Search PubMed⌕ Search

Biomedical subjects

H Smith

Publications and source records attributed to H Smith.

At least 505 records · Page 28Linked to original sources
PubMed1982

Tissue immunoglobulins and early recurrence in Crohn's disease.

The early recurrence rates following surgical treatment of Crohn's disease are distressingly high. In clinical studies in which an attempt is made to correlate duration, severity and extent of disease, the prediction as to which patients are prone to have the disease recur was not successful. The immunoglobulin G value is elevated in the diseased portion and in 50 per cent of the normal appearing margins of resected intestine from patients with Crohn's disease. Half of the patients with immunoglobulin G values above 18 milligrams per gram of dry weight at the margins had recurrences at the suture line within three years. The immunoglobulin G concentrations do not correlate with steroid treatment, duration of symptoms, extent of disease, presence of epithelioid granulomas or previous recurrent disease. Immunoglobulin A and immunoglobulin M values are not helpful in predicting recurrences. Elevation of immunoglobulin G values at the resection margins appears to be a reliable indicator of early recurrence in patients with Crohn's disease.

Adolescent↗
PubMed1982

Tissue carcinoembryonic antigen, dysplasia, and disease duration in colonic inflammatory bowel disease.

Tissue carcinoembryonic antigen (CEA) was studied in five groups of patients: eight ulcerative colitis patients with mild or no dysplasia, five ulcerative colitis patients with severe dysplasia, seven Crohn's disease patients with nondiseased colon, nine Crohn's disease patients with diseased colon, and 18 colorectal cancer patients from the noncancerous colon resection margins. CEA levels were significantly lower in the normal colon Crohn's group than all other groups (p less than 0.05). CEA levels were significantly higher in the severe dysplasia ulcerative colitis group than all other groups (p less than 0.05). The Crohn's disease patients with diseased colon, the ulcerative colitis patients with mild or no dysplasia, and the colorectal cancer group with noncancerous colon all had similar intermediate CEA levels.

Carcinoembryonic Antigen↗
PubMed1982

Physician performance in a prepaid health plan: results of the peer review program of the Health Insurance Plan of Greater New York.

A peer review program to evaluate the quality of medical care was established by the Health Insurance Plan of Greater New York in 1973. Physician performance is assessed through application of explicit process criteria to medical care as recorded in the patient record. A total of 6,788 records were reviewed in terms of the clinical management of acute otitis media, hypertension and breast lesions. Follow-up procedures to bring about positive changes in delivery of health care were integrated into the program at the time of the initial audit. Reaudit of 715 records were used to measure change in physician compliance with medical care standards. Results of this audit/reaudit process demonstrated statistically significant improvement in quality of clinical practice as measured by the assessment parameters.

Ambulatory Care↗
PubMed1981

A comparison of cancer risk in Crohn's disease and ulcerative colitis.

The authors estimated cancer risk among 589 patients hospitalized with Crohn's disease between 1960-1976 by calculating the ratios of observed number of cancers (O) in our hospital sample to the expected number of cancers (E) based on the age- and sex-specific cancer rates of a standard population. The authors then compared these O/E ratios with the O/E ratios similarly calculated among 267 patients hospitalized with ulcerative colitis. The risk of colorectal cancer was significantly increased in Crohn's disease (O/E = 6.9, P less than 0.001). This increase was similar in magnitude to that found in left-sided ulcerative colitis (O/E = 8.6, P less than 0.001) but was much less than that found in universal ulcerative colitis (O/E = 26.5, P less than 0.001). The incidence of small bowel cancer was greatly increased in the combined group of regional enteritis and ileocolitis (O/E = 85.8, P less than 0.001), and even more so in the regional enteritis group alone (O/E = 114.5, P less than 0.001). The incidence of extraintestinal cancer did not increase in any of the patient groups.

Adolescent↗
PubMed1981

A survey of clinical trials of antibiotic prophylaxis in colon surgery: evidence against further use of no-treatment controls.

To evaluate the use of antibiotics given prophylactically of colon surgery, we examined 26 trials published from 1965 to 1980 in which patients given various antibiotic regiments were compared with controls given no antibiotic treatment. In 22 (85 per cent of these trials) antibiotics reduced postoperative wound infection (p less than 0.05 in 14). Combining the results of the trials published from 1965 to 1975 reveals a 95 per cent confidence interval from the true difference in infection rates of 14 +/- 6 per cent (36 per cent for control group vs. 22 per cent for treatment group) and the true difference in death rates of 6.7 +/- 4.4 per cent (11.2 per cent for control group vs 4.5 per cent for treatment group). Yet trials employing control groups given no treatment continue to be reported. Since the use of such controls is justified only when no effective alternative therapy exists, we believe that any further trials of antibiotic prophylaxis in colon surgery should employ a previously proved standard. However, steadily increasing efficacy of treatment means that comparisons of new therapies with standard therapies will become prohibitively expensive because of the large number of patients required.

Anti-Bacterial Agents↗
PubMed1981

Effect of informed consent and educational background on patient knowledge, anxiety, and subjective responses to cardiac catheterization.

Thirty-four patients undergoing elective cardiac catheterization were followed linearly with three questionnaires during their hospitalization to study some of the effects of informed consent. Patients learn about catheterization from the informed consent session conducted by a cardiology fellow. Several areas of knowledge deficiency were found. The emotional experience of hospitalization and the amount of knowledge about catheterization determined at the end of hospital stay is shown to be dependent on the educational level of the patient. Several recommendations are made for the conduct of the informed consent sessions to improve the knowledge of the less educated.

Adult↗
PubMed1981

The effect of slow releasing oral magnesium chloride on the QTc interval of the electrocardiogram during open heart surgery.

Recent work in both animal and human studies emphasizes the value of magnesium in the maintenance of the functional and structural integrity of cardiac muscle. Both intracellular and extracellular magnesium concentrations can vary independently and the serum and red cell magnesium levels may not give an accurate account of intracellular cardiac magnesium deficiency. However, electrocardiographic studies of magnesium levels could provide an accurate index of intracellular cardiac magnesium levels. Twenty-four patients scheduled electively for mitral valve replacement were studied to evaluate the effect of slow releasing oral magnesium chloride on the QTc interval of the electrocardiogram. Although pretreatment QTc values in all patients were not significantly different, there was a highly significant difference between the control group and the treatment group after four days of preoperative treatment with oral magnesium chloride. During the postoperative phase of the trial, all patients developed a similar pattern of increase in QTc interval, reaching a peak at the end of the second day and followed by a decrease over the final two days. All patients who developed arrhythmias postoperatively had not been pretreated (primed) with oral magnesium chloride and had abnormal QTc intervals both before and after operation. The results of this study demonstrate the usefulness of oral magnesium chloride in reducing the QTc interval of the electrocardiogram and so protecting the myocardium against possible arrhythmias.

Administration, Oral↗
PubMed1981

Coronary flow studies in patients with left ventricular hypertrophy of the hypertensive type. Evidence for an impaired coronary vascular reserve.

Increased myocardial blood flow occurs in ventricular hypertrophy, but flow per 100 grams of myocardium remains normal. The increase in flow may be obtained at the expense of the existing coronary vascular reserve or by an increase in the vascular bed. The coronary vascular reserve was studied by analyzing the hyperemic reaction to selective injection of contrast agent into the coronary arteries in 25 patients: a control group (9 patients) with chest pain syndrome, normal coronary arteries and a normal left ventricle (Group I) and 16 patients with aortic stenosis, left ventricular hypertrophy and normal coronary arteries (Group II). The hyperemic response in Groups I and II was 73.3 +/- 2.2 and 65.8 +/- 9.1 percent, respectively (difference not significant). Group II was subdivided into two groups: Group IIA had five patients with a left ventricular mass of less than 200 g (mean 158.8 +/- 25.9); this group had a hyperemic response of 102.3 +/- 9.9 percent. Group IIB had 11 patients with a left ventricular mass of more than 200 g (mean 308.9 +/- 22.5) and a hyperemic response of 49.27 +/- 10.42 percent. The hyperemic response was correlated with the diastolic left ventricular-aortic gradient (r = +0.64, p less than 0.001), left ventricular mass (r = -0.51, p less than 0.01) and aortic diastolic pressure (r = +0.636, p less than 0.001). Group I had a left ventricular mass similar to that of Group IIA (124.9 +/- 9 and 158.8 +/- 26 g, respectively) but a lower hyperemic response (73.3 +/- 2 and 102.3 +/- 10 percent, respectively). These data suggest that severe left ventricular hypertrophy is associated with a reduction in coronary vascular reserve; it is speculated that this decrease in the vascular reserve capacity may be related to the ischemic component of hypertrophic heart disease.

Adult↗