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Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Universal Health Care For Americans, Frank Clemente

Henry Ford Hospital Medical Journal

No abstract provided.

Training The Urban Health Care Provider: One Department's First Steps, James Schindler

Henry Ford Hospital Medical Journal

As our country faces a national crisis in health care, few have outlined plans to improve the shortage of primary care physicians. This is especially critical in urban areas where sociocultural impacts on health are large. The Department of Family Practice and Community Medicine at the University of Texas School of Medicine in Houston has begun development of a division of Urban Family Medicine to address the special training needs of the urban family practitioner. Subdivisions that have been formed focus on undergraduate curriculum, graduate educational strategies, service, and research and policy to further develop the training model.

Federal, State, And Local Partnerships In Providing Primary Care: One Urban Health Department's Endeavor With A State University Medical Center, Joy L. Getzenberg, D. Patrick Lenihan

Henry Ford Hospital Medical Journal

We describe how the federal government, the City of Chicago, and the State of Illinois worked together to increase the availability and accessibility of health care services on Chicago's underserved west side by reopening a bankrupt, federally-funded community health center. The federal government made the building available to the City which then contracted with a state university medical center to be the provider of services. This partnering has allowed the Chicago Department of Health to offer services in a previously underserved area. The University has gained an opportunity for community-based primary care teaching, as well as community relations. Patients have …

Public Health Care Delivery In Five U.S. Municipalities: Lessons And Implications, David G. Whiteis, J. Warren Salmon

Henry Ford Hospital Medical Journal

Increasing pressures on private and public hospitals have necessitated a reassessment of urban health care delivery. Patients left unserved by stressed private hospitals have placed a greater burden on public institutions, which themselves are often old, underfunded, and in danger of closure. As policy analysts consider remedies, primary care in community-based settings has reemerged as an important component of planning. We present results of a comparative analysis of five public health care delivery systems (Boston, Dallas, Denver, Milwaukee, and Seattle), reflecting their economic, political, and cultural dynamics. Although significant differences in the relative centralization of care and reliance on community-based …

Pace: A Capitated Model Towards Long-Term Care, John Shen, Ann Iverson

Henry Ford Hospital Medical Journal

No abstract provided.

The Structure And Function Of Urban Pharmacies: Visits To Community Pharmacies In Inner-City Chicago, Thomas J. Reutzel, Laura A. Wilson

Henry Ford Hospital Medical Journal

Visits were made to 21 pharmacies in two poor neighborhoods on the west side of Chicago and interviews conducted with pharmacists-in-charge. The objective of the study was to provide a comprehensive description of the function, capabilities, and problems of urban pharmacy. We present results on the structure and function of these inner-city pharmacies. The pharmacies fit one of three structural forms: chain, independent, or medical center. The majority of respondents viewed the function of the inner-city pharmacy as patient-centered but also identified several barriers to effective patient communication. The results suggest that inner-city physicians and pharmacists should communicate with patients …

Health Priorities Of The State Of Michigan, Vernice Davis Anthony

Henry Ford Hospital Medical Journal

No abstract provided.

Moving From Health Care Research To Action, Claudia R. Baquet, Katherine Marconi, George Alexander

Henry Ford Hospital Medical Journal

Although the United States spends more on health care than any country in the world, access to that care is becoming increasingly difficult. The National Cancer Institute and other federal agencies are sponsoring innovative research for delivering effective medical services, particularly to underserved populations. Models of successful collaboration between private and public sectors concerned with health care can be adapted and implemented at the national, state, and local levels. However, other measures are needed to ensure access to adequate health care for all Americans. Minimal but effective regulations are needed to ensure quality control, reduce duplication of services, and minimize …

The Urban Hospital: Rediscovering Abandoned Values, Thomas W. Chapman

Henry Ford Hospital Medical Journal

No abstract provided.

Urban Hospitals: Their Plight And Mission, Jeffrey C. Merrill, Elliott C. Roberts, Mary Corita Heid

Henry Ford Hospital Medical Journal

No abstract provided.

Adenocarcinoma Of The Prostate: Overview Ii, Joseph C. Cerny

Henry Ford Hospital Medical Journal

No abstract provided.

The Epidemiology Of Prostate Cancer In Black Men, David A. Burks, Ray H. Littleton

Henry Ford Hospital Medical Journal

Data on the epidemiology of prostate cancer from the 1930s to the present document a dramatic racial difference in incidence, survival, and mortality rates in American men. American black men have the highest incidence and mortality rates of prostate cancer in the world. Survival data have been related to access to medical care, genetic and environmental factors, and cultural differences, including diet and social habits. Most reports present conflicting data with no clear positive correlations, and conclusions are often speculative. Better controlled, prospective studies of epidemiologic variables and a comprehensive genetic evaluation of black families with prostate cancer are needed …

Therapeutic Options For Localized Carcinoma Of The Prostate: The Role Of External Beam Radiation Therapy, Mark S. Khil, Jae Ho Kim

Henry Ford Hospital Medical Journal

During the last three decades the use of ionizing radiation, both external beam radiotherapy and interstitial radionuclide implant (brachytherapy), has greatly increased for the treatment of cancer of the prostate. The increased use of radiation therapy is in part due to the technological advance of high-energy megavoltage units as well as the steadily improving long-term results of radiotherapy. Because of the comparable tumor control rates, patients with early stage prostate cancer have several therapeutic options for curative treatment including radical prostatectomy, external beam radiation therapy, and interstitial brachytherapy. The role of external beam radiotherapy is discussed in terms of the …

Radical Surgery In The Treatment Of Localized Carcinoma Of The Prostate, Dinesh J. Telang, Brian J. Miles, Riad N. Farah, Ray H. Littleton, Aaron K. Kirkemo, James O. Peabody, David A. Burks, Caleb Fleming, Joseph C. Cerny

Henry Ford Hospital Medical Journal

New methods of early detection combined with recent advances in surgical techniques have resulted in more patients undergoing radical surgery for treatment of localized carcinoma of the prostate. Over 350 radical prostatectomies have been performed by our group since January 1987. We review the role of radical prostatectomy in the treatment of prostate cancer and our experience with 100 patients undergoing radical retropubic prostatectomy since the advent of nerve-sparing techniques to preserve potency.

Maximal Androgen Ablation: A Review, Brian J. Miles, Joseph Babiarz

Henry Ford Hospital Medical Journal

Primary management of advanced (stage D) adenocarcinoma of the prostate is androgen ablation. Since this principle was discovered in the early 1940s, therapeutic alternatives and "progress" have centered around different ways to obtain castrate levels of androgens. The role of adrenal androgens in supporting prostate or prostatic cancer growth has been debated for decades and until recently was believed to be minimal. In the 1980s the concept of maximum androgen suppression, involving both the testes and adrenal glands, was reintroduced with some investigators claiming exceptional results. We review studies that have examined this concept, with emphasis on the largest trial …

Advances In Therapy Of Female Stress Incontinence, Carl G. Klutke

Henry Ford Hospital Medical Journal

No abstract provided.

Megakaryoblastic Termination Of Myeloproliferative Disorders, Mahul B. Amin, Koichi Maeda, John L. Carey, Ramesh V. Babu, B. K. S. Raman

Henry Ford Hospital Medical Journal

Megakaryoblastic termination of myeloproliferative disorders is rare. The morphology of megakaryoblastic transformation can be subtle and is often mistaken for myeloid or lymphoid proliferations. Previously reported observations suggest a relatively poor prognosis for this category of patients, making precise diagnosis imperative. A multifaceted approach using morphology, ultrastructure, cytochemistry, and immunological membrane analysis may be helpful. We present two cases of myeloproliferative disorder with aggressive megakaryoblastic phases (myelofibrosis with agnogenic myeloid metaplasia and chronic myeloid leukemia with blast crisis). The clinical course is described and the results of the morphological, cytochemical, ultrastructural, and cytogenetic studies of both cases are presented. In …

Cerebral Oxygen Extraction During Severe Viral Encephalitis, Mark G. Goetting, Marwan L. Haddad

Henry Ford Hospital Medical Journal

Viral encephalitis can cause devastating neurologic injury. Little is known about cerebral hemodynamics and metabolism in this condition. We report two patients with severe encephalitis, one proven and the other suspected to be due to herpes simplex, in whom the global cerebral oxygen extraction ratio (OER) and carbon dioxide (CO2) responsiveness was assessed. OER was low in both patients throughout the acute period. CO2 responsiveness was present initially in both and disappeared later in the more severely affected child. These cases demonstrate that cerebral hyperemia occurs in severe viral encephalitis and that hyperventilation can effectively reduce the intracranial pressure.

The Emerging Role Of Htlv-I/Ii And Hiv-1 Among Intravenous Drug Users In Detroit, Anthony F. Ognjan, Chris A. Lewandowski, Bradley T. Belian, John Burczak, Norman Markowitz, Helen Lee, Louis D. Saravolatz

Henry Ford Hospital Medical Journal

During 1987-1988, a seroprevalence study of the human immunodeficiency virus (HIV-1) and the human T-cell lymphoma/leukemia virus (HTLV-l/II) was performed among Detroit intravenous drug users unaffiliated with substance abuse programs. Seroprevalence data along with patient demographic information were compared to a similar study performed in 1985-1986. In the earlier study, 12 (12.5%) of 96 individuals tested positive for HIV-1. Of the 74 available negative samples retested in 1987-1988 for retroviruses, 7 (9.5%) tested positive for HTLV-I/II. Thus, the overall retroviral (HIV-1, HTLV-I/II) seropositive rate for 1985-1986 was 22%. In 1987-1988, 11 (15.7%) of 70 individuals tested positive for HIV-1 and …

Interpretation Of The Pattern In Rate Ratios Across Strata, Paul F. Visintainer, Suzanne Havstad

Henry Ford Hospital Medical Journal

The pattern in the ratio of disease rates over strata is a summary statistic used to describe the changing risk of disease in one group relative to another. While patterns of the ratios of disease rates over strata appear to correspond to specific changes in disease rates, plots of the disease rates over strata seem to contradict the information yielded by the ratios. For example, if disease rates from populations A and B have identical rates of decline (parallel lines), the difference in the rates (A - B) at each strata remains constant, while the ratio of the rates (AIB) …

Presentation And Evaluation Of Patients With Epidermoid Head And Neck Cancers, Michael S. Benninger

Henry Ford Hospital Medical Journal

Epidermoid cancer of the head and neck occurs most frequently in individuals with predisposing factors for neoplastic development. Primarily these include exposure to smoking and alcohol, although other predisposing factors may he present. Site-speciflc symptoms along with a history of predisposing environmental exposure can direct physicians to suspect head and neck cancer. Endoscopy and ancillary testing are performed for tumor staging and subsequent treatment planning.

The Why And Wherefore Of Fructosamine, Daniel B. Mendlovic, Fred W. Whitehouse, Craig C. Foreback

Henry Ford Hospital Medical Journal

No abstract provided.

Prognostic Factors In Ganglionic And Thalamic Haemorrhages: A Clinical And Radiological Study., Aziz Sonawalla, Z Abbas, Mohammed Ataullah Khan

Department of Medicine

Clinical and radiological features of 43 patients admitted for ganglionic (21) and thalamic (22) haemorrhages were studied to ascertain the factors that would determine prognosis in the acute stage of the illness. Nineteen patients died, 16 of them in the first week. The adverse clinical factors were an altered state of consciousness, decorticate/decerebrate posturing, ataxic respiration, abnormalities of gaze and presence of bilateral Babinski's sign. Adverse radiological factors were the presence of thalamic haemorrhage of 3 cm or more, intraventricular spread of the haemorrhage and midline shift of 0.5 cm of more. The significance of these findings is discussed.

An Unusual Presentation Of Ischiorectal Abscess, K Hameed, R Maniar

Department of Surgery Docs

No abstract provided.

Necrotizing Enterocolitis In Infants Weighing Less Than 2000 G, P Mufti, Z A. Bhutta

Department of Paediatrics and Child Health

Over a 4 year period, nine of 180 (5%) infants weighing less than 2000 G, admitted to the Aga Khan University Hospital (AKUH) developed necrotizing enterocolitis (NEC). An outbreak of NEC occurred in 1989, during which six infants developed the clinical illness. Overall incidence was 1.1%. Thirty-one birth weight and gestation matched controls were selected for comparison. Risk factors usually considered as predisposing factors, i.e., low 5 min Apgar score, rate of maternal complications, respiratory distress syndrome, mechanical ventilation, umbilical catheterisation, patient ductus arteriosus, use of antibiotics and feeding practices were found with equal frequency in both cases and controls. …

Prevention Of First Variceal Bleeding: New Prospects, S Hamid, W Jafri

Section of Gastroenterology

No abstract provided.

A Comparison Of Standard-Dose And High-Dose Epinephrine In Cardiac Arrest Outside The Hospital, Charles G. Brown, Daniel R. Martin, Paul E. Pepe, Harlan Stueven, Richard O. Commins, Edgar Gonzalez, Michael Jastremski, The Multicenter High-Dose Epinephrine Study Group

Emergency Medicine Publications

BACKGROUND.

Experimental and uncontrolled clinical evidence suggests that intravenous epinephrine in doses higher than currently recommended may improve outcome after cardiac arrest. We conducted a prospective, multicenter study comparing standard-dose epinephrine with high-dose epinephrine in the management of cardiac arrest outside the hospital.

METHODS.

Adult patients were enrolled in the study if they remained in ventricular fibrillation, or if they had asystole or electromechanical dissociation, at the time the first drug was to be administered to treat the cardiac arrest. Patients were randomly assigned to receive either 0.02 mg of epinephrine per kilogram of body weight (standard-dose group, 632 patients) …

Elder-Caregiving Among University Employees: Responsibilities And Needs, Constance L. Coogle, Edward F. Ansello

Virginia Center on Aging Publications

Although many institutions of higher education often house the researchers who study eldercare, few have documented the need for information and services among their estimated 460,000 employees who face the difficult task of effectively balancing work and eldercare responsibilities. Even fewer have established programs to address this need.

Drs. Constance Coogle and Edward Ansello have recently completed an exhaustive survey of VCU employees (N = 11,430) to determine the extent to which they provide care to disabled parents or spouses.[1] A longer, more detailed survey was sent to those who indicated that they were eldercaregivers to measure their perceived …

The Binding Of Urinary Components And Uropathogens To A Silicone Latex Urethral Catheter, G. Reid, C. Tieszer, R. Foerch, H. J. Busscher, A. E. Khoury, H. C. Van Der Mei

Cells and Materials

The adhesion of uropathogens to urethral catheters initiates the infectious process which causes morbidity in a large patient population. Catheters were examined by X-ray photoelectron spectroscopy after use in three patients and following incubation in vitro with human urine, urea and creatinine, and found to have adsorbed a conditioning film containing carbon, nitrogen and in some cases phosphorous, calcium and sodium containing components. The binding of three strains of uropathogenic bacteria to the catheter surface was significantly influenced by the suspending fluid composition.