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Biomedical subjects

U Freund

Publications and source records attributed to U Freund.

At least 37 records · Page 2Linked to original sources
PubMed1994

Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. A review of 290 sympathectomies.

OBJECTIVES: To describe the surgical technique of endoscopic transthoracic sympathectomy for the treatment of palmar hyperhidrosis and to identify associated complications. DESIGN: Prospective clinical study. SETTING: University referral center. PATIENTS: A consecutive series of 150 patients with primary palmar hyperhidrosis. INTERVENTION: The surgical procedure is performed under general anesthesia. A trocar and endoscope are inserted into the chest cavity. The sympathetic chain and the second, third, and fourth ganglia are then identified, cauterized, and cut. After reinflation of the lung, the procedure is repeated on the other side. RESULTS: Two hundred ninety sympathectomies were performed with a 98% success rate. Complications of the procedure included pneumothorax in seven patients (2.4%), hemothorax in three (1.0%), and temporary Horner's syndrome in two (0.7%). Severe postoperative pain during the first 2 to 4 hours required treatment. Of 60 patients who were followed up for 12 months, 50% developed compensatory sweating and 8.3% developed rebound sweating. Hyperhidrosis recurred in three patients. CONCLUSION: Endoscopic transthoracic sympathectomy is an effective form of treatment for palmar primary hyperhidrosis, is associated with a low morbidity, and can be performed as an ambulatory procedure.

Adolescent↗
PubMed1994

The effects of beta-adrenoreceptor blockade on oxygen consumption during cardiopulmonary bypass.

The effect of chronic beta-adrenoreceptor blockade (beta-blockade) on hemodynamics and oxygen consumption (VO2) during cardiopulmonary bypass (CPB) in mild hypothermia (34 degrees C) was studied in 34 patients. The study group included 17 patients who received beta-adrenergic blocking drugs for at least 1 mo prior to the study. Seventeen patients who did not receive beta-adrenergic blockers served as controls. Demographic data in the two groups were comparable. Prior to induction of anesthesia, the heart rate was slower in the beta-adrenergic blocker group as compared to the control group. During CPB, measurements were made at two pump flow rates: 2.4 L.min-1.m-2 and 3.0 L.min-1.m-2. Oxygen delivery was similar in the two groups (beta-adrenergic blocker vs control) but the oxygen consumption was significantly lower in the beta-adrenergic blocker group as compared to the control group at both flow rates (P = 0.009). Increasing the flow rate from 2.4 L.min-1.m-2 to 3.0 L.min-1.m-2 produced a similar increase (P = 0.0001) in oxygen consumption in both groups. Increasing flow rate increased mean arterial pressure (MAP) and central venous pressure (CVP) and decreased systemic vascular resistance index (SVRI) and reservoir volume similarly in both groups. Thus, compared to the control group, patients on chronic beta-adrenergic blocker medication have a lower VO2 during CPB.

Adrenergic beta-Antagonists↗
PubMed1993

[Widespread gastrointestinal CMV infection as the presenting manifestation of AIDS].

A 53-year-old man is reported who developed a widespread gastrointestinal infection due to cytomegalic (CMV) virus and was found to be suffering from AIDS. He died of overwhelming pulmonary infection. There is need for awareness of the rapid increase of AIDS in our local population, particularly in groups not regarded as at high risk. It is imperative to keep this diagnosis in mind when dealing with patients with gastroenterocolitis not responding to standard treatments. CMV has a broad spectrum of clinical manifestations, from carrier state to life-threatening infection. In the gastrointestinal system it causes inflammation and ulcers in the mucosa that may bleed or perforate. There are increasing numbers of reports of CMV ileocolitis in homosexuals with AIDS. The rate of sero-positive CMV in healthy homosexual populations is 94-100% and in 14% there is active infection. CMV is the main infective agent in patients suffering from AIDS; 90% will develop an infection with this virus and in most cases it will be fatal.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Effect of dopexamine on the hemodynamics of coronary surgery patients with and without bisoprolol blockade].

Patients with coronary artery disease undergoing coronary artery bypass grafting can develop perioperative low cardiac output failure requiring positive inotropic support. Commonly, the sympathetic amines, dopamine, dobutamine or adrenaline are used in low-output state. However, patients on long-term cardioselective beta-blocking therapy may experience problems with such a treatment. Dopexamine, a new synthetic amine, possesses positive inotropic effects by indirect stimulation of the beta 1-receptors and direct stimulation of the beta 2-receptors. We therefore studied the hemodynamic efficacy of dopexamine in patients with and without beta-receptor blockade. In 12 patients with coronary artery disease classed as NYHA II or III, six without any beta-blocker medication, and six with beta 1-blocker medication (bisoprolol 5 mg), anesthesia was induced with high-dose fentanyl (0.05 mg/kg) and pancuronium (0.1 mg/kg). The patients were normoventilated with a mask (O2:air 1:1, tidal volume 10 ml/kg with a rate of 10/min) for 5 min and then intubated. Following intubation anesthesia was continued with 0.025 mg/kg/h fentanyl. In anesthesia steady state the patients of both groups were treated with 2 micrograms/kg/min dopexamine over a period of 15 min and then with 4 micrograms/kg/min dopexamine over a further period of 15 min. Measurements of cardiovascular dynamics included heart rate (HR), cardiac index (CI), stroke volume index (SVI), mean arterial blood pressure (MAP), coronary perfusion pressure (CPP), systemic vascular resistance (SVR), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), right atrium pressure (RAP), pressure work index (PWI) and arterial-mixed venous oxygen content difference (AVDO2), which were monitored or calculated by standard formulas.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1993

[Radiation sensitivity of the normal bile duct during high dose rate afterloading irradiation with Iridium 192. Experimental studies in pigs].

This animal study was designed to assess the tolerance of the normal bile duct to a single intraluminal high-dose-rate afterloading irradiation. This information is essential for treatment recommendations in irradiation therapy of malignant bile duct stenoses. In 16 pigs bile duct catheters were inserted surgically. Over these devices single intraductal doses of 7.5 Gy and 15 Gy were applied using an iridium-192 source. After a period of two to three months the bile ducts and the surrounding structures were investigated by means of cholangiography, angiography, and macropathological and histological investigations. A single intraductal dose of 7.5 Gy leads to a slightly scarred shrinkage of the bile duct with sclerosis and obliteration of the capillary vessels. Vasculitis and necrosis of the bile duct wall are still evident three months after irradiation. A single dose of 15 Gy leads to severe lesions with widespread necroses of the bile duct wall which tend to bleed, and result in a high degree of shrinkage of the bile duct. The radiation damage is most prevalent near the papilla and in the narrow segments near the liver. Single intraluminal high-dose-rate afterloading doses of 7.5 and 15 Gy cause significant lesions and complications at the bile ducts. As the intact bile duct is the Achilles heel of intraductal therapy, considerably lower single doses are recommended for a fractioned treatment.

Animals↗
PubMed1992

Low-output syndrome after heart surgery: is a monotherapy with phosphodiesterase-III inhibitors feasible? A comparative study of amrinone and enoximone.

In order to determine whether the primary use of a phosphodiesterase-III (PDE) inhibitor as monotherapy for severe cardiac low-output states (LOS) is in fact practicable, we investigated the haemodynamic effects of amrinone and enoximone in a prospective randomized study. After elective CABG, AVR, or MVR, patients with cardiac LOS were given amrinone (n = 10) or enoximone (n = 9). Following bolus saturation (1.0-2.0 mg/kg [XA = 1.4] or 0.5-1 mg/kg [XE = 0.9] in total), a dose of 5-10 microgram/kg/min was given by infusion. The standard monitoring program included discontinuous haemodynamic measurements (Swan-Ganz) over a maximum time period of 48 hours, arterial and venous blood-gas analyses, and clinical chemistry. The preoperative clinical and haemodynamic status of the enoximone (E) group (55% CABG patients; MPAP 27 +/- 2.5 mmHg, PCWP 20 +/- 2.9 mmHg, PVR 201 +/- 35 dyn.s.cm-5) was considerably worse than that of the amrinone (A) group (70% CABG patients; MPAP 23 +/- 2.3 mmHg, PCWP 16 +/- 3.5 mmHg, PVR 153 +/- 28 dyn.s.cm-5). Both PDE inhibitor preparations led to a significant increase in cardiac index (from 1.9 +/- 0.1 to 2.5 +/- 0.12 L/min/m2 (A) and from 1.98 +/- 0.1 to 2.6 +/- 0.18 L/min/m2 (E) within 30 minutes, accompanied by a simultaneous decrease in filling pressures and vascular resistances. For up to 2 hours, 3/10 (A) and 2/9 (E) patients required additional positive inotropic support with adrenaline. There were no significant differences between the two groups at any time.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Rectus sheath hematoma: a complication of laparoscopic cholecystectomy.

We describe a complication in laparoscopic cholecystectomy. The routine introduction of a midclavicular secondary trocar resulted in a large hematoma of the rectus sheath. The patient developed atelectasis and pneumonia and required extended hospitalization. This previously described complication is detailed with recommendations to prevent its occurrence.

Abdominal Muscles↗
PubMed1992

The possible role of Chlamydia trachomatis in perineal suppurative hidradenitis.

OBJECTIVE: To find out if there is an association between perineal suppurative hidradenitis and Chlamydia trachomatis infection. DESIGN: Open study. SUBJECTS: Seven consecutive patients treated for perineal suppurative hidradenitis during the past three years, and 10 control subjects who were being treated for acute cryptogenic perianal abscesses. MAIN OUTCOME MEASURE: Presence of C. trachomatis detected by direct immunofluorescent staining. RESULTS: All but one patient had serological evidence of C. trachomatis infection. All 10 control subjects failed to react to IgA antibodies to C. trachomatis, and two reacted to IgG antibodies. CONCLUSION: There may be a link between C. trachomatis infection and suppurative hidradenitis, but it is uncertain whether it is a direct cause or a predisposing factor.

Abscess↗
PubMed1992

[The concentration of atrial natriuretic peptides (ANP). ANP in different sections of the circulation during atrial volume load with and without anesthesia].

We studied the effect of a volume load induced by a 45 degrees Trendelenburg position on atrial natriuretic peptide (ANP) secretion in awake and anaesthetized patients with coronary artery disease undergoing aortocoronary bypass surgery. ANP was measured in different parts of the circulation before and after induction of high dose fentanyl anaesthesia at fixed times prior to and after extracorporeal circulation. METHOD. In eight patients with coronary artery disease (NYHA classification II-III), who received neither diuretic nor positive inotropic therapy, ANP was measured in the various parts of the circulation: in a peripheral vein, a radial artery, in the pulmonary artery and in the coronary sinus. The measurements were made in the supine and 45 degrees Trendelenburg position. Measurements of mean arterial pressure (MAP), central venous pressure (RAP), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI) and heart rate (HR) were taken simultaneously. The measurements were taken in the awake patient, during steady-state high-dose fentanyl anaesthesia with 50% O2 in N2O and after extracorporeal circulation. RESULTS. Compared to measurements in a control group, ANP levels were significantly higher in all parts of the circulation in patients with coronary artery disease, although clinical symptoms of heart failure were absent. After extracorporeal circulation, significantly higher levels of ANP were found at all measurement sites; however the concentration gradient of ANP between coronary sinus and arterial or venous blood was reduced. In awake and anaesthetized patients a change in body position, causing a significant increase in filling pressures, did not produce an increase in ANP levels at all measurement sites. The induction of high-dose fentanyl anaesthesia did not have an influence on plasmatic ANP levels. CONCLUSION. The results of this study lead to the following conclusions: 1. ANP levels in patients with CAD are increased, even if clinical heart failure symptoms are absent. 2. ANP is secreted in the coronary vessels. Following dilution in the atrial blood, it is metabolized to inactive compounds in the periphery. 3. Basic ANP levels are not changed by high-dose fentanyl anaesthesia. Marked increases of the filling pressures do not correlate with atrial ANP levels either before or after induction of anaesthesia. 4. After extracorporeal circulation ANP levels are significantly increased in all parts of the circulation. The concentration gradient between coronary sinus blood, on the one hand, and arterial and venous blood on the other hand is reduced. This phenomenon is probably caused by an alteration in the metabolism of ANP during hypothermic extracorporeal circulation.

Aged↗
PubMed1992

Seasonal pattern in the incidence of bleeding caused by peptic ulcer in Israel.

We have reviewed all endoscopies performed in our hospital between 1977 and 1986. During that period, 1337 endoscopies were performed to identify bleeding from peptic ulcers. Excluded were cases in which a predisposing factor was found, such as the use of ulcerogenic drugs. Also excluded were chronic or critically ill patients. The remaining 540 cases were reviewed. In 447 of those cases, the bleeding lesion was a duodenal ulcer, whereas, in 93 cases, a gastric ulcer was found (a ratio of 5:1). The seasonal variation in the incidence of bleeding from peptic ulcers was evaluated. We found a significant difference in bleeding in the cold and hot seasons, the incidence being significantly greater during the cold season (November until February). A similar pattern was found for bleeding from both duodenal and gastric ulcers.

Duodenal Ulcer↗
PubMed1991

[Use of somatostatin analogue for intestinal and pancreatic fistulas].

The hormone somatostatin, a tetra-deca-peptide, was discovered in 1972. It inhibits the central nervous system and the endocrine and exocrine secretions of the gastrointestinal tract. The first clinical use of the hormone was to inhibit hormone-secreting tumors of the CNS. It has also been used to treat hormone-secreting tumors of the pancreas and GI tract. Treatment of small bowel and pancreatic fistulas has also been attempted. A new synthetic analogue of the hormone, SMS 210-995, (Sandostatin) has a long half-life and is highly effective after subcutaneous injection. It was used in the treatment of 3 patients with fistulas of the small bowel and pancreas. In all impressive reduction of fistula secretion was achieved within 24 hours. In 2 there was complete, spontaneous closure of the fistula: in 1 after 10 days and in the other after 15 days of treatment. In the 3rd, there was significant reduction of fistula output. There were no side-effects except for mild pain at the injection site in 1 patient. Previous reports and our own results indicate that this somatostatin analogue may be very useful in the nonsurgical treatment of GI tract fistulas.

Aged↗
PubMed1991

Reflex apnea induced by high-frequency oscillatory ventilation in rabbits.

In rabbits with intact vagus nerves, HFOV applied for 10-20 s caused apnea (i.e., respiratory arrest for as long as HFOV lasted) accompanied by tonic discharges of the diaphragm. To identify the vagal mechanisms involved in this type of apnea, the vagus nerves of anaesthetized rabbits were gradually cooled from 37 degrees C to 0 degree C, i.e., the vagal fibres were, corresponding to their diameter, successively blocked. At each temperature, the effects of HFOV on spontaneous breathing were compared with those of static lung inflation and deflation: Between 20 degrees C and 14 degrees C, the lung inflation reflex (mediated by pulmonary slowly adapting stretch receptors = PSR) was weakened or abolished, whereas the lung deflation reflex (mediated by rapidly adapting stretch receptors = RAR) was reinforced; the HFOV-induced apnea occurred less frequently, however, the accompanying diaphragmatic activity was enhanced. Between 14 degrees C and 5 degrees C, both HFOV and large static inflation caused a slight increase of breathing frequency in the majority of animals. Some animals, however, responded even below 14 degrees C by apnea to both HFOV and inflation, and, under these conditions, both HFOV- and inflation-induced apnea were accompanied by a pronounced tonic diaphragmatic activity. At 5 degrees C, the effects of HFOV as well as of inflation (except in two animals) and deflation were abolished. From the results we conclude that in rabbits the apnea during HFOV is mainly mediated by stimulation of PSR, and the concomitant tonic activity of the diaphragm is mainly due to stimulation of RAR, as it is reinforced with gradual blockade of PSR fibres and abolished when only non-myelinated fibres are intact.

Animals↗
PubMed1990

[Hemodynamics and myocardial energy balance in coronary surgery patients during high-dose fentanyl-pancuronium anesthesia and modified neurolept-pancuronium anesthesia].

In 8 patients with coronary artery disease (CAD) classed as NYHA II or III, anesthesia was induced with high-dose fentanyl (0.05 mg/kg) and pancuronium (0.1 mg/kg). The patients were ventilated normally with the aid of a mask (O2: air 1:1, tidal volume 10 ml/kg with a rate of 10/min) for 5 min and then intubated. In 8 further patients with CAD NYHA class II or III, anesthesia was induced with 0.02 mg/kg flunitrazepam, N2O/O2 1:1 and isoflurane 0.5 vol%; they were relaxed with pancuronium (0.1 mg/kg) in combination with a bolus of 0.005 mg/kg fentanyl. These patients were also ventilated normally for 5 min and then intubated. Measurements of cardiovascular dynamics included cardiac output (CO), heart rate (HR), arterial pressure (AP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), myocardial blood flow (MBF), and arterial and coronary sinus oxygen and lactate contents. Cardiac index (CI), stroke volume index (SVI), total peripheral resistance (TPR), myocardial oxygen consumption (MVO2), coronary vascular resistance (CVR), coronary perfusion pressure (CPP), myocardial oxygen content difference (AVDO2cor) and myocardial lactate extraction rate (LE) were calculated from standard formulas. Measurements and an electrocardiogram were taken before anesthesia, after induction of anesthesia and after intubation. The hemodynamic parameters HR, AP, CI, CPP were relatively stable in patients anesthetized with high-dose fentanyl and pancuronium, whereas we found greater decreases in these parameters with the balanced anesthesia technique. Determinants of myocardial oxygen demand were higher in the high-dose fentanyl group; therefore, myocardial blood flow and oxygen consumption did not decrease to the same extent as in the balanced anesthesia group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Pyogenic liver abscess.

A retrospective study of 18 adults admitted to Meir General Hospital with pyogenic liver abscess during the years 1982-88 was conducted. Our most useful diagnostic tool was ultrasound, which was accurate in all 15 patients in whom it was performed. Only two patients presented with multiple abscesses. Increased alkaline phosphatase was the most predictive laboratory finding, seen in all but one patient. One person was treated conservatively by antibiotics only. In one patient the abscess drained spontaneously into the right thoracic cavity. Initial surgical drainage was done in nine patients and percutaneous catheter drainage in seven. Only one patient died, of septic shock, yielding a mortality rate of 5.5%. The treatment-related complication rate, observed in almost half of the patients, was high. All patients with such complications required repeated drainage, which was achieved surgically in all cases.

Adolescent↗
PubMed1989

Perforated adenocarcinoma of the colon during pregnancy.

Performated carcinoma of the colon in pregnant women is a rare event. Only six cases have been reported in the literature, all except one in the recto-sigmoid. We present a case of perforated adenocarcinoma of the colon located above the peritoneal reflection and discuss the problem of diagnosis and management.

Adenocarcinoma↗
PubMed1989

[Intracavitary high-dose-rate-afterloading-radiotherapy in the esophagus of the pig].

The tolerance of sound esophageal mucosa to intracavitary high dose rate afterloading contact therapy with unique doses of 6 Gy and 12 Gy, respectively, was investigated in 15 pigs. Whereas no macroscopic or microscopic alterations of the mucosa are found after 6 Gy, a unique application of 12 Gy produces most severe side effects such as vascular occlusion due to fibrosis of the intima, formation of fistulas, and perforations of the esophagus wall. Future investigations will have to aim at the elaboration of schemes for dosage and fractionation.

Animals↗