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Biomedical subjects

H E Sarles

Publications and source records attributed to H E Sarles.

At least 19 recordsLinked to original sources
PubMed1986

The long and short of flexible sigmoidoscopy: does it matter?

Physicians performing fiberoptic sigmoidoscopy may choose between a 35 and 60 cm instrument. Confusion and dispute exist concerning the advantages of one over the other. In an effort to resolve this question, 100 consecutive symptomatic patients were examined in an outpatient sigmoidoscopy clinic. Both the Olympus OSF-30 and Olympus OSF-60 flexible sigmoidoscopes were used on each patient alternately. Mean examination time, patient tolerance, diagnostic findings, instrument cost, physician training time, and insertion length were recorded and compared. The longer scope detected five more polyps and 25 additional cases of diverticulosis which were located beyond the reach of the shorter scope. The increased number of findings with the longer scope was expected; however, the increased number of polyps was not statistically significant. The additional number of findings with the longer scope was expected and with increased number of examinations the increased number of polyps may prove to be statistically significant. Neither instrument can substitute for colonoscopy in the overall management of colorectal neoplasms. We conclude that with adequate training and cost control, either instrument can be used for screening proctosigmoidoscopy; but the trend suggests a greater number of polyps are detected with the longer instrument.

Clinical Competence↗
PubMed1985

Course and complications of endoscopic variceal sclerotherapy: a prospective study of 50 patients.

Fifty consecutive patients with bleeding esophageal varices were treated with endoscopic variceal sclerotherapy (EVS) using the free hand method and a flexible fiberoptic endoscope. During the study period, November 1981 through April 1984, 11 patients (22%) rebled after the initiations of EVS and six patients were lost to follow-up. Obliteration of esophageal varices was achieved in 14 patients and none of these patients rebled for a mean follow-up time of 305 days. Survival curves generated by Willcoxson life table analysis demonstrated 51% 1-year survival for all patients, 21% for Child's class C patients, and 100% for Child's A and B patients. The complications associated with EVS were ulcerations 78%, strictures 20%, fever 44%, and perforations 2%. This study indicates that EVS is a safe and effective treatment for acute variceal hemorrhage and obliteration of esophageal varices can be achieved. Once varices are obliterated rebleeding may not occur. Survival in Child's A and B patients may be improved with EVS but the survival in Child's C patients is unaffected.

Acute Disease↗
PubMed1979

Results of parathyroidectomy for autonomous hyperparathyroidism.

Autonomous hyperparathyroidism occurred in 15% of 152 patients maintained by long-term home dialysis during the past nine years. Twenty-two patients with elevated serum parathormone levels and progressive bone disease in the presence of normal serum phosphate and calcium levels were treated by subtotal parathyroidectomy. All had parathyroid hyperplasia. Eighteen of the 22 patients are presently alive and undergo dialysis. Symptoms of bone pain, pruritus, and muscle cramps had improved in three fourths of the patients. The serum parathormone level decreased from a preoperative average of 576 muLEq/mL to an average of 188 muLEq/mL postoperatively. All 18 patients, observed for six to 77 months, showed improvement in x-ray films of their bone disease. The autonomous hyperparathyroidism of end-stage renal disease is corrected by subtotal parathyroidectomy, and the effect is sustained.

Adult↗
PubMed1978

Effect of thymosin on T-lymphocyte functions in patients with acute thermal burns.

Patients with severe thermal burns demonstrate a decreased cellular immunity. The purpose of this study was to ascertain whether thymosin enhances in vitro T-lymphocyte functions in such patients. Peripheral blood lymphocytes were obtained serially from 22 burned patients and 35 health adults. In vitro lymphocyte functions were evaluated by E-rosette formation, lymphocyte culture responses to PHA, Con A, PWM, PPD, SK-SD, mumps antigen, and tetanus toxoid, and mixed lymphocyte culture reactions. These tests were performed with and without in vitro addition of thymosin. Most of the parameters examined were significantly decreased in patients during the first 2 weeks postburn. The in vitro addition of thymosin significantly restored impaired lymphocyte responses, except in mixed lymphocyte culture reactions. These results demonstrate that thymosin enhances certain in vitro T-lymphocyte functions in burned patients. They further suggest that the administration of thymosin may restore decreased cell-mediated immunity in severely burned patients.

Adult↗
PubMed1977

The risk of anticoagulation in hemodialysis patients.

The risks of intermittent anticoagulation with heparin for hemodialysis and longterm anticoagulation with warfarin to prevent clotting of arteriovenous shunts were assessed in a group of 125 home dialysis patients. Over a 7-year period, there were nine bleeding complications attributable to heparin anticoagulation for an incidence of one complication for every 40 patient year on dialysis. In contrast, 20 of 48 patients anticoagulated with warfarin for an average of 2 years each, had a total of 50 hemorrhagic complications requiring 542 days in the hospital and 15 operative procedures. Concersion to an alternative form of vascular access, the internal arteriovenous fistula, obviated the need for warfarin therapy and its unacceptably high complication rate in this population of patients.

Blood Coagulation↗
PubMed1976

The nephrotic syndrome associated with neoplasia: an unusual paraneoplastic syndrome. Report of a case and review of the literature.

The nephrotic syndrome complicating malignancy in the absence of renal vein thrombosis, amyloid or neoplastic infiltration of the kidney is an unusual occurrence. A case of diffuse, well differentiated, lymphocytic lymphoma and lipoid nephrosis documented by light microscopy, electron microscopy and immunofluorescent studies is reported. A review of the literature revealed 76 case reports in which the nephrotic syndrome was associated with neoplasia. The most frequently associated neoplasms are Hodgkin's disease, various carcinomas, nonHodgkin's lymphoma and leukemia in descending order. The most frequent renal lesion in patients with the nephrotic syndrome associated with various carcinomas is membranous glomerulonephritis (81 per cent) as opposed to patients with lymphomas or leukemias who have predominantly lipoid nephrosis (60 per cent). The evidence is reviewed suggesting that the lesions in membranous nephropathy are immunologically mediated by tumor or viral antigen-antibody complexes and in lipoid nephrosis perhaps by a defect in t-lymphocyte function.

Aged↗
PubMed1976

Hyperparathyroidism in the maintenance dialysis patient.

At least one component of the secondary hyperparathyroidism of end stage renal failure is hyperphosphatemia. Since 1968, 101 patients were treated definitively in a home dialysis program, and 78 of the patients remain active. Despite maintenance of the serum phosphate level below 5 milligrams per cent, one-fourth eventually had progressive hyperparathyroidism develop, primarily manifested by bone disease. Serum calcium levels were generally normal and, except at the extremes, were not predictive. The incidence of hyperparathyroidism was not influenced by the age of the patient, but it increased with duration of dialysis. Hyperparathyroidism developed in 13 of 15 patients with serum parathormone levels greater than 500 but in only six of 56 patients with values less than 500. The single most important manifestation was progressive bone disease. Of 16 patients treated by subtotal parathyroidectomy, all had large hyperplastic parathyroid glands. All of the patients who were observed for longer than six months had progressive improvement in the bone disease. Hyperparathyroidism is a significant problem in the dialysis patient, despite phosphate control. Progressive bone disease and elevated serum parathormone levels are the most important indicators. The incidence is directly influenced by duration of dialysis. Subtotal parathyroidectomy is effective in reversing the bone changes.

Adult↗
PubMed1976

Progressive multifocal leukoencephalopathy in renal transplant recipients.

Progressive multifocal leukoencephalopathy, a slowly progressive papovavirus infection of the CNS, has been reported in more than 110 patients to date, over half of whom have had either leukemia or lymphoma. Our patient is the fourth case of PML occurring after long-term immunosuppression for renal transplantation. We believe that PML is emerging as a potentially serious problem in renal transplant recipients.

Adult↗
PubMed1975

B-lymphocytosis factor in human plasma.

Patients with acute thermal burns experience an increase of serum immunoglobulins associated with marked B-lymphocytosis during the recovery phase from the burn injury. This study was performed to delineate humoral factors which may induce the B-lymphocytosis in such patients. Plasma samples were obtained serially from 14 adult patients and 14 adult controls. One-half ml of plasma was injected intraperitoneally into C3H/He male mice, and absolute numbers of surface immunoglobulin-bearing cells in the mouse peripheral blood were counted. Fractionation of plasma samples was performed. The biologically active plasma fraction, tentatively termed B-lymphocytosis factor (BLF), was cultured with normal human peripheral blood lymphocytes to determine in vitro lymphocyte transformation. The solubility of 125I-labelled BLF in various organic solvents was examined. Plasma obtained from burned patients induced a marked increase of IgG, IgA, and IgM-bearing cells in the peripheral blood of mice within 3 hours after injection. The B-lymphocytosis activity of normal plasma was not significant. The molecular weight of BLF was estimated to be close to that of ribonuclease A (M.W. 13,400). Transformation of normal human peripheral blood lymphocytes was observed when cultured with BLF. 125I-labelled BLF was not soluble in organic solvents. These data suggest that BLF is not a lipopolysaccharide, and plays a role in regulation of B-lymphocyte levels in burned patients.

Adolescent↗
PubMed1975

Femoral neuropathy and ischemic colitis associated with amyloidosis in hemodialysis patients.

Renal failure is often the presenting problem with amyloidosis and it portends a generally poor prognosis. Two of 121 patients in a home dialysis program were found to have amyloidosis after they developed unusual complications, ischemic colitis and femoral neuropathy. Both ultimately died as a result of their disease. From the limited experience that is reported, it appears that renal transplantation offers a better alternative for long term therapy than hemodialysis.

Adult↗
PubMed1975

Lymphocele: a significant complication following renal transplantation.

Six pelvic lymphoceles occurred in a series of 88 renal transplants. All of the patients had ipsilateral leg edema and one-half had a urinary tract infection and/or pain. Displacement of the urinary bladder away from the kidney with or without some degree of ureteral obstruction was diagnostic. External or internal drainage resulted in reliev of the symptoms.

Adolescent↗
PubMed1975

Bovine graft fistulas in patients with vascular access problems receiving hemodialysis.

Thirty-three bovine grafts were placed in 28 patients for vascular access for hemodialysis. The indications were lack of shunt sites and anticoagulation with Coumadin in patients without vessels suitable for construction of a primary arteriovenous fistula. All but one of the grafts were loops placed in the forearm. There were 20 complications associated with the 33 procedures. Three patients required replacement of the initial graft in the early postoperative period due to thrombosis. One additional patient required two graft replacements and eventual anticoagulation with Coumadin before a successful result was obtained. There have been no serious ischemic problems. Presently, there are 27 functional bovine grafts, and 68 per cent of these are currently used for vascular access for dialysis. Patient acceptance of the fistulas has been good. The loop bovine graft fistula in the arm is an excellent means for vascular access in the patient receiving hemodialysis.

Animals↗
PubMed1975

Ouabain-sensitive adenosine triphosphatase from human kidneys.

Adenosine triphosphatase (ATPase) was studied in tissue homogenates and subcellular fractions derived from human cadaver kidneys maintained in an organ preservation unit for transplantation. The activity of ouabain-sensitive ATPase was highest in the medulla, intermediate in the cortex and lowest in the papilla, The cortical enzyme activity diminished with time during maintenance perfusion of the kidneys. Similar concentrations of K+, Na+, Mg++, ATP and MgATP were required for half-maximal rates of ouabain-sensitive ATPase activity from the cortex or the medulla. The sensitivity of the enzyme to ouabain from both parts of the kidney was similar. K+ antagonized inhibition of the enzyme by ouabain. Chlormerodrin, mersalyl, mercaptomerin and ethacrynic acid were inhibitors of the enzyme.

Adenosine Triphosphatases↗
PubMed1975

Oubain-sensitive adenosine triphosphatase from human kidneys.

Adenosine triphosphatase (ATPase) was studied in tissue homogenates and subcellular fractions derived from human cadaver kidneys maintained in an organ preservation unit for transplantation. The activity of ouabain-sensitive ATPase was highest in the medulla, intermediate in the cortex and lowest in the papilla. The cortical enzyme activity diminished with time during maintenance perfusion of the kidneys. Similar concentrations of K+, Na+, Mg++, ATP and MgATP were required for half-maximal rates of ouabain-sensitive ATPase activity from the cortex or the medulla. The sensitivity of the enzyme to ouabain from both parts of the kidney was similar. K+ antagonized inhibition of the enzyme by ouabain. Chlormerodrin, mersalyl, mercaptomerin and ethacrynic acid were inhibitors of the enzyme.

Adenosine Triphosphatases↗