778 results on '"C. Rowland"'
Search Results
752. Retention of all-polyethylene acetabular components after femoral revision of a cemented total hip replacement.
- Author
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Hamlin BR, Rowland C, and Morrey BF
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip instrumentation, Cementation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Polyethylenes, Proportional Hazards Models, Prosthesis Failure, Reoperation, Risk Factors, Survival Analysis, Treatment Failure, Treatment Outcome, Acetabulum, Arthroplasty, Replacement, Hip methods, Hip Prosthesis
- Abstract
Background: This study was undertaken to provide a basis for decision-making when a well-fixed cemented cup is encountered at the time of a revision of a femoral component of a total hip replacement. It may be beneficial to retain the cup in some instances and thus reduce morbidity, complications, blood loss, operative time, and cost., Methods: All patients who had a revision of the femoral component and retention of an all-polyethylene acetabular component from 1971 to 1996 were identified. Three hundred and seventy-four patients with a total of 395 cemented total hip replacements fit the inclusion criteria. The gender, date of and age at the index surgery, type of acetabular implant, and time of and reason for the revision of the femoral component were reviewed. The time to subsequent cup revision or latest surveillance was noted. The average age (and standard deviation) was 66.5 +/- 11.8 years at the time of the femoral revision, which was performed at an average of 8.0 +/- 4.4 years after the primary arthroplasty. For the purposes of this study, the end point for survival of the acetabular component was cup revision for any reason., Results: At the time of the latest follow-up, at an average of nine years after the femoral revision and 17.3 years after the primary arthroplasty, 342 (86.6%) of the 395 cups remained in situ. Fifty-three cups (13.4%) in fifty-two patients had been revised, at an average of 10.0 +/- 5.7 years after the femoral revision and 16.7 +/- 5.3 years after the primary arthroplasty. The rate of survival of the retained acetabular components was 96.9% at five years, 89.3% at ten years, and 78.7% at fifteen years after the femoral revision and was 95.1% at fifteen years and 87.1% at twenty years after the primary arthroplasty. Increased age (p < 0.0001) and a shorter time-interval (less than 7.5 years) between the primary arthroplasty and the femoral revision (p = 0.05) were significantly associated with an increased likelihood of survival free of cup revision. Femoral head size, acetabular component design, gender, and primary diagnosis did not affect prosthetic survival in this sample of patients., Conclusions: The likelihood of survival of the unrevised cup was associated with patient age and duration of implantation, with the age of the patient being the more dominant factor predicting failure of the acetabular component.
- Published
- 2001
- Full Text
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753. Thirty-day mortality after elective total hip arthroplasty.
- Author
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Parvizi J, Johnson BG, Rowland C, Ereth MH, and Lewallen DG
- Subjects
- Aged, Cause of Death, Elective Surgical Procedures mortality, Female, Humans, Intraoperative Complications epidemiology, Male, Middle Aged, Prevalence, Retrospective Studies, Risk Factors, Time Factors, Arthroplasty, Replacement, Hip mortality
- Abstract
Background: Previous reports on perioperative mortality associated with hip arthroplasty have not documented, to our knowledge, patient characteristics and surgical factors that increase the likelihood of death. The purpose of this study was to determine the prevalence of and associated risk factors for perioperative death after elective hip arthroplasty., Methods: The records of 30,714 consecutive patients who had undergone elective hip arthroplasty at our institution from 1969 to 1997 were retrospectively reviewed to identify patients who had died within thirty days after the procedure. Mortality rates were determined according to age, gender, diagnosis, implant type, and fixation mode., Results: Ninety deaths occurred within thirty days after elective total hip arthroplasty, for an overall mortality rate of 0.29% (ninety of 30,714). The thirty-day mortality rate was significantly higher for patients with preexisting cardiovascular disease (p < 0.0001), male patients (p < 0.0001), and patients who were seventy years of age or older (p < 0.0002). The mortality rate was slightly, but not significantly, higher for patients with an underlying diagnosis of rheumatoid arthritis (p < 0.36) and those receiving cemented implants (p < 0.57). There was no difference in the thirty-day mortality rate for revision as compared with primary hip arthroplasty (p < 0.92)., Conclusions: Factors that are associated with an increased risk of mortality within thirty days after elective hip arthroplasty include an older age, male gender, and a history of cardiorespiratory disease. There has been a significant decline in the thirty-day mortality rate after elective hip arthroplasty in the last decade (p < 0.0002); during the 1990s, the overall rate at our institution was 0.15% (twenty-three of 14,989).
- Published
- 2001
- Full Text
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754. Adrenocortical carcinoma: surgical progress or status quo?
- Author
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Kendrick ML, Lloyd R, Erickson L, Farley DR, Grant CS, Thompson GB, Rowland C, Young WF Jr, and van Heerden JA
- Subjects
- Adolescent, Adrenal Cortex Neoplasms mortality, Adrenal Cortex Neoplasms pathology, Adult, Aged, Female, Humans, Male, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Adrenal Cortex Neoplasms surgery
- Abstract
Hypothesis: Outcome of patients with adrenocortical carcinoma (ACC) has improved with the advent of more widely available and higher quality imaging. Operative management strategies and use of adjuvant therapy have not changed., Design: Retrospective review of patient histories, imaging studies, operative data, adjuvant therapy, and outcomes at a single institution. Follow-up was complete for a mean of 53 months. Data was compared with prior institutional experience., Setting: Tertiary care referral center., Patients: All patients undergoing operative management for ACC during the period from 1980 to 1996., Main Outcome Measures: Determinants of recurrence, survival, and the effect of adjuvant therapy on overall outcome., Results: Fifty-eight patients (30 men, 28 women) with a mean age of 53 years underwent primary operative management for ACC. Functional tumors were identified in 27 patients (47%). Mean tumor size was 12.5 cm. Stage according to the TNM staging system (AJCC Cancer Staging Manual) at presentation was I (n = 0), II (n = 30), III (n = 7), and IV (n = 21). Surgical management included curative resection in 41 (71%), noncurative resection in 14 (24%), and open biopsy in 3 (5%). Perioperative mortality was 5%. Recurrence occurred in 30 patients (73%) with a median time to recurrence of 17 months. Five-year survival by the Kaplan-Meier method was 37%. Prognostic factors (P<.05) included functional status, stage, and chemotherapy in stage III/IV patients. When compared with our prior institutional experience (1960-1980), current patients were more likely to present with stages I to II (52% vs. 34%), have curative resections (71% vs. 50%), and have improved 5-year survival (37% vs. 16%)., Conclusions: (1) Surgical resection remains the principal treatment for stage I to III disease. (2) Adjuvant therapy may improve survival in patients with stage III or IV disease. (3) Current patients were more likely to present at an earlier stage, undergo curative resections, and have improved 5-year survival than institutional historical comparisons.
- Published
- 2001
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755. Assembly of very low density lipoproteins in mouse liver: evidence of heterogeneity of particle density in the Golgi apparatus.
- Author
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Swift LL, Valyi-Nagy K, Rowland C, and Harris C
- Subjects
- Animals, Blotting, Western, Electrophoresis, Polyacrylamide Gel, Golgi Apparatus ultrastructure, Liver ultrastructure, Male, Mice, Mice, Inbred ICR, Microscopy, Electron, Golgi Apparatus metabolism, Lipoproteins, VLDL metabolism, Liver metabolism
- Abstract
The assembly of very low density lipoproteins (VLDL) by hepatocytes is believed to occur via a two-step process. The first step is the formation of a dense phospholipid and protein-rich particle that is believed to be converted to VLDL by the addition of bulk triglyceride in a second step. Previous studies in our laboratory led us to hypothesize a third assembly step that occurs in route to or in the Golgi apparatus. To investigate this hypothesis, nascent lipoproteins were recovered from Golgi apparatus-rich fractions isolated from mouse liver. The Golgi fractions were enriched 125-fold in galactosyltransferase and contained lipoprotein particles averaging approximately 35 nm in diameter. These lipoproteins were separated by ultracentrifugation into two fractions: d < 1.006 g/ml and d1.006;-1.210 g/ml. The d < 1.006 g/ml fraction contained apolipoprotein B-100 (apoB-100), apoB-48, and apoE, while the d1.006;-1.210 g/ml fraction contained these three apoproteins as well as apoA-I and apoA-IV. Both fractions contained a 21-kDa protein that was isolated and sequenced and identified as major urinary protein. Approximately 50% of the apoB was recovered with the denser fraction. To determine if these small, dense lipoproteins were secreted without further addition of lipid, mice were injected with Triton WR1339 and [(3)H]leucine, and the secretion of apoB-100 and apoB-48 into serum VLDL (d < 1.006 g/ml) and d1.006;-1.210 g/ml fractions was monitored over a 2-h period. More than 80% of the newly synthesized apoB-48 and nearly 100% of the apoB-100 were secreted with VLDL. These studies provide the first characterization of nascent lipoproteins recovered from the Golgi apparatus of mouse liver. We conclude that these nascent hepatic Golgi lipoproteins represent a heterogeneous population of particles including VLDL as well as a population of small, dense lipoproteins. The finding of the latter particles, coupled with the demonstration that the primary secretory product of mouse liver is VLDL, suggests that lipid may be added to nascent lipoproteins within the Golgi apparatus.
- Published
- 2001
756. Is calciphylaxis best treated surgically or medically?
- Author
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Kang AS, McCarthy JT, Rowland C, Farley DR, and van Heerden JA
- Subjects
- Adult, Aged, Calciphylaxis etiology, Calciphylaxis mortality, Female, Humans, Male, Middle Aged, Parathyroidectomy, Retrospective Studies, Calciphylaxis surgery
- Abstract
Background: Calciphylaxis is a rare, painful, life-threatening problem of cutaneous necrosis and refractory healing in patients with uremia and secondary hyperparathyroidism. The pathogenesis involves abnormalities in calcium and phosphorus metabolism and acute deposition of calcium in tissues., Method: The clinical course of 16 patients who were diagnosed with calciphylaxis at our institution from 1994 through 1998 was reviewed., Results: Fourteen female patients and 2 male patients had chronic renal disease, secondary hyperparathyroidism, and characteristic skin necrosis (mean age, 56 years; range, 39-70 years). All patients underwent intensive medical therapy, including ongoing hemodialysis (n = 16 patients), parathyroidectomy (n = 7 patients), and debridement of cutaneous lesions (n = 8 patients). Mean serum values in surgical and nonsurgical patients were significantly different for phosphorus, calcium-phosphorus product, and parathormone levels. Median survival was 9.4 months; 15 patients (93%) have died. The median survival time for parathyroidectomy versus nonparathyroidectomy was 14.8 and 6.3 months (P =.22), for skin debridement versus nondebridement was 14.1 and 6.1 months (P =.08), and for diabetic versus nondiabetic patients was 6.5 and 13.9 months (P =.11)., Conclusions: Calciphylaxis has a female preponderance, with a dismal prognosis. A multidisciplinary approach that uses frequent hemodialysis to normalize calcium and phosphorus levels and local debridement of skin lesions seems prudent. Parathyroidectomy cannot be recommended routinely in all patients, unless severe hyperparathyroidism mandates intervention.
- Published
- 2000
- Full Text
- View/download PDF
757. Combined proton MR spectroscopy and dynamic contrast enhanced MR imaging of human intracranial tumours in vivo.
- Author
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Manton DJ, Lowry M, Rowland-Hill C, Crooks D, Mathew B, and Turnbull LW
- Subjects
- Contrast Media metabolism, Humans, Brain Neoplasms diagnosis, Magnetic Resonance Imaging methods, Magnetic Resonance Spectroscopy methods
- Abstract
A study was undertaken to determine if the vascular characteristics measured by dynamic contrast-enhanced magnetic resonance imaging (primarily permeability surface area product and extracellular-extravascular tissue volume fraction) would be beneficial in explaining the inter-lesion metabolic heterogeneity displayed by human intracranial tumours. Magnetic resonance spectroscopy was carried out using a single-voxel STEAM sequence and dynamic imaging was carried out using a combination of pre-contrast proton density-weighted FSPGR images (to remove the influence of native tissue T1), bolus injection of Gd-DTPA and subsequent T1-weighted FSPGR dynamic imaging. A two-compartment pharmacokinetic model was employed to determine vascular characteristics. Results obtained from 12 meningiomas suggest a possible correlation between the level of lipids/macromolecules and permeability surface area product, although the confounding issue of extra-voxel contamination arising from lipids in the scalp and skull marrow cannot be ruled out in the more superficial lesions. Results obtained from 11 gliomas (four low and seven high grade) demonstrate that permeability surface area product is not specific for the range of vascular characteristics and metabolite profiles observed in gliomas and is therefore unable to explain metabolic heterogeneity in these lesions., (Copyright 2000 John Wiley & Sons, Ltd.)
- Published
- 2000
- Full Text
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758. Surgical treatment of adult primary hepatic sarcoma.
- Author
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Poggio JL, Nagorney DM, Nascimento AG, Rowland C, Kay P, Young RM, and Donohue JH
- Subjects
- Adult, Aged, Aged, 80 and over, Antineoplastic Agents therapeutic use, Disease-Free Survival, Female, Humans, Liver Neoplasms drug therapy, Liver Neoplasms pathology, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Preoperative Care methods, Retrospective Studies, Sarcoma drug therapy, Sarcoma pathology, Liver Neoplasms surgery, Sarcoma surgery
- Abstract
Background: Primary sarcomas of the liver are extremely rare in adults. Optimal therapeutic approaches remain unclear., Methods: Twenty consecutive adult patients who had surgical treatment for primary hepatic sarcomas were reviewed. Patient age ranged from 23 to 80 years. Other than one patient with primary hepatic angiosarcoma who had a history of thorium dioxide colloid (Thorotrast) exposure 23 years before diagnosis, no predisposing causes were apparent. Nineteen patients had hepatic resection and one patient had an orthotopic liver transplant. No patient received neoadjuvant chemotherapy or radiotherapy but radiotherapy was delivered intraoperatively in one patient., Results: Leiomyosarcoma was the most common histological type of sarcoma diagnosed (five of 20 patients), followed by malignant solitary fibrous tumour (four) and epithelioid haemangioendothelioma (three). Fourteen tumours were high-grade sarcomas and six were low grade malignancies. Thirteen patients developed a recurrence. Distant metastases (ten patients) and intrahepatic recurrence (six) were the predominant sites of initial treatment failure. Six patients received salvage chemotherapy. Histological grade was the only factor significantly associated with overall patient survival (P= 0.03). With complete resection, patients with high-grade tumours had a 5-year survival rate of 18 (95 per cent confidence interval 5-62) per cent compared with 80 (52-100) per cent for patients with low-grade tumours. The 5-year survival rate for all 20 patients was 37 (20-60) per cent., Conclusion: Surgical resection is the only effective therapy for primary hepatic sarcomas at present. Better adjuvant therapy is necessary, especially for high-grade malignancies, owing to the high failure rate with operation alone.
- Published
- 2000
- Full Text
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759. Effects of transdermal nicotine treatment on structure and function of coronary artery bypass grafts.
- Author
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Clouse WD, Yamaguchi H, Phillips MR, Hurt RD, Fitzpatrick LA, Moyer TP, Rowland C, Schaff HV, and Miller VM
- Subjects
- Actins metabolism, Administration, Cutaneous, Animals, Calcimycin pharmacology, Cotinine blood, Desmin metabolism, Diffusion Chambers, Culture, Dogs, Endothelium, Vascular drug effects, Endothelium, Vascular physiology, Integrin-Binding Sialoprotein, Ionophores pharmacology, Male, Nicotine blood, Nitrates blood, Nitric Oxide pharmacology, Nitrites blood, Saphenous Vein metabolism, Sialoglycoproteins metabolism, Thrombin pharmacology, Vasodilation, Coronary Artery Bypass, Nicotine pharmacology, Saphenous Vein drug effects, Saphenous Vein transplantation
- Abstract
Smoking is a major risk factor for failure of coronary artery bypass grafts (CABG). Experiments were designed to determine effects of transdermal nicotine, independent of smoking, on structure and function of CABG. Saphenous veins were placed as CABG in untreated dogs (control) or in dogs treated with transdermal nicotine (one 11-mg or two 22-mg patches/day) for 5 wk. Serum nicotine and plasma nitric oxide were measured. Grafts were removed and prepared for organ chamber studies and histology. Serum nicotine averaged 12.1 and 118.7 ng/ml in the 11 mg/day and 44 mg/day groups, respectively. Plasma nitric oxide was higher in dogs treated with 11 mg/day doses compared with controls. In organ chamber studies, endothelium-dependent relaxations to thrombin and A-23187 and endothelium-independent relaxations to nitric oxide were greatest in grafts from dogs treated with 11 mg/day doses. Intimal thickness of the grafts were similar among groups. However, staining for bone sialoprotein was increased in the media of grafts from the 11 mg/day treatment group. These data suggest that transdermal nicotine in doses comparable and double to those used for conventional smoking cessation treatment in humans does not adversely affect early patency of canine CABG up to 4 wk postoperatively. Transdermal nicotine, however, may increase production of and response to nitric oxide in bypass grafts.
- Published
- 2000
- Full Text
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760. The impact of antidepressant use on social functioning: reboxetine versus fluoxetine.
- Author
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Venditti LN, Arcelus A, Birnbaum H, Greenberg P, Barr CE, Rowland C, and Williamson T
- Subjects
- Adrenergic Uptake Inhibitors therapeutic use, Adult, Depressive Disorder psychology, Female, Fluoxetine therapeutic use, Humans, Male, Morpholines therapeutic use, Reboxetine, Selective Serotonin Reuptake Inhibitors therapeutic use, Severity of Illness Index, Treatment Outcome, Adrenergic Uptake Inhibitors pharmacology, Depressive Disorder drug therapy, Fluoxetine pharmacology, Morpholines pharmacology, Selective Serotonin Reuptake Inhibitors pharmacology, Social Behavior
- Abstract
Depression compromises affected individuals' functional well-being and impairs their level of social and workplace performance. Improved social functioning in depressed patients may improve their work productivity. This study evaluated the differential effects of two antidepressants on social functioning outcomes for patients with major depression comparing reboxetine, a non-tricyclic, selective noradrenaline reuptake inhibitor and fluoxetine, a commonly prescribed selective serotonin reuptake inhibitor. A model using data from 284 depressed patients (138 reboxetine, 146 fluoxetine) in two 8-week clinical trials was developed to predict the percentage change over time in continuous outcome assessments as measured by a 21-item self-rating scale called the Social Adaptation Self-evaluation Scale (SASS). The percentage change from baseline SASS score was modelled as a function of both time-invariant and time-varying covariates. Results suggest that, by mid-study, the more severely ill subjects benefitted more from reboxetine treatment in terms of the outcome improvement rate and, by study-end, this effect also extended into the less severely ill population. In addition, a significant relationship was identified between the change in depression symptom severity as measured by the standard Hamilton Depression Rating Scale score and the change in social functioning per the SASS.
- Published
- 2000
- Full Text
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761. Thermal balloon and rollerball ablation to treat menorrhagia: two-year results of a multicenter, prospective, randomized, clinical trial.
- Author
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Grainger DA, Tjaden BL, Rowland C, and Meyer WR
- Subjects
- Adult, Catheterization methods, Female, Follow-Up Studies, Hot Temperature, Humans, Hysterectomy, Prospective Studies, Catheter Ablation methods, Electrosurgery methods, Menorrhagia surgery
- Abstract
Study Objective: To evaluate 2-year follow-up results in patients participating in a randomized, clinical trial comparing uterine balloon therapy with rollerball endometrial ablation., Study Design: Prospective, randomized, clinical trial (Canadian Task Force classification I)., Setting: Fourteen university-affiliated and private practice sites., Patients: Two hundred fifty-five women with menorrhagia., Interventions: Patients were randomized to rollerball or uterine balloon endometrial ablation., Measurements and Main Results: Patient satisfaction with both treatments was consistently high. Only 15 hysterectomies had been performed (6 for menorrhagia) at the end of 2 years, 11 in the rollerball group, 4 in the balloon therapy group., Conclusion: Endometrial ablation by both procedures was highly successful in avoiding hysterectomy and relieving symptoms of menorrhagia. Additional benefits were reduction in dysmenorrhea and premenstrual syndrome.
- Published
- 2000
- Full Text
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762. Treatment of invasive thymoma with single-agent ifosfamide.
- Author
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Highley MS, Underhill CR, Parnis FX, Karapetis C, Rankin E, Dussek J, Bryant B, Rowland C, Hodson N, Hughes J, and Harper PG
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- Adult, Aged, Female, Humans, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Survival Rate, Thymoma mortality, Thymoma pathology, Thymus Neoplasms mortality, Thymus Neoplasms pathology, Antineoplastic Agents, Alkylating therapeutic use, Ifosfamide therapeutic use, Thymoma drug therapy, Thymus Neoplasms drug therapy
- Abstract
Purpose: To evaluate single-agent ifosfamide in the treatment of invasive thymoma., Patients and Methods: Fifteen patients (eight male and seven female) with histologically confirmed invasive thymoma were treated. The median age was 48 years (range, 23 to 76 years). Four patients had stage III disease, seven patients had stage IVa disease, and four patients had stage IVb disease. The most common histologic type was lymphoepithelial. Seven patients had received prior treatment, including one patient who received chemotherapy. Ifosfamide 1.5 g/m(2) was given on days 1 to 5, with mesna as a uroprotector., Results: Thirteen patients were assessable for response. Five complete responses (38.5%; 95% confidence interval [CI], 17.7% to 64.5%) and one partial response (7.7%; 95% CI, 1.4% to 33.3%) were seen. The median duration of complete response was 66+ months (range, 25 to 87 months), and the estimated survival rate 5 years after ifosfamide treatment was 57% (SE, 32% to 79%). The most frequent toxicities were nausea, vomiting, and leucopenia, but these were well tolerated., Conclusion: Single-agent ifosfamide possesses significant activity against invasive thymoma and is comparable to currently used combination regimens. The inclusion of ifosfamide in combination therapy, particularly in place of cyclophosphamide in regimens such as cisplatin, doxorubicin, and cyclophosphamide, needs to be evaluated.
- Published
- 1999
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763. Use of parents, sibs, and unrelated controls for detection of associations between genetic markers and disease.
- Author
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Schaid DJ and Rowland C
- Subjects
- Female, Gene Frequency, Genotype, Humans, Male, Genetic Diseases, Inborn genetics, Genetic Markers, Models, Genetic, Models, Statistical, Nuclear Family, Parents
- Abstract
Detecting the association between genetic markers and complex diseases can be a critical first step toward identification of the genetic basis of disease. Misleading associations can be avoided by choosing as controls the parents of diseased cases, but the availability of parents often limits this design to early-onset disease. Alternatively, sib controls offer a valid design. A general multivariate score statistic is presented, to detect the association between a multiallelic genetic marker locus and affection status; this general approach is applicable to designs that use parents as controls, sibs as controls, or even unrelated controls whose genotypes do not fit Hardy-Weinberg proportions or that pool any combination of these different designs. The benefit of this multivariate score statistic is that it will tend to be the most powerful method when multiple marker alleles are associated with affection status. To plan these types of studies, we present methods to compute sample size and power, allowing for varying sibship sizes, ascertainment criteria, and genetic models of risk. The results indicate that sib controls have less power than parental controls and that the power of sib controls can be increased by increasing either the number of affected sibs per sibship or the number of unaffected control sibs. The sample-size results indicate that the use of sib controls to test for associations, by use of either a single-marker locus or a genomewide screen, will be feasible for markers that have a dominant effect and for common alleles having a recessive effect. The results presented will be useful for investigators planning studies using sibs as controls.
- Published
- 1998
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764. Cost effectiveness of pramipexole in Parkinson's disease in the US.
- Author
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Hoerger TJ, Bala MV, Rowland C, Greer M, Chrischilles EA, and Holloway RG
- Subjects
- Antiparkinson Agents therapeutic use, Benzothiazoles, Cost-Benefit Analysis, Humans, Parkinson Disease drug therapy, Pramipexole, Quality-Adjusted Life Years, Sensitivity and Specificity, Thiazoles therapeutic use, United States, Antiparkinson Agents economics, Parkinson Disease economics, Thiazoles economics
- Abstract
Objective: Pramipexole was recently approved in the US for treatment of the symptoms of idiopathic Parkinson's disease (PD). Although pramipexole has been found to be safe and efficacious when compared with placebo, little data are yet available on its cost effectiveness when compared with baseline treatment. The aim of this study was to estimate the costs and cost effectiveness (cost utility) of pramipexole compared with baseline treatment in patients with early and advanced PD., Design and Setting: We developed a cost-effectiveness (CE) model in the US setting that linked Unified Parkinson's Disease Rating Scale (UPDRS) Part II (activities of daily life) and III (motor) scores to disease progression, costs and patient utility. Data for the model were obtained from clinical trials, a literature review and a survey of 193 patients' health resource use and utility. We used cost and quality-adjusted life-year (QALY) estimates from the model to estimate the incremental cost effectiveness of pramipexole relative to baseline treatment patterns. We performed separate analyses for patients with early and advanced PD. We also performed extensive sensitivity analyses by adding other dopamine agonists to the no-pramipexole treatment regimen and varying disease progression parameters. The study was conducted from the societal perspective, although data presentation allows interpretation of cost effectiveness from either the societal or payer perspective., Main Outcome Measures and Results: For patients with both early and advanced PD, treatment with pramipexole had higher costs but was more effective than baseline treatment. For patients with early onset of PD, the incremental total CE ratio for pramipexole was $US8837/QALY. For patients with advanced PD, the incremental CE ratio was $US12 294/QALY (1997 costs). These ratios were lower than the CE ratios of many widely used medical treatments., Conclusions: Subject to the inherent limitations of modelling chronic disease progression and subsequent healthcare costs and patient utility, the results suggested that pramipexole was a cost effective treatment for patients with early and advanced PD in the US.
- Published
- 1998
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765. Surgical management of intrahepatic cholangiocarcinoma: a 31-year experience.
- Author
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Lieser MJ, Barry MK, Rowland C, Ilstrup DM, and Nagorney DM
- Subjects
- Adult, Aged, Aged, 80 and over, Disease-Free Survival, Female, Humans, Male, Middle Aged, Survival Analysis, Treatment Outcome, Bile Duct Neoplasms surgery, Bile Ducts, Intrahepatic surgery, Cholangiocarcinoma surgery
- Abstract
Intrahepatic cholangiocarcinoma (ICC) is the second most common malignant primary tumor of the liver. It is, though, a rare tumor and little is known regarding its natural history, clinicopathologic characteristics, or the outcomes of surgical therapy. We reviewed the experience of 61 patients with ICC seen by the surgical service at the Mayo Clinic over a 31-year period. Patient demographic and clinical data were recorded, as were survival statistics. Pathologic data were also obtained and patients stratified according to the TNM classification. Twenty-eight patients were resected for cure. Overall, 45 patients died of ICC. Of the patients resected for cure, survival at 3 years was 60%. No pathologic condition was found to be associated with the development of ICC. Overall survival correlated with stage of the tumor. Among patients resected for cure, stage did not correlate with survival. Prognosis for patients with ICC remains poor; resection, though, appears to prolong survival.
- Published
- 1998
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766. Quality of life and pharmaco-economic aspects of obsessive-compulsive disorder. A South African survey.
- Author
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Stein DJ, Roberts M, Hollander E, Rowland C, and Serebro P
- Subjects
- Activities of Daily Living psychology, Adult, Humans, Male, Middle Aged, Obsessive-Compulsive Disorder drug therapy, Selective Serotonin Reuptake Inhibitors therapeutic use, Social Adjustment, Socioeconomic Factors, Surveys and Questionnaires, Obsessive-Compulsive Disorder economics, Obsessive-Compulsive Disorder psychology, Quality of Life, Selective Serotonin Reuptake Inhibitors economics
- Abstract
Objective: The quality of life and pharmaco-economic aspects of obsessive-compulsive disorder (OCD) have received relatively little research attention to date. We aimed to gather preliminary data on these in a South African patient sample., Design: A survey of members of the Obsessive-Compulsive Disorder Association of South Africa was undertaken by means of a detailed self-report questionnaire., Results: Results of the survey suggest that OCD causes significant morbidity, leading to clear distress and Interference with academic, occupational, social and family function. Unfortunately, correct diagnosis and appropriate treatment have been delayed in many patients, and the financial costs of such incorrect management are likely to be considerable., Conclusion: Much further work needs to be done by the medical profession and by interested consumers to raise awareness about OCD and to provide information about its management. In South Africa, it is particularly Important to undertake such psycho-education at a primary health care level and to impact on patients of low socio-economic status.
- Published
- 1996
767. The impact on unemployment of an intervention to increase recognition of previously untreated anxiety among primary care physicians.
- Author
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Yelin E, Mathias SD, Buesching DP, Rowland C, Calucin RQ, and Fifer S
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- Adult, Aged, Anxiety Disorders diagnosis, Anxiety Disorders psychology, Colorado, Female, Health Maintenance Organizations, Humans, Male, Middle Aged, Patient Education as Topic, Primary Health Care, Treatment Outcome, Absenteeism, Anxiety Disorders rehabilitation, Patient Care Team, Rehabilitation, Vocational
- Abstract
Anxiety is a common, though often unrecognized, problem in primary care settings. This study examines the effect on employment of an intervention designed to attune primary care physicians to previously unrecognized and untreated anxiety. Primary care physicians in a mixed-model health maintenance organization (HMO) were randomized by practice site to groups with (intervention) and without (usual care) intensive one-on-one education about anxiety and periodic feedback about their patients with anxiety. All persons 21-65 years of age presenting to the offices of these primary care providers were screened for anxiety with the SCL-90-R on two occasions. Those meeting the SCL-90-R cutpoints for anxiety and whose medical records provided no evidence of recognition or treatment for a mental health condition within the last 6 months were eligible for the study (n = 637). Of these, 573 (90%) completed two follow-up assessments. The present study evaluates the impact of the intervention aimed at the primary care physicians on the labor force participation rate of the persons with anxiety after 5 months of follow-up. The study also evaluates the impact of the intervention on hours of work and the presence of days spent in bed among the persons with anxiety working at the baseline interview and after 5 months. At baseline, the patients of intervention and usual care physicians with previously unrecognized and untreated anxiety did not differ in labor force participation rates. At the conclusion of the study, the patients of the intervention group physicians had significantly lower rates of labor force participation than those of the usual care group physicians. Among those working both at the beginning and conclusion of the study, the intervention had no impact on hours of work or the presence of days spent in bed. We conclude that attuning physicians may reduce labor force participation rates.
- Published
- 1996
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768. Hygienic hand disinfection tests in three laboratories.
- Author
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Ayliffe GA, Babb JR, Davies JG, Newsom SW, Rowland C, Platt JH, and Mason B
- Subjects
- Chlorhexidine administration & dosage, Female, Humans, Laboratories, Male, Chlorhexidine analogs & derivatives, Chlorhexidine therapeutic use, Hand Disinfection standards, Soaps therapeutic use, Staphylococcal Skin Infections drug therapy
- Abstract
A comparative study was made in three laboratories of a test for hygienic hand disinfection. Staphylococcus aureus was applied to the fingertips of a total of 74 volunteers (49 female and 25 male) and the effect of washing with three chlorhexidine preparations and one non-medicated soap was assessed after one and five applications. Fingertip inoculation is convenient and is a realistic representation of the in-use situation. Although significant differences were obtained between log10 reductions in test organisms using the same formulation in different centres, and different periods in the same centre, the maximum differences after a single application of a preparation were small, e.g. between centres 0.39 and between periods in the same centre 0.55, and after multiple applications the maximum difference between centres was 0.42 and between periods in the same centre it was 0.51. The differences between preparations were similar in all centres. This test compares well with other similar tests and products can be placed in rank order of effectiveness. It is concluded that this test, if carried out under the controlled conditions described, is sufficiently reproducible between laboratories and repeatable within laboratories to be used as a standard test.
- Published
- 1990
- Full Text
- View/download PDF
769. Microbiological studies on lomefloxacin--a new quinolone.
- Author
-
Newsom SW and Rowland C
- Subjects
- Acinetobacter isolation & purification, Enterobacteriaceae isolation & purification, Escherichia coli isolation & purification, Humans, Microbial Sensitivity Tests, Pseudomonas isolation & purification, Staphylococcus isolation & purification, Acinetobacter drug effects, Anti-Infective Agents pharmacology, Enterobacteriaceae drug effects, Escherichia coli drug effects, Fluoroquinolones pharmacology, Pseudomonas drug effects, Quinolones pharmacology, Staphylococcus drug effects
- Published
- 1989
770. Cost-benefit analysis: a research tool for evaluating innovative health programs.
- Author
-
Bootman JL, Rowland C, and Wertheimer AI
- Subjects
- Evaluation Studies as Topic, Financing, Government, Health Resources statistics & numerical data, Humans, Models, Theoretical, United States, Cost-Benefit Analysis, Decision Making, Health Services economics
- Abstract
This article reviews the evaluation methodology known as cost-benefit analysis. Studies which have utilized this technique are presented and briefly reviewed. In addition, the closely related technique known as cost-effectiveness (C-E) analysis is described and contrasted with cost-benefit analysis. Several research articles utilizing C-E are described. It is recommended that cost-benefit analysis be used as a mechanism to evaluate innovative health programs. This may be the sole mechanism that will enable health practitioners to cost-justify their innovative services to the federal government and other third-party payers.
- Published
- 1979
- Full Text
- View/download PDF
771. Studies on perioperative skin flora.
- Author
-
Newsom SW and Rowland C
- Subjects
- Bacteria isolation & purification, Baths methods, Chlorhexidine therapeutic use, Drug Resistance, Microbial, Hand Disinfection methods, Humans, Intraoperative Period, Methicillin pharmacology, Penicillin Resistance, Postoperative Period, Staphylococcus epidermidis drug effects, Surgical Wound Infection prevention & control, Wound Healing drug effects, Bacteria drug effects, Chlorhexidine pharmacology, Skin microbiology
- Abstract
Chlorhexidine in spirit is used to reduce the skin bacterial load before surgery; and recently prewashing with chlorhexidine scrub has been advocated. We describe three studies on cardio-thoracic surgical patients--particularly those having coronary artery grafts with long leg and sternal wounds. Two studies compared prewashes with chlorhexidine scrub (Hibiscrub-ICI) or soap. Study Number One (250 patients per group) was of wound infections; and Number Two (25 patients per group) was of alterations in skin flora for 10 days postoperation. Chlorhexidine scrub failed to reduce overall wound infection rates in Study 1, although leg wounds healed more quickly with less inflammation. Study Two showed that the scrub had a significant effect on skin flora that lasted at least 3 days postoperation. Study Number Three was of 100 patients (no chlorhexidine scrub) examined for methicillin-resistant coagulase-negative staphylococci (MRSE) by cultures of swabs from the leg, sternum and chest drain site before and after operation on methicillin agar. Three per cent of patients had MRSE preoperation (1 doctor) and 23% postoperation. One thousand strains were tested by agar dilution against methicillin and chlorhexidine. MRSE had a 2-8-fold increased resistance to chlorhexidine compared to a greater than 256-fold to methicillin. Thus although chlorhexidine has a marked persistent effect on skin flora, emergence of major resistance is unlikely. Use of postoperative chlorhexidine should be investigated further.
- Published
- 1988
- Full Text
- View/download PDF
772. Multicenter study of trilostane: a new hormonal agent in advanced postmenopausal breast cancer.
- Author
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Williams CJ, Barley V, Blackledge G, Hutcheon A, Kaye S, Smith D, Keen C, Webster DJ, Rowland C, and Tyrrell C
- Subjects
- Dexamethasone administration & dosage, Dihydrotestosterone administration & dosage, Dihydrotestosterone adverse effects, Dihydrotestosterone therapeutic use, Female, Humans, Menopause, Multi-Institutional Systems, Breast Neoplasms drug therapy, Carcinoma drug therapy, Dihydrotestosterone analogs & derivatives
- Abstract
Trilostane, an inhibitor of the production of adrenal estrogens, was administered, together with dexamethasone, to 97 eligible postmenopausal women with advanced breast cancer. Seventy-four patients who had either received trilostane for a minimum of 10 weeks or whose disease had progressed while on trilostane before this period were assessed for tumour response. Eighteen patients (25%) had objective responses (two complete, 16 partial); a further 21 patients had stable disease. The response rate among all 97 patients, including those not treated for a minimum 10-week period, was 19%. Thirty-two of 97 patients reported adverse reactions which were attributed to trilostane and/or dexamethasone. Therapy was stopped for 15 patients, and the dose of trilostane was reduced for ten. Diarrhea was the commonest side effect, being reported in 16 patients, of whom nine stopped treatment. Trilostane, given with a corticosteroid, is an effective alternative hormonal agent acting by adrenal blockade for postmenopausal women with advanced breast cancer.
- Published
- 1987
773. Cost of individualizing aminoglycoside dosage regimens.
- Author
-
Bootman JL, Zaske DE, Wertheimer AI, and Rowland C
- Subjects
- Aminoglycosides administration & dosage, Aminoglycosides blood, Anti-Bacterial Agents blood, Costs and Cost Analysis, Hospital Bed Capacity, 300 to 499, Humans, Kinetics, Minnesota, Anti-Bacterial Agents administration & dosage, Drug Administration Schedule economics, Pharmacy Service, Hospital economics
- Abstract
The estimated annual costs associated with operating a clinical pharmacokinetics service within a 450-bed, metropolitan county hospital were studied. Using three aminoglycoside serum level determinations, a computer program estimates the patient's pharmacokinetic variables and calculates a dosage regimen which will maintain serum concentrations in the desired range. Pharmacists are involved in assessing the patient's initial clinical condition and in recommending doses and dosing intervals. Fixed costs included the costs of the physical facility and office equipment ($778/yr). Operating costs included salaries, equipment leasing fees, journal subscription fees and medical supplies ($73,915/yr). The estimated cost per blood sample analyzed for aminoglycoside content was $17.35/sample (4,305 samples/yr). The study provides a basis for comparing the cost of operating a pharmacokinetics service with the cost of other innovative pharmaceutical services.
- Published
- 1979
774. Pharmacokinetic study of the interaction between rifampicin and ketoconazole.
- Author
-
Doble N, Shaw R, Rowland-Hill C, Lush M, Warnock DW, and Keal EE
- Subjects
- Drug Interactions, Humans, Ketoconazole administration & dosage, Male, Opportunistic Infections blood, Opportunistic Infections drug therapy, Rifampin administration & dosage, Ketoconazole pharmacokinetics, Rifampin pharmacokinetics
- Abstract
This study assessed the potential pharmacokinetic interaction between rifampicin and ketoconazole, two drugs used to treat the increasingly common combination of Mycobacterium tuberculosis and Candida albicans infection in AIDS patients. The peak plasma rifampicin concentrations in six healthy male subjects were not altered when taken in conjunction with ketoconazole. However, the peak plasma ketoconazole levels were significantly diminished when taken in conjunction with rifampicin, compared to when taken alone (P less than 0.015). The mean area under the curve (AUC) for ketoconazole was significantly diminished when taken with oral or intravenous rifampicin (P less than 0.001).
- Published
- 1988
- Full Text
- View/download PDF
775. Individualizing gentamicin dosage regimens in burn patients with gram-negative septicemia: a cost--benefit analysis.
- Author
-
Bootman JL, Wertheimer AI, Zaske D, and Rowland C
- Subjects
- Cost-Benefit Analysis, Drug Administration Schedule economics, Gentamicins adverse effects, Gentamicins therapeutic use, Humans, Kinetics, Length of Stay economics, Models, Theoretical, Pharmaceutical Services economics, Sepsis complications, Sepsis mortality, Burns complications, Gentamicins administration & dosage, Sepsis drug therapy
- Abstract
Services provided by a clinical pharmacokinetics laboratory were evaluated in terms of an accepted cost--benefit model, and a model to evaluate clinical services provided by the pharmacist is presented. A retrospective study was conducted to evaluate the impact, in terms of patient outcomes, of individualizing gentamicin dosage regimens in severely burned patients. Analysis was conducted using multivariate statistical techniques and appropriate nonparametric and parametric tests to determine significant differences. This analysis provided the necessary data to quantify the impact of the pharmacokinetic service. The findings suggest that significant differences do exist in comparing individually dosed patients against those who were not, based upon discriminant and multiple regression analyses and/or nonparametric tests. Furthermore, the results will be useful for insurance companies, third-party payers, and government agencies in deciding which innovative clinical services should be reimbursed.
- Published
- 1979
- Full Text
- View/download PDF
776. Application of the hygienic hand-disinfection test to the gloved hand.
- Author
-
Newsom SW and Rowland C
- Subjects
- Escherichia coli drug effects, Humans, Soaps, Gloves, Surgical, Hand Disinfection
- Abstract
The Austrian Standard Hygienic Hand-Disinfection Test was adapted for comparing the effect of washing artificially contaminated hands (using Escherichia coli) with contaminated gloved hands, using liquid soap and rinsing with water. Tests showed that a single soap wash completely removed all the bacteria from the glove, and was more than 1000 times more effective on the glove than on the hand.
- Published
- 1989
- Full Text
- View/download PDF
777. Open versus closed glove changing.
- Author
-
Fraser J and Rowland C
- Subjects
- Hand Disinfection methods, Humans, Gloves, Surgical, Operating Room Nursing
- Published
- 1987
778. What is in the surgeon's glove?
- Author
-
Newsom SW, Rowland C, and Wells FC
- Subjects
- Anti-Infective Agents, Local standards, Bacteriological Techniques, Cetylpyridinium analogs & derivatives, Hand Disinfection methods, Humans, Skin microbiology, Gloves, Surgical, Hand Disinfection standards
- Abstract
Three aspects of surgical hand hygiene have been studied: the attitude of the surgeon, the microbiology of glove changing during an operation, and the use of antiseptic-coated gloves together with different handwash routines. The survey revealed that the predominant factor in choice of agent for surgical hand hygiene was skin tolerance. The microbiological studies showed that 'closed' glove changing was to be preferred to 'open' changing, and that antiseptic-coated gloves further suppressed the skin flora, even after prolonged operations, compared to standard gloves.
- Published
- 1988
- Full Text
- View/download PDF
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