Biomedical subjects

K K Christians

Publications and source records attributed to K K Christians.

5 recordsLinked to original sources

PubMed2001

Postoperative atrial fibrillation in noncardiothoracic surgical patients.

BACKGROUND: Atrial fibrillation is a common arrhythmia whose prevalence increases with age. It is a well-known complication of cardiothoracic surgery, but the incidence and contributing factors to the development of atrial fibrillation in noncardiothoracic surgical patients are less well known. This study was undertaken to investigate the incidence, association with known risk factors, treatment, and outcome of atrial fibrillation in postoperative noncardiac, nonthoracic surgical patients. METHODS: A 2-year retrospective review was performed of all noncardiac, nonthoracic surgical patients that developed atrial fibrillation within 30 days of operation. Incidence, risk factors, treatment and outcome related to the development of this arrhythmia were analyzed. RESULTS: Fifty-one patients developed atrial fibrillation during this study period for an incidence of 0.37%. Most had preexisting cardiac risk factors, a positive fluid balance, or had electrolyte or arterial oxygen saturation abnormalities. Two thirds were discharged home on new cardiac medications, 16% remained in atrial fibrillation, and 12% died. CONCLUSIONS: New onset atrial fibrillation in this group of noncardiothoracic surgical patients is an uncommon problem that is a morbid event associated with significant mortality.

Adult↗

PubMed2001

Hepatocellular carcinoma: multimodality management.

BACKGROUND: Hepatocellular carcinoma is one of the most common tumors worldwide. Surgical resection has been the standard treatment but can only be applied to a small percentage of patients. In recent years, several other treatment options, including ablative procedures and transplantation, have been used in patients with hepatocellular carcinoma. METHODS: For 6 years, 110 patients with hepatocellular carcinoma were managed at the Medical College of Wisconsin. Fifty-five patients received only chemotherapy (n = 5) or palliative treatment (n = 50) because of advanced cirrhosis (P <.03) or tumor. Thirty-one patients had tumor ablation with percutaneous ethanol injection, cryoablation, radiofrequency ablation, or arterial chemoembolization. Twenty-eight patients underwent surgical resection (n = 18) or hepatic transplantation (n = 10). Relatively more patients (38%; P <.001) were treated with ablation in the second period of the study (1998-2000). RESULTS: Thirty-day mortality was 3% with ablation and 0% with resection. Median survival was 6 months with no treatment, 27 months with ablation (P <.001), and 35 months with resection (P <.001). Patients who underwent liver transplantation had the longest median survival (53 months). A multivariate analysis suggested that treatment modality (ablation or resection; P <.001) and Child-Pugh classification (P <.01) were the most important factors predicting outcome. CONCLUSIONS: This study suggests that treatment of hepatocellular carcinoma requires multidisciplinary expertise and that ablation and operation can be performed safely. Outcome is influenced most by treatment modality and Child-Pugh classification. Patients in Child-Pugh classes A and B should be treated with ablation, surgical resection, or liver transplantation.

Adult↗

PubMed1999

Cost analysis in the management of esophageal coins: endoscopy versus bougienage.

PURPOSE: The aim of this study was to compare the safety, efficiency, and overall cost effectiveness of esophageal bougienage versus endoscopy in the retrieval of ingested coins. METHODS: Retrospective review of patients treated for esophageal coin ingestion at Children's Hospital of Wisconsin over a 1-year period using bougienage or endoscopic retrieval was conducted. (inclusion criterion) RESULTS: Twenty-seven patients were evaluated over the 1-year study period. Two patients spontaneously passed the coins before arrival and needed no further treatment. Twelve patients met criteria for bougienage, and this treatment was successful in 10 of the 12 patients. Mean length of hospital stay was 2.15 hours, and the mean cost was $546. Thirteen patients were treated successfully with endoscopy. The mean length of hospital stay was 22.7 hours, and the mean cost was $5,230. There were no complications in any of the 25 patients. CONCLUSIONS: Bougienage is equally safe, more efficient, and much less expensive than endoscopy for treatment of esophageal coins in properly selected patients. Nearly half of the patients were excluded from bougienage because of delayed presentation alone. Education of parents and physicians regarding symptoms of coin ingestion would allow primary treatment with bougienage in the majority of cases.

Child, Preschool↗

PubMed1999

Cryotherapy extends the indications for treatment of colorectal liver metastases.

BACKGROUND: Hepatic resection for colorectal metastases has been established as the best option for patients with 4 or less lesions meeting specified criteria. Recently, the use of intraoperative ultrasound has increased the detection of previously occult liver lesions, and cryotherapy has allowed the treatment of liver lesions in inaccessible areas with less destruction of normal liver in the case of multiple lesions. 14e prospectively performed hepatic resection or cryotherapy to test the hypothesis that more than 4 liver metastases could be safely and successfully treated with improved long-term survival. METHODS: From August 1993 to January 1999, 137 patients with liver metastases from colorectal cancer were treated with hepatic resection or cryotherapy at the Medical College of Wisconsin. Preoperative and postoperative computed tomography scans, intraoperative assessments of lesion number and curability, number of blood transfusions administered, length of stay, complications experienced, and overall survival rates were reviewed. RESULTS: One hundred thirty-seven patients were explored. Treatment consisted of resection alone in 34, cryotherapy alone in 20, both treatments in 52, and no treatment was possible in 31 patients. "Curability" was defined as complete resection or cryotherapy of all identifiable tumor at the conclusion of the operation. A Cox proportional hazards model demonstrated that survival was determined by the destruction of all identifiable metastases (P < . 001) and was not statistically influenced by age, gender type of therapy, or the number of metastases treated. CONCLUSIONS: Surgical treatment of colorectal liver metastases remains the best option for patients with this disease. A key factor in overall survival is the destruction or resection of all identifiable disease and not the number of tumors per se. Using cryotherapy as an addition to the surgical arsenal, patients previously deemed unresectable because of the number of lesions have a chance for long-term survival. This study demonstrates improved long-term survival for "cured" patients with more than 4 metastatic lesions, thereby extending the indications for resection/ablation.

Adult↗

PubMedDate not supplied

Ablation of liver metastasis: is preoperative imaging sufficiently accurate?

The recent introduction of cryotherapy and radiofrequency ablation of liver metastasis has expanded the indications for treatment. As technology has advanced, a percutaneous approach has been developed. Percutaneous treatment, however, requires accurate preoperative imaging. From 1993 to 1999, 179 patients underwent operative exploration for treatment of suspected hepatic metastases from colorectal carcinoma. One hundred seventy-seven patients were staged by preoperative CT, two patients were staged by MRI, and complete data were available in 176. Hepatic tumor count by preoperative imaging was compared to intraoperative tumor count obtained by inspection, palpation, ultrasonographic examination using a 3.5/7.5 MHz T probe, and careful gross sectioning of the resected specimen. Post hoc analysis was performed on 35 CT scans by two radiologists who specialize in abdominal CT. These radiologists were blinded to the intraoperative findings. Their interpretations were compared to the intraoperative counts and to each other. Thirty-four (19%) of 179 patients were deemed untreatable at operation because of unsuspected overwhelming liver involvement in 11 (6%) or extrahepatic metastases in 23 (13%). For the group, CT was accurate in 80 patients (45%), showed more lesions than were found in 16 (9%), and showed fewer metastases than were found in 80 (45%). When the preoperative scan predicted a solitary metastasis, it was correct in 45 (65%) of 69 patients and underestimated disease in 24 (35%). In the post hoc analysis, the mean numbers of lesions reported by the two radiologists did not differ from the mean number of tumors found; however, the radiologists' counts agreed on 16 (59%) and disagreed on 11 (41%) of the scans. The accuracy of CT decreased with increasing numbers of lesions. Regardless of the type of preoperative imaging, intraoperative findings altered the course of the operation in 96 (55%) of 176 patients. Preoperative imaging is not sufficiently accurate to permit adequate percutaneous treatment of hepatic metastases from colorectal carcinoma.

Bias↗