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Biomedical subjects

M Horowitz

Publications and source records attributed to M Horowitz.

At least 253 records · Page 14Linked to original sources
PubMed1996

Circumcision: successful glanular reconstruction and survival following traumatic amputation.

PURPOSE: Circumcision remains the most common operation performed on male individuals in the United States. Unfortunately various complications may occur during circumcision ranging from trivial to tragic. We report 7 cases of traumatic amputation of the glans penis and/or urethra during circumcision. In addition, errors in circumcision technique as probable mechanisms of injury, principles of repair and limits of tissue viability are discussed. MATERIALS AND METHODS: The medical records of 7 patients who underwent traumatic circumcision amputation of the glans penis and/or urethra were reviewed. Glanular amputation occurred in 6, 8-day-old neonates during ritual circumcision and in 1, 5-month-old infant circumcised by a physician. RESULTS: Excised glanular tissue remained viable up to 8 hours after injury. Followup ranged from 8.5 to 108 months. All patients had an acceptable cosmetic result. No long-term complications developed in the 8-day-old group but a distal urethral fistula formed in the 5-month-old patient. CONCLUSIONS: Careful selection of technique and device as well as strict attention to detail at circumcision should eliminate most injuries. On the basis of our results we recommend reanastomosis of the glans and/or urethra following distal amputation even when there is a delay in surgical repair of up to 8 hours.

Amputation, Traumatic↗
PubMed1996

Gastric emptying in early noninsulin-dependent diabetes mellitus.

UNLABELLED: The aims of this study were to determine in early noninsulin-dependent diabetes mellitus (NIDDM): (a) the prevalence of disordered gastric emptying of glucose; (b) the relationship between the blood glucose response to an oral glucose load and gastric emptying; and (c) the relationship between appetite and gastric emptying. METHODS: Sixteen patients (ages 39-79 yr) with recently diagnosed NIDDM consumed 350 ml water containing 75 g glucose and 99mTc-sulfur colloid while sitting in front of a gamma camera. Blood glucose concentrations were monitored immediately before and after the drink. Hunger and fullness were evaluated using visual analog scales. The results were compared to those obtained in 13 normal subjects of similar age and body mass index. All patients and control subjects were white and non-Hispanic. RESULTS: Gastric emptying was slightly slower in the NIDDM patients when compared to the control subjects (retention at 180 min 15.9 +/- 2.3% versus 3.8 +/- 1.0%, p < 0.001), but there was no significant difference in the 50% emptying time between the two groups. In the NIDDM patients, there was an inverse relationship between the magnitude of the increase in the blood glucose concentration and gastric emptying, e.g., between the area under the curve for blood glucose from 0-60 min and the intragastric retention of the drink at 60 min (r = -0.60, p < 0.05). In the NIDDM patients, fullness was greater (p < 0.005) both before and after the drink, and the score for hunger at 30 min was inversely related to the rate of gastric emptying (r = -0.52, p < 0.05). CONCLUSION: In patients with early NIDDM, gastric emptying of 75 g glucose is similar to that of normal subjects and is a significant determinant of the glycemic response.

Adult↗
PubMed1996

Gastric emptying in diabetes: an overview.

Gastric emptying is delayed in 30%-50% of patients with longstanding diabetes mellitus. The prevalence of disordered gastric emptying in patients with "early" Type 2 diabetes is controversial, but it has been suggested that gastric emptying is often accelerated. The pathogenesis of delayed gastric emptying in diabetes is poorly understood. It is, however, clear that acute changes in the blood glucose concentration have a major effect on gastric motor function and gastric emptying. There is an inverse relationship between the rate of gastric emptying and the blood glucose concentration, so that emptying is slower during hyperglycaemia and faster during hypoglycaemia. The motor dysfunctions responsible for delayed gastric emptying in patients with diabetes are heterogeneous. There is a high prevalence of upper gastrointestinal symptoms in diabetes. However, the correlation between symptoms and delay in gastric emptying is poor. Recent studies indicate that the blood glucose concentration modulates the perception of some sensations arising from the gastrointestinal tract. In both normal subjects and patients with diabetes the blood glucose response to oral carbohydrate and gastric emptying are related and there is evidence that modulation of the rate of gastric emptying, by dietary or pharmacological means, could be used to optimise glycaemic control. The use of prokinetic drugs, particularly cisapride, is currently the most effective approach to the treatment of symptomatic patients with gastroparesis. An improved understanding of the pathophysiology of both symptoms and delayed gastric emptying is fundamental to the development of more effective treatments.

Appetite↗
PubMed1995

Gaucher's disease variant characterised by progressive calcification of heart valves and unique genotype.

Gaucher's disease is the most prevalent sphingolipid storage disease, characterised by substantial genetic and phenotypic variability. Cardiac manifestations are rare. We report 12 Arab Gaucher's disease patients, 2-20 years of age, who presented with oculomotor apraxia but only slight classic signs of the disease. All but the youngest had calcifications of the aortic or mitral valves or both. All these patients were homozygous for the rare point mutation D409H (1342C). Valvular calcifications increased with age and showed progression during 2 years of follow-up. Two of the oldest patients underwent aortic valve replacement, and one sibling had died suddenly at age 16, before this study, Corneal opacities were another common feature. The potentially fatal course of this Gaucher's disease variant, and the availability of a reliable PCR-based method for heterozygote detection, mean that population screening and genetic counselling in the geographic area at risk are important. Affected individuals should be closely monitored by echocardiography to gauge the need for valve replacement. The potential of enzyme replacement to prevent these cardiac complications cannot be ascertained at present, because of the high cost of therapy.

Adolescent↗
PubMed1995

Treatment of dural sinus thrombosis using selective catheterization and urokinase.

Thrombosis of the cerebral dural venous sinuses, cortical draining veins, and deep cerebral veins is a rare clinical finding. Because of its low incidence and multiple etiologies, the optimum therapy for this condition will only be elucidated by a multicenter, randomized prospective study. At our institution, we favor early and aggressive management of cerebral venous sinus thrombosis with transfemoral, venous intradural infusions of the fibrinolytic agent urokinase. To date, treatment of only 13 patients using this technique has been reported in the English literature. This report adds 12 more such treated patients. Despite the presence of preinfusion infarcts in 5 patients, four of which were hemorrhagic, we incurred no major therapeutic morbidity. Functional sinus patency was achieved in 11 of 12 patients, with our only true failure occurring in an individual with symptoms of at least 2 months' duration. Good to excellent clinical outcome was achieved in 10 of 11 patients (one newborn had inadequate follow-up).

Adult↗
PubMed1995

Effect of cisapride on myoelectrical and motor responses of antropyloroduodenal region during intraduodenal lipid and antral tachygastria in conscious dog.

The myoelectrical and motor response of the antropyloroduodenal region to intraduodenal nutrient stimulation or antral tachygastria represent useful models for, respectively, physiological and pathophysiological gastric stasis to test the efficacy of prokinetic drugs. We evaluated the effects of an intravenous bolus of cisapride (0.63 mg/kg) on the myoelectrical and motor response of the antropyloroduodenal region to an intraduodenal triglyceride emulsion (10% Intralipid, 0.5 ml/min) or antral tachygastria in conscious dogs. Intraduodenal lipid suppressed antral motility (P < 0.05, compared to intraduodenal saline) and stimulated phasic pyloric contractions (P < 0.01, compared to intraduodenal saline), a motor pattern known to be associated with delayed gastric emptying. During intraduodenal lipid stimulation cisapride virtually abolished all isolated pyloric motor events (P < 0.05) and stimulated antral and duodenal motility (P < 0.05 for both) and antropyloroduodenal coordination (65% versus 15%; P < 0.05). Antral tachygastria was associated with a higher number of isolated pyloric motor events in the fasted state [0.8 (0.7-1.1) per minute versus 0.2 (0-0.3) per minute; P < 0.05], but not during intraduodenal lipid stimulation [1.1 (0.9-1.7) per minute versus 1.2 (1.0-1.9) per minute; NS]. Cisapride decreased the number and duration of spontaneous episodes of antral tachygastria during intraduodenal saline and lipid infusion (P < 0.05 for both) and abolished the tachygastria-associated motor patterns. Cisapride induced a 20% decrease in the antral slow-wave frequency during intraduodenal saline and lipid, irrespective of gastric pacemaker rhythm. We conclude that: (1) cisapride overcomes feedback from small intestinal lipid receptors on myoelectrical and motor activities of the antropyloroduodenal region and decreases antral slow-wave frequency, and (2) cisapride inhibits antral tachygastria and tachygastria-associated motor patterns. These effects may contribute to the effective gastrokinetic properties of cisapride in physiological and certain forms of pathophysiological gastric stasis.

Animals↗
PubMed1995

Gynecologic and obstetric aspects of Gaucher's disease: a survey of 53 patients.

OBJECTIVE: We report our experience on the gynecologic and obstetric features of 53 female patients with Gaucher's disease. STUDY DESIGN: Each patient was interviewed for a detailed medical history, and all underwent a complete physical examination and laboratory work-up. RESULTS: Delay of puberty onset was encountered in two thirds of the patients without subsequent infertility. Heavy menstrual bleeding was a major problem and was best treated with low-dose oral contraceptives. Of the 102 spontaneous pregnancies' 25 (24.5%) ended in spontaneous first-trimesters abortions; 72 continued beyond the twenty-second week. Nine patients (27.7%) were diagnosed as having Gaucher's disease during their first pregnancies. Aggravation of thrombocytopenia and anemia were prominent features, but antepartum blood transfusion was not required. Early postpartum hemorrhage and fever were increased after both cesarean and vaginal deliveries. Development of bone crisis in seven women during the third trimester and early postpartum periods recurred in subsequent pregnancies. Genotypes had not influenced the gynecologic or obstetric manifestations. CONCLUSIONS: Gynecologic and obstetric complications play a significant role in this patient population, representing an additional burden to female patients with Gaucher's disease.

Abortion, Spontaneous↗
PubMed1995

Metastasectomy for sarcomatous pediatric histologies: results and prognostic factors.

We reviewed our experience of pediatric metastasectomy to define (1) morbidity/mortality in this population and (2) any preoperative or intraoperative prognostic predictors of survival. One hundred fifty-two patients with median age 19 years (range, 5 to 33 years) had 258 thoracic explorations (Ewing's sarcoma, 28; rhabdomyosarcoma, 6; nonrhabdomyosarcoma soft tissue sarcoma, 42; and osteosarcoma, 76). Resections were accomplished by 218 wedge resections, 19 anatomic resections, 14 wedge and anatomic resections, 4 wedge and chest wall resections, and 3 wedge resections/other procedures. An initial complete resection was accomplished in 121/152 patients (80%). With a median potential follow-up of 10.6 years, median survival from initial thoracotomy is 2.2 years. By the Cox proportional hazards model, three or more positive nodules (p = 0.021), histology other than osteosarcoma (p = 0.0054), and incomplete resection (p < 0.0001) were unfavorable prognostic factors for survival. Two or more positive nodules (p = 0.0049), left location (p = 0.0031), age 14 years or greater at diagnosis (p = 0.0052), or rhabdomyosarcoma (p = 0.0066) predicted shorter pulmonary progression-free survivals after resection. Nonrhabdomyosarcoma pediatric metastasectomy can yield selected long-term survival. Morbidity/mortality is low, and a complete resection, if possible, is paramount. Prognostic factors can be defined that can be used to define the limits of this therapy to the patient and family.

Adolescent↗
PubMed1995

Evaluation of cerebral blood flow and hemodynamic reserve in symptomatic moyamoya disease using stable Xenon-CT blood flow.

Moyamoya disease is a vascular abnormality seen in children and adults characterized by progressive narrowing of the internal carotid, middle, anterior, and posterior cerebral arteries and the development of leptomeningeal and proximal internal carotid artery collaterals, which appear diaphanous on angiogram. Although adults tend to present with subarachnoid hemorrhage and children with ischemic events, the clinical sequelae in these two populations overlap. Expanding upon work done at this institution using stable xenon computer tomographic blood flow determinations with acetazolamide and carbon dioxide challenge to predict which population of patients with severe carotid disease and hemodynamic compromise would benefit from surgical intervention, we used similar rationale to determine which patients with moyamoya disease would likely benefit from revascularization. Data and outcome concerning four such patients make up the body of this report.

Adult↗
PubMed1995

Transurethral resection of the prostate versus open prostatectomy: long-term mortality comparison.

To determine whether transurethral prostatectomy results in higher long-term mortality rates than open prostatectomy, we reviewed retrospectively 1,125 patients treated by transurethral and 190 treated by nonperineal open prostatectomy for benign disease at 1 institution from 1978 through 1987. Patients in whom prostatic cancer was found were excluded. We identified age, preoperative medical illnesses and urinary retention, American Society of Anesthesiologists category, type of anesthesia, length of followup, health status and cause of death. For statistical analysis the study cohort consisted of 527 patients in whom the charts were complete and followup was adequate (421 in the transurethral prostatectomy and 106 in the open prostatectomy groups). Mean age for the 2 groups was 66.3 and 67.5 years, respectively. With an average followup of 70.7 months 77% of the transurethral prostatectomy group were alive, compared to 78% of the open prostatectomy group at an average followup of 71.4 months. We found no supportive evidence that transurethral prostatectomy results in higher long-term mortality rates than does an open operation (log-rank test p = 0.74). Also, there was no significant survival difference in patients who required a preoperative Foley catheter. We also examined a subset of patients with adequate followup who had no significant medical history (for example hypertension, diabetes, heart disease and so forth) and compared them to patients with medical illnesses at prostatectomy. There was a significant survival difference between those with and without preoperative medical conditions (Wilcoxon test p = 0.047) in the transurethral prostatectomy group but not in the open group (p = 0.58). However, there was no significant survival difference between procedures among the healthiest subset of patients (p = 0.16).

Aged↗
PubMed1995

Effect of age on bone density and bone turnover in men.

OBJECTIVE: Little is known about the pattern of age-related bone loss in men, and although androgens are required for optimum bone mass it is not clear whether the fall in bone mass with age in men is related to falling androgens. DESIGN: Cross-sectional measurement of bone density, at five sites, and markers of bone resorption and formation in 147 normal volunteers aged 20-83 years. SUBJECTS: Healthy laboratory workers, hospital staff, their relatives, and husbands of women attending our osteoporosis clinic. MEASUREMENTS: Forearm density (fat corrected), spine L2-L4, femoral neck, Ward's triangle and trochanter density; serum procollagen I C-terminal extension peptide, osteocalcin, bone alkaline phosphatase and collagen I C-terminal telopeptide; fasting urine hydroxyproline/creatinine, pyridinoline/creatinine and deoxy-pyridinoline/creatinine; and free androgen index (FAI), measured as serum testosterone/sex hormone binding globulin. RESULTS: Bone loss accelerated at most sites after age 50. There was a significant fall in FAI from the third decade onwards. The levels of all bone markers fell with age. CONCLUSIONS: Bone loss in men appears to accelerate from age 50 and is associated with decreased bone formation which may be associated with falling levels of free androgen.

Adult↗
PubMed1995

Relationship between fractional calcium absorption and gastric emptying.

The relationship between calcium absorption and gastric emptying and the precision of measurement of fractional calcium absorption using a single isotope technique were evaluated in 14 normal postmenopausal women (age range 61-72 years). On two occasions separated by between 5 and 15 days, each subject was given 250 mL water containing 0.2 MBq of 45Ca in 20 mg of calcium carrier as the chloride, 20 mg kg-1 paracetamol and 9 MBq of 99mTc sulphur colloid. Venous blood samples were taken at -2, 15, 30, 45, 60, 90, 120, 150 and 180 min after consumption of the drink, and gastric emptying (GE) was monitored with a gamma camera. Fractional calcium absorption in the first hour (alpha 6) was calculated from the blood samples obtained at 15, 30, 45, 60, 90 and 120 min. An absorption rate was also derived from the 60 min sample using only a calibration curve (alpha 1). There were close correlations between radiocalcium absorption on the two study days (r = 0.89, P < 0.001 for both alpha 1 and alpha 6) and between alpha 1 and alpha 6 (r = 0.93, P < 0.001). Plasma paracetamol concentrations at 15 min were directly related to the early phase of GE (r = 0.42, P < 0.05). In contrast, calcium absorption was inversely related to GE (r = 0.45, P < 0.05). We conclude that radiocalcium absorption is not greatly influenced by gastric emptying rate and that the single blood sample procedure has similar precision to the six-blood sample test.

Acetaminophen↗
PubMed1995

Postural changes in proximal gastric volume and pressure measured using a gastric barostat.

A barostat was used to examine the effect of changes in posture on the volume and pressure in a bag positioned in the proximal stomach of 14 normal volunteers. Volumes in the supine position were compared with those in the standing, left lateral and right lateral positions at a constant pressure 2 mmHg above basal intragastric pressure. A separate series of measurements was then used to evaluate the effects of the same postural changes on pressure within the bag whilst its volume was kept constant. Changing from the supine to the left lateral position decreased bag volume by 62% when pressure was controlled; pressure increased by 60% when volume was controlled. In contrast, movement from the supine to the right lateral position resulted in a 68% increase in bag volume and a 31% fall in pressure. Moving from supine to standing had inconsistent effects on bag volume and pressure. There was a negative correlation between the magnitudes of the changes in pressure and volume (r2 = 0.557). The observed effects of posture probably result from changes in the compression of the stomach by abdominal viscera and indicate that subject position must be specified and maintained constant in studies of proximal gastric motor function using a barostat.

Adult↗
PubMed1995

Effect of drink temperature on antropyloroduodenal motility and gastric electrical activity in humans.

There is little information on the motor mechanisms underlying the effects of meal temperature on gastric emptying. The effects on antropyloric pressures and the surface electrogastrogram of ingesting drinks at 4 degrees C, 37 degrees C, and 50 degrees C (350 ml normal saline and 50 ml low calorie (7 kj) orange cordial) given in randomised order were measured over 60 minutes in 12 normal volunteers (10 men and 2 women, aged 18-55 years). The warm and cold drinks suppressed antral pressure waves (p < 0.05), altered the organisation of antropyloric pressure waves (p < 0.05), stimulated isolated pyloric pressure waves (p < 0.05), and increased electrogastrogram frequency (p < 0.05) when compared with the 37 degrees C drink. These changes were greatest in the first 30 minutes after ingestion and greater (p < 0.05) with the 4 degrees C drink. Temperature has major effects on postprandial antropyloroduodenal motility in normal subjects. Both cold and warm drinks stimulate a pattern of motility associated with retardation of transpyloric flow.

Adolescent↗
PubMed1995

Evaluation of antral motility in humans using manometry and scintigraphy.

Recent studies suggest that scintigraphy can be used to evaluate non-invasively antral motility in humans, although scintigraphic techniques have not yet been compared with more conventional measurements of intraluminal pressures by manometry. Simultaneous scintigraphic and manometric measurements of antral motility were performed in nine healthy volunteers. After intubation with a sleeve/sidehole catheter which incorporated five pressure sideholes located at 1.5 cm intervals spanning the antrum, each subject ingested 100 g minced beef labelled with 100 MBq 99mTc-chicken liver and 150 ml water. Between 40-43, 60-63, 80-83, and 100-103 minutes after meal ingestion, radioisotopic data were acquired in two second frames. Time-activity curves showing antral 'contractions' resulting from wall motion were derived by drawing small regions of interest over the antrum to coincide with the position of the antral manometric sideholes. Scintigraphic contraction rates approximated 3/minute, whereas antral pressure waves that occluded the lumen were less frequent (p < 0.01 for all), particularly in the proximal antrum. The amplitude of wall motion, evaluated scintigraphically, and the amplitude of pressure waves were both inversely related to the distance from the pylorus (r > -0.32, p < 0.05) and antral volume r > -0.29 (p < 0.05). There were significant relationships between the amplitude of contractions assessed scintigraphically and the number of lumen-occlusive antral pressure waves in the distal antrum (r -0.48, p < 0.05) but not in the more proximal antral regions. It is concluded that scintigraphy can detect antral wall motion with greater sensitivity than manometry, particularly in the proximal antrum. As manometry gives information on the amplitude as well as the temporal and spatial organisation of those contractions which result in lumen occlusion, the combination of scintigraphic and manometric techniques in the evaluation of antral motility shows considerable promise.

Adult↗