Showing papers by "Michael A. Province published in 1988"

Proliferative index of breast carcinoma by thymidine labeling: prognostic power independent of stage, estrogen and progesterone receptors.

Abstract: We studied cellular proliferation by measuring the tritiated thymidine labeling index (TLI) in slices of primary invasive breast carcinomas. Estrogen receptor (ER) and progesterone receptor (PgR) were measured by ligand-binding assay. The TLI was a strong independent predictor of survival and relapse-free survival in women with or without axillary lymph nodal metastases and in American Joint Committee stage I. In operable node-negative women treated surgically, predicted survival at 5 years was 89 ± 4% (probability±standard error) for 81 patients with low TLI (⩽3%), 64 ± 7% for 101 with mid TLI (3.1 – 8%), and 66 ± 6% for 86 with high TLI (>8%) (P = 0.001). Probabilities of survival for patients with positive axillary nodes were 79 ± 6% for 86 with low, 71 ± 7% for 71 with mid, and 52 ± 6% for 89 with high TLI (P = 0.0002). In stage I patients (tumor diameter not exceeding 2 cm), 5-year survival probabilities were 93 ± 4% in 70 with low, 72 ± 8% in 43 with mid, and 58 ± 10% in 35 with high TLI, (P = 0.0005). The TLI was predictive for survival and relapse-free survival within subgroups positive and negative for ER and positive for PgR (P<0.05) in stage I patients, and a predictive trend was observed in the PgR-negative subgroup (P = 0.16). TLI also predicted within different categories of vascular invasion and nuclear grade. A stepwise Cox proportional hazards model selected TLI, number of positive axillary lymph nodes, and maximum diameter of the breast carcinoma as independent variables predictive of relapse, and added ER as a fourth variable for prediction of survival.

Laryngeal/voice findings in patients with velopharyngeal dysfunction.

Abstract: It is reported frequently that individuals with palatal clefts have a high occurrence of laryngeal/voice symptoms. It has been speculated that vocal pathology in this population is the result of laryngeal compensation for abnormal velopharyngeal valving. This paper describes the prevalence of laryngeal/voice findings in a group of 85 patients referred for multimethod evaluation of velopharyngeal dysfunction. Forty-one percent of the patients had auditorily perceived voice symptoms and/or observable laryngeal abnormalities. Twenty-one percent of the patients had vocal fold nodules or thickened vocal folds. There was no clear relationship between laryngeal/voice findings and nasoendoscopic or aerodynamic assessments of velopharyngeal dysfunction. However, there was a significant relationship between laryngeal/voice findings and estimated subglottal pressure. Patients with laryngeal/voice findings (with or without nodules) had average estimated subglottal pressure values which were outside the normal range more often than patients without laryngeal/voice findings. These results suggest patients referred for assessment of velopharyngeal dysfunction should receive a comprehensive evaluation which includes screening laryngeal structure and function.

Familial aggregation in the presence of temporal trends.

Abstract: Models for assessing temporal trends in familial aggregation are described for both cross-sectional and longitudinal family data. Simultaneous linear structural equations on latent variables are used to model the dependence among family members. The coefficients of the equations are assumed to be parametric functions of time, so that quite complex temporal trends in familial aggregations can be accommodated. Variable family sizes and missing data values pose no problem as the parameters of the models are estimated via maximum likelihood techniques. One of the models is applied to systolic blood pressure data in 542 Japanese–American nuclear families. The results indicate limited evidence for temporal variation in the genetic expression, but that there is substantial temporal variation in environmental influences, which appear to peak at middle age.