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Biomedical subjects

E Strauss

Publications and source records attributed to E Strauss.

At least 19 recordsLinked to original sources
PubMed1995

Gunshot wounds to the upper extremity. Evaluation and management of vascular injuries.

Gunshot wounds to the upper extremity are uncommonly life threatening but are associated with a high incidence of significant long-term disability. The identification of vascular injuries is dependent on careful clinical examination and the liberal use of arteriography. Standard techniques of vascular repair should be followed for arterial reconstruction. The rate of successful vascular repair is in excess of 90%, but long-term function is limited by a high incidence of associated nerve injury.

Arm↗
PubMed1995

Gunshot wounds to the forearm.

The rising incidence of civilian gunshot wounds has been well documented. Approximately 4% to 20% of these wounds consist of injuries to the forearm. An organized approach to the treatment of these injuries should be used to obtain an optimal result. Factors to be considered in treatment include the type of weapon and bullet involved, the neurovascular status of the patient, the possibility of compartment syndrome, the presence and type of fracture, and soft-tissue injury.

Algorithms↗
PubMed1995

Metaphyseal dissociation fractures of the proximal tibia. An analysis of treatment and complications.

A study was done of 44 metaphyseal dissociation fractures of the proximal tibia in 42 patients (27 men and 15 women, aged 22 to 77 years; mean, 42 years). Follow-up ranged from 6 months to 4 years. There were 2 study groups: a retrospective group (group 1, 22 fractures) given a variety of treatments ranging from casts to dual plates, and a prospective group (group 2, 22 fractures) treated by combining external fixation and optional minimal internal fixation. There were 12 comminuted fractures in group 1 and 20 in group 2 (P < 0.01). All fractures eventually healed, with an average healing time in group 1 of 3.8 months, and 5.3 months in group 2. There was one delayed union in group 2. Results were graded from poor to excellent, based on pain, range-of-motion, and malunion. There were 6 poor and 4 fair results in group 1, and no poor and 3 fair results in group 2. Complications included 6 deep infections, 5 in group 1 (1 requiring a free-flap procedure); and 1 pin-tract infection resulting in septic arthritis in group 2. There were 7 gastrocnemius flaps required in group 1, and 1 in group 2. The results of this study suggest that patients treated with external fixation had better results with less infection and soft-tissue complications than those treated with conventional internal fixation.

Adult↗
PubMed1994

Callosal morphology and performance on intelligence tests.

Variation in the size of the human corpus callosum was examined in relation to variation in measured IQ. The midsagittal surface area of the corpus callosum, obtained by magnetic resonance imaging, was measured in 47 patients with epilepsy. Intellectual ability was positively related to a larger posterior callosal area. We suggest that the relationship between the posterior callosal region and measured intelligence is "non-functional" in itself, but rather, may reflect other anatomical-cognitive associations. That is, differences in splenial size may reflect differences in the number of cortical neurons and interconnections between areas of the brain that are important for processing the kind of information measured on intelligence tests. Our conclusions, however, must be tempered by a number of factors; in particular, the nature of our subjects and the relatively small sample size.

Adolescent↗
PubMed1994

Detecting dissimulation: profiles of simulated malingerers, traumatic brain-injury patients, and normal controls on a revised version of Hiscock and Hiscock's Forced-Choice Memory Test.

A computer-administered memory test was given to normal subjects instructed to feign brain damage, normal controls, and traumatic brain-injured (TBI) patients with complaints of memory dysfunction. The test, a revised version of an instrument developed by Hiscock and Hiscock (1989) employed forced, two-choice recognition of previously presented five-digit numbers. Two levels of item difficulty and three retention intervals were used. Control and TBI subjects performed at near ceiling level on easy items and items with short retention intervals. Feigning subjects performed worse than TBI and control subjects at all levels of item difficulty and all retention intervals. Subjects groups were maximally distinguishable from one another by performance on difficult items and items with the longest retention interval. All TBI patients performed at or above chance level. Only 15% of the feigning subjects performed below chance level on any section of the test. Jack-knifed discriminant function analysis correctly classified 83% of all subjects into their respective groups. Although evaluation of patient performance relative to chance probability is useful for indicating the presence of extremely exaggerated memory deficits, criteria derived from sample distributions of group scores were superior for evaluation of motivation in less obvious cases. The Victoria Revision may be useful for detecting true memory deficit as well as dissimulation.

Accidents, Traffic↗
PubMed1994

Collapse of intertrochanteric hip fractures fixed with sliding screws.

A retrospective analysis of postoperative fracture collapse was performed using data from 142 patients with intertrochanteric hip fractures fixed anatomically with sliding screws. Of the 142 patients, 80 had unstable, three- or four-part hip fractures. Significant collapse (as defined by strict radiographic criteria relating the height of the femoral head to the greater trochanter and by Doppelt's criteria) was seen in 26 of the unstable fractures. The degree of collapse was classified as type I (minimal), type II (moderate), and type III (severe). Average follow-up was 31 months. An in-depth clinical and radiographic analysis was performed evaluating pain, limp, abductor weakness, and leg-length discrepancy. The numerical degree of both vertical and horizontal fracture collapse was also analyzed. Of the patients with moderate or severe collapse, 93% had a poor functional result, whereas all the patients with minimal collapse remained asymptomatic. Although postoperative fracture impaction of hips fixed with sliding screws may promote early healing, a high rate of union, and a low rate of hardware failure, excessive collapse is a problem that needs to be addressed.

Aged↗
PubMed1994

Portal hypertension in schistosomiasis: a long-term follow-up of a randomized trial comparing three types of surgery.

The long-term follow-up of patients with the severe form of Manson's schistosomiasis who had had elective surgical treatment for portal hypertension, in a randomized trial, was clinically evaluated. Of 94 patients, proximal splenorenal shunting was performed in 32, esophagogastric devascularization with splenectomy in 32 and distal splenorenal shunting in 30. Patients were observed during a mean of 85.7 +/- 33.1 mo, excluding nine patients (9.6%) who were lost to follow-up. Recurrence of upper gastrointestinal tract bleeding occurred in 24.1% of the patients, without statistical differences among the three groups, but rebleeding because of varices was more frequent after esophagogastric devascularization with splenectomy. Hepatic encephalopathy was significantly higher after proximal splenorenal shunting (39.3%) when compared with distal splenorenal shunting (14.8%) and with esophagogastric devascularization with splenectomy (0%). Lethality was also significantly higher after proximal splenorenal shunting (42.9%) when compared with distal splenorenal shunting (14.8%) and with esophagogastric devascularization with splenectomy (7.1%). Indirect hyperbilirubinemia was absent after esophagogastric devascularization with splenectomy and more frequent after distal splenorenal shunting (52%) although also present after proximal splenorenal shunting (29.6%). Esophagogastric devascularization with splenectomy was demonstrated to be the best option because of the absence of encephalopathy and because of low mortality rates. Hepatic encephalopathy occurred after distal splenorenal shunting but in a lesser percentage than after proximal splenorenal shunting. The higher incidence of encephalopathy and lethality proscribes proximal splenorenal shunting in Manson'schistosomiasis.

Adolescent↗
PubMed1993

Dual task performance by patients with left or right speech dominance as determined by carotid amytal tests.

Patients who had their speech dominance determined by carotid Amytal testing were evaluated with a dual task procedure consisting of reading and finger tapping. As expected, the asymmetry of interference between tasks varied with speech dominance. Patients with left hemisphere speech tended to show greater interference in the right hand whereas patients with right hemisphere speech showed greater interference in the left hand. Since the right hemisphere dominant patients were also right-handed, the results suggest that interference effects are more closely linked to speech than to motor dominance.

Adolescent↗
PubMed1993

A prospective study of bacterial infections in patients with cirrhosis.

One hundred and seventy hospitalized patients with cirrhosis were included in a prospective and sequential study, to verify the prevalence and most frequent causes of bacterial infection. The differences in clinical and laboratory data between the two groups were analyzed: group I--80 patients who developed bacterial infection and group II--90 patients without bacterial infection. The prevalence or cumulative frequency of the development of bacterial infection during one hospitalization was 47.06%. Among these, the most frequent types of infection were: spontaneous bacterial peritonitis (SBP): 31.07%, urinary tract infection (UTI): 25.24% and pneumonia: 21.37%. Community infections were more frequent (56.25%) than nosocomial infections (32.50%) and they occurred sequentially in 11.25% of the cases. The agents responsible were gram negative bacteria in 72.34% of the cases. Clinical and biochemical parameters in bacterial infection were generally correlated with the severity of liver disease. Child-Pugh classification showed a predominance of class C in infected cirrhotic patients compared to non-infected ones. During hospitalization, the mortality rate of group I was 30% whereas in group II it was 5.55% (P = 0.0001). SBP and pneumonia were the most severe types of infection, with high mortality rates, 31.25% and 40.91%, respectively. These results indicate that bacterial infection is a severe complication in the course of cirrhosis.

Adult↗
PubMed1993

Wisconsin Card Sorting Performance: effects of age of onset of damage and laterality of dysfunction.

Wisconsin Card Sorting Performance was examined in patients with complex partial seizures of left (n = 35) or right (n = 42) temporal-lobe origin. Our findings suggest that poor performance, in the form of perseveration, occurs in the context of nonfrontal dysfunction and depends not only on the laterality of the epileptogenic disturbance but also on the age of onset of the damage. The ability to shift set is most impaired by left temporal-lobe dysfunction, but only when the damage occurs very early in life. Left temporal-lobe dysfunction after one year of age leaves sorting behavior relatively intact. Perseveration may also occur in the context of right temporal-lobe dysfunction, regardless of the age of onset of the damage, although the deficit tends to be less marked. Finally, the occurrence of the deficit does not depend upon the status of the cerebral speech pattern or general intellectual level.

Adult↗
PubMed1992

Depression in male and female subjects with complex partial seizures.

Eighty-four epileptic patients, with seizures originating in either the left or the right hemisphere, were evaluated to determine the relations between lateralization of epileptogenic foci, gender, and depression. Our data suggest that male subjects, but not female subjects, with left-sided foci may be particularly vulnerable to depression.

Adult↗
PubMed1992

Sex differences in interhemispheric reorganization of speech.

Ninety-four epileptic patients who had undergone the carotid amytal test were evaluated in order to determine whether sex affects the pattern of hemispheric reorganization following cerebral injury. Our data suggest that the period during which hemispheric reorganization for speech can occur differs between the sexes. Females have a relatively short window, with reorganization most likely during the first year of life. The length of this window is more difficult to define for males but may extend until puberty. The period during which a shift to left-handedness can occur does not appear to be affected by gender. Here, both males and females seem to show a relatively short window.

Adult↗
PubMed1992

Theophylline metabolism in patients with hepatosplenic mansoniasis and cirrhosis.

The pharmacokinetics of theophylline were studied in 12 patients with hepatosplenic mansoniasis, 14 patients with cirrhosis and 16 normal controls. Following a single intravenous dose of aminophylline volumes of distribution, serum half-lives and body clearances were determined. Volumes of distribution of theophylline in patients with schistosomiasis (mean 0.624 l/kg) did not differ from cirrhotic patients (mean 0.616 l/kg) or normal controls (mean 0.593 l/kg). Cirrhotic patients had a prolonged half-life compared to normal subjects (mean 22.1 vs. 9.9 h), while patients with schistosomiasis did not substantially differ from normal controls (15.8 vs. 9.9 h). Body clearance in patients with schistosomiasis was similar to controls (34.02 vs. 49.20 ml/h per kg) but decreased (29.24 ml/h per kg) in patients with cirrhosis. Individual analysis of the group with schistosomiasis disclosed three patients with reduced theophylline elimination. No relationship was found between laboratory tests of liver function and the pharmacokinetics of theophylline in any group. The administration of theophylline to patients with hepatosplenic schistosomiasis, although less dangerous than in cirrhosis, must be closely followed.

Adolescent↗
PubMed1992

Sex-related differences in the cognitive consequences of early left-hemisphere lesions.

Epileptic patients who had undergone the carotid amytal test were assessed on a variety of measures of verbal and nonverbal ability. All patients had left-hemisphere dysfunction early in life, before 1 year of age. In males, such damage results in generalized cognitive retardation regardless of the status of the cerebral speech pattern. In females, intellectual retardation is linked specifically to a shift in speech processes. This sex-related difference in behavioral outcome may reflect interruption at different maturational stages and/or the influences of the immediate hormonal milieu.

Adult↗
PubMed1992

Double-blind randomized clinical trial comparing neomycin and placebo in the treatment of exogenous hepatic encephalopathy.

Hepatic encephalopathy due to cirrhosis is frequently precipitated by exogenous factors, and the effectiveness of a specific treatment with neomycin sulfate has so far not been submitted to clinical trials. Over a period of five years, 102 cirrhotic patients developed hepatic encephalopathy at admission or during hospitalization, and 39 were randomized for treatment with either neomycin sulfate or placebo. Exclusion criteria were: 1. current usage of specific treatment for hepatic encephalopathy, 2. chronic hepatic encephalopathy and 3. multiple organ failure syndrome associated with hepatic encephalopathy. The group of excluded patients (n = 63) was compared with the randomized group (n = 39), and no statistical differences were found regarding sex and age distributions, Child-Pugh classification, etiology of cirrhosis, percipitating factors and grade of hepatic encephalopathy. These same parameters were also comparable among the 20 patients who received active neomycin and the 19 who were treated with placebo. The therapy for hepatic encephalopathy consisted in the control of precipitating factors associated with 6 g of neomycin sulfate "per os" or placebo. Therapeutic failure and death by the fifth day of treatment, occurred in four patients (10.2%), two in each of the randomized groups. The time elapsed between the initiation of the therapeutic procedure and regression to grade zero of hepatic encephalopathy was 39.11 +/- 23.04 hours for the group of active neomycin, and 49.47 +/- 21.92 hours for the placebo group, but this difference did not achieve statistical significance.

Adult↗
PubMed1991

Functional analysis and in vivo footprinting implicate the erythroid transcription factor GATA-1 as a positive regulator of its own promoter.

Transcription of erythroid-expressed genes and normal erythroid development in vivo are dependent on a regulatory protein (GATA-1) that recognizes a consensus GATA motif. GATA-1 expression is itself restricted to erythroid progenitors and to two related hematopoietic lineages, megakaryocytes and mast cells. During cellular maturation the levels of GATA-1 RNA and protein increase progressively. In an effort to delineate mechanisms by which this pivotal transcription factor is itself regulated we have characterized the mouse GATA-1 gene and cis-elements within its promoter. We find that the isolated promoter retains cell specificity exhibited by the intact gene. Full promoter activity requires the presence of proximal CACCC box sequences and an upstream, double GATA motif that binds a single GATA-1 molecule in an asymmetric fashion. Using in vivo footprinting of mouse erythroleukemic cells we detect protein binding in vivo to both cis-elements. On the basis of these findings we propose that a positive feedback loop mediated through GATA-1 serves two complementary functions: maintenance of the differentiated state by locking the promoter into an "on" state, and programming the progressive increase in protein content throughout cellular maturation.

Amino Acid Sequence↗
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↗