Digital Commons Network^™

Predicting Prognosis In Lung Cancer: Use Of Proliferation Marker, Ki67 Monoclonal Antibody, I N. Soomro, J Holmes, W F. Whimster

Department of Pathology and Laboratory Medicine

An investigation was carried out to assess the prognostic significance of proliferation marker Ki67 in a group of lung cancer patients treated by surgery (limited disease). Tissue was not available for Ki67 immunostaining in inoperable group. The diagnosis is established by bronchial biopsy which does not carry enough tissue for frozen section and counting. This study is supplemented by estimating the prognostic significance of histological sub-types in the operable group and in a group of inoperable patients with extensive disease. These are usually treated by radiotherapy and/or chemotherapy. In all, 267 patients were studied including 105 treated by surgery. These …

Comparison Of Mandibular Surgical Techniques For Accessing Cranial Base Vascular Lesions, Michael A. Devlin

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: Treatment of vascular lesions of the high cervical internal carotid artery (zone III) resulting from penetrating trauma, blunt trauma, aneurysms, and atherosclerosis pose a challenge for vascular surgeons due to bony interference's of the mandibular ramus and mastoid process. Although many techniques have been described, two methods, have been identified as effective and associated with low morbidity. The purpose of this study is to compare these two methods, mandibular distraction and vertical ramus osteotomy, for their effectiveness at increasing access to the cranial base and distal internal carotid artery.

Materials and Methods: Five fresh frozen cadavers were utilized …

Dna Methylation And Carcinogenesis In Digestive, Javed Yakoob, Fan Xue-Gong, Hu Guo-Ling, Zhang Zheng

Section of Gastroenterology

No abstract provided.

A Comparison Of Severe Pre-Eclampsia/Eclampsia In Patients With And Without Hellp Syndrome, N F. Zuberi, K Arif, F M. Khan, J A. Pal

Department of Obstetrics & Gynaecology

Background: The relationship of Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome with maternal and perinatal health and its presentation in Pakistani population is not known.
Purpose: To determine the mode of presentation along with maternal and perinatal outcome of patients with HELLP syndrome.
Methods: Case records of patients with severe hypertension in pregnancy who delivered between January 1, 1989 and December 31, 1994 at The Aga Khan University Hospital, Karachi. Out of 120 cases of severe pre-eclampsia/eclampsia, there were 36 cases of HELLP syndrome (Group-A). These were then compared with cases without HELLP syndrome (Group B) for their …

Effects Of First And Second Trimester Vaginal Bleeding On Pregnancy Outcome, S A. Karim, I Bakhtawar, A T. Butta, M Jalil

Department of Obstetrics & Gynaecology

The effects of vaginal bleeding during first and second trimester on pregnancy outcomes was assessed in a hospital-based population of 268 non-diabetic women. The group of non-bleeders comprised 173 females whereas, there were 71 females with first and 24 with second trimester bleeding. Fetal loss (abortion) occurred in 34% of first trimester and 25% of second trimester bleeders. Low birth weight and preterm delivery were significantly associated with second trimester haemorrhage. The results suggest that first and second trimester vaginal bleeding correlates with adverse infant outcomes.

Effects Of Metformin On Spontaneous And Clomiphene-Induced Ovulation In The Polycystic Ovary Syndrome, John E. Nestler , M.D., Daniela J. Jakubowicz , M.D., William S. Evans , M.D., Renato Pasquali , M.D.

Obstetrics and Gynecology Publications

ABSTRACT

Background Obese women with the polycystic ovary syndrome are relatively unresponsive to the induction of ovulation by clomiphene. We hypothesized that reducing insulin secretion by administering metformin would increase the ovulatory response to clomiphene.

Methods We performed oral glucose-tolerance tests before and after the administration of 500 mg of metformin or placebo three times daily for 35 days in 61 obese women with the polycystic ovary syndrome. Women who did not ovulate spontaneously were then given 50 mg of clomiphene daily for five days while continuing to take metformin or placebo. Serum progesterone was measured on days 14, 28, …

State Regulation Of Assisted Living Facilities, Sonya A. Sterbenz

Case Studies from Age in Action

Educational Objectives

1. To define the role of assisted living facilities in the continuum of long-term care options for older adults.

2. To present the various arguments concerning the regulation of the assisted living industry.

Voices From The Floor - A Pcom Anthology (Winter 1998), Pcom

Voices from the Floor

The Winter 1998 issue includes:

• "One Day at at Time with Michael" by Mary DeJoseph, DO and Paul DeJoseph, DO,
• "The Bloodless Medical Care Option" by Ronald C. Morgan
• "Going Home" by By Maria J. Hoertz, MPH, MSIII
• "The Humors in Uniform" by Susan Entwistle Marshall, MSII

A Comparison Of Rectal Diazepam Gel And Placebo For Acute Repetitive Seizures, Fritz E. Dreifuss , M.D., N. Paul Rosman , M.D., James C. Cloyd , Pharm.D., John M. Pellock , M.D., Ruben I. Kuzniecky , M.D., Warren D. Lo , M.D., Fumisuke Matsuo , M.D., Gregory B. Sharp , M.D., Joan A. Conry , M.D., Donna C. Bergen , M.D., Walter E. Bell , Ph.D

Neurology Publications

ABSTRACT

Background Acute repetitive seizures are readily recognizable episodes involving increased seizure frequency. Urgent treatment is often required. Rectal diazepam gel is a promising therapy.

Methods We conducted a randomized, doubleblind, parallel-group, placebo-controlled study of home-based treatment for acute repetitive seizures. Patients were randomly assigned to receive either rectal diazepam gel, at doses ranging from 0.2 to 0.5 mg per kilogram of body weight on the basis of age, or placebo. Children received one dose at the onset of acute repetitive seizures and a second dose four hours later. Adults received three doses — one dose at onset, and two …

Acquired Arterio-Venous Fistula With Mycetoma: Two Entities Coinciding: A Case Report, Saldar Nasim Khan, Nabil Wasif, Masood Umar, Mohamrnad Umar

Section of Orthopaedic Surgery

No abstract provided.

Experiencing Physical Violence During Pregnancy: Prevalence And Correlates, Vilma E. Cokkinides, Ann L. Coker

CRVAW Faculty Journal Articles

Violence during pregnancy directly impacts the mental and physical health of pregnant women. We assessed the prevalence and correlates of physical violence around the time of pregnancy in a representative sample of 6,718 women in South Carolina. Physical violence, defined as "being physically hurt by husband or partner" or "being involved in a physical fight" was reported by 10.9% of recently pregnant women. These were correlates of violence: experiencing increased numbers of stressful life events, being unmarried, having increased parity, being on Medicaid, and having an unwanted pregnancy. Screening to identify violence in pregnancy in health care settings is vital …

The Hidden Age Revolution: Emergent Integration Of All Ages, Matilda White Riley

Center for Policy Research

Over the past 30 years my colleagues and I have been focusing on conceptual and empirical work (the aging and society paradigm) that does not create policies, but can inform them. The most immediate phase of this long cumulative history is leading us now to hidden changes in people's lives and social institutions that herald a new phenomenon world-wide--a phenomenon that may have momentous implications for the policies of the future. We call it "age integration" because it *integrates* older people with others of every age. When I come to the end of my lecture, I hope you will see …

Is Mammography Useful In Screening For Local Recurrences In Patients With Tram Flap Breast Reconstruction After Mastectomy For Multifocal Dcis?, A P Salas, M A Helvie, E G Wilkins, H A Oberman, P W Possert, Alan M. Yahanda Md, Facs, A E Chang

PCI Publications and Projects

BACKGROUND: Skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction is being used more often for the treatment of breast cancer. Mammography is not used routinely to evaluate TRAM flaps in women who have undergone mastectomy. We have identified the potential value of its use in selected patients.

METHODS AND RESULTS: We report on four women who manifested local recurrences in TRAM flaps after initial treatment for ductal carcinoma in situ (DCIS) or DCIS with microinvasion undergoing skin-sparing mastectomy and immediate reconstruction. All four patients presented with extensive, high-grade, multifocal DCIS that precluded breast conservation. Three of four …

Decisions At The End Of Life, Catherine A. Marco

Emergency Medicine Faculty Publications

As members of the Church, we believe that our Heavenly Father, in His divine judgment, chooses the appropriate time of death, the essential step and passageway to the next and more perfect life. Although medical technology has created many possibilities for increasing the quality and duration of life in many cases, its use must be appropriately and cautiously implemented. The role of medicine and technology should be to assist in providing cure and comfort to patients in need, rather than the artificial postponement of the natural process of dying.

Management Of Hyperlipidaemia In General Practice, Waris Qidwai

Department of Family Medicine

Hyperlipidaemia is a powerful predictor of coronary artery disease, with a strong, independent, continuous and grades positive associationbetweencholesterol levels and risk of coronary events. Several large studies have shown the benefit of cholesterol reduction and there is clear evidence of the efficacy of statins in the reduction of events inprimazy and secondary prevention¹. A 1% reduction in the total serum cholesterol reduces the frequency of fatal coronary heart disease by atleast 2%². A l0% meandecrease inthe total serum choelsterol level reduces the incidence of both fatal and nonfatal myocardial infarctions³. Family physicians need to …

Initial Multicenter Experience With Double Nucleoside Therapy For Human Immunodeficiency Virus Infection During Pregnancy., N S Silverman, D H Watts, J Hitti, D M Money, E Livingston, J Axelrod, J M Ernest, D Robbins, M M Divito

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To study maternal and neonatal effects of combination nucleoside analog therapy administered to human immunodeficiency virus (HIV)-infected pregnant women for maternal indications.

METHODS: A multicenter, prospective observational study was undertaken at six perinatal centers in the United States and Canada that supported regional referral programs for the treatment of HIV-infected pregnant women. Demographic, laboratory, and pregnancy outcome data were collected for 39 women whose antiretroviral treatment regimens were expanded to include more than one nucleoside analog for maternal indications. The 40 newborns were monitored at pediatric referral centers through at least three months of age to ascertain their HIV …

Determinants Of Antepartum Human Immunodeficiency Virus Testing In A Non-Medicaid Obstetric Population., E Cardonick, S Daly, M Dooley, K Elles, N S Silverman

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To determine voluntary human immunodeficiency virus (HIV) testing rates and factors influencing testing in a private obstetric practice.

METHODS: Antepartum patients were offered HIV testing after completing a self-assessment questionnaire. Perceived risks and demographics were correlated with testing rates.

RESULTS: Overall, 348/600 (58%) women consented to HIV testing. In a univariate analysis, patients with "any" perceived risk(s) were more likely to be tested. Single women and those with an at-risk partner(s) or a history of sexually transmitted disease (STD) were more likely to desire testing. These factors remained independently associated with voluntary testing in a multivariate regression model. No …

Role Of Serum Angiotensin Converting Enzyme In Sarcoidosis, Aysha Habib, Farooq Ghani, Mohammad Khurshid, Amanullah Khan, M. Atta Khan

Department of Pathology and Laboratory Medicine

This study was conducted to determine the role of Serum Angiotensin Converting Enzyme (SACE) as a marker in the differential diagnosis of pulmonary diseases and prognosis of sarcoidosis, A retrospective analysis of 113 medical records of patients at The Aga Khan University Hospital, with laboratory investigation for SACE was performed. Among 113 patients, 51 cases were found to have sarcoidosis, 44 of them had SACE levels greater than 52 lU/L (mean ACE 104.44). SACE levels were also found elevated in other clinical conditions like tuberculosis (mean 58.64 lUlL), but the enzyme level were less (p0.04) than those found in sarcoidosis …

Diagnostic Evaluation Of Fine Needle Aspiration Cytology In The Management Of Palpable Breast Lesions, S. H. Shah, Naila Kayani, S. H. Hasan, I. N. Soomro, Shahid Pervez, A. S. Hussainy

Department of Pathology and Laboratory Medicine

A total of 113 fine needle aspirates of the breast masses were evaluated in which the subsequent biopsy or mastectomy specimen were also available for histological examination. The age ranged from 16 to 80 years with a mean of 42 years. In benign conditions the mean age was 34.7 years while in malignant cases it was 48 years. The cytological diagnoses were compared with the histological results which revealed that the specificity and sensitivity of fine needle aspiration cytology in the palpable breast lesions was 86.1% and 89.2% respectively with a positive predictive value of 93% and efficiency of 88.2%. …

Ectopic Placement Of Central Venous Catheter, Importance Of X-Ray Chest, Nadeem A. Zaidi, Fazal Hameed Khan

Department of Anaesthesia

A case of malpositioning of central venous catheter which was judged to be correctly placed on clinical criteria isbeing presented. Abberant positioning was picked up on X-ray

Percutaneous Nephrostomy: A Non-Operative Management Of Urinomas: 2 Case Reports, Tanveer-Ul-Haq, I H. Rizvi, Z A. Khan, A A. Khan

Department of Radiology

No abstract provided.

Patient Dumping: Implications For The Elderly, George P. Smith Ii

Scholarly Articles

Before 1986, the Common Law provided that physicians and hospitals had no duty to admit or treat persons who sought their care except in limited circumstances. Congress enacted The Emergency Medical Treatment and Active Labor Act (EMTALA) to curb this so-called patient-dumping problem. EMTALA provides, essentially, that Medicare-participating hospitals must treat all patients who arrive in emergency conditions.

This article first discusses the patient-dumping problem and how EMTALA has provoked many hospitals to curtail their emergency facilities in order to avoid treating indigent and uninsured patients. The Article then proceeds to analyze the specifics of EMTALA’s main statutory provision, Section …

Terminal Sedation As Palliative Care: Revalidating A Right To A Good Death, George P. Smith Ii

Scholarly Articles

Not everyone finds a “salvific meaning” in suffering. Indeed, even those who do subscribe to this interpretation recognize the responsibility of each individual to show not only sensitivity and compassion but render assistance to those in distress. Pharmacologic hypnosis, morphine intoxication, and terminal sedation provide their own type of medical “salvation” to the terminally ill patient suffering unremitting pain. More and more states are enacting legislation that recognizes this need of the dying to receive relief through regulated administration of controlled substances. Wider legislative recognition of this need would go far toward allowing physicians, in the exercise of their reasonable …

The Spectrum Of Bacterial Infections In Febrile Neutropenic Patients: Effect On Empiric Antibiotic Therapy, Ikram A. Burney, Tariq Siddiqui, Badar J. Farooqui, Mohammad Khurshid

Department of Medicine

The aim of this retrospective analysis was to look at the spectrum of bacterial isolates and their resistance patterns to the commonly used antIbiotics in the settmg of febrile neutropenia. A total of 127 bacteria were isolated from patients with acute leukemias, lymphoproliferative disorders, aplastic anaemia and various solid tumours. Fifty-four percent organisms were gram negative; while the rest were gram positive. E. coli, pseudomónas aeruginosa, staphylococcus aureus, enterococcus and streptococci were the commonly isolated organisms. Forty-eight percent organisms were isolated from blood, 16% from urine, 13% from wounds and superficial abscesses and 11% from respiratory tract. E. coli exhibited …

Factors Which Influence Women's Decisions For Choice Of Primary Surgery For Stage I And Stage Ii Breast Cancer, Barbara Mastaglia

Theses : Honours

A descriptive correlational study was conducted to describe the factors that Western Australian women with either Stage I or Stage II Breast Cancer, perceived to be important considerations when deciding upon either Modified Radical Mastectomy (MRM) or Breast Conserving Treatment (BCT) for surgical treatment. The Conflict Theory of Decision Making (Janis & Mann, 1977) was used as the theoretical framework to guide this study. Ward, Heidrich and Wolberg's (1989) Factor List, the Multidimensional Health Locus of Control (MHLC) Scale (Wallston, Wallston & De Vellis, 1978) and a demographic questionnaire were used to measure variables. Questionnaires were mailed to a consecutive …

Dyslipidemia And Its Relation With Body Mass Index Versus Waist Hip Ratio, A Jabbar, A Irfanullah, J Akhter, Y K. Mirza

Section of Pulmonary & Critical Care

To study the magnitude of dyslipidemia in asymptomatic subjects and its relation to body mass index (BMI) and waist-hip-ratio (WHR), 88 subjects attending the health analysis programme were examined and their age, sex, BMI, WHR, fasting blood glucose and lipids were measured. The distribution of the lipid levels and the frequency of dyslipidemia were noted. Forty-eight percent had a total cholesterol of > 200 mg/dl and 50% had an HDL-cholesterol of < 40 mg/dl. On comparing the means of total cholesterol to BMI and WHR, it was found that total cholesterol level was statistically significant for WHR above and below 0.9 for males and 0.8 for females, whereas not so for BMI above and below 27 kg/m2. The prevalence of dyslipidemia in asymptomatic people in this group emphasizes the need for routine health screening for early institution of preventive measures. The correlation with WHR rather than BMI points towards importance of measuring parameters of central obesity rather than body weight and height only.

Ossifying Fibroma Of Nasal Cavity, Abbas Zafar Abbas Zafar, Muhammad Shafi Muhammad Shafi, Shaukat Malik Shaukat Malik, Shahid Pervez

Department of Pathology and Laboratory Medicine

No abstract provided.

The Association Of Hla-Drb Genes And The Shared Epitope With Rheumatoid Arthritis In Pakistan, K Hameed, S Bowman, E Kondeatis, R Vaughan, T Gibson

Section of Internal Medicine

The association of particular HLA-DR alleles and the shared epitope with rheumatoid arthritis (RA) is now well established. The strength of these links varies between races. Furthermore, the proposition that the presence of the shared epitope is indicative of severe disease has been more difficult to sustain in non-Europeans. This study examines the frequency of HLA-DR and HLA-DRB1 amongst Pakistanis for the first time. Using the polymerase chain reaction (PCR) and sequence-specific oligonucleotide probes (PCR-SSOP) and primers (PCR-SSP), HLA-DR phenotype and genotype frequencies were ascertained in 86 RA hospital out-patients and 79 healthy controls matched for age, gender and ethnicity. …

Predicting Red Blood Cell Transfusions In Very Low Birth Weight Infants Based On Clinical Risk Factors., David A. Paul, Stephen A. Pearlman, Kathleen H. Leef, John L. Stefano

Department of Pediatrics Faculty Papers

OBJECTIVE: To describe the clinical factors most predictive of red blood cell transfusion in very low birth weight (VLBW) infants.

STUDY DESIGN: Retrospective review of VLBW infants cared for at a single level III NICU during a two year period, n = 199.

RESULTS: Overall transfusion requirement was 4.6 +/- 6.2 transfusions/infant/hospital course. Length of hospital stay, days of mechanical ventilation, requirement for dopamine support, birth weight, initial hematocrit, periventricular leukomalacia and necrotizing enterocolitis all independently correlated with number of transfusions and donors. Bronchopulmonary dysplasia and patent ductus arteriosus were associated with donor but not transfusion number.

CONCLUSIONS: Our data …

An Evaluation Of The Sensitivity Of Subjects With Peanut Allergy To Very Low Doses Of Peanut Protein: A Randomized, Double-Blind, Placebo-Controlled Food Challenge Study, Jonathan O'B. Hourihane, Sally A. Kilburn, Julie A. Nordlee, Susan L. Hefle, Steve L. Taylor, John O. Warner

Department of Food Science and Technology: Faculty Publications

The minimum dose of food protein to which subjects with food allergy have reacted in double-blind, placebo-controlled food challenges is between 50 and 100 mg. However, subjects with peanut allergy often report severe reactions after minimal contact with peanuts, even through intact skin.

Objective: We sought to determine whether adults previously proven by challenge to be allergic to peanut react to very low doses of peanut protein.

Methods: We used a randomized, double-blind, placebo-controlled food challenge of 14 subjects allergic to peanuts with doses of peanut ranging from 10 μg to 50 mg, administered in the form of …