Prevalence and typing of HPV DNA in atypical squamous cells in pregnant women.

Objective: To determine the prevalence and typing of HPV DNA in pregnant women with a diagnosis of atypical squamous cells (ASC) and to assess whether pregnancy-related changes contribute to the diagnosis of ASC.

Study Design: HPV testing was performed on residual specimens from the ThinPrep Pap test (Cytyc Corp., Boxborough, Massachusetts, U.

Factitious oxygen desaturation after isosulfan blue injection.

Profound pulse oximetery desaturations are observed following isosulfan blue dye injection during breast sentinel node biopsy. The objective of this study was to examine the effect isosulfan dye has on oxygenation status and the reliability of pulse oximetery in evaluating this parameter. After study design, institutional review board approval was obtained.

The efficacy of percutaneous transluminal angioplasty in the treatment of infrainguinal vein bypass graft stenosis.

Hypothesis: Percutaneous angioplasty would provide a durable alternative to surgical revision in the treatment of infrainguinal vein graft stenosis.

Design: Outcome analysis of the results of percutaneous angioplasty of infrainguinal vein graft stenosis.

Setting: Academic vascular surgical practice in a university-affiliated community hospital.

Is duplex ultrasonography an effective single modality for the preoperative evaluation of peripheral vascular disease?

The purpose of this study was to determine whether duplex ultrasonography can be used as an effective modality for the preoperative evaluation of lower-extremity arterial occlusive disease. The records of all patients undergoing both color flow duplex scanning and contrast arteriography of the lower extremities during a 13-month period were reviewed. Comparisons between the two modalities were made at the femoral, popliteal, and tibial artery levels.

Are preoperative serum calcium, parathyroid hormone, and adenoma weight predictive of postoperative hypocalcemia?

The objective of this study is to determine whether preoperative serum calcium, parathyroid hormone, or adenoma weight is predictive of postoperative hypocalcemia after removal of a parathyroid adenoma. A retrospective chart review was performed for consecutive parathyroidectomy patients over a 6-year period at a community-based teaching institution. Patients with renal failure (serum creatinine >1.

Choriocarcinoma brain metastasis in a patient with viable intrauterine pregnancy. Case report.

The authors report the case of a woman who presented during her 30th week of pregnancy with a large brain metastasis from a previously undetected metastatic choriocarcinoma. The metastasis caused significant neurological deficit due to mass effect, necessitating rapid intervention. Medical management included a regimen of high-dose corticosteroid medications for 36 hours, followed by cesarean delivery of the fetus and craniotomy to remove the metastatic tumor, chemotherapy and radiation therapy were begun within 1 week postsurgery.

Non-greater saphenous vein grafting for infrageniculate bypass.

Infrainguinal bypass grafting with greater saphenous vein has proven to be a highly effective procedure with primary 5-year patency and limb salvage rates exceeding 80 per cent. However, because of prior usage or intrinsic venous disease the greater saphenous vein is often not available as a conduit. Numerous studies have shown that patency rates for prosthetic bypass grafting to the infrageniculate vessels are clearly inferior to that reported for greater saphenous vein bypass.

Does surgical intervention significantly prolong the patency of failed angioaccess grafts previously treated with percutaneous techniques?

In the last decade, percutaneous techniques have been increasingly used to treat angioaccess graft thrombosis. Often when catheter-based treatment fails, surgeons are called upon to treat these occluded bridge fistulas. It has been our impression that operative intervention has not significantly increased the longevity of angioaccess grafts that have failed percutaneous intervention.

Diagnosis and management of laryngotracheal trauma.

Laryngotracheal trauma is life-threatening. We identified 23 patients between 1992 and 1998 with laryngeal (12), tracheal (8), and combined injuries (3). Nineteen patients had penetrating trauma (gunshot wound, 12; stab wound, 7), and four patients had blunt injury.

Release of allergens as respirable aerosols: A link between grass pollen and asthma.

Background: Asthma incidence has long been linked to pollen, even though pollen grains are too large to penetrate into the airways where asthmatic responses originate. Pollen allergens found in small, respirable particles have been implicated in a number of asthma epidemics, particularly ones following rainfall or thunderstorms.

Objective: The aim of this study was to determine how pollen allergens form the respirable aerosols necessary for triggering asthma.

A new look at nurse burnout: the effects of environmental uncertainty and social climate.

As healthcare organizations deal with changes in the external environment, uncertainty in the internal environment is created. The purpose of this study was to explore the relationships among environmental uncertainty, social climate, and burnout among staff nurses. Multiple regression analysis was used to explore relationships among study variables.

Axillofemoral bypass for aortoiliac occlusive disease.

Background: Although aortoiliac disease remains a common cause of lower extremity ischemia, the efficacy of axillofemoral bypass in this setting remains controversial. This report summarizes our institutional experience with axillofemoral bypass.

Methods: A retrospective review of consecutive axillofemoral bypass grafts was performed at a single institution between 1984 and 1997.

The utility of transesophageal echocardiography in determining the source of arterial embolization.

Arterial embolism is frequently of a cardiac source. Arterial-arterial and paradoxical embolization also occurs. Failure to identify the origin may subject the patient to an important series of events.

Blunt chest trauma in the elderly patient: how cardiopulmonary disease affects outcome.

Blunt trauma patients with rib fractures have significant risk of morbidity and mortality. The risk of complications increases with age and cardiopulmonary disease. We reviewed our experience at a community hospital Level II trauma center over a 5-year period.

Hepatitis B transplantation: special conditions.

Patients with hepatitis B virus (HBV) infection may be coinfected with other viral diseases, such as hepatitis C virus (HCV) and/or D virus (HDV), or have serious diseases secondary to the hepatitis, such as hepatocellular carcinoma. These coexisting conditions have an impact on the success of treatment and of liver transplantation. Patients with HBV and HDV are at lower risk for HBV recurrence than are patients with HBV alone; likewise, patients with HBV/HCV coinfection appear to have a higher 5-year survival rate posttransplantation.

Restructuring the therapeutic environment to promote care and safety for the obese patient.

Fifty-four percent of American adults are overweight. Obesity is a chronic disease associated with a number of conditions, such as diabetes, heart disease, hypertension, certain types of cancers, and breathing problems. The direct and indirect costs related to obesity exceed $70 billion annually.

Survival, intracranial lesions, and neurodevelopmental outcome in infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation.

Objective: Before the use of extracorporeal membrane oxygenation (ECMO), infants with a severe form of congenital diaphragmatic hernia (CDH) had a high mortality and morbidity. Recent studies have shown an improvement in the survival of these infants after ECMO treatment; however, the existing data do not provide sufficient informations regarding the quality of survival and developmental outcome of these infants. The objective of this study was to evaluate survival, intracranial lesions, and the neurodevelopmental outcome of infants with CDH treated with ECMO.

First radiotherapy of human metastatic brain tumors delivered by a computerized tomography scanner (CTRx).

Purpose: This Phase I study was designed to evaluate the computed tomography (CT) scanner as a device for radiation therapy of human brain tumors (CTRx). This first use in humans of a modified CT for treatment was founded on extensive research experience with canine tumors. An additional objective was to increase the therapeutic radiation dose to tumors compared to normal tissue by concentration of infused contrast material in tumors, an effect available at diagnostic x-ray energies but not at megavoltage energies.

Doppler ultrasound accurately screens patients with appendicitis.

Ultrasound (US) has been reported as a useful aid to increase the sensitivity and specificity of the diagnosis of appendicitis. To determine the accuracy of US, we performed a prospective study of patients evaluated in the emergency department for acute appendicitis. US results of 125 consecutive patients over an 11-month period were correlated with operative and pathologic findings and clinical follow-up.

The utility and reliability of computed tomography scan in the diagnosis of small bowel obstruction.

Accurate diagnosis and treatment of small bowel obstruction (SBO) is critical to prevent complications and reduce costs. The purpose of the current study was to evaluate the evolving role of CT scan for patients with suspected SBO and compare its sensitivity and specificity with plain abdominal films. We identified 108 patients over a 1-year period with an admission or discharge diagnosis of SBO.

Is laparoscopy safe and effective for treatment of acute small-bowel obstruction?

Background: Acute small bowel obstruction (SBO) has been a relative contraindication for laparoscopic treatment due to the potential for bowel distention and the risk of enteric injury. However, as laparoscopic experience has increased, surgeons have begun to apply minimal access techniques to the management of acute SBO.

Methods: A retrospective review was performed of all patients with acute SBO in whom laparoscopic treatment was attempted.