Medical Specialties Commons^™

A Comparison Of Four Muscle Relaxant Techniques And Their Incidence Of Postoperative Myalgia In Ambulatory Patients, William James Garske Jr.

Community & Environmental Health Theses & Dissertations

Postoperative myalgia was measured 24 and 72 hours following the administration of four different anesthetic regimens to 36 patients undergoing outpatient or 23-hour admission procedures. Each patient, ASA class I or II, was to undergo procedures of limited duration, 30 to 90 minutes, and surgical stimulation, including procedures such as knee arthroscopy, hernia repair, and breast biopsy. Anesthesia was induced with propofol 1.5 mg/kg, fentanyl 50 mcg, and maintained with O₂ , N₂O, and isoflurane. Group I (n=20), the control, received no muscle relaxant and was maintained with mask ventilation. Group II (n=5) received succinylcholine 1.5 mg/kg …

The Degree Of Exposure To Anesthetic Nitrous Oxide Waste Gas In The Operating Room During Various Surgical Procedures, Kathryn Ann Longworth

Community & Environmental Health Theses & Dissertations

Halsey (1991) summarized the underlying reasons for continuing concern about the problem of waste anesthetic gases. Careful and systematic monitoring studies indicate that individual trends in anesthetic pollution levels are not as low as was confidently predicted 10 years ago, when scavenging devices became commonplace. Second, there are now clear legal requirements for assessment of the situation. It is estimated that each year more than 200,000 health professionals are occupationally at risk of illness as a consequence of chronic exposure to low doses of waste anesthetic gases (Rogers, 1986).

These contaminants are suspected pf being ~eratogenic, carcinogenic, mutagenic, and embryo-lethal. …

Interaoperative Frozen Section Consultation: An Analysis Of Accuracy In A Teaching Hospital., Farrukh Aijaz, Suhail Muzaffar, Akbar Shah Hussainy, Shahid Pervez, Sheema H. Hasan, Hizbullah Sheikh

Department of Pathology and Laboratory Medicine

This Is a retrospective quality assurance study of all frozen sections done at The Aga Khan University Hospital during a six year period (1986 to 1991). There were 1,031 frozen sections out of a cumulative total of 42,985 surgical specimens (2.39%). Nine hundred and seventy-six (94.66%) were concordant. In 92(8.9%) fresh specimens were brought from other hospitals of Karachi, in 37 cases (3.58%) the diagnosis was deferred till the evaluation of permanent paraffin sections and 18 (1,74%) were discordant with 7 (0.67%) false positive and 11(1,06%) false negative. Among the discordant cases, 9 were attributed to misinterpretation, 7 due to …

The Effect Of The Cooper Wellness Program In Promoting Long- Term Lifestyle Behavior Changes, Ernesto P. S. Medina Jr.

Loma Linda University Electronic Theses, Dissertations & Projects

Most research on health behavior change programs examines their effectiveness in producing initial behavior changes, but fails to evaluate long-term maintenance of those changes. This study examined the effectiveness of the Cooper Wellness Program (CWP) in Dallas, Texas, in promoting maintenance of lifestyle behavior changes for one year or longer in the areas of diet, exercise, and stress management.

The CWP offers an intensive live-in lifestyle behavior modification program in four-, seven-, or 13-day formats. Data were collected from 223 individuals who attended the CWP between January, 1989, to February, 1992. The study addressed the following areas: 1) long-term maintenance …

Aggressive Angiomyxoma Of Vulva, Farrukh Aijaz, Shahid Pervez, Shehnaz Wasti, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

No abstract provided.

Diet And Colon Cancer Risk In The Population Of Thailand, Nithat Sirichotiratana

Loma Linda University Electronic Theses, Dissertations & Projects

Epidemiological studies have emphasized environmental influences, especially a diet high in animal fat and low in fiber, as major risk factors for colon cancer. In order to examine the relationship between dietary fat and fiber and occurrence of colon cancer, patient medical records from the National Cancer Institute between 1981-1991 were used for the first hospital-based case-control study of diet and colon cancer in Thailand. These records included a total of 168 cases and 357 controls. Data on the frequency consumption of various food items were obtained by using an existing food frequency questionnaire, completed as part of patient’s history …

Self-Efficacy And Self-Care In The Hypertensive Female Patient, Robert Davis Lutz

Loma Linda University Electronic Theses, Dissertations & Projects

This study focused upon physician/patient interaction as it pertains to patient involvement in personal health-care planning decision making, and self-care. The study was a multi-intervention trial that allowed for testing the effectiveness of two instruments used separately or simultaneously, in combination. Participants were 73 female patients, ages 41 to 76, diagnosed with essential hypertension and requiring medication for control.

Patients were randomly assigned to four groups: 1) a control group that was given no intervention, 2) a Pre-Knowledge Intervention (PKI) group that was given an interactive treatment plan with foreknowledge of what their physicians would probably do at their next …

Oral Contraceptives And Reproductive Cancers: Weighing The Risks And Benefits, Ann L. Coker, Susan Harlap, Judith A. Fortney

CRVAW Faculty Journal Articles

The hypothetical incidence of reproductive cancers resulting from oral contraceptive use was estimated in several models comparing the cumulative lifetime incidence of cancer of the breast, cervix, ovary and endometrium expected in pill users with the incidence expected in nonusers. The potential number of cancer-free days that would be gained or lost by pill users was com- pared with similar estimates among nonusers. If five years or more of pill use were associated with a 20% increase in the risk of breast cancerbeing diagnosed before age 50, a 20% increase in cervical cancer risk and a 50% reduction in the …

Rethinking Postpartum Health Care, Martha Brady, Beverly Winikoff

Reproductive Health

These proceedings come from papers and discussions as part of the Population Council invitational seminar entited "Rethinking Postpartum Health Care," in 1992. The seminar on postpartum reproductive health was the fifth in a series of seminars convened by the Population Council as part of its Robert H. Ebert Program on Critical Issues in Reproductive Health and Population. The program focuses on four topics: 1) improving and devising new approaches to postpartum care; 2) improving the quality of care in family planning and reproductive health services; 3) managing unwanted pregnancy and preventing the consequences of unsafe abortion; and 4) bringing attention …

The Relationship Of Locus-Of-Control And Altruism To Prehospital Emergency Medical Care Providers Universal Precaution Practices, Joanne L. Wakeham

Health Services Research Dissertations

The purpose of this study was to determine the relationship between locus of control, altruism, occupational risk, and personal factors to the frequency of universal precautions practices of prehospital emergency medical care providers. The effects of OSHA's Occupational Exposure to Bloodborne Pathogens; Final Rule on reducing prehospital emergency medical care providers occupational exposure to bloodborne pathogens were also examined. Prehospital emergency medical care providers from municipal and private EMS agencies in the Tidewater Emergency Medical Services region participated in this study. Prehospital emergency medical care providers self-reported perceptions of locus of control, altruism, occupational risk, and universal precautions practices were …

Localization Of The Gene For Men 2a, Jay B. Lichter, Michael Difilippantonio, Jingshi Wu, Diane Miller, David C. Ward, Paul J. Goodfellow, Kenneth K. Kidd

Henry Ford Hospital Medical Journal

The search for the gene that causes the multiple endocrine neoplasia type 2A (MEN 2A) syndrome is entering a new phase. Genetic linkage studies have localized the gene to the pericentromeric region of chromosome 10. The statistical portion of mapping the gene for MEN 2A is nearly complete and now classical molecular biological/gene mapping techniques will be employed. We have used fluorescence in situ hybridization to estimate the size of the MEN2A region to be about 2 to 5 mb, using some liberal assumptions; at worst the region should contain no more than about 10 mb of non-alphoid DNA. Our …

Microsurgical Lymph Node Dissection For Metastatic Asymptomatic C-Cell Carcinoma, Heinz J. Buhr, Friedrich Kallinowski, Friedhelm Raue, Christian Herfarth

Henry Ford Hospital Medical Journal

In persistent, clinically inapparent medullary thyroid carcinoma, microsurgical dissection of all lymph node compartments of the neck was performed. Between August 1988 and September 1991, 28 cases (mean age 43.3 years) were treated with 38 surgical interventions. Twenty patients had the sporadic form and eight patients the familial form. Unilateral neck dissection resulted in normalization of serum calcitonin (CT) levels even after pentagastrin stimulation in two patients whereas 16 patients exhibited abnormal CT stimulation tests. Eight of ten patients who had bilateral neck dissections had positive pentagastrin test results after surgery. The main postoperative complications included loss of local cutaneous …

Cutaneous Lesion Associated With Multiple Endocrine Neoplasia Type 2a: Lichen Amyloidosis Or Notalgia Paresthetica?, O. Chabre, F. Labat, N. Pinel, F. Berthod, V. Tarel, I. Bachelot

Henry Ford Hospital Medical Journal

Three patients of a French family demonstrated an association of multiple endocrine neoplasia type 2A (MEN 2A) with a pruritic scapular skin lesion. The lesions are similar to those described as familial cutaneous lichen amyloidosis in unrelated MEN 2A and medullary thyroid carcinoma families, but histological, immunohistochemical, and ultrastructural analysis of skin biopsies from each patient in the French family did not show amyloid deposition. The topography of the lesion follows dermatomes C8-D3. The patients report not only pruritus but also paresthesia and hyperalgesia, and one showed touch hypoesthesia and pain hyperesthesia in the area of the lesion. Such an …

Primary Hyperparathyroidism In Patients With Multiple Endocrine Neoplasia Type 1: Experience By A Single Surgical Team In Japan, Takao Obara, Yoshihide Fujimoto, Yukio Ito

Henry Ford Hospital Medical Journal

Nineteen patients were surgically treated for hyperparathyroidism associated with multiple endocrine neoplasia type 1 syndrome. Fourteen patients (74%) had removal of three or more parathyroid glands at the first operation, and five (26%) by removal of 2 1/2 or fewer glands. Two patients had recurrent hypercalcemia during the mean follow-up period of 65 months. One had a recurrence 10 years after subtotal parathyroidectomy. Reexploration in this patient revealed enlargement of the remaining tissue in the neck and an enlarged supernumerary gland in the aorticopulmonary window. The other patient had persistent hypercalcemia after removal of two hyperplastic parathyroid glands until after …

Medullary Thyroid Carcinoma: Australian Experience With Genetic Testing, Janet L. Ward, Valentine J. Hyland, David S. Andrew, Debbie J. Marsh, Bruce G. Robinson

Henry Ford Hospital Medical Journal

Linkage analysis has been performed in four pedigrees with multiple endocrine neoplasia type 2A (MEN 2A) or familial medullary thyroid carcinoma (MTC) using pericentromeric chromosome 10 probes. Important information regarding carrier status has been provided in 10 individuals, many of whom would not have been identified by pentagastrin stimulation testing. We have also used pulsed field gel electrophoresis (PFGE) to link the probes H4JRBP and pMCK2 to a 150 kb fragment. Using PFGE, no evidence was found in DNA from lymphocytes of a major DNA rearrangement in two individuals affected with MEN 2A and an individual with MEN 2B compared …

Oncogene And Growth Factor Expression In Men 2 And Related Tumors, Jeffrey F. Moley, Göran K. Wallin, Michele B. Brother, Michael Kim, Samuel A. Wells Jr., Garrett M. Brodeur

Henry Ford Hospital Medical Journal

Pheochromocytomas occur sporadically or in individuals affected by inherited syndromes including multiple endocrine neoplasia (MEN) type 2A and 2B, neurofibromatosis, and the von Hippel-Lindau syndrome (vHL). Medullary thyroid carcinomas (MTCs) also occur sporadically or as part of MEN 2A, MEN 2B, and familial MTC. Little is known of the molecular genetic background of these tumors. We have shown previously that activation of the N-ras, H-ras, and K-ras oncogenes does not occur in these tumors, but that deletions of the short arm of chromosome 1 are extremely common (> 60%) and may indicate loss of a suppressor gene in the chromosomal …

Mineral Metabolic Effects Of Thyroidectomy And Long-Term Outcomes In A Family With Men 2a, Henry G. Bone Iii, Leonard J. Deftos, William H. Snyder, Charles Y. C. Pak

Henry Ford Hospital Medical Journal

We have followed a family with multiple endocrine neoplasia type 2A for 18 years. Four members have undergone total thyroidectomy for medullary thyroid carcinoma or C-cell hyperplasia, and one has required bilateral adrenalectomy for pheochromoctyoma. None has developed hypercalcemic hyperparathyroidism, although parathyroid hormone levels were relatively high prethyroidectomy and fell postoperatively in the patients with high calcitonin levels. In three of the four cases, intestinal calcium absorption decreased following thyroidectomy.

Statistical Analysis Of Histomorphological Findings In Medullary Thyroid Carcinoma: Distinction Between The Different Familial Forms Of The Disease, B. Franc, M. Rosenberg-Bourgin, B. Auvert, B. Caillou, N. Dutrieux-Berger, J. Floquet, M. Houcke-Lecomte, E. Justrabo, F. Labat-Moleur, M. F. Le Bodic, A. Pages, M. Patey, G. Viennet, F. Vilde, J. P. Saint-Andre

Henry Ford Hospital Medical Journal

A multifactorial analysis of morphological findings was performed on 153 cases of medullary thyroid carcinoma (MTC). The aim of the study was to utilize histological criteria to discriminate between MTC associated with multiple endocrine neoplasia type 2A (MEN 2A) and that associated with the inherited MTC only syndrome. The presence of fusiform cells associated with several other markers seemed to he more predictive of MEN 2A. A comparison of inherited MTC only and sporadic MTC only showed fusiform cells to be significantly less common in inherited MTC only. These results suggest that the inherited MTC only syndrome is a distinct …

Genetics Of The Multiple Endocrine Neoplasia Type 2b Syndrome, Charles E. Jackson, Robert A. Norum

Henry Ford Hospital Medical Journal

Multiple endocrine neoplasia type 2B (MEN 2B) is similar to MEN 2A in that both autosomal dominant syndromes include medullary thyroid cancers and pheochromocytomas. It is distinct in that MEN 2B patients have much earlier age of onset with more aggressive tumors and mucosa/neuromas of the lips and tongue. The neuromas allow ascertainment generally before age 5. Studies of two and three generations of 14 MEN 2B families disclosed close linkage of the MEN 2B gene to DNA markers to which MEN2A had been linked. Multipoint analysis utilizing additional results in three generations of a 15th family have disclosed a …

High-Sensitivity Serum Calcitonin Assays Applied To Screening For Thyroid C-Cell Disease In Multiple Endocrine Neoplasia Type 2a, Michael M. Kaplan, Glenn M. Stall, Timothy Cummings, Andrew Macaulay, Philippe Motté, Hubert J. Wolfe, Seymour Reichlin, Arman J. Tashjian Jr.

Henry Ford Hospital Medical Journal

Two serum calcitonin assays with sensitivities ≤ 10 pg/mL were compared to our standard radioimmunoassay (sensitivity 100 pg/mL) in multiple endocrine neoplasia type 2A (MEN 2A) screening. Values from the Nichols displacement radioimmunoassay averaged 38% higher than values from the CIS immunoradiometric assay; values from both were highly correlated, r = 0.845. In three individuals, both of the newer assays revealed abnormalities in pentagastrin tests three to four years before abnormalities were detected by the standard assay. Pentagastrin tests after total thyroidectomy were assayed by the newer methods in patients with medullary thyroid carcinoma (MTC) diagnosed at initial testing (group …

A Preliminary Analysis Of Consortium Data For Markers Tightly Linked To Multiple Endocrine Neoplasia Type 2a, J. B. Lichter, S. M. Hackleman, B. A. J. Ponder, D. Easton, S. A. Narod, G. M. Lenoir, R. F. Gagel, N. E. Simpson, E. Gardner, P. J. Goodfellow, S. Takai, A. J. Pakstis, K. K. Kidd

Henry Ford Hospital Medical Journal

We have analyzed DNA marker typing data contributed by six independent groups to estimate the pairwise genetic distances between these markers and the locus for multiple endocrine neoplasia type 2A (MEN 2A). We used LIPED to calculate these distances for female, male, and sex-average linkage maps and to determine the corresponding LOD scores. The preliminary analyses of this large data set (89 MEN 2A families and five non-MEN 2A references families, with 1,934 total individuals) are reported here. These refined estimates of the genetic map in this region will aid in the assignment of presymptomatic diagnoses. This study clearly points …

Surgical Approach Of Synchronous Medullary Thyroid Carcinoma And Pheochromocytoma In Men 2 Syndrome, Georg F. W. Scheumann, Henning Dralle

Henry Ford Hospital Medical Journal

In cases with concurrent medullary thyroid carcinoma (MTC) and pheochromocytoma, discussion regarding a one-stage versus two-stage treatment strategy approach remains open. From 1975 to 1990, 11 of 25 multiple endocrine neoplasia type 2 (MEN 2) patients presented with biendocrinopathies or triendocrinopathies synchronously. All patients were treated surgically and followed subsequently in our hospital. Of the group of nine patients with concurrent MTC and pheochromocytoma, five were treated in one-stage and four in two-stage procedures. No patient had major complications intraoperatively. For the two-stage group, the total hospital stay (preoperatively and postoperatively) averaged 35 days. For the one-stage group, the total …

Pdn-21 (Katacalcin) And Chromogranin A: Tumor Markers For Medullary Thyroid Carcinoma, Friedhelm Raue, Eberhard Blind, Andreas Grauer

Henry Ford Hospital Medical Journal

The malignant C-cell releases several markets of potential clinical significance into the circulation. To determine the usefulness of these markers for management of medullary thyroid carcinoma (MTC), it is necessary to compare the usefulness of these markers with calcitonin (CT), the classical tumor marker for MTC. Measurement of serum concentrations of the peptide PDN-21 (katacalcin), a carboxyterminal cleavage product of procalcitonin. showed a high correlation with serum CT levels (r = 0.99, P < 0.01, n = 65 patients with MTC). The presence of equimolar concentrations of CT and PDN-21 (CT/PDN-21 molar ratio = 0.95 ± 0.33) indicates the peptide is cosecreted with CT. Stimulation of CT release by intravenous pentagastrin was associated with a parallel increase of PDN-21, providing further evidence of cosecretion of these two peptides. Finally, measurement of either PDN-21 or CT in selective venous catheterization specimens was useful for localization of MTC. Chromogranin A (CgA) levels were also measured in patients with MTC. Circulating levels were elevated in most patients with advanced disease. There was a moderate correlation between CgA and CT serum levels (r = 0.87, P < 0.01. n = 61 patients with MTC). Pentagastrin did not stimulate CgA, and the long half-life of CgA in the circulation did not make it possible to use this peptide for tumor localization by selective venous catheterization. We conclude that measurement of PDN-21 provides an independent assay system for diagnosis, localization, and postoperative management of MTC. whereas CgA measurement is not useful in early diagnosis of MTC and is of limited value for localization or management of progressive disease.

Patterns Of Neoplasia In C-Mos Transgenic Mice And Their Relevance To Multiple Endocrine Neoplasia, Nicholas Schulz, Friedrich Propst, Michael M. Rosenberg, R. Ilona Linnoila, Richard S. Paules, Douglas Schulte, George F. Vande Woude

Henry Ford Hospital Medical Journal

We have previously described a neurological phenotype for transgenic mice carrying the c-Mos proto-oncogene. Pheochromocytomas and C-cell thyroid neoplasms occur in these transgenic lines in patterns that are similar to those seen in multiple endocrine neoplasia type 2 (MEN 2). Characterization of the pathological lesions via immunohistochemistry underscores similarities between MEN 2 and these transgenic mice. When transgenic mice that do not display the MEN 2 phenotype are crossed to a different background, the progeny display the MEN 2 phenotype. Thus the interaction of the background with the transgene is such that it can suppress tumor information. This observation bears …

Sublocalization Of The Multiple Endocrine Neoplasia Type 1 Gene, Catharina Larsson, Gunther Weber, Marie Janson

Henry Ford Hospital Medical Journal

Tumorigenesis in multiple endocrine neoplasia type 1 (MEN 1) involves the unmasking of a recessive mutation at the MEN 1 locus which has been mapped to chromosomal region 11q11-13. By analyzing 58 DNA markers on a panel of radiation-reduced somatic cell hybrids, the region encompassing the MEN 1 gene was divided into nine subregions. Pulsed field gel electrophoresis analysis of markers within subgroups showed that the recombination rate around the MEN 1 locus is high. Combined linkage analysis in MEN 1 families and deletion mapping in MEN 1-related tumors suggest the MEN 1 gene is located centromeric to D11S807 and …

Prospective Screening In Multiple Endocrine Neoplasia Type 1, Britt Skogseid, Kjell Oberg

Henry Ford Hospital Medical Journal

To assess the age of clinically detectable onset of multiple endocrine neoplasia type 1 (MEN 1), 88 members of four families were invited to participate in a ten-year biochemical screening program. Evidence for clinically detectable MEN 1 was found in adolescence. Pancreatic endocrine dysfunction constituted the presenting lesion in a majority of these individuals. The age at diagnosis of pancreatic endocrine tumors averaged 25 years and was lowered by almost two decades by prospective investigation. Furthermore, the penetrance of the pancreatic endocrine and parathyroid lesions equaled the penetrance found in autopsy studies. The use of a standardized meal stimulation test …

The Importance Of Screening For The Men 1 Syndrome: Diagnostic Results And Clinical Management, C. J. M. Lips, H. P. F. Koppeschaar, M. J. H. Berends, J. M. Jansen-Schillhorn Van Veen, A. Struyvenberg, Th. J. M. V. Van Vroonhoven

Henry Ford Hospital Medical Journal

No abstract provided.

Prad1 (Cyclin D1): A Parathyroid Neoplasia Gene On 11q13, Andrew Arnold, Toru Motokura, Theodora Bloom, Carol Rosenberg, Allen Bale, Henry Kronenberg, Joan Ruderman, Milton Brown, Hyung Goo Kim

Henry Ford Hospital Medical Journal

Hyperparathyroidism is a central component of multiple endocrine neoplasia type 1 (MEN 1), and both sporadic and familial forms of parathyroid disease may share certain pathogenetic features. We recently identified a gene that is clonally rearranged with the PTH locus in a subset of sporadic parathyroid adenomas. This candidate oncogene, PRAD1 (previously D11S287), appears to contribute to parathyroid tumorigenesis in a fashion analogous to activation of C-MYC or BCL-2 by rearrangement with tissue-specific enhancers of the immunoglobulin genes in B-lymphoid neoplasia. The PRAD1 gene maps to 11q13 and has been linked to the BCL-1 breakpoint locus, although not to the …

Surgical Treatment Of The Endocrine Pancreas And Zollinger-Ellison Syndrome In The Men 1 Syndrome, Norman W. Thompson

Henry Ford Hospital Medical Journal

Islet cell neoplasia is a frequent occurrence in multiple endocrine neoplasia type 1 (MEN 1). Sixteen of 27 patients with MEN 1 developed functioning endocrine pancreatic tumor syndromes. Eleven of the 16 developed Zollinger-Ellison syndrome and each was evaluated by a combination of computed tomography and hepatic angiography to exclude hepatic metastasis and percutaneous transhepatic catheterization to localize the tumor. Seven of the 11 patients were found to have duodenal gastrinomas with multiple duodenal tumors in three patients. Four of the 11 patients had only pancreatic gastrinomas. In addition to the gastrinomas, other types of islet tumors in the pancreatic …

Characterization Of The Clinical Features Of Five Families With Hereditary Primary Cutaneous Lichen Amyloidosis And Multiple Endocrine Neoplasia Type 2, Marion F. Robinson, Eric J. Furst, Vincenzo Nunziata, Maria Luisa Brandi, Jorge P. Ferrer, Maria J. G. Martins Bugalho, Guiseppe Di Giovanni, Richard J. H. Smith, Donald T. Donovan, Bobby R. Alford, James F. Hejtmancik, Vittorio Colantuoni, Loredana Quadro, Edward Limbert, Irene Halperin, Enric Vilardell, Robert F. Gagel

Henry Ford Hospital Medical Journal

The hereditary conditions of primary cutaneous lichen amyloidosis and multiple endocrine neoplasia type 2 (MEN 2) are rare clinical entities. The initial reports of two families in which the two conditions coincided have led to the identification of at least eight additional families with this clinical syndrome. In this report we describe the clinical features in five of these eight families. The salient feature in these five families is the presence of unilateral (46%) or bilateral (64%) pruritic and lichenoid skin lesions located over the upper portion of the back. Family members describe these skin lesions as intermittently intensely pruritic …