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R Spicer

Publications and source records attributed to R Spicer.

10 recordsLinked to original sources
PubMed2005

Case report of a Wilms' tumor and a left-sided inferior vena cava. A common tumor with a normal variant of surgical significance.

We report a case of a successful surgical resection of a Wilms' tumor in the right kidney with a coincidental preoperative imaging finding of a left-sided inferior vena cava. To our knowledge, these 2 conditions occurring together has not been previously reported in literature. Diagnostic features and the value of magnetic resonance imaging are emphasized. We also review the literature of major venous anomalies and their influence on surgical procedures carried out on such patients.

Child↗
PubMed2005

Establishing site specific reference levels for fungi in outdoor air for building evaluation.

Culturable airborne fungal spore sampling at five building sites during 2002-2003 provided a bank of outdoor data (102 samples total) to evaluate differences in levels of individual species of airborne fungi during the morning and afternoon hours. A minimum of 15 (outdoor) air samples was collected at each site, and data were segregated into morning (before noon) and afternoon subsets. Significant differences in airborne levels for all detected fungal types between the morning and afternoon subsets were determined for each site, using a direct calculation of probability. Significance was defined by differences in frequency of detection above the combined median (p=0.90 or greater) for the respective fungal type. The levels of various species of fungi in the outdoor air varied significantly between morning and afternoon data sets at all five sites, with no pattern by species, time of day, or location. Levels of Penicillium, Aspergillus, or other fungal species associated with problematic buildings if detected outdoors, can be significantly greater in the morning or afternoon (or exhibit no significant difference) on any given day. The data does not indicate laboratory analysis as a major contributor to the variability exhibited in bioaerosols, and underscores the necessity of collecting sufficient number of samples in the outdoor air in both the morning and afternoon to prevent bias when comparing a suspect indoor environment to outdoor conditions.

Aerosols↗
PubMed2005

Comparison of injury case fatality rates in the United States and New Zealand.

OBJECTIVE: To compare injury case fatality rates in the United States (US) with New Zealand (NZ) to guide future information collection, research, and evaluation. DESIGN: Using NZ (1992-96) and US (1996-98) mortality censuses, NZ national 1992-96 hospital discharge censuses, and US 1996-98 National Hospital Discharge Survey data, the authors compared case fatality rates by mechanism and intent of injury and age group. The analysis was restricted to severe injuries (AIS> or =3). SUBJECTS: NZ (1992-96) and US (1996-98) populations. MAIN OUTCOME MEASURES: Ratio of case fatality rates in NZ versus the US (RCFR(NZ:US)). RESULTS: Overall, among cases meeting the study criteria, unintentional injuries were 1.57 times more likely fatal in NZ and intentional assault injuries were 1.14 times more likely to be fatal in the US. Firearms were involved in 50% of US assaults versus 8% of NZ assaults. By mechanism, cutting/piercing injuries were 1.86, firearm injuries were 1.41, and motor vehicle injuries were 1.44 times more to be likely fatal in NZ. Natural/environmental injuries (RCFR(NZ:US) = 0.57), unintentional poisonings (RCFR(NZ:US) = 0.26), and unintentional suffocations (RCFR(NZ:US) = 0.67) were significantly more likely to be fatal in the US. CONCLUSIONS: Possible reasons for the observed results include: differences in geography and proportion of population in rural areas, trauma system differences, road design and vehicle types, seat belt use, larger role of firearms in US assaults, coding practices, policies, and environmental factors. Disparities evoke hypotheses to test in future research that will guide priority setting and intervention.

Accidents, Traffic↗
PubMed2001

HARM 2000: crash cost and consequence data for the new millennium.

This paper presents the most detailed and current costs per US motor vehicle crash victim. These unit costs, which include the first keyed to AIS90, are reported by category, body part, whether a fracture/dislocation was involved, and MAIS. This level of detail allows for reliable analyses of interventions targeting narrow ranges of injuries and, hopefully, for the development of a biomechanical injury cost model.

Accidents, Traffic↗
PubMed1999

Unilateral agenesis of the diaphragm: a separate entity or an extremely large defect?

Since the mid-1980s, unilateral agenesis of the diaphragm (DA) has attracted the attention of paediatric surgeons as more babies affected by this extreme form of congenital diaphragmatic hernia (CDH) survive. Some authors believe that it represents a separate clinical entity. We undertook a retrospective analysis of all babies with CDH treated in the South-West Regional Paediatric Surgical Centre in Bristol between 1981 and 1995. Of 108 babies 16 (14.8%) were identified as having DA. All presented with severe respiratory distress from birth. In comparison to the group of patients with postero-lateral hernia, neonates with DA had lower Apgar scores and required longer preoperative stabilisation with inotropic support and vasodilators. Nine were subjected to operation and all required diaphragmatic replacement. Only 3 survived; thus, mortality in the DA group was 81.25%, and among those who underwent surgery 66.6% The same data for babies with postero-lateral hernia were 15.2% and 7.2%, respectively. Our results indicate that DA is associated with high morbidity and mortality, but we have not found any evidence that this anomaly is a distinct entity. In addition, we reviewed all post-mortem reports of fetuses with diaphragmatic defects available for the same period. Of 19 fetuses, 10 (52.6%) had DA. The morphological details of the diaphragmatic defect and the presence of associated anomalies were analysed. Our observations support the hypothesis that DA occurs in the very early stages of embryonic life and may be attributed to developmental arrest of the septum transversum.

Diaphragm↗
PubMed1996

Is delayed surgery really better for congenital diaphragmatic hernia?: a prospective randomized clinical trial.

Delayed surgery has become widely accepted in the management of congenital diaphragmatic hernia after comparing outcomes only with historical retrospective controls. It was the aim of this study to compare early and delayed hernia repair in a randomized prospective clinical trial. Fifty-four infants were randomized to receive either early repair (within 4 hours of admission) or delayed repair (more than 24 hours after birth). The survival rate was higher for the delayed group (57% v 46%), but the difference was not significant (difference: -11; 95% confidence limits: -37.5, 15.5). There were no significant differences between the two groups with respect to length of hospital stay, ventilator dependency, or survival time. Recorded preoperative risk factors were similar for the two groups. Eight infants in the delayed repair group died without having undergone surgery. The optimum time for surgery still needs clarification.

Blood Gas Analysis↗
PubMed1988

The cryopreserved homograft valve in the pulmonary position: early results and technical considerations.

Since September, 1985, 20 patients have undergone implantation of a homograft valve in the pulmonary position (16 pulmonary, 4 aortic). There were 11 primary operations and 9 reoperations. In 7 of 11 primary operations the homograft valve was utilized as a composite conduit with a short Dacron extension. In four of five reoperations for a failed porcine valved conduit, a composite homograft conduit was used. Four patients underwent implantation of a free homograft in a previously repaired right ventricular outflow tract (RVOT). Age ranged from 15 days to 22 years. There was one operative death (5%), a seven-week-old infant with truncus arteriosus. Long-term follow-up ranges from 1 to 30 months. Clinical performance has been satisfactory in 18 of 19 patients. One patient undergoing free implantation of a pulmonary valve in the RVOT required replacement at 18 months with a porcine valve. In this patient, pulmonary insufficiency was caused by distortion of the annulus secondary to dilatation and pulmonary hypertension. Nine of 18 survivors do not require medication. Eleven of 18 have trivial to mild pulmonary insufficiency murmurs without symptomatology. The homograft valve is extremely useful in reconstruction of the right heart, however, early insufficiency murmurs have been noted. Distortion of the valve annulus may contribute to the early onset of a benign insufficiency murmur. Residual distal obstruction or pulmonary hypertension may be a contraindication to the use of a free homograft in the orthotopic position.

Adolescent↗
PubMedDate not supplied

Prospective single-arm protocol of carvedilol in children with ventricular dysfunction.

The objective of this study was to evaluate the safety and efficacy of carvedilol in pediatric patients with stable moderate heart failure. We performed a single-arm prospective drug trial at three academic medical centers and the results were compared to historical controls. Patients were 3 months to 17 years old with an ejection fraction <40% in the systemic ventricle for at least 3 months on maximal medical therapy including ACE inhibitors. Treated patients were started on 0.1 mg/kg/day and uptitrated to 0.8 mg/kg/day or the maximal tolerated dose. Echocardiographic parameters of function were prospectively measured at entry and at 6 months. Two composite endpoints were recorded: severe decline in status and significant clinical change. Adverse events were reviewed by a safety committee. Data were also collected from untreated controls with dilated cardiomyopathy meeting entry criteria, assessed over a similar time frame. Twenty patients [12 dilated cardiomyopathy (DCM) and 8 congenital] with a median age of 8.4 years (range, 8 months to 17.8 years) were treated with carvedilol. Three patients discontinued the drug during the study. At entry, there was no statistical difference in age, weight, or ejection fraction between the treated group and controls. The ejection fraction of the treated DCM group improved significantly from entry to 6 months (median, 31 to 40%, p = 0.04), with no significant change in ejection fraction in the control group [median, 29 to 27%, p = not significant (NS)]. The median increase in ejection fraction was larger for the treated DCM group than for the untreated DCM controls (7 vs 0%, p = 0.05). By Kaplan-Meier analysis, time to death or transplant tended to be longer in treated patients (p = 0.07). The difference in the proportion of patients with severe decline in status or significant clinical change in the treated group was not significant compared to the controls (5 vs 12%, p = NS). We conclude that in this prospective protocol of pediatric patients, the use of adjunct carvedilol in the DCM group improved ejection fraction compared to untreated controls and trended toward delaying time to transplant or death.

Adolescent↗