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Biomedical subjects

R J Rubin

Publications and source records attributed to R J Rubin.

At least 145 records · Page 8Linked to original sources
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The dilemma of pilonidal disease: pilonidal cystotomy, reappraisal of an old technique.

A series of 126 patients treated by inhospital pilonidal cystotomy is reviewed. One hundred twenty-four were treated using local anesthesia with supplemental diazepam or Innovar. Most patients spent only three days in the hospital, with healing occurring in less than two months. Recurrences occurred in 20.9 per cent of the patients. The recurrences were treated by office procedures in all but one instance. Most patients were pain-free and back to work within two weeks after operation.

Adult↗
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Endometrioid carcinoma of the rectum arising in endometriosis: report of a case.

The case of a patient with an endometrioid carcinoma arising in endometriosis of the rectum is presented. This lesion grossly appeared to be a carcinoma arising from the rectal mucosa until microscopic examination of the specimen was completed. The endometrial implant continued to grow and eventually degenerated into a carcinoma in spite of bilateral salpingoophorectomy. This was believed to be due to maintenance of the patient on diethylstilbestrol. This case is believed to be the ninth reported case of carcinoma arising in an endometrial implant in the colon or rectum.

Adenocarcinoma↗
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Surgical treatment of complete rectal prolapse.

The Ripstein procedure was used to effect a cure of rectal procidentia in 30 patients. There was no operative mortality, and morbidity was confined to problems related to two patients with intestinal obstruction, one with fecal impaction, and one with wound infection. We believe the operation to be the treatment of choice in patients to control the anatomic and clinical abnormalities related to rectal procidentia. Associated colonic abnormalities, such as an extremely redundant sigmoid or associated diverticulitis, may dictate the choice of a different procedure that does not require introduction of a foreign material.

Adult↗
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Detachment of the continent ileostomy poucn from the anterior abdominal wall: report of two unusual cases.

The cases of two patients with continent ileostomies are presented. These illustrate the problems encountered with detachment of the pouch from the abdominal wall resulting in angulation of the efferent loop of the pouch in relation to the nipple valve and difficulty intubating the pouch. Both patients required operative correction of the separation. Several suggestions are made in order to prevent or decrease the incidence of the complications. Removal of a peritoneal strip around the efferent loop of the pouch appears to facilitate adequate fixation of the pouch to the anterior abdominal wall.

Adult↗
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The outpatient management of acute hemorrhoidal disease.

A procedure for the outpatient management of acute hemorrhoidal disease is presented. Treatment, using local anesthesia with hyaluronidase, is directed to (1) relieve pain, (2) decrease edema, (3) treat appropriately the internal hemorrhoidal disease, and (4) treat the external thrombosis if present. Adequate treatment of the acute disease will, in a significant proportion of patients, avoid further surgical intervention. Eperience with results of this modality of treatment in patients is presented.

Acute Disease↗
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Fate in humans of the plasticizer, di-2-ethylhexyl phthalate, arising from transfusion of platelets stored in vinyl plastic bags.

Platelet concentrates were shown to contain 18 to 38 mg/dl of a phthalate plasticizer (DEHP) which arose by migration from the vinyl plastic packs in which the platelets were prepared and stored. Transfusion of these platelets into six adult patients with leukemia resulted in peak blood plasma levels of DEHP ranging from 0.34 to 0.83 mg/dl (approximately 0.02 mg/dl plasma per mg DEHP administered per square meter of surface area). The blood levels fell monoexponentially with a mean rate of 2.83 per cent per minute and a half-life of 28.0 minutes. Urine was assayed by a method that would measure unchanged DEHP as well as all phthalic acid-containing metabolites. In two patients, at most 60 and 90 per cent of the infused dose, respectively, was excreted in the urine collected for 24 hours posttransfusion. These estimates, however, could be high due to the simultaneous excretion of DEHP remaining from previous transfusions or arising from uncontrolled environmental exposures.

Blood Platelets↗
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Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak.

Disorders of calcium metabolism are not generally considered important either clinically or pathophysiologically in essential hypertension. Recent reports, though, suggest that increased parathyroid gland function may be one of the more common endocrine disturbances associated with hypertension. We measured serum parathyroid hormone (PTH) concentrations as well as routine blood and urine chemistries in 34 hypertensives. Their mean PTH, 79.1 +/- 3.1 muliter Eq/muliter, was significantly higher (p less than 0.025) than the mean PTH, 66.9 +/- 3.3, of an age- and sex-matched normotensive control population. The mean serum calcium, 9.5 +/- 0.1 mg%, was identical in the two populations. Compared to a second age- and sex-matched normotensive population, the hypertensives demonstrated a significant (p less than 0.005) relative hypercalciuria. For any level of urinary sodium, hypertensives excreted more calcium. These preliminary data suggest that parathyroid gland function may be enhanced in essential hypertension. This increased gland activity appears, in part, to be an appropriate, physiologic response to a previously unrecognized relative hypercalciuria, or renal calcium leak, associated with essential hypertension. We conclude that the increased prevalence of hypertension in subjects with hyperparathyroidism probably represents the final event in a continuum that begins with obligatory urinary calcium losses in hypertensives, but whose pathological presentation is hyperparathyroidism. The results of this pilot study indicate a need for derivative experiments directed at defining the importance of our preliminary findings in the pathogenesis of human and experimental hypertension.

Adult↗
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Hypertension and the Department of Health and Human Services.

Hypertension affects from 17% to 25% of all Americans. Because of its fundamental charge to help protect the public health, the Department of Health and Human Services (HHS) is substantially concerned with the condition. Additionally, hypertension represents a significant source of underwriting risk to which HHS is exposed in its role as health insurer of the poor and the elderly. HHS has invested hundreds of millions of dollars in hypertension research, development and testing of treatment regimens, and education of health care providers and consumers. However, much of the etiology of hypertension still eludes us. Sodium's apparent importance as a "causal" agent to the development of hypertension, and in its treatment, has waxed and waned over the past several generations; research to date has not yet finally settled the issue. Is sodium or some other cation the key? While research on this issue continues, HHS is currently faced with deciding whether and how to require inclusion of sodium content in nutrition labelling. In the debate, attention has to be given not only to the current best evidence on sodium; additional issues of consumer choice, costs, and education are also of importance.

Aged↗
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Outcomes and effectiveness research in the private sector.

Private-sector health care organizations increasingly tout the use of outcomes and effectiveness research in activities ranging from pharmaceutical research to insurance coverage determinations. The rapid development of this research raises important questions about the role of the Agency for Health Care Policy and Research (AHCPR) as the producer, funder, and champion of outcomes and effectiveness research. To address this issue, we reviewed the activities of pharmaceutical companies, insurers, managed care organizations, health information technology companies, and other private-sector actors in outcomes and effectiveness research. We found that it is being used in a focused way to promote business goals and other organizational objectives, particularly in the pharmaceutical, insurance, and managed care industries. We also found significant gaps in its application to important public health issues and virtually no overlap with prior federal activities in this area.

Health Services Research↗
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Determinants of ganglion-receptor cell interaction during development of the inner ear. A heterochronic ganglia study.

It has been suggested that inner ear sensory receptors produce attractant fields that guide neurite outgrowth from statoacoustic ganglion (SAG) neurons to appropriate target sites within the developing labyrinth. This experiment tested the temporal limitations of SAG neurons in their ability to respond to these attractant fields. Statoacoustic ganglia were excised from 12, 13, 14 and 15 gestation day (GD) mouse embryos. This temporal series of SAG was implanted into aganglionic 12 GD otocysts. All cultures were grown for 7 days in vitro, then fixed and processed for nerve fiber staining. Specimens were evaluated for the presence of neurites associated with the inner ear sensory receptors that developed within the otic explants. All of the implanted heterochronic ganglia (i.e. 13, 14 or 15 GD) as well as the homochronic (i.e. 12 GD) ganglion controls extended neurites to sensory epithelium of both vestibular and auditory character. Neurites made contact with the base of hair cells in all of the sensory structures. These findings demonstrate that SAG neurons are capable of extending processes in response to otic attractant fields for an extended period during the embryonic development of this ganglion. This observation supports the hypothesis that the onset and duration of receptor generated attractant fields may act as a controlling factor in establishing patterns of innervation within the developing inner ear.

Animals↗
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The economic impact of Staphylococcus aureus infection in New York City hospitals.

We modeled estimates of the incidence, deaths, and direct medical costs of Staphylococcus aureus infections in hospitalized patients in the New York City metropolitan area in 1995 by using hospital discharge data collected by the New York State Department of Health and standard sources for the costs of health care. We also examined the relative impact of methicillin-resistant versus -sensitive strains of S. aureus and of community-acquired versus nosocomial infections. S. aureus-associated hospitalizations resulted in approximately twice the length of stay, deaths, and medical costs of typical hospitalizations; methicillin-resistant and -sensitive infections had similar direct medical costs, but resistant infections caused more deaths (21% versus 8%). Community-acquired and nosocomial infections had similar death rates, but community-acquired infections appeared to have increased direct medical costs per patient ($35,300 versus $28,800). The results of our study indicate that reducing the incidence of methicillin-resistant and -sensitive nosocomial infections would reduce the societal costs of S. aureus infection.

Community-Acquired Infections↗
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Financing capital under Medicare--an evaluation.

Here's a "middle-of-the-road" evaluation of HCFA's capital reimbursement proposal from a physician and president of a leading Washington, D.C., consulting group, former policy adviser to the Secretary of HHS and the man who chaired the task force that developed and implemented PPS.

Capital Expenditures↗
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How much does defensive medicine cost?

Many key health reform bills in the 103rd Congress include proposals to overhaul the medical malpractice system. One of the factors motivating such legislation is the practice of defensive medicine, or care that does not benefit the patient and is provided solely to avoid malpractice claims. Estimating the costs of defensive medicine is difficult because of the many conflicting and overlapping motivations facing physicians. Although our estimates delineate a wide range of potential savings, systemwide savings from aggressive malpractice reform could approach $41 billion over five years.

Cost Savings↗
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Role of blood flow in carbon monoxide- and hypoxic hypoxia-induced alterations in hexobarbital metabolism in rats.

The flow dependency of hepatic hexobarbital metabolism was examined in the isolated perfused rat liver. At low flow rates (0.5-1.0 ml/min/g of liver) hexobarbital clearance was found to depend on perfusion fluid flow, whereas at higher flow rates drug clearnace approached flow independence. Calculation of the in vivo hepatic blood flow rate suggested that hexobarbital metabolism in vivo should be highly dependent upon flow. Blood flow in the conscious rat was measured by use of radiolabeled microspheres during acute exposure to levels of hypoxic hypoxia (lowered pO2) or carbon monoxide which resulted in equal alterations in arterial oxyhemoglobin content (approximately 65% oxyhemoglobin). Hypoxic hypoxia (8% O2) caused a massive redistribution of flow away from the splanchnic area, resulting in a 45% decrease in hepatic blood flow. Carbon monoxide (500 ppm) was without significant effect on hepatic blood flow. These data would appear to explain the relatively greater inhibitory potency of hypoxic hypoxia on drug metabolism in vivo, since drug delivery to the liver is depressed by hypoxic hypoxia but unaffected by carbon monoxide exposure.

Animals↗