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Biomedical subjects

K Dougherty

Publications and source records attributed to K Dougherty.

14 recordsLinked to original sources
PubMed2004

Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals.

OBJECTIVE: To identify alternatives to the CSF-Venereal Disease Research Laboratory (VDRL) test for the diagnosis of neurosyphilis in HIV-infected individuals. METHODS: CSF fluorescent treponemal antibody (FTA) reactivity and % CSF lymphocytes that were B cells in fresh and frozen samples were determined for 47 HIV-infected cases with syphilis and 26 HIV-infected controls. As for serum, CSF fluorescent treponemal antibody reactivity > or =2+ was considered positive. Based on the results in controls and cases with normal CSF measures, cut-offs for elevated CSF B cells were proposed to be > or =9% in fresh and > or =20% in frozen samples. Neurosyphilis was defined as a reactive CSF-VDRL. RESULTS: CSF-FTA-ABS (absorbed) and CSF-FTA (unabsorbed and undiluted) were 100% sensitive for the diagnosis of neurosyphilis. Elevated % CSF B cells in fresh and cryopreserved samples was specific (100%) but not sensitive (40 and 43%) in post hoc analyses. The results of CSF-FTA and assessment of % CSF B cells together allowed 16% of cases with pleocytosis but nonreactive CSF-VDRL to be diagnosed with neurosyphilis and 26% to be diagnosed as not having neurosyphilis. CONCLUSION: When the CSF-VDRL is nonreactive, CSF-FTA and % CSF B cells may help exclude or establish the diagnosis of neurosyphilis.

Absorption↗
PubMed2001

Unusual case of AneuRx stent-graft failure two years after AAA exclusion.

PURPOSE: To present a case of type-III endoleak due to separation of modular components and suture breakage after abdominal aortic aneurysm (AAA) repair with the AneuRx stent-graft. CASE REPORT: A 58-year-old man with a 78-mm AAA underwent successful aneurysm exclusion with an AneuRx stent-graft in 1998. Because the bifurcated component migrated during deployment, an additional aortic cuff was deployed to extend the stent-graft proximally to just below the renal arteries. On routine evaluation with computed tomography at 2 years postimplantation, a type-III endoleak with anterior displacement of the stent-graft was discovered. Angiography revealed separation of the aortic cuff from the stent-graft body. The aneurysm, which had decreased to 70 mm at 6 months, had enlarged to 80 mm in diameter. The patient underwent surgical AAA repair with removal of the stent-graft. Macroscopic examination showed suture breakage and separation of the stent rings and the graft material. CONCLUSIONS: This late complication of the AneuRx endograft underscores the need for frequent imaging surveillance in all patients undergoing endoluminal AAA repair.

Aortic Aneurysm, Abdominal↗
PubMed2001

Outcomes following extracranial carotid artery stenting in high-risk patients.

BACKGROUND: Carotid artery angioplasty and stenting has become a viable alternative to carotid endarterectomy (CEA), especially for patients considered at high risk for post-operative complications. This study investigated the feasibility, safety and long-term outcome of carotid artery stenting (CAS) in high-risk patients. METHODS: From July 1995 to November 2000, sixty-two consecutive patients considered to be at high risk for post-operative complications of CEA were followed prospectively after undergoing extracranial CAS procedures. RESULTS: Sixty-two patients [37 men (60%) and 25 women (40%)] underwent a total of 69 CAS procedures. The mean age was 67 +/- 9 years (range, 32-89 years). Comorbid conditions included hypertension in 95% and severe coronary artery disease in 58%. Sixteen patients (26%) had a previous ipsilateral CEA, twenty-one percent had a history of neck radiation and 32% had a history of significant contralateral carotid artery disease. Fifty-two patients (84%) were symptomatic. All 69 CAS procedures were technically successful. The major post-operative complications were two minor strokes (2.8%), one major stroke (1.4%) and one fatal major stroke (1.4%). The mean length of follow-up was 17 months (range, 4 months to 5.6 years). Two patients (2.8%) have suffered ipsilateral neurologic events following CAS. Long-term follow-up revealed restenosis at 6 months in 4 patients (5.7%). CONCLUSIONS: Carotid artery angioplasty and stenting is safe and feasible. This procedure produces satisfactory outcomes in patients who are at high risk for post-operative complications of CEA.

Aged↗
PubMed2000

Personal and professional beliefs and practices regarding herbal medicine among the full time faculty of the newark-based schools of the university of medicine and dentistry of new jersey.

Background: The use of alternative and herbal medicine is increasing among the general population in the United States. The use of herbal medicine by health care professionals has not been documented. Health care professionals tend to base personal and professional practices on scientific research and facts. This population interacts with the public and with health care students. Therefore, personal and professional practices will impact these audiences. Methods: A survey was distributed to all faculty members of the University of Medicine and Dentistry of New Jersey via interoffice mail. A total of 904 surveys were sent. Statistical analyses included descriptive analysis of personal and professional practice regarding herbal medicine and chi(2) analysis of the relationship between personal and professional practices regarding herbal medicine. Significance was set at alpha <.05. Results: The overall response rate was 51%. Approximately one-third (29.6%, n = 134) of the population reported personal use of herbal medicine, 22.1% (n = 42) of the population who provide patient care recommend herbal medicine, 9.4% (n = 36) of those involved in teaching include herbal medicine in coursework, and 1.1% of the population were involved in research on herbs. Respondents who use herbal medicine were more likely to recommend herbs to patients (p <.0001); likewise, users of herbal medicine were more likely to teach students about herbal medicine (p =.001). Conclusions: The results support the hypothesis that personal beliefs and practices do impact professional practices within the clinical and academic settings of the university.

Journal Article↗
PubMed1993

In vitro evaluation of blood flow through autoperfusion balloon catheters.

The effective flow rates with human blood through an autoperfusion catheter cannot be monitored in vivo and have not been experimentally determined in vitro. The manufacturers (Advanced Cardiovascular Systems [ACS], Temecula, CA) have suggested that "the flow rate" through the Stack over the wire and the RX-60 monorail catheter is 60 ml/min with a pressure gradient of 80 mmHg. We measured human blood flow rates in vitro through these catheters under different continuous pressure regimens (between 40 and 120 mmHg), with varying hematocrit levels (between 25% and 62%). Measured blood flows at a gradient of 80 mmHg were found to vary from 32 to 65 cc/min, with hematocrit levels of 62-25%. Minor variations in the circuitry, besides the viscosity of the medium, cause significant changes in observed flow rates (such as kinking of the catheter and blood sedimentation). In vitro determinations of blood flows cannot automatically be transferred to the in vivo condition, primarily because in vitro determinations do not account for the systolic intramural pressure increase (which may overcome the aortic pressure). If such a phenomenon is also considered, then the in vitro flow rates reported here should be multiplied by a factor of 0.40-0.60 to determine effective in vivo flow rates. Such information is relevant for the clinical operator of angioplasty, especially in the treatment of patients at high risk for undergoing percutaneous transluminal coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1990

Septic sacroiliitis due to Proteus mirabilis.

This case demonstrates the difficulty frequently encountered in making an early diagnosis of septic sacroiliitis. The proper use of appropriate laboratory tests and radiologic examinations can narrow the differential diagnosis significantly, with confirmation resting on culture results. Appropriate antibiotic therapy will depend on the organism isolated. When confronted by the typical clinical findings and supporting ancillary data of septic sacroiliitis, the physician should consider the possibility of an unusual organism such as Proteus mirabilis and should direct antibiotic therapy accordingly.

Adolescent↗
PubMed1987

Quantitation of proteinuria by the use of protein-to-creatinine ratios in single urine samples.

Measurements of protein-to-creatinine ratios in single-voided urine samples were compared with 24-hour urinary protein excretions for quantitation of proteinuria in inpatients and outpatients. Patients included those representing a broad spectrum of renal diseases, a wide range of proteinuria, and various degrees of reduction in glomerular filtration rate. Protein-to-creatinine ratios in single-voided urine samples correlated well with measurements of 24-hour urinary protein. This simple single-voided test is reliable and useful in the screening, assessment, and follow-up of proteinuria and avoids the problems associated with 24-hour urine collection.

Adolescent↗
PubMed1986

Dealing with DRGs: analysis of serum theophylline assays in Medicare patients.

To investigate the therapeutic and economic implications of serum theophylline assay (STA) use in Medicare patients classified in diagnosis-related group 88 as having chronic obstructive pulmonary disease, a retrospective audit was conducted of all serum theophylline assays ordered for these patients in a large teaching hospital during a 6-month period. Based on established pharmacokinetic principles of theophylline therapy, analysis was conducted on rational indication for assay use (n = 146), correct sampling procedure regarding steady-state and peak/trough concentrations (n = 99), and appropriateness of physician response (n = 100). Percentages of appropriate use found for these three parameters were 79.2%, 56.6%, and 85.0%, respectively. Overall compliance regarding all three considerations was 52.1%; this figure declined to 29.9% when admission level assays were excluded from consideration. A need is identified to improve STA sampling procedures in order to insure availability of accurate and valid results on which to make indicated changes in drug therapy.

Diagnosis-Related Groups↗
PubMed1984

Identification of drug costs within diagnosis related groups.

This study was designed to identify the DRG distribution of discharged Medicare patients during a given period of time in two similar hospital sites. Additionally, drugs costs (both total and average) for each patient in these DRGs were determined and analyzed as to similarity between the two sites as well as significance in terms of percentage of DRG total reimbursement rate. The assumption that DRGs would be homogeneous for drug costs was not found to be true in this study. Percentage of total reimbursement attributed to drug costs for DRG categories studied (less than 4%) was consistent with previously acquired data in established DRG prospective payment programs. Average drug cost was not found to be a reliable indicator for comparison of drug utilization, either within DRGs or between hospital sites. Length of stay emerges as the primary focus for future efforts in drug utilization reviews and cost control programs. A model for future DRG-based drug utilization reviews is proposed.

Analysis of Variance↗
PubMed1981

Shifts in phonetic identification with changes in signal presentation level.

Identification functions for stimuli from a two-formant [bdg] continuum were assessed at three levels of signal presentation: 55, 70, and 90 dB SPL. At 90 dB the [b] category was narrowed, the [d] category virtually eliminated, and the [g] category greatly enlarged. Since high SPLs can alter the identification functions for these simplified speech signals, caution should be exercised when using stimuli of this nature to compare the speech perception abilities of normal hearing and hearing impaired listeners. If high SPLs, independent of cochlear damage, can alter identification functions, then perceptual experiments may best be conducted at equal SPLs rather than at equal SLs.

Hearing Loss, Sensorineural↗