Medicine and Health Sciences Commons^™

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 …

Suzanne Falgout's Review Of Martha C. Ward's Nest In The Wind: Adventures In Anthropology On A Tropical Island, Suzanne Falgout

Pacific Studies

No abstract provided.

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 …

The Right To Die: An Old Woman's Formula, Mary Guinan

School of Public Health Faculty Research

On December 26, 1990, Nancy Cruzan died, 12 days after her feeding tube was removed. She had been in an irreversible coma for seven years and her parents had sued for the right to remove the feeding tube that was keeping her alive. The pain and suffering of her family in coming to this decision was certainly compounded by those who disagreed with them and tried to prevent the extubation. Whether one agrees with this particular decision or not, most of us will not be faced with such clear alternatives, ie, leave the tube in or take it out in …

Suicide In Micronesia: The 1920s And 1930s, David C. Purcell Jr.

Pacific Studies

No abstract provided.

Maine Aids Alliance Newsletter (February 1991), Maine Aids Allaince

Newsletter / Maine AIDS Alliance (1990-1991)

No abstract provided.

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. …

Using Joint Fact-Finding To Resolve Disputes Over Cleanup Of Hazardous Waste Sites, R. Steven Konkel

Environmental Health Science Faculty and Staff Research

This research demonstrates how and why joint fact-finding works to break impasses in negotiations and overcome obstacles to the cleanup of hazardous waste sites. Superfund cleanup negotiations often involve multiple-party, multi-issue disputes. Disputes often arise over identification of the responsible parties, allocation of cost and liability, definition and interpretation of cleanup standards, and development of a viable settlement structure. In 1988, Marks and Susskind identified disagreements over the accuracy and validity of data as critical barriers to cleanup of Superfund and other hazardous waste sites. Disputes over data have led to delays, costly supplemental studies, and site fragmentation into multiple …

Review Of John V. Schappi, Improving Job Attendance (Bna Books), W. J. Hankins

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

Review of JOHN V. SCHAPPI, IMPROVING JOB ATTENDANCE. (BNA Books 1988.) [187 pp.] Appendices, bibliography, index. LC 87-27638; ISBN 0-87179-535-3

Evaluation Of Particulate Air Filters For Indoor Air Cleaning, Murray R. Clark, Kevin Tennal, Thomas Rimmer, Malay K. Mazumder

Journal of the Arkansas Academy of Science

No abstract provided.

Molecular Epidemiologic Techniques In Analysis Of Epidemic And Endemic Shigella Dysenteriae Type 1 Strains, Nancy A. Strockbine, Julie Parsonnet, Katherine Greene, Julia A. Kiehlbauch, I. Kaye Wachsmuth

United States Public Health Resources

During 1988 the number of Shigella dysenteriae type 1 infections reported in the United States increased fivefold. To determine if recent isolates from Mexico were related to those that caused epidemics of dysentery worldwide, Southern hybridization analysis was done with Shiga toxin and ribosomal RNA gene probes. Western hemisphere and Eastern Hemisphere strains differed by the size of a single EcoRI fragment carrying the Shiga toxin genes. Three ribosomal DNA (rDNA) patterns were observed, which correlated with the strain;s continental origin for 81 of 83 isolates tested. Together the Shiga toxin and rDNA probe results indicated that recent Mexican …

The Use Of Health Service Areas For Measuring Provider Availability, Diane M. Makuc, Bengt Haglund, Deborah D. Ingram, Joel C. Kleinman, Jacob J. Feldman

United States Public Health Resources

Measurement of the availability of health care providers in a geographic area is a useful component in assessing access to health care. One of the problems associated with the county provider-to-population ratio as a measure of availability is that patients frequently travel outside their counties of residence for health care, especially those residing in non-metropolitan counties. Thus, in measuring the number of providers per capita, it is important that the geographic unit of analysis be a health service area. We have defined health care service areas for the coterminous United States, based on 1988 Medicare data on travel patterns between …

Manual Para El Diseño De Investigación Operativa En Planificación Familiar, Andrew A. Fisher, John E. Laing, John E. Stoeckel, John Townsend

Reproductive Health

El Manual para el diseño de investigación operativa en planificación familiar, publicado por primera vez en inglés por el Population Council en 1983, se basó en las experiencias de los autores en investigaciones operativas en Asia. Esta segunda edición contiene secciones revisadas y aumentadas. En su caso, se han agregado ejemplos de América Latina y África. En la Introducción se hace una revisión completa y actualizada del desarrollo de la investigación operativa (IO) en salud y planificación familiar. Se han agregado nuevos capítulos sobre la selección de la intervención a ser probada en un investigación operativa sobre la descripción de …

A Comparison Between Physiological And Perceived Exertion During Maximal And Submaximal Treadmill Exercise At Three Menstrual Cycle Phases, Kathleen M. Mccune

Masters Theses

The purpose of this study was to investigate the differences in physiological and subjective perceived exertion levels at maximal and submaximal treadmill exercise between three phases of the menstrual cycle in eumennorheic women.

Nine females of varying fitness levels were subjects in the study. None of the subjects were using oral contraception or hormone altering medications at the time of the study.

The subjects performed three separate maximal graded exercise tests (GXT) using the Balke protocol. During each GXT, oxygen uptake (VO₂), heart rate (HR), blood pressure (BP), respiratory quotient (RQ), rate of perceived exertion, and total time …

An Investigation Into Physiological Responses And Ratings Of Perceived Exertion To Submaximal Cycle Ergometry When Using Aerodynamic And Drop Handlebars, Haydn Jarrett

Masters Theses

No abstract provided.

The Selection And Implementation Of A Drug And Alcohol Intervention Program/Model For Grand Coulee Dam Junior High School, Grand Coulee, Washington, Scott L. Ramsey

All Graduate Projects

The purpose of this study was to plan and implement an intervention program to combat adolescent substance abuse at Grand Coulee Dam Junior High School, Grand Coulee, Washington. This study presented a review of the research and literature related to drug and alcohol intervention models and has documented the steps and procedures taken by the Grand Coulee Dam Junior High School Core Team to implement the intervention model selected.

Prevention Of Morbidity And Mortality From Induced And Unsafe Abortion In Nigeria, Friday E. Okonofua, Toun Ilumoka

Reproductive Health

These proceedings are from a seminar organized by the Department of Obstetrics, Gynaecology, and Perinatology, Obafemi Awolowo University, Ile-Ife (Nigeria) in collaboration with the Population Council. The primary purpose of the multidisciplinary seminar was to identify the determinants of the high rate of mortality and morbidity from unsafe abortion in Nigeria. The specific objectives were: 1) to identify measures that could be undertaken on a short- and long-term basis to reduce the rate of abortion-related mortality, and 2) to set an agenda for research into abortion in Nigeria. The seminar consisted of oral presentations on related topics by researchers and …

Man/Hombre/Homme: Respuestas A Las Necesidades De La Salud Reproductiva Masculina En América Latina, Debbie Rogow, Judith Bruce, Ann Leonard

Poverty, Gender, and Youth

Esta edición de Quality/Calidad/Qualité responde a la siguiente pregunta: ¿cómo pueden los programas de planificación familiar entender y atender mejor a los intereses de los hombres? Las propuestas del artículo se derivan de la experiencia de PRO-PATER, en São Paulo, Brasil, y brevemente, de las actividades de la Clínica para el Hombre de Profamilia en Colombia. Las experiencias de tanto PRO-PATER como Profamilia sugieren que, aunque las necesidades de salud reproductiva de los hombres pueden ser distintas a las que expresan las mujeres, de todas maneras ellos están muy interesados. Queda claro que existe una abundante demanda para servicios de …

The Effect Of Psychosocial Factors On The Immune Response Of Hiv Infected Individuals As Measured By The Extent Of Relationship With Cd-4 T Cell Count And Physical Symptoms, Richard R. Taylor

Theses

The effect of psychosocial factors on the immune response of HIV infected human subjects was assessed by measuring the degree of relationship to CD-4 T cell count and physical symptoms.

Twenty six participants (22 white and 2 black males) all who had been diagnosed as HIV positive completed a battery of 11 psychological tests and a social and medical history questionnaire. Fifty four psychosocial factors were selected as having the potential to have a significant effect on immune response.

Correlational analyses yielded no strong relationships between the psychosocial factors and CD-4 T cell count or physical symptoms. Moderate associations were …

The Bangladesh Women's Health Coalition, Bonnie J. Kay, Adrienne Germain, Maggie Bangser

Poverty, Gender, and Youth

The Bangladesh Women's Health Coalition (BWHC) represents an important initiative in the movement toward more responsive modes of family planning delivery. In the context of a society where there are strict limits on the social role and physical mobility of most girls and women, BWHC has set itself the ambitious goal of enabling women—no matter what their income or education—to learn how to manage their own reproductive health and the health of their children in a way that enhances their sense of strength and competence. One of the real strengths of BWHC has been its willingness to learn from experience …

Child Care: Meeting The Needs Of Working Mothers And Their Children, Caroline Arnold, Jorge Mejia, Aster Haregot, Ann Leonard, Cassie Landers

Poverty, Gender, and Youth

This issue of SEEDS, developed in cooperation with the Consultative Group on Early Childhood Care and Development, with support from UNICEF, seeks to bring together the critical elements of women's work and child care, reviewing the issues from three different perspectives: child care as a means of enabling women to work, as a source of employment for women, and as a way of meeting the developmental needs of young children. The report examines three different UNICEF-supported approaches to child care on three different continents—Asia (Nepal), Africa (Ethiopia), and South America (Ecuador)—that have been developed with the needs of working women …