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125361. The added cost of urgent cholecystectomy to health systems. (Abstract)

The added cost of urgent cholecystectomy to health systems. The purpose of this study is to assess the cost and reimbursement differential between elective and urgent laparoscopic cholecystectomy.All visits for laparoscopic cholecystectomy (ICD-9 Code 51.23) to the University of Michigan Health System were reviewed for 1997 to 2001 (n = 752). Data were obtained from the University of Michigan Data Warehouse. Patients were grouped into urgent and elective cases, and further subgrouped (...) when stratified by complicated and uncomplicated DRGs.The urgency of the operation significantly elevates the costs and resource consumption associated with laparoscopic cholecystectomy. These cost differences should also be recognized when setting reimbursement premiums under risk-bearing systems, such as Medicare Diagnosis Related Group reimbursement. Consideration for including urgent operation as a comorbidity should be assessed.

2003 Journal of the American College of Surgeons

125362. Portal versus systemic drainage of small bowel allografts: comparative assessment of survival, function, rejection, and bacterial translocation. (Abstract)

procedures from January 1995 to August 2001 were reviewed. Portal drainage was performed in 19 patients (PD group). Systemic drainage was performed in 18 patients (SD group). Median followup was 531 days.PD and SD patients had similar ICU stays (median 7 versus 9 days) and endotracheal intubation durations (median 3 versus 5 days). All current survivors, with the exception of one patient in each group, are independent from parenteral nutrition. Liver function tests were similar in both groups (...) Portal versus systemic drainage of small bowel allografts: comparative assessment of survival, function, rejection, and bacterial translocation. Portal venous drainage of small bowel grafts is theoretically more physiologic than systemic drainage, but is technically more demanding. Comparisons in animal models have not demonstrated a clear advantage of one technique over the other, but clinical data are lacking.Clinical records of 36 patients who underwent 37 small bowel transplantation

2002 Journal of the American College of Surgeons

125363. Proteolysis, the ubiquitin-proteasome system, and renal diseases. Full Text available with Trip Pro

that alterations in proteolytic enzymes/cofactors or in the structure of protein substrates that render them more or less susceptible to degradation are responsible for disorders associated with kidney cell malfunctions. Multiple pathways exist for protein degradation. The best-described proteolytic system is the ubiquitin-proteasome pathway, which requires ATP and degrades the bulk of cellular and some membrane proteins. This review will survey examples of renal abnormalities that are associated (...) Proteolysis, the ubiquitin-proteasome system, and renal diseases. Protein degradation is a critical process for the growth and function of cells. Proteolysis eliminates abnormal proteins, controls many cellular regulatory processes, and supplies amino acids for cellular remodeling. When substrates of proteolytic pathways are poorly recognized or there is mistiming of proteolysis, profound changes in cell function can occur. Based on these potential problems, it is not surprising

2003 American Journal of Physiology. Renal physiology

125364. Primary central nervous system lymphoma in Korea: comparison of B- and T-cell lymphomas. (Abstract)

Primary central nervous system lymphoma in Korea: comparison of B- and T-cell lymphomas. The great majority of primary central nervous system lymphoma (PCNSL) is known to be of B-lineage, with T-cell PCNSL (T-PCNSL) accounting for <5%. We report an unusually high incidence of T-cell lymphoma among the PCNSLs originated in a large general-care hospital in the metropolitan Seoul area. PCNSLs (n = 42) accrued from April 1995 through June 2001 were reviewed for histologic and clinical features

2003 American Journal of Surgical Pathology

125365. Use of the PROACT System for reduction of postsurgical peritoneal adhesions. (Abstract)

Use of the PROACT System for reduction of postsurgical peritoneal adhesions. To assess the efficacy and safety of a new surgical device designed to prevent adhesions.Prospective, controlled two-phase porcine study.Good Laboratory Practice-certified animal facility.Phase I: 10 pigs underwent peritoneal treatment with the PROACT System (NTERO Surgical, Inc., Palo Alto, California) at the time of the laparotomy incision, and four had the incision made without treatment. Phase II: 22 animals were (...) randomized to treatment or control groups.Animals in both groups underwent laparotomy incision and small bowel resection. The treatment group received treatment to the peritoneum before the peritoneal incision was made. Necropsy and adhesion evaluation were conducted by a blinded reviewer 7-13 days after the initial surgery.Presence or absence of adhesions.Phase I: no treated animal developed adhesions to the incision site; three of four control animals developed adhesions to the incision site. Phase II

2003 Fertility and Sterility

125366. Histology of upper pole is unaffected by prenatal diagnosis in duplex system ureteroceles. (Abstract)

Histology of upper pole is unaffected by prenatal diagnosis in duplex system ureteroceles. We determined whether the histology of upper pole nephrectomy specimens vary with prenatal detection or ureterocele position.Between 1992 and 2000, 95 patients with ureteroceles associated with a duplex system underwent surgical interventions, including upper pole nephrectomy in 60. A total of 55 specimens, of which 25 and 30 involved a prenatal and postnatal diagnosis, and 18 and 37 involved (...) an intravesical and extravesical location, respectively, were available for independent review by a single pathologist. Histological lesions were classified into the 5 categories of chronic interstitial inflammation, fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Each category was divided into moderate/severe histological lesions (greater than 25% involvement) and minimal/mild lesions (25% or less involvement).A moderate/severe histological lesion was identified in 38 patients (69

2002 Journal of Urology

125367. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. (Abstract)

Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. The purpose of this study was to show that magnetic resonance imaging (MRI) can accurately and noninvasively evaluate the articular cartilage overlying osteochondral lesions of the talus, using arthroscopy as the standard, and provide information about lesion stability. A classification system applicable to both MRI and arthroscopy is proposed.Retrospective review with MRI and arthroscopy (...) correlation.A retrospective analysis involving 26 men and 28 women who underwent MRI of the ankle and in whom arthroscopy had been performed. The talar dome cartilage was evaluated using the following grading system: 0, normal cartilage; 1, abnormal signal but intact; 2, fibrillation or fissures not extending to bone; 3, flap present or bone exposed; 4, loose undisplaced fragment; 5, displaced fragment. There was a history of trauma in 80% of cases.At surgery, 14 ankle joints had intact cartilage and 40

2003 Arthroscopy

125368. Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems. (Abstract)

Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems. The goal of this study was to perform a retrospective review of arthroscopically treated osteochondral lesions of the talus (OCLTs) to determine their outcome and to analyze the correlation of 3 subjective outcome scoring systems for the ankle.Between 1985 and 1999, 37 arthroscopic debridement or subchondral drilling procedures were performed on 33 ankles to treat OCLTs. The charts (...) of these patients were reviewed for general demographic, preoperative, surgical, and postoperative information. Patients were sent a questionnaire that included 3 subjective outcome scoring systems: the Martin Score questionnaire; the Berndt and Harty scale; and the Single Assessment Numeric Evaluation (SANE) question. Twenty-eight people responded to the questionnaire. Twenty-four patients reported a history of trauma. There were 17 lesions on the medial aspect of the talus, 10 laterally, and 1 centrally

2003 Arthroscopy

125369. Scoring systems for the functional assessment of the shoulder. (Abstract)

Scoring systems for the functional assessment of the shoulder. A number of instruments have been developed to measure the quality of life in patients with various conditions of the shoulder. Older instruments appear to have been developed at a time when little information was available on the appropriate methodology for instrument development. Much progress has been made in this area, and currently an appropriate instrument exists for each of the main conditions of the shoulder. Investigators (...) planning clinical trials should select modern instruments that have been developed with appropriate patient input for item generation and reduction, and established validity and reliability. Among the other factors discussed in this review, responsiveness of an instrument is an important consideration as it can serve to minimize the sample size for a proposed study. The shoulder instruments reviewed include the Rating Sheet for Bankart Repair (Rowe), ASES Shoulder Evaluation Form, UCLA Shoulder Score

2003 Arthroscopy

125370. Critical evaluation of Mirels' rating system for impending pathologic fractures. (Abstract)

Critical evaluation of Mirels' rating system for impending pathologic fractures. This project examined the hypothesis that Mirels' rating system for impending pathologic fractures is reproducible, valid, and applicable across various experience levels and training backgrounds. Twelve true clinical histories and corresponding radiographs for patients with femoral metastatic lesions were reviewed by 53 participants from five experience levels: orthopaedic residents, musculoskeletal radiologists (...) showed good agreement for site, moderate agreement for type, and fair agreement for size and pain. There was no significant difference in overall scores across experience levels. The pooled odds ratio favored Mirels rating system over clinical judgment regardless of experience level. Overall sensitivity was 91% and specificity was 35%. Mirels' system seems to be reproducible, valid, and more sensitive than clinical judgment across experience levels. However, although the system is a valuable

2003 Clinical Orthopaedics and Related Research

125371. Evidence of effects of environmental chemicals on the endocrine system in children. (Abstract)

Evidence of effects of environmental chemicals on the endocrine system in children. Pollutant chemicals that are widespread in the environment can affect endocrine signaling, as evidenced in laboratory experiments and in wildlife with relatively high exposures. Although humans are commonly exposed to such pollutant chemicals, the exposures are generally low, and clear effects on endocrine function from such exposures have been difficult to demonstrate. Several instances in which there are data (...) from humans on exposure to the chemical agent and the endocrine outcome are reviewed, including age at weaning, age at puberty, and sex ratio at birth, and the strength of the evidence is discussed. Although endocrine disruption in humans by pollutant chemicals remains largely undemonstrated, the underlying science is sound and the potential for such effects is real.

2003 Pediatrics

125372. Treating exacerbations of asthma in children: the role of systemic corticosteroids. (Abstract)

Treating exacerbations of asthma in children: the role of systemic corticosteroids. To review the use of systemic corticosteroids to treat recurrent, acute asthma episodes in children, with a focus on the role of oral corticosteroids.A comprehensive review of the literature was performed using the Medline database (January 1966-October 2002) and the Embase database (January 1980-August 2002).The significant findings of 17 selected, controlled clinical trials of oral corticosteroids (OCSs

2003 Pediatrics

125373. Local and systemic control in Ewing's sarcoma of the femur treated with chemotherapy, and locally by radiotherapy and/or surgery. (Abstract)

Local and systemic control in Ewing's sarcoma of the femur treated with chemotherapy, and locally by radiotherapy and/or surgery. The role of radiotherapy and/or surgery in the local treatment of Ewing's sarcoma has still to be determined. The outcome of Ewing's sarcoma may differ according to its location and a selection bias towards surgery limits the ability to compare methods of local treatment. We have carried out a retrospective review of 91 consecutive patients treated for non-metastatic

2003 The Journal of Bone and Joint Surgery British Volume

125374. Total hip arthroplasty with use of the cementless Zweymüller Alloclassic system. A ten to thirteen-year follow-up study. (Abstract)

cementless system at our institution between February 1988 and March 1991, and 104 hips (ninety-four patients) were retrospectively reviewed after a minimum duration of follow-up of ten years. The mean age of the patients at the time of the arthroplasty was 62.3 years (range, twenty-five to seventy-seven years). The mean duration of follow-up was 11.3 years. Standard radiographs were made for all patients immediately after the operation, at six and twelve months, and annually thereafter for at least ten (...) Total hip arthroplasty with use of the cementless Zweymüller Alloclassic system. A ten to thirteen-year follow-up study. The Zweymüller Alloclassic total hip arthroplasty system is widely used, although few intermediate-term studies have been published. The purpose of the present study was to evaluate the clinical and radiographic results of this system after ten years.One hundred and twenty-four consecutive primary total hip arthroplasties were performed with the Zweymüller Alloclassic

2003 The Journal of Bone and Joint Surgery. American Volume

125375. Nonmetastatic osteosarcoma of the extremity with pathologic fracture at presentation: local and systemic control by amputation or limb salvage after preoperative chemotherapy. Full Text available with Trip Pro

Nonmetastatic osteosarcoma of the extremity with pathologic fracture at presentation: local and systemic control by amputation or limb salvage after preoperative chemotherapy. To determine whether a pathologic fracture in osteosarcoma of long bones has prognostic importance, and limb salvage can be safely performed in such cases, we reviewed the surgical treatment and oncologic results in 46 patients with nonmetastatic osteosarcoma of the extremity and pathologic fracture at presentation who

2003 Acta Orthopaedica Scandinavica

125376. The effects of antiglaucoma and systemic medications on ocular blood flow. (Abstract)

The effects of antiglaucoma and systemic medications on ocular blood flow. Based on the body of evidence implicating ocular blood flow disturbances in the pathogenesis of glaucoma, there is great interest in the investigation of the effects of antiglaucoma drugs and systemic medications on the various ocular vascular beds. The primary aim of this article was to review the current data available on the effects of antiglaucoma drugs and systemic medications on ocular blood flow. We performed (...) a literature search in November 2002, which consisted of a textword search in MEDLINE for the years 1968-2002. The results of this review suggest that there is a severe lack of well-designed long-term studies investigating the effects of antiglaucoma and systemic medications on ocular blood flow in glaucomatous patients. However, among the 136 articles dealing with the effect of antiglaucoma drugs on ocular blood flow, only 36 (26.5%) investigated the effects of medications on glaucoma patients. Among

2003 Progress in Retinal and Eye Research

125377. Late corneal scarring after photorefractive keratectomy concurrent with development of systemic lupus erythematosus. (Abstract)

Late corneal scarring after photorefractive keratectomy concurrent with development of systemic lupus erythematosus. To report a case of late-onset corneal haze following previous photorefractive keratectomy (PRK) concurrent with the development of systemic lupus erythematosus.Single case report and review of medical literature.A 41-year-old woman underwent uneventful bilateral, non-simultaneous photorefractive keratectomy (PRK) with retreatment of the right eye after 1 year. Two months after (...) retreatment, the patient presented with headaches and mental status changes and was diagnosed with systemic lupus erythematosus. Severe reticular corneal scarring developed in the right eye 1 year after retreatment. After the patient's disease was well controlled on a maintenance dose of hydroxychloroquine 200 mg twice a day, mechanical debridement was performed on the right cornea with a marked decrease in corneal haze and improved best spectacle-corrected vision.Patients who manifest with autoimmune

2002 Journal of Refractive Surgery

125378. Adverse systemic effects from pledgets of topical ocular phenylephrine 10%. (Abstract)

Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute, Portland, Oregon) were reviewed. Age, sex, duration of therapy, other drugs the patient was taking, and systemic reactions are provided in the series of 11 cases with adverse systemic reactions.Eleven cases of adverse systemic reactions to topical ocular phenylephrine 10% applied in pledget form occurred in 8 male and 3 female patients with an age range from 1 to 76 years. All cases occurred after a single exposure, most patients noted (...) Adverse systemic effects from pledgets of topical ocular phenylephrine 10%. To report 11 cases of adverse systemic reactions to topical ocular application of phenylephrine 10% in pledget form and to discourage this method of treatment for hemostasis in laser assisted in-situ keratomileusis (LASIK) surgery and other ophthalmic uses.Observational case series.The literature, reports provided to the spontaneous reporting system of the United States Food and Drug Administration and the National

2002 American Journal of Ophthalmology

125379. Systemic adverse effects of beta-adrenergic blockers: an evidence-based assessment. (Abstract)

Systemic adverse effects of beta-adrenergic blockers: an evidence-based assessment. To present an evidence-based review of the systemic adverse effects of beta-adrenergic blockers and recommend safety guidelines for use of ophthalmic beta-adrenergic blockers.Literature review of published articles in peer-reviewed journals and medical texts.Pre-MEDLINE and MEDLINE search of relevant English language articles from 1966 to the present. Cardiovascular, pulmonary, endocrine/metabolic, central (...) or trigger bronchospasm in patients with asthma or pulmonary disease associated with hyper-reactive airways. This review identifies no scientific studies supporting the development of worsening claudication, depression, hypoglycemic unawareness, or prolonged hypoglycemia in non-insulin-dependent diabetes, sexual dysfunction, or impaired neuromuscular transmission with systemic or ophthalmic beta-adrenergic blockers.Many commonly presumed adverse beta-adrenergic blocker effects observed via systemic

2002 American Journal of Ophthalmology

125380. Progressive outer retinal necrosis in immunocompetent patients treated initially for optic neuropathy with systemic corticosteroids. (Abstract)

Progressive outer retinal necrosis in immunocompetent patients treated initially for optic neuropathy with systemic corticosteroids. To report two cases of progressive outer retinal necrosis occurring in immunocompetent individuals after treatment with corticosteroids for presumed optic neuropathy.Observational case report.University-based tertiary eye hospital.Retrospective review of existing clinical records.Two patients were treated empirically with systemic corticosteroids for suspected (...) is not confined to patients with underlying severe immunodeficiency, such as acquired immune deficiency syndrome. Initial treatment of acute, unexplained vision loss with systemic corticosteroids may lead to catastrophic visual loss in patients with evolving necrotizing herpetic retinopathy.

2003 American Journal of Ophthalmology

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