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Biomedical subjects

G R Zuckerman

Publications and source records attributed to G R Zuckerman.

At least 19 recordsLinked to original sources
PubMed1997

Enteroscopy-enteroclysis: experience with a combined endoscopic-radiographic technique.

BACKGROUND: Video enteroscopy provides high-quality diagnostic and therapeutic capabilities in the proximal small bowel. Enteroclysis remains an essential diagnostic technique in the distal small bowel. We report our experience with the combination of these techniques. METHODS: Seventy-one patients with obscure gastrointestinal bleeding (group A, 54 patients) or abnormal radiologic studies (group B, 17 patients) were evaluated with enteroscopy. Enteroclysis via a tube inserted on withdrawal of the enteroscope was performed in all patients with nondiagnostic enteroscopy. RESULTS: Enteroscopy identified bleeding sites in 29 of 54 (54%) group A patients (12 angiodysplasia, 10 ulcers, 7 gastric erosions, 1 vessel, 1 aortoenteric fistula), and lesions in 11 of 17 (65%) group B patients (7 ulcers, 3 benign strictures, 2 radiation enteritis, 1 mass). In group A, 13 (24%) patients had findings detectable by standard esophagogastroduodenoscopy. Enteroclysis identified masses in 2 of 24 (8%) group A patients, and lesions in 5 of 10 (50%) group B patients (3 strictures, 1 mass, 1 large diverticulum). No complications occurred. CONCLUSIONS: The combination of enteroscopy and enteroclysis is safe and offers quality small bowel examinations in more comfortable and convenient single diagnostic sittings. This combination detected bleeding sources in 57% and lesions in 70% of patients. Though enteroclysis identified bleeding sources in only 8% of patients, this study excluded lesions other than angiodysplasia.

Diagnosis, Differential↗
PubMed1997

BLEED: a classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage.

OBJECTIVE: To develop an outcome prediction tool (BLEED: ongoing bleeding, low systolic blood pressure, elevated prothrombin time, erratic mental status, unstable comorbid disease) for clinical use in patients with either acute upper or acute lower gastrointestinal (GI) hemorrhage. DESIGN: A cohort study. SETTING: Barnes Hospital and Jewish Hospital, two private university-affiliated teaching hospitals in St. Louis, MO. PATIENTS: Four hundred sixty-five patients with either acute upper or acute lower GI hemorrhage admitted from the emergency department. INTERVENTIONS: Admission of patients to the intensive care unit or hospital ward was determined by emergency department physicians, without use or knowledge of BLEED criteria. Patients meeting any BLEED criteria at their initial assessment in the emergency department were classified as "high-risk." All other patients were classified as "low-risk." MEASUREMENTS AND MAIN RESULTS: The main outcome measure was the occurrence of an inhospital complication, defined as recurrent GI hemorrhage, surgery to control the source of hemorrhage, and hospital mortality. Patients classified as high-risk had significantly greater rates of inhospital complications at both Barnes Hospital (relative risk, 2.47; 95% confidence interval, 1.38 to 4.44; p < .001) and Jewish Hospital (relative risk, 8.94; 95% confidence interval, 3.92 to 20.41; p < .001) compared with patients classified as low-risk. Patients classified as high-risk at either hospital were significantly more likely to develop additional organ system derangements, require a greater number of transfused units of packed red blood cells, and have longer hospital stays compared with patients classified as low-risk (p < .006). The BLEED classification also identified a greater frequency of intensive care admission for both low-risk (RR, 4.21; 95% Cl, 2.24 to 7.89) and high-risk (relative risk, 1.58; 95% confidence interval, 1.23 to 2.02) patients at Barnes Hospital compared with those patients at Jewish Hospital, although no beneficial effects on patient outcome were reported. CONCLUSIONS: The BLEED classification, applied at initial emergency department evaluation and before admission, predicts hospital outcomes for patients with acute upper or lower GI hemorrhage. This outcome prediction tool also identified variations in intensive care utilization between two hospitals.

APACHE↗
PubMed1996

Practical considerations and technical procedures for post-retained restorations.

Post-retained restorations are a practical and dependable treatment option for restoring teeth with insufficient coronal tooth structure. Manufactured post patterns combined with an effective clinical procedure will provide a simple, reliable, and economic method to produce restorations with a cast tapered post. The cast tapered post can be used for all clinical applications in which a post-retained restoration is indicated.

Crowns↗
PubMed1996

An ounce of prevention. Toward preventing gastrointestinal endoscopic complications.

This preventive or preemptive approach to endoscopic complications is based on the premise that the knowledgeable and prepared physician can ensure that the procedure is performed under optimal conditions and results in maximal patient safety. It is obvious that a directed patient history is one of the keys to this preventive approach. This information is only a primer and requires continuous updating to improve patient outcomes.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1996

Negative outcomes related to gastrointestinal endoscopic procedures. Definitions, classification, and quality review process.

Endoscopic retrograde cholangiopancreatography (ERCP), together with its substantial therapeutic capabilities, carries a higher potential for complications compared with other endoscopic procedures. Complications of ERCP vary in severity from trivial to lethal, and their presentation has a variable timing. The incidence of ERCP complications correlates with physician experience and clinical environments and may be underestimated if routine follow-up is not provided. Physicians should be fully trained in therapeutic endoscopy, and their volume of procedure should be sufficient to maintain therapeutic skills.

Endoscopy, Gastrointestinal↗
PubMed1996

Enteroscopy with enteroclysis.

The authors conclude that their experiences support the conclusion that the combination of enteroscopy and enterocysis is safe and offers quality small bowel examinations in a more comfortable and convenient single diagnostic setting. Although enteroclysis has identified bleeding sources in only 8% of patients who underwent this study, other lesions than angiodysplasia were confidently excluded in the remainder of patients. The combined procedure is well tolerated in the outpatient setting, more comfortable, and safer by decreasing radiation exposures than enteroclysis alone. Use of small bowel enteroscopy at an earlier stage in the evaluation of patients with obscure gastrointestinal bleeding increases cost effectiveness without compromising quality.

Barium Sulfate↗
PubMed1996

Planning fixed partial dentures for severely misaligned abutments.

When the abutment teeth of a fixed partial denture are severely misaligned, insertion of the prosthesis becomes more difficult. Some of the methods traditionally recommended to overcome the problems associated with this situation are examined. One design that simplifies treatment and improves the prosthesis is suggested.

Dental Abutments↗
PubMed1995

An objective measure of stool color for differentiating upper from lower gastrointestinal bleeding.

Subjective reporting of the color of blood passed per rectum has been used to predict the location of gastrointestinal bleeding, but the validity of this clinical approach has never been evaluated systematically. In this study we determined the spectrum of patient and physician descriptors used to characterize the color of blood passed per rectum and evaluated prospectively if an objective test of stool color would correlate with or improve upon subjective descriptions in predicting bleeding locations. The objective test employed was a card containing five numbered colors that typify the spectrum of stool blood colors. One hundred twenty patients used 23 different descriptors or terms to verbalize the color of blood they passed per rectum, and in 22% of cases there was a seeming discrepancy between their verbalized color and the color they pointed to on the test card. Patients pointing to card color 4 (the black color) resulted in closer matching to an upper bleeding source than physicians using terminology such as melena or tarry stools. Likewise, patients picking card colors 1 and 2 (the brightest red colors) resulted in closer matching to a coloanorectal bleeding source than physicians using the terms hematochezia or bright red blood per rectum (P < 0.02 for each comparison). The positive predictive value of card color 4 for an upper bleeding source was very high both when patients pointed to this color or when it was determined from the available stool (0.95 and 0.98, respectively). The positive predictive value of card color 1 for lower bleeding was greater for patients selecting this color than for a direct stool comparison (1.00 vs 0.83).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Triage considerations for patients with acute gastrointestinal hemorrhage admitted to a medical intensive care unit.

OBJECTIVE: To determine whether previously identified clinical criteria, available at the time of triage, can predict clinical outcomes for patients with acute gastrointestinal (GI) hemorrhage. DESIGN: An inception cohort study. SETTING: Barnes Hospital, an academic tertiary care center. PATIENTS: One hundred eight consecutive hospital admissions (103 patients) triaged to intensive care for GI hemorrhage. INTERVENTIONS: Prospective patient surveillance, data collection, and risk stratification using preselected clinical criteria and outcomes assessment. MEASUREMENTS AND MAIN RESULTS: Using clinical data available at the time of triage, 28 (25.9%) intensive care unit admissions were classified as low risk for having poor outcomes. There was no difference in the distribution of upper and lower GI tract sources of hemorrhage for the two risk groups (p = .310). Stigmata of recent hemorrhage were endoscopically identified for six (21.4%) of the low-risk patient admissions and for 16 (20.0%) of the high-risk patient admissions (p = .872). Patient admissions identified as low risk had significantly lower rates of recurrent GI hemorrhage (3.6% vs. 22.5%; p = .022), less acquired organ system derangements (1.0 +/- 0.3 vs. 1.5 +/- 1.0 organs; p < .001), shorter lengths of hospitalization (4.9 +/- 3.5 vs. 8.8 +/- 7.4 days; p < .001), required transfusion with fewer units of packed red blood cells (1.3 +/- 1.2 vs. 6.2 +/- 4.7 units; p < .001), and had a lower overall hospital mortality rate (0.0% vs. 21.3%; p = .008) compared with patient admissions identified as being high risk. CONCLUSION: These data suggest that objective clinical criteria, available at the time of triage determination, can be utilized to identify a low-risk group of patients with acute GI hemorrhage, having favorable outcomes and potentially no need for intensive care unit services.

Acute Disease↗
PubMed1993

Cervical esophageal web associated with a patch of heterotopic gastric mucosa.

Cervical esophageal webs are a relatively common finding on esophograms. We report a web resulting from the squamocolumnar junction produced by heterotopic gastric mucosa. The clinical significance of this lesion is discussed and the importance of differentiating it from Barrett's esophagus is stressed.

Barrett Esophagus↗
PubMed1992

Dies with resin copings for accurate registrations.

A simple, accurate, and reliable technique is available for use when individual dies are made for fixed partial denture construction. Resin copings are used to record the spatial relationship between abutments, create occlusal registrations, verify the dimensional accuracy of the dies, test the path of insertion of the prosthesis, and visualize the marginal adaptation of the retainers. The resin copings are compatible with any elastic impression material selected for the pickup impression.

Acrylic Resins↗
PubMed1990

Prospective trial comparing a combination pH probe-nasogastric tube with aspirated gastric pH in intensive care unit patients.

Upper GI bleeding related to stress ulcer syndrome is estimated to affect as much as 15% of patients in an ICU. Since the occurrence of bleeding after ICU admission may be associated with increased morbidity and mortality, many efforts have been directed at defining optimal therapy for stress ulcer prophylaxis. Titration of intragastric pH with antacids or iv doses of H2-receptor antagonists may prevent stress ulcer bleeding in high-risk ICU patients. We evaluated a recently developed pH probe incorporated into an NG tube and compared it with aspiration of gastric contents using pH paper as a means to monitor pH in 22 surgical ICU patients. Regression analysis comparing the intragastric probe pH values with the aspirated pH values showed a good correlation between the two methods (r = .71). This new technique for intragastric pH measurement appears technically simple and clinically applicable for use on patients at risk for stress ulcer bleeding. It may be more accurate than pH paper in patients receiving antacids.

Adult↗
PubMed1990

Analysis of resistance and retention of complete veneer crown retainers.

The resistance and retention of a fixed partial denture are influenced by the number and distribution of the abutment teeth that support it, the path of insertion, the shape of the arch to which it must conform, and the occlusal relationship it will have with the opposing teeth. If the prosthesis is to be designed properly, it is necessary to understand how each of these factors influences the stability of the prosthesis and its ability to resist dislodgment. If the conditions that contribute to the instability of the prosthesis are misunderstood, overlooked, or ignored, it is impossible to design a prosthesis that will be predictably successful.

Bite Force↗
PubMed1987

Therapeutic goals and treatment options for prevention of stress ulcer syndrome.

Stress ulcer syndrome, the occurrence of acute upper gastrointestinal bleeding or perforation from stress-related mucosal damage, is a significant cause of morbidity and mortality in critically ill patients. The mortality rate in critically ill patients who have bled from stress ulcers ranges from 50 to 77 percent, whereas the mortality rate for similar patients without stress ulcer bleeding ranges from 9 to 22 percent. The mortality rate may be as high as 90 percent in patients with clinically overt bleeding; as many as one-third of these deaths can be directly related to bleeding. Prophylactic therapy for prevention of stress ulcer bleeding is based on three premises: (1) morbidity and mortality related to stress ulcer syndrome are significant; (2) the population at risk can be identified prior to bleeding; and (3) therapy that decreases gastric acidity or improves gastric mucosal defense mechanisms will prevent ulcer formation or progression to bleeding. A review of prospective clinical studies utilizing prophylactic therapy in critically ill patients and patients undergoing surgery revealed a 17 percent overall bleeding rate for placebo groups compared with lower bleeding rates for antacid- and histamine (H2)-receptor-antagonist-treated groups (4 and 7 percent, respectively). Studies varied greatly in definition of bleeding, dosage regimens, and gastric pH goals. The need to measure gastric pH during treatment is controversial, and the optimal pH goal and the length of time for which it must be maintained remain unknown. Controversy exists as to the best therapeutic option for prophylaxis of stress ulcer syndrome, but when prevention of clinically significant bleeding is the therapeutic goal, antacids and H2-receptor antagonists appear to be equally efficacious.

Acute Disease↗
PubMed1987

Prophylactic therapy for stress ulcer bleeding: a reappraisal.

The combined data from 16 prospective trials (2133 patients) appear to suggest that antacids prevent stress ulcer bleeding more effectively than does cimetidine. However, the use of occult blood detection methods to diagnose stress ulcer bleeding may have led to the recognition of clinically insignificant bleeding. When the data from these trials are categorized according to the criteria used for the diagnoses of bleeding (either occult blood detection or clinically overt bleeding), there was no significant difference between antacids and cimetidine in the prevention of overt bleeding (3.3% of 458 compared with 2.7% of 402 patients who bled, respectively; p = 0.69). In addition, both agents were more effective (p less than 0.001) than placebo (15% of 720 patients who bled) in the prevention of overt bleeding. Cimetidine and antacids are equal in preventing significant stress ulcer bleeding.

Antacids↗
PubMed1985

Scanning electron microscopic appearance of chronic ulcerative colitis with and without dysplasia.

This study was conducted to determine whether scanning electron microscopy of colonic mucosal biopsy specimens can help to detect dysplasia in patients with chronic ulcerative colitis. In the first phase of the study, using light microscopy as the standard for the diagnosis, the scanning electron microscopic appearance of specimens from patients with chronic ulcerative colitis and control patients was examined. Descriptive criteria were established to identify normal, atrophic, and dysplastic colonic mucosa. In the second phase, quantitative techniques were used to develop more objective criteria for the diagnosis of dysplasia in ulcerative colitis. Twenty-one coded colonic specimens from 11 patients were sequentially examined by scanning electron microscopy and by light microscopy. The three morphometric analyses performed on the surface epithelial cells were number of cells per unit area, number of microvilli per unit area, and percentage of microvilli with a normal width. The cell count and percentage of microvilli with a normal width were significantly reduced in the seven specimens with colonic dysplasia as compared with non-dysplastic tissues. Scanning electron microscopy may serve as an adjunct to light microscopy in the diagnosis of colonic dysplasia.

Atrophy↗