Biomedical subjects
M Deutsch
Publications and source records attributed to M Deutsch.
"Stockless" cost reduction in the operating room.
St. Paul-Ramsey Medical Center in St. Paul, MN became one of the first hospitals in the United States to initiate a "stockless" par level inventory system. Successes with stockless led the hospital to look at implementing it in the OR to achieve a reduction of expense to revenue. Materiel Management and Surgical Services discussed a number of issues relevant to implementing a stockless program, including product flow, accuracy and cost of case carts and preference cards, item pricing, committed usage of items brought into the system and establishment of a steering committee. Specific OR issues and practices required evaluation and adjustment, such as the routine use of emergency direct ordering. Information systems support was brought in and a products committee established to do education and oversee the program. Savings for 1993-94 were $185,146.
Crystalloid versus blood cardioplegia in coronary by-pass surgery. A prospective, randomized, controlled study in 100 consecutive adults.
In a prospective randomized trial we investigated the benefit of blood versus asanguinous cardioplegia in routine coronary by-pass grafting. One hundred consecutive adult patients were randomly assigned to two groups: Group A (53 patients) received cold blood cardioplegia and group B (47 patients) had standard St. Thomas solution. In all patients we combined ante- and retrograde administration, in group A warm reperfusion was carried out before aortic declamping. Aortic cross clamp times, amount of cardioplegic solution and blood potassium levels at the end of cardio-pulmonary by-pass were higher in group A than in group B. The need for inotropic support at the end of the operation as well as in the postoperative period was more frequent in the crystalloid cardioplegia group. The occurrence of atrial fibrillation showed no clear correlation to the kind of cardioplegia used. Perioperative infarction was less frequent in the blood cardioplegia group (3.7% vs 6.3%; p < 0.01) and 30-day-mortality was nil (0% vs 3.2%; p < 0.01). Hospital stay did not differ between the two groups. In this clinical trial we could demonstrate the superiority of blood versus crystalloid cardioplegia in routine coronary by-pass grafting. Ante- and retrograde delivery of cold blood cardioplegia followed by warm reperfusion is a safe and simple method yielding satisfactory results.
The influence of aortic valve prosthesis diameter on the reversibility of pulmonary hypertension in isolated aortic stenosis.
Patients with pulmonary artery hypertension in the late course of isolated aortic stenosis are considered to have a poor prognosis. The aim of the following study was to determine the incidence of pulmonary artery hypertension, the postoperative course after valve replacement and the reversibility of pulmonary hypertension dependent on the valve prosthesis diameter. Seventy-six consecutive patients with symptomatic aortic stenosis undergoing isolated aortic valve replacement were studied. Preoperative right and retrograde left heart catheterization was performed in the cardiac catheterization laboratory. Three days after valve replacement, hemodynamic evaluation was repeated by a Swan-Gantz catheter. Patients with preoperative pulmonary hypertension (systolic pulmonary artery pressure > 30 mmHg, n = 53) differed significantly from patients without pulmonary hypertension (n = 23) with respect to systolic pulmonary pressure (52.4 +/- 17 vs. 24.3 +/- 4 mmHg), pulmonary capillary wedge pressure (22.3 +/- 10 vs. 8.8 +/- 2, p < 0.001), left ventricular end diastolic pressure (29.6 +/- 13 vs. 21.4 +/- 11) and valve area (0.64 +/- 0.10 vs. 0.79 +/- 0.11 cm2, p < 0.05). No difference was found with respect to age, maximum systolic transvalvular aortic gradient or cardiac output. Following valve replacement, the two groups did not differ significantly in fatal (2/53 vs. 1/23 or non-fatal (14/53 vs. 5/23) complications. In patients with pulmonary hypertension, systolic pulmonary pressure decreased from 52.4 +/- 17 to 38.9 +/- 6, diastolic pressure from 24.7 +/- 9 to 12.6 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
In vitro-lined endothelium: initial integrity and ultrastructural events.
BACKGROUND: The early fate of in vitro-endothelialized prosthetic vascular grafts was assessed in the nonhuman primate. METHODS: Each of 17 male chacma baboons received a control and a confluently endothelialized 4 mm polytetrafluoroethylene graft in femoro-femoral positions (8.2 +/- 0.8 cm). All experimental grafts were precoated with fibrinolytically inhibited fibrin glue and lined with cultured autologous endothelial cells (EC) from the external jugular vein. The average time period needed to obtain first-passage mass-cultures sufficient for preconfluent graft endothelialization was 19.8 +/- 5.2 days. Before implantation in vitro-lined grafts were kept in culture for another 16.1 +/- 4.3 days to achieve complete confluence and maturation of the EC cytoskeleton. RESULTS: After 9 days of implantation, endothelial-lined grafts still showed a confluent endothelium that was free of any fibrin deposits. However, the EC density was significantly lower than at implantation (39.7 +/- 7.6 x 10(3) versus 59.9 +/- 8.5 x 10(3) EC/cm2; p < 0.05), and occasional 10-microns-wide intercellular gaps with adherent platelets and leukocytes were visible. Transmission electron microscopy showed leukocytes and cell debris in the underlying fibrin glue. After 4 weeks of implantation, the endothelium of experimental prostheses had regained a high cell density (72.7 +/- 10.5 x 10(3) EC/cm2) with a mature and well-differentiated morphologic appearance. At both observation periods, the surface of control grafts showed a wide range from fibrin deposits to an amorphous protein coverage containing spread platelets. CONCLUSIONS: The endothelium of in vitro-endothelialized vascular prostheses remains confluent after implantation and is nonthrombogenic in spite of a moderate initial cell loss.
X-ray specular-reflectivity study of the liquid-vapor density profile of 4He.
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Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer.
BACKGROUND AND METHODS: Women with ductal carcinoma in situ have been treated both by lumpectomy and by lumpectomy followed by radiation therapy, but the benefit of combined therapy is uncertain. A group of 818 women with ductal carcinoma in situ were randomly assigned to undergo lumpectomy or lumpectomy followed by breast irradiation (50 Gy). Sufficient tissue was removed that the margins of the resected specimens were histologically tumor-free. The mean duration of follow-up was 43 months (range, 11 to 86). The principal end point of the study was event-free survival, as defined by the presence of no new ipsilateral or contralateral breast cancers, regional or distant metastases, or other cancers and by no deaths from causes other than cancer. RESULTS: Five-year event-free survival was better in the women who received breast irradiation (84.4 percent, vs. 73.8 percent for the women treated by lumpectomy alone; P = 0.001). The improvement was due to a reduction in the occurrence of second ipsilateral breast cancers; the incidence of each of the other events was similar in the two groups. Of 391 women treated by lumpectomy alone, ipsilateral breast cancer developed in 64 (16.4 percent); it was noninvasive in 32 and invasive in the remaining 32. Of 399 women treated with lumpectomy and breast irradiation, ipsilateral breast cancer developed in 28 (7.0 percent) (noninvasive in 20 and invasive in 8). The five-year cumulative incidence of second cancers in the ipsilateral breast was reduced by irradiation from 10.4 percent to 7.5 percent for noninvasive cancers and from 10.5 percent to 2.9 percent for invasive cancers (P = 0.055 and P < 0.001, respectively). CONCLUSIONS: Breast irradiation after lumpectomy is more appropriate than lumpectomy alone for women with localized ductal carcinoma in situ.
Electronic charge distribution in crystalline diamond, silicon, and germanium.
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Effect of D,L-alpha-difluoromethylornithine (DFMO) enhanced [3H]putrescine uptake on 9L tumor cell growth and colony forming efficiency.
PURPOSE: This study explored the possible use of D,L- alpha-difluoromethylornithine (DFMO) to enhance the uptake of [3H] putrescine in order to selectively kill brain tumor cells. METHODS AND MATERIALS: Gliosarcoma cells (9L) were grown for 4 or 20 day periods in monolayer cultures with or without [3H] putrescine and/or DFMO. Cells in culture incubated for 20 days were replated at 4-day intervals. Cells were counted on a Coulter Electronic Particle Counter and percent viability was determined by eosin dye exclusion. Survival of cells with proliferative capacity was assayed by their colony. Forming ability and surviving fraction was calculated. The radioactive counts due to [3H] putrescine were measured in 9L cells and in medium and expressed as cpm/100 cells or cpm/ml, respectively. RESULTS: As previously reported (15), DFMO treatment resulted in termination of cell proliferation that was reversible by the addition of exogenous putrescine. Specifically, after 4 days in culture, cell counts in groups exposed to 10 mM DFMO were 55% of those in control groups and addition of 3 mM putrescine reversed the DFMO effects. Uptake of [3H] putrescine into untreated cells increased in proportion to the amount of exogenous putrescine present during 4 days of culture (range 0.01 nmol to 100 nmol) and the presence of DFMO in the medium enhanced the uptake 9 fold throughout these ranges. At activities greater than 100 cpm/100 cells the cell count was reduced to 23 to 48% of control after 4 days in culture. Extending the treatment to 20 days of incubation increased the killing of 9L cells. During the 20-day incubation, control cells increased from 5 x 10(5) to 13 x 10(12) of which 90% were colony forming cells. Treatment with either 25 microCi [3H] putrescine or 1 mM DFMO for 4 days followed by removal of these agents and incubation for an additional 16 days for a total of 20 days resulted in 31 x 10(8) or 18 x 10(7) colony forming cells, respectively. Combining [3H] putrescine and DFMO treatments during the first 4 days of the 20 day incubation reduced the colony forming cells to 21 x 10(5) (surviving fraction to 67%). When the DFMO treatment was present during the entire 20 days, it became cytotoxic since the colony forming cells were reduced to 35 x 10(3) (surviving fraction was 17%). The combination of the 4-day [3H putrescine and the 20 day DFMO treatments resulted in only 1200 surviving colony forming cells (surviving fraction was only 2%). CONCLUSION: DFMO treatment of 9L cells for 20 days resulted in increased uptake of [3H] putrescine, a 10(10) fold inhibition of colony forming cells and extensive 9L cell killing relative to untreated controls.
X-ray reflectivity study of the surface of liquid gallium.
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[Clinical late results following surgical ablation of an accessory atrioventricular connection in Wolff-Parkinson White syndrome].
All patients operated because of WPW-syndrome between 1980 and 1990 at the University clinics of Zürich were followed up by clinical examination and by electrocardiography. Relief from symptoms (tachycardia, vertigo and/or syncopes) was defined as "symptomatic" success, lack of preexcitation in the ECG at rest as "surgical" success. Overall 56 patients (40 men, 16 women) aged from 13 to 66 years had been operated in the stated time period. Before operation 52 of these patients had pre-excitations in the ECG, 54 had tachycardia and 23 had syncopes. None of the patients died from the operation. In order to localize the AAVVs epicardial cartography was performed in all patients during operation before the AAVVs were cut through an endocardial access. The follow-up was possible after an average interval of 5.5 years (1-120 months) in 50 of the 56 patients. One patient died 10 years after operation from heart failure. 6 patients were reported to be out of the country. The follow-up revealed symptomatic success of the intervention, defined as absence of tachycardia, in 88% (44 out of 50). In 84% (42 out of 50) also a surgical success of the operation was found. In these patients the accessory atrio-ventricular bundle had been successfully ablated, and they were free of tachycardia and of preexcitation in the ECG. Two patients with persisting preexcitation remained free of clinical symptoms. Insofar the rate of symptomatic success was higher than the rate of surgical success. Summarizing the results surgical transsection (ablation) of an accessory atrioventricular bundle in patients with WPW-syndrome is a good therapeutic option with favorable long term success. It has today still its place--in selected cases--as alternative to the now available radio-frequency ablation.
Surface crystallization of liquid normal-alkanes.
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Transvaginal sonographic detection of skeletal anomalies in the first and early second trimesters.
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Improved zipper closure of the abdominal wall in patients requiring multiple intra-abdominal operations.
Optimal management of pancreatic abscess and septic complications of acute pancreatitis remains controversial. With the "open packing" approach, repeated closure of the midline fascia is complicated by loss of tissue integrity and suture strength. An improved zipper closure of the abdominal wall in six patients with pancreatic abscess is presented. Improvements included: (1) using a separating jacket-type zipper to allow maximal intraoperative exposure; (2) employing a removable tuck for expansion of the patch covering the wound; (3) substituting a nonmeshed polytetrafluoroethylene material for the polypropylene mesh to prevent adherence to the underlying viscera; and (4) creating a flap underneath the zipper teeth to protect the underlying tissue from injury. Satisfactory results were achieved with the improved zipper technique.
[Stenosis of the contralateral iliac artery by a wall stent after the successful recanalization of an obstruction of the A. iliaca communis].
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[Long-term results of percutaneous atherectomy in peripheral arterial occlusive disease].
In a retrospective study the indications and the long-term results of percutaneous atherectomy of a nonselected group of patients were analysed. From March 1988 to November 1989, 94 patients suffering from peripheral vascular disease were treated using Simpson's atherectomy technique. There were 132 lesions, 101 stenoses and 31 occlusions in a total of 94 patients. The primary success rate was 95%. After 12 months of follow-up the cumulative patency rate was 69% and after 24 months, 42%. After a follow-up period of 15 months patent arteries and recurrences were recorded and the results used to analyse the factors that influence patency after Simpson atherectomy. The patency rate is 71% in diabetics and 62% in non-diabetics. It is 51% in occlusions and 73% in stenoses. The patency rate in patients with fair runoff is 69%, in patients with poor runoff 60%. Comparing these results with historical studies concerning balloon dilation the results are poor. Residual stenoses after balloon dilation seem to be the optimal indication for percutaneous atherectomy.
The endothelium: a key to the future.
The vascular endothelium is a complex modulator of a variety of biological systems and may well be the key to definitive success in the treatment of cardiovascular disorders. Surgically-induced endothelial injury may occur preoperatively during cardiac catheterization and intraoperatively from mechanical manipulation, ischemia, hypothermia, and exposure to cardioplegic solutions. The normal endothelium is antithrombogenic and yet promotes platelet aggregation and coagulation if injured. Vasospasm, occlusive intimal hyperplasia, and accelerated arteriosclerosis can also all occur as a result of endothelial injury. Furthermore, endothelial injury is harmful even in the absence of disruption of its monolayer integrity. Thus, preservation of the endothelium should be an additional objective for all cardiovascular surgeons. Synthetic vascular grafts, cardiac valves, and artificial ventricles do not spontaneously endothelialize and thus usually require some form of anticoagulation to maintain patency. Hence, endothelialization of prosthetic implants became an attractive concept. A number of different methods of obtaining an endothelial lining of prosthetic material has since been developed; these include facilitated endothelial cell migration, and endothelial cell seeding by using either venous or microvascular endothelial cells. Manipulating the endothelium might well provide the next major advancement for therapeutic and preventive measures for cardiovascular disease.
Mucosal origin and shedding of an early colonic tumor marker defined by Adnab-9 monoclonal antibody.
Recent attention has been drawn to the diagnostic potential of tests based on shed colonic tumor markers. Adnab-9 monoclonal antibody raised against neoplastic, potentially premalignant colonic adenomas recognizes a marker in colonic effluent or tissue which correlates with the presence of tumors or risk of colorectal cancer. The origin of this antigen and optimal collection of colonic effluent were investigated by enzyme-linked immunosorbent assay and Western blotting. Mean Adnab-9 binding in effluent samples from colorectal cancer patients even after resection is high as compared with that in normal subjects (P < 0.05). Effluent samples are best collected in the morning hours. Antigen proteolysis may be significant depending on the site and timing of effluent collection, but breakdown products are reactive. Tissue and effluent Adnab-9 binding at any one anatomic site of collection appear to correlate (r = 0.88, P = 0.01). The Adnab-9 antigen is constitutively expressed at low levels throughout the distal bowel and localized to the deepest regions of the mucosal crypts. Other than meconium, no significant levels of binding are found in other body fluids. This antigen is specific for the gastrointestinal tract, its binding in conveniently collected effluent samples correlates with tissue content, and the antigen is constitutively expressed in the crypts of the distal small bowel and colonic mucosa.