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Biomedical subjects

S Sherman

Publications and source records attributed to S Sherman.

225 records · Page 13Linked to original sources
PubMedDate not supplied

Post-ERCP pancreatitis: randomized, prospective study comparing a low- and high-osmolality contrast agent.

Diagnostic and therapeutic ERCPs are complicated by pancreatitis in 1% to 10% of patients, and evidence suggests that the contrast agent used for ERCP may be important in the pathogenesis of such pancreatitis. This prospective, double-blind study was undertaken to determine whether the use of a low-osmolality, nonionic contrast agent (Omnipaque 300; iohexol, 672 mOsm/kg H2O) would reduce the frequency and severity of postprocedure pancreatitis as compared to a high-osmolality, ionic contrast agent (Hypaque 50%; diatrizoate sodium, 1515 mOsm/kg H20). Six hundred ninety patients undergoing diagnostic ERCP (pancreatogram, cholangiogram, or both) either with or without sphincter of Oddi manometry and therapy were randomized to iohexol or diatrizoate sodium. Postprocedure pancreatitis was diagnosed when the serum amylase or lipase level was elevated to at least four times the upper limits of normal at 18 hours and was associated with increased abdominal pain persisting for at least 24 hours after the procedure that required administration of narcotic analgesics. The pancreatitis was graded as mild, moderate, or severe depending on the length of hospital stay and the need for intervention. The overall frequency (7.2% versus 7.5%) and severity (4.3% mild, 2% moderate, 0.9% severe for the diatrizoate sodium group versus 4.3% mild, 2.6% moderate, and 0.6% severe for the iohexol group) of postprocedure pancreatitis and the frequency and severity within each procedure category were similar for the two contrast agent groups (p > .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

Local thrombolytic therapy as part of a multidisciplinary approach to acute axillosubclavian vein thrombosis (Paget-Schroetter syndrome).

PURPOSE: To evaluate the efficacy of thrombolytic therapy in the treatment of acute axillosubclavian vein thrombosis in patients with Paget-Schroetter syndrome. MATERIALS AND METHODS: A 4.5-year, retrospective study of all patients with "effort" thrombosis of the axillosubclavian vein was performed. RESULTS: Six men and eight women (age range, 18-56 years; mean, 34 years) presented with acute axillosubclavian vein thrombosis. Twenty thrombotic events occurred in the 14 patients and were treated with urokinase only (14 of 20) or urokinase combined with percutaneous transluminal angioplasty (PTA) (six of 20), Nine of the 14 treatments with urokinase only (64%) resulted in complete lysis of thrombus, whereas four treatments (29%) resulted in restoration of flow with some residual stenosis, yielding an immediate patency rate of 93%. Eight of the 14 patients remained asymptomatic after thrombolytic therapy (urokinase or urokinase and PTA) alone (n = 4), or in combination with a first rib resection (n = 4) at a mean follow-up of 24 months (range, 1-36 months). CONCLUSIONS: Thrombolytic therapy appears to be a safe and efficacious method of establishing immediate patency of the axillosubclavian vein and may be helpful in establishing a symptom-free result in patients with Paget-Schroetter syndrome. Rib resection and repeated thrombolytic therapy are frequently necessary to complete treatment.

Acute Disease↗
PubMedDate not supplied

Correlations between vascular calcification and atherosclerosis: a comparative electron beam CT study of the coronary and carotid arteries.

PURPOSE: Electron beam CT (EBCT)-derived coronary artery calcium scores correlate with the extent of atherosclerosis, but there is a substantial variance about the general relationship between coronary calcification and coronary atherosclerosis. The relationship between calcification and atherosclerosis may also differ in various arteries. This study was designed to evaluate whether the relation between carotid artery intima-media thickness (IMT) and carotid artery calcium could be used as a correction factor to improve the correlation between coronary calcification and coronary atherosclerosis. METHOD: We measured atherosclerosis in the coronary and carotid arteries by angiography and ultrasonography, respectively, and quantified coronary and carotid calcium deposition with EBCT in 50 subjects. The correlation between the findings in the carotid and coronary arteries was investigated. RESULTS: Coronary artery calcium score correlated with coronary angiography and with carotid calcium score. Coronary stenosis correlated with carotid IMT. There was no meaningful correlation of carotid IMT and carotid calcium. CONCLUSION: There is an intraindividual variation in the relationship of plaque mass to calcification among different vessels. The relation between carotid artery calcification and carotid IMT is not predictive of the relation between coronary artery calcification and coronary obstruction.

Aged↗
PubMedDate not supplied

Hypertensive pancreatic sphincter.

Major papilla pancreatic sphincter dysfunction, a variant of sphincter of Oddi dysfunction, causes pancreatitis or pancreatic-type pain. Endoscopic manometry as performed at endoscopic retrograde cholangiography is the most commonly used method to identify sphincter dysfunction. Noninvasive testing, such as secretin-stimulated ultrasound analysis of duct diameter, is less reliable and of relatively low sensitivity. Two-thirds of patients with sphincter of Oddi dysfunction have elevated pancreatic basal sphincter pressure. Patients with suspected or documented sphincter of Oddi dysfunction may respond to biliary sphincterotomy alone, but warrant evaluation of their pancreatic sphincter if symptoms persist after therapy. Whether such pancreatic and biliary sphincters should be treated at the first treatment session is controversial. Pancreatic sphincterotomy is associated with a complication rate very similar to that of biliary sphincterotomy except that the pancreatitis rate is two- to fourfold higher. Prophylactic pancreatic stenting diminishes such pancreatitis by approximately 50%.

Catheter Ablation↗
PubMedDate not supplied

Priorities for maternal and child health services: the consumer's perspective.

A convenience sample of 206 inner city department of public health patients were asked to rank the importance of health care services relative to other problems they face. Respondents spontaneously ranked money, unemployment, and housing as their most pressing concerns. When presented with a list of potential problems, housing, crime, and rent were most frequently cited. Health of children and own health were priorities for 15 and 21 respondents respectively. Pregnancy prevention and having a good pregnancy were important for seven individuals. The priorities attached by these medically and socially high risk people for maternal and child health services are placed in the context of published data on expert opinion on need for maternal and child health services and the availability of these services. The results of this survey suggest that public health administrators define realistic, specific goals for preventive maternal and child health services. Aggressive consumer education programs aimed at providing information on the importance of these services to maintaining well-being are also in order.

Adult↗