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Biomedical subjects

D Rosenthal

Publications and source records attributed to D Rosenthal.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

Carbohydrate-deficient glycoprotein syndrome-associated pericardial effusion treated with corticosteroids and salicylic acid.

We describe an infant with a persistent pericardial effusion who was diagnosed with carbohydrate-deficient glycoprotein syndrome (CDGS)-Ia. She was born with mild dysmorphic features and common cardiac abnormalities. However, she re-presented at 2.5 months of age with a pericardial effusion. We decided to embark on a therapeutic trial of corticosteroids and salicylic acid therapy in an attempt to avoid pericardectomy. After 3 weeks of medical treatment the effusion resolved. This experience allows us to propose that medical management with corticosteroids and salicylic acid can be considered as an alternative to surgical therapy for CDGS-I patients with persistent pericardial effusions.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Functional abnormalities of monocytes/macrophages in HIV1-infected patients as demonstrated by the skin window procedure.

Skin window (SW) tests were performed in ten HIV1-infected patients and in ten healthy volunteers. The chemotaxis of monocytes/macrophages is weakened in AIDS patients, since the number of monocytes/macrophages attracted by the SW stimulus decreases in HIV1-infected subjects during the observation time, whereas the number increases in control individuals. HLA-DR expression decreases faster in AIDS patients than in healthy volunteers. Giant cell formation occurs and disappears earlier in HIV1-infected patients than in healthy control individuals. The results suggest that, at least in part, the impairment of chemotaxis and other functional abnormalities of mononuclear phagocytes are caused by their accelerated aging in HIV1-infected patients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Hickman catheter separation.

Seven patients with Hickman/Broviac catheters implanted via the percutaneous subclavian route are reported to have had catheter separation and embolization; one catheter implanted via cephalic vein cutdown also separated. The method of percutaneous subclavian catheter insertion is briefly described, and the mechanism of catheter separation is discussed. Percutaneous insertion routes the silicone catheter between the clavicle and first rib, producing compressive/shearing force which can cause the catheter to break--usually after several months. Embolized catheter fragments can be retrieved with a percutaneous transfemoral venous snare. The described complication represents a 1% incidence. Recommendations to minimize this problem include: placement of subclavian puncture at or lateral to midclavicular line; chest x-rays at 2- to 3-month intervals to identify catheter indentation at the thoracic inlet; early removal of catheters for patients with radiologic evidence of significant catheter compression.

Adult↗
PubMedDate not supplied

Prevention of gynaecological adhesions using haemostatic fleece in a rabbit model.

This pre-clinical study was performed to investigate the ability of the haemostatic fleece TachoComb to prevent adhesion formation following uterine surgery. Thirty rabbits were randomized to receive TachoComb or no intervention following incision to the right uterine horn. After 14 days, the animals were killed and examined for the presence of adhesion. The lengths of any adhesions were measured and the severity was recorded as a score (0, no adhesion; 1, adhesion easy to lyse; 2, adhesion lysed with traction; 3, adhesion separated by sharp dissection). The incidence of adhesions was 100% in the control group compared with 33% in the TachoComb-treated animals. The mean adhesion score was significantly lower (0.7 versus 2.2) and the mean adhesion length category was significantly shorter (0.4 versus 2.0) with TachoComb than in the control group. This study indicates that TachoComb is a well-tolerated and effective means of preventing adhesion following gynaecological surgery.

Animals↗
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Project planning, training, measurement and sustainment: the successful implementation of voice recognition.

Computerized voice recognition systems (VR) can reduce costs and enhance service. The capital outlay required for conversion to a VR system is significant; therefore, it is incumbent on radiology departments to provide cost and service justifications to administrators. Massachusetts General Hospital (MGH) in Boston implemented VR over a two-year period and achieved annual savings of $530,000 and a 50% decrease in report throughput. Those accomplishments required solid planning and implementation strategies, training and sustainment programs. This article walks through the process, step by step, in the hope of providing a tool set for future implementations. Because VR has dramatic implications for workflow, a solid operational plan is needed when assessing vendors and planning for implementation. The goals for implementation should be to minimize operational disruptions and capitalize on efficiencies of the technology. Senior leadership--the department chair or vice-chair--must select the goals to be accomplished and oversee, manage and direct the VR initiative. The importance of this point cannot be overstated, since implementation will require behavior changes from radiologists and others who may not perceive any personal benefits. Training is the pivotal factor affecting the success of voice recognition, and practice is the only way for radiologists to enhance their skills. Through practice, radiologists will discover shortcuts, and their speed and comfort will improve. Measurement and data analysis are critical to changing and improving the voice recognition application and are vital to decision-making. Some of the issues about which valuable date can be collected are technical and educational problems, VR penetration, report turnaround time and annual cost savings. Sustained effort is indispensable to the maintenance of voice recognition. Finally, all efforts made and gains achieved may prove to be futile without ongoing sustainment of the system through retraining, education and technical support.

Certification↗
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[Nontoxic multinodular goiter: evaluation of recurrence rate and function after partial thyroidectomy. Retrospective analysis of 39 cases].

The postoperative goiter recurrence and hypophysial-thyroid function in 39 patients who underwent partial thyroidectomy for nontoxic multinodular goiter, during the 1970-1983 period, was evaluated, seeking relations among thyroid function, extension of surgery and goiter recurrence. The incidence of recurrent goiter was approximately 15%, most of these goiters having been identified ten or more years after thyroidectomy. More extensive surgery lowered the recurrence rate but increased the risk of subclinical-hypothyroidism. No statistical significant differences with regard to serum T3, T4, F T4 and TSH (basal and after TRH) of patients with and without recurrent goiter were found. Thus, the maintenance of a recurrent nontoxic goiter does not seem to depend exclusively on increased serum TSH levels. In one patient, the postoperative treatment with thyroxine did not prevent the appearance of recurrent goiter. Since most patients who underwent thyroidectomy remain euthyroid and the goiter recurs in only a small number, the routine postoperative use of thyroid hormone for the prophylaxis of multinodular goiter recurrence seems to be questionable.

Adolescent↗
PubMedDate not supplied

Nd:YAG iliac and femoropopliteal laser angioplasty: results with large probes as "sole therapy".

Laser assisted balloon angioplasty with a laser heated metallic capped fiberoptic catheter may be effective in the treatment of femoral and iliac artery occlusive disease. In order to avoid the inherent trauma of balloon angioplasty, yet at the same time "debulk" atheroma, 75 patients underwent laser angioplasty of the superficial femoral and iliac arteries as "sole therapy". Laser angioplasty was performed using an Nd:YAG laser coupled to a 600 micron fiber and a 3.5 mm probe (22-28 watts), 4.2 mm or 5.0 probe (32-40 watts). Fifty-nine patients had laser angioplasty for claudication and 16 for limb salvage. The initial angiographic success rate was 84% (41/49) (lesion length 2-14 cm) for the superficial femoral and 69% (18/26) (lesion length 2-14 cm) for the iliac arteries. In follow-up extending to 21 months (mean 14.4 months) 73% (30/41) of the superficial femoral artery and 76% (14/18) of the initially recanalized iliac arteries remain patent. When initial failures are included, this represents an overall intermediate-term patency rate of 52% (32/49) for superficial femoral and 49% (14/26) for iliac arteries respectively. By avoiding the disruptive effect on the arterial wall architecture caused by balloon angioplasty, while at the same time ablating and vaporizing more atheromatous material with larger laser probes, the long-term patency rates of laser angioplasty as "sole therapy" may prove to be superior to those of laser assisted balloon angioplasty.

Angioplasty, Laser↗
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Prosthetic above-knee femoropopliteal bypass for intermittent claudication.

There is no consensus about the most appropriate management of the patient with intermittent claudication due to a superficial femoral artery occlusion. To evaluate the natural history of prosthetic above-knee femoropopliteal (AKFP) bypass, 200 operations for intermittent claudication were reviewed. One hundred AKFP bypasses were done with PTFE and 100 with dacron. In the 30 day postoperative period, four PTFE and three dacron grafts occluded without consequence and only one patient died. Analysis of results by the life-table method demonstrated statistically similar primary graft patency rates at five years (PTFE 65% SE +/- 6.5, dacron 57% +/- 6.2) and ten years (PTFE 31% +/- 18/9, dacron 32% +/- 13.2) (p greater than 0.10). Redo procedures (e.g., thrombectomy, angioplasty) were necessary on 21 grafts (12 PTFE, 9 dacron) and "secondary" patency rates at five years were 76% PTFE and 62% dacron; no grafts which required a redo procedure were patent at ten year follow-up. Major amputations during ten year follow-up were necessary in 16 (8%) patients; all amputations were in diabetic patients. Survival rates were 79% at five and 42% at ten years. An anticipated, the leading cause of death was cardiac related (25 patients); 28 (14%) patients underwent aortocoronary bypass during follow-up. A prosthetic AKFP bypass graft is a safe and durable operation which provides relief from the symptoms of intermittent claudication while allowing for the preservation of the saphenous vein for use later in the coronary or infrapopliteal circulations, should the need arise. These results indicate that the risk of amputation after AKFP is no greater than the natural history of untreated claudication; however, AKFP offers a significant improvement in life-style.

Adult↗
PubMedDate not supplied

Axilloaxillary bypass: is it worthwhile?

To evaluate the efficacy and long-term patency results of axilloaxillary bypass, a review of 32 patients with follow-up extending to 11 years was done. Twenty-two bypasses were performed for vertebrobasilar symptoms or subclavian steal and 10 for upper extremity claudication and/or ischemia. The mean age of the operative group was 66 years, 94% of patients had more than one atherosclerotic risk factor (hypertension, diabetes, coronary artery disease, smoking), and 75% had undergone a previous arterial reconstruction operation. There were no operative deaths, and the only postoperative complication was a sterile seroma which responded to aspiration. At late follow-up extending to 11 years, three grafts had thrombosed while another became infected and had to be removed; no limb loss resulted from these graft failures and the actual late patency rate was 87%. Carotid-subclavian bypass, intrathoracic bypasses, and endarterectomy at the site of occlusion have all been suggested for the treatment of symptomatic proximal subclavian artery disease. With axilloaxillary bypass, however, the hazards associated with carotid artery manipulation, operation on the notoriously treacherous subclavian artery, and the morbidity related to thoracotomy in this older, high-risk patient population can be avoided. The axilloaxillary bypass is safe and simple, and the excellent long-term patency rates make it the procedure of choice for symptomatic subclavian artery disease.

Aged↗
PubMedDate not supplied

"Chronic-contained" ruptured abdominal aortic aneurysm: is it real?

Rupture of an abdominal aortic aneurysm is readily diagnosed when the triad of abdominal or back pain, shock and a pulsatile abdominal mass are present. Clinical diagnosis can be difficult, however, when patients present with chronic pain and an aneurysm which is not readily palpable. In these patients with confusing abdominal symptoms, CT scan provides a rapid, noninvasive diagnosis. The acute leaking AAA has been documented, but only rarely. This report identifies two patients who ruptured an aortic aneurysm several "months" prior to operation--a "contained chronic" rupture.

Aged↗
PubMedDate not supplied

External iliac artery occlusion by bicycle handle injury.

Blunt injury in a youth to the external iliac artery with secondary thrombosis, associated clinically with a seemingly minor blunt injury to the right lower quadrant of the abdomen, is presented. Symptoms were delayed, but eventually became dramatic. The methods of diagnosis and evaluation are discussed and the selection of the operative procedure is outlined. The potential of significant vascular injury should be suspected and followed closely in all blunt injuries in the proximity of major vascular conduits. Early and aggressive treatment in the young is mandatory to prevent not only the usual complications of limb ischemia, but the discrepant limb lengths seen in the growing youth deprived of normal circulation to an extremity.

Arterial Occlusive Diseases↗