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Biomedical subjects

M A Cahan

Publications and source records attributed to M A Cahan.

11 recordsLinked to original sources
PubMed1999

Duplex ultrasound insertion of inferior vena cava filters in multitrauma patients.

BACKGROUND: Techniques for placement of inferior vena cava (IVC) filters have undergone continued evolution from open surgical exposure of the venous insertion site to percutaneous insertion in most cases today. However, the required transport either to an operating room or interventional suite can be complex and potentially hazardous for the multiply injured trauma patient who may require ventilator support, controlled intravenous infusions, or skeletal immobilization. Increased experience with color-flow duplex scanning for routine IVC imaging and portability of ultrasound equipment have suggested the usefulness of duplex-guided IVC filter insertion (DGFI) in critically ill trauma and intensive care unit (ICU) patients. METHODS: A total of 25 multitrauma/ICU patients were considered for DGIF. Screening color-flow duplex scans were performed on all patients, and obesity or bowel gas prevented ultrasound imaging in 2 cases, leaving 23 patients suitable for DGFI. In each case, the IVC was imaged in the transverse and longitudinal planes. The right renal artery was identified as it passed posterior to the IVC and was used as a landmark of the infrarenal segment of the IVC. All procedures were performed at the bedside in a monitored ICU setting using percutaneous placement of titanium Greenfield filters. Duplex scanning after insertion was used to document proper placement, and circumferential engagement of the filter struts in the IVC wall. An abdominal radiograph was also obtained in each case to confirm proper filter location. Duplex ultrasound imaging was repeated within 1 week of insertion to assess IVC and insertion site patency. RESULTS: DGFI was successful in all cases. The filter was deployed at a suprarenal level in one case, as was recognized at the time of postprocedural scanning. Three patients died as a result of their injuries but there were no pulmonary embolism deaths. Repeat duplex scanning was obtained in 17 patients, and revealed no case of IVC or insertion site thrombosis. CONCLUSIONS: Vena caval interruption can be safely performed under ultrasound guidance in a monitored, ICU environment. In selected multiply injured trauma patients, this will reduce the risk, complexity and cost of transport for these critically ill patients. DGFI also reduces procedural costs compared with an operating room or interventional suite, and eliminates intravenous contrast exposure. Preprocedural scanning is essential to identify patients suitable for DGFI, and careful attention must be paid to the known ultrasonographic anatomical landmarks.

Adult↗
PubMed1999

The prevalence of carotid artery stenosis in patients undergoing aortic reconstruction.

BACKGROUND: Coronary artery disease occurs frequently in patients undergoing aortic reconstruction, and it has been presumed that internal carotid artery occlusive disease is also common. This has led to the practice of screening for and repairing significant carotid lesions in asymptomatic patients prior to aortic reconstruction. The purpose of this study was to determine the true prevalence of internal carotid artery disease in these patients. METHODS: The records of 240 patients who underwent duplex ultrasound screening for carotid artery disease prior to aortic reconstruction were reviewed. Surgery was performed for aortic aneurysm (AA) or aorto-iliac occlusive disease (AO). The prevalence of hyperlipidemia and coronary artery disease was similar between the two groups, but tobacco use, hypertension, and diabetes mellitus differed. RESULTS: Internal carotid artery stenosis > or = 50% occurred in 26.7% of the total group (64 of 240 cases). Stenosis > or = 50% was more common in the AO group (40 of 101 cases, 39.6%) than the AA group (24 of 139 cases, 17.3%, P = 0.0001). Severe disease (70% to 99%) was also more common in the AO group than the AA group (9.9% versus 3.6%, P = 0.0464). CONCLUSION: Internal carotid artery disease occurs commonly in patients undergoing aortic reconstruction, and screening is worthwhile. Significant disease is more common in patients with aorto-iliac occlusive disease than in those with aortic aneurysm, although atherosclerotic risk factors occur with varying frequency in the two groups. These findings suggest that additional factors may contribute to the higher prevalence of internal carotid artery stenosis in aorto-iliac occlusive disease.

Aged↗
PubMed1999

The effect of cigarette smoking status on six-minute walk distance in patients with intermittent claudication.

The purposes of the study were threefold: (1) to compare 6-minute walk performance as a measure of exercise tolerance among three different groups of peripheral arterial occlusive disease (PAOD) patients with intermittent claudication-current smokers, former smokers, and patients who have never smoked; (2) to identify important covariates that might affect the relationship between smoking and exercise in the PAOD population; (3) to determine whether differences among the three groups in 6-minute walk performance persist after statistically controlling for the significant covariates. Recruited into the study were 415 PAOD patients with intermittent claudication between the ages of 42 and 88 years. The self-reported smoking status consisted of 182 current smokers, 196 former smokers, and 37 patients who had never smoked. The authors recorded 6-minute walk distance, a reliable measurement of exercise tolerance in PAOD patients, as well as age, body composition, self-reported ambulatory function, self-reported physical activity, and standard peripheral hemodynamics. Nonsmokers walked significantly farther (413 +/- 14 m; mean +/- standard error) and took more steps (665 +/- 14 steps) than either current (352 +/- 7 m; 563 +/- 9 steps) or former smokers 370 +/- 7 m; 600 +/- 8 steps) (p<0.05). The nonsmokers had a higher ankle-brachial index (ABI) value (0.70 +/- 0.03) than patients who actively smoked 0.62 +/- 0.01 (p<0.03); the authors observed an inverse relationship between smoking history and self-reported physical activity (WIQ Distance Score: nonsmokers 51 +/- 6%, former smokers 38 +/- 3%, and smokers 32 +/- 2%) (p<0.01). From a multivariate perspective, ABI, physical activity, and perceived walking ability were the only independent predictors of 6-minute walk distance. Differences in the adjusted 6-minute walk distance among the nonsmokers (388 +/- 13 m), current smokers (359 +/- 6 m), and former smokers (368 +/-6 m) no longer remained after controlling statistically for these covariates. The findings suggest that 6-minute walk distance is a sensitive measure to detect differences in submaximal exercise performance between smoking and nonsmoking PAOD patients with intermittent claudication. Moreover, the group difference in the 6-minute walk distance is explained by group differences in walking perception, PAOD severity, and physical activity level.

Adult↗
PubMed1996

Less common orbital fracture patterns: the role of computed tomography in the management of depression of the inferior oblique origin and lateral rectus involvement in blow-in fractures.

During the past decade, advances in radiographic imaging have made it possible for the surgeon managing orbital fractures to adopt a rational therapeutic strategy based on a knowledge of alterations in surgical anatomy secondary to traumatic injury. To illustrate the value of computed tomography in the surgeon's armamentarium for management of orbital fractures, cases are presented in which imaging proved decisive in planning a course of therapy. Two patients presented with two types of isolated lateral blow-in fracture, an uncommon fracture pattern. The other cases underscore the value of defining involvement of the inferior oblique origin and lateral rectus muscles in imaging complex orbital fractures, issues not emphasized in earlier literature. Although diplopia alone does not always warrant surgical intervention, diplopia in the context of computed tomography-defined muscle entrapment or muscle origin displacement justifies operative therapy. These cases demonstrate the value of computed tomography in directing surgical therapy with resolution of diplopia and prevention and correction of enophthalmos.

Accidental Falls↗
PubMed1994

Interstitial taxol delivered from a biodegradable polymer implant against experimental malignant glioma.

Taxol is a novel antitumor agent with demonstrated efficacy against ovarian, breast, and non-small cell lung cancers in Phase II clinical trials, but which has been shown not to cross the blood-brain barrier. To adapt taxol as a therapy for brain tumors, we have incorporated it into a biodegradable polyanhydride matrix for intracranial implantation and evaluated this formulation in a rat model of malignant glioma. Fischer 344 rats bearing intracranial 9L glioma tumors were treated with 10 mg poly[bis(p-carboxyphenoxy)propane-sebacic acid] (20:80) copolymer discs, containing 20-40% taxol by weight, 5 days after tumor implantation. The taxol-loaded polymers doubled (38 days, 40% taxol loading, P < 0.02) to tripled (61.5 days, 20% taxol loading, P < 0.001) the median survival of rats bearing tumor relative to control rats (19.5 days). Drug loadings of 20-40% taxol by weight released intact taxol for up to 1000 h in vitro. In rats followed up to 30 days postimplant, the polymer maintained a taxol concentration of 75-125 ng taxol/mg brain tissue (100-150 microM taxol) within a 1-3-mm radius of the disc. At points more distant from the disc (up to 8 mm away, the size limit of the rat brain), the polymer maintained a taxol concentration of greater than 4 ng taxol/mg brain tissue (5 microM). We conclude that taxol shows promise as a therapy for malignant glioma when delivered interstitially from a biodegradable polymer.

Animals↗
PubMed1994

Cytotoxicity of taxol in vitro against human and rat malignant brain tumors.

Taxol is a novel antitumor alkaloid that has shown clinical activity against several tumors, including ovarian and breast carcinoma and melanoma. To evaluate taxol's potential as a therapy for malignant brain tumors, we measured the sensitivity of four human (U87, U373, H80, and D324) and two rat (9L, F98) brain-tumor cell lines to taxol. The cells were exposed to taxol in vitro using a clonogenic assay. Log cell kill (LD90) occurred at concentrations of 42 (9L), 25 (F98), 19 (H80), 7.2 (U373), 9.1 (U87), and 3.9 nM (D324) when cells were continuously exposed to taxol for 6-8 days. The human cell lines were uniformly more sensitive to taxol than were the rat lines. The duration of exposure had a significant effect on taxol's cytotoxicity. When cells were exposed to taxol for 1 h the LD90 increased to 890 nM for the 9L rat line and 280 nM for the human U373 line. On the basis of these results, we conclude that taxol has significant potency in vitro against malignant brain tumors and that the activity occurs at concentrations of taxol that have previously been shown to be effective for several tumors against which the drug is currently being evaluated clinically.

Animals↗
PubMed1994

Detection of biological activity in the cerebrospinal fluid of patients with central nervous system tumors.

Tumor markers for brain tumors are important for initial diagnosis and monitoring of treatment. We used a modification of the phagokinetic track assay, which measures the migration of cells across a coverslip that is coated with colloidal gold, to assess whether the CSF from patients with brain tumors and other non-neoplastic neurological disorders altered the migration of Balb/c 3T3 fibroblasts. We found that CSF from patients with brain tumors stimulated the migration activity at a significantly higher level than did CSF from patients without tumors (mean migration activity: 65 +/- 9% for CSF from 113 patients with brain tumors; 14 +/- 4% for 44 patients with non-neoplastic CNS disease; and 9 +/- 1.2% for 54 patients with metabolic or other disorders). Thus the ability of CSF to stimulate migration of 3T3 cells appears to be a promising approach to detecting, understanding and following the activity of brain tumors.

3T3 Cells↗
PubMed1994

Development of endogenous beta-galactosidase and autofluorescence in rat brain microvessels: implications for cell tracking and gene transfer studies.

Cell transplantation is commonly used in studies of CNS development, tumor biology, and gene therapy. Fluorescent dyes and the E. coli lacZ reporter gene are used to identify transplanted cells in host tissues. The usefulness of these methods depends on host autofluorescence and beta-galactosidase (beta-Gal) activity. Our interest in the CNS vasculature led us to examine vascular autofluorescence and beta-Gal activity in postnatal and adult rat brains. Brains were perfusion-fixed (3.7% paraformaldehyde), cryoprotected, and cryostat-sectioned (12 microns). Autofluorescent vessel profiles were quantitated in sections using rhodamine filter sets and beta-Gal-positive vessels were quantitated under bright-field after incubation of sections with X-Gal chromogenic substrate for 1-18 hr at 37 degrees C. Multifocal vessel autofluorescence appeared in postnatal Day (PND) 18 Lewis rats (0.6 +/- 0.4 vessels/field) and increased tenfold in adults (6.8 +/- 0.3/field). The numbers of beta-Gal-positive vessels in PND 18 and adult sections incubated with X-Gal for 18 hr were 21.1 +/- 1.7 and 119 +/- 17, respectively. Host beta-Gal staining was similar to that produced by implanted endothelial cells expressing the bacterial lacZ reporter gene. Reducing incubation times in X-Gal to less than 4 hr eliminated endogenous staining and retained lacZ-specific staining. The presence of vascular autofluorescence and endogenous beta-Gal activity must be considered when either fluorescence- or lacZ-dependent cell markers are used in rat brain.

Animals↗
PubMed1992

The Johns Hopkins Swallowing Center database.

A special database has been constructed for faculty working in the Swallowing Center of The Johns Hopkins University School of Medicine. The database supports the clinical, research, and publication needs of the Center. This database on swallowing disorders includes over 6000 references to the literature dating from the mid-1960s. The system operates on microcomputer technology and uses relatively inexpensive and intuitive software programs. Monthly updates keep members informed of the latest developments in a multidisciplinary literature.

Databases, Factual↗
PubMed1989

GRATEFUL MED: a tool for studying searching behavior.

The latest release of GRATEFUL MED offers medical libraries an opportunity to monitor searching patterns of end users searching the databases of the National Library of Medicine (NLM). A GRATEFUL MED use log records information from each search session. Analysis of the log from a recent beta test program at the Welch Medical Library indicates that most NLM searches occur in the MEDLINE database. Moreover, the study reveals that searchers overlook many user-friendly features of the program. Evaluation of the use log suggests changes for future versions of the program.

Academic Medical Centers↗