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Biomedical subjects

A Shapiro

Publications and source records attributed to A Shapiro.

At least 145 records · Page 8Linked to original sources
PubMed1990

Preoperative and postoperative gait evaluation in cerebral palsy.

The purpose of the study was to evaluate objectively and quantitatively the possible effects of surgical correction for equinus deformity on the gait of children with cerebral palsy (CP). Evaluation criteria selected were based on time and distance parameters of stride during gait. Ten children with confirmed diagnoses of CP took part in the study. They were tested before surgery and after surgery at four-month intervals for a period of up to one year. Results were compared to published data obtained on able-bodied, growing children to determine whether progress after the operation was faster than that expected in normal growth. Gait improvement was demonstrated by a decrease in support time and an increase in walking speed and stride length. Overall improvement was sometimes preceded by an initial, temporary deterioration. Results indicate that the time and distance parameters of stride can provide reliable objective evaluation of gait improvement after tendo Achilles lengthening in children with CP.

Achilles Tendon↗
PubMed1989

[Intrapleural marcaine for postoperative analgesia].

Intrapleural marcaine has been described as an effective method of analgesia following upper abdominal and thoracic operations and is no longer regarded as experimental. We have shown that the same quality of analgesia can be achieved by injecting the drug through a catheter inserted intraoperatively through the surgical incision. In our method, applied in 9 cases, there is no risk of pneumothorax as a result of piercing the chest wall, since intraoperative placement of the intrapleural catheter is very easy. We therefore suggest it as the method of choice for postoperative analgesia in kidney operations. It is especially recommended in elderly patients with chronic pulmonary disease who do not tolerate narcotics well.

Bupivacaine↗
PubMed1989

The interaction of human papillary and reticular fibroblasts and human keratinocytes in the contraction of three-dimensional floating collagen lattices.

Fibroblasts derived from the papillary and reticular dermis of human skin and human keratinocytes show differences in their abilities to contract floating three-dimensional gels constructed from type I collagen. Reticular fibroblasts produce greater gel contraction than papillary fibroblasts. When equal numbers of papillary and reticular fibroblasts are mixed in the gels, papillary fibroblasts consistently inhibit gel contraction by reticular fibroblasts indicating interaction between these cell types in the contraction process. Surprisingly, keratinocytes alone produce greater gel contraction than that produced by either fibroblast type. Cooperativity in the gel contraction process is observed when fibroblasts are incorporated into the collagen matrix and keratinocytes are seeded onto the gel surface. Keratinocytes and dermal fibroblasts adhere to the collagen fibril to induce gel contraction by different mechanisms. Fibroblast contraction of collagen gels does not require fibronectin but is a serum-dependent reaction. In contrast, keratinocyte contraction of collagen gels occurs in a serum-free environment. Polyclonal, affinity-purified antibodies to human plasma fibronectin at high concentrations do not inhibit gel contraction by keratinocytes, making unlikely the possibility that fibronectin synthesized by the keratinocyte is a significant factor in the gel contraction process. We are currently examining the possibilities either that keratinocytes are synthesizing other adhesion proteins or that receptors on the cell surface can interact directly with the collagen fiber.

Cell Adhesion↗
PubMed1989

Extradural bupivacaine and methadone for extracorporeal shock-wave lithotripsy.

Combined extradural bupivacaine and methadone analgesia was investigated in 144 patients who underwent extracorporeal shock wave lithotripsy (ESWL). Patients were assigned randomly to one of three groups: group I--extradural 0.5% bupivacaine hydrochloride 0.75 mg kg-1; group II--extradural 0.1% methadone hydrochloride 4 mg after the bupivacaine; group III--as group II, plus a continuous extradural infusion of methadone 0.3 mg h-1 after operation. In all patients, only partial motor deficit occurred. During ESWL, patients who received extradural bupivacaine and methadone had significantly less pain compared with those who had bupivacaine alone (P less than 0.025). Extradural anaesthesia and immersion in the warm water bath were accompanied by only mild fluctuations in arterial pressure. After ESWL, significantly more patients with continuous methadone infusion were pain free (P less than 0.05) and they required less systemic analgesics. The anaesthesia during and after the ESWL procedure may be carried out safely and effectively by the administration of small doses of bupivacaine combined with methadone followed by infusion of the opioid.

Analgesia, Epidural↗
PubMed1989

Isolated pulmonary blast injury in rats--a new model using the extracorporeal shock-wave lithotriptor.

Blast injury to the lungs is one of the most overwhelming threats to survival following exposure to powerful explosions. The pathophysiology of blast injuries differs significantly from other forms of trauma. Using the extracorporeal shock-wave lithotriptor, originally designed for the noninvasive treatment of nephrolithiasis, we were able to produce isolated, typical pulmonary blast effects in rats. The immediate mortality was associated with bilateral pneumothorax and hemothorax. A nonlethal dose of shock waves caused intra-alveolar and intrabronchial hemorrhages and an immediate 2- to 3-fold increase in the lung weight. Additional marked increase in lung weight started 12 to 24 hours later, consistent with the clinical picture of delayed respiratory insufficiency which occurs after a latent period of 12 to 48 hours in many blast casualties. The use of air-containing vest as a protective measure completely prevented blast injury to the lungs.

Animals↗
PubMed1988

Olfactory sensitivity, nasal resistance, and autonomic function in patients with multiple chemical sensitivities.

A frequent, if not predominant, complaint of persons reporting symptoms of multiple chemical sensitivities (MCS) is that of heightened sensitivity to smells. In this study odor detection thresholds for phenyl ethyl alcohol (a major component of rose oil) and methyl ethyl ketone (a common solvent) were measured in 18 persons exhibiting symptoms of MCS and in 18 matched normal controls. In addition, nasal resistance, blood pressure, heart rate, and respiration rate were determined before and after the olfactory tests. Scores on the Beck Depression Inventory were obtained prior to testing. Although olfactory thresholds were equivalent in the two study groups, the MCS group evidenced significantly higher nasal resistances, respiration rates and Beck Depression Inventory scores. Decreases in systolic blood pressure and pulse were noted in both groups across the test sessions. These results do not support the hypothesis that MCS is associated with greater olfactory threshold sensitivity (at least to the two target chemicals), but do suggest that MCS is associated with depression, increased respiration rate, and decreased nasal airway patency.

Adult↗
PubMed1988

Can extracorporeal shock wave lithotripsy eradicate persistent urinary infection associated with infected stones?

Infected renal stones can be treated by extracorporeal shock wave lithotripsy but it still is not clear whether successful stone fragmentation and the disappearance of all macroscopic stone fragments guarantee eradication of the infection. Therefore, a prospective study was done in 135 patients with renal or upper ureteral stones associated with persistent urinary tract infection. The urinary infection was localized in each patient by bilateral ureteral catheterization. Upper tract infection in the kidney containing the stone was found in 75.6 per cent of the cases. A total of 94 patients completed treatment with extracorporeal shock wave lithotripsy and were followed for 3 to 16 months (mean followup 6.4 months). A marked correlation between the incidence of residual macroscopic stone fragments and the presence of persistent infection was noted. Of the 51 patients who became free of stones 48 (94 per cent) had sterile urine. Only 3 of the 51 patients had persistent infection in the treated kidney despite complete disappearance of the stones. In 45 of the 59 patients with stones smaller than 2 cm. (76 per cent) the infection was eradicated, whereas of the 35 with larger stones the urine became sterile in only 13 (37 per cent). We conclude that extracorporeal shock wave lithotripsy can be endorsed for treatment of small infected stones but it is inadequate for treatment of stones larger than 2 cm. unless combined with percutaneous nephrolithotripsy or chemical dissolution of the residual infected fragments.

Adult↗
PubMed1988

Treatment of complete staghorn calculi by extracorporeal shock wave lithotripsy monotherapy with special reference to internal stenting.

Extracorporeal shock wave lithotripsy monotherapy was used to treat 41 patients with complete staghorn calculi. In 20 patients polyethylene angiographic pigtail catheters were inserted prophylactically as ureteral stents and the other 21 patients did not receive stents. Prophylactic stenting reduced the incidence of complications and the need for percutaneous nephrostomy tubes to relieve subsequent ureteral obstruction. Internal stenting maintained the sterility of the urinary tract and reduced the average hospital stay by a third. Residual stone fragments representing less than 5 per cent of the original stone mass remained in 56 per cent of the patients, particularly in those with hydronephrotic kidneys. We suggest that extracorporeal shock wave lithotripsy monotherapy with prophylactic stenting is the preferred treatment for noninfected complete staghorn calculi.

Adult↗
PubMed1988

Vesicouterine fistula: a rare complication of cesarean section.

Vesicouterine fistula is a rare complication of cesarean section. Most patients present early postoperatively, while others are seen months later with urinary incontinence. Recurrent urinary infections, menstruation through the bladder (menouria), secondary infertility and amenorrhea are less common reasons for consultation. Although more than 100 such cases have been described, there have been few reports on fertility after surgical cure of the fistula. We report 4 cases of a vesicouterine fistula after cesarean section. The first patient was treated nonoperatively and the other 3 patients were treated surgically. Three patients had normal pregnancies after resolution of the problem. The clinical features, etiological factors and treatment modalities are discussed.

Adult↗
PubMed1988

Influence of body tilt within the sagittal plane on odor identification performance.

Odor identification performance, nasal airflow resistance, blood pressure, and heart rate were assessed in 8 men and 8 women in the following body tilt positions within the sagittal plane: 0 degree (upright), 90 degrees (supine), 135 degrees, and 180 degrees (upside down). The order of testing across the tilt conditions was systematically counterbalanced using a Latin square procedure. Average odor identification performance decreased monotonically as a function of increased body tilt. Significant decreases in heart rate and blood pressure were observed as the body was tilted from the upright condition, although blood pressure was equivalent in the upright and upside down conditions. Nasal resistance was highly variable and was not systematically altered as a function of body tilt. These data support the hypothesis that olfactory function, like visual, auditory, and vestibular function, is significantly influenced by body position within a gravitational field.

Adult↗
PubMed1987

Prevention of human bladder tumor cell implantation in an in vitro assay.

The high recurrence rate of bladder tumors can be reduced by prevention of tumor cell reimplantation on denuded urothelium following transurethral resection. This can be achieved by intravesical chemotherapy immediately after the resection of the bladder tumors. We have demonstrated, in an in-vitro system, the process of human bladder tumor cell implantation on a naturally produced extracellular matrix (ECM) which simulates the exposed bladder basement membrane and submucosa. Using this model we examined the efficacy of various cytotoxic agents in preventing tumor cell adhesion to the ECM. Human bladder tumor cell implantation was prevented following exposure of the cells to distilled water, epodyl or mitomycin C, and significantly reduced following one hour incubation in cisplatinum and doxorubicin. The maximal effect for each of these cytotoxic agents was reached within 30 to 60 minutes of treatment. Mitomycin C reached maximal effect within 10 minutes. In contrast, thiotepa did not cause a significant reduction in cell adherence to ECM as compared to untreated control cells.

Antineoplastic Agents↗
PubMed1987

Identification of bacteria in association with immune components in human carious dentin.

Actinomyces viscosus, A. naselundii, Streptococcus mutans serotype "c" and S. mutans serotype "d/g" were identified in human carious dentin using histological and immunofluorescent techniques. A. viscosus was most frequently found in association with patient's immunoglobulins and complement, followed by S. mutans serotype "d/g", S. mutans serotype "c", and A. naeslundii.

Actinomyces↗
PubMed1987

Use of internal polyethylene ureteral stents in extracorporeal shock-wave lithotripsy of staghorn calculi.

Ureteral stenting during extracorporeal shock-wave lithotripsy (ESWL) of complete staghorn calculi, using an internal polyethylene pigtail catheter, was found to be an efficient prophylactic measure against the high rate of complications in these cases. In the presence of a ureteral stent the stone fragments passed more easily into the bladder, accumulation of obstructing stone streets was prevented, and internal drainage of the urine was guaranteed. The need for auxiliary measures such as percutaneous nephrostomy, ureteroscopy or ureteral meatotomy was prevented in most cases. This prophylactic measure may turn ESWL to become the primary treatment of large staghorn calculi.

Catheters, Indwelling↗