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At least 217 records · Page 12Linked to original sources
PubMed1998

Management of thyroid carcinoma invading the aerodigestive tract.

OBJECTIVES: To evaluate approaches to thyroid carcinoma invading the aerodigestive tract, with particular attention to well-differentiated carcinomas. STUDY DESIGN: Retrospective review of experience with thyroid carcinoma invading the aerodigestive tract over a 20-year period at a tertiary referral hospital. METHODS: The medical records of all patients with a diagnosis of thyroid cancer treated at Emory University Hospital, Atlanta, Georgia, from 1977 through 1997 were reviewed. Multiple clinical variables were analyzed including treatment, development of recurrence, and survival. Survival and time to local recurrence were determined by Kaplan-Meier analysis, and statistical comparisons were made using log-rank analysis. RESULTS: Five hundred thirty-six cases were identified; 28 patients (5.2%) were identified with invasive disease involving the aerodigestive tract. Histologic findings at the time of invasion included 15 well-differentiated (WD) carcinomas and 13 poorly differentiated (PD) carcinomas. Eight of the 28 patients (5 WD, 3 PD) underwent surgical resection of some portion of the aerodigestive tract with curative intent. Ten patients (8 WD, 2 PD) underwent incomplete resection with tumor left adjacent to aerodigestive tract structures. All patients undergoing incomplete resection developed local recurrence. Six required salvage resection, as opposed to no recurrences in WD carcinomas following complete resection (P = .01). Survival at 5 years for WD carcinomas undergoing complete resection versus initial incomplete resection was 100% versus 50%, respectively (P = .27). CONCLUSION: Review of our experience shows that complete resection of thyroid carcinoma invading the aerodigestive tract can offer prolonged palliation, improved local control, and the opportunity for cure in selected patients.

Adult↗
PubMedDate not supplied

Antecedents of nursing school attrition: attitudinal dimensions.

In an attempt to identify attitudinal orientations that might be used as indicators of attrition, demographic, academic performance, and attitudinal data on 261 students enrolled in the Woodruff School of Nursing at Emory University, Atlanta, between 1968 and 1972, were studied. Traditional measures of scholastic aptitude were not found to be good indicators. The higher the father's educational attainment, the more likely attrition was to occur. The higher the mother's occupational status, the less likely attrition was to occur. Attitudinal measures used in the study seemed to have little direct impact on attrition.

Attitude↗
PubMed1989

Primary treatment of the infected sternotomy wound with muscle flaps: a review of 211 consecutive cases.

Between 1978 and 1987, 15,595 median sternotomies were performed at Emory University Hospitals. Sternal wound infections developed in 246 patients (1.6 percent). Mediastinitis was present in 211 patients, while superficial infections were detected in the remaining 35 patients. Debridement and muscle or omental flap closure were performed in all instances of mediastinitis, with an overall mortality rate of 5.3 percent. The results of this treatment are reviewed, and the evolution of current therapeutic guidelines is described. When compared with closed-catheter irrigation and open granulation techniques, flap closure is shown to result in a fourfold decrease in mortality, an increased success of primary therapy, and a diminished length of hospitalization following treatment. This evidence supports the conclusion that debridement and flap closure should be considered the primary therapy for patients with poststernotomy mediastinitis.

Humans↗
PubMed2002

Trends in unilateral breast reconstruction and management of the contralateral breast: the Emory experience.

Recent trends in breast reconstruction have transitioned toward the skin-sparing type of mastectomy and immediate reconstruction using autologous tissue. This study was designed to document trends in the management of patients with unilateral breast cancer and to determine how they influence management of the contralateral breast. All patients who underwent unilateral breast reconstruction at Emory University Hospitals from January of 1975 to December of 1999 were reviewed. The cohort was stratified by timing of reconstruction (immediate versus delayed), method of reconstruction, and mastectomy type (skin-sparing versus non-skin-sparing). The methods of reconstruction included implant, latissimus dorsi flap, and transverse rectus abdominis musculocutaneous (TRAM) flap. Contralateral procedures to achieve symmetry included augmentation, mastopexy, augmentation/mastopexy, and reduction. A total of 1394 patients were evaluated, including 689 delayed and 705 immediate reconstructions. Sixty-seven percent of delayed-reconstruction patients (462 of 689) had a symmetry procedure performed on the opposite breast, compared with 22 percent for the immediate-reconstruction patients (155 of 705) (p </= 0.001). The percentage of times a contralateral procedure was performed was highest for implant reconstructions (89 percent delayed and 57 percent immediate) and lowest for TRAM flap reconstructions (59 percent delayed and 18 percent immediate). Augmentation mammaplasty was the most common symmetry procedure for implant reconstruction (41 percent), whereas reduction was the most common procedure for autologous tissue reconstruction (57 percent). Immediate unilateral breast reconstructions were stratified into non-skin-sparing mastectomy (n = 205) and skin-sparing mastectomy (n = 500). Thirty-four percent of patients with a non-skin-sparing mastectomy defect (70 of 205) underwent a contralateral breast procedure, compared with 17 percent of patients with a skin-sparing mastectomy defect (85 of 500) (p = 0.001). The percentage of times a contralateral procedure was performed in immediate reconstruction, stratified by mastectomy and reconstruction type, was only significant for TRAM flap reconstructions (25 versus 11 percent). Trends in the management of unilateral breast cancer from delayed to immediate reconstruction and from implants to autologous tissue have reduced the incidence of contralateral symmetry procedures. Reduction mammaplasty is the most common symmetry procedure used for autologous tissue reconstruction, with augmentation predominating when implants are used. The type of mastectomy also effects the management of the opposite breast, with skin-sparing mastectomy further reducing the incidence of contralateral procedures in immediate TRAM flap reconstruction, compared with non-skin-sparing mastectomy.

Breast Implants↗
PubMed1975

Papillomas of the nasal and paranasal cavities.

Intranasal papilloma is an uncommon, benign tumor of the nasal cavity and, by extension, the paranasal sinuses. It occurs only once for every 25 cases of ordinary nasal polyps. A recent case is reported, followed by a summary of the cases treated at the Emory University Hospitals in the last ten years. The histologic classification is reviewed, as well as current treatment, with an emphasis on wide surgical excision through the lateral rhinotomy approach. Because about 10% of these tumors will have associated malignancy, guidelines are given to insure that this malignant transformation is not missed.

Adult↗
PubMed1976

Hypophysectomy in the treatment of disseminated carcinoma of the breast and prostate gland.

Transsphenoidal hypophysectomy offers gratifying palliative relief of pain to patients with metastatic cancer of the breast and prostate. This report represents the results of two years' experience with this procedure at Emory University School of Medicine. The physiologic rationale and clinical indications for hypophysectomy are described, as is the operative technic using the open transsphenoidal microsurgical approach. The series of cases reported here includes 20 men with disseminated prostatic carcinoma and 23 women and one man with metastatic carcinoma of the breast. All 44 procedures were done by the transsphenoidal microsurgical approach. Pain was the preoperative indication for surgery in 41, while three patients were operated on for extensive disease without pain. Satisfactory relief of pain was obtained in 76% of the patients with prostatic cancer and in 83% of the breast cancer patients. While the results are gratifying with regard to relief of pain, the duration of follow-up is not sufficient to comment on the value of the procedure in significantly prolonging life.

Adult↗
PubMed1976

Cardiac valve replacement in the first 21 years of life.

From 1969 through 1974, 25 patients under age 21 years had prosthetic cardiac vlave replacement at the Emory University Hospital. Twenty-nine valves were replaced in this group. Patients ranged in age from 2 to 21 years, with a mean of 14 years. Concomitant correction of associated cardiac lesions was required in 14 (56%). Five (21%) had had prior open valvuoplastic procedures. Operative mortality for the entire group was 12%, with an additional late mortality of 8%. There have been no early or late deaths in the last three years' experience. Best results are obtained when early correction of isolated valvular lesions is done as soon as clinical deterioration on vigorous medical management is recognized. The presence of multiple intrcardiac lesions or prior valve surgery does not preclude excellent results. Current indications for surgical correction and follow-up management are presented.

Adolescent↗
PubMed1977

Benign tumors of the esophagus: experience with 20 cases.

Benign tumors of the esophagus are rare and require an alert suspicion for early diagnosis. These tumors may not cause symtoms before attaining large size, yet they may prove fatal when small. Because of the possibility of malignancy and their tendency to obstruct, benign tumors of the esophagus should be resected when diagnosed. This report details our experience in 20 patients with benign esophageal tumors seen at Emory University Hospital between 1955 and 1975. There were 15 men and five women in the group, ranging in age from 17 to 75 years. The tumor series included 13 leiomyomas, four cysts, two cases of multiple polyps, and one case of granular cell myoblastoma. Six of the tumors were asymptomatic; the remaining 14 had symptoms of dysphagia, pain, and hematemesis. In one instance, episodic hematemesis and melena were so severe that they produced hemorrhagic shock. Characteristic radiologic features helped in making the preoperative diagnosis in 18 of the 20 cases. Two patients had coexisting disease masking the presence of the esophageal tumor. Seventeen patients had surgical resection. There were no operative deaths and follow-up results have been satisfactory.

Adolescent↗
PubMed1977

Repeat myocardial revascularization for uncontrollable angina after occlusion of prior aortocoronary bypass.

Twelve patients at Emory University Hospital have had repeat myocardial revascularization for recurrent, uncontrollable, disabling angina pectoris after previous coronary artery bypass grafts. The interval betweeen initial bypass procedure and reoperation ranged from six weeks to six years. The native coronary circulation remained unchanged in six, had developed additional proximal (left main) obstruction in four, and had advanced stenosis at the site of former anastomosis in three. Repeat revascularization consisted of new vein graft construction in eight and vein and internal mammary artery graft in four, with an average of 1.9 grafts per patient. There were no deaths. Seven of 12 patients (60%) are now asymptomatic and three of 12 (25%) are significantly improved. Patency of new grafts studied by elective repeat coronary angiography in six patients showed patency of all grafts to the left anterior descending artery and four of six grafts to other vessels. Analysis of the initial graft closures, method for selecting patients to undergo a second procedure, and operative technics believed important in safety of reoperation and avoidance of repeat early graft occlusion are presented.

Adult↗
PubMed1978

Metamorphosis of breast cancer.

In two decades there has been a sweeping metamorphosis of the antiquated conception of breast cancer as a solitary mass of questionable operability, accompanied by numerous axillary lymph nodes and probably distant metastasis. An undreamed-of recognizable preclinical stage of breast cancer has drastically changed attitudes and reactions in physicians and patients. These changes have paralleled the applications of clinical mammography. The smallest of premammography breast cancers are now advanced cancers. The average size of operable breast cancers at Emory University is now less than 1 cm in diameter, and ten-year cure rates with minimal cancers exceed 95%. The treatment of these minimal breast cancers, often in a two-stage surgical procedure with the patient participating in decisions, may include psychotherapy and reconstructive surgery. Pathologists have assumed new roles in coping with disturbing epithelial cellular changes in premalignant and borderline malignant breast lesions. Today predictive clinical signs and symptoms are associated with advanced cancer, with limited specific clinical changes relating to early breast cancer. Over one third of breast cancers are being discovered in women under 50 years of age, and mammography is the primary means of detecting these cancers.

Attitude↗
PubMed1979

Vascular access for cancer chemotherapy.

A persistent problem in caring for patients receiving long-term intravenous chemotherapy for cancer is the maintenance of access to the vascular system. At Emory University Hospital between January 1975 and December 1977, 48 cancer chemotherapy patients had upper-arm bovine arteriovenous fistulas created for vascular access. The heterografts were inserted from the distal brachial artery to the proximal brachial vein under local, regional block, or general anesthesia. Grafts were functioning satisfactorily in 81% of the subjects at the time of death or at termination of treatment. The mean duration of useful graft patency for the entire group was 4.6 months, with a range of 0 to 27 months. Thrombosis of the graft was the most frequently encountered complication; infection and bleeding occurred infrequently. Reoperation was required in 35% of grafts, of which one half were salvaged. No mortality was attributable to the operative procedures or to the presence of a chronic arteriovenous fistula.

Arteriovenous Shunt, Surgical↗
PubMed1980

Temporal arteritis in a black patient.

A review of the medical records between 1971 and 1977 from four Emory University affiliated hospitals revealed 12 white patients and one black patient who had biopsy-proven temporal arteritis. Anemia and an elevated alkaline phosphatase level were noted in eight of the 13 patients, and the ESR was elevated in all thirteen. Symptoms resolved rapidly with corticosteroid therapy. No differences were noted in presentation, response to therapy, or complications between the two racial groups studied here and those reviewed in the literature.

Aged↗
PubMed1981

Primary hyperparathyroidism and the gastrointestinal tract.

To determine the frequency of gastrointestinal symptoms in primary hyperparathyroidism, we retrospectively analyzed 100 consecutive patients seen at Emory University Hospital from Jan 1, 1977 through March 1, 1979. At the time of diagnosis, 28 patients complained of nausea, 19 of vomiting, 29 of abdominal pain, and 33 of constipation. One patient presented with acute pancreatitis and 14 had ulcer disease (two gastric and 12 duodenal ulcers). Hypercalcemia increases gastric acid secretion and may account for associated ulcer disease and the ulcer-like pain in primary hyperparathyroidism. The mechanisms causing the other gastrointestinal symptoms in hypercalcemia remain to be elucidated. These symptoms abate on correction of hyperparathyroidism.

Constipation↗
PubMed1981

Transsphenoidal hypophysectomy in disseminated breast cancer.

Sixty patients with metastatic breast cancer had transsphenoidal hypophysectomy at Emory University Hospital. Median survival for the entire group was ten months. Survival was increased (longer than 14 months) in good responders as compared to nonresponders (three months). Pain was significantly relieved in the majority of those patients who had severe pain. Operative complications were minimal. The technic of transsphenoidal hypophysectomy offers a substantial chance of objective and subjective palliation with minimal morbidity in advanced breast cancer.

Adult↗
PubMed1981

Arthroscopy and arthrography of the knee: a comparison study.

Between 1975 and 1978, over 200 knee arthroscopies were performed at the Emory University Hospitals; the findings were totally correct in 91%. During the same period, arthrograms were performed on 79 different patients, 39 of whom had confirming arthrotomies. The arthrograms were totally correct in 38%. Fifteen totally incorrect arthrograms were reviewed without knowledge of the operative findings; 12 were considered by the radiologist to be technically acceptable for review. Of these, five correlated partially, but none completely, with findings at arthrotomy. We discuss the difficulty in arthrographic reading of lateral meniscus tears, anterior cruciate tears, and osteochondral loose bodies. We conclude that, although arthroscopy and arthrography can be complementary, arthrography must be used only with the best equipment and technic by a motivated, experienced, and enthusiastic radiologist.

Adolescent↗
PubMed1982

Aortovenous fistulas due to ruptured infrarenal aortic aneurysms: experience with six cases.

A review of patients undergoing aortic aneurysmectomy between 1970 and 1979 at the Emory University Hospital and the Atlanta Veterans Administration Medical Center disclosed six patients with aortovenous fistulas. Four fistulas were aorta to vena cava; one, aorta to left renal vein; and one, aorta to left iliac vein. Four of the arteriovenous fistulas were identified preoperatively. In another patient the symptoms and signs were masked by concomitant retroperitoneal rupture of the aneurysm. The final patient was asymptomatic preoperatively, but had an occluded fistula discovered at operation when laminated thrombus was removed from the wall of the aneurysm. One patient died while being prepared for operation; five were operated upon and survived. Successful management of this problem is contingent upon preoperative recognition, careful manipulation of the aneurysm with endoaneurysmal closure of the fistula, and judicious perioperative fluid management.

Aged↗
PubMed2001

Neuro-ophthalmic manifestations of head trauma.

OBJECTIVE: To describe the neuro-ophthalmic findings in a group of patients with head trauma. MATERIALS AND METHODS: A retrospective chart review of all patients given a diagnosis code of head trauma in the neuroophthalmology unit at Emory University between 1991 and 1999. RESULTS: A total of 326 consecutive patients were reviewed (203 [63%] men and 123 [37.0%] women). Age ranged from 2 to 86 years, with a mean of 30 years. Motor vehicle accident was the most common cause of head trauma, occurring in 195 (59.8%) patients. An abnormal neuro-ophthalmic examination was noted in 185 of 326 patients (56.7%). Loss of consciousness was not associated with any outcome, but the presence of a neuroimaging abnormality, particularly intracranial hemorrhage, was significantly associated with specific neuroophthalmic deficits. CONCLUSIONS: Head trauma causes a number of neuroophthalmic manifestations. The afferent and efferent pathways are vulnerable to traumatic injury, although the efferent system is more commonly affected. Loss of consciousness may not be a reliable predictor of specific neuro-ophthalmic outcomes, but neuroimaging abnormalities may.

Adolescent↗
PubMed2006

Repaving the road to academic success: the IMeRGE approach to peer mentoring.

In recent years, academic health centers have made a considerable effort to encourage medical students and physicians-in-training to consider academic medicine as a career choice. For physicians, selecting a career in academic medicine may be the first hurdle, but the challenge of successfully maintaining an academic career is perhaps a more formidable task. Mentoring is a much-needed response to this challenge. But the success of traditional mentoring programs at academic institutions is often limited by, among other things, the availability of senior faculty who can serve as mentors. The authors describe the formation and organization of the Internal Medicine Research Group at Emory (IMeRGE), an innovative peer mentoring group within the Division of General Medicine at Emory University. This group, born partially out of the mentoring needs of our women and minority faculty, shared the primary goal of fostering a collaborative atmosphere among junior faculty, while simultaneously acquiring experience through advanced faculty development. The authors present our methods of garnering division support for designated time and financial resources, defining member responsibilities, developing a curriculum, providing peer support, and seeking advisors with expertise in the areas on which we wished to focus. In addition to the development of IMeRGE, the authors provide an overview of the pros and cons of traditional mentoring versus peer mentoring; discuss the challenges faced by IMeRGE and strategies for addressing these issues; and present the paradigm of IMeRGE as a template for alternative forms of academic mentorship.

Academic Medical Centers↗