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Biomedical subjects

H Stern

Publications and source records attributed to H Stern.

At least 73 records · Page 4Linked to original sources
PubMed1989

Use of thoracoabdominal incision for cancer of the splenic flexure in the obese patient.

The thoracoabdominal incision is not a common incision in colonic surgery. However, it may be of unique benefit in tumors of the splenic flexure in which adequate mobilization and adequate lateral resection margins may otherwise be difficult to achieve. These tumors are believed to carry a poorer prognosis in part because of reduced accessibility. Specifically, exposure in short, obese patients with locally advanced lesions may be improved significantly with a thoracoabdominal incision. This report presents a patient with a tumor of the splenic flexure invading the diaphragm, greater curvature of the stomach, splenic hilum, and tail of the pancreas. The exposure provided by this incision made a radical cancer operation possible, which would not have been possible with an abdominal incision.

Adenocarcinoma↗
PubMed1989

Use of Nd-Yag laser ablation in colorectal obstruction and palliation in high-risk patients.

Conventional treatment for colonic obstruction due to cancer or benign anastomotic strictures in high-risk patients or unresectable cases in some form of colostomy. This procedure has the negative aspects of requiring a general anesthetic and leaves the infirm patient with a stoma that they cannot easily attend to. Ablation of tumor by Nd-Yag laser has been available for several years, with passage of the laser fiber through a colonoscope. To evaluate the role of laser photocoagulation in the palliation of colorectal tumors or benign strictures, the authors summarized their initial experience, trying to define the indications, various methods of treatment, and complication rate in these patients. This technique is difficult to perform and has the added risk of intestinal perforation but does obviate anesthetic and surgical risks. Seven patients with recurrent metastatic colorectal obstruction, three patients with benign colonic strictures, and two patients with large villous tumors were treated with Nd-Yag laser passed via the colonoscope. The mean age was 71 years (range, 52 to 86 years). Five patients received sedatives only, six patients received epidural anesthetic, and one had a general anesthetic. The average total energy used was 3702 joules on noncontact fibers, and the average number of pulses was 126. Distance of the lesion from the anal margin ranged from 0.5 to 30 cm. Ten of twelve tumors were within 15 cm of the dentate line. In the most distal lesions, manual debulking with biopsy forceps facilitated the laser treatment. Symptomatic relief was achieved in all patients. One patient required a colostomy one month after treatment because of incontinence. Another patient needed a resection of a benign stricture after three laser treatments. Other than one case of microperforation, treated conservatively with antibiotics, no other complications occurred and there was no mortality. The authors believed that the Nd-Yag laser plays a specific role in the treatment of high-risk patients.

Aged↗
PubMed1989

The posterior interosseous artery free flap.

A case is reported in which retrograde flow in the posterior interosseous artery did not perfuse the posterior interosseous artery flap, which was subsequently transferred as a free tissue transfer based on the proximal posterior interosseous vessels.

Adult↗
PubMed1989

The prophylactic role of intravenous and long-term oral acyclovir after allogeneic bone marrow transplantation.

Eighty-two patients were randomly allocated to receive intravenous acyclovir 5 mg kg-1 t.d.s. for 23 days followed by oral acyclovir 800 mg 6-hourly for 6 months or matching placebos after allogeneic bone marrow transplantation. Herpes simplex and varicella zoster virus infections were significantly reduced during the period of administration of acyclovir. No reduction in cytomegalovirus infection was demonstrated. The drug was not toxic.

Acyclovir↗
PubMed1989

Cytomegalovirus pneumonia: the use of ganciclovir in marrow transplant recipients.

Sixteen bone marrow transplant recipients with cytomegalovirus pneumonia diagnosed by rapid, non-invasive methods were treated with ganciclovir. Seven patients survived the acute infection and there were five long term survivors. Excellent in-vivo suppression of cytomegalovirus was observed. Marrow toxicity was noted in four patients but was rapidly reversible and not life threatening. Clinical features common to surviving patients included good clinical condition, insidious development of infection and evidence of normal alveolar gas exchange. The fulminant onset of symptoms, radiographic abnormalities and hypoxaemia were characteristic of non-survivors. These results offer some encouragement towards further study of ganciclovir for the early treatment of cytomegalovirus pneumonia. To identify such patients, the use of rapid diagnostic methods and aggressive viral surveillance is recommended. Convincing evidence for the efficacy of this drug will only emerge from randomized prospective studies.

Acyclovir↗
PubMed1989

[The accuracy of Doppler echocardiography determination of shunt volume in children with isolated atrial septal defect and left-right shunt].

The accuracy of shunt calculations derived from Doppler echocardiography was assessed in 15 children (5-15 years, mean 8.5 yrs.) with secundum-type atrial septal defect and left-to-right (L-R) shunt. Qp/Qs was calculated by measuring stroke volumes over the aorta and pulmonary artery prior to and 4-15 days after corrective surgery. The measuring error of the Doppler method was defined as deviation of the postoperative shunt value from zero. A residual shunt was excluded by careful intraoperative testing and physical examination. Intraoperative inspection revealed normal pulmonary venous drainage. L-R-shunt, as calculated by Doppler echo, significantly decreased after surgery (p less than 0.001). Although all septal defects were closed, calculations by Doppler echo resulted in a median residual shunt of 16% (0-50.7%). IN 2/15 children a L-R shunt of more than 40% was derived by echo recordings. The size of the measuring error increased in children with great preoperative shunts. There was a significant correlation between the ratio of pulmonary to aortic cross-sectional area and the measuring error (p less than 0.03, r = 0.59). Poor estimation of cross-sectional areas in dilated pulmonary arteries was the most important limiting factor in shunt calculation. Doppler echocardiography provides a valuable noninvasive method for shunt calculation. Similarly to Fick's principle, in some patients the measuring error may be considerable and become relevant for clinical decisions. Thus Doppler-derived shunt calculations must be complemented by additional information of two-dimensional echo and physical examination.

Adolescent↗
PubMed1988

[Hemodynamic effect of captopril in children with dilated cardiomyopathy].

Hemodynamic effects of captopril were prospectively studied in 12 children suffering from dilative cardiomyopathy. Before the administration of the drug all patients were put on a stable medication of diuretics and/or glycosides. A median daily dose of 1.83 mg captopril/kg body weight was given in 3 or 4 single doses depending on age. Median body weight of the children was 18.6 kg (range 2.7-42.2) and the median age was 5.8 years (range 0.2-15). Left ventricular volume was determined in systole and diastole using 2-D echo, and the stroke volume als well as the ejection fraction were calculated. Cardiac index (CI) and systemic resistance (Rs) were measured by Doppler echo. Blood pressure and heart rate were recorded at each echo registration. ESVI (-32%), EDVI (-21%) and SVI (-7%) were significantly (p less than 0.05) reduced by short-term captopril treatment. This effect was maintained under long-term therapy. EF, CI, Rs, blood pressure and heart rate showed only minor changes under captopril. Adverse effects were recorded only in one child. They disappeared after dose reduction.

Adolescent↗
PubMed1988

[Spontaneous variability and reproducibility of Doppler echocardiography determination of heart minute volumes in infancy].

UNLABELLED: Day-to-day variability in Doppler derived cardiac output measurements was assessed in 10 infants (0-6 months of age) and in 12 older children (1-13 years, mean: 7.4 years) with congenital heart disease which had been treated surgically. There was no valvular stenosis or ventricular septal defect, all patients had technically excellent imaging quality. Standard commercial equipment (Mark 8, ATL; 3, 5 or 7.5 MHz scanheads) was used for echo recordings, which were stored on video tapes and blindly evaluated by an independent investigator. Cardiac outout (CO) was measured over the aortic and pulmonary valves on two consecutive days using standard projections. Mean CO variability of the infants was 32% and 41% for the aortic and pulmonary valves, respectively. The corresponding variability in CO in the older children was 41% and 32% for the aortic and pulmonary valves respectively. The greatest difference existed in measuring cross-sectional areas of aorta and pulmonary artery (29-37%). The Doppler parameters showed the lowest variability (13-26%), except for the pulmonary artery in the infants (46%). On heart rate, there was a "physiological" day-to-day variability of 10-20%. CONCLUSION: There is a considerable variability in Doppler derived CO measurements. The detection of CO changes in critically ill children might be missed by this error. CO measurements over the aortic valve seem to be more reliable than over the pulmonary valve.

Adolescent↗
PubMed1988

Effect of beta-adrenergic blockade on the growth rate of abdominal aortic aneurysms.

We retrospectively identified 136 patients with abdominal aortic aneurysms (AAAs) who were initially evaluated as outpatients. Twenty-seven of these patients met the following criteria for eligibility in the study: (1) roentgenographic documentation of an AAA larger than 3 cm, (2) at least two serial ultrasound size determinations over a minimum six-month interval, and (3) a documented medication history. Of these 27 patients, 12 received long-term beta-blockade, while 15 received no beta-blockade. The two groups were comparable with respect to age, sex, initial aneurysm size, mean systolic and diastolic blood pressure, and duration of follow-up (mean, 34 months). Among patients with beta-blockade, the mean growth rate was 0.17 cm/y. The rate for the controls was 0.44 cm/y. One patient of 12 (8%) in the beta-blocker group had a rate that exceeded the mean for the overall group compared with eight patients of 15 (53%) in the group with no beta-blockade. This difference was statistically significant. Thus, beta-blockade may be associated with a decreased AAA growth rate in this small, retrospective study.

Adrenergic beta-Antagonists↗
PubMed1988

Improved results following use of an advancement technique in the treatment of ileoanal anastomotic complications.

Between December 1981 and March, 1987, 188 ileal reservoir and ileoanal anastomosis procedures were performed at the University of Toronto. Anal anastomotic complications occurred in 24 (12.8%) patients. There were 19 patients who developed a leak as a result of non-healing of the ileoanal anastomosis (group 1). Late fistulae occurred in 5 patients (group 2). Various treatments were employed. In group 1, 2 of 15 (13%) patients treated with drainage and antibiotics, 3 of 7 (43%) in whom the anastomosis was resutured, and 5 of 7 (71%) in whom repair was performed by advancing the ileal outlet and resuturing the anastomosis, healed their anastomosis. One patient was treated successfully by performing a fistulotomy. Treatment was unsuccessful in one patient in whom the ileal reservoir and ileoanal anastomosis were revised and re-anastomosed. One patient (50%) in group 2 was treated successfully by advancing the ileal outlet and resuturing the anastomosis. Complete healing of the anastomosis was achieved in 12 patients (50%), although 3 patients subsequently required excision of the reservoir because of inability to evacuate spontaneously (1), incontinence (1), or psychological reasons (1). All nine (38%) patients who were functioning with their ileal reservoir were continent. One patient intubated the reservoir. The rate of urgency and soiling, and the number of bowel movements per 24 hours did not differ significantly from those of patients without these anastomotic complications. Our results suggest that early diagnosis and repair of ileoanal anastomotic dehiscence by advancement of the ileal outlet and resuturing of the ileoanal anastomosis results in improved reservoir salvage and satisfactory functional results.

Abdominal Muscles↗
PubMed1988

The ileal reservoir and ileoanal anastomosis procedure. Factors affecting technical and functional outcome.

A retrospective review was undertaken to determine factors important in predicting functional results following the ileal reservoir and ileoanal anastomosis procedure. One hundred seventy-nine patients underwent ileal reservoir and ileoanal anastomosis at the University of Toronto between December 1981 and January 1987. One hundred sixty-three patients had ulcerative colitis, 11 had familial adenomatous polyposis, and five had Crohn's disease. A J-reservoir was constructed in 72 patients and an S-reservoir in 107 patients. Functional results were assessed in 102 patients who had their loop ileostomies closed for more than one year. The most significant technical complications were anal anastomotic leaks (10 percent), reservoir anastomotic leaks (3.9 percent), anal anastomotic stricture (7.8 percent), late fistula-inano (2.8 percent), small-bowel obstruction (19 percent), and loop ileostomy complications (23 percent). Overweight males and patients with operative blood loss greater than 1000 cc developed anal stricture more frequently (P less than .005). Patients who had a stapled J-reservoir had a higher rate of reservoir leak. The average number of bowel movements reported by patients for 24 hours was 6.2 +/- 3.1. Only ten (9.8 percent) patients had to intubate their reservoir to empty it. Urgency was experienced by 24 patients and soilage at night by 23 (22.5 percent) and during the day by 18 (17.6 percent). Seven patients (6.8 percent) were incontinent during the night and only one during the day. Pouchitis was reported in 16 patients (15.7 percent). Patients with anal anastomotic stricture had more urgency and pouchitis, and had to intubate their reservoir more frequently (P less than .05). No other factors analyzed affected technical or functional results.

Adolescent↗
PubMed1988

The effect of temperature on recombination activity in testes of rodents.

An extractable enzyme system capable of catalyzing recombination in vitro was described in murine spermatocytes [Hotta et al. (1985) Chromosoma 93, 140-151]. The system is specific to meiosis, its activity increasing 400-fold between the premeiotic S-phase and mid-pachytene. The present study examines the effect of temperature on this system since the elevation of testicular temperature is one of the major factors causing impairment of testicular function. A strong depression of in vitro recombination activity occurred immediately after raising the testicular temperature in vivo by translocating the testes into the abdominal cavity (cryptorchid). The in vitro study also showed that the extract from spermatocytes preferred lower temperatures (30-32 degrees C) than somatic cells (37 degrees C) for maximal activity of recombination. These results suggest that the strong depression of recombination activity may be an important factor which causes degeneration of testes by heat.

Animals↗
PubMed1988

Low-artifact intravascular devices: MR imaging evaluation.

Flow-phantom magnetic resonance (MR) imaging, with use of both spin-echo (SE) and gradient-echo (GRE) techniques at 1.5 T, was performed on the percutaneous Greenfield (beta-III titanium alloy [TMA wire]), Amplatz (MP32-N alloy), and Simon nitinol filters and TMA wire facsimiles of the bird's nest, Gunther, new retrievable, and Amplatz vena caval filters. SE imaging allowed detection of thrombi as small as 5 X 5 mm trapped within the percutaneous Greenfield, Simon nitinol, and TMA-wire facsimile filters; with the MP32-N Amplatz filter, a larger volume of thrombus (10 X 20-mm clots) was necessary for clot detection. GRE imaging allowed detection of intraluminal tilting of the percutaneous Greenfield and facsimile Amplatz (TMA-wire) filters. GRE imaging was useful for demonstrating postfilter turbulence due to clots, which was greatest for the Amplatz filter. Imaging of facsimile vascular devices made of tantalum or TMA wire did not cause the severe "black-hole" MR artifacts typical of the stainless-steel devices. SE and GRE imaging were very useful for determining caval patency in two patients with previously placed Mobin-Uddin filters. Noninvasive MR evaluation of blood vessels in the presence of a variety of low-artifact intravascular devices appears feasible.

Blood Vessel Prosthesis↗