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Biomedical subjects

S Roman

Publications and source records attributed to S Roman.

At least 55 records · Page 3Linked to original sources
PubMed1996

Clinical-based vs insurance-based recommendations for substance abuse treatment level.

An exploratory study of 250 patients was conducted at three treatment facilities in Western Pennsylvania, USA, to determine: 1) the extent of disagreement between clinical-based [using American Society of Addiction Medicine (ASAM) criteria] and insurance-based [using Managed Care Organization (MCO) criteria] recommendations for treatment levels, and 2) the extend of ASAM recommendations that become the actual treatment. Cross-tabulations showed: 1) ASAM and MCO recommendations were the same for 85% of the cases, and 2) ASAM recommendations became the actual treatment in 93% of the cases. The exceptionally high level of ASAM-MCO agreement suggests a convergence in ASAM and MCO criteria and a deference to ASAM criteria in practice.

Adolescent↗
PubMed1996

[Phacoemulsification and topical anesthesia. Apropos of 40 cases].

BACKGROUND: To evaluate topical anaesthesia for cataract surgery. METHODS: Thirty-nine patients (40 eyes) underwent cataract surgery by phacoemulsification with topical anaesthesia consisting in instillations of tetracaine eyedrops. Thirty-four eyes were implanted with a foldable lens and 6 eyes received a PMMA lens. Final visual acuity (1 month minimum follow-up), patients reactions (sensibility, pain), anaesthetic and surgery difficulties were specially studied. RESULTS: Mean initial corrected visual acuity was 0.21. Mean final corrected visual acuity was 0.72; 90 % of the subjects experienced no pain. Implantation was the most sensitive moment. Eye mobility was not a problem except during capsulhorexis which had to be done with forceps. CONCLUSION: Simplicity of topical anaesthesia eliminates the complications of the other anaesthetic methods. It is necessary to have a close patient-surgeon relationship. Carefully chosen topical anaesthesia is an interesting alternative.

Aged↗
PubMed1996

[Teratoma of the middle ear. Apropos of 4 new cases].

Teratomas are benign hereditary tumors which are exceptionally located in the middle ear. We observed 4 cases and underline the difficulty in preoperative differential diagnosis with hereditary cholesteatoma using CT scan and emphasize the potential of MRI. Generally, diagnosis can only be confirmed by the peroperative macroscopic aspect of the tumor and after pathology examination (multi-tissue teratoma). The difficulty in excising the tumor is directly related to the degree of the subsequent deformation of the middle ear. Ossiculoplasty was required in 2 of our 4 cases. Finally, rare recurrence requires follow-up in these young patients.

Adolescent↗
PubMed1995

26Mg(6Li

Explore the source record for details and available documents.

Journal Article↗
PubMed1995

Continuous quality improvement for introduction of automated blood culture instrument.

Despite the critical nature and high cost of blood cultures, hospitals rely on manufacturers' test site data. As a result, in-hospital testing and compliance evaluation of newly acquired instruments are seldom done. The goal of this study was to apply a continuous quality improvement approach and to develop assessment criteria for all stages from the purchase order, through the on-site instrument evaluation, to the compliance evaluation. Despite the introduction of an automated high-blood-volume instrument (BacT/Alert) in our hospital, 56% of adult patients had only one venipuncture and 89.5% had < or = 20 ml of total blood volume sampled. False positives were associated with overfilling of bottles. These problems occurred because the phlebotomists did not like to perform multiple venipunctures on ill patients; therefore, they were drawing 20 ml of blood from one venipuncture and splitting it between two bottles. Unknown to the staff, the vacuum in the bottles draws significantly more than 10 ml of blood; therefore, the first bottle in the set was frequently overfilled and the second bottle was frequently underfilled. A diagrammatic guideline for a new blood culture protocol based on two venipunctures, taken one immediately after the other, to inoculate three bottles was developed. Compliance evaluation demonstrated that within 1 month of starting the new protocol, 74% of patients had at least two or more venipunctures and 60% had > or = 30 ml of blood drawn per patient episode. This study demonstrates the need for continuous quality improvement, including compliance evaluation, to ensure that the potential benefits of newer blood culture technology are actually realized.

Adult↗
PubMed1995

Diagnosis of follicular thyroid lesions by proton magnetic resonance on fine needle biopsy.

Most thyroidectomies are currently performed for diagnostic purposes. It has been established that proton magnetic resonance spectroscopy (MRS) on excised thyroid tissue can distinguish normal thyroid from invasive carcinomas (P < 0.0001). The purpose of this study was to assess whether the same discrimination could be obtained preoperatively from fine needle biopsy (FNB). This has clinical importance because cytological examination of fine needle aspirates cannot distinguish between benign and malignant follicular thyroid lesions. Here we demonstrate a sensitivity of 95% for proton MRS to correctly identify clinically or histologically proven carcinoma. MRS measurements were made on FNB specimens (containing as few as 10(6) cells) from solitary thyroid nodules. MR assessment of FNB was inconsistent with that of the corresponding tissue in only 6.5% of cases. The discrimination between cancer and normal tissue was based on altered cellular chemistry measured as a one-dimensional spectral ratio of resonances from the amino acid lysine and lipid. Benign follicular lesions were separated into two groups: 67% with a spectral ratio similar to malignant thyroid tumors, and 33% with a spectral ratio comparable to that in normal thyroid tissue. Thus, in contrast with histopathology, MRS offers a method for assessment of FNB of follicular lesions with the potential to identify a biologically benign group, which could avoid thyroid surgery for purely diagnostic purposes.

Adenocarcinoma, Follicular↗
PubMed1995

[Search for etiology in 110 cases of uveitis. Value of punctures of the aqueous humor and vitreous body].

PURPOSE: Evaluation of the frequency of each aetiology, comparison with recent and previous publications, focus on less classical pathologies, and interest of some complementary investigations. METHODS: Prospective study of one hundred and ten cases of uveitis, submitted to aetiological investigations, including, when feasible or necessary, an anterior chamber paracentesis and a vitreous paracentesis. RESULTS: An aetiology was identified in 65% of the cases. Toxoplasmosis still remained the most frequent diagnosis (one out of four), followed by viral infection (15%), especially herpes simplex (9%), a notion as yet not mentioned in large statistical surveys, including recent ones. Tuberculosis allergy and rhumatismal diseases (ankylosing spondylitis) represent the two other large groups (5% each). The rest is divided among the other classical causes. These results, particularly toxoplasmosis and viruses, are always based on biological criteria, on the Witmer-Desmonts ratio in aqueous humour, or even the same ratio in vitreous. CONCLUSION: This study confirms the predominant role of anterior chamber paracentesis, the only means of establishing a firm diagnosis for certain categories of uveitis (toxoplasmosis and viruses); it is difficult to conceive how such an investigation can be questioned, to the benefit of a purely biomicroscopic diagnosis, leading to blatant errors, as demonstrated by the results of anterior chamber paracentesis. This study also shows, due to this paracentesis, the increasing role of viruses in the aetiology of uveitis, emphasizing the risks taken when any uveitis is systematically submitted to corticotherapy.

Adolescent↗
PubMed1994

Results of photorefractive keratectomy on 63 myopic eyes with six months minimum follow-up.

We present our experience with 63 myopic eyes that had photorefractive keratectomy with an excimer laser. Minimum follow-up was six months. Mean preoperative myopia was -3.98 diopters (D) (range: -9.00 D to 1.25 D) and mean preoperative uncorrected visual acuity, 20/220. The epithelium was removed and fixation accomplished with a suction ring. Photoablation was then performed on a 5.0 mm diameter optical zone. Mean postoperative myopia was -0.60 D (range: -6.35 D to +2.25 D) after six months. Mean uncorrected visual acuity was 20/30. All corneas had a subepithelial haze that decreased progressively. There were no major complications. Except in a few cases, predictability was satisfactory. Photorefractive keratectomy proved effective throughout the trial. We need to study more patients with a longer follow-up to determine the indications and applications of this technique.

Adolescent↗
PubMed1993

[Pseudoaneurysms of the femoral artery--noninvasive diagnosis and compression therapy].

In 8 patients with pseudoaneurysms of the femoral artery, diagnosis and possible nonsurgical treatment is presented: After primary clinical diagnosis and color-Doppler or angiographic confirmation, aneurysms of less than 5 cm in diameter are treated by manual or color Doppler-supported compression. Within 9 to 36 min the lumen is occluded, remaining closed even in controls up to 12 months.

Aneurysm, False↗
PubMed1991

Alpha 2-antiplasmin, plasminogen activator inhibitor (PAI) and dilute blood clot lysis time in selected disease states.

This paper is an attempt to assess the relevance of the inhibitors of fibrinolysis for clot lysis in selected disease states and to discuss the mechanisms leading to acquired abnormal levels of such inhibitors. When compared to 20 control subjects the 30 hypertriglyceridemic patients (14 with type IIb and 16 with type IV) displayed significantly (p less than 0.001) increased plasma plasminogen activator inhibitor (PAI) activity (221 +/- 88% and 290 +/- 104% respectively; mean +/- SD), moderately (p less than 0.01) increased alpha 2 antiplasmin (alpha 2AP) level (112 +/- 11% and 115 +/- 16%) and accordingly an obviously prolonged dilute blood clot lysis time (DBCLT). Neither PAI activity and alpha 2AP level nor DBCLT were significantly different from controls in the 10 patients with hyperlipoproteinemia type IIa. The 18 patients with severe hepatic cirrhosis had low alpha 2AP level (59 +/- 19.7%) and accelerated clot lysis, while mean PAI activity (160 +/- 87%) was slightly (p less than 0.05) increased. In the 17 nephrotic patients alpha 2AP was increased (115 +/- 12%) while PAI activity was similar to controls and DBCLT rather shorter. Two liver secretion enzymes, namely serum cholinesterase and plasma protein C, were found to be decreased in cirrhotic patients, similar to control values in hyperlipoproteinemia type IIa and obviously increased in nephrotic patients as well as in hypertriglyceridemic subjects. The relevance of PAI and alpha 2AP for clot lysis was considered in relation to data in the literature concerning the behaviour of t-PA and factor XIII.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[The clinical and therapeutic characteristics of a bulky gastrinoma].

The case of a 55-year-old woman with a duodenal ulcer developing since 6 months is reported, in whom the surgical indication was early established on the basis of increasing of suffering and inefficacy of the medical treatment. Intraoperatively an exophytic pancreatic tumour sited on the upper border of the isthmus, sized 5/6/4 cm, was found. In view of the suspicion of gastrinoma and considering that total gastrectomy or splenopancreatectomy would be excessive taking into account the patient's state, option was made for exeresis of the tumour. The ulcerous suffering disappeared and the histological examination of the specimen (weighting 70 g) confirmed a benign gastrinoma. The peculiarities of the case and data from the literature dealing with gastrinomas are discussed.

Duodenal Ulcer↗
PubMed1991

[A solitary nonparasitic liver cyst].

The paper reports on an observation of hepatic nonparasitic solitary cyst, size 10/12 cm, noncomplicated, in a 77-year-old woman. The lesion was treated by digital enucleation and suture of the hepatic wound, with a good result. The paper presents literature data on the hepatic nonparasitic solitary cyst.

Aged↗
PubMed1991

Primary care in New York State: report and recommendations of the associated medical schools of New York.

Medical education in New York is unique in the country in its scope and its diversity. It is important, as we go forward, that these strengths be neither eroded nor compromised. The AMS member institutions are making a collective commitment to work together to promote changes that will improve medical education for all students by providing them with enriched experience in primary care. Our major resource is faculty. To whatever degree medical schools can influence career choice, it is essential to this aim that the best possible people are placed in the settings in which primary care is taught. The schools will intensify their efforts to recruit and retain such faculty and, in whatever way is appropriate to each institution, provide them with the stature needed to emphasize the value which the school places on primary care. The schools will also work to provide exposure to primary care early in a student's academic career given anecdotal evidence, at least, that such early experience can influence subsequent specialty choice. Finally, the medical schools will assume greater responsibility for graduate medical education. If, with state support, ambulatory teaching sites are developed, the schools will make every effort to assure that they are staffed with high-quality faculty. Residents and students must see primary care practiced with total commitment to quality. It is hoped that, with state-initiated improvements in the practice environment, the ultimate outcome will be an increase in the number of our graduates selecting primary care disciplines for their practices and locating in areas in need of physicians.2+ Corporation, and the Greater New York Hospital Association. We are ready to work with others toward our common objectives, and we call on all of those who share these concerns to participate with us.

Career Choice↗