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Back Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Assessment Of The Orifice Area Of Bioprosthetic Valves By Orifice-View Roentgenography, Paul D. Stein, James F. Brymer, Daniel T. Anbe, Hani N. Sabbah, Gordon M. Folger Jr.

Henry Ford Hospital Medical Journal

Orifice-view angiography permits us to visualize en face the orifice of the aortic or mitral valve. The radiopaque annulus of bioprosthetic valves assists in permitting the angiographer to position the patient exactly, so that the valve can be seen as if looking directly into the orifice. Orifice-view angiography of porcine bioprosthetic valves has been useful in assessing the size and configuration of the valve orifice. It can reveal a failure of leaflet opening that would indicate degeneration, even when hemodynamic measurements remain equivocal.

Natural History Of The Porcine Bioprosthetic Heart Valve, Donald J. Magilligan Jr., Joseph W. Lewis Jr., J. Lancelot Lester Iii, Paul D. Stein, Mohsin Alam, Jeffrey B. Lakier, Julio C. Davilia, David W. Smith

Henry Ford Hospital Medical Journal

The porcine bioprosthesis has been the prosthetic valve of choice at Henry Ford Hospital since October 1971. By 1979, 23 cases of degeneration had been seen, and the rate seven years after implantation was 16%. Now, with a ten-year follow-up, there are 41 degenerated valves. After seven years, the percent free of degeneration is 88%, (SE of 2% [standard error]); at eight years, 82% (SE of 2.9%,); at nine years, 80% (SE of 3.4%); and at ten years, the percent free of degeneration is 69% (SE of 6.5%,). There was no difference in degeneration between men and women, between aortic …

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Studies On Porcine Bioprosthetic Heart Valves At Henry Ford Hospital: An Overview, Paul D. Stein

Henry Ford Hospital Medical Journal

No abstract provided.

Frequency Content Of Heart Sounds And Systolic Murmurs In Patients With Porcine Bioprosthetic Valves: Diagnostic Value For The Early Detection Of Valvular Degeneration, Paul D. Stein, Hani N. Sabbah, Jeffrey B. Lakier, Stephen R. Kemp, Donald J. Magilligan Jr.

Henry Ford Hospital Medical Journal

The frequency content of heart sounds and murmurs in patients with implanted bioprosthetic valves may reveal evidence of degenerative changes before such changes are clinically apparent. An increased dominant frequency of the heart sound caused by a bioprosthetic valve in either the aortic or mitral positions suggests stiffening of the leaflets. While a musical systolic murmur of a bioprosthetic valve in the mitral position suggests flutter from a torn, insufficient leaflet, limited observations of musical systolic murmurs in the aortic position do not seem to indicate a degenerated valve.

Fluid Dynamic Stresses In The Region Of A Porcine Bioprosthetic Valve, Hani N. Sabbah, Paul D. Stein

Henry Ford Hospital Medical Journal

Mechanical forces caused by the dynamics of blood flow in the region of porcine bioprosthetic valves may directly injure the valve as well as formed elements of the blood. Previous in vitro studies in our laboratory evaluated quantitatively the fluid dynamic stresses in the region of such valves. In this paper we discuss our results in relation to fluid dynamic stresses found in patients with normal and diseased natural aortic valves. The levels of fluid dynamic stresses that may produce mechanical injury to erythrocytes and platelets are reviewed. These may indicate the extent to which fluid dynamic stresses may activate …

Immunological Involvement In Porcine Bioprosthetic Valve Degeneration: Preliminary Studies, Rollin H. Heinzerling, Paul D. Stein, Jeanne M. Riddle, Donald J. Magilligan Jr., John J. Jennings

Henry Ford Hospital Medical Journal

Preliminary animal model studies have indicated that porcine bioprosthetic valves can be recognized by the immune system. This report presents the results of a preliminary investigation on the implanted valves of 27 patients. While none of the 27 demonstrated an immune response to porcine serum proteins, five patients developed antibodies against the implanted valve leaflets. Cells were enzymatically eluted from a degenerated bioprosthetic valve and were classified by means of monoclonal antibodies. Although these cells were not found to be of T-lymphocyte lineage, they did express la determinants and had the morphologic appearance of plasma cells. We therefore conclude that …

Clinical Note: Use Of Clonidine To Detoxify Opiate-Addicted Patients, Dennis L. Caffrey, Tai P. Yoo

Henry Ford Hospital Medical Journal

This study investigated the utility of systematically administering clonidine to detoxify opiate-dependent inpatients. Fifteen patients received a 0.1 mg dose of clonidine orally at 8:00 am, 12:00 noon, 4:00 pm, and at bedtime. A 0.1 mg dose was also administered as needed if any withdrawal signs were evidenced, but this additional dose was rarely needed after the second day of treatment. Night sweats were the only significant complaint reported. All 15 patients were successfully detoxified after ten days of treatment.

Growing Old In Changing Micronesia, Leonard Mason

Pacific Studies

No abstract provided.

Terence E. Hays' Review Of Judith Farquhar And D. Carleton Gajdusek's Kuru: Early Letters And Field Notes From The Collection Of D. Carleton Gajdusek, Terence E. Hays

Pacific Studies

No abstract provided.

Echocardiographic Evaluation Of Porcine Bioprosthetic Valve Degeneration, M. Alam, J. B. Lakier, S. Goldstein

Henry Ford Hospital Medical Journal

Spontaneous cusp degeneration is one of the most common long-term complications associated with porcine bioprosthetic valves (1-6). Recognition of its occurrence is essential for appropriate management to be instituted. In this report we have reviewed our echocardiographic experience with porcine bioprosthetic valve degeneration (7-8).

A Morphologic Overview Of The Porcine Bioprosthetic Heart Valve, Jeanne M. Riddle, Paul D. Stein, Donald J. Magilligan Jr.

Henry Ford Hospital Medical Journal

The glutaraldehyde-processed porcine aortic heart valve is similar in its microscopic organization to the human aortic valve (1). It is important to understand the detailed histology of this bioprosthetic valve because distinct components of its leaflets are altered selectively when the valve is initially collected from the pig and stabilized with the commercial glutaraldehyde fixation process. Further structural modifications also occur after the commercially processed valve has been inserted into a patient where it undergoes progressive degeneration.

Observations Suggesting A Possible Link Between Gammacarboxyglutamic Acid And Porcine Bioprosthetic Valve Calcification, Joseph A. Helpern, Stephen J. Mcgee, Jeanne M. Riddle

Henry Ford Hospital Medical Journal

Observations that link gammacarboxyglutamic acid (Gla) peptides with ectopic calcification are accumulating in the literature and may be summarized as follows: 1) Gla peptides selectively bind calcium and hydroxyapatite. 2) The presence of detectable levels of Gla in calcified tissue is concurrent with the onset of mineralization. 3) In an animal model, osteocalcin (a Gla-containing protein) accounts for more than 90% of all the Gla found in the resulting subcutaneously implanted calcified leaflet. 4) Vitamin D stimulates osteocalcin synthesis in cultures of osteosarcoma cells, and in vitamin D deficient rats subcutaneously implanted valve leaflets are not calcified. 5) Gla content …

The Surgeon And The Patient With Cancer: The Development Of Surgical Oncology, Angelos A. Kambouris

Henry Ford Hospital Medical Journal

No abstract provided.

Effects Of Tetracycline On Fecal Bile Acid Pool Composition In A Human: A Preliminary Report, Jerome R. Waldbaum, William T. Beher, Robert J. Priest, Sofia Stradnieks

Henry Ford Hospital Medical Journal

We studied the effect of tetracycline on bile acid pool composition in a human subject. A dosage of 250 mg (qid) of tetracycline for one week completely eliminated deoxycholic and lithocholic acid from the pool. Tetracycline may be of value for limiting the build-up of lithocholic acid in patients who are treated with chenodeoxycholic acid to dissolve gallstones.

Medical Grand Rounds: Open And Closed Loop Insulin Delivery Systems In Diabetes: Current Status, F. John Service

Henry Ford Hospital Medical Journal

No abstract provided.

Editorials

Henry Ford Hospital Medical Journal

No abstract provided.

Commencement Program 1982 (Summer Conferring Of Degrees), Loma Linda University

Commencement Programs

CONTENTS

3 | The Academic Procession

4 | Conferring of Degrees

6 | Candidates for Degrees

13 | Awards

Evaluation Of The Urban Indian Health Program's Management And Administrative Capabilities And Training Conference To Reinforce Desirable Management And Administrative Techniques, American Indian Health Care Association

Native Health Database Full Text

A study was conducted to evaluate the management and administration of urban Indian health programs by the Urban Program Branch at the Indian Health Service (IHS). In order to do this, an assessment was made of the ability of the Urban Program Office and the IHS Area Offices to successfully carry out their duties and responsibilities to the urban Indian health programs; and the ability of the individual urban Indian health programs to meet their IHS contract and grant obligations.

Medullary Carcinoma Of The Thyroid With Bone Metastasis, Sheldon S. Stoffer, Sidney D. Kobernick, Richard M. Zirkin, Stuart W. Hamburger, Susan E. Harold

Henry Ford Hospital Medical Journal

A woman with medullary carcinoma of the thyroid and a past history of breast cancer was found to have metastatic bone lesions. It was initially assumed that this was due to recurrent breast carcinoma, but bone biopsy revealed medullary carcinoma of thyroid origin. Although clinical bone metastasis is a rare event in patients with medullary carcinoma, quite clearly such an occurrence is possible. Medullary carcinoma should be considered in the differential diagnosis of patients with metastatic bone lesions.

Hemoptysis Complicating Mitral Stenosis: Case Report With Attention To Differential Diagnosis And A Review Of The Literature, Michael S. Eichenhorn, John Popovich Jr., Jan R. Radke

Henry Ford Hospital Medical Journal

The differential diagnosis of hemoptysis in patients with mitral stenosis includes many primary pulmonary problems besides those peculiar to mitral stenosis. We describe the case of a 40-year-old woman with a 40-pack-year smoking history whose presenting symptom of hemoptysis was wrongly ascribed to pulmonary embolus and infarction, based on a presumably positive angiogram, and to chronic bronchitis, based on endoscopic findings at fiberoptic bronchoscopy, as provided by the referring physician. The features differentiating between cardiac and primary pulmonary disease are described, and the pathophysiology of hemoptysis in mitral stenosis is reviewed. In a case like the one we describe, hemoptysis …

Isoenzyme Update: Creatine Kinase And Lactate Dehydrogenase, Craig C. Foreback

Henry Ford Hospital Medical Journal

Creatine kinase (CK) and lactate dehydrogenase (LD) are isoenzymes that have been measured in clinical laboratories for over 20 years; their separation has proved valuable in the diagnosis of myocardial infarction and other cardiac-related diseases. Although, historically, electrophoresis was the preferred method to measure both isoenzymes, there has been controversy over the best method for separating the CK isoenzyme. lon exchange chromatography has been used successfully to isolate CK isoenzymes, and the procedure was adapted to determine CK-MB activity in serum. New methods to quantify CK-MB have also been tested, including an automated column technique, the immunoinhibidon/ immunoprecipitadon technique, and …

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Familial Hypokalemic Periodic Paralysis In Blacks, Jack M. Bernstein, Michael Kleerekoper

Henry Ford Hospital Medical Journal

Hypokalemic periodic paralysis is an uncommon disease that has rarely been reported in blacks. Historical, clinical, and pathological findings in three black patients, in addition to those previously reported in the literature, suggest that the spectrum of the disease is identical in both blacks and whites. Considering the disease as either different or unknown in the black population is probably not justified.

Chronic Idiopathic Thrombocytopenic Purpura: Effective Preoperative Preparation And Long-Term Results Of Splenectomy, James C. Gruenberg, Melvin A. Block, Ellis J. Van Slyck, Joseph P. Abraham

Henry Ford Hospital Medical Journal

A retrospective review of 98 patients seen at Henry Ford Hospital from 1953 through 1977 demonstrated that splenectomy for chronic idiopathic thrombocytopenic purpura provided a good response which usually was sustained on long-term follow-up (72% at 15 years). Although splenectomy for this condition had a low mortality, morbidity was significant in patients older than 40 years. When compared to patients whose response to splenectomy was sustained, patients who relapsed had significantly lower platelet counts preoperatively both when they were untreated (mean: 9,194 per cc versus 18,524 per-cc) and/or when they were treated with steroids (mean: 85,647 per cc versus 142,590 …

Effect Of Levamisole On The Incidence Of Spontaneous Mammary Tumors In C3h Mice, Robert H. Page, Duilio A. Valdivia, Robert W. Talley, Robert A. Huseby

Henry Ford Hospital Medical Journal

Spontaneous mammary carcinoma in C3H mice is preceded by premalignant hyperplastic alveolar nodules. When a primary tumor is evident, examination of the other mammae will reveal a number of microscopic precancerous lesions in various stages of transformation to overt malignant tumors. In an effort to inhibit the development of additional malignant tumors after surgical removal of the first apparent tumor, we treated female C3H/HeJ mice with subcutaneous injections of levamisole (0.6 mg per kg of body weight) on a twice weekly regimen. All further tumors were surgically excised when they became palpable. The surgical excision of bulk tumor burden, immunorestoration …

Acid Phosphatase: Clinical Utility Of The First Tumor Marker, Christopher J. Dipaolo, Jan Rival

Henry Ford Hospital Medical Journal

Acid phosphatase was the first tumor marker to be measured in blood. Although it is used as a marker of prostatic carcinoma, serum levels are also elevated in many diseases of prostate, bone, and hematologic tissue. While serum acid phosphatase concentration is elevated in patients with prostatic carcinoma or infarction, it may also be increased merely with benign hypertrophy and after prostate massage. Recent studies demonstrate that levels are not significantly increased after routine rectal examination. Although of limited use as a screening test, the assay may be useful in staging, prognostication during hormonal therapy, and in making clinical decisions. …

The Central Surgical Association Turns Forty: Some Highlights Of The First Twenty Years, Conrad R. Lam

Henry Ford Hospital Medical Journal

The Central Surgical Association assembled for the first time in Detroit and Ann Arbor, Michigan in February, 1941. On the 40th anniversary of this meeting, the Association met again in the same geographical region, in Dearborn. Selected papers from the first twenty years have been chosen as highlights. Criteria for choosing a few from many significant papers were the originality of the material, its time-proven value, and the subsequent impressive careers of the authors. Appropriate credit is given to Dr. Roy D. McClure for his concept of an organizadon of surgeons in the central geographical area and for his efficient …

Compression Of The Duodenum By The Root Of The Mesentery, Peter A. Haas, Jawaid Akhtar, Lester Kobylak

Henry Ford Hospital Medical Journal

Compression of the duodenum by the root of the mesentery is a rare pathological entity that has caused much controversy because it has been mistakenly identified as the "superior mesenteric artery syndrome" or the "vascular compression of the duodenum." We discuss the pathological anatomy and the diagnosis of the disease, and report an illustrative case. Some authors report many cases of the syndrome, while others doubt its existence. Before surgery is considered, the diagnosis should be established beyond doubt and a prolonged period of observation, medical treatment, and nutritional support should be provided. The barium contrast swallowing test combined with …