Public Health Commons^™

Nineteen-Year Radiographic Follow-Up Of Untreated Paget's Disease Of Bone, Christopher K. Shier, Burton I. Ellis, Gregory Tennyson, Michael Kleerekoper

Henry Ford Hospital Medical Journal

Radiographic and histologic findings in Paget's disease of bone have been previously well described, and characteristic features of each stage have been determined. Long-term radiographic follow-up of untreated patients is rarely reported. We had the opportunity to observe the radiographic evolution of untreated Paget's disease of the tibia. Sequential radiographic studies spanning a 19-year period have allowed us the opportunity to study the natural course of this disease.

Endodermal Sinus Tumor In A 14-Year-Old Girl, Lorenzo C. Boyce, Kiran Balchandani, Roshinder Padda

Henry Ford Hospital Medical Journal

A case report on a 14-year-old girl with a large pelvic and abdominal mass is presented. Initial evaluation suggested the mass to be of ovarian origin, and the diagnosis of endodermal sinus tumor was confirmed by the pathological specimen. Alpha fetoprotein (AFP) levels on admission were 12,700 mg/dL. but AFP decreased immediately in the postoperative period and has continued to decline toward normal levels over the past four months of combination chemotherapy. After completion of chemotherapy, AFP levels will continue to be monitored and a second-look procedure may be in order.

Injection Sclerotherapy Of Bleeding Esophageal Varices: The Henry Ford Hospital Experience, Stephen R. Verbeck, Martin C. Zonca, Dominic K. H. Wong

Henry Ford Hospital Medical Journal

An update is provided of our ongoing sclerotherapy experience at Henry Ford Hospital, based on 47 patients who have undergone this procedure. One-month mortality rates for Child's classes C, B, and A were 50%, 22%, and 0%, respectively. Follow-up after one month revealed ten additional mortalities, but none were secondary to esophageal variceal hemorrhage. Strictures secondary to sclerotherapy were amenable to dilation. We advocate sclerotherapy as the treatment of choice for esophageal variceal hemorrhage.

Chest Radiographs In Surgical Intensive Care Patients: A Valuable "Routine", H. Mathilda Horst, Brian Fagan, Gordon H. Beute

Henry Ford Hospital Medical Journal

A total of 411 "routine" chest films were evaluated to determine their clinical value for surgical intensive care unit patients. There were 138 unexpected findings on 112 chest radiographs. These unexpected findings were equally divided between pulmonary problems (72) and device malposition (66). Of the unexpected findings, 30% were considered potentially life-threatening. On the basis of this study, we recommend "routine" chest films for monitoring in critically ill surgical intensive care patients.

Hemodynamic Response To Fluid Challenge: A Means Of Assessing Volume Status In The Critically Ill, H. Mathilda Horst, Farouck N. Obeid

Henry Ford Hospital Medical Journal

Cardiovascular and oxygen transport variables were studied during fluid challenges in 50 critically ill patients. The results show three distinct patterns of response: hypovolemic, normovolemic, and hypervolemic. Colloid fluid challenge is a rapid, effective diagnostic modality for determination of cardiovascular function in the surgical critical care patient.

The Failure Of Anthropometry As A Nutritional Assessment Tool, Judith J. Bencich, Diana L. Twyman, Ann Fierke

Henry Ford Hospital Medical Journal

Anthropometric measurements are commonly used to assess body composition changes and adequacy of nutritional support in the hospitalized patient. To test their utility as nutritional assessment tools in the intensive care unit (ICU) patient, body weight, triceps skinfold (TSF), mid-arm muscle circumference (MAMC). and fluid balance and intake were collected on 21 critically ill patients during their ICU stay. Correlations were sought between adequacy of nutritional support and changes over time in weight. MAMC, fluid balance, and TSF. A significant change over time in mean body weight (p < 0.0001) was seen, reflecting a mean weight loss despite a positive cumulative fluid balance of almost 20 L by day 14 for all patients (p < 0.0001). There was a significant change over time in the mean fractional intake of required calories ranging from 41.7% on observation day 1 to a peak of 84.0% on day 22 (p < 0.001). TSF and MAMC could not be obtained on a large percentage of ICU patients due to severe edema including the mid-upper arm. Obtained measurements showed no change over the study period in TSF (p = 0.24) and MAMC (p = 0.71) despite significant changes in weight (p < 0.0001). caloric intake (p = 0.0001). and cumulative fluid balance (p = 0.0001). From these data it appears that anthropometric indices of TSF and MAMC are unrelated to nutritional intake and weight in ICU patients and are therefore not of use in the nutritional assessment of this population.

Evaluation Of The Economic Impact Of Pharmacist Involvement In Hyperalimentation Therapy, Larry Crots, Larry Shoup

Henry Ford Hospital Medical Journal

A prospective parallel study of patients receiving total parenteral nutrition (TPN) was undertaken to identify characteristics of TPN solution use and waste. Thirty consecutive patients receiving TPN by order of the primary clinical service (control group) were compared with 25 consecutive patients receiving TPN under the supervision and monitoring of the Nutritional Support Service (study group). The patients were evenly divided between medical and surgical problems, with 53% of the control group being surgical patients compared to 56% of the study group. There were 136 L of TPN or 4.5 L/patient discarded in the control group compared to 65 L …

D-Penicillamine-Induced Polymyositis Occurring In Patients With Rheumatoid Arthritis: A Report Of Two Cases And Demonstration Of A Positive Lymphocyte Stimulation Test To D-Penicillamine, Takayuki Matsumura, Takamichi Yuhara, Kazuhide Yamane, Ichiro Kono, Teizo Kabashima, Heihachiro Kashiwagi

Henry Ford Hospital Medical Journal

Two patients with erosive, seropositive rheumatoid arthritis developed polymyositis during treatment with D-penicillamine. In both patients the HLA tissue typing revealed the presence of DR4. The myopathy improved promptly after withdrawal of D-penicillamine and institution of prednisolone therapy. In one patient, hypersensitivity to D-penicillamine was demonstrated by a lymphocyte stimulation test. This is the first case of D-penicillamine-induced polymyositis in which T-cell proliferative response to D-penicillamine was demonstrated in vitro.

Idiopathic Bilateral Chylothorax Presenting As A Left-Sided Neck Swelling, Larry B. Tankanow, Carlos Petrozzi, Joseph C. Ward, George C. Bower

Henry Ford Hospital Medical Journal

No abstract provided.

Joseph A. Johnston, Md: An Appreciation, Gordon Manson

Henry Ford Hospital Medical Journal

EDITOR'S NOTE: Over the years many fine and distinguished physicians have helped make Henry Ford Hospital one of the leading medical institutions in Michigan and throughout the United States. With this issue we begin our tribute to those "pioneers" who have played an integral part in the history of Henry Ford Hospital. At the first meeting of the Henry Ford Hospital Joseph A. Johnston Pediatric Society, October 11. 1985. Dr Gordon Manson honored the late Dr Johnston. The following is Dr Manson's personal presentation and tribute to his long-time friend and colleague, Johnny Johnston.

Medical Challenges In Space, Boy Frame

Henry Ford Hospital Medical Journal

No abstract provided.

Imaging, Screening, Artificial Intelligence, And The Diagnostic Dilemma: An Epidemiologist's Response, John C. Lane

Henry Ford Hospital Medical Journal

Issues in imaging, screening, and information processing discussed in a special issue of this Journal (Henry Ford Hosp Med J 1985;33:65-148) have implications for the decision-making algorithms of all clinicians who use those imaging and screening techniques. Epidemiologic and psychological research show that clinicians, like other professionals, do not obey the laws of conditional probability in their judgments of risk or outcomes under uncertainty. Although physicians cannot be expected to make complex probabilistic calculations every time they receive the result of a screening test, teachers of medicine should present algorithms that would allow the physician-in-training to make efficient use of …

Back Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Correlates Of Birth Weight And Gestation Age : Baseline Data For Health Education, Adanetch Kidanemariam

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose. The study examined the correlation of maternal occupation, urinary tract infection, smoking, and working during pregnancy with infant birth weight and gestational age in order to generate baseline data for development of a health education intervention program protocol for pregnant women In the work place.

Primary Hypotheses. (1) The four maternal risk factors: (a) occupation during lifetime, (b) reported urinary tract infection, (c) cigarette smoking, (d) working, are individually and interactively correlated with infant birth weight and gestational age. (2) The effects of the interactive associations are greater on birth weight than gestational age.

Procedure. A sample of …

Factors That Influence Prepared Childbirth Couples' Use Of Epidural Anesthesia For Labor And Delivery, Terri S. Chambers

Community & Environmental Health Theses & Dissertations

The purpose of this study was to identify factors that influence a Prepared Childbirth couple's decision to utilize epidural anesthesia for labor and delivery. Review of the literature indicated a high correlation between epidural use for uncomplicated labors and deliveries and a high incidence of maternal complications and low neonatal neurological and behavioral scores.

A sample of twenty-nine couples was used in this prospective, non-experimental field study for the research. Data were collected utilizing two developed demographic and factual event tools, Rotter's Internal-External Locus of Control Tool and Spanier's Dyadic Marital Adjustment Tool.

Three hypotheses were developed and data were …

Interventional Neuroradiology: Henry Ford Hospital Experience With Nonembolization Procedures, Clifford R. Jack, Bharat A. Mehta, Roushdy S. Boulos, Suresh C. Patel, James I. Ausman, Ghaus M. Malik

Henry Ford Hospital Medical Journal

Innovative technical developments over the past two decades have resulted in the development of a variety of useful interventional procedures for minimally invasive treatment of a variety of head and neck lesions. We have had experience with four different types of nonembolization interventional neuroradiologic procedures at Henry Ford Hospital from 1981 through 1985. Percutaneous transluminal angioplasty of six external carotid artery stenoses has been performed in five patients. Five were successful, and the artery became occluded in one patient. Intracarotid BCNU infusion was performed successfully in five patients with recurrent astrocytoma. Intraarterial streptokinase infusion was performed in one patient with …

Dnr — A God-Like Decision, Dwain Gade

Henry Ford Hospital Medical Journal

No abstract provided.

Recovery Following Acute Pontine Hemorrhage, Janice M. T. Redmond, B. K. Ahmad

Henry Ford Hospital Medical Journal

Massive pontine hemorrhage does not always carry a fatal prognosis. A case report is presented in which many of the features usually associated with a fatal outcome were seen: severe disturbance of consciousness with early onset of coma, decerebrate posturing, systolic BP ranging from 200 mm Hg to 250 mm Hg, and hypopnea. Intensive supportive therapy was instituted during the critical phase, and the patient recovered. Electrophysiological studies helped to define the neurological deficit.

The Phenomenon Of Multiple Stretch Reflexes, Robert D. Teasdall

Henry Ford Hospital Medical Journal

Multiple stretch reflexes occur in muscles adjacent to or remote from the tap. The response may be ipsilateral or bilateral. These reflexes are encountered not only in normal subjects with brisk stretch reflexes but particularly in patients with lesions of the upper motor neuron. The concussion obtained by the blow is conducted along bone to muscle. Muscle spindles are stimulated, and in this manner independent stretch reflexes are produced in these muscles. This mechanism is responsible for the phenomenon of multiple stretch reflexes. The thorax and pelvis play important roles in the contralateral responses by transmitting these mechanical events across …

Nutritional Support Of The Brain Injured Patient: Five Years Of Clinical Study In Perspective, Diana L. Twyman, Brack A. Bivins

Henry Ford Hospital Medical Journal

No abstract provided.

High-Frequency Ventilation: Current Status, John Popovich Jr.

Henry Ford Hospital Medical Journal

No abstract provided.

Back Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Muscle Pathology In Total Knee Replacement For Severe Osteoarthritis: A Histochemical And Morphometric Study, Mark A. Glasberg, Janet R. Glasberg, Richard E. Jones

Henry Ford Hospital Medical Journal

We evaluated a series of 12 biopsies from 11 patients with total knee replacements for severe osteoarthritis. All 12 biopsies showed denervation atrophy, while five cases had significant myopathic changes. Morphometric studies indicated a positive atrophy factor (greater than 150) in the type I myofibers in seven cases, the IIA myofibers in nine cases, and the IIB myofibers in all 12 cases. Type I predominance occurred in six cases, IIA paucity in two cases, and IIB paucity in two cases. The results indicate that patients with severe osteoarthritis of the knee have both significant neuropathic and myopathic changes in quadriceps …

Catamenial Hemoptysis: A Case Report, Paul S. Harkaway, Michael S. Eichenhorn

Henry Ford Hospital Medical Journal

A young woman presented with recurrent hemoptysis temporally associated with menstruation. Catamenial hemoptysis, an extremely uncommon disorder, is usually caused by the presence of ectopic endometrial tissue within the lung. The use of progesterone suppressed menstruation and hemoptysis during four months of treatment. Chest x-ray was normal.

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Science Or Technology: A Challenge For Clinical Neurosciences, Stanton B. Elias

Henry Ford Hospital Medical Journal

No abstract provided.

Interventional Neuroradiology: Henry Ford Hospital Experience With Transcatheter Embolization Of Vascular Lesions In The Head, Neck, And Spine, Bharat A. Mehta, Clifford R. Jack Jr., Roushdy S. Boulos, Suresh C. Patel, James I. Ausman, Ghaus M. Malik

Henry Ford Hospital Medical Journal

Innovative developments over the past 15 years have resulted in increased sophistication and effectiveness of therapeutic neuroembolization procedures. As a result, percutaneous transcatheter embolization has assumed an increasingly important role in the management of patients with vascular lesions of the head, neck, and spine. By reducing bleeding during surgery, this technique can markedly facilitate the surgical approach to difficult vascular lesions. The technique may also be applied in cases where surgery is contraindicated. Therapeutic neuroembolization has been performed in 23 patients with vascular lesions of the head, neck, or spine at Henry Ford Hospital. Devascularization of the extraaxial blood supply …

The Effect Of Sta-Mca Bypass On Regional Cerebral Blood Flow In Ischemic Foci, Wendy M. Robertson, K. M. A. Welch, James R. Ewing, James I. Ausman, Fernando G. Diaz

Henry Ford Hospital Medical Journal

The effect of STA-MCA bypass on regional cerebral bloodflow (rCBF) is unclear Since asymmetries of rCBF have previously been shown to identify the focus of maximal cerebral ischemia, a study was performed to assess the effects of surgical revascularization on rCBF in this focus. Sixteen candidates for STA-MCA bypass were studied preoperatively and postoperatively. The rCBF vms measured by the '"Xenon inhalation technique with eight contralateral probe pairs. The probe pair with the maximal percentage difference in initial slope index (ISI) was identified and corresponded to the clinically involved hemisphere in 14 patients. Following surgery, the ISI increased in the …

Psychocardiologic Perspectives Of Coronary Artery Disease, Richard Ketai

Henry Ford Hospital Medical Journal

The importance of mind, emotion, and behavior as they relate to the heart, particularly coronary artery disease, is growing in recognition. A review of the research shows increasingly sophisticated demonstrations of links unifying heart function and mind. "Psychocardiology" would be an appropriate term for the diverse areas of interest which focus on the psychosocial correlates of heart disease. This paper illustrates this concept through a review of psychosocial and behavioral aspects of coronary artery disease.

Intussusception Of The Appendix And Endometriosis, Roberta E. Sonnino, Mohammed R. Ansari

Henry Ford Hospital Medical Journal

Intussusception of the appendix, though uncommon, is usually diagnosed during surgery. Endometriosis in an intussuscepted appendix is rarely described. A case of appendiceal intussusception of a rare morphologic type associated with endometriosis is presented, and the literature is briefly reviewed. Etiology, classification, and diagnosis are discussed.