Showing papers by "Wayne State University published in 1988"

Von Hippel–Lindau disease maps to the region of chromosome 3 associated with renal cell carcinoma

Abstract: Von Hippel-Lindau disease (VHL) is an autosomal dominant disorder with inherited susceptibility to various forms of cancer, including hemangioblastomas of the central nervous system, phaeochromocytomas, pancreatic malignancies, and renal cell carcinomas. Renal cell carcinomas constitute a particularly frequent cause of death in this disorder, occurring as bilateral and multifocal tumours, and presenting at an earlier age than in sporadic, non-familial cases of this tumour type. We report here that the VHL gene is linked to the locus encoding the human homologoue of the RAF1 oncogene, which maps to chromosome 3p25 (ref. 4). Crossovers with the VHL locus suggest that the defect responsible for the VHL phenotype is not a mutation in the RAF1 gene itself. An alternative or prior event to oncogene activation in tumour formation may be the inactivation of a putative 'tumour suppressor' which can be associated with both the inherited and sporadic forms of the cancer. Sporadic renal cell carcinomas have previously been associated with the loss of regions on chromosome 3p (refs 5, 6). Consequently, sporadic and VHL-associated forms of renal cell carcinoma might both result from alterations causing loss of function of the same 'tumour suppressor' gene on this chromosome.

Leininger's Theory of Nursing: Cultural Care Diversity and Universality

Abstract: This paper is focused on the essential features of the nursing theory of cultural care diversity and universality. An overview of the essential features is discussed to show how the theory was developed and how it has evolved during the past three decades. The theory was initiated from clinical experiences recognizing that culture, a wholistic concept, was the missing link in nursing knowledge and practice. Through a creative process of concept explication, reformulation, and resynthesis, the the ory of cultural care was set forth as a guide for the development of nursing knowledge. The concept of culture was derived from anthropol ogy and the concept of care was derived from nursing. The theorist holds that cultural care provides the broadest and most important means to study, explain, and predict nursing knowledge and concomitant nursing care practice. The ultimate goal of the theory is to provide cultural congruent nursing care practices. The author contends that if one fully discovers care meanings, p...

Social support in patients' and husbands' adjustment to breast cancer.

Abstract: Data were obtained from 50 mastectomy patients and their husbands at 3 days and 30 days postsurgery to determine the nature of the relationship between social support and the adjustment of mastectomy patients and their husbands over time. Psychosocial adjustment was related to both patients' and husbands' levels of social support. Patients and husbands who reported higher levels of social support reported fewer adjustment difficulties at both 3 days and 30 days postsurgery. Patients and husbands differed significantly in the levels of support they perceived over time; husbands perceived less support from friends, nurses, and physicians. This study underscores the importance of assessing the support resources of both patients and husbands over time.

Serum thymulin in human zinc deficiency

Abstract: The activity of thymulin (a thymic hormone) is dependent on the presence of zinc in the molecule. We assayed serum thymulin activity in three models of mildly zinc-deficient (ZD) human subjects before and after zinc supplementation: (a) two human volunteers in whom a specific and mild zinc deficiency was induced by dietary means; (b) six mildly ZD adult sickle cell anemia (SCA) subjects; and (c) six mildly ZD adult non-SCA subjects. Their plasma zinc levels were normal and they showed no overt clinical manifestations of zinc deficiency. The diagnosis of mild zinc deficiency was based on the assay of zinc in lymphocytes, granulocytes, and platelets. Serum thymulin activity was decreased as a result of mild zinc deficiency and was corrected by in vivo and in vitro zinc supplementation, suggesting that this parameter was a sensitive indicator of zinc deficiency in humans. An increase in T101-, sIg-cells, decrease in T4+/T8+ ratio, and decreased IL 2 activity were observed in the experimental human model during the zinc depletion phase, all of which were corrected after repletion with zinc. Similar changes in lymphocyte subpopulation, correctable with zinc supplementation, were also observed in mildly ZD SCA subjects. Inasmuch as thymulin is known to induce intra- and extrathymic T cell differentiation, our studies provide a possible mechanism for the role of zinc on T cell functions.

The Mindlessness of Organizational Behaviors

Abstract: Much organizational behavior is argued to be performed mindlessly, on the basis of scripts learned through organizational socialization, work experience, and symbolic management. While scripts conserve cognitive capacity, provide a basis for organizing and evaluating behavior, legitimate organizational activities, moderate role conflict, andfacilitate sense making, prediction, and control, they also induce a lack of vigilance and authenticity in operating routines, and bunkered perceptions, premature closure, and superstitious learning in decision making. Directions for future research include documenting the existence and effects of mindlessness, and exploring the predisposing conditions of script processing and means of maximizing the functional and minimizing the dysfunctional aspects of scripts on organizational effectiveness.

Impact of Critical Care Physician Staffing on Patients With Septic Shock in a University Hospital Medical Intensive Care Unit

Abstract: To evaluate the effects of reorganizing physician resources in a medical intensive care unit (MICU), we studied the impact of these changes in patients with septic shock. Patients were compared during two consecutive 12-month periods: (1) an interval in which faculty without critical care medicine (CCM) training supervised the MICU (before CCM, n = 100) and (2) following staffing with physicians formally trained in CCM (after CCM, n = 112). Acute Physiology and Chronic Health Evaluation scores were utilized to compare severity of illness and were similar for each group (29 ±11 before CCM vs 28 ± 10 after CCM). However, mortality was significantly lower during the post-CCM interval (74% vs 57%, respectively). There was no significant difference in the frequency of use of mechanical ventilation (83% vs 87%), although pulmonary artery catheters (48% vs 64%) and arterial catheters (24% vs 73%) were employed more frequently after CCM. The number of subspecialty consultations and MICU and hospital length of stay were similar for both intervals. We conclude that the implementation of dedicated staffing by CCM physicians in a university hospital MICU was associated with a favorable impact on patients with septic shock. ( JAMA 1988;260:3446-3450)

Contributions from behavioral theories of choice to an analysis of alcohol abuse.

Abstract: Discussion des etudes experimentales consacrees aux effets de deux categories de variables (contraintes directes et indirectes) sur la consommation d'alcool ou d'autres substances chez l'homme et chez l'animal

Evaluation of nonradioactive, colored microspheres for measurement of regional myocardial blood flow in dogs.

Abstract: Measurement of regional myocardial blood flow (RMBF) is crucial in experimental studies of myocardial ischemia and reperfusion in dogs. The standard measurement technique uses radioactive microspheres; however, not all institutions are able to dispose of radioactive waste and therefore cannot make use of this method. We tested a new, nonradioactive microsphere, labeled with colors instead of nuclides. Simultaneous blood flow measurements with two nuclide-labeled and two colored microspheres were performed after coronary occlusion in dogs. Both techniques show a within-method correlation of r greater than 0.98. Duplicate variability for paired RMBF values in 80 samples was 8.7 +/- 0.1% when computed with radioactive microspheres and 13.2 +/- 1.8% when computed with colored microspheres. There was a good correlation in the measurement of RMBF between the radioactive- and colored-microsphere methods (r = 0.98). The best-fitting linear regression line was expressed by the formula: Colored-microsphere RMBF = 1.11 (radioactive-microsphere RMBF)-0.02. When measured by colored microspheres, RMBF was approximately 8% higher than when computed with radioactive microspheres for blood flow values of 0-2 ml/min/g. When blood flow was increased pharmacologically to levels of 2-7.5 ml/min/g, colored microspheres yielded blood flow values 39% higher than the values computed by radioactive microspheres. We conclude that the nonradioactive, colored-microsphere method correlates with the radioactive technique, but at high flows, it yields values greater than those obtained with radioactive microspheres.

Comparison of clinical assessment with APACHE II for predicting mortality risk in patients admitted to a medical intensive care unit.

Abstract: The APACHE II ( Acute Physiology and Chronic Health Evaluation ) system has been widely used as an objective means of predicting outcome in critically ill patients. We prospectively evaluated patients consecutively admitted to the medical intensive care unit to compare the predictive accuracy of APACHE II with clinical assessment by critical care personnel. At the time of admission to the intensive care unit, the house staff and nurse responsible for each patient were asked to estimate the patient's hospital mortality risk. The patient's APACHE II score was calculated and a prediction of the patient's hospital mortality risk was then computed on the basis of this score. A total of 366 patients were studied. Mortality predictions were obtained from 57 physicians and 33 critical care nurses. We were unable to demonstrate a significant difference in the accuracy of APACHE II predictions compared with either physicians' or nurses' predictions. Clinical assessment and APACHE II were both highly predictive of outcome. ( JAMA 1988;260:1739-1742)

A reduction method to find spanning Eulerian subgraphs

Abstract: We ask, When does a graph G have a subgraph Γ such that the vertices of odd degree in Γ form a specified set S ⊆ V(G), such that G - E(Γ) is connected? If such a subgraph can be found for a suitable choice of S, then this can be applied to problems such as finding a spanning eulerian subgraph of G. We provide a general method, with applications.

Vivid Memories and the Reminiscence Phenomenon: The Role of a Self Narrative

Abstract: Autobiographical memory research has shown that, for the most part, the retention function for personal memories strongly resembles the retention function identified in laboratory research. However, t

Implantation of posterior chamber lens in the absence of capsular and zonular support

Abstract: • We have developed surgical techniques for implanting a posterior chamber lens in the absence of capsular and zonular support by securing both haptics of the posterior chamber lens to the sclera at the ciliary sulcus with 10-0 prolene suture. These techniques have been successfully performed and have produced good visual results in six monocularly aphakic patients who had contact lens intolerance and/or contraindications to anterior chamber lens implantations. In consideration of the high incidence and the great variety of complications associated with anterior chamber lenses, these newly developed surgical techniques will be a useful alternative to anterior chamber lenses, even in patients who do not have definite contraindications to anterior chamber lens implantations.

Pathogenesis and Epidemiology of Vulvovaginal Candidiasis

Abstract: In contrast to women with infrequent episodes of candidal vaginitis, women with chronic and recurrent candidal vaginitis do not have recognizable precipitating or causal factors. Analysis of vaginal yeast isolated from women with recurrent candidal vaginitis, although revealing a higher percentage of non-albicans Candida sp., indicates that resistance to imidazoles is not a causal factor, and other fungal virulence factors that could explain the repeated attacks have not been identified. Strain typing of sequential clinical isolates indicates a pattern of vaginal relapse rather than frequent vaginal reinfection, and attempts to reduce attacks by treating sexual partners and suppressing a gastrointestinal tract focus have failed. Recent immunological studies suggest the possibility of an acquired Candida antigen-specific immunological deficiency resulting in uncontrolled vaginal Candida proliferation and hence repeated clinical attacks. In support of the immunological hypothesis is the recent report of normal T lymphocyte suppression of Candida hyphal production.

Short-term memory errors for spoken syllables are affected by the linguistic structure of the syllables.

Abstract: Three experiments on short-term serial memory for spoken syllables are reported. The stimuli were CVC (consonant-vowel-consonant) syllables in Experiment 1, CCVs in Experiment 2, and VCCs in Experiment 3. Analyses of subjects' errors showed that the phonemes within a syllable were not equally free to break apart and recombine. Certain groups of phonemes—the vowel- final consonant group of a CVC, the initial cluster of a CC V, and a vowel-liquid group within a VCC—tended to behave as units. These results are consistent with the view that syllables are coded in terms of an onset (initial consonant or cluster) and a rime (remainder). Errors in short- term memory for spoken syllables are affected by the linguistic structure of the syllables. behave as independent units in short-term memory. Rather, syllables are coded in terms of onset and rime units. Preliminary evidence for onset/rime coding was provided by Brady, Shankweiler, and Mann (1983). They reported that children's errors more often preserved the V and final C of a stimulus than the initial C (or CC) and V. We sought to provide further evidence for linguistic units in short-term memory by systematicall y comparing errors on syllables of different structures. As well as asking whether syllables are coded in terms of onset and rime units, we also asked whether rimes are coded in terms of subunits. Some evidence for subunits of the rime was found in a study by Treiman (1984), in which subjects could divide VCCs after the V or after the first C. VC/C divisions predominated when the postvocalic C was a liquid (/I/ or /r/). When the postvocalic C was a nasal (/m/, /n/, or /rj/), VC/C divisions and V/CC divisions did not differ in frequency. Finally, when an obstruent (like /p/ or /$/) fol- lowed the vowel, V/CC divisions tended to outnumber VC/ C divisions. These results were interpreted in terms of the linguistic notion of a sonority hierarchy (Hooper, 1976; Ki- parsky, 1979). Liquids, which are high on the sonority hier- archy or vowel-like, seem to be grouped with the preceding vowel. Nasals, which are intermediate in sonority, are some- what less likely to form a unit with the vowel. Obstruents are low in sonority and have least cohesion with the preceding vowel. To ask whether short-term memory errors differ as a function of the postvocalic consonant, the present experi- ments compared syllables with postvocalic liquids, nasals, and obstruents.

Hearing disorders in children with fetal alcohol syndrome: findings from case reports

Abstract: Fourteen children with the fetal alcohol syndrome were evaluated by standard audiologic procedures. Thirteen of the 14 children had childhood histories of hearing disorders. All 13 of these children (93%) had clinically significant histories of bilateral recurrent serous otitis media (ie, they were otitis prone), and at least four children (29%) had bilateral sensorineural hearing losses in addition to being otitis prone. Many of the children with recurrent serous otitis media required repeated myringotomies with placement of ventilation tubes, and those with sensorineural hearing losses required sound amplification during childhood. Recurrent respiratory infections (secondary to immune deficiencies) and eustachian tube dysfunction (secondary to embryonic malformations of the first and second branchial arches) are discussed as possible etiologic factors in the presence of the recurrent serous otitis media. An alcohol-induced neuroectoderm syndrome and alcohol ototoxicity are discussed as possible etiologic factors in the occurrence of sensorineural hearing loss. The findings suggest that hearing disorders are a heretofore unrecognized characteristic of the fetal alcohol syndrome. Such hearing disorders may contribute to the speech and language and learning difficulties seen in children with fetal alcohol syndrome. The present study also provided confirmatory evidence of visual, health, and speech and language disorders in children with this syndrome.

Comparison of the Tono-Pen to the Goldmann Applanation Tonometer

Abstract: • Oculab Tono-Pen tonometry was compared with Goldmann applanation tonometry in 142 eyes of 71 patients without corneal problems. Overall we found 63% of the Tono-Pen readings to be within ±2 mm Hg of the Goldmann applanation tonometry readings and 77% to be within ±3 mm Hg, while 4% were within at least ±7 mm Hg difference. The correlation coefficient between the readings of the two instruments was.84. The mean value of the paired differences was 0.81 ± 3.09 mm Hg overall, −1.78 ± 1.86 mm Hg in the 4 to 10 mm Hg interval, 0.07 ± 2.97 mm Hg in the 11 to 20 mm Hg interval, 1.27 ± 2.62 mm Hg in the 21 to 30 mm Hg interval, and 4.15 ± 2.28 mm Hg in the 31 to 45 mm Hg interval. We conclude that the Tono-Pen measures intraocular pressure in a manner that corresponds well to the Goldmann tonometer in the 11 to 20 mm Hg interval, and fairly well in the 4 to 10 mm Hg and 21 to 30 mm Hg intervals. It lacks good correspondence in the 31 to 45 mm Hg interval.

Morphological study of the interaction of intravascular tumor cells with endothelial cells and subendothelial matrix

Abstract: Multiple steps or events have been described as essential in the metastatic cascade. Tail vein injection of single cell suspensions was used to study the ultrastructural details of the events involved in the initial arrest and attachment of circulating tumor cells. Lewis Lung Carcinoma (3LL) and a mammary adenocarcinoma (16c) were compared to a previous ultrastructural study of B16 amelanotic melanoma (B16a) detailing morphological events in the initial arrest and attachment of tumor cells in lung. The three murine tumors followed similar steps and varied only slightly in the time sequence of the steps. We observed the following steps: (a) initial arrest of tumor cells was characterized by an intimate tumor endothelial cell contact; (b) platelet activation and aggregation was noted by two minutes. Platelet aggregation continued for 1-4 h until a thrombus formed; (c) after approximately 4 h endothelial cell separation with extension of the tumor cell to the subendothelial matrix was noted; (d) at approximately 24 h the tumor cell associated thrombus dissipated and the attached tumor cells were exposed to a reestablished circulation. (e) mitoses were observed after 24 h with cell division and the development of intravascular tumor nodules; (f) the final step in the extravasation sequence was dissolution of the basement membrane by the attached tumor cells.

Determination of graft tension before fixation in anterior cruciate ligament reconstruction.

Abstract: Summary This study was performed to determine the tension needed to be applied on an anterior cruciate ligament graft before fixation to obtain normal anteroposterior translation following an anterior cruciate ligament reconstruction. Ten fresh-frozen cadaver knees underwent arthroscopy and were determined to have intact anterior and posterior cruciate ligaments and both menisci. A knee arthrometer (model KT 1000, MedMetric Corp., San Diego, CA, U.S.A.) was used to determine the anteroposterior translation with a 20 lb load. The anterior cruciate ligament was arthroscopically sectioned, and a repeat arthrometer measurement was made. Isometric points in the femur and tibia were determined using a tension isometer before drilling bony tunnels. The central third patellar tendon (bone-tendon-bone) complex, semitendinosus that was doubled on itself, and an iliotibial band approximately 3 cm wide were harvested. The grafts were separately passed through the knee, the femoral end was secured, and various tensions were applied to the tibial end before fixation. Repeat knee arthrometer measurements were performed after each new tension was applied. Arthrometer testing was continued until the post-reconstruction 20 lb anterior drawer equalled the anterior cruciate ligament intact drawer. The patellar tendon returned the knee to its preoperative condition with a mean 3.6 lb of tension, the semitendinosus with 8.5 lb, and the iliotibial band with 13.6 lb. All these differences were statistically significant (p