Search PubMed⌕ Search

Biomedical subjects

J J Greenberg

Publications and source records attributed to J J Greenberg.

At least 19 recordsLinked to original sources
PubMed1997

The effects of different corticosteroids on the healing colon anastomosis and cecum in a rat model.

Corticosteroids are known to adversely affect wound healing in experimental skin models; however, their effect on healing colonic anastomoses is still disputed. Different steroids have not been compared to each other in the same study. We studied the effect of equipotent doses of dexamethasone, hydrocortisone, and methylprednisolone on healing colon anastomoses in a rat model. High-dose steroid therapy was started 2 days prior to the operation and continued until the bursting pressures were measured at 5 and 7 days after the surgery. Anastomotic bursting pressure was not decreased for any of the steroid treatments when compared to the control, but the frequency of anastomotic rupture in the dexamethasone group at day 5 was significantly higher than either of the other steroid groups or the control group (P < 0.01). Bursting pressures of the intact cecum were lower in all the steroid-treated groups compared with the control group. We concluded that dexamethasone slows the rate of wound healing, but short-term high-dose steroid therapy does not decrease the strength of the anastomoses as measured by bursting pressure.

Adrenal Cortex Hormones↗
PubMed1996

Appendicitis after laparoscopic appendectomy: a warning.

Surgical options for appendicitis have increased, just as they have with cholecystitis. The laparoscope can now be utilized in place of the standard open operation for treatment of appendicitis. Like laparoscopic cholecystectomy, laparoscopic appendectomy can be associated with increased morbidities, not usually seen with open surgery. We present a case of the unusual complication of recurrent appendicitis in a generous appendiceal remnant after laparoscopic appendectomy.

Adult↗
PubMed1995

Breast-feeding in a low-income population. Program to increase incidence and duration.

OBJECTIVE: To evaluate the efficacy of an intervention program to increase breast-feeding in a low-income, inner-city population. DESIGN: A randomized, nonblinded clinical control trial. Patients were followed up through pregnancy, delivery, and the first year of the infant's life or until the time of weaning from the breast, whichever came first. SETTING: The ambulatory care center for prenatal and pediatric care and the inpatient maternity unit of a primary care center that serves a low-income, inner-city population. PATIENTS: There were a total of 108 patients: 51 were randomized to the intervention group that received prenatal and postnatal lactation instruction from a lactation consultant, and 57 were randomized to the control group that received the standard of care at the institution. Patients in the control group were not seen by the lactation consultant. The two groups were similar demographically. INTERVENTION: This program consisted of individual prenatal lactation consultation, daily rounds by the lactation consultant on the postpartum unit, and outpatient follow-up at 48 hours after discharge, at the time that the infant was 1 week of age, and at all future health supervision visits for infants up to 1 year of age. MAIN OUTCOME MEASURES: The incidence and duration of breast-feeding. RESULTS: There was a markedly higher incidence of breast-feeding in the intervention group, as compared with that of the control group (61% vs 32%, respectively; P = .002). The duration of breast-feeding was also significantly longer in the intervention group (P = .005). CONCLUSIONS: This lactation program increased the incidence and duration of breast-feeding in our low-income cohort. We suggest that similar efforts that are applied to analogous populations may increase the incidence and duration of breast-feeding in low-income populations in the United States.

Adult↗
PubMed1995

Rupture of the deep femoral artery from blunt trauma.

Massive hemorrhage from the deep femoral artery is an uncommon entity in the setting of blunt extremity trauma without femur fracture. A case of deep femoral artery injury causing massive hemorrhage treated by angiographic embolization is reported. In this patient, persistent unexplained hypotension warranted angiographic analysis of a pelvic fracture. Because of a swollen right thigh, the negative pelvic angiogram was extended to include the lower extremity, confirming the diagnosis of a ruptured branch of the deep femoral artery. Bleeding was controlled with embolization that promptly resolved the patient's hemodynamic instability. The salient feature in common with previous reported cases of deep femoral artery injury was hemodynamic instability beyond accountable blood loss. We recommend angiographic analysis with radiological and surgical intervention in the setting of thigh swelling without femur fracture and unexplained hypotension. This management strategy was well tolerated, and the patient received minimal transfusions.

Acetabulum↗
PubMed1989

Radiographic diagnosis, surgical treatment, and long-term follow-up of cholesterol granulomas of the petrous apex.

Cholesterol granuloma is an unusual lesion of the petrous apex. Accurate preoperative differentiation of the various lesions of the petrous apex by computed tomography scanning only has been difficult. We reviewed the clinical findings, computed tomography and magnetic resonance imaging scans, surgical approaches, and long-term follow-up in 10 patients with cholesterol granuloma of the petrous apex who were seen between 1971 and 1988. Headache and deficits of the 5th, 6th, 7th, and 8th cranial nerves were common presenting symptoms. Magnetic resonance imaging with special imaging techniques was accurate in diagnosing cholesterol granuloma in four patients preoperatively and three patients prior to revision surgery. The optimal surgical approach was chosen on the basis of clinical and radiographic findings and included the transsphenoidal, infralabyrinthine, transcochlear, and suboccipital routes. Our review reveals that magnetic resonance imaging is more specific than computed tomography in establishing a preoperative diagnosis and is also the technique of choice in follow-up. The long-term results are discussed.

Adult↗
PubMed1988

DDD pacemakers maximize hemodynamic benefits and minimize complications for most patients.

A 44-month retrospective analysis was performed on 666 pacemakers implanted at Mt. Sinai Medical Center. Mapping techniques and endocardial waveform analyses were used during lead positioning to ensure the best electrical environment. The optimal pacing lead type was selected based on the clinical situation. Follow-up evaluations were rigorous. Patient population ranged in age from 28 to 103 with a mean of 78 years at time of implant. Seventy percent of the patients received DDD pacemakers with an 81% survival incidence at 44 months. Of the VVI population (30% of the implants), there was a 62% survival incidence. Most problems associated with the pacing systems were related to the atrial channel. Loss of atrial sensing occurred in 7.5% of the population and was corrected noninvasively in 5.8%. Due to chronic loss of atrial sensing, 1.7% of the population remained programmed to DVI/VVI. A total of 7.7% were chronically reprogrammed from DDD to VVI, 5.6% secondary to atrial fibrillation. Reoperations were necessary in 1.2% of the malfunctioning systems that could not be corrected by reprogramming. The following conclusions were reached: (1) maximizing hemodynamic benefits and minimizing pacemaker complications permitted a survival rate equal to or better than that of the general population, and (2) chronic problems related to the atrial lead and malfunctions of the pacing system were minimized by careful patient selection, appropriate pacemaker and lead selection, endocardial waveform analysis, and thorough follow-up.

Adult↗
PubMed1986

Pacemaker clinic evaluations: key to early identification of surgical problems.

The pacemaker center evaluation was responsible for the timely reoperation of 341 pacemaker patients over the last three years. The most common indication for reoperation was battery end-of-service (46.3%). Battery testing and maintenance of accurate records for trend analysis ensures prompt generator replacement. Atrial and/or ventricular lead malfunction was the second largest indication (26.3%). Lead malfunction detected by bracketing capture and sensing thresholds included: dislodgement, penetration, exit block, fracture, insulation failure, and abnormal sensing. The third largest indication for reoperation was pacemaker pocket erosion and/or infection (15.5%). Examination of the pacemaker pocket site is an integral part of an evaluation. In conclusion, the three largest indications for reoperations can be best demonstrated in a pacemaker center where evaluations are personal and thorough, and accurate record keeping is maintained.

Adult↗
PubMed1977

Coronary artery bypass surgery in patients seventy years of age and older.

Fifty patients 70 years of age and older underwent coronary artery bypass surgery for disabling angina pectoris or congestive heart failure or both (two quadruple, 11 triple, 25 double grafts, 12 single). Twenty additional procedures were done (11 mitral valve replacements for papillary muscle dysfunction, six ventricular aneurysmectomies, four aortic valve replacements, and one repair of ventricular septal defect). Surgical mortality rate was 8 per cent (four patients). Total mortality rate was 14 per cent, after a mean follow-up of 17 months. Of 30 patients undergoing coronary artery bypass surgery alone, two died during surgery and none of follow-up. Age alone should not be a contraindication for coronary artery bypass surgery. Surgical risk is acceptable in older patients, and improvement can be expected in the majority of patients.

Age Factors↗
PubMed1977

Mitral valve replacement in medically unresponsive congestive heart failure due to papillary muscle dysfunction.

Forty patients with a mean age of 65 years (range 44-76 years) were operated on; 30 of 40 patients (75%) had prior myocardial infarction. All had severe therapy-resistant congestive heart failure, 75% (30 of 40 patients) were symptomatic at rest, and 25% (10 of 40 patients) were symptomatic on minimal exertion. Cardiac index ranged from 1.24-2.84 L/min/m2 (mean 1.99). Left ventricular end-diastolic pressure ranged from 3-36 mm Hg (mean 18). All patients had significant mitral insufficiency and contractility was reduced markedly to moderately in 63% (25 of 40 patients). Significant coronary artery disease (obstruction greater than or equal to 75%) was present in all patients. All had mitral valve replacement, 30 had bypass surgery, and 7 left ventricular aneurysmectomy. Five died during surgery or before discharge (early mortality 12.5%). After a mean follow-up period of 16 months, another eight patients died, two with causes not related to the cardiovascular system (total mortality 32.5%). Of 20 patients with a cardiac index greater than or equal to 1.5 L/min/m2 and an ejection fraction greater than or equal to 0.40, 17 survived surgery and improved postoperatively. Mitral valve replacement for this group of patients is recommended.

Adult↗
PubMed1976

A noninvasive technique for the study of cardiac hemodynamics utilizing C15-O2 inhalation.

A new technique for the study of cardiac hemodynamics is described which utilizes single-breath inhalation of C15O2 (T 1/2 = 124 sec.) and the recording of activity vs. time curves with scintillation counters placed externally over the left ventricle and right lung. The results from 10 normal volunteers and 28 patients with acquired or congenital heart disease have been compared to the findings at cardiac catheterization. The technique is safe, rapid, and nontraumatic, and yielded no false positives or negatives in this series.

Aortic Valve↗
PubMed1975

Long-term results of "simple" thrombectomy for thrombosed Björk-Shiley aortic valve prostheses.

During the past two years 8 patients were seen with thrombosis of their Bjork-Shiley aortic valves. Six patients were from our series, an incidence of 4% and 2 patients had their original valve implanted at another institution. All patients had substantial problems with anticoagulation therapy. Three died prior to operation. Early detection and emergency surgical intervention is mandatory for survival. At operation debridement of all thrombotic material from the valve provided satisfactory immediate hemodynamic improvements as well as freedom from complications for up to two years. Therapeutic levels of anticoagulation with warfarin are the only apparent protection from thrombosis of the Bjork-Shiley aortic valve.

Anticoagulants↗
PubMed1975

Noninvasive cardiac evaluation (NICE) of intracardiac shunts using inhaled radioactive carbon dioxide.

A totally new, noninvasive technique is presented for the detection and analysis of left-to-right cardiac shunts. Five millicuries of oxygen 15-labeled carbon dioxide is administered by a single-breath inhalation technique. The resultant lung washout curve accurately reflects the presence or absence of a shunt. The quantitative studies are promising, but the method must be compared with standard techniques in a statistically significant series. This work is in progress.

Carbon Dioxide↗