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Biomedical subjects

E Lerner

Publications and source records attributed to E Lerner.

12 recordsLinked to original sources
PubMed1992

A randomized study of propranolol on postprandial portal hyperemia in cirrhotic patients.

Propranolol, a nonselective beta-adrenergic blocker, has been shown to reduce portal pressure and the risk fo variceal bleeding. The portal pressure-reducing effect of propranolol is mediated by splanchnic arterial constriction, which decreases portal flow. A double-blind randomized control study (crossover on 2 consecutive days) was designed to compare the effects of propranolol vs. placebo on portal flow in cirrhotic patients during fasting and after a standardized meal. Portal flow was measured with an ATL Ultramark 8 echo-Doppler system (Advanced Technological Laboratories, Bothel, WA) in 23 cirrhotic patients. Fasting portal flow and heart rate were obtained at baseline and 2 hours after the administration of propranolol or placebo. A standard test meal was then given, and measurements were repeated 30 minutes later. Thirteen patients (group 1) received placebo on day 1 and propranolol on day 2, whereas 10 patients (group 2) received propranolol on day 1 and placebo on day 2. In group 1 patients, heart rate declined by 20% (P less than 0.0001) and portal flow decreased by 12% (P less than 0.05) after propranolol administration. Similar reductions were found in heart rate (-21%, P less than 0.0001) and portal flow (-17%, P less than 0.001) for group 2 patients. For all 23 patients, 2 hours after propranolol administration, heart rate declined by 21% (P less than 0.0001) and portal blood flow was reduced by 14% (P less than 0.0001). The 10 patients who received propranolol on day 1 (group 2) showed a carryover effect of propranolol on day 2. On day 2, baseline portal flow and heart rate values were significantly lower than baseline values on day 1. This long-lasting effect of a single dose of propranolol may be caused by the longer half-life of propranolol in cirrhotic patients. The postprandial portal blood flow percentage increase after the meal was similar for both placebo and propranolol. Propranolol did not blunt postprandial hyperemia. However, whereas the absolute value of blood flow after the meal increased significantly in comparison with baseline in placebo-treated patients (P less than 0.001), this did not occur with propranolol. Furthermore, in propranolol-treated patients the absolute value of blood flow after the meal was lower than in placebo-treated patients. This may constitute a protective effect of propranolol in portal hypertension.

Female↗
PubMed1991

Effect of lovastatin on intimal hyperplasia after balloon angioplasty: a study in an atherosclerotic hypercholesterolemic rabbit.

Restenosis, the major limitation of balloon angioplasty, is the result of intimal hyperplasia after the procedure. Lovastatin, a 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) inhibitor, may influence intimal hyperplasia by lowering serum cholesterol and by blocking deoxyribonucleic acid (DNA) synthesis. To determine whether lovastatin reduces intimal hyperplasia, a prospective, randomized blinded study was performed in 60 atherosclerotic New Zealand White male rabbits. Atherosclerosis was produced by air desiccation injury followed by a 28 day diet of 2% cholesterol and 6% peanut oil that was terminated before balloon angioplasty was performed. Angioplasty could not be performed in 14 rabbits with bilateral femoral artery occlusion, and in one rabbit the procedure was a technical failure. Forty-five rabbits underwent balloon angioplasty performed with use of a 2.5-mm balloon inflated to 10 atm for three 1 min dilations at 1 min intervals. Seven rabbits died during the procedure. Thirty-eight rabbits were randomized to either a lovastatin group (6 mg/kg body weight per day) or a control group. Angioplasty was performed on all patent vessels (n = 54); the procedure was bilateral in 16 rabbits and unilateral in 22. Fifteen lovastatin-treated and 15 control rabbits survived 39 days after angioplasty and were then killed. Angiograms, obtained before and 10 min and 39 days after balloon angioplasty, were read with use of electronic calipers by two observers who had no knowledge of treatment data. After the rabbits were killed, vessels were pressure perfused using a standardized protocol to maintain in vivo dimensions for blinded quantitative histologic analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1979

Analysis of ascitic fluid in cirrhosis.

In order to determine the composition of "normal" ascitic fluid, the results of analysis of the first paracentesis on 347 consecutive cirrhotic patients with ascites at the West Haven Veterans Administration Hospital between 1955 and 1976 were examined. The ascites was considered "normal" in 259 patients. Bacterial peritonitis was present in 51, malignant ascites in 18, pancreatitic ascites in 15, and ascites of other types in 4 patients. Normal ascites is sterile, usually clear, and contains 281 +/- 25 leukocytes/mm3 (mean +/- SEM), 27 +/- 2% of which are polymorphonuclear. In spontaneous bacterial peritonitis the fluid is usually cloudy, contains 6084 +/- 858 white blood cells/mm3, 77 +/- 4% of which were PMN and culture is positive for a single bacterial species, usually enteric in origin. Malignant and pancreatitis ascites are sterile, often cloudy, and contain an average of 696 +/- 273 and 1821 +/- 833 leukocytes/mm3, respectively, about half of which are polymorphonuclear. Amylase activity is increased in pancreatitic ascites, but not in other types of ascites. Stained smears of sediment for bacteria are often positive in bacterial peritonitis, but not in the other categories. Neither the specific gravity, protein concentration, nor glucose level is useful in the differential diagnosis of ascites. Based on the critical number of leukocytes alone, (500/mm3), one can accurately differentiate infected from uninfected fluid in over 90% of ascitic patients.

Amylases↗
PubMed1978

The yale cervical orthosis: an evaluation of its effectiveness in restricting cervical motion in normal subjects and a comparison with other cervical orthoses.

The Yale cervical orthosis is a lightweight polyethylene foam Philadelphia collar with molded fiberglass extensions over the thorax. This orthosis was studied on 17 normal subjects in the extremes of the ranges of flexion, extension, rotation, and lateral bending using roentgenograms and axial photographs to assess how effectively it limited motion of the neck. Overall, it satisfactorily controlled cervical motion and was similar to the most effective rigid cervical orthoses. Flexion and extension ranges were compared at different segmental levels of the spine. The Yale orthosis was most successful in restricting flexion in the area of the middle and lower cervical spine and was acceptable in controlling extension range. The orthosis was least effective in controlling motion in the upper spine, particularly at the atlantoaxial articulation. The Yale orthosis is recommended for postsurgical protection of the middle and lower cervical spine and in select situations of spinal instability, but it is not recommended for control of odontoid fractures or atlantoaxial subluxation.

Adult↗
PubMed1977

Computer-assisted monocyte esterase assay by flow-cytophotometry.

A Wang model 2200 computer has been interfaced with the Bio/Physics Systems, Inc. model 6300 Cytograf and model 2100 Distribution Analyzer. Using a custom designed software program, in conjunction with an azo-dye technic for staining monocytes for nonspecific esterase activity, it has been possible to obtain rapid and reliable data concerning relative values for intracellular monocyte esterase activity. The method is based on measuring the axial light-loss voltage signal for each of one thousand stained monocytes. Individual stained monocytes were assigned to one of four groups (A, B, C, D), dependent upon the magnitude of the signal and were given different rating values (1, 2, 3, 4) according to their group designation. A "score" was derived for each blood sample by multiplying the percentage of cells (monocytes) in each group category by the appropriate factor and summing these values. The technic permits rapid objective assessment of intracellular nonspecific esterase activity in monocytes suspended in a mixed cell population. Both Gaussian and bi-modal patterns for monocyte esterase were observed. The latter suggests a dual monocyte population.

Computers↗
PubMed1976

Assessment of monocyte esterase activity by flow cytophotometry.

An azo dye supravital method has been devised for selectively staining human monocytes in suspension for nonspecific esterase activity. Stained cells can be identified and rapidly enumerated by presenting the suspension of stained cells to the Cytograf, a flow-through cell discriminating cytophotometer. The intensity of stain is proportional to the intracellular esterase activity. By analysis of the oscilloscope display, it has been possible to obtain relative data concerning the degree of activity of monocyte nonspecific esterase activity. These observations suggest a unique approach to the measurement of intracellular enzyme activity in selected cells in a mixed population.

Autoanalysis↗
PubMed1975

Associated diagnoses which complicate rehabilitation of the patient with bilateral lower extremity amputations.

Cardiopulmonary problems were the most common limiting factor in the rehabilitation of 42 bilateral lower limb amputees. Diabetes mellitus and local stump problems, most common in below knee amputees, delayed rehabilitation but, subsequently, obtained the highest goals. Thirty of the 42 amputees finally were self sufficient; the average time required was 30 weeks to maximum benefit.

Adult↗
PubMed1975

Rehabilitation after bilateral lower extremity amputation.

Fourty-four men (average age, 61.5 years) who had undergone amputation of both lower extremities were studied at a Veterans Administration hospital. Vascular insufficiency was the most frequent reason for amputation. In 26 of the patients bilateral below-knee amputations had been performed. Although diabetes mellitus was present in 26 of the patients, it severely hampered rehabilitation in only four. Twenty-nine (nearly 65%) of the 44 patients became totally independent in daily functions. However, the average time required for maximum rehabilitation was almost 30 weeks.

Aged↗
PubMed1975

What influence does age have on rehabilitation of amputees?

A study of 194 male lower extremity amputees, with an average age of 56.8 years, showed that vascular disease is the most common cause of limb loss at all ages. Increasing age was correlated with an increasing incidence of bilateral amputation and arteriosclerotic and pulmonary problems, lower goals and levels of achievement, increased mortality during therapy, fewer amputees who were able to return home, an increased number of aids (cane, crutches, wheelchair), and a longer rehabilitation period. Many patients over age 65 required nearly a year of rehabilitation to achieve maximum benefit.

Adult↗
PubMedDate not supplied

Successful rehabilitation following amputation of dominant versus nondominant extremities.

In a study of 154 lower extremity amputees who received prostheses, those patients who lost a left lower extremity tended to make better progress in rehabilitation than those who required a prosthesis for the right leg. Eighty-three percent of the amputations were performed for vascular disease with no right-left difference. Heart disease played a greater role as a factor in limiting rehabilitation in those with left limb loss. Goals set and attained for loss of the left leg were higher than those for loss of the right leg. Left leg amputees can navigate more frequently without aids than can the right leg amputees. The use of a cane made both groups equal in rehabilitation time. Patients with a loss of the left leg attained maximum benefits of rehabilitation sooner than their colleagues with a loss of the right leg. Differences were nearly 2.3 weeks when the median was 22 weeks.

Adult↗