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Biomedical subjects

G Kandel

Publications and source records attributed to G Kandel.

33 records · Page 2Linked to original sources
PubMed1986

A clinical view of recent advances in ascites.

We discuss current perspectives in ascites, focusing on newer developments of interest to clinicians and stressing the value and limitations of therapeutic paracentesis. Because there is considerable evidence to support both the "underfilled" and "overflow" hypotheses for the development of ascites, current concepts concentrate on integration of these two theories. In the management of ascites the rate of ascites mobilization is more important than the method by which excess peritoneal fluid is removed; thus salt restriction may not have to be rigid if diuretics are used judiciously. An approach to intractable ascites emphasizes the difference between unresponsive and refractory ascites, but in both situations a conservative philosophy is recommended. Nonhepatic causes of ascites are briefly reviewed since their management may require principles different from those used in cirrhosis.

Animals↗
PubMed1984

Pyogenic liver abscess: new concepts of an old disease.

Early recognition of pyogenic liver abscess requires a high index of suspicion. The abrupt onset of hectic fevers and jaundice is rarely seen today; instead, an insidious progression of malaise, abdominal pain, and night sweats is more common. Biliary tract disease is the most frequent underlying disorder. An elevated alkaline phosphatase is a useful clue to the condition, but diagnosis depends on imaging of an abscess cavity followed by aspiration. Treatment involves antibiotics together with drainage, which can often be performed successfully by a nonsurgical percutaneous approach. However, prognosis continues to be poor unless the diagnosis is made promptly.

Alkaline Phosphatase↗
PubMed1983

Selected developments in the understanding of diabetic ketoacidosis.

Advances in the understanding of diabetic ketoacidosis have contributed to the recent decrease in the morbidity and mortality associated with this condition. The role of counterregulatory hormones in its pathogenesis is considerable, but insulin deficiency is necessary for diabetic ketoacidosis to develop. Therapy begins with identification and treatment of the factors precipitating ketosis. Isotonic saline is the fluid of choice for initial intravenous therapy; subsequently 0.45% saline is appropriate. Sodium bicarbonate is necessary only if the arterial pH is less than 7.1, and phosphate should be given only when the serum phosphate level is below 0.5 mg/dl (0.16 mmol/l). Factors other than pH are important in causing the hyperkalemia so commonly seen at the time of presentation, but whether or not hyperkalemia is present potassium supplementation is almost always necessary and should be given as long as the urinary output is adequate. Intravenous doses of insulin as low as 5 to 15 U/h are sufficient in most cases, but the occasional patient will require larger amounts. Close clinical and biochemical monitoring is necessary for successful management.

Adult↗
PubMed1983

Mixed venous oxygen saturation. Its role in the assessment of the critically ill patient.

Except in the presence of left to right shunts, slow aspiration from the distal lumen of a catheter placed in the pulmonary artery can provide a sample of mixed venous blood. The oxygen saturation of such a sample (SvO2) is dependent on arterial oxygen saturation, hemoglobin concentration, cardiac output, and tissue oxygen demands. A fall in SvO2 usually implies anemia, arterial oxygen desaturation, and/or decreased cardiac output; however, a normal or high value does not exclude such disturbances. When employed in conjunction with the other indicators of tissue oxygenation available in an intensive care unit, SvO2 can be useful as a guide for both prognosis and urgency of therapy.

Biological Transport↗
PubMed1980

Female epispadias: report of a case and review of the literature.

Female epispadias is a congenital anomaly representing a mild form of the spectrum of exstrophy of the bladder. Unrecognized an untreated, the handicap associated with the physical malformation can create overwhelming clinical and psychological problems for the affected female. Radiographic findings of spinal dysrhaphism with diastasis of the public bones are often associated with, and can afford the first clue to, the physical findings of absent clitoris, ununited labia and patulous and foreshortned urethra.

Child, Preschool↗
PubMedDate not supplied

Potency preservation following conformal radiotherapy for localized prostate cancer: impact of neoadjuvant androgen blockade, treatment technique, and patient-related factors.

PURPOSE: Impotence is a familiar sequela of both definitive external-beam radiotherapy (EBRT) and radical prostatectomy for localized prostate cancer. Among surgical options, nerve-sparing radical prostatectomy (NSRP) offers the highest potency preservation rate of 70%. We report the change in potency over time in an EBRT-treated population, determine the significantly predisposing health and treatment factors affecting post-EBRT potency, and compare age- and stage-matched potency rates with those of NSRP-treated patients. PATIENTS AND METHODS: Our results are from a retrospective study of 287 patients diagnosed with prostate cancer in clinical stages A to C and treated with conformal techniques to 6200 to 7380 cGy. Information regarding preradiotherapy potency, medical and surgical history, neoadjuvant antiandrogen use, and post-EBRT potency was documented for each patient. The median follow-up time was 34 months. RESULTS: At months 1, 20, 40, and 60, actuarial potency rates were 96%, 75%, 59%, and 53%, respectively. Factors identified as significant predictors of post-EBRT impotence include pre-EBRT partial potency, diabetes, coronary artery disease, and anti-androgen medication usage. Among treatment factors, a trend toward potency preservation was noted for the six-field versus the four-field technique. Finally, age- and stage-matched comparisons of potency rates for our population and NSRP-treated patients were performed. For patients older than 70 years, 60.9% of EBRT patients and 32.9% of NSRP patients remained potent after treatment. Overall, EBRT patient potency preservation was 71.3%, versus 66.2% for NSRP patients. DISCUSSION: Pre-EBRT partial potency, diabetes, coronary artery disease, and anti-androgen medication usage are significant predispositions to impotence in EBRT-treated prostate cancer patients. In comparing EBRT with NSRP for various age and stage groups, EBRT offers notably higher potency preservation rates than NSRP for patients older than 70 years.

Aged↗