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Biomedical subjects

G J Merli

Publications and source records attributed to G J Merli.

35 records · Page 2Linked to original sources
PubMed1990

Prophylaxis for deep vein thrombosis and pulmonary embolism in the geriatric patient undergoing surgery.

The difficulty surrounding guidelines for the prophylaxis of deep vein thrombosis (DVT) and pulmonary embolism (PE) stems from the willingness to accept some degree of DVT in the calf, with the resultant lower risk of fatal PE, versus the risk of bleeding from a more effective prophylaxis that prevents DVT. This article reviews the etiology, risk factors, methods of prophylaxis, incidence of DVT/PE in various surgeries, and guidelines for DVT/PE prophylaxis.

Adult↗
PubMed1989

Lymphedema of the lower extremities: evaluation by microcolloidal imaging.

Contrast lymphangiography has been the traditional radiographic method for imaging the lymphatic system of the lower extremities. Because of the difficulty in performing the procedure and its potential side effects, radionuclide lymphangiography is a safe and reliable alternative. Technetium-99m labeled to antimony trisulfide colloid was used in nine patients presenting with lymphedema of the lower extremities. The procedure was relatively simple to perform, and no adverse effects were noted.

Abdomen↗
PubMed1988

Deep vein thrombosis: prophylaxis in acute spinal cord injured patients.

The purpose of this prospective, randomized study was to evaluate the efficacy of low-dose heparin, alone or in combination with electric stimulation, in the prevention of deep vein thrombosis (DVT) in C2 to T11 motor complete and incomplete-preserved motor, nonfunctional spinal cord injured patients. The tibialis anterior and gastrocnemius-soleus muscle groups were stimulated bilaterally, using 50 microsecond pulses given at 10Hz with a four-second "on" and an eight-second "off" cycle for 23 hours daily over a 28-day period. Forty-eight patients, less than two weeks after injury, were randomly assigned to saline placebo (n = 17), low-dose heparin (5,000U, subcutaneous every eight hours) (n = 16), and low-dose heparin plus electric stimulation (n = 15). A normal 125-I fibrinogen scan and impedance plethysmography were required for entry into the study. Surveillance for DVT was evaluated by daily 125-I fibrinogen scanning. Venography was performed to confirm a positive impedance plethysmography and/or 125-I fibrinogen scanning tests for two consecutive days and at the completion of the study. The incidence of DVT was 8 of 17 in the placebo group, 8 of 16 in the low-dose heparin group, and 1 of 15 in the electric stimulation plus low-dose heparin group. The use of electric stimulation plus low-dose heparin significantly (p less than 0.05) decreased the incidence of DVT compared to the other treatments.

Electric Stimulation Therapy↗
PubMed1988

Dihydroergotamine/heparin in the prevention of deep-vein thrombosis after total hip replacement. A controlled, prospective, randomized multicenter trial.

In a randomized, double-blind, placebo-controlled multicenter trial, the efficacy and safety of dihydroergotamine mesylate/heparin sodium as a prophylactic agent for deep-vein thrombosis were evaluated in 148 patients who were forty years old or more and who underwent total hip replacement. The incidence of venographically proved postoperative deep-vein thrombosis was 52 per cent in the placebo group and 25 per cent in the dihydroergotamine mesylate/heparin sodium group (p = 0.002). Proximal thrombi developed in only 5 per cent and extensive thrombi, in only 10 per cent of the patients who received dihydroergotamine mesylate/heparin sodium. In contrast, proximal thrombi and extensive thrombi developed in 19 and 25 per cent, respectively, of the patients in the placebo group (p less than 0.05). Adverse reactions in the two groups did not differ significantly: in the treatment group they consisted primarily of hematoma at the site of injection (9 per cent), hematoma at the wound (5 per cent), and excessive postoperative bleeding, and in the placebo group there was hematoma at the site of injection (3 per cent). It was concluded that the combination agent dihydroergotamine mesylate/heparin sodium was effective and safe prophylaxis against deep-vein thrombosis for the patients who underwent total hip replacement in this study.

Adult↗
PubMed1987

The medical consultant.

This article reviews the historical development of the medical consultant. The major articles that have set the foundation for this art are reviewed. Future directions and a mnemonic for successful consultations are presented.

Consultants↗
PubMed1987

Prophylaxis for deep vein thrombosis and pulmonary embolism in the surgical patient.

This article reviews the pathophysiology for the development of deep vein thrombosis and pulmonary embolism in the surgical patient. Patients are stratified into risk groups based on predisposing criteria for the development of thrombosis. Seven modalities of prophylaxis are reviewed with respect to appropriate application. Five major types of surgery are described assessing incidence and prophylaxis of choice. The final section deals with the special consideration of patients with thrombotic disease undergoing surgery.

Humans↗
PubMed1987

Preoperative management of the surgical patient with neurologic disease.

This article reviews neurologic problems that have been categorized into two groups: parenchymal and vascular disease. Each disease has a brief summary of key clinical points, followed by recommended management strategies. The neurologic diseases most frequently encountered by the medical consultant are presented.

Humans↗
PubMed1986

Panvenography and pulmonary angiography in the diagnosis of deep venous thrombosis and pulmonary thromboembolism.

In summary, high-quality pulmonary angiography remains the most accurate and reliable means of diagnosing pulmonary embolism. It can be performed with relative safety, and the inherent mortality risks with pulmonary angiography (in the range of 0.2 to 0.5 per cent in active angiography laboratories) must be weighed against the significant risks incurred with inaccurate diagnosis obtained without pulmonary arteriography. Pulmonary arteriography and transvenous catheter embolectomy can be of great benefit in sudden cardiovascular collapse due to massive pulmonary embolism. Transvenous catheter embolectomy has survival rates at least as good as those of open embolectomy, and it has the advantage that it can be performed in any hospital with angiographic facilities and trained personnel, thus allowing more expeditious management of massive pulmonary embolism in hospitals that do not have cardiopulmonary bypass capabilities.

Acute Disease↗
PubMed1986

Cardiac dysrhythmias associated with ophthalmic atropine.

Atropine sulfate, a mydriatic and cycloplegic agent, is frequently used in patients undergoing glaucoma surgery. Trabeculectomy with peripheral iridectomy is the most common glaucoma surgery performed to decrease intraocular pressure and preserve vision. Systemic absorption of ophthalmic atropine does occur and may result in toxic and adverse side effects. Cardiac dysrhythmias are one of the major adverse reactions. This case study reviews three patients who had a trabeculectomy for glaucoma and received ophthalmic atropine. One patient received both systemic and ocular atropine. Two patients developed atrial fibrillation and one a supraventricular tachycardia. Two patients required admission to a cardiac intensive care unit for management of the dysrhythmia and a third reverted to normal sinus rhythm spontaneously. The cardiac effects of ophthalmic atropine should be considered in the preoperative and postoperative assessment of patients with dysrhythmias.

Absorption↗
PubMed1985

Acute transverse myelopathy: association with body position.

The syndrome of acute transverse myelopathy (ATM) has been described in the medical literature for decades. Despite the clinical descriptions, ATM continues to be poorly understood etiologically. Current thinking associates the syndrome with viral infections, multiple sclerosis, vascular disease, and malignancy. Three cases of ATM seen since 1972 are reported. All three patients described unusual stressful body posturing immediately preceding the onset of neurologic deficit. This presentation focuses on vascular compromise associated with stressful body positioning as another possible etiologic factor for ATM.

Adolescent↗
PubMed1984

Immobilization hypercalcemia in acute spinal cord injury treated with etidronate.

Hypercalcemia developed in a 30-year-old C5 quadriplegic six months after he received a gunshot wound in the cervical spine. Short-term treatment consisted of fluids and diuretics, but conventional drug therapy for long-term maintenance of normocalcemia was not effective. A regimen of etidronate disodium was then instituted, which resulted in normocalcemia. When use of this drug was discontinued at intervals during the therapy, the hypercalcemia recurred. The patient's condition was maintained on the etidronate regimen until full mobilization occurred, at which time the drug therapy was discontinued and normocalcemia persisted. This case represents, to our knowledge, the first reported success with the use of etidronate in the treatment of hypercalcemia in the immobilized patient with acute spinal injury.

Acute Disease↗
PubMed1984

Postphlebitic syndrome.

Postphlebitic syndrome occurs in 20 per cent of patients with deep vein thrombosis. Symptoms are nonspecific; they include heaviness, fatigue, pain, and vary from patient to patient. The signs of edema, skin pigmentation, dermatitis, varicosities, and ulceration are a result of the increased retrograde venous pressure secondary to the valve destruction by the phlebitic process. The aim of therapy is to improve venous support by graduated elastic stockings and to ensure good skin care and exercise.

Clothing↗
PubMed1984

Lymphedema.

Lymphedema is swelling that results from the accumulation of lymph due to a malformation or obstruction of the lymphatic system. Once other causes (cardiac, renal, and hepatic) of lower extremity edema have been ruled out, categorization into primary and secondary lymphedema is undertaken. A complete history, physical, and laboratory evaluation is completed to diagnose the specific type of lymphedema and appropriate management is recommended.

Adult↗
PubMedDate not supplied

Low-molecular-weight heparins versus unfractionated heparin in the treatment of deep vein thrombosis and pulmonary embolism.

In the United States, there are approximately 217,000 patients with deep-vein thrombosis hospitalized each year. The cause for these thrombotic events include surgery, trauma, malignancy, hereditary thrombotic disorders, stroke, spinal cord injury, and idiopathic. Frequently, a number of these patients are cared for in rehabilitation units or centers to improve their functional status. This rehabilitation process is often interrupted with the development of deep vein thrombosis and or pulmonary embolism. These patients are placed on bedrest and, often, are transferred to an acute care hospital to receive continuous infusion unfractionated heparin with a targeted activated partial thromboplastin time of 1.5-2.5 times the baseline value and warfarin to achieve an international normalized ratio of 2-3. Recently, the low-molecular-weight heparins have been shown to be as or more effective than unfractionated heparin, have less major bleeding complications, and do not require laboratory monitoring of coagulation tests to adjust medications. The purpose of this article is to review the efficacy and safety of low-molecular-weight heparins and provide physiatrists with a rationale approach for managing patients with deep vein thrombosis and or pulmonary embolism on their respective units.

Activities of Daily Living↗