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Biomedical subjects

D Fromm

Publications and source records attributed to D Fromm.

At least 37 records · Page 2Linked to original sources
PubMed1990

Upper GI bleeding in an urban hospital. Etiology, recurrence, and prognosis.

Acute upper gastrointestinal bleeding (UGIB) continues to be a common cause of hospital admission and morbidity and mortality. This study reviews 469 patients admitted to a surgical service of an urban hospital. There were 562 total admissions because 53 patients were readmitted 93 times (recurrence rate, 20%). The most common causes of bleeding, all endoscopically diagnosed, included acute gastric mucosal lesion (AGML) (135 patients, 24%), esophageal varices (EV) (121 patients, 22%), gastric ulcer (108 patients, 19%), duodenal ulcer (78 patients, 14%), Mallory-Weiss tear (61 patients, 11%), and esophagitis (15 patients, 3%). Nonoperative therapy was sufficient in 504 cases (89.5%). Endoscopic treatment was used in 144 cases. Operations were performed in 58 cases (10.5%), including 29% of ulcers. Emergency operations to control hemorrhage were required in only 2.5% of all cases. The rate of major surgical complications was 11% and the mortality rate was 5.2%. There were 58 deaths (12.6%), with 36 deaths directly attributable to UGIB. Factors correlating with death include shock at admission (systolic blood pressure less than 80), transfusion requirement of more than five units, and presence of EV (all p less than 0.001). Most cases of UGIB can be treated without operation, including endoscopic treatment, when diagnostic endoscopy establishes the source. Subsequent operation in selected patients can be done with low morbidity and mortality rates.

Adolescent↗
PubMed1989

Functional communication in Alzheimer's disease.

This study investigated functional communication skills in subjects with mild (n = 26) and moderate (n = 22) Alzheimer's disease (AD) and compared their performance with that of normal elderly (n = 26), Wernicke's aphasic (n = 26), and elderly depressed (n = 15) subjects. Communicative Abilities in Daily Living (CADL) (Holland, 1980), a formal test of functional communication, was administered to all subjects. Subjects with mild and moderate AD were impaired on the CADL, and the impairment was more severe in the moderately demented group than in the mildly demented group. In addition, functional language skills were impaired in elderly depressed subjects as compared with normal elderly control subjects; however, the elderly depressed subjects were less impaired than were the mild AD subjects. The depressed subjects responded incompletely rather than in the irrelevant, vague, rambling style that characterized the AD subjects. Finally, although performance of the moderate AD and Wernicke's aphasic subjects did not differ in terms of total CADL score, the performance of these groups across pragmatic categories and types of error responses were markedly different.

Aged↗
PubMed1989

Predictors of language restitution following stroke: a multivariate analysis.

A consecutive sample of 50 language-impaired patients was evaluated prospectively during the first 3 to 4 months following unilateral left- or right-hemisphere stroke. A multiple logistic linear regression model was used to assess the relative importance of eight predictor variables on the likelihood of language recovery. Those found to be significantly associated with language recovery included age (favoring younger patients) and length of hospital stay (favoring shorter stays). Gender (favoring males), type of stroke (favoring hemorrhages), and side of lesion (favoring right) were only moderate correlates of recovery. Neither race nor history of previous stroke was a significant predictor of language recovery. Multivariate statistical analysis was useful in illuminating the joint relationship between clinical and demographic predictor variables and language recovery.

Age Factors↗
PubMed1989

Preservation of the distal part of the stomach by esophagoantral jejunal interposition.

An alternative approach to reconstruction after proximal two-thirds gastrectomy for benign disease involves proximal gastric vagotomy and interposition of a jejunal segment between the esophagus and antrum. This permits preservation of pyloric function and avoids reflux esophagitis. The latter can also be circumvented by interposing a jejunal segment between the esophagus and antrum in the course of an esophago-proximal gastrectomy for a malignant condition.

Anastomosis, Surgical↗
PubMed1988

Characteristics of recovery of drawing ability in left and right brain-damaged patients.

Drawings of a "person" were obtained from 21 patients with left brain damage (LBD) and 13 patients with right brain damage (RBD) at hospital discharge and 1 month postdischarge, corresponding to 2-4 and 6-8 weeks postonset, respectively. Early LBD drawings were simplistic and often incoherent. Most were placed in the upper left quadrant of the page. RBD drawings were scattered, fragmented, and elaborately detailed. Many showed evidence of left-sided neglect. The resolution of drawing disability also differed between the two groups: LBD subjects recovered drawing abilities more rapidly and more completely than RBD subjects. These differences in drawing characteristics and in the resolution of drawing disability were discernable for experienced neuropsychologists.

Adult↗
PubMed1988

An analysis of when patients eat after gastrojejunostomy.

Eighty-five patients who underwent a gastrojejunostomy either alone or in conjunction with vagotomy or gastric resection were evaluated for the day of beginning an oral intake adequate enough to sustain nonoliguric output. This occurred on the average by the seventh to eighth postoperative day, by which time at least 78% of patients were consuming an adequate oral intake. Adequate liquid intake occurred on the average 5.3 days in the absence of vagotomy and 8.8 days in the presence of vagotomy. However, this significant difference is accounted for by the patients who had gastrojejunostomy with vagotomy. Vagotomy with antrectomy, antrectomy alone, and subtotal gastrectomy were not significantly different. The apparent influence of vagotomy on gastrojejunostomy may be due to a type II statistical error. However, 92% of patients who had vagotomy with pyloroplasty consumed adequate liquids by the seventh postoperative day compared with 56% of patients who had vagotomy with gastrojejunostomy.

Adult↗
PubMed1988

Retropancreatic control of the suprarenal aorta.

An alternative approach to occluding the suprarenal abdominal aorta involves a Kocher maneuver and isolation of the retropancreatic aorta between the origins of the celiac axis and the superior mesenteric artery. The use of this approach is supported by operative dissections upon cadavers, as well as upon two patients in whom it was used without difficulty.

Aorta, Abdominal↗
PubMed1987

Mechanisms involved in gastric mucosal resistance to injury.

The healthy stomach resists the potentially devastating effects of its own secreted H+. Even though the resulting concentration gradient favors diffusion of luminal H+ into the mucosa, the actual amount of diffusion is limited in extent under normal conditions. Enhanced diffusion of H+ into the mucosa can be associated with the development of obvious injury, but this is not necessarily the case if the tissue effectively buffers H+. Conversely, in circumstances where the ability to dispose of H+ is impaired, what would be considered to be a usual amount of H+ diffusion can be troublesome. While several factors of mucosal defense have been identified, it is unlikely that alteration of a single mechanism accounts for gross damage. The interplay between defensive mechanisms may account for the variable endoscopic effects observed for damaging agents in man, especially in situations where the luminal concentrations of H+ and drug are variable.

Biological Transport↗
PubMed1987

Histamine receptor effects on dissipation of an intracellular proton gradient of isolated gastric mucosal surface cells.

The effects of histamine and several H1 and H2 receptor agents on Na+/H+ and Cl-/HCO-3 exchange systems of isolated gastric mucosal surface cells were studied. The cells were acid-loaded by the NH4Cl prepulse technique and the spontaneous Na+- and HCO-3-induced dissipation of the intracellular proton gradient (pHi) was followed using the metachromatic dye acridine orange. Histamine (10(-2-5) M) stimulates HCO-3-induced dissipation of the pHi but has no effect on Na+-induced or spontaneous dissipation. The H1 agonist 2-(2-aminoethyl)pyridine and the H2 agonist dimaprit also have no effect on Na+-induced or spontaneous pHi dissipation. However, both of these agents mimic the effect of histamine on HCO-3-induced dissipation, but only at a higher concentration (10(-3) M). The combination of 2-(2-aminoethyl)pyridine and dimaprit produces a histamine-like effect at lower concentrations (10(-5) and 10(-4) M). The effects of histamine are blocked by either the H1 antagonists diphenhydramine and pyrilamine or the H2 antagonists cimetidine and SKF 93479. The results suggest that the effect of histamine on HCO-3-induced dissipation of a pHi in gastric mucosal surface cells is mediated through a coordinated mechanism involving both H1 and H2 receptor sites.

Animals↗
PubMed1987

How do non-steroidal anti-inflammatory drugs affect gastric mucosal defenses?

The gastric mucosa possesses a number of mechanisms permitting resistance to damage from its own secreted acid. No single mechanism can account for gastric mucosal defense. Mucosal permeability to acid, active ion transport, blood flow, mucus secretion, epithelial restitution, and prostaglandin synthesis are among the multiple factors involved in gastric mucosal defense. Non-steroidal anti-inflammatory drugs (NSAIDs) cause gross mucosal damage by affecting these defenses. The net effect of NSAIDs is to make the mucosa more susceptible to the damaging effects of acid in the lumen. Acid plays a dual role in this process, by increasing drug absorption (which in turn increases mucosal permeability) and by diffusing from the lumen into the mucosa. If a sufficient amount of acid entering the tissue is unbuffered, necrosis occurs. NSAIDs affect tissue bicarbonate in several ways. These drugs decrease cellular production and secretion of bicarbonate, but increase tissue entry of bicarbonate from blood. NSAIDs also have a dual effect on blood flow. Microvascular stasis occurs at sites of gross mucosal damage, but blood flow increases at visibly normal sites. Mucus is impermeable to pepsin, slows acid diffusion to some degree, traps bicarbonate to create an alkaline interface, and traps cell slough, forming another putative barrier. NSAIDs inhibit mucus secretion and modify its structure. Perhaps related to mucus is the hydrophobic property of the mucosa attributable to an absorbed layer of surfactant. Aspirin reduces surface hydrophobicity, an effect that may increase ion permeability. In addition to secreting mucus, the cells lining the luminal surface also play a key role in maintaining the permeability and active transport properties of the mucosa.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

The labeling problem in aphasia: an illustrative case.

Twenty-five "experts" on neurogenic motor speech disorders participated in a tutorial exercise. Each was given information on M, a patient who had communication difficulties as the result of stroke, and asked to complete a questionnaire about his problem. The information included a detailed case description, an audiotape of M's speech obtained at 4, 9, 13, and 17 days post-stroke, and test results from the Western Aphasia Battery, the Token Test, and a battery for apraxia of speech. The experts were in excellent agreement on M's primary problem, although it was called by seven different names. The experts were in poor agreement on his secondary problem(s), e.g., the presence and type of aphasia and dysarthria. The results suggest that labeling is difficult, even for "experts." Furthermore, the practicing clinician needs to be sensitive to the likelihood of more than one coexisting problem.

Adult↗
PubMed1986

An application of exploratory statistical methods to language pathology: analysis of the Western Aphasia Battery's Cortical Quotient in acute stroke patients. Research note.

Two simple exploratory statistical techniques, stem and leaf displays and box plots, are described and applied to the analysis of Western Aphasia Battery Cortical Quotient scores for 111 acute stroke patients. A stem and leaf display highlights the shape of a distribution of data and is useful for quickly ordering and displaying data in the form of a frequency distribution; box plots focus special attention on the tails of a distribution and are valuable for summarizing, analyzing, and comparing group data. These methods were used to determine an internal Cortical Quotient cutoff score to distinguish between normal and cognitively impaired patients. The utility of this Cortical Quotient cutoff score and the relevance of these statistical techniques to other research in communicative disorders are discussed.

Adult↗
PubMed1986

Salicylate effects on proton gradient dissipation by isolated gastric mucosal surface cells.

The effects of salicylate were examined on Na+/H+ exchange by isolated gastric mucosal surface cells loaded with H+ and resuspended in a buffered medium. Choline salicylate (pH 7.4) increases the dissipation of an intracellular proton gradient which was measured using acridine orange. The exchange of extracellular Na+ with intracellular H+ by surface cells not only remains intact but also is enhanced upon exposure to salicylate. This was confirmed by cellular uptake of 22Na and titration of cellular H+ efflux. Salicylate increases Na+/H+ exchange via a pathway predominantly sensitive to amiloride. However, the data also suggest that salicylate dissipates an intracellular proton gradient by an additional mechanism. The latter is independent of extracellular Na+ and not due to a generalized increase in cellular permeability.

Amiloride↗
PubMed1986

Wound closure in obese patients.

A five year randomized prospective study was carried out to compare subcutaneous drains versus a type of stay suture closure in morbidly obese patients. While acceptable wound infection rates were found, no statistical superiority was established between these types of closures.

Adult↗
PubMed1985

Various consequences of subcortical stroke. Prospective study of 16 consecutive cases.

Sixteen consecutive cases of subcortical stroke were studied prospectively and systematically. Behavioral and neurological manifestations of different sides, sites, and causes of lesion were evaluated by means of daily, standard observations during the patient's hospitalization and formal testing at monthly intervals thereafter. Language and cognitive impairments were observed following hemorrhagic and nonhemorrhagic strokes to both the left and right thalami and basal ganglia. The patterns were unlike those characteristic of traditional aphasia syndromes. One patient was asymptomatic; four demonstrated only dysarthria or dysarthria with abnormal affect; and 11 displayed a combination of speech, language, and cognitive deficits. Language skills recovered more rapidly and completely than did cognitive skills. Recovery was most dramatic within the first six to eight weeks after onset.

Adult↗