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Biomedical subjects

R K Spence

Publications and source records attributed to R K Spence.

78 records · Page 5Linked to original sources
PubMedDate not supplied

Surgical considerations for treatment of amiodarone-induced thyrotoxicosis.

PURPOSE: We present our experience with surgical management of amiodarone-induced thyrotoxicosis, including preoperative, intraoperative, and postoperative considerations. METHODS: Retrospective review of the medical records and the histological slides and a Medline search of amiodarone and thyroid gland. CONCLUSIONS: Amiodarone is a drug used to treat potentially lethal ventricular arrhythmia. One of the known side effects is thyroid dysfunction. In patients who cannot safely discontinue amiodarone or when medical therapy is ineffective in controlling thyrotoxicosis, thyroidectomy is the treatment of choice.

Journal Article↗
PubMedDate not supplied

Finding a lasting cure for U.S. health care.

In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.

Cost Control↗
PubMedDate not supplied

Exsanguinating upper extremity vascular injury: is an initial approach by clavicular resection adequate?

Clavicular resection has been recommended by some as an acceptable approach to the repair of subclavian and axillary vascular injuries. We believe this may not be the best approach in patients with severe trauma and exsanguinating injuries. During the last 5 years, we have treated 11 patients with trauma to the subclavian or axillary vessels, four of whom presented in shock from exsanguinating injuries. After initial fluid resuscitation, we operated on each patient by resecting the medial portion of the clavicle. Three of the four patients required further surgery or extension of the incision to control bleeding. In our experience, clavicular resection as a primary approach to exsanguinating injuries did not provide either adequate tamponade of bleeding or the exposure needed to repair injured vessels safely. Clavicular resection may be acceptable for hemodynamically-stable patients with minimal soft tissue damage and simple, right-sided vessel lacerations, but we cannot recommend it as an initial approach in patients with severe, exsanguinating injuries.

Accidents, Traffic↗
PubMedDate not supplied

Thoracic aortic aneurysm secondary to giant cell arteritis: a reappraisal of etiology, treatment and possible prevention.

43 patients with thoracic aortic aneurysms (TAA) were treated over a ten-year period at our hospital. Five (11.6%) had giant cell arteritis (GCA). Although many types of arteritis have been reported, all have pathologic features of elastic degeneration and granulomatous inflammation and may share a common underlying etiology. TAA secondary to arteritis frequently involves the ascending aorta, leading to aortic root dilatation and valvular insufficiency. Three of five of our patients had these findings and had successful surgical repair by combined aortic valve and ascending aorta replacement. Patients with TAA secondary to arteritis should be investigated further, looking for evidence of additional arterial disease. Because corticosteroids have prevented the progression of other types of arteritis, further investigation of their efficacy in the treatment of giant cell arteritis may be warranted.

Adult↗