Biomedical subjects

D Stein

Publications and source records attributed to D Stein.

204 records · Page 12Linked to original sources

PubMedDate not supplied

Heparin-bonded circuits improve clinical outcomes in emergency coronary artery bypass grafting.

Compared to patients undergoing elective or urgent coronary artery bypass grafting (CABG), those undergoing emergency CABG (EM-CABG) have a higher morbidity and mortality. The use of heparin-bonded circuits (HBC) has been shown to improve clinical outcomes in nonemergent CABG patients. It is not known, however, whether the improved hemostasis and attenuation of the inflammatory response to cardiopulmonary bypass, conferred by HBC, can overcome the high incidence of comorbid risk factors in (EM-CABG) patients and improve their outcomes. A retrospective analysis of 206 consecutive patients undergoing EM-CABG over 4 years (1993-1997) at one institution was performed. Eighty-one patients were treated with conventional non-heparin-bonded circuits (NHBC) with full anticoagulation protocol (FAP, activated clotting time [ACT] > 480 sec); 125 patients were treated with HBC and a lower anticoagulation protocol (LAP, ACT > 280 seconds). Outcomes and results were collected prospectively and are presented as mean +/- SD. Preoperative risk profiles were similar in both treatment groups. Postoperatively, compared with the NHBC group, patients treated with HBC/LAP required fewer homologous donor units (4.1 +/- 10.7 vs 8.2 +/- 13.6 units, p = 0.005), were less likely to require inotropic support (18.6% vs 38.3%, p = 0.005), and had a lower incidence of perioperative myocardial infarction (MI, 3.2% vs 12.3%, p = 0.04) and pulmonary complications (4.0% vs 12.3%, p = 0.04). The use of HBC/LAP resulted in a decreased incidence of postoperative complications (12.8% vs 28.4%, p = 0.01, odds ratio 0.37 with 95% confidence interval [CI] 0.18-0.76). This resulted in a shorter duration of ventilatory support (30.5 +/- 54.0 vs 72.8 +/- 16.7 hours, p = 0.009), ICU stay (38.2 +/- 36.5 vs 91.5 +/- 68.7 hours, p = 0.009), hospital stay (8.0 +/- 7.1 vs 11.0 +/- 8.9 days, p = 0.008), and therefore cost. In conclusion, the use of HBC/LAP in EM-CABG resulted in a reduction of homologous transfusion and postoperative complications associated with decreased hospital stays and cost.

Aged↗

PubMedDate not supplied

Sleep disturbances in children with attention-deficit/hyperactivity disorder: a comparative study with healthy siblings.

The sleep profiles of 13 children with attention-deficit/hyperactivity disorder (ADHD) who were treated with a fixed dose of methylphenidate for at least 1 month were compared with those of 16 healthy siblings. Sleep disturbances were assessed according to a structured sleep questionnaire, and the severity of ADHD was evaluated via the Conners Parents Teachers Rating Scale. The results indicated that significantly more children with ADHD demonstrated single or multiple sleep disturbances as well as higher rates of specific sleep disorders, such as initial and middle insomnia, compared with their siblings. No correlation was found between the severity of ADHD and disturbed sleep. Sleep duration and satisfaction with sleep were similar in the two groups. These findings raise important questions regarding the association between ADHD and disturbed sleep.

Attention Deficit Disorder with Hyperactivity↗

PubMedDate not supplied

Cervical myelopathy due to chronic vitamin B12 deficiency or herniated cervical disc or both.

OBJECTIVE: A female patient with diagnosis of combined system degeneration due to vitamin B12 deficiency and multi-level cervical disc herniation underwent a comprehensive neurophysiologic tests. MATERIALS AND METHODS: Central conduction time (CCT) was calculated after recording of the SSEPs from cervical, brainstem, and parietal sensory cortex to peripheral stimulation. RESULTS: The CCT between the lower cervical spine and brainstem was 3.63 msec and 3.41 msec for left and right side. All values were within the normal range. The visual EPs and brain-stem auditory EPs were also normal. The MR imaging of the cervical region was remarkable for multi-level degenerative changes as well as osteophyte formation at C4-7 segments causing canal stenosis. CONCLUSIONS: It is possible that her symptoms are related to two separate chronic problems. The first is history of B12 deficiency, causing a subacute systems degeneration syndrome. The second is evidence of a cervical spondylotic myelopathy.

Cervical Vertebrae↗

PubMedDate not supplied

Alkalinization of mepivacaine accelerates onset of interscalene block for shoulder surgery.

Reports evaluating the effect of alkalinization of mepivacaine on the onset of regional anesthesia have been controversial. The effect of alkalinization of mepivacaine on the onset of interscalene block has not been reported and is the subject of this study. Forty patients received an interscalene block by elicitation of paresthesia with 25-gauge, blunt level needle. Twenty patients received 40 ml 1.4% mepivacaine, which contained epinephrine (1:200,000). Another 20 patients received 40 ml 1.4% mepivacaine, epinephrine (1:200,000), and 4 mEq of NaHCO3. Time to onset of block was determined by awareness of cold, and loss of pain perception and motor function at the shoulder, elbow and hand. The duration of block for each observation was determined. The onset was significantly faster for all tested modalities in the pH-adjusted group. No statistically significant differences in the duration of either motor or sensory were found between the study and control groups.

Bicarbonates↗

PubMedDate not supplied

A systemic lupus erythematosus-like syndrome induced by procainamide.

A syndrome that resembles Systemic Lupus Erythematosus both clinically and on laboratory studies may be induced by procainamide. It is associated with multisystemic involvement, positive Antinuclear Antibody titers (ANA), and positive LE cell preparations. In patients on procainamide therapy the syndrome must be differentiated from osteoarthritis, myocardial infarction, and pulmonary embolism. When procainamide is discontinued, this Lupus-like syndrome is usually reversible. Other drugs, including hydralazine and isoniazid have also been implicated in provoking this Lupus-like syndrome.

Aged↗

PubMedDate not supplied

University of Wisconsin solution versus Stanford cardioplegic solution and the development of cardiac allograft vasculopathy.

BACKGROUND: University of Wisconsin (intracellular) solution has been shown to offer some distinct benefits of myocardial preservation over Stanford (extracellular) solution, including a more rapid functional recovery, improved adenosine triphosphate preservation, and a tendency for less postoperative inotropic agents. However intracellular solutions with high potassium content have been reported to cause a functional if not structural endothelial injury in laboratory experiments. METHODS: Because of this information we retrospectively viewed our follow-up angiographic data for the development of the cardiac allograft vasculopathy in a consecutive series of 195 heart transplant recipients. These patients were treated in identical fashion, with the same immunosuppression regimen, except for the type of cardioplegia used--Stanford solution (group I n = 95) and University of Wisconsin solution (group II n = 100). RESULTS: With a mean follow-up of 24 months after transplantation, a significant difference was seen in the development of cardiac allograft vasculopathy in group II (22%) versus group I (14%, p < 0.03). Although significant differences were observed with univariate analysis with respect to donor age and ischemic time favoring group I and with multivariate statistical analysis with respect to overall rejections favoring group II, the only significant variable for the difference in the development of allograft vasculopathy was University of Wisconsin cardioplegic solution (p < 0.003). A subgroup of 30 patients previously randomized for a functional study comparing the two cardioplegic agents showed a tendency for statistical significance with a freedom from allograft vasculopathy of 93% in group I, as compared with 83% in group II, after 13 months follow-up (p = 0.09). The overall probability of being free of vasculopathy at 24 months was 86% for group I and 70% for group II. CONCLUSIONS: The data support the conclusion that University of Wisconsin intracellular solution is associated with an increased incidence of vasculopathy versus Stanford solution and warrants investigation for modification of this preservation agent in heart transplantation.

Adenosine↗