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Biomedical subjects

E Abraham

Publications and source records attributed to E Abraham.

At least 163 records · Page 9Linked to original sources
PubMed1988

Continuous oxygen consumption measurement during initial emergency department resuscitation of critically ill patients.

A portable microcomputer-based monitoring system was adapted to permit frequent, on-line measurement of oxygen consumption (VO2) in critically ill, unstable patients in the ED during initial resuscitation. Nine adult patients were monitored with this system; they were found to have initial VO2 values that were markedly elevated, averaging 409 +/- 53 ml/min.m2. In the 11 major physiologic events which were observed in these patients, VO2 changes appropriately reflected alterations in the patients' clinical condition induced by therapeutic interventions or changes in cardiorespiratory state. This study demonstrates the feasibility of VO2 monitoring during initial resuscitation and suggests that measurement of VO2 in the ED may assist in the management of critically ill patients in this setting.

Adolescent↗
PubMed1988

Generation of functionally active suppressor cells by haemorrhage and haemorrhagic serum.

Mitogen (PHA)-induced proliferation of peripheral blood mononuclear cells (PBMC) was reduced by more than 70% 2 h after the haemorrhage of 30% of blood volume. Experiments using isolated macrophages and lymphocytes showed that post-haemorrhage macrophages were functionally normal and that lymphocytes were responsible for the observed haemorrhage-induced depression of proliferative response. Surface marker determinations showed that at least some, if not all, of the haemorrhage-induced suppressor cells are of the OX8+ phenotype. Exposure of PBMCs to serum from bled animals also brought about activation of OX8+ suppressor T cells. These results suggest that the depressed proliferative response of PBMCs induced by haemorrhage or by exposing the cells to haemorrhagic serum (serum from bled animals) is due to the activation of OX8+ suppressor T cells.

Animals↗
PubMed1988

Effects of hemorrhage on interleukin-1 production.

Depression of lymphocyte proliferative response occurs after trauma and hemorrhage. Because abnormalities in interleukin-1 (IL-1) production can result in depression of mitogen-induced lymphocyte proliferation, we investigated the effects of unanesthetized hemorrhage on IL-1 generation. The capacity of peripheral blood monocytes to produce IL-1 increased more than five fold by 2 h after loss of 30% of the total blood volume and returned to normal by 12 h after hemorrhage. Removal of 15% of total blood volume did not result in any alterations in IL-1 production. These results show that the diminished lymphocyte proliferative response which occurs after unanesthetized hemorrhage was not due to decreased IL-1 production. The increase in IL-1 generation which occurs shortly after severe hemorrhage may play a role in mediating the acute phase reaction which follows hemorrhage and trauma.

Animals↗
PubMed1988

The surgical treatment of chronic lateral humeral epicondylitis by common extensor release.

This retrospective study reports on the surgical treatment of chronic lateral epicondylitis. Thirty-four elbows were followed for an average of four years after surgery. Only those patients with persistent or recurrent local pain and muscle weakness, nonresponsive to conservative measures for at least six months, were considered for surgery. A complete release of the common extensor tendon permitted about a 1-cm distal muscle slide to a new resting length. The results indicate 73% excellent, 18% good, and 9% failures. Complete pain relief was obtained in 25 of 34 (73%) elbows, and eight of 33 (24%) had minimal residual symptoms that did not impair activity. There was no loss of range of motion in any patient, and 33 of 34 (97%) elbows had improved extremity muscle strength. All but one patient (97%) returned to their regular jobs on the average of five weeks after surgery. The gross and histologic findings were consistent with a degenerative process. This relatively simple outpatient procedure using Bier block anesthesia is recommended for carefully selected patients.

Adult↗
PubMed1987

Cardiorespiratory patterns in viral septicemia.

Viral infections are known to produce hypotension and shock, but the cardiorespiratory patterns associated with viral septic shock have not been described. The clinical course of nine patients who died from overwhelming cytomegalovirus sepsis was reviewed. Viral septicemia was associated with increased cardiac index, decreased systemic vascular resistance index (SVRI), and elevated oxygen delivery. This pattern appeared during early and late stages of shock. In contrast to bacterial sepsis and endotoxemia, the pulmonary vascular resistance index (PVRI) was normal. These results indicate that overwhelming viral infection can produce shock associated with a high cardiac output, low peripheral resistance state similar to that seen with bacterial shock. Relative sparing of the pulmonary circulation in viral shock is consistent with the absence of endotoxemia in these patients.

Adult↗
PubMed1986

Conjunctival oxygen tension monitoring during helicopter transport of critically ill patients.

To investigate the utility of conjunctival oxygen tension measurement during helicopter transport, we monitored conjunctival oxygen tension (PcjO2) in 36 clinically unstable patients. Sixteen (44%) of the patients were found to have ventilatory or circulatory compromise as determined by PcjO2 less than 50 torr. In only three of these patients would vital sign determinations have detected the unstable clinical states. In 12 patients (33%), respiratory intervention or expansion of intravascular volume resulted in improvement of tissue oxygenation and clinical state. These results demonstrate that a substantial fraction of our patients transported by helicopter had underlying physiologic abnormalities that were not apparent by monitoring of vital signs, but were detected and corrected by measurement of conjunctival oxygen tension.

Adolescent↗
PubMed1986

Clinical orthopedic medicine course for physical therapy students. Aligning content with current practice.

The purpose of our study was to obtain information that would help align instruction in a clinical orthopedic medicine course for physical therapy students with the current practice of physical therapists. We sent a questionnaire concerning treatment of orthopedic conditions to 3,000 physical therapists. Of the 1,804 (60%) respondents, 58.8% were in general practice, and 35% combined specialty areas with general practice. The respondents indicated that they treated two distinct groups (four categories each) of musculoskeletal disorders. Of the respondents, 87.6% spent less than five hours a week treating bone infections, tumors, and developmental and congenital disorders, whereas 63.4% worked more than five hours a week with fractures and dislocations, low back and neck pain, ligament and soft tissue injuries, and arthritis. We provide a model that uses survey results and course content analysis for planning critical orthopedic medicine instruction for physical therapy students.

Bone Diseases↗
PubMed1986

Cellular and humoral bases of hemorrhage-induced depression of lymphocyte function.

Bacterial infection often occurs after trauma and hemorrhage and is believed to be a reflection of a compromised host defense system. In the present study, the effect of hemorrhage on phytohemagglutinin-induced lymphocyte proliferation was investigated. Lymphocytes obtained from rats 2 h after blood withdrawal in an amount equivalent to 30% of total blood volume showed a 48% reduction in proliferative response as compared to cells obtained from the same animal before bleeding. This depression in lymphocyte proliferative capacity appeared to be due to a serum factor or factors induced by hemorrhage. The hemorrhage-induced serum factor(s) is heat-stable, dialyzable, and has an apparent molecular weight between 13,000 and 23,000 on gel filtration chromatography. The hemorrhage-induced factor seems to suppress lymphocyte proliferation in a rapid and irreversible manner. This abnormality in host defense mechanisms may contribute to the increased incidence of sepsis present after trauma and hemorrhage.

Animals↗
PubMed1986

Noninvasive measurement of conjunctival PCO2 with a fiberoptic sensor.

A miniaturized fiberoptic PCO2 probe permits direct measurement of tissue PCO2 on nonkeratinized tissue surfaces without the heating effects produced by transcutaneous PCO2 sensors. This study of anesthetized dogs compared PCO2 measured at the palpebral conjunctiva (PcjCO2) with PaCO2 and mixed venous (PVCO2) measurements during normovolemic normotension and hypovolemic hypotension. During the control period, the average PcjCO2 was 3 +/- 1 (SEM) torr greater than PaCO2 (r = 0.98) when the latter ranged from 20 to 80 torr. There was a close association (r = 0.94) between PcjCO2 and PaCO2 when the cardiac index (CI) was greater than 2.0 L/min X m2. However, as CI decreased below this value, PcjCO2 and PaCO2 were less well correlated (r = 0.69). PcjCO2 was closely associated with PVCO2 at all stages of the experiment, both above (r = 0.95) and below (r = 0.82) a CI of 2 L/min X m2. Fiberoptic conjunctival PCO2 monitoring seems promising as a noninvasive measure of physiologic status.

Animals↗
PubMed1986

Lack of effect of exogenous recombinant interleukin-2 on trauma-induced abnormalities in lymphocyte proliferation.

Injury impairs cell-mediated immune function by depressing mitogen-induced lymphocyte proliferation and decreasing interleukin-2 (IL-2) production. In this study, we examined the ability of exogenous, recombinant IL-2 to restore lymphocyte proliferation after trauma. Recombinant IL-2 was added to cultures of phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells obtained from seven healthy volunteers and from 21 victims of accidental trauma. In comparison to the healthy group, lymphocyte proliferation was reduced approximately 20% in patients with minor and moderate injuries, and 50% in patients with severe injuries. The addition of recombinant IL-2 to PHA-stimulated lymphocytes from injured patients did not substantially improve cellular proliferation. These results suggest that the depressed response of lymphocytes to mitogen stimulation after trauma is not due to decreased IL-2 generation.

Adult↗
PubMed1986

Cardiorespiratory and conjunctival oxygen tension monitoring during resuscitation from hemorrhage.

Placement of an unheated miniaturized oxygen electrode against the palpebral conjunctiva permits noninvasive measurement of tissue oxygen tension. In this study, the relationship between conjunctival oxygen tension (PcjO2) and standard cardiorespiratory variables was examined during a sequential resuscitation protocol after acute hemorrhage. Anesthetized dogs were rapidly bled to a mean arterial pressure of 40 mm Hg and then retransfused with the shed blood in a stepwise fashion. PcjO2 fell to 2% of control values after hemorrhage and did not return to prehemorrhage values until more than 90% of the shed blood had been reinfused. PcjO2 was among the last set of cardiorespiratory variables to return to control values during resuscitation and was the last noninvasive variable to normalize. The ratio of PcjO2 to arterial oxygen tension decreased from a prehemorrhage value of 0.76 +/- 0.05 (SEM) to 0.02 +/- 0.003 after hemorrhage, and did not increase to values greater than 0.50 until resuscitation was more than 90% complete. Conjunctival oxygen monitoring may play an important role in assessing the adequacy of resuscitation after acute hemorrhage.

Animals↗
PubMed1986

Conjunctival oxygen tension monitoring during hemorrhage.

Placement of an unheated, miniaturized oxygen electrode against the palpebral conjunctiva permits noninvasive measurement of tissue oxygen tension without the heating artifacts present with transcutaneous monitoring. In this study, the relationship between conjunctival oxygen tension (PcjO2) and standard cardiorespiratory variables was examined in a sequential hemorrhage model. PcjO2 was among the first set of physiologic variables that differed significantly from control values during hemorrhage. PcjO2 was the first noninvasively measured parameter to become abnormal. In particular, PcjO2 fell at an earlier point and more rapidly than did blood pressure. Conjunctival oxygen monitoring may have a useful clinical role in the early identification of blood loss.

Animals↗
PubMed1986

Noninvasive monitoring of cardiorespiratory parameters.

Noninvasive methods for monitoring pH, pCO2 and pO2 have not achieved the original aim of providing a noninvasive, continuous assessment of arterial blood gases under all clinical conditions. Fingertip and ear oximeters provide measurement of oxygen saturation in arterial blood under most conditions, but accuracy is lost when intense peripheral vasoconstriction is present. Transcutaneous and conjunctival O2 and CO2 sensors also function as accurate trend monitors of PaO2 and PaCO2 in the hemodynamically stable patient. Measurement of pH by placement of a sensor into the subcutaneous tissue provides a continuous assessment of arterial pH in neonates with normal CO, but the use of these sensors in adult patients remains largely unproven. Noninvasive assessment of the adequacy of peripheral perfusion, cardiac function, and intravascular volume status can be performed using transcutaneous or conjunctival O2 and CO2 sensors. Early detection and correction of hypovolemia and diminished CO can be accomplished by monitoring tissue PO2 and PCO2. In the emergency department setting, in which the evaluation and initial treatment of critically ill patients often is performed by measurement of a limited set of physiologic parameters, the ability to evaluate tissue perfusion on a continuous basis is an important clinical advance.

Adult↗
PubMed1986

The role of interleukin 2 in hemorrhage-induced abnormalities of lymphocyte proliferation.

Depression of lymphocyte proliferative response occurs after trauma and hemorrhage. Because abnormalities in production or utilization of interleukin 2 (IL-2) can result in depression of mitogen-induced lymphocyte proliferation, we investigated the effects of unanesthetized hemorrhage on the generation of IL-2 by rat peripheral blood lymphocytes and the response of these cells to exogenous IL-2. Two hours after loss of 30% of total blood volume, IL-2 production was reduced by greater than 90%. Return to normal levels of IL-2 generation occurred by 48 hr after hemorrhage. Addition of purified rat IL-2 to cultures of phytohemagglutin-stimulated peripheral blood lymphocytes obtained from normal animals resulted in suppression of the proliferative response. Exogenous IL-2 produced a similar degree of suppression in the proliferation of cells obtained from hemorrhaged animals. These results show a profound hemorrhage-induced suppression of IL-2 generation, but no benefits of exogenous IL-2 in improving the depressed lymphocyte proliferative response that exists after hemorrhage.

Animals↗