Showing papers by "Thomas Jefferson University Hospital published in 1986"
TL;DR: The dynamics of grief are reviewed and intervention in the following six phases are discussed: contacting the survivors; arrival of thesurvivors; notification of death; the grief response; viewing the body; and the concluding process.
104 citations
TL;DR: A multivariable analysis was performed of all patients registered and confirmed to have bronchoalveolar cell carcinoma of the lung in the Tumor Registry of Thomas Jefferson University Hospital between 1969 and 1983, and no correlation could be found in this series between a patient's age, sex, smoking history, or occupational exposure and the incidence or outcome of the disease.
82 citations
TL;DR: Endorectal ultrasound was used prospectively to stage 85 patients with rectal cancer to suggest that it is more accurate than CT in detecting the site of tumour and slightly more accurate in detecting level II lymph node involvement.
Abstract: Endorectal ultrasound was used prospectively to stage 85 patients with rectal cancer. All patients had surgical exploration and histological analysis. Demonstration of tumour, extension into perirectal fat and lymph node involvement were evaluated. Eighty-one tumours were successfully imaged by endorectal ultrasound. The results suggest that: endorectal ultrasound is more accurate than CT in detecting the site of tumour; endorectal ultrasound is more accurate than CT in detecting perirectal fat infiltration; endorectal ultrasound is slightly more accurate than CT in detecting level II lymph node involvement.
80 citations
TL;DR: The use of a surgical procedure in carcinomas of the anterior tongue and floor of the mouth was associated with a smaller percentage of infield recurrences at 2 years, than when radiation therapy alone was used (27% versus 88% p less than .01).
Abstract: For the identification of predictive factors for local (head and neck) control and metastases and impact on survival in squamous cell cancer of the head and neck, we have used data from over 2000 patients from the Patterns of Care Study (PCS) and the Radiation Therapy Oncology Group (RTOG) studies. Complete local response (C.R.) is significantly related to T stage, N stage, general performance status (Karnofsky), and site of primary tumor. There is a strong association between T and N stage. T1N0 tumors showed a C.R. of 99%, whereas, TIN' had a C.R. of 57%. T4N0 showed a C.R. of 75%, but this went down to 31% in the T4N3 lesions. Glottic tumors showed a C.R. of 96% versus the other sites, which ranged from 81% for the nasopharynx to 59% for the hypopharynx. Patients with a performance status (KPS) of less than 90% showed a C.R. of 60% versus 88% for AKPS 90% or higher. Absence of local recurrence after C.R. is significantly related to T stage, N stage, and the site of primary tumor (glottis versus the rest). The appearance of distant metastases is significantly related only to N stage and primary site. This relationship persists in control of loco/regional tumors. In Stages III & IV in non-glottic head and neck cancer, metastases as the cause of death play an increasingly important role. This can be as high as 30%. The appearance of new malignant tumors and death unrelated to cancer, that is, death related to lifestyle, assumes an important role in patients with advanced head and neck cancer. The number of advanced glottic larynx was too small to examine this question. The use of a surgical procedure in carcinomas of the anterior tongue and floor of the mouth was associated with a smaller percentage of infield recurrences at 2 years, than when radiation therapy alone was used (27% versus 88% p < .01). The same observation was noted at 3 years in the glottic and supraglottic Stage III & IV tumors (p < .01).
74 citations
TL;DR: Analysis of the Group 3 results indicate that the problem of distant metastasis, in spite of adjuvant chemotherapy, still remains overwhelming--especially to the liver--and requires development of more effective regimens.
Abstract: Since 1978, 86 patients with unresectable localized adenocarcinoma of the pancreas have been treated with a combined modality program using radioactive iodine 125-Implantation, external beam radiation, and systemic chemotherapy Three treatment approaches were used with sequential modifications of the technique based on the course of disease and patterns of failure Group 1 was comprised of 13 patients treated with a combination of implantation followed by a planned external radiation dose of 5000 to 6000 cGy delivered in 6 weeks Group 2 included patients treated as in Group 1 followed by adjuvant chemotherapy The most recent group of 54 patients, Group 3, has been treated since 1981 with implantation into the tumor of radioactive Iodine 125 seeds (12000 cGy minimal peripheral dose), perioperative chemotherapy (5-FU, Mito-C), and external beam irradiation (5000–5500 cGy) followed by further chemotherapy Incidence of perioperative mortality has been reduced from 31% (1032) in Groups 1 & 2 to 7% (454) in Group 3 Clinical local control of tumor has been excellent in all three groups (84%) Analysis of the Group 3 results indicate that the problem of distant metastasis, in spite of adjuvant chemotherapy, still remains overwhelming (64%)—especially to the liver—and requires development of more effective regimens Median survival in the three groups of patients is 55, 113, and 125 months The 2-year survival is 0, 15, and 22%, retrospectively in the three groups
73 citations
TL;DR: This study suggests that the diagnosis of achondroplasia can be reasonably made when the femur is abnormally short, and when the Femoral length is appropriate prior to 30 weeks, more caution should be taken in interpretation.
Abstract: Seven cases of heterozygous achondroplasia were examined in utero. Although the head shape and growth were normal, the initially normal femur length showed a decrease in growth and fell below the lower 99 per cent confidence limit in all cases. The time of presentation of achondroplasia varied between 21 and 27 gestational weeks. This study suggests that the diagnosis of achondroplasia can be reasonably made when the femur is abnormally short. When the femoral length is appropriate prior to 30 weeks, more caution should be taken in interpretation. Because of the variability in presentation, the fetus could be normal or still could be affected.
48 citations
TL;DR: It is concluded that scanty neuromelanin is detectable by EM in rat SN and that the content of this pigment increases with age, which may explain why higher doses and longer treatment with MPTP is required in rats to obtain biochemical and behavioral signs of nigrostriatal dysfunction in this species.
48 citations
TL;DR: Reduction by caffeine of the ADR-induced cell cycle delays is attributed to either the decrease in the intracellular ADR dose in the presence of caffeine, or to an effect of caffeine similar to that exerted after exposure of cells to ionizing radiation.
Abstract: Exponentially growing Chinese-hamster V79-cells were treated with various doses of adriamycin (ADR) for 1 hr in the presence or absence of 2 mM caffeine and were subsequently incubated for 24 hr in fresh medium with or without caffeine (2 mM) before plating to assay for survival. The results indicated a reduction in killing when caffeine was present during treatment with ADR (e.g., reduction in killing from 0.03 to 0.3 after exposure to 0.5 μ/ml ADR). This reduction in killing was even more pronounced after a 24 hr treatment with ADR in the presence of caffeine (e.g, reduction from 0.005 to OS after exposure to 0.08 μg/ml ADR). Incubation with caffeine after ADR treatment (1 hr) caused only a comparably small increase in cell survival. Presence of caffeine either simultaneously or after treatment with ADR caused a reduction of the inhibition of growth and mean-cell-volume increase, and a reduction of the accumulation of cells in G2-phase. Qualitatively similar results were also obtained after continuous treatment with ADR in the presence or absence of caffeine. Reduction in growth inhibition and accumulation of cells in G2-phase was observed under conditions only slightly affecting cell survival, thus suggesting that caffeine may affect these two phenomena by independent mechanisms. Flow cytometry measurement of the intracellular ADR content indicated a reduction in the presence of caffeine. Furthermore, post-treatment incubation with caffeine was found to increase the rate of decay of ADR-related fluorescence. Quantitative comparison between the effect of caffeine in the intracellular ADR accumulation and cell survival suggested that the observed reduction in killing could be attributed to a decrease in the intracellular drug levels. The reduction by caffeine of the ADR-induced cell cycle delays is attributed to either the decrease in the intracellular ADR dose in the presence of caffeine, or to an effect of caffeine similar to that exerted after exposure of cells to ionizing radiation. Trifluoperazine, which had only a small effect on cell survival of cells treated with ADR alone, potentiated killing when cells were treated with ADR in the presence of caffeine. This effect can be partly attributed to the observed modification in the intracellular ADR content under these conditions but, as a quantitative comparison suggests, other effects might also be involved.
31 citations
TL;DR: Use of an appropriate biological safety cabinet in conjunction with good aseptic technique and the recommended procedures for safe handling of antineoplastic drugs may reduce the potential for dispersal of drug into the pharmacy workroom environment.
Abstract: Fluorouracil content was studied in air samples from a hospital pharmacy work area where a vertical laminar-airflow biological safety cabinet (BSC) vented into the work area was used for the preparation of antineoplastic drugs. The BSC was run 24 hours per day and used approximately 6 hours per day. During one 56-hour period and one 95-hour period, a portable pump delivering room air at 2 L/min was positioned 12 inches outside the BSC. Fluorouracil content in extracts from 0.5-micron Teflon filters housed in the pump was assayed by high-performance liquid chromatography. The assay's lower limit of fluorouracil detection was 0.2 ng/cu m air. In the 56-hour sampling period and the 96-hour sampling periods, 25.4 g and 25 g, respectively, of fluorouracil were prepared. No fluorouracil was detectable in the filter extracts. Use of an appropriate biological safety cabinet in conjunction with good aseptic technique and the recommended procedures for safe handling of antineoplastic drugs may reduce the potential for dispersal of drug into the pharmacy workroom environment.
21 citations
TL;DR: Radiology is valuable in determining the cause of pacemaker malfunction and in the evaluation of lead position and integrity.
Abstract: Radiology is valuable in determining the cause of pacemaker malfunction and in the evaluation of lead position and integrity.
20 citations
TL;DR: Profiles of the specific absorption rate (SAR) at 1-cm depth show that deionized water coupling significantly distorts the SAR distributions of the Clini-Therm 915-MHz 10 X 10 and 15 X 15 cm2 applicators.
Abstract: Deionized water is commonly used to couple microwave applicators to the patient surface in the administration of local hyperthermia. Profiles of the specific absorption rate (SAR) at 1-cm depth show that deionized water coupling significantly distorts the SAR distributions of the Clini-Therm 915-MHz 10 X 10 and 15 X 15 cm2 applicators. Maxima and minima that are discernible in the SAR profiles obtained by direct applicator load contact are amplified producing unexpected hot and cold regions in the heating pattern. An exception is coupling achieved by use of the Clini-Therm cooling pad, oriented such that the direction of deionized water flow is perpendicular to the electric field. The distortion in the SAR distribution can also be eliminated by replacing deionized water with mineral oil, a material having a much lower dielectric constant (epsilon = 2). The SAR profiles for mineral oil coupling are comparable to those obtained for direct contact; however, the efficiency of power transfer is slightly less (70%) and the level of microwave leakage is approximately four times greater.
TL;DR: Gallium-67 scans have a limited but valuable role in the diagnosis and management of sarcoidosis.
Abstract: Gallium-67 scans have been widely employed in patients with sarcoidosis as a means of indicating alveolitis and the need for corticosteroid therapy. Observation of 32 patients followed 3 or more years after gallium scans showed no correlation between findings and later course: of 10 patients with pulmonary uptake, 7 recovered with minor residuals; of 18 patients with mediastinal of extrathoracic uptake, 10 had persistent or progressive disease; of 4 patients with negative initial scans, 2 had later progression. The value of gallium-67 scans as an aid to diagnosis was studied in 40 patients with extrapulmonary sarcoidosis. In 12 patients, abnormal lacrimal, nodal, or pulmonary uptake aided in selection of biopsy sites. Gallium-67 scans and serum ACE levels were compared in 97 patients as indices of clinical activity. Abnormal gallium-67 uptake was observed in 96.3% of the tests in active disease, and ACE level elevation occurred in 56.3%. In 24 patients with inactive or recovered disease, abnormal gallium-67 uptake occurred in 62.5% and ACE level elevation in 37.5%. Gallium-67 scans have a limited but valuable role in the diagnosis and management of sarcoidosis.
TL;DR: A case of leukemic macrocheilitis associated with hairy-cell leukemia and the Melkersson-Rosenthal syndrome is presented and a possible relationship between these entities is proposed.
Abstract: Specific cutaneous infiltrates in hairy-cell leukemia have distinctive histopathologic and histochemical findings. The true incidence of leukemia cutis in hairy-cell leukemia is uncertain, however, because reports often fail to document these distinctive features. A case of leukemic macrocheilitis associated with hairy-cell leukemia and the Melkersson-Rosenthal syndrome is presented. The Melkersson-Rosenthal syndrome is a clinically defined entity composed of Bell's palsy, macrocheilitis, and lingua plicata. Granulomatous cheilitis is often seen on histopathologic examination of the swollen lip tissue; in some cases, however, the findings may be nonspecific. Neoplastic macrocheilitis has not been reported in Melkersson-Rosenthal syndrome. Furthermore, leukemic macrocheilitis has not been reported in hairy-cell leukemia. A possible relationship between these entities is proposed.
TL;DR: The results suggest that serum glucose levels cannot be quantitatively predicted after a single intravenous bolus of D-50, and that known diabetics and non-diabetic patients with altered levels of consciousness should not be considered to be diabetic.
Abstract: A prospective clinical trial was conducted to estimate the rise in serum glucose level after an intravenous bolus of 50 ml of 50% dextrose solution (D-50) in the emergency department setting. Fifty one subjects with altered levels of consciousness were studied. Of these, 23 patients were known diabetics, and 28 were not diabetic. The change in glucose level for the total study group ranged from a low of 37 mg/dl to a high of 370 mg/dl, with a mean of 166 ± 77 mg/dl. The mean for the diabetic and non-diabetic groups were 177 ± 80 mg/dl and 154 ± 75 mg/dl. These results suggest that serum glucose levels cannot be quantitatively predicted after a single intravenous bolus of D-50.
TL;DR: The authors' findings indicate that a person does not have to travel to an endemic area to become infected with this parasite, which is endemic in the Orient and the Middle East.
Abstract: Severe diarrhea in a female outpatient was caused by an intestinal fluke, identified as Heterophyes heterophyes, a natural parasite of humans and domesticated and wild fish-eating mammals. This parasite is endemic in the Orient and the Middle East. A detailed case history revealed that the woman had never traveled outside the continental United States but became infected while eating raw fresh-water fish (sushi) that had been served at a local Japanese restaurant. The restaurant specialized in serving a great variety of fresh-water and salt-water fish that were flown in from the Orient and other parts of the world. The authors' findings indicate that a person does not have to travel to an endemic area to become infected with this organism.
TL;DR: Experimental and clinical applications of autologous blood cells labeled with gamma-emitting radionuclides aimed at the studies of in vivo cell kinetics and detecting abnormal lesions by external imaging will be discussed.
Abstract: During the past few years, the clinical and experimental applications of autologous blood cells labeled with gamma-emitting radionuclides, i.e., technetium-99m (Tc-99m) and indium-111 (In-111) have continued to grow rapidly. Investigations have centered around developing techniques that would label blood cells efficiently without alteration of cell viability and their pathophysiologic integrity. Experimental and clinical applications have been aimed at the studies of in vivo cell kinetics and detecting abnormal lesions by external imaging. These will be discussed in detail together with their advantages and disadvantages, and the future directions will be outlined.165 references.
TL;DR: Water supplementation to the normal term newborn does not affect or disrupt the establishment of lactation, indicating that water supplementation of breast-fed newborns does not affecting or disrupting the establishmentof lactation.
Abstract: It has been suggested that water supplementation of breast-fed newborns may delay the arrival of true milk. A total of 136 healthy term neonates were divided into two groups. Seventy-eight nursed exclusively on demand, and 58 received in addition supplemental water ad lib. Mean time for arrival of milk in the unsupplemented group was 54.9 hours and in the supplemented group 56.6 hours. This difference was not significant, indicating that water supplementation to the normal term newborn does not affect or disrupt the establishment of lactation.
TL;DR: The ultrasonic anatomy of the normal fetal head throughout the second and third trimesters is discussed, as are the normal changes taking place with growth.
Abstract: Since the early 1960s it has been possible to identify the fetal head using A-mode ultrasound. The introduction of high-resolution, real-time, grayscale ultrasound in the mid-to-late 1970s first enabled the routine display of subtle internal anatomy. Using presently available equipment, the fetus can be imaged from 7 weeks after the last menstrual period until term and the internal anatomy of the fetal head can be detected after 11–12 weeks. The ultrasonic anatomy of the normal fetal head throughout the second and third trimesters is discussed, as are the normal changes taking place with growth.
TL;DR: A case of reflex sympathetic dystrophy syndrome (RSDS) is presented in which the condition was exacerbated after the excision of impacted teeth.
TL;DR: Curve-fitting the data from a reference source to a paralyzable model in which the true total count rate in the selected window is estimated from the observed total rate, and the statistical uncertainty of the data corrected by this method is not significantly increased.
Abstract: Quantitative studies performed with scintillation detectors often require corrections for lost data because of the finite resolving time of the detector. Methods that monitor losses by means of a reference source or pulser have unacceptably large statistical fluctuations associated with their correction factors. Analytic methods that model the detector as a paralyzable system require an accurate estimate of the system resolving time. Because the apparent resolving time depends on many variables, including the window setting, source distribution, and the amount of scattering material, significant errors can be introduced by relying on a resolving time obtained from phantom measurements. These problems can be overcome by curve-fitting the data from a reference source to a paralyzable model in which the true total count rate in the selected window is estimated from the observed total rate. The resolving time becomes a free parameter in this method which is optimized to provide the best fit to the observed reference data. The fitted curve has the inherent accuracy of the reference source method with the precision associated with the observed total image count rate. Correction factors can be simply calculated from the ratio of the true reference source rate and the fitted curve. As a result, the statistical uncertainty of the data corrected by this method is not significantly increased.
TL;DR: Postural brachial plexus compression neuropathy occurs more frequently than usually realized and may be complicated by concurrent vascular compression, concurrent reflex sympathetic dystrophy, and associated inflammatory musculotendinous conditions.
TL;DR: An overview of the five surveys conducted between 1974 and 1983 of radiation therapy facilities with megavoltage equipment in the U.S. is provided.
Abstract: The American College of Radiology periodically collects data on all radiation therapy facilities with megavoltage equipment n the U.S. The following is an overview of the five surveys conducted between 1974 and 1983.
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TL;DR: The adolescent unit of this hospital was closed due to a low occupancy rate and the decreased profitability of the separate unit, and the influence of DRGS on this administrative action was due to the general emphasis on cost containment and maximizing profitability as a measure to guard against hospitals absorbing extensive outlying costs.
TL;DR: Throat swabs from 404 patients with suspected pharyngitis were collected using duplicate swabs to inoculate 5% sheep blood agar plates, which were incubated in an anaerobic atmosphere for the isolation of Group A streptococci.
Abstract: Throat swabs from 404 patients with suspected pharyngitis were collected using duplicate swabs. Both swabs were used to inoculate 5% sheep blood agar plates, which were incubated in an anaerobic atmosphere for the isolation of Group A streptococci. The throat swabs were tested for the presence of Group A antigen using the Culturette Brand 10-Minute Group A Strep ID kit (Marion Scientific, Kansas City, MO), and the Direct Antigen Identification D.A.I. Strep A Test (Difco Laboratories, Inc., Detroit, MI). We found that 77 of the 404 specimens were culture positive for Group A streptococci. The Strep ID kit had a sensitivity of 83.7% and a specificity of 91.6%. The positive and negative predictive values were 72% and 95.6%, respectively. The D.A.I. test had a sensitivity of 80.2% and a specificity of 100%. The positive and negative predictive values were 100% and 94.5%, respectively. There was not a significant difference in the sensitivity of the two kits (P less than 0.1), but there was a significant difference in the specificity (P less than 0.01).
TL;DR: An 18-year-old white woman was admitted complaining of right-sided chest pain for five days duration, which was sharp and acute in onset, pleuritic in nature, and felt diffusely throughout the right chest.
TL;DR: Physicians involved in the care of patients with spinal cord injuries should be aware of the method of evaluating polyuric conditions, particularly while the patient is undergoing catheterization.
TL;DR: In all cases of unilateral choanal atresia, computed tomography demonstrated the definitive components accounting for this deformity and is now the imaging modality of choice in this entity.
TL;DR: A method of concurrent antibiotic-use review in a 60-bed pediatric hospital that has resulted in substantial improvement in antibiotic prescribing by physicians at this hospital is described.
Abstract: A method of concurrent antibiotic-use review in a 60-bed pediatric hospital is described. The pharmacy department monitors appropriateness of antibiotic prescribing using criteria specified by the pharmacy and therapeutics committee. Antibiotic orders are reviewed by the pharmacist for compliance with the criteria at the time that the orders are written. At three-month intervals, information about the infections treated and the percentage compliance for all physicians, as well as for each individual physician, is compiled and reported to the pharmacy and therapeutics committee. Written and oral feedback are provided to each physician to further improve compliance. This comprehensive monitoring system has resulted in substantial improvement in antibiotic prescribing by physicians at this hospital.