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Biomedical subjects

J C Gruenberg

Publications and source records attributed to J C Gruenberg.

10 recordsLinked to original sources
PubMed1992

A quantitative, qualitative, and critical assessment of surgical waste. Surgeons venture through the trash can.

OBJECTIVES: To quantitatively and qualitatively evaluate the surgical waste produced from several common surgical procedures, define categories of waste that might be readily separated for alternative disposal practices or substitution, and determine the change in surgical waste output that elimination or alternative handling methods may effect. DESIGN: A case series evaluating the surgical waste from five types of surgical procedures including operations of the back, heart, abdomen, hip and knee, and herniorrhaphies, prospectively identified and allocated at the availability of the investigator. SETTING: A single tertiary community teaching hospital. OUTCOME MEASURES: Weight, volume, and percentage of disposable linen, paper, and plastic plus miscellaneous material from surgical waste with a later subset separating plastics from miscellaneous items to completely identify all categories. RESULTS: Surgical waste weighing 610.5 lb (274.7 kg) and occupying 171.6 cu ft (5.1 m3) from 27 cases was examined. Disposable linens accounted for 39% of the weight; paper, 7%; plastic, 26%; and miscellaneous waste, 27%. By volume, disposable linen and paper accounted for 69%; plastic, 23%; and miscellaneous waste, 7%. Disposable linen, paper, and recyclable plastic accounted for 73% +/- 7% (mean +/- SD) by weight and 93% +/- 4% by volume of total surgical waste. CONCLUSION: Nationally, annual surgical waste from these five procedures weighs 5.1 x 10(7) lb (2.3 x 10(7) kg) and occupies 1.4 x 10(7) cu ft (4.0 x 10(5) m3). By using reusable linen products and engaging in recycling methods currently available and feasible, we estimate that weight reductions of 73% and volume reductions of 93% in surgical waste are possible.

Disposable Equipment↗
PubMed1989

Prospective evaluation of C-reactive protein in patients suspected to have acute appendicitis.

C-reactive protein (CRP) was measured in 70 consecutive patients hospitalized with the diagnosis of acute appendicitis. Of these, 28 patients (Group 1) had acute appendicitis, 25 patients (Group 2) had no identifiable focus of infection and improved with general supportive care, and 17 patients (Group 3) had an identifiable cause for their illness, though not appendicitis. CRP level was not helpful in distinguishing among patients in any group when symptoms were present for 12 hours or less. When symptoms were present for more than 12 hours, all patients in Groups 1 and 3 and half of the patients in Group 2 had a significant increase in CRP value. Thus, a normal CRP value in a patient presenting with a duration of symptoms of more than 12 hours occurred only in Group 2; this difference was statistically significant (P less than 0.001). When symptoms are present for more than 12 hours, an increased CRP value supports the diagnosis of acute appendicitis and will identify patients who have signs and symptoms similar to acute appendicitis but who have another identifiable illness. When the CRP value is normal in a patient who has had symptoms for more than 12 hours, this patient does not have acute, appendicitis and can be followed in an outpatient setting.

Acute Disease↗
PubMed1986

Splenectomy in systemic lupus erythematosis.

Of 860 patients with systemic lupus erythematosus (SLE) who were evaluated during a 25-year-period, 16 (1.9%) underwent splenectomy. Twelve of these patients had steroid resistant thrombocytopenia. An excellent long-term outcome occurred in eight (67%), significant improvement occurred in three (25%), and one patient died who also had chronic active hepatitis and portal hypertension. In two of three patients (67%) with autoimmune hemolytic anemia, the condition was corrected by splenectomy; in the third patient there was some improvement, but reduced doses of corticosteroids were required. One patient with severe neutropenia and recurrent bacterial infection obtained lasting benefit following splenectomy. Histologic examination of the removed spleen was not helpful in corroborating the diagnosis of SLE in these well established cases. Splenectomy had no adverse affect upon other aspects of SLE, in particular upon renal function. The authors conclude that the indications for splenectomy have proven to be of value in selected SLE patients with autoimmune or hypersplenic cytopenia.

Adolescent↗
PubMed1976

Percutaneous adrenal suppression with topically applied corticosteroids.

Synthetic fluorinated derivatives of cortisone, when topically applied, are absorbed readily and may suppress adrenal function. In the case presented here, large quantities of topically applied triamcinolone acetonide were used in the treatment of atopic dermatitis. This caused a noticeable decrease in the plasma cortisol level. That this was the result of adrenal suppression rather than insufficiency was indicated by a satisfactory response of the plasma cortisol levels to a cosyntropin injection test. In patients with a history of recent and extensive use of topically applied corticosteroids, appropriate diagnostic and therapeutic measures are indicated to avoid postoperative adrenal insufficiency.

Adrenal Cortex Hormones↗
PubMed1975

Inherited antithrombin-III deficiency causing mesenteric venous infarction: a new clinical entity.

Primary superior mesenteric venous thrombosis is sometimes preceded by peripheral thrombophlebitis. Inherited antithrombin-III deficiency is a recently recognized autosomal dominant trait, which is characterized by thrombophlebitis and pulmonary embolism. This case report illustrates many features of both entities and strongly suggest a causal relationship. While long-term therapy has yet to be established, prophylactic therapy is recommended when asymptomatic individuals with known antithrombin-III deficiency are at increased risk of thrombosis. The efficacy of heparin alone has been unreliable, whereas Coumadin has been encouraging. Antithrombin-III concentrates are being developed and theoretically should be helpful. Patients with thrombophlebitis or pulmonary embolism should be suspected of having antithrombin-III deficiency. Such individuals also represent one mechanism to explain "primary" mesenteric venous thrombosis.

Adult↗
PubMedDate not supplied

Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical considerations for improved outcome.

Experience with several incarcerations that resulted in emergent surgery for children with known indirect inguinal hernias prompted this review to determine if there is an optimal time after hernia diagnosis during which elective repair should be undertaken to avoid incarceration. Over a 30 month period, 228 children less than 10 years of age underwent 303 indirect inguinal hernia repairs. They were analyzed for age, sex, interval between diagnosis and repair, predisposing conditions, major complications, and length of hospitalization. Excluded were 21 children who presented with incarceration of a previously undiagnosed indirect inguinal hernia that required operative reduction, 13 children with conditions predisposing to indirect inguinal hernia, and 53 children for whom the interval between diagnosis and repair was unknown, leaving a study group of 141 children who underwent 190 indirect inguinal hernia repairs. Nearly 13% (18 of 141) of the children developed incarcerated hernia prior to elective repair. Compared to children who underwent repair of a reducible indirect inguinal hernia, those with incarceration were more likely (p less than 0.05): 1) to have major complications (11% vs 0.6%), 2) to have a shorter interval between diagnosis and repair (26 vs 49 days), 3) to be younger (7.5 vs 25.6 mos), and 4) to require greater than 24 hours of hospitalization. Had children with reducible incarcerated indirect inguinal hernia been hospitalized and undergone repair 24 to 48 hours later, 83% of subsequent incarcerations would have been prevented. Furthermore, this experience supports the recommendation that for healthy children less than 10 years of age, indirect inguinal hernia repair should be performed on a semi-elective basis within 7 days of diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMedDate not supplied

Pneumatosis intestinalis: a clinical classification.

Review of our experience with pneumatosis intestinalis has allowed identification of three major clinical groups of patients. In each of these groups, the etiology of pneumatosis intestinalis usually can be identified, and it frequently has an ominous prognosis. Treatment should be directed to the underlying condition when possible, and hence must be individualized. Those patients who would be categorized as Group I can simply be kept under observation. Patients in Group II might obtain relief from breathing increased concentrations of oxygen. For patients in Group III vigorous therapeutic measures generally are necessary to ensure survival. The increasing use of mechanically controlled ventilation and positive end-expiratory pressure may be contributing to the incidence of pneumatosis intestinalis. The ileus sometimes observed in these patients may accompany or precede the development of intramural air, a condition identifiable on roentgenographic examination. Awareness of the possible presence of intramural air may help in identifying patients who may not need operation. But even when roentgenographic examination has confirmed the presence of intramural air, abdominal exploration still may be necessary to rule out a diagnosis of perforated viscus. We hope that these concepts and our emphasis upon individualization of treatment may improve the prognosis for patients who have pneumatosis intestinalis.

Adolescent↗