Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 21
Filter
1.
J Pediatr Urol ; 15(5): 471.e1-471.e6, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31327660

ABSTRACT

BACKGROUND: Repair of distal hypospadias is one of the most common pediatric urology procedures in the US. However, the risk of postsurgical complications has been reported primarily from single-institution and tertiary center studies, with short duration of patient follow-up. OBJECTIVE: The aim of the study was to examine the incidence of re-operation and risk factors for re-operation following outpatient distal hypospadias repair in a large, representative sample of US children. METHODS: A retrospective cohort study of patients aged 0-18 years undergoing single-stage distal hypospadias repair was conducted. Data were obtained from the State Ambulatory Surgery and Services Databases of 9 participating states. Patients who underwent outpatient surgery in 2008-2013 were identified using Current Procedural Terminology (CPT) codes. Patients with records suggesting prior surgery for hypospadias (CPT) were excluded, as were patients who underwent the initial repair <2 years before the end of state data availability. Return outpatient surgery visits across institutions within each of the 9 states were tracked to identify re-operations after the single-stage repair, using CPT codes for surgical treatment of hypospadias complications in 2008-2015. Time-to-event analyses were used to estimate the probability (risk) of re-operation over time and to examine whether patient and institutional characteristics were predictive of re-operation (age, race/ethnicity, health insurance, facility ownership, and institutional volume of hypospadias repair). RESULTS: A total of 4673 children treated across 148 institutions were included. The median follow-up time was 4.1 years (range: 2-7.9). Most patients were <1 year of age at the time of initial repair (53%). The risk of re-operation was 2.6% (95% confidence interval [CI]: 2.1-3.0%) at 1 year and 6.7% (95% CI: 6.0-7.5%) at 5 years after initial repair (Figure). Approximately 13% of re-operation patients had the re-operation at a different institution. None of the patient or institutional factors examined was a significant predictor of the risk of re-operation. DISCUSSION: In this population-based cohort, the estimated 5-year risk of re-operation following single-stage distal hypospadias repair was 6.7% (95% CI: 6.0-7.5). Most re-operations occurred after the first year, informing long-term expectations about postoperative complications. This study was limited by a lack of data on severity of hypospadias and surgeon characteristics and the inability to track re-operations outside of the state in which the original repair was performed. CONCLUSION: Approximately 7% of children undergoing distal hypospadias repair undergo a re-operation within 5 years. None of the factors studied were predictive of re-operations.


Subject(s)
Hypospadias/surgery , Outpatients , Postoperative Complications/epidemiology , Risk Assessment/methods , Urologic Surgical Procedures, Male/methods , Adolescent , Child , Child, Preschool , Follow-Up Studies , Humans , Incidence , Infant , Infant, Newborn , Male , Reoperation , Time Factors , Treatment Outcome , United States/epidemiology
2.
Leukemia ; 26(4): 700-7, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22005790

ABSTRACT

In cell and animal models, telomere erosion promotes chromosomal instability via breakage-fusion-bridge cycles, contributing to the early stages of tumorigenesis. However, evidence involving short telomeres in cancer development in humans is scarce, epidemiological and indirect. Here we directly implicate telomere shortening as a critical molecular event for malignant evolution in aplastic anemia (AA). Patients' telomere lengths at diagnosis of AA, while comparable to age-matched controls, inversely correlated with the probability of developing a cytogenetically abnormal clone. A significantly increased number of telomere signal-free chromosomal ends and chromosomal numerical and structural abnormalities were observed in bone marrow cells of patients with shorter telomeres in comparison with patients with longer telomeres and healthy subjects. The proportion of monosomy-7 cells in the bone marrow at diagnosis of AA inversely correlated with telomere length, years before the emergence of an autonomous and clinically detectable abnormal clone. Marrow cells of clinically healthy individuals carrying loss-of-function telomerase mutations and with extremely short telomeres also showed chromosomal instability in vitro. These results provide the first clinical direct evidence in humans that short telomeres in hematopoietic cells are dysfunctional, mediate chromosomal instability and predispose to malignant transformation in a human disease.


Subject(s)
Aged , Anemia, Aplastic/genetics , Cell Transformation, Neoplastic/genetics , Chromosomal Instability , Hematopoietic System/metabolism , Telomere Shortening , Adolescent , Adult , Aged, 80 and over , Anemia, Aplastic/complications , Aneuploidy , Child , Child, Preschool , Female , Humans , Male , Middle Aged
3.
South Med J ; 85(3): 248-54, 1992 Mar.
Article in English | MEDLINE | ID: mdl-1546348

ABSTRACT

Colorectal cancer is the second most common form of cancer in the United States, but controversy exists over the feasibility, benefits, and methods of screening. We conducted a large-scale, community-based screening program to determine the cost of screening for colorectal cancer. Based on detailed cost analysis, we arrived at a cost of $15,233 per case of colon cancer diagnosed through mass screening, and $7611 per polyp discovered. These figures are much higher than those previously reported in less detailed studies. Other studies currently under way will determine whether morbidity and mortality are decreased by screening. Our data add the information necessary to determine the cost-effectiveness of mass screening for colon cancer, and will be useful in designing future strategies for the secondary prevention of colorectal cancer.


Subject(s)
Colorectal Neoplasms/prevention & control , Mass Screening/economics , Adult , Aged , Colorectal Neoplasms/economics , Costs and Cost Analysis , Female , Humans , Male , Mass Screening/methods , Middle Aged
4.
N Engl J Med ; 326(2): 136; author reply 136-7, 1992 Jan 09.
Article in English | MEDLINE | ID: mdl-1727226
5.
Rev Infect Dis ; 11(5): 741-54, 1989.
Article in English | MEDLINE | ID: mdl-2682947

ABSTRACT

We present four cases of disseminated zygomycosis that illustrate the characteristic clinical syndromes and natural history of this infection. The zygomycetes affect individuals immunosuppressed by age, drug therapy, or underlying disease. A previous splenectomy or deferoxamine therapy may be an additional factor in the development of disseminated zygomycosis. Clinical syndromes reflect vascular invasion and organ infarction. Diagnosis requires consideration of risk factors followed by biopsy of the affected organ for culture and for demonstration of broad nonseptate hyphae in tissue sections. Despite advances in the management of many bacterial and fungal infections in the immunosuppressed host, the results of therapy for disseminated zygomycosis remain dismal.


Subject(s)
Mucormycosis/pathology , Adult , Female , Gastrointestinal Diseases/complications , Humans , Immune Tolerance , Kidney Diseases/complications , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Neoplasms/complications , Risk Factors , Virginia/epidemiology
6.
JAMA ; 261(4): 580-5, 1989 Jan 27.
Article in English | MEDLINE | ID: mdl-2642563

ABSTRACT

Colorectal cancer is the second most common cause of cancer in the United States. The overall mortality rate approaches 60%. However, the detection of early lesions results in a mortality rate of 20% or less. Therefore, if improvement in survival is to occur, increased efforts need to be focused not only on primary prevention but also on early detection of malignant lesions and the eradication of potentially malignant lesions. There is no universal consensus as to how this can be accomplished. The purpose of this article is to serve as a guideline, providing a practical basis for improving early detection and management of colorectal cancer and its precursors.


Subject(s)
Colorectal Neoplasms/diagnosis , Adult , Aged , Barium Sulfate , Biopsy , Colonoscopy , Colorectal Neoplasms/genetics , Colorectal Neoplasms/surgery , Enema/methods , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Occult Blood , Population Surveillance , Sigmoidoscopy/methods , Time Factors
7.
South Med J ; 82(1): 29-31, 1989 Jan.
Article in English | MEDLINE | ID: mdl-2911760

ABSTRACT

In a ten-year review at a large community teaching hospital clostridia accounted for less than 1% of all positive bloodstream isolates (26 episodes in 25 patients). All but one of the isolates were clinically significant. Twenty-two patients (88%) had a serious underlying medical condition, and 17 of the episodes (65%) were associated with a bowel source; twelve patients (48%) died of their infection. Clostridial bloodstream infections are particularly clinically significant in patients with serious underlying disease.


Subject(s)
Clostridium Infections , Sepsis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Clostridium Infections/diagnosis , Clostridium Infections/drug therapy , Female , Humans , Infant , Male , Middle Aged , Sepsis/diagnosis , Sepsis/drug therapy
8.
Gastroenterol Clin North Am ; 16(4): 591-9, 1987 Dec.
Article in English | MEDLINE | ID: mdl-2831152

ABSTRACT

When attempting to establish a diagnosis of HCC, the clinician may now choose from a variety of imaging techniques. This choice depends on the availability of technology, the experience and skill of the interpreting physician, and cost. At times, a single study may be all that is necessary to establish the diagnosis, but, at other times, multiple techniques may be necessary. There is no doubt that rapid technologic improvements will continue to alter our diagnostic approach to this disease.


Subject(s)
Carcinoma, Hepatocellular/diagnosis , Diagnostic Imaging/methods , Liver Neoplasms/diagnosis , Angiography , Carcinoma, Hepatocellular/diagnostic imaging , Humans , Liver Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Tomography, Emission-Computed , Ultrasonography
11.
J Clin Gastroenterol ; 7(4): 292-5, 1985 Aug.
Article in English | MEDLINE | ID: mdl-3876367

ABSTRACT

A 62-year-old man developed massive lower gastrointestinal tract bleeding. Upper endoscopy and superior mesenteric arteriography initially failed to disclose a cause of bleeding. On rebleeding, intra-arterial vasopressin infusion during repeated arteriography caused reflux of dye into the iliac vessels to allow visualization of an arterial-enteric fistula. Exploratory laparotomy subsequently revealed perforation of the small bowel and common iliac artery by a toothpick which had been swallowed.


Subject(s)
Arterial Occlusive Diseases/etiology , Foreign Bodies/complications , Gastrointestinal Hemorrhage/etiology , Iliac Artery , Intestinal Fistula/etiology , Intestinal Perforation/complications , Jejunal Diseases/etiology , Humans , Iliac Artery/pathology , Male , Mesenteric Arteries/diagnostic imaging , Middle Aged , Radiography
13.
Psychosom Med ; 46(5): 454-62, 1984.
Article in English | MEDLINE | ID: mdl-6093183

ABSTRACT

The relationship of the endogenous opioid system and the hypothalamic-pituitary-adrenal axis to obesity was studied. Morning levels of plasma cortisol and beta-endorphin immunoreactivity in obese patients before diet treatment were found to be no different from those in matched family members of normal weight. In 32 untreated obese patients, no relationship between weight or body mass index (a measurement of obesity) and plasma levels of beta-endorphin immunoreactivity or cortisol was found. However, plasma cortisol levels were significantly correlated with obese patient ratings on the depression subscale of the General Health Questionnaire. Dexamethasone administration failed to suppress plasma beta-endorphin levels in untreated obese patients, but this finding has been reported in normal subjects in whom a similar assay methodology was used; it suppressed plasma cortisol levels in 29 of 32. The three patients resistant to suppression also suffered from benign essential hypertension. Plasma beta-endorphin immunoreactivity was unchanged, but cortisol levels significantly decreased as weight was lost on a 400-calorie/day modified protein fast. Patients who failed to complete the 6-month diet program had significantly increased plasma beta-endorphin levels compared to those who successfully completed the program.


Subject(s)
Endorphins/blood , Hydrocortisone/blood , Obesity/blood , Adult , Dexamethasone , Diet, Reducing/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Obesity/diet therapy , Obesity/psychology , Radioimmunoassay , beta-Endorphin
14.
Va Med ; 111(7): 384-9, 1984 Jul.
Article in English | MEDLINE | ID: mdl-6485519
15.
Int J Psychiatry Med ; 13(3): 233-8, 1983.
Article in English | MEDLINE | ID: mdl-6654613

ABSTRACT

Individuals restricted to 400 calories per day were treated with weekly group therapy. The process involved development of group cohesiveness due to a commonly shared experience. The group was unable to accept that weight control meant severe caloric limitation. Themes of dependency and pairing tended to distract the group from their basic task of tolerating severe caloric limitation. Behavioral techniques as well as fostering of insight did not appear effective. Explanations for such a group format are discussed.


Subject(s)
Diet, Reducing , Obesity/therapy , Psychotherapy, Group , Adult , Behavior Therapy , Body Weight , Combined Modality Therapy , Female , Group Processes , Humans , Male , Middle Aged , Obesity/psychology , Reinforcement, Psychology
19.
Angiology ; 28(12): 832-8, 1977 Dec.
Article in English | MEDLINE | ID: mdl-23713

ABSTRACT

Although it is often relatively easy for the clinician to differentiate between the heart and the esophagus as sources of chest pain, there remains a substantial minority of patients in whom this task is difficult. We have attempted to review points of differential significance which can be elicited through assessment of the patient's symptoms. Diagnostic studies for the detection of esophageal disorders have been reviewed, and the relative usefulness of these studies has been emphasized. As the result of advancements in diagnostic techniques as well as better understanding of esophageal pathophysiology, the clinician is now capable of accurately identifying the esophagus as the source of chest pain.


Subject(s)
Angina Pectoris/diagnosis , Esophageal Diseases/complications , Esophageal Diseases/diagnosis , Angina Pectoris/complications , Esophageal Diseases/diagnostic imaging , Esophagitis, Peptic/complications , Esophagoscopy , Esophagus/physiopathology , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/diagnostic imaging , Humans , Hydrogen-Ion Concentration , Manometry , Pain , Radiography , Radionuclide Imaging , Spasm/complications , Spasm/diagnosis , Spasm/diagnostic imaging , Time Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...