Medical Specialties Commons^™

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 …

Epidural Spinal Cord Compression From Metastatic Cancer: Clinical Features And Management, H Shaheen, S Abubakar, I Malik, I Altafullah, F Alam, A Khan

Section of Nephrology

We retrospectively analyzed thirty-three patients (21 males, 12 females) with malignancy induced spinal cord compression (SCC). The mean age of the patients was 42.8 years and almost half (51%) of them presented with SCC. Mean duration of symptoms was 4.5 months and the mean interval between the original diagnosis of cancer and the development of SCC was 14.6 months. Back pain was the most frequent (97%) symptom with an equal number of patients having subjective or objective evidence of lower limb weakness. Majority (73%) of the patients were non-ambulatory at the time of diagnosis. Spinal level involvement was mostly thoracic …

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 …

The Effects Of Suxamethonium And Pancuronium On The Haemodynamic Response To Endotracheal Intubation, F A. Khan, R S. Kamal

Department of Anaesthesia

The pharmacological effects of suxamethonium and pancuronium on the cardiovascular system may vary and therefore alter the haemodynamic response to intubation. The arterial blood pressure, the heart rate and the rate pressure product were measured as parameters of haemodynamic change in forty adult ASA. I and II patients undergoing laryngoscopy and endotracheal intubation in a randomised controlled study. The patients were induced with either thiopentone/suxamethonium (Group A) or thiopentone/pancuronium (Group B). There was no significant difference between the groups on comparison of systolic and diastolic blood pressure changes. Pancuronium, however, caused a significantly higher rise in the heart rate after …

Clinical Features And Management Of Malignant Ascites, I Malik, S Abubakar, I Rizwana, F Alam, J Rizvi, A Khan

Section of Cardiology

Retrospective analysis of 45 patients (33 females, 12 males) with cytologically-proven malignant ascites is presented. Abdominal pain was the most frequent symptom (69%). Fiftythree percent cases had low serum albumin. Ascitic fluid was haemorrhagic or serosanguinous in 48% cases, in the rest it was clear or straw-coloured. Peritoneal effusion was exudative in 84% cases. Mean glucose content of ascitic fluid was 95 mg/dl and the mean white cell count of 919 cells/cmm. Vast majority (82%) of the cases had metastatic adenocarcinomas. Primary malignancy was mostly ovarian (47%) followed by non-Hodgkin's lymphoma (11%) and gall bladder carcinoma (9%). Primary site could …

Gestational Diabetes In A Developing Country, Experience Of Screening At The Aga Khan University Medical Centre, Karachi, Khalid S. Khan, Javaid H. Rizvi, Rahat Qureshi, Rauf Mazhar

Department of Obstetrics & Gynaecology

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga khan University Medical Centre were subjected to a 75g glucose challenge followed 2hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at < 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at < 28 weeks gestation. The glucose challenge test was abnormal (2hr plasma glucose> 1 40mg%) in 8.6% of the screened population. Follow-up oral glucose tolerance test on these patients revealed a prevalence of 3.2% of gestationat diabetes and 1.9% of impaired glucose tolerance test based on the modified …

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. …

Gestational Diabetes In A Developing Country, Experience Of Screening At The Aga Khan University Medical Centre, Karachi, Khalid S. Khan, Javaid H. Rizvi, Rahat N. Qureshi, Rauf Mazhar

Department of Obstetrics & Gynaecology

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga Khan University Medical Centre were subjected to a 75 g glucose challenge followed 2 hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at less than 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at less than …

Bacterial Isolates In Neutropenic Febrile Patients, M Karim, W Khan, B Farooqi, I Malik

Section of Internal Medicine

One hundred consecutive patients with documented bacteremia and neutrophil count of 0.5 x 10(9)/L or below were retrospectively studied to determine the pattern of infection at the Aga Khan University Hospital in Karachi. These included patients with primary haematologic malignancies presenting with low counts, and those patients with cancer who developed neutropenia as a result of chemotherapy. The gram negative organism pseudomonas aeruginosa was the most common bacterial organism isolated constituting 31% of all positive blood cultures. Gram positive organisms were frequently isolated comprising 24% of all isolates of which 15% were Staph.aureus. Staph. epidermidis was not isolated in this …

Correspondence: Nh Professional Matters: Perrin To Roger, John P. Perrin

William Kirmes, D.O. Collection

A letter from John Perrin, Executive Director of the American Osteopathic Association, to Dr. Alan C. Roger regarding the Care-a-Van mobile health clinic program.

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

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

This part of the article describes events leading to the creation of the Consumer Product Safety Commission - and the on-going debate between those who believe safety regulation is necessary and those who believe that market forces can achieve acceptable levels of Risk. The author also sets the stage for a detailed examination of bicycle Risk. In the next issue, he compares the accomplishments of the CPSC's bicycle standard with, e.g., the development and use of hard-shell bicycle helmets. Moreover, he discusses the role of tort liability in managing Risk and ultimately concludes that, in the case of bicycle safety, …

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

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

Prophylatic Cord Care: Is It Necessary?, Karen Coyle

Theses : Honours

Since the evolution of 'open' cord care in 1974, the umbilical cord of the newborn has been treated prophylactically with many different forms of antibacterial solutions. Recent studies have demonstrated that cord separation is facilitated by bacteria and many of the current treatments, such as the use of alcohol, actually delay separation. The purpose of this study was to compare cleaning the cord with alcohol to dry cord care, a method of cord care which is now being considered as an acceptable alternative to prophylactic umbilical cord treatment. A convenience sample of 205 babies was taken from a small private …

Instrumentation For A Postural Sway Platform, Robert B. Shanks, Paul C. Mcleod

Journal of the Arkansas Academy of Science

A postural sway platform has been developed for studies involving elderly falters. It will be used to assist in determining reasons some elderly people are prone to falling and others are not. Results of these postural sway tests will be combined with other tests on both fallers and nonfallers to determine specific reasons for falling. A simple Z-axis platform has been developed that utilizes a unique hanger system and three strain gage transducers. The output of these transducers is input to an analog-to-digital conversion board in a personal computer. Software has been written to take data from the platform and …

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

Evaluation Of A Patient Education Program For Patients With Non-Insulin Dependent Diabetes (Type Ii), Helen M. Walker

Theses : Honours

The purpose of this study was to evaluate a group outpatient program for patients with non-insulin dependent diabetes (Type II). It endeavoured to establish whether at the completion of a patient education program, and again at the 3 month follow-up period, the patients were complying with : (a) the recommended dietary plan, (b) the exercise program, and (c) were monitoring blood glucose levels at home, as evidenced by weight loss and metabolic control of their diabetes. The study also investigated factors influencing non-compliance. The theoretical rationale used for this study was Pender's Health Promotion Model, which theorises that health-promoting behaviour …

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 …

The Undrained Brain: The Other Side Of The Foreign Medical Graduate Resident Issue, C M. Smythe

Section of Neurology

No abstract provided.

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.