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J K Harness

Publications and source records attributed to J K Harness.

At least 19 recordsLinked to original sources
PubMed1996

Operative experience of U.S. general surgery residents with diseases of the adrenal glands, endocrine pancreas, and other less common endocrine organs.

The aim of this study was to determine if the experience of general surgery residents is adequate and effective. The Resident Statistic Summaries (Report C) of the Residence Review Committee (Surgery) for eight academic years from 1986 to 1994 were analyzed. The main outcome measurements were total number of residents and programs, average number of operations performed, maximum number of operations performed, standard deviation, and the most common number of operations performed. For adrenalectomy, the average per resident was 0.98. The maximum range was from 7 to 15. The standard deviations ranged from 1.12 to 2.00. For pancreatic endocrine operations the average per resident was 0.15 with maximums of 3 to 10. For other endocrine procedures (nonthyroid and nonparathyroid) the average per resident was 0.14, with the maximums ranging from 7 to 19. The most common number of any of these procedures performed by U.S. graduates was 0. The number of adrenal, endocrine pancreas, and other less common endocrine procedures available for graduates of U.S. residency training programs is limited. As a consequence, most U.S. resident graduates have little or no experience with any of these procedures. Our findings suggest a strong need for fellowship training for any surgeon hoping to develop expertise in the management of these unusual and infrequent endocrine surgical diseases.

Adrenal Gland Diseases↗
PubMed1995

Operative experience of U.S. general surgery residents in thyroid and parathyroid disease.

BACKGROUND: We wanted to determine whether the experience of general surgery residents is adequate and effective. METHODS: The Resident Statistic Summaries (Report C) of the Residency Review Committee (Surgery) for 8 academic years from 1986 through 1994 were analyzed. The main outcome measurements were total number of residents and programs, average number of operations performed, maximum number of operations performed, standard deviation, and the most common number of operations performed. RESULTS: For thyroidectomy the average per resident ranged from 10.3 to 12.6. The maximum ranged from 52 to 102. The standard deviations ranged from 6.96 to 8. The most common number of thyroidectomies performed ranged from 7 to 10 per graduating resident. For parathyroidectomy the average ranged from 4.1 to 5.1, the standard deviations were 3.44 to 4, the maximum ranged from 25 to 60, and the most common number performed was 2. CONCLUSIONS: U.S. graduates have highly variable experience in thyroid and parathyroid surgery. Most residents have inadequate experience in parathyroid surgery and marginal experience in thyroid surgery.

Humans↗
PubMed1994

Is needle-directed breast biopsy overused?

We undertook this study of needle-localized breast biopsy--a frequently done surgical procedure--to examine current practice patterns and to determine if the technique is overused in any group of patients. From a retrospective review of medical records of all patients who had needle-localized breast biopsy at a teaching hospital between June 1, 1988, and October 31, 1990, we found that a total of 125 were done: 24 biopsy specimens showed malignancy (19%). Mammographic indications for biopsy were microcalcification (n = 62, or 50%), mass or density (n = 60, or 48%) and mass and calcifications (n = 3, or 2%). Indications for biopsy in patients with cancer were microcalcification (14 patients) and mass or density (10 patients). The incidence of malignancy increased with age. In patients younger than 40 years, no biopsy showed malignancy. Only 2 of 30 biopsies done in patients younger than 50 showed cancer (7%). Breast cancer was most frequently discovered in patients in the seventh and eighth decades of life, and this group accounted for 75% of "positive" biopsies. Needle-localized breast biopsy is a useful technique in the early diagnosis of breast cancer. Although indications for the procedure should remain liberal, in women younger than 50, the percentage of biopsies that reveal malignancy is low.

Adult↗
PubMed1993

The success of duplex ultrasonographic scanning in diagnosis of extremity vascular proximity trauma.

OBJECTIVE: To determine if duplex ultrasonographic scanning is diagnostically equivalent to arteriography and/or operative exploration in the diagnosis of extremity vascular proximity trauma. DESIGN: A prospective evaluation comparing duplex scanning with arteriography or operative exploration in 50 patients. Subsequently, duplex scanning was used alone for 175 extremity vascular proximity injuries, with other diagnostic methods used when injury was indicated on the duplex scan. SETTING: A busy urban trauma center. PATIENTS: Consecutive sample of 200 patients with 225 extremity injuries. SELECTION CRITERIA: Vascular proximity injury or diminished strength of the extremity pulse. MAIN OUTCOME MEASURES: The presence or absence of vascular proximity injury confirmed on angiography and/or operative exploration. RESULTS: Duplex scanning had 100% sensitivity and 100% specificity compared with arteriography and/or operative exploration in the first 50 cases. In the remaining 175 cases of extremity trauma, vascular injuries were diagnosed with duplex scanning alone. Duplex scanning detected 18 injuries, 17 of which were confirmed by correlation with arteriograms and/or operative exploration. One false-positive result--spasm of the superficial femoral artery--was found on arteriography. Seven unsuspected venous injuries were also diagnosed. CONCLUSIONS: Duplex scanning is a noninvasive, safe, effective method for the initial evaluation of potential extremity vascular proximity injury. It has replaced arteriography in the initial diagnosis of extremity vascular proximity trauma by our trauma service.

Angiography↗
PubMed1993

Benefits of a multidisciplinary approach to breast care.

The University of Michigan Breast Care Center (BCC) was established in 1985 to provide comprehensive, multidisciplinary diagnosis and treatment of benign and malignant breast disease. This work presents an overview of our experience in the BCC and assesses the clinical, academic, financial, and educational effectiveness of the program. A database was used to generate a list of all patients seen in the BCC between February 1, 1985 and December 31, 1991. Participating departments provided information regarding outpatient, inpatient, clinical and consultative activities, and referral patterns attributable to BCC endeavors. BCC educational and academic activities were reviewed and profiled. Clinical information was culled from the BCC database, hospital records, and the hospital tumor registry. The BCC has resulted in a fivefold increase in breast care related activity at the University of Michigan Medical Center. Over half of the patients treated in the BCC with primary operable breast cancer receive breast-conserving therapy. The BCC performs a unique educational function, providing the primary breast care experience for house staff as well as one third of the third year medical school class. The BCC supports over 20 clinical research protocols, and patient enrollment in clinical trials has increased dramatically since 1985. The BCC also provides support to basic science researchers receiving over 2.5 million dollars in peer reviewed direct cost support. These data suggest that a multidisciplinary approach to patient care as embodied by the BCC can be clinically, financially, and academically superior and productive. This model warrants further investigation not only in the field of breast care, but also in other clinical situations that require multidisciplinary input and therapy.

Breast Diseases↗
PubMed1990

Training obstetrics-and-gynecology residents to manage breast disease. Incorporation into a breast care clinic.

The American Board of Obstetricians and Gynecologists recently issued a directive that education in breast disease be incorporated into all residency training programs. At the University of Michigan Medical Center, the Comprehensive Breast Care Center (BCC) provides the vehicle for the education and training of residents in the area of breast disease. The department of obstetrics and gynecology is fully integrated and participates actively in the care of patients in the BCC.

Ambulatory Care Facilities↗
PubMed1988

Flow cytometric measurements of nuclear DNA and ploidy analysis in Hürthle cell neoplasms of the thyroid.

Nuclear DNA content and nuclear DNA ploidy were measured in 36 Hürthle cell neoplasms (HCNs) to better define their potential roles in predicting the clinical behavior of these lesions. An EPICS V flow cytometer (Coulter Electronics, Hialeah, Fla) was used. Measurements were taken from paraffin-embedded tissue. Isolated nuclei were stained with propidium iodide. The study was conducted in a blinded fashion. Observed NDC and PDY patterns were classified as diploid, aneuploid, or suspicious. Twenty-nine lesions (81%) were diploid and seven (19%) were aneuploid. Twelve (33%) HCNs were malignant, 23 (64%) were benign, and one (3%) was indeterminate. Eight (67%) of 12 malignant HCNs were diploid and four (33%) of 12 were aneuploid. In comparison, 20 (87%) of 23 benign lesions were diploid and three (13%) of 23 were aneuploid. The indeterminate neoplasm was diploid. There were three deaths in this group of patients; all three had aneuploid neoplasms, and all had locally recurrent disease with distant metastases. There was a significant cross correlation between histologic features and DNA content with regard to outcome. These preliminary data suggest that NDC and PDY are not helpful in distinguishing histologically benign from malignant HCNs; however, they may be useful in determining prognosis.

Adenoma↗
PubMed1987

Developing a comprehensive breast center.

In 1985 the University of Michigan Medical Center established a multidisciplinary breast care center (BCC) to provide comprehensive diagnosis and treatment for patients with benign and malignant breast disease. Ninety-eight per cent of the first 500 new patients were women and 2 per cent were men. One-hundred thirty-one women (26.7%) and no men had breast cancer. Of the remaining 359 women, 75.3 per cent had some element of fibrocystic disease. Patients who had breast cancer were evaluated during their initial visit to the BCC by a nurse, general surgeon, radiation therapist, and oncologist. Ninety-five per cent of all patients were given a definitive treatment plan or a second opinion at the conclusion of their one visit to the center. Patient and physician satisfaction with the center concept has been high. The center emphasizes patient education and choice between mastectomy and breast-sparing procedures and radiation therapy for the control of primary cancers. Adjuvant chemotherapy or hormonal therapy is given to all nodal-positive patients. Establishment of multidisciplinary centers, such as the BCC, requires the commitment of all physician specialty groups, nursing and hospital administration. High quality patient care can be provided in such centers in a more efficient and coordinated manner than in the non-center setting. The center can serve as a source of increased patient referrals and research opportunities.

Adolescent↗
PubMed1986

Radionuclide evaluation of bile leakage and the use of subhepatic drains after cholecystectomy.

Our study addresses the question of efficacy of drainage after cholecystectomy by evaluation of the leakage of radiolabeled bile. Based on our data, drains placed at the time of surgery do not appear to reliably remove bile or to decrease morbidity. Our study reveals that bile leakage after cholecystectomy is frequent, cannot be accurately predicted at operation, is not related to the experience of the operating surgeons, and does not necessarily correlate with morbidity. The shorter postoperative hospital stay in the group of patients with subhepatic bile leakage compared with the group without evidence of leakage after cholecystectomy is not statistically significant. However, this trend does suggest that there is no increase in morbidity associated with bile leakage per se. A large, clinically significant bile leak can easily be treated by modern interventional radiologic techniques if drainage is indicated. A larger, double-blind study is necessary to further evaluate the issues surrounding bile leakage and drainage after cholecystectomy.

Adult↗
PubMed1986

Symptomatic biliary tract disease in the elderly patient.

Acute symptomatic biliary tract disease in the elderly is usually associated with a tenfold increase in operative morbidity and mortality when compared to the disease in non-elderly patients. Over a 10-year period 118 elderly patients with a mean age of 77.2 years (range 65 to 98 years) were operated on for benign biliary tract disease. Acute cholecystitis was found at operation in 33 patients (28%), empyema in nine (7.6%), gangrene of the gallbladder in three (2.5%), and 24 patients (20.3%) were found to have common bile duct stones. Seventy-three patients had chronic cholecystitis. Complications occurred in 29 patients (24.6%), with pneumonia and wound infection as the two most common. Fifteen patients died, making the overall mortality rate 12.7 per cent. The mean age of the patients who died was 81.5 years. Two patients died following elective operations (mortality rate 1.7%), while the remainder died after emergent or urgent operations (11%). Elective biliary tract surgery in the elderly for symptomatic disease is safe and will reduce postoperative morbidity and mortality.

Age Factors↗
PubMed1984

Follicular carcinoma of the thyroid gland: trends and treatment.

Pure follicular carcinoma of the thyroid gland has become a relatively uncommon type of primary thyroid neoplasm in the United States. During a 20-year period (1962 to 1982) 37 cases of pure follicular carcinoma were treated at the University of Michigan Medical Center. Cases of the follicular variant of papillary carcinoma and Hürthle cell carcinoma were excluded. There were 26 women and 11 men in the series. The mean ages were 46.9 +/- 17.5 and 45.3 +/- 11.5 years, respectively. The overall, mean age was 46.4 +/- 15.9 years. Surgical treatment included total thyroidectomy in 83.8% of the cases. Seventy-six percent of the patients were treated after operation with 131I irradiation. The mean total dose was 230.5 mCi. Three patients (8.1%) had regional lymph node involvement. Six patients (16.2%) had distant metastases to bone and/or lung at the time of diagnosis. Seven patients (18.9%) died after a mean survival of 7.7 years. Six patients (16.2%) died of their disease. Twenty-nine patients (78.4%) are alive and disease free after a mean follow-up interval of 11.8 years. Pure follicular carcinoma is decreasing in incidence and usually occurs at an older age than do other forms of differentiated thyroid cancers. It is frequently more aggressive than papillary carcinoma although lymph node metastases are less common. Total thyroidectomy and 131I therapy are the recommended treatments since metastases to bone and/or lung are the usual locations of distant spread. Bone metastases are rarely if ever cured. However, excellent long-term palliation may be achieved.

Adenocarcinoma↗
PubMed1982

The anatomy of primary hyperparathyroidism.

Although several classic anatomic studies describing the number, location, size, and weight of normal parathyroid glands have been reported, as detailed description of the parathyroid glands in a large series of patients with primary hyperparathyroidism has not been available. Drawings were made of the exact locations of each of the normal and enlarged parathyroid glands identified, immediately following neck explorations in all patients with primary hyperparathyroidism during a 4-year period (1977 to 1981). The enlarged glands were also measured and weighed after excision. The records of 273 patients were reviewed. Single gland enlargement (adenoma) was found in 218 patients (80%). Hyperplasia of all identified parathyroid glands was found in 42 patients (15%). Two adenomas (at least two other glands grossly and microscopically normal) were found in seven patients (2.6%). Seven patients (2.6%) with biochemical evidence of the disease had only normal glands at neck exploration. Adenomas in ectopic locations were frequent. However, their locations, with few exceptions, were predictable. The larger an adenoma, the more likely it was to be ectopic. Right superior gland adenomas (mean size 2.6 cm) were ectopic in 39%. Left superior glands (mean size 2.62 cm) were ectopic in 36%. No superior parathyroid adenomas were intrathyroidal. five of 223 (2%) adenomas were entirely surrounded by thyroid parenchyma in the lower pole. Nearly all inferior gland adenomas within the thymus could be readily excised through the cervical incision. In the seven cases in which only normal parathyroids were identified, no fewer than three glands wer proven in each. Three patients have had subsequent mediastinal exploration and excision of an adenoma. This failure rate of cervical exploration (4%) is attributed to mediastinal adenomas, and a second adenoma, and incorrect diagnosis. An awareness of the frequency of ectopic adenomas and their usual locations is of considerable benefit to the surgeon. Identification of the normal glands is of great importance as the search for a specific missing gland (adenoma) can be conducted in a logical sequence based on anatomic and embryologic knowledge of the parathyroids.

Adenoma↗