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Biomedical subjects

J A Robbins

Publications and source records attributed to J A Robbins.

49 records · Page 3Linked to original sources
PubMed1983

Complications following abdominal fascial closures using various nonabsorbable sutures.

With the use of the interrupted far-and-near fascial closure technique, four suture materials were compared: nylon, polypropylene and two brands of braided Dacron (Ethibond and Polydek). There were no wound dehiscences among the 96 patients studied. During the average follow-up period of 12 months, significantly more suture granulomas occurred with the braided Dacron than with the monofilament materials (p less than 0.05). Those that did occur with monofilament material occurred almost exclusively in thin patients.

Abdomen↗
PubMedDate not supplied

Long-term efficacy, tolerability, and safety of the combination of enalapril and felodipine ER in the treatment of hypertension. Enalapril-Felodipine ER Factorial Study Group.

A recent 8-week, double-masked, placebo-controlled, 3 x 4 factorial-design study demonstrated that enalapril-felodipine extended-release (ER) combinations had statistically significant additive effects for reducing both sitting systolic blood pressure (SiSBP) and sitting diastolic blood pressure (SiDBP) and were generally well tolerated in hypertensive patients with SiDBPs ranging from 95 to 115 mm Hg. The present open-label study was undertaken to assess the long-term efficacy, tolerability, and safety of such combinations. Patients from the factorial study were eligible for the 1-year, open-label extension. Initially, all patients received enalapril 5 mg-felodipine ER 2.5 mg once daily; if SiDBP was not controlled (< 90 mm Hg) after 4 weeks of treatment, the dose was titrated upward at 2- to 4-week intervals to a maximum of enalapril 10 mg-felodipine ER 10 mg. Hydrochlorothiazide (HCTZ) 12.5 mg was added to the regimen of patients whose hypertension was not controlled at the highest enalapril-felodipine ER dose. A total of 507 patients were enrolled, of whom 502 were assessable. At their last study visit, 391 (78%) of the assessable patients were receiving only an enalapril-felodipine ER combination. The enalapril-felodipine ER combinations resulted in mean trough SiDBPs of 85 to 89 mm Hg (decreases of 13 to 16 mm Hg from baseline) and SiSBPs of 137 to 140 mm Hg (decreases of 13 to 21 mm Hg). Overall, 407 (81%) of the 502 assessable patients achieved an SiDBP < 90 mm Hg or a reduction from baseline > or = 10 mm Hg (responders); such a response was recorded in 331 patients (66%) taking a combination of enalapril-felodipine ER alone and 76 patients (15%) taking the combination with the addition of HCTZ 12.5 mg. Blood pressure reductions were maintained throughout the treatment period. Drug-related adverse events were relatively infrequent, often transient, usually mild, and apparently not dose related. The most frequently reported drug-related adverse events were edema/swelling, asthenia/fatigue, dizziness, cough, and headache. These results suggest that combination therapy with enalapril-felodipine ER is effective for long-term blood pressure reduction, has an excellent safety profile, and is generally well tolerated. Addition of low-dose HCTZ to the enalapril-felodipine ER combination appears to provide further blood pressure control without increasing drug-related adverse events.

Adult↗
PubMedDate not supplied

Influence of echocardiography on management of patients with systemic emboli.

To determine the impact of echocardiography in management of patients with systemic embolism, we retrospectively reviewed medical records and echocardiograms of 191 consecutive patients with suspected systemic embolism. One hundred sixteen patients had two dimensional echocardiograms and 75 patients had M-mode echocardiograms only. Patients were divided into three groups: Group 1 had no cardiovascular disease; Group 2 had cardiovascular disease, and Group 3 had hypertension only. Changes in therapy following echocardiogram were defined as initiation or discontinuation of anticoagulants or antiplatelet agents, cardioversion, or surgical intervention. M-mode echocardiogram did not identify any heart as a likely source of systemic embolism. Two dimensional echocardiogram defined 13 hearts as likely sources of emboli. All of these patients had known cardiovascular disease. Four of 13 patients (30.7%) whose hearts were likely sources of emboli had a change in therapy compared with 42 of 126 patients (33.3%) with low probability echocardiograms. We conclude that M-mode echocardiogram has no role in evaluation of patients with systemic emboli. Two dimensional echocardiogram may identify the heart as a source of emboli in patients with cardiovascular disease but does not alter early management.

Adult↗
PubMedDate not supplied

Continuity of care for family practice patients in a university hospital-based residency program.

In the present study, conducted in a university hospital-based family practice residency program, 271 new patients to the family practice clinic were followed for a mean length of 3.4 years. During that time 27 (10 percent) patients were hospitalized at least once. Of a total of 58 hospitalizations, lasting an average of 6.3 days, only eight were made from the family practice clinic and only four family practice patients were actually admitted to the family practice ward service. Furthermore, more than half of the admissions were to the internal medicine or the obstetrics and gynecology services. This would appear to be inappropriate, given the fact that family physicians are trained to care for acutely ill adult patients and many obstetrical and gynecological patients. A review of hospital admissions records revealed a variety of issues in continuity of care. Recommendations are made regarding possible solutions and further research in this area.

Adult↗