PubMed Health⌕ Search

Biomedical subjects

R K Tompkins

Publications and source records attributed to R K Tompkins.

At least 73 records · Page 4Linked to original sources
PubMed1981

Prognostic factors in bile duct carcinoma: analysis of 96 cases.

A computerized analysis of prognostic variables was performed in 96 proven cases of extrahepatic bile duct carcinoma treated over a 24-year period at UCLA. Forty-nine percent of the lesions were in the upper third of the bile ducts and 47% of these were resected, for an operative mortality rate of 23% and a maximum survival rate of 4.5 years. Palliative procedures in this region were associated with a 16% mortality rate and maximum survival rate of three years. The patients whose lesions were in the middle third suffered no operative mortality rate for resection or palliation and had a 12% five-year survival rate, with the longest survivor lasting 11 years. In the lower third lesions, 67% were resected by Whipple's procedures, for an 8% mortality rate and a five-year survival rate of 28% extending to nine years. Resection of these difficult carcinomas offers the best hope of survival but must be weighed against the high operative mortality risk in those lesions located in the hilar region.

Adult↗
PubMed1981

Effect of prophylactic antibiotics in acute nonperforated appendicitis: a prospective, randomized, double-blind clinical study.

A prospective, randomized, double-blind clinical study was performed to determined the efficacy of short-term (24 hr) perioperative antibiotics in preventing septic complications after emergency appendectomy for nonperforated appendicitis. The patients were stratified into three clinical arms: Group I (placebo, n = 45), Group II (cefamandole, n = 46) and Group III (cefamandole plus carbenicillin, n = 45). The three groups of patients were similar in regard to age, sex, duration of operation and pathologic classification of the appendix. The overall incidence of infection in the study was 5.1%. The infection rates in Groups II (2.2%) and III (0%) were significantly lower than Group I (placebo) (13.3%), (p less than 0.05). No difference was observed between cefamandole alone and cefamandole plus carbenicillin. Average postoperative hospital days per patient for each group was: Group I - 3.8 days; Group II - 2.9 days; Group III - 3.1 days. Cost analysis of hospitalization including cost of prophylactic antibiotics revealed a $247.99 per patient saving for Group II versus Group I and $95.53 for Group III versus Group I. Systemic prophylactic antibiotics can successfully reduce septic complications after appendectomy for nonperforated appendicitis, and a single drug (cefamandole) directed at the facultative pathogens is as effective as double drug therapy, which includes specific anaerobic coverage.

Acute Disease↗
PubMed1980

Effects of long-term ingestion of soya phospholipids on serum lipids in humans.

The average reduction of 22 percent in serum cholesterol and 26 percent in triglycerides in the participants in this study was achieved by a diet low in fat and cholesterol supplemented with lecithin. The results are important because all of the participants were able to follow the diet protocol while continuing their normal activities and did so willingly and eagerly over the entire 26 month period. Although the statistical analyses of the data in this small group do not enable us to conclude that lecithin added to the low fat diet actually produced the reduced levels of cholesterol and triglycerides, the trend is encouraging. Because the lecithin and low fat diet was tolerated well with no significant side effects for 2 years, we suggest that a long-term prospective randomized study with a larger group of patients, including appropriate linoleic acid controls, be carried out to confirm or deny these preliminary findings.

Aged↗
PubMed1980

An efficient strategy for managing acute respiratory illness in adults.

A safe, effective, and efficient clinical algorithm (management rule) for the care of adults with acute respiratory illness by nonphysician providers is presented. The algorithm was created from a data base collected on more than 5000 patients and prospectively evaluated on an additional 2637. It eliminates unhelpful diagnostic tests and minimizes physician involvement in patient care without compromising clinical standards, illness outcome, or patient satisfaction. Total direct medical care costs when the algorithm was used were approximately 40% of those costs generated by physicians managing similar patients, primarily because the algorithm directed an 80% reduction in a diagnostic test costs. The results suggest that significant savings can result when algorithms are used in the care of ambulatory patients with common illnesses.

Acute Disease↗
PubMed1979

Matched control study of distal splenorenal and portacaval shunts in the treatment of bleeding esophageal varices.

A matched control study was conducted to compare the effects of portacaval shunting with those of distal splenorenal shunting in patients with advanced hepatic cirrhosis and bleeding gastroesophageal varices. Patients in whom distal splenorenal shunts were performed had significantly less postoperative encephalopathy and hepatic failure and a significantly longer survival than did patients who underwent portacaval shunts.

Adult↗
PubMed1979

Relationship of obesity to bile lithogenicity in man.

Gallbladder bile was aspirated and analyzed for content of bile salts, cholesterol, and phospholipids in 97 patients undergoing jejunoileal bypass. Lithogenic indices (LI) (mole % cholesterol in sample/mole % cholesterol at saturation) were correlated with age, sex, lipid levels and hepatic fatty metamorphosis. The overall incidence of gallstones in the group was 43%(N = 121). Cholelithogenesis was unrelated to age, serum lipid concentrations, LI, or hepatic morphology. A significant relationship was noted between cholelithogenesis and female sex (p less than .03). The incidence of gallstones was greater in patients weighing more than 270% of ideal body weight and the LI greater in those weighing more than 230%. The mean LI of bile was greater than 1.0 (supersaturated) in all patients except nongallstone forming diabetics. The lithogenic index in diabetics without gallstones was 0.88 +/- 0.11, while in nondiabetics without gallstones, the LI was 1.49 +/- 0.10 (p less than 0.001). These observations indicate that grossly obese patients have an increased incidence of cholelithiasis, probably related to supersaturation of bile with cholesterol. In addition, female patients are especially at risk, while other parameters had little or no detectable influence on cholelithogenesis in this group of patients.

Adult↗
PubMed1979

Surgical treatment of chronic pancreatitis. Twenty-two years' experience.

Seventy-four patients underwent operation for chronic pancreatitis during a 22 year period at UCLA Hospital. Follow-up data obtained for 60% of these patients an average of 3.2 years postoperation were analyzed by computer for statistically significant benefit between paired operation combinations and the variables of pain relief, stool habits, alcohol use, readmission for pancreatitis, and narcotic use. The combined group of total and cephalic pancreaticoduodenectomy proved more effective with respect to pain relief and readmission (p less than 0.05) than the group that had pseudocyst drainage. The comparison of groups that underwent resection or ductal drainage showed no statistical differences for the above variables. Regardless of type of operation, if the patient had evidence of pancreatic calcifications and had abstained from alcohol postoperatively, the likelihood of a return to normal activity was more favorable (p less than 0.05).

Adult↗
PubMed1979

Reproducibility of clinical data and decisions in the management of upper respiratory illnesses: a comparison of physicians and non-physician providers.

The ability of non-physician providers to collect the data required by an algorithm for upper respiratory illness management, and the appropriateness of resulting key management decisions, were studied by comparing non-physician data and management decisions on 426 patients with those of internists. The internists, blinded to Amosists' findings and plans, evaluated the same patients and indicated management without using the algorithm (AM-MD) study). To control for variability of internists' data collecting and illness management, 171 additional patients were evaluated and managed consecutively by two internists, each also kept unaware of the other's findings and plans (MD-MD study). Overall AM-MD agreement on history and physical findings (90 per cent and 81 per cent) and on the need for tests (84 per cent) and treatment (87 per cent) was as high as MD-MD aggrement (91 per cent, 80 per cent, 88 per cent, and 75 per cent, respectively). In both studies, there was significantly more agreement on history data than on physical findings, evaluation, and therapy.

Decision Making↗
PubMed1979

The Warren shunt in treating bleeding esophageal varices.

In patients who have impaired hepatic reserve, the Warren shunt has been proposed as an effective operation because it decompresses the esophageal varices without disturbing portal perfusion of the liver. However, early reports of high operative mortality and technical difficulties have impeded acceptance of the procedure. The operation was done in a series of 17 patients. All patients in whom elective variceal decompression with a patent splenic vein was required and without clinical ascites were candidates for this operation. Follow-up ranged from 2 to 48 months. Six patients had alcoholic cirrhosis, two had primary biliary cirrhosis and seven had postnecrotic cirrhosis; in two the cause of the liver disease was unknown. Five patients were categorized as Child's class A, nine as class B and three as class C. No intraoperative or early postoperative deaths owing to hemorrhage occurred. However, there was one death two weeks postoperatively from pulmonary sepsis and one death five weeks postoperatively due to antigen-positive hepatitis. Two patients died from hepatic failure six weeks and five months after operation, respectively; in the first of these, chronic active hepatitis was diagnosed at the time of operation. In one patient hemorrhage recurred and transfusion was required. Although ascites, which eventually resolved, developed in eight patients after operation, the results in 76 percent of patients have been good without new episodes of hemorrhage or encephalopathy. We conclude that the Warren shunt is a safe and effective elective operation for the treatment of patients in whom hemorrhage from esophageal varices has occurred.

Adolescent↗
PubMed1978

The usefulness of x-ray examinations in the evaluation of patients with back pain.

Process and outcome data from 440 patients with back pain were analyzed. As a part of their care, 106 patients (24 percent) had back x-ray examinations. The non-x-rayed group of patients was used as a naturally occurring control group to determine what contribution back radiographs made to the cost, to the diagnoses and therapeutic decisions of providers, and to the outcome and satisfaction of patients. Although back x-rays contributed more to the cost of patient care than any other diagnostic study, their contribution to diagnosis was minimal, and had little effect on therapeutic decisions. Patients receiving back x-rays were more likely to have had prolonged symptoms at their first visit, and less likely to be symptom-free at four weeks, but were more likely to be satisfied with their care. The authors conclude that, for patients under 50, back x-ray examinations have negligible diagnostic value and their use could be reduced without decreasing the quality of medical care.

Adolescent↗