Thyroid lymphoma: is there a role for surgery?

The role of surgery in the treatment of Stage I and II non-Hodgkin's thyroid lymphoma (NHTL) is not well defined. At our institution, we have treated seven patients (six women and one man) with NHTL during the past 6 years. Three patients (43%) had a prior history of thyroid disease, usually lymphocytic thyroiditis.

Critical assessment of the head and neck clinical skills of general surgery residents.

Head and neck surgery is an important part of general surgery. There is, however, little information about the quality of residents' clinical skills in this important field. In an Objective Structured Clinical Examination (OSCE), residents encounter multiple patients with various clinical problems and are rated by faculty members using objective criteria.

The reliability of six faculty members in identifying important OSCE items.

Purpose: To measure the agreement among faculty members about the importance of items on a checklist used to grade an objective structured clinical examination (OSCE) station.

Methods: Six faculty members rated the importance of 47 items for an OSCE station in which students took the history of a patient with sore throat and hoarseness.

Results: Of the 47 items, the raters independently identified 15 items as very important.

Subjective and expressive emotional responses in depression.

Twenty-four depressed and twenty-three nondepressed male patients rated pleasantness of slides varying in hedonic content. Depressed patients rated positive slides as less pleasant and less arousing but did not differ from nondepressed patients in subjective response to normatively unpleasant images. Analysis of videotapes of facial expressions while watching the slide images showed that depressives exhibited more negative expressions than nondepressives to negative slides.

Advances in the diagnosis and therapy of adrenal tumors.

There continues to be controversy regarding the optimal evaluation and treatment of adrenal tumors. Magnetic resonance imaging, metaiodobenzylguanidine scan, single-photon emission tomography imaging, endoscopic ultrasound, and radiolabeled somatostatin analogues are just a few of the newer imaging techniques being investigated to improve our ability to obtain a specific diagnosis of an adrenal mass. Although the diagnosis and treatment of pheochromocytomas are relatively straightforward, the evaluation and treatment of incidentally discovered adrenal masses is less clear-cut.

Protein kinase C-dependent and Ca2+-dependent mechanisms of secretion from streptolysin O-permeabilized platelets: effects of leakage of cytosolic proteins.

Human platelets containing dense granules labelled with 5-hydroxy[14C]tryptamine ([14C]5-HT) were permeabilized by exposure to streptolysin O (SLO) in the presence of 4 mM [gamma-32P]ATP. Addition of either 100 nM phorbol 12-myristate 13-acetate (PMA) or of Ca2+ (pCa 5) at the same time as SLO induced secretion of dense-granule [14C]5-HT and the phosphorylation of pleckstrin by protein kinase C (PKC). Ca2+ also induced phosphorylation of myosin P-light chains.

Induction of apoptosis and cell cycle arrest by CP-358,774, an inhibitor of epidermal growth factor receptor tyrosine kinase.

The epidermal growth factor receptor (EGFR) is overexpressed in a significant percentage of carcinomas and contributes to the malignant phenotype. CP-358,774 is a directly acting inhibitor of human EGFR tyrosine kinase with an IC50 of 2 nM and reduces EGFR autophosphorylation in intact tumor cells with an IC50 of 20 nM. This inhibition is selective for EGFR tyrosine kinase relative to other tyrosine kinases we have examined, both in assays of isolated kinases and whole cells.

Expression of an epitope tagged human C5a receptor and antibody-mediated immobilization of detergent-solubilized receptor for drug discovery screening.

In order to screen combinatorial libraries of peptides and/or small organic molecules against the human C5a receptor, we have developed a novel method for immobilizing and screening 7-transmembrane segment (7-TMS) receptors. The epitope for a high affinity monoclonal antibody (mAb179) was added to the C-terminus of the human C5a receptor, and CHO cell lines expressing the epitope tagged receptor (C5aR-KH) and the wild-type receptor (C5aR) were established. The addition of the epitope tag did not affect the affinity of C5aR-KH for C5a.

Efficacy of postoperative radiation therapy for recurrent squamous cell carcinoma of the head and neck.

Purpose: Postoperative radiation therapy (RT) following surgical resection is often the recommended treatment for recurrent squamous cell carcinoma (SCC) of the head and neck. Despite common use, there are few published series evaluating such a management approach.

Methods And Materials: We evaluated the efficacy of postoperative RT in 31 patients with recurrent SCC of the head and neck treated between 1981 and 1993.

Improving residents' clinical skills with the structured clinical instruction module for breast cancer: results of a multiinstitutional study. Breast Cancer Education Working Group.

Background: The purpose of this study was to determine, in a multiinstitutional setting, the effectiveness of the structured clinical instruction module (SCIM) as an instructional format for surgical residents.

Methods: The breast cancer SCIM is an abbreviated (3-hour) clinical skills course that places residents in realistic clinical settings. The curriculum encompasses all aspects of breast cancer patient assessment.

Cancer pain education among family physicians.

This study used performance-based testing (objective structured clinical evaluation, OSCE) to evaluate the skills of family physicians in assessing and managing the severe pain of a cancer patient, and evaluated a new method of education about the management of cancer pain. Twenty-four primary care physicians completed a detailed pain assessment of the same standardized cancer pain patient (Part A). A proctor observed the interviews and rated the physicians on a variety of pre-determined items believed to be important for pain assessment.

Elective laparoscopic splenectomy for hematologic disorders.

Laparoscopic splenectomy has been reported to be the procedure of choice in selected patients with hematologic disorders. The purpose of this study is to review our experience with laparoscopic splenectomy in this patient population. The charts of all patients with hematologic disorders who presented for laparoscopic splenectomy over a 17-month period were reviewed.

Ward evaluations: should they be abandoned?

Even in the era of the objective structured clinical examination (OSCE), the predominant method of resident evaluation is the faculty ward evaluation (WE), despite many concerns about its reliability. The aim of this study was to determine the value of the WE as a measurement of clinical competence in terms of both reliability and validity. In a one-year period, surgery faculty members evaluated 72 residents.

Residents' evaluation of a problem-based learning curriculum in a general surgery residency program.

Methods: To determine residents' satisfaction with problem-based learning and its tutors, to determine how residents prepare for sessions, and to identify the characteristics of both effective sessions and tutors, we analyzed 132 evaluations from 24 residents who completed 1 or more of the 9 cases presented during the first 9 months of our program. The 38-item evaluation questionnaire asked residents to rate tutor characteristics, various aspects of the sessions, and methods used to prepare for the sessions.

Results: Residents were well satisfied with the problem-based learning sessions and with the logistics of our program; they found the overall quality of the tutor more important than that of the case; they valued an active, thought-provoking tutor more than a traditional facilitator; and they most often used standard textbooks to prepare for the sessions.

The multidisciplinary structured clinical instruction module as a vehicle for cancer education.

Background: The Structured Clinical Instruction Module (SCIM) modifies the Objective Structured Clinical Examination (OSCE) for teaching purposes. This study determined the effectiveness of a breast cancer SCIM in enhancing residents' clinical skills.

Methods: Twenty-five residents, 15 faculty members, and 12 breast cancer patients (simulated and actual) participated in the multistation, multidisciplinary SCIM.

The structured clinical instruction module as a tool for improving students' understanding of breast cancer.

The Structured Clinical Instruction Module (SCIM) is a novel format for teaching clinical skills. A multidisciplinary SCIM was presented to 30 medical students to improve their understanding of breast cancer. The SCIM consisted of 12 10-minute stations, each covering a different aspect of the diagnosis and management of breast cancer (e.

Functional consequences of truncating amino acid side chains located at a calmodulin-peptide interface.

To test the relevance of the calmodulin-peptide crystal structures to their respective calmodulin-enzyme interactions, amino acid side chains in calmodulin were altered at positions that interact with the calmodulin-binding peptide of smooth muscle myosin light chain kinase but not with the calmodulin kinase IIalpha peptide. Since shortening the side chains of Trp-800, Arg-812, and Leu-813 in smooth muscle myosin light chain kinase abrogated calmodulin-dependent activation (Bagchi, I. C.

Development and evaluation of a chicken breakfast sausage manufactured with mechanically deboned chicken meat.

Leghorn spent hen mechanically deboned chicken meat (MDCM) was utilized in the preparation of a value-added chicken sausage. The sausage was manufactured by combining MDCM with hand-deboned skinless chicken thigh meat, fat replacer ingredients (blend of modified food starch and oat flour), and either 1) no ingredient with antioxidant properties, 2) Colorlife powdered rosemary concentrate, 3) Herbalox Type O oleoresin rosemary extract or 4) Tenox 6 antioxidant. The 454-g sausage chubs were stored at 4 +/- 1 C (refrigerated) and -20 +/- 1 C (frozen) for 10 d and 6 mo, respectively.

Measuring the ability of residents to manage oncologic problems.

Background: An OSCE was used to measure the ability of a cohort of residents to manage oncologic problems.

Methods: Nine oncologic clinical problems were presented to 56 surgical residents. Each problem contained a 5-minute data-gathering period (DGP) and a 5-minute data-interpretation period (DIP).

Penetrating injuries of the neck: selective management evolving.

Since 1990, a selective management algorithm has been used in our Trauma Center to treat 91 patients with penetrating neck injuries. Group A (n = 37) sustained zone I, zone III, or multiple-zone injuries; Group B (n = 54) sustained zone II injuries [most (55, 66.4%) from gunshot or shotgun wounds].