Biomedical subjects
Publications and source records attributed to M D Kerstein.
Echinococcal infestation, although still a rare occurrence in most of the United States, is being seen with increasing frequency. Three cases of hepatic echinococcosis are described. A review of the salient features of the disease is presented along with various aspects of diagnosis and therapy.
Barium sulfate granuloma of the rectum may develop when this contrast material is forced through a discontinuity in the rectal mucosa. The ensuing mass may be confused with carcinoma. Preoperative biopsy and attention to plain films will prevent unnecessary inappropriate surgery.
Reversal of the morbid hepato-renal syndrome has been achieved in a cirrhotic patient with ascites following successful side-to-side portacaval shunt. The hepatorenal syndrome is defined as progressive unresponsive renal failure with previously normal kidneys in the presence of impaired hepatic function. Although the etiologic mechanism has not been defined, it is suggested the relationship of increased intrahepatic sinusoidal pressure on the thoracic duct and subsequent decreased lymph flow are interrelated to increased levels of aldosterone and manifested by (chylous) ascites. Laboratory and clinical evidence suggest that cirrhotics with ascites have remarkably high levels of aldosterone secretion via the rennin-angiotensin-adrenal cortex mechanism. This is the group that develops hepatorenal syndrome. Reduction of the intrahepatic pressure and decompression of the portal hypertension can be successfully achieved with a side-to-side shunt which should return the aldosterone-rennin-angiotensin axis to normal and subsequently reverse the hepatorenal syndrome.
Succinic dehydrogenase (SDHG) has been studied in the rabbit cadaver kidney. Increasing warm ischemia time decreases the ability of the organ to utilize oxygen and therefore lowers its SDHG activity. The addition of perfusing solutions further decreases the SDHG activity; saline has a more adverse affect than either Perfudex or albumin.
A university affiliated Veterans Administration Hospital had an increase in the number of serratia isolates. An epidemiologic investigation, including personnel and environmental prevalence study, helped correct errors in technique, management and judgment. A nurse epidemiologist prevented a cluster of infections from becoming an epidemic.
Seven cases of above-knee amputation stump breakdown following surgery for arteriosclerosis obliterans were successfully treated with Travase ointment. (Bacillus subtilis proteinase). Rehabilitation was facilitated because secondary closure of the previously infected necrotic wounds could be more rapidly undertaken.
Cardiopulmonary problems were the most common limiting factor in the rehabilitation of 42 bilateral lower limb amputees. Diabetes mellitus and local stump problems, most common in below knee amputees, delayed rehabilitation but, subsequently, obtained the highest goals. Thirty of the 42 amputees finally were self sufficient; the average time required was 30 weeks to maximum benefit.
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Fourty-four men (average age, 61.5 years) who had undergone amputation of both lower extremities were studied at a Veterans Administration hospital. Vascular insufficiency was the most frequent reason for amputation. In 26 of the patients bilateral below-knee amputations had been performed. Although diabetes mellitus was present in 26 of the patients, it severely hampered rehabilitation in only four. Twenty-nine (nearly 65%) of the 44 patients became totally independent in daily functions. However, the average time required for maximum rehabilitation was almost 30 weeks.
A study of 194 male lower extremity amputees, with an average age of 56.8 years, showed that vascular disease is the most common cause of limb loss at all ages. Increasing age was correlated with an increasing incidence of bilateral amputation and arteriosclerotic and pulmonary problems, lower goals and levels of achievement, increased mortality during therapy, fewer amputees who were able to return home, an increased number of aids (cane, crutches, wheelchair), and a longer rehabilitation period. Many patients over age 65 required nearly a year of rehabilitation to achieve maximum benefit.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.