Northwestern University Medical School Research Articles

Diagnosis and Management of Concussion in Sports

The clinical validity of a standardized assessment of concussion in high school football players was confirmed at the Rehabilitation Institute of Chicago, and Northwestern University Medical School, Chicago, IL.

The anti-herpes simplex virus (HSV) activity of n-docosanol includes inhibition of the viral entry process : *L.E. Pope, *J.F. Marcelletti, **M.L. Parish, **P.G. Spear and *D.H. Katz. *LIDAK Pharmaceuticals, La Jolla, CA, USA and **Northwestern University Medical School, Chicago, IL, USA

The anti-herpes simplex virus (HSV) activity of n-docosanol includes inhibition of the viral entry process : *L.E. Pope, *J.F. Marcelletti, **M.L. Parish, **P.G. Spear and *D.H. Katz. *LIDAK Pharmaceuticals, La Jolla, CA, USA and **Northwestern University Medical School, Chicago, IL, USA

Behaviors of Entry-level Physical Therapy Students That Alert Clinical Instructors to Unsafe and Ineffective Student Performance

Northwestern University Medical School, Programs in Physical Therapy, Chicago, Ill. This work was supported by a grant from the Chicagoland Clinical Educators Forum.

Reforming medical education: Preparing students for medical practice in the 21st century

Background: The shortcomings of traditional medical curricula have been debated, and reforms proposed, for decades. The faculty of Northwestern University Medical School addressed this need for major curricular change and implemented a totally new preclinical curriculum. Summary: The new curriculum was predicated on a commitment to small‐group interaction replacing some, but not all, lecture‐based teaching. This hybrid curriculum contains the best elements of lecture‐based and $$sel directed, interactive learning. It does so through horizontal integration of the basic $$st ence disciplines into 3 courses spanning the first 2 years of medical school. Vertical integration of clinical disciplines into this framework occurred through a rigorous curriculum in communication skills, fundamental clinical skills, and problem‐based learning sessions. An experiential curriculum exposes students to the social, behavioral, and ethical foundations of medicine. Conclusions: The feasibility of wide‐sweeping curricular reform involves inclusion of the faculty, reformation of the curriculum committee, and strong central leadership from the dean's office. The process by which such change occurs is examined in detail.

Tumour suppressor genes and angiogenesis: the role of TP53 in fibroblasts.

‘Department of Microbiology-Immunology; ‘Department of Pathology; ‘R.H. Lurie Cancer Center, Northwestern University Medical School, Chicago, Illinois 60611; 4Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02 115; and ‘Howard Hughes Medical Institute, Center for Cancer Research and Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, U.S.A.

New perspectives in clinical oncology from angiogenesis research.

TUMOUR BURDEN AFFECTS TUMOUR ANGIOGENESIS SINCE THE early 197Os, the conventional wisdom in angiogenesis research was that the neovascularisation in a given tumour bed was an isolated event, unrelated to other turnours. In the past 2 years, it has been recognised that total tumour burden can affect angiogenesis in remote metastases. This recognition came about because of the demonstration by O’Reilly and associates [l] that a primary tumour could suppress angiogenesis in its metastases and that this would iead to inhibition of growth of the metastases. This process was found to be mediated by a novel endogenous angiogenesis inhibitor, angiostatin, generated by the primary tumour [ 11. Angiostatin is a 38 kD protein with homology to the first four kringle structures of plasminogen. It is a specific inhibitor of endothehal cell proliferation. Three converging lines of experimental work led up to O’Reilly’s discovery of angiostatin. The first was that, during the 198Os, my laboratory had been trying to understand how certain primary tumours could suppress the growth of their metastases. Since the turn of the century, clinicians and laboratory investigators have recognised that certain human and animal primary tumours could suppress the growth of their metastases [2-81. Furthermore, Prehn argued with compelling data that the rate of tumour growth was inversely proportional to total tumour burden, regardless of how the tumour was distributed, e.g. single tumour versus multiple implants or metastases [9, lo]. Oncologists have observed that very large tumours may grow very slowly and that ‘debulking’ of a large tumour mass may render the residual tumour more susceptible to cytotoxic chemotherapy. Many explanations have been offered to explain these phenomena, including mechanisms based on immunity (concomitant immunity), hormonal interactions and metabolic changes (accumulation of catabolites). The second line of experiments was a collaboration with Douglas Hanahan (of the University of California, San Francisco). We were studying the mechanism of the switch to the angiogenic phenotype by beta cell carcinomas arising de nowo in the pancreatic islets of transgenic mice [ 11, 121. Two angiogenic proteins, aFGF (acidic fibroblast growth factor) and VEGF (vascular endothelial growth factor) revealed similarly high levels of expression by these islets, before and after the angiogenic switch [13, 141. This provocative result forced us to think that the angiogenic switch could not be explained entirely by positive regulators of angiogenesis, but could also involve some role by negative angiogenic regulators. The third line of experiments was reported in 1989, from Noel Bouck’s laboratory at Northwestern University Medical School, Chicago, Illinois, U.S.A. 1151. Thrombospondin was identified as a negative regulator of angiogenesis that was downregulated during the switch to the angiogenic phenotype in transformed fibroblasts. Subsequently, thrombospondin was shown to be upregulated in human tumour cells by the restoration of ~53 tumour suppressor function, thus negating the angiogenesis inducers that the cells themselves produced as well as added bFGF, leading to blocked angiogenesis [ 161. It immediately occurred to us that a primary tumour elaborating both angiogenic stimulators and ‘left-over’ inhibitor(s) could generate accumulating levels of the putative inhibitor in the circulation, if such an inhibitor had a longer half-life in the circulation than the stimulator. Thus, when O’Reilly found that angiostatin accumulated in the serum and urine of tumour-bearing mice, but disappeared from serum and urine after removal of the tumour, this suggested a role for angiostatin as a mediator of the suppression of metastases by the primary tumour. It became clear that a primary tumour could influence the growth of a metastasis by inhibiting angiogenesis in the metastasis, without communicating directly with its tumour cells.

Adult Airway Management

Adult Airway Management: Principles and Techniques, Rafael A. Ortega and Harold Arkoff. Norwood, MA: SilverPlatter Education, Inc., 1994, 250 pp, $175.00 individual, $495.00 library for a multimedia CD-ROM compact disc. Requirements: Windows PC--8 MB RAM, Microsoft Windows, version 3.1, hard disc with 4 MB free space, MS DOS 5.0 or later, MPC standard CD-ROM player, sound board, and speakers. Macintosh--8 MB RAM, system 7.0 or later, CD-ROM player, standard Mac color monitor, and Mac sound. This CD uses a multimedia approach demonstrating the equipment and techniques applied for airway management. It is designed for use with a personal computer by people with only basic computer skills. This CD covers a great deal of information in 17 chapters. Each chapter is minimal in text, is narrated well, and combines pictures, drawings, and video presentation. Similar to a textbook, the CD has a Table ofcontents consisting of 17 chapters with a total of 250 pages. Chapters vary in length from 2 to 47 pages. Chapters 1 and 2 discuss airway anatomy and evaluation of the airway. Chapter 3 jumps to causes and management of foreign body airway obstruction, followed by descriptions of endotracheal tubes and double-lumen tubes in Chapters 4 and 5. Adult Airway Management: Principles and Techniques includes a considerable amount of pediatric material, suggesting that a change in title might be less misleading. The airway is described from the nares to the carina. The bronchial anatomy was excluded. One of the factual errors was in the description of the four eminences in the aryepiglottic fold as being the arytenoids; later these are correctly noted to be the paired cuneiform and corniculate cartilages. The title of Chapter 12, "Translaryngeal Injection," would be better if changed to "Anesthesia and Analgesia of the Airway," as it describes different techniques of topical anesthesia and superior laryngeal and glossopharyngeal nerve blocks to abolish the pain, gag, and cough reflexes during awake oro-naso-tracheal intubation. Chapter 13, "What Is a Difficult Airway?" would also benefit from a title change and reorganization of the contents. This 47-page chapter devotes two pages to the American Society of Anesthesiologists algorithm for the difficult airway. The rest of the chapter describes various techniques applied to the management of the difficult airway. Six pages are devoted to the use of the esophageal obturator and esophageal-gastric tube airway, and four pages describes the Augustine guide, compared with three pages devoted to fiberoptic intubation, which includes description of the endoscopy mask and intubating airways. Chapter 15, "Extubation Criteria," not only covers the criteria applied for tracheal extubation, but also discusses extubation techniques, difficult extubation, complications of extubation, and prevention and treatment of complications during and after extubation. The usual textbook is intrinsically linear, with each chapter to be read straight through. Nonlinear books make excellent CDs, allowing searching and cross-referencing to be performed readily. The true multimedia approach should be multilevel and interactive, allowing each use of the CD to be a different experience, to access diverse but self-contained portions of information on each occasion. This CD on adult airway management goes only partway toward full use of the multimedia potential. The CD does include useful animation, film, and sound clips, but otherwise does not progress beyond being a commentary and slide show. In the next edition, the authors might consider the use of hypertext to explain difficult concepts or to hide less informative sections. Several of the links provided were imperfect in their execution and could be improved. In summary, the main menu is clear and gives good coverage of the CD's extensive contents. The optional use of video and sound clips allows the user additional insight not usually available in a book. The text is short and informative, each page designed to be self-contained. This is a good start for multimedia presentation of airway management. The authors are to be congratulated on their extensive review of this topic. Andranik Ovassapian, MD Colin Shanks, MD Department of Anesthesiology Northwestern University Medical School Anesthesiology Service V.A. Lakeside Medical Center Chicago, IL 60611

Potential mechanisms of plastic adaptive changes in the vestibulo-ocular reflex.

Annals of the New York Academy of SciencesVolume 781, Issue 1 p. 499-512 Potential Mechanisms of Plastic Adaptive Changes in the Vestibulo-Ocular Reflexa B. W. PETERSON, B. W. PETERSON Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this authorG. A. KINNEY, G. A. KINNEY Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this authorK. J. QUINN, K. J. QUINN Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this authorN. T. SLATER, N. T. SLATER Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this author B. W. PETERSON, B. W. PETERSON Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this authorG. A. KINNEY, G. A. KINNEY Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this authorK. J. QUINN, K. J. QUINN Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this authorN. T. SLATER, N. T. SLATER Northwestern University Medical School 303 East Chicago Avenue Chicago, Illinois 60611Search for more papers by this author First published: June 1996 https://doi.org/10.1111/j.1749-6632.1996.tb15723.xCitations: 7 a This work was supported in part by grants EY 06485 and NS 31805 from the NIH and grant ONR 14–941265 from the Office of Naval Research. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume781, Issue1New Directions in Vestibular ResearchJune 1996Pages 499-512 RelatedInformation

Politicians, AIDS Experts Wage Budget Debate

A NEW REPORT that recommends restructuring federal AIDS research has reignited a tug-of-war over who should control the purse strings for such research. During a news conference last month in Chicago, Ill, a trio of AIDS experts called on a small group in Congress to restore full spending authority to the Office of AIDS Research (OAR) of the National Institutes of Health (NIH). The promise of AIDS research is very much at risk because of these debates, said Mathilde Krim, PhD, chair of the American Foundation for AIDS Research (AmFAR). Krim was joined by Mark Harrington, policy director of the New York, NY—based Treatment Action Group, and Steven Wolinsky, MD, associate professor of medicine at the Northwestern University Medical School in Chicago. Harrington and Wolinsky were among the 114 scientists, academics, drug company representatives, and community advocates who conducted a sweeping review of the $1.4 billion NIH AIDS research effort.

Optimization and stability of acoustically reflective liposomes for ultrasonic enhancement: Sasha E. Murer, Bonnie J. Kane, Michael J. Vonesh, Melvin E. Klegerman, David D. McPherson, Hayat Alkan-Onyuksel, Northwestern University Medical School and the University of Illinois College of Pharmacy, Chicago, Illinois

Optimization and stability of acoustically reflective liposomes for ultrasonic enhancement: Sasha E. Murer, Bonnie J. Kane, Michael J. Vonesh, Melvin E. Klegerman, David D. McPherson, Hayat Alkan-Onyuksel, Northwestern University Medical School and the University of Illinois College of Pharmacy, Chicago, Illinois

Carotid artery plaque tissue characterization using radiofrequency backscatter analysis: Sandra C. Carr, Michael J. Vonesh, David D. McPherson, James S.T. Yao, Northwestern University Medical School, Chicago, Illinois

Carotid artery plaque tissue characterization using radiofrequency backscatter analysis: Sandra C. Carr, Michael J. Vonesh, David D. McPherson, James S.T. Yao, Northwestern University Medical School, Chicago, Illinois

Prognostic value of dobutamine stress echocardiography in patients with ischemic and non-ischemic cardiomyopathy: Gil M. Vardi, Kishin Ramani, Gorav Ailawadi, Jason T. Tauke, Michele A. Parker, Robert O. Bonow, Farooq A. Chaudhry; Northwestern University Medical School, Chicago, Illinois

Prognostic value of dobutamine stress echocardiography in patients with ischemic and non-ischemic cardiomyopathy: Gil M. Vardi, Kishin Ramani, Gorav Ailawadi, Jason T. Tauke, Michele A. Parker, Robert O. Bonow, Farooq A. Chaudhry; Northwestern University Medical School, Chicago, Illinois

New Studies Say Viral Burden Tops CD4 as a Marker of HIV Disease Progression

EARLY FINDINGS from two large clinical studies may signal a major shift in how physicians monitor disease progression and use antiviral drugs in patients infected with the human immunodeficiency virus (HIV). The data indicate that a change in viral burden, as measured by RNA polymerase chain reaction (RNA-PCR) at baseline and following therapy, is superior to CD4 cell count as a surrogate marker of HIV disease progression. "This is the first large-scale trial supporting this finding," said William W. Freimuth, MD, PhD, medical monitor of the studies sponsored by Pharmacia & Upjohn Inc, Kalamazoo, Mich. Most clinicians and activists already consider viral burden testing useful, as a result of findings from smaller studies, Freimuth noted. "Now these data give it ammunition." The findings, as yet unpublished, are "very important," said John Phair, MD, director of the Comprehensive AIDS Center at Northwestern University Medical School, Chicago, Ill, and an investigator at

When Men Kill

Ruth and Evelyn Dunbar Distinguished Professor of Psychiatry and Behavioral Sciences, Emeritus Northwestern University Medical School Chicago, Illinois Family Violence Research Program University of Rhode Island, Kingston

An active-learning approach to basic clinical skills.

Within the context of comprehensive changes in the preclinical curriculum at Northwestern University Medical School, the authors sought to create an active-learning approach to teaching the basic clinical skills of communication, physical examination, and diagnostic reasoning. This approach is built upon the premise that repetitive practice using a structured database, which is emphasized in traditional curricula, is necessary but not sufficient for students' early development as clinicians, as it marginalizes essential areas of discourse and restricts students' understanding of the scope of the medical encounter. Accordingly, this clinical skills curriculum incorporates small-group, patient-instructor, and peer-observation formats to encourage critical thinking and reflection. The clinical skills units have been among the most popular aspects of Northwestern's new curriculum. Preliminary data suggest that the overall attitudes, knowledge, and clinical proficiency of students completing this curriculum compare favorably with those of students who progressed through the preclinical curriculum before the active-learning approach was introduced.

Primary Lateral Sclerosis with Gaze Paralysis

Three children in a Jordanian family, with consanguinous parents, who met the Stark and Moersch (1945) criteria for the diagnosis of primary lateral sclerosis (PLS) are reported from the King Faisal Specialist Hospital and Research Centre, and King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia, and Northwestern University Medical School, Chicago, Illinois, USA.

Ampulla, sphincter, or hernia?: Lin S, Brasseur JG, Pouderoux P, Kahrilas PJ (Department of Medicine, Northwestern University Medical School, Chicago, Illinois; and Department of Mechanical Engineering, Pennsylvania State University, University Park, Pennsylvania). The phrenic ampulla: distal esophagus or potential hiatus hernia? Am J Physiol 1995;268:G320–G327 (February)

Ampulla, sphincter, or hernia?: Lin S, Brasseur JG, Pouderoux P, Kahrilas PJ (Department of Medicine, Northwestern University Medical School, Chicago, Illinois; and Department of Mechanical Engineering, Pennsylvania State University, University Park, Pennsylvania). The phrenic ampulla: distal esophagus or potential hiatus hernia? Am J Physiol 1995;268:G320–G327 (February)

At least 2 low-molecular-weight heparins are more effective and safer than standard unfractionated heparin

TherapeuticsNovember 1, 1995At least 2 low-molecular-weight heparins are more effective and safer than standard unfractionated heparinBrian P. Schmitt, MDBrian P. Schmitt, MDNorthwestern University Medical School Chicago, Illinois, USA (B.P.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1995-123-3-061 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationLensing AW, Prins MH, Davidson BL, Hirsh J. Treatment of deep venous thrombosis with low-molecular-weight heparins. A meta-analysis. Arch Intern Med. 1995 Mar 27;155: 601-7.References1 Nurmohamed MT, Rosendaal FR, Buller HR, et al. Lancet. 1992;340:152-6. Google Scholar2 Warkentin TE, Levine MN, Hirsh J, et al. N Engl J Med. 1995;332:1330-5. Google Scholar Author, Article, and Disclosure InformationAffiliations: Northwestern University Medical School Chicago, Illinois, USA (B.P.S.) Nextarticle Advertisement FiguresReferencesRelatedDetails November 1, 1995Volume 123, Issue 3Page: 61KeywordsArthroplastyCancer treatmentDeath ratesDeep vein thrombosisHematologic testsHemorrhageHeparinHipInformation storage and retrievalPulmonary embolismSafetyThrombosis ePublished: 9 March 2020 Issue Published: November 1, 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.Loading ...

Cystic neoplasms of the pancreas. A clinicopathologic study, including DNA flow cytometry.

To review the classification, clinical behavior, and appropriate therapy for cystic neoplasms of the pancreas. We examined patient demographics, clinical parameters, preoperative imaging modalities, histologic findings, and tumor DNA content to determine which best predict outcome. Case series and survey of pathologic specimens. Tertiary care center. Twenty-two patients with cystic neoplasms of the pancreas treated at affiliates of Northwestern University Medical School, Chicago, Ill. Predictive value of preoperative testing, tumor DNA content, patient survival. In 20 patients undergoing computed tomographic scan, the tumor was visualized in every case. All other imaging studies evaluated were less likely to demonstrate the lesion. Eight of 10 patients with serous cystadenomas were alive with no evidence of disease at the time of this report; one patient was alive with local recurrence, and a second patient had died of unrelated causes. All patients with mucinous cystadenomas were alive with no evidence of disease. Three of seven patients with cystadenocarcinomas had aneuploid, high S-phase tumors, and one had a diploid, high S-phase tumor; all four died (mean survival, 4.8 months). Two patients with cystadenocarcinomas had diploid, low S-phase tumors; both were long-term survivors but died of their disease at 8.6 and 9.3 years. (1) Computed tomographic scan is the most valuable diagnostic imaging study for preoperative evaluation of these patients. (2) Precise preoperative determination of tumor type is not possible. (3) DNA flow cytometry may help identify patients with aggressive tumors who may benefit from adjuvant chemoradiation.

Quality standard for the immunization of infants and children born to women infected with human immunodeficiency virus.

Catherine M. Wilfert, Jonathan E. Kaplan, Peter A. Gross, Henry Masur, King K. Holmes, and John P. Phair From Duke University, Durham, North Carolina; the Centers for Disease Control and Prevention, Atlanta, Georgia; Hackensack Medical Center, Hackensack, New Jersey, the National Institutes of Health, Bethesda, Maryland; the University of Washington, Seattle, Washington; and Northwestern University Medical School, Chicago, Illinois