Biomedical subjects

Raoul J Burchette

Publications and source records attributed to Raoul J Burchette.

15 recordsLinked to original sources

PubMed2007

A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws.

BACKGROUND: Debate exists regarding the optimal graft for anterior cruciate ligament reconstruction. Few studies have compared the differences in outcome after reconstruction using similar fixation methods. HYPOTHESIS: Similar outcomes will be seen after anterior cruciate ligament reconstruction with bone-patellar tendon-bone or quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Ninety-nine patients were prospectively randomized to bone-patellar tendon-bone (46 patients) or quadruple-strand semitendinosus/gracilis (53 patients) reconstruction groups. The bone-patellar tendon-bone group had slightly lower preinjury Tegner scores (6.7 vs 7.1, P = .03); otherwise, the groups were similar. All surgeries were performed by a single surgeon using an endoscopic technique with bioabsorbable interference screw fixation. Patients were evaluated at 3, 6, 12, and 24 months. RESULTS: Forty-six bone-patellar tendon-bone and 50 quadruple-strand semitendinosus/gracilis patients were available at 24 months (97%). No differences in International Knee Documentation Committee grade, Lysholm score, Tegner activity level, range of motion, single-legged hop test, KT-1000 arthrometer manual maximum difference, Short Form-36, or patient knee rating were found. The bone-patellar tendon-bone group had better flexion strength in the operated leg than in the nonoperated leg (102% vs 90%, P = .0001), fewer patients complaining of difficulty jumping (3% vs 17%, P = .03), and a greater number of patients returning to preinjury Tegner level (51% vs 26%, P = .01). The quadruple-strand semitendinosus/gracilis group had better extension strength in the operated leg than in the nonoperated leg (92% vs 85%, P = .04), fewer patients with sensory deficits (14% vs 83%, P = .0001), and fewer patients with difficulty kneeling (6% vs 20%, P = .04). Both groups showed significant improvement in KT-1000 arthrometer manual maximum difference, Lysholm score, Tegner activity level, International Knee Documentation Committee grade, and patient knee rating score. CONCLUSIONS: Good outcomes were seen in both the bone-patellar tendon-bone and quadruple-strand semitendinosus/gracilis groups. Subtle differences were noted between the groups, which may help guide optimal graft choice.

Adult↗

PubMed2006

Subsequent risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after a colposcopic diagnosis of CIN 1 or less.

OBJECTIVE: The purpose of this study was to determine the risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after colposcopic diagnosis of CIN 1 or less. STUDY DESIGN: After colposcopy for an abnormal cytology, women with CIN 1 or less had annual cytology evaluations and high-risk human papillomavirus (HPV) tests (Hybrid Capture II). Colposcopy was repeated if the cytology result was ASC-H, or worse, ASC-US/high-risk HPV test positive, or every 2 years if the cytology was normal/high-risk HPV test positive. Differences in rates of CIN 3 or cancer were compared by log rank Kaplan-Meier survival analysis. RESULTS: With median follow-up periods of 26.3 months, 47 of 2490 women (1.9%) with CIN 1 or less subsequently had CIN 3 or cancer. Subsequent CIN 3 or cancer was more likely if the high-risk HPV test was initially positive (45/1960 women [2.3%]) compared with negative (2/530 women [0.4%]; P = .0002) and if women were older (age > or = 30 years, 28/1021 women [2.7%]; age 20-29 years, 17/1017 women [1.7%]; age < 20 years, 2/452 women [0.4%]; P = .045). When CIN 3 or cancer was diagnosed, 45 of 46 women (97.8%) had positive high-risk HPV test and 42/46 women (91.3%) had an abnormal cervical cytology. The yield of CIN 3 or cancer per colposcopy for women (4/205 women [2.0%]) who had normal cervical cytology/positive high-risk HPV tests was lower than for women (41/541 women [7.6%]) who had abnormal cervical cytology/positive high-risk HPV tests (chi-square test, 8.3; P < .005), and it did not increase with increasing length of follow-up. CONCLUSION: Annual cytology and high-risk HPV tests with colposcopy for high-risk HPV test positive/abnormal cytology and at least every 2 years for high-risk HPV test positive/normal cytology is advised after a colposcopic diagnosis of CIN 1 or less.

Adult↗

PubMed2006

The case for case reports: avoiding statistical seduction.

The management of patients with cancer teaches us the worth of logical thought, the advantage of flexibility of thinking and the thrill of occasionally doubting the experts. Asking questions and learning from the answers teaches us how to think. On the other hand, searching for the single best treatment, when no single treatment works for all patients, leads to a sort of intellectual tyranny that has numerous names: the gold standard, the community standard, best practice, and evidence-based medicine (EBM), with the implication that to take an alternative management route is substandard and unethical.

Evidence-Based Medicine↗

PubMed2006

Arthroscopic release and latissimus dorsi transfer for shoulder internal rotation contractures and glenohumeral deformity secondary to brachial plexus birth palsy.

BACKGROUND: Internal rotation contractures due to external rotation weakness secondary to brachial plexus birth palsy frequently lead to glenohumeral deformity and impaired shoulder function. Our surgical approach to treat these contractures relies on arthroscopic release for young children (less than three years old) and combines arthroscopic release with latissimus dorsi transfer for older children. We report the results for the first thirty-three children followed for a minimum of two years after such treatment. METHODS: Nineteen children with a mean age of 1.5 years (all younger than three years of age) underwent arthroscopic contracture release as the only primary procedure, and fourteen children with a mean age of 6.7 were also treated with a latissimus dorsi transfer. Passive external rotation with the arm at the side and passive and active elevation were measured for all patients preoperatively. Passive and active external rotation, internal rotation, and elevation were measured for all patients postoperatively. Magnetic resonance imaging was performed preoperatively and postoperatively to evaluate the status of the glenohumeral joint. RESULTS: Preoperative passive external rotation averaged -2 degrees for the children who underwent arthroscopic contracture release only and -24 degrees for those who also were treated with a latissimus dorsi transfer. Arthroscopic release achieved a marked increase in passive external rotation and a centered position of the glenohumeral joint at the time of surgery in all but the oldest child in the series, who had severe deformity. The contracture recurred in four of the younger children who had an isolated release, and this was treated with a repeat arthroscopic release and a secondary latissimus dorsi transfer. None of the children who had a primary latissimus dorsi transfer had recurrence of the contracture. At the time of follow-up, the mean passive external rotation was increased by 67 degrees (p < 0.005) in the fifteen children with a successful arthroscopic release, 81 degrees (p < 0.005) in those treated with a primary latissimus dorsi transfer, and 78 degrees in the four patients who were treated with a late latissimus dorsi transfer because the isolated arthroscopic release failed. The mean active elevation increased 12 degrees , 3 degrees , and 10 degrees , respectively, in the three groups. Internal rotation was not measured consistently preoperatively, but when it had been it was found to have decreased substantially postoperatively. Magnetic resonance imaging performed prior to the surgery showed a pseudoglenoid deformity in eighteen of the children. At two years, magnetic resonance images were available for fifteen of those children, and twelve of the images showed marked remodeling of the deformity. CONCLUSIONS: In children who are younger than three years of age, arthroscopic release effectively restores nearly normal passive external rotation and a centered glenohumeral joint at the time of surgery. In most of these children, external rotation strength is sufficient to maintain this range of motion and to improve glenoid development when preoperative deformity was present. The addition of a latissimus dorsi transfer in older children predictably results in similar improvements. Gains in active elevation are minimal. All children have a loss of internal rotation, which is moderate in most of them but is severe in some.

Arthroscopy↗

PubMed2005

Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey.

The epidemiology of prolapse and incontinence questionnaire (EPIQ) was developed to screen for female pelvic floor disorders (PFD). Content and face validity, reliability, internal consistency and criterion validity of the EPIQ to detect the presence of pelvic organ prolapse (POP), stress urinary incontinence (SUI), overactive bladder (OAB) and anal incontinence (AI) is presented. Cronbach's alpha; Spearman's, kappa, intraclass correlations, factor analysis and Chi-Squared tests were used for analysis. Questions related to PFD proved internally consistent (alpha = 0.91) and reproducible (correlations >0.70) for all but three items on the EPIQ. Positive and negative predictive values of the EPIQ to detect PFD were: POP = 76% and 97%, SUI = 88% and 87%, OAB = 77% and 90% and AI = 61% and 91% respectively. EPIQ is a psychometrically validated screening instrument that may identify women at high risk of having pelvic floor disorders in large undiagnosed populations.

Adult↗

PubMed2005

Hospitalization for acute diverticulitis does not mandate routine elective colectomy.

BACKGROUND: Previous studies suggest that elective colectomy is often required after an episode of acute diverticulitis. HYPOTHESIS: Acute diverticulitis initially treated nonoperatively does not require elective colectomy. DESIGN: Retrospective cohort study. SETTING: Twelve Kaiser Permanente hospitals in Southern California. PATIENTS: Three thousand one hundred sixty-five patients with acute diverticulitis. INTERVENTIONS: Colectomy or nonoperative treatment with or without percutaneous abscess drainage. MAIN OUTCOME MEASURES: Recurrent diverticulitis. RESULTS: Emergency colectomy was performed in 614 patients (19.4%). Nonoperative treatment was initially used in 2551 patients (80.6%). Of these, 185 patients (7.3%) had an elective colectomy and the remaining 2366 patients (92.7%) did not. Factors associated with undergoing elective colectomy compared with nonoperative treatment were younger age of the patient, fewer comorbidities, and percutaneous abscess drainage. Mean follow-up was 8.9 years, with a maximum of 12 years. After nonoperative treatment, 314 patients (13.3%) recurred-222 patients had a single recurrence and 92 patients had a rerecurrence. After adjusting for other variables, older age (hazard ratio, >/=50 years vs <50 years = 0.68; 95% confidence interval, 0.53-0.87) was associated with a lower recurrence, whereas higher comorbidity was associated with higher recurrence. Gender and percutaneous abscess drainage had no influence on recurrence. All 92 rerecurrences were treated nonoperatively. The risk of a rerecurrence (29.3%) was significantly higher than a first recurrence (P<.001). Age, gender, Charlson comorbidity index, and percutaneous abscess drainage did not predict rerecurrence. CONCLUSIONS: Very few patients with acute diverticulitis treated nonoperatively have recurrence. Younger age was associated with recurrence. A first recurrence was the only factor that predicted rerecurrences. The low recurrence rate argues against routine elective colectomy after successful nonoperative management of acute diverticulitis.

Acute Disease↗

PubMed2005

Surgical salvage of peritoneal dialysis catheters from chronic exit-site and tunnel infections.

BACKGROUND: Chronic exit-site and tunnel infections of the peritoneal dialysis catheter are significant causes of catheter loss. Surgical salvage procedures that can effectively resolve the infection and preserve dialysis are of major importance. METHODS: Thirteen patients with chronic exit-site and tunnel infections underwent surgical salvage consisting of unroofing the tunnel tract and shaving of the superficial catheter cuff. A control group of 138 patients implanted during the same time span as the study group was used for infection rate and survival comparisons. RESULTS: The salvage procedure cured the infection in all patients. No dialysate leaks occurred. Peritoneal dialysis was not interrupted. Surgical salvage provided successful long-term peritoneal dialysis that was equivalent to the cohort dialysis population. CONCLUSION: Surgical salvage by unroofing/cuff shaving is an effective long-term solution for chronic exit-site and tunnel infection.

Case-Control Studies↗

PubMed2004

The use of Visual Analog Scale in urogynecologic research: a psychometric evaluation.

OBJECTIVE: The purpose of this study was to assess the validity of Visual Analog Scales in urogynecologic research. STUDY DESIGN: In phase I, 35 women completed short forms of the urogenital distress inventory, incontinence impact questionnaire, and Beck depression inventory fast screen using the Likert-type scale and Visual Analog Scale formats. Reliability was estimated with Spearman's correlations and Cronbach's alpha; construct validity was assessed with the use of factor analyses. In phase II, 101 women were recruited for the test-retest reliability assessment of the Visual Analog Scale formats of the urogenital distress inventory and incontinence impact questionnaire short forms. Reproducibility was analyzed with intraclass correlations. RESULTS: In phase I, correlations between the Likert-type scale and the Visual Analog Scale were good: urogenital distress inventory (0.748), incontinence impact questionnaire (0.787), and Beck depression inventory fast screen (0.852; P <.05). In phase II, intraclass correlations were 0.898 and 0.938 for the urogenital distress inventory and incontinence impact questionnaire scores, respectively ( P <.001). CONCLUSION: The Visual Analog Scale is a simple, reliable, and reproducible method for the assessment of quality of life in urogynecologic research.

Factor Analysis, Statistical↗

PubMed2003

Restenosis in Intervened Coronaries with Hyperhomocysteinemia (RICH).

BACKGROUND: Controversy exists regarding the contribution made by elevated serum homocysteine evels in raising the risk of restenosis after percutaneous coronary interventions. The objective of this study was to determine whether elevated homocysteine evels increase the risk of restenosis. METHODS: Two hundred and two consecutive patients undergoing percutaneous coronary intervention with stents on previously nonintervened native coronary arteries were eligible for enrollment in the study. Before the percutaneous coronary intervention, a fasting serum homocysteine evel was drawn. Patients were followed-up by their primary cardiologists for recurrence of symptoms. Those patients who had a recurrence of anginal symptoms consistent with clinical restenosis were referred for a repeat angiogram. All other patients were followed-up medically. The homocysteine evels of the patients who had repeat angiography for recurrent symptoms were compared to those who were followed-up medically. RESULTS: Age, stent ength, stent diameter, and homocysteine evels were all associated with an increased risk of restenosis in the univariate analysis. In the multiple ogistic regression model, the only variable that remained significant in relation to an increased risk of restenosis was homocysteine. There was a significant difference in the mean homocysteine evels between the restenosis group (13.7 micromol/L) and those without restenosis (9.6 micromol/L; P <.0001). A homocysteine evel > or =11.1 micromol/L was identified as the best threshold for an increased risk of restenosis with a sensitivity of 75.0% and specificity of 76.9% (OR 6.5, CI 2.3-18.6; P =.0004). CONCLUSION: This study demonstrates that elevated homocysteine evels strongly correlate with an increased risk of restenosis.

Aged↗

PubMed2003

Penicillin skin testing in advance of need: multiyear follow-up in 568 test result-negative subjects exposed to oral penicillins.

BACKGROUND: There are few published data on adverse drug reactions and/or resensitization associated with oral penicillin use in penicillin allergy history-positive/penicillin skin test-negative individuals during routine clinical care with multiyear follow-up. OBJECTIVES: We sought to provide long-term follow-up data on the type, severity, and frequency of adverse reactions associated with oral penicillin use in individuals who have histories of penicillin "allergy" yet also have negative results on penicillin skin tests done in advance of need. We also aimed to repeat testing on individuals with penicillin-associated adverse reactions. METHODS: Medical records were reviewed for penicillin use and associated adverse reactions in all 568 penicillin skin test-negative individuals who had received at least 1 course of oral penicillin after testing but before December 31, 2001, during routine care. These individuals were drawn from a group of 1246 penicillin skin test-negative individuals seen initially between November 16, 1994, and August 13, 2001. RESULTS: The mean length of follow-up was 4.26 +/- 1.64 years (range, 0.39-7.12 years). The mean penicillin exposure was 3.94 +/- 3.91 courses (range, 1-22 courses). Only 65 (11.4%) of 568 subjects had any penicillin-associated reactions, and 6 subjects had 2 reactions each. A reaction occurred in 27 subjects (4.8%) with their first penicillin reexposure. There were 71 (3.2%) reactions with 2236 total penicillin courses. There were no serious reactions. Repeated testing was done in 33 subjects older than age 18 years. Only 1 subject was positive on repeated penicillin skin testing. CONCLUSION: Penicillin use after negative penicillin skin testing done in advance of need is safe, and resensitization is rare.

Administration, Oral↗

PubMed2003

Family practitioners' attitudes and knowledge about irritable bowel syndrome: effect of a trial of physician education.

BACKGROUND: Primary physicians care for most patients with irritable bowel syndrome (IBS), but data on their attitudes and knowledge about the disorder are limited to research in the UK. OBJECTIVE: The purpose of the present study was to assess US family practitioners' attitudes and knowledge about IBS and determine the effect of a single education class on these measures. METHODS: In a large health maintenance organization (HMO), a baseline group of family practitioners twice completed a questionnaire on attitudes and knowledge about IBS, 3 months apart. A class group completed it pre-class, immediately post-class and 3 months post-class. RESULT: Thirty-five physicians ranked IBS among five chronic, painful syndromes as highest in difficulty satisfying patients, tied with headache for highest in difficulty in practice strategy decision, second in time required, and fourth in diagnostic confidence and satisfaction in caring for patients. IBS and heartburn had widely separated rankings in all five attitudes. The correct answer rate on seven of 13 knowledge questions was <50%, and a majority did not identify the Rome II symptom criteria as typical and lacked other important knowledge. Of the 30 class physicians, the knowledge scores (mean +/- SD; maximum possible, 13) of 29 increased from 5.59 +/- 1.84 pre-class to 10.21 +/- 1.76 immediately post-class (P < 0.0001); 3 months later, the scores were lower (8.93 +/- 0.36) than post-class (P < 0.0001), but still higher than pre-class (P < 0.0001). Their attitude rankings were nearly identical pre-class and 3 months later (P > 0.05). In the 19 baseline physicians, IBS attitude rankings and knowledge scores did not change significantly over 3 months (P > 0.05). CONCLUSION: These US family practitioners had attitudes about IBS patients and lacked knowledge that could interfere with patient care. A single class improved short-term knowledge but had little effect on attitudes about IBS.

Adult↗

PubMed2003

Comparison of arthroscopic findings with magnetic resonance imaging and arthrography in children with glenohumeral deformities secondary to brachial plexus birth palsy.

BACKGROUND: Characterization of glenohumeral deformities secondary to brachial plexus birth palsy with plain radiography is difficult because the glenohumeral joint does not completely ossify until puberty. The purpose of this study was to compare the findings on magnetic resonance imaging and arthrography with those on arthroscopy to better understand the roles of these methods in the evaluation of glenohumeral development in this condition. METHODS: Eighty-four children who ranged in age from seven months to thirteen years and six months had glenohumeral arthrography while they were under general anesthesia for operative treatment of an internal rotation contracture. Thirty-six children also received magnetic resonance imaging with use of cartilage-sensitive axial gradient-echo sequences. Thirty-seven children were evaluated arthroscopically. RESULTS: Arthrography showed a concentric glenohumeral joint in thirty-three children, a flat glenoid in eight, a biconcave glenoid in seventeen, and a pseudoglenoid in twenty-six. Thus, 61% (fifty-one) of the eighty-four children with an internal rotation contracture had a substantial deformity. The severity of the contracture was associated with the existence and the type of the deformity (p = 0.001). Magnetic resonance imaging showed greater detail than arthrography did in defining the severity of the deformity in both the glenoid and the humeral head. The thirty-seven children who were examined arthroscopically showed a progression from those who had a concentric, conforming joint to those who had a markedly deformed joint with a bifurcated glenoid and a flattened, oval-shaped humeral head that articulated with the posterior aspect of the glenoid. Irregularities and cavitation of the anterior aspect of the glenoid were common. The subscapularis and rotator interval tissue were the primary sites of contracture. CONCLUSIONS: Profound glenohumeral deformities secondary to brachial plexus birth palsy are commonly seen within the first two years of life. The information provided by imaging studies is helpful in defining the natural history of this condition and in determining the success of surgical intervention.

Adolescent↗

PubMedDate not supplied

Optimal peritoneal dialysis catheter type and exit site location: an anthropometric analysis.

An anthropometric analysis of 200 adult patients was performed to provide better guidance in catheter selection and placement. Height, weight, various abdominal wall measurements, and gender effects were analyzed. Suitability of Tenckhoff catheters with straight and preformed bends in the intercuff segment was evaluated regarding ability to produce deep pelvic position of the catheter tip and ideal exit site location. Conflicts with belt line and with skin creases and folds were recorded. Results showed that abdominal wall measurements varied widely by height and weight. Swan neck catheters with a downwardly directed external limb and exit site were significantly better suited for females (62% versus 27%, p < 0.0001). Tenckhoff catheters with straight intercuff segments with a laterally directed tunnel tract and exit site were significantly better matched to males (78% versus 30%, p < 0.0001). Neither catheter was suitable in 25% of subjects, emphasizing the need for an extended catheter system capable of remotely locating the exit site to the upper abdomen or chest without compromising pelvic position of the catheter tip. Appropriate preoperative evaluation with selection of the best suited catheter should replace the substandard practice of using a pet catheter to fit all patients and rigidly placing the insertion incision at a set location irrespective of body habitus.

Abdomen↗

PubMedDate not supplied

The efficacy of silver-ion implanted catheters in reducing peritoneal dialysis-related infections.

BACKGROUND: Dialysis-related infections are the commonest cause of catheter loss and transfer to hemodialysis. Surface modifications of the catheter that reduce infections are of major importance. OBJECTIVE: The efficacy of silver-ion treated catheters in reducing dialysis-related infections was tested. METHODS: The study design was a prospective, randomized controlled trial. Patients were implanted with either a silver-treated study catheter or a control catheter. Prospective collection of data included infectious complications and catheter survival. RESULTS: The subject groups were comprised of 67 silver-treated catheters and 72 control catheters. Demographic characteristics of the study and control groups were equal. Exit-site infection rates for the study group and control group (0.52 and 0.45 episodes/patient-year of dialysis respectively) were not different by Poisson regression analysis (p > 0.4). Peritonitis rates were identical for the two groups (0.37 episodes/patient-year) and were not different by Poisson analysis (p > 0.9). Antibiotic-free intervals between infections for the study and control groups were not significantly different for exit-site infections (p = 0.58), peritonitis (p = 0.44), or both infections combined (p = 0.47). Actuarial analyses showed no differences between the groups in the probability of remaining free of exit-site infection (p > 0.2) or peritonitis (p > 0.7). Similarly, catheter survival was not significantly different between the groups (p > 0.6). CONCLUSION: Surface modification of catheters with ion beam implantation of silver produced no clinical effect with respect to reducing dialysis-related infections.

Adult↗

PubMedDate not supplied

Prospective comparison of downward and lateral peritoneal dialysis catheter tunnel-tract and exit-site directions.

OBJECTIVE: Guidelines for optimal peritoneal dialysis access support both downward and lateral exit-site directions. Numerous clinical reports support the superiority of downward exit sites but none substantiate lateral configurations. METHODS: This prospective study compared infectious and mechanical complications between 85 catheters with a preformed arcuate bend to produce a downward exit site and 93 catheters with a straight intercuff segment configured to create a lateral exit site. RESULTS: Kaplan-Meier survivals were not different for time to first exit-site infection (p = 0.62), tunnel infection (p = 0.89), or peritonitis (p = 0.38) for downward and lateral exit-site directions. Poisson regression showed no differences in rates (episodes/patient-year) of exit-site infection (0.26 vs 0.27, p = 0.86), tunnel infection (0.02 vs 0.03, p = 0.79), peritonitis (0.42 vs 0.43, p = 0.87), or catheter loss (0.06 vs 0.09, p = 0.29) for downward and lateral exit sites. Kaplan-Meier analyses of antibiotic-free intervals for exit-site (p = 0.94) and peritonitis infections (p = 0.72) were not different for the two groups. There was one case of catheter tip displacement with flow dysfunction in each group. There were no pericatheter hernias or spontaneous cuff extrusions. Catheter survival between groups was not different (p = 0.20). CONCLUSIONS: Catheter types employing downward and lateral tunnel-tract and exit-site configurations produce equivalent outcomes for infectious and mechanical complications.

Catheter-Related Infections↗