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Biomedical subjects

E Abraham

Publications and source records attributed to E Abraham.

At least 199 records · Page 11Linked to original sources
PubMed1984

Sequential cardiorespiratory patterns associated with outcome in septic shock.

Sequential hemodynamic and oxygen transport monitoring was performed in 33 patients with septic shock to define physiologic patterns associated with outcome. Measurements taken over a 24-hour period prior to the hypotensive crisis, defined as the lowest initial mean arterial pressure (MAP) after a decrease of at least 30 mm Hg from initial normal values, were compared to those taken during the 24 hours thereafter. In the 24-hour period prior to the hypotensive crisis, the 19 survivors demonstrated significantly greater cardiac index (CI), left cardiac work index (LCWI), oxygen delivery (DO2), and oxygen consumption (VO2) than the 14 patients who died. No other significant differences were found between the two patient groups. When sequential cardiorespiratory patterns were examined, significant increases in CI, LCWI, left ventricular stroke work index (LVSWI), DO2, and VO2 were present in survivors as early as eight hours before the hypotensive crisis. The results presented in this study suggest that patterns of survival may be determined in critically-ill septic patients before shock, as defined by the initial hypotensive episode, develops.

Aged↗
PubMed1984

Sequential hemodynamic and oxygen transport abnormalities in patients with acute pancreatitis.

Physiologic abnormalities were evaluated by sequential hemodynamic and oxygen transport measurements in 33 patients with acute pancreatitis. The hypotensive crisis, which was defined as the lowest mean arterial pressure (MAP), was used as the common temporal reference point to align the data in a coherent fashion. The data of the 48-hour periods before and after the hypotensive crisis then were evaluated. The patients were divided into normotensive and hypotensive groups and the latter were divided into survivors and nonsurvivors to evaluate the severity of the disorder and to identify the patterns representative of survival and death. The physiologic abnormalities of the hypotensive patients include decreased systemic vascular resistance index (SVRI) and compromised cardiac function. The latter was demonstrated during the hypotensive episode by significantly reduced left ventricular stroke work index (LSWI), despite increases in heart rate (HR), central venous pressure (CVP), pulmonary capillary wedge pressure (WP), and cardiac index (CI). The normotensive group had increased oxygen consumption (Vo2), oxygen delivery (Do2), pulmonary shunt (Qsp/Qt), LSWI, normal SVRI, and high CI. The hypotensive nonsurvivors had lower MAP, LSWI, SVRI, Do, and hematocrit as well as higher pulmonary vascular resistance index (PVRI) and Qsp/Qt than did the survivors. These findings do not support myocardial depression as the primary cardiovascular abnormality in acute pancreatitis, but rather suggest the decreased vascular tone from flow maldistribution in the peripheral microcirculation limits tissue oxygenation in the face of increased metabolic requirements of the hypercatabolic state.

Acute Disease↗
PubMed1983

Position and diaphoresis in acute asthma.

Presence of pulsus paradoxus, PCO2, sternocleidomastoid retraction, and flow rates have been used at the bedside to assess the severity of acute asthma. In our study of 49 adult patients, pulse rate, respiratory rate and pulsus paradoxus were shown to be significantly higher in patients assuming the upright position on admission to the emergency center; arterial pH, PO2, and peak expiratory flow rate were significantly lower in the upright patients. All upright patients had sternocleidomastoid retraction. Peak expiratory flow rate was 73.3 +/- 5 liters per minute in diaphoretic patients, 134 +/- 21 liters per minute in non-diaphoretic, upright patients, and 225 +/- 7.5 liters per minute in recumbent patients (p less than 0.02). No recumbent patient had a peak expiratory flow rate of less than 150 liters per minute or a PCO2 of greater than 44 mm Hg. The index of Fischl, signifying a need for admission to the hospital if greater than 4, was 4 or higher in 70 percent of upright patients and in 88 percent of diaphoretic patients. Only 7 percent of recumbent patients had Fischi indexes of greater than 4.

Adolescent↗
PubMed1983

Central venous catheterization in the emergency setting.

To determine the appropriateness and rate of complications from central venous catheterization (CVC) in the emergency department of a university teaching hospital, criteria for justifiability were established and all such catheterizations during a 1-yr period were reviewed. Of 61 catheterizations in 57 patients, 41% could not be justified according to the criteria established. Eight (14%) patients had serious complications from catheter placement. This complication rate is higher than that in any previously published study, but no other study has examined only emergent catheter placement. These findings underline the importance of adhering to a limited set of indications for CVC in emergency departments.

Catheterization↗
PubMed1983

Sequential cardiorespiratory patterns in septic shock.

Sequential hemodynamic and oxygen transport monitoring was performed in 33 patients with septic shock to define the temporal pattern of physiologic events. Measurements taken over a 24-h period before the hypotensive crisis, defined as the lowest initial mean arterial pressure (MAP), were compared to those taken during the 48 h thereafter. In the 24-h period before the hypotensive crisis, there were increases in cardiac index (CI), central venous pressure (CVP), pulmonary capillary wedge pressure (WP), pulmonary vascular resistance index (PVRI), and pulmonary shunt (Qsp/Qt), but decreases in MAP, systemic vascular resistance index (SVRI) and oxygen delivery (Do2). When sequential cardiorespiratory patterns were examined, oxygen consumption (VO2) fell transiently to significantly low values 12 h before as well as at the time of the hypotensive crisis. SVRI fell and CI rose to values significantly different from normal in the 4 h before the low MAP. During the subsequent 48 h after the hypotensive crisis, CI, CVP, WP, PVRI and Qsp/Qt remained elevated. Values for MAP, SVRI, DO2, and VO2 were significantly reduced. These results demonstrate the existence of antecedent cardiorespiratory alterations that precede the hypotensive episode in septic shock and suggest that flow maldistribution in the systemic circulation is an early event with possible pathogenic significance.

Adult↗
PubMed1983

Childhood head injuries in Israel: epidemiology and outcome.

Results are reported of a regional survey of hospitalized head injuries in Israeli children aged 0-7 years during the period 1970-1976. There were 370 such cases surveyed. Incidence of head injury requiring hospitalization was 1.71/1000 per year. Follow-up examination 4-10 years after injury was achieved in 50 per cent of the cases. Late seizures and focal neurological deficit were rare, while school failure and various neuropsychiatric symptoms were common. Prevalence of seizures and new nervous habits was significantly related to severity of injury, while the prevalence of fears, nightmares, dizziness and school failure was not.

Achievement↗
PubMed1982

A new technique for securing a chest tube.

Most techniques described for securing a chest tube in position do not discuss closing the orifice in the chest wall after removal of the tube. An air tight closure of the chest wall and good approximation of the wound edges after removal of the chest tube must be done to prevent complications and obtain a cosmetically good scar. A technique for securing a chest tube is described that permits excellent approximation of the wound edges upon removal.

Humans↗
PubMed1982

Effect of pneumatic trousers on pulmonary function.

Little information is available concerning the effect of pneumatic antishock trousers (PT) on pulmonary function. To examine this issue, we measured the effects of PT inflation on forced expired volumes, subdivisions of lung volumes, quasistatic lung compliance, single-breath diffusing capacity for carbon monoxide, and transdiaphragmatic pressure at resting lung volume in 10 healthy nonsmoking adults. All subjects were studied seated without PT, supine with PT uninflated, and supine with PT inflated to 100 mm Hg. When seated subjects assumed the supine position without PT inflation, significant reductions were found in the forced expired volume in 1 sec, in subdivisions of lung volume, total lung capacity (TLC), functional residual capacity (FRC), expiratory reserve volume (ERV) and in transdiaphragmatic pressure. However, PT inflation itself did not produce significant changes in any of the measured pulmonary indices except transdiaphragmatic pressure. We conclude that PT inflation in supine normovolemic individuals does not produce acutely significant alterations in lung function.

Adult↗
PubMed1980

[The relation between work activity and retirement plans].

In the course of the research project "Work Activities and Retirement Plans" financed by the National Foundation of Research, a study was made to explore the consequences of longterm working activities on planning of the time of retirement. 200 persons at the age of 64 years, working on shop floor of enterprises in the metal industry were asked about their work, leizure and plans about the approaching retirement. It was hypothesized that plans are necessary for the successful coping of the retirement situation. For the setting up of plans it is required that social and cognitive competence can be acquired and constantly trained. It has been shown that the proportion of persons with none or unspecific plans rises with the span of action getting smaller. Furthermore the study showed that persons who could train their cognitive competence at work set up more plans with cognitive content than persons who could not: the analogical result has been found with the social competence.

Achievement↗
PubMed1980

Fracture of distal medial femoral epiphysis with subluxation of the knee joint.

A case of complete posterior displacement of a Salter-Harris Type III distal medial femoral epiphysis fracture with posterior subluxation of the knee is reported. Invagination of the gastrocnemius muscle by the displaced fragment was blamed for failure of closed reduction. No significant ligamentous injury of the joint occurred.

Adolescent↗