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Biomedical subjects

S Snyder

Publications and source records attributed to S Snyder.

At least 55 records · Page 3Linked to original sources
PubMed1993

Combined laparoscopic and endoscopic management of cholelithiasis and choledocholithiasis.

With the advent of laparoscopic cholecystectomy, optimal management of common duct stones remains controversial. Seven hundred six patients underwent laparoscopic cholecystectomy in our institution from January 1990 through January 1992. From this group of patients, 50 were identified as having clinical or radiographic evidence of common duct stones. Thirty-one patients demonstrated preoperative risk factors for common duct stones and underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP). The risk factors included jaundice (19%), pancreatitis (23%), elevated liver function tests (52%), and ultrasound evidence of choledocholithiasis (6%). Preoperative ERCP was performed in 94% of patients. There were two failures due to periampullary diverticula. Common duct stones were identified in 18 patients (62%) and successfully removed by endoscopic sphincterotomy in all of these patients. Nineteen patients were found to have unsuspected common duct stones on intraoperative cholangiography. Eighteen patients (95%) underwent successful ERCP and endoscopic sphincterotomy with stone extraction. Overall, major morbidity was 2% and included one patient who experienced endoscopic sphincteroplasty. The three endoscopic failures were managed by open common duct exploration, laparoscopic duct exploration, and combined laparoscopic and open common duct exploration. We conclude that combined laparoscopic and endoscopic therapy is a viable option for the management of cholelithiasis with choledocholithiasis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1992

Prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery.

A prospective, randomized trial of inpatient vs. outpatient bowel preparation for elective colorectal surgery was performed in 100 consecutive patients. Bowel preparation was standardized for both groups and consisted of 4 liters of Colyte (Reed & Carnrick, Piscataway, NJ) and oral neomycin and Flagyl (G. D. Searle & Co., Skokie, IL) the day before surgery. Patients were randomized into four subcategories: ileocolostomy, colocolostomy, abdominal perineal resection, and other. Tap water enemas were administered on the morning of surgery to ensure and adequate mechanical preparation. Ninety-six percent of the inpatient group and 97 percent of the outpatient group were able to drink three-fourths or more of the oral lavage preparation (P = 0.789, Fisher's exact text). A mean of 2.26 tap water enemas was required to achieve clear returns for the inpatient group, compared with 2.28 tap water enemas for the outpatient group (P = 0.221, Fisher's exact test). The adequacy of the bowel preparation as graded by the primary surgeon was good (84 percent), fair (12 percent), and poor (4 percent) in the outpatient group (P = 0.673, Fisher's exact test). Wound infection developed in 4 percent of the inpatient group and 4 percent of the outpatient group (P = 1.0, Fisher's exact test). Anastomotic leak of intra-abdominal abscess was seen in one patient in each group (P = 1.0, Fisher's exact test). We conclude that outpatient bowel preparation is as effective as inpatient bowel preparation for elective colorectal surgery and offers the advantage of cost savings and shorter hospitalization.

Adult↗
PubMed1992

Prevalence of mental disorders in newly admitted medical inpatients with AIDS.

The authors evaluated 42 newly admitted medical inpatients with acquired immune deficiency syndrome (AIDS) using DSM-III-R criteria and obtained quantitative ratings of psychiatric morbidity using standard instruments. A current Axis I disorder was present in 61.9% of the patients. Organic mental disorders predominated (47.6% of all patients) and were more common in the most severely ill patients. Major depressive syndrome was rarer than expected (9.5%). Recent physical disability was correlated with repeated hospitalizations, and trends were found suggesting correlation of recent physical disability with increased anxiety and cognitive impairment. This study, using actual patient evaluations, suggests predictors of psychiatric morbidity in this setting and argues for routine psychiatric screening of medical inpatients with AIDS.

AIDS Dementia Complex↗
PubMed1992

Protection from reperfusion injury by preconditioning hearts does not involve increased antioxidant defenses.

Preconditioning the heart with 5 min of ischemia renders the heart very resistant to infarction from subsequent ischemia by an unknown mechanism. We investigated whether the protective effect of preconditioning might be related to an increase in rabbit heart antioxidant defenses. The antioxidant activities of catalase, glutathione peroxidase, Mn superoxide dismutase, Cu,Zn superoxide dismutase, glucose-6-phosphate dehydrogenase, glutathione reductase, and total glutathione were measured in ischemic and normal regions from both control and preconditioned rabbit hearts. All hearts experienced 30 min regional ischemia and 5 min reperfusion. None of the antioxidant enzymes changed in activity when comparing nonischemic and postischemic zones in either nonpreconditioned or preconditioned hearts. Total glutathione, however, was reduced in reperfused zones and showed better preservation in preconditioned hearts. To determine whether this preservation resulted from a higher value at the onset of reperfusion or slower washout during reperfusion, we analyzed a second group of nonreperfused hearts after 30 min ischemia. The hearts had normal glutathione content in both ischemic and nonischemic zones of either preconditioned or control hearts. The most likely explanation is that preconditioned hearts experienced less washout of glutathione simply because they were less injured. We therefore conclude that enhancement of antioxidant defenses is not the mechanism of preconditioning.

Adaptation, Physiological↗
PubMed1992

Estimation of computerized tomography derived abdominal fat distribution.

Measurements of intra-abdominal fat (IAF) may be important since it is associated with numerous metabolic disorders. The relationship between computerized tomography (CT) measured fat distribution and densitometry measures was investigated in a sample of 61 male Caucasian subjects, aged 18 to 30 years with varying adiposity. Regression models were developed for estimating CT-derived fat of 40 men to estimate IAF. Two equations were developed to estimate IAF. The first used only anthropometric measures. Waist circumference and log chest ratio entered the equation and accounted for 67% of the variance. The second model included densitometry-measured percentage fat with the centred product of waist and hip circumferences, accounting for 73% of the variance. Regression equations were also developed to estimate subcutaneous fat area so that the ratio of IAF to subcutaneous fat might be estimated. Although subcutaneous fat could be estimated, the ratio between IAF and subcutaneous fat could not be estimated accurately. A validation of all regression equations developed for male subjects who also completed using a separate validation sample (n = 21). Only the studies with sample characteristics similar to those found in the validation sample validated satisfactorily. Results indicate that anthropometric and densitometry measures cannot be used to estimate CT-derived abdominal fat with precision, however they may be of value in health risk screening of individuals with high levels of IAF. Proper selection procedures with regard to age, adiposity, and morbidity must be used.

Adipose Tissue↗
PubMed1991

Laparoscopic cholecystectomy: a multicenter study.

Laparoscopic cholecystectomy has been developed as an alternative to open cholecystectomy for the treatment of symptomatic cholelithiasis. A collaborative study of 261 patients undergoing laparoscopic cholecystectomy at three Texas institutions was performed to determine the effectiveness and safety of this technique. There were 65 males and 196 females with a mean age of 49 years (range 17-94 years). Acute cholecystitis was present in 38 patients and chronic cholecystitis in 223 patients. Mean length of surgery was 80 minutes (20 min to 4 hr). Fifteen patients were converted to the open technique intraoperatively due to bleeding, adhesions, or difficulty of dissection. There were no perioperative deaths and morbidity was 3% including urinary retention, small bowel obstruction, arrhythmia, wound infection, and bile leakage. There were no common duct injuries. Hospitalization ranged from outpatient surgery to 7 postoperative days with a mean of 1.2 days. We conclude that laparoscopic cholecystectomy can be performed safely and with low morbidity and offers shorter hospitalization and postoperative recovery.

Adolescent↗
PubMed1991

Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients.

OBJECTIVE: The authors hypothesized that psychiatric liaison screening of elderly patients with hip fractures would shorten the average length of hospital stay and increase the proportion of patients who returned home after discharge. METHOD: The study was performed at Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago. The subjects were 452 patients 65 years or older who were consecutively admitted for surgical repair of fractured hips. During a baseline year the patients received traditional referral for psychiatric consultation. During the experimental year all the patients at Mount Sinai and the patients on one Northwestern Unit were screened for psychiatric consultation. RESULTS: The patients who received psychiatric liaison screening had a higher consultation rate than those who received traditional consultation. The rates of DSM-III disorders in the experimental year were 56% at Mount Sinai and 60% at Northwestern. The mean length of stay was reduced from 20.7 to 18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern, resulting in reductions in hospital costs ($647/day) of $166,926 and $97,361, respectively. Fees generated from Medicare service delivery could have paid for the $20,000 psychiatric intervention cost at each site. There was no difference, however, between the two years in the discharge placement of patients. CONCLUSIONS: Admission psychiatric liaison screening of elderly patients with hip fractures results in early detection of psychiatric morbidity, better psychiatric care, earlier discharge, and substantial cost savings to the hospital.

Aged↗
PubMed1991

Movies and juvenile delinquency: an overview.

Film viewing may affect the juvenile delinquent through the processes known as social learning and instigation. Identification with the movie and its characters by the delinquent viewer is common, and studies have consistently demonstrated that films can affect delinquents, although in some cases the effects are small. Numerous examples of how films may serve as either the initiator or the final common pathway of delinquent acts are presented. However, prosocial aspects of films dealing with delinquency may exert a positive influence on the juvenile delinquent. Treatment implications of these observations are discussed from social learning and other perspectives.

Adolescent↗
PubMed1990

Detection of borderline oxacillin-resistant Staphylococcus aureus and differentiation from methicillin-resistant strains.

Eighty-eight Staphylococcus aureus clinical isolates meeting criteria for borderline oxacillin resistance (intermediate susceptibility or resistance to oxacillin but susceptibility to amoxicillin/clavulanic acid upon disk diffusion testing) were studied to determine optimal test techniques and conditions for differentiating borderline oxacillin-resistant Staphylococcus aureus (BORSA) from methicillin-resistant Staphylococcus aureus (MRSA). Further testing revealed three distinct resistance patterns: 61 strains (69%) consistently met BORSA criteria and had average beta-lactamase levels five- to six-fold higher than oxacillin-susceptible controls; 11 strains (13%) were markedly heteroresistant MRSA with delayed appearance of resistant colonies leading to spurious susceptibility to amoxicillin/clavulanic acid; 16 strains (18%) appeared to be oxacillin-susceptible on repetitive testing. Under conditions used to elicit intrinsic methicillin resistance in Staphylococcus aureus, a large percentage of BORSA appeared resistant to amoxicillin/clavulanic acid. This clearly shows that BORSA may be misidentified as MRSA while heteroresistant MRSA may appear to be BORSA. It is concluded that amoxicillin/clavulanic acid zone sizes should be measured after a full 24 hours of incubation, that susceptibility testing of Staphylococcus aureus under certain environmental conditions should be interpreted with caution, and that MIC testing is the most reliable technique for differentiating these two resistance patterns in Staphylococcus aureus.

Amoxicillin↗
PubMed1990

Differentiating major depression from adjustment disorder with depressed mood in the medical setting.

Although the psychiatric consultant in the general hospital setting is frequently called on to distinguish major depression from adjustment disorder, no studies to date have examined whether the two diagnoses are in fact distinguishable. Analysis of computerized data base records from 944 cases seen by psychiatric consultants from 1981-1987 revealed 59 cases of major depression and 130 cases of adjustment disorder with depressed mood. Patients with major depression were more likely to be older (p less than 0.001), widowed (p less than 0.001), and living alone (p less than 0.005). Patients with adjustment disorder with depressed mood received higher ratings on Axis IV (p less than 0.01), and lower severity of illness ratings (p less than 0.001) were seen later in the hospital stay (p less than 0.05), and they were more likely to be rated by the consultant as improved by the time the case was terminated (p less than 0.001). The results suggest that the two disorders may be distinguished in the consultation population and that adjustment disorder with depressed mood may have descriptive validity in the medical inpatient setting.

Adaptation, Psychological↗
PubMed1990

Effect of various irrigating fluids on the ultrastructure of articular cartilage.

The effect of five different irrigating fluids on the ultrastructure of articular cartilage was studied utilizing the scanning electron microscope. Gross histologic studies have shown no significant difference amongst commonly used irrigating fluids on the surface or matrix composition of articular cartilage. Recent in vivo and in vitro biochemical studies, in addition, have shown no significant deleterious effects of irrigating fluids on articular cartilage composition. This study was prospectively undertaken to assess the effect of irrigating fluids on the ultrastructure of articular cartilage. When comparing five irrigating solutions utilizing the scanning electron microscope, specimens irrigated with 1.5% glycine seemed to show a more consistently smooth appearance. Ultrastructural changes were noted with the other four irrigating solutions tested.

Adult↗