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PubMedDate not supplied

Diagnostic electron microscopy in the U.S. Veterans Administration.

The diagnostic electron microscopy (EM) programme in the VA is described with emphasis on its central administrative aspects. There are now 45 separate diagnostic EM units, each directed by a pathologist who is initially provided with comparable resources and operates under a common administrative framework. Considerable autonomy in medical and scientific matters remains with the unit directors. Some experiences in the programme are displayed in numerical data for 1975 through 1979. Coordinated use of available EM resources for both diagnostic and research purposes is not occurring to develop better utilization. Preliminary efforts to assess the contributions of diagnostic EM in morphological diagnosis and in patient management are described.

Diagnostic Services↗
PubMed2007

Clinical implications of hepatic steatosis in patients with chronic hepatitis C: a multicenter study of U.S. veterans.

Studies have indicated a high prevalence of hepatic steatosis in patients with chronic hepatitis C (CHC). To address the impact of steatosis on the clinical course of CHC and treatment response requires large multicenter studies. The present study analyzed hepatitis C virus (HCV)-infected veterans enrolled in a U.S. Veteran Administration multicenter study of the epidemiology and response to interferon alpha-2b and ribavirin treatment. Of the 357 patients, 97.1% were males, with a mean age of 48.7+/-6.4 years, and 184 (51.5%) had hepatic steatosis. The mean body mass index (BMI) was 29.3+/-5.2 kg/m(2), including 37.1% who were obese (BMI, > or =30 kg/m(2)). Stage III-IV fibrosis was present in 111 of 334 (33.3%) of the patients. After adjusting for age, race, and history of alcohol use in the past 12 months, only stage III-IV fibrosis was independently and significantly associated with hepatic steatosis (P=0.03). There was a trend of association between obesity and steatosis independent of the other factors. Only HCV genotype was independently associated with a sustained virological response (SVR) to interferon alpha-2b and ribavirin treatment after adjusting for age, alcohol use, steatosis, BMI, stage III-IV fibrosis, serum AFP, and HCV load. In conclusion, analyses of our multicenter trial data demonstrated that the prevalence of hepatic steatosis is 51.5% in HCV-infected U.S. veterans. We found that steatosis is independently associated with stage III-IV fibrosis. However, only HCV genotype, and not steatosis, obesity, or stage III-IV fibrosis, was associated with SVR to interferon alpha-2b and ribavirin treatment.

Adult↗
PubMed2000

The Washington University-EPRI Veterans' Cohort Mortality Study: preliminary results.

This article presents the design of and some results from a new prospective mortality study of a national cohort of about 50,000 U.S. veterans who were diagnosed as hypertensive in the mid 1970s, based on approximately 21 yr of follow-up. This national cohort is male with an average age at recruitment of 51 +/- 12 yr; 35% were black and 81% had been smokers at one time. Because the subjects have been receiving care at various U.S. Veterans Administration (VA) hospitals, access to and quality of medical care are relatively homogeneous. The health endpoints available for analysis include all-cause mortality and specific diagnoses for morbidity during VA hospitalizations; only the mortality results are discussed here. Nonpollution predictor variables in the baseline model include race, smoking (ever or at recruitment), age, systolic and diastolic blood pressure (BP), and body mass index (BMI). Interactions of BP and BMI with age were also considered. Although this study essentially controls for socioeconomic status by design because of the homogeneity of the cohort, selected ecological variables were also considered at the ZIP code and county levels, some of which were found to be significant predictors. Pollutants were averaged by year and county for TSP, PM10, CO, O3, and NO2; SO2 and Pb were considered less thoroughly. Both mean and peak levels were considered for gases. SO(4)2- data from the AIRS database and PM2.5, coarse particles, PM15, and SO(4)2- from the U.S. EPA Inhalable Particulate (IP) Network were also considered. Four relevant exposure periods were defined: 1974 and earlier (back to 1953 for TSP), 1975-1981, 1982-1988, and 1989-1996. Deaths during each of the three most recent exposure periods were considered separately, yielding up to 12 combinations of exposure and mortality periods for each pollutant. Associations between concurrent air quality and mortality periods were considered to relate to acute responses; delayed associations with prior exposures were considered to be emblematic of initiation of chronic disease. Preexposure mortality associations were considered to be indirect (noncausal). The implied mortality risks of long-term exposure to air pollution were found to be sensitive to the details of the regression model, the time period of exposure, the locations included, and the inclusion of ecological as well as personal variables. Both positive and negative statistically significant mortality responses were found. Fine particles as measured in the 1979-1984 U.S. EPA Inhalable Particulate Network indicated no significant (positive) excess mortality risk for this cohort in any of the models considered. Among the positive responses, indications of concurrent mortality risks were seen for NO2 and peak O3, with a similar indication of delayed risks only for NO2. The mean levels of these excess risks were in the range of 5-9%. Peak O3 was dominant in two-pollutant models and there was some indication of a threshold in response. However, it is likely that standard errors of the regression coefficients may have been underestimated because of spatial autocorrelation among the model residuals. The significant variability of responses by period of death cohort suggests that aggregation over the entire period of follow-up obscures important aspects of the implied pollution-mortality relationships, such as early depletion of the available pool of those subjects who may be most susceptible to air pollution effects.

Aged↗
PubMed1983

Selected factors in the risks of upper alimentary cancers.

This study investigates whether liver cirrhosis, alcoholic beverages, smoked tobaccos, age, occupations, and multiple primary cancers are significant risk factors for malignancies of the upper alimentary tract. It utilizes maximum likelihood estimates of logistic parameters in multivariate analyses of these factors to assess risks of upper alimentary cancers (UAC) among 529 cancer patients, 204 with liver cirrhosis and 325 without liver cirrhosis. All patients are black males, discharged from U.S. Veterans Administration Hospitals from 1969 to 1975 with newly diagnosed and histologically confirmed primary cancers. In comparison with cirrhotics without UAC, cirrhotics with UAC have similar frequencies of liver cirrhosis by type, severity, and histological confirmation but are notably younger and have liver cirrhosis before cancer at a significantly higher frequency and over a significantly longer period. When there is simultaneous adjustment for all six factors, only liver cirrhosis, age, and multiple primaries (mainly at floor of mouth, soft palate, and esophageal sites) are significantly associated with increased cancer risk at upper alimentary sites where such processes as glycogen storage in some squamous cells, as obtains in the liver, may contribute to further elucidation of the implication of liver cirrhosis as a major pathway in cancer risk at upper alimentary sites.

Alcohol Drinking↗
PubMed2003

A prospective trial of primary inguinal hernia repair by surgical trainees.

The main hypotheses were that the Lichtenstein inguinal hernia repair has a lower recurrence rate and similar incidence of chronic groin pain compared to sutured repairs when performed by surgical trainees. In a U.S. Veterans Administration Hospital, 150 primary hernia repairs were randomized to a Lichtenstein, McVay, or Shouldice repair. The Shouldice repair included a routine relaxing incision. First- and second-year residents, under the supervision of an experienced general surgeon, performed the procedure. Long-term follow-up was obtained in 81% of patients. Hernia recurrence rate was Lichtenstein 8%, McVay 10%, Shouldice 5% ( P>0.1) at 6-9 years follow-up. More patients had chronic groin pain following Lichtenstein repair (38%) than after Shouldice repair (7%) ( P<0.05). More information is needed on long-term groin pain following anterior mesh repair. The Shouldice inguinal hernia repair may have a role in open primary herniorrhaphy to decrease the risk of chronic groin pain.

Adult↗
PubMed1994

Standard approach to antiepileptic drug treatment in the United States.

Antiepileptic drugs (AEDs) are administered to patients for acute and long-term treatment of seizures. Most patients with acute convulsions receive intravenous (i.v.) benzodiazepine (BZD), frequently followed by i.v. loading with phenytoin (PHT), especially when seizures continue. For patients with absence status epilepticus, BZD is usually followed by ethosuximide (ESM) or valproate (VPA). The decision to continue AED therapy is based on the likelihood that seizures will continue or recur. Once epilepsy is diagnosed, long-term treatment with AEDs is recommended, beginning with monotherapy. Two studies sponsored by the U.S. Veterans Administration (VA), which compared the efficacy of carbamazepine (CBZ), PHT, phenobarbital (PB), primidone (PRM), and VPA, recommend that most adults with recurrent partial seizures receive either CBZ or PHT. The 1992 VA study suggests that VPA is equal to CBZ or PHT in efficacy when partial seizures become secondarily generalized. Primary generalized epilepsies are most frequently treated with VPA when combinations of generalized seizures exist. ESM is prescribed most often when typical childhood absence seizures exist alone. Although many authorities do not recommend long-term treatment of childhood febrile seizures, PB is administered by some when febrile seizures have complex symptomatology. In general, AED monotherapy is currently preferred, but those with more refractory epilepsy receive polytherapy. CBZ, PHT, PB, PRM, VPA, and ESM are the primary AEDs prescribed in the United States. PHT, followed by CBZ and VPA, is the most frequently prescribed AED as both new and total prescriptions. The introduction of felbamate, gabapentin,and lamotrigine may alter these patterns in the future.

Adult↗
PubMed1998

A trivariate distribution for the height, weight, and fat of adult men.

Using exploratory data analysis, probability plots, scatterplots, and computer animations to rotate and visualize the data, we fit a trivariate Normal distribution to data for the height, the natural logarithm of body weight, and the body fat for 646 men between the ages of 50 and 80 years as reported by the medical staff of the U.S. Veterans Administration's "Normative Aging Study" in Boston, MA. Although these data do not include any children, women, or young men, the measurements represent the best data that we could find through a 4-year search. We believe that these data are well measured and reliable for men in the specified age range and that these data reveal an interesting statistical pattern for use in probabilistic PBPK models.

Adipose Tissue↗
PubMed1965

INTERACTION OF VISCID MATERIAL OF STAPHYLOCOCCUS AUREUS WITH SPECIFIC IMMUNE SERUM.

Mudd, Stuart (U.S. Veterans Administration Hospital, Philadelphia, Pa.), and Samuel J. DeCourcy, Jr. Interaction of viscid material of Staphylococcus aureus with specific immune serum. J. Bacteriol. 89:874-879. 1965.-Re-examination of the phenomenon of Price and Kneeland and of Wiley revealed the following. (i) The prototype "wound strain" of Wiley, and viscid-colony strains obtained by aging and selection of laboratory or field strains, differed in growth characteristics in liquid and solid media from the Smith encapsulated strain and from ordinary, unselected laboratory and field strains of coagulase-positive staphylococci. (ii) The wound strain and ordinary unselected strains, unlike the Smith encapsulated strain, did not exhibit capsules when examined in thin films of Pelikan Waterproof Drawing Ink. (iii) The phenomenon of Price and Kneeland and of Wiley is exhibited when the wound strain and other viscid-colony strains interact with anti-Wiley immune sera or various human sera. In our experience, this phenomenon was not exhibited by the Smith or by ordinary, unselected strains. (iv) The staphylococcal polysaccharide antigen previously characterized as the capsular substance of a Smith-like strain was completely different chemically and serologically from extracellular material prepared from the Wiley wound strain. We conclude that the viscid-colony strains are not, in fact, encapsulated, and that the phenomenon in question is a precipitation of extracellular material about the periphery of the cells.

Culture Media↗
PubMed1966

Role of serum in the intracellular killing of staphylococci in rabbit monocytes.

Shayegani, Mehdi G. (U.S. Veterans Administration Hospital, Philadelphia, Pa.), and Stuart Mudd. Role of serum in the intracellular killing of staphylococci in rabbit monocytes. J. Bacteriol. 91:1393-1398. 1966.-Although some intracellular killing occurs in rabbit monocytes with heated normal serum or even in monocytes washed three times with Hanks' solution and with staphylococci not exposed to serum, efficient killing of coagulase-positive Staphylococcus aureus cells in the mononuclear phagocytes of rabbits is shown to require heat-labile components of serum. The effect of serum in promoting phagocytosis and intracellular killing may be exhibited either by presensitization of the staphylococcal cells before contact with leukocytes or by the presence of serum in the phagocytic system. Under any conditions studied the rate of intracellular killing of S. aureus is very slow.

Animals↗