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Biomedical subjects

B L Hainer

Publications and source records attributed to B L Hainer.

At least 19 recordsLinked to original sources
PubMed1996

'See and treat' electrosurgical loop excision of the cervical transformation zone.

BACKGROUND: "See and treat" electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure that enables simultaneous histologic diagnosis and treatment of premalignant cervical disease, thus eliminating the need for a preliminary cervical biopsy and an additional patient visit. Indications for the procedure include an abnormal cervical Papanicolaou (Pap) smear and a colposcopic impression of cervical intraepithelial neoplasia (CIN). The purpose of this study was to assess the "see and treat" ELECTZ procedure performed by family physicians. METHODS: Women who were scheduled for colposcopic evaluation because of an abnormal cervical cytology report were enrolled from the practices of three family physician colposcopists located at three sites. The "see and treat" ELECTZ procedure was performed on patients with both abnormal Pap smear results and abnormal colposcopic findings. Procedural complications were documented. Subjects were evaluated at follow-up examinations during the first postoperative year to determine therapeutic cure. RESULTS: "See and treat" ELECTZ was performed on 48 women. The histologic results from "see and treat" ELECTZ were normal for 36.1% of subjects. When subjects with a low-grade lesion on Pap smear were considered, 40.7% had normal loop histologic findings. Of women with a preoperative colposcopic impression of low-grade lesion, 54.2% had normal histologic results, and 12% of women with a high-grade colposcopic impression had normal histologic results (P<.001). When the colposcopic impression was reported as high-grade disease, 82% of loop specimens were reported as CIN 2 or 3. CONCLUSIONS: Selective use of "see and treat" ELECTZ may be appropriate only when practiced by experienced colposcopists who are able to reliably differentiate low-grade from high-grade disease by means of colposcopy, and if cytologic and colposcopic findings unequivocally indicate high-grade cervical disease.

Adolescent↗
PubMed1995

Electrosurgical loop excision of the cervical transformation zone: the experience of family physicians.

BACKGROUND: Electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure for treatment of premalignant cervical disease and the abnormal transformation zone by wire loop electrodes. The purpose of this study was to describe and assess the clinical experiences and complications of family-physician-performed ELECTZ and ELECTZ conization. METHODS: Women who were scheduled for the ELECTZ or ELECTZ conization procedures were enrolled in the study between March 1992 and March 1993, inclusive. Subjects were recruited from the practices of six family physician colposcopists located at five sites. The ELECTZ and ELECTZ conization procedures were performed on patients with abnormal Papanicolaou (Pap) smears or abnormal histologic results and abnormal colposcopic findings. Procedural complications were documented. Subjects were serially assessed during the first postoperative year by Pap smears, colposcopy, and, when necessary, by biopsy to determine therapeutic cure. RESULTS: Of 198 subjects enrolled in the study, 148 women were assessed at least once in follow-up by Pap smear and colposcopy. Only 7.6% of women were defined as treatment failures by subsequent histologic assessment. Women treated by ELECTZ conization were older (32.2 vs 25.1 years, P = .02), were more likely to develop posttreatment cervical stenosis (25.9% vs 3.8%, P = .001), and were more likely to have the postoperative squamocolumnar junction positioned in the endocervical canal (32.4% vs 8.7%, P = .002) than were women treated by ELECTZ: Loop excision specimen margins demonstrated dysplasia for 27 (13.6%) subjects. Significant operative bleeding (> 25 mL) was noted in 6.8% of subjects. Histologic thermal artifact was reported for 9.6% of specimens. One case of microinvasive cancer and one case of invasive cancer were identified unexpectedly by ELECTZ conization. CONCLUSIONS: Electrosurgical loop excision of the cervical transformation zone and ELECTZ conization may be safely and effectively performed in office settings by family physicians. Complications and treatment failure rates for the ELECTZ and ELECTZ conization procedures were similar to those experienced by other clinicians.

Adolescent↗
PubMed1994

Gynecologic and dermatologic electrosurgical units: a comparative review.

Electrosurgery is a popular surgical technique in which high-frequency, low-voltage electrical energy produced by an electrosurgical unit is used to excise abnormal tissue with hemostasis. In this study, electrosurgical units were critically evaluated for safety, electrical specifications, design, and performance characteristics. Quantitative electrical specification and histologic thermal artifact measurements and qualitative observations were recorded for 13 electrosurgical units representing 11 manufacturers. The Aspen Sabre 180 and Laerscope e10 were considered exemplary units based on safety criteria alone. Cut-mode thermal artifact was less than 10 microns for the Cooper Leep 6000, Laserscope e10, and Utah Finesse. A maximum fulguration distance of greater than 0.5 mm was demonstrated by the Gyne-Tech Autolepe 2000 and 4000, Laserscope e10, and the Elmed ESU 30. For gynecologic electrosurgery, the Aspen Sabre 180 and Laserscope e10 were rated best, followed closely by the Utah Finesse and Finesse II and the Gyne-Tech Autolepe 4000. Dermatologic electrosurgery may be well accomplished with many of the electrosurgical units, except as noted.

Ambulatory Surgical Procedures↗
PubMed1994

Preplacement evaluations.

A subcategory of fitness-for-duty evaluation, preplacement evaluations have a primary purpose of helping patients function as employees in occupations suited to their abilities, safely and with minimal risk to themselves, fellow workers, and the public. This article discusses the components of preplacement evaluations, ethical issues, and the effectiveness of these evaluations.

Confidentiality↗
PubMed1992

The effect of aspirin on niacin-induced cutaneous reactions.

BACKGROUND: Niacin (nicotinic acid) is one of the first-line agents recommended for the treatment of hyperlipidemia. Bothersome cutaneous reactions (flushing, feeling of warmth, itching, and tingling), however, often limit patient acceptability and tolerability. The National Cholesterol Education Program recommends giving aspirin or another nonsteroidal anti-inflammatory drug before administering niacin. Lack of scientific data supporting this recommendation, however, led to this randomized, double-blind, placebo-controlled trial to evaluate the efficacy of 80 mg of aspirin and 325 mg of aspirin in reducing these cutaneous reactions. METHODS: Thirty-one healthy subjects were randomized into one of four groups. Each group completed four different treatment regimens (placebo-placebo; 80 mg of aspirin-500 mg of niacin; 325 mg of aspirin-500 mg of niacin; and placebo-500 mg of niacin). Subjects received one of each of the four treatment regimens on separate visits that were at least 24 hours apart. Intensity and tolerability of cutaneous reactions were evaluated by an intensity rating scale and a visual analog scale. RESULTS: Results indicate that 325 mg of aspirin is significantly better than 80 mg of aspirin in decreasing intolerability to niacin. Aspirin reduced the incidence of warmth and flushing associated with niacin, but not the itching and tingling. CONCLUSIONS: It appears from this pilot study that preceding niacin with 325 mg of aspirin will decrease the warmth and flushing associated with niacin.

Adult↗
PubMed1991

Relationship between patient race and survival following admission to intensive care among patients of primary care physicians.

This study investigated the existence of racial differences in the survival of patients admitted to intensive care by family physicians and general internists for circulatory illnesses. The study population consisted of 249 consecutive patients admitted by these specialists to an ICU in a tertiary care hospital in Pitt County, North Carolina, during the June 1985 to June 1986 period. Logistic regression was used to specify the unique effect of race on ICU patient survival in-hospital, controlling for potential confounding factors such as disease severity, type of health insurance, and case mix. Black patients were almost three times more likely than white patients to die in-hospital following admission to the ICU (RR = 2.9, 95 percent I = 1.5, 5.6). Most of this difference in survival was explained by racial differences in disease severity.

Black People↗
PubMed1991

Electrosurgery for cutaneous lesions.

Electrosurgery can be used to excise tissue, coagulate blood vessels or destroy tumors. Electrosurgical techniques include cutting, coagulation, desiccation and fulguration. For skin lesions, electrosurgery offers the advantages of rapid treatment, hemostasis at the time of incision, preservation of a specimen for pathologic examination and cosmetically acceptable results.

Electrosurgery↗
PubMed1988

Comparison of critical care provided by family physicians and general internists.

Privilege conflicts and credentialing issues involving family physicians' care of hospitalized patients are controversial areas. This study compares the process and outcome of critical care provided by family physicians and general internists. We studied 523 patients admitted by these specialists to the medical intensive and cardiac care units of a large regional hospital over a one-year period. The length of stay and readmission rate in the intensive care unit and hospital, severity of illness, discharge diagnosis, proportion who died, time until death of those who died, consultation rate, and hospital charges did not differ significantly between patients cared for by physicians in the two specialties. Application of Cox's proportional hazard model to the data indicated the risk of death to be significantly related to patient race, age, and severity of illness, but not to physician specialty. Regression analysis of several morbidity variables showed no relationship to physician specialty. Lack of differences in outcome and process in the hospital studied leads us to believe that both family physicians and general internists are entitled to have equal access to the care of patients in critical care units.

Adult↗
PubMed1987

Cat-scratch disease.

Cat-scratch disease is a self-limited disease associated with contact with cats that causes regional lymphadenopathy in children and young adults. Recently identification of the probable causative organism, a gram-negative, non-acid-fast coccobacillus, has been achieved through special staining techniques from skin inoculation sites and involved lymph tissue. Differential diagnosis includes a variety of other infectious diseases and neoplasms. Diagnosis of cat-scratch disease can be made by presence of typical clinical findings, history of exposure to cats, results of skin testing to cat-scratch antigen, and in some circumstances, biopsy or fine-needle aspiration from skin inoculation site or involved lymph nodes. Future developments awaiting culture of the suspected bacterium include a vaccine for prevention, rapid diagnostic methods, and antimicrobial testing.

Cat-Scratch Disease↗
PubMed1982

Limulus lysate assay in detection of gonorrhea in women from a low-incidence population.

An evaluation of the limulus amebocyte lysate assay for detection of gonococcal endotoxin in cervical secretions was undertaken in 48 women from an ambulatory population with a low incidence of gonococcal infection. When cervical secretions were diluted 1 : 2,000, positive limulus amebocyte lysate assay results were obtained in four women (100%) with culture-proved gonococcal infection, and negative results were obtained in 25 of 44 women (57%) with culture-negative specimens. The limulus amebocyte lysate assay was not sufficiently specific in a low-incidence, largely asymptomatic population to be recommended as a rapid diagnostic procedure (60 minutes) in such a group. Standardization of sampling technique, size, and reagent preparation and elimination of vaginal contamination of cervical secretions may produce a limulus amebocyte lysate test with more consistent performance characteristics in varied populations. Since the predictive value of a test varies with the prevalence of the disease in the populations tested, a test proposed for use in a population with a low likelihood of disease must be tested in such a population.

Adolescent↗
PubMed1982

Selective patient enrollment: a tool for improved residency training.

Providing a full range of problems to be managed in a model family practice unit is the goal of selective enrollment of patients at the Medical University of South Carolina. A computerized problem-oriented medical record is used to help distribute families with selected chronic diseases equitably to residents. Attention to the demographics of each resident's practice panel can help influence the distribution of health problems which a resident may experience at the model unit. Knowledge of the demographics of families at the model unit can help determine how representative they are of the surrounding community. Reallocation of families to new resident physicians when their old resident physicians complete training is logically planned. Work loads of resident physicians are monitored to adjust family assignments in their practice panels. The patient enrollment process is responsive to resident and faculty input regarding deficiencies in the health care experiences of the resident.

Demography↗