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Regulation Vs. The Market: The Case Of Bicycle Safety (Part Ii), Ross D. Petty

RISK: Health, Safety & Environment (1990-2002)

In this part, Professor Petty examines bicycle Risk in detail, comparing the accomplishments of the CPSC's bicycle standard with market forces resulting in, e.g., the development and use of hardshell bicycle helmets. Moreover, he briefly discusses the role of tort liability in managing Risk. Ultimately he concludes that, in the case of bicycle safety, regulation has failed to be as effective as other forces tending to reduce bicycle injuries. [Part I appears at 77.]

Nutrition Support Of Hiv+ Patients, Johanna T. Dwyer

Henry Ford Hospital Medical Journal

Case management strategies for the nutritional support of patients infected with the human immunodeficiency virus (HIV) are evolving as the disease becomes less rapidly fatal and more chronic. Nutritional status changes in advanced HIV infection are similar in many respects to protein-calorie malnutrition. Current clinical effort and research focuses on the beneficial effects of preserving lean body mass and keeping asymptomatic patients in good nutritional status by preventing micronutrient deficiencies and by treating preexisting nutritional problems rather than attempting to intervene late in the disease's course, after secondary malnutrition has already developed. Nutrition support and intervention trials only late in …

Human Growth Hormone Treatment: Henry Ford Hospital Experience 1964-1990, David C. Leach

Henry Ford Hospital Medical Journal

Treatment with human growth hormone (GH) at Henry Ford Hospital began in 1964 and has included 145 patients. A total of 68 patients were treated with extracted hormone and 77 with recombinant GH. The appearance of Creutzfeldt-Jakob disease, now five cases worldwide, in patients treated with extracted hormone abruptly stopped its use in the United States. The development of recombinant GH in 1985 has resulted in greater availability of treatment. Diagnostic criteria are now more liberal and certain patients without GH deficiency, i.e., those with the Turner syndrome, are now being successfully treated with GH. GH is expensive and its …

Chronic Pancreatitis Progressing To Duodenal Obstruction In The Absence Of Classic Symptoms, John R. Condit Jr., Dominic K. H. Wong

Henry Ford Hospital Medical Journal

We report the case of a 34-year-old alcoholic who was initially seen in March 1985 because of acute pancreatitis. A mass was demonstrated in the head of the pancreas. Serial sonogram and computed tomography scans over 4 1/2 years revealed progressive encroachment of the duodenum without symptoms attributable to obstruction. In 1989, three separate endoscopies with multiple biopsies showed chronic inflammation and strictures. Hypotonic duodenography confirmed stricture and obstructed duodenum. Surgical intervention is being considered. Duodenal obstruction secondary to chronic pancreatitis is rare. It may proceed subclinically for several years independent of continued alcohol use. Only when obstruction became severe …

Back Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

A Thyroid Testing Algorithm: Results Of A Pilot Study, Hossam Ibrahim, Malachi J. Mckenna, Carolyn S. Feldkamp

Henry Ford Hospital Medical Journal

We conducted a pilot study to evaluate an algorithm for thyroid function testing consisting of initial serum thyrotropin values, measured by a sensitive immunoradiometric assay (TSH-IRMA) followed by a computer-directed decision to order further studies. We divided 216 outpatients according to their serum TSH-IRMA values as follows: suppressed (< 0.1 mU/L, group I); low (0.1 to 0.4 mU/L, group II); normal (0.5 to 5.0 mU/L, group III); and high (> 5.0 mU/L, group IV). Thyroxine (T4), resin uptake (RU). and free thyroxine index (FTI) tests on groups I, Il, and IV revealed that T4 and RU were normal for most patients in all groups and FTI was normal in 80% of group 1, 93.4 % of group ll, and 93.3% of …

Measurement Of Left Ventricular Ejection Fraction Using Gated 99mtc-Sestamibi Myocardial Planar Images: Comparison To Contrast Ventriculography, David A. Parker, Ramon L. Lloret, Francesco Barilla, Lori Douthat, Mihai Gheorghiade

Henry Ford Hospital Medical Journal

Using the new myocardial perfusion agent 99mTc-sestamibi and multigated acquisition on a nuclear medicine gamma camera, the left ventricular ejection fraction (LVEF) was derived in 13 patients with coronary artery disease (CAD). Cross-sectional activity profiles were used to measure the left ventricle from end-diastolic and end-.systolic images. Several different geometric methods were then utilized to derive ejection fractions from the nuclear data. Comparison of the resultant ejection fractions to those obtained from contrast ventriculography showed significant correlation for all geometric methods (P < 0.01,S y X x = 6.2 to 9.6). We conclude that in patients with CAD one or more of these simple geometric methods can provide a useful estimate of the LVEF when performing 99mTc-sestamibi multigated myocardial perfusion imaging.

Disturbances In Lipid Metabolism Associated With Chylothorax And Its Management, Malachi J. Mckenna, Jau-Wen Chu, Dorothy M. Kahkonen

Henry Ford Hospital Medical Journal

Changes in circulating lipid status were studied in a 70-year-old woman during management of chylothorax that included chest drainage, pleuroperitoneal shunting, and a successful thoracic duct ligation. Hypolipidemia with a relative decline in high-density lipoprotein (HDL) cholesterol was apparent at presentation. Following recovery, serum HDL cholesterol rose to the upper limit of normal. Apolipoprotein A-l (Apo A-l) was discordantly raised during the period of pleuroperitoneal shunting. We speculate that diversion of chylomicrons to the liver with subsequent hydrolysis accounted for a release of Apo A-l particles into the circulation at a time when the formation of HDL was compromised by …

The Phenomenology Of Cushing's Syndrome: One Patient's Account, Andrew Armstrong, J. David Fachnie

Henry Ford Hospital Medical Journal

Cushing's syndrome caused by ectopic secretion of adrenocorticotropic hormone (ACTH) is often a serious disease and a diagnostic dilemma. In the reported patient, the source of ACTH proved to he a benign pulmonary carcinoid tumor. The patient describes his trying experiences through the six months from initial diagnosis to definitive therapy.

Cushing's Disease: Dilemmas Of Diagnosis And Management, M. Saeed-Uz-Zafar, Raymond C. Mellinger, Max Wisgerhof

Henry Ford Hospital Medical Journal

Determining the cause of Cushing's disease and correcting the abnormality presents a continuing challenge to the clinician despite remarkable advances in diagnostic and therapeutic techniques. We present seven cases to illustrate 1) the classic disorder cured by pituitary adenomectomy: 2) persistence of the disease after adenomectomy: 3) Cushing's disease manifesting in the puerperium and remitting with dopamine agonist therapy: 4) a patient whose disease relapsed at least five times during 20 years of treatment by adrenalectomy, pituitary radiation, mitotane, and pituitary adenomectomy; 5) the Nelson syndrome; 6) the ectopic adrenocorticotropic hormone (ACTH) syndrome in a patient with dexamethasone suppressible urinary …

Hyperandrogenemia And Virilization With Simultaneous Pituitary And Adrenal Adenomas, Jeffrey A. Jackson, Raymond C. Mellinger

Henry Ford Hospital Medical Journal

We describe a postmenopausal woman who presented with virilizing hyperandrogenemia and was found to have an intrasellar tumor and a large left adrenal mass. Pathologic studies showed an undifferentiated hypophyseal adenoma with immunostaining for chromogranin only and a benign adrenocortical adenoma. In light of current understanding of the regulation of adrenal androgen secretion and adrenocortical mitogenesis, we postulate that this case may be explained by secretion of adrenal androgen-stimulating and mitogenic factors by the pituitary tumor.

Contemporary Approach To Thyroid Disease Emphasizing Use Of High-Sensitivity Thyrotropin Assays, Carolyn S. Feldkamp, Malachi J. Mckenna

Henry Ford Hospital Medical Journal

Capabilities of new high-sensitivity immunoradiometric assays for thyroid-stimulating hormone (TSH-IRMA) to distinguish among hypothyroid, euthyroid, and hyperthyroid subjects and patient groups with low TSH for nonthyroidal causes suggested an algorithmic approach (directed TSH) to the evaluation of patients with suspected thyroid disease. Utilizing the algorithm, a TSH-IRMA result outside normal limits (0.5 to 5.0 mUlL) generates follow-up tests on the same sample. The interpretation of thyroid function tests (TSH-IRMA, thyroxine, resin uptake, free thyroxine index) and associated studies in the context of different clinical settings is reviewed. The approach is a cost-effective and efficient utilization of laboratory services.

An Ambulatory Approach To Self-Care Of Diabetes, Fred W. Whitehouse, Iris J. Whitehouse, Mary Sue Cox, Dorothy M. Kahkonen

Henry Ford Hospital Medical Journal

Managing the insulin-requiring diabetic patient in an ambulatory selling includes metabolic regulation of the diabetes and education in its self-care. Means of achieving these goals include structured group or one-on-one individualized sessions. Third party policies relating to ambulatory care are challenged and their need for fiscal support emphasized. During the coming decade, diabetic patients should 1) have access to ambulatory care programs for metabolic regulation and education in self-care. 2) expect third party support of these programs, and 3) heighten their own priorities on diabetes care to ensure quality management of their diabetes.

Vertebral Compression Fractures At The Onset Of Acute Lymphoblastic Leukemia In A Child, M. Beatriz Oliveri, Carlos A. Mautalen, Carlos A. Rodriguez Fuchs, M. Del Carmen Romanelli

Henry Ford Hospital Medical Journal

A child with acute lymphoblastic leukemia, spinal osteoporosis with vertebral compression fractures, and hypercalcemia appearing early in the course of the hematologic disease was followed for two and a half years. Bone mineral density (BMD). measured by single photon absorptiometry at the radial shaft. was within normal limits for age and sex. However, x-rays of vertebrae and vertebral BMD. measured by dual photon absorptiometiy, showed marked demineralization. Despite leukemic remission, the spinal osteoporosis became worse and the patient required aggressive treatment for eight months. Treatment included 50 units of calcitonin subcutaneously every other day. 1.000 mg/day of oral calcium, and …

Primary Hyperparathyroidism And Monoclonal Gammopathy, D. Sudhaker Rao, Rosella Antonelli, Kevin R. Kane, John E. Kuhn, Celina Hetnal

Henry Ford Hospital Medical Journal

Coexistent primary hyperparathyroidism and monoclonal gammopathy, although rare, has been reported previously by a number of investigators. We report four patients with such an occurrence who were seen between 1976 and 1988. Another patient with primary hyperparathyroidism also had multiple myeloma and was in remission for 12 years. These patients represent approximately 1% of the 386 patients with primary hyperparathyroidism seen during the same 12-year period. Although several mechanisms have been proposed to explain this concurrence, we believe it is the result of a chance occurrence. A review of the literature, an estimate of the chance occurrence of coincidental monoclonal …

Molecular Mechanism Of The Stimulation Of Alkaline Phosphatase Activity In Human Bone Cells By 1,25(Oh)2 D3, Eru Kyeyune-Nyombi

Loma Linda University Electronic Theses, Dissertations & Projects

To facilitate this study an in vitro human model system was established that exhibited many aspects of normal osteoblasts. The human osteosarcoma cell line (TE85 cells) expressed a skeletal alkaline phosphatase activity (an accepted bone cell differentiation marker) which was stimulated by 1,25(OH)₂D₃ (a potent differentiating agent), under serum-free conditions in a dose-dependent, time-dependent, and cell density-dependent manner. Cytochemical analysis of the stimulation of ALP activity by 1,25(OH)₂D₃ showed that 1,25(OH)₂D₃ increased the number of TE85 cells that expressed detectable ALP activity, suggesting that 1,25(OH)₂D₃ promoted the process …

Chloramphenicol Therapy Of Typhoid Fever, Z A. Bhutta, S H. Naqvi, S Durrani, A Suria

Department of Paediatrics and Child Health

In a prospective study we compared two different dosage regimens of IV chloramphenicol succinate (100 mg/kg/day and 75 mg/kg/day) in children with culture proven typhoid. Trough and peak blood samples, obtained at 48 hrs, were analysed for free chloramphenicol by high pressure liquid chromatography (HPLC). Although the mean trough (8.8 +/- 7.7 versus 5.4 +/- 2.6 mcg/ml) and peak (19.9 +/- 12.2 versus 15.4 +/- 6.1 mcg/ml) chloramphenicol concentrations were comparable in both groups, a significantly wider range was found in the group receiving 100 mg/kg/day. Potentially toxic levels (greater than 30 mcg/ml) developed in two patients with liver dysfunction. …

Southeastern University Of The Health Sciences Catalog 1991-1993, Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

Oncolog, Volume 36, Issue 02, April-June 1991, Gilbert H. Fletcher M.D., James M. Bowen Phd

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Redefining the risks of chemotherapy during pregnancy Renewing the assault on pancreatic cancer
• Significance of cancer volume in radiotherapy

Oncolog, Volume 36, Issue 01, January-March 1991, Michael S. Ewer Md, Mph, T. C. Hsu Ph.D., John R. Redman M.D.

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Decision making in critical illness: Who knows best?
• Successful Hodgkin's disease treatment can also preserve reproductive function
• Chromosomes and cancer

Digest Of The Philadelphia College Of Osteopathic Medicine (Winter 1991), Philadelphia College Of Osteopathic Medicine

Digest

The Winter 1991 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• A Master Plan to Grow on: City Avenue Campus
• Emanuel Fliegelman, DO: Reminding Us That to be Human is to be Best
• PCOM's Computer Hospital: High-tech Medical Education
• New Appointments
• On Campus
• Just Published
• Class Acts
• In Memoriam
• Coming Events

Pharmacokinetics, Immune Response, And Biodistribution Of Iodine-131-Labeled Chimeric Mouse/Human Igg1, K 17-1a Monoclonal Antibody, Ruby Meredith, Albert Lobuglio, Walter Plott, Roger Orr, Ivan Brezovich, Charles Russell, Elizabeth Harvey, Michael Yester, Mansoor Saleh

Haematology and Oncology, East Africa

Pharmacokinetics,immunogenicity,and biodistributionof a 131I-Iabeledmouse/human chimenc monoclonal antibody (C17-1A) was studiedin six metastaticcoloncancerpatients. Pharmacokinetics obtalned from serum radioactivity or chi mera concentration were identical after 5 mCi of 131I(>17-1A withmeanalphahalf-livesof 17.6±2.3 and19.7±2.9 and meanbeta half-livesof 100.9±16.1 and 106.4±14.1 hr, respectively. HPLC analysis documented the monomeric chi rneiic17-lA withoutevidenceof immunecomplexesorfree 1311 None of the patients developed antibody after ‘31I-chi merle17-1A exposure.Radiolocalizationoccurredin known areas of disease >4 cm in all patients. The half-life of total body radioactivity was 58 ±7 hr by whole-body counts and 64 ±13 hr by urine measurements. Whole-body and bone marrow dose estimates ranged from 0.75-1 .03 and …

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Neuropsychological Sequelae Of Brain Tumors, John L. Fisk, Jerel E. Del Dotto

Henry Ford Hospital Medical Journal

Investigation of the neuropsychological sequelae of brain tumors is extremely complex largely because the neurobehavioral consequences of brain tumors depend upon complex interactions among disease and treatment variables as well as patient characteristics. To illustrate some of these complexities, we present case studies of two patients in whom the behavioral outcome was not easily predictable on the basis of our current understanding of brain-behavior relationships in tumor patients. The case studies do illustrate how neuropsychological evaluation aids in identifying cognitive deficits which have implications for subsequent quality of life. Recommendations for future experiments and statistical analyses of neurobehavioral data of …

Health And Adjustment In Young Adults: Preliminary Findings From An Epidemiologic Survey, Naomi Breslau, Glenn C. Davis, Patricia Andreski

Henry Ford Hospital Medical Journal

No abstract provided.

Response To Cpap And Uppp In Apnea, Frank J. Zorick, Timothy Roehrs, William Conway, George Potts, Thomas Roth

Henry Ford Hospital Medical Journal

Ninety-two consecutive patients with obstructive sleep apnea syndrome (OSAS) were studied before and six weeks after treatment with either nasal continuous positive airway pressure (CPAP) or uvulopalatopharyngoplasty (UPPP) (n = 46 per group). Assignment of patients to treatment was based on clinical considerations and patient preference. Patients were assessed by nocturnal polysomnography and performance on the Multiple Sleep Latency Test (MSLT) the following day. Before treatment, the CPAP and UPPP groups did not differ in sleep-related respiratory disturbance, oxygenation during sleep, fragmentation of sleep, or the level of excessive daytime sleepiness indicated by the MSLT. Both treatments produced significant improvement …

Perioperative Management Of Diabetes, Gary W. Edelson, J. David Fachnie, Fred W. Whitehouse

Henry Ford Hospital Medical Journal

No abstract provided.

The Physiologic Basis For Nutritional Support In Hepatic Failure, John J. Fath

Henry Ford Hospital Medical Journal

Hepatic failure is often perceived as a unidimensional progression from near normal clinical function (Child's class A) to overt clinical failure (Child's class C). As this view fails to distinguish between patients who are capable of using exogenous protein and those who cannot, it hinders the nutritional support team in determining protein supplementation. This report addresses the physiologic basis for variable findings in hepatic failure and proposes a simple definition of hepatic faliure based upon ability to utilize amino acids.

Nutritional Implications Of Liver Transplantation, Jeanette M. Hasse

Henry Ford Hospital Medical Journal

Malnutrition is a common problem of patients undergoing liver transplantation. To treat malnutrition, it must first be identified through a nutritional assessment. Because many objective nutritional assessment parameters have limitations in end-stage liver disease, subjective nutritional indicators may be used as an alternative. Nutritional needs following transplantation are categorized as short and long term. The short-term nutritional goal, anabolism, can be complicated by the nutritional status of the patient, surgical procedures, and necessary medications. The increased nutrient needs during the early posttransplant phase require particular nutritional support. Nutrition-related problems following transplantation may include obesity, hyperlipidemia. hypertension, diabetes mellitus. hyperkalemia, edema, …