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Biomedical subjects

F A Garcia

Publications and source records attributed to F A Garcia.

17 recordsLinked to original sources
PubMed2001

Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth.

OBJECTIVE: To determine whether the academic affiliation and obstetric volume of the delivering hospital has an impact on clinical and economic outcomes. METHODS: We performed a cross-sectional analysis of data for all births in the State of Maryland during 1996. Acute hospital discharge data were obtained from the publicly available Maryland Health Services Cost Review Commission database. Institutions were classified as community hospitals, community teaching hospitals, and academic medical centers. Principal outcome variables included cesarean birth and complication rates, total hospital charges, and length of stay. RESULTS: A total of 63,143 cases were identified for analysis. The cesarean delivery rate was lower among academic medical centers, compared with community teaching hospitals and community hospitals (18.4% compared with 24.3% and 21.2%, respectively). After adjustment for patient case-mix, the adjusted odds ratio (OR) for cesarean birth was 0.66 at academic medical centers and 1.23 at community teaching hospitals compared with community hospitals (P <.01). Rates of episiotomy and serious complications were lower at academic medical centers compared with community hospitals. Adjusted total hospital charges were lower and length of stay was shorter for community hospitals compared with academic medical centers ($2937 compared with $3564 and 2.2 days compared with 2.5 days, respectively). CONCLUSION: Hospital academic affiliation was an important predictor of clinical outcomes. Better clinical outcomes were found primarily among patients at academic medical centers, although these institutions demonstrated moderately higher resource utilization, compared with community hospitals.

Academic Medical Centers↗
PubMed2001

Progression curves for endometrial lesions.

OBJECTIVE: To derive a numeric measure for the progression of endometrial lesions as a baseline study for an eventual assessment of chemopreventive intervention efficacy. STUDY DESIGN: Tissue sections from normal endometrium at the proliferative and secretory phase, simple hyperplasia, atypical hyperplasia from cases free of concomitant adenocarcinoma and adenocarcinoma of the endometrium were recorded at high spatial resolution. Six cases from each diagnostic category were chosen as "typical," and 60 epithelial nuclei were randomly selected for measurement for each case. Discriminant analyses were carried out to derive a direction of progressive change in feature space and to correct the progression curve for the presence of cells not expressing progressive change among the random sample of nuclei. RESULTS: A well-conditioned progression curve was derived based on the mean discriminant function scores for each diagnostic category and the mean nuclear abnormality of the nuclei in each category, as expressed by their deviation in feature values from normal reference nuclei. The lesion signatures showed a clear trend toward extension into the range of higher nuclear abnormalities with increasing progression. There was an indication that abnormal endometrial lesions may comprise cases with distinctly different degrees of nuclear abnormality. CONCLUSION: A numeric assessment of lesion progression for endometrial lesions, based on karyometric measurements, is possible. The data suggest that additional analysis may provide further characterizing information for individual lesions.

Adenocarcinoma↗
PubMed2001

Nuclear chromatin patterns in normal, hyperplastic and atypical endometrium.

OBJECTIVE: To characterize the nuclei of endometrial lesions for the diagnostic categories of normal glandular tissue, simple hyperplasia, atypical hyperplasia and adenocarcinoma of the endometrium, with the specific goal of probing for heterogeneity. STUDY DESIGN: For each diagnostic category the images of 360 nuclei were recorded on a high-resolution video microphotometer. Features descriptive of the statistical and spatial distribution of nuclear chromatin were computed for each nucleus. A nonsupervised learning algorithm, P-index, was employed to establish subsets of nuclei within each diagnostic category and to determine whether these subsets were statistically significantly different in the nuclear chromatin pattern. RESULTS: Lesions from cases of hyperplasia, atypical hyperplasia and adenocarcinoma of the endometrium each contained several subsets of nuclei with statistically significantly different chromatin patterns. For one such subset from each diagnostic category, a clear trend of progression toward adenocarcinoma could be demonstrated. CONCLUSION: The nuclei in endometrial lesions represent a highly heterogeneous set. Any measure of lesion progression or regression due to chemopreventive intervention, in an individual case, will have to examine the proportion of nuclei in each of these subsets as well as measures of deviation from normal for each subset.

Adenocarcinoma↗
PubMed2000

Economic and clinical outcomes of microlaparoscopic and standard laparoscopic sterilization. A comparison.

OBJECTIVE: To compare micro-laparoscopic surgical sterilization and standard laparoscopic sterilization with respect to cost effectiveness and patient preferences. STUDY DESIGN: A retrospective study of all laparoscopic surgical sterilizations performed under general anesthesia at Johns Hopkins Bayview Medical Center--16 micro-laparoscopies and 34 standard laparoscopies. Cases selected for review were limited to patients undergoing surgical contraception and not requiring additional, concurrent procedures. Laparoscopic surgical sterilization was performed using a double-puncture technique with silicone band application. In each case either a standard, 10-mm laparoscope or a 2-mm micro-laparoscope was used, and the procedure was performed under general anesthesia. Postoperative pain management was achieved by nonsteroidal antiinflammatory drugs and/or narcotic analgesia. All cases were performed by residents under faculty supervision. Medical records and hospital billing records were reviewed, and a standardized telephone interview was conducted to assess postoperative quality of life and patient satisfaction. RESULTS: Both techniques were comparable in cost effectiveness. There was no significant difference in operating room time, average operating room costs, average ancillary department costs, instrument and supply costs, or length of stay. Postoperative discomfort was significantly less with microlaparoscopy (P = .05), and patient satisfaction was higher in the microlaparoscopy group. CONCLUSION: Microlaparoscopy and the standard laparoscopic approach for surgical sterilization are associated with similar hospital charges. Postoperative pain and overall patient satisfaction were significantly better with microlaparoscopy than standard laparoscopy.

Arizona↗
PubMed1997

Implantable hormonal and emergency contraception.

Recent publications about emergency and implantable contraception focused on increasing the awareness about emergency contraceptive methods and on updating readers about the controversies surrounding Norplant. Both emergency and implantable contraception have excellent safety and efficacy profiles, yet neither has realized its potential for widespread use. This review addresses these concerns and attempts to place these issues in perspective.

Contraception↗
PubMed1996

Laparoscopic ovarian cystectomy for a benign teratoma in a 10-year-old girl.

A 10-year-old girl was diagnosed with an 8-cm mature cystic teratoma. An outpatient ovary-conserving cystectomy was performed, and the girl recovered fully in 24 hours. We suggest that laparoscopy can be effective in the conservative management of some gynecologic disorders in properly selected children.

Child↗
PubMed1992

Kinetics and stability of a Chromobacterium viscosum lipase in reversed micellar and aqueous media.

The lipolytic activity of Chromobacterium viscosum lipase B (EC 3.1.1.3.; triacylglycerol hydrolase) solubilized both in water and AOT/isooctane reversed micelles has been investigated using triolein as a substrate. The influence of relevant parameters in the catalytic activity such as temperature, pH, surfactant and substrate concentrations, and water content was tested and compared in both media. A study of stability of the lipase was carried out, with particular reference to the influence of pH. Three major effects of the encapsulation of the lipase in the micelles were observed: increased activity (up to 7 times higher than in water), greater stability, specially at pH 7, and higher resistance to thermal deactivation.

Chromobacterium↗
PubMed1992

Human pharmacokinetics and radiopharmacological studies of the myocardial perfusion agent: technetium (2-carbomethoxy-2-isocyano-propane)6+.

The myocardial perfusion agent technetium (2-carbomethoxy-2-isocyano-propane)6+ (99mTc-CPI) is unique from other cationic technetium isonitrile complexes in that it exhibits moderate washout from the heart and rapid hepatobiliary clearance in animal models and human volunteers. Dynamic imaging and HPLC analysis were performed in humans and guinea pigs to outline the pharmacological basis of its pharmacokinetics. Enzymatic hydrolysis of the terminal ester groups in blood was found to occur at a moderate rate producing new species that have been shown not to accumulate in heart tissue. However, after extraction by the heart, liver or kidneys, the 99mTc-CPI complex undergoes metabolism at a much slower rate than observed in the blood. Differences in hydrolysis rate and products obtained indicate separate mechanisms of hydrolysis occurring in blood and other organs. It is proposed that the heart washout occurring after hydrolysis produces a neutral compound which is no longer retained by the negative cytosolic and mitochondrial membrane potentials in myocardial tissue.

Adult↗
PubMed1980

Diastematomyelia in an adult.

Surgical treatment of diastematomyelia, with removal of the spur and dural septum, is indicated in adults with progressive symptoms. The patient may improve, or at least the progression of the neurological damage may be halted. The utilization of microneurosurgical techniques was found to be of value in decreasing the danger of spinal cord or nerve injury during the procedure. The seventh case reported in the literature of diastematomyelia with onset of symptoms in adult life is presented.

Adult↗
PubMedDate not supplied

Association between polycystic ovary syndrome and glucose intolerance during pregnancy.

The purpose of our study was to determine if women with polycystic ovary syndrome are more likely than other women with infertility to develop gestational diabetes. All women who were successfully treated for infertility in the reproductive endocrinology clinic at the University of Arizona Health Sciences Center from January 1, 1990, to January 1, 1995, were identified. A retrospective cohort study was performed comparing the incidence of gestational diabetes and abnormal diabetic screening tests among subjects with polycystic ovary syndrome (N = 24) and a general infertility control group (N = 44). The incidence of gestational diabetes diagnosed in subjects with a history of polycystic ovary disease was similar to the incidence of gestational diabetes in subjects with infertility not ascribed to polycystic ovary disease (four subjects, 16.7% v. three subjects, 6.7%; relative risk [RR] 2.05, 95% confidence interval [CI] 0.31-13.57). A greater number of subjects with polycystic ovary syndrome had a positive diabetic screening test compared to the control group (13 subjects, 54% v. 10 subjects, 23%; RR 2.44, 95% CI 1.26-4.71). Our study suggests that women with polycystic ovary syndrome are more likely to have a positive diabetic screening test, but no more likely to have gestational diabetes than other women with infertility.

Cohort Studies↗
PubMedDate not supplied

The Filshie clip for laparoscopic adnexal surgery.

BACKGROUND: Gynecologic endoscopic procedures are increasingly common and require the ability to control large vascular structures. METHOD: The Filshie clip is a silicone-lined, titanium occlusive device, originally designed and Food and Drug Administration (FDA) approved for surgical contraception. This device also has the potential for occluding vascular structures during laparoscopic surgery. EXPERIENCE AND RESULTS: We describe a salpingectomy, an excision of bilateral hydrosalpinges, and a salpingo-oopherectomy. We performed all procedures laparoscopically using this device as the primary modality for assuring hemostasis. CONCLUSION: The Filshie clip is a useful and economical device for assuring hemostasis during gynecologic endoscopic surgery.

Adnexa Uteri↗