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Biomedical subjects

G R Zuckerman

Publications and source records attributed to G R Zuckerman.

At least 19 recordsLinked to original sources
PubMed1992

Dies with resin copings for accurate registrations.

A simple, accurate, and reliable technique is available for use when individual dies are made for fixed partial denture construction. Resin copings are used to record the spatial relationship between abutments, create occlusal registrations, verify the dimensional accuracy of the dies, test the path of insertion of the prosthesis, and visualize the marginal adaptation of the retainers. The resin copings are compatible with any elastic impression material selected for the pickup impression.

Acrylic Resins↗
PubMed1990

Prospective trial comparing a combination pH probe-nasogastric tube with aspirated gastric pH in intensive care unit patients.

Upper GI bleeding related to stress ulcer syndrome is estimated to affect as much as 15% of patients in an ICU. Since the occurrence of bleeding after ICU admission may be associated with increased morbidity and mortality, many efforts have been directed at defining optimal therapy for stress ulcer prophylaxis. Titration of intragastric pH with antacids or iv doses of H2-receptor antagonists may prevent stress ulcer bleeding in high-risk ICU patients. We evaluated a recently developed pH probe incorporated into an NG tube and compared it with aspiration of gastric contents using pH paper as a means to monitor pH in 22 surgical ICU patients. Regression analysis comparing the intragastric probe pH values with the aspirated pH values showed a good correlation between the two methods (r = .71). This new technique for intragastric pH measurement appears technically simple and clinically applicable for use on patients at risk for stress ulcer bleeding. It may be more accurate than pH paper in patients receiving antacids.

Adult↗
PubMed1990

Analysis of resistance and retention of complete veneer crown retainers.

The resistance and retention of a fixed partial denture are influenced by the number and distribution of the abutment teeth that support it, the path of insertion, the shape of the arch to which it must conform, and the occlusal relationship it will have with the opposing teeth. If the prosthesis is to be designed properly, it is necessary to understand how each of these factors influences the stability of the prosthesis and its ability to resist dislodgment. If the conditions that contribute to the instability of the prosthesis are misunderstood, overlooked, or ignored, it is impossible to design a prosthesis that will be predictably successful.

Bite Force↗
PubMed1987

Therapeutic goals and treatment options for prevention of stress ulcer syndrome.

Stress ulcer syndrome, the occurrence of acute upper gastrointestinal bleeding or perforation from stress-related mucosal damage, is a significant cause of morbidity and mortality in critically ill patients. The mortality rate in critically ill patients who have bled from stress ulcers ranges from 50 to 77 percent, whereas the mortality rate for similar patients without stress ulcer bleeding ranges from 9 to 22 percent. The mortality rate may be as high as 90 percent in patients with clinically overt bleeding; as many as one-third of these deaths can be directly related to bleeding. Prophylactic therapy for prevention of stress ulcer bleeding is based on three premises: (1) morbidity and mortality related to stress ulcer syndrome are significant; (2) the population at risk can be identified prior to bleeding; and (3) therapy that decreases gastric acidity or improves gastric mucosal defense mechanisms will prevent ulcer formation or progression to bleeding. A review of prospective clinical studies utilizing prophylactic therapy in critically ill patients and patients undergoing surgery revealed a 17 percent overall bleeding rate for placebo groups compared with lower bleeding rates for antacid- and histamine (H2)-receptor-antagonist-treated groups (4 and 7 percent, respectively). Studies varied greatly in definition of bleeding, dosage regimens, and gastric pH goals. The need to measure gastric pH during treatment is controversial, and the optimal pH goal and the length of time for which it must be maintained remain unknown. Controversy exists as to the best therapeutic option for prophylaxis of stress ulcer syndrome, but when prevention of clinically significant bleeding is the therapeutic goal, antacids and H2-receptor antagonists appear to be equally efficacious.

Acute Disease↗
PubMed1987

Prophylactic therapy for stress ulcer bleeding: a reappraisal.

The combined data from 16 prospective trials (2133 patients) appear to suggest that antacids prevent stress ulcer bleeding more effectively than does cimetidine. However, the use of occult blood detection methods to diagnose stress ulcer bleeding may have led to the recognition of clinically insignificant bleeding. When the data from these trials are categorized according to the criteria used for the diagnoses of bleeding (either occult blood detection or clinically overt bleeding), there was no significant difference between antacids and cimetidine in the prevention of overt bleeding (3.3% of 458 compared with 2.7% of 402 patients who bled, respectively; p = 0.69). In addition, both agents were more effective (p less than 0.001) than placebo (15% of 720 patients who bled) in the prevention of overt bleeding. Cimetidine and antacids are equal in preventing significant stress ulcer bleeding.

Antacids↗
PubMed1985

Scanning electron microscopic appearance of chronic ulcerative colitis with and without dysplasia.

This study was conducted to determine whether scanning electron microscopy of colonic mucosal biopsy specimens can help to detect dysplasia in patients with chronic ulcerative colitis. In the first phase of the study, using light microscopy as the standard for the diagnosis, the scanning electron microscopic appearance of specimens from patients with chronic ulcerative colitis and control patients was examined. Descriptive criteria were established to identify normal, atrophic, and dysplastic colonic mucosa. In the second phase, quantitative techniques were used to develop more objective criteria for the diagnosis of dysplasia in ulcerative colitis. Twenty-one coded colonic specimens from 11 patients were sequentially examined by scanning electron microscopy and by light microscopy. The three morphometric analyses performed on the surface epithelial cells were number of cells per unit area, number of microvilli per unit area, and percentage of microvilli with a normal width. The cell count and percentage of microvilli with a normal width were significantly reduced in the seven specimens with colonic dysplasia as compared with non-dysplastic tissues. Scanning electron microscopy may serve as an adjunct to light microscopy in the diagnosis of colonic dysplasia.

Atrophy↗
PubMed1985

Practical considerations for using the face-bow for complete denture prosthodontics.

Until an instrument that can adjust to all the anatomic hinge axis asymmetries becomes available, it is more appropriate to use a method other than the face-bow record for orienting the maxillary cast in an articulator for complete denture prosthetics. The objective of the alternate method should be to achieve a cast-articulator assembly that reflects the patient's vertical cranial posture.

Dental Articulators↗
PubMed1985

Upper gastrointestinal bleeding in patients with chronic renal failure.

Endoscopy to evaluate upper gastrointestinal bleeding was done for 482 patients over a 42-month period. Fifty-nine patients (12%) had chronic renal failure and upper gastrointestinal bleeding; the remaining 423 did not have renal failure. Angiodysplasia of the stomach or duodenum was the most frequent source of bleeding in patients with renal failure. Angiodysplasia (p less than 0.001) and erosive esophagitis (p less than 0.01) were significantly commoner causes of bleeding in the renal failure population than in the group without renal failure. Recurrent bleeding was also more frequent in patients with renal failure (25%) than in the other patients (11%). Angiodysplasia was the most frequent source of recurrent bleeding in patients with renal failure (53%) whereas peptic lesions were the most likely sources in those without renal failure (51%). These data show that the differential diagnoses of first and subsequent upper gastrointestinal bleeding sites differ for patients with and without chronic renal failure.

Adult↗
PubMed1985

Angiodysplasia as a cause of upper gastrointestinal bleeding.

Angiodysplasia of the stomach, the proximal part of the small intestine, or both was diagnosed in 30 patients by upper gastrointestinal (Gl) endoscopy over a 40-month period. This diagnosis represented 4% of 676 patients referred over the same time period for endoscopic examination of suspected upper Gl bleeding. Twenty-three patients (77%) had experienced at least one episode of overt bleeding (hematemesis or melena) prior to diagnosis. Multiple gastroduodenal angiodysplastic lesions were found in 19 (63%) of the patients, and additional colonic angiodysplasia was detected in six of 12 patients who also underwent colonoscopy. Renal insufficiency was significantly more prevalent in the patients with angiodysplasia than in a comparison group of similar age with upper Gl bleeding from other lesions (60% v 24%). We conclude that angiodysplasia, although uncommon, should be considered in the differential diagnosis of both occult and overt upper Gl bleeding. The lesion appears to be associated with renal insufficiency.

Adult↗
PubMed1984

Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit.

One hundred seventy-four patients (179 admissions) were prospectively evaluated for the subsequent occurrence of upper gastrointestinal ("stress") bleeding after admission to a medical/respiratory intensive care unit. Evidence for either overt or occult gastrointestinal bleeding developed in 25 (14 percent). The group of bleeders had a higher mortality (64 percent versus 9 percent), duration of intensive care unit stay (median 14.2 versus 4.2 days), number of patients requiring mechanical ventilatory support (84 percent versus 26 percent), and duration of such support for those who required it (median 9.5 versus 4.2 days) than the group who did not bleed. In three patients, death was related to bleeding. Upon patients' admission to the intensive care unit, diagnoses of an acute respiratory illness (but not specifically chronic obstructive pulmonary disease), a malignancy, or sepsis were more common among those who subsequently bled. Of factors tested, a coagulopathy and the need for mechanical ventilation were most strongly associated with the risk of bleeding. Other factors did not add to the risk once these two were taken into account. Among patients receiving mechanical ventilation, the risk of overt bleeding was particularly low for those who required such support for less than five days (only 3 percent). It is concluded that (1) significant upper gastrointestinal bleeding occurring after medical intensive care unit admission is an uncommon event, and (2) prolonged mechanical ventilation and/or the presence of a coagulopathy are the most potent risk factors. Medical patients with either of the latter conditions are most likely to benefit from prophylaxis regimens against "stress"-induced upper gastrointestinal bleeding.

Adult↗
PubMed1984

The hypertrophied anal papilla: recognition on air-contrast barium enema examinations.

Anal papillae are acquired structures that arise from the base of the rectal columns of Morgagni at the dentate line. They enlarge in response to congestion, irritation, injury, or infection. Although anal papillae are commonly seen endoscopically, they are rarely demonstrated radiographically. Three cases are reported of hypertrophied anal papillae that were demonstrated on air-contrast barium enema examinations. Radiographically an enlarged anal papilla appears as a smooth polyp located just inside the anal verge. Endoscopically it is differentiated from an adenomatous polyp by its white appearance and its origin from the lower (squamous) aspect of the dentate line in the anal canal. Hypertrophied anal papilla should be included in the differential diagnosis of a smooth mass located near the anal verge, especially in a patient with a history of chronic and irritation or infection.

Aged↗
PubMed1984

Esophageal dysplasia. Assessment by light microscopy and scanning electron microscopy.

This study was performed to determine the characteristics of esophageal dysplasia by scanning electron microscopy. A total of 82 esophageal biopsy specimens were taken from 30 patients who were divided into three groups. Group 1 patients had no known esophageal disease. Group 2 patients had squamous cell cancer. Group 3 patients had esophagitis. Mucosal biopsy specimens that had been diagnosed by light microscopy as normal, esophagitis, or dysplastic mucosa were examined by scanning electron microscopy. A characteristic appearance for each type of mucosa was recognized by scanning electron microscopy. A quantitative analysis of the scanning electron microscopy feature of microridge density showed a statistically significant difference not only between normal and dysplastic mucosa, but also between esophagitis and dysplastic mucosa. The addition of scanning electron microscopy to light microscopy may prove helpful in the diagnosis of dysplasia as well as in the understanding of the biologic behavior of dysplastic cells and possibly their relationship to esophageal carcinoma.

Adult↗
PubMed1981

Gastric bypass for morbid obesity: a medical--surgical assessment.

With the operative modifications and dietary guidelines described in this report, death and complications from gastric bypass were minimal, and weight loss was marked. Ninety per cent of a group of 69 patients lost more than half of their excess weight within the first two years after operation. Stringent preselection of patients for operation was crucial to the success of the operation, and marked alterations of eating behavior was necessary to achieve the weight loss. Mild electrolyte deficiencies and hypovitaminosis occurred in up to one-fourth of the patients. While none of these abnormalities was harmful to the patients, and all were easily corrected, their occurrence demonstrates the importance of long-term follow-up after the operation. We conclude that gastric bypass, with a 50-60 cc pouch and a small (1-1.2 cm) gastrojejunostomy, remains the operation of choice for morbid obesity.

Adolescent↗
PubMed1978

Alcoholic liver disease presenting with marked elevation of serum alkaline phosphatase. A combined clinical and pathological study.

Twenty patients with longstanding alcoholism and biopsy-proven alcoholic liver disease presented with marked elevation of serum alkaline phosphatase (in excess of four times the upper limit of normal). None had a past or present history to suggest pancreatitis or biliary tract disease, nor had any of these patients recently taken medication which could be implicated in cholestatic jaundice. Thirteen (65%) of this group either had radiologic or post mortem confirmation of nonobstructed biliary systems. The histologic findings in this group of patients were compared with those of a group of patients with alcoholic liver disease and normal or only mild elevation of serum alkaline phosphatase. Significantly more hepatocellular necrosis (P less than 0.05), alcoholic hyaline (P less than 0.02), and cholestasis (P less than 0.002) were noted in the severely hyperphosphatasemic group. Minimal degrees of steatosis were found in both groups. These data indicate that intrahepatic cholestasis occurs in patients with alcoholic liver disease, and this may often be secondary to alcoholic hepatitis. Overemphasis has previously been given to alcoholic fatty liver as a cause of this syndrome.

Adult↗
PubMed1978

Oral cholecystography in chronic renal insufficiency.

Thirty-two patients with chronic renal insufficiency (CRI) had oral cholecystography. Eleven of 15 patients (73%) with moderately advanced renal impairment had diagnostically inadequate single-dose cholecystograms. In contrast, all 11 patients on chronic hemodialysis had diagnostically opacified gallbladders following a single dose of contrast. Six other patients had biliary disease, either calculi (5 patients) or neoplasia (1 patient). These data suggest that CRI diminishes the likelihood of diagnostic gallbladder opacification, even in the absence of gallbladder disease, and that if the metabolic consequences of CRI are controlled by dialysis, the chances of diagnostic opacification are significantly improved (P less than 0.005). As oral cholecystography may not only result in inadequate opacification, but also carry the potential of renal toxicity, abdominal ultrasound should prove a safer and possibly more effective alternative in such patients.

Biliary Tract Diseases↗