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Biomedical subjects

D Sacks

Publications and source records attributed to D Sacks.

At least 55 records · Page 3Linked to original sources
PubMed1989

Femoral arterial injury following catheterization. Duplex evaluation.

Over a 24-month period, 21 patients underwent duplex Doppler evaluation for arterial injury secondary to catheterization. There were seven pseudoaneurysms, one arteriovenous fistula, eight hematomas, and one true aneurysm. Duplex ultrasound was 100% sensitive and specific for detection of pseudoaneurysms and arteriovenous fistulas. The real-time examination alone was unreliable. The only necessary criterion for diagnosis of a femoral pseudoaneurysm was the presence of pulsatile flow in a cystic collection separate from the common femoral artery. This could be determined rapidly. Arterial flow in the femoral vein confirmed the presence of an arteriovenous fistula.

Aneurysm↗
PubMed1988

Cervical screening in an inner city area: response to a call system in general practice.

To determine whether a cervical screening call system based in general practice in a deprived inner city area would increase the numbers of women who came forward for cervical smears the response to letters of invitation for screening was monitored for one year in one general practice in the Paddington and North Kensington district of London. Women aged 20-64 were identified from the computerised age-sex register. Only 16% of these women had had a smear test. A total of 750 call letters was sent out. Initially the response was poor (57 women; 22%), and 85 (32%) letters were returned marked "address unknown." After the age-sex register was updated the response to call was 330 women (44%). The response of women aged over 35 was better than the response of women aged 35 and under (229 (53%) v 101 (32%)). In the year of the study the number of women aged 20-64 on the revised register who had been screened rose by 330 (14%). A general practice based call system can improve uptake of cervical screening even in a highly mobile, socially underprivileged population.

Adult↗
PubMed1988

Ureteral leak around an aortic bifurcation graft: complication of ureteral stenting.

Aortoiliac bypass surgery has a 2 to 20 per cent incidence of ureteral injury causing postoperative hydronephrosis frequently without symptoms. We describe a patient in whom a ureteral stricture developed 12 days after placement of an aortic bifurcation graft. Treatment consisted of ureteral dilation and stenting following which a ureteral leak developed around the bifurcation graft from the stented dilation site, presumably from pressure necrosis of the ureter caught between the pulsating graft and the ureteral stent. The patient did well with external nephrostomy drainage. We conclude that ureteral stenting of patients suffering from significant aortoiliac disease should be approached with great caution, using the softest stent material available.

Aged↗
PubMed1988

A false-positive hepatobiliary scan in a patient with cystic fibrosis.

A case of nonvisualization of the gallbladder in an adult patient with cystic fibrosis in the absence of acute cholecystitis is reported. Delayed images to 20 hours showed persistent nonvisualization. Review of the literature on cystic fibrosis suggests that nonvisualization of the gallbladder may be secondary to inspissated mucus rather than acute cholecystitis, and therefore a positive hepatobiliary scan in these patients should be interpreted with caution.

Adult↗
PubMed1988

Renal and related retroperitoneal abscesses: percutaneous drainage.

Renal and related retroperitoneal abscesses cause significant morbidity and mortality and almost always require drainage. The authors report 18 cases of percutaneous drainage of renal and related retroperitoneal abscesses, all of which were successfully managed. In 11 of these cases (61%), percutaneous drainage constituted the only treatment required. In the remaining seven (39%), the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy with fewer complications. These results are comparable to those achieved with percutaneous abdominal abscess drainage and justify the use of percutaneous drainage for renal and related retroperitoneal abscesses as the therapeutic procedure of choice.

Abscess↗
PubMed1988

Transgastric percutaneous drainage of pancreatic pseudocysts.

Transgastric pancreatic pseudocyst drainage provides unique advantages that mimic the benefits of surgical cystogastrostomy while avoiding the disadvantages of external drainage. This procedure was performed under CT guidance in eight patients with pancreatic pseudocysts. There was no communication with the pancreatic duct at the time of initial aspiration. Communication was later demonstrated in six of eight patients and persisted for the entire duration of drainage. Resolution of the cysts occurred in seven of the eight patients. In one patient an infection of the pancreatic collection developed that required surgery. As with abdominal abscess drainage, a preexisting fistula may be opacified only after several days of catheter drainage and cannot be predicted at the time of initial aspiration. The percutaneous transgastric approach mimics the surgical approach and allows a mature tract to form from the cyst to the stomach. This eliminates the risk of a pancreaticocutaneous fistula and permits tube removal within a reasonable period of time.

Adult↗
PubMed1988

Diagnostic criteria for carotid duplex sonography.

Optimal criteria for the duplex sonographic diagnosis of carotid artery stenosis have not yet been defined. We studied 205 vessels in 105 patients with both duplex sonography and angiography. Four diagnostic groups were defined on the basis of Doppler flow characteristics. Receiver-operating-characteristic curves were used to compare diagnostic criteria at significant stenosis levels, and to select threshold values that emphasize specificity as well as sensitivity. Peak systolic velocity, systolic velocity ratios, and end-diastolic velocity were all shown to be equivalent predictors of significant disease. We chose peak systolic velocity in the internal carotid artery as our best parameter because of its ease of measurement. The use of combined parameters offered no significant statistical advantage over the use of a single parameter. The real-time assessment of stenosis and ulceration was not found to be reliable. ROC curves should be used to select Doppler criteria with desired sensitivities and specificities to maximize the benefit in each clinical setting.

Angiography↗
PubMed1985

Reasons for patient referral to occupational therapy units by health care professionals.

This study sought to discover the main reasons four professional groups--physicians, nurses, physical therapists, and mental health professionals--referred patients to occupational therapy services. A total of 162 subjects completed a specially devised questionnaire listing various reasons for referral. Seven factors were uncovered representing reasons for referring patients. Significant differences were found among professional groups and among the type of institutional settings--psychiatric, geriatric, or physical care. Interpretation of the results revealed one main motivation for referring patients to occupational therapists involving the contributions in the psychological aspects of patient care. Another major motivation for referral was the medical contributions of occupational therapy in improving physical functions. Physical therapists differed considerably from the three other professional groups, tending to place greater emphasis on referral motives related to the latter approach.

Female↗
PubMed1983

Resistance to macrophage-mediated killing as a factor influencing the pathogenesis of chronic cutaneous leishmaniasis.

Cutaneous leishmaniasis can be either a spontaneously healing or chronic disease, depending upon the strain of parasite and the immunological status of the host. We have investigated parasite factors responsible for the variable pathogenesis observed in leishmanial infections by testing the sensitivity of several leishmanial strains to intracellular killing in lymphokine (LK) activated mouse macrophages. Significant microbicidal activity against Leishmania tropica, a strain which heals in C57BL/6 (B6) mice, was found. In contrast, a strain (Maria) which has previously been shown to induce chronic nonhealing cutaneous lesions in B6 mice was resistant to killing in activated macrophages. This resistance to killing was observed in macrophages activated by LK obtained from either Bacille Calmette-Guérin-, L. tropica, or the Maria strain infected mice. The inability of LK activated macrophages to kill the Maria strain was shown not to be due to parasite induced inhibition of killing mechanisms, since Maria strain infected, LK treated macrophages exhibited tumoricidial activity similar to uninfected macrophages. Furthermore, LK activated macrophages simultaneously infected with the Maria strain and another intracellular pathogen, Toxoplasma gondii, killed Toxoplasma, but not the Maria strain. Temperature was also found to significantly influence the multiplication and killing of Leishmania parasites. As would be expected from their cutaneous nature, L. tropica and Maria strain parasites multiplied better at 35 degrees C than at 37 degrees C. Also consistent with the failure of cutaneous strains to visceralize in immunocompetent mice was the observation that the killing of leishmanial parasites was enhanced at the higher temperature. Thus, the temperature dependent growth capacity and sensitivity to killing of a given leishmanial strain in macrophages may be important factors influencing the pathogenesis of cutaneous leishmaniasis.

Animals↗
PubMedDate not supplied

Alum-precipitated autoclaved Leishmania major plus bacille Calmette-Guérrin, a candidate vaccine for visceral leishmaniasis: safety, skin-delayed type hypersensitivity response and dose finding in healthy volunteers.

In a previous efficacy study, autoclaved Leishmania major (ALM) + bacille Calmette-Guérrin (BCG) vaccine was shown to be safe, but not superior to BCG alone, in protecting against visceral leishmaniasis. From June 1999 to June 2000, we studied the safety and immunogenicity of different doses of alum-precipitated ALM + BCG vaccine mixture administered intradermally to evaluate whether the addition of alum improved the immunogenicity of ALM. Twenty-four healthy adult volunteers were recruited and sequentially allocated to receive either 10 microg, 100 microg, 200 microg, or 400 microg of leishmanial protein in the alum-precipitated ALM + BCG vaccine mixture. Side effects were minimal for all doses and confined to the site of injection. All volunteers in the 10 microg, 100 microg, and 400 microg groups had a leishmanin skin test (LST) reaction of > or = 5 mm by day 42 and this response was maintained when tested after 90 d. Only 1 volunteer out of 5 in the 200 microg group had a LST reaction of > or = 5 mm by day 42 and the reasons for the different LST responses in this group are unclear. This is the first time that an alum adjuvant with ALM has been in used in humans and the vaccine mixture was safe and induced a strong delayed type hypersensitivity (DTH) reaction in the study volunteers. On the basis of this study we suggest that 100 1 microg of leishmanial protein in the vaccine mixture is a suitable dose for future efficacy studies, as it induced the strongest DTH reaction following vaccination.

Adult↗