Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Emory University”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMed1993

Recommendations of the International Task Force for Disease Eradication.

This report summarizes the conclusions of the International Task Force for Disease Eradication (ITFDE), a group of scientists who were convened by a secretariat at the Carter Center of Emory University six times during 1989-1992. The purpose of the ITFDE was to establish criteria and apply them systematically to evaluate the potential eradicability of other diseases in the aftermath of the Smallpox Eradication Program. The ITFDE defined eradication as "reduction of the worldwide incidence of a disease to zero as a result of deliberate efforts, obviating the necessity for further control measures." The names of the members of the ITFDE, the criteria they developed and used, and summaries of the papers that were presented to the ITFDE by various experts are included in this report, as well as a brief history of the concept of disease eradication since the late 19th century. The ITFDE considered more than 90 diseases and reviewed 30 of these in depth, including one noninfectious disease. It concluded that six diseases--dracunculiasis, poliomyelitis, mumps, rubella, lymphatic filariasis, and cysticercosis--could probably be eradicated by using current technology. It also concluded that manifestations of seven other diseases could be "eliminated," and it noted critical research needs that, if realized, might permit other diseases to be eradicated eventually. The successful eradication of smallpox in 1977 and the ongoing campaigns to eradicate dracunculiasis by 1995 and poliomyelitis by 2000 should ensure that eradication of selected diseases will continue to be used as a powerful tool of international public health.

Communicable Disease Control↗
PubMed1993

Changing clinical characteristics of coronary surgery patients. Differences between men and women.

BACKGROUND: There is uncertainty as to the relative efficacy of coronary artery bypass graft surgery (CABG) in men and women. Differences between sexes may be of greater importance than heretofore because of increased frequency of risk factors for adverse outcome. It is the purpose of this study to examine the changing clinical characteristics of patients undergoing CABG and to determine the influence of these changes on the results of CABG in men and in women. METHODS AND RESULTS: The source of data was the clinical database at Emory University Hospitals. The population comprised 13,368 patients (2648 women, 10,720 men) who had cardiac catheterization followed by CABG between 1974 and 1991. The patients were divided into the time periods 1974 through 1979 (532 women, 2792 men), 1980 through 1983 (727 women, 3151 men), 1984 through 1987 (695 women, 2619 men), and 1988 through 1991 (694 women, 2158 men). Data were collected prospectively and entered into a computerized database. The women were older (63 +/- 10 versus 58 +/- 10 years, P < .0001) and more frequently had diabetes (26.0% versus 15.4%, P < .0001). The in-hospital mortality was 3.8% in women and 1.6% in men. The multivariate correlates of death were older age, emergent surgery, reduced ejection fraction, female sex, diabetes, and more severe distribution of coronary arterial narrowings. Each of these risk factors for death became more prevalent, such that the mortality in men increased from 1.0% in 1974 through 1979 to 2.7% in 1988 through 1991, whereas the mortality in women increased from 1.3% in 1974 through 1979 to 5.4% in 1988 through 1991. CONCLUSIONS: The population undergoing CABG has aged, with correlates of in-hospital death becoming more common. The higher mortality in women could only partially be explained by other clinical variables. In addition, the risk of death after CABG has increased in women more than in men because women have consistently been older, have more emergent surgery and diabetes, and in recent years more women undergoing CABG have three-vessel or left main disease.

Age Factors↗
PubMed1993

Extracorporeal membrane oxygenation service at Egleston: two years' experience.

Extracorporeal membrane oxygenation (ECMO) is a perfusion support procedure that has been used to treat more than 7,000 patients with life threatening cardiac and/or respiratory failure. After 6 months of training and preparation, an ECMO service was opened on January 2, 1991, in Egleston Children's Hospital at Emory University. During the first 2 years, 96 neonatal, 31 pediatric, and 8 cardiac patients have been referred for possible ECMO. Of these 135 patients, 21 had disqualifying conditions. Sixty-four were considered candidates for ECMO but were able to be supported using less invasive therapies; only one of these died. Fifty patients were treated with ECMO of whom 39 survived (78%). Survival rates for neonatal, pediatric, and cardiac cases as separate groups as well as for each diagnostic category within these groups compare favorably with those reported by the international ELSO Registry. Notable in this series is the fact that 26/35 neonatal patients and 7/10 pediatric patients were successfully supported using venovenous (VV) rather than venoarterial (VA) perfusion, with the major indication for venoarterial ECMO being inability to introduce the 14F venovenous catheter into the patient's internal jugular vein. No patient initially managed with VV ECMO required conversion to VA. It is anticipated that avoidance of carotid ligation along with other innovations, such as the impending commercial availability of heparin-coated ECMO circuits, will make ECMO a highly attractive and appropriate therapy for an increasing number of high risk neonatal and pediatric patients in our state and region.

Adolescent↗
PubMed1993

Hepatic arterioportal fistula.

Hepatic arterioportal fistula (HAPF) is uncommon, arising largely from either a ruptured hepatic artery aneurysm or from penetrating trauma. It is being encountered increasingly, secondary to rising numbers of percutaneous transhepatic procedures. We will describe five cases of HAPF seen at Emory University Hospital over the last 5 years and conclude with a review of the current status of treatment of this condition. HAPF occurred secondary to ruptured hepatic artery aneurysm in two patients, operative injury in two patients, and after trauma in one patient. The predominant clinical manifestation in these patients were complications of portal hypertension, most commonly gastrointestinal bleeding. Angiography remains the definitive diagnostic procedure and it was used to accurately diagnose HAPF in all cases. However, duplex ultrasonography is rapidly becoming a useful screening tool and was the initial imaging modality in the most recent case. Several factors determine the therapeutic approach including the location of the HAPF and associated comorbidity. Due to the development of portal hypertension even asymptomatic fistulas should be treated. In general, surgery is the procedure of choice for extrahepatic fistula, while embolization is optimal for intrahepatic fistulas. Embolization is also useful for patients in whom associated comorbidity prohibits surgical treatment. The goal of surgery is to interrupt the fistula, to maintain hepatic arterial flow, and to close the defect in the portal vein.

Adolescent↗
PubMed1994

A prospective evaluation of surgically treated groin complications following percutaneous cardiac procedures.

During an 18-month study period, 100 noncardiac surgical complications of a percutaneous cardiac interventional procedure were treated at Emory University Hospital. These were predominantly pseudoaneurysms (61.2%), groin hematomas (11.2%) arteriovenous fistulae (10.2%), and external bleeding (6.1%). Less common complications included retroperitoneal hematomas (5.1%), arterial thromboses (3.1%), groin abscess (2.0%), and a mycotic pseudoaneurysm (1.0%). The complication rate following diagnostic catheterization was 0.6 per cent, after percutaneous transluminal angioplasty, 1.5 per cent, atherectomy 2.2 per cent, and after stent placement 16 per cent (P < 0.0001). The arterial puncture site was other than the common femoral artery in 34 per cent of cases. Risk factors for the development of complications were postprocedure anticoagulation (P < 0.0001), female gender (P < 0.005), increased age (P < 0.0001), and small stature (P < 0.0001). Duplex scanning had 98 per cent accuracy in diagnosis of suspected groin complications, and clinical diagnostic accuracy was 77 per cent. We describe our technique for repair of pseudoaneurysms and arteriovenous fistula and discuss the possible future role of ultrasound guided compression. Mean hospital stay after the procedure was 3.2 days. Morbidity of surgical repair was 21 per cent and mortality was 2.1 per cent. Groin complications following percutaneous cardiac procedures are related to the type of procedure performed, female gender, and periprocedure anticoagulation.

Abscess↗
PubMed1993

Enumerating deaths among homeless persons: comparison of medical examiner data and shelter-based reports--Fulton County, Georgia, 1991.

Characteristics of causes of death and mortality patterns in homeless populations have been constrained by limitations in both the accuracy of estimates of the size of the homeless population and enumeration of the number of deaths of homeless persons (1,2). For example, studies of mortality among homeless persons in Fulton County (Atlanta), Georgia, based on medical examiner records estimated approximately 40 deaths of homeless persons annually (1,3); in contrast, a media report based on information supplied by shelters for homeless persons reported 191 deaths of homeless persons in Atlanta during 1991 (4,5). As a basis for improving characterization of mortality patterns in the homeless population of Fulton County, Emory University and CDC assessed the differences in the estimates of deaths among homeless persons that were obtained from medical examiner records and those based on death reports from shelters that are in or adjacent to Fulton County (1990 population: 648,951) during 1991. This report summarizes the findings of that study.

Coroners and Medical Examiners↗
PubMed1996

Idiopathic fibrosing pancreatitis: a rare cause of obstructive jaundice in children.

Idiopathic fibrosing pancreatitis is a rare cause of obstructive jaundice in children and young adults. Only 30 cases have been previously reported. Four children with this entity have been treated at Egleston Children's Hospital at Emory University since 1970. Diagnosis was established by imaging studies and open pancreatic biopsy. Treatment was by bilioenteric bypass, and excellent results have been achieved with follow-up periods up to 25 years.

Adolescent↗
PubMed1996

Molecular basis of phenylketonuria and a correlation between genotype and phenotype in a heterogeneous southeastern US population.

OBJECTIVE: To determine the molecular basis of phenylketonuria (PKU) and related hyperphenylalaninemia (HPA) and to establish correlations between phenylalanine hydroxylase (PAH) genotypes and biochemical and clinical phenotypes in an ethnically diverse US population, PAH genotypes were determined in 35 patients with PKU or HPA and 1 carrier from the Medical Genetics Clinic of the Emory University School of Medicine. METHODOLOGY: Patients were identified through Georgia's population-based newborn screening program. PAH genotypes in these individuals were determined from dried blood spots or whole-blood samples using a combination of polymerase chain reaction-mediated amplification, denaturing gradient gel electrophoresis, and direct-sequence analysis. The phenotypic severity of patients with PKU and HPA was based on pretreatment serum phenylalanine (PHE) levels during the neonatal period and on dietary tolerance of PHE later in life. RESULTS: Sixty-eight (96%) of 71 mutant alleles were identified. Major mutations in this population included R408W (11 of 71), I65T (11 of 71), Y414C (6 of 71), L348V (4 of 71), and IVS10 (4 of 71). Five new nucleotide substitutions, E76A (1 of 71), R241L (1 of 71), Q304R (2 of 71), C334S (1 of 71), and R400R (2 of 71) were also detected. Thirty-two of the thirty-five nonrelated patients examined in this study were completely genotyped. Strong correlations were observed between the level of PAH activity predicted from the genotype, when known from previous in vitro expression studies of the mutant proteins, and pretreatment serum PHE levels (r = .841) or clinical severity (Kendall rank-order correlation coefficient, .936). CONCLUSIONS: These results demonstrate strong correlations between PAH genotype and biochemical and clinical phenotypes in this heterogeneous American sample population, extending our previous findings from relatively homogeneous European populations. These correlations further demonstrate the clinical utility of genotype analysis in the treatment of patients with PKU and HPA.

Alleles↗
PubMed1995

Using a health risk appraisal to determine an Appalachian community's health care needs.

The Health Risk Appraisal developed by The Carter Center of Emory University was used as a basis for diagnosing an Appalachian community's health care needs. Concepts identified included (a) demographics, (b) nutrition/exercise, (c) lifestyle, (d) contentment, and (e) preventive health behaviors. The sample consisted of 108 individuals residing in subsidized housing projects within Appalachia. The findings of this study suggest that although these participants perceived their health to be generally good, their health practices were poor. However, the HRA was not culturally sensitive to the specific health and social needs of this community.

Adolescent↗
PubMed1995

Tire explosion injuries to the upper extremity.

We describe a protocol for treating tire explosion injuries to the hands on the basis of treatment of five cases over a 3-year period at Emory University Hospital. These high-energy wounds frequently require emergent initial debridement and stabilization, followed by complex soft tissue and skeletal reconstruction to maximize function. Data from all cases are summarized to show similarities among these injuries and differences in their response to treatment. We define the stages of treatment, emphasizing prevention, complete assessment, and early intervention, especially for limb-threatening conditions with fasciotomy, revascularization, thorough debridement, and rigid fixation. We also discuss the importance of aggressive therapy, close follow-up, and treatment of late complications. Functional reconstruction was achieved in each case, suggesting that our treatment protocol can be used successfully.

Adult↗
PubMed1997

Mesenteric and omental cysts in children.

Mesenteric and omental cysts are rare intra-abdominal lesions. The rarity of these lesions, with an incidence of only about 1 in 140,000 hospital admissions, and the absence of characteristic clinical findings makes diagnosis difficult. Fourteen patients were treated for either mesenteric and/or omental cysts between 1965 and 1994 at Egleston Children's Hospital at Emory University. Of the 14 patients, 6 were female, 8 male; 3 were non-Caucasian, and 11 were Caucasian. They ranged in age from in-utero to 12 years old, with the most common presenting symptoms being abdominal distention (71%), pain (50%), vomiting (50%), and pain and distention (43%). Ultrasonography was the diagnostic method of choice. Other diagnostic modalities included intravenous pyelogram, barium enema, upper gastrointestinal series, CT scan, and MRI in selected patients. A single mesenteric cyst (79%) was most common, with only one patient (7%) having multiple mesenteric cysts as well as an omental cyst. The remaining two patients (14%) had single omental cysts. On gross examination, most (64%) were single, multilocular cysts. On pathological examination, the cysts ranged in size from 3.5 x 1 x 0.2 cm to 30 x 40 x 10 cm, with a mean of 14.9 x 11.5 x 4.7 cm. Six of the 14 contained fluid consistent with hemorrhage into the cysts. The most common treatment was simple excision (71%) followed by excision with partial bowel resection (29%). None received drainage alone as a treatment. There were no major postoperative complications and no reported recurrences of the cysts.

Child↗
PubMedDate not supplied

Using physician work relative value units to profile surgical packages: methods and results for kidney transplant surgery.

BACKGROUND: This investigation outlines an approach for using the physician work relative value units (RVUs) in the Medicare Fee Schedule (MFS) to profile physician clinical activities. These techniques were then used to profile the physician services associated with kidney transplant patients at Emory University System of Health Care. METHODS: All physician services associated with 179 patients who had kidney transplant surgery in 1993 were studied. By using billing data, physician work RVUs were assigned to each service and the results were analyzed by type of service and the hospital department providing the service for physician work RVUs and physician charges. RESULTS: A mean of 130.4 physician work RVUs were involved in the 179 episodes of care. Surgical services represented 48.7% of the physician work activity in the kidney transplant. Visit and consultative services make up the next highest share with 25.5% of the physician work RVUs, whereas anesthesia makes up 13.3% of physician work RVUs. Physician charges totaled $16,249 for kidney transplants in 1993 dollars. Surgical services accounted for 54.2% of physician charges connected with kidney transplants, whereas visits and consultative services represented 20.6% of physician charges. CONCLUSIONS: Physician work RVUs in the MFS offer a unique and much needed perspective on physician clinical activities. Physician work RVUs are an important new tool for healthcare and researchers and their use needs to be more fully explored and benchmarks developed for all major medical and surgical services.

Fee Schedules↗
PubMed1997

The outcome of unrelated donor bone marrow transplantation in patients with hematologic malignancies using tacrolimus (FK506) and low dose methotrexate for graft-versus-host disease prophylaxis.

Initial studies of FK506 combined with methotrexate (MTX) in patients receiving unrelated donor BMT have demonstrated a possible-decrease in the incidence of severe GVHD but high rates of severe stomatitis and nephrotoxicity. With this background, we undertook a pilot study evaluating FK506 in combination with a lower than usual dose of MTX in an attempt to improve the tolerability of this immunoprophylaxis regimen. Between July 1993 and October 1994, 26 consecutive adults receiving unrelated donor BMT at Emory University Hospital were enrolled on this study. All patients received FK506 intravenously at an initial dose of 0.03 mg/kg/day beginning day -1 and continuing until oral FK506 was tolerated. Patients also received MTX intravenously at 5 mg/m2 on days 1, 3, 6, and 11. The preparative regimen administered to all but one patient included cyclophosphamide at 200 mg/kg over 4 days followed by total body irradiation (TBI) at 1400 cGy in twice daily fractions over 4 days. The median age of patients was 31 years (range: 19 to 52). Sixteen donor/recipient pairs were matched for HLA-A, -B, and -DR by serology and molecular typing. Ten paris were minor mismatches at either class I or class II. Twenty-two of 26 patients (85%) completed four doses of MTX on schedule. Nephrotoxicity was the most common adverse event associated with the administration of FK506: 88% of patients experienced a doubling of their serum creatinine. One patient died of central nervous system hemorrhage prior to engraftment. Twenty-four of the remaining 25 patients (96%) engrafted. Fourteen of 24 patients (50%) evaluable developed grades 2-4 acute GVHD. The rate of severe (grades 3-4) acute GVHD was 25%. Chronic GVHD developed in 11 of 20 (55%) evaluable patients. At a median follow-up of 461 days, 14 patients (54%) are alive. All are relapse-free with a median Karnofsky performance status of 90% (range: 70-100%). The cumulative probability of 2-year disease-free survival is 50% (95% confidence interval [CI]: 0.33 to 0.77); for low risk patients 67% (95% CI: 0.47 to 0.95) and for high risk patients 23% (95% CI: 0.049 to 1.00). These preliminary data indicate that FK506-based immunosuppression following unrelated donor BMT is effective in preventing severe acute GVHD and warrants comparison to CSA-based regimens.

Adult↗
PubMed1998

Mesenchymal hamartoma of the liver.

Mesenchymal hamartomas of the liver are the second most common benign liver tumor of childhood. The experience with this tumor at Egleston's Children Hospital at Emory University from 1989 to 1994 is reviewed. Eight patients presented with abdominal distention or an upper abdominal mass. Six patients presented at a mean age of 8 months, and two patients presented at 17 and 23 years of age, respectively. Four patients displayed normal alpha-fetoprotein levels, whereas one patient had an elevated level. Liver function studies were normal in all patients. Abdominal ultrasonography and CT scans revealed a cystic, septated mass within the liver or on a pedicle in all patients. Five patients had simple excision of the tumor, and two had major hepatic resections. The cysts were multiloculated and lined with cuboidal bile duct epithelium surrounded by stroma containing proliferating bile ducts, blood vessels, and compressed liver tissue with no calcifications. In one patient, some pathologists favored the diagnosis of malignant myxoid fibrous histiocytoma because of similar-appearing stroma. Follow-up (mean, 35 months) revealed one symptomatic recurrence after initial resection was incomplete. There were no other recurrences and no malignant transformations. A septated, noncalcified, cystic hepatic mass in an infant with normal liver function studies and characteristic ultrasound or CT is likely a benign mesenchymal hamartoma that can be cured by total local excision.

Adolescent↗
PubMed1996

Finger pad tophi in gout.

OBJECTIVE: To determine frequency and prevalence of finger pad tophaceous deposits in patients with chronic tophaceous gout. METHODS: We examined 36 consecutive patients with chronic tophaceous gout for intracutaneous tophaceous urate deposits in the fingers pads. Subjects were patients of outpatient clinics at 2 large university hospitals, Emory and the University of Pennsylvania Affiliated Hospital Systems. RESULTS: Finger pad tophaceous deposits were found in 30.5%, which was surprising, given how few cases are reported. CONCLUSION: Finger pad tophi may be more common than generally believed.

Adult↗
PubMedDate not supplied

Too good to be true.

Explore the source record for details and available documents.

Biomedical Research↗