Biomedical subjects
Publications and source records attributed to B Lerman.
Ethanol sensitivity is a syndrome of flushing, tachycardia, weakness, fatigue, and other dysphoric symptoms in response to relatively small doses of ethanol. We describe a case of extreme ethanol sensitivity presenting with coma and review the pathophysiology of the syndrome.
When it occurs after a recent (less than eight weeks) myocardial infarction, sustained ventricular tachycardia (VT) or fibrillation (VF) has resulted in a high one-year mortality despite antiarrhythmic drug therapy. We have operated on 29 patients with this syndrome either on an emergency basis because they had medically refractory VT or VF (19 patients) or electively if they had persistent congestive heart failure or angina and VT or VF (10 patients). Ages ranged from 36 to 82 years (mean, 60 years), and the mean left ventricular ejection fraction was 31 +/- 13%. Each patient had failed a trial of one or more (average, four) antiarrhythmic drugs and because of VT, required electrical cardioversion on an average of five occasions. Intraoperative mapping was complicated by multiple VT morphologies (9 patients), the rapid degeneration of VT to VF (5 patients), and the inability to induce VT reliably (5 patients). Subendocardial excision was performed at the site of the earliest electrical activity, or if no single site could be identified, a wide subendocardial excision of all visible scar was performed. There were 4 perioperative deaths (14%). All operative survivors underwent postoperative electrophysiological studies. Twenty of them required no further antiarrhythmic therapy, but 5 patients required drug therapy because of either spontaneous (2 patients) or electrically induced (3 patients) VT. During follow-up (average, 16 months) of these 25 patients, there have been 3 late deaths, 2 of them sudden. Two of the 3 late deaths were those of patients taking antiarrhythmic drugs. Our results demonstrate the effectiveness of early operative intervention when sustained ventricular arrhythmias complicate recovery after myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
A persistent problem for emergency physicians is the patient who returns unscheduled to the emergency department with a problem that either has not improved or has worsened. The purpose of this study was to evaluate the frequency of revisits and the nature of the problems. All patients returning within 72 hours of their initial visit were entered into the study. The charts were evaluated for classification of problem, unavoidable v avoidable returns, and errors in medical care or patient education. Of the 64,336 patients seen during the study, 255 returned within 72 hours. Eighty-three (32.5%) of the returns were found to be avoidable with better patient education or medical care on the initial visit. The revisit population is a high-risk group of patients who should be approached carefully by emergency physicians.
Various methods for the calculation of left-ventricular volume by the count-based method utilizing red-blood-cell labeling with 99mTc and a parallel-hole collimator are evaluated. Attenuation correction, linked to an additional left posterior oblique view, is utilized for all 26 patients. We examine (1) two methods of calculating depth, (2) the use of a pair of attenuation coefficients, (3) the optimization of attenuation coefficients, and (4) the employment of an automated program for expansion of the region of interest. The standard error of the estimate (SEE) from the correlation of the radionuclide volumes with the contrast-angiography volumes, and the root-mean-square difference between the two volume sets at the minimum SEE are computed. It is found that optimizing a single linear attenuation coefficient assumed for attenuation correction best reduces the value of the SEE. The average of the optimum value from the end-diastolic data and that from the end-systolic data is 0.11 cm-1. This value agrees with the mean minus one standard deviation value determined independently from computed tomography scans (0.13-0.02 cm-1). It is also found that expansion of the region of interest beyond the second-derivative edge with an automated program, in order to correctly include more counts, does not lower the SEE as hoped. This result is in contrast to the results of others with different data and a manual method. Possible causes for the difference are given.