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Biomedical subjects

M M Shabot

Publications and source records attributed to M M Shabot.

70 records · Page 4Linked to original sources
PubMed1982

Aspiration cytology is superior to Tru-Cut needle biopsy in establishing the diagnosis of clinically suspicious breast masses.

Eighty-one consecutive patients with breast masses clinically suspicious for malignancy were evaluated prospectively. There were 31 benign lesions and 50 malignancies. Clinical diagnosis was correct in 85% (2.5% false negative, 12.5% false positive). Mammography was diagnostic in 52.8% (31.5% false negative, 15.7% false positive). Needle biopsy was accurate in 78.9% (21.1% false negative, 0% false positive). Aspiration cytology was diagnostic in 96.2% (3.8% false negative, 0% false positive). Statistical comparison of all four tests revealed that aspiration cytology was slightly more accurate than physical examination for all lesions (p = 0.07), but significantly more accurate for benign lesions (p = 0.005). Overall, aspiration cytology was significantly more accurate than mammography (p = 0.000001) and needle biopsy (p = 0.008). Only one minor complication, a superficial infection, occurred with aspiration cytology and needle biopsy. Thin-needle aspiration cytology is a benign procedure that appears to be superior to physical examination, mammography, and needle biopsy in establishing the diagnosis of clinically suspicious breast masses.

Adult↗
PubMed1981

Contact plate thermography: a new technique for diagnosis of breast masses.

Ninety-four consecutive patients who underwent breast biopsy were prospectively evaluated with contact plate thermography. Final diagnosis based on surgically excised tissue was used as the standard of comparison. There were 77 benign lesions and 17 malignant lesions in the study group. A diagnosis of cancer was made by contact plate thermography in 11 of the 17 patients with malignant neoplasms, with six false-negative diagnoses. Among the 77 histologically benign lesions, contact plate thermography made the correct diagnosis in 66 cases, with 11 false-positive results. Considering all 94 patients, contact plate thermography was accurate in 81.9%, with 6.4% false-negative and 11.7% false-positive diagnoses. These data compared favorably with other diagnostic data used in this study, namely physical examination and mammography. Contact plate thermography is a quick, inexpensive, and harmless diagnostic procedure. Further evaluation of it is indicated, including its possible inclusion in breast cancer screening programs.

Adenocarcinoma↗
PubMed1979

Nasogastric suction in alcoholic pancreatitis.

In order to assess the usefulness of nasogastric suction in acute alcoholic pancreatitis, 37 patients with alcoholic pancreatitis were prospectively investigated. The study failed to demonstrate efficacy of nasogastric suction in those patients with mild disease. Application of a system of prognostic signs proved useful in discriminating between mild and severe disease. Routine use of ultrasound examinations detected three pancreatic pseudocysts before they became clinically apparent. In instituting appropriate therapy in mild pancreatitis, factors such as patient comfort should be considered in the absence of proven significant value of nasogastric suction.

Adult↗
PubMed1979

Cardiorespiratory monitoring in postoperative patients: I. Prediction of outcome and severity of illness.

An index for prediction of outcome for use as a measure of the severity of illness was developed by a nonparametric multivariate analysis of cardiorespiratory data from 113 critically ill postoperative general surgical patients. This severity (predictive) index was based on a computerized algorithm that compares a given observed value with the frequency distributions of survivors and nonsurvivors. The difference in the mean values of this index for survivors and nonsurvivors was statistically significant (p less than 0.001) during each stage of shock. Sensitivity of the index in prediction of survival ranged from 70-93% depending upon stage, the specificity of the index ranged from 76-92%, and the predictive accuracy ranged from 87-96%. The severity index is used as a process measure to track the course of critically ill patients and to evaluate the efficacy of alternative therapies.

Cardiovascular System↗
PubMed1979

Cardiorespiratory monitoring in postoperative patients: II. Quantitative therapeutic indices as guides to therapy.

Immediate (proximate) and late (optimal) therapeutic goals for critically ill postoperative general surgical patients were based on the frequency distributions of cardiorespiratory data of the survivors immediately after resuscitation and in the late stage of shock, respectively. An algorithm was developed which expresses in quantitative terms the distance from observed values for each variable to both of these therapeutic goals. Further, composite indices were also made of related cardiorespiratory variables that reflect the important aspects of acute circulatory failure and its therapy; i.e., volume, flow, tissue perfusion, oxygen transport, and bodily response to stress. The therapeutic indices of nonsurvivors were found to have greater mean deficits that survivors (p less than 0.05) during all but the middle stage of shock. The therapeutic indices greatly aid in the organization and display of monitored cardiorespiratory variables by expressing the circulatory defects in easily understood indices that can be related to therapeutic interventions. Moreover, the interactions of the various aspects of cardiorespiratory function before and after therapy may be easily observed.

Cardiovascular System↗
PubMed1978

Resuscitation algorithm for management of acute emergencies.

Assuming that unrecognized or inadequately corrected hypovolemia results in higher mortality and morbidity rates, we developed a systematic approach to resuscitation that would: 1) identify criteria to aid in the recognition of hypovolemia and ensure the expeditious correction of this defect without interfering with diagnostic workup and management; 2) define criteria to prevent fluid overload which may jeopardize the patient's course, and 3) express these criteria in an explicit, systematic, patient care algorithm, ie, protocol, useful to both the resident and the practicing physician. We are now conducting prospective clinical trials with one service using the algorithm and the others acting as the control group. Preliminary results comparing patient outcomes suggest that the algorithm improves patient care by shortening resuscitation time and results in fewer hospital days, intensive care unit days, febrile days, and days on mechanical ventilation as well as reduced mortality. The algorithm provides a systematic plan to organize patient care so that the most urgently needed procedures are not delayed or overlooked.

Algorithms↗
PubMed1978

Physiologic monitoring goals for the critically ill patient.

Definition of the appropriate therapeutic goals for physiologic monitoring of patients postoperatively was approached by analyzing more than 50,000 values of the 20 most commonly monitored variables in a series of 113 critically ill patients throughout their immediate postoperative course. In general, normal values were poor criteria for monitoring, since normal values were restored in an average of 75 per cent of the survivors and 76 per cent of the nonsurvivors for the five most frequently measured variables; that is, arterial pressure, heart rate, central venous pressure, wedge pressure and cardiac output. Moreover, an average of 56 per cent of the 20 most commonly monitored variables of nonsurvivors was restored to the normal range. Furthermore, 34 per cent of all the nonsurvivors' values were within the normal range; this was only 2.4 per cent less than the percentage of normal values for the survivors. The empirically determined median value of the survivors taken in the late stage during periods remote from therapy was found to be a better criterion for therapeutic goals for most variables, including blood flow, oxygen transport and most intravascular pressures. However, normal values were satisfactory for arterial pressure, peripheral resistance, pH, mixed venous oxygen tension and arterial carbon dioxide tension, largely because of the biphasic patterns of these variables.

Blood Chemical Analysis↗
PubMed1976

Local delayed cutaneous hypersensitivity reactions in breast cancer patients with and without removal of axillary lymph nodes.

Fifty-five patients were sensitized to dinitrochlorobenzene (DNCB). Two weeks later they were challenged. The minimal concentration yielding 2+ reactivity and one dilution above and below were then applied to the anterior chest wall on both the operated and nonoperated sides. Using multinomial chi-square statistical analysis, we found that the operated and nonoperated sides evidenced equal reactivity. Futhermore, the absence of axillary lymph nodes did not diminish the reactivity in the operated area. These data support the contention that maintenance of local cellular immunity, as assessed by DNCB skin test reactivity, is systemic and counters the argument that regional lymphadenectomy impairs local and/or systemic cellular immunity.

Animals↗
PubMed1975

Benign obstructing papilloma of the ampulla of Vater in infancy.

Obstructive jaundice due to benign neoplasms of the extrahepatic bile ducts is rare in all age groups. A case is reported which represents the first obstructing papilloma of the ampulla of Vater found in the pediatric age group and the literature pertaining to benign obstructing neoplasms is reviewed briefly. Differential diagnosis of persistent jaundice past the immediate neonatal period is discussed and the need for operative cholangiogram and open liver biopsy in difficult cases is stressed. Obstructing papillomas and other neoplasms of the extrahepatic bile ducts should be added to the differential diagnosis of jaundice in the pediatric age group.

Ampulla of Vater↗
PubMedDate not supplied

Transfusion-associated noncardiogenic pulmonary edema. Report of a case and a warning regarding treatment.

Although noncardiogenic pulmonary edema (NCPE) is a recognized complication of blood transfusion, the precise etiology is not well understood. NCPE may be secondary to complement-mediated pulmonary capillary injury initiated by either donor or recipient anti-leukocyte antibodies. It is not caused by simple volume overload. Recent blood banking texts and published case reports continue to suggest diuretics as part of the initial therapy for this complication. We report a case of transfusion-associated NCPE in which empirical diuretic therapy clearly was detrimental and suggest that the use of diuretics for treatment of this condition is not warranted. Reversal of progressive hypoxemia is the mainstay of therapy. Hemodynamic monitoring is important in differentiating NCPE from pulmonary edema secondary to cardiac failure or volume overload and should be used as a guide for further therapy.

Adult↗
PubMedDate not supplied

Rapid bedside computation of cardiorespiratory variables with a programmable calculator.

The value prompt assessment of hemodynamic cardiorespiratory function in critically ill medical and surgical patients is widely appreciated. We have presented a system for rapidly computing these variables on real time in the ICU, for a capital outlay of less than $250. In so doing, we hope to extend the benefits of this type of assessment to the smaller community hospital ICU and individual clinicians.

Computers↗
PubMedDate not supplied

Reducing the frequency of errors in medicine using information technology.

BACKGROUND: Increasing data suggest that error in medicine is frequent and results in substantial harm. The recent Institute of Medicine report (LT Kohn, JM Corrigan, MS Donaldson, eds: To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 1999) described the magnitude of the problem, and the public interest in this issue, which was already large, has grown. GOAL: The goal of this white paper is to describe how the frequency and consequences of errors in medical care can be reduced (although in some instances they are potentiated) by the use of information technology in the provision of care, and to make general and specific recommendations regarding error reduction through the use of information technology. RESULTS: General recommendations are to implement clinical decision support judiciously; to consider consequent actions when designing systems; to test existing systems to ensure they actually catch errors that injure patients; to promote adoption of standards for data and systems; to develop systems that communicate with each other; to use systems in new ways; to measure and prevent adverse consequences; to make existing quality structures meaningful; and to improve regulation and remove disincentives for vendors to provide clinical decision support. Specific recommendations are to implement provider order entry systems, especially computerized prescribing; to implement bar-coding for medications, blood, devices, and patients; and to utilize modern electronic systems to communicate key pieces of asynchronous data such as markedly abnormal laboratory values. CONCLUSIONS: Appropriate increases in the use of information technology in health care- especially the introduction of clinical decision support and better linkages in and among systems, resulting in process simplification-could result in substantial improvement in patient safety.

Decision Support Systems, Clinical↗