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Biomedical subjects

J L Berger

Publications and source records attributed to J L Berger.

At least 37 records · Page 2Linked to original sources
PubMed1986

[Recurrent nerve paralysis and Claude Bernard-Horner syndrome following an interscalene block of the brachial plexus].

The association of a recurrent laryngeal block with a Horner's syndrome occurred in one patient after right interscalene brachial plexus block. Hoarseness was the main clinical symptom of recurrent paralysis and lasted 4 h. The subsequent course was totally uneventful and required no specific treatment. But the interscalene route of brachial plexus block may be potentially hazardous in the patient with a full stomach.

Adult↗
PubMed1986

[Brachial plexus block in children. Approach through the brachial canal].

This study included 35 children (average age: 8 years) undergoing surgery of the upper limb under brachial plexus block. The brachial plexus was approached by the brachial canal route, which is a simple, rapid and efficient way (34 were successful). The main advantage of this technique was the avoidance, in most children, of general anaesthesia as a complement. In addition, postoperative analgesia was satisfactory in all cases. In spite of large doses and volumes of lidocaine and bupivacaine used with this technique, no complication was observed.

Adolescent↗
PubMed1985

[Is automatic oscillometric measurement of blood pressure reliable in hypotension?].

The reliability of an automatic oscillometric device for measurement of blood pressure (BP) was assessed in a large range of BP values during intraoperative normotension and induced hypotension. Direct BP measurements were carried out with a radial catheter. Data were compared with those obtained with the oscillometric device placed on the opposite arm. Nine patients were studied, undergoing 234 measurements of BP ranging from 55 to 208 mmHg (7.3 to 27.7 kPa) for systolic blood pressure (Pasys), from 32 to 130 mmHg (4.3 to 17.3 kPa) for diastolic blood pressure (Padia) and from 36 to 154 mmHg (4.8 to 20.5 kPa) for mean blood pressure (Pa). Good correlation between the two techniques was found for Pasys measurements recorded during both normotension and hypotension (r = 0.93; p less than 0.01). 92% of the values recorded with the oscillometric device were lower than those measured invasively. In the other cases (8% of the data), the mean difference between the two techniques was 5.5 mmHg (0.7 kPa). When BP values lower than 90 mmHg (12 kPa) for Pasys, 60 mmHg (8 kPa) for Padia and 70 mmHg (9,3 kPa) for Pa were considered individually, the correlation coefficients were 0.83, 0.73 and 0.77 respectively. These findings suggested that the oscillometric method can be considered as relatively suitable for monitoring moderate hypotension induced by vasodilators. The invasive technique must however remain the method of choice during profound hypotension.

Anesthesia, General↗
PubMed1985

Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC 45) in patients with cirrhosis.

To evaluate the effect of liver cirrhosis on the pharmacokinetics and the pharmacodynamics of vecuronium, 12 patients with cirrhosis, aged (mean +/- SD) 52 +/- 12 yr, and 14 control patients, 42 +/- 15 yr, undergoing elective surgery under general anesthesia were studied. The simultaneous time courses of the plasma concentration of vecuronium and of the neuromuscular blockade were studied after the administration of a bolus dose of 0.2 mg X kg-1. Vecuronium plasma concentration declined biexponentially in both groups. Vecuronium plasma clearance was reduced significantly (P less than 0.01) from 4.26 +/- 1.38 ml X min-1 X kg-1 in the controls to 2.73 +/- 1.19 ml X min-1 X kg-1 in the patients with cirrhosis. The elimination half-life was 58 +/- 19 min in the controls and was prolonged significantly to 84 +/- 23 min (P less than 0.01) in the patients with cirrhosis. The total apparent volume of distribution was unchanged in patients with cirrhosis (0.253 +/- 0.086 1 X kg-1 vs. 0.246 +/- 0.092 1 X kg-1 in the controls). Cirrhosis caused a prolongation of the neuromuscular blockade induced by vecuronium: the duration of effect from injection to 50% recovery of the twitch height was prolonged by 100% (P less than 0.01) from 62 +/- 16 min in the controls to 130 +/- 52 min in patients with cirrhosis. The recovery rate (TH 25-75) also was prolonged (P less than 0.05) from 21 +/- 7 min in the controls to 44 +/- 18 min in patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Anesthesia in patient with the ventricular pre-excitation syndrome].

The Wolff-Parkinson-White syndrome or its variant, the pre-excitation syndrome, are described in about 1.2 per 1000 of the population, so the anaesthetic management of patients with this syndrome is important. Our experience is reported in 15 elective operations on seven patients with pre-excitation syndrome. The most significant feature is the occurrence of variation of the morphology of QRS complexes. Rhythm disturbance most commonly encountered is supraventricular tachycardia, but different cardiac arrhythmias may occur and sometimes these are fatal. In our study, major complications or cardiac arrhythmias did not occur. With regard to the anaesthetic technique, care should be taken not to produce tachycardia. Atropine is not absolutely contraindicated for premedication. Preoperative use of propranolol or of quinidine is questionable.

Adult↗
PubMed1983

[Comparative study of ORG NC 45 and pancuronium during anesthesia].

The muscle relaxant effects of ORG NC 45 and pancuronium were compared in anesthetized patients with normal liver and renal functions. In all patients, the muscle relaxant effect was monitored by measuring the strength of the adductor pollicis muscle elicited by supramaximal stimulation of the ulnar nerve at the wrist. Different modes of administration of the muscle relaxants were used. In order to facilitate tracheal intubation, a dose of 100 mu X kg-1 of ORG NC 45 or pancuronium was administered. This dose was followed or not according to the type of surgery by repeated doses of 25 micrograms X kg-1. The results of this study indicate that ORG NC 45 is much shorter acting than pancuronium, and non cumulative. The dose of 100 micrograms X kg-1 produced adequate conditions for tracheal intubation 3 to 4 min after the administration of the muscle relaxant. The recovery of the muscle strength to 75% of control value was achieved 46 min and 100 min after a single dose of 100 micrograms X kg-1 of ORG NC 45 and pancuronium respectively. The interval of time between repeat injections averaged 20 min for ORG NC 45 and 40 min for pancuronium.

Adolescent↗
PubMed1983

[Tubular gastrostomy].

Development and generalization of the use of mechanical suturing apparatuses has led to re-evaluation of tubular gastrostomy. Use of the 1AG clamp ensures gastric tubulization under good safety conditions (quality of the suture and absence of opening of the gastric tube). The choice of location of the tube depends upon the size of the stomach. The main indication is for feeding gastrostomies of long duration, particularly cases with irreversible lesions of the esophagus or in the ENT sphere. The quality of the apparatus and the facility with which it can be employed has transformed survival in these patients. A further possible indication is in acute necrotic pancreatitis, its use suppressing complications of classical gastrostomies (Fontan type) (gastric fistulae, disinsertions, difficulties with the apparatus). The only inconvenience of this procedure, minimal in regard to the benefits obtained, is the need for surgical closure.

Abdominal Muscles↗
PubMed1983

[Present role of Hartmann's operation. Apropos of 50 cases].

Of 50 Hartmann's operation conducted, 22 (including 19 for sigmoid diverticulitis) were for non-neoplastic lesions. Emergency surgery was necessary for lesions complicated by perforation, abscess, or occlusion in 34 cases, the indications for operation being local and general conditions, where immediate re-establishment of colorectal continuity was not possible, in the other 16 patients. Overall mortality was 22 p. cent, being much higher in cancer cases (32 p. cent) than in those with sigmoiditis (52 p. cent). Postoperative morbidity was marked, and was dominated by parietal complications and those due to the colostomy, and by thromboembolic complications particularly in the sigmoiditis cases. Secondary re-establishment of intestinal continuity was possible in 19 patients (6 cancers and 13 benign lesions) with a single postoperative death. Whereas the employ of Hartmann's operation in cancer would appear to be justified only in urgent complicated cases it is certainly a valid procedure in the acute phase of sigmoid diverticulitis, where its mortality is relatively low. Current mechanical suturing techniques, by facilitating secondary re-establishment of continuity, reduce the classical inconveniences of Hartmann's operation, suggesting its wider use for the emergency treatment of complicated lesions of the colon.

Adult↗
PubMed1982

Localization of gelfoam emboli after partial splenic embolization utilizing 99mTc-labeled emboli.

Partial splenic embolization using 99mTc-labeled Gelfoam was employed to manage of four renal transplant patients with thrombocytopenia and leukopenia. In each patient the individual Gelfoam particles could be seen on the persistence scope of a gamma camera as they arrived in the spleen. This allowed the precise location of each Gelfoam particle to be defined immediately. Gamma camera imaging of the 99mTc Gelfoam particles in the spleen proved as accurate as selective splenic arteriography in determining the amount of spleen embolized. No ectopic 99mTc Gelfoam particles were found as judged by total body gamma camera imaging obtained immediately after the partial splenic embolization procedure was completed.

Adolescent↗
PubMed1981

Pathogenesis of giant colonic diverticula.

The clinical, radiographic, and pathologic findings of 3 patients with giant colonic diverticula are presented. Although several theories have been proposed for the formation of these diverticula, they have not been fully documented. One of our cases illustrates the evolution of this disorder following typical colonic diverticulitis. The pathogenesis and differential diagnosis of this unusual entity are discussed.

Acute Disease↗
PubMed1981

Infarction after embolization of the ileocolic artery.

Treatment of colonic hemorrhage by therapeutic embolization of the involved artery may, rarely, result in bowel infarction. In one patient with angiodysplasia, bowel infarction resulted from a therapeutic embolization of the ileocolic artery, because of the arterial anatomy of the cecum, occlusion of the cecal branches can result in devascularization of the cecum and appendix, even if the colic and ileal branches are not occluded. Thus, the ileocolic artery may not be a good candidate for therapeutic embolization.

Cecum↗
PubMed1981

Pulmonary lymphangioleiomyomatosis.

A case of pulmonary lymphangioleiomyomatosis is reported and the computed tomographic findings are described. The disease is characterized by chylous pleural effusions, a reticulonodular pattern, and the development of air trapping with bullous formation. Computed tomography is useful in demonstrating the early presence of these bullae and in excluding a malignant etiology in a patient with spontaneous chylothorax.

Chylothorax↗