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Biomedical subjects

G S Weinstein

Publications and source records attributed to G S Weinstein.

At least 91 records · Page 5Linked to original sources
PubMed1985

The use of a periosteal strip for eyelid reconstruction.

Strips of periosteum from the zygoma were used to reconstruct very extensive lateral canthal and temporal eyelid defects in 11 patients. The strips were reflected nasally, sutured to residual tarsal stumps, and covered anteriorly with myocutaneous flaps. After a minimum follow up of one year, cosmesis was excellent in five patients, satisfactory in five, and poor in one. Minor complications related to this procedure included ectropion and low lateral contour (one patient each), blunting of the lateral canthal angle (three patients), eyelid notching and dehiscence (one patient each), and symblepharon formation (one patient). However, only one patient had a complication that was significant enough to require a second surgery. This technique allows for one-stage reconstruction, an open palpebral fissure, and the ability to reconstruct extensive loss of the temporal portion of two adjacent eyelids when sharing techniques are not possible.

Adenocarcinoma↗
PubMed1985

The Coronary Artery Surgery Study (CASS). A critical appraisal.

The applicability of the Coronary Artery Surgery Study (CASS) to clinical practice is seriously hampered by the following findings. (1) The CASS randomized study applies to only a small minority of patients with coronary artery disease. Attempts to extend the conclusions of CASS to the vast majority of patients with coronary artery disease are unjustified. (2) The high percentage of crossover of the medical group made it impossible for CASS to accomplish its primary goal of contrasting medical and surgical treatment. (3) Despite the fact that crossover of medically assigned patients created a bias against surgical treatment, the observed mortality in the surgical group was still 31% lower than that in the medical group. (4) The failure of CASS to find this difference to be statistically significant must take into account the fact that the statistical power of CASS was so low that a real difference was likely to be overlooked. (5) The conclusion that patients similar to those in the study may safely defer operation is unwarranted and violates the principles of prospective study design. In addition, CASS failed to address the possibility that deferring operation may compromise long-term survival.

Angina Pectoris↗
PubMed1985

Delayed socket granuloma formation following evisceration.

We report a rare granuloma of the socket that simulated a conjunctival squamous cell carcinoma in a patient treated with evisceration six and a half years earlier. An excisional biopsy revealed loose connective tissue with marked capillary proliferation and lymphocytic infiltration. The cut end of a silicone exoplant, used to treat a preceding traumatic retinal detachment, was found at the base of the lesion. Prior operative procedures should be reviewed in patients presenting with socket lesions to exclude the presence of an iatrogenic foreign body.

Adult↗
PubMed1984

Adjunctive operative coronary artery balloon-catheter dilatation: review of Lenox Hill experience.

Operative transluminal coronary angioplasty (OTCA) has been used as an adjunct to coronary artery bypass surgery in 65 patients over a 56-month period beginning in May 1978. Experience has led us to use OTCA primarily in the left anterior descending coronary artery. The angioplasty catheter has undergone a number of modifications. Late restudy (8 to 56 months; mean, 24.1) data in 17 patients demonstrated that 15 of 19 angioplasty segments (78.9%) were patent.

Angioplasty, Balloon↗
PubMed1984

Canalicular cystocele.

We report a rare case of acquired canalicular cystocele in a patient with obstructions at both the proximal and distal ends of the inferior canaliculus. Histopathologic examination revealed a dilated tubule lined with nonkeratinizing squamous epithelium that measured 19 mm long and 7 mm wide. No mucous secreting goblet cells were observed in any sections. The fibrotic, thickened wall was infiltrated with epithelioid, lymphoid, and occasional plasma cells.

Aged↗
PubMed1983

Acute and subacute orbital myositis.

Of 12 consecutive patients (nine women and three men ranging in age from 18 to 70 years) with orbital myositis, four had histories of ocular or systemic autoimmune disease. Five patients treated within two weeks of developing acute orbital pain and extraocular muscle dysfunction were classified as having acute myositis. They responded to corticosteroids within 72 hours although three had single recurrences during six- to 16-month follow-up periods. No patients were heterotropic or proptotic at the final examination. Seven patients with less severe or atypical symptoms who had delays of two or more months between onset and treatment were classified as having subacute myositis. All had recurrences with five having two or more. Three required supplemental radiation therapy during seven- to 20-month follow-up periods. At the final examinations, six patients had motility defects and one had proptosis, indicating that delays in treatment may lead to recurrences, extraocular muscle dysfunction, and proptosis.

Acute Disease↗
PubMed1983

Cryptosporidiosis in a patient with hemophilia, common variable hypogammaglobulinemia, and the acquired immunodeficiency syndrome.

A 36-year-old man had chronic, debilitating diarrhea due to cryptosporidiosis. This patient had longstanding common variable hypogammaglobulinemia and recurrent bacterial infections. Immunologic evaluation after discovery of Cryptosporidium showed lymphopenia with persistently reduced numbers of helper/inducer cells (OKT-4), variable numbers of suppressor/cytotoxic cells (OKT-8), OKT-4/OKT-8 ratio of 0.09, and increased levels of serum alpha-interferon, all of which describe the acquired immunodeficiency syndrome. Oocysts of Cryptosporidium were found in feces from the patient's cat, thus identifying a possible source of his infection. The patient had disseminated candidiasis, cytomegalovirus pneumonia, and cryptosporidiosis when he died.

Adult↗
PubMed1982

Congenital lacrimal sac mucoceles.

Seven infants had tense, blue-gray swellings inferior to the medial canthal tendon with otherwise normal-appearing eyelids and puncta. All lacrimal sacs transilluminated and A-scan ultrasonography performed in one case demonstrated a nonloculated cystic cavity. Four (57%) infants had uncomplicated mucoceles. One was treated with massage, and has remained asymptomatic for 14 months. The other three were cured with a single probing and irrigation of the entire lacrimal system. Three (43%) infants had developed erythema of the tissues overlying the swollen lacrimal sacs by the time of referral. Because none of the mucoceles could be decompressed by massage, prompt probing and irrigations were performed in each case. Cultures from the aspirates of all three sacs yielded Staphylococcus organisms. In contrast to the uncomplicated cases, two patients developed recurrences that necessitated additional treatment.

Erythema↗
PubMed1982

Modification of the Müller's muscle-conjunctival resection operation for blepharoptosis.

We used a modified Müller's muscle-conjunctival resection operation to correct cases of minimal blepharoptosis with good levator function. After we everted the eyelid, we placed a marking suture through the conjunctiva and Müller's muscle 4 mm above the superior tarsal border. The suture was used to tent up Müller's muscle and the conjunctiva from the underlying levator aponeurosis, facilitating placement of a resection clamp. These improvements ensure excision of the proper amount of tissue and reduce intraoperative trauma. Eighteen (95%) of 19 eyelids treated with this modification were cosmetically acceptable.

Adolescent↗
PubMed1982

Preliminary experience with aspirin for anticoagulation in children with prosthetic cardiac valves.

Twenty-four children (ages 1 to 18 years, mean 12.2 years) underwent 27 operations for aortic, mitral, or combined aortic and mitral valve replacement. There was 1 operative death. Of the 23 operative survivors (12 aortic, 8 mitral, 3 combined valve replacement), only 5 were given warfarin for long-term anticoagulation. The remaining 18 (10 aortic, 8 mitral valve replacement) were given aspirin (plus dipyridamole in 5). Twelve of the 18 had at least one mechanical valve (11 Björk-Shiley and Beall valves; 1 Björk-Shiley valve was replaced with a Beall disc valve as the child grew). These 18 patients were followed for 1 to 59 months (mean, 20.4 months). There was no thrombotic, embolic, or bleeding complications. There were 2 late deaths (one cardiac). Review of the available literature indicates that in children with prosthetic cardiac valves, aspirin (with or without dipyridamole) provides adequate protection against thromboemboli and avoids the hemorrhagic complications associated with warfarin.

Adolescent↗
PubMed1982

Use of operative transluminal coronary angioplasty as an adjunct to coronary artery bypass.

Operative transluminal coronary angioplasty (OCTA) was used to improve coronary artery bypass graft (CABG) runoff in patients having complex segmental and diffuse coronary artery obstructions. OTCA was performed during CABG through the bypass arteriotomy on 64 arteries in 58 patients. An angioplasty system specifically designed for operative use was employed. In 13 cases, angioplasty was performed both proximal and distal to the coronary arteriotomy, for a total of 77 angioplasty sites. Elective restudy was performed on 36 angioplasty sites in 28 arteries in 24 patients: Sixteen patients were restudied between 18 and 21 days (mean 16) and eight between 4 and 32 months (mean 20.5). Patency rate, as assessed at each angioplasty site, was 86.1% (20/24 studied early and 11/12 studied late). Three coronary perforations (4.7%) occurred and were repaired without perioperative infarction or other sequelae. The one operative death (1.7%) occurred in a patient with preoperative refractory cardiogenic shock. There were seven perioperative infarctions (12.1%), of which three (4.7%) were in the distribution of the coronary artery undergoing OTCA. The favorable short-term and medium-term patency rates indicate that OTCA is a useful adjunct to CABG that permits more complete revascularization of small or diffusely diseased coronary arteries.

Adult↗