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Biomedical subjects

M Michaelson

Publications and source records attributed to M Michaelson.

32 records · Page 2Linked to original sources
PubMed1986

Crush injury to the lower limbs. Treatment of the local injury.

We treated fifteen patients who had been trapped under the masonry of collapsed buildings for various periods of time. In one group of patients who had been buried for twelve hours, treatment commenced only twenty-four hours after the injury, and the other group was treated more promptly. In the second group, the success of forced diuresis and alkalinization of the urine in preventing the renal complications of the crush syndrome was evident. A reassessment of the treatment of the local lesion was made and a scheme of treatment is proposed. The injury is essentially closed, and incomplete excision of the necrotic muscle is fraught with risk. Local rigor in the affected muscles is important.

Acute Kidney Injury↗
PubMed1985

Control of spasticity by implantable continuous flow morphine pump.

Continuous flow pumps are being used for the delivery of morphine sulfate to the intrathecal and epidural space for control of pain. We have encountered several patients who had a combination of pain and spasticity or who had spasticity so intense that it was the source of pain. One to two milligrams of intrathecal morphine dramatically relieved their spasticity and pain. Three such patients have subsequently undergone pump implantation with prolonged control of their spasticity. This has initiated a formal clinical investigation directed at determining the physiological mechanism of this phenomenon, as well as its long term efficacy.

Adult↗
PubMed1984

Management of crush syndrome.

Our experience in treating seven patients with severe crush injury of the lower limbs is described. They were brought to hospital 12 h after rescue and had no treatment until then. All seven developed acute renal failure due to myoglobinuria and dehydration. Five were anuric and three non-oliguric. All developed severe sepsis and two had also acute respiratory failure. No bleeding tendency was observed. They were treated along the following lines: early extensive fasciotomy and removal of dead tissues; early fluid challenge; early peritoneal dialysis and/or hemodialysis; high caloric, high protein nutrition; vigorous antibiotic therapy when infection was evident. There were no deaths in our patients. Our management and results are discussed and compared with those in the literature.

Adolescent↗
PubMed1984

Prevention of acute renal failure in traumatic rhabdomyolysis.

Following the collapse of a building, seven subjects (aged 18 to 41 years) were released from under the rubble within one to 28 hours. All seven suffered from extensive crush injuries with evidence of severe rhabdomyolysis and were treated by the induction of an alkaline solute diuresis immediately on their extrication from the debris. The leakage of muscle constitutents was estimated by quantifying the net total body potassium losses, which averaged 395 mEq (SD, +/- 198) over the first 60 hours of therapy. In the past, injuries of similar severity have been associated with a high incidence of acute renal failure and a high mortality rate, yet none of our patients had azotemia or renal failure. We attribute this success to the unprecedented early institution of appropriate therapy.

Acid-Base Equilibrium↗
PubMed1984

Crush syndrome: experience from the Lebanon War, 1982.

Eight patients with crush syndrome were treated in our department during the Lebanon War, 1982. They arrived after having been trapped under fallen masonry for 4 to 28 h. They all had injuries of the lower limbs, with neurological deficiency and myoglobinuria. The local and general aspects of the syndrome are presented and discussed and a successful treatment protocol outlined.

Crush Syndrome↗
PubMedDate not supplied

Crush injury and crush syndrome.

Crush injury is caused by continuous prolonged pressure on the limbs. It is found in patients extricated after being trapped for at least 4 hours. The main injury is to the muscles of the limbs. Treatment should be conservative and fasciotomy should be avoided. If fasciotomy is performed, it should be followed by radical debridement of the injured muscle in an attempt to avoid infection of the injured limb. Infection endangers the patient's life and is the main cause of morbidity and mortality today. The outcome of conservative local treatment of crush injury is much superior to that of operative treatment. The pathophysiology of crush injury is not fully understood and no good animal model is known. Crush syndrome, which is the general manifestation of crush injury, is better understood. If not prevented, it will lead to acute renal failure. A method for preventing acute renal failure is discussed and a protocol is described. There is no doubt that prevention of acute renal failure is the goal in the treatment of crush syndrome and can be achieved.

Acute Kidney Injury↗