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Biomedical subjects

R A Bernstein

Publications and source records attributed to R A Bernstein.

At least 19 recordsLinked to original sources
PubMed2001

Critical care of acute ischemic stroke.

Advances in neurologic therapeutics and intensive care medicine have expanded the arsenal of treatments available for the critical care of ischemic stroke. Several agents are available for acute reperfusion of the ischemic brain. These include intravenous recombinant tissue-plasminogen activator (rtPA), which is effective in a 3-hour time window, and intra-arterial thrombolytics, which may be effective within 6 hours. In addition, newer agents such as Ancrod and abciximab may be effective within the acute time period. Efforts to prevent secondary brain injury in critically ill patients with stroke often include prevention and reduction of fever, induced hypertension, and mechanical ventilation. Finally, death due to severe brain edema after massive hemispheric infarction can often be prevented with surgical or medical intervention. Unfortunately, there is a critical lack of well-designed clinical studies to guide the clinician in the use of these interventions. In addition, there is concern that some of these interventions may preserve life at the cost of quality of life. This article reviews the evidence behind these approaches to the critical care of ischemic stroke.

Acute Disease↗
PubMed1996

Juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis occurs quite rarely, but should be suspected in a child presenting with arthralgias and systemic signs of sepsis. Once diagnosed, treatment necessitates a multidisciplinary approach to address the social, medical, and surgical issues. Current research into serologic methods of diagnosis shows great promise for better classifying patients, which ultimately will facilitate treatment. Recent well-designed randomized trials are providing better objective information on pharmacologic treatment alternatives. Surgery is reserved for recalcitrant cases that fail medical and occupational therapy. The goals of surgery in children with JRA are to delay or prevent joint destruction and closure of the epiphysis, to prevent or correct deformity, to decrease pain, and to maintain growth and joint motion.

Antirheumatic Agents↗
PubMed1994

Endoscopic carpal tunnel release.

Carpal tunnel syndrome (CTS) is a common affliction of the upper extremity with the classic symptoms of numbness in the radial three and one-half digits, and pain often secondary to repetitive motions. The 1990s have seen a surge in the incidence of CTS, possibly because of increased awareness, recognition, or an increased prevalence of repetitive motion-type disorders. Furthermore, with the increasing use of computers, more people are sitting at keyboards entering text and data, which may lead to more cases of CTS. Recently, the technique of endoscopic carpal tunnel release has gained increased notoriety. The reported benefits include decreased surgical time, decreased postoperative attention, early return to work, diminished pillar pain, and increased thenar strength.

Carpal Tunnel Syndrome↗
PubMed1992

Treatment of ununited tibial fractures: a comparison of surgery and pulsed electromagnetic fields (PEMF).

The use of pulsed electromagnetic fields (PEMF) is gaining acceptance for the treatment of ununited fractures. The results of 44 articles published in the English language literature have been compiled to assess the effectiveness of PEMF vs surgical therapy. For ununited tibial fractures, 81% of reported cases healed with PEMF vs 82% with surgery. After multiple failed surgeries, the success rate of PEMF is reported to be greater than with surgery; this discrepancy increases with additional numbers of prior surgeries. In infected nonunions, the results of surgical treatment decreased by 21% and were less than the results utilizing PEMF (69% vs 81%). In open fractures, surgical healing exceeded PEMF (89% vs 78%), whereas in closed injuries PEMF cases healed more frequently (85% vs 79%). In general, PEMF treatment of ununited fractures has proved to be more successful than noninvasive traditional management and at least as effective as surgical therapies. Given the costs and potential dangers of surgery, PEMF should be considered an effective alternative. Experience supports its role as a successful method of treatment for ununited fractures of the tibia.

Electromagnetic Fields↗
PubMed1987

Computerized tomography of the patellofemoral joint before and after lateral release or realignment.

Computerized tomography (CT) provides an accurate diagnostic tool for evaluating tilt and subluxation of the patella. Using a previously described technique, this study reviews 62 computerized tomograms, including those of 21 patients before and after lateral release or anteromedial tibial tubercle transfer. One patient was evaluated before and after soft-tissue realignment of the patella. Additional CT studies were evaluated to establish the most appropriate reference line for determining patellar tilt. Results show that lateral retinacular release effectively reduces abnormal patellar tilting as determined by CT. Anteromedial tibial tubercle transfer similarly reduces abnormal tilt. Patellar subluxation may improve substantially following either lateral release or anteromedial tibial tubercle transfer, but this study suggests that correction of subluxation is less consistent than reduction of abnormal tilt with tibial tubercle transfer or lateral release alone. Once articular degeneration has progressed to the point of facet collapse, lateral release fails to restore normal tilt.

Adult↗
PubMed1985

Ventriculocholecystic shunt. A mortality report.

Ventriculocholecystic shunts are not commonly used for the treatment of hydrocephalus. We present a case of a child who underwent such a procedure and died of unusual complications. This case represents a unique juxtaposition of uncommon neurosurgical entities and complications including acquired communicating hydrocephalus, bilious ventriculitis secondary to a ventriculocholecystic shunt, and pulmonary edema. The unusual features of this case are discussed and emphasis is placed on the pathophysiologic findings.

Cerebrospinal Fluid Shunts↗
PubMed1984

Criteria for using imaging ultrasound during brain and spinal cord surgery.

Imaging ultrasonography was performed during 23 brain and five spinal cord operations with real-time B-mode instruments. Criteria for the utilization of ultrasound at neurosurgical procedures were identified in terms of assistance in the diagnosis or better definition of lesions. The diagnosis criteria were detection and exclusion. Because of the accuracy of preoperative imaging, usually little further help was provided by operative ultrasonography in detecting previously totally unknown abnormalities or excluding lesions found on positive studies. The definition criteria were localization, distinction of tissue features, and assessment of spatial relations. Operative ultrasonography was most useful when applied on the basis of these definition criteria. Operative ultrasonography was considered to be useful in 22 of 28 operations (79 per cent) in which it assisted in exposing, accessing, and extirpating disease.

Adult↗
PubMed1982

Response strategies for chart requests from psychiatric inpatients.

Of 452 patients seen during one year on a medical-school-affiliated general hospital psychiatric unit, 26 requested to see their charts. These patients tended to be younger, more likely to have character disorders, and less likely to have an affective disorder than patients who did not make chart requests. The apparent increase in the number of patients who ask to see their records may be linked to increasing medical consumerism. Rather than causing therapists to become defensive, record requests should provide an opportunity for education and treatment. The authors outline methods of interpreting and responding to chart requests.

Adolescent↗
PubMed1981

Physician attitudes toward patients' requests to read their hospital records.

Little has been written about physicians' attitudes toward patient record requests. We had predicted that physicians would not welcome such requests and would respond to them defensively. Of the 280 physicians at a university affiliated medical center included in this study, 67 per cent thought that patients were motivated to ask for their hospital charts because they wanted more information or further treatment. Only 16 per cent of the physicians said that the requests were prompted by litigious motives, and 23 per cent thought that they came from the need to obtain secondary gain. A majority of the physicians, 62 per cent, viewed the requests as an opportunity to treat or educate, but 83 per cent felt that reading the hospital record could be harmful to patients. The financial and interpersonal aspects of patient education through a response to chart requests are discussed in the final section of this article.

Attitude of Health Personnel↗
PubMed1981

The dialysis exercise: a learning simulation for medical students.

The dialysis exercise is a small group decision-making clinical simulation which has been completely successful as an educational technique. The success of the exercise stems from its ability to engage students cognitively and affectively while teaching problem solving skills. This complete learning package is presented, together with comments on our experience, for use in other settings.

Behavior↗
PubMed1980

The effect of visiting on psychiatric patients in a general hospital.

A study of the visiting patterns of a general hospital psychiatric unit was undertaken to determine what difference could be detected between visited and unvisited patients. The physical rehabilitation floor at the same hospital was used as a "control." The results indicate that no significant differences could be found between the two groups of psychiatric patients but that a surprisingly large number, 40%, were not visited at all. A comparison of the visiting rates to both services favors rehabilitation 2:1 with visitors coming from a much greater distance than to psychiatry. A discussion of the data raises questions about the social isolation of psychiatric patients. The dynamics of visiting are assessed in light of their tratment implications for patients in both the hospital and the community.

Adult↗
PubMed1980

Liaison psychiatry: a model for medical care on a general hospital psychiatric unit.

Liaison psychiatry is traditionally practiced on the medical and surgical floors of the general hospital. The need for liaison psychiatry on the inpatient psychiatric unit as opposed to its usual setting was realized when the medical care requirements of hospitalized psychiatric patients was assessed. In many general hospitals this medical care is provided by a psychiatrist in consultation with medical and surgical colleagues. Over a three-year period at the Medical Center Hospital of Vermont 563 medical/surgical consultations were provided to the inpatient psychiatric unit. To utilize these consultations most effectively, the role best suited for the psychiatrist was that of liaison-consultee. Case examples are used to demonstrate the effectiveness of employing liaison skills in the treatment of somatic problems on the inpatient psychiatric unit. The educational implications of learning the liaison model in this context are discussed.

Adult↗