Biomedical subjects
Publications and source records attributed to S A Jacobson.
This report deals with the experience gained by observation and treatment of 114 Vietnamese combat injuries from December 1965 to April 1969. The report covers all aspects of rehabilitation, medical, physical and socio-economic.
Malignancy metastasis to the penis is an uncommon clinicopathological entity. We present two cases of malignant priapism following penile metastasis, in which the diagnosis was established by core needle biopsy of the corpus cavernosum. Primary tumors were urothelial carcinoma of the urinary bladder in one case (the patient having concomitant high-grade prostatic adenocarcinoma) and prostatic adenocarcinoma in the other. The clinicopathological features of 51 previously reported cases of penile metastasis in the recent literature are reviewed.
We report the case of a primary renal carcinoid tumor associated with a horseshoe malformation in a 43-year-old man who presented with testicular pain. The tumor was centrally located and purely solid and had features ascribed to hindgut neuroendocrine neoplasia. The relative risk of developing a carcinoid tumor in a horseshoe kidney is estimated to be x82.
OBJECTIVES: This study was performed to compare the safety and efficacy of intravenous 2% dodecafluoropentane (DDFP) emulsion (EchoGen) with that of active control (sonicated human albumin [Albunex]) for left ventricular (LV) cavity opacification in adult patients with a suboptimal echocardiogram. BACKGROUND: The development of new fluorocarbon-based echocardiographic contrast agents such as DDFP has allowed opacification of the left ventricle after peripheral venous injection. We hypothesized that DDFP was clinically superior to the Food and Drug Administration-approved active control. METHODS: This was a Phase III, multicenter, single-blind, active controlled trial. Sequential intravenous injections of active control and DDFP were given 30 min apart to 254 patients with a suboptimal echocardiogram, defined as one in which the endocardial borders were not visible in at least two segments in either the apical two- or four-chamber views. Studies were interpreted in blinded manner by two readers and the investigators. RESULTS: Full or intermediate LV cavity opacification was more frequently observed after DDFP than after active control (78% vs. 31% for reader A; 69% vs. 34% for reader B; 83% vs. 55% for the investigators, p < 0.0001). LV cavity opacification scores were higher with DDFP (2.0 to 2.5 vs. 1.1 to 1.5, p < 0.0001). Endocardial border delineation was improved by DDFP in 88% of patients versus 45% with active control (p < 0.001). Similar improvement was seen for duration of contrast effect, salvage of suboptimal echocardiograms, diagnostic confidence and potential to affect patient management. There was no difference between agents in the number of patients with adverse events attributed to the test agent (9% for DDFP vs. 6% for active control, p = 0.92). CONCLUSIONS: This Phase III multicenter trial demonstrates that DDFP is superior to sonicated human albumin for LV cavity opacification, endocardial border definition, duration of effect, salvage of suboptimal echocardiograms, diagnostic confidence and potential to influence patient management. The two agents had similar safety profiles.
Delirium is a state of disturbed consciousness and attention and cognition or perception, which develops acutely, fluctuates during the course of the day, and is attributable to a physical disorder. This syndrome is the focus of increasing attention in light of emerging evidence of its enormous impact in human suffering as well as patient care costs. As currently conceptualized, delirium is a threshold phenomenon in which systemic and cerebral insults are cumulative and, in most cases, are multifactorial in origin. Because delirium results from an underlying medical condition, its prognosis is dependent largely on how quickly that condition is identified and appropriately treated. A basic algorithm for initial delirium management is reviewed, which includes discontinuing noncritical medications, instituting close observation, monitoring vital signs and fluid intake and output, obtaining a complete history, performing initial laboratory studies to determine the causes, implementing environmental and psychosocial interventions, and instituting pharmacologic treatment as indicated for agitation and psychosis. The pharmacologic treatment of choice is an antipsychotic of the butyrophenone class. Benzodiazepine use is reserved for the specific treatment of alcohol and sedative withdrawal, and for adjunctive use with antipsychotic agents in treatment-refractory cases. There is growing evidence that the cognitive impairment of delirium is not entirely reversible in all patients, and it may be that delirium represents a time of significant risk for progression of underlying dementia. Preventive measures discussed in the text are, therefore, of particular importance in this population.
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Serial quantitative electroencephalographic (QEEG) studies were performed in 33 elderly delirious, demented, and control subjects to determine which QEEG variables were associated with changes in clinical state as measured by the Folstein Mini-mental State Examination (MMSE). Conventional EEGs and brain maps were independently rated by two electroencephalographers without knowledge of clinical diagnoses. Correlational analyses were performed using these ratings, along with numerical data from QEEG. In the delirium group (n = 15), changes in scores for the relative power map and changes in relative power in the alpha band had significant associations with changes in MMSE. In the dementia group (n = 10), changes in score for absolute power maps and changes in absolute power in the delta band had significant associations with changes in MMSE. In the control group, changes in MMSE over time were negligible. These findings have potential clinical utility in diagnosing delirium, and in providing a quantitative measure of its severity, which can be used serially.
This study was performed to determine whether an admission quantitative EEG (QEEG) could assist in the differential diagnosis of encephalopathy among a group of elderly subjects with delirium, dementia, and delirium coexistent with dementia. Thirty four subjects from 57 to 93 years had standard 17-channel EEG and quantitative EEG studies, using a linked-ear reference. EEGs were independently rated by two electroencephalographers blind to clinical diagnosis, using conventional criteria to assess the degree of encephalopathy. Brain maps were scored by a scale developed by the authors. Numerical data examined included mean posterior dominant frequency, absolute and relative power in the delta, theta and alpha bands, and slow-wave ratios. The grouping of experimental subjects was by the discharge diagnosis, made using DSM-III-R criteria. Stepwise discriminant analysis was performed to determine which EEG and QEEG variables were best able to distinguish cases. Variables which collectively distinguished normal from encephalopathic records were Mini-Mental State Examination scores and relative power in the alpha frequency band. Variables which collectively distinguished delirium from dementia were EEG theta activity, relative power in delta, and brain map rating. The results suggest that cross-sectional QEEG study is potentially useful in the early differential diagnosis of encephalopathy, and that the variables which distinguish normal from encephalopathic patients might differ from the variables which distinguish delirium from dementia.
It has long been known that the conventional electroencephalogram (EEG) is a useful tool in the evaluation of delirium. There are moderate correlations between the amount of slowing seen on EEG and the degree of confusion or level of arousal observed among delirious patients. The usefulness of the EEG for assessment and diagnosis in this area has been limited, however, by: (a) difficulties in assessing the significance of slow-wave activity, (b) problems in detecting changes in relative EEG power, and (c) the logistical problem of lengthy recording sessions with agitated patients. This article selectively reviews the development of quantitative EEG methods and presents preliminary data from an ongoing longitudinal study of the use of these methods among elderly delirious patients. There has been little work done in applying quantitative methods to the study of delirium, and no work done that has systematically compared conventional EEG analysis to quantitative analysis. Delirium shares electrophysiological characteristics with other organic mental syndromes, however, where quantitative EEG has been shown to be useful. Furthermore, analysis of digital EEG data is inherently superior to visual inspection in assessing the distribution of EEG power among different frequency bands. Previous studies, as well as data presented here, suggest that quantitative EEG is a clinically useful supplement to the conventional EEG for the assessment of elderly patients with delirium.
Acute adrenal insufficiency postoperatively is an uncommon problem and, if unrecognized, it may cause serious morbidity and can be fatal. It can occur as the result of acute bilateral adrenal hemorrhage associated with anticoagulation, inadvertent injury to or removal of a solitary adrenal gland, or postoperative stress in an individual with incipient adrenal insufficiency. Its manifestations, such as fever, tachycardia, hypotension, lethargy, abdominal pain and gastrointestinal dysfunction, mimic the other more common postoperative complications and compound the difficulty in establishing the correct diagnosis. Once the diagnosis is made the condition is readily managed successfully. We report 3 cases of acute adrenal insufficiency occurring after salvage cystectomy, ileal replacement of the ureter and retropubic prostatectomy, which illustrate the salient clinical features, problems in diagnosis and predisposing risk factors. All 3 patients survived once the diagnosis of adrenal insufficiency was made. These cases emphasize the need to be aware of the possibility of this complication to make the correct diagnosis and to institute proper treatment.
Polyhistioma, a neoplasm whose basic cells are small and round like those of Ewing's sarcoma, but which differentiate into various mesenchymal structures, most often bone, is described. Those cases that produce cartilage have been called mesenchymal chondrosarcoma; the others therefore are mostly urecognized. The name "polyhistioma" is suggested in the hope that with this terminology more of these tumors will be diagnosed. Polyhistiomas are not excessively rare; they affect bone and soft tissue. Half the patients with polyhistiomas died within 2 years. Treatment has resulted in survival of over 20 years. Thirty-eight of the 144 patients with polyhistioma have survived 5 years or more following first definitive treatment. Thirty-seven cases of the disease are presented.
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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.
Explore the source record for details and available documents.