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Biomedical subjects

D Kahn

Publications and source records attributed to D Kahn.

At least 271 records · Page 15Linked to original sources

Injection sclerotherapy in adult patients with extrahepatic portal venous obstruction.

Thirty-nine adult and teenage patients with extrahepatic portal venous obstruction (EHPVO) were treated with injection sclerotherapy. There were 22 males and 17 females with a mean age of 27 years (range 12-69). Oesophageal varices were eradicated in 33 patients after seven injections (range 1-17) over a mean of 14.5 months (range 1-48). Fewer injections were needed to eradicate varices in older patients. Variceal bleeding occurred on 13 occasions in 9 patients before eradication of varices and on 4 occasions in 4 of the 33 patients in whom varices had been eradicated, with a mean follow-up of 44 months (range 3-105). There were no deaths during the study period. Complications, mostly of a minor nature, occurred in 25 patients and included injection site leak in 5, stenosis in 7 and mucosal ulceration in 23. We conclude that injection sclerotherapy is the treatment of choice in patients with EHPVO.

Adolescent↗

Healing modes correlate with visuotectal pattern formation in regenerating embryonic Xenopus retina.

After removal of the nasal or the temporal two-thirds of the embryonic (stage 32) eye, the remaining one-third sized fragment undergoes wound healing and then, in most cases, regenerates to form a new eye. Using gross anatomy and histology techniques, we categorized eye fragments into three healing mode categories over the first 24 hr after surgery (stage 37-38). Representative animals were reared through metamorphosis and their visuotectal projections were assayed using standard electrophysiology techniques. In the "rounded-up" healing mode, the cut edges of the fragment pinch to close the wound; retinal cell type layers (pigmented retinal epithelium (pre), photoreceptors, interneurons, ganglion cells) and a lens are present by 24 hr postsurgery. No extraneous or disorganized cells are present either internal or external to the fragments. These fragments regenerated to form normal projections 83% of the time and pattern duplicated projections only 17% of the time. In the "intermediate" healing mode, wound closure is not complete by 24 hr post surgery and groups of disorganized cells are present in the fragment and amassed between the healing cut edges. These fragments formed pattern duplicated projections 72% of the time. In the tongue healing mode, an ectopic mass of cells, contiguous with the main body of the fragment, forms a supernumerary retina in the region of the ablation. At 24 hr post surgery, the cells of the main body fragment form retinal layers; the cells of the tongue, excluding the presence of differentiated pre cells, remain undifferentiated, resembling ciliary margin. The cut edges of the main body fragment eventually fuse with the tongue to form a single eyeball. Tongue fragments formed pattern duplicated projections 100% of the time. In addition, pattern duplicated points derived from nasal fragments appeared most often in the posterior region of the tectum, the normal site of innervation of the nasal retina. This differed significantly from temporal fragment derived duplicated points which appeared more often in the front of the tectum, the normal site of innervation by temporal retina. Thus, the specificity of pattern duplicated innervation is related to the positional values remaining in the fragment after partial retinal ablation. The data indicate that cell movements during healing, whether overt as in the tongue healing mode, or remaining internal to the fragment as in the intermediate healing mode, are intimately correlated with pattern forming mechanisms which underlie pathological visuotectal duplication.

Animals↗

Continuation ECT in the management of relapses of major affective episodes.

Three cases are reported describing the use of continuation ECT. Continuation ECT consisted of six to twelve treatments for about 3 to 6 months after recovery from the index affective episode. Continuation ECT may be indicated in patients with a severe episode of illness, optimal acute response to ECT, and negative response to continuation drug therapy. In such patients, the mostly theoretical risks associated with the procedure may be outweighed by the dangers associated with early relapse.

Adult↗

Transcription patterns of Rhizobium meliloti symbiotic plasmid pSym: identification of nifA-independent fix genes.

We performed a systematic survey of transcription of a large region of the Rhizobium meliloti symbiotic plasmid pSym. This led to the discovery of two new sequences induced during symbiosis. The first sequence was linked to the known nitrogen fixation (nif-fix) gene cluster, and its expression depended on the nifA gene product. The second sequence was a novel fix locus (M.-H. Renalier, J. Batut, J. Ghai, B. Terzaghi, M. Gherardi, M. David, A.-M. Garnerone, J. Vasse, G. Truchet, T. Huguet, and P. Boistard, J. Bacteriol. 169:2231-2238, 1987) whose expression was independent of the nifA gene product; therefore this fix locus undergoes a novel type of symbiotic regulation.

DNA, Bacterial↗

Orthotopic liver transplantation in dogs receiving FK-506.

Ten dogs that survived the perioperative events of liver transplantation were treated with 1 mg/kg/d oral FK. Eight of the recipients lived for at least 1 month postoperatively, and seven are still alive with normal hepatic function after 35 to 65 days. The consistency and good quality of results with this difficult transplant preparation using FK, in spite of its rumored great toxicity in dogs, have highlighted the importance of further developing the drug.

Animals↗

Bone scintigraphic findings in patellar tendonitis.

Three patients with the signs and symptoms of patellar tendonitis were studied with technetium-99m utilizing the triple phase technique. The scans demonstrated characteristic abnormal radiotracer localization at the inferior pole of the patella or tibial tuberosity on early and delayed images. The regional patellar anatomy likely explains the bone scintigraphic findings in patellar tendonitis.

Adult↗

Limitations of multiple injection sclerotherapy sessions for acute variceal bleeding.

Sixty-six patients with active bleeding (127 episodes) from oesophageal varices treated by balloon-tube tamponade followed by injection sclerotherapy with a rigid endoscope were followed up for at least 1 year and analysed to determine whether the number of acute injection sessions during each hospital admission (87) or any other known parameter of liver function, e.g. Child's grading, affected the outcome. Definitive control of bleeding was achieved with one or two injections during 75 of these admissions (86%) with a mortality rate of 21%. However, the mortality rate in those patients who received three or four injections was 66% and reached 89% when Child's category A patients were excluded. It is concluded that the mortality rate in poor risk patients becomes unacceptably high when more than two injection sessions are required during a single hospital admission. Other methods of treatment, such as emergency portacaval shunting or devascularization procedures, should be instituted in the small subgroup of patients whose variceal bleeding is not controlled by two injection sessions.

Esophageal and Gastric Varices↗

Venous anatomy of the lower oesophagus in portal hypertension: practical implications.

The venous anatomy of the lower oesophagus and upper stomach in man was studied using high resolution resin casts obtained from ten fresh cadavers. Four layers of veins were identified in the oesophagus of both normal and portal hypertension patients. Intra-epithelial channels drained into a superficial venous plexus which connected to larger deep intrinsic veins. Both the superficial plexus and the deep intrinsic veins communicated directly with their counterpart veins in the stomach. Perforating veins connected the deeper veins with the adventitial plexus, the fourth layer. In patients with portal hypertension all of these veins were significantly dilated. Typical large oesophageal varices arose from the main trunks of the deep intrinsic veins which communicated directly with gastric varices. This study clarifies the anatomy of oesophageal varices and may explain why sclerotherapy is usually effective. The venous communications are probably partly responsible for the recurrence of varices after sclerotherapy.

Adolescent↗

Sclerotherapy in acute variceal bleeding: technique and results.

The current Cape Town management policy for patients with suspected acute variceal bleeding includes vasopressin infusion 0.4 units/minute, and emergency diagnostic endoscopy. Sengstaken balloon tube tamponade is reserved for patients with active variceal bleeding at the time of emergency endoscopy. Only these patients have early emergency sclerotherapy. The results of the Cape Town five-year prospective evaluation of sclerotherapy with the rigid Negus oesophagoscope using general anaesthesia are presented. We conclude that the combined use of balloon tube tamponade and sclerotherapy has markedly simplified the management of patients with variceal bleeding at our institution. The preliminary results of the 2-year analysis of our ongoing prospective randomised controlled clinical trial comparing the above technique with a new combined paravariceal and intravariceal sclerotherapy technique using a fibreoptic endoscope without anaesthesia are presented. We conclude that both techniques successfully control acute variceal bleeding in the majority of poor-risk patients, but that the rigid scope has some advantages, particularly in those few patients who rebleed at the time of injection. We currently recommend a standard portacaval shunt or a devascularisation and transection procedure for the rare failures of sclerotherapy. Controversial areas of sclerotherapy are reviewed, and a new treatment policy for acute variceal bleeding is proposed on the basis of our experience and a review of the literature.

Acute Disease↗

For how long can the liver tolerate ischaemia?

In this study the ability of the normal liver to tolerate normothermic ischaemia was assessed. The survival rate in pigs after 3, 6 and 12 h of normothermic hepatic ischaemia was 71, 46 and 0%, respectively. A patient who survived after inadvertently being subjected to 90 min of normothermic hepatic ischaemia is also presented. These findings suggest that the 'safe period' for liver blood flow occlusion could be extended beyond 1 h.

Animals↗

Lamellar ichthyosis with episodic psoriasiform reaction pattern.

The skin of a girl born with the typical appearance of "collodion baby," evolved into an exfoliative erythroderma that clinically was lamellar ichthyosis. However, biopsy specimens done in early infancy showed psoriasis. Over the ensuing sixteen years she has continued to have clinical lamellar ichthyosis with rare occasions of febrile episodes and superficial pustules. Some biopsy specimens have been diagnosed as showing lamellar ichthyosis, while others have again shown psoriasis.

Adolescent↗

In vitro studies of a new synthetic thrombin inhibitor.

(2R, 4R)4-methyl-1-[N alpha-(3-methyl-1,2,3,4-tetrahydro-8-quinoline- sulfonyl)-L-arginyl]-2-piperidine carboxylic acid monohydrate (MCI-9038) was found to be a potent synthetic inhibitor of thrombin. In concentrations as low as 1 microM, the thrombin time, prothrombin time, and partial thromboplastin time were more than doubled. The venom (Bothrops atrox) time was similarly prolonged. The drug also inhibited the thrombin-induced activation of factors VIII and XIII. While MCI-9038 in concentrations of 10(-4) M had no effect on platelet aggregation induced by collagen, ADP, epinephrine, and arachidonate, nanomolar concentrations inhibited thrombin-induced platelet aggregation and the release of platelet ADP. The drug also significantly inhibited the adhesion of thrombin-treated platelets to cultured bovine aortic endothelial cells. We conclude that MCI-9038 is an extremely potent inhibitor of the effects of thrombin on platelets and clotting factors.

Arginine↗

Liver blood flow after partial hepatectomy in the pig.

The role of liver blood flow in liver regeneration remains controversial. This study in 17 pigs documents the total hepatic blood flow, and portal and arterial components measured with an electromagnetic flowmeter, the portal pressure, and the cardiac output for 6 days after partial hepatectomy (PH) or sham operation. There was a twofold increase in total flow immediately after PH which rose to three- to fourfold by the second postoperative day. Thereafter values decreased but remained elevated above preoperative values; no similar increase was noted in sham animals. The increase in flow was both absolute as well as relative to the proportion of liver remnant remaining. The portal component increased from 74 +/- 3% preoperatively to 84 +/- 3% (P less than 0.05) on the second postoperative day, and portal pressure was apparently increased. These changes in flow precede the previously documented maximum regeneration response between Days 3 and 4. The factors resulting in the increased flow may be responsible in part, for regeneration.

Animals↗