Expression of HER-2/neu oncoprotein and epidermal growth factor receptor and prognosis in gastric carcinoma.

Fifty-six specimens of gastric carcinoma were examined for the localization of HER-2/neu oncoprotein (HER-2/neu) and epidermal growth factor receptor (EGFR) by immunohistochemistry using polyclonal antibodies on paraffin-embedded material. Strong membrane staining for HER-2/neu was noted in 14 cases (25%), all of which were of the intestinal type. Only cytoplasmic staining was found in an additional 21 cases (37.5%), including seven diffuse tumors. Twenty-four cases (nine diffuse and 15 intestinal) showed cytoplasmic staining with accentuation on the cell membrane for EGFR. Patchy staining was common for HER-2/neu, while EGFR immunoreactivity was always diffuse. Twenty cases (35.7%) showed positive staining for both, 15 cases (26.8%) for HER-2/neu only, four cases (7.1%) for EGFR only, and 17 cases (30.4%) for neither. Expression of HER-2/neu was more commonly associated with intermediate-grade and high-stage tumors. Cases with positive (either membrane or cytoplasmic) staining for HER-2/neu showed poorer overall mean survival (308 days) than cases that failed to stain (763 days). The EGFR-positive cases showed shorter mean survival (387 days) than the negative cases (547 days), but this difference did not reach statistical significance. The EGFR positivity did not further reduce survival in HER-2/neu-positive cases (362 days). The results of this study support the hypothesis that the expression of HER-2/neu may be a significant predictor of prognosis in patients with gastric carcinoma. Our findings also suggest that expression of these two closely related protooncogenes in malignant and benign gastric tissues is independent of each other and that EGFR does not potentiate the oncogenic effect of HER-2/neu.

Performances of family practice diplomates on successive mandatory recertification examinations.

BACKGROUND: In 1969 the American Board of Family Practice (ABFP) became the 19th medical specialty board and the first since the inception of medical specialty certification to mandate recertification. As of July 1993, 16 other boards have adopted time-limited certification, but only two have reached the first recertification of their diplomates. As recertification approaches for the 14 boards, each will be faced with decisions concerning process, examination content and scope, and standards for passing. The physicians who will be facing mandatory recertification must be adequately prepared or accept the consequences of losing their certification. METHOD: This study examined the performances of six cohorts of family physicians--three cohorts of 711 practice-qualified physicians certified in 1971, 1972, and 1973, and three cohorts of 1,233 residency-trained physicians certified in 1977, 1978, and 1979--who were successfully recertified on successive six-year cycles from 1977 through 1991. Analyses of variance, multiple regression analysis, and Pearson correlation coefficients were used to investigate the relationships among the composite scores on the various certification and recertification examinations and among examination composite scores and demographic variables. RESULTS: There were significant (p < .01) declines in performance on each recertification examination. The residency-trained physicians had higher examination scores than did the practice-qualified physicians. Multiple regression analysis showed the last recertification score to be the strongest predictor of the next recertification score. The combination of previous scores and demographic variables resulted in the ability to predict between 63% and 74% of the variance in the most current recertification composite score. CONCLUSION: The results raise questions for further investigation, and such investigation may affect specialty boards' design of and/or examinees' test-taking strategies on future recertification examinations. For example, the decline in examination performance from certification through successive recertifications may result from factors related to the practice of medicine. It is possible that as the practice life of a family physician evolves, the focus of the practice becomes narrower, and this narrowed focus results in a decline in performance on an examination, half of which covers the breadth of the specialty. Thus, the medical specialties addressing mandatory recertification may wish to give thorough consideration to the focus of the examination--scope of specialty or scope of the practice, or some combination of both--as well as the implications of the standard-setting process used for recertification.

Stability of medical specialty selection at the University of Kentucky.

In the fall of 1989, all graduates of a 30-year-old medical college were surveyed by questionnaire concerning their motivations for their original selections of specialties, motivations for changing their specialties when such changes had occurred, and factors involved in their current choices of specialties. The 723 respondents were grouped by specialty response into one of three groups (primary care plus medicine and pediatrics subspecialties; surgery; or controllable lifestyle), and responses were statistically analyzed. The most important factors influencing initial specialty selection were perceived match of personality and specialty; technology and methodology characteristic of the specialty; and time for family activities, in that order. The ratings of the 175 respondents who stated that they had changed specialties indicated that time for avocational pursuits and time for family activities were the most important reasons for change. The reasons for selecting a different specialty varied. This study's findings suggest that a student's likelihood of making an inappropriate specialty choice may be reduced by a broad undergraduate medical education with realistic experiences in clinical activity. Students' lack of awareness of the lifestyle of a particular specialty may be a significant factor in the flow of physicians from noncontrollable lifestyle specialty areas. Those who counsel medical students need to be aware of the increasing importance of controllable lifestyle features, changing attitudes, faculty role-modeling, and mentors as strong influences on students' choices of specialties.

Patient compliance--a factor in facial trauma repair.

The clinical records of 25 consecutive patients who were treated for facial trauma were reviewed and analyzed to ascertain what effect patient cooperation had on the outcome of facial fracture repair. The study was designed to establish the incidence of complications and to discover what factors contributed to untoward sequela in such patients. Overall, 15 patients (60%) were noncompliant in one or more aspects of their care. Six patients (24%) had significant postoperative complications associated with their facial injuries. Four of these patients were not fully cooperative.

The controllable lifestyle factor and students' attitudes about specialty selection.

Questionnaires were distributed to 346 fourth-year students in nine medical schools. The students were asked to state their selected specialty and to rank the importance that each of 25 influences, listed as questionnaire items, had had in making their choice of specialty. Factor analysis showed that particular items were significantly associated with particular factors. The first factor emphasized perceived lifestyle (items in this category gave importance to remuneration, personal time, and prestige); the second factor emphasized cerebral activities and a practice orientation; and the third factor stressed altruistic values and attitudes. The authors classified the selected specialties into three groups: those characterized as having a non-controllable lifestyle (NCL), those with a controllable lifestyle (CL), and surgery. (CL specialties were defined as those that allow the physician to control the number of hours devoted to practicing the specialty.) Data were analyzed using factor analysis, and analysis of variance, and the Scheffé method. Analysis indicated that the perceived lifestyle factor was most closely associated with the responses of those students choosing CL specialties. Furthermore, this factor received the highest total loading of the three factors from all the students, thus indicating the level of interest in lifestyle factors. Responses to items that defined the cerebral and practice factor were highest from the group of students choosing CL specialties and lowest from the group choosing NCL specialties. The NCL students scored highest in the altruism factor and the CL students scored the lowest. The surgery and NCL groups were similar in attitude patterns, and both were substantially different in attitude patterns from those of the CL groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Controllable lifestyle: a new factor in career choice by medical students.

To determine whether control of work hours (controllable lifestyle) was becoming an increasingly important factor in choices of specialties by medical students, data from three medical schools over the past ten, ten, and six years, respectively, were reviewed for the types of specialty training entered by students in the top 15% of their classes. Since students in the upper 15% of the class are likely to obtain the specialties of their choice, any change in the pattern of their specialty preferences probably reflects a general trend. Specialties that feature a controllable lifestyle (CL) were defined as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry, and radiology. Non-CL specialties were surgery, medicine, family practice, pediatrics, and obstetrics-gynecology. The results showed that the percentages of students entering CL specialties increased significantly at all three schools, the percentages of students entering non-CL specialties decreased significantly at all three schools, and there was no significant change in the percentage of students entering surgical specialties.

Identification of patients at risk for unnecessary or excessive TMJ surgery.

Musculoskeletal pain in the head and neck may be associated with a variety of psychological and psychiatric conditions. Therefore, patients with persistent temporomandibular (TMJ) and masticatory muscle complaints must also be evaluated for affective disorders. Identification of patients at risk for unnecessary or excessive TMJ surgery is enhanced when the surgeon is aware of a pattern of persistent pain and illness insistence that characterizes these patients. This article presents a list of characteristics that may identify a patient with an undiagnosed affective disorder who may be exposed to unnecessary treatment.

Chemotaxis of polymorphonuclear leukocytes from donors of different races toward Neisseria gonorrhoeae of three different auxotypes.

Urethral gonorrhea is typified by the presence of large numbers of polymorphonuclear leukocytes, which are presumably attracted to the urethra by an as yet uncharacterized chemotaxin. Culture supernatants from three different auxotypes of Neisseria gonorrhoeae, one requiring arginine, hypoxanthine, and uracil (Arg-,Hyx-,Ura-), one requiring proline, arginine (not satisfied by ornithine), and uracil (Pro-,Arg-[Orn*],Ura-), and one requiring proline (Pro-), were tested for their chemotactic activity against leukocytes from men of two racial groups, white and black. These auxotypes were chosen because the Pro- auxotype is isolated more frequently from black patients, and the Arg-,Hyx-,Ura- and the Pro-,Arg-(Orn*),Ura- auxotypes are isolated more frequently from white patients. Chemotaxis was tested in blind-well chambers in the absence of complement; membranes with a pore size of 3 microns were used. The culture supernatants of the Pro- auxotype were the most chemotactic, while those of the Arg-,Hyx-,Ura- were the least chemotactic when analyzed by a three-way analysis of variance: F = 22.83, df = 2.6, P less than .001. There were no differences in migration with respect to the race of the donor. Gonococcal culture supernatants did not require complement for chemotaxis.

Quantified human smoking behavior among various disease categories.

The present study reports the various quantified aspects of smoking behavior among patients (N = 244) with seven primary diagnostic categories; namely, neoplasms, endocrine, blood, circulation, respiratory, digestive, and GU. The study results indicate that patients with neoplasms and respiratory patients had longer puff durations than those in the other diagnostic categories. Patients with circulatory problems took longer to smoke a cigarette than patients with other diseases. Furthermore, patients with neoplasms tended to have higher tar delivery per cigarette than patients with other diseases. Finally, endocrine patients had the highest level of nicotine delivery per cigarette, with neoplasms and respiratory patients at the lowest level. These findings suggest a need for quantifying smoking behavior among patients of different disease categories in further studies.

Facial pain complaints in the elderly.

The incidence of facial pain and mandibular dysfunction was studied in a population of elderly, middle-class Americans (median age, 71 years) using a self-report questionnaire. The questionnaire was mailed to 839 volunteer subjects of both sexes; responses were obtained from 562 (67%) individuals. Results showed that 536 respondents (95.4%) were free of facial pain and that only 25 (4.4%) had temporomandibular joint pain. Joint sounds and teeth clenching and grinding were associated with facial pain in 50% of those who reported this combination.

Incidence of disseminated gonococcal infection correlated with the presence of AHU auxotype of Neisseria gonorrhoeae in a community.

Strains of Neisseria gonorrhoeae requiring arginine, hypoxanthine, and uracil (AHU) may cause disseminated gonococcal infection (DGI). A significant epidemiologic association was noted between the incidence of disseminated gonococcal infection and the presence of gonococci of the AHU auxotype in the community over a nine-year period. Thirty-nine patients with DGI were identified from hospital records of January 1974-December 1982. During this interval, gonococcal isolates from patients in the community were collected at a venereal disease clinic and a hospital emergency room. The incidence of patients hospitalized for DGI dropped significantly after 1978. The year of highest incidence of DGI was 1977, when there were 429 cases of DGI per 100,000 cases of uncomplicated gonorrhea; the incidence of gonococcal isolates of the AHU auxotype in that year was 26.3%. In contrast, this auxotype accounted for only 4.6% of gonococcal isolates in 1980, when the incidence of DGI had decreased to 58 cases per 100,000 cases of uncomplicated gonorrhea. When DGI and gonococci of the AHU auxotype from the community were ranked for incidence by year, a significant correlation between the two was found (P less than .001). Thus the incidence of patients with DGI in the hospital reflected the presence of gonococci of the AHU auxotype in the community.

Evaluation of occlusal splint therapy and relaxation procedures in patients with temporomandibular disorders.

Twenty-four patients were selected to participate in this study. Twelve patients were randomly selected to receive occlusal splint therapy and the other 12 to receive a simplified relaxation therapy technique. Observable pain scores, maximum comfortable interincisal distance, and maximum interincisal distances were recorded for each group before and after treatment. The occlusal splint group showed a significant decrease in total mean observable pain scores (decrease score of 10.5, t = 3.124; P less than 0.1). The relaxation group showed no significant decrease in total mean observable pain scores (decrease score of 1.8, t = 0.888; P = ns). The occlusal splint group showed a significant increase in the mean maximum comfortable opening (an increase of 12.4 mm, t = 5.085; P less than .01). The relaxation group showed no significant increase in the mean maximum comfortable opening (an increase of 2.3 mm, t = 0.734; P = ns). The occlusal splint group showed a significant increase in the mean maximum opening (an increase of 6.0 mm, t = 2.471; P less than .05). The relaxation group showed no increase in the mean maximum opening (decrease of 0.7 mm, t = 0.343; P = ns). This study suggests that occlusal splint therapy is a more effective treatment for the pain, tenderness, and limited mandibular opening associated with temporomandibular disorders than relaxation therapy. In this study, the relaxation technique used had no significant effect on the patients' pain, tenderness, or limited opening.

The short-term and long-term soft-tissue profile changes accompanying mandibular advancement surgery.

To provide an improved data base for predicting the soft-tissue changes that accompany mandibular advancement surgery, short- and long-term serial cephalograms from the records of eighteen patients were analyzed. Hard- and soft-tissue landmarks were located on serial tracings and later were reduced to rectangular X-Y coordinates for computer-generated measurement data and statistical analyses. The interpretation of mean value, ratio, and regression equation data showed that the lower lip, inferior labial sulcus, and chin tissues moved forward and downward. The mandibular short-term (mean = 3.7 months postsurgery) horizontal change means were greater than the long-term (mean = 18 months postsurgery) horizontal change means. The posteriorly directed long-term means may result from functional adaptations that follow the short-term surgery-related spatial changes. These data also show the need for long-term prediction data to supplement the short-term data base.

On the perceived meaning of symptoms.

The importance of understanding the manner in which symptoms are interpreted is generally recognized, but has received relatively little direct research attention. In an attempt to obtain some evidence on the meaning attached to each of a set of 45 symptoms, subjects were asked to rate the symptoms on eight semantic properties. The symptom ratings on the various properties were then correlated and the correlation matrix subjected to a principal components factor analysis. Three factors of perceived meaning emerged. The first factor is defined by the extent to which symptoms are perceived as threatening, disruptive and painful. The second factor consists of the familiarity of symptoms and the perceived personal responsibility for their occurrence. The third factor reflects how embarrassing the symptoms are. This structure of perceived meaning of symptoms is discussed with reference to the literature on delay in seeking medical care.

Antiarrhythmic anesthetic action I: the effect of halothane on canine intracardiac impulse conduction during sinus rhythm.

The effect of halothane on intracardiac impulse conduction was assessed in dogs before and after pharmacologic vagotomy. Impulse conduction was measured by anesthetic-related changes in the A-H and H-V intervals of the His bundle electrogram. Prior to vagotomy, both "light" and "deep" halothane prolonged the A-H interval significantly. Maximal A-H interval prolongations corresponded to the maximal decrease in heart rate with either dose of anesthetic. Following vagotomy, the A-H prolongation produced by light halothane was abolished and the prolongation produced by the deep level greatly reduced. Neither dose of halothane had a measurable effect on the H-V interval before or after vagotomy. In one animal in which the effects of increasing rates of atrial pacing were measured without the addition of halothane, the A-H interval lengthened with no measurable change in the H-V interval. In two dogs in which the heart rate was held near pre-halothane levels by atrial pacing, the A-H interval was slightly prolonged and the H-V interval unchanged during the administration of deep halothane. These studies indicate that during sinus rhythm: (1) halothane prolongs A-V impulse conduction, (2) that this effect is correlated with a concomitant decrease in heart rate, and (3) that these effects are largely dependent upon intact vagal innervation of the heart. During atrial pacing, A-V conduction is prolonged by increased heart rate or by deep halothane when the heart rate is held constant. Thus, in addition to the known effects of halothane on pacemaker automaticity, concomitant changes in conduction may contribute to the antiarrhythmic action of this anesthetic.

Behavioral factors and denture status.

The experiences and impressions for most of the 64 patients who entered the project in 1968 reveal that the opportunity to obtain new dentures, prepared according to the best available technology by highly skilled dentists and dental laboratory technicians, has had an identifiable impact on each of the several behavioral variables for which changes were predicted before the study began. There has been general improvement in self-image, confidence, and relaxation, and these changes often were associated with perceived improvement in fit of dentures, ability to eat, ability to talk, and general health. Although some patients experienced serious health problems during the 6 year study period, neither were these attributed to nor did they appear associated in any way with denture status. The patient population, in general, was very cooperative. Fifty-three patients stayed with the study for 6 years. Most kept their appointments and followed the instructions and advice of their dentists on all matters but one--that of removing their dentures at night. In explaining why they did not remove their dentures at night, most of the patients gave evidence of a high degree of sexual symbolism associated with teeth and denture status.