Search PubMed⌕ Search

Biomedical subjects

J Rosenberg

Publications and source records attributed to J Rosenberg.

At least 19 recordsLinked to original sources
PubMed1997

[Effect of sublingual nitroglycerin on pain following ERCP].

Nitroglycerine, acting a nitric oxide donor, is known to relax visceral smooth muscle. We report a case where pain associated with pancreatitis after ERCP was successfully treated with sublingual nitroglycerine 0.5 mg. The analgesic effect lasted approximately two hours. Further controlled studies should evaluate the effect of nitroglycerine on pain associated with pancreatitis as well as clarify the mechanisms involved.

Administration, Sublingual↗
PubMed1997

[Time used in monitoring of postoperative oxygen status].

The purpose of the study was to compare use of time with pulse oximetry versus arterial blood gas measurement on the general surgical ward. Eighty patients who had just had major orthopaedic or abdominal surgery were included in the study at two hospitals in Copenhagen. Success rate for pulse oximetry was 100% but only 89% for arterial blood gas measurement, because the laboratory did not analyse samples where the ice surrounding the syringe had melted when arriving at the laboratory or if there were air bubbles in the blood sample. At Hvidovre Hospital the results from the blood gas analysis were delayed median 58 minutes compared with 32 minutes at Sundby Hospital (p < 0.001). The delay at Hvidovre Hospital was largely due to prolonged time for transportation of the sample from the surgical ward to the laboratory by the hospital porter. No patient had hypercapnia or acid-base disturbances requiring treatment. With pulse oximetry reliable monitoring of arterial oxygenation can be obtained non-invasively and with a high success rate. Furthermore, the results are available for the clinician immediately compared with arterial blood gas measurement, where there is a delay in getting the results. We recommend that all general surgical wards should have a portable pulse oximeter for monitoring arterial oxygenation after major surgery.

Adult↗
PubMed1997

Postoperative Serratia marcescens wound infections traced to an out-of-hospital source.

From 25 August to 28 September 1994, 7 cardiovascular surgery (CVS) patients at a California hospital acquired postoperative Serratia marcescens infections, and 1 died. To identify the outbreak source, a cohort study was done of all 55 adults who underwent CVS at the hospital during the outbreak. Specimens from the hospital environment and from hands of selected staff were cultured. S. marcescens isolates were compared using restriction-endonuclease analysis and pulsed-field gel electrophoresis. Several risk factors for S. marcescens infection were identified, but hospital and hand cultures were negative. In October, a patient exposed to scrub nurse A (who wore artificial fingernails) and to another nurse-but not to other identified risk factors-became infected with the outbreak strain. Subsequent cultures from nurse A's home identified the strain in a jar of exfoliant cream. Removal of the cream ended the outbreak. S. marcescens does not normally colonize human skin, but artificial nails may have facilitated transmission via nurse A's hands.

Adult↗
PubMed1997

Validation of pulse oximetry for monitoring of hypoxaemic episodes in the late postoperative period.

We monitored 12 patients undergoing major abdominal surgery using a pulse oximeter (Nellcor N-200) and a transcutaneous oxygen tension monitor (TINA, Radiometer A/S) on the second or third night after operation. Of the shortest hypoxaemic episodes measured with the pulse oximeter (< or = 30 s duration), 78% also occurred in the transcutaneous oxygen tension measurement. Episodes of longer duration (> or = 1 min duration on the pulse oximeter) were, in 95% of cases, reflected in the transcutaneous oxygen tension measurement also. Thus postoperative episodic desaturations lasting > or = 1 min are at least 95% likely to be a real phenomenon.

Abdomen↗
PubMed1996

[Perioperative fluid therapy. A quality control study].

This paper presents a retrospective analysis of the fluid balance during the first 12 hours after laparotomy in 60 consecutive patients. The analysis showed that the majority of patients received greater volumes of crystalloid infusions than recommended, and that the actual number of blood transfusions given did in many circumstances not comply with the available guidelines. Perioperative fluid therapy is an area that needs increased attention since overhydration may contribute to cardiopulmonary morbidity. Perioperative fluid therapy regimens should be evaluated in future prospective, controlled, randomized trials.

Adolescent↗
PubMed1996

[Emergency care during ambulatory vasectomy].

We describe a case of cardiac arrest during outpatient vasectomy. The possible mechanisms and need for monitoring are discussed. We recommend that the surgeon should be able to provide basic life support during outpatient vasectomy. Routine electronic monitoring during and after the procedure is probably not warranted and should at least await clinical studies on cardiac function and morbidity during and after the procedure.

Adult↗
PubMed1996

Double blind randomised controlled trial of effect of metoprolol on myocardial ischaemia during endoscopic cholangiopancreatography.

OBJECTIVE: To evaluate the effect of metoprolol, a beta adrenergic blocking drug, on the occurrence of myocardial ischaemia during endoscopic cholangiopancreatography. DESIGN: Double blind, randomised, controlled trial. SETTING: University Hospital. SUBJECTS: 38 (two groups of 19) patients scheduled for endoscopic cholangiopancreatography. INTERVENTIONS: Metoprolol 100 mg or placebo as premedication two hours before endoscopy. MAIN OUTCOME MEASURES: Heart rate, arterial oxygen saturation by continuous pulse oximetry, ST segment changes during endoscopic cholangiopancreatography (an ST segment deviation > 1 mV was defined as myocardial ischaemia), electrocardiogram monitored continuously with a Holter tape recorder. RESULTS: All patients had increased heart rate during endoscopy compared with rate before endoscopy, but heart rate during endoscopy was significantly lower in the metoprolol group compared with the placebo group (P = 0.0002). Twenty one patients (16 placebo, 5 metoprolol; P = 0.0008) developed tachycardia (heart rate > 100/min) during the procedure, and 11 patients (10 placebo, 1 metoprolol; P = 0.003) developed myocardial ischaemia. One patient in the placebo group had an acute inferolateral myocardial infarction. In the 10 other patients with signs of myocardial ischaemia during endoscopy the ST deviation disappeared when the endoscope was retracted. In all patients myocardial ischaemia was related to increases in heart rate, and 10 of the 11 patients had tachycardia coherent with myocardial ischaemia. CONCLUSIONS: Metoprolol prevented myocardial ischaemia during endoscopic cholangiopancreatography, probably through lowering the heart rate. Thus, tachycardia seems to be a key pathogenic factor in the development of myocardial ischaemia during endoscopy.

Adrenergic beta-Agonists↗
PubMed1996

Adverse events with continuous doxapram infusion against late postoperative hypoxaemia.

OBJECTIVE: A randomized double-blind controlled trial of doxapram versus placebo against late postoperative hypoxaemia was planned to include 40 patients (2 x 20). RESULTS: After inclusion of 18 patients a serious adverse event was encountered with development of a brain stem infarction in a 90-year-old woman receiving doxapram. At this point the randomization code was broken and we decided to terminate the trial. Three of nine patients receiving doxapram had had an adverse event whereas none of the patients receiving placebo had adverse events (P = 0.2). In the 18 patients studied, there was an insignificant trend towards higher mean oxygen saturation in the doxapram group, and a significantly higher minimum oxygen saturation and reduced number of hypoxaemic events on the first postoperative night. CONCLUSION: Although these preliminary data on the effect of doxapram on postoperative hypoxaemia seem promising, further studies on the effect of continuous nocturnal postoperative doxapram infusion on levels of arterial oxygen saturation should be postponed until more knowledge about the pharmacokinetics of doxapram in this particular clinical situation has been gathered.

Adult↗
PubMed1996

Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices.

OBJECTIVES: To determine the cause of increased central venous catheter-associated (CVC) bloodstream infection (BSI) rates in a cohort of pediatric hematology /oncology patients receiving home health care (HHC). METHODS: A retrospective cohort study of hematology/oncology patients with CVCs receiving HHC from January 1992 through November 1994. RESULTS: Of 182 patients with CVCs identified during the study period, 58 (32%) acquired 90 BSIs during 75,085 CVC days. BSI rates increased significantly from 1992 through 1994 (0.8 vs 1.0 vs 1.7 BSIs per 1000 CVC days; p < 0.005). Known risk factors, including catheter type, patient age less than 5 years, sex, or diagnosis, were not associated with increased BSI rates. After introduction of needleless devices for CVC access to the HHC regimen in May 1993, BSI rates increased 80% (from 0.81 to 1.46 BSIs/1000 CVC days, relative risk 1.8; p < 0.02). The only other significant risk factor was the race of the patient. White children had the lowest BSI rate before and after needleless-device introduction (0.4 vs 0.9 BSIs/1000 CVC days; p > 0.1), whereas black patients had the highest, unaffected by the introduction of these devices (2.5 BSIs/1000 CVC days). Both Hispanic (0.5 vs 1.6 BSIs/1000 CVC days) and Asian-American children's (0.4 vs 1.5 BSIs/1000 CVC days) BSI rates increased threefold and fourfold after the introduction of needleless devices. CONCLUSIONS: Our data suggest that pediatric hematology/oncology patients receiving HHC via needleless devices may have an increased risk of BSIs, and this risk may vary by race. We hypothesize that prevention of BSIs may require consideration of cultural, ethnic, and language differences when parents are trained to provide care for their children with CVCs in the home.

Adolescent↗
PubMed1996

Correlation between expression of antibodies to histone H2B and clinical activity in HIV-infected individuals.

Levels of autoantibodies specific for the histone, H2B, were measured in individuals with HIV infection. In comparison with normal (uninfected) controls, infected patients, particularly those with symptomatic disease, had significantly elevated titres of anti-H2B antibodies. Longitudinal studies confirmed that levels of these antibodies were highest in patients with lymphadenopathy and declined with the development of AIDS. In preliminary experiments designed to determine the biological significance of the anti-histone antibodies, H2B was shown to be immunologically cross-reactive with an 18-kD antigen on the surface of HIV-infected or mitogen-activated CD4+ cells. Protein sequencing of the 18-kD antigen has since shown complete homology with histone H2B. Because the titres of H2B autoantibodies were found to parallel the numbers of circulating CD4 cells, it is possible that these antibodies are involved in the destruction of the helper/inducer T lymphocyte population.

Autoantibodies↗
PubMed1996

Pulse oximetry and supplemental oxygen during gastrointestinal endoscopy: a critical review.

A high proportion of the mortality and morbidity associated with endoscopic procedures may be of cardiopulmonary origin. For this reason, the appropriate degree of monitoring and prophylactic measures to be used in the sedated patient undergoing endoscopy has become a topic of discussion during recent years. The development of myocardial ischaemia during gastrointestinal endoscopy has traditionally been considered to be due to the simultaneous arterial hypoxaemia; however, recent investigations have suggested that tachycardia may be a more important pathogenic factor. No study has ever shown that pulse oximetry monitoring or supplemental oxygen will reduce the morbidity or mortality during gastrointestinal endoscopy. The current guidelines for monitoring and oxygen therapy are therefore not supported by scientific data. There is a need for further studies on the pathogenic mechanisms in myocardial ischaemia during endoscopy, and the influence of hypoxaemia on the outcome after upper and lower endoscopy should be clarified.

Arrhythmias, Cardiac↗
PubMed1996

Sleep after laparoscopic cholecystectomy.

The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration of opioids. There were no significant changes in the total time awake or the number of arousals on the postoperative night compared with the night before operation. During the postoperative night, we found a decrease (P = 0.02) in slow wave sleep (SWS) with a corresponding increase in stage 2 sleep (P = 0.01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.

Adult↗
PubMed1996

The effect of posture on late postoperative oxygenation.

Twelve patients had their arterial oxygen saturation measured pre-operatively and on days 1, 4 and 7 after laparotomy. Measurements were performed in the supine, sitting and standing positions on each day. Arterial oxygen saturation was significantly higher during sitting and standing on days 1 and 4 after operation compared with the supine position (p < 0.05). These results give further evidence for the benefits of patient mobilisation after major surgery.

Abdomen↗
PubMed1996

No effect of oxygen therapy on myocardial ischaemia during gastroscopy.

BACKGROUND: Myocardial ischaemia (defined as an ST-segment depression on ECG) may occur during upper gastrointestinal endoscopy, but the mechanism is still unknown. The aim of our study was to evaluate the effect of oxygen therapy and tachycardia on the occurrence of ST-segment depression during routine diagnostic esophagogastroduodenoscopy. METHODS: Eighty-nine consecutive patients were randomized to receive either oxygen (21/min by nasal prongs) or nothing during endoscopy, in which arterial oxygen saturation was measured by continuous pulse oximetry, and ECG was measured continuously with a Holter tape recorder. RESULTS: A total of 28 patients (12 receiving oxygen) developed ST-segment depression ( > 0.1 mV) during endoscopy. In 22 patients (12 receiving oxygen) ST depression was related to tachycardia, and in 5 of these (none receiving oxygen) simultaneous episodic hypoxaemia was present during the event. Thus, in every case of ST depression related to episodic hypoxaemia there was simultaneous tachycardia. In six patients developing ST depression during endoscopy we did not find preendoscopy levels, and 63 patients (29 receiving oxygen) developed tachycardia during the procedure (rate > 100 min-1_. CONCLUSIONS: Oxygen therapy had no significant effect on the occurrence of ST-segment depression during upper gastrointestinal endoscopy. The results suggest that tachycardia is more important than hypoxaemia in the pathogenesis of ST depression during gastroscopy.

Adult↗