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Biomedical subjects

W M Kirsch

Publications and source records attributed to W M Kirsch.

At least 37 records · Page 2Linked to original sources
PubMed1992

A new method for microvascular anastomosis: report of experimental and clinical research.

Principles of microvascular anastomotic surgery are uncertain in contrast to the standardized suture methods for the repair of large arteries. Complications of early thromboses or late stricture at the microvascular anastomotic line can be related to the inherent biologic response of these delicate tissues to penetrating needle and suture. A new method for microvascular reconstruction based on the principle of flanged, nonpenetrated, intimal approximation by an arcuate-legged clip has proven biologically and technically superior to the penetrating microsuture. These conclusions are based on extensive testing in multiple surgical laboratories of the following parameters: long- and short-term patency, morphology of wound repair, and burst and tensile strength. Details of the new surgical system and experimental studies are described.

Anastomosis, Surgical↗
PubMed1992

Tissue reconstruction with nonpenetrating arcuate-legged clips. Potential endoscopic applications.

A new system for tissue approximation consisting of a nonpenetrating arcuate-legged clip applied to everted tissue edges to form an elastomeric flanged joint is described. The flanged joint has unusual physical and morphologic properties. Novel systems for tissue eversion, clip application and clip removal have been tested at the micro scale in blood vessels and the rat vas deferens (vasovasostomy). Human applications have been successful (cerebrovascular reconstruction, free-flap transfer, skin grafting, A-V access). The system is biologically and technically equivalent to or superior to the needle-and-suture technique. Avoidance of intimal or mucosal penetration or intraluminal foreign body is associated with prompt wound healing and the reconstitution of tubular integrity. The system is readily adaptable for endoscopic surgical reconstructions, providing the surgeon with enhanced reconstructive abilities.

Anastomosis, Surgical↗
PubMed1991

Testolactone, sulindac, warfarin, and vitamin K1 for unresectable desmoid tumors.

Ten patients with large inoperable desmoid tumors in various body locations were treated with testolactone. Four tumors (40%) responded with major regressions, i.e., more than 50% reduction in volume. Eight patients received nonsteroid anti-inflammatory drugs (indomethacin, sulindac, or sulindac with warfarin and vitamin K1 [Mephyton]) for periods of 2 to 91 months. There was one major regression, one partial regression, and three instances of tumor growth arrest over periods up to 8 years. Seven patients were treated with nonsteroid anti-inflammatory drugs concurrent with or after testolactone or tamoxifen. There were five major regressions and one partial regression with extensive central necrosis of an enormous intra-abdominal tumor. The last patient has been treated for only 12 months, with no change in tumor volume. It appears that estrogens function as growth factors for desmoid tumors, and that minimization of these effects inhibits tumor growth in some, but not all, cases. In those instances where antiestrogens were not effective as single agents, the tumors usually responded to subsequent nonsteroid anti-inflammatory drug therapy. Withdrawal of estrogen may be followed by inhibition of transcription of genes that support tumor cell proliferation, and sulindac and indomethacin may augment these effects by inhibiting prostaglandin and cyclic AMP synthesis and the activity of protein kinase C. Warfarin may function as a protonophore to acidify the cytoplasm and prevent the alkalinization that is necessary to initiate DNA synthesis and cell cycle progression, again an impairment of the transcription process.

Abdominal Neoplasms↗
PubMed1987

Atlanto-axial dislocation in acute rheumatic fever. Case report.

A 10-year-old boy had a sore throat, followed in 4 weeks by acute rheumatic fever and in 6 weeks by atlanto-axial dislocation. Reduction of the dislocation by means of a halo vest relieved his pain, but the cervical spine remained unstable after 3 months of immobilization and required an occiput-C1-2 fusion and rib graft to stabilize the atlanto-axial joint. This is the eighth reported case of atlanto-axial dislocation associated with acute rheumatic fever. The features of previous cases are summarized and the clinical aspects, mechanisms, diagnosis, and treatment of atlanto-axial dislocation are reviewed.

Acute Disease↗
PubMed1984

Aminomalonic acid: identification in Escherichia coli and atherosclerotic plaque.

Aminomalonic acid (Ama) has been isolated from proteins of Escherichia coli and human atherosclerotic plaque. The presence of Ama has important biological implications because the malonic acid moiety potentially imparts calcium binding properties to protein. Ama was obtained by anaerobic alkaline hydrolysis and identified by chromatographic behavior, quantitative acid-mediated decarboxylation to glycine, and unambiguous gas chromatographic/mass spectral detection. The chromatographic, chemical, and mass spectral properties of naturally occurring Ama were identical to those of the synthetic compound. Amino acid analysis and GC/mass spectrometry also revealed the presence of beta-carboxyaspartic acid and gamma-carboxyglutamic acid in the base hydrolysate of human atherosclerotic plaque. The ratio of Ama to beta-carboxyaspartic acid to gamma-carboxyglutamic acid was 20:1:10, and the quantity of Ama per 1,000 glycine residues was 0.2. Ama is a relatively unstable, minor amino acid in complex structures such as bacteria or tissues. This may explain why it has escaped detection previously, despite intensive investigation.

Amino Acids↗
PubMed1980

Retrospective analysis of 22 patients with chronic pain treated by peripheral nerve stimulation.

Twenty-two patients with chronic pain, chiefly from posttraumatic neuropathy, were treated by implanted peripheral nerve stimulators located proximal to the pain. Thirteen of these (62%) have experienced pain control for an average of 25 months. The experience of the surgeon is thought to be a major factor contributing to the successful results. There are theoretical and practical advantages to electrical stimulation and proximal portions of the peripheral nervous system. The surgical technique for implantation is described and the necessity for reoperation in some patients is explained.

Brachial Plexus↗
PubMed1978

Immunoelectron microscopic localization of s-100 protein in cultured rat glioma cells.

Immunoelectron microscopic localization of the nervous system specific protein S-100 in the cultured rat glioma cells was successfully conducted by an unique immunocytochemical technique using peroxidase-labeled antigen binding Fab' fragments. The intensely electron dense reaction product for S-100 protein was localized mainly at ribosome granules associated with endoplasmic reticulum membranes and at free ribosome granules. S-100 protein was also associated to some extent with the cytoplasmic and nuclear membranes. A positive reaction was localized at the nuclear pores as if it were being prevented from entering into the nucleus. No activity was found in the nucleoplasm except for a slightly positive reaction product associated with nucleolus. The possible role for S-100 protein in neural cells was discussed in relation to the nuclear acidic proteins involved in genomic regulation.

Animals↗
PubMed1978

Screening of human brain tumors for SV40-related T antigen.

A series of 39 human brain tumors has been screened for the presence or absence of SV40-related T antigen by the direct and indirect immunoperoxidase methods. Two tumors of ependymal origin (malignant ependymoma, choroid plexus papilloma) revealed markedly positive nuclear staining for T antigen both in vivo and in vitro. The relationship of these tumors to their experimental counterparts inducible by recent human papovavirus isolates is discussed.

Antigens, Viral↗
PubMed1978

Immunocytochemical evidence of SV 40-related T antigen in two human brain tumours of ependymal origin.

A series of thirty-time human brain tumours has been screened for the presence or absence of SV 40-related T antigen by the direct and indirect immunoperoxidase techniques. Two tumours (an ependymoma and a choroid plexus papilloma) of ependymal origin revealed markedly positive nuclear staining for T antigen both in in vivo and in vitro. The possible viral etiology of these human brain tumours is discussed in relation to recent human papovavirus isolates.

Animals↗
PubMed1978

Left stellectomy in the long QT syndrome.

Recent investigations have reaffirmed the role of autonomic innervation of the heart in the genesis of certain cardiac arrhythmias. The long QT syndrome (LQTS) has been described for years, but only recently has evidence of its link to autonomic imbalance been established. A case of LQTS is presented with intraoperative evidence at the time of left stellectomy of life-threatening arrhythmias triggered by stimulation of this neural body. Removal of the left stellate ganglion normalized the electrocardiographic (ECG) abnormalities and has rendered the patient asymptomatic since surgery. Left stellectomy may become definitive therapy for selected patients with the LQTS.

Adult↗
PubMed1978

Reoperation after lumbar intervertebral disc surgery.

This retrospective study includes 53 patients who underwent reoperation after failure of lumbar disc surgery to relieve pain. All patients had leg pain before reoperation, which was successful in 28% of cases. Most clinical features, such as persistence or mode of recurrence of pain, radicular quality of pain, positive straight-leg raising, and myelographic root sleeve defects, were not helpful in predicting successful and unsuccessful reoperations. However, a significantly larger percentage of women than men had successful reoperations. Patients who had past or pending compensation claims, who had sensory loss involving more than one dermatome, or who failed to have myelographic dural sac indentations resembling those caused by a herniated disc did poorly with reoperation. A very convincing myelographic defect appears to be needed to justify reoperation at a previously unoperated location. Excision of scar alone or dorsal rhizotomy was of no avail in these cases.

Adult↗