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Biomedical subjects

B I Bodai

Publications and source records attributed to B I Bodai.

At least 19 recordsLinked to original sources
PubMed2001

Total cost comparison of 2 biopsy methods for nonpalpable breast lesions.

OBJECTIVE: To identify, quantify, and compare total facility costs for 2 breast biopsy methods: vacuum-assisted biopsy (VAB) and needle-wire-localized open surgical biopsy (OSB). STUDY DESIGN: A time-and-motion study was done to identify unit resources used in both procedures. Costs were imputed from published literature to value resources. A comparison of the total (fixed and variable) costs of the 2 procedures was done. PATIENTS AND METHOD: A convenience sample of 2 high-volume breast biopsy (both VAB and OSB) facilities was identified. A third facility (OSB only) and 8 other sites (VAB only) were used to capture variation. Staff interviews, patient medical records, and billing data were used to check observed data. One hundred and sixty-seven uncomplicated procedures (71 OSBs, 96 VABs) were observed. Available demographic and clinical data were analyzed to assess selection bias, and sensitivity analyses were done on the main assumptions. RESULTS: The total facility costs of the VAB procedure were lower than the costs of the OSB procedure. The overall cost advantage for using VAB ranges from $314 to $843 per procedure depending on the facility type. Variable cost comparison indicated little difference between the 2 procedures. The largest fixed cost difference was $763. CONCLUSIONS: Facilities must consider the cost of new technology, especially when the new technology is as effective as the present technology. The seemingly high cost of equipment might negatively influence a decision to adopt VAB, but when total facility costs were analyzed, the new technology was less costly.

Biopsy↗
PubMed1996

The myths of managed care. Surgical perspectives.

Managed care is the contemporary and near-future system of medicine in which we must learn to exist. Many are afraid of managed care only because they are not familiar with the concept. Misconceptions abound in the medical community concerning the sudden rise of managed care systems. Surgeons, their postgraduate training and experience, daily practice, multiple outside interests, and future governance of their craft are not at risk in the managed care environment.

Education, Medical, Graduate↗
PubMed1996

Complications after negative laparotomy for trauma: long-term follow-up in a health maintenance organization.

OBJECTIVE: To assess short-term and long-term complication rates after trauma laparotomy in a group of health maintenance organization (Kaiser Permanente) patients. DESIGN: Retrospective cohort study of patients belonging to Kaiser Permanente. MATERIALS AND METHODS: Eighty Kaiser patients who underwent a negative or nontherapeutic laparotomy for trauma at a Level I trauma center (University of California, Davis Medical Center (UCDMC)) between April 1989 and May 1994 were identified. Demographic data, past medical history, mechanism of injury, indications for surgery, findings at laparotomy, and short-term complications were abstracted from the UCDMC record. Long-term complications were taken from the Kaiser record. MEASUREMENTS: Long-term complications, including small bowel obstruction, hernia, and cosmesis. Short-term complications, including pneumonia, cellulitis, wound infection, prolonged ileus, and urinary tract infection. RESULTS: The single death in the early postoperative period was not related to the laparotomy. Mean follow-up was 36 +/- 2 months (median, 36 months); 86% had follow-up of at least 1 year. The incidence of short-term complications was 43% in patients with associated extra-abdominal injuries and 20% in patients without associated extra-abdominal injuries (p = 0.17). On long-term follow-up, there were no small bowel obstructions, incisional hernias, or cosmetic problems requiring correction. One patient developed a stitch abscess 6 weeks after the operation. CONCLUSIONS: The incidence of long-term complications after negative or nontherapeutic laparotomy for trauma is low.

Abdominal Injuries↗
PubMed1989

The injury potential and lethality of stab wounds: a Folsom Prison Study.

The morbidity and mortality of stab wounds is unknown since much of the data is unobtainable. Folsom Prison, a closed system with respect to population at risk and medical care, represents a unique situation where all stab wounds and subsequent care are accounted for. A retrospective review of stabbing incidents at Folsom Prison identified 751 wounds in 270 prisoners. Overall mortality was 3%. Thirty-five per cent of the victims were hospitalized. The overall chance of serious injury, defined as an assault victim requiring more than cleansing and suturing of his wounds, was 25%. The most common procedures were tube thoracostomy (performed 36 times) and celiotomy (performed 31 times). We believe that this is the first study of its kind involving a closed population to accurately assess the overall morbidity and mortality of stab wounds. The 3% mortality and the 25% requiring a procedure beyond suturing reflects the low injury potential long clinically suspected in stab wounds.

Adult↗
PubMed1988

Simple ligation vs stump inversion in appendectomy.

The records of 886 patients who had appendectomy performed by the same surgeons within a five-year period were used to contrast appendiceal stump inversion vs simple ligation. Our analysis contrasted inversion vs simple ligation techniques as related to postoperative complications, hospital stay, and pathologic diagnosis. Adhesions requiring repeated operation to relieve bowel obstruction occurred in five of 87 patients with acute gangrenous appendicitis treated by inversion. Of 106 patients with acute gangrenous appendicitis treated with simple ligation, postoperative obstruction developed in none. No other statistically significant differences existed between the two techniques. These data suggest that simple ligation is at least as good as and probably better than inversion of the appendiceal stump.

Acute Disease↗
PubMed1988

Retropharyngeal hematomas.

Hyperextension of the cervical spine in the elderly can cause retropharyngeal hematomas. We report this unusual cause of retropharyngeal hematoma in a 77-year-old women. The airway must be thoroughly evaluated in any such patient in whom this lesion is suspected.

Aged↗
PubMed1987

Cystic neoplasms of the pancreas.

Eight patients with cystic neoplasms of the pancreas were seen at four Northern California hospitals between the years 1978 and 1986. Three of the tumors were benign and five were malignant. Three females, whose average age was 61 years, had cystadenomas. Three females and two males, whose average age was 48 years, had mucinous cystadenocarcinomas. Clinical presentations were similar among all patients. Abdominal pain was a prominent feature. Anorexia, weight loss, nausea and vomiting with a palpable abdominal mass were seen in five of eight patients. Obstructive jaundice was seen in two of eight patients. Among patients with benign lesions, one lesion was in the head and two lesions were in the tail of the pancreas. The malignant lesions were in the head of the pancreas in three patients and in the tail or body in two. A presumptive diagnosis was made preoperatively on the basis of the clinical, laboratory and roentgenographic findings in seven of eight patients. Of the patients with benign tumors, two are alive and well at seven years and four months and one patient was lost to follow-up study at four years. Among the patients with a malignant condition who underwent operation, resection for cure was performed upon four patients. One patient died postoperatively and the other three patients are alive and well without evidence of a recurrence at three and one-half, four and four years after resection. Pancreaticoduodenectomy was performed upon two patients and distal pancreatectomy in another. Palliation was attempted in one critically ill patient with an unresectable tumor by longitudinal pancreaticojejunostomy. This procedure was not effective in providing pain relief because of obstruction of the pancreatic duct by the viscous mucoid secretion of the tumor. The preoperative diagnosis of these very rare tumors is usually possible roentgenographically, especially with the use of the computed tomography scan. The presence of a thick mucoid secretion of high viscosity is diagnostic of mucinous cystadenocarcinoma. Cystic neoplasms of the pancreas should always be resected, if possible, with the expectation of long term survival.

Adult↗
PubMed1987

Enterolith ileus resulting from small bowel diverticulosis.

Small intestine diverticula are infrequent. These acquired pulsion diverticula are postulated to be a result of intestinal dyskinesis. Usually asymptomatic, they can produce a variety of disorders such as malabsorption, hemorrhage, diverticulitis, and perforation. The rarest complication appears to be enterolith formation and obstruction. It is postulated that dyskinesis and stasis leads to bacterial overgrowth causing decomposition of bile salts allowing precipitation and concretion. Presented is an ileal obstruction from a small bowel enterolith. A literature review revealed 25 other cases of obstruction. Most of these cases were treated with simple removal, some with small bowel resection. Results are good and recurrences have not been observed.

Aged↗
PubMed1985

Guidelines for discontinuing prehospital CPR in the emergency department--a review.

We provide information that we believe should allow the establishment of rational guidelines for discontinuing, with physician supervision, unsuccessful prehospital CPR. Goldberg has advocated that CPR be terminated only after evidence of brain or cardiac death has persisted for more than one hour of adequately applied advanced CPR. This recommendation was made for inhospital resuscitation and does not reflect the limited capabilities of basic and advanced CPR techniques to sustain life outside the hospital. In addition, White and associates have demonstrated that after resuscitation from prolonged cardiac arrest, cerebral cortical blood flow is reduced severely. This state of hypoperfusion may last up to 18 hours. Because this condition can result in extensive neurologic damage, it may explain the poor survival rates after prolonged resuscitation. We propose that CPR be terminated in the ED when, despite adequate rescue attempts (intubation, defibrillation, IV medications, CCCM en route) by those responding at the scene of cardiac arrest, intrinsic cardiac activity has not been achieved in patients brought to the hospital with asystole or bradyarrhythmia. Additionally patients who have had advanced prehospital CPR for more than 45 minutes without generation of any intrinsic cardiac activity are not resuscitatable by current standard techniques, and CPR may be discontinued. These criteria must not be used for victims of hypothermia before a core temperature of 35 C to 36.1 C is achieved by active core rewarming during CPR. The available data suggest that if these criteria are implemented, many unproductive hospital-based resuscitative efforts can be eliminated without jeopardizing potential survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Death↗
PubMed1985

Prehospital stabilization of critically injured patients: a failed concept.

Prehospital resuscitation and stabilization of major trauma victims is increasingly employed. To evaluate the benefits of one such maneuver, fluid administration, we reviewed 52 consecutive trauma cases in which patients had a blood pressure of less than 100 mm Hg either at the scene or on arrival to hospital. In all cases, transport time to hospital was less than IV establishment time. Fluid volume infused had little influence on final outcomes. A percentage of patients with correctable surgical lesions might have been salvaged had prompt transport been instituted. Field maneuvers in critically injured patients should be minimized to decrease ultimate mortality.

California↗
PubMed1984

Diagnosis and management of ingested foreign bodies: a ten-year experience.

Ingested gastrointestinal foreign bodies may be managed by observation, endoscopy, and/or surgical intervention. We retrospectively reviewed 87 consecutive cases of foreign body ingestion. In 49 patients the ingested foreign body had passed beyond the gastroesophageal junction, and these cases form the basis of this study. Of the 49 patients, 19 (38.7%) required surgical intervention for removal of the swallowed object. Nearly 75% of these patients had swallowed objects that were more than 6.5 cm in length. Of 30 adults, more than 50% required surgery for removal of the foreign body. However, fewer than 16% of children who had swallowed and retained foreign bodies required surgery for ultimate cure. Based on these findings, guidelines are presented for the management of foreign body ingestion.

Adolescent↗