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At least 1,441 records · Page 80Linked to original sources
PubMed1998

Carotid endarterectomy surgery and ICU admissions: a regional anesthesia perspective.

Stroke is a major cause of mortality and morbidity in the United States. This study was performed to determine whether the authors' practice of monitoring the majority of patients in the postanesthesia care unit for 2 hours, selectively admitting the recovering carotid endarterectomy patients to the intensive care unit when feasible, and using regional anesthesia for the majority of cases, resulted in adverse outcomes or compromised the safety of the operation at a tertiary care academic medical center. The records of 337 patients (a total of 420 procedures) who underwent carotid endatertectomy surgery without concurrent heart surgery during a consecutive 18-month period ending in June, 1995 were reviewed. Regional anesthesia was the technique used in 97% of the procedures. Shunt placement was deemed necessary in 7% of the procedures. Postoperative strokes occurred in approximately 1% of patients. No shunted patients had a postoperative stroke. The rate of admission to intensive care units was 4%. Blood pressure control accounted for 73% of the patients admitted to intensive care units. Most patients required 2 hours of monitoring in the postanesthesia care unit before triage to the appropriate level of postoperative care. These results suggest that a monitoring period of 2 hours in the postanesthesia care unit allows for safe assessment of the postoperative carotid endarterectomy patient, and that routine intensive care unit admission after carotid endarterectomy surgery is not necessary.

Adult↗
PubMed1987

Fetal hydrocephalus: sonographic detection and clinical significance of associated anomalies.

Sixty-one cases of fetal hydrocephalus were reviewed to determine the accuracy and clinical significance of prenatal ultrasound (US) for detecting concurrent anomalies. Of 61 fetuses studied, 51 (84%) had one or more major central nervous system (CNS) malformations (38 fetuses with 39 anomalies) and/or extra-CNS anomalies (34 fetuses). Only ten (16%) fetuses had no concurrent anomaly. Anomalies of the CNS were correctly identified with US in 35 of 39 (90%) cases. Of 34 fetuses (56%) with extra-CNS anomalies, 27 had multiple anomalies. One or more extra-CNS abnormality was identified with US in 22 of the 27 (81%) fetuses with multiple anomalies but no anomalies were identified with US in the seven patients with an isolated anomaly. Fetal mortality was directly related to the presence of extra-CNS anomalies (P less than .01). Many important anomalies coexisting with fetal hydrocephalus can be identified with US. Furthermore, sonographic detection of extra-CNS malformations carries a poor prognosis and was associated with a uniformly fatal outcome in this series.

Abnormalities, Multiple↗
PubMedDate not supplied

Fine needle aspiration biopsy of vertebral and paravertebral lesions: retrospective study of 124 cases.

OBJECTIVE: To evaluate the diagnostic value of image-guided fine needle aspiration biopsy (FNAB) in the diagnosis and management of vertebral and paravertebral lesions and to review similar studies in the literature. STUDY DESIGN: One hundred twenty-four FNAB cases (113 [corrected] patients) of vertebral and paravertebral lesions occurring over a 10-year period were retrieved from the archives of the University of Mississippi Medical Center for review and clinico-radiologic correlation. Thirty-four of the cases included a concurrent core needle biopsy sample, 15 cases had subsequent surgical specimens, while 32 cases had previously established malignancy. The age range was 11 days to 91 years (mean, 46 years), with 57 male patients and 56 female. RESULTS: One hundred five cases were vertebral lesions, and 19 cases were paravertebral lesions. FNAB diagnosis were malignant in 33.87% of cases, benign in 5.64%, suspicious in 4.03%, infectious/inflammatory and degenerative in 12.91%, unsatisfactory in 16.13% and negative in 27.42%. The overall sensitivity of the procedure was 89.3% and the specificity, 93.8%. The positive predictive value was 95.7% and negative predictive value, 85.2%. CONCLUSION: FNAB is an effective means of establishing a definitive diagnosis of vertebral and paravertebral lesions, allowing appropriate patient management. Cell blocks, core biopsies and ancillary studies are useful adjuncts in rendering the diagnosis.

Adolescent↗
PubMed1999

Clozapine-associated elevation in serum triglycerides.

OBJECTIVE: This study was conducted to determine serum lipid level changes in patients who received clozapine or haloperidol. METHOD: Medical records of 222 inpatients treated with clozapine or haloperidol were reviewed. Age, weight, gender, daily antipsychotic dose, total cholesterol level, serum triglyceride level, and concurrent medications were recorded. RESULTS: Clozapine-treated men had significantly higher follow-up serum triglyceride concentrations over baseline than did haloperidol-treated men. Female patients experienced serum triglyceride level elevations regardless of antipsychotic treatment. Changes in total cholesterol levels were not significantly different between treatment groups. CONCLUSIONS: An increase in serum triglyceride levels occurred in clozapine-treated patients; screening for serum triglyceride elevations may be warranted before treatment with clozapine.

Adult↗
PubMedDate not supplied

Laryngeal dysgenesis.

A case of a previously undescribed anomaly of the larynx is presented and offers insight and support of current concepts of fetal laryngeal development. The patient possessed unilateral absence of true and false vocal cords, laryngeal ventricle, and saccule. Current concepts of embryological development would place the development of this anomaly and most of the patient's other multiple anomalies in the period of the 6th to 9th weeks of fetal life. This report lends substantiation to the stages of laryngeal development by demonstrating an aberration in the normal sequential development. Additionally, the time period of this maldevelopment is suggested by the concurrence of multiple other anomalies. Aspects of laryngeal embryology relevant to laryngeal maldevelopment are reviewed.

Abnormalities, Multiple↗
PubMed2001

Risk factors and behaviors associated with separation anxiety in dogs.

OBJECTIVES: To determine potential risk factors and behaviors associated with separation anxiety and develop a practical index to help in the diagnosis of separation anxiety in dogs. DESIGN: Case-control study. ANIMALS: 200 dogs with separation anxiety and 200 control dogs with other behavior problems. PROCEDURES: Medical records were reviewed for signalment, history of behavior problems, home environment, management, potentially associated behaviors, and concurrent problems. RESULTS: Dogs from a home with a single adult human were approximately 2.5 times as likely to have separation anxiety as dogs from multiple owner homes, and sexually intact dogs were a third as likely to have separation anxiety as neutered dogs. Several factors associated with hyperattachment to the owner were significantly associated with separation anxiety. Spoiling activities, sex of the dog, and the presence of other pets in the home were not associated with separation anxiety. CONCLUSIONS AND CLINICAL RELEVANCE: Results do not support the theory that early separation from the dam leads to future development of separation anxiety. Hyperattachment to the owner was significantly associated with separation anxiety; extreme following of the owner, departure cue anxiety, and excessive greeting may help clinicians distinguish between canine separation anxiety and other separation-related problems.

Age Factors↗
PubMed2002

Concurrent chemoradiotherapy in cervical cancer (a new paradigm in cervical cancer treatment).

During the last century, the mainstay for the treatment of uterine cervix cancer has been via two main primary treatment modalities, these being radical surgery (radical hysterectomy and regional lymph nodes dissection) and radiotherapy. Generally, radical surgery is restricted to stages I and IIa of FIGO (the International Federation of Gynecology and Obstetrics) Classification, while radiotherapy may be applied to all stages of cervical cancer. In 1999 the National Cancer Institute Clinical Announcement established concurrent chemoradiotherapy as a new primary treatment modality, which is the focus of this review.

Combined Modality Therapy↗
PubMed2002

The safety and efficacy of prosthetic hernia repair in clean-contaminated and contaminated wounds.

Prosthetic mesh reinforcement of abdominal wall hernias has gained acceptance as a result of its ease of placement and a favorably low incidence of hernia recurrence. However, its use in contaminated wounds secondary to open bowel exposure is felt to be contraindicated because of potential septic complications and lack of incorporation. The impact of permanent mesh placement in contaminated fields on wound morbidity, hernia recurrence, and mortality was examined. Records of 24 consecutive patients having permanent mesh placement in contaminated wounds for repair of abdominal wall hernias between 1994 and 2001 were reviewed. Factors examined included age, hernia type, body mass index, comorbidity, degree of contamination, concurrent gastrointestinal procedures, wound morbidity, and mortality. The mean age and body mass index were 63 years and 26.1 kg/m2 respectively. Twelve patients had risk factors for wound complications or were immunocompromised. There were 11 incisional, eight parastomal, two femoral, and two inguinal repairs and one obturator hernia repair. Twenty-three were repaired with polypropylene and one with Gore-Tex mesh. Prosthetic herniorrhaphy was performed in nine patients with ostomies already in place and in 15 patients with concomitant bowel resections. Of those with bowel resections five had enterocutaneous fistulae, three had bowel resection because of injury during mobilization, six had resections for necrotic bowel, and one had enterostomy closure. Fourteen cases were clean contaminated and ten contaminated. Eight cases were performed under emergency conditions. Wound-related morbidity occurred in five patients (21%) and in all but one was limited to cellulitis and minor wound infections. Three patients died, but in all cases death was unrelated to the surgical procedure. No patient required mesh removal. One patient had a recurrent hernia after parastomal repair. Placement of permanent mesh prostheses in clean-contaminated and contaminated operative fields can be performed with minimal wound-related morbidity and patient mortality. Utilization of permanent mesh in these wounds is associated with a low incidence of hernia recurrence and eliminates the need for further surgery.

Adult↗
PubMed2002

Management of spinal trauma in 69 cats.

This study sought to evaluate a series of clinical and radiological findings on spinal trauma in cats and the outcome that emerged from conservative or surgical treatment using 2 types of spinal stapling: stabilization using a Steinmann pin and coated polypropylene. Case records were reviewed for their diagnostic approaches on the basis of physical and neurological conditions, and concurrent disorders in addition to spinal trauma. Radiological examinations of the vertebral column were carried out using survey radiography, myelography and epidurography. All cases were classified according to etiopathogenesis of the disease. Surgical treatment consisted of decompression (laminectomy, hemilaminectomy and durotomy), or decompression with stabilization which was performed by one of two methods. The first one was the employment of translaminar stapling at the base of a spinous process and the other involved spinal stapling at the spinous process. The spinal lesions were identified as cervical (n = 2), thoracic (n = 35), lumbar (n = 22), sacral and caudal (n = 10). While 19 out of 30 conservatively managed cases recovered, the rest had persistent residual paresis and ataxia. Complete recovery was seen in 4 cats that underwent hemilaminectomy and 3 subjected to laminectomy. Partial recovery was observed in 5 cases involving laminectomy; however, there was no improvement observed in another 2 cases. Each animal was followed for at least a 3-month period to evaluate the clinical assessment of the results following treatment. The results of conservative and operative management of spinal trauma indicated that the type and degree of spinal cord degradation strongly influenced any prognosis. The results emerging from decompressive procedures seemed satisfactory for those cases where instability was not an issue. Both stabilization techniques were not ideal in terms of their methodological versatility or regarding weaknesses of bone structure observed in intra- and postoperative periods. However, translaminar stapling at the base of a spinous process was deemed to be the superior technique.

Animals↗
PubMed2004

Combined parathyroid adenoma and an occult papillary carcinoma.

Although the pathological association of thyroid and parathyroid disease is common, the association of both parathyroid adenoma and thyroid cancer is rare. We report here a case of a 45-year-old Saudi woman who was diagnosed to have primary hyperparathyroidism due to a single parathyroid adenoma as confirmed biochemically and radiologically. At operation, the adenoma was found to be an intrathyroid and therefore a thyroid lobectomy was performed. Histology of the excised lobe revealed in addition to the intrathyroid parathyroid adenoma a concurrent occult thyroid papillary carcinoma. This interesting association is discussed based on a literature review.

Carcinoma, Papillary↗
PubMed1985

Hyperactivity. Overview and new directions.

An enormous number of articles have been published in recent years on this most researched and best known of the childhood behavior disorders. This article discusses the syndrome of hyperactivity in terms of postdictive, concurrent, and predictive validity. Future research is considered and follow-up studies are reviewed.

Adolescent↗
PubMed1995

Patency following microsurgical vasoepididymostomy and vasovasostomy: temporal considerations.

PURPOSE: We evaluate the temporal parameters of patency following vasoepididymostomy and vasovasostomy. MATERIALS AND METHODS: A series of consecutive and concurrent vasoepididymostomies (100) and vasovasostomies (100) performed by a single surgeon (M. G.) was reviewed. RESULTS: Patency rates following vasoepididymostomy and vasovasostomy were 65% and 99%, respectively (p < 0.001). Motile sperm were observed at a mean of 5.8 +/- 0.8 months (standard error) following vasoepididymostomy and 2.1 +/- 0.2 months following vasovasostomy (p < 0.01). Late failure rates were 21% for vasoepididymostomy and 12% for vasovasostomy. Pregnancy rates following vasoepididymostomy and vasovasostomy were 21% and 52%, respectively. CONCLUSIONS: Patency is rapid following vasovasostomy but requires 12 or more months following vasoepididymostomy. Intervention for azoospermia is appropriate 6 months after vasovasostomy and 1 year after vasoepididymostomy. Intraoperative cryopreservation of sperm in men undergoing vasoepididymostomy and postoperatively in all men with motile sperm will maximize fertility options.

Anastomosis, Surgical↗
PubMed1995

Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients.

BACKGROUND: Pain can adversely affect a patient's physiological and psychological recovery, yet little is known about the pain experience of cardiac surgical patients. OBJECTIVES: To examine nursing practice regarding analgesic administration and measure pain intensity and patient satisfaction with pain management practices. METHODS: To establish baseline nursing practice regarding analgesic administration, charts were reviewed retrospectively in 50 adult cardiac surgical patients, and the same information was collected concurrently for a prospective sample of 51 patients. The subjects completed visual analogue scales as a measure of pain intensity twice daily while in the cardiothoracic intensive care unit and Pain Relief Satisfaction Questionnaires on the day after transfer from the unit. RESULTS: Patients in the prospective group received significantly more analgesia. Pain intensity was moderate (4 or greater on the Visual Analogue Scale). Women had higher overall visual analogue scale scores than did men, 4.57 versus 3.70. Patients in whom an internal mammary artery had been used as a bypass graft had significantly higher scores compared with patients with vein grafts. The Pain Relief Satisfaction Questionnaire responses indicated that 96% of the patients experienced effective pain management in the cardiothoracic intensive care unit. CONCLUSIONS: Despite receiving analgesic doses twice those reported elsewhere for similar populations, the patients in this study reported moderate pain intensity. This finding was confounded by the fact that 96% expressed satisfaction with their pain management in the cardiothoracic intensive care unit. Frequent assessment and documentation of both pain and pain relief from interventions are necessary if the healthcare team is to implement an individualized analgesic regimen.

Adult↗
PubMed1996

Studies on the helminth parasites of birds from Egypt: 1-trematoda and cestoda.

A total number of 1019 wild birds were examined, of which 486 (49%) were found infected with one or more species of helminth parasites. Digeneans were recovered from 151 (15%) and cestodes from 249 (24%) birds. Out of 20 helminth species recovered, 10 were found new (7 trematodes and 3 cestodes). The prevalence and the effect of concurrent infection on the most frequently occurring helminth parasites were recorded and discussed. A review of all the trematode and cestode parasites previously described from the Egyptian birds was also given.

Animals↗
PubMed2007

Reduction of concurrent antipsychotic prescribing practices through the use of PSYCKES.

The New York State Office of Mental Health has implemented the browser based Psychiatric Clinical Knowledge Enhancement System (PSYCKES) medication application throughout its inpatient system of care. PSYCKES provides detailed current medication regimens and histories, as well as medication best practices reports at the patient, psychiatrist, ward, and facility levels. South Beach Psychiatric Center (SBPC) has made specific use of a best practices report which details proportions of caseloads and number of patients on two or more concurrent antipsychotic medications. Psychiatrists received extensive application and desktop support and individual and group training was conducted. PSYCKES current and historical medication regimens were reviewed for individual cases and best practices reports were used in psychiatry supervision from January 2004 to March 2005. SBPC psychiatrists achieved marked reductions in the proportions of their caseloads on two or more concurrent antipsychotics. Although we cannot impute causality from this pre-post implementation design, the results of this evaluation suggest that the use of PSYCKES was effective in reducing such regimens for inpatients.

Antipsychotic Agents↗
PubMed1998

Recurrent hyperbilirubinaemia, a feature of familial Mediterranean fever: report of a child and review of the literature.

Recurrent hyperbilirubinaemia was described as a feature of familial Mediterranean fever in the 1950s and early 1960s. However, over the last 33 years only one case has been published. We present a 12-year-old Arab boy who developed recurrent hyperbilirubinaemia in the course of familial Mediterranean fever. His response to colchicine was excellent. Review of the literature reveals that hyperbilirubinaemia of familial Mediterranean fever has a distinct clinical picture characterized by concurrent peritonitis, minimal jaundice and short duration. Factors contributing to the paucity of reports in recent literature are discussed.

Child↗
PubMed1992

Skin reactions to radiotherapy--a spectrum resembling erythema multiforme: case report and review of the literature.

Eruptions resembling erythema multiforme associated with radiotherapy are rare. Although several case reports are cited in the older literature, only recently has this phenomenon been described in patients receiving external beam radiation therapy both with and without contributory concurrent medications. The eruption typically begins within the radiation port and then generalizes; it is usually self-limited, but serious and fatal outcomes are reported. We review the literature and report a case of an eruption resembling erythema multiforme associated with external beam irradiation and 5-fluorouracil.

Adenocarcinoma↗
PubMed1997

The role of thoracic radiotherapy in the management of limited-stage small cell lung cancer: past, present, and future.

The role of thoracic radiation therapy in the management of limited-stage small cell lung cancer (SCLC) is reviewed. Although chest irradiation has been used to treat SCLC for over four decades, its standard role in the management of limited-stage disease was established only during the last decade. Multiple prospective randomized trials have shown that the addition of thoracic radiation therapy to chemotherapy usually halves local failure rates, from >60% with chemotherapy alone to about 30% with chemoradiation therapy. Additionally, survival at 3 years is also improved by 50%, from 10% with chemotherapy alone to about 15% with chemoradiation therapy. However, issues relating to the timing, volume (ie, prechemotherapy vs postchemotherapy), and the dose fractionation scheme of thoracic radiation therapy in the treatment of limited-stage SCLC still remain unresolved. Recent review of the literature indicates the most optimal timing of thoracic radiation therapy appears to be concurrent with chemotherapy vs either a sequential or an alternating approach. Studies are currently under way evaluating the optimal volume and dose fractionation scheme to use in the delivery of thoracic radiation therapy. In summary, thoracic radiation therapy significantly improves both local chest control and survival in the treatment of limited-stage SCLC.

Antineoplastic Agents↗