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Biomedical subjects

M Kobernick

Publications and source records attributed to M Kobernick.

12 recordsLinked to original sources
PubMed1985

Should the emergency IVP be used more selectively in blunt renal trauma?

A retrospective study was performed to determine if the emergency intravenous pyelogram (IVP) is being overused in the evaluation of blunt renal trauma. Medical records of 105 blunt renal trauma patients undergoing IVPs for suspected blunt renal trauma were analyzed. Eighty-eight patients (83.8%) had normal IVPs, and 17 patients (16.2%) had abnormal IVPs. Three of the 105 patients (2.9%) required urologic surgical intervention. The medical records of these patients were examined in detail because it was believed that this patient population needed to be identified by emergency IVP. All three patients requiring urologic surgery had gross hematuria. All three patients had one or more associated injuries. Two of the three patients had flank tenderness and/or flank mass. The third patient was obtunded. From this study and information from the literature an algorithm has been constructed as a guideline for a prospective study. Following this guideline no patients in the study requiring urologic surgical intervention would have been missed. Of patients requiring an emergency IVP, 7.3% would have required urologic surgery. This would have resulted in a savings of $10,432 at our institution.

Emergencies↗
PubMed1984

Vertebral artery transection from blunt trauma treated by embolization.

Transection of a vertebral artery due to blunt trauma is infrequently seen. This report emphasizes the importance of angiography to confirm clinical suspicion. Hemostasis was achieved by embolization with a coil at angiography, a technique not previously described for vertebral artery transection.

Accidents, Traffic↗
PubMed1984

Black widow spider bite.

Latrodectus mactans has now invaded towns and cities. The spider's venom is a neurotoxin that causes little local reaction but produces pain and spasm in large skeletal muscle groups within 30 minutes to three hours after the bite. Severe envenomation may result in respiratory failure and coma. First aid is of no value. Muscle relaxants are useful in treatment, as is calcium gluconate. Antivenin is indicated for high-risk victims, such as those with hypertension and persons younger than 16 or older than 60 years of age.

Antivenins↗
PubMed1983

Airway trauma.

The mechanism of injury, diagnosis, and treatment of maxillofacial, laryngeal, tracheal, and bronchial trauma are considered. Also discussed is pulmonary barotrauma.

Airway Obstruction↗
PubMed1983

Botulism.

Clostridium botulinum is ubiquitous in the environment, yet symptoms of botulism occur in humans only if toxin A, B, or E is ingested, absorbed in the intestine, and bound and eventually internalized in the neuronal receptors, producing neuromuscular blockade. Clinically, botulism is divided into four types: food borne, infantile, wound, and unclassified. Systemic neurological symptoms occur within 72 hours of gastrointestinal symptoms and can progress rapidly to respiratory paralysis. Diagnosis depends on a high index of suspicion, but cultures and special tests may be helpful. Treatment remains mostly supportive with good respiratory care emphasized. Use of botulism antitoxin and guanidine may be helpful in some cases.

Botulism↗
PubMed1979

Treatment plan for acute and chronic adrenergic poisoning crisis utilizing sympatholytic effects of the B1-B2 receptor site blocker propranolol (Inderal) in concert with diazepam and urine acidification.

In a large series of patients who have abused a variety of commercially available "amphetamine-like" agents as well as "street drugs" with CNS stimulant activity, the specific lytic effects of propranolol (Inderal) were utilized to reverse the dangerous hyperkinetic cardiovascular and frightening CNS phenomena noted in these non-comatose individuals. Presented here is a logical and clinically proven mode of therapy by which the authors have consistently, successfully, and safely managed such patients in "adrenergic crisis" by judicious titration of electrolytes, propranolol, and diazepam.

Acute Disease↗
PubMed1978

Pilot experience of a family practice-based combined clerkship.

In order to explore alternatives in clinical undergraduate medical education, an experimental Combined Clerkship was developed and implemented on the Grand Rapids campus of Michigan State University. Two third-year medical students spent three half-days per week for 36 weeks seeing patients in the family practice office, of a facluty member. Hospitalized patients from this practice were worked-up and used as the source of inpatient specialty learning. The students attended lectures and took oral and written examinations of all required clerkships, but had no specific hospital assignment during this time. Two hundred nineteen patients were followed by these students, compared to 174 required by the clerkships. All written and oral examinations were passed. In addition to meeting all clerkship objectives, the students cared for 680 outpatients presenting 1,035 ICHPPC-coded problems. The top ten diagnoses were identified collectively and individually, and were compared to other published studies for corroboration of representative patient problems. This project demonstrates that the objectives of required clerkships can be met in an alternative setting that allows the addition of other important experiences.

Education, Medical, Undergraduate↗