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Biomedical subjects

S A Hirsch

Publications and source records attributed to S A Hirsch.

At least 19 recordsLinked to original sources
PubMed1989

Reoperation for complications of stabilized human umbilical vein grafts.

Among 211 femoropopliteal bypass grafts constructed with stabilized human umbilical vein performed between 1977 and 1986, 3 major complications were seen: graft thrombosis, aneurysm formation, and infection. Early thrombosis (within 30 days of operation) was successfully treated in 14 of 17 patients (82 percent) with either graft thrombectomy (13 of 17 patients) or graft replacement (1 patient). Late graft closure (2 to 55 months after operation) was successfully treated with thrombectomy in 17 of 28 patients (61 percent) or graft revision or replacement in 4 patients (14 percent). Aneurysms and graft infections were each seen in 3 percent of the grafts at risk. The former were successfully reconstructed in six of seven instances, whereas the latter eventuated in amputation in six of seven patients. An aggressive approach to graft closure in stabilized human umbilical vein grafts is recommended as this conduit is amenable to thrombectomy or revision if closure occurs.

Aneurysm↗
PubMed1988

Whiplash syndrome. Fact or fiction?

A sprain/strain syndrome or "whiplash injury" is the most common cervical injury associated with rear-end impact motor vehicle accidents. This results in a complex injury, often associated with extensive soft tissue injury in the cervical spine. There is additional potential for long term alteration in neurologic, muscular, and skeletal function. Evaluation and treatment should follow standard orthopedic principles.

Humans↗
PubMed1988

The computer. An orthopedic instrument.

The computer has become an important tool in orthopedic practice. Indeed, it is now invaluable and will soon be essential. It is still possible to run an orthopedic office without a computer--just as it is still possible to perform meniscectomy by arthrotomy--but that is not what most of us would do. The computer enhances efficiency, can improve business practice, assists in marketing, and helps store and retrieve medical information. The ultimate impact is not only on "business" functions but also on the quality of care.

Ambulatory Care Information Systems↗
PubMed1985

Small-bowel obstruction caused by intraluminal migration of prosthetic grafts.

Two patients who had undergone prosthetic grafting in the venous system presented with small-bowel obstruction. The first had undergone mesocaval shunting with a Dacron graft and the second, replacement of the inferior vena cava with a polytetrafluoroethylene graft after an extensive resection of retroperitoneal tumor. In both instances the grafts were within the lumen of the small bowel, causing a mechanical obstruction. No evidence of retroperitoneal bleeding subsequent to detachment of the grafts was noted.

Adult↗
PubMed1984

The use of stabilized human umbilical vein for femoropopliteal bypass. Experience with 133 operations with 5-year follow-up.

One hundred thirty-three femoropopliteal bypasses using stabilized human umbilical vein were performed in 116 patients during a 5-year period. The indications for operation were claudication in 35% and limb salvage in 65%. There were eight deaths in the postoperative period, all due to myocardial infarctions, and all occurring in patients operated upon for limb salvage. Patients operated upon for claudication had a cumulative patency rate of 83% at 1 year and 63.5% at 5 years, while patients operated upon for limb salvage had patency rates of 66% and 50% at 1 and 5 years. Diabetics had a patency rate of 69% at 5 years. The quality of arteriographic runoff was the leading determinant of patency in all groups. Two instances of aneurysmal degeneration of the graft were seen, both 5 years after implantation, and two graft infections were observed.

Adult↗
PubMed1983

Current diagnosis and management of upper extremity ischemia.

Although the causes of upper extremity ischemia are diverse, their management follows well established surgical principles in most instances. Evaluation that emphasizes precise physical examination and exploits simple noninvasive determinations aids in reducing cost and complexity. Subclavian occlusive lesions are optimally managed by bypass procedures that avoid thoracotomy. Occlusions in the arm may usually be treated with bypass grafts of reversed autogenous saphenous vein. Brachial artery occlusion after cardiac catheterization should be approached with early exploration, using local reconstruction of the artery if necessary. Vasospastic symptoms should be evaluated thoroughly in an attempt to identify their cause. Most often they may be treated with medications, singly or in combination. Sympathectomy is of benefit only in unusual instances, when no specific cause of the vasospastic symptoms can be found after prolonged evaluations.

Arm↗
PubMed1980

Hip dysplasia in infancy. Diagnosis and treatment.

Diagnosis of hip dysplasia in the newborn is entirely by physical examination. In older infants, however, x-ray examination is valuable in confirming the diagnosis. The Pavlik harness is recommended as a safe, simple, and effective method of treatment; but no matter which device is preferred, once hip dysplasia is suspected, treatment should begin immediately.

Braces↗
PubMed1980

Musculoskeletal problems in hemophilia.

Spontaneous deep muscle and joint bleeding is a common characteristic of severe hemophilia, often causing damage to the musculoskeletal system. The development of concentrated replacement factors, however, has made home care programs possible, helped prevent deformity, and improved surgical management.

Bone Diseases↗
PubMed1978

Cervicofacial actinomycosis following surgical trauma in rats.

Cervicofacial actinomycosis in man is often associated with physical trauma. The presence of intrabony abscesses in rat mandibles following surgical trauma supports the clinical observation that antecedent trauma is an important factor in the pathogenesis of cervicofacial actinomycosis.

Abscess↗
PubMed1978

Gingival biopsy in thrombotic thrombocytopenic purpura.

Gingival biopsy has been advocated as a readily available, safe, rapid histologic confirmation of the clinical diagnosis of thrombotic thrombocytopenic purpura. Eighteen gingival biopsies from 16 patients with proven thrombotic thrombocytopenic purpura were reviewed. Seven (39%) showed characteristic histologic changes: [1] subendothelial hyalinelike deposits; [2] intraluminal deposits; [3] lack of inflammatory change in vessels and stroma. To assess specificity, gingival sections from 154 patients with oral pathology only and from 50 unselected autopsies were reviewed: 10% to 20% of biopsies from patients with oral pathology only (primarily inflammation) and three of 50 autopsy specimens showed occasional intraluminal deposits but no subendothelial deposits. In addition, other histologic features permitted them to be distinguished from thrombotic thrombocytopenic purpura. We conclude that gingival biopsy in thrombotic thrombocytopenic purpura, although helful in confirming the diagnosis, is less often positive than has been suggested. Biopsy of grossly inflamed gingiva should be avoided.

Biopsy↗