Biomedical subjects

R M Hoyle

Publications and source records attributed to R M Hoyle.

4 recordsLinked to original sources

PubMed1994

Case management in cerebral revascularization.

PURPOSE: We examined the clinical and financial outcomes of case management coupled with the initiation of selective use of the intensive care unit (ICU) in all cerebral revascularization procedures. METHODS: Three hundred eighty-four procedures in 331 patients were retrospectively reviewed. Morbidity and mortality rates, hospital length of stay, cost, and ICU or hospital readmissions were examined. Hypertension was examined as an independent variable for its effect on patient outcome. RESULTS: Cerebral revascularization, including carotid endarterectomy, vertebral-carotid artery transposition, and subclavian-carotid artery transposition, yielded a 0.78% stroke rate and 0.26% perioperative death rate in this series. ICU admission was necessary in nine patients (2.3%) for cardiac or respiratory instability. Three patients (0.78%) required transfer to the ICU for management of hypertension or hypotension. The mean hospital length of stay after institution of case management was reduced by 2.1 days, and the mean cost was decreased by $1987, a savings of 28.9% of total hospital cost. CONCLUSION: The dual approach of case management and selective use of the ICU promotes quality patient care, conserves financial resources without adversely affecting morbidity or mortality rates, enhances physician/nurse collaboration, and improves patient satisfaction.

Aged↗

PubMed1990

Surgical separation of conjoined twins.

The studies and their sequence should be carefully planned based on the type of fixation, associated anomalies and need for immediate separation. The current excellent outcomes, even in difficult cases of conjoined twinning, suggest that separation should always be considered, with rare exception. Carefully planned and rehearsed operations approached by a team of surgeons, anesthesiologists and skilled nurses should yield a high success rate in separating conjoined twins who otherwise would lead a life of ridicule and deformity.

Humans↗

PubMed1989

Twenty-three-year follow-up of separated ischiopagus tetrapus conjoined twins.

This paper presents a 23-year follow-up of the separation of ischiopagus tetrapus conjoined twins reported in Annals of Surgery in December 1966. One twin died of septicemia at age 2 years after bilateral pelvic osteotomies for the treatment of her marked pelvic diastasis. The surviving twin has done reasonably well, and her most significant problem is related to her musculoskeletal system. She has an increasing T7-10, L-1 apex right congenital scoliosis with wedged vertebra at T-10, as well as marked pubic diastasis and bilateral subluxation of her hips. This has resulted in a somewhat aberrant physical appearance and a "waddling" gait. Her colostomy functions well and she has normal renal and bladder function. This patient's history illustrates that many problems remain after successful separation of conjoined twins. However these problems are manageable and do not preclude the possibility that such a patient may be a productive member of society.

Adult↗

PubMed1988

Effects of 2'-deoxy-5-fluorouridine on regenerating liver following partial hepatectomy in the rat.

UNLABELLED: This study evaluated the effect of 2'-deoxy-5-fluorouridine (FUDR) on the regeneration of the liver following partial (68%) hepatectomy in the rat. Male Sprague-Dawley rats weighing between 190 and 240 g underwent partial hepatectomy under ether anesthesia. Twelve hours postoperatively rats received intraperitoneal injections of 2'-deoxy-5-fluorouridine or 0.9% NaCl solution as follows: Group I, 0.9% NaCl solution (n = 49); Group II, 89 mg 2'-deoxy-5-fluorouridine/kg of body weight (n = 25); and Group III, 178 mg 2'-deoxy-5-fluorouridine/kg of body weight (n = 24). Sham groups underwent celiotomy and liver palpation followed by 0.9% NaCl solution injections (n = 5) or low dose 2'-deoxy-5-fluorouridine (n = 5) and high dose 2'-deoxy-5-fluorouridine (n = 5). The regenerative ability of the liver was evaluated by weight and deoxyribonucleic acid synthesis in the liver remnant. RESULT: Both low and high dose 2'-deoxy-5-fluorouridine delayed the peak of deoxyribonucleic acid synthesis from 36 to 72 hr as compared to control animals which had maximal synthesis at 25 to 36 hr postoperatively (P less than 0.01). Weight of the liver remnants demonstrated a similar pattern. CONCLUSION: High doses of 2'-deoxy-5-fluorouridine administered intraperitoneally delay, but do not inhibit, liver regeneration following partial (68%) hepatectomy as reflected by DNA synthesis and weight of the remnant.

Analysis of Variance↗