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Biomedical subjects

D E Beck

Publications and source records attributed to D E Beck.

72 records · Page 4Linked to original sources
PubMed1987

Postoperative perineal hernia.

Eight patients (seven male and one female) with symptomatic postoperative perineal hernias treated at the Cleveland Clinic Foundation from 1975 to 1986 are reviewed. The patients ranged in age from 43 to 68 years (mean, 61 years). Seven had previous abdominoperineal resections of the rectum and one had a pelvic exenteration. The first two patients underwent repair via a perineal approach and both had recurrences of their hernias. These recurrences, as well as the presenting hernias in the six later patients, were repaired with mesh placed through an abdominal approach. Of these, there was one recurrence, which was repaired via an abdominal approach. There was no operative mortality. Based on experience, the authors believe that the best method of repair for this uncommon problem, involves placement of Marlex mesh across the pelvic inlet through an abdominal approach. This allows attachment of the mesh to the lateral musculature and posterior sacral periosteum under direct vision. The anterior borders of the mesh can be secured to the apex of the vaginal or prostatic tissue. The placement of metallic clips to the edges of the mesh allows for confirmation of the mesh position by radiographic examination during follow-up.

Aged↗
PubMed1987

The surgery of idiopathic constipation.

This paper has described the methods of patient evaluation and treatment that have been developed at the Cleveland Clinic Foundation for patients with idiopathic constipation. An orderly concise work-up should identify the small group of patients that will benefit from surgical therapy and assist the surgeon in selecting the type of therapy for the greatest success. Patients with outlet obstruction appear to benefit from anorectal myectomy while those with slow colonic transit should undergo a subtotal colectomy and ileorectal anastomosis. Additional investigations will hopefully increase our knowledge of the best way to manage these patients.

Colon↗
PubMed1987

Effect of bisacodyl on gut lavage cleansing for colonoscopy.

The effect of 10 mg oral bisacodyl (n = 19) or placebo (n = 26) on colon cleansing with polyethylene glycol electrolyte lavage solution was studied during colonoscopy. Patient tolerance was evaluated by questionnaire. During colonoscopy endoscopists graded adequacy of cleansing and subjective amounts of residual fluid and recorded the actual amount of fluid suctioned. Patient tolerance and adequacy of cleansing were not different between bisacodyl and placebo. There was no difference in subjective and measured residual fluid between the two groups. Compared to placebo, 10 mg oral bisacodyl does not influence adequacy of cleansing, patient tolerance, or residual fluid following polyethylene glycol electrolyte lavage solution for colonoscopy. This suggests that the beneficial cleansing effects with bisacodyl for barium enema may occur by mechanisms other than simple fluid evacuation.

Adolescent↗
PubMed1987

Accuracy of three methods for predicting concentrations of free phenytoin.

Predictions of free (unbound) serum phenytoin concentration by three methods were compared with results obtained by the Abbott TDx Free Phenytoin ultrafiltration and fluorescence-polarization immunoassay technique. Data were obtained for hospitalized adults who had been receiving phenytoin for at least five days and were free of renal or hepatic disease. Total phenytoin concentration was determined, and free phenytoin concentration was measured in ultrafiltrate at 25 degrees C. For each patient, measured concentrations of total phenytoin and albumin were used to predict free phenytoin concentrations by the Gugler method, the Sheiner-Tozer nomogram, and the Sheiner-Tozer equation. Mean measured percentages of free phenytoin were 17.79%, 12.13%, and 8.73%, respectively, for patients with albumin concentrations of less than 2 g/dL (n = 5), 2-3 g/dL (n = 18), and greater than 3 g/dL (n = 26). There was a strong correlation between actual and predicted free phenytoin concentrations for each of the methods, but all methods were found to lack precision. All methods also exhibited bias, as demonstrated by overprediction of the free concentration; however, none of the methods exhibited bias when the difference between the in vitro temperature of 25 degrees C and the in vivo temperature of 37 degrees C was considered. Because of their poor precision, the three methods evaluated in this study are not recommended for predicting free phenytoin concentration.

Adult↗
PubMed1986

Comparison of oral lavage methods for preoperative colonic cleansing.

Polyethylene glycol electrolyte lavage solution was compared with a 10 percent mannitol solution for preoperative colonic cleansing. Eighty patients were prepared randomly with one of these solutions on the afternoon prior to surgery. Colonic cleansing was better with polyethylene glycol electrolyte lavage (90 percent optimal cleansing vs. 75 percent). Analysis of hematologic, biochemical, and weight changes before and after the bowel preparation, demonstrated a mild subclinical dehydration with the use of mannitol. Evaluation of patient tolerance demonstrated more nausea, cramps, and abdominal pain with mannitol. Other symptoms were similar with both preparations. Colonic hydrogen gas was sampled during surgery, and two patients in the mannitol group had combustible levels. This study confirms that both 10 percent mannitol and polyethylene glycol electrolyte lavage are safe, effective methods of preoperative bowel cleansing. Better cleansing, patient tolerance, and lower hydrogen gas level make polyethylene glycol electrolyte lavage the preferred method.

Adolescent↗
PubMed1986

Popliteal artery pseudoaneurysm following arthroscopy.

An 18-year-old male presented with left foot ischemia secondary to emboli from a pseudoaneurysm of the left popliteal artery. His past history was significant only for two arthroscopies of his left knee. After evaluation, the patient was successfully treated with obliteration of the aneurysm and a reverse saphenous vein bypass graft.

Adolescent↗
PubMed1986

Gastric neurofibroma in an adolescent.

A 14-year-old white girl with a large, bleeding, ulcerated mass of the stomach was treated with surgical excision. Histologically, the mass was a plexiform neurofibroma. These tumors are uncommon, especially in the pediatric age group, and are best treated by surgical resection.

Adolescent↗
PubMed1986

Accuracy of five methods for predicting phenobarbital concentrations in pediatric patients.

Four published methods of predicting steady-state phenobarbital concentrations were evaluated and compared with a new method. In phase 1, steady-state serum phenobarbital concentrations were obtained from 36 complaint patients who were 6 months to 15 years old. Patients were stratified into five groups according to weight. Each patient's steady-state serum phenobarbital concentration was then predicted using clearance (CL) values from four published methods (methods 1-4), and these serum-concentration values were compared with actual steady-state concentrations. In phase 2, 17 new patients were selected. The mean CL values determined for each weight group of phase 1 patients were incorporated into another method (method 5) and used to calculate steady-state phenobarbital concentrations for phase 2 patients. In both study phases, predicted concentrations were compared with both the actual concentration in each patient and a naive predictor. In phase 1, method 1 was the least biased; methods 2-4 were significantly biased and were not significantly better than the naive predictor. In phase 2, methods 1-4 were more biased and less precise than method 5. In both study phases, methods 2-4 consistently under-predicted phenobarbital concentrations. The prediction method based on clearance data obtained in a group of pediatric patients at our institution (method 5) appears to be more useful for predicting serum phenobarbital concentrations than four other prediction methods based on published clearance values.

Adolescent↗
PubMed1985

Comparison of cleansing methods in preparation for colonic surgery.

Golytely, an oral gut lavage solution, was compared with a standard bowel cleansing preparation in patients undergoing elective colonic surgery. Sixty patients were randomly assigned to either a one-day preparation with Golytely and bisacodyl or a standard method using a three-day clear liquid diet, cathartics, and enemas. Colon cleansing was better with Golytely (100 percent optimal cleansing vs. 64 percent, P less than 0.05). Patients receiving Golytely had less weight loss and found this preparation more tolerable. Quantitative stool cultures before and after preparation and intraoperatively were not significantly different between the two preparations. In this surgical bowel preparation study, Golytely and Bisacodyl were found to be safe, rapid, and effective. The preparation was well tolerated by patients and has become our preferred method of colonic cleansing.

Adult↗
PubMed1985

Bowel cleansing with polyethylene glycol electrolyte lavage solution.

We reviewed our experience with an oral gut lavage solution (GoLYTELY), used as a rapid bowel cleansing preparation, and the prospective clinical trials reported in the literature to compare the overall experience with this type of preparation for colonoscopy and colon surgery. Five studies (546 patients) compared GoLYTELY to standard preparations for colonoscopy, while three trials (177 patients) have studied surgical patients. After evaluating patient tolerance, quality of colonic cleansing, and changes in microflora and colonic gas, GoLYTELY was found to be safe, rapid, and effective. It is well tolerated by patients and may become the preferred method of bowel cleansing.

Colonic Diseases↗
PubMed1985

Routine operative cholangiography.

The records of 300 consecutive patients who underwent cholecystectomy at a large military teaching hospital from January 1981 through August 1982 were reviewed; 270 patients (90 per cent) had intraoperative cholangiograms. Four clinical indications were helpful in predicting the likelihood of a positive intraoperative cholangiogram: 1, jaundice; 2, pancreatitis; 3, dilated common bile duct, and 4, palpable stones. The 63 patients with at least one of these indications had a 35 per cent incidence of true positive cholangiograms, while the 207 patients without such indications had a 0.5 per cent incidence of true positive studies (p less than 0.01). The incidence of false-positive studies was 0.7 per cent in our series and 3.1 per cent in our review of the literature of 2,580 cholangiograms. We conclude that cholangiography in the absence of clinical indications has a low yield. If cholangiography had been used selectively during the time period of 20 months of our retrospective study, more than 25,000 dollars could have been saved without missing significant pathologic findings in the common bile duct. We conclude that the thoughtful surgeon should perform cholangiography on a selective rather than routine basis.

Adolescent↗
PubMed1981

Toxicities with intravenous and subcutaneous administration of a petroleum distillate.

Although ingestion of petroleum distillates is common, injection of these products has not been widely reported. The effects of subcutaneous administration have not been fully documented. Presented is a 27-year-old male who developed a sterile abscess and pneumonitis following concurrent intravenous and subcutaneous administration of a petroleum distillate.

Adult↗
PubMed1980

Evaluation of an educational program on compliance with medication regimens in pediatric patients with renal transplants.

An educational program was initiated in an attempt to improve compliance in taking medications among pediatric renal transplant patients. Compliance was assessed by pill counts and by knowledge about medications by interview and questionnaire before, during, and after a six-month study period. Forty-three percent of the population was initially found to be in some way noncompliant with medication regimens, and 19% remained so after extensive counseling and instruction. Factors associated with noncompliance were adolescence, female sex, and family instability. Compliance was associated with direct parental involvement and voluntary maintenance of medication calendars. Although knowledge about drugs significantly improved, there was no correlation with compliance; motivational factors appeared to be of greater importance.

Adolescent↗
PubMedDate not supplied

Discontinuous appendiceal involvement in ulcerative colitis: pathology and clinical correlation.

Continuous mucosal involvement from the rectum proximally is one of the hallmarks of ulcerative colitis. However, recent pathologic series report appendiceal ulcerative colitis in the presence of a histologically normal cecum, representing a "skip" lesion. The clinical significance of this finding has not been established. Eighty patients, 54 males and 26 females, average age 37.9 years (range 14 to 82 years) who underwent proctocolectomy for ulcerative colitis from January 1990 to September 1995 were examined to determine the rate of discontinuous appendiceal involvement. Excluded were 12 patients with prior appendectomy and 11 with fibrotic obliteration of the appendiceal lumen. Of the remaining 57 patients, seven (12.3%) had clear appendiceal involvement in the presence of a histologically normal cecum. These seven patients clinically were indistinguishable from the 50 patients without skip involvement of the appendix in terms of age at surgery, pretreatment medications, type of surgery, interval from diagnosis to definitive procedure, complications, functional results, and clinical course. Discontinuous appendiceal involvement was found in 12.3% of patients undergoing proctocolectomy for ulcerative colitis, and clinically these patients behave as those without this feature.

Adolescent↗
PubMedDate not supplied

Alcoholic fathering and its relation to child's intellectual development: a pilot investigation.

In this study, the relationship between being raised by an alcoholic father and intellectual and academic achievement of the child were investigated. One hundred children of non-alcoholic mothers, 50 of whom had alcoholic fathers and 50 of whom had non-alcoholic fathers, were administered age-appropriate IQ, developmental, and achievement tests. Analysis of covariance revealed significant relationships between alcoholic fathering and IQ and achievement scores, independent of a number of possibly confounding variables. When children with alcoholic biological fathers were excluded, a relationship between IQ and alcoholic fathering persisted. Thus children raised by alcoholic fathers are a population at risk, in need of further scientific and clinical attention.

Adolescent↗
PubMedDate not supplied

Modifying the environment: a community-based injury-reduction program for elderly residents.

The Department of Public Health, City and County of San Francisco, established the Community and Home Injury Prevention Program for Seniors (CHIPPS) to reduce the rate of unintentional injuries among elderly residents. Through a collaboration between the CHIPPS program, the University of California at Berkeley School of Public Health and the University of California at San Francisco School of Medicine, we tested the hypothesis that providing minor home safety modifications would reduce rates of falls, scalds, and burns. A one-group, pretest-posttest design was used to compare self-reported falls, scalds, and burns for six-month periods before and after the intervention. The intervention used 10 person-hours of unskilled labor and $93 worth of materials on average and included home safety assessments and modifications such as removing clutter; installing hand rails, grab bars, nonskid strips; and securing rugs and electrical cords. Reported falls were reduced by 60% after the intervention, from 0.81 to 0.33 falls per person year (p < .01). Scalds were reduced from 9 to 0 (P < .01) and burns from 7 to 0 (P < .02) during the six-month periods before and after the intervention. Some of the apparent effect may be due to differential reporting. This community-based program to reduce hazards in the home environments of senior citizens was feasible, well accepted, and probably effective in preventing falls, burns, and scalds. Medical Subject Headings (MeSH): accidental falls/prevention and control, aged, safety.

Accident Prevention↗