Treatment of severe hypophosphatemia with intraperitoneal phosphate.
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Chronic Disease↗
Biomedical subjects
S J Goldstein
Publications and source records attributed to S J Goldstein.
Variable efficacy of calcium carbonate tablets.
Orally administered calcium carbonate tablets are commonly prescribed as a calcium supplement and for their phosphate-binding effects in renal failure patients. Two cases are reported in which a commercially available brand of calcium carbonate tablets appeared to be ineffective. Formal investigation of the bioavailability of this product revealed it to have impaired disintegration and dissolution and a lack of clinical efficacy. Recommendations that will enable physicians to avoid prescribing and pharmacists to avoid dispensing ineffective calcium carbonate tablets are proposed.
Adult↗
Radiological case of the month. Epidermoid cyst of the orbit.
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Adolescent↗
Thrombotic complications of indwelling central catheters used for chronic hemodialysis.
A new double-lumen silicone-rubber dialysis catheter, designed to be placed surgically in central veins, is now available. There is little published data concerning the long-term use of this catheter for hemodialysis, but a review of the literature suggests that pericatheter thrombus formation with or without occlusion of major veins has been a complication of chronic central venous catheterization with a variety of catheters, in both dialysis and nondialysis settings. We had this catheter placed in four diabetic patients who had severe problems related to maintenance of adequate vascular access. Two of the four patients underwent venography within 3 months of catheter placement because of impaired catheter function and were found to have thrombi on the outside of their catheters. These thrombi could not be dissolved with fibrinolytic agents, and the catheters were removed surgically without incident. The other two patients have no radiologic evidence of thrombus formation 4 and 7 months, respectively, after catheter placement. We suggest that proper selection of patients for this type of vascular access should be the subject of future studies and that patients with malfunctioning catheters undergo venography to rule out the presence of significant catheter related thrombosis.
Adult↗
Heparin free dialysis: comparative data and results in high risk patients.
Heparin free hemodialysis was compared to systemic heparinization, intermittent saline flushes and constant saline infusions in eight, stable chronic patients dialyzing on hollow-fiber artificial kidneys (HFAK) at blood flows of 250 to 300 ml/min. No significant differences in small molecule clearance, fluid removal or dialyzer clotting were noted. Since this data showed that heparin free hemodialysis without supplemental saline was feasible in a group of stable, chronic dialysis patients, we then prospectively studied twenty-nine patients judged to be at increased risk of hemorrhage from heparinization during 100 heparin-free dialyses. The incidences of severe and moderate dialyzer clotting were 7% and 20%, respectively. Seventeen of 27 treatments in which moderate or severe clotting occurred had identifiable factors thought to predispose to dialyzer clotting such as low blood flows, poor vascular-access function, severe hypotension and intradialytic blood transfusions. Although higher hematocrit values were associated with greater degrees of dialyser clotting, stepwise discriminant analysis employing blood flow, blood pressure, hematocrit and transfusion administration could not develop an accurate predictor or combination of predictors of clotting. No patient experienced de novo or increased bleeding and problems with inadequate dialysis were not observed. Since this method of heparin free dialysis is as safe and effective as previously reported strategies and requires no specialized equipment or procedures, it is a reasonable initial strategy for dialyzing high risk patients.
Acute Kidney Injury↗
Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea.
Obstructive sleep apnea may lead to disordered sleep architecture and impair the physiologic slow wave sleep related growth hormone release. Obstructive sleep apnea occurs with craniofacial syndromes and in children with airway narrowing, pharyngeal hypoplasia, tonsillar adenoidal hypertrophy, micrognathia and achondroplasia. To examine the relationship between disordered sleep and growth hormone release we studied a 9 year old male with achondroplasia, growth failure (3 cm/year) and obstructive sleep apnea. Polysomnography data and a 20 min sampling for sleep entrained growth hormone showed before therapeutic tracheostomy numerous apneic episodes, absent slow wave sleep and abnormal low growth hormone secretion during sleep. Normalized slow wave sleep entrained growth hormone secretion after tracheostomy led to a sustained increase in growth rate. Normal growth rate (greater than 5 cm/year) continues 2 years after tracheostomy. We conclude that obstructive sleep apnea may impair sleep related growth hormone release. Obstructive sleep apnea may be a useful model for other diseases in which growth failure and sleep disturbances are linked.
Achondroplasia↗
Magnetic resonance imaging of the sella turcica and parasellar region. A clinical-radiographic evaluation with computed tomography.
Thirty-one magnetic resonance (MR) scans and computed tomography (CT) scans were obtained on 25 patients in whom lesions involving the sella turcica or parasellar region were clinically suspected. Surgical pathologic studies were available in 19 cases. Twenty-two of the MR scans were of diagnostic value equivalent to that of the corresponding CT studies. In two small meningiomas, an empty sella, and a sphenoid-middle fossa tumor, MR technology failed to delineate the pathologic process adequately. In the remaining five patients, MR either more convincingly demonstrated the pathologic anatomy or yielded diagnostic information not present in the CT study. In view of the absence of ionizing radiation, high degree of tissue contrast and spatial resolution, and multiplanar capability, magnetic resonance scanning will probably become the initial imaging modality of choice in patients suspected of harboring sellar and parasellar tumors.
Adolescent↗
Comparison of coaxial and side-by-side double lumen subclavian catheters with the single lumen catheter.
Subclavian catheters are increasingly being used for vascular access. Many double lumen catheters (DLCs) have been designed to alleviate the need for a single-needle machine. Clinical studies comparing the safety of various DLCs with single lumen catheters (SLCs) are scarce. This study compares our experience with Sh-SLCs (Single-Shiley), Vas-DLCs (Coaxial-Vascath), and Qu-DLCs (Side-by-Side, Quinton). Similar aseptic insertion and handling techniques were used. The catheters were filled with heparin at the end of dialysis (HD) and no interdialytic infusions were given. Fifty-two Sh-SLCs were inserted in 46 patients for 253 HDs, 71 Vas-DLCs in 47 patients for 185 HDs, and 51 Qu-DLCs in 38 patients for 215 HDs. HDs/catheter were 4.9, 2.6, and 4.2, the percent incidence of septicemia was 2%, 7%, and 0%, and the catheter failure was 11%, 48%, and 16% for Sh-SLCs, Vas-DLCs, and Qu-DLCs, respectively (P less than 0.05 Vas-DLC v Sh-SLC and Qu-DLC). The poor flow problems were more frequent on the left side with Vas-DLCs (16/31) and Qu-DLCs (7/17), but not with Sh-SLCs (2/25). Other major complications were not noted. These results suggest that infections and mechanical problems may be more frequent with Vas-DLCs than Sh-SLCs and Qu-DLCs. Use of Qu-DLCs is a safe and may be preferred since a single-needle machine is not required. Insertion of a DLC on the right side may be preferred due to higher mechanical problems on the left side.
Catheters, Indwelling↗
Magnetic resonance and computed tomographic imaging of mass lesions of the cerebral ventricles. A prospective comparative study.
This study was undertaken to investigate the relative merits of magnetic resonance (MR) imaging and computed tomography (CT) in the evaluation of primary lesions of the cerebral ventricles. Since 1982, 14 patients, 7 males and 7 females, aged 8 to 68 years were diagnosed as harboring ventricular mass lesions. Eight masses were located in the lateral, 5 in the third, and one in the fourth ventricle. The diagnostic contribution and relative merits of two imaging modalities were compared in each case. In 57 per cent of cases the CT scan was of superior diagnostic value, and in 21 per cent of the patients MR imaging proved to be either more sensitive or specific than CT scanning. The availability of intravenous contrast agents for CT and not MR, as well as the capability of CT to definitely identify lesion calcification, accounted for the better performance of CT scanning in this series of patients.
Adult↗
Imaging the centenarian brain. A computed tomographic study.
Ten healthy and mentally alert centenarians underwent cranial computed tomography (CT) using a fourth-generation CT scanner. The subjects ranged in age from 100 to 102 years, and included six women and four men. Two of them used alcohol on a daily basis and five had systolic blood pressures of at least 160 mmHg. The CT scans demonstrated considerable variation in the degree of cerebral atrophy, which had no relation to either sex, alcohol use, or hypertension. Three of the centenarians had evidence of mild periventricular white matter lucency. Although progressive cerebral atrophy is an integral aspect of the normal aging process in the very elderly, its exact relationship to cognitive function remains unclear.
Aged↗
Achondroplasia and obstructive sleep apnea: correction of apnea and abnormal sleep-entrained growth hormone release by tracheostomy.
Severe obstructive sleep apnea in a patient with achondroplasia syndrome was found to result in a definitive deficiency of overnight growth hormone secretion related to absence of slow-wave sleep. Resolution of the apnea by tracheostomy resulted in normalization of growth hormone release and normal growth rates postoperatively. Sleep-related growth hormone deficiency may contribute to the short stature so often seen in a variety of craniofacial syndromes. Furthermore, this short stature may be reversible.
Achondroplasia↗
Aplasia of the cervical internal carotid artery and malformation of the circle of Willis associated with Klippel-Trenaunay syndrome. Case report.
The authors describe the radiographic findings in a patient with Klippel-Trenaunay syndrome who also had aplasia of the left internal carotid artery and a very unusual malformation of the circle of Willis. This constellation of clinical and radiographic findings is unique and has not been previously reported in the medical literature.
Adult↗
Craniopharyngioma intrinsic to the third ventricle.
The case of a third ventricular craniopharyngioma in a 57-year-old woman is reported. This lesion is rare, having been previously identified in only eight adults. Intraventricular craniopharyngioma is also unusual in that it is not associated with tumoral calcification or cyst formation, as is frequently seen with the more common suprasellar craniopharyngioma. The role of computed tomography scanning in the diagnosis of this tumor is presented and discussed.
Adult↗
Positive-contrast computed cranial tomographic encephalography in children.
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Adult↗
Occipital condyle fracture associated with cervical spine injury.
Fracture of the occipital condyle is a rare sequela of craniocervical trauma; it has been reported in only 8 patients since 1816. In one-third of the cases, the fracture was associated with dislocation of the atlantooccipital junction, a uniformly fatal injury. We report a case of fracture of the occipital condyle associated with fractures of C6 and C7, a combination of injuries not previously reported to the best of our knowledge.
Adult↗
Limited usefulness of aortic arch angiography in the evaluation of carotid occlusive disease.
The role of aortic arch angiography in the evaluation of cerebral ischemic disease is not well defined. In an attempt to develop guidelines for its optimal use, a prospective study of 100 patients with carotid distribution ischemic events was undertaken. Each patient underwent bilateral selective carotid angiography followed by arch aortography. In only two of the cases did the arch examination affect patient management. In the other individuals, the arch study either added no clinically useful information (69), or demonstrated abnormalities that did not affect patient care (29). The findings of this study support the use of arch aortography only in those patients who have surgical lesions demonstrated by the selective carotid examinations.
Adolescent↗
Fractures of the articular processes of the cervical spine.
Fractures of the articular processes occurred in 16 (20.8%) of 77 patients with cervical spine fractures as demonstrated by multidirectional tomography. Plain films demonstrated the fractures in only two patients. Acute cervical radiculopathy occurred in five of the patients with articular process fractures (superior process, two cases; inferior process, three cases). Persistent neck pain occurred in one other patient without radiculopathy. Three patients suffered spinal cord damage at the time of injury, which was not the result of the articular process fracture itself. In the other seven cases, no definite sequelae occurred. However, disruption of the facet joint may predispose to early degenerative joint disease and chronic pain; unilateral or bilateral facet dislocation was present in five patients. In patients with cervical trauma who develop cervical radiculopathy, tomography should be performed to evaluate the articular processes.
Cervical Vertebrae↗
Dissecting hematoma of the cervical vertebral artery. Case report.
A 31-year-old woman developed a sudden onset of vertebrobasilar ischemia while exercising. Cerebral arteriography revealed a dissecting hematoma of the cervical portion of the dominant vertebral artery. Both the neurological deficits and the intramural hematoma of vertebral artery resolved with conservative therapy alone.
Adult↗