Showing papers by "Bethesda Hospital published in 2004"

Does the declining prevalence of Helicobacter pylori unmask patients with idiopathic peptic ulcer disease? Trends over an 8 year period.

Abstract: Objectives Recent studies have suggested that the prevalence of Helicobacter pylori infection in patients with ulcer disease who were not using non-steroidal anti-inflammatory drugs (NSAIDs) has been overestimated. The decreasing prevalence of H. pylori could lead to a relative increase in the number of patients with this idiopathic peptic ulcer disease (IPUD). This study aimed to investigate the prevalence of IPUD and any possible trends. Design and methods The reports of all upper gastrointestinal endoscopies performed in a Dutch regional hospital over the period 1991 to 1998 were reviewed. If a gastric and/or duodenal ulcer had been diagnosed, data concerning possible H. pylori infection (culture, histology, rapid in-house urease test) were retrieved. If H. pylori tests were negative, hospital files were examined for possible use of NSAIDs or other rare causes of ulcer disease. When these were not found, stored biopsy specimens were tested for H. heilmanii by using the polymerase chain reaction technique. Results Ulcer disease was diagnosed in 405 patients who had undergone endoscopy (1159 with gastric ulcer, 235 with duodenal ulcer, and 11 with both gastric and duodenal ulcer). H. pylori infection was found in 349 of these patients (86.2%). Thirty-three of the 56 H. pylori negative patients used NSAIDs and three patients had Crohn's disease, leaving 20 patients with IPUD (4.9%,12 gastric ulcer and eight duodenal ulcer). Time trends over the study period showed a decrease of H. pylori associated peptic ulcer disease (P <0.002) and an increase of NSAID associated peptic ulcer disease (P <0.0005). The prevalence of IPUD remained stable (P = 0.978). Conclusions The prevalence of patients with H. pylori negative ulcer disease significantly decreased in our study population due to an increase in the number of patients with NSAID associated peptic ulcer disease. IPUD was rare and its prevalence did not increase over a period of 8 years. (C) 2004 Lippincott Williams Wilkins.

Off-pump versus on-pump coronary artery bypass surgery: does the pump influence outcome?

Abstract: Background This study assessed hospitalization outcome differences for patients undergoing off-pump coronary artery bypass (OPCAB) grafting compared with patients having coronary artery bypass grafting with cardiopulmonary bypass. Study design We conducted a nested case—control study from an 8-year, hospitalization cohort (n = 7,905) in which the data were collected prospectively. Inclusion criteria included a coronary artery bypass graft only and age greater than 18 years. Cases were patients undergoing OPCAB (n = 360) and controls were patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (n = 1,080). Cases were matched to controls 1:3 on five variables: age (± 3 years), gender, diabetes, New York Heart Association Functional Classification, and surgical year (± 3 years). The 13 outcomes of interest were mortality, length of hospitalization, ICU length of stay, return to ICU, ventilator time, intraoperative complications, pulmonary complications, neurologic complications, renal complications, gastrointestinal complications, sternal wound infections, highest postoperative creatine kinase level, and units of blood products given during the procedure. Using logistic regression we controlled for eight confounding variables. Results Patients undergoing OPCAB had a significantly shorter length of hospitalization (relative risk [RR] = 0.95; 95% CI, 0.91–0.99%), fewer pulmonary complications (RR = 0.45; 95% CI, 0.22–0.88%), fewer intraoperative complications (RR = 0.04; 95% CI, 0.0048–0.31%) fewer blood product units given (RR = 0.31; 95% CI, 0.14–0.42%) and lower postoperative creatine kinase (RR = 0.99; 95% CI, 0.98–0.99%). There were no considerable differences for the remaining nine outcomes, including mortality and neurologic complications. Conclusions Patients undergoing OPCAB had a considerably shorter length of hospitalization, had fewer pulmonary and intraoperative complications, and received a lower volume of blood products.

Bilateral epilepsy surgery in a 4-year-old child

Abstract: Objective: Reports on bilateral epilepsy surgical interventions are anecdotal because of the possible neurological deficits caused by them. Methods: We report on a four-year-old amaurotic child with catastrophic epilepsy due to bilateral occipital cortical dysplasia. After video-EEG monitoring and intraoperative electrocorticography he underwent a two-step bilateral occipital lobectomy. Results: The first resection resulted in only temporary seizure cessation; however, he became seizure-free after the second operation (follow-up: 20 months). Conclusion: Patients with catastrophic epilepsy due to bilateral epileptogenic lesions but without a high risk of additional post-surgical deficit may be good candidates for epilepsy surgery.

The Ottawa knee rule: avoiding unnecessary radiographs in sports.

Abstract: Physicians are often called upon to evaluate acute knee injuries. Radiographs are frequently ordered, but they may not be helpful for making the diagnosis and guiding treatment of soft-tissue injuries. A set of clinical criteria, called the Ottawa knee rule, has been established to predict when radiographs are truly necessary. The sensitivity and negative predictive value of the rule were both validated at 100% for fractures of the knee in adults. By using the Ottawa knee rule, at least 25% of unnecessary films can be avoided without risking patient safety. The rule has not specifically been studied among sports participants, but indications are that it can be useful in this population.