Biomedical subjects

James B Unger

Publications and source records attributed to James B Unger.

9 recordsLinked to original sources

PubMed2005

Tying a loop-to-strand suture: is it safe?

OBJECTIVE: This study was undertaken to evaluate the integrity of the loop-to-strand knot when tied with square and nonidentical sliding knots. STUDY DESIGN: The synthetic absorbable monofilament suture poliglecaprone 25 in 0 and 2-0 suture gauges was used in this experiment. For each suture gauge, 3 groups of knots were tested: (1) single strand-to-single strand, flat square knot, (2) loop-to-single strand, flat square knot, and (3) loop-to-single strand, nonidentical sliding knot. All knots were tied with 6 throws. The proportion of knots becoming untied was compared among the 3 groups for each suture gauge. Ultimate load required to untie or break knots within each group was also evaluated. RESULTS: The loop-to-strand knot performed well in both suture gauges tested as long as it was tied with a flat square knot. The loop-to-strand knot tied with a nonidentical sliding knot had an unacceptably high failure rate. CONCLUSION: The loop-to-strand termination of a continuous suture may be acceptable when tied with a 6-throw flat square knot but not acceptable if tied with sliding knots.

Catgut↗

PubMed2004

The effect of number of throws on knot security with nonidentical sliding knots.

OBJECTIVE: The study was undertaken to test the integrity of nonidentical sliding knots made with 3 throws compared with those made with 6 throws with monofilament and braided absorbable suture. STUDY DESIGN: The 3 throw nonidentical sliding knot was compared with the 6 throw nonidentical sliding knot in 4 different suture groups. The groups were 0-0 polydioxanone, 2-0 polydioxanone, 0-0 polyglactin 910, and 2-0 polyglactin 910. Knots were tested to failure with a tensiometer. The proportion of 3 throw knots becoming untied was compared with the 6 throw knot within each group. Ultimate load required to break tied knots within each suture group was also evaluated. RESULTS: The 3 throw knots had very high rates of knot failure and untied significantly more often than the 6 throw knots. CONCLUSION: The 6 throw nonidentical sliding knot demonstrates superior knot integrity compared with the 3 throw knot with both monofilament and braided absorbable suture.

Female↗

PubMed2004

Detection of recurrent cervical cancer by whole-body FDG PET scan in asymptomatic and symptomatic women.

OBJECTIVE: To determine the ability of whole-body [(18)F]fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) scan to detect recurrent cervical carcinoma in both symptomatic and asymptomatic women. MATERIALS AND METHODS: We retrospectively reviewed the records of 44 women previously treated for cervical cancer who underwent 47 posttreatment whole-body FDG PET scans in an attempt to detect recurrent disease. Twenty-six scans were performed in asymptomatic women, whereas 21 scans were performed in women with symptoms suggestive of recurrence. RESULTS: About 30.8% of asymptomatic women had recurrent disease detected by PET scan compared to 66.7% of women in the symptomatic group. The sensitivity of PET scan for recurrent disease in asymptomatic women was 80.0%, specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 88.9%. For symptomatic women, the sensitivity of PET was 100%, specificity of 85.7%, a positive predictive value of 93.3%, and a negative predictive value of 100%. CONCLUSIONS: The whole-body FDG PET scan is a sensitive imaging modality for the detection of recurrent cervical carcinoma in both symptomatic and asymptomatic women.

Adult↗

PubMed2004

Knot integrity with nonidentical and parallel sliding knots.

OBJECTIVE: The study was performed to test the knot integrity of parallel and nonidentical sliding knots with the use of monofilament suture. STUDY DESIGN: We investigated the proportion of parallel sliding knots that become untied compared with nonidentical sliding knots in four different monofilament suture configurations: group A, 6 throws, 0-0 gauge; group B, 10 throws, 0-0 gauge; group C, 6 throws, 2-0 gauge; group D, 10 throws, 2-0 gauge. Each combination was tested 20 times, for a total of 160 knots. RESULTS: The nonidentical sliding knot untied 40% of the time in group A compared with 0% for the parallel knot (P=.003). In the other 6-throw group, group C, 45% of the nonidentical knots became untied compared with 0% of the parallel knots (P=.001). There were no significant differences in the proportions of untying for each knot type in the 10-throw groups. CONCLUSION: Parallel sliding knots demonstrate superior knot integrity compared with nonidentical sliding knots with monofilament suture. The addition of throws to the nonidentical knot improves its knot security.

Humans↗

PubMed2002

Hysterectomy for the massive leiomyomatous uterus.

OBJECTIVE: To determine if the complication rate of abdominal hysterectomy is increased in women with greatly enlarged myomatous uteri. METHODS: Three groups of women undergoing abdominal hysterectomy were analyzed according to uterine size: group 1, 208 women with uteri less than 500 g; group 2, 63 women with uterine weights of 500-999 g; and group 3, 47 women with leiomyomata whose uteri weighed at least 1000 g. Logistic regression was used to compare the groups on the risks of having at least one major complication. Adjusted comparisons on other surgical outcomes were performed using a logistic model (for qualitative variables) or a general linear model (for quantitative variables). RESULTS: The risk of experiencing at least one perioperative complication, including blood loss over 500 mL, perioperative blood transfusion, major organ injury, therapeutic antibiotic use, and hospital readmission, increased significantly with uterine weight (P =.006). Group 3 women were at greater risk of having at least one of these complications than either group 1 or group 2 women, with adjusted odds ratios of 3.42 (95% confidence interval [CI] 1.62, 7.25) and 2.64 (95% CI 1.14, 6.13), respectively. Estimated blood loss with surgery also increased with increasing uterine weight (P <.001). Mean estimated blood losses for the study groups were 555.8 +/- 386.5 mL (group 3), 464.3 +/- 285.2 mL (group 2), and 387.6 +/- 281.4 mL (group 1) (P =.032). CONCLUSION: The complication rate from hysterectomy increases with increasing uterine weight, due mainly to an increased blood loss associated with surgery for larger uteri.

Adult↗

PubMed2002

Mechanical performance of knots using braided and monofilament absorbable sutures.

OBJECTIVE: The study was undertaken to test the integrity of various flat and sliding knots with the use of braided and monofilament absorbable sutures. STUDY DESIGN: There were four study groups, each of which consisted of a single suture type and size, with five different knots. Each combination was tested 10 times for a total of 200 experiments. The suture types used were 0-0 and 2-0 Glycomer 631 (Biosyn) and 0-0 and 2-0 coated Lactomer (Polysorb). Knots tested were the square knots, surgeon's knots, modified granny flat knots, and modified identical and nonidentical sliding knots. Knots were tested to failure with a tensiometer. We compared the proportion of knots becoming untied within each group and the ultimate load required to break tied knots. RESULTS: In the 0-0 and 2-0 Lactomer groups, 90% and 60% of modified identical sliding knots, respectively, became untied, significantly more than all other knots. CONCLUSION: When 0-0 and 2-0 Lactomer sutures were used, modified identical sliding knots should be avoided.

Absorption↗

PubMed2002

Satisfaction with hysterectomy: low-income underinsured teaching hospital patients versus insured patients at a private hospital.

OBJECTIVE: The purpose of this study was to measure patient health-related quality of life/satisfaction with the results of hysterectomy in 2 distinct groups of women. STUDY DESIGN: A health-related outcomes questionnaire was completed 3 months after hysterectomy by 50 low-income women who underwent operation at a state-supported teaching hospital and by 50 women who underwent operation at a private hospital. RESULTS: The women at the teaching hospital had a significantly worse outcome satisfaction score than the women at a private hospital. However, 98% of the patients at the teaching hospital and 100% of patients at the private hospital noted their symptoms to be improved. Factors such as race, age, preoperative indications, route of hysterectomy, oophorectomy, and hormone replacement therapy did not affect outcome scores. CONCLUSION: Low-income women who undergo operation at a university teaching hospital experience lower satisfaction after hysterectomy than do other women.

Adult↗

PubMedDate not supplied

Ovarian cancer in women with prior hysterectomy.

OBJECTIVE: To determine the proportion of women with ovarian cancer treated at our institution who may have had their disease prevented if oophorectomy had been performed during prior hysterectomy. MATERIALS AND METHODS: One hundred twelve women with ovarian cancer treated at our institution were identified through records in our Gynecologic Oncology office. We identified 19 women (17%) who had undergone prior hysterectomy without bilateral oophorectomy (Group 1). We compared age at cancer diagnosis, stage of disease, and cell type between these women and the 93 without prior hysterectomy (Group 2). RESULTS: The mean age at hysterectomy for women in Group 1 was 33.8+/-5.9 years (range 21-44 years). There were 7 women over the age of 35 years, 3 of whom were over the age of 40 years at time of hysterectomy. Overall, 17.0% of ovarian cancer cases theoretically could have been prevented if bilateral oophorectomy had been performed at the time of hysterectomy. However, this drops to only 2.7% if oophorectomy was limited to women over 40 years. CONCLUSION: Women in our study who underwent prior hysterectomy did so at a relatively young age. This limited the impact prophylactic oophorectomy could have had on ovarian cancer prevention in our population.

Adult↗

PubMedDate not supplied

Malignant mixed mullerian sarcomas of the uterus--the LSUHSC Shreveport experience.

OBJECTIVE: To evaluate our experience with malignant mixed mullerian sarcomas of the uterus (MMMT) and the clinical factors affecting survival. STUDY DESIGN: The records of 18 women with MMMT who received treatment at our hospital between 1989-2002 were reviewed. We analyzed factors influencing survival such as stage, presence of heterologous components, and post-operative radiation. Survival analysis was performed using Kaplan-Meier survival curve. RESULTS: All women underwent surgical tumor debulking. Eleven women were Stage I, three were Stage II, two were Stage III, and two were Stage IV. Five women had tumors with heterologous elements. As expected, survival was most influenced by stage of disease, with the best overall survival in women with Stage I tumors, P < 0.001. Cumulative 5-year survival was 60% for Stage I disease, for Stage II, 34%, and 0% for Stage III and Stage IV. CONCLUSIONS: The initial stage of women presenting with MMMTs is the most important predictive factor for survival.

Adult↗