Biomedical subjects

C Katholi

Publications and source records attributed to C Katholi.

4 recordsLinked to original sources

PubMed2001

Fast-tracking pulmonary resections.

OBJECTIVE: We streamlined our care after pulmonary resection for quality and cost-effectiveness. METHODS: A single surgeon performed 500 consecutive pulmonary resections through a thoracotomy over a 2(3/4)-year period in a university setting. Patients were extubated in the operating room and sent directly to their hospital room. Chest tubes were placed to water seal and removed on postoperative day 2 if there was no air leak and drainage was less then 400 mL/d. Epidural catheters were used and removed by postoperative day 2. The plan for each day and discharge on postoperative day 3 or 4 was reviewed with the patients and families daily during rounds. The patient went home the day the last chest tube was removed. Persistent air leaks were treated with Heimlich valves. RESULTS: There were 500 patients (338 men), with a median age of 58 years (range, 3-87 years). Of these patients, 293 had pre-existing conditions. Seventy-three (15%) patients had been denied operations by at least one other surgeon. Four hundred nineteen (84%) patients had successful placement of a functioning preoperative epidural catheter. Pneumonectomy was performed in 32 (6%) patients, segmentectomy was performed in 16 (3%) patients, and lobectomy, sleeve lobectomy, and/or bilobectomy was performed in 194 (39%) patients. Nonanatomic resections were performed for metastasectomy. This included a single wedge resection in 161 (32%) patients and multiple wedge resections in 97 (19%) patients. A total of 482 (96%) patients were extubated in the operating room, and 380 (76%) patients were sent to their hospital room. The remaining 120 patients went to the intensive care unit for a median of 1 day (range, 1-41 days). Complications occurred in 107 (21%) patients, and operative mortality was 2.0%. Median day of discharge was postoperative day 4 (range, 2-119 days). A total of 327 (65%) patients left the hospital on postoperative day 4 or sooner. By survey, 97% of patients had excellent or good satisfaction with their care at hospital discharge, and 91% were extremely happy or satisfied at the 2-week follow-up contact. CONCLUSIONS: Most patients who undergo elective pulmonary resection can be extubated immediately after the operation, go directly to their room and avoid the intensive care unit, be discharged on postoperative day 3 or 4, and have minimal morbidity and mortality with high satisfaction both at discharge and at the 2-week follow-up contact. Techniques that seem to accomplish this include the following: the use of a water seal, removal of epidural catheters on postoperative day 2, early chest tube management, treatment of persistent air leaks with Heimlich valves, and daily reinforcement of the planned events for each day, as well as on the date of discharge with the patients and their families.

Adolescent↗

PubMed2001

Decline in US stroke mortality: an analysis of temporal patterns by sex, race, and geographic region.

BACKGROUND AND PURPOSE: Although stroke mortality rates have declined rapidly over the past 30 years, the decline has slowed to a plateau. Here, we assess whether the race-sex-region groups have participated equally in this decline and whether there are groups in which stroke mortality rates are still declining, and we predict how these rates will eventually differ. METHODS: Data on stroke mortality in the United States between 1968 and 1996 were analyzed in a 3-step procedure: (1) we calculated "crude" age-adjusted stroke mortality rates by race, sex, and county; (2) we "smoothed" the rates across counties and years; and (3) we fit a model to describe the temporal pattern. From this model we calculated the percent decline in stroke mortality, the anticipated additional decline (thereby identifying regions that will continue to decline), and the anticipated eventual stroke mortality rates. RESULTS: Maps by race-sex-region group describe the above parameters. White men have experienced the largest decline in stroke mortality, and black men have seen the smallest. Generally, stroke mortality appears to still be slowly declining for blacks but not for whites. Geographic differences in stroke mortality are predicted to persist. CONCLUSIONS: The analysis suggests that the Deep South (Alabama and Mississippi) will fall from the stroke belt and be replaced by other regions (notably Oregon, Washington, and Arkansas). New York City and southern Florida had low stroke mortality rates in 1968, have experienced large declines, and continue to experience declines, resulting in even larger relative heterogeneity of stroke mortality rates. The reasons for these differences in the pattern of the decline in stroke mortality are not understood.

Black People↗

PubMed1995

The effect of mobilization on cervical headaches.

Headaches of cervical origin are often treated with mobilization. Mobilization of the upper cervical spine, occiput-C3, and effect on frequency, duration, and intensity of cervical headaches were studied utilizing an A-B-A single case design. Ten subjects who met the operational criteria of cervical headaches completed the study. A headache log was used to document headache frequency, duration, and intensity throughout all three phases (A-B-A). The baseline phase (A) lasted approximately 1 month, and no intervention was performed. The intervention phase (B) consisted of 9-12 treatment sessions, two times per week for 3-4 weeks. Visual analysis of data plots revealed a decrease in headache frequency, duration, and intensity from the baseline phase to the treatment phase. This improvement continued through the second A phase for frequency but leveled off for both duration and intensity. A one-way analysis of variance supported the findings from the visual analysis. In these 10 subjects, mobilization had a therapeutic effect on cervical headaches.

Adult↗

PubMed1983

The comparative effects of organic brain disease on cerebral blood flow and measured intelligence.

Raw scores for cerebral blood flow (CBF), determined by xenon 133 inhalation, and for Wechsler Adult Intelligence Scale (WAIS) were measured in five groups of 12 subjects each: young normals, aged normals, and patients with cerebrovascular disease without dementia, dementia with cerebrovascular disease, and degenerative brain disease. Important differences were present in the raw data according to age and sex. When these were adjusted, a quadratic model revealed a highly significant (p less than 0.0001, r = 0.86) correlation between CBF and measured intelligence score. We interpret these findings to indicate that in dementing illnesses the WAIS raw score reflects the severity of the brain disorder, regardless of cause, and that CBF is reduced as a function of the severity rather than the cause of the abnormality.

Adult↗