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Biomedical subjects

J W Schaefer

Publications and source records attributed to J W Schaefer.

At least 19 recordsLinked to original sources
PubMed1991

Marked elevations of serum alkaline phosphatase in patients with AIDS.

We have observed many patients with AIDS who have unexplained marked elevations in serum alkaline phosphatase. To determine the frequency of alkaline phosphatase elevations in patients with AIDS, and to identify diagnoses, medications, and demographic factors associated with such elevations, we conducted a retrospective study of the first 90 consecutive AIDS cases in hospitals affiliated with the University of Colorado Health Sciences Center in Denver, Colorado. We found elevations of alkaline phosphatase in excess of 1,000 IU/L in 17% of consecutive patients with AIDS. This level of elevation was less frequent in patients with Kaposi's sarcoma but there was otherwise no significant association with diagnoses or medications, or transmission categories for AIDS. The majority of the patients with elevations to this level did not have documented opportunistic infections or biliary tract dilatation previously described in the "cholangitis" syndrome in AIDS patients. Other explanations for these elevations for this common laboratory finding may exist.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Peritoneovenous shunt in the management of the hepatorenal syndrome.

The hepatorenal syndrome (HRS) is a terminal complication of severe liver disease associated with a mortality of 80 to 90%. Although the renal functional abnormalities in the HRS suggest prerenal azotemia, volume expansion with saline, albumin or ascitic fluid rarely results in reversal of the HRS because fluid redistributes from the vascular space. Since the peritoneovenous (PV) shunt causes sustained central volume expansion, it has been advocated for the treatment of the HRS. We prospectively compared the PV shunt (N = 10) to Medical Therapy (MED) (N = 10) on renal function and mortality in 20 patients with the HRS associated with alcoholic liver disease. The HRS was diagnosed on the basis of clinical, hemodynamic, and laboratory criteria. The insertion of a PV shunt resulted in an increase in pulmonary capillary wedge pressure (4.2 +/- 1.1 vs. -1.5 +/- 1.0 mm Hg, P less than 0.01) and in cardiac index (0.8 +/- 0.3 vs. -0.2 +/- 0.3 1/min/m2, P less than 0.05). After 48 to 72 hours, weight (+3.1 +/- 1.1 kg) and serum creatinine (3.9 +/- 0.5 to 5.5 +/- 0.7 mg/dl, P less than 0.001) were increased with MED therapy and decreased (weight: -3.7 +/- 0.7 kg; serum creatinine: 3.6 +/- 0.4 to 3.0 +/- 0.5, P less than 0.05) with the PV shunt. Despite improvement in renal function, only one patient with the PV shunt had prolonged survival (210 days). In the remainder, survival was 13.8 +/- 2.2 days compared to 4.1 +/- 0.6 days with MED therapy. We conclude that the PV shunt often stabilizes renal function, but does not prolong life in patients with the HRS.

Adult↗
PubMed1982

Chylous ascites after an H-graft interposition mesocaval shunt.

A case of chylous ascites occurring after an emergency mesocaval shunt is reported. After an attempt at conservative management had failed, the patient was surgically explored. Although a lymphatic leak could not be identified, oversewing the retroperitoneum in the area of previous dissection and reinforcement with an omental pedicle was successful in preventing postoperative reaccumulation of chylous ascites. A review of the 26 reported cases of postoperative chylous ascites indicates a spontaneous resolution rate of 41% with non-operative management including low fat diet, paracenteses, and total parenteral nutrition. If conservative measures fail, surgical repair of the traumatised lymphatic bed has been successful.

Adult↗
PubMed1982

Esophageal ulceration and bleeding after flexible fiberoptic esophageal vein sclerosis.

Three patients with portal hypertension and variceal hemorrhage were treated with flexible fiberoptic esophageal vein sclerosis by injection of sodium morrhuate. Each of these patients bled after sclerotherapy, and deep esophageal ulcers were found at the previous injection sites. Postsclerotherapy pathologic features are presented in 2 patients. It is suggested that the sclerotherapy caused esophageal ulceration and bleeding. Careful evaluation of the sclerosing technique and its histopathologic consequences is needed.

Adult↗
PubMed1980

Selective intra-arterial vasopression in fusion for upper gastrointestinal tract hemorrhage: a controlled trial.

In a prospective randomized study, 38 patients with massive upper gastrointestinal tract hemorrhage, mostly due to esophageal varices or erosive gastritis, were treated with either standard medical therapy or standard therapy plus selective intra-arterial vasopressin infusion. Cessation of hemorrhage occurred more frequently in the vasopressin-treated group. The study design did not permit meaningful comparisons of mortality of transfusion requirements. We conclude that in patients bleeding from esophageal varices or gastritis, selective intra-arterial vasopressin is more effective in controlling hemorrhage than standard therapy.

Adult↗
PubMed1978

Complications of diagnostic paracentesis in patients with liver disease.

A retrospective analysis of 242 consecutive diagnostic abdominal paracenteses in patients with liver disease disclosed seven major complications, including serious hemorrhage (four), perforation of bowel with generalized peritonitis (one), perforation of bowel with abdominal wall abscess (one), and a catheter fragment left in the abdominal wall or cavity (one). The results of this study emphasize the potential dangers of this procedure in these patients and raise the possibility that complications may be more common than previously thought.

Abdominal Muscles↗
PubMed1977

Clinitest ingestion.

Eight patients who had ingested Clinitest tablets were seen in one hospital over four years. Nineteen reported cases were also reviewed. Clinitest ingestion seems to be more common than was thought. Gastric lesions are common, though the frequency of serious sequelae has been overestimated in reports. Some features of Clinitest ingestion differ from those produced by ingesting other alkalis. These include a higher frequency of adult and accidental ingestion, a lower prevalence of pharyngeal lesions, and oesophageal strictures that tend to be more proximal, shorter, and earlier in onset. The incidence of accidental ingestion by adults would probably be reduced if other methods of testing urine were used in patients who are likely to misunderstand instructions or mistake the tablets for others and if Clinitest tablets could be made in a distinctive size and shape.

Adolescent↗
PubMed1977

Oral cholecystography after alcoholic pancreatitis.

Retrospective and prospective studies were done to evaluate the efficacy of oral cholecystography (OCG) performed before hospital discharge on alcoholic patients with acute pancreatitis. In the retrospective study, OCG adequately opacified the gallbladder in 21 of 26 patients (81%). Of the 5 patients with inadequate opacification, 1 was jaundiced at the time of OCG; the other 4 had OCG before resumption of solid food. In the prospective study, OCG done in nonjaundiced patients shortly after resumption of food yielded adequate opacification in 19 of 21 patients (90%) without gallstones. We conclude that in nonjaundiced alcoholic patients with acute pancreatitis not caused by gallstones, OCG performed after resumption of a solid diet and before hospital discharge is usually successful in opacifying the gallbladder.

Alcoholism↗
PubMed1972

Failure of hypoxic pulmonary vasoconstriction in patients with liver cirrhosis.

The combination of arterial hypoxemia and low pulmonary vascular resistance in patients with liver cirrhosis is unexplained. Pulmonary microcirculatory dilation, but not gross arterio-venous shunts, has been the usual postmortem finding in patients with liver cirrhosis. When 10 patients with alcoholic liver cirrhosis breathed 10% oxygen in nitrogen, they failed to increase their pulmonary vascular resistance. However, four patients with functional murmurs, three patients with hyperkinetic heart syndrome, six patients with normal pulmonary artery pressures and intracardiac left to right shunts, and five patients with renal failure and anemia all increased their pulmonary vascular resistances when they breathed 10% oxygen in nitrogen. These findings suggested that in liver cirrhosis the normal regulating mechanism (hypoxic vasoconstriction) of the pulmonary circulation may be impaired, resulting in failure of the lung to match perfusion with ventilation.

Adolescent↗