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Biomedical subjects

J L Nosher

Publications and source records attributed to J L Nosher.

At least 55 records · Page 3Linked to original sources
PubMed1984

Percutaneous catheter versus open surgical drainage in the treatment of abdominal abscesses.

In the past 3 years, percutaneous catheter drainage (PCD) was performed for 24 abdominal and retroperitoneal abscesses while open surgical drainage (OSD) was used for treatment of 24 similar abscesses at the affiliated hospitals of UMDNJ-Rutgers Medical School. Although the method of treatment was arbitrarily selected by the attending physician, the two groups were similar with respect to abscess location, underlying illnesses, and previous operations. In the PCD group, 17 of 24 abscesses developed after operations versus 16 of 24 in the OSD group. Location of abscesses were: PCD group: abdominal (9), renal (5), pelvic (4), subphrenic (3), hepatic (2), pancreatic (1); OSD group: abdominal (10), renal (4), subphrenic (4), pelvic (3), hepatic (2), pancreatic (1). With PCD, the abscesses were localized by ultrasound or computerized tomography scan; a 20- or 22-gauge needle passed into the cavity, followed by progressively larger guide wires, dilators, and catheters; the pus evacuated; and abscess cavity thoroughly irrigated with sterile saline. Percutaneous catheter drainage was successful in 22 of 24 cases. There were two inconsequential complications. The mean post-PCD hospital stay was 11.7 days. With OSD, five patients developed major complications, including three deaths from sepsis. The mean post-OSD stay for surviving patients was 21.2 days. The advantages of PCD versus OSD are: 1) precise noninvasive localization of abscesses, 2) avoidance of general anesthesia, 3) avoidance of major complications, and 4) shorter postdrainage hospital stay. Open surgical drainage should be reserved for cases where PCD fails to control sepsis, close fistulae, or when noninvasive scanning either fails to demonstrate a discrete abscess in the face of intra-abdominal sepsis or identifies an abscess that cannot be percutaneously drained without traversing the bowel.

Abdomen↗
PubMed1983

The initial experience with the use of a portable infusion pump in the delivery of human menopausal gonadotropins.

The initial experience with the use of a portable infusion pump for the delivery of human menopausal gonadotropins (hMG) in the therapy of ovulation dysfunction of women who failed to conceive following (1) either clomiphene citrate (five patients with polycystic ovary syndrome) or danazol (three patients with mild endometriosis) and (2) standard intramuscular hMG-human chorionic gonadotropin therapy is reported. In six of these patients this approach was used because of suboptimal response of serum estradiol levels to standard hMG therapy, and all six patients had an increase in estradiol response with infusion therapy; therapy duration and total dosage of hMG were similar in both treatment modalities. Sonography suggested stimulation of several follicles with infusion therapy. Advantages and disadvantages of the use of the infusion pump for hMG therapy are discussed. In conclusion, hMG therapy via the infusion pump is feasible. This mode of administration appears to lead to more satisfactory follicular development in selected patients. Multiple follicular stimulation is to be expected. Self-administration of medication is readily achieved by the educated patient. Further consideration and exploration of hMG infusion therapy is suggested.

Adult↗
PubMed1980

Aspiration with amylase determination in differentiating pancreatic from renal cysts.

Cyst puncture has become a valuable diagnostic tool in the management of renal masses considered to be cystic by ultrasound. A case is reported of a mass that was considered to be a renal cyst after urographic, sonographic and angiographic examination. However, the correct diagnosis was made by determining the amylase content of the aspirated fluid.

Adult↗
PubMed1980

Fine needle aspiration of the liver with ultrasound guidance.

Ultrasonically guided fine needle aspiration was carried out in 23 hepatic tumors. Malignant neoplasm was found in 14 of 15 cases and a benign process was diagnosed in 3. No false-positive diagnosis of neoplasm was made. A single complication of clinically insignificant pneumothorax was encountered.

Biopsy, Needle↗
PubMed1975

The clinical significance of cervical esophageal and hypopharyngeal webs.

One thousand consecutive cinefluorographic examinations of the hypopharynx and cervical esophagus were reviewed to determine the incidence of webs in a population routinely referred for upper gastrointestinal examination. The age, sex, and incidence of iron deficiency anemia in patients with webs were compared with those of the controls, and dysphagia and associated diseases were noted. 5.5% of the patients had one or more webs; these patients had a similar sex distribution to the control group but were generally older. Both groups had the same incidence of iron deficiency anemia. None of the patients with webs met the criteria for Plummer-Vinson syndrome. The authors believe that most cervical esophageal and hypopharyngeal webs are of no clinical significance.

Adolescent↗
PubMedDate not supplied

Antibiotic bonded nephrostomy catheters for percutaneous nephrostomies.

A prospective controlled trial of the effectiveness of a cefoxitin-bonded nephrostomy catheter was undertaken to determine the effectiveness of an antibiotic bonded catheter in decreasing the infectious complications of percutaneous nephrostomy. The study concludes that bonding of the antibiotic cefoxitin to percutaneous nephrostomy catheters did not influence the incidence of bacteriuria or urinary tract infection. In addition, observations on the overall incidence of complications from percutaneous nephrostomy are made.

Adolescent↗
PubMedDate not supplied

Over-the-wire placement of large bore thoracostomy tubes.

A simple method is described for placement of large caliber thoracostomy tubes utilizing an over-the-wire (Seldinger) technique. The method employs an angioplasty balloon catheter on which a renal fascial dilator and sheath are mounted. Through the sheath a large caliber thoracostomy tube is placed into the pleural space.

Humans↗
PubMedDate not supplied

Peripheral venous access ports: outcomes analysis in 109 patients.

PURPOSE: To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data. METHODS: One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gamma-globulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. A combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data. RESULTS: Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)-in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p = 0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically significant (p = 0.6). Aspiration occlusion occurred in 13 patients (11.7%). Intracatheter urokinase was infused in eight of these patients and successfully restored catheter function in all but two instances. These complication rates are comparable to or better than those reported with chest ports. CONCLUSION: Peripheral ports for long-term central venous access placed by interventional radiologists in the interventional radiology suite are as safe and as effective as chest ports.

Adult↗
PubMedDate not supplied

The role of interventional radiology in the management of intra- and extra-peritoneal leakage in patients who have undergone continent urinary diversion.

PURPOSE: To assess how radiologic intervention altered the hospital course of patients undergoing continent urinary diversion. METHODS: Thirty-seven consecutive patients with bladder cancer invading the muscular layer were treated with total cystectomy and construction of a continent urinary reservoir. Eleven of 37 patients suffered early and late anastomotic leakage; six had prolonged extraperitoneal leakage at the urethroenteric anastomosis, three had prolonged intraperitoneal pouch leaks, and two had delayed ureteroenteric leaks. Seven of these patients required radiologic intervention. RESULTS: Intervention in the form of drainage catheter manipulation (n = 4), percutaneous nephrostomy (n = 4), or ureteral stent placement (n = 2) resulted in cessation of leakage without surgical intervention in all seven patients. Intraperitoneal pouch leaks were more difficult to control than extraperitoneal leakage and required longer drainage intervals. CONCLUSION: Interventional radiologic procedures played a key role in the management of continent urinary diversion complications, obviating the need for repeat surgical intervention in all instances.

Adult↗
PubMedDate not supplied

Translumbar placement of paired hemodialysis catheters (Tesio catheters) and follow-up in 10 patients.

For lack of other suitable access, 10 consecutive patients received paired hemodialysis catheters for long-term hemodialysis using a translumbar approach to the inferior vena cava (IVC). All attempts were successful. Five paired catheters were placed using the single-puncture technique, and five using the dual-puncture technique. Catheters were in place for a total of 2252 catheter days. The average duration of catheter placement was 250 days (range 30-580 days). All catheters were functioning up to the time the study was completed or the patient died. The most common complication was partial dislodgment of the catheter in 3 of 23 catheters (13%), all occurring in obese patients. One episode of retroperitoneal hemorrhage was noted in a patient having the single-access technique. There were no episodes of infection or IVC thrombosis.

Catheterization↗
PubMedDate not supplied

Salmonella mediastinitis--a rare disease.

A case report is presented of a young man who was seen because of pleuritic chest pain and fever. CT cross sectional imaging defined a mediastinal mass. Diagnosis of acute mediastinitis due to Salmonella java was made from culturing material at mediastonotomy.

Adolescent↗