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Biomedical subjects

J C Gruenberg

Publications and source records attributed to J C Gruenberg.

28 records · Page 2Linked to original sources
PubMed1980

Peritoneal lavage in penetrating thoracic trauma.

Fifty-one patients with penetrating wounds of the thorax at or below the 4th intercostal space were evaluated with peritoneal aspiration and lavage. Nineteen gunshot wound and 32 stab wounds were studied and there was a 22% incidence of diaphragmatic penetration and/or intra-abdominal injury. There were ten true positive and one false positive study. There were 39 true negative and one false negative lavage. Peritoneal aspiration and lavage is a test of high sensitivity (91%) and specificity (98%). It has proven to be a useful screening technique in patients with penetrating wounds of the thorax. Peritoneal aspiration and lavage identify the patients with diaphragmatic penetration and intra-abdominal injury and minimize negative exploration.

Abdominal Injuries↗
PubMed1976

Percutaneous adrenal suppression with topically applied corticosteroids.

Synthetic fluorinated derivatives of cortisone, when topically applied, are absorbed readily and may suppress adrenal function. In the case presented here, large quantities of topically applied triamcinolone acetonide were used in the treatment of atopic dermatitis. This caused a noticeable decrease in the plasma cortisol level. That this was the result of adrenal suppression rather than insufficiency was indicated by a satisfactory response of the plasma cortisol levels to a cosyntropin injection test. In patients with a history of recent and extensive use of topically applied corticosteroids, appropriate diagnostic and therapeutic measures are indicated to avoid postoperative adrenal insufficiency.

Adrenal Cortex Hormones↗
PubMed1975

Inherited antithrombin-III deficiency causing mesenteric venous infarction: a new clinical entity.

Primary superior mesenteric venous thrombosis is sometimes preceded by peripheral thrombophlebitis. Inherited antithrombin-III deficiency is a recently recognized autosomal dominant trait, which is characterized by thrombophlebitis and pulmonary embolism. This case report illustrates many features of both entities and strongly suggest a causal relationship. While long-term therapy has yet to be established, prophylactic therapy is recommended when asymptomatic individuals with known antithrombin-III deficiency are at increased risk of thrombosis. The efficacy of heparin alone has been unreliable, whereas Coumadin has been encouraging. Antithrombin-III concentrates are being developed and theoretically should be helpful. Patients with thrombophlebitis or pulmonary embolism should be suspected of having antithrombin-III deficiency. Such individuals also represent one mechanism to explain "primary" mesenteric venous thrombosis.

Adult↗
PubMedDate not supplied

Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical considerations for improved outcome.

Experience with several incarcerations that resulted in emergent surgery for children with known indirect inguinal hernias prompted this review to determine if there is an optimal time after hernia diagnosis during which elective repair should be undertaken to avoid incarceration. Over a 30 month period, 228 children less than 10 years of age underwent 303 indirect inguinal hernia repairs. They were analyzed for age, sex, interval between diagnosis and repair, predisposing conditions, major complications, and length of hospitalization. Excluded were 21 children who presented with incarceration of a previously undiagnosed indirect inguinal hernia that required operative reduction, 13 children with conditions predisposing to indirect inguinal hernia, and 53 children for whom the interval between diagnosis and repair was unknown, leaving a study group of 141 children who underwent 190 indirect inguinal hernia repairs. Nearly 13% (18 of 141) of the children developed incarcerated hernia prior to elective repair. Compared to children who underwent repair of a reducible indirect inguinal hernia, those with incarceration were more likely (p less than 0.05): 1) to have major complications (11% vs 0.6%), 2) to have a shorter interval between diagnosis and repair (26 vs 49 days), 3) to be younger (7.5 vs 25.6 mos), and 4) to require greater than 24 hours of hospitalization. Had children with reducible incarcerated indirect inguinal hernia been hospitalized and undergone repair 24 to 48 hours later, 83% of subsequent incarcerations would have been prevented. Furthermore, this experience supports the recommendation that for healthy children less than 10 years of age, indirect inguinal hernia repair should be performed on a semi-elective basis within 7 days of diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMedDate not supplied

Pneumatosis intestinalis: a clinical classification.

Review of our experience with pneumatosis intestinalis has allowed identification of three major clinical groups of patients. In each of these groups, the etiology of pneumatosis intestinalis usually can be identified, and it frequently has an ominous prognosis. Treatment should be directed to the underlying condition when possible, and hence must be individualized. Those patients who would be categorized as Group I can simply be kept under observation. Patients in Group II might obtain relief from breathing increased concentrations of oxygen. For patients in Group III vigorous therapeutic measures generally are necessary to ensure survival. The increasing use of mechanically controlled ventilation and positive end-expiratory pressure may be contributing to the incidence of pneumatosis intestinalis. The ileus sometimes observed in these patients may accompany or precede the development of intramural air, a condition identifiable on roentgenographic examination. Awareness of the possible presence of intramural air may help in identifying patients who may not need operation. But even when roentgenographic examination has confirmed the presence of intramural air, abdominal exploration still may be necessary to rule out a diagnosis of perforated viscus. We hope that these concepts and our emphasis upon individualization of treatment may improve the prognosis for patients who have pneumatosis intestinalis.

Adolescent↗
PubMedDate not supplied

Chronic acalculous cholecystitis: changes in patient demographics and evaluation since the advent of laparoscopy.

BACKGROUND AND OBJECTIVE: To analyze patients with chronic acalculous cholecystitis over ten years, during which laparotomy was replaced by laparoscopy as the dominant operation for cholecystectomy in regard to patient demographics, diagnostic evaluations, follow-up symptoms, and additional operations. METHODS: Of 7181 cholecystectomies from June 1985 to June 1995, 301 patients had chronic acalculous cholecystitis. All subsequent hospital admissions and emergency room visits were reviewed through May 1997. Office records were available for review in 158 cases. Two eras were defined, the open era from June 1985 through May 1990, and the laparoscopic era from June 1990 through June 1995. RESULTS: Twice as many patients with chronic acalculous disease underwent cholecystectomy after the advent of laparoscopy. Patients with chronic acalculous disease were significantly younger than patients with cholelithiasis in both open and laparoscopic cases. The percentage of white women increased from 64.7% in the open to 75.7% in the laparoscopic era (p<0.05). The numbers of preoperative diagnostic tests performed decreased from 4.7+/-2.4 in the open to 3.2+/-1.8 in the laparoscopic era (p<0.05). Twenty-two percent of patients had continued symptoms postoperatively, and 8 patients (2.7%) required other abdominal operations within one year of cholecystectomy. CONCLUSION: Chronic acalculous cholecystitis is a disease of white females, doubling in frequency over the decade of review. Of these, 78% of patients had resolution of their symptoms on long-term follow-up.

Adolescent↗
PubMedDate not supplied

"AEIOU: the ABC's" of conversion from laparoscopic to open cholecystectomy.

BACKGROUND AND OBJECTIVES: To examine and classify the reasons for conversion and the points at which laparoscopic cholecystectomies are converted to open procedures and whether these change over time. METHODS: This is a retrospective study of all patients undergoing cholecystectomy from June 1, 1990 to June 30, 1995. Reasons for conversion were classified using the "AEIOU:ABC" system developed for this study and conversion points were assigned chronologically. RESULTS: The "AEIOU:ABC" classification system was utilized. The most common reasons for conversion were: acute inflammation N = 61 (26.1%); adhesions N = 51 (21.8%); and organ system pathology N = 39 (16.7%). The most common conversion points were; after visualization of the peritoneal cavity but prior to dissection of the cystic structures N = 103 (44.0%); dissection of the cystic structures N = 58 (24.8%); initial laparoscopy N = 36 (15.4%). When the reasons for conversion were evaluated for changes over time there was no statistically significant change for the total group or any individual surgeon. Conversion points did not change with increasing operative experience. CONCLUSION: The "AEIOU:ABC" classification system is a simple, effective and easy to use system for classifying the myriad of reasons for conversion. The system needs to be validated prospectively not only for laparoscopic cholecystectomy but for possible application to other laparoscopic procedures.

Cholecystectomy↗