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Biomedical subjects

H S Soroff

Publications and source records attributed to H S Soroff.

At least 19 recordsLinked to original sources
PubMed1992

Efficacy of enhanced external counterpulsation in the treatment of angina pectoris.

Eighteen patients with chronic angina despite surgical and medical therapy were treated with an improved system of enhanced external counterpulsation (EECP) (1 hour daily for a total of 36 hours). Patients underwent a baseline treadmill thallium-201 stress test. After EECP treatment, a thallium stress test was repeated for the same exercise duration. One week after treatment, patients also underwent a maximal stress test. All patients improved in anginal symptoms and generally decreased antianginal medications, with 16 obtaining complete relief from angina. Pre- and post-thallium stress testing performed for the same duration showed complete resolution of ischemic defects in 12 patients (67%), reduction in the area of ischemia in 2 (11%), and no change in 4 (22%). Thus, a decrease in myocardial ischemia was observed in 14 patients (78%; p less than 0.01). The exercise duration of maximal stress testing after EECP significantly improved from 8.14 +/- 0.71 to 9.72 +/- 0.77 minutes (p less than 0.005), although the double product did not change significantly. Analysis of these 2 tests in the subgroup of 14 patients with improvement in thallium studies showed significant increases in both exercise duration (8.58 +/- 0.66 to 10.44 +/- 0.59 minutes; p less than 0.001) and double product (21,827 +/- 2,044 to 24,842 +/- 1,707 mm Hg.beats/min; p less than 0.01). The improvement in reperfusion defects and increase in exercise duration are reflections of improved perfusion to ischemic regions of the myocardium. EECP uses additional thigh balloons and sequenced balloon inflation, effecting a significant increase in diastolic augmentation over previously available methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1992

Single dose cephalosporin prophylaxis in high-risk patients undergoing surgical treatment of the biliary tract.

During June 1985 through October 1986, 292 patients considered to be at high risk for having postoperative complications develop underwent cholecystectomy and were evaluated in a multicenter, randomized, prospective, double-blind study. Risk factors included age greater than 70 years, acute cholecystitis within the previous six months, obstructive jaundice, obesity and diabetes mellitus. One gram of cefamandole was administered intravenously to 144 patients and 148 patients received 1 gram of cefotaxime intravenously 30 minutes prior to skin incision. Culture-proved bactibilia was found in 55 patients and 11 of the patients had choledocholithiasis. Of the risk factors considered to place patients at high risk for postoperative infectious complications, obesity and acute cholecystitis proved to be the more common. However, age greater than 70 years, diabetes mellitus and obstructive jaundice were more significant risk factors predisposing to bactibilia. The most common organisms isolated from the bile and gallbladder intraoperatively were Staphylococcus, Streptococcus and Klebsiella species along with enterococcus, Escherichia coli and diphtheroids. Clinically significant postoperative infections occurred in eight patients, including six patients in the cefamandole group and two patients in the cefotaxime group. Antibiotic concentrations were measured in the serum, muscle, subcutaneous fat, gallbladder and bile, with cefamandole showing statistically significant greater concentrations in bile, gallbladder and muscle tissue. There was no statistical significance between the postoperative infection rates, total period of hospitalization or total hospital charges for each group. Therefore, there is no significant advantage between a single prophylactic dose of cefamandole versus cefotaxime for high-risk patients undergoing biliary tract operation.

Adolescent↗
PubMed1991

Inguinal herniorrhaphy. Reduced morbidity by service standardization.

To ascertain if service specialization and procedure standardization would improve the complication rate of inguinal herniorrhaphy, the results of all inguinal herniorrhaphies performed during a 3-year period by board-certified general surgeons who also performed a variety of other procedures common to the field of general surgery, assisted by general surgical residents (group B, 390 patients), were compared in the same institution with the results of inguinal herniorrhaphy when performed during 3 years under protocol by a Hernia Service directed by a senior faculty member assisted by junior surgical residents (group C, 442 patients). Group B patients had essentially no follow-up until they reappeared for care at the Hernia Service, whereas patients in group C achieved an 82% 7-year follow-up. The infection and recurrence rates of group C patients (0.45% and 0.9%, respectively) were significantly better than those of group B patients (5.9% and 4.6%, respectively). These results suggest that in our institution, the concentration of patients with hernias in a hernia service, manned by a specialized surgeon, produced better short- and long-term results than those obtained by general surgeons not dedicated to the field of hernia repair. Further studies will be necessary to confirm these findings.

Follow-Up Studies↗
PubMed1989

The effect of trifluoperazine, a calmodulin antagonist, on the growth of normal and malignant epidermal keratinocytes in culture.

Calmodulin, a cytoplasmic calcium binding protein, is present in concentrations two- to four-fold higher in malignant cells compared to normal cells. In an effort to learn the significance of these elevated levels, we examined the effect of calmodulin blockage on the growth of normal and malignant keratinocytes in vitro. The level of calmodulin in SCC12.B2, a line of keratinocytes derived from an epidermal squamous cell carcinoma (SCC), was about 3.5 times greater than in normal, human newborn foreskin keratinocytes. When exposed to trifluoperazine (TFP), an inhibitor of calmodulin, cell growth was reduced primarily in the cultures of normal keratinocytes. This growth inhibition resulted from two changes in the replicating population of cells, namely an increase in cell cycle length and an increase in rate of cell cycle withdrawal. Cell cycle withdrawal is the irreversible arrest of the cell cycle and is an early event in keratinocyte terminal differentiation. There was no measurable effect on the cell cycle time or withdrawal rate in SCC12.B2. The increased resistance to growth arrest in SCC cells may be a consequence of the elevated level of calmodulin in these cells.

Calmodulin↗
PubMed1988

The effect of growth-promoting agents on replication and cell cycle withdrawal in cultures of epidermal keratinocytes.

Epidermal keratinocytes grow in culture to form a stratified squamous epithelium. These cultures contain a replicating as well as a terminally differentiating population and undergo surface desquamation. Epidermal growth factor (EGF) and cholera toxin are usually employed as growth-promoting agents because they reduce the population doubling time; that is, the period required to increase the total cell number twofold. There are three ways in which this reduction in population doubling time could be achieved: (a) the time for one cell cycle or the cell cycle length may be shortened; (b) the number of cells that withdraw from the cell cycle and terminally differentiate may be reduced; or (c) the number of cells that desquamate into the medium over a set period of time may be reduced. We have explored these possibilities in growing cultures of epidermal keratinocytes using a newly developed double-label assay. This assay gives a measure of both cell length and cell cycle withdrawal. Results show that the growth enhancement induced by EGF and cholera toxin can be attributed primarily to a reduction in cell cycle withdrawal and, to a lesser degree, to a reduction in cell cycle length. EGF and cholera toxin have no significant effect on the rate of desquamation. A linear correlation was noted between cell cycle lengths and withdrawal, suggesting an interconnection between the rate of cell renewal and the likelihood of undergoing terminal differentiation.

Cell Cycle↗
PubMed1987

The treatment of generalized peritonitis by closed postoperative peritoneal lavage. A critical review of the literature.

Thirty-nine studies of closed postoperative peritoneal lavage were reviewed, including four prospective, randomized studies, eight nonrandomized comparative studies, and 27 noncomparative studies. Mortality rates and abscess rates were determined for various subsets of patients. Despite the large number of studies performed, the therapeutic value of this procedure remains unknown. It is unlikely that further noncomparative or nonrandomized studies will yield useful information. There remains a need for a large-scale, prospective, randomized study to evaluate closed postoperative peritoneal lavage. Smaller prospective, randomized studies can contribute meaningfully if data on the specific causes of peritonitis, severity of disease, and patient age and chronic health status are provided in the form of widely used and well-validated stratification systems.

Anti-Bacterial Agents↗
PubMed1987

Herniorrhaphy in the elderly. Benefits of a clinic for the treatment of external abdominal wall hernias.

Elective abdominal herniorrhaphy carries morbidity and mortality rates of 26 percent and 1.5 percent, respectively, in patients over 65 years of age. These figures climb to 55 percent and 15 percent during emergent surgery. Our purpose was to investigate if standardization of treatment could improve such results. Our program stressed centralization of care in a hernia clinic; early operation of patients at risk of incarceration; optimization of underlying systemic disorders by consultative services; operation under local anesthesia; preoperative, operative, and postoperative protocol; and continuity of care by senior personnel. Over a 4 year period, we have performed 241 abdominal herniorrhaphies in patients over 65 years of age (median age 71.5 years old) who exhibited an 84 percent incidence of significant preoperative systemic disorders. Since the inception of our program, our rate of emergent operation has decreased significantly from 7 percent to 2 percent (chi-square less than or equal to 0.05). Our rate of systemic complications after elective operation was 1.2 percent and 0 after emergent operation. These data are statistically better than those reported in the literature (chi-square less than or equal to 0.05). These results suggest that the creation of a hernia clinic significantly improves the care of herniated patients.

Age Factors↗
PubMed1986

Current status of external counterpulsation.

This article traces the development of external counterpulsation from its beginnings to the present. Initially, counterpulsation was carried out by cannulating the femoral artery. The hemodynamic goals were to reduce the afterload of the left ventricle, and to raise or augment the diastolic pressure. This gave rise to the term "counterpulsation." The intra-aortic balloon is capable of producing these salutary effects because of its proximity to the outlet of the left ventricle. The same hemodynamic effects can be obtained by external counterpulsation. However, one must produce a negative pressure during cardiac systole, and ensure that this is applied to the lower extremities. The only clinical study in which this was done was in the treatment of patients in cardiogenic shock by Soroff and colleagues. The results of the clinical studies reviewed are all suggestive of benefits derived from external counterpulsation in a variety of clinical settings. These studies suggest the following avenues for improvement in the equipment used to carry out external counterpulsation: 1. Inclusion of the vascular bed of the buttocks to be subjected to the external pressures, as advocated by Zheng. 2. Inclusion of a negative pressure blanket, as advocated by Soroff. 3. Further investigation of graded-sequential external counterpulsation, using the buttocks and negative pressure. 4. Application of external counterpulsation earlier in cardiogenic shock and for at least 4 hours in acute myocardial infarction. Our evaluation is that this method has not been studied in a way that demonstrates its full potential. We feel that it is on the threshold of being shown to be useful in all of the clinical settings reviewed, and we hope that the necessary equipment will be created to allow investigators to establish its proper place in our therapeutic armamentarium.

Acute Disease↗
PubMed1985

Unusual extraperitoneal presentations of diverticulitis.

Extraperitoneal presentations of complicated diverticular disease are unusual. The initial clinical presentations of these extraperitoneal manifestations have been described in the perineum, scrotum, buttock, hip, joints, thigh, lower extremities, mediastinum, and neck. These presentations render the diagnosis difficult and may lead to the delay of the proper therapy. The purpose of this report is to call attention to these unusual extraperitoneal presentations of complicated diverticular disease to describe the routes of spread and to present a case in point. Reviewing the literature, we have concluded that these unusual presentations occur more commonly in women and the elderly, that a delayed diagnosis significantly increases the mortality rate, and that the most common site of an extraperitoneal presentation is in the area of the hip.

Abscess↗
PubMed1983

Randomized prospective study of the comparative efficacy of spectinomycin and gentamicin in urinary tract infections.

A prospective, randomized study was undertaken in 32 hospitalized patients with urinary tract infections to compare the efficacy of spectinomycin versus gentamicin. Spectinomycin was found to be of equal efficacy if not more efficacious in eradicating Escherichia coli, Klebsiella and Proteus mirabilis in our patient population. No significant side-effects were noted. A review of the literature with emphasis on the use of spectinomycin in infections other than anogenital gonorrhea is made.

Adult↗
PubMed1981

Choice of route for central venous cannulation: subclavian or internal jugular vein? A prospective randomized study.

The clinical need for central venous cannulation has been well established. The usual route for catheter placement is by either the subclavian or internal jugular vein. No randomized, prospective evaluation has been yet conducted to determine which of these approaches, if either, is better with respect to reliability, placement, and frequency of nonseptic complications. One hundred consecutive patients requiring elective central venous cannulation were randomized to either the subclavian or internal jugular route. Successful venipuncture and catheter passage were significantly more common with the subclavian route, and in the absence of special clinical situations, it appears to be the route of choice.

Catheterization↗
PubMed1978

An analytical approach to the determination of optimal phasing for external counterpulsation.

An inhomogeneous linear one-dimensional mathematical model is constructed as a conceptual approach to the study of the effects of External Counterpulsation (ECP) on the pressure and flow at the root of the aorta. The optimal operation of ECP is defined by two conditions: (1) minimization of the mean systolic pressure; and (b) maximization of the ratio of diastolic area over systolic area under the total pressure curve. The phase shift of the external pressure is determined so as to satisfy these two requirements. It is demonstrated within our approximation that with a given magnitude of external pressure, the phase shifts that satisfy these two requirements are the same. These phase shifts are linear functions of the systolic fraction of the total cardiac period, and depend on the time for the external wave to travel from the site of application up the vascular bed to the root of the aorta, plus the reflection contributions. Even though these results are derived from a simple model far from the complexity of the actual vasculature, the basic concepts would remain valid even if more complex mathematical treatments would have been used.

Aorta↗