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At least 307 records · Page 17Linked to original sources
PubMed1989

Coronary arteriography and percutaneous transluminal coronary angioplasty. Changing patterns of use and results.

The use and practice patterns associated with coronary arteriography and percutaneous transluminal coronary angioplasty (PTCA) have significantly changed since their initial application for the diagnosis and treatment of coronary atherosclerotic heart disease. From 1981 to 1986 at Emory University Hospital, there has been increased use of PTCA as the initial revascularization technique employed in patients undergoing their first known coronary arteriogram. This practice pattern has resulted in a dramatic increase in patient age and disease complexity in those currently referred for coronary artery bypass graft surgery. Since 1980, PTCA success rates have improved and complications decreased due to operator experience and technical innovation. Long-term follow-up studies of patients initially treated with PTCA have documented excellent survival in those with single-vessel disease and milder forms of multiple-vessel disease. The application of PTCA as an initial revascularization strategy in patients with more diffuse and complex multiple-vessel disease is not known and awaits the results of ongoing prospective randomized trials.

Angiography↗
PubMed1989

[The development of health risk appraisal for Japanese as a new health educational tool].

Health risk appraisal (HRA) is a new health educational tool widely-used in the United States, which informs clients about how their health habits and lifestyles affect their probability of dying from potentially preventable causes and helps to motivate them to reduce their personal health risks. It personalizes mortality statistics and epidemiologic data by combining these data with a person's risk factors. We have got started the development of HRA for Japanese with reference to a new version of HRA named "Healthier People" revised by the Carter Center of Emory University and the Centers for Disease Control in the United States.

Health Education↗
PubMed1985

[Redilatation of coronary stenoses. Effect on long-term results].

Subsequent to percutaneous transluminal coronary angioplasty (PTCA), with a primary success rate of between 84 and 94%, restenosis is reported to occur in 17 to 47%. Redilatation has been considered in about 30% of dilated patients and carried out in 20%. The experience presented is based on 608 consecutive patients who underwent PTCA at Emory University in Atlanta as well as 350 consecutive patients treated at the University of Genf. In general, the primary success rate of repeated PTCA is reported to be significantly better. Based on our data, the primary success of redilatation was 97%, as compared with an 87% success rate on initial dilatation. Associated with second and third dilatations, there is a substantially lower incidence of complications; in our patients, obstructive dissections occurred in 1% as compared with 7% at the time of initial dilatation and myocardial infarction was not observed (as compared with 1% initially). Emergency bypass surgery was required in only 1% as compared with 5% at initial dilatation. With regard to longterm results, the data reported shows some differences. While most of the figures indicate a rate of restenosis comparable to that seen after initial dilatation, a higher incidence of restenosis has been observed. In our patients, the rate of restenosis after repeat PTCA was essentially similar to that seen after initial PTCA; overall, however, that associated with LAD stenoses was notably higher. On use of redilatation, 78% of all patients, instead of only 63% after successful initial dilatation, had longterm benefits from this mode of therapy.

Angina Pectoris↗
PubMed1988

Perianal infections in acute leukemia. Second place winner: Conrad Jobst Award.

Perianal infections in patients with acute leukemia and granulocytopenia are potentially lethal conditions. To evaluate the management of perianal infections in patients with granulocytopenia and acute leukemia, all such patients treated at Emory University Hospital between January 1, 1980, and December 31, 1985, were reviewed. Twenty patients were found to have severe granulocytopenia (fewer than 500 polymorphonuclear leukocytes/mm3) and perianal infection, representing 5.7 per cent of all hematology service admissions during that period. Eleven patients were managed conservatively with broad-spectrum antibiotics and supportive measures, and nine patients underwent operative drainage of the perianal infection in addition to conservative measures. The two groups were similar in respect to age, associated conditions, length of hospitalization, and degree of perianal infection, with the exception that operatively drained patients were more likely to have positive blood cultures (7/9 operatively drained; 4/11 conservatively managed). Mortality was higher in the operatively drained group (44.4% vs 9% in the conservatively managed), and three patients had progression of the local infection after drainage, two of whom required a diverting colostomy. The overall mortality attributed to perianal disease in these severely granulocytopenic patients was 25 per cent. From this review, operative drainage of perianal infection does not appear to increase survival or decrease morbidity in patients with severe granulocytopenia.

Acute Disease↗
PubMed1988

Microcomputer analyses of clinical ERG, EOG, and other tests of retinal function.

The electroretinogram (ERG) and electro-oculogram (EOG) are two of the most frequently used visual electrodiagnostic tests of retinal function. The ERG and EOG are easily measured, but there are many engineering difficulties in processing their signal data because the response amplitudes are relatively small, and the relevant signals are buried in electromagnetic and biologic noise. These tests tend to be time consuming, so they lend themselves to automatic control. This article describes the engineering designs relative to a microprocessor-based electrophysiologic laboratory at Emory University Clinic to perform ERG, EOG, and other clinical tests of retinal function. A comparable system that offered both the ability to accept data from a variety of transducers and the flexibility to permit all of the planned testing protocols was not available from any commercial source.

Computers↗
PubMed1986

Reoperation for prosthetic valve degeneration after Konno aortoventriculoplasty.

Since the introduction of the aortoventriculoplasty procedure by Konno in 1975, 16 patients have undergone aortic root augmentation by this method at the Woodruff Medical Center of Emory University. In four patients bioprosthetic valve degeneration 2 to 5 years after the Konno procedure has necessitated repeat operation and replacement of the prosthetic aortic valve. Modification of the septal patch or repeat right ventriculotomy has not been required. One patient required an additional lateral anulus-enlargement procedure (Manouguian) whereas the other three have demonstrated stability or growth of the aortic anulus. We have not observed recurrent subvalvular stenosis or problems with the right ventricular outflow tract. Repeat operation after aortoventriculoplasty has been relatively simple and has usually involved only the supra-annular aorta.

Adult↗
PubMed1986

Complications of the Angelchik prosthesis in the management of gastroesophageal reflux.

There have been a number of reports on the complications of the Angelchik silicone prosthesis since Angelchik and Cohen first reported the use of the device in 46 patients with gastroesophageal reflux. The exact incidence of complications is difficult to estimate; however, the company estimates 0.81 per cent for migration and 0.15 per cent for erosion of the prosthesis. The purpose of this paper is to review our experience with 13 complications related to the Angelchik prosthesis in eight patients referred to Emory University Hospital. These complications consisted of recurrent reflux esophagitis in six patients, intractable dysphagia in two, esophageal stricture in two, displacement of the prosthesis in two, disruption of the prosthesis in one patient, and gastric erosion in two patients. The management of these complications required removal of the prosthesis and performance of a Nissen fundoplication in six patients. Distal esophagectomy with esophagogastrostomy was performed in one patient, and colon interposition was performed in another patient. In summary, serious complications of the Angelchik prosthesis implanted for gastroesophageal reflux and their management are presented.

Adult↗
PubMed1978

Cytological and quantitative cytochemical studies of post-radiation dysplasia.

A total of 60 vaginal smears from 19 women treated with ionizing radiation for malignancies of the genital tract in the past seven years in the Division of Radiation Therapy of Emory University School of Medicine were studied for the presence of post-radiation dysplasia (PRD) by means of Feulgen cytospectrophotometry and cytological analysis. PRD was diagnosed on the basis of the presence of dysplastic cytological changes, absence of clinically detectable lesions, and presence of aneuploid DNA values in the dysplastic cells. PRD was detected in 21% of the studied cases. Uniform criteria for PRD, describing premalignant and malignant post-radiation lesions, diagnosed on the basis of aneuploid DNA values, as well as cytological observations is suggested.

Adult↗
PubMed1984

Carcinoma of the cervix: can a viral etiology be confirmed?

The etiological role of viruses in various animal cancers is no longer in doubt; a similar role in human cancers is, however, yet to be confirmed. Indeed, until recently, virus infections were considered to be responsible for only a small proportion of the clinical states encountered in humans and the view that viruses may be etiological agents for human malignant tumours was not seriously entertained. With the introduction of more advanced techniques in immunovirology, the role of viruses in clinical syndromes the etiology of which had been obscure became clearer. The Emory University Group first postulated in 1964 an association between herpes simplex virus (HSV) infection and cervical neoplasia, following studies of an infant with neonatal HSV infection and his mother's cervical HSV infection. This postulate was based on the observation that women with genital HSV (herpes simplex virus type-2 (HSV-2] infection have a greater frequency of cervical neoplasia than women in the general population. Demographic surveys of cancer of the cervix have established patterns of high risk that strongly suggest that the disease may be transmitted venereally. Similarly, evidence has accumulated to show that HSV-2 is a sexually transmitted disease. It has thus been postulated that this virus may be an initiating or promoting carcinogenic factor transmitted to the female during sexual intercourse. Various multicentric approaches, from epidemiological studies to molecular studies, have been employed to substantiate this association. Even though the weight of circumstantial evidence supporting the role of HSV-2 in human carcinoma of the cervix has increased, no definitive 'cause-and-effect' association has been established between the virus and carcinoma of the cervix. The question arises, therefore, whether or not an etiological association between the virus and the disease can be confirmed. To prove a definitive cause-and-effect relationship, further studies will be required, such as the recent demonstration of the involvement of papillomavirus.

Female↗
PubMed1984

Analytic thinking: educating students for the practice of modern medicine.

The medical school curriculum is dominated by efforts to teach the mass of facts that comprise an ever-expanding pool of biomedical knowledge. As a result, little time remains for learning the scientific method, how to evaluate medical information, and how to apply analytic processes for the prevention, diagnosis, and management of disease. A new component in the medical curriculum at Emory University School of Medicine, a course titled Analytic Medicine, is proposed as a first step toward correcting these deficiencies. Analytic Medicine is intended to provide the opportunity and the necessary skills, through a problem-oriented approach, for medical students to learn to reason scientifically and to utilize analytic processes, including computers, in making clinical decisions.

Curriculum↗
PubMed1984

Does contralateral carotid occlusion influence neurologic fate of carotid endarterectomy?

Divergent opinions regarding operative risks and late prognosis of patients undergoing endarterectomy for carotid stenosis with contralateral carotid occlusion have prompted a review of the experience at Emory University Hospital from Jan. 1, 1978, through Dec. 31, 1982. Fifty-four patients (37 men, 17 women; mean age 63 years) who underwent carotid endarterectomy (CEA) with contralateral carotid occlusion (group I) were compared with 410 demographically similar patients without contralateral carotid occlusion (group II) who underwent 503 CEAs during the same interval. CEA indications in group I were the following and were proportionately similar to those of group II: hemispheric transient ischemic attacks, 22 patients; asymptomatic stenosis, 12 patients; nonhemispheric symptoms, 11 patients; previous cerebral infarction, eight patients; and vascular tinnitus, one patient. General anesthesia, routine intraluminal shunting, systemic heparinization, and arteriotomy closure without patch were routinely employed in both groups. Three patients in group I suffered permanent neurologic deficits after operation (5.6%) and two had transient postoperative deficits with complete recovery. Ten patients (2.0%) in group II suffered permanent neurologic deficits and 10 patients experienced transient neurologic events after operation. Neither the transient nor the permanent neurologic deficit rates were statistically different (p greater than 0.05; Fisher exact test) in the two groups. Operative mortality rates for group I and group II were 0% and 0.8%, respectively, and were not significantly different (p greater than 0.10; Fisher exact test). Late postoperative ischemic brain infarctions occurred in two patients in group I (3.8%) and in 13 patients (3.6%) in group II (p greater than 0.10; Fisher exact test). Kaplan-Meier survival analyses were virtually identical in both groups, with the majority of deaths caused by cardiac occlusion may undergo CEA with morbidity and mortality rates similar to those without contralateral occlusions. Contralateral carotid occlusion does not necessarily portend an unfavorable early or late prognosis after CEA.

Adult↗
PubMed1983

The porcine bioprosthesis. A review of 1,000 consecutive patients undergoing cardiac valve replacement.

Early and late experience with 1,000 patients undergoing porcine xenograft replacement of cardiac valves from 1974 through 1981 at Emory University Hospital is presented. Hemodynamic performance of the modified orifice Hancock and the Carpentier-Edwards valves has been quite satisfactory. There has been a low incidence of thromboembolism in the absence of routine anticoagulation. Less than 20 per cent of our patients are anticoagulated long-term, the primary indication being chronic artrial fibrillation. Endocarditis has developed in 0.7 per cent of patients, an incidence comparing most favorably with that of mechanical prostheses. Valve dysfunction secondary to primary tissue failure is a definite problem. The highest incidence of tissue failure occurred in young patients after six years of implantation. Detailed analysis of long-term patient survival showed a low incidence of valve related deaths. The porcine xenograft is a satisfactory prosthesis for cardiac valve replacement. Our data suggests its use should be limited to older patients or to patients in whom anticoagulation is contraindicated. It should be explained to all patients that long-term durability is unknown and that re-replacement of these bioprostheses within a decade is quite likely.

Adolescent↗
PubMed1984

A computer-managed clinical evaluation system: implications for competency-based dietetic education programs.

Instruments for evaluating clinical performance of students were developed, tested, and designed for a computer-managed evaluation system for the competency-based dietetic internship program at Emory University, Atlanta. The development, evaluation, and utilization of the instruments are described. The method of development included: (a) analysis of validated competencies and performance criteria to determine aspects of behavior appropriate to measure in clinical settings, (b) specification of major areas to be evaluated, (c) specification of component behaviors within each of the major areas, (d) specification of criteria to be used in evaluating component behaviors, and (e) definition of the rating continuum. Validation of the instruments consisted of determinations of content validity, interrater reliability, and practicality. Results of the use of the computer-managed evaluation system indicated that the instruments were valid, reliable, and practical to use for evaluating students' clinical performance.

Computers↗
PubMed1983

Infectious complications of the peritoneovenous shunt.

The peritoneovenous shunt has been recently advocated to relieve massive ascites refractory to medical therapy. Several complications of the shunt have been described but the incidence of infection has not been elucidated. We reviewed the records of all patients undergoing peritoneovenous shunt at the Emory University Affiliated Hospitals from 1975 to 1980. Eighty-five peritoneovenous shunts were done in 56 patients. Eighteen of the shunt insertions (21%) were followed by a major infection--eight bacteremias, eight peritonitis, and nine wound infections. Most infections were caused by aerobic gram-negative bacilli or Staphylococcus aureus. Fever was common (62%) in the immediate postoperative period but was not clearly related to infection, or the administration of antibiotics or antipyretics. Shunt removal appeared to be necessary in treating bacteremic patients but not in patients with only peritonitis or wound infections. Infection is a common complication of the peritoneovenous shunt and may limit its usefulness.

Anti-Bacterial Agents↗
PubMed1978

Clinical value of liver scans.

The contribution of technetium sulfacolloid liver scans on patient care was evaluated in 200 consecutive patients; 100 in a public (Grady) and 100 in a private (Emory University) hospital. The problem oriented record clearly described the effect of liver scan on: 1. assessment of the patient's problem(s) and 2. plans made for its diagnosis or management. For the diagnosis and treatment of 30 patients with intrinsic hepatobiliary diseases, the scan was useful in five but was misleading in four. Specific diagnosis was obtained by other methods which made the liver scan an unnecessary overutilization of a diagnostic procedure in the evaluation of patients with primary liver or biliary diseases. The scan was useful in 95 of 123 patients with extrahepatic malignancy. This was mostly due to chemotherapy protocols requiring the scans. Only 18% of positive scans had no other clinical evidence for hepatic malignancy. Definite diagnosis was not made in any of the 123 patients by liver scan. In 47 miscellaneous conditions the scan was useless in 37 (79%). In three of these the scan was misleading and impaired patient care.

Cholestasis↗
PubMed1981

A computer-managed instruction system applied to dietetic education.

The emergence of competency-based programs in dietetic education has introduced the need for a systematic method of managing student performance information. A computer-managed instruction system which performs many of the routine clerical tasks usually assumed by instructors is being utilized in Emory University's Dietetic Internship Program. Preliminary use of the system indicates that it was well received by both instructors and students. Its most obvious benefits were the immediate feedback on performance and decreased demands on faculty time for evaluation and record-keeping processes.

Computer-Assisted Instruction↗
PubMed1981

Reviewing histologic diagnosis of lymphoma: comparison of original and review diagnoses in 269 cases.

By analyzing the pathology records of patients at Emory University Hospital, Atlanta, who had a diagnosis of suspected or proved malignant lymphoma (ML) based on examination of a biopsy specimen obtained elsewhere, the rates of agreement between original and review diagnoses were determined. Ninety-six percent of the cases submitted as ML were accepted as ML on review. In 96% of those referred to us as non-Hodgkin's lymphoma (NHL), this diagnosis was confirmed. All cases submitted as Hodgkin's disease (HD) were accepted as ML, but 13% were reclassified as NHL. Based on the review diagnoses, expressed according to the Lukes-Butler (HD) or Rappaport (NHL) classifications, 69% of the HD cases and 29% of the NHL cases bore original diagnoses that agreed. Nonuse and incorrect use of standard classifications contributed greatly to these discrepancies. Pathology review is strongly recommended for all cases of ML, to reduce diagnostic error where possible and to promote the use of histopathologic terminology that bears on clinical decisions.

Biopsy↗
PubMed1978

Interventional neuroradiology: a joint effort of the neuroradiologist and neurosurgeon in the treatment of vascular lesions of the head and neck.

Close cooperation between the neuroradiologist and neurosurgeon has made possible the treatment of certain lesions of the head and neck by embolization procedures. The experience at Emory University Hospital with embolizations of arteriovenous malformations, carotid-cavernous fistulae, dural-cavernous sinus fistulae and glomus jugulare tumors is discussed.

Adolescent↗