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Biomedical subjects

J Graff

Publications and source records attributed to J Graff.

At least 73 records · Page 4Linked to original sources
PubMed1989

Critical evaluation of treatment of staghorn calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.

The combined use of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy in patients with staghorn calculi has become an established treatment regimen. We evaluated the results of 90 staghorn calculi-bearing kidneys treated with such combination therapy after a mean follow-up of approximately 2 years. A total of 69 kidneys (76.7 per cent) became free of stones at some point after treatment. However, due to stone recurrence this number decreased to 55 kidneys (61.1 per cent) at the end of follow-up. Patients who had undergone a previous open operation on the stone-bearing kidney showed less favorable results than the over-all group. When our results were compared to reported data on open surgery or percutaneous nephrolithotomy alone even better results may have been obtained by such treatment modalities. However, our data indicate that percutaneous stone debulking combined with further destruction of residual stone fragments by shock wave lithotripsy certainly is less invasive than an open operation and provides an alternative to percutaneous treatment alone, which can yield comparable results.

Adult↗
PubMed1989

Lack of effectiveness of lidocaine for sustained, wide QRS complex tachycardia.

Records of 31 episodes of sustained, wide QRS complex tachycardia treated with IV boluses of lidocaine in 20 consecutive patients were reviewed. Most of the episodes were managed in the emergency department. Patient ages ranged from 18 to 91 years (mean +/- SD, 64 +/- 17), and 17 of 20 were men. All but three had coronary artery disease. Although 19 of 20 patients were admitted with a diagnosis of "rule out acute myocardial infarction," only two had this diagnosis confirmed. Seventeen patients had ventricular tachycardia, and three had wide QRS complex supraventricular tachycardia. Patients were given one to three boluses of lidocaine totaling 75 to 400 mg (127 +/- 64 mg). Termination of the tachycardia was temporally related to lidocaine administration in only six of 31 episodes (19%) occurring in five of 20 patients. In three of these five patients, lidocaine was given again for a recurrence of the tachycardia and was ineffective. A similarly low efficacy was seen in 20 episodes initially managed in the hospital compared with 11 episodes initially managed by paramedics. Thus, although lidocaine is widely considered the drug therapy of first choice for sustained wide QRS complex tachycardia, it was not usually effective in our study. Patients presenting to the ED with this rhythm disturbance rarely prove to have acute myocardial infarction. Although this small retrospective study should not be the basis for a change in standard medical practice, the recommendation of lidocaine as initial therapy for such patients should be reexamined.

Adolescent↗
PubMed1988

Long-term followup in 1,003 extracorporeal shock wave lithotripsy patients.

We evaluated 1,003 patients treated with extracorporeal shock wave lithotripsy after a mean followup of 19.1 months (range 12 to 26 months). Followup excretory urograms were normal in 97 per cent of the patients. Two-thirds of the patients reported further discharge of residual fragments, mainly during the first 3 months. Rehospitalization was necessary in 57 patients. Over-all, the rate free of stones after followup was 72.2 per cent and it was not different for primary and recurrent stone patients. Rates free of stones were influenced mainly by the primary stone location and the number of stones in a renal unit. Patients with lower caliceal stones had a rate without calculi of only 57.8 per cent. Almost identical results were obtained for stones other than in the lower calix, when fragments were found in the lower calix at the time the patient was discharged from the hospital. The pre-treatment stone volume, as determined by measuring the stone area in square millimeters, did not influence the final rates free of stones for calculi up to 400 mm.2, that is 2.4 cm. of a sphere. Only calculi larger than 400 mm.2 showed an inverse relationship to the final rate free of stones. Multiple stones yielded a success rate of 64 per cent, with 90 per cent of the patients having regrowth of residual fragments. Serious complications during followup were not encountered.

Adolescent↗
PubMed1988

Extracorporeal shock wave lithotripsy for ureteral stones: a retrospective analysis of 417 cases.

We treated 417 patients with upper ureteral stones with extracorporeal shock wave lithotripsy. All patients with obstructing stones underwent retrograde manipulation, which was successful in 57 per cent. Management of obstructing stones in situ (215 patients) with and without decompression of the collecting system required additional treatments in 13 per cent and ancillary procedures in 25 per cent. Nonocclusive ureteral stones were not manipulated. Treatment of these stones in situ slightly increased the need for postoperative ancillary procedures, compared to successful repositioning into the kidney (5.9 versus 3 per cent). Secondary treatments, however, were necessary as often as with occlusive stones. The main reason for failure of extracorporeal shock wave lithotripsy was the lack of fluid around an impacted stone. An energy absorptive effect of muscle tissue for stones projecting on the psoas muscle could not be demonstrated. The best and most consistent results were obtained when the stone was manipulated successfully into the renal collecting system.

Female↗
PubMed1988

New generator for low pressure lithotripsy with the Dornier HM3: preliminary experience of 2 centers.

The technical innovation of a low pressure generator with a standard ellipsoid installed into the Dornier HM3 lithotriptor leads to a decrease in pressure at the second focus by 30 per cent. The preliminary experience with 273 patients treated at 2 centers is presented. The success rate in terms of stone disintegration was similar compared to the old generator (96 versus 97 per cent). However, the rate of secondary treatments increased from 8 to 15.5 per cent, respectively. Owing to the lower peak pressures at the second focus, an additional 700 impulses per session were necessary. The method of anesthesia was changed to a combination of an anxiolytic and analgesic drug in the majority of the patients. Treatment was judged as free of pain or with easily tolerable pain in 93 and 88 per cent of the patients, respectively.

Anesthesia, Epidural↗
PubMed1988

Heterotopic pregnancy after in vitro fertilization and ovulatory drugs.

We report two cases of heterotopic pregnancy in women who were previously infertile. One of these patients conceived with the aid of ovulation stimulatory drugs, and the other from in vitro fertilization. In each case an ultrasound of the pelvis revealed a viable intrauterine pregnancy (twins in one case). Both patients presented in hypovolemic shock and required exploratory laparotomy. At the time of surgery a ruptured ectopic pregnancy with accompanying hemoperitoneum was found in each. Simultaneous ectopic and intrauterine pregnancy, though rare, should be suspected in patients who conceive with the aid of ovulatory drugs or in vitro fertilization.

Abortion, Spontaneous↗
PubMed1988

Influence of drugs on the TXA2/PGI2 balance and on the atherogenic index in myocardial ischemia in dogs.

The effect of drugs on eicosanoid production and on the development of atherogenic index was investigated in canine myocardial ischemia. Iloprost, verapamil, the trapidil derivative AR 12463 or 0.9% NaCl solution were administered 60 min after coronary artery ligation in anaesthetized dogs. Both iloprost and AR 12463 reduced the thromboxane A2/prostacyclin (TXA2/PGI2) ratio in coronary sinus plasma in comparison to controls. The atherogenic index was significantly decreased in the iloprost as well as in the AR 12463-treated group in comparison to the control group. Verapamil had no influence on the investigated parameters.

Animals↗
PubMed1987

Influence of verapamil and its combination with glucose-insulin-potassium-infusion on acute myocardial ischemia in dogs.

The influence of verapamil (V) and of V combined with glucose-insulin-potassium (VG) on ischemic injured myocardium was investigated in dogs after ligation of the left anterior descending coronary artery. Three hours after coronary artery ligation with VG application during the last two hours the left ventricular end diastolic pressure (LVEDP) and the pressure rate product were decreased in contrast to the behaviour after V infusion. Contents of ATP and creatine phosphate were preserved in equal extent by V and VG, but the lowest content in inorganic phosphate was found in ischemic and nonischemic left ventricular tissue after VG application. Thus, VG seems to enable the tissue to save more effective energy rich phosphates and to contribute to the economization of cardiac work by reduction of preload.

Adenosine Triphosphate↗
PubMed1987

[Coronary surgery in females].

In the last three years, of a total of 617 patients undergoing surgery for ischemic heart disease, 53 were women (8.6%). With one exception, all were in or shortly before the menopause. As compared with men, the women were found to have a preponderance of risk factors. The most unfavorable combination, that of hypertension and hypercholesterolemia, was present in one-third of the patients. Hospital mortality for isolated revascularization was higher in women at 4.9% than in men at 1.5%. The one-year survival rates, however, of 94.4% and 95%, respectively, did not differ between the two sexes. In women, the number of grafts per patient was 2.1 as compared with 2.9 in men. Complete revascularization was achieved less frequently in women than in men; similarly graft patency rate at one year of 66% in women was less than the 84% observed in men. The more marked coronary sclerosis as well as morphologic characteristics of coronary arteries in women construe a special challenge to the surgeon and prerequisite a high degree of technical skill.

Adult↗
PubMed1986

[Confirming a mediastinal lipoma with cardiac computerized tomography].

It is reported on an at present 32-year-old male patient, in whom at the age of 30 years an excessive mediastinal lipoma was excised. For 12 years the cardiological diagnosis was not clear and could completely be clarified only with the help of the computed tomography of the heart.

Adult↗
PubMed1986

Combined treatment of branched calculi by percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy.

Eighty-seven patients with branched renal calculi were treated by a combination of percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. Stone debulking was achieved by percutaneous nephrolithotomy and residual stone fragments were destroyed by shock wave lithotripsy. Of the patients 70 (80 per cent) required 2 to 3 treatments, 12 (14 per cent) required 4 treatments and 5 (6 per cent) required 5 to 6 treatments. Results after 3 months indicated that 58 patients were free of stones, 3 had recurrent stones and 12 had disintegrated stone particles (less than 3 mm.) in the collecting system, while 13 were lost to followup. One patient had undergone nephrectomy. This treatment plan minimized the disadvantages of either technique when used alone and made open operative intervention unnecessary. Procedural and fluoroscopy times were reduced drastically compared to reported data on percutaneous nephrolithotomy only. We believe that more than 90 per cent of all branched calculi can be treated with this combined technique.

Adolescent↗
PubMed1986

Giant hydroureteronephrosis. Case report and review of the literature.

A case of giant hydroureteronephrosis in a man is reported. Diagnostic evaluation included ultrasound, urethrocystoscopy and percutaneous puncture to assess the outline of the urinary tract and to locate a suspected ectopic ureteral orifice. Standard treatment usually consists of primary nephroureterectomy. A review of the literature with respect to etiology, diagnostic criteria and treatment modalities is presented.

Adult↗
PubMed1986

Effect of oestrogen or cyproterone acetate treatment on adrenocortical function in prostate carcinoma patients.

The antiandrogen cyproterone acetate (CA), as well as oestrogens have been reported to influence pituitary-adrenal function in prostate cancer patients, but the clinical relevance of these findings is unknown. We therefore investigated serum cortisol (F), dehydro-epiandrosterone sulphate (DS), testosterone (T) and prolactin (Prl) levels in patients treated with CA or oestradiol undecylate for at least 6 months. Hypothalamic-pituitary-adrenal function was further assessed by analysis of diurnal hormone variation and by ACTH stimulation and dexamethasone suppression tests. To differentiate between direct CA or oestrogen effects and secondary effects resulting from therapy-induced hypogonadism, we performed similar tests in untreated normogonadal and hypogonadal patients. CA treatment effected a significant decrease in serum F (-40%), DS (-73%) and T (-58%) levels and an increase in serum Prl (+118%). Oestrogen treatment resulted in markedly lowered T levels (-89%), slightly elevated serum F (+24%) and significantly increased serum Prl (+192%). Corresponding changes of F, DS and Prl could not be found in the untreated hypogonadal controls, thus indicating a direct drug-related effect. Neither diurnal rhythmicity of serum F nor adrenal response to ACTH stimulation or sensitivity to dexamethasone suppression significantly changed under CA or oestrogen treatment. We conclude that, although serum F levels may decrease under CA or increase slightly under oestrogen therapy for prostate carcinoma, these findings do not justify specific treatment, since neither clinical side effects nor an impairment of hypothalamic-pituitary-adrenal feedback occurs.

Adrenal Cortex↗
PubMed1986

[The vascular wall and fibrinolysis--pathologic aspects].

The plasminogen activating factor of tissue detectable by fibrinolysis autography is diminished in varicosis with and without postthrombotic syndrome, in diabetic nephropathy, in viral pneumonia and after short-term cyclophosphamide therapy. The only condition in which an increase of this factor can be observed is mechanical damage of tissue. The importance of the findings for pathogenesis and therapy is stressed. Whether the results are influenced by inhibitors of extrinsic plasminogen activation is discussed.

Diabetic Nephropathies↗