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J H Shapiro

Publications and source records attributed to J H Shapiro.

At least 19 recordsLinked to original sources
PubMed1999

Anesthesia by the pediatric specialist.

There is increasing evidence that involvement of pediatric anesthesiologists in the perioperative care of infants and children can positively impact outcome. Considerable data have emerged in the past several years that clearly show that infants and small children experience untoward events at a much higher rate than do older children and adults. Herein the author presents some of this literature as well as data suggesting that anesthesiologists with interest and additional training in the care of infants and children can improve anesthesia outcomes. Even in these days of cost containment, it makes sense to provide the best pediatric team to care for the pediatric patient during the perioperative experience.

Anesthesiology↗
PubMed1999

Raising eyebrows: problems that get anesthesiologists' attention.

There are many clinical situations of concern that may be unique to pediatric anesthesiologists. The author discusses four of the more common presentations: asthma, cystic fibrosis, anterior mediastinal masses, and latex allergy. Many such issues can be resolved before surgery by consultation with members of the operating team. Some issues may require additional input from nonsurgical pediatric specialists. By maintaining good communication between the anesthesiologist and the surgeon, delays and cancellations can be minimized and patient care enhanced.

Asthma↗
PubMed1994

Methemoglobin levels during prolonged combined nitroglycerin and sodium nitroprusside infusions in infants after cardiac surgery.

Nitroglycerin (NTG) and sodium nitroprusside (SNP) are routinely used perioperatively in infants with congenital heart defects. In this study, NTG and SNP were infused in the operating room to increase venous capacitance, reduce systemic and pulmonary afterload, facilitate weaning off cardiopulmonary bypass, stabilize hemodynamics for transport to the intensive care unit (ICU), and reduce the fluid resuscitation needed upon arrival in the ICU. Because of the risk for accumulation of methemoglobin (MetHb) and cyanmethemoglobin (cyan-MetHb) during prolonged continuous infusion of NTG and SNP, it was decided to (1) quantify ICU use, (2) measure % MetHb at 12-hour intervals, and (3) look indirectly for the accumulation of cyan-MetHb by comparing simultaneous pulse oximetry (SpO2) (Nellcor N-100 [Nellcor, Haywood, CO]) and CO-oximetry (SaO2) (Corning 270 [Corning, Medfield, MA]). A total of 69 arterial samples were obtained from 16 infants (median age 4.4 months) following cardiac surgery with bypass. Median doses of NTG, 6.0 mg/kg (range 0.7 to 27.5), and SNP, 3.3 mg/kg (range 0.6 to 33.4), were infused over a median of 64.5 hours (range 12 to 183) (N = 16 patients). The median MetHb was 0.6% (range 0.0 to 1.5) after infusions of NTG, 1.8 micrograms/kg/min (range 0.5 to 4), and SNP, 1.3 micrograms/kg/min (range 0.3 to 8.4) (N = 69 measurements). Regression analysis of oximetry data yielded the equation: SpO2 = 1.04 SaO2 - 3.7%, r = 0.97. The mean difference between SpO2 and SaO2 data pairs was 0.0% (bias) with a SD (precision) of +/- 2.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1994

Bradycardia during anesthesia in infants. An epidemiologic study.

BACKGROUND: The frequency and morbidity of bradycardia during anesthesia in infants are not well documented. This study sought to determine the frequency of bradycardia during anesthesia in infants (0 to 1 yr) compared to that in older children, describe causes and morbidity, and identify factors that influence its frequency. METHODS: Computerized information abstracted from 7,979 anesthetic records of patients ages 0-4 yr undergoing noncardiac surgery were examined for the presence or absence of intraoperative bradycardia. To study bradycardia in infants, 4,645 anesthetics in patients aged 0-1 yr were considered. Those with bradycardia to heart rates less than 100 beats/min were examined for causes, morbidity, and treatment of the bradycardia. For analysis of influencing factors, the frequency of bradycardia in infants was related to age, sex, race, ASA physical status, surgical site (body cavity), complexity (major or minor) and duration, type of primary anesthetist, type of supervising anesthesiologist, and anesthetic agents. Logistic regression was used to estimate the significance (P < 0.05) and odds ratios for each. RESULTS: The frequency of bradycardia was 1.27% in the 1st yr of life, but only 0.65% in the third and 0.16% in the 4th yr, a significant difference. Causes of bradycardia in infants included disease or surgery in 35%, the dose of inhalation agent in 35%, and hypoxemia in 22%. Morbidity included hypotension in 30%, asystole or ventricular fibrillation in 10%, and death in 8%. Treatment involved epinephrine in 30% and chest compression in 25%. Associated factors included an ASA physical status of 3-5 (vs. 1 or 2) and longer (vs. shorter) surgery. Bradycardia was less than half as likely when the supervising anesthesiologist was a member of the Pediatric Anesthesia Service as with other anesthesiologists (P < 0.001). CONCLUSIONS: Bradycardia is more frequent in infants undergoing anesthesia compared to older children and is associated with substantial morbidity. It is more likely in sicker infants undergoing prolonged surgery and less likely when a pediatric anesthesiologist is present.

Age Factors↗
PubMed1994

Dr Henry Garland: the man, the myth, the legend, and the legacy. Garland Lecture from the 1991 California Radiological Society meeting.

In a century of American radiology, a relatively small number of radiologists have emerged as unquestioned leaders of the specialty. One of those was L. Henry Garland, late of San Francisco, whose multifaceted accomplishments and vigorous personality made him a significant contributor to advances in radiology during 3 decades. The Garland family has endowed an annual lecture at the meeting of the California Radiological Society. This essay is taken from the 1991 lecture, which was an assessment of Garland's significance.

California↗
PubMed1986

Inefficacy of routine laboratory analysis of CSF obtained during myelography for suspected disc disease.

The routine laboratory analysis of cerebrospinal fluid (CSF) obtained during myelography is performed in many institutions. The records of 100 consecutive patients who had myelography for suspected disc disease were reviewed retrospectively. The laboratory analysis of the CSF obtained during myelography did not benefit patient management in any instance. In one case, the CSF results adversely affected patient management. The CSF analysis did not add any information to the myelogram result. The CSF protein level did not correlate in a statistically significant way with the degree of disc protrusion seen myelographically.

Cerebrospinal Fluid↗
PubMed1985

The specific diagnosis of hepatocellular carcinoma by scintigraphy. Multiple radiotracer approach.

The accuracy of scintigraphy in diagnosing hepatocellular carcinoma (HCC) at Boston City Hospital between January 1, 1978 and September 30, 1983 is retrospectively reviewed. A combined protocol using technetium-99m sulfur colloid (TsSC), gallium (Ga), and scintiangiography (STA) was employed in order to enhance diagnostic specificity. There were 14 cases of HCC, of which 10 were proven histologically. The others were diagnosed clinically and angiographically. With one exception, all patients who had triple tracer scintigraphy showed a specific pattern of findings: (1) cold defects with TcSC; (2) Ga-avid foci, and (3) increased vascular supply from hepatic arteries. One false-positive study and one false-negative study were originally reported, although in both cases, strict adherence to the three criteria above would have avoided diagnostic error. These results indicate that triple tracer scintigraphy may be an effective diagnostic test for HCC. The relative efficacy of scintigraphy, ultrasonography, and computerized tomography in diagnosing HCC is also discussed.

Adult↗
PubMed1985

Scintiangiographic demonstration of parasitization of systemic blood supply by inflammatory lung disease.

An unusual case in which a computed tomogram demonstrated abnormal, enlarged vessels in the right lower lobe of the lung and suggested an arteriovenous malformation is presented. A scintiangiogram showed abnormal systemic supply to this area in the aortic phase. Contrast angiography demonstrated hypertrophy of the right inferior phrenic artery with abnormal systemic supply to the pleura and parenchyma of the right lower lobe, presumably on the basis of old infection.

Erythrocytes↗
PubMed1985

Comparison of overhead and cross-table lateral views for detection of knee-joint effusion.

Prompted by the failure to detect a clinically evident knee-joint effusion on the cross-table lateral view of an injured patient, a prospective study was carried out to compare the routine overhead and cross-table lateral knee views for detection of joint effusion in 18 patients with acute knee trauma. In every case, the size of the effusion as determined by the "fat-pad separation sign" was greater on the overhead view (p less than 0.001). In three patients the effusion would have been missed radiologically had the vertical-beam projection been omitted. The authors conclude that the cross-table lateral view is less sensitive than the routine overhead lateral view in the detection of knee-joint effusions because of fluid shift into the lateral recesses of the suprapatellar bursa with the patient in the supine position. This phenomenon is demonstrated by arthrography and computed tomography in one patient.

Adult↗
PubMed1984

Hepatocellular carcinoma: uptake of 99mTc-IDA in primary tumor and metastasis.

Four consecutive cases of proven hepatocellular carcinoma (HCC) showed significant avidity of 99mTc -labeled iminodiacetic acids (Tc- IDAs ) in preoperative scintigraphy. In one patient, the pulmonary metastasis showed uptake of Tc-IDA. Such scintigraphic findings were obvious only in the delayed scans, performed 2 1/2-4 hr after injection. Since Tc- IDAs and bilirubin are functional analogs physiologically, the ability of HCC to concentrate Tc- IDAs may be related to the ability of HCC neoplastic cells to form bile intracellularly. This hypothesis is supported by the fact that intracellular bile granules were found in the tumor cells of all four patients. This suggests a potential for using Tc- IDAs for the specific and preoperative diagnostic of HCC.

Adult↗
PubMed1983

Specific diagnosis of hepatoma using 99mTc-HIDA and other radionuclides.

The difficulty of clinical and radiographical diagnosis of hepatoma is discussed. A case of hepatoma is reported. Both the primary tumor and distant metastases showed strong avidity for 99mTc-HIDA, which normally is concentrated by parenchymal cells of the liver. The potential of using 99mTc-HIDA for the noninvasive investigation of patients suspected of having hepatoma is discussed. The association between tumor avidity for 99mTc-HIDA and the bile-forming ability of tumor cells is of interest.

Adult↗
PubMed1982

Radionuclide angiography for the diagnosis of thyroid cancer.

The conventional static thyroid scan is sensitive but nonspecific in detecting thyroid tumors. Radionuclide angiography is a noninvasive and simple technique that can improve the specificity of the conventional scan significantly, since it can demonstrate hypervascularity of tumors. Our case reports demonstrated hypervascularity of the primary tumor and metastatic cervical lymph nodes.

Adult↗