Biomedical subjects
Publications and source records attributed to T Siegel.
We present a case of a 78-year-old woman with abdominal-wall muscle paralysis following cutaneous herpes zoster in the T12-L1 dermatomes. An EMG confirmed paralysis, and a CT scan ruled out fascial defect. The paralysis had completely resolved 1 year later. A review of the literature regarding these unusual sequelae of herpes zoster is presented.
PURPOSE: Erectile dysfunction is a common side effect in men treated for prostate cancer. Previously published studies document the incidence of erectile dysfunction in men treated for prostate cancer to be between 20% and 88%. To our knowledge a prospective evaluation focused on the development of erectile dysfunction in men treated for prostate cancer has not elucidated components of its chronology or risk factors. MATERIALS AND METHODS: A centralized prospective database of 2,956 patients diagnosed with prostate cancer at a single institution was studied in regard to pretreatment and posttreatment erectile dysfunction. Of these 2,956 patients 802 had sufficient information regarding erectile function and comprise our study population. Factors analyzed in regard to treatment and erectile dysfunction include treatment modality, that is radical prostatectomy, external beam radiation therapy and watchful waiting, and ethnicity, patient age, clinical stage and tumor histological grade. RESULTS: No significant difference was noted in the posttreatment erectile function between patients treated with radical prostatectomy or external beam radiation (10% versus 15%). Patients selecting watchful waiting had the lowest risk of erectile dysfunction. Clinical stage and race were significant predictors for the development of erectile dysfunction in the watchful waiting and external beam radiation treatment groups. CONCLUSIONS: Erectile dysfunction develops in greater than 80% of patients treated for prostate cancer. External beam radiation has the same risk for erectile dysfunction as radical prostatectomy.
N-Acetyl-leukotriene E4 has been identified as an endogenous, biologically less active cysteinyl leukotriene metabolite in rodents and humans. To evaluate the ratio of hepatobiliary to renal elimination of leukotrienes noninvasively by positron emission tomography (PET), we synthesized N-[11C]acetyl-leukotriene E4 by chemical N-acetylation of leukotriene E4. After the intravenous injection of N-[11C]acetyl-leukotriene E4 in normal rats and monkey, uptake by the liver and subsequent excretion into bile were largely responsible for its rapid elimination from blood. In the Cynomolgus monkey, renal excretion of the leukotriene into urine was of additional quantitative importance. Kinetic modeling indicated a mean transit time through the liver of 17 minutes and 34 minutes in rat and monkey, respectively; the corresponding hepatic excretion half-times amounted to 8.5 minutes and 16 minutes. In a mutant rat strain deficient in the hepatobiliary excretion of cysteinyl leukotrienes across the canalicular membrane, the apparent mean liver transit time was 54 minutes, and the hepatic excretion half-time was 29 minutes, indicating prolonged organ storage and metabolism. After transport from the liver back into the circulating blood of omega-oxidized and beta-oxidized metabolites of N-[11C]acetyl-leukotriene E4, renal excretion compensated for the impairment of hepatobiliary elimination in the transport mutant. Metabolite analyses in urine after intravenous injection of N-[3H]acetyl-leukotriene E4 indicated the extensive inactivation of N-acetyl-leukotriene E4 by beta-oxidation from the omega-end in the mutants. A similar shift from hepatobiliary to renal cysteinyl leukotriene elimination was monitored in rats with cholestasis due to bile duct obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Before 1955 blunt traumatic ruptures of the heart and pericardium were reported almost exclusively in autopsy reports. Since then, because of improved prehospital care and early triage, it has been demonstrated that injuries resulting in rupture of the heart and pericardium are no longer always fatal. We present a case of a patient who arrived at the hospital with increasing abdominal girth and a tender abdomen who on exploration was found to have a tear of the pericardium and atrial appendage compounded by a supradiaphragmatic tear of the inferior vena cava.
The present study evaluated alternative treatments for children (N = 112, ages 7-13) referred for severe antisocial behavior. Children were randomly assigned to one of three treatments: problem-solving skills training (PSST), problem-solving skills training with in vivo practice (PSST-P), which included therapeutically planned activities to extend training to settings outside of treatment, or client-centered relationship therapy (RT). PSST and PSST-P children showed significantly greater reductions in antisocial behavior and overall behavior problems, and greater increases in prosocial behavior than RT children. These effects were evident on measures obtained immediately after treatment and at a 1-year follow-up, and on measures of child performance at home and at school. PSST-P children showed greater changes than PSST children on measures of functioning at school at posttreatment, but these differences were no longer evident at follow-up. Children in both PSST conditions showed significant reductions in deviant behavior and improvements in prosocial behavior from pretreatment to follow-up, whereas RT children tended to remain at their pretreatment level of functioning. Notwithstanding the significant improvements, comparisons with nonclinic (normative) samples revealed that the majority of youth remained outside of the normal range of deviant behavior. Possible directions for improving treatment for antisocial youth are highlighted.
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Colonogastric fistula, more commonly called "gastrocolic," is a rare complication of Crohn's colitis. The 17th incidence of this fistula is reported. Fecal halitosis is a prominent symptom. Barium enema is the most accurate diagnostic tool. Colonoscopy plays a role in delineating surgical therapy. The stomach resection is described. Because of its pathogenesis, the authors prefer to call this "colonogastric" fistula, rather than gastrocolic fistula.
From 1973 through 1983, 197 patients were treated at Harper-Grace Hospital, Detroit, according to a protocol designed to minimize the effects of possible gastrojejunal disruption. All had high-risk resections or bypasses of the stomach reconstructed with an end-to-end Roux-en-Y anastomosis using a long (100-cm) jejunal limb. Eighteen anastomoses leaked, producing fever, pain, and mild respiratory distress in 14 patients and peritonitis with shock in four. Nine of the 14 patients without shock avoided surgery, requiring only antibiotics and nutritional support. The other five had a subphrenic abscess, necessitating drainage. The four patients with shock were treated with staged intestinal discontinuity, nutritional support, and reestablishment of gastrointestinal continuity at a later date. Seventeen patients (94%) survived this serious complication, a significant improvement compared with the mortality of historical controls.
The effects of intralesional chemotherapy with 7 different drugs on line 10 hepatoma grown in strain 2 guinea pigs were compared with the sensitivity of line 10 tumor cells in vitro, using a micro modification of the tumor stem assay with capillary tubes. A modified method was used to evaluate the in vitro dose-response curves. The correlation for in vivo/in vitro resistance was found to be 100% and for in vivo/in sensitivity it was 80%.
Most investigators have emphasized that both a small reservoir and a narrow stoma are critical to the success of a gastric bypass. This prospective study was performed to test this clinical hypothesis. All patients had a similar 30-45 ml proximal gastric reservoir created; however, stoma size was determined by the lumen of the jejunum, averaging 3.2 cm in cross-sectional diameter. We found that stoma size had little effect on the success of the gastric bypass if a tiny (less than 45 ml) reservoir was consistently created and a Roux-en-Y anastomosis was used for reestablishing intestinal continuity. The avoidance of a small stoma virtually eliminates postbypass emesis as a major complication.
Between 1978 and 1981, we have used a vertical axillary thoracotomy in 106 patients for 109 operations. The approach provides a fast and easy entrance into the thoracic cavity. Exposure was adequate. The procedure was well tolerated, even by patients with respiratory compromise, and morbidity was minimal. This approach is recommended as an alternative to the formal posterolateral thoracotomy and anterior mediastinotomy in selected patients.
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The intense clinical interest in bleomycin as an anti-tumour agent has led to different methods of administration in an attempt to administer sufficiently high concentrations of the drug to the tumor. Therefore, a study was designed to determine the distribution and the therapeutic effect of a bleomycin emulsion and aqueous bleomycin after different routes of application. The tissue distribution of radioactively labelled bleomycin emulsion and aqueous bleomycin was determined in tumor-free CF 1 and tumor-bearing (EL 4, L 1210) C 57 Bl 6 and DBA 2 mice after local (s.c., i.t.) and systemic (i.v.) injection. The distribution studies for aqueous 57Co-bleomycin showed increased activity in the injection sites and the lymph nodes draining the injection sites after s.c. and i.t. injection compared to i.v. administration of the drug. In comparison to the aqueous local administration, the application of 57Co-bleomycin emulsion resulted in a disproportional increase of the 57Co-bleomycin concentration at the injection sites and in the draining lymph nodes. To prove the therapeutic relevance of the bleomycin tissue distribution tumor-bearing (line 10) strain 2 guinea pigs were treated with different modes of bleomycin. Animals with already lymphogenously metastasized tumors have been cured by means of low i.t. doses of the bleomycin emulsion. Guinea pigs treated with i.t. administration of aqueous bleomycin need, compared to the bleomycin emulsion, five times higher doses for tumor-free survival. Intravenously treated animals died either because of progressive tumor growth or because of toxic bleomycin effects. These findings made by animal experiments favor the i.t. treatment of head and neck carcinomas with a bleomycin emulsion.
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