PubMed Health⌕ Search

Biomedical subjects

D Silver

Publications and source records attributed to D Silver.

At least 37 records · Page 2Linked to original sources
PubMed1988

Surgical management of refractory venous stasis ulceration.

A 15-year experience with 27 patients, 20 to 75 years of age, with refractory venous stasis ulcers is presented. All patients had been managed with support hose, elevation, elastic wraps, Unna's paste boots, and graduated compression stockings. Because of multiple recurrences of their ulcers, the patients were offered surgical treatment to reduce the venous hypertension in the areas of ulceration. The 27 patients had 32 modified Linton procedures. Five had bilateral procedures. At the time of operation, 18 limbs had medial malleolar ulcers, five had bimalleolar ulcers, four had lateral ulcers, three had posterior ulcers, and two patients were free of ulcer. Medial incisions were used in 20 limbs, lateral incisions in six, medial and lateral incisions in three, and midposterior incisions in three. Split-thickness skin grafts were placed on six limbs the day of surgery and on 22 limbs 4 to 7 days later. Postoperative complications included deep venous thrombosis in two, partial flap necrosis in three, and cellulitis of the lower leg in three patients. Follow-up has ranged from 6 months to 10 years. During the most recent clinic visits, 21 limbs were completely healed, whereas six limbs had a recurrence of the ulcer. Five patients have been lost to follow-up. The good long-term results in 78% of the cases indicate that patients with recurrent venous stasis ulcers may receive lasting benefit from modified Linton procedures.

Adult↗
PubMed1988

Heparin-coated catheters and heparin-induced thrombocytopenia.

Ten patients with heparin-coated pulmonary artery catheters had heparin-induced thrombocytopenia, which persisted after all other sources of heparin were discontinued. The thrombocytopenia occurred in approximately 0.4% of the patients receiving heparin-coated catheters and remitted when the catheters were removed. The platelet counts averaged 59,000/mm3 at the time of the diagnosis and recovered to an average of 143,000/mm3 by 3 days (range 2 to 4 days) after removal of the heparin-coated catheters. One patient required a second catheter 31 days after the first catheter had been removed. When the second heparin-coated catheter was inserted, the platelet count decreased from 307,000/mm3 to 102,000/mm3 in 4 days. Segments of heparin-coated pulmonary artery catheters were placed in platelet-rich plasma and incubated with serum from patients with known heparin-associated antiplatelet antibodies or with serum from volunteers with no exposure to heparin. The heparin-coated catheters induced platelet aggregation in all samples containing serum from patients with heparin-induced thrombocytopenia. However, platelet aggregation did not occur when the catheters were incubated with the serum of the volunteers. Non-heparin-coated catheters failed to produce platelet aggregation when incubated with either sera. The high mortality and morbidity rates associated with heparin-induced thrombocytopenia mandate that afflicted patients receive no more heparin, at least until the heparin-associated antiplatelet antibodies are no longer detectable. Patients with heparin-coated catheters who have thrombocytopenia should be tested for the presence of heparin-associated antiplatelet antibodies. If heparin-induced thrombocytopenia is confirmed, the catheters must be removed if the thrombocytopenia is to be reversed and complication avoided.

Aged↗
PubMed1988

Lower extremity edema from bladder compression of the iliac veins.

Two elderly men were referred to our vascular clinic for the management of bilateral lower extremity edema of 2 to 3 months' duration. Their evaluation included phlebograms, which demonstrated external compression of their iliac veins. CT scans of the pelvis suggested that large bladders caused the compression. Each patient had mild symptoms of prostatism. Transurethral resection of the prostate was recommended to and accepted by each patient. Decompression of the bladder was accompanied by complete relief of the lower extremity venostasis in both patients. Review of the literature yielded only eight similar cases of this unusual cause of lower extremity edema.

Aged↗
PubMed1988

Aneurysms and pseudoaneurysms of the superficial temporal artery caused by trauma.

Superficial temporal artery (STA) aneurysms as a result of trauma represent less than 1% of reported aneurysms. During the past 200 years only the type of trauma and the preferred treatment have significantly changed. Patients are generally young men with a recent history of blunt head trauma. They may complain of a mass, headache, or other vague symptoms. Neurologic defects are rare; however, if a neurologic deficit exists, the physician should consider either arteriography or a head CT scan to search for intracranial pathologic conditions. In most cases the diagnosis may be made by obtaining a complete history and physical examination. The treatment of choice is ligation and resection, which may be accomplished with the patient under local or general anesthesia. In rare instances, arteriography with selective embolization may be useful when the traumatic aneurysm is complicated by severe facial trauma. Three cases of STA aneurysms are presented. The history, pathophysiology, origin, presentation, diagnosis, differential diagnosis, and treatment of STA aneurysms are reviewed.

Adolescent↗
PubMed1988

Some determinants of individual differences in the behaviour of children of parentally deprived parents.

Parents who had been placed in an orphanage as children rated the behaviour of all their children who were between the ages of 6-18 years on a children's behaviour survey instrument. All families were intact and the parents had not requested professional help for marital problems. A significant number of relationships were found between parental background variables and higher reported levels of conflict with siblings and with parents, dependent-unassertive behaviour, and undemandingness in the children. Although sampling difficulties preclude generalization, the results suggest that repercussion of events in the lives of the first and second generation that are usually pathogenic may be seen in the third generation, even when the second generation may not be grossly adversely affected. These events most frequently related to individual differences in the third generation in the area of undercontrol of aggression directed toward parents and siblings.

Adaptation, Psychological↗
PubMed1988

Psychopathic adaptations in the vulnerable patient.

The purpose of this paper is to discuss the fluidity of symptoms that a group of psychiatric patients presents during the passage of time. Although clinically recognizable and worthy of attention, this fluctuation makes the illness difficult to conceptualize under a definitive diagnostic category. Such a dilemma is very familiar to the hospital psychiatrist. The authors present a case to illustrate the fluidity of symptoms manifested by a patient throughout the course of her illness. Awareness of the changing clinical presentations may alert us both to reformulate the patient on an ongoing basis, and to identify the different intervention needs at various points in time.

Adaptation, Psychological↗
PubMed1988

Should prophylactic anticonvulsants be administered to patients with newly-diagnosed cerebral metastases? A retrospective analysis.

We analyzed a retrospective series of 195 patients with documented intracerebral metastases (ICM) to assess the frequency of late seizure development and the impact of prophylactic anticonvulsants. Eighteen percent of the patients presented with seizures. Of the remaining patients, 40% received prophylactic anticonvulsants (diphenylhydantoin [DPH] in greater than 90%). Ten percent developed late seizures at an interval from the diagnosis of ICM ranging from 1 to 59 weeks. No patient with a posterior fossa lesion developed seizure; conversely, patients with evidence on initial examination of cerebral hemispheric dysfunction had a higher incidence of late seizure development. The incidence of seizure was virtually identical in patients who received DPH compared with those in whom it was withheld, although two thirds of patients who developed seizure while on DPH had a serum anticonvulsant level that was subtherapeutic. Based on the above findings and until prospective data become available, we recommend that anticonvulsants be withheld in newly-diagnosed patients with ICM until the first seizure.

Adult↗
PubMed1987

Reliability of continuous-wave Doppler probes.

Small-diameter, thin-walled latex tubes, through which a blood-simulating agent (0.1% suspension of simethicone in 0.9% sodium chloride) flowed at controlled rates, were embedded at varying depths in a tissue-mimicking matrix of powered graphite suspended in 4% agar. A continuous-wave (CW) Doppler probe was mounted at a 45-degree angle to the flow and passed transversely over the tube by a motorized drive mechanism at a rate of 0.42 mm/sec. Flow rates through the tubes were monitored with electromagnetic flow probes. The maximum depth from which quantitatively reliable signals could be obtained was 1.2 cm for 10 MHz probes and 3.3 cm for 5 MHz probes. Qualitative detection of flow was possible to a depth of 3.1 cm for 10 MHz probes and 7.0 cm for 5 MHz probes. The distances from the tube center for obtaining quantitatively reliable signals were limited to +/- 0.9 mm with a 10 MHz probe and +/- 1.8 mm with a 5 MHz probe. Qualitatively useful signals could be detected +/- 2.9 mm from the beam center by the 10 MHz probes and +/- 4.4 mm by the 5 MHz probes indicating a need for cautious interpretation as an interfering signal might be generated by any vessel within that range. Twenty percent of the randomly tested CW probes were considered unsuitable for use in quantitating blood flow, which underscores the importance of probe characterization before use.

Blood Flow Velocity↗
PubMed1987

The heparin-induced thrombocytopenia syndrome: an update.

One hundred sixty-nine patients with heparin-induced thrombocytopenia are reported and compared with the 62 patients reported in 1983. Prompt recognition of heparin-induced thrombocytopenia and immediate cessation of heparin administration lowered the complication and death rates from 61% (38/62) to 22.5% (38/169) and from 23% (14/62) to 12% (21/169), respectively. Platlet count and duration of heparin administration were not useful in predicting the outcome of the heparin-induced thrombocytopenia syndrome. Patients who received heparin in therapeutic doses were at higher risk for developing complications than were patients receiving lower doses of heparin. Platelet aggregation tests became negative as early as 7 days after discontinuation of heparin but persisted as long as 28 months. Heparin reexposure (2 days to 34 months after positive aggregation studies) was uneventful in 13 of 15 patients, whereas two patients suffered devastating thrombotic complications. Five patients continued to receive heparin despite positive platelet aggregation tests. The serious complications suffered by two of these five patients illustrate the necessity to discontinue heparin as soon as the diagnosis of heparin-induced thrombocytopenia is established.

Adolescent↗
PubMed1987

Spontaneous arterial perforation: the Ehlers-Danlos specter.

The Ehlers-Danlos syndrome (EDs) is one of the most frequently inherited disorders of connective tissue. Type IV EDs, the arterial-ecchymotic type, is of concern to vascular surgeons because it is frequently associated with spontaneous catastrophic bleeding. This article summarizes our experience with five members of a family and reviews the 31 patients with type IV EDs described in the literature. The 22 male and 14 female patients had a mean age of 26 years. The 36 patients included 23 with easy "bruisability," 22 with hypermobility of their joints (especially the fingers), 13 with transparent skin, and 11 with excessive elasticity of the skin. The patients had 41 episodes of hemorrhage and 29 vascular surgical procedures. Twenty-nine of the patients had an aneurysm or a dissection, whereas eight patients had arteriovenous fistulas. Arteriography was associated with a complication rate of 67%. The prognosis for a patient with type IV EDs is poor; 44% die before surgery and 19% die during the operative period. Bleeding should be managed nonoperatively when possible. Fifty-one percent die before reaching 40 years of age. Arteriography should be avoided. The standard repair of aneurysms and perforations is unlikely to be successful because of marked vessel friability. Bleeding vessels should be repaired with buttressed sutures and no tension or should be ligated. Genetic counseling with assay of collagen production is recommended for family members.

Adolescent↗
PubMed1987

Intimal integrity and fibrinolytic potential of reversed and in situ vein grafts.

The improved patency rates of in situ vein grafts are attributed to better flow characteristics, anastomotic "fit," and intimal preservation. This study compared the early changes in intimal morphology and fibrinolytic activity of in situ and reversed vein bypass grafts from mongrel dogs. Four to six centimeter in situ and reversed vein segments were used to bypass left and right femoral and internal carotid arteries, respectively. Heparin (100 U/kg) was administered before arterial clamping. Anastomoses were fashioned end to side and the intervening artery was ligated. Fifty-two grafts were harvested at day 1 (12 grafts), day 7 (16 grafts), day 14 (12 grafts), and 12 weeks (12 grafts). The veins were analyzed for histologic changes by light microscopy and scanning electron microscopy. The fibrinolytic activity of the grafts was assayed by the fibrin slide and fibrin plate techniques. There were no significant differences in morphology or fibrinolytic activity between the reversed and in situ grafts at any time period. These findings indicate that the improved patency rates associated with in situ grafts are not dependent on improved preservation of intimal structure or fibrinolytic activity.

Animals↗
PubMed1987

Intensive treatment of characterologically difficult patients. A general hospital perspective.

This article describes the development of a long-term inpatient treatment program in a general hospital setting for severely disturbed patients with personality disorder. A treatment model is outlined, with case vignettes included, that illustrates pertinent clinical issues. Also, the issue of regression in therapy, the role of consultation in a teaching unit, and research perspectives are discussed.

Adult↗
PubMed1986

Is thrombosis of the infrarenal abdominal aortic aneurysm an acceptable alternative?

Aortic aneurysm thrombosis with extra-anatomic bypass has been proposed for persons with infrarenal aortic aneurysms who are "too debilitated" to undergo standard aortic reconstruction. Thirteen patients (mean age, 75 years) were selected between January 1980 and June 1984 for axillobifemoral bypass with bilateral iliac artery occlusion to manage their infrarenal aortic aneurysms (mean size, 6.3 cm; range, 4.9 to 7.5 cm). Preoperative risk factors were cardiac (angina, compensated congestive heart failure, and significant preoperative arrhythmias), 100% of patients; pulmonary (symptomatic chronic obstructive pulmonary disease with a 1-second forced expiratory volume less than 50% of the predicted value), 46% of patients; renal (creatinine value greater than or equal to 2.0 mg/dl or creatinine clearance less than 20 ml/min), 46% of patients; or nutritional (albumin less than or equal to 3.5 gm/dl or body weight less than 90% of ideal), 46%. Ninety-two percent of the patients had two risk factors whereas 46% had three or more risk factors. The operative mortality rate was 31%; three patients died of multisystem organ failure and another died of thrombin-induced consumptive coagulopathy and hemorrhage. (Our operative mortality rate for conventional graft replacement of abdominal aortic aneurysms is less than 3%.) Morbidity in persons surviving at least 1 month included thrombosis of the extra-anatomic bypass graft requiring thrombectomy (three patients), ischemic colitis (two patients), ischemic neuropathy (one patient), and patients), ischemic colitis (two patients), ischemic neuropathy (one patient), and bilateral above-knee amputations (one patient). Thrombosis of the aneurysm was not achieved in two patients despite use of fluoroscopically controlled embolization of runoff vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Psychodynamics and psychotherapeutic management of the self-destructive character-disordered patient.

This article addresses some of the therapeutic strategies that the author has employed over the past number of years in treating a large number of patients usually referred to in the literature as having borderline or narcissistic personality disorders. The author refers to these patients as characterologically difficult. The focus of the treatment strategies is on the more fragile of these patients.

Borderline Personality Disorder↗
PubMed1979

Vasospastic disorders.

Acute digital ischemia not due to thromboembolism may be the result of either a primary vasospastic disorder (Raynaud's disease, acrocyanosis, livedo reticularis) or vasospasm associated with a systemic, regional, or traumatic disorder (Raynaud's syndrome, cold injury). Raynaud's disease versus syndrome is distinguishable up to 95% of the time from clinical criteria.

Arteries↗