Partial hand amputation.
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Amputation, Traumatic↗
Biomedical subjects
S Kramer
Publications and source records attributed to S Kramer.
The patterns of care study: a specialty effort to improve care.
The Patterns of Care Study is a comprehensive ongoing review of radiation therapy practice in the United States. Outcome studies have established national benchmarks for six cancer sites. Analysis of the factors influencing recurrence and complications have established important causal relationships that the radiation oncologist can manipulate to improve results. Care processes have been identified, and outcome correlations established.
Data Collection↗
Comparison of the sensitivity of different diagnostic tests for pancreatitis in cats.
The objective of this study was to compare the sensitivity of different diagnostic tests for pancreatitis in cats. Twenty-one cats with confirmed pancreatitis were evaluated at the Small Animal Clinic of the School of Veterinary Medicine in Hannover, Germany, between September 1997 and January 1999. Clinical signs of affected cats were nonspecific, with 95% of the cats showing anorexia and 86% lethargy. Also, hematologic and biochemical abnormalities of affected cats were nonspecific. Serum feline trypsin-like immunoreactivity (fTLI) in these 21 cats with pancreatitis was 127.5 +/- 109.5 microg/L (mean +/- SD; range, 24-500 microg/L). Fourteen of the 21 cats with pancreatitis had complicating conditions. Their serum fTLI was 153.9 +/- 124.3 microg/L (mean +/- SD; range, 29 500 microg/L). In this study, abdominal ultrasound showed a sensitivity for pancreatitis of 24%, and abdominal computed tomography had a sensitivity of 20%. Serum fTLI had a sensitivity between 86% when a cut-off value of 49 microg/L was used (upper limit of the control range) and 33% when a cut-off value of 100 microg/L was used. We conclude that in this group of cats with pancreatitis, measurement of serum fTLI was the most sensitive diagnostic test of those evaluated. Abdominal ultrasound, however, may be a valuable diagnostic tool in some cats with pancreatitis.
Animals↗
Taking a second look at security systems in the dental office.
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Crime↗
Effect of radiation therapy on metastatic choroidal tumors.
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Adult↗
Silver anode treatment of chronic osteomyelitis.
Twenty-five patients with active, chronic osteomyelitis, resistant to conventional management, were treated with surgical debridement and daily application of electrically activated silver dressings. Sixteen (64%) cases resulted in closed, stable, pain-free wounds, with the remainder resulting in persistent drainage or amputation. Nine of 12 cases complicated by nonunion achieved union. In 13 patients an open-bone graft was performed and silver treatment continued: these tended to remain free of purulent drainage but fared no better than average in the long-term follow-up. The silver anode dressing seems to be an effective aid in the treatment of chronic bone infection when combined with adequate surgical debridement, thereby reducing the need for prolonged systemic antibiotics.
Adult↗
[Pain therapy in dogs and cats--clinical experiences with buprenorphine (Temgesic)].
Buprenorphine was used as a post-operative analgesic drug in 40 dogs and 30 cats. The analgesic properties of buprenorphine failed in 20% (dogs) respectively 23.3% (cats) of the cases even after high doses of 0.1 mg/kg in dogs and 0.01 mg/kg in cats. The unsatisfactory results were seen in fracture-patients with a concurrent severe tissue damage. Side effects even after high doses were of no clinical relevance.
Analgesics, Opioid↗
[Evaluation of the antinociceptive effect of systemic and epidurally applied xylazine in general anesthesia with isoflurane in dogs and the effect of atipamezole infection on postoperative analgesia].
The alpha 2-selective adrenergic agonist xylazine has a long lasting antinociceptive effect (> 4 hours) after lumbosacral injection in dogs (Rector, 1996). The present study was performed to find out if epidurally administered xylazine acts locally as well as systemically. In a clinical investigation 30 dogs anesthetized with isoflurane in oxygen (1.9 Vol.% ET) were examined before and after epidural and intramuscular injection of xylazine (0.25 mg/kg) during surgery and over a 240-minute postoperative period. All dogs underwent surgery caudal the costal arch. The surgical patients were divided into three groups: group I: xylazine (0.25 mg/kg) epidural and aqua pro injectione i.m. (n = 10 dogs); group II: aqua pro injectione epidural and xylazine (0.25 mg/kg) i.m. (n = 10 dogs); group III: aqua pro injectione epidural and aqua pro injectione i.m. (n = 10 dogs). The division of xylazine epidural or i.m. or aqua pro injectione only was randomized. Prior to surgery, in all three groups somatic stimuli were exerted by pressure on the nailbed of a hind- and a forelimb before and after the epidural injection under general anesthesia. Heart rate, mean arterial pressure and rate of ventilation were used to determine the analgesic effect. During surgery, heart rate and mean arterial pressure were measured every 15 minutes. At the end of the operation, all patients were treated with the (alpha 2-selective adrenergic-antagonist atipamezole. During a 240 minute post operative examination heart rate, mean arterial pressure, rate of ventilation and reaction to pressure on the surgery site were used to determine the analgesic properties of xylazine. In this study it could be shown, that the concurrent epidural (group I) or intramuscular injection (group II) of xylazine in isoflurane anesthetized dogs leads to a better analgesic effect than isoflurane alone (group III) after somatic stimulation of a hind- and forelimb. From the antinociceptive effect in the forelimb after epidural administration of xylazine it was concluded that xylazine acts both locally as well as systemically. This was also confirmed by the hemodynamic changes, which were similar in group I (xylazine epidurally) and group II (xylazine i.m.). In the two groups treated with xylazine (group I and II), bradycardia and AV-blocks I and II were observed in three dogs during the first 30 minutes after epidural and intramuscular injection of xylazine. Hemodynamic changes were seen at the time of maximal plasma xylazine concentrations. One dog in the control group also had a bradycardia in connection with an AV-block II. During surgery no hemodynamic differences could be observed between the three groups. Heart rate was within normal limits and mean arterial pressure showed a slight hypotension. In agreement with the investigation of Rector (1996) it was shown in this study that xylazine has a long lasting (> 4 hours) antinociceptive effect after lumbosacral injection in the epidural space (group I). This analgesic effect is of local, spinal cord origin, as it was impossible to antagonize the analgesia by systemic application of atipamezole. In contrast to this, atipamezole reversed all analgesic properties totally after systemically administered xylazine in group II. However, sufficient analgesic plasma xylazine concentrations could only be detected in group II up to 180 minutes after injection. After this time period, an analgesic effect could not be expected anyway, even without antagonization. It can be concluded that the epidural administration of xylazine offers advantages in contrast to a systemic administration, as a longer lasting analgesic effect can be observed (after the epidural application), and systemic side effects can be reversed without effecting spinal analgesia.
Adrenergic alpha-Agonists↗