B. Chir - Academia.edu (original) (raw)
Papers by B. Chir
The Journal of Pediatrics, 1979
The term "late metabolic acidosis" is generally used to define a population of apparently healthy... more The term "late metabolic acidosis" is generally used to define a population of apparently healthy LB W infants who jail to grow and have a base deficit in excess of 5 mEq/l (CO2To T <21 raM). A relationship between hypobasemia and the lack of appropriate growth was postulated This conclusion was reached, howevet, in the absence of adequate information regarding the distribution of acid-base variables in healthy LBW infants. The results of this study demonstrate that ?he C02TO T of LBW infants (n = 114) rises between birth and three weeks of life from a mean of 18.6 to 20.3 raM. The frequency distribution of CO,to T values did not show any significant deviations from normality, and 2 SD included values as low as 14.5 mM. No difference in the rate of growth was detected between "'hypobasemic'" infants given a solution of bicarbonate calculated to bring their blood C02TO T to > 21 mM and those given similar amounts of isotonic saline solution. The ability of the LB W infants to excrete an ammonium chloride load was not related to their acid-base status and was comparable to that of term infants. It is apparent that the definition of late metabolic acidosis needs to be reconsidered.
The Journal of Pediatrics, 1976
Clinica Chimica Acta, 2012
Human biospecimens are subjected to collection, processing, and storage that can significantly al... more Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality
Circulation, 1981
The realization that bias in patient selection may influence the results of clinical studies has ... more The realization that bias in patient selection may influence the results of clinical studies has helped to establish the randomized controlled clinical trial in medical research. However, bias can be equally important at other stages of a trial, especially at the time of analysis. Withdrawing patients from consideration in the analysis because of ineligibility on account of study entry criteria, lack of compliance to the protocol, or data of poor quality may be a source of systematic error. Examples to illustrate the possible consequences are taken from trials in the cardiovascular field. We recommended that reported study results should include outcome data from all subjects randomized in the group to which they were originally assigned.
Dysphagia, 1994
Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obta... more Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints
World Journal of Surgery, 1993
During 7057 conventional cholecystectomies (1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)... more During 7057 conventional cholecystectomies (1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991), 16 bile duct injuries occurred, amounting to a risk of 0.22%. A total of 1022 laparoscopic cholecystectomies were performed without such a complication since April 1990. In a retrospective study, 64 patients (16 of our patients and 48 referrals) with an injury or stricture due to conventional cholecystectomy were investigated. In 14 of our 16 patients the injury was recognized and immediately repaired with a good long-term result of 93 %, including one successful repair of a subsequent stricture. Two cases of unrecognized injury were managed by nonoperative means. The group of 48 referred patients comprised 10 early postoperative complications (21%) and 38 strictures after an "uneventful" cholecystectomy. Of the 64 total patients, 10 (16%) underwent nonoperative treatment, and 54 required surgery. The mean foUow-up period after surgery was 7.4 -+ 4.9 years. Most cases (93%) were repaired by bilioenteric anastomosis (i.e., foremost hepaticojejunostomy) with an 18% restricture rate. Including second and third repairs for restricture, a total of 60 operations (14 primary and 46 secondary reconstructions) were performed without hospital mortality. A good long-term result after stricture repair was achieved in 75% of the patients, whereas 17% had a poor outcome owing to restricture or death (10% had related mortality within 10 years). The other 8% had a moderate result due to recurrent cholangitis. Thus immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.
Journal of Vascular Surgery, 2009
Calculating wound area reduction after 4 weeks is a valid tool to estimate the probability that a... more Calculating wound area reduction after 4 weeks is a valid tool to estimate the probability that a diabetic foot wound will heal. A 50% wound area reduction after 4 weeks of therapy indicates likely healing of a diabetic foot wound.
The Journal of Pediatrics, 1973
A syndrome of supravalvular pulmonary stenosis and an abnormal facial appearance is described in ... more A syndrome of supravalvular pulmonary stenosis and an abnormal facial appearance is described in 15 children. The auscultatory findings suggest stenosis of the pulmonary valve. The presence of an abnormal facial appearance consisting of hypertelorism, a flat nasal bridge, a ...
The Journal of Pediatrics, 1981
infants of birth weights < 801 gm were referred from outlying hospitals'. The survival rate was 2... more infants of birth weights < 801 gm were referred from outlying hospitals'. The survival rate was 25%for the whole group and 35%for those weighing 700 to 800 gm. Many were in a poor condition on arrival One hundred and nineteen died. The most common causes of death were intracranial hemorrhage (39), RDS (26), and infection (13). Thirty-seven of the 39 survivors were followed until 18 months postterm. Growth failure was common-57% were below the third percentile in weight, 37% in length, and 17% in head circumference. Three had retrolental fibroplasia. Five children (14%) had major neurologic sequelae. Eight were severely handicapped with a Bayley score of < 70 and ten were moderately handicapped with a Bayley score between 70 and 84, resulting in a neurodevelopmental handicap rate of 49%. Significant factors correlating with survival and intact outcome were birth weight >_ 700 gm, gestation >_ 26 weeks, the absence of asphyxia, and good condition on arrival at the NICU. There was no intact survival below 700 gm birth weight. The handicap rate of survivors between 700 and 800 gm was only 39%. Although intensive care in a referral unit may not be justified for those < 700 gm, every effort should be made in the care of those 700 to 800 gm.
Journal of Pediatric Surgery, 1973
At the age of 13 wk a male infant was admitted, having passed fresh blood and clots per rectum. F... more At the age of 13 wk a male infant was admitted, having passed fresh blood and clots per rectum. For 3 wk, there had been screaming attacks, reluctance to feed, and progressive pallor. He was very pale and in shock, and the combination of upper abdominal tenderness and a mass in the left hypochondrium, with absence of bowel gas in the right iliac fossa on a plain abdominal x-ray, suggested intussusception. A barium enema, however, was normal. Hemoglobin, packed cell volume, and mean corpuscular hemoglobin count were 5.2 g/100 ml, 18%, and 29%, respectively. Hypochromia, with moderate numbers of normoblasts and myelocytes, suggested acute or chronic blood loss. The Fig. 1. Barium meal on 18th postoperative day showing ulcer crater.
Journal of Neurosurgery, 1999
During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were succe... more During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding. Patients were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annual questionnaires. Stable angiographic occlusion was evident in 86.4% of small and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients (between 11 and 35 months posttreatment) and by rupture of a coincidental untreated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embolization, with no rebleeding in subsequent years. Rebleeding occurred in three (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms that appeared stable on angiography. Periodic follow-up angiography after coil embolization is recommended to identify aneurysm recurrence and those patients at a high risk of late rebleeding.
International Journal of Radiation Oncology*Biology*Physics, 1981
... A plethysmographic technique has been reported by Travis et al.&amp;quot; which enabl... more ... A plethysmographic technique has been reported by Travis et al.&amp;quot; which enables ventilation in mice to be monitored using a sensitive microphone. ... In Frontiers of Radiation Therapy and Oncology, Vol. 6, Vaeth, JM, Bazel, E. and Harger. S. (Eds.). Karger, Basel, 1972, pp. ...
International Journal of Radiation Oncology*Biology*Physics, 1983
Dysphagia, 1994
Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obta... more Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints were examined and schematic drawings of the relevant radiographs were made. These were superimposed on to the actual EDAT printed chart of the same swallow event, their exact time relationship with respiration and cervical swallow sounds being preserved. The results allow events in the barium videofluoroscopy to be related to events in the feeding respiratory pattern and swallow sounds recorded by EDAT.
Critical Care Medicine, 1985
The effect of positive end-expiratory pressure (PEEP) on PaO2 during collapse of a single pulmona... more The effect of positive end-expiratory pressure (PEEP) on PaO2 during collapse of a single pulmonary lobe was investigated in seven dogs. Increasing PEEP to the ventilated region of lung increased the proportion of cardiac output flowing to the collapsed lobe and decreased PaO2 and pH. PaCO2 increased at the onset of lobar collapse but was not significantly altered by changes in PEEP. In impaired lungs, the benefits of PEEP may be offset by an increase in blood flow to the unventilated region and hence lead to a decrease in PaO2.
Cancer, 1984
The effects of radiotherapy on immune status in patients with localized carcinoma of the cervix h... more The effects of radiotherapy on immune status in patients with localized carcinoma of the cervix have been assessed serially up to 5 years remission by a wide range of methods. Neutrophil function and serum immunoglobulins were essentially normal throughout. Peripheral blood neutrophil and lymphocyte counts and the proportions of T and B-cells fell with treatment but were all normal at 5 years, with the exception of B-cell proportions which remained significantly low. Marked deterioration was seen in in vivo cellular immune responses and this persisted even at 5 years remission. Reduced in vitro immunoreactivity is not therefore a reliable marker of disease recurrence and persisting defects in cellular immunity after radiotherapy do not seem to adversely affect the host tumor response. However, in three of the six patients who subsequently relapsed after therapy, subnormal PHA lymphocyte transformation responses were observed at presentation; all patients achieving sustained remission had normal pretreatment responses.
Breast Cancer Research and Treatment, 1983
The American Journal of Cardiology, 1996
Annals of Surgery, 1980
Circular, full-thickness dermal burn-and freeze-produced wounds were produced in rats to compare ... more Circular, full-thickness dermal burn-and freeze-produced wounds were produced in rats to compare the difference in healing between the two types of thermal injuries. Contraction did not occur in wounds (n = 30) caused by freezing, while burn wounds (n = 30) contracted to less than one-third of original size by 21 days after injury. If the centers of the freezeproduced wounds (n = 12) were excised, contraction would then occur and proceed at the same rate as an open wound. Histologically, the degree of initial tissue destruction by the two types of injuries was similar. The burn wound contained only half the amount of collagen found in the freeze-produced wound. There was a greater and more rapid replacement of collagen in the burn wounds. With both injuries, the highest concentration of collagen was found on the fifteenth day and returned to normal by the twenty-eighth day. The burn wound contained three times the amount of collagen in normal skin, while the freeze-produced wound contained only 14 times the amount in normal skin. Contraction does not seem to occur in the healing of the freeze-injured skin because the slow removal and replacement of the residual matrix prevents contraction.
The Journal of Pediatrics, 1979
The term "late metabolic acidosis" is generally used to define a population of apparently healthy... more The term "late metabolic acidosis" is generally used to define a population of apparently healthy LB W infants who jail to grow and have a base deficit in excess of 5 mEq/l (CO2To T <21 raM). A relationship between hypobasemia and the lack of appropriate growth was postulated This conclusion was reached, howevet, in the absence of adequate information regarding the distribution of acid-base variables in healthy LBW infants. The results of this study demonstrate that ?he C02TO T of LBW infants (n = 114) rises between birth and three weeks of life from a mean of 18.6 to 20.3 raM. The frequency distribution of CO,to T values did not show any significant deviations from normality, and 2 SD included values as low as 14.5 mM. No difference in the rate of growth was detected between "'hypobasemic'" infants given a solution of bicarbonate calculated to bring their blood C02TO T to > 21 mM and those given similar amounts of isotonic saline solution. The ability of the LB W infants to excrete an ammonium chloride load was not related to their acid-base status and was comparable to that of term infants. It is apparent that the definition of late metabolic acidosis needs to be reconsidered.
The Journal of Pediatrics, 1976
Clinica Chimica Acta, 2012
Human biospecimens are subjected to collection, processing, and storage that can significantly al... more Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality
Circulation, 1981
The realization that bias in patient selection may influence the results of clinical studies has ... more The realization that bias in patient selection may influence the results of clinical studies has helped to establish the randomized controlled clinical trial in medical research. However, bias can be equally important at other stages of a trial, especially at the time of analysis. Withdrawing patients from consideration in the analysis because of ineligibility on account of study entry criteria, lack of compliance to the protocol, or data of poor quality may be a source of systematic error. Examples to illustrate the possible consequences are taken from trials in the cardiovascular field. We recommended that reported study results should include outcome data from all subjects randomized in the group to which they were originally assigned.
Dysphagia, 1994
Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obta... more Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints
World Journal of Surgery, 1993
During 7057 conventional cholecystectomies (1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)... more During 7057 conventional cholecystectomies (1972)(1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991), 16 bile duct injuries occurred, amounting to a risk of 0.22%. A total of 1022 laparoscopic cholecystectomies were performed without such a complication since April 1990. In a retrospective study, 64 patients (16 of our patients and 48 referrals) with an injury or stricture due to conventional cholecystectomy were investigated. In 14 of our 16 patients the injury was recognized and immediately repaired with a good long-term result of 93 %, including one successful repair of a subsequent stricture. Two cases of unrecognized injury were managed by nonoperative means. The group of 48 referred patients comprised 10 early postoperative complications (21%) and 38 strictures after an "uneventful" cholecystectomy. Of the 64 total patients, 10 (16%) underwent nonoperative treatment, and 54 required surgery. The mean foUow-up period after surgery was 7.4 -+ 4.9 years. Most cases (93%) were repaired by bilioenteric anastomosis (i.e., foremost hepaticojejunostomy) with an 18% restricture rate. Including second and third repairs for restricture, a total of 60 operations (14 primary and 46 secondary reconstructions) were performed without hospital mortality. A good long-term result after stricture repair was achieved in 75% of the patients, whereas 17% had a poor outcome owing to restricture or death (10% had related mortality within 10 years). The other 8% had a moderate result due to recurrent cholangitis. Thus immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.
Journal of Vascular Surgery, 2009
Calculating wound area reduction after 4 weeks is a valid tool to estimate the probability that a... more Calculating wound area reduction after 4 weeks is a valid tool to estimate the probability that a diabetic foot wound will heal. A 50% wound area reduction after 4 weeks of therapy indicates likely healing of a diabetic foot wound.
The Journal of Pediatrics, 1973
A syndrome of supravalvular pulmonary stenosis and an abnormal facial appearance is described in ... more A syndrome of supravalvular pulmonary stenosis and an abnormal facial appearance is described in 15 children. The auscultatory findings suggest stenosis of the pulmonary valve. The presence of an abnormal facial appearance consisting of hypertelorism, a flat nasal bridge, a ...
The Journal of Pediatrics, 1981
infants of birth weights < 801 gm were referred from outlying hospitals'. The survival rate was 2... more infants of birth weights < 801 gm were referred from outlying hospitals'. The survival rate was 25%for the whole group and 35%for those weighing 700 to 800 gm. Many were in a poor condition on arrival One hundred and nineteen died. The most common causes of death were intracranial hemorrhage (39), RDS (26), and infection (13). Thirty-seven of the 39 survivors were followed until 18 months postterm. Growth failure was common-57% were below the third percentile in weight, 37% in length, and 17% in head circumference. Three had retrolental fibroplasia. Five children (14%) had major neurologic sequelae. Eight were severely handicapped with a Bayley score of < 70 and ten were moderately handicapped with a Bayley score between 70 and 84, resulting in a neurodevelopmental handicap rate of 49%. Significant factors correlating with survival and intact outcome were birth weight >_ 700 gm, gestation >_ 26 weeks, the absence of asphyxia, and good condition on arrival at the NICU. There was no intact survival below 700 gm birth weight. The handicap rate of survivors between 700 and 800 gm was only 39%. Although intensive care in a referral unit may not be justified for those < 700 gm, every effort should be made in the care of those 700 to 800 gm.
Journal of Pediatric Surgery, 1973
At the age of 13 wk a male infant was admitted, having passed fresh blood and clots per rectum. F... more At the age of 13 wk a male infant was admitted, having passed fresh blood and clots per rectum. For 3 wk, there had been screaming attacks, reluctance to feed, and progressive pallor. He was very pale and in shock, and the combination of upper abdominal tenderness and a mass in the left hypochondrium, with absence of bowel gas in the right iliac fossa on a plain abdominal x-ray, suggested intussusception. A barium enema, however, was normal. Hemoglobin, packed cell volume, and mean corpuscular hemoglobin count were 5.2 g/100 ml, 18%, and 29%, respectively. Hypochromia, with moderate numbers of normoblasts and myelocytes, suggested acute or chronic blood loss. The Fig. 1. Barium meal on 18th postoperative day showing ulcer crater.
Journal of Neurosurgery, 1999
During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were succe... more During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding. Patients were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annual questionnaires. Stable angiographic occlusion was evident in 86.4% of small and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients (between 11 and 35 months posttreatment) and by rupture of a coincidental untreated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embolization, with no rebleeding in subsequent years. Rebleeding occurred in three (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms that appeared stable on angiography. Periodic follow-up angiography after coil embolization is recommended to identify aneurysm recurrence and those patients at a high risk of late rebleeding.
International Journal of Radiation Oncology*Biology*Physics, 1981
... A plethysmographic technique has been reported by Travis et al.&amp;quot; which enabl... more ... A plethysmographic technique has been reported by Travis et al.&amp;quot; which enables ventilation in mice to be monitored using a sensitive microphone. ... In Frontiers of Radiation Therapy and Oncology, Vol. 6, Vaeth, JM, Bazel, E. and Harger. S. (Eds.). Karger, Basel, 1972, pp. ...
International Journal of Radiation Oncology*Biology*Physics, 1983
Dysphagia, 1994
Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obta... more Simultaneous recording of adult subjects sipping small amounts of fluid from a cup have been obtained by videofluoroscopy together with feeding respiratory patterns and swallow sounds from the Exeter Dysphagia Assessment Technique (EDAT). These allowed visual representations of respiration and swallow sounds to be superimposed on a videofluoroscopy recording using a split-screen technique. Sequentially numbered, 1/50 sec, half-frame photographic prints were examined and schematic drawings of the relevant radiographs were made. These were superimposed on to the actual EDAT printed chart of the same swallow event, their exact time relationship with respiration and cervical swallow sounds being preserved. The results allow events in the barium videofluoroscopy to be related to events in the feeding respiratory pattern and swallow sounds recorded by EDAT.
Critical Care Medicine, 1985
The effect of positive end-expiratory pressure (PEEP) on PaO2 during collapse of a single pulmona... more The effect of positive end-expiratory pressure (PEEP) on PaO2 during collapse of a single pulmonary lobe was investigated in seven dogs. Increasing PEEP to the ventilated region of lung increased the proportion of cardiac output flowing to the collapsed lobe and decreased PaO2 and pH. PaCO2 increased at the onset of lobar collapse but was not significantly altered by changes in PEEP. In impaired lungs, the benefits of PEEP may be offset by an increase in blood flow to the unventilated region and hence lead to a decrease in PaO2.
Cancer, 1984
The effects of radiotherapy on immune status in patients with localized carcinoma of the cervix h... more The effects of radiotherapy on immune status in patients with localized carcinoma of the cervix have been assessed serially up to 5 years remission by a wide range of methods. Neutrophil function and serum immunoglobulins were essentially normal throughout. Peripheral blood neutrophil and lymphocyte counts and the proportions of T and B-cells fell with treatment but were all normal at 5 years, with the exception of B-cell proportions which remained significantly low. Marked deterioration was seen in in vivo cellular immune responses and this persisted even at 5 years remission. Reduced in vitro immunoreactivity is not therefore a reliable marker of disease recurrence and persisting defects in cellular immunity after radiotherapy do not seem to adversely affect the host tumor response. However, in three of the six patients who subsequently relapsed after therapy, subnormal PHA lymphocyte transformation responses were observed at presentation; all patients achieving sustained remission had normal pretreatment responses.
Breast Cancer Research and Treatment, 1983
The American Journal of Cardiology, 1996
Annals of Surgery, 1980
Circular, full-thickness dermal burn-and freeze-produced wounds were produced in rats to compare ... more Circular, full-thickness dermal burn-and freeze-produced wounds were produced in rats to compare the difference in healing between the two types of thermal injuries. Contraction did not occur in wounds (n = 30) caused by freezing, while burn wounds (n = 30) contracted to less than one-third of original size by 21 days after injury. If the centers of the freezeproduced wounds (n = 12) were excised, contraction would then occur and proceed at the same rate as an open wound. Histologically, the degree of initial tissue destruction by the two types of injuries was similar. The burn wound contained only half the amount of collagen found in the freeze-produced wound. There was a greater and more rapid replacement of collagen in the burn wounds. With both injuries, the highest concentration of collagen was found on the fifteenth day and returned to normal by the twenty-eighth day. The burn wound contained three times the amount of collagen in normal skin, while the freeze-produced wound contained only 14 times the amount in normal skin. Contraction does not seem to occur in the healing of the freeze-injured skin because the slow removal and replacement of the residual matrix prevents contraction.