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Biomedical subjects

I Cohn

Publications and source records attributed to I Cohn.

At least 19 recordsLinked to original sources
PubMed1991

Germfree animals and technics in surgical research.

Germfree animals have been reared to a size, weight, and age permitting the performance of major surgical procedures and the pursuit of a variety of surgical research problems. Germfree dogs have been maintained in the isolator system through three generations, indicating that life, reproduction, and growth are all possible in the absence of microbial contamination. The value of the germfree approach to surgical problems has been utilized in studies of a variety of gastrointestinal problems, shock, cancer, immunology, burns, wound healing, and in direct patient application. Patients have been maintained in isolator environments for prevention of infection, for operative procedures, for treatment of extensive burns, and for management of immune-suppressed individuals. We conclude that germfree animals and germfree technics provide a valuable addition to the armamentarium of the surgeon in both research and clinical applications.

Animals↗
PubMed1991

Management of penetrating colon injuries. A prospective randomized trial.

Fifty-six patients with penetrating colon injuries were entered into a randomized prospective study. Management of the colon injury was not dependent on the number of associated injuries, amount of fecal contamination, shock, or blood requirements. Twenty-eight patients were treated with primary repair or resection and anastomosis and 28 patients were treated by diversion (24 colostomy, 3 ileostomy, 1 jejunostomy). The average Penetrating Abdominal Trauma Index score was 23.9 for the diversion group and 26 for the primary repair group. There were five (17.9%) septic-related complications in the diversion group. This included four intra-abdominal abscesses and one subcutaneous wound infection. There were six (21.4%) septic-related complications in the primary repair group. This included one wound infection, two positive blood cultures, and three intra-abdominal abscesses. There were no episodes of suture line failure in the primary repair/anastomosis group. The authors conclude that, independent of associated risk factors, primary repair or resection and anastomosis should be considered for treatment of all patients in the civilian population with penetrating colon wounds.

Adolescent↗
PubMed1989

Villous tumors of the duodenum.

Five cases of villous tumors of the duodenum are reported, all of which involve the ampulla of Vater. Three of the five lesions contained either infiltrating carcinoma or carcinoma in situ. Although preoperative endoscopic biopsy was performed on all tumors no malignancy was identified. Frozen sections done at the time of operation on the three patients with carcinoma also failed to identify malignancy. One patient underwent pancreaticoduodenectomy and four patients had local excision of the tumor. Three of the patients treated with local excision developed recurrence and two subsequently had pancreaticoduodenectomy. Because of the difficulty in making an accurate diagnosis and the chance of recurrence when local excision is employed, strong consideration should be given to pancreaticoduodenectomy as the initial form of treatment of these lesions.

Adenoma↗
PubMed1989

Pedigrees of southern surgical chairmen.

This review details the birth, medical education, surgical training, and previous academic appointments of the chairmen of departments of surgery in the medical schools in the geographic distribution of the Southern Medical Association.

Faculty, Medical↗
PubMed1988

Surgical management of the acutely obstructed colon. A review of 127 cases.

The surgical results in 127 cases of acute obstruction of the colon are presented. Carcinoma continues to account for the overwhelming number of cases, and there has been no appreciable change in the site of obstruction or age groups affected. In the current study, the overall mortality rate in patients with acute obstruction from all causes was 27 percent, which does not appear to be significantly different than it was 30 years ago. The overall mortality rate in patients with obstruction secondary to carcinoma was 23 percent. Under the specific circumstances of the cases reported herein, and on the basis of a limited experience, total colectomy and left colectomy as initial procedures in acute obstruction secondary to cancer had the same mortality rate as staged resection of the left colon. The only benefit found from either approach was an increase in the disease-free 5 year survival rate with staged resection. The overall survival rate was not enhanced by either approach.

Acute Disease↗
PubMed1988

Acute colonic diverticulitis.

Colonic diverticulosis is truly a disease of the 20th century. A direct correlation is thought to exist between the incidence of diverticular disease and the amount of dietary fiber. Acute colonic diverticulitis occurs in approximately 25 per cent of the patients with diverticula, and 20 per cent of the patients with diverticulitis will ultimately require surgical intervention. Because of the often virulent nature of the disease in younger patients and the prevalence in the geriatric population, an aggressive approach is advocated. Primary resection of the involved segment of colon is advocated in all cases requiring operation. A primary anastomosis can be constructed in stage I and some cases of stage II disease. This results in lower morbidity and mortality rates as well as fewer days of hospitalization and disability. Newer techniques such as diagnostic CT scanning, percutaneous drainage of diverticular abscess, and greater application of surgical stapling devices have done much to improve the ultimate outcome of colonic diverticulitis.

Abdomen, Acute↗
PubMed1987

Gastric carcinoma in the young.

Thirty-eight cases of gastric carcinoma in patients 35-years-old and younger, occurring in the period 1948 to 1983, are reviewed. They comprised 2.2% of 1710 cases in all ages for the same 35 year period at the Charity Hospital. Women were afflicted as commonly as men. Blacks outnumbered whites 2.9:1.0. Obstruction, pain, and weight loss of relatively short duration were prominent symptoms. Tumors tended to be located distally in the stomach, and scirrhous in appearance. Histologically, diffuse type lesions were more common than intestinal or other type tumors. Radiographic evidence of disease was usually present in patients undergoing upper gastrointestinal series. Endoscopy with biopsy was a valuable diagnostic tool. Resectability in this group was not less than that achieved for all ages, however, only one patient has survived for five years. Advanced stage lesions predominated and were associated with poor survival. Earlier stage lesions in this age group appear to bear a more favorable prognosis.

Adult↗
PubMed1986

Early gastric cancer. 21-year experience.

From 1963 through 1983, 327 patients underwent resection for gastric adenocarcinoma at Charity Hospital in New Orleans. Fifteen lesions (4.6%) were early gastric carcinoma (limited to the mucosa or submucosa regardless of nodal metastases). These lesions were in eight men and seven women (14 blacks and 1 white), with a mean age of 65.3 years (range: 52-80 years). Upper gastrointestinal series were obtained in 13 (6 suspicious, 2 inconclusive, and 5 normal). By comparison, endoscopy on 11 patients provided a tissue diagnosis in ten patients (90.9%). Surgical procedures ranged from total gastrectomy to a local excision, and every specimen was free of lymph node metastases. Macroscopically, there were six Type I, four Type IIb, and Type IIc, three Type III, and one with two separate lesions (IIa and IIb); microscopically, ten were intramucosal and five had submucosal invasion. Five-year survival calculated by the actuarial method was 64.2% (observed) and 100% (adjusted). This compares with 18.8% (observed) for all 327 patients. Six of the patients with early gastric cancer are alive (range: 16-219 months). The nine patients who died had no evidence of recurrent disease at the time of death. Surgical resection of early gastric carcinoma in the United States offers an excellent prognosis similar to the Japanese experience. Increased detection of gastric carcinoma in its curable stages may be achieved through early endoscopic investigation of symptomatic patients.

Adenocarcinoma↗
PubMed1983

Emergency autotransfusion: partial cleansing of bacteria-laden blood by cell washing.

Intraoperative autotransfusions for selected patients can ease demands on blood banks. In 33 cases (trauma, elective vascular, and cardiac procedures), we saved 80.7 L of blood with a cell washer blood recovery system (Cell Saver). In eight trauma cases, including three with intestinal perforation, cell washing salvaged 31.5 L of shed blood as a lifesaving emergency procedure. This stimulated interest in defining the limits of the instrumentation in cleansing blood of bacteria. In 18 in vitro experiments, discarded banked blood was inoculated with Escherichia coli to simulate light, moderate, or heavy bacterial contamination. Volumes of blood (500 ml) containing a total of 6.3 X 10(5), 4.8 X 10(7), or 3.2 X 10(10) bacteria were processed. The original blood, filtered blood, plasma supernate, effluent wash solution, and final washed packed red cells were cultured quantitatively in each experiment. The mean total number of E. coli retained in the final washed packed red cells was 1.4 X 10(5), 6.3 X 10(6), or 1.6 X 10(9) bacteria, or 23%, 13%, and 5% of each original inoculum. Additional washing with 10 L of saline did not remove significantly more bacteria (p greater than 0.20). Although emergency autotransfusion of blood contaminated with intestinal contents was lifesaving, we recommend caution since these results show that cell washing does not remove all bacteria. Further laboratory and clinical studies are needed to determine the levels of bacterial contamination of autotransfused blood that can be tolerated, and to determine adjunctive means of rendering contaminated or potentially contaminated blood safe for autotransfusion.

Blood↗
PubMed1979

Intraperitoneal povidone-iodine in experimental canine and murine peritonitis.

In dogs with appendicitis-peritonitis, intraperitoneal povidone-iodine caused death more rapidly than the instillation of saline solution. The bacterial content of canine peritoneal fluid increased with time. Although fewer bacteria were found in fluid from povidone-iodine-treated dogs, the differences were not statistically significant. Qualitative chemical analysis of peritoneal fluid revealed iodide, but not free iodine, 15 to 30 minutes after instillation of povidone-iodine. Iodine was present in the peritoneum at 2 hours but not at 3 or 6 hours. The antibacterial effect of povidone-iodine was demonstrated in mice challenged intraperitoneally with lethal doses of Escherichia coli. Povidone-iodine diminished mortality when injected immediately (p less than 0.005) but not when given 1 to 3 hours later. Immediate injection of povidone-iodine into mice lowered the number of E. coli by 3 logs. Injection of povidone-iodine 3 hours after bacterial challenge lowered the number of E. coli by only 1/3 log. This lesser bactericidal effect in mice is attributed to greater dispersal and sequestration of bacteria throughout the peritoneal cavity with time and with inactivation of povidone-iodine by reduction to iodide in vivo. In dogs with appendicitis-peritonitis, the more rapid death after treatment with povidone-iodine was not associated with differences in peritoneal microflora but with peritoneal absorption of excessive amounts of iodide.

Animals↗
PubMed1978

Adenocarcinoma of the stomach: review of 1,497 cases.

The records of 1,497 patients with histologically proven adenocarcinoma of the stomach were reviewed from Charity Hospital over the 25-year period, 1948 to 1973. The operability rate was 82% and the resectability rate was 48%. In this series gastric carcinoma predominated in males and Negroes. Necropsy studies indicate a similar frequency of involvement of various organs in patients not operated upon as well as those subjected to a prior operation, which suggests the need for some therapeutic endeavors aimed at a wider base than the primary organ. The five-year survival rate, 7.4 overall, varied from 2.0% after esophagogastrectomy to 22.1% after radical subtotal gastrectomy, and to 30.3% for those with localized disease. One hundred one patients survived five years or more, and 5.4% survived ten years or more after the diagnosis of gastric cancer. Radical subtotal gastrectomy gave the best results in this series, whether measured in terms of median survival, five-year survival, or operative mortality. Esophagogastrectomy and by-pass procedures had high mortality and low survival rates, and should be reserved for special conditions.

Adenocarcinoma↗