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Biomedical subjects

Alan T Lefor

Publications and source records attributed to Alan T Lefor.

10 recordsLinked to original sources
PubMed2005

Total circulatory arrest for the replacement of the descending and thoracoabdominal aorta.

HYPOTHESIS: Hypothermic total circulatory arrest (TCA) in the resection and replacement of the thoracoabdominal and descending thoracic aorta is safe, will significantly decrease the incidence of postoperative renal failure, and should be preferentially performed over left heart bypass (LHB). DESIGN: Retrospective review case series. SETTING: Large, private, urban teaching hospital. PATIENTS: All adult patients with aortic disease that involved the distal aortic arch, the descending thoracic aorta, or the thoracoabdominal aorta who underwent resection and graft replacement of the diseased segment via LHB or TCA at our institution from 1989 to 2001 are included in this study. A total of 59 patients were evaluated: 10 had descending thoracic aneurysms, 20 had thoracoabdominal aneurysms, 22 had chronic type B dissections, 4 had acute type B dissections, and 3 had adult coarctations. INTERVENTIONS: In 1989 to 1994, LHB was primarily used; in 1994 to 2001, TCA was primarily used. MAIN OUTCOME MEASURES: Renal failure, 30-day operative mortality, paraplegia, and any other morbidities. RESULTS: A significant decrease occurred in the incidence of postoperative renal failure from 15% (3/20) in patients who underwent LHB to 0% (0/39) in patients who underwent TCA (P = .04). Furthermore, a significant decrease occurred in the 30-day operative mortality, which decreased from 20% (4/20) in patients who underwent LHB to 5% (2/39) in patients who underwent TCA (P = .04). Postoperative paraplegia decreased from 5% (1/20) in patients who underwent LHB to 2.6% (1/39) in patients who underwent TCA (P > .99). CONCLUSIONS: Our use of TCA in the resection and replacement of the diseased thoracoabdominal and descending thoracic aorta has produced excellent results. Our patients have experienced no postoperative renal failure and a low 30-day operative mortality. The use of TCA in this patient population is a viable option for surgeons comfortable with the technique.

Adult↗
PubMed2005

Attitudes regarding surgeons' attire.

BACKGROUND: No studies to date exist regarding the attire of physicians on a surgical service. The objective of this study was to determine patient, surgeon, and nonhospitalized public (NHP) attitudes and preferences regarding surgeons' attire and mannerisms. METHODS: A questionnaire was developed to survey each group. The Internet was used as a novel avenue to survey the NHP. Eight questions were presented to each group, and each question had three possible responses: agree, disagree, or no opinion. Total responses and percentages were determined for each group's answers, and statistical analysis was performed using chi-square test. RESULTS: Thirty-eight surgical inpatients, 38 surgeons, and 334 NHP participated in the study. All groups agreed that surgeons should wear nametags while they are seeing patients. Inpatients agreed with surgeons that surgeons should wear white coats while seeing patients (P > .05). Surgeons considered scrubs and clogs to be acceptable attire, which differed from all other groups (P < .05). Although 31% of the NHP considered blue jeans acceptable, only 10% of surgeons (P < .05) and 22% of patients (P > .05) considered them acceptable. All groups believed that a surgeon's appearance influences their perceptions and impressions regarding the quality of medical care they received (P < .05). CONCLUSIONS: Based on the agreement of all groups that a surgeon's appearance and mannerisms affects perceptions of the quality of medical care received, surgeons should respond to these perceptions and dress accordingly while seeing surgical patients.

Attitude of Health Personnel↗
PubMedDate not supplied

Scientific misconduct and unethical human experimentation: historic parallels and moral implications.

Although a great deal of human experimentation has been performed to elucidate information otherwise not obtainable, there are many recorded instances of unethical human experimentation. There is also a history of crimes that were committed and disguised as human experiments, best exemplified by the activities of some physicians in Nazi Germany from 1933 until 1945. As a direct result of these activities, a war-crimes trial after World War II resulted in the creation of the Nuremberg Code, to guide future human experimentation. Despite this, unethical experiments were conducted at major academic institutions in the United States in the years after World War II by otherwise normal physicians who did not feel that the Nuremberg Code applied to them personally. There are several possible explanations for such activities, but the desire for personal advancement is prominent among these. Episodes of scientific misconduct such as falsification of experimental data or of personal qualifications seem to be more commonly reported recently and have also been described in the popular press. This activity may also be motivated by desire for personal advancement, giving it a parallel to the conduct of unethical human experimentation. Education may be the best way to prevent these activities that may have similar motivating factors.

Codes of Ethics↗
PubMedDate not supplied

The physiologic effects of laparoscopy: applications in oncology.

The use of laparoscopic approaches to surgical disease continues to advance quickly. Laparoscopy applied to oncologic surgery continues to be debated. We review the experience of laparoscopy as it relates to surgery for tumors. Specifically, we discuss the physiologic changes and tumor response to laparoscopy, as well as the current concepts explaining port site recurrence.

Humans↗
PubMedDate not supplied

Minimally invasive treatment of stomach cancer.

The rate of detection of early gastric cancer has increased because of the development of diagnostic techniques, such as endoscopy, biopsy, and endoscopic ultrasonography. Recently, minimally invasive surgical procedures for benign gastric conditions have been advocated, and the laparoscopic approach is noted as a technique that increases the quality of life. However, the development of laparoscopic gastric resections and laparoscopically assisted gastric operations for malignancy still deserve a word of caution. Laparoscopic local resection of the stomach is used to treat mucosal cancer without lymph node metastasis, and laparoscopy-assisted distal gastrectomy is used to treat early gastric cancer with lymph node metastasis in the perigastric portion. According to short-term results reported by a small group of surgeons, laparoscopic approaches for gastric cancer result in a minimally invasive approach, early recovery, and decreased morbidity and mortality. However, the longterm results of these less invasive treatments are not known in advanced gastric cancer. If the results of randomized controlled studies for advanced gastric cancer are confirmed, the use of these techniques will spread worldwide and may become a standard technique for the resection of gastric cancer.

Clinical Trials as Topic↗