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At least 397 records · Page 22Linked to original sources
PubMed1991

Failed in vitro fertilization of human oocytes: a cytogenetic analysis.

OBJECTIVE: To investigate possible causes of in vitro fertilization (IVF) failure. DESIGN: A retrospective cytogenetic study of human oocytes divided into four groups or, alternatively, into two groups according to fertilization rates and whether the patients became pregnant or not. Two additional groups included oocytes in which there was no or only partial fertilization. SETTING: Primary treatment of infertility in an institutional practice. PATIENTS, PARTICIPANTS: Two hundred fifty-three inseminated-unfertilized oocytes from 87 women entering the IVF program because of tubal, unknown, and male infertility. Immunological infertility was excluded. INTERVENTIONS: Ultrasound-guided transvaginal follicular aspiration. MAIN OUTCOME MEASURE(S): Planned after data collection. RESULTS: The rate of chromosome anomalies did not show any significant difference among the four groups established according to the fertilization rate and between pregnant and nonpregnant patients. Independently, our data identified male factor as responsible for 41%, chromosome anomalies 19.3%, oocyte immaturity 11.8%, and unknown etiology 41% of fertilization failures (based on analysis of 161 oocytes). CONCLUSIONS: Fertilization rate and pregnancy outcome after IVF are not related to the incidence of oocyte chromosome anomalies.

Analysis of Variance↗
PubMed1990

Improving a hospital pharmacy externship program.

The revision and implementation of a pharmacy student externship program at a cancer treatment and research facility are described. The Department of Pharmacy Academic Programs evaluated the student externship program of the Division of Pharmacy at The University of Texas M. D. Anderson Cancer Center and identified a variety of weaknesses. These included scheduling conflicts, insufficient supervision and feedback, excessive task orientation, lack of defined roles and responsibilities of program participants, and generally poor organization. As a result, the program was revised by establishing specific goals, defining program participants and their roles, setting specific responsibilities for externs and encouraging self-initiated learning, developing standardized evaluation forms and documentation requirements, and educating the pharmacy staff about the program. Since the revised program was implemented in June 1988, 21 students have completed externship rotations. Their evaluations of the program suggest greater satisfaction with this important educational experience than was realized before the revision was undertaken. A more organized approach to the externship program gave pharmacy students a better opportunity to experience the range of professional activities and challenges that occur in the institutional practice setting.

Cancer Care Facilities↗
PubMed1984

Positions held by graduates of ASHP-accredited pharmacy residency programs.

Current positions of graduates of ASHP-accredited residency programs were determined in an April 1983 survey of the directors of 154 ASHP-accredited residency programs. For each residency graduate (RG), respondents indicated one of 16 employment categories. Data were grouped according to number of years since completion of the residency. Responses were received from 122 directors (79%), representing 2522 RGs. The percentage of RGs in pharmacy directorships increased from 4% one to two years after graduation to 27% after 10 years. After 10 years, 49% were employed in institutional pharmacy practice and 80% in some health-related activity. Most RGs currently practice in institutional pharmacy settings or hold positions in other fields that enable them to build on their institutional pharmacy background.

Education, Pharmacy, Graduate↗
PubMed1982

Comprehensive pharmaceutical services for a state correctional facility.

A contractual model for comprehensive pharmaceutical services involving a major medical center pharmacy, a university, and a state department of corrections is described. Project goals and methods for the provision of services are described. These include areas of formulary development, inventory management, drug distribution, on-site placement of pharmacy operations, and educational development. Impact of the program was assessed over a 30-month period. Development of policies and procedures for drug use in a correctional setting enabled implementation of a strict patient population-specific drug formulary. Procedural changes resulted in an 83% decrease in on-site drug inventories and a 62% decrease in quarterly drug expenditures. A one-time saving of more than $26,500 resulted from the decrease in on-site inventory, and an annual saving of $44,000 is projected for decreased drug expenditures. All but five controlled substances were removed from the formulary, and only 13 nonprescription items remained in the formulary. An educational course on health care in correctional settings provided exposure for pharmacy students to this new area of institutional practice. The contractual model proved both cost-effective and functional for the department of corrections.

Education, Pharmacy↗
PubMed1993

Investigation of potential HIV transmission to the patients of an HIV-infected surgeon.

OBJECTIVE: To ascertain if a surgeon infected with the human immunodeficiency virus (HIV) transmitted HIV to patients during invasive surgical procedures. DESIGN: Survey of patients and acquired immunodeficiency syndrome (AIDS) case registries, and laboratory analysis of nucleotide sequence data. SETTING: One surgeon's private and institutional practices within one academic referral hospital. PATIENTS: A total of 1131 persons identified in hospital databases who underwent invasive surgical procedures from 1984 through 1990 and for whom the surgeon was listed as the admitting or operating surgeon. MEASUREMENT: Patients presumed to be living were surveyed by mailed questionnaire. The AIDS case registries were reviewed for all patients having undergone invasive procedures and death certificates were obtained. Person-hours of surgery during which exposure might have occurred were calculated for surgical procedures. RESULTS: Of 1131 patients, 101 were dead, 119 had no address, 413 had test results known, and 498 did not respond to the questionnaire. No study patient name was found in reported AIDS case registries. One newly detected, HIV-seropositive patient was determined (through nucleotide sequencing) to have been most probably infected in 1985 during a transfusion. There was no HIV transmission in 369 person-hours of surgical exposure, indicating that HIV transmission to patients is unlikely to occur more frequently than once per 1000 person-hours of surgical exposure. CONCLUSIONS: If study validity and resources permit, investigation of publicly disclosed, HIV-infected health care workers whose practices involve invasive procedures should be pursued. The risk of HIV transmission during surgery may be so small that it will be quantified only by pooling data from multiple, methodologically similar investigations.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Angiovideo-assisted hemodynamic correction of varicose veins.

OBJECTIVE: Evaluation of the feasibility and utility of angioscopy in the hemodynamic correction (French acronyms is CHIVA) of primary varicose veins disease. EXPERIMENTAL DESIGN: Prospective evaluation of 25 patients, undergoing hemodynamic correction of primary varicose disease with intraoperative videoangioscopic guide. Patients have been selected according to criteria emerged from a prospective study that we had previously conducted. Follow-up lasted 1 year (range 8-18 months). SETTING: Department of Surgery, University of Ferrara, Italy. Institutional practice. One-day surgery. PATIENTS: Their selection has been carried out in our Vascular Laboratory. The adopted clinical criteria of selection were: Primary varicose disease of the long saphenous vein territory, no previous thrombophlebitis and/or sclerotherapy. Doppler cw and Duplex criteria followed were: competent deep venous system, long saphenous vein diameter minor than 10 mm and incompetent perforating veins diameter minor than 4 mm. INTERVENTIONS: 25 hemodynamic corrections according to the CHIVA method described by Franceschi. An angioscope, introduced through a distal collateral of the long saphenous vein, permitted the precise interruption of the venous-venous shunts and of the superficial venous system, just below the perforators chosen as re-entry points in the deep venous system. MEASURES: Clinical: varices and symptomatology reduction. Duplex and Doppler cw: detection of the superficial blood flow re-entry, in the deep venous system, through the perforators and identification of recurrences or new refluxes. Pre and postoperative Ambulatory Venous Pressure and Refilling Time have also been measured. RESULTS: In 20 patients symptoms and varices relief were recorded (80%), in 5 patients varices reduction was observed only during walking (20%). In 2 of these latter patients there was no re-entry through the perforators, with a recurrent sapheno-femoral reflux in 1 of them. Early complications recorded were: 2 long saphenous vein thrombosis (8%); 7 ecchimosis (28%) when heparine/saline solution had been used for angioscopic clearance. CONCLUSIONS: Intraoperative angioscopy is feasible and useful when the hemodynamic situation is complex and the Duplex map is difficult to be interpreted by the surgeon. In this series the second look percentage rate has been minor compared to the percentage rates published so far by other authors.

Adolescent↗
PubMed1996

Valve replacement with the CarboMedics bileaflet mechanical prosthesis: clinical results at midterm.

OBJECTIVE: We study the clinical midterm results of the valve replacement with the CarboMedics bileaflet mechanical prosthesis. EXPERIMENTAL DESIGN AND SETTING: Retrospective study. Institutional practice (National Cardiovascular Center, Osaka, Japan). PATIENTS AND INTERVENTIONS: 167 CarboMedics prostheses were implanted in 144 patients from April, 1990 and December, 1993. Of these, 77 patients underwent isolated aortic valve replacement (AVR), 45 patients underwent isolated mitral valve replacement (MVR), 21 patients underwent double (aortic and mitral) valve replacement (DVR), and one patient underwent triple (aortic, mitral and tricuspid) valve replacement (TVR). MEASURES: Events were defined in accordance with the guidelines for reporting morbidity and mortality after cardiac valve operations of the Society of Thoracic Surgeons/American Association for Thoracic Surgery.

Aortic Valve↗
PubMed1995

Alternative saphenous vein sparing surgery for future grafting.

OBJECTIVE: Evaluation of long saphenous vein sparing surgical procedures alternative to high ligation and distal stab avulsion, in terms of effectiveness and suitability for eventual by-pass surgery. EXPERIMENTAL DESIGN: Prospective evaluation of 125 operations for primary varicose veins, 52 external valve-plasties of the sapheno-femoral junction (EV-SFJ) (42 performed using the hand sewing technique and 10 using the Veno-cuff device), mean follow-up 45 months, and 73 hemodynamic correction of varicose veins (French acronyms: CHIVA), mean follow-up 30 months. SETTING: Department of General Surgery, University of Ferrara. Institutional practice, one-day surgery. PATIENTS: Patients were selected using clinical, Doppler cw, and duplex scanning evaluations. Patients with early varices due to sapheno-femoral reflux with duplex scanning evidence of mobile valve leaflets underwent EV-SFJ. The other patients were operated on using the hemodynamic correction technique. Both groups underwent preoperative ambulatory venous pressure (AVP) and light reflection rheography-refilling time (LRR-RT) measurements. INTERVENTIONS: EV-SFJ restores valve function correcting vein wall dilitation by applying an external prosthesis. CHIVA consists of selected ligatures of the superficial veins that allow superficial blood aspiration in the deep veins through the perforators. MEASURES: The outcome was evaluated with clinical and ultrasonographic examinations, AVP and LRR-RT measurements. RESULTS: Long saphenous vein patency registered after EV-SFJ and CHIVA was 94.2% and 90.4%, respectively. Both treatments preserve the drainage function in the saphenous system. Varicose veins recurrence percentage rate was 9.6% and 10.9%, respectively. CONCLUSIONS: Following the proposed selection criteria, these two alternative procedures seem to be more effective in varices treatment than high ligation and have the advantage of preserving saphenous veins suitable for eventual by-pass surgery.

Adult↗
PubMed1996

Surgical experience of total anomalous pulmonary venous connection with mid-term follow-up in a developing country.

OBJECTIVE: To illustrate the incidence, the different age group, varied clinical presentation, incremental risk factors for surgery and follow-up results from this part of the world. EXPERIMENTAL DESIGN: Retrospective study with follow-up from 3 months to 5 years. SETTING: Institutional practice with hospitalised care. SELECTION PROCEDURE: Hospitalised patients with a diagnosis of total anomalous pulmonary venous connection. INTERVENTIONS: All patients who were diagnosed to have total anomalous pulmonary venous connection underwent corrective surgery. RESULTS: There were 20 hospital deaths postoperatively. The mean follow-up was 1.9 year. Logistic regression analysis identified age group, timing of surgery, associated anomalies preoperative symptoms, anatomical type of lesion, pulmonary artery hypertension, duration of ventilation, low cardiac output as risk factors for surgery. The mean survival time was 4-8 years. CONCLUSION: Mortality continues to be higher from this part of the world due to severe malnourishment, late presentation. Sociodemographic factors also play a major role in affecting surgical outcome apart from the identified risk factors for surgery.

Cardiac Surgical Procedures↗
PubMed1997

Clinical parameters of tumescent anesthesia in skin cancer reconstructive surgery. A review of 86 patients.

OBJECTIVE: To describe and define the viability of using tumescent anesthetic technique (TAT) in skin cancer reconstructive surgery with good results and without adverse reactions. DESIGN: Phase 3 clinical trial. SETTING: The National Institute of Cancer in Bogotá, Colombia, is a national referral center with an institutional practice. PATIENTS: From June 1992 to June 1994, 86 ambulant patients, who were of low to middle socioeconomic class, were referred from oncology to dermatology for moderately complicated surgery. As outpatients, they underwent skin cancer surgery using the TAT. The 2-year, postoperative follow-up included only 81 patients, because 5 patients (5.85%) could not be reached. INTERVENTIONS: The following formula was used: 0.5 L of 0.9% sodium chloride, 0.025 L of 2% lidocaine (epinephrine 1:200,000), and 5-mmol/L of sodium bicarbonate. MAIN OUTCOME MEASURES: The primary study outcome measures were planned before the data collection began. Relevant age and sex data, skin cancer characteristics, and the type of reconstruction performed were tabulated for these patients. Photographs of the patients were taken. Patients were asked to rate the level of pain during the injection, during the surgery, and after the surgery. The amount of bleeding and the cosmetic results, were also evaluated. RESULTS: Anatomical distortion before surgery was present in all the patients. The level of pain and bleeding (no patients experienced severe pain or bleeding) was minimal, and visualization of the surgical planes was good during the reconstruction using the TAT. On average, the size of the surgical specimen was 6.12 cm2. On the first day after surgery, tumescence decreased by 90% in each patient. Only 1 patient had a complication, which was a hematoma, attributable to trauma rather than to the TAT. The cosmetic results were good in 90% of the patients. CONCLUSION: The TAT in skin cancer reconstructive surgery offers good results and minimal complications.

Anesthesia, Local↗