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Biomedical subjects

R Ferguson

Publications and source records attributed to R Ferguson.

At least 19 recordsLinked to original sources
PubMed1992

Determinants of clean surgical wound infections for breast procedures at an oncology center.

OBJECTIVE: To determine the clean surgical wound infection rate for breast procedures and the risk factors predisposing patients to these infections. DESIGN: A survey study. SETTING: Oncology center. PATIENTS: A consecutive sample of adult female patients who underwent surgical breast procedures for suspected carcinoma of the breast. Patients undergoing excisional biopsy, lumpectomy, or mastectomy from January 1985 to January 1987 were included in the study. INTERVENTION: Clean surgical wound infection rates were derived overall and for each procedure type. The medical records of all patients were then reviewed to extract data on patient characteristics and operative information in order to assess the risk factors for infection. RESULTS: Among the breast procedures performed on 448 patients, the overall clean surgical wound infection rate was 8.7% (39/448). The clean surgical wound infection rate for each procedure type was as follows: biopsy 2.3%, lumpectomy 6.6%, and mastectomy 19%. In addition to the type of procedure, factors significantly (p less than .05) associated with the development of clean surgical wound infection in the univariate analysis included: presence of surgical drains (p less than .01); closed suction drainage (odds ratio [OR] = 16.5, 95% confidence interval [CI95] = 5.0-54.7); location of the drain (OR = 3.3, CI95 = 1.7-6.6); prolonged preoperative stay (OR = 1.2, CI95 = 1.0-1.5); length of surgery (OR = 2.2, CI95 = 1.7-3.0); and greater mean age (OR = 1.6, CI95 = 1.2-2.1). CONCLUSION: Clean surgical wound infections are not uncommon in patients undergoing breast procedures. Factors relating to both the patient and operative techniques contribute to the clean surgical wound infection rate. Further consideration should be given to perioperative antibiotic prophylaxis for selected breast procedures, and the role of surgical drains should be reassessed.

Biopsy↗
PubMed1992

Venous occlusion: a rare complication of transvenous cardiac pacing.

Venous occlusion is an uncommon complication of transvenous cardiac pacing. Fibrotic occlusion of the right subclavian and innominate veins and stenosis of the left innominate vein, after the insertion of transvenous pacing wire, was corrected surgically with an external iliac vein graft.

Adult↗
PubMed1991

Phase I/II trial of superselective arterial 5-FU infusion with concomitant external beam radiation for patients with either anaplastic astrocytoma or glioblastoma multiforme.

From August 1987 through September 1989, 25 patients with either anaplastic astrocytoma (8 patients) or glioblastoma multiforme (17 patients) were entered into a Phase I trial of combined intra-arterial 5-fluorouracil (5-FU) and external beam radiation therapy. The intra-arterial 5-FU was given in a superselective, supraopthalmic fashion, in escalating doses from 200 mg to 600 mg on a weekly basis during the radiotherapy. Each patient received from 1-4 courses of 5-FU. Radiotherapy consisted of 5,000 rads in 25 fractions given to partial brain fields including the mass and surrounding edema plus a 3-cm margin as defined by computed tomography scan. There were a total of 4 significant acute complications out of a total of 70 infusions. These included 3 ischemic events of which 2 were transient. In addition, 1 patient experienced a cerebral bleed. No patients developed ocular complications. Electroencephalograms (EEGs) were performed immediately before and during 21 intra-arterial infusions. Two patients developed significant EEG changes during intra-arterial infusion, and both of these patients experienced untoward reactions. The remaining patients showed no EEG changes during their infusions. The median survival for patients with glioblastoma multiforme was 15 months. We believe the toxicity of superselective intra-arterial 5-FU infusion combined with external beam radiotherapy is acceptable. This type of treatment deserves further study.

Adult↗
PubMed1991

End-stage renal disease and race: an overview and perspective.

The epidemiology of end-stage renal disease (ESRD) in the United States is reviewed. Hypertension and diabetes as etiologic factors in ESRD in minorities are discussed, as is the question of a familial ESRD. It is hypothesized that diuretics as sole antihypertensive therapy in blacks may in the long term result in chronic volume contraction, increased sympathetic stimulation, and therefore, decreased renal function. As such, a rational basis for the long-term use of diuretics as the sole antihypertensive therapeutic in blacks becomes questionable at best.

Black People↗
PubMed1990

The effect of race on the relationship between fetal death and altered fetal growth.

This population study examines racial differences in the relationship between birth weight and fetal death. An earlier report showed that a birth weight that results in a fourfold increased risk of stillbirth is not a constant birth weight percentile (2nd percentile at 25 weeks, 17th percentile at 42 weeks). This analysis was applied to 782,430 white and black births in Illinois from 1980 to 1984. Mean and 10th percentile growth for white and black infants is identical before 34 weeks' gestation and growth diverges by 250 gm at term, with white infants being larger. Race-specific birth weights resulting in quadrupling of the stillbirth rate were determined with an exponential regression analysis of the relationship between birth weight and fetal death rate for each gestational age. The data indicate (1) that the birth weights resulting in quadrupling the stillbirth rate are substantially above the Denver 10th percentile and the previously unpublished race-specific Illinois 10th percentiles and (2) that at term white infants demonstrate this constant risk at the 12th percentile, whereas black infants exhibit the risk at the 18th percentile. From these data we conclude that black fetuses are more sensitive than white fetuses to factors that adversely affect growth and that continued use of "race-neutral" data for clinical management in racially heterogenous populations will not accurately predict the risk of stillbirth.

Black or African American↗
PubMed1990

A model for the prospective analysis of perinatal deaths in a perinatal network.

This prospective study assesses factors that contribute to perinatal mortality. The study population includes the 1362 perinatal deaths that occurred among 85,402 live births between 1983 and 1987 at hospitals of the University of Chicago Perinatal Network. After peer review of demographic, clinical, and pathologic data, each perinatal death was classified in one of the following categories: (1) the result of congenital malformation incompatible with life, (2) unavoidable, (3) potentially avoidable by patient, by health provider, or by both, or (4) of undetermined responsibility. Of 1362 deaths, 12.3% involved congenital malformations incompatible with life, 56.9% were classified as unavoidable, 28.1% were judged potentially avoidable, and 2.7% due to undetermined causes. Of potentially avoidable deaths, 36% were due to patient factors (primarily noncompliance), 59% to health provider factors, and 15% to combined patient and provider factors. There was a significant reduction in the potentially avoidable cases during the study period. The maximum attainable reduction in perinatal mortality under optimal conditions is calculated. Intervention plans to achieve this goal are discussed.

Chicago↗
PubMed1989

Tympanic ECochG and conventional ABR: a combined approach for the identification of wave I and the I-V interwave interval.

Identification of wave I and measurement of the I-V interwave interval (IWI) are important parameters of the auditory brain stem response (ABR). However, at low stimulus sensation levels, wave I may be absent in the presence of wave V when the ABR is recorded conventionally with scalp electrodes. Several studies have shown that the amplitude and detectability of wave I (or N1) can be enhanced via extratympanic electrocochleography (ECochG), and even more so with tympanic ECochG. In the present study, tympanic ECochG was combined with conventional ABR to compare the amplitude and sensitivity of N1, wave I, and wave V in normally hearing subjects, and to identify the N1-V IWI in hearing impaired subjects whose conventional ABRs did not contain a reliable wave I. For the normally hearing subjects, the amplitude of the N1 was considerably larger than the amplitudes of waves I and V of the conventional ABR and there was no significant difference between N1 and wave V thresholds. For the hearing impaired group, the combined ECochG-ABR approach allowed for the identification of N1 and measurement of the N1-V IWI in all subjects. Our results support the use of tympanic ECochG in combination with conventional ABR for certain audiological and neurological applications.

Audiometry, Evoked Response↗
PubMed1989

A population study of the relationship between fetal death and altered fetal growth.

In order to describe the relationship between fetal death rate and impaired fetal growth, we examined over 850,000 births in Illinois between 1980-1984 (using the state computer data file) and assessed the mean/modal birth weights at each gestational age and the relationship between birth weight and fetal death rate at each gestational age. We were interested in the following questions: 1) Is the relationship between impaired fetal growth and fetal death rate the same at each gestational age? and 2) What birth weight would result in a quadrupling of the fetal death rate at each gestational age? Using exponential regression analysis, we determined for each gestational age the fetal death rate at the modal birth weight and similarly, the birth weight expected to result in a quadrupling of the fetal death rate. As gestational age advanced, the birth weight percentile resulting in the constant outcome also increased (second percentile at 25 weeks; 17th percentile at 42 weeks). We also compared these data with similar data from Denver. The findings indicate the following: 1) Fetal death rate increases exponentially as birth weight decreases at each gestational age; 2) the birth weight percentile that results in a constant outcome is not consistent at each gestational age; and 3) if assessment of risk is to be inferred based on the relationship between birth weight and gestational age, the tenth percentile (whether Denver, Illinois, or elsewhere) does not predict stillbirth accurately. The implications point to the use of outcome-oriented risk assessments to predict fetal death when examining the relationship between birth weight and gestational age.

Birth Weight↗
PubMed1979

Cimetidine in treatment of reflux oesophagitis with peptic stricture.

Twenty patients with reflux oesophagitis causing a tight peptic oesophageal stricture entered a randomised double-blind crossover trial in which they received cimetidine, 1.6 g daily, and matching placebo each for six months. The gross endoscopic appearances of oesophagitis, though not the grades of histopathological changes, showed significant improvement during treatment with cimetidine. The need for dilatation of the strictures, however, was not reduced.

Aged↗
PubMed1979

Splenectomy for undiagnosed splenomegaly.

During the 9-year period 1968-76 116 splenectomies were performed at the General Hospital, Nottingham. Of these, 13 (11 per cent) were undertaken for unexplained splenomegaly. In 6 patients a diagnosis was established by the operative procedure (2 with sarcoidosis, 2 splenic cysts, 1 Gaucher's disease and 1 haemangiosarcoma). Histological examination of the excised spleens in the remaining 7 patients showed no specific features. Two of these patients benefited considerably from removal of very large spleens. Another patient died from lymphosarcoma which was diagnosed 21 months after splenectomy. In the remaining 4 patients with mild to moderate splenomegaly, there were no real diagnostic or therapeutic advantages. It is concluded that splenectomy should always be considered in patients with unexplained moderate or gross splenomegaly but it may not be helpful in the patient whose spleen is only midly enlarged.

Adolescent↗
PubMed1979

An open-loop insulin delivery device for the control of experimental diabetes.

A new insulin delivery device has been developed and tested. It includes a reservoir, a pump, and a power pack. The reservoir holds 75 ml and is coupled to a precision peristaltic pump whose delivery can be set to any one of 128 different flow rates from 0 to 80 microliter/min (+/- 1.6% over 10 months) using the flow rate controller included in the battery power pack. The system weighs 525 g, consuming 50 mW at the maximum pumping rate, proportionately less at lower rates. Ten pumps have undergone bench tests for 30 days. One has been subjected to an extended life test of 16 months without change of tubing while seven complete systems have been used on dogs to demonstrate their capability for precise long-term (up to 16 months) intravenous insulin therapy. With this system, experimental diabetes has been controlled in 7 dogs for periods now extending beyond 16 months. This device now qualifies for-long term studies on hospitalized patients with diabetes mellitus.

Animals↗
PubMed1978

A portable precision pumping system for chronic, programmed insulin infusion.

This paper provides some details of a new insulin delivery system which includes a reservoir, a pump and a power pack. The reservoir holds 50 ml and is coupled to a precision peristaltic pump whose delivery can be set to any one of 128 different mean flow rates from 0 to 80 microliter/min (+/- 1.6% over 10 months) using the flow rate controller included in the battery power pack. The system weighs 525 g consuming 60 mW at the maximum pumping rate, proportionately less at lower rates. Ten pumps have undergone bench tests for 30 days. One has been subjected to an extended life test of 11 months while seven complete systems have been used on dogs to demonstrate their capability for precise longterm intravenous insulin therapy. With this system experimental diabetes has been reversed in 4 dogs for periods now extending beyond 6 months. This device now qualifies for long-term studies on hospitalized patients with diabetes mellitus.

Animals↗