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Biomedical subjects

R J Geller

Publications and source records attributed to R J Geller.

8 recordsLinked to original sources
PubMed1992

Orthostatic hypotension in ciguatera fish poisoning.

PURPOSE: The purpose of this study was to investigate the pathophysiology of persistent orthostatic hypotension in a patient with ciguatera fish poisoning. METHODS: A patient who became ill and who developed prolonged and symptomatic orthostatic hypotension with ciguatera fish poisoning after eating barracuda is described. Studies of autonomic function included measurements of plasma catecholamine levels in the supine and standing positions, and pressor responses to infusions of norepinephrine, atropine, and propranolol. RESULTS: Volume depletion was excluded as a cause for hypotension. Our patient showed low plasma catecholamine levels and marked pressor hypersensitivity to norepinephrine infusion. Hypotension and bradycardia were reversed by atropine infusion. The heart rate freed from autonomic influences, ie, after atropine plus propranolol infusion, was normal. CONCLUSIONS: In ciguatera fish poisoning, orthostatic hypotension appears to be a result of both parasympathetic excess and sympathetic failure.

Animals↗
PubMed1991

Cyanide toxicity from acetonitrile-containing false nail remover.

A patient presented without symptoms 30 minutes after ingesting acetonitrile, also known as methylacyanide. He had prompt gastric lavage and activated charcoal administration. Hours later, the onset of clinical toxicity was heralded by mental status abnormalities and vomiting prior to a generalized seizure. Following administration of sodium thiosulfate, the patient made an uneventful recovery. A blood cyanide level drawn shortly after presentation, but reported after the patient had been discharged, documented significant exposure. During hospitalization, cyanide toxicity was inferred from the history of ingestion of acetonitrile, plus a significant absence of venous blood hemoglobin desaturation. Because even small amounts can be harmful and toxicity is delayed, all acetonitrile ingestions should be presumed dangerous. Patients should be observed and repeatedly evaluated for at least 24 hours. In the absence of cyanide level determinations, lethargy, vomiting, seizures, and the lack of normal venous blood hemoglobin desaturation are clues to cyanide toxicity.

Acetonitriles↗
PubMed1990

Poison centers in America: how well do they perform.

Marked differences in cell volume, service area, and center resources continue to exist between poison centers certified by the American Association of Poison Control Centers as Regional Poison Centers and those not meeting these criteria. However, the present clinical significance, if any, of these factors remains unproven. The only previous study, conducted in 1980, used only 1 test problem and did not attempt to separately analyze each of the differences between Regional Poison Centers and Non-regional Poison Centers. This study solicited the participation of all 208 US poison centers existing. Fifty-four poison centers (REGIONAL CENTERS 16/34 = 47%, NON-REGIONAL CENTERS 38/173 = 22%) agreed to participate. Three problems were presented to each center by simulated callers. Considerable variation was observed in efficiency and in extent of information provided. Overall, Regional Centers provided complete and correct answers for 83% of the presented cases, while Non-regional Centers did so in 57% of the cases. Although Regional Center status, staff experience, center call volume, medical direction all appear to be important, the most predictive factors were staff and center experience.

Humans↗
PubMed1986

Human effects of veterinary biological products.

A 14-year-old male drank two glasses of milk from a gallon inoculated with 21 vials of live virus vaccine intended to immunize 1000 baby chicks against Newcastle Disease. The patient was managed with catharsis and careful observation, and remained completely asymptomatic in the following 28 days. Newcastle Disease virus (NDV) may cause paralytic neurotropic, viscerotropic, or pneumonotropic disease in chickens, but has limited effects on humans. Systemic exposure to this vaccine has not previously been reported in humans, although an aerosol NDV vaccine has caused self-limited conjunctivitis following ocular exposure. The human effects of veterinary biologicals remain poorly defined. The limited literature existing in regards to the human experience with common veterinary vaccines is reviewed.

Adolescent↗
PubMedDate not supplied

Computer optimization of enteral hyperalimentation.

A computer program has been developed to allow the generation of written orders for the logical progression of enteral hyperalimentation by the technique of continuous nasogastric infusion. Data required for entry include name, age, sex, height, usual and current weights, degree of stress, and if indicated, restrictions of nitrogen, fluids, sodium and potassium. A specific formulation may be requested, or the computer will pick a single nutrient solution or combination of two solutions that will best meet the requested constraints. Output includes entered data with English and Metric interconversion, surface area, and estimates of basal energy expenditure, protein wastage, protein and caloric requirements. If requested, daily orders are written to include a reasonable progression of infusion rates and concentrations of the solutions(s). Daily values are printed for the total amounts to be infused of fluid, calories, protein, sodium, potassium, and mOsm. The programs have been demonstrated to run in either on-line or batch mode. The system is easily accessible by physician, dietician, nurse, or other interested professionals.

Adult↗
PubMedDate not supplied

Acid and alkaline diuresis. When are they of value in the treatment of poisoning?

The utility of both acid and alkaline diuresis has been brought into question because of the ability to increase the elimination rate of many toxins by less care-intensive methods such as repeated-dose charcoal. Alkaline diuresis is a technique which uses a common drug, but acid diuresis is not a technique known to most physicians. The former is currently the best therapy for quinine poisoning. Phencyclidine elimination is increased by 10%, but most patients recover with only supportive care. Acidification has been effective in some hands; data suggest that renal elimination is not the only mechanism of action of this therapy. In deeply comatose patients with hypotension, acidification should be considered. Alkalinisation, the mainstay of therapy for salicylate and phenobarbital poisoning over many decades, is effective, although no more so than charcoal, and less than dialysis.

Acids↗