Search PubMed⌕ Search

Biomedical subjects

D Rosenthal

Publications and source records attributed to D Rosenthal.

At least 199 records · Page 11Linked to original sources
PubMed1984

Management of a subcutaneous colostomy perforation. The role of a new synthetic skin.

Colostomy perforation is an infrequent but often disastrous and lethal complication. In the majority of patients, the traumatic perforation occurs during irrigation through the colostomy stoma. This case report reviews the clinical course of a patient with a subcutaneous colostomy perforation and the subsequent development of an extensive abscess. Aspects of the management included mobilization of the colostomy and thorough surgical debridement and drainage. In addition, the report introduces the use of the new semisynthetic biologic dressing, BioBrane. This synthetic, semipermeable skin substitute served as a temporary dressing, provided good stability, and supported the application of a stoma appliance.

Abdominal Muscles↗
PubMed1984

Carotid and coronary arterial disease. A rational approach.

One hundred thirty-four patients referred for myocardial revascularization had oculoplethysmography/carotid phonoangiography (OPG/CPA) evaluations as a screening test for possible carotid arterial disease. On the basis of preoperative neurologic symptoms or hemodynamically positive OPG/CPA studies, 52 patients had carotid arteriography. Forty-six patients with coexistent carotid and coronary arterial occlusive disease were identified. Twenty-nine had a previous history of central nervous system (CNS) dysfunction, while ten patients (20%) were asymptomatic. Twenty-two patients had "staged" coronary artery bypass grafts (CABG) and carotid endarterectomy (CE) procedures, while 24 had simultaneous CABG/CE. Of the staged patients, one fatal myocardial infarction occurred after CE but prior to CABG; two patients experienced neurologic deficits after CABG yet prior to CE. Twenty-four patients had simultaneous CE/CABG, and no cardiac or neurologic complications occurred. All patients undergoing cardiovascular surgery should have preoperative noninvasive carotid screening studies performed. If OPG/CPA studies indicate a hemodynamically significant lesion, arteriography is indicated. When OPG/CPA studies are negative, yet a history consistent with previous CNS dysfunction is present, a digital intravenous arteriogram is performed. In the presence of coexistence severe coronary and extracranial carotid stenotic or ulcerative plaque disease, simultaneous CE/CABG is advocated.

Arterial Occlusive Diseases↗
PubMed1983

A phase I-II study of combination therapy with thymidine and cytosine arabinoside.

Twenty-one patients with leukemia and lymphoma refractory to conventional therapy were treated with thymidine (dThd) at a dose of 75 g/m2/day for 48 h by continuous intravenous (IV) infusion, followed by cytosine arabinoside (ara-C) on an escalating dose schedule of 25-625 mg/m2/day for 48 h by continuous IV infusion. Toxicity included somnolence (1 patient), mucositis (2 patients), and myelosuppression (19 patients). One patient died prior to completion of therapy. Because of the patient population studied (mainly consisting of patients with leukemia refractory to conventional therapy) and the prevalence of myelosuppression prior to therapy, a median toxic dose was not evaluable. Therapeutic responses included a partial remission in a patient with acute myelogenous leukemia (AML) refractory to ara-C. An additional six patients with acute leukemia refractory to ara-C transiently cleared their peripheral blood of blasts, and a decrease in circulating blasts was noted in two other patients. Biochemical studies conducted on the peripheral blasts of two patients confirmed an enhancement by dThd of the incorporation of ara-C into the DNA of circulating blasts.

Adolescent↗
PubMed1983

Carcinoid tumors of the appendix.

The data presented in this series support the premise that simple appendectomy is adequate therapy for appendiceal carcinoids less than 1 cm in diameter. However, little argument can be made against more radical surgery for gross lymph node metastases. When surgical margins after appendectomy are not free of tumor, additional surgery seems warranted, although in the present series there was a patient who was followed for 30 years who had residual microscopic disease in the appendiceal stump. Adequate treatment for tumors larger than 2 cm includes radical right hemicolectomy. What constitutes adequate therapy for tumors in the 1 to 2 cm range continues to be a point of controversy. From the data presented herein, it seems that appendectomy alone is sufficient except in those instances when both mesoappendiceal and subserosal lymphatic invasion is identified microscopically.

Adolescent↗
PubMed1983

Cystosarcoma phylloides in adolescent female patients.

Nine cases of cystosarcoma phylloides in adolescent female patients are reported along with an additional 35 cases collected from the literature. Analysis of these 44 cases revealed 37 (84.1 percent) benign lesions, 6 (13.6 percent) malignant tumors, and 1 borderline lesion. Excision was the most common operative procedure and was performed in 35 patients. Nine patients underwent mastectomy. There were three recurrent lesions (one benign and two malignant) for a recurrence rate of 6.8 percent. Wide excision was successful in the treatment of recurrent lesions. On the basis of these data, excision is the preferred initial therapy of cystosarcoma phylloides in the adolescent patient regardless of the histologic classification of the lesion. Malignant cystosarcoma is more likely to recur than a benign lesion but a recurrence can be managed with reexcision. Sacrifice of the adolescent breast at the initial procedure is strongly discouraged.

Adolescent↗
PubMed1983

Propranolol and hyperthyroidism: serum free fatty acids and glucose-induced insulin release in nondiabetic thyrotoxic patients during treatment to clinical compensation.

Glucose-induced insulin secretion was studied in 10 hyperthyroid patients, without personal or familial diabetic background, treated with increasing weekly doses of propranolol until clinical compensation was obtained. Intravenous glucose tolerance tests (25g) with concomitant determination of serum glucose, insulin and FFA were done before treatment, at 240 mg/day of propranolol and after clinical compensation. Patients were divided into two groups according to laboratory data and propranolol dosage needed for clinical compensation (group A: 240 mg/day; group B: 320-400 mg/day). Fasting serum insulin, glucose disappearance rate, and estimates of total insulin secretion after intravenous glucose did not change significantly during propranolol therapy and were within the normal range. Fasting FFA of untreated patients were significantly higher than control values (p less than 0.001), but a significant decrease was already seen at 240 mg/day of propranolol, even before clinical compensation. There was a marked difference in the insulin secretion pattern of thyrotoxic patients as compared to controls. Serum insulin and insulin:glucose ratios increased promptly, and at 5 min after glucose reached significantly higher levels than in normal subjects, before treatment as well as after clinical compensation with the propranolol therapy. Both the increased levels of FFA and of T3 could be involved in this pattern of the insulin response of nondiabetic thyrotoxic patients, since the secretion of insulin during the first 10 min after intravenous glucose was directly correlated to fasting serum FFA before propranolol, and serum T3 was directly correlated with total insulin response after clinical compensation. Furthermore the comparison of the results obtained in group A and group B patients raises the possibility that an increased beta-cell responsiveness to beta-adrenergic stimuli might also be involved in this pattern of insulin secretion.

Adult↗
PubMed1983

Sensation seeking, reinforcement, and student drug use.

College student volunteers completed the Sensation Seeking Scale, a drug use survey, and provided demographic information. Subjects were also asked to generate a list of the events that they found most reinforcing (Reinforcer List). Drug use was positively related to scores on all subscales of the Sensation Seeking Scale. Although neither drug use nor sensation seeking scores were related to the total number of items generated on the Reinforcer List, drug users did generate a higher percentage of items rated as high sensation producing items, and percent high sensation reinforcers was correlated with scores on the Sensation Seeking Scale. These results illustrate the importance of the sensation seeking motive as a correlate of student drug use.

Adult↗
PubMed1983

Total skin electron irradiation for mycosis fungoides: failure analysis and prognostic factors.

From 1970 to 1980, 106 patients with mycosis fungoides received total skin electron irradiation to full tolerance. The majority received 30 Gy of 3 MeV electrons in 12 treatments over three weeks. Eighty-eight patients had received prior therapy. Fifty patients had cutaneous plaques only (T1-2N0), and 56 had more advanced disease. At five years, actuarial survival is 66.7% and disease-free survival 21.4%. The median time to relapse is 12 months; prolonged survival is seen only with complete response. Compared with more advanced stages, T1-2N0 patients have more frequent complete response (96% vs 71%) and better relapse-free survival at five years (32 vs 7%). Of 14 patients with T2 disease in continuous complete remission for from 45-113 months, only one has relapsed. This suggests that cure is possible in up to 26% of patients with T2 disease who achieve complete response. In advanced stages, complete response is more likely with doses over 25 Gy (80 vs 50%). First recurrences were predominently in sites of previous involvement. Death resulted mainly from extracutaneous dissemination or failure to induce remission.

Aged↗
PubMed1983

Clinical value of ultrasonography for the management of non-Hodgkin lymphoma patients as compared with abdominal computed tomography.

In 50% of 84 ultrasonographic (US) examinations ordered for staging and restaging of non-Hodgkin lymphoma (NHL) patients, the abdomen and pelvis were not sufficiently visualized to allow diagnostic conclusions, whereas nondiagnostic studies were found in only 3% of the 102 computed tomographic (CT) examinations. Discrepancy about the presence and extent of disease below the diaphragm between US and CT occurred in 74%. The US underestimated the presence or extent of disease in nodal stations caudal to the pancreas more commonly than in other areas evaluated. Because of increased cost, patient inconvenience, and delay in therapeutic intervention due to repeat examinations, it is recommended that CT be used as the initial examination for staging, restaging, or following infradiaphragmatic disease in NHL patients.

Abdominal Neoplasms↗
PubMed1983

Computed tomography of the abdomen and pelvis in non-Hodgkin lymphoma.

The experience of one institution using abdominal computed tomography (CT) for staging and restaging of non-Hodgkin lymphoma (NHL) patients is reported. In 49% of abnormal examinations no significant difference in quantity of involved nodes between diffuse and nodular lymphomas appeared. High paraaortic, iliac, and mesenteric nodal sites were most commonly involved. At restaging examination, usually less extent of disease was found. Abdominal involvement could not be predicted from the presence of peripheral adenopathy. Computed tomography changed the staged during initial workup significantly in 14%. During restaging, CT detected unsuspected active disease in 43% and changed the clinical impression from limited to extensive involvement in 16%. Computed tomography proved to be useful in the management of NHL patients and is recommended as the primary imaging procedure in the abdomen in this disease.

Abdominal Neoplasms↗
PubMed1983

Differentiation patterns in the blastic phase of chronic myeloid leukemia.

The surface antigen phenotype of 30 patients with the blast phase of chronic myeloid leukemia (CML) was determined using a panel of monoclonal antibodies recognizing differentiation antigens of normal myeloid, erythroid, megakaryocyte, and lymphoid cells. Ten patients' cells expressed a phenotype corresponding to an immature myeloid cell and were felt to have "myeloid" blast crisis. None of these myeloid leukemias were TdT+ or responded to vincristine (V) and prednisone (P). Eleven patients expressed a phenotype similar to acute lymphoblastic leukemia cells and probably reflect maturation to an early B lymphocyte. All of these "lymphoid" leukemias were TdT+, and 67% of evaluable patients had a complete response to V and P. One leukemia had the phenotype of an erythroleukemia, one patient's cells expressed the phenotype of megakaryoblastic leukemia, and one leukemia had populations of both myeloid and lymphoid blasts. Six leukemias did not express surface markers characteristic of any lineage and were termed "undifferentiated." This group was heterogeneous with respect to TdT expression, but no patient had a complete response to V and P. Determination of surface antigen phenotype in CML blast crisis thus provides clinically useful information for the structuring of treatment protocols.

Adolescent↗
PubMed1983

[Success of treatment with a low-molecular-weight heparin fraction in a case of pulmonary embolism complicated by heparin-induced thrombopenia].

A 40-year-old woman was admitted to Ambroise-Paré Hospital with a mitral stenosis and right ventricular failure. On the admission, heparino-therapy was started (Heparine Calcique Leo 30,000 IU/24 h); 11 days after, a thrombocytopenia (platelet count 60 . 10(9)/l) was observed and a few days later a pulmonary embolus was diagnosed. "In vitro", a heparin dependent plasma platelet aggregating factor was found (with Heparine Leo and all other standard ones tested) leading to the diagnosis of heparin associated thrombocytopenia; on the other this aggregating factor was not found with a low molecular weight (LMW) heparin fraction (Choay laboratory, Paris, batch CY216). We decided to stop standard heparin and to treat this patient with the LMW fraction (7,500 IU every 8 h SC) associated with oral antivitamin K. A rapid clinical improvement was observed and the platelet count rose progressively reaching 300 . 10(9)/l and has subsequently always been greater than 200 . 10(9)/l. The occurrence of heparin induced thrombocytopenia associated with thrombosis leads to heparin cessation; the treatment of the thrombotic episode seems to be improved by the use of LMW heparin associated with vitamin K antagonists.

Adult↗
PubMed1983

Neurologic deficit after carotid endarterectomy: pathogenesis and management.

During a 7-year period, 818 patients underwent carotid endarterectomy (CE) and were evaluated for postoperative neurologic deficits. Three hundred and eighteen had CE performed with a shunt; transient deficits occurred in 2.9% (nine patients) and permanent deficits occurred in 1.6% (five patients). CE was performed without a shunt in 274 patients; transient deficits occurred in 2.9% (eight patients), while permanent deficits occurred in 2.2% (six patients). CE was monitored by surveillance in 226 patients; transient deficits were found in 2.2% (five patients), while permanent deficits occurred in 1.6% (four patients). There was no significant difference in the incidence of postoperative neurologic deficits between the groups (P greater than 0.25). The concept of inadequate collateral cerebral flow during endarterectomy could not, therefore, be indicted as the cause of the postoperative neurologic complications. Technical errors that caused carotid thrombosis or cerebral emboli, and not inadequate collateral cerebral flow, accounted for most of the neurologic deficits after CE. Deficits occurred most frequently in neurologically unstable patients, those who were first seen with stroke in evolution or with postreversible ischemic neurologic deficit and poststroke symptoms. Twenty-two patients awoke from CE with minor transient deficits, and neurologic function rapidly returned. Fifteen patients with profound postoperative deficits had reoperations immediately; intracranial emboli were identified in three patients, while a thrombosed CE site was demonstrated in seven. Three late (greater than 6 hours) postoperative deficits were due to thrombosis of the CE site. Patients with minimal postoperative deficits will improve without intervention, but reoperation is mandatory if a major deficit occurs in the immediate postoperative period. A protocol for the management of the post-CE neurologic deficit is presented.

Adult↗
PubMed1983

Propranolol and hyperthyroidism: sequential changes in serum iodothyronine (T4, T3, rT3) concentrations during therapy until clinical remission.

The sequential clinical and laboratory (serum T4, T3 and rT3 concentrations) effects of propranolol were studied in 21 hyperthyroid patients. The amount of propranolol required to achieve clinical compensation ranged from 240 to 400 mg/day. For two patients, 480 mg/day, the maximal dose used, did not produce clinical compensation. The only significant changes in serum iodothyronines was detected in the 9 patients compensated with 240 mg/day. T3 decreased from 362 to 299 ng/dl (P less than 0.05) and the rT3/T3 molar ratio increased from 3.4 to 6.5 (P less than 0.025). The increases of rT3 from 113 to 168 ng/dl and of the rT3/T4 molar ratio from 6.7 to 10.8 were not statistically significant (P = 0.052). A slight decrease of serum T3 and increase of serum rT3 occurred during the first or second week in the other patients but the changes were not sustained over the whole period of treatment. These results show that the effects of propranolol on hyperthyroidism were independent of its transitory effects on the peripheral metabolism of thyroid hormones, thus providing further support for the current view that the clinical improvement of hyperthyroid patients on propranolol therapy is probably due to beta-adrenergic receptor blockade. A small percentage of thyrotoxic patients may not show clinical improvement even when propranolol doses of more than 400 mg/day are used.

Adolescent↗
PubMed1983

Femoropopliteal bypass: the preferred site for distal anastomosis.

In many patients undergoing femoropopliteal bypass, an occluded superficial femoral artery may reconstitute at the adductor canal and the popliteal artery will be patent. For these patients, uncertainty exists as to whether the preferred site for the distal anastomosis is an above-knee (AK) or below-knee (BK) bypass graft. Operation is, therefore, often based on personal preference rather than fact. To evaluate this problem, we undertook a 6-year review of the cases of 90 patients who had femoropopliteal bypass to a patent popliteal artery. Seventy AK bypass grafts were performed: 20 with autogenous vein, 25 with Dacron, and 25 with polytetrafluoroethylene (PTFE). Based on the life table analysis method, the late patency rate was 70% for vein, 68% for PTFE, and 64% for Dacron. These results were compared against results in 25 patients who had BK femoropopliteal bypass with autogenous vein, in whom the late patency rate was 65%. There was no statistical difference between these groups (P less than 0.25). An AK femoropopliteal bypass with a prosthesis yielded long-term patency rates that were similar to those of AK or BK vein grafts. When the popliteal artery is patent and the distal anastomosis can be done proximal to the knee joint, a prosthetic graft should be used. A prosthetic graft will reduce operative time, shorten recuperation time, and spare the saphenous vein for use in the coronary or infrapopliteal vessels if the need arises.

Adult↗