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Biomedical subjects

R Zeppa

Publications and source records attributed to R Zeppa.

At least 55 records · Page 3Linked to original sources
PubMed1982

Early hepatic failure or upper gastrointestinal bleeding following a distal splenorenal shunt.

Hepatic failure and upper gastrointestinal bleeding following a distal splenorenal shunt is distinctly unusual. Should either or both of these complications develop in the immediate or early postoperative period, adequate angiographic studies should be done without delay so as to identify accurately the status of the portal and splenic venous systems. If an unligated coronary vein is apparent, transhepatic clotting should be accomplished. The presence of other major collateral vessels between the portal and splenic circulations may require surgical ligation. The presence of thrombosis of the portal vein represents a more serious problem, with thrombectomy and arterialization of the portal vein offering the best chance for survival in a patient with a deteriorating condition.

Aged↗
PubMed1982

Comparisons of scintigraphy with In-111 leukocytes and Ga-67 in the diagnosis of occult sepsis.

In a prospective study involving 32 patients with clinical suspicion of focal infection, the sensitivity and specificity of In-111-labeled leukocyte (In-WBC) scintigraphy were compared with those of Ga-67 scintigraphy performed 24-48 hr later. Of a total of 192 body sites studied, 26 foci of infection were diagnosed by aspiration, cultures, or chest radiographs. Indium-WBC indicated 19 (73%) true-positive (TP) and four (2.5%) false-positive (FP) foci of abnormal accretion; Ga-67 had 21 (81%) TP and 15 (9%) FP. The 7/26 (27%) false-negative (FN) In-WBC scintigrams involved infection foci of more than 2-wk duration; the 5/26 (19%) FN Ga-67 studies were in patients with infections manifested for less than 1 wk. The results of this study are useful in considering the indications of the two tracers.

Abscess↗
PubMed1981

Biliary excretion of moxalactam.

The biliary excretion of moxalactam was studied in 11 postsurgery patients who had indwelling T-tubes inserted in their common bile ducts. Peak levels of moxalactam in the bile reached mean levels of 33.7 +/- 11.1 and 173.7 +/- 67.0 micrograms/ml 2 h after intravenous administration of a single 500- or 2,000-mg dose, respectively. In 5 of the 10 patients given the 2,000-mg dose, peak moxalactam concentrations in the bile were 2 to 12 times higher than simultaneous serum levels, but considerable variation in the biliary excretion of moxalactam was observed among the individual patients.

Bile↗
PubMed1980

The role of H.I.D.A./P.I.P.I.D.A. scanning in diagnosing cystic duct obstruction.

A newer approach to the early diagnosis of acute biliary tract disease is review. Ninety-two patients were evaluated with a new hepatobiliary agent (H.I.D.A/P.I.P.D.A.) for the presence of cystic duct obstruction. Seven patients with suspected acute gall bladder disease were dropped from the study for the lack of pathologic confirmation of the diagnosis. Forty-four of the remaining 85 patients were subsequently operated on and found to have acute cholecystitis. Forty-three of the 44 had cystic duct obstruction demonstrated on H.I.D.A. Scan (one false negative). An additional 23 patients underwent cholecystectomy for chronic disease. In this group, the gallbladder scan was only 43% (10/23) accurate in correctly identifying disease. Eighteen patients with nonbiliary disease had normal scans. The accuracy of ultrasonography and the scan are also compared in a smaller subgroup of 53 patients who had both studies.

Acute Disease↗
PubMed1980

Sex and ethnicity in surgical clerkship performance.

Attitudes, personality, and career preferences of Anglo and Hispanic (Cuban) male and female junior students at the University of Miami School of Medicine were studied when they entered their surgical clerkship, and their performance in seven areas was measured 12 weeks later. Cuban females had more intolerance of ambiguity, felt less in control of their lives, anticipated more from the clerkship, preferred pediatrics, scored lower on written and verbal examinations, but performed higher on ward behaviors than other groups. Anglo females had the best written and verbal performance of any group and higher overall grades. Anglo and Cuban males preferred a surgical career more than other students did. Most differences observed were a result of the Hispanic females who, because of their role in the Cuban family, may not as yet be as assimilated into the core culture as the Cuban male.

Attitude↗
PubMed1979

Bacteriologic and systemic effects of intraoperative segmental bowel preparation with povidone iodine.

A technique for intraoperative segmental preparation of the large bowel, using 10% povidone iodine, was evaluated in 25 patients undergoing elective colon resection. Qualitative and quantitative bacteriology was obtained from the normal bowel content and from segments of colon treated with povidone iodine or normal saline. Forty-five of 50 segments treated with povidone iodine demonstrated no growth, whereas the segments injected with normal saline maintained bacterial counts of 3.5 x 10(8) colony forming units per milliliter. There were no septic complications in this group of patients and the levels of triiodothyroninc and thyroxin remained unchanged despite a substantial absorption of iodine, as demonstrated by protein-bound iodine determinations. Intraoperative segmental preparation of the colon with 10% povidone iodine is a simple technique that may be useful in the enhancement of other methods of bowel preparation by further reducing the endogenous bacterial inoculum at the time of transection of the colon.

Adult↗
PubMed1979

A longitudinal study of tryptophan involvement in hepatic coma.

Previous cross-sectional studies have demonstrated that hepatic coma is associated with abnormally high levels of plasma free tryptophan. Establishment of a more definitive relationship between this biochemical abnormality and hepatic coma requires an evaluation of biochemical changes in individual patients as they undergo alterations in the function of their central nervous systems. The present report is an evaluation of tryptophan and substances believed to influence its entry into the brain in six patients whose clinical status progressed from hepatic coma to complete recovery. Consistent significant decreases in plasma free tryptophan and free fatty acids were demonsrated to occur as the patients recovered. No consistent changes, however, were found in the plasma levels of the amino acids which have been reported to compete with tryptophan for transport across the blood-brain barrier, except for leucine which was significantly decreased in all six patients upon recovery from coma. Assay of lumbar cerebrospinal fluid for both tryptophan and the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), showed no consistent changes as the patients recovered from hepatic coma.

Adult↗
PubMed1979

The undergraduate surgical clerkship. A cutting edge which separates the clinical from the nonclinical medical specialists.

The role of the surgical clerkship in the curriculum has often been debated. This study highlights its function in the students' decision making process. Junior students (N = 164) were measured on interest in surgery before and after the clerkship and divided into groups that changed significantly in a positive or negative direction, or that remained essentially unchanged. Background factors, learning styles of the students, and their evaluations of the clerkship showed that students who changed negatively (12%), compared with those who changed positively (44%), did not learn as well from clinical experiences and evaluated certain aspects of the clerkship, related to time and clinical demands, less positively. The unchanged group resembled the positive change students. Performance in the clerkship did not differ significantly among the three groups. The group that changed positively had none interested in surgery as a career before the clerkship, 15% who chose surgery afterward, and who later entered a surgical residency. The negative change group entered with high, perhaps unrealistic, levels of interest, left with none selecting surgery, and a third entering nonclinical type residencies. The surgical clerkship appears to have a unique role to help students make decisions about future careers based on their underlying personalities and learning styles.

Adult↗
PubMed1979

Pancreatic duct ligation in the therapy of chronic pancreatitis.

Total ligation of the pancreatic ducts of a normal gland in dogs and man results in atrophy of the acinar cells with preservation of islet cell function. Theoretically, this might be applied in the therapy of chronic pancreatitis since, in effect, an exocrine pancreatectomy results. Sustained islet cell function, as evidenced by a normal glucose tolerance test, following pancreatic duct ligation, was demonstrated in dogs for periods of up to two years. Resection of the head of the pancreas and ligation of the distal gland in six patients with chronic pancreatitis and an abnormal glucose tolerance test resulted in the development of insulin-dependent diabetes in all instances. Insulin-dependent diabetes was also demonstrated in one patient with a normal preoperative glucose tolerance test. Recurrent pancreatitis developed in only one patient. The study suggests that pancreatic duct ligation is effective in treating chronic pancreatitis but casts considerable doubt on the effectiveness of this procedure in preventing the development of diabetes, if the glucose tolerance test is abnormal

Adult↗