Biomedical subjects
David Rubin
Publications and source records attributed to David Rubin.
Long-term survival is superior after resection for cancer in high-volume centers.
BACKGROUND: A number of studies have demonstrated that surgical resection at high-volume centers is associated with improved short-term perioperative outcome. Whether long-term results after resection of visceral malignancies are superior at high-volume centers is largely unknown. METHODS: All patients who were subjected to pancreatectomy or hepatectomy for cancer in the years 1995 and 1996 were identified in the National Medicare database. Data extracted and examined include demographics, comorbidities, and long-term survival. All survival was confirmed through 2001, providing actual 5-year survival. Long-term survival was examined as related to hospital volume. RESULTS: In the study period, there were 2592 pancreatectomies and 3734 hepatectomies performed at 1101 and 1284 institutions, respectively. High-volume center was defined as >25 cases/y. By this definition, there were 10 high-volume centers for pancreatectomy and 12 centers for hepatectomy performing 11% (n = 291) of the pancreatectomies and 12% (n = 474) of the hepatectomies in this study period. Comparison by log-rank demonstrated superior survival for patients resected at high-volume centers (pancreatectomy: P = 0.001; hepatectomy: P = 0.02). This was confirmed by multivariate analysis. All analyses included an adjustment for within-center correlation. CONCLUSION: Superior long-term survival is associated with complex visceral resections for cancer at high-volume centers.
Subacute endocarditis caused by Gemella haemolysans and a review of the literature.
We report the first documented case of Gemella haemolysans endocarditis in the United States in a patient following denture fixation. G. haemolysans was isolated form the patient's blood cultures. The patient was treated with ampicillin for 6 weeks with significant clinical improvement. This case highlights the fact that endocarditis prophylaxis should be considered in denture fixation for high risk patients.
Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology.
In this study, we compared magnetic resonance arthrography results with hip arthroscopy findings to assess the diagnostic value of this imaging technique in evaluating acetabular labral tears and concurrent articular hip pathology. One hundred one consecutive patients (102 hips) with a clinical diagnosis of acetabular labral tear were assessed using magnetic resonance arthrography and had hip arthroscopy after failing to improve with nonoperative treatment. Magnetic resonance arthrography detected 71 of 93 (76%) acetabular labral tears (92 patients) with five false positive studies in five patients (4.9%). Articular cartilage findings diagnosed by magnetic resonance arthrography were confirmed by arthroscopy in 64 hips in 64 patients (62.7%). With respect to labral pathology, magnetic resonance arthrography showed a sensitivity of 71%, specificity of 44% positive predictive value of 93%, negative predictive value of 13%, and accuracy of 69%. With respect to articular cartilage pathology, magnetic resonance arthrography had a sensitivity of 47%, specificity of 89%, positive predictive value of 84%, negative predictive value of 59%, and accuracy of 67%. Although magnetic resonance arthrography is an excellent positive predictor in diagnosing acetabular labral tears and articular cartilage abnormalities, it has limited sensitivity. A negative imaging study does not exclude important intra-articular pathology that can be identified and treated arthroscopically.
First two patients with ulcerative colitis who developed classical thrombotic thrombocytopenic purpura successfully treated with medical therapy and plasma exchange.
The association of ulcerative colitis (UC) and thrombotic thrombocytopenic purpura (TTP) is rare. Only one prior patient with these two syndromes has been reported in the literature. In that case, splenectomy and proctectomy were performed to control the symptoms of TTP. We present two patients with UC who developed TTP and were successfully treated with multiple plasma exchanges (PEXs) in conjunction with medical therapy without the necessity for surgical intervention. Acquired TTP may be another extraintestinal autoimmune feature of UC. TTP in association with UC may be refractory to high-dose steroids and PEX, possibly requiring vincristine and splenectomy, as in the one previously reported case, to achieve remission.
Percutaneous transluminal septal reduction for hypertrophic obstructive cardiomyopathy: report from an international pilot study.
Assessing the effectiveness of newer treatments for rare diseases can be challenging because of the small number of patients treated at individual centers. We enrolled patients undergoing percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM) at five international centers (1 Japan, 2 United Kingdom, and 2 United States). Our study group developed standard data definitions regarding clinical symptom severity, previous HOCM treatment, procedure status, and outcome, and entered patient data directly into a shared, web-based registry system. In the first 10 months of 1998, 51 patients were enrolled in our registry, with 47 ultimately receiving the PTSMA procedure. Although HOCM is consider a single disease, there were significant differences among centers in patient characteristics (age, gender, and family history of HOCM), symptom severity, diagnostic techniques (measurements taken after provocation), and treatment (amount of alcohol used, timing of injection, and number of branches attempted).
The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer.
BACKGROUND: This study explores the volume-mortality relationship for 3 groups of cancer procedures to determine whether higher-volume hospitals, higher-volume surgeons, or both are associated with lower in-hospital mortality. METHODS: New York's Statewide Planning and Research Cooperative System was used to identify more than 32,000 hospital inpatients with a cancer diagnosis who underwent colectomy, lobectomy of the lung, or gastrectomy between January 1, 1994, and December 31, 1997. The association of in-hospital mortality rates with provider (hospital and surgeon) volume was examined after adjusting for differences in age, demographics, organ metastasis, socioeconomic status, and comorbidities. RESULTS: For hospital volume for gastrectomy, the highest-volume quartile had an absolute risk-adjusted mortality rate that was 7.1% lower (P <.0001) than the lowest-volume quartile, although the overall mortality rate for the procedure was only 6.2%. For surgeon volume for colectomy, the highest- and lowest- volume quartiles differed by 1.9% (P <.0001), although the procedure mortality rate was only 3.5%. For hospital volume for lung lobectomy, the absolute difference in mortality was 1.7%. Patients undergoing operations performed by high-volume surgeons in high-volume hospitals usually had significantly lower risk-adjusted mortality rates than did patients who had low-volume surgeons or who were in low-volume hospitals, or both. CONCLUSIONS: For all 3 procedure groups, the risk-adjusted in-hospital mortality is significantly lower when the procedures are performed by high-volume providers.
CT and MR Arthrography of the Glenoid Labroligamentous Complex.
Because they distend the shoulder joint and bathe the labrum with contrast, CT arthrography (CTa) and MR arthrography (MRA) are both excellent tests for evaluating the labrum. In this article, we discuss the advantages and disadvantages of each examination. We also describe techniques for performing CTa and MRA, including how to maximize image quality. The normal anatomy of the labrum and glenohumeral ligaments is described and demonstrated on both CTa and MRA images. To improve communication with orthopedic surgeons, the discussion of the pathology and normal variants of the labroligamentous complex is organized by functional anatomic regions. CTa and MRA images are then used to demonstrate a variety of pathologic and normal variant appearances of the labroligamentous complex.
Auditory hallucinations associated with migraine.
OBJECTIVE: Two children experienced auditory hallucinations during migraine (one with migraine without aura and one with migraine with aura). These hallucinations only occurred during headache. BACKGROUND: Auditory hallucinations are rarely reported in patients with migraine. These patients often have other psychiatric or neurologic disorders such as affective disorder or epilepsy. METHODS: Case report and a review of the literature. RESULTS: No other neuropsychiatric disorder was identified in either patient at presentation or upon follow-up. CONCLUSIONS: Auditory hallucinations can rarely occur in patients with migraine. Further study of this association might provide insight to any relationship between migraine, auditory hallucinations, and the temporal lobe.
Choosing a child and adolescent psychiatry residency.
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