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Biomedical subjects

H Stern

Publications and source records attributed to H Stern.

247 records · Page 14Linked to original sources
PubMedDate not supplied

Distal splenorenal shunt vs. portal-systemic shunt: current status of a controlled trial.

A prospective controlled comparison of portal-systemic (PSS) and distal splenorenal shunts (DSRS) in cirrhotic patients who had survived hemorrhage from esophagogastric varices was undertaken 5 yr ago at five hospitals by the Boston-New Haven Collaborative Liver Group. The clinical and endoscopic criteria for massive hemorrhage were satisfied in 155 patients. Thirty-four patients were excluded, primarily because of uncontrolled hemorrhage. Thirty-four were rejected because the were poor operative risks and 21 because they did not satisfy criteria. Thirteen patients refused to participate; the remaining 53 were randomized; 29 to receive PSS and 24, DSRS. The two groups were similar in clinical, laboratory, and manometric characteristics. The DSRS group was older and tended to have had more previous hemorrhages. Followup ranged from 1 to 56 months (mean 21). After PSS, which was performed by 10 different surgeons, 6 patients died during the hospital admission (21%) compared to 2 after DSRS (12%). There were 6 late deaths in the PSS group and 4 in the DSRS group. Portal-systemic encephalopathy occurred in 5 of the 23 survivors of PSS (23%), and in 6 of the 19 who survived DSRS (32%. Two patients in the PSS group bled (9%), 1 after thrombosis and 1 after stenosis of the shunt. Three patients in the DSRS group bled (16%) and all had thrombosis of the shunt. PSS was associated with an unexplained but inordinately high operative mortality. Although the DSRS was accomplished with an acceptably low operative mortality, it was associated with frequent portal-systemic encephalopathy, shunt occlusion, and recurrent hemorrhage. Similar incidences of portal-systemic encephalopathy, shunt occlusion, and recurrent hemorrhage were observed in the PSS group. More patients and longer followup are necessary to determine which of these portal decompressive procedures is superior.

Clinical Trials as Topic↗
PubMedDate not supplied

Treatment of pneumatosis cystoides intestinalis with high FIO2: report of two cases.

We have successfully treated two patients with symptomatic pneumatosis cystoides intestinalis using a high FIO2 delivered by face mask, with administration interrupted at meal times. While we advocate oxygen therapy for this disease, caution must be taken to avoid the complications of high PaO2, namely proliferative and fibrotic lung changes. Close attention should be paid to the development of increasing cough, dyspnea and shortness of breath. As the frequency of the diagnosis of pneumatosis cystoides intestinalis increases, the success of high inspired oxygen as therapy should be recognized.

Aged↗
PubMedDate not supplied

Urolithiasis risk factors in continent reservoir ileostomy patients.

Conventional ileostomy patients are at an increased risk to urinary stone formation compared to normal controls. This study was designed to evaluate any further risk factors to urinary stone formation in patients with Kock ileostomies. Nine Kock ileostomy patients were matched for age, sex, and body weight with nine conventional ileostomy patients and nine controls. Two 24-hour urine samples from each patient were analyzed for volume, pH, Na+/K+ ratio, oxalate, and uric acid concentration. Both ileostomy groups demonstrated reduced urinary volume and Na+/K+ ratio as compared to the control groups (P less than 0.05). The Kock ileostomy group had the lowest urinary volume. There was no significant reduction in urinary pH or elevation in urine uric acid concentration in the Kock ileostomy group. The results suggest that there is no significantly added risk to uric acid stone formation in Kock ileostomy patients.

Calcium↗
PubMedDate not supplied

Quantification of periprosthetic valve leakage with multiple regurgitation jets by magnetic resonance imaging.

A patient with aortic prosthetic valve endocarditis required replacement of the prosthesis, After initial recovery, his left ventricular function gradually declined and echocardiography revealed minor paravalvular leakage and a cavern around the prosthesis. Magnetic resonance imaging was performed, flow-imaging and volume-based measurements showed high-grade paravalvular leakage of 45 and 58% regurgitant fraction, respectively. Intraoperatively, the dehiscence of more than half of the circumference of the aortic prosthesis was seen. This study shows that MRI can accurately assess even periprosthetic valve leakage with multiple regurgitation jets.

Adolescent↗
PubMedDate not supplied

Development of optical process for accessing three-dimensional patient topology.

A commercial optical system developed by Solid Photography, Inc., has been used to generate precise paraffin--polyethylene tissue compensators. A program with the objective of constructing a medical facility has been undertaken to access patient topology for treatment planning, tissue-compensator fabrication, and patient positioning verification on the treatment table. Currently, patients are taken to a specially equipped studio where a series of microprocessor-controlled reticles are projected on the surface to be analyzed and photographs are taken automatically for computer processing. The topology data then drives a machine tool to sculpt the tissue compensators and may be transmitted via acoustic-coupled terminals to a treatment-planning computer at the Medical Center. The tissue compensators have been found to conform accurately to patient contours. At present, data bases can be generated to accommodate volumes of approximately 70,000 cm3.

Models, Structural↗
PubMedDate not supplied

Pulmonary nodule in an asymptomatic 64-year-old woman.

The unexpected finding of a pulmonary nodule in an asymptomatic patient is a common clinical event. This paper examines the case of a 64-year-old woman who was discovered to have a small pulmonary nodule on routine examination. Differential diagnosis, modes of examination, and pathological findings are examined.

Adenocarcinoma↗
PubMedDate not supplied

Collagenase: an experimental study of intervertebral disc dissolution.

This study reports the use of a purified form of the enzyme collagenase (Nucleolysin) to effect dissolution of the normal nucleus pulposus in a series of dogs and monkeys. A consistent dissolution effect has been observed. The toxicity of the enzyme to surrounding local tissues has been studied in the same species with an indication of safety in all areas other than intrathecal administration. A margin of safety in intrathecal administration between the effective dose and toxic dose has been suggested in the monkey. Mice LD50 studies and systemic toxicity studies in dogs show a satisfactory margin of safety for this enzyme. Guinea pig studies show no significant antigenicity.

Adult↗