Biomedical subjects

J F Reed

Publications and source records attributed to J F Reed.

At least 37 records · Page 2Linked to original sources

PubMed1997

Value of carcinoembryonic antigen monitoring in curative surgery for recurrent colorectal carcinoma.

PURPOSE: This study is designed to review a carcinoembryonic antigen (CEA)-driven postoperative protocol designed to identify patients suitable for curative reresection when recurrent colorectal cancer is identified. METHODS: A total of 285 patients who were operated on for colon or rectal carcinoma between 1981 and 1985 were evaluated (with CEA levels) every two months for the first two years, every three months for the third year, every six months for years 4 and 5, and annually thereafter. CEA levels above 5 microg were considered abnormal and were evaluated with diagnostic imaging and/or endoscopy. RESULTS: Follow-up was available for 280 patients (98.2 percent). Distribution of patients by Astler-Coller was: A, 14 percent; B1, 20 percent; B2, 39 percent; C1, 5 percent; C2, 21 percent. There were 62 of 280 patients (22 percent) who developed elevated CEA levels, with 44 patients who demonstrated clinical or radiographic evidence of recurrence. Eleven patients were selected for surgery with curative intent (4 hepatic resections, 1 pulmonary wedge resection, 2 abdominoperineal resections, 2 segmental bowel resections, and 2 cranial metastasectomies). Three of 11 patients (27 percent) benefited and have disease-free survivals greater than 60 months. Of the 223 patients without elevated CEA, 22 (9.9 percent) had recurrent cancer without any survivors. Overall, 3 of 285 patients (1.1 percent) were cured as a result of CEA follow-up. CONCLUSION: CEA-driven surgery is useful in selected patients and can produce long-term survivors.

Aged↗

PubMed1997

Reemployment of patients with surgical salvage of open, high-energy tibial fractures: an outcome study.

Between January 1, 1988, and December 31, 1990, 36 patients with 37 type III high-energy open tibial shaft fractures were treated at Lehigh Valley Hospital. Patients with primary amputations were excluded. All patients with high-energy open tibial fractures with an intact posterior tibial nerve, protective sensations of the plantar surface of the foot, and warm ischemia time of less than 6 hours were considered salvageable. A retrospective review of the charts was completed. Twenty-eight patients with 29 fractures were interviewed for work status, an average of 39 months after treatment. Twenty-five patients with 25 fractures were working at the time of the accident. Three patients with four fractures were not working at the time of the accident. Nineteen of 25 patients (76%) returned to work. Sixteen of 25 patients (64%) returned to work at a similar level of manual labor. The average delay between injury and return to work was 11 months (range, 3-18 months). Two of the 36 patients (5.5%) required secondary amputations. Twenty-five of 28 patients (89%) interviewed reported one or more subjective complaints. The two amputees reported no subjective complaints.

Adolescent↗

PubMed1997

Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage.

OBJECTIVE: To review the success rate of embolization in stopping hemorrhage for unstable patients with severe pelvic fractures, to calculate the time to achieve embolization, and to determine the yield from angiography. DESIGN: Retrospective review of patients admitted to a Level I trauma center with pelvic fractures during a 5-year period. MATERIALS AND METHODS: Charts were reviewed for Injury Severity Score, age, blood pressure, prothrombin time/partial thromboplastin time, pelvic fracture type, mortality, time to reach the angiography suite, time to achieve embolization, and mechanism of injury. MEASUREMENTS AND MAIN RESULTS: Of 806 patients admitted with pelvic fractures, 35 underwent pelvic angiography, and 15 (1.9%) required embolization. Embolization was successful for all patients. No deaths resulted from ongoing hemorrhage. Angiography yield in initially unstable patients was 64%. The mean age and initial hemodynamic instability were significantly greater in nonsurvivors. The time from arrival in the trauma bay to arrival in the angiography suite ranged from 50 to 1,140 minutes, and the time spent in the angiography suite performing embolization ranged from 50 to 140 minutes, with an average time of 90 minutes. Patients who were embolized within 3 hours of arrival had a significantly greater survival rate. CONCLUSION: Only a small percentage of patients with pelvic fractures require embolization, but when it is used, embolization can be 100% effective. Age, time to achieve embolization, and initial hemodynamic instability appear to be important factors in survival.

Adolescent↗

PubMed1997

Asymptomatic carotid endarterectomy. Patient and surgeon selection.

BACKGROUND AND PURPOSE: The applicability of prospective carotid endarterectomy protocols to the general population has been questioned. Outcomes for asymptomatic patients undergoing carotid endarterectomy were compared with the results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) patients treated concurrently at our institution. METHODS: Asymptomatic patients undergoing carotid endarterectomies (n = 277) from 1987 to 1993 (ACAS enrollment period) were reviewed. Primary end points were mortality, myocardial infarction, and stroke. Five subgroups were studied: (1) ACAS surgical patients; (2) ACAS-eligible patients not enrolled and ACAS surgeons; (3) ACAS-eligible patients not enrolled and non-ACAS surgeons; (4) ACAS-ineligible patients and ACAS surgeons; and (5) ACAS-ineligible patients and non-ACAS surgeons. RESULTS: ACAS-eligible patients were younger (P = .014), had more severe carotid stenosis (P = .001), and had lower incidences of pulmonary (P = .015) and renal (P = .008) diseases compared with ineligible patients. Patient selection (ACAS eligibility) significantly improved outcomes for mortality (P = .014) and myocardial infarction (P = .006). Length of stay favored ACAS-eligible patients (P = .004). ACAS surgeons operated on more severely stenotic carotid lesions (P = .005) and on patients with a lower incidence of coronary artery disease (P = .007). There was no difference in outcomes between ACAS and non-ACAS surgeons. CONCLUSIONS: Patient selection was a significant factor in determining outcome. With strict adherence to ACAS enrollment guidelines, the conclusions of ACAS appear applicable to patients seen at our institution with asymptomatic carotid stenosis.

Adult↗

PubMed1997

Thigh muscle size and strength after anterior cruciate ligament reconstruction and rehabilitation.

It is the hypothesis of the senior author (GAA) that high circumference measurements are not an accurate reflection of thigh muscle cross-sectional area or muscle strength after standard rehabilitation following anterior cruciate ligament reconstruction. Likewise, normal quadriceps femoris strength is not achieved in these patients despite aggressive rehabilitation. The purpose of our study was to quantify thigh muscle size and strength and correlate thigh circumference, muscle cross-sectional area by magnetic resonance imaging (MRI), and isokinetic strength in our patients. Thirty-three patients with anterior cruciate ligament repair utilizing autografts of iliotibial band (N = 28), semitendinosus autograft (N = 3), and bone-patellar tendon-bone autograft (N = 2) were retrospectively evaluated 48.7 +/- 6.91 months after surgery. We compared involved operated extremities with uninjured, uninvolved contralateral extremities, measuring thigh circumference, isokinetic peak torque, and cross-sectional area by MRI. We found a significant 1.8% decrease in thigh circumference, a 10% decrease in average quadriceps torque, and a 8.6% decrease in quadriceps cross-sectional area by MRI in the involved extremities compared with the uninvolved extremities. A positive correlation between MRI cross-sectional area, quadriceps, and hamstring peak torque was recorded in involved and uninvolved extremities. A positive correlation between thigh circumference, quadriceps, and hamstring peak torque was found in uninvolved extremities but not in operated extremities. The authors concluded that thigh circumference underestimates atrophy and is not correlated with cross-sectional thigh muscle area by MRI or strength in operated extremities. Persistent quadriceps weakness and decreased cross-sectional area at 49 months postsurgery and rehabilitation continue to challenge our efforts. The pathophysiology of the decrease in thigh muscle size and quadriceps femoris strength is discussed.

Adolescent↗

PubMed1996

Variations in colon and rectal surgical mortality. Comparison of specialties with a state-legislated database.

PURPOSE: This study was designed to examine variations in operative mortality among surgical specialists who perform colorectal surgery. METHODS: Mortality rates were compared between six board-certified colorectal surgeons and 33 other institutional surgeons using comparable colorectal procedure codes and a validated database indicating patient severity of illness. Thirty-five ICD-9-CM procedure codes were used to identify 2,805 patients who underwent colorectal surgery as their principal procedure between July 1986 and April 1994. Atlas, a state-legislated outcome database, was used by the hospital's Quality Assurance Department to rank the Admission Severity Group (ASG) of 1,753 patients from January 1989 to April 1994 (higher ASG, 0 to 4, indicates increasing medical instability). RESULTS: Colorectal surgeons had an eight-year mean in-hospital mortality rate of 1.4 percent compared with 7.3 percent by other institutional surgeons (P = 0.0001). There was a significantly lower mortality rate for colorectal surgeons compared with other institutional surgeons in ASG 2 (0.8 and 3.8 percent, respectively; P = 0.026) and ASG 3 (5.7 and 16.4 percent, respectively; P = 0.001). CONCLUSIONS: Board-certified colorectal surgeons had a lower in-hospital mortality rate than other institutional surgeons as patients' severity of illness increased.

Colon↗

PubMed1996

Data management of a pneumonia screening algorithm in Veterans Affairs Medical Centers.

The Veterans Affairs External Peer Review Program (EPRP) reviews patient care episodes in Veterans Affairs Medical Centers (VAMCs) across the United States. This review process uses screening algorithms, followed by peer review, to identify deviations in the care provided by the VAMCs. A schematic model of the case selection, data acquisition at each VAMC, data flow between the VAMCs and the West Virginia Medical Institute (WVMI), data processing at WVMI, and the peer review process are given. A model pneumonia clinical practice guideline was generated by an expert panel of physicians external to the VAMCs. This guideline identifies benchmark criteria that reflect the clinical standards for diagnosing and treating hospitalized pneumonia patients. A screening algorithm was then designed, tested, and implemented to identify deviations in the quality of care delivered by VAMCs to hospitalized pneumonia patients.

Adolescent↗

PubMed1996

Hinge estimators of location: robust to asymmetry.

Robust estimators have been developed and tested for symmetric distributions via simulation studies. The primary objective of these robust estimators was to show that these estimators had a higher efficiency than the sample mean over these symmetric distributions. Little attention has been given to how these estimators perform on data that are from asymmetric distributions or from distributions that have inherent anomalies-so called 'messy data'. This study is intended to supplement previous studies by examining the behavior of several robust estimators over asymmetric distributions. The objective is to demonstrate several adaptive 'asymmetric' robust estimators which utilize sample selector statistics to identify the underlying distribution and to demonstrate the efficiency of these adaptive estimators. From a methodology point rather than a theoretical basis, reasonable alternatives should be available. In the asymmetric data distributions faced on a daily basis, estimators that adapt themselves to the data may be formulated and used. We recommend the use of the following algorithm in examining data sets: (a) compute the ancillary statistics-skewness and tail-length to classify the data distribution; (b) analyze each data set using at least one alternative estimator to the usual XM; (c) if the results are similar, report the XM analysis; (d) if the results are dissimilar, report the alternative analysis and the reasons for using the alternative analysis (i.e. t-tests based on a T alpha, HQ1, HQ2, or SK5).

Algorithms↗

PubMed1996

Outcome of severe brain injury: a multimodality neurophysiologic study.

We screened all head-injured trauma patients admitted to Lehigh Valley Hospital during a 2-year period. From 725 screened patients, 69 patients in a coma on the second day after trauma were entered into this study. During the first week, these patients underwent electroencephalography (EEG), evoked potentials, ocular pneumoplethysmography, and transcranial Doppler (TCD) sonography. Clinical examinations were undertaken 2 and 7 days after trauma. Test results were correlated with functional clinical outcome at 6 months. In a multiple regression analysis, EEG was the major independent variable that significantly predicted 6-month outcome based on Glasgow Outcome Scale score. Transcranial Doppler sonography contributed a small additional component. Though EEG was the most significant predictive factor in this neurophysiological battery, it did not add significantly to the predictive power of Glasgow Coma Scale score determined at day 7. These findings suggest that in neurophysiologic testing in this type of patient is not useful in improving predictive outcome data.

Adolescent↗

PubMed1995

The impact of mandated in-hospital coverage on primary cesarean delivery rates in a large nonuniversity teaching hospital.

OBJECTIVE: Our purpose was to determine whether attending physician call status affected the primary cesarean delivery rates of the resident or private services after institution of in-hospital coverage. STUDY DESIGN: Data for the study year, during which in-hospital attending coverage was in place, were compared with those of the previous year, during which in-hospital attending coverage of residents was not in place. Birth records were analyzed retrospectively for physician and patient factors. RESULTS: For the year before in-hospital coverage the institutional total cesarean rate was 24.9%, with a primary cesarean section rate of 17.6%. In the first year of coverage the total cesarean delivery was 21.7%, with a decrease in the primary rate to 15.3%. The resident service primary cesarean delivery rate was 10.6% during the study year, which was unchanged from 10.9% the prior year and did not contribute to the overall decrease. Conversely, the private service primary cesarean rate decreased from 18.0% in the prestudy year to 13.4% when the attending physician was on call in the hospital but remained higher at 17.5% when the attending physician was on call not in the hospital. CONCLUSIONS: In-hospital attending physician coverage lowered individual attending physicians' private service primary cesarean rates. Resident service primary cesarean rates were lower than private service and were unaffected by the initiation of in-hospital coverage.

Adult↗

PubMed1995

Monte Carlo generation of SB and SU distributions.

Generating random variables from specific bounded or unbounded distributions is a problem frequently encountered in Monte Carlo studies. Of particular interest is that of transforming variables from a standard normal distribution to a given Johnson's SB or SU distribution with specified (gamma, delta) parameters. We use a composite standard normal generator N (0.1) to generate Johnson's SB or SU distributions with (gamma, delta) parameters. Goodness-of-fit tests and graphical illustrations demonstrate the adequacy of the empirical distributions.

Chi-Square Distribution↗

PubMed1995

Carotid artery stenosis: preoperative noninvasive evaluation in a community hospital.

PURPOSE: The purpose of this study was to determine whether noninvasive evaluation with duplex ultrasonography and magnetic resonance angiography of patients with carotid artery stenosis can replace contrast angiography at our institution. METHODS: This study consisted of a retrospective chart review of 40 patients (74 carotid arteries) in combination with a blinded reanalysis of original data. Contrast angiography was compared with duplex ultrasonography and magnetic resonance angiography. The overall diagnostic accuracy of duplex ultrasonography and magnetic resonance angiography was determined individually and concordantly in patients being evaluated for carotid artery stenosis. RESULTS: The overall sensitivity of duplex ultrasonography was 88.5%, and the specificity was 91.7% (Spearman correlation coefficient = 0.8456; p < 0.001). For magnetic resonance angiography the sensitivity was 92.3%, and the specificity was 97.9% (Spearman correlation coefficient = 0.9086; p < 0.001). In the presence of concordance, the noninvasive studies exhibited a sensitivity of 100%, (correlation coefficient = 0.9661; kappa value = 0.9655). No occlusions or severe lesions were missed by both studies. In only one vessel (1.52%) was a false-positive concordance noted. CONCLUSIONS: Carotid endarterectomy may be undertaken with a high degree of confidence that the operation will be appropriate if the noninvasive evaluations are concordant. In the absence of concordance of the noninvasive studies, contrast angiography should be considered.

Aged↗

PubMed1994

Analyzing the performance of diagnostic tests.

When a single diagnostic test is used to assess the disease state of a patient, the classic univariate measures of sensitivity and specificity are used. When combining two or more diagnostic tests, other methods provide alternative methods for assessing the utility of combining these tests. We have written and tested a program in FORTRAN that computes the univariate statistics and bivariate concordant/discordant statistics analyses of all possible combinations of diagnostic tests as compared with the 'gold standard'.

Confidence Intervals↗

PubMed1994

Death and adverse cardiac events after carotid endarterectomy.

PURPOSE: This study evaluated operative mortality rate and adverse cardiac events after carotid endarterectomy. Efficacy of preoperative cardiac evaluation was studied and stroke mortality rate was determined. METHODS: This was a retrospective review of 562 patients undergoing carotid endarterectomy at a 740-bed community hospital. Data were analyzed with chi 2 analysis, logistic regression analysis, and Goldman criteria for cardiac risk. RESULTS: The mortality rate was 1.6% (nine patients). There were 10 myocardial infarctions (1.8%). Six of these (1.1%) were fatal. The Goldman Index allowed us to classify 530 patients in a low-risk group (Goldman classes I and II, operative mortality rate = 1.1%) and 32 patients in a high-risk group (Goldman classes III and IV, mortality rate = 9.4%). Independent risk variables were identified for myocardial infarction and overall operative death. These variables were then used to develop a probability model for prediction of operative death and adverse cardiac events. The stroke rate in the 562 patients was 0.7% (four patients). For the 345 patients with symptoms, the stroke rate was 0.6% (two patients); for the 217 symptom-free patients, it was 0.9% (two patients). The combined stroke mortality rate was 2.3%. For patients with symptoms, it was 2.9%; for symptom-free patients, it was 1.4%. CONCLUSIONS: Independent clinical variables can help determine patients at increased risk for perioperative myocardial infarction or operative death. Patients in Goldman classes III and IV are at increased risk for adverse events. Carotid surgery can be performed safely in our medical community.

Aged↗

PubMed1994

Internal carotid artery redundancy is significantly associated with dissection.

BACKGROUND AND PURPOSE: Redundant internal carotid arteries have been considered a risk factor in tonsillectomy, adenoidectomy, and surgical treatment of peritonsillar abscess and also a potentially treatable cause of stroke. However, an association between internal carotid artery redundancy and spontaneous dissection has not yet been clearly demonstrated. METHODS: We reviewed, for spontaneous carotid artery dissection, records of all patients admitted to our institution during the period from 1986 through 1992 with the diagnosis of stroke or transient ischemic attack. We also reviewed 108 percutaneous cerebral arteriograms performed between September 1992 and December 1992 for presence of carotid artery redundancies. RESULTS: Thirteen patients exhibited spontaneous dissection. Of these, 8 of 13 (62%) patients and 13 of 20 (65%) internal carotid arteries, viewed to the siphon, had significant redundancies, kinks, coils, or loops. Of 108 consecutive arteriograms of patients without dissection, in which 187 internal carotid arteries were viewed to the siphon, there were 20 (19%) patients and 22 (12%) of 187 vessels with significant redundancy. Five patients in the dissection group and 2 in the nondissection group had bilateral internal carotid artery redundancy (P = .0019 and P = .0001, respectively). CONCLUSIONS: We found a significant correlation between internal carotid artery redundancy and dissection, particularly if redundancy is present bilaterally.

Adult↗

PubMed1994

Safety, efficacy, and acceptance of intramuscular sedation: assessment of 900 dental cases.

Intramuscular (IM) sedation techniques remain the least used by clinicians, possibly because of their limited exposure in the undergraduate and graduate dental curricula. To assess the safety and efficacy of these techniques, the authors conducted a retrospective study of 900 dental cases. A total of 308 patients received ketamine, 356 received a meperidine/promethazine combination, and 236 received midazolam. Results revealed a high safety record, efficacy, and good evaluations from clinicians and patients, in addition to some advantages over other sedation techniques.

Adolescent↗

PubMed1994

Laparoscopic colectomy: at what cost?

The purpose of this study was to compare laparoscopic to open colectomy with respect to: 1) morbidity and mortality, 2) adequacy of resection for cancer (margins and number of nodes), 3) operative time, 4) postoperative time for tolerating diet and discharge, and 5) total hospital charges. A historical control group of open colon surgery patients was used. Laparoscopic colectomy was completed in 18/24 patients and 6 were converted to open colectomy. There were no operative or perioperative mortalities. In procedures for cancer, all margins were free of tumor. The average number of nodes in the laparoscopic group (LC) was higher than in open colectomy (OC) group. The average operative time was slightly longer in the LC group compared to the OC group. Postoperative length of stay was shorter in the LC group, and considerably shorter in the elective LC group. Corrected average total hospital cost was lower in the LC group than in the OC group. Laparoscopic colectomy has acceptable morbidity and mortality, is cost-efficient and seems to provide adequate resection for cancer, although long-term data will be crucial to this issue.

Adult↗

PubMed1993

Hemorrhage following colonoscopic polypectomy.

Clinically significant hemorrhage following colonoscopic polypectomy may occur primarily as the polyp is removed or manifest itself days to weeks later secondary to clot dissolution. The rate of hemorrhage following colonoscopic polypectomy ranges widely from 0.3 to 6.1 percent, depending on whether the data are derived from studies using the number of patients or number of polypectomies. A retrospective study was performed in our institution to study 4,721 patients who underwent polypectomy between January 1987 and December 1991. Twenty (0.4 percent) of these patients required hospital admission because of 9 primary and 11 delayed hemorrhages. Fifty-four polyps were removed from these patients: 11 in the right colon, 7 in the transverse colon, 17 in the descending colon, and 19 in the sigmoid colon. Eight polyps were 2 cm or larger, 10 were pedunculated, and 44 were sessile. Six patients underwent cauterization or resnaring of the bleeding polyp site, one patient underwent subtotal colectomy, and the remainder of the patients stopped bleeding spontaneously. Factors that could be associated with the outcome of hemorrhage include patient age, size, location, number and morphology of polyps (i.e., sessile or thick stalk), and use of anticoagulants. An experienced endoscopist with knowledge of electrosurgical and technical principles may be the most important factor for prevention of postpolypectomy bleeding.

Adult↗