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Depressed Contractile Responses To Neurokinin A In Idiopathic But Not Neurogenic Overactive Human Detrusor Muscle, Donna Sellers, Christopher Chapple, Douglas Hay, Russell Chess-Williams

Russ Chess-Williams

Objective: The role of tachykinins such as neurokinin A in regulating bladder function is unclear, but NK2 receptors seem to mediate contraction in the human bladder and it has been suggested that these peptides may have a role in the pathophysiology of bladder dysfunction. The present study investigates neurokinin receptor-mediated contractility of detrusor muscle in the idiopathic overactive and neurogenic overactive bladder and investigates the neurokinin receptor subtypes involved.

Methods: Human bladder was obtained from patients undergoing cystectomy (normal) or clam cystoplasty (idiopathic overactive) and from patients with spinal injuries (neurogenic overactive). Strips of isolated detrusor muscle were mounted in …

What Is The Cost To Employers Of Direct Medical Care For Chronic Obstructive Pulmonary Disease?, Tursynbek Nurmagambetov, Adam Atherly, Seymour Williams, Fernando Holguin, David M. Mannino, Stephen C. Redd

David M. Mannino

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the United States. In 2000, an estimated 10.5 million people had COPD, of which more than 7.2 million were from the under-age 65 employed population. The prevalence of COPD in the workforce population was substantial with 46.5% of current employment among adults having the disease. However, the cost burden in the employed population is unknown. We examined COPD prevalence and costs in a large employment-based population. Using claims data from 1999 to 2003, we estimated the cost associated with COPD-related hospitalizations, emergency department visits, outpatient services, …

The Effect Of Timing Of Radiotherapy After Breast-Conserving Surgery In Patients With Positive Or Close Resection Margins, Young Age, And Node-Negative Disease, With Long Term Follow-Up, Olga Vujovic, Anil Cherian, Edward Yu, A. Dar, Larry Stitt, Francisco Perera

Edward Yu

Purpose: The aim of this study was to determine the effect of timing of radiotherapy after conservative breast surgery on local recurrence in women with positive resection margins and young age, treated without systemic therapy. Methods and materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, between January 1, 1985, and December 31, 1992, at the London Regional Cancer Centre. 63 patients (11.1%) had positive/close resection margins (< 2 mm) and 48 patients (8.4%) were age < or = 40 years. For patients with positive resection margins, the time intervals from breast surgery to breast irradiation used for analysis were, 0 to 8 weeks, > 8 to 12 weeks and > 12 weeks. For patients < or = 40 years, the intervals used for analysis were 0 to 8 weeks and > 8 weeks. Results: Median follow up was 11.2 years. For patients …

Is It Useful To Measure Sedimentation Rate (Esr) As A Broad Screening Test In The Emergency Department?, Paris B. Lovett

Paris B Lovett

Is It Useful to Measure Sedimentation Rate (ESR) as a Broad Screening Test in the Emergency Department? Breen LM, Lovett PB, Greenwald RA NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY; Long Island Jewish Medical Center, New Hyde Park, NY Background: Multiple studies have reported that markedly elevated sedimentation rates (ESR_100) are associated with several groups of diagnoses: infection, systemic inflammatory disorders, malignancy, and renal disease. These associations are largely drawn from case series. ESR is sometimes used as a screening test in the emergency department (ED), yet the clinical value of such screening is uncertain. Study Objectives: Our …

Applicants Report That Their Rankings Of Em Programs Are Most Driven By Wellness, Morale, Happiness And Rapport, Paris B. Lovett

Paris B Lovett

Applicants Report That Their Rankings of EM Programs Are Most Driven by Wellness, Morale, Happiness and Rapport

Lovett PB, Sayan OR, Glassman GD, Petrik R

New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY

Study Objectives: Our objectives were to (1) determine which factors are considered most important to residency applicants as they choose between residency programs in emergency medicine (EM) and (2) compare the response rates on this electronic/Web survey against response rates in prior comparable paper/mail surveys.

Methods: We surveyed all 118 applicants who interviewed at an urban, academic PGY1-4 EM program in 2005-6. A Web …

Respiratory Symptoms: A Reason To Obtain Spirometry, David M. Mannino

David M. Mannino

Comment on

Discrepancy in the use of confirmatory tests in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease or congestive heart failure. [Respir Care. 2006]

http://rc.rcjournal.com/content/51/10/1116.full.pdf

Spirometric Screening - Does It Work?, David M. Mannino

David M. Mannino

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2104769/

Changing The Burden Of Copd Mortality, David M. Mannino, Victor A. Kiri

David M. Mannino

COPD is a major cause of mortality and morbidity worldwide with an estimated 2.75 million deaths in 2000 (fourth leading cause of death). In addition to the considerable morbidity and mortality associated with COPD, this disease incurs significant healthcare and societal costs. Current COPD guidelines acknowledge that the following can improve COPD mortality: smoking cessation; long-term oxygen therapy; and lung volume reduction surgery in small subsets of COPD patients. To date, no randomized controlled trials have demonstrated an effect of pharmacological treatment on mortality, although several observational studies suggest that both long-acting bronchodilators and inhaled corticosteroids may provide a survival …

The Role Of Body Mass Index And Diabetes In The Development Of Acute Organ Failure And Subsequent Mortality In An Observational Cohort, Katarina Slynkova, David M. Mannino, Greg S. Martin, Richard S. Morehead, Dennis E. Doherty

David M. Mannino

Introduction

Several studies have shown a correlation between body mass index (BMI) and both the development of critical illness and adverse outcomes in critically ill patients. The goal of our study was to examine this relationship prospectively with particular attention to the influence of concomitant diabetes mellitus (DM).

Methods

We analyzed data from 15,408 participants in the Atherosclerosis Risk in Communities (ARIC) study for this analysis. BMI and the presence of DM were defined at baseline. We defined 'acute organ failure' as those subjects who met a standard definition with diagnostic codes abstracted from hospitalization records. Outcomes assessed included the …

Women And Chronic Obstructive Pulmonary Disease: Does Sex Influence Survival?, David M. Mannino

David M. Mannino

Comment on

Sex differences in survival of oxygen-dependent patients with chronic obstructive pulmonary disease. [Am J Respir Crit Care Med. 2006]

Beliefs About Essences And The Reality Of Mental Disorders, Woo-Kyoung Ahn, Elizabeth H. Flanagan, Jessecae K. Marsh, Charles A. Sanislow

Charles A. Sanislow, Ph.D.

Do people believe mental disorders are real and possess underlying essences? The current study found that both novices and practicing clinicians held weaker essentialist beliefs about mental disorders than about medical disorders. They were also unwilling to endorse the idea that mental disorders are real and natural. Furthermore, compared with novices, mental health clinicians were less likely to endorse the view that there is a shared cause underlying a mental disorder and that one needs to remove the cause to get rid of the mental disorder. Clinicians were polarized on their views about whether mental disorders are categorical or dimensional. …

Syndrome Of Inappropriate Antidiuretic Hormone Secretion (Siadh) In Patients With Limited Stage Small Cell Lung Cancer, Patricia Tai, Edward Yu, Kurian Jones, Evgeny Sadikov, Shazia Mahmood, Jon Tonita

Edward Yu

A few series in the literature were published before 1987 on syndrome of inappropriate antidiuretic hormone secretion (SIADH) in small cell lung cancer (SCLC). This study examines the outcome in more recent era. From 1981-1998, there were 1417 new cases of SCLC diagnosed in the provincial registry, of which 244 were of limited stage (LS). A chart review and statistical analyses were performed using Mann-Whitney test, chi-square test and Kaplan-Meier method. Fourteen LS patients (group A) had SIADH at presentation. Group B consisted of 230 LS patients without SIADH. There were more patients with poorer performance status (ECOG 2-4) in …

The Role Of Radiation Therapy In Malignant Pleural Mesothelioma: A Systematic Review, Yee Ung, Edward Yu, Conrad Falkson, Adam Haynes, Denise Stys-Norman, William Evans

Edward Yu

Introduction: Radiation therapy may offer patients presenting with malignant pleural mesothelioma (MPM) symptom palliation and improvements in quality of life. This systematic review will address the role of radiation therapy in the management of MPM. Methods: A thorough systematic search of the literature was conducted for published articles and conference proceedings for applicable abstracts. Relevant trials were selected and assessed. Results: Three small randomized controlled trials compared prophylactic external beam radiation therapy to no radiation therapy for patients with thoracic tracts caused by drainage tubes or diagnostic procedures. None of those trials reported any serious adverse effects. A pooled analysis …

Descriptive And Longitudinal Observations On The Relationship Of Borderline Personality Disorder And Bipolar Disorder, John G. Gunderson, Igor Weinberg, Maria T. Daversa, Karsten D. Kueppenbender, Mary C. Zanarini, M. Tracie Shea, Andrew E. Skodol, Charles A. Sanislow, Shirley Yen, Leslie C. Morey, Carlos M. Grilo, Thomas H. Mcglashan, Robert L. Stout, Ingrid R. Dyck

Charles A. Sanislow, Ph.D.

OBJECTIVE: The purpose of this study was to test whether borderline personality disorder is a variant of bipolar disorder by examining the rates of co-occurrence in both disorders, the effects of co-occurrence on a longitudinal course, and whether the presence of either disorder confers the risk for new onsets of the other.

METHOD: A prospective repeated-measures design with reliable independent diagnostic measures and 4 years of follow-up was used to assess 196 patients with borderline personality disorder and 433 patients with other personality disorders.

RESULTS: Patients with borderline personality disorder had a significantly higher co-occurrence of bipolar disorder (19.4%) than …

Hospitalization For Patients With Sarcoidosis: 1979-2000, M. G. Foreman, David M. Mannino, L. Kamugisha, G. E. Westney

David M. Mannino

BACKGROUND AND AIM:

Sarcoidosis is a multi-system granulomatous disease of unknown etiology with significant racial and gender differences in disease severity, incidence, and prevalence. Primarily treated in outpatients, limited information is available on hospital outcomes in patients with sarcoidosis. The National Hospital Discharge Survey (NHDS) was analyzed over a 22-year period to determine trends in hospitalization and the impact of concurrent comorbidities.

METHODS:

Secondary analysis was done of the NHDS, a national survey of inpatient medical care for short stays in nonfederal facilities.

RESULTS:

There were a total of 750 million hospitalizations over this 22-year period, with 593,455 (0.08%) hospitalizations …

Injury Prevalence Among Children And Adolescents With Mental Retardation, Elspeth M. Slayter, Deborah W. Garnick, Joanna M. Kubisiak, Christine E. Bishop, Daniel M. Gilden, Rosemarie B. Hakim

Elspeth Slayter

The Insecure Airway: A Comparison Of Knots And Commercial Devices For Securing Endotracheal Tubes, Paris B. Lovett

Paris B Lovett

Abstract Background: Endotracheal Tubes (ETTs) are commonly secured using adhesive tape, cloth tape, or commercial devices. The objectives of the study were (1) To compare degrees of movement of ETTs secured with 6 different commercial devices and (2) To compare movement of ETTs secured with cloth tape tied with 3 different knots (hitches). Methods: A 17 cm diameter PVC tube with 14 mm "mouth" hole in the side served as a mannequin. ETTs were subjected to repeated jerks, using a cable and pulley system. Measurements: (1) Total movement of ETTs relative to "mouth" (measure used for devices) (2) Slippage of …

Predictors Of 2-Year Outcome For Patients With Borderline Personality Disorder, John G. Gunderson, Maria T. Daversa, Carlos M. Grilo, Thomas H. Mcglashan, Mary C. Zanarini, M. Tracie Shea, Andrew E. Skodol, Shirley Yen, Charles A. Sanislow, Donna S. Bender, Ingrid R. Dyck, Leslie C. Morey, Robert L. Stout

Charles A. Sanislow, Ph.D.

OBJECTIVE: The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up.

METHOD: Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences …

Anomalia Anorretal: Relato De Caso Clínico / Anorectal Malformations: A Case Report, Everton Fernando Alves, Jucélia Lins Dos Santos Oliveira, Maria Do Rosário Martins

Everton Fernando Alves

A Anomalia Anorretal é uma importante causa de obstrução gastrintestinal, com alta taxa de morbi-mortalidade em recém-natos. Há diversos mecanismos patológicos possíveis para explicar esta malformação e duas explicações clássicas de sua gênese são um defeito de recanalização do tubo intestinalou uma interrupção no suprimento sanguíneo durante a vida intra-uterina, entretanto a causa ainda é desconhecida. Desta forma, o presenteestudo tem por objetivo descrever um caso clínico de uma criança internada em um Hospital do Município de Maringá-PR, portadora de uma anomalia anorretal (Ânus imper-furado). Para este estudo, foram coletados dados do prontuário da criança, exame físico e uma entrevista …

Eleven-Year Follow-Up Results In The Delay Of Breast Irradiation After Conservative Breast Surgery In Node-Negative Breast Cancer Patients, Olga Vujovic, Edward Yu, Anil Cherian, A. Dar, Larry Stitt, Francisco Perera

Edward Yu

Purpose: This retrospective review was conducted to determine if delay in the start of radiotherapy after conservative breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients. Methods and materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy, between January 1, 1985 and December 31, 1992 at the London Regional Cancer Centre. The time intervals from definitive breast surgery to breast irradiation used for analysis were 0 to 8 weeks (201 patients), greater than 8 to 12 …

Membrane Sweeping At Initiation Of Formal Labor Induction - A Randomized Controlled Trial, Siti Zawiah Omar

Siti Zawiah Omar

OBJECTIVE: To determine the benefit of membrane rate, reduced oxytocic drug use, shortened induction to sweeping at initiation of labor induction in conjunction delivery interval, and improved patient satisfaction. with formal methods of labor induction. METHODS: Two hundred seventy-four women at term with a singleton fetus in cephalic presentation and intact membranes were randomly assigned to receive membrane sweeping or no membrane sweeping at initiation of formal labor induction with either dinoprostone pessary or amniotomy. Outcome measures included mode of delivery, induction-to-delivery interval, dinosprostone dose, any oxytocin use and duration of oxytocin use in labor, visual analog score for pain …

Perfectionism And Depressive Symptoms 3 Years Later: Negative Social Interactions, Avoidant Coping, And Perceived Social Support As Mediators., David M. Dunkley, Charles A. Sanislow, Carlos M. Grilo, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Although research has demonstrated perfectionism to have a negative impact on the treatment of depression, little research has examined the mechanisms or processes through which perfectionism predicts subsequent depressive symptoms in clinical populations over time. Using data from a prospective, 3-year study of a clinical sample (N = 96), hierarchical regression analyses indicated that perfectionism, assessed by the Dysfunctional Attitude Scale (Weissman AN, Beck AT. Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. Paper presented at the 86th annual convention of the American Psychological Association, Toronto, Ontario, Canada; 1978), is distinguished from major depression and neuroticism for …

New Trends In Shock Resuscitation, Christopher Michetti

Christopher P. Michetti, M.D., F.A.C.S.

No abstract provided.

Comparative Planning Evaluation Of Intensity-Modulated Radiotherapy Techniques For Complex Lung Cancer Cases, Slav Yartsev, Jeff Chen, Edward Yu, Tomas Kron, George Rodrigues, Terry Coad, Kristina Trenka, Eugene Wong, Glenn Bauman, Jake Van Dyk

Edward Yu

Background and purpose: Lung cancer treatment can be one of the most challenging fields in radiotherapy. The aim of the present study was to compare different modalities of radiation delivery based on a balanced scoring scheme for target coverage and normal tissue avoidance. Patients and methods: Treatment plans were developed for 15 patients with stage III inoperable non-small cell lung cancer using 3D conformal technique and intensity-modulated radiotherapy (IMRT). Elective nodal irradiation was included for all cases to create the most challenging scenarios with large target volumes. A 2 cm margin was used around the gross tumour volume (GTV) to …

Prospective Assessment Of Treatment Use By Patients With Personality Disorders, Donna S. Bender, Andrew E. Skodol, Maria E. Pagano, Ingrid R. Dyck, Carlos M. Grilo, M. Tracie Shea, Charles A. Sanislow, Mary C. Zanarini, Shirley Yen, Thomas H. Mcglashan, John G. Gunderson

Charles A. Sanislow, Ph.D.

OBJECTIVE: This study examined the utilization of mental health treatments over a three-year period among patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders compared with patients with major depressive disorder and no personality disorder.

METHODS: A prospective, longitudinal study design was used to measure treatment use for 633 individuals aged 18 to 45 years during a three-year period.

RESULTS: Patients with borderline personality disorder were significantly more likely than those with major depressive disorder to use most types of treatment. Furthermore, all patients continued using high-intensity, low-duration treatments throughout the study period, whereas individual psychotherapy attendance declined significantly after …

Longitudinal Changes In Visual Acuity In Keratoconus, Larry J. Davis, Kenneth B. Schechtman, Brad S. Wilson, Carol E. Rosenstiel, Colleen H. Riley, David P. Libassi, Ralph E. Gundel, Louis Rosenberg, Mae O. Gordon, Karla Zadnik

Larry Davis

Air Pollutants And Respiratory Symptoms Among Adults, Paulo A. Lotufo

Paulo A Lotufo

Air pollutants are associated with adverse respiratory effects mainly in susceptible groups such as children, elderly people and people with pre-existent respiratory disease. This study was designed to assess the impact of the inorganic composition of particulate matter on 33 adult asthmatics respiratory functions in São Paulo city, Brazil. From May to July 2002, fine and coarse particulate matter fractions were collected and trace metals (Fe2+, Mn2+, Zn2+, Pb2+, Cu2+) and major ions (Na+, Mg2+, K+, Ca2+, NH4 +, Cl-, NO3-, SO42-) composition was determined in each aqueous-extract fraction by Atomic Absorption Spectrometry with Graphite Furnace (AAS-GF) and Ion Chromatography, …

The Acute-Phase Proteins Serum Amyloid A And C Reactive Protein In Transudates And Exudates, Paulo A. Lotufo

Paulo A Lotufo

The distinction between exudates and transudates is very important in the patient management. Here we evaluate whether the acute-phase protein serum amyloid A (SAA), in comparison with C reactive protein (CRP) and total protein (TP), can be useful in this discrimination. CRP, SAA, and TP were determined in 36 exudate samples (27 pleural and 9 ascitic) and in 12 transudates (9 pleural and 3 ascitic). CRP, SAA, and TP were measured. SAA present in the exudate corresponded to 10% of the amount found in serum, that is, the exudate/serum ratio (E/S) was 0.10±0.13. For comparison, the exudate/serum ratio for CRP …

Epidemiological Studies In The Information And Genomics Era: Experience Of The Clinical Genome Of Cancer Project In São Paulo, Brazil, V Wunsch, Jose Eluf-Neto, Paulo A. Lotufo, Marco A. Zago

Paulo A Lotufo

No abstract provided.

Social Medicine In The Twenty-First Century, Scott Stonington Phd, Md, Seth M. Holmes Phd, Md, The Plos Medicine Editors

Seth M. Holmes PhD, MD

No abstract provided.