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Biomedical subjects

L C Brown

Publications and source records attributed to L C Brown.

At least 55 records · Page 3Linked to original sources
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Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial.

BACKGROUND: Endovascular aneurysm repair (EVAR) is a new technology to treat patients with abdominal aortic aneurysm (AAA) when the anatomy is suitable. Uncertainty exists about how endovascular repair compares with conventional open surgery. EVAR trial 1 was instigated to compare these treatments in patients judged fit for open AAA repair. METHODS: Between 1999 and 2003, 1082 elective (non-emergency) patients were randomised to receive either EVAR (n=543) or open AAA repair (n=539). Patients aged at least 60 years with aneurysms of diameter 5.5 cm or more, who were fit enough for open surgical repair (anaesthetically and medically well enough for the procedure), were recruited for the study at 41 British hospitals proficient in the EVAR technique. The primary outcome measure is all-cause mortality and these results will be released in 2005. The primary analysis presented here is operative mortality by intention to treat and a secondary analysis was done in per-protocol patients. FINDINGS: Patients (983 men, 99 women) had a mean age of 74 years (SD 6) and mean AAA diameter of 6.5 cm (SD 1). 1047 (97%) patients underwent AAA repair and 1008 (93%) received their allocated treatment. 30-day mortality in the EVAR group was 1.7% (9/531) versus 4.7% (24/516) in the open repair group (odds ratio 0.35 [95% CI 0.16-0.77], p=0.009). By per-protocol analysis, 30-day mortality for EVAR was 1.6% (8/512) versus 4.6% (23/496) for open repair (0.33 [0.15-0.74], p=0.007). Secondary interventions were more common in patients allocated EVAR (9.8% vs 5.8%, p=0.02). INTERPRETATION: In patients with large AAAs, treatment by EVAR reduced the 30-day operative mortality by two-thirds compared with open repair. Any change in clinical practice should await durability and longer term results.

Aged↗
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A GC/MS method for the determination of 4,4'-diaminodiphenylmethane and substituted analogues in urine.

A sensitive and specific gas chromatography/mass spectrometry (GC/MS) method has been developed for the analysis of 4,4'-diaminodiphenylmethane (DDM), 3-ethyl DDM (EDDM), and 3,3'-diethyl DDM (DEDDM) in urine. The method has been applied to the analysis of urine samples from workers exposed to a mixture of all three compounds, and the analysis has shown that EDDM and DEDDM are excreted in urine. We have also shown that there are two classes of conjugates present in urine. EDDM and DEDDM are excreted as heat labile conjugates, while DDM and EDDM are excreted, at least in part, as heat stable but alkaline hydrolyzable conjugates. It is proposed that the method described here could be used for biological monitoring of workers exposed to mixtures of DDM, EDDM, and DEDDM.

Aniline Compounds↗
PubMedDate not supplied

Federal court's decisions will clarify the Health Care Quality Improvement Act.

Peer reviewers are anxiously awaiting the decision of the U.S. Court of Appeals for the Ninth Circuit in two antitrust cases. Both cases, Smith v. Ricks and Fobbs v. Holy Cross Health System Corp., were fully briefed and argued on the same day earlier this year, and the decisions are expected sometime this summer. In both matters, the court is expected to flesh out the meaning of the Health Care Quality Improvement Act of 1986, commonly known as "HCQIA." Based on contemporary press accounts of the parties' oral arguments before the court, however, it is uncertain whether the decisions will strengthen or weaken medical staff peer review.

California↗
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Centers for Medicare and Medicaid Services, U.S.↗