Biomedical subjects
Publications and source records attributed to A Greenstein.
We present a case of cerebral air embolism after a gunshot wound to the lung, combined with mechanical ventilation. Hyperbaric and pharmacologic therapy resulted in complete recovery. The discussion focuses on hyperbaric therapy as the mainstay of treatment, the importance of prophylactic measures, and prompt diagnosis.
Ventilatory lung function was studied in 528 Navy selectees 16 to 23 yr of age. Analysis of the pulmonary function data indicated that height and chest circumference were the best "predictors" of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Other factors, such as amount of sports activity, ethnicity, weight, or Quetelet index, were of minimal predictive value. Linear prediction formulas of ventilatory lung function for young male adults of this age range were derived. Analysis of variance showed that the apparently greater FVC found in smokers than that found in nonsmokers was related to the smokers being older and consequently taller than the nonsmokers. After adjusting for age (even in this narrow age range) and height, no difference in pulmonary function between the 2 groups could be demonstrated.
Ligation or embolization of the hypogastric arteries for control of intractable hemorrhage from the bladder has been used in the past with equal results and without ill effect. Gluteal pain following hypogastric embolization is common and was reported to be resolved in less than 48 hours. A 57 year old man in our ward underwent a bilateral hypogastric embolization. The bleeding decreased considerably but a severe gluteal pain and claudication ensued. The pain persisted over a month necessitating frequent Morphine injections. We propose to use superselective catheterization technique in the future sparing the superior gluteal artery.
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The early recurrence rates following surgical treatment of Crohn's disease are distressingly high. In clinical studies in which an attempt is made to correlate duration, severity and extent of disease, the prediction as to which patients are prone to have the disease recur was not successful. The immunoglobulin G value is elevated in the diseased portion and in 50 per cent of the normal appearing margins of resected intestine from patients with Crohn's disease. Half of the patients with immunoglobulin G values above 18 milligrams per gram of dry weight at the margins had recurrences at the suture line within three years. The immunoglobulin G concentrations do not correlate with steroid treatment, duration of symptoms, extent of disease, presence of epithelioid granulomas or previous recurrent disease. Immunoglobulin A and immunoglobulin M values are not helpful in predicting recurrences. Elevation of immunoglobulin G values at the resection margins appears to be a reliable indicator of early recurrence in patients with Crohn's disease.
A case of first degree atrio-ventricular block, probably representing cardiac involvement by decompression sickness, is presented. The conduction defect resolved spontaneously 36 h after the initiating decompression insult, and was not accompanied by any other cardiovascular changes. The contribution of a recompression treatment, which alleviated accompanying Type I decompression sickness (DCS) symptoms, to the resolution of cardiac DCS is not certain. Cardiac symptoms of DCS do not receive enough consideration. It is suggested that an electrocardiogram should, whenever possible, form part of the basic evaluation of suspected DCS and of the initial workup of candidates for diving. A flow diagram for management of cardiac DCS is proposed.
The pulmonary manifestations of decompression sickness have been attributed to various mechanisms, all of which invoke bubble formation and presence in the lung as the cause of symptoms. A case of persistent "chokes" syndrome, which responded to recompression of 72 h after presentation, is described. The possible physiological mechanisms and the late response to therapy is discussed.
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Asparaginase induced hemorrhagic pancreatitis is a rare but serious development occurring in less than 0.5% of patients treated with this drug. Severe pancreatitis with progressive abdominal distention, toxemia, hypotension and respiratory insufficiency occurred in an 18-year-old patient with acute lymphoblastic leukemia following treatment with asparaginase. There was a dramatic response to high flow peritoneal lavage with rapid recovery within 24 hours from a moribund state. The subsequent development of a pseudocyst, with progressive increase in size and development of obstructive symptoms, required surgical decompression. Transgastric cystogastrostomy was successfully carried out.
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The literature concerning the use of metaphase inducing agents as clinical sensitisers to radiation is briefly reviewed, and five cases are reported, which suggest that under ordinary clinical conditions, these agents are not likely to be of value. These results accord with animal experiments and a possible reason is suggested.
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