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Biomedical subjects

S N Klein

Publications and source records attributed to S N Klein.

6 recordsLinked to original sources
PubMed2001

Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy.

PURPOSE: Fissure-in-ano is characterized by pain, bleeding, and internal anal sphincter hypertonicity. Spasm of the internal sphincter also plays a role in hemorrhoidal disease and may be a source of anal pain after hemorrhoid surgery. Inducing sphincter relaxation with a nitroglycerin ointment has shown promise in healing anal fissures and relieving symptoms of pain. Our study attempts to test the hypothesis that topical nitroglycerin applied to the perianal region is beneficial in reducing pain after hemorrhoidectomy. METHODS: After hemorrhoidectomy 39 patients were randomly assigned to receive 0.2 percent nitroglycerin ointment (n = 19) or placebo (n = 20). Ointments were applied to the perianal region three times daily for seven days. Patients were prescribed hydrocodone bitartrate to take as needed. Visual analog scales were used to measure postoperative pain intensity and ointment benefits. Patients completed questionnaires to record medication morbidity and number of prescribed or nonprescribed medications taken. RESULTS: Patients using nitroglycerin had less pain and greater benefit from ointment than those did in the placebo group, but differences were not significant. Narcotic use was higher in the placebo group when considered on a daily basis, but was statistically significant on the second postoperative day only (P < 0.05). Morbidity from ointment application was significantly higher in the nitroglycerin group (P < 0.002) and included a headache in 8 of 19 patients. Nonsteroidal anti-inflammatory drugs and acetaminophen were not prescribed, but were taken more frequently in nitroglycerin patients (P < 0.0003). CONCLUSION: Perianal application of 0.2 percent nitroglycerin ointment after hemorrhoidectomy significantly reduced narcotic requirements on the second postoperative day. Headaches and a subsequent need for nonnarcotic medications may limit benefits of nitroglycerin.

Administration, Topical↗
PubMed2000

Insulin and raclopride combine to decrease short-term intake of sucrose solutions.

We have previously reported that the hormone insulin can modulate synaptic function of dopamine neurons. To evaluate whether insulin can alter performance of a task which is dependent on intact dopaminergic signaling, we tested rats in a five minute lick rate task, with a range of concentrations of sucrose or oil solutions. Rats received either ip (t -15 min) saline or the D2 receptor antagonist raclopride (50 microg/kg), and intraventricular (t -4 h) saline or insulin (5 mU). Although ineffective on its own, insulin combined with raclopride treatment resulted in significant suppression of sucrose lick rates compared to the saline/saline group. The overall results are consistent with our hypothesis that insulin may modify performance in tasks that are dependent on dopaminergic signaling.

Animals↗
PubMed2000

Is total colonic evaluation for anal cancer necessary?

The purpose of this study was to evaluate the necessity of total colonic evaluation in patients diagnosed with anal cancer. We reviewed the cases of 69 patients treated for neoplasm of the anus from January 1973 through November 1998. Patients underwent a barium enema, flexible sigmoidoscopy or colonoscopy; findings from these procedures were analyzed. Anal pathology included: squamous cell carcinoma, 48 patients (72%); adenocarcinoma, 6 patients (9%); and squamous cell carcinoma in situ, 10 patients (15%). Chemoradiation was completed in 41 patients (61%), and 6 patients (9%) underwent abdominal perineal resection. Wide excision was the primary therapy in 15 patients (22%). Procedures included: colonoscopy, 31 patients (46%); flexible sigmoidoscopy only, 15 patients (22%); barium enema only, 3 patients (5%); and a combination of flexible sigmoidoscopy and barium enema, 18 patients (27%). Eighty-five per cent of patients had a normal colonic evaluation. Ten patients (15%) had single or multiple polyps identified. Six adenomatous polyps and two hyperplastic polyps were found. No synchronous colorectal malignancy was identified. We conclude that colonoscopy is an integral part of colonic surveillance in patients diagnosed with anal carcinoma, but our study fails to find evidence to support such intervention. The standard screening recommendation for colorectal cancer based on age and risk factors is appropriate intervention for patients diagnosed with anal cancer; anal cancer itself does not appear to be one of these risk factors.

Adult↗
PubMed1995

Ileoproctostomy is preferred over ileoanal pull-through in patients with indeterminate colitis.

A 15-year retrospective review was undertaken to evaluate the operative outcomes of patients with indeterminate colitis who were referred for rectal-sparing operations. Review of 95 consecutive patients operated for ulcerative colitis (UC) or indeterminate colitis (IC) revealed characteristics of IC in 13 patients. In the group as a whole, there were 45 females and 50 males; the average age was 33. A total of 64 patients had ileoanal pull-through (IAA). Analysis revealed that four of these patients had IC revealed by findings before operation in three patients and following the first stage of operation in one patient. Three of these four patients have subsequently required permanent ileostomy. Six patients who underwent IAA have subsequently demonstrated signs and symptoms of Crohn's disease (CD). All six have subsequently required ileostomy. Overall 10 patients with CD underwent IAA, and nine have required permanent ileostomy. Fourteen patients had ileorectal anastomosis (IRA) for UC or IC. IRA was performed for patients with IC in nine cases, and five patients with UC elected this operative option. Indications for IRA in patients with UC included obesity, 2; mental retardation, 1; advanced age, 1; and patient preference, 1. Of the patients with IC who underwent IRA, two have subsequently shown signs and symptoms of Crohn's disease. Overall, 14 of 14 patients who had IRA still have functioning IRA. None has required ileostomy. The poor results in patients with UC or IC subsequently shown to have CD have caused us to change our operative approach in patients with any question in the diagnosis of UC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Functional and surgical anatomy of the lateral ankle.

Inversion ankle injuries resulting in soft tissue injury or various types of fractures are seen frequently by podiatrists, and diagnosis and evaluation of treatment require a thorough knowledge and understanding of the anatomy of the area. In this paper, the authors approach the anatomy from the point of view of surgical dissection, with emphasis on the soft tissue structures. X

Ankle↗