Biomedical subjects

Cathy Schleck

Publications and source records attributed to Cathy Schleck.

11 recordsLinked to original sources

PubMed2006

Symptoms and quality of life in community women with fecal incontinence.

BACKGROUND & AIMS: Assessments of symptom severity are necessary to guide therapy in fecal incontinence (FI). However, there is no consensus on how self-reported symptom severity in FI should be measured for this purpose, and the relationship between symptoms of FI and its impact on quality of life (QOL) is not known. METHODS: A questionnaire was mailed to an age-stratified random sample of 5300 women identified through the Rochester Epidemiology Project. Symptom severity was assessed by a validated scale (Fecal Incontinence and Constipation Assessment [FICA]), and impact on 15 domains of QOL was evaluated for subjects who had any FI during the past year. The scale incorporated the type, frequency, and amount of FI, as well as the circumstances surrounding FI (ie, urge or passive FI). A QOL-weighted symptom severity score was derived by weighting the responses for these characteristics, in each subject, by the average QOL impact for all subjects who reported that specific symptom characteristic. The relationship between symptom severity and the QOL-weighted symptom severity score was assessed by Spearman rank correlation. RESULTS: Altogether, 2800 of 5300 (53%) women responded to the survey. FI symptoms were mild (45%), moderate (50%), or severe (5%). Among women with FI, the FICA symptom severity scale was strongly correlated (r(s) = 0.92, P < .0001) with the QOL-weighted symptom severity score. CONCLUSIONS: Among unselected women in the community, self-reported symptom severity, rated by the FICA scale, was strongly correlated with the impact of FI on QOL, supporting the use of this scale to assess symptom severity in FI.

Activities of Daily Living↗

PubMed2005

Selective management of intrathoracic anastomotic leak after esophagectomy.

OBJECTIVE: We sought to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy. METHODS: All patients who had intrathoracic anastomotic leaks after esophagectomy were reviewed. Management and factors affecting outcome were analyzed. RESULTS: From March 1993 through February 2003, 761 patients had esophagectomy with intrathoracic anastomosis at our institution. Forty-eight (6.3%) patients had an anastomotic leak; one refused authorization to review his medical record and was excluded from further analysis. Twenty-four (51.1%) patients had a contained leak. Twenty-seven (57.4%) patients were managed nonoperatively. Twenty (42.6%) patients required surgical intervention that included primary anastomotic repair in 14 patients, reinforcement of the anastomosis with viable tissue in 6 patients, and esophageal diversion in 2 patients. A single reoperation was done in 15 patients, and 5 patients had 2 reoperations. Median hospitalization in the reoperative group was 31 days (range, 15-97 days) and 20 days (range, 10-42 days) in the nonoperative group ( P = .0037). Four (8.5%) patients died. Cause of death was sepsis in 2 patients and multiorgan failure and myocardial infarction in 1 patient each. At follow-up (median, 8 months; range, 1-120 months), 10 (58.8%) patients in the reoperative group were eating a normal diet and 5 (29.4%) patients required at least one dilatation compared with 20 (76.9%) patients in the nonoperative group who were eating a normal diet and 9 (34.6%) who required at least one dilatation. A noncontained leak had an adverse effect on long-term survival ( P = .04). CONCLUSION: Intrathoracic anastomotic leak after esophagectomy is associated with significant morbidity and mortality. Contained leaks often can be managed nonoperatively. When surgical management is required, esophagogastric continuity can often be maintained in the majority of patients. Long-term functional results are satisfactory and similar in both the reoperative and nonoperative groups. However, a noncontained leak adversely affected long-term survival.

Adenocarcinoma↗

PubMed2005

Dislocation rate after hip hemiarthroplasty in patients with tumor-related conditions.

BACKGROUND: Hemiarthroplasty is frequently used to treat femoral neck insufficiency resulting from neoplastic disease in the proximal part of the femur. The authors of a recent study analyzed the dislocation rates following hemiarthroplasty but excluded patients with tumor involvement of the site of the surgery as they hypothesized that the dislocation rates would be markedly higher in such patients. The current study was performed to compare the dislocation rate following hemiarthroplasties performed in patients without tumor involvement with the rate following hemiarthroplasties in patients with tumor involvement of the surgical site. METHODS: Patients who had undergone hemiarthroplasty following resection of a tumor involving the proximal part of the femur were identified in a total joint registry, and the patients' charts were reviewed retrospectively to determine dislocation rates, preoperative conditions, and postoperative outcomes and treatments. Between 1974 and 2001, 1812 patients were treated with hemiarthroplasty for reasons other than tumor involvement and 320 hemiarthroplasties were performed because of tumor-related conditions. The patients who were treated for a tumor-related condition were younger, and a higher proportion of them were men. RESULTS: The ten-year dislocation rate after the hemiarthroplasties performed for tumor-related conditions (10.9%) was higher than that following the hemiarthroplasties performed for non-tumor-related conditions (2.1%) (p = 0.002). The median time to dislocation in the patients with a tumor-related condition (twenty-four days) was shorter than that for the patients without tumor involvement (thirty-seven days). Preservation of the greater trochanter in patients with tumor involvement did not have a significant influence on the dislocation rate, but it showed a favorable trend toward decreasing that rate (hazard ratio = 3.5, p = 0.06). CONCLUSIONS: The short-term and long-term dislocation rates associated with hemiarthroplasties performed for a tumor-related condition at the site of the surgery were significantly higher than those associated with hemiarthroplasties performed for reasons other than tumor involvement. Preservation of the greater trochanter showed a trend toward decreasing the likelihood of dislocation following the hemiarthroplasty, and it was more influential than the level of resection and the extent of soft-tissue compromise. We think that preservation of the greater trochanter should be attempted when it is justifiable according to the principles of oncologic surgery.

Adolescent↗

PubMed2004

Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy.

BACKGROUND: The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy. METHODS: From 1976 to 2001, 22 patients (mean age 61 +/- 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 +/- 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients. RESULTS: Total follow-up was 82.5 patient-years (mean 3.7 +/- 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent valve replacements, and 1 required cardiac transplantation 3.4 +/- 2.8 years after valve repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their repaired valve function. Overall survival, freedom from cardiac death, and freedom from valve reoperation or cardiac transplantation at 5 years for early survivors was 66%, 85%, and 88%, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors. CONCLUSIONS: Functional status was good in two-thirds of late survivors. However, severe dysfunction of the repaired valve developed in 32% of early survivors and 16% required further surgery. Valve repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of repairs after mediastinal radiation in this series suggests that valve replacement might be preferable.

Adult↗

PubMed2004

Rotator cuff repair in patients fifty years of age and younger.

BACKGROUND: Currently, there is no information on the long-term results of rotator cuff repair in young patients. The purpose of the present study was to determine the results, the risk factors for an unsatisfactory outcome, and the rates of failure of this procedure in patients fifty years of age and younger. METHODS: Thirty-two patients (thirty-six shoulders) who were fifty years of age or younger underwent repair of a full-thickness rotator cuff tear between 1976 and 1987. Seven patients (seven shoulders) died after less than thirteen years of follow-up. The remaining twenty-nine shoulders, which had been followed for a minimum of thirteen years or until revision surgery, were included in the analysis. The most recent follow-up was performed in the clinic for five shoulders and by means of a questionnaire for twenty-four shoulders. RESULTS: There were three small, fifteen medium, six large, and five massive tears. Rotator cuff repair was associated with significant long-term pain relief (p = 0.0001). However, there was no significant long-term improvement in active abduction or external rotation. Postoperative pain, active abduction, and external rotation did not vary significantly according to gender, tear size, repair type, or whether a distal clavicular excision had been performed. There were eleven excellent, five satisfactory, and thirteen unsatisfactory results. Seven shoulders had additional surgery for the treatment of a recurrent tear (five), instability (one), or osteoarthritis (one). Three of the five repairs that were done for the treatment of a recurrent tear were performed ten years or more after the time of the index procedure. CONCLUSIONS: Rotator cuff repair in young patients is associated with long-term pain relief. However, this procedure is not associated with significant long-term improvement in motion, and a large proportion of patients have an unsatisfactory long-term result. The results of rotator cuff repair in young patients appear to be less favorable than those in a mixed-age population.

Adult↗

PubMed2003

Understanding endoluminal gastroplications: a histopathologic analysis of intraluminal suture plications.

BACKGROUND: Endoluminal gastroplication is used to treat GERD, with modest results. Little is known of the histologic reaction to endosutures. Thus, the histologic response to intraluminal plications at different penetration depths within the gastric wall was studied in an animal model. METHODS: Intraluminal gastroplications were performed through a laparotomy in 18 New Zealand rabbits. Three sets of everted plications were placed at different penetration depths in each stomach: submucosa (SMpl), muscularis propria (Mpl), and serosa (Spl). Animals were randomized to survival times of 3, 10, or 60 days (respectively, Groups I, II, and III). Plications were compared with a grade scale for each histologic healing phase and gross inspection. RESULTS: Fusion between folds was absent in all groups. Serosa differed from muscularis propria with respect to the proportion of samples with microscopic ischemia (67% vs. 8%; p = 0.015), remaining sutures in Group III (33% vs. 3%; p < 0.05 in a single test of significance, but correction for multiple testing removes this significance), and remaining plications in Group II (96% vs. 54%; p < 0.05 in a single test of significance, but correction for multiple testing removes this significance). All of the total and partial histologic scores for the corresponding healing phase in each group escalated with penetration depth. Overall comparison of the histologic scores showed a significant difference among the plications in the proliferation (Group II, p = 0.004) and maturation (Group II, p = 0.009) phases. Total scores also differed among the plications in Groups II (p < 0.001) and III (p < 0.001). Plications were absent in all of Group III, with Spl resulting only in a flat scar. CONCLUSION: Everted intraluminal gastroplications do not result in fusion between folds irrespective of suture-penetration depth. A flat scar is the final outcome and appears proportional to the amount of ischemia, foreign body reaction, and suture depth.

Anastomosis, Surgical↗

PubMed2003

Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease.

OBJECTIVES: The purpose of this study was to evaluate the role of endovascular and open surgical reconstructions in patients with superior vena cava (SVC) syndrome caused by nonmalignant disease. METHODS: Clinical data from 32 consecutive patients who underwent endovascular or open surgical reconstruction of central veins because of symptomatic benign SVC syndrome between November 1983 and June 2001 were retrospectively reviewed. RESULTS: The study included 17 male and 15 female patients (mean age, 38 years; range, 5-69 years). Presenting symptoms were head fullness (n = 26), dyspnea or orthopnea (n = 23), headache (n = 17), or dizziness (n = 11); physical signs were head swelling (n = 31), chest wall collateral vessels (n = 29), facial cyanosis (n = 18), or arm swelling (n = 17). Etiologic factors included mediastinal fibrosis (n = 19), indwelling catheter (n = 8), idiopathic thrombosis (n = 4), or post-surgery (n = 1). Two patients were heterozygous for factor V Leiden; 1 patient had antithrombin III deficiency. Twenty-nine patients underwent surgical reconstruction with 31 bypass grafts: spiral saphenous vein (n = 20), superficial femoral vein (n = 4), human allograft (n = 1), or expanded polytetrafluoroethylene (ePTFE, n = 6). Eleven patients underwent percutaneous transluminal angioplasty or stenting; 3 primary and 8 secondary endovascular procedures were performed to treat graft stenosis (n = 7) or occlusion (n = 1). There were no early deaths. Five early graft failures in 3 ePTFE grafts and 2 bifurcated vein grafts (thrombosis, n = 4; stenosis, n = 1) were successfully treated with open surgical revision. Over a mean follow-up of 5.6 years (range, 0.4-16.6 years) in surgical patients, 17 additional secondary interventions were performed in 8 patients, 14 endovascular and 3 surgical. Primary, assisted primary, and secondary patency rates of surgical bypass grafts were 63%, 79%, and 85%, respectively, at 1 year, and 53%, 68%, and 80%, respectively, at 5 years. Graft patency was significantly higher in vein grafts compared with ePTFE grafts (P =.02). Mean follow-up after percutaneous transluminal angioplasty or stenting was 3.1 years (range, 1 day-11.7 years). Twelve secondary endovascular interventions were performed in 6 patients (primary group, 3 of 3; secondary group, 3 of 9 grafts in 8 patients) to maintain patency in 11 of 12 reconstructions. Mean follow-up in the entire patient cohort was 5.3 years (range, 0.4-16.6 years). In 79% of patients symptoms had resolved or were significantly improved at last follow-up. CONCLUSIONS: Surgical treatment of benign SVC syndrome is effective over the long term, with secondary endovascular interventions to maintain graft patency. Straight spiral saphenous vein graft remains the conduit of choice for surgical reconstruction, with results superior to those with bifurcated vein and ePTFE. Endovascular treatment is effective over the short term, with frequent need for repeat interventions. It does not adversely affect future open surgical reconstruction and may prove to be a reasonable primary intervention in selected patients. Patients who are not suitable for or who fail endovascular intervention merit open surgical reconstruction.

Adolescent↗

PubMed2003

Open versus laparoscopic splenectomy for idiopathic thrombocytopenic purpura: clinical and economic analysis.

BACKGROUND: Since 1991, laparoscopic splenectomy (LS) has gained acceptance in the treatment of hematologic disorders, including idiopathic thrombocytopenic purpura (ITP). Several studies suggest that LS provides benefits over open splenectomy (OS). However, study design flaws hinder formal technology assessment. METHODS: We retrospectively reviewed medical and administrative records of patients who underwent splenectomy for ITP between January 1995 and December 2000 to compare clinical and economic outcomes associated with LS and OS. RESULTS: Eighty-six patients were identified; 42 underwent an attempted LS and 44 had OS. Preoperative patient characteristics were similar between groups. Mean operative and anesthesia times for LS and OS were 167 and 201 minutes and 119 and 151 minutes, respectively (P <.001). Overall transfusion and postoperative complication rates were similar between groups. On average, LS patients required 1.2 fewer days of parenteral analgesia and were able to tolerate a general diet 1.7 days earlier. Mean postoperative stay was 2 days lower for LS patients and mean total direct costs did not differ by surgical method (US dollars 8134 vs US dollars 8200). CONCLUSIONS: This observational study shows that LS is safe and offers advantages over OS: less postoperative pain, earlier general diet tolerance, and shorter hospital stay. These benefits are obtained at no significant additional cost.

Adolescent↗

PubMed2002

Contemporary management of acute mesenteric ischemia: Factors associated with survival.

PURPOSE: Acute mesenteric ischemia (AMI) is a morbid condition with a difficult diagnosis and a high rate of complications, which is associated with a high mortality rate. For the evaluation of the results of current management and the examination of factors associated with survival, we reviewed our experience. METHODS: The clinical data of all the patients who underwent operation for AMI between January 1, 1990, and December 31, 1999, were retrospectively reviewed, clinical outcome was recorded, and factors associated with survival rate were analyzed. RESULTS: Fifty-eight patients (22 men and 36 women; mean age, 67 years; age range, 35 to 96 years) underwent study. The cause of AMI was embolism in 16 patients (28%), thrombosis in 37 patients (64%), and nonocclusive mesenteric ischemia (NMI) in five patients (8.6%). Abdominal pain was the most frequent presenting symptom (95%). Twenty-five patients (43%) had previous symptoms of chronic mesenteric ischemia. All the patients underwent abdominal exploration, preceded with arteriography in 47 (81%) and with endovascular treatment in eight. Open mesenteric revascularization was performed in 43 patients (bypass grafting, n = 22; thromboembolectomy, n = 19; patch angioplasty, n = 11; endarterectomy, n = 5; reimplantation, n = 2). Thirty-one patients (53%) needed bowel resection at the first operation. Twenty-three patients underwent second-look procedures, 11 patients underwent bowel resections (repeat resection, n = 9), and three patients underwent exploration only. The 30-day mortality rate was 32%. The rate was 31% in patients with embolism, 32% in patients with thrombosis, and 80% in patients with NMI. Multiorgan failure (n = 18 patients) was the most frequent cause of death. The cumulative survival rates at 90 days, at 1 year, and at 3 years were 59%, 43%, and 32%, respectively, which was lower than the rate of a Midwestern white control population (P <.001). Six of the 16 late deaths (38%) occurred because of complications of mesenteric ischemia. Age less than 60 years (P <.003) and bowel resection (P =.03) were associated with improved survival rates. CONCLUSION: The contemporary management of AMI with revascularization with open surgical techniques, resection of nonviable bowel, and liberal use of second-look procedures results in the early survival of two thirds of the patients with embolism and thrombosis. Older patients, those who did not undergo bowel resection, and those with NMI have the highest mortality rates. The long-term survival rate remains dismal. Timely revascularization in patients who are symptomatic with chronic mesenteric ischemia should be considered to decrease the high mortality rate of AMI.

Acute Disease↗

PubMed2002

Shoulder arthroplasty for arthritis after instability surgery.

BACKGROUND: We are not aware of any large published studies regarding the intermediate to long-term results of shoulder arthroplasty performed for the treatment of osteoarthritis after instability surgery. Therefore, we reviewed the results of this procedure, the risk factors for an unsatisfactory outcome, and the rates of failure in our patients. METHODS: Between January 1, 1978, and December 31, 1997, thirty-three patients (thirty-three shoulders) with glenohumeral arthritis after instability surgery were treated with a shoulder arthroplasty at our institution. Two patients were excluded from the study: one died less than two years postoperatively, and one had not been managed by the senior surgeon. The remaining thirty-one patients, including twenty-one patients who had had a total shoulder arthroplasty and ten who had had a hemiarthroplasty, were followed for a minimum of two years (mean, seven years) or until the time of revision surgery. The mean age at the time of the shoulder arthroplasty was forty-six years. RESULTS: Shoulder arthroplasty was associated with significant pain relief (p < 0.001) as well as significant improvement in external rotation (from 4 degrees to 43 degrees; p < 0.001) and active abduction (from 94 degrees to 141 degrees; p < 0.001). There was not a significant difference between the hemiarthroplasty group and the total shoulder arthroplasty group with regard to postoperative external rotation, active abduction, or pain. According to a modification of the rating system of Neer et al., there were four excellent, two satisfactory, and four unsatisfactory results in the hemiarthroplasty group and three excellent, five satisfactory, and thirteen unsatisfactory results in the total shoulder arthroplasty group. Three patients in the hemiarthroplasty group and eight patients in the total shoulder arthroplasty group underwent revision surgery. The estimated survival of the components (and 95% confidence interval) was 97% (91% to 100%) at two years, 86% (74% to 99%) at five years, and 61% (42% to 86%) at ten years. CONCLUSIONS: The data from the present study suggest that shoulder arthroplasty for the treatment of osteoarthritis of the glenohumeral joint following instability surgery in this relatively young group of patients provides pain relief and improved motion but is associated with high rates of revision surgery and unsatisfactory results due to component failure, instability, and pain due to glenoid arthritis.

Adult↗

PubMedDate not supplied

Complications of total shoulder arthroplasty: are they fewer or different?

There has been significant evolution of total shoulder arthroplasty design and improvement in technique over the past 25 years, but there is no information available as to whether this has translated into lower complication rates or different sorts of complications. The purpose of this study was to determine the contemporary complications and their frequency. Between 1990 and 2000, 431 total shoulder arthroplasties were performed with a cemented all-polyethylene glenoid component. Follow-up averaged 4.2 years. Complications were categorized by type as early or late and as minor, major, or major requiring reoperation. In total, 53 surgical complications occurred in 53 patients (12%). Of these, 32 were major complications (7.4%), with 17 of these requiring reoperation. Index complications in order of frequency included rotator cuff tearing, postoperative glenohumeral instability, and periprosthetic humeral fracture. Notably, glenoid and humeral component loosening requiring reoperation occurred in only 1 shoulder. Developing a complication was unrelated to diagnosis, previous surgery, age, sex, humeral head size, or cementing or not cementing the humeral component. Data from the contemporary patient group suggest that there are fewer complications of shoulder arthroplasty and less need for reoperation. Especially striking is the near absence of component revision because of loosening or other mechanical factors. Periprosthetic humeral fractures are more common; the explanation for this warrants further study.

Adult↗