Introduction: Venous thromboembolism (VTE) is a potentially fatal disorder. Prophylaxis is often suboptimal in medical inpatients, attributed to the difficulty in identifying at-risk patients. Simple and validated risk-assessment models... more
Introduction: Venous thromboembolism (VTE) is a potentially fatal disorder. Prophylaxis is often suboptimal in medical inpatients, attributed to the difficulty in identifying at-risk patients. Simple and validated risk-assessment models (RAMs) are available to assist clinicians in identifying and stratifying patients who have a higher likelihood for developing VTE. Despite the well-documented association of immobility with increased risk of thrombosis, immobility is not consistently defined in clinical studies. Methods: We conducted a systematic review of published RAMs, based on objective criteria, to determine how the term immobility is defined in RAMs. Results: We identified seventeen RAMs with six being externally validated. The concept of immobility is vaguely described in different RAMs, impacting the validity of these models in clinical practice. The widespread variability in defining mobility in RAMs precluded its accurate clinical application further limiting generalization...
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Abdominal palpation is a difficult skill to master in the physical examination. It is through the tactile sensation of touch that abdominal tenderness is detected and expressed through pain. Its findings can be used to detect peritonitis... more
Abdominal palpation is a difficult skill to master in the physical examination. It is through the tactile sensation of touch that abdominal tenderness is detected and expressed through pain. Its findings can be used to detect peritonitis and other acute and subtle abnormalities of the abdomen. Some techniques, recognized as signs or medical eponyms, assist clinicians in detecting disease and differentiating other conditions based on location and response to palpation. Described in this paper are medical eponyms associated with abdominal palpation from the period 1890 to 1917. PubMed, Medline, on-line Internet word searches, textbooks and references from other source text were used as the data source. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign. We present brief historical background information about the physician who reported the sign, original description of the sign, and its clinical application a...
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Relative bradycardia is a poorly understood paradoxical phenomenon that refers to a clinical sign whereby the pulse rate is lower than expected for a given body temperature. To provide an overview and describe infectious and noninfectious... more
Relative bradycardia is a poorly understood paradoxical phenomenon that refers to a clinical sign whereby the pulse rate is lower than expected for a given body temperature. To provide an overview and describe infectious and noninfectious causes of relative bradycardia. PubMed and Medline databases were searched using individual and Medical Subject Headings terms including relative bradycardia, fever, pulse-temperature dissociation and pulsetemperature deficit in human studies published from inception to October 2, 2016. The causes and incidence of relative bradycardia were reviewed. Relative bradycardia is found in a wide variety of infectious and noninfectious diseases. The pathogenesis remains poorly understood with proposed mechanisms including release of inflammatory cytokines, increased vagal tone, direct pathogenic effect on the myocardium, and electrolyte abnormalities. The incidence of this sign varies widely, which may be attributable to multiple factors, including populat...
Research Interests: Medicine and Bradycardia
Flushing disorders with involvement of the gastrointestinal tract represent a heterogeneous group of conditions. In part 1 discussed were neuroendocrine tumors (NET), mast cell activation disorders (MCAD), and hyperbasophilia. In this... more
Flushing disorders with involvement of the gastrointestinal tract represent a heterogeneous group of conditions. In part 1 discussed were neuroendocrine tumors (NET), mast cell activation disorders (MCAD), and hyperbasophilia. In this section are covered the remaining flushing disorders which primarily or secondarily involves the gastrointestinal tract. This includes dumping syndrome, mesenteric traction syndrome, rosacea, hyperthyroidism and thyroid storm, anaphylaxis, panic disorders, paroxysmal extreme pain disorder, and food, alcohol and medications. With the exception of paroxysmal pain disorders, panic disorders and some medication these disorders presents with dry flushing. A detailed and comprehensive family, social, medical and surgical history and recognizing the presence of other systemic symptoms are important in distinguishing the different disease that cause flushing with gastrointestinal symptoms.
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Subclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events. A retrospective cohort study was conducted to... more
Subclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events. A retrospective cohort study was conducted to determine the association of treatment via combination therapy (antiplatelet drug plus either by-pass surgery or percutaneous transluminal angioplasty (PTA) with or without stent implantation) versus antiplatelet drug therapy alone on cardiovascular events and all-cause mortality in Marshfield Clinic patients diagnosed with symptomatic SAS from January 1, 1995 to December 31, 2009. Of the total 2153 cases, 100 patients were identified as eligible to be included in the study. Of these 100 patients that met inclusion criteria, 30 underwent combination therapy while 70 were managed only with drug treatment. A median length of follow-up was 8.45 years. Adverse cardiovascular events occurred in 5/30 (17%) of combination therapy patients compared to 28/70 (40%)...
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BACKGROUND Factor XIII deficiency is a rarely encountered bleeding disorder traditionally identified by clot dissolution in 5 molar urea (urea solubility test). METHODS We report a patient with delayed post-surgical bleeding... more
BACKGROUND Factor XIII deficiency is a rarely encountered bleeding disorder traditionally identified by clot dissolution in 5 molar urea (urea solubility test). METHODS We report a patient with delayed post-surgical bleeding characteristic of factor XIII deficiency with a normal urea solubility test. RESULTS Factor XIII deficiency was identified by an automated assay that measured factor XIII antigen. The patient was successfully treated with cryoprecipitate. CONCLUSIONS Patients with excessive bleeding with normal screening tests should be tested for factor XIII using a sensitive assay procedure. The urea solubility assay for factor XIII should be discontinued due to its lack of sensitivity.
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Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the human nervous system caused by the JC virus. We report what is, to the best of our knowledge, the second reported case using a combination of mefloquine... more
Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the human nervous system caused by the JC virus. We report what is, to the best of our knowledge, the second reported case using a combination of mefloquine and mirtazapine in a patient with non-AIDS-related PML with a good clinical outcome. Conversely, the recent trial of mefloquine in 21 patients with AIDS and 3 without AIDS failed to show a reduction of JC viral DNA levels in the cerebral spinal fluid. However, the positive clinical response seen in our patient after the initiation of this combination therapy suggests that further studies in the form of randomized controlled trials for the treatment of non-AIDS-related PML are warranted.
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With the recent advances in molecular biology and genetics over the past several decades, we have grad-ually uncovered the elusive cause of some of the malignant diseases that have been, and continue to be, a major factor in human... more
With the recent advances in molecular biology and genetics over the past several decades, we have grad-ually uncovered the elusive cause of some of the malignant diseases that have been, and continue to be, a major factor in human mortality. Infectious disease agents, so ubiquitous in our environment, have now become the most credible link in our search for the cause of cancer. The number of malignancies associated with specific infectious disease agents continues to grow and now represents approximately 20% of all cancers. This perspective represents a brief summary of those cancers that have been associated with or caused by infectious disease agents. Hopefully, knowledge of this relationship can be translated into more effective means of treatment.
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Anorexia nervosa is a common problem in young adults that may present with a variety of metabolic and hematologic abnormalities, as well as weight loss and psychological disturbances. We present a young man with a long history of anorexia... more
Anorexia nervosa is a common problem in young adults that may present with a variety of metabolic and hematologic abnormalities, as well as weight loss and psychological disturbances. We present a young man with a long history of anorexia nervosa who developed pancytopenia associated with decreased bone marrow cellularity and abnormal architecture and marrow infiltration with an amorphous, gelatinous substance characteristic of anorexia nervosa. The patient also developed osteopenia with evidence of excessive calcium excretion. The pancytopenia and marrow function reverted to normal with therapeutic and dietary intervention. The effects of eating disorders can result in serious consequences with respect to an individual's health and well-being. A host of hematologic abnormalities that are associated with anorexia nervosa have the potential of increasing the risk of infection and bleeding. Additionally, because of the insidious development of anemia in some patients, decreased pe...
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... J. Mazza, MD, MACP Joseph J. Mazza, MD, MACP Department of Hematology/Oncology Marshfield Clinic 1000 North Oak Avenue Marshfield, WI 54449 E-mail: mazza.joseph@ marshfieldclinic.org ... 23. Ronco G, Costa G, Lynge E. Cancer risk... more
... J. Mazza, MD, MACP Joseph J. Mazza, MD, MACP Department of Hematology/Oncology Marshfield Clinic 1000 North Oak Avenue Marshfield, WI 54449 E-mail: mazza.joseph@ marshfieldclinic.org ... 23. Ronco G, Costa G, Lynge E. Cancer risk among Danish and Italian farmers. ...
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The case of a patient with two unusual dermatologic entities, multiple glomus tumors and the painful purpura of Gardner-Diamond syndrome, is reported. The diagnosis of multiple glomus tumors was confirmed by biopsy, and the... more
The case of a patient with two unusual dermatologic entities, multiple glomus tumors and the painful purpura of Gardner-Diamond syndrome, is reported. The diagnosis of multiple glomus tumors was confirmed by biopsy, and the Gardner-Diamond syndrome was confirmed by reproduction of the painful purpura with the intradermal injection of the patient's sonicated erythrocytes.
Research Interests: Biopsy, Humans, Autoimmune diseases, Female, Skin, and 5 moreClinical Sciences, Adult, Erythrocytes, Glomus Tumor, and Purpura
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We designed a phase II trial of arsenic trioxide (AT) for the treatment of relapsed and refractory acute lymphoblastic leukemia (ALL). The dose administered was 0.25 mg/kg/day intravenously for 5-7 days per week for up to 60 days. Of 11... more
We designed a phase II trial of arsenic trioxide (AT) for the treatment of relapsed and refractory acute lymphoblastic leukemia (ALL). The dose administered was 0.25 mg/kg/day intravenously for 5-7 days per week for up to 60 days. Of 11 patients eligible, eight had B-cell and three T-cell ALL and two were Philadelphia chromosome-positive. The median duration of therapy was 21 days (range 7-28). One patient died of an infection. There were no responses. Ten patients have died. The median survival was 3.2 months (range 1.2-4.1). We conclude that AT is not active in the treatment of ALL.
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For some physicians, retirement means leaving their practice and severing ties with their institution, while others may wish to maintain a more active role within their institution. Many institutions have designed programs that enable... more
For some physicians, retirement means leaving their practice and severing ties with their institution, while others may wish to maintain a more active role within their institution. Many institutions have designed programs that enable these individuals to maintain an academic relationship and provide services to their institution. This manuscript provides a brief experience of the Marshfield Clinic (MC) and Marshfield Clinic Research Foundation (MCRF) recent development of an emeritus program for research and education. The program is designed to provide opportunities for physicians, clinical PhDs, dentists, and other clinicians with terminal degrees and the necessary qualifications as researchers, to continue to contribute to the MC/MCRF research mission after retirement from clinical practice. Assignment to various aspects of the program is determined by the individual's expertise, experience and institutional needs. Expectations and performance of each individual is evaluated. The infrastructure of the program was assembled by reviewing institutes that have had an emeritus program in operation and integrating the unique aspect of MC/MCRF resources. Alignment of the unique skills, expertise, knowledge, and wealth of experience of emeritus faculty along institutional needs has provided added value to the institution without major financial investment.
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High-dose cytosine arabinoside ( HDARAC ) and 4'-(9 acridinylamino) methane sulfon -m-anisidine (m-AMSA) was administered as induction therapy to 40 patients with relapsed or refractory acute nonlymphocytic leukemia (ANLL) with... more
High-dose cytosine arabinoside ( HDARAC ) and 4'-(9 acridinylamino) methane sulfon -m-anisidine (m-AMSA) was administered as induction therapy to 40 patients with relapsed or refractory acute nonlymphocytic leukemia (ANLL) with the following results: 28 patients (70%) achieved complete remission, one patient achieved a partial remission; five patients died with hypoplastic bone marrows containing less than 5% blasts; four patients died with hypoplastic marrowing containing greater than 5% blasts; and three patients failed to achieve marrow aplasia and died without significant cytoreduction in percentage of blasts. Consolidation therapy was not used and maintenance therapy was given to less than 10% (three patients) of remission patients. The median duration of remission for all patients was 6.0 months and the median time for the complete remission patients exceeded eight months. This regimen has acceptable toxicity and the results are equivalent to those obtained from conventional induction therapy of de novo ANLL patients.
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Between July 1, 1981 and November 1, 1982, 45 patients with acute nonlymphocytic leukemia (age, greater than or equal to 70 years) were randomly assigned to receive induction chemotherapy using either daunorubicin, cytosine arabinoside,... more
Between July 1, 1981 and November 1, 1982, 45 patients with acute nonlymphocytic leukemia (age, greater than or equal to 70 years) were randomly assigned to receive induction chemotherapy using either daunorubicin, cytosine arabinoside, and 6-thioguanine in full dosage (F DAT) or an attenuated schedule of the same drugs (At DAT) as part of an Eastern Cooperative Oncology Group controlled trial. Forty patients were deemed evaluable, 20 on each arm. The overall complete remission (CR) rate for all patients in both arms was 28% (11/40). There was no significant difference in CR rates between the two arms. There were 12 early deaths (less than 60 days) in the F DAT arm compared with only five early deaths on the At DAT arm (P = .05). Due primarily to this early death rate, the median survival for the F DAT group was 29 days v 159 days for the At DAT groups (P = .02). The range of survival of the patients in CR for the At DAT group given either one or two cycles of induction therapy was 121 to 414 days, while the survival range for the F DAT CR patients was 121-186 + days. The median survival for those not achieving CR was 14 days for the F DAT group v 80 days for the At DAT (P less than .02). Fifty-nine percent of the At DAT patients spent greater than 100 days out of the hospital v 12% for the F DAT group. Attenuated chemotherapy with lower doses of DAT is the preferred induction regimen for elderly patients with acute nonlymphocytic leukemia since it causes fewer early deaths, allows a better quality of life, and yields survival times as durable as intensive therapy.
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... Cooperative Oncology Group. Hines JD, Mazza JJ, Oken MM, Bennett JM, Adelstein DJ, Keller A, O'Connell MJ. PMID: 3839318 [PubMed - indexed for MEDLINE]. Publication Types: Research Support, US Gov't, PHS. MeSH Terms. ...
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Heparin (Lipo-Hepin, Liquaemin Sodium) and warfarin sodium (Coumadin, Panwarfin) are the classic anticoagulants in use for venous thromboembolic disease. They work by modifying the coagulation mechanism, heparin having an immediate effect... more
Heparin (Lipo-Hepin, Liquaemin Sodium) and warfarin sodium (Coumadin, Panwarfin) are the classic anticoagulants in use for venous thromboembolic disease. They work by modifying the coagulation mechanism, heparin having an immediate effect and warfarin having a more delayed effect. The most common adverse effects of anticoagulation therapy are hemorrhagic complications. Thrombolytic therapy should be considered in all patients with massive pulmonary embolism with hypotension and in patients with deep venous thrombosis in the popliteal area or higher. Such therapy has been shown to help preserve the pulmonary microcirculation after pulmonary embolism and to decrease the incidence of the postthrombotic syndrome following deep venous thrombosis. If certain clinical guidelines are followed rigidly, the incidence of significant bleeding complications is low. Although the use of tissue plasminogen activator in venoocclusive disease has been limited to isolated cases, results have been very promising.
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ABSTRACT
... 1987 Jun;14(2 Suppl 1):37-9. Prolonged survival after high-dose cytosine arabinoside and amsacrine induction in patients with previously untreated de novo acute nonlymphocytic leukemia.Hines JD, Mazza JJ, Oken MM, Adelstein DJ, Keller... more
... 1987 Jun;14(2 Suppl 1):37-9. Prolonged survival after high-dose cytosine arabinoside and amsacrine induction in patients with previously untreated de novo acute nonlymphocytic leukemia.Hines JD, Mazza JJ, Oken MM, Adelstein DJ, Keller A, Bennett JM, O'Connell MJ. ...
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The clinical future of hematopoietic growth factors appears promising. They will probably achieve broad clinical application in a wide variety of hematologic disorders. Their use in infectious diseases associated with granulocytopenia and... more
The clinical future of hematopoietic growth factors appears promising. They will probably achieve broad clinical application in a wide variety of hematologic disorders. Their use in infectious diseases associated with granulocytopenia and in cancer-treatment regimens as adjuvant agents against myelosuppression and perhaps as stimulants of the natural anti-cancer effects of host cells also seems appropriate.
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The aim of this study was to compare the rate of recurrent venothromboembolic (VTE) events and factors contributing to VTE events in patients with inferior vena caval (IVC) filters on chronic anticoagulation to those in whom... more
The aim of this study was to compare the rate of recurrent venothromboembolic (VTE) events and factors contributing to VTE events in patients with inferior vena caval (IVC) filters on chronic anticoagulation to those in whom anticoagulation was discontinued. Retrospective cohort study of 353 patients who received IVC filters between 1986 and 2002. Anticoagulation status was available for 304 patients (132 on coumadin anticoagulation therapy and 172 who did not receive any anticoagulation therapy) whose IVC filters were placed within 30 days of their qualifying thromboembolic event. Two-year event-free survival for the anticoagulated group was 80.6% (95% confidence interval--CI--76.9, 84.3] and was 67.8% (95% CI 63.2, 72.3) for the non-anticoagulated group. Patients who had Greenfield filter had a higher, but not statistically significant different, rate of recurrence compared to those with other types of filters (hazard ratio 1.4; 95% CI 0.9, 2). The rate of recurrent VTE events was...
Research Interests: Survival Analysis, Treatment Outcome, Humans, Female, Male, and 14 morecerebral Venous sinus thrombosis, Follow-up studies, Thromboembolism, Anticoagulants, Recurrence, Clinical Sciences, Aged, Middle Aged, Adult, Warfarin, Leg, Retrospective Studies, prosthesis Design, and Combined Modality Therapy
Venothromboembolism (VTE) is an important condition in hospitalized patients accounting for significant morbidity and mortality, and the risk of VTE often continues post-hospitalization. Although risk assessment models have been developed... more
Venothromboembolism (VTE) is an important condition in hospitalized patients accounting for significant morbidity and mortality, and the risk of VTE often continues post-hospitalization. Although risk assessment models have been developed to predict the risk of deep venous thrombosis (DVT) in hospitalized patients, no models have been developed that determine the risk of DVT during the post-hospitalization period. The objective of this study was to create a risk profile using risk factor assessment that could be used to predict which patients are at highest risk of developing DVT within 60 days following hospital discharge. The computerized medical records of 380 patients (190 with DVT and 190 without DVT) who received care from 1995-2002 and were subsequently re-hospitalized within 60 days of discharge were retrospectively reviewed. Univariate and multivariate logistic regression analyses were conducted to identify risk variables related to VTE. A novel risk assessment model was cr...
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For some physicians, retirement means leaving their practice and severing ties with their institution, while others may wish to maintain a more active role within their institution. Many institutions have designed programs that enable... more
For some physicians, retirement means leaving their practice and severing ties with their institution, while others may wish to maintain a more active role within their institution. Many institutions have designed programs that enable these individuals to maintain an academic relationship and provide services to their institution. This manuscript provides a brief experience of the Marshfield Clinic (MC) and Marshfield Clinic Research Foundation (MCRF) recent development of an emeritus program for research and education. The program is designed to provide opportunities for physicians, clinical PhDs, dentists, and other clinicians with terminal degrees and the necessary qualifications as researchers, to continue to contribute to the MC/MCRF research mission after retirement from clinical practice. Assignment to various aspects of the program is determined by the individual's expertise, experience and institutional needs. Expectations and performance of each individual is evaluated...
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Thirty-eight patients with a diagnosis of relapsed acute lymphocytic leukemia were accrued to a treatment program of reinduction therapy by the Eastern Cooperative Oncology Group (ECOG). A combination of mitoxantrone, etoposide (VP-16),... more
Thirty-eight patients with a diagnosis of relapsed acute lymphocytic leukemia were accrued to a treatment program of reinduction therapy by the Eastern Cooperative Oncology Group (ECOG). A combination of mitoxantrone, etoposide (VP-16), and high-dose cytarabine (ARA-C) were administered over a five day period. Thirty-four patients were eligible for follow-up subsequent to treatment. Twenty-seven patients were in first relapse and seven were in second relapse. Fifteen of the thirty-four patients treated were given two cycles of induction chemotherapy. The complete remission (CR) rate for the entire group treated was 17%. The median duration of the CR was 2.4 months and the estimated median survival for first relapse patients was 4.5 months and 5.0 months for second relapse patient group. There were five deaths attributable to toxicity associated with the chemotherapy. The study emphasizes the difficulty in achieving durable remissions in adult patients with relapsed ALL.