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Biomedical subjects

R B Reinhold

Publications and source records attributed to R B Reinhold.

At least 19 recordsLinked to original sources
PubMed1997

Abnormal intraoperative cholangiography. Treatment options and long-term follow-up.

OBJECTIVE: To determine the long-term outcome in patients with filling defects on intraoperative cholangiography. DESIGN: Case series; retrospective review. SETTING: Community teaching hospital. PATIENTS: All patients (n = 872) undergoing cholecystectomy from July 1993 through June 1995. Of 281 intraoperative cholangiograms performed, 89 had abnormal findings. Defects were classified as stone (n = 47), unsure (n = 29), and artifact (n = 13). Medical records were reviewed for immediate and long-term follow-up results. INTERVENTION: Need for common bile duct exploration (CBDE) or endoscopic retrograde cholangiopancreatography (ERCP). OUTCOME: Morbidity and interventions required 1 to 3 years after surgery. RESULTS: Of the 47 patients with suspected stones, 24 underwent successful operative bile duct clearance. One patient required irrigation. Of the 22 patients who left the operating room with unresolved stones, only 2 ERCPs were required. Of the 29 patients with unsure filling defects, operative clearance was successful in 1; irrigation achieved clearance in 4. Only 1 of the 24 patients who left the operating room with unsure filling defects required subsequent ERCP. CONCLUSIONS: Observation of common bile duct defects of 4 mm or smaller is an appropriate clinical alternative. Defects of 5 mm or larger represent a gray area, although few 5- to 8-mm stones will cause subsequent symptoms. In our experience, if stone extraction is clinically important, especially if the patient has jaundice, open CBDE is more effective than transcystic laparoscopic CBDE.

Cholangiography↗
PubMed1994

Fine-needle aspiration biopsy of pancreatic ductal adenocarcinoma: loss of diagnostic accuracy with small tumors.

Eighty-three patients underwent CT-directed fine-needle aspiration biopsies (FNAB) for pancreatic ductal adenocarcinoma. Five factors that might have influenced the diagnostic sensitivity of FNAB were analyzed: clinical history, the number of passes for each FNAB, and three radiologic criteria including tumor size, tumor location, and the presence or absence of suspected tumor necrosis by CT scan. Sixty-three patients had a diagnosis of pancreatic carcinoma confirmed by FNAB (overall sensitivity = 76%). Tumor size was the only factor that correlated with the diagnostic sensitivity of FNAB. [table: see text] Of 12 patients whose FNAB was negative but suspicious for malignancy, 10 had a repeat FNAB and 4 were positive for carcinoma. We conclude that the diagnostic sensitivity of FNAB decreases significantly with decreasing tumor size and that a repeat FNAB for suspicious biopsies should be done to increase the diagnostic yield.

Biopsy, Needle↗
PubMed1994

Late results of gastric bypass surgery for morbid obesity.

OBJECTIVE: Morbid obesity (excess body weight of 45.5 kg or 100% over ideal body weight) is associated with > 3-fold increased mortality in men and women and is resistant to dietary intervention. Gastric bypass (GBP) and vertical banded gastroplasty (VBG) are the currently accepted surgical treatments. The purpose of this study was to analyze retrospectively 153 consecutive morbidly obese patients who underwent GBP from 1975-1986 and were followed for a minimum of 5 years. METHODS: Data were analyzed from 1-16 years postoperative comparing preoperative morbidity, operative complications, postoperative morbidity, interval weight loss, maximum weight loss, and weight regain. RESULTS: At the 1- and 5-year intervals, 129 and 86 patients respectively were available for review. Operative mortality was < 1%. Weight loss at 1 year = 48.5 kg rising to 57 kg at 24 months. Statistically significant weight loss of 37.0 kg (19.2 SD)(p < .001) was achieved at 5 years. The mean percent excess body weight lost was 66.4 and 50.9% at 1 and 5 years, respectively. No obesity-related deaths occurred in the follow-up period. Incidence of hypertension, cardiac disease and diabetes was reduced by 25-50% during follow-up. CONCLUSIONS: GBP is a safe and effective operation which achieves sustained weight loss of > 35 kg at 5 years and reduces the complications of morbid obesity.

Adult↗
PubMed1992

Evidence for diminished B12 absorption after gastric bypass: oral supplementation does not prevent low plasma B12 levels in bypass patients.

Vitamin and mineral assays were performed on blood in 20 gastric bypass patients preoperatively and 6 and 12 months postoperatively. Values were compared with serial food records in nine patients. Postoperatively, all patients were prescribed a supplement containing the recommended dietary allowances (RDA) for vitamins and minerals. Weight, calorie and protein intake, and total serum protein decreased over the study interval (p less than 0.01). Dietary intakes of vitamins B1, B2, B6, folate, iron and zinc fell (p less than 0.01), but total intake (i.e., diet + supplement) did not decrease with the exception of iron. Blood indicators of these nutrients were normal preoperatively and did not decline. However, plasma vitamin B12 levels decreased from 385 pg/ml preoperatively to 234 pg/ml at 1 year (p = 0.0064), despite an increase in total vitamin B12 intake from 2.6 to 11.7 micrograms/day (p = 0.1173). Five patients (27.8%) had abnormally low plasma vitamin B12 levels at 1 year postoperatively; four were taking at least the RDA for vitamin B12 as supplements. Although oral supplementation containing the RDA for micronutrients can prevent abnormal blood indicators of most vitamins and minerals, it is insufficient to maintain normal plasma B12 levels in about 30% of gastric bypass patients.

Absorption↗
PubMed1990

Gallstone lithotripsy vs cholecystectomy. A preliminary cost-benefit analysis.

From July 1988 to January 1989, we compared the course of 48 patients undergoing elective cholecystectomy with that of 18 undergoing extracorporeal shock wave lithotripsy for symptomatic cholelithiasis with respect to treatment, hospitalization, recovery, and cost. For elective cholecystectomy, average length of surgery was 76 minutes (range, 31 to 186 minutes); average length of stay was 4 days; total cost was $6240; morbidity was 10%; and return to work averaged 5 weeks. Average extracorporeal shock wave lithotripsy treatment length was 136 minutes (80 to 158 minutes); average length of stay was 2 days; total cost was $5921; and hematuria and petechiae were seen in 33% and 28%, respectively. Re-treatment cost was $4880. All of these patients were active in 24 hours; return to work averaged 3 days. As results of the Food and Drug Administration study are still pending, recurrence and re-treatment rates are unknown. We conclude that extracorporeal shock wave lithotripsy is less costly, initially, with further reductions probable when performed on an outpatient basis. Though re-treatment may be required, return to normal activity is dramatically shortened.

Adult↗
PubMed1989

Management of biliary obstruction. A comparison of percutaneous, endoscopic, and operative techniques.

Surgery for obstructive jaundice is being challenged by endoscopic and percutaneous techniques. To compare their safety and efficacy, the courses of 157 patients treated for biliary obstruction were examined. Outcome was judged by mortality, complications, and need for further intervention. Forty-eight patients underwent endoscopic papillotomy (43 [90%] had stone disease) with two deaths and 11 cases of (23% incidence) of cholangitis. Pancreatitis developed in 9 (19%). Twenty-seven patients (56%) required further endoscopic, percutaneous, or surgical intervention. Sixty-five patients underwent transhepatic drainage (58 [89%] had malignant neoplasms) with a 28% (n = 18) mortality rate. Cholangitis developed in 26 (40%), and 50 (77%) required further transhepatic or surgical intervention. Forty-four patients underwent surgery (22 [50%] had stone disease and 12 [27%] had malignant neoplasms) with a 4.5% (n = 2) mortality rate. Cholangitis developed in 3 (7%), pancreatitis developed in 2 (4.5%), and bleeding developed in 1 (2%). Eight (18%) required further intervention. While endoscopic papillotomy provides efficacious treatment for stone disease, surgery provides a more expeditious, less morbid relief for malignant obstruction.

Adult↗
PubMed1989

Extracorporeal shock-wave lithotripsy of gallstones: Boston experience with the Dornier MPL 9000 lithotripter.

After the success of shock-wave therapy for fragmentation of renal stones, machines for shock-wave therapy of gallbladder stones were quick to follow. In Munich, gallstones were successfully treated in 174 of 175 patients who were also taking ursodiol to help solubilize the calculous rubble left after treatment. In Boston, of the initial 87 patients accepted, 58 were treated for a single stone (mean diameter 15.7 mm), 16 were treated for 2 stones, and 13 for 3 stones. Although reporting of exact results is not possible before the Food and Drug Administration issues a clearance, it is fair to say that both patients and physicians are generally pleased with the results.

Boston↗
PubMed1988

Prospective study comparing imipenem-cilastatin with clindamycin and gentamicin for the treatment of serious surgical infections.

Surgical infection remains a leading cause of hospital morbidity and mortality. We compared the efficacy and toxicity of imipenem-cilastatin sodium in 32 patients with that of clindamycin phosphate and gentamicin sulfate in 25 patients. In the imipenem-cilastatin group, 87.5% had a favorable outcome, with a 12.5% failure rate and 13 adverse reactions. In the clindamycin-gentamicin group, 80% had a favorable outcome, with a 20% failure rate and ten adverse reactions. Two significant superinfections with Pseudomonas and Candida were noted in patients treated with impenem-cilastatin. Each group had one case of Clostridium difficile-associated colitis. Cost analysis showed no differences between treatment arms, except in the appendicitis subgroup. For serious surgical infections, single-agent therapy with imipenem-cilastatin appears to be as efficacious as combination therapy with clindamycin and gentamicin.

Adolescent↗
PubMed1987

The short and long term effect of gastric partitioning surgery on serum protein levels.

The morbidly obese who undergo elective gastric partitioning surgery serve as models of surgical stress and subsequent severe protein calorie restriction. The short and long term effects of gastric partitioning surgery on circulating proteins and the specific micronutrients carried by the proteins were studied in 22 such patients (ages 23-56 years). Serum micronutrient values paralleled the levels of their carrier proteins. Mean concentrations of both short and long turnover proteins decreased significantly in the early postoperative period, whereas the acute phase reactant ceruloplasmin reached preoperative levels by the seventh postoperative day. Transthyretin and retinol binding protein remained depressed with long term reductions in protein and calorie intake, whereas ceruloplasmin and transferrin were somewhat less sensitive to prolonged protein-calorie restriction. Mean serum albumin, after an initial postoperative fall, rose to the baseline level by 1 month after surgery. Serum albumin levels remained within the normal range despite low protein and calorie intakes.

Adult↗
PubMed1985

Accuracy and cost-effectiveness of fine needle aspiration biopsy.

Two hundred eighty-six fine needle aspiration biopsies were reviewed. The sensitivity for the diagnosis of malignancy was 90 percent for lymph node specimens, 93 percent for skin and soft tissue masses, and 74 percent for breast cancer. The overall accuracy of the technique was 82 percent for breast lesions, and 90 to 92 percent for soft tissue and lymph node lesions. Traditional open biopsy in an outpatient setting for these tumors is twice as costly as fine needle aspiration biopsy. Further refinement in the use of the cytocentrifuge and immunohistochemical techniques will result in fewer inadequate fine needle aspiration specimens and an increase in the diagnostic information available with this technique. Fine needle aspiration is recommended as the first biopsy technique of choice for localized solid tumors.

Biopsy, Needle↗
PubMed1983

Management of malignant ascites with peritoneovenous shunting.

The onset of intractable ascites secondary to malignant disease is a harbinger of a short life span (less than 8 weeks) in most patients. Repeated paracentesis is a preferable form of management unless a longer life span is anticipated. In patients with ovarian or breast carcinoma, peritoneovenous shunting is an effective means of controlling malignant ascites. In addition, long-term symptomatic relief can be achieved for the balance of the patient's life. Postoperative coagulation defects are minimal if most of the ascites is removed at the time of shunt placement. Circulating fibrin split products universally appear postoperatively in the peripheral circulation of patients with patent shunts. Pulmonary metastasis is not a clinically significant problem secondary to placement of the peritoneovenous shunt for malignant ascites.

Ascites↗
PubMed1979

Electrocoagulation: palliative surgery to control metastatic cutaneous malignancy.

The adaptation of the principles of electrocoagulation to controlling symptomatic cutaneous metastatic disease is discussed. The technique permits minimal anesthesia, excellent hemostasis, local control, satisfactory cosmesis with reduced hospitalization. Two illustrative cases are reported of metastatic malignant melanoma and metastatic leiomyosarcoma.

Aged↗
PubMed1976

Skoraya Pomosch: Emergency Medical Service of the Soviet Union.

The Emergency Medical Service of the Soviet Union as witnessed in 1975 shows evidence of central communication, organization, and planning. The Skoraya Pomosch has developed into an elite medical corps with general multispecialty emergency teams that include well-trained physicians and physicians' assistants, with emphasis on bringing medical care to the patient at the site of the emergency. At its optimum, it is an elite corps that is uniformly available and capable of response to minor emergencies as well as major community disasters. Chronic problems of inadequate equipment and inappropriate use of the system continue to plague the Skoraya as they do other aspects of Soviet medicine. Certain qualities, such as the central communication network, are probably adaptable to the United States' situation, but in general, we must continue to improve and devise our own emergency medical system.

Adult↗