Intracranial hemorrhage during systemic anticoagulation in patients with cerebral metastasis.
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Aged↗
Biomedical subjects
M W Wolfe
Publications and source records attributed to M W Wolfe.
Right heart pseudotumor simulated by ascitic pseudocyst. An unusual complication of peritoneovenous shunting.
Peritoneovenous shunting (PVS) for intractable ascites has an extensive clinical experience, with several well-described complications. We recently noted an unusual complication of PVS with a Denver shunt. A 37-year-old woman who had placement of a shunt for chylous ascites 18 months prior to presentation demonstrated on a large, mobile mass filling the right atrium which, during atrial systole, partially prolapsed into the right ventricle. At cardiac surgery, a 4 X 10 cm mass with attachment to the tip of the shunt was found. Intracardiac ascitic pseudocyst is a potentially lethal complication of PVS with the Denver shunt which should be considered with a high index of suspicion and evaluated with echocardiography.
Adult↗
Prolonged and functional survival with the asplenia syndrome.
Asplenia syndrome is a rare congenital complex of splenic agenesis, cardiac malformation, and malposition of the abdominal viscera. Prolonged functional survival is very uncommon, with death usually caused by severe infection or congestive heart failure. A 21-year-old man with typical asplenia syndrome who is currently asymptomatic and in his third year of college is described.
Abnormalities, Multiple↗
Plaquelike Clearings Induced by Antimicrobial Agents on Lawns of Pseudomonas aeruginosa.
Plaques similar in appearance to those induced by phage were observed adjacent to chloramphenicol and tetracycline discs on Pseudomonas aeruginosa lawns used for the determination of antibiotic susceptibility. Thirteen strains were selected for study, 10 of which exhibited the plaquing phenomenon. The ability to form plaques induced by tetracycline was not related to any of the biochemical properties of the strains studied, their overall antimicrobial susceptibility pattern, or their pathological source. Some pseudomonad strains were capable of pyocin production; however, the relationship between plaque formation and pyocin production was not apparent. Supernatant fluids of resuspended plaque contents of eight strains originally demonstrating clearings could induce plaques on sensitive indicator lawns only when collected from tetracycline-induced plaque areas; supernatant fluids of the same strains could not produce clearings without previous exposure to the drug. Of the eight supernatant fluids capable of plaque induction, three were active on their homologous indicator lawns. In a subsequent survey of 95 P. aeruginosa strains, it was found that 28 isolates exhibited plaques. Of these, 17 were associated with tetracycline, 7 were associated with chloramphenicol, 3 were associated with triple sulfa; and 1 was associated with nalidixic acid.
Journal Article↗
Comparison of reagent-impregnated paper strips and conventional tests for distinguishing Escherichia from Aerobacter: correlation with colonial morphology.
The means for distinguishing Escherichia from Aerobacter (Enterobacter) differ in laboratories and range from complete dependence on colonial reactions on typical gram-negative media to reliance on one or more of the classical indole, methyl red, Voges-Proskauer, citrate (IMViC) parameters. Three colonial types (one prejudged as Escherichia) of lactose-positive rods were catalogued on each of the most commonly used selective media, MacConkey Agar, Endo Agar, and E M B Agar. Each cultural type was presumptively diagnosed and then compared with the expected outcome of individual IMViC tests. The distribution of preliminary identifications was similar from growth patterns on MacConkey Agar and E M B Agar, but it differed markedly from Endo Agar. When organisms initially diagnosed by cultural methods were compared by single IMViC tests, it was found that for each colonial type one of the biochemical parameters was best suited. Thus, for those types initially considered Escherichia, the methyl red or Voges-Proskauer test results agreed most consistently; for other types, the citrate reaction was most satisfactory. In addition, when newly formulated reagent-impregnated paper strip methods for indole, Voges-Proskauer, and citrate were evaluated and compared to the standard methods, agreement was 97% for indole, 90% for Voges-Proskauer, and 95% for Simmons' citrate.
Bacteriological Techniques↗
New diagnostic system for the identification of lactose-fermenting gram-negative rods.
The identification of prompt lactose-fermenting gram-negative rods has generally relied heavily upon colonial morphology coupled with one or more indole, methyl red, Voges-Proskauer, citrate (IMViC) parameters, hydrogen sulfide, and motility. Studies were undertaken to compare diagnoses dependent solely upon the more orthodox criteria to a system for identification based upon hydrogen sulfide, ornithine decarboxylase, and citrate utilization (HOC). The results suggest that the IMViC scheme of identification is neither consistent nor applicable when applied to the current nomenclature of the above group of organisms and should be discarded, whereas the HOC system may prove to be of significant value to clinical microbiologists.
Bacteriological Techniques↗
Endoscopic observation of ampullary hemorrhage secondary to occult pancreatitis.
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Ampulla of Vater↗
Syringomyelia and developmental scoliosis.
We attempted to characterize the signs and symptoms of patients presenting with scoliosis as a manifestation of occult syringomyelia, and to determine the effect of syrinx decompression on the deformity and neurologic deficits. This study represented 21 patients treated from 1981 through 1991 at the authors' institution. All patients with occult syringomyelia and no other central nervous system lesions underwent decompression of the syrinx, with improvement in neurologic signs and symptoms. Three of the four with scoliosis that were not treated by arthrodesis showed improvement of their deformity at an average follow-up of 35 months. Three of five patients with myelodysplasia, occult syringomyelia, and scoliosis not previously treated with spinal arthrodesis showed stabilization or improvement of their deformity at an average follow-up of 21 months. We conclude that syringomyelia is associated with a high incidence of developmental scoliosis, and that decompression of the syrinx leads to improvement in, or stabilization of, the majority of scoliotic curves, or postpones the need for fusion.
Adolescent↗
Development of lower leg strength and flexibility with the strength shoe.
The Strength Shoe is a modified athletic shoe with a 4-cm thick rubber platform attached to the front half of the sole. It is promoted as an effective method of increasing "speed, quickness, and explosive power," as well as ankle flexibility and calf circumference, when used in a plyometrics-based training regimen. This study evaluates, in a prospective, randomized trial, the efficacy and safety of the Strength Shoe training regimen for increasing lower leg flexibility and strength in intercollegiate track and field participants. No enhancement of flexibility, strength, or performance was observed for participants wearing the Strength Shoe at the end of an 8-week training program, following the suggested regimen of the manufacturer. The use of the Strength Shoe cannot be recommended as a safe, effective training method for development of lower leg strength and flexibility. However, the use of plyometrics in a properly supervised setting may improve athletic performance and merits further investigation.
Evaluation Studies as Topic↗
Patellar resurfacing in total knee arthroplasty.
Whether or not to resurface the patella when performing a primary total knee arthroplasty remains an open question. A number of recent studies have added new information relevant to this controversy. Anatomic studies show that there is normally substantial variability in the anatomy of the trochlear groove. Implanting a femoral component therefore results in a change in the surface topography of the knee in a high percentage of cases. Even though a number of intraoperative techniques have been described in an attempt to accurately reproduce femoral and tibial component rotation, studies of the application of these techniques reveal that component malpositioning or malrotation of a measurable degree occurs in 10% to 30% of cases, depending on the surgical technique and landmarks used. There has been substantial change in the design of both femoral and patellar components in recent years. Even with current designs, biomechanical studies indicate that some degree of change in kinematics and contact stresses occurs following total knee arthroplasty. However, the results of clinical studies have been extremely variable, with most showing either no difference or very little difference between resurfaced and nonresurfaced patellae in osteoarthritic knees. The decision to resurface the patella or not must be individualized on the basis of the surgeon's training and experience and an intraoperative assessment of the patellofemoral articulation.
Arthroplasty, Replacement, Knee↗
The relation of clinical outcome to dissection and thrombus formation during coronary angioplasty. Heparin Registry Investigators.
BACKGROUND: Although the development of thrombus or dissection during percutaneous transluminal coronary angioplasty (PTCA) increases the risk of abrupt vessel closure, the magnitude of the effect is difficult to define. OBJECTIVE: The aim of the study was to determine prospectively the effect of the development of thrombus or dissection on PTCA procedural outcome. METHODS: Data from 591 consecutive angioplasty procedures involving 756 lesions at 9 clinical centers were included in a prospective registry with a core angiographic laboratory. RESULTS: Clinical success (defined as < 50% stenosis of all target lesions assessed in a core angiographic laboratory, with no major complications of death, Q wave or non-Q wave myocardial infarction or emergency CABG) was achieved in 497 patients (84%). Major complications occurred in 45 (7.6%). Abrupt vessel closure, including both established closure (TIMI grade 0 or I flow) and impending closure (> 50% stenosis, TIMI grade 0-2 flow, plus use of additional interventions) occurred in 65 patients (11%). Angiographically visible dissections developed in 40% of lesions; more severe grades of dissection were associated with reduced success rates, and increased incidence of and abrupt vessel closure and major complication. Angiographic evidence of thrombus (filling defects) developed in 12.3% of lesions; the presence of thrombus was associated with significantly lower procedural success (61% vs. 86%) and significantly higher rates of abrupt vessel closure (28% vs 7%) and major complications (24% vs. 6%). With multivariable analysis, thrombus was identified as an independent predictor of procedural success, abrupt vessel closure, and major complications. CONCLUSIONS: The development of severe dissections or thrombus following PTCA is associated with significantly lower procedural success rates and higher rates of abrupt vessel closure and major complications. Patients who develop severe dissection or thrombus may be appropriate candidates for more aggressive forms of therapy.
Adult↗