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A Shapiro

Publications and source records attributed to A Shapiro.

At least 55 records · Page 3Linked to original sources
PubMed2001

Bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements after major abdominal surgery.

UNLABELLED: To assess the analgesic efficacy of patient-controlled bupivacaine wound instillation, 50 patients undergoing major intraabdominal surgery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard general anesthetic was administered. On completion of surgery, two multihole 20-gauge epidural catheters were tunneled through the proximal and distal apices of the surgical wound and placed above the fascia such that the tips were at the margin of the first and second thirds of the surgical wound, respectively. Postoperatively, a patient-controlled analgesia (PCA) device was connected to the instillation system. Either bupivacaine 0.25% (Bupivacaine Group) or an equal volume of sterile water (Control Group) was administered. The PCA device was programmed to deliver 9.0 mL with a 60-min lockout interval and no basal infusion. During the first six postoperative hours, a coinvestigator administered "rescue" morphine (2 mg IV). Thereafter, meperidine 1 mg/kg IM was administered on patient request for additional analgesia. Instillation attempts and actual number of injections were similar between the groups. The mean number of pump infusions and the mean "rescue" opioid requirements during the 24-h study period were similar between the groups. The total "rescue" morphine administered during the first six postoperative hours was 16 +/- 17 mg vs 18 +/- 14 mg for the Bupivacaine and Control Groups, respectively. The total meperidine administered during this period was 1.6 +/- 1.4 mg/kg and 2 +/- 1.2 mg/kg for the Bupivacaine and Control Groups, respectively. Preoperatively, hourly for the first six postoperative hours, and on removal of the instillation catheter, patient-generated visual analog scales for pain were similar at rest, on coughing, and after leg raise. In conclusion, bupivacaine wound instillation via an electronic PCA device and a double-catheter system does not decrease postoperative opioid requirements after surgery performed through a midline incision. IMPLICATIONS: After major abdominal surgery performed through a 20-cm incision, repeated 0.25% bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements.

Abdomen↗
PubMed2001

The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy.

UNLABELLED: To assess the effect of local anesthetic wound instillation on visceral and somatic pain, we studied 36 patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy. A standard general anesthetic was administered. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above the superficial abdominal fascia such that the tip was at the midpoint of the surgical wound. After surgery, either bupivacaine 0.25% (Bupivacaine group) or sterile water (Control group) was administered via a patient-controlled analgesia device programmed to deliver 9.0 mL with a 60-min lockout interval. During the first 6 h after surgery, rescue IV morphine (2 mg) was administered every 10 min until a visual analog scale score of <30 mm was achieved. Thereafter, on patient request, rescue meperidine 1 mg/kg IM was administered. When compared with the Control group, significantly (P < 0.001) less rescue analgesia was administered to patients in the Bupivacaine group. Rescue morphine administered during the first 6 h after surgery was 6 +/- 4 mg versus 12 +/- 6 mg (P < 0.001) for the Bupivacaine and Control groups, respectively. Rescue meperidine administered was 29 +/- 37 mg versus 95 +/- 36 mg (P < 0.001) for the Bupivacaine and Control groups, respectively. Nausea and antiemetic drug administration was significantly (P = 0.003) less in the Bupivacaine group. Pain scores were similar between the groups. Patient satisfaction was significantly (P = 0.04) more in the Bupivacaine group. We conclude that bupivacaine wound instillation decreases opioid requirements and nausea in the first 24 h after total abdominal hysterectomy with bilateral salpingo-oophorectomy. IMPLICATIONS: Bupivacaine instillation via an electronic patient-controlled analgesia device provides effective analgesia after total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Adult↗
PubMed2001

Renal cell carcinoma: evaluation of the 1997 TNM system and recommendations for follow-up after surgery.

OBJECTIVE: We evaluated the tumor recurrence pattern after radical or nephron-sparing surgery for localized renal cell carcinoma. Based on this pattern, we suggest a surveillance protocol after surgery. METHODS: The outcome of 200 consecutive patients with localized renal cell carcinoma (RCC) that were operated on between January 1982 and December 1997 was evaluated retrospectively. Radical nephrectomy was performed in 155 patients (77.5%), and nephron-sparing surgery in 45 patients (22.5%). The timing and site of disease recurrence were correlated with parameters of the primary tumor. RESULTS: One hundred and twenty-four patients (62%) had pathological stage T1, 26 (13%) had stage T2, and 50 (25%) had stage T3 (41 stage T3a, 8 stage T3b, and 1 stage T3c). The mean follow-up was 47 months (range 6--169 months). Four patients (3.2%) with stage T1, 6 patients (23%) with T2, and 13 patients (26%) with T3 developed recurrent disease. None of the patients with a stage T1 tumor, smaller than 4 cm, had tumor recurrence. There were no recurrences after nephron-sparing surgery compared to 23 recurrences (14.8%) among patients after radical nephrectomy (p = 0.01). Only 1 patient who underwent pulmonary lobectomy for asymptomatic metastases smaller than 2.5 cm, found by routine chest CT, attained long-term survival. CONCLUSIONS: The prognosis of patients after radical nephrectomy for renal cell carcinoma, smaller than 4 cm, is excellent and they do not need radiological follow-up. Patients with larger T1 tumors, 4--7 cm in diameter, or a higher stage should be followed with CT of the chest and abdomen done every 6 months for 5 years and then annually. Following partial nephrectomy of small renal tumors periodic renal ultrasonography should be done to rule out local recurrence in the operated kidney.

Adult↗
PubMed2001

Is the pediatric ureter as efficient as the adult ureter in transporting fragments following extracorporeal shock wave lithotripsy for renal calculi larger than 10 mm.?

PURPOSE: We determined whether the thin ureter of the young child transports stone fragments after extracorporeal shockwave lithotripsy (ESWL) as efficiently as the adult ureter does. This determination was done by comparing the outcome after lithotripsy of renal stones greater than 10 mm. between young children and adults. MATERIALS AND METHODS: Our study group consisted of 38 children 6 months to 6 years old (median 3 years) with renal stones greater than 10 mm. in diameter. This group was further divided into 3 subgroups according to the longest stone diameter on plain abdominal film. There were 21 children with a renal stone diameter of 10 to 15 mm. (subgroup 1), 8, 16 to 20 mm. (subgroup 2) and 9 greater than 20 mm. (subgroup 3). The control group consisted of 38 adults older than 20 years randomly selected from the local ESWL registry. Each adult was matched with a child regarding stone diameter and localization. The control group was similarly divided into subgroups 1a, 2a and 3a. ESWL was performed with the unmodified Dornier HM-3 lithotriptor (Dornier Medical Systems, Inc., Marietta, Georgia). The stone-free rate, complication rate, and need for tubes, including stent or nephrostomy, and greater than 1 ESWL session were compared. RESULTS: The stone-free rate was 95% in the study and 78.9% in the control group (p = 0.086). Stone-free rates were 95%, 100% and 89% in subgroups 1, 2 and 3, and 95%, 65% and 56% in subgroups 1a, 2a and 3a, respectively. There were 10 children and 4 adults who underwent greater than 1 ESWL session (p = 0.14). Then there were 10 children and 6 adults who required a tube before ESWL (p = 0.04), and almost all of them were included in subgroups 3 and 3a. Early complications were rare in both the study and control groups. Late complications had included 2 cases of Steinstrasse in the control and none in the study group. CONCLUSIONS: The stone-free rate after ESWL for large renal stones is higher in young children compared to adults with matching stone size. Renal stones greater than 20 mm. often require more than 1 ESWL session. The pediatric ureter is at least as efficient as the adult for transporting stone fragments after ESWL.

Child↗
PubMed2000

Study of charmless hadronic B meson decays to pseudoscalar-vector final states.

We report results of searches for charmless hadronic B meson decays to pseudoscalar( pi(+/-), K+/-, pi(0), or K(0)(S))-vector( rho, K(*), or omega) final states. By using 9.7x10(6) BB pairs collected with the CLEO detector, we report the first observation of B(-)--->pi(-)rho(0), B(0)-->pi(+/-)rho(-/+), and B(-)-->pi(-)omega, which are expected to be dominated by hadronic b-->u transitions. The measured branching fractions are (10.4(+3.3)(-3.4)+/-2.1)x10(-6), (27.6(+8.4)(-7.4)+/-4.2)x10(-6), and (11.3(+3.3)(-2.9)+/-1. 4)x10(-6), respectively. Branching fraction upper limits are set for all of the other decay modes investigated.

Journal Article↗
PubMed2000

Measurement of charge asymmetries in charmless hadronic B meson decays.

We search for CP-violating charge asymmetries (alpha(CP)) in the B meson decays to K(+/-)pi(-/+), K(+/-)pi(0), K(0)(S)pi(+/-), K(+/-)eta('), and omega pi(+/-). Using 9.66 million upsilon(4S) decays collected with the CLEO detector, the statistical precision on alpha(CP) is in the range of +/-0.12 to +/-0.25 depending on decay mode. While CP-violating asymmetries of up to +/-0.5 are possible within the standard model, the measured asymmetries are consistent with zero in all five decay modes studied.

Journal Article↗
PubMed2000

Search for CP violation in B+/- --> J/psiK+/- and B+/- --> psi(2S)K+/- decays.

We present a search for direct CP violation in B+/--->J/psiK+/- and B+/--->psi(2S)K+/- decays. In a sample of 9.7x10(6) B&Bmacr; meson pairs collected with the CLEO detector, we have fully reconstructed 534 B+/--->J/psiK+/- and 120 B+/--->psi(2S)K+/- decays with very low background. We have measured the CP-violating charge asymmetry to be [+1.8+/-4.3(stat)+/-0.4(syst)]% for B+/--->J/psiK+/- and [+2.0+/-9. 1(stat)+/-1.0(syst)]% for B+/--->psi(2S)K+/-.

Journal Article↗
PubMed2000

Measurement of plasma uracil using gas chromatography-mass spectrometry in normal individuals and in patients receiving inhibitors of dihydropyrimidine dehydrogenase.

A sensitive gas chromatographic-mass spectrometric method is described for reliably measuring endogenous uracil in 100 microl of human plasma. Validation of this assay over a wide concentration range, 0.025 microM to 250 microM (0.0028 microg/ml to 28 microg/ml), allowed for the determination of plasma uracil in patients treated with agents such as eniluracil, an inhibitor of the pyrimidine catabolic enzyme, dihydropyrimidine dehydrogenase. Calibration standards were prepared in human plasma using the stable isotope, [15N2]uracil, to avoid interference from endogenous uracil and 10 microM 5-chlorouracil was added as the internal standard.

Calibration↗
PubMed2000

Observation of radiative leptonic decay of the tau lepton

Using 4.68 fb(-1) of e(+)e(-) annihilation data collected with the CLEO II detector at the Cornell Electron Storage Ring, we have studied tau radiative decays tau(-)-->nu(tau)&mgr;(-)nu;(&mgr;)gamma and tau(-)-->nu(tau)e(-)nu;(e)gamma. For a 10 MeV minimum photon energy in the tau rest frame, the branching fraction for radiative tau decay to a muon or electron is measured to be (3.61+/-0.16+/-0. 35)x10(-3) or (1.75+/-0.06+/-0.17)x10(-2), respectively. The branching fractions are in agreement with standard model theoretical predictions.

Journal Article↗
PubMed2000

Continuous intravenous diclofenac does not induce opioid-sparing or improve analgesia in geriatric patients undergoing major orthopedic surgery.

STUDY OBJECTIVE: To assess the analgesic efficacy and perioperative opioid-sparing effects of adjuvant intravenous (IV) diclofenac. DESIGN: Prospective, controlled, double-blind study. SETTING: Large referral hospital. PATIENTS: 40 ASA physical status I, II, and III geriatric patients (>65 years) undergoing open reduction and internal fixation of subcapital fracture of the femur. INTERVENTIONS: A standardized general anesthetic was administered. On induction of anesthesia, patients in the diclofenac group received an IV bolus of diclofenac (0.7 mg/kg) followed by a constant infusion (0.15 mg/kg/hr) until the end of surgery. In the saline group, an equal volume of saline was administered. "Rescue" fentanyl was administered in response to an increase in mean arterial pressure or heart rate (exceeding 20% of the patient's preinduction "baseline" values) that did not respond to a 30% increase in the inspired isoflurane concentration. Postoperative pain was assessed using a four-point patient-generated pain score (1 = none, 2 = mild, 3 = moderate, 4 = severe) as well as number of attempts and actual morphine delivered via a patient-controlled analgesia (PCA) device. MEASUREMENTS AND MAIN RESULTS: The two treatment groups were demographically comparable. The perioperative hemodynamic variables, as well as the induction and "rescue" fentanyl dosages, were unaffected by the treatment modality. Pain scores, PCA attempts, and actual morphine delivered were statistically similar between the two groups. CONCLUSIONS: Adjuvant IV diclofenac does not improve intraoperative stability or decrease postoperative opioid requirements in geriatric patients undergoing internal fixation of subcapital fracture of the femur.

Aged↗
PubMed2000

Cervical papanicolaou smear abnormalities and Chlamydia trachomatis in sexually active adolescent females.

STUDY OBJECTIVE: To examine the effect of cervical Chlamydia trachomatis infection on the prevalence of Papanicolaou (Pap) smear abnormalities in adolescent females. DESIGN: Retrospective study performed by examination of previously obtained cervical C. trachomatis cultures and Pap smear results. SETTING: Urban adolescent health care clinic in the Bronx, New York. PARTICIPANTS: Sexually active females, aged 13 to 23 (mean age: 17.9 years), attending the clinic for evaluation of sexually transmitted diseases. INTERVENTION: Patients who had undergone a gynecological examination with performance of cervical Pap smears and culture for C. trachomatis were enrolled in the study. MAIN OUTCOME MEASURE: Determine the prevalence of cervical C. trachomatis infection and compare cervical smear abnormalities in those with and without infection. RESULTS: Of a study population of 257 females, 24 patients (9.3%) were culture positive for C. trachomatis and 58 patients (22.6%) had significant cervical smear abnormalities, i.e., atypical squamous cells of undetermined significance (ASCUS), low grade squamous intraepithelial lesion (LGSIL), or high grade squamous intraepithelial lesion (HGSIL). The 24 patients infected with C. trachomatis showed the following cervical smear abnormalities: within normal limits-37.5%, benign cellular changes-41.7%, ASCUS-12. 5%, and LGSIL-8.3%. A total of 233 patients (90.7%) were culture negative for C. trachomatis and showed the following cervical smear abnormalities: within normal limits-37.3%, benign cellular changes-39.9%, ASCUS-13.3%, LGSIL-8.6%, and HGSIL-.9%. Statistical analysis suggested no significant differences between the two groups (P >.9 by the Kruskal-Wallace test). CONCLUSIONS: The isolation of C. trachomatis from the cervix of sexually active adolescent females at a single point in time does not impact on the prevalence of significant cervical smear abnormalities.

Adolescent↗
PubMed2000

Hereditary thrombocythaemia is a genetically heterogeneous disorder: exclusion of TPO and MPL in two families with hereditary thrombocythaemia.

Hereditary thrombocythaemia (HT) is an autosomal dominant disorder with clinical presentation and complications resembling sporadic essential thrombocythaemia (ET). Mutations in the thrombopoietin (TPO) gene causing overproduction of TPO and elevated TPO serum levels have been found previously in three families with HT. Here, we present evidence for genetic heterogeneity by demonstrating that HT in a Spanish and a US family is caused by genes other than TPO. Affected family members in both families had normal TPO serum levels. Genetic linkage analysis with TPO microsatellite markers excluded TPO as the disease gene in the Spanish HT family, and sequencing of the TPO gene revealed no mutations in the propositus of the US family. To test a role for MPL, the gene for the TPO receptor, we identified three single nucleotide polymorphisms (SNP) and a novel polymorphic CA microsatellite marker. By linkage analysis, we excluded MPL as the cause of HT in the Spanish family. Interestingly, mapping of the CA microsatellite marker to a region 40.5 kb upstream of MPL revealed the presence of sequences from the TIE gene, which encodes a tyrosine kinase receptor expressed on megakaryocytes and endothelial cells. Thus, MPL and TIE are in close physical proximity, and the CA microsatellite described here will be a useful genetic marker for both genes.

Adult↗
PubMed2000

The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery.

To assess the efficacy and safety of wound instillation of ropivacaine, when administered via a patient-controlled elastometric pump, 50 term parturients undergoing cesarean delivery were enrolled into this prospective, placebo-controlled, double-blinded study. In all cases, a standard spinal anesthetic was administered. After the surgery, a multihole 20-gauge epidural catheter (B. Braun, Melsungen, Germany) was placed above the fascia such that the tip was sited at the point that demarcated 50% of the length of the surgical wound. Thereafter, the catheter was connected to the elastometric pump. According to a computer-generated randomization schedule, the pump was filled with either ropivacaine 0.2% (Ropivacaine Group) or an equal volume of sterile water (Control Group). Postoperatively, patient-controlled analgesia was administered via the elastometric pump. During the first 6 postoperative hours, a coinvestigator administered "rescue" morphine (2 mg, IV). Thereafter, "rescue" dipyrone (1 g) was administered on patient request. In a subset of 10 patients, blood ropivacaine levels were assessed. Compared with the Control Group, significantly fewer patients in the Ropivacaine Group received "rescue" morphine (92% vs. 48%, respectively) (P<0.01). The total "rescue" morphine administered during the first 6 postoperative hours was 2+/-3 mg vs. 10+/-5 mg (P<0.01) for the Ropivacaine and Control Groups, respectively. Patient-generated resting pain scores were similar between the groups. However, pain scores generated after coughing and leg raise were significantly (P<0.04) less in the Ropivacaine Group. More patients in the Ropivacaine Group than in the Control Group described their analgesia as good or excellent. In the subset of patients (n = 10) studied, unbound ropivacaine blood levels were below the toxic threshold (600 ng/mL). However, blood ropivacaine accumulation was noted. All patients stated that the elastometric pump was easy to use. Ropivacaine wound instillation via an elastometric pump is a simple technique that provides safe and effective analgesia after cesarean delivery.

Adult↗
PubMed2000

Neuropsychological counseling improves social behavior in cognitively-impaired multiple sclerosis patients.

We studied the effectiveness of a newly-developed cognitive-behavioral intervention in 15 patients with marked cognitive impairment and behavior disorder. The design was a single-blind test of a neuropsychological intervention, with pre- and post-treatment assessments of personality and social behavior. MS patients underwent neurological examination and neuropsychological testing at baseline. The patients were then randomly assigned to neuropsychological counseling or standard, non-specific supportive psychotherapy. The active 12-week treatment emphasized enhancement of insight through education, social skills training, and behavior modification. All patients were re-examined within 2 weeks of the termination of treatment. Neuropsychological technicians were blind to treatment condition. Both groups showed evidence of cognitive impairment and personality/behavior disorder prior to treatment and were well matched on demographic, disability, and cognitive measures. Patients who underwent neuropsychological counseling showed significant positive response on measures of social behavior (e.g. excessive ego-centric speech) compared to those who underwent standard counseling. We conclude that these data support the use of non-pharmacological, neuropsychological counseling in patients with acquired, MS-associated behavior disorder.

Adult↗
PubMed2000

Pediatric oncology: regulatory initiatives.

The majority of children with cancer receive therapy as participants in clinical research protocols coordinated by national pediatric cooperative groups. One of the highest priorities of these groups is the development of novel therapies. Due to differences in the biology of pediatric and adult tumors and in physiology between adults and children, it is usually necessary to evaluate the safety and effectiveness of new drugs separately in adult and pediatric populations. To stimulate the development of new therapies for pediatric indications and encourage the submission of clinical data to support pediatric product labeling, the U.S. Food and Drug Administration has undertaken two initiatives. In 1998 the FDA issued a regulation (The 1998 Final Pediatric Rule) that mandated if a drug or biological is under review for a claim and the disease exists in both pediatric and adult populations, pediatric studies must be performed. Section 111 of the FDA Modernization Act of 1997 states that if a drug product has exclusivity based on a patent or marketing license, the exclusivity can be extended by six months for the submission of pediatric data to the FDA. The incentive applies to both approved drugs and those under development. These initiatives are intended to enhance access to new anticancer therapies and promote labeling for pediatric oncology indications.

Child↗
PubMed2000

Diffusion- and perfusion-weighted MR imaging of dural sinus thrombosis.

A patient with dural sinus thrombosis had progressively worsening symptoms and signs that resolved after intradural thrombolysis. Intradural sinus pressures were 54 mm Hg. Echo-planar MR imaging revealed complex abnormalities of diffusion and widespread delay in mean transit time that improved immediately after thrombolysis. This case suggests that diffusion- and perfusion-weighted imaging can provide valuable information noninvasively to help triage patients with dural sinus thrombosis between conservative and aggressive management.

Adult↗
PubMed2000

Immunostaining of cytokeratin 20 in cells from voided urine for detection of bladder cancer.

PURPOSE: Cytokeratin 20 is a cytoskeletal protein expressed in colon and bladder cancer cells but only rarely in normal urothelium. Previous studies have shown that identification of RNA coded for cytokeratin 20 in urine samples using polymerase chain reaction is highly sensitive for detection of bladder tumors. We examined the efficacy of immunocytology on cells from voided urine samples using monoclonal antibodies against cytokeratin 20 for noninvasive detection of bladder tumors. MATERIALS AND METHODS: A total of 174 patients comprised the study, including 80 who were evaluated because of hematuria or irritative voiding symptoms and 94 who were examined during followup visits after resection of bladder tumors. Voided urine samples were obtained for immunocytology and cytopathology. Each patient underwent cystoscopy, and biopsies were done when a bladder tumor was detected or carcinoma in situ was suspected. Indirect immunoperoxidase staining was done on cytocentrifuge slides using a monoclonal antibody against cytokeratin 20. RESULTS: Bladder tumors were found in 87 patients. Immunocytology resulted in 81.6% sensitivity, 77% specificity and 80% accuracy. False-negative results occurred in 12 patients with superficial low grade tumors and in 4 with high grade invasive tumors. Cytopathology resulted in 51.7% sensitivity and 94.2% specificity. CONCLUSIONS: Immunocytology of the cytokeratin 20 antigen is significantly more sensitive than cytopathology for bladder tumor detection, especially low grade and low stage cancer. The results are not affected by inflammation or previous treatments with bacillus Calmette-Guerin. Immunocytology may miss high grade tumors and, therefore, cannot be used alone as a substitute for cystoscopy.

Biomarkers, Tumor↗