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Biomedical subjects

M J Shapiro

Publications and source records attributed to M J Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1994

Hyperbilirubinemia without common bile duct abnormalities and hyperamylasemia without pancreatitis in patients with gallbladder disease.

OBJECTIVE: To determine the incidence of jaundice and hyperamylasemia in the absence of common bile duct abnormalities or clinical pancreatitis in patients undergoing cholecystectomy. DESIGN: A continuous, prospective analysis of a consecutive case series was performed on all patients undergoing cholecystectomy. SETTING: An urban, tertiary care university hospital. PATIENTS: Adult patients with gallbladder disease. INTERVENTION: All patients underwent cholecystectomy. MAIN OUTCOME MEASURES: The presence or absence of common bile duct abnormalities was evaluated by cholangiography, and pancreatitis was identified by clinical signs, imaging studies, and direct visual inspection during cholecystectomy. RESULTS: All patients (N = 1746) undergoing cholecystectomy were prospectively categorized as having chronic calculous (n = 1410), acute calculous (n = 217), chronic acalculous (n = 70), or acute acalculous (n = 49) gallbladder disease. It was uncommon for patients with chronic calculous cholecystitis to have an elevated bilirubin level with no choledocholithiasis and a normal common bile duct or to have hyperamylasemia without pancreatitis. Twenty-five percent of the patients with acute calculous cholecystitis had a serum bilirubin level between 34 and 86 mumol/L (2.0 and 5.0 mg/dL) with no common bile duct abnormality and 4% had hyperamylasemia without pancreatitis. Over one third of the patients with acute acalculous cholecystitis had an elevated bilirubin level with a normal common bile duct or an elevated amylase level without pancreatitis. CONCLUSION: Jaundice and hyperamylasemia can be produced by gallbladder disease alone.

Acute Disease↗
PubMed1994

Right coronary artery occlusion secondary to blunt trauma.

The heart lies in a vulnerable position when the chest is subjected to direct blunt trauma. Acute occlusion of a coronary artery from blunt chest trauma is rare, with occlusion of the right coronary artery at its origin recorded only twice in the English literature. A young male unrestrained driver sustained an acute deceleration injury with significant chest trauma when he crashed, crushing the steering wheel against his chest. Creatine phosphokinase isoenzymes were initially 2% of the total and 8% 12 h later. There were marked electrocardiographic changes, and an echocardiogram revealed abnormal left ventricular systolic function with an akinetic inferior-posterior wall and right ventricular enlargement. A wide mediastinum and mechanism of injury led to the performance of aortography which failed to disclose a right coronary vessel. Subsequently coronary angiography confirmed acute occlusion of the proximal right coronary artery. Because of other associated injuries, nonoperative medical management was successfully utilized.

Adult↗
PubMed1994

Traumatic train injuries.

Train accidents involving motor vehicles and pedestrians can be devastating. Approximately 1,234 fatalities were recorded in the United States in 1989. The literature from the United States is sparse, prompting a 7-year review of 23 consecutive train accident victims. Twenty (87%) were male, with an average age of 30.6 years. Sixteen (70%) were intoxicated at the time of the accident, and the average Injury Severity Score was 21.4. There was a total of eight traumatic amputations occurring in the 11 (48%) patients involved as pedestrians. Two of these were railroad workers, and nine were trespassers. Fourteen (61%) accidents occurred between the hours of 2300 and 0700. Three (14%) patients died. Although alcohol use occurred in 16 (70%), there was no significance between alcohol use and amputation. Thus, non-railroad employed pedestrians, because of a lack of protection, are more prone to traumatic amputations, primarily of the lower extremities, than those involved in motor vehicle accidents.

Accidents↗
PubMed1994

Computed tomography as a screening exam in patients with suspected blunt aortic injury.

BACKGROUND: Chest computed tomography (CT) screening of patients with blunt trauma for thoracic aortic injury is controversial. This study was undertaken to determine whether CT could exclude aortic injury and be used to select patients for aortography. METHODS: Computed tomography and aortography were used to evaluate 155 patients with blunt trauma. Computed tomography scans were reviewed separately by four attending radiologists who were unaware of the patients' clinical course and angiographic findings. RESULTS: Eight of 155 patients had aortic injuries requiring operation. Computed tomography scans in five patients were read as positive by all reviewers. One scan was read as positive by three reviewers and as negative by one. Two scans were read as positive by two radiologists and as negative by two. After poor scans were excluded, the combined sensitivity of CT for detecting aortic injury was 88%, specificity was 54%, positive predictive value was 9%, and negative predictive value 99%. CONCLUSIONS: The sensitivity of CT scan for indicating the need for aortography is observer dependent. As CT manifestations of aortic injury are often subtle, CT does not reliably exclude aortic injury.

Adolescent↗
PubMed1994

Analysis of radiocontrast-induced nephropathy by dual-labeled radionuclide clearance.

RATIONALE AND OBJECTIVES: This study was devised to develop a method of measuring the acute effects of radiocontrast media on renal function and assessing the relationship of the dose of radiocontrast media infused with the incidence of radiocontrast-induced renal failure. In addition, the drug adenosine phosphate-magnesium chloride (ATP-MgCl2) was evaluated as a renoprotective agent. METHODS: Eighteen patients with pre-existing renal impairment, (serum creatinine greater than 133 mumol/L) were randomized to receive a continuous infusion of ATP-MgCl2 or placebo before and during a radiocontrast procedure. Subjects were monitored with daily serum creatinine and with radionuclide renal clearance studies at baseline, during, and 24 hours after the radiocontrast procedure. RESULTS: There was an initial deterioration in renal clearance in the entire study group (from 44.2 +/- 4.6 to 32.6 +/- 3.9 mL/min, P = .001) which was independent of the dose of radiocontrast infused. There was a persistent deterioration in renal clearance only in those who received greater than 135 mL of contrast media (from 48.6 +/- 7.8 to 37.1 +/- 3.9 mL/min, P = .05). There also was an increase in serum creatinine that persisted only in those subjects who received greater than 135 mL of contrast media (230 +/- 27 to 283 +/- 44 mumol/L, P = .01). CONCLUSION: Persistent deterioration in renal function after radiocontrast administration appears to be dose-dependent and is not prevented by the use of ATP-MgCl2. Radionuclide techniques are useful in monitoring acute changes in renal function during radiocontrast procedures and may be of value in assessing renal impairment in future intervention studies.

Acute Kidney Injury↗
PubMed1994

Fallopian tube recanalization in an unrestricted patient population.

PURPOSE: To review the effectiveness of fallopian tube recanalization (FTR) when performed without restriction based on history or tubal condition. MATERIALS AND METHODS: From October 1989 to July 1992 in 37 consecutive women, aged 22-44 years (mean, 35 years), 42 FTRs were performed (five patients each underwent two FTRs). Water-soluble contrast material and selective ostial salpingography and/or microcatheter technique were used exclusively. Eighty tubes were evaluated, since four patients had previously undergone unilateral salpingectomy. Sixty-three tubes (79%) were occluded at the outset of the procedure. RESULTS: Complete recanalization was achieved in 45 of 63 (71%) occlusions. Adhesions were present in 25 of 80 (31%) tubes, salpingitis isthmica nodosa in 12 (15%), and hydrosalpinx in nine (11%). The 42 procedures resulted in 14 (33%) conceptions, nine (64%) of which involved pathologic tubes. Eleven intrauterine pregnancies resulted in five spontaneous first-trimester abortions, five full-term deliveries, and one continuing pregnancy. CONCLUSION: Favorable conception and live birth rates can be achieved with FTR, despite a high prevalence of tubal disease.

Adult↗
PubMed1994

Arterial abnormalities following orthotopic liver transplantation: arteriographic findings and correlation with Doppler sonographic findings.

OBJECTIVE: We studied the findings on conventional arteriography in patients who had suspected graft ischemia after orthotopic liver transplantation to determine the value of a single Doppler signal in predicting these lesions. MATERIALS AND METHODS: We retrospectively reviewed selective visceral arteriograms with abnormal findings from 20 adults who had suspected graft ischemia after orthotopic liver transplantation and a single Doppler signal from the hepatic artery at the porta hepatis on sonograms obtained before arteriography. Arteriographic abnormalities were categorized according to morphology and location as follows: stenosis of recipient's hepatic artery, occlusion or stenosis of the transplanted extrahepatic artery, and occlusion or stenosis of the transplanted intrahepatic artery. RESULTS: Twenty-three arteriographic abnormalities were detected: four recipient celiac axis stenoses, seven extrahepatic occlusions, nine extrahepatic stenoses, and two occlusions and one stenosis of the transplanted intrahepatic artery. Six of the extrahepatic occlusions, two of the extrahepatic stenoses, and none of the recipient artery stenoses or the intrahepatic occlusions or stenoses were correctly diagnosed on the basis of Doppler findings. One patient with both an extrahepatic stenosis and an extrahepatic occlusion was thought to have an intrahepatic occlusion, and two patients with mild (< 50%) extrahepatic stenoses and one with an intrahepatic occlusion were thought to have an extrahepatic occlusion. CONCLUSION: A wide spectrum of abnormalities in the recipient's celiac axis or the transplanted arteries that may be associated with graft ischemia after orthotopic liver transplantation are often not detected or findings are misinterpreted on routine Doppler examination. In patients with suspected graft ischemia, visceral arteriography should be performed promptly to confirm the diagnosis and to allow early intervention.

Adult↗
PubMed1994

CT done 4-6 hr after CT arterial portography: value in detecting hepatic tumors and differentiating from other hepatic perfusion defects.

OBJECTIVE: Nontumorous perfusion defects occur during CT arterial portography (CTAP) as normal variants or in cirrhosis, focal fatty infiltration, and portal vein obstruction. The purpose of this study was to determine whether delayed CT 4-6 hr after CTAP improves sensitivity to hepatic tumors and differentiates them from other hepatic perfusion defects. SUBJECTS AND METHODS: CTAP was done at 1-cm increments on 26 patients for evaluation of hepatic tumors. Delayed CT scans were obtained 4-6 hr later in all patients. Two observers retrospectively reviewed the CT scans obtained during CTAP and recorded size, shape, and location of suspected hepatic tumors. Confidence levels were assigned for each tumor. The delayed CT scan was then interpreted in conjunction with the CT scans obtained during CTAP, and confidence levels were reassigned. Surgical correlation was obtained for all patients. In the 26 patients, 86 masses were found at surgery. The sensitivity and number of false-positives for both CTAP alone and CTAP combined with delayed CT were compared with a two-tailed Student t-test. Receiver-operating-characteristic analysis also was performed. RESULTS: CTAP detected 73 (85%) of the 86 hepatic masses. Delayed CT had no effect on the sensitivity of CTAP. However, adding delayed CT decreased the total number of false-positives by 11, a statistically significant difference (p < .05). Receiver-operating-characteristic analysis revealed a significantly greater (p < .05) area under the curve (Az index) of 0.927 +/- 0.025 for CTAP combined with delayed CT compared with 0.886 +/- 0.032 for CTAP alone. Delayed CT was most useful for larger (> 1 cm) wedge-shaped perfusion defects and least useful for smaller (< 1 cm) round defects. CONCLUSION: Delayed CT has no effect in detecting tumors but may be useful for differentiating tumors from other hepatic perfusion defects seen on CTAP. The greatest benefit of delayed CT is in evaluating regions obscured by large wedge-shaped perfusion defects on CT scans obtained during CTAP.

Colorectal Neoplasms↗
PubMed1994

National survey of state trauma registries--1992.

Registries, such as those for oncology, have demonstrated usefulness in collating information. Trauma care can be improved through the accumulation of local, regional, and state trauma statistics. The efforts to develop a National Trauma Registry in the United States are still in their infancy. A four-page survey questionnaire was returned by each of the 50 State Emergency Medical Services (EMS) Directors, as well as the EMS Directors of the District of Columbia and five American possessions, to evaluate the status of state trauma registries in the United States. In 1992, 24 (48%) states had a registry. Development costs average $101,107 and annual maintenance costs averaged $72,105. An average of 1.7 full-time equivalents (FTE) was necessary to maintain the registry. Fourteen (58%) states have effected legislation through the registry. Trauma prevention has been promoted in nine (38%) states and a decrease in mortality recognized through the registry in five (21%) states. Trauma registries are labor intensive and expensive but are effective in decreasing morbidity and mortality. The need for a National Trauma Registry incorporating and comparing data from health care facilities around the United States and its possessions has the potential of improving trauma health care.

Data Collection↗
PubMed1994

The role of the radiologist in the management of gastrointestinal bleeding.

The purposes of this article are to clarify the current status of barium studies, radionuclide scans, and arteriography in the diagnosis and management of the bleeding patient; to provide one interventional radiologist's approach to the diagnosis and management of both upper and lower gastrointestinal tract hemorrhage in the adult population, incorporating both radiologic and nonradiologic techniques; and to review the diagnosis and management of several less frequent causes and special categories of bleeding, such as that associated with portal hypertension.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Acute acalculous cholecystitis in the critically ill.

Acute acalculous cholecystitis, inflammation of the gall-bladder without evidence of calculi, accounts for 2 to 15% of all cases of acute cholecystitis. The incidence of acute acalculous cholecystitis in adults undergoing cholecystectomy may be as high as 15 per cent and up to 32 per cent in the pediatric population. During the past 10 years, 22 patients who were being treated in the intensive care unit for other reasons underwent cholecystectomy for acute acalculous cholecystitis. Eighteen (82%) of the patients were male, the average age was 61 years, and patients spent an average of 19 days in the intensive care unit prior to cholecystectomy. The most common clinical findings were right upper quadrant tenderness and pain. Fifteen (68%) of the patients had a previous operative procedure. HIDA scans were positive in all 12 patients in which they were performed. Ultrasounds were positive in 13 of 17 (76%) patients, and CT scans 7 of 9 (78%). Nine (41%) patients died. Early diagnosis with rapid intervention is crucial in managing this disease if outcome is to be improved. Gangrene and/or necrosis of the gallbladder was present in 13 (59%) of patients, suggesting that cholecystectomy may be the best approach to management.

Abdominal Pain↗
PubMed1993

Spontaneous and traumatic vitreous hemorrhage.

PURPOSE: The authors sought to provide relevant data regarding the demographic and clinical aspects of spontaneous and traumatic vitreous hemorrhages to guide clinicians in better delineating the expected etiologic patterns of these hemorrhages in an urban environment. METHODS: The records of 253 consecutive patients with newly diagnosed vitreous hemorrhage seen in a general eye clinic were selected for retrospective analysis. To minimize selection bias of a tertiary care center, patients who were referred to the clinic by outside ophthalmologists for vitreoretinal consultation or those with a history of recent intraocular surgery, postoperative complications, or loss to follow-up were excluded from study. Demographic, ocular, and general medical variables were tabulated for the 200 patients (230 eyes) who met our inclusion criteria. RESULTS: Fifty percent of the patients were black, 26% were white, 23% were Hispanic, and 1% was Oriental. The causes of vitreous hemorrhage were proliferative diabetic retinopathy (PDR) (35.2%), trauma (18.3%), retinal vein occlusion (7.4%), retinal tear without a detachment (7.0%), posterior vitreous detachment (6.5%), proliferative sickle retinopathy (5.7%), retinal tear with a detachment (4.8%), subretinal neovascularization from macular degeneration (2.2%), hypertensive retinopathy (1.7%), unknown (2.5%), and other causes (8.7%). Among black patients with spontaneous vitreous hemorrhage, sickle cell retinopathy and retinal vein occlusion were major causes, each accounting for more than 15% of the cases. Systemic hypertension was associated with vitreous hemorrhage from retinal vein occlusion. CONCLUSION: The authors propose that despite the wide array of causative factors of vitreous hemorrhage, the evaluation of demographic, ocular, and medical variables can significantly aid clinicians in identifying its etiologic patterns.

Adolescent↗
PubMed1993

Disseminated intravascular coagulopathy due to salmonellosis precipitated by blunt trauma.

We have reported an unusual cause of disseminated intravascular coagulopathy (DIC) in a patient with multiple injuries from blunt trauma. The source of continued hemorrhage remained elusive despite laparotomy and thoracotomy. Bleeding appeared to resolve only after discovery and treatment of infection due to Salmonella enteritidis, which the patient had contracted during a recent trip to Mexico.

Adult↗
PubMed1993

Hemodynamics of failing dialysis grafts.

Pressures were measured in the graft and the central vein during 104 consecutive angiographic examinations of failing hemodialysis grafts. Stenosis severity greater than 40% led to a statistically significant rise in graft pressure. In grafts in which all stenoses were of 40% or less severity, the systolic pressures in the venous and arterial limbs of the grafts were 31% +/- 16 and 45% +/- 17, respectively, of systemic systolic pressure. In grafts in which the highest grade of stenosis was greater than 40%, pressures in the venous and arterial limbs of the grafts were 53% +/- 25 and 75% +/- 24, respectively, of systemic systolic pressure. Graft thrombosis tended to occur at a higher degree of lumen reduction (but at similar pressures) with central vein stenoses compared with venous anastomotic stenoses. Dialysis graft pressures can help determine the hemodynamic importance of stenoses and the need for intervention. Percutaneous intervention should achieve arterial and venous limb pressures of less than 50% and 33% of systemic pressure, respectively.

Angiography, Digital Subtraction↗
PubMed1993

Occluded coloanal anastomosis: transrectal US-guided balloon dilation.

Balloon dilation is a well-described, nonoperative, alternative treatment for postoperative strictures of the colon and rectum. This procedure may not be technically feasible when an occluded lumen prevents passage of a guide wire across the obstruction. The authors describe the use of transrectal ultrasound guidance to initially pass a needle across an occlusive web at the coloanal anastomosis after proctosigmoidectomy. This allowed placement of a guide wire across the occlusion and subsequent successful balloon dilation.

Anal Canal↗