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Biomedical subjects

D Rosenthal

Publications and source records attributed to D Rosenthal.

At least 19 recordsLinked to original sources
PubMed1992

Amaurosis fugax: is it innocuous?

A 10 year retrospective study of 103 patients with amaurosis fugax was done. Sixty-two patients with symptoms of amaurosis fugax underwent arteriography, which demonstrated ulcerated carotid plaque in 36 and hemodynamically significant stenoses (greater than 75% diameter reduction) in 26. These 62 patients underwent carotid endarterectomy. The other 41 patients who had proven ulcerated plaque (33 patients) or hemodynamic stenoses (eight patients) were not treated surgically and served as a control series. No strokes or deaths occurred in the immediate postoperative period. Follow-up of the 62 operated patients extending to 10 years (mean 4.2 years), revealed one (1.6%) patient with recurrent amaurosis fugax symptoms, two (3.2%) with transient ischemic attacks, and one (1.6%) with a stroke in the operated hemisphere. In the nonoperated group, despite aspirin or warfarin treatment, four (9.7%) patients had ongoing amaurosis fugax symptoms, and two (4.8%) developed transient ischemic attacks that led to carotid endarterectomy. One (2.4%) other patient developed sudden, permanent monocular blindness, and two (4.8%) suffered hemispheric strokes, one of which was fatal. The cumulative morbidity (ongoing ocular or transient ischemic attack symptoms, perioperative and late stroke) in the operated group was 6.4% (four patients), while the cumulative morbidity in the nonoperated group was significantly higher at 21.9% (nine patients) (p = 0.02). When patients present with symptoms of amaurosis fugax and have demonstrable carotid bifurcation disease, carotid endarterectomy is recommended. Amaurosis fugax should be regarded as a harbinger of monocular blindness and stroke.

Adult↗
PubMed1992

The social context of adolescent sexuality: safe sex implications.

This study was an examination of the sexual worlds of 153 adolescents aged 15 to 18 years through the content analysis of interviews on the topics of love, romance, relationships between the sexes, sexual values and sexual behaviors. The aim was to develop more detailed descriptions of the dimension of adolescent sexuality and relate these dimensions to sexual risk, that is, the tendency to engage in unprotected intercourse, an activity which increases vulnerability to AIDS and other sexually transmitted diseases. To this end, seven themes were isolated from the interview scripts, these being permissiveness, double standards, belief about sexual control (the Id Factor), romance, regrets about permissiveness, sexual aggression, and questioning. Measures of four of these themes were constructed, and sex and sub-group differences explored, as were the relationships between themes and sexual risk. The implications of different "pathways" to sexual risk-taking were discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Combined treatment with oral etretinate and electron beam therapy in patients with cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome).

BACKGROUND: Total skin irradiation for early-stage mycosis fungoides produces clinical remission in 90% of patients, but the median duration of remission is only 2 to 4 years. Etretinate has proven efficacy in advanced mycosis fungoides. Its potential as adjuvant therapy to radiation could be limited by toxicity from the combination. OBJECTIVE: Our purpose was to determine whether oral etretinate at 1 mg/kg can be combined with 35 Gy of radiation without intensifying or prolonging the radiation reaction and to determine the relapse-free survival rate. METHODS: Twenty-three patients began etretinate on day one of radiation and the dose was reduced for nose bleeds, dry skin, or hyperlipidemia. During the reaction skin toxicity questionnaires were completed weekly. Nine concurrent patients receiving only radiation completed identical forms. RESULTS: Etretinate did not intensify the skin reaction but did prolong it by 2 weeks. At a median follow-up of 2 years the relapse-free survival rate in complete responders was similar to stage-matched concurrent and historic control subjects. CONCLUSIONS: Both radiation and etretinate can be given together with acceptable toxicity and without compromising either therapy.

Administration, Oral↗
PubMed1992

Laparoscopic colectomy.

Fifty-one laparoscopic colectomies were attempted at two institutions. The clinical results and methods are presented. Seven cases (14%) were converted to facilitated procedures, and four cases (8%) were converted to "open." Cases of cancer, diverticulitis, endometriosis, regional enteritis, villous adenomas, and sessile polyps were operated. Right, transverse, left, low anterior, and abdominoperineal colectomies were performed. Colotomies and wedge resections were also performed. Laparoscopic suturing was required in five cases of incomplete anastomosis by circular stapler (18%). Suturing was required in all right, transverse colectomies and colotomies. Operative time averaged 2.3 hours. Hospitalization averaged 4.6 days. Four patients had complications (8%), and one 95-year-old died of pneumonia (2%). Laparoscopic colectomies can be performed safely, but require two-handed laparoscopic coordination, as well as suturing and knot-tying skills.

Adult↗
PubMed1992

Endovascular infrainguinal in situ saphenous vein bypass: a multicenter preliminary report.

The ideal operative approach for infrainguinal in situ bypass grafting would render the saphenous vein (SV) valves incompetent while occluding venous tributaries from within the SV: an endovascular in situ SV bypass. Forty-six femoropopliteal-tibial in situ bypasses were performed in part by the endovascular occlusion technique. Valvulotomy was accomplished with a retrograde "cutter" valvulotome, and endoluminal cannulation of 84 SV tributaries was performed with a shape memory metal alloy (nickle-titanium), electronically steerable catheter under angioscopic surveillance. Sixty-nine SV tributaries (82%) were totally occluded and 15 (18%) were partially occluded with platinum occlusion coils. Twelve coils that "recoiled" into the SV lumen were retrieved uneventfully. The valvulotomes caused six SV perforations that were repaired without consequence. Intraoperative fluoroscopy confirmed coil placement and verified venous tributary occlusion, as well as SV graft patency. During short-term follow-up (mean 9.2 months; range 1 to 15 months), all patients have undergone ultrasonography of the in situ bypasses. All 69 of the SV tributaries that occluded initially have remained occluded and 84% (39/46) of the in situ bypasses have remained patent. This study demonstrates that an electronically steerable nitinol catheter can be used safely to occlude venous tributaries from within the SV. Endovascular occlusion of SV tributaries may ultimately obviate the need for long incisions the length of the leg, thus reducing wound-related problems and shortening recuperation.

Aged↗
PubMed1992

Properitoneal synthetic mesh repair of recurrent inguinal hernias.

Safe reconstruction of the inguinal floor is the goal of any operation for repair of groin herniation. Operating in the properitoneal space avoids dissection of the scarred cord, and the incidence of testicular complications is markedly lowered. This study reports our experience with placing synthetic mesh between the peritoneum and the deficient inguinal floor for the repair of recurrent hernias of the groin area. During a five year period, 84 men underwent repair of 100 recurrent inguinal hernias using the properitoneal approach. Fifty-four patients had repair of a unilateral recurrent hernia, 16 had repair of a bilateral recurrent hernia and 14 had repair of both a recurrent hernia and a contralateral primary hernia. Postoperative complications occurred in six patients. No testicular complications were observed. Postoperative follow-up study ranged from six months to five years. There were only three recurrent hernias after this repair. All occurred within the first six months postoperatively. The properitoneal approach for repair of recurrent groin hernias using prosthetic mesh safely creates a new "fascia transversalis" with a low rate of recurrence and effectively eliminates testicular complications.

Adult↗
PubMed1992

The protective effect of vitamin E on the hemolysis associated with dapsone treatment in patients with dermatitis herpetiformis.

OBJECTIVE: This study looked at whether oral vitamin C and vitamin E would protect the erythrocyte from oxidant damage caused by dapsone in patients with dermatitis herpetiformis. DESIGN: Fifteen consecutive patients with dermatitis herpetiformis taking dapsone therapy received, in addition, 800 U/d of vitamin E for 4 weeks; then 1000 mg of vitamin C per day for 4 weeks, and, finally, combined vitamin E and vitamin C therapy for 4 weeks. Hemolysis indexes were assessed at baseline and after each 4-week period. RESULTS: Statistical analysis of the results suggests that oral administration of 800 units of vitamin E daily for 4 weeks confers partial protective effect against dapsone-induced hemolysis in patients with dermatitis herpetiformis. CONCLUSION: Partial protection against dapsone-induced hemolysis by orally administered vitamin E, if confirmed as being clinically relevant by further trials, may allow clinicians to continue dapsone therapy orally in patients who develop significant hemolysis. Prophylactic vitamin E to minimize potential hemolysis at the initiation of dapsone therapy may also be appropriate.

Adult↗
PubMed1991

Thermal laser-assisted balloon angioplasty of the superficial femoral artery: a multicenter review of 602 cases.

A multicenter review of 602 procedures was performed to evaluate the effects of thermal laser-assisted balloon angioplasty on the superficial femoral artery. Four hundred thirty-nine (73%) patients underwent laser-assisted balloon angioplasty for claudication, and 163 (27%) underwent the procedure for limb salvage. Two hundred ninety-two laser-assisted balloon angioplasty procedures were performed for multifocal stenotic disease (greater than 80%) diameter reduction), 258 for total occlusion, and 52 procedures for both superficial femoral artery stenosis and occlusion. The initial recanalization rate was 89% (538/602) depending on the length of the lesion. Success of laser-assisted balloon angioplasty was verified by angioscopy or arteriography, and all patients underwent segmental Doppler studies before discharge and during midterm follow-up extending to 30 months (mean, 11.3 months). Complications occurred in 62 (10%) patients, but only one limb amputation occurred because of a complication related to a laser-assisted balloon angioplasty. Overall, 60% of initially successful procedures have remained patent, but long segment (greater than 7 cm) occlusions have fared poorly (25% patency at 30 months). This minimally invasive technology affords the opportunity to treat short segment (less than 7 cm) symptomatic superficial femoral artery occlusive disease with minimal risk. Initial success and midterm patency rates for appropriate lesions appear to make laser-assisted balloon angioplasty a viable adjunct in the treatment of superficial femoral artery occlusive disease.

Adult↗
PubMed1991

Human immunodeficiency virus-associated eosinophilic folliculitis. A unique dermatosis associated with advanced human immunodeficiency virus infection.

We studied 13 patients with human immunodeficiency virus (HIV) infection and a chronic pruritic folliculitis that was unresponsive to systemic treatment with bactericidal anti-staphylococcal antibiotics. The skin eruption was characterized by multiple urticarial follicular papules scattered on the trunk (100%), the head and neck (85%), and the proximal aspect of the extremities (62%). Absolute peripheral eosinophil counts were increased in six of 13 patients; a relative peripheral eosinophilia was present in 10 of 13 patients. Serum IgE levels were elevated in all seven patients tested (range, 88 to 9050 IU). Histopathologic features included a folliculitis with eosinophils. Pathogenic bacteria were not consistently found by routine bacterial skin cultures, cultures of skin biopsy specimens, or histopathologic evaluation. CD4 counts were decreased in all of the 12 patients tested (less than 300 cells per cubic millimeter) and were below 250 cells per cubic millimeter in 10 patients. A clinical response was noted to astemizole, to ultraviolet light in the B range, and to topical clobetasol propionate. These observations demonstrate that HIV-associated eosinophilic folliculitis is a unique HIV-related cutaneous disorder that is characterized by a culture-negative, chronic, pruritic folliculitis and a characteristic histopathologic picture. Of special importance, because it is associated with CD4 counts of less than 250 to 300 cells per cubic millimeter, eosinophilic folliculitis appears to be an important clinical marker of HIV infection and, particularly, of patients at increased risk of developing opportunistic infections. We suggest that the term eosinophilic pustular folliculitis (Ofuji's disease), previously used to describe this dermatosis in HIV-infected patients, should be discarded.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Prophylactic interruption of the inferior vena cava: immediate and long-term hemodynamic effects.

Two hundred patients were evaluated retrospectively to determine the clinical effects of prophylactic inferior vena cava (IVC) interruption in association with aortic reconstruction. No pulmonary embolism occurred in the group with IVC interruption, but embolisms did occur in seven of 68 patients who had aortic reconstruction performed without IVC interruption. In two patients, the pulmonary embolism was fatal. Postoperative incidence of deep vein thrombosis was fatal. Postoperative incidence of deep vein thrombosis was 9% in both groups. Clinical and hemodynamic effects of prophylactic IVC interruption were studied in 20 additional patients. Venous hemodynamics (maximum venous outflow, inferior vena cava pressure, and ambulatory venous pressure) showed no change following interruption in 19/20. Sixteen patients from the original group of patients with prophylactic interruption were studied hemodyamically. No pulmonary embolism was clinically evident. One new case of deep vein thrombosis was seen. Again, venous hemodynamics showed no change as a result of IVC interruption. Prophylactic IVC interruption is a safe means of decreasing the incidence of pulmonary embolism without increasing venous-related morbidity.

Aorta↗
PubMed1979

Positive blood culture as an aid in the diagnosis of secondary aortoenteric fistula.

The successful management of aortoenteric fistula (AEF) requires early diagnosis. To evaluate the accuracy of our diagnostic approach, the hospital course of seven patients with AEF was reviewed. In six patients, the initial bleeding episodes were of the low volume type characterized by hematemesis and melena or by melena alone. All patients were febrile. In six patients, blood cultures obtained preoperatively were positive for enteric organisms identical to those found in cultures obtained intraoperatively from the AEF site. Roentgenographic examination of the upper gastrointestinal (GI) tract performed in three patients was diagnostic for AEF in only one. Endoscopy in seven patients revealed a bleeding suture line in one. Angiography was not diagnostic in the six patients in whom it was performed. When patients are seen with the triad of GI bleeding, a history of aortic surgery, and fever, aerobic and anaerobic blood cultures should be obtained. If blood cultures are positive for enteric organisms, the diagnosis of AEF should be strongly suspected, and early surgical intervention is indicated.

Aged↗
PubMed1979

Prophylactic interruption of the inferior vena cava. A retrospective evaluation.

One hundred sixty patients were retrospectively evaluated to determine the effect of prophylactic inferior vena caval interruption in association with aortic surgery. Sixty-three patients underwent aortic procedures without inferior vena caval interruption and ninety-seven patients underwent placement of an Adams-DeWeese clip as prophylaxis against pulmonary embolism. Pulmonary embolism occurred in 10 per cent of the group without the clip and in no patients in the group with the clip. The incidence of deep vein thrombosis was identical in both groups (10 per cent). The 6 per cent rate of early (within 6 months) postoperative leg edema in the group with the inferior vena caval clip was a significant problem in only one patient after twenty-four months. Prophylactic interruption of the inferior vena cava has been shown to be a safe method of decreasing the incidence of pulmonary embolism without increasing the incidence of venous-related complications.

Aged↗
PubMed1979

Was Thomas Wolfe a borderline?

The distinction between the two types of borderline proposed by Spitzer, Endicott, and Gibbon--the Schizotypal Personality type of borderline and the Borderline Personality type of borderline--suggests an advance in our thinking about the borderline concept. However, it can be shown, at least in the case of Thomas Wolfe, that an appreciable amount of overlap exists between the two borderline types, in the sense that the same person can load substantially on items from both types. Such findings may tend to blur the distinction between the two types. Also, Wolfe, hailed as a genius, manifested unusual behaviors which are rarely observed and may constitute a form of borderline condition that challenges current diagnosis.

Adult↗
PubMed1979

Quantitative determination of delta 9-tetrahydrocannabinol in cadaver blood.

We have described a highly sensitive, accurate, and selective method for the determination of delta 9-THC in postmortem blood. Although the method requires the use of fairly complex and sophisticated equipment, the procedure is straightforward and has been reproduced many times in our laboratories. It is thought that this procedure will serve as a useful adjunct to the forensic scientist in his armamentarium for determining physiological levels of important, abused drugs in postmortem analysis.

Adult↗
PubMed1979

Interposition grafting with expanded polytetrafluoroethylene for portal hypertension.

If an interposition graft for the decompression of esophageal varices is necessary, Gore-Tex may be the graft material of choice. It is intert, nonthrombogenic and, possibly, thrombo-resistant. These characteristics of Gore-Tex explain the ease with which a graft thrombectomy was performed in one patient when necessary. Final appraisal of a synthetic venous prosthesis requires many months, if not years, of in vivo evaluation. Nevertheless, when an interposition graft is necessary for the decompression of esophageal varices, it appears that a clinical trial of Gore-Tex is reasonable in view of its characteristics.

Adult↗
PubMed1979

Fibromuscular dysplasia of the external iliac arteries: surgical treatment by graduated internal dilatation technique.

A case of fibromuscular dysplasia of the external iliac arteries treated by graduated internal dilatation is presented. At follow-up extending to 7 years, the external iliac arteries are patent with no evidence of recurrent disease by arteriography, and the patient remains asymptomatic. The recently reported successes with percutaneous balloon catheter angioplasty offers a nonsurgical alternative in the treatment of external iliac fibromuscular disease. A consideration of balloon catheter angioplasty in future similar cases is suggested. If balloon catheter angioplasty is unsuccessful, the option of operation remains available.

Arterial Occlusive Diseases↗