Biomedical subjects
M Weinstein
Publications and source records attributed to M Weinstein.
Bullous lichen sclerosus et atrophicus: treatment by tangential excision.
The bullous variant of lichen sclerosus et atrophicus (LSA) is a rare disorder for which there is no satisfactory treatment. A patient is reported with extensive plaques of bullous LSA on the pretibial skin that did not respond to sharp debridement, vigorous local care, or intralesional corticosteroid injections. Tangential partial-thickness excision of diseased tissues resulted in an extended remission. To our knowledge this approach has not been previously employed for bullous LSA, and it offers an encouraging surgical alternative to other therapeutic modalities.
The effect of single-dose methyldopa and diuretic on BP and left ventricular mass.
The effect of a single daily dose of 500 mg of methyldopa with 50 mg of hydrochlorothiazide and 5 mg of amiloride hydrochloride was studied in 21 patients with mild to moderate hypertension. It was shown that the average morning BP changed from 182/103 +/- 15/9 mm Hg to 145/83 +/- 16/8 mm Hg following one day of treatment. Similarly, the average of seven hourly measurements (7BP) dropped from 170/99 +/- 11/7 mm Hg to 145/86 +/- 11/8 mm Hg. In 12 patients, the same therapy lowered the morning BP from 186/104 +/- 16/9 mm Hg to 144/83 +/- 15/8 mm Hg and the 7BP from 168/98 +/- 10/6 mm Hg to 142/83 +/- 12/7 mm Hg following three weeks. After eight weeks, normal values were still maintained. Left ventricular mass was elevated in all the patients (330 +/- 67) and dropped by an average of 12% and 17% by three and eight weeks after initiation of therapy. Unchanged left ventricular end diastolic volume and decreased muscle thickness indicate true reduction in hypertrophy in addition to the BP-lowering effect of this combined single-dose therapy described.
Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy.
Between January, 1967 and July, 1980, 176 women who were referred to the Joint Center for Radiation Therapy (JCRT) for definitive breast irradiation underwent low axillary dissection. A typical operative technique is described. The dissection stops short of the axillary vein although the vein is usually visualized. One hundred thirty-two axillae were thought to be N0 or N1a. Forty-six axillae were felt to be N1b. Seventeen percent of the T1 N0 patients had pathologically positive nodes. Twenty-seven percent of the T2 N0 patients had positive nodes. When 5 or less nodes were removed at axillary sampling the incidence of nodal involvement was very low. There were no differences in nodal positivity when comparing upper quadrant to lower or central lesions. Lateral lesions appeared to have higher positivity rates compared with either medial or central lesions. Ninety-four percent of axillae with N1b lesions were pathologically confirmed. The complication rate for this procedure was low. There were 5 transient non-surgical complications and 1 cellulitis resulting in a frozen shoulder, which required corrective surgery. There were no cases of moderate or severe arm edema. Axillary sampling is compared to axillary dissection as a diagnostic procedure. Axillary sampling may underestimate the true pathologic positive rate, but diagnostic accuracy appears excellent if level 1 and 2 nodes are sampled.
Nonoperative drainage of fluid collections following operations on the biliary tract.
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Nursing: committee plan helps resolve problems between departments.
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Adverse reactions following T-tube removal.
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Serum chromium levels and chronic dialysis.
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Correlation of clinical and angiographic findings in brain ischemia with regional cerebral blood flow measured by the xenon inhalation technique.
Eighty-eight patients with brain ischemia underwent cerebral angiography and measurement of regional cerebral blood flow (rCBF) after 133Xe inhalation. A fast compartment flow rate and an initial slope index were computed for each detector and for each hemisphere. The clinical presentation, angiographic findings, and rCBF results were then examined for significant correlations. Patients with hemispheric infarction most frequently showed bilateral diffusely decreased rCBF. In patients with transient ischemic attacks, no specific pattern emerged. Patients with unilateral internal carotid artery occlusion frequently hd bilateral diffusely decreased rCBF. Patients with severe internal carotid artery stenosis were more likely to show decreased rCBF than were patients with mild or moderate stenosis. The initial slope index seemed to be a more sensitive indicator of brain ischemia than the fast compartment flow rate. The possible pathophysiological significance and relationship to patient management of the various rCBF patterns are discussed.
Hospital cuts costs with telephone system.
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Surgical experience with nasopharyngeal angiofibroma.
Recent reports have suggested that radiotherapy may be preferable to other forms of treatment of juvenile nasopharyngeal angiofibroma. There are, however, potentially serious short- and long-term complications associated with the use of radiotherapy in the head and neck. For the past three years, ten consecutive patients with juvenile nasopharyngeal angiofibroma have been treated at The Cleveland Clinic Foundation with an approach that permits accurate removal with minimal complications. With this method of treatment, intraoperative blood loss, the necessity for blood transfusion, and length of hospital stay have been greatly decreased. There have been no substantive complications and no recurrences to date. If further experience with this approach to management in a larger series of patients has the same results, it would seem that radiotherapy should be relegated to a secondary position in the treatment of juvenile nasopharyngeal angiofibroma, except for cases wherein intracranial extension would prevent total excision.
Stress thallium-201 myocardial scintigraphy and exercise technetium ventriculography in the detection and location of chronic coronary artery disease: comparison of sensitivity and specificity of these noninvasive tests alone and in combination.
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Analysis of factor VIII coagulant antigen in normal, thrombin-treated, and hemophilic plasma.
The relationship between Factor VIII coagulant antigen (VIII:CAg) and Factor VIII-associated von Willebrand factor (VIII:vWF), and the effect of thrombin on VIII:CAg have been determined in plasma by using complexes of VIII:CAg and 125I-labeled human anti-VIII:CAg-Fab. Antibody-treated plasma samples were electrophoresed on NaDodSO4/polyacrylamide agarose gels and analyzed by autoradiography. The major VIII:CAg-125I-labeled Fab complex that persisted in NaDodSO4 had Mr 3.2 x 10(5). This Mr value was confirmed by column chromatography and sucrose density centrifugation and is presumed to reflect a free VIII:CAg of Mr 2.7 x 10(5). Minor bands were also present on autoradiograms of normal plasma corresponding to Mr values of 2.5, 1.85, and 1.7 x 10(5) (free VIII:CAg related proteins with Mr values of 2.0, 1.35, and 1.2 x 10(5), respectively). None of the VIII:CAg bands was present in plasma samples from five patients with severe hemophilia A. No radioactivity was associated with VIII:vWF multimers on NaDodSO4 gels. Thrombin treatment of normal plasma eliminated the radioactive band at 3.2 x 10(5) and increased the intensity of a band of Mr 1.7 x 10(5). Generation of this presumed VIII:CAg fragment of Mr is approximately equal to 1.2 x 10(5) coincided with a thrombin-induced increase in Factor VIII coagulant activity. These data demonstrate that the form of VIII:CAg detected in normal plasma is not covalently linked to VIII:vWF multimers and is absent in plasma from five hemophilia A patients. Thrombin-induced proteolysis of VIII:CAg can be detected in microliter quantities of normal plasma.
Two cases of rhinocerebral zygomycosis (mucormycosis) with common epidemiologic and environmental features.
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A marker for megakaryocytes: serotonin accumulation in guinea pig megakaryocytes.
Serotonin accumulation was studied in guinea pig megakaryocytes and platelets. Megakaryocyte suspensions, 80% to 90% pure, and platelet-rich plasma were used. 14C-serotonin was used to assay serotonin uptake. Maximum capacity for serotonin storage in 2.5 x 10(5) megakaryocytes was 4.2 nmol and in 2.5 x 10(8) platelets was 3.1 nmol. One thousand times as many platelets as megakaryocytes were used to normalize for protein content of the two cells. Thus the megakaryocyte's capacity for accumulating serotonin is equivalent to, if not greater than, that of the platelet. Serotonin accumulation in individual megakaryocytes and other hematopoietic cells was studied by autoradiography. Whole marrow suspensions were incubated with 3H-serotonin. Cells in whole marrow suspensions, cells in the pellet of the albumin density gradient, and purified megakaryocytes were then analyzed by autoradiography. The pellet of the albumin density gradient was inspected because it is known to contain megakaryocytes that are not recovered in the purified megakaryocyte suspensions. Examination of whole marrow cell suspensions revealed that virtually all megakaryocytes had taken up serotonin, but there was no evidence of serotonin accumulation in other hematopoietic cells. Over 95% of megakaryocytes in the pellet of the albumin density gradient had retained serotonin. The megakaryocytes that had not retained serotonin or not accumulated the amine did not comprise a specific population in respect to maturity. Evaluation of purified megakaryocytes showed that megakaryocytes at various stages of maturation, as defined by diverse size and cytoplasmic/nuclear maturation, had accumulated equivalent amounts of serotonin. Thus the capacity for serotonin accumulation is established in the immature megakaryocyte. Serotonin uptake can serve as a marker for the identification of the immature megakaryocyte.
Serum magnesium levels in acute medical and surgical conditions.
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Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913--1978).
A retrospective clinicopathologic review of 105 cases of sympathetic ophthalmia showed histologic features of prognostic significance and evaluated the role of therapy. Classic descriptions omit retinal changes, but 58.0% of our cases had retinal detachment and 42.2% showed intraretinal inflammation. The optic nerve and/or meninges were inflamed in 51%. Optic atrophy was seen in 54.4%. Plasma cells are said to be characteristically absent, but 65.0% of steroid-treated and 85.7% of cases before the steroid era showed plasma cell infiltration. Severity of inflammation pathologically correlated with final visual outcome, and corticosteroid therapy changed both the character and severity of inflammation. Early enucleation of the exciting eye after onset of symptoms in the fellow eye was found to improve visual prognosis. Electron microscopy performed on fresh tissue and choroidal cell cultures revealed no viral particles, and viral and mycoplasma cultures all proved negative.
Determinants of adverse reaction following postoperative T-tube cholangiogram.
The incidence, nature, and mechanisms of adverse reaction following postoperative T-tube cholangiogram have received little attention in the medical literature. This paper presents the experience at one hospital over a 30-month period (1975--1977) covering 139 patients who had 170 cholangiograms. Factors examined included intraoperative and postoperative cultures of bile, the use of antibiotics prior to the performance of the cholangiogram, the technique of cholangiography, the interval between operation and cholangiogram. Eleven (6.5%) cholangiograms were followed by an adverse reaction. Two of these reactions were severe, manifested by signs of septic shock. The administration of antibiotics was not associated with a reduction in adverse reactions. The cholangiographic technique of gravity infusion of dye, which effectively limits the amount of pressure generated during the study, was associated with a significant reduction in adverse reactions. No severe reactions occurred following any study performed by the gravity technique. There was no significant correlation between the age of the patient or the number of days postoperative with adverse reaction. A review of the literature suggests that the mechanism for these severe reactions is cholangiovenous reflux. The avoidance of high intraductal pressures (above 25 cm of water) during the performance of postoperative T-tube cholangiogram should significantly reduce the incidence of adverse reactions.