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Biomedical subjects

J Freischlag

Publications and source records attributed to J Freischlag.

At least 19 recordsLinked to original sources
PubMed2000

Yield of repeated screening for abdominal aortic aneurysm after a 4-year interval. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators.

BACKGROUND: Little is known about the rate at which new abdominal aortic aneurysms (AAAs) develop or whether screening older men for AAA, if undertaken, should be limited to once in a lifetime or repeated at intervals. METHODS: A large population of veterans, aged 50 through 79 years, completed a questionnaire and underwent ultrasound screening for AAA. Of these, 5151 without AAA on the initial ultrasound (defined as infrarenal aortic diameter of 3.0 cm or larger) were selected randomly to be invited for a second ultrasound screening after an interval of 4 years. Local records and national databases were searched to identify deaths and AAA diagnoses made during the study interval in subjects who did not attend the rescreening. RESULTS: Of the 5151 subjects selected for a second screening, 598 (11.6%) had died (none due to AAA), and 20 (0.4%) had an interim diagnosis of AAA. A second screening was performed on 2622 (50.9%), of whom 58 (2.2%; 95% confidence interval, 1.6%-2.8%) had new AAA. Three new AAAs were 4.0 to 4.9 cm, 10 were 3.5 to 3.9 cm, and 45 were 3.0 to 3.4 cm. Independent predictors of new AAA at the second screening included current smoker (odds ratio, 3.09; 95% confidence, 1.74-5.50), coronary artery disease (odds ratio, 1.81; 95% confidence interval, 1.07-3.07), and, in a separate model using a composite variable, any atherosclerosis (odds ratio, 1.97; 95% confidence interval, 1.16-3.35). Adding the interim and rescreening diagnosis rates suggests a 4-year incidence rate of 2.6%. Rescreening only in subjects with infrarenal aortic diameter of 2.5 cm or greater on the initial ultrasound would have missed more than two thirds of the new AAAs. CONCLUSIONS: A second screening is of little practical value after 4 years, mainly because the AAAs detected are small. However, the incidence that we observed suggests that a second screening after longer intervals (ie, more than 8 years) may provide yields similar to those seen in initial screening and therefore warrants further study.

Aged↗
PubMed1999

Gelatin-sealed polyester resists Staphylococcus epidermidis biofilm infection.

BACKGROUND: The purpose of this study was to show that gelatin-impregnated polyester grafts inhibit Staphylococcus epidermidis biofilm infection in a canine model of aortic graft interposition. A clinically native species and two engineered strains, which differed in slime and adhesin antigen components, were compared to determine differential gelatin and slime interactions. METHODS: In vitro bacterial graft colonization was validated by immersion of graft segments in inoculating solutions (10(6) colony forming units/ml) of a clinically native species RP62A and two genetically engineered S. epidermidis species, M187sn3 (SN3: slime and adhesin negative) or M187sp11 (SP11: slime and adhesin positive), for 18 h at 23 degrees C. The grafts were washed, sonicated, and cultured to assess in vitro bacterial graft adherence. Grafts similarly inoculated were placed as aortic interposition grafts in dogs. Three sterile grafts were implanted as controls. Grafts were excised after 6 weeks and cultured for bacterial growth as in the in vitro study. Infection was defined by a positive culture in the excised grafts. Data were analyzed with nonparametric statistical methods. RESULTS: In vitro bacterial graft adherence in colony forming units per milliliter was similar at 18 h postsonication for RP62A (8 x 10(4) +/- 1 x 10(4)), SN3 (7 x 10(4) +/- 2 x 10(4)), and SP11 (6 x 10(4) +/- 2 x 10(4)) (P = NS). Only one of five grafts inoculated with RP62A was culture positive after 6 weeks. No grafts inoculated with the engineered strains SN3 or SP11 were culture positive after explanation. CONCLUSION: In vitro bacterial inoculation of gelatin-impregnated polyester was similar among the species and not dependent upon the presence of slime and adhesin components. Gelatin-impregnated polyester grafts demonstrated in vivo resistance to coagulase-negative staphylococcal biofilm infection.

Animals↗
PubMed1993

Female surgeons in the 1990s. Academic role models.

As part of a larger survey of the membership of the Association of Women Surgeons, data were collected to characterize the participation of women in academic surgery and surgical education. Of the 1500 members, 676 (45%) responded, and 318 of these respondents held a faculty appointment. Two hundred thirty-nine of the respondents' practices were based in a university or university-affiliated hospital. This sample was biased toward more academically motivated, upwardly mobile surgeons. Two hundred thirty-six of the respondents believed policies relating to tenure are unfair to women. Four hundred fifty-three respondents reported having role models at some point in their career, half of whom were men. However, only 204 still had access to role models or mentors at the time of the survey. Six hundred thirty respondents believed that female medical students need successful female surgeons as role models.

Adult↗
PubMed1993

Urokinase therapy for thrombosed hemodialysis access grafts.

Urokinase, with or without angioplasty, is an alternative to surgical treatment for the treatment of thrombosed polytetrafluoroethylene vascular access grafts. To evaluate the efficacy and outcome of thrombolytic therapy, all available charts of patients with a thrombosed graft treated at the University of California at Los Angeles Medical Center from June 1988 to August 1991 were reviewed. Twenty-three grafts in 21 patients underwent 43 procedures, 17 thrombolytic and 26 surgical, during this period. Four procedures in the thrombolytic group and the surgical group were patent less than 48 hours. Complications occurred in a significantly higher percentage of the thrombolytic group (11 of 17) than the surgical group (two of 26) (p < 0.001). Using life-table analysis, the primary patency was approximately 40 percent at six months and 20 percent at one year in both groups. Urokinase therapy was significantly more expensive than surgical therapy in this study. This increased cost was the result of ten of 17 patients receiving urokinase for more than eight hours. It is concluded that percutaneous delivery of thrombolytic therapy with angioplasty of any documented lesion is as effective as surgical procedure in the treatment of thrombosed hemodialysis access grafts, thrombolytic therapy is associated with a significantly higher complication rate and urokinase treatment that requires more than six to eight hours to lyse the graft thrombus may not be cost-effective.

Catheters, Indwelling↗
PubMed1993

Unilateral upper extremity edema. A case report.

A case report of a 28-year-old Hispanic male with a 5-month history of left arm, face and supraclavicular edema is presented. Chest radiography revealed bilateral pleural effusions. Thoracentesis was negative for malignant cells. Left arm venogram demonstrated compression of the left subclavian vein and lymphangiogram was consistent with perilymphatic stasis. Computerized tomography and magnetic resonance imaging demonstrated a questionable mass in the left side of the neck. On exploration of the left supraclavicular fossa, a severely fibrotic thoracic duct was encountered as well as a prominent scalene lymph node. Pathological section revealed an adenocarcinoma in both specimens which was positive for keratin and carcinoembryonic antigen. Chemotherapy was begun, however, the patient died 3 months later secondary to a respiratory arrest. This presentation of an adenocarcinoma arising from an unknown gastrointestinal source is unusual. A search should be made to locate the primary site. Prognosis is unclear but presumed poor due to the rarity of this presentation.

Adenocarcinoma↗
PubMed1992

Determinants of failure in superficial femoral artery angioplasty.

Although results of iliac artery balloon angioplasty have been shown to be good, there are much less data regarding initial success and durability of superficial femoral artery (SFA) dilation. The authors retrospectively reviewed the results of 22 patients treated for 27 SFA lesions between 1981 and 1986. Mean age was 64.5 years (fifty-five to seventy-six). Results were analyzed with respect to initial, early (< twelve months), and late (> twelve months) angiographic and clinical success. Indications were claudication (22), nonhealing ulcer (3), and rest pain (2). Mean follow-up was 30.9 months; 100% at one year and 92% at two years. Initial failure occurred in 9 (33%) lesions. There were 2 early and 2 late failures for a cumulative patency rate of 90.3% and 78% at one and two years, respectively. Predictors of clinical failure were: (1) initial--age, SFA occlusion, and angioplasty rating; (2) early--age, SFA occlusion, degree of atherosclerosis, and angioplasty rating; (3) late--angioplasty rating. There were 3 complications (11%). The authors conclude that: (1) 33% of attempted SFA angioplasties were initially unsuccessful and that the cumulative patency rate was 78% at two years. (2) Age is predictive of initial and early failure; SFA occlusion, of initial and early failure; degree of atherosclerosis, of early failure; and angioplasty appearance, of initial, early, and late failures. (3) Complications did not result in limb loss or require surgery.

Age Factors↗
PubMed1990

Traumatically-induced embolus to the hand from a thrombosed PTFE vascular access graft.

We report a case of a traumatically-induced embolus from a thrombosed PTFE vascular access graft in a patient who had undergone a successful cadaveric renal transplant. Although usually thought to be without subsequent sequelae, thrombosed PTFE grafts can be a source of emboli to the hand in active young patients. Diagnosis, etiology, and management are discussed. Therapeutic intervention includes exclusion of the graft from the arterial circulation to the hand and removal of all existing thrombus.

Adult↗
PubMed1990

Carotid artery disease in patients with head and neck carcinoma.

Irradiation has been shown experimentally to cause accelerated development of atherosclerosis in exposed large arteries. However, occurrence of such an entity in carotid arteries of patients after treatment for head and neck carcinoma is unknown. Therefore, we reviewed 179 patient charts who had undergone head and neck operations with or without irradiation between 1979-1987. Of these 179 patients, 107 (59.8%) were dead at time of follow-up. Cause of death was unknown in 42 (40%) patients; in the remainder included: respiratory arrest--33; carcinoma-related--18; cardiac--6;pneumonia--7; and trauma--1. Average interval from treatment to death was 23.5 months. Of the 72 patients known to be alive, follow-up was obtained in 52 patients. Their average age was 64.9 years. Risk factors for atherosclerosis included: male gender--43; smoking--50; hypertension--9; diabetes--4; coronary artery disease--12; and peripheral vascular disease--4. Seventy-five per cent of these patients received postoperative irradiation. Average follow-up was 64.5 months. Duplex scans were performed on 34 patients. Three patients had common or internal carotid stenoses greater than 75 per cent. All of these patients had received irradiation and none of them were symptomatic. Seven patients had carotid stenoses between 50 to 75 per cent; five of these had received irradiation. Of these five patients, one had a stroke 60 months postoperatively, and one had a TIA 36 months postoperatively. The remaining 58 patients (of which 48 had irradiation) had carotid stenoses less than 50 per cent and none were symptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

The effects of in vivo antibiotics on neutrophil (PMN) activity in rabbits with peritonitis.

Antibiotics play an important role in helping the host fight infection; however, the direct cellular effect of antibiotics on polymorphonuclear cells remains undefined. Adherence, chemotaxis, phagocytosis, and superoxide anion production are important steps in the cascade of events initiated by the polymorphonucleocyte in bacterial killing. Previous studies have shown inhibition as well as stimulation of neutrophil antibacterial therapy by antibiotics. Peritoneal and blood polymorphonuclear neutrophils (PMN) respond differently to peritonitis and to external agents. The purpose of this study was to investigate the effects of in vivo clindamycin and netilmicin on infected rabbit peritoneal and blood polymorphonuclear adhesiveness, phagocytosis, chemotaxis, and superoxide anion production. Peritoneal and blood PMNs were obtained from rabbits which had undergone appendiceal devascularization 18 hr earlier: antibiotics were administered intramuscularly 1 hr prior to appendectomy and every 8 hr postoperatively for 5 days; these PMNs were compared to infected rabbits which did not receive antibiotics. Clindamycin and netilmicin in vivo cause significant inhibition of phagocytosis, peritoneal adhesiveness, and, when used in combination, blood adhesiveness and peritoneal superoxide anion production. No effects were seen on chemotaxis. Based on this data we conclude that antibiotics, while vitally important in fighting infections, may in and of themselves be agents of immunosuppression at the cellular level.

Animals↗
PubMed1986

Complications of diverticular disease of the colon in young people.

Diverticular disease of the colon in patients under the age of 40 years is uncommon. Between 1975 and 1985, 58 patients (31 men and 27 women) were admitted for pathologically or radiographically proven acute diverticulitis. Seventeen (29.3 percent) were younger than 40 years. Fifteen of the 17 (88.2 percent) required urgent or emergent surgery for complications of diverticular disease. This represents a significantly (P less than 0.02) larger proportion of that age group than those patients older than the age of 40 (17/41 or 41.5 percent). Twelve of the patients younger than age 40 (70.6 percent) had had their symptoms for 72 hours or less, and in 13, surgery was required during the first attack. Indications for surgery included abscess, perforation, and persistence of symptoms. Six patients required surgery in less than 24 hours. In young people, the initial attack of colonic diverticulitis is frequently severe, often requiring an urgent operation for complications. Excellent results with few complications can be obtained when the index of suspicion is high, an early diagnosis is made, and timely surgical intervention is employed.

Adult↗
PubMed1986

Comparison of blood and peritoneal neutrophil activity in rabbits with and without peritonitis.

The neutrophil (polymorphonuclear cell, or PMN) function is an essential component of the host defense against infection. However, infection itself may alter PMN activity. To investigate both the effects of infection on PMN activity and PMN activity on survival, we evaluated control and infected blood and peritoneal PMN phagocytosis, chemotaxis, and superoxide anion production in rabbits with and without peritonitis. Control blood and peritoneal PMNs were obtained from noninfected rabbits which were subjected to intraperitoneal infusion of sterile hypertonic saline. Infected blood and peritoneal PMNs were obtained from rabbits which had undergone appendiceal devascularization and ligation 18 hr earlier. Phagocytosis was similar in all groups except for a threefold increase in normal peritoneal PMNs. Chemotaxis was inhibited by infection in the blood and peritoneal PMNs. Normal peritoneal PMNs also had decreased chemotaxis. Superoxide anion production was comparable in the infected and control blood; however, both control and infected peritoneal PMNs had elevated superoxide anion production. Of the infected rabbits, four died in 5 days or less. Of the six that lived, two developed intraabdominal abscesses. Blood and peritoneal PMN activity was similar in all rabbits despite their outcome. We conclude that (1) blood and peritoneal PMNs have different basal activities and responses to infection; (2) the milieu of the peritoneal cavity appears to alter the PMNs present; and (3) PMN activity did not predict morbidity or mortality.

Animals↗
PubMed1985

Blood and peritoneal neutrophil (PMN) adherence in rabbits: the effects of hemoglobin, peritoneal fluid, and infection.

Neutrophil (PMN) adherence is an important first step in PMN migration. Peritoneal fluid and hemoglobin have been implicated as inhibitors of blood PMN function. The purpose of this study was to evaluate the effects of peritoneal fluid and hemoglobin on PMN adherence in both blood and peritoneal PMNs. Adherence was measured by nylon fiber filtration. Control blood PMNs were obtained from rabbit heparinized blood. Control peritoneal PMNs were obtained by saline lavage 18 hr after the intraperitoneal instillation of hypertonic saline. Infected blood and peritoneal PMNs were similarly obtained from rabbits which had undergone appendiceal devascularization 18 hr earlier. Blood and peritoneal PMNs were tested in normal saline, serum, hemoglobin, and peritoneal fluid from infected and noninfected rabbits. Cell adhesiveness of blood and peritoneal neutrophils from infected and noninfected rabbits was similar in all groups. In normal saline and serum, cell adhesiveness was approximately 70%. In hemoglobin and peritoneal fluid, all groups of neutrophils showed a statistically significant decrease in cell adhesiveness. Based on these data we conclude: (1) Blood and peritoneal PMNs with and without infection have similar adherence. (2) Both hemoglobin and peritoneal fluid inhibit PMN adherence.

Animals↗
PubMed1984

A comparative study of cefamandole versus gentamicin plus clindamycin in the treatment of documented or suspected bacterial peritonitis.

Our data support the premise that antimicrobial therapy for peritonitis must be individualized. In the patient with minimal and moderate contamination who is not suppressed and who will undergo prompt and correct surgical therapy, then a single antimicrobial agent, such as cefamandole or perhaps even a first generation cephalosporin, such as cefazolin, will be adequate therapy even in instances of polymicrobial peritonitis when anticipated resistant organisms are present. In this situation, a single drug will be just as effective and safer when compared with the combination of an aminoglycoside and a specific antianaerobic agent. On the other hand, in the patient with immunosuppression, who is late to come to treatment or who has hospital acquired sepsis with probably a large contamination of resistant organisms, either a third generation cephalosporin with extended coverage or triple drug therapy, including a broad spectrum penicillin, an aminoglycoside and an anaerobic effective agent, should be the treatment of choice. Also, for infections with a culture proved overwhelming anaerobic flora, an antimicrobial specific for these pathogens should be used. The dictum, however, that all instances of peritonitis mandate double or triple drug therapy is a clinical impression based upon experimental models which do not correctly simulate the clinical situation.

Adolescent↗
PubMed1984

Topical versus systemic cephalosporin administration in elective biliary operations.

The role of prophylactic antibiotic lavage in elective biliary tract operations is controversial. To investigate this question, a prospective, randomized study was undertaken between 1979 and 1983. All patients more than 18 years of age who underwent elective biliary operations were included. Eighty-eight patients were enrolled in the study and were stratified into the following antibiotic groups: (1) cefamandole nafate 2 gm administered intravenously preoperatively and 6 hours postoperatively in four doses; (2) cefamandole nafate 0.4% solution: 250 ml to irrigate the abdominal wound on opening, 500 ml to irrigate the peritoneal cavity, and 250 ml to irrigate the wound on closing; and (3) systemic plus topical administrations as in Nos. 1 and 2. Age, sex, type of operation, and underlying diseases were comparable in all groups. The patients were then evaluated for postoperative infections. In the intravenous cefamandole group there was only one patient who developed a urinary tract infection after operation. In the topical cefamandole group there were four postoperative infections: wound-one, urinary tract--two, and cholangitis--one. In the intravenous plus topical cefamandole group there were four postoperative infections: wound--one, urinary tract--two, and pneumonia--one. No deaths occurred in any group. Blood, subcutaneous, and peritoneal drug levels were sampled 1 hour after opening and before closing. Therapeutic serum levels of cefamandole are 1 to 16 micrograms/ml and adequate serum levels were achieved in all groups. However, higher levels were obtained in the subcutaneous tissue and peritoneum when topical cefamandole was used. We conclude: (1) Topical cefamandole lavage alone is adequate prophylaxis in elective biliary operations and achieves comparable results as perioperative systemic administration; (2) topical cefamandole resulted in higher subcutaneous tissue and peritoneal levels than intravenous cefamandole and also achieved therapeutic serum levels; and (3) there is no advantage to the use of systemic plus topical antibiotics in elective biliary operations.

Administration, Topical↗
PubMed1983

The value of postoperative fever evaluation.

Evaluation of fever in the early postoperative period often includes a battery of diagnostic tests to determine the source of or to exclude a serious infection. In order to evaluate the clinical usefulness and cost effectiveness of the information obtained from these tests, the data for 464 patients who had undergone abdominal operation were reviewed. Of the 464 patients, 71 (15%) fulfilled the criterion of fever with rectal temperature of 38.5 degrees C or greater in the first 6 postoperative days. For 27% (19/71) of the patients with a postoperative fever, culture-proven infection was responsible for the fever. For 74% (14/19) of the patients with infection, the correct diagnosis was made based on clinical findings and confirmed by a single appropriate test. The remaining five patients with infection were diagnosed via a battery of test because of the absence of clinical findings indicating the source of their infection. Rote ordering of unnecessary tests resulted in an excess expenditure of $19,738, or $278 per febrile patient. We conclude that routine evaluations of fever do not alter the outcome of the majority of patients and are not cost effective.

Adolescent↗