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Biomedical subjects

A Joseph

Publications and source records attributed to A Joseph.

At least 55 records · Page 3Linked to original sources
PubMed2001

Extra-anatomic arterial reconstruction with ligation of common iliac arteries and embolization of the aneurysm for the treatment of abdominal aortic aneurysms in high-risk patients.

PURPOSE: The mortality of an unrepaired abdominal aortic aneurysm (AAA) generally exceeds the mortality associated with surgical repair. However, as our longevity increases, more frequently we see patients whose risk of surgical repair approximates the risk of rupture. We present an extra-anatomic bypass graft with complete aneurysm exclusion by iliac ligation and coil embolization of the aneurysm as an alternative for these high-risk patients. METHODS: An extra-anatomic bypass graft, followed by bilateral iliac artery ligation (retroperitoneal approach) and complete coil embolization of the AAA, was performed in eight patients (mean age, 77 years) found to be at prohibitive operative risk because of multiple comorbidities (American Society of Anesthesiologists class IV). Most patients (5 of 8) were symptomatic on presentation with a mean AAA diameter of 7 cm (range, 6.7-9.5 cm). We repair approximately 30 infrarenal aneurysms per year electively at our institution. RESULTS: All patients tolerated the surgical procedures. The average hospital stay was 8 days. All but two aneurysms demonstrated complete thrombosis by 48 hours. After 48 months there was no incidence of graft thrombosis, peripheral ischemia, visceral ischemia or thrombus infection. There was one perioperative death from aspiration pneumonia. Seventy-five percent (6 of 8) of patients have survived at least 1 year without surgical complications. No patient has had a ruptured aneurysm. CONCLUSION: Combining an extra-anatomic bypass graft and complete exclusion of the AAA by ligation of the common iliac arteries and a coil embolization is an effective, less invasive treatment option for patients with AAA and prohibitive operative risk. We emphasize the need for complete embolization documented by decreased aneurysm size.

Aged↗
PubMed2001

Failure of amniotic membrane transplantation in the treatment of acute ocular burns.

AIM: To report the failure of amniotic membrane transplantation (AMT) for ocular surface reconstruction in patients with severe acute chemical and thermal burns. METHODS: Four eyes of three patients who suffered severe chemical (n=3) and thermal (n=1) burns were studied. The aim of AMT was to prevent symblepharon formation, promote conjunctival regeneration, inhibit corneal melting by promoting epithelialisation, and to protect the ocular surface while associated lid burns were treated. AMT was used to cover the entire ocular surface of all the severely burnt and ischaemic eyes, 2-3 weeks after the injury. Where indicated, AMT was repeated by itself or in combination with other procedures in all patients. RESULTS: Three of the four eyes developed symblepharon and progressive corneal melt requiring urgent tectonic keratoplasty. All four eyes had persistent epithelial defects. Less than 25% of conjunctival regeneration occurred in three eyes. Two eyes autoeviscerated, one patient underwent lid sparing exenteration for a painful blind eye and one eye became phthysical. CONCLUSIONS: AMT did not help to restore the ocular surface or preserve the integrity of the eye in all our patients with severe acute burns, when used by itself or in combination with other surgical procedures. This reflects the extreme severity of the ocular burns in these patients and, in turn, draws attention to the fact that the current classification system does not adequately reflect such severity. In the current system such burns would be grouped under grade IV injuries to the eye (more than 50% limbal ischaemia). The prognosis of patients with 100% limbal ischaemia is much worse than patients with just over 50% limbal ischaemia. This inadequacy of the classification system probably also explains the difference between outcomes of management of grade IV burns (with AMT) in this series, compared with others.

Acute Disease↗
PubMed2001

Viability of water weeds and microalga in pulp and paper mill wastewater.

Water weeds Azolla pinnata and Lemna minor and the chlorophycean alga Scendesmus bijugatus were grown in a paper mill wastewater. The objective of the study was to assess the viability of these species upon exposure to such effluents and to assess their potential in the improvement of effluent quality. The wastewater was analysed before and after the treatment with these species. The growth of the alga and the hydrophytes was also measured. The algal assay revealed that the clear effluent will promote algal growth on addition of fertilizer while water weeds did not require fertilizer input. Both the algae and macrophytes could reduce the BOD and COD of the effluent.

Araceae↗
PubMed2000

Transthoracic Doppler echocardiographic comparison of left internal mammary grafts to left anterior descending coronary artery with ungrafted right internal mammary arteries in patients with and without myocardial ischemia by dobutamine stress echocardiography.

To characterize Doppler flow patterns of the grafted left internal mammary artery (LIMA) in patients with and without dobutamine stress induced wall motion abnormalities in the graft distribution, we studied 29 patients who underwent coronary artery bypass surgery using LIMA grafts to the left anterior descending coronary artery (LAD). The ungrafted right internal mammary artery (RIMA) was used as a control. RIMA Doppler flow pattern was predominantly systolic in all patients. In patients without ischemia in the LAD distribution, LIMA flow was predominantly diastolic. In patients with ischemia, LIMA flow was predominantly systolic. In the grafted LIMA, a ratio of diastolic to systolic time-velocity integral of > 1.5 best showed absence of ischemia in the graft distribution. In summary, characterization of the Doppler flow pattern in the internal mammary arteries is feasible. In the grafted LIMA, ratios of diastolic to systolic flow are less in patients with an ischemic response in the subtended vascular bed than in those without ischemia.

Aged↗
PubMed2000

Bernard-Soulier syndrome: common ancestry in two African American families with the GP Ib alpha Leu129Pro mutation.

Bernard-Soulier syndrome (BSs) is a rare bleeding disorder characterized by circulating giant platelets, thrombocytopenia, and a prolonged bleeding time. BSs usually has an autosomal recessive inheritance pattern, with a preponderance of Caucasian and Japanese ancestry when the ethnic background has been reported. Underlying this disorder of platelet function is a defect in the platelet glycoprotein (GP) Ib-IX-V complex, composed of four polypeptides, GP Ib alpha, GP Ib beta, GP IX, and GP V. Molecular characterization of individuals with BSs has identified mutations in the GP Ib alpha, GP Ib beta, and GP IX genes responsible for the expressed phenotype. In this study, we report a family of African-American descent, with autosomal recessive BSs showing a point mutation in codon 129 of the GP Ib alpha gene. This mutation, CTC:wild-type to CCC:mutant, is similar to that of another African American family where the resulting leucine to proline substitution in the 5(th) leucine-rich repeat of GP Ib alpha is responsible for the observed BSs phenotype. Comparison of the intragenic polymorphisms of GP Ib alpha, as well as microsatellite markers in a 17.5 cM region of chromosome 17p12 that contains the GP Ib alpha gene, suggests that, although socially unrelated, the Leu129Pro mutation in these two families has a common founder.

Africa↗
PubMed2000

Analysis and interpretation of cost data in dialysis: review of Western European literature.

BACKGROUND: Constant improvements in dialysis technology, combined with a growing chronic renal failure population and limited funds, have put clinicians under pressure to prescribe the most cost-effective therapies. Improvements in dialysis, which eliminates metabolic waste products and preserves a normal electrolyte and fluid balance, have enhanced the quality of care among renal patients but at high monetary cost to health systems. Several recent studies report that yearly costs of peritoneal dialysis (PD) (because of technical differences in treatment strategies) are less than hemodialysis (HD) with hospital and other costs included. However, cost analyses of dialysis modalities are not always complete. As a result they are often difficult to directly compare. Furthermore, input costs, health care organizations, and patient use of dialysis vary from country to country in important ways. OBJECTIVE: To review critically the European literature in dialysis where cost data in caring for patients is available, and maximize information about the nature of the cost data in dialysis. METHODS: Survey of published literature including an economic evaluation with cost values in Western Europe; 25 such studies were identified, described in 20 publications. The search focused primarily on articles and reports published since 1990. The appraisal of studies took place according to standard costing procedures, covering, but not limited to, specification of analytic perspective and cost components considered. RESULTS: Costs between dialysis modalities vary from country to country in important ways, although power to detect such differences was limited. The disclosure of details regarding costing methods ranged widely. Only four studies presented adequate descriptive information for dialysis costs. CONCLUSIONS: Errors should be expected in all exercises to estimate dialysis costs. But, potentially misleading conclusions about the relative costs of dialysis therapies have been published in the absence of supporting evidence. Costing information in this field is often handled inconsistently and unsatisfactorily. The analysis and reporting of costs within publications concerning dialysis needs improvement. The review suggests a positive cost advantage to peritoneal dialysis over hemodialysis, but the magnitude of the difference is difficult to evaluate at this time.

Costs and Cost Analysis↗
PubMed2000

Acute tracheal rupture related to endotracheal intubation: case report.

Tracheal laceration is a rare complication of endotracheal intubation. We present a case of tracheal laceration after a simple prehospital tracheal intubation in a patient with severe tracheomalacia. The most likely cause of the tracheal injury was massive overinflation of the endotracheal tube cuff and the preexisting tracheal wall weakness. The case illustrates the classic radiologic signs of tracheal laceration, and we review the relevant literature.

Acute Disease↗
PubMed2000

The reality of unsafe abortion in a rural community in South India.

Though the law in India has permitted medical termination of pregnancy on broad legal grounds for over two decades, unsafe abortions carried out by unqualified providers show no signs of decreasing. A community-based study was undertaken in rural South India to determine the prevalence of induced abortion, women's reasons for seeking abortion, who was providing abortions and whether the procedures were safe or unsafe. A cross-sectional study design was used that included focus group discussions with 88 women and a quantitative survey with 195 married women who had a birth interval of two or more years since their last pregnancy. There was a high prevalence of induced abortion (28 per cent) among the study population, mainly among women who were not using contraception. Most abortions were carried out in the first trimester of pregnancy and unqualified practitioners performed 65 per cent of terminations. The preference for illegal, untrained providers in a country where abortion is legally available exposes the ambiguity in the status of abortion and how inadequacies in legal service provision have served to promote and sustain unsafe providers and practices. An integrated approach to family planning and reproductive health which includes abortion is imperative if the reproductive health status of Indian women is to be improved. The poor utilisation of existing government facilities suggests the need for improving the quality of services, expansion of abortion facilities and the introduction of safer methods of abortion. To do this, a re-examination and re-framing of aspects of the 1971 abortion law is needed.

Abortion, Induced↗
PubMed2000

Implementing emergency department observation units within a multihospital network.

BACKGROUND: The proportion of emergency department (ED) chest pain patients who undergo an extended "rule out MI (myocardial infarction)" evaluation beyond the ED determines both the quality and cost of patient care. The higher an organization's rate of such evaluations, the lower the average miss rate for MI. Five of the 13 hospitals in the Voluntary Hospital Association Northeast multihospital network implemented ED observation units by June 1997 for outpatient rule out MI evaluations. RESULTS: Compared with historical and case controls, the five hospitals with ED observation units had a higher observation rate (16% versus 0% [p < .001] and 2% [p < .001]) and a higher rule out MI evaluation rate (61% versus 46% [p < .01] and 45% [p < .01]), without a significantly higher admission rate (47% versus 46% and 45%). For the three hospitals with observation units that collected charge data during 1997 on a consecutive series of chest pain patients who had negative rule out MI evaluations, charges for patient services were lower for patients evaluated in the ED observation unit ($2,214.80 +/- $80.40) than in the hospital ($5,464.30 +/- $393.60). CONCLUSIONS: ED observation units represent a cost-effective restructuring of the diagnostic approach to patients with acute chest pain. In an improvement of quality of patient care, a larger proportion of ED chest pain patients receive an extended evaluation than is possible with hospital admission as the only ED disposition option.

Chest Pain↗
PubMed2000

Cardioesophageal reflexes: an invasive human study.

Neural reflex arcs from the esophagus and heart have been shown in both animals and man. The purpose of this study was to further investigate these pathways in individuals undergoing cardiac catheterization. A total of 298 patients undergoing cardiac catheterization were asked to participate in the protocol. Thirty patients were able to complete the study. Esophageal manometry and pH were monitored throughout the cardiac procedure. Afterwards, esophageal provocation with ice water, hydrochloric acid, and balloon inflation was performed with observation of cardiac rate and rhythm. Twelve patients with normal coronary arteries developed diffuse esophageal spasm on either esophageal or cardiac provocation. In one patient with abnormal coronary arteries, coronary angioplasty precipitated diffuse esophageal spasm. Esophageal acid sensitivity was increased in patients with normal coronaries as compared to those that were abnormal. The esophageal pain threshold was significantly lower in patients undergoing angioplasty versus those undergoing coronary angiography alone. There was no significant change in esophageal pH during invasive cardiac maneuvers and manipulations. In conclusion, cardiac manipulation can induce esophageal motility abnormalities, but not gastroesophageal reflux. Coronary angioplasty is associated with esophageal hyperalgesia.

Angioplasty, Balloon, Coronary↗
PubMed2000

The impact of lymphatic filariasis on labour inputs in southern India: results of a multi-site study.

A multi-site study was undertaken, in the rural areas of three districts in Tamil Nadu state, in southern India, to examine the impact of acute and chronic forms of lymphatic filariasis, caused by infection with Wuchereria bancrofti, on labour inputs. More than half of the acute episodes of adenolymphangitis (ADL) observed in the study communities caused total disability. The mean (S.D.) time that each ADL case was able to allocate to economic activity each day during these acute episodes was much less than seen in the controls matched for sex, age and occupation [0.97 (2.36) v. 4.48 (3.82) h; P < 0.01]. The acute disease also severely affected domestic activities, with female ADL cases spending only 1.54 (2.12) h/day on domestic activity, compared with 4.18 (2.61) h by controls. The subjects with chronic filariasis also spent significantly less time in economic activity than their matched controls [4.40 (3.79) v. 5.13 (3.83) h/day; P < 0.01). Although the acute episodes have a dramatic effect on the productivity of the affected individual, the labour loss caused by chronic disease is more serious, as the manifestations of chronic disease mostly affect the most productive age-groups, persist for life and are mostly irreversible. The adverse impact of acute and chronic filariasis was observed in males and females, farmers and non-farmers and during the rainy, winter and summer seasons. It is estimated that about 3.8% of the potential labour inputs of the men and 0.77% of those of the women were lost because of lymphatic filariasis. In addition to this loss, the total economic burden of the disease must include the costs of treatment and other health care and of the resources spent on control programmes. Estimates of the disease burden are likely to be useful in determining the costs and benefits of the recently launched campaign to eliminate lymphatic filariasis.

Acute Disease↗