Biomedical subjects
Publications and source records attributed to S Phelan.
A 10-year-old girl presented with abdominal distension and vomiting due to a jejunojejunal bowel fistula, forming a blind loop. This was related to neonatal necrotizing enterocolitis (NEC) in her first few weeks of life, which was followed by apparently a full recovery. We would like to raise awareness of possible long-term gastrointestinal sequelae in children who have had NEC.
PURPOSE: Intramuscular vascular malformations are uncommon lesions in the head and neck that may mimic salivary gland disease. This study reports on the use of various imaging modalities and recommends a surgical approach in the management of vascular malformations of the masseter muscle. PATIENTS AND METHODS: This is a retrospective study of 7 consecutive patients with vascular tumors of the masseter muscle treated in one unit between 1995 and 2004. The age, gender, signs and symptoms, imaging methods, and surgical outcome are reported. A previously unreported surgical approach is described. RESULTS: All patients had atypical swellings in and around the parotid region that were difficult to diagnose on plain radiography and computed tomography. Magnetic resonance imaging provides accurate three-dimensional images and provisional diagnosis of lesions within the masseter muscle. Six of the 7 patients underwent surgery by the recommended approach. No patients developed permanent facial weakness following modified parotidectomy. No recurrence of the vascular tumors occurred when the recommended approach is used. CONCLUSIONS: Magnetic resonance imaging remains the imaging modality of choice for the management of tumors of the masseter muscle. The extended parotidectomy approach gives good and safe surgical access in the management of these uncommon lesions.
Although cycloooxygenase-2 (COX-2) is upregulated by factors associated with oral mucositis, its role in the pathogenesis of mucositis has not been studied. We investigated the kinetics of mucosal COX-2 expression following radiation exposure, and assessed its relationship to the development of oral mucositis in an established animal model using immunohistochemical endpoints. While little or no COX-2 expression was observed in unirradiated mucosa or in tissue taken 2 days after radiation, COX-2 expression was dramatic on days 10 and 16, especially in submucosal fibroblasts and endothelium. The kinetics of COX-2 expression paralleled mucositis severity. A burst of angiogenic activity was seen on day 21 following peak COX-2 expression. The kinetics of COX-2 expression relative to mucositis progression suggests that COX-2 is not a primary driver of radiation injury, but instead plays an amplifying role.
OBJECTIVE: The present study examined whether long-term weight loss maintenance is enhanced by maintaining the same diet regimen across the week and year or by dieting more strictly on weekdays and nonholiday periods than at other times. METHOD: National Weight Control Registry participants (N=1429) indicated on an eight-point scale whether they dieted more strictly on weekends than weekdays, adhered to the same diet regimen throughout the week, or dieted more strictly on weekdays. Participants responded to a similar question about holiday and vacation eating. Participants were then followed prospectively to determine whether scores on these questions were related to self-reported weight regain over the subsequent 12 months. RESULTS: There was a linear relationship between scores on the dieting consistency questions and weight change over the 1-y period (P's <0.01), with smaller weight gains in those who reported more consistency. Participants who reported a consistent diet across the week were 1.5 times more likely to maintain their weight within 5 pounds over the subsequent year (OR=1.58, 95% CI: 1.2-2.2) than participants who dieted more strictly on weekdays. A similar relationship emerged between dieting consistency across the year and subsequent weight regain. CONCLUSION: Dieting consistency appears to be a behavioral strategy that predicts subsequent long-term weight loss maintenance.
Oral mucositis is a common, dose-limiting, acute toxicity of radiation therapy administered for the treatment of cancers of the head and neck. Accumulating data would suggest that the pathogenesis of mucositis is complex and involves the sequential interaction of all cell types of the oral mucosa, as well as a number of cytokines and elements of the oral environment. While a number of studies have reported on gene expression of particular cell types in response to radiation, the overall response of irradiated mucosa has only been evaluated in a limited way. The present study was undertaken to evaluate the expression of a target group of genes using RNA quantification assays and, more broadly, to assess patterns of mucosal gene expression using DNA microarray hybridization. Our results demonstrate the sequential upregulation of a series of genes that, when taken collectively, suggest an intricate functional interaction.
BACKGROUND: Despite considerable professional consensus that modest weight losses of 5% to 10% are successful for reducing the comorbid conditions associated with obesity, obese patients often desire weight losses 2 to 3 times greater than this. Examining ways to reduce the disparities between treatment expectations and subsequent outcomes, this study evaluated the role of physical characteristics, treatment setting, and mood in patients' evaluations of treatment outcomes. METHODS: This study was conducted in a university outpatient weight loss clinic with a sample of 397 obese individuals seeking weight loss by a variety of modalities. Before treatment, participants' heights and weights were measured, and the Beck Depression Inventory and the Goals and Relative Weight Questionnaire were administered. RESULTS: Outcome evaluations ranged from 64.4 +/- 11.1 kg (mean +/- SD) for dream weight to 90.1 +/- 19.1 kg for disappointed weight. Initial body weight was the strongest predictor of disappointed, acceptable, and happy weights (beta =.90,.76, and.57, respectively). Sex (beta = -.37) and height (beta =.37) were the strongest determinants of dream weight. Heavier participants chose higher absolute weights, but the weight loss required to reach each of the outcomes was greater for heavier than for lighter patients. CONCLUSIONS: These data signal a therapeutic dilemma in which the amount of weight loss produced by the best behavioral and/or pharmacologic treatments is viewed as even less than disappointing. Patients with the highest pretreatment weights are likely to have the most unrealistic expectations for success.
OBJECTIVE: To determine weight loss maintenance among participants in a commercial weight loss program (Weight Watchers) who had reached their goal weights 1-5 y previously. DESIGN: A national sample (n=1002) was surveyed by phone to obtain demographic and weight-related information. An oversample (n=258) was recruited and weighed in person to develop a correction factor for self-reported weights in the national sample. RESULTS: Based on corrected weights, weight regain from 1 to 5 y following weight loss ranged between 31.5 and 76.5%. At 5 y, 19.4% were within 5 lb of goal weight, 42.6% maintained a loss of 5% or more, 18.8% maintained a loss of 10% or more, and 70.3% were below initial weight. CONCLUSIONS: These results are not directly comparable to those obtained in clinical settings because of differences in the populations studied. Nonetheless, they suggest that the long-term prognosis for weight maintenance among individuals who reach goal weight in at least one commercial program is better than that suggested by existing research.
BACKGROUND: This study presents findings on the effect of an office-based obstetrics training program (given the acronym OBIWOM) on substance use assessment, management, and referral self-efficacy among obstetricians and staff of private, community-based obstetric practices. METHODS: Participants were obstetricians and staff from 10 of 27 available community-based, private obstetric practices in the target areas, for a practice participation rate of 37%. This study used a delayed treatment design to compare self-efficacy between practice staff randomly assigned to an immediate or delayed intervention group. RESULTS: Self-efficacy increased significantly after intervention from baseline to first follow-up for the immediate group, while no change was shown for the delayed (control) group. The impact of the intervention on self-efficacy was replicated in the assessment construct only after the intervention for the delayed group. CONCLUSION: This research shows that education and training can effectively improve self-efficacy in obstetricians and their staff in the management of substance use and pregnancy.
OBJECTIVE: This paper describes an initial, 4-week evaluation of a commercial weight loss program. RESEARCH METHODS AND PROCEDURES: Respondents (n = 985) to newspaper advertisements in two metropolitan areas were assigned to 4 weeks of either the Weight Watchers program or to a Self-Help condition. Weight loss, psychological vitality, and eating behavior were evaluated before and after the 4-week intervention. RESULTS: Weight Watchers participants showed greater improvements than Self-Help participants on all measures; weight losses averaged 1.87 and 0.77 kg, respectively. The superior outcomes shown by Weight Watchers participants on measures of vitality and eating behavior were still evident when extent of weight loss was controlled. Weight losses across different sites, incomes, and levels of obesity were similar. DISCUSSION: Although the present study's intervention and outcome assessments were short-term, the promising results obtained suggest that longer term studies should be undertaken.
BACKGROUND: Professional attributes such as honesty, integrity, and reliability are critical to success in medical school and postgraduate practice, yet such noncognitive attributes have traditionally been poorly evaluated. METHOD: A program of evaluating students' noncognitive professional attributes at the University of New Mexico School of Medicine was reviewed over a four-year period, from 1987-88 through 1990-91, involving the approximately 525 students enrolled at the school at that time. The evaluation program enabled faculty and staff to quantify their impressions of problem students in a uniform manner, by using an evaluation form that listed and described seven basic professional traits. RESULTS: Over the study years the program identified ten students with difficulties in the basic science and clinical years regarding their character and professionalism. For these ten students, interventions ranged from nothing being done, in one case, to such significant remediations as recommendations of extensive counseling and a leave of absence. One student was dismissed, on the basis of poor academic performance, and the other nine have graduated. In some cases, students noticeably improved their professional behaviors, but whether their behaviors changed as a result of the interventions can't be determined. CONCLUSION: By identifying and tracking students with difficulties, the program offers the opportunity for intervention and, ideally, remediation. This program can complement systems that evaluate academic performance. Such a program can help an institution assure not only the cognitive competence of its graduates, but the competence of their professional behaviors as well.
Although uncommon, testosterone producing neoplasms of the ovary and the adrenal cortex occur periodically. Forty-seven instances involving the adrenal gland have been published since 1925; five, including the present patient, have occurred since 1981. Confusion concerning the site of the androgen secretion has been generated in the past because of limited roentgenographic study and the poor predicability of selective suppression or stimulating testing of the adrenal gland and the ovary. Of the 22 patients with testosterone producing neoplasms of the adrenal cortex reported since 1973, 45 per cent underwent needless ovarian surgical treatment prior to the correct diagnosis. By recognizing the significant correlation between a serum testosterone of 200 nanograms per deciliter or greater, a serum dehydroepiandrostenone of greater than 6,600 nanograms per milliliter coupled with a thorough pelvic examination, pelvic ultrasound and a more liberal use of high resolution computerized tomography of the adrenal gland, the correct diagnosis can be made. The patient presented herein illustrates the pitfalls inherent in the management of a patient with this problem.