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Biomedical subjects

A Rothman

Publications and source records attributed to A Rothman.

At least 91 records · Page 5Linked to original sources
PubMed1990

Reliability and validity of the objective structured clinical examination in assessing surgical residents.

The purpose of this research was to assess reliability and construct validity of the objective structured clinical examination (OSCE) for evaluating the clinical skills of surgical residents. Reliability refers to precision of the examination and construct validity to the degree to which the examination can discriminate between different levels of training. Twenty-seven second postgraduate year surgical residents took a 38-station OSCE representing seven surgical specialties and that tested history-taking, physical examination, problem-solving, technical skills, and attitudes. A couplet methodology was used wherein a patient encounter was followed by written questions aimed at testing problem-solving and patient management capabilities. Thirty-six standardized patients were trained and 36 surgeons served as examiners marking from structured checklists. Overall reliability, Cronbach's alpha, was 0.89. Construct validity was examined by comparing the scores of the residents with those of a group of graduates of foreign medical schools applying for a "pre-internship" program. For 17 of 19 stations that both groups took, the residents performed significantly better (p less than 0.01). Individual station validity was significant for 32 of 38 stations (r = 0.36 to 0.82, p less than 0.05). The examinations took 3.83 hours at a cost of $5,293 (Canadian dollars). The OSCE has been shown to be a reliable method of assessing clinical skills of surgical residents, construct validity has been established, and inter-item validity confirmed. Reliabilities achieved exceed those traditionally required for both acceptance and promotion decisions.

Analysis of Variance↗
PubMed1990

Balloon dilation of branch pulmonary artery stenosis.

We consider balloon angioplasty to be an established, highly useful procedure in the management of branch pulmonary artery stenosis. It is successful in approximately 60% of cases. Current figures would indicate a low but significant mortality rate (1%) and a risk of aneurym formation (3%). Patients undergoing balloon angioplasty in the acute postpulmonary artery surgical period constitute a particularly high risk group for vessel rupture. Restenosis after branch pulmonary dilation is infrequent, but does occur. Further improvements in the use of this procedure should probably involve the use of expandable intravascular stents for patients with failed dilations or evidence of restenosis.

Aneurysm↗
PubMed1989

Pulmonary hypertension and asthma in two patients with congenital heart disease.

Reactive airway disease has only rarely been associated with pulmonary hypertension. We treated two patients with congenital heart disease and asthma who had increased pulmonary arterial pressure at cardiac catheterization. Pulmonary hypertension could not be explained solely by the cardiac lesion, nor by respiratory mechanical factors, as the patients did not have wheezing during the catheterization study. After long-term treatment with bronchodilators, corticosteroids, and oxygen, and coincident with improvement in the airway disease, there was catheterization-proved diminution of pulmonary hypertension. Whether asthma and pulmonary hypertension were causally linked is unknown, but further work seems indicated to elucidate the relationship between bronchoconstriction and pulmonary vasoconstriction. Furthermore, aggressive management of even mild reactive airway disease may be warranted in patients with pulmonary hypertension, regardless of apparent cause.

Asthma↗
PubMed1989

Upper thoracic disk herniation secondary to vertebral metastases.

Thoracic disk herniations are exceedingly rare, particularly those in the upper thoracic region. The etiology of these protrusions is generally considered to be either traumatic or degenerative in nature. A case of upper thoracic disk herniation secondary to destructive changes caused by breast cancer metastatic to the vertebral body is presented.

Aged↗
PubMed1987

Incisional adenocarcinoma after intracranial metastasis resection.

Skin and subcutaneous secondary tumors are unusual, especially in cases of colonic adenocarcinoma. They usually signify disseminated metastases. A rare case of an isolated incisional tumor after resection of a metastasis to the cerebellum is presented. The pathophysiology and management of such an event is discussed. The clinical setting suggests that this occurrence represented the result of microscopic deposits of neoplastic cells in the wound rather than hematogenous spread.

Adenocarcinoma↗
PubMed1987

Surgical management of subaortic obstruction in single left ventricle and tricuspid atresia.

Subaortic obstruction caused by either a restrictive bulboventricular foramen in single left ventricle with an outflow chamber or by a restrictive ventricular septal defect in tricuspid atresia with transposition of the great arteries can lead to a hypertrophied, noncompliant ventricle and excessive pulmonary blood flow. This combination is disadvantageous to potential Fontan procedure candidates because they are dependent on good ventricular function and low pulmonary vascular resistance for survival. The results of surgical procedures to directly or indirectly relieve significant subaortic obstruction (gradient greater than 30 mm Hg) in 24 patients, 16 with single left ventricle and 8 with tricuspid atresia, were reviewed. Four patients had a left ventricular apex to descending aorta valved conduit; none survived. Seven patients had resection of subaortic tissue; four survived and four developed heart block at surgery. Adequate gradient relief was evident in only one of the four survivors. Thirteen patients had a main pulmonary artery to ascending aorta anastomosis or conduit; six survived. All survivors had adequate gradient relief. The overall survival was 42% (10 of 24). None of seven patients with a subaortic gradient greater than 75 mm Hg survived. These data show that: Surgical relief of established subaortic obstruction in patients with single left ventricle and tricuspid atresia carries a high mortality rate, especially if the subaortic gradient is greater than 75 mm Hg. The best procedure appears to be the pulmonary artery to ascending aorta anastomosis. A clearer understanding of the factors leading to the development of significant subaortic obstruction is necessary to prevent it or to devise improved therapeutic strategies.

Adolescent↗
PubMed1987

Hemodynamic analysis of associated extracranial atraumatic vertebral artery aneurysm and arteriovenous fistula. Case report.

A case of atraumatic arteriovenous (AV) fistula of the extracranial vertebral artery associated with an atraumatic aneurysm of the contralateral extracranial vertebral artery is reported. The fistulous lesion was excised after distal and proximal ligation of the vessel. Subsequently, the contralateral aneurysm underwent spontaneous dissolution. Seven cases of extracranial vertebral AV fistulae associated with ipsilateral vertebral artery aneurysms (four traumatic and three as part of vascular dysplastic syndromes) have been reported previously.

Adult↗
PubMed1986

General practitioners' retirement plans and what influences them.

The results of a study of the attitudes of 197 general practitioners aged 55 and over towards retirement and their plans for retirement are reported. Few wished to retire very early, and only a further 40% definitely planned a clean break from practice. Nearly half planned on taking "24 hour retirement," even though most (78%) will be entitled to full pension rights. Job satisfaction and health were the most important factors influencing the timing of the retirement. Seventy seven per cent thought that there should be no formal retirement policy, 79% wanted no compulsory retirement age, and 80% wanted no further controls or safeguards directed at older practising general practitioners. Half of the general practitioners in the sample were not looking forward to retirement. Personal discussions with respondents aged 65 and over suggested that there are many older general practitioners who plan to practise for some time, who feel that they will know when the time has come to stop, but who often express the hope that they may "die in harness." A large proportion of older doctors are in single-handed practice. In view of this, and also of the evidence from North America which suggests that older doctors may practise inferior medicine, it is thought that the ability of such general practitioners to evaluate their competence should be studied by methods such as peer assessment techniques.

Age Factors↗
PubMed1983

Aids to cardiac auscultation.

Despite the wide application of aids for cardiac auscultation, their diagnostic efficacy has not been comprehensively evaluated. The most commonly used auscultatory aids, including respiration (Carvallo's maneuver), Müller and Valsalva maneuvers, squatting, standing, handgrip, intrinsic cycle length changes, and amyl nitrite, are discussed. A review of the literature suggests that enthusiasm for these aids must be tempered because of limitations in sensitivity and specificity as well as weaknesses in the methods used in the validation studies.

Amyl Nitrite↗
PubMed1980

A method for the ultrastructural demonstration of non-specific esterase in human blood and lymphoid tissue.

Using the substrate 2-naphthylthiol acetate (NTA), we developed a reproducible method of demonstrating a non-specific esterase while retaining nuclear and cytoplasmic details at the ultrastructural level. The NTA esterase had a distribution and pattern of staining similar to those of esterases demonstrable at the light microscopic level by the alpha-naphthyl acetate or naphthol AS-D acetate esterase reaction. The NTA esterase appeared as intensely electron-dense granules of varying size and shape in the cytoplasm. The granules were most abundant in the cells of the histiomonocytic series. The large number of diffusely scattered granules in the cytoplasm of the histiocytes and monocytes made it possible to separate these cells from other haematopoietic elements. There was usually no direct relationship between the NTA esterase positivity and the amount or the location of lysosomes or mitochondria, although in some histiocytes the granules appeared to be associated with lysosomes. The NTA esterase-positive granules were usually more numerous than lysosomes and were located outside the lysosomal granules. Some of the lymphocytes outside the germinal centres and most of the lymphocytes in the blood showed a punctate positivity in the form of 1--4 electron-dense dots. Plasma cells were usually negative but, in rare cases, contained an occasional single dot-like reaction product similar to that in some of the lymphocytes. Granulocytes were always negative. The method described in this paper can be used effectively for identification and study of human haematopoietic cells lines at the ultrastructural level.

Carboxylic Ester Hydrolases↗