Biomedical subjects

A J Singer

Publications and source records attributed to A J Singer.

84 records · Page 5Linked to original sources

PubMed1994

Pressure dynamics of various irrigation techniques commonly used in the emergency department.

STUDY OBJECTIVE: To evaluate the pressure dynamics of common irrigation techniques used in the treatment of traumatic wounds. DESIGN: Matched experimental trial. PARTICIPANTS: Ten male volunteers. INTERVENTIONS: Pressure curves were obtained while performing manual irrigation with 250-mL boluses of normal saline with 19-gauge needles on 35-mL syringes, 19-gauge needles on 65-mL syringes, IV bags pierced with 19-gauge needles, and plastic bottles pierced with 19-gauge needles. Measurements also were obtained using an IV bag with tubing attached to either a 19-gauge or 16-gauge needle within a pressure cuff inflated to 400 mm Hg. RESULTS: Median peak pressures were 35 lb/in.2 (psi)(range, 25 to 40 psi) and 27.5 psi (range, 15 to 40 psi) using a 35-mL syringe and a 65-mL syringe, respectively. Median peak pressures with the IV bag and plastic bottle were 4 psi (range, 2 to 5.5 psi) and 2.3 psi (range, 1.2 to 4.5 psi), respectively. The IV bag in a pressure cuff generated pressures of 6 to 10 psi and 4 to 6 psi using 19-gauge and 16-gauge needles, respectively. CONCLUSION: Both 35-mL and 65-mL syringes with a 19-gauge needle are effective in performing high-pressure irrigation in the range of 25 to 35 psi. The use of IV bags and plastic bottles should be discouraged when high-pressure irrigation is required.

Adult↗

PubMed1994

Mercuric chloride poisoning due to ingestion of a stool fixative.

We present a case of ingestion of a commonly used stool fixative containing 675 mg of mercuric chloride per 15 mL vial. Early chelator therapy with dimercaprol and aggressive hydration were initiated and the patient remained asymptomatic. Safety packaging of this product is recommended.

Adult↗

PubMed1993

Testicular carcinoma: a study of knowledge, awareness, and practice of testicular self-examination in male soldiers and military physicians.

Multiple-choice questionnaires devised to evaluate knowledge and awareness of testicular carcinoma and the practice of testicular self-examination (TSE) were distributed to 717 male soldiers and 200 military physicians in the Israeli army. Twenty-one percent of the soldiers had received explanations about the importance of TSE; 16% actually received instruction on TSE; yet only 2% practiced TSE regularly. Seventy percent of physicians had been taught how to examine testicles, but only 10% of physicians examined testicles in their routine physical exams. TSE was practiced most frequently among soldiers who had received instruction in the technique. Physicians should encourage their young male patients to practice TSE.

Adolescent↗

PubMed1992

Spontaneous pneumomediastinum: clinical and natural history.

STUDY OBJECTIVE: To evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum. DESIGN: A retrospective case series was conducted to identify patients diagnosed with spontaneous pneumomediastinum. ICD-9 discharge codes were used for 1984 to 1990 at two institutions, and emergency department records of a third hospital were reviewed for 1981 to 1986. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. SETTING: Three university tertiary care hospitals. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of spontaneous pneumomediastinum. INTERVENTIONS: None. RESULTS: Seventeen cases were identified. Age range was 15 to 41 years (mean, 25 years). Presenting symptoms were chest pain in eight (47%), dyspnea in three (18%), both symptoms in three (18%), and neither in three (18%). Three patients complained only of throat discomfort. Nine (52%) had a Hamman's crunch, 11 (65%) had subcutaneous emphysema, and two (11%) had a small pneumothorax. Five (29%) were smokers, and five (29%) had normal esophograms. Thirteen of 17 (76%) cases were associated with illicit inhalation drug use. Twelve cases (70%) had history of a "Valsalva-type" maneuver. All but three were admitted to a hospital, with a mean stay of 2.5 days (range, one to six). No patient suffered complications or required interventions for spontaneous pneumomediastinum. Specifically, no patient developed a subsequent pneumothorax or airway compromise. The three patients not admitted were followed up by telephone contact. All did well with rapid resolution of their symptoms. CONCLUSION: Most spontaneous pneumomediastinum cases occur in the setting of inhalational drug use. One hundred percent of patients will have a symptom directly related to the spontaneous pneumomediastinum, with 82% presenting with either dyspnea or chest pain. Most (88%) will present with either subcutaneous emphysema or a Hamman's crunch on examination. Simple spontaneous pneumomediastinum has a very benign course and does not require hospitalization. Serial radiographs, likewise, did not change the medical management of spontaneous pneumomediastinum.

Administration, Inhalation↗

PubMed1991

Pathophysiology of the gastrointestinal tract during pregnancy.

Pregnancy is associated with a wide variety of physiologic changes in virtually all the organ systems of the body. Some of these changes, such as the hyperventilation of pregnancy with its resulting respiratory alkalosis, are clinically silent, whereas others, such as heart-burn and hemorrhoids, cause significant distress. The effects of pregnancy on the hepatobiliary system have been the subject of much scrutiny and many publications, whereas disturbances of the hollow viscera have been infrequently reviewed. In this report, we will discuss the major pathophysiologic changes that occur along the length of the hollow viscera of the gastrointestinal tract during pregnancy.

Animals↗

PubMed1990

Genitourinary involvement of systemic sarcoidosis confined to testicle.

We report on a patient with systemic sarcoidosis who presented with a lesion of the genitourinary tract confined to the testicle. Clinically evident sarcoidosis of the testicle has been identified in few instances. Several recommendations in evaluating such lesions have been offered. A consensus on treatment is not yet defined. The therapeutic options are presented and the literature is reviewed.

Adult↗

PubMed1990

Traumatic dislocation of testes.

Traumatic dislocation of the testicle is characterized by an ectopically displaced testis as the result of closed injury. We report on 1 patient with subcutaneous inguinal dislocation of the testis that was successfully treated by immediate closed reduction. Forty-nine other cases (36 unilateral and 13 bilateral) have been previously cited. Diagnostic guidelines, our therapeutic approach, and the relevant literature are presented.

Adult↗

PubMed1987

Postoperative urinary retention. Guidelines and an algorithm.

Postoperative urinary retention is a common problem after surgery. Prevention includes obtaining a preoperative history and physical, having the patient void just before surgery, avoiding overhydration, and encouraging micturition soon after surgery. Management requires sterile catheterization, when indicated, to drain the urinary bladder completely. Urine cultures must be done when indwelling catheters are used. Antibiotics may be necessary.

Algorithms↗

PubMedDate not supplied

Comparative trial of octyl-cyanoacrylate and silver sulfadiazine for the treatment of full-thickness skin wounds.

A prospective, randomized, blinded, controlled experimental trial was performed in pigs to compare the rates of reepithelialization of 126 full-thickness cutaneous 4-mm punches treated with an octyl-cyanoacrylate spray, silver sulfadiazine, or a dry gauze (controls). Full thickness biopsies were taken 7, 14, or 30 days later for histopathological evaluation of hematoxylin and eosin stained tissue sections by a dermatopathologist. The primary outcome measure was the proportion of wounds completely re-epithelialized at days 7 and 14. Secondary outcomes were the rates of infection, foreign body reactions, and the depth of any resulting cutaneous dells measured with a micrometer. Between-group comparisons were performed with ANOVA or Chi-square tests. Octyl-cyanoacrylate treated wounds re-epithelialized more slowly, as fewer wounds treated with octyl-cyanoacrylate were re-epithelialized at day 7 in comparison with silver sulfadiazine or control wounds (50% vs. 90% vs. 100%, p < 0.001). There were no infections or foreign body type reactions. Amounts of granulation tissue were similar among groups. Octyl-cyanoacrylate wounds were more depressed than silver sulfadiazine wounds at days 7 and 14 yet had similar histopathological characteristics at day 30. We conclude that treatment of small, full thickness cutaneous wounds with octyl-cyanoacrylate results in delayed re-epithelialization and dermal repair in comparison with silver sulfadiazine, yet it does not result in any foreign body-type reaction. However, by 30 days, histopathological wound characteristics were similar in all groups.

Animals↗

PubMedDate not supplied

Effects of prehospital nitroglycerin on hemodynamics and chest pain intensity.

OBJECTIVE: To assess the effects of prehospital nitroglycerin (NTG) on vital signs and chest pain intensity. METHODS: A retrospective review of advanced life support (ALS) run sheets was performed in a suburban volunteer emergency medical services (EMS) system receiving 8,000 annual ALS calls. All consecutive patients who were administered NTG by EMS were included. Standardized forms were used to collect data on patient demographics, history, and physical exam. Patients assessed their chest pain (CP) before and after NTG on a verbal numeric scale of 0-10 from least to most severe. The presence of syncope, dysrhythmias, or profound hypotension [loss of peripheral pulses, a systolic blood pressure (SBP) of <90 mm Hg after NTG, or a drop of >100 mm Hg in BP] was noted. Results. One thousand six hundred sixty-two patients received NTG over 18 months, their mean age was 66 years, and 48% were female. Indications for NTG included CP (83%), dyspnea (45%), and congestive heart failure (20%). After NTG administration, the CP score decreased from 6.9 to 4.4 (mean difference = 2.6; 95% CI = 2.4 to 2.8). The CP completely resolved in 10% of the patients. Mean decreases in SBPs and diastolic BPs were 11.8 mm Hg (95% CI = 10.7 to 13.0) and 4.0 mm Hg (95% CI = 2.9 to 5.1). The mean pulse rate increased by 2.7 beats/min (95% CI = 0.6 to 4.9). There were 12 patients with adverse events [0.7% (95% CI = 0.4% to 1.3%)], including profound bradycardia and hypotension (1), transient drop in SBP of 100 mm Hg responding to fluids (6), post-NTG SBP <90 mm Hg (4), and syncope (1). There were no deaths in the prehospital setting. CONCLUSIONS: Use of prehospital NTG appears safe. While NTG reduces CP, most patients have residual pain.

Advanced Cardiac Life Support↗

PubMedDate not supplied

Comparison of forearm and upper arm blood pressures.

OBJECTIVE: In the prehospital setting it is not always feasible to obtain blood pressure (BP) readings from the upper arm. This study was performed to compare BPs obtained from subjects' forearms and upper arms in order to assess the utility of forearm BP as a surrogate for standard BP. METHODS: The authors performed a prospective, cross-sectional, convenience study in a sample of ambulatory university ED patients, where each subject had sequential determinations of left upper arm and forearm BPs with an automated monitor at ED triage. The order of measurement was determined by the day of the week. Demographic and clinical data were also recorded. The main outcome measure was the correlation between upper arm and forearm systolic and diastolic BPs. Pearson's correlation coefficient and Student's t-test were used to analyze the data. RESULTS: 151 patients were enrolled. The mean age was 35.3+/-15.7 years; 40% were female and 78% were white. The mean forearm and upper arm systolic BPs were 129.8+/-20.7 mm Hg and 126.2+/-17.6 mm Hg (p = 0.002). The mean forearm and upper arm diastolic BPs were 80.7+/-14.5 mm Hg and 76.8+/-13.4 mm Hg (p<0.001). The correlations between forearm and upper arm systolic and diastolic BPs were 0.75 (p<0.001) and 0.72 (p<0.001). The differences between forearm and upper arm systolic and diastolic BPs were within 20 mm Hg in 86% and 94% of patients, respectively. CONCLUSION: Forearm BP is a fairly good predictor of standard upper arm BP in most patients. Forearm BP may be used when measurement of upper arm BP is not feasible.

Adult↗

PubMedDate not supplied

National analgesia prescribing patterns in emergency department patients with burns.

Previous studies suggest that many patients with burns receive inadequate analgesia. A secondary analysis of the 1992 to 1999 National Hospital Ambulatory Medical Care Survey (a national, weighted sample of emergency department [ED] encounters) was performed to estimate national analgesia prescribing patterns in ED patients with burns. In 1999, there were 21,103 patient encounters sampled from 376 EDs, resulting in an estimated 102.8 million ED visits in 1999. One hundred thirty-eight patients in the sample (0.7%) had burns for an estimated 827,000 annual burns. Patient mean age was 28 years. Forty-three percent were female, 25% were children under 18 years of age, and 81% were white. Pain assessments were performed in about half of the patients, and only half of the patients received analgesics. Analgesia administration did not differ by year, sex, age, race, ethnicity, geographic location, or insurance payment type, yet it was more likely with increased pain. We conclude that many patients with burns do not have documentation of pain assessment or analgesia administration while in the ED.

Adolescent↗