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Biomedical subjects

R Rosenblatt

Publications and source records attributed to R Rosenblatt.

At least 37 records · Page 2Linked to original sources
PubMed1995

From roadside to bedside: the regionalization of trauma care in a remote rural county.

OBJECTIVE: To determine the current role of rural hospitals and prehospital agencies in the care of motor vehicle crash victims in a remote, rural county prior to the statewide regionalization of trauma care. Specifically, we determined the proportion of crashes that required a response by emergency medical services (EMSs), the timeliness of the response, the proportion of patients treated in local hospitals, and the factors that predicted referral to trauma centers. DESIGN: Population-based retrospective cohort study linking emergency medical services, emergency department, and hospital discharge data to police motor vehicle crash reports and coroner data. SETTING: Okanogan County, Washington. SUBJECTS: All motor vehicle occupants, pedestrians or pedalcyclists who were involved in a motor vehicle collision with a response by emergency medical system personnel or the county coroner. INTERVENTION: None. MAIN OUTCOME MEASURES: EMS response times, emergency department and hospital discharge disposition, Injury Severity Scores, hospital length of stay, procedures, deaths. RESULTS: Twelve percent of 669 crashes reported to the police led to the dispatch of EMS. Crashes with EMS involvement were more likely to include occupants without restraints, who were ejected from the vehicle or who had alcohol as a contributing circumstance. The median interval between crash and EMS dispatch was 5 minutes (95th percentile: 40 minutes), the median scene time was 15 minutes (95th percentile: 35 minutes), and the median interval between dispatch and emergency department arrival was 48 minutes (95th percentile: 95 minutes). Among the 210 patients treated by EMSs, 67 (32%) were admitted to local hospitals, and 19 (9%) were referred to a distant trauma center. Of these, 17 were referred directly from the emergency department, one from the scene, and one after local admission. Compared with patients who were admitted locally, referred patients had a significantly higher mean Injury Severity Score (14.4 vs. 5.1), hospital length of stay (9.1 vs. 1.8 days), and rate of operative procedures (37% vs. 9%). Of the 13 crash-related deaths during the year, nine were declared dead at the scene before EMS arrival, three were asystolic at the time of EMS arrival at the scene, and one died at a referral hospital. CONCLUSIONS: The linkage of data from police, prehospital agencies, and hospitals can reveal important information about the sequence of health care for trauma patients. The rural hospitals in this county currently play a major role in the stabilization and treatment of motor vehicle crash victims.

Accidents, Traffic↗
PubMed1994

Do providers adhere to ACOG standards? The case of prenatal care.

OBJECTIVE: To examine the extent to which obstetric providers abide by prenatal practice guidelines published by ACOG. METHODS: The prenatal records were abstracted for low-risk patients initiating care with randomly selected urban obstetrician-gynecologists, rural obstetrician-gynecologists, urban family physicians, rural family physicians, and urban certified nurse-midwives in Washington state between September 1, 1988 and August 30, 1989. The prenatal care recorded in their medical charts was compared with the ACOG-recommended guidelines. RESULTS: Overall, providers of all five types adhered closely to the published standards. Certified nurse-midwives recorded a standard of practice that most closely matched that recommended by ACOG. Overall, there was less complete adherence in the recording of maternal height, fetal activity after 30 weeks' gestation, and fetal presentation at or after 36 weeks' gestation. Those laboratory tests that ACOG has recommended most recently (serum alpha-fetoprotein and diabetes screening) and those not recommended for routine use were ordered less often on average by providers. CONCLUSIONS: The cross-sectional nature of this study cannot demonstrate definitively that ACOG's guidelines have changed provider prenatal practices. However, these findings demonstrate that providers in varying specialties and geographic locations can adhere to a detailed set of clinical guidelines if they are appropriately disseminated and implemented.

Adult↗
PubMed1993

Detection of a deep lipoblastoma by MRI and ultrasound.

Lipoblastoma is a rare benign tumor of the soft tissue occurring predominantly during the first two years of life. We report here the application of MRI and ultrasound to the detection of a soft tissue lipoblastoma. By MRI and ultrasound, we precisely evaluated the extent of the tumor, the presence of atypical areas of cystic and mucoid degeneration within the tumor, and its lack of vascularity. Our patient's lipoblastoma did not demonstrate the signal characteristics of a fatty tumor on MRI.

Humans↗
PubMed1991

Utero-vaginal hypoplasia. Sonographic, embryologic and clinical considerations.

Congenital absence of hypoplasia of the uterus is a cause of primary amenorrhea in approximately 15% of cases. Ultrasound is often employed as an early imaging modality in the evaluation of patients with primary amenorrhea. Demonstration of total absence or marked hypoplasia of the uterus in the presence of normal ovaries during pelvic ultrasound examination, suggests the diagnosis of congenital uterine aplasia or hypoplasia. Sonography may obviate the need for laparoscopy and for other imaging modalities. A case report of uterovaginal hypoplasia in association with anal atresia and recto-vaginal fistula is presented, and the value of ultrasound in the diagnosis of this entity is discussed. The embryology and clinical features of this anomaly are also reviewed.

Abnormalities, Multiple↗
PubMed1991

Sonographic appearance and significance of arcuate artery calcification.

During routine pelvic ultrasonography, we observed calcification of the arcuate branches of the uterine artery in eight patients. Calcification was manifest as symmetric, hyperechoic foci with acoustic shadowing in the periphery of the uterine myometrium. Uterine arterial calcification is important to recognize, as patients often have severe underlying systemic disease. Arcuate artery calcification can be differentiated from other pathologic causes of calcification in the uterus.

Adult↗
PubMed1991

Reversible symptomatic biliary obstruction associated with ceftriaxone pseudolithiasis.

Ceftriaxone, a third-generation cephalosporin, has been associated with the development of sludge or stones in the gallbladders of some patients treated with this medication. Such precipitates, which are usually reversible upon discontinuation of the drug, sometimes cause symptoms, have simulated acute cholecystitis, and have even led to cholecystectomy in some cases. We report the first known instance of biliary obstruction and secondary pancreatitis in association with reversible ceftriaxone-induced pseudolithiasis.

Aged↗
PubMed1990

Time-related increase in hematocrit on chronic hemodialysis: uncertain role of renal cysts.

We studied the long-term changes in hematocrit in 283 center hemodialysis patients. Mean duration of dialysis (+/- SD) was 53.8 +/- 43.4 months, with a range of 6 to 176 months. The correlations of hematocrit with clinical factors, laboratory values, and renal cystic changes were investigated. Time on dialysis was the strongest single predictor of hematocrit for the whole group (r = 0.351, P less than 0.001) and for men and women analyzed separately. Longitudinal 5-year (n = 83) and 10-year (n = 21) data showed a continuous increase in hematocrit levels over time (r = 0.414, P less than 0.001 over 10 years). Patients at the dialyzer reuse center (n = 224) had higher hematocrit levels than those at the center that did not reuse (n = 59). Although time on dialysis was strongly correlated with increasing extent of renal cystic change (r = 0.387, P less than 0.001), the correlations of cyst extent and time on dialysis with hematocrit were not independent by multiple regression analysis. We conclude that hematocrit increases progressively over time in patients on chronic hemodialysis. The mechanisms responsible for this do not seem to involve cystic transformation of the kidneys and remain unclear.

Adult↗
PubMed1987

Renal peripelvic multicystic lymphangiectasia.

Renal peripelvic multicystic lymphangiectasia is an unusual benign peripelvic fluid collection. The sonographic appearance, etiology, and differential diagnosis of peripelvic fluid collections are reviewed.

Female↗
PubMed1986

Social functioning in chronic pain patients.

Although investigators have explored the effects of chronic illnesses on social functioning during the course of treatment, much less is known about the impact of treatment outcome on social functioning. In this study we examine whether the outcome of treatment for chronic pain in a pain clinic exerts a significant effect on the eventual social functioning. The findings indicate that a more favorable outcome is associated with increased marital satisfaction, a heightened desire for sex, and an increased desire and ability for recreational activities. These findings have implications for family practitioners as they assess social functioning after treatment for chronic pain.

Chronic Disease↗
PubMed1985

Uterine perforation and embedding by intrauterine device: evaluation by US and hysterography.

Uterine perforation and deep embedding by an intrauterine device (IUD) require exact determination of its location as a necessary step to safe and effective retrieval. Six cases of uterine perforation and four of embedding by an IUD were studied with ultrasonography (US) and hysterography. While US findings suggested the correct diagnosis of perforation in five of the six cases, hysterography yielded more exact diagnostic information. Deep embedding could only be diagnosed with hysterography. A classification of the types of perforation and an algorithm for diagnosing ectopic IUD are presented. Undue reliance on the sonographic appearance of an IUD in the center of the uterine image may lead to hazardous attempts at transvaginal removal of a device that is partly intramural. In this study, hysterography offered the most precise diagnostic information.

Adult↗
PubMed1983

The role of technetium-99m iminodiacetic acid (IDA) cholescintigraphy in acute acalculous cholecystitis.

Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of 99mTc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The 99mTc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.

Acute Disease↗