procedure, subordinates had higher basal CORT levels, but about 40% of these animals showed a reduced, or absent, CORT response to restraint. These findings indicate that subordination may be reflected in high magnitude changes consistent with physiological indices of prolonged stress. Dominant rats of such groups may also show physiological changes suggesting stress, particularly when the groups are comprised of highly aggressive males only. The VBS colony model thus appears to enable rat groups to produce natural, stress-engendering, social interactions that constitute a particularly relevant model for investigating the behavioral, neural, and endocrine correlates of chronic stress.

Adrenal Glands↗
PubMed1995

Physiologic evaluation of bronchial asthma. Why objective testing is essential.

Physiologic evaluation of bronchial asthma is extremely valuable. Simple objective measurements of expiratory airflow and lung volume help physicians determine disease status and monitor patient response to therapy. More elaborate measurements of pulmonary function are not commonly needed in primary care practice. The three case studies described in this article show that objective assessment of lung function is critical in effective treatment of asthma.

Adult↗
PubMed1994

Enteritis necroticans with midgut necrosis caused by Clostridium perfringens.

Enteritis necroticans is a necrotizing process manifesting as segmental gangrene of the bowel, triggered by Clostridium perfringens toxins under specific dietary conditions. It is a rare disease in developed countries and is probably underdiagnosed. A case of enteritis necroticans presenting with midgut necrosis with sepsis and hemolysis is reported herein. Bacteriologic culture of blood and peritoneal content revealed C perfringens. Dietary history, including the ingestion of meat together with sweet potatoes, should increase clinical suspicion of enteritis necroticans. Early recognition and timely surgical intervention are required for successful treatment. Clinicians are encouraged to be aware of this clinically fulminant yet rarely recognized surgical entity.

Clostridium Infections↗
PubMed1994

Outcome from respiratory failure.

A physician's assessment of the probable outcome of an episode of respiratory failure should be based on a combination of survival data from large studies and specific knowledge about the individual case in question. Clearly, mortality rates in cases of ARF are influenced by a number of factors. In general, only a minority of patients with ARF complicating COPD require mechanical ventilation. In these cases, mortality often is related to the nature of the precipitating illness and the severity of the patient's underlying chronic respiratory disease. The long-term prognosis in patients with COPD who survive an episode of ARF is related primarily to the severity of the patient's underlying disease. Acute mortality is higher in patients with ARDS than in patients with ARF complicating COPD. Although a significant number of ARDS patients die of their underlying illness, mortality in others more commonly appears to be related to sepsis and multiple organ failure rather than end-stage respiratory disease. Pulmonary function in survivors of ARDS is quite variable, and may be related to the severity of the acute episode. ARF has a particularly poor prognosis when associated with certain underlying illnesses such as hematologic malignancy.

Acute Disease↗
PubMed1994

Splenic abscess.

The character and management of splenic abscess has changed in the past decade. The condition is more frequent, diagnosis is more easily established, and survival is more likely. Seven patients with splenic abscess from 1981-1992 were retrospectively reviewed. These patients had different etiologies for their splenic abscess, including hematogenous bacteria spread, contiguous spread, and previous history of trauma to the spleen or left upper quadrant. Most patients presented clinically with fever, left upper quadrant tenderness, and leukocytosis. All patients underwent CT scanning that was reliably diagnostic. All seven patients underwent splenectomy. Six of the seven patients were discharged from the hospital. We conclude that CT scan remains the gold standard for definitive diagnosis of splenic abscess, and splenectomy is very effective therapy.

Abscess↗
PubMed1994

Acute inhalation injury.

Toxic inhalants cause injury through a variety of different mechanisms, including direct irritation of the respiratory tract mucosa, asphyxiation, and systemic absorption of the toxin. The nature and extent of the acute injury depends on the inhalant's water solubility, aerodynamic features, pH, and concentration. In addition, a patient's underlying respiratory function may affect the clinical response. Smoke inhalation is a particularly challenging clinical problem because patients often are exposed to a large number of inhaled toxins and may suffer thermal injury to the respiratory tract as well. Several chronic respiratory problems have been identified following acute inhalation injuries. Chronic airflow obstruction has been reported in patients exposed to ammonia, chlorine, nitrogen dioxide, and sulfur dioxide; bronchiolitis obliterans may follow exposure to nitrogen dioxide and sulfur dioxide. Inhalation injuries can be difficult to manage because exposures occur infrequently, and the exact toxic agents involved often are not known immediately. Prevention of occupational exposures remains a cornerstone in the overall management of inhalation injuries.

Burns, Inhalation↗
PubMed1993

Subordination stress: behavioral, brain, and neuroendocrine correlates.

In mixed-sex rat groups consistent asymmetries in offensive and defensive behaviors of male dyads are associated with the development of dominance hierarchies. Subordinate males can be differentiated from dominants on the basis of both agonistic and non-agonistic behaviors, wound patterns, weight changes. Their behavior changes suggest chronic defensiveness and are also broadly isomorphic to many of the symptoms of depression; their voluntary alcohol consumption increases, and their life-spans are shortened. Both subordinate and dominant males tend to show organ change compared to non-grouped controls, with adrenal and spleen enlargement and thymus reduction. However, these changes appear to be more marked in subordinates, and only subordinates show reduced testes weights. Basal corticosterone (CORT) levels were sharply higher, and plasma testosterone (T) sharply lower, in subordinates compared to both dominants and controls, and reduced corticosterone binding globulin further enhanced free CORT for subordinates particularly. Many subordinates failed to show a normal CORT response to restraint stress. Subordinates also appear to show widespread changes in serotonin systems, with increased 5-HIAA/5-HT ratios in a number of brain areas, and alterations of 5-HT1A receptor binding at some sites. These changes suggest that subordination, a common and consistent feature of life for many animals living in social groups, may be a particularly relevant model for investigating the behavioral, neural and endocrine correlates of chronic stress.

Aggression↗
PubMed1993

False negative breast biopsy for palpable mass.

Open breast biopsy is considered to be the most reliable method for the diagnosis of breast cancer in patients with palpable masses. Rarely, after a breast biopsy has been reported to be benign, cancer will be identified at the site of the biopsy. Eight patients were reviewed in whom breast cancer was demonstrated at the site of a previously negative biopsy at intervals ranging between 4 months and 3 years after the original, negative biopsy. Several possible explanations exist to account for this occurrence. The surgeon must be aware that the presence of a mass at the site of prior breast biopsy may be an indication for repeat excision.

Biopsy↗
PubMed1993

Immunological responses of breast cancer patients to behavioral interventions.

This article reports the results of an 18-month study of immune system and psychological changes in stage 1 breast cancer patients provided with relaxation, guided imagery, and biofeedback training. Thirteen lymph node negative patients who had recovered from a modified radical mastectomy were randomly assigned to either an immediate treatment or a delayed treatment control group. Multiple pre-post psychological measures were performed. Significant effects were found in natural killer cell (NK) activity (p < .017), mixed lymphocyte responsiveness (MLR) (p < .001), concanavalin A (Con-A) responsiveness (p < .001), and the number of peripheral blood lymphocytes (PBL) (p < .01). No significant psychological changes were detected; however, reductions were seen in psychological inventory scales measuring anxiety. The results show that behavioral interventions can be correlated with immune system measures, thereby replicating the results of an earlier pilot study from our Center. Discussion is provided on differential T-cell and B-cell responsiveness to behavioral interventions.

Adult↗
PubMed1993

Complications of fiberoptic bronchoscopy in thrombocytopenic patients.

STUDY OBJECTIVE: To determine the risk of epistaxis and pulmonary hemorrhage due to fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in the presence of thrombocytopenia. DESIGN: Prospective study of all patients undergoing FOB with BAL with a 4.9-mm-diameter bronchoscope after bone marrow transplantation (BMT) during a 6-month period. SETTING: A single BMT center. PATIENTS: Forty-seven BMT recipients undergoing 66 FOB with BAL. Thrombocytopenia (platelets < 100,000/ml) was present in 58 (88 percent). Platelets were < 50,000/ml in 44 (67 percent) and < 20,000/ml in 13 (20 percent). In the thrombocytopenic patients, FOB with BAL was transnasal in 37 (64 percent), transoral in 5 (9 percent), and via endotracheal tube in 16 (28 percent). INTERVENTIONS: Fiberoptic bronchoscopy with BAL using a bronchoscope (Pentax FB-15H) (4.9-mm diameter). In one case, a pediatric bronchoscope (Pentax FB-10H; 3.5-mm diameter) was used in a 7-year-old patient. MEASUREMENTS AND RESULTS: The BAL was diagnostic in 22 of 47 patients studied (47 percent). Complications occurred in 7 of 58 (12 percent) thrombocytopenic patients (epistaxis and/or hemoptysis, 4; bradycardia, 2; bronchospasm, 1) of which all but 1 were minor and self-limiting. One life-threatening complication of severe epistaxis occurred during a transoral FOB in a patient with prior epistaxis (platelet count, 18,000/ml). One of 8 (13 percent) nonthrombocytopenic patients had hemoptysis. No patient had worsening fever or oxygenation at 4 h and no patient displayed worsening radiographic infiltrates suggestive of pulmonary hemorrhage attributable to the BAL at 24 h. CONCLUSIONS: We conclude that transnasal FOB in thrombocytopenic patients was safe, being associated with minor airway bleeding in 3 of 37 patients (8 percent). In conclusion, FOB with BAL, even via the transnasal route, may be performed with relative safety despite the presence of significant thrombocytopenia.

Adult↗
PubMed1993

Transmembrane segment prediction from protein sequence data.

We consider the automated identification of transmembrane domains in membrane protein sequences. 324 proteins (containing 1585 segments) were examined, representing every protein in the PIR database having the transmembrane domain feature annotation. Machine learning techniques were used to evaluate the efficacy of alternative hydrophobicity measures and windowing techniques. We describe a simpler measure of hydrophobicity and a new variable window size concept. We demonstrate that these techniques are superior to some previous techniques in minimizing the segment error rate. Using these new techniques, we describe an algorithm that has a 7.9% segment error rate on the sampled proteins, while classifying 16.7% of the amino acid residues as transmembrane.

Algorithms↗
PubMed1992

Surgical complications of intraoperative radiation therapy: the Radiation Therapy Oncology Group experience.

Intraoperative radiotherapy (IORT) is being used with increasing frequency in many institutions in the United States but little is known about the surgical complication rates. The Radiation Therapy Oncology Group initiated three prospective studies in IORT in 1986 and we report here the experience in advanced malignancies of the stomach, pancreas, and rectum. The incidence and nature of major surgical complications were reviewed and presented with their implications in regard to future IORT trials. Two hundred twenty-seven patients were entered on three studies by 20 participating institutions between 1985 and 1989. One hundred twenty-nine patients received IORT while 98 patients were found to have too advanced disease to be benefited by IORT and underwent palliative surgical procedures only. IORT doses ranged from 12-22 Gy and bowel anastomoses were not irradiated. Wound infection in the IORT group was 6% vs. 2% in the non-IORT patients but this was not significant at the P = 0.05 level. Other complications included anastomotic leak (n = 5), operative bleeding (n = 10), pancreatitis (n = 2), and were not statistically different in the IORT and non-IORT groups. The mortality rate for the IORT and non-IORT groups combined was 1.8%. This large multi-institutional experience in patients with advanced malignancy demonstrates that patients receiving IORT do not have a higher surgical complication rate than those not receiving IORT. Long-term survival data await the implementation of Phase III trials in advanced intra-abdominal malignancy.

Combined Modality Therapy↗