Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Unnecessary Procedures”

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 145 records · Page 8Linked to original sources
PubMed1998

Mediastinal lipomatosis.

Mediastinal lipomatosis is a benign condition characterized by a large amount of mature adipose tissue within the mediastinum. It widens the mediastinum and may simulate mass lesions, thus leading to diagnostic errors. We describe a new case of a huge mediastinal lipomatosis and review 36 cases previously reported in the literature. Computed tomography has an important role in the diagnosis of this disease. To avoid invasive and unnecessary procedures, this diagnosis should be considered in any patient with Cushing's syndrome.

Adipose Tissue↗
PubMed2004

"Out points" criteria for breast implant removal without replacement and criteria to minimize reoperations following breast augmentation.

Breast augmentation is a totally elective, medically unnecessary procedure, and surgeons and patients must prioritize minimizing tradeoffs, costs, and risks at the primary operation and at reoperations. At the U.S. Food and Drug Administration's advisory panel hearings in October of 2003 to consider approval of conventional silicone gel implants, data documented an overall reoperation rate of 20 percent at just 3 years after primary breast augmentation. Subsequently, the premarket approval was not granted. Similarly high reoperation rates have been reported in previous saline and silicone gel premarket approval studies over the past two decades, demonstrating that high reoperation rates are not device dependent and suggesting a need to reexamine surgical management criteria. Bilateral implant removal without replacement limits additional reoperations in a wide range of clinical situations. Surgeons and patients often prefer other options to avoid removal without replacement, but other options carry a higher tradeoffs, costs, and risks to the patient. If minimizing tradeoffs, costs, and risks of reoperations is a priority, surgeons must define and patients must understand and accept "out points," that is, specific criteria for bilateral implant removal without replacement. Defining out points is challenging. Enforcing them when difficult clinical situations occur is even more challenging. This article presents out points that have been incorporated into staged, repetitive informed consent documents and used in the author's practice for more than 10 years. In peer-reviewed and published reports of more than 1600 patients, these out points criteria, in conjunction with the TEPID system (tissue characteristics of the envelope, parenchyma, and implant and the dimensions and fill distribution dynamics of the implant) of implant and pocket selection based on individual patient quantifiable tissue criteria and surgical techniques that minimize tissue trauma and bleeding, resulted in an overall reoperation rate of 3 percent in 1662 reported cases with up to 7 years of follow-up, compared with the 20 percent reoperation rate at 3 years in the most recent Food and Drug Administration study.

Breast Implants↗
PubMed2005

Cryopreservation of mature human adipocytes: in vitro measurement of viability.

Cryopreservation of fat grafts for autologous fat transplantation renders repeated harvesting procedures unnecessary. Anecdotic reports have been published, yet data about adipocyte survival are sparse. The beneficial effect of added cryoprotective agents (CPA) is known from other tissues but has not been investigated in adipocytes. Fat cells were harvested using the Coleman method (n = 24). Tests were done after 0, 2, 7, 14, and 30 days of cooling to -20 degrees C and -80 degrees C and after addition of various CPA. Analysis included cell stains, measurement of metabolic activity by MTT and XTT tests, and measurement of cell stability by assessment of extracellular glycerol-3-phosphate-dehydrogenase enzyme. After freezing, up to 92.7% of metabolic activity was lost, but the addition of CPA led to preservation of up to 54% of baseline activity. Also, lower storage temperature showed more cell destruction but yielded higher viability of the surviving cells. Our results implicate that the widely used practice of simple storage in a freezer leads to reinjection of nonviable tissue. Cell survival can be improved by addition of CPA.

Adipocytes↗
PubMed1995

The effect of cerebrospinal fluid dilution of isobaric 0.5% bupivacaine used for spinal anaesthesia.

A prospective study was conducted to see the effect on spinal anaesthesia of the dilution of isobaric 0.5% bupivacaine with cerebrospinal fluid. Sixty patients were randomly allocated to three groups. In group 1, patients received 3 ml isobaric 0.5% bupivacaine intrathecally without aspirating cerebrospinal fluid. In groups 2 and 3, cerebrospinal fluid 1 ml and 2 ml was aspirated respectively and mixed with 3 ml isobaric 0.5% bupivacaine. A total volume of 4 ml in group 2 and 5 ml in group 3 was administered. Thus, the volume of cerebrospinal fluid remained unchanged. Pinprick analgesia and motor block was evaluated from induction until recovery. No differences in onset time, duration and 'two segments regression' were noticed. The only statistical difference was the time to reach complete motor block, which was shorter in group 1 as compared to groups 2 and 3 (6.9 SD 1.4 min versus 11.3 SD 3.0 and 13.5 SD 3.9 min respectively). The mean value of maximum decrease in systolic blood pressure was small, being less than 15% of the pre-operative value for each group. In conclusion, the effect of diluting isobaric 0.5% bupivacaine with cerebrospinal fluid, 1 ml and 2 ml, is minimal and it is an unnecessary procedure with limited clinical effect.

Adult↗
PubMed1983

Glomus tympanicum tumours: demonstration by high resolution C.T.

The situation and extent of small glomus tumours confined to the middle ear cavity have been reliably demonstrated by high resolution C.T. The distinctive clinical and radiological features of four cases are described. High resolution C.T. is now considered to be the definitive radiological investigation and angiography is regarded as an unnecessary procedure in most patients with this condition.

Aged↗
PubMed2006

Testicular venous sampling in determining the possible origin of tumour markers and its influence on management.

Testicular vein sampling is a well-known technique in the investigation of testicular function, or in determining the origin of certain plasma protein markers. We describe the application of this technique in the case of a patient who had previously undergone right radical orchidectomy for testicular teratoma, to discover the source of persistently raised tumour markers following the operation. We found this diagnostic tool useful in avoiding unnecessary procedures of the remaining testis and in guiding further treatment.

Adult↗
PubMed1978

The problem of defensive medicine.

Defensive medicine--the use of diagnostic and end-treatment measures explicitly for the purposes of averting malpractice suits--is frequently cited as one of the least desirable effects of the current rise in medical litigation. Many physicians and policy-makers claim that defensive medicine is responsible not only for the increasing costs of health care but the exposing of patients to significant risks of harm from unnecessary procedures. Very little solid information is available about defensive medicine. The studies that have been conducted have been fraught with statistical difficulties and are by no means definitive. Even more important than the issue of defensive medicine is the more basic problem of our system of compensation for medical injuries.

Adult↗
PubMed2004

Willingness to pay for cataract surgery in Kathmandu valley.

AIM: A cross sectional study was carried out on 78 screened cataract patients of two screening camps in Kathmandu valley, Nepal, to assess the willingness to pay for cataract surgery. METHODS: A non-probability sampling technique with open ended and close ended questionnaires was used. RESULTS: The average age of patients was 68.8 years. The ratio of men and women was 0.9:1. 42.3% (33) of patients were willing to pay for cataract surgery. Among them 48.5% (16) of people were willing to pay less than dollars 13 and 51.5% (17) were willing to pay more than dollars 13. The mean was dollars 2.3 (SD dollars 15.5) per case. Patients with bilateral cataract were more willing to pay than unilateral cases. Poverty (44.4%, 20) was the main barrier for unwillingness to pay for cataract surgery. Other reasons were the lack of family support (28.9%, 13), lack of knowledge of surgery and belief that it was an unnecessary procedure (15.6%, seven), and waiting for a free surgical service (11.1%, five). CONCLUSION: This study clearly indicates that although there was awareness of the availability of treatment and services provided within the reach, people are not willing to pay for the surgery and use the facility primarily because of poverty. Hence, to change patients' attitudes, a more holistic approach is needed, keeping in view the cultural, social, and economic background of the society.

Aged↗
PubMed2004

Late presenting congenital diaphragmatic hernia.

Delayed herniation of the abdominal contents through a congenital diaphragmatic hernia may occur beyond the neonatal period. The case is reported of a 9 month old child presenting with acute respiratory distress secondary to tension gastrothorax. The chest radiograph showed a tension gastrothorax. Nasogastric tube placement confirmed herniation of the stomach into the left chest and is the initial treatment of choice when a tension gastrothorax is identified. The late presenting congenital diaphragmatic hernia poses considerable diagnostic challenges often leading to misdiagnosis and risk of thoracocentesis. The possibility of late presenting congenital diaphragmatic hernia should be considered in unusual cases of pneumothorax, especially in the absence of trauma so that unnecessary procedures like chest tube drainage can be avoided.

Diagnosis, Differential↗
PubMed1999

Unexplained fever in neonates may be associated with hepatitis B vaccine.

AIM: To investigate whether hepatitis B vaccination has increased the number of cases of unexplained neonatal fever. METHOD: The files of all infants born from 1 January 1991 to 31 December 1992, in whom a diagnosis of "injected antibiotic" or "disease of temperature regulation" was recorded, were reviewed. Those who had unexplained fever of 38 degrees C or higher during the first three days of life were divided into two groups: infants who did not receive the hepatitis B vaccine (1991) and infants who did (1992). RESULTS: In 1992 the incidence of unexplained fever in hepatitis B vaccinated neonates was significantly higher than in the 1991 group of pre-vaccination neonates (35 out of 5819 (0.6%) vs 14 out of 5010 neonates (0.28%) respectively, p=0.013). CONCLUSIONS: The increase in the number of cases of unexplained neonatal fever seems to be associated with the introduction of routine hepatitis B vaccination on the first day of life. The possibility that an excess number of neonates will undergo unnecessary procedures and treatment to diagnose unexplained fever justifies planning a controlled study to determine whether these preliminary findings point to a significant problem.

Fever of Unknown Origin↗
PubMed1987

Midtrimester genetic amniocentesis in eastern Ontario: a review from 1970 to 1985.

Greater use of genetic amniocentesis in the Eastern Ontario region occurred once the results from the various national trials were published. Acceptance also paralleled an increase in the number of low parity older women having children and the centralisation and greater publicity given to our programme in the late 1970s. A centralised approach has had the positive effects of preventing unnecessary procedures, assuring appropriate patient counselling, follow up, and review, and of increasing obstetric and laboratory expertise. Advanced maternal age has been largely responsible for the increased demand for the service and accounted for an increasing proportion of tests performed, while the absolute number for several other diagnostic categories remained unchanged. We found no evidence that women with a history of previous miscarriage had a higher rate of pregnancy loss following the procedure, and comparison with a group of women who declined amniocentesis did not show that the test increased the risk of miscarriage.

Abortion, Spontaneous↗
PubMed1982

Osteoradionecrosis of the skull stimulating bone metastases.

Multiple skull erosions which simulated bone mestatases developed in a 54-year-old patient who had been treated for favus by radiotherapy 40 years earlier. Radiation necrosis should be recognized and differentiated from defects and erosions due to malignant or infectious process in order to prevent unnecessary procedures and treatment.

Diagnosis, Differential↗
PubMedDate not supplied

Imaging characteristics of malignant lesions of the male breast.

Most men referred for breast imaging have palpable lumps, breast enlargement, or tenderness. Most of the evaluated lesions are benign. Male breast cancer accounts for less than 1% of total male breast lesions. Differentiation between benign and malignant masses is critical because it alleviates patient anxiety and allows unnecessary procedures to be avoided. Clinically suspicious lesions referred for imaging should first be evaluated with mammography. In patients with questionable findings at mammography and for lesions that are difficult to image with mammography, ultrasonography (US) is often useful for further characterization. A discrete mass at mammography or US is suspicious for malignancy. The relationship of the mass to the nipple should be carefully assessed; an eccentric location is highly suspicious for cancer. Secondary signs occur earlier in male patients because of smaller breast size. Such signs include nipple retraction, skin ulceration or thickening, increased breast trabeculation, and axillary adenopathy. US of the axillary region is helpful for staging. At pathologic analysis, cystic lesions commonly demonstrate malignant findings; therefore, all cysts and complex masses should be worked up as potentially malignant lesions. Benign conditions that may mimic male breast cancer include gynecomastia, lipoma, epidermal inclusion cyst, pseudoangiomatous stromal hyperplasia, and intraductal papilloma.

Breast Neoplasms, Male↗
PubMed2001

Role of percutaneous image-guided biopsy in the evaluation of renal masses.

OBJECTIVE: The objective of the present study was to evaluate the indications, accuracy, complications and impact of image-guided percutaneous biopsy of renal masses. MATERIALS AND METHODS: Between 1994 and 1999, percutaneous biopsies under ultrasonography or computerized tomography guidance were performed in 33 patients with renal mass (22 men and 11 women, mean age 57.5 years, range 21-88). We retrospectively analyzed the relationship between clinical and histopathological findings, and discuss the appropriateness of the indications for image-guided percutaneous biopsy in the diagnosis of renal masses. RESULTS: The indications used in our institution were as follows: (1) clinical and radiological findings to suggest a diagnosis other than primary renal cell carcinoma (RCC) (n = 15); (2) suspicious lesions of RCC in multiple cystic renal masses (n = 7); (3) differentiation of transitional cell carcinoma of the renal pelvis from RCC (n = 7); (4) differentiation of angiomyolipoma from RCC (n = 4). Sufficient amounts of tissues were obtained from all patients for pathological diagnosis. Among 33 patients, 21 (63.6%) were diagnosed positive for malignancy, and 15 underwent surgical intervention. The histopathological findings between percutaneous biopsy and surgically resected tissue were identical in 13 cases (86.7%). No patient developed major complications requiring surgical treatment. CONCLUSION: If performed under appropriate selection of patients, percutaneous image-guided biopsy is a safe, reliable and accurate method of managing suspicious and/or indeterminate renal mass, and may contribute to the selection of appropriate clinical management by avoiding unnecessary procedures.

Adult↗
PubMed1984

Round atelectasis.

Round atelectasis is a little-known form of peripheral pulmonary collapse which may mimic a neoplastic tumor. Usually the atelectasis forms a well-demarcated round or oval intrapulmonary pleural-based mass at the basal, posterior or interlobar pleura. It is thought to be a sequela of a pleural effusion. If the radiographic features are characteristic, and fine-needle biopsy finding negative, the diagnosis of round atelectasis can be made with assurance, and unnecessary procedures such as thoracotomy and pulmonary resection can be avoided. In this paper experiences of 11 patients with this condition are presented. In 4 the diagnosis was established by surgery and in 7 a long-term follow-up confirmed the diagnosis of a nonmalignant intrapulmonary lesion. The pathogenesis, clinical and radiological features, and the diagnostic workup are discussed.

Adult↗
PubMed1979

Infantile hepatic haemangioendothelioma. Angiographic considerations.

Angiographic abnormalities in infantile hepatic haemangioendothelioma are analysed on the basis of previos reports and on 3 new cases. It is emphasized that the high specificity of angiography of the hepatic artery should make other diagnostic procedures unnecessary.

Aorta, Abdominal↗
PubMed2006

Bleeding disorders in premenopausal women: (another) public health crisis for hematology?

Premenopausal women with bleeding disorders represent a major public health problem. Estimates suggest up to 20% of women with menorrhagia have an underlying bleeding disorder (corresponding to a prevalence of 1.5-4 million American women). Von Willebrand disease (VWD) is the most common bleeding disorder among women with menorrhagia, affecting up to 20% of such patients. Besides menorrhagia, important consequences of bleeding disorders in premenopausal women include iron deficiency anemia, miscarriage, postpartum bleeding, uterine bleeding and hysterectomy. These patients face many obstacles in achieving optimum care. Recognition is difficult as women may consider their symptoms "normal" and come to attention only after serious bleeding events. Symptoms of VWD may also overlap with benign conditions, primary providers may not suspect the diagnosis, and convenient hematologic input may be unavailable. Diagnosis is difficult as there is no single definitive test for VWD, and test results are variable, often being affected by extragenic factors, including stress, contraceptives, hormones, and pregnancy. Hemostatic treatment is limited by DDAVP tachyphylaxis, the lack of recombinant VWD concentrates, and the ineffectiveness of hormonal therapy, leading to unnecessary procedures and early hysterectomy. Finally, significant controversy exists regarding classification of type 1 VWD as a disease: given the overlap in symptoms and laboratory assays within the normal population, evaluation for those with VWD might be seen as identification of potential bleeding risk rather than detection of a disease. This symposium seeks to explore these issues in greater detail from the combined perspectives of the obstetrician-gynecologist and the hematologist to promote a better public health approach to this problem.

Adult↗
PubMed2004

Analysis of inadequate cervical smears using Shewhart control charts.

BACKGROUND: Inadequate cervical smears cannot be analysed, can cause distress to women, are a financial burden to the NHS and may lead to further unnecessary procedures being undertaken. Furthermore, the proportion of inadequate smears is known to vary widely amongst providers. This study investigates this variation using Shewhart's theory of variation and control charts, and suggests strategies for addressing this. METHODS: Cervical cytology data, from six laboratories, serving 100 general practices in a former UK Health Authority area were obtained for the years 2000 and 2001. Control charts of the proportion of inadequate smears were plotted for all general practices, for the six laboratories and for the practices stratified by laboratory. The relationship between proportion of inadequate smears and the proportion of negative, borderline, mild, moderate or severe dyskaryosis as well as the positive predictive value of a smear in each laboratory was also investigated. RESULTS: There was wide variation in the proportion of inadequate smears with 23% of practices showing evidence of special cause variation and four of the six laboratories showing evidence of special cause variation.There was no evidence of a clinically important association between high rates of inadequate smears and better detection of dyskaryosis (R2 = 0.082). CONCLUSIONS: The proportion of inadequate smears is influenced by two distinct sources of variation - general practices and cytology laboratories, which are classified by the control chart methodology as either being consistent with common or special cause variation. This guidance from the control chart methodology appears to be useful in delivering the aim of continual improvement.

Cytological Techniques↗