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Biomedical subjects

W O Griffen

Publications and source records attributed to W O Griffen.

At least 37 records · Page 2Linked to original sources
PubMed1989

Career change: in quest of a controllable lifestyle.

Over the past decade, top medical students are selecting "controllable lifestyle" (CL) specialties at an increasing rate. CL specialties include anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, pathology, psychiatry, and radiology. The choice of "noncontrollable lifestyle" (NCL) specialties such as family practice, internal medicine, obstetrics/gynecology, and pediatrics was negatively affected by this trend. The effect of CL on the selection of surgical training by top medical students was variable. The purpose of this study was to determine if CL is a factor in career change by young surgeons during and after residency. Graduates of the University of Kentucky College of Medicine from 1975 to 1983 (n = 796) were questioned regarding the specialty they entered after graduation and whether they remained in that specialty as of March, 1988. NCL and surgery specialties showed a net loss of practitioners during the study period (P less than 0.005) and CL showed a net gain (P less than 0.005). When physicians changed specialties, the direction of change occurred from NCL and surgery to CL (P less than 0.05). Change from CL to NCL and surgery occurred infrequently.

Career Choice↗
PubMed1989

Controllable lifestyle: a new factor in career choice by medical students.

To determine whether control of work hours (controllable lifestyle) was becoming an increasingly important factor in choices of specialties by medical students, data from three medical schools over the past ten, ten, and six years, respectively, were reviewed for the types of specialty training entered by students in the top 15% of their classes. Since students in the upper 15% of the class are likely to obtain the specialties of their choice, any change in the pattern of their specialty preferences probably reflects a general trend. Specialties that feature a controllable lifestyle (CL) were defined as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry, and radiology. Non-CL specialties were surgery, medicine, family practice, pediatrics, and obstetrics-gynecology. The results showed that the percentages of students entering CL specialties increased significantly at all three schools, the percentages of students entering non-CL specialties decreased significantly at all three schools, and there was no significant change in the percentage of students entering surgical specialties.

Achievement↗
PubMed1989

Gastrointestinal disconnection and the treatment of intra-abdominal sepsis.

Current operative treatment for intra-abdominal sepsis secondary to internal gastrointestinal fistulas is aimed at wide drainage of septic foci and elimination of continued peritoneal soilage. Although methods for surgical drainage of abscesses and fistulous tracts are well established, the optimal method for surgical prevention of continued peritoneal soilage remains controversial. The authors applied the principle of complete gastrointestinal disconnection and performed diversion of the gastrointestinal tract and tube decompression proximal to the fistulous opening in the treatment of 22 critically ill patients with intra-abdominal sepsis from gastric or small bowel fistulas. Patient survival varied according to the level of the site of gastrointestinal leakage. All patients (5 out of 5) who had leakage in the distal small bowel survived. Six of nine (66%) patients with leakage from the proximal jejunum and six of eight (75%) of patients with gastroduodenal leakage survived. The overall survival rate of 77 per cent observed in this group of patients supports the authors' hypothesis that complete gastrointestinal disconnection is a valuable adjunct in the treatment of these severely ill patients.

Abdomen↗
PubMed1988

Intraoperative endoscopy for recurrent gastrointestinal bleeding.

We report a case series of patients with significant recurrent gastrointestinal bleeding. All forms of nonoperative investigation, diagnostic celiotomy, and even resection of portions of the gastrointestinal tract were used unsuccessfully to find the lesions. Using a modification of Bowden's technique of intraoperative endoscopy with transillumination, the nonpalpable lesions were identified and treated successfully.

Adolescent↗
PubMed1988

Gastric bypass revision: lessons learned from 920 cases.

Roux-en-Y gastric bypass (RGB) is an accepted operation for the control of body weight in morbidly obese patients. Early technical complications and inadequate weight loss, well-known sequelae of this procedure, necessitated reoperation in 42 patients of 920 who underwent RGB in a 10-year period. Indications for reoperation included dilated gastrojejunal anastomosis (16), inadequate weight loss without demonstrable enlargement of the anastomosis (10), staple line breakdown (6), anastomotic obstruction (4), anastomotic leak (4), and enlarged proximal gastric pouch (2). Reoperation consisted of completely redoing the initial RGB in 20 patients, redoing the anastomosis alone in 17 patients, staple line revision in four patients, and intraoperative dilatation of the anastomosis in one patient. After initial RGB, 26 of the 42 patients (61.9%) experienced major complications. After revision of RGB, there were major complications in 21 patients (50%). In conclusion, major postoperative complications may contribute to RGB failure, RGB revision for early technical failure or inadequate weight loss is associated with a high incidence of major complications and, subsequently, negligible weight loss. Therefore repair of RGB for technical failure or complications is not recommended.

Adult↗
PubMed1987

Medical education: a continuum in disarray.

I have addressed the issue of medical education from the standpoint of a person who has been actively involved in the field for more than 30 years. The enthusiasm for technologic advancements and the emphasis on a regulated life with adequate creature comforts has made the teaching of the basics of good medicine, that is, listening carefully to the patient and examining carefully all of the patient, at best, a secondary effort. This has been enhanced by the emphasis in medical schools on research and the results of research, publications which are more often than not counted or weighed rather than read. Suggestions for change include (1) putting the patient first in the health care equation; (2) rewarding teaching and clinical care equally with research; (3) placing real clinicians on medical school faculties; and (4) establishing a national health service in which all medical school graduates must serve in physician-sparse areas for a period of time after graduation, preferably without a single computerized tomography scanner, magnetic resonance imaging unit, or advanced radiologic imaging device within reach.

Education, Medical↗
PubMed1987

Axillary artery aneurysm as an occult source of emboli to the upper extremity.

Reported here is a case of axillary artery aneurysm secondary to crutch trauma as a source of emboli to the upper extremity. This patient along with several reported in the literature was initially diagnosed and treated for brachial artery embolism. It is believed that awareness of this entity as a cause of forearm and hand ischemia is important in planning the appropriate surgical therapy.

Aneurysm↗
PubMed1986

The sonographic fat/muscle ratio.

A wide variety of biochemical and morphometric parameters have been applied to estimation of nutritional status. A-mode ultrasound has been used to estimate subcutaneous fat thickness in humans; similar studies are reported in the veterinary literature. We applied B-mode ultrasonography to the triceps region of the nondominant arm. Subcutaneous fat and triceps muscle thickness were measured and the ratio of fat to muscle calculated.

Adipose Tissue↗
PubMed1985

Cholecystokinin cholecystography: is it a useful test?

We reviewed 57 patients, who during the last four years had cholecystokinin cholecystography during evaluation of abdominal pain, and found this test to be reliable for diagnosing chronic acalculous cholecystitis. Eighty-eight percent of the patients in whom abdominal pain was reproduced during cholecystokinin cholecystography and who had less than 50% contraction of the gallbladder were cured or improved after cholecystectomy.

Adult↗
PubMed1985

Prototype coil for magnetic resonance imaging of the female breast. Work in progress.

Magnetic resonance imaging (MRI) of the breast was performed in 35 women using a prototype breast coil at 0.15 T. The distribution of fibroglandular and fatty tissues was demonstrated sufficiently well to permit correlation with the mammographic patterns of Wolfe, and it was possible to identify 1-cm cysts. The signal intensity of the cysts varied from low to high as repetition time (TR) and echo time (TE) using the spin echo technique (TR/TE) were prolonged from 250/30 to 1,000/120. In two women, fibroadenomas were seen as low-intensity, smoothly marginated lesions surrounded by fat. A range of in vivo observed T1 values is summarized for normal and pathologic tissues. It is concluded that MRI of the female breast, currently in the developmental phase, is feasible and further evaluation is indicated.

Adipose Tissue↗