226
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Brennan M, Morgan HJ. Painless lymphadenopathy. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:427-8. [PMID: 3489129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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227
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Louis DS, Hankin FM, Hankin RC, Brennan M, Greene TL. Synovial cell sarcoma: a case report with a comment on 27 years of treatment. J Hand Surg Am 1986; 11:578-81. [PMID: 3013984 DOI: 10.1016/s0363-5023(86)80204-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The long-term survival of patients after surgical removal of soft tissue sarcomas is dependent on many factors. This case report shows that a postsurgical clinical "cure" may depend more on the biologic behavior of the neoplasm than on any specific operative modality.
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228
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Brennan M, Morgan HJ, George AL. Abdominal pain and flank ecchymosis in an elderly woman. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:292-3. [PMID: 2941622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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229
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Brennan M, Morgan HJ, George A. Deep venous thrombosis with localized skin necrosis. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:210. [PMID: 3713169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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230
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Brennan M, Morgan HJ, George A. Refractory hypoglycemia in a truck driver. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:210-1. [PMID: 3086624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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231
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Brennan M, Morgan HJ. Chest pain following Thanksgiving dinner. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:159-60. [PMID: 3702397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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232
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Brennan M, Morgan HJ. Unexplained tachycardia in an elderly patient. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:158-9. [PMID: 3702396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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233
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Brennan M, Morgan HJ. Haemophilus influenzae and systemic disease--not strictly a pediatric pathogen. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:95. [PMID: 3485219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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234
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Brennan M, Morgan HJ. Exotic infection in the immunocompromised host. JOURNAL OF THE TENNESSEE MEDICAL ASSOCIATION 1986; 79:94. [PMID: 3951233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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235
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Fitzgerald D, O'Donnell D, Brennan M, O'Malley K, O'Brien E. Accuracy and reliability of the Del Mar Avionics pressurometer III. JOURNAL OF HYPERTENSION. SUPPLEMENT : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF HYPERTENSION 1985; 3:S359-61. [PMID: 2856738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We assessed the accuracy and reliability of the Avionics pressurometer, a fully automated ambulatory blood pressure recorder. Accuracy was assessed in 96 patients against the Hawksley random-zero sphygmomanometer. Two recordings were made with each device in a random sequence. No mean difference was found between methods. However, there was a marked variation in the difference between Avionics and Hawksley recordings. This was not due to variability in blood pressure alone since the agreement between Avionics and pressurometer systolic recordings (r = 0.88) was less than the agreement between sequential systolic blood pressure measurements with the Hawksley (r = 0.976, P < 0.001). In addition, a small degree of inter-device variability was demonstrated between three Avionics recorders, one device giving higher readings. Reliability was assessed in 30 patients during normal daily activities and compared with the Remler M2000. The rate of markedly artefactual recordings was higher with the Avionics. Thus, variability in Avionics recordings makes this device unreliable.
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236
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Ownby DR, Ownby HE, Bailey J, Frederick J, Tilley B, Brooks SC, Russo J, Heppner G, Brennan M. Presurgical serum immunoglobulin concentrations and the prognosis of operable breast cancer in women. J Natl Cancer Inst 1985; 75:655-63. [PMID: 3862898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Serum concentrations of IgG, IgA, IgM, IgE, and allergen-specific IgE were measured in presurgical serum samples from 400 women admitted to a multidisciplinary study of primary breast cancer. The relationships between the serum immunoglobulins and patient survival were analyzed with the use of a Cox proportional hazards linear model. After adjustment for TNM stage, tumor histopathologic grade, and estrogen receptor (E2R) status, lower IgM concentrations were associated with longer survival. Lower IgE concentrations were also associated with longer survival, but only in patients whose tumors were E2R positive. IgG and IgA were not related to survival. Serum IgM and IgE concentrations, allergen-specific IgE scores, and the tumor E2R status were combined to construct a three-level risk classification that was more prognostic than any of the individual components. Cox model analysis demonstrated that this combination of immunologic and hormonal variables provided significant new information beyond that obtained from TNM staging and histopathologic grading of the tumors (P = .01). This new information may be useful to physicians in advising patients with primary, operable breast cancer about the relative risks and benefits of adjuvant therapy and in designing clinical trials of adjuvant therapy.
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237
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Abstract
The paper describes a graduate studies programme designed to prepare outstanding family physicians for academic leadership and reports an evaluation of the programme. The programme aims to produce academic family physicians who exhibit certain qualities: outstanding clinical skills, professional interest in the organization and transmission of knowledge, and a scholarly approach through research and skills of leadership. The course includes clinical and teaching practice, formal course work and a scholarly thesis; the emphasis is on teaching and learning, theoretical foundations of family medicine, whole person medicine, research design and techniques, ethical decision making, and administration of organizations. A survey of the first 30 graduates of the programme indicated that the majority did more clinical teaching, small group teaching, research, writing and administration than before the course. The graduates' opinions of the programme indicated the extent to which the programme goals have been met; to provide a coherent learning experience integrating the art, science and technology of the discipline of family medicine.
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238
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Brennan M, Davison PF, Paulus H. Preparation of bispecific antibodies by chemical recombination of monoclonal immunoglobulin G1 fragments. Science 1985; 229:81-3. [PMID: 3925553 DOI: 10.1126/science.3925553] [Citation(s) in RCA: 155] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Preparation of bispecific antibodies by the chemical reassociation of monovalent fragments derived from monoclonal mouse immunoglobulin G1 is inefficient because of side reactions during reoxidation of the multiple disulfide bonds linking the heavy chains. These side reactions can be avoided by using specific dithiol complexing agents such as arsenite and effecting disulfide formation with a thiol activating agent such as 5,5'-dithiobis(2-nitrobenzoic acid). In this way bispecific antibodies were obtained in high yield and free of monospecific contaminants from monoclonal mouse immunoglobulin G1 fragments. The bispecific antibodies were used as agents for the selective immobilization of enzymes.
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239
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Brennan M. Adverse effects of NSAIDs. CANADIAN MEDICAL ASSOCIATION JOURNAL 1985; 132:733. [PMID: 3978491 PMCID: PMC1345851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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240
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Glenn J, Kinsella T, Glatstein E, Tepper J, Baker A, Sugarbaker P, Sindelar W, Roth J, Brennan M, Costa J. A randomized, prospective trial of adjuvant chemotherapy in adults with soft tissue sarcomas of the head and neck, breast, and trunk. Cancer 1985; 55:1206-14. [PMID: 3882217 DOI: 10.1002/1097-0142(19850315)55:6<1206::aid-cncr2820550612>3.0.co;2-e] [Citation(s) in RCA: 111] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Since 1977, 31 patients were entered in a randomized, prospective study testing the efficacy of adjuvant chemotherapy after aggressive local treatment of high-grade sarcomas of the head, neck, breast, and trunk (excluding retroperitoneal sarcomas). All patients had complete resection of gross tumor and underwent postoperative radiotherapy (6000-6300 rads over 7-8 weeks). Seventeen patients received adjuvant chemotherapy consisting of doxorubicin (less than or equal to 550 mg/m2), cyclophosphamide (less than or equal to 5500 mg/m2), and methotrexate (less than or equal to 1000 mg/kg). Three-year actuarial disease-free survival in the chemotherapy arm was 77%, compared to 49% in the no-chemotherapy arm (P = 0.075). Three-year overall actuarial survivals in the two treatment arms, however, were 68% and 58%, respectively (P = 0.38). Considering only patients with tumors of the trunk (22 patients), 3-year actuarial disease-free survival in the chemotherapy arm was 92%, compared to 47% in the no-chemotherapy arm (P = 0.006). Actuarial 3-year overall survival in the chemotherapy arm was 82%, compared to 61% in the no-chemotherapy arm (P = 0.18). An additional 26 patients were treated in an identical fashion, but were not part of the randomized trial because of contraindications to chemotherapy, refusal to enter the randomized trial, or because they were treated before 1977 in a trial in which all patients received chemotherapy. Considering the entire group of 57 patients, follow-up ranged from 10 to 86 months (median, 35 months). Local control was achieved in 46 patients (81%); 3-year actuarial disease-free and overall survivals were 67% and 77%, respectively. A tendency toward improved disease-free survival was apparent among patients treated with chemotherapy (P = 0.018), but there was no statistically significant improvement in overall actuarial survival (P = 0.46). The subgroup of patients with sarcomas of the trunk (39 patients) demonstrated the greatest benefit from chemotherapy, with regard to disease-free survival (P less than or equal to 0.001). The most significant toxicity associated with chemotherapy was doxorubicin-induced cardiomyopathy, which resulted in clinically apparent congestive heart failure in five patients. Thus, the use of chemotherapy when combined with aggressive local measures appears to improve disease-free survival, but additional patients and longer follow-up are necessary to determine if improved overall survival will result.
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241
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Brennan M, Kirkland J. Comparison of perceptual dimensions uncovered from infant-cry signals using the method of pair-comparisons and the semantic differential. Scand J Psychol 1985; 26:12-20. [PMID: 4001894 DOI: 10.1111/j.1467-9450.1985.tb01137.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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242
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Gowdey CW, Brennan M. Adverse Drug Reaction Reporting Program of the Ontario Medical Association: the first 3 years. CANADIAN MEDICAL ASSOCIATION JOURNAL 1985; 132:19-23. [PMID: 3871167 PMCID: PMC1346498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This paper describes the Adverse Drug Reaction Reporting Program developed and operated by the Committee on Drugs and Pharmaco-therapy of the Ontario Medical Association. Analyses were done to demonstrate some of the trends derived from the reports. Some of the clinical observations based on the reports, which are published quarterly and circulated to physicians and to pharmacy, nursing and hospital organizations, are also reviewed.
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243
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Brennan M. Adverse effects of NSAIDs on renal function. CANADIAN MEDICAL ASSOCIATION JOURNAL 1984; 131:1012-3. [PMID: 6498709 PMCID: PMC1483785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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244
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Neville-Smith CH, Brandon S, Harrison RF, Brennan M. How informed are patients who have given informed consent? BRITISH MEDICAL JOURNAL 1984; 289:558. [PMID: 11658541 PMCID: PMC1442753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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245
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Harrison RF, Brennan M. How informed are patients who have given informed consent? West J Med 1984. [DOI: 10.1136/bmj.289.6444.558-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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246
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Abstract
One hundred and eighty one primigravid women delivering vaginally in July and August 1982 in the Rotunda Hospital, Dublin, were randomly allocated to one of two groups. Patients in one group were to undergo episiotomy. Those in the other group were not to undergo episiotomy unless it was considered to be essential. The outcome was compared with that of the clinical practice over the previous six months at the hospital. Of the 92 patients allocated not to undergo episiotomy, seven (8%) had one done for medical reasons compared with 507 (89%) in the previous six months. First degree tears occurred in 23 (25%) and second degree tears in 43 (47%). Nineteen (21%), however, retained an intact perineum compared with only 35 (6%) of the women who had delivered in the preceding six months. Assessments of perineal pain, bruising, swelling, and healing and records of ingestion of analgesics were made for the first four days after delivery, and again at a check up six weeks after delivery, in patients who had had spontaneous vertex deliveries. Forty patients who underwent episiotomy and 37 who sustained a second degree tear formed two comparable groups. There was no difference in outcome between them. Data were also evaluated for 19 women who retained an intact perineum, 22 who sustained a first degree tear, and 11 who underwent episiotomy and epidural anaesthesia; all 52 of these women had spontaneous vertex deliveries. Despite severe soft tissue injury in two patients those who fared best were those who retained an intact perineum. First degree tears were associated with symptoms similar to those associated with second degree tears. Those who fared worst were women who underwent episiotomy after epidural anaesthesia. The value of routine episiotomy in primigravid patients is questioned, but the final decision can be made only by the accoucheur at the time of imminent delivery.
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247
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Fulton A, Heppner G, Roi L, Howard L, Russo J, Brennan M. Relationship of natural killer cytotoxicity to clinical and biochemical parameters of primary human breast cancer. Breast Cancer Res Treat 1984; 4:109-16. [PMID: 6743837 DOI: 10.1007/bf01806393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We have determined the natural killer (NK) activity of peripheral blood lymphocytes obtained from 121 women undergoing surgery for primary breast cancer. NK activity was measured using 51Cr-labeled K562 target cells and effector: target ratios of 100:1, 50:1 and 10:1. The patients' lymphocytes gave a wide range of values with a mean (+/- S.E.) cytotoxicity of 22.6% +/- 1.3, and a median of 20.9% at the 50:1 effector:target ratio. These results did not differ significantly from the mean and median NK levels obtained with the peripheral blood lymphocytes of normal blood donors (mean = 23.1% +/- 1.9, median = 18.8%). Mean NK activity determined at the first postsurgical examination (less than or equal to 6 months postoperative) was significantly lower than the mean NK activity at surgery. The most significant decreases were seen in patients undergoing chemotherapy prior to the first follow-up examination. Subsequent tests (greater than 6 mo, less than or equal to 12 mo) show a recovery of NK activity to preoperative levels. A negative correlation was seen between NK level and maximum tumor diameter. NK levels also varied with tumor histiotype. No association was seen between NK levels and either the number of involved lymph nodes, pathologic tumor grade, the presence of estrogen or progesterone receptor, or the age, menopausal status or smoking history of the patients. A positive correlation was seen, however, between NK levels and number of pregnancies and live births.
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248
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Tomasson HO, Brennan M, Bass MJ. Tuberculosis and nonsteroidal anti-inflammatory drugs. CANADIAN MEDICAL ASSOCIATION JOURNAL 1984; 130:275-8. [PMID: 6692212 PMCID: PMC1875351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In 1980 and 1982 two case reports documented reactivation of pulmonary tuberculosis in patients who had used nonsteroidal anti-inflammatory drugs (NSAIDs). A case-control study was designed to test the hypothesis that such an association does exist. Data for 38 patients were obtained from the patients' family physicians, and each patient was matched with a control from the same practice for age, sex, race and length of time in that practice. A statistically significant relation was found between the reactivation of tuberculosis and the use of NSAIDs. However, further research is imperative to determine whether the association is direct, indirect or secondary to an unknown factor. Physicians should keep in mind that NSAIDs are potent anti-inflammatory agents and may thus activate, spread and mask infections.
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249
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Brennan M, Kirkland J. Perceptual dimensions of infant cry signals: a semantic differential analysis. Percept Mot Skills 1983; 57:575-81. [PMID: 6634341 DOI: 10.2466/pms.1983.57.2.575] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the present study the Semantic Differential technique was used to examine perceived characteristics of infant cry sounds. 24 cries (6 each of pain, hunger, birth, and "pleasure") were rated by 39 mothers on 50 scales. A factor analysis of the scale ratings uncovered three main factors, labelled Affect, Potency, and Evaluation, respectively. 5 "factorially-pure" scales were selected to represent each factor. A hierarchical cluster analysis of the mean factor-scale ratings uncovered 3 major cry clusters which essentially represented 3 cry-type groups, hunger, pleasure, and pain/birth. A close correspondence was found between this set of clusters and another set generated independently from cry-recognition data, indicating that the semantic differential factor-scales effectively discriminated perceptually distinct cries. This procedure adequately separates the physical (acoustic) properties of signals from their listener-perceived (auditory) ones. This distinction is not possible with studies which depend upon multivariate techniques and casts doubt on their findings.
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250
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Abstract
The cross-linked peptides in cyanogen bromide digests from rabbit and calf fibrils of type I collagen have been compared by gel filtration and electrophoresis. Fibrils were prepared in vitro from acid-soluble collagen, or tendons were used; both were reduced with borohydride to stabilize cross-linking adducts. The cross-linked peptides were isolated and hydrolyzed, and the reducible cross-links were analyzed. We propose that a prominent pattern of cross-linking involves in-register palisades of molecules overlapping by 27 nm and joined through the condensation of amino-terminal aldol adducts on the carboxy-terminal helical regions of overlapping molecules. Lateral association probably occurs through the carboxy-terminal aldehydes from two molecules forming tri- or quadrivalent adducts with residues in the overlapped molecule. This model favors the recently proposed quasi-hexagonal organization of molecules in fibrils in which rows of molecules occur in lateral register.
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