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Biomedical subjects

A Greenfield

Publications and source records attributed to A Greenfield.

At least 37 records · Page 2Linked to original sources
PubMed1996

Evolving concepts in the diagnosis and treatment of arterial high flow priapism.

PURPOSE: We investigated 2 evolving concepts in the management of arterial priapism: 1) the efficacy of perineal duplex Doppler ultrasound as a diagnostic alternative to arteriography and 2) the therapeutic alternative of expectant management. MATERIALS AND METHODS: We evaluated 10 patients with high flow arterial priapism. RESULTS: Compared to selective internal pudendal arteriography, perineal duplex Doppler ultrasonography was associated with 100% sensitivity and 73% specificity rates. Compared to physical examination, followup duplex ultrasonography had a sensitivity of 75% and specificity of 100%. Followup penile duplex ultrasound demonstrated restoration of antegrade flow in the cavernous artery after embolization. Patients on expectant management remained potent as long as 31 years. CONCLUSIONS: Diagnostic perineal duplex Doppler ultrasonography and expectant management are valuable tools for the treatment of arterial priapism. A new algorithm for patient care is presented.

Adolescent↗
PubMed1995

The Sry-related gene Sox9 is expressed during chondrogenesis in mouse embryos.

Mutations in the human SRY-related gene, SOX9, located on chromosome 17, have recently been associated with the sex reversal and skeletal dysmorphology syndrome, campomelic dysplasia. In order to clarify the role of this gene in skeletal development, we have studied the expression of mouse Sox9 during embryogenesis. Sox9 is expressed predominantly in mesenchymal condensations throughout the embryo before and during the deposition of cartilage, consistent with a primary role in skeletal formation. Interspecific backcross mapping has localized mouse Sox9 to distal chromosome 11. The expression pattern and chromosomal location of Sox9 suggest that it may be the gene defective in the mouse skeletal mutant Tail-short, a potential animal model for campomelic dysplasia.

Amino Acid Sequence↗
PubMed1995

Expression of a linear Sry transcript in the mouse genital ridge.

Sry is the Y-chromosomal gene that is pivotal in the determination of sex in mammals, however the structure of the Sry transcript produced in the embryo has not been determined. We show here that the transcript expressed in the developing mouse gonad at the sex determining stage of development is linear, polyadenylated and encoded by a single exon, in contrast to the circular, apparently untranslated transcript produced in adult testes. The linear transcript was not detected in any other fetal tissue nor in any adult tissue tested, and was expressed only in the genital ridge portion of the urogenital ridge. The spatial and temporal profile of Sry expression suggests that its role in the mouse fetus is limited to initiating Sertoli cell development during testis determination.

Animals↗
PubMed1994

Project WINS: integrating vocational services on mental health case management teams.

In an effort to expand employment opportunities available to psychiatric consumers, a research demonstration project was developed to incorporate vocational services into case management teams. Following psychiatric rehabilitation principles, Project WINS employs professionals as Vocational Specialists and consumers as Peer Support Specialists to work with clients and their case managers. This report describes the characteristics of clients eligible for WINS services, the implementation of the program, and the impact of WINS on clients and on the mental health and vocational systems. It also describes the challenges and barriers this innovative service is confronting.

Adult↗
PubMed1993

Role of arteriography for blunt or penetrating injuries in proximity to major vascular structures: an evolution in management.

Over a 14-month period at Boston City Hospital, 93 consecutive patients who had received a blunt or penetrating extremity injury in proximity to a major vascular structure were evaluated. All patients were totally asymptomatic and underwent arteriography for proximity as a sole indication. Twenty-seven patients (27%) were found to have abnormal arteriograms. Muscular branches of the profunda femoris artery were the most frequently injured arteries (28%). Arterial spasm (41%) was the most common radiographic finding. All patients were managed nonoperatively and followed closely by serial pulse examinations. Follow-up arteriography or duplex scanning was used in isolated cases. No patients in this study required operative intervention based on arteriographic findings. No patients have subsequently required operative intervention for delayed arterial abnormalities. Based on these findings we believe the use of arteriography for asymptomatic injuries in proximity to major vascular structures is unwarranted.

Adolescent↗
PubMed1992

An analysis of treatment services provided in group homes for adults labeled mentally ill.

Although group homes for adults labeled mentally ill have been the focus of significant attention in deinstitutionalization discussions, substantive research on their operation has been lacking. The present study addresses past limitations by focusing on a well-defined sample of small group homes, with higher staffing levels and in-home treatment provided. Thirty homes were randomly selected; all home residents (N = 253) were studied. Data were collected from case managers, residents, and home staff to assess residents' functioning, services and treatments provided, and the environment of the home. The findings were examined in terms of adequacy and appropriateness of care provided in the home, using accepted guidelines. The results indicated that there are aspects of a homelike environment, emotional support from staff, and skill-development activities within the home. However, an institutional focus still seems prevalent, along with limited rehabilitation and socialization activities. Residents expressed high levels of satisfaction, which may reflect their dislike of the group home alternative, e.g., the state hospital. Policy implications are discussed vis-a-vis current efforts to move away from group homes toward supported housing initiatives.

Activities of Daily Living↗
PubMed1991

Percutaneous endoscopic laser lithotripsy of a cystic duct stone: a case report.

A case report of an elderly patient with severe heart disease and chronic obstructive pulmonary disease who required laser lithotripsy for a retained cystic duct stone is presented. This high-risk patient underwent a laparoscopic cholecystostomy and gallstone removal as treatment for symptomatic gallstone disease. On cholecystography the patient was found to have a small stone fragment in the cystic duct. Under intravenous sedation this stone fragment was fragmented and removed using an 8.5F flexible ureteroscope and a coumarin pulsed-dye laser lithotriptor. The stone was fragmented and washed into the common bile duct. Follow-up cholecystogram prior to removal of the cholecystostomy tube demonstrated no stones in the gallbladder, cystic duct, or common bile duct. The management of percutaneous removal of retained stones is reviewed.

Aged↗
PubMed1990

Traumatic laceration of intracavernosal arteries: the pathophysiology of nonischemic, high flow, arterial priapism.

Two forms of priapism are known to occur. The more common type, veno-occlusive priapism, presents with a prolonged painful erection, and it is characterized by ischemia and pooling of blood within the corpora cavernosa. The less common form, high flow priapism, is characterized by lack of pain and ischemia. The pathophysiology of this disorder is poorly understood and the treatment is unclear. We report 2 cases of nonischemic priapism, one of which occurred after blunt perineal trauma and the other after intracavernosal self-injection with papaverine and phentolamine. Based on our 2 cases as well as a review of the literature (5 cases), we propose that the pathophysiological mechanism of this disorder is unregulated arterial inflow into the corpora, classify it as arterial priapism, and describe a diagnostic and therapeutic algorithm for its management.

Adult↗
PubMed1989

Malignant fibrous histiocytoma obstructing the thoracic aorta.

Neoplasms of the aorta are rare. In this report, we present a case of a malignant fibrous histiocytoma that nearly obliterated the lumen of the thoracic aorta. The neoplasm was resected and aortic continuity was reestablished with an interposition graft. This case is particularly unusual because the patient had an isolated lymph node excised 5 years previously that contained the same neoplasm.

Aorta, Thoracic↗
PubMed1989

Stomal varices: percutaneous transhepatic embolization.

Peristomal varices occasionally form in patients with chronic liver disease who have surgically created intestinal anastomoses and stomas. Hemorrhage from these varices carries an estimated mortality of 3%-4% per episode, as opposed to the 30%-40% mortality associated with gastroesophageal variceal bleeding. The cases of four patients who underwent transhepatic mesenteric vein catheterization with embolization of stomal varices for recurrent, intractable bleeding are presented. In three of the four patients there was no additional hemorrhage for at least 5 months. One patient was lost to follow-up. There were no complications. Since stomal variceal hemorrhage has a low mortality, transhepatic embolization is presented as a means of hemorrhage control when sclerotherapy fails and when shunt surgery presents an unacceptably high rate of morbidity and mortality relative to the underlying disease.

Aged↗
PubMed1986

Transplant ureteral obstruction masquerading as recurrent rejection episodes: management by percutaneous antegrade balloon dilatation.

We report a 52-year-old male renal transplant recipient who had three "rejection episodes." The first of these responded to conventional antirejection therapy; however, the next two episodes showed incomplete responses to treatment for rejection. At subsequent presentation with deteriorating renal function, ureteral obstruction was evident and was relieved with percutaneous antegrade balloon dilatation with a return of his plasma creatinine to normal. Obstruction of the ureter was a major component in our patient's course given the lack of response to conventional antirejection therapy and the normalization of renal function with relief of the documented ureteral stenosis. This case illustrates that ureteral obstruction can mimic rejection in the renal transplant recipient. Management of ureteral stenosis in transplant patients with percutaneous antegrade balloon dilatation appears to be an effective procedure and can supplant the need for open surgical procedures.

Catheterization↗
PubMed1983

Treatment of hepatic metastases by transaxillary hepatic artery chemotherapy using an implanted drug pump.

The objective of this study was to evaluate the feasibility of integrating an implantable, refillable drug infusion pump with transaxillary angiographic hepatic arterial catheterization. The implantation is performed under local anesthesia in the radiology suite. A 2-3 cm incision in the left upper arm is made through skin and subcutaneous tissue. Through an axillary artery puncture, a 5.3F polyethylene catheter is fluoroscopically placed into the hepatic artery. To minimize gastroduodenitis, the gastroduodenal artery is occluded with a Gianturco coil and Gelfoam. The Model 400 Infusaid pump is implanted in the upper chest and attached subcutaneously to the angiography catheter using a friction connector. Patients are discharged 2-3 days later. Over a two-year period, 20 such implants have been performed. Floxyuridine (FUdR) has been used by continuous infusion; mitomycin-C (MMC) and 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) by intermittent intra-arterial infusion. The pump/catheter system has been left in place for as long as 18 months. Partial responses in the colorectal cases are as follows: FUdR four of nine patients, MMC two of three, FUdR + MMC one of one, and FUdR + MMC + BCNU three of three. No arm vascular complications, hepatic arterial occlusions, peripheral emboli, pump malfunctions, or catheter occlusions took place over a total experience of 3210 patient days. Three catheter migrations occurred requiring repositioning in two patients, and three cracked catheters required replacement. This innovative approach offers a comfortable, convenient method for long-term ambulatory hepatic arterial chemotherapy obviating both laparotomy and extra-corporeal pumps.

Antineoplastic Agents↗
PubMed1983

Oesophageal mucosal changes in patients with varices.

Histological examination of oesophageal rings removed at transection for varices reveals dilated intraepithelial blood filled channels. These are present in all oesophageal rings removed at transection for varices. A comparison has been made between rings removed from variceal patients with oesophageal rings removed during resections for oesophageal and gastric tumours. Although a small number of non-varices patients had intraepithelial channels they were significantly larger and more numerous in the varices patients (p less than 0.01). Similarly, the area and number of dilated subepithelial channels (just beneath the epithelium) and the area of lamina propria channels were significantly greater in the varices patients (p less than 0.05). Depth of papillae and thickness of the squamous epithelium were also significantly greater in the varices group (p less than 0.05, p less than 0.01 respectively). Under electron microscopy the channels were lined with flattened cells which were not typical of endothelial cells but stained positively for Factor VIII related antigen using indirect immunofluorescence. These channels may correspond to the cherry-red spots seen on endoscopy and may have a role in the pathogenesis of variceal haemorrhage.

Epithelium↗
PubMed1980

Transcatheter embolization of intrahepatic arterial aneurysms.

Four patients with intrahepatic arterial aneurysms were treated with transcatheter embolization. Two patients had multiple aneurysms, and two had single aneurysms; in two the aneurysms were post-traumatic, and in the other two they were mycotic. Either Gelfoam or isobutyl-2-cyanocrylate was used to occlude the hepatic artery branches. It is concluded that transcatheter embolization is a safe and effective method for the management of these aneurysms and can be used as an alternative to surgery.

Adult↗