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Biomedical subjects

J A Singer

Publications and source records attributed to J A Singer.

18 recordsLinked to original sources
PubMed1992

Axillary versus combined axillary and pectoral drainage after modified radical mastectomy.

Initial attempts to obliterate dead space and minimize fluid accumulation in patients after mastectomy using closed suction drainage, used insertion of a single axillary drain. Today, surgeons often insert two drains in the postoperative wound, one in the axilla and the other beneath the pectoral flaps. The current study was done to determine whether or not there is an advantage in using two drains rather than a single axillary drain after mastectomy. A randomized, clinical trial was conducted with 84 women undergoing modified radical mastectomy. Thirty-seven patients had one axillary drain and 47 had two drains placed postoperatively, one in the axilla and the other beneath the pectoral flaps. Follow-up results were obtained four weeks postoperatively for complication data, including seroma and hematoma formation, flap necrosis and infection. The average total drainage was 870.4 milliliters per patient in the group with one drain and 997.4 milliliters per patient in the group with two drains (p value not significant). The overall complication rate in the group with one drain was 35.0 percent compared with a rate of 31.9 percent for all complications observed in the group with two drains. These differences did not reach statistical significance. Comparing the frequency of each complication in the two groups again showed no significant difference. However, the data suggest a trend toward an increased incidence of flap necrosis in the group with two drains that used a drain beneath the pectoral flaps. Use of a single axillary drain after modified radical mastectomy seems to result in no increase in postoperative complications, is less costly and may assist in reducing the incidence of flap necrosis.

Adult↗
PubMed1992

Subtotal colectomy as a last resort for unrelenting, unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases.

A 7-year experience involving 12 cases of massive, unrelenting lower gastrointestinal hemorrhage is presented. In these patients, the bleeding could not be localized by multiple diagnostic modalities and was managed by blind subtotal colectomy. While the procedure was efficacious in arresting bleeding in all cases, a resultant mortality of four cases (33%) ensued. Morbidity among the survivors was significant. Only three patients (25%) survived without complications, which enabled an early discharge from the hospital. Diverticulosis was the most common cause (83%) of uncontrollable and preoperatively undiagnosed bleeding in this group of patients. These 12 cases of blind subtotal colectomy for massive lower gastrointestinal bleeding represent one of the larger series in the literature. These data are consistent with more recent reports that indicate that subtotal colectomy for lower gastrointestinal bleeding is an effective but a formidable procedure. This is contrary to the earlier published results.

Aged↗
PubMed1991

Frown incision for minimizing induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation.

A new technique, the frown incision, was developed and a series of 62 eyes with 6 mm and 7 mm incisions for intercapsular phacoemulsification and implantation of a 6 mm or 7 mm one-piece biconvex poly(methyl methacrylate) (PMMA) posterior chamber intraocular lens with single horizontal mattress suture closure was prospectively evaluated for induced astigmatism. A prior series of 34 eyes that had a similar procedure with 6 mm and 7 mm standard scleral pocket incisions closed with an infinity suture or a horizontal running single-knotted suture containing three loops was retrospectively reviewed and compared with the frown incision trial. Vector analysis calculations of diopters (D) of mean induced keratometric astigmatism for the frown incision versus the scleral pocket incision groups were 0.80 D versus 1.19 D (P = .0263) at one day; 0.74 D versus 1.03 D (P = .0547) at one week; 0.71 D versus 1.07 D (P = .0057) at four weeks; 0.84 D versus 1.15 D (P = .0072) at six months; 0.82 D versus 1.30 D (P = .0144) at one year. The frown incision group consistently had a lower standard deviation from the mean induced astigmatism than the scleral pocket incision group. Using regression analysis and Pearson product-moment correlations, the frown incision group had a higher degree of linear dependence of postoperative astigmatism on preoperative astigmatism. Recent modifications of the frown incision have reduced its chord length for insertion of any given optic size. Results suggest that the frown incision may provide many of the benefits of a 4 mm scleral pocket incision for flexible optic lenses.

Astigmatism↗
PubMed1987

Insulinoma and gastrinoma in Wermer's disease (MEN I).

The association of gastrin- and insulin-producing tumors of the pancreas is rare. In the 30 years' experience of Zollinger and others, of 40 patients with gastrinoma none had insulin-producing tumors. In contrast to patients with Zollinger-Ellison syndrome, of whom 15% to 26% are classified as having multiple endocrine neoplasias type I (MEN I), only 3% to 4% of patients with insulinomas have other endocrine neoplasms. Insulinomas in patients with MEN I are usually single tumors that usually can be cured with enucleation of the tumor. In contradistinction, gastrinomas in patients with MEN I are diffuse in nature and resection only rarely can be accomplished. Long-term management of gastric hypersecretion is best accomplished by H2-receptor antagonists. If the patient does not respond to H2-receptor antagonists or is unwilling to take the drug indefinitely, he or she will be a candidate for total gastrectomy.

Adenoma, Islet Cell↗
PubMed1987

Red blood cell homeostasis: recognition of distinct types of damaged homologous red blood cells by a mouse macrophage cell line.

The mouse macrophage (M phi) cell line IC-21 preferentially ingests a subpopulation of homologous red blood cells (MRBC) from normal mice. This subpopulation presumably bears the so-called transfusion lesion, a consequence of damage acquired during the drawing and processing of blood. To determine if all damaged MRBC were recognized by a common receptor site on IC-21 M phi, we prepared suspensions of MRBC damaged in vitro by treatment with tannic acid and compared the phagocytic uptake of these cells with those bearing the transfusion lesion. Trypsin treatment of IC-21 M phi rendered them unable to recognize MRBC bearing the transfusion lesion; but it had no effect on the uptake of tannic acid-damaged MRBC, showing that IC-21 M phi have separate recognition sites for these two populations of damaged MRBC.

Animals↗
PubMed1987

Diverticular disease of the cecum and ascending colon. A review of 881 cases.

A total of 881 cases of diverticula of cecum and the ascending colon were reviewed, including 30 new cases at the authors' institution. The average patient age was 43.6 years. The preoperative diagnosis was correct in only 7 per cent of the cases. Appendicitis accounted for 68 per cent of the preoperative diagnoses. Even at the time of surgery, the diagnosis was correct in only 58.7 per cent. Carcinoma was incorrectly diagnosed in 37.2 per cent. Operative procedures varied markedly. Diverticulectomy was performed in 28.2 per cent of the cases, 3.6 per cent had invagination of the diverticula, and 37.6 per cent had right hemicolectomy. The overall mortality rate was 2.5 per cent. The authors advocate local resection of the diverticulum, when possible, and a right hemicolectomy or segmental resection when the diagnosis is in doubt or when local resection or invagination will jeopardize the ileocecal valve or the blood supply to the intestine.

Adolescent↗
PubMed1987

Mesenteric cysts.

Mesenteric cysts continue to be of special interest because of their diverse presentation and the lack of definitive diagnostic tests. Nine patients with mesenteric cysts were treated at St. Agnes Hospital between 1973 and 1984. The most common location was in small bowel mesentery (67%) followed by the mesocolon (33%). The mesenteric cysts were incidental findings in four of the nine patients (45%). Enucleation was the treatment of choice in eight patients (88%), followed by right hemicolectomy in one patient. Two patients had complications, one wound infection and one urinary tract infection. Simple enucleation has proven to be adequate treatment in most instances. Large bowel resection may be necessary when mesenteric cysts are located in the mesocolon and enucleation is not feasible without compromising the blood supply to the adjacent bowel.

Adolescent↗
PubMed1986

Erythrocyte homeostasis: antibody-mediated recognition of the senescent state by macrophages.

We tested the hypothesis that the accumulation of bound autologous antibody on a "senescent epitope" identifies aged erythrocytes for phagocytic removal by macrophages. Erythrocytes were collected from mice maintained on a hypertransfusion protocol designed to yield cells of defined age. The mouse erythrocytes were assayed for the presence of bound antibody by measuring their susceptibility to ingestion by macrophages from mouse peritoneal exudates and by flow cytofluorometry. Both assays disclosed that only the oldest mouse erythrocytes bore detectable levels of antibody. Flow cytofluorometric analysis revealed that the frequency distribution of IgG isotypes bound to the cells reflected their levels in normal serum. Finally, treatment with trypsin abolished the ability of the macrophages to ingest erythrocytes aged in vivo. These findings support the hypothesis that antibody mediates the clearance of senescent mouse erythrocytes from the circulation and demonstrate that the presence of a trypsin-sensitive recognition structure on macrophages is an essential requirement in this homeostatic process.

Animals↗
PubMed1978

Gastric ulcer: the importance of follow-up care.

One hundred forty-four gastric ulcer patients in an inner city hospital were studied retrospectively over a five year period. Emphasis was placed on patient follow-up after discharge. The length of hospitalization and the mortality were higher for the surgical group; however, the recurrence rate was higher in the medically treated group. Almost half the patients were followed for less than six months. Reasons are given for this poor follow-up. The high recurrence rates necessitate close follow-up for a prolonged period.

Female↗
PubMed1978

Hepatic failure and death from erythropoietic protoporphyria.

A 60-year-old white male presenting with a clinical picture of obstructive jaundice was subsequently found to have erythropoietic protoporphyria. The diagnosis was suspected because of a history of life-long photosensitivity and was confirmed by finding high levels of erythrocyte protoporphyrin. Liver biopsy revealed birefringent deposits of protoporphyrin by polarization microscopy accompanied by severe hepatic injury and fibrosis. The patient died rapidly from liver failure, and at autopsy the biliary tree was patent. Despite the autosomal dominant transmission of erythropoietic protoporphyria, we failed to detect any family members with the disease. This report is concluded with a brief discussion of the liver involvement in erythropoietic protoporphyria.

Cholestasis↗
PubMed1977

Cirrhotic pleural effusion in the absence of ascites.

A 61-year-old female presented with a right transudative pleural effusion in the absence of ascites and other stigmata of chronic liver disease. A diagnosis of cirrhosis with a secondary hydrothorax was eventually established; however, ascites could never be demonstrated clinically or radiographically until just before her death, when hypertonic saline was administered for symptomatic hyponatremia. Based on the autopsy finding of a 1-mm hole in the right diaphragm and her clinical course, a mechanism for the production of a cirrhotic pleural effusion in the absence of asictes is proposed.

Ascites↗
PubMed1976

Ridge at internal edge of cataract incision.

A white ridge that resembled an inverted snowbank and protruded into the anterior chamber from the region of the internal lips of the cataract incision was visualized gonioscopically during and after cataract operation. Its clinical apearance and course are delineated and documented, and its importance in relation to the formation of postoperative peripheral anterior synechiae, vitreous adhesions, and hyphemas is discussed.

Cataract Extraction↗
PubMed1975

Effect of metabolic state on phytohemagglutinin-P agglutination of normal human erythrocytes.

A reproducible quantitative assay for the lectin-mediated agglutination of human erythrocytes, depending on different rates of settling of agglutinated and nonagglutinated erythrocytes, was developed. This assay was used to study the aggregation of human erythrocytes by phytohemagglutinin-P. The aggregation of human erythrocytes by phytohemagglutinin-P was found to depend upon the metabolic state of the cells. Metabolically depleted erythrocytes agglutinated much less readily than did similar cells supplied with adenosine. This was not due to swelling and rigidity of the cells, since erythrocytes in hypotonic solution did not exhibit significantly altered phytohemagglutinin-P agglutination. Metabolically depleted erythrocytes, or erythrocytes from blood stored 8 weeks, lysed and resealed in the presence of ATP, were agglutinated by phytohemagglutinin-P to a much greater extent than control samples without ATP. The presence of Mg2+, either alone or with ATP, had little effect on the agglutinability of the resealed membranes. Low concentrations of Ca2+ (0.2 mM) had little effect on agglutinability, although high Ca2+ (5 mM) inhibited agglutinability of the resealed membranes somewhat. Both metabolically depleted erythrocytes and depleted erythrocytes, previously treated with adenosine, when treated with trypsin released similar amounts of sialic acid. The agglutinability of the trypsinized adenosine-supplemented cells increased more readily than did that of trypsinized metabolically depleted cells. The agglutination of erythrocytes was not affected by cytochalasin B (40 mug/ml). Vinblastine (0.2 mM) caused depleted erythrocytes to agglutinate similarly to adenosine-supplemented erythrocytes, but had no effect on the agglutination of adenosine-supplemented erythrocytes. It is concluded that ATP in the human erythrocyte probably participates in the modulation of phytohemagglutinin-P agglutinability. This is not a consequence of the more rigid membrane known to accompany ATP depletion in the erythrocyte, or of the effect of ATP levels on Ca2+ or Mg2+ content. It appears likely that ATP modulates human erythrocyte phytohemagglutinin-P agglutinability through interaction, direct or indirect, with a membrane-associated component, which might also be sensitivie to vinblastine.

Adenosine↗
PubMedDate not supplied

Further studies on the ridge at the internal edge of the cataract incision.

A pathologic and experimental study of the etiology and morphology of the ridge, visible gonioscopically in the region of the internal lips of the cataract incision during and after the cataract operation, is described. The ridge observed clinically cannot be reproduced in human eye-banks eyes but can be reproduced in vivo in the eye of the owl monkey. Histopathology and ultramicroscopic studies of these experimental eyes, together with evidence derived from histopathologic slides of postmortem human eyes, suggest that the ridge is probably the result of immediate edematous swelling of the deeper layers of the corneal stroma after the incision transects corneal endothelium and the Descemet membrane. While internal wound lip malapposition may be a contributing factor to formation of the ridge, it is probably not an essential component. The ridge is not caused by the incision-closing sutures for it is already present prior to suturing of the wound. The role in ridge formation of mechanical stress alterations produced immediately by the incision is considered but is not known.

Animals↗