Search PubMed⌕ Search

Biomedical subjects

I Cohn

Publications and source records attributed to I Cohn.

At least 37 records · Page 2Linked to original sources
PubMed1984

Pancreatic cancer.

Cancer of the pancreas remains a disease for which there is no satisfactory treatment. A specific population at risk and etiologic factors have not been clearly defined. The increased incidence in industralized countries over the past 30 to 40 years is not understood. Technological advances have permitted more frequent diagnosis at an early stage, but this has not influenced survival statistics. Clearly, there is a need for a reliable tumor marker that will allow diagnosis to be made even earlier. Radical surgery appears to have reached a plateau in terms of improving survival. Morbidity and mortality have decreased since pancreatoduodenectomy began to be widely used. This decrease is probably due to better pre- and postoperative surgical management than to major improvements in technique. More radical procedures have failed to demonstrate clearcut improvements in survival. Radiotherapy and chemotherapy are in the early stages of systematic exploration in treating pancreatic cancer. Most reports deal only with palliating advanced, nonresectable disease. The utility of radiotherapy and chemotherapy as adjuncts to surgery have not been defined.

Combined Modality Therapy↗
PubMed1983

Emergency autotransfusion: partial cleansing of bacteria-laden blood by cell washing.

Intraoperative autotransfusions for selected patients can ease demands on blood banks. In 33 cases (trauma, elective vascular, and cardiac procedures), we saved 80.7 L of blood with a cell washer blood recovery system (Cell Saver). In eight trauma cases, including three with intestinal perforation, cell washing salvaged 31.5 L of shed blood as a lifesaving emergency procedure. This stimulated interest in defining the limits of the instrumentation in cleansing blood of bacteria. In 18 in vitro experiments, discarded banked blood was inoculated with Escherichia coli to simulate light, moderate, or heavy bacterial contamination. Volumes of blood (500 ml) containing a total of 6.3 X 10(5), 4.8 X 10(7), or 3.2 X 10(10) bacteria were processed. The original blood, filtered blood, plasma supernate, effluent wash solution, and final washed packed red cells were cultured quantitatively in each experiment. The mean total number of E. coli retained in the final washed packed red cells was 1.4 X 10(5), 6.3 X 10(6), or 1.6 X 10(9) bacteria, or 23%, 13%, and 5% of each original inoculum. Additional washing with 10 L of saline did not remove significantly more bacteria (p greater than 0.20). Although emergency autotransfusion of blood contaminated with intestinal contents was lifesaving, we recommend caution since these results show that cell washing does not remove all bacteria. Further laboratory and clinical studies are needed to determine the levels of bacterial contamination of autotransfused blood that can be tolerated, and to determine adjunctive means of rendering contaminated or potentially contaminated blood safe for autotransfusion.

Blood↗
PubMed1982

Primary carcinoma of the gallbladder.

The records of patients with primary carcinoma of the gallbladder treated at Charity Hospital, New Orleans, Louisiana, from 1965 through 1978 were reviewed. Eighty patients had histologically proven primary carcinoma of the gallbladder. Sixty-nine patients had sufficient data available for evaluation. Only one patient (1.4%) was clinically free of disease at five years. Surgical procedures were performed in 45 of the 69 patients. The remainder of the patients had their disease proved at autopsy. Thirty-five patients had widespread metastatic disease at the time of operation. None of these patients survived more than one year. Only 10 patients had potentially curable lesions. The diagnosis of carcinoma of the gallbladder was not made at operation in eight of these patients. The only five-year survivor was in this subgroup. This patient had papillary adenocarcinoma confined to the mucosa and muscularis, and had a cholecystectomy alone. This report reinforces the difficulty in diagnosis and the dismal prognosis for patients with primary carcinoma of the gallbladder. Intraoperative examination of the gallbladder, earlier operation for documented gallbladder disease, and more aggressive surgical therapy should improve survival figures.

Adenocarcinoma↗
PubMed1982

Intestinal antisepsis.

The role of antibiotics in large bowel surgery was established by experimental studies indicating that antibiotics could protect a colonic anastomosis subjected to unusual stress. A number of different agents were studied to patients to determine which ones significantly altered the bacterial flora of the colon. Clinical studies were conducted with the agent of choice on the basis of these results. This paper describes a program for preparing patients for elective surgery of the colon.

Animals↗
PubMed1981

Mallory-Weiss syndrome. Review of 69 cases.

The records of patients treated for upper gastrointestinal bleeding from 1974 through 1978 were reviewed. Five percent of this group (69 patients) had bleeding due to the Mallory-Weiss syndrome. Only 36 percent of patients had a correct admitting diagnosis. Esophagogastroscopy proved the most reliable diagnostic tool, with 94 percent of 63 patients studied having the diagnosis of Mallory-Weiss laceration confirmed. Initial management was medical in all patients. Twenty-one patients (30 percent) required operative intervention. There was a good correlation between the transfusion requirement and the need for operation. There were two deaths in this series; both were considered preventable. The Mallory-Weiss syndrome is common. Esophagogastroscopy performed early can result in a diagnostic accuracy rate of greater than 90 percent. Aggressive nonsurgical therapy after early diagnosis should continue to reduce the role of operation in the treatment of this condition. However, if bleeding continues after initial medical management, or if bleeding continues after 1,500 ml of blood is required, then surgical therapy should be instituted without delay.

Adult↗
PubMed1980

Femoral anastomotic aneurysms.

Both the literature and this experience support host vessel degeneration as the primary etiologic factor in femoral anastomotic aneurysms. Associated factors that produce increased "intra-anastomotic tension," such as hypertension, superficial femoral artery occlusion, and flow turbulence, appear to contribute to vessel deterioration. Other factors, much less prevalent in present-day vascular surgery, such as rigid grafts, deficient suture material, inappropriate angle of incidence, and excessive tension on the graft can contribute to anstomotic disruption. Certain guidelines may be helpful in the management of femoral pseudoaneurysm. 1) Redo the entire anstomosis, rather than simply resuturing a disrupted edge. 2) Use minimal dissection to avoid injury to outflow vessels and to limit disruption of supportive tissue. 3) Use braided synthetic suture material. 4) Avoid tension by interposing a segment of graft between the proximal graft limb and the host vessel. 5) Use knitted Dacron for the interposed segment so the new anastomosis to the host vessel will be with softer, more pliable fabric. 6) Assure smooth adequate outflow by end-to-end anastomosis with a patch angioplasty or distal bypass. These guidelines should lead to a safe, reliable solution to one of the vexing complications of aortofemoral bypass procedure.

Aged↗
PubMed1979

Intraperitoneal povidone-iodine in experimental canine and murine peritonitis.

In dogs with appendicitis-peritonitis, intraperitoneal povidone-iodine caused death more rapidly than the instillation of saline solution. The bacterial content of canine peritoneal fluid increased with time. Although fewer bacteria were found in fluid from povidone-iodine-treated dogs, the differences were not statistically significant. Qualitative chemical analysis of peritoneal fluid revealed iodide, but not free iodine, 15 to 30 minutes after instillation of povidone-iodine. Iodine was present in the peritoneum at 2 hours but not at 3 or 6 hours. The antibacterial effect of povidone-iodine was demonstrated in mice challenged intraperitoneally with lethal doses of Escherichia coli. Povidone-iodine diminished mortality when injected immediately (p less than 0.005) but not when given 1 to 3 hours later. Immediate injection of povidone-iodine into mice lowered the number of E. coli by 3 logs. Injection of povidone-iodine 3 hours after bacterial challenge lowered the number of E. coli by only 1/3 log. This lesser bactericidal effect in mice is attributed to greater dispersal and sequestration of bacteria throughout the peritoneal cavity with time and with inactivation of povidone-iodine by reduction to iodide in vivo. In dogs with appendicitis-peritonitis, the more rapid death after treatment with povidone-iodine was not associated with differences in peritoneal microflora but with peritoneal absorption of excessive amounts of iodide.

Animals↗
PubMed1978

Adenocarcinoma of the stomach: review of 1,497 cases.

The records of 1,497 patients with histologically proven adenocarcinoma of the stomach were reviewed from Charity Hospital over the 25-year period, 1948 to 1973. The operability rate was 82% and the resectability rate was 48%. In this series gastric carcinoma predominated in males and Negroes. Necropsy studies indicate a similar frequency of involvement of various organs in patients not operated upon as well as those subjected to a prior operation, which suggests the need for some therapeutic endeavors aimed at a wider base than the primary organ. The five-year survival rate, 7.4 overall, varied from 2.0% after esophagogastrectomy to 22.1% after radical subtotal gastrectomy, and to 30.3% for those with localized disease. One hundred one patients survived five years or more, and 5.4% survived ten years or more after the diagnosis of gastric cancer. Radical subtotal gastrectomy gave the best results in this series, whether measured in terms of median survival, five-year survival, or operative mortality. Esophagogastrectomy and by-pass procedures had high mortality and low survival rates, and should be reserved for special conditions.

Adenocarcinoma↗