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Biomedical subjects

M Barry

Publications and source records attributed to M Barry.

At least 181 records · Page 10Linked to original sources
PubMed1989

A quality assurance model of operative mortality in coronary artery surgery.

Quality assurance in coronary artery bypass grafting (CABG) surgery requires a comparison of operative mortality against an accepted standard of care. Raw mortality statistics are unacceptable in this context, and risk factor analysis is essential. However, this principle has not been adequately demonstrated in previous reports. Our goal in this study was to develop a risk model of accepted CABG mortality and illustrate its proper use in coronary artery surgery. The model was derived from a Bayesian analysis of 6,630 patients undergoing CABG in the Coronary Artery Surgery Study (CASS) registry. Age, sex, ventricular function, previous myocardial infarction, extent of coronary artery disease, unstable angina, and surgical priority were used by the model to sort patients into risk categories. From January 1984 through December 1987, 840 patients underwent isolated CABG at our hospital. With raw mortality data, the 3.9% (33/840) mortality of our patients was significantly different from the 2.3% (153/6,630) CASS mortality (p less than 0.001). When our patients were entered into the CASS model for risk stratification, however, our CABG mortality conformed to the CASS experience. These results illustrate the fallacy of using raw mortality statistics for interinstitutional comparisons. This type of risk model is a fundamental element of CABG quality assurance.

Aged↗
PubMed1989

Assuring safe travel for today's elderly.

The increased availability of time and resources has made travel attractive to many elderly patients. Both healthy and chronically ill geriatric patients can travel safely and without medical complications in many circumstances. Many of these patients, however, have special health needs that call for specific advice from practitioners. Patients with medical problems, such as chronic obstructive pulmonary disease, cardiovascular disease, thrombotic disease, sinus conditions, or diabetes, should be aware of possible complications involved in travel. In addition, medical advice regarding vaccinations, traveler's diarrhea, jet lag, and malaria prophylaxis should be tailored to this population. Such a prescribed regimen may make travel safe and feasible for many geriatric patients.

Aged↗
PubMed1988

Microsurgical anatomy of the choroidal fissure.

The microsurgical anatomy of the choroidal fissure was examined in 25 cadaveric heads. The choroidal fissure, the site of attachment of the choroid plexus in the lateral ventricle, is located between the fornix and thalamus in the medial part of the lateral ventricle. The choroidal fissure is divided into three parts: (a) a body portion situated in the body of the lateral ventricle between the body of the fornix and the thalamus, (b) an atrial part located in the atrium of the lateral ventricle between the crus of the fornix and the pulvinar, and (c) a temporal part situated in the temporal horn between the fimbria of the fornix and the lower surface of the thalamus. The three parts of the fissure are the thinnest sites in the wall of the lateral ventricle bordering the basal cisterns and the roof of the third ventricle. Opening through the body portion of the choroidal fissure from the lateral ventricle exposes the velum interpositum and third ventricle. Opening through the temporal portion of the choroidal fissure from the temporal horn exposes the structures in the ambient and crural cisterns. Opening through the atrial portion of the fissure from the atrium exposes the quadrigeminal cistern, the pineal region, and the posterior portion of the ambient cistern. The neural, arterial, and venous relationships of each part of the fissure are reviewed. The operative approaches directed through each part of the fissure are also reviewed.

Cerebral Arteries↗
PubMed1987

The effect of calcium channel blockade with nifedipine on splanchnic and systemic haemodynamics in cirrhosis.

The splanchnic and systemic haemodynamic effects of a single sublingual dose of nifedipine (slow calcium channel blocker) in nine patients with cirrhosis of the liver and portal hypertension were studied. Nifedipine produced a significant reduction in the mean arterial blood pressure (98 +/- 5.3 vs. 86 +/- 5 mmHg, P less than 0.05) but did not alter the mean heart rate, portal venous pressure or total liver blood flow. The systemic antihypertensive effect of nifedipine can be achieved without altering liver blood-flow in patients with chronic liver disease and portal hypertension.

Hemodynamics↗
PubMed1986

Departments of medicine and international health.

There is an emerging role in international health for departments of medicine that care to accept the challenge. Supervised medical rotations in the developing world and the care of culturally distinct immigrant populations provide unique opportunities to expand the scope of medical education while emphasizing a sensitive and humanistic approach to health care. The restraints imposed by diminished laboratory support and limited availability of drugs can foster reliance on diagnostic skills and the essential elements of therapy. Medical schools may elect to become involved in international health, but they must do so without becoming exploitative. Rotations of students, residents, and faculty in both directions should lead to productive interaction at both the clinical and research levels, for all participants.

Costs and Cost Analysis↗
PubMed1986

Microsurgical anatomy and operative approaches to the lateral ventricles.

The anatomy needed to plan microoperative approaches to the lateral ventricles was examined in 20 cadaveric cerebral hemispheres. The neural, arterial, and venous structures in the walls of the lateral ventricles and the relationship of the lateral ventricles to the third ventricle and basal cisterns were examined. The operative approaches to the lateral ventricle are reviewed.

Arteries↗
PubMed1986

Parasitic infections of the central nervous system.

The authors give a comprehensive review of the epidemiology, clinical presentations, diagnosis and current therapy of parasitic infections with CNS manifestations in both the normal and immunocompromised host. These include toxoplasmosis, malaria, amebiasis, neurocystcersosis, hydatid disease, and trichinosis. Additional sections cover disseminated strongyloidiasis, eosinophilic meningitis, visceral and ocular larva migrans, schistosomiasis, and cerebral paragonimiasis. Emphasis is on the neurologic complications of these diseases and their presentations in populations at increased risk for acquiring or reactivating these infections.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Early clinical signs identify low-risk patients with acute upper gastrointestinal hemorrhage.

Early identification of patients at low risk for poor outcome after acute upper gastrointestinal hemorrhage would allow reduction of diagnostic and therapeutic interventions. We identified six early predictors of good outcome: age less than 75 years, no unstable comorbid illness, no ascites found on physical examination, normal prothrombin time, and, within an hour after presentation, systolic blood pressure of 100 mm Hg or greater and nasogastric aspirate free of fresh blood. Presence of all six predictors defined the low-risk population. Among 162 patients in the development and retrospective validation phases of our study, all 74 low-risk patients had good outcomes. A prospective validation study of 111 patients further established the accuracy of our predictive method; only two of 52 low-risk patients had poor outcomes. Application of our method should allow more selective management of patients with acute upper gastrointestinal hemorrhage.

Acute Disease↗
PubMed1985

Microsurgical anatomy of the superficial veins of the cerebrum.

The microsurgical anatomy of the superficial cortical veins was examined in 20 cerebral hemispheres. The superficial cortical veins are divided into three groups based on whether they drain the lateral, medial, or inferior surface of the hemisphere. The veins on the three surfaces are further subdivided on the basis of the lobe and cortical area that they drain. The superficial cerebral veins collect into four groups of bridging veins: a superior sagittal group, which drains into the superior sagittal sinus; a sphenoidal group, which drains into the sphenoparietal and cavernous sinuses on the inner surface of the sphenoid bone; a tentorial group, which converges on the sinuses in the tentorium; and a falcine group, which empties into the inferior sagittal or straight sinus or their tributaries. The superior sagittal group drains the superior part of the medial and lateral surfaces of the frontal, parietal, and occipital lobes and the anterior part of the basal surface of the frontal lobe. The sphenoidal group drains the parts of the frontal, temporal, and parietal lobes adjoining the sylvian fissure. The tentorial group drains the lateral surface of the temporal lobe and the basal surface of the temporal and occipital lobes. The falcine group drains an area that includes the cingulate and parahippocampal gyri and approximates the cortical parts of the limbic lobe of the brain. The relationship of these veins to the venous lacunae was also examined.

Adult↗
PubMed1985

The use of high-dose pulse methylprednisolone in rheumatoid arthritis. Unproved therapy.

Pulse methylprednisolone therapy has been used for the treatment of rheumatoid arthritis. The recent literature describing pulse therapy for this disorder is reviewed. The effects of pulse steroids on the immune system, potential side effects of therapy, and recommendations for its use are presented. Because of the lack of substantial benefit and the possibility of adverse side effects, pulse methylprednisolone therapy should be considered investigational for short-term use in patients with aggressive rheumatoid arthritis undergoing induction therapy with long-term agents such as gold or penicillamine. More study is indicated before generalized use of this modality can be advocated.

Antigen-Antibody Complex↗