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Biomedical subjects

D Tenney

Publications and source records attributed to D Tenney.

9 recordsLinked to original sources
PubMed1997

Assessment of the economic impact of an overage reduction program in the operating room.

STUDY OBJECTIVES: To delineate excessive supply preparation in the operating rooms (ORs) of Yale-New Haven Hospital, and to measure the reduction in such overage as a result of nursing and administration cost-containment efforts. DESIGN: Before and after trial. SETTING: Inpatient ORs of Yale-New Haven Hospital. INTERVENTIONS: After the initial documentation of overage, several cost-containment measures were instituted, including nursing education, review of overage data, and updating of surgical request lists. MEASUREMENTS AND MAIN RESULTS: The hospital cost of case-specific overage generated by all surgical procedures performed during two 2.5-month periods in 1992 and 1994 (before and after the interventions) were compared. One-thousand three hundred eighteen cases in 1992 were compared with 1,367 cases in 1994. A 45% reduction in mean per case overage occurred between the two assessment periods. Extrapolation of the data to the incidence of similar cases throughout the United States projected a comparable savings. CONCLUSIONS: Efforts to increase the efficiency of OR supply management can be measured, in part, by overage evaluation, which can serve as a resource for focusing efforts at cost-containment.

Cost Control↗
PubMed1990

Long-term serum creatinine values after radical nephrectomy.

Both pre- and postnephrectomy levels of serum creatinine were measured in 52 consecutive patients who underwent radical nephrectomy for localized renal cell carcinoma between 1971 and 1976. At the time of follow-up, 17 patients were alive and 35 had died, 14 of renal cell carcinoma and 21 of other causes. Follow-up lasted a minimum of 115.5 months (mean 151.1 months, median 141.1, range 115.5-211.3 months) for 16 of the 17 patients who were alive. In this group only 2 patients had elevations in the serum creatinine level above 1.6 mg/dL-1.9 mg/dL and 2.4 mg/dL, respectively. The patient whose value was 2.4 mg/dL was a diabetic who required insulin. No serious renal failure, renal disease, or tumors in the contralateral kidney occurred among the total group of 52 patients. These data indicate that renal function remains adequate in patients who have a normal contralateral kidney and are treated by radical nephrectomy.

Carcinoma, Renal Cell↗
PubMed1989

Are frozen-section examinations of ureteral margins required for all patients undergoing radical cystectomy for bladder cancer?

Unsuspected malignant disease was discovered by frozen-section examination of the ureteral margins in 8 of 403 patients (2%) undergoing cystectomy for treatment of bladder cancer. Once malignant disease was demonstrated, a short segment of the proximal ureter was resected in 6 patients; in 5 instances dysplastic changes remained at the second margin, which was anastomosed to the bowel. No clinically recognized tumor developed at this site in any of the 8 patients. In an additional 26 instances (19 patients), dysplastic changes were known to be present in the ureteral margin at the time of ureteroenteric anastomoses. Again, no recognizable tumor has developed at the anastomotic site after a median follow-up of six years. We conclude that frozen-section examinations of the ureteral margins prior to constructing the ureteroenteric anastomosis are not indicated for the patient undergoing routine cystectomy for bladder cancer, but should be reserved for patients who are at increased risk for carcinoma in situ (those with multifocal bladder carcinoma in situ or transitional cell carcinoma of the prostatic ducts).

Follow-Up Studies↗
PubMed1989

Are lymphangiograms necessary before placing patients with nonseminomatous testicular tumors on surveillance?

Lymphangiographic findings in 174 patients with early stage nonseminomatous testicular tumors were evaluated retrospectively to determine the need to perform the procedure before patients are placed on surveillance. When physical examination, chest x-ray, computerized tomographic scans and serum tumor marker levels were normal, lymphangiography detected unsuspected metastasis in only 4 per cent of the patients, while providing misinformation in another 4 per cent. Plain radiographs of 99 patients on surveillance taken at 2-month intervals resulted in only 1 instance when the x-rays became positive and were the first evidence of metastasis. These findings indicate that routine lymphangiography is not necessary to assess the retroperitoneum when computerized tomography and the serum tumor markers are unequivocally normal.

Follow-Up Studies↗
PubMed1988

Ketoconazole therapy for hormonally refractive metastatic prostate cancer.

Twenty-two patients who had progressive metastatic prostatic carcinoma (Stage D2) despite androgen-deprivation therapy (bilateral orchiectomy, 10 cases; bilateral orchiectomy followed by diethylstilbestrol, 7 cases; diethylstilbestrol, 3 cases; combined megestrol acetate and low-dose estrogen, 2 cases) were treated with ketoconazole. Of 19 evaluable patients, 2 (11%) achieved a partial response (for 6 and 8 months) and 7 others (37%) achieved stabilization of disease (for periods of 3-8 months). Of 16 patients in whom pain was a prominent clinical feature, 13 (81%) noted improvement in pain for periods of one to eight months (median 3 months). We conclude that ketoconazole is a useful addition to our current armory for management of patients with metastatic prostatic cancer resistant to prior hormonal therapy.

Aged↗
PubMed1988

Medical castration using megestrol acetate and minidose estrogen.

Sixty-two men who presented with previously untreated metastatic carcinoma of the prostate (D0: 10 patients; D1: 29 patients; D2: 23 patients) received oral megestrol acetate (80 mg twice daily) and minidose estrogen (diethylstibestrol 0.1 mg or ethinyl estradiol 0.05 mg once daily) as a means of achieving total androgen ablation (testicular and adrenal). A high incidence of feminizing side effects (70-74%), a higher than expected rate of cardiovascular complications (18%), an unexpected need for cortisone replacement (13%), and failure of patients with Stage D2 disease to obtain results better than those of standard therapy during the first year of observation suggest this regimen offers no advantage over other more conventional therapy.

Adenocarcinoma↗