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Biomedical subjects

H L Abrams

Publications and source records attributed to H L Abrams.

At least 37 records · Page 2Linked to original sources
PubMed1984

Medical resources after nuclear war. Availability v need.

In defining capacity to "survive" a massive nuclear exchange, it is important to assess the medical resources that will be available in the post-nuclear war world. Approximately 80% of these resources--hospital beds and personnel, blood, drugs, and medical supplies--will have been destroyed, since they are located in or near the densely populated areas that constitute primary targets of attack. Casualty estimates published by federal agencies, together with data from the Hiroshima-Nagasaki experience, suggest the numbers and types of injuries that will afflict the US population. With a probable 48,000 surviving physicians to treat 32 million casualties, there will be one physician for every 663 patients. Of the trauma and burn victims, approximately 55% will require hospitalization; this will mean 64 patients for each available hospital bed. Data from recent wars have been utilized to determine the trauma-related blood requirements in the post-nuclear war world. Of the 64 million units of whole blood needed, only 14,000 will be available. Other medical resources will be in equally short supply. This disparity between need and availability indicates the difficulty of developing a meaningful medical response for the surviving injured.

Blood Transfusion↗
PubMed1984

The cost of underutilization. Percutaneous transluminal angioplasty for peripheral vascular disease.

Despite the considerable literature on the overuse of new medical technologies, little attention has been paid to the biologic and monetary costs that may be incurred by underuse. Percutaneous transluminal angioplasty as a treatment for peripheral vascular disease is an example of an important technology that has been underused. Although angioplasty alone is less costly but also less efficacious than surgery, a strategy that combines the two procedures (angioplasty first, then surgery if angioplasty is unsuccessful or if occlusion recurs) is uniformly superior to surgery alone in patients who have lesions for which angioplasty can be considered. From a nationwide perspective, if 40 per cent of all patients with iliac or femoral disease (or both) requiring intervention were treated with the combined strategy, there would be an estimated savings (as compared with surgery alone) of 352 lives and $82 million, as well as an additional 5006 patent limbs. Despite these advantages, the use of angioplasty during the period under consideration (up to 1980) was limited, possibly because of the mechanism of patient triage and the inertial forces that operate when a therapeutic method that appears effective--even if more complex and hazardous than a newer approach--has been widely applied.

Angioplasty, Balloon↗
PubMed1984

Centripetal spread of endothelial cell mitotic activity in the artery leading to a rapidly growing tumor.

Vascular proliferation and growth have been attributed either to biophysical forces in the vessel lumen or to chemical mediators. In this study growth and endothelial cell tritiated thymidine uptake in the spermatic artery of the rat during early growth of the Walker 256 carcinoma in the testicle were examined. Testicular blood flow was measured with radioactive microspheres; radioautography following administration of tritiated thymidine was employed to define the endothelial cell labeling index; angiography was employed to assess the diameter of the spermatic artery lumen; and the mass of the artery was determined directly. Endothelial proliferation in the spermatic artery was increased on the second day, simultaneous with rather than subsequent to a significant increase in blood flow to the testicle. Moreover, endothelial cell thymidine uptake began to decline well before the blood flow through the artery reached a maximum. A gradient in endothelial cell proliferation and in lumen diameter of the spermatic artery became apparent during tumor growth; the increase in both lumen diameter and endothelial cell thymidine uptake in the spermatic artery occurred first in the portions nearest the testicle and spread centripetally throughout the length of the artery over several days. Because the spermatic artery is an end artery, without branches and without a normal change in internal diameter, and because the increase in blood flow must have occurred throughout the length of the artery at the same time, we conclude that factors other than those related to an increase in blood flow were primarily responsible for the increase in endothelial cell turnover. These observations make a chemical messenger, perhaps moving retrogradely through cell-to-cell contact, the most likely candidate as the responsible mediator.

Animals↗
PubMed1984

Selection criteria for upper gastrointestinal examinations: attempts at improvement.

An attempt was made to improve upon selection criteria for the performance of upper gastrointestinal (UGI) series in three settings: a teaching hospital, a community hospital, and a health maintenance organization. Two statistical techniques, the polychotomous logistic model (to develop predictive algorithms for the identification of specific diseases) and the maximum attainable discrimination technique, were used to show the relationship between the percentage of patients with any disease detected and the percentage of UGI examinations performed. Results showed that neither technique improved significantly upon selection criteria for identifying patients with abnormal UGI series.

Decision Theory↗
PubMed1984

Cost reduction opportunities in radiology departments.

The recent institution of prospective methods of hospital reimbursement has created a strong incentive to reduce costs. Significant savings were achieved in the cardiovascular-interventional radiology section of our hospital by obtaining competitive bids, purchasing in bulk, purchasing certain comparable but less expensive supplies, reducing film use, and altering patterns of use of some supplies.

Cost Control↗
PubMed1984

Evaluating the radiographic assessment of pulmonary venous hypertension in chronic heart disease.

This study evaluated how accurately the chest film could be used to determine pulmonary capillary wedge pressure (PCW) in patients with chronic heart disease. Six experienced readers interpreted the erect posteroanterior chest radiographs of 50 patients whose measured PCWs ranged from 6 to 38 mm Hg. Direct numeric estimates of PCW from the films were closely related to measured levels of PCW (r = 0.675). This linear correlation increased to 0.81 when individual-reader variations were reduced by taking a "consensus" (mean) of the six readers' estimates for each case. A combination of the judged degree of pulmonary blood flow redistribution (PFR) and three particular signs of pulmonary venous hypertension (PVH), basal and perihilar vascular blurring and alveolar edema, adequately summarized the radiographic information about PCW. These combined judgments of PFR/PVH identified films from patients with higher and lower PCW levels as accurately as readers' numeric estimates of PCW. Other radiographic signs (enlargement of the heart and central pulmonary vessels and the presence of Kerley lines or pleural effusion) were also positively related to increases in PCW, but added little to the information provided by the PFR/PVH criteria.

Adolescent↗
PubMed1983

A prospective study of computed tomography and ultrasound in the detection and staging of pelvic masses.

Findings from computed tomography (CT) and ultrasound (US) examinations of 74 patients who were clinically thought to have pelvic masses and of 110 patients who had possible recurrence of pelvic tumors were analyzed. There was no significant difference in the ability of the two modalities to identify masses or to predict disease extent. Although both CT and US failed to detect some examples of spread outside of the pelvis, overstaging (apart from two cases of unconfirmed parametrial spread) did not occur with CT and occurred only once with US. The sensitivity was 0.96 for CT and 0.91 for US in the detection of pelvic masses. Both modalities had an accuracy of 0.81 in the detection of recurrent disease.

Diatrizoate↗
PubMed1983

Computed tomography, ultrasound, and scintigraphy of the liver in patients with colon or breast carcinoma: a prospective comparison.

A prospective evaluation of computed tomography (CT), ultrasonography (US), and Tc-99m sulfur colloid scintigraphy of the liver was performed in 189 patients who had either colon (n = 129) or breast (n = 60) carcinoma. Imaging was performed with fourth-generation CT scanners, gray-scale or phased array ultrasound scanners, and 37-tube gamma cameras. Studies were evaluated independently and receiver operating characteristic (ROC) curves were constructed. In addition, a standard 2 X 2 matrix analysis was performed. In patients who had all three examinations (n = 122), the matrix analysis showed that CT had a slightly higher sensitivity (0.93) than scintigraphy (0.86) or US (0.82); specificities were 0.88, 0.83, and 0.85, respectively. These differences were not statistically significant. However, ROC curves showed that CT had the highest true-positive ratio at every false-positive ratio, and that US had the lowest. The performance of CT did not differ significantly from that of scintigraphy, but was better than that of US (p less than .05), especially in patients with breast carcinoma. Overall, CT provided the most accurate means for detecting liver metastases from both primary lesions.

Breast Neoplasms↗
PubMed1982

Computed tomography versus ultrasound of the adrenal gland: a prospective study.

A prospective study of the accuracy of computed tomography (CT) and ultrasound was undertaken in 112 consecutive patients with suspected adrenal disease. CT had a sensitivity of 84% (47/56), a specificity of 98% (55/56), and an accuracy of 90%. Ultrasound had a sensitivity of 79% (22/28), a specificity of 61% (14/23), and an overall accuracy of 70%. When patients with Cushing disease and adrenal hyperplasia were excluded, and only masses such as pheochromocytoma, adenoma, and carcinoma were considered, the sensitivity of both CT and ultrasound was increased. Receiver operating characteristic (ROC) curves differed for CT and ultrasound, and strongly supported the diagnostic superiority of CT.

Adrenal Gland Diseases↗
PubMed1982

A prospective evaluation of computed tomography and ultrasound of the pancreas.

A prospective cooperative study was performed to assess the relative efficacy of computed tomography (CT) and ultrasound in detecting and identifying pancreatic lesions. Of the 279 patients in the study, 146 were found to have a normal pancreas, and 133 had an abnormal pancreas. All patients underwent both CT and ultrasound examinations. Forty-four ultrasound examinations were technically unsatisfactory. When these suboptimal examinations were excluded, CT had a sensitivity of 0.87 and a specificity of 0.90 in detecting an abnormal pancreas. Ultrasound had a sensitivity of 0.69 and a specificity of 0.82. In detecting a lesion and identifying it as malignant or inflammatory, CT had a sensitivity of 0.84 and ultrasound had a sensitivity of 0.56. It is concluded that CT is the method of choice for detecting a pancreatic lesion, assessing its extent, and defining its etiology.

False Negative Reactions↗
PubMed1982

Idiopathic renal vein varices: incidence and significance.

To determine the incidence of renal vein varices, an analysis of 132 consecutive renal venograms was performed. Varices were found in 8 patients (6%), always on the left side. Four were solitary, and four represented a dilated venous network adjacent to the renal pelvis and upper ureter. Only a single patient had hematuria attributed to renal vein varices. It is concluded that varices in association with hematuria cannot be assumed to be causative; they may equally well be incidental findings.

Adolescent↗
PubMed1982

Balloon occlusion superior mesenteric arteriography for improved venous opacification: a clinical trial.

Balloon occlusion superior mesenteric arteriography and nonocclusion superior mesenteric arteriography were compared prospectively and retrospectively for adequacy of mesenteric and portal venous visualization. Prospective, occlusion studies in 20 patients were uniformly judged of excellent visual quality, while retrospectively, only 30% of nonocclusion studies from 20 other patients were considered optimal. In 10 of the patients who had balloon occlusion superior mesenteric arteriography, the procedure was preceded by a control nonocclusion superior mesenteric arteriography study. In only two (20%) patients was the nonocclusion study rated of excellent visual quality. Each study was assessed a rating of 0-3, according to how well the mesenteric and portal venous system visualized. Prospectively, all 20 balloon occlusion superior mesenteric arteriography studies were given the highest obtainable rating (3). Retrospectively, only six (30%) 20 nonocclusion superior mesenteric arteriography studies received a rating of 3; hence, 14 (70%) of the nonocclusion studies were rated less than excellent in visual quality when looked at retrospectively. No complications occurred with balloon occlusion superior mesenteric arteriography, and the occlusion procedure consistently gave excellent visualization of the mesenteric and portal venous anatomy.

Angiography↗
PubMed1982

Garland lecture. Coronary arteriography: pathologic and prognostic implications.

Coronary arteriography is properly considered the in vivo "gold standard" by which all other clinical diagnostic criteria and noninvasive tests of coronary disease are gauged. In most respects, the radiographic-morphologic findings of the coronary arteriogram are readily translated into the pathologic substrate of disease. Careful correlative studies suggest, however, that in an important group of patients the arteriogram underpredicts the degree of disease, and in a far smaller group it overpredicts. Furthermore, there is no "one" correct interpretation of the coronary arteriogram; there are striking inter- and intraindividual variations in the assessment of the degree of stenosis when experts evaluate the examinations. Despite the discrepancies in angiographic-pathologic correlation and in multiple observer analysis, coronary arteriography in its present form represents an important predictive element in assessing the prognosis for the patient with coronary disease. The distribution and degree of the lesions per se are important prognostic factors, but these take on additional force in the presence of asynergy, cardiac enlargement, congestive heart failure, or depressed ejection fraction, all of which worsen the prognosis significantly.

Angina Pectoris, Variant↗
PubMed1981

Complications of angiography.

This study was designed to assess the complications of angiography, including transfemoral, transaxillary, and translumbar approaches. Detailed questionnaires were completed by radiologists at 514 of the 2,066 hospitals surveyed. The radiologists reported on the complications of 118,591 examinations. The overall arteriography complication rates were: transfemoral 1.73%, translumbar 2.89%, and transaxillary 3.29%. Thirty deaths were reported, eight of which were caused by aortic dissection or aneurysm rupture. Among the three techniques, there was no difference in the incidence of cardiac complications. There were significantly more neurologic complications, including seizures, in the transaxillary group than there were in either the transfemoral or translumbar groups. Similarly, hemorrhage, arterial obstruction, and pseudoaneurysms were more common with the transaxillary technique than with either of the other approaches. Vessel perforation and extraluminal contrast material were seen most frequently with the translumbar technique. Overall, between the two selective approaches, the transfemoral route carried a significantly smaller risk of complications than the transaxillary approach. There was an inverse relationship between complication rate and the annual number of arteriograms obtained. This was most striking in hospitals without residency training programs. The complications of adrenal venography, peripheral venography, pedal lymphography, and of studies for suspected pheochromocytoma were also assessed.

Adrenal Gland Neoplasms↗