Showing papers by "Rush University Medical Center published in 1987"

Surgical pathologic spread patterns of endometrial cancer: A gynecologic oncology group study

Abstract: The surgical pathologic features of 621 patients with Stage I carcinoma of the endometrium are presented. All patients were treated with primary surgery consisting of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and paraaortic lymphadenectomy and peritoneal cytology. An appreciable number of patients (144—22%) with Stage I cancers have disease outside of the uterus (lymph node metastasis, adenexal disease, intraperitoneal spread and/or malignant cells in peritoneal washings). Multiple prognostic factors particularly grade and depth of invasion are related to extrauterine disease. This study adds credence to the primary surgical approach with individualized postoperative therapy as indicated.

Incidence and characteristics of pain in a sample of medical-surgical inpatients.

Abstract: The purposes of this study were to determine the incidence and characteristics of pain in hospitalized patients and to explore the type and perceived effectiveness of pharmacologic and nonpharmacologic therapies. Three hundred and fifty-three randomly selected patients reported experiencing pain during this hospitalization; 58% of these patients experienced excruciating pain. Fewer than half of the patients with pain had a member of the health care team ask them about their pain or note the pain in the patient record. The methods perceived as most effective in decreasing pain were analgesics, sleep, immobilization and distraction. As in earlier studies, the dose of analgesic administered over a 24-h period was less than a quarter of the amount ordered. This study concluded that (1) pain in hospitalized patients is more prevalent than has previously been reported, (2) patients with pain continue to receive inadequate dosages of analgesics, and (3) the identification and treatment of patients with pain remains a significant health care problem.

Homocysteinemia due to folate deficiency

Abstract: We examined the relationship between serum folate and total homocyst(e)ine levels by determining protein-bound homocyst(e)ine in stored serum from 19 subjects with subnormal serum folate (less than 2 ng/mL), 137 subjects with low normal serum folate (between 2.0 and 3.9 ng/mL), 44 subjects with normal serum folate (between 4.0 and 17.9 ng/mL), and 38 subjects with high serum folate (above 18 ng/mL). Eighty-four percent of the subjects with subnormal serum folate and 56% of the subjects with low normal serum folate had more than 7.05 nmol/mL serum total homocyst(e)ine (ie, more than two standard deviations above the normal mean). Thirty-two percent of these subjects had more than a three-fold increase in serum total homocyst(e)ine. These observations support the hypothesis that depletion of tissue folate causes homocysteinemia in nonhomocystinuric subjects. Subnormal as well as low normal concentrations of serum folate appear to produce an accumulation of homocyst(e)ine. In addition, relatively normal levels of serum total homocyst(e)ine were observed in four pregnant women with low serum folate, supporting previous suggestions of an influence of female sex hormone(s) in homocysteine metabolism.

Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study.

Abstract: The authors report prospective uniform clinical data differentiating 25 patients who committed suicide from 929 patients who did not in a group of 954 patients with major affective disorder followed for an average of 4 years in the Collaborative Program on the Psychobiology of Depression. Eight (32%) of the suicides occurred within 6 months and 13 (52%) within 1 year of entry into the study. Hopelessness, loss of pleasure or interest, and mood cycling during the index episode differentiated the suicide group. Diagnostic subcategories, suicidal ideation at entry to the study, suicide attempts during current or past episodes, and medical severity of prior attempts did not differentiate the suicide group.

Synaptophysin expression in neuroendocrine neoplasms as determined by immunocytochemistry.

Abstract: Synaptophysin is an integral membrane glycoprotein originally isolated from presynaptic vesicles of bovine neurons. The authors have studied a wide spectrum of neuroendocrine (NE) neoplasms by immunofluorescence microscopy on cryostat sections of freshly frozen tissues using a monoclonal antibody to this protein (SY 38). Without exception, they found the identical--or a very similar--protein expressed in all neuroblastomas, ganglioneuroblastomas, ganglioneuromas, pheochromocytomas, and paragangliomas studied. In these "neural" type NE neoplasms, synaptophysin was coexpressed with neurofilament proteins. Synaptophysin was also demonstrated in NE neoplasms of "epithelial" type in which it was predominantly coexpressed with cytokeratins and desmoplakin. It was invariably found in all variants of islet cell neoplasms and in all medullary thyroid carcinomas. Synaptophysin was also demonstrated in several adenomas of the hypophysis and parathyroids, in the majority of carcinoids of the bronchopulmonary and gastrointestinal tracts, and in many, though not all, NE carcinomas of the same sites, and of the skin. Conversely, SY 38 did not immunostain any of a large number of benign and malignant non-NE epithelial neoplasms; nor was any immunostaining obtained in a group of mesenchymal tumors. It is remarkable that SY 38 did not immunostain a number of malignant melanomas, including several that were immunostained for neuron-specific enolase (NSE) and several neuropeptides. Parallel studies conducted on conventionally fixed, paraffin-embedded tissue sections immunostained by the use of the avidin-biotin complex technique yielded very similar results. The findings indicate that synaptophysin is expressed in the whole range of NE neoplasms without detectable relation to the expression of other NE markers such as NSE, serotonin, and neuropeptides. Nor could the expression of synaptophysin by these tumors be correlated with their epithelial and/or neural cytoskeletal characteristics, their clinical aggressiveness, or the presence or absence of endocrinologic abnormalities. While the consistent expression of synaptophysin by the "neural" type of NE neoplasms would seem predictable its presence in diverse benign and malignant NE tumors of "epithelial" type is remarkable. It is concluded that synaptophysin is a significant as well as novel NE marker, and the use of antibody SY 38 as a broad range marker for the study and diagnosis of NE neoplasms is proposed.

Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies.

Abstract: Postoperative hemorrhage in patients undergoing open-heart surgery is a major cause of morbidity and mortality. Monitoring of coagulation in these patients has routinely involved the activated clotting time. Thromboelastography is currently used as a monitor of coagulation during liver transplantation. The thromboelastogram, by providing information on the interaction of all the coagulation precursors, gives more clinically useful information on coagulation than that available from the coagulation profile or the activated clotting time alone. This study was done to assess the usefulness of thromboelastography in open-heart surgery. Thirty-eight patients (29 undergoing coronary artery bypass grafting and 9 undergoing valve replacement) were studied with activated clotting time, thromboelastography, and coagulation profiles during three periods: before bypass, during bypass, and after protamine administration. Thromboelastography was a significantly better predictor (87% accuracy) of postoperative hemorrhage and need for reoperation than was the activated clotting time (30%) or coagulation profile (51%). Thromboelastography is easy to use and provides diagnostic data within 30 minutes of blood sampling.

Primary tumors of the spine.

Abstract: Primary neoplasms of the spine encompass a broad spectrum of tumors, ranging in their tissue of origin, local behavior, and potential for metastasis. The diagnosis and treatment of these disorders is accordingly varied. As a category, non-myeloproliferative primary tumors of the spine are rare, accounting for approx 5% of all bone tumors, when one excludes hemangiomas (1,2). In frequency, therefore, they are much less common than metastatic and/or myeloproliferative neoplasms involving the spine, as well as non-neoplastic processes such as infection, metabolic disorders, and other pathologies. The diagnosis of primary tumors of the spine, therefore, must occur with careful consideration of other more common entities. In this chapter, we discuss the common benign and malignant tumors that afflict the spinal column, and describe the appropriate algorithm for evaluating and treating these conditions.

Chronic intrathecal morphine for intractable pain

Abstract: Forty-three patients with intractable pain received intrathecal morphine delivered by implanted continuous-infusion (Infusaid) or programmable (Medtronic) devices. In 35 patients the pain was due to cancer, and eight patients had chronic nonmalignant pain. The origin of the nonmalignant pain included lumbar arachnoiditis, multiple sclerosis, severe osteoporosis resulting in a thoracic compression fracture, and intractable pain as a consequence of cancer therapy in individuals cured of their disease. Twenty-eight (80%) of the patients with cancer-related pain experienced excellent or good relief. Side effects were rare. Tolerance occurred infrequently and could be managed effectively. The results of this study support earlier studies on the application of chronic intrathecal morphine for intractable cancer pain. These findings also indicate that, in carefully selected patients, nonmalignant pain may be managed satisfactorily with this technique.

Environmental factors in the etiology of Parkinson's disease.

Abstract: Parkinson's disease (PD) has been proposed to result from the interaction of aging and environment in susceptible individuals. Defective metabolism of debrisoquine, inherited as an autosomal recessive, has been associated with this susceptibility. In 35 PD patients and 19 age-matched controls, no significant differences in debrisoquine metabolism were found, although a trend to impaired metabolism was noted in patients with disease onset less than or equal to 40. Foci of PD patients were associated with rural living and well water drinking, or rural living coupled with market gardening or wood pulp mills. In a questionnaire survey, patients with PD onset less than or equal to age 47 were significantly more likely to have lived in rural areas and to have drunk well water than those with onset greater than or equal to age 54 (p less than or equal to 0.01). Because of population mobility in North America, a case-control study designed to test environmental, occupational, dietary and other proposed risk factors for PD was conducted in China, where the population is more stationary and the environment more stable. No significant differences in incidences of head trauma, smoking or childhood measles were found between patients and controls.

Telepathology and the networking of pathology diagnostic services.

Abstract: Telepathology is the practice of pathology over a long distance. Components of a telepathology system include the following: a remote-controlled light microscope attached to a high-resolution video camera; a pathologist workstation incorporating controls for manipulating the microscope and a high-resolution video monitor; and a telecommunications linkage. An immediate challenge is to establish the specifications for a telepathology system. Breast tissue has served as a model. Receiver operator characteristic curve studies show that the pathologist's ability to discriminate benign from malignant breast tumors is similar using either a conventional light microscope or a video monitor with approximately 1000 lines of resolution. The percentage of cases for which pathologists render an "equivocal" diagnosis is the same for the two modalities. Telepathology may be an effective way to provide on-line consultations in difficult cases and to provide hospitals in remote areas with immediate access to anatomic pathology services.

Effects of Progressive Blood Loss on Coagulation as Measured by Thrombelastography

Abstract: The effects of progressive blood loss on coagulation were studied in 87 adults (age 23-66 yr) undergoing a variety of operations under general anesthesia. None had preoperative alterations in coagulation or liver function and none were receiving anticoagulant or antiplatelet medication. Whole blood coagulation status was quantitated using thrombelastography (TEG). Blood samples for TEG were obtained 5 min before and 15 min after induction of anesthesia, after each increment of blood loss (EBL) equalling 5% of estimated blood volume (EBV), at the end of surgery, and 2 hr post-operatively. Patients with EBL exceeding 0.15 EBV were given packed red cells and crystalloid solution. Patients with EBL less than 0.15 EBV received only crystalloid. Thrombelastography analysis showed a trend toward increased coagulability with progressive blood loss. Two of four patients with 80% loss of EBV maintained normal to enhanced coagulation status, although the other two developed clinical and thrombelastographic evidence of coagulopathy. Thrombelastography allowed rapid intraoperative diagnosis and specific treatment of loss of platelet activity in the latter two patients. We conclude that during moderate to massive blood loss, use of supplemental fresh frozen plasma and/or platelets should be reserved for patients with documented defects in coagulation. Thrombelastography is useful for the detection and management of coagulation defects associated with intraoperative blood loss.

Clonidine and Gilles de la Tourette's syndrome: Double‐blind study using objective rating methods

Abstract: Clonidine has been suggested to be effective in Gilles de la Tourette's syndrome (GTS), but no double-blind study has ever evaluated its effects using objective measures. Thirty patients with GTS completed a 6-month placebo-controlled crossover study of the effectiveness of clonidine. Videotapes were obtained at each 3-week visit and were evaluated randomly at the end of the study for distribution, frequency, and severity of motor and vocal tics. Quantifiable psychometric examinations were performed as well. The use of clonidine did not significantly (p less than 0.05) reduce motor tics, vocalizations, or behavior. The effect of a low dose (0.0075 mg/kg/day) was no different from that of a high dose (0.015 mg/kg/day); children's responses were no different from adults'; and those also receiving neuroleptic agents showed the same lack of efficacy as seen in patients on no other medication. Dosing schedule did not affect the objective ratings; scores from clonidine given twice a day were equivalent to those for three times a day.

Enhancement of human monocyte and peritoneal macrophage chemiluminescence activities in women with endometriosis.

Abstract: Preliminary reports indicate that products of human mononuclear phagocytes may contribute to the infertility associated with endometriosis. To determine whether the generation of reactive oxygen metabolites by blood monocytes and peritoneal macrophages is altered in women with endometriosis, the present study evaluated luminol-enhanced chemiluminescence (CL) in cells at rest and following stimulation with phorbol myristate acetate (PMA) or serum-opsonized zymosan (SOZ). Peripheral venous blood and peritoneal fluid samples were collected from 60 infertile women undergoing diagnostic laparoscopy at midluteal phase and mononuclear phagocytic cell fractions were obtained by density gradient centrifugation. Whereas there was no significant difference between resting CL values in peripheral blood monocytes collected from women with and without endometriosis, PMA- and SOZ-stimulated monocyte CL was significantly greater in endometriosis patients. In contrast, there was a significant elevation in resting CL values when peritoneal macrophages from endometriosis patients were compared with macrophages obtained from patients with normal pelvic organs. It appears that chronic stimulation of macrophages in the peritoneal cavity provokes constitutive release of large quantities of reactive oxygen products in women with endometriosis. This may occur secondary to the accumulation of activated monocytes into the peritoneal cavity.

Corneal neovascularization. Pathogenesis and inhibition.

Abstract: Corneal neovascularization (CNV) can cause significant visual loss because of the scarring and lipid deposition that frequently accompany it. In addition, penetrating keratoplasty in a vascularized recipient carries a significant risk of failure from allograft rejection. Frequently CNV is induced by

The relationship of psychological distress, extent of disease, and performance status in patients with lung cancer.

Abstract: This study examined the association between two primary covariates, extent of disease (ED) and performance status rating (PSR), and the outcome of psychological distress in patients with small cell carcinoma of the lung. Patients were studied at the time of entry onto one of three Cancer and Leukemia Group B (CALGB) protocols: 7781 (N = 165) and 8083 (N = 139) for limited disease; and 7782 (N = 151) for extensive disease. Besides ED (limited versus extensive), a four-point rating of PSR was obtained. Psychological distress was measured by the standardized Profile of Mood States (POMS). Gender, age, marital status, education, PSR, ED and two relevant interaction terms (PSR X ED; gender X ED) were analyzed using multiple linear and hierarchical regressions. Of the six main variables, gender and PSR had significant association with POMS total mood disturbance, a summary score for POMS emotional subscales, and most of the individual subscales. The PSR X ED interaction provided a rationale for testing a new regression model in which PSR and ED were combined into a single index of impairment. The final index resulted in five levels of physical impairment which bear an approximately linear relationship to increasing levels of distress (Overall regression, P less than 0.001). These data suggest that PSR is an important factor in modelling POMS distress at both levels of ED, and that ED becomes an important factor with poorer performance status only.

Correlation of serum HIV antigen and antibody with clinical status in HIV-infected patients.

Abstract: An enzyme immunoassay (EIA) has been developed which detects antigen(s) (Ag) of the human immunodeficiency virus (HIV) in the serum of patients with the acquired immunodeficiency syndrome (AIDS), AIDS-related complex (ARC), and patients at high risk for HIV infection. The test has a sensitivity of approximately 50 pg/ml of HIV protein. The specificity of the assay was determined with various virus infected cell lines, normal human sera/plasma, and serum from patients not known to be at risk for HIV infection. No false-positive HIV-Ag results were seen. Sera from 69% of patients with AIDS were positive for HIV-Ag as were 46% of patients with ARC and 19% of asymptomatic, HIV-antibody-positive individuals. There were significant associations between the stage of HIV infection--ie, AIDS vs ARC vs asymptomatic--and the detection of HIV-Ag in serum (p less than 0.0001) and the lack of detection of antibody to HIV core Ag (p less than 0.0001). HIV-Ag was also found in the serum of two asymptomatic antibody-negative individuals who were at high risk for AIDS and who later developed HIV antibody. The presence of HIV-Ag in sera was confirmed by an inhibition procedure. Thus, HIV-Ag can be detected in the serum of infected individuals prior to antibody production and correlates with the clinical stage of HIV infection.

The response of the seated human to sinusoidal vibration and impact.

Abstract: Low back pain has been shown to occur more frequently among vehicle drivers than in representative control groups. Thus the response of the human to vibration and impact is of interest. This study investigated the response of the spine to both impact and sinusoidal excitation in either a relaxed or erect seated posture. The sinusoidal testing apparatus used was a resonating system consisting of two parallel wooden beams, simply supported, and the impact testing apparatus a bearing-guided, spring-suspended platform, struck from below. Ten subjects (5 males, 5 females) were evaluated using both methods. Transfer functions were compared at 2-4 Hz, 4-8 Hz and 8-16 Hz intervals using a sign test. Although in 24 comparisons of either test method (vibration or impact) or posture (erect or relaxed) where eleven showed differences significant at the p less than .05 level, only 2 out of 24 comparisons were the differences distinct enough to be significant (at the p less than .01 level). Both of these latter differences were due to test method while the subjects were sitting erect. In those instances where there were no significant differences due to test method, the impact method may be a viable replacement for the vibration test method. Where the levels of significance are higher (p less than .01 or p less than .05), further study of the magnitude of the differences is indicated and may reveal further insight into the seated individual as a system.

Intramembrane charge movement in frog skeletal muscle fibres. Properties of charge 2.

Abstract: 1. Membrane currents were measured in cut skeletal muscle fibres voltage-clamped in a double Vaseline gap in solutions that had impermeant ions substituted for Na+, K+ and Cl-. The fibres were maintained at a holding potential of 0 mV. Pulses to positive voltages elicited outward currents that were proportional to voltage at all times; these were used to estimate linear capacitive currents, which in turn were used in the construction of non-linear current transients. 2. Large negative-going pulses elicited proportionally larger inward currents that decayed during the pulse with voltage-dependent kinetics. A portion of the non-linear current could be eliminated by solutions containing EGTA, as well as by large negative conditioning pulses of 200 ms or more. This portion was probably an inward Ca2+ current. 3. The non-linear current remaining in EGTA-containing solutions had characteristics of intramembrane charge movement ('charge 2'). This charge depended on voltage according to a two-state Boltzmann function of average parameters Qmax = 47.7 nC/microF, V = -115 mV, K = 21.5 mV (seven fibres). 4. The charge movement current transients were single-exponential decays (after a short rising phase) with time constants (tau) that depended on voltage (V). A single-barrier Eyring rate model described well the dependence of time constant on voltage. This fit permitted an independent estimate of a transition voltage, V, and a slope parameter K related to apparent valence of the mobile particle. The values of V and K that best fitted the kinetic data were close to the corresponding values estimated from the charge vs. voltage distribution. 5. Effective capacitance was measured by the transfer of capacitive charge by a small pulse superimposed on a variable pre-pulse. The capacitance was found to depend on pre-pulse voltage. The voltage dependence of the capacitance was as expected from the properties of charge 2 measured independently in the same fibres. 6. The presence of charge 2, defined as charge that moves in a very negative voltage range, was compared on the same fibres in a depolarized and a normally polarized (holding potential = -100 mV) situation. All fibres had less charge 2 at a holding potential of -100 mV (14 nC/microF average reduction). In these fibres charge 1, explored with pulses from -70 mV to 0 mV, was greater at a holding potential of -100 mV (18 nC/microF average increase).(ABSTRACT TRUNCATED AT 400 WORDS)

Predictors of cardiovascular events and mortality in the systolic hypertension in the elderly program pilot project

Abstract: Do the established cardiovascular risk factors for younger persons remain important predictors of cardiovascular disease events and mortality in those who are older? The authors examined this question in the Systolic Hypertension in the Elderly Program pilot project which prospectively followed 551 men and women 60 years of age and older with pretreatment systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg who were enrolled between May 1981 and July 1982 Mean age was 72 years, 37% were men, 82% were white, and 24% had attended college The vital status of all 551 participants was known at the end of follow-up, an average of 34 months after entry; there were 39 deaths from all causes, 66 first cardiovascular events, 18 strokes, and 20 episodes of myocardial infarction/sudden death Univariate Cox proportional hazard analysis revealed that age was a predictor (p less than 005) of all-cause mortality, first cardiovascular event, and stroke Less than college education was a predictor of all-cause mortality and first cardiovascular event, smoking was a predictor of first cardiovascular event and myocardial infarction/sudden death, cholesterol was a predictor of first cardiovascular event, and lower body mass index was a predictor of increased all-cause mortality After adjustment for covariables, age, lower education, lower body mass index, and baseline electrocardiographic abnormalities were significant predictors of all-cause mortality, and age, lower education, history of cardiovascular event, and smoking remained significant predictors of first cardiovascular event Sex was not a risk factor, and the ability to examine hypertension as a risk factor was impaired by the fact that the entire cohort had systolic hypertension at baseline, and most were treated These findings, combined with prior evidence, suggest that smoking, low education level, and perhaps serum cholesterol are risk factors for cardiovascular disease in the elderly Although the excess risk conveyed by these factors is large, its reversibility needs to be demonstrated by intervention studies

Sulfone therapy in the treatment of leukocytoclastic vasculitis. Report of three cases.

Abstract: Dapsone therapy for leukocytoclastic (necrotizing) vasculitis has been little used, except for the variant forms of erythema elevatum diutinum and urticarial vasculitis. We report three patients with the common (palpable purpura) form of the disease, limited to the skin, and successfully treated with moderate doses of dapsone (100–150 mg daily). Although the natural course of leukocytoclastic vasculitis is highly unpredictable, the prompt disappearance of new lesion formation after initiation of treatment and the rapid recurrence of lesions after therapy is discontinued (both often within 4 to 8 days after the critical dose level is reached) reflect drug efficacy. We believe that dapsone deserves wider evaluation as a therapeutic agent for chronic or recurrent cases of the common form of leukocytoclastic vasculitis.

Isolation and characterization of a nuclear depressive syndrome.

Abstract: We investigated the nosology of endogenous depression by numerical taxonomy. Five hundred and sixty-nine patients diagnosed as having unipolar major depressive disorder in the NIMH Clinical Research Branch Program on the Psychobiology of Depression – Clnical were studied. Thirty-six symptoms which might distinguish endogenous from non-endogenous depressions were chosen from the literature. Patients' symptom profiles assessed by structured interview were grouped by two methods: a K-means improvement of Ward's method of cluster analysis, and a latent class algorithm. The methods produced very similar groups and several internal validity criteria suggested that the groups were not spurious. Cluster 1, ‘nuclear depression,’ included a nucleus of patients common to multiple definitions of endogenous depression. The non-nuclear group scored as less neurotic than the nuclear group on personality tests administered during the index episode. The groups do not differ in frequency, number or severity of reported life events prior to onset of the index episode. The nuclear group shows a poor prognosis on two-year prospective follow-up, greater disturbance on personality inventories, and increased heritability of depression in siblings.

Prediction of outcome in acute renal failure.

Abstract: In an attempt to predict outcome in acute renal failure (ARF) we have utilized multiple logistic regression to analyze clinical data from 151 patients with ARF seen over a 15-month period. Recovery of renal function occurred in 60% of patients with a 58% survival. Our analysis demonstrated sepsis, respiratory failure, and oliguria to be the major predictors of nonrecovery of renal function. A logistic equation was generated for prediction of outcome and was validated in a second independent group of patients with ARF. Prediction of outcome could be achieved with a sensitivity of 75% and a specificity of 80%. Maximum sensitivity (100%) was associated with a 17% specificity, while maximum specificity (98%) yielded a sensitivity of 20%.

Herpes Simplex Viral Hepatitis in Adults: Two Case Reports and Review of the Literature

Abstract: Herpes simplex viral (HSV) hepatitis is uncommon in adults. Two new cases are reported herein; a literature review revealed an additional 33 patients. Ages ranged from 13 to 87 years; the mean age was 32.6 years, and the median was 28 years. HSV hepatitis usually occurs as part of disseminated HSV infection and is characterized by fulminant hepatic necrosis with serum transaminase levels frequently elevated 100- to 1,000-fold. Disseminated intravascular coagulation was present in 90% of the cases. Outcome was poor; 86% of the patients died. Eighty-six percent of the patients had an underlying condition associated with impaired host defenses. Renal transplantation (26%), steroid use other than in renal transplant patients (26%), and pregnancy (23%) were the most frequent underlying conditions. Early recognition and prompt initiation of antiviral therapy may offer a chance for improved survival rates.