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Biomedical subjects

R Katz

Publications and source records attributed to R Katz.

At least 55 records · Page 3Linked to original sources
PubMed1998

Phrenic nerve injury after coronary artery bypass grafting: will it go away?

BACKGROUND: Phrenic nerve injury after coronary artery bypass grafting resolves in most cases. The purpose of this study was to analyze the causes and effects of persistent phrenic nerve injury after coronary artery bypass grafting. METHODS: From a registry of patients with chronic obstructive pulmonary disease who underwent coronary artery bypass grafting, 64 patients were identified who experienced phrenic nerve injury during their operation. Fifteen patients either died during follow-up (n = 9) or were lost to follow-up (n = 6). At the last follow-up visit, all the patients underwent an ultrasound evaluation of the diaphragm and were divided into those who had persistent dysfunction (group I) and those who had normal function (group II). The groups were compared for preoperative and operative risk factors, acute and midterm postoperative results, and quality of life at last follow-up. RESULTS: There were 13 patients in group I and 36 in group II. There were no significant differences in preoperative and operative risk factors between the groups. The length of hospitalization was similar for both groups (9.2 +/- 4.5 versus 8.5 +/- 3.3 days, respectively; p = 0.77). More patients in group I required reintubation (23% versus 14%, respectively; p = 0.04). The mean duration of follow-up was 32.7 +/- 9.2 months. At that time, both groups suffered a reduction of forced expiratory volume in 1 second compared with preoperative values. Group I had a greater reduction in forced expiratory volume in 1 second (p = 0.05). There were a total of 125 postoperative readmissions during the follow-up period, 36 in group I and 89 in group II. There were more admissions because of pulmonary problems in group I (85% versus 53%; p = 0.04). Of the 49 patients, 21 perceived a decline in quality of life after operation. More patients in group I (46% versus 22%; p = 0.05) complained of this decrease. CONCLUSIONS: A significant number of patients who incur phrenic nerve injury after coronary artery bypass grafting have persistent phrenic nerve injury. Patients with persistent phrenic nerve injury have increased acute and midterm morbidity after operation, as well as reduced quality of life.

Aged↗
PubMed1998

CT diagnosis of non-traumatic subarachnoid haemorrhage in patients with brain edema.

The aim of the study is to prove, retrospectively, that it is unlikely that the computerized tomography (CT) diagnosis of subarachnoid haemorrhage (SH) accompanies the CT diagnosis of generalized brain edema. A total of 100 comatose patients underwent CT of the brain. Of this number, 42 underwent an enhanced CT scan. In 26 patients, lumbar puncture was also performed. A control group of ten patients diagnosed with headache and having a normal CT scan underwent NECT and ECT. Measurements of the white and gray matter density in Hounsfield units (HU) were performed in all 110 cases, including the controls. The brain tissue density and the difference between the densities of the white and gray matter were lower in the cases with brain edema than in the controls. The data values were statistically significant. Small cerebral ventricles, sulci and cisterns and small differences between white and gray matter measurements were observed in the CT scans of the brain edema cases. All 100 patients had CT diagnosis of brain edema and SH. There was no bloody or xanthochromic CSF in any of the 26 lumbar punctures performed. In the enhanced CT scans, there was poor or no filling of the lateral sinuses. The compression of the lateral sinuses by the edematous brain tissue most probably results in their stenosis or obstruction due to disturbed brain venous drainage which can mimic CT findings of SH.

Adolescent↗
PubMed1998

An association between imaging and acute posttraumatic ear bleeding with trismus.

OBJECTIVES: Computed tomography findings for each of 94 patients with unilateral ear bleeding and trismus correlated with either comminuted temporal bone fracture (26 cases) or bilateral temporomandibular joint fracture (68 cases). STUDY DESIGN: Ninety-four patients with post-traumatic unilateral ear bleeding and 10 asymptomatic adults underwent coronal computed tomography examinations of their temporomandibular joints. Of these, 26 patients with intact temporomandibular joints underwent axial computed tomography of the temporal bones. For 23 of the 94 symptomatic patients, computed tomography was the final imaging procedure; for the other 71 symptomatic patients, it was the first imaging procedure. Quantifications of the radiation dose and the per-patient cost of imaging were performed. Measurement of the maximal mandibular movements in vertical and horizontal directions was performed clinically in the 10 asymptomatic adult control subjects and in the 94 patients with trismus and ear bleeding. RESULTS: Ten control subjects had maximal opening values of 40 mm or more, and horizontal movement exceeded 24 mm. In 68 symptomatic patients, coronal computed tomography demonstrated bilateral fracture: there was bilateral high condylar fracture in 35 patients, and there was ipsilateral to the bleeding high condylar fracture with contralateral subcondylar fracture dislocation in 33 patients. Axial computed tomography scans in 26 symptomatic patients with intact temporomandibular joints demonstrated comminuted petrous bone fracture ipsilateral to the ear bleeding. CONCLUSIONS: Patients with post-traumatic ear bleeding associated with trismus should first be evaluated by computed tomography. Any other initial procedure doubles the radiation dose as well as the cost of the imaging.

Acute Disease↗
PubMed1998

The supracostal percutaneous nephrostomy for treatment of staghorn and complex kidney stones.

From March 1995 to May 1997, 104 patients underwent 115 supracostal percutaneous nephrolithotomy (PCNL) procedures for the treatment of 102 complete staghorn calculi, 6 large semistaghorn calculi, 3 large upper-caliceal stones, and 4 significant volumes of residual stone fragments after SWL. Additional renal access was required mainly for complete staghorn stones (23 patients; 20%). Extracor poreal lithotripsy was performed in 30.4% of cases, and second-look PCNL was done in 15.6%. The stone-free rate was 87%, and the infection-free rate at 7 to 33 months was 88.5%. Among 115 supracostal PCNL procedures, complications were encountered in 10 (8.7%). These problems included four large pleural effusions that were drained by chest tube in three patients and by repeated thoracocentesis in one patient. Six patients developed significant atelectasis, which was treated by vigorous physiotherapy in five and flexible bronchoscopy in one. We conclude that the supracostal approach provides direct and optimal access to most staghorn calculi with an excellent stone-free rate. The advantages of this approach can be achieved with a slight and acceptable increase in morbidity.

Adolescent↗
PubMed1998

Prognostic significance of DNA replication errors in young patients with colorectal cancer.

OBJECTIVE: To determine the DNA replication error (RER) status in young patients with colorectal cancer (CRC), and to compare the clinical and pathologic characteristics of RER-positive and RER-negative cases. SUMMARY BACKGROUND DATA: Recent studies suggest that patients with RER-positive CRC have an improved prognosis. Further data are required to confirm this observation in young CRC patients. METHODS: All patients 40 years of age and younger with CRC admitted to the National Naval Medical Center between 1970 and 1992 were considered for inclusion in the study. After review, 36 patients for whom the original archived pathology specimen could be retrieved served as the study population. The RER status was determined using a previously described polymerase chain reaction-based assay. The clinical and pathologic features and survival data were compared to RER status. RESULTS: RER-positive tumors were found in 17 cases (47%). There was no significant difference in Dukes' stage or histologic grade at the time of diagnosis between patients with RER-positive tumors compared to RER-negative tumors. Patients with RER-positive tumors were found to have an improved prognosis: the 5-year survival probability for patients with RER-positive tumors was 68%, as compared to 32% for patients with RER-negative tumors (p < 0.05). CONCLUSIONS: RER-positive tumors are common in young patients with CRC, and patients with RER-positive tumors have a significantly improved prognosis. Because of their young age, survival data and prognosis play an important role in the overall treatment plan of young patients with CRC. Therefore, knowledge of RER status could affect initial therapy, postoperative chemotherapy, and follow-up.

Adult↗
PubMed1998

Intussusception in children: reduction with repeated, delayed air enema.

PURPOSE: To evaluate the efficacy of pneumatic reduction of intussusception with an emphasis on repeated, delayed trials. MATERIALS AND METHODS: Seventy-one patients with intussusception were treated with air enemas. Before 1993, one trial of air reduction was performed; since 1993, up to three trials of air reduction were performed. The patients were categorized according to the duration of signs and symptoms: less than 12 hours (group A), 12-24 hours (group B), and longer than 24 hours (group C). RESULTS: The success rate for air reduction was 83% overall (59 of 71 patients), 89% in group A (25 of 28 patients), 83% in group B (20 of 24 patients), and 74% in group C (14 of 19 patients). The success rate was 70% (19 of 27 patients) before 1993 and 91% (40 of 44 patients) since 1993 (P < .05). When patients in whom air reduction was successful were compared with patients in whom it was unsuccessful, there was a statistically significant difference in radiographic signs of intestinal obstruction and duration of signs and symptoms but no important difference in age or rectal bleeding. There were no episodes of complications. CONCLUSION: Repeated, delayed pneumatic reduction of intussusception improves the outcome.

Case-Control Studies↗
PubMed1998

Genetic and non-genetic subtypes of major depressive disorder.

BACKGROUND: We aimed to examine the hypotheses that major depression is aetiologically heterogeneous consisting of a mixture of 'genetic' and 'non-genetic' forms or, alternatively, a mixture of one form that is 'pure' depression and another that has a familial relationship with alcohol dependency or other disorders. METHOD: One hundred and eleven twin pairs (44 monozygotic, 67 dizygotic) where the proband had received treatment for DSM-IV major depression were ascertained via a hospital register. Family history information on parents and siblings was obtained from the proband, co-twin or both. Diagnoses on parents and siblings were made blind to twin zygosity or concordance and compared in the relatives of concordant versus discordant twins. RESULTS: The lifetime prevalence and age-corrected risk of depression were no different in the relatives of concordant and discordant twin pairs. There was a marginally significant increase in the rate of alcohol abuse or dependence among the relatives of concordant twins but no difference between concordant and discordant pairs in respect of other axis I diagnosis among family members. CONCLUSIONS: The results argue against genetic heterogeneity and suggest that major depression cannot usefully be divided into genetic and non-genetic forms or into 'pure' depression and depression associated with other disorders such as alcohol dependency.

Age of Onset↗
PubMed1997

Deficits in gray matter volume are present in schizophrenia but not bipolar disorder.

Studies using magnetic resonance (MR) imaging have provided strong evidence that patients with schizophrenia as a group have structural brain abnormalities, including enlarged ventricles and sulci as well as smaller cortical gray matter volumes. This study was undertaken to investigate whether the brain abnormalities found in schizophrenia could be distinguished from those seen in bipolar disorder. The MR scans of 23 patients with schizophrenia were compared to those of 17 healthy community volunteers and 14 patients with bipolar disorder. Images were processed using computer-based image processing techniques to generate quantitative measures of cerebrospinal fluid (CSF), gray matter and white matter volumes. Compared to the community volunteers, the schizophrenia group had larger total CSF volumes while the bipolar group had larger ventricles. Smaller cortical gray matter volumes were found in the schizophrenia group, but not in the bipolar group. The schizophrenia group had regional deficits in gray matter volumes in comparison with both the community volunteers and the bipolar group. These findings suggest that the brain tissue abnormalities found in schizophrenia and bipolar disorder may be distinguishable using MR imaging.

Adult↗
PubMed1997

[Superficial dorsal penile vein thrombosis (Mondor's disease)].

Superficial venous thrombosis of the chest wall was first described by Mondor in 1939. Braun-Falco reported in 1955 superficial penile vein involvement in diffuse thrombophlebitis of the abdominal wall and in 1958 Helm and Hodge first described isolated superficial dorsal penile vein thrombosis. Since then, fewer than 50 cases have been reported. The clinical presentation is usually redness and swelling of the dorsum of the penis, accompanied by a palpable, tender thrombotic vein. This acute and painful disease frightens the patients, who is concerned about his fertility and sexual function. The main cause of this disease is frequent sexual intercourse. Diagnosis is based upon anamnesis, physical examination and penile sonography with color Doppler imaging. It is usually a benign disease which resolves quickly under appropriate medical therapy. We present a man who was admitted for this condition and was successfully treated.

Adult↗
PubMed1997

Recurrent inhibition between motor nuclei innervating opposing wrist muscles in the human upper limb.

1. Effects of conditioning motor volleys of increasing amplitude on antagonistic motor nuclei were tested at the wrist and elbow level in man. 2. The modifications of biceps, triceps, flexor carpi radialis (FCR) and extensor carpi radialis (ECR) motoneurone excitability were tested both in post-stimulus time histogram (PSTH) and rectified averaged EMG experiments. 3. Conditioning motor volleys were evoked in biceps, triceps, FCR and ECR muscles by electrical stimuli applied to the corresponding nerves. The intensity of the conditioning stimuli was systematically varied from an intensity just below motor threshold to one giving rise to a motor response equal to half of the maximal direct motor response (Mmax). 4. The effect of the injection of a cholinergist agonist, L-acetylcarnitine (L-Ac), on antagonistic conditioning motor volleys was tested for each motor nucleus. 5. Results obtained at the wrist and elbow level were strikingly different. Antagonistic motor volleys resulted in an early and long-lasting inhibition enhanced by L-Ac injection in wrist motor nuclei, while no modification was observed in elbow motor nuclei. 6. The characteristics of the early and long-lasting inhibition evoked in wrist motor nuclei by antagonistic motor volleys suggest that they are due to the activation of Renshaw cells by the conditioning motor volleys. 7. It is therefore concluded that these experiments provide further evidence that the interconnections between motoneurones, interneurones mediating reciprocal inhibition and Renshaw cells at the wrist level are different from those described elsewhere. Indeed, it has already been shown that the interneurones mediating reciprocal inhibition between FCR and ECR are not inhibited by Renshaw cells, and the results presented here suggest that FCR-coupled Renshaw cells inhibit ECR motoneurones and vice versa.

Adult↗
PubMed1997

Phrenic nerve injury after coronary artery grafting: is it always benign?

BACKGROUND: The purpose of this study was to evaluate the effect of phrenic nerve injury (PNI) occurring during coronary artery bypass grafting in patients with major chronic obstructive pulmonary disease (COPD). METHODS: Over a 42-month period, 1,303 patients underwent primary coronary artery bypass grafting. Sixty-seven (5.14%) had major COPD, and 29 (43.3%) of these 67 sustained PNI (group I). These patients were matched for age and ejection fraction with 29 CABG patients with COPD but without PNI (group II), 29 patients without COPD but with PNI (group III), and 29 patients with neither COPD nor PNI (group IV). The groups were compared on the basis of preoperative and operative factors and immediate and midterm morbidity and mortality. RESULTS: There were no significant differences between the groups with respect to hypertension, diabetes, ejection fraction, number of grafts, internal mammary artery use, cardiopulmonary bypass time, and ischemic time. Postoperatively, group I had a longer total hospitalization (group I, 11.7 days; group II, 7.8 days; group III, 7.8 days; and group IV, 6 days; p = 0.0001) and stay in the intensive care unit (I, 3.6 days; II, 2.2 days; III, 2.1 days; and IV, 1.2 days; p = 0.0023). More patients in group I required reintubation (I, 37.9%; II, 3.4%; III, 6.9%; and IV, 0%; p < 0.0001). Mean follow-up was 32.8 months (range, 7 to 48 months). Group I had more hospital readmissions (I, 78; II, 50; III, 61; and IV, 28; p < 0.007) and lower cumulative survival (I, 60.6%; II, 93%; III, 96.8%; and IV, 100%; p < 0.0015) compared with the other groups. CONCLUSIONS: In patients with COPD, PNI during coronary artery bypass grafting has a major negative impact on immediate and midterm results.

Aged↗
PubMed1997

Assessment of a new self-rating scale for post-traumatic stress disorder.

BACKGROUND: In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage. METHODS: Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R. RESULTS: The scale demonstrated good test-retest reliability (r = 0.86), internal consistency (r = 0.99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects. CONCLUSIONS: The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.

Adult↗
PubMed1997

Life-threatening retroperitoneal hematoma caused by anticoagulant therapy for myocardial infarction after SWL.

Extracorporeal shock wave lithotripsy, the primary treatment for renal and ureteral stones, is an elective procedure with a low rate of complications, although most patients have macrohematuria which lasts for a few hours, and as many as 25% develop a renal or perirenal hematoma. Therefore, SWL is not performed during anticoagulant therapy, and any blood dyscrasias should be corrected prior to the procedure. We present a case of a patient who had an acute myocardial infarction after SWL, was treated with anticoagulation and emergency coronary angioplasty, and subsequently developed a life-threatening retroperitoneal hemorrhage. Cessation of anticoagulation with fluid support and drainage of a pleural effusion eventually resulted in complete recovery.

Angioplasty↗
PubMed1997

Abdominal compartment syndrome due to delayed identification of a ureteral perforation following abdomino-perineal resection for rectal carcinoma.

Abdominal compartment syndrome develops whenever the mean intraperitoneal pressure rises above the physiological pressure, leading to renal and mesenteric ischemia and respiratory decompensation due to pressure on the diaphragm. Abdominal compartment syndrome may occur after conditions such as peritonitis, intestinal obstruction, laparoscopic procedures, or abdominal tumors. Leakage from the urinary tract may cause accumulation of urine in the peritoneal cavity which commonly manifests as single or multiple urinomas, or urinary ascites. The case of a patient who had delayed identification of a ureteral perforation following the abdomino-perineal resection of a rectal carcinoma is presented. Massive urinary leakage into the peritoneal cavity led to the abdominal compartment syndrome. Peritoneal drainage and ureteral stenting improved her condition. A high index of suspicion is necessary in order to diagnose this rare condition.

Colectomy↗
PubMed1997

Bladder outlet obstruction by a lymphocele following kidney transplantation.

Lymphocele is a well-known complication of kidney transplantation. Patients usually present with deteriorating renal function, hydronephrosis, a nontender lower abdominal mass or ipsilateral leg edema. Urinary retention, however, is an unusual presentation of lymphocele. We herein report a case of a female patient who developed chronic urinary retention due to a pelvic lymphocele after kidney transplantation.

Chronic Disease↗