Harry S. Soroff

Three-year sustained benefit from enhanced external counterpulsation in chronic angina pectoris.

Abstract Both the short-term and now long-term (over a 3-year period) clinical benefits of EECP appear to be maintained in almost all patients treated for chronic disabling angina. That most patients maintained their 3-year benefits suggests that long-term improvement in myocardial perfusion can occur. Future angiographic studies are planned to evaluate collateral function in these patients.

Collagenase ointment and polymyxin B sulfate/bacitracin spray versus silver sulfadiazine cream in partial-thickness burns: a pilot study.

A multifaceted approach that involves early debridement and control of infection is critical to successful and rapid burn wound healing. This pilot study was conducted in 15 adult patients with burns to assess the usefulness of early enzymatic debridement with a combination of collagenase ointment and polymyxin B sulfate/bacitracin spray versus silver sulfadiazine cream in partial-thickness burns. Combination treatment with collagenase and polymyxin B sulfate/bacitracin resulted in significantly shorter time to achieve a clean wound bed than silver sulfadiazine (median 6 vs 12 days; p = 0.0012) and significantly more rapid wound healing than silver sulfadiazine (median 10 vs 15 days; p = 0.0007). These results are encouraging and justify implementation of a larger, multicenter, comparative study.

Can angiographic findings predict which coronary patients will benefit from enhanced external counterpulsation

Enhanced external counterpulsation is an effective treatment for chronic angina. Theoretical considerations predict greatest benefit in patients with at least 1 patent conduit in this group of 50 patients (all of whom improved clinically). Improvement in radionuclide stress perfusion imaging was seen in 80% of treated patients and was inversely related to extent of coronary disease.

Evaluation of the effectiveness of controlled pH in management of massive upper gastrointestinal bleeding

Abstract Twenty-five patients with massive upper gastrointestinal hemorrhage have been treated by control of the intragastric pH at 7.0 with antacids. In twenty-three of the twenty-five patients, bleeding stopped. The two treatment failures included one patient in whom the pH could not be raised above 4.5 despite massive instillations of antacid; the other failure occurred in a patient who had had thrombolytic therapy and extensive small bowel resection for gangrene.

Successful fibrinolytic therapy for superior vena cava thrombosis secondary to long-term total parenteral nutrition.

Thrombosis of the superior vena cava and other major central veins is an unusual and infrequent complication of total parenteral nutrition. When it does occur, it may be life threatening and prompt therapy is indicated. A case of superior vena cava thrombosis secondary to an indwelling Broviac catheter for long-term parenteral nutrition is presented, which was successfully treated with Streptokinase with reestablishment of flow through the catheter and veins.

Improved sternal closure using steel bands: Early experience with three-year follow-up

BACKGROUND Use of stainless steel wires in median sternotomy closure is at times associated with serious complications. In view of this, the efficacy and safety of a stainless steel band designed for fixation and approximation of the sternum in cardiothoracic procedures was evaluated in a prospective, randomized study. METHODS Forty-eight patients undergoing open heart operations that involved a median sternotomy were studied. Group I (n = 21) was closed with four to six steel bands, and group II (n = 27) with six to eight standard stainless steel wires. The average age of the patients and the risk factors predisposing to dehiscence were similar in both groups. RESULTS One postoperative death occurred in each group due to cardiac failure. In group I, the mean length of the postoperative hospital stay was 10.2 +/- 1.76 days (+/- 2 standard errors), whereas in group II the mean was 13.9 +/- 3.4 days (+/- 2 standard errors). Banded patients complained less of postoperative pain, although statistical significance was not achieved. No problems arose in either group during the 3-year follow-up. CONCLUSIONS The steel bands, compared with wires, provided not only effective fixation, but a reduction in both postoperative pain and postoperative hospital stay. The band is now being studied in a larger group of patients to evaluate the incidence and type of complications associated with its use, as well as length of postoperative hospital stay.

Herniorrhaphy in the elderly: Benefits of a clinic for the treatment of external abdominal wall hernias

Elective abdominal herniorrhaphy carries morbidity and mortality rates of 26 percent and 1.5 percent, respectively, in patients over 65 years of age. These figures climb to 55 percent and 15 percent during emergent surgery. Our purpose was to investigate if standardization of treatment could improve such results. Our program stressed centralization of care in a hernia clinic; early operation of patients at risk of incarceration; optimization of underlying systemic disorders by consultative services; operation under local anesthesia; preoperative, operative, and postoperative protocol; and continuity of care by senior personnel. Over a 4 year period, we have performed 241 abdominal herniorrhaphies in patients over 65 years of age (median age 71.5 years old) who exhibited an 84 percent incidence of significant preoperative systemic disorders. Since the inception of our program, our rate of emergent operation has decreased significantly from 7 percent to 2 percent (chi-square less than or equal to 0.05). Our rate of systemic complications after elective operation was 1.2 percent and 0 after emergent operation. These data are statistically better than those reported in the literature (chi-square less than or equal to 0.05). These results suggest that the creation of a hernia clinic significantly improves the care of herniated patients.

Psychosocial effects of enhanced external counterpulsation in the angina patient.

Enhanced external counterpulsation (EECP) is a noninvasive pantaloon device designed to increase coronary artery flow in the treatment of angina. This pilot study, conducted in 1992-1993, which used psychosocial testing pre- and posttreatment, yielded data suggesting that EECP is well tolerated psychosocially and produces improvement in the anginal syndrome. More comprehensive research is under way to test these preliminary conclusions.

The effect of trifluoperazine, a calmodulin antagonist, on the growth of normal and malignant epidermal keratinocytes in culture

Calmodulin, a cytoplasmic calcium binding protein, is present in concentrations two- to four-fold higher in malignant cells compared to normal cells. In an effort to learn the significance of these elevated levels, we examined the effect of calmodulin blockage on the growth of normal and malignant keratinocytes in vitro. The level of calmodulin in SCC12.B2, a line of keratinocytes derived from an epidermal squamous cell carcinoma (SCC), was about 3.5 times greater than in normal, human newborn foreskin keratinocytes. When exposed to trifluoperazine (TFP), an inhibitor of calmodulin, cell growth was reduced primarily in the cultures of normal keratinocytes. This growth inhibition resulted from two changes in the replicating population of cells, namely an increase in cell cycle length and an increase in rate of cell cycle withdrawal. Cell cycle withdrawal is the irreversible arrest of the cell cycle and is an early event in keratinocyte terminal differentiation. There was no measurable effect on the cell cycle time or withdrawal rate in SCC12.B2. The increased resistance to growth arrest in SCC cells may be a consequence of the elevated level of calmodulin in these cells.

The effect of growth-promoting agents on replication and cell cycle withdrawal in cultures of epidermal keratinocytes

SummaryEpidermal keratinocytes grow in culture to form a stratified squamous epithelium. These cultures contain a replicating as well as a terminally differentiating population and undergo surface desquamation. Epidermal growth factor (EGF) and cholera toxin are usually employed as growth-promoting agents because they reduce the population doubling time; that is, the period required to increase the total cell number twofold. There are three ways in which this reduction in population doubling time could be achieved: (a) the time for one cell cycle or the cell cycle length may be shortened; (b) the number of cells that withdraw from the cell cycle and terminally differentiate may be reduced; or (c) the number of cells that desquamate into the medium over a set period of time may be reduced. We have explored these possibilities in growing cultures of epidermal keratinocytes using a newly developed double-label assay. This assay gives a measure of both cell length and cell cycle withdrawal. Results show that the growth enhancement induced by EGF and cholera toxin can be attributed primarily to a reduction in cell cycle withdrawal and, to a lesser degree, to a reduction in cell cycle length. EGF and cholera toxin have no significant effect on the rate of desquamation. A linear correlation was noted between cell cycle lengths and withdrawal, suggesting an interconnection between the rate of cell renewal and the likelihood of undergoing terminal differentiation.