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Biomedical subjects

M Nussbaum

Publications and source records attributed to M Nussbaum.

81 records · Page 5Linked to original sources
PubMedDate not supplied

Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model.

In previous studies we reported that an acute elevation in intra-abdominal pressure (IAP) is responsible for the elevation in intracranial pressure (ICP) and mean blood pressure (MBP). Thus far, the reasons for the increased ICP during an acute elevation in IAP and the combined effects of increased IAP and ICP on hemodynamics have not been reported. Five large animals (swine) were studied. Each animal served as its own control. A subarachnoid screw was placed for ICP monitoring. The jugular vein, femoral vein, and femoral artery were cannulated. ICP, MBP, central venous pressure above (CVPA) and below (CVPB) the diaphragm, and PaC02 were monitored after a pneumoperitoneum with C02 was established at 5, 15, and 30 mm Hg of IAP. Cavography was performed to evaluate the morphology of the inferior vena cava at different increments of IAP. Measurements were obtained in reverse Trendelenburg (group 1), supine (group 2), and Trendelenburg (group 3) positions. Multiple regression analysis was used to examine the effects of IAP and positioning in separate models with different blood pressures as dependent variables. Increased IAP significantly increased CVPA, CVPB, ICP, and MBP. There were no changes in cerebral perfusion pressure. The change in position (from group 1 to group 3) significantly increased CVPA and decreased the CVPB. Cavograms performed on animals in the supine position with increased IAP showed a narrowing of the IVC at the level of the diaphragm. Increases in IAP will increase ICP and MBP without altering the cerebral perfusion pressure. A mechanical effect mediated by compression of the inferior vena cava at the level of the diaphragm with increased central venous pressure and decreased drainage from the lumbar plexus and central nervous system is responsible for this effect.

Abdomen↗
PubMedDate not supplied

Hypodermic needles: an unusual tracheobronchial foreign body.

Case reports of foreign bodies in the upper aerodigestive regions and descriptions of the various methods used to retrieve them have been recorded in the medical literature since ancient times. Sharp, penetrating foreign bodies are most dangerous and may cause acute complications if they perforate the air and food passages. Recently, the authors encountered nine cases of hypodermic needles in the tracheobronchial tree. Seven of the nine needles were removed endoscopically without complications and two were expelled by the patients.

Adult↗
PubMedDate not supplied

Intestinal placement of pH-sensing nasointestinal feeding tubes.

Intestinal access for enteral nutrition can be achieved by spontaneous intestinal nasogastric tube passage or by endoscopic, fluoroscopic, or surgical placement methods. Each of these methods has limitations that may compromise clinical utility. pH-sensing nasointestinal feeding tubes allow active placement with minimal equipment and expertise; however, this method requires an acidic gastric pH. We sought to determine whether antiulcer regimens used at our institution would preclude intestinal pH-sensing tube placement. Twenty-five patients had 25 (81%) successful intestinal placements in 31 attempts. Observed pH values and calculated pH changes were compared within and between successful and unsuccessful groups by using a Student's t test. Initial, lowest, and final pH values did not differ significantly between groups. The pH change initial-to-lowest (4.7 +/- 0.18 vs 3.6 +/- 0.59, p < .03) and lowest-to-final (5.0 +/- 0.18 vs 3.0 +/- 0.47, p < .0001) differed significantly between groups, whereas the pH change initial-to-final did not. Cost analysis of endoscopic ($782), fluoroscopic ($341 to $382), spontaneous ($167 to $212), and pH-sensing ($162) methods revealed 3% to 79% savings when the pH-sensing placement method was used. We conclude that the antiulcer therapies used in our patient population did not preclude intestinal pH-sensing tube placement. If the pH changes from initial-to-lowest and lowest-to-final were greater than 4, successful intestinal placement occurred in 91% of attempts. Finally, the method was cost-effective at our institution.

Anti-Ulcer Agents↗