Into the deep well: the evolution of medical school loan debt.
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Education, Medical↗
Biomedical subjects
J F Naradzay
Publications and source records attributed to J F Naradzay.
Acute stroke.
Disruption of cerebral blood flow may influence brain energy metabolism to produce reversible or irreversible neurologic deficits. The emergency physician is in a unique position to provide timely treatment during the first few hours of an acute stroke. He or she must be facile with unique pharmacologic and non-pharmacologic treatment designed for the stroke patient concerning ventilation, blood pressure, and circulation.
Anticoagulants↗
Ophthalmologic therapeutics.
For the treatment of ocular disorders, the emergency physician has access to a variety of medications and delivery systems. This article focuses on topically applied ophthalmic medications: ointments and solutions, which are placed in the inferior conjunctival cul-de-sac, and hyperosmotic agents, which are administered parenterally. The indications, contraindications, potential side effects, mechanism of action, and dosage schedules for eight categories of ophthalmic agents are described. For most patients requiring ophthalmologic treatment in the emergency department, topical agents are highly efficacious, easy to administer, associated with few side effects, and inexpensive.
Emergencies↗
Vascular morphology and permeability in fetal CNS grafts to the renal capsule.
According to conventional neovascularization concepts, due to local tissue factors, a viable graft of central nervous (CNS) tissue should be expected to retain a complete blood-brain barrier (BBB) in its new site. In order to determine if grafted CNS would alter the phenotype of ingrowing peripheral vessels we have used an uncomplicated model. Rat fetal cortex, which already has a BBB to protein, was grafted to the subcapsular space of the host rat kidney. After postoperative times between 4 weeks and 3 months, horseradish peroxidase was injected systemically for periods between 90 s and 4 min. Correlative electron microscopy depicted vascular morphology. Each graft contained protein exudation particularly around large vessels in the neuropil. At the EM level some of the vascular endothelia had fenestrations, were invested with collagen, and were not contacted by astroglia. Capillaries indigenous to the CNS grafts and related normally to astroglial end feet were also prominent. The presence of non-CNS vessels with peripheral ultrastructural and permeability characteristics would appear to contradict conventional theory in that CNS grafts can be vascularized by vessels of a different phenotypic and physiologic nature.
Animals↗
The cutting-edge microvascular needle. A scanning electron microscopic study.
The authors have compared the vascular endothelial damage caused by blunt-tipped microvascular needles as reported previously with that of sharp cutting-edged needles of comparable size. The same four distinct vascular lesions were found with cutting-edged needles as with the blunt-tipped needles. Even though one experimenter made all of the lesions, and all of the tissue was handled in the same fashion, there was much variation in the extent of the intimal damage. Overall, cutting-edged needles produced slightly less intimal tearing and platelet aggregation than blunt-tipped needles, but the difference was not striking.
Animals↗
Antiepileptic drug therapy: clinical laboratory significance.
When evaluating a patient who is taking an antiepileptic medication, it is important for the emergency physician to correlate the clinical presentation with the antiepileptic drug level. Therapeutic ranges have been suggested for most antiepileptic medications, but these must be interpreted in light of clinical efficacy and patient tolerance. When considering the efficacy of anti-epileptic medications, it is necessary to consider the patient's unique metabolism, side-effect tolerance, and overall response to therapy. Suggested therapeutic ranges should be the first reference for the emergency physician. The purpose of this report is to discuss the laboratory values of commonly prescribed antiepileptic medications. Therapeutic ranges, side-effects, and common medication interactions are discussed concerning phenytoin, phenobarbital, carbamezapine, and valproic acid.
Aged↗
Cerebral ventricular shunts.
Cerebral ventricular shunts are siphoning devices used to treat hydrocephalus. They are placed within cerebral ventricles and peripheral cavities such as the ventricular atrium or peritoneal cavity. Complications include obstruction of cerebral spinal fluid (malfunction) and infection. Morbidity and mortality rates are high when shunt malfunction and infection are not treated emergently. This report summarizes the physical examination of patients with ventricular shunts, reviews the type of shunts commonly used, discusses shunt malfunctions (causing overshunting or undershunting of cerebrospinal fluid) and infections, and makes recommendations concerning empiric antibiotic therapy for shunt infection. The technique of tapping a shunt is presented for management of patients with elevated intracranial pressure that does not respond to non-invasive maneuvers to lower the pressure.
Bacterial Infections↗
Prescription noncompliance: contribution to emergency department visits and cost.
We randomly surveyed 100 patients in the acute care section of a large urban university hospital Emergency Department (ED) on 6 days with regard to the existence of and reasons for prescription noncompliance. Noncompliance was considered a major factor contributing to the ED visit if: (1) no medications had been taken for at least 48 h before the ED visit; (2) the medications, when previously taken, had routinely controlled the condition for which the patient was presenting to the ED; and (3) no other significant cause or illness was believed to have precipitated the ED visit. ED, admissions, and yearly medication costs were calculated for all patients. Noncompliance was found to be a contributing factor in the cases of 22 patients (22%). The most common medications involved were phenytoin and albuterol. Cost was the most common reason for noncompliance (11 [50%]). The average ED charge per noncompliant patient discharged was $576.61. Six noncompliant patients were admitted at an average cost of $4,834.62. The average cost of a year's medication was $520.72. Noncompliance with drug prescriptions is a significant contributor to ED visits and health care costs.
Adult↗