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Biomedical subjects

L Schultz

Publications and source records attributed to L Schultz.

At least 73 records · Page 4Linked to original sources
PubMed1990

Laser laparoscopic herniorraphy: a clinical trial preliminary results.

Laser laparoscopic inguinal herniorraphy represents an extension of current technology. Based on the principles of preperitoneal inguinal herniorraphy, it is performed by internal incision of the peritoneum and identification of the musculofascial defect through a laparoscope. Polypropylene mesh is then passed down the laparoscope, placed into the defect to obliterate the space, and the edges of the peritoneum are then reapproximated. Results in 20 patients with an 11 month followup indicates success in nineteen exhibiting early resumption of activity (3.3 days) and minimal pain (2.1 Tylenol #3 tablets per patient). One early recurrence suggests that anatomic identification of a direct space hernia may be difficult and that routine support of this area with additional mesh may be a requirement of a complete inguinal hernia repair.

Evaluation Studies as Topic↗
PubMed1988

Risk identification at the time of admission to coronary care unit in patients with suspected myocardial infarction.

The in-hospital clinical course was evaluated in 2,162 consecutive patients admitted with a diagnosis of suspected myocardial infarction. Of these, 1609 patients were considered to be in the high-risk group, based on the presence of 16 clinical criteria present at the time of admission. The remaining 553 patients were classified as low risk. The overall rate of complications in the coronary care unit was greater in the high-risk group, 64%, compared to 26% in the low-risk group (p less than 0.001). Similarly life-threatening events (occurrence or recurrence of ventricular fibrillation, sustained ventricular tachycardia, complete heart block, asystole, or cardiogenic shock) were more common in the high risk-group compared to the low-risk group, 11% and 0.9%, respectively (p less than 0.001). The high-risk group required significantly more interventions, such as electrical cardioversion, temporary pacing, pulmonary artery catheterization, and intraaortic balloon counterpulsation, compared to the low-risk group (20% vs 2%, respectively; p less than 0.001). Myocardial infarction was confirmed in 892 patients in the high-risk group (55%) compared to 90 (16%) in the low-risk group (p less than 0.001). The coronary care unit mortality rate was greater in the high-risk group compared to the low-risk group (8.2% vs 0.4%, respectively; p less than 0.0002). It is concluded that based on readily available clinical criteria at the time of admission, a subgroup of patients at low risk for developing life-threatening complications requiring coronary care unit interventions can be identified and admitted directly to an intermediate-care unit.

Coronary Care Units↗
PubMed1987

Efficacy of propranolol therapy after acute myocardial infarction related to coronary arterial anatomy and left ventricular function.

The effect of the beta-adrenergic blocking agent propranolol on morbidity and mortality risk after acute myocardial infarction was studied relative to coronary anatomy and left ventricular (LV) ejection fraction in a subset of 406 patients participating in a randomized study of 3,837 patients in the Beta Blocker Heart Attack Trial (BHAT). Median follow-up for this subset of patients was 28 months. The mortality rate was 2% (2 of 100) in patients with 2- and 3-vessel coronary artery disease taking propranolol and 10% (12 of 126) in those taking placebo (p less than 0.02). In patients with 2- and 3-vessel coronary artery disease with decreased LV function (defined as ejection fraction less than 50%), no patient taking propranolol died, whereas 17% (7 of 42) taking placebo died (p less than 0.04). The salutary effect of propranolol on mortality in the larger BHAT after acute myocardial infarction also was evident in this population studied in regard to their coronary and LV anatomy and function.

Coronary Vessels↗
PubMed1987

High-dose clonidine motor syndrome: relationship to serotonin syndrome.

Reciprocal forepaw treading, hindlimb abduction, and Straub tail are some of the abnormal motor behaviors of the classical 'serotonin syndrome,' which results from activation of serotonin (5-HT) receptors. However, we also observed them in the syndrome evoked by the alpha-adrenergic agonist clonidine, at high doses (5-40 mg/kg). Other features of the clonidine syndrome (scored from videotapes) were body and head tremor, forelimb hyperextension, ataxia, vertical jumping, tactile hyperreactivity, and autonomic signs (piloerection, pupillary dilatation, salivation, proptosis). The clonidine syndrome persisted for several hours and was not lethal. Clonidine suppressed locomotor activity (photocell recording) and induced episodes of catalepsy and 5-HT-independent impairment of motor habituation. Single high doses of drugs active at several different neurotransmitter receptors significantly reduced total behavioral score through effects primarily on tremor and autonomic signs, but none prevented the clonidine syndrome. Lesions of monoaminergic neurons [intracisternal 5,7-dihydroxytryptamine (DHT) or 6-hydroxydopamine] or monoamine depletion by intraperitoneal reserpine all failed to prevent this motor syndrome. Co-administration of 5-HTP and clonidine did not exacerbate the clonidine syndrome in naive rats and did not prevent the onset of the serotonergic syndrome in rats with DHT lesions. These data suggest that neither catecholamines nor 5-HT have a major role in the serotonin-like behavioral responses to high doses of clonidine.

Adrenergic alpha-Antagonists↗
PubMed1987

Regional lymph node and pulmonary metastases after local hyperthermia of melanomas in C57BL/6 mice.

The effects of local tumor hyperthermia on regional lymph node metastases are inconclusive. We studied the effects of hyperthermia on the incidence of popliteal, femoral, and abdominal lymph node metastases in C57BL/6 mice with primary B16 melanomas (F10 variant) growing subcutaneously in the left foot. Tumors were heated to 42.3, 43.5, and 44.2 degrees C for 90 minutes either 7 days after inoculation of 5 X 10(4) viable cells (microscopic tumor = mic) or when the tumors were approximately 3 mm in diameter (macroscopic tumor = mac). Femoral lymph node metastases occurred in 0/21 control animals and in 8/22 (36%), 11/19 (58%), and 11/17 (65%) animals whose primary tumors were heated to 42.3, 43.5, and 44.2 degrees C, respectively. For all three treatments, the increase in metastases as compared to controls was statistically significant (p less than 0.004, Fisher's exact test). The incidence of abdominal lymph node metastasis was slightly higher in the treated groups than controls. Twenty of 21 (95%) control mice developed popliteal lymph node metastases and hyperthermia-induced increases could not be demonstrated. Fifteen of 21 control mice killed 3 weeks after amputation of tumor-containing leg had pulmonary metastases with an average of 6 +/- 4 (standard deviation) lesions per affected mouse. Pulmonary metastases occurred in 22/22 (100%), 17/19 (89%), and 13/17 (76%) of mice whose tumors were heated to 42.3, 43.5, and 44.2 degrees C, respectively. The numbers of metastases for affected mice were significantly increased compared to controls for tumors heated to 43.5 and 44.2 degrees C (28 +/- 43, 43 +/- 52, 119 +/- 121, p greater than 0.02, p less than 0.006, p less than 0.002, for two sample T-test). While 0/8 mic tumors were cured 5/9 mac tumors heated to 44.2 degrees C disappeared (p less than 0.03, Fisher's exact test) and there was a growth delay in the remaining mice. Mic tumors, heated to 43.5 degrees C, had an accelerated onset of growth while mac tumors heated to this temperature had a slight growth delay. Growth of both mic and mac primary tumors heated to 42.3 degrees C was similar to controls. These results show that therapeutic and subtherapeutic local hyperthermia increases metastases to regional lymph nodes and to lungs even when primary tumor growth rate is partially or totally controlled.

Animals↗
PubMed1986

Defective lymphopoiesis in bone marrow of motheaten (me/me) and viable motheaten (mev/mev) mutant mice. I. Analysis of development of prothymocytes, early B lineage cells, and terminal deoxynucleotidyl transferase-positive cells.

This study identifies defects in the early stages of lymphopoiesis that may contribute to the abnormalities in the development and/or function of peripheral T and B lymphocytes in mice homozygous for the motheaten (me/me) and viable motheaten (mev/mev) mutations. The results indicate that in me/me and mev/mev mice prothymocytes in bone marrow are present in essentially normal numbers, as determined by intrathymic injection, but apparently lack the ability to home effectively to the thymus, as determined by intravenous transfer; early B lineage cells in bone marrow, identified by the B220 antigen, are markedly depleted, including immature B cells (sIg+), pre-B cells (cIg+, sIg-), and pro-B cells (B220+, cIg-, sIg-); TdT+ bone marrow cells, especially a subset that expresses the B220 B lineage antigen, are markedly depleted by two weeks of age; normal numbers of TdT+ thymocytes are present during the first 3 wk of postnatal life, but rapidly decrease thereafter. The results further indicate that neither the defective thymus homing capacity of prothymocytes nor the deficiency of TdT+ bone marrow cells is due to autoantibodies. The possible relationship of the defective development of lymphoid precursor cells to the premature onset of thymic involution and to the abnormalities of peripheral T and B lymphocytes in me/me and mev/mev mice is discussed; as are the results of in vitro studies (presented in a companion paper), which suggest that a primary defect in the stromal microenvironment of the bone marrow is responsible for the abnormal development of the lymphoid precursor cells.

Animals↗
PubMed1986

Carcinomas of the colon and rectum. A comparison of staging classifications.

Five staging methods for colorectal cancer were compared to the Dukes method in order to assess which methods were most sensitive and specific. Three hundred fifty-two patients with resected carcinomas of the colon and rectum were followed from 6 to 11 years or until death. All patients were staged by intraoperative and pathological criteria. Survival curves were constructed for each stage. The pTNM system was most sensitive at predicting death. The Gastrointestinal Tumor Study Group (GITSG) system was the most specific at predicting survival. However, the Dukes system did no worse than either of these staging systems and predicted relatively few false-positive and false-negative cases. The sensitivity and correctness of the Dukes system was improved by adding information regarding percent of lymph node metastases, ulceration of the primary tumor, and adjacent organ invasion.

Adenocarcinoma↗
PubMed1985

Perioperative allogeneic blood transfusions. Survival in patients with resected carcinomas of the colon and rectum.

Blood transfusion (BT) is reported to cause immunosuppression. We postulated that BT might therefore adversely affect the prognosis of carcinomas of the colon and rectum. We analyzed the overall and recurrence-free survival of 366 patients whose colorectal carcinomas were resected. The 199 patients who received perioperative BTs appeared to survive less well than the 167 patients who received no blood products. However, Cox analysis, which adjusts for other prognostic variables, shows that the difference was not statistically significant. Although 43% of transfused patients survived, as compared with 56.5% of nontransfused patients, this difference was due to variables other than transfusion. This study did not support the hypothesis that BT has an adverse effect on survival of patients with colorectal cancer.

Adenocarcinoma↗
PubMed1985

Effects of serotonergic activity in nucleus accumbens septi on drug-induced circling.

The effects of injections of 5-hydroxytryptamine (5-HT) into the nucleus accumbens and lesions of the nucleus accumbens induced by 5,7-dihydroxytryptamine (5,7-DHT) on drug-induced circling were investigated in rats with unilateral nigrostriatal lesions induced by 6-hydroxydopamine (6-OHDA). Injections of 5-HT (60-120 micrograms in 1 microliter; 1 microliter/min) into the nucleus accumbens caused a significant decrease in the circling response to 5.0 mg/kg of d-amphetamine (s.c.). The distribution of radioactivity after intracerebral injections of [3H]5-HT using these parameters showed that although much of the injected material was retained in the nucleus accumbens there was also considerable spread to the frontal cortex. However, in further behavioural experiments, using an injection procedure (0.5 microliter; 0.11 microliter/min) which caused much greater retention of injected material in the nucleus accumbens, with minimal spread to the frontal cortex, the ability of 5-HT injected into the accumbens to block amphetamine-induced circling was not diminished. Moreover, injections of 5-HT into the frontal cortex did not have any effect on amphetamine-induced circling. Lesions of the nucleus accumbens induced by 5,7-DHT caused a significant enhancement of the contralateral circling response to 1.0 mg/kg of apomorphine and a similar but non-significant tendency to increase the circling responses to several other doses of apomorphine and amphetamine. The results provide evidence that serotonergic mechanisms in the nucleus accumbens inhibit circling behaviour generated by unilateral activation of nigrostriatal dopaminergic mechanisms.

5,7-Dihydroxytryptamine↗
PubMed1978

Pneumococcal polysaccharide immunization in infants and children.

By using indirect hemagglutination, the antibody responses of normal infants and children to an octavalent pneumococcal vaccine that contained pneumococcal polysaccharide types 1, 3, 6, 7, 14, 18, 19, and 23 were evaluated. By 2 years of age, there was a significant rise in hemagglutination titers to all the polysaccharide types, except type 19. By 6 to 8 months of age, five of the eight types of pneumococcal polysaccharides tested resulted in up to 60% responders and, by 2 years, a significant number responded to all pneumococcal polysaccharide types in the vaccine. Pneumococcal polysaccharide type 3 resulted in a significant antibody response as early as 3 months of age, whereas type 19 never resulted in a significant antibody response. Except for type 3, it seemed that when the other pneumococcal polysaccharides tested produced an antibody response, the degree of resonse did not subsequently change significantly with increasing age. The relationship of antibody response to age for pneumococcal polysaccharides is similar to that found for other polysaccharide vaccines. Based on the results of our study, we would recommend immunization with pneumococcal vaccine at 6 months of age with repeat immunization at 2 years of age, especially in high-risk children.

Age Factors↗
PubMed1975

Papillary lymphoid hyperplasia of the terminal ileum: an unusual cause of intussusception and gastrointestinal bleeding in childhood.

Papillary lymphoid hyperplasia of the terminal ileum is a benign condition associated with abdominal pain, intussusception, and gastrointestinal hemorrhage. It appears to represent a distinct clinicopathologic entity, separate from the usual idiopathic intussusception of infancy and childhood. The lesions are reasonably well circumscribed, localized in the submucosa of the terminal ileum, and composed of lymphoid tissue with prominent germinal follicles. Management by ileocolectomy resulted in complete cure with no postoperative complications in our six cases. However, many authors recommend conservative therapy. The cause is not known but there may be some relationship between these cases and intestinal adenovirus infection.

Adenoviridae Infections↗