Biomedical subjects

R Sherman

Publications and source records attributed to R Sherman.

At least 19 recordsLinked to original sources

PubMed2003

Effects of magnesium sulphate on cerebral haemodynamics in healthy volunteers: a transcranial Doppler study.

BACKGROUND: Magnesium is increasingly being considered as a neuroprotective agent. We aimed to study its effects on middle cerebral artery blood flow velocity (V(mca)), cerebral autoregulation and cerebral vascular reactivity to carbon dioxide (CRCO(2)) in healthy volunteers. METHODS: Fifteen healthy volunteers were recruited. Using transcranial Doppler ultrasonography, V(mca) was recorded continuously. The strength of autoregulation was assessed by the transient hyperaemic response test, and the CRCO(2) was measured by assessing changes in V(mca) to the induced changes in end-tidal carbon dioxide. I.V. infusion of magnesium sulphate was then started (loading dose of 16 mmol followed by an infusion at the rate of 2.7 mmol h(-1)) for 45 min. The cerebral haemodynamic variables were measured again near the end of the infusion of magnesium sulphate. RESULTS: Total serum magnesium levels were doubled by the infusion regimen. However, there were no significant changes in V(mca), strength of autoregulation, or CRCO(2). Five of the volunteers reported marked nausea and two developed significant hypotension during the loading dose. CONCLUSIONS: Infusion of magnesium sulphate, in a dose that doubles its concentration in plasma, does not affect V(mca), strength of autoregulation or CRCO(2) in healthy volunteers. However, it can be associated with nausea and hypotension.

Adolescent↗

PubMed2001

A phase II trial of intraluminal irrigation with recombinant human tissue factor pathway inhibitor to prevent thrombosis in free flap surgery.

A multicenter, multinational, blinded, randomized, parallel-group, phase II study was conducted to investigate the use of recombinant human tissue factor pathway inhibitor (rhTFPI; SC-59735) as an antithrombotic additive to the intraluminal irrigating solution during microvascular anastomosis in free flap reconstructive surgery. A total of 622 patients undergoing free flap reconstruction were randomly assigned to three groups. For each group, a different intraluminal irrigating solution was administered at completion of the microvascular arterial and venous anastomoses and before blood flow to the flap was reestablished: rhTFPI at a concentration of 0.05 or 0.15 mg/ml (low-dose or high-dose group, respectively) or heparin at a concentration of 100 U/ml (current-standard-of-practice group). There were no other differences in treatment among the groups. Patient characteristics, risk factors, and surgical techniques used were similar among all three groups. Flap failure was lower (2 percent) in the low-dose rhTFPI group than in the high-dose rhTFPI (6 percent) and heparin (5 percent) groups, but this difference was not statistically significant (p = 0.069). There were no significant differences in the rate of intraoperative revisions of vessel anastomoses (11 percent, 12 percent, and 13 percent) or postoperative thrombosis (8 percent, 8 percent, and 7 percent) among the low-dose rhTFPI, high-dose rhTFPI, and heparin groups, respectively. The rate of postoperative wound hematoma was significantly lower in the low-dose rhTFPI group (3 percent) than in the high-dose rhTFPI (8 percent) and heparin (9 percent) groups (p = 0.040). There were no differences in blood chemistry or coagulation values among the three study groups. Other than hematomas, there were no differences in the incidence or severity of adverse reactions among the three groups. It is concluded that use of rhTFPI as an intraluminal irrigant during free flap reconstruction is safe, well tolerated, and as efficacious as use of heparin for preventing thrombotic complications during and after the operation. Furthermore, the lower dose of rhTFPI (0.05 mg/ml) may reduce the occurrence of postoperative hematoma and help prevent flap failure.

Adolescent↗

PubMed2001

Control of bone bleeding at the sternum and iliac crest donor sites using a collagen-based composite combined with autologous plasma: results of a randomized controlled trial.

In a randomized controlled trial, hemostatic effectiveness of a collagen-based composite (experimental group) was compared with standard hemostatic methods (ie, electrocautery and collagen sponge) (control group) at two bone sites. Hemostatic success, time to "controlled bleeding," and time to "complete hemostasis" were determined at the sternal edge following median sternotomy (n=64) and at the iliac crest following bone graft harvest (n=19). Almost twice the percentage of sternal edge patients (83% versus 44%, P=.002) and nearly three times the percentage of iliac crest patients (83% versus 29%, P<.05) achieved complete hemostasis in the experimental group compared to controls. Time to controlled bleeding and complete hemostasis for all bone sites also favored the experimental group over the control group at highly significant levels (P<.0001 for most comparisons). There were no adverse events related to experimental treatment use. The results support the use of this investigational hemostatic agent to control cancellous bone bleeding.

Adult↗

PubMed2000

CoStasis provides superior control of diffuse bleeding at muscle-flap donor sites, compared to manual compression.

This prospective, controlled trial evaluated the hemostatic effectiveness of an experimental collagen-based composite (CoStasis), compared to a collagen sponge applied with manual pressure at diffusely-bleeding muscle-flap donor sites. Hemostatic success, time to "controlled bleeding," and time to "complete hemostasis" were determined at raw muscle-flap harvest sites among 22 experimental and 25 control subjects. There was a similar distribution in large-sized (e.g., latissimus dorsi) and moderate-sized (e.g., rectus abdominis) muscle flaps evaluated between treatment groups. More than twice the percentage of experimental subjects achieved complete hemostasis within 10 min of observation, compared to controls (100 percent vs. 48 percent, p < 0.0001). Time to controlled bleeding and complete hemostasis also favored the experimental group at statistically highly significant levels (p < 0.0001 for both comparisons). For example, greater than 60 percent of experimental subjects achieved complete hemostasis within 2 min compared to only 5 percent of controls. There were no adverse events related to the experimental treatment in this study. These results support the use of this investigational hemostatic agent to control diffuse bleeding at muscle-flap donor sites.

Animals↗

PubMed2000

Limb salvage for chronic tibial osteomyelitis: an outcomes study.

BACKGROUND: The decision to undergo a limb salvage procedure is difficult and multifaceted. This study reviews the outcomes of patients with chronic tibial osteomyelitis who underwent limb salvage and hopes to enhance our understanding of the impact this complex procedure has on the patient's ability to have a functional and fulfilling life. METHODS: Forty-six patients, with at least 18 months follow-up, who had undergone limb salvage for chronic, refractory tibial osteomyelitis were evaluated. A modification of the Limb Extremity Outcomes Instrument was utilized emphasizing inquiries pertaining to quality of life. RESULTS: Thirty-nine (85%) of the 46 patients were able to ambulate independently without pain. All patients younger than 45 years of age had successful outcomes. Thirty-one percent of the patients with a positive smoking history were failures, and 71% of all failures were smokers. CONCLUSION: Limb salvage seems to be a satisfactory option for patients with chronic tibial osteomyelitis. A history of smoking and advanced age may have adverse affects and are relative contraindications.

Adolescent↗

PubMed2000

Management of chronic deep infection following rotator cuff repair.

BACKGROUND: Deep infection of the shoulder following rotator cuff repair is uncommon. There are few reports in the literature regarding the management of such infections. METHODS: We retrospectively reviewed the charts of thirteen patients and recorded the demographic data, clinical and laboratory findings, risk factors, bacteriological findings, and results of surgical management. RESULTS: The average age of the patients was 63.7 years. The interval between the rotator cuff repair and the referral because of infection averaged 9.7 months. An average of 2.4 procedures were performed prior to referral because of infection, and an average of 2.1 procedures were performed at our institution. All patients had pain on presentation, and most had a restricted range of motion. Most patients were afebrile and did not have an elevated white blood-cell count but did have an elevated erythrocyte sedimentation rate. The most common organisms were Staphylococcus epidermidis, Staphylococcus aureus, and Propionibacterium species. At an average of 3.1 years, all patients were free of infection. Using the Simple Shoulder Test, eight patients stated that the shoulder was comfortable with the arm at rest by the side, they could sleep comfortably, and they were able to perform activities below shoulder level. However, most patients had poor overhead function. CONCLUSIONS: Extensive soft-tissue loss or destruction is associated with a worse prognosis. Extensive débridement, often combined with a muscle transfer, and administration of the appropriate antibiotics controlled the infection, although most patients were left with a substantial deficit in overhead function of the shoulder.

Adult↗

PubMed2000

Expanding Medicaid to cover the uninsured.

A decade of unparalleled economic prosperity has done little to reduce the number of Americans without health insurance. Despite an expansion of government-funded health insurance for the nation's low-income children, the number of working parents without health insurance continues to rise. Many states are looking at how Medicaid, long the health insurance program for families on welfare, could provide a health insurance safety net for the working poor. This issue of States of Health summarizes the issue and explores the Medicaid expansion strategies some states are using to provide health coverage for the working uninsured.

Eligibility Determination↗

PubMed1999

Salvage and reconstruction of complex post-extirpative knee wounds: a successful surgical protocol.

Six patients with massive post-extirpative wounds of the knee, all of whom had received adjuvant therapy, underwent wound closure and limb salvage via free-tissue transfer in all but one case. No instance of delayed wound healing requiring surgery occurred among the patients reconstructed by microsurgical tissue transfer. Five of the six patients are presently ambulating on the salvaged extremity. A protocol for management of these complex wounds is presented.

Amputation, Surgical↗

PubMed1999

Angiotensin II improves random-flap viability in a rat model.

Angiotensin II (AII) is a naturally occurring peptide that has been shown to be angiogenic, cause the proliferation of several primary cell types (including endothelial cells), accelerate the repair of dermal injuries, and increase production of growth factors and extracellular matrix. The effect of a single administration of AII on the viability and vascularity of a random flap was assessed in a rat model. In the control model, the viability of the distal portion of the flap was reduced consistently by postoperative day 8. Initially, AII was administered in an aqueous vehicle (phosphate-buffered saline [PBS]) and a viscous vehicle (10% carboxymethyl cellulose [CMC]). Administration of 1 mg per milliliter AII in PBS did not affect the viability of random flaps (1.2 x 7 cm) in this animal model. However, a single administration of a higher dose of AII in PBS (10 mg per milliliter) or 1 mg per milliliter AII in the CMC vehicle resulted in 67% of the grafts being fully viable at postsurgical day 12, in contrast to vehicle-treated control flaps, none of which were fully viable at day 12. Furthermore, the portion of the flap that was viable was increased significantly (p < or = 0.05). Subsequently, a study was conducted to assess the dose-response curve for AII in a CMC vehicle in this rat model. As the dose of AII was reduced, the percentage of animals with fully viable flaps and the percentage of the flap that was viable decreased correspondingly. Administration of 0.03 mg per milliliter AII and greater increased significantly (p < or = 0.05) the viability of the flaps. In conclusion, AII appears to be highly efficacious in increasing the percentage of distal flap surface area survival when administered as a single topical dose to the wound bed.

Analysis of Variance↗

PubMed1999

Culture results in open wound treatment with muscle transfer for tibial osteomyelitis.

Fifty-three patients who underwent a two-staged protocol of debridement and muscle flap coverage for chronic osteomyelitis of the tibia between 1991 and 1996 were evaluated. All patients underwent a thorough debridement of all nonviable tissue and bone at initial debridement. Multiple cultures were taken, including aerobic, anaerobic and fungal cultures from the pus, soft tissue, bone curettings and bone. All patients were treated with open wound management and dressing changes. Between 2 to 7 days, median 4 days, all patients underwent a second debridement with a complete set of identical cultures, and immediate soft tissue muscle transfer. There were 42 free vascularized and 11 local tissue transfers. The 53 patients were classified according to the Cierny-Mader classification for chronic osteomyelitis. Twenty-four patients had Stage IVA osteomyelitis, 10 patients had Stage IIIA osteomyelitis, nine patients had Stage IIIB osteomyelitis, eight patients had Stage IVB osteomyelitis, one patient had Stage IA osteomyelitis, and one patient had Stage IIB osteomyelitis. All 53 patients had positive cultures at the time of their initial debridement, and 14 of 53 (26%) had a positive culture at the time of the second debridement. Based on the results, it seems from a bacteriologic stand-point that the second debridement allows for the opportunity for redebridement and wound sterilization of organisms that still may be present.

Adolescent↗

PubMed1999

Urinary incontinence among female soldiers.

A self-administered questionnaire was developed to assess the prevalence of urinary incontinence among active duty female soldiers. The questionnaire also addressed basic demographic information, including height, age, weight, and the subjects' present and past military activities. Adaptive measures that the soldiers commonly used to continue exercising and perform their duties were also explored. Seven hundred thirteen questionnaires were handed out to female soldiers at Fort Lewis (Washington), Fort Benning (Georgia), and Fitzsimons Army Medical Center (Colorado) during preparation for physical fitness tests. Of the 563 soldiers (79%) who returned completed questionnaires, 31% indicated that they commonly experienced urinary incontinence during duty and/or training to the extent that it interfered with job performance, hygiene, or was socially embarrassing. Thus, urinary incontinence is a pervasive problem among female soldiers.

Activities of Daily Living↗

PubMed1999

The female athlete triad: prevalence in military women.

The objective of this study was to define the prevalence of the female athlete triad, i.e., the simultaneous occurrence of disordered eating, amenorrhea, and osteoporosis, in military women. A total of 423 active duty female soldiers participated in a three-part prospective, cross-sectional study. Part 1 entailed completing the Eating Disorder Inventory and a clinical interview with those women "at risk" for an eating disorder. Part 2 consisted of a clinical evaluation and laboratory studies of any woman with menstrual irregularities. Part 3 evaluated the bone mineral density of all women meeting the inclusion criteria for parts 1 and 2 using dual-energy X-ray absorptiometry. Of the 423 active duty women who participated in the study, no subject exhibited the full female athlete triad. Thirty-three women (8%) had an eating disorder and 109 women (26%) were at risk for an eating disorder. Our results suggest that the female athlete triad is not a clinically significant problem for the Army.

Adolescent↗

PubMed1999

New England's Blue Cross Blue Shield shake-out: a case study in consumer activism.

For two generations, Blue Cross Blue Shield (BCBS) insurance plans could be counted on to play a key role in the financing of every community's health care system. "The Blues" dominated the health insurance market, yet they were also a reliable "insurer of last resort." In recent years, BCBS plans have begun to re-structure to stay competitive. Four of New England's BCBS plans have proposed or completed mergers with Anthem Insurance, a mutual insurance company based in Indiana. This issue of States of Health looks at how advocates in New England are working together to protect health care consumers amid this transformation.

Blue Cross Blue Shield Insurance Plans↗

PubMed1999

Unfinished business: the restoration of immigrant health access after welfare reform.

One in ten Americans is a recent immigrant and, until 1996, even the poorest had access to health care through Medicaid. That changed radically with the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), the federal welfare reform law, which sharply restricted immigrant access to public benefits, including Medicaid. This issue of States of Health looks at PRWORA's impact--and what advocates and immigrants are doing to restore health care access for these newcomers, who are among the most vulnerable in our communities.

Eligibility Determination↗

PubMed1998

Milking dilatation: a pilot study.

Under certain circumstances during microsurgical anastomosis, vasospasm may persist, despite the use of multiple topical vasodilators. Mechanical dilatation may be needed but is difficult to perform in vessels smaller than 1 mm in diameter. Milking dilatation, a simple maneuver similar to a milking patency test, is introduced and tested for vessels of such a size. The femoral arteries of 10 Sprague-Dawley rats were used. Milking dilation was performed on both sides, and a forceful milking dilation method was also used 10 times on one side subsequently. The dilated segments demonstrated a 67.3 percent (29 to 100 percent) increase in their original sizes. The vessels were all patent, with no gross signs of thrombosis or aneurysm formation, when exposed immediately, 1 week, and 4 weeks post procedure. Half of the dilated segments, even those forcefully dilated, returned to their normal size at 4 weeks; the remainder were still dilated. The results of this study demonstrated that milking dilatation is effective and safe for dilating arteries about I mm in diameter or less. However, further study is required before any long-term conclusions can be drawn.

Anastomosis, Surgical↗

PubMed1998

Ambulatory urodynamics of female soldiers.

The purpose of this study was to assess the accuracy of ambulatory urodynamic monitoring compared with conventional urodynamic studies for the detection of exercise-induced urinary incontinence in the female soldier. Fifty active duty female soldiers with exercise-induced urinary incontinence and 10 asymptomatic control soldiers underwent conventional multichannel cystometry and then ambulatory monitoring during work or exercise. Ambulatory monitoring detected a greater number of abnormalities than conventional multichannel urodynamic studies in exercise-induced urinary incontinence. This greater sensitivity is valuable in formulating more effective treatment. Behavioral interventions were effective in treating exercise-induced urinary incontinence in this population. Test results normalized after behavioral intervention. It is neither cost-effective nor efficacious to require sophisticated urodynamic testing before instituting behavioral interventions.

Adult↗

PubMed1997

The relationship of recirculation to access blood flow.

The relationship between vascular access recirculation and access blood flow has been obscured by measurement techniques that overestimate recirculation. We measured brachial artery blood flow (a surrogate for access blood flow) using Doppler ultrasound and access recirculation using a two-needle slow/stop flow method and the standard peripheral vein method in 77 chronic hemodialysis patients. These patients had 25 native arteriovenous fistulae and 52 polytetrafluoroethylene grafts. Access recirculation by the slow/stop flow method was uniformly absent in these patients unless their access blood flow rate was less than the dialyzer blood flow rate. The peripheral vein method averaged 10.7% in these patients; many values were considerably higher. We conclude that access recirculation is a function of access blood flow and does not occur (in the absence of or reversed needle cannulation) unless access blood flow is markedly impaired.

Arteriovenous Shunt, Surgical↗

PubMed1997

Quantitative evaluation of the effects of gravity and dependency on microvascular tissue transfer to the lower limb, with clinical applications.

The authors have attempted quantitatively to evaluate the effects of gravity and dependency on free-tissue transfers to the lower limb, particularly in the immediate postoperative period, using the diagnostic modalities of Doppler ultrasonography and interstitial compartment pressure measurements. Results of these quantitative evaluations promoted a change in postoperative management among patients undergoing lower-limb tissue transfer. The experience in two patient cohorts is presented.

Adult↗