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PubMedDate not supplied

Trends in laparoscopic cholecystectomy in Indiana.

Laparoscopic cholecystectomy is a fairly new procedure that is quickly gaining widespread use among surgeons. In Indiana, 45% of cholecystectomies performed on Medicare beneficiaries over the age of 65 were via the laparoscopic approach, resulting in a shorter average length of stay, 5.9 days, compared to 12.3 days for those who underwent the open procedure. Among these Medicare beneficiaries, the complication rate for laparoscopic cholecystectomy was lower than for those who had the open procedure, 11.3% compared with 16.6%. The trend of the use of the laparoscopic approach for cholecystectomy for older patients and the complications arising from this procedure need further evaluation.

Aged↗
PubMedDate not supplied

Descriptive epidemiology of animal bites in Indiana, 1990-92--a rationale for intervention.

Animal bites are a reality of life throughout the world. They arise out of an imperfect relationship with domestic animals and wildlife. Most bite injuries are preventable. The principal approaches to community-wide bite prevention programs include reducing the number of domestic animals roaming in the community (animal control) and teaching people to refrain from behaviors likely to provoke bites. This article addresses the epidemiologic basis and justification for a bite prevention program targeted toward children. Animal bite data from Indiana for the years 1990, 1991, and 1992 were analyzed for trends that might suggest opportunities for preventive intervention. Bites inflicted by humans were not included in this data base. Children of all age groups were disproportionately affected, with the highest incidence in the 5-9 year age group. The dog and the cat were the most commonly reported biting animals. Wild and pet rodents were the next most frequent biting group. The bites most frequently reported from nonrodent wild animals were inflicted by raccoons. The incidence of animal bites in children peaked during the spring (April-June). Boys were bitten at a higher rate than girls, but this difference between the sexes narrows with age and was not noted in the adult population. Residents of urban counties (population greater than 100,000) had higher reported bite rates than residents of nonurban counties.

Adolescent↗
PubMed1977

A reclassification of the genus Aplodontopus (Acari: Sarcoptiformes) with a description of Aplodontopus micronyx sp. n. from the thirteen-lined ground squirrel, Spermophilus tridecemlineatus, in Indiana, USA.

The genus Aplodontopus is transferred from the family Glycyphagidae to the family Chortoglyphidae and a new species Aplodontopus micronyx is described. The new species is from the tail-hair follicles of Spermophilus tridecemlineatus in Indiana, USA; deutonymphs and a female are described.

Animals↗
PubMedDate not supplied

Indiana family physician attitudes and practices concerning smoking cessation.

Most physicians are aware of the health benefits of smoking cessation and agree they have a responsibility to help smokers quit. Many physicians, however, do not regularly address smoking cessation with their patients. Questionnaires were sent to 2,095 family practice physicians in Indiana. Information obtained included: demographic data; office-based smoking cessation practices; counseling; and physicians' perceptions of intervention outcomes. Most physicians (86%) asked new patients if they smoked, and 23% questioned patients about their exposure to passive smoke. Younger physicians, female physicians and urban physicians were more likely to ask new patients if they smoked. A formal smoking cessation program was used by 28% of the responding physicians. Among those not using a program, 7% reported plans to implement one in the coming year, 40% were not planning to implement one, and 53% were unsure. Physician and practice characteristics were not correlated with the use of smoking cessation programs. Only 11% of physicians considered their smoking cessation counseling skills to be excellent; 27% indicated the need for improvement in skills. One-half (52%) believed their counseling efforts were effective; almost half (45%) believed that current reimbursement policies limited their involvement in smoking cessation interventions. Most respondents have not instituted smoking cessation programs in their practices. It is likely that a combination of strategies, including both undergraduate, graduate and continuing medical education programs and reform in reimbursement practices for cessation programs, will be required to achieve significant increases in long-term smoking abstinence rates.

Adult↗
PubMedDate not supplied

Racial differences in the impact of smoking-attributable disease on health care costs in Indiana.

The purpose of this investigation was to estimate the direct health care costs attributable to smoking in Indiana and address these costs in the context of the differential health impact of tobacco use on minorities. Estimates of direct health care costs for smoking in 1990 were calculated using the Smoking Attributable Morbidity and Mortality and Economic Costs (SAMMEC 2.1) computer-based program developed by the Centers for Disease Control and Prevention. The proportion of direct health care costs attributable to smoking were calculated by evaluating personal health expenditures from five cost centers including hospitalization, physician services, services of other health practitioners, nursing home care and drugs. Study findings indicate that direct health care costs were more than $700 million in 1990. Health care spending among whites accounted for 53% of total costs. Per capita costs among smokers and nonsmokers > or = 35 years of age amounted to $278. Although whites accounted for the majority of direct health care costs attributable to smoking, per capita costs were higher among African Americans compared to whites, reflecting the differential smoking-attributable mortality rates experienced by these two groups.

Adult↗
PubMedDate not supplied

The Indiana Prenatal Substance Use Prevention Program: its impact on smoking cessation among high-risk pregnant women.

The Indiana Prenatal Substance Use Prevention Program (PSUPP) was established in 1988 to help pregnant women quit cigarette smoking as well as alcohol and drugs. PSUPP directors implement the Screen, Intervene and Follow-up (SIF) model to assess substance use and provide services to help clients stop smoking. During fiscal year 1995, almost 25,000 individuals were impacted directly or indirectly by the PSUPP. Of these, 1,334 pregnant women were screened for substance use by PSUPP. Of the 987 women identified with a known substance use risk factor, 42.4% (418) were high-risk smokers (more than five cigarettes per day) and 9.9% (98) were medium-risk smokers (smoking between one and four cigarettes per day). PSUPP directors counseled their high/medium risk smokers an average of four times during their pregnancy. The PSUPP appears to be effective in getting high-risk smokers to change their smoking behavior during their pregnancy. Approximately one-half (49.9%) of the 516 high- or medium-risk smokers decreased or quit smoking while participating in the PSUPP. When surveyed, about 80% of the PSUPP participants stated that the knowledge they gained through PSUPP relative to tobacco use was "very helpful." Only two-thirds of the PSUPP clients responded that they "strongly agreed" with the statement that tobacco use causes babies to have a lower birth weight. While pregnancy may provide the "teachable moment" for women who smoke, more attention needs to be placed on making women more aware of the risks involved with smoking during pregnancy.

Adolescent↗
PubMed1996

Spontaneous abortions possibly related to ingestion of nitrate-contaminated well water--LaGrange County, Indiana, 1991-1994.

Health effects associated with ingestion of nitrate-contaminated water have included methemoglobinemia (i.e., blue baby syndrome) in infants and spontaneous abortions in laboratory animals and livestock; however, only one study in humans has reported an association between increased methemoglobin levels and spontaneous abortion. During March 1993, the LaGrange County (Indiana) Health Department (LCHD) identified three women who reported a total of six spontaneous abortions during 1991-1993 and who resided in proximity to each other; each had obtained drinking water from nitrate-contaminated private wells in LaGrange County (1995 population: 29,350). LCHD was subsequently notified about a fourth woman from another part of the county who had had two spontaneous abortions after she had moved into a new home with a nitrate-contaminated private well. This report summarizes the investigations of these reports by LCHD, which indicate the need for further assessment of a possible relation between ingesting nitrate-contaminated water and spontaneous abortion.

Abortion, Spontaneous↗
PubMed1997

Respiratory diphtheria caused by Corynebacterium ulcerans--Terre Haute, Indiana, 1996.

Diphtheria is a potentially severe illness; among unvaccinated persons, the case-fatality rate may be 5%-10%, even with appropriate treatment. During 1990-1995, approximately 4000 deaths resulted from the ongoing diphtheria epidemic in the former Soviet Union. In the United States, respiratory diphtheria is rare: during 1980-1995, only 41 cases were reported. Serologic studies in the 1970s and 1980s indicated that 20%-60% of U.S. adults aged > or = 20 years lacked immunity to diphtheria. This report describes a recent case of respiratory diphtheria caused by a toxin-producing strain of Corynebacterium ulcerans. The case occurred in a resident of Indiana, and an investigation by public health authorities indicated that acquisition of the organism occurred locally in the state.

Corynebacterium↗
PubMed1997

Clinical orthodontics in predoctoral education. Six years of experience at Indiana University.

Since 1990, clinical achievement in orthodontics has been a graduation requirement at Indiana University. To be certified for graduation, all dental students must treat at least one limited orthodontic problem and observe the retention of at least one previously treated, limited orthodontics patient. Although clinical orthodontics for adults appears to be a very successful addition to the predoctoral curriculum, the specific accreditation requirements that mandated it have been rescinded. However, the positive response of the students, apparent acceptance by the orthodontic community, and the national acclaim afforded the program indicate that a hands-on clinical experience in orthodontics is a positive addition to the predoctoral curriculum.

Accreditation↗
PubMed1977

Treatment results of retinoblastoma at Indiana University Hospitals.

This paper summarizes a review of all cases (70) of retinoblastoma seen at Indiana University Hospitals over the past 25 years (from 1952 to 1977) to determine the results of treatment and causes of failure. All cases from July, 1967, to the present were managed by the same group of physicians, thus following a consistent philosophy of treatment for those patients. Thirty-two patients treated during this latter period have survived a minimun of two years and are alive. Visual acuity of 20/20 has been preserved in all 16 patients with unilateral disease and a range of 20/50 to 20/20 in 12 of the 16 patients with bilateral disease. Because of the highly specialized diagnostic and therapeutic techniques and equipment required for optimal treatment results, it is recommended that patients with retinoblastomas be referred to treatment centers specializing in the management of this disease.

Child↗
PubMed1978

Carcinoma of the lower lip: treatment results at Indiana University Hospitals.

Sixty-six consecutive cases of carcinoma of the lower lip were seen at the Indiana University Hospitals from 1960 to 1972. Each patient's records were reviewed as to age, sex, race, stage, stage by treatment modality, pathology, treatment methods used and cause of failure. Early lip cancer represents a highly curative lesion whether treated by surgery or radiation therapy. Close followup is mandatory on all patients as the development of neck nodes, if discovered late, carries a grave prognosis. Advanced carcinoma of the lip can be successfully treated with current radiation therapy techniques using fractionated doses providing excellent cosmetic results.

Adult↗
PubMed1986

The Reitan-Indiana Aphasia Screening Test: scoring and factor analysis.

This article presents a scoring system and factor analysis for the Reitan-Indiana Aphasia Screening Test. Eight content categories were clinically identified and scored (N = 197). Also, the interrelationships of these content areas were explored by factor analysis. The analysis revealed two major factors, a general language abilities factor and a sensorimotor coordination factor. The pattern of loadings was interpreted with reference to hypothesized relationships and previous research on the test. The findings also have implications for the clinical interpretation of test results.

Brain Diseases↗
PubMed2000

Colonic adenocarcinoma occurring in an Indiana pouch: report of a case and review of the literature.

Colonic adenocarcinoma has been frequently reported after ureterosigmoidostomy based on carcinogenic substances created when feces and urine are mixed. However, colonic adenocarcinoma has never been reported arising in an Indiana pouch after cystectomy. We report a case of adenocarcinoma arising in a urinary pouch after cystectomy for transitional cell cancer. We believe this to be caused by hereditary nonpolyposis colon cancer (an autosomal dominant syndrome that puts individuals at risk for genitourinary, colonic, and several other cancers) rather than carcinogenic effects of urine on colonic mucosa. When planning urinary reconstruction after cystectomy for malignancy, it is important to consider the possibility that an individual may suffer from hereditary nonpolyposis colon cancer before selecting the colon as a urinary reservoir.

Adenocarcinoma↗
PubMed1991

Trends in the operative management of invasive squamous carcinoma of the vulva at Indiana University, 1974 to 1988.

From January 1974 to March 1988, 150 patients with primary invasive squamous cell carcinoma of the vulva underwent surgery at Indiana University. There has been a trend toward more conservative surgical management of this disease. To determine the impact of this trend on clinical outcome, cases were divided into three groups according to date of operation: group I, 1974 to 1978; group II, 1979 to 1983; and group III, 1984 to 1988. Overall, 80 patients had en bloc radical vulvectomy and groin dissection, 20 had modified radical vulvectomy and bilateral groin dissection through three separate incisions, and 36 had modified radical vulvectomy and unilateral superficial groin dissection. Fourteen patients had other operations. Forty-two patients (27.3%) had radiotherapy in addition to surgery. Among the three groups, there were no differences when mean age, International Federation of Gynecology and Obstetrics stage distribution (1988 system), mean lesion size, mean depth of invasion, or grade distribution were compared. A significant trend toward more conservative surgical therapy was observed. En bloc radical vulvectomy was performed in 77.4% of group I patients, 71.1% of group II patients, and 35.8% of group III patients (p less than 0.001). Mean days of hospitalization were also reduced significantly. Group I had a mean stay of 30 days, group II had a mean stay of 23 days, and group III had a mean stay of 11 days (p less than 0.001). Mean operative blood loss (group I, 754.8 ml; group II, 620.0 ml; group III, 393.6 ml; p = 0.03), mean units of blood transfused (group I, 1.4 units; group II, 1.3 units; group III, 0.4 units; p less than 0.01), and mean hours of operating time (group I, 3.7 hours; group II, 3.7 hours; group III, 3.2 hours; p = 0.02) were also reduced.

Adult↗
PubMed1995

Clinical stage B non-seminomatous germ cell testis cancer: the Indiana University experience (1965-1989) using routine primary retroperitoneal lymph node dissection.

Between 1965 and 1989, 1180 patients at Indiana University, U.S.A., underwent retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ cell (NSGC) testis cancer of whom 638 cases had primary RPLND. A subset of 174 cases were considered clinical stage B (or II) before surgery (retroperitoneal nodal metastases by clinical staging). Surgery revealed that 23% (n = 41) had pathological stage A disease (no cancerous nodes). This error rate in clinical staging has decreased somewhat with improved techniques, but remains approximately 20% over the last decade. The relapse rate in pathological stage A (n = 41) was 5% (n = 2), both of whom were cured by chemotherapy. The relapse rate in pathological stage B without postoperative adjuvant treatment (n = 54) was 35% (n = 19); 2 patients died. This indicates that 65% of pathological stage B cases were cured by RPLND alone. From 1979 to 1989, the 140 pathological stage B cases participated in a randomised prospective trial of post-RPLND adjuvant chemotherapy versus no postoperative treatment. Forty two per cent (n = 59) received postoperative platinum-based therapy (two cycles), and there has been no relapse after RPLND for stage B disease. While advances in chemotherapy for NSGC testis cancer have led to its application by several study groups to clinical stage B (or II) testis cancer (with surgery reserved only for those in partial remission), the equivalent cure rate with RPLND surgery with chemotherapy rescue reserved for those who relapse appears to have both cost and risk-benefit advantages.

Chemotherapy, Adjuvant↗
PubMed2006

Stereotactic body radiotherapy for bilateral primary lung cancers: the Indiana University experience.

PURPOSE: To review the outcomes of 10 patients treated with stereotactic body radiotherapy for bilateral primary medically inoperable lung cancer. METHODS AND MATERIALS: Between July 2001 and February 2005, 10 patients were treated at Indiana University with stereotactic body radiotherapy for bilateral multiple primary lung cancers using a stereotactic body frame (Elekta, Stockholm, Sweden). Nine patients had cancers that were deemed inoperable secondary to multiple medical comorbidities. One patient refused surgery. All patients had biopsy proven non-small-cell lung carcinoma of at least one of their masses and presented with either metachronous or synchronous pulmonary nodules. Positron emission tomography scans were done for all patients before treatment. Radiation dose varied between 4800 and 6600 cGy given in 3 fractions prescribed to the 80% line covering at least 95% of the planning target volume. We performed a retrospective review of the outcome of these patients. RESULTS: The mean follow-up time was 20.7 months and the median time was 18.5 months (range, 7-42 months). At the time of this review, all 10 patients were living. Eight (80%) of 10 patients had no evidence of disease progression. One patient developed distant metastasis 5 months after treatment and a second patient developed a local recurrence within the radiation field 11 months after treatment. Six patients had either acute or late pulmonary toxicity, but all toxicity was < or =Grade 2 as defined by the Radiation Therapy Oncology Group toxicity criteria. CONCLUSION: Our preliminary results indicate that stereotactic body radiotherapy is a possibly safe and potentially effective treatment option for patients with bilateral multiple primary lung cancers that are deemed medically inoperable.

Academic Medical Centers↗
PubMed1997

Ileocecal valve resistance augmentation using glutaraldehyde cross-linked collagen: a canine model for endoscopic salvage of the leaking Indiana reservoir.

PURPOSE: Periurethral injection of glutaraldehyde cross-linked collagen is a well-established modality for the treatment of patients with incontinence caused by structural defects at the bladder outlet. Little is known about the potential usefulness of this approach to the nonfunctioning continence mechanism of a leaking continent urinary reservoir. An animal model of an incontinent Indiana reservoir was created using the naturally incompetent canine ileocecal valve. The effectiveness and feasibility of endoscopic submucosal injection of glutaraldehyde cross-linked collagen into the ileocecal valve to increase resistance were examined. MATERIALS AND METHODS: Seven beagle dogs underwent isolation of the ileocecal segment. The right colon and ileum were brought to the skin as 2 stomas. Baseline leak point pressures of the ileocecal valve were determined while infusing contrast material into the right colon. The leak point was observed fluoroscopically, and the pressure at which contrast material crossed the valve was measured. Glutaraldehyde cross-linked collagen, 4 to 10 ml., was injected endoscopically into the valve in a circumferential pattern. Leak point pressures were measured immediately, 1 month after injection and 3 months after injection. RESULTS: An average of 7.1 gm. (range, 4.1 to 10.1 gm.) was required to create an endoscopically "closed" ileocecal valve. Leak point pressure increased from a mean 3.8 mm. water (range, 2.5 to 6.0 mm. water) at baseline to mean 35.7 mm. water after injection (range, 22.0 to 57.0 mm. water). At 1 month, mean leak point pressure decreased slightly to 26.7 mm. water. This pressure stabilized at 3 months at 29.5 mm. water. CONCLUSIONS: Endoscopic delivery of glutaraldehyde cross-linked collagen into the ileocecal valve consistently enhanced resistance as measured by leak point pressure. This effect was durable over a 3-month period of observation. Admittedly, this period of observation is relatively short. Longer followup may have demonstrated significant diminution of collagen migration or resorption. However, this feasibility study demonstrates that collagen injections may provide a minimally invasive means of treating the incontinent continent urinary reservoir.

Animals↗
PubMed1994

Evolution of the Indiana continent urinary reservoir.

The Indiana continent urinary diversion evolved from the Gilchrist procedure. Full detubularization of the reservoir segment, tapering of the efferent limb with staples, plication of the ileocecal valve, and tunneled tenial implants have resulted in a reliable and reproducible continent cutaneous urinary reservoir. In this report the first 69 patients treated with these techniques are reviewed after a minimum 2-year followup. Overall day and night continence rates were 97% by 1 year after surgery. More than 80% of all patients are able to sleep a normal nighttime interval without catheterizing or leaking. Early plus late reoperation rates for problems related to the pouch were 17%. This rate compares favorably to other series of continent cutaneous reservoirs and even to series of ileal conduits.

Cystitis↗