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Biomedical subjects

M D Kerstein

Publications and source records attributed to M D Kerstein.

At least 19 recordsLinked to original sources
PubMed1992

Comparative effects of endothelin (ET-1) and U46619 on human saphenous vein and gastroepiploic artery, sources of human autologous grafts.

The effects of endothelin (ET-1) on smooth muscle contractile activity were investigated and compared in human saphenous vein and gastroepiploic artery, vessels frequently used in revascularization procedures. ET-1 contracted saphenous vein and gastroepiploic artery in a concentration-dependent manner. The peptide produced a greater maximal effect in the vein than in the artery and, in both preparations, ET-1 was less efficacious than U46619, an agent which mimics the actions of thromboxane A2 at the thromboxane A2/prostaglandin H2 receptor. The contractile response to ET-1 declined spontaneously at a more rapid rate in the artery than in the vein. The present data indicate that ET-1 has significant contractile activity in both vessels which are used for coronary arterial bypass surgery and suggest that although, a weaker vasoconstrictor than U46619, the peptide could induce vasospasm in both graft vessels.

Arteries↗
PubMed1992

Femoral artery pseudoaneurysm in a monkey.

Pseudoaneurysm formation as a complication of routine blood collection was diagnosed in a monkey. Damage to the femoral artery resulted in hematoma formation with secondary organization, encapsulation, and vascular communication. Progressive lameness and muscular atrophy were the primary clinical signs. Surgical correction of the artery defect helped resolve the monkey's lameness and muscle atrophy.

Angioplasty↗
PubMed1992

Thrombolytic therapy of synthetic graft occlusions before vascular reconstructive procedures.

The objective of this study was to evaluate the impact of thrombolysis of synthetic grafts before urgent vascular reconstruction. In 29 patients, 41 thrombosed synthetic grafts that underwent intraarterial thrombolysis were studied. The cases were divided into three groups: group I--complete thrombolysis followed by reconstruction; group II--complete thrombolysis alone; and group III--incomplete lysis requiring reconstruction or sympathectomy. Follow-up ranged from 1 to 556 days (mean: 149 days). Kaplan-Meier analysis was used to determine patency and limb salvage rates. One-year patency and limb salvage rates were 53% and 95%, 34% and 67%, and 38% and 48%, respectively, for groups I, II, and III. Eighteen complications occurred in 16 of the 41 (39%) episodes. One patient died of intracranial hemorrhage. The best results were achieved when complete lysis was followed by appropriate reconstruction. Patency was equally poor in complete thrombolysis alone and reconstructions required by incomplete thrombolysis. Limb salvage was better after complete thrombolysis, regardless of the appropriate reconstruction.

Aged↗
PubMed1992

Inadequacy of bedside clinical indicators in identifying significant intracranial injury in trauma patients.

During 1987 and 1988, the trauma service at Hahnemann University Hospital, a level I trauma center, evaluated 1,875 consecutive patients. Four hundred ninety-seven consecutive computed tomographic (CT) scans were performed to evaluate intracranial trauma in the emergency department. These patients' records were reviewed to determine the adequacy of loss of consciousness, amnesia, Glasgow Coma Scale (GCS) score, and mechanism of injury in predicting intracranial findings. In 302 patients with a GCS score of 13 or greater, 55 (18%) CT scans showed abnormal findings. Eleven (4%) of these patients required neurosurgical intervention. Furthermore, patients with normal CT scans required no interventions for head trauma. Mechanism of injury directly influenced the incidence of neurosurgical intervention. Current bedside methods to evaluate patients for possible intracranial injury in our trauma patient population are inadequate. Emergency department CT scans should be performed on all patients referred to the trauma service with previously classified mild- or low-risk criteria for intracranial trauma, regardless of GCS score.

Brain Injuries↗
PubMed1992

Differential recovery of prostacyclin and endothelium-derived relaxing factor after vascular injury.

Differential recovery of prostacyclin and endothelium-derived relaxing factor after vascular injury. Am. J. Physiol. 262 (Heart Circ. Physiol. 31): H1449-H1457, 1992. The recovery of prostacyclin (prostaglandin I2, PGI2) synthesis and endothelium-derived relaxing factor (EDRF) activity, as demonstrated by acetylcholine (ACh)-induced relaxation, by rabbit aorta was examined up to 8 wk after balloon catheter-induced injury. Following injury, basal 6-keto-PGF1 alpha formation was decreased acutely; however, after 3 wk it was not different from control. Arachidonic acid-stimulated 6-keto-PGF1 alpha formation was decreased, returning to control levels at 3 and 8 wk for thoracic and abdominal aorta, respectively. ACh-induced relaxation did not return to control levels over the 8-wk study. Initiation of reendothelialization with a layer of hyperplastic endothelial cells overlying subendothelial fibrosis and intimal hyperplasia were present at 2-3 wk. Intimal hyperplasia appeared 2 wk after injury and progressed throughout the period of the study. These data indicate that following balloon catheter-induced injury the formation of both PGI2 and EDRF is reduced and that recovery follows a differential time course. In addition, the recovery of PGI2 formation did not coincide with the attenuation of intimal hyperplasia, whereas the relationship between EDRF formation and intimal hyperplasia is uncertain.

Acetylcholine↗
PubMed1992

Adult respiratory distress syndrome. Sequence and importance of development of multiple organ failure. The Prostaglandin E1 Study Group.

STUDY OBJECTIVE: To determine the epidemiology of multiple organ failure (MOF) in patients with the adult respiratory distress syndrome. PATIENTS: We followed up 50 patients with serial determinations of respiratory and nonrespiratory organ function for seven days after diagnosis. DESIGN: Data were stratified between patients who died and those who survived (defined as hospital discharge). MEASUREMENTS AND RESULTS: Values that did not differ at any time between the two groups of patients included oxygen availability, oxygen consumption, oxygen extraction, PaCO2, respiratory rate, heart rate, systolic blood pressure, cardiac output, stroke index, systemic vascular resistance, and temperature. Patients who died had greater defects in oxygenation (from day 1 through day 7). They also exhibited decreased arterial oxygen content (from day 1 to day 4), decreased mixed venous oxygen content (day 1), increased peak inspiratory pressure (present on day 2, persisted to day 5, reappeared on day 7), decreased diastolic blood pressure (seen on days 1 through 3, reappeared on day 7), and increased mean pulmonary artery pressure (seen on days 2 and 3). Nonsurvivors also exhibited greater degrees of thrombocytopenia (from day 1 to day 4). Decreases in pH (seen on day 1, reappeared from days 4 to 7), abnormalities in liver function (seen only on day 1), and increases in serum creatinine levels (appeared on day 7) were also observed. CONCLUSIONS: Multiorgan dysfunction (MOD) was frequently observed in both groups of patients. Alterations in organ function and the pattern of abnormalities were often subtle and would not be characterized as significant organ dysfunction by most available organ scoring systems. Adult respiratory distress syndrome is a manifestation of systemic disease produced by widespread increases in endothelial permeability; lung dysfunction dominates the early clinical course. When respiratory function is supported, it becomes evident that alterations occur in other organs. Multiorgan failure is really a misnomer; the term emphasizes end-stage changes. Multiorgan dysfunction is common and often resolves without progressing to MOF. Alternatively, MOD can progress to MOF.

Blood Pressure↗
PubMed1992

Role of three hour roentgenogram of the chest in penetrating and nonpenetrating injuries of the chest.

The current study examined whether a three hour roentgenogram of the chest was as reliable as the six hour roentgenogram of the chest in detecting delayed complications (that is, pneumothorax and hemothorax) of penetrating and nonpenetrating trauma to the chest. The 285 patients in the study were placed into three groups: those stabbed in either the chest or back; those sustaining multiple fractures of the ribs, and those with gunshot wounds to the chest or back. All the patients selected for study by three and six hour films of the chest were asymptomatic on admission and no pneumothorax or hemothorax was seen on initial anteroposterior and lateral roentgenograms of the chest. None of the patients included in the study required immediate operation. Twelve patients (4 percent) had delayed pneumothoraces on the three hour roentgenogram of the chest. Nine of these 12 (75 percent) required thoracostomy tube drainage, while the remaining three patients were managed with needle aspiration. No additional patients had complications on the six hour roentgenogram of the chest. Computed tomographic (CT) scan discovered five additional patients (2 percent) with pneumothoraces not visualized by the three or six hour films. Seventeen patients (6 percent) had delayed pneumothoraces despite negative admission roentgenograms of the chest and lack of symptoms. Twelve of the 17 (71 percent) were discovered on three hour roentgenogram of the chest, while an additional five of 17 (29 percent) were only seen by CT scan. Three hour roentgenograms of the chest are as reliable as six hour roentgenograms of the chest in visualizing the development of delayed complications of penetrating and nonpenetrating thoracic trauma. The CT scan is more effective than the roentgenogram of the chest in visualizing small pneumothoraces, but its use as a screening tool for detection of delayed complications of trauma to the chest pneumothoraces is probably cost-prohibitive.

Adolescent↗
PubMed1992

The effects of prostaglandin E1 on non-pulmonary organ function during clinical acute respiratory failure. The Prostaglandin E1 Study Group.

The effects of prostaglandin E1 (PGE1) on non-pulmonary vital organs in critically ill patients are not well defined. This study evaluated the role of exogenous PGE1 in systemic homeostasis during the adult respiratory distress syndrome (ARDS). Indicators of end-organ function were analyzed retrospectively in 146 septic or post-trauma patients with ARDS who received PGE1 (30/ng/kg/min) or placebo IV for up to 7 days in a randomized, double-blind clinical trial. Hemodynamic variables and serum levels of creatinine, bilirubin, and SGOT, platelet count, and changes in the white blood cell count were measured daily. Our results indicate that mean arterial pressure, pulmonary artery pressure, and systemic and pulmonary vascular resistance indices were significantly lower in the PGE1 group versus the placebo-treated group. Cardiac index, stroke index, and oxygen delivery index were significantly increased in the PGE1 group. Serum bilirubin and SGOT were decreased significantly among PGE1-treated patients compared with placebo-treated patients, while the white blood cell count increased more significantly from baseline values with PGE1 treatment. Intergroup differences in platelet count and serum creatinine levels were not statistically significant. The results indicate that PGE1 improves cardiovascular performance, hepatic function, and leukocyte availability during clinical ARDS. Prostaglandin E1 did not affect platelet counts and renal function in this study.

Acute Disease↗
PubMed1991

Colonoscopically guided tube decompression in Ogilvie's syndrome.

Ogilvie's syndrome (pseudo-obstruction of the colon) may result in gangrene and perforation of the colon if not effectively treated. Colonoscopic decompression and endoscopically guided rectal tube placement were employed to treat five patients with this syndrome who had failed medical therapy. All patients tolerated the procedure well and required no further treatment.

Adult↗
PubMed1991

Infrainguinal revascularization for limb salvage in patients with end-stage renal disease.

We studied the efficacy of infrainguinal bypass for limb salvage in patients with end-stage renal disease. The patency of 42 femoropopliteal and femorodistal bypasses, performed for limb salvage in 37 patients with end-stage renal disease, was assessed with Doppler ultrasonography and dye tests. Patency rates and limb salvage were determined by life-table analysis. Average age was 45 years (range, 28 to 61 years); 23 of the 37 were men. Twenty-three patients had diabetes mellitus, and 16 were smokers. Bypass procedures were done in 32 instances while the patients were maintained with chronic hemodialysis and in five instances with peritoneal dialysis; in five instances the patients had had successful renal transplantation. Indications for revascularization included pain at rest, nonhealing ulcer, or distal gangrene. Femoropopliteal bypass was done in 32 limbs; 10 were more distal procedures. Reversed saphenous vein was the conduit in 30 cases; prosthetic material was used in the remainder. Autogenous material was used in all distal bypasses. Four patients required graft revision during the initial hospitalization, but none thereafter. Two patients died within the operative period, nine within 18 months of operation. Nine major operations were required. Three-month cumulative graft patency was achieved in 41 cases and corresponding limb salvage in 33 cases; 18-month patency was achieved in 34 cases and overall limb salvage in 33 cases. Success of limb salvage most closely correlated with preoperative ankle-brachial ratio and level of bypass required.

Adult↗
PubMed1990

Concentration-activity profile of the modulation of cyclooxygenase product formation by reduced glutathione in microsomal fractions from the goat lung.

Age-related changes in pulmonary formation of arachidonic acid (AA) metabolites are thought to play an important role in regulating cardiopulmonary function. This study addresses the potential role of reduced glutathione (GSH) in modulating cyclooxygenase product formation in the developing lung. Prostaglandin H2 (PGH2) metabolism was studied in microsomal fractions isolated from the lungs of unventilated fetal, neonatal and adult goats. GSH-dependent PGH2 to PGE2 isomerase activity in microsomal fractions from the perinatal (fetal and neonatal) goat lung was not saturable with respect to GSH and can respond to changes in GSH concentration over the range of 0.01 to 30 mM, which encompasses the full range the intracellular GSH levels reported in the literature. However, in fractions from the adult, a lower rate of PGE2 formation is observed at higher GSH concentrations. In addition, the tissue levels of GSH exhibited developmental stage-related differences with fetal being higher than neonatal or adult. The present observations may have physiologic relevance, in that decreases in pulmonary GSH levels after birth may contribute to decreases in plasma PGE2 levels by decreasing pulmonary PGE2 synthesis, thereby contributing to closure of the ductus arteriosus; conversely, increased GSH levels associated with hyperoxia may contribute to persistence of ductal patency. Formation of 6-keto-PGF1 alpha and of TXB2 (the stable metabolites of prostacyclin and TXA2) was decreased when PGE2 formation was increased by GSH activation of PGE2 isomerase in fractions isolated from all three developmental stages. A similar pattern of product formation was observed when AA was employed as substrate. These data suggest the possibility that changes in GSH concentration may modulate eicosanoid formation in cells that contain GSH-dependent PGE2 isomerase, as well as either or both prostacyclin or thromboxane synthase(s).

6-Ketoprostaglandin F1 alpha↗
PubMed1990

Safe extracranial vascular evaluation and surgery without preoperative arteriography.

Carotid surgery without preoperative arteriography was performed in 101 consecutive patients with an average age of 68.5 years and almost equal sex distribution. This prospective study analyzed risk factors, operative approach, bruits, indications for surgery, and outcome. All patients were studied by real-time B-mode ultrasound and spectral analysis and none were referred for arteriogram. The majority of patients had a standard carotid endarterectomy, and the findings at surgery correlated with noninvasive imaging. No mortality was recorded in this series of patients; a 1% rate of neurologic morbidity was noted. These results suggest that one can safely operate on the basis of a duplex scan. A preoperative arteriogram is not always necessary for carotid evaluation.

Aged↗
PubMed1990

Increased prostacyclin and thromboxane A2 formation in human varicose veins.

Increased urinary metabolites of the antiaggregatory vasodilator prostacyclin (PGI2) and the proaggregatory vasoconstrictor thromboxane A2 (TXA2) have been reported in deep vein thrombosis; however, the tissue(s) of origin is uncertain. Because little is known about the formation of PGI2 or TXA2 from its common precursor, prostaglandin (PG) endoperoxide H2 (PGH2), by varicose veins, we determined the formation of 6-keto-PGF1 alpha (the stable metabolite of PGI2), TXB2 (the stable metabolite of TXA2), and PGE2. Segments of normal saphenous vein and varicose vein (nine and six patients, respectively) were incubated with 10 microM [14C]PGH2 for 2 min at 37 degrees C; products were separated by thin-layer chromatography. Surface area and mass of normal and varicose vascular segments were 19.5 +/- 0.8 versus 18.8 +/- 0.6 mm2 and 11.6 +/- 1.4 versus 10.7 +/- 0.7 mg, respectively. Formation of 6-keto-PGF1 alpha and TXB2 by the segments of varicose vein was significantly increased over that of normal vein: 157 +/- 14 versus 243 +/- 17 pmole of 6-keto-PGF1 alpha (P less than 0.005) and 22 +/- 3 versus 35 +/- 5 pmole of TXB2 (P less than 0.01). The formation of PGE2 by segments of varicose vein was not significantly different from that of normal vein (201 +/- 9 vs 219 +/- 11, respectively). Deoxyribonucleic acid (DNA) content of normal and varicose vein was 1.69 +/- 0.12 and 1.51 +/- 0.13 mg per gram of tissue, respectively. The data suggest that the increased PGI2 formation may reflect increased activity or content of PGI2 synthase. The increase in TXA2 formation may reflect increased productivity or an increased presence of residual platelets or microemboli.

6-Ketoprostaglandin F1 alpha↗
PubMed1990

Efficacy of home health care in patients with peripheral vascular disease.

This investigation was designed to study the effects of home health care (HHC) on patients who have been hospitalized with peripheral vascular disease. For a patient to have HHC, the patient had to have a defined wound, educational needs, or both. Sixty patients, 30 with HHC and 30 without, were contacted approximately 30 days after their last hospital discharge. The 30 patients with HHC were deemed to be at increased risk because of multisystem disease with multiple medications, infirmity, early senility, and often complex wounds. In a prospective fashion, each patient was interviewed by either a registered nurse or medical student using a standardized data collection form. The following issues were assessed: incidence of postoperative complications, knowledge of the patient of his or her disease, compliance with medication (knowledge of, regular use), incidence of readmission, and unscheduled clinic or emergency department visits. Upon statistical analysis using the two-sample t-test and Pearson chi-square test, no significant differences were found between the two groups in terms of complications, compliance, or patient education. HHC, therefore, was found to be helpful to patients with peripheral vascular disease. In our study, the use of HHC made the risk of complications in a group of patients with defined teaching needs and wound care needs equal to that in a group with no such defined needs on discharge from the hospital.

Chi-Square Distribution↗
PubMed1990

Factors important to students in selecting a residency program.

A 22-item questionnaire, designed to assess the factors students considered important when they ranked residency programs, was distributed to the 1988 senior class of Tulane University School of Medicine just before the submission deadline of the National Residency Matching Program. Completed surveys were obtained from 111 of the 157 graduating students (approximately 71%) and were representative of the entire class in terms of sex, age, race, marital status, and anticipated field of specialization. Results of this investigation suggest that the satisfaction of a program's house officers and the seniors' general impression at the interview were the most important selection factors of the matriculating seniors surveyed. Diversity of the training experience and geographic location were also important selection factors. House officer benefits and salary were low-priority factors in the seniors' program selections.

Career Choice↗
PubMed1990

Obstructive jaundice caused by hepatoma fragments in the common hepatic duct.

A 67-year-old black male diabetic who had never consumed alcohol presented with anorexia, weakness, weight loss, and jaundice. Ultrasound demonstrated common bile duct obstruction; computed tomography scanning revealed multiple liver masses; endoscopic retrograde cholangiopancreatography showed a filling defect; aortogram confirmed the neovascularity of tumor proliferation; and percutaneous transhepatic cholangiography confirmed high-grade common duct obstruction. Operative intervention demonstrated hepatocellular emboli to the common bile duct causing obstruction. We review the literature on this problem.

Aged↗