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Biomedical subjects

M J Shapiro

Publications and source records attributed to M J Shapiro.

At least 109 records · Page 6Linked to original sources
PubMed1991

Cardiac injury complicating traumatic asphyxia.

During a 3-year period (1986-1989), 8 patients were seen at St. Louis University Medical Center exhibiting the stigmata of traumatic asphyxia. Fewer than 200 cases of traumatic asphyxia have been reported and there is only a single report of a cardiac injury. In this series, 3 of 8 (37.5%) patients were found to have an injury to the heart: two cardiac contusions and a ventricular rupture. Five patients were crushed in motor vehicle collisions, one by an elevator counterweight, and two patients by river barges. Injuries associated with these patients include pulmonary contusion, hemopneumothorax, traumatic pneumatocele, traumatic retinopathy, bone fractures, mental confusion, and liver contusion. There was one death in the series, a patient with rupture of the right ventricle and severe splenic and liver injuries. The cardiac status of the patients was evaluated by serial serum cardiac enzyme determinations, electrocardiograms, and echocardiography. This report illustrates the importance of complete cardiac evaluation in patients with traumatic asphyxia.

Accidents, Occupational↗
PubMed1991

Efficacy of thrombolysis in infrainguinal bypass grafts.

The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombosed infrainguinal grafts in 37 patients was analyzed. There was an 88% (38/43) technical success rate (complete clot lysis) and a 74% (32/43) clinical success rate. Complications occurred in 10 patients (23%) and were related to bleeding in four patients (9%). Patient age, graft age, location, material, and the duration of occlusion did not significantly influence the initial outcome, although there was a trend toward a higher bleeding complication rate among grafts less than or equal to 1 month of age at the time of thrombolysis. A second group of 43 infrainguinal grafts successfully recanalized using regional infusions of thrombolytic agents were followed for long-term patency. This group included 32 grafts successfully treated with urokinase and 11 grafts recanalized with streptokinase. By life-table analysis there was a 55.6% 1-year patency, which fell to 42.4% at 4 years. Vein grafts had significantly (p = 0.01) better long-term patency than prosthetic grafts (69.3% versus 28.6% at 30 months). Grafts with flow-limiting lesions identified and corrected by angioplasty or surgery also had significantly (p = 0.01) better long-term patency than those without such lesions (79.0% versus 9.8% at 2 years). Based on the results of our study compared with a survey of long-term results following secondary surgical procedures for thrombosed infrainguinal grafts, thrombolysis can be recommended in several circumstances. Thrombolysis is indicated for thrombosed vein grafts or when thrombus is present in distal runoff vessels. Thrombosed prosthetic grafts should be replaced by autogenous vein grafts whenever possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Structures of paralytic acylpolyamines from the spider Agelenopsis aperta.

The structures are given for five paralytic acylpolyamines from the venom of the funnel web spider, Agelenopsis aperta. The acyl moieties are derived from (3-indolyl)acetic acid, (4-hydroxy-3-indolyl)acetic acid, and 4-hydroxybenzoic acid. The polyamine portions of the toxins are novel. Three toxins (AG489, AG505, and AG452) contain 1, 5, 9, 13, 18, 22-hexaazadocosane which is unique as a natural polyamine because of its length and hydroxylation at the 5-aza position. The polyamine portions of two other alpha-agatoxins (AG488 and AG504) are unusual also, containing guanidinooxy moieties.

Animals↗
PubMed1990

Usefulness of an antireflux valve in the intensive care unit.

The Keith Antireflux Valve (ARV) is a one-way valve placed on the sump port of a double-lumen NG tube. ARV use in critically injured patients significantly prevents reflux through the sump port and decreases the incidence of both patient gown and linen change and NG tube repositioning. There is no evidence to indicate that the ARV may lead to malfunction of the NG tube, aspiration, or gastric dilation. The cost savings in materials and nursing time are significant.

Humans↗
PubMed1990

Acute aortic valvular incompetence following blunt thoracic deceleration injury: case report.

Blunt trauma leading to aortic valvular incompetence is rarely encountered, with 27 cases reported to date. All cusps and commissures are involved to a similar degree. Treatment includes either reattachment of cusps to the annulus (80% recurrence of incompetence) or valvular replacement (no recurrence). Valve replacement is the treatment of choice for these patients.

Accidents, Traffic↗
PubMed1990

Palmaz vascular stent: initial clinical experience.

The safety and efficacy of the Palmaz balloon-expandable vascular stent and its effect on the results of percutaneous transluminal angioplasty (PTA) were assessed in a prospective study. Technical success was achieved in the placement of 34 of 35 stents (97%) in 27 common and external iliac artery lesions in 19 patients (23 limbs) who presented with disabling claudication, rest pain, or gangrene. Stent placement improved the angiographic results achieved by PTA alone in all 19 patients. Seventeen of 23 limbs (74%) had significant (greater than 20%) elevation of the ankle-arm index after combined angioplasty and stent placement, including nine limbs with occlusive outflow lesions. All 10 patients with continuous runoff distal to the stent and one patient with discontinuous runoff had resolution of their symptoms, remaining unchanged at a mean follow-up time of 6 months. There were three complications: One significantly altered the patient's hospital course, but none detracted from the achieved stent result. Stent placement is effective and does not significantly increase the complication rate of conventional iliac PTA. The current delivery system, however, may limit its utility.

Angioplasty, Balloon↗
PubMed1990

Extremity osteosarcomas: intraarterial chemotherapy and limb-sparing resection with 2-year follow-up.

Twenty-eight consecutive patients with extremity osteosarcoma (24 stage II, four stage III) received their entire preoperative course of chemotherapy intraarterially in order to maximize local drug concentration and tumor shrinkage to facilitate limb-sparing resection. Eighteen tumors were located in the femur, seven in the tibia, two in the humerus, and one in the fibula. Most patients underwent two catheterizations; thus there was a total of 51 procedures. The average duration of each infusion was 10.4 days. There were eight procedure-related complications, but none precluded completion of intraarterial chemotherapy. Limb-sparing surgery was performed on 25 patients. At a mean follow-up of over 2 years, there was one local recurrence. Among limb-salvage patients with stage II disease, 90% (18 of 20) survived and 75% (15 of 20) are disease-free. Compared with patients from previous studies, this technique permits a high percentage of patients with osteosarcoma to undergo limb-sparing resection without compromise of local disease control or survival.

Adolescent↗
PubMed1990

Needle aspiration biopsy of the thyroid and parathyroid.

Aspiration biopsy is the most definitive diagnostic step in the investigation of thyroid masses. The clear fluid from the rare parathyroid cyst should be sent for parathyroid hormone assay. Guided fine-needle aspiration identifies parathyroid tumors in cases in which reexploration is necessary.

Biopsy, Needle↗
PubMed1989

The misconception of trauma reimbursement.

As health care costs increase, hospital reimbursement from trauma victims is decreasing. Thus, the number of institutions dedicated to trauma care continues to decrease in this country. Two hundred eight consecutive patients admitted to a level 1 trauma center were evaluated during a 10-month period. The total bill for 207 patients was $4,044,156, averaging $19,537 per patient. Total reimbursement 6 months after billing was $2,054,090, 51% of the total bill. Methods to improve reimbursement include increasing the ratio of blunt to penetrating trauma victims and by assembling a team knowledgeable in reimbursement options. However, because a major portion of trauma reimbursement comes under federal government regulation, topics such as diagnostic related groups and other classification criteria of critically injured patients need to be reevaluated, or underpayment for trauma patients will continue to be a national plague.

Adolescent↗
PubMed1989

Perforation of the retroperitoneal sigmoid colon secondary to fracture-dislocation of the left sacroiliac joint: case report.

Most traumatic injuries of the sigmoid colon are penetrating, such as those due to stab and bullet wounds, but an occasional patient may have a perforated colon as a result of a pelvic fracture. Such lesions may be occult, resulting in delayed diagnosis, with substantial morbidity. Injury to the sigmoid colon in association with sacroiliac fracture has apparently not been described in the English-language literature. This paper reports such a case and describes the mechanism of injury and its recognition.

Abdominal Injuries↗
PubMed1989

Acceleration of thrombolysis with a high-dose transthrombus bolus technique.

The rate of complication and the time necessary to achieve thrombolysis remain major disadvantages of regional thrombolytic therapy. By lacing the entire length of arterial or arterial bypass graft occlusions in the lower extremities of 49 patients with one of two different bolus doses of urokinase (mean, 52,000 International U in 35 infusions = low-dose group [28 patients]; mean, 230,000 U in 23 infusions = high-dose group [21 patients]) prior to identical continuous infusions, it was possible to demonstrate a decrease in the time needed to complete thrombolysis from 33.6 hours in the low-dose group to 10.4 hours in the high-dose group (P less than .001). The total urokinase dose necessary for successful thrombolysis was also significantly less in the high-dose group (P less than .001). The major complication rate was 22.9% in the low-dose group and 8.7% in the high-dose group, although the difference was not statistically significant. The use of urokinase and a high-dose transthrombus bolus injection technique significantly accelerates thrombolysis, decreases the total urokinase dose needed, and may lower the major complication rate.

Aged↗
PubMed1988

Balloon catheter dilation of ureteroenteric strictures: long-term results.

Balloon catheter dilation of benign ureteroenteric anastomotic strictures has been proposed as an alternative to either surgical revision or chronic ureteral stenting, with moderately successful short-term results reported by several groups in a limited number of patients. However, the authors' experience with 29 patients exhibiting 37 benign ureteroenteric strictures treated over the past 7 years revealed that in the majority of cases (23 patients, 26 strictures [70%]), strictures recurred within 6 months of balloon catheter dilation/ureteral stent therapy. Furthermore, of the 11 strictures that appeared to have been successfully dilated at a follow-up interval of 6 months, five restenosed within 1 year. Therefore, only six of 37 (16%) ureteroenteric stricture dilations could be considered successful when viewed at least 1 year after interventional therapy. Furthermore, repeat dilations have often been required to maintain ureteral patency in these patients.

Adult↗
PubMed1988

Enteral and intranasal treatment for vasopressor-dependent hypotension in C1 tetraplegia.

A complete traumatic C1 spinal cord lesion leads to bradycardia and temporary hypotension until fluid administration can restore blood volume and pressure to the autosympathectomized capacitance vessels. In spite of adequate volume status, however, our patient required intravenous pressor agents to maintain adequate arterial and central venous pressure several weeks after injury. Using oral pseudoephedrine and occasional nasal phenylephrine, intravenous lines could be removed with maintenance of arterial pressure and resolution of bradycardia.

Administration, Intranasal↗
PubMed1988

Severe hemoptysis associated with pulmonary aspergilloma. Percutaneous intracavitary treatment.

Surgical therapy for massive hemoptysis associated with pulmonary aspergilloma carries a high morbidity and mortality in patients with limited pulmonary reserve. Bronchial artery embolization has proven ineffective in treating and in preventing recurrent episodes of hemoptysis in this group of patients. Over a four-and-one-half year period, we have successfully treated six episodes of acute hemoptysis in four patients using a percutaneously placed catheter and intracavitary instillation of amphotericin B, N-acetylcysteine, and aminocaproic acid. Advantages of this method of treatment for patients with severely compromised pulmonary reserve include: (1) no further loss of lung function; (2) ease and rapidity of catheter insertion; (3) prompt response to treatment; (4) relatively short hospitalization; and (5) ability to repeat the procedure in the same or another cavity if necessary.

Acetylcysteine↗