PubMed Health⌕ Search

Biomedical subjects

I Cohn

Publications and source records attributed to I Cohn.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1978

Presidential address: Gastrointestinal cancer. Surgical survey of abdominal tragedy.

The experience with gastrointestinal cancer at a single large hospital has been utilized as a "micro-model" of the experience for the country at large, and the reasons why such a comparison might be possible have been presented. The incidence of various lesions has been discussed in terms of sex, age, and race. The changing incidence of various lesions has been pointed out. Survival results have been determined for total series, for various types of operative procedures, and for various extents of disease. The comparability of survival results from this one institution and those collected from the literature have been discussed. The emergence of newer diagnostic and therapeutic measures has been highlighted. The importance of education of both patients and physicians is emphasized repeatedly by the late stage at which so many of the patients with any gastrointestinal cancer present to and are diagnosed by the physician. The educational task for all of medicine is apparent and must be faced in some effective fashion.

Adenocarcinoma↗
PubMed1978

Evaluation of wound irrigation by pulsatile jet and conventional methods.

Irrigation of wounds to remove bacteria and foreign material is an essential of wound management along with debridement. The effectiveness of saline lavage by high pressure (50 psi) pulsatile jet irrigation has been compared with conventional gravity flow and bulb syringe procedures. Experimental paravertebral incisional surface wounds in 234 randomized rats were either clean or traumatized and soiled. Wounds in 200 of the rats were seeded with E. coli (log 8.80). Swab specimens of each wound were taken at incision, after seeding, after irrigation, and at three, seven, and ten days after closure. Eulates of more than 1600 specimens were cultured. No anaerobes were found. Irrigation diminished bacterial counts in all wounds, but only pulsatile jet irrigation brought about significant (P less than 0.05) reduction of bacteria in each type of wound. After three days E. coli was significantly diminished in all wounds, regardless of irrigation or none, owing to host defense mechanisms. Nevertheless, clean contaminated wounds were infected at three days but not at seven days after lavage, while traumatized wounds remained infected at ten days except for those initially irrigated by pulsatile jet. Thus, pulsatile jet irrigation removed bacterial from experimental wounds more efficiently than conventional procedures.

Animals↗
PubMed1978

Intraperitoneal povidone-iodine in experimental peritonitis.

Two experimental models were utilized to study the efficacy of intraperitoneal povidone-iodine in an established peritonitis. In both models, there was a 100% mortality in the povidone-iodine treated group. In laboratories which have reported favorable results, the animals were treated before peritonitis was allowed to develop. Clinical studies with povidone-iodine lavage have used dilute solutions which did not remain in the infected space. The effectiveness of this method was probably due to mechanical continuous irrigation. Our toxicity studies showed povidone-iodine to be fatal in normal animals in dosages exceeding 4.0 ml/kg. However, a dose of 2.0 ml/kg, which was nontoxic in normal animals, was fatal in animals with peritonitis. This study strongly suggests that the intraperitoneal administration of povidone-iodine can be fatal when the animal is compromised by peritonitis. The mechanism of this effect is unclear. On the basis of these studies, the intraperitoneal administration of povidone-iodine cannot be recommended for therapy of peritonitis.

Animals↗
PubMed1978

Simulation experiments of tumor measurement in clinical trials.

A simple model of tumor growth involving stochastic growth factors as well as measurement errors in explored in the context of a simulated "clinical trial" comparing two treatments. The model shows how treatment effects on tumor growth translate themselves into "improvement rates" derived from measurement on diameters. Furthermore, it shows that treatment contrasts of considerable magnitude (such as doubling of mass or volume versus shrinkage to one half) may escape recognition in clinical trials. A number of "power" tables are presented that provide the probability of making correct judgments of treatment effects. The tables indicate that the actual power in trials of this nature is in satisfactory agreement with that claimed in the standard power tables which are currently used in guiding trial strategy based on improvement rates.

Clinical Trials as Topic↗
PubMed1978

Microbial flora of the diseased stomach at resection.

The relation of microbial flora in stomach contents and stomach wall was examined in paired specimens from 10 surgical patients and in specimens of wall from 10 additional patients. The flora of both contents and wall were similar. Paired specimens from five patients contained the same kinds of bacteria. Paired specimens from these patients were sterile. Contents from two patients contained bacteria, but the wall was sterile. Microorganisms isolated were streptococci, lactobacilli, bifidobacteria, bacteroides, staphylococci yeast, and coliforms. Bacterial counts ranged from 0 to 10(7.5) per ml or g in both contents and tissue. Survey of the literature shows that most specimens from patients with gastric ulcers or gastric malignancies are positive for bacteria, while only about 60% of specimens from patients with duodenal ulcers are positive.

Bacteria↗
PubMed1977

The National Pancreatic Cancer Project: an update.

Cancer of the pancreas is now the fourth most common cause of cancer-related death in the United States. The diagnosis of this disease is difficult and the therapeutic results are discouraging. Recognizing these factors, the National Cancer Institute has funded the National Pancreatic Cancer Project as of 1 January 1975, in an attempt to stimulate new and more active research in this field at both the basic and the clinical levels. Some of the work that has already been funded by the project is outlined as a means of familiarizing a larger number of people with the activities of this particular National Organ Site Program.

Animals↗
PubMed1977

Review of abdominoperineal resections for cancer.

One hundred eighty-six consecutive abdominoperineal resections for primary carcinoma of the anus, rectum, or sigmoid colon performed at Charity Hospital of Louisiana at New Orleans between January 1, 1963 and December 31, 1974 were reviewed. The operative mortality was 16 per cent. Complications during the same hospitalization occurred in 70 percent of the patients. Although most of the complications were minor, 22 percent did require some form of surgical intervention. Twenty-nine percent of the patients who were discharged developed late mechanical or cancer-caused complications which required surgical correction. A history of congestive heart failure or a significant weight loss were the most consistent preoperative findings in the operative mortality group. The overall five year survival rate was 25 percent. White females with no history of weight loss had the best long-term prognosis. Better survival in white patients can be accounted for by the less advanced lesions in these patients. No such difference between male and female patients could be demonstrated. Better selection of surgical candidates with alternate forms of therapy for poor risk patients have probably been the most significant factors in decreasing the operative mortality from 21 percent in the first six years of the study to 9 percent in the last six years. Primary closure of the perineal wound would appear to be of value in decreasing operative morbidity.

Abdomen↗
PubMed1976

Cancer of the pancreas: detection and diagnosis.

Since cancer of the pancreas is now the fourth most common cause of death from cancer in the United States, and since the signs and symptoms of this disease are such poor indicators of its presence, other more effective diagnostic methods must be utilized in an attempt to lower the mortality of pancreatic cancer. The newer studies which appear to hold some promise include endoscopy alone and in combination with pancreatography, selective and superselective angiography with or without pharmacologic assistance, and various forms of scanning. Resolution of some of the problems associated with the technique of biopsy and immunologic studies may make these studies of greater value. A clearer distinction between cancer arising in the pancreas itself from those lesions arising in the ampullary area will be of great value in clarifying both thinking and therapeutic approaches to the problem. Activation of the National Pancreatic Cancer Project and some other ongoing multi-institutional cooperative studies should do much to stimulate further advances in our knowledge about pancreatic cancer.

Angiography↗
PubMed1976

Diagnosis and management of blunt abdominal trauma.

The records of 437 patients with blunt abdominal trauma admitted to Charity Hospital, New Orleans, from 1967-1973 have been reviewed and computer-analyzed. There was an 80% increase in the incidence of blunt abdominal trauma when compared with the preceding 15-year experience. Forty-three per cent of all the patients presented with no specific complaint or sign of injury. Blunt abdominal injury was usually diagnosed preoperatively using conventional methods including history, physical examination, and routine laboratory tests and x-rays. Abdominal paracentesis via a Potter needle had an 86% accuracy. The incidence and management of specific organ injuries with associated morbidity and mortality have been discussed. Mortality and morbidity continue to be significant in blunt abdominal trauma. Isolated abdominal injuries rarely (5%) resulted in death, even though abdominal injuries accounted for 41% of all deaths. Associated injuries, especially head injury, greatly increased the risk. The insidious nature of blunt abdominal injury is borne out by the fact that more than one-third of the "asymptomatic" patients had an abdominal organ injured. A high index of suspicion and an adequate observation period therefore are mandatory for proper care of patients subjected to blunt trauma.

Abdominal Injuries↗
PubMed1976

Parotid neoplasms: a report of 250 cases and review of the literature.

A 25-year experience with parotid tumors was reviewed. From a total of 250 neoplasms, 173 were histologically benign and 77 were malignant. Benign mixed tumors accounted for 59% of all lesions. Clinical parameters used to diagnose parotid neoplasms were found to be unreliable in determining whether a given tumor was benign or malignant. The mean age for malignant lesions was 10 years greater than for benign lesions. The phenomenon of malignant transformation of a benign tumor was considered in four patients. Complete surgical excision is the safest and preferred method for diagnosis. Preoperative needle or incisional biopsy are associated with a high degree of local recurrence. The appropriate management of any parotid tumor is predicated on special histological type. Local excision or enucleation no longer have a place in the surgical management of benign parotid tumors. Postoperative tumor recurrence and morbidity are directly related to awareness of surgical anatomy and pursuit of correct surgical techniques for adequate resection. The five-year recurrence rate for 102 benign mixed tumors was 6%. Recurrence in malignant tumors varied with specific histological types but was generally high. Five-year survival for all malignant parotid tumors was 48%.

Adolescent↗
PubMed1976

Tetanus: 2,449 cases in 68 years at Charity Hospital.

The 68-year Charity Hospital experience with tetanus has been reviewed with particular emphasis on the past 8 years. There were 2,449 cases treated at Charity Hospital from 1906 through 1974. The mortality rate has remained high. There were 24 cases in the past 8 years, with a 58% case fatality rate. Clues to our high mortality rate could be: 1) many cases with a short period of onset, 2) none of our 24 cases received treatment at time of injury, and 3) there were more severe cases, as judged by the high rate of need for tracheostomy. The method of management emphasizes: 1) wound care, 2) neutralization of the toxin, 3) antibiotic therapy, 4) supportive measures including good nursing care with control of convulsions and seizures, and 5) completion of active immunization. Prophylaxis is stressed, with particular emphasis on wound debridement and toxoid. The decreasing incidence of the disease is encouraging, probably related directly to proper immunization. However, the mortality rate remains high and the solution to the problem of tetanus is still prophylaxis. Epidemiologic considerations were discussed with particular emphasis on tetanus in the five Gulf States, the South in general, and the decreasing incidence in endemic areas.

Adolescent↗