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Biomedical subjects

J Pollak

Publications and source records attributed to J Pollak.

At least 19 recordsLinked to original sources
PubMed2001

Evaluation of various maneuvers for prevention of air embolism during central venous catheter placement.

This study is designed to evaluate the various physiologic maneuvers (Valsalva, humming, breath-hold) for the potential prevention of air embolism during central venous catheter placement. Central venous pressure measurements were prospectively obtained in 40 patients undergoing central venous catheter placement. The average central venous pressure at baseline was 3.275 mm Hg (range = -4 to 16, SD = 5.99). The average central venous pressure during breath hold was 6.1 mm Hg (range = -6 to 24, SD = 7.99). The average central venous pressure during humming was 5.1 mm Hg (range = -4 to 20, SD = 6.4) The average central venous pressure during the Valsalva maneuver was 18.43 (range = -3 to 48, SD = 14.73). Forty percent of patients (16 of 40) had negative central venous pressures at rest, 25% (10 of 40) had negative pressures during breath hold, 20% (8 of 40) had negative pressures during humming, and 2.5% (1 of 40) had negative pressures during Valsalva maneuver. The average increases in central venous pressure during breath hold, humming, and Valsalva were 2.85, 1.82, and 15.2 mm Hg, respectively. The difference between pressures during Valsalva and other maneuvers was statistically significant (P <.05). The conclusion is that the Valsalva maneuver is superior to breath-hold and humming for increasing central venous pressure during central venous catheter placement and, therefore, it is more likely to prevent air embolism in cooperative patients.

Adult↗
PubMed2000

Pulmonary arteriovenous malformations: cerebral ischemia and neurologic manifestations.

BACKGROUND: There is an increasingly recognized association between pulmonary arteriovenous malformations (PAVM) and cerebral ischemia, frequently attributed to paradoxical embolization. PAVM occur in 20 to 30% of the hereditary hemorrhagic telangiectasia (HHT) population. OBJECTIVE: To evaluate the risk determinants for cerebral ischemia and neurologic manifestations in patients with PAVM. METHODS: A retrospective cross-sectional study was performed on consecutive patients admitted between 1988 and 1992 for treatment of PAVM. The number of PAVM, feeding artery (FA) diameters, and aneurysmal sizes were determined by pulmonary angiography. Patients were categorized as having single or multiple PAVM with an FA diameter of > or = 3 mm. History, examination, and cerebral imaging studies were used to determine the prevalence of neurologic manifestations. Patients were defined as having cerebral paradoxical embolization if there was radiologic evidence of cortical infarction. RESULTS: There were 75 cases: 26 single PAVM and 49 multiple PAVM. Cortical infarction was present in 14% of patients with single PAVM. Patients with multiple PAVM had a greater prevalence of any infarction (OR 3.2; 95% CI, 1.2 to 9.44, p = 0.030), cortical infarctions (OR 2.3; 95% CI, 0.58 to 9.2, p = 0.230), subcortical infarctions (OR 2.1; 95% CI, 0.58 to 7.95, p = 0.249), abscesses (OR 2.3; 95% CI, 0.46 to 11.94; p = 0.295), and seizures (OR 6.4, 95% CI 0.77 to 53.2, p = 0.054). Patients with multiple PAVM had markedly greater odds of having any clinical or radiologic evidence of cerebral ischemic involvement (OR 4.5; 95% CI, 1.47 to 14; p = 0.008). CONCLUSION: There is a strong association between single PAVM and various neurologic manifestations. The prevalence is greater for patients with multiple PAVM, suggesting increased predisposition for paradoxical embolization with a greater number of malformations.

Adolescent↗
PubMed2000

Postoperative management of lower extremity amputation.

Postoperative management of lower extremity amputation continues to evolve with advances in prosthetic technology, surgical technique, and rehabilitation considerations. Almost 50 years ago, the first immediate postoperative prosthesis was conceived, and has been used since with varying degrees of success. More recently, use of the removable rigid dressing combined with aggressive physical therapy has been found to be a safe and cost-effective method of treatment for the new amputee.

Amputation, Surgical↗
PubMed1999

Placement of an intracoronary stent via translumbar puncture.

Translumbar puncture for access to the central arterial tree has been used for aortography and for selective coronary angiography in selected patients where conventional peripheral access is not possible. A single case report of coronary angioplasty through this access technique is available in the literature. We report a case of coronary stent placement using the translumbar approach to access the coronary arteries.

Angiography↗
PubMed1999

A clinical-pharmacological evaluation of percutaneous isolated hepatic infusion of doxorubicin in patients with unresectable liver tumors.

A dose escalation study of hepatic arterial infusion of doxorubicin during hemodynamic isolation of the liver (the Delcath system) was conducted to: 1) study the pharmacokinetics of regional doxorubicin therapy, and 2) define therapeutic efficacy in the treatment of unresectable liver tumors. Eighteen patients with unresectable primary or metastatic tumor in the liver were treated with 57 procedures. Pharmacokinetic studies were performed on all treatments. Hepatic extraction ratio of doxorubicin remained constant at 60.3+/-12.1%. independent of the dose escalation. The calculated intrahepatic concentration of doxorubicin ranged from 30 to 88 microg/ml when the dosage of doxorubicin was escalated from 50 to 120 mg/m2. Dose-limiting systemic toxicity (grade 4 myelosuppression) was observed at 120 mg/m2. Twelve of 14 patients who received more than one treatment at 90 or 120 mg/m2 were evaluable for disease response: there were 4 partial responses, 3 minor responses, I stable disease, and 4 progressive disease. The median overall survival of responders was 23 months, and for nonresponders it was 8 months. We have demonstrated a dose-response effect of hepatic infusion of doxorubicin at 90 and 120 mg/m2 in advanced hepatic malignancies. The isolated hepatic perfusion system improves the therapeutic index of doxorubicin and provides pharmacologic justification for its use in the treatment of unresectable hepatic malignancies, especially metastatic melanoma and sarcoma.

Adult↗
PubMed1998

Transcatheter closure of an anomalous venous connection by a novel method.

Left superior vena cavae draining to the left atrium have traditionally been treated with surgical ligation. Advances in cardiac catheterization have made transcatheter closure a viable alternative to surgery. We report on an innovative method using a Greenfield filter and Gianturco coils for closure of a persistent left superior vena cava.

Abnormalities, Multiple↗
PubMed1989

Countertransference and failure to report child abuse and neglect.

Though every state has laws requiring the report of suspected child abuse and neglect, failure to report remains a significant problem. Review of previous research on failure to report suggests that the reporters' anxieties about disrupting their relationship with the child's family as well as the reporters' gender, experience, and training affect willingness to report. Countertransference fear, guilt, shame, and sympathy are discussed as a basis for understanding the reporter's anxieties. We suggest that countertransference issues should be addressed in the training and ongoing practice of mandated reporters. The following mechanisms are offered to deal with this issue in training and practice: (1) teaching professionals about how countertransference reactions may arise during the reporting process (this training may include the use of risk management groups for private practitioners); (2) identification of a community child abuse expert for consultation; and (3) educating child protection workers about psychodynamics aspects of case management.

Anger↗
PubMed1987

Relationship of obsessive-compulsive personality to obsessive-compulsive disorder: a review of the literature.

The nature of the relationship between obsessive-compulsive personality and obsessive-compulsive disorder has been the subject of considerable debate. The present article dealt with clinical opinion and reviewed empirical data bearing on this issue. It was concluded that, although the two clinical entities bear a surface similarity in terms of shared behavioral features and defenses, obsessive-compulsive personality is neither a necessary nor sufficient factor in the development of obsessive-compulsive disorder, though the latter appears to be more frequently associated with premorbid obsessive-compulsive personality patterns than with other personality patterns. Suggestions for future research study are made.

Compulsive Personality Disorder↗
PubMed1979

[A splitcast made of plastic].

A new two-piece plastic split cast consisting of an assembly plate and a disposable part was described; its use as a diagnostic an control device was discussed. The split is available for all standard articulators.

Dental Articulators↗
PubMedDate not supplied

Long-term outcome of embolotherapy and surgery for high-flow extremity arteriovenous malformations.

PURPOSE: To assess the long-term efficacy of embolotherapy in combination with surgery for management of symptomatic high-flow arteriovenous malformations (HFAVMs) of the lower and upper extremities. MATERIALS AND METHODS: Twenty consecutive patients with symptomatic high-flow lower extremity AVMs (LE-AVMs; n = 9) and upper extremity AVMs (UE-AVMs; n = 11) were treated from 1982 to 1999. All nine patients with LE-AVM had pain and seven had ulceration of the skin. All 11 patients with UE-AVM had debilitating pain, seven had weakness of the affected hand, and two had bony erosion. Embolization of the nidus beneath the site of maximum pain or ulceration was performed percutaneously from the femoral artery through coaxially placed microcatheters (n = 18) or surgical cutdown (n = 2). Cyanoacrylate (isobutyl or n-butyl) diluted with iophendylate or ethiodized oil was used in 19 of 20 patients. RESULTS: Follow-up was completed in eight of nine patients with LE-AVM (mean, 8.6 y) and nine of 11 patients with UE-AVM (mean, 7.4 y) after treatment. One patient with localized LE-AVM was functioning well 13 years after embolotherapy and another was functioning well 16 years after undergoing three embolotherapy procedures and two skin grafts. Five of nine patients with LE-AVM required below-the-knee (n = 4) or above-the-knee (n = 1) amputation 1-6 years after technically and clinically successful embolotherapy. All three trifurcation arteries were diffusely involved in HFAVM in patients requiring amputation. Healing of the two amputation sites, involved by AVM at the knee, was excellent after preoperative geniculate artery embolotherapy. All 11 patients with UE-AVM experienced marked symptomatic improvement; seven after embolotherapy alone and the other four after resection of AVM. One complication of digital spasm was reversed by administration of nerve blocks. CONCLUSIONS: LE-AVM with diffuse involvement of all three trifurcation arteries ultimately required amputation because of recurrence of symptoms after technically and clinically successful embolotherapy. Cyanoacrylate embolotherapy alone or in combination with surgical resection of the AVM provided excellent long-term palliation in patients with UE-AVM.

Adolescent↗
PubMedDate not supplied

Embolotherapy of pulmonary arteriovenous malformations with detachable balloons: long-term durability and efficacy.

PURPOSE: To determine long-term durability and efficacy of pulmonary arteriovenous malformation (PAVM) embolotherapy using detachable gold valve latex (GVB) and silicone balloons (DSB). MATERIALS AND METHODS: Eighty-two patients were treated with either GVBs or DSBs between 1991 and 1996. Complete follow-up, consisting of chest radiography or high-resolution chest computed tomography, was obtained in each patient between 1996 and 1998. The PAVM was considered cured if the aneurysmal portion was involuted with or without a small residual scar. RESULTS: Eighty-two of the 85 DSBs (96%) were inflated 2-4 years later, and none of the 56 GVBs remained inflated 1-3 years after placement. Despite early deflation of the GVB (91% at 1 month), only one PAVM persisted in both groups (DSB and GVB). Clinical and radiographic involution of the PAVMs was complete in all patients except one, who was easily re-treated. No migration of DSBs or GVBs to the systemic circulation occurred. CONCLUSIONS: DSBs and GVBs provide immediate cross-sectional occlusion of PAVM and are equally effective in "curing" the PAVM. The DSBs remain inflated 2-4 years after placement provided isoosmotic contrast material is used to inflate them and volume recommendations are adhered to. No early or late migration of the DSB or GVB occurs, provided they are securely placed.

Adult↗