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Biomedical subjects

P Reissman

Publications and source records attributed to P Reissman.

At least 73 records · Page 4Linked to original sources
PubMed1993

Transfusion-related adult respiratory distress syndrome.

Leukocyte antibodies are the major cause of nonhemolytic transfusion reactions. One of the less frequent but severe forms of this reaction is the adult respiratory distress syndrome, or transfusion-related acute lung injury. This rare phenomenon is the result of leukocyte antibodies forming immune complexes with granulocytes, complement activation, sequestration of activated granulocytes in the pulmonary capillary bed, and their degranulation associated with release of proteolytic and cytotoxic substances. This cascade causes endothelial damage with increased capillary permeability. Plasma fluids and proteins accumulate in the interstitial and intra-alveolar spaces, leading to respiratory insufficiency. We present two patients with transfusion-related adult respiratory distress syndrome associated with leukocyte HLA antibodies, who were successfully treated in our hospital. The pathogenesis, diagnostic measures and treatment of this uncommon yet critical condition is discussed.

Adrenal Cortex Hormones↗
PubMed1992

Anaerobic osteomyelitis in patients with Gaucher's disease.

Bone involvement in patients with Gaucher's disease is common, and some of its clinical manifestations may resemble acute osteomyelitis. In addition, many studies have emphasized the high risk of secondary infection when surgical procedures are performed at the site of the involved bone. Nevertheless, these infections have never been well documented in the literature. Presentation of a patient with Gaucher's disease and osteomyelitis due to Prevotella (Bacteroides) melaninogenica provided us the opportunity to review 10 other similar case reports documented in the literature since 1966. This review suggests that acute hematogenic osteomyelitis is an uncommon complication of Gaucher's disease, but it is of interest that in most cases it is due to unusual organisms, particularly anaerobes.

Adult↗
PubMed1992

Case report: the management of penetrating cardiac trauma with major coronary artery injury--is cardiopulmonary bypass essential?

Major coronary artery injury in penetrating cardiac trauma is relatively uncommon and is associated with a poor prognosis. However, for a variety of reasons, the outcome for such patients has been improving during the last two decades. The main factor responsible for this change is, according to some authors, the use of emergency cardiopulmonary bypass (CPB). We present a case of complete transection of the LAD coronary artery managed by primary ligation of the vessel, but because of progressive signs of extensive myocardial infarction, the patient underwent emergency CPB and an aortocoronary bypass graft. The patient experienced a good cardiac recovery but died 5 days later of irreversible anoxic brain damage. In reviewing the literature concerning the absolute need for emergency CPB in the management of penetrating coronary artery injury (PCAI), we found that the overall outcome for patients treated with emergency CPB was not significantly better than for those treated with ligation alone. We believe that CPB is not always essential in the management of PCAI and should be instituted only when the injury to a main coronary artery is very proximal, whenever associated intracardiac injuries exist, or when the patient develops extensive myocardial infarction or uncontrolled arrhythmias following ligation of the injured coronary vessel.

Adult↗
PubMed1992

Duodenocolic fistula: an unusual presentation of esophageal squamous cell carcinoma.

Duodenocolic fistula, one of the less common forms of entero-enteric fistulas, is usually associated with colonic malignancies at the hepatic flexure or Crohn's disease of the colon or duodenum. We report an unusual case of duodenocolic fistula caused by metastatic esophageal squamous cell carcinoma in which the primary esophageal tumor remained asymptomatic. In several collected series of clinical and autopsy studies of over 2800 patients, no similar complication of metastatic esophageal squamous cell carcinoma has been reported.

Carcinoma, Squamous Cell↗
PubMed1991

Oxygen therapy in hemorrhagic shock.

Decreased oxygen delivery and cellular hypoxia are important factors in the pathophysiology of hemorrhagic shock. We studied the effects of 100% oxygen at 1 and 3 ATA (atmosphere absolute) in a severe model of hemorrhagic shock induced by bleeding 50% of the total blood volume in rats. Post-treatment with 100% oxygen at 1 and 3 ATA maintained mean arterial blood pressure (MABP) in hemorrhaged rats at significantly higher values compared to untreated controls (P less than 0.01 at 1 and 3 ATA). Treatment with oxygen attenuated the increase in plasma activities of the lysosomal hydrolase cathepsin D (P less than 0.05 at 1 ATA; P less than 0.01 at 3 ATA). Oxygen at 3 ATA also attenuated the plasma accumulation of free amino-nitrogen compounds (P less than 0.05). Furthermore, hyperoxia prevented the final increase in hematocrit (P less than 0.05 at 1 ATA; P less than 0.01 at 3 ATA). Hemorrhaged rats treated with oxygen also exhibited a significantly longer survival time (P less than 0.01 at both doses), and higher survival rates (50% at 1 ATA and 100% at 3 ATA; P less than 0.05 and P less than 0.01, respectively) than untreated shock rats. No significant effect on any of the above mentioned variables was found in hemorrhaged rats treated with 7% oxygen at 3 ATA (oxygen pressure 0.2 ATA), indicating that all salutary effects can be attributed to oxygen and not to the increased ambient pressure per se. Our results indicate that 100% oxygen in normobaric and hyperbaric conditions exerts important beneficial effects in hemorrhagic shock and may be a useful drug for the treatment of this condition.

Animals↗
PubMed1990

Inner ear decompression sickness following a shallow scuba dive.

Inner Ear Decompression Sickness (IEDCS)--manifested by tinnitus, vertigo, nausea, vomiting, and hearing loss--is usually associated with deep air or mixed gas dives, and accompanied by other CNS symptoms of decompression sickness (DCS). Early recompression treatment is required in order to avoid permanent inner ear damage. We present an unusual case of a scuba diver suffering from IEDCS as the only manifestation of DCS following a short shallow scuba dive, successfully treated by U.S. Navy treatment table 6 and tranquilizers. This case suggests that diving medical personnel should be more aware of the possible occurrence of IEDCS among the wide population of sport scuba divers.

Adult↗
PubMed1989

[Routine omentectomy during Tenckhoff catheter insertion for peritoneal dialysis].

Peritoneal dialysis is now one of the main methods of treating acute and chronic renal failure, and the number of patients treated by continuous ambulatory peritoneal dialysis (CAPD), instead of hemodialysis, is increasing. The most commonly used device for CAPD is the Tenkhoff catheter. The major complications after its insertion are infection and catheter obstruction. To reduce the incidence of obstruction and related complications, usually the result of omental occlusion of catheter ports, we performed routine omentectomy on insertion of the catheter. During 1984-1987 we inserted 56 Tenckhoff catheters for CAPD in 32 males and 20 females ranging in age from 2.5 to 83 years (mean 50.1 +/- 19.7). 32 suffered from end-stage renal disease and 20 from acute temporary renal failure. In 87% local anesthesia was used, and in the others general anesthesia. Omentectomy was performed in 81%. In only 8 patients (15%) omentectomy could not be performed, as the omentum was either too short or was adherent to the abdominal wall as a result of previous abdominal surgery. In an additional 2 patients the omentum was not resected, in 1 because of previous surgery for a perforated duodenal ulcer and in the other because the procedure was performed at the bedside. Peritonitis followed in 14 cases, but in 12 of them it completely resolved after administration of antibiotics. Over a follow-up period of 32 months there was only 1 case of catheter obstruction, significantly fewer than reported in other series. We conclude that routine omentectomy during insertion of the Tenckhoff catheter for CAPD under local anesthesia is safe and reduces the incidence of catheter obstruction during short and long term use.

Acute Kidney Injury↗
PubMedDate not supplied

Elective laparoscopic appendectomy in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.

Adolescent↗
PubMedDate not supplied

Laparoscopic colorectal surgery: ascending the learning curve.

The aim of this study was to prospectively assess the results of our first 100 consecutive patients who underwent laparoscopic or laparoscopy-assisted colorectal operations. The parameters studied included the type and length of procedure, intra- and postoperative complications, conversion to open surgery, length of ileus, and hospitalization. A total of 100 laparoscopic and laparoscopy-assisted procedures were performed between May 1991 and April 1994. The mean patient age was 49 years (12-88 years). The procedures included 36 total abdominal colectomies (TACs) (ileoanal reservoir 28, ileorectal anastomosis 6, end-ileostomy 2), 39 segmental resections of the colon and small bowel, 8 resections of the rectum, 7 diverting stoma creations, 7 reversals of Hartmann's procedure, and 3 other procedures. In seven cases (7%) the laparoscopic procedure was converted to a laparotomy. A group of 22 patients sustained 26 complications that included enterostomy (n = 5), hemorrhage (n = 6), intraabdominal abscess (n = 4), prolonged ileus (n = 4), wound infection (n = 2), anastomotic leak (n = 1), aspiration (n = 1), cardiac arrhythmia (n = 1), upper intestinal bleeding (n = 1), and postoperative small bowel obstruction (n = 1). There were no deaths. When divided into three equal, consecutive groups, the patients in the early (n = 33) and intermediate (n = 33) groups had a significantly higher complication rate (42% and 27%, respectively), than those in the late group (n = 34, 12%;p < 0.05). The complication rate in each group was also directly related to the number of TACs performed (18 in the early, 13 in the intermediate, and 5 in the late group). The overall complication rate in TAC cases was significantly higher (42%) when compared to that of all other procedures (segmental resection 9%, nonresectional 12%;p < 0.01). The mean operating time was 4 hours (2.5-6.5 hours) for TAC, 2.5 hours (1.5-5.5 hours) for segmental colonic resection, and 1.6 hours (1.0-2.5 hours) for the nonresectional procedures. The length of ileus was 3.5 days (2-7 days) after TAC, 3 days (2-7 days) after the segmental resections, and 2 days (1-4 days) after the nonresectional procedures. The mean hospital stay was 7.3 days (2-40 days): 8.4 (5-40), 7.0 (4-12), and 6.8 (2-11) days for the TAC, segmental resection, and nonresectional procedures, respectively. We conclude that the feasibility of laparoscopic colorectal surgery has been well established. The morbidity associated with laparoscopic colorectal surgery correlates with a steep learning curve but is also related to the type of procedure. TAC is associated with a higher complication rate than are other laparoscopic colorectal procedures.

Adolescent↗