Medicine and Health Sciences Commons^™

Patterns Of Breast Recurrence In A Pilot Study Of Brachytherapy Confined To The Lumpectomy Site For Early Breast Cancer With Six Years' Minimum Follow-Up, Francisco Perera, Edward Yu, Jay Engel, Ronald Holliday, Leslie Scott, Frank Chisela, Varagur Venkatesan

Edward Yu

PURPOSE: In this pilot study of high-dose-rate brachytherapy to the lumpectomy site as the sole radiation, ipsilateral and contralateral breast recurrences are documented with specific attention to the location of recurrence relative to the lumpectomy site. METHODS: Between March 1992 and January 1996, 39 patients with T1 (32 patients) and T2 breast cancers received 37.2 Gy in 10 fractions (b.i.d.) over 1 week prescribed to a volume encompassing the surgical clips. Thirteen received adjuvant tamoxifen, and 4 received chemotherapy. Follow-up included annual bilateral mammograms and clinical breast examination every 3 to 6 months. Whereas 13 patients had intraoperative implantation of …

Amygdala Hyperreactivity In Borderline Personality Disorder: Implications For Emotional Dysregulation, Nelson H. Donegan, Charles A. Sanislow, Hilary P. Blumberg, Robert K. Fulbright, Cheryl Lacadie, Pawel Skudlarski, John C. Gore, Ingrid R. Olson, Thomas H. Mcglashan, Bruce E. Wexler

Charles A. Sanislow, Ph.D.

BACKGROUND: Disturbed interpersonal relations and emotional dysregulation are fundamental aspects of borderline personality disorder (BPD). The amygdala plays important roles in modulating vigilance and generating negative emotional states and is often abnormally reactive in disorders of mood and emotion. The aim of this study was to assess amygdala reactivity in BPD patients relative to normal control subjects. We hypothesized that amygdala hyperreactivity contributes to hypervigilance, emotional dysregulation, and disturbed interpersonal relations in BPD.

METHODS: Using functional magnetic resonance imaging, we examined neural responses to 20-sec blocks of neutral, happy, sad, and fearful facial expression (or a fixation point) in 15 …

Shifting From Hypofractionated To "Conventionally" Fractionated Thoracic Radiotherapy: A Single Institution's 10-Year Experience In The Management Of Limited-Stage Small-Cell Lung Cancer Using Concurrent Chemoradiation, Gregory Videtic, Pauline Truong, A. Dar, Edward Yu, Larry Stitt

Edward Yu

PURPOSE: To perform a retrospective review of a single institution's 10-year experience in treating limited-stage small-cell lung cancer (LS-SCLC) with a concurrent chemoradiation regimen modeled after the experimental arm of a randomized National Cancer Institute of Canada trial in which hypofractionated radiotherapy started with cycle 2 of chemotherapy. We then looked at the impact on patient outcomes of changing the RT during the course of the decade to a "conventionally" (2 Gy) fractionated regimen, with a focus on toxicity and survival rates. METHODS AND MATERIALS: Between 1989 and 1999, 215 LS-SCLC patients received six cycles of chemotherapy consisting of cyclophosphamide, …

The Natural Course Of Bulimia Nervosa And Eating Disorder Not Otherwise Specified Is Not Influenced By Personality Disorders, Carlos M. Grilo, Charles A. Sanislow, M. Tracie Shea, Andrew E. Skodol, Robert L. Stout, Maria E. Pagano, Shirley Yen, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: To examine prospectively the natural course of bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) and to test the effects of personality disorder (PD) comorbidity on the outcomes.

Method: Ninety-two female patients with current BN (N ¼ 23) or EDNOS (N ¼ 69) were evaluated at baseline enrollment in the Collaborative Longitudinal Personality Disorders Study (CLPS). Eating disorders (EDs) were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders. Personality disorders (PDs) were assessed with the Diagnostic Interview for DSM-IV PD (DIPD-IV). The course of BN and EDNOS was assessed with the Longitudinal Interval Follow-up …

Clinical Features And Impairment In Women With Borderline Personality Disorder (Bpd) With Post-Traumatic Stress Disorder (Ptsd), Bpd Without Ptsd, And Other Personality Disorders With Ptsd, Caron Zlotnick, Dawn M. Johnson, Shirley Yen, Cynthia Battle, Charles A. Sanislow, Andrew E. Skodol, Carlos M. Grilo, Thomas H. Mcglashan, John G. Gunderson, Donna S. Bender, Mary C. Zanarini, M. Tracie Shea

Charles A. Sanislow, Ph.D.

The aims of this study were to examine differences in clinical features, impairment, and types of childhood traumas among women with borderline personality disorder (BPD), women with BPD and posttraumatic stress disorder (PTSD), and those with other personality disorders and PTSD. Using baseline data from the Collaborative Longitudinal Study of Personality Disorders, 186 women were divided into 3 groups (BPD+PTSD, BPD, PTSD), based on structured diagnostic interviews for Axis I and Axis II disorders and compared on selected clinical variables. The additional diagnosis of PTSD in borderline women did not significantly increase the degree of borderline pathology and psychiatric morbidity …

Offering To Return Results To Research Participants: Attitudes And Needs Of Principal Investigators In The Children's Oncology Group, Conrad Fernandez, Eric Kodish, Susan Shurin, Charles Weijer

Charles Weijer

PURPOSE: The offer to return a summary of results to participants after the conclusion of clinical research has many potential benefits. The authors determined current practice and attitudes and needs of researchers in establishing programs to return results to research participants.

METHODS: An Internet survey of all 236 principal investigators (PIs) of the Children's Oncology Group in May 2002 recorded PI and institutional demographics, current practice, and perceived barriers to and needs of PIs for the creation of research results programs.

RESULTS: One hundred fifty (63.8%) PIs responded. Few institutions (n = 5) had established, comprehensive programs to offer the …

The Representation Of Four Personality Disorders By The Schedule For Nonadaptive And Adaptive Personality Dimensional Model Of Personality, Leslie C. Morey, Megan B. Warner, M. Tracie Shea, John G. Gunderson, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

This study examined the relationships of the Schedule for Nonadaptive and Adaptive Personality (SNAP) model of personality to 4 targeted personality disorders (PDs) in a large multisite sample of patients. Data were examined from 529 patients, who were assigned 1 of 5 primary diagnoses: borderline, schizotypal, avoidant, and obsessive–compulsive PDs and major depression without PD. Patients were administered the SNAP questionnaire and results were compared among diagnostic groups and between patient groups and nonclinical norms. Results indicated that the dimensions of the model appear to have considerable promise in differentiating normal from abnormal personality, particularly in the propensity of individuals …

Axis I And Ii Disorders As Predictors Of Prospective Suicide Attempts: Findings From The Collaborative Longitudinal Personality Disorders Study, Shirley Yen, M. Tracie Shea, Maria Pagano, Charles A. Sanislow, Carlos M. Grilo, Thomas H. Mcglashan, Andrew E. Skodol, Donna S. Bender, Mary C. Zanarini, John G. Gunderson, Leslie C. Morey

Charles A. Sanislow, Ph.D.

This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant …

Neural Correlates Of Memories Of Abandonment In Women With And Without Borderline Personality Disorder, Christian G. Schmahl, Bernet M. Elzinga, Eric Vermetten, Charles A. Sanislow, Thomas H. Mcglashan, J. Douglas Bremner

Charles A. Sanislow, Ph.D.

BACKGROUND: Borderline personality disorder (BPD) is a common psychiatric disorder that is often linked to early stressors. One particularly salient feature of the disorder is fear of abandonment. This pilot study was conducted to measure neural correlates of memories of abandonment in women with and without BPD.

METHODS: Twenty women with a history of childhood sexual abuse underwent measurement of brain blood flow with positron emission tomography imaging while they listened to scripts describing neutral and personal abandonment events. Brain blood flow during exposure to abandonment and neutral scripts was compared among women with and without BPD.

RESULTS: Memories of …

Gender Differences In Borderline Personality Disorder: Findings From The Collaborative Longitudinal Personality Disorders Study, Dawn M. Johnson, M. Tracie Shea, Shirley Yen, Cynthia L. Battle, Caron Zlotnick, Charles A. Sanislow, Carlos M. Grilo, Andrew E. Skodol, Donna S. Bender, Thomas H. Mcglashan, John G. Gunderson, Mary C. Zanarini

Charles A. Sanislow, Ph.D.

A majority of the literature on borderline personality disorder (BPD) focuses on its occurrence in women or does not specifically assess for gender differences in clinical presentations. Some studies report that men with BPD may be more likely to be diagnosed with substance use disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders (PDs). Additionally, women with BPD appear to be more likely to report histories of adult physical and sexual abuse and to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and eating disorders. The purpose of the present study was to further examine gender differences …

Is The Use Of Placebo Controls Ethically Permissible In Clinical Trials Of Agents Intended To Reduce Fractures In Osteoporosis?, Baruch Brody, Nancy Dickey, Susan Ellenberg, Robert Heaney, Robert Levine, Richard O'Brien, Ruth Purtilo, Charles Weijer

Charles Weijer

Substantial progress has been made in developing treatments that reduce the risk of fractures in osteoporosis. However, available treatments are only partially effective, they are not widely used, and there is need to search for more effective means of fracture prevention. Currently known effective means of reducing fractures were found using randomized placebo-controlled trials. The use of placebo controls in clinical trials has been a subject of significant controversy in recent years. The Declaration of Helsinki revision of October 2000 caused great concern among clinical investigators about the future use of placebo controls if known effective therapeutic agents are available. …

Changes In Postural Stability In Women Aged 20 To 80 Years, Nancy Low Choy, Sandra Brauer, Jennifer Nitz

Nancy Low Choy

Background.
A study of postural stability was undertaken to identify the relationship between vision and support surface across age decades. Understanding when reliance on vision for postural stability emerges and the support conditions contributing to this instability may provide the evidence required to introduce falls-prevention strategies in younger age decades.

Methods.
We measured postural stability in 453 women aged 20 to 80 years using the Balance Master force-plate system while the women performed the modified Clinical Test for the Sensory Interaction and Balance (firm and foam surfaces, eyes open and closed) and the Single-Limb Stance Test (eyes open and closed). …

Continued Cigarette Smoking By Patients Receiving Concurrent Chemoradiotherapy For Limited-Stage Small-Cell Lung Cancer Is Associated With Decreased Survival, Gregory Videtic, Larry Stitt, A. Dar, Walter Kocha, Anna Tomiak, Pauline Truong, Mark Vincent, Edward Yu

Edward Yu

PURPOSE: To determine the impact of continued smoking by patients receiving chemotherapy (CHT) and radiotherapy (RT) for limited-stage small-cell lung cancer (LSCLC) on toxicity and survival. PATIENTS AND METHODS: A retrospective review was carried out on 215 patients with LSCLC treated between 1989 and 1999. Treatment consisted of six cycles of alternating cyclophosphamide, doxorubicin, vincristine and etoposide, cisplatin (EP). Thoracic RT was concurrent with EP (cycle 2 or 3) only. Patients were known smokers, with their smoking status recorded at the start of chemoradiotherapy (CHT/RT). RT interruption during concurrent CHT/RT was used as the marker for treatment toxicity. RESULTS: Of …

Do Eating Disorders Co-Occur With Personality Disorders? Comparison Groups Matter., Carlos M. Grilo, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Robert L. Stout, M. Tracie Shea, Mary C. Zanarini, Donna S. Bender, Leslie C. Morey, Ingrid R. Dyck, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To assess and compare lifetime rates of occurrence of eating disorders (ED) with four Axis II personality disorders (PD) and with major depressive disorder (MDD) without PD. The eating disorders met criteria outlined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

METHOD: Six hundred sixty-eight patients recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were reliably assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and the Diagnostic Interview for DSM-IV Personality Disorders. The distribution of ED diagnoses was compared among four PD study groups (schizotypal, borderline, avoidant, obsessive-compulsive) and …

Die Vroeë Kommunikasieontwikkeling Van 'N Groep Babas Met Pediatriese Miv / Vigs In Sorgsentrums, Isabel Bam, Alta Kritzinger, Brenda Louw

Brenda Louw

Representations Of Therapists By Patients With Personality Disorders, Donna S. Bender, Barry A. Farber, Charles A. Sanislow, Ingrid R. Dyck, Jesse D. Geller, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

The purpose of this study was to investigate attributes of mental representations of therapists by patients with specific personality disorders (PDs), schizotypal (STPD), borderline (BPD), avoidant (AVPD), and obsessive-compulsive (OCPD), and a comparison group with Major Depressive Disorder and no PD (MDD). The Therapist Representation Inventory-II (TRI) measured characteristics of participants' extra-session thoughts about their therapists. Results showed that patients with STPD had the highest level of mental involvement with therapy outside the session, missing their therapists and wishing for friendship, while also feeling aggressive or negative. Patients with BPD exhibited the most difficulty in creating a benign image of …

Correlates Of Suicide Risk In Juvenile Detainees And Adolescent Inpatients, Charles A. Sanislow, Carlos M. Grilo, Dwain C. Fehon, Seth R. Axelrod, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

OBJECTIVE: To compare correlates of risk for suicidal behavior in juvenile detainees with those in another high-risk group, adolescent psychiatric inpatients.

METHOD: Eighty-one adolescents in a short-term juvenile detention center were contrasted with a matched group of 81 adolescent psychiatric inpatients on a clinical assessment battery of established instruments including a measure for risk of suicidal behavior.

RESULTS: Juvenile detainees and adolescent psychiatric inpatients reported similar levels of distress on measures of suicide risk, depression, impulsivity, and drug abuse. After controlling for depression, impulsivity and drug abuse remained significantly associated with suicide risk scores in the juvenile detention group, but …

278 Blunt Duodenal Injuries From A Large Multi-Institutional Study: Incidence, Diagnosis, And Outcome, Christopher Michetti, S Fakhry, D Watts, L Weireter, B Daley

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

No abstract provided.

A Role Of The Basal Ganglia In Movement: The Effect Of Precues On Discrete Bi-Directional Movements In Parkinson's Disease, Andrew Johnson, Philip Vernon, Quincy Almeida, Linda Grantier, Mandar Jog

Andrew M. Johnson

The effect of a precue on improving movement initiation (i.e., reaction time; RT) is well understood, whereas its influence on movement execution (i.e., movement time; MT) has rarely been examined. The current study investigated the influence of a directional precue (i.e., left vs. right) on the RT and MT of simple and discrete bi-directional movements in a large sample of Parkinson's disease patients and healthy control participants. Both patients and controls were tested twice, with testing sessions separated by 2 hours. Patients were tested first following an overnight levodopa withdrawal and again after they had taken their medication. Both patients …

Black Men Who Have Sex With Men And The Hiv Epidemic: Next Steps For Public Health, David J. Malebranche

David J Malebranche

No abstract provided.

Crisis Intervention Services In Juvenile Detention Centers, Charles A. Sanislow, John Chapman, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

The prevalence of mental disorders among juvenile detainees is estimated to be as high as 60 percent, and reports suggest that adolescents who are detained have a three- to fourfold risk of suicide. The transfer of juveniles who commit serious offenses to the adult legal system and the problems of overwhelmed child care agencies appear to have precipitated a shift in the composition of populations in juvenile detention centers. Adolescents are often detained for minor legal charges that occur in the context of severe behavioral problems and family stress. We report on a collaborative venture between a state juvenile justice …

Plausibility And Possible Determinants Of Sudden 'Remissions' In Borderline Patients, John G. Gunderson, Donna S. Bender, Charles A. Sanislow, Shirley Yen, Jennifer Bame Rettew, Regina Dolan-Sewell, Ingrid R. Dyck, Leslie C. Morey, Thomas H. Mcglashan, M. Tracie Shea, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

THIS STUDY documents dramatic improvements in patients with borderline personality disorder (BPD) and explores their possible determinants. From a sample of the 160 carefully diagnosed borderline patients on whom prospective follow-along data was collected, a subsample of 18 was identified whose DSM-IV criteria count fell to two or fewer during the course of the first 6 months of the study and retained that improvement for the next 6 months. Follow-along data including month-by-month ratings of BPD criteria; week-by-week ratings of Axis I disorders, medication changes, and life events were then used to establish concensus ratings on four hypothesized causes: Axis …

Validation Of The Lognormal Model For Prediction Of Long-Term Survival Rates From Short-Term Follow Up Data In Stages Iii And Iv Breast Cancer, P. Tai, E. Yu, D. Skarsgard, J. Tonita

Edward Yu

No abstract provided.