Renae Kavlock

Renae Kavlock

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Renae Kavlock

Publications Authored By Renae Kavlock

ᅟ: The purpose of the current study was to determine the accuracy of the clinical diagnosis in non-melanoma skin malignancy as confirmed by histopathological examination of the specimen. Positive predictive value (PPV) was selected as a reliable measure of diagnostic accuracy.
Clinical diagnosis was made in the outpatient clinic by a consultant oral and maxillofacial surgeon.Read More

We reviewed the electronic charts of 210 patients with non-melanoma skin malignant tumours and calculated the positive predictive value of the initial clinical diagnosis. Histological confirmation for each lesion was compared with the provisional clinical diagnosis made in the clinic.
Of the 147 lesions provisionally diagnosed as basal cell carcinomas, 133 lesions were histologically confirmed to be basal cell carcinomas (BCC) (PPV 90.4 %). Of the 63 lesions provisionally thought to be squamous cell carcinomas, 47 lesions were histologically confirmed as squamous cell carcinomas (SCC) (PPV 74.6 %). The difference between the PPVs for the two types of malignancy in our study was not significant (p = 0.39). Statistics between our results for BCC and SCC and those reported from two other cancer institutes revealed no significant difference (p = 0.58 and 0.07).
The present study supports that relying on clinical diagnosis with the purpose to formalise a treatment plan for head and neck non-melanoma skin cancer is safe and efficient. This is more reliable in cases of basal cell carcinoma in comparison to suspected squamous cell carcinomas. Although positive predictive value represents a reliable measure of diagnostic accuracy, it is increased when populations with higher prevalence of the disease are studied.

Br J Oral Maxillofac Surg
Br J Oral Maxillofac Surg 2013 Oct 15;51(7):669-70. Epub 2013 May 15.

Accurate and timely collection of clinical records is of utmost importance in planning, evaluating, and auditing orthognathic operations. The minimum dataset guidelines of the British Orthodontic Society (BOS) and the British Association of Oral and Maxillofacial Surgeons (BAOMS) were published in an attempt to standardise the collection of clinical records of patients having orthognathic operations. This multicentre retrospective audit aimed to assess and compare compliance with the guidelines in 3 maxillofacial units over a 1-year period.Read More

A total of 105 cases were reviewed. Compliance varied. Documentation of altered sensation was consistently poor and too many unnecessary radiographs were taken. There may be a need to circulate the guidelines again to increase awareness and reduce variability between centres.

J Surg Case Rep
J Surg Case Rep 2010 1;2010(3). Epub 2010 May 1.

We discuss a case of idiopathic cervical epidural abscess, complicated by osteomyelitis, presenting with dysphagia as the main complaint. No predisposing factors were identified and blood cultures were negative. Case was treated conservatively by long course of IV antibiotics.Read More

We present a review of presentation of spinal epidural abscesses and indications for surgical intervention.

Am. J. Gastroenterol.
Am J Gastroenterol 2006 Dec 6;101(12):2790-6. Epub 2006 Oct 6.
Division of Gastroenterology/Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242-1009, USA.

Whether defecation is influenced by body position or stool characteristics is unclear.
We investigated effects of body position, presence of stool-like sensation, and stool form on defecation patterns and manometric profiles.
Rectal and anal pressures were assessed in 25 healthy volunteers during attempted defecation either in the lying or sitting positions and with balloon-filled or empty rectum.Read More

Subjects also expelled a water-filled (50 cc) balloon or silicone-stool (FECOM) either lying or sitting and rated their stooling sensation.
When attempting to defecate in the lying position, a dyssynergic pattern was seen in 36% of subjects with empty rectum and 24% with distended rectum. When sitting, 20% showed dyssynergia with empty rectum and 8% with distended rectum. More subjects (p < 0.05) showed dyssynergia in lying position. When lying, 60% could not expel balloon and 44% FECOM. When sitting, fewer (p < 0.05) failed to expel balloon (16%) or FECOM (4%). FECOM expulsion time was quicker (p < 0.02). Stool-like sensation was more commonly (p < 0.005) evoked by FECOM than balloon.
In the lying position, one-third showed dyssynergia and one-half could not expel artificial stool. Whereas when sitting with distended rectum, most showed normal defecation pattern and ability to expel stool. Thus, body position, sensation of stooling and stool characteristics may each influence defecation. Defecation is best evaluated in the sitting position with artificial stool.

Am. J. Gastroenterol.
Am J Gastroenterol 2004 Dec;99(12):2405-16
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.

The colonic neuromuscular dysfunction in patients with constipation and the role of colonic manometry is incompletely understood.
To study prolonged colonic motility and assess its clinical significance.
Twenty-four-hour ambulatory colonic manometry was performed in 21 patients with slow-transit constipation and 20 healthy controls by placing a 6-sensor solid-state probe up to the hepatic flexure.Read More

Quantitative and qualitative manometric analysis was performed in 8-h epochs. Patients were followed up for 1 yr.
Constipated patients showed fewer pressure waves and lower area under the curve (p < 0.05) than controls during daytime, but not at night. Colonic motility induced by waking or meal was decreased (p < 0.05) in patients. High-amplitude propagating contractions (HAPCs) occurred in 43% of patients compared to 100% of controls and with lower incidence (1.7 vs 10.1, p < 0.001) and propagation velocity (p < 0.04). Manometric features suggestive of colonic neuropathy were seen in 10, myopathy in 5, and normal profiles in 4 patients. Seven patients with colonic neuropathy underwent colectomy with improvement. The rest were managed conservatively with 50% improvement at 1 yr.
Patients with slow-transit constipation exhibited either normal or decreased pressure activity with manometric features suggestive of colonic neuropathy or myopathy as evidenced by absent HAPC or attenuated colonic responses to meals and waking. In refractory patients, colonic manometry may be useful in characterizing the underlying pathophysiology and in guiding therapy.

BMC Anesthesiol
BMC Anesthesiol 2004 Jan 16;4(1). Epub 2004 Jan 16.
Department of Anesthesiology, University of Virginia Health Center, Charlottesville, Virginia, USA.

BACKGROUND: We report a case of a patient with apparent resistance to local anesthetics. While similar cases of failure of regional anesthetics are often attributed to technical failure, the overall clinical presentation and history of this patient suggests a true resistance to local anesthetics. CASE PRESENTATION: This patient presented for elective cesarean section and the decision for regional anesthesia was made.Read More

While attempting to place an epidural, the patient failed to achieve adequate skin analgesia despite multiple attempts at local infiltration. When a spinal was ultimately placed, sensory or motor blockade was not obtained despite no evidence of technical problems with technique. Further questioning revealed multiple prior episodes of local anesthetic failure in this patient. CONCLUSIONS: While the failure rate of spinal anesthesia has been shown range from 4-13% and is often attributed to technical failure, elements of this particular case suggest a true resistance to local anesthetics.