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Biomedical subjects

M Cooperman

Publications and source records attributed to M Cooperman.

At least 19 recordsLinked to original sources
PubMed1993

Hippocampal cholinergic alterations and related behavioral deficits after early exposure to ethanol.

The present study was designed to ascertain septohippocampal cholinergic alterations and their related behavioral deficits after early exposure to ethanol. Mouse pups were exposed to ethanol, 3 g/kg by daily subcutaneous injection on postnatal days 2-14. At age 50 days, the ethanol-exposed mice had significant reductions from control levels in eight-arm maze performance. For example, on the fourth testing day, the number of correct entries in the ethanol group was 21% below control levels (P < 0.05) and the number of trials needed to enter all arms was 48% above control (P < 0.001). It took the ethanol-exposed mice twice the time to reach criterion than it did control (P < 0.01). A 33% increase from control level in muscarinic receptor number (Bmax) was found in the treated mice of age 22 days and a 64% increase at age 50 days (P < 0.001). However, no differences between control and treated groups could be detected in the presynaptic component of the cholinergic innervation, choline acetyltransferase activity. The results suggest that early ethanol exposure acts on hippocampal function similarly to phenobarbital, probably via alterations in postsynaptic processes in the septohippocampal cholinergic pathways.

Acetylcholine↗
PubMed1992

Right upper quadrant calcification: porcelain gallbladder disease.

Large solitary calcification in the right upper quadrant is rarely seen in the United States. It may indicate disease in the gallbladder, adrenal glands, kidneys, pancreas, lungs or chest wall. Disease processes associated with calcification in these organs include echinococcal cysts, calcified renal cysts, chest wall masses and degenerative cystic lesions of the pancreas and adrenal glands. However, if calcification is associated with porcelain gallbladder, the incidence of carcinoma is high. Treatment consists of cholecystectomy with a careful search for malignancy.

Calcinosis↗
PubMed1986

Acute pancreatitis in elderly patients. Pathogenesis and outcome.

Forty patients over 70 years of age with acute pancreatitis were studied. The most common cause of pancreatitis was biliary tract disease (14 patients, 35 percent). Twelve patients (30 percent) were discharged with a diagnosis of idiopathic pancreatitis, but tests such as endoscopic retrograde cholangiopancreatography that might have established the cause of disease were frequently not employed. Eight of the 40 patients died, for a mortality rate of 20 percent. Significant morbidity occurred in an additional seven (17.5 percent). Multisystem failure was the cause of death in all eight patients, and only two patients with multisystem failure survived. The mortality rate was significantly higher in those patients with postoperative pancreatitis. Acute pancreatitis in the elderly carries a grave prognosis. All patients should undergo thorough evaluation, as biliary tract disease is the most common cause. Cholecystectomy should be performed in those with biliary disease to prevent recurrent attacks.

Acute Disease↗
PubMed1985

Endoscopic retrograde cholangiopancreatography in the management of pancreatic pseudocysts.

The value of ERCP was studied in 25 patients with pancreatic pseudocysts. There were no episodes of sepsis; however, acute pancreatitis developed in one patient for an overall complication rate of 4 percent. Results of ERCP were positive in 24 of the 25 patients (96 percent), with filling of the pseudocyst in 17 and pancreatic ductal obstruction in 7. Biliary tract abnormalities were found in seven patients and included common bile duct strictures in four, bile duct dilatation in two, and cystic duct obstruction in one. ERCP also detected six pseudocysts not diagnosed by ultrasonography, five of which were small and resolved with nonoperative therapy. ERCP is a safe diagnostic procedure for patients with pancreatic pseudocysts and may provide important information about coexistent biliary tract disease not otherwise available. It is also sufficiently sensitive to detect small pseudocysts that otherwise would be missed.

Adolescent↗
PubMed1985

Massive upper gastrointestinal hemorrhage from an arteriovenous malformation of the stomach.

Arteriovenous malformations of the stomach are rare; blood loss may be manifested either by chronic anemia or by massive recurrent hemorrhage. We report a patient with massive upper gastrointestinal hemorrhage from a gastric arteriovenous malformation. Emergency operation to control hemorrhage precluded the performance of angiography; diagnosis was made from the appearance of the lesion and dilatation of the veins draining the involved area. Complete operative excision of the lesion was curative.

Angiography↗
PubMed1983

Cholecystectomy in elderly patients.

Cholecystectomy was performed in 93 patients over the age of 70 years with an overall mortality of 7.5 percent. Complications occurred in 28 percent. Patients who underwent elective operations fared far better than those who required emergency surgery. Of the 50 patients who underwent elective cholecystectomy, there was 1 death (2 percent), and 10 patients (20 percent) experienced complications. In contrast, of the 43 patients who required emergency operation, 6 died (14 percent). Complications occurred in 14 (33 percent). Elective cholecystectomy in the elderly patient with symptomatic biliary tract disease is advocated before acute complications that necessitate emergency operation develop.

Age Factors↗
PubMed1983

Use of the EEA stapling instrument for control of bleeding esophageal varices.

Transection of the esophagus with the EEA stapling device (United States Surgical Corp.) has been used to treat 20 patients with bleeding esophageal varices. Their ages ranged from 38 to 73 years (mean 56.7 years). Sixteen patients (80%) had Laënnec's cirrhosis. A previous occluded portosystemic shunt was present in five patients. Based on Child's classification, there were one class A patient, 18 class C patient, and one patient who was unclassified. Five patients underwent elective operation; four survived (80%). The cases of the remaining 15 patients were treated as emergencies or semiemergencies after intensive preoperative intervention including intravenous administration of vasopressin (Pitressin) (100%), balloon tamponade in 11 (73%), and sclerotherapy in three (20%) failed to control the hemorrhage adequately. None of the patients had rebleeding from varices during the postoperative period. However, 11 of the 15 patients (73%) died. All deaths were related to liver failure, except for two patients who died of irreversible acidosis secondary to shock. Technical difficulty was encountered six times with use of the stapling device, resulting in three perforations of the esophagus, which were recognized and repaired at the time. No deaths were attributed to this complication. Of the eight patients who survived the early postoperative period, three have since died--two of variceal hemorrhage and the other of hepatic failure. Two others have had recurrent variceal hemorrhage controlled by sclerotherapy. The duration of follow-up ranges from 10 to 60 months (mean 31 months). Transection of the esophagus with the EEA stapling device for acute variceal hemorrhage is associated with an excessively high mortality rate despite the fact that it controls variceal hemorrhage. It appears to be of value when used on an elective basis for selected patients who cannot benefit from other modes of treatment.

Adult↗
PubMed1982

Surgical management of pancreas divisum.

Pancreas divisum is a congenital anatomic variant characterized by nonunion of dorsal and ventral pancreatic ducts in an otherwise fused pancreas. Of 21 patients with divisum documented by endoscopic retrograde cholangiopancreatography, 6 (28 percent) were found to have no reason other than divisum to account for multiple attacks of pancreatitis. Cholelithiasis was present in one patient, who remains free of recurrent pancreatitis after cholecystectomy only. The remaining five patients underwent surgical treatment directed at pancreas divisum in the belief that stenosis of the duct of Santorini at the entrance into the duodenum is responsible for recurrent attacks of pancreatitis. Four of five have done well with follow-up of 12, 13, 18 and 28 months. Successful sphincteroplasty of the duct of Santorini appears to prevent recurrent attacks of pancreatitis due to pancreas divisum. Pancreaticojejunostomy is reserved for those with markedly dilated ducts secondary to chronic pancreatitis.

Acute Disease↗
PubMed1982

Inguinal and femoral hernia repair in geriatric patients.

In a five year period, 62 patients aged 70 to 91 years underwent operative inguinal hernial repair. Other significant ailments were present in 46 of the 51 men and six of the 11 women. Postoperatively, complications occurred in 16 patients, four of whom died. In 44 patients with reducible hernia undergoing elective repair, there were no deaths and complications occurred in eight, while, in contrast, of the 18 with incarcerated or strangulated hernia, complications occurred in ten, and four died. The differences statistically significant. Local anesthesia was associated with the lowest complication rate. All cardiovascular complications and all deaths occurred in those receiving either general or spinal anesthesia. Inguinal herniorrhaphy can be safely performed in geriatric patients. Because of high morbidity and mortality associated with incarceration, elective repair of inguinal hernia under local anesthesia should be done whenever possible.

Age Factors↗
PubMed1981

Endoscopic retrograde cholangiopancreatography. Its use in the evaluation of nonjaundiced patients with the postcholecystectomy syndrome.

Forty-two patients with the postcholecystectomy syndrome were studied by endoscopic retrograde cholangiopancreatography (ERCP). Both the biliary ductal system and pancreatic duct were well visualized in all patients. The ERCP was abnormal in 22 patients (52%). Abnormal findings included choledocholithiasis, papillary stenosis, pancreas divisum, pancreatic carcinoma, sclerosing cholangitis, incomplete cholecystectomy, and chronic pancreatitis. The results of one or more standard liver function tests and/or other noninvasive tests were abnormal in 36 patients; however, none reliably predicted the presence or specific anatomical type of pancreaticobiliary tract disease. Our data indicate that ERCP is essential in the diagnosis and management of the postcholecystectomy syndrome. The high yield of abnormal findings amenable to surgical correction in patients with recurrent biliary tract symptoms following cholecystectomy justifies the use of this procedure in all such patients.

Adult↗
PubMed1981

Idiopathic acute pancreatitis: the value of endoscopic retrograde cholangiopancreatography.

Acute pancreatitis is classified as idiopathic when an underlying cause cannot be identified through a careful history and appropriate noninvasive tests. Unless a cause can be identified, recurrent attacks cannot be effectively prevented. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 35 patients considered to have idiopathic recurrent acute pancreatitis, and an anatomic abnormality of either the pancreatic or biliary ductal system was demonstrated in 16. Ten underwent appropriate surgical procedures based on the results of ERCP, and 80% had no further episodes of acute pancreatitis. ERCP established the precise nature of potentially correctable anomalies and thereby facilitated precise preoperative planning. The wider use of ERCP in these patients may lessen the number of cases of acute pancreatitis considered to be idiopathic and lead to appropriate surgical therapy.

Acute Disease↗
PubMed1980

EEA esophageal stapling for control of bleeding esophageal varices.

Esophageal transection with the EEA stapler was performed in five patients with bleeding esophageal varices. Bleeding from varices has not recurred in surviving patients during follow-up of up to 27 months. One death occurred during the postoperative period. Esophageal transection with the EEA stapler is an effective means of preventing recurrent variceal hemorrhage. This technique is best suited for patients requiring emergency operation to prevent exsanguination and for those in whom a major shunting procedure is contraindicated because of the severity of hepatic disease or other medical illness.

Adult↗
PubMed1980

Evaluation of ischemic intestine by Doppler ultrasound.

Intraoperative Doppler ultrasound examination of ischemic intestine was used to determine viability and to establish margins of resection, even when the findings differed from the surgeon's clinical appraisal. Ten of 25 segments in 23 patients were clinically judged nonviable, but because of arterial flow within the segments was detected by Doppler ultrasound, none was resected. The subsequent benign clinical courses of the patients demonstrated the viability of the segments. Two segments were judged clinically viable, but because Doppler signals were absent, both were resected. Histologic examination demonstrated severe ischemic changes in both segments. Nine segments were judged both by clinical criteria and by Doppler ultrasound examination to be nonviable, and all nine were resected. Histologic examination confirmed ischemia or infarction in all. Doppler ultrasound was a more reliable intraoperative predictor of viability of ischemic intestine than clinical assessment alone, and its use averted postoperative complications and unnecessary second-look procedures.

Humans↗
PubMed1980

Determination of intestinal viability by Doppler ultrasonography in venous infarction.

The accuracy of Doppler ultrasound in predicting the viability of ischemic intestine secondary to venous obstruction was assessed. Twenty loops of ischemic intestine were created in dogs by temporarily obstructing venous return from the bowel. Doppler arterial flow signals within the intestine quickly disappeared following venous occlusion. In ten segments, arterial signals promptly returned following release of venous occlusion. Nine of these ten segments were viable at reoperation 24 hours later. In ten segments, no arterial signals could be detected following release of venous occlusion, and only one segment proved to be viable. Doppler ultrasound findings were far more accurate in distinguishing between viable and nonviable intestine thatn were clinical guides to intestinal viability.

Animals↗