30 results on '"Pamela Hartzband"'
Search Results
2. Combined molecular and histologic end points inform cancer risk estimates for thyroid nodules classified as atypia of undetermined significance
- Author
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Paul A. VanderLaan, James V. Hennessey, Allison M. Onken, Pamela Hartzband, and Michiya Nishino
- Subjects
Thyroid nodules ,Cancer Research ,Pathology ,medicine.medical_specialty ,Biopsy, Fine-Needle ,medicine.disease_cause ,Malignancy ,Pathology and Forensic Medicine ,Adenocarcinoma, Follicular ,Atypia ,medicine ,Humans ,Thyroid Neoplasms ,Thyroid Nodule ,Thyroid neoplasm ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Thyroid ,Cancer ,medicine.disease ,Carcinoma, Papillary ,medicine.anatomical_structure ,Fine-needle aspiration ,Oncology ,Cytopathology ,Radiology ,Cancer risk ,business - Abstract
Background Thyroid nodules classified as atypia of uncertain significance (AUS) on fine-needle aspiration cytology are heterogeneous. Prior studies reported a higher risk of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)/cancer among AUS nodules that had cytologic (AUS-C) versus architectural (AUS-A) atypia; however, such studies were generally confined to resected cohorts, introducing bias into risk calculations. The authors hypothesized that combined histologic and molecular end points would permit clinically meaningful calculations of NIFTP/malignancy risk among AUS nodules. Methods The study consisted of 279 thyroid nodules classified as AUS on initial fine-needle aspiration and tested by the Afirma Gene Expression Classifier (GEC) between June 2013 and October 2017. Results of GEC testing and histopathologic diagnoses were stratified by AUS classifiers. The AUS-A category was further subclassified as 1) hypocellular microfollicular or 2) cellular with mixed but predominantly microfollicular architecture. NIFTP/cancer risk was calculated for each subgroup, with the inclusion of unresected nodules that had benign GEC results as low-risk end points comparable to histologically benign nodules. Results When only histologic end points were considered, there was no difference in NIFTP/cancer risk (25% vs 23%; P = .82). By using molecular and histologic end points, AUS cases with cytologic atypia trended toward higher NIFTP/cancer risk than AUS-A cases (14% vs 6%; P = .06). Furthermore, AUS-A cases showed a trend toward lower NIFTP/cancer risk for hypocellular microfollicular aspirates (3%) compared with cellular samples that had mixed/predominantly microfollicular architecture (13%; P = .18). Conclusions The inclusion of unresected benign GEC nodules in risk-of-malignancy calculations provides more accurate results, which may be helpful for informing patient management as well as quality improvement in the cytopathology laboratory.
- Published
- 2021
3. Repeat Fine Needle Aspiration Cytology Refines the Selection of Thyroid Nodules for Afirma Gene Expression Classifier Testing
- Author
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Pamela Hartzband, James V. Hennessey, Per-Olof Hasselgren, Roselyn Cristelle Isidro Mateo, Michiya Nishino, Amanda F. Elliott, Changyu Shen, Anna Z. Feldman, Helen H. Wang, and Holly Kilim
- Subjects
Adult ,Male ,Thyroid nodules ,Pathology ,medicine.medical_specialty ,Cytodiagnosis ,Endocrinology, Diabetes and Metabolism ,Biopsy, Fine-Needle ,Clinical Decision-Making ,030209 endocrinology & metabolism ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Fine needle aspiration cytology ,Cytology ,Adenocarcinoma, Follicular ,medicine ,Humans ,Genetic Testing ,Thyroid Nodule ,Thyroid cancer ,Selection (genetic algorithm) ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Cancer ,Thyroid Cancer and Nodules ,Middle Aged ,medicine.disease ,Gene Expression Regulation, Neoplastic ,Adenocarcinoma, Papillary ,Treatment Outcome ,Fine-needle aspiration ,030220 oncology & carcinogenesis ,Female ,business ,Indeterminate - Abstract
Background: Molecular testing (MT) refines risk stratification for thyroid nodules that are indeterminate for cancer by fine needle aspiration (FNA) cytology. Criteria for selecting nodules for MT vary and remain largely untested, raising questions about the best strategy for maximizing the usefulness of MT while minimizing the harms of overtesting. We used a unique data set to examine the effects of repeat FNA cytology-based criteria for MT on management decisions and nodule outcomes. Methods: This was a study of adults (age 25–90 years; 281 women and 72 men) with cytologically indeterminate (Bethesda III/IV) thyroid nodules who underwent repeat FNA biopsy and Afirma Gene Expression Classifier (GEC) testing (N = 363 nodules from 353 patients) between June 2013 and October 2017 at a single institution, with follow-up data collected until December 2019. Subgroup analysis was performed based on classification of repeat FNA cytology. Outcomes of GEC testing, clinical/sonographic surveillance of unresected nodules, and histopathologic diagnoses of thyroidectomies were compared between three testing approaches: (i) Reflex (MT sent on the basis of the initial Bethesda III/IV FNA), (ii) SemiRestrictive (MT sent if repeat FNA is Bethesda I–IV), and (iii) Restrictive (MT sent only if repeat FNA is Bethesda III/IV) testing approaches. Results: Restricting MT to nodules that remain Bethesda III/IV on repeat FNA would have missed 4 low-risk cancers and 3 noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) (collectively 2% of the test population) but would have avoided diagnostic surgery for 42 benign nodules (12% of the test population). The Restrictive testing strategy was more specific (delta 0.126 confidence interval [CI 0.093 to 0.159] and 0.129 [CI 0.097 to 0.161], respectively) but less sensitive (delta −0.339 [CI −0.424 to −0.253] and −0.340 [CI −0.425 to −0.255], respectively) than the Reflex and SemiRestrictive approaches for detecting NIFTP or cancer. Conclusions: Repeat FNA cytology can guide the selection of cytologically indeterminate thyroid nodules that warrant MT. The Restrictive model of performing Afirma GEC only on nodules with two separate biopsies showing Bethesda III/IV cytology would reduce the rate of diagnostic surgery for histologically benign nodules while missing only rare low-risk tumors. Given the low but nontrivial risks of thyroidectomy, the higher specificity of the Restrictive testing approach disproportionately outweighs the potential harms.
- Published
- 2021
4. Physician Burnout, Interrupted
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Jerome E. Groopman and Pamela Hartzband
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Physician burnout ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,media_common.quotation_subject ,Pneumonia, Viral ,030204 cardiovascular system & hematology ,Burnout ,Personal autonomy ,Competence (law) ,03 medical and health sciences ,Professional Competence ,0302 clinical medicine ,Nursing ,Physicians ,Humans ,Medicine ,030212 general & internal medicine ,Burnout, Professional ,Pandemics ,media_common ,Motivation ,Salaries and Fringe Benefits ,business.industry ,COVID-19 ,General Medicine ,United States ,Health Care Reform ,Personal Autonomy ,Health care reform ,Coronavirus Infections ,business ,Autonomy - Abstract
Physician Burnout, Interrupted The burnout problem won’t be solved without addressing the issues of autonomy, competence, and relatedness. During the Covid-19 pandemic, a sense of altruism and urge...
- Published
- 2020
- Full Text
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5. Postoperative Management After Pituitary Surgery
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Pamela Hartzband and Anna Z. Feldman
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Transsphenoidal surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Perioperative ,medicine.disease ,Postoperative management ,Surgery ,Diabetes insipidus ,Medicine ,business ,Pituitary surgery ,Hormone ,Hydrocortisone ,medicine.drug ,Antidiuretic - Abstract
All patients should ideally be seen by an endocrinologist before admission for transsphenoidal pituitary surgery. Once admitted, hormone evaluation for cortisol status is the most important test. Depending on the preoperative cortisol adequacy, insufficiency, excess, or unknown status, perioperative and postoperative treatment with hydrocortisone is often indicated. Peri- and postoperative treatment should also include monitoring and treatment for diabetes insipidus or inappropriate secretion of antidiuretic hormone. Close monitoring of water and sodium balance is required. Finally, the patient should follow up with an endocrinologist 1–2 weeks after surgery so that pituitary hormone status can be reevaluated and proper treatment and follow-up arranged.
- Published
- 2020
6. The Power of Regret
- Author
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Jerome E. Groopman and Pamela Hartzband
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Male ,Medical curriculum ,Decision Making ,Emotions ,education ,MEDLINE ,Power (social and political) ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Nursing ,Humans ,Medicine ,030212 general & internal medicine ,Patient participation ,Disappointment ,030219 obstetrics & reproductive medicine ,business.industry ,Regret ,General Medicine ,Treatment Outcome ,Patient Satisfaction ,Female ,Patient Participation ,medicine.symptom ,Centrality ,business - Abstract
Despite the centrality of regret in medicine, studies have largely failed to capture its complexity and consequences. Many proposed instruments for measuring it fail to differentiate it from disappointment, and it is still largely absent from the medical curriculum.
- Published
- 2017
7. Abstract #217 Pseudohypoparathyroidism Type 1B Presenting with Minimally Symptomatic Hypocalcemia in Adulthood
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Gregory P. Westcott and Pamela Hartzband
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Pediatrics ,medicine.medical_specialty ,Endocrinology ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine ,Pseudohypoparathyroidism Type 1b ,General Medicine ,business - Published
- 2019
8. Interview with Jerome E. Groopman and Pamela Hartzband
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Pamela Hartzband, Jerome E. Groopman, and Andrea Mariani
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Psychoanalysis ,Sociology ,Quality of Life Research - Published
- 2013
9. Medical Taylorism
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Pamela Hartzband and Jerome Groopman
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Practice Guidelines as Topic ,Task Performance and Analysis ,Practice Management, Medical ,Electronic Health Records ,Humans ,General Medicine ,Efficiency, Organizational ,Delivery of Health Care - Published
- 2016
10. Abstract #806 A Case of a Dopamine Secreting Paraganglioma Undetected on Initial Urine Metanephrine and Catecholamine Testing
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Zsu-Zsu Chen and Pamela Hartzband
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medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,General Medicine ,medicine.disease ,Urine metanephrine ,Endocrinology ,Paraganglioma ,Internal medicine ,medicine ,Catecholamine ,business ,medicine.drug ,Dopamine-Secreting - Published
- 2018
11. Synchronous Parathyroid Carcinoma, Parathyroid Adenoma, and Papillary Thyroid Carcinoma in a Patient with Severe and Long-Standing Hyperparathyroidism
- Author
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James L. Connolly, Judy L. Shih, Melanie Goldfarb, Patrick O'Neal, Pamela Hartzband, and Per-Olof Hasselgren
- Subjects
Male ,Thyroid nodules ,medicine.medical_specialty ,Pathology ,endocrine system diseases ,Adenoma ,Endocrinology, Diabetes and Metabolism ,Article ,Thyroid carcinoma ,Endocrinology ,medicine ,Humans ,Thyroid Neoplasms ,Parathyroid adenoma ,Hyperparathyroidism ,business.industry ,General Medicine ,Middle Aged ,Hyperparathyroidism, Primary ,medicine.disease ,Carcinoma, Papillary ,Parathyroid Neoplasms ,Parathyroid carcinoma ,Concomitant ,Radiology ,business ,hormones, hormone substitutes, and hormone antagonists ,Primary hyperparathyroidism - Abstract
To describe a patient presenting with the rare constellation of synchronous parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma.We summarize the clinical presentation, diagnostic work-up, surgical management, and pathologic features of our patient and review the pertinent literature.The patient was a 59-year-old man who presented with severe clinical manifestations of long-standing primary hyperparathyroidism, a serum calcium concentration of 14.4 mg/dL, and a parathyroid hormone level of 2,023 pg/mL. He was found to have a 3.4-cm parathyroid carcinoma on the left side and a 3.2-cm papillary carcinoma in the right thyroid lobe. In addition, a 917-mg parathyroid adenoma was found on the right side.Synchronous parathyroid and thyroid carcinomas are extremely rare. To our knowledge, our patient is the first documented case with a parathyroid adenoma in addition to synchronous parathyroid and thyroid carcinomas. The presence of concurrent parathyroid carcinoma and parathyroid adenoma can cause diagnostic confusion and should be considered in patients presenting with severe hyperparathyroidism. Any concomitant thyroid nodules must be investigated to rule out thyroid carcinoma.
- Published
- 2009
12. There Is More to Life Than Death
- Author
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Jerome E. Groopman and Pamela Hartzband
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Adult ,Male ,medicine.medical_specialty ,business.industry ,Prostatic Neoplasms ,Breast Neoplasms ,General Medicine ,Middle Aged ,Prostate-Specific Antigen ,Risk Assessment ,Outcome (game theory) ,Decision Support Techniques ,Death ,Quality of Life ,Key (cryptography) ,Humans ,Medicine ,False Positive Reactions ,Female ,business ,Intensive care medicine ,Early Detection of Cancer ,Mammography ,Decision analysis - Abstract
In classic medical decision analysis, when outcomes are uncertain and risk is involved, the “best” choice is the one with the “highest expected utility.” The outcome usually measured is death, which is readily determined and quantified. But what of other key outcomes?
- Published
- 2012
13. Money and the Changing Culture of Medicine
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Pamela Hartzband and Jerome E. Groopman
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Career Choice ,Attitude of Health Personnel ,business.industry ,media_common.quotation_subject ,Culture ,Health Care Costs ,General Medicine ,Monetary economics ,United States ,Economics, Medical ,Monetary value ,Physicians ,Humans ,Medicine ,Quality (business) ,business ,Productivity ,media_common - Abstract
Drs. Pamela Hartzband and Jerome Groopman argue that assigning a monetary value to every aspect of a physician's time and effort may actually reduce productivity, impair the quality of performance, and thereby even increase costs.
- Published
- 2009
14. Hypercalcemia in an AIDS patient treated with growth hormone
- Author
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George Sakoulas, Christine Wanke, Michelle Lally, Pamela Hartzband, and Nicholas A. Tritos
- Subjects
Adult ,Male ,medicine.medical_specialty ,Immunology ,Pamidronate ,Parathyroid hormone ,HIV Wasting Syndrome ,Gastroenterology ,Cachexia ,Immunopathology ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,Vitamin D ,Wasting ,Acquired Immunodeficiency Syndrome ,Diphosphonates ,Parathyroid hormone-related protein ,business.industry ,Metabolic disorder ,Parathyroid Hormone-Related Protein ,Proteins ,medicine.disease ,Discontinuation ,Infectious Diseases ,Endocrinology ,Parathyroid Hormone ,Growth Hormone ,Hypercalcemia ,Calcium ,medicine.symptom ,business ,Complication ,hormones, hormone substitutes, and hormone antagonists - Abstract
Method: Recombinant human growth hormone (rhGH) is a newly approved treatment for weight loss and wasting in patients with AIDS. We report a male patient with advanced AIDS who developed hypercalcemia 2 weeks after institution of rhGH therapy. Results: Parathyroid hormone, parathyroid hormone-related peptide and 1,25-dihydroxyvitamin D levels were suppressed, suggesting that hypercalcemia was mediated through alternative mechanisms. The hypercalcemia responded to discontinuation of rhGH and a single dose of intravenous pamidronate disodium and has not recurred in 8 months of follow-up. Conclusion: We believe this to be the first reported case of rhGH-induced hypercalcemia in an HIV-infected patient.
- Published
- 1997
15. Should We Treat for Subclinical Hypothyroidism?
- Author
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Pamela Hartzband, Risa B. Burns, Carol K. Bates, and Gerald W. Smetana
- Subjects
education.field_of_study ,medicine.medical_specialty ,business.industry ,Thyroid disease ,Population ,Thyroid ,030209 endocrinology & metabolism ,General Medicine ,Disease ,Guideline ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,medicine.anatomical_structure ,Internal medicine ,Internal Medicine ,medicine ,030212 general & internal medicine ,education ,business ,Intensive care medicine ,Risk assessment ,Body mass index ,Subclinical infection - Abstract
In May 2015, the U.S. Preventive Services Task Force issued a guideline on screening for thyroid disease that included a systematic evidence review and an update of its 2004 recommendations. The review assessed the effect of treating screen-detected subclinical thyroid dysfunction on health outcomes. It found adequate evidence that treating subclinical hypothyroidism does not provide clinically meaningful improvements in blood pressure, body mass index, bone mineral density, lipid levels, or quality-of-life measures. The review also concluded that evidence was inadequate to determine whether screening for thyroid dysfunction reduced cardiovascular disease or related morbidity and mortality. In separate guidelines, the American Association of Clinical Endocrinologists and American Thyroid Association advocated aggressive case-finding and recommended screening persons with certain clinical conditions or characteristics rather than the general population. These societies argue that subclinical hypothyroidism adversely affects cardiovascular outcomes and thus merits case-finding. Here, 2 experts discuss their perspectives on whether treating subclinical hypothyroidism reduces morbidity and mortality, whether there are harms of treatment, and how they would balance the benefits and harms of treatment both in general and for a specific patient.
- Published
- 2016
16. Why 'quality' care is dangerous
- Author
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Jerome, Groopman and Pamela, Hartzband
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Benchmarking ,Clinical Protocols ,Practice Guidelines as Topic ,Acrylic Resins ,Humans ,Quality Improvement ,Quality of Health Care - Published
- 2012
17. Untangling the Web--patients, doctors, and the Internet
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Jerome E. Groopman and Pamela Hartzband
- Subjects
Directories as Topic ,Internet ,Patient Access to Records ,Physician-Patient Relations ,Consumer Health Information ,business.industry ,MEDLINE ,General Medicine ,World Wide Web ,Core (graph theory) ,Medicine ,Humans ,The Internet ,business - Abstract
The Web is profoundly changing communication between doctor and patient. Drs. Pamela Hartzband and Jerome Groopman write that, nonetheless, the core relationship should not change.
- Published
- 2010
18. Keeping the patient in the equation--humanism and health care reform
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Jerome E. Groopman and Pamela Hartzband
- Subjects
Gerontology ,National health ,Evidence-Based Medicine ,Cost Control ,business.industry ,Context (language use) ,General Medicine ,Humanism ,Public administration ,Universal Health Insurance ,Health Care Reform ,Patient-Centered Care ,Medicine ,Humans ,Health care reform ,Patient Participation ,business - Abstract
Drs. Pamela Hartzband and Jerome Groopman write that two major movements, the medical humanism movement and evidence-based practice, will now play out in the context of national health care reform. Today, when it is most important for these two movements to coalesce, they are poised to collide.
- Published
- 2009
19. Off the record--avoiding the pitfalls of going electronic
- Author
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Jerome E. Groopman and Pamela Hartzband
- Subjects
Medical Records Systems, Computerized ,business.industry ,Electronic medical record ,MEDLINE ,Workload ,General Medicine ,Documentation ,World Wide Web ,User-Computer Interface ,Electronic records ,Patient information ,Medicine ,Humans ,Electronics ,business - Abstract
The ultimate goal of the electronic medical record is to make all patient information immediately accessible and easily transferable and to allow its essential elements to be held by both physician and patient. Drs. Pamela Hartzband and Jerome Groopman write that before blindly embracing electronic records, we should consider their current limitations and potential downsides.
- Published
- 2008
20. Uncommon presentations of some common malignancies: Case 1. Sequential paraneoplastic endocrine syndromes in small-cell lung cancer
- Author
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Olivier Kocher, Stuart M. Berman, Aaron M. Cypess, Mark S. Huberman, Stephen A. Mayer, Balazs Halmos, and Pamela Hartzband
- Subjects
Male ,Cancer Research ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,business.industry ,Respiratory disease ,Prostatic Neoplasms ,Neoplasms, Second Primary ,medicine.disease ,Malignancy ,Inappropriate ADH Syndrome ,ACTH Syndrome, Ectopic ,Oncology ,Lung disease ,Paraneoplastic Endocrine Syndromes ,Carcinoma ,Medicine ,Humans ,Non small cell ,Carcinoma, Small Cell ,business ,Lung cancer ,Aged - Published
- 2005
21. Is there a therapeutic role for octreotide in patients with ectopic Cushing's syndrome?
- Author
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Lynnette K. Nieman, Karel Pacak, Boaz Hirshberg, Pamela Hartzband, Clara C. Chen, Gabriel I. Uwaifo, and Christian A. Koch
- Subjects
Adult ,Male ,endocrine system ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,Hydrocortisone ,Endocrinology, Diabetes and Metabolism ,Somatostatin Analog Therapy ,Octreotide ,Adrenocorticotropic hormone ,Neuroendocrine tumors ,Scintigraphy ,Gastroenterology ,Cushing syndrome ,Endocrinology ,Hormone Antagonists ,Adrenocorticotropic Hormone ,Internal medicine ,medicine ,Humans ,Radionuclide Imaging ,Cushing Syndrome ,medicine.diagnostic_test ,Somatostatin receptor ,business.industry ,medicine.disease ,Somatostatin ,Radiopharmaceuticals ,business ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
Cushing's syndrome (CS) due to ectopic ACTH secretion (EAS) has a high morbidity and mortality, because of the underlying tumor and the sequelae of severe hypercortisolemia. Therefore, rapid treatment of ectopic CS is mandatory. Scintigraphy shows that up to 80% of ectopic ACTH-producing tumors have somatostatin receptors. While this suggests that somatostatin analogs may reduce ACTH production and treat patients with EAS, the therapeutic role of these agents is still evolving. Here we demonstrate the spectrum of responses to octreotide therapy in 3 patients with EAS. Diagnostic imaging with the 111In-pentetreotide scan did not predict the therapeutic response to octreotide. Two patients with positive somatostatin receptor scintigraphy failed to respond to octreotide, while one with a negative scan reached eucortisolemia on a maintenance dose of 75 microg octreotide twice daily or octreotide LAR 30 mg per month. We conclude that octreotide is not a first line agent to control hypercortisolemia but may be a useful agent when other inhibitors of steroidogenesis fail or parenteral administration is required. Before therapy an octreotide challenge test may predict therapeutic response. Cortisol levels should be monitored regularly on somatostatin analog therapy, because of its unpredictable long-term pharmacodynamic profile.
- Published
- 2003
22. The New Language of Medicine
- Author
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Jerome E. Groopman and Pamela Hartzband
- Subjects
medicine.medical_specialty ,Vocabulary ,Medical education ,Evidence-Based Medicine ,business.industry ,media_common.quotation_subject ,Commerce ,Alternative medicine ,MEDLINE ,Obstetrics and Gynecology ,General Medicine ,Evidence-based medicine ,Constructed language ,Professional Role ,Family medicine ,Terminology as Topic ,Humans ,Medicine ,sense organs ,business ,Set (psychology) ,media_common ,Language - Abstract
In the new language of medicine, patients are “customers” or “consumers”; doctors and nurses are “providers.” The words we use to explain our roles set expectations and shape behavior. This change in the language of medicine has important and deleterious consequences.
- Published
- 2012
23. Rapid improvement of osteoporosis following parathyroidectomy in a premenopausal woman with acute primary hyperparathyroidism
- Author
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Pamela Hartzband and Nicholas A. Tritos
- Subjects
musculoskeletal diseases ,Parathyroidectomy ,Adult ,medicine.medical_specialty ,endocrine system diseases ,Bone disease ,medicine.medical_treatment ,Osteoporosis ,Lumbar vertebrae ,Bone Density ,Internal Medicine ,medicine ,Humans ,Bone mineral ,Hyperparathyroidism ,business.industry ,medicine.disease ,Symptomatic relief ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Premenopause ,Acute Disease ,Female ,business ,Primary hyperparathyroidism - Abstract
We describe a premenopausal white woman with symptomatic acute primary hyperparathyroidism and marked osteoporosis. After undergoing a parathyroidectomy, the patient experienced not only rapid symptomatic relief, but also marked improvement in bone mineral density, which increased by 25% in the hip and by 22% in the lumbar spine 1 year after the surgery. Acute primary hyperparathyroidism should be considered in any patient with severe symptomatic hypercalcemia. Appropriate treatment with early parathyroidectomy can result in significant and rapid improvement in bone mineral density.
- Published
- 1999
24. Hypothyroidism in Two Patients after Hepatic Arterial Chemoembolization
- Author
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Keith Stuart, Nicholas A. Tritos, and Pamela Hartzband
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Thyroid ,MEDLINE ,General Medicine ,medicine.disease ,Gastroenterology ,medicine.anatomical_structure ,Thyroid-stimulating hormone ,Thyroid hormones ,Internal medicine ,Internal Medicine ,medicine ,biology.protein ,Adenocarcinoma ,Antibody ,business - Published
- 2001
25. Antibody seronegative human T-lymphotropic virus type III (HTLV-III)- infected patients with acquired immunodeficiency syndrome or related disorders
- Author
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M. G. Sarngadharan, Lawrence N. Shulman, Myron Essex, Saira Salahuddin, Robert C. Gallo, Pamela Hartzband, MF McLane, and Jerome E. Groopman
- Subjects
viruses ,Immunology ,Biochemistry ,Virus ,Antigen ,Acquired immunodeficiency syndrome (AIDS) ,immune system diseases ,hemic and lymphatic diseases ,Medicine ,Arc (protein) ,Leukopenia ,biology ,business.industry ,Viral culture ,virus diseases ,Cell Biology ,Hematology ,biology.organism_classification ,medicine.disease ,Virology ,Deltaretrovirus ,biology.protein ,Antibody ,medicine.symptom ,business - Abstract
The human T-lymphotropic virus type III (HTLV-III) is the primary cause of the acquired immunodeficiency syndrome (AIDS) and related disorders (ARC). Prior studies have reported that nearly all symptomatic patients with AIDS or ARC manifest antibody to HTLV-III. This observation has engendered efforts to screen for HTLV-III, especially prior to blood donation, with assays for antibody to HTLV-III. We report the first two cases, one with AIDS and one with ARC, that are HTLV-III virus positive but antibody negative. Accurate diagnosis of HTLV-III infection in some cases may require direct virus culture or tests for antigen. In addition, lack of HTLV-III antibody may indicate an atypical clinical course of AIDS.
- Published
- 1985
26. Histological characterization of a lingual mass using thyroglobulin immunoperoxidase staining
- Author
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D. L. Diehl, A. J. Van Kerle, Pamela Hartzband, and K. J. Lewin
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Adult ,Calcitonin ,endocrine system ,Pathology ,medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Thyroid Gland ,Thyroglobulin ,Tongue Diseases ,Immunoenzyme Techniques ,Endocrinology ,Tongue ,stomatognathic system ,Humans ,Medicine ,Immunoperoxidase Staining ,Pathological ,Ectopic thyroid ,Salivary gland ,business.industry ,Thyroid ,Salivary Gland Neoplasms ,stomatognathic diseases ,medicine.anatomical_structure ,Female ,business - Abstract
We report a patient with a lingual mass clinically diagnosed as lingual thyroid. Due to marked distortion of the normal thyroidal architecture from prior 131I therapy, pathological examination of the mass was consistent with a mixed salivary gland tumor. Immunoperoxidase staining for thyroglobulin was utilized to correctly characterize the lingual mass as ectopic thyroid.
- Published
- 1984
27. A unique growth factor in patients with acromegaloidism
- Author
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David W. Golde, Andre J. Van Herle, Noelle Bersch, Michael W. Ashcraft, and Pamela Hartzband
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Adult ,Male ,medicine.medical_specialty ,Erythrocytes ,Adolescent ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Clinical Biochemistry ,Dwarfism ,Biology ,Fibroblast growth factor ,Biochemistry ,Endocrinology ,Epidermal growth factor ,Internal medicine ,Acromegaly ,medicine ,Humans ,Growth Substances ,Erythroid Precursor Cells ,Growth factor ,Biochemistry (medical) ,Syndrome ,Middle Aged ,medicine.disease ,Hematopoietic Stem Cells ,Somatomedin ,Nerve growth factor ,Female ,Cell Division - Abstract
Acromegaloidism is a syndrome characterized by features of acromegaly without biochemical evidence of excessive GH or somatomedin production. We searched for a growth factor in the serum of patients with this syndrome. Growth-promoting activity was measured by determining the stimulatory effect of whole and fractionated serum on colony formation by human erythroid progenitors in vitro. Sera from five subjects with acromegaloidism gave a mean (+/- SEM) stimulated colony growth of 211 +/- 4.0 colonies, in contrast to normal sera which yielded a mean colony growth of 100 +/- 11.0 (n = 9; P less than 0.001). When serum was chromatographed on a Sephadex G-200 column, the maximal stimulation of colony growth was found in the fractions coinciding with the descending slope of the second protein peak. Based on gel filtration chromatography, the estimated molecular weight was 70,000 daltons. Epidermal growth factor, nerve growth factor, fibroblast growth factor, and platelet-derived growth factor resulted in no substantial stimulation of colony growth under the conditions used. Although the erythroid progenitor cells of a Laron dwarf were unresponsive to 200 ng/ml human GH, they were clearly stimulated by serum from a patient with acromegaloidism. The present study describes the presence of a heretofore unidentified growth factor in the serum of subjects with acromegaloidism. This factor also stimulated the erythroid precursor cells of a Laron dwarf whose cells were unresponsive to GH. The physiological role of this growth factor in normal man as well as its pathogenic role in subjects with acromegaloidism remain to be established.
- Published
- 1983
28. The treatment of hyperthyroidism
- Author
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Pamela Hartzband and David H. Solomon
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Methimazole ,Adolescent ,business.industry ,Carbimazole ,Goiter ,General Medicine ,Lithium ,Hyperthyroidism ,Propranolol ,Graves Disease ,Iodine Radioisotopes ,Antithyroid Agents ,Pregnancy ,Propylthiouracil ,medicine ,Thyroidectomy ,Humans ,Female ,business ,Child ,Iodine - Published
- 1981
29. Assessment of hypothalamic-pituitary-adrenal (HPA) axis dysfunction: comparison of ACTH stimulation, insulin-hypoglycemia and metyrapone
- Author
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D. Cope, A. J. Van Herle, L. Sorger, and Pamela Hartzband
- Subjects
Adult ,Blood Glucose ,Male ,endocrine system ,medicine.medical_specialty ,Hydrocortisone ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Pituitary Diseases ,Cortodoxone ,Adrenocorticotropic hormone ,Basal (phylogenetics) ,chemistry.chemical_compound ,Endocrinology ,Dehydroepiandrosterone sulfate ,Adrenocorticotropic Hormone ,Prednisone ,Adrenal Cortex Hormones ,Internal medicine ,medicine ,Humans ,Insulin ,Acth stimulation ,Aldosterone ,Aged ,Metyrapone ,business.industry ,Dehydroepiandrosterone Sulfate ,Dehydroepiandrosterone ,Middle Aged ,chemistry ,Insulin hypoglycemia ,Female ,business ,hormones, hormone substitutes, and hormone antagonists ,Hypothalamic Diseases ,medicine.drug ,Adrenal Insufficiency - Abstract
The response to ACTH stimulation, insulin-hypoglycemia and metyrapone in patients with suspected HPA axis dysfunction due to corticosteroid therapy (Group I, n = 10), or pituitary surgery (Group II, n = 7) and in a control population (Group III, n = 8) was studied. Group I patients had been maintained on a stable low dose of prednisone 5.0–7.5 mg/day for 1 month-16 yr (mean = 31 mos) prior to testing. Basal 08:00 h cortisol levels in this group were not different from control values. However, the mean responses to all three testing procedures were suppressed (Group I vs III, ACTH p < 0.001, insulin p< 0.01, metyrapone p< 0.05). Group II patients had undergone surgery 1–26 months (mean = 10 mo) prior to testing and had been maintained subsequently on a stable dose of prednisone 5.0–7.5 mg/day. In this group basal mean 08:00 h cortisol and the cortisol response to ACTH and insulin-hypoglycemia were not significantly different from control values while the response to metyrapone was suppressed (Group II vs III p< 0.02). Basal serum DHEA-S levels were suppressed in both Groups I and II when compared to Group III (p< 0.001 ). Discordant responses to the three testing procedures were noted in 6 patients with suspected HPA dysfunction with abnormal test results in 1/6 using cortrosyn, 3/6 using insulin-hypoglycemia and 4/6 using metyrapone. We conclude that: (1) Low doses of prednisone cause subtle, but significant HPA axis suppression, (2) DHEA-S levels do not correlate with standard tests of the HPA axis, and (3) Although no single test identified every subject with an abnormal HPA axis, metyrapone was more useful in detecting subtle degrees of HPA dysfunction than ACTH or insulin-hypoglycemia. Metyrapone is simple, safe and may be the test of choice in assessing patients with suspected secondary adrenal insufficiency.
- Published
- 1988
30. Circular Dichroism Studies of Cyanate-Induced Conformational Changes in Hemoglobins A and S
- Author
-
Chava Chapman, John C. Whitin, Elizabeth R. Simons, and Pamela Hartzband
- Subjects
Circular dichroism ,Conformational change ,Binding Sites ,Macromolecular Substances ,Protein Conformation ,Circular Dichroism ,chemistry.chemical_element ,Cyanate ,Biochemistry ,Oxygen ,chemistry.chemical_compound ,Crystallography ,Protein structure ,chemistry ,Oxyhemoglobins ,Humans ,Hemoglobin ,Heme ,Cyanates ,Protein Binding - Abstract
Circular dichroism and difference spectroscopy have been used to study dilute aqueous solutions of oxygenated, deoxygenated, and carbamoylated deoxygenated hemoglobins A and S (HbA and HbS, respectively). The spectra of HbA and HbS, in comparable state of oxygenation or carbamoylation, are identical, strongly implying identical conformations about the heme groups of the respective proteins. The spectra of the oxygenated forms change little upon addition of KCNO, which is known to carbamoylate the NH2 terminals of the individual chains (Cerami and Manning, 1971). The spectra of the deoxygenated forms, on the other hand, are markedly altered. The decreased magnitude of the 430-nm extremum with increased cyanate concentration can be used to calculate an addition curve which becomes asymptotic at a cyanate:heme molar ratio of approximately 10(3). This conformational change occurs in the absence of O2 and has been predicted (Njikam et al.,1973); it can also be demonstrated by difference spectroscopy techniques, whereby a comparable addition curve can be constructed from changes in the 555-nm absorption, while the 541-nm absorption remains invariant. The change described corresponds to the formation of a new conformation, corresponding to carbamoyldeoxyhemoglobin, carrying one carbamoyl group per chain. In the presence of a small quantity of oxygen, however, the above reported changes in CD are accompanied by a concomitant rise in the 415-nm peak-corresponding to the formation of oxyhemoglobin-while those in the difference spectra reflect not only a change in the 555-nm band but also a parallel one at 541 nm, confirming the formation of oxyhemoglobin. Thus the conformation achieved upon carbamoylation of deoxyhemoglobin has the higher oxygen affinity predicted by Nigen et al. (1974) for carbamoyldeoxyhemoglobin. Cyanate has been used (Cerami and Manning, 1971) as an antisickling reagent in vivo and in vitro, but, although it has been shown that it binds covalently to the NH2-terminal residues of hemoglobin (Lee and Manning, 1973), its effect on hemoglobin conformation has not been previously shown nor has its mechanism of action been fully clarified. The results presented here show that the effect of cyanate on hemoglobin is the formation of a new conformation with heightened oxygen affinity. Since oxyHbS does not aggregate while deoxyHbS does, in a temperature-dependent fashion, the formation of carbamoyldeoxyHbS interferes with such aggregation in vitro in deoxygenated samples. In vivo, where there are generally low residual concentrations of O2, the formation of oxyHb is favored by the higher O2 affinity of carbamoyldeoxyHbS, and aggregation with concomitant red cell sickling is therefore disfavored.
- Published
- 1976
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