Search

The purpose of the study was to examine teratogenic risk of antiretroviral (AVR) drugs. Antiretroviral Pregnancy Registry data demonstrate no increase in prevalence of birth defects overall or among women exposed to lamivudine, nelfinavir, nevirapine, stavudine, and zidovudine.

BACKGROUND: For more than 40 years carotid endarterectomy (CE) has been used in the treatment of extracranial carotid disease for the prevention of stroke. Recent prospective clinical trials have confirmed the benefit of CE for both symptomatic and asymptomatic patients. Our purpose was to examine statewide trends in the numbers of CE over a 6-year time period and to evaluate outcomes. METHODS: Using data from the North Carolina Medical Database Commission (NCMDC) all CE procedures from 1988 to 1993 were identified. Numbers of CE were compared with the population and hospital admissions. Variables of length of stay, hospital charges, discharge disposition, and occurrence of stroke and death were analyzed. RESULTS: A total of 11,973 CE were performed in 6 years. Compared by admissions, population, and the proportion of elderly, the number of CE increased yearly. The stroke rate was 1.7% and the death rate 1.2% for an overall in-hospital stroke plus mortality rate of only 2.7%. CONCLUSIONS: From a diverse group of hospitals and a large number of surgeons and patients, this hospital-based study documents the acceptance and safety of CE in the treatment of extracranial carotid disease. Am J Surg. 1997;174:655-661. [C] 1997 by Excerpta Medica, Inc.

BACKGROUND: To assess the use and usefulness of fine-needle aspiration cytologic biopsy (FNAB) of the thyroid in our hospital. METHODS: All cytology slides and charts of patients who had FNAB of the thyroid done in our hospital in 1993 were reviewed. Charts of all patients having thyroid surgery in our hospital in 1993 were reviewed to determine the pathological diagnosis and whether FNAB had been performed preoperatively. Finally, we reviewed all consecutive thyroid surgery cases for an 8-year period, and we calculated the yearly percentage of malignancy. RESULTS: Fifty-five FNAB were done in 53 patients. In 21 patients the FNAB gave indication for thyroid surgery, yet surgery was done in only 12 (57.1 %). Forty-two patients had surgery for a thyroid nodule, but only 20 patients (47.6%) had a preoperative FNAB. There were 3 malignancies among the 20; 2 were correctly predicted by FNAB. The FNAB was correct in 18 of 20. In all, 378 thyroid operations were done from 1987 to 1994. The yearly proportion of thyroid malignancy ranged from 11 % to 29%, but showed no change corresponding with increasing diagnostic sophistication. CONCLUSIONS: Fine-needle aspiration cytologic biopsy in the workup of patients with thyroid masses is strikingly underutilized in our institution. While accurate in 90% of cases where used, FNAB appears to play a minor role in the surgeon's decision regarding surgery. As a result of these findings, we developed a grading system for better communication of the FNAB report and a clinical guideline to improve the evaluation of patients with thyroid masses.

The administration of oral contrast (OC) is widely recommended for computed tomography (CT) of the abdomen in patients with blunt trauma. The purpose of this study was to determine whether routine abdominal CT scans performed without 0C were associated with diagnostic error in patients with blunt trauma. Four hundred ninety-two patients were identified from our Trauma Registry who had CT scans for the evaluation of blunt abdominal trauma between January 1988 and December 1991. Seventysix percent (372) of the CT scans were interpreted as negative, and 2.4% (120) were considered positive. OC was used in 8 (1.6%) of 492 patients. Only 1 of 372 patients whose initial non-OC-enhanced scan was negative subsequently required surgery. There were 5 bowel injuries among the 42 patients who underwent an abdominal operation; in none would the use of OC have ensured the preoperative diagnosis. We found that the omission of 0C did not represent a disadvantage to patients with blunt trauma undergoing a routine abdominal CT scan. Potential time delays and the hazards associated with the use of OC were minimized.

The most common vascular procedure besides heart surgery performed in the US is carotid endarterectomy. Carotid endarterectomy removes the cholesterol-plaque thickened inner lining of the carotid arteries (arteries that provide the main blood supply to the brain). It is questionable whether the benefits of this surgery outweigh the risks and complications, particularly among the elderly who are at greater risk for carotid blockage. A review was undertaken to examine the outcome of patients undergoing carotid endarterectomy surgery at a community hospital. In addition, the incidence of death and stroke in patients over 75 years of age was compared with that of younger patients. There were 810 operations performed on 634 patients; 21 percent of the operations were performed on patients over 75 years (133 patients). The most common reason for the surgery was transient ischemic attack (temporary diminished blood flow to the brain). The older patients were more likely than the younger group to have had a previous heart attack and to require medication to control hypertension. There was also a larger proportion of women in the older group. The incidence of stroke among the older patients was 2 percent compared with a 1 percent incidence among younger patients. The death rate was 5 percent in the older group, and 2 percent in the younger group. Logistic regression showed that when other factors (such as diabetes, pre-existing heart disease, and gender) were controlled, patients over 75 were not at greater risk for stroke or surgery-related mortality than the younger patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

• To determine differences in outcome between unilateral and staged bilateral carotid endarterectomies, we reviewed 850 carotid endarterectomies done by 14 surgeons in a community hospital. Results of 528 unilateral procedures were compared with those of 161 bilateral procedures. Data were abstracted from records for an 11-year period. Twelve of the patients in the unilateral group had nonfatal strokes, and 14 died within 30 days of surgery (stroke+death rate, 4.9%). There were no nonfatal strokes among patients in the bilateral group, and nine died (stroke+death rate, 5.6%). Seven of 14 deaths in the unilateral group and six of nine deaths in the bilateral group were due to neurologic events. In the bilateral group, death was associated with postoperative hypertension and a short intersurgical interval. The stroke+death rate was not significantly different between unilateral and bilateral procedures and compared favorably with North American Symptomatic Carotid Endarterectomy Trial guidelines and other published reports. Staged bilateral carotid endarterectomy can be safely performed in a community hospital.(Arch Surg. 1992;127:793-799)