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Biomedical subjects

Rajan Gupta

Publications and source records attributed to Rajan Gupta.

17 recordsLinked to original sources
PubMed2006

Clinical evaluation of a bioresorbable membrane (polyglactin 910) in the treatment of Miller type II gingival recession.

Coverage of denuded roots has become one of the most challenging procedures in periodontal plastic surgery. The search for the appropriate root coverage technique has taken many different approaches. Various surgical options with predictable outcomes are available. In this clinical study, patients were treated using polyglactin 910 (Vicryl mesh) and a coronally positioned flap. Clinical parameters for 15 patients were recorded immediately prior to surgery and after a minimum of 6 months. Postoperatively, significant root coverage, reductions in probing depths, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. The final esthetics, both color match and tissue contours, were acceptable to both the patients and the clinicians.

Absorbable Implants↗
PubMed2005

The invisible trauma patient: emergency department discharges.

BACKGROUND: As the malpractice and financial environment has changed, injured patients evaluated by the trauma team and discharged from the emergency department (ED) are now commonplace. The evaluation, care, and disposition of this population has become a significant workload component but is not reported to accrediting organizations and is relatively invisible to hospital administrators. Our objective was to quantify and begin to qualify the evolving picture of the trauma ED discharge population as a work component of trauma service function in an urban, Level I trauma center with an aeromedical program. METHODS: Trauma registry (contacts, mechanism, transport, injuries, and disposition) and hospital databases (ED closure, occupancy rates) were queried for a 5-year period (1999-2003). Trend analysis provided statistical comparisons for questions of interest. RESULTS: During the 5-year study period, the total number of trauma contacts rose by 18.1% (2,220 in 1999 vs. 2,622 in 2003; trend p < 0.05). This increase in total contacts was not a manifestation of an increase in admissions (1,672 in 1999 vs. 1,544 in 2003) but rather a reflection of a marked increase in patients seen primarily by the trauma team and discharged from the ED (473 in 1999 vs. 1,000 in 2003; trend p < 0.05). These ED discharge patients were increasingly transported by helicopter (12.3% in 1999 vs. 29.2% in 2003; trend p < 0.05) and less frequently from urban areas (57.1% in 1999 vs. 48.1% in 2003; trend p < 0.05) over the course of the study period. Average injury severity of this group increased over the study period (Injury Severity Score of 2.7 +/- 0.1 in 1999 vs. 3.3 +/- 0.1 in 2003; trend p < 0.05). ED length of stay for this group increased 19.8% over the study period (trend p < 0.05), averaging nearly 5 hours in 2003. CONCLUSION: The total number, relative percentage, and injury severity of patients evaluated by the trauma team and discharged from the ED has significantly increased over the last 5 years, representing nearly 5,000 patient care hours in 2003. Systems to care for these patients in a cost- and resource-efficient fashion should be put in place. The impact of this growing population of patients on the workload of the trauma center should be recognized by accrediting agencies, hospital administration, and Emergency Medical Services.

Abbreviated Injury Scale↗
PubMed2005

Use of goniometry to predict inadequate flexion-extension roentgenograms: a preliminary study.

BACKGROUND: Flexion-extension roentgenograms (FER) of the cervical spine are often inadequate because of limited range of motion (ROM). The purpose of this study was to determine the utility of goniometry to predict a patient's ability to achieve sufficient ROM to obtain adequate FER. METHODS: We evaluated 65 consecutive blunt trauma patients undergoing evaluation by FER in the emergency department. Patients were evaluated by goniometry before performing FER. Adequate ROM was defined as flexion and extension of >30 degrees from neutral. RESULTS: Seventy-five percent of patients had adequate FER. All of these patients were predicted to have sufficient ROM by goniometry. Goniometry predicted limited ROM in 69% of patients who had inadequate FER. The positive predicative value of goniometry in predicting inadequate FER was 100%. The incidence of cervical spine injuries was 44% in patients with inadequate ROM by goniometry and 23.0% in patients with inadequate FER (versus 7.69% in patients with adequate FER). CONCLUSION: Goniometry accurately predicted those patients who were unable to achieve sufficient ROM for adequate FER. Patients with inadequate FER were at a higher risk for cervical spine injury compared with patients with adequate FER (23.0 versus 7.69%). Early identification of these patients will help limit the number of inadequate studies obtained and expedite evaluation of high-risk patients.

Adult↗
PubMed2005

Seasonal variation in undiagnosed HIV infection on the general medicine and trauma services of two urban hospitals.

OBJECTIVE: To examine the seroprevalence of undiagnosed HIV and variation by season among patients admitted to the general internal medicine (GIM) and trauma services of two urban hospitals. DESIGN: A cross-sectional blinded HIV-1 seroprevalence survey. SETTING: A 725-bed academic medical center's hospital and an affiliated 324-bed tertiary care hospital. PARTICIPANTS: Residual serological specimens were obtained for unique patients aged 17 to 65 to study services in summer (June 16 to September 4, 2001) and fall to winter (November 1, 2001 to January 8, 2002). METHODS: Hospital files provided data on demographics, service type, and discharge clinical categories (fall-winter group only). HIV ELISA (enzyme-linked immunosorbent assay) tests with confirmatory Western blot were linked to subjects' de-identified files. We excluded 34 subjects with known HIV. Of the remaining unique admissions in summer (n=604) and fall-winter (n=978), 60% and 55% were tested, respectively. Predictors of undiagnosed HIV infection were examined using multivariate analysis. RESULTS: The summer cohort (n=362) had significantly lower unadjusted seroprevalence of undiagnosed HIV infection (1.4%; 95% confidence interval [CI], 0.4% to 3.2%) than the fall-winter cohort (n=539; 3.7%; 95% CI, 2.3% to 5.7%; P=.04). Overall, undiagnosed HIV was somewhat less likely in women (adjusted odds ratio [AOR], 0.45; 95% CI, 0.19 to 1.07) but more likely in black patients (AOR, 3.46; 95% CI, 0.70 to 17.06). In the fall-winter cohort, undiagnosed HIV was more likely for discharges with the following clinical categories versus those with a cardiac condition: dermatologic/breast (AOR, 14.90; 95% CI, 1.20 to 184.77), renal/urological (AOR, 22.43; 95% CI, 2.12 to 236.75), or infectious (AOR, 31.08; 95% CI, 2.40 to 402.98). CONCLUSIONS: The higher seroprevalence of undiagnosed HIV in the fall-winter admissions to GIM and trauma services supports especially targeting HIV testing in these months.

Adolescent↗
PubMed2005

2% sodium fluoride-iontophoresis compared to a commercially available desensitizing agent.

BACKGROUND: Dentin hypersensitivity is a common clinical condition and age-old complaint, presenting problems to both the patient and the dentist. Besides causing discomfort, the condition may deter a person from establishing or maintaining adequate oral hygiene procedures, further complicating oral health. The failure to practice satisfactory plaque control has well-established consequences on gingival and periodontal health. Thus, a cycle of sensitive teeth leading to reduced plaque control, more periodontal disease, and more recession may be established. METHODS: The hypersensitive teeth were identified by the patient and verified by the light stroke of a dental explorer along the cervical area of all teeth present. Subjects fulfilling the inclusion and exclusion criteria were evaluated using tactile, 1-second air blast, and cold water stimuli, and the subject's response was recorded on the verbal rating scale. A total of 425 teeth from 50 patients included in this study were randomly divided into two groups: group 1, who received 2% sodium fluoride-iontophoresis (NaF) and group 2, who received an aqueous solution of hydroxy-ethyl-methacrylate and glutaraldehyde (HEMA-G). The teeth were evaluated immediately after treatment and at 2 weeks, 1 month, and 3 months. In case of failure at the 2-week interval, the affected tooth was retreated with the same drug as before and evaluated further. RESULTS: The results were statistically analyzed, and it was found that group 1 treatment was more effective than group 2 at 1- and 3-month intervals. There was a comparatively greater recurrence of hypersensitivity in group 2. A comparable number of teeth required repeat dosage in both groups. Teeth which required repeat dosage had greater mean discomfort scores at baseline for all three tests than the teeth which did not require a repeat dose. CONCLUSIONS: Both agents showed significant reduction in sensitivity at all time intervals compared to baseline; however, NaF had a comparatively greater effect than HEMA-G at both the 1- and 3-month intervals; an almost equal number of teeth in both groups required repeat doses. Teeth with a higher initial sensitivity score required a repeat dose. Both agents were found to be equally effective immediately after application; the 2% NaF was comparatively better than HEMA-G in providing long-term relief.

Administration, Topical↗
PubMed2004

Cerebral cortical oxygenation: a pilot study.

BACKGROUND: Cerebral hypoxia (cerebral cortical oxygenation [Pbro2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing Pbro2 in patients with traumatic brain injury (TBI). METHODS: A prospective observational cohort study was performed. Institutional review board approval was obtained. All patients with TBI who required measurement of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and Pbro2 because of a Glasgow Coma Scale score < 8 were enrolled. Data sets (ICP, CPP, Pbro2, positive end-expiratory pressure (PEEP), Pao2, and Paco2) were recorded during routine manipulation. Episodes of cerebral hypoxia were compared with episodes without. Results are displayed as mean +/- SEM; t test, chi2, and Fisher's exact test were used to answer questions of interest. RESULTS: One hundred eighty-one data sets were abstracted from 20 patients. Thirty-five episodes of regional cerebral hypoxia were identified in 14 patients. Compared with episodes of acceptable cerebral oxygenation, episodes of cerebral hypoxia were noted to be associated with a significantly lower mean Pao2 (144 +/- 14 vs. 165 +/- 8; p < 0.01) and higher mean PEEP (8.8 +/- 0.7 vs. 7.1 +/- 0.3; p < 0.01). Mean ICP and CPP measurements were similar between groups. In a univariate analysis, cerebral hypoxic episodes were associated with Pao2 < or = 100 mm Hg (p < 0.01) and PEEP > 5 cm H2O (p < 0.01), but not ICP > 20 mm Hg, CPP < or = 65 mm Hg, or Pac2 < or = 35 mm Hg. CONCLUSION: Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.

Adult↗
PubMed2004

Integrating emergency general surgery with a trauma service: impact on the care of injured patients.

BACKGROUND: There has been considerable discussion on the national level on the future of trauma surgery as a specialty. One of the leading directions for the field is the integration of emergency general surgery as a wider and more attractive scope of practice. However, there is currently no information on how the addition of an emergency general surgery practice will affect the care of injured patients. We hypothesized that the care of trauma patients would be negatively affected by adding emergency general surgery responsibilities to a trauma service. METHODS: Our institution underwent a system change in August 2001, where an emergency general surgery (ES) practice was added to an established trauma service. The ES practice included emergency department and in-house consultations for all urgent surgical problems except thoracic and vascular diseases. There were no trauma staff changes during the study period. Trauma registry data (demographics, injuries, injury severity, and procedures) and performance improvement data (peer-review judgments for all identified errors, denied days, audit filters, and deaths) were abstracted for two 15-month periods surrounding this system change. Chi-square, Fisher's exact, and t tests provided between-group comparisons. RESULTS: The trauma staff evaluated a total of 5,874 patients during the 30-month study. There were 1,400 (51%) trauma admissions in the pre-ES group and 1,504 (48%) in the post-ES group, of which 1,278 and 1,434, respectively, met severity criteria for report to our statewide database (Pennsylvania Trauma Outcome Study [PTOS]). There were 163 (12.7% of PTOS) deaths in the pre-ES group compared with 171 (11.9% PTOS) deaths in the post-ES group (p = not significant [NS]). There was one death determined to be preventable by the peer review process for the pre-ES group, and none in the post-ES group. Both groups had 10 potentially preventable deaths, with the remaining mortalities being categorized as nonpreventable (p = NS). Unexpected deaths by TRISS methodology were 36 (2.8%) and 41 (2.9%) for the two groups, respectively (p = NS). There was no difference in the number of provider-specific complications between the groups (23, [1.8%] vs. 19 [1.3%], p = NS). The addition of emergency surgery has resulted in an additional average daily workload of 1.3 cases and 1.2 admissions. CONCLUSION: Despite an increase in trauma volume over the study period, the addition of emergency surgery to a trauma service did not affect the care of injured patients. The concept of adding emergency surgery responsibilities to trauma surgeons appears to be a valid way to increase operative experience without compromising care of the injured patient.

Emergency Service, Hospital↗
PubMed2003

Training in trauma surgery: quantitative and qualitative aspects of a new paradigm for fellowship.

OBJECTIVE: To describe outcomes from a clinical trauma surgical education program that places the board-eligible/board-certified fellow in the role of the attending surgeon (fellow-in-exception [FIE]) during the latter half of a 2-year trauma/surgical critical care fellowship. SUMMARY BACKGROUND DATA: National discussions have begun to explore the question of optimal methods for postresidency training in surgery. Few objective studies are available to evaluate current training models. METHODS: We analyzed provider-specific data from both our trauma registry and performance improvement (PI) databases. In addition, we performed TRISS analysis when all data were available. Registry and PI data were analyzed as 2 groups (faculty trauma surgeons and FIEs) to determine experience, safety, and trends in errors. We also surveyed graduate fellows using a questionnaire that evaluated perceptions of training and experience on a 6-point Likert scale. RESULTS: During a 4-year period 7,769 trauma patients were evaluated, of which 46.3% met criteria to be submitted to the PA Trauma Outcome Study (PTOS, ie, more severe injury). The faculty group saw 5,885 patients (2,720 PTOS); the FIE group saw 1,884 patients (879 PTOS). The groups were similar in respect to mechanism of injury (74% blunt; 26% penetrating both groups) and injury severity (mean ISS faculty 10.0; FIEs 9.5). When indexed to patient contacts, FIEs did more operations than the faculty group (28.4% versus 25.6%; P < 0.05). Death rates were similar between groups (faculty 10.5%; FIEs 10.0%). Analysis of deaths using PI and TRISS data failed to demonstrate differences between the groups. Analysis of provider-specific errors demonstrated a slightly higher rate for FIEs when compared with faculty when indexed to PTOS cases (4.1% versus 2.1%; P < 0.01). For both groups, errors in management were more common than errors in technique. Twenty-one (91%) of twenty-three surveys were returned. Fellows' feelings of preparedness to manage complex trauma patients improved during the fellowship (mean 3.2 prior to fellowship versus 4.5 after first year versus 5.8 after FIE year; P < 0.05 by ANOVA). Eighty percent rated the FIE educational experience "great -5" or "exceptional- 6." Eighty-five percent consider the current structure of the fellowship (with FIE year) as ideal. Ninety percent would repeat the fellowship. CONCLUSION: The educational experience and training improvement offered by the inclusion of a FIE period during a trauma fellowship is exceptional. Patient outcomes are unchanged. The potential for an increased error rate is present during this period of clinical autonomy and must be addressed when designing the methods of supervision of care to assure concurrent senior staff review.

Colonic Pouches↗
PubMed2002

Direct cryogenic-temperature transmission electron microscopy imaging of phospholipid aggregates in soybean oil.

Cryogenic-temperature transmission electron microscopy (cryo-TEM) was fine-tuned to make it applicable to the study of a natural oil-based system. While liquid ethane, the cryogen of choice for specimen preparation, was found to dissolve the oil, we observed that the triglycerides found in many natural oils serve as cryoprotectants that allow vitrification of such oil systems in liquid nitrogen, a cryogen that provides relatively low cooling rates. Using the modified technique combined with digital imaging by a cooled CCD camera, we were able to directly visualize inverse micellar and liquid-crystalline aggregates formed in the soybean oil/soybean phospholipids/water/hexane system, which is commercially important in soybean oil processing. The method developed here should be widely applicable to other organic solvent-based systems.

Journal Article↗
PubMed2002

Abdominal compartment syndrome in the open abdomen.

BACKGROUND: Multiple methods exist to manage in the intensive care unit the patient with an open abdomen. An increasingly common method is the vacuum packed technique. This method accommodates considerable expansion of intra-abdominal contents and should obviate the potential development of the abdominal compartment syndrome (ACS). Despite this, some patients with these temporary abdominal dressings will go on to develop ACS. For the purpose of this study we have defined this clinical entity as the open abdomen ACS. HYPOTHESIS: Patients with an open abdomen who develop ACS have a poor prognosis. Fluid requirements and resuscitative indices may predict which of these patients will develop open abdomen ACS. METHODS: A retrospective review was performed of patients with trauma who had an open abdomen treated with vacuum packed dressings at our urban level I trauma center. Over 1 year (July 1, 1999-June 30, 2000), 5 patients managed with an open abdomen developed ACS. These patients were compared with 15 consecutive patients with an open abdomen who did not develop clinical ACS during that same period. Fluid resuscitation, base deficit, pH, lactate level, systolic blood pressure, prothrombin time, temperature, peak inspiratory pressure, and PCO(2) were abstracted. The Fisher exact test was used for statistical analysis. RESULTS: In patients managed with an open abdomen, ACS developed between 1.5 and 12 hours (mean [SD], 7.5 [3.9] hours) after placement of the vacuum packed dressing. The base deficit, pH, peak inspiratory pressure, PCO(2,) and lactate level were more abnormal and the crystalloid requirements were significantly higher in the ACS group. The systolic blood pressure, temperature, and prothrombin time did not differ between groups. Three patients with ACS developed a second episode of ACS. Mortality in the ACS group was 3 (60%) of 5 patients vs 1 (7%) of 15 patients in the control group. CONCLUSIONS: Management of the open abdomen with the temporary abdominal closure does not prevent the development of ACS. Mortality is high when ACS occurs in this scenario. Severe physiologic derangement and high crystalloid requirements may predict which patients will develop ACS.

Abdomen↗
PubMed2002

Hepatic angiography in patients undergoing damage control laparotomy.

OBJECTIVE: Patients undergoing damage control (DC) laparotomy require intensive and aggressive resuscitation, and may require additional maneuvers to control parenchymal bleeding. Those patients suffering significant liver injury are at high risk for arterial bleeding deep within the liver, and many require hepatic angiography in addition to hepatic packing. We reviewed our experience with hepatic angiography, and sought to determine its safety in the DC population of penetrating and blunt trauma patients. METHODS: A 3-year (June 1997-May 2000) retrospective review generated 37 DC patients. Patients sustaining hepatic trauma constituted the study group. Patients undergoing angiography in addition to DC laparotomy were compared with the group of patients not undergoing angiography. Data regarding mechanism of injury, patient demographics, extent of hepatic injury, and presence of associated injuries were collected. Physiologic parameters including vital signs at admission, lowest pH and base excess in the operating room, and lactate levels in the intensive care unit, as well as volumes of fluid resuscitation throughout all phases of DC were examined. Complications including death, intra-abdominal processes, acute respiratory distress syndrome and/or multiple organ dysfunction syndrome, and acute renal failure were reviewed. RESULTS: Nineteen patients (51%) had hepatic trauma and underwent perihepatic packing as a part of DC laparotomy. Eleven had sustained penetrating injury and 8 had blunt injury. There was 1 American Association for the Surgery of Trauma grade I, 5 grade II, 3 grade III, and 10 grade IV injuries. Nine patients in the study population underwent angiography, and eight of these were hepatic artery angiograms. One hepatic angiogram was obtained before operation and seven were obtained in the immediate postoperative period. Six underwent embolization of bleeding hepatic vessels, for a therapeutic liver angiography rate of 75%. There was no statistical difference in physiologic parameters or fluid requirements between the patients who underwent angiography and those who did not. There were no mishaps or complications from angiography or while in the angiography suite. CONCLUSION: Hepatic angiography is a safe adjunct to the principles of damage control. It has a high therapeutic ratio, with no significant untoward effect in this small study population.

Adolescent↗
PubMed2002

Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma.

BACKGROUND: The purpose of this study is to investigate the usefulness of flexion and extension radiographs of the cervical spine for the acute evaluation of ligamentous injury in cases of awake blunt trauma. METHODS: A review of 106 consecutive cases of blunt trauma evaluated with flexion and extension radiographs of the cervical spine obtained in the acute setting at a Level I trauma center was performed. The data compiled included the age, sex, mechanism of injury, type of radiographic evaluations, interpretation of all radiographic studies, and clinical outcome on follow-up. RESULTS: Sixty-six of the patients (62%) were involved in motor vehicle crashes. Other injuries included 15 falls (14%), 9 blunt assaults (8.5%), and 16 other types of blunt trauma (15%). Thirteen cervical spine injuries were diagnosed in 9 of 106 patients (8.5%). Injuries included two fractures, eight acute disc herniations, two ligamentous injuries, and one cord contusion diagnosed on the basis of all radiologic evaluation and clinical follow-up. Seventy-four patients (70%) had a range of flexion and extension motion interpreted as adequate for diagnostic purposes. Five of the 74 patients (6.75%) with an adequate range of motion had cervical spine injuries. No ligamentous injuries were misdiagnosed in this group. Thirty-two of the flexion and extension examinations (30%) were interpreted as inadequate because of limited motion. Four of the 32 patients (12.5%) with inadequate flexion and extension examinations had injuries subsequently detected on cross-sectional imaging (computed tomographic scanning or magnetic resonance imaging) including severe ligamentous injury. CONCLUSION: When adequate motion was present on flexion and extension radiographs, the false-negative rate was zero in this study. However, in the acute setting, 30% of the examinations were limited by inadequate motion. A higher percentage of injury (12.5%) was detected by subsequent cross-sectional imaging in these patients. Limited flexion and extension motion on physical examination should preclude the use of flexion and extension radiographs, as they are of limited diagnostic utility. Cross-sectional imaging may be warranted in this high-risk group of patients.

Acute Disease↗
PubMed2002

Pelvic radiography in blunt trauma resuscitation: a diminishing role.

BACKGROUND: An anteroposterior pelvic radiograph (PXR) continues to be recommended by Advanced Trauma Life Support protocol as an early diagnostic adjunct in the resuscitation of blunt trauma patients. At the same time, computed tomographic (CT) scanning has become a practice standard for diagnosis of most abdominal and pelvic injury. The objective of this study was to determine the necessity of obtaining an early PXR in stable trauma patients who will undergo CT scanning during the initial resuscitation. METHODS: A retrospective review of all blunt trauma patients undergoing immediate abdomen and pelvic CT scanning was performed from July 2000 until June 2001 at an urban Level I trauma center. These patients were divided into two groups depending on whether they also received a PXR (group I) or not (group II). At the time of the study, there was no formal protocol to determine which patients underwent pelvic radiography. Radiology reports of all PXRs and CT scans were reviewed. Patient demographics and Injury Severity Scores (ISSs) were abstracted from our trauma registry. The data were analyzed using Student's test. RESULTS: A total of 686 patients with blunt trauma underwent CT scanning of the abdomen and pelvis. Group I consisted of 311 (45%) patients with an average ISS of 12.3 +/- 0.7. In group I, 56 (10%) patients were found to have at least one pelvic fracture on CT scan, 38 of which were also identified on the PXR. Defining CT scanning as the definitive test, the sensitivity and specificity of the PXR in group I was 68% and 98%, respectively. The false-negative rate for pelvic radiography was 32%. In all patients with a positive PXR, the majority (55%) had either additional fractures or an increase in the Young and Burgess grade of fracture diagnosed on CT scan. Group II consisted of 375 patients, with 16 fractures noted in 13 (3%) patients, none of which required treatment. The mean ISS of group II was 8.0 +/- 0.5. CONCLUSION: The PXR has limited sensitivity for detecting pelvic fractures compared with CT scanning. Selected hemodynamically stable patients who undergo CT scanning during their immediate resuscitation do not need a routine PXR. The PXR may continue to be beneficial in unstable patients, those with positive physical findings, or those who cannot undergo CT scanning because of other clinical priorities.

Abdominal Injuries↗
PubMed2002

Incidence and natural history of below-knee deep venous thrombosis in high-risk trauma patients.

BACKGROUND: Venous thromboembolic disease remains a difficult problem in the trauma patient population. The purpose of this study was to delineate the incidence and natural history of below-knee deep venous thrombosis (BKDVT) in high-risk trauma patients. METHODS: Patients were stratified into risk categories (low, high, or very high) for deep venous thrombosis on the basis of an institutional practice management guideline and known risk factors. All at-risk patients received either sequential compression devices (SCDs) or subcutaneous heparin (SQH) compounds, and high-risk patients also underwent weekly surveillance by duplex scanning. Very-high-risk patients had prophylactic inferior vena cava (IVC) filter placement. This prospective, observational study examines the duplex results on all high-risk patients. Data regarding method of prophylaxis, the incidence of proximal propagation on serial duplex examinations, and changes in management (anticoagulation or IVC filter placement) were collected on the high-risk patients who developed a BKDVT. RESULTS: Between March 1997 and June 2001, 601 patients were stratified into the high-risk category and underwent a total of 1,109 duplex examinations. Eighty-five patients (14.1%) had 113 BKDVTs. These patients underwent a total of 212 duplex examinations; all patients developed their BKDVTs within 34 days. Weekly incidence was 40 (47.1%), 25 (29.4%), 15 (17.6%), 1 (1.2%), and 4 (4.7%) for weeks 1 through 5, respectively. SCDs, SQH compounds, and SCDs with SQH compounds were used on 73, 3, and 9 patients, respectively. In 4 of 85 (4.7%) patients, the BKDVT propagated proximally to an above-knee location in 4 to 8 days. Two of these patients were anticoagulated, and two underwent placement of an IVC filter. One patient (1.2%) with a BKDVT that had not propagated on duplex study developed a pulmonary embolus. CONCLUSION: Patients identified as high-risk by our practice management guideline had a 14.1% incidence of a BKDVT; 94.1% were diagnosed within the first 3 weeks of hospitalization. Proximal propagation occurred in 4.7% and led to changes in management. Serial duplex examination of the BKDVT alone, rather than systemic anticoagulation or IVC filter placement, appears to be a reasonable treatment alternative.

Adolescent↗
PubMed2002

The role of positive examinations in training for the focused assessment sonogram in trauma (FAST) examination.

The purpose of this study is to determine whether the inclusion of known positive patients to the practical portion of a Focused Assessment Sonogram in Trauma (FAST) training course improves overall training and increases FAST accuracy. This is a prospective double-blind design. Original course participants (PRE) underwent a 2-hour didactic session and practicum with ten normal volunteers. Modified course participants (POST) additionally imaged five peritoneal dialysis (PD) patients to simulate positive examinations. The practitioners (six PRE and five POST) were compared as to their ability to detect and quantify intraperitoneal fluid (0-2000 cc) in nine PD patients during a double-blind prospective examination. Test results were reported as positive or negative. Positive results were further quantified by volume. Each practitioner performed ten examinations. Data for inexperienced clinicians are presented. Sensitivity for detecting < or = 750 cm3 was 45 per cent PRE and 87 per cent POST (P = 0.02). Accuracy in quantifying volume within 250 cm3 was 38 per cent PRE and 44 per cent POST (not significant). FAST accuracy for inexperienced sonographers--particularly in diagnosing smaller volumes--can be improved significantly by including positive studies in training. Exposure to positive FAST examinations during training improves the learning curve. With the growing dependency on FAST to accurately triage blunt abdominal trauma safe and effective FAST training should consist of didactic education and a practical portion that includes positive studies. When screened properly PD patients can be used effectively to demonstrate positive FAST studies.

Abdominal Injuries↗
PubMedDate not supplied

Changes in the American interventional radiology literature: comparison over a 10-year time period.

PURPOSE: To determine the changes that occurred regarding interventional radiologic research in the major American radiology journals between 1992-1993 and 2002-2003. METHODS: Articles published in three major American radiology journals (Journal of Vascular and Interventional Radiology, American Journal of Roentgenology, and Radiology) during two distinct 24-month time periods (1992-1993 and 2002-2003) were evaluated. All articles judged to be pertinent to the interventional radiologic community were included. Investigations included in journal subheadings other than "interventional" or "vascular radiology" were included if the emphasis of the article was on a vascular imaging modality or peripheral intervention. Exclusions included: case reports, technical reports, letters to the editor, breast interventions, and primary neurointerventions. Data were collected regarding the affiliations of the primary author (nationality, hospital type, department); primary category of interest of the investigation; funding information; and study design variables. Two-by-two chi-squared statistical analyses were performed comparing the variables from the early and late data sets. RESULTS: A total of 405 articles met the inclusion criteria for the early data set (1992-1993); 488 articles met the inclusion criteria for the late data set (2002-2003). Variables that demonstrated a statistically significant decrease from the early data set to the late data set included: articles in which the primary author was from a department of radiology (91.1% vs. 86.3%; p < 0.025); articles written by a primary author who was American (69.4% vs. 44.6%; p < 0.001); and articles with a primary category of investigation that had a nonvascular intervention focus (22.7% vs. 11.9%; p < 0.001). Variables that demonstrated a statistically significant increase from the early data set to the late data set included primary authors from Western Europe (18.0% vs. 30.1%; p < 0.001) and Asia (6.6% vs. 18.4%; p < 0.001), the primary field of investigation, with significant increases noted for primary cancer interventions (6.5% vs. 13.3%; p < 0.001), gynecologic interventions (0.2% vs. 4.5%; p < 0.001), stent-grafts (0 vs. 2.9%; p < 0.001), and spine interventions (0 vs. 1.8%; p < 0.01). Studies receiving funding also demonstrated a significant increase when comparing the early and late data sets (11.3% vs. 23.0%, respectively; p < 0.001). CONCLUSIONS: Articles published in the American radiologic literature have changed significantly over the past 10 years. Primary authors are more likely to be nonradiologists and less likely to be American. Investigations dealing primarily with nonvascular interventions are less common; however, some forms of intervention (particularly cancer interventions) are seen more frequently in the literature. The percentage of funded projects has more than doubled in the same time frame.

Periodicals as Topic↗