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 127 records · Page 7Linked to original sources
PubMed1990

Changing use of coronary angioplasty and coronary bypass surgery in the treatment of chronic coronary artery disease.

Changes in the use of coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) over the last several years have resulted in a new and different environment for the interventional treatment of coronary artery disease. This study explores these changes as applied to the treatment of chronic coronary artery disease. The study population comprised 14,078 patients undergoing diagnostic cardiac catheterization between 1981 and 1988. In 1981, 1,704 patients underwent a first known cardiac catheterization at Emory University Hospital or Crawford W. Long Hospital and were found to have significant coronary artery disease. Of these patients, 51.7% were treated medically, 44.0% by CABG and 4.3% with PTCA. A similar group comprised 1,719 patients in 1988. Of this group 41.2% were treated medically, 28.5% with CABG and 30.3% with PTCA. The data reveal a much more complex phenomenon than a simple increase in PTCA for the treatment of coronary disease at the expense of CABG. The CABG group aged such that the percent of the CABG population more than 65 years old increased from 26.0% of the total in 1981 to 44.9% of the total in 1988. The percent of patients with ejection fractions less than 50% in the CABG population increased from 24.5% in 1981 to 29.7% in 1988. The PTCA population had less severe disease, was younger and had better left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Technical aspects of myocardial SPECT imaging with technetium-99m sestamibi.

Most reports to date using single photon emission computed tomography (SPECT) with technetium-99m (Tc-99m) sestamibi have used acquisition parameters that were optimized for thallium-201. To fully utilize the superior imaging characteristics of Tc-99m sestamibi, there is a need to optimize the technical aspects of SPECT imaging for this agent. Performance can be enhanced through the careful selection of optimal radiopharmaceutical doses, imaging sequences, acquisition parameters, reconstruction filters, perfusion quantification methods and multidimensional methods for visualizing perfusion distribution. The current report describes theoretical considerations, phantom studies and preliminary patient results that have led to optimized protocols, developed at Emory University and Cedars-Sinai Medical Center, for same-day rest-stress studies, given existing instrumentation and recommended dose limits. The optimizations were designed to fit a low-dose-high-dose rest-stress same-day imaging protocol. A principal change in the acquisition parameters compared with previous Tc-99m sestamibi protocols is the use of a high-resolution collimator. The approach is being developed in both prone and supine positions. A new method for extracting a 3-dimensional myocardial count distribution has been developed that uses spherical coordinates to sample the apical region and cylindrical coordinates to sample the rest of the myocardium. New methods for visualizing the myocardial distribution in multiple dimensions are also described, with improved 2-dimensional, as well as 3- and 4-dimensional (3 dimensions plus time) displays. In the improved 2-dimensional display, distance-weighted and volume-weighted polar maps are used that appear to significantly improve the representation of defect location and defect extent, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Graphics↗
PubMed1992

Background and methods for the lovastatin restenosis trial after percutaneous transluminal coronary angioplasty. The Lovastatin Restenosis Trial Study Group.

Restenosis remains a critical limitation of percutaneous transluminal coronary angioplasty (PTCA). Recent experimental and clinical data have suggested that lovastatin, an hydroxymethylglutaryl coenzyme A reductase inhibitor, may reduce the rate of restenosis through reduction of low density-lipoprotein (LDL) cholesterol or possibly by direct effects. Lovastatin may therefore produce favorable alterations in endothelial healing, resulting in a decreased smooth muscle cell proliferative response to injury after angioplasty. Emory University, in conjunction with Merck Research Laboratories, has initiated a 10-center double-blinded, placebo-controlled, randomized trial to assess the effect of both pretreatment and aggressive lipid lowering with lovastatin in reducing the rate of restenosis. Lovastatin achieves approximately 75% of its effect on LDL cholesterol by 1 week. Thus, patients scheduled for PTCA are randomly assigned pretreatment with lovastatin, 40 mg twice daily, or placebo 7 to 10 days before PTCA. Therapy is continued for 6 months, at which time repeat coronary arteriography is performed. A detailed safety algorithm was designed, with patients receiving lovastatin and matching placebo back-titrated on a 1:1 basis for LDL cholesterol less than 50 mg/dl. The power is a 90%, alpha = 0.05, 2-tailed test to reduce restenosis from 30 to 15%. The sample size is 360 patients in the 2 arms; allowing for a 10% dropout rate, approximately 400 patients will be randomized. Patients with successful PTCA, less than 50% residual diameter stenosis and greater than or equal to 20% diameter stenosis reduction are analyzed for restenosis at 4 to 6 months by quantitative coronary arteriography.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1992

Initial management and long-term clinical outcome of restenosis after initially successful percutaneous transluminal coronary angioplasty.

Restenosis remains a critical limitation after percutaneous transluminal coronary angioplasty (PTCA). The clinical experience with restenosis was reviewed in 1,490 patients who had restenosis of at least 1 site within 1 year of their PTCA. The source of data was the clinical database at Emory University. Patients who had previous coronary bypass surgery or PTCA and patients who underwent PTCA in the setting of acute myocardial infarction were excluded. When restenosis was angiographically documented, 363 were treated medically, 1,051 with repeat PTCA, and 76 with coronary bypass surgery. In the repeat PTCA group there were 778 patients who originally had 1-vessel disease and 273 with multiple vessel disease. Re-dilatation of restenotic sites was performed in 95%. Angiographic success of all lesions dilated was achieved in 99%. Coronary bypass surgery was required in 2.5% of patients with restenosis first treated with repeat PTCA. One patient with multiple vessel disease died. Coronary bypass surgery was performed in fewer patients aged greater than or equal to 65 years, but more patients with multiple vessel disease. Two (2.6%) of the coronary bypass surgery patients had Q-wave myocardial infarction and there were no deaths. In the PTCA group, 5-year actuarial survival was 95%, and cardiac survival 96%. Freedom from cardiac events or further revascularization procedures was 51% at 5 years. Patients treated with PTCA and medically treated patients had similar cardiac survival rates. The most important correlates of cardiac survival were age and the presence of diabetes mellitus. At 5 years, cardiac survival without diabetes was 97 and 83% with diabetes (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Effect of restenosis at one previously dilated coronary site on the probability of restenosis at another previously dilated coronary site.

The purpose of this study was to determine whether in patients with 2 sites dilated by percutaneous transluminal coronary angioplasty (PTCA), the sites undergo restenosis independently. Although restenosis remains a critical limitation after PTCA, there is little information separating site- and patient-dependent determinants of restenosis. In particular, if patients with 2 sites dilated have restenosis at 0 or 2 sites more frequently and at 1 site less frequently than expected by random chance, then patient-related factors may be important in the restenosis process. The source of data was the clinical data base at Emory University. Patients who had previously coronary surgery or PTCA, and those who underwent PTCA in the setting of acute myocardial infarction were excluded. In all, 515 patients with 2 sites dilated undergoing angiographic restudy at 4 months to 1 year after PTCA formed the study population. Site 1 was the first site dilated. At site 1, 224 of 515 sites (45%) were restenotic, and at site 2, 193 (33%) were restenotic. Multiple clinical and angiographic variables were analyzed as possible correlates of restenosis. The most powerful univariate and multivariate correlate of restenosis at either site 1 or 2 was the behavior of the other site. If site 2 was patent, then site 1 was restenotic 28% of the time compared with 69% if site 2 was restenotic. If site 1 was patent, site 2 was restenotic 20% of the time compared with 60% if site 1 was restenotic. This relation was stronger if the 2 sites were in the same coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts.

This study examines the long-term frequency of reoperative coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) after CABG. The source of data was the clinical database at Emory University Hospitals. The population comprised 3,480 patients undergoing a first CABG between 1978 and 1981. Event-free survival was determined using the Kaplan-Meier method and determinants of survival with the Cox proportional-hazards model. The in-hospital mortality was 1.0% and 5-, 10- and 12-year survival was 91, 78 and 70%. The 5-, 10- and 12-year freedom from reoperative CABG was 98, 88 and 80%. The 5-, 10- and 12-year freedom from PTCA was 98, 91 and 85%. The 5-, 10- and 12-year freedom from either CABG or PTCA was 96, 81 and 69%. Younger patients had much higher incidences of repeat procedures. The yearly incidence of repeat procedures accelerated over time. These data reveal the ultimately palliative nature of revascularization for coronary artery disease.

Aged↗
PubMed1994

Predicting hospital costs for first-time coronary artery bypass grafting from preoperative and postoperative variables.

To predict hospital costs after coronary artery bypass grafting (CABG) from preoperative characteristics and postoperative complications, 4 analyses of the data were used: (1) a univariate analysis of each preoperative and postoperative variable, (2) a multivariate analysis of the preoperative variables (model 1), (3) a multivariate analysis of the postoperative variables (model 2), and (4) a multivariate analysis of pre- and postoperative variables (model 3). Eight-hundred seven patients who underwent a first-time CABG at Emory University during 1990 were analyzed in this study. Using model 1, the determinants of costs were higher angina grade (p = 0.0006), previous myocardial infarction (p = 0.0133), older age (p = 0.0001), congestive heart failure (p = 0.0001), and a higher number of diseased vessels (p = 0.0001). For model 2, the determinants of costs were adult respiratory distress syndrome (p = 0.0073), intraaortic balloon pumping (p < 0.0001), pneumonia (p < 0.0001), septicemia p < 0.0001), major arrhythmia (p < 0.0001), reexploration for bleeding (p < 0.0001), wound infection (p = 0.0632), neurologic event (p = 0.0013), fluid overload (p = 0.0516), and absence of pericarditis (p = 0.0588). For univariate analysis, the determinants of increased costs were similar to those from models 1 and 2. Although there is considerable variance in hospital costs for any number of complications, utilized resources (costs) increase inexorably as patients have more complications after coronary surgery. The mean cost to the hospital for the 382 patients who underwent CABG and experienced no complications was $16,776.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1994

Left ventricular dilatation and multivessel coronary artery disease on thallium-201 SPECT are important prognostic indicators in patients with large defects in the left anterior descending distribution.

This study examines the importance of left ventricular (LV) dilatation, and evidence of multivessel coronary artery disease identified on thallium-201 (TI-201) single-photon emission computed tomographic (SPECT) scintigrams, for predicting long-term outcome in patients with an extensive left anterior descending (LAD) perfusion deficit. Impaired contractility of the left ventricle determined by low ejection fraction, elevated LV end-systolic volume, and dilatation of the left ventricle are known as major predictors of mortality after myocardial infarction. TI-201 single-photon emission computed tomography primarily reveals status of perfusion/redistribution, but also contains indirect information on LV function. To date, there are no TI-201 SPECT data on impaired function of the left ventricle (LV dilatation) and extent of perfusion deficits, discussed together as correlates of survival. Patient data were prospectively collected in the computer data base at Emory University. A large perfusion defect involving more than one third of the LAD territory was identified in 291 of 2,652 consecutive patients examined with TI-201 SPECT initial and 3-hour redistribution studies. Follow-up data were obtained for 284 patients (98%) at 38 +/- 14 months. Of the 291 patients, 58 died. The most powerful multivariate correlates of death were LV dilatation, multivessel disease, and the ratio of the LAD severity stress score to total severity of SDs stress score. Cox model analysis was used to determine correlates of survival. Three-year survival for patients with LV dilatation was 73% versus 89% without LV dilatation (p < 0.001). Three-year survival in patients with 1-vessel disease ("LAD only") was 94% versus 78% for multivessel disease (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1977

Hypothyroid Graves' disease.

Graves' disease has recently been shown to exist in a euthyroid form in untreated patients. Sporadic reports of a hypothyroid form are beginning to emerge, thus illustrating the multifaceted nature of this disorder, with thyrotoxicosis at one end of the spectrum and hypothyroidism at the other. Three patients with nonthyrotoxic Graves' disease and concomitant hypothyroidism were seen at Emory University Hospital in one year, and deatailed studies were made to help elucidate the nature of this unusual combination. Results of these studies are reported and briefly discussed. It is suggested that, until more is known about this intriguing aspect of the Graves' disease spectrum, the label "hypothyroid Graves' disease" is justifiable.

Adult↗
PubMed1994

Adnexal torsion: can the adnexa be saved?

OBJECTIVE: Our purpose was to identify which cases of adnexal torsion may be managed with adnexal conservation. STUDY DESIGN: A retrospective chart review was conducted on all patients diagnosed with adnexal torsion between February 1983 and February 1993 at four hospitals in the Emory University system. RESULTS: Fifty-nine patients ranging in age from 23 months to 73 years (mean 31.9 years) were reviewed. Almost half of the patients were nulliparous. Lower abdominal pain (83%) and an adnexal mass (72%) were the most common presenting findings, but in general clinical findings were nonspecific. Most patients were treated with extirpative therapy of the affected adnexa. Untwisting of the adnexa was performed in 10 patients; however, adnexal conservation was accomplished in only one patient. There were no thromboembolic complications in any of the patients. CONCLUSIONS: Adnexal torsion is a diagnostic challenge, often with nonspecific symptoms. There is growing evidence that untwisting the involved adnexa to observe for tissue reperfusion and viability is safe. However, significant delay in surgical intervention may result in irreversible tissue necrosis, rendering the adnexa unsalvageable.

Adnexa Uteri↗
PubMed1975

Arcial growth with metallic implants in mandibular growth prediction.

The present investigation was undertaken to determine whether the Ricketts theory of arcial growth of the mandible can be put to practical use by the clinician to predict mandibular morphology. Eight subjects (six girls and two boys) were selected from the earliest implant samples at the Orthodontic Department of Emory University School of Dentistry. The initial cephalograms were coded and sent to Ricketts, and a 6-year manual growth forecast using the arcial method was requested. The final cephalograms were traced and compared. The three tracings (initial, prediction, and final) were superimposed over the metallic implants and presented on a case-by-case basis. The forecasts, in form, were clinically acceptable in five of the eight cases. In two of the cases (girls) (Cases 2 and 4) a hand-wrist radiograph to determine skeletal age would have improved their accuracy. The forecast in Case 2 was not acceptable. In view of our results in this small sample, the arcial method appears valid for prediction of amndibular growth; however, hand-wrist radiographs will improve the accuracy of short-range predictions of the amount of growth expected. For this reason, the orthodontist should constantly monitor his patients, watching for each individual to assert himself.

Adolescent↗
PubMed1989

Large cell carcinoma of the lung: a highly aggressive tumor with dismal prognosis.

A retrospective review was made of 96 consecutive patients with large cell carcinoma of the lung admitted to Emory University Hospital over 10 years. Only 10 patients were seen with stage I lesions favorable for resection. The remainder were treated primarily with irradiation or chemotherapy. Mean survival for clinical stage I patients was 15.9 months; stage IIIA patients, 7.9 months; stage IIIB patients, 7.1 months; and stage IV patients, 5.8 months. Only 1 patient survived for 5 years. This distinct and highly aggressive form of lung cancer most commonly is seen at an advanced stage and is associated with an unusually dismal prognosis regardless of the method of treatment employed.

Carcinoma, Small Cell↗
PubMed1993

Thoracic approaches to anterior spinal operations: anterior thoracic approaches.

We performed a retrospective review of 36 patients aged 23 to 71 years (mean age, 52 years) who underwent 46 operations through a thoracic or thoracolumbar approach for orthopedic or neurosurgical procedures at Emory University Affiliated Hospitals. Pathologic indications for operation were metastatic disc disease in 10, herniated nucleus pulposus in 11, osteomyelitis in 6, vertebral fracture in 2, spinal deformities in 4, spinal abscess in 1, Pott's disease in 1, and liposarcoma in 1. Major indications for operation were infection and progressive paraparesis or paresthesias. Surgical approach consisted of a posterior lateral thoracotomy in 23, thoracotomy with retroperitoneal exposure in 6, thoracoabdominal exposure in 4, and cervical/upper sternotomy in 3. Diaphragmatic mobilization was required in 12. Surgical approach is dictated by the level of the lesion and its length. Lesions of T1 to T6 are approached through an upper sternotomy or right thoracotomy; lesions of T6 to L3, through a left thoracotomy with or without diaphragmatic mobilization. Specific techniques of segmental vessel division, diaphragmatic mobilization, and evaluation of artery of Adamkiewicz are emphasized. Rib grafts are harvested as needed. The thoracic surgeon can greatly enhance preoperative assessment, operative exposure and closure, and postoperative care for patients undergoing thoracotomy for spinal conditions.

Female↗
PubMed1996

Esophageal perforation: emphasis on management.

BACKGROUND: Perforation of the esophagus is a deadly injury that requires expert management for survival. METHODS: We performed a retrospective clinical review of 66 patients treated at Emory University affiliated hospitals for esophageal perforation between 1973 and 1993. RESULTS: Iatrogenic perforations accounted for 48 injuries (73%), barogenic perforations occurred in 12 patients (17%), trauma was causative in 3 (5%), and 3 patients had esophageal infection and other causes. Lower-third injuries occurred in 43 cases (65%), middle third in 14 (21%), and upper third in 9 (14%). Early contained perforations were managed successfully by limiting oral intake and giving parenteral antibiotics in 12 patients. Cervical perforations were drained without attempt at closure of the leak. Perforations with mediastinal or pleural contamination recognized early were managed by primary closure and drainage in 28 patients. Reinforcement of the primary closure using stomach fundus, pleural, diaphragmatic, or pericardial flap was performed in 16 patients. Those perforations that escaped early recognition required thoughtful management, using generous debridement and drainage and sometimes esophageal resection. The esophageal T tube provided control of leaks in 3 of these patients and was a useful adjunct. Using these management principles, we achieved a 76% survival rate for all patients. Six patients with perforations complicating endoesophageal management of esophageal varices were a high-risk subset with an 83% mortality rate. CONCLUSIONS: Esophageal perforation remains an important thoracic emergency. Aggressive operative therapy remains the mainstay for treatment; however, conservative management may be preferred for contained perforations and the esophageal T tube may be used for late perforations.

Aged↗
PubMed1996

Lung volume reduction surgery: lessons learned.

BACKGROUND: The concept of lung volume reduction for generalized emphysema was proposed by Brantigan and associates in 1958 and reintroduced by Cooper and colleagues in 1994. The present study presents lessons learned from an 18-month experience. METHODS: From August 1, 1994, to August 1, 1995, 53 patients underwent lung volume reduction at Emory University for generalized emphysema. There were 17 women and 36 men ranging in age from 55 to 75 years. The length of stay ranged from 10 to 59 days. At the time of presentation, 47 patients were receiving oxygen and 35 were receiving steroids. Forty-six patients were operated on using a median sternotomy and 7 through a unilateral thoracotomy. All patients underwent preoperative and postoperative pulmonary rehabilitation. RESULTS: There was one early death and four late deaths. Lessons learned from this group of patients are presented. CONCLUSIONS: Lung volume reduction surgery remains a sea of relatively uncharted waters, with the future direction yet to be determined.

Aged↗
PubMed1976

Compound and complex odontomas.

One hundred forty-nine cases of odontoma were reviewed: sixty-five cases were accepted from the literature, and eighty-four additional cases were included from the files of the Pathology Department of the Emory University School of Dentistry. The cases were combined and analyzed together. Odontomas are most often diagnosed in the second decade of life. Sixty-five per cent of all odontomas occur in the maxilla. Compound odontomas are more common in the anterior maxilla, whereas complex odontomas occur more frequently in the posterior jaws. A slight predominance in males was seen. The most common presenting symptom was an impacted tooth with retention of deciduous teeth.

Adolescent↗
PubMed1981

Verrucous carcinoma of the oral cavity. A review of forty-nine cases.

Verrucous carcinoma is a distinctive, extremely well-differentiated, slow-growing variant of the squamous cell carcinoma. Forty-nine cases of this neoplasm were gathered from the Oral Pathology Service at the Emory University School of Dentistry from 1965 to 1979. The most common site of occurrence was the buccal mucosa, followed by the mandibular alveolar ridge and gingiva. The majority of our patients were between the ages of 50 and 80 years, and most of them were Caucasians. Although most other series of oral verrucous carcinoma show a male predominance, almost 60 percent of our cases occurred in females. The role of radiation therapy in treatment of oral verrucous carcinoma is controversial, and adequate surgical excision appears to be the treatment of choice.

Adult↗
PubMed1989

Ameloblastoma in young persons: a clinicopathologic analysis and etiologic investigation.

Ameloblastoma, an odontogenic tumor of ectodermal origin, has been reported to arise, on rare occasions, in a primordial or dentigerous cyst of a young person. Numerous authors have suggested differing nomenclatures for these ameloblastomas (e.g., mural, unicystic, monocystic, intracystic, cystogenic, cystic, plexiform unicystic) and have sought to describe and classify the clinical and histopathologic features. These tumors have been characterized as a distinct variant exhibiting less aggressive behavior and a lower rate of recurrence than conventional ameloblastoma. Furthermore, various etiologic factors have been proposed for these cystic ameloblastomas, including (1) nonspecific irritational factors such as extraction, caries, trauma, infection, inflammation, or tooth eruption; (2) nutritional deficit disorders, and (3) viral infection. The files of the combined accessioned cases of Emory University's and Temple University's oral pathology laboratories were searched and a review of the literature was performed. Thirty-eight cases of mandibular ameloblastoma (37 intraosseous, 1 peripheral) in persons 19-year-old and younger were found from a combined total of 311 accessioned cases of ameloblastoma (12.2%). The average age at diagnosis was 10.4 years for the 18 males and 20 females. Of the 33 cases in which race was stated, 19 (57.6%) were white and 14 (42.4%) were black. In the 28 cases in which a clinical diagnosis was offered, fifteen (53.6%) were thought to be dentigerous cysts. Ten cases from patients less than 19 years old were investigated by means of an immunohistochemical staining technique for the detection of human papilloma virus (HPV) genus-specific structural antigen in formalin-fixed, paraffin-embedded tissue. Three of the ten cases (cases 31, 37 and 38) were positive for HPV capsid antigen, whereas none of ten randomly selected ameloblastomas in adults was positive. A discussion of the clinical and histopathologic comparative findings, with emphasis on treatment results and possible HPV etiology, is included. The preliminary nature of finding HPV in the tumor cells is stressed, with recommendation for further verification and typing with the more sensitive in situ hybridization technique.

Adolescent↗