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PubMedDate not supplied

Prognostic value of thyroid hormone levels in patients evaluated for liver transplantation.

The thyroid hormones T4, T3, rT3 and TSH were assayed in 134 adult patients evaluated and accepted as potential liver transplant candidates at the University of Pittsburgh from March, 1981 to December, 1983. The subsequent course of these patients was evaluated with respect to the levels of these hormones obtained at the time of acceptance for transplantation. T4 levels were increased significantly while their T3 levels were reduced (both p less than 0.01) in those who survived and were discharged home as compared to either those who died waiting to be transplanted or died following the procedure. As a result, the ratio of T3/T4 was reduced markedly (p less than 0.01) in those who were transplanted and survived as compared to those not transplanted or dying following transplantation. Importantly, the rT3 levels clearly separated (p less than 0.01) those who would die prior to transplantation from those who would survive to be transplanted. Finally, the ratio rT3/T3 even more clearly separates those who will die prior to transplantation (p less than 0.01) from the other two groups. These data suggest that thyroid hormone levels, particularly rT3 levels, might be useful in setting priorities for which patients referred for a transplantation evaluation should be accepted into the program and in determining who among accepted patients should be operated upon in preference to others also accepted and waiting to be transplanted.

Carcinoma, Hepatocellular↗
PubMed1995

The television, school, and family smoking prevention and cessation project. VIII. Student outcomes and mediating variables.

BACKGROUND: This paper presents the student outcomes of a large-scale, social-influences-based, school and media-based tobacco use prevention and cessation project in Southern California. METHODS: The study provided an experimental comparison of classroom delivery with television delivery and the combination of the two in a 2 x 2 plus 1 design. Schools were randomly assigned to conditions. Control groups included "treatment as usual" and an "attention control" with the same outcome expectancies as the treatment conditions. Students were surveyed twice in grade 7 and once in each of grades 8 and 9. The interventions occurred during grade 7. RESULTS: We observed significant effects on mediating variables such as knowledge and prevalence estimates, and coping effort. The knowledge and prevalence estimates effects decayed partially but remained significant up to a 2-year follow-up. The coping effort effect did not persist at follow-ups. There were significant main effects of both classroom training and TV programming on knowledge and prevalence estimates and significant interactions of classroom and TV programming on knowledge (negative), disapproval of parental smoking, and coping effort. There were no consistent program effects on refusal/self-efficacy, smoking intentions, or behavior. CONCLUSIONS: Previous reports demonstrated successful development and pilot testing of program components and measures and high acceptance of the program by students and parents. The lack of behavioral effects may have been the result of imperfect program implementation or low base rates of intentions and behavior.

Child↗
PubMed1994

CD40 ligation in B cell activation, isotype switching and memory development.

Interaction of CD40 on B cells with its ligand on activated T helper cells is crucial for the generation of mature T-dependent antibody responses. Experimental observations suggest that CD40 ligation acts at several points in B cell differentiation; however, it is not clear whether the consequences of ligation are direct or indirect. While its role in B cell activation is clearly direct we discuss the several ways in which it might drive isotype switching, the influence that it has on the development of memory B cells and the possibility that certain types of T-dependent antibody response are CD40L-independent. Experiments in which the ligation of CD40 is blocked in vivo reveal that early CD40 signals are important for the development of memory B cells but this may only reflect the ability of 'memory precursors' generated by CD40 ligation to accept subsequent programming or survival signals.

Animals↗
PubMedDate not supplied

Concomitant adjuvant chemotherapy and radiotherapy for high risk breast cancer patients.

Thirty four patients treated with mastectomy and axillary node dissection for potentially curable breast cancer received a seven month combined adjuvant chemotherapy and radiation therapy program. These patients were considered to be at high risk for recurrence because they had either three or more positive axillary lymph nodes or their primary tumor was greater than 5 cm in diameter. The chemotherapy given at 3-week intervals consisted of cyclophosphamide, 600 mg/m2, Adriamycin 40 mg/m2, and methotrexate 40 mg/m2 during cycles 1 through 3 and 7 through 9. Radiation therapy was administered during cycles 4 through 6 with concomitant administration of 5-fluorouracil 600 mg/m2, vincristine 1.4 mg/m2, and prednisone 40 mg/m2 for 7 days. Median follow up time from initiation of study is 60 months (range 36-93). Seventeen of 34 patients (50%) remain free of recurrent breast cancer. Distant metastases and local-regional recurrence have occurred in 16 (47%) and 4 (12%) patients, respectively. Significant myelosuppression and infections requiring hospitalization were seen in 4 patients, with 1 treatment-related death. Adriamycin-containing chemotherapy and post-operative radiotherapy can thus be combined in an adjuvant treatment program with acceptable toxicity.

Adult↗
PubMed1999

A client server model to facilitate creation of a medical image teaching library.

A simple and convenient system for indexing and archiving medical images used in teaching was developed. The approach was to combine a smart client-side graphical user interface that controlled image size, file format, and keyword structure, and communicated with the hospital information system via hypertext mark-up language, to populate the interface with user selectable pull-down menus. The result is a system that is easily extensible beyond the radiology images for which it was originally designed. Only minor modifications of the client interface are required to adapt the program to accept any file format or image type.

Computer-Assisted Instruction↗
PubMedDate not supplied

Evaluation of a bayesian pharmacokinetic program for phenytoin concentration predictions in outpatient population.

The present work evaluates the performances of a Bayesian program (PKS) for phenytoin concentration predictions in an outpatient population. The retrospective study involved 19 epileptic adults receiving oral phenytoin. The program was used to predict estimated serum concentrations from 0, 1, 2 or 3 feedback concentrations. Measurements of prediction bias (ME) decreased as soon as one steady-state concentration (Css) was used for estimations. Precision (MAE) was significantly improved with 1 Css and was even better and stable with 2 and 3 Css. Likewise, RMSE (composite of bias and precision) regularly decreased when the number of Css used increased. On a clinical way, 12% of the estimations were unacceptable (prediction error > 5 mg/l) with 1 Css and less than 3% with 2 or 3 Css. This number of rejected estimations increased to 45% when no feedback concentration was used. Besides, the program was able to predict important rises of serum levels in spite of relative low increase of the dose when 1 Css at least was known. Thus, the phenytoin dosing program has acceptable performances when at least 1 Css is known, and represents a potential tool to assist the clinician in the particular condition of outpatient population.

Adolescent↗
PubMed2004

Familial pancreatic carcinoma in Jews.

Pancreatic cancer (PC) is the most fatal of all gastrointestinal cancers, wherein its mortality compares strikingly with its incidence. Unfortunately, 80-90% of PCs are diagnosed in the nonresectable stage. While the lifetime risk of PC in developed countries is approximately 1-3%, it is the fifth most common cause of cancer deaths among both males and females in Western countries. It occurs in excess in Jews. Approximately 5-10% of PC shows familial clustering. Examination of such familial clusters must take into consideration cancers of diverse anatomic sites, such as malignant melanoma in the familial atypical multiple melanoma (FAMMM) syndrome due to the CDKN2A (p16) germline mutation, and combinations of colorectal and endometrial carcinoma, ovarian carcinoma, and several other cancers in hereditary nonpolyposis colorectal cancer (HNPCC), which are due to mismatch repair germline mutations, the most common of which are MSH2 and MLH1 . Other hereditary disorders predisposing to PC include Peutz-Jeghers syndrome, due to the STK11 mutation, familial pancreatitis due to the cationic trypsinogen gene, site-specific familial pancreatic cancer which may be due to the 4q32-34 mutation, hereditary breast-ovarian cancer (HBOC) syndrome that is due to BRCA2 and possibly some families with HBOC that is due to BRCA1 , familial adenomatous polyposis due to the ATP gene, and ataxia telangiectasia due to the ATM germline mutation. This extant heterogeneity mandates that the physician be knowledgeable about these PC-prone syndromes which play such an important role when considering the differential diagnosis of hereditary PC. Unfortunately, there are no PC screening programs with acceptable sensitivity and specificity. However, the gold standard for screening at this time is endoscopic ultrasound. Clearly, there is a great need for the development of novel screening approaches with acceptable sensitivity and specificity. Further research is needed to elucidate those etiologic factors that contribute to the apparent excess of PC in Ashkenazi Jews. Attention should also be given to the search for mutations predisposing to PC in Jews so that opportunities to learn more about the disease's pathogenesis, as well as screening and control, may take place.

Adult↗
PubMed1982

A conversational microcomputer-based health risk appraisal.

We have developed a conversational microcomputer-based health risk appraisal program. This appraisal has been tested on over 200 users at 3 locations in urban and suburban Minneapolis. It was considered helpful by 92% of its users, and 25% stated that they would probably or definitely change a living habit based on its use. All 3 populations considered it comparably helpful, irrespective of their different age and sex distributions. A complex health appraisal, which was formerly assumed to require batch processing on a large computer, can be carried out on a small personal system in an interactive mode. Such a program is acceptable to users and has the potential to motivate change in risky behavior.

Adult↗
PubMed1993

Clustering on the basis of longitudinal data.

A menu-drive PC program, ZDIST, for computing the distances between the estimated polynomial growth curves of subjects who have been followed longitudinally is described, illustrated, and made available to interested readers. These distances can be computed on the basis of the individual growth curves themselves and/or from estimates of individuals' growth velocity and acceleration curves. The resulting distance matrices can be saved in ASCII format and subsequently imported into any clustering program which accepts this type of input, e.g. SYSTAT.

Achondroplasia↗
PubMed1985

Pregnancy, childbirth, mother and child care among the indigenous people of Zimbabwe.

Even in areas of Zimbabwe with easy access to Western-type delivery care, the majority of women are cared for and delivered by traditional birth attendants who are members of their extended family. To understand the social, cultural context of pregnancy, childbirth and subsequent maternal and child care and to use this information for the improvement of maternal and child-health care an anthropological investigation was conducted in an area near Harare, Zimbabwe from June 1983 to the end of 1984. Certain aspects of childbirth such as primagravida deliveries and the origins of peripartum complications, are intimately linked to the religious beliefs and values; other aspects such as the relationship of nutrition and pregnancy are not so linked. An understanding of the traditional concepts of pregnancy, delivery and child care is invaluable if not essential for the upgrading of pregnancy and delivery care, the elimination of harmful practices and the building of supportive links between the traditional and the formal health system.

Female↗
PubMed1991

Negative cross-match selection of HLA-DR compatible kidneys for highly sensitised patients.

Patients who have developed alloantibodies against almost all foreign HLA antigens are very difficult to transplant, because the cross-match with potential donors is often positive. The ideal donor for such patients is an HLA identical or compatible donor, but due to the enormous polymorphism of the HLA complex, the chance of finding such a donor is very small. The acceptable mismatch program, which takes advantage of the HLA-A and B antigens toward which the patient has not developed antibodies, and HLA-DR matching in the computerised selection of kidney donors, has significantly decreased the waiting time for these highly sensitised patients. Furthermore, graft survival is similar to that of non-highly sensitised patients.

Graft Survival↗
PubMedDate not supplied

Osteoporosis: impact on the elderly societal concerns, and the role of radiology.

Osteoporosis has recently become a concern in both the medical and lay communities. Osteoporosis may be defined as a decrease in bone mass with maintenance of normal bone composition. The increase in bone fragility results in an increased incidence of fractures. The disease most commonly affects postmenopausal women, particularly Caucasians. It is estimated that 1.2 million fractures per year can be attributed to osteoporosis. These fractures cost the health care system approximately $18.1 billion per year. Given the magnitude of the health and attendant financial problems, osteoporosis deserves the attention of clinicians and researchers. This article will deal with the pathophysiologic processes, techniques for bone mineral determination, therapeutic regimens and the advisability of mass screening. The relationship between bone mineral content and fracture risk has not been clearly defined. If every American woman between the ages of 40 and 54 years were given a single bone mineral screening examination, the cost would be approximately $187.5 million/year. At this price and in the absence of accepted treatment programs, it does not seem prudent for radiologists or other physicians to recommend expensive mass screening.

Aged↗
PubMed2004

Effects of a home walking exercise program on functional status and symptoms in heart failure.

BACKGROUND: Hospital-based exercise programs using a bicycle ergometer or a combination of exercise modalities have shown positive benefits in heart failure, but may not be readily accessible to many patients. Thus, we sought to evaluate the effects of a 12-week home walking exercise program on functional status and symptoms in patients with heart failure. METHODS: A randomized controlled trial comparing a 12-week progressive home walking exercise program (n = 42) to a "usual activity" control group (n = 37) was conducted in patients with heart failure (78 [99%] male; mean age 62.6 +/- 10.6 years; ejection fraction 27% +/- 8.8%; 63 [80%] New York Heart Association class II; 15[20%] New York Heart Association class III-IV) from a Veterans Affairs medical center and a university-affiliated medical center. Functional status (peak oxygen consumption via cardiopulmonary exercise testing, 6-minute walk test, the Heart Failure Functional Status Inventory), and symptoms (Dyspnea-Fatigue Index score with a postglobal rating of symptoms) were measured at baseline and 12 weeks. RESULTS: No adverse events related to exercise training occurred. Overall mean compliance to training was 74 +/- 37%. Peak oxygen consumption and the Heart Failure Functional Status Inventory were unchanged with training. Compared to the usual activity group, the training group had significantly longer walking distances measured by the 6-minute walk test (1264 +/- 255 vs 1337 +/- 272 feet, P =.001), and improved postglobal rating of symptoms (P =.03). CONCLUSION: In patients with heart failure, a progressive home walking exercise program is acceptable, increases walking distance, and decreases global rating of symptoms.

Aged↗
PubMed2005

Support surfaces: beds, mattresses, overlays-oh my!

The prevention and treatment of pressure ulcers are major concerns for health care providers across the care continuum. The selection of a support surface is an important component of a comprehensive pressure ulcer prevention program. The accepted standard in clinical practice for pre-venting pressure ulcers and other complications of immobility is to either turn patients manually at frequent intervals or to use a pressure-reducing device. The longer a patient is immobilized, the more profound will be the systemic complications. The costs associated with the complications of immobility are staggering in terms of human suffering, physiologic damage,and real dollars. A variety of specialty beds, mattresses, and overlays have been designed to address pressure, shear, friction, and moisture. Limited data exist regarding the efficacy of these products. Clinicians want to choose a support surface for their patients on the basis of product performance. With the push toward establishing standards for testing methods and reporting information, clinicians can look forward to making support surface decisions based on the evidence and outcome data resulting from controlled clinical studies and expert opinion and consensus.

Beds↗
PubMed2005

Lack of impact of human leukocyte antigen matching in living donor kidney transplantation: experience at Akdeniz University.

Lack of expansion of the deceased donor supply has resulted in a severe shortage of organs worldwide. Spousal donors are one possible alternative organ source for patients on the kidney transplant waiting list. Despite human lymphocyte antigen (HLA) matching between recipients and unrelated donors being poor, the reported survival rates for these grafts, including spouses, are comparable to those for grafts from living related donors and higher than those for deceased donor kidneys. In 2000, our renal transplantation program began accepting living donor-recipient pairs with one or zero HLA matches. The purpose of this study was to assess this policy for accepting living unrelated donors. The 3-year graft survival rates for the transplants from living unrelated donors were similar to that for transplants from living related donors (log-rank = 0.078). The number of HLA mismatches did not significantly influence the survival rates for either of these groups of living donor transplants. Multivariate analysis revealed that dialysis duration (P = .057) and recipient age (P = .066) negatively influenced patient survival in living donor kidney transplantation. The graft and patient survival rates for the donor transplantations were higher than those for deceased donor transplantations. In light of these findings and considering the increasing problem of organ shortage, we conclude that living unrelated kidney transplantation should be performed, with strict guidelines. Spousal donation is the most favorable form of living unrelated renal transplantation.

Adult↗
PubMed1991

Prerequisites for successful human sperm cryobanking: sperm quality and prefreezing holding time.

Frozen-thawed donor semen was used in artificial inseminations and in vitro fertilization programs. Semen accepted for donation was characterized (mean +/- SE) by sperm concentration of 150 +/- 18.6 x 10(6)/mL, normal morphology of 57% +/- 1.4%, good progressive motility at 1 hour of 57% +/- 1.0%, and post-thaw motility of 45% +/- 1.0%. Delay of the freezing process for greater than 1 hour after semen delivery caused a deleterious effect to the freezability of sperm. The average monthly fecundability for the 1st 6 months after inseminations was 13.6%. This value decreased dramatically to 2.6% from the 7th month onward. In 74 IVF/embryo transfer (ET) cycles, the fertilization rate was 55.3% +/- 3.8%, pregnancy rate (PR) per ET was 39.6%, and the PR per woman was 42.8%.

Cryopreservation↗
PubMed1985

Worldwide patterns of infertility: is Africa different?

The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples. The study was conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world. Over 5800 couples completed the investigation. African centres had a pattern of infertility different from those in other developing regions or the developed countries. African couples were more likely than those from elsewhere to have secondary infertility or longer duration, a history of sexually transmitted diseases or pregnancy complications, and infertility diagnoses (such as bilateral tubal occlusion or pelvic adhesions) suggestive of previous genital infections.

Adult↗