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Biomedical subjects

M Sherman

Publications and source records attributed to M Sherman.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Liver disease activity and hepatitis B virus replication in chronic delta antigen-positive hepatitis B virus carriers.

Delta antigen is currently thought to reflect superinfection of the liver with a defective RNA virus (delta agent), requiring helper function from hepatitis B virus for its replication. To assess the influence of delta agent on hepatitis B virus replication in patients persistently infected with both viruses and showing chronic liver disease, we measured serum and liver hepatitis B virus DNA in HBsAg-positive chronic liver disease patients who were either positive or negative for delta antigen in the liver. Hepatitis B virus DNA was assayed in the serum of 21 patients with delta antigen-positive/HBsAg-positive chronic liver disease and in 21 patients with delta antigen-negative/HBsAg-positive chronic liver disease matched for HBeAg/anti-HBe status and underlying liver histology. HBcAg and delta antigen in liver was determined by immunofluorescence or immunoperoxidase staining. In delta antigen-positive/HBsAg-positive chronic liver disease, serum hepatitis B virus DNA was detected transiently in 4 of 21 cases (19%) and was present in these patients at low levels (trace to 2+). In contrast, 9 of 21 (43%) delta antigen-negative/HBsAg-positive chronic liver disease patients were serum hepatitis B virus DNA positive, and five of these had high serum hepatitis B virus DNA levels (3+ to 4+). Serum HBsAg and anti-HBc titers were significantly lower in delta antigen-positive cases and correlated with reduced amount of HBcAg in the liver.(ABSTRACT TRUNCATED AT 250 WORDS)

Carrier State↗
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Percutaneous ethanol injection of unresectable medium-to-large-sized hepatomas using a multipronged needle: efficacy and safety.

Fine needles with an end hole or multiple side holes have traditionally been used for percutaneous ethanol injection (PEI) of hepatomas. This study retrospectively evaluates the safety and efficacy of PEI of unresectable medium-to-large (3.5-9 cm) hepatomas using a multipronged needle and with conscious sedation. Twelve patients, eight men and four women (age 51-77 years; mean: 69) received PEI for hepatomas, mostly subcapsular or exophytic in location with average tumor size of 5.6 cm (range: 3.5-9.0 cm). Patients were consciously sedated and an 18G retractable multipronged needle (Quadrafuse needle; Rex Medical, Philadelphia, PA) was used for injection under real-time ultrasound guidance. By varying the length of the prongs and rotating the needle, the alcohol was widely distributed within the tumor. The progress of ablation was monitored by contrast-enhanced ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) after each weekly injection and within a month after the final (third) injection and 3 months thereafter. An average total of 63 mL (range: 20-154 ml) of alcohol was injected per patient in an average of 2.3 sessions. Contrast-enhanced CT, ultrasound, or MRI was used to determine the degree of necrosis. Complete necrosis was noted in eight patients (67%), near-complete necrosis (90-99%) in two (16.7%), and partial success (50-89%) in two (16.7%). Follow-up in the first 9 months showed local recurrence in two patients and new lesions in another. There was no mortality. One patient developed renal failure, liver failure, and localized perforation of the stomach. He responded to medical treatment and surgery was not required for the perforation. One patient had severe postprocedural abdominal pain and fever, and another had transient hyperbilirubinemia; both recovered with conservative treatment. PEI with a multipronged needle is a new, safe, and efficacious method in treating medium-to-large-sized hepatocellular carcinoma under conscious sedation. Its survival benefits require further investigations.

Administration, Cutaneous↗
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Arteriovenous malformation of the mandible.

A recent case of a vascular malvormation involving the mandible prompted the review of this subject. There are less than 80 cases of this rare but serious disease reported in the literature. There is no accepted standard treatment, but recent contributions have improved the safety and effectiveness of therapy.

Arteriovenous Malformations↗
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Nursing skills and practice.

This article discusses the value placed on basic nursing skills and practice in preregistration diploma programmes (Project 2000). The authors argue that the current emphasis on the early acquisition of theoretical knowledge must not underestimate the importance of practising basic skills for the development of students' confidence in clinical settings.

Attitude of Health Personnel↗
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Intraperitoneal chemotherapy: a prolonged infusion of 5-fluorouracil using a novel carrier solution.

A novel carrier solution, icodextrin 20 (7.5%) has allowed exploration of prolonged intraperitoneal (IP) infusion of the cytotoxic drug, 5-fluorouracil. Eighteen patients with intraperitoneal carcinomatosis were entered into a feasibility and pharmacokinetic study of prolonged regional (IP) chemotherapy.. Specialist nurses trained the patients to self-administer their own treatment via a permanent i.p. catheter. A twin bag delivery system was used to perform one exchange daily. It proved possible to deliver continuous (5 days per week) i.p. 5-fluorouracil at doses of 200 mg/m2 and 300 mg/m2 for up to 12 weeks. The toxicities seen were infective peritonitis, nausea and vomiting, lethargy and anorexia. This was a nurse-led study and the home-based therapy holds promise for patients with malignant peritoneal disease.

Adult↗
PubMedDate not supplied

Osteoid osteoma. Distant, periarticular, and subarticular lesions as a cause of knee pain.

Osteoid osteoma, a benign osteoblastic tumour comprised of osteoid and atypical bone, is a well-known entity. However, clinical diagnosis may be delayed, especially when the pain is referred to a nearby joint. This paper reports a series of 11 cases occurring in physically active patients in whom the diagnosis was delayed because of pain referral to the knee. The mean duration from the onset of symptoms to diagnosis of osteoid osteoma was 20 months (range 3 to 48 months). Review of these 11 lesions indicates that they can be classified on the basis of their anatomical location: (a) distant to the knee; (b) periarticular; or (c) subarticular (intraarticular). It should be noted that initially only 5 of the 11 cases displayed characteristic x-ray findings; in the remaining 6 cases, diagnosis was dependent on positive 99mTc radionuclide bone scans, tomograms, and computerised tomography scans. Of the 9 patients who underwent surgical resection of their lesions, all had complete relief of symptoms and all continued to be asymptomatic at follow-up evaluations.

Adolescent↗
PubMedDate not supplied

Compression: is it necessary for bone healing?

The authors present a review of bone healing. A literary search on the subject reveals a variety of experiments performed on healing bone using different techniques. The review of this literature establishes that compression in bone healing is not absolutely necessary. It also relates that bone healing without any fixation is not desired. Therefore, the goal of this paper is to enlighten the surgeon that controlled, semirigid, semicompressed fixation with active range of motion is the ideal criteria for bone healing, and decreases the chance of cast disease.

Bone Regeneration↗
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A quantitative method of determining the pneumatic ankle tourniquet setting.

Pneumatic ankle tourniquets are currently used in podiatry for maintaining hemostasis during foot surgery. The literature is limited concerning the safest pressure to use with this device. This study was undertaken to develop a simple and reliable method of deriving a proper pressure setting that would be safe and efficacious. Using a Doppler stethoscope, the minimum effective tourniquet pressure was established on 54 limbs from 35 patients undergoing foot surgery at our institution. The average pressure needed to obtain a "bloodless field" was 218.6 +/- 34.6 mm. Hg. However, in the younger, normotensive patients the average pressure utilized was 203.9 +/- 22.3 mm. Hg. The lower pressures used were felt to be safer and better tolerated by the patients. The authors concluded that the minimum effective pressure should be determined for each patient preoperatively and the routine use of a maximum safe pressure of 250 mm. Hg should be discouraged.

Adolescent↗
PubMedDate not supplied

Cutaneous horns: review of literature and case report.

Cutaneous horns, although rarely seen in the podiatric practice, must be considered in one's differential diagnosis when treating keratinous skin lesions. These lesions have been described as both malignant and premalignant, and an adequate amount of tissue at the base of the lesion must be obtained for proper biopsy. The authors discuss a case in which an unusual surgical technique is used in the treatment of a cutaneous horn.

Aged↗
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Surgical treatment of Freiberg's infraction with the use of total joint replacement arthroplasty.

Freiberg's infraction is an osteochondrosis of the second metatarsal head, although it may be seen less often in the other metatarsals. It usually occurs in the second decade of life and is more commonly seen in females. The etiology is generally of a traumatic nature and symptoms include painful, limited range of motion of the joint. If untreated, destructive joint changes may lead to a painful degenerative arthritis requiring surgical intervention. The authors discuss joint replacement with a Swanson Silastic flexible hinged toe implant.

Female↗
PubMedDate not supplied

Hallux varus--surgical correction and review of the literature.

Acquired hallux varus may follow correction of hallux abducto valgus by the modified McBride procedure. The authors discuss correction of both acquired and congenital hallux varus and show pre- and postoperative illustrations of both types.

Foot Deformities, Acquired↗