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Biomedical subjects

S D Reed

Publications and source records attributed to S D Reed.

At least 19 recordsLinked to original sources
PubMed2006

Leiomyoma characteristics and risk of subsequent surgery after myomectomy.

OBJECTIVE: Evaluate the association between leiomyoma characteristics at myomectomy with subsequent surgery risk. METHODS: A population-based nested case control study from a cohort of women at a large HMO, identified as having had a myomectomy was performed; 82 cases had subsequent uterine surgery; 82 controls, frequency matched for age and date of first surgery, did not. Medical records were abstracted; follow-up was 18-128months. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. RESULTS: Women without subserosal myomas were more likely to have a second surgery as compared to women with at least one subserosal myoma, aOR=4.1(95% CI 1.5-10.9). Size of myomas did not predict subsequent surgery in subanalyses by type of surgery. Number of leiomyomas was not predictive of a subsequent uterine surgery overall or in subgroup analyses. CONCLUSION: Myoma location, but not number or size, impacts the risk for subsequent leiomyoma uterine surgery.

Adult↗
PubMed2003

Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer.

We performed an economic analysis of data from 180 women in a clinical trial of conventional-dose chemotherapy vs high-dose chemotherapy plus stem-cell transplantation for metastatic breast cancer responding to first-line chemotherapy. Data on resource use, including hospitalizations, medical procedures, medications, and diagnostic tests, were abstracted from subjects' clinical trial records. Resources were valued using the Medicare Fee Schedule for inpatient costs at one academic medical center and average wholesale prices for medications. Monthly costs were calculated and stratified by treatment group and clinical phase. Mean follow-up was 690 days in the transplantation group and 758 days in the conventional-dose chemotherapy group. Subjects in the transplantation group were hospitalized for more days (28.6 vs 17.8, P=0.0041) and incurred higher costs (US dollars 84055 vs US dollars 28169) than subjects receiving conventional-dose chemotherapy, with a mean difference of US dollars 55886 (95% CI, US dollars 47298-US dollars 63666). Sensitivity analyses resulted in cost differences between the treatment groups from US dollars 36528 to US dollars 75531. High-dose chemotherapy plus stem-cell transplantation resulted in substantial additional morbidity and costs at no improvement in survival. Neither the survival results nor the economic findings support the use of this procedure outside of the clinical trial setting.

Adult↗
PubMed2001

Inpatient costs, length of stay, and mortality for cerebrovascular events in community hospitals.

BACKGROUND: Accurate estimates of inpatient cost, length of stay (LOS), and mortality are necessary for the development of economic models to estimate the cost-effectiveness of stroke-related treatments. Estimates based on data from academic institutions may not be generalizable to community hospitals. In this study, the authors estimated inpatient costs, LOS, and in-hospital mortality for patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic cerebral infarction (ICI), and TIA who were treated in community hospitals. METHODS: The authors selected patients using International Classification of Diseases-9-Clinical Modification primary diagnosis codes from the HBSI EXPLORE database. They analyzed patient-level data and inpatient costs, derived from detailed utilization data, for all patients admitted to 137 community hospitals in 1998. Multivariate statistical techniques were used to examine patient-, hospital-, and outcome-related factors associated with inpatient costs. RESULTS: Patients with SAH incurred the highest average cost ($23,777, n = 1,124), followed by patients with ICH ($10,241, n = 3,139), ICI ($5,837, n = 18,740), and TIA ($3,350, n = 7,861). Patient subgroups ranked in the same order for average LOS at 11.5 days for SAH, 7.5 days for ICH, 5.9 days for ICI, and 3.4 days for TIA. Almost one third of patients with SAH (29.0%) and ICH (33.1%) died during hospitalization, whereas 7.0% with ICI and 0.2% with TIA died. For each event, as patient age increased, average costs consistently decreased. Also, average costs were higher among patients treated in community teaching hospitals compared to community nonteaching hospitals for each cerebrovascular event (10 to 29%). CONCLUSIONS: Inpatient costs, LOS, and mortality for patients with cerebrovascular disease are dependent on patient and hospital characteristics.

Aged↗
PubMed2001

Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals.

BACKGROUND AND PURPOSE: Most analyses of intravenous tissue plasminogen activator (IV tPA) use for acute stroke in routine practice have been limited by sample size and generally restricted to patients treated in large academic medical facilities. In the present study, we sought to estimate among community hospitals the use of IV tPA and to identify factors associated with the use of IV tPA and inpatient mortality. METHODS: We evaluated a retrospective cohort of 23 058 patients with ischemic stroke from 137 community hospitals. RESULTS: Three hundred sixty-two (1.6%) patients were treated with IV tPA, and 9.9% of those patients died during the hospitalization period. In 35.0% of the hospitals, no patients were treated with IV tPA, whereas 14.6% of hospitals treated approximately 3.0% with IV tPA. After control for multiple factors, younger patients, more severely ill patients (OR 2.02, 95% CI 1.36 to 3.01), and patients treated in rural hospitals (OR 1.80, 95% CI 0.99 to 3.26) were more likely to receive IV tPA, whereas black patients were less likely (OR 0.54, 95% CI 0.31 to 0.95). There also was a trend showing that women were less likely to receive IV tPA (OR 0.84, 95% CI 0.69 to 1.03). Factors associated with an increased odds of inpatient mortality included receipt of IV tPA among men (OR 2.81, 95% CI 1.72 to 4.58) and increased age. Black patients were 27% less likely to die during hospitalization (95% CI 0.60 to 0.90). CONCLUSIONS: In this large, retrospective evaluation of community hospital practice, the use IV tPA and inpatient mortality rates among IV tPA-treated patients were consistent with those of other studies. The likelihood of receiving IV tPA varies by race, age, disease severity, and possibly gender. These factors may influence mortality rates.

Aged↗
PubMed1991

Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens.

One hundred nineteen patients with tuboovarian abscess were evaluated for response to antibiotics. Results were stratified into three groups by antimicrobial regimen. Group 1 consisted of 37 patients treated with a single-agent broad-spectrum intravenous antibiotic and oral doxycycline. Initial clinical response (defined as decreased pain, diminished white blood cell count, or defervescence) in group 1 was 31/37 (84%). Group 2 consisted of 64 patients treated with clindamycin in combination with an aminoglycoside with or without a penicillin. There was an initial clinical response in 45 of 64 (70%). Group 3 consisted of 18 patients from group 1 who were changed to a clindamycin-containing regimen after 2 to 3 days of initial treatment with a single-agent broad-spectrum antibiotic. The decision to switch antibiotics was not based on treatment failure but occurred when delayed ultrasonography confirmed the diagnosis of tuboovarian abscess. The switch reflected physician preference for clindamycin-containing regimens in the treatment of tuboovarian abscesses. The response rate in this subset of patients was 14 of 18 (78%). Overall initial clinical response rate was 90 of 119 (75%). There were no statistically significant demographic or clinical differences among the three groups. There was no statistical difference in the rate of early and late antibiotic failure rates among the groups. Our study demonstrates that extended-spectrum antibiotic coverage, including single-agent broad-spectrum antibiotics such as cefoxitin, in conjunction with doxycycline has efficacy that is equivalent to that of clindamycin-containing regimens. An overall medical treatment success rate of 75% suggests that conservative treatment of tuboovarian abscesses is warranted.

Abscess↗
PubMed1990

Fecal proteolytic activity in clinically normal cats and in a cat with exocrine pancreatic insufficiency.

Fecal proteolytic activity determined in single samples collected on each of 3 consecutive days from each of 20 clinically normal cats ranged from 19 to 363 azocasein units (ACU)/g of feces when determined colorimetrically, using azocasein substrate, and ranged from undetectable (in 1 sample from 1 cat) to 21 mm of gel-clearing when determined using radial enzyme diffusion in agar gels containing a casein substrate. Corresponding mean 3-day values for each cat ranged from 29 to 207 ACU/g and from 5 to 16 mm, respectively. Studies of proteolytic activity remaining after treatment of fecal extracts with a specific trypsin inhibitor indicated that trypsin accounted for 0 to 77% of proteolytic activity. In a cat with exocrine pancreatic insufficiency, fecal proteolytic activity was 0, 0, and 3 ACU/g in a sample of feces collected from each of 3 consecutive days and was undetectable by use of radial enzyme diffusion. Assay of fecal proteolytic activity by use of either azocasein hydrolysis or radial enzyme diffusion allows evaluation of pancreatic function in cats, provided that several samples of feces are tested.

Animals↗
PubMed1988

Cardiovascular asymmetries and cardiac perception.

Two strategies for evaluating the lateral specificity of cardiac sensory innervation were reviewed: (1) electrophysiological recording of cardiac-relevant cortical activity; and (2) behavioral assessment of right versus left differences in cardiac sensory perception. Electrophysiological data from two different laboratories suggest strongly that there is a link between cardiac events and cortical response to stimulation, but only for the right hemisphere. Two experiments from our laboratory suggest that there is a complex relationship among cerebral lateral preference, assessed by conjugate lateral eye movements, arousal, and individual differences in accuracy of self-perception of heart beats. The data, overall, suggest that the right hemisphere is involved specifically in heartbeat perception.

Brain↗
PubMed1985

Chromosomal abnormalities associated with congenital contractures (arthrogryposis).

In a study of 350 patients with multiple congenital contractures (arthrogryposis), 80 (23%) patients had mental retardation or were developmentally delayed. Out of that group of 80 patients, 13 (16%) were found to have abnormal karyotypes. Two of the thirteen had a family history of chromosomal abnormalities without congenital contractures, therefore, 11 patients had chromosomal anomalies which appeared to be associated with the congenital contractures. Five of the eleven (45%) had chromosome mosaicism, three of those had tissue mosaicism. Two had abnormal skin fibroblast cell lines and normal peripheral leukocyte chromosome studies and one had a normal bone marrow karyotype with abnormal peripheral leukocyte chromosome studies. Chromosome studies were done in these patients with congenital contractures because of developmental delay and multisystem involvement, or recognition of clinical features typical of a chromosomal syndrome. We recommend first lymphocyte; and if those are normal, then fibroblast studies be done on all patients with multiple joint contractures and developmental delay, particularly if unusual facial features or multisystem abnormalities are present.

Abnormalities, Multiple↗
PubMed1983

Part I. Amyoplasia: a common, sporadic condition with congenital contractures.

A specific congenital contracture (arthrogryposis) syndrome has been recognized in 135 out of 350 patients with various kinds of congenital contractures. This sporadic syndrome, designated amyoplasia is characterized by absence of limb muscles that are replaced by fibrous and fatty tissue. At birth there is characteristic positioning of the limbs with internal rotation at shoulders, extension at elbows, and flexion of the hands at the wrists. Severe equinovarus deformities of the feet are usually present. Contractures at knees and hips occur in a variety of positions. Typically, the face is round with a frontal midline capillary hemangioma and slightly small jaw. Intelligence is normal. Approximately 63% of our patients had involvement of four limbs (almost always symmetrically), 24% mainly of lower limbs, and 13% mainly upper limbs. Typically, no other malformations are present. However, minor anomalies are seen often, and include hypoplastic digits and hypoplasia of scrotum or labia, the umbilical cord may be wrapped about a limb at birth. In utero fetal activity is decreased and breech delivery is increased in amyoplasia. All cases were sporadic; identical twins are discordantly affected.

Adolescent↗
PubMed1983

Part II. Amyoplasia: twinning in amyoplasia--a specific type of arthrogryposis with an apparent excess of discordantly affected identical twins.

We report on 11 cases of amyoplasia in one of identical twins. In total, 135 patients with amyoplasia were ascertained from a study of 350 patients with multiple congenital joint contractures (arthrogryposis). These 11 cases of identical twins with amyoplasia represent 8% of our patients with amyoplasia. At least 18 sets of twins with congenital contractures have been reported previously. However, only four of these appear to involve identical twins discordant for amyoplasia. Thus, 15 cases in which only one of identical twins are affected with amyoplasia have been identified.

Adolescent↗
PubMed1982

The distal arthrogryposes: delineation of new entities--review and nosologic discussion.

We report on 44 patients (18 with additional affected family members), with congenital distal limb contractures identified from a large study of over 350 patients with congenital joint contractures. Fourteen propositi (seven familial cases, seven isolated cases) had a newly recognized form of arthrogryposis, which we have designated distal arthrogryposis type 1, with the predominant manifestations of autosomal dominant inheritance; tightly clenched fists at birth, with medially overlapping fingers, ulnar deviation, and camptodactyly in adults; and positional foot deformities. Contractures at other major joints are variable. There are no associated visceral anomalies; intelligence is normal. There can be marked intrafamilial and interfamilial variability. Twenty-two propositi with similar distal contractures had additional findings and were classified into five subcategories of distal arthrogryposis (type IIA-E). Among type II patients cleft palate, cleft lip, small tongue, trismus, ptosis, epicanthal folds, keratoconus, short stature, scoliosis, a unique hand position, and dull normal intelligence were seen. These characteristics were seen in various combinations and patterns and allowed sorting into groups that were the basis for the categorization. The remaining eight propositi were recognized to have previously described conditions with distal contractures and autosomal dominant inheritance, ie, the Freeman-Sheldon syndrome, trismus-pseudo-camptodactyly syndrome, congenital contractural arachnodactyly, and familial camptodactyly. Pathogenetically we postulate similar underlying defects of abnormal tendon attachments, attenuation, and absence; careful nosologic comparisons are important for prognostic counseling and habilitative management.

Adolescent↗
PubMed1982

Limb pterygium syndromes: a review and report of eleven patients.

Conditions with limb pterygia and congenital contractures were reviewed as part of a study of over 350 infants with arthrogryposis. Emphasis was placed on inheritance and variability of distinct pterygium conditions. Eleven patients with limb pterygia were recognized in our study and are described here. Seven of the 350 patients with congenital contractures had the autosomal recessively inherited multiple pterygium syndrome (Patients 1-7). Three of the seven are sibs, a fourth was born to consanguineous parents, and three were chance isolated cases. These seven had multiple joint webs, unusual finger contractures, syndactyly, rocker bottom feet, ptosis, antimongoloid slant of palpebral fissures, epicanthal folds, highly arched palate, scoliosis, and short stature. There is intrafamilial variability. Three patients from one family had a lethal multiple pterygium syndrome. Two were monozygotic twins. They had webbing and contractures of the elbows, knees, neck, and fingers, calcaneovalgus deformity of the feet, and an unusual facial appearance: hypertelorism, flat nose, antimongoloid slant of palpebral fissures, apparently low-set ears. One had a cleft palate. Internal malformations included: bilateral pulmonary hypoplasia, small heart, absence of the appendix, and attenuation of the ascending and transverse colon. One sporadic case of lethal popliteal pterygium with facial clefts was studied. Multiple anomalies included: ankyloblepharon filiforme adnatum, upslanting palpebral fissures, hypoplasia of nasal cartilages, frenula, clefts into the oropharynx lateral to the mouth, apparently low-set ears with slit-like canals, large popliteal pterygia, syndactyly with fusion of all digits in hands and feet, and hypoplastic labia.

Abnormalities, Multiple↗
PubMed1982

Teratogens associated with congenital contractures in humans and in animals.

An evaluation of over 350 patients in a study of congenital contractures of the joints (arthrogryposis) included a review of family, pregnancy, and delivery histories for teratogenic exposures. Fifteen out of the total 350 patients studied had a possible teratogenic exposure: an infectious agent (viral or bacterial), maternal drug or toxin ingestion, chronic maternal neurologic or muscular illness, or a direct physical insult such as a structural uterine anomaly. Literature was reviewed for all human and animal cases reported with congenital contractures of the joints with an associated teratogenic insult. Those findings are discussed here.

Animals↗
PubMed1982

Three distinct types of X-linked arthrogryposis seen in 6 families.

Six families with arthrogryposis (congenital contractures) inherited in an X-linked recessive manner are reported. Family histories from a study of over 350 patients with congenital contractures of the joints (arthrogryposis) were reviewed and of these, three probands had family histories consistent with X-linked recessive inheritance. Three other families were recognized through correspondence. Three forms of X-linked recessively inherited arthrogryposis are described: (1) Severe lethal X-linked arthrogryposis with severe contractures scoliosis deformities, hypotonia, and death due to respiratory insufficiency within 3 months of birth (1 family); (2) Moderately severe X-linked arthrogryposis with severe contractures, ptosis, microphallus, cryptorchidism, inguinal hernias, and normal intelligence (2 families); and (3) Resolving X-linked arthrogryposis with mild to moderate contractures at birth which improve dramatically with time (2 families and 1 sporadic case).

Arthrogryposis↗
PubMed1980

Congenital hypothalamic hamartoblastoma, hypopituitarism, imperforate anus and postaxial polydactyly--a new syndrome? Part I: clinical, causal, and pathogenetic considerations.

We report on six infants with a neonatally lethal malformation syndrome of hypothalamic hamartoblastoma, postaxial polydactyly, and imperforate anus. Some, but not all, patients had laryngeal cleft, abnormal lung lobulation, renal agenesis and/or renal dysplasia, short 4th metacarpals, nail dysplasia, multiple buccal frenula, hypoadrenalism, microphallus, congenital heart defect, and intrauterine growth retardation. The infants also had hypopituitarism and hypoadrenalism. All were sporadic cases, parents were not consanguineous, chromosomes were apparently normal. Family histories were unremarkable. There was insecticide and/or herbicide exposure in several of the cases, but no exposures were common to all 6 mothers. Five of the patients were born within an 8-month period, but all in different geographic locations. It is postulated that this is a previously apparently unreported syndrome of presently unknown cause.

Anus, Imperforate↗