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Biomedical subjects

H Stern

Publications and source records attributed to H Stern.

At least 91 records · Page 5Linked to original sources
PubMed1988

Rectovaginal fistula: initial experience.

Rectovaginal fistulas are not common, but the associated symptoms can be emotionally and physically disabling. The authors report their experience of 10 patients with a diagnosis of rectovaginal fistula, seen between December 1982 and July 1986. The women ranged in age from 28 to 74 years. All complained of passing feces or flatus, or both, through the vagina. In the majority of cases, fistulas were present for longer than 6 months before surgical repair. The fistulas were due mainly to trauma. Endorectal advancement flaps were used in seven patients with excellent results. Small fistulas due to obstetric trauma may heal spontaneously, so in these cases a 6-month waiting period before operation is recommended. However, fistulas due to inflammatory bowel disease will not heal spontaneously and should be repaired as soon as the patient's condition is optimal.

Adult↗
PubMed1987

A stapled S-shaped ileoanal reservoir.

An S-shaped ileoanal reservoir has the advantage of greater ease in obtaining adequate length for safe anastomosis vs. the J-pouch. The hand-sewn S-shaped pouch, however, takes considerably longer (70 vs. 20 minutes) to construct than either a hand-sewn or stapled J-pouch. Because of potential necrosis of the central bridge of tissue created between two longitudinal stapled lines in an S-pouch, the same techniques of stapling a J-pouch cannot be used in an S-pouch. The authors have developed a safe, rapid, stapling technique for construction of an S-pouch in the dog and have used it with success in four patients.

Anal Canal↗
PubMed1987

Effect of two potent calmodulin antagonists on calcium transport of brush border and basolateral vesicles from human duodenum.

In the present in-vitro study we investigated the possible role of the calmodulin-antagonistic drugs loperamide and calmidazolium in the regulation of transepithelial Ca2+ transport of human duodenum. Brush border membrane vesicles and basolateral membrane vesicles were simultaneously prepared from surgically resected pieces of morphologically intact human duodenum with a modified Percoll-gradient centrifugation method. Brush border and basolateral membrane vesicles were characterized using enzyme marker analysis and electron microscopy: alkaline phosphatase was enriched 20-fold in brush border membrane vesicles, whereas [Na+ + K+]-stimulated adenosine triphosphatase was enriched 15-fold in basolateral membrane vesicles. Calmodulin activity was determined by a specific radioimmunoassay after solubilizing brush border and basolateral membrane vesicles in 1% Triton X-100. In basolateral membrane vesicles, we found no calmodulin activity. In brush border membrane vesicles calmodulin activity was impaired by 50% after pre-incubation with loperamide or calmidazolium. We measured calcium, sodium, D-glucose and D-mannitol uptake with a rapid filtration technique. Before the transport experiments, brush border and basolateral membrane vesicles were pre-incubated with 5 microM loperamide or 5 microM calmidazolium for 60 min at 5 degrees C. In drug-pretreated, brush border membrane vesicles calcium uptake was significantly reduced after 1 min incubation (-25% +/- 5%, P less than 0.05); this effect was completely reversed in the presence of 5 microM calmodulin. In basolateral membrane vesicles, we found two Ca2+ transport systems: (1) Na+/Ca2+ exchange and (2) ATP-dependent Ca2+ transport. In basolateral membrane vesicles loperamide had no effect. Calmidazolium had no effect on Na+/Ca2+ exchange, but significantly inhibited ATP-dependent Ca2+ transport. This effect could not be reversed by calmodulin.

Biological Transport, Active↗
PubMed1987

Effect of inhibitors on sodium and chloride transport in brush border vesicles from human jejunum and ileum.

Brush border vesicles were isolated from surgically resected pieces of human jejunum and ileum using a Mg2+/EGTA precipitation method. When compared to the homogenate, the final membrane preparation contained alkaline phosphatase at a 14 times higher concentration and almost no (Na++K+)-stimulated adenosine triphosphatase. An Na+/H+ antiport could be demonstrated in the jejunum by imposing a pH gradient between the interior and the outside of the vesicles (pHinside 5.2, pHoutside 7.2). In the presence of amiloride or harmaline, Na+/H+ antiport was inhibited by 60 +/- 5% (p less than 0.05) or 65 +/- 5% (p less than 0.05), respectively. In vesicles of human ileum we found an Na+/H+ antiport and in contrast to the jejunum a Cl-/OH- antiport could be demonstrated by imposing a pH gradient (pHinside 5.2, pHoutside 7.2). Besides this double-exchange mechanism for sodium and chloride, a Na+/Cl- cotransport and a Cl- conductive pathway could be detected in ileal brush border vesicles. In the presence of the anion transport inhibitors, furosemide, SITS and DIDS activities of Cl-/OH- antiport and Na+/Cl- cotransport were suppressed by 30 +/- 5% (p less than 0.05), 35 +/- 5% (p less than 0.05) and 40 +/- 5% (p less than 0.05), respectively. We conclude that absorption of sodium and chloride in the absence of organic solutes is mediated through different transport mechanisms at the luminal plasma membrane, which are in part subject to regulation by sodium and chloride transport inhibitors.

Biological Transport, Active↗
PubMed1987

Effect of the somatostatin analogue SMS 201-995 on ATP-dependent calcium transport of basolateral vesicles from human duodenum.

Brush border membrane vesicles (BBMV) and basolateral membrane vesicles (BLMV) were simultaneously prepared from surgically resected pieces of morphologically intact human duodenum with a modified Percoll gradient centrifugation method. Alkaline phosphatase was enriched 20-fold in BBMV, whereas (Na+ + K+)-stimulated adenosine triphosphatase was enriched 15-fold in BLMV. BBMV and BLMV were preincubated with 3 microM synthetic somatostatin-14 or 3 microM SMS 201-995 for 10 min at 5 degrees C. In BBMV calcium, sodium, D-glucose, L-alanine, and D-mannitol uptake was unaffected by somatostatin-14 and SMS 201-995. In BLMV we found two Ca++ transport systems: Na+/Ca++ exchange and ATP-driven Ca++ transport. Somatostatin-14 had no effect on either of the two transport mechanisms. SMS 201-995 had no effect on Na+/Ca++ exchange but significantly inhibited basolateral ATP-dependent Ca++ transport (-40% +/- 5%, p less than 0.005).

Adenosine Triphosphate↗
PubMed1987

[Coronary insufficiency in type II aortic dissection].

After coronary sclerosis, aortic dissection represents an important differential diagnosis in the evaluation of acute thoracic pain. We report on a 55-year-old patient with aortic dissection, type II, in whom the diastolic collapse of the true aortic lumen was verified by angiography and transesophageal echocardiography. The collapse led to a temporary perfusion deficit of the left coronary artery with clinical symptoms and ECG changes. Clinical symptoms, additional diagnostic procedures and follow-up of this patient, as well as the value of transesophageal echocardiography, are presented.

Aortic Dissection↗
PubMed1987

Ambulatory procedures in anorectal surgery.

In view of the broad spectrum of conventional and unconventional STDs in the homosexual man, the following diagnostic workup is recommended: History. Physical examination, including proctosigmoidoscopy with biopsy. Urethral, pharyngeal, and rectal cultures. Darkfield examination of any genital ulceration. Stool cultures for bacteria and parasites. Serologic analysis, including VDRL and, where indicated, for Chlamydia trachomatis and amebiasis. It is an essential part of proctologic practice for the surgeon to be able to recognize, diagnose, and treat sexually transmitted diseases.

Ambulatory Surgical Procedures↗
PubMed1987

Repair of anorectal incontinence in an adolescent boy with neonatal anal atresia.

Fecal continence, the ability to retain intestinal contents until evacuation is desired, requires the complex interaction of several factors. They include: the motor action of the sphincters, sensibility of skin and sphincters and function of the rectum and central nervous pathways. Appropriate and effective management is available to treat many disorders of continence. However, the success of these treatments depends on careful delineation of the various contributing factors. The authors present the case of an 18-year-old boy with disabling fecal incontinence, secondary to neonatal anal atresia and its primary management, in order to illustrate the importance of careful assessment of each of the contributing factors. His staged surgical treatment has been successful in returning him to a more normal state.

Adolescent↗
PubMed1987

Surgical treatment of anal incontinence.

The records of 18 consecutive patients operated upon for fecal incontinence between January 1983 and March 1986 were reviewed. Anterior sphincteroplasty was performed on 11 patients with direct sphincter trauma. The results were excellent in eight, fair in two and poor in one. A postanal repair was performed on seven patients, with excellent results only in two, fair in four and poor in one. The indications for surgery and the results were assessed clinically and manometrically. A careful classification of the physiologic and anatomic derangements of the anal sphincter aids in the appropriate selection of candidates for surgical treatment. In general, anterior sphincteroplasty gives good results, whereas results of postanal repairs are less satisfactory. Manometry is of some use in providing objective measurements.

Adolescent↗
PubMed1987

Functional defect of zinc transport in patients with Crohn's disease.

In the present study, we investigated the question whether the zinc deficiency in Crohn's disease is, at least partly, related to defective zinc entry at the jejunal brush border membrane. Brush border membrane vesicles (BBMV) were prepared from surgically resected pieces of morphologically intact human jejunum by a Mg++ precipitation method. We studied zinc, D-glucose, sodium and D-mannitol uptake into BBMV in 27 patients: 1) 20 patients with Crohn's disease 2) 7 controls. In 8/20 patients with Crohn's disease we found a significant decrease in zinc uptake (-25% +/- 5%, p less than 0.05) into BBMV. This impairment of zinc uptake in 40% of our patients with Crohn's disease was not associated with changes in the transport rates for D-glucose, sodium or D-mannitol. In addition no differences in enzyme marker concentrations or electron microscopic appearance were found.

Biological Transport↗
PubMed1986

An early marker of fetal infection after primary cytomegalovirus infection in pregnancy.

Fourteen patients with primary cytomegalovirus infection diagnosed by serological screening at antenatal attendances were examined for their responses in the lymphocyte transformation test against cytomegalovirus. Tests were done during pregnancy, shortly after the diagnosis of primary infection. Eight women showed positive lymphocyte transformation responses and gave birth to uninfected babies. Six showed negative responses and four of the babies were born congenitally infected. Cellular immunity therefore plays a part in preventing intrauterine transmission of cytomegalovirus, and its depression after primary infection in the mother during pregnancy may be used as an early marker of fetal infection.

Adolescent↗