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Biomedical subjects

J E Barone

Publications and source records attributed to J E Barone.

At least 19 recordsLinked to original sources
PubMed1992

Severe hypophosphatemia in postoperative patients.

Severe hypophosphatemia may develop in postoperative patients for several reasons including alcohol withdrawal, diabetic ketoacidosis, nutritional recovery (refeeding) syndrome, and severe respiratory alkalosis. Severe hypophosphatemia may result in central nervous system abnormalities, muscle weakness, and renal, hepatic, cardiac, and respiratory dysfunction. Hypophosphatemia may be prevented by close monitoring of phosphorus concentrations in serum, especially in patients predisposed to developing this problem. Proper techniques for the maintenance and repletion of phosphate for both enteral and parenteral use are described.

Administration, Oral↗
PubMed1992

Arterial substitution in lower extremity trauma: autogenous vein vs polytetrafluoroethylene.

This review article compares the two most commonly used grafts, autogenous saphenous vein and polytetrafluoroethylene (PTFE), for treatment of arterial trauma. Late graft occlusion is more common with PTFE, but PTFE may be better in situations where infection is a concern and extra-anatomic bypass is not possible. When infected, saphenous vein is much more of a risk because of its tendency to undergo sudden hemorrhagic disruption. PTFE grafts usually show only moderate suture line bleeding, which alerts the surgeon to the presence of a problem with the graft.

Blood Vessel Prosthesis↗
PubMed1991

Radionuclide cholescintigraphy in patients with suspected biliary tract obstruction.

Radionuclide cholescintigraphy is used to help establish the diagnosis of acute cholecystitis and is thought to provide additional information regarding the patency of the biliary duct system. Nonvisualization of the extrahepatic biliary duct system and lack of excretion into the duodenum despite uptake in the liver (a positive study) is considered indicative of common bile duct obstruction. The authors retrospectively reviewed 281 hepatobiliary cholescintigrams done at Stamford Hospital from July 1, 1987 to June 30, 1989. Previous authors have demonstrated a false-positive rate of eight to 15 per cent in those cases that have a documented normal extrahepatic biliary system at operation. Of those patients explored after a common bile duct obstruction pattern depicted by cholescintigram in the authors' series, 46 per cent of patients were found to have normal extrahepatic biliary systems. Factors possibly contributing to this high false-positive rate are discussed. The utility of radionuclide hepatobiliary scans may be limited for diagnosis of biliary duct obstruction.

Cholecystitis↗
PubMed1991

Treatment strategies in shock: use of oxygen transport measurements.

Shock has traditionally been categorized according to its cause. Shock can result from hemorrhage, primary cardiac failure, central nervous system failure, trauma, or sepsis. Therapeutic principles have been developed for each etiologic type. End points for such therapy have included optimization of pulmonary capillary wedge pressure, cardiac output, blood pressure, and urine output. Recent investigators agree that the common denominator in each of the shock syndromes is a reduction in the amount of oxygen consumed by the cell. The logical therapeutic approach would be to increase oxygen delivery to support the increased metabolic demand of the cells. The end point of resuscitation should be optimization of oxygen delivery and oxygen consumption. These variables are easily calculated by using data obtained from pulmonary artery catheter and laboratory measurements. The physician or nurse caring for critical ill patients should have a thorough understanding of the rationale for the use of oxygen transport calculations and the methods of manipulating oxygen delivery. A simple explanation of these principles including the importance of hemoglobin, cardiac index, and percent saturation of hemoglobin and suggested treatment strategies are presented.

Aged↗
PubMed1991

Selective microscopic examination of gallbladders, hernia sacs, and appendices.

The usefulness of many "routine" medical procedures is being challenged in the health care atmosphere of today. This study was undertaken to determine the utility of routine microscopic pathologic examination of three frequently submitted surgical specimens. Pathology reports of 39,568 consecutive specimens, 17,105 appendices, 14,654 hernia sacs, and 7,809 gallbladders, submitted over a 49-year period, were reviewed. Microscopic examination of these tissues detected few unexpected findings. In those instances in which unexpected findings were discovered the primary surgery was curative or additional surgery would not have altered the prognosis. When careful, thorough gross examination by the surgeon and pathologist failed to disclose significant abnormalities or confirmed obvious disease such as inflammation, microscopic examination of these tissues might have been eliminated without a change in patient outcome. Although it could be argued that this microscopic pathologic correlation may be helpful for quality control and/or feedback of surgical decision making, the data indicate that gross examination alone may be sufficient in most cases, since unexpected microscopic findings are rare. The indications for microscopic examination of appendices, hernia sacs, and gallbladders are listed. Substantial savings of resources and time may be expected when selective microscopic examination is used.

Appendix↗
PubMed1990

Abdominal and anorectal surgery and the acquired immune deficiency syndrome in heterosexual intravenous drug users.

Over a period of seven years, 474 patients with acquired immune deficiency syndrome (AIDS) or AIDS-related complex were admitted on 782 occasions to the St. Francis Medical Center, Trenton, New Jersey. Abdominal surgery was performed on 16 (3.4 percent) patients, 14 (88 percent) of whom were heterosexual intravenous drug users. Anorectal surgery was performed on 20 (4.2 percent), 14 (70 percent) of whom were intravenous drug users. Intravenous drug users undergoing abdominal surgery had the same types of surgical abdominal conditions that occur in the general population. None required surgery for complications secondary to cytomegalovirus, visceral lymphoma, or visceral Kaposi's sarcoma. The postoperative morbidity rate was 72 percent. The postoperative mortality rate (30 day) was 0 percent. No intravenous drug users who underwent anorectal surgery had associated anorectal malignancies or infectious diseases. Five of six homosexual patients had either an anorectal malignancy or an associated anorectal infectious disease. Anorectal wounds did not heal within one month in one third of the intravenous drug users. The rate of wound healing was inversely related to the white blood cell count. One third of the intravenous drug users undergoing anorectal surgery were dead within six months.

AIDS-Related Complex↗
PubMed1990

Squamous cell cancer of the larynx in an intravenous drug user with AIDS.

We present the case of a 29-year-old intravenous drug user with AIDS and squamous cell cancer of the larynx. Profound immunosuppression was evident by an OKT4:OKT8 ratio of 0.1. Simultaneous treatment of the laryngeal cancer by laser vaporization and treatment of immunosuppression with zidovudine resulted in no tumor recurrence after one year.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Crack-induced enteric ischemia.

Rare instances of intestinal ischemia subsequent to cocaine use have been reported. Crack abuse, linked to gastroduodenal ulcer perforation, has not been associated with mesenteric infarction until this case report.

Adult↗
PubMed1989

Aseptic synovitis.

We report the first case of aseptic synovitis that occurred after a titanium knee prosthesis failed. This complication should be considered when a patient with a titanium prosthesis develops tenderness, erythema, and swelling of that joint.

Aged↗