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Biomedical subjects

M D Kerstein

Publications and source records attributed to M D Kerstein.

At least 217 records · Page 12Linked to original sources
PubMed1983

Septic pelvic thrombophlebitis: an update.

Septic pelvic thrombophlebitis is the result of serious pelvic infection usually following obstetric or gynecologic procedures. The management of this condition is of historical interest to the department of obstetrics and gynecology at Tulane, and therefore a retrospective case evaluation and a prospective surveillance were undertaken. This study indicates that septic pelvic thrombophlebitis is seen very rarely today. Possible reasons for the decline in the incidence of this problem and a management plan are presented. Three cases are included.

Adult↗
PubMed1983

Improving predictive value of complementary tests in carotid artery disease.

In a prospective study the accuracy of B-mode ultrasound imaging alone was compared with its use in conjunction with bidirectional Doppler ultrasound, carotid phonoangiography, and oculoplethysmography to independently assess contrast arteriograms of carotid arteries studied for presumed extracranial vascular disease. The addition of B-mode real-time imaging improved the accuracy of diagnosis by nearly 10%.

Aged↗
PubMed1982

Leg ulcer. Conservative management or surgical treatment?

In a specific indigent socioeconomic setting, the nonsurgical management of 65 patients with chronic leg ulcers resulted in 59 cures. There were 42 patients (67%) with postphlebitic syndrome. Twenty-two patients (33%) had varicose veins (eight had postoperative vein stripping), 14 (22%) had deep-vein thrombosis, and 11 (15%) had associated neurological problems. Fifty-six patients (86%) were treated with pressure dressings that were changed once a week in an outpatient clinic, seven patients wore skintight plaster casts for variable periods of time, and two patients had split thickness skin grafts plus lumbar sympathectomies. In more than two thirds of the patients, the ulcers healed. In another 17 patients (26%), a satisfactory response to treatment was observed. In only six patients did therapy fail. Failures were attributed to the multiple medical and surgical problems of the patients or their lack of cooperation. Nonsurgical treatment of venous stasis ulcer is inexpensive and effective.

Adult↗
PubMed1982

Management of traumatic peripheral vein injuries. Primary repair or vein ligation.

The management and outcome of 83 patients who had 86 venous injuries were retrospectively reviewed to identify optimal management techniques in patients with peripheral vein injuries. Venous injuries of the arms were associated with no long-term sequelae, and management with vein ligation appears safe. In patients with venous injuries of the legs, primary repair by lateral suture or primary end-to-end reanastomosis is recommended when technically easy. In patients who are unstable or in whom primary repair cannot be performed, vein ligation is recommended. Autogenous vein interposition grafting appears indicated only in the popliteal area when vein reconstitution should be aggressively sought. Vein ligation in peripheral vein injuries should be followed with aggressive postoperative management to prevent the development of distal edema. Limb elevation is effective in minimizing the development of adverse sequelae.

Adolescent↗
PubMed1982

Perineal trauma and vasculogenic impotence.

Twenty men were subjected to a brief period of perineal compression. Measurement of brachial, ankle and penile blood pressures revealed a reversible decrease in pressure. Penile pressure can be measured accurately. It represents an objective method of measuring vasculogenic impotence.

Adult↗
PubMed1982

The role of dilantin in the prevention of pulmonary edema associated with cerebral hypoxia.

Twenty-five mongrel dogs were subjected to isolated cerebral hypoxia or noncerebral systemic hypotension to create the congestive pulmonary lesions of the shock lung syndrome (SLS). Eleven of the experimental dogs were pretreated with 5, 5-diphenylhydantoin (DPH). Prophylactic DPH protects the lung from the injury that is a consequence of hypoxic cerebral perfusion in the dog, but does not afford protection from pulmonary damage caused by isolated, noncerebral systemic hypotension. DPH confers this protection on the brain; there is no evidence that DPH exerts this protective effect by an action on the pulmonary parenchyma directly or on other tissue in the body.

Animals↗
PubMed1982

Brachial artery reconstruction after traumatic disruption.

We describe a series of 21 cases of traumatic disruption of the brachial artery that required surgical intervention. Stab wounds were most frequent (11), followed by gunshot wounds (six) and blunt trauma (four). Ten patients had associated upper extremity injuries including bone, nerve, and vein. Arterial repair with lateral sutures could be accomplished in only one case. Segmental resection of the artery required interposition grafts using autogenous saphenous or cephalic vein in 11 patients. No synthetic graft material was used, and prophylactic antibiotics were given to all patients. All patients are without sequelae a median of 12 months after operation. Complete neurovascular evaluation, including arteriography and venography where indicated, followed by prompt repair is necessary for a successful outcome. The cephalic vein was an excellent alternative for an interposition graft in this series of patients. Primary repair of concomitant injuries, use of perioperative prophylactic antibiotics, and rigid immobilization for a short period followed by active mobilization will yield the best results.

Adult↗
PubMed1982

Pulmonary extraction of biogenic amines during septic shock.

The effect of live Escherichia coli on the pulmonary extraction of the biogenic amines 14C 5-hydroxytryptamine, (5-HT) and 3H-epinephrine was investigated. The labeled isotopes were injected into a central venous catheter and collected from an aortic catheter. One hundred per cent of the labeled epinephrine was recovered in the control and septic state. Only 32.8 +/- 3.6% SEM of the 5-hydroxytryptamine was recovered before sepsis and 42.5 +/- 4.9% SEM after sepsis. During sepsis, mean arterial pressure fell to 58 mm Hg from 121 mm Hg. Pulmonary shunt increased from .7 +/- .05 SEM to .33 +/- .09 SEM.

Animals↗
PubMed1982

Effect of hemorrhagic shock on 5-hydroxytryptamine removal by the lung.

The biogenic amine, radioactive 5-hydroxytryptamine, is removed from the blood during passage through the pulmonary vasculature. After one hour of hemorrhagic shock, the extraction rate increased from 74 to 89 per cent. One and two hours after resuscitation, the lung extracted only 30 per cent of the 5-hydroxytryptamine. The relationship between the pathophysiologic state and altered amine removal is a reflection of prolonged exposure to receptor sites or increased diffusion of serotonin across the endothelium.

Animals↗
PubMed1981

A humoral factor in the plasma of dogs with hemorrhagic hypotension causing histopathologic changes when infused into normals.

The presence of circulating factors in the plasma of shocked dogs which would be capable of causing lung lesions when infused into normotensive dogs was demonstrated by light and electron microscopy. Light microscopy only identified significant differences in atelectasis, vascular congestion, and interstitial edema in the shock and shock-plasma recipient animals. On electron microscopy, interstitial edema and disruption of collagen bundles were consistently found in shocked dogs and in dogs that had received shocked plasma. There was a consistent increase in pulmonary interstitial sodium in both shock and shock-plasma recipient groups. It is concluded that a plasma factor present in the serum of shocked dogs may be transferred to other dogs and cause histopathologic changes seen in the lungs of shocked animals.

Animals↗
PubMed1981

Operations on the colon without preoperative oral antibiotic therapy.

The ideal preparation of the intestine prior to elective colonic resection has been a controversial subject. With the development of new and more effective antibiotics, many modalities of intestinal preparation preoperatively have been used in an effort to reduce the number of infectious complications. Mechanical cleansing of the intestine, when accompanied by perioperative parenteral antibiotics, is adequate preparation prior to resection of the intestine. One hundred consecutive operations upon the colon by one surgeon were the subject of this retrospective study. Approximately 70 per cent of the operations were for carcinoma and the remainder for inflammatory disease. Preparation consisted of the administration of cathartics and saline solution enemas combined with a liquid diet for 48 hours prior to operation. Perioperative parenteral antibiotic therapy was given for 48 to 72 hours or as long as intravenous fluids were administered. All anastomoses were the open, two layer type, using nonabsorbable suture material. All abdominal incisions were closed primarily. There were no operative deaths, anastomotic leaks, intra-abdominal abscesses or fistulas. There were six instances of wound infection. Our results with this type of management compare favorably with those of other surgeons using various modes of preoperative oral antibiotic therapy and suggest that oral preoperative antibiotic therapy may not be necessary in elective operations on the colon.

Administration, Oral↗
PubMed1981

When to ambulate the patient with a vascular graft in the groin.

Ankle blood pressure studied pre- and postoperatively in 60 patients after aortofemoral and femoral distal bypass surgery showed no adverse effect after major positional changes (supine, sitting, and standing). Early ambulation was not harmful to graft dynamics in this group of patients.

Aged↗
PubMed1980

The arteriovenous fistula. Its construction in the management of hemophilia.

Arteriovenous fistulae using expanded polytetrafluorethylene (E-PTFE [Gore-Tex]) grafts were constructed in six patients with hemophilia for long-term vascular access where veins had been obliterated. The range of patency was four to 28 months, with a mean of 20 months. All patients had less than 8% level of factor VIII, which may have contributed to fistula patency. This approach was helpful in the management of these patients' conditions.

Adolescent↗