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Biomedical subjects

J D Baker

Publications and source records attributed to J D Baker.

At least 91 records · Page 5Linked to original sources
PubMed1988

Cost of treating advanced leg ischemia. Bypass graft vs primary amputation.

We compared the hospital costs of 94 patients undergoing femoropopliteal bypass grafts with those of 53 patients undergoing primary amputation. The total cost of uncomplicated bypass surgery averaged +20,300, compared with +14,000 for uncomplicated below-knee amputation. However, including the cost of prosthesis and rehabilitation, the total cost of primary amputation was +20,400, equivalent to that of the bypass operation. Complications requiring revision of a bypass graft increased hospitalization by 4.5 days with the total cost rising to +28,700; complications that ended with major amputation added 15 hospitalization days and had an average cost of +42,200. In contrast, complicated below-knee amputation cost +40,600 and added 12.5 hospitalization days. There is therefore no cost-benefit in primary amputation when compared with arterial reconstruction, and cost should not be used to deny a patient the opportunity for limb salvage.

Amputation, Surgical↗
PubMed1988

Accommodative esotropia following surgical correction of congenital esotropia, frequency and characteristics.

This study was undertaken to look at the development of accommodative esotropia, which occurs following the surgical correction of congenital esotropia. A retrospective review was done on all congenital esotropia patients operated on by one of the authors from 1974 through mid-1984. The criterion of a minimum of 3 years postsurgical follow-up was met by 101 patients. Of these patients, 52 developed accommodative esotropia, 25 within 3 months of surgery and 27 from 3 to 60 months after surgery. The average preoperative refractive error in the early group was +3.90 and +1.95 in the later group. The average time to develop accommodative esotropia in this group with later onset was 27 months following the initial surgery. It would appear that if the preoperative refractive error is +3.00 or more, and especially if the preoperative deviation responds to spectacles with a reduction of 15 prism diopters or more, then it is very likely that glasses will be required for accommodative esotropia very soon following surgery. There appear to be no clues as to which patients will need glasses later for accommodative esotropia.

Accommodation, Ocular↗
PubMed1988

Is the preferential use of polytetrafluoroethylene grafts for femoropopliteal bypass justified?

The objective of this review is to analyze the long-term results of femoropopliteal bypass done preferentially with polytetrafluoroethylene (PTFE) grafts in patients who presumably had saphenous vein available. The results are analyzed according to preoperative variables in an attempt to determine those instances in which PTFE grafts may be preferred for the first reconstruction and to identify those patients who benefited from vein preservation. From 1979 to 1985, 146 femoropopliteal bypass operations were performed in 120 patients with 6 mm PTFE grafts used preferentially. The results with follow-up at 5 years are analyzed by actuarial methods. The patency rate at hospital discharge was 100%. The overall primary patency rate at 5 years was 57%. Reconstructions above the knee (101) and below the knee (45) had significantly different 5-year patency rates (63% vs 44%, p less than 0.03). Sixty-two reconstructions done to alleviate disabling claudication had a 5-year primary patency rate of 69% and no amputations. Eighty-one reconstructions were done to treat critical ischemia with a 5-year patency rate of 49% and a 5-year foot salvage rate of 73%. When secondary operations were required to treat graft failures, the 4-year cumulative patency rate of the secondary reconstruction was 18% when performed with a prosthetic graft, in contrast to 70% when performed with the spared saphenous vein. We conclude that femoropopliteal reconstruction with PTFE grafts is a reasonable alternative for older patients with disabling claudication. Patients with critical ischemia will likely benefit from preservation of the vein with initial femoropopliteal reconstruction done with PTFE. Staged infrainguinal revascularization for foot salvage may improve present results. In this regard the sequence PTFE-then-vein carries a higher predicted patency rate than the sequence vein-then-PTFE.

Actuarial Analysis↗
PubMed1988

Suggested standards for reports dealing with cerebrovascular disease. Subcommittee on Reporting Standards for Cerebrovascular Disease, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery/North American Chapter, International Society for Cardiovascular Surgery.

The evaluation of clinical reports on vascular disease is often made difficult by variations in descriptive terms, clinical classification, and outcome criteria. In 1983 the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery created the Ad Hoc Committee on Reporting Standards to address these problems and recommend solutions. Some general problems were addressed in the initial report dealing with lower extremity ischemia. This article concerns clinical standards for reports dealing with cerebrovascular disease, suggests a scheme for clinical classification, and recommends standardized reporting practices for grading risk factors, angiographic and other diagnostic findings, and the results and complications of therapeutic intervention.

Cerebrovascular Disorders↗
PubMed1988

Can clinical evaluation and noninvasive testing substitute for arteriography in the evaluation of carotid artery disease?

The objective of this study was to prospectively assess the value of combining clinical assessment and noninvasive testing in predicting the spectrum of carotid bifurcation pathology, as subsequently proven by arteriography, in order to determine the safety and accuracy of performing carotid endarterectomy without angiography. A panel of eight specialists representing vascular surgery, neurology, and neurosurgery were presented with the history, physical findings, and noninvasive test results (GEE-OPG and duplex scan) of 85 patients. They were asked to make an anatomic prediction of the status of each carotid artery (170 arteries) as to whether the bifurcation was normal, ulcerated, had a hemodynamically significant stenosis, or was occluded. The predictions were then prospectively evaluated and correlated with angiographic findings; 159 of 170 (93.5%) carotid arteries were accurately characterized; 73 of 80 (91%) symptomatic carotid arteries and 86 of 90 (95.5%) asymptomatic arteries were correctly characterized; 61 of 61 (100%) stenoses of hemodynamic significance, nine of 14 (64.3%) ulcerations without stenosis, and 18 of 18 (100%) of total occlusions were accurately identified by the panel. Twenty-nine patients have subsequently had 32 carotid endarterectomies without angiography, and the predicted lesion was confirmed at the time of exploration. The combination of clinical assessment and noninvasive testing, particularly duplex scanning, when performed in a laboratory with validated accuracy may with defined qualification be safely used as a substitute for contrast angiography.

Aged↗
PubMed1988

Headache after lumbar puncture: review of the epidural blood patch.

The incidence of accidental dural puncture during epidural block is 2.9%; headache follows in as many as 76.5% of these patients. Treatment by injection of autologous blood into the epidural space has gained wide acceptance since its introduction in 1960, though it is contraindicated by blood dyscrasias, anticoagulant therapy, bleeding, and localized infection. The procedure is done by slowly injecting 15 to 20 ml of blood into the same interspace, no sooner than 24 hours after the original puncture. Serious complications are rare.

Blood Transfusion↗
PubMed1988

Beyond career choice: the role of learning style analysis in residency training.

A recent article in this journal took an important step toward rethinking the utility of behavioural instruments designated as learning style tests (Jewett et al. 1987). The authors of that paper made much of a distinction between the terms 'learning style' and 'learning preference'. However, the results of their study do not seem to substantiate a marked difference between the function of the Rezler Learning Preference Inventory (LPI) and Kolb's Learning Style Inventory (LSI) with which it was contrasted. The most important aspect of their paper was that it rescued the concept of learning style analysis from the arena of career choice prediction at the undergraduate level and applied these ideas to doctors who had already made their specialty selections and were actively engaged in residency training. Clinical instructors in teaching institutions have, for the most part, little or no formal background in educational principles. For these individuals, an easily comprehensible model of resident-instructor psychology can be very useful on a daily basis. This article reviews the authors' experience with the LSI and describes their utilization of Kolb's Experimental Learning Model in the areas of resident counselling and residency curriculum design. The results of two recent studies are also presented in which learning style was examined as a predictor of success in residency, and teacher-resident learning style distributions were shown to exhibit parallel relationships at four different anaesthesiology residency training programmes.

Anesthesiology↗
PubMed1988

Carotid duplex sonography: a multicenter recommendation for standardized imaging and Doppler criteria.

A complex duplex carotid evaluation involves high resolution imaging and characterization of the carotid plaque as well as quantitative Doppler spectral analysis to determine the presence and degree of flow restriction. Each of the components of the examination is essential to evaluate the carotid arteries adequately for the presence of disease. Both of these components should be assimilated into a final report that can be used to determine who is at risk for embolic as well as flow restrictive disease. By carefully following the reporting system described in this paper, an accurate and reproducible means of evaluating the carotid arteries can be achieved that permits comparison of studies. In addition, this will allow accurate communications among institutions and help to insure a better understanding of the etiology and pathogenesis of atherosclerotic carotid artery disease.

Arteriosclerosis↗
PubMed1987

Incidence and mechanism of post-carotid endarterectomy hypertension.

Hypertension following carotid endarterectomy occurs frequently but is poorly understood. Its occurrence has been correlated with an increased incidence of neurologic complication. We identified those factors that correlate with an increased incidence of post-carotid endarterectomy hypertension. The records of 100 patients who underwent carotid endarterectomy at UCLA Medical Center from November 1981 to September 1983 were examined. One hundred fifty variables were surveyed to determine those factors associated with this problem. Fifty-eight percent of the study patients developed post-carotid endarterectomy hypertension (an increase in systolic blood pressure greater than 35 mm Hg over baseline, and/or blood pressure requiring treatment with sodium nitroprusside). Of patients who developed this problem, 93% had diabetes mellitus, 75% received isoflurane anesthesia, 71% had peripheral vascular occlusive disease, 71% underwent ipsilateral transient ischemic attacks, and 65% had high-grade ipsilateral carotid stenosis. These variables have in common the loss of or interference with cerebral autoregulation. Central dysautoregulation may set the stage for a positive feedback mechanism that results in increased blood pressure. Anesthetic agents that do not interfere with cerebral autoregulation may reduce the incidence of this complication, and an aggressive treatment program may prevent neurologic complications.

Adult↗
PubMed1987

Bleeding through PTFE grafts.

There have been four cases in which there has been bleeding through PTFE grafts at the time of implantation. In each case the initial leaking through needle holes stopped completely within 5 mins. About 10 mins after the graft had been opened there appeared leaking through the interstices of the graft (without further bleeding at the needle holes). Protamine administration and topical application of haemostatic agents failed to arrest the process. In each case the bleeding gradually subsided over a period of 60 mins. In reviewing each of these cases no abnormality or unusual feature could be found to explain the bleeding encountered. Routine preoperative coagulation studies were normal. All grafts were handled according to manufacturer's recommendations. Portions of two of the grafts were analysed by light and electron microscopy and were in all ways similar to normal grafts. The etiology of this unusual complication has not been determined, but the process appears to be self-limited, stopping within an hour when it does occur.

Aged↗
PubMed1987

Observer variability with conventional and digital subtraction carotid angiograms.

A study was carried out to evaluate the intra- and inter-observer variability in the determination of the severity of carotid artery stenosis on conventional and digital subtraction angiograms. The primary goal was to compare the two types of contrast studies as "gold standards" for the evaluation of non-invasive tests. Linear regression analysis of the continuous variable of percentage stenosis yielded correlation coefficients from 0.90 to 0.99. Findings were also evaluated in terms of the discrete variables formed by dividing the lesions into five categories of stenosis: kappa analysis ranged from 0.53 to 0.91. Although the digital subtraction arteriograms had greater variability than conventional ones, careful measurement of the digital images can provide a reliable estimate of the degree of stenosis.

Adult↗
PubMed1987

Selection of anesthesiology residents.

The large numbers of medical graduates seeking residency training in anesthesiology have created a logistical problem for many programs. This difficulty and the recurrent phenomenon of the misplaced physician have prompted a search for better selection criteria and more efficient evaluation systems. The literature does not provide a concise description of the ideal resident candidate, but it does contain several approaches taken by a few individual teaching centers to improve applicant review procedures. Computer-assisted resident candidate selection (CARCS) is a three-phase system of preinterview screening, interview evaluation, and final ranking. Based on faculty criteria, the entire process uses data management technology that provides automatic calculation of selection parameters, sorting on any data field or combination thereof, and maintenance of a concise information profile for each candidate. CARCS allows equitable consideration of all who apply, with significant cost savings to both program and applicants. This paper reviews traditional methods of selecting anesthesiology residents, describes the CARCS system, and previews the future of resident candidate selection.

Anesthesiology↗