Howard Christian Naffziger: the surgeon and his syndrome.
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Eponyms↗
Biomedical subjects
T Keller
Publications and source records attributed to T Keller.
Hemodynamic effects of transurethral alprostadil measured by color duplex ultrasonography in men with erectile dysfunction.
PURPOSE: We evaluated the hemodynamic effects of transurethral alprostadil in 21 patients with erectile dysfunction using color duplex ultrasonography. MATERIALS AND METHODS: Penile arterial diameter, peak flow velocity and end diastolic velocity were compared following intraurethral administration of 500 microg. alprostadil and intracavernosal injection of 10 microg. alprostadil. RESULTS: A dose of 500 microg. transurethral alprostadil resulted in significant increases in corporeal blood flow comparable to those achieved with intracavernosal injection of 10 microg. alprostadil as measured by duplex ultrasonography in men with erectile dysfunction. Transurethral alprostadil resulted in statistically significant increases in arterial diameter and peak flow velocity comparable to those achieved with intracavernosal injection. End diastolic velocities were higher after transurethral alprostadil than intracavernosal injections. Color ultrasonography following transurethral alprostadil showed arterial and venous hyperemia of the corpus spongiosum and corpora cavernosa. Furthermore, color ultrasonography revealed communicating vessels between the corpus spongiosum and corpora cavernosa following administration of transurethral alprostadil. CONCLUSIONS: The visualization of communicating vessels between the corpus spongiosum and corpora cavernosa after transurethral alprostadil suggests local mechanisms of drug transfer from one to the other. In addition to potential clinical benefits, transurethral alprostadil may be useful to visualize the vascular anatomy of the penis and to test for patient responsiveness to local vasoactive agents.
Adult↗
Gas chromatographic examination of postmortem specimens after maprotiline intoxication.
Ingestion of an unknown quantity of Ludiomil (maprotiline)-costed tablets in a suicide is described. Although maprotiline is known for over 20 years now, relatively few cases of intoxications due to maprotiline overdose have been reported. The authors report a new and quick method to analyze and determine maprotiline and N-desmethylmaprotiline concentration in body fluids and postmortem specimens. The analytes and an internal standard (amitriptyline) were extracted from alkalinized samples into ethyl acetate before GC-NPD analysis. The proposed method resulted in a rapid procedure most useful in cases of deliberate poisoning with the tetracyclic antidepressant drug Ludiomil.
Antidepressive Agents, Second-Generation↗
Some notable American spine surgeons of the 19th century.
In the 19th century, American physicians were drawn to the renowned medical centers of Europe, beacons of excellence in all areas of clinical science, to complement and supplement medical education and training. Such Old World master surgeons as Victor Horsley and William Macewen constantly reported novel and innovative operative procedures, including a significant number of operations on the spine and spinal cord. In this same era, a number of American surgeons made important contributions to the emerging specialty of spine surgery. The lives and work of Alban Smith, Berthold Hadra, DeForest Willard, and Robert Abbe are submitted in this report as examples.
History, 19th Century↗
Application of ion mobility spectrometry to the rapid screening of methamphetamine incorporated in hair.
Using ion mobility spectrometry (IMS), a simple, sensitive and rapid screening for methamphetamine (MA) incorporated in user's hair has been developed. To completely unbind MA from hair matrix and to achieve its effective vaporization for the IMS detection, the hair sample was digested in 5 M NaOH (methanol-water, 4:1, v/v) solution prior to IMS measurement. MA in hair was semi-quantitatively detected by monitoring the digested hair sample employing dibenzylamine (DBA) as internal standard. The minimum amount of hair sample required was 2 mg and its digested sample was ample for four IMS measurements. The detection limit of MA in hair was 0.5 ng mg(-1). This proposed method was applicable to the semi-quantitative detection of MA in users' hair samples, and to the sectional analysis for MA in a limited amount of user's hair. The IMS results obtained were in good agreement with their GC-MS determination.
Hair↗
Fatal overdose of clozapine.
An ingestion of an unknown quantity of Leponex (clozapine) tablets in a suicide is described. Although clozapine is known for over 30 years now, relatively few cases of intoxications due to clozapine overdose have been reported. The authors report a new and quick method to analyze and determine the clozapine and N-desmethylclozapine concentration in body fluids. The analytes and an internal standard (zolpidem) were extracted from alkalinized samples into ethyl acetate before GC/NPD analysis. The proposed method resulted in a rapid procedure most useful in cases of deliberate poisoning with the neuroleptic drug Leponex.
Adolescent↗
Adverse prognostic features of collagen injection therapy for urinary incontinence following radical retropubic prostatectomy.
PURPOSE: We identified and characterized predictive factors associated with an unfavorable outcome of collagen injection therapy in post-radical prostatectomy incontinence. MATERIALS AND METHODS: A total of 46 patients, 49 to 85 years old (mean age 67) and incontinent after radical retropubic prostatectomy, underwent a mean of 2.8 transurethral injections of collagen (mean cumulative volume injected 31 ml.). Preoperatively, all patients underwent fluoroscopic multichannel video urodynamics including determination of Valsalva's leak point pressure. Stress urinary incontinence was subjectively graded as 1 (0 to 1 pad per day), 2 (2 to 3 pads per day) and 3 (greater than 3 pads per day). Patient age, duration and severity of pretreatment incontinence, presence of detrusor instability and anastomotic strictures, number of injections, total volume of collagen delivered and the impact of a nerve sparing procedure plus adjuvant radiation therapy were assessed and correlated with treatment outcome. RESULTS: Of the patients 11 (24%) became completely dry (9 after 3 or fewer treatments), 21 (41%) improved (17 after 3 or fewer treatments) and 14 (30%) showed no benefit (after more than 3 treatments). Of the 14 patients in whom treatment failed 6 had undergone adjuvant radiation treatment, pretreatment urinary incontinence was grade 3 in all, and concomitant detrusor instability was present in 11 (79%). All patients had received more than 3 treatments (mean total volume injected 37 ml.). CONCLUSIONS: Notwithstanding the need for multiple treatments, the prospect for cure by collagen injection of the post-radical prostatectomy incontinent patient is significantly affected by the severity of pretreatment incontinence, concomitant detrusor overactivity and exposure to radiation therapy. Age, duration of incontinence, presence of mild to moderate anastomotic strictures and a nerve sparing technique did not seem to influence treatment outcome.
Aged↗
Differences in older versus younger hemodialysis patients' noncompliance with oral medications.
Hemodialysis patients' compliance with their therapeutic regimens, including dietary and fluid restrictions, dialysis treatments and medications, is generally suboptimal. Recently, the mean age of the dialysis population has increased. Since impaired cognitive function, which sometimes accompanies aging, interferes with the ability to comprehend instructions, elderly dialysis patients might be at greater risk for noncompliance than are their younger counterparts. In this project, 135 hemodialysis patients (68 patients > 65 years of age and 67 patients < or = 65 years) were studied. Rates of noncompliance with oral antihypertensives and phosphate binders, as tracked by a medication event monitoring system (MEMS), are reported here. More than 42% of older patients (> 65) and 47% of younger patients (< or = 65) were repeated noncompliers with antihypertensives, missing at least 20% of the prescribed doses. Similarly, 65% of older patients and 80% of younger patients exhibited repeated noncompliance with phosphate binders. Almost 30% of older patients and more than 32% of younger patients missed their antihypertensives completely on 20% or more of the prescribed days. Only 18% of the older subjects, but 33% of younger patients missed taking their phosphate binders for 20 or more percent of the prescribed days. Rates of noncompliance were found to differ between the two populations of patients in that younger patients made significantly more dosing errors with their antihypertensives and missed taking their phosphate binders on more days than did their older counterparts.
Administration, Oral↗
An unusual penetrating neck wound by a golf club: precise forensic imaging.
An unusual case of a penetrating neck injury by a golf club with the weapon retained in situ is presented. The contemporary imaging technology that delineated the clinical and forensic aspects is demonstrated as another tool to assist in criminal investigation.
Adult↗
Factor VIIa and antithrombin III activity during severe sepsis and septic shock in neutropenic patients.
Septic shock and multiple organ failure may be associated with coagulation activation, disseminated fibrin formation, and consumption of coagulation inhibitors such as antithrombin III. We have evaluated prospectively coagulation measurements in patients with severe chemotherapy-induced neutropenia. This group of patients was chosen because of their high risk of developing severe septic complications, thus allowing serial prospective coagulation testing before and during evolving sepsis or septic shock. Sixty-two patients with febrile infectious events were accrued to the study. Of these, 13 patients progressed to severe sepsis and 13 additional patients to septic shock as defined according to standard diagnostic criteria. At the onset of fever, factor (F) VIIa activity, FVII antigen and antithrombin III (AT III) activity decreased from normal baseline levels and were significantly lower in the group of patients who progressed to septic shock compared with those that developed severe sepsis (medians: 0.3 v 1.4 ng/mL, 21 v 86 U/dL and 45% v 95%; P < .001). The decrease of these measurements in septic shock was accompanied by an increase in prothrombin fragment 1+2 (median: 3.6 v 1.4 nmol/L; P = .05), a marker of thrombin generation. These differences were sustained throughout the septic episode (P < .0001). FVIIa and AT III levels of < 0.8 ng/mL and < 70%, respectively, at onset of fever predicted a lethal outcome with a sensitivity of 100% and 85%, and a specificity of 75% and 85%, respectively. In contrast, FXIIa-alpha antigen levels were not different between groups at onset of fever but increased modestly during the course of septic shock (P = .001). Thus, septic shock in neutropenic patients is associated with increased thrombin generation. Furthermore, both FVIIa and AT III measurements are sensitive markers of an unfavorable prognosis.
Adult↗
The rise and fall of Erichsen's disease (railroad spine).
The railroad represented one of the major technologic achievements of the 19th century. Sadly, railroad collisions, which resulted in major injuries and loss of life, began to tarnish the image of this popular mode of transportation. Public alarm about rail travel intensified in 1866, when noted British surgeon John Eric Erichsen described a peculiar progressive spinal disorder, similar to spinal concussion, that was a sequela to railroad accident or injury. The history of this disorder, which came to be known as "railroad spine" or "Erichsen's disease", represents a little known yet important chapter in the evolution of the modern comprehension of functional illness that can complicate or even replace an initial substrate of organic disease.
Diagnosis, Differential↗
Victor Horsley's surgery for cervical caries and fracture. The Centennial Anniversary.
On August 25, 1895, Victor Horsley, the doyen of British neurosurgery, presented the results of his surgery for trauma and caries (tuberculosis) of the cervical spine at the Surgery Section of the British Medical Association Annual Meeting. All of the patients recovered from their operations and four were in attendance at the meeting to attest to the results of their operations. For the surgeon of 1895, laminectomy of the cervical spine was a daunting undertaking. Although effective anesthesia and antiseptic techniques had become available, roentgenologic evaluation of spinal fracture and disease was still a future diagnostic modality. The special relationship of Victor Horsley with William Gowers, neurologist of Queen's Square Hospital, London, is presented. The status of therapy for cervical fracture and tuberculosis at the close of the 19th century is described to gauge the magnitude of this event as a major contribution to the progress of spinal surgery.
Cervical Vertebrae↗
The first primary brain tumor operation in America.
On February 25, 1886, in San Francisco, California the first documented resection of a primary brain tumor in the United States was performed by Drs. Hirschfelder and Morse. This operation followed fourteen months after the first recognized resection of a primary brain tumor in history was performed by Mr. Rickman Godless in London, England, November 25, 1884. Hirschfelder and Morse's operation is presented, and the contemporary medical technology that made this operation possible is summarized. The unique circumstances that explain the occurrence of this milestone in the history of American neurosurgery are documented.
Brain Neoplasms↗
The superantigen exfoliative toxin induces cutaneous lymphocyte-associated antigen expression in peripheral human T lymphocytes.
Several immune-mediated dermatoses including psoriasis and atopic dermatitis can be exacerbated by bacterial infections. Superantigen producing bacteria can be isolated from skin lesions of these dermatoses. Consistent with superantigen effects, skewed T cell receptor variable gene usage has been demonstrated within these lesions. Therefore, the question arises whether superantigen induce a skin-seeking phenotype within peripheral T cells. In this study, we investigated the in vitro influence of the V beta 2-selective superantigen exfoliative toxin from Staphylococcus aureus on the expression of the cutaneous lymphocyte-associated antigen on peripheral T lymphocytes of healthy donors. We demonstrate that exfoliative toxin dramatically upregulates cutaneous lymphocyte-associated antigen expression on T cell receptor V beta 2+ lymphocytes. Up to 69% of V beta 2+ lymphocytes expressed cutaneous lymphocyte-associated antigen after 5 days of in vitro culture. Additionally, exfoliative toxin also increased cutaneous lymphocyte-associated antigen expression in CD3+ T cell receptor V beta 2- lymphocytes indicating a different effect as caused by the superantigen-T cell receptor V beta 2 interaction. Our findings suggest influence of bacterial superantigens on T lymphocyte skin homing in vivo.
Antigens, Differentiation, T-Lymphocyte↗
"Gamekeeper's thumb" variant, complicated by reflex sympathetic dystropy.
A case of gamekeeper's thumb resulting from a motor vehicle accident is presented. This injury was complicated by the onset of reflex sympathetic dystrophy. An overview of the presentation and management of these disorders, which may result in severe disability without prompt recognition and therapy, is submitted for discussion.
Adult↗
Cardioprotective potency of the radical scavenger S-2-(3 aminopropylamino) ethylphosphorothioic acid in the post-ischaemic rat heart.
S-2-(3 aminopropylamino) ethylphosphorothioic acid (WR-2721) shown to surpass radical scavenging thiols in their radioprotective efficacy in cancer-type diseases has been tested for its protective potential in the reperfused heart. We investigated the radical scavenger properties of the compound in a radical generating system in vitro as well as in isolated rat hearts subjected to 30 min ischaemia and 30 min reperfusion with the electron-paramagnetic resonance spin trap technique. The action on high-energy phosphates is observed by means of phosphorus-31 nuclear magnetic resonance (NMR) spectroscopy while its influence on left ventricular systolic segmental length change (SSLC) during 60 min reperfusion following 60 min regional ischaemia was assessed with a fibreoptic system in anaesthetized open-chest rats. WR-2721 (0.1 mM) reduced the vascular concentration of radical adduct in isolated hearts by up to 78% (275 +/- 84% of pre-ischaemic baseline values vs 1260 +/- 413%, p < 0.05) between 5 and 12.5 min reperfusion. This was accompanied by a reduction of the left ventricular end diastolic pressure to pre-ischaemic values at 30 min of reperfusion (9 +/- 6 mmHg vs 42 +/- 8 mmHg in the absence of WR-2721, p < 0.02). An accelerated recovery of creatine phosphate levels (78 +/- 5% of pre-ischaemia values vs 41 +/- 5% within 60 min reperfusion: p < 0.05) was observed under similar conditions with NMR-spectroscopy, although the post-ischaemic tissue content of adenosine triphosphate was not affected.(ABSTRACT TRUNCATED AT 250 WORDS)
Amifostine↗
A double-blind, randomized, placebo-controlled, multi-center study of brofaromine in the treatment of post-traumatic stress disorder.
A large multi-center, double-blind, parallel trial to assess the efficacy of brofaromine in the treatment of post traumatic stress disorder (PTSD) failed to show a significant difference between the brofaromine and placebo treatment groups. The placebo response rate in this study was higher than that in previously published double-blind, placebo-controlled studies of PTSD.
Adult↗
Railway spine revisited: traumatic neurosis or neurotrauma?
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Accidents↗