Search PubMed⌕ Search

Biomedical subjects

S R Klein

Publications and source records attributed to S R Klein.

At least 91 records · Page 5Linked to original sources
PubMed1984

Assessment of perfusion in the diabetic foot by regional transcutaneous oximetry.

Regional transcutaneous oximetry is a new, noninvasive diagnostic technique for the investigation of peripheral vascular disease (PVD) that uses differences in limb and trunk transcutaneous PO2 to assess the adequacy of local perfusion. The application of such measurements would be of great importance in diabetes, in which limb ischemia is commonly difficult to assess. A group of diabetic subjects with symptomatic PVD was studied with regional oximetry, Doppler-assisted blood pressure measurements, and arteriography. Doppler studies correlated poorly to symptom grade and angiographic data, while oximetry clearly demonstrated limb hypoxia under the functional conditions appropriate to the patients' clinical symptomatology. The superiority of oximetry to Doppler studies was highly significant (X2 = 12.64, P less than 0.001). Regional transcutaneous oximetry should therefore be the noninvasive diagnostic test of choice in the initial evaluation of the diabetic limb for PVD. Because of its dependence on the adequacy of local oxygenation, transcutaneous oximetry is a powerful tool for investigation of the pathophysiology of PVD and will, in the future, have wide-ranging applications to the diagnosis and therapy of PVD.

Aged↗
PubMed1984

Indications for surgery for Bell's palsy.

Transmastoid surgical decompression of the facial nerve was found to have no positive effect in recovery from facial nerve function in patients with Bell's palsy. Since the risks of such surgery are greater than the benefits, this procedure should not be performed on patients with Bell's palsy unless a tumor is suspected. A mass lesion is suspected if there is complete paralysis and loss of response to evoked electromyography within the first 2 weeks after onset of the palsy or if there is recurrent facial paralysis on the same side. Rehabilitation surgical procedures should be reserved for patients with acute Bell's palsy with keratitis unresponsive to medical therapy or for those seen late in the course of the disease to correct undesirable sequelae.

Electromyography↗
PubMed1983

The effect of antisecretagogues on gastric microflora.

We examined the effect of cimetidine in altering gastric microflora in patients undergoing gastric resection for peptic ulcer disease. Ten patients had administration of cimetidine stopped at least six hours before surgery. Their mean gastric pH was 2.02 +/- 1.51, and 0.4 +/- 0.97 organisms were isolated per patient. Ten patients were maintained on a regimen of cimetidine and their mean gastric pH was 5.69 +/- 1.80, with 3.2 +/- 1.62 organisms isolated per patient. We reached the following conclusions: cimetidine alters the gastric pH of preoperative patients; cimetidine therapy is associated with an increase in gastric flora; stopping administration of cimetidine six hours before surgery reacidifies the stomach, decreases the number of organisms isolated from the stomach, and decreases the risk of septic complications.

Bacteria↗
PubMed1983

Amebic liver abscess. The surgeon's role in management.

Hepatic amebic abscess presented as an acute abdominal illness in 71 patients seen at the Harbor-UCLA Medical Center during the past 10 years. Most of the patients were young, Mexican and male, and half had coexistent medical diseases. The correct diagnosis was made by ultrasonography in 27 patients, laparotomy in 6, and radionuclide scan in 38. More than half (38 patients) were diagnosed accurately within 24 hours of admission. Sixty-seven abscesses were located in the right or both lobes; only 4 were limited to the left lobe, all of which had caused perforation. Operative findings in 20 patients were ruptured abscess in 12 and unruptured abscess in 2; abscesses were missed during exploration in 6 patients, one of whom had acute cholecystitis and another, a small bowel infarction. Other complications were intrathoracic rupture in four and intrapericardial rupture in one. Metronidazole was successful as initial drug therapy in 64 patients. Ultrasonographically-guided percutaneous drainage was used as a diagnostic and therapeutic adjunct to management in 15 patients. In a metropolitan population, the surgeon must consider amebic abscess in the evaluation of a febrile patient with right upper quadrant illness. With ultrasonography or radionuclide scanning, he can establish a reliable diagnosis in 24 hours. Although medical therapy is effective, surgery is required in 20 percent of patients for drainage of the ruptured abscess or treatment of a coexistent surgical condition. An unruptured abscess should be sought in an apparently negative exploration. A solitary abscess of the left lobe is rare but has a particular propensity to cause perforation.

Adolescent↗
PubMed1983

Evoked electromyography and idiopathic facial paralysis.

The purpose of this study was to standardize and evaluate the results of evoked electromyography (EEMG) in normal patients and in patients with acute idiopathic facial paralysis. A comparison of the amplitude of response to EEMG from one side of the face to the other in 288 normal patients yielded a great variability in results. The amplitude difference was not greater than 50%, and therefore a difference of less than 50% was considered normal. Test-retest variability of the percentage difference in amplitude in 10 subjects showed a 10% variation in seven patients and up to a 20% variation in the remaining three patients. Fifty patients with acute idiopathic facial paralysis were seen within 14 days of onset. A favorable prognosis was based on an EEMG amplitude of more than 25% of the normal side. With this criterion EEMG was accurate in predicting complete recovery in 36 (92%) of 39 patients. When EEMG was 25% of normal or less, incomplete recovery occurred in 9 (82%) of 11 patients. The response was 0% to 10% in six patients; four had a poor recovery and the remaining two had a fair recovery. The technique, interpretation of results, avoidance of pitfalls, and shortcomings of this test are discussed.

Electromyography↗
PubMed1983

Facial nerve decompression complications.

Every structure contained within the temporal bone in close proximity to the facial nerve is at risk during intratemporal bone surgery on the facial nerve. We present a review of the causes of injuries to these structures and of ways to prevent such injuries. This review includes information drawn from pertinent literature, from the author's experience managing 139 patients undergoing temporal bone surgery for a variety of facial nerve disorders between 1974 and 1981, from an analysis of 43 of our patients whose hearing was evaluated before transmastoid facial nerve surgery and again 6 months after surgery, and from the experiences of colleagues. We found that the most frequent complication of intratemporal facial nerve surgery is auditory involvement. An air-bone gap of 15 dB or greater was noted in 14% of the 43 patients studied and a sensorineural loss, primarily at the 4000 and 8000 cycles, occurred in 51% of these patients. A decrease in discrimination of 15% or greater was noted in 7% of patients, and a shift in speech reception threshold of 15 dB or greater was noted in 16% of the patients. Twelve percent of the patients had tinnitus following surgery and 5% required a hearing aid as a result of a combined sensorineural and conductive hearing loss which occurred in their better hearing ear as a result of surgery. Structures less commonly injured during transmastoid decompression of the facial nerve included the facial nerve itself, the chorda tympani nerve, the balance function of the labyrinth, the cochlea, the ossicles, the sigmoid sinus and superior petrosal vein, the middle meningeal artery and the stylomastoid artery, the dura, and the brain. We review all of these complications, as well as discuss the incidence of cerebrospinal fluid leak and infection which also may result from this type of surgery.

Ear↗
PubMed1983

Acute Bell's palsy: prognostic value of evoked electromyography, maximal stimulation, and other electrical tests.

Thirty-seven patients with acute Bell's palsy who had complete unilateral facial paralysis were selected for this study. Evoked electromyography, conduction latency, electromyography, and nerve excitability testing was done by one author while the maximal stimulation test was done by another on each patient. The patients were examined within ten days of onset of facial paralysis and evaluated six months after onset to determine the degree of recovery of facial motor function. The results of the tests were correlated with the degree of recovery of facial motor function in each patient. Evoked electromyography and maximal stimulation tests were the most accurate electrical tests for predicting the course of acute facial paralysis when they were performed serially within the first ten days after onset. When the results of the maximal stimulation test were equal on the involved and uninvolved sides of the face, there was a 92 percent chance of complete recovery of facial function on the involved side. In those patients in whom the response to the maximal stimulation test was markedly reduced or absent, there was an 86 percent chance of incomplete recovery of facial function. When the response to evoked electromyography on the involved side was 30 percent or greater of that on the normal side, 84 percent of the patients had complete recovery of facial function; however, when the response was 25 percent or less of normal, there was an 88 percent chance of incomplete recovery. The results of evoked EMG and the maximal stimulation test agreed in 89 percent of cases in predicting the ultimate outcome of facial paralysis.

Electric Stimulation↗
PubMed1982

Effect of suture technique on arterial anastomotic compliance.

To determine the immediate effect of running and interrupted suture on anastomotic compliance, catheters were positioned in both femoral arteries of ten dogs for pressure measurement and introduction of an electromagnetic rheoangiometry loop probe. Changes in the area of the loop allowed simultaneous determination of the static and pulsatile internal diameter of the vessel when the loop was in an externally induced magnetic field. After dynamic diameter compliance (Cd) of the undisturbed femoral arteries was obtained, they were exposed, stripped of their adventitia, and divided. They were subsequently anastomosed with 6-0 polypropylene suture using a running anastomosis for one femoral artery and an interrupted anastomosis for the other; Cd was then measured 1 cm proximal to the anastomoses, at the anastomoses, and 1 cm distal to the anastomoses. The Cd significantly decreased with both running and interrupted anastomoses; running anastomoses showed significantly greater decrease in compliance than did interrupted.

Animals↗
PubMedDate not supplied

Maintenance of compliance in a small diameter arterial prosthesis.

This study demonstrates that 20 to 30 microns porous, Replamineform silicone rubber prostheses remain isocompliant with adjacent arterial segments up to 8 months following implantation. This finding contrasts with the results of currently available prostheses, including autologous vein, which rapidly become minimally compliant. We conclude that this vascular construction is stable over the long-term following implantation and may improve the success of small internal diameter arterial reconstruction by eliminating failures caused by intimal hyperplasia.

Animals↗
PubMedDate not supplied

Endoscopic surgery training: application of an in vitro trainer and in vivo swine model.

The development of endoscopic surgical procedures is changing general surgery, with many operations such as cholecystectomy, appendectomy, and hernia repair being performed using laparoscopic surgical techniques. Training and credentialing of surgeons are key issues for the safe and ethical introduction of these new procedures. This article reviews techniques employed at our institution for laparoscopic surgical training and certification including didactic instruction, an in-vitro model for learning instrumentation and hand-eye coordination, and in-vivo training using the porcine animal model.

Animals↗
PubMedDate not supplied

Management strategy of vascular injuries associated with pelvic fractures.

To establish the frequency of major vascular trauma, facilitate recognition of potential injury based on fracture pattern, and formulate a systematic approach to evaluation and management, we studied 429 consecutive patients with acute blunt pelvic fracture. Fracture patterns were grouped as non-ring brakes (n = 43), anterior pelvic ring (n = 197), posterior pelvic ring (n = 104), or acetabular (n = 85) involvement. Mean age was 31 (range 2 to 90); 55% were male. Injuries resulted primarily from motor vehicle accidents (31%), pedestrian injuries (26%), and motorcycle accidents (19%). The fracture pattern was correlated with the occurrence of documented vascular injury, modality of management, transfusion greater than or equal to 10 units in the first day, associated injuries, and outcome. Laparotomy was performed in 22 patients (5%), but helpful only if associated visceral injuries were encountered. There were no instances of iliac or femoral vascular injuries. Hemodynamically unstable patients (BP less than 90) with major pelvic fractures and no other documented source of bleeding underwent pelvic angiography. Posterior ring disruption was associated with vascular injury requiring intervention (p less than 0.001). The occurrence of associated injuries (p less than 0.001), need of greater than 10 units of blood transfusion in the first 24 hours (p less than 0.005), and death (p less than 0.01) were consequences of posterior ring disruption. Based on this experience we conclude that: (1) aortoiliac and femoral arterial as well as iliofemoral venous injuries are a very rare consequence of pelvic fracture; (2) pelvic fracture with posterior ring disruption has a higher incidence of vascular injury necessitating intervention, associated injury, major transfusion requirement, and death; (3) early interventional radiology is efficacious in the control of arterial disruption caused by pelvic fracture; and (4) a tailored management strategy using the expertise of the vascular and orthopedic surgeon as well as the radiologist is required for recalcitrant hemorrhage.

Accidents, Traffic↗
PubMedDate not supplied

Preservation of compliance in a small diameter microporous, silicone rubber vascular prosthesis.

Compliance is believed to be a significant factor in maintaining the patency of small diameter vascular grafts. This study evaluated the compliance changes with time of microporous Replamineform silicone rubber prostheses. The compliance of 15 canine femoral artery interpositions (4 mm internal diameter X 6 cm length) was measured by in-vivo electromagnetic rheoangiometry immediately following implantation and at intervals to eight months. At implantation, silicone rubber grafts were overcompliant (15.0 +/- 1.1% radial change/mmHg X 10(-2); mean +/- S.E.) compared to the proximal artery (7.7 +/- .6%). The compliance of the prostheses decreased within two weeks (6.3 +/- .9%) and remained isocompliant to the proximal artery for eight months. The compliance determinations for the silicone rubber grafts were compared with those from PTFE prostheses and vein grafts acquired by the same method in a previous study. The analysis demonstrates the preservation of isocompliance of the silicone rubber prostheses compared to the native arteries. In contrast, the minimally compliant vein grafts and PTFE prostheses continued to decrease in compliance following implantation. This microporous silicone rubber graft may improve the success of small internal diameter arterial reconstructions by eliminating failures caused by compliance mismatch between the artery and the prosthesis.

Animals↗
PubMedDate not supplied

Laser welding of large diameter arteries and veins.

Based on our preliminary studies and the results of this study, we conclude that argon laser welding of 4-8 mm internal diameter veins, arteries, and arteriovenous fistulas may have several potential advantages compared to conventional suture techniques. The benefits of laser repairs may include improved mechanical properties, and absence of the foreign body response related to sutures. Laser welding is sterile, nontactile and possibly time conserving, and the wounds heal rapidly without aneurysms or excess tissue proliferation.

Animals↗
PubMedDate not supplied

Biliary and portal obstruction by celiac artery aneurysm.

This report describes a unique case of biliary and portal obstruction by a massive celiac artery aneurysm. Severe portal hypertension with extensive retroperitoneal varices and a perforated gallbladder complicated the surgical management. A survey of the literature emphasized the novelty of this case.

Aneurysm↗