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Biomedical subjects

M Cooperman

Publications and source records attributed to M Cooperman.

At least 19 recordsLinked to original sources
PubMed1992

Right upper quadrant calcification: porcelain gallbladder disease.

Large solitary calcification in the right upper quadrant is rarely seen in the United States. It may indicate disease in the gallbladder, adrenal glands, kidneys, pancreas, lungs or chest wall. Disease processes associated with calcification in these organs include echinococcal cysts, calcified renal cysts, chest wall masses and degenerative cystic lesions of the pancreas and adrenal glands. However, if calcification is associated with porcelain gallbladder, the incidence of carcinoma is high. Treatment consists of cholecystectomy with a careful search for malignancy.

Calcinosis↗
PubMed1979

Chronic and recurrent appendicitis.

Acute appendicitis is a well known clinical entity, but many physicians are unwilling to accept appendicitis as a chronic or recurrent illness. Of 225 patients undergoing appendectomy, sixteen (7 per cent) had findings suggestive of chronic, recurrent, or subacute appendicitis. Four patients had chronic abdominal pain and histologic findings of chronic inflammation. Nine patients had previous episodes similar to that which resulted in appendectomy. All had acute suppurative appendicitis pathologically. Three patients had only one episode of abdominal pain, but had pathologic evidence of subacute inflammation. Because this study was retrospective, we suspect that the true incidence of recurrent appendicitis is significantly greater, as reported by others. Indications for operation must be strict, for unless there are specific signs and symptoms of appendiceal disease, appendectomy will often be of no benefit.

Abdomen↗
PubMed1979

Detection of deep venous thrombosis by impedance plethysmography.

Ninety-eight limbs in sixty-seven patients supected of having lower extremity deep venous thrombosis were evaluated by physical examination, venous impedance plethysmography (IPG), and venography. Diagnosis based on physical signs commonly associated with deep venous thrombosis was false-positive in 43 to 66 per cent and false-negative in 26 to 73 per cent when compared with evidence obtained by venography. The overall accuracy of IPG was 94 per cent, with false-positive results occurring in 10 per cent and false-negative results in 4 per cent. IPG is sufficiently accurate to be considered a reliable screening test for lower extremity deep venous thrombosis.

Adolescent↗
PubMed1979

Surgical decision-making in the treatment of pancreatic pseudocysts. Internal versus external drainage.

One hundred patients with documented pancreatic pseudocysts who underwent surgical drainage are reported on. Accurate assessment of the size and location of the pseudocyst using ultrasonography, endoscopic retrograde cholangiopancreatography, angiography, and upper gastrointestinal roentgenography is essential. After diagnosis, the next 4 to 7 weeks is a critical period, after which surgical intervention becomes mandatory if the cyst has not resolved. This period between diagnosis and operation is hazardous and demands close clinical follow-up. When oepration is required, the preferred procedure continues to be internal drainage because it is associated with less morbidity and a lower mortality. However, external drainage appears to be a suitable second choice. Fewer than 10 per cent of the patients in this series who underwent external drainage developed fistulas, and the overall rate of late morbidity was acceptable.

Abscess↗
PubMed1979

Use of Doppler ultrasound in intestinal surgery.

Doppler ultrasonography was used intraoperatively in 117 patients undergoing intestinal anastomosis or enterostomy to determine the adequacy of blood supply at the margins of resection. Doppler findings were compared with clinical assessment of intestinal blood flow by the operating surgeon. In 92 per cent of cases, Doppler signals and clinical observation coincided. However, in five of six cases in which Doppler signals were absent at one margin, the surgeon resected additional intestine, selecting margins within 1 cm of the nearest arterial Doppler signal. All five patients had uneventful healing. In the one case in which the surgeon chose to rely onthe appearance of the bowel despite the absence of Doppler arterial signals, ischemic necrosis of the proximal segment and anastomotic disruption occurred. The technique of Doppler ultrasonography is readily learned, and the instrument is available in most hospitals. Intraoperative use of Doppler ultrasonography can help identify intestine lacking a blood supply adequate to assure viability before changes in the appearance of the bowel alert the surgeon to the problem.

Colon↗
PubMed1979

Use of Doppler ultrasound in intraoperative localization of intestinal arteriovenous malformation.

Precise localization of an intestinal arteriovenous malformation is essential for the complete resection of the lesion. Identification at operation can be difficult, and intraoperative angiography is not without complications. Blood flow within the small vessels of the bowel wall can be easily detected by Doppler ultrasonography, and arterial flow can be distinguished from venous flow. Intraoperative use of the Doppler ultrasound technique localized an AVM in the small intestine. Distinctive flow signals were present over the intestinal AVM which allowed it to be easily differentiated from adjacent normal intestine. Confirmation was secured by measuring the PO2 of blood aspirated from the vein draining the involved segment and comparing it to the PO2 from a vein draining an adjacent segment.

Arteriovenous Malformations↗
PubMed1979

Assessment of anastomotic blood supply by Doppler ultrasound in operations upon the colon.

Doppler ultrasound was used to determine whether or not colonic anastomoses have sufficient blood supply for healing to occur. Experimental anastomoses placed at, or 1 centimeter from, the last audible arterial signal healed; those placed 2 or 3 centimeters distally had a high incidence of disruption. Results were statistically significant by chi-square analysis, p less than 0.05. Clinical parameters of intestinal viability would not have predicted anastomotic failure.

Animals↗
PubMed1979

Correction of hypersplenism following distal splenorenal shunt.

The effect of splenorenal shunt on hypersplenism was assessed in 47 patients with splenomegaly, 26 of whom had significant thrombocytopenia or leukopenia. Of 16 patients with thrombocytopenia, platelet count returned to normal in 15 (94%) following operation, an improvement which was statistically highly significant (P less than 0.001). Of 16 patients with leukopenia, leukocyte count returned to normal in 11 (69%), also a highly significant improvement (P less than 0.001). Dramatic relief of hypersplenism occurs in the majority of patients following splenorenal shunt. Thrombocytopenia is more consistently corrected than is leukopenia. The etiology of liver disease appeared not to be a factor, but leukopenia was corrected more consistently in alcoholic than in nonalcoholic patients, while there was no difference in the postoperative response of thrombocytopenia to the operation. Long-term follow-up in 26 patients demonstrated sustained improvement in 57% of patients with preoperative leukopenia and 78% of patients with thrombocytopenia. Since significant improvement in leukopenia and thrombocytopenia will occur following the distal splenorenal shunt, hypersplenism is not a contraindication to this procedure.

Female↗
PubMed1978

Intraoperative localization of intestinal arteriovenous malformation.

Intestinal arteriovenous malformation (AVM) is an uncommon cause of gastrointestinal hemorrhage and is difficult to diagnose. Selective visceral angiography is essential to make the diagnosis and to localize the lesion. We treated two patients in whom AVMs of the small intestine were located by means of arteriography and intraoperative selective mesenteric venous pressure and PO2 measurements. The local venous return from an intestinal AVM is characterized by elevated venous pressure and PO2 levels compared with the venous drainage of adjacent normal intestine.

Aged↗
PubMed1978

Significance of asymptomatic carotid bruits.

To assess the significance of the asymptomatic carotid bruit, the subsequent occurrence of symptomatic cerebrovascular insufficiency and stroke in 256 patients who had undergone operation for atherosclerosis arterial occlusive disease of the lower extremities was documented during a period of two to seven years postoperatively. At the time of operation, none had had a stroke or exhibited symptoms of cerebrovascular insufficiency, but 60 of the 256 patients had audible carotid bruits. A statistically significant difference was demonstrated: 21 (35%( of the 60 patients with carotid bruits exhibited manifestations of cerebrovascular insufficiency, in contrast to 30 (16%) of the 196 patients without bruits. It seems that detection of an asymptomatic carotid bruit is not an innocent finding, but rather predicts a higher incidence of cerebrovascular complications than that expected on the basis of generalized atherosclerosis alone.

Adult↗
PubMed1978

An assessment of carotid phonoangiography and oculoplethysmography in the detection of carotid artery stenosis.

Carotid phonoangiography (CPA) and oculophlethysmography (OPG) examinations for the detection of extracranial carotid occlusive disease were performed in 308 patients, 103 of whom underwent arch angiography. When correlated with angiographic findings, the overall accuracy of CPA/OPG was 86 per cent. There were 4 per cent false-positive 9.6 per cent false-negative results, and these were further analyzed. Significant carotid bruits demonstrated by CPA strongly suggested the presence of appreciable carotid stenosis. Noninvasive CPA/OPG is an excellent diagnostic tool in patients with non-hemispheric symptoms, in those with asymptomatic bruits, as a screening procedure in potential stroke victims, and for follow-up after cartotid endarterectomy. Caution is advised in relying on this and other noninvasive technics as the sole method for recommending angiography and operative treatment in symptomatic patients.

Adult↗
PubMed1978

Abdominal aortic surgery in the presence of a horseshoe kidney.

Prior experience with the rare combination of horseshoe kidney and significant atherosclerotic vascular disease suggests difficulty in intraoperative management, often requiring division of the renal isthmus or sacrifice of some renal tissue. Seven patients have been managed successfully over the past ten years at The Ohio State University Hospital. There were six men and one woman, ranging in age from 39 to 66 years. Of the five patients with abdominal aortic aneurysm, four had a pulsatile abdominal mass, three had abdominal pain, and one had back pain. The other two patients had progressively symptomatic aortoiliac disease. All seven patients had hypertension, easily controlled by medication. Critical diagnostic procedures are preoperative intravenous pyelogram (IVP) and abdominal aortic arteriogram. The IVP detected the previously unsuspected diagnosis in 100% of the cases. The arteriogram accurately located the aneurysm in relation to the renal vascular supply, and disclosed aberrant blood supply in three of four patients with aberrant vessels. All seven horseshoe kidneys were fused at the lower pole. The operative approach involves meticulous dissection of the aberrant blood supply to the kidneys, and mobilization of the isthmus for adequate retrorenal aortic exposure. In six of the seven patients, the grafts were placed posterior to the isthmus. There were no deaths, and there were no complications related to the presence of the horseshoe kidney. In three of the seven patients, hypertension improved. Patients with horseshoe kidney and aortic disease may be safely operated upon without damage to the kidney. IVP and selective angiography are essential to provide preoperative information.

Adult↗
PubMed1978

Observations on fifty distal splenorenal shunts.

Fifty patients underwent conventional distal splenorenal shunts for bleeding esophageal varices. Five patient died within 30 days, giving an operative mortality of 10%. Three patients were lost of follow-up, but 47 patients were evaluated. Twelve patients died, 11 of liver failure, with more than half of the deaths occurring with 1 year, three fourths within 2 years, and all within 3 years after operation. Eleven patients rebled, and seven of these were among those who died. Sixteen patients had ascites prior to operation, but all responded to aggressive medical therapy. Twenty-two patients were available for study 2 or more years following operation. Eighteen (82%) are well with no encephalopathy, although the remaining four (18%) have had transient episodes of encephalopathy. Sixteen of the 18 patients judge their lifestyles to be productive. If the patient survived 24 months or longer, he had a four in five chance of living a normal life.

Adolescent↗
PubMed1978

Determination of viability of ischemic intestine by Doppler ultrasound.

Doppler ultrasound was used to determine the viability of ischemic small intestine and to select the optimum point for resection of nonviable bowel. Twenty ischemic segments of small intestine were produced in dogs by ligating the vascular supply. The Doppler ultrasound probe then was used to determine the last point of arterial flow within the bowel wall. The dogs were reexplored after 24 hours. Histological examination of full-thickness biopsies showed the intestine to be normal in all 20 segments at the last audible Doppler signal, and in 19 of the 20 segments at 1 cm distal to the last signal. Progressive degrees of necrosis were observed at 2 and 3 cm distal to the last signal. Twenty-five segments of ischemic intestine were resected in baboons. All resections performed at the last Doppler signal or 1 cm distal to it were normal 1 month later. Of 15 resections performed at 2, 3, and 4 cm distal to the last signal, 10 showed evidence of stricture or anastomotic disruption. Doppler ultrasound is a reliable method for determining the viability of ischemic intestine and for selecting the optimum point for resection of nonviable bowel.

Animals↗
PubMed1978

The significance of asymptomatic unilateral carotid bruits in preoperative patients.

The significance of asymptomatic carotid bruits was evaluated in patients undergoing major vascular operative procedures. A retrospective analysis of 588 patients was performed. Ninety-two patients (15%) had unilateral carotid bruits detected on admission examination. None had had cerebrovascular symptoms. Four postoperative strokes occurred in the total group of 588 patients. All occurred in patients without bruits. There were no permanent or transient postoperative neurological deficits in the group of patients with asymptomatic unilateral carotid bruits. We can find no data to support the necessity for preoperative carotid arteriography and endarterectomy in the patient with an asymptomatic carotid bruit prior to undergoing a major operative procedure.

Auscultation↗