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Berger Y, Sullivan BJ, Bekhor EY, Carpiniello M, Leigh NL, Pletcher ER, Solomon D, Sarpel U, Hiotis SP, Labow DM, Cohen NA, Golas BJ. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Effects of postoperative fluids beyond the first 24 h. J Surg Oncol 2023; 128:1133-1140. [PMID: 37519102 DOI: 10.1002/jso.27407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/27/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVES There are no guidelines for intravenous fluid (IVF) administration after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). This study assessed rates of post-CRS/HIPEC morbidity according to perioperative IVF administration. METHODS All patients undergoing CRS/HIPEC March 2007 to June 2018 were reviewed, recording clinicopathologic, operative, and postoperative variables. Patients were divided by peritoneal cancer index (PCI), comparing IVF volumes and types administered intraoperatively and during the first 72 h postoperatively. Optimal IVF rate cutoffs calculated using area under the receiver operating characteristic curves and Youden's index determined associations with complications. RESULTS Overall, 185 patients underwent CRS/HIPEC, and 81 (51%) had low PCI (<10) and 77 (49%) had high PCI (≥10). In low-PCI patients, high IVF rates on postoperative days (POD) #0-2 were associated with higher overall complications: POD#0 (46% vs. 89%, p = 0.001), POD#1 (40% vs. 86%, p < 0.05), and POD#2 (42% vs. 72%, p < 0.05). High IVF rates were associated with respiratory distress (7% vs. 26%, p = 0.02) on POD#0, ileus (14% vs. 47%, p = 0.007) and intensive care unit stay (11% vs. 33%, p = 0.022) on POD#1, and ICU stay (8% vs. 33%, p = 0.003) on POD#2. CONCLUSIONS For low PCI patients undergoing CRS/HIPEC, higher IVF rates were associated with postoperative complications. Post-CRS/HIPEC, IVF rates should be limited to prevent morbidity.
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Affiliation(s)
- Yael Berger
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brianne J Sullivan
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eliahu Y Bekhor
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew Carpiniello
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Natasha L Leigh
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric R Pletcher
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Solomon
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Umut Sarpel
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Spiros P Hiotis
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel M Labow
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noah A Cohen
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin J Golas
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Berger Y, Sullivan BJ, Leigh NL, Bekhor EY, Dhorajiya P, Mani M, Magge DR, Cha DE, Sarpel U, Hiotis SP, Labow DM, Ward SC, Golas BJ, Cohen NA. ASO Visual Abstract: Gallbladder Cancer: A Single-Institution 10-Year Experience-Analysis of Adenocarcinoma Subtypes and Tumors Arising From Intracholecystic Papillary Neoplasms. Ann Surg Oncol 2022. [PMID: 35595940 DOI: 10.1245/s10434-022-11793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yael Berger
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA.
| | - Brianne J Sullivan
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Natasha L Leigh
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Eliahu Y Bekhor
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Pooja Dhorajiya
- Department of Pathology, Mount Sinai Hospital/Icahn School of Medicine, The Lillian and Henry, M. Stratton-Hans Popper, New York, NY, USA
| | - Malary Mani
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Deepa R Magge
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Da Eun Cha
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Spiros P Hiotis
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Stephen C Ward
- Department of Pathology, Mount Sinai Hospital/Icahn School of Medicine, The Lillian and Henry, M. Stratton-Hans Popper, New York, NY, USA
| | - Benjamin J Golas
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Noah A Cohen
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
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Berger Y, Sullivan BJ, Leigh NL, Bekhor EY, Dhorajiya P, Mani M, Magge DR, Cha DE, Sarpel U, Hiotis SP, Labow DM, Ward SC, Golas BJ, Cohen NA. Gallbladder Cancer: A Single-Institution 10-Year Experience-Analysis of Adenocarcinoma Subtypes and Tumors Arising from Intracholecystic Papillary Neoplasms. Ann Surg Oncol 2022; 29:5167-5175. [PMID: 35437668 DOI: 10.1245/s10434-022-11719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gallbladder cancer accounts for 1.2% of global cancer diagnoses. Literature on biliary-type adenocarcinoma (BTA), and specifically carcinoma arising from intracholecystic papillary-tubular neoplasms (ICPNs), is limited. This study describes a retrospective, single-institution experience with gallbladder cancer, focusing on histological subtypes and prognosis. METHODS A retrospective review was performed of patients who underwent cholecystectomy for a malignant neoplasm of the gallbladder between 2007 and 2017. Demographic, clinicopathologic, and operative variables, as well as survival outcomes, were analyzed. RESULTS From a total of 145 patients, BTAs were most common (93, 64%). Compared with non-BTAs, BTAs were diagnosed at a lower American Joint Committee on Cancer stage (p = 0.045) and demonstrated longer median recurrence-free survival (38 vs. 16 months, p = 0.014; median follow-up 36 months). Tumors arising from ICPNs (18, 12%) were more commonly associated with BTA (14 cases). Compared with BTAs not associated with ICPNs (29 patients), associated cases demonstrated lower pathologic stage (p = 0.006) and lower rates of liver and perineural invasion (0% vs. 49% and 14% vs. 48%, respectively; p < 0.05). Cumulative 5-year survival probability was higher for patients with gallbladder neoplasm of any subtype associated with ICPNs compared with those that were not associated with ICPNs (54% vs. 41%, p = 0.019; median follow-up 23 months). This difference was also significant when comparing BTAs associated with ICPNs and non-associated cases (63% vs. 52%, p = 0.005). CONCLUSIONS This study demonstrated unique pathological and prognostic features of BTAs and of carcinomas arising from ICPNs. Histopathological variance may implicate prognosis and may be used to better guide clinical decision making in the treatment of these patients.
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Affiliation(s)
- Yael Berger
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA.
| | - Brianne J Sullivan
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Natasha L Leigh
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Eliahu Y Bekhor
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Pooja Dhorajiya
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Malary Mani
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Deepa R Magge
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Da Eun Cha
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Spiros P Hiotis
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Stephen C Ward
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Benjamin J Golas
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Noah A Cohen
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
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Leigh N, Sullivan BJ, Anteby R, Talbert S. Perforated jejunal diverticulitis: a rare but important differential in the acute abdomen. Surg Case Rep 2020; 6:162. [PMID: 32632508 PMCID: PMC7338329 DOI: 10.1186/s40792-020-00929-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diverticulosis of the small bowel is rare and, in most cases, discovered incidentally. However, diverticulitis and other complications are important to consider in the differential of an acute abdomen, especially in the elderly population. CASE PRESENTATION The patient was a 59-year-old female who presented with acute lower abdominal pain progressing to peritonitis. Computed tomography scan showed a large inflamed and perforated diverticulum on the mesenteric side of the jejunum. Exploratory laparotomy revealed a dilated proximal jejunum with a 5-cm inflamed and perforated mesenteric diverticulum. A small bowel resection with primary anastomosis was performed. CONCLUSIONS Jejunal diverticulitis remains a diagnostic challenge. Although uncommon, owing to its high mortality rate, it is an important clinical entity to consider and requires timely management.
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Affiliation(s)
- Natasha Leigh
- Department of General Surgery, Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital, 425 West 59th Street, Suite 7B, New York, NY 10019 USA
| | - Brianne J. Sullivan
- Department of General Surgery, Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital, 425 West 59th Street, Suite 7B, New York, NY 10019 USA
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Susan Talbert
- Department of General Surgery, Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital, 425 West 59th Street, Suite 7B, New York, NY 10019 USA
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Sullivan BJ, Leigh NL, Bekhor EY, Carpiniello M, Solomon D, Magge DR, Sarpel U, Golas BJ, Labow DM. Distal pancreatectomy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: Identifying risk and improving patient selection. Am J Surg 2020; 220:1235-1241. [PMID: 32654767 DOI: 10.1016/j.amjsurg.2020.06.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/22/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become a principal tool in the management of peritoneal carcinomatosis (PC), but inclusion of pancreatic resection to obtain optimal debulking remains controversial. METHODS We performed a retrospective review of 419 patients with PC who underwent CRS/HIPEC. The patients were divided into two cohorts, those with distal pancreatectomy (DP) and those without (NP), and morbidity and survival outcomes were compared. RESULTS The DP cohort (n = 37) and the NP cohort (n = 371) had similar clinicopathologic characteristics (age, p = 0.596; gender, p = 0.328; ASA, p = 0.072). Operative time, number of organs resected, and EBL were greater in the DP cohort (<0.0001). A complete cytoreduction was achieved in 90% of the NP cohort versus 69% of the DP cohort (p = 0.0004). Major perioperative morbidity was more common in those with pancreatic resection (41% vs 19%, p = 0.002). However, there was no significant difference in 90-day mortality or overall survival. CONCLUSION Achieving complete cytoreduction is critical to improving long term outcomes for patients with PC. Although pancreatic resections are associated with higher morbidity, short-term survival is not impacted adversely. Pancreatic involvement should not be a strict exclusion criterion for CRS/HIPEC, but patients need to be selected carefully, with close attention to disease burden prior to proceeding.
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Affiliation(s)
| | - Natasha L Leigh
- Division of Surgical Oncology, Mount Sinai St. Luke's Roosevelt, USA
| | - Eliahu Y Bekhor
- Division of Surgical Oncology, Mount Sinai St. Luke's Roosevelt, USA
| | | | - Daniel Solomon
- Division of Surgical Oncology, Mount Sinai St. Luke's Roosevelt, USA
| | - Deepa R Magge
- Division of Surgical Oncology, Mount Sinai St. Luke's Roosevelt, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Mount Sinai St. Luke's Roosevelt, USA
| | - Benjamin J Golas
- Division of Surgical Oncology, Mount Sinai St. Luke's Roosevelt, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Mount Sinai St. Luke's Roosevelt, USA
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Anteby R, Sullivan BJ, Mani M, Golas B. Recurrent metastatic primary inflammatory myofibroblast tumour of the gallbladder following pancreaticoduodenectomy. BMJ Case Rep 2020; 13:13/2/e232861. [PMID: 32047084 DOI: 10.1136/bcr-2019-232861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inflammatory myofibroblast tumour (IMT) is an uncommon soft tissue tumour with an unpredictable clinical course: mostly benign, occasionally locally aggressive and rarely capable of metastasis. Diagnosed mainly in the mesentery, omentum, retroperitoneum, pelvis and lungs, IMT is extremely rare as a primary gallbladder tumour. Despite improved radiographical capabilities, differentiating the tumour from other more common causes of gallbladder neoplasms necessitates histopathological and immunohistochemistry tests. Once diagnosed, malignant potential should be taken into consideration, striving for an en bloc R0 resection and postoperative long-term follow-up with routine ancillary imaging. The authors present the case of a recurrent primary IMT of the gallbladder, after two surgical treatments, including a pancreaticoduodenectomy. Now 3 years after initial diagnoses the patient is asymptomatic, but has developed local and distant metastases and is being treated with systemic corticosteroid.
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Affiliation(s)
- Roi Anteby
- Division of Surgical Oncology, Mount Sinai Hospital, New York, NY, USA .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Malary Mani
- Department of Pathology, Mount Sinai Hospital, New York, NY, USA
| | - Benjamin Golas
- Division of Surgical Oncology, Mount Sinai Hospital, New York, NY, USA
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Sullivan BJ, Maliha S, Henderson PW. Microsurgery Fellows' Impression of Clinical and Educational Offerings during Fellowship Year. J Reconstr Microsurg 2019; 36:191-196. [DOI: 10.1055/s-0039-1698468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background Acquisition of microsurgical skill and clinical knowledge is the primary goal of a microsurgery fellowship. There has yet to be any comprehensive reporting in the literature of how American microsurgery fellows viewed their curricula and training at the conclusion of their fellowship year.
Methods An anonymous, electronic survey was developed and distributed to all 2016 to 2017 microsurgery fellows (n = 37) at the U.S.-based microsurgery fellowship programs (n = 23). Qualitative questions were assessed using either a Likert-type scale of 1 (not at all) to 5 (very), multiple choice, or free response.
Results Twenty-six of 37 fellows (70%) responded to the survey. Respondents reported a mean of 14.4 lectures offered, with a range of 0 to 100. Dry laboratory simulation training was formally incorporated into 32% of microsurgery fellowships and live animal simulation training was formally incorporated into 12%. The median number of free deep inferior epigastric perforator flap cases performed was 112.5, ranging from 60 to 230. A majority felt that an organized microsurgical educational curriculum would be “beneficial,” with 42% reporting that an organized microsurgery curriculum would be “very beneficial.” Twenty-six of the respondents (100%) said that they would choose to do a microsurgery fellowship again if given the choice.
Conclusion Respondent data show that microsurgery fellows are satisfied with training, clinical experience is variable but adequate, educational experiences and opportunities vary from program to program, simulation skills training are perceived to be underutilized, and a program-organized microsurgery curriculum is believed to be advantageous to optimize development of technical and clinical skills.
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Affiliation(s)
- Brianne J. Sullivan
- Department of Surgery, Mount Sinai St. Luke's/Roosevelt Hospital, New York, New York
| | - Samantha Maliha
- Hansjörg Wyss Department of Plastic Surgery, Langone NYU School of Medicine, New York, New York
| | - Peter W. Henderson
- Division of Plastic Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Sullivan BJ, Bekhor EY, Carpiniello M, Leigh NL, Pletcher ER, Solomon D, Magge DR, Sarpel U, Labow DM, Golas BJ. Diaphragmatic Peritoneal Stripping Versus Full-Thickness Resection in CRS/HIPEC: Is There a Difference? Ann Surg Oncol 2019; 27:250-258. [DOI: 10.1245/s10434-019-07797-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 12/30/2022]
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Sullivan BJ, Bolton N, Sarpel U, Magge D. A unique presentation of superinfected pseudomyxoma peritonei secondary to a low-grade appendiceal mucinous neoplasm. World J Surg Oncol 2019; 17:34. [PMID: 30777068 PMCID: PMC6379993 DOI: 10.1186/s12957-019-1578-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/11/2019] [Indexed: 11/22/2022] Open
Abstract
Background Pseudomyxoma peritonei (PMP) is an uncommon condition characterized by diffuse mucinous material in the abdomen and pelvis, generally arising from a perforated epithelial neoplasm. Typically, the disease presents as suspected acute appendicitis, ovarian mass, abdominal distension, or ventral hernia. Our case represents a very rare presentation of superinfected PMP. Case presentation A 46-year-old female with a past medical history notable for depression, asthma, and uterine leiomyomas presented to an urgent care with 5 days of progressive abdominal pain, bloating, nausea, and subjective fevers. The patient had a diffusely tender abdomen, without peritonitis, was mildly tachycardic, and had a white blood cell count of 15 K. A CT of the abdomen/pelvis was consistent with PMP with a ruptured appendiceal mucocele versus PMP secondary to an adnexal ovarian neoplastic pathology with an infectious component. The patient initially improved on antibiotics but ultimately required two surgeries, the first of which controlled intraabdominal sepsis while the second permitted definitive management of PMP with cytoreductive surgery (CRS) and HIPEC. Conclusion Superinfected PMP is a rare entity with very few documented cases. A staged approach that incorporates clearing the peritoneal infection, with or without resection of the primary tumor, followed by rehabilitation and definitive surgery appears to be a safe and effective management strategy.
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Affiliation(s)
- Brianne J Sullivan
- Department of Surgical Oncology, Mount Sinai St. Luke's West Hospital, 425 W. 59th St., 7th Floor, New York, NY, 10019, USA.
| | - Nathan Bolton
- Department of Surgical Oncology, Mount Sinai St. Luke's West Hospital, 425 W. 59th St., 7th Floor, New York, NY, 10019, USA
| | - Umut Sarpel
- Department of Surgical Oncology, Mount Sinai St. Luke's West Hospital, 425 W. 59th St., 7th Floor, New York, NY, 10019, USA
| | - Deepa Magge
- Department of Surgical Oncology, Mount Sinai St. Luke's West Hospital, 425 W. 59th St., 7th Floor, New York, NY, 10019, USA
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Sullivan BJ, Kim GJ, Sara G. Treatment dilemma for survivors of rituximab-induced bowel perforation in the setting of post-transplant lymphoproliferative disorder. BMJ Case Rep 2018; 11:e226666. [PMID: 30567238 PMCID: PMC6301592 DOI: 10.1136/bcr-2018-226666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 12/17/2022] Open
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a recognised complication of solid and haematopoietic stem cell transplant. It consists of a heterogeneous group of lymphoid neoplasms that arises secondary to post-transplant immunosuppression. Although there is no definite standard of care for the optimal treatment for PTLD, rituximab, a monoclonal antibody, with and/or without chemotherapy (usually CHOP=cytoxan, doxorubicin, vincristine, prednisone) has become a routine part of the treatment of any CD20 (+) PTLD, with response rates similar to chemotherapy with decreased toxicity. A rare and often lethal, complication of rituximab therapy for PTLD is bowel perforation secondary to tumour lysis of lymphoma involving the intestine. A small number of cases of bowel perforation have been reported, with very few documented survivors. The risk for recurrent perforation in the setting of ongoing rituximab treatment is unknown. There is sparse data supporting how to best treat the survivors.
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Affiliation(s)
- Brianne J Sullivan
- Department of Surgery, Mount Sinai Health System, New York, New York, USA
| | - Grace J Kim
- Department of Surgery, Mount Sinai Health System, New York, New York, USA
| | - Gabriel Sara
- Department of Oncology, Mount Sinai Health System, New York, New York, USA
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11
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Carter BM, Sullivan BJ, Landers JR, Kadam SD. Dose-dependent reversal of KCC2 hypofunction and phenobarbital-resistant neonatal seizures by ANA12. Sci Rep 2018; 8:11987. [PMID: 30097625 PMCID: PMC6086916 DOI: 10.1038/s41598-018-30486-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/31/2018] [Indexed: 01/22/2023] Open
Abstract
Neonatal seizures have an incidence of 3.5 per 1000 newborns; while hypoxic-ischemic encephalopathy (HIE) accounts for 50-60% of cases, half are resistant to 1st-line anti-seizure drugs such as phenobarbital (PB). Tyrosine receptor kinase B (TrkB) activation following ischemic injury is known to increase neuronal excitability by downregulation of K-Cl co-transporter 2 (KCC2); a neuronal chloride (Cl-) co-transporter. In this study, three graded doses of ANA12, a small-molecule selective TrkB antagonist, were tested in CD1 mice at P7 and P10 following induction of neonatal ischemia by a unilateral carotid ligation. The PB loading dose remained the same in all treatment groups at both ages. Evaluation criteria for the anti-seizure efficacy of ANA12 were: (1) quantitative electroencephalographic (EEG) seizure burden and power, (2) rescue of post-ischemic KCC2 and pKCC2-S940 downregulation and (3) reversal of TrkB pathway activation following ischemia. ANA12 significantly rescued PB resistant seizures in a dose-dependent manner at P7 and improved PB efficacy at P10. Additionally, female pups responded better to lower doses of ANA12 compared to males. ANA12 significantly reversed post-ischemic KCC2 downregulation and TrkB pathway activation at P7 when PB alone was inefficacious. Rescuing KCC2 hypofunction may be critical for preventing emergence of refractory seizures.
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Affiliation(s)
- B M Carter
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA
| | - B J Sullivan
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA
| | - J R Landers
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA
| | - S D Kadam
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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Anderson ORJ, Small CJ, Croxall JP, Dunn EK, Sullivan BJ, Yates O, Black A. Global seabird bycatch in longline fisheries. ENDANGER SPECIES RES 2011. [DOI: 10.3354/esr00347] [Citation(s) in RCA: 277] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Romanowski B, de Borba PC, Naud PS, Roteli-Martins CM, De Carvalho NS, Teixeira JC, Aoki F, Ramjattan B, Shier RM, Somani R, Barbier S, Blatter MM, Chambers C, Ferris D, Gall SA, Guerra FA, Harper DM, Hedrick JA, Henry DC, Korn AP, Kroll R, Moscicki AB, Rosenfeld WD, Sullivan BJ, Thoming CS, Tyring SK, Wheeler CM, Dubin G, Schuind A, Zahaf T, Greenacre M, Sgriobhadair A. Sustained efficacy and immunogenicity of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine: analysis of a randomised placebo-controlled trial up to 6.4 years. Lancet 2009; 374:1975-85. [PMID: 19962185 DOI: 10.1016/s0140-6736(09)61567-1] [Citation(s) in RCA: 276] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prophylactic human papillomavirus (HPV) vaccines have to provide sustained protection. We assessed efficacy, immunogenicity, and safety of the HPV-16/18 AS04-adjuvanted vaccine up to 6.4 years. METHODS Women aged 15-25 years, with normal cervical cytology, who were HPV-16/18 seronegative and oncogenic HPV DNA-negative (14 types) at screening participated in a double-blind, randomised, placebo-controlled initial study (n=1113; 560 vaccine group vs 553 placebo group) and follow-up study (n=776; 393 vs 383). 27 sites in three countries participated in the follow-up study. Cervical samples were tested every 6 months for HPV DNA. Management of abnormal cytologies was prespecified, and HPV-16/18 antibody titres were assessed. The primary objective was to assess long-term vaccine efficacy in the prevention of incident cervical infection with HPV 16 or HPV 18, or both. We report the analyses up to 6.4 years of this follow-up study and combined with the initial study. For the primary endpoint, the efficacy analysis was done in the according-to-protocol (ATP) cohort; the analysis of cervical intraepithelial neoplasia grade 2 and above (CIN2+) was done in the total vaccinated cohort (TVC). The study is registered with ClinicalTrials.gov, number NCT00120848. FINDINGS For the combined analysis of the initial and follow-up studies, the ATP efficacy cohort included 465 women in the vaccine group and 454 in the placebo group; the TVC included 560 women in the vaccine group and 553 in the placebo group. Vaccine efficacy against incident infection with HPV 16/18 was 95.3% (95% CI 87.4-98.7) and against 12-month persistent infection was 100% (81.8-100). Vaccine efficacy against CIN2+ was 100% (51.3-100) for lesions associated with HPV-16/18 and 71.9% (20.6-91.9) for lesions independent of HPV DNA. Antibody concentrations by ELISA remained 12-fold or more higher than after natural infection (both antigens). Safety outcomes were similar between groups: during the follow-up study, 30 (8%) participants reported a serious adverse event in the vaccine group versus 37 (10%) in the placebo group. None was judged related or possibly related to vaccination, and no deaths occurred. INTERPRETATION Our findings show excellent long-term efficacy, high and sustained immunogenicity, and favourable safety of the HPV-16/18 AS04-adjuvanted vaccine up to 6.4 years. FUNDING GlaxoSmithKline Biologicals (Belgium).
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Belongia EA, Sullivan BJ, Chyou PH, Madagame E, Reed KD, Schwartz B. A community intervention trial to promote judicious antibiotic use and reduce penicillin-resistant Streptococcus pneumoniae carriage in children. Pediatrics 2001; 108:575-83. [PMID: 11533321 DOI: 10.1542/peds.108.3.575] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Inappropriate use of antibiotics is common in primary care, and effective interventions are needed to promote judicious antibiotic use and reduce antibiotic resistance. The objective of this study was to assess the impact of parent and clinician education on pediatric antibiotic prescribing and carriage of penicillin-nonsusceptible Streptococcus pneumoniae in child care facilities. METHODS A nonrandomized, controlled, community intervention trial was conducted in northern Wisconsin Clinicians. Clinic staff received educational materials and small-group presentations; materials were distributed to parents through clinics, child care facilities, and community organizations. Prescribing data were analyzed for 151 clinicians who provided primary pediatric care; nasopharyngeal carriage of penicillin-nonsusceptible S pneumoniae was assessed for 664 children in the baseline period (January-June 1997) and for 472 children in the postintervention period (January-June 1998). RESULTS The median number of solid antibiotic prescriptions per clinician declined 19% in the intervention region and 8% in the control region. The median number of liquid antibiotic prescriptions per clinician declined 11% in the intervention region, compared with an increase of 12% in the control region. Retail antibiotic sales declined in the intervention region but not in the control region. Among participating children in child care facilities, there were no significant differences in antibiotic use or penicillin-nonsusceptible S pneumoniae colonization between the intervention and control regions. CONCLUSIONS A multifaceted educational program for clinicians and parents led to community-wide reductions in antibiotic prescribing, but in child care facilities, there was no apparent impact on judicious antibiotic use or colonization with drug-resistant S pneumoniae. Longer follow-up time or greater reductions in antibiotic use may be required to identify changes in the pneumococcal susceptibility.
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Affiliation(s)
- E A Belongia
- Marshfield Medical Research Foundation and Marshfield Clinic, Marshfield, Wisconsin, USA.
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15
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Brown JA, Phang PT, Sullivan BJ, Mason AC. Cecocutaneous fistula after remote appendectomy: case report. Can Assoc Radiol J 2000; 51:20-2. [PMID: 10711290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- J A Brown
- Department of Radiology, St. Paul's Hospital, Vancouver, BC
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16
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Ferrer M, Sullivan BJ, Godbout KL, Burke E, Stump HS, Godoy J, Golden A, Profy AT, van Schravendijk MR. Structural and functional characterization of an epitope in the conserved C-terminal region of HIV-1 gp120. J Pept Res 1999; 54:32-42. [PMID: 10448968 DOI: 10.1034/j.1399-3011.1999.00082.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Through an integrated study of the reactivity of a monoclonal antibody, 803-15.6, with synthetic peptides and native recombinant HIV-1 envelope glycoprotein gp120, we have obtained structure-functional information on a region of rgp120 not yet elucidated by X-ray crystallography. mAb 803-15.6 binds with high affinity and broad cross-clade specificity to the conserved C-terminal region (amino acids 502-516) of HIV-1 rgp120. Phage display selection from a random peptide library identified the core binding motif as AXXKXRH, homologous to residues 502-508. Using quantitative binding analyses, the affinity of mAb 803-15.6 for native, monomeric recombinant gp120HXB2 (rgp120) was found to be similar to that for the synthetic gp120 peptide (502-516). Circular dichroism studies indicate that the synthetic peptide largely has a random coil conformation in solution. The results therefore suggest that the 803-15.6 epitope is fully accessible on rgp120 and that this region of rgp120 is as flexible as the synthetic peptide. Residues 502-504 are on the edge of a putative gp41 binding site that has been postulated to change conformation on CD4 binding. However, the affinity of mAb 803-15.6 for rgp120 is not affected by binding of CD4 and vice-versa. These results suggest either that the 502-504 region does not change conformation upon CD4 binding, or that recombinant gp120 does not undergo the same changes as occur in the native viral gp120-gp41 oligomer. The detailed characterization of the 803-15.6 epitope may be useful for further study of the role of the C5 region of gp120 in the viral attachment and fusion process.
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Affiliation(s)
- M Ferrer
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138, USA
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17
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Sullivan BJ, Sekhar LN, Duong DH, Mergner G, Alyano D. Profound hypothermia and circulatory arrest with skull base approaches for treatment of complex posterior circulation aneurysms. Acta Neurochir (Wien) 1999; 141:1-11; discussion 11-2. [PMID: 10071680 DOI: 10.1007/s007010050259] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cardiopulmonary bypass with profound hypothermia and circulatory arrest has seen a resurgence as an adjunct technique in neurological surgery. We report our experience with this technique in treating seven complex vertebro-basilar aneurysms. METHODS Skull base approaches were used in all cases, providing excellent exposure and minimizing brain retraction. There were six basilar artery aneurysms and one giant fusiform vertebro-basilar artery aneurysm. All aneurysms but one had an apparent neck, which could be clipped. The fusiform vertebro-basilar artery aneurysm was trapped, partially resected, and the circulation was reestablished with a saphenous vein graft from the cervical internal carotid artery to the mid-basilar artery. RESULTS Five patients had an excellent outcome and two had a good outcome at one year or at latest follow up. Two of the patients showed improvement of neurological deficits which were present before the surgical intervention. CONCLUSION Applying very strict selection criteria in this small series of patients with posterior circulation aneurysms, excellent or good results were achieved using the profound hypothermic circulatory arrest technique.
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Affiliation(s)
- B J Sullivan
- Department of Neurological Surgery, George Washington University Medical Center, Washington DC, USA
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18
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Sekhar LN, Sullivan BJ. Hypothermic circulatory arrest in neurovascular surgery: evolving indications and predictors of patient outcome. Neurosurgery 1999; 44:686-7. [PMID: 10069610 DOI: 10.1097/00006123-199903000-00154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Golden A, Austen DA, van Schravendijk MR, Sullivan BJ, Kawasaki ES, Osburne MS. Effect of promoters and signal sequences on the production of secreted HIV-1 gp120 protein in the baculovirus system. Protein Expr Purif 1998; 14:8-12. [PMID: 9758745 DOI: 10.1006/prep.1998.0926] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We compared insect cell production levels of secreted HIV-1 gp120 glycoprotein encoded by five different baculovirus expression constructs. Combinations consisting of one of two baculovirus promoters (very late or hybrid late/very late) and one of three different signal sequences [human tissue plasminogen activator (tpa), human placental alkaline phosphatase (pap), or baculovirus envelope glycoprotein (gp67)] were constructed. Production of secreted gp120 from these constructs was analyzed in two enzyme-linked immunosorbent assay formats, one detecting the total amount of secreted gp120 protein and the other measuring the level of "active" gp120 (as defined by the ability to bind to CD4). We found that for all of the constructs, approximately 50 to 90% of the secreted gp120 protein was active. Furthermore, our results indicated that expression from either promoter yielded comparable production of secreted protein, despite the fact that transcription from the hybrid promoter begins at an earlier time. By contrast, the signal sequence had a much greater effect on the levels of secreted gp120: the tpa leader yielded the highest level of secreted protein, followed by the gp67 and pap sequences. This result suggests that transcription is not a limiting factor in the production of secreted gp120, but rather that downstream processing of the protein is more critical. Furthermore, these results confirm the notion that the "optimal" signal sequence is protein dependent and that an insect-derived signal sequence is not optimal in all cases.
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Affiliation(s)
- A Golden
- Procept, Inc., 840 Memorial Drive, Cambridge, Massachusetts, 02139, USA
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20
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Bejjani GK, Duong DH, Kalamarides M, Ziyal I, Sullivan BJ. Cerebral vasospasm after tumor resection. A case report. Neurochirurgie 1998; 43:164-8. [PMID: 9696892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE AND IMPORTANCE Symptomatic cerebral vasospasm can occur after resection of tumors in or adjacent to the basal cisterns, causing delayed neurological deterioration. This potentially treatable condition may go unrecognized. Delay in its recognition will adversely affect the outcome of the patients. There has been a few cases of vasospasm after tumoral resection reported in the literature, mostly in adults. We report a case of vasospasm after resection of a third nerve schwannoma in a pediatric patient. This is the youngest patient reported to date with vasospasm after resection of a brain tumor. CLINICAL PRESENTATION A six years old girl presented with sudden onset diplopia. Radiological work-up revealed a third nerve mass. She underwent a craniotomy for resection of her mass. Pathological findings were consistent with a third nerve schwannoma. One week postoperatively, her mental status deteriorated. A CT scan revealed a diffuse hypodense area involving the right frontal and temporal lobes in the middle cerebral artery distribution as well as the midbrain. The absence of these findings on the MRI imaging performed on the first postoperative day made us evoke a vascular etiology. A cerebral angiogram was performed and revealed vasospasm in the right internal carotid artery and in the right middle and posterior cerebral arteries. Hyperdynamic hypervolemic hemodilutional therapy was instituted. CONCLUSION Delayed clinical deterioration from vasospasm is a potentially reversible condition, if recognized early. A high index of suspicion should be maintained in case delayed clinical deterioration occurs after surgery of tumors in the basal cisterns. Cerebral angiography will confirm the diagnosis. Early institution of hyperdynamic hypervolemic hemodilutional therapy and angioplasty may reverse the deficit and improve outcome.
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Affiliation(s)
- G K Bejjani
- Department of Neurosurgery, George Washington University, Washington, DC 20037, USA
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21
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Ferrer M, Godbout KL, Sullivan BJ, Austen DA, Sanderson CT, Kelley KC, Osburne MS, Harrison SC, van Schravendijk MR. Construction and characterization of a radio-iodinatable mutant of recombinant human CD4. J Immunol Methods 1997; 210:215-25. [PMID: 9520304 DOI: 10.1016/s0022-1759(97)00195-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recombinant soluble human CD4 (rsCD4) has been used in iodinated form to study the interaction of CD4 with its ligands. However, the utility of [125I]-rsCD4 is limited because rsCD4 is inefficiently iodinated and the iodinated protein is poorly active. The iodination properties of rsCD4 most likely reflect the poor accessibility of the tyrosine residues, apparent from the available X-ray structures. We have generated an iodinatable mutant of rsCD4 by substituting Tyr for Phe(179) in the flexible, solvent-exposed C-terminal region of rsCD4(183), a truncated form of CD4 that consists of the first 183 residues of CD4 and includes the binding sites for HIV-1 gp120 and MHC class II molecules. When F179Y rsCD4(183) is iodinated under trace-labeling conditions, the efficiency of 125I incorporation and the percentage of iodinated molecules that are active are much enhanced compared with WT rsCD4. Moreover, trace-labeled [125I]-F179Y rsCD4(183) has the same affinity for HIV-1 rgp120 as unlabeled WT rsCD4. The improved activity of trace-labeled [125I]-F179Y rsCD4(183) appears to be due to effective competition by Y179 for reactive iodine species that, in WT rsCD4, react with traces of denatured protein and/or with residues critical for activity or conformational integrity. The incorporation of accessible tyrosine residues may improve the iodinatibility of a protein both by introducing a readily iodinatable residue and by protecting sensitive proteins from adverse reactions.
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Affiliation(s)
- M Ferrer
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA 02138, USA
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22
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24
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Abstract
A similarity measure based on the number of coincident bits in multichannel images is presented. The similarity criterion incorporated in the image registration algorithm uses a coincident bit counting (CBC) method to obtain the number of matching bits between the frames of interest. The CBC method not only performs favorably compared with traditional techniques, but also renders simpler implementation in conventional computing machines. An image registration algorithm that incorporates the CBC criterion is proposed to determine the translation motion among sequences of images. The errors caused by noise, misregistration, and a combination of these two are analyzed. Some experimental studies using low-contrast coronary images from a digital angiographic sequence are discussed. The results compare favorably with those obtained by using other nonparametric methods.
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Affiliation(s)
- J Y Chiang
- Dept. of Electr. Eng. & Comput. Sci., Northwestern Univ., Evanston, IL
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25
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Abstract
The expectation maximization (EM) algorithm has received considerable attention in the area of positron emitted tomography (PET) as a restoration and reconstruction technique. In this paper, the restoration capabilities of the EM algorithm when applied to radiographic images is investigated. This application does not involve reconstruction. The performance of the EM algorithm is quantitatively evaluated using a "perceived" signal-to-noise ratio (SNR) as the image quality metric. This perceived SNR is based on statistical decision theory and includes both the observer's visual response function and a noise component internal to the eye-brain system. For a variety of processing parameters, the relative SNR (ratio of the processed SNR to the original SNR) is calculated and used as a metric to compare quantitatively the effects of the EM algorithm with two other image enhancement techniques: global contrast enhancement (windowing) and unsharp mask filtering. The results suggest that the EM algorithm's performance is superior when compared to unsharp mask filtering and global contrast enhancement for radiographic images which contain objects smaller than 4 mm.
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Affiliation(s)
- J C Brailean
- Department of Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois 60208
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26
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Sullivan BJ. Immune response to Hib conjugate vaccine. Am J Dis Child 1992; 146:145-7. [PMID: 1580909 DOI: 10.1001/archpedi.1992.02160140011005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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27
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Dlesk A, Balian AA, Sullivan BJ, Mitchell PD, Marx JJ. Diagnostic dilemma for the 1990s: Lyme disease versus rheumatic fever. Wis Med J 1991; 90:632-4. [PMID: 1759468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 15-year-old boy developed an annular erythematous skin rash, fever, knee pain, syncope, and was found to be in complete heart block requiring temporary transvenous pacing. His recovery was complete following therapy with high dose steroids, aspirin, and IV ceftriaxone followed by oral penicillin. Serologic tests documented diagnostic levels of antibodies to Borrelia burgdorferi as well as to Group A streptococcal DNase B. Diagnoses of both Lyme disease and rheumatic fever are based on clinical presentation and serologic confirmation. Our patient had a clinical presentation compatible with either diagnosis and serologic test results suggestive of infection by both B burgdorferi and Group A streptococci. The patient's management was aimed at preventing complications of both diseases, since clinicians involved with the patient's case could not agree on the most likely diagnosis. We present this case to emphasize the following: both rheumatic fever and Lyme disease should be considered in patients presenting with annular skin rashes and complete heart block; serologic studies may be confusing in both Lyme disease and rheumatic fever since neither is entirely sensitive nor specific and efforts should be made to document the causative organism by appropriate cultures, biopsies, and stains when possible; and improved immunoserologic testing for Lyme disease, in particular, is highly needed.
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Affiliation(s)
- A Dlesk
- U.P. Internal Medicine Associates, Marquette, Mich. 49855
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28
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Sullivan BJ, Swallow CJ, Girotti MJ, Rotstein OD. Bacterial translocation induces procoagulant activity in tissue macrophages. A potential mechanism for end-organ dysfunction. Arch Surg 1991; 126:586-90. [PMID: 2021342 DOI: 10.1001/archsurg.1991.01410290062013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The ability of bacterial translocation to induce cell-associated procoagulant activity was examined in a rodent model. Intestinal decontamination with streptomycin sulfate and bacitracin followed by oral feeding with a streptomycin-resistant strain of Escherichia coli produced monoassociation of the gastrointestinal tract with this microorganism. Using this model, the rate of bacterial translocation at day 3 increased from 6% (1 of 17) to 90% (28 of 31). Cell-associated procoagulant activity was measured in the mononuclear cell population of mesenteric lymph nodes as well as portal and systemic blood and also in hepatic nonparenchymal cells. In monoassociated animals, the procoagulant activity of mesenteric lymph node mononuclear cells was significantly greater than in control animals at day 3 (210% +/- 28% vs 100% +/- 6%) but not at days 1 or 6. Procoagulant activity of hepatic nonparenchymal cells was elevated in monoassociated animals at days 3 and 6 compared with control animals. Both control and monoassociated animals remained well throughout the experiment. The histologic features of the gastrointestinal tract, mesenteric nodes, and liver did not differ between groups. These studies provide evidence that bacterial translocation, in the absence of external stimuli, is able to induce cell activation at sites remote from the gastrointestinal tract and may therefore contribute to the pathogenesis of multiple organ failure.
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Affiliation(s)
- B J Sullivan
- Department of Surgery, University of Toronto, Ontario, Canada
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29
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Abstract
The antibody response to three Haemophilus influenzae type b vaccines was examined in 134 infants 17 to 22 months of age. Sera were collected from each subject before and 1 month after vaccination with either purified H. influenzae type b capsular polysaccharide (polyribosyl-ribitol phosphate (PRP] or one of two protein-conjugated vaccines (PRP-D or HbOC). Comparison of the two conjugate vaccines revealed that HbOC produced an antibody response greater than or equal to 1.0 micrograms/ml in 96% compared with 72% who were vaccinated with PRP-D (P less than 0.05). The isotype distribution of the antibodies produced by the two vaccines was similar. While all of the vaccines resulted in higher concentrations of anticapsular IgG1 than IgG2, the IgG1:IgG2 ratio was significantly higher in subjects immunized with HbOC. The IgG1:IgG2 ratio was similar in subjects immunized with PRP or PRP-D. The clinical significance of these observations remains to be determined.
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Affiliation(s)
- R B Turner
- Department of Pediatrics, Medical University of South Carolina, Charleston 29425
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30
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Sullivan BJ, Schiller MR, Horvath MC. Nutrition education and counseling: knowledge and skill levels expected by dietetic internship directors. J Am Diet Assoc 1990; 90:1418-22. [PMID: 2212425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Development of nutrition education and counseling skills is important in the educational preparation of dietitians. A national survey of dietetic internship directors was conducted to determine competency levels expected of students at the start of an internship, internship training given, and further preparation students need in 32 knowledge/skills areas deemed essential for delivery of nutrition education and counseling services. Completed questionnaires were received from 66 of 102 (65%) internship directors surveyed. The majority of directors expected only basic preparation for group nutrition education and individual counseling knowledge/skills areas. Internship training in nutrition education competencies was "moderate" to "extensive," whereas preparation in nutrition counseling competencies was more likely to be "extensive." Directors perceived the internship to provide adequate preparation in all but the advanced practice skills, such as behavior modification and motivational strategies, for which further preparation was recommended. The majority of internship directors reported that more than 25% of the intern practice experience was in patient counseling, with less experience in group instruction. Implications for undergraduate dietetic education are discussed in relation to internship directors' expectations as well as to present and future trends in the dietetic profession.
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Affiliation(s)
- B J Sullivan
- School of Home Economics, Ohio University, Athens 45701
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31
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Sloma A, Rufo GA, Rudolph CF, Sullivan BJ, Theriault KA, Pero J. Bacillopeptidase F of Bacillus subtilis: purification of the protein and cloning of the gene. J Bacteriol 1990; 172:5520-1. [PMID: 2118514 PMCID: PMC213227 DOI: 10.1128/jb.172.9.5520-5521.1990] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- A Sloma
- BioTechnica International, Inc., Cambridge, Massachusetts 02140
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32
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Sloma A, Rufo GA, Rudolph CF, Sullivan BJ, Theriault KA, Pero J. Bacillopeptidase F of Bacillus subtilis: purification of the protein and cloning of the gene. J Bacteriol 1990; 172:1470-7. [PMID: 2106512 PMCID: PMC208622 DOI: 10.1128/jb.172.3.1470-1477.1990] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We have purified a minor extracellular serine protease from Bacillus subtilis. Characterization of this enzyme indicated that it was most likely the previously reported enzyme bacillopeptidase F. The amino-terminal sequence of the purified protein was determined, and a "guess-mer" oligonucleotide hybridization probe was constructed on the basis of that sequence. This probe was used to identify and clone the structural gene (bpr) for bacillopeptidase F. The deduced amino acid sequence for the mature protein (496 amino acids) was preceded by a putative signal sequence of 30 residues and a putative propeptide region of 164 amino acids. The bpr gene mapped near pyrD on the chromosome and was not required for growth or sporulation.
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Affiliation(s)
- A Sloma
- BioTechnica International, Inc., Cambridge, Massachusetts 02140
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33
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Abstract
The gene for a novel extracellular metalloprotease was cloned, and its nucleotide sequence was determined. The gene (mpr) encodes a primary product of 313 amino acids that has little similarity to other known Bacillus proteases. The amino acid sequence of the mature protease was preceded by a signal sequence of approximately 34 amino acids and a pro sequence of 58 amino acids. Four cysteine residues were found in the deduced amino acid sequence of the mature protein, indicating the possible presence of disulfide bonds. The mpr gene mapped in the cysA-aroI region of the chromosome and was not required for growth or sporulation.
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Affiliation(s)
- A Sloma
- BioTechnica International, Inc., Cambridge, Massachusetts 02140
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34
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Abstract
We have isolated and characterized two minor extracellular proteases from culture supernatants of a strain of Bacillus subtilis containing deletion mutations of the genes for the extracellular proteases subtilisin (apr) and neutral protease (npr) and a minor extracellular protease (epr) as well as intracellular serine protease-I (isp-1). Characterization studies have revealed that one of these enzymes is the previously described protease bacillopeptidase F. The second enzyme, the subject of this report, is a novel metalloprotease, which we designate Mpr. Mpr is a unique metalloprotease that has been purified to apparent homogeneity by using both conventional and high-performance liquid chromatography procedures. Mpr has a molecular mass of approximately 28 kilodaltons on sodium dodecyl sulfate-polyacrylamide gel electrophoresis and a basic isoelectric point of 8.7. The enzyme showed maximal activity against azocoll at pH 7.5 and 50 degrees C. Mpr was inhibited by dithiothreitol and a combination of beta-mercaptoethanol and EDTA. Activity was moderately inhibited by beta-mercaptoethanol and EDTA alone as well as by cysteine and citrate and only marginally by phosphoramidon 1,10-phenanthroline and N-[N-(L-3-trans-carboxyoxiran-2-carbonyl)-L-leucyl]-agmatine. Mpr was not inhibited by phenylmethylsulfonyl fluoride. In addition, Mpr showed esterolytic but not collagenolytic activities. Our studies suggest that Mpr is a secreted metalloprotease containing cysteine residues that are required for maximal activity.
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Affiliation(s)
- G A Rufo
- BioTechnica International, Inc., Cambridge, Massachusetts 02140
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Abstract
This report describes a newborn with recurrent herpes simplex meningoencephalitis despite vigorous antiviral therapy. The course is unusual in that the presenting symptom was hoarseness. Despite probable adequate acyclovir levels in the spinal fluid, a second episode or progression of herpetic encephalitis occurred, suggesting impairment of host defenses, particularly cellular immunity. This episode was treated with both acyclovir and vidarabine. Pharmacokinetics of the antiviral therapy and immune responses are discussed.
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Affiliation(s)
- J C Opitz
- Department of Pediatrics, Marshfield Clinic, Wisconsin 54449
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Biellik RJ, Patriarca PA, Mullen JR, Rovira EZ, Brink EW, Mitchell P, Hamilton GH, Sullivan BJ, Davis JP. Risk factors for community- and household-acquired pertussis during a large-scale outbreak in central Wisconsin. J Infect Dis 1988; 157:1134-41. [PMID: 3373018 DOI: 10.1093/infdis/157.6.1134] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To identify risk factors associated with community- and household-acquired pertussis, we studied 61 households (HHs) with members with culture-positive illnesses and compared their characteristics with 58 neighborhood control-HHs and 62 randomly selected control-HHs. Case-HHs were more likely than either control group to have members 12-18 y of age (P less than .01); these individuals accounted for 34% of all primary cases. A history of exposure outside the home was the most important predictor of community-acquired infection (P less than .001), with adolescents being at higher risk than other age-groups (odds ratio, 3.2; P less than .001). After known exposure to a culture-positive case in the same HH, the risk of illness was unrelated to age; lengthy delays in initiating erythromycin therapy and prophylaxis were the only factors associated with secondary spread (P less than .01). The risk of pertussis may be related more to the likelihood of exposure than to age-related increases in susceptibility, and the risk can be reduced with appropriate use of erythromycin.
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Affiliation(s)
- R J Biellik
- Division of Immunization, Centers for Disease Control, Atlanta, Georgia 30333
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37
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38
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39
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Abstract
In our private clinic-hospital setting, respiratory syncytial virus (RSV) was isolated from infants more frequently and sooner from nasal washes (84%; 4.2 days) than from throat swabs (45%; 5.5 days) or nasopharyngeal swabs (39%; 5.7 days). Immunofluorescence of nasal wash cells identified 72% of the infants with virus isolations from nasal washes in less than one day. We therefore recommend the combination of isolation and immunofluorescence on nasal wash specimens for optimal detection of RSV-infected infants. Immunofluorescence of respiratory tract cells was also useful for monitoring the presence of RSV antigen in intubation secretions during ribavirin antiviral therapy. RSV infectivity was maintained in phosphate-buffered saline at room temperature for 6 h. Transport and inoculation of specimens in less than 6 h yielded RSV isolates from 50% of sampled infants during the two RSV seasons examined. For optimal RSV isolation, we recommend inoculation of HEp-2 tubes less than or equal to 4 days old. Replacing medium after 3 days as compared with 7 days did not increase recovery of RSV and provided little practical reduction in time to detection of cytopathology.
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Claflin K, Sullivan BJ. Chronic meningococcemia. Wis Med J 1984; 83:25-6. [PMID: 6523901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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41
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Sullivan BJ, Selvaggio E. Negative parental evaluations: how they affect the child. Aust Nurses J 1979; 8:39-41. [PMID: 256486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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42
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Sullivan BJ, Dickerman JD. Steroid-associated catatonia: report of a case. Pediatrics 1979; 63:677-9. [PMID: 440886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Abstract
The Rosenberg Self-Esteem Scale, Beck Depression Inventory, and Sullivan Diabetic Adjustment Scale were administered to 105 adolescent girls with diabetes. Results indicate that levels of self-esteem and depression highly correlate with the level of adjustment as assessed on the Diabetic Adjustment Scale (DAS). That is, the adjustment of adolescent diabetic girls in peer and family relationships, dependence-independence conflicts, and attitudes toward diabetes is significantly related to self-esteem; and the level of depression is significantly related to all these adjustment factors as well as body image. The results point to the usefulness of the DAS as a potential screening device for low self-esteem and depression in adolescent girls who have diabetes. The importance of diabetes as a scapegoat for normal adolescent concerns is discussed. It was also hypothesized that depression in adolescents may be expressed through concerns about diabetes. The importance of exploring relationships with peers and fathers is emphasized.
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Abstract
A 37-item scale was designed to assess life adjustment in 105 adolescent girls with juvenile diabetes. The scale elicited information on peer relationships, family relationships, body image concerns, dependence-independence conflicts, school adjustment, and attitudes toward diabetes. Results of this initial attempt at measuring diabetic adjustment suggest that this group of girls was relatively well adjusted and that their attitudes toward diabetes correlate positively with many adjustment factors. The importance of self-report scales which address the realities of life with diabetes is emphasized.
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Abstract
This investigation was designed to examine self-esteem and depression in diabetic adolescent girls. One hundred nondiabetic girls age 12-16 and 105 diabetic girls age 12-16 were administered the Rosenberg Self-Esteem Scale and the Beck Depression Inventory. Results indicated no significant difference between diabetic and nondiabetic girls in self-esteem scores. Diabetic girls showed significantly more depression than nondiabetic girls. Close examination of results revealed that, in fact, diabetic and nondiabetic adolescent girls were very similar. A major finding was that depression in the diabetic group was expressed primarily through physiologic symptoms of depression as seen in the vital depression scores, rather than through the pessimism, indecision-inhibition, or self-debasement measures of depression. Results were interpreted to mean that diabetic girls did not manifest deeper depression than nondiabetic girls but, rather, a greater awareness of their physiologic status. Diabetes emerged as a focus for the expression of normal adolescent conflicts. The importance of integrating developmental issues into the treatment plans for diabetic patients is emphasized.
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Sullivan BJ, Denney DR. Expectancy and phobic level: effects on desensitization. J Consult Clin Psychol 1977. [PMID: 20456 DOI: 10.1037//0022-006x.45.5.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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50
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