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At least 685 records · Page 38Linked to original sources
PubMed1999

A randomized trial of peroral versus transnasal unsedated endoscopy using an ultrathin videoendoscope.

BACKGROUND: Potential advantages of unsedated endoscopy include the prevention of side effects or morbidity related to the use of sedative drugs, less intensive patient monitoring, and less expense. We compared transnasal (T-EGD) with peroral (P-EGD) unsedated endoscopy by using an ultrathin video instrument with respect to patient tolerance and acceptance. METHOD: Patients were randomized to T-EGD or P-EGD. If the initial route of insertion failed, the patient was crossed over to the other route. If this also failed, the patient underwent endoscopy under conscious sedation with an ultrathin instrument. A questionnaire for tolerance was completed by the patient (a validated 0-10 scale where "0" represents none/well tolerated and "10" represents severe/poorly tolerated). RESULTS: Of 105 recruited patients, 60 consented to undergo unsedated endoscopy. There were 20 men and 11 women (mean age 45 years) in the P-EGD group and 15 men and 14 women (mean age 48 years) in the T-EGD group. Of 35 total P-EGD patients (4 were crossed over T-EGD patients), 34 (97%) completed an unsedated examination. Of 29 T-EGD patients, 25 (86%) had a complete examination. Three T-EGD examinations failed for anatomical reasons; all 3 patients when crossed over to the P-EGD route had a successful examination. One patient was unable to tolerate either route. Between the P-EGD and the T-EGD groups, pre-procedure anxiety (3.6 +/- 0.5 vs. 3.0 +/- 0.6), discomfort during insertion (2.1 +/- 0.5 vs 3.3 +/- 0.7), gagging (4.7 +/- 0.5 vs. 3.2 +/- 0. 6), and overall tolerance (2.4 +/- 0.5 vs. 3.8 +/- 0.7) were similar (p > 0.05). However, discomfort on insertion was significantly greater in the T-EGD versus the P-EGD group (4.4 +/- 0.6 vs. 2.7 +/- 0.5: p < 0. 05). Eighty-nine percent of P-EGD patients and 69% of T-EGD patients, p = 0.07, were willing to undergo unsedated endoscopy in the future. CONCLUSION: T-EGD patients experienced significantly more pain on insertion than did P-EGD patients. Otherwise, unsedated endoscopy by either the transnasal or the peroral route is generally well tolerated. In this study it was completed in 59 of 60 patients.

Adult↗
PubMedDate not supplied

Detecting symptoms of alcohol abuse in primary care settings.

BACKGROUND: Studies on alcohol abuse are frequently based on patients who meet minimum diagnostic criteria, thus ignoring patients with individual symptoms of harmful or hazardous use. Consequently, we are unable to characterize alcohol-abusing patients with sufficient clarity to effectively focus screening for primary prevention. OBJECTIVE: To determine the prevalence of harmful and hazardous use of alcohol, assess screening instruments for detecting alcohol abuse or dependence, and assess the impact of alcohol use on other diagnoses treated in outpatient settings. DESIGN: Survey (cross-sectional study). SETTING: Hospital-based outpatient clinic. PARTICIPANTS: Three hundred randomly selected adults (aged 18 years and older). MAIN OUTCOME MEASURE: Diagnosis of alcohol abuse or dependence based on the Diagnostic Interview Schedule (DIS). RESULTS: About 18% met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria of abuse or dependence while almost 50% had at least one symptom of harmful or hazardous use. The T-ACE questionnaire, a modified version of the CAGE questionnaire, was the most effective screening instrument for both men and women. Selected diagnoses, personal characteristics such as family history of alcohol abuse, and self-reported patterns of alcohol use could identify patients likely to meet diagnostic criteria. CONCLUSIONS: Many symptoms of substance use disorders are not adequately addressed in outpatient practice. Little is known about how alcohol use in varying quantities affects health care utilization and treatment of conditions commonly seen in outpatient medicine. Consequently, we lack a full appreciation of the burden of disease borne by alcohol use and have yet to achieve a universally accepted method of approaching primary and secondary prevention of alcohol-related problems.

Adult↗
PubMed2001

Using the prevalence of an elevated serum alanine aminotransferase level for identifying communities with a high prevalence of hepatitis C virus infection.

BACKGROUND: Antibody to hepatitis C virus (anti-HCV) is a widely accepted method for the diagnosis of HCV infection. However, it is too expensive to use in large-scale health surveys. OBJECTIVE: To investigate the use of the serum alanine aminotransferase (ALT) level to predict the prevalence of HCV infection. PATIENTS AND METHODS: A sample of 6095 residents aged 35 years old or older in a small township of southern Taiwan, Republic of China, were examined in a community health survey. These persons were walk-ins to the government-sponsored stations after an intensive health promotion for this survey. Blood samples were obtained and analyzed for serum ALT levels. The presence of hepatitis B surface antigen and anti-HCV were determined by enzyme immunoassay methods. RESULTS: The overall prevalences of hepatitis B surface antigens(+), anti-HCV(+), and elevated ALT levels were 11.8%, 15.0%, and 7.5%, respectively. Among the 13 villages in this community, the prevalence of hepatitis B surface antigen(+) ranged from 6.8% to 17.3%, anti-HCV(+) ranged from 7.2% to 37.6%, and an elevated ALT level ranged from 5.8% to 16.5%. A strong positive correlation was found between the prevalence of an elevated ALT level and anti-HCV(+) (r= 0.91, Spearman rank correlation; P<.001). However, nearly 0 correlation (r= -0.05, P=.87) was obtained between the prevalence of an elevated serum ALT level and hepatitis B surface antigen(+). CONCLUSION: The prevalence of an elevated serum ALT level in a community is a strong indicator of its prevalence of anti-HCV(+), even in areas where there is a similar prevalence of hepatitis B virus infection. This result is useful for economically identifying hyperendemic communities with HCV infection.

Alanine Transaminase↗
PubMed1981

Indentation laser photocoagulation of peripheral retinal neovascularization.

The treatment of peripheral retinal neovascularization by laser photocoagulation is an accepted technique. One of its limitations is the difficulty in photocoagulating retinal neovascularization that has become even slightly elevated from the underlying pigment epithelium. The failure to close the neovascular frond and the production of a vitreous hemorrhage are the complications from the direct photocoagulation of elevated neovascularization. The currently accepted method of treating the feeding retinal arteriole and venule, although successful, requires multiple treatment sessions. The use of a scleral indentation funnel at the time of laser photocoagulation permits the direct photocoagulation of elevated neovascularization in some cases. This technique increases the number of neovascular fronds that are amenable to direct laser photocoagulation, improves the rate of success of closure of the neovascularization by photocoagulation, decreases the necessary number of treatment sessions, and decreases the risks from treatment.

Fluorescein Angiography↗
PubMed2000

Management of malignant melanoma of the head and neck using dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy.

BACKGROUND: The sentinel lymph node (SLN) biopsy is revolutionizing the surgical management of primary malignant melanoma. It allows accurate nodal staging, and targets patients who may benefit from regional lymphadenectomy and systemic therapy; however, its use in the management of head and neck melanoma has not been widely accepted. METHODS: A retrospective review of patients treated for clinical stages I and II malignant melanoma of the head and neck with dynamic lymphoscintigraphy and gamma probe-guided SLN biopsy. RESULTS: Fifty-eight patients (47 male and 11 female) were identified. Primary melanoma sites included the scalp (21), ear (8), face (13), neck (15), and eyelid (1). Primary tumor staging was T2 (11), T3 (24), and T4 (23). Dynamic lymphoscintigraphy visualized SLNs in 57 patients (98.3%). In 43 cases (75%) a single draining nodal basin was identified, and in 14 cases there were multiple draining nodal basins. Sentinel lymph nodes were successfully identified in 72 (96%) of 75 nodal basins. Positive SLNs were identified in 10 patients (17.5%). Sentinal lymph node positivity by tumor staging was T3, 16.7% and T4, 27.3%. Completion lymphadenectomy revealed residual disease in 3 patients (30%). Relapse occurred in 10 (21.3%) of the 47 patients with negative SLN biopsy results and 7 (70%) of those with positive results. CONCLUSIONS: Gamma probe-guided SLN localization in the head and neck region was successful in 96% of draining nodal basins. It can target regional lymphadenectomy in patients who may benefit from regional nodal dissection.

Adolescent↗
PubMed1977

Versatile Karapandzic lip reconstruction.

The Karapandzic reconstruction of lip defects is a versatile, anatomically sound, physiologically and cosmetically acceptable method that should be known to all surgeons who excise lip cancers. Because these myocutaneous advancement flaps have intact nerve and vascular supply, the physiologic functions for speech and managing food are quickly restored, in stark contrast to many other major lip reconstruction techniques.

Humans↗
PubMed1981

Complications of internal jugular vein catheterization.

Percutaneous cannulation of the internal jugular vein has become a widely accepted method for monitoring central venous pressure, hyperalimentation, and rapid fluid administration. Although complications from this procedure have been rare, many unusual case reports are found in the literature. Three cases of otolaryngologic importance are presented. A revised technique of the internal jugular vein catheterization is described.

Aged↗
PubMed1994

Microvascular free flaps in head and neck reconstruction. Report of 200 cases and review of complications.

OBJECTIVE: Microvascular free-tissue transfer to the head and neck has become an accepted method of reconstruction owing to increased success rates and superior aesthetic and functional results. Although the large number of arteries and veins in the neck make free-flap revascularization easier than in other recipient sites of the body, there are also unique problems that pose significant risks to the success of the procedure. We report our experience with 200 microvascular free flaps performed between 1987 and 1992. SETTING: This study was conducted at a tertiary referral center. PATIENTS: The majority of patients in this series underwent surgery for squamous cell cancer. Approximately 75% of the reconstructions were performed for defects of the oral cavity. There were 120 vascularized bone-containing free flaps for mandibular and midface reconstruction. The remaining 80 soft-tissue flaps were used for a variety of defects ranging from the scalp to the pharyngoesophagus. RESULTS: An overall success rate of 93.5% for free-tissue transfers is reported. Greater experience with this technique has resulted in a reduction and a change in the nature of the complications encountered compared with those seen in the early part of our series. Donor and recipient site complications, including flap failures and anastomotic revisions, are analyzed in detail with respect to age, radiation status, donor site, and whether the ablative procedure was done for a primary or recurrent neoplasm.

Adolescent↗
PubMed1996

Preoperative vascular imaging for the fibular osteocutaneous flap.

The fibular osteocutaneous free flap has become a well-accepted method of mandibular reconstruction. Aberrations in the blood supply to the foot affect 5% to 7% of the population, and substantial atherosclerotic disease of the lower extremities is often found in elderly individuals, many of whom have been smokers. Therefore, the use of preoperative vascular imaging is justified in all patients scheduled for fibular osteocutaneous free-flap harvest. In a series of 25 consecutive patients clinically judged to be satisfactory candidates for fibular free-flap reconstruction, preoperative arteriograms excluded 4 patients from use of this donor site and determined which leg was used in 2 other patients.

Arteriosclerosis↗
PubMed1977

Total hip arthroplasty: an editiorial comment.

Total hip arthroplasty has become an accepted method of management of severe painful problems of the hip. It has undergone some dramatic changes, the major thrust now being to more nearly match the mechanical characteristics of the implant to the bone and cartilage they replace.

Arthroplasty↗
PubMed1977

Current status of total knee arthroplasty.

Total knee arthroplasty has become an acceptable method of surgical management for severe, disabling gonarthropathy. The three major biomechanical classifications of total knee prostheses are minimally constrained, partially constrained, and fully constrained. The major indication for total knew arthroplasty is pain, followed in a much lower frequency by instability, loss of motion, and deformity. The principal contraindications for the various types relate solely to the residual or restorable ligamentous stability of the knee and the degree of bone loss. In general, the greater the instability and bone loss, the more constrained the prosthesis must be Theoretically, loosening rates increase with increasing shear stresses, which are generally highest with the most constrained prostheses. The major complications are sepsis, loosening, and instability. Various prostheses have incorporated patellofemoral resurfacing as the final dimension in producing a total knee arthroplasty. Knee arthroplasty is very effective in preserving functional knee motion, with relief of pain as an alternative to arthrodesis.

Arthroplasty↗
PubMed1991

Surgical management of pneumothorax in patients with acquired immunodeficiency syndrome.

Pneumocystis carinii pneumonia in a patient with acquired immunodeficiency syndrome may cause severe alveolar damage, resulting in pneumothoraces that are often bilateral, recurrent, and refractory to accepted methods of treatment. The clinical features, management, and follow-up results were assessed in 22 consecutive patients who presented with a pneumothorax and acquired immunodeficiency syndrome. Seventeen patients died within the time frame of this study. Their average survival time was 147 days. Five surviving patients have lived an average of 366 days. We proposed an algorithm to assist in the management of pneumothoraces in these patients. We concluded that pneumothorax in patients with acquired immunodeficiency syndrome is prognostic of short-term survival. The results in the treatment of pneumothorax in the patient with acquired immunodeficiency syndrome are related to the pathologic lesions of the lung that are associated with Pneumocystis pneumonia and not to the surgical treatment that is employed.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Quality of malnutrition assessment surveys conducted during famine in Ethiopia.

CONTEXT: During 1999 and 2000, approximately 10 million people were affected by famine in Ethiopia. Results of nutrition assessments and surveys conducted by humanitarian organizations were used by donors and government agencies to determine needs for food aid and to make other decisions on geographic allocation of limited resources; however, accurate results might have been hampered by methodological errors. OBJECTIVES: To identify common methodological errors in nutrition assessments and surveys and to provide practical recommendations for improvement. DESIGN AND SETTING: Nutrition assessments and surveys (n = 125) conducted by 14 nongovernmental organizations (NGOs) in 54 woredas (districts) in Ethiopia from May 1, 1999, through July 31, 2000. Surveys were ranked as valid and precise according to 5 criteria: use of population proportional to size sampling, sample size, number of clusters, number of children per cluster, and use of weight-for-height index. MAIN OUTCOME MEASURES: Number and proportion of surveys that used standard, internationally accepted methods and reported valid and precise results. RESULTS: Fifty-eight of the 125 surveys (46%) were not intended to be standard 30 x 30 cluster surveys. Of the remaining 67 surveys, 6 (9%) met predetermined criteria for validity and precision. All 67 used the anthropometric index of weight-for-height, with 58 (87%) reporting z scores. Fifty-four (81%) used nonrandom sampling without consideration of population size and 6 (9%) had sample sizes of fewer than 500 persons. CONCLUSIONS: Major methodological errors were identified among 30 x 30 cluster surveys designed to measure acute malnutrition prevalence in Ethiopia during the famine of 1999-2000. Donor agencies and NGOs should be educated about the need for improved quality of nutrition assessments and their essential role in directing allocation of scarce food resources.

Adult↗
PubMed1999

Use of omentum pedicled graft to protect great vessels in gastric transposition for pharyngoesophageal cancer.

BACKGROUND AND OBJECTIVES: Transmediastinal gastric transposition and pharyngogastric anastomosis is perhaps one of the most widely accepted methods for restoration of the alimentary continuity after pharyngoesophageal resection. The need of neck dissection, mediastinal tracheostomy, and previous radiotherapy may favor exposure and rupture of major vessels. Protection with omentum may prevent this complication. A comprehensive review of omentum flap use in surgery was undertaken. METHODS: A modified omentum pedicled flap was used in 6 out of 36 patients submitted to total pharyngolaryngoesophagectomy and gastric transposition (PLE&GT). RESULTS: None of the patients had major vessel rupture as compared with a 13% carotid and innominate artery rupture of a series of 30 patients previously operated on without omentum pedicled flap protection. CONCLUSIONS: The omental pedicled flap, performed as described, may provide reliable protection for carotid and innominate artery exposure, adding little time to the procedure.

Brachiocephalic Trunk↗
PubMed1996

The National Cancer Data Base report on ovarian cancer treatment in United States hospitals.

BACKGROUND: Epithelial ovarian cancer continues to challenge clinicians. There is no accepted method of screening for ovarian cancer, and most patients present with advanced disease. In spite of advances in surgery and chemotherapy, survival continues to be poor. METHODS: The data, comprising the ovarian cancer caseloads of 940 hospitals, are from the National Cancer Data Base. The 15,254 patients, diagnosed in 1988 or 1993, had no prior cancer diagnosis. RESULTS: Data quality had improved by 1993; 89.4% of the records included American Joint Committee on Cancer (AJCC) staging information in 1993, compared with 67.9% in 1988. Borderline epithelial tumors and germ cell tumors were most commonly found in younger women and were more likely to be diagnosed at Stage I. The percentage of women with carcinoma treated only with surgery increased substantially by 1993. Relative survival decreased with increasing tumor stage or grade. Five-year survival was considerably lower for women with carcinoma (38%) than for women with either borderline carcinoma (95%) or germ cell tumors (86%). The addition of chemotherapy to the treatment of Stage I carcinoma did not improve outcome, nor was dramatic improvement in survival brought about by the addition of chemotherapy to the treatment of Stage II and III low grade disease. Chemotherapy was beneficial to patients with Stage II or III disease, Grade 3 or 4, and Stage IV disease. CONCLUSIONS: Most women with epithelial ovarian cancers continue to present with advanced disease. No improvements in early detection were apparent in the reference years studied. The benefits of the addition of chemotherapy to the treatment of this disease were most obvious in patients with Stage II and III disease, Grade 3 or 4, and those with Stage IV disease. These benefits were less clear in early stage disease. However, there continues to be significant room for improvement in the diagnosis and treatment of this disease.

Adult↗
PubMed1999

A Phase II study of gemcitabine in patients with malignant pleural mesothelioma. European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group.

BACKGROUND: Gemcitabine has shown activity in patients with less chemosensitive solid tumors. Phase II screening of novel drugs is an accepted method with which to investigate new therapies in malignant mesothelioma. The European Organization for Research and Treatment of Cancer-Lung Cancer Cooperative Group has performed several sequential Phase II trials of new agents for the treatment of mesothelioma over the last 10 years. METHODS: Twenty-seven chemotherapy-naive patients with histologically proven malignant mesothelioma were treated with gemcitabine as a 30-minute intravenous administration of 1250 mg/m2 on Days 1, 8, and 15 of a 28-day cycle. Therapy continued for up to ten cycles unless disease progression or excessive toxicity mandated discontinuation. RESULTS: With a median relative dose intensity of 96%, toxicity was mild and neutropenia of > or = Grade 3 (according to National Cancer Institute criteria) occurred in 30% of patients, without episodes of febrile neutropenia. One case of hemolytic-uremic syndrome, most likely related to gemcitabine use, was observed. Overall, 2 objective responses were observed (response rate of 7%; 95% confidence interval, 1-24%). The median survival was 8 months. CONCLUSIONS: At the prescribed dosage and schedule, single agent gemcitabine appears to have limited activity in chemotherapy-naive patients with malignant pleural mesothelioma.

Adult↗
PubMed2000

Guidelines for the recognition, prevention, and remediation of burnout in health care professionals participating in the care of children with cancer: report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology.

This is the eighth official document of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology, instituted in 1991. It deals with a topic discussed and approved by the SIOP Committee; namely, "Recognition, prevention, and remediation of burnout in health care professionals participating in the care of children with cancer." It is addressed to the Pediatric Oncology community and outlines: 1) the general definition of burnout as mental and physical exhaustion, indifference, sense of failure as a professional, and sense of failure as a person; 2) the causes of burnout from the nature of the work itself, the work environment, and the characteristics of the individual; 3) the prevention of burnout, changing the detrimental aspects of one's work environment and modifying one's own behavior; and accepting methods to remediate burnout when it occurs.

Burnout, Professional↗
PubMed1978

Treatment of the ameloblastoma: a controversy.

Treatment of the ameloblastoma should be re-evaluated based on microscopic behavior. We suggest that conservative therapy is the initial treatment of choice. Although medullary bone is invaded by tumor cells, compact bone only is eroded. Therefore, treatment should be directed at removal of involved medullary bone, leaving as much medial and lateral cortical plates and inferior mandibular border as possible. Four patients with ameloblastoma treated conservatively are presented. Evaluation from 21 months to seven years after initial therapy revealed marked bone regeneration. Three of the four had smaller lesions remaining, requiring less radical surgery than would normally have been performed initially. No tumor was evident on rebiopsy of the fourth patient. Conservative treatment and proper follow-up were acceptable methods of initial treatment in our cases.

Adult↗