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Biomedical subjects

J Varon

Publications and source records attributed to J Varon.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Mediastinal teratoma presenting as massive hemoptysis in an adult.

Massive hemoptysis is a rare but potentially life-threatening presentation in the emergency department (ED). We describe a case of massive hemoptysis caused by a mediastinal teratoma in an otherwise healthy young man. The teratoma had invaded into a bronchus and was resected successfully. The literature regarding massive hemoptysis due to mediastinal teratoma is reviewed. A differential diagnosis for massive hemoptysis is presented. The initial management of these patients in the ED and the diagnostic options are discussed.

Adult↗
PubMedDate not supplied

Acute pancreatitis secondary to ifosfamide.

Acute pancreatitis in cancer patients can be secondary to the malignant process itself. It is also a rare complication of antineoplastic agent administration. Ifosfamide is an effective drug in the treatment of several tumors and has known neurologic, renal, and hematologic toxicities. There is only one recent report in the literature of pancreatitis associated with ifosfamide. We report a case of a 65-year-old woman with small cell bronchogenic carcinoma without pancreatic metastases who developed acute pancreatitis after ifosfamide administration.

Acute Disease↗
PubMedDate not supplied

From Creutzfeldt-Jakob disease to the mad cow epidemic.

Hans-Gerhard Creutzfeldt and Alfons Jakob independently authored clinical and pathologic descriptions of a new syndrome in the 1920s. This syndrome, which subsequently came to be named after them, was characterized by dementia, motor and coordination abnormalities, a fatal course, and pathologic findings of diffuse spongiform neuronal degeneration. Although it appeared for many years to be little more than a medical curiosity, Creutzfeldt-Jakob disease attained widespread attention by its pathologic similarity to kuru and bovine spongiform encephalopathy, "mad cow disease." Because there are sporadic, familial, and iatrogenic forms of Creutzfeldt-Jakob disease, it is considered to have both genetic and infectious aspects. Although its causation has for some time been ascribed to "slow viruses," the etiology of Creutzfeldt-Jakob disease is currently thought to be due to prions, small proteinaceous infectious particles that have genetic encoding. The debate regarding whether the appearance of atypical Creutzfeldt-Jakob disease can be linked to the epidemic of "mad cow disease" is currently unresolved.

Adolescent↗
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Acute thoracic aortic dissection: the basics.

With an increasing incidence, aortic dissection is the most common acute illness of the aorta. In the setting of chronic hypertension, with or without other risk factors for aortic dissection, this diagnosis should be considered a diagnostic possibility in patients presenting to the emergency department with acute chest or back pain. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode. But with successful initial therapy, the 5-year survival rate increases to 75%. Hence, timely recognition of this disease entity coupled with urgent and appropriate management is the key to a successful outcome in a majority of the patients. This article reviews acute thoracic aortic dissection, including ED diagnosis and management.

Acute Disease↗
PubMedDate not supplied

Malignant airway obstruction: recognition and management.

Malignant airway obstruction affects up to 80,000 patients annually, many of whom will present acutely to the emergency department (ED). This clinical entity should be sought in any patient presenting to the ED with increasing shortness of breath, recurrent chest infections, hemoptysis, and an inability to lie flat. Interventions suggested in malignant airway obstruction include: maintenance of spontaneous ventilation by avoiding respiratory depressing sedation, muscle relaxants or narcotics; changes in patient's position; avoidance of general anesthesia and positive pressure ventilation, if possible; placement of endotracheal tube beyond the level of obstruction; radiotherapy; corticosteroids; availability of helium-oxygen mixtures, cardiopulmonary bypass, or extracorporeal membrane oxygenation. If time allows, further diagnostic studies will be of assistance in assessing the best therapy before definitive intervention.

Airway Obstruction↗
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Mechanical ventilation: past and present.

Emergency physicians commonly manage patients with acute respiratory failure who require assisted mechanical ventilation. Several different modes of positive pressure mechanical ventilation can be used to manage these patients when they present to the emergency department. These modes of ventilation have evolved over the last three decades. A comprehensive review of the most important historical moments in mechanical ventilation as well as the different modes commonly used in the emergency department are presented. In addition, new techniques in noninvasive mechanical ventilation are presented.

Emergencies↗
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Nalmefene: a long-acting opioid antagonist. Clinical applications in emergency medicine.

The use of the opioid antagonist naloxone is well known to the experienced health care provider. The availability of the longer acting opioid antagonist nalmefene has several potential benefits in clinical practice. Nalmefene has a plasma half-life of almost 11 h, compared to 60-90 min for naloxone. Nalmefene has been shown to reverse opioid intoxication for as long as 8 h, reducing the need for continuous monitoring of intoxicated patients and repeated dosing of naloxone. Single dose administration has also been used effectively in the reversal of opiate-assisted conscious sedation. In addition, this agent has been used in the treatment of diseases as diverse as interstitial cystitis and chronic alcohol dependence. However, the long duration of action enables extended withdrawal reactions in the chronically opioid-dependent patient. The prolonged opioid antagonism of nalmefene has several applications in the clinical practice of emergency medicine, and is a useful addition in certain situations to the pharmacologic armamentarium of the practicing emergency physician.

Procedural Sedation↗
PubMedDate not supplied

Rupert Waterhouse and Carl Friderichsen: adrenal apoplexy.

The Waterhouse-Friderichsen (WFS) syndrome, also known as purpura fulminans, is described as acute hemorrhagic necrosis of the adrenal glands and is most often caused by meningococcal infection. This clinical entity is more frequently seen in the pediatric than the adult population and is associated with a high morbidity and mortality. The initial presenting complaints for patients with the WFS usually include a diversity of nonspecific, vague symptoms such as cough, dizziness, headache, sore throat, chills, rigors, weakness, malaise, restlessness, apprehension, myalgias, arthralgias, and fever. These symptoms are usually abrupt in their onset. Petechiae are present in approximately 50-60% of patients. The clinical diagnosis of WFS may be relatively straightforward or extremely challenging. Patients who appear in the initial and nontoxic-appearing stage without any skin lesions may be difficult to distinguish from a benign viral illness. When a patient presents with fever and petechiae, WFS must be considered, even when the patient has a non-toxic appearance. Due to the rapid progression and often devastating consequences, therapy should be instituted as soon as the diagnosis is suspected.

Denmark↗
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Carbon monoxide poisoning: a review for clinicians.

Carbon monoxide (CO) poisoning continues to be a significant health problem both in the United States and in many other countries. CO poisoning is associated with a high incidence of severe morbidity and mortality. Epidemics of CO poisoning commonly occur during winter months and sources include: smoke from fires, fumes from heating systems burning fuels, and exhaust fumes from motor vehicles. The history of exposure and carboxyhemoglobin levels should alert the physician to this diagnosis. In the absence of exposure history, CO poisoning should be considered when two or more patients are simultaneously sick. The clinical presentation is non-specific and may range from nausea and headache to profound central nervous system dysfunction. The mainstay of therapy for CO poisoning is supplemental oxygen, ventilatory support, and monitoring for cardiac dysrhythmias. This article reviews up-to-date information of this potentially devastating exposure.

Carbon Monoxide Poisoning↗
PubMedDate not supplied

Management of increased intracranial pressure: a review for clinicians.

Emergency physicians are frequently confronted with head-injured patients, many of whom have intracranial hypertension. Since direct correlations have been reported between increased intracranial pressure (ICP) and adverse outcome, it is important to rapidly identify and treat these patients. Furthermore, since the actual brain damage that occurs at the time of injury cannot be modified, the maximization of neurological recovery depends upon minimizing secondary insults to the brain, most notably preventing hypotension and hypoxemia. Volume resuscitation to maintain an adequate mean arterial pressure, airway control, and sedation and analgesia to prevent surges in ICP remain the cornerstone of early management. These principles and the emergency department management of the head-injured patient are reviewed in this paper.

Brain Injuries↗