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At least 19 recordsLinked to original sources
PubMed1985

Randomized trials of coronary artery bypass surgery: impact on clinical practice at Duke University Medical Center.

Trends in practice patterns at Duke University Medical Center were assessed in patient groups comparable to those enrolled in the three major randomized trials of coronary artery bypass grafting (CABG). In addition, changes in practice patterns that appeared unrelated to the randomized trials were examined. Most patients with 75% or greater left main stenosis have been treated surgically after publication of the Veterans Administration Cooperative Study, but little change was noted in the proportion of patients with 50% left main stenosis who have been treated surgically. A trend towards selection of surgical therapy for patients with three-vessel disease and normal left ventricular function was evident before the publication of the European Coronary Surgery Study, although one-third of patients in this category continue to be treated nonsurgically after publication of the results of the trial. For the past decade, most patients who would have been eligible for the Coronary Artery Surgery Study have been treated nonsurgically. We have also documented trends in practice patterns that are independent of the results of randomized trials. The advent of percutaneous transluminal angioplasty has provided another therapeutic alternative that has been used increasingly. In addition, growing numbers of patients with advanced age, unstable angina, or markedly depressed left ventricular ejection fraction are being evaluated with cardiac catheterization despite the lack of supporting randomized trials. Randomized trials have placed our understanding of the effects of CABG on a sound foundation, but it is evident that clinicians continue to consider many other factors when therapeutic decisions are made.

Academic Medical Centers↗
PubMed2004

Cardiac transplantation at Duke University Medical Center.

Since beginning cardiac transplantation in 1985, Duke University Medical Center has performed 485 de novo heart transplants in adult recipients. Our program has broadened the access of patients to transplantation through the aggressive use of ventricular assist devices as bridge to transplant in patients with acute heart failure and shock, as well as through the introduction of an alternate list program for suboptimal transplant candidates. Despite this broadening of the recipient pool, our long-term outcomes have remained good, with 5-year survival of 75% and 10-year survival of 51%. Continued advances in immunosuppression and treatment for cardiac allograft vasculopathy seem likely to continue to improve long-term outcomes from cardiac transplantation. Expanding indications for VAD support (such as destination therapy) and continued improvements in this technology seem certain to impact patient selection and therefore the results of transplantation in the future. Appropriate triage of patients with advanced heart failure among available therapies will be the cornerstone of optimizing outcomes in this critically ill patient population.

Academic Medical Centers↗
PubMed1977

Antibiotic use at Duke University Medical Center.

A study of antibiotic use at Duke University Medical Center in June 1973 showed that 34.2% of all patients received antibiotics (43.6% surgical, 21.4% medical patients). Cephalothins were most frequently ordered for surgical patients, ampicillin sodium and penicillin G or penicillin V with potassium for other patients. A retrospective analysis of 50 randomly selected patients, according to the Kunin's categories of use, showed 64% of total antibiotic therapy as not indicated or inappropriately administered in terms of drug or dosage. These results are similar to previous reports of antibiotic surveillance and further establish the need for continuing education of prescribing physicians.

Anti-Bacterial Agents↗
PubMed1989

Morphologic and immunocytochemical studies of bronchioloalveolar carcinoma at Duke University Medical Center, 1968-1986.

Between 1968 and 1986, the tumor registries at Duke University Medical Center and Durham VA Medical Center accumulated a total of 193 patients with a diagnosis of bronchioloalveolar carcinoma (BAC). All available histologic sections of primary lung tumors and all available respiratory and pleural cytologic material were reviewed for 135 cases having an initial histologic diagnosis of BAC and no history of a primary nonpulmonary adenocarcinoma. Thirty-nine cases showed a pure BAC pattern in histologic sections; 76 showed a dominant BAC pattern with focal areas of fibrosis and acinar differentiation; 16 were carcinomas with a focal BAC pattern; and 4 were adenocarcinomas lacking a BAC pattern. Of the 115 cases with at least a dominant BAC pattern, 51 showed predominantly mucinous differentiation while 64 showed predominantly nonmucinous differentiation. Adequate cytologic material was available for review from 111 patients. For cases having at least a dominant BAC pattern, tumor cells were present in 77 of 172 adequate sputums (44.8%), 36 of 133 bronchoscopy specimens (27.1%), 15 of 18 needle aspirates (83.3%) and 14 of 15 pleural fluids (93.3%). Of all patients in this group, 60.2% had at least one specimen positive for malignancy. No cytologic features clearly distinguished adenocarcinomas having only focal bronchioloalveolar differentiation from those with a pure or dominant BAC pattern. A significant degree of overlap was observed in the cytologic features of mucinous and nonmucinous tumors. Histologic sections from 19 mucinous and 16 nonmucinous tumors were stained with monoclonal antibody B72.3: all showed some staining, with no significant difference in degree of staining between the two groups. This suggests that expression of the tumor-associated glycoprotein TAG-72 is independent of mucinous differentiation.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1981

Rh isoimmunization: a 24 year experience at Duke University Medical Center.

A retrospective analysis was made of Rh-sensitized patients delivered of their babies at Duke University Medical Center during a 24 year period. Records of 202 obstetric patients representing 280 sensitized pregnancies from a pool of 39,910 deliveries were analyzed for past obstetric history, blood group information, antibody determinations, amniocentesis data, and details of the pregnancy and delivery. The medical records of the corresponding infants were analyzed for their neonatal course. A severity index (SI) was devised to classify the degree of severity of the erythroblastosis fetalis. A significant correlation between SI and the delta OD450 of amniotic fluid, umbilical cord hematocrit, and bilirubin was noted. The evaluation of amniotic fluid delta OD450 is considered to be the cornerstone of clinical management. Twenty-nine patients had initial Liley zone 1 determinations which decreased to delta OD450 = 0.000; however, only 10 of 29 (34.5%) of the infants were unaffected, and 13 of 29 (44.8%) had mild sensitization, four of 29 (13.8%) had moderate sensitization, and two of 29 (6.9%) had severe sensitization. The previously held concept of "critical titer" as a guide for initiating amniocentesis is challenged, and the recommendation is made that amniocentesis for amniotic fluid determination should be undertaken in any patient with a positive indirect Coombs titer.

Adolescent↗
PubMed1986

Medulloblastoma: the Duke University Medical Center experience.

We have reviewed the clinical experience in the treatment of medulloblastoma with radiotherapy at Duke University Medical Center. One hundred and twenty-seven patients treated between January 1, 1940 and December 31, 1983 were evaluated. The irradiation technique was reviewed and all irradiation doses were recalculated as minimum tumor doses in Gray (Gy). The mean follow-up was 24.4 years and the median follow-up was 26.5 years. The energy of the treatment machine was known in 102 cases. Sixty patients were treated with orthovoltage equipment and 42 patients were treated with megavoltage equipment. As a gross assessment of the impact of the details of radiotherapy treatment upon outcome, patients were grouped into excellent, good, fair, and poor treatment groups. Patients undergoing cranio-spinal axis (CSA) irradiation and receiving greater than or equal to 52 Gy to the posterior fossa and greater than or equal to 30 Gy to the clinically uninvolved remainder of the CSA were classified as having "excellent" technique. Patients undergoing CSA irradiation and receiving 40 to 52 Gy to the posterior fossa and greater than or equal to 20 Gy to the remainder of the CSA were classified as "good." Patients receiving 20 to 40 Gy to the posterior fossa and greater than or equal to 10 Gy to the spinal axis with or without prophylactic cranial irradiation were designated "fair." Any patient not fulfilling the above minimum criteria was categorized as "poor." The actuarial 5-year survival for the entire population was 33%. The 10-year survival was 21%. In 93 patients for whom records were detailed enough to allow categorization of treatment technique, 5-year actuarial survivals were: Excellent 37% (n = 17), Good 55% (n = 13), Fair 35% (n = 23), Poor 20% (n = 40). A complete surgical resection was not correlated with improved disease-free survival (DFS) in the excellent and good groups, but was correlated with an improved DFS in the fair and poor groups. The posterior fossa accounted for 62% of the failures in the 55 patients completing irradiation where the initial site of failure was known. An examination of patterns of failure in the spinal canal failed to demonstrate a dose response relationship above 10 Gy for spinal canal prophylactic irradiation. No patient developed recurrence beyond their period of risk as defined by "Collins' Law."(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Ten years of respiratory cytopathology at Duke University Medical Center. II. The cytopathologic diagnosis of lung cancer during the years 1970 to 1974, with a comparison between cytopathology and histopathology in the typing of lung cancer.

In 1975 Duke University Medical Center, a retrospective and prospective survey of respiratory cytopathologic specimens was undertaken for the ten-year period 1970 to 1979. The purpose of this study was to document the role of cytopathology in the diagnosis of lung cancer at this institution. This paper presents the results of the cytopathologic and histopathologic typing of cases of lung cancer seen at Duke University Medical Center from 1970 to 1974. During this period, 9,892 cytologic specimens from the lower respiratory tract were processed. Cytopathologic diagnoses of cancer with tissue confirmation were made on 483 specimens from 232 patients. Because original cytologic diagnoses, but not histopathologic diagnoses, had been made in conformity with a modified WHO classification of lung neoplasms, all histopathologic material was reviewed and reclassified when necessary. This was carried out by one of the authors (E.H.B.) as a blind review without benefit of knowledge of either preexisting cytopathologic or histopathologic diagnoses. Twenty-six patients were excluded from the current study because of lack of satisfactory histologic material. In 94 patients classified by histopathology as having squamous cell carcinoma, 76.4% of the positive cytologic specimens were also called squamous cell carcinoma; 18.6% were interpreted as large cell undifferentiated carcinoma. In 39 patients classified by tissue as having large cell undifferentiated carcinoma, the cytology agreed in 42.4% of the positive specimens. For the 29 patients thought histologically to have small cell undifferentiated carcinoma, the same diagnosis was rendered in 95.5% of the cytologically positive specimens from these patients. For the adenocarcinoma group of 43 patients, a cytopathologic diagnosis of adenocarcinoma was made in 67.8% of the positive specimens.

Adenocarcinoma↗
PubMedDate not supplied

Ten years of respiratory cytopathology at Duke University Medical Center. I. The cytopathologic diagnosis of lung cancer during the years 1970 to 1974, noting the significance of specimen number and type.

In 1975 at Duke University Medical Center, a retrospective and prospective survey of respiratory cytopathologic specimens was undertaken for the ten-year period 1970 to 1979. The purpose of this study was to document the role of cytopathology in the diagnosis of lung cancer at this institution. This paper, the first of a series on the subject, presents the relationship between the number of cytopathologic specimens examined, the types of respiratory cytopathologic specimens examined and the cytopathologic diagnosis of lung cancer during the first five years of the study. Of the total, 363 patients had respiratory cytopathologic specimens that were interpreted as being diagnostic of cancer. Among those patients with cytopathology diagnostic of cancer, a diagnosis was made with five satisfactory specimens in 86.6%. Sputum only revealed neoplastic cells in 47.1% of the cases, bronchial material only in 26.0% and both sputum and bronchial material in 26.9%. Among the total number of primary lung cancers seen during this five-year period, a definitive cytopathologic diagnosis of cancer was made in approximately 50% of cases.

Bronchi↗
PubMed1993

The Duke University Medical Center.

The events leading up to the creation of Duke University, the Duke University School of Medicine, and Duke Hospital are reviewed. The efforts of many individuals during more than 80 years were rewarded by an endowment and then a bequest by James B. Duke that converted Trinity College into Duke University and made possible the origination of its Medical Center. The first neurosurgical operation at the new hospital was performed on July 24, 1930, the fourth day it was open.

Academic Medical Centers↗
PubMedDate not supplied

Ten years of respiratory cytopathology at Duke University Medical Center. III. The significance of inconclusive cytopathologic diagnoses during the years 1970 to 1974.

This paper reports on the significance of inconclusive cytopathologic diagnoses made on cytologic specimens from the lower respiratory tract of patients seen at the Duke University Medical Center during the years 1970 to 1974. During that period, a total of 9,892 cytopathologic specimens from the lower respiratory tract were processed. Conclusive cytopathologic diagnoses of cancer were made in 363 patients. In 218 additional patients, one or more inconclusive cytopathologic diagnoses were made. In 70 patients, a cytopathologic diagnosis of atypical metaplasia was made. In 28 of these 70 patients (40% of the group), this diagnosis was followed by a tissue confirmation of cancer. In the remaining 42 patients (60%), the follow-up studies revealed the presence of a variety of nonneoplastic diseases, usually inflammatory in origin. In these patients, various types of pneumonias constituted the most frequent type of disease. Another 135 patients had originally been given a cytopathologic diagnosis of "atypical cells suspicious for malignancy." In 92 (approximately 68%) of these patients, this suspicion of cancer was confirmed by tissue. In 43 patients (approximately 32%) no cancer was found. In this latter group of patients, the most common underlying disease process was also pneumonia.

Bronchi↗
PubMed1999

Melanoma of the gallbladder: a review of cases seen at Duke University Medical Center.

BACKGROUND: Both primary and metastatic melanoma of the gallbladder are rare. In cases involving isolated tumors of the gallbladder, there continues to be controversy regarding the establishment of primary status. Despite appropriate therapy, the diagnosis of either condition portends a poor prognosis, with few patients surviving more than 2 years. METHODS: A review of all patients seen at Duke University Medical Center since 1970 generated 1 case of primary and 19 cases of secondary melanoma of the gallbladder. These were analyzed with respect to presentation, clinical and pathologic diagnosis, treatment, and prognosis. RESULTS: The sole patient with a primary lesion presented with acute cholecystitis. Ultrasound demonstrated a mass in the lumen of the gallbladder. Cholecystectomy revealed melanoma, and the patient eventually died of disseminated disease 13.5 months later. Survival was poor for patients who presented with metastases to the gallbladder in the setting of widespread disease, with 0% survival at 1 year (n=11). Those with isolated, resectable lesions fared better overall, with 100% survival (n=6) at 1 year. One patient remains alive and free of disease 13.8 years later, which, to our knowledge, represents the longest documented survival for a patient with melanoma that has metastasized to the gallbladder. CONCLUSIONS: Surgery remains the mainstay of therapy for patients with gallbladder melanoma and appears to improve patient outcome in the setting of resectable disease. Hopefully, further investigations will lead to standardized protocols for the treatment of these lesions.

Adult↗
PubMed1998

Mucosal melanoma of the female genitalia: a clinicopathologic study of forty-three cases at Duke University Medical Center.

BACKGROUND: Mucosal melanoma of the female genitalia is a rare neoplasm. Only nine reports reviewing more than 40 patients have been published on this subject in the past 30 years. These lesions arise from melanocytes, which can be found within the mucosa lining the female genital tract. Surgical resection is the mainstay of therapy, with little use for other modalities except in palliative roles. The overall prognosis is poor, with reported 5-year survival rates usually below 50%. METHODS: Forty-three patients with primary mucosal melanoma of the female genitalia seen at the Duke University Medical Center Melanoma Clinic during a 25-year period were studied retrospectively. Specific information was obtained from the patients' clinic charts and computerized databases. RESULTS: Thirty vulvar, nine vaginal, and four cervical lesions were identified. The median age at diagnosis was 61.4 years. At initial presentation, two thirds of the patients had localized disease only. Tumor ulceration and thickness of the primary lesion had a measurable impact on prognosis, whereas the presence of regional metastases at presentation did not. All but one patient underwent resection with curative intent. The performance of radical operations did not improve outcome among patients with vulvar melanoma. Many of the treatment failures were the result of local recurrences, hinting at the need to improve local control. Despite therapy, the overall corrected 5-year survival rate was 54%. CONCLUSIONS: Prospective multicenter trials for patients with vulvovaginal melanoma could be helpful in establishing uniform, standardized surgical protocols and delineating the applicability of new modalities and therapies, such as lymphoscintigraphy with sentinel node biopsy and high-dose interferon.

Adult↗
PubMed2000

HIV vaccine development at Duke University Medical Center.

With the AIDS epidemic continuing to spread throughout the world, development of a safe, practical, and effective HIV vaccine is a national priority. HIV vaccine research efforts are currently targeted towards design of HIV immunogens that induce both cellular and humoral immunity. This brief review summarizes ongoing work at the Duke University School of Medicine on HIV vaccine development.

AIDS Vaccines↗
PubMed1998

Lung transplantation at Duke University Medical Center.

Lung transplantation is a viable therapy for patients with a variety of end-stage lung diseases. Our active program now includes over 200 lung transplant operations with acceptable one- and 3-year survival rates of 78% and 61%. A major focus of clinical research at this institution is to design strategies to prevent the development of chronic allograft dysfunction. Our preliminary work in this regard has been encouraging. In addition, a major research focus has been to design protocols to prevent the development of posttransplant infections. Our work with aerosolized ABLC represents a major advance at our center, and additional randomized prospective studies are ongoing to define the optimal antifungal prophylaxis after transplantation. Ongoing clinical and basic research at Duke and elsewhere should continue to advance the field of clinical transplantation and ultimately lead to more acceptable long-term outcomes for lung allograft recipients.

Adult↗
PubMed1986

Career choices of 135 cardiology trainees at Duke University Medical Center from 1970 to 1984.

Alarm has been expressed at recently presented evidence showing that diminishing numbers of physicians are entering academic careers. The experience of the cardiology training program at a university medical center between 1970 and 1984 was reviewed to determine the career paths chosen by its trainees. During the study period, 135 physicians received training. Between 1970 and 1978 the percentage of trainees making academic medicine their initial career choice fluctuated considerably. Beginning in 1978, the percentage entering academic medicine steadily increased; in the most recent class, 8 of 9 trainees accepted academic faculty positions. Among 72 former trainees who joined an academic faculty after finishing training, approximately 7% per year left academic medicine for clinical practice. The median length of an academic career was 10 years. Individual institutions may be able to reverse the national trend of trainees making clinical practice their initial career choice. However, physicians who leave academic medicine for clinical practice may continue to deplete faculty ranks.

Academic Medical Centers↗
PubMed1986

Radiation therapy in the management of neuroblastoma: the Duke University Medical Center experience 1967-1984.

We have evaluated the role of radiotherapy in providing local control of primary tumors and to palliate metastases from neuroblastoma (NB). Fifty-five children with histologically verified NB were evaluated and treated from 1967 to 1984. In univariate analysis, the actuarial survival of eight children with thoracic primaries (85%) was significantly better than the survival of 39 children with intra-abdominal primaries (35%, p = 0.0287). The survival of 28 children less than or equal to 18 months of age at diagnoses was 73%, whereas 27 children older than 18 months had a survival probability of 10% (p = 0.0001). The survival by Evans stage was: I 100% (2 patients), II 85% (7), III 60% (13), IV 4% (27) and IV-S 100% (6). According to the Pediatric Oncology Group (POG) staging system, the survival was: A 100% (3), B 66% (9), C 66% (9), D 23% (34). A multivariable analysis indicated that the Evans staging system was a more powerful indicator of prognosis than the POG system. The analysis also indicated that Evans stage and patient age were independent determinants of survival. The primary tumor site did not add significant prognostic information beyond these two factors. Children with Stage I disease were treated with surgery alone. Most children with Stages II and III disease were treated with surgery, irradiation, and Cyclophosphamide or Cyclophosphamide plus Vincristine. All seven patients with Stage II disease received post-operative irradiation to the primary tumor and were locally controlled with doses of 4.8 to 26.5 Gy. Eleven of the 13 patients with Stage III disease were irradiated post-operatively. Seven of these 11 patients were locally controlled with doses of 12 to 48.4 Gy. The four Stage III patients with in-field recurrences were older children with large radiotherapy fields and/or low doses administered. The Radiation Therapy Oncology Group pain score system was used to evaluate response of painful bony metastases to irradiation. A response was observed in 65% of the sites irradiated. A response was observed at 67% of the soft tissue metastases irradiated. Hepatomegaly causing respiratory embarrassment or inferior vena cava obstruction was treated with irradiation in seven patients. All patients responded with doses ranging from 5 to 24.4 Gy. Five of the 17 children who survived for more than 5 years following treatment had significant scoliosis or kyphosis secondary to vertebral body abnormalities in irradiated bones. All five children were irradiated at a young age with megavoltage equipment.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdominal Neoplasms↗