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Biomedical subjects

P Bove

Publications and source records attributed to P Bove.

At least 19 recordsLinked to original sources
PubMed1999

Reexamining the value of hematuria testing in patients with acute flank pain.

PURPOSE: Hematuria testing is routinely performed in patients with acute flank pain to screen for ureterolithiasis and to help determine the need for excretory urography. Unenhanced helical computerized tomography (CT) has recently been shown to be superior to excretory urography in diagnosing ureteral obstruction and can evaluate many other causes of flank pain. Given the speed, accuracy and safety of CT the value of hematuria testing for acute flank pain should be reexamined. MATERIALS AND METHODS: We reviewed the medical records of 267 consecutive patients with acute flank pain referred for unenhanced helical CT. Microscopic and dipstick urinalysis data were obtained in 195 patients. Using helical CT as the gold standard, we calculated the sensitivity, specificity, predictive value and accuracy of hematuria for diagnosing ureterolithiasis. RESULTS: Of the patients with ureterolithiasis 33% had 5 or less, 19% had 1 or less and 11% had no red blood cells (RBCs) per high power field. Of the patients without ureterolithiasis 24% had greater than 5 and 51% had greater than 1 RBC per high power field. Of the patients with ureterolithiasis 14% had a negative dipstick test and 1 RBC or less per high power field. There were 25 patients without ureterolithiasis who had CT abnormalities unrelated to the urinary tract, of whom 8 had greater than 1 RBC per high power field. CONCLUSIONS: Absence of hematuria in the setting of acute flank pain cannot exclude a diagnosis of ureterolithiasis and should not obviate other diagnostic testing. Even when strongly positive on microscopy, hematuria has insufficient positive predictive value for diagnosing ureterolithiasis and may be misleading as other serious conditions resulting in acute flank pain may yield a positive test.

Acute Disease↗
PubMed1998

The value of unenhanced helical computerized tomography in the management of acute flank pain.

PURPOSE: We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute flank pain and suspected ureteral obstruction. MATERIALS AND METHODS: During a 25-month interval 417 patients with acute flank pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome. RESULTS: Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone extraction in 7, additional imaging (excretory urography) was performed in only 1. Additional imaging studies generated by CT were done in 3 cases in which the dictated reports were indeterminate for ureteral stones, including negative excretory urography in 2 and retrograde urography in 1. In 1 patient in whom CT misdiagnosed a ureteral stone unnecessary retrograde urography revealed the calcification to be a gonadal vein phlebolith. Seven patients with false-negative examinations reported spontaneous stone passage with no complications. CONCLUSIONS: Unenhanced helical CT accurately determines the presence or absence of ureterolithiasis in patients with acute flank pain. CT precisely identifies stone size and location. When ureterolithiasis is absent, other causes of acute flank pain can be identified. In most cases additional imaging is not required.

Abdomen, Acute↗
PubMed1995

Colorectal complications following cardiac surgery. Six-year experience.

PURPOSE: This study was undertaken to assess colorectal complications following cardiopulmonary bypass surgery. METHOD: This is a retrospective review of 5,801 patients who underwent 5,801 cardiopulmonary bypass procedures from 1985 to 1991. Patients were evaluated for type of bypass procedure, postoperative colorectal complications, age, sex, bypass time, aortic cross-clamp time, elective vs. emergency cases, uses of intra-aortic balloon pump, perioperative hypotension, and use of vasopressors. Statistical analysis was performed using chi-squared analysis and Student's t-test. RESULTS: Nineteen of the 5,801 patients developed 19 colorectal complications, a prevalence of 0.3 percent for the initial hospital stay following bypass surgery. Mortality in those with complications was 37 percent (7/19). Of the 19 complications, 9 (47 percent) followed coronary artery bypass grafting, whereas 10 (53 percent) followed valve replacement or combined coronary artery bypass grafting with other cardiac procedures. Five (26 percent) of the complications followed emergency cases, whereas 14 (74 percent) followed elective cases. Average age of those with complications was 69.8 years, compared with 63.2 years for those without complications. Average aortic cross-clamp time for those with complications was 71 +/- 25 minutes; pump time was 106 +/- 34 minutes. That was significantly higher than in those without complications. Nine (47 percent) patients with complications required vasopressors during the perioperative period, whereas eight (42 percent) suffered prolonged hypotension (systolic blood pressure, < 90 mmHg). CONCLUSIONS: It appears that increased age, valve replacement, or combined cardiac procedures, emergency procedures, and prolonged aortic cross-clamp and bypass pump times are risk factors for development of colorectal complications. Hypoperfusion, as suggested by prolonged pump times, clamp times, and emergency procedures may be a possible cause for development of colorectal complications.

Aged↗
PubMed1995

Use of fibrinolytic agents to coat wire implants to decrease infection. An animal model.

RATIONALE AND OBJECTIVES: Infection is a serious complication of metallic prosthesis implantation and may necessitate removal of the prosthesis. This study uses an animal model to evaluate the effects of coating stainless steel wire implants with fibrinolytic agents to prevent infection after bacterial contamination. METHODS: Three types of steel wire implants were used: plain stainless steel, heparin-coated steel, and urokinase-heparin-coated steel. Wire implants were incubated in a known concentration of Staphylococcus epidermidis and placed into the subcutaneous tissues of three groups of anesthetized hamsters. The implants and surrounding tissues were excised after 1 week and submitted for quantitative cultures. RESULTS: Using 100 organisms as the upper allowable limit to categorize abscesses as noninfected, the following rates of noninfectivity were observed: group 1 (control), 0% noninfected; group 2 (heparin-coated wire), 40% noninfected; and group 3 (urokinase-heparin-coated wire), 50% noninfected. The noninfectivity rates of groups 2 and 3 were significantly higher than the rate of group 1 (P < 0.001). There was no significant difference between groups 2 and 3 (P = 0.19). CONCLUSIONS: Both the heparin-coated and urokinase-heparin-coated wire exhibited significantly decreased infection rates compared with uncoated wire; the heparin coating may inhibit bacterial adherence. The urokinase coating of the heparin-coated wire appears to further decrease the infection rate, but not to a statistically significant degree.

Abscess↗
PubMed1994

Evaluation of outcome following open lung biopsy.

The utility of open lung biopsy in the management of patients with acute pulmonary infiltrates and/or progressive respiratory failure remains controversial, particularly in regard to its timing and impact on therapy. We reviewed our most recent 10-year experience with open lung biopsies in 73 patients and evaluated its effect on patient management and outcome. A total of 62 biopsies were done for progressive infiltrating disease, 53 with diffuse bilateral disease, and 9 with more focal infiltrates; 11 biopsies were done for nodular disease. Overall mortality was 25 per cent (18/73), all from the group with infiltrates; there were no deaths in patients with nodular disease (P = 0.034). No patients died who did not have acute respiratory failure (ARF) preoperatively, but mortality was 38 per cent (18/47) in those with ARF (P < 0.001). Immune system status and timing of the biopsy did not affect survival. Clinical management was changed in 40 patients based on biopsy results, but this did not affect survival, with a mortality rate of 20 per cent (8/40) in the group with changed management versus 30 per cent (10/33) for those with no changes (P = 0.457). In those patients with ARF, changes in management based on biopsy results occurred in 31 patients, eight of whom died (26 per cent); no changes in management were made in 16 patients, ten of whom died (62%, P = 0.033).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

The effects of hexavalent and trivalent chromium on fertilization and development in sea urchins.

The action of Cr6+ (as chromate) and Cr3+ (as sulfate and nitrate) on fertilization and development has been investigated in sea urchins. By rearing the embryos in the presence of chromate (5 X 10(-5) to 5 X 10(-4) M), the differentiation of the gut and skeleton was severely affected. The treatment of sperm before fertilization with CrO2- 4 (10 to 30 min, 10(-4) to 10(-2) M) resulted in a number of abnormal larvae, depending on the length of exposure and the CrO2- 4 concentration. Morphological and quantitative changes of mitotic activity during cleavage were observed as a result of CrO2- 4 exposure of zygotes, as well as of sperm and egg pretreatment. The exposure of embryos to Cr3+ after fertilization permitted larval differentiation, but affected the motility and hatchability of the embryos. The pretreatment of gametes with Cr3+ never induced larval malformations. Cr3+ exerted a strong depressive action on fertilization by decreasing the fertilizing capacity of sperm and leaving the fertilizability of the eggs almost unaffected.

Animals↗